Saturday, July 18, 2009

Patient sues NHS after having terminal cancer wrongly diagnosed

When Philip Collins was told that he had cancer and had just six months to live, he quit his job, cashed in his pension and bought himself a powerful motorcycle. He was determined to enjoy the time left to him. When he was still alive a year later his doctors conducted a re-examination and admitted that there had been a mistake. The inoperable “tumour” on his gall bladder was a relatively harmless abscess.

Far from being delighted at his unexpected reprieve Mr Collins, 59, was devastated. He had spent his life savings and the powerful drugs that the doctors prescribed to keep him alive as long as possible had destroyed his health. Mr Collins, now 61, had even planned his own funeral. As well as buying the Triumph motorcycle, he had bought his wife Isabel a new car so that she would have transport after he had gone. The couple spent an emotional “last” Christmas together.

Two years later Mr Collins is seeking compensation from the NHS for his ordeal, which he said had left him “an absolute wreck” due to the quantity of drugs he had needlessly taken. Mr Collins, of Yetminster, Dorset, said: “When they told me I had cancer I knew I had a chance to do everything I wanted. I was a fit man and a keen motorcyclist. I still had a lot of working life left in me.

“When they told me I did not have cancer, it knocked me off balance. Now I cannot do anything. I’m an absolute wreck. If you have spent two years thinking you are going to die, then you are told you are not, it knocks you backwards.”

Mrs Collins, 62, said that the couple were delighted that the original diagnosis was a mistake, but added that it had ruined her husband’s life. She said: “We just don’t understand how it could have happened. They obviously didn’t look at the tests closely enough. I never used to believe in suing or compensation or anything like that.”

Mr Collins’s ordeal began when he lost his appetite suddenly and suffered weight loss and anaemia. He was given a scan at Dorset County Hospital in Dorchester that revealed he had an abnormal gall bladder and liver. Further tests led doctors to believe that he had cancer and they told the the couple that he had only six months to live.

Mrs Collins said: “He was bitter and tearful but he took the news that he was going to die calmly. We took £18,000 out of a pension and he bought the Triumph motorbike, which had always been his dream. He even told me he wanted his coffin to be carried on the back of it at his funeral, which he had arranged.”

After a grim “last Christmas” his 60th birthday came and went. Three weeks after a second CT scan doctors told Mr Collins that although he still had cancer, it was not terminal. Two weeks later he was told that he was suffering not from cancer, but from an abscess.

Dorset County Hospital’s chief executive, Jan Bergman, has written to Mr Collins disclosing that the initial diagnosis was made before all the test results had been examined. He said that practices had been reviewed to ensure that surgeons looked at all information before reaching a conclusion. Mr Collins is now being treated at Yeovil District Hospital. A spokesman for Dorset County Hospital said: “We have been in contact with Mr and Mrs Collins about the conclusions of our investigation.”


NHS: £286m to help terminally ill to die at home ‘lost in system’

Millions of pounds of extra funds pledged by the Government for the care of terminally ill patients are failing to reach frontline health services, The Times has discovered. Nine out of ten local health authorities cannot identify their share of the £286 million promised last year to help people who want to die in their own homes, rather than in hospital.

Alan Johnson, then Health Secretary, announced the spending over two years last July as part of the End of Life Care strategy, claiming that it would honour Labour’s manifesto pledge to double investment in specialist palliative care by 2011. Hospice directors say, however, that the money is being lost on the NHS balance sheet or spent on other services because it has not been ring-fenced.

Research by the charity Help the Hospices, seen by The Times, shows that of a sample of 28 NHS primary care trusts, only three could provide evidence of extra investment in palliative care this year. At least six of the trusts surveyed — in Blackpool, Bury, Cumbria, Devon, North Lancashire and West Essex — said that there was no extra money for end-of-life care because of financial pressures and the need for savings. Others were unable to identify a specific sum for end-of-life care, or said that no new money had appeared in their annual baseline allocation.

