Saturday, December 31, 2005

MORE PUBLIC HOSPITAL NEGLIGENCE

'Dead' man found alive in morgue

A 95-year-old man was moved from a hospital morgue in Portugal to a care unit after he was heard coughing several hours after a doctor declared him dead, Portuguese media reported today.

Family members called an ambulance to bring Manuel Lino to a public hospital in the town of Abrantes, some 120km northeast of Lisbon, on December 1 because he was not feeling well, daily Jornal de Noticias said. When Lino arrived at the hospital the doctor who examined him inside of the ambulance said he could not find a pulse and ordered his body sent to the morgue, it added. "With great pain we left him there and returned home where we started preparing the funeral," Lino's stepson-in-law, Joao Baco, told the paper.

Later that same day the family received a telephone call from an emergency services worker informing them that Lino was alive after all, Baco said. "We can't understand how someone can make a mistake like this, causing so much pain to a family," he added.

Lino, who was bedridden before being taken to the hospital, was discharged on December 7 and spent Christmas with his family, Baco said. Hospital officials said they had opened an inquiry into the incident.

Source





WHY MOST AUSTRALIANS USE PRIVATE DENTISTS

Waiting times for Queensland's public dental services have been described as "atrocious", with some patients waiting up to five years for a basic check-up, according to the Australian Dental Association. And the continuing inability to attract staff will mean that significant funding increases by the state government would be unlikely to alleviate waiting times.

ADA Queensland immediate past president Dr Michael Foley, who works as a public sector dentist for Queensland Health, said the average length people were waiting for basic services was greater than three years. "At Logan it is five years. Where I used to work at Inala it is 4« years. South Brisbane, where I currently am, it is four years," Dr Foley said. "These are people we are getting off the waiting list to do check ups, fillings, basic cut and polishes. This is simply unacceptable - it is atrocious. We all know anything in public health there is going to involve waiting lists - our patients accept that. But to be waiting that long is an abrogation of responsibility by the State Government."

Figures provided by Queensland Health and Health Minister Stephen Robertson confirm Dr Foley's claim on the length of times people were waiting for public dental services. But Queensland Health claimed that the average wait decreased by 11 weeks between July 2004 and November 2005 and that patients requiring emergency care were generally seen within 24 hours. In response to a question on notice regarding the Gold Coast's Palm Beach Dental Clinic, Mr Robertson admitted the numbers of patients being seen had declined. "In 2003-04 there were 9901 occasions of service provided by the Palm Beach Oral Health Clinic. In 2004-05 there were 8773 occasions of service provided by the Palm Beach Oral Health Clinic," Mr Robertson said.

Dr Foley said many young dentists were going into private practice where they could get significantly better pay and conditions than working for Queensland Health. Dr Foley said young dentists working in the public sector were faced with doing very basic dental work, while their colleagues in private practice could perform a greater range of dental services to develop their skills. He said government funding increases would not offset the problem. "They can pour as much money in it as they want, but if we can't recruit the staff we won't be able to see the patients," Dr Foley said. "Dentistry has changed in last 20 to 30 years, but government dentistry hasn't and dentists are voting with their feet. They are fed up with angry patients who are fed up with having to wait for years."

Opposition Health spokesman Dr Bruce Flegg said public dental services in Queensland were "over-stretched and virtually inaccessible for the majority of Queenslanders". "They are another example of making unmet promises to people instead of telling them the true status of the services," he said.

Source

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Friday, December 30, 2005

MORE GLORIES OF PUBLIC MEDICINE IN NEW ZEALAND

Repeated negligence leads to death

Wellington Hospital junior doctors told a dying Napier student to walk home to the Newtown flat where her body was found a day later, an inquest has found. Cassandra (Cassie) Ann Laurent, 19, was found dead by flatmates at her Newtown home on July 25, 2003.

Wellington coroner Garry Evans found the talented graphic art student died of pneumonia after a series of oversights by unsupervised junior doctors. Cassie had been discharged from Wellington Hospital's emergency department three times in the six days leading up to her death. Each time, she showed worsening flu-like symptoms and stiffness in her limbs and neck. On her first visit to the emergency department, a chest X-ray revealed lung abnormalities pointing to pneumonia. But the film was not read by a radiographer until the day Cassie died and a report was not made available to emergency staff until four days after.

Wellington coroner Garry Evans found that all four doctors who examined Cassie were juniors, not one of whom sought a reading of the X-ray or an opinion from senior staff. The court heard that the first doctor to examine the young woman considered a diagnosis of pneumonia but did not prescribe any antibiotics for it because the X-ray "looked normal" to her.

The inquest was told that even if Cassie had been prescribed antibiotics on her third visit, on July 23, there was a very good chance she would have survived anyway. Instead, she was kept overnight before deciding she felt better and was left to walk home after being discharged by another junior doctor.

Today, Cassie's uncle and godfather Mark Laurent expressed anger at the hospital's actions. "They made her walk home so she could curl up in bed and die. "Her lungs at that point were consolidating, going hard." One doctor had not even consulted Cassie's electronic file, stored within the hospital's computer, a decision which probably cost Cassie her life. "He didn't even bother to read her notes, and the first doctor had put 'possible pneumonia' in her file."

Cassie was "no dummy", Mr Laurent said. She would have known she was dying but respected the opinions of doctors who said she was okay....

Experts told the inquest raised concerns that, despite Cassie's worsening condition, no-one asked for a second chest x-ray. More experienced doctors were likely to have diagnosed and treated her pneumonia.

Mrs Laurent said her daughter had died because of simple failures and vowed to take legal action so that further deaths could be prevented. "In this day and age and with the technology, it's just unbelievable they didn't read her X-rays in time. The health system is a bit of a joke. "The whole crux of it is; who let her die? Someone has to be held accountable. "Those four doctors - are there repercussions for them? "They'll walk away and think: 'Thank God that's over'. But what about next time?"

One junior doctor told the inquest a four to five-day wait for films to be read was not unusual....

More here

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Thursday, December 29, 2005

AN INTERESTING EMAIL FROM THE RICH COAST

A reader writes:

I read with much interest your blog on Socialized Medicine today about the Canadian system of health care. I can say, from experience, that there are good and bad things about socialized medicine.

I live in Costa Rica where everyone is guaranteed medical treatment. They have a system called the "Caja" that allows medical treatment to everyone and a family plan costs very little, but if you have an income you are required to pay. My wife and I, being from the United States can take advantage of this system and we pay about $US12 per month for a voluntary plan. We don't pay the additional amount for retirement as the Costa Ricans would pay but that would only add an additional $3 or 4 a month to the payments. Where the minimum monthly income is around $200 per month this is quite reasonable and those who can't afford to pay can apply to receive the service gratis. They make up much of the difference between the cost of medical care and the amount charged by charging employers approximately 30% of their workers wages for a complete plan where the employer is obligated to pay 21 of the 30% and the employee 9%. Being that the 9% is somewhat more expensive than the voluntary amount many workers prefer to have their own insurance and the employer doesn't mind considering the savings and usually will give the worker the additional money to pay for the voluntary plan. This doesn't help the financial status of the system and is against the law but being very hard to control is a common practice. Insurance with the Caja also doesn't insure for instances of injury on the job, this is another insurance!

In addition to the "Caja", an employer also has to purchase insurance from the national insurance company (INS) for any work related injuries but for each worker this is only about $80 a year and is well worth the cost. Treatment is given at an INS clinic and medications are provided by private pharmacies at no cost to the insured. Private pharmacies carry a much wider range of medications than those available through the Caja hospitals. Private health insurance is also available through INS for individuals and for my wife and I, both being in our early 60s the cost is a little more than $500 each a year. With this insurance we can obtain full coverage at any private facility in the country.

With the Caja you can elect to use a private physician who can prescribe treatment and medications through the Caja so you can bypass the long waiting lines at the Caja clinics, receive immediate medical attention and then any extensive tests or medications can be received from the Caja at no cost. A regular doctor's visit to a private physician who is recognized by the Caja usually costs about $15 per visit. To be recognized by the Caja a Dr. has to give a certain amount of time each week to the local Caja hospital and mine gives two evenings a week of four hours to the emergency room. All doctors who work for the Caja also have private practices so this benefits all.

The major problem with the Caja is much as it is in Canada. They try and keep all costs low and this is only detrimental to the patient. The system is slow and the waiting rooms are packed with patients waiting for appointments. The Caja hospitals truly resemble third-world facilities and the people working there care little about the discomfort of the patients. There is also little communication between the hospitals and the referring physicians!

In October of 2004 I was experiencing severe chest pains on an intermittent basis and went to my doctor for an examination in the nearest town of Turrialba. He discovered that I had acid reflux and within a month of taking medication the problem was resolved. Unfortunately, an x-ray taken for the examination revealed a spot in the upper lobe of my right lung that was of considerable concern. I was admitted to the local hospital and taken to another hospital some distance away in San Jose for a cat scan in early December of that year, having to wait for a slot that was available to my local hospital. I then waited until February for the results of the cat scan to finally be forwarded to my doctor who then referred me to a pulmonary specialist in yet another town, Cartago, in another hospital. After being examined by this doctor I was scheduled for a bronchioscope and as this doctor performed the procedure it was relatively timely, only a few days after the original appointment. Then, I was referred back to the hospital in San Jose to speak with a surgeon about having a biopsy on the suspected nodule. It was now April of 2005 and I was told that as soon as a bed in surgery was available that they would call me.

In July the hospital in San Jose had a fire and the surgical recovery facility was destroyed! Being with the Caja this was the only hospital that was authorized to admit me due to the location that I live, although several others could have performed the biopsy.

In August I had a follow-up appointment with my pulmonary specialist and he was considerably belligerent that nothing had as yet been done towards having the biopsy. I should note at this point that all prior tests were proving negative as to having a malignant nodule but nothing was positive. There had also been no notable growth in the nodule. He immediately made contact with the hospital in San Jose and they no longer had me on the list for a bed as they were only taking emergency patients so had purged all other lists. Then he contacted another surgeon with whom I received an appointment with in just a few days and I was given the option of continuing with the Caja (where he guaranteed me that I would get immediate treatment) or going to a private hospital for the procedure. The difference was that through the Caja, which is severely restricted on available equipment, I would have had to had open chest surgery and with the private clinic the procedure could be done with a probe and only would require open chest surgery were the nodule malignant. Also, with the Caja the biopsy results would take fourteen days, possibly requiring another surgery to remove the lobe, and with the private clinic the results would be immediate. I didn't know about the private INS insurance at the time and would have to absorb the total cost of the operation but elected to go the private route.

Two weeks later after a one week trip to the US, and at the cost of $6, 034, I was home recovering knowing that the nodule had been benign. The surgery, food, and care provided by Clinica Cima was without parallel. For this instance it was a bit late but we now have the private insurance through INS!

Socialized medicine has it's place in poor countries where many can't afford even remedial care but in affluent societies it just creates more bureaucracies and the actual cost to the taxpayer should be seriously evaluated before any country embarks upon such a plan. It should also be considered if you wish the government to have control of this much of the counties GNP which was estimated at 14% when the Clinton government was trying to institute Socialized medicine in the US.

I won't even elaborate on the graft which diminishes the available services for which one past president of Costa Rica is now under investigation and house arrest.

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Wednesday, December 28, 2005

THE MYTH OF HEALTH INSURANCE

Prepare for a bit of brain strain below as Arnold Kling applies economic thinking to health insurance and concludes that few people want real health insurance. What they want is a freebie that someone else pays for. I think he is a bit too cynical but agree that the only realistic way to prevent free-riders is to mandate that everyone contribute to some health insurance scheme or other -- as is already done in Australia

Policy pundits are unhappy with the state of health insurance. What is the problem? After considering some alternative theories, I believe that the best explanation is simply that most people do not want health insurance. The cost of health insurance has been rising, leading to well-publicized problems in the employer-provided health insurance system and increasing numbers of uninsured. But blaming insurance companies for that is like saying that the calories in a double-fudge chocolate cake are all in the icing. The cake of health care expenses consists of health care services -- doctor visits, surgeries, and all the rest. The icing consists of health insurance -- administrative costs, profits and all that. In dollar terms, the icing represents less than ten percent of the iced cake.

Many proposals to reform health care finance mistake the icing for the whole cake. They act as if the cost problem is concentrated in health insurance per se, rather than the medical system as a whole. They make proposals to change the system of icing in various ways, with the most dramatic proposal being single-payer health care, with the government providing people with health insurance. The reality is that re-doing the icing will not have much effect on the cake, as the icing is not the reason that the cake has so many calories.

On the Left, the arguments runs: Europeans have lower per capita spending on health care than Americans. Europeans have much more of their health care paid for by government than Americans. Therefore, we could lower our spending on health care by switching to single-payer health insurance. However that is like saying that because a fruit cup topped with powdered sugar has lower calories than double-fudge chocolate cake topped with icing, that we could have a low-caloried dessert by replacing the icing on the cake with powdered sugar. Consider this list of factors that affect the cake of health care costs.

* health insurance industry greed
* health insurance industry paperwork, inefficiency, and overhead
* asymmetrical information in the health care market (see below)
* premium medicine -- expensive specialists and medical equipment

All of these factors are present, and they all contribute to the calories in the cake. But when we talk about the breakdown of the health insurance market, we need to ask: why now? Have insurance company executives become greedier in recent years? Have they become less and less efficient? Have information asymmetries increased? Has there been an increase in specialization and use of high-tech medical equipment?

The first three possibilities are dubious, at best. But the fourth explanation holds up pretty well. For example, since 1975, we have more than quadrupled the number of gastroenterologists, pulmonologists, and diagnostic radiologists. Since 1980, the annual number of CT scans has grown from less than 4 million to more than 50 million and the annual number of MRI's has grown from 0 to close to 25 million.

Or consider the "natural experiment" of Medicare and Medicaid, which is a much thinner layer of icing according to New York Times columnist Paul Krugman and other advocates of single-payer health care. If the icing really is thinner, and if the icing is a big factor in the total calories of the cake, then total health care spending under Medicare and Medicaid should be noticeably lower than spending under private insurance, after controlling for population characteristics. Instead, if one uses other OECD countries as a control group, our spending on the elderly is as excessive relative to other countries as is our spending on those without private insurance. In fact, Medicaid and Medicare, which together cover less than half the U.S. population, absorb a higher proportion of our GDP than many other countries' single-payer systems that cover their entire population.

Massachusetts Governor Mitt Romney has a proposal to reform health insurance in his state. One interesting fact about Massachusetts is that per capita health care spending there is more than 20 percent above the national average of over $5000 per person. Do you suppose that is because insurance companies are greedier or more inefficient in Massachusetts than in other states? Or could it be because Massachusetts is home to top-flight medical schools and world-class hospitals, giving it an unusually high number of specialists per capita as well as plenty of high-tech equipment? I suspect the latter, in which case Governor Romney's proposal to tinker with the icing will probably not work.

Krugman has pointed out, correctly, that 5 percent of the population accounts for 50 percent of health care spending. This suggests that in a health insurance pool, the sickest 5 percent could have their expenses paid by everyone else. In any given year, 95 percent of people would not be paid claims, but the sickest 5 percent would receive payments from health insurance.

