Tuesday, November 11, 2008

Standard of care at NHS children's hospital 'worse than in the developing world'

Treatment at Birmingham Children's Hospital is worse than in the developing world and parents are 'told lies' to cover up sub-standard care, a doctors' report claims. In the document, surgeons at the hospital claimed they had less support during kidney transplant operations than when they performed the same procedures in Lagos, Nigeria.

Consultants also complained that complex operations were delayed because staff did not recognise common surgical implements, and said children were receiving a third-class service. It is also claimed that children with neurological problems have been involved in 'close calls' because of delays in admitting the to the right specialist ward, and that nurses on the ward have resigned because of dangers to patients. Doctors said they had stopped reporting the problems because 'there is no point' as hospital managers did nothing to address the issues.

The report was commissioned by the NHS primary care trusts in Birmingham after senior doctors at the hospital and at neighbouring University Hospital Birmingham said their repeated attempts to raise the alarm had been ignored. Speaking on the BBC Politics Show, Alan Johnson, the Health Secretary, also vowed to 'keep a close eye' on inquiries and promised the Healthcare Commission would investigate. MPs have called for a full inquiry into the quality of care at the hospital, where children are treated for life-threatening conditions such as liver or kidney failure, neurological problems and chronic heart complaints.

Among the most serious failings highlighted in the report was the lack of any specialist junior doctor cover on the liver transplant ward between 9pm and 9am, and staff forced to remain on call seven days a week. It also said that doctors lie to parents about why their child has undergone a major operation because they cannot admit the hospital does not have the staff and infrastructure to carry out safer procedures.

The report authors added: 'Theatres are not prepared for the procedures carried out, equipment and knowledge of the procedure is lacking at Birmingham College Hospital owing to the trust not having dedicated teams to support the tertiary service.'

Paul O'Connor, the hospital's chief executive said there was no immediate clinical risk to patients but has commissioned a separate inquiry by Dr Jane Collins of London's Great Ormond Street Hospital which he has promised to publish.

Andrew Lansley, the shadow Health Secretary, called for an urgent response, while John Black, president of the Royal College of Surgeons, called the report alarming. Jonathan Fielden, chairman of the British Medical Association's consultants' comittee, said the report showed hospital managers had put financial concerns ahead of improving care for highly vulnerable patients.

The report calls for better general management and leadership and urges doctors to follow the formal process of reporting incidents of bad practice. A spokesperson for the Department of Health added: 'The Department of Health is waiting to receive the findings of this investigation. When we do we will consider these findings very carefully and respond in due course. We take these matters extremely seriously.'

One disturbing story to have emerged about the state of care of Birmingham Children's Hospital was that of Lisa Weale and her partner Jason Smith. Their four-month-old baby, Thomas, died after surgery on a hole in his heart, when his heart machine was accidentally switched off as a doctor was cleaning it. Miss Weale said: 'When he tried to turn the machine on again the doctor had put it into reverse and air was being pumped into Thomas's bloodstream.' Thomas's parents complained to the Healthcare Commission and after a two-year inquiry their complaint was upheld. They have received an out-of-court settlement over the death of their son.

Lisa Weale said of the new report: 'I knew that it was no only us who had been through such bad treatment. I feel the hospital have been getting away with this silently.'


Michigan Asbestos malpractice

One reason we know about the great silicosis legal scam is that a Texas judge was brave enough to expose doctors who'd been paid by tort lawyers to gin up phony diagnoses. So it is encouraging to see a Michigan judge now helping to expose evidence of similar medical fraud in asbestos claims.

This action is taking place in the courthouse of Wayne County Circuit Court Judge Robert Colombo, Jr. Asbestos defendants have been attempting to disqualify Michael Kelly, a physician who appears to have falsely diagnosed thousands of people with asbestos-related disease. Judge Colombo recently gave them an opening, which is already having a dramatic effect on state asbestos claims.

Michigan is one of the last state holdouts against asbestos tort reform. Texas, Ohio and Mississippi have passed laws or created court procedures to clean up their dockets, and new asbestos filings are declining nationally. But they're still climbing in Michigan, the venue for nearly 14% of U.S. asbestos suits and No. 1 in 2007 for new filings (996).

Enter Dr. Kelly, who is behind many of these cases. The Lansing physician is neither a radiologist nor a pulmonologist. In 1989 he failed the federal test that certifies doctors to read X-rays for lung disease. Yet according to Michigan state records, over 15 years Dr. Kelly has reported 7,323 cases of asbestos-related disease. Lawyers paid him $500 per person screened.

Unlike the silicosis doctors who did their own phony work, Dr. Kelly made the mistake of sending his clients to a hospital for X-rays. Under hospital procedures, staff radiologists read the X-rays first. When asbestos defendants obtained the plaintiff medical records, the hospital findings were included. In 88% of the 1,875 cases in which plaintiff X-rays were reviewed both by Dr. Kelly and hospital radiologists, the hospital readers found no evidence of disease. The medical records also showed that the vast majority of the lung-function tests Dr. Kelly performed failed to meet accepted standards.

Of the 91 asbestos cases Judge Colombo was set to oversee this month, Dr. Kelly provided a diagnosis in 80. In addition to giving the judge a broad picture of Dr. Kelly's work, defense attorneys also retained two respected pulmonologists to review specific cases. Jack Parker, who spent years at the Centers for Disease Control, provided the court with a blind study in which independent X-ray readers found an abnormality in only one of 68 (1.5%) X-rays that Dr. Kelly read. Dr. Kelly had found abnormalities in 88% of those X-rays.

Judge Colombo, who has been the state's asbestos judge since the early 1990s, initially balked at diving into this medical evidence -- suggesting he preferred a quick and easy settlement. But in the face of evidence that up to 90% of the cases in front of him were fraudulent, he ultimately relented and last week agreed to a hearing on Dr. Kelly. At which point something astonishing happened. Within 24-hours of the judge's decision, the plaintiffs attorneys voluntarily pulled all but one of the suits. They clearly have no interest in subjecting their "doctor," and his methods, to judicial scrutiny.

Judge Colombo should do it anyway, and get to the bottom of Dr. Kelly. It's always easier for judges to orchestrate quiet settlements than to preside over trials, which take time and effort. But the reason so many asbestos defendants have pre-emptively settled over the past 20 years is because court rules have been stacked against them. Now that they've finally cracked the lid on this diagnosing for dollars fraud, courts have a responsibility to investigate.


No comments: