Friday, July 10, 2009

NHS nurse mocked frail old lady as 'drama queen'

By the time Ann McNeill was admitted to Edgware Hospital, in North London, her legs were raw and covered in bandages. The 71-year old grandmother had been diagnosed with the superbug MRSA, and the infection Clostridium difficile at nearby Barnet General Hospital following a succession of major operations.

Having spent decades working as a nurse, Mrs McNeill hated to bother the staff during the 10 months she spent in both hospitals before she died. When the stench of dried urine from a neighbouring bed in her ward in Barnet became overpowering, it was her husband Richard, who asked if it could be cleaned.

When a nurse told the frail pensioner that she "would never be going home" Mrs McNeill said nothing, only weeping later, when her husband visited. In October 2007 she was transferred to Edgware Hospital. The skin on her legs was raw, and partly covered with bandages, both to protect her wounds, and the fragile skin surrounding them.

As a night nurse roughly hoisted her into bed, knocking her legs, Mrs McNeill gasped in pain. "Oh, we've got a drama queen here," laughed the nurse, leaving the pensioner in agony, as blood slowly soaked the sheets. On many occasions, she was left in her own faeces.

Her widower recalls: "She hated disturbing the nursing staff, but she was totally compos mentis and she hated the indignity of it. She would plead with them to change her, but the answer was always firm: 'We will get to you when we have time". Mr McNeill was not convinced that time pressures were the problem. "Often I would wait at the nursing station, for perhaps five minutes, to ask for help for Ann. "They would keep chatting about this and that and I didn't want to interrupt them, I wanted to be polite. "But then when they got to the end of their conversation, they would go off, as though I wasn't there at all. I remember once I felt so desperate, I said to them, 'Are we invisible?'"

On another occasion, he arrived at Edgware hospital to find his wife sitting in a chair, her clothes covered in vomit. He was unable to find a nurse. In the next bed, the heavy breaths of an old woman, whose oxygen mask had fallen off, appeared to go undetected by staff.

On Monday 15 October 2007, less than a week after her surgeon said Mrs McNeill was recovering well, she died of bronchopneumonia, a condition which is closely linked to MRSA.

Her widower, now 75, says: "I know there is nothing I can do to bring Ann back, but it destroys me to think of what she went through, even with me trying my best for her every step of the way."

A spokesman for Barnet and Chase Farm Hospitals trust, which runs Barnet General Hospital, extended their apologies to Mrs McNeill's family for additional distress caused by the circumstances surrounding her death. He said the patient was in the hospital's care for an extended period of time, and that the trust would be happy to meet with her widower to hear his concerns. He added: "We are anxious to take the opportunity to make any improvements in the quality of care we provide."

Barnet primary care trust, which runs Edgware Community Hospital, said it worked to maintain high standards of health care and had not received any complaints about Mrs McNeill's care.


This is the sort of nut that the NHS can unleash on you

NHS nutritionist gave 'dangerous' food advice to diabetic patients

An NHS nutritionist told diabetic patients to eat a range of bizarre and trendy foods, including some that were 'dangerous', a disciplinary panel heard yesterday. Katie Peck, 32, recommended dandelion tea, kelp granules, milk thistle, flax seed oil and chromium supplements - all apparently without any clinical reason. She also allegedly recommended expensive vitamin supplements, including co-enzyme Q10, for which there is no evidence of any benefit.

A colleague at the Coxheath Centre Diabetes Clinic, near Maidstone in Kent, told a hearing most of the advice was baffling but harmless - but in the cases of two diabetic patients it was 'dangerous'. One, known as ES, who was on insulin and was also being treated for a thyroid condition, was told to take granules of kelp seaweed - a rich source of iodine. Sally Norris, a specialist diabetes dietician, told the Health Professions Council that extra iodine could dangerously interfere with both conditions. 'There would be a safety issue,' she said.

Another diabetic patient, KA, who was awaiting kidney dialysis and had high potassium levels, was told to eat half a large green banana - even though the fruit is known to be rich in potassium. Mrs Norris told the panel: 'What does that mean? Why does the banana have to be green? 'And I would certainly not expect somebody with high potassium levels to be recommended to eat bananas because it would be dangerous.'

Miss Peck also allegedly forbade some patients from eating grapes or drink coffee, and said one should eat cottage cheese - but never with pineapple. She banned mashed potato and alcohol and said red meat should not be eaten more than once a fortnight. Her other directions included that water must be filtered, eggs must be free-range and the dried fruit on one patient's daily porridge had to be organic, the panel heard.

