AMUSING OPTIMISM IN TENNESSEE
The more "painless" it is, the more it will be overused and the more costs will skyrocket!
Gov. Phil Bredesen says his new healthcare program hit a "home run" Tuesday. BlueCross BlueShield of Tennessee won both of the contracts to offer health insurance to the working poor Tuesday in a new state plan, providing a benefits package that Bredesen said is a "no-brainer" for those eligible to enroll. The contracts were awarded for CoverTN, the main part of Bredesen's Cover Tennessee health insurance plan. CoverTN is targeted at the uninsured, working poor who are employed by small businesses.
Bredesen announced BlueCross BlueShield as the winner at a mid-afternoon news conference at the state Capitol. "I don't always get to stand up here and say `This is a home run,'" Bredesen said. "But this is a home run." Premiums for the benefit will be targeted at $150 a month, with the state paying $50, an individual's employer paying $50, and the individual chipping in $50. Of the $150 average premium, BlueCross BlueShield will devote $140 toward providing benefits, which is one of the main reasons the Chattanooga-based company won both contracts, Bredesen said. "This exceeds my fondest hopes," Bredesen said. Under the two plans offered to the uninsured working poor, benefits will include:
* Enrollees will pay an $8 or $10 co-pay for generic prescription drugs - depending on the plan selected - and a $25 co-pay for brand name scripts. Those covered will be subject to a $250 per quarter spending cap on the drug's costs.
* Coverage up to $15,000 for an enrollee admitted to a hospital who is receiving medical, surgical or psychiatric care. That comes with a $100 co-pay per admission to the hospital.
* One free adult physical exam per calendar year, subject to a five-visit limit for medical, surgical or preventative services.
The $50 average monthly premium for an individual could change, however, based on their age, weight and tobacco use. Bredesen said the premium could be as low as $34 a month or up to $99 a month. "If you're old and smoke and overweight, it'll cost you $99, but you probably won't be around that long," Bredesen quipped.
Dave Goetz, state commissioner of the Department of Finance and Administration, which has oversight of Cover Tennessee, said the two plans offer a "full complement of health benefits." "For the 600,000 people who are uninsured in this state, this is a great result," Goetz said.
Enrollment will start in the first few months of next year. State officials hope to have 45,000 Tennesseans in the program by June 2008. The state has budgeted $34 million this year to pay for Cover TN, but doesn't expect to spend that much. Goetz said it will cost about $30 million a year when 45,000 people are enrolled. Cover TN is mainly targeted at small businesses whose owners can't afford to offer their employees health insurance. Small businesses can qualify if they employ 25 or fewer full-time employees and have at least 50 percent of their workers earning less than $41,000 a year. Gary Selvy, the state director of the National Federation of Independent Business, said the price of the monthly premium is "very comfortable" for small businesses, especially. "This looks, on the surface, to be very attractive," Selvy 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 Pages are here or here or here.
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Sunday, December 31, 2006
Saturday, December 30, 2006
NHS takes cash meant for charity
They've got a lot of bureaucrats to support
A pioneering scheme to help mental patients may have to close because the Department of Health has pocketed money promised by the Treasury. Dame Elisabeth Hoodless, the executive director of the charity Community Service Volunteers, said it was outrageous that £3.7 million had disappeared into the NHS and that all attempts to extract it had failed. Appeals to ministers have been ignored, and only recourse to lawyers and a threat to tell the press what had happened produced any response.
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 Pages are here or here or here.
***************************
They've got a lot of bureaucrats to support
A pioneering scheme to help mental patients may have to close because the Department of Health has pocketed money promised by the Treasury. Dame Elisabeth Hoodless, the executive director of the charity Community Service Volunteers, said it was outrageous that £3.7 million had disappeared into the NHS and that all attempts to extract it had failed. Appeals to ministers have been ignored, and only recourse to lawyers and a threat to tell the press what had happened produced any response.
Yesterday the Department of Health said that the money would be with CSV by the end of January — ten months late — although Dame Elisabeth is not counting on it. The money is the final tranche of a £7.3 million grant made by the Treasury in 2004 under the “Invest to Save” programme, designed to show that by investing money to improve services, more can be saved.
CVS won the grant for Capital Volunteering, in which people in London who have suffered mental illnesses such as depression or bipolar disorder are encouraged to get involved in voluntary activities. This can include acting as helpers for other sufferers of mental illness, or activities such as gardening, sports and music. Its results are promising, with 25 per cent saying that they are gaining skills and 17 per cent reporting improved confidence.
At the end of March the Treasury passed £3.7 million to the Department of Health. It should have filtered through to the project via London Strategic Health Authority, Camden and Islington Primary Care Trust, Islington Mental Health Trust and the London Development Centre — a procedure that Dame Elisabeth describes as “pure Yes Minister”.
Somewhere along the line the cash-strapped NHS decided it would hang on to the money. “What authority had it got to do this?” Dame Elisabeth asked. “It is an abuse of power.”
CVS’s efforts to extract the cash have also been worthy of Yes Minister. It approached the Treasury, who condemned what the Department of Health had done as unacceptable. But nothing happened. Dame Elisabeth then went to a higher level in the Treasury, who agreed that the situation could not continue. But it did. Next she went to Ed Miliband, Minister responsible for the Third Sector (voluntary organisations) who said that he was anxious to help.
Hilary Armstrong, the Cabinet Office Minister, then spoke to Ivan Lewis, Economic Secretary to the Treasury. Nothing happened. “On Monday we took the decision to ask lawyers to sort it out,” Dame Elisabeth said, “and we also said we would be talking to the press.
“Things began to happen. We were told it would be in the ‘next bundle’ at the end of January. That’s not acceptable. Even if we get the money, we have lost £90,000 in interest it would have earned us, and which we need.
“What is distressing for us is that the Government is all the time saying it wants partnerships with the voluntary sector, but our trustees are now asking if this is a risk we want to take. “We’re not alone. There are a number of other organisations who have been let down by the department.”
Dame Elisabeth — the author of Getting Money from Central Government — is not in a mood to compromise. She wants the money, plus interest, immediately, before some of the staff face redundancy.
A Department of Health spokeswoman said: “They will get the money in January.” She made no mention of interest.
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 Pages are here or here or here.
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Friday, December 29, 2006
Obese may be denied priority NHS care: Patients with 'self-inflicted' illnesses face discrimination
No word yet, however, about fatties, smokers and drinkers being refunded their compulsory health insurance payments
Smokers, people with alcohol problems and the obese could be denied priority treatment on the NHS if they do not try to change their lifestyle. The Cabinet is discussing the controversial idea as part of a drive by Tony Blair to secure his domestic political legacy by pushing through a final round of public service reforms before he departs next year.
Ministers will confront a panel of 100 ordinary people with some of the "tough choices" facing the Government under a consultation exercise giving the public a direct say in the new policies. One question will be whether people whose lifestyle makes them ill should get the same priority as other patients. This would mean changing NHS guidelines saying that people should not be discriminated against "even if their illnesses are to some extent self-inflicted".
A Cabinet review group on public services was shocked by the scale of the burden caused by people's lifestyles. "Ministers were shocked by the fact that half of all years of healthy life are lost as a result of behavioural factors (e.g. smoking and diet)," a Government source said. Ministers want a "cultural change" in public services so the state can support and encourage people to change their behaviour to improve their life chances and well-being. They also want to extend the number of "contracts" between the citizen and the state, such as the 30 pounds -a-week education maintenance allowances paid to over-16s who remain in further education.
Experts warned this month that obesity, which costs the NHS 7 billion a year, could bankrupt it if left unchecked and predicted that the proportion of obese adults would rise from one in five to one in three by 2010. Smoking-related diseases cost an estimated 1.7bn a year, with the same amount spent on alcohol-related problems. The treatment of alcohol-related harm, such as violent crime and traffic accidents, costs an estimated 20bn.
Downing Street sources said no decisions had been taken on whether to change the guidelines and stressed that the public would be asked their views on the issue first. The suggestion is bound to provoke criticism. Forest, the pro-smoking group, has claimed that some smokers have already suffered discrimination. It argues that tobacco revenues, which bring in 7bn a year for the Government, dwarf the cost of smoking-related illness.
The cabinet group, one of six drawing up the Blair Government's last policies, will also look at how public satisfaction measures can improve state-run services. Ministers will try to learn lessons from retailers like Tesco, which has used the technology behind its Clubcard system to offer a more personalised service. The 100 people, a representative cross-section of the British public, will be recruited across the regions in the new year and organised lobby groups will be excluded. In February, they will see the papers discussed by the six cabinet groups and, in March, a public services summit will be held in Downing Street at which the "people's panel" will reach decisions. These will be presented to the Cabinet in mid-March.
Hazel Blears, the Labour Party chairman, is looking at other ways in which the public could influence government policy and the way that services are run. A Blair aide said: "This process of public engagement recognises that politics is changing. The public level of expectations is rising both in terms of the provision which they receive and the right which they have to influence those services. It will identify in more detail the areas which the public want us to focus on and develop a series of radical and progressive solutions."
The cabinet reviews have already provoked controversy. A paper for the security, crime and justice group, leaked at the weekend, suggested that crime could rise for the first time in more than a decade as economic growth slows, and that the prison population, already at a record 80,000, could rise to 100,000 over the next five years. The Government has promised an extra 8,000 prison places but it is not clear how they will be funded. The Treasury has frozen the Home Office budget in real terms from 2008-11 other than for spending on security and anti-terrorism work.
Yesterday David Davis, the shadow Home Secretary, challenged the Chancellor, Gordon Brown, to address the "chronic shortage" of prison places. He said: "All we have seen from Gordon Brown has been a miserly approach which, as well as putting the public at risk, is short-sighted. The cost of having a serious criminal free on the streets to commit crime far outweighs the cost of imprisoning and rehabilitating that individual."
Source. Tangled Web has some comments.
***************************
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 Pages are here or here or here.
***************************
No word yet, however, about fatties, smokers and drinkers being refunded their compulsory health insurance payments
Smokers, people with alcohol problems and the obese could be denied priority treatment on the NHS if they do not try to change their lifestyle. The Cabinet is discussing the controversial idea as part of a drive by Tony Blair to secure his domestic political legacy by pushing through a final round of public service reforms before he departs next year.
Ministers will confront a panel of 100 ordinary people with some of the "tough choices" facing the Government under a consultation exercise giving the public a direct say in the new policies. One question will be whether people whose lifestyle makes them ill should get the same priority as other patients. This would mean changing NHS guidelines saying that people should not be discriminated against "even if their illnesses are to some extent self-inflicted".
A Cabinet review group on public services was shocked by the scale of the burden caused by people's lifestyles. "Ministers were shocked by the fact that half of all years of healthy life are lost as a result of behavioural factors (e.g. smoking and diet)," a Government source said. Ministers want a "cultural change" in public services so the state can support and encourage people to change their behaviour to improve their life chances and well-being. They also want to extend the number of "contracts" between the citizen and the state, such as the 30 pounds -a-week education maintenance allowances paid to over-16s who remain in further education.
Experts warned this month that obesity, which costs the NHS 7 billion a year, could bankrupt it if left unchecked and predicted that the proportion of obese adults would rise from one in five to one in three by 2010. Smoking-related diseases cost an estimated 1.7bn a year, with the same amount spent on alcohol-related problems. The treatment of alcohol-related harm, such as violent crime and traffic accidents, costs an estimated 20bn.
Downing Street sources said no decisions had been taken on whether to change the guidelines and stressed that the public would be asked their views on the issue first. The suggestion is bound to provoke criticism. Forest, the pro-smoking group, has claimed that some smokers have already suffered discrimination. It argues that tobacco revenues, which bring in 7bn a year for the Government, dwarf the cost of smoking-related illness.
The cabinet group, one of six drawing up the Blair Government's last policies, will also look at how public satisfaction measures can improve state-run services. Ministers will try to learn lessons from retailers like Tesco, which has used the technology behind its Clubcard system to offer a more personalised service. The 100 people, a representative cross-section of the British public, will be recruited across the regions in the new year and organised lobby groups will be excluded. In February, they will see the papers discussed by the six cabinet groups and, in March, a public services summit will be held in Downing Street at which the "people's panel" will reach decisions. These will be presented to the Cabinet in mid-March.
Hazel Blears, the Labour Party chairman, is looking at other ways in which the public could influence government policy and the way that services are run. A Blair aide said: "This process of public engagement recognises that politics is changing. The public level of expectations is rising both in terms of the provision which they receive and the right which they have to influence those services. It will identify in more detail the areas which the public want us to focus on and develop a series of radical and progressive solutions."
The cabinet reviews have already provoked controversy. A paper for the security, crime and justice group, leaked at the weekend, suggested that crime could rise for the first time in more than a decade as economic growth slows, and that the prison population, already at a record 80,000, could rise to 100,000 over the next five years. The Government has promised an extra 8,000 prison places but it is not clear how they will be funded. The Treasury has frozen the Home Office budget in real terms from 2008-11 other than for spending on security and anti-terrorism work.
Yesterday David Davis, the shadow Home Secretary, challenged the Chancellor, Gordon Brown, to address the "chronic shortage" of prison places. He said: "All we have seen from Gordon Brown has been a miserly approach which, as well as putting the public at risk, is short-sighted. The cost of having a serious criminal free on the streets to commit crime far outweighs the cost of imprisoning and rehabilitating that individual."
Source. Tangled Web has some comments.
***************************
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 Pages are here or here or here.
***************************
Thursday, December 28, 2006
BRITAIN: A LESSON FROM VETERINARY MEDICINE
Our small dog was in a bad way – vomiting, and with a dreadful case of the ‘scoots’ as we say in Scotland. We thought he had eaten something nasty, and it would soon pass. But by 6pm we realised that we needed a vet.
It was Sunday evening. Indeed, it was Christmas Eve. But the vet answered the phone straight away, and told us to come round to the surgery. Ten minutes later, he was examining the dog, and fifteen minutes after that, he had diagnosed the problem, given him three injections, bottled up a week’s dose of two different kinds of medicine, told us he would recover just fine, swiped 34 pounds off our credit card, and assured us that it was just fine to call him on Christmas day if we had any further problems. That’s what I call good service.
By contrast, as I say, a few weeks back I needed to see the doctor. It was a Friday evening, and a recorded message told me that the surgery was now closed until Monday. If I had a real emergency I could leave a message and someone – obviously not my regular doctor – would call me. It wasn’t an emergency, so I called back on Monday, and managed to get an appointment ten days later (though in honesty, I could have seen another doctor in a shorter time). The doctor wrote me a prescription, again for two medicines, but I had to walk half a mile up to the chemist to get them. They cost me around £14 (the standard NHS medicines charge), almost half what the vet charged me for his whole on-the-spot consultation and prescription.
Why do vets give such better service? I am sure that doctors are just as dedicated to their vocation. But with the vet, the link between serving your customers and getting paid by them is immediate. It concentrates the mind on giving good service. In the NHS, remuneration is negotiated and paid by government quangos. There is no clear link between getting paid and giving a good service to your customers.
Doctors should be remunerated like vets. And if some people cannot afford their fees, then those people should be subsidized through the welfare system. The rest of us should pay cash. We might grumble at that thought: but we would get such a better service that overall, we would probably grumble far less.
