Thursday, April 30, 2009

Incompetent DC Emergency Medical Services

And hushing it up is all that Mayor Fenty and the DC administration want to do about it

A man whose brother died of a heart attack hours after being told by a D.C. paramedic that he suffered from acid reflux says his family is outraged to learn that fire officials had prior warning that the paramedic needed retraining. "It's just a slap in the face to my family," said Anthony Givens, 36, the brother of Edward L. Givens of Northeast, who died at his home in December after the call to D.C. Fire and Emergency Medical Services.

The Washington Times reported Friday that scores of the District's paramedics either failed to meet the minimum national standard on written exams that tested their medical knowledge or they mishandled basic lifesaving procedures during videotaped assessments, according to videos, documents and interviews with industry professionals.

The materials also were requested on numerous occasions by the family of slain journalist David E. Rosenbaum. The family repeatedly asked about the testing as part of a settlement in 2008 of a multimillion-dollar lawsuit against the city.

Toby Halliday, Mr. Rosenbaum's son-in-law, said he began late last year asking about the tests conducted at the Maryland Fire and Rescue Institute (MFRI), and the fire department refused to disclose the results, even though the testing was initiated more than a year ago. "The department had initial results on these evaluations late last summer. Despite repeated requests, the department has not released the results to the public, but has characterized the performance of their paramedics on these tests in very positive terms," Mr. Halliday said.

"To the extent that the department feels that the MFRI evaluations demonstrate gaps in performance that require remedial training, we support that effort and are eager to hear what additional training is being provided and when that effort began. We recently met with the mayor to discuss our concerns about these tests and other issues in the EMS program. We are awaiting his response to those concerns," he said.

Mayor Adrian M. Fenty told The Washington Times on Friday that he was unaware of the newspaper report and declined to comment on it until he had a chance to review the matter. Asked about a press release with his name on it that was issued by the fire department on Wednesday addressing questions raised by The Times, Mr. Fenty again said he was unaware of the report and would not comment on it before reviewing the matter. "I think I owe that to the people who elected me," he said. Asked whether he would revisit his decision to leave EMS under the administration of the fire department - after pledging in 2006 as a candidate for mayor to separate the agencies - Mr. Fenty said: "No."

Mr. Givens said he was disappointed with Mr. Fenty's decision. "It's just outright disrespectful for the mayor to say one thing, and then we elect him and he does another," Mr. Givens said. Mr. Givens, whose family has sued the District over the handling of his brother's case, said he was angry that fire officials defended the performances on the videos and the written test scores, the vast majority of which were below 60 percent. "It's almost shameful," he said. "It's like a low blow to my family to say some of the things they're saying."

One professional who viewed the videotapes for The Times expressed concerns specifically about the assessment of the firefighter-paramedic who treated Mr. Givens. "Based upon viewing the videotape, I would have serious concerns about him performing any medical practice," said Graydon Lord, a licensed paramedic and former fire and EMS chief in Cherokee County, Ga. "I would recommend that the medical director make his determination as to whether this provider can safely practice medicine in the pre-hospital-care environment," Mr. Lord said.

Fire Chief Dennis L. Rubin told WRC-TV Channel 4 on Friday that he had not seen any of the tapes until they surfaced in news reports. "Of course it is cause for concern, but the entire idea is that we contracted with the Maryland Fire and Rescue Institute, perhaps the best medical agency in the country, to evaluate our performance in a way that we can change our protocols and train our people."

Mr. Givens said fire officials have not acknowledged any wrongdoing in his brother's case. "I'm so [angry] about this situation. The more I try to uncover things, the [angrier I get]," he said. "I think all too often this happens in Washington."


Shortage of Doctors an Obstacle to Obama Goals

Cutting way back on the time and money that doctors have to spend on red tape would be a great start

Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president. The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans. One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.

Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors — a difficult argument at a time of huge budget deficits.

Some of the proposed solutions, while advancing one of President Obama’s goals, could frustrate others. Increasing the supply of doctors, for example, would increase access to care but could make it more difficult to rein in costs.

