Sunday, June 14, 2009

NHS Hospital "sorry" as young mother dies after meningitis is undiagnosed for 15 hours

The rapid progression of meningococcal disease is well-known but it can normally be cured by antibiotics if diagnosed immediately on presentation to a doctor. Treatment should be commenced immediately if there is any doubt

A health trust has apologised after a young mother died when doctors took 15 hours to spot that she had contracted the meningitis that eventually killed her. Shazia Ahmed, 26, died in hospital five days after contracting the bug after out-of-hours doctors twice failed to respond to emergency calls. Health bosses yesterday admitted that she may have lived if they had treated her more quickly.

Miss Ahmed, who lived in Oxford and was engaged to marry her partner Aaron Willett next year, had a six-year-old son called Kaishaan. She began to feel ill on February 20 and phoned an out-of-hours service to explain her symptoms of a tingling sensation in her legs at 7pm and was told she probably had a virus and that a doctor would not visit her.

By 2am she felt worse and was told to collect an anti-sickness tablet from the NHS out-of-hours centre but, again, no doctor was available. Her condition worsened, she began to vomit and suffer diarrhoea and she developed a purple rash so Miss Ahmed's mother Lorraine Lewis, 50, took her to the John Radcliffe Hospital in Oxford.

Mrs Lewis said: "When we got there I overheard a doctor outside the cubicle asking a consultant if he thought it could be meningitis? He just said 'no, it won't be that'. "Then from 5.30am to 9.40am, they just left her and we mopped up her vomit and diarrhoea. "They realised her condition was really bad and took her through to intensive care. "Those hours definitely made a difference."

Miss Ahmed was put into a coma in the intensive care unit before suffering a brain haemorrhage four days later.

A spokesman for the Oxfordshire Primary Care Trust yesterday said: "We are deeply sorry for the distress which Shazia's family are experiencing following her tragic death. "It is possible that an earlier diagnosis may have had a different outcome but it is impossible to say what this might have been in Shazia's case."


How Safeway Is Cutting Health Insurance Costs

Market-based solutions can reduce the national health-care bill by 40%

Effective health-care reform must meet two objectives: 1) It must secure coverage for all Americans, and 2) it must dramatically lower the cost of health care. Health-care spending has outpaced the rise in all other consumer spending by nearly a factor of three since 1980, increasing to 18% of GDP in 2009 from 9% of GDP. This disturbing trend will not change regardless of who pays these costs -- government or the private sector -- unless we can find a way to improve the health of our citizens. Failure to do so will make American companies less competitive in the global marketplace, increase taxes, and undermine our economy.

At Safeway we believe that well-designed health-care reform, utilizing market-based solutions, can ultimately reduce our nation's health-care bill by 40%. The key to achieving these savings is health-care plans that reward healthy behavior. As a self-insured employer, Safeway designed just such a plan in 2005 and has made continuous improvements each year. The results have been remarkable. During this four-year period, we have kept our per capita health-care costs flat (that includes both the employee and the employer portion), while most American companies' costs have increased 38% over the same four years.

Safeway's plan capitalizes on two key insights gained in 2005. The first is that 70% of all health-care costs are the direct result of behavior. The second insight, which is well understood by the providers of health care, is that 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity). Furthermore, 80% of cardiovascular disease and diabetes is preventable, 60% of cancers are preventable, and more than 90% of obesity is preventable.

As much as we would like to take credit for being a health-care innovator, Safeway has done nothing more than borrow from the well-tested automobile insurance model. For decades, driving behavior has been correlated with accident risk and has therefore translated into premium differences among drivers. Stated somewhat differently, the auto-insurance industry has long recognized the role of personal responsibility. As a result, bad behaviors (like speeding, tickets for failure to follow the rules of the road, and frequency of accidents) are considered when establishing insurance premiums. Bad driver premiums are not subsidized by the good driver premiums.

As with most employers, Safeway's employees pay a portion of their own health care through premiums, co-pays and deductibles. The big difference between Safeway and most employers is that we have pronounced differences in premiums that reflect each covered member's behaviors. Our plan utilizes a provision in the 1996 Health Insurance Portability and Accountability Act that permits employers to differentiate premiums based on behaviors. Currently we are focused on tobacco usage, healthy weight, blood pressure and cholesterol levels.

Safeway's Healthy Measures program is completely voluntary and currently covers 74% of the insured nonunion work force. Employees are tested for the four measures cited above and receive premium discounts off a "base level" premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families. Should they fail any or all tests, they can be tested again in 12 months. If they pass or have made appropriate progress on something like obesity, the company provides a refund equal to the premium differences established at the beginning of the plan year.

At Safeway, we are building a culture of health and fitness. The numbers speak for themselves. Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant. When surveyed, 78% of our employees rated our plan good, very good or excellent. In addition, 76% asked for more financial incentives to reward healthy behaviors. We have heard from dozens of employees who lost weight, lowered their blood-pressure and cholesterol levels, and are enjoying better health because of this program. Many discovered for the first time that they have high blood pressure, and others have been told by their doctor that they have added years to their life.

Today, we are constrained by current laws from increasing these incentives. We reward plan members $312 per year for not using tobacco, yet the annual cost of insuring a tobacco user is $1,400. Reform legislation needs to raise the federal legal limits so that incentives can better match the true incremental benefit of not engaging in these unhealthy behaviors. If these limits are appropriately increased, I am confident Safeway's per capita health-care costs will decline for at least another five years as our work force becomes healthier.

The Healthy Measures program currently applies only to our nonunion work force. While we have numerous health and wellness provisions in our union contracts, we are working with union leaders like Joe Hansen of the United Food and Commercial Workers to incorporate healthy measures provisions in our union work force as well.