Only one in five deaths in England — most of which follow chronic illness such as heart disease, cancer or dementia — occurs in the home, although two thirds of people say that is where they would prefer to die. By comparison, 58 per cent of people die in hospital. Families complain that a lack of support, local hospice beds or pain management services leaves them no alternative.

A review of end-of-life care published yesterday by the Department of Health painted a quite different picture, claiming that the £286 million programme had made a good start and was set to deliver real service improvements. Mike Richards, the department’s national director for cancer, added that while some funds had gone directly to trusts, money was also being held by the department “for national work”.

The ten-year strategy aims to shift public attitudes to death and dying, invest in local workforce training and create “rapid response” nursing teams to provide care and support to those who wish to die in a hospice or at home.

David Praill, chief executive of Help the Hospices said: “This is a tragic indictment of the system. PCTs have been given a substantial amount of money to improve end-of-life care, and it simply isn’t good enough that, one year on, many don’t know where it is.”

The pressure on local hospices — three quarters of which are funded by local charities rather than by the NHS — is rising, with more than 100,000 patients using services last year.

Adult hospices in England receive on average only 31 per cent of their funding from the Government, and the gap between what they spend on NHS patients and what the NHS contributes to that care is estimated at £200 million a year, and widening. Help the Hospices is concerned that the extra funding will be diverted to hospital-based care rather than the voluntary sector.

Richard Cowie, chief executive of St Clare Hospice, in Harlow, Essex, said that many local charitable organisations had not seen money being passed on by local NHS managers. “We have a decent working relationship with our local PCT, but their key statement is that they have to make cost-savings on existing budgets and that there is no new money,” he said.


President Obama’s top five health care lies

President Barack Obama walked into the Oval Office with a veritable halo over his head. In the eyes of his backers, he could say or do no wrong because he had evidently descended directly from heaven to return celestial order to our fallen world. Oprah declared his tongue to be "dipped in the unvarnished truth." Newsweek editor Evan Thomas averred that Obama "stands above the country and above the world as a sort of a God."

But when it comes to health care reform, with every passing day, Obama seems less God and more demagogue, uttering not transcendental truths, but bald-faced lies. Here are the top five lies that His Awesomeness has told--the first two for no reason other than to get elected and the next three to sell socialized medicine to a wary nation.

Lie One: No one will be compelled to buy coverage.

During the campaign, Obama insisted that he would not resort to an individual mandate to achieve universal coverage. In fact, he repeatedly ripped Hillary Clinton's plan for proposing one. "To force people to buy coverage," he insisted, "you've got to have a very harsh penalty." What will this penalty be, he demanded? "Are you going to garnish their wages?" he asked Hillary in one debate.

Yet now, Obama is behaving as if he said never a hostile word about the mandate. Earlier this month, in a letter to Sens. Max Baucus, D-Mont., and Ted Kennedy, D-Mass., he blithely declared that he was all for "making every American responsible for having health insurance coverage, and making employers share in the cost." But just like Hillary, he is refusing to say precisely what he will do to those who want to forgo insurance. There is a name for such a health care approach: It is called TonySopranoCare.

Lie Two: No new taxes on employer benefits.

Obama took his Republican rival, Sen. John McCain, to the mat for suggesting that it might be better to remove the existing health care tax break that individuals get on their employer-sponsored coverage, but return the vast bulk--if not all--of the resulting revenues in the form of health care tax credits. This would theoretically have made coverage both more affordable and portable for everyone. Obama, however, would have none of it, portraying this idea simply as the removal of a tax break. "For the first time in history, he wants to tax your health benefits," he thundered. "Apparently, Sen. McCain doesn't think it's enough that your health premiums have doubled. He thinks you should have to pay taxes on them too."