Until that happens, though, next time there is something wrong with me, I shall be consulting a vet.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Our small dog was in a bad way – vomiting, and with a dreadful case of the ‘scoots’ as we say in Scotland. We thought he had eaten something nasty, and it would soon pass. But by 6pm we realised that we needed a vet.
It was Sunday evening. Indeed, it was Christmas Eve. But the vet answered the phone straight away, and told us to come round to the surgery. Ten minutes later, he was examining the dog, and fifteen minutes after that, he had diagnosed the problem, given him three injections, bottled up a week’s dose of two different kinds of medicine, told us he would recover just fine, swiped 34 pounds off our credit card, and assured us that it was just fine to call him on Christmas day if we had any further problems. That’s what I call good service.
By contrast, as I say, a few weeks back I needed to see the doctor. It was a Friday evening, and a recorded message told me that the surgery was now closed until Monday. If I had a real emergency I could leave a message and someone – obviously not my regular doctor – would call me. It wasn’t an emergency, so I called back on Monday, and managed to get an appointment ten days later (though in honesty, I could have seen another doctor in a shorter time). The doctor wrote me a prescription, again for two medicines, but I had to walk half a mile up to the chemist to get them. They cost me around £14 (the standard NHS medicines charge), almost half what the vet charged me for his whole on-the-spot consultation and prescription.
Why do vets give such better service? I am sure that doctors are just as dedicated to their vocation. But with the vet, the link between serving your customers and getting paid by them is immediate. It concentrates the mind on giving good service. In the NHS, remuneration is negotiated and paid by government quangos. There is no clear link between getting paid and giving a good service to your customers.
Doctors should be remunerated like vets. And if some people cannot afford their fees, then those people should be subsidized through the welfare system. The rest of us should pay cash. We might grumble at that thought: but we would get such a better service that overall, we would probably grumble far less.
Until that happens, though, next time there is something wrong with me, I shall be consulting a vet.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Wednesday, December 27, 2006
"Healthy Americans" Act: More Good news than bad?
Excerpts from an article by Steve Trinward that appears to have been censored at its original source
A new national healthcare plan was revealed this week, sponsored by Sen. Ron Wyden, a Democrat from Oregon. On first glance, it may appear to be just another variation on the Hillarycare model for socialized medicine, and in some ways it seems to be being promoted that way. However, this may be a case where marketing undercuts the reality, the way so many Hollywood films of recent vintage have done. (Who could have known how sensitive Adam Sandler's characters in Spanglish or 50 First Dates could be . based on the same old slapstick shown in the previews?)
Is it possible to craft a program that can blaze a path toward a true reform in healthcare? Let's find out, by examining the major ideas being brought forth in the Wyden plan. To begin with, let's summarize (details below): The Good News: (1) The program focuses strongly on wellness and prevention as a paradigm for healthcare; (2) It stresses self-responsibility, and offers a way out of the "employee benefit" box; and (3) It pushes for "portability" and individual ownership and control of that wellness. The Downside, at least for many libertarians, is: (a) how many mandates there are for government involvement in making this happen, requiring compliance from many segments of society, including those same individuals and their employers; (2) the fullscale trampling of the Tenth Amendment, mandating state creation of local coverage programs and monitoring of the results; and (3) perhaps most significantly, the lack of mention of Medical Savings Accounts, or other methods for funding self-responsible wellness, as part of its prescription.
Aside from this, however, there's a lot to recommend here. From the very first sentence, although the title is "Guaranteed Private Coverage," the explanatory statement following it (in the summary document) reads, "Within two years of enactment States must create a system as outlined in the bill to provide individuals the opportunity to purchase a Healthy Americans Private Insurance (HAPI) plan that meets the requirements of the Act." Notice how it says, "provide individuals the opportunity," not "require" them to; unless this is just more politico-speak, there's clearly some element of choice here.
On the other hand, the next section DOES use some coercive language: "Adults (over age 19, U.S. citizens, not incarcerated) must enroll themselves and dependent children in a plan offered through the state-wide Health Help Agency (HHA) [emphasis added] unless . [a laundry-list of specific exceptions]." It also then calls for a penalty for non-compliance, based on the period of such non-compliance times the average monthly premium for an appropriate plan, plus a 15% penalty, payable to the given state's HHA.
This seems coercive, and indeed it is; however, given the incentives for getting on board with the program, this might be considered almost forgivable. Note that the Senator does not mandate all of this in a vacuum. He begins by promoting the idea (long overdue, and presented several times in this space of late) that employers should stop providing health insurance for their hired hands, and should instead reallocate their funding of current programs to pay-raises, so the employees can do so themselves.
The catch is, those employees would then be expected to put that extra money into paying for their own health coverage, choosing among existing plans and those newly created under the program. The good news is, Wyden is encouraging self-responsibility for able-bodied, employable individuals, offering them an incentive to take charge of their own wellbeing. The bad part: As mentioned in the summary at the top, there's no reference anywhere in the document to medical savings accounts, or to combining high-deductible coverage with an MSA, or permitting any unused windfall (provided the person has maintained proper checkup and screening appointments, and been found hale and hearty thereunder) to become one's own "property" at the end of each year. Both concepts would not only allow for some intelligent decision-making for each of us, but would also enhance both cost savings and personal responsibility in the process.
There's also a very strong precedent already in place, in the existing employee programs at Whole Foods Company: The owner no longer pays insurance premiums, but pays the deductible amount on the policies of his workers - at the beginning of each year, and directly into their hands, to do with as they choose, while they remain responsible for maintaining their own wellness by whatever means possible. If at year's end, there is money left over, it's the employee's to spend as (s)he chooses. (Also, we might note, since this natural foods store-chain has both progressive and libertarian roots, one might think Sen. Wyden would already know of this program.)
As noted above, the Senator also would infringe further on the 10th Amendment to the Constitution, by mandating what each state should provide - "at least two plans that meet the requirements of the Act" - as well as in dictating what such plans may include: "(1) plans similar to the Blue Cross Blue Shield Standard Plan provided under the Federal Employees Health Benefit Program as of January 1, 2007; (2) plans with additional benefits added to the standard plan so long as those benefits are priced and displayed separately; and (3) actuarial equivalent plans to the standard plan." States-rights activists might not buy into this idea - however well-intended it may be - yet that intention is pretty clean on its surface......
An entire section of the HAPI plan addresses the division of "responsibilities" (thereby setting it far apart from almost every other government program within this editor's awareness). The requirements on individuals are simple: Enroll oneself and family in an approved plan, and pay the premiums required. If you wish to be subsidized for all or part of your premiums, you must turn in the proper paperwork, and keep the local HHA aware of any changing conditions or addresses. Otherwise, it's up to you to pay your premiums and use the services as needed. (Here's a chart showing the projected relative effect on various types of people in this plan.)
From employers, Wyden seeks an annual (relatively small, compared to paying health insurance premiums) administrative fee (based on the number of employees) and a transition from paying those insurance premiums, to paying workers more directly, so they can do so for themselves. (Companies above a certain size that aren't now providing such benefits would be expected to find a way to begin paying their workers some sort of increase, or suffer rather large fines. Here, the details are somewhat fuzzy.)
Moreover, says Wyden in no uncertain terms, "Individuals own their medical records." He wants us to start taking control of our own documentation, which is not all that burdensome, if we're getting regular preventive care from a chosen set of healthcare providers. (This chart shows the relative effect on various levels of employer-status.)....
And finally, the role of the Feds themselves is spelled out [paraphrasing here]: (a) fund insurance-premium subsidies; (b) establish a new "Healthy Americans Public Health Trust Fund" to feed with premiums and employer contributions (Wyden apparently believes in the "lockbox" concept that's worked so well for Social Security); (c) create a tax credits system for employees and employers who comply immediately with the new programs (as well as for retirement coverage); (d) create a Healthcare Standard Deduction for all citizens (mitigating or offsetting taxes on money spent on your own wellness), based on the level of coverage taken on; and (e) generally getting out of the way otherwise.....
Wyden also seeks to establish a baseline income-level, below which one would be eligible for total subsidy of such policy premiums, setting the current "poverty level" ($9,800 individual, $20,000 for a family of four) as that marker, with a sliding scale of subsidies extending up to the $40K ($80K per family) income-level. Again, by meshing a program that pushes people toward self-responsibility with one that subsidizes them directly, he tempts the fates to lose all perspective. Charitable work should not be conflated with pay-your-own-way and "hand up" ideas, lest both efforts be attenuated by the lack of clear intention.
Is this idea perfect? No, it still includes some very coercive features, which must be eliminated before it could truly become a self-responsible system. Does it address the major problems of the present healthcare mess? Yes, emphatically so. It also shows some promise for leading to a future where the vast majority of us are healthy, wealthy . and a lot wiser about what we do to our own bodies - that keeps them going longer, stronger and less in need of all that expensive "end-care" that is bankrupting us all. Senator Wyden is to be complimented on a very strong and extensive first step on this issue.
More here or 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 Pages are here or here or here.
***************************
Excerpts from an article by Steve Trinward that appears to have been censored at its original source
A new national healthcare plan was revealed this week, sponsored by Sen. Ron Wyden, a Democrat from Oregon. On first glance, it may appear to be just another variation on the Hillarycare model for socialized medicine, and in some ways it seems to be being promoted that way. However, this may be a case where marketing undercuts the reality, the way so many Hollywood films of recent vintage have done. (Who could have known how sensitive Adam Sandler's characters in Spanglish or 50 First Dates could be . based on the same old slapstick shown in the previews?)
Is it possible to craft a program that can blaze a path toward a true reform in healthcare? Let's find out, by examining the major ideas being brought forth in the Wyden plan. To begin with, let's summarize (details below): The Good News: (1) The program focuses strongly on wellness and prevention as a paradigm for healthcare; (2) It stresses self-responsibility, and offers a way out of the "employee benefit" box; and (3) It pushes for "portability" and individual ownership and control of that wellness. The Downside, at least for many libertarians, is: (a) how many mandates there are for government involvement in making this happen, requiring compliance from many segments of society, including those same individuals and their employers; (2) the fullscale trampling of the Tenth Amendment, mandating state creation of local coverage programs and monitoring of the results; and (3) perhaps most significantly, the lack of mention of Medical Savings Accounts, or other methods for funding self-responsible wellness, as part of its prescription.
Aside from this, however, there's a lot to recommend here. From the very first sentence, although the title is "Guaranteed Private Coverage," the explanatory statement following it (in the summary document) reads, "Within two years of enactment States must create a system as outlined in the bill to provide individuals the opportunity to purchase a Healthy Americans Private Insurance (HAPI) plan that meets the requirements of the Act." Notice how it says, "provide individuals the opportunity," not "require" them to; unless this is just more politico-speak, there's clearly some element of choice here.
On the other hand, the next section DOES use some coercive language: "Adults (over age 19, U.S. citizens, not incarcerated) must enroll themselves and dependent children in a plan offered through the state-wide Health Help Agency (HHA) [emphasis added] unless . [a laundry-list of specific exceptions]." It also then calls for a penalty for non-compliance, based on the period of such non-compliance times the average monthly premium for an appropriate plan, plus a 15% penalty, payable to the given state's HHA.
This seems coercive, and indeed it is; however, given the incentives for getting on board with the program, this might be considered almost forgivable. Note that the Senator does not mandate all of this in a vacuum. He begins by promoting the idea (long overdue, and presented several times in this space of late) that employers should stop providing health insurance for their hired hands, and should instead reallocate their funding of current programs to pay-raises, so the employees can do so themselves.
The catch is, those employees would then be expected to put that extra money into paying for their own health coverage, choosing among existing plans and those newly created under the program. The good news is, Wyden is encouraging self-responsibility for able-bodied, employable individuals, offering them an incentive to take charge of their own wellbeing. The bad part: As mentioned in the summary at the top, there's no reference anywhere in the document to medical savings accounts, or to combining high-deductible coverage with an MSA, or permitting any unused windfall (provided the person has maintained proper checkup and screening appointments, and been found hale and hearty thereunder) to become one's own "property" at the end of each year. Both concepts would not only allow for some intelligent decision-making for each of us, but would also enhance both cost savings and personal responsibility in the process.
There's also a very strong precedent already in place, in the existing employee programs at Whole Foods Company: The owner no longer pays insurance premiums, but pays the deductible amount on the policies of his workers - at the beginning of each year, and directly into their hands, to do with as they choose, while they remain responsible for maintaining their own wellness by whatever means possible. If at year's end, there is money left over, it's the employee's to spend as (s)he chooses. (Also, we might note, since this natural foods store-chain has both progressive and libertarian roots, one might think Sen. Wyden would already know of this program.)
As noted above, the Senator also would infringe further on the 10th Amendment to the Constitution, by mandating what each state should provide - "at least two plans that meet the requirements of the Act" - as well as in dictating what such plans may include: "(1) plans similar to the Blue Cross Blue Shield Standard Plan provided under the Federal Employees Health Benefit Program as of January 1, 2007; (2) plans with additional benefits added to the standard plan so long as those benefits are priced and displayed separately; and (3) actuarial equivalent plans to the standard plan." States-rights activists might not buy into this idea - however well-intended it may be - yet that intention is pretty clean on its surface......
An entire section of the HAPI plan addresses the division of "responsibilities" (thereby setting it far apart from almost every other government program within this editor's awareness). The requirements on individuals are simple: Enroll oneself and family in an approved plan, and pay the premiums required. If you wish to be subsidized for all or part of your premiums, you must turn in the proper paperwork, and keep the local HHA aware of any changing conditions or addresses. Otherwise, it's up to you to pay your premiums and use the services as needed. (Here's a chart showing the projected relative effect on various types of people in this plan.)
From employers, Wyden seeks an annual (relatively small, compared to paying health insurance premiums) administrative fee (based on the number of employees) and a transition from paying those insurance premiums, to paying workers more directly, so they can do so for themselves. (Companies above a certain size that aren't now providing such benefits would be expected to find a way to begin paying their workers some sort of increase, or suffer rather large fines. Here, the details are somewhat fuzzy.)
Moreover, says Wyden in no uncertain terms, "Individuals own their medical records." He wants us to start taking control of our own documentation, which is not all that burdensome, if we're getting regular preventive care from a chosen set of healthcare providers. (This chart shows the relative effect on various levels of employer-status.)....
And finally, the role of the Feds themselves is spelled out [paraphrasing here]: (a) fund insurance-premium subsidies; (b) establish a new "Healthy Americans Public Health Trust Fund" to feed with premiums and employer contributions (Wyden apparently believes in the "lockbox" concept that's worked so well for Social Security); (c) create a tax credits system for employees and employers who comply immediately with the new programs (as well as for retirement coverage); (d) create a Healthcare Standard Deduction for all citizens (mitigating or offsetting taxes on money spent on your own wellness), based on the level of coverage taken on; and (e) generally getting out of the way otherwise.....
Wyden also seeks to establish a baseline income-level, below which one would be eligible for total subsidy of such policy premiums, setting the current "poverty level" ($9,800 individual, $20,000 for a family of four) as that marker, with a sliding scale of subsidies extending up to the $40K ($80K per family) income-level. Again, by meshing a program that pushes people toward self-responsibility with one that subsidizes them directly, he tempts the fates to lose all perspective. Charitable work should not be conflated with pay-your-own-way and "hand up" ideas, lest both efforts be attenuated by the lack of clear intention.
