Tuesday, January 06, 2009

Teenager died of brain haemorrhage... after NHS doctors denied her a vital scan

When Jenna Lester's parents told doctors she had been suffering severe headaches, bouts of fainting and vomiting, they might have expected their fears of a serious illness to be shared. But medical staff thought the 16-year-old simply had a stomach infection and did not offer a brain scan. A week later she died of a brain haemorrhage.

Now, after a legal battle lasting almost three years, the NHS has admitted that the teenager might still be alive if doctors had acted sooner. Jenna, who had been expected to achieve straight As in her GCSEs, had been taken to the Medway Maritime Hospital in Kent, after collapsing unconscious in the bathroom. Her parents Mark, 42, and Sonia, 40, say they told doctors their daughter had been suffering from splitting headaches for two months. But as Jenna was not considered a 'patient of high priority', she was not sent for a brain scan.

It was only when her condition deteriorated considerably that she was finally given one - five days after she first collapsed. The scan showed that she had a blood clot on her brain, and at that stage one of the doctors turned to her parents and said: 'We should have done the scan days ago.' Jenna, who had been made sports-woman of the year at Fort Pitt Grammar School, Chatham, was transferred to King's College Hospital, London, for an operation to remove the clot. Doctors initially thought the surgery had been successful. But Jenna's brain swelled dramatically and she died on February 17, 2006.

Her parents spent almost three years pursuing the Trust through Health Service complaints procedures. And last week the Medway NHS Foundation Trust admitted it had 'failed to properly assess and investigate' the teenager's condition. Her parents were sent 10,000 in compensation. But Mr Lester, a plumber, who lives with his wife, and teenage son and daughter in Rochester, said the sum could never replace Jenna. 'When we first took Jenna into hospital, we kept telling everybody that she had hit her head when she fell in our bathroom. 'We made sure that the casualty office knew about her two-month history of headaches. 'But no one examined her head, gave her an X-ray or a scan until it was too late. Doctors were convinced that she was suffering from a gastric virus.'

At the inquest, in August 2007, the coroner ruled that Jenna had died from swelling of the brain because of bleeding from a rare condition called arteriovenous malformation. In a narrative verdict, the coroner said her chances of survival would have been 'enhanced' if doctors had got to the blood clot sooner. The condition would have been detected earlier if a scan had been performed.

The NHS Trust expressed its ' sincere apologies to the Lesters for the shortcomings in Jenna's care. 'Whilst nothing can compensate for this tragic experience, lessons have been learnt and robust arrangements are in place to ensure this does not happen again.' [Bulldust, bulldust!]


If You Think Health Care is Expensive...

Health care, says the man most concerned with that 17 percent of America's economy, can be "a nation-ruining issue." As Michael Leavitt ends four years as secretary of health and human services, he offers this attention-arresting arithmetic: Absent fundamental reforms, over the next two decades the average American household's health care spending, including the portion of its taxes that pays for Medicare and Medicaid, will go from 23 percent to 41 percent of average household income.

It is, Leavitt says, "predictable" that today's traumatizing economic turbulence, by heightening Americans' insecurity, will complicate reforming entitlements. This, too, is predictable: By curtailing revenues, today's recession will bring closer the projected exhaustion of the Medicare Part A trust fund, from early 2019 to perhaps 2016. That should get the president-elect's attention.

When Medicare was created in 1965, America's median age was 28.4; now it is 36.6. The elderly are more numerous and medicine is more broadly competent than was then anticipated. Leavitt says that Medicare's "big three" hospital procedure expenses today are hip and knee replacements and cardiovascular operations with stents, which were not on medicine's menu in 1965.

After being elected to three terms as Utah's governor, but before coming to HHS, Leavitt headed the Environmental Protection Agency. He came to consider it a public health agency because the surge in Americans' longevity in the last third of the 20th century correlated with cleaner air and fewer water-borne diseases. Longevity is, however, expensive, and demography is compounding the problem.

In the 43 years since America decided that health care for the elderly would be paid for by people still working, the ratio of workers to seniors has steadily declined. And the number of seniors living long enough to have five or more chronic conditions -- 23 percent of Medicare beneficiaries -- has increased. Many of those conditions could be prevented or managed by better decisions about eating, exercising and smoking. The 20 percent of Americans who still smoke are a much larger percentage of the 23 percent who consume 67 percent of Medicare spending. Furthermore, nearly 30 percent of Medicare spending pays for care in the final year of patients' lives.

Suppose, says Leavitt, buying a car were like getting a knee operation. The dealer would say he does not know the final cumulative price, so just select a car and begin using it. Then a blizzard of bills would begin to arrive -- from the chassis manufacturer, the steering-wheel manufacturer, the seat and paint manufacturers. The dealership would charge for time spent there, and a separate charge would cover the salesperson's time.

Leavitt says that until health care recipients of common procedures can get, upfront, prices they can understand and compare, there will be little accountability or discipline in the system: "In the auto industry, if the steering-wheel maker charges an exorbitant price, the car company finds a more competitive supplier. In health care, if the medical equipment supplier charges an exorbitant price, none of the other medical participants care."

Medicare is a price-fixing system for upward of 12,000 procedures and drug codes -- and for hundreds of categories of equipment, the providers of which tenaciously oppose competition. Leavitt began implementing a tiny program of competitive bidding covering just 10 products in 10 cities. Based on the 15 days it lasted before Congress repealed it, savings were projected to be substantial. That is why equipment providers got it repealed.

Rather than ruining the new year by dwelling on Medicare's unfunded liabilities of about $34 trillion (over a 75-year span), ruin it with this fact: In the next 50 years, Medicaid, the program for the poor -- broadly, sometimes very broadly defined -- could become a bigger threat than Medicare to the nation's prosperity.

This is partly because of the cost of long-term care for the indigent elderly, some of whom shed assets to meet Medicaid's eligibility standard -- sometimes as high as income under 200 percent of the federal poverty level. And many states, eager to expand the ranks of the dependent with the help of federal Medicaid money, use "income disregards" to make poverty an elastic concept. For example, they say: A person who gets a raise that eliminates his eligibility can disregard the portion of his income that pays for housing, or transportation.

Governments with powerful political incentives to behave this way will play an increasingly large role in health care. As is said, if you think health care is expensive now, just wait until it is free.


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