The catch is that the cutoff for being in the sickest 5 percent is $10,000 of health expenditures. Real health insurance would have a deductible of $10,000 per person, so that the other 95 percent of people would not receive any money. Do you think that politicians will propose single-payer health insurance with a $10,000 deductible? Don't hold your breath. We do not observe insurance policies with $10,000 deductibles in the market. There are two possible explanations for this:

* asymmetrical information
* people do not really want insurance

The asymmetrical information story is that people know too much, relative to insurance companies, about their risk of requiring expensive care. As Tim Harford puts it in The Undercover Economist:

"the insurance company only sells insurance to people who are confident they will use it. As a result, the insurer loses clients who are unlikely to make claims and acquires the unwanted clients who are likely to make costly claims, and then the insurer has to cut back on benefits and raise premiums...More and more people cancel their policies... The curious conclusion, which is obvious in retrospect, is that an insurance policy depends on mutual ignorance."

This is a clever story, due originally to Nobel Laureate Joseph Stiglitz and much beloved in the economics profession, for why health insurance markets might break down. The very term "asymmetrical information" is esoterically cool. For example, it is the title of one of the best economics blogs around. In reality, however, when it comes to forecasting our health care needs, consumers and insurance companies operate in an environment that more closely resembles mutual ignorance than asymmetrical information. Mark Pauly and Bradley Herring, who, unlike the many armchair theoreticians, have examined actual health insurance markets, find that insurance companies can pool risks reasonably well.

Recently, Alex Tabarrok commented on a number of markets where economists like to trumpet information asymmetries. His conclusion is that real people and real markets have found solutions to prevent the "adverse-selection death spiral."

What we are left with, then, is that people do not want real health insurance. I would gladly take a health insurance policy with a $10,000 deductible per individual, and I suspect that many of my wise, risk-averse TCS readers would, too. But we are in a tiny minority! Most people do not want to be responsible for the first $10,000 in medical expenses, and most people believe that an insurance policy that is expected to pay no claims 95 percent of the time is a bad deal.

I am willing to claim that no insurance market in history ever arose because of spontaneous demand on the part of consumers. Maritime insurance, which was one of the first forms of insurance, was demanded by creditors as a condition for lending money to shippers. Life insurance also initially arose to meet the needs of creditors who were lending money to pensioners. Homeowners' insurance is standard because it protects mortgage lenders. Collision insurance for autos is optional if you own yours free and clear, but not if you still owe money to the finance company. William Tucker is right. For the most part, people buy insurance because it is mandated by others. Insurance does not have a large natural market.

What we call health insurance also arose to meet the needs of creditors. In this case, the creditors were doctors and hospitals, who wanted assurance that they would be paid for service. Comprehensive, first-dollar health coverage, which is not really health insurance, protects suppliers, not consumers.

During World War II, employers entered the picture. According to Milton Friedman, they offered health care benefits instead of wage increases, because the latter were capped by wartime controls. My strong suspicion is that people like health insurance as it exists today because they mistakenly believe that they are getting something for free.

Tucker argues that government should mandate a low-premium, high-deductible health care policy. (In the Romney plan for Massachusetts, the only way to avoid such a mandate is to post a $10,000 "bond" that guarantees that you will pay your medical bills.) Ironically, this is a relatively libertarian proposal. It is relatively libertarian because the only realistic alternative is for government to continue to provide and/or subsidize the comprehensive "insurance" that is prevalent today.

In fact, I think that Americans are too mentally ill to accept a proposal as sensible as mandatory catastrophic health insurance. We will continue to act as if health care is something that should be paid for only by someone else, never by oneself. We will forever be demanding the double-fudge chocolate cake, and expecting someone to come up with a way to get rid of the calories by messing with the icing. In that sense, mandatory catastrophic health insurance would be just one more attempt to mess with the icing. However, it might get people to pay attention to the calories that are in the cake.

Ultimately, I believe that America could use a commission to provide more information about the calories in the cake of modern medicine. In other words, consumers need data on the costs and benefits of various medical protocols. But as long as consumers are insulated from cost by the so-called health insurance that exists today, there is no incentive for them to pay attention to such data.

Source

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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 27, 2005

A Deficient Monopoly: Canadian health-care - nothing close to paradise

Canada's universal-health-care system has long been a darling of the nanny-state Left. Its stated purpose, jealously touted by swooning cohorts of compassion from coast to coast, is to provide free and equal health care for all, regardless of ability to pay. In practice, sadly, this high-minded endeavor has hit a few snags. The pesky fetters of reality have imposed stingy budget constraints on the enterprise, while the promise of free service for all has increased the demand for treatment. The Canadian government has thus struggled to treat more patients while spending as sparingly as possible on each of them, causing waiting lists to swell and the quality of care to sag. Not helping matters have been some medical professionals, who have fled the public system in search of better compensation. With shaking heads and sullen spirits, everyone involved agrees: It's just not fair.

Now, with a national election shaping up for the end of January, Canadians are wondering how they will finally mend their creaking structure of social justice. The nation's politicians have worked themselves up into their usual frenzy of health-care debate. But this time, a new blip has appeared on the radar screen - in the form of Jacques Chaoulli, a 53-year-old French Canadian physician who in June won a health-care-related lawsuit against the government of Quebec. Chaoulli had alleged that the province's regime of restrictive health-care regulations was oppressive to the point of illegality, and the Canadian Supreme Court ultimately agreed. Chaoulli's story is interesting not only in its own right, but also for the light it sheds upon the strange politics of the country to our north (and to our left).

HEAL THYSELF

Before filing his lawsuit, Dr. Chaoulli had been practicing medicine in Canada for years. At one time, he was in the practice of making house calls to some of his more enfeebled patients who found it difficult to leave their homes. He had even converted his personal car into a sort of makeshift ambulance for emergency situations. "I bought a siren and got an emergency driver's license," he says. But the good doctor's intrepid spirit did not win him many friends among his fellow physicians. At the time, all doctors in Canada labored under a law that capped the amount of income a doctor could receive for his public services over a defined period of time. Because doctors were paid by the government, and the government was trying to control costs, it had set the income cap fairly low. Low enough, anyway, so that most doctors could easily reach the cap without having to expend too much energy by doing things like making house calls and working extra hours.

Many of the doctors worried that Chaoulli's house calls were setting too hectic of an example and raising patients' expectations too high. There were whispers that he was making them look lazy by comparison. To put an end to the problem, the medical union pushed through a new law imposing harsh financial penalties on doctors who made house calls, effectively preventing Chaoulli from continuing. In protest against the new law, Dr. Chaoulli went on a hunger strike, undeterred by his medical knowledge of exactly what would happen to his body as he starved himself. He went on for four weeks before his supporters prevailed on him to stop, at which point he resolved that he could no longer work as a government doctor. He decided to opt out of the state health-care system, and began making private house calls for private pay.

But try as he might, Dr. Chaoulli couldn't escape the tentacles of the state: The Canadian government, as part of its effort to maintain tight control over the country's health-care system, had forbidden private insurance companies from paying for medical services that were also officially provided by the public system. For the patients who could not afford to pay Chaoulli for his services without the assistance of insurance, there remained little choice but to wait in the long lines that clogged the government health offices. (Private clinics were also forbidden from providing core health services, but a few black-market clinics still serviced patients who were willing to break the law to get treatment.)

Before long, Dr. Chaoulli came upon a patient who was waiting to undergo hip-replacement surgery. Already suffering from the painful immobility that his illness entailed, the patient had his plight exacerbated by his country's oppressive blanket of regulations: With private clinics prohibited from performing hip-replacement surgeries, and private insurance companies banned from paying for such services, the patient had no choice but to take a place in the public-health-rationing line. He would have to endure his crippling condition for an indefinite period, until the state decided it could fit him into its schedule. To make matters even worse, there were concerns about the quality of the prosthetic hip replacement that awaited Dr. Chaoulli's patient at the end of the line. It is in the nature of universal-public-health provision that quality must often take a back seat to quantity: Any cash-strapped government that tries to provide free prosthetics to all needy recipients will tend to purchase the cheapest units possible. This was exactly the situation in Canada, Chaoulli says, and patients were given no further choice about it: To guard against special treatment for "the rich," public-health patients were prohibited from chipping in some extra cash of their own to upgrade their prosthetics.

