Wednesday, April 30, 2008

A new global bureaucracy?

For years, international activists have tried to argue that patent protection for new drugs is incompatible with global health. They may have finally found a sympathetic ear. Later this month, the World Health Organization (WHO) is convening its Intergovernmental Working Group on Intellectual Property (IGWG) in Geneva to consider “redrawing” global intellectual property rules. This Group intends to undermine patents and increase government’s role in R&D in order to improve the availability of medicines in poorer countries. But by effectively nationalizing R&D, the WHO risks scaring away those entities in the best position to engage in risky and expensive drug research: big pharmaceutical companies. A better way to boost commercial research on neglected diseases would be to lower research costs and improve the likelihood of private companies’ turning a profit.

The IGWG is still in its early stages, but it has already shown a troubling deference to many of the most prominent anti-patent groups.These activists want to replace the existing intellectual property regime for drugs, which is founded on patents, with a legally-binding global treaty for medical research and development. They hope that the treaty would create a new United Nations bureaucracy that would set a global agenda for drug R&D, including identifying research priorities, allocating funding, awarding research contracts, and distributing cash prizes to successful inventors, all in lieu of patents. The UN would license any of the resulting products for sale at marginal prices.

The establishment of such a global R&D bureaucracy would be highly counterproductive. First, giving bureaucrats the power to set a global research agenda would politicize drug R&D. High-profile diseases would hog the attention, and expensive medicines would be favored over cheaper but more effective prevention measures. In a centrally directed system—such as the British National Health Service—resources always flow to the loudest pressure groups.

Second, the notion that a drug bureaucracy can pick “winners” is not supported by recent history: consider, for example, the U.S. government’s ill-fated attempt to find a cure for malaria in the 1980s, which produced little other than a $60 million bill for taxpayers and corruption charges for several project members. A global drug bureaucracy would transform innovative, research-focused drug companies into highly regulated utilities dependent on government contracts. In other regulated utilities—such as water, electricity, and gas—companies do the bare minimum to fulfill their contractual obligations. This is hardly a recipe for medical innovation.

Finally, using state-funded prizes as the major incentive for R&D is extremely problematic. Advocates of a prize system for drug research cite the example of the Ansari X Prize for a reusable spacecraft as evidence that such a mechanism can work in the pharmaceutical sector. However, engineering and drug research require completely different business models. Pharmaceutical R&D entails enormous up-front expenditures and many unknown risks—both scientific and regulatory—since the vast majority of drug candidates fail. Without the lure of temporary monopoly profits that accompany drug patents, many firms would shift their capital elsewhere.

Instead of dismantling patents, we should make commercial R&D work better for the few tropical diseases that remain under-researched. To that end, we should build on successful legislation like the U.S. Orphan Drug Act (ODA), which led to an explosion of new treatments for rare diseases with small patient populations. Enacted in January 1983, the ODA offers tax credits, seven years of market exclusivity, and consultations with Food and Drug Administration (FDA) staff to companies that develop drugs for these populations. In the first 16 years of the bill’s life, the average annual number of new drugs for rare diseases was 12 times greater than it was during the previous decade. Tellingly, Japan and the European Union have embraced similar legislation.

Building on the ODA, in 2006 researchers at Duke University proposed a transferable voucher system for developers of drugs for neglected diseases, an idea that became law as part of the Food and Drug Administration Amendments Act of 2007. Under the new system, companies that develop a new drug for a neglected disease will receive a voucher for FDA “priority review” of any of their other drugs. Researchers estimate that priority review will lead the FDA to evaluate the drug application in about six months, which is 12 months faster than a standard evaluation. For companies with a potential “blockbuster” drug, getting to market a year sooner might mean hundreds of millions of dollars in additional revenue. Smaller companies or nonprofits that developed drugs for neglected diseases can also auction the voucher to the highest bidder, raising millions in additional funds for new research.

Starting next September, the vouchers will be available for treatments of 16 neglected diseases or “any other infectious disease for which there is no significant market in developed nations.” These types of policies show how free markets can work for even the world’s poorest citizens. We hope that the activists are paying attention, in Geneva and elsewhere.


Tuesday, April 29, 2008

British nurses are engulfed by a tide of NHS paperwork

Ass-covering via paperwork trumps patient care in a socialized system

Nurses spend more than a million hours a week on non-essential paperwork, according to the Royal College of Nursing. A survey found that of the 1,700 nurses questioned, 88 per cent believed that the time needed for such paperwork had increased in recent years. Only one in five had seen a corresponding rise in administrative support. One in four said they had no access to clerical support.

The union called on NHS trusts to employ administrative staff to relieve the burden on nurses. Peter Carter, the general secretary said: “The danger is that this is undermining their ability to care for patients and support relatives.” The poll was published as nurses gathered in Bournemouth for the union’s annual conference.

Nurses working in the community and in out-patient departments were most burdened, two-fifths saying they had to do all their own clerical tasks.

A separate poll suggested that 80 per cent of nurses had felt distress at being unable to treat patients with due dignity. In particular, hospitals could not guarantee patients single-sex accommodation.


Monday, April 28, 2008

Superbug fears hit British playgrounds

Panton and Valentine associated the toxin with soft tissue infections in 1932 so the NHS has had time to think of something to do about it

A superbug to which children are particularly vulnerable is spreading in Britain and specialists say the government is failing to take action to stop it. A Sunday Times investigation has found at least 10 youngsters aged between six and 13 have been left fighting for their lives after contracting the infection. Doctors are concerned because they appear to have caught the bug in playgrounds and parks.

The children were all hit by Panton-Valentine leukocidin (PVL), a toxin that combines with MRSA, the bacteria that cause thousands of infections, sometimes lethal, in hospitals. Mark Enright, professor of molecular epidemiology at Imperial College London, said: “This infection can kill healthy children in one to two days, but the authorities are continuing to treat MRSA as purely a hospital problem and trying to assuage public opinion.”

Other specialists accuse the government of ignoring warnings about the seriousness of PVL-MRSA, failing to mount adequate infection surveillance and blocking the use of a treatment to tackle it. Professor Richard Wise, a leading microbiologist, says that he warned a government health minister three years ago of the threat, but little has been done.

The phenomenon of PVL-MRSA was identified in America several years ago. British doctors have now reported cases from the south coast to the Midlands. They include a six-year-old girl left brain-damaged after she fell off her scooter and contracted the infection in her shin bone, from where it spread throughout her body, and a nine-year-old boy who was crippled after a graze playing football.

The mother of a 10-year-old boy in London who caught the bug said: “One day he was playing happily and the next day he couldn’t see, speak or move. The doctors didn’t know what was happening. It was terrifying.” Official figures show that the number of recorded PVL infections rose from 224 in 2005 to 496 in 2006.


Australia: Fewer beds at major NSW hospital than 13 years ago

Despite a significant rise in the population

THERE are 186 fewer beds at Sydney's troubled Royal North Shore Hospital than there were 13 years ago when the state Labor Government came to power, Health Department figures reveal. In March 1995, 776 beds were available to patients, but on the latest available figures the hospital has just 590 beds. The figures, obtained by the NSW Opposition under freedom of information, measured bed decline from 1993 to September last year. Opposition health spokesman Jillian Skinner said the figure was alarming when the remaining 590 beds included cots, bassinets, critical-care beds, mental-health beds, maternity beds, and "transition beds" in patients' homes.

Under the $702 million hospital redevelopment announced by Health Minister Reba Meagher in November last year, the hospital will end up with 626 beds. In 2003, when Premier Morris Iemma was health minister, the number of beds reached its lowest point at 547. "Every RNSH doctor who gave evidence at the parliamentary inquiry into the hospital last year spoke of the desperate shortage of acute-care beds," Ms Skinner said. "The NSW Labor Government has stripped more than 180 beds from RNSH since it came to power 13 years ago," Ms Skinner said. "It also expanded the definition of a bed so even those in a patient's own home are counted as hospital beds. The new hospital will be seriously short of beds."

Ms Meagher yesterday said there was less need for large numbers of beds as patients now stayed in hospital for shorter periods. "The 23-hour unit at Royal North Shore Hospital today performs a number of day-only procedures that 10 years ago would have resulted in a five-day stay in hospital," she said. "For example, hernia and varicose-vein procedures, which resulted in a three- to seven-day stay in hospital 10 years ago, are now performed mostly as day only procedures."


Sunday, April 27, 2008


Two current articles from Australia below

Your regulators will protect you (1)

The State Government should publish online "report cards" for doctors so the public can judge their competency, the daughter of a woman who died after an obesity operation said yesterday. Leesa MacLeod's mother Ursula died in 2003 after having a biliary pancreatic diversion - which involves a radical reduction of the stomach and small intestine. Ms MacLeod said yesterday her mother, who was 57, would not have allowed Gold Coast surgeon Russell Broadbent to operate had she known there were questions about his skills.

Dr Broadbent faces suspension or deregistration for his allegedly incompetent surgical and post-operative treatment on at least 11 patients. Court documents have revealed that six of the surgeon's former patients who had radical surgery to combat obesity suffered severe complications. Three of the six died. The Medical Board of Queensland was granted leave in the Health Practitioners Tribunal yesterday to refer the names of two more patients to the tribunal for investigation after receiving an expert opinion into their treatment.

Ms MacLeod said her mother's treatment had been appalling and that she had been living a nightmare since her death more than four years ago. She said prospective patients would benefit from a system where a doctor's record - including success and mortality rates - was transparent. The Medical Board began proceedings against the surgeon in the tribunal late last year following a complaint from Ms MacLeod.

The board has also taken up the complaints of five other former patients of Dr Broadbent's, all of whom allege they received surgical procedures that resulted in complications. One of those patients has already sued Dr Broadbent and received $650,000 in damages in an out-of-court settlement. Dr Broadbent's operations took place between 2000 and 2007 in the Allamanda and Pindara private hospitals on the Gold Coast.

