Texas: Drowning In Health Care Costs?
Noting the Health Savings Account alternative
One of four Texans lack health insurance and one of five children live below the federal poverty threshold. For financially-strapped Texans, health care is a daunting challenge. Many legislators seek to give Texans relief by expanding Medicaid and the Children's Health Insurance Program. Because state-subsidized health care is unsustainable, this "relief" spells disaster. Economists say Medicaid and CHIP will bankrupt every state, including Texas, by 2014. Signs of the impending crisis are evident in health care cost over-runs and budget shortfalls.
A little over 26 percent of the state budget is devoted to Medicaid, a portion that exceeds average national investment by 21 percent. By the end of 2004, $17 billion will be invested in Medicaid, covering 3,000,000 Texans and an additional $808 million will underwrite CHIP, covering 407,000. Because the price of government health care is expected to double within the next ten years, no state - not even Texas- can bankroll Medicaid and CHIP. Before expanding enrollment and making more Texans dependent on a sinking program, it would be useful to look at Tennessee.
Ten years ago, Tennessee lawmakers offered a government-subsidized health care program to residents not covered by other insurance. Today, TennCare covers nearly 25 percent of the state's population and consumes nearly 33 percent of Tennessee's budget. Tripling costs forced lawmakers to institute draconian controls and now Tennessee rations medical care - 12 doctor visits per year and 6 prescriptions per month. Anticipating a $650 million deficit in funding for TennCare in 2005, Democratic Governor Phil Bredesen is proposing to jettison the program.
Although Texas is traveling the same route as Tennessee, there is an alternative. Health Savings Accounts pair a major medical insurance policy - for big medical expenses after a deductible is met - with a tax-exempt savings account that pays for routine medical expenses such as preventive care. HSAs first became available on January 1, 2004. Although new, there is solid information about how HSAs work, based on experience of their predecessor, Medical Savings Accounts. HSAs are affordable. Most participants pay less than $100 monthly, an amount that is almost half the cost of a conventional health insurance. With HSAs, participants can tailor health spending to avert expensive care - participants invest in about 30 percent more preventive care than used by individuals with conventional plans.
Flexibility allows HSAs to meet the needs of the old and young (more than 70 percent are over age 40), individuals and families (more than 75 percent are families with children), and people in all income brackets (nearly half earn family incomes of less than $50,000 and 27 percent have a net worth of less than $25,000). High rates of re-enrollment suggest people prefer consumer-centered health care over conventional insurance. For Texans struggling to make ends meet, HSAs offer an affordable alternative to conventional health insurance. For employers, HSAs offer a way to furnish health benefits to employees at a reasonable cost. Some companies have reduced health care costs by 11 percent in replacing conventional health insurance with HSAs.
For lawmakers, HSAs offer a way to control government health costs. Securing a federal waiver to expand Medicaid vouchers (now used for acute and long-term care in Texas), HSAs could be provided for Texans enrolled in government health programs. For the uninsured, HSAs offer the most promise. Over the past year, HSAs have reduced the number of uninsured Americans. Texas could reduce its uninsured population by establishing a clearinghouse of information about consumer-centered health care alternatives.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, December 07, 2004
Monday, December 06, 2004
QUALITY PUBLIC HOSPITAL CARE IN LOS ANGELES
This is a story of a hospital that is unimaginably bad. The excerpts below leave out case-studies that are horrifying. It might be tempting to dismiss it as a "black" hospital and remark that its standard of care is exactly what is to be expected of staff trained under affirmative action, but the point is that it continues to exist only because most of its patients have nowhere else to go. If medical choice were available to its patients (via a voucher scheme or any other scheme) it would have been deserted long ago. Only public funding allows it to exist.
King/Drew, a 233-bed public hospital in Willowbrook, just south of Watts, has a long history of harming, or even killing, those it was meant to serve. Over the last year, reports by journalists and regulators have offered stark glimpses of failings at King/Drew: Nurses neglecting patients as they lay dying. Staff failing to give patients crucial drugs or giving them toxic ones by mistake. Guards using Taser stun guns on psychiatric patients, despite an earlier warning to stop. Over the same period, a team of Times reporters has been systematically examining the hospital. They conducted hundreds of interviews, studied years of malpractice cases and reviewed records of the hospital and its regulators. They looked closely at individual departments and physicians. And, to put their findings in perspective, they consulted outside experts in hospitals and medical care. The investigation reveals that King/Drew is much more dangerous than the public has been told.
Among the findings: Errors and neglect by King/Drew's staff have repeatedly injured or killed patients over more than a decade, a pattern that remains largely unscrutinized and unchecked. Some lapses were never reported to authorities — or even to the victims or their families. And some people learned of the severity of the failings only by suing or, in several instances, from Times reporters who sought them out to learn about their care.
Although King/Drew opened in 1972 with the promise that it would be "the very best hospital in America," it is now, by various measures, one of the very worst. It pays out more per patient for medical malpractice than any of the state's 17 other public hospitals or the six University of California medical centers. Entire departments are riddled with incompetence, internal strife and, in some cases, criminality. Employees have pilfered and sometimes sold the hospital's drugs; chronic absenteeism is rampant; assaults between hospital workers are not uncommon. Despite King/Drew's repeated promises to regulators, the problems have gone unfixed for years.
The hospital's failings do not stem from a lack of money, as its supporters long have contended. King/Drew spends more per patient than any of the three other general hospitals run by Los Angeles County. Millions of dollars go to unusual workers' compensation claims and abnormally high salaries for ranking doctors. The hospital's governing body, the county Board of Supervisors, has been told repeatedly — often in writing — of needless deaths and injuries at King/Drew. Recently the supervisors have made some aggressive moves aimed at fixing the hospital. But for years, the board shied away from decisive action in the face of community anger and accusations of racism.
King/Drew, founded in the aftermath of the 1965 Watts riots, has stood for more than three decades as a symbol of justice and political power to many black people in South Los Angeles and beyond. In reality, if not officially, the hospital was established by and for African Americans; the majority of its staff always has been black. "That hospital means hope to us," said Karimu McNeal, 52, an African American woman treated successfully for colon cancer at King/Drew in 2002. "When you go into the hospital and you see people that look like you and take care of you, it gives you hope for the whole race that we're achieving and doing something."
Mixed with community pride is an undercurrent of concern about King/Drew's standards. For about three decades it has been known by an unflattering nickname, "Killer King." Patients have fled ambulances to avoid it, according to paramedics and one ranking fire official. And police officers say they have an understanding among themselves that, if shot, they will not be taken there.
Every hospital makes mistakes, some of them fatal. Filing a lawsuit is one of the few recourses patients and their families have when something goes wrong. But taken together, the malpractice cases involving King/Drew portray a place where things often go wrong — sometimes in the same way, over and over. King/Drew spent $20.1 million on malpractice payouts during fiscal years 1999 to 2003, an extraordinary sum for a public hospital its size in California. Adjusting for the number of patients the hospital saw, that figure is more than at any of the state's other public hospitals or the University of California medical centers. Even County-USC Medical Center, which is three times larger and not without troubles of its own, spent less. (King/Drew's payouts cannot be compared to those at public hospitals outside the state, because California has strict limits on malpractice damages.)
Malpractice awards are just one sign of trouble at King/Drew. From 1999 to March 2004, the hospital was cited for violating California health regulations more often than 97% of hospitals statewide, according to a Times analysis of state data. It had more violations than any of the county's three other general hospitals. The two most prominent national accrediting groups rate King/Drew among the nation's most troubled institutions. It is the only hospital in America to have received the lowest possible rating in its last two reviews from the Accreditation Council for Graduate Medical Education. The group has ordered the closure of three of King/Drew's 18 doctor-training programs: surgery, radiology and neonatology. A fourth, orthopedic surgery, may be phased out under pressure from the council.
King/Drew is also one of only seven U.S. hospitals that the Joint Commission on Accreditation of Healthcare Organizations has said should lose overall accreditation this year. The group accredits 4,579 hospitals nationwide. King/Drew has appealed the decision, but if it fails, it could be forced to close all its doctor-training programs and lose nearly $15 million in private insurance contracts. "This hospital," said Dr. Dennis O'Leary, the joint commission's president, "has problems of orders of magnitude that are substantially greater than almost all other hospitals in this country."
Even the top county health official finds King/Drew's failings hard to fathom. "I'm not sure who would imagine the depths of the problems," said Dr. Thomas Garthwaite, director of the Department of Health Services. "I'm not sure anybody has the life experiences to prepare themselves for this."....
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
This is a story of a hospital that is unimaginably bad. The excerpts below leave out case-studies that are horrifying. It might be tempting to dismiss it as a "black" hospital and remark that its standard of care is exactly what is to be expected of staff trained under affirmative action, but the point is that it continues to exist only because most of its patients have nowhere else to go. If medical choice were available to its patients (via a voucher scheme or any other scheme) it would have been deserted long ago. Only public funding allows it to exist.
King/Drew, a 233-bed public hospital in Willowbrook, just south of Watts, has a long history of harming, or even killing, those it was meant to serve. Over the last year, reports by journalists and regulators have offered stark glimpses of failings at King/Drew: Nurses neglecting patients as they lay dying. Staff failing to give patients crucial drugs or giving them toxic ones by mistake. Guards using Taser stun guns on psychiatric patients, despite an earlier warning to stop. Over the same period, a team of Times reporters has been systematically examining the hospital. They conducted hundreds of interviews, studied years of malpractice cases and reviewed records of the hospital and its regulators. They looked closely at individual departments and physicians. And, to put their findings in perspective, they consulted outside experts in hospitals and medical care. The investigation reveals that King/Drew is much more dangerous than the public has been told.
Among the findings: Errors and neglect by King/Drew's staff have repeatedly injured or killed patients over more than a decade, a pattern that remains largely unscrutinized and unchecked. Some lapses were never reported to authorities — or even to the victims or their families. And some people learned of the severity of the failings only by suing or, in several instances, from Times reporters who sought them out to learn about their care.
Although King/Drew opened in 1972 with the promise that it would be "the very best hospital in America," it is now, by various measures, one of the very worst. It pays out more per patient for medical malpractice than any of the state's 17 other public hospitals or the six University of California medical centers. Entire departments are riddled with incompetence, internal strife and, in some cases, criminality. Employees have pilfered and sometimes sold the hospital's drugs; chronic absenteeism is rampant; assaults between hospital workers are not uncommon. Despite King/Drew's repeated promises to regulators, the problems have gone unfixed for years.
The hospital's failings do not stem from a lack of money, as its supporters long have contended. King/Drew spends more per patient than any of the three other general hospitals run by Los Angeles County. Millions of dollars go to unusual workers' compensation claims and abnormally high salaries for ranking doctors. The hospital's governing body, the county Board of Supervisors, has been told repeatedly — often in writing — of needless deaths and injuries at King/Drew. Recently the supervisors have made some aggressive moves aimed at fixing the hospital. But for years, the board shied away from decisive action in the face of community anger and accusations of racism.
King/Drew, founded in the aftermath of the 1965 Watts riots, has stood for more than three decades as a symbol of justice and political power to many black people in South Los Angeles and beyond. In reality, if not officially, the hospital was established by and for African Americans; the majority of its staff always has been black. "That hospital means hope to us," said Karimu McNeal, 52, an African American woman treated successfully for colon cancer at King/Drew in 2002. "When you go into the hospital and you see people that look like you and take care of you, it gives you hope for the whole race that we're achieving and doing something."
Mixed with community pride is an undercurrent of concern about King/Drew's standards. For about three decades it has been known by an unflattering nickname, "Killer King." Patients have fled ambulances to avoid it, according to paramedics and one ranking fire official. And police officers say they have an understanding among themselves that, if shot, they will not be taken there.
Every hospital makes mistakes, some of them fatal. Filing a lawsuit is one of the few recourses patients and their families have when something goes wrong. But taken together, the malpractice cases involving King/Drew portray a place where things often go wrong — sometimes in the same way, over and over. King/Drew spent $20.1 million on malpractice payouts during fiscal years 1999 to 2003, an extraordinary sum for a public hospital its size in California. Adjusting for the number of patients the hospital saw, that figure is more than at any of the state's other public hospitals or the University of California medical centers. Even County-USC Medical Center, which is three times larger and not without troubles of its own, spent less. (King/Drew's payouts cannot be compared to those at public hospitals outside the state, because California has strict limits on malpractice damages.)
Malpractice awards are just one sign of trouble at King/Drew. From 1999 to March 2004, the hospital was cited for violating California health regulations more often than 97% of hospitals statewide, according to a Times analysis of state data. It had more violations than any of the county's three other general hospitals. The two most prominent national accrediting groups rate King/Drew among the nation's most troubled institutions. It is the only hospital in America to have received the lowest possible rating in its last two reviews from the Accreditation Council for Graduate Medical Education. The group has ordered the closure of three of King/Drew's 18 doctor-training programs: surgery, radiology and neonatology. A fourth, orthopedic surgery, may be phased out under pressure from the council.
King/Drew is also one of only seven U.S. hospitals that the Joint Commission on Accreditation of Healthcare Organizations has said should lose overall accreditation this year. The group accredits 4,579 hospitals nationwide. King/Drew has appealed the decision, but if it fails, it could be forced to close all its doctor-training programs and lose nearly $15 million in private insurance contracts. "This hospital," said Dr. Dennis O'Leary, the joint commission's president, "has problems of orders of magnitude that are substantially greater than almost all other hospitals in this country."
Even the top county health official finds King/Drew's failings hard to fathom. "I'm not sure who would imagine the depths of the problems," said Dr. Thomas Garthwaite, director of the Department of Health Services. "I'm not sure anybody has the life experiences to prepare themselves for this."....
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, December 05, 2004
Hospitals crippled by poor planning
Australia's public health system shows total lack of foresight
NSW's health system is groaning under the weight of bad management and poor planning, with a doctors' group warning of increasing discontent among staff in public hospitals. An Australian Medical Association survey of 632 visiting medical officers found bureaucrats had failed to plan for the impact of an ageing medical workforce, especially in regional areas. The NSW president of the association, John Gullotta, said the survey painted a picture of a rural medical workforce nearing retirement. "The average [visiting medical officer] in regional and rural NSW is in his or her early 50s ... but [the health system] is not planning for that reality," Dr Gullotta said. "The survey shows that the state's most senior doctors are extremely dissatisfied with the standard of planning, management and quality initiatives - there is a clear need to prevent additional senior doctors leaving the public hospital system out of frustration and to encourage doctors to pursue a career outside the big cities."
The association wants hospital management to be held accountable for its performance in areas such as cancellation of elective surgery lists, access to theatres, training and retention of junior medical staff and access to beds. "The cancellation of elective surgery lists is a deceitful method used to meet budgets," Dr Gullotta said. "Dedicated elective surgery lists must be established that are not affected by demands in other parts of the hospital." The association was also critical of the newly amalgamated area health service model, which is to be run by advisory councils - a move that doctors say will further undermine their role in the public health system.
However the NSW Health Minister, Morris Iemma, rejected the association's criticisms of the health service model, saying doctors had had significant representation on each of the health advisory committees, guaranteeing clinician input. He acknowledged that the cancellation of elective surgery lists was a source of frustration for doctors, pointing to a committee of prominent surgeons that had been reviewing the provision of surgical services. "In any and every event, emergency surgery will always take precedence and that will always lead to some elective surgery being displaced," a spokesman for Mr Iemma said.
The committee, headed by the director of surgery for Wentworth Area Health Service, Patrick Cregan, will release its findings on December 11. It is expected to recommend that area health service management overhauls its planning processes and stops using the cancellation of elective surgery as a way of managing budget blow-outs. Mr Iemma also warned that the country was "sleepwalking its way into a medical workforce crisis", brought on by the lack of places for medical and nursing graduates in universities. Mr Iemma said the blame lay squarely at the feet of the Federal Government.