Is this idea perfect? No, it still includes some very coercive features, which must be eliminated before it could truly become a self-responsible system. Does it address the major problems of the present healthcare mess? Yes, emphatically so. It also shows some promise for leading to a future where the vast majority of us are healthy, wealthy . and a lot wiser about what we do to our own bodies - that keeps them going longer, stronger and less in need of all that expensive "end-care" that is bankrupting us all. Senator Wyden is to be complimented on a very strong and extensive first step on this issue.
More here or 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 Pages are here or here or here.
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Tuesday, December 26, 2006
THE STRANGE PRIORITIES OF GOVERNMENT MEDICINE IN CALIFORNIA
Jail inmates, most of whom are citizens, go without medical care while non-citizens get a huge amount spent on them. Government medicine always has to prioritize but these priorities don't seem to be medical at all. Two reports below from one newspaper on the same day.
Inmates
Treatment errors and other breakdowns in medical care have contributed to the deaths of at least 14 inmates in the Los Angeles County Jail system since 1999, according to a newspaper report. The jail system lacks enough doctors, nurses and other medical workers, resulting in long delays in treatment for conditions ranging from hernias to heart disease, the Los Angeles Times reported in Sunday editions. Inmates sometimes have wait weeks for exams they're supposed to receive within 24 hours of making a request.
Officials acknowledge that 20 percent of inmates who ask to see a doctor are released from jail without ever being examined, according to the Times. Jody Kent, a court-sanctioned monitor who for three years walked the county's cellblocks documenting complaints for the American Civil Liberties Union, said inmates showed her gaping wounds from infections, broken bones and bulging hernias. "I basically saw grown men crying because they were in such pain," Kent said.
Sheriff's Lt. Stephen Smith, who oversees the jail system's medical services bureau, said treating prisoners is difficult because some conceal a medical condition while others feign illness or are mentally ill. "We face unique challenges, and we do the best we can," Smith said. "These are difficult, angry, messed-up people. We try to treat people with the respect, not that they necessarily deserve, but that human decency demands."
A large problem is understaffing. In a confidential 2004 report, a consultant said an additional 720 jail medical workers were needed to meet minimum state treatment standards. At the time, the work force stood at about 980. "The county incurs significant liability for continuing a system of care that clearly is not working," the consultant said in the report to the Los Angeles County Board of Supervisors. Spurred by those findings, officials began to bolster the ranks of doctors and nurses, but several hundred medical workers are still lacking. An average of about 200,000 people enter the county jails each year. On most nights, the population hovers around 18,000, with more than a third requiring medical care.
The county Sheriff's Department, which runs the jails, is required by law to provide basic medical care to all inmates. When inmates are booked, they are questioned to determine if they are physically or mentally ill. About half require additional screening or treatment before being assigned to a cell. If inmates develop medical problems later, there are daily "sick calls" in which they can sign up to see a nurse. The volume of inmates, coupled with a shortage of doctors and nurses, has resulted in a backlog of hundreds of inmates waiting to be examined. "I could have every doctor in the county of Los Angeles here, and it still wouldn't be enough," said Sander Peck, chief physician in the jail system. "I don't know what 'enough' would be."
Source
Illegals
More than 100,000 undocumented women each year bear children in California with expenses paid by Medi-Cal, according to state reports. Such births and related expenses account for more than $400 million of the nearly $1 billion that the program spends annually on health care for illegal immigrants in California, the Los Angeles Times reported, citing state reports. California long has been one of the more generous states in offering such benefits to illegal immigrants, covering everything from pregnancy tests to postpartum checkups.
Many illegal immigrants who might otherwise shy away from government services view care associated with childbirth as safe to seek. "I wasn't afraid at all," said Sandra Andrade, an illegal immigrant from Colombia who recently gave birth at a Los Angeles hospital. "I'd always heard that pregnant women are treated well here."
Nationally, a debate is simmering about the costs of providing medical care to illegal immigrants. Anti-illegal immigration groups argue that "birthright" U.S. citizenship for babies born in America is an incentive for illegal immigrants to have their children here. "I think most Americans think that while they certainly don't want to do anything to harm children you cannot have a policy that says anybody in the world come here and have a baby and we have a new American," said Ira Mehlman, a spokesman for the Federation of American Immigration Reform, an immigration control group based in Washington, D.C.
Prenatal care is one of the most controversial aspects of providing health care to illegal immigrants. While labor and delivery long have been considered emergencies, entitled to some federal reimbursement, federal officials have often balked at covering prenatal care. Generally, the state and federal governments share the cost of Medicaid programs, called Medi-Cal in California. Advocates of such coverage say it's cheaper to pay for prenatal care than risk complications that could saddle the government with huge medical bills. "Without prenatal care, there's a serious risk that a child will be born with severe disabilities," said Lucy Quacinella, a lobbyist for the Los Angeles-based social service nonprofit group Maternal and Child Health Access. "The cost of caring for that child over a lifetime is astronomical when you compare the cost of having provided the prenatal care."
Still, investing in pregnant illegal immigrants is costly. Births and prenatal care are the biggest single outlay by Medi-Cal for illegal immigrants' health care, with the rest going for various other emergency treatments, limited breast and cervical cancer treatment, abortions and some nursing home care, according to the state. In Los Angeles County's public and private hospitals, undocumented women accounted for 41,240 Medi-Cal births in 2004, roughly half the deliveries covered by the public program. In the four county-run hospitals alone, undocumented women and their newborns will receive more than $20 million in delivery, recovery, nursery and neonatal ICU services this year, according to a county estimate.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Jail inmates, most of whom are citizens, go without medical care while non-citizens get a huge amount spent on them. Government medicine always has to prioritize but these priorities don't seem to be medical at all. Two reports below from one newspaper on the same day.
Inmates
Treatment errors and other breakdowns in medical care have contributed to the deaths of at least 14 inmates in the Los Angeles County Jail system since 1999, according to a newspaper report. The jail system lacks enough doctors, nurses and other medical workers, resulting in long delays in treatment for conditions ranging from hernias to heart disease, the Los Angeles Times reported in Sunday editions. Inmates sometimes have wait weeks for exams they're supposed to receive within 24 hours of making a request.
Officials acknowledge that 20 percent of inmates who ask to see a doctor are released from jail without ever being examined, according to the Times. Jody Kent, a court-sanctioned monitor who for three years walked the county's cellblocks documenting complaints for the American Civil Liberties Union, said inmates showed her gaping wounds from infections, broken bones and bulging hernias. "I basically saw grown men crying because they were in such pain," Kent said.
Sheriff's Lt. Stephen Smith, who oversees the jail system's medical services bureau, said treating prisoners is difficult because some conceal a medical condition while others feign illness or are mentally ill. "We face unique challenges, and we do the best we can," Smith said. "These are difficult, angry, messed-up people. We try to treat people with the respect, not that they necessarily deserve, but that human decency demands."
A large problem is understaffing. In a confidential 2004 report, a consultant said an additional 720 jail medical workers were needed to meet minimum state treatment standards. At the time, the work force stood at about 980. "The county incurs significant liability for continuing a system of care that clearly is not working," the consultant said in the report to the Los Angeles County Board of Supervisors. Spurred by those findings, officials began to bolster the ranks of doctors and nurses, but several hundred medical workers are still lacking. An average of about 200,000 people enter the county jails each year. On most nights, the population hovers around 18,000, with more than a third requiring medical care.
The county Sheriff's Department, which runs the jails, is required by law to provide basic medical care to all inmates. When inmates are booked, they are questioned to determine if they are physically or mentally ill. About half require additional screening or treatment before being assigned to a cell. If inmates develop medical problems later, there are daily "sick calls" in which they can sign up to see a nurse. The volume of inmates, coupled with a shortage of doctors and nurses, has resulted in a backlog of hundreds of inmates waiting to be examined. "I could have every doctor in the county of Los Angeles here, and it still wouldn't be enough," said Sander Peck, chief physician in the jail system. "I don't know what 'enough' would be."
Source
Illegals
More than 100,000 undocumented women each year bear children in California with expenses paid by Medi-Cal, according to state reports. Such births and related expenses account for more than $400 million of the nearly $1 billion that the program spends annually on health care for illegal immigrants in California, the Los Angeles Times reported, citing state reports. California long has been one of the more generous states in offering such benefits to illegal immigrants, covering everything from pregnancy tests to postpartum checkups.
Many illegal immigrants who might otherwise shy away from government services view care associated with childbirth as safe to seek. "I wasn't afraid at all," said Sandra Andrade, an illegal immigrant from Colombia who recently gave birth at a Los Angeles hospital. "I'd always heard that pregnant women are treated well here."
Nationally, a debate is simmering about the costs of providing medical care to illegal immigrants. Anti-illegal immigration groups argue that "birthright" U.S. citizenship for babies born in America is an incentive for illegal immigrants to have their children here. "I think most Americans think that while they certainly don't want to do anything to harm children you cannot have a policy that says anybody in the world come here and have a baby and we have a new American," said Ira Mehlman, a spokesman for the Federation of American Immigration Reform, an immigration control group based in Washington, D.C.
Prenatal care is one of the most controversial aspects of providing health care to illegal immigrants. While labor and delivery long have been considered emergencies, entitled to some federal reimbursement, federal officials have often balked at covering prenatal care. Generally, the state and federal governments share the cost of Medicaid programs, called Medi-Cal in California. Advocates of such coverage say it's cheaper to pay for prenatal care than risk complications that could saddle the government with huge medical bills. "Without prenatal care, there's a serious risk that a child will be born with severe disabilities," said Lucy Quacinella, a lobbyist for the Los Angeles-based social service nonprofit group Maternal and Child Health Access. "The cost of caring for that child over a lifetime is astronomical when you compare the cost of having provided the prenatal care."
Still, investing in pregnant illegal immigrants is costly. Births and prenatal care are the biggest single outlay by Medi-Cal for illegal immigrants' health care, with the rest going for various other emergency treatments, limited breast and cervical cancer treatment, abortions and some nursing home care, according to the state. In Los Angeles County's public and private hospitals, undocumented women accounted for 41,240 Medi-Cal births in 2004, roughly half the deliveries covered by the public program. In the four county-run hospitals alone, undocumented women and their newborns will receive more than $20 million in delivery, recovery, nursery and neonatal ICU services this year, according to a county estimate.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Monday, December 25, 2006
AUSTRALIA: WOMEN PAY FOR CONSTANT LITIGATION AGAINST OBSTETRICIANS
By Bettina Arndt
The battle was supposed to be won more than 30 years ago when the women's movement pushed for the right to make informed decisions about their health care.... Women emerged determined to no longer be passive recipients of over-medicalised health care, particularly during childbirth. But those of us old enough to remember those days are blown away by what's happening in today's obstetric care.
Recently a 50-something Sydney midwife spent a few days working in a Sydney private hospital. She was amazed that of the 30 to 40 new mothers she cared for, only a handful had vaginal births and many chose elective caesarean with no medical indication. How can so many women have been hoodwinked into thinking that a caesarean is the best option for them and their babies?
What's happened is the doctors have been burnt. There have been some major payouts for medical negligence over cases where it was argued obstetricians should have done a caesarean, or done one sooner. The result is obstetricians are fast losing the skills to handle the difficult cases.
This all gives the impression that caesareans are a safer method of delivery, for women and their babies. Yet, a recent French study suggested caesarean delivery more than triples a woman's risk of dying in childbirth compared to vaginal delivery. Luckily these risks are small, but they rise significantly with each caesarean. These babies are more likely to suffer respiratory distress; labor prepares babies for breathing by massaging respiratory organs and aiding elimination of mucus from their systems.
Yes, there are horror stories but many women are being conned into thinking caesareans offer an easy way out. Even the broken coccyx I experienced during my son's natural birth was nothing compared to the ordeal of recovering from my two caesareans. For every mother on the internet claiming the caesarean was a breeze, there are others talking of horrible post-surgery pain, the problems looking after a new baby with a painful scar, difficulties with healing, long-term complications.
It's hardly surprising there is evidence caesarean births mean mothers are more likely to have early parenting difficulties and post-traumatic stress. Yet our caesarean rates are soaring. The caesarean rate hit close to 30 per cent in 2004, increasing to 38 per cent for women in private hospitals, according to figures released by the Australian Institute of Health and Welfare. If these figures keep rising, it may spell the end of normal vaginal births. There simply won't be the skilled obstetricians or midwives available to help if the going gets tough.
And more mothers and babies will die as a result. Countries like Brazil, which have already gone down that route, are showing increases in maternal and child mortality. In affluent areas of Brazil, there are hospitals with more than 80 per cent caesarean rates. Across Australia, maternity hospitals are already feeling the strain, as elective caesareans add to the burden on theatres, surgical and nursing resources.
Women contemplating elective caesarean, without good medical reasons, need to understand the risks to themselves and their babies. The majority of Australian women believe women's bodies were made to give birth without a knife.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
By Bettina Arndt
The battle was supposed to be won more than 30 years ago when the women's movement pushed for the right to make informed decisions about their health care.... Women emerged determined to no longer be passive recipients of over-medicalised health care, particularly during childbirth. But those of us old enough to remember those days are blown away by what's happening in today's obstetric care.
Recently a 50-something Sydney midwife spent a few days working in a Sydney private hospital. She was amazed that of the 30 to 40 new mothers she cared for, only a handful had vaginal births and many chose elective caesarean with no medical indication. How can so many women have been hoodwinked into thinking that a caesarean is the best option for them and their babies?
What's happened is the doctors have been burnt. There have been some major payouts for medical negligence over cases where it was argued obstetricians should have done a caesarean, or done one sooner. The result is obstetricians are fast losing the skills to handle the difficult cases.
This all gives the impression that caesareans are a safer method of delivery, for women and their babies. Yet, a recent French study suggested caesarean delivery more than triples a woman's risk of dying in childbirth compared to vaginal delivery. Luckily these risks are small, but they rise significantly with each caesarean. These babies are more likely to suffer respiratory distress; labor prepares babies for breathing by massaging respiratory organs and aiding elimination of mucus from their systems.
Yes, there are horror stories but many women are being conned into thinking caesareans offer an easy way out. Even the broken coccyx I experienced during my son's natural birth was nothing compared to the ordeal of recovering from my two caesareans. For every mother on the internet claiming the caesarean was a breeze, there are others talking of horrible post-surgery pain, the problems looking after a new baby with a painful scar, difficulties with healing, long-term complications.
It's hardly surprising there is evidence caesarean births mean mothers are more likely to have early parenting difficulties and post-traumatic stress. Yet our caesarean rates are soaring. The caesarean rate hit close to 30 per cent in 2004, increasing to 38 per cent for women in private hospitals, according to figures released by the Australian Institute of Health and Welfare. If these figures keep rising, it may spell the end of normal vaginal births. There simply won't be the skilled obstetricians or midwives available to help if the going gets tough.
And more mothers and babies will die as a result. Countries like Brazil, which have already gone down that route, are showing increases in maternal and child mortality. In affluent areas of Brazil, there are hospitals with more than 80 per cent caesarean rates. Across Australia, maternity hospitals are already feeling the strain, as elective caesareans add to the burden on theatres, surgical and nursing resources.
Women contemplating elective caesarean, without good medical reasons, need to understand the risks to themselves and their babies. The majority of Australian women believe women's bodies were made to give birth without a knife.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Sunday, December 24, 2006
CALIFORNIA HEALTH CARE PLAN A RECIPE FOR DISASTER
State Senate President Don Perata has a plan to provide all uninsured working Californians with health insurance at an estimated cost of $5 billion to $7 billion without a tax increase. OK? The Perata plan would force businesses that do not provide health insurance and their employees, through a payroll deduction, to pay into a state agency that would attempt to negotiate for "affordable" coverage. When paying taxes, workers would have to show proof of medical insurance. This is just plain wrong on so many levels. Let me count the ways.