The board alleges that Dr Broadbent failed to manage and treat Mrs MacLeod's fluid intake and renal function after the operation. The board further says he failed to investigate her persistent vomiting, diarrhoea and rectal bleeding and that he failed to start treatment for septicaemia in a timely manner. It also accuses the doctor of failing to refer Mrs MacLeod to other specialists to assist in the investigation of her deterioration. Civil proceedings have been launched in the Supreme Court on behalf of Ms McLeod. The matter will again be mentioned before the tribunal in two weeks.


Your regulators will protect you (2)

Every time Dr Cynthia Weinstein's head pops up in the news, I get a little shock. Not just because her face looks like it has been tightly stretched, burned and painted. No, what most shocks me about seeing her face is that Dr Cynthia Weinstein is still allowed to work as a doctor. I believe she should have been struck off years ago.

I first met Cynthia Weinstein 12 years ago when investigating a story about professional standards in the cosmetic surgery business. I saw her operate on patients wearing her civilian clothes and without the obvious, usual scrubbing up. I saw the silicone she had stored for injecting into patients' faces, even though this was not an approved procedure.

One poor young woman had turned up for skin treatment and Cynthia Weinstein told her that if she didn't also have eyelid surgery she could go blind. It was all dangerous baloney, as explained by a reputable surgeon I showed my tapes to. I later found out that Dr Weinstein had also offered this particular patient a discount if she was filmed for my TV report. Sounds a lot like inappropriate inducement. It all went horribly wrong, of course, and I was not allowed to see the suffering patient after surgery because, as Dr Weinstein told me with no hint of irony, the woman was in pain and having trouble seeing.

The crucial question then and now is, how best can the public be protected from the likes of Dr Cynthia Weinstein? Dr Weinstein is currently up before the board for professional misconduct for the third time. In a spectacular case of deja vu, she is facing allegations that she messed up the surgeries of six patients and performed cosmetic procedures that she was banned from doing.

This set of allegations may or may not be proved. The main point, it seems to me, is that what already has been proved against her should be more than sufficient to retire her. Dr Weinstein has been found guilty of being grossly professionally negligent by subjecting patients to treatment by unqualified personnel. She is also guilty of ripping off Medicare and has a criminal conviction from the County Court. She is now quibbling with what surgery means, arguing if she cuts her patients with a laser instead of scalpel she's not really operating on them.

I've heard people say its hard to feel sympathy for anyone who chooses to have treatment from someone who looks like Cynthia Weinstein. But the question of appearances can do weird things to people's heads, so to speak. It seems reasonable to assume that the woman's face is not what you'd call a good advertisement for her line of work. And yet there are many, many people who think otherwise. The patient I met who was talked into having her eyes done told me she thought Cynthia's face was gorgeous and a credit to her profession. Seriously.

Cynthia herself seems very happy with the way she looks. She did her own phenol skin peel years ago and now appears to me to have skin resembling shiny plastic. Her nose appears to be a fraction of its former size and her cheeks appear strangely bulbous and sited high on her skull. She looks thin enough to snap in a mild breeze. A colleague of Dr Weinstein's has told the Practitioners Board that patients flock to Cynthia because of her looks. And it's true, she sees an average of 25 patients a day. Fair enough if this is anyone's idea of beauty, we live in a free society.

But while we can't protect people from themselves, we can help protect them from unprofessional or negligent medical practitioners.


Children in Australia's boom State may be forced to go elsewhere for surgery

WA children could be forced to travel interstate for surgery because Princess Margaret Hospital can't cope with the booming population, staff at the hospital have warned. A six-day-old boy recently had to undergo heart surgery in the Eastern States purely because there was not enough theatre space at PMH. The boy was transferred to Royal Children's Hospital in Melbourne.

The state's only children's heart surgeon Dr David Andrews warned that it could become a trend. He said that theatre space at PMH was reaching "critical'' condition. "We have had no increase in theatre space since I started (at PMH) eight years ago,'' Dr Andrews said. "There is no spare theatres... everyone has to juggle around and try to be available when they are not normally available so they can use the theatre when it's free. "I know a lot of staff are doing out of hours surgery or changing around private operating lists so they can be free when there is a spare spot at PMH. "It is getting harder and the patients are getting shuffled more to fit in. "The (Health) Minister (Jim McGinty) has all the information that the workload has gone up.''

There has been a 20 per cent increase in WA births in the past two years. It is expected a record 30,000 babies will be born in the state this year.

Opposition Health spokesman Dr Kim Hames said the State Government must announce their future plans for PMH. "They need to be getting on with it now before building prices get significantly worse,'' Dr Hames said. "We've been saying over and over again that this needs to happen now.''

Australian Medical Association vice-president Dr Gary Geelhoed said the boom in population could mean more local children are sent interstate for surgery unless PMH woes were addressed. "This will be inevitably happening in the future and more frequently if nothing changes in terms of resources available,'' Dr Geelhoed. "In the recent past they have sent one child (interstate) not because there was a clinical need but because they just couldn't fit it into the schedule here. "The equation of having the doctors, enough theatre space and ICU space was such that they just couldn't do it.''

Dr Geelhoed said interstate trips for child surgery could be problematic. "Medical risk aside, clearly the cost involved and the inconvenience to the families is a major thing,'' Dr Geelhoed said.

Dr Andrews said he was frustrated that the future of PMH was still undecided. 'There is no direction. They still haven't announced where PMH is heading,'' Dr Andrews said. "In the meantime, they need to acknowledge that the birth rate has gone up therefore the attendances to the hospital have gone up. "Every department will tell you they are under strain compared to what they used to be.''

A PMH nurse, who did not want to be named for fear of losing her job, said that WA urgently needed a bigger children's hospital. She said that PMH's Intensive Care Unit, which only has 10 beds, was running to maximum capacity. "We need a bigger children's hospital in WA,'' she said. "Children are forced to fly interstate because we just don't have the facilities to accommodate them. "As a booming state with such an exceptional increase in population, the government is severely lacking in its consideration of the children of the future.''

The nurse said a lack of government funding and red-tape was jeopardising patient care. "Late last year a five-year-old boy came in for an MRI scan on the weekend,'' she said. "We don't have government funding to use the MRI on the weekend so that child had to be kept under spinal precaution until Monday. "It was a situation that could have quite easily been managed if we could have had that scan.''


Saturday, April 26, 2008

NHS fight against MRSA going nowhere

The government's drive to combat MRSA superbug infections in NHS hospitals faltered in the final quarter of last year, figures from the Health Protection Agency revealed yesterday. The number of infections in England had fallen sharply for three years, but increased slightly from 1,080 cases between July and September to 1,087 between October and December. John Reid, the former health secretary, promised in 2004 to halve the number of MRSA infections by the end of March 2008. When Gordon Brown became prime minister in June, he made hygiene a priority for the NHS. In September, he said every ward should be deep-cleaned by the end of March.

The agency said: "Over the last year cases of MRSA bloodstream infection have been steadily falling. We would obviously like to have seen the trend continued in this quarter." To achieve Reid's target, the NHS would have to reduce the number of cases from 642 a month in 2004 to 321 a month between April and June this year. In the final quarter of last year, there were 362 a month.

Ann Keen, the health minister, said: "The MRSA target remains within reach. However, one case of avoidable infection is one too many and I am challenging the NHS to make full use of the resources at their disposal to eradicate avoidable infections."


Australian cancer patient at death's door as a result of gross public hospital negligence

A dying woman has won a settlement from the Melbourne hospital she says misdiagnosed the cancer that will soon claim her life. The 52-year-old has been told she will die in the coming weeks from pancreatic cancer, which she claims grew unchecked for a year after Western Hospital doctors noticed a lump but failed to investigate further. The woman won an undisclosed sum from Western Health, which she sued for robbing her of a chance to overcome the disease.

She is in hospital and too sick to be interviewed, and asked not to be named. But she asked that her story be publicised, so hospitals would be forced to be more accountable and other patients would not suffer through misdiagnosis. A statement of claim lodged with the Supreme Court this month alleged that the woman had gone to the Footscray hospital in August 2006 suffering abdominal pain, and that a CT scan revealed a 1cm lump in her pancreas. She claimed that despite recommendations for further tests, informal reports advising doctors to perform a biopsy and a surgeon later suggesting the mass may need to be cut out, the lump was not investigated; instead, she was diagnosed as having mild gastritis and duodenitis, and referred back to her doctor.

A year later, she went back to the hospital in crippling pain and the lump was found to have grown to 11cm. She claimed that on Christmas Eve, doctors revealed they believed that the mass was cancer, and was spreading. By January, it was confirmed as a metastatic adenocarcinoma with widespread tumours in her liver, and complications to her portal vein and spleen. Chemotherapy could not overcome the cancer.

Arnold Thomas and Becker solicitor Larry Dent said his client had made a determined stand for other patients. "It is important that the issue of patients being lost in the system and lost to follow-up is dealt with," he said. "The root cause of this problem is that this lady was lost to follow-up. "If anyone thinks there is something wrong, they should first seek medical advice, and then legal advice if they think they are not getting anywhere. And they should not let it go."

A spokeswoman for Western Health, which did not admit liability, said the hospital could not comment on the case or the confidential settlement of it. "We are extremely sensitive to what she is going through at the moment in terms of her cancer and the impact it is having on her and her family," Anne Learmonth said. "However, we can't say much more than that."


Friday, April 25, 2008

Health Savings Sabotage

Democrats have made affordable health care a mainstay of their election agenda, but apparently only if you're willing to get insurance through the government. Witness their stealthy assault on Americans who prefer the private-sector option of Health Savings Accounts. This week, the House passed legislation that included a provision to require every HSA transaction be reviewed and verified as a legitimate medical expense. Democrats say this is to ensure that consumers are using their tax-free withdrawals for a knee replacement, rather than a new iPod. In reality it adds a layer of bureaucracy that could sharply reduce the appeal and cost savings of HSAs.

A key player here is Ways and Means Health Subcommittee Chairman Pete Stark, whose main purpose in politics is to give the U.S. a government-run health-care system. He is a known opponent of HSAs – once comparing them to "weapons of mass destruction" – because they introduce more individual choice into the health-care marketplace.

Pushing for the provision was a company called Evolution Benefits, which has patented a system for the substantiation of health-care expenses. Evolution's lobbyist, John McManus, was the former staff director of the Health Subcommittee under Republican Bill Thomas. The company first lobbied for the HSA provision, then withdrew its support when Republicans began to focus on its role. But Ways and Means Chairman Charlie Rangel helped make sure the provision was in the bill, which passed largely on partisan lines.

Liberals claim HSAs are insurance for the "healthy and wealthy," but there's little evidence this is true. How they work is that an employer or individual first buys a cheap, high-deductible policy for large, unexpected medical costs. Then the insured can open an HSA and make an annual contribution up to $2,900 for an individual in 2008, which he can use to pay for ordinary health needs. Savings not spent in any given year can build up tax-free.

This is health insurance many Americans can afford, and it doesn't force those who have better use for their scarce dollars to buy gold-plated insurance with special-interest mandates (cover the chiropractors!) that Democrats want to force on everyone. HSAs also give consumers more reason to care about prices, bringing much-needed market discipline.

Since HSAs were created in December 2003, 3.2 million HSA accounts have been opened, covering 4.5 million Americans. Nearly a third of new HSA users previously had no insurance and bought coverage on their own. Thirty-three percent are small businesses that had not previously offered coverage to their employees. Isn't this what good progressives claim to want?

Apparently not if it means a free market in health insurance. Having lost the policy argument when HSAs were created, Democrats are now trying to kill them with regulatory subterfuge. The new scheme purports to ensure that money saved tax-free in an HSA is actually used for health expenses. But this is a nonproblem: Any withdrawal from an HSA is already subject to a federal tax audit, just as individual tax returns are. In any case if people cheat on their HSAs, they are only cheating themselves. When a medical expense arises below the insurance deductible, they will be the ones paying for it, whether from their HSA or another bank account.

Democrats, including Hillary Clinton and Barack Obama, decry the high and rising costs of health care, including insurance "overhead." Mr. Stark and his friends want to impose the same bureaucratic overhead even on spending that consumers do with their own money. The Senate should stop this one dead in its tracks.


Australian (NSW) public hospital kills cop

Concord Hospital and a leading specialist have been secretly [SECRETLY?? How obnoxious!] disciplined by the Health Care Complaints Commission after a patient was found dead on the floor in the middle of the night. Widow Jacqui Day complained about the treatment of her husband Andy, a top undercover police officer, after an anonymous letter from nurses at the hospital said: "Mr Day should not have died." Detective Inspector Day, 45, was being treated for pneumonia and died when his oxygen tube fell out of its wall tap for the second time in six hours.

After an inquiry behind closed doors, the HCCC found that Concord, a major teaching hospital, had provided below standard care to Mr Day "in a number of respects", The Daily Telegraph can reveal. The commission also found that Professor Matthew Peters, the head of respiratory medicine at the hospital, had "departed from the acceptable standard of care" in two areas. He was referred to the Medical Board's conduct committee for "counselling" for not transferring Mr Day to the intensive care unit and for failing to appropriately monitor his oxygen needs.

Mrs Day will today appear before the Government's special commission of inquiry into the state's ailing health system, sitting at Concord, to demand answers and ask why the complaints procedure is shrouded in such secrecy. There was evidence before the HCCC from four medical experts that Mr Day should have been moved to intensive care. Professor Peters told the inquiry there were no intensive care beds available and Mr Day did not want to be moved.

The commission's report, obtained by The Daily Telegraph, said there had been at least one bed available on five of the eight days Mr Day was in hospital and there was no record in the medical notes of Mr Day's comments. "In 2008, you can't leave your loved one in a public hospital on their own," Mrs Day said yesterday, adding that all adverse HCCC findings should be made public. "I still do not know how a 45-year-old man can be admitted to hospital and die on the floor in the middle of the night."

It will be Mrs Day's first visit to the hospital since her husband died at 3.30am on November 14, 2003, after eight days treatment. The HCCC took 18 months on its inquiry. The anonymous letter from nurses was sent to the coroner who conducted a 2006 inquest into Mr Day's death. The cause of death was recorded as a lack of oxygen "due to displacement of oxygen supply", however coroner John Abernethy found Mr Day's condition was so serious he would have died even with different care.

HCCC executive officer Kim Swan said legislation limited what the commission could release to the public. The Medical Board did not return calls. Professor Peters is overseas.


Thursday, April 24, 2008

Crookedness in an Australian public hospital

The head of The Alfred's intensive-care unit has been interviewed by the Ombudsman's office as part of an inquiry into billing practices at the Melbourne hospital. The Australian has been told the Ombudsman's office plans to examine the records of Alfred ICU director Carlos Scheinkestel as part of its inquiry. The revelation follows the resignation last week of trauma unit head Thomas Kossmann after a peer review found he was an incompetent surgeon who had rorted [misused] funds from compensation authorities, including Victoria's Transport Accident Commission. The Australian contacted Professor Scheinkestel yesterday but he refused to comment.

Professor Kossmann - who rejects the peer review's findings - faces the prospect of a criminal investigation into his billing practices and separate investigations from the TAC, Medicare and the Ombudsman. The Ombudsman's inquiry has extended beyond Professor Kossmann to a broad investigation into billing practices. The Alfred yesterday said the Ombudsman had not requested any information from it about Professor Scheinkestel. A spokesman said the intensive-care unit billed as a group so there was no way any one physician within the department stood to gain personally from any billing activity.

In January, Professor Scheinkestel was interviewed by the panel investigating Professor Kossmann and was asked about the German-born doctor's billing and surgical methods. But the interview was solely about the allegations concerning Professor Kossmann rather than anything to do with Professor Scheinkestel himself. It came after a deputy director in intensive care made a supportive submission to the panel about Professor Kossmann.

The panel, led by orthopedic specialist Bob Dickens, interviewed Professor Scheinkestel to see if he supported the submission. He told the panel he did not have sufficient knowledge or insight to comment on Professor Kossmann's surgical skills or billing methods.

Fresh allegations emerged last week when The Alfred accused Professor Kossmann of failing to declare hundreds of thousands of dollars allegedly owed to the hospital for surgery on TAC and workplace injury patients. He is also accused of getting a junior doctor to falsify a medical record to aid his defence. Professor Kossmann has denied all wrongdoing and on resigning said he was the victim of a witch-hunt.


Wednesday, April 23, 2008

Doctor gifts: Much ado over very little in Mass.

State licences for salesmen??

The state Senate unanimously approved a first-in-the-nation law banning all gifts to doctors from pharmaceutical companies, but lawmakers removed a controversial provision that would have criminalized the practice. The gift ban was approved as part of a sweeping package of reforms seeking to control skyrocketing health-care costs. Other provisions of the bill would force the adoption of computerized medical records and require health insurers to publicly document annual cost increases.

But the gift ban drew the most attention as health industry lobbyists battled to alter the legislation, arguing that it would go too far by restricting distribution of educational materials and would potentially hurt patient care. The bill still needs approval from the House of Representatives and Gov. Deval Patrick. State Sen. Mark Montigny (D-New Bedford), the principal author of the gift ban provision, said he agreed to compromise by removing language that would have made gift-giving a criminal offense. But he insisted the bill has retained its essential elements. “This will prevent the illicit marketing that is compromising the doctor-patient relationship,” Montigny said. “Billions is being spent on schmoozing and sending doctors on junkets, and it shouldn’t be happening.”

The new law goes further than similar measures on the books in other states. Vermont and Minnesota have instituted restrictions on gifts of certain monetary values, but the Massachusetts law is the first to ban all gifts, no matter how much they are worth. The law also forces pharmaceutical companies and medical device manufacturers to obtain state licenses for sales agents; any agent caught violating the gift ban could be fined up to $5,000 for each offense.

The measure passed the Senate 36-0 on Thursday despite sharp criticism from medical and pharmaceutical companies. “Strictly interpreted, the ‘anything of value ban’ could bring clinical trials to a halt in Massachusetts, severely cut into necessary and mandated continuing educational studies undertaken by physicians, and mean that fewer new medicines are readily available to patients,” the Massachusetts Biotechnology Council wrote in a letter to lawmakers.


Tuesday, April 22, 2008

'Thousands of English patients go to Wales for free prescriptions'

More NHS weirdness

Tens of thousands of English patients could be registering with Welsh GPs and making day-trips to the country to obtain free prescriptions, it was claimed yesterday. Statistics show that three million people are registered with Welsh GPs, about 100,000 more than the official population. Wales is the only part of Britain not to have prescription charges. England has the highest at 7.10 pounds, followed by Northern Ireland at 6.85 and Scotland at 5 pounds.

The Conservative Party in Wales claimed that the figures pointed to patients from England travelling to Wales and called on the Welsh Assembly executive to stop "prescription tourism". Darren Millar, a Tory member of the assembly, said: "It has long been my suspicion that prescription tourism is rife in my constituency. We must tackle it sooner rather than later." The Tories suspect that English people could be using the addresses of friends and relatives in Wales to register.

However, David Bailey, the British Medical Association chairman in Wales, said: "The extra patients may be students or people who have come to Wales to work." An assembly spokesman said: "There is no evidence to suggest that patients are coming to Wales to benefit from free prescriptions. There has historically been a difference between the number of people registered with GPs and the population. "It is a long-standing problem across the UK and is mainly caused by people registering with a new practice before de-registering with their existing practice."


Monday, April 21, 2008

Negligent Australian public hospital kills little kid

Every day Katey Locock looks at her baby daughter Jasmine and her heart breaks. Seven months ago Mrs Locock and her husband, Gayvn, were overjoyed at the birth of Jasmine and her twin Gemma, sisters for two-year-old Amber. But last month Gemma died of heart failure after acquiring Kawasaki disease, an inflammatory condition, which can be treated simply if detected. The Lococks say doctors at John Hunter Children's Hospital in Newcastle failed to diagnose the condition, despite telltale symptoms - and they want to know why. "Every time we do something for Jasmine we know we should be doing it for Gemma as well. It breaks our hearts," Mrs Locock said. Jasmine knows something's wrong. She has not been the same since her sister died, her parents say.