But Dr Gullotta said that unless the NSW Government took action the crisis would worsen. "There are already 70,000 on the elective surgery waiting lists, if we leave it longer we are going to have no workforce and a waiting list topping 100,000," he said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Australia's public health system shows total lack of foresight
NSW's health system is groaning under the weight of bad management and poor planning, with a doctors' group warning of increasing discontent among staff in public hospitals. An Australian Medical Association survey of 632 visiting medical officers found bureaucrats had failed to plan for the impact of an ageing medical workforce, especially in regional areas. The NSW president of the association, John Gullotta, said the survey painted a picture of a rural medical workforce nearing retirement. "The average [visiting medical officer] in regional and rural NSW is in his or her early 50s ... but [the health system] is not planning for that reality," Dr Gullotta said. "The survey shows that the state's most senior doctors are extremely dissatisfied with the standard of planning, management and quality initiatives - there is a clear need to prevent additional senior doctors leaving the public hospital system out of frustration and to encourage doctors to pursue a career outside the big cities."
The association wants hospital management to be held accountable for its performance in areas such as cancellation of elective surgery lists, access to theatres, training and retention of junior medical staff and access to beds. "The cancellation of elective surgery lists is a deceitful method used to meet budgets," Dr Gullotta said. "Dedicated elective surgery lists must be established that are not affected by demands in other parts of the hospital." The association was also critical of the newly amalgamated area health service model, which is to be run by advisory councils - a move that doctors say will further undermine their role in the public health system.
However the NSW Health Minister, Morris Iemma, rejected the association's criticisms of the health service model, saying doctors had had significant representation on each of the health advisory committees, guaranteeing clinician input. He acknowledged that the cancellation of elective surgery lists was a source of frustration for doctors, pointing to a committee of prominent surgeons that had been reviewing the provision of surgical services. "In any and every event, emergency surgery will always take precedence and that will always lead to some elective surgery being displaced," a spokesman for Mr Iemma said.
The committee, headed by the director of surgery for Wentworth Area Health Service, Patrick Cregan, will release its findings on December 11. It is expected to recommend that area health service management overhauls its planning processes and stops using the cancellation of elective surgery as a way of managing budget blow-outs. Mr Iemma also warned that the country was "sleepwalking its way into a medical workforce crisis", brought on by the lack of places for medical and nursing graduates in universities. Mr Iemma said the blame lay squarely at the feet of the Federal Government.
But Dr Gullotta said that unless the NSW Government took action the crisis would worsen. "There are already 70,000 on the elective surgery waiting lists, if we leave it longer we are going to have no workforce and a waiting list topping 100,000," he said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, December 04, 2004
SICK PRIORITIES -- BUT PREDICTABLE FOR A BUREAUCRACY
The number of hospital administrators skyrocketed 58 per cent in the five years between 1997 and 2002, making it the fastest growing health specialty in Australia. In comparison, the number of surgical specialists increased by nine per cent and the number of public health physicians fell by 25 per cent. Doctors told The Australian the figures confirmed hospitals were increasingly focusing on money rather than patients. "We are replacing clinicians with administrators and beds with clipboards," said the Australian Medical Association's Queensland president, David Molloy. "It's the wrong way for the health system to be going. The emphasis is on managing a budget, rather than looking after a patient. It's a very worrying trend." Dr Molloy said that, while administrators played an important role in the running of hospitals, supply had exceeded demand. "The number of doctors and nurses in the past 20 years has remained reasonably static and the biggest increase in the health system has been in administration, not in people who clinically care for other people," Dr Molloy said.
Royal Australasian College of Surgeons standards board chairman Russell Stitz said key medical positions were being filled by administrators rather than doctors. In 2001-2002 hospitals spent $992 million on administration - the third-biggest expenditure item behind wages and medical-surgical supplies. "Important directorships - such as the role of executive director of surgical services at Royal Brisbane Hospital, for example - are being filled by administrators rather than doctors," he said. "That means we have people in these administrative positions who are not fundamentally orientated towards clinical care."
The issue of over-administration is becoming an increasing bug-bear of surgeons, who warn they are being restricted in their practices and efforts to train new surgeons by bureaucratic cuts to theatre times to contain costs. A crisis meeting was held yesterday with about 30 surgeons - covering a range of specialties - voicing their concern that debate this month about insufficient surgical training places did not give a true picture of the challenges facing doctors trying to educate even the existing trainees.
Chairman of the Royal Australasian College of Surgeons surgical training board, Stephen Dean, told the Sydney meeting the college had planned to increase positions from 200 to 240 next year. Professor Dean said the college could ensure adequate teaching for 240 trainees next year, but would be stretched to cope with the 260 it will now enrol after talks with the New South Wales, Victoria and South Australia governments.
Council of Procedural Specialists chairman Don Sheldon, who organised yesterday's meeting, said quality surgeons could not be produced in a "sausage factory environment... Our trainees need real operating time," he said. "It is disturbing the public hospital system is constantly reducing available operating time through rationing and periodic closures. This disruption and reduction is causing loss of quality training time."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The number of hospital administrators skyrocketed 58 per cent in the five years between 1997 and 2002, making it the fastest growing health specialty in Australia. In comparison, the number of surgical specialists increased by nine per cent and the number of public health physicians fell by 25 per cent. Doctors told The Australian the figures confirmed hospitals were increasingly focusing on money rather than patients. "We are replacing clinicians with administrators and beds with clipboards," said the Australian Medical Association's Queensland president, David Molloy. "It's the wrong way for the health system to be going. The emphasis is on managing a budget, rather than looking after a patient. It's a very worrying trend." Dr Molloy said that, while administrators played an important role in the running of hospitals, supply had exceeded demand. "The number of doctors and nurses in the past 20 years has remained reasonably static and the biggest increase in the health system has been in administration, not in people who clinically care for other people," Dr Molloy said.
Royal Australasian College of Surgeons standards board chairman Russell Stitz said key medical positions were being filled by administrators rather than doctors. In 2001-2002 hospitals spent $992 million on administration - the third-biggest expenditure item behind wages and medical-surgical supplies. "Important directorships - such as the role of executive director of surgical services at Royal Brisbane Hospital, for example - are being filled by administrators rather than doctors," he said. "That means we have people in these administrative positions who are not fundamentally orientated towards clinical care."
The issue of over-administration is becoming an increasing bug-bear of surgeons, who warn they are being restricted in their practices and efforts to train new surgeons by bureaucratic cuts to theatre times to contain costs. A crisis meeting was held yesterday with about 30 surgeons - covering a range of specialties - voicing their concern that debate this month about insufficient surgical training places did not give a true picture of the challenges facing doctors trying to educate even the existing trainees.
Chairman of the Royal Australasian College of Surgeons surgical training board, Stephen Dean, told the Sydney meeting the college had planned to increase positions from 200 to 240 next year. Professor Dean said the college could ensure adequate teaching for 240 trainees next year, but would be stretched to cope with the 260 it will now enrol after talks with the New South Wales, Victoria and South Australia governments.
Council of Procedural Specialists chairman Don Sheldon, who organised yesterday's meeting, said quality surgeons could not be produced in a "sausage factory environment... Our trainees need real operating time," he said. "It is disturbing the public hospital system is constantly reducing available operating time through rationing and periodic closures. This disruption and reduction is causing loss of quality training time."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, December 03, 2004
REGULATORY INJUSTICE
In the public health system of the Australian State of New South Wales
Delays of up to three years have struck investigations into 56 doctors, nurses and other health practitioners over serious allegations such as sexual assault of patients - with many of those accused still practising despite multiple complaints against them. The Herald has obtained documents from the NSW Health Care Complaints Commission under freedom of information laws that show 140 investigations pending, with 45 cases outstanding for more than 18 months and 12 of those for three years. The acting complaints commissioner, Ken Taylor, said much work had been done to clear the backlog but acknowledged some complaints - particularly those involving multiple allegations and complex investigations - had not been dealt with.
When Judge Taylor was appointed head of the troubled health watchdog in March, he found more than 900 files waiting for assessment and 448 investigations pending into complaints received before August 2003. Some had been outstanding since 1998. He said the backlog would be cut to 34 by the end of next month. "Delay is an evil, it generates a sense of grievance in the complainants and the respondents," he said. "We spent four of five months reviewing files and ensuring the difficult cases were investigated and resolved." He said it appeared many of the cases involving multiple complaints had gone unresolved because of a lack of resources.
This year, the NSW Government boosted the commission's funding by an extra $5.7 million, allowing the commission to double its investigation team and clear the backlog. The crisis in confidence in the commission came to a head in December last year, when the Government sacked the commissioner, Amanda Adrian, and set up a special commission of inquiry into dozens of allegations of poor patient care at Camden and Campbelltown hospitals. Describing the commission as "close to paralysed" when he arrived, Judge Taylor said his first task was to refocus the commission on rigorously investigating cases of poor health care. Of the practitioners with multiple complaints against them, 53 were suspended or had restrictions placed on their practice, the commission said.
The executive director of the Consumers' Health Forum, Helen Hopkins, said despite improvements the health complaints system still lacked transparency. "Clearing the backlog is not the end. The next step is to ensure they are introducing systemic changes that make it easier to talk about what might have gone wrong," she said. The executive director of the Australian Salaried Medical Officers' Federation, Peter Somerville, acknowledged there had been significant improvements at the commission in the past year. However, he said if Ms Adrian had had the resources Ken Taylor had, the commission might not have fallen so far behind. Judge Taylor said the commission could come under stress again if it was required to investigate a big incident.
Source
MORE ON THE "DESTINY" HEALTH INSURANCE SYSTEM
I mentioned the "Destiny" health insurance system yesterday. Readers might well ask why such a sane system has not been more widely implemented. One of my medical correspondents suggests why:
"One problem with Destiny - it runs against the game of the "poverty" and other industries - there are HUGE numbers of people who would be put out of work within a few years if Destiny was widely adopted: This is limited mainly to Diabetes; there are many others. For example:
1 Diabetic care specialists - nurses that visit patients at home, write notes about how this old fart won't take his medicine or follow his diet.
2 Diabetic foot care specialists - cut toenails etc..
3 Social workers - who tell patients what's "owed" them through Government programs for "the poor" and "the sick".
4 Surgeons who now are milking Medicare dollars since obesity has been declared "a disease" and now funding Gastric Bypass type surgery - so patients don't have to "feel bad" about poisionig themselves with food.
5 Vascular surgeons - a large part of their clientelle are diabetics and smokeres.
Smoking greatly increases "peripheral vascular disease; this not only causes narrowing of arteries requiring surgery; poor circulation reduces blood flow to all organs, such as bone, and infections are more difficult to cure in smokers). Some surgeons have gone so far as to refuse to do certain operations, such as hip and knee replacements in smokers - osteomyelitis is very difficult to treat in such patients. Of course, "smokers rights" groups would claim "insensitivity" "
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
In the public health system of the Australian State of New South Wales
Delays of up to three years have struck investigations into 56 doctors, nurses and other health practitioners over serious allegations such as sexual assault of patients - with many of those accused still practising despite multiple complaints against them. The Herald has obtained documents from the NSW Health Care Complaints Commission under freedom of information laws that show 140 investigations pending, with 45 cases outstanding for more than 18 months and 12 of those for three years. The acting complaints commissioner, Ken Taylor, said much work had been done to clear the backlog but acknowledged some complaints - particularly those involving multiple allegations and complex investigations - had not been dealt with.
When Judge Taylor was appointed head of the troubled health watchdog in March, he found more than 900 files waiting for assessment and 448 investigations pending into complaints received before August 2003. Some had been outstanding since 1998. He said the backlog would be cut to 34 by the end of next month. "Delay is an evil, it generates a sense of grievance in the complainants and the respondents," he said. "We spent four of five months reviewing files and ensuring the difficult cases were investigated and resolved." He said it appeared many of the cases involving multiple complaints had gone unresolved because of a lack of resources.
This year, the NSW Government boosted the commission's funding by an extra $5.7 million, allowing the commission to double its investigation team and clear the backlog. The crisis in confidence in the commission came to a head in December last year, when the Government sacked the commissioner, Amanda Adrian, and set up a special commission of inquiry into dozens of allegations of poor patient care at Camden and Campbelltown hospitals. Describing the commission as "close to paralysed" when he arrived, Judge Taylor said his first task was to refocus the commission on rigorously investigating cases of poor health care. Of the practitioners with multiple complaints against them, 53 were suspended or had restrictions placed on their practice, the commission said.
The executive director of the Consumers' Health Forum, Helen Hopkins, said despite improvements the health complaints system still lacked transparency. "Clearing the backlog is not the end. The next step is to ensure they are introducing systemic changes that make it easier to talk about what might have gone wrong," she said. The executive director of the Australian Salaried Medical Officers' Federation, Peter Somerville, acknowledged there had been significant improvements at the commission in the past year. However, he said if Ms Adrian had had the resources Ken Taylor had, the commission might not have fallen so far behind. Judge Taylor said the commission could come under stress again if it was required to investigate a big incident.
Source
MORE ON THE "DESTINY" HEALTH INSURANCE SYSTEM
I mentioned the "Destiny" health insurance system yesterday. Readers might well ask why such a sane system has not been more widely implemented. One of my medical correspondents suggests why:
"One problem with Destiny - it runs against the game of the "poverty" and other industries - there are HUGE numbers of people who would be put out of work within a few years if Destiny was widely adopted: This is limited mainly to Diabetes; there are many others. For example:
1 Diabetic care specialists - nurses that visit patients at home, write notes about how this old fart won't take his medicine or follow his diet.
2 Diabetic foot care specialists - cut toenails etc..
3 Social workers - who tell patients what's "owed" them through Government programs for "the poor" and "the sick".
4 Surgeons who now are milking Medicare dollars since obesity has been declared "a disease" and now funding Gastric Bypass type surgery - so patients don't have to "feel bad" about poisionig themselves with food.
5 Vascular surgeons - a large part of their clientelle are diabetics and smokeres.
Smoking greatly increases "peripheral vascular disease; this not only causes narrowing of arteries requiring surgery; poor circulation reduces blood flow to all organs, such as bone, and infections are more difficult to cure in smokers). Some surgeons have gone so far as to refuse to do certain operations, such as hip and knee replacements in smokers - osteomyelitis is very difficult to treat in such patients. Of course, "smokers rights" groups would claim "insensitivity" "
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, December 02, 2004
PRIVATE MEDICINE CUTS COSTS
Everywhere we look it seems that health care is more expensive: prescription drug prices are increasing, costs to visit the doctor are up, the price of health insurance is rising. But look closer, even closer, closer still. Don't see it yet? Perhaps you should have your eyes corrected at a Lasik vision center.
Laser eye surgery has the highest patient satisfaction ratings of any surgery, it has been performed more than 3 million times in the past decade, it is new, it is high-tech, it has gotten better over time and... laser eye surgery has fallen in price. In 1998 the average price of laser eye surgery was about $2200 per eye. Today the average price is $1350, that's a decline of 38 percent in nominal terms and slightly more than that after taking into account inflation.
Why the price decline in this market and not others? Could it have something to do with the fact that laser eye surgery is not covered by insurance, not covered by Medicaid or Medicare, and not heavily regulated? Laser eye surgery is one of the few health procedures sold in a free market with price advertising, competition and consumer driven purchases. I'm seeing things more clearly already.
Source
THE FUTURE DIRECTION FOR HEALTH INSURANCE
In the next few weeks, millions of American employees will choose which health insurance plan will cover them and their families for calendar year 2005. Among the choices facing some is an innovative insurance plan pioneered in 1992 in South Africa by a firm called Discovery and marketed in the United States as Destiny Health. It's an approach George W. Bush's and Congress's health care policymakers should keep in mind as they scramble to come up with proposals to deliver on Bush's vaguely worded campaign promises to reform health care finance.
The Destiny health plan has several intelligent features. One is an annual deductible: you pay for basic expectable medical expenses before insurance kicks in. One reason for the high cost of most health insurance is that we expect it to pay for routine medical expenses: it is as if your auto insurance policy covered oil changes but didn't pay you when the car was totalled.
When insurance kicks in, it is in the form of a personal medical fund, similar to the health savings account model that was part of the 2003 Medicare/prescription drug act. Unused amounts can be rolled over into the next year, and employees who leave the company will have access to remaining balances. This encourages employees to treat the money as if it is their own -- which it is -- and to keep cost in mind while making health care decisions. Experts of all ilks agree that one reason health care costs keep rising so rapidly is that consumers have gotten into the habit of making decisions with no regard at all for cost. The Destiny plan encourages them to break that habit.