The need for more doctors comes up at almost every Congressional hearing and White House forum on health care. “We’re not producing enough primary care physicians,” Mr. Obama said at one forum. “The costs of medical education are so high that people feel that they’ve got to specialize.” New doctors typically owe more than $140,000 in loans when they graduate.

Lawmakers from both parties say the shortage of health care professionals is already having serious consequences. “We don’t have enough doctors in primary care or in any specialty,” said Representative Shelley Berkley, Democrat of Nevada. Senator Orrin G. Hatch, Republican of Utah, said, “The work force shortage is reaching crisis proportions.”

Even people with insurance have problems finding doctors. Miriam Harmatz, a lawyer in Miami, said: “My longtime primary care doctor left the practice of medicine five years ago because she could not make ends meet. The same thing happened a year later. Since then, many of the doctors I tried to see would not take my insurance because the payments were so low.”

To cope with the growing shortage, federal officials are considering several proposals. One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants. A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods.

Senator Max Baucus, a Montana Democrat and chairman of the Finance Committee, said Medicare payments were skewed against primary care doctors — the very ones needed to coordinate the care of older people with chronic conditions like congestive heart failure, diabetes and Alzheimer’s disease. “Primary care physicians are grossly underpaid compared with many specialists,” said Mr. Baucus, who vowed to increase primary care payments as part of legislation to overhaul the health care system.

The Medicare Payment Advisory Commission, an independent federal panel, has recommended an increase of up to 10 percent in the payment for many primary care services, including office visits. To offset the cost, it said, Congress should reduce payments for other services, an idea that riles many specialists. Dr. Peter J. Mandell, a spokesman for the American Association of Orthopaedic Surgeons, said: “We have no problem with financial incentives for primary care. We do have a problem with doing it in a budget-neutral way. “If there’s less money for hip and knee replacements, fewer of them will be done for people who need them.”

The Association of American Medical Colleges is advocating a 30 percent increase in medical school enrollment, which would produce 5,000 additional doctors each year. “If we expand coverage, we need to make sure we have physicians to take care of a population that is growing and becoming older,” said Dr. Atul Grover, the chief lobbyist for the association. “Let’s say we insure everyone. What next? We won’t be able to take care of all those people overnight.”

The experience of Massachusetts is instructive. Under a far-reaching 2006 law, the state succeeded in reducing the number of uninsured. But many who gained coverage have been struggling to find primary care doctors, and the average waiting time for routine office visits has increased. “Some of the newly insured patients still rely on hospital emergency rooms for nonemergency care,” said Erica L. Drazen, a health policy analyst at Computer Sciences Corporation. The ratio of primary care doctors to population is higher in Massachusetts than in other states.

Increasing the supply of doctors could have major implications for health costs. “It’s completely reasonable to say that adding more physicians to the work force is likely to increase health spending,” Dr. Grover said. But he said: “We have to increase spending to save money. If you give people better access to preventive and routine care for chronic illnesses, some acute treatments will be less necessary.”

In many parts of the country, specialists are also in short supply. Linde A. Schuster, 55, of Raton, N.M., said she, her daughter and her mother had all had medical problems that required them to visit doctors in Albuquerque. “It’s a long, exhausting drive, three hours down and three hours back,” Ms. Schuster said.

The situation is even worse in some rural areas. Dr. Richard F. Paris, a family doctor in Hailey, Idaho, said neighboring Custer County had no doctors, even though it is larger than the state of Rhode Island. So he flies in three times a month, over the Sawtooth Mountains, to see patients.

The Obama administration is pouring hundreds of millions of dollars into community health centers. But Mary K. Wakefield, the new administrator of the Health Resources and Services Administration, said many clinics were having difficulty finding doctors and nurses to fill vacancies.

Doctors trained in internal medicine have historically been seen as a major source of frontline primary care. But many of them are now going into subspecialties of internal medicine, like cardiology and oncology.


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