Gemma spent four days in hospital after she became ill with what her parents say were distinctive symptoms of Kawasaki disease, including a persistent high fever for more than five days, severe rash, red lips, red eyes and peeling skin on her hands and feet. Her parents say they were told to take their daughter home. Six weeks later she died. "The doctors kept saying it was a mystery and just gave her Panadol. They only ever ran one blood test," Mrs Locock said from her Belmont home. "But she had at least four symptoms [of Kawasaki disease]. If they had done their job properly, Gemma would still be with us today."

Kawasaki disease, an uncommon illness that mostly affects children under five, causes inflammation of small blood vessels known as vasculitis. In extreme cases the coronary arteries swell, which can block the blood supply to the heart. Most children recover after receiving a simple intravenous drip of gammaglobulin - an ingredient of the blood that helps fight infection - and a high dose of aspirin to reduce the risk of heart damage.

The Lococks say doctors failed to order an echocardiogram, which would have shown the heart damage. Mrs Locock also made two visits to the family GP, which resulted only in a prescription for reflux medication. On March 16, Gemma began having breathing difficulties and within two hours she was dead. "It was such a shock, it all happened so fast," Mrs Locock said.

The day after Gemma's death, Jasmine and Amber were summoned to the hospital for blood tests. When Jasmine's test showed abnormalities, the Lococks say they were forced to wait another day for her echocardiogram because no one was available to do it. "We'd already lost one baby and time was crucial but they still made us wait," Mrs Locock said. Jasmine was eventually given the gammaglobulin drip as a precaution and is healthy.

Gemma's great-grandfather, Terry McCormack, said her death had "devastated our family". He has launched a blog - - inviting parents who have had "unsatisfactory dealings" with the John Hunter Children's Hospital to contact him.

"This is a devastating situation and we understand and share the grief that the family is experiencing," the hospital said in a statement on Friday. It said Gemma displayed only one clinical feature - skin rash. "It would be extremely difficult for any doctor to diagnose Kawasaki disease solely by the presence of a skin rash in the absence of the other signs of the condition," it said. The hospital said the Locock family had been invited to meet senior doctors once the final post-mortem examination report was completed.


Sunday, April 20, 2008

McCain's healthcare plan bests Obama's

For some time now, the debate over how best to reform the American healthcare system has been dominated by the question of "universal coverage," how to provide health insurance to those without it. However, if Sens. John McCain (R-Ariz.) and Barack Obama (D-Ill.) become the candidates for president this fall, we may see a subtle but useful shift that could actually lead to improving how healthcare is provided in this country.

Throughout the primaries Sen. Hillary Rodham Clinton (D-N.Y.) and Obama have clashed over the question of an individual mandate (requiring every American to purchase insurance). Hillary supports such a mandate, claiming that it's the only way to ensure universal coverage. Obama opposes one, arguing that "the reason people don't have health insurance is not because they don't want it; it's because they can't afford it." Instead of a mandate, therefore, Obama would focus on a combination of cost cutting and subsidies to reduce the price of insurance. While he believes that his proposal would greatly increase the number of Americans with insurance, he admits it will fall short of 100 percent coverage.

McCain also puts cost control before universal coverage. "Bringing costs under control is the only way to stop the erosion of affordable health insurance," McCain says. A McCain spokesman adds, "You worry about the uninsured, but they are a symptom of a larger problem. Unless you do something about cost, you are chasing your proverbial tail."

That is not to say that Obama and McCain agree on how to reduce healthcare costs. Obama would rely much more on the heavy hand of government. Among other things, he would impose caps on insurance premiums and price controls on drug companies. He would have the government establish national practice standards for doctors. And, he would create a National Health Insurance Exchange as a sort of clearinghouse to make it easier for businesses and individuals to shop for the best insurance.

McCain, in contrast, would attempt to promote greater competition among private health insurers. He would allow people to buy insurance plans across state lines, which will help drive down rates. And he would try to shift away from our current employment-based insurance system toward a system where individuals purchase and own their own insurance plans. He would do this by replacing the current tax break for employer-provided insurance with a refundable $2,500 tax credit for individuals, and $5,000 for families. The idea is that once people start to buy their own insurance, they'll be in a position to insist on lower prices and higher quality — just as they do with every other product they buy.

Overall, McCain has the better proposal. Obama's plan, with its heavy reliance on government, leads to the same problems that bedevil universal healthcare systems all over the world: limited patient choices and rationed care. McCain's proposal is much more consumer-centered and taps into the best aspects of the free market. But regardless of who becomes president, we can expect major changes for the American healthcare system. And it's a good sign that we're beginning to debate the right things.


Saturday, April 19, 2008

UK Prescription Tourism

Tens of thousands of English patients could be registering with Welsh GPs and making day-trips to the country to obtain free prescriptions, it was claimed yesterday.

Statistics show that three million people are registered with Welsh GPs, about 100,000 more than the official population. Wales is the only part of Britain not to have prescription charges.

England has the highest at £7.10, followed by Northern Ireland at £6.85 and Scotland at £5.

The Conservative Party in Wales claimed that the figures pointed to patients from England travelling to Wales and called on the Welsh Assembly executive to stop "prescription tourism".

Darren Millar, a Tory member of the assembly, said: "It has long been my suspicion that prescription tourism is rife in my constituency. We must tackle it sooner rather than later." The Tories suspect that English people could be using the addresses of friends and relatives in Wales to register.
Ah, socialized medicine -- national health care designed by a committee and managed by regional bureaucracies.
Exaggerated data, lazy argument

An average of 280 children under 5 drown every year in swimming pools; that's about five actual children a week. Using the logic of Juan Figueroa of the Universal Health Care Foundation of Connecticut, pools should be outlawed because "one life to lose is too many."

Mr. Figueroa's demagoguery came in response to a report that claimed three (statistical) adults die a week in Connecticut for lack of health insurance. Reports The Hartford Courant: "Families USA estimates that 150 Connecticut adults died in 2006 due to a lack of insurance, and FBI statistics show 108 murders in the state that year." Translation: What's happening is criminal.

Families USA, a leading advocate of taxpayer-funded health care, said 209,000 (11 percent) of the state's 1.9 million adults were uninsured in 2006, and 150 died because they lacked insurance. It's a tossup whether its data or methodology is more flawed.

The state Office of Health Care Access says 136,000 adults were uninsured in 2006. But 44 percent were uninsured by choice and 25 percent were noncitizens, so the discussion is really about roughly 42,000 people (2.2 percent of all adults) who might have benefited from universal health care. Extrapolating Families USA's calculations, the number of statistical deaths was really 0.58 a week, but even that number is vastly inflated.

Families USA relied on an Institute of Medicine formula that a Health Research Service analysis, which otherwise sympathized with the institute's cause, concluded was based on wild exaggerations that made the "magnitude of the estimated effect of insurance on mortality ... too large to be credible."

In addition, Families USA wrongly presumed the uninsured forego care when they are injured or ill, but hospital administrators know all too well how the uninsured consider emergency rooms their free health clinics. Further, the group believes socialized medicine is superior to the American health-care system; many in Britain and Canada living under the tyranny of universal health care would beg to differ.

Families USA, Mr. Figueroa et al. would have Connecticut spend hundreds of millions more annually on socialized medicine based on exaggerated statistics and a lazy argument: "If it saves one life, it's worth it."

The fact is, they can't document a single death irrefutably caused by the lack of health insurance and can't guarantee that inevitable health-care rationing under a government-run program wouldn't be deadlier than going without coverage.


Cancer coverup in Australia

The Queensland government does not want the failings of their country hospitals to become known

Life-saving cancer research is being blocked by Queensland Government restrictions on scientists gaining access to a register of sufferers throughout the state. The Cancer Council of Queensland has launched unprecedented legal action in Brisbane's Supreme Court for access to the register to enable independent study of the disease, including blocked work into why survival rates are lower in regional and rural Queensland. Scientists believe the study may embarrass Queensland Health because it is likely to reveal detection and treatment standards are failing outside of Brisbane.

Queensland is the only state in Australia, and one of the few jurisdictions in the Western world, where researchers require case-by-case approval to access the cancer register for the development of prevention and treatment strategies. Queensland Health has refused to release localised cancer statistics and has failed to fund the collation of data on the stages that cancers are being discovered in different areas.

The battle has emerged as suspected cancer clusters - involving the ABC's Brisbane studios and firefighters in north Queensland - are being investigated by the Government. Documents obtained by The Australian show that some of Australia's leading scientists - including former Australian of the Year Ian Frazer - have repeatedly appealed to Premier Anna Bligh and Health Minister Stephen Robertson to grant routine access to the data.

The Cancer Council of Queensland - which was awarded management rights of the register in 2001 - has been denied access or forced to wait up to a year for approval to use theinformation and start the research. A two-year backlog in collating the data, partly blamed on underfunding, has further blown out the delays. Queensland Health has enforced the approval procedure for access to the register because of concerns the release of information could identify an individual sufferer.


Friday, April 18, 2008

Chronic challenges to healthcare policy

There were several news stories this week worth commenting on here. Each involved the relationship between medicines and the chronically ill, and each served to highlight the fact that conventional allopathic, Big Pharma-created and FDA-approved "drugs" are not getting the job done - at least not to the satisfaction of those who most need the relief they promise. The implications of this may range much further than that segment of our society.

The first was a Reuters piece on how dietary supplements are being used by our society; as it turns out, their most common use is among those with chronic disease, who've apparently discovered they get at least as much benefit from naturopathy as from more accepted methods. According to the article, "Having one or more chronic illness [sic] is the primary factor associated with the use of dietary supplements. Cancer survivors also use supplements to treat chronic medical conditions . a new study shows."