FIGHT THE POWER

For Chaoulli, the situation had become intolerable. He and his patient filed a joint lawsuit against the government of Quebec for violating the individual rights to life, security, and liberty that were guaranteed by both the Canadian Charter and the Quebec Charter. In order to see the case through, Chaoulli agreed to pay all the costs of the litigation himself. He temporarily stopped practicing medicine and began studying law. Luckily, his generous father-in-law from Japan was able to provide financial support, but Chaoulli still had trouble paying for basic expenses such as food. Eventually, he had to send his wife and daughter away to stay with relatives outside of the country. He also lost many friends, who came to view his assault upon the public health-care system as either crazy or evil, or both.

When asked why he chose to endure such hardships to challenge the state medical monopoly, Chaoulli says matter-of-factly, "The answer is quite simple. Because I realized that a number of individuals were suffering and dying from the deficiencies of that monopoly."

After Chaoulli lost in some lower courts, his case finally made it to the highest court in Canada. Everyone was sure that his cause was hopeless, and most Canadian legal authorities dismissed his chances out of hand. It therefore came as quite a shock when, in June, Chaoulli triumphed: In a narrow decision, the Supreme Court ruled that Quebec's health-care regulations constituted an infringement of individual rights under the Quebec Charter, and that this infringement could not be justified on the grounds of any legitimate state purpose. "Access to a waiting list is not access to health care," the Court proclaimed, going on to say that as long as the government was unable to provide effective health services, it had no business preventing its citizens from procuring these services through private means.

It is still unclear whether the principles of the Chaoulli case will be applied nationwide. Chaoulli himself is adamant that they will be, pointing out that the individual-rights guarantee in the Canadian Charter is similar to the one in the Quebec Charter. In addition, he notes that the Court has already decided that there is no legitimate state interest in handcuffing private health-insurance companies. Chaoulli hopes to employ the same legal reasoning in a wave of new lawsuits throughout the country, with the ultimate goal of bringing the state medical monopoly crashing to the ground. If he succeeds, he will aim to leverage his newfound fame into a business endeavor, providing brand-name accreditation for health-service providers in a competitive private market.

But Chaoulli may yet face an uphill battle, as he confronts Canada's long love affair with state-monopolized health care. Quebec has until June 2006 to come up with innovative ways to comply with the Court's decision in Chaoulli's lawsuit, and many Canadian politicians are still wary of committing any market-based medical apostasy. Some public figures are starting to come around, but most still reserve the phrase "private health care" for those occasions when they declare their opposition to it. Even Conservative leader Stephen Harper, while campaigning on a platform of modest health-care reform, has been going out of his way lately to reassure voters that he has no intentions of allowing the toxic sludge of competition to seep into the picture. "There will be no private, parallel system," he recently promised at a rally in Winnipeg.

This longstanding hostility to private health-care alternatives cannot be explained away simply by noting that most Canadians have bought into the Left's premise that taxpayers have an obligation to pick up the hospital bills of every citizen who ever gets sick. Something further is required to explain why some Canadians think sick people should be actively prevented from using their own money to purchase health care from private companies that deliver service better and faster than the government.

Some have claimed that the emergence of private health-care alternatives would undermine Canada's public-health system. This is quite a stretch: The public system is funded by compulsory taxation, making it impossible for new private alternatives to drain funds away. True, some doctors might be lured away from public health-care positions into the more lucrative private sector, but this negative impact would be more than offset by the benefits of an emerging private system: The new private entities would help to reduce some of the workload faced by the public system, shortening public waitlists and alleviating budget shortfalls - thus benefiting customers of the public system.

So it's highly unlikely that the emergence of private health care in Canada would undermine anything of value, or harm anyone at all - except, perhaps, some government workers' unions. Yet there remains a strong ideological motive that drives the opposition to private health care: the seductive sentiment of old-school egalitarianism, which cannot countenance the possibility that some people might be able to afford better health care than others. This egalitarian disposition has been parodied by Thomas Sowell, who once remarked that if everyone woke up tomorrow twice as wealthy, some people would complain that the gap between the rich and the poor had only widened. Obsessed with the empty goal of equality, such naysayers would be blinded to the fact that everyone had in fact become better off.

Robert Nozick called this the politics of envy; it would be equally accurate to describe it as a brand of uncompromising left-wing idealism. Leftists want so badly to realize their vision of quality health care, free and equal for everyone, that they are unwilling to entertain any of the imperfect alternatives that are available in reality. In the words of Jack Layton, head of Canada's leftist New Democratic party, "We want our health-care system to be one where it's your health-care card that gets you the health care - not your credit card." And if the health-care card can't get the job done? Well, then everyone will enjoy an equal share of misery. Fairness demands it.

Source

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Monday, December 26, 2005

Nine families sue UCI's liver transplant program over deaths

Nine families whose relatives died while waiting for liver transplants have filed a wrongful death lawsuit against an Orange County hospital that last month suspended its transplant program. The lawsuit filed Friday names the University of California, Irvine, Medical Center as a defendant as well as staff doctors, the former head of the transplant program and the University of California regents. It seeks unspecified general damages and wrongful-death damages for the loss of companionship and earnings.

"The interesting part of this case that makes it novel and above a regular malpractice case is the fraud and misrepresentation that was presented by the liver transplant program," said attorney Larry Eisenberg, who filed the lawsuit in Orange County Superior Court. The program kept accepting new patients when officials knew they didn't have the ability to perform the transplants, Eisenberg said. The transplant program also failed to perform the minimum number of transplants required by federal regulations and did not have a full-time liver transplant surgeon on staff and lied about it to federal regulators, Eisenberg said.

A telephone call Friday to the UCI medical center was not immediately returned. University Chancellor Michael V. Drake shut down the liver transplant program Nov. 10 after a stinging report by the Centers for Medicare and Medicaid Services was made public. The report found that UCI's program had a one-year survival rate of 68 percent to 70 percent between July 2001 and June 2004 - far below the federal requirement of 77 percent. More than 30 patients died while waiting for transplants over the past two years, according to federal data. The hospital, which operated Orange County's only liver transplant program, also performed far fewer than the 12 transplants per year required by the government for federal reimbursement, with as few as five transplants so far this year.

Eisenberg previously filed a lawsuit on behalf of the widow of a man who died in 2004 while waiting for a liver and a couple who waited six years for the wife to receive a liver at UCI before transferring to a Chicago hospital. That lawsuit was filed seeking class-action status to preserve the statute of limitations, Eisenberg said

Source

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Sunday, December 25, 2005

ANOTHER TRIUMPH OF PUBLIC MEDICINE: DEATH

A man dying from a brain haemorrhage was forced to wait for hours as Sydney's public hospital system battled to find him a bed and neurosurgeon to treat him. Bernard Pozo died yesterday just 30 minutes after he finally got a bed more than four hours after an ambulance took him to Campbelltown hospital. The 64-year-old collapsed at Campbelltown RSL, was picked up by ambulance officers about 8.50pm on Thursday, arriving at the hospital at 9pm. A CT scan taken showed bleeding in Mr Pozo's brain. But because Campbelltown hospital has no neurosurgeon, Mr Pozo's family were told about 11pm he would have to be transferred to another hospital.

Despite his critical condition, Mr Pozo was rejected from Liverpool and Westmead hospitals because neither had intensive-care beds available. It was 1am before a helicopter was available to transfer Mr Pozo to St George hospital.

Mr Pozo's death comes two years after a Health Care Complaints Commission investigation found serious concerns about the number of deaths and patient care at Campbelltown and Camden hospitals. It also comes after an extra $25million funding was given to NSW Health this financial year to pay for a total of 57 new intensive care beds.

Mr Pozo's son Robert said that from his symptoms it was obvious that his father had suffered a brain aneurism. "He needed urgent care by a neurosurgeon and every hospital was refusing to take him," he said. "It took hours before anyone would agree to take him. "It was a life and death situation and no beds were available. This is a person dying as the health system passed him from one hospital to the next."