Mrs Norris said there was no reason for that and it would cost the patients more.

She also said to have inappropriately recommended specific brands of products, including Rachel's probiotic yoghurt, Tilda brown basmati rice and Alpro soya milk.

Miss Peck was hired by West Kent NHS Primary Care Trust to cover for Mrs Norris when she went on maternity leave in 2005. When she returned to work in 2007 she sat in on one of Miss Pecks' consultations and was immediately concerned when Miss Peck tried to measure a patient's waist 'in the wrong place completely'. Mrs Norris then went through files and found dozens of examples of peculiar advice, which she reported to managers. She said: 'I was very concerned that things had been written down that didn't seem to have any explanation behind them and I could not see any clinical reasoning. 'There was no evidence that I could see that was behind what was being recommended.'

Miss Peck faces disciplinary charges in relation to 27 patients. John Harding, for the HPC, said: 'The allegation is that Katie Peck's fitness to practise is impaired by reason of lack of competence. 'It will be seen that in relation to each patient there is a common theme that develops - that the note-keeping was in a poor state and that recommendations made by Katie Peck were without any obvious reasons.'

Miss Peck denies any wrongdoing. The hearing in South London continues.


In Obama's America you are going to have to be rich to get good health care

The Obama administration might like to "spread the wealth around," but its proposed "health care reform" wouldn't spread consumer choice around. Rather, it would constrict consumer choice substantially — except for the very rich. That's the great irony of President Obama's ambitious health care agenda: His administration, which seems to feel little empathy for the rich, is paving the way to a two-tiered system in which only the very rich would have a choice.

Under ObamaCare, the rich would continue to get the care they want — whether here or abroad — by paying for it out of their own pockets. The rest of us would stand in line and wait for rationed care.

Most Americans want consumer freedom. They want to be able to shop for health care value — for the best care, at the best prices. They'd like to have a lot more freedom to shop for such value than they currently have. That's why Democrats are couching their proposed expansion of government-run health care in the language of competition and choice.

Listen to the president as he pitches the centerpiece of that agenda — a "public option," a form of Medicare for all. He says it's merely a way to give Americans another choice: People can buy private health insurance, just like now, or they can instead choose the government option. But millions of middle-class Americans who are happy with their employer-provided insurance would soon find the choice isn't theirs to make. The government would make it cheaper for employers to contribute to the government-run option than to keep providing private insurance. Millions of employers would do the math and pick the government option. The "public option" would provide a choice — for millions of employers, against the wishes of millions of employees.

The Lewin Group, a prominent consulting firm, estimates that a widespread "public option" with Medicare-like reimbursement rates would result in 118 million Americans losing their private insurance and being forced into government-run care. Meanwhile, private insurance wouldn't be able to compete on the uneven playing field that Congress would establish.

In its competition with FedEx and UPS, the Post Office at least has to provide a service. But the "public option" would merely use government's coercive powers to dictate prices and availability of services provided by others — by doctors, nurses, hospitals, etc. Private insurance can't similarly fix prices and would be run out of business.

Lower reimbursement rates, coupled with a dwindling pool of private insurers to whom to pass on costs, would mean lower incomes for medical professionals. The eventual result would be fewer people entering the medical profession.

A two-tiered system would then emerge: The very rich would take their spots like first-class passengers on the Titanic, paying for fine care and not asking the price. The rest of us would take our spots in steerage class, awaiting the inevitable collision between government-run health care and the iceberg of budgetary disaster.

White House budget director Peter Orszag recently opined that "the deficit impact of every other fiscal policy variable" is "swamped" by the deficit-threat posed by Medicare and Medicaid. Obama's solution? A massive new Medicare-like program! Medicare may not pay much to doctors, but taxpayers pay plenty to Medicare. As my recent Pacific Research Institute study shows, since 1970, Medicare's costs have risen 34% more, per patient, than the costs of all health care in America apart from Medicare and Medicaid. Medicare's costs have risen $2,511 more per patient.

Across nearly four decades, government-run health care has been far more expensive than privately run care. It comes down to a simple comparison and an obvious verdict: Privately run care offers choice and is cheaper. Government-run care denies choice and is more expensive.

But the particular losers under Obama-Care would be the middle class. The uninsured poor would largely benefit, although they might benefit even more — while hurting others far less — from fixing the unfairness in the tax code and giving them the health care tax-break that millions of insured Americans already enjoy.

The truly rich would be largely unaffected, as they never really needed private insurance anyway. They would continue to pay for the care they want, because they can.