A plan that is estimated to cost $5 billion to $7 billion will, if past government program estimates are any guide, cost a lot more than first advertised. One only has to look at the Bush prescription benefit plan as a reminder.
Apparently our state's second-most-powerful elected official believes there is such a thing as a free lunch. He should know that a plan that compels businesses to lay out more for labor than its market value is a tax on those businesses. It will cost businesses and, as the increased costs are passed on, it will also cost consumers, too. Employees, many working at low-wage jobs, will see a reduction in their paychecks. Just like the other taxes they pay, this health insurance charge will translate into less take-home pay.
As the cost of employment goes up, workers are likely to face a second problem: fewer jobs. What is worse than no health insurance? No health insurance and no job. And proof of insurance to pay taxes? This would only force one more nuisance, clerical mandate on a public already overwhelmed with nuisance mandates from government.
And a state-run program is a recipe for disaster. Anyone who has had dealings with an unaccountable bureaucracy like the DMV or the post office knows what a headache even a minor problem can become.
Perata justifies his plan as cost-effective because, he says, taxpayers already pay the health care costs for the uninsured when they end up in our emergency rooms. But the senator ignores the elephant in the room. The additional burden that is breaking the back of our emergency health care system is illegal immigrants. Our neighbors to the south are "outsourcing" their health care demands. As long as the federal government takes a lackadaisical approach to border enforcement, this problem will continue. Solving a health care problem, a major component of which is caused by those who are in the country illegally, should not be the financial obligation of small businesses, their work force or of California taxpayers.
This is a federal responsibility, and now that California representatives have new positions of power in Washington, D.C., Perata would be well advised to press fellow Bay Area Democrat, and soon to be speaker of the House, Nancy Pelosi, to see that the federal government makes good on its obligations. However, the issue of state-mandated and supervised health care is part of an even larger problem. That problem is powerful politicians who are committed to a government that is all things to all people, and who believe this can be accomplished without cost.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
State Senate President Don Perata has a plan to provide all uninsured working Californians with health insurance at an estimated cost of $5 billion to $7 billion without a tax increase. OK? The Perata plan would force businesses that do not provide health insurance and their employees, through a payroll deduction, to pay into a state agency that would attempt to negotiate for "affordable" coverage. When paying taxes, workers would have to show proof of medical insurance. This is just plain wrong on so many levels. Let me count the ways.
A plan that is estimated to cost $5 billion to $7 billion will, if past government program estimates are any guide, cost a lot more than first advertised. One only has to look at the Bush prescription benefit plan as a reminder.
Apparently our state's second-most-powerful elected official believes there is such a thing as a free lunch. He should know that a plan that compels businesses to lay out more for labor than its market value is a tax on those businesses. It will cost businesses and, as the increased costs are passed on, it will also cost consumers, too. Employees, many working at low-wage jobs, will see a reduction in their paychecks. Just like the other taxes they pay, this health insurance charge will translate into less take-home pay.
As the cost of employment goes up, workers are likely to face a second problem: fewer jobs. What is worse than no health insurance? No health insurance and no job. And proof of insurance to pay taxes? This would only force one more nuisance, clerical mandate on a public already overwhelmed with nuisance mandates from government.
And a state-run program is a recipe for disaster. Anyone who has had dealings with an unaccountable bureaucracy like the DMV or the post office knows what a headache even a minor problem can become.
Perata justifies his plan as cost-effective because, he says, taxpayers already pay the health care costs for the uninsured when they end up in our emergency rooms. But the senator ignores the elephant in the room. The additional burden that is breaking the back of our emergency health care system is illegal immigrants. Our neighbors to the south are "outsourcing" their health care demands. As long as the federal government takes a lackadaisical approach to border enforcement, this problem will continue. Solving a health care problem, a major component of which is caused by those who are in the country illegally, should not be the financial obligation of small businesses, their work force or of California taxpayers.
This is a federal responsibility, and now that California representatives have new positions of power in Washington, D.C., Perata would be well advised to press fellow Bay Area Democrat, and soon to be speaker of the House, Nancy Pelosi, to see that the federal government makes good on its obligations. However, the issue of state-mandated and supervised health care is part of an even larger problem. That problem is powerful politicians who are committed to a government that is all things to all people, and who believe this can be accomplished without cost.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Saturday, December 23, 2006
FDA may ease access to new drugs
A small step forward or more bureaucracy?
The Food and Drug Administration said Monday that it is proposing to expand access to experimental drugs for seriously sick patients, and would allow drug companies to charge for as yet unapproved therapies. For decades the FDA has allowed some patients to take drugs that are still under investigation and awaiting government approval. But the guidelines for when those drugs could be used were not explicit or broad enough, the FDA said, nor was there enough awareness among doctors and patients of what options were available.
The new rules are intended to give physicians clear directives on when to grant access to medications, even perhaps at the very earliest stage of development, in cases in which the potential benefit is deemed to outweigh the risks. The goal, the FDA said, is to give "many more patients" access to unapproved medicines. For example, until now the rules limited the use of such drugs to certain groups.
Additionally, the FDA said it was moving to address "inequities in access" to experimental drugs. In situations outside the most sophisticated teaching hospitals, it has been possible for viable treatment options to get overlooked. "We expect that clearly articulating procedures and standards for expanded access will result in more patients with serious or immediately life-threatening diseases or conditions getting the earliest possible access to these therapies," the FDA said.
In some situations in recent years, according to patient advocates, drugs that appeared to give significant hope to the seriously ill were withheld for further testing. One example they cite is Erbitux, which was not widely distributed until final FDA approval even though it had shown efficacy early on in treating some forms of cancer.
Use of these unapproved drugs, even those of unknown safety, will be reserved for the most grave medical problems, said Dr. Rachel Behrman, deputy director of the FDA's office of medical policy. "We are not talking about the temporary relief of minor pain," Behrman said. "We are talking about serious diseases." The FDA would also allow researchers to charge patients for experimental drugs to recover the costs of development, but not a profit. This is intended to make drugs more available in cases in which their high cost might deter a small pharmaceutical company from offering an unproven treatment.
"FDA hopes this proposal will increase awareness in the health-care community of the range of options available for obtaining experimental drugs for seriously ill patients," said Dr. Janet Woodcock, the agency's deputy commissioner for operations. The proposal, which is open for comment for 90 days, codifies and makes formal policies that have grown up over the years.
Use of unproven drugs has been a hot-button issue for decades. AIDS activists have long complained that the approval process for drugs is too slow. The FDA noted that tens of thousands of patients have already received unapproved drugs for treatment of HIV, cancer and heart disease. However, the existing regulations did not adequately describe the full range of programs available, the agency said in statement.
One health advocate sounded a warning about the proposal to use drugs that have not been proven risk-free. "None of these drugs do we know are safe and effective," said Dr. Sidney Wolfe, editor of WorstPills.org, a part of Public Citizen. "You may be doing people more harm than good," he said. Wolfe noted that experimental drugs for cancer and AIDS often have toxic side effects that can present a danger to patients.
But Frank Burroughs, president of the Abigail Alliance for Better Access to Developmental Drugs, said the FDA does not go far enough in assuring quick access to all drugs that could help patients. Burroughs said that in many cases it is quickly apparent that a drug is safe and effective yet still is not made available to people who would benefit from it. "A good example is Erbitux," Burroughs said. He said that Erbitux quickly displayed effectiveness in treating cancers of the head, neck and colon. "Abigail was my daughter," Burroughs said. "She died in 2001 after being unable to get Erbitux."
Next year a federal court is scheduled to hear a case brought by the Abigail Alliance and the Washington Legal Foundation aimed at making experimental drugs more accessible to patients.
Source
TWO YEAR WAIT FOR SOME IN BRITAIN
Some patients needing orthopaedic surgery are still waiting more than two years for treatment, according to new figures.
The latest official statistics on NHS performance with regard to the 18-week waiting times target showed that some specialities were performing particularly poorly.
In what is widely considered to be the most ambitious target for the health service, the Government has pledged that no patient should wait more than 18 weeks from GP referral to the start of treatment, whether they are an in-patient or an out-patient, by the end of 2008.
Figures released yesterday by Andy Burnham, Health Minister showed that most specialities - including gynaecology, dermatology and cardiology - treat between 30 per cent and 50 per cent of in-patients within 18 weeks. But that figure falls to below 20 per cent in trauma and orthopaedics - which includes hip replacements and broken bones - where the average patient waits an average of 39 weeks for treatment. The new figures show that an average of 70 per cent to 80 per cent of patients who do not require hospital admission are treated within 18 weeks.
When it comes to patients needing hospital admission, only 35 per cent are seen within the target.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
A small step forward or more bureaucracy?
The Food and Drug Administration said Monday that it is proposing to expand access to experimental drugs for seriously sick patients, and would allow drug companies to charge for as yet unapproved therapies. For decades the FDA has allowed some patients to take drugs that are still under investigation and awaiting government approval. But the guidelines for when those drugs could be used were not explicit or broad enough, the FDA said, nor was there enough awareness among doctors and patients of what options were available.
The new rules are intended to give physicians clear directives on when to grant access to medications, even perhaps at the very earliest stage of development, in cases in which the potential benefit is deemed to outweigh the risks. The goal, the FDA said, is to give "many more patients" access to unapproved medicines. For example, until now the rules limited the use of such drugs to certain groups.
Additionally, the FDA said it was moving to address "inequities in access" to experimental drugs. In situations outside the most sophisticated teaching hospitals, it has been possible for viable treatment options to get overlooked. "We expect that clearly articulating procedures and standards for expanded access will result in more patients with serious or immediately life-threatening diseases or conditions getting the earliest possible access to these therapies," the FDA said.
In some situations in recent years, according to patient advocates, drugs that appeared to give significant hope to the seriously ill were withheld for further testing. One example they cite is Erbitux, which was not widely distributed until final FDA approval even though it had shown efficacy early on in treating some forms of cancer.
Use of these unapproved drugs, even those of unknown safety, will be reserved for the most grave medical problems, said Dr. Rachel Behrman, deputy director of the FDA's office of medical policy. "We are not talking about the temporary relief of minor pain," Behrman said. "We are talking about serious diseases." The FDA would also allow researchers to charge patients for experimental drugs to recover the costs of development, but not a profit. This is intended to make drugs more available in cases in which their high cost might deter a small pharmaceutical company from offering an unproven treatment.
"FDA hopes this proposal will increase awareness in the health-care community of the range of options available for obtaining experimental drugs for seriously ill patients," said Dr. Janet Woodcock, the agency's deputy commissioner for operations. The proposal, which is open for comment for 90 days, codifies and makes formal policies that have grown up over the years.
Use of unproven drugs has been a hot-button issue for decades. AIDS activists have long complained that the approval process for drugs is too slow. The FDA noted that tens of thousands of patients have already received unapproved drugs for treatment of HIV, cancer and heart disease. However, the existing regulations did not adequately describe the full range of programs available, the agency said in statement.
One health advocate sounded a warning about the proposal to use drugs that have not been proven risk-free. "None of these drugs do we know are safe and effective," said Dr. Sidney Wolfe, editor of WorstPills.org, a part of Public Citizen. "You may be doing people more harm than good," he said. Wolfe noted that experimental drugs for cancer and AIDS often have toxic side effects that can present a danger to patients.
But Frank Burroughs, president of the Abigail Alliance for Better Access to Developmental Drugs, said the FDA does not go far enough in assuring quick access to all drugs that could help patients. Burroughs said that in many cases it is quickly apparent that a drug is safe and effective yet still is not made available to people who would benefit from it. "A good example is Erbitux," Burroughs said. He said that Erbitux quickly displayed effectiveness in treating cancers of the head, neck and colon. "Abigail was my daughter," Burroughs said. "She died in 2001 after being unable to get Erbitux."
Next year a federal court is scheduled to hear a case brought by the Abigail Alliance and the Washington Legal Foundation aimed at making experimental drugs more accessible to patients.
Source
TWO YEAR WAIT FOR SOME IN BRITAIN
Some patients needing orthopaedic surgery are still waiting more than two years for treatment, according to new figures.
The latest official statistics on NHS performance with regard to the 18-week waiting times target showed that some specialities were performing particularly poorly.
In what is widely considered to be the most ambitious target for the health service, the Government has pledged that no patient should wait more than 18 weeks from GP referral to the start of treatment, whether they are an in-patient or an out-patient, by the end of 2008.
Figures released yesterday by Andy Burnham, Health Minister showed that most specialities - including gynaecology, dermatology and cardiology - treat between 30 per cent and 50 per cent of in-patients within 18 weeks. But that figure falls to below 20 per cent in trauma and orthopaedics - which includes hip replacements and broken bones - where the average patient waits an average of 39 weeks for treatment. The new figures show that an average of 70 per cent to 80 per cent of patients who do not require hospital admission are treated within 18 weeks.
When it comes to patients needing hospital admission, only 35 per cent are seen within the target.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Friday, December 22, 2006
NHS BANNING NECKTIES
In an attempt to deflect blame for MRSA from where it really belongs -- dirty hospitals and negligent staff
Doctors have been banned from wearing ties in an effort to contain the spread of superbug MRSA. An NHS trust has told hospital staff, including senior consultants, that the wearing of ties and "other superfluous clothing" could result in disciplinary action. The rules have been introduced by the Brighton and Sussex University Hospitals NHS Trust in a bid to reduce its rate of MRSA infection, which is one of the highest in England. The new dress code policy also bans staff involved in direct clinical care from wearing jewellery, watches, scarves and wraps.
But doctors say the new rules stem from political correctness rather than scientific evidence and fear that patients will have less confidence in casually dressed medics. One consultant, who works for the trust but did not want to be named, told the Sunday Times: "If you come to see a consultant, you will be greeted by an open-neck-shirted doctor who will look as if he is the hospital DJ, but will in fact be the consultant." Dr Michael Dixon, chairman of the NHS Alliance, which represents primary care trusts, and wears a bow-tie at his GP surgery, told the paper: "This is political correctness rather than science. Patients need to be able to respect and trust their doctors and going around without ties might damage that relationship."
Earlier this year the British Medical Association suggested that doing away with functionless items of clothing such as ties may help reduce rates of MRSA and other hospital acquired infections. Over 3,500 cases of MRSA blood-stream infection were reported in NHS hospitals between October 2005 and March 2006 and the number of deaths where the superbug is mentioned on death certificates has increased each year from 1993 to 2004. A spokeswoman for the trust said action was needed to improve infection control rates and that the new measures were introduced following consultation with staff.
Source
Harmed in NSW public hospitals: 500 errors a record
NSW is Australia's most populous State
Almost 500 medical errors in NSW public hospitals either seriously harmed patients or could have done so in 2005-06 - the highest number in the three years the statistics have been collected. Problems with diagnosis, treatment and specialist referral topped the list of incidents judged to be in the most serious category, followed by 137 suicides that occurred outside hospital within a week of the person having been seen by a mental-health professional. Birth problems and avoidable falls also figured prominently, and 36 operations or X-rays were either performed or planned for the wrong person or part of the body. Instruments were left in the body after 11 operations. There were four serious problems with medication or intravenous fluids in the reporting period to June 30.