The third and perhaps most interesting feature of the Destiny plan is its wellness programs, designed to encourage healthier lifestyles. Employees' insurance premiums are cut if they abstain from smoking, exercise regularly, hold down their weight and seek preventive care such as Pap smears or prostate exams. For achieving such goals, they earn "vitality points," which can be redeemed for health club memberships and travel discounts.
These health plans have proved popular. Destiny enrollment increased from 300,000 in 1998 to 1.6 million in 2004. A survey of Destiny members showed that 75 percent are familiar with the terms of their plan, compared with 38 percent for those in other plans, and that 97 percent believe a person's lifestyle choices have done something to reduce the cost of health care, compared to 29 percent for those in other plans. Some 85 percent of Destiny members have started an exercise program and 76 percent have started a nutrition program in the preceding year. For employers, the payoff is tangible: single-digit increases in the cost of health insurance, compared to double-digit increases for most other plans.
The Destiny model addresses one of the leading causes of increased health care costs in America: bad lifestyle choices. In their book "Epidemic of Care," Kaiser Permanente CEO George Halvorsen and Dr. George Isham note that there has been a 33 percent increase in the number of Americans with diabetes since 1990 -- and that type II diabetes can usually be prevented by appropriate behavior and diet changes. "We eat foods that make us vulnerable to diabetes and heart disease," they write, "and then don't exercise enough to keep those diseases from taking over our bodies." This is hugely expensive: diabetes requires expensive medical interventions that all health insurance policyholders must indirectly pay for. The Destiny wellness program pays policyholders to avoid behaviors that, statistically, will produce huge health care costs later on. It looks to be well worth the money, even in the short term.
Destiny's approach is part of a larger trend. Starting in the New Deal era and in World War II, government provided and encouraged employers to provide social insurance and health insurance that would guarantee benefits and buffer individuals against the workings of the market. Today, no one wants to eliminate the social safety net entirely. But it has become apparent that insulating individuals against cost has adverse consequences: low savings rates, unsustainable rises in health care spending, harmful personal behaviors that lead to enormous health care problems and costs. And it has become apparent as well that individuals are not helpless or incompetent beings in need of protection from the marketplace by big government or large corporations. With an adequate safety net, and within an appropriate structure, they can figure out things for themselves. The Destiny plan helps show us the way.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Everywhere we look it seems that health care is more expensive: prescription drug prices are increasing, costs to visit the doctor are up, the price of health insurance is rising. But look closer, even closer, closer still. Don't see it yet? Perhaps you should have your eyes corrected at a Lasik vision center.
Laser eye surgery has the highest patient satisfaction ratings of any surgery, it has been performed more than 3 million times in the past decade, it is new, it is high-tech, it has gotten better over time and... laser eye surgery has fallen in price. In 1998 the average price of laser eye surgery was about $2200 per eye. Today the average price is $1350, that's a decline of 38 percent in nominal terms and slightly more than that after taking into account inflation.
Why the price decline in this market and not others? Could it have something to do with the fact that laser eye surgery is not covered by insurance, not covered by Medicaid or Medicare, and not heavily regulated? Laser eye surgery is one of the few health procedures sold in a free market with price advertising, competition and consumer driven purchases. I'm seeing things more clearly already.
Source
THE FUTURE DIRECTION FOR HEALTH INSURANCE
In the next few weeks, millions of American employees will choose which health insurance plan will cover them and their families for calendar year 2005. Among the choices facing some is an innovative insurance plan pioneered in 1992 in South Africa by a firm called Discovery and marketed in the United States as Destiny Health. It's an approach George W. Bush's and Congress's health care policymakers should keep in mind as they scramble to come up with proposals to deliver on Bush's vaguely worded campaign promises to reform health care finance.
The Destiny health plan has several intelligent features. One is an annual deductible: you pay for basic expectable medical expenses before insurance kicks in. One reason for the high cost of most health insurance is that we expect it to pay for routine medical expenses: it is as if your auto insurance policy covered oil changes but didn't pay you when the car was totalled.
When insurance kicks in, it is in the form of a personal medical fund, similar to the health savings account model that was part of the 2003 Medicare/prescription drug act. Unused amounts can be rolled over into the next year, and employees who leave the company will have access to remaining balances. This encourages employees to treat the money as if it is their own -- which it is -- and to keep cost in mind while making health care decisions. Experts of all ilks agree that one reason health care costs keep rising so rapidly is that consumers have gotten into the habit of making decisions with no regard at all for cost. The Destiny plan encourages them to break that habit.
The third and perhaps most interesting feature of the Destiny plan is its wellness programs, designed to encourage healthier lifestyles. Employees' insurance premiums are cut if they abstain from smoking, exercise regularly, hold down their weight and seek preventive care such as Pap smears or prostate exams. For achieving such goals, they earn "vitality points," which can be redeemed for health club memberships and travel discounts.
These health plans have proved popular. Destiny enrollment increased from 300,000 in 1998 to 1.6 million in 2004. A survey of Destiny members showed that 75 percent are familiar with the terms of their plan, compared with 38 percent for those in other plans, and that 97 percent believe a person's lifestyle choices have done something to reduce the cost of health care, compared to 29 percent for those in other plans. Some 85 percent of Destiny members have started an exercise program and 76 percent have started a nutrition program in the preceding year. For employers, the payoff is tangible: single-digit increases in the cost of health insurance, compared to double-digit increases for most other plans.
The Destiny model addresses one of the leading causes of increased health care costs in America: bad lifestyle choices. In their book "Epidemic of Care," Kaiser Permanente CEO George Halvorsen and Dr. George Isham note that there has been a 33 percent increase in the number of Americans with diabetes since 1990 -- and that type II diabetes can usually be prevented by appropriate behavior and diet changes. "We eat foods that make us vulnerable to diabetes and heart disease," they write, "and then don't exercise enough to keep those diseases from taking over our bodies." This is hugely expensive: diabetes requires expensive medical interventions that all health insurance policyholders must indirectly pay for. The Destiny wellness program pays policyholders to avoid behaviors that, statistically, will produce huge health care costs later on. It looks to be well worth the money, even in the short term.
Destiny's approach is part of a larger trend. Starting in the New Deal era and in World War II, government provided and encouraged employers to provide social insurance and health insurance that would guarantee benefits and buffer individuals against the workings of the market. Today, no one wants to eliminate the social safety net entirely. But it has become apparent that insulating individuals against cost has adverse consequences: low savings rates, unsustainable rises in health care spending, harmful personal behaviors that lead to enormous health care problems and costs. And it has become apparent as well that individuals are not helpless or incompetent beings in need of protection from the marketplace by big government or large corporations. With an adequate safety net, and within an appropriate structure, they can figure out things for themselves. The Destiny plan helps show us the way.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, December 01, 2004
In the Delivery Room, Baby AND Doctor are at Risk
The phone call that ultimately would alter the path of Kevin Kearney's medical career brought him to a hospital delivery room on Maryland's Eastern Shore on an August evening 16 years ago. The obstetrician arrived to find an 18-year-old woman, well into labor and buckling under the weight of a 42-week pregnancy. She begged for a Caesarean section. Kearney drew on his decade as an obstetrician, gently counseling her, "Have it on your own."
Cascading from that decision was a marathon delivery marred by complications: The baby became so tightly wedged in the birth canal that Kearney was forced to launch a desperate struggle to dislodge him. The delivery would leave permanent injuries. Aug. 24, 1988, marked the birth of Donnette Dennis's first son, Richard. It also marked the start of a legal battle that reverberates today, as political leaders in Annapolis ponder medical malpractice reform.
Like so many cases across the country, in which bad outcomes in the delivery room lead to a courtroom, the desire to assess blame for Richard Turner Jr.'s damaged right arm and scarred right eye became grist for litigation. On one side was Kearney, a Johns Hopkins University-trained obstetrician and gynecologist who was one of the last remaining specialists performing high-risk deliveries in rural towns from Ocean City to Easton. On the other was Dennis's attorney, John Schochor, whose Baltimore firm has filed more malpractice cases over the past two decades than any other law office in Maryland.
Today, years after the jury reached its verdict, those on both sides of Dennis v. Kearney say the case holds valuable insights for politicians in Annapolis. Both Kearney and Schochor have spent time this year lobbying Maryland's leaders over the fast-rising malpractice insurance rates that have prompted, by the estimate of Maryland's medical society, 26 of the state's 750 obstetricians to close their practices. Gov. Robert L. Ehrlich Jr. (R) has predicted that a new wave of closures will follow a 33 percent rise in the cost of malpractice insurance that takes effect Wednesday.
In letters and during private meetings with key lawmakers, Kearney argued for limits on jury awards in malpractice suits. In sessions with Ehrlich, Schochor called for doctors to reduce what he said are the staggering numbers of medical errors being committed by a handful of the worst offenders. Both positions trace, in part, to a split-second decision made in that delivery room 16 years ago.
Some details
It was on a summer evening in 1988 that the call came to oversee Dennis's delivery. Kearney glanced through her charts and said he saw little to warrant a Caesarean. This being her first baby, he surmised, it might take time. But the labor dragged on for hours. When the baby's head finally started to emerge, the birth stalled, this time by a rare complication called shoulder dystocia -- which occurs when the shoulder becomes locked in the birth canal. "You don't forget the moment these sort of catastrophic events occur," Kearney said later. "Shoulder dystocia, it's what you live in fear of, literally."
The longer the baby was stuck, the more risks mounted. With his umbilical cord compressed and his lungs unable to expand, Dennis's baby could not breathe. Move too slowly, Kearney knew, and the infant's brain would be starved of oxygen. Twist the wrong way, and risk damaging the nerves running through the shoulder to the chest and arms. As he plotted a course, "minutes felt like hours."
He first tried to get the baby out by force. Nurses pushed back hard on Dennis's legs and pressed downward on her abdomen. And Kearney pulled -- hard -- on the baby's head, first using forceps, then his hands. Nothing. Kearney's next maneuver: to reach under the baby's armpit with one finger, and use it like a hook to yank one arm through the birth canal. That freed up room for the baby to emerge. In a matter of seconds, Richard Turner was born. Kearney visited Dennis the next morning. By then, he had seen the lack of tone in Richard's right arm. "He just told me what had happened in the delivery room, that he was sorry for what he had done," she said. "He was sorry about what happened to Richard's arm."
Kearney said he left the hospital heartbroken. He doesn't remember apologizing to Dennis but said that if he did, it wasn't to convey that he "goofed." In fact, he felt certain he handled the procedure correctly. It may be the most vexing aspect of shoulder dystocia, he said. If the baby is born with an injury, there is no way to know whether it occurred during delivery or during the baby's descent. The only certainty, Kearney believes, is that the doctor handling the delivery will be sued. Say the words "shoulder dystocia," Kearney said, "and you'll see a smile cross the face of any plaintiff's attorney." .....
Kearney did not let the court's ruling disrupt his practice. Over the next several years, in fact, his caseload grew. And so did his legal exposure. He began doing more Cesarean sections out of an abundance of caution. Still, he was sued six more times, including a second case involving shoulder dystocia, which he settled. By contrast, the average OB-GYN is sued 2.6 times over a career, according to the American College of Obstetricians and Gynecologists. His insurance bills crept up.
Then in December 2003, his carrier wrote to say that the company was getting out of the malpractice insurance business and that he would be dropped. "I tried everywhere to find new insurance, but they kept giving me these outrageous quotes," Kearney said. One company offered to cover him for $150,000, more than double the region's average rate. Another set the premium at $200,000 "because I had notches in my gun." For six weeks, Kearney tried to resolve this crisis as 150 pregnant patients waited in limbo. Reluctantly, he dialed each one, arranged to transfer their charts and pledged to track their progress. At 56, he had delivered his last baby.
Though his small gynecological practice will keep him afloat until retirement, he has become bitter. He's taped a bright orange bumper sticker to the front door of his office. It says: "Become a doctor: Support a lawyer." ....
Not only are obstetricians closing their practices, but the specialty is no longer the draw it once was. Of the 128 students graduating from the University of Maryland Medical School in 2003, none chose obstetrics. And though the previous three generations of Kearney's family have delivered babies, his son plans to specialize in orthopedics
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The phone call that ultimately would alter the path of Kevin Kearney's medical career brought him to a hospital delivery room on Maryland's Eastern Shore on an August evening 16 years ago. The obstetrician arrived to find an 18-year-old woman, well into labor and buckling under the weight of a 42-week pregnancy. She begged for a Caesarean section. Kearney drew on his decade as an obstetrician, gently counseling her, "Have it on your own."
Cascading from that decision was a marathon delivery marred by complications: The baby became so tightly wedged in the birth canal that Kearney was forced to launch a desperate struggle to dislodge him. The delivery would leave permanent injuries. Aug. 24, 1988, marked the birth of Donnette Dennis's first son, Richard. It also marked the start of a legal battle that reverberates today, as political leaders in Annapolis ponder medical malpractice reform.
Like so many cases across the country, in which bad outcomes in the delivery room lead to a courtroom, the desire to assess blame for Richard Turner Jr.'s damaged right arm and scarred right eye became grist for litigation. On one side was Kearney, a Johns Hopkins University-trained obstetrician and gynecologist who was one of the last remaining specialists performing high-risk deliveries in rural towns from Ocean City to Easton. On the other was Dennis's attorney, John Schochor, whose Baltimore firm has filed more malpractice cases over the past two decades than any other law office in Maryland.
Today, years after the jury reached its verdict, those on both sides of Dennis v. Kearney say the case holds valuable insights for politicians in Annapolis. Both Kearney and Schochor have spent time this year lobbying Maryland's leaders over the fast-rising malpractice insurance rates that have prompted, by the estimate of Maryland's medical society, 26 of the state's 750 obstetricians to close their practices. Gov. Robert L. Ehrlich Jr. (R) has predicted that a new wave of closures will follow a 33 percent rise in the cost of malpractice insurance that takes effect Wednesday.
In letters and during private meetings with key lawmakers, Kearney argued for limits on jury awards in malpractice suits. In sessions with Ehrlich, Schochor called for doctors to reduce what he said are the staggering numbers of medical errors being committed by a handful of the worst offenders. Both positions trace, in part, to a split-second decision made in that delivery room 16 years ago.
Some details
It was on a summer evening in 1988 that the call came to oversee Dennis's delivery. Kearney glanced through her charts and said he saw little to warrant a Caesarean. This being her first baby, he surmised, it might take time. But the labor dragged on for hours. When the baby's head finally started to emerge, the birth stalled, this time by a rare complication called shoulder dystocia -- which occurs when the shoulder becomes locked in the birth canal. "You don't forget the moment these sort of catastrophic events occur," Kearney said later. "Shoulder dystocia, it's what you live in fear of, literally."
The longer the baby was stuck, the more risks mounted. With his umbilical cord compressed and his lungs unable to expand, Dennis's baby could not breathe. Move too slowly, Kearney knew, and the infant's brain would be starved of oxygen. Twist the wrong way, and risk damaging the nerves running through the shoulder to the chest and arms. As he plotted a course, "minutes felt like hours."
He first tried to get the baby out by force. Nurses pushed back hard on Dennis's legs and pressed downward on her abdomen. And Kearney pulled -- hard -- on the baby's head, first using forceps, then his hands. Nothing. Kearney's next maneuver: to reach under the baby's armpit with one finger, and use it like a hook to yank one arm through the birth canal. That freed up room for the baby to emerge. In a matter of seconds, Richard Turner was born. Kearney visited Dennis the next morning. By then, he had seen the lack of tone in Richard's right arm. "He just told me what had happened in the delivery room, that he was sorry for what he had done," she said. "He was sorry about what happened to Richard's arm."
Kearney said he left the hospital heartbroken. He doesn't remember apologizing to Dennis but said that if he did, it wasn't to convey that he "goofed." In fact, he felt certain he handled the procedure correctly. It may be the most vexing aspect of shoulder dystocia, he said. If the baby is born with an injury, there is no way to know whether it occurred during delivery or during the baby's descent. The only certainty, Kearney believes, is that the doctor handling the delivery will be sued. Say the words "shoulder dystocia," Kearney said, "and you'll see a smile cross the face of any plaintiff's attorney." .....
Kearney did not let the court's ruling disrupt his practice. Over the next several years, in fact, his caseload grew. And so did his legal exposure. He began doing more Cesarean sections out of an abundance of caution. Still, he was sued six more times, including a second case involving shoulder dystocia, which he settled. By contrast, the average OB-GYN is sued 2.6 times over a career, according to the American College of Obstetricians and Gynecologists. His insurance bills crept up.