Middle-class Americans wouldn't enjoy that freedom. They would lose their employer-provided insurance and be left with only the government-run "option." And, under a government monopoly, they would get rationed care. And every April 15, they would get a higher tax bill for their troubles, which just might make them feel sick enough to get back in line.


Medicare’s mythical administrative cost savings

by Megan McArdle

The title of this post is going to make some of my readers very angry. Medicare has lots of administrative cost savings, they will say. This may be so. But I mean mythical in another sense: there's ultimately no way to prove or disprove these amazing savings. The problem is indeterminate.

Jon Cohn, who I respect greatly, spends a lot of time on the money and time that insurance companies put into denying claims. This is undoubtedly true. But I have two caveats. First, some of that effort is a good thing: without it, there would be fraud. No, not the automatic denials so many insurers are fond of, and I'm not defending. But Medicare should probably spend a lot more effort rooting out excessive billing. And I don't know what percentage of claims denial consists of refusing to line the pockets of doctors and labs.

But the more important point is that I doubt this is the majority of their administrative costs, or even the difference between their administrative costs and Medicare's. I'm not trying to justify the bullshit automatic claims denial, but that's not actually a very costly process: a hospital submits a bill, they deny it, you yell at them. Nor is refusing to cover people with pre-existing conditions, or any of the other multifarious complaints of single-payer advocates.

Rather, private insurers have costs that Medicare doesn't have within the agency. Private insurers bill. Medicare does too, but the IRS has its own budget--hell, its own courts--which don't show up on Medicare's balance sheet. Private insurers negotiate with suppliers. Medicare does too, but most of the negotiation takes place between lobbyists and Congressmen who again, do not show up on Medicare's balance sheet. The Federal government has all sorts of these little items which relieve government agencies of reporting certain costs. But the costs remain.

My guess would be that these explicit costs are still lower than Medicare's. But then there are implicit costs to government fiat that markets don't have. As Tyler Cowen points out, taxation has deadweight losses, and Medicare is a tax on employment, which is something we are particularly anxious not to suppress right now.

The final point is that while people commonly think of administrative costs as "wasted", in fact, they are an important part of the market system. As Alex Tabarrok points out, and I have myself from time to time, many of the arguments in favor of national health care are literally socialist. And no, I am not using that term to apply to "anyone who is in favor of redistribution" or "government programs". But consider the following common arguments:

* National health care will be cheaper because we will reduce administrative overhead

* National health care will reduce wasteful competition in the form of me-too drugs

* National health care will reduce wasteful competition in the form of advertising and other marketing expenses

* National health care will allow us to rationally distribute care to where it does the most good rather than the current messy, wasteful hodge-podge

* National health care will use resources for production instead of profits

* National health care will achieve economies of scale in purchasing and record-keeping

* People will not overuse free goods because there are hard limits to desired consumption

These were all arguments advanced in favor of socialism. Contrary to popular conservative belief, socialists were not unfamilier with either the incentive problems of communism (people will not work hard if there's no benefit to doing so) or the Hayekian argument about the value of prices, aka the Socialist Calculation Problem. Rather, smart socialists thought that they could overcome these problems with a combination of status competitions (Hero of the Soviet Union, Second Class) and massive efficiencies gained by wringing all that fragmented, wasteful competition out of the system. Economists who would be ashamed to make these sorts of arguments about Proctor and Gamble or the used car market suddenly start parroting these things as if they hadn't been thoroughly discredited by the last seventy years.

But why were they discredited? That list looks really, really good on paper, even to my jaded libertarian eyes. A lot of the answer lies in the reason that we don't like monopolies--even though that list is just as true of monopolies as it is of the government. Monopolies, government or private, are risk averse, slow to innovate, and generally run things for the benefit of themselves rather than their customers. Hamstringing them with regulations can limit measurable outcomes, like excess profit-taking, but not unmeasurable ones, like the people who might have been cured by a drug the system didn't invent. And the political system introduces its own problems. As Robert Heinlein pointed out years ago, systems that have only positive feedback loops tend to fail catastrophically.

My critics will want me to explain why, then, Europe can do it cheaper. The answer is threefold. First, most European nations have better governance than we do--the American political system is a Public Choice disaster. Second, they pay people less money in a way that's hard to replicate here (and even if it wasn't, would be a one time savings that wouldn't check the rate of growth). Third, we're still driving quite a bit of product innovation. Our messy, organic, wasteful, unfair, irrational system allows experimentation, and they cherry pick the best results. If we stopped doing this, their system would stop looking so good.


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