In a separate notice distributed to area health services in April, the Health Department informed doctors and managers of a "near miss" involving the leukaemia drug vincristine, which is intended for intravenous injection and is almost always fatal if injected into the spinal canal.
The Minister for Health, John Hatzistergos, said the increase - to 499 serious incidents from 429 the previous year - did not mean hospitals were less safe, and instead reflected an increased willingness by health workers to record incidents they witnessed. As well, the reporting program had been extended to the ambulance and prison health services.
Cliff Hughes, the chief executive officer of the Clinical Excellence Commission responsible for analysing the cases, said the increase in reports "tells us the system has a desire to improve". "The aim is to be proactive in preventing serious adverse events from harming our patients," he said. The reports demonstrated health workers' confidence in bringing dangerous incidents to light in a no-blame environment, he said, and represented "a huge culture change".
The commission was formed as a supervisory body for public hospital treatment standards after a group of nurses at Camden and Campbelltown hospitals revealed numerous medical errors. Its analysis found policies and procedures were to blame for a quarter of the errors and near misses. These included inadequate training requirements for some staff. Another quarter were attributable to communication problems, particularly when patient care was handed over to a different medical team or between shifts. Incompetence or outdated skills were behind almost 100 cases, and inadequate ratios of medical staff to patients, or rostering of junior doctors into senior roles, was at the heart of about 70 of the problems. Equipment failure was much less common.
Some improvements could be made by basic changes to practice, Professor Hughes said. Hospital infection rates had been reduced after the provision of bedside alcohol-based gels for cleaning hands, instead of requiring health workers to go to the sink to wash. New protocols were being developed to identify people most at risk of falls - the over-65s and those taking multiple medications - so they could be given extra assistance in hospital.
But Mr Hatzistergos said a certain level of human and system error was unavoidable. "We haven't reached a stage where we have infallibility or perfection in medical science," he said. The collection of data would be further expanded to take in private hospitals in NSW, which perform the majority of colonoscopies and some other procedures.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
In an attempt to deflect blame for MRSA from where it really belongs -- dirty hospitals and negligent staff
Doctors have been banned from wearing ties in an effort to contain the spread of superbug MRSA. An NHS trust has told hospital staff, including senior consultants, that the wearing of ties and "other superfluous clothing" could result in disciplinary action. The rules have been introduced by the Brighton and Sussex University Hospitals NHS Trust in a bid to reduce its rate of MRSA infection, which is one of the highest in England. The new dress code policy also bans staff involved in direct clinical care from wearing jewellery, watches, scarves and wraps.
But doctors say the new rules stem from political correctness rather than scientific evidence and fear that patients will have less confidence in casually dressed medics. One consultant, who works for the trust but did not want to be named, told the Sunday Times: "If you come to see a consultant, you will be greeted by an open-neck-shirted doctor who will look as if he is the hospital DJ, but will in fact be the consultant." Dr Michael Dixon, chairman of the NHS Alliance, which represents primary care trusts, and wears a bow-tie at his GP surgery, told the paper: "This is political correctness rather than science. Patients need to be able to respect and trust their doctors and going around without ties might damage that relationship."
Earlier this year the British Medical Association suggested that doing away with functionless items of clothing such as ties may help reduce rates of MRSA and other hospital acquired infections. Over 3,500 cases of MRSA blood-stream infection were reported in NHS hospitals between October 2005 and March 2006 and the number of deaths where the superbug is mentioned on death certificates has increased each year from 1993 to 2004. A spokeswoman for the trust said action was needed to improve infection control rates and that the new measures were introduced following consultation with staff.
Source
Harmed in NSW public hospitals: 500 errors a record
NSW is Australia's most populous State
Almost 500 medical errors in NSW public hospitals either seriously harmed patients or could have done so in 2005-06 - the highest number in the three years the statistics have been collected. Problems with diagnosis, treatment and specialist referral topped the list of incidents judged to be in the most serious category, followed by 137 suicides that occurred outside hospital within a week of the person having been seen by a mental-health professional. Birth problems and avoidable falls also figured prominently, and 36 operations or X-rays were either performed or planned for the wrong person or part of the body. Instruments were left in the body after 11 operations. There were four serious problems with medication or intravenous fluids in the reporting period to June 30.
In a separate notice distributed to area health services in April, the Health Department informed doctors and managers of a "near miss" involving the leukaemia drug vincristine, which is intended for intravenous injection and is almost always fatal if injected into the spinal canal.
The Minister for Health, John Hatzistergos, said the increase - to 499 serious incidents from 429 the previous year - did not mean hospitals were less safe, and instead reflected an increased willingness by health workers to record incidents they witnessed. As well, the reporting program had been extended to the ambulance and prison health services.
Cliff Hughes, the chief executive officer of the Clinical Excellence Commission responsible for analysing the cases, said the increase in reports "tells us the system has a desire to improve". "The aim is to be proactive in preventing serious adverse events from harming our patients," he said. The reports demonstrated health workers' confidence in bringing dangerous incidents to light in a no-blame environment, he said, and represented "a huge culture change".
The commission was formed as a supervisory body for public hospital treatment standards after a group of nurses at Camden and Campbelltown hospitals revealed numerous medical errors. Its analysis found policies and procedures were to blame for a quarter of the errors and near misses. These included inadequate training requirements for some staff. Another quarter were attributable to communication problems, particularly when patient care was handed over to a different medical team or between shifts. Incompetence or outdated skills were behind almost 100 cases, and inadequate ratios of medical staff to patients, or rostering of junior doctors into senior roles, was at the heart of about 70 of the problems. Equipment failure was much less common.
Some improvements could be made by basic changes to practice, Professor Hughes said. Hospital infection rates had been reduced after the provision of bedside alcohol-based gels for cleaning hands, instead of requiring health workers to go to the sink to wash. New protocols were being developed to identify people most at risk of falls - the over-65s and those taking multiple medications - so they could be given extra assistance in hospital.
But Mr Hatzistergos said a certain level of human and system error was unavoidable. "We haven't reached a stage where we have infallibility or perfection in medical science," he said. The collection of data would be further expanded to take in private hospitals in NSW, which perform the majority of colonoscopies and some other procedures.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Thursday, December 21, 2006
SECOND BABY KILLED BY NEGLIGENCE ABOUT CLEANLINESS IN A LOS ANGELES PUBLIC HOSPITAL
Very reminiscent of the problems in Britain's dirty public hospitals
A baby died Monday after being infected by a virulent bacterium during an outbreak that prompted officials at an East Los Angeles hospital to stop accepting patients to its neonatal intensive care unit. The infant was among five patients at White Memorial Medical Center who were infected by Pseudomonas aeruginosa - a common but potentially deadly bacterium for those with weak immune systems. An autopsy was under way, although hospital officials said it was likely the baby died because of the infection. The infant is the second to die since the bacterium was detected Nov. 30. No autopsy was conducted on the first baby, although the infection was believed to be the likely cause of death, said Dr. Rosalio Lopez, the hospital's chief medical officer. "We want to express our sincere sympathies to the families affected, and ensure the public that we take the health and safety of our patients very seriously," Lopez said in a telephone interview, adding he was confident the outbreak has been contained.
The source appears to be improper cleaning of laryngoscope blades, a piece of medical equipment used to insert breathing tubes, hospital and county health officials said. In a letter to the hospital Monday, county officials noted a preliminary investigation had determined the blades had previously been disinfected by a "central supplier" as part of a manufacturer recommendation. For reasons not immediately known, the practice was changed in March and the unit's staff began cleaning the instruments. "These blades may have become contaminated due to inconsistent and improper cleaning practices that were in place between March and December 4," said Dr. Laurene Mascola, director of the county's acute communicable disease control unit, which is investigating the outbreak.
The others who were infected by the germ were treated with antibiotics and "continue to improve," Lopez said. They include two older children in the pediatrics intensive care ward who were not infected by the equipment, he said. The source of their infection has yet to be determined.
The hospital temporarily ceased new admissions to its pediatrics intensive care ward last week. It was back to normal operations Monday after hospital officials sterilized the unit and found no further trace of the bacterium. The hospital was working with county and federal health officials to determine when to reopen the neonatal intensive care unit, which was closed to new patients Dec. 4, Lopez said. He said most babies treated in the unit are either born prematurely or have multiple medical problems. In her letter to the hospital, Mascola said there was no evidence of further contamination and recommended reopening the unit.
Source
MORE DETAILS OF THE LATEST NHS SUPERBUG DISGRACE
As I predicted on 19th, it was due to a failure of asepsis -- negligence about cleanliness, in other words
The husband of a nurse who became the first person in Britain to die from a new deadly strain of MRSA contracted in hospital described the heartbreak yesterday of bringing up their newborn baby alone. Maribel Espada died four days after undergoing an emergency Caesarean at the University Hospital of North Staffordshire, where she had worked as a nurse for four years.
Health experts believe that Mrs Espada had previously picked up the Panton-Valentine leukocidin (PVL)-MRSA bug while working at the hospital. But it got into her bloodstream during the emergency operation last September.
Wen Espada, 30, told The Times that he was devastated at the thought of bringing up their son, Arwen, alone. "This was our first child and the only comfort I have is that Maribel got to see him and spent six days with him before her death. The doctors never mentioned MRSA and they had not mentioned to my wife that there had been an outbreak of MRSA even though she worked at the hospital."
Mr Espada, a warehouse worker, said that Maribel became ill four days after Arwen was delivered on September 20. Doctors told Mr Espada that his wife had died of an infection, and a postmortem examination confirmed PVL-MRSA.
One other patient at the hospital is known to have died there in March from the bacterium and an internal investigation carried out after Mrs Espada's death has identified a further nine cases at the hospital. Mr Espada said that he had instructed a firm of solicitors. "If the hospital has tried to cover this up, they should be made to pay for it," he said. The University Hospital of North Staffordshire refused to comment on Mrs Espada's death.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Very reminiscent of the problems in Britain's dirty public hospitals
A baby died Monday after being infected by a virulent bacterium during an outbreak that prompted officials at an East Los Angeles hospital to stop accepting patients to its neonatal intensive care unit. The infant was among five patients at White Memorial Medical Center who were infected by Pseudomonas aeruginosa - a common but potentially deadly bacterium for those with weak immune systems. An autopsy was under way, although hospital officials said it was likely the baby died because of the infection. The infant is the second to die since the bacterium was detected Nov. 30. No autopsy was conducted on the first baby, although the infection was believed to be the likely cause of death, said Dr. Rosalio Lopez, the hospital's chief medical officer. "We want to express our sincere sympathies to the families affected, and ensure the public that we take the health and safety of our patients very seriously," Lopez said in a telephone interview, adding he was confident the outbreak has been contained.
The source appears to be improper cleaning of laryngoscope blades, a piece of medical equipment used to insert breathing tubes, hospital and county health officials said. In a letter to the hospital Monday, county officials noted a preliminary investigation had determined the blades had previously been disinfected by a "central supplier" as part of a manufacturer recommendation. For reasons not immediately known, the practice was changed in March and the unit's staff began cleaning the instruments. "These blades may have become contaminated due to inconsistent and improper cleaning practices that were in place between March and December 4," said Dr. Laurene Mascola, director of the county's acute communicable disease control unit, which is investigating the outbreak.
The others who were infected by the germ were treated with antibiotics and "continue to improve," Lopez said. They include two older children in the pediatrics intensive care ward who were not infected by the equipment, he said. The source of their infection has yet to be determined.
The hospital temporarily ceased new admissions to its pediatrics intensive care ward last week. It was back to normal operations Monday after hospital officials sterilized the unit and found no further trace of the bacterium. The hospital was working with county and federal health officials to determine when to reopen the neonatal intensive care unit, which was closed to new patients Dec. 4, Lopez said. He said most babies treated in the unit are either born prematurely or have multiple medical problems. In her letter to the hospital, Mascola said there was no evidence of further contamination and recommended reopening the unit.
Source
MORE DETAILS OF THE LATEST NHS SUPERBUG DISGRACE
As I predicted on 19th, it was due to a failure of asepsis -- negligence about cleanliness, in other words
The husband of a nurse who became the first person in Britain to die from a new deadly strain of MRSA contracted in hospital described the heartbreak yesterday of bringing up their newborn baby alone. Maribel Espada died four days after undergoing an emergency Caesarean at the University Hospital of North Staffordshire, where she had worked as a nurse for four years.
Health experts believe that Mrs Espada had previously picked up the Panton-Valentine leukocidin (PVL)-MRSA bug while working at the hospital. But it got into her bloodstream during the emergency operation last September.
Wen Espada, 30, told The Times that he was devastated at the thought of bringing up their son, Arwen, alone. "This was our first child and the only comfort I have is that Maribel got to see him and spent six days with him before her death. The doctors never mentioned MRSA and they had not mentioned to my wife that there had been an outbreak of MRSA even though she worked at the hospital."
Mr Espada, a warehouse worker, said that Maribel became ill four days after Arwen was delivered on September 20. Doctors told Mr Espada that his wife had died of an infection, and a postmortem examination confirmed PVL-MRSA.
One other patient at the hospital is known to have died there in March from the bacterium and an internal investigation carried out after Mrs Espada's death has identified a further nine cases at the hospital. Mr Espada said that he had instructed a firm of solicitors. "If the hospital has tried to cover this up, they should be made to pay for it," he said. The University Hospital of North Staffordshire refused to comment on Mrs Espada's death.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Wednesday, December 20, 2006
MRSA OUT OF CONTROL IN NHS HOSPITALS
The hospital where two people, including a previously healthy nurse, died from a new strain of MRSA was named yesterday as it was revealed that three further cases had been identified. The University Hospital of North Staffordshire NHS Trust in Stoke-on-Trent confirmed that a healthcare worker and a patient had died after falling victim to a form of the toxin Panton-Valentine leukocidin (PVL) earlier this year.
The pair fell ill in March and September after becoming infected by a bacterium that had not been seen previously at the hospital, the trust said. Six colleagues and housemates of the health worker were found to carry the bug, after staff who had direct contact with the nurse were screened after the outbreak.
There have also been three further cases, one of which was a former patient. The hospital said: "No current patients have been identified as affected. All those affected have been informed and there is no need for any other patient to be concerned. Where screening swabs from members of staff are positive for this, or any other strain of MRSA, they are being given decolonisation treatment and followed up by the occupational health department before returning to work. "With the exception of one infection, it is not clear at this stage whether transmission has occurred within the hospital or, as is more common, in the community which it serves." The hospital said that it was taking advice from the Health Protection Agency (HPA).
Figures for the first seven months of the year show that up to 47 of the 55 patients treated for MRSA-related illness at the hospital contracted the bug within the 1,200-bed site. The eight other patients are thought to have been carrying the infection before admission. The commonly known "hospital-associated MRSA" strains, which do not produce PVL, typically affect elderly hospitalised patients. But PVL attacks white blood cells leaving the sufferer unable to fight infection and putting healthy people at risk. The HPA said that strains of MRSA that produced PVL had been seen in Britain, but usually in the community rather than in a hospital. It added: "This outbreak is the first time transmission and deaths due to this strain are known to have occurred in a healthcare setting in England and Wales." Andrew Lansley, the Shadow Health Secretary, said: "It is time for us to take on the threat of new and more dangerous bacteria."
Source
AUSTRALIA: ANOTHER DODGY PUBLIC HOSPITAL DOCTOR
It's a lottery what you'll get when you go to a public hospital. The "regulators" say almost anyone with some sort of medical degree is OK. It's the only way they can find "enough" doctors. Paying more and training more are too hard
Coroner Tina Previtera, inquiring into suicides, will report the actions of an overseas-trained doctor to the Queensland Medical Board. Coroner Previtera said yesterday she would provide information to the board on Errol Van Rensburg, who discharged a severely depressed patient, Patrick Lusk, from Cooktown Hospital in April 2005 without adequate assessment. Lusk, 66, a taxi driver, committed suicide two days later.
Ms Previtera, who inquired into the deaths of Lusk, Yarrabah resident Charles Barlow and Kuranda teenager Emily Baggott (Dr Van Rensburg only treated Lusk), also made strong recommendations that Queensland Health, as a matter of priority, "actively implement" its own policies and guidelines for reducing the incidence of suicide. "What the situation now dictates is that everything cannot stay the same," said Ms Previtera. She said Barlow, 36, who hanged himself an hour after being refused a transfer to the Cairns Mental Health Unit, had not been assessed at all "due to pressure on resources". Baggott, 16, and Lusk had been inadequately assessed.
Ms Previtera said Lusk had gone to Cooktown Hospital with his ex-wife, Cheryl Prigg, on the advice of his GP who also provided Cairns Hospital records of his treatment for a previous major depressive illness. "Not only was Dr Van Rensburg's assessment inadequate, but no written referral to the mental health service was made or actively pursued," Ms Previtera said. She also said Dr Van Rensburg had been unable to recall Lusk's death in a sentinel review less than a month after the death. Ms Previtera said Dr Van Rensburg, appearing in the coroner's court, had been observed to be "disoriented, confused, evasive, obtuse, avoidant and vague during his evidence".
She said Dr Van Rensburg had been granted "special purpose registration" by the Queensland Medical Board after moving to Australia in 2002. He had relocated from Cooktown to Cairns on June 14, 2005. On June 30, a doctor wrote to the Cairns Base Hospital medical director expressing "significant concerns" about Dr Van Rensburg's capacity to practise "competently and safely". A Cairns Base Hospital spokesman said Dr Van Rensburg continued to work there under supervision.
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 Pages are here or here or here.
***************************
The hospital where two people, including a previously healthy nurse, died from a new strain of MRSA was named yesterday as it was revealed that three further cases had been identified. The University Hospital of North Staffordshire NHS Trust in Stoke-on-Trent confirmed that a healthcare worker and a patient had died after falling victim to a form of the toxin Panton-Valentine leukocidin (PVL) earlier this year.
The pair fell ill in March and September after becoming infected by a bacterium that had not been seen previously at the hospital, the trust said. Six colleagues and housemates of the health worker were found to carry the bug, after staff who had direct contact with the nurse were screened after the outbreak.
There have also been three further cases, one of which was a former patient. The hospital said: "No current patients have been identified as affected. All those affected have been informed and there is no need for any other patient to be concerned. Where screening swabs from members of staff are positive for this, or any other strain of MRSA, they are being given decolonisation treatment and followed up by the occupational health department before returning to work. "With the exception of one infection, it is not clear at this stage whether transmission has occurred within the hospital or, as is more common, in the community which it serves." The hospital said that it was taking advice from the Health Protection Agency (HPA).
Figures for the first seven months of the year show that up to 47 of the 55 patients treated for MRSA-related illness at the hospital contracted the bug within the 1,200-bed site. The eight other patients are thought to have been carrying the infection before admission. The commonly known "hospital-associated MRSA" strains, which do not produce PVL, typically affect elderly hospitalised patients. But PVL attacks white blood cells leaving the sufferer unable to fight infection and putting healthy people at risk. The HPA said that strains of MRSA that produced PVL had been seen in Britain, but usually in the community rather than in a hospital. It added: "This outbreak is the first time transmission and deaths due to this strain are known to have occurred in a healthcare setting in England and Wales." Andrew Lansley, the Shadow Health Secretary, said: "It is time for us to take on the threat of new and more dangerous bacteria."
Source
AUSTRALIA: ANOTHER DODGY PUBLIC HOSPITAL DOCTOR
It's a lottery what you'll get when you go to a public hospital. The "regulators" say almost anyone with some sort of medical degree is OK. It's the only way they can find "enough" doctors. Paying more and training more are too hard
Coroner Tina Previtera, inquiring into suicides, will report the actions of an overseas-trained doctor to the Queensland Medical Board. Coroner Previtera said yesterday she would provide information to the board on Errol Van Rensburg, who discharged a severely depressed patient, Patrick Lusk, from Cooktown Hospital in April 2005 without adequate assessment. Lusk, 66, a taxi driver, committed suicide two days later.
Ms Previtera, who inquired into the deaths of Lusk, Yarrabah resident Charles Barlow and Kuranda teenager Emily Baggott (Dr Van Rensburg only treated Lusk), also made strong recommendations that Queensland Health, as a matter of priority, "actively implement" its own policies and guidelines for reducing the incidence of suicide. "What the situation now dictates is that everything cannot stay the same," said Ms Previtera. She said Barlow, 36, who hanged himself an hour after being refused a transfer to the Cairns Mental Health Unit, had not been assessed at all "due to pressure on resources". Baggott, 16, and Lusk had been inadequately assessed.
Ms Previtera said Lusk had gone to Cooktown Hospital with his ex-wife, Cheryl Prigg, on the advice of his GP who also provided Cairns Hospital records of his treatment for a previous major depressive illness. "Not only was Dr Van Rensburg's assessment inadequate, but no written referral to the mental health service was made or actively pursued," Ms Previtera said. She also said Dr Van Rensburg had been unable to recall Lusk's death in a sentinel review less than a month after the death. Ms Previtera said Dr Van Rensburg, appearing in the coroner's court, had been observed to be "disoriented, confused, evasive, obtuse, avoidant and vague during his evidence".
She said Dr Van Rensburg had been granted "special purpose registration" by the Queensland Medical Board after moving to Australia in 2002. He had relocated from Cooktown to Cairns on June 14, 2005. On June 30, a doctor wrote to the Cairns Base Hospital medical director expressing "significant concerns" about Dr Van Rensburg's capacity to practise "competently and safely". A Cairns Base Hospital spokesman said Dr Van Rensburg continued to work there under supervision.
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 Pages are here or here or here.
***************************
Tuesday, December 19, 2006
DEADLY NEW STRAIN OF MRSA FOUND IN NHS HOSPITALS
An almost inevitable outcome of dirty hospitals and negligence about aseptic procedures
A healthy hospital worker died after contracting a deadly new strain of MRSA that had never before been reported as a cause of death in hospitals. Four other workers at the same hospital also contracted Panton-Valentine Leukocidin-positive (PVL) MRSA, with two of their friends, said the Health Protection Agency. An investigation subsequently found that the strain had killed a patient at the hospital earlier this year.
The strain, which is particularly virulent, attacks healthy young people and can cause symptoms ranging from minor infections in the skin and soft tissue to a form of pneumonia that can kill in 24 hours. The outbreak, which has only just been reported, was identified when a previously healthy female healthcare worker, named only as “Case One”, developed a severe MRSA infection and pneumonia and died after emergency surgery in September, the agency said. The bacterium that she had contracted, PVL-positive MRSA, had never been found to cause a death inside a hospital. It was contracted by at least three other workers in two wards in a West Midlands hospital, and two of their friends. It was also found to have caused the death of a patient at the hospital in March.
A statement from the agency said: “Eight cases of PVL- positive community-associated MRSA have been identified among individuals in a hospital and their close household contacts in the West Midlands. Four of these individuals developed an infection, two of whom subsequently died.” The agency declined to give further details but said that extensive contact tracing had not identified more cases at the hospital. However, the strain has been found in other hospitals, including the University Hospital of North Staffordshire, which is understood to have identified two non-fatal cases of the bug.
The discovery is significant as hospital-acquired MRSA has tended to affect elderly and infirm patients rather than younger people. PVL is a toxin that destroys white blood cells, which are the key to fighting infectious diseases. It occurs in about 2 per cent of strains of the common bacterium known as staphylococcus aureus, which is termed MRSA when it is resistant to the antibiotic methicillin.
Although it is rare, a small number of cases of PVL- positive MRSA have been reported across England and Wales — however, these have usually been in the community rather than a hospital. The strain is thought to have caused the death of a Royal Marine recruit, Richard Campbell-Smith, 18, in 2004. Forty-eight hours before the young recruit died, he scratched himself on a gorse bush during a training exercise and contracted an MRSA-related infection.
Infections caused by PVL-positive MRSA normally cause skin abscesses or boils and inflammations, but they can cause more severe invasive infections such as septic arthritis, blood poisoning, flesh necrosis and pneumonia. Screening of patients and staff on the ward where Case One worked revealed that one of her friends, a hospital employee who had previously reported skin abscesses caused by MRSA, was carrying the same strain.
Four housemates of the two workers had also contracted the strain. One of these, Case Five, worked in the hospital on a different ward and is thought to have infected another worker there, who detailed a four-month history of recurrent infection of the eyelids. One further case was identified in March 2006 through retrospective analysis of MRSA samples kept in the laboratory. The patient (Case Eight) developed a suspected hospital-acquired pneumonia while in the ward where Case One worked, and died within 24 hours of the positive blood sample being taken.
A spokesman for the Health Protection Agency said that PVL-MRSA was “more toxic than other strains of MRSA”, but it could still be treated with antibiotics. Angela Kearns, an MRSA expert, added: “When people contract PVL-producing strains of MRSA, they usually experience a skin infection such as a boil or abscess. Most infections can be treated successfully with everyday antibiotics, but occasionally a more severe infection may occur. “The Health Protection Agency is advising the hospital on outbreak-control measures, and will continue to monitor MRSA infection nationally.”
PVL-producing strains are more commonly contracted in the community and generally affect previously healthy young children and young adults. This contrasts with the hospital-associated MRSA strains, which do not produce PVL and are more commonly associated with causing wound infections and blood-poisoning in elderly hospital patients.
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 Pages are here or here or here.
***************************
An almost inevitable outcome of dirty hospitals and negligence about aseptic procedures
A healthy hospital worker died after contracting a deadly new strain of MRSA that had never before been reported as a cause of death in hospitals. Four other workers at the same hospital also contracted Panton-Valentine Leukocidin-positive (PVL) MRSA, with two of their friends, said the Health Protection Agency. An investigation subsequently found that the strain had killed a patient at the hospital earlier this year.
The strain, which is particularly virulent, attacks healthy young people and can cause symptoms ranging from minor infections in the skin and soft tissue to a form of pneumonia that can kill in 24 hours. The outbreak, which has only just been reported, was identified when a previously healthy female healthcare worker, named only as “Case One”, developed a severe MRSA infection and pneumonia and died after emergency surgery in September, the agency said. The bacterium that she had contracted, PVL-positive MRSA, had never been found to cause a death inside a hospital. It was contracted by at least three other workers in two wards in a West Midlands hospital, and two of their friends. It was also found to have caused the death of a patient at the hospital in March.
A statement from the agency said: “Eight cases of PVL- positive community-associated MRSA have been identified among individuals in a hospital and their close household contacts in the West Midlands. Four of these individuals developed an infection, two of whom subsequently died.” The agency declined to give further details but said that extensive contact tracing had not identified more cases at the hospital. However, the strain has been found in other hospitals, including the University Hospital of North Staffordshire, which is understood to have identified two non-fatal cases of the bug.
The discovery is significant as hospital-acquired MRSA has tended to affect elderly and infirm patients rather than younger people. PVL is a toxin that destroys white blood cells, which are the key to fighting infectious diseases. It occurs in about 2 per cent of strains of the common bacterium known as staphylococcus aureus, which is termed MRSA when it is resistant to the antibiotic methicillin.
Although it is rare, a small number of cases of PVL- positive MRSA have been reported across England and Wales — however, these have usually been in the community rather than a hospital. The strain is thought to have caused the death of a Royal Marine recruit, Richard Campbell-Smith, 18, in 2004. Forty-eight hours before the young recruit died, he scratched himself on a gorse bush during a training exercise and contracted an MRSA-related infection.
Infections caused by PVL-positive MRSA normally cause skin abscesses or boils and inflammations, but they can cause more severe invasive infections such as septic arthritis, blood poisoning, flesh necrosis and pneumonia. Screening of patients and staff on the ward where Case One worked revealed that one of her friends, a hospital employee who had previously reported skin abscesses caused by MRSA, was carrying the same strain.
Four housemates of the two workers had also contracted the strain. One of these, Case Five, worked in the hospital on a different ward and is thought to have infected another worker there, who detailed a four-month history of recurrent infection of the eyelids. One further case was identified in March 2006 through retrospective analysis of MRSA samples kept in the laboratory. The patient (Case Eight) developed a suspected hospital-acquired pneumonia while in the ward where Case One worked, and died within 24 hours of the positive blood sample being taken.
A spokesman for the Health Protection Agency said that PVL-MRSA was “more toxic than other strains of MRSA”, but it could still be treated with antibiotics. Angela Kearns, an MRSA expert, added: “When people contract PVL-producing strains of MRSA, they usually experience a skin infection such as a boil or abscess. Most infections can be treated successfully with everyday antibiotics, but occasionally a more severe infection may occur. “The Health Protection Agency is advising the hospital on outbreak-control measures, and will continue to monitor MRSA infection nationally.”
PVL-producing strains are more commonly contracted in the community and generally affect previously healthy young children and young adults. This contrasts with the hospital-associated MRSA strains, which do not produce PVL and are more commonly associated with causing wound infections and blood-poisoning in elderly hospital patients.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Monday, December 18, 2006
Comment from a senior American anesthesiologist about yesterday's post
The scenario sounds to me like the sinus infection had spread beyond the eye socket, perhaps downward into the pharynx (behind the tongue), making inserting a breathing tube more difficult, perhaps stirring up bleeding or pus, which would make visualizing the airway more difficult or impossible. If Ms Bromiley was overweight, the large tongue might make intubation difficult. With repeated attempts at intubation, the airway may become swollen. Awakening the patient before this point may have saved her; we have done this on occasion; inconvenient, but life-saving. Careful preoperative examination of the airway may have alerted the anesthesiologist to the precarious conditions present.
Actually, a tracheostomy is NOT the preferred treatment - this takes several minutes. A "cricothyrotomy" - a needle through a membrane, takes seconds, and the patient can be ventilated for a while before a better airway is established. We practice doing cricothyrotomy on dummies.
Of course, if the infection extends all the way to the throat, a tracheostomy or cricothyrotomy may not be possible. For such cases, a flexible fiberoptic device may enable the anesthesiologist to see around corners, and place the breatihing tube. Again, careful preoperative discussion between anesthesiologist and surgeons may make for better planning.
Here in the USA, we have a "difficult airway algorithm". See here
We drill our trainees (and ourselves) many times about these guidelines, on paper, with test questions, and on an electronic simulator (PC verson, and life size rubber dummy connected to a computer). This is standard practice here. This pilot would be stunned if he could see the level of our training on this issue. We have airway workshops where we can practice fiberoptic intubation on dummies, and we do it on patients as well. See here
Having a TV screen is a giant step forward (our institution is too cheap) - it allows the instructor to see what the trainee sees, and speeds up the teaching process.