Campbelltown hospital doctors yesterday reviewed Mr Pozo's case. Hospital general manager Amanda Larkin said there was "no evidence of unreasonable delay or inadequate care at Campbelltown hospital" for Mr Pozo. "Time is required to ensure any patient is stable for transfer and to make sure appropriate transport is organised," she said. [Let's hope Amanda Larkin has a brain anuerism sometime]

Source

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Saturday, December 24, 2005

ANOTHER TRIUMPH OF BRITISH PUBLIC MEDICINE

And the last sentence below gives the lie to the BS

A hospital has apologised after a woman found maggots crawling on her mother's face in its intensive care unit. Nyree Ellison Anjos alerted staff at Gloucestershire Royal Hospital, Gloucester, when she saw the maggots near a feeding tube attached to her mother's nose. Mrs Ellison Anjos's mother, Christine Ellison, 59, died two days later from a separate illness. The family said it was satisfied the maggots had no bearing on the death in July.

Ellison Anjos, 34, from Gloucester, said she had chosen to speak out in the hope that maggots would not be found on another patient. She said: "We saw there was a fly flying around there. The next day I went there and there was this yellow thing by her tube. She kept touching her nose and fiddling with it and we could see it was bothering her. I had a close look and could see little maggots moving in there."

Gloucestershire Hospitals NHS Foundation Trust said: "We would like to offer our sincere apologies to the family of Mrs Ellison for any distress caused by this incident. "We can confirm that a very small number of maggots, each the size of a pinhead, were found. "The incident was incredibly rare and we took immediate steps to prevent it from happening again. "We have always been commended for our high standards of cleanliness and hygiene. It is important to remember that this particular incident is an isolated and rare occurrence and at no time was Mrs Ellison's treatment compromised."

The same hospital was criticised in October this year after one of its treatment rooms had to be fumigated after maggots were found on a discarded sandwich.

Source

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Friday, December 23, 2005

ARROGANT BASTARDS INTERFERING IN A PERSONAL DECISION FINALLY DEFEATED

A 36-year-old woman has won a seven-year legal battle to use her dead husband's sperm to get pregnant. The Victorian Civil and Administrative Tribunal today gave the woman permission to use the sperm as part of IVF treatment in NSW.

The woman, referred to as YZ, was living with her husband in the ACT when he died in a car accident in Victoria in July 1998. She successfully won a court order to extract and freeze a sperm sample from her husband the day after the fatal accident. The woman then fought to use the sperm to get pregnant using IVF treatment, but lost a Supreme Court battle earlier this year after Attorney-General Rob Hulls opposed the request. Justice Kim Hargrave ruled that YZ's request was prohibited by the state's IVF laws.

A subsequent bid to have the procedure done in the ACT failed when the territory's IVF authority rejected her request. But after discovering the procedure was allowed in NSW, YZ went to VCAT seeking permission to take the frozen sperm sample interstate. Following a hearing last month, Justice Stuart Morris today granted permission for the sperm to be transported to Sydney to allow the woman to begin IVF treatment. In his ruling, Justice Morris said the matter did "not involve questions about the legality of proposed conduct, but about the scope, nature and exercise of a discretion to permit the sperm to be taken to another state of Australia to enable its use".

The tribunal was told that YZ wanted to have children, but did not want to begin another relationship, and preferred not to use an anonymous sperm donation. "She wishes to have a child, or children, using her late husband's sperm as she regards him as her life partner and wants him to be the genetic father of her children," Justice Morris said. "I do not find this to be a case where the applicant is motivated by grief. Although the decision she has made will not be the decision of most widows, many widows would choose to move on and find a new partner I accept that her decision is rational and genuine." Justice Morris said it was important that the family of the dead man referred to as XZ support YZ's bid to have his children. He said it did not matter that any child born using the treatment would not have a living father. "It is trite to observe that many children born naturally do not have a father or a loving father, yet still live long and happy lives." "In my opinion, the fact that any child born as a result of the export of the sperm the subject to this proceeding will not have a father or will be conceived from the sperm of a man who is dead is not of major consequence."

The woman will now be able to begin IVF treatment in NSW, but must inform Victoria's Infertility Treatment Authority should she give birth.

Source

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Thursday, December 22, 2005

British public hospitals ignoring new killer superbug

They would be sued for millions if they were private facilities

A winter superbug that kills as many people as MRSA is being routinely neglected by hospitals, the Government's health watchdog gives warning today. More than a third of hospital trusts are failing to follow basic guidelines that could prevent the spread of the deadly hospital-acquired infection Clostridium difficile which kills 1,000 people a year.

The Healthcare Commission described the revelations from its survey of 118 hospitals as "deeply worrying". Sir Liam Donaldson, the Chief Medical Officer, has now written to every trust chief executive to give warning of the need to monitor and treat effectively the infection, which was linked to the deaths of 12 patients at Stoke Mandeville Hospital earlier this year.

In the survey, released today, nearly 90 per cent of trusts admitted that they did not have a ward for isolating patients with C. difficile while more than a third said that they were unable to isolate routinely such patients. In the case of an outbreak, 40 per cent of trusts admitted that they did not routinely follow government guidance, which recommends that they should inform the local consultant in communicable disease control. Thirty-eight per cent said they did not have restrictions in place to prevent the inappropriate use of antibiotics, which would help to minimise the risk of C. difficile spreading.

Marcia Fry, head of operational development at the Healthcare Commission, said it was "deeply worrying" that many hospitals were not doing enough. "We recognise outbreaks are not easy to control, but trusts must do more to ensure that they have systems in place to protect patients from this potentially lethal infection."

Older people are most at risk from the bug, which causes diarrhoea and can lead to serious illness and death. Those who have undergone surgery are also vulnerable. In 2003, 934 people died from C. difficile in England and Wales, compared with 321 who died from MRSA. There were 44,488 cases of C. difficile reported in the over-65s in England. Last year 1,219 people died from enterocolitis because of C. difficile.

Professor Graham Medley, an infectious disease epidemiologist at Warwick University, said: "We understand all about these infectious diseases and how to control them, but what we lack is the political and economic will to change the current situation and reduce the incidences of these diseases. "This is because a change would require restricting hospital visiting hours and having hospital beds free in case there is a need to isolate patients. That would result in an increase in waiting lists."

A new strain of C. difficile has recently been detected in a number of NHS trusts in England. Outbreaks of this strain were first reported in Canada and the USA and have been associated with more deaths and relapses. Infections with this strain caused 109 deaths over a six-month period in Quebec last year and it was later identified at an outbreak at Stoke Mandeville Hospital.

Andrew Lansley, the Shadow Health Secretary, said: "It is very concerning that trusts are not following guidelines to reduce infection rates. What's the point of guidelines if they are not implemented? "Hospitals should take every possible measure to prevent outbreaks of C. difficile. There is no clear line of accountability, there is no requirement for access to 24/7 cleaning, there is no measure for the availability of isolation facilities and there is no requirement to reduce excessive bed occupancy rates." Today's report is an interim study. A more detailed version will be published in the spring.

Jane Kennedy, the Health Minister, said: "Some trusts still have work to do. The new hygiene code currently under scrutiny in Parliament will make it a statutory duty for trusts to have all these systems in place; and the Healthcare Commission will have the power to issue improvement notices if hospitals are failing to carry out these measures. "The Chief Medical Officer has written a firm reminder to all trusts today, to help ensure that they have all the relevant practice in place to minimise the risk of C. difficile infection

Source

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Wednesday, December 21, 2005

U.K.: Treating doctors like murder suspects

The trial of Dr Howard Martin shows how the process of dying is becoming a sordid battleground

The trial of Dr Howard Martin, found not guilty of murdering his patients, shows the atmosphere of suspicion engendered by today's spotlight on the final hours of life. Both those who advocate and those who oppose a change in the law on assisted suicide have helped to create a climate where all general practitioners (GPs) are seen as potential Harold Shipmans - the GP jailed for murdering his patients. The constant calls for a tightening of the law on assisted suicide have made doctors, who most people used to trust with their own lives and the lives of their loved ones, into murder suspects.