Of course, after these two introductory sentences, the Reuters story goes immediately into dutiful obeisance to the conventional idols of regulation and orthodoxy, quoting a National Cancer Institute representative (who led the study) on her concerns about the "dangers" of permitting such free choices on the part of patients. As Dr. Melissa Farmer Miller reportedly puts it, "We really are just beginning to build an evidence base on the benefits of dietary supplements." She then adds the kicker: "Even if there's not a benefit, there is a potential for them to cause harm." In other words, the assumption is of the negative effects of these supplements, rather than of their possible value - in spite of the obvious market evidence of their widespread use by the chronically ill.

Let's leave that one for a moment and turn to another story almost as significant. An entry from the National Center for Policy Alternatives deals with another study, this one showing that these same chronically ill people are getting far less quality in their healthcare, despite a huge increase in the quantity (and cost) of such care. It cites a report from the Dartmouth Institute for Health Policy and Clinical Practice, which examined spending patterns in this realm, focusing on the final two years of the lives of these chronic-illness patients.

The variations in the duration and extent of hospitalization for such patients were far more dependent on the geography around them than on any correlation with their degree of illness, chance of survival or other factors. The report found that hospital stays and number of doctor visits during those last two years of existence were between three and five times as long and/or prevalent in Manhattan or Los Angeles than in smaller cities in Oregon or Utah. The implications of this on Medicare spending (the primary funding source for such visits by those patients) are obvious.

A third story, about yet another study, is also somewhat related here. It addresses the issue of narcotic painkiller prescriptions (Oxycontin, Vicodin and even some stronger Pharma pain-treatment creations), and ways that physicians can continue to prescribe them to treat legitimate pain issues in their patients, without risking the loss of their medical licenses, in the face of Drug Enforcement Administration crackdowns against the resale or diversion of these powerful drugs to the black market. According to a Health News Digest article, a new study from the University of Michigan and the Ohio State University shows "how doctors and their office staff might be able to keep their balance" between these two conflicting arenas.

And finally, there was an MSNBC consideration of the recent increase in state-driven programs for "recycling" unused prescription pharmaceuticals - both to prevent them from ending up in the waterways (after "flushing unused meds" as was once routinely recommended), and to cut the costs of such medicines for the uninsured and the poor. (Most programs require an intermediate step, of vetting by a pharmacist to check for dosage and safety, before passing them on hospitals and charitable clinics for free distribution to those in need of them.) The story notes that these drugs "run the gamut and include antibiotics, antipsychotics, blood thinners and antidepressants."

What do these four stories have in common? At first glance, perhaps not a lot, since they each deal with rather diverse issues. However, on closer examination it might be said that each one addresses a different component of the same societal problem: the increased reliance of everyone on high-potency prescription drugs . and the relatively low effectiveness these have produced. Even the chronically ill, who by all expectations should be most locked into reliance on allopathic methodologies for relief, are now demonstrably seen as seeking out natural and alternative medical channels for the easing of their distress.

It's pretty clear that these folks, with very little to lose at this stage, are eager to find ANY solution that mitigates their pain and suffering; they're also more than willing to encounter a few possible side-effects (and in most cases, less severe ones than the accepted laundry-list attached to your average Big Pharma concoction), on the off-chance that one or more of these "folk remedies" might actually improve their conditions, or at least ease the agony that accompanies them. (Moreover, as shown by the second study, although this segment of society appears to be spending more time under physician care, if not in the hospitals themselves, the frequency seems driven more by demographics than by any evidence of healing.)

The other two stories deal with the societal costs of the attempts to control the process, and keep the ailing members of our population chained to the prescriptions and the painkillers, instead of seeking ways to not just mitigate symptoms, but actually move to more curative methods. The first tries to show how doctors can better control the distribution of the drugs they prescribe; the second deals with how state and local governments are finding ways to get even more people reliant on these high-potency pharmaceuticals, including those who cannot afford them on their own devices.

In both cases, the question never asked is this: Why are we so focused on expanding access to these Pharma-created substances, instead of working to promote a lesser NEED for such remedies, dealing with ailments we may be able to PREVENT in the first place, with a little more focus on healing and wellness?

We're not discounting the fact that for some people conventional medication may be the only solution to their ailments. Brain chemistry is affected, and therefore sometimes may be re-balanced, even with laboratory-created psychoactive substances; meanwhile, some major pain issues must also be treated using these synthetic Pharma-concoctions. However, for most of us, the real key to managing our lives still lies in developing our own lifestyles and habits to promote overall wellness and disease-prevention; relying on synthetic pharmaceutical devices (which mostly function by suppression and distortion of our body's normal functioning) is clearly not the first resort in achieving and maintaining a healthy physical condition.

Oddly enough (or perhaps not?), this week's Backgrounder posting, by Mike Adams of Natural News (fka News Target) is most appropriate to this consideration, since it does ask that question. The piece, published some four years ago, offers the basic premise that for most people (including those for whom advancing age has come hand-in-hand with almost automatic recommendations for pharmaceutical prescriptions from their family physicians) the avoidance of Big Pharma drugs is actually a good decision for their health and wellness!

Adams, the self-defined "Health Ranger," has been commenting on these matters for a while now. However, this piece from several years back presents his most basic thesis: We can affect our health and wellness, and resisting the temptation to medicate (mask symptoms), and instead seeking cures and healing, is part and parcel of that paradigm-shift.

Judging from these news stories, he would appear to have been onto something, even four years ago. He would also be the first to declare that his ideas are hardly original, but that he`s merely the latest messenger, reminding us of what previous cultures have known for millennia.


Thursday, April 17, 2008

The Health Insurance Mafia

Most discussions about the rising cost of health care emphasize the need to get more people insured. The assumption seems to be that insurance – rather than the service delivered by doctor to patient – is the important commodity. But perhaps the solution to much of what currently plagues us in health care – rising costs and bureaucracy, diminishing levels of service – rests on a radically different approach: fewer people insured.

You don't need to be an economist to understand that any middleman interposed between seller and buyer raises the price of a given service or product. Some intermediaries justify this by providing benefits, such as salesmanship, advertising or transport. Others offer physical facilities, such as warehouses. A third group, organized crime, utilizes fear and intimidation to muscle its way into the provider-consumer chain, raking in hefty profits and bloating cost, without providing any benefit at all.

The health insurance model is closest to the parasitic relationship imposed by the Mafia and the like. Insurance companies provide nothing other than an ambiguous, shifty notion of "protection." But even the Mafia doesn't stick its nose into the process; once the monthly skim is set, Don Whoever stays out of the picture, but for occasional "cost of doing business" increases. When insurance companies insinuate themselves into the system, their first step is figuring out how to increase the skim by harming the people they are allegedly protecting through reduced service.

Insurance is all about betting against negative consequences and the insurance business model is unique in that profits depend upon goods and services not being provided. Using actuarial tables, insurers place their bets. Sometimes even the canniest MIT grads can't help: Property and casualty insurers have collapsed in the wake of natural disasters.

Health insurers have taken steps to avoid that level of surprise: Once they affix themselves to the host – in this case dual hosts, both doctor and patient – they systematically suck the lifeblood out of the supply chain with obstructive strategies. For that reason, the consequences of any insurance-based health-care model, be it privately run, or a government entitlement, are painfully easily to predict. There will be progressively draconian rationing using denial of authorization and steadily rising co-payments on the patient end; massive paperwork and other bureaucratic hurdles, and steadily diminishing fee-recovery on the doctor end.

Some of us are old enough to remember visiting the doctor and paying him/her directly by check or cash. You had a pretty good idea going in what the service was going to cost. And because the doctor had to look you in the eye – and didn't need to share a rising chunk of his profits with an insurer – the cost was likely to be reasonable. The same went for hospitals: no $20 aspirins due to insurance-company delay tactics and other shenanigans. Few physicians became millionaires, but they lived comfortably, took responsibility for their own business model, and enjoyed their work more.

Several years ago, I suffered a sports injury that necessitated an MRI. The "fee" for a 20-minute procedure was over $3,000. My insurance company refused to pay, so I informed the radiologist that I'd be footing the bill myself. Immediately, the "fee" was cut by two thirds. And the doctor was tickled to get it.

A few highly technical and complex procedures that need to amortize the purchase of extremely expensive hardware will be out of reach for any but the wealthiest patient. For that extremely limited category, insurance might work. A small percentage of indigent individuals won't be able to afford even low-cost procedures. For them, government-funded county facilities are the answer, because any decent society takes care of the weakest among us. But a hefty proportion of health-care services – office visits, minor surgeries – would be affordable to most Americans if the slice of the health-care dollar that currently ends up in the coffers of insurance companies was eliminated.

When I was in practice as a psychologist, I discussed fees up front with prospective patients, prior to their initial visit. People appreciated knowing what to expect and my bad debt rate was less than 1%. That allowed me to keep my charges reasonable and, on occasion, to lower them for less fortunate patients. And I loved my job because I was free to concentrate on what I went to school for: helping people, rather than filling out incomprehensible forms designed to discourage me from filing them in the first place.

Physicians and other providers need to liberate themselves from the Faustian bargain they've cut with the Mephistophelian suits who now run their professional lives. Because many doctors are loath to talk about money, they allowed themselves to perpetuate the fantasy that "insurance is paying." It isn't. There is no free lunch and no free physical exam.

If substantial numbers of health-care providers shook off the insurance monkey on their back, en masse, and the supply of providers was substantially increased by opening more medical schools, the result would be a more honest, cost-effective system benefiting everyone. Except the insurance companies.


Wednesday, April 16, 2008

Another negligent and uncaring public hospital in NSW (Australia)

Amy and Jo, daughters of the journalist Mike Willesee, were sure their mother was not depressed but that she was suffering from a serious undiagnosed medical condition. But Nepean Hospital medical staff failed to take a history from the women, despite their mother Carol, an accomplished stage actress, being in such a state she was unable to communicate, they told the Special Commission of Inquiry into acute care services in NSW yesterday. Carol Willesee had gone from a healthy active woman in June 2006, to within four months not being able to walk unassisted. She died in December 2006, aged 59, of the extremely rare neurological Creutzfeldt-Jakob disease.

