EVEN CASTRO CAN'T GET GOOD SOCIALIZED MERDICINE

Cuban leader Fidel Castro has long prided himself on Cuba's doctors and free public health care system, but that system seems to have let him down after he fell ill in July , U.S.-based doctors said on Tuesday. Based on a report in Tuesday's edition of Spain's El Pais newspaper, the doctors -- who have no first-hand knowledge of Castro's condition -- said Castro had received questionable or even botched care at the hands of health experts on his communist-ruled island. "It's not a good story. Too bad they didn't send him to Miami for surgery," said Dr. Charles Gerson, a clinical professor of medicine in the gastroenterology division of New York's Mt. Sinai School of Medicine.

According to two medical sources cited by El Pais, the veteran revolutionary was in "very serious" condition after three failed operations on his large intestine for diverticulitis, or pouch-like bulges in the intestine, complicated by infection. The sources in El Pais were from the same Madrid hospital where a surgeon who visited the 80-year-old Castro in late December works. The Spanish surgeon, Jose Luis Garcia Sabrido, had not changed his opinion that Castro was slowly recovering after stomach surgery for an undisclosed ailment, his secretary said. But El Pais said Castro was being fed intravenously and his outlook was bleak. If confirmed, the newspaper's account was the first with details of Castro's clinical history since he first underwent surgery six months ago. His condition is considered a state secret inside Cuba

Gerson and Dr. Meyer Solny, a veteran gastrointestinal expert at New York Presbyterian Hospital and the Weill Cornell College of Medicine, said Castro's doctors erred by seeking to avoid a colostomy -- or opening in the abdomen to get rid of stool -- after an initial operation to remove part of his large intestine. "They took a chance, which was probably not the best judgment under the circumstances," Gerson said. "It sounds like they tried to spare him the colostomy, which would have been the safer and more conservative approach, and what they did was to try to establish continuity of the bowel by sewing the colon to the rectum, and for one reason or another it sounds like that didn't work. And now there are troubles," said Solny.

Gerson said the Cuban doctors appeared to have suffered one problem after another. "What you're into is multiple operations with complications and infection in someone his age, you know, the wear and tear is going to start wearing him down, and he's going to get weaker," he said.

U.S. medical experts were also puzzled by El Pais' report that Castro had undergone a third operation to implant a Korean-made prosthesis, possibly an artificial stretch of bowel, after a second failed operation to clean and drain an infected area and perform a colostomy. "I would say that that would likely be a very risky situation because of the nature of the large intestine, which is a sewage line," said Dr. Stephen Hanauer, chief of gastroenterology at the University of Chicago. He said the use of a prosthesis in such cases was "experimental" at best and unheard of in the United States. "I think the prognosis is very grave at this point," said Dr. Roshini Rajapaksa, a gastroenterologist at NYU Medical center and assistant professor at the NYU School of Medicine. "For an elderly person to undergo major abdominal surgery three times, especially when they're unsuccessful, is a very serious situation."

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Australia: More stupid medical bureaucracy

If you are a Pakistani doctor killing people regularly that is fine but if you just take a break for once you are negligent! And a bureaucracy that fails to consider the impact of its decisions is CLEARLY negligent. These dummies wouldn't know malpractice if they fell over it

Eight Kingaroy doctors have labelled the Medical Board of Queensland's suspension of a colleague as "absolutely disgusting". Patrick Lip, who has practised in the nearby South Burnett town of Wondai for 36 years, was suspended last month after allegations that his response to an emergency had contributed to a patient's death from a drug overdose.

A letter to Dr Lip, signed by the eight general practitioners and faxed to Health Minister Stephen Robertson, said other doctors in the region were finding it hard to cope with the extra workload resulting from his suspension. "For this to happen three days before Christmas was badly timed and is absolutely disgusting," the letter said. "There must be thousands of patients dependent on the very devoted medical services you have offered over the past 30-odd years. "Our real concern is for these patients now having to find another GP in an area that is totally short of doctors in any case."

The doctors said their Kingaroy surgeries had been swamped by requests from Dr Lip's patients to join their practices. "Unfortunately, most are already very busy working 12 hours on a daily basis, and many of your patients are turned away," they wrote. "The situation is intolerable and the future looks dismal."

Wondai Mayor David Carter said he knew of at least one patient who had travelled 90 minutes to Gympie to see a GP since Dr Lip's suspension. He said the suspension had created great angst in the town. Cr Carter said Dr Lip was the type of doctor who still made house calls. "I've been that ill myself, my wife has called and he came straight round," Cr Carter said.

Dr Lip, who has appealed his suspension, has declined to comment on legal advice. A Queensland Health spokeswoman said the department was very committed to maintaining GP services in rural and remote areas. But she said it also had a duty of care to ensure patient safety. The Medical Board of Queensland said it was working hard to resolve the matter as quickly as possible.

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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?

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