Then in December 2003, his carrier wrote to say that the company was getting out of the malpractice insurance business and that he would be dropped. "I tried everywhere to find new insurance, but they kept giving me these outrageous quotes," Kearney said. One company offered to cover him for $150,000, more than double the region's average rate. Another set the premium at $200,000 "because I had notches in my gun." For six weeks, Kearney tried to resolve this crisis as 150 pregnant patients waited in limbo. Reluctantly, he dialed each one, arranged to transfer their charts and pledged to track their progress. At 56, he had delivered his last baby.
Though his small gynecological practice will keep him afloat until retirement, he has become bitter. He's taped a bright orange bumper sticker to the front door of his office. It says: "Become a doctor: Support a lawyer." ....
Not only are obstetricians closing their practices, but the specialty is no longer the draw it once was. Of the 128 students graduating from the University of Maryland Medical School in 2003, none chose obstetrics. And though the previous three generations of Kearney's family have delivered babies, his son plans to specialize in orthopedics
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, November 30, 2004
GOVERNMENT MAKES WAR ON DOCTORS
The current Congress has a few lame ducks, but they're still mighty busy birds - trying to push through lots of big legislation such as 1000 pages of a $338 billion omnibus spending bill. They're also hoping that little bills zip right through, below the public's radar, such as H.R. 3015 which targets physicians and pharmacists in the take-no-prisoners war on pain drugs and patients suffering chronic pain. H.R. 3015, the National All Schedules Prescription Electronic Reporting Act, the US House of Representatives in October. It's now before the Senate where it's slated for a voice vote before the current session of Congress expires on January 2, 2005. A voice vote is a way to pass a bill quickly without a record of which way each senator voted.
This bill would encourage states to establish programs requiring physicians and other providers such as pharmacists to report any and every prescription for a wide range of commonly prescribed drugs, including pain medications and anti-depressants. In addition to the medicine and dose, the doctor would have to give the government the patient's name, address and telephone number. This private prescription information would then become part of a national computer database, available to the police and also possibly to employers, newspapers, blackmailers, or anybody else curious about such information.
The patient would not even know about the release of this prescription information, much less consent to its release or review. Police would have access to personal prescription information without having probable cause to believe a crime had been committed and without convincing a judge to issue a search warrant.
Drug Enforcement Administration (DEA) agents and state licensure boards already have great powers. They currently can get information on prescriptions written for controlled substances and have sweeping authority to investigate anybody they choose and to prosecute doctors for prescribing more pain killers than agents think appropriate. HR 3015 would dramatically enhance the reach of police and DEA agents into the privacy of doctors and patients.
Some government officials liken doctors to terrorists, and want equal judicial vigor in pursuing doctors. For example, Assistant U.S. Attorney Gene Rossi declared to a reporter that "our office will try our best to root out [certain doctors] like the Taliban. Stay tuned." according to a September press release from the Association of American Physicians and Surgeons.
In opposition to the bill, Rep. Ron Paul, MD, of Texas said HR 3015 "is yet another unjustifiable attempt by the federal government to use the war on drugs as an excuse for invading the privacy and liberties of the American people and for expanding the federal government's disastrous micromanagement of medical care." He pointed out that the government is embarking on a "war on pain patients and their doctors" which "has already resulted in the harassment and prosecution of many doctors... whose only 'crime' is prescribing legal medication... to relieve their patients' pain. These prosecutions, in turn, have scared other doctors so that they are unwilling to prescribe an adequate amount of pain medication, or even any pain medication, for their suffering patients."
Could it be that government agents are going after innocent and hard-working doctors because the doctors are easy targets? Are real criminals going free because these same government agents find it too much work to break through the complicated logistic and legal defenses that real criminals sometimes build and hide behind?
Rather than giving non-medical officials more authority, power and money, congress and the president should restrain the DEA from essentially telling doctors how to practice medicine. Rather than using resources to send trained actors feigning pain to entrap doctors, the DEA and other agencies should communicate and cooperate with doctors.
To further this goal, the Association of American Physicians and Surgeons (AAPS) recently developed a 3-point "Communicate and Cooperate" proposal to encourage physicians and law enforcement to work together to prevent prescription drug abuse. The proposal includes several ways law enforcement agents can work with doctors, such as:
1. Working together to track suspected drug abusers. To balance current laws requiring doctors to provide information about suspected abusers to the government, government agencies would notify doctors about suspicious patient behavior such as contact with know drug dealers or abusers.
2. Reviewing possible cases with professional medical boards before filing charges in court. Doctors would review a physician's practice with police before non-medical prosecutors would file criminal charges. This would help prevent embarrassing errors by government agents and would prevent worsening the current shortage of doctors willing to adequately treat patients with chronic and painful medical conditions.
3. Mutual training of law enforcement and medical personnel. Law enforcement people would educate doctors about recognizing patterns of illegal activity and criminal intent; doctors would educate police about modern pain treatment.
And why is the US Senate vote scheduled for only a "Yea" or "Nay" voice vote, without recording which senator voted which way? One reason is often so that senators can't be held to account for their votes. As Rep. Paul says, "Instead of further eroding our medical privacy, Congress should take steps to protect it."
Source
RATIONING MEDICAL CARE COVERTLY
The US healthcare system doesn't need the burgeoning medical costs of baby boomers to make it unsustainable. It already is. With costs every year rising two percentage points faster than personal income, it's universally acknowledged that the system is broken, but no one can agree on how to fix it. The nub of the problem is that Americans refuse to accept any form of rationing in a system that accounts for 14.1per cent of GDP, the highest in the world, yet which still leaves 45 million people without insurance and the rest paying premiums averaging 8.2 per cent of gross pay.
All of this so patients can have the expensive tests they demand - but may not need - given to them by doctors who are forced, by threat of lawsuits, to practice defensive medicine. But the reality is that rationing goes on every day, mostly behind closed doors with patients left out of the loop. "You can eat up all of your profits if one or two patients linger in the intensive care unit of a hospital," says Lorraine Micheletti, head nurse at Philadelphia's Northeastern Hospital. Under management orders to cut stays to keep the hospital open, Micheletti told the Wall Street Journal she encouraged families of older patients with not much in the way of quality years left to not keep them alive.
Under a form of rationing proposed by Washington-based analyst Robert Hungate, health insurance subscribers would pay little to visit their family doctor, half of specialists' fees and then a substantial part - though it will be capped - for hospital stays and expensive procedures. "What I argue is that we have to achieve rationing by choice," he says. "That's what markets do, and markets ration better than bureaucracies."
Critics, though, say healthcare is a fundamental right and should not be determined by factors such as costs. The American Medical Association's declaration of professional responsibility says a physician's duty is to treat the sick and injured with competence and compassion, and without prejudice, says private physician David Rogers. "Without prejudice means to avoid any bias that could possibly interfere with or reduce the quality of care," he says. "In my opinion, this would include using costs when making treatment decisions."
But Annie Liebowitz, former chief medical officer of Aetna, one of the biggest health insurers in the US, asks whether it is good to burden a patient with expenses that could have been avoided, or prescribe a brand name drug when a generic drug at half the cost is equally effective. "When given the choice of two equally effective diagnostic tests, or treatment approaches or medication options, physicians must consider which is likely to cost less," Dr Liebowitz says. "Our patients' needs are our first priority, but the healthcare system we all depend on is also our patient."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The current Congress has a few lame ducks, but they're still mighty busy birds - trying to push through lots of big legislation such as 1000 pages of a $338 billion omnibus spending bill. They're also hoping that little bills zip right through, below the public's radar, such as H.R. 3015 which targets physicians and pharmacists in the take-no-prisoners war on pain drugs and patients suffering chronic pain. H.R. 3015, the National All Schedules Prescription Electronic Reporting Act, the US House of Representatives in October. It's now before the Senate where it's slated for a voice vote before the current session of Congress expires on January 2, 2005. A voice vote is a way to pass a bill quickly without a record of which way each senator voted.
This bill would encourage states to establish programs requiring physicians and other providers such as pharmacists to report any and every prescription for a wide range of commonly prescribed drugs, including pain medications and anti-depressants. In addition to the medicine and dose, the doctor would have to give the government the patient's name, address and telephone number. This private prescription information would then become part of a national computer database, available to the police and also possibly to employers, newspapers, blackmailers, or anybody else curious about such information.
The patient would not even know about the release of this prescription information, much less consent to its release or review. Police would have access to personal prescription information without having probable cause to believe a crime had been committed and without convincing a judge to issue a search warrant.
Drug Enforcement Administration (DEA) agents and state licensure boards already have great powers. They currently can get information on prescriptions written for controlled substances and have sweeping authority to investigate anybody they choose and to prosecute doctors for prescribing more pain killers than agents think appropriate. HR 3015 would dramatically enhance the reach of police and DEA agents into the privacy of doctors and patients.
Some government officials liken doctors to terrorists, and want equal judicial vigor in pursuing doctors. For example, Assistant U.S. Attorney Gene Rossi declared to a reporter that "our office will try our best to root out [certain doctors] like the Taliban. Stay tuned." according to a September press release from the Association of American Physicians and Surgeons.
In opposition to the bill, Rep. Ron Paul, MD, of Texas said HR 3015 "is yet another unjustifiable attempt by the federal government to use the war on drugs as an excuse for invading the privacy and liberties of the American people and for expanding the federal government's disastrous micromanagement of medical care." He pointed out that the government is embarking on a "war on pain patients and their doctors" which "has already resulted in the harassment and prosecution of many doctors... whose only 'crime' is prescribing legal medication... to relieve their patients' pain. These prosecutions, in turn, have scared other doctors so that they are unwilling to prescribe an adequate amount of pain medication, or even any pain medication, for their suffering patients."
Could it be that government agents are going after innocent and hard-working doctors because the doctors are easy targets? Are real criminals going free because these same government agents find it too much work to break through the complicated logistic and legal defenses that real criminals sometimes build and hide behind?
Rather than giving non-medical officials more authority, power and money, congress and the president should restrain the DEA from essentially telling doctors how to practice medicine. Rather than using resources to send trained actors feigning pain to entrap doctors, the DEA and other agencies should communicate and cooperate with doctors.
To further this goal, the Association of American Physicians and Surgeons (AAPS) recently developed a 3-point "Communicate and Cooperate" proposal to encourage physicians and law enforcement to work together to prevent prescription drug abuse. The proposal includes several ways law enforcement agents can work with doctors, such as:
1. Working together to track suspected drug abusers. To balance current laws requiring doctors to provide information about suspected abusers to the government, government agencies would notify doctors about suspicious patient behavior such as contact with know drug dealers or abusers.
2. Reviewing possible cases with professional medical boards before filing charges in court. Doctors would review a physician's practice with police before non-medical prosecutors would file criminal charges. This would help prevent embarrassing errors by government agents and would prevent worsening the current shortage of doctors willing to adequately treat patients with chronic and painful medical conditions.
3. Mutual training of law enforcement and medical personnel. Law enforcement people would educate doctors about recognizing patterns of illegal activity and criminal intent; doctors would educate police about modern pain treatment.
And why is the US Senate vote scheduled for only a "Yea" or "Nay" voice vote, without recording which senator voted which way? One reason is often so that senators can't be held to account for their votes. As Rep. Paul says, "Instead of further eroding our medical privacy, Congress should take steps to protect it."
Source
RATIONING MEDICAL CARE COVERTLY
The US healthcare system doesn't need the burgeoning medical costs of baby boomers to make it unsustainable. It already is. With costs every year rising two percentage points faster than personal income, it's universally acknowledged that the system is broken, but no one can agree on how to fix it. The nub of the problem is that Americans refuse to accept any form of rationing in a system that accounts for 14.1per cent of GDP, the highest in the world, yet which still leaves 45 million people without insurance and the rest paying premiums averaging 8.2 per cent of gross pay.
All of this so patients can have the expensive tests they demand - but may not need - given to them by doctors who are forced, by threat of lawsuits, to practice defensive medicine. But the reality is that rationing goes on every day, mostly behind closed doors with patients left out of the loop. "You can eat up all of your profits if one or two patients linger in the intensive care unit of a hospital," says Lorraine Micheletti, head nurse at Philadelphia's Northeastern Hospital. Under management orders to cut stays to keep the hospital open, Micheletti told the Wall Street Journal she encouraged families of older patients with not much in the way of quality years left to not keep them alive.
Under a form of rationing proposed by Washington-based analyst Robert Hungate, health insurance subscribers would pay little to visit their family doctor, half of specialists' fees and then a substantial part - though it will be capped - for hospital stays and expensive procedures. "What I argue is that we have to achieve rationing by choice," he says. "That's what markets do, and markets ration better than bureaucracies."
Critics, though, say healthcare is a fundamental right and should not be determined by factors such as costs. The American Medical Association's declaration of professional responsibility says a physician's duty is to treat the sick and injured with competence and compassion, and without prejudice, says private physician David Rogers. "Without prejudice means to avoid any bias that could possibly interfere with or reduce the quality of care," he says. "In my opinion, this would include using costs when making treatment decisions."
But Annie Liebowitz, former chief medical officer of Aetna, one of the biggest health insurers in the US, asks whether it is good to burden a patient with expenses that could have been avoided, or prescribe a brand name drug when a generic drug at half the cost is equally effective. "When given the choice of two equally effective diagnostic tests, or treatment approaches or medication options, physicians must consider which is likely to cost less," Dr Liebowitz says. "Our patients' needs are our first priority, but the healthcare system we all depend on is also our patient."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, November 29, 2004
Father left to suffer in agony
Fortunately, private compassion took over from uncaring public medicine bureaucrats
A 37-year-old father of three could lose one of his legs because the Health Department took more than three months to organise treatment for him in a NSW hospital. Mark Mathews, who is in agony from a circulation disease that has caused gaping ulcers on his legs, eventually accepted a lifeline thrown to him by a Queensland hospital that agreed to treat him first and chase payment later. Mr Mathews, of Yamba, said he waited in vain to hear back from NSW Health after his doctors sought treatment for his condition in a hyperbaric chamber at Sydney's Prince of Wales Hospital. "But I heard nothing despite ringing several times. Now I'm afraid the delay in treatment may cost me my leg," he said.
Mr Mathews' plight was eased when he rang the Centre for Hyperbaric Medicine at Brisbane's Wesley Hospital. "They were shocked and said, 'Just get up here as quickly as possible.' ... "After all I'd been through, I couldn't believe it. They've been fantastic." Centre manager David King said he had decided to treat Mr Mathews first and "ask questions later".
Liberal MP for Clarence Steve Cansdell said he was appalled at the treatment of Mr Mathews. "It's a bureaucratic bungle. They've treated him like he was applying for a licence," Mr Cansdell said. "This is one of the worst cases that I've come across."
Mr Mathews suffers from Buerger's disease, a severe and painful form of thrombosis that affects the hands and legs. When at home, he cannot sleep lying down and struggles to walk. He spends his days and nights sitting and sleeping upright in a chair.
The Northern Rivers Area Health Service said there had been a communication breakdown when Mr Mathews switched doctors. A spokesman said the cost of his treatment in Queensland would be met by Northern Rivers Area Health.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Fortunately, private compassion took over from uncaring public medicine bureaucrats
A 37-year-old father of three could lose one of his legs because the Health Department took more than three months to organise treatment for him in a NSW hospital. Mark Mathews, who is in agony from a circulation disease that has caused gaping ulcers on his legs, eventually accepted a lifeline thrown to him by a Queensland hospital that agreed to treat him first and chase payment later. Mr Mathews, of Yamba, said he waited in vain to hear back from NSW Health after his doctors sought treatment for his condition in a hyperbaric chamber at Sydney's Prince of Wales Hospital. "But I heard nothing despite ringing several times. Now I'm afraid the delay in treatment may cost me my leg," he said.
Mr Mathews' plight was eased when he rang the Centre for Hyperbaric Medicine at Brisbane's Wesley Hospital. "They were shocked and said, 'Just get up here as quickly as possible.' ... "After all I'd been through, I couldn't believe it. They've been fantastic." Centre manager David King said he had decided to treat Mr Mathews first and "ask questions later".