Doctors had previously determined her problems were psychosomatic. Her daughters took her to a private psychiatric hospital in Richmond at the end of October 2006. "At that point we felt lost in the system because we had nowhere to go . plus we had the absolute terror that something was significantly wrong with her. She appeared to us to be dying," Amy Willesee said. Within days that hospital sent her by ambulance to Nepean Hospital's emergency department.

Amy Willesee told the inquiry the family became increasingly distressed during their mother's four-week stay at Nepean because they felt ignored by medical staff who did not speak to them at all about what their mother might be suffering from or what tests they were organising. She said she suspected that because her mother had come from a psychiatric hospital her condition was not being treated as medical. She had suspected her mother had the disease after researching her symptoms on the internet, but it was not until weeks after Carol was admitted that the doctors said they were investigating the possibility of CJD despite medical notes revealing later that it had been initially raised in emergency.

She said her mother was not adequately treated while at Nepean and the neurological team did not document many of the "frightening" symptoms she had witnessed, such as her arm being straight up in the air so stiff she could not pull it down. "It meant that Mum's pain and distress was never treated until she was diagnosed which was 23 days after her admission." The family never got to speak with her treating neurologist despite several requests and the junior doctor gave them scant information, she said. "Every day we would attempt to make contact with the specialist," she said. "We didn't ever meet the specialist."

She said family were not told of any tests being conducted and were not given the opportunity to ask questions. "We felt that she was just lying there dying," she said. Outside the inquiry she said: "At no time did any of the doctors at that hospital talk to us about what might be wrong with Mum".


Tuesday, April 15, 2008

Britain's already pathetic maternity services to be cut even further

Plans to downgrade maternity units in four London boroughs and other parts of the country are unacceptable and will deny women choice in how and where they give birth, leading midwives have said. Maternity services in Bexley, Bromley, Greenwich and Lewisham are underfunded and shortstaffed, with an overspend predicted to be 57 million pounds a year by 2010-11.

However, the Royal College of Midwives said that it has “significant reservations” over plans to cut costs by closing at least one – and probably two – maternity units and providing more home births and deliveries by midwives. The planned changes mirror proposals in other parts of the country, with maternity units in Greater Manchester, Teesside, and Oxfordshire already earmarked for radical overhauls.


Complaints against doctors to go public in NSW (Australia)

Long overdue. Better something than nothing. The public have had only the illusion of protection so far

Complaints against doctors will be aired at open hearings chaired by lawyers under landmark legislation to smash the code of secrecy surrounding rogue operators such as the "Butcher of Bega". In the fallout from the Bega case, where Dr Graeme Reeves is accused of mutilating hundreds of women, the NSW Government will today announce an unprecedented overhaul of the medical regulatory system. It means doctors will no longer be able to escape scrutiny by appearing at closed and confidential hearings presided over by fellow medics. The laws will include:

* A "guillotine provision" that automatically bans any doctor who breaches conditions on their practice;

* New powers for the NSW Medical Board to urgently suspend a doctor to protect the lives or health of patients;

* Making Professional Standards Committee (PSC) hearings open to the public and publishing findings;

* Employing non-medical personnel to help decide on disciplinary action against doctors, with a legal representative as chairperson;

* Forcing doctors by law to report colleagues they believe have engaged in sexual abuse, drug or alcohol intoxication or other serious misconduct;

* Requiring the NSW Medical Board and the Health Care Complaints Commission (HCCC) to consider all patient complaints, even after a doctor has been struck off;

* Ordering professional disciplinary bodies to examine doctors' overall "patterns of conduct" rather than on an individual complaint basis.

In an exclusive interview with The Sunday Telegraph, NSW Health Minister Reba Meagher said doctors will face more scrutiny than ever before. The new legislation will be presented to parliament early next month. It comes in the wake of revelations about Reeves, the disgraced ex-gynaecologist and obstetrician who allegedly mutilated and abused hundreds of women across NSW without detection by authorities for more than a decade. "The Reeves case challenged public confidence in the way the medical profession was being regulated and disciplined," the minister said.

But the proposals have met a lukewarm response from the medical profession. Dr Andrew Keegan, president of the Australian Medical Association (NSW), doubts they will make a lot of difference and is concerned about practicalities. "Frankly, lay people and legal people are not going to understand (medical details at PSC hearings), so you need a medical person there," he said. "Doctors need to have guidance on reporting colleagues - you can't work on hearsay. "The other thing we know is what we are told by patients is not always reliable." But Dr Rosanna Capolingua, president of the Federal AMA, supported the laws, which she said "enshrine existing professional and ethical obligations".

For the first time, anyone will be able to attend PSC hearings into alleged professional misconduct by doctors. "At the moment, it's assumed the (hearings) will be heard in private - we say it's going to be the other way around," Ms Meagher said. Legal and non-medical representatives will be introduced in a bid to overturn the system of "doctors regulating doctors" and improve objectivity.

Doctors who fail to raise the alarm about colleagues who have committed serious misconduct may face "failure to report" penalties themselves,ranging from counselling to being suspended or struck off. Those who make a report must have good grounds and will be granted immunity from defamation but will not gain anonymity. Under the "guillotine provision", the Medical Board will be able to immediately suspend or deregister a doctor who breaks rules of practice. It took the Board 20 months to deregister Reeves after discovering he was breaching an obstetrics ban - during which time he was able to treat other patients.


Monday, April 14, 2008

Australian trainee doctors miss out on experience at childbirth

They now learn little about anatomy so I suppose this is the next step. I am sure that they learn a lot about multicultural "sensitivity", though. I am glad my doctor is an older guy

MEDICAL students might graduate without ever having witnessed a natural birth or delivering a baby. A survey of Australian medical schools found rising caesarean rates and a dramatic rise in the number of trainee doctors and midwives competing to be in the birth suite meant opportunities to be involved in labour and delivery were diminishing. It also found many women would not consent to a medical student performing the delivery, even under supervision of a midwife or doctor.

The survey by Professor Caroline de Costa, of Queensland's James Cook University - published in the latest issue of medical journal O&G - found some medical schools had dropped or scaled back the mandatory requirement for students to attend a delivery. Yet the Australian College of Midwives requires its students to have performed 40 normal deliveries.

Australian Medical Students' Association president Michael Bonning said: "We believe it compromises patient safety and is inconsistent with community standards for medical graduates not to be exposed to the normal birthing process."

But some universities have decided it is no longer practical to have a fixed quota of births to attend. Simon Broadley, from Queensland's Griffith University, said that, while it recommended students observe all types of deliveries, including instrumental (forceps or vacuum) and caesarean, teaching hospitals were already full of training nurses, midwives and paramedics and didn't have room for the hundreds of new doctors coming through universities. Almost 11,000 students were enrolled in 18 medical schools in 2006. Three new medical schools have since opened in NSW.

Associate Professor Broadley said most interns were not usually expected to deliver a baby. But Michael Chapman, head of the School of Women's and Children's Health at the University of NSW, said the public expected a doctor to display a certain level of competence when faced with labour emergencies. "I think the community would have an expectation that a doctor who has graduated from a medical school and is confronted with a lady in labour in a taxi would be able to deliver it," Professor Chapman said.

Requirements range from nothing at universities such as Newcastle to Melbourne's Monash University where students must experience three normal births, a birth using forceps and a caesarean. Professor de Costa said experiencing childbirth also encouraged junior doctors to choose a career in obstetrics. UNSW student Natalie Ammala said delivering a baby was "a powerful experience" that had pushed her towards becoming an obstetrician. "The experience has given me much more confidence than just learning from a textbook," she said.


Sunday, April 13, 2008

Australia: Public hospital doctor kills because he failed to recognize or consider a fully symptomatic meningococcal case

A doctor made a serious error of judgment in ordering a lumbar puncture for a boy, 11, infected with meningococcal disease, a coroner has found. Coroner Dyson Hore-Lacy yesterday recommended that all hospitals review their guidelines in the light of Ryan Fitch's tragic death. And he expressed concern that the Frankston Hospital had not been prepared to admit a mistake was made.

Ryan, of Chelsea, died on August 5, 2005, from respiratory arrest as a result of a lumbar puncture. The sports-mad boy told his mum he loved her shortly before having a seizure at Frankston Hospital. He was put in an induced coma and flown to the Royal Children's Hospital, where he was declared brain-dead.

Ryan's devastated parents said yesterday they were pleased with the coroner's recommendations. "If it helps the next person, then that has to be a good thing," mum Robyn Fitch said. "There's comfort in the fact that if they adopt the recommendations, at least someone else will have the benefit of having antibiotics before they have a lumbar puncture." She said the family were yet to decide if they would take further action.

Dad Ron Fitch said he'd the highest respect for the doctor who performed the lumbar puncture, Dr Ted Lowther. "He was man enough to get up (at the inquest) and say 'I'm sorry for what I've done'." Mrs Fitch said Ryan's death must have affected Dr Lowther as well. "I know it wasn't his intention to come to work and have something like this happen. Unfortunately, it did happen. "And there are consequences, and we live with those consequences every day," Mrs Fitch said.

She said the family were upset with the way the hospital had handled the matter. At the inquest, Dr James Tibballs, of the RCH, took issue with the decision to perform the spinal tap. He said a patient suspected of having meningococcal should be given antibiotics, and doctors should then await the results of blood tests.

Mrs Fitch rushed Ryan to the Frankston Hospital's emergency department when she found him sick, vomiting and writhing with back pain. In the hours after he was admitted on August 3, staff investigated whether he was suffering pneumonia, a kidney infection and gastro. Mr Hore-Lacy said every one of Ryan's symptoms was consistent with meningococcal disease, and he was concerned that no one suspected it for 13 hours. By that stage, Ryan had developed a rash on his legs and one of his eyes.

