Sunday, October 14, 2007

Ridiculous medical credentialism

Ideally one would hope that certification to operate in one State would automatically apply to all at all times but at least in emergency situations that should be so.

Laws aimed at breaking legal hurdles that prevented hundreds of doctors and nurses from volunteering to help Hurricane Katrina victims in 2005 are gaining momentum in states from Oregon to Pennsylvania. The legislation would allow doctors, nurses, pharmacists, coroners, emergency medical technicians and veterinarians who aren't licensed in states struck by disaster to get quick authorization to offer medical help. Laws have been approved in Colorado, Kentucky and Tennessee and are awaiting the governor's signature in California. Proponents say they expect 20 more states to consider legislation in 2008.

Interest stems from the confusion and government red tape that kept volunteer health workers out of New Orleans when flooding wiped out hospitals and left residents desperate for medical care. At the city's Superdome shelter, Jullette Saussy and a handful of doctors struggled to provide basic care with few supplies and very little help. "We found out later that there were hundreds, if not thousands, of volunteers that were stopped (80 miles away) in Baton Rouge and were not allowed to come into the city and help" because of questions about credentialing and liability, says Saussy, emergency medical services chief for New Orleans. Two years later, Saussy says, "It gives me goose bumps, it makes me so angry."

Health care workers wanting to help in disasters would have to register with the government. Once approved, they would be under the supervision of officials in the state where they volunteer. Using the registries, officials in disaster zones could check to verify that volunteer health workers are properly credentialed and insured. The legislation grants states and practitioners protection from lawsuits.

The National Conference of Commissioners on Uniform State Laws, group that drafts model laws for legislatures, came up with the proposal last year. In a disaster, officials coping with problems from lack of phone service and impassable roads shouldn't be expected to deal with the complex legal and medical issues involved in allowing doctors to practice across state lines, says Raymond Pepe, a member of the commission.

In Louisiana, "in the fog of war, so to speak, people didn't know what the rules were," Pepe says. It was a source of frustration for those who wanted to help. Preston "Chip" Rich, chief of trauma surgery at the University of North Carolina Hospitals, headed to New Orleans shortly after Katrina hit in a 35-car convoy of 100-plus health care workers - but the group never got across the Louisiana line. State officials wouldn't let them come in and start practicing. "It was just a brick wall" of bureaucracy, Rich says. "It was chaos."

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AUSTRALIA'S PUBLIC HOSPITAL MADNESS CONTINUES

Four current articles below



Rage boils over at public hospital delays

Three days in great pain waiting for treatment becomes too much

TERRIFIED patients and staff were evacuated from the Gold Coast Hospital as an enraged bikie demanding immediate haemorrhoid surgery for his wife threatened to call in his gang to "trash the place", a court was told yesterday. "I'm the king of the Gold Coast and we don't wait in line for anyone," senior Finks bikie gang member Richard Savage told hospital staff. "I'm going to get 30 of my Finks mates and drink piss and party 'til my wife gets her operation."

Savage pleaded guilty yesterday in Southport District Court to threatening violence and wilful damage. The charges stemmed from a fracas on July 8, 2005, when Savage's wife was in the Gold Coast Hospital awaiting haemmorrhoid surgery. Crown prosecutor Bob Falconer said Savage became aggressive as the wait for surgery continued. Mr Falconer said Savage snapped after being told by staff that operating theatres were full and it was doubtful his wife would be operated on that day. He punched a hole in the wall and told staff: "You better call the police because my mates are on the way. "We're going to trash this place. My wife has been waiting for surgery for three days and I'm sick of waiting."

Mr Falconer said frightened and tearful patients, some of whom had just had surgery, had to be evacuated from the ward, along with staff. He said while the Crown accepted that Savage's wife was in "terrible pain" and he was frustrated, his behaviour was unacceptable. Barrister Tony Glynn, for Savage, said his client had been under great stress but accepted his actions went "well beyond what was a proper and measured reaction to that sort of stress". Mr Glynn said Savage had completed an anger management course and was so impressed he referred two associates.

Judge Fleur Kingham said she accepted that Savage's wife was in extreme pain and had been for some days. But she said he had "simply lost control" and reacted in a way which was "firstly out of proportion and, secondly, entirely unacceptable". "In seeking to alleviate the pain and distress your wife was in, you also caused a great deal of distress, including to patients who had already undergone surgery," Judge Kingham told Savage. She accepted Crown and defence submissions for a wholly suspended 12-month jail sentence for Savage.

