Dying for FDA reform

This year, Congress is considering a variety of legislative changes that would substantially affect the regulation of pharmaceutical drugs. There is growing momentum for congressional action to address several perceived drug safety problems, but all of the proposals under consideration would harm, not improve, patient safety by making it more difficult to get promising new drugs approved and into the hands of doctors and patients. These ill-conceived policies would also increase the already astronomical costs of bringing these medicines to market, raise prices, and reduce incentives for developers to undertake experimental projects.

Source. Full document in PDF here





No room at a major public hospital in South Australia

DOCTORS have been asked to stop sending patients to the Flinders Medical Centre emergency department. The overcrowded EU has admitted up to 74 patients a day at its emergency department during the past fortnight. That is just one below the point at which it would execute its "extreme emergency" code white plan, developed last winter after unprecedented demand for services. Documents obtained by The Advertiser show up to 180 people a day were presenting themselves at the Flinders emergency department and up to another 100 nightly. However, not all are admitted for treatment. Few are 'flu cases.

Southern Adelaide Health Service acute services executive director Michael Szwarcbord this week instructed hospital medical and nursing staff to:

DISCHARGE early as many patients as possible.

ACTIVELY "pull" patients out of emergency to other wards to free-up beds.

DEFER voluntary and planned admissions.

NOT accept any non-urgent patient transfers.

In a memo, stamped "urgent", issued to all Flinders staff on Monday, Mr Szwarcbord revealed GPs had been asked to avoid referring patients to the emergency department if there were "safe alternatives for their care".

Australian Medical Association state president Dr Peter Ford, however, said that message "placed considerable pressure on GPs" who were already heavily taxed. He claimed there was "considerable denial" in the Health Department over the pressures the system was under. As a further example, he said first-time mothers who had normal deliveries were being sent home from the Women's and Children's Hospital the same day they gave birth.

Opposition health spokeswoman Vickie Chapman yesterday claimed the documents showed Flinders was "in crisis" and the State Government's health budget was "more about saving money than lives". "The public is in pain and it is only going to get worse, not better," she said. "Those of us lucky enough to survive until 2016, when the Government's new Marjorie Jackson-Nelson Hospital opens, might have a chance but I expect the mortality rate to increase before then."

Health Minister John Hill, who is also Minister for the Southern Suburbs, admitted winter would be "a challenge for health staff". He said the Government had a strategic plan to unite hospitals, health and ambulance services, GPs and rehabilitation services in the face of a huge increase in demand. "There will also be more emphasis on keeping out of hospital patients who do not need to be there," he said. "South Australians can be assured that our health system is prepared and that our services will be providing the best possible care for our community." Mr Hill said sending patients home was "entirely a matter for the clinicians and nobody is telling them to do that". He also queried Dr Ford's suggestion officials were unaware of the pressure, saying: "We sure are, that's why we have introduced these reforms, because without them, the system will buckle."

Mr Szwarcbord's June 18 memo revealed 22 non-urgent elective surgery cases and four non-urgent elective procedures scheduled for Tuesday this week had been cancelled. "The hospital is experiencing overcrowding as a result of the high number of patients presenting to the emergency department and the number of patients requiring admission," he said. "At present, there are 61 patients in the emergency department, 35 of whom are waiting for an in-patient bed."

Memos, dated June 7, 13 and 18 obtained by The Advertiser, reveal the emergency department has been operating on code grey - 60 to 74 patients - for the past two weeks. The department has a "winter escalation plan" which works on a colour code system of green for up to 37 patients, amber for up to 54 patients, red for up to 60 patients, grey for up to 74 patients and white for 75 or more.

Mr Szwarcbord said the Flinders problem was exacerbated by the nearby Noarlunga Hospital operating at full capacity and the Repatriation General Hospital experiencing high demand. He advised staff on Monday that, while a range of measures had been implemented to "ease the situation", a "code white" would be activated if the problem escalated. Under the emergency code white, the hospital will:

INCREASE staff levels by hiring more casuals.

EXPEDITE patient discharges at all three southern region hospitals.

FACILITATE internal patient transfers, where appropriate.

LOCATE SA Ambulance staff on site to assist with transfers.

OPEN selected treatment, day patient and outpatient clinical areas for beds.

RESTRICT access to the emergency department to key staff only.

Mr Szwarcbord was unavailable for comment yesterday but Emergency Medicine director Dr Di King said in an emailed statement that high demand over the past two weeks could be the result of industrial action and reduced beds because of an upgrade of the pediatric unit. Dr King said that as part of a $153 million redevelopment at the hospital, the emergency department would be expanded to cope with a "growing volume of patients". Minor works were under way in ward 4G to provide care for 20 additional 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?

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