The hospital's guidelines recommend that meningococcal disease be treated with antibiotics as soon as it is suspected, and that a lumbar puncture is usually not necessary and involves an increased risk in some patients. It can be performed when the patient is stable, but the coroner said Ryan shouldn't have been considered stable. "No doctor could give a (substantial) reason why a lumbar puncture had to be performed, let alone conducted before antibiotics had a chance to take effect. "This may bring back to clinicians the danger of lumbar puncture where there is so little to gain and so much to lose," Mr Hore-Lacy said. He said Dr Lowther now waited until the day after administering antibiotics to perform any lumbar puncture, which was a recognition that he'd made a mistake.

Frankston Hospital, part of Peninsula Health, said it would not comment until it had reviewed the findings.


Saturday, April 12, 2008

Another Australian public hospital horror

A mother yesterday told of her harrowing ordeal of having been sent home from a major Sydney hospital with her dead unborn baby still inside her because of a lack of beds. Zareen Nisha gave evidence at the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals yesterday, telling of the derelict treatment she received at Westmead Hospital. Ms Nisha, who was seven months pregnant at the time, said despite her GP phoning ahead to the hospital to alert them that the baby had developed serious problems, staff had told her to take a number in the queue and made her wait almost 30 minutes before seeing her.

Tests performed at the Westmead-based University Clinic on April 17, last year showed the the unborn baby boy was dead - the umbilical cord had twice wrapped around its neck. However, hospital staff sent her home because "there were no beds" to deliver the stillborn child. The Merrylands resident returned to the hospital at 2am the following day - finally giving birth to the dead baby she named Aahil - about 8pm that night.

"The midwife told me he was a perfect angel," Ms Nisha said. "There was no disability or anything - he died because the cord had coiled around his neck. "Ultrasounds would have picked up that he was becoming tangled in the cord. But they only gave me one ultrasound."

Ms Nisha said she believed a lack of clinical care throughout her pregnancy had caused the death of her son. The 36 year old said her pregnancy should have been considered high risk from the start due to a history of pregnancy-induced diabetes and other well-documented reproductive complications. She said when her GP told her she was pregnant in November 2006 it took 12 weeks to get an appointment at Westmead because the clinic had closed over Christmas. Ms Nisha said because of her age she had wanted the baby tested for Down syndrome, however the clinic never carried out the tests. She finally paid to have tests done privately.

At 20 weeks, the hospital carried out its first - and only - ultrasound on her unborn baby. At 29 weeks the clinic told her it was dead. "If they had seen the cord was tangling they would have saved him - I believe if they had done more ultra sounds they would have seen that," Ms Nisha said. "I don't blame the hospital for my baby's death but I would like them to be more accountable." Ms Nisha, whose first child Zoya, 9, was born in Fiji, said she had wrongly believed the health system would be better in Australia. "The standard of care is higher in Fiji than it is here," she said.


Friday, April 11, 2008

NHS authorised ambulance teams to give restricted drugs

An ambulance service jeopardised patient and staff safety to try to improve its performance, a health watchdog said. Staffordshire Ambulance Service NHS Trust also issued staff with drugs that they were not legally allowed to have, the Healthcare Commission found. The trust took risks with patient and staff safety while making “innovative” attempts to improve its service. The service has since merged with West Midlands Ambulance.

In a 96-page report, the commission emphasised that the Staffordshire service was a “good performer” in terms of response times for emergency calls. But the eight-month inquiry found that the achievements of the service were undermined by a “culture and approach” that did not prioritise safety. Investigators found that ambulance staff and volunteer community first responders were supplied with controlled drugs, such as the sedatives diazepam and midazolam, that they were not entitled to possess. It was also discovered that medicines in the trust’s stations regularly went missing or were unaccounted for and that community first responders were allowed to drive at speed using blue lights and sirens without the necessary advanced driver training.

Commenting on the report, Anna Walker, the Healthcare Commission chief executive, said that managers at Staffordshire Ambulance Service NHS Trust were motivated by the best intentions. But she added: “Some of the practices in the trust put the safety of patients, volunteers and staff at risk. “Patients, staff and the public could have been seriously hurt as a result of the compromised safety culture. The trust sought to be innovative, and that is to be applauded, but it did not have effective systems in place to handle this innovation safely. “This undermined many of the good achievements made on behalf of patients.”


Phone calls don't make you healthier! How surprising!

Making socialized medicine work well is beyond the wit of man. Many have tried but nothing succeeds

An ambitious three-year experiment to see whether the Medicare system could prevent expensive hospital visits for people with chronic conditions like congestive heart failure and diabetes has suggested that such an approach may cost more than it saves. The test borrowed a practice long available through private health plans. Nurses periodically place phone calls to patients to check whether they are taking their drugs and seeing the right doctors. The idea is that keeping people healthier can help patients avoid costly complications. After paying eight outside companies about $360 million since mid-2005 to try to improve such patients’ health, Medicare is still trying to figure out whether the companies were able to keep people healthier. But the preliminary data indicate that the government is unlikely to save money.

The experiment, meanwhile, is proving something else: how difficult it can be, politically and practically, to make fundamental changes in the sprawling $400 billion federal Medicare program, which now covers some 44 million Americans. With health costs soaring, few would dispute that the government needs to find better ways to spend its Medicare dollars. But because the system relies heavily on private industry and is subject to Congressional oversight, few changes come easily, and even experimental programs can take on lives of their own.

Several of the companies, including two that specialize in disease management, Healthways and Health Dialog, are pressing Medicare to continue the project in some fashion beyond the end of this year, saying the government mishandled the experiment. The senators from the home states of those two companies, including John Kerry, Democrat of Massachusetts, and Lamar Alexander, Republican of Tennessee, have taken up their cause, demanding that Medicare rethink ending the experiment. “Stopping this program,” the senators wrote in a letter to Medicare last month, “creates serious health risks for the Medicare beneficiaries already enrolled and heavily reliant” on the services provided by the experiment.

Medicare, for its part, says the experiment so far has not reduced medical bills enough to offset the fees the companies are charging the government — as much as $2,000 a year for each patient. A final accounting of the experiment is likely to come no sooner than next year. About 160,000 people have taken part in the test, known as the Medicare Health Support program, and some 70,000 are still receiving calls from nurses employed by the companies.

Experts say that Medicare and the companies alike were too optimistic about how easy it would be to prevent costly complications and hospital visits by patients who are very sick. “Everybody shares some blame,” said Dr. David B. Nash, a health policy professor at Thomas Jefferson University in Philadelphia, who at the outset was enthusiastic about the program’s prospects for transforming Medicare.

On the experiment’s front lines are nurses like Jill Coker, who works for Healthways and makes 25 to 30 telephone calls a day, trying to ensure that each patient receives a call every few weeks. Through dozens of such nurses, Healthways, based in Nashville, is overseeing the care of 16,000 people in Maryland and Washington. Ms. Coker said she spent most of her time on rudimentary issues, like explaining to patients what prescription drugs they are on and helping them devise ways to make sure they remember to take their medicine. She may also arrange a conference call with a patient’s doctor if there are some worrisome new symptoms, or she may direct someone to a specialist to get better care. “There have been numerous diabetics who didn’t even know what an endocrinologist was,” she said.

Medicare has not finished studying how well patients do under the program and whether patients are satisfied with the help. Three of the original companies — Cigna, McKesson and LifeMasters — eventually dropped out. The program has failed to meet the government’s original financial target: an overall savings to Medicare of 5 percent after factoring in the companies’ fees and the patients’ medical bills. Initially, the companies were supposed to return their payments if they did not hit that target. Late last year, Medicare relaxed its standard, requiring only that the experiment not end up costing the government money. The agency says that it will consider keeping any promising pieces of the program. But it says it cannot legally extend the experiment beyond December if it is not budget neutral.


Thursday, April 10, 2008

More than half of NHS staff feel patient care is not the priority

Less than half of NHS staff believe that patient care is the top priority where they work, according to the annual survey of staff opinion run by the Healthcare Commission. One in four does not believe that health trusts see patient care as their most important issue, with 29 per cent undecided. The poll also indicated that only 26 per cent of NHS staff think their employers value their work; just 22 per cent believe there is effective communication between staff and senior managers, and only 23 per cent feel staff are involved in important decisions.

Survey forms were returned by 155,922 employees from all 391 NHS trusts - a response rate of 54 per cent. The poll found wide variations between hospitals on measures taken to fight infections such as Clostridium difficile and MRSA. Only 61 per cent said handwashing equipment was always available when they needed it. The number saying it was always available varied from the 39 per cent at Homerton University Hospital NHS Foundation Trust in East London, to 82 per cent at the Queen Victoria Hospital NHS Foundation Trust in East Grinstead.

Thirteen per cent of those questioned had suffered physical violence at the hands of a patient or their relatives in the past year, the same as in 2006 and 1 per cent more than in 2005. Among those working in ambulance trusts, 29 per cent reported being attacked, while the figure was 22 per cent for mental health trusts.

Anna Walker, the commission's chief executive, said: "We know that health workers are more likely to experience violence, harassment and abuse than workers from other sectors and the NHS has made a concerted effort to address this problem. "Trusts must continue to step up to this challenge because it is unacceptable for NHS staff, who provide vital, often life-saving care, to be put in the position where they face violence and abuse as they go about their work."

The findings were released as a second survey showed that GPs are pessimistic about the future of the NHS. The poll in Pulse, the medical magazine, suggests that the advance of the private sector into primary care is unstoppable. A quarter of the 500 GPs who responded to the poll said that they had already been approached by a private firm with an offer to team up in providing primary care. About 40 per cent of the GPs said they were prepared to practise in a surgery owned by a private company, and a third said that they were willing to work for a private concern.

Meanwhile, figures released by the Department of Health show that GPs are still failing to offer patients a choice of hospitals for elective operations. The annual patient choice survey showed that, in November 2007, 44 per cent of patients said that they had been offered a choice of hospitals. This was down from the figure of 45 per cent in September 2007 and 48 per cent recorded in March 2007


Chilly reception from government hospital in Chile

CHILE'S government publicly apologised overnight after a woman was forced to give birth in the lavatory of a public hospital after she failed to receive medical attention, and ordered an investigation. Bernadita Vega, 37, from Peru, arrived at a public hospital in the capital Santiago in labour overnight, and waited two hours for a doctor to see her. Ultimately, her partner helped her deliver a baby boy in a hospital restroom.

