Friday, July 17, 2009

A 9-month wait for NHS arthritis treatment: Delay can mean a lifetime of agony for victims

Thousands of rheumatoid arthritis sufferers face a lifetime of agony because they are not being treated quickly enough, a report says. Guidelines state that patients should receive treatment within three months of the first symptoms appearing. But the average wait is nine months - and GPs are not trained well enough to know what help to offer.

There is no cure, but experts say that if arthritis is diagnosed in the first three months, drugs can be given which limit its progression. This means the disease will not be as painful as it would have been if the condition was diagnosed later. The study by the National Audit Office found that patients do not know enough about the condition, and therefore delay going to see their GP. Between half and three-quarters of people with symptoms wait more than three months before seeking medical help, and about a fifth delay for a year or more.

GPs lack the specialist knowledge required to diagnose the condition quickly, and on average it takes four visits before a patient is referred to a specialist for diagnosis and treatment, the report adds. Its author, Chris Groom, said: 'This is a nasty disease, a progressive auto-immune disease, which attacks otherwise healthy joints. Early symptoms are joint pain and stiffness and it leads to inflammation and loss of strength. 'It also affects other parts of the body, such as the heart and lungs, and is also associated with increased risk of cardiovascular disease.'

The report found that the average length of time from the onset of symptoms to treatment has not improved in the past five years. Mr Groom said that services needed to be better coordinated and designed around people's needs, including helping them remain in work.

Three-quarters of sufferers are of working age when diagnosed, meaning delays cost the economy almost £2billion a year - about £560million a year in NHS healthcare costs and £1.8billion in sick leave and work-related disability. 'Once people fall out of the job market with this disease, it is very hard to get back in', Mr Groom said.

The report also found that 50 per cent more people have rheumatoid arthritis than was previously thought. Mr Groom added: 'We estimate that 580,000 adults in England have the condition, which is higher than existing estimates of 400,000 for the UK, and that there are 26,000 new cases each year in England, compared to estimates of 12,000 for the UK.'

Neil Betteridge, chief executive of the charity Arthritis Care, said: 'The report echoes what people with rheumatoid arthritis have been telling Arthritis Care for years. 'Early diagnosis and referral for suitable treatment is crucial as it can stop this debilitating condition in its tracks. 'We applaud the audit's recommendations that the Department of Health and Primary Care Trusts replace their often scattergun delivery with joined-up services.'

Tory MP Edward Leigh, chairman of the Commons public accounts committee, said the NHS needed to improve support services for people with arthritis.

Health minister Ann Keen said: 'We welcome this report and will consider it carefully before responding.'


Your regulators will protect you (NOT)

Some charming reports from California about its "caring" nurses. And nobody cares about the abuses

Nurse Owen Jay Murphy Jr. twisted the jaw of one patient until he screamed. He picked up another one – an elderly, frail man – by the shoulders, slammed him against a mattress and barked, "I said, 'Stay in bed.' " He ignored the alarms on vital-sign monitors in the emergency room, shouted at co-workers and once hurled a thirsty patient's water jug against the wall, yelling, "How do you like your water now?" according to state records.

Murphy's fellow nurses at Kaiser Permanente Riverside Medical Center finally pleaded with their bosses for help. "They were afraid of him," a hospital spokesman said. Under pressure, Murphy resigned in May 2005. Within days, Kaiser alerted California’s Board of Registered Nursing: This nurse is dangerous.

But the board didn't stop Murphy from working elsewhere, nor did it take steps over the next two years to warn potential employers of the complaints against him. In the meantime, Murphy was accused of assaulting patients at two nearby hospitals, leading to convictions for battery and inflicting pain, board and court records show. Even Murphy, who has since taken classes to curb his anger, was surprised the board didn't step in earlier. "The nursing board is there to protect the public from me," he said in an interview.

The board charged with overseeing California's 350,000 registered nurses often takes years to act on complaints of egregious misconduct, leaving nurses accused of wrongdoing free to practice without restrictions, an investigation by The Times and the nonprofit news organization ProPublica found.