ASA has close claims data, the best source of complications. I believe there has not been a case (or, more likely, too few to count) of airway disasters where a difficult airway has been diagnosed preoperatively; such cases alert the anesthesiologists to use more care or special methods (like fiberoptic). The most litigation is in emergency C-sections in (usually morbidly obese) where the airway is lost. This is why regional (spinal, epidural) anesthesia is so popular (but there are times and conditions where regional anesthesia is not possible. Hopefully, if intubation is abandoned after multiple attempts, the "cannot intubate cannot ventilate" scenario will never occur; if it does, surgical airway is a no brainer.
Pulse oximeters are a standard of care. When the oxygen in the skin drops, we are alerted that something must be done - NOW. One recently developed device is the Laryngeal Mask airway (LMA). This device allows maintaining an airway in a patient where the larynx cannot be visualized; it has been a lifesaver.
I had a recent emergency C-section in a fat lady where I couldn't intubate her. I could have maintained ventilation, but that would not protect her from vomiting and aspiration. All contraindications are relative; I used a LMA because I believed the small risk of vomiting and aspiration was less than the risk of airway obstruction from further attempts at intubation.
The anesthesiologist is normally in charge of the airway. If we must, WE request the surgeon to establish a surgical airway. The senior anesthesiologist is "in charge". Unfortunately, nervous surgeons may confuse the issue at times. I believe the British pilot would be pleasantly surprised at the level American doctors do such things. There is ACLS (advanced cardiac life support, both for adults and children); ATLS (advanced trauma life support) courses, exams, computer drills, ethc.
I am amused at nurses who claim an exclusive as "patient advocates". I am very proud what anesthesiologists have done to improbe patient safety. We are "patient advocates" as well. It was anesthesiologists who raised hell with hospital administrations to buy equipment to make anesthesia safer. Much of our improvement in safety has been with the initiatives of anesthesiologists, not Government mandates. When the Government demands better safety, then we must begin to worry.
***************************
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 Pages are here or here or here.
***************************
The scenario sounds to me like the sinus infection had spread beyond the eye socket, perhaps downward into the pharynx (behind the tongue), making inserting a breathing tube more difficult, perhaps stirring up bleeding or pus, which would make visualizing the airway more difficult or impossible. If Ms Bromiley was overweight, the large tongue might make intubation difficult. With repeated attempts at intubation, the airway may become swollen. Awakening the patient before this point may have saved her; we have done this on occasion; inconvenient, but life-saving. Careful preoperative examination of the airway may have alerted the anesthesiologist to the precarious conditions present.
Actually, a tracheostomy is NOT the preferred treatment - this takes several minutes. A "cricothyrotomy" - a needle through a membrane, takes seconds, and the patient can be ventilated for a while before a better airway is established. We practice doing cricothyrotomy on dummies.
Of course, if the infection extends all the way to the throat, a tracheostomy or cricothyrotomy may not be possible. For such cases, a flexible fiberoptic device may enable the anesthesiologist to see around corners, and place the breatihing tube. Again, careful preoperative discussion between anesthesiologist and surgeons may make for better planning.
Here in the USA, we have a "difficult airway algorithm". See here
We drill our trainees (and ourselves) many times about these guidelines, on paper, with test questions, and on an electronic simulator (PC verson, and life size rubber dummy connected to a computer). This is standard practice here. This pilot would be stunned if he could see the level of our training on this issue. We have airway workshops where we can practice fiberoptic intubation on dummies, and we do it on patients as well. See here
Having a TV screen is a giant step forward (our institution is too cheap) - it allows the instructor to see what the trainee sees, and speeds up the teaching process.
ASA has close claims data, the best source of complications. I believe there has not been a case (or, more likely, too few to count) of airway disasters where a difficult airway has been diagnosed preoperatively; such cases alert the anesthesiologists to use more care or special methods (like fiberoptic). The most litigation is in emergency C-sections in (usually morbidly obese) where the airway is lost. This is why regional (spinal, epidural) anesthesia is so popular (but there are times and conditions where regional anesthesia is not possible. Hopefully, if intubation is abandoned after multiple attempts, the "cannot intubate cannot ventilate" scenario will never occur; if it does, surgical airway is a no brainer.
Pulse oximeters are a standard of care. When the oxygen in the skin drops, we are alerted that something must be done - NOW. One recently developed device is the Laryngeal Mask airway (LMA). This device allows maintaining an airway in a patient where the larynx cannot be visualized; it has been a lifesaver.
I had a recent emergency C-section in a fat lady where I couldn't intubate her. I could have maintained ventilation, but that would not protect her from vomiting and aspiration. All contraindications are relative; I used a LMA because I believed the small risk of vomiting and aspiration was less than the risk of airway obstruction from further attempts at intubation.
The anesthesiologist is normally in charge of the airway. If we must, WE request the surgeon to establish a surgical airway. The senior anesthesiologist is "in charge". Unfortunately, nervous surgeons may confuse the issue at times. I believe the British pilot would be pleasantly surprised at the level American doctors do such things. There is ACLS (advanced cardiac life support, both for adults and children); ATLS (advanced trauma life support) courses, exams, computer drills, ethc.
I am amused at nurses who claim an exclusive as "patient advocates". I am very proud what anesthesiologists have done to improbe patient safety. We are "patient advocates" as well. It was anesthesiologists who raised hell with hospital administrations to buy equipment to make anesthesia safer. Much of our improvement in safety has been with the initiatives of anesthesiologists, not Government mandates. When the Government demands better safety, then we must begin to worry.
***************************
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 Pages are here or here or here.
***************************
Sunday, December 17, 2006
Robust NHS patient killed by disorganized and poorly-trained doctors
Elaine Bromiley kissed her husband Martin and their children Victoria, then six, and Adam, five. "Bye-ee," she called to them, waving as she was wheeled down the corridor towards the operating theatre. The otherwise healthy 37-year-old had suffered for years from chronic sinusitis, an inflammation of the nasal passages. Then, early in 2005, one of her eye sockets became infected. The threat of permanent damage to the optic nerve led her surgeon to recommend a minor operation to straighten the inside of the nose - a possible contributory factor.
Once they'd said their goodbyes, Martin and the children went home to wait for word that Elaine was awake and ready to see them all again. It never came. Two hours after she'd gone into theatre, Martin received a call from the Ear, Nose and Throat (ENT) surgeon to say Elaine was having difficulty waking up. Even then, Martin wasn't unduly worried. But when he arrived at the hospital, he was told Elaine was in intensive care, and, because she'd been deprived of oxygen during the operation, there was a risk of significant brain damage. The next few days were a blur as, numb with shock, Martin, with the help of friends, did his best to care for his family. Desperately anxious about his wife, he tried to maintain as normal a life as possible for the children, who continued going to school.
Meanwhile, Elaine was put into a medically-induced coma for three days to give her swollen brain a chance to recover. "I spent every minute I could with Elaine, holding her hand and telling her how much I loved her," says Martin. "The day after the operation was the 21st anniversary of our first date. I was told that the eventual outcome could be a full recovery, or that my wife could be alive but in a vegetative state - or any point between the two extremes. "My head was spinning. I couldn't grasp how life could change so quickly and in such a devastating way. I really couldn't see past the next day and had no idea what the future held for us."
Five days after the operation, a brain scan indicated little if any activity and Martin was told Elaine had suffered brain death. "It was like a TV screen covered in static: no shape, no texture, no colour to show that anything was working," he recalls. "Years ago, Elaine had told me that she did not wish to live as a vegetable. I made the decision that life support should be withdrawn and I prepared myself for a life without Elaine that I could not begin to imagine." Mrs Bromiley was observed for three days and then taken off life support. She survived for another four days, dying in the middle of the night when Martin was at home with the children. "I'd decided that they were the priority now," he says.
He had kept the children informed of their mother's progress, telling them "first that Mummy was going to be ill, just like Granny was when she had a stroke, but that she will get better". Then he had to explain that "Mummy wasn't going to wake up, she was going to die". Martin recalls those desolate days. "I just couldn't imagine how life would go on," he says. What Martin hung on to, he says, was his professional work ethic as a pilot. He took it for granted that - as is routine in aviation - an investigation would automatically be carried out. His hope was that at the very least lessons would be learnt to protect other patients in the future. He felt, if anything, comradeship with the operating team responsible. "I was 99.9 per cent sure that what had happened to Elaine could not have been predicted and that when the emergency occurred, the team did what they believed to be right but things just didn't work out."
When he discovered that no inquiry would be carried out unless he sued or made a complaint, he walked into the hospital chief executive's office to insist there was one. The subsequent investigation was headed by Professor Michael Harmer, a former president of the Association of Anaesthetists. The inquiry revealed that Elaine's operation was a textbook example of how surgery, carried out by technically proficient professionals, can go horribly wrong. The cause: human error. So much is made of the latest medical advances that it comes as something of a shock to learn that human error still figures significantly in modern healthcare.
Yet last month, the Chief Medical Officer, Sir Liam Donaldson, warned that the odds of dying as a result of clinical error in hospital are 33,000 times higher than those of dying in an air crash. "In the airline industry, the risk of death is one in 10 million. If you go into a hospital, the risk of death from a medical error is one in 300," he said. And yet it seems little is being done to improve those odds. Five years after chairing the inquiry into the deaths of 29 babies during heart surgery at Bristol Royal Infirmary, Sir Ian Kennedy, now chairman of the Health Commission, drew attention to the lack of progress. "It is almost as though avoidable deaths and injuries are accepted as part of the risk of care and treatment," he told a meeting of clinicians in London in July.
And it gets worse: the National Patient Safety Agency (NPSA), which was set up by the Government in response to the Bristol inquiry, with a brief to ensure that patient safety was a priority within the NHS, was recently described as "dysfunctional" by the National Audit Office. The agency has no idea how many people die each year as a result of medical error. It is currently under investigation, with a report on its future due out this week. The National Audit Office estimates that there may be up to 34,000 deaths annually as a result of patient safety incidents. But in reality the NHS simply does not know.
Contrast this with the approach taken by other high-risk industries. For years, businesses from motor racing to oil refining have recognised the dangers of human error, and the importance of communication and teamwork in dealing with emergencies. They have introduced what is known as Human Factors (HF) training, which teaches basic skills designed to promote safety. While much-prized technical skills are essential, they are not always enough in a fast-moving, high-risk situation. At critical moments, organisational and social skills are just as important. This means good communication and an ability to work together with each member of the team.
It appears that moments after being sedated, Elaine's airway collapsed, preventing adequate levels of oxygen from reaching her brain. Though potentially an emergency, the event is a recognised risk during an anaesthetic and, as such, should be manageable. Surgeons and anaesthetists are drilled to follow a series of steps at this point - beginning with a non-invasive attempt to get the patient breathing normally, and ending, as a last resort, with an emergency surgical procedure. This is usually a tracheotomy - where the surgeon cuts through the windpipe, inserting a tube directly into the airway through the throat.
At first the drill was followed impeccably. But then a problem arose: the surgical team tried to get a tube into the airway to help Elaine breathe, but encountered some kind of blockage. According to the drill, this was the time to consider doing a tracheotomy. Elaine, by this point, was turning blue in the face and one of the nurses fetched tracheotomy equipment. A second nurse phoned through to the intensive care unit to check there was a spare bed available.
But the three consultants appear to have made the sort of human error that is horribly common in crisis situations. They became fixated on what they were doing. The consultants also appear to have ignored the junior staff and remained intent on finding a way to insert a tube into the airway. The minutes ticked by. After 25 minutes, they were finally able to get a tube into her airway -but even then, the team failed to secure the tube and it was a full 35 minutes before adequate oxygen levels to the brain were restored.
At the inquest, held in October last year, the lead anaesthetist admitted that he had lost control and there was a dispute over exactly who was in charge of the procedure, making life-and-death decisions.
All of which could have been the end of the investigation. But Martin Bromiley had an unusual insight into the factors that led to his wife's death. He is both a pilot and a specialist in HF training, which has been mandatory for British pilots and crew since the mid-1990s. "Fixation is a normal reaction to stress. HF training teaches people that it's normal to carry on trying to take the usual action, even when it's clearly not working," he says. "But at some point, a decision has to be made to break out of that pattern of behaviour. The way to ensure that happens is for all members of the team to see it as their duty to speak out to keep the patient safe." There was no comfort in knowing that two of the nurses knew how to save his wife's life. "What they didn't know - and what HF would have taught them - is how to broach the subject with their bosses," he says.
"The same problem used to exist in aviation. It was common for the evidence from black boxes to show that junior members of staff had been aware that a mistake had been made and had either kept quiet or been ignored." Clinicians tended to view human error as a sign of weakness or the result of poor performance, says Martin. "Yet high-risk industries have shown that by accepting that it is normal to make mistakes, it becomes the team's responsibility to watch out for errors and catch them before they cause significant harm."
Martin began to ask questions and soon found that he was not the only person to be concerned about the risks of modern surgery. Indeed, for the past year the Royal College of Surgeons has been developing HF training courses in which surgeons have worked with experts from the aviation industry. Last month, it also organised a conference where leading doctors, nurses and managers heard speakers from the military, the oil industry and motor racing, among others, all described the dramatic impact on safety levels following the introduction of HF training. Martin himself also addressed the conference. "Patients want surgeons who can communicate well with them and effectively with members of the team,' says Tony Giddings, the Royal College of Surgeons council member responsible for patient safety issues and a former surgeon and trained pilot. "And there is a growing understanding of their importance within the profession. These skills are not unique to medicine; they are skills for life itself. They enable people to be confident and self-assured yet acknowledge they are not infallible. "Unless people have these skills intuitively, they need to be trained. Surgeons, anaesthetists, nurses and other members of the team can be trained together to develop these essential skills."
However, unless such training is mandatory, the surgeons who need it most won't participate, says Mr Giddings. It also needs funding. HF training could save thousands of lives every year, yet he says there is a reluctance at government level to commit resources to a scheme which could cost millions of pounds every year. "But however expensive mandatory training is, there is considerable evidence that human error in medicine is far more costly, both in human and financial terms." For Roger Goss, co-director of campaign group Patient Concern, there is no question that HF training must be implemented. "If the aviation industry uses this type of training, then that's good enough for me: flying is the safest mode of transport," he says. "Patient safety must become a priority in health care. It's not at the moment. Chief executives are constantly being criticised for failing to make it a priority, and instead focusing on keeping within their budget. The NHS has a moral obligation to do anything humanly possible to minimise the risks of surgery."
This week, Martin is meeting the Deputy Chief Medical Officer to discuss a number of initiatives. As he approaches a second Christmas without his wife, he is determined that his family's terrible experience will have a positive impact on the culture of surgery. "There is no question in my mind that Elaine's death will bring enormous change to clinical practice," he says with quiet determination
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Elaine Bromiley kissed her husband Martin and their children Victoria, then six, and Adam, five. "Bye-ee," she called to them, waving as she was wheeled down the corridor towards the operating theatre. The otherwise healthy 37-year-old had suffered for years from chronic sinusitis, an inflammation of the nasal passages. Then, early in 2005, one of her eye sockets became infected. The threat of permanent damage to the optic nerve led her surgeon to recommend a minor operation to straighten the inside of the nose - a possible contributory factor.