Liberal MP for Clarence Steve Cansdell said he was appalled at the treatment of Mr Mathews. "It's a bureaucratic bungle. They've treated him like he was applying for a licence," Mr Cansdell said. "This is one of the worst cases that I've come across."
Mr Mathews suffers from Buerger's disease, a severe and painful form of thrombosis that affects the hands and legs. When at home, he cannot sleep lying down and struggles to walk. He spends his days and nights sitting and sleeping upright in a chair.
The Northern Rivers Area Health Service said there had been a communication breakdown when Mr Mathews switched doctors. A spokesman said the cost of his treatment in Queensland would be met by Northern Rivers Area Health.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, November 28, 2004
ANOTHER EXAMPLE OF THE NEED FOR TORT REFORM
Last week, my wife and I took two of our three sons to see the film The Incredibles. If you have no young children begging you to see it and think it has no message applicable to adults, allow me to correct you. It is a powerful movie in its storyline, animation, and moral lessons. Mr. Incredible is one of a number of superheroes who fight crime and, as you would imagine, do good deeds. During one incident, Mr. Incredible saves a man jumping from a building. It turns out that the man did not want to be saved and responds to the good deed by filing a lawsuit. Eventually, legal action causes all the superheroes to retire and go undercover in a government protection program. The plot of the movie revolves around living in a litigious society and overcoming those who insist that anyone with a special gift or talent be forced into mediocrity.
The message is striking, although the idea of superheroes saving the day is obviously farfetched. As I thought about the movie, though, I realized that litigiousness and mediocrity are some of the biggest obstacles in our culture. The propensity to settle every dispute by legal action undermines values, such as trust and forgiveness, that are essential to the maintenance of genuine community. Fear of rewarding or achieving excellence discourages human persons from fulfilling God-given potential.
The story of Mr. Incredible is actually more common than most of us would like to admit. I asked a friend of mine to relate his father's story to illustrate my point. He wrote:
Dr. Bill's vocation, his calling, has been taken away from him. No one gains, but the entire population of Escanaba loses.
The fictional tale of Mr. Incredible comes to life in this doctor's story. With thousands of other similar stories, it is testimony to the profound need for tort reform in our nation. Pastors are afraid to counsel people. Nurses are nervous about giving needed care. Teachers fear to address the issues they know are troubling the lives of their students. Manufacturers raise the cost of their product because of the constant threat of lawsuits. Restaurants warn people that their coffee is hot and shouldn't be carried in their laps. At some point, it becomes simply ridiculous and any sense of biblical fairness is lost.
Of course we need to maintain avenues of justice for those who have been injured by the actions of another. But without some limitation, without the exercise of some prudence, without some appreciation for what we are doing to ourselves and our culture, we are in danger of suing ourselves into oblivion.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Last week, my wife and I took two of our three sons to see the film The Incredibles. If you have no young children begging you to see it and think it has no message applicable to adults, allow me to correct you. It is a powerful movie in its storyline, animation, and moral lessons. Mr. Incredible is one of a number of superheroes who fight crime and, as you would imagine, do good deeds. During one incident, Mr. Incredible saves a man jumping from a building. It turns out that the man did not want to be saved and responds to the good deed by filing a lawsuit. Eventually, legal action causes all the superheroes to retire and go undercover in a government protection program. The plot of the movie revolves around living in a litigious society and overcoming those who insist that anyone with a special gift or talent be forced into mediocrity.
The message is striking, although the idea of superheroes saving the day is obviously farfetched. As I thought about the movie, though, I realized that litigiousness and mediocrity are some of the biggest obstacles in our culture. The propensity to settle every dispute by legal action undermines values, such as trust and forgiveness, that are essential to the maintenance of genuine community. Fear of rewarding or achieving excellence discourages human persons from fulfilling God-given potential.
The story of Mr. Incredible is actually more common than most of us would like to admit. I asked a friend of mine to relate his father's story to illustrate my point. He wrote:
"My father is a retired Obstetrician-Gynecologist. He attended Notre Dame for undergrad then Loyola Medical School. After his residency in Chicago he was offered a terrific position with a hospital in Chicago which would have put him on the cutting edge of Obstetrics and Gynecology at a time (the late '60s) when that field was on the edge of extraordinary change."
"My Dad turned down that job. He decided to return to his small hometown of Escanaba, Michigan. Escanaba is a town of 12,000 people located in the Upper Peninsula. There he could give back to the community that raised him and gave him so much. He would be the first OB-GYN specialist that small community ever saw. During the late '60s, the '70s and early '80s, my Dad was the only Ob-Gyn specialist within a 45-mile radius of Escanaba. He enjoyed long hours, long nights, phone calls at all hours, and the ineffable joy of ushering in new human life to the small town he loved. His commitment to that community was heroic and tireless. And his connection with the community was intimate. He delivered hundreds of babies each year and he passionately and humanely cared for women in and around Escanaba during some very traumatic moments in their lives."
"In the mid to late '80s, his malpractice premiums become so onerous (roughly $150,000 per year) that he was forced to consider retirement. The premium problem along with the new awful reality of having to look at each new patient or case as a potential lawsuit started sucking the joy and satisfaction right out of the practice for him."
"In the early '90s, he was sued twice as a tangential defendant in two lawsuits where he had been called into difficult deliveries at the last minute because he was a specialist. In these two lawsuits he was deposed by a plaintiff's attorney from lower Michigan who treated my father so uncivilly and disrespectfully that my Dad finally had the joy of his practice completely taken away. The premiums were outrageous, the trial lawyers were everywhere, and the demand was for perfect babies, or else."
"Alas, in 1995, my Dad retired for good at age 59. The medical practice he loved became a potential exposure he could not afford; and it became an adversarial environment he would never understand. Escanaba, Michigan, sadly lost one of the finest physicians it has ever, or will ever, have the honor of calling "Doctor Bill." It was tragic and it was wholly preventable."
Dr. Bill's vocation, his calling, has been taken away from him. No one gains, but the entire population of Escanaba loses.
The fictional tale of Mr. Incredible comes to life in this doctor's story. With thousands of other similar stories, it is testimony to the profound need for tort reform in our nation. Pastors are afraid to counsel people. Nurses are nervous about giving needed care. Teachers fear to address the issues they know are troubling the lives of their students. Manufacturers raise the cost of their product because of the constant threat of lawsuits. Restaurants warn people that their coffee is hot and shouldn't be carried in their laps. At some point, it becomes simply ridiculous and any sense of biblical fairness is lost.
Of course we need to maintain avenues of justice for those who have been injured by the actions of another. But without some limitation, without the exercise of some prudence, without some appreciation for what we are doing to ourselves and our culture, we are in danger of suing ourselves into oblivion.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, November 27, 2004
LEGAL MADNESS: DOCTORS HAVE LESS RIGHTS THAN OTHER WORKERS?
Do doctors have to form a union to get the same rights to strike etc as everyone else? It seems so. It's all hot air, of course. Anybody who thought that prosecuting the doctors is a solution to anything would soon get the boot one way or another
Maryland doctors who take part in group boycotts or work slowdowns to protest the state's high medical-malpractice insurance rates run the risk of violating antitrust law, state officials say. "Doctors can lobby and they can also make independent, unilateral decisions on how they want to handle their own business. But what they can't do is get together and agree not to see patients," said Ellen S. Cooper, an assistant attorney general in Maryland. Ms. Cooper would not specifically comment on recent actions by physicians in Prince George's and Washington counties.
Last week, doctors at Prince George's Hospital Center and in Washington County in Western Maryland said they would cancel nonemergency procedures to draw public attention to the rising cost of medical-malpractice insurance. At issue is whether independent doctors in Maryland decided as a group to withhold services to change their economic circumstances. If so, they might be crossing a line from political protest to price fixing and collusion, antitrust lawyers warned.
"It sounds pretty dangerous to me," said Herb Hovenkamp, a professor at the University of Iowa who specializes in antitrust law. "There is a labor exemption that permits employees to do this, but independent doctors don't qualify for labor immunity." Mr. Hovenkamp said doctors could be penalized for participating in work slowdowns or group boycotts. They could be forced to reimburse monetary losses that result from the slowdown. "If the hospital takes a big hit in revenue, the damages could get quite large," he said.
Bob Howell, a spokesman for the Prince George's Hospital Center, said it hasn't suffered in the slowdown. "From our perspective, we haven't seen that much of a difference," Mr. Howell said. "There haven't been any doctors unavailable to do certain procedures."
"Professionals are not exempted from the antitrust laws, and they're not allowed to ... boycott or fix prices," said Bert Foer, president of the D.C.-based American Antitrust Institute. "They're at a risk when they do this sort of thing."
The doctors who participated in the recent slowdowns say they want state lawmakers to call a special session to reduce malpractice insurance premiums. The doctors say the rising rates are forcing many physicians to retire, leave the state or change specialities. Last week, Gov. Robert L. Ehrlich Jr., a Republican, said he planned to deliver a revised medical-malpractice insurance reform bill to Democratic legislative leaders this week. Mr. Ehrlich has been working with House Speaker Michael E. Busch and Senate President Thomas V. Mike Miller Jr., both Democrats, on a malpractice reform measure for a special General Assembly session before a 33 percent increase in insurance premiums takes effect Dec. 31. The doctors' first payments of the higher premiums are due Dec. 1.
Dr. Willie C. Blair, president of the medical staff at Prince George's Hospital Center, said the slowdown was a last resort for doctors because lawmakers have been slow to call a special session. He said the slowdown, in which more than 100 physicians participated, will not continue this week. About 40 physicians from Prince George's County and more than 60 from Washington County participated in last week's slowdown, which included halting elective procedures such as biopsies and hernia operations. Dr. Blair said he wasn't worried about facing sanctions as a result of the slowdown. "Lock me up and send me to jail," he said. "I can't pay my workers, I can't pay my malpractice insurance. ... The lawyers said we couldn't do it, and they've been keeping us in line all along. We followed the rules and followed the rules, and look where it got us. We're down and out." ... Dr. Blair said physicians will not rule out another slowdown. But he doesn't expect that to happen anytime soon. "We just wanted to be heard," he said. "We're trying to get some results."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Do doctors have to form a union to get the same rights to strike etc as everyone else? It seems so. It's all hot air, of course. Anybody who thought that prosecuting the doctors is a solution to anything would soon get the boot one way or another
Maryland doctors who take part in group boycotts or work slowdowns to protest the state's high medical-malpractice insurance rates run the risk of violating antitrust law, state officials say. "Doctors can lobby and they can also make independent, unilateral decisions on how they want to handle their own business. But what they can't do is get together and agree not to see patients," said Ellen S. Cooper, an assistant attorney general in Maryland. Ms. Cooper would not specifically comment on recent actions by physicians in Prince George's and Washington counties.
Last week, doctors at Prince George's Hospital Center and in Washington County in Western Maryland said they would cancel nonemergency procedures to draw public attention to the rising cost of medical-malpractice insurance. At issue is whether independent doctors in Maryland decided as a group to withhold services to change their economic circumstances. If so, they might be crossing a line from political protest to price fixing and collusion, antitrust lawyers warned.
"It sounds pretty dangerous to me," said Herb Hovenkamp, a professor at the University of Iowa who specializes in antitrust law. "There is a labor exemption that permits employees to do this, but independent doctors don't qualify for labor immunity." Mr. Hovenkamp said doctors could be penalized for participating in work slowdowns or group boycotts. They could be forced to reimburse monetary losses that result from the slowdown. "If the hospital takes a big hit in revenue, the damages could get quite large," he said.
Bob Howell, a spokesman for the Prince George's Hospital Center, said it hasn't suffered in the slowdown. "From our perspective, we haven't seen that much of a difference," Mr. Howell said. "There haven't been any doctors unavailable to do certain procedures."
"Professionals are not exempted from the antitrust laws, and they're not allowed to ... boycott or fix prices," said Bert Foer, president of the D.C.-based American Antitrust Institute. "They're at a risk when they do this sort of thing."
The doctors who participated in the recent slowdowns say they want state lawmakers to call a special session to reduce malpractice insurance premiums. The doctors say the rising rates are forcing many physicians to retire, leave the state or change specialities. Last week, Gov. Robert L. Ehrlich Jr., a Republican, said he planned to deliver a revised medical-malpractice insurance reform bill to Democratic legislative leaders this week. Mr. Ehrlich has been working with House Speaker Michael E. Busch and Senate President Thomas V. Mike Miller Jr., both Democrats, on a malpractice reform measure for a special General Assembly session before a 33 percent increase in insurance premiums takes effect Dec. 31. The doctors' first payments of the higher premiums are due Dec. 1.
Dr. Willie C. Blair, president of the medical staff at Prince George's Hospital Center, said the slowdown was a last resort for doctors because lawmakers have been slow to call a special session. He said the slowdown, in which more than 100 physicians participated, will not continue this week. About 40 physicians from Prince George's County and more than 60 from Washington County participated in last week's slowdown, which included halting elective procedures such as biopsies and hernia operations. Dr. Blair said he wasn't worried about facing sanctions as a result of the slowdown. "Lock me up and send me to jail," he said. "I can't pay my workers, I can't pay my malpractice insurance. ... The lawyers said we couldn't do it, and they've been keeping us in line all along. We followed the rules and followed the rules, and look where it got us. We're down and out." ... Dr. Blair said physicians will not rule out another slowdown. But he doesn't expect that to happen anytime soon. "We just wanted to be heard," he said. "We're trying to get some results."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, November 26, 2004
ROMNEYCARE: SOUNDS INTERESTING
"Governor Mitt Romney today proposed a sweeping expansion of private health coverage for the state's 460,000 uninsured people, and extended a hand to Democrats in the Legislature to pass a healthcare program next year.
In an article published in the Globe's opinion pages, Romney said he wants to change insurance laws to encourage insurers to offer stripped down health plans to small businesses and individuals. He would also provide "aggressively managed treatment" to send the working poor to clinics and hospitals for healthcare, redouble efforts to steer eligible people into Medicaid, and target Medicaid fraud.
Romney argued that his "Commonwealth Care" plan can "lead to every citizen in Massachusetts having health coverage." The governor insisted his proposal would not require a tax increase, or force employers to provide coverage to their workers, or make the state responsible for insuring everyone.
"Next year I am committed to working with the Legislature to pass a comprehensive, market-based reform program for healthcare," Romney wrote. "It will not require new taxes. What it will do is restrain the growth in healthcare costs and change how we provide healthcare for those who receive it at taxpayer expense."
More here
BUT MAYBE NOT
Making it more expensive to hire people is really dumb -- unless you WANT to create high unemployment
Massachusetts: Healthcare plan targets businesses: "Governor Mitt Romney said yesterday that he envisions a range of penalties for businesses that fail to provide health insurance, such as forcing them to pay a higher minimum wage, banning them from doing business with state agencies, or slapping a decal on their window to publicize their refusal. The Republican governor, disclosing details of his new healthcare proposal for the first time, said a system of 'carrots and sticks' would persuade businesses that don't provide health insurance to their workers to do so. Most of the employers he is targeting are small businesses with fewer than 50 workers. 'It could actually be a lot cheaper for businesses to provide insurance than to have to conform to the higher minimum wage for those that don't provide insurance,' Romney told reporters in a briefing in his State House office."
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
"Governor Mitt Romney today proposed a sweeping expansion of private health coverage for the state's 460,000 uninsured people, and extended a hand to Democrats in the Legislature to pass a healthcare program next year.
In an article published in the Globe's opinion pages, Romney said he wants to change insurance laws to encourage insurers to offer stripped down health plans to small businesses and individuals. He would also provide "aggressively managed treatment" to send the working poor to clinics and hospitals for healthcare, redouble efforts to steer eligible people into Medicaid, and target Medicaid fraud.
Romney argued that his "Commonwealth Care" plan can "lead to every citizen in Massachusetts having health coverage." The governor insisted his proposal would not require a tax increase, or force employers to provide coverage to their workers, or make the state responsible for insuring everyone.
"Next year I am committed to working with the Legislature to pass a comprehensive, market-based reform program for healthcare," Romney wrote. "It will not require new taxes. What it will do is restrain the growth in healthcare costs and change how we provide healthcare for those who receive it at taxpayer expense."