It's a high-stakes gamble that no one will be hurt as nurses with histories of drug abuse, negligence, violence and incompetence continue to provide care across the state. While the inquiries drag on, many nurses maintain spotless records. New employers and patients have no way of knowing the risks.

Reporters examined the case of every nurse who faced disciplinary action from 2002 to 2008 – more than 2,000 cases in all – as well as hundreds of pages of court, personnel and regulatory reports. They interviewed scores of nurses, patients, families, hospital officials, regulators and experts.

Among the findings:

* The board took more than three years, on average, to investigate and discipline errant nurses, according to its own statistics. In at least six other large states, the process typically takes a year or less.

"It's really discouraging that when you do report people . . . they don't take action," said Joan Jessop, a retired chief nursing officer in Los Angeles who filed multiple complaints with the board during her 43-year career. "What is so frightening to me is that these people will go on and do it to somebody else."

* The board failed to act against nurses whose misconduct already had been thoroughly documented and sanctioned by others. Reporters identified more than 120 nurses who were suspended or fired by employers, disciplined by another California licensing board or restricted from practice by other states – yet have blemish-free records with the nursing board.

* The board gave probation to hundreds of nurses – ordering monitoring and work restrictions – then failed to crack down as many landed in trouble again and again. One nurse given probation in 2005 missed 38 drug screens, tested positive for alcohol five times and was fired from a job before the board revoked his probation three years later.

* The board failed to use its authority to immediately stop potentially dangerous nurses from practicing. It obtained emergency suspensions of nurses' licenses just 29 times from 2002 to 2007. In contrast, Florida's nursing regulators, who oversee 40% fewer nurses, take such action more than 70 times each year.

In interviews last week, the board's leaders and other state officials defended its record. "We take what we do – protecting the public – very, very seriously," said Executive Officer Ruth Ann Terry.

Terry, at the helm for nearly 16 years and on staff for 25, acknowledged that the pace of the disciplinary process has "always been unacceptable" and said the system was being streamlined. But she blamed other parts of the state bureaucracy for delays and was vague about what changes would be made.

Later, the state Department of Consumer Affairs, which oversees the board, sent reporters a three-page list of "process improvements." Many were mundane or incremental adjustments – such as revising disciplinary guidelines or planning expert witness training. Others seemed more directly aimed at reducing delays: adding staff, meeting with investigators about stalled cases and using computer systems to better track complaints.

Patricia Harris, acting chief deputy director of the department, stood behind the board. "I think they do a good job," she said.

More here

Health reform would tax the rich and near-rich

Americans would face new requirements to obtain health insurance or face hefty tax penalties as part of a $1.5 trillion health care reform plan introduced by House Democrats on Tuesday that will be paid for, in part, by a new 5.4 percent tax on the wealthiest Americans.

Employers would have to provide coverage to employees or face penalties of their own under the 1,018-page bill, released by Democratic leaders and chairmen of three committees that share jurisdiction over health care. It would also create a public health insurance program and impose a series of new regulations on the insurance industry, including a ban on denying coverage of pre-existing conditions.

"This is a defining moment for our country," said Rep. Henry A. Waxman, California Democrat and chairman of the House Energy and Commerce Committee. "We are about to undertake what has eluded so many presidents and Congresses for far too long and that is the objective of getting good quality, affordable health care insurance to every American."

The health care reform bill, which was praised by President Obama for creating new competition for insurance companies, would reshape the country's focus on health care coverage as a right of all Americans and a responsibility of the government.

The bill's release was met with enthusiasm by health care advocates but slammed by the industry and other business groups. A "pay or play" mandate on businesses drew condemnation as a job killer from a group of more than 30 trade associations, including the U.S. Chamber of Commerce, the Business Roundtable and the National Retail Federation. "We believe that some of the approaches under consideration in the House legislation would not improve the system, but in fact would jeopardize the parts of the system that currently work," the groups said in a letter to members of the House.

