Saturday, March 28, 2009

More NHS incompetence

IVF mother died during caesarian birth after 'doctors starved her brain of oxygen'. The NHS relies heavily on overseas doctors who are often poorly trained. "Prasad" is an Indian surname

A mother who spent years undergoing IVF treatment died after a bungled birth and never saw the baby she longed for, an inquest was told yesterday. Joanne Lockham had a Caesarean operation to deliver baby Finn but her brain was starved of oxygen for up to 30 minutes, it was claimed. Within moments of the birth she suffered a heart attack and she died two days later after sustaining massive irreversible brain damage. Her husband Peter is now bringing up Finn on his own.

The inquest jury heard that Mrs Lockham, a 45-year-old nurse from Wendover, Buckinghamshire, had been through countless rounds of failed IVF treatment when she finally became pregnant. Her baby was six days overdue when she went into Stoke Mandeville Hospital to have her labour induced on October 9, 2007.

Because doctors were concerned about the slow progress of the labour, they decided to perform a Caesarean with the assistance of an epidural anaesthetic. But later Mrs Lockham was told that further complications involving foetal distress meant she needed a general anaesthetic. She sobbed as she was told of the change of plan but midwives assured her that she would soon be holding her first child.

Jacqueline Hall, a consultant in obstetrics and gynaecology, said she did not anticipate any complications when she 'strongly' advised the Caesarean at 6pm. However, problems arose in the operating theatre. The jury heard that three attempts were made by anaesthetist Dr Prasad to insert a tube to give Mrs Lockham oxygen before it was eventually believed to have been successful.

Dr Prasad broke down in the witness box as he told how he repeatedly tried to intubate Mrs Lockham. He told the jury that on the first occasion on which he tried to provide a tube to get air to her lungs, he was unable to do it sufficiently. On the second try, the equipment was not working as he believed it should. Dr Prasad then made a third attempt to insert a tube using a mask and thought he was successful. Dr Prasad said: 'I was doing my job, but I was in a complete state of shock, I couldn't think, I was trying to be useful in anything I could. 'I went in at that point in time with a particular plan and it didn't happen. 'It was completely out of the blue and the equipment was not giving way, so I didn't know what to do, it completely numbed me, it was not what I was expecting.'

The inquest was told that just before 7pm the obstetrician started the operation and the baby was delivered. Then Mrs Lockham went into cardiac arrest. When consultant anesthetist Dr Bogdanov arrived at the hospital at 7.30pm after being paged because of the complication, he was unhappy with the placement of the intubation tube and removed it. He used the same piece of equipment that Dr Prasad believed was faulty to re-intubate Mrs Lockham.

When Dr Prasad was asked if he was blaming the equipment for his own inadequacy, he replied: 'No, I am not.' Mrs Lockham was transferred to intensive care but following brain stem tests, the decision was made to switch off her life support machine.


National Health Preview

The Massachusetts debacle, coming soon to your neighborhood

Praise Mitt Romney. Three years ago, the former Massachusetts Governor had the inadvertent good sense to create the "universal" health-care program that the White House and Congress now want to inflict on the entire country. It is proving to be instructive, as Mr. Romney's foresight previews what President Obama, Max Baucus, Ted Kennedy and Pete Stark are cooking up for everyone else.

In Massachusetts's latest crisis, Governor Deval Patrick and his Democratic colleagues are starting to move down the path that government health plans always follow when spending collides with reality -- i.e., price controls. As costs continue to rise, the inevitable results are coverage restrictions and waiting periods. It was only a matter of time.

They're trying to manage the huge costs of the subsidized middle-class insurance program that is gradually swallowing the state budget. The program provides low- or no-cost coverage to about 165,000 residents, or three-fifths of the newly insured, and is budgeted at $880 million for 2010, a 7.3% single-year increase that is likely to be optimistic. The state's overall costs on health programs have increased by 42% (!) since 2006.

Like gamblers doubling down on their losses, Democrats have already hiked the fines for people who don't obtain insurance under the "individual mandate," already increased business penalties, taxed insurers and hospitals, raised premiums, and pumped up the state tobacco levy. That's still not enough money.

So earlier this year, Mr. Patrick appointed a state commission to figure out how to control costs and preserve "this grand experiment." One objective is to change the incentives for preventative care and treatments for chronic disease, but everyone says that. It sometimes results in better health but always more spending. So-called "pay for performance" financing models, on the other hand, would do away with fee for service -- but they also tend to reward process, not the better results implied.

What are the alternatives? If health planners won't accept the prices set by the marketplace -- thus putting themselves out of work -- the only other choice is limiting care via politics, much as Canada and most of Europe do today. The Patrick panel is considering one option to "exclude coverage of services of low priority/low value." Another would "limit coverage to services that produce the highest value when considering both clinical effectiveness and cost." (Guess who would determine what is high or low value? Not patients or doctors.) Yet another is "a limitation on the total amount of money available for health care services," i.e., an overall spending cap.

The Institute for America's Future -- which is providing the intellectual horsepower (we use the term loosely) for reforms like those in Massachusetts -- argues that the cost overruns prove the state must cap how much insurers are allowed to charge consumers and regulate their profits. If Mr. Patrick doesn't get there first, that is. He reportedly told insurers and hospitals at a closed meeting this month that if they didn't take steps to hold down the rate of medical inflation, he would.

Even the single-payer cheerleaders at the New York Times have caught on to this rolling catastrophe. In a page-one story this month, the paper reported on the "expedient choice" that Mr. Romney and Democrats made to defer "until another day any serious effort to control the state's runaway health costs. . . . Those who led the 2006 effort said it would not have been feasible to enact universal coverage if the legislation had required heavy cost controls. The very stakeholders who were coaxed into the tent -- doctors, hospitals, insurers and consumer groups -- would probably have been driven into opposition by efforts to reduce their revenues and constrain their medical practices, they said."

Now they tell us. What really whipped along RomneyCare were claims that health care would be less expensive if everyone were covered. But reducing costs while increasing access are irreconcilable issues. Mr. Romney should have known better before signing on to this not-so-grand experiment, especially since the state's "free market" reforms that he boasts about have proven to be irrelevant when not fictional. Only 21,000 people have used the "connector" that was supposed to link individuals to private insurers.

Which brings us to Washington, where Mr. Obama and Congressional Democrats are about to try their own Bay State bait and switch: First create vast new entitlements that can never be repealed, then later take the less popular step of rationing care when it's their last hope to save the federal fisc.

The consequences of that deception will be far worse than those in Massachusetts, however, given that prior to 2006 the state already had a far smaller percentage of its population uninsured than the national average. The real lesson of Massachusetts is that reform proponents won't tell Americans the truth about what "universal" coverage really means: Runaway costs followed by price controls and bureaucratic rationing.


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