More here
BUT MAYBE NOT
Making it more expensive to hire people is really dumb -- unless you WANT to create high unemployment
Massachusetts: Healthcare plan targets businesses: "Governor Mitt Romney said yesterday that he envisions a range of penalties for businesses that fail to provide health insurance, such as forcing them to pay a higher minimum wage, banning them from doing business with state agencies, or slapping a decal on their window to publicize their refusal. The Republican governor, disclosing details of his new healthcare proposal for the first time, said a system of 'carrots and sticks' would persuade businesses that don't provide health insurance to their workers to do so. Most of the employers he is targeting are small businesses with fewer than 50 workers. 'It could actually be a lot cheaper for businesses to provide insurance than to have to conform to the higher minimum wage for those that don't provide insurance,' Romney told reporters in a briefing in his State House office."
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, November 25, 2004
Operating theatres shut to save cash as thousands of Australians wait for surgery
Hospitals are closing operating theatres to doctors wanting to perform planned surgery for up to a third of the year to save money, despite there being almost 70,000 people on NSW waiting lists. Nepean Hospital surgeon Richard Hanney said the hospital suspended planned surgery for around 12 weeks each year, including breaks over Christmas, Easter and other school holidays. Also, surgeons were expected to give up a day's worth of operating every two months to make room for more emergency surgery. As a result, some doctors who were available to do one list a week for 52 weeks were getting into the theatres for only 35 weeks a year.
The most recently available figures show that last September there were 2524 people waiting for planned surgery at Nepean, including 762 who had waited for more than a year. Dr Hanney, a member of the board of the NSW branch of the Royal Australasian College of Surgeons, said it was hard to work out just how long the state's teaching hospitals were closed to planned surgery, because each hospital restricted it in different ways. For example, aside from holiday shutdowns, the Royal North Shore Hospital ceases to perform elective surgery after 3pm each day.
The president of the NSW branch of the Australian Medical Association, John Gullotta, said an AMA phone survey showed some of Sydney's teaching hospitals had increased their holiday shutdowns since 2002. It revealed the Prince of Wales Hospital ceased performing elective surgery for four weeks over the 2002 holiday season. The hospital will do likewise this year but for six weeks from December 19. Dr Gullotta said he did not believe there was any reason to stop performing planned surgery except on the major public holidays.
The Opposition health spokesman, Barry O'Farrell, yesterday attacked the State Government for allowing elective surgery operating times to be cut while waiting lists were so high. "There are currently 65,348 people waiting for elective surgery in NSW. More than 9000 have been waiting over a year," he said. "There is no doubt that waiting lists would be reduced if the Carr Government showed a greater commitment to funding surgery times."
Representatives of three area health services contacted by the Herald yesterday said that the holiday suspension of elective surgery was to give staff and surgeons time off. As well, they said, patients preferred not to have surgery during peak holiday periods. Nurses upset over staffing shortages at Maitland Hospital have closed 26 beds. The nurses carried out their threat of industrial action after representatives of the NSW Nurses Association met the Hunter Area Health Service's Reasonable Workloads Committee to ask for extra staff. It is believed to be the first time such action has been taken by nurses in NSW. Four of the paediatrics ward's 14 beds, four of the medical ward's 34 beds and eight of the surgical ward's 34 beds have been closed. The general secretary of the association, Brett Holmes, said nurses were furious that Hunter Health had not provided sufficient funds to employ enough nurses to run the hospital safely. A Hunter Health spokeswoman said additional nurses were being recruited.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Hospitals are closing operating theatres to doctors wanting to perform planned surgery for up to a third of the year to save money, despite there being almost 70,000 people on NSW waiting lists. Nepean Hospital surgeon Richard Hanney said the hospital suspended planned surgery for around 12 weeks each year, including breaks over Christmas, Easter and other school holidays. Also, surgeons were expected to give up a day's worth of operating every two months to make room for more emergency surgery. As a result, some doctors who were available to do one list a week for 52 weeks were getting into the theatres for only 35 weeks a year.
The most recently available figures show that last September there were 2524 people waiting for planned surgery at Nepean, including 762 who had waited for more than a year. Dr Hanney, a member of the board of the NSW branch of the Royal Australasian College of Surgeons, said it was hard to work out just how long the state's teaching hospitals were closed to planned surgery, because each hospital restricted it in different ways. For example, aside from holiday shutdowns, the Royal North Shore Hospital ceases to perform elective surgery after 3pm each day.
The president of the NSW branch of the Australian Medical Association, John Gullotta, said an AMA phone survey showed some of Sydney's teaching hospitals had increased their holiday shutdowns since 2002. It revealed the Prince of Wales Hospital ceased performing elective surgery for four weeks over the 2002 holiday season. The hospital will do likewise this year but for six weeks from December 19. Dr Gullotta said he did not believe there was any reason to stop performing planned surgery except on the major public holidays.
The Opposition health spokesman, Barry O'Farrell, yesterday attacked the State Government for allowing elective surgery operating times to be cut while waiting lists were so high. "There are currently 65,348 people waiting for elective surgery in NSW. More than 9000 have been waiting over a year," he said. "There is no doubt that waiting lists would be reduced if the Carr Government showed a greater commitment to funding surgery times."
Representatives of three area health services contacted by the Herald yesterday said that the holiday suspension of elective surgery was to give staff and surgeons time off. As well, they said, patients preferred not to have surgery during peak holiday periods. Nurses upset over staffing shortages at Maitland Hospital have closed 26 beds. The nurses carried out their threat of industrial action after representatives of the NSW Nurses Association met the Hunter Area Health Service's Reasonable Workloads Committee to ask for extra staff. It is believed to be the first time such action has been taken by nurses in NSW. Four of the paediatrics ward's 14 beds, four of the medical ward's 34 beds and eight of the surgical ward's 34 beds have been closed. The general secretary of the association, Brett Holmes, said nurses were furious that Hunter Health had not provided sufficient funds to employ enough nurses to run the hospital safely. A Hunter Health spokeswoman said additional nurses were being recruited.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, November 24, 2004
GETTING POLITICAL BIASES MADE PART OF PROFESSIONAL ETHICS IS TOO CLEVER BY HALF
If such rules are enforced that will just lead to the discrediting and ditching of the professional ethics concerned
When Gov. Ernie Fletcher signed a death warrant for a convicted killer this month, he may have done more than start the clock ticking on an execution. Some say Fletcher, a doctor, may have put his medical license at risk. American Medical Association guidelines bar doctors from taking part, directly or indirectly, in executions. And Kentucky requires doctors to follow AMA ethical guidelines. "I think it's a clear violation," said Dr. Arthur Zitrin, an 86-year-old retired psychiatrist in New York and an outspoken death-penalty opponent. Zitrin is also challenging the license of a Georgia doctor accused of helping nurses find a vein in a condemned man for a lethal injection.
A group of doctors is seeking an opinion from the Kentucky Board of Medical Licensure on whether Fletcher can sign death warrants without running the risk of having his medical license revoked. The board is not scheduled to take up the matter until at least January, and would not comment in the meantime.
On Nov. 8, Fletcher signed a death warrant for 51-year-old Thomas Clyde Bowling, convicted of shooting to death the husband-and-wife owners of a dry cleaning business outside their store in 1990. Bowling is set to die by lethal injection Nov. 30. Fletcher's executive counsel, John Roach, said the Republican governor did not violate AMA guidelines or other ethical standards. "By signing a death warrant, in no way is Gov. Ernie Fletcher participating in the conduct of an execution," Roach said. "Gov. Fletcher's role under the law is consistent with the roles of judges fulfilling their legal duty and jurors fulfilling their legal obligations regardless of their professions."
The AMA guidelines forbid doctors to actively take part in an execution or to take any "action which would directly cause the death of the condemned" or "which would assist, supervise or contribute" to the death of the inmate.....
Fletcher, 52, earned his medical degree at the University of Kentucky and was a family practitioner until he was elected to Congress in 1998. He was elected governor last year and is still licensed as a physician in Kentucky.
The Federation of State Medical Boards said it has no information on any doctors who may have been disciplined for taking part in an execution. Not all states incorporate AMA guidelines into state law. For example, it would not be illegal in California for a physician to participate in an execution, according to Candis Cohen, spokeswoman for the Medical Board of California.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
If such rules are enforced that will just lead to the discrediting and ditching of the professional ethics concerned
When Gov. Ernie Fletcher signed a death warrant for a convicted killer this month, he may have done more than start the clock ticking on an execution. Some say Fletcher, a doctor, may have put his medical license at risk. American Medical Association guidelines bar doctors from taking part, directly or indirectly, in executions. And Kentucky requires doctors to follow AMA ethical guidelines. "I think it's a clear violation," said Dr. Arthur Zitrin, an 86-year-old retired psychiatrist in New York and an outspoken death-penalty opponent. Zitrin is also challenging the license of a Georgia doctor accused of helping nurses find a vein in a condemned man for a lethal injection.
A group of doctors is seeking an opinion from the Kentucky Board of Medical Licensure on whether Fletcher can sign death warrants without running the risk of having his medical license revoked. The board is not scheduled to take up the matter until at least January, and would not comment in the meantime.
On Nov. 8, Fletcher signed a death warrant for 51-year-old Thomas Clyde Bowling, convicted of shooting to death the husband-and-wife owners of a dry cleaning business outside their store in 1990. Bowling is set to die by lethal injection Nov. 30. Fletcher's executive counsel, John Roach, said the Republican governor did not violate AMA guidelines or other ethical standards. "By signing a death warrant, in no way is Gov. Ernie Fletcher participating in the conduct of an execution," Roach said. "Gov. Fletcher's role under the law is consistent with the roles of judges fulfilling their legal duty and jurors fulfilling their legal obligations regardless of their professions."
The AMA guidelines forbid doctors to actively take part in an execution or to take any "action which would directly cause the death of the condemned" or "which would assist, supervise or contribute" to the death of the inmate.....
Fletcher, 52, earned his medical degree at the University of Kentucky and was a family practitioner until he was elected to Congress in 1998. He was elected governor last year and is still licensed as a physician in Kentucky.
The Federation of State Medical Boards said it has no information on any doctors who may have been disciplined for taking part in an execution. Not all states incorporate AMA guidelines into state law. For example, it would not be illegal in California for a physician to participate in an execution, according to Candis Cohen, spokeswoman for the Medical Board of California.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, November 23, 2004
THE REALITY OF CANADIAN SOCIALIZED MEDICINE
The Barbarian Invasions, recently released on DVD by Buena Vista Home Video, offers a disturbing vision of state-run medicine. The Canadian film won two awards at the 2003 Cannes Film Festival (best screenplay and best actress) and took home this year's Oscar for best foreign-language film. It is the story of a man with a terminal disease who renews his relationships with his friends and family, especially his adult son. Much of the action takes place in a hospital in Montreal, Quebec, where director and screenwriter Denys Arcand dissects the Canadian health care system.
The film opens with a nun struggling down the corridor of a crowded ward to administer Holy Communion. Patients, health professionals, even electricians, are tripping over each other, packed into an environment of general confusion. And yet there is another floor of the hospital that is completely closed, thanks to a government directive.
The dying man's son is a successful investment banker in London. He's the kind of guy who can wriggle around anything. First he wrangles his way into the hospital's management offices without a pass and corners the manager, who is completely isolated from the chaos outside. He offers her a bribe to get his father moved out of the zoo and into a private space on the empty floor. She quietly takes the bribe but points out that she can do nothing without the hospital employees' union. The son pays off the union boss to prepare a private room on the empty floor. Painters, carpenters, and other workers quickly make it up.
Then, because there is virtually no access to PET (positron emission tomography) scans in Canada, the banker takes his father to Vermont to get one. One of the son's friends in Baltimore -- one of many Canadian doctors who have emigrated to the U.S. -- examines the scan and informs him his father will have a much better chance in Baltimore than in Montreal. Remarkably, the father will have none of it: "I voted for socialized health care," he proclaims, "and I'm prepared to suffer the consequences!"
With this line, the father speaks for too many Canadians, who often wrap their national identity in nationalized health care. This is why Canadian politicians have not had the courage to give Canadians more health freedom. But the pain and inhumanity caused by the Canadian system are starting to make even the most nationalistic of us reconsider the amount of control over health services that we've ceded to our government.
The Barbarian Invasions tells us a lot about the consequences of government monopoly health care. The hospitals are poorly managed, the doctors and nurses confused, the unions who really run the show thuggish, the patients all but ignored. The film has sparked a debate in Canada about the role of the state in health care. Any American who thinks health care in the United States would be improved by implementing a single-payer system would learn much from it too.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The Barbarian Invasions, recently released on DVD by Buena Vista Home Video, offers a disturbing vision of state-run medicine. The Canadian film won two awards at the 2003 Cannes Film Festival (best screenplay and best actress) and took home this year's Oscar for best foreign-language film. It is the story of a man with a terminal disease who renews his relationships with his friends and family, especially his adult son. Much of the action takes place in a hospital in Montreal, Quebec, where director and screenwriter Denys Arcand dissects the Canadian health care system.
The film opens with a nun struggling down the corridor of a crowded ward to administer Holy Communion. Patients, health professionals, even electricians, are tripping over each other, packed into an environment of general confusion. And yet there is another floor of the hospital that is completely closed, thanks to a government directive.
The dying man's son is a successful investment banker in London. He's the kind of guy who can wriggle around anything. First he wrangles his way into the hospital's management offices without a pass and corners the manager, who is completely isolated from the chaos outside. He offers her a bribe to get his father moved out of the zoo and into a private space on the empty floor. She quietly takes the bribe but points out that she can do nothing without the hospital employees' union. The son pays off the union boss to prepare a private room on the empty floor. Painters, carpenters, and other workers quickly make it up.
Then, because there is virtually no access to PET (positron emission tomography) scans in Canada, the banker takes his father to Vermont to get one. One of the son's friends in Baltimore -- one of many Canadian doctors who have emigrated to the U.S. -- examines the scan and informs him his father will have a much better chance in Baltimore than in Montreal. Remarkably, the father will have none of it: "I voted for socialized health care," he proclaims, "and I'm prepared to suffer the consequences!"
With this line, the father speaks for too many Canadians, who often wrap their national identity in nationalized health care. This is why Canadian politicians have not had the courage to give Canadians more health freedom. But the pain and inhumanity caused by the Canadian system are starting to make even the most nationalistic of us reconsider the amount of control over health services that we've ceded to our government.
The Barbarian Invasions tells us a lot about the consequences of government monopoly health care. The hospitals are poorly managed, the doctors and nurses confused, the unions who really run the show thuggish, the patients all but ignored. The film has sparked a debate in Canada about the role of the state in health care. Any American who thinks health care in the United States would be improved by implementing a single-payer system would learn much from it too.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, November 22, 2004
CANADIAN COURT REFUSES TO LEGISLATE
SCOTUS should take note
The Supreme Court of Canada refused to elevate health funding to a constitutional right in a ruling that was a stunning setback for families of autistic children asking the state to pay for expensive treatment. The unanimous and unequivocal decision overturned two British Columbia court rulings that found the provincial government violated the Charter of Rights equality guarantees for the disabled. Yesterday's decision will have an impact across Canada, hindering lawsuits in which parents in several provinces are seeking court orders forcing governments to pay for early intervention therapy that costs up to $60,000 per year per child.
The case was considered one of the most significant social policy issues to reach the high court in years. All 10 provinces and Ottawa intervened to warn the judges that governments would need unlimited budgets if health care were to become all things to all people. Constitutional expert Jamie Cameron said that it would have been difficult for the court to carve out an exception for autistic children without exposing the stretched health system to a flood of lawsuits on behalf of people seeking coverage for other disabilities. "The court has shown appropriate institutional caution here in resisting the invitation to constitutionalize the health-care system," said Mr. Cameron, a law professor at York University in Toronto. "Once the precedent is created, it would encourage other claims."
Parents of autistic children are devastated and outraged. At the Supreme Court, Ottawa mother Debbie Barbesin, her eyes filled with tears, wondered how she will continue to pay therapy bills for her eight-year-old son, Dylan. David Sherriff-Scott, an Ottawa lawyer whose autistic son turned 11 yesterday, said the absence of state funding "dooms these children to a life of being marginalized." In Langley, B.C., Sabrina Freeman, mother of 16-year-old Miki, denounced the ruling as "total unadulterated garbage" and chastised the judges for caving in to political pressure. "If my child is not entitled to be part of the health care system, then the government is not entitled to my taxes," she said.