The Pharmaceutical Research and Manufacturers of America (PhRMA), the trade group of the pharmaceutical industry, said it won't support the bill because of changes in the Medicare Part D benefit, which it said would constitute a tax increase on seniors.

The bill was praised by various health care advocacy groups such as AARP. Families USA Executive Director Ron Pollack said the bill would "ensure that virtually all Americans have access to high-quality, affordable health coverage and care."

The bill still faces opposition from factions of the Democrat caucus and has already prompted widespread criticism from Republicans. A group of fiscally conservative "Blue Dog" Democrats stalled the release of the bill last week over concerns that it be deficit neutral, control costs and include stronger protections for small businesses and rural patients. The group said it plans to incorporate more cost cutting measures into the bill.

More here

Universal Health Care Isn't Worth Our Freedom

What would Thoreau have made of the current debate?

People who seek the services of auto mechanics want car repair, not "auto care." Similarly, most people who seek the services of medical doctors want body repair, not "health care."

We own our cars, are responsible for the cost of maintaining them, and decide what needs fixing based partly on balancing the seriousness of the problem against the expense of repairing it. Our health-care system rests on the principle that, although we own our bodies, the community or state ought to be responsible for paying the cost of repairing them. This is for the ostensibly noble purpose of redistributing the potentially ruinous expense of the medical care of unfortunate individuals.

But what is health care? The concept of reimbursable health-care service rests on the premise that the medical problem in need of servicing is the result of involuntary, unwanted happenings, not the result of voluntary, goal-directed behavior. Leukemia, lupus, prostate cancer, and many infectious diseases are unwanted happenings. Are we going to count obesity, smoking, depression and schizophrenia as the same kinds of diseases?

Many Americans would willingly pay for insurance to protect them against the exorbitant cost of treating their own leukemia. But how many Americans would willingly pay for insurance to protect them from the expenses of treating their own depression?

Everyone recognizes that the more fully we wish insurance companies to defray our out of pocket expenses for our car repairs, the higher the premium they will charge for the policy. Yet foregoing reimbursement for trivial or unnecessary health-care costs in return for a more suitable health-care policy is an option unavailable under the present system. Everyone with health insurance is compelled to protect himself from risks, such as alcoholism and erectile dysfunction, that he would willingly shoulder in exchange for a lower premium.

The idea that every life is infinitely precious and therefore everyone deserves the same kind of optimal medical care is a fine religious sentiment and moral ideal. As political and economic policy, it is vainglorious delusion. Rich and educated people not only receive better goods and services in all areas of life than do poor and uneducated people, they also tend to take better care of themselves and their possessions, which in turn leads to better health. The first requirement for better health care for all is not equal health care for everyone but educational and economic advancement for everyone.

Our national conversation about curbing the cost of health care is crippled by the vocabulary in which we conduct it. We must stop talking about "health care" as if it were some kind of collective public service, like fire protection, provided equally to everyone who needs it. No government can provide the same high quality body repair services to everyone. Not all doctors are equally good physicians, and not all sick persons are equally good patients.

If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price. We will become the voluntary slaves of a "compassionate" government that will provide the same low quality health care to everyone.

Henry David Thoreau famously remarked, "If I knew for a certainty that a man was coming to my house with the conscious design of doing me good, I should run for my life." Thoreau feared a single, unarmed man approaching him with such a passion in his heart. Too many people now embrace the coercive apparatus of the modern state professing the same design.



Clint said...

Szasz' commentary on health care seemed exceptionally poor. He argues that health care is not a right, that people get sick only because of voluntary choices and other such nonsense. He even says richer people tend to be healthier (perhaps because they can afford better health care, sigh).

I wrote a response to it if you're interested.

"The board took more than three years, on average, to investigate and discipline errant nurses, according to its own statistics."


Anonymous said...

The private sector and competitive market forces, not the federal government, are the best means to meeting our country’s rapidly expanding health care needs. One of the things I think we can do to help make that happen is support American businesses and the U.S. Chamber of Commerce ( They’re doing things to reach out and show people that they can get involved, too.