While comprehensive health-care reform needs to address a number of other key issues, we believe that personal responsibility and financial incentives are the path to a healthier America. By our calculation, if the nation had adopted our approach in 2005, the nation's direct health-care bill would be $550 billion less than it is today. This is almost four times the $150 billion that most experts estimate to be the cost of covering today's 47 million uninsured. The implication is that we can achieve health-care reform with universal coverage and declining per capita health-care costs.

There is a very real possibility that we will see positive transformational health-care reform in the near future. I am encouraged by the effort I see on Capitol Hill, particularly the bipartisan effort in the Senate. While some tough issues remain, if we continue to work in a bipartisan manner I believe we will resolve these issues successfully and find agreement on meaningful reform.


Australian public health bureaucrats botching swine flu response

It really is an epidemic in Victoria but the bureaucratic response there borders on the insane. It is a situation where prompt responses are crucial, but promptness is simply beyond bureaucrats

ANGRY GPs have slammed a "conspicuous lack of leadership" in Australia's response to the swine flu crisis, with some patients waiting eight days for test results or receiving anti-viral drugs too late to limit the infection. The doctors have blamed delays and inconsistent responses at state and federal levels for undermining efforts to contain the disease in Australia, placing the nation on the front line of the world's first flu pandemic in more than 40 years.

The World Health Organisation conceded defeat early yesterday in global efforts to confine the novel H1N1 strain, upgrading its six-level warning system to full-blown pandemic. Despite the worldwide upgrade, Australia yesterday did not lift its own pandemic alert status to the highest level, on the basis that the disease remained a mild one for most of the population.

The number of Australians infected with the new H1N1 strain is, however, believed to be far higher than last night's official national tally of 1391 because Victoria has abandoned its daily caseload updates. The state last Wednesday cut back its laboratory testing for the virus from about 500 to 1000 samples a day to 50 to 70 a day, after acknowledging it could no longer contain the disease.

Even then, patients were falling through the cracks in the testing system, Melbourne GP Kirstin Charlesworth told The Australian. She said a 17-year-old boy who came to her Toorak practice two weeks ago with classic flu symptoms, including a 39C fever, had to wait for eight days for test results to confirm his diagnosis, by which stage he was back at school. The patient was initially refused priority testing because he fell outside Victoria's risk criteria, and could not be fast-tracked even after classmates tested positive to swine flu. "They said they couldn't do it - it was on the slow train to nowhere and had been sent interstate," Dr Charlesworth said. "I asked if I could at least have Tamiflu for the patient, for his household, and for myself - and they said, 'No, because he doesn't have swine flu at this stage'."

Thomas Lyons, a GP from Eagleby, southeast of Brisbane, said logistics were "falling over" in the fight to contain the virus, and likened the bureaucrats responsible for organising the national swine flu response to the generals in charge at Gallipoli. "There is a conspicuous lack of leadership at the state level here in Queensland," he said. Dr Lyons said a woman who had been a passenger on the Pacific Dawn cruise liner, which hosted a major swine flu outbreak, had told him hospital staff had promised that masks and other equipment needed for her quarantine would be sent to her home. "It arrived eight days later - much too late to be of any epidemiological or biological use whatsoever," Dr Lyons said. Pathology companies were quoting him testing turnaround times of between two and five days, yet the anti-viral Tamiflu commonly used for treatment was largely ineffective more than 48 hours into the course of the disease. "Giving it more than 72 hours after the onset of symptoms is a waste of time," Dr Lyons said.

Sydney GP Mike Moore, chief executive of the Central Sydney GP Network, said authorities could have managed the situation better. "If we had been more careful, we could probably have delayed entry of the virus into the country, and (if) various jurisdictions had been more co-ordinated," he said.

Federal Health Minister Nicola Roxon yesterday sought to head off doctors' concerns by announcing almost $4 million in new funding to provide extra support for GPs. [Irrelevant tokenism]


Australia: NSW government hospital freezes elderly patients for two weeks

While management sit in their warm offices ignoring the problem. It's only luck that there were no deaths

DOZENS of patients were left in freezing conditions, some so cold they could not eat, after one of Sydney's leading hospitals failed to fix a broken heating system as temperatures plunged during this week's cold snap. Prince of Wales Hospital, run by an area health service the Opposition says is almost bankrupt, admitted yesterday that heating on Level 7 was broken as temperatures fell to just 6C.

Orthopaedic patients struggled in the cold, with one 97-year-old woman suffering a broken hip unable to hold a spoon in her numb hands. Eva Lang's niece Marika Pogany took her a portable heater in a bid to keep her warm before she was finally moved to a rehabilitation hospital yesterday after two freezing weeks at Prince of Wales. There were another three patients in Ms Lang's room and her niece estimated another 30 patients were in the frozen wing of the hospital.

Mrs Pogany said nurses had told her the heating was supposed to be turned up on June 1 but was discovered to be broken.

"The patients are all elderly people after operations. They are freezing. At lunch time when I went there her hands were blue, (My aunt) could not even hold a spoon," Ms Pogany said. "They are fragile people. Hospitals should be warm. I don't know what they are spending the money on."

Opposition Health spokeswoman Jillian Skinner said the South Eastern Sydney Area Health Service was almost bankrupt. "It is deplorable, I suspect it all comes down to not enough money to fix the problem," Ms Skinner said. "To the Government, sitting in their warm offices, the patients are out of sight and out of mind, the hospital and area health service are absolutely on the brink. "It is lucky some of these people's health hasn't been compromised to the point where they died. When people are old and frail their condition can deteriorate very quickly."

The hospital claimed maintenance staff were only alerted to the problem on Thursday and workers would try to have the heating fixed by today. "If the hospital didn't know the heating was broken, they have some answers to provide," Ms Skinner said.


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