The 7-0 ruling was the culmination of a six-year legal battle begun by four B.C. families after the government refused to fund what is known as Lovaas autism treatment, saying it was "novel, controversial, experimental and not a medically necessary service." The treatment, which has shown dramatic results in some cases, was pioneered in the United States by psychologist Ivar Lovaas in the late 1980s. Autistic children undergo 20 to 40 hours a week of intensive one-on-one therapy that is most effective when a child is young.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
SCOTUS should take note
The Supreme Court of Canada refused to elevate health funding to a constitutional right in a ruling that was a stunning setback for families of autistic children asking the state to pay for expensive treatment. The unanimous and unequivocal decision overturned two British Columbia court rulings that found the provincial government violated the Charter of Rights equality guarantees for the disabled. Yesterday's decision will have an impact across Canada, hindering lawsuits in which parents in several provinces are seeking court orders forcing governments to pay for early intervention therapy that costs up to $60,000 per year per child.
The case was considered one of the most significant social policy issues to reach the high court in years. All 10 provinces and Ottawa intervened to warn the judges that governments would need unlimited budgets if health care were to become all things to all people. Constitutional expert Jamie Cameron said that it would have been difficult for the court to carve out an exception for autistic children without exposing the stretched health system to a flood of lawsuits on behalf of people seeking coverage for other disabilities. "The court has shown appropriate institutional caution here in resisting the invitation to constitutionalize the health-care system," said Mr. Cameron, a law professor at York University in Toronto. "Once the precedent is created, it would encourage other claims."
Parents of autistic children are devastated and outraged. At the Supreme Court, Ottawa mother Debbie Barbesin, her eyes filled with tears, wondered how she will continue to pay therapy bills for her eight-year-old son, Dylan. David Sherriff-Scott, an Ottawa lawyer whose autistic son turned 11 yesterday, said the absence of state funding "dooms these children to a life of being marginalized." In Langley, B.C., Sabrina Freeman, mother of 16-year-old Miki, denounced the ruling as "total unadulterated garbage" and chastised the judges for caving in to political pressure. "If my child is not entitled to be part of the health care system, then the government is not entitled to my taxes," she said.
The 7-0 ruling was the culmination of a six-year legal battle begun by four B.C. families after the government refused to fund what is known as Lovaas autism treatment, saying it was "novel, controversial, experimental and not a medically necessary service." The treatment, which has shown dramatic results in some cases, was pioneered in the United States by psychologist Ivar Lovaas in the late 1980s. Autistic children undergo 20 to 40 hours a week of intensive one-on-one therapy that is most effective when a child is young.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, November 21, 2004
THE LATEST ON TENNCARE
A decade after Tennessee inaugurated a health care plan for the state's most vulnerable residents that was hailed as a model for the nation, the program is once more being held up as a model - of failure in an era of soaring medical costs and voters' aversion to higher taxes. Today the plan, TennCare, which sought to improve health care for Medicaid recipients while covering those who fall through the federal program's cracks, is on the ropes. Gov. Phil Bredesen, a conservative Democrat and former health maintenance organization entrepreneur, has threatened the program with extinction, saying that rising costs and generous benefits - TennCare consumes nearly a third of the state's $25 billion budget - make it unaffordable unless it can be radically restructured to save money and limit benefits.
In the coming year alone, the program faces a potential deficit of $650 million. After more than a week of tense negotiations between the governor and advocates for TennCare's 1.3 million users - nearly a quarter of the state's population, including an estimated 430,000 who would not be covered by Medicaid if TennCare disappeared - the two sides decided to "step back from the brink," as Mr. Bredesen put it. "Before I go down the road of taking 430,000 people off the rolls - more specifically, before I can face even one of them, individually, and tell them that it is over, that I can no longer help - I need to be clear in my own heart that I've done everything that I know how to do to solve this," the governor said. Rather than immediately kill TennCare, as he was poised to do, the governor agreed on Wednesday to one more round of talks after Thanksgiving, though he said saving the program was still a long shot.....
The fate of TennCare has profound national as well as personal implications. Other governors, also under pressure to stem rising health insurance costs, are watching to see whether Tennessee will provide a model for how to trim their own programs.... Created by former Gov. Ned McWherter, TennCare replaced Medicaid for those Tennessee residents not covered by other health insurance on Jan. 1, 1994. As costs for health care and prescription drugs rose steadily in subsequent years, TennCare became a larger and larger portion of the state's budget and a frequent political flashpoint.....
By the time Mr. Bredesen, a former Nashville mayor, ran for governor in 2002, TennCare had become the state's sharpest political thorn, and he won partly by promising to overhaul it. In 2003, the state began phasing in a preferred drug list to cut the cost of prescriptions. On Feb. 17, citing a recent report that TennCare would be $650 million in the hole in 2005, Mr. Bredesen offered what he called a "last chance" to save the program. "We need to face the facts," he said. "We have too many people with too many benefits for the money we have." He said he could come up with a new, permanent TennCare fix that was affordable and fraud-free without cutting benefits for children, pregnant women and the disabled. In May, the Legislature approved the broad outlines of his plan, including a limit of 10 doctor visits per year (later raised to 12) and six prescriptions per month (recently, the governor said that might have to be lowered to four). "What began as a grand vision had become a political scramble to cut the program as fast as possible," said Gordon Bonnyman, head of the Tennessee Justice Center and the leading legal advocate for TennCare recipients.
The program's advocates fought back. In June, Mr. Bonnyman went to federal court to argue that the changes violated four consent decrees he had won over the years that forced TennCare to abide by federal standards in certain crucial areas, like eligibility, home health visits and medical screening for children..... The lines were firmly drawn. On one side was the governor, the Legislature and representatives for doctors, hospitals and drug companies. On the other side were Mr. Bonnyman and other advocates for TennCare's users, like AARP, the Children's Defense Fund and dozens of charities and associations like the Alzheimer's Foundation and the National Mental Health Foundation.
In September, Mr. Bredesen officially requested federal approval of some of the changes he had sought, providing fresh specifics that further troubled the program's advocates. Meanwhile, the governor has grown increasingly vocal about what he calls the advocates' intransigence, and ratcheted up his rhetoric, comparing the health care program favored by Mr. Bonnyman to "a dictator in a glass coffin" and declaring the program he was proposing as "more American." The advocates have also shown a willingness to appeal to emotions. "Certainly, some people will die who would not otherwise have died," if the program is killed, Mr. Bonnyman said. On Nov. 10, attacking the advocacy groups for their persistent lawsuits, Mr. Bredesen said he was ready to give up his overhaul efforts and pull the plug on TennCare.
Mr. Bonnyman asked for more time and the governor said he would continue talking. On Wednesday, just when it appeared that negotiations were stalled for good, Mr. Bredesen invited Mr. Bonnyman to his office for their first one-on-one meeting and, that evening, made his unexpected announcement. "These talks have not gone well, and we are at an impasse," the governor said. "By any reasonable measure, I should say, 'it's over,' and move on." Instead, the governor promised to give it one more try after a vacation and a Thanksgiving holiday.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
A decade after Tennessee inaugurated a health care plan for the state's most vulnerable residents that was hailed as a model for the nation, the program is once more being held up as a model - of failure in an era of soaring medical costs and voters' aversion to higher taxes. Today the plan, TennCare, which sought to improve health care for Medicaid recipients while covering those who fall through the federal program's cracks, is on the ropes. Gov. Phil Bredesen, a conservative Democrat and former health maintenance organization entrepreneur, has threatened the program with extinction, saying that rising costs and generous benefits - TennCare consumes nearly a third of the state's $25 billion budget - make it unaffordable unless it can be radically restructured to save money and limit benefits.
In the coming year alone, the program faces a potential deficit of $650 million. After more than a week of tense negotiations between the governor and advocates for TennCare's 1.3 million users - nearly a quarter of the state's population, including an estimated 430,000 who would not be covered by Medicaid if TennCare disappeared - the two sides decided to "step back from the brink," as Mr. Bredesen put it. "Before I go down the road of taking 430,000 people off the rolls - more specifically, before I can face even one of them, individually, and tell them that it is over, that I can no longer help - I need to be clear in my own heart that I've done everything that I know how to do to solve this," the governor said. Rather than immediately kill TennCare, as he was poised to do, the governor agreed on Wednesday to one more round of talks after Thanksgiving, though he said saving the program was still a long shot.....
The fate of TennCare has profound national as well as personal implications. Other governors, also under pressure to stem rising health insurance costs, are watching to see whether Tennessee will provide a model for how to trim their own programs.... Created by former Gov. Ned McWherter, TennCare replaced Medicaid for those Tennessee residents not covered by other health insurance on Jan. 1, 1994. As costs for health care and prescription drugs rose steadily in subsequent years, TennCare became a larger and larger portion of the state's budget and a frequent political flashpoint.....
By the time Mr. Bredesen, a former Nashville mayor, ran for governor in 2002, TennCare had become the state's sharpest political thorn, and he won partly by promising to overhaul it. In 2003, the state began phasing in a preferred drug list to cut the cost of prescriptions. On Feb. 17, citing a recent report that TennCare would be $650 million in the hole in 2005, Mr. Bredesen offered what he called a "last chance" to save the program. "We need to face the facts," he said. "We have too many people with too many benefits for the money we have." He said he could come up with a new, permanent TennCare fix that was affordable and fraud-free without cutting benefits for children, pregnant women and the disabled. In May, the Legislature approved the broad outlines of his plan, including a limit of 10 doctor visits per year (later raised to 12) and six prescriptions per month (recently, the governor said that might have to be lowered to four). "What began as a grand vision had become a political scramble to cut the program as fast as possible," said Gordon Bonnyman, head of the Tennessee Justice Center and the leading legal advocate for TennCare recipients.
The program's advocates fought back. In June, Mr. Bonnyman went to federal court to argue that the changes violated four consent decrees he had won over the years that forced TennCare to abide by federal standards in certain crucial areas, like eligibility, home health visits and medical screening for children..... The lines were firmly drawn. On one side was the governor, the Legislature and representatives for doctors, hospitals and drug companies. On the other side were Mr. Bonnyman and other advocates for TennCare's users, like AARP, the Children's Defense Fund and dozens of charities and associations like the Alzheimer's Foundation and the National Mental Health Foundation.
In September, Mr. Bredesen officially requested federal approval of some of the changes he had sought, providing fresh specifics that further troubled the program's advocates. Meanwhile, the governor has grown increasingly vocal about what he calls the advocates' intransigence, and ratcheted up his rhetoric, comparing the health care program favored by Mr. Bonnyman to "a dictator in a glass coffin" and declaring the program he was proposing as "more American." The advocates have also shown a willingness to appeal to emotions. "Certainly, some people will die who would not otherwise have died," if the program is killed, Mr. Bonnyman said. On Nov. 10, attacking the advocacy groups for their persistent lawsuits, Mr. Bredesen said he was ready to give up his overhaul efforts and pull the plug on TennCare.
Mr. Bonnyman asked for more time and the governor said he would continue talking. On Wednesday, just when it appeared that negotiations were stalled for good, Mr. Bredesen invited Mr. Bonnyman to his office for their first one-on-one meeting and, that evening, made his unexpected announcement. "These talks have not gone well, and we are at an impasse," the governor said. "By any reasonable measure, I should say, 'it's over,' and move on." Instead, the governor promised to give it one more try after a vacation and a Thanksgiving holiday.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, November 20, 2004
AUSTRALIAN STATE FAILS TO COPE WITH HEALTH NEEDS: BLAMES AGING
And aging is the one problem that was totally predictable -- a problem that should therefore have been easily planned for by our bureaucratic geniuses
"When doctors at St George Hospital switched off Isaac Messiha's life support last Thursday night, it highlighted a much larger issue than the end of one man's life. Welcome to the medical dilemma of the future: in an age of technological breakthrough but seriously limited resources, who will receive help? And who won't? Messiha, 75, suffered a heart attack on October 17 and his family claimed the hospital flicked the switch to free up a bed in intensive care. The hospital denies this. But, hard-hearted or hard-headed, sadly it is a pointer to the future.
Few would argue that the health system is buckling under the strain of coping. Most experts say the onset of the ageing population is to blame. NSW Nurses Association general secretary Brett Holmes told The Sun-Herald: "We are running our health system at 100 per cent occupancy. We have an insufficient bed capacity to deal with the increasing demand." It is no secret that people are living longer and, consequently, requiring more medical care. Everyone predicted the greying population would create a demographic time bomb. What went wrong was that no one correctly estimated when it would explode.
NSW Health Minister Morris lemma admitted to The Sun-Herald that the Government, like many others around the world, had fallen behind the eight ball. And although he plans to "ramp up" the nursing workforce in the next year, the results from his initiatives will not be seen for another two or three years. He hopes to double the number of TAFE places available for enrolled nurses next year and attract more overseas-trained nurses from the US, Canada, Britain, Ireland, the Philippines, Singapore, Hong Kong, Scandinavia and possibly India. He is also trying to tempt nurses who have left the profession back into the workforce. Since 2002,1140 have returned but many are only casual or part-time.
NSW hospitals need about 12,000 extra nurses by 2014 but lemma's main problem is luring workers into a system which appears to be cracking underthe pressure. The workload for nurses has never been greater and it seems each week hospital emergency departments are placed on code red because they are unable to take any more patients. To ensure more beds are available in emergency wards, major public hospitals such as the Prince of Wales, in Sydney's eastern suburbs, are developing programs to "fast track" elderly patients.
When these patients present themselves, they will bypass the normal route and be cared for by a specialist team. About 33 per cent of patients treated in emergency departments are aged over 70. They represent a very special case: often, their first appearance will be the precursor to many more. Sometimes, because of their home circumstances, there is nowhere else for them to go. It is yet to be seen whether the minister's initiatives will alleviate some of the stress. He gets full marks for trying. But is it too little too late?"
The above is an excerpt from an editorial that appeared in the Sydney (Australia) "Sun-Herald" on November 14, 2004
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
And aging is the one problem that was totally predictable -- a problem that should therefore have been easily planned for by our bureaucratic geniuses
"When doctors at St George Hospital switched off Isaac Messiha's life support last Thursday night, it highlighted a much larger issue than the end of one man's life. Welcome to the medical dilemma of the future: in an age of technological breakthrough but seriously limited resources, who will receive help? And who won't? Messiha, 75, suffered a heart attack on October 17 and his family claimed the hospital flicked the switch to free up a bed in intensive care. The hospital denies this. But, hard-hearted or hard-headed, sadly it is a pointer to the future.
Few would argue that the health system is buckling under the strain of coping. Most experts say the onset of the ageing population is to blame. NSW Nurses Association general secretary Brett Holmes told The Sun-Herald: "We are running our health system at 100 per cent occupancy. We have an insufficient bed capacity to deal with the increasing demand." It is no secret that people are living longer and, consequently, requiring more medical care. Everyone predicted the greying population would create a demographic time bomb. What went wrong was that no one correctly estimated when it would explode.
NSW Health Minister Morris lemma admitted to The Sun-Herald that the Government, like many others around the world, had fallen behind the eight ball. And although he plans to "ramp up" the nursing workforce in the next year, the results from his initiatives will not be seen for another two or three years. He hopes to double the number of TAFE places available for enrolled nurses next year and attract more overseas-trained nurses from the US, Canada, Britain, Ireland, the Philippines, Singapore, Hong Kong, Scandinavia and possibly India. He is also trying to tempt nurses who have left the profession back into the workforce. Since 2002,1140 have returned but many are only casual or part-time.
NSW hospitals need about 12,000 extra nurses by 2014 but lemma's main problem is luring workers into a system which appears to be cracking underthe pressure. The workload for nurses has never been greater and it seems each week hospital emergency departments are placed on code red because they are unable to take any more patients. To ensure more beds are available in emergency wards, major public hospitals such as the Prince of Wales, in Sydney's eastern suburbs, are developing programs to "fast track" elderly patients.
When these patients present themselves, they will bypass the normal route and be cared for by a specialist team. About 33 per cent of patients treated in emergency departments are aged over 70. They represent a very special case: often, their first appearance will be the precursor to many more. Sometimes, because of their home circumstances, there is nowhere else for them to go. It is yet to be seen whether the minister's initiatives will alleviate some of the stress. He gets full marks for trying. But is it too little too late?"