In this climate of fear, it is perhaps not surprising that relatives of three men who died shortly after a visit by Dr Martin initiated a prosecution against him. Dr. Martin was accused of killing Harry Gittins, 74, Stanley Weldon, 74, and Frank Moss, 59, all patients at his surgery in Newton Aycliffe in Country Durham. The prosecution alleged that the GP had administered huge doses of powerful painkilling drugs with the intention of killing them. The implication was that, corrupted by his own power, Dr Martin killed these patients long before it was their time to die. As the prosecution said in court, he 'determined the lives' of the three men. Family members testified that Mr. Weldon looked 'jolly and happy' just days before dying.

However, the defence pointed out that all three were in the final stages of dying. It argued that the prosecution had failed to prove that the doses of morphine and diamorphine had killed the three men. One of the most important witnesses, Karol Sikora, a professor of cancer medicine at the Imperial College School of Medicine, told the court that in similar circumstances he might have done the same thing. Professor Sikora told the court that he felt that Harry Gittins had less than 24 hours left to live even without the morphine. Home Office pathologist Nathaniel Carey noted that it was impossible to conclude that morphine was the cause of the death of Frank Moss. 'It would not be appropriate to include morphine as a cause of death, otherwise we would have to include it for any people that died in a hospice.'

If cases like this become more common, it is the dying who will suffer. It seems that ambulance-chasing lawyers are being distracted by passing hearses. Adverts now offer: 'Did your loved ones dies as a result of a doctor's actions? Call this freephone number..' It's likely that more remains will be exhumed, and fear and suspicion will further increase. Doctors will be wary of administering the necessary dose of a 'double effect' - pain killers that may also hasten death - forcing patients to suffer more during their last few hours. Who would place a loved one in a hospice - or indeed choose to work in a hospice - when it could be portrayed in court as akin to a gas chamber?

In a somewhat sinister press release, Deborah Annets, chief executive of the Voluntary Euthanasia Society, argued that: 'The sooner we move to a patient-based system of regulation that allows a patient's wishes to be respected with proper safeguards the better protected all patients will be.' Protected against doctors who have been declared innocent in a court of law, presumably? Or against all the doctors who spent their lives caring for patients and who took brave decisions in their interests?

Assisted suicide advocates often accuse their opponents of scare mongering by using the 'slippery slope' argument. But the Voluntary Euthanasia Society has turned the slippery slope innuendo into an artform. Why is there an assumption that doctors and patients want different things? When did doctors transform from kindly helpers to budding Mengeles out to 'determine the lives' of helpless patients? The twisted logic of the Voluntary Euthanasia Society is that the only way for a dying person to take control is if they force the doctor to kill them at a time of their choosing.

The problem is that dying renders a human being entirely helpless. Often there is no possibility of making meaningful choices and the dying individual can only trust those around them to act in their interest. Anything that jeopardises that essential trust can only hurt the vulnerable, not protect them. Cases like this create a dismal spiral of distrust, chaos and fear at the end of life

Source

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Tuesday, December 20, 2005

Years in an Australian public hospital for nothing

At huge cost and with very destructive side-effects

Teenager Samantha Farr spent four years bedridden in a $650-a-day hospital room after being diagnosed with a rare immune disorder that independent medical experts say she may never have had. In a case the NSW Health Care Complaints Commission found involved "serious identified breaches of practice", Ms Farr has been left diabetic, addicted to drugs and with no reproductive cycle after her treatment. Now 21, Ms Farr also suffered a series of serious health setbacks during her hospital stay, including kidney and liver failure, septic shock, lung disease and catching a hospital "superbug".

Health investigators are now pursuing answers from a number of hospitals and neurologist Suzanne Hodgkinson over the case, which cost taxpayers millions of dollars in public hospital costs. Her family is seeking millions in compensation from the NSW Government.

Ms Farr's father, Andy, claims she "nearly died" as a result of the treatment at Liverpool Hospital in southwest Sydney. "Sam has lost four years of her life and she has been physically and psychologically damaged for life. It is appalling that a leading hospital could do this to a patient," he said.

Dr Hodgkinson is the wife of controversial University of NSW professor of immunology Bruce Hall, who was publicly accused of exaggerating laboratory results before obtaining a federal research grant. Professor Hall - whom an inquiry later found guilty of academic misconduct but cleared of scientific fraud - was the director of medicine at Liverpool while his wife was treating Ms Farr there.

The Farr family's saga began in Cairns in 2000 when Ms Farr, then barely 16, suddenly "stopped breathing". After a battery of tests, Cairns Base Hospital doctors could not find a cause and referred the case to specialists at Sydney Children's Hospital in Randwick, where doctors diagnosed her with a rare and obscure disease called myasthenia gravis, which affects five in every 100,000 people. This is caused by an abnormality of the immune system in which antibodies attack or attach themselves to the nerve endings that control muscle movement, including breathing. In 2001, Mr Farr and his wife Kim moved to Blackheath in the Blue Mountains west of Sydney and after an attack Ms Farr was transferred to Liverpool Hospital, where she was seen by the head of neurology, Dr Hodgkinson.

"Dr Hodgkinson told us Sam was suffering from 'refractory' myasthenia gravis and that she needed 'aggressive treatment' or she would die," Mr Farr said. Mr Farr, who now has access to all her daughter's medical records, said she was given "dozens of plasma exchanges that did nothing"; strong immuno-suppressant drugs; corticosteroids; morphine-based painkillers; anti-cancer drugs; and ... powerful myasthenia gravis drugs, all of which had side effects". "The crazy thing was that one of these drugs in particular had side-effects that mimic the disease, affecting muscle movement and breathing," he said. "Every time we saw Sam she seemed worse ... Dr Hodgkinson told us that if Sam stopped taking this particular drug she would 'die within hours'." That is why Mr Farr was so disturbed when he went to Liverpool Hospital in April to find out that Dr Hodgkinson was on "stress leave".

Her patients were given to another neurologist, who immediately sent Ms Farr to specialists at the Royal Prince Alfred Hospital, the main teaching hospital for Sydney University, for a second opinion. Mr Farr said most of the tests came up negative, including the test for raised antibodies. By this time, Mr Farr had complained to his MP and then health minister Morris Iemma, who ordered another "independent neurological assessment" by a retired neurology professor at Sydney University. "The professor concluded that, at worst, at some stage, Samantha may have had a 'mild case' of myasthenia gravis -- effectively 'drooping eyelid'," Mr Farr said.

Dr Hodgkison yesterday defended her diagnosis, saying "there were excellent reasons for believing Samantha had myasthenia gravis". Dr Hodgkinson said she did "reassess" Samantha through her 3 1/2 years in hospital under her care. "It was a long, long time, but she was a very sick girl."

A spokesman for the NSW Health Minister John Hatzistergos said: "It is not appropriate to comment as the case has been referred to the Health Care Complaints Commission for investigation." But a spokesman for the NSW Southwest Area Health Service said: "This is a very complex case and the hospital remains in close contact with the family. It is being investigated internally and externally at the Area Health Service's request. "Our investigations have led to a full review of our protocols and procedures, particularly regarding long-term patients."

Source




Alabama: State set to track patients' use of drugs: "Alabama will soon keep track of who is taking Xanax, OxyContin and other addictive drugs and how often. The tracking will be done with a prescription drug database system designed to prevent addicts and drug pushers from 'doctor shopping' for multiple doses of pain killers and other medicines. At least 20 other states have such databases. State Health Officer Don Williamson said the program will begin as a pilot project on Jan. 1, with doctors and pharmacists providing the prescription data voluntarily. Mandatory reporting will begin on April 1, he said. ... At least 20 other states have established such databases to crack down on prescription drug abuse, according to the Web site of the National Conference of State Legislatures."

