Saturday, April 18, 2009

Mother who died giving birth in NHS hospital toilet never saw twins

There have been notorious examples of this in Australian public hospitals too. Delay, delay, delay is the hallmark of public medicine and it can be fatal -- as in this instance.

A woman died in labour in a hospital lavatory after her induction was delayed because of a lack of specialist staff, an inquest was told yesterday. Sarah Underhill, a policewoman aged 37, was in her 36th week of pregnancy when she was admitted to hospital suffering from pre-eclampsia.

The birth was to have been induced because of her condition, which causes high blood pressure. She was admitted to the John Radcliffe Hospital, in Oxford, on October 2 last year but the procedure was planned for October 6. However, the day before she was due to be induced she collapsed in the toilet and was forced to call for help by banging on the door.

Doctors fought to save her twins, conceived by IVF, but she died without having seen them. The babies were delivered by emergency Caesarean section and survived after a “magnificent” effort by staff.

Yesterday the inquest was told that doctors could not have prevented her death. Mrs Underhill had previously suffered a miscarriage in 2006 after an earlier IVF pregnancy. [Which should have meant extra care this time]

Sebastian Lucas, a pathologist, told the hearing that Mrs Underhill died after amniotic fluid from the womb entered her bloodstream. He told Oxford Coroner’s Court that the condition could be survived, but was “unpreventable”. Professor Lucas said: “Why did she draw the short straw and suffer severely where others may not? Who knows? It is an act of God.”

Mrs Underhill’s husband Richard, 39, a fellow Thames Valley Police officer, was not with his wife when she died. He had left her bedside the previous day because he was suffering from a cold and did not wish to pass on any germs. Close to tears, he told the inquest: “I wish I had stayed.”

Mr Underhill now cares for the twins, Hannah and James, at his home in Didcot, Oxfordshire. The inquest heard that it was “extraordinary” that both infants survived.

Previously, Mr Underhill described his wife as “glowing” in the days before she gave birth and said that she was greatly looking forward to becoming a mother. The couple met in 2000 and married five years later. Mr Underhill spoke of the doctors’ decision to induce the birth. “I think we were relieved, because the bump was getting so big,” he said. “Sarah just wanted it over and done with.” He said he was told that the induction was planned for October 6 — a Monday — rather than the preceding weekend, because of a lack of specialist staff on the maternity unit. In a written statement submitted to the inquest, he said he believed that his wife should have had the babies delivered sooner.

Lawrence Impey, a consultant obstetrician who treated Mrs Underhill in the days before her death, said: “If I had known what was going to happen on the Sunday, I would completely agree with him. But we had no indication this was going to happen.” He said that the condition that killed her, amniotic fluid embolism, was “impossible to predict”. He added: “What is clear is that it is not the pre-eclampsia that did this. We have clear evidence that it was a completely different diagnosis, which is usually fatal and which is impossible to predict.”

The Oxford Radcliffe Hospitals Trust offered its condolences to Mr Underhill for his wife’s death and said that it was keen to learn any possible lessons from the tragedy.


Wal-Mart Diagnoses Your Ills: Medical-Office Inconvenience and High Prices Driving Consumers to Retail-Owned Clinics

Americans, frustrated by endless waits at the doctor's office, are sidestepping their family physician and taking their rashes, strep throat and pink eye to stores such as Wal-Mart and Walgreens instead. As this trend gains more traction, experts say it could define the market for primary care. "In many ways these retail clinics are a response to a broken health care system," Jonathan Weiner, professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, told "Not everyone has good access to primary care. We're also dealing with a shortage of primary care doctors in this country," he said.

Public health experts say retail clinics can, to some extent, fill the gap. But there's one caveat. "I suspect these store clinics will be around for a long time, but they won't take over everything that a doctor can do," Dr. Sherry Glied, chairwoman of the Mailman School Department of Health Policy and Management at Columbia University's School of Public Health, told CNNMoney writer Parija B. Kavilanz.

Wal-Mart, Walgreens, CVS and Rite-Aid are among an expanding number of retailers that operate in-store health clinics. It's not merely a public service — Bruce Carlson, publisher with healthcare market research firm Kalorama Information, says retail clinics are a lucrative niche market for merchants, CNNMoney reports.

The firm said these clinics numbered just over 1,200 in 2008 with annual revenue of $545 million. By 2013, Carlson said the total is estimated to reach 2,400 with revenue of about $2 billion. These "retail clinics" are typically staffed by nurse practitioners. They administer vaccinations and treat customers — both uninsured and insured — for minor ailments. They also test for conditions such as hypertension and diabetes.

Although in-store clinics have only been around for a few years, it's only recently that their appeal has grown with consumers, according to the latest industry survey from consulting firm WSL Strategic Retail. The survey, which polled 1,500 consumers, showed awareness about retail clinics has jumped to 56% in 2009, up from 38% in 2007.

The survey also showed that usage of store clinics has increased the most among younger consumers, who are less likely to have ties to a family physician or to have insurance.

Candace Corlett, principal and retail analyst with consulting firm WSL Strategic Retail, believes the survey findings indicate consumers are treating health care as a commodity. "Just like you pick your favorite store to get your beauty advice and products, people are picking their favorite store to get their earache treated. There's a cultural shift that's going on with how we approach health care, and I think the retail market is ready for health care becoming a commodity," Corlett told CNNMoney.


Australia: No privacy under socialism

Patient files demanded from doctors

THE Rudd Government will demand patients' intimate medical records - from past infectious diseases to current medications - under a plan to catch doctors defrauding Medicare. Doctors will be forced to hand over the patient medical files to prove they have performed the services they have claimed in a move the Government says will save taxpayers about $148 million over four years.

The plan immediately sparked warnings about the dangers of providing bureaucrats with highly sensitive personal information. But while the draft legislation - which was released on the eve of the Easter long weekend - was condemned by the Australian Medical Association and the Australian Privacy Foundation, the Government yesterday argued it was needed to ensure the sustainability of Medicare.

AMA president Rosanna Capolingua warned that patients would not be honest with their doctors if they knew their records could be seized. "The patient record will be completely exposed, extracts obtained, copied, retained and potentially submitted in court for all to see," Dr Capolingua said. "Doctors will be compelled to hand over highly sensitive medical information to justify Medicare claims, potentially including a patient's intimate concerns and examination findings, their test results, weight, sexual health, infections - nothing is protected."

The Health Insurance Amendment (Compliance) Bill 2009 also allows the Government to fine health professionals who make incorrect claims of more than $2500.

A Senate inquiry will be held into the legislation. Human Services Minister Joe Ludwig said yesterday only authorised Medicare staff would be able to view "relevant" extracts within doctors' files, and information would be stored securely and then destroyed after the audit process. [In Britain, bureaucrats LOSE similar information roughly once a month -- exposing it to anyone who finds it. How would you like your medical details left on a train for anyone to pick up and read? That's what the British experience is. Does anybody seriously think that our bureaucrats are more careful?]


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