"We are very sad about what has happened and worried about this incredible incident, and we are going to take the appropriate measures," Health Minister Maria Soledad Barria told Radio Cooperativa. "We must check what happened and ask forgiveness from the family," she said.


Wednesday, April 09, 2008

Patients 'being let down and ignored by the NHS,' says damning report

Elderly patients are being left to starve in soiled bedclothes, a damning report into the Health Service says today. Tens of thousands of patients suffer appalling service - but their complaints are ignored by negligent trusts, it is claimed. The report, by watchdog the Healthcare Commission, also said that mothers are being left alone during labour without pain relief. And GPs come under attack for being rude, allowing patients only the briefest of consultations, and missing signs of deadly diseases.

The commission said that far too often the NHS failed to take complaints seriously, or failed to apologise when clearly in the wrong. The Daily Mail's Dignity for the Elderly campaign has highlighted the poor quality of hospital food and the raw deal many pensioners get in hospitals and care homes. Last night Charlotte Potter, senior policy officer at Help the Aged, said: "Older people are the biggest users of the NHS, yet all too often receive below par treatment. "Thirty per cent of complaints about hospitals concerned lapses in fundamental aspects of nursing care. Nutrition, privacy and dignity, and communication should not be optional extras."

The Spotlight on Complaints report looked at more than 10,000 complaints independently reviewed by the commission between August 2006 and July 2007. Twenty per cent were upheld - up from 8 per cent the year before. And there was a large rise in the number of cases where the NHS response was "not as accurate as it should be". More than half of complaints were about hospital care, and of those a third were about the "fundamentals of nursing care". This includes unmet personal hygiene needs, a lack of privacy, inadequate help with eating, and nurses being "abrupt" or "sharp".

Some elderly patients were unable to reach call bells, or were left in soiled bedding and clothing. Other patients complained about inadequate clothing such as "gowns not maintaining patients' modesty" or bedside curtains being opened when the patient was receiving intimate care. And patients were not given regular baths, hair care, nail care or oral hygiene. Nutrition was also a problem for many, with a lack of choice of meals, inedible food, and nursing staff not helping frail patients to eat.

A third of complaints were against GP practices, with many saying their examination was too quick, GPs were rude or did not listen, and surgeries were "unwelcoming". In casualty departments, signs of health problems were often not recognised, meaning some patients - mainly elderly - were sent home only for the problem to get worse.

Common complaints against maternity services were that staff did not listen, women were left alone in labour without pain relief, and that midwives were too busy or were rude.

Health minister Ann Keen said healthcare in Britain was as safe as in the U.S., Australia, New Zealand or Denmark. But she said patients deserved an apology when mistakes happened.


Tuesday, April 08, 2008

Privacy or “Free” Health Care?

Many liberals are up in arms these days over the USA PATRIOT Act and other recent assaults on our civil liberties. Hurray! Alas, many of these same liberals are chomping at the bit to implement even more intrusions upon our privacy. They want the government to know about your every throat swab, hemorrhoid exam, and AIDS test. That is, they are calling for some form of socialized medicine. Message to liberals: please reconsider!

Seriously, do you really want people like Dick Cheney to have access to your medical records? With any form of single-payer healthcare they will. You are probably envisioning single-payer healthcare as part of an overall victory by your party, and it would be – temporarily. But even if the Republicans get a drubbing this fall, at some time they will be back in power, and then they will have access to records of every psychiatric exam, birth control prescription and abortion. Is that what you want?

Worth the risk, you say? Better to lose some privacy than to continue our current heartless and inefficient healthcare system? You might be right if those were our only two choices. They aren’t. Alternatives exist. If we so desire, we could have a healthier nation, with affordable, patient-driven healthcare. But it does require opening our minds to many different ideas. The solutions to our dilemma consist of many tweaks to the existing system.

U.S. healthcare is bad for many reasons: drugs and doctors are expensive, insurance and managed care are fraught with moral hazards, poor people fail to get cheap early care and then clog the emergency rooms, and Americans in general are unhealthy. That’s right; our healthcare system is bad in part because we are unhealthy – not the other way around. Better diet and exercise would do much to reduce the incidence of heart disease, depression, diabetes and other expensive to treat maladies. Reduce the incidence of expensive diseases, and the cost of insurance goes down. Cut he cost of insurance and more poor people could afford insurance, which would unclog the emergency rooms. (Read my column from last month for ideas on how to improve America’s diet.)

But even if insurance costs go down by a factor of two, health insurance would still be expensive for many. One solution would be a tax credit for getting health insurance. Unlike a tax deduction, a tax credit would be valuable to the poor, the very people most need health insurance. Such a tax credit could go to the individual instead of the employer, putting an end to corporate wage serfdom. The tax credit should be a fixed amount. If you can find adequate coverage that costs less than the credit, you get to pocket the difference. This gives consumers and incentive to shop, which is very important to reducing moral hazards.

But we wouldn’t be thinking so much in terms of insurance if doctors and drugs were cheaper. Doctors are so expensive because we have a cartel in place; doctors are required for many tasks that could be done by health practitioners with lesser degrees. Imagine if it required a Ph.D. in computer science to put up a web page.

Drugs are so expensive in the U.S. because our FDA is far more cautious than equivalent agencies in other First World countries. We could cut drug prices by simply approving drugs that have been approved in other First World countries. If we wish to be cautious, we could require that such other country approvals be in place for several years to take advantage of their post-market monitoring.

Healthcare in the United States can be fixed without resort to a single-payer plan. But healthcare advocates have to want it. Otherwise, we are stuck with the choice between big corporations and Homeland Security having access to our medical records.

Let me end by conceding one advantage to single-payer healthcare: Roe v. Wade becomes moot. If the federal government has a record of every healthcare transaction, no one can argue with a straight face that medical decisions are a matter of personal privacy. Whether abortion is a legitimate medical procedure becomes a matter for legislatures to decide. What? You don’t like this feature of single-payer healthcare? Too bad. The Religious Right will be aware of the line of reasoning above the moment single-payer gets implemented. I will make sure of it.


Your regulators will protect you -- again

Crooked and incompetent German doctor allowed to practice in Australia for years -- despite complaints and at great cost to the community

One of Australia's most senior trauma surgeons faces the sack for incompetence and a possible criminal investigation for billing for operations that never occurred. The stellar career of Thomas Kossmann, the head of the nation's busiest and most prestigious trauma unit at The Alfred hospital in Melbourne is in tatters after a three-month investigation by an expert panel into his surgical and administrative practices. The panel's damning findings are contained in a confidential report obtained by The Australian.

The scandal once again raises serious questions about the ability of medical authorities to properly assess doctors before allowing them to work in this country. The panel reports that more attention needs to be paid nationally to how specialist doctors are credentialled to practise in the public health system.

The key findings against Professor Kossmann are that he performed unnecessary surgery and undertook surgery he was incapable of doing. The panel found he invoiced Victoria's Transport Accident Commission, the WorkCover Authority and Medicare Australia for operations that were not performed, surgery he did not carry out and surgery that was unnecessary. The panel found that in his billing he used multiple Medicare item numbers that are mutually exclusive and used item numbers not in the spirit of funding agreements. They found he did not have the required expertise to practise or teach spinal and pelvic surgery - something he was routinely doing at The Alfred. He was found to have misrepresented his surgical experience on his curriculum vitae by overstating his level of experience and training in the area of orthopaedic surgery. And he was found to have performed surgery that had not been performed in Australia or overseas before and which was flawed in its conception and harmful in its effect.

The expert panel's final assessment of Professor Kossmann is scathing. In relation to his invoicing habits, it concluded: "The professor failed to perceive a problem, almost to a level where he seemed to have no concept of what constituted a moral approach to patient billing." The panel recommends that the TAC - Victoria's publicly funded traffic accident compensation system - Medicare Australia and the WorkCover Authority conduct audits of Professor Kossmann's entire billing history.

He told the panel his billing practices were no different to those of his colleagues. He said that because the TAC had never questioned his billing, he assumed he was billing appropriately.

The panel was also critical of Professor Kossmann's clinical performance. It called his surgical practices and decision-making inappropriate, unnecessary and beyond the accepted norm. "The nature of these practices and decision-making was beyond any level of acceptable behaviour and standard of care, and was flawed in its conception and harmful in its effect," the report states. It dismisses Professor Kossmann's defence that if such an audit were conducted of other surgeons a comparable rate of incidents would be found. Professor Kossmann argued to the panel that the cases where he was found to have exercised wrong clinical judgment reflected differences of medical opinion. The panel disagreed.

The investigation was established by Bayside Health, which runs The Alfred hospital, after four surgeons lodged complaints against Professor Kossmann last August. Respected Victorian child orthopedic specialist Bob Dickens led the panel. The other members were Brisbane orthopedic surgeon John Tuffley and Sydney orthopedic surgeon Stephen Ruff. The panel examined 24 cases raised by the four doctors in their complaints against Professor Kossmann. In all but seven of the cases, the panel substantiated the complaints. It randomly reviewed a further 31 of Professor Kossmann's cases and, of these, found three where there were significant concerns about his clinical and/or administrative practices.

During the investigation, Professor Kossmann was interviewed by the panel members - two of whom are examiners in orthopedics for the Royal Australasian College of Surgeons - to test his understanding of basic science. He failed dismally. "All panel members are of the opinion that if an orthopedic candidate in his/her final exam had given the answers which the professor had given, they would have seriously considered failing that candidate," the report states.

It is understood the hospital has sent the final report to Professor Kossmann. He has two weeks to respond. Professor Kossmann has taken legal action in the Victorian Supreme Court against the hospital following its suspension of him on full pay last November after adverse preliminary findings were made against him in a draft report.