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Monday, December 19, 2005

ABSURD PUBLIC HOSPITAL PRACTICES KILL LITTLE GIRL

Queensland Health has been accused of ignoring a top-level report that might have saved the life of a 10-year-old girl. Elise Neville died two days after being seen and sent home by a junior doctor in charge of Caloundra Hospital's emergency ward in January 2002. The State Liberals said this was contrary to a special report delivered to Queensland Health in 2001 which said that senior doctors – not junior doctors on their own – should work in emergency wards. The Liberals said yesterday that the report was not only ignored by the department, but had been kept secret. Details were obtained this week by Liberals deputy leader Bruce Flegg through Freedom of Information.

The Review of Emergency Services, Sunshine Coast Health Service District, was written by Dr Bill Rodgers, former medical superintendent at Nambour Hospital. Its recommendations were not implemented and when Elise Neville went to Caloundra Hospital after a fall from a bunk, inexperienced junior doctor Dr Andrew Doneman was in charge and 20 hours into a 24-hour shift. Dr Doneman did not admit the young girl to hospital or perform tests that would have shown she had a serious head injury. She was sent home after some minor treatment, and died two days later from internal bleeding and swelling of the brain.

Dr Doneman pleaded guilty in the Health Practitioners Tribunal in November 2004 to unsatisfactory professional conduct. He was sacked by the Government, though he was later allowed to practise after an appeal to the Medical Board. The Australian Medical Association and College of Emergency Medicine said at the time Dr Doneman had been made a scapegoat for Queensland Health's "unsafe practices" of making staff work dangerously long hours.

Dr Flegg, the Liberals' health spokesman, yesterday accused the State Government of a blatant cover-up of information in the Rodgers report which was relevant to Elise Neville's death. He said that if the report, which examined emergency medicine arrangements at Caloundra and other Sunshine Coast hospitals, had been acted on instead of covered up "the result would have most probably been quite different". The report said: "The population of Caloundra mandates an emergency department capable of dealing with emergencies and principal house officer (senior) level staffing is considered appropriate." Dr Rodgers recommended that until Queensland Health could recruit principal house officers, senior medical officers should maintain 24-hour duty cover for the department. His main recommendation was: "Caloundra Hospital appoint five principal house officers to staff the emergency department at all times."

However, Dr Flegg said that one year after the report was written a junior doctor with less than two years' experience was on duty in the emergency ward when Elise Neville was taken in. "Not only were these recommendations hidden from the public, they were ignored," he said. Dr Flegg said the Queensland Health report was never made available to the Medical Board tribunal, the Coroner, the Neville family, their lawyers, or Dr Doneman. "It seems that the Government would have left this report under wraps, as they failed to produce it," he said.

Queensland Health said a decision was made in October 2001 to recruit five senior doctors for the emergency ward, but the first did not come on board until early 2002. Five principal house officers, plus two emergency specialists, were working there now. Health Minister Stephen Robertson said he was unaware of the document but would investigate.

Source

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Sunday, December 18, 2005

AUSTRALIA: A COUNTRY MEDICAL SCHOOL TO ENCOURAGE COUNTRY PRACTICE

Townsville [a small regional city in Queensland] is set to revolutionise health services in country Australia after a $3 million federal grant was awarded to James Cook University yesterday. Health Minister Tony Abbott travelled to Townsville to announce a new rural medical school at JCU. The Federal Government will inject $3 million over two years to establish the landmark clinic at the university. He said the rural clinic would allow more students to study in Cairns, Atherton and Mackay, getting hands on experience in rural and remote communities. "The Government's initiative will give more future doctors an experience of rural and remote medicine, plus the skills to deliver the best possible health care when they get there.

Mr Abbott said training doctors in the country was important, because country trained doctors were more likely to practice in regional areas. Mr Abbott said the Government was trying to increase rural training at universities across the country and he listed JCU as a leader in the initiative. "It's particularly important at universities like James Cook, as the first non-metropolitan medical school in Australia." The minister's visit was scheduled to coincide with JCU's first medical class graduation ceremony. "It's actually a pretty important day for country Australia as this is the first graduating class from a non metropolitan medical school," he said.

Mr Abbott said Australia's health services were going through a period of positive change, with non-state capital city medical schools being established in Canberra, Woolongong, west Sydney and Fremantle. "There are a lot of changes happening but James Cook has been a flagship of change when it comes to trying to get medical graduates in country areas." Mr Abbott said there were 11 rural clinical schools across Australia, and as a result, a quarter of the nation's medical students were spending at least a year training in remote areas.

The executive dean of the JCU faculty of medicine, health and molecular sciences, Professor Ian Wronski, welcomed the additional funding. "We have always wanted to train doctors in the North, for the North, and the rural clinical school will give us more facilities and more teachers in communities across the region."

More here




Australian health boss pisses into the wind: "Greed should not be the motivator of the nation's doctors, and highly paid specialists such as anaesthetists should not get more money from Medicare unless they guarantee to pass the savings on to patients. Health Minister Tony Abbott has revealed he understands why doctors walk out of the "chaotic" public health system in disgust, but has warned that an exodus could undermine public confidence in the profession. Pledging extra payments to GPs who undertake procedures, he warned the Government would not give more money to anaesthetists because they were likely to pocket the cash, not pass on the savings to patients. "Notwithstanding legitimate grievances about the scheduled fee and indexation, the Government is very reluctant to increase rebates for comparatively high-earning specialities such as anaesthesia, in the absence of binding undertakings from the profession that the money will go to patients," he said".

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Saturday, December 17, 2005

PUBLIC HEALTH FAILURE WITH AIDS

To put it as bluntly as possible, the main reason that AIDS is spreading to its current deadly dimensions around the world is this: We are practicing the social and political equivalent of laissez-faire when dealing with a killer-virus. And while "hands off" is usually the best approach for generating economic growth, if a virus, on the contrary, gets the equivalent of a free hand, it will also flourish -- but that's the kind of explosive growth we don't want.

Two decades ago, American AIDS activists came up with the slogan, "Silence = Death." But the issue, in practice, wasn't talking about AIDS, but rather doing something about AIDS. So the American slogan became, in effect, "Behavior Change = Life." And the biggest single life-saving change, back then, was behavioral restraint. Gay bathhouses were shut down, and millions of Americans, many of them gay, changed their sexual patterns: They got serious about condoms, safe sex, or outright abstinence. Were these changes tough to live by? Sure. But they beat the alternative. Let's face it: Just as quarantining worked in the past -- remember leper colonies? -- so the same basic idea, of separating oneself from the threat, works today.

Currently in the U.S., it is common for gay men -- especially as one moves up the ladder, in terms of education and health-consciousness -- to say things like, "I don't know anybody who has died of AIDS in five or ten, or even fifteen years." That is, in their medically aware circle -- after the initial wave of deaths in the 80s -- people got the message. And of course, thanks to medical breakthroughs, many of those who are HIV positive can carry on functional lives for the long term.

Today in America, a few incredibly unlucky people get AIDS through freak accidents. But the blunt reality is that AIDS mostly afflicts those who can be diagnosed as terminally reckless. An example is junkies using dirty needles -- or any needle at all. How does society realistically save the life of someone who holds his or her own life in such obvious contempt? As with smoking, drinking, over-eating, gun-playing and drag-racing, some behavior choices simply defy life-saving. Or to take another example, it's recognized by now that anal sex without condoms, known as "barebacking," is widely recognized as a death trip, and yet plenty of people still seem to do it, with the full complicity of modern marketing. At some point, confronted by the lethal combination of lust and greed, even the best-intentioned American public-health advocates have to throw up their hands in defeat.

That's the U.S., where at least the problem has been isolated to a few hard-to-reach, albeit seemingly suicidal, sectors. Around the world, the situation is far worse. And so, on World AIDS Day, it's time for some honest talk: AIDS, having already killed 15 million, having infected 40 million more, is spreading -- because too many people, and too many governments, have been unwilling to change their behavior, and their policies.

We might consider, as an ominous indicator, this recent article, entitled, plainly enough, "HIV Is Spreading Via India's Highways." The Associated Press' Margie Mason reports, "Just as in Africa two decades ago, truckers and the sex they buy have helped fuel India's spread of a disease that revolves mainly around sex and injecting drugs." Now let's think about that: 20 years after it became obvious that sex-working (known less politely as prostitution) was a major AIDS vector in Africa and elsewhere, India seems to be doing little to put a stop to those same deadly practices. Oh sure, no doubt any number of Indian government agencies and NGOs are busy "working" on the problem, but with more than five million Indians infected, it's obvious that they are not working effectively.

So what would AIDS effectiveness look like? Most obviously, it would begin with a stern, even fierce, crackdown on the sex and drug trades. Such fierceness explains why Singapore, to name a healthy counter-example, doesn't have this widescale problem.

Which do we prefer? India or Singapore? The AIDS Establishment has made its choice apparent to all: It puts freedom, most obviously sexual freedom, ahead of strict public health measures. That is, the preservation of the Sexual Revolution matters more than people's lives. That disturbing reality came clear to me last summer at the World AIDS Summit in Bangkok, in which brazen sexual braggadocio overwhelmed modesty, let alone safety. And yes, it does seem that AIDS activists are better at announcing holidays and staging summits than stymieing the disease; if media-savvy showmanship were the same as public-health stewardship, the world would be well. But instead, the Band Plays On, at the modern equivalent of a Masque of the Red Death.

The AIDS Establishment argues that it's simply not reasonable to demand that Africans and Indians, or anyone else, for that matter, change their behavior patterns. If people wish voluntarily to change their behavior, that's OK, but never, ever, should serious suasion or sanction be applied -- no matter how many lives might be saved. And so it is that the dubious values of the American Civil Liberties Union are being applied to the whole world....

And extreme cynicism, of course, is the obvious result of, first, "do your own deadly thing," and, second, "let others make a good living off of your dying." After a quarter century, many in the AIDS Establishment must know that they are facilitating the disease, not eradicating it. But they have carved out a good living for themselves, financially, as well as a high status for themselves, morally.

This arrangement is working, on its own cynical terms, and working well. It's working so well, in fact, that top figures from around the world are visibly prostrating themselves before the putative pieties of the AIDS Establishment. Earlier this week Jim-yong Kim, director of the HIV Department at the World Health Organization, actually apologized for his failure to implement WHO's "3 by 5" program. As with so many other AIDS-related efforts, "3 by 5" had a catchy title, but never the prospect for success. And since the WHO-crats should know that by now, their apology, absent profound changes in their methods, should not be accepted. Although, of course, failure, now and forever, won't stop the WHO from receiving more funding, for as far into the future as the eye can see.

More here

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Friday, December 16, 2005

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MEDICAL MISHAPS AS SYSTEM FAILURES

Post lifted from the Adam Smith blog

Star speaker at the Adam Smith Institute House of Commons breakfast yesterday was Sir Liam Donaldson, the NHS Chief Medical Officer, talking about patient safety. Though the papers (and lawyers) seem to like to go after individual doctors when mistakes happen, Donaldson's view is that most of the problem is down to human error right enough, but human error in a weak system.

"Patient safety has not been a priority," he told the 60 or so guests, senior figures from private and public healthcare, journalism and politics. "Control systems are too weak for the high-risk industry that we are in." They just wouldn't be allowed in transport, for example - 2004 was the safest year in airline history, and 2005 looks like ending up even safer. In 2000, the NHS killed more people through infusion pump errors than died in the Hatfield crash that year: the difference is that Hatfield led to huge changes in safety procedures.

Bad teamwork and poor communication with patients and other healthcare professionals both kill patients. But traditionally, doctors have seen their role as applying medical knowledge, and have not regarded communication and teamwork as core skills. That at least is now changing, said Sir Liam.

But he was still skeptical about the way that medical accidents are dealt with. The General Medical Council, the Crown Prosecution Service and the media always like to pin the blame on specific doctors, when really it is NHS systems that are to blame. And most official inquiries into medical accident "result in no learning whatsoever" because few take a systems view of the problem.

So it's not surprising that doctors are reluctant to report accidents or near-misses. But I think that we would have much more confident in our doctors if they did - a point confirmed by another speaker, Jim Johnson of the Dana-Faber Cancer Institute in Boston. "We listed all our mistakes over the last decade in the Boston Globe," he said. "It actually made our competitors angry, because everyone thought, if we are big enough to own up to our mistakes, we've probably made efforts to fix things, and we're probably safer than everyone else." A lesson for doctors here, perhaps?





Too many choices : "The new Medicare prescription drug plan will save senior citizens billions of dollars, so why are so many of them afraid to sign up for it? You wouldn't think such a beneficent program would have to put a metaphorical gun to people's heads (in the form of a 1 percent per month premium penalty) to get them to enroll now. Yet that is what seems to be happening. Senior citizens are confused. The government has turned the insurance companies loose, with the result that in some states there are more than 50 plans to choose from -- all of them complicated -- and nowhere is there a simple metric that people can use to determine which plan is best for them. Befuddled seniors are clutching their heads and asking someone, anyone (their pharmacists, their kids, AARP) for help."

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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Thursday, December 15, 2005

GERMANY HAS HUGE TAXES BUT ITS DOCTORS ARE STILL POORLY PAID

The money goes on bureaucracy instead

Native [German] doctors (clinical doctors) are going out on strike these days to get a 30% pay increase. No, not 3%, not 13%, that’s right; 30%. Sound outrageous? Of course it’s outrageous. But they are just a Produkt ihrer Umwelt (a product of their environment), because the real outrage is how they are being paid right now.

These doctors work their 50 or even 60 hours a week just like everywhere else in the world (I guess) but get paid roughly 25% that of what an American doctor gets for doing the same job. They’re actually earning 7% less (proportionally) than they were in 1993. They’ve become a new type of Wirtschaftsfl├╝chtling (economic refugee) and are leaving the country in droves (3000 German doctors have gone to England, for instance) and nobody wants to become a doctor in this country anymore. It’s said that only about 60% of the native medical students complete their studies here and a quarter of the ones who do go into pharmacy or insurance or some other medical-related field.

The new government’s Minister of Health (she was also the Minister of Health under the old government so she must be really good) says however that she has alles im Griff (everything under control) and won’t be blackmailed or led astray and her rigid cost-control measures (ha, ha) will continue and there will most certainly not be any increase in the outrageously high insurance payment rate all native workers have to pay here each month. Right. In six months tops they're going to raise that rate again and everybody knows it.

And that makes one wonder. Hmmmm. If the doctors aren’t getting all of this money that everybody has to shell out every month, who is? The hundreds of Krankenkassen (Health Insurance Agencies) for all of their redundant administrative costs (Japan has just one, for instance)? The Hospitals? They wouldn’t be pocketing all of this cash, now would they? And a native [German] would never go to a doctor if he didn't need to, right? And what about the pharmaceutical industry? Naah, not them. Forgive me. I don’t know what I was thinking just now.

Excerpt from here





The truth about WHO and AIDS: "If you're like most people I know, World AIDS Day passed you by last Thursday with scarcely a nod. And for good reason, because the World Health Organization, which sponsors the observance, is keeping a low profile these days. And well it should. Any way you look at it, the WHO effort to stop AIDS has been a dismal failure. In fact many believe the World Health Organization is actually making things worse. It was June 1981 when U.S. public health officials first reported a strange illness that afflicted six homosexual men. Who would have believed that nearly 25 years later, the deadly virus would be infecting 5 million new persons each year, and that a staggering 40 million persons -- 70% of whom live in Africa -- are now HIV-positive?"

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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.

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