Once they'd said their goodbyes, Martin and the children went home to wait for word that Elaine was awake and ready to see them all again. It never came. Two hours after she'd gone into theatre, Martin received a call from the Ear, Nose and Throat (ENT) surgeon to say Elaine was having difficulty waking up. Even then, Martin wasn't unduly worried. But when he arrived at the hospital, he was told Elaine was in intensive care, and, because she'd been deprived of oxygen during the operation, there was a risk of significant brain damage. The next few days were a blur as, numb with shock, Martin, with the help of friends, did his best to care for his family. Desperately anxious about his wife, he tried to maintain as normal a life as possible for the children, who continued going to school.
Meanwhile, Elaine was put into a medically-induced coma for three days to give her swollen brain a chance to recover. "I spent every minute I could with Elaine, holding her hand and telling her how much I loved her," says Martin. "The day after the operation was the 21st anniversary of our first date. I was told that the eventual outcome could be a full recovery, or that my wife could be alive but in a vegetative state - or any point between the two extremes. "My head was spinning. I couldn't grasp how life could change so quickly and in such a devastating way. I really couldn't see past the next day and had no idea what the future held for us."
Five days after the operation, a brain scan indicated little if any activity and Martin was told Elaine had suffered brain death. "It was like a TV screen covered in static: no shape, no texture, no colour to show that anything was working," he recalls. "Years ago, Elaine had told me that she did not wish to live as a vegetable. I made the decision that life support should be withdrawn and I prepared myself for a life without Elaine that I could not begin to imagine." Mrs Bromiley was observed for three days and then taken off life support. She survived for another four days, dying in the middle of the night when Martin was at home with the children. "I'd decided that they were the priority now," he says.
He had kept the children informed of their mother's progress, telling them "first that Mummy was going to be ill, just like Granny was when she had a stroke, but that she will get better". Then he had to explain that "Mummy wasn't going to wake up, she was going to die". Martin recalls those desolate days. "I just couldn't imagine how life would go on," he says. What Martin hung on to, he says, was his professional work ethic as a pilot. He took it for granted that - as is routine in aviation - an investigation would automatically be carried out. His hope was that at the very least lessons would be learnt to protect other patients in the future. He felt, if anything, comradeship with the operating team responsible. "I was 99.9 per cent sure that what had happened to Elaine could not have been predicted and that when the emergency occurred, the team did what they believed to be right but things just didn't work out."
When he discovered that no inquiry would be carried out unless he sued or made a complaint, he walked into the hospital chief executive's office to insist there was one. The subsequent investigation was headed by Professor Michael Harmer, a former president of the Association of Anaesthetists. The inquiry revealed that Elaine's operation was a textbook example of how surgery, carried out by technically proficient professionals, can go horribly wrong. The cause: human error. So much is made of the latest medical advances that it comes as something of a shock to learn that human error still figures significantly in modern healthcare.
Yet last month, the Chief Medical Officer, Sir Liam Donaldson, warned that the odds of dying as a result of clinical error in hospital are 33,000 times higher than those of dying in an air crash. "In the airline industry, the risk of death is one in 10 million. If you go into a hospital, the risk of death from a medical error is one in 300," he said. And yet it seems little is being done to improve those odds. Five years after chairing the inquiry into the deaths of 29 babies during heart surgery at Bristol Royal Infirmary, Sir Ian Kennedy, now chairman of the Health Commission, drew attention to the lack of progress. "It is almost as though avoidable deaths and injuries are accepted as part of the risk of care and treatment," he told a meeting of clinicians in London in July.
And it gets worse: the National Patient Safety Agency (NPSA), which was set up by the Government in response to the Bristol inquiry, with a brief to ensure that patient safety was a priority within the NHS, was recently described as "dysfunctional" by the National Audit Office. The agency has no idea how many people die each year as a result of medical error. It is currently under investigation, with a report on its future due out this week. The National Audit Office estimates that there may be up to 34,000 deaths annually as a result of patient safety incidents. But in reality the NHS simply does not know.
Contrast this with the approach taken by other high-risk industries. For years, businesses from motor racing to oil refining have recognised the dangers of human error, and the importance of communication and teamwork in dealing with emergencies. They have introduced what is known as Human Factors (HF) training, which teaches basic skills designed to promote safety. While much-prized technical skills are essential, they are not always enough in a fast-moving, high-risk situation. At critical moments, organisational and social skills are just as important. This means good communication and an ability to work together with each member of the team.
It appears that moments after being sedated, Elaine's airway collapsed, preventing adequate levels of oxygen from reaching her brain. Though potentially an emergency, the event is a recognised risk during an anaesthetic and, as such, should be manageable. Surgeons and anaesthetists are drilled to follow a series of steps at this point - beginning with a non-invasive attempt to get the patient breathing normally, and ending, as a last resort, with an emergency surgical procedure. This is usually a tracheotomy - where the surgeon cuts through the windpipe, inserting a tube directly into the airway through the throat.
At first the drill was followed impeccably. But then a problem arose: the surgical team tried to get a tube into the airway to help Elaine breathe, but encountered some kind of blockage. According to the drill, this was the time to consider doing a tracheotomy. Elaine, by this point, was turning blue in the face and one of the nurses fetched tracheotomy equipment. A second nurse phoned through to the intensive care unit to check there was a spare bed available.
But the three consultants appear to have made the sort of human error that is horribly common in crisis situations. They became fixated on what they were doing. The consultants also appear to have ignored the junior staff and remained intent on finding a way to insert a tube into the airway. The minutes ticked by. After 25 minutes, they were finally able to get a tube into her airway -but even then, the team failed to secure the tube and it was a full 35 minutes before adequate oxygen levels to the brain were restored.
At the inquest, held in October last year, the lead anaesthetist admitted that he had lost control and there was a dispute over exactly who was in charge of the procedure, making life-and-death decisions.
All of which could have been the end of the investigation. But Martin Bromiley had an unusual insight into the factors that led to his wife's death. He is both a pilot and a specialist in HF training, which has been mandatory for British pilots and crew since the mid-1990s. "Fixation is a normal reaction to stress. HF training teaches people that it's normal to carry on trying to take the usual action, even when it's clearly not working," he says. "But at some point, a decision has to be made to break out of that pattern of behaviour. The way to ensure that happens is for all members of the team to see it as their duty to speak out to keep the patient safe." There was no comfort in knowing that two of the nurses knew how to save his wife's life. "What they didn't know - and what HF would have taught them - is how to broach the subject with their bosses," he says.
"The same problem used to exist in aviation. It was common for the evidence from black boxes to show that junior members of staff had been aware that a mistake had been made and had either kept quiet or been ignored." Clinicians tended to view human error as a sign of weakness or the result of poor performance, says Martin. "Yet high-risk industries have shown that by accepting that it is normal to make mistakes, it becomes the team's responsibility to watch out for errors and catch them before they cause significant harm."
Martin began to ask questions and soon found that he was not the only person to be concerned about the risks of modern surgery. Indeed, for the past year the Royal College of Surgeons has been developing HF training courses in which surgeons have worked with experts from the aviation industry. Last month, it also organised a conference where leading doctors, nurses and managers heard speakers from the military, the oil industry and motor racing, among others, all described the dramatic impact on safety levels following the introduction of HF training. Martin himself also addressed the conference. "Patients want surgeons who can communicate well with them and effectively with members of the team,' says Tony Giddings, the Royal College of Surgeons council member responsible for patient safety issues and a former surgeon and trained pilot. "And there is a growing understanding of their importance within the profession. These skills are not unique to medicine; they are skills for life itself. They enable people to be confident and self-assured yet acknowledge they are not infallible. "Unless people have these skills intuitively, they need to be trained. Surgeons, anaesthetists, nurses and other members of the team can be trained together to develop these essential skills."
However, unless such training is mandatory, the surgeons who need it most won't participate, says Mr Giddings. It also needs funding. HF training could save thousands of lives every year, yet he says there is a reluctance at government level to commit resources to a scheme which could cost millions of pounds every year. "But however expensive mandatory training is, there is considerable evidence that human error in medicine is far more costly, both in human and financial terms." For Roger Goss, co-director of campaign group Patient Concern, there is no question that HF training must be implemented. "If the aviation industry uses this type of training, then that's good enough for me: flying is the safest mode of transport," he says. "Patient safety must become a priority in health care. It's not at the moment. Chief executives are constantly being criticised for failing to make it a priority, and instead focusing on keeping within their budget. The NHS has a moral obligation to do anything humanly possible to minimise the risks of surgery."
This week, Martin is meeting the Deputy Chief Medical Officer to discuss a number of initiatives. As he approaches a second Christmas without his wife, he is determined that his family's terrible experience will have a positive impact on the culture of surgery. "There is no question in my mind that Elaine's death will bring enormous change to clinical practice," he says with quiet determination
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
Saturday, December 16, 2006
NHS spend 7 billion pounds of taxpayer's money on 'private consultants'
And it's not medical consultants we are talking about
More than 7 billion pounds [Yes. That's billions, not millions] of taxpayers' money was lavished on private consultants in the public services over the last three years - thanks to soaring costs in the NHS. Spending on consultants in the Health Service has increased 18 fold in just two years, from 31million in 2004 to a staggering 578m in the 12 months to April - partly thanks to the spiralling costs of the new NHS computer system. That raised the total bill for consultants in the public services to 2.8bn last year - a rise of a third over the last two years.
The National Audit Office warned there is no evidence at all that taxpapyers have got value for money because Whitehall departments keep such poor records. A hard hitting report by the government spending watchdog found that ministers could save more than 1billion over three years if they put in place even basic controls to cut the number of consultants and get better value from their contracts.
The company cashing in the most is computer firm IBM, with contracts worth 275m pounds last year, while Accenture - the management company who have worked for Labour since before the 1997 election - raked in 175m. PA Consulting, who are presiding over the controversial ID card scheme, pocketed 102million last year.
The report slams government departments for paying consultants millions on a daily 'time and materials' rate which encourages them to spin out contracts to milk money from the public purse, rather making payments dependent on delivering successful projects. The worst offender is the Department of Education and Skills, which receives four 'red lights' for its failure to get a grip on consultant spending. After the NHS, the biggest slice of the bill comes from local government, where consultants earned 386m last year. The Department for International Development, despite being a small ministry, ran up a gigantic bill of 255m. The Ministry of Defence spent 213m and the Environment department 160m.
Among the contracts singled out for criticism is the Home Office's ID cards project, where more than 2m a month was being funnelled to PA Consulting last year. The report complains that the department rather than the consultants 'bear the costs for increases in project duration', which have exceeded original estimates. The NAO concluded that most departments do not bother to 'make a proper assessment of whether internal resources could have been used instead of consultants' or 'collect adequate information on their use of consultants'. Crucially their report said that departments do not talk to each other about which consulting firms and partners at those firms do a good job, nor do they make sure consultants train up civil servants to do the job once they have left. It concludes: 'Fewer than half of central government organisations collect information on how the consultants have performed against what they were intended to do.'
Keith Davis, director of the NAO efficiency centre which compiled the report, said: 'The way that Government is managing consultants doesn't represent value for money. Part of the problem is there is no clear information.' Edward Leigh, chairman of the Public Accounts Committee, said: 'Today's report from the NAO confirms what many of us have long suspected: the external consultancy gravy train continues full steam ahead, courtesy if the public purse. 'In the past three years, 7.3bn of taxpayers' money has gone to big consultancy firms. Too often departments hand over a signed cheque to consultants without first looking to see what skills they have in-house. 'Perhaps the most damning finding is that, time and again, departments fail to keep an eye on how these companies perform or if they are delivering.'
Sir John Bourn, head of the National Audit Office, branded progress in government 'disappointing'. He said: 'Departments need to think ahead about what skills they should have, so they don't have to rely on consultants year after year. Peter Hill, chief executive of the Management Consultancies Association said: 'The increase in the use of management consultants is against a background of unprecedented public sector reform which requires skills and competency not available in sufficient numbers in the public sector.' CBI director of public services Dr Neil Bentley said: 'Consultants offer expertise and experience often not found in the public sector, but government departments need to make a clear business case for using them if the taxpayer is to get value for money. 'As the NAO rightly suggests, this does not always happen.'
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
And it's not medical consultants we are talking about
More than 7 billion pounds [Yes. That's billions, not millions] of taxpayers' money was lavished on private consultants in the public services over the last three years - thanks to soaring costs in the NHS. Spending on consultants in the Health Service has increased 18 fold in just two years, from 31million in 2004 to a staggering 578m in the 12 months to April - partly thanks to the spiralling costs of the new NHS computer system. That raised the total bill for consultants in the public services to 2.8bn last year - a rise of a third over the last two years.
The National Audit Office warned there is no evidence at all that taxpapyers have got value for money because Whitehall departments keep such poor records. A hard hitting report by the government spending watchdog found that ministers could save more than 1billion over three years if they put in place even basic controls to cut the number of consultants and get better value from their contracts.
The company cashing in the most is computer firm IBM, with contracts worth 275m pounds last year, while Accenture - the management company who have worked for Labour since before the 1997 election - raked in 175m. PA Consulting, who are presiding over the controversial ID card scheme, pocketed 102million last year.
The report slams government departments for paying consultants millions on a daily 'time and materials' rate which encourages them to spin out contracts to milk money from the public purse, rather making payments dependent on delivering successful projects. The worst offender is the Department of Education and Skills, which receives four 'red lights' for its failure to get a grip on consultant spending. After the NHS, the biggest slice of the bill comes from local government, where consultants earned 386m last year. The Department for International Development, despite being a small ministry, ran up a gigantic bill of 255m. The Ministry of Defence spent 213m and the Environment department 160m.
Among the contracts singled out for criticism is the Home Office's ID cards project, where more than 2m a month was being funnelled to PA Consulting last year. The report complains that the department rather than the consultants 'bear the costs for increases in project duration', which have exceeded original estimates. The NAO concluded that most departments do not bother to 'make a proper assessment of whether internal resources could have been used instead of consultants' or 'collect adequate information on their use of consultants'. Crucially their report said that departments do not talk to each other about which consulting firms and partners at those firms do a good job, nor do they make sure consultants train up civil servants to do the job once they have left. It concludes: 'Fewer than half of central government organisations collect information on how the consultants have performed against what they were intended to do.'
Keith Davis, director of the NAO efficiency centre which compiled the report, said: 'The way that Government is managing consultants doesn't represent value for money. Part of the problem is there is no clear information.' Edward Leigh, chairman of the Public Accounts Committee, said: 'Today's report from the NAO confirms what many of us have long suspected: the external consultancy gravy train continues full steam ahead, courtesy if the public purse. 'In the past three years, 7.3bn of taxpayers' money has gone to big consultancy firms. Too often departments hand over a signed cheque to consultants without first looking to see what skills they have in-house. 'Perhaps the most damning finding is that, time and again, departments fail to keep an eye on how these companies perform or if they are delivering.'
Sir John Bourn, head of the National Audit Office, branded progress in government 'disappointing'. He said: 'Departments need to think ahead about what skills they should have, so they don't have to rely on consultants year after year. Peter Hill, chief executive of the Management Consultancies Association said: 'The increase in the use of management consultants is against a background of unprecedented public sector reform which requires skills and competency not available in sufficient numbers in the public sector.' CBI director of public services Dr Neil Bentley said: 'Consultants offer expertise and experience often not found in the public sector, but government departments need to make a clear business case for using them if the taxpayer is to get value for money. 'As the NAO rightly suggests, this does not always happen.'
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. 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 Pages are here or here or here.
***************************
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