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Hospital doctor shortage getting worse, not better

SYDNEY's emergency departments are in crisis with one in five senior doctor positions vacant and no recruitment program in place, leaving burnt-out staff angry and ready to quit. More than 22 specialist positions in 24 metropolitan emergency departments had been vacant for several months, despite pleas from doctors who were working overtime to cover the shortfall, the executive director of the Australian Salaried Medical Officers Federation, Dr Sim Mead, said yesterday. "The health department is denying there is a freeze on recruitment, so why are they not advertising these positions? It is completely baffling and I can only draw the conclusion that the longer they take to fill the positions, the more money they save, but it is at the expense of the doctors trying to hold the system up." Dr Mead said advertisements for some positions were later cancelled when it was discovered all the applicants were from other Sydney emergency departments "It's moving the deck chairs around on the Titanic."

The NSW chairman of the Australasian College for Emergency Medicine, Dr Tony Joseph, said emergency specialists could earn up to $100,000 a year more in Queensland and many younger doctors were tempted to leave. "When you spend all day cajoling and arguing with people about moving patients out of the emergency department and into wards, the registrars see that and they don't want it for the rest of their lives." Dr Joseph said the Health Department needed to address overcrowding in hospitals, employ adequate numbers of senior doctors and start listening to staff on the frontline.

One emergency medicine registrar, Dr Claire Skinner, said several doctors were reducing their hours because they felt burnt-out and unable to cope: "The intensity of the work is incredible and has definitely increased. It is stressful and emotionally intense and there is no recovery. We cannot provide the quality of care that we should be able to and that is making us all very stressed. People are leaving and there is a massive risk that we won't be able to train the next generation." She said 43 per cent of emergency department registrars were trained in Australia, with the balance made up of overseas-trained doctors and locums, costing the State Government an extra $35 million a year. "Some are great and some are disasters. Most locums are not familiar with the environment, and emergency departments are quite chaotic at the best of times. It is also erosive for morale when permanent staff are overseeing locums who are earning three times as much as they are."

A survey in May by the University of Sydney's Workplace Research Centre found that almost half of the 140 emergency doctors surveyed said they did not have the time to take a toilet break as soon as they needed. About 66 per cent of the doctors had reported rarely or never completing clinical support activities in rostered time. The Health Department said yesterday it was advertising in Britain and that it had increased the number of staff specialists by 13 per cent and junior staff by 10 per cent in the past three years.

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Stupid penny-pinching by hospital bureaucrats

Firing just one of their many "administrators" would have done a whole lot more good but bureaucrats are sacrosanct, of course

A SURGEON says removing cracker biscuits from Royal Hobart Hospital operating theatres to save money is exhausting staff and putting patients' lives at risk. Senior surgeon Stephen Wilkinson said low blood sugar interfered with doctors' ability to make life and death decisions during overnight emergency surgery that often ran into the morning. "It's administration gone mad," said Dr Wilkinson, who was doing emergency surgery into the early hours yesterday. "Morale is already at an all-time low, with surgeons close to walking out. All we want is the Salada biscuits and Vegemite reinstated. It might sound petty but it makes a big difference. "We get hypoglycemic, a headache and we're trying to think clearly so you can make difficult decisions on the run. People's lives are relying on it."

He said the hardest work was at night. "That's when you get the car accidents, bowel obstructions, perforated ulcers," he said. "We need to get our concentration back and sugars up. "It's a stressful environment already. I think it's unsafe." The operating suite tearoom had long had "simple crackers and biscuits", but now had only teabags and instant coffee.

Dr Wilkinson was so angry he rang chief executive officer Craig White during the early hours of yesterday. The hospital said it had stopped providing food and snack items to maximise resources for direct patient care. "The RHH is experiencing significant budget pressure and identified the provision of food and snack items to doctors' lounges and staff tea rooms as an expenditure that would be redirected to patient care," spokeswoman Pene Snashall said.

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And we trust Indian doctors?

There is no way these doctors can have received anything like Western-standard medical training

A COUPLE has been charged with the murder of one of their sons after they tried to transfuse his blood into his elder brother to make him smarter. The elder boy is fighting for his life. The Indian Express said the couple were both doctors and the mother had a dream in which a guru advised blood transfusion to make their elder son do better at his studies. Police said the couple initially claimed the boy, 11, was killed in an attack but later confessed.

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1 comment:

Frank Zavisca said...

Indians have a wide range of standards for medical training.

"The rich" can buy a medical degree.