The above is an excerpt from an editorial that appeared in the Sydney (Australia) "Sun-Herald" on November 14, 2004
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, November 19, 2004
THAT'S BUREAUCRATIC MEDICINE FOR YOU
Australian hospitals are "underprepared" for an infectious disease outbreak, compromised by limited resources, inadequate training and a lack of co-operation between the states and the commonwealth. According to a highly critical report prepared by the federal Parliamentary Library, there are "major deficiencies" in the emergency health response to the outbreak of infectious disease in the Australia.
While health authorities appear prepared for a single infectious disease outbreak, there are serious questions about how well the "messy" system would work when it came under pressure, particularly against several disease fronts. Experts said that hospitals were not able to deal with a sudden influx of multiple casualties, because of insufficient intensive care facilities. Based on interviews with experts in public health policy and practice between March and May this year, the paper says there is a potentially damaging "tug-of-war" between the commonwealth and states over disease management.....
The respondents also argued that policy-makers with limited public health knowledge were making decisions on critical public health matters with little or no consultation with experts or practitioners in the field.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Australian hospitals are "underprepared" for an infectious disease outbreak, compromised by limited resources, inadequate training and a lack of co-operation between the states and the commonwealth. According to a highly critical report prepared by the federal Parliamentary Library, there are "major deficiencies" in the emergency health response to the outbreak of infectious disease in the Australia.
While health authorities appear prepared for a single infectious disease outbreak, there are serious questions about how well the "messy" system would work when it came under pressure, particularly against several disease fronts. Experts said that hospitals were not able to deal with a sudden influx of multiple casualties, because of insufficient intensive care facilities. Based on interviews with experts in public health policy and practice between March and May this year, the paper says there is a potentially damaging "tug-of-war" between the commonwealth and states over disease management.....
The respondents also argued that policy-makers with limited public health knowledge were making decisions on critical public health matters with little or no consultation with experts or practitioners in the field.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, November 18, 2004
PRIVATE MEDICINE DELIVERS IN INDIA
What a piece of work is India! I have just returned from Mumbai, reeling from the collision of first with third worlds. I had rushed to Santa Cruz, a smart suburb of Mumbai, to be by my father's bedside at a hospital with the worryingly old-fashioned name of the Dr Dadubhai Saraswati Hospital. My father had suffered a heart attack and was undergoing tests to establish what needed to be done.
In times past, we would have flown him to some private hospital in London, where he would have had the latest technology at his disposal and we could confidently expect a moonlighting and highly qualified NHS cardiologist to carry out the operation. No more. India is awash with cardiologists and surgeons. The country that has stuffed every global corporation with IT experts and accountants is also producing medical specialists by the thousands. Mumbai has hospitals full of world-class surgeons, scalpels at the ready.
So, Dr Dadubhai Saraswati Hospital it is. Mongrel dogs and their puppies are in the hospital compound. The monsoon has ensured that everywhere is splattered with mud and dirt. And dozens and dozens of people crowd the entrance. I am shown the way to the intensive-care unit. Nothing could be more different from the scene I've left behind. The hum of air-conditioning heralds a spanking-clean waiting room. No mosquitoes, no flies, just quiet efficiency. There is a video screen in the corner that responds to touch commands. I type in my father's name. Up comes all sorts of information - the name of the doctor in charge, his room number, and not just the day and date of my father's admission but the precise time: 10.44.50. The people at the reception are courteous. They tell me that visiting hours are from 10 to 11 in the morning. As it is 9.45am, we should be able to see him shortly. All this, and no money has exchanged hands. Modern, secular, corruption-free India is here at last!
The next few days pass with a surprising orderliness. Guards closely manage the waiting room, ensuring that no more than two people are allowed in at any one time. Bags are checked - not for suspect terrorist equipment but to remove any food and drink from visitors. Indians, given half a chance, will bring out their home-made chapattis and tiffin boxes anywhere and at any time. But Dr Saraswati was wise to this and has banned such behaviour.
We meet many times with the surgeon. It would be hard to come across a more urbane, sophisticated man. He answers our questions with practised ease. More than that: he fills us with confidence. He is one of India's top surgeons and charges a pretty packet, but he is right up-to-date with the latest in surgical techniques. And he is planning to perform the operation using a new technique called "beating heart" surgery. It turns out (as we discover later that night surfing the internet) that this method does what it says on the tin: namely, keeps the heart beating while the operation is under way. It replaces the more conventional method in which the heart is stopped and blood diverted through a heart-and-lung bypass machine, then artificially pumped back around the body. Just two years ago, the BBC was reporting the trials of this technique at the Bristol Royal Infirmary. Now our man in Mumbai is going to use it on my father.
The surgeon's account of what he will do is so assured and stated with such conviction that we consent. The date for the operation is set. We all meet again three days prior to the operation. One of the surgeon's assistants informs us that he will need five pints of blood. Jolly interesting information, I think to myself. But I am missing the point. We are to provide the blood. I'm sorry? Yes. Apparently it's our job to provide fresh blood for the operation. Hospitals do have their own supplies but they are limited and could be stale. Suddenly, we are back to third-world reality. India does not have an effective blood donor system. The whole business takes me aback - but my sister immediately starts sending text messages to all her friends to find out (a) who is B+ and (b) whether they are ready to give a pint for her father. All sorts of people reply. The good news is that everyone seems to know his or her blood type. But some are recovering from an illness; others are away. One text simply says "me, me, me, me - please let it be me". By that night, three have agreed. In the morning, two more come forward. The blood is given and tea and biscuits handed out. Even better news comes the next day - all the blood is "good".
Come the day of the operation, we all head for the hospital. It's going to be a six-hour operation starting at 10am. We arrive by 9am with no thought other than to be around as the surgery progresses. We rest content in the knowledge that, here in the stiflingly damp heat of the monsoon, my father is in the hands of a surgeon as good as anyone in the world, carrying out an operation at the cutting edge of cardiac surgery. Within minutes of our arrival, a very typical Indian commotion disturbs the calm of the intensive-care unit waiting room. The word "platelet" is bandied about a lot. Apparently, the surgeon wants six platelets to be ready by 11.30. I do not have a clue what a platelet is. (Dictionary definition: "Platelets are one of the three types of blood cells, along with red and white blood cells. Platelets are small and sticky and their job is to prevent bruising and stop bleeding after an injury.")
The trouble turns out to be that Dr Dadubhai Saraswati Hospital doesn't have any platelets of its own. It might have the latest high-tech equipment in the operating theatre but its blood banks do not have "platelets". A nearby hospital - 30 minutes in Mumbai traffic - apparently does. Whose job, though, is it to collect them from the other hospital? No one seems to know the answer. But now somebody has to go. Once again, members of my family come to the rescue. Of course, we cannot just go and collect them. We need a form, signed in triplicate by an official of the hospital. It is now 9.45am. The operation is about to start. In the cubicle where the official sits, we are told to sit down and wait. The official is deep in discussion with someone else. My sister translates the conversation for me. They are talking about the merits of particular taxi services and making arrangements for the transportation of some patient in about two weeks' time. Any attempt at pushing this along is met with a stony glare and an implication that the taxi conversation could go on for a good deal longer if we don't do as we were told. The official merely shrugs when told that the surgeon has requested the platelets by 11.30am.
My brother goes back to the intensive-care unit to persuade someone to call the platelet official. The call is made and the official finally looks up at us, scribbles something down and instructs us to go to the next office. It takes her precisely 30 seconds. In the next room, two girls are painting their nails. Some slightly hysterical conversations later, we receive the forms. We need to copy them but, it transpires, Dr Dadubhai Saraswati Hospital does not possess a photocopying machine. One of my cousins, wise in the ways of Mumbai street traders, rushes out into the main road, finds a kiosk that makes photocopies and returns within minutes.
A frantic journey ensues through traffic-laden Mumbai streets. Mercifully, the hospital with the platelets delivers the precious blood cells with speed and efficiency. The car races back to deliver the platelets to the operating theatre. By the evening, the operation is over. It turns out my father needed a triple heart bypass. A little later, the surgeon comes to see us in a scene familiar to viewers of all medical soap operas. But it is good news. He is very happy with the way the operation has gone. Now, it's up to my father. The next 72 hours are critical. He is in the post-operative intensive-care unit. A video screen is set up for us and a camera placed in front of my father's bed. We can see him: knocked out and full of tubes coming out of every part of his body. But there he is. And within days he is able to speak to us through the video screen.
Today, my father is back at home, just ten days after his operation. I am back in England. Oh, one last thing. When it came to paying our suave and sophisticated surgeon his fee, how did he wish to be paid? Cash, of course. Some things will never change.
This article by Samir Shah first appeared in the "New Statesman" of November 15, 2004 under the title "A Bollywood hospital saga"
Florida: Judge blocks "bad doctor" amendment: "A judge Monday temporarily halted a new state constitutional amendment that would yank the licenses of doctors who commit three acts of medical malpractice, saying that some specifics need to be spelled out before it takes effect. Circuit Judge Janet E. Ferris agreed in part with hospitals that sued seeking to block the amendment from taking effect until some aspects of it can be clarified, most likely by the Legislature when it meets in the spring, or by the courts."
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
What a piece of work is India! I have just returned from Mumbai, reeling from the collision of first with third worlds. I had rushed to Santa Cruz, a smart suburb of Mumbai, to be by my father's bedside at a hospital with the worryingly old-fashioned name of the Dr Dadubhai Saraswati Hospital. My father had suffered a heart attack and was undergoing tests to establish what needed to be done.
In times past, we would have flown him to some private hospital in London, where he would have had the latest technology at his disposal and we could confidently expect a moonlighting and highly qualified NHS cardiologist to carry out the operation. No more. India is awash with cardiologists and surgeons. The country that has stuffed every global corporation with IT experts and accountants is also producing medical specialists by the thousands. Mumbai has hospitals full of world-class surgeons, scalpels at the ready.
So, Dr Dadubhai Saraswati Hospital it is. Mongrel dogs and their puppies are in the hospital compound. The monsoon has ensured that everywhere is splattered with mud and dirt. And dozens and dozens of people crowd the entrance. I am shown the way to the intensive-care unit. Nothing could be more different from the scene I've left behind. The hum of air-conditioning heralds a spanking-clean waiting room. No mosquitoes, no flies, just quiet efficiency. There is a video screen in the corner that responds to touch commands. I type in my father's name. Up comes all sorts of information - the name of the doctor in charge, his room number, and not just the day and date of my father's admission but the precise time: 10.44.50. The people at the reception are courteous. They tell me that visiting hours are from 10 to 11 in the morning. As it is 9.45am, we should be able to see him shortly. All this, and no money has exchanged hands. Modern, secular, corruption-free India is here at last!
The next few days pass with a surprising orderliness. Guards closely manage the waiting room, ensuring that no more than two people are allowed in at any one time. Bags are checked - not for suspect terrorist equipment but to remove any food and drink from visitors. Indians, given half a chance, will bring out their home-made chapattis and tiffin boxes anywhere and at any time. But Dr Saraswati was wise to this and has banned such behaviour.
We meet many times with the surgeon. It would be hard to come across a more urbane, sophisticated man. He answers our questions with practised ease. More than that: he fills us with confidence. He is one of India's top surgeons and charges a pretty packet, but he is right up-to-date with the latest in surgical techniques. And he is planning to perform the operation using a new technique called "beating heart" surgery. It turns out (as we discover later that night surfing the internet) that this method does what it says on the tin: namely, keeps the heart beating while the operation is under way. It replaces the more conventional method in which the heart is stopped and blood diverted through a heart-and-lung bypass machine, then artificially pumped back around the body. Just two years ago, the BBC was reporting the trials of this technique at the Bristol Royal Infirmary. Now our man in Mumbai is going to use it on my father.
The surgeon's account of what he will do is so assured and stated with such conviction that we consent. The date for the operation is set. We all meet again three days prior to the operation. One of the surgeon's assistants informs us that he will need five pints of blood. Jolly interesting information, I think to myself. But I am missing the point. We are to provide the blood. I'm sorry? Yes. Apparently it's our job to provide fresh blood for the operation. Hospitals do have their own supplies but they are limited and could be stale. Suddenly, we are back to third-world reality. India does not have an effective blood donor system. The whole business takes me aback - but my sister immediately starts sending text messages to all her friends to find out (a) who is B+ and (b) whether they are ready to give a pint for her father. All sorts of people reply. The good news is that everyone seems to know his or her blood type. But some are recovering from an illness; others are away. One text simply says "me, me, me, me - please let it be me". By that night, three have agreed. In the morning, two more come forward. The blood is given and tea and biscuits handed out. Even better news comes the next day - all the blood is "good".
Come the day of the operation, we all head for the hospital. It's going to be a six-hour operation starting at 10am. We arrive by 9am with no thought other than to be around as the surgery progresses. We rest content in the knowledge that, here in the stiflingly damp heat of the monsoon, my father is in the hands of a surgeon as good as anyone in the world, carrying out an operation at the cutting edge of cardiac surgery. Within minutes of our arrival, a very typical Indian commotion disturbs the calm of the intensive-care unit waiting room. The word "platelet" is bandied about a lot. Apparently, the surgeon wants six platelets to be ready by 11.30. I do not have a clue what a platelet is. (Dictionary definition: "Platelets are one of the three types of blood cells, along with red and white blood cells. Platelets are small and sticky and their job is to prevent bruising and stop bleeding after an injury.")
The trouble turns out to be that Dr Dadubhai Saraswati Hospital doesn't have any platelets of its own. It might have the latest high-tech equipment in the operating theatre but its blood banks do not have "platelets". A nearby hospital - 30 minutes in Mumbai traffic - apparently does. Whose job, though, is it to collect them from the other hospital? No one seems to know the answer. But now somebody has to go. Once again, members of my family come to the rescue. Of course, we cannot just go and collect them. We need a form, signed in triplicate by an official of the hospital. It is now 9.45am. The operation is about to start. In the cubicle where the official sits, we are told to sit down and wait. The official is deep in discussion with someone else. My sister translates the conversation for me. They are talking about the merits of particular taxi services and making arrangements for the transportation of some patient in about two weeks' time. Any attempt at pushing this along is met with a stony glare and an implication that the taxi conversation could go on for a good deal longer if we don't do as we were told. The official merely shrugs when told that the surgeon has requested the platelets by 11.30am.
My brother goes back to the intensive-care unit to persuade someone to call the platelet official. The call is made and the official finally looks up at us, scribbles something down and instructs us to go to the next office. It takes her precisely 30 seconds. In the next room, two girls are painting their nails. Some slightly hysterical conversations later, we receive the forms. We need to copy them but, it transpires, Dr Dadubhai Saraswati Hospital does not possess a photocopying machine. One of my cousins, wise in the ways of Mumbai street traders, rushes out into the main road, finds a kiosk that makes photocopies and returns within minutes.
A frantic journey ensues through traffic-laden Mumbai streets. Mercifully, the hospital with the platelets delivers the precious blood cells with speed and efficiency. The car races back to deliver the platelets to the operating theatre. By the evening, the operation is over. It turns out my father needed a triple heart bypass. A little later, the surgeon comes to see us in a scene familiar to viewers of all medical soap operas. But it is good news. He is very happy with the way the operation has gone. Now, it's up to my father. The next 72 hours are critical. He is in the post-operative intensive-care unit. A video screen is set up for us and a camera placed in front of my father's bed. We can see him: knocked out and full of tubes coming out of every part of his body. But there he is. And within days he is able to speak to us through the video screen.
Today, my father is back at home, just ten days after his operation. I am back in England. Oh, one last thing. When it came to paying our suave and sophisticated surgeon his fee, how did he wish to be paid? Cash, of course. Some things will never change.
This article by Samir Shah first appeared in the "New Statesman" of November 15, 2004 under the title "A Bollywood hospital saga"
Florida: Judge blocks "bad doctor" amendment: "A judge Monday temporarily halted a new state constitutional amendment that would yank the licenses of doctors who commit three acts of medical malpractice, saying that some specifics need to be spelled out before it takes effect. Circuit Judge Janet E. Ferris agreed in part with hospitals that sued seeking to block the amendment from taking effect until some aspects of it can be clarified, most likely by the Legislature when it meets in the spring, or by the courts."
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Subscribe to:
Posts (Atom)