Yet now Obama is signaling his willingness to go along with a far worse scheme to tax employer-sponsored benefits to fund the $1.6 trillion or so it will cost to provide universal coverage. Contrary to Obama's allegations, McCain's plan did not ultimately entail a net tax increase because he intended to return to individuals whatever money was raised by scrapping the tax deduction. Not so with Obama. He apparently told Sen. Baucus that he would consider the senator's plan for rolling back the tax exclusion that expensive, Cadillac-style employer-sponsored plans enjoy, in order to pay for universal coverage. But, unlike McCain, he has said nothing about putting offsetting deductions or credits in the hands of individuals. In other words, Obama might well end up doing what McCain never set out to do: Impose a net tax increase on health benefits for the first time in history.

Lie Three: Government can control rising health care costs better than the private sector.

Ignoring the reality that Medicare--the government-funded program for the elderly--has put the country on the path to fiscal ruin, Obama wants to model a government insurance plan--the so-called "public option"--after Medicare in order to control the country's rising health care costs. Why? Because, he repeatedly claims, Medicare has far lower administrative costs and overhead than private plans--to wit, 3% for Medicare compared to 10% to 20% for private plans. Hence, he says, subjecting private plans to competition against an entity delivering such superior efficiency will release health care dollars for universal coverage.

But lower administrative costs do not necessarily mean greater efficiency. Indeed, the Congressional Budget Office analysis last year chastised Medicare's lax attitude on this front. "The traditional fee-for-service Medicare program does relatively little to manage benefits, which tends to reduce its administrative costs but may raise its overall spending relative to a more tightly managed approach," it noted on page 93. In short, extending the Medicare model will further ruin--not improve--even the functioning aspects of private plans.

Lie Four: A public plan won't be a Trojan horse for a single-payer monopoly.

Obama has repeatedly claimed that forcing private plans to compete with a public plan will simply "keep them honest" and give patients more options--not lead to a full-blown, Canadian-style, single-payer monopoly. As I argued in my previous column, this is wishful thinking given that government programs such as Medicare have a history of controlling costs by underpaying providers, who make up the losses by charging private plans more. Any public plan modeled after Medicare will greatly increase this forced subsidy, eventually driving private plans out of business, even if that weren't Obama's intention.

But, as it turns out, it very much is his intention. Before he decided to run for office--and even during the initial days of his campaign--Obama repeatedly said that he was in favor of a single-payer system. What's more, University of California, Berkeley Professor Jacob Hacker, who is a key influence on the Obama administration, is on tape explicitly boasting that a public plan is a means for creating a single-payer system. "It's not a Trojan horse," he quips, "it's just right there."

But even if Obama wanted to, it is simply impossible to design a public plan that could compete with private insurers on a level playing field and without "feeding off the public trough" as Obama claims.

At the very least, such a plan would always carry an implicit government guarantee that, should it go bust, no one in the plan would lose coverage. This guarantee would artificially lower the plan's capital reserve requirements, giving it an unfair edge over private plans. What's more, it is simply not plausible to expect that the plan wouldn't receive any start-up subsidies or use the government's muscle to negotiate lower rates with providers. If it eschewed all these things, there would be no reason for it to exist--because it would be just like any other private plan.

Lie Five: Patients don't have to fear rationing.

Obama has been insisting, including during his ABC Town Hall event last week, that the rationing patients would face under a government-run system wouldn't be any more draconian than what they currently confront under private plans. This is complete nonsense.

The left has been trying to address fears of rationing by trotting out an old and tired trope, namely, that rationing is an inescapable fact of life because every system rations whether by price or fiat. But there is a big difference between the two. If I can't afford caviar and champagne every night, any rationing involved is metaphoric, not real. Genuine rationing occurs when someone else controls access--how much of a particular good I can consume.

By that token, Obama's stimulus bill has set in motion rationing on a scale unimaginable in the land of the free. Indeed, the bill commits over $1 billion to conduct comparative effectiveness research that will evaluate the relative merits of various treatments. That in itself wouldn't be so objectionable--if it weren't for the fact that a board will then "direct financing" toward approved, standardized treatments. In short, doctors will find it much harder to prescribe newer or non-standard treatments not yet deemed effective by health care bureaucrats. This is exactly along the lines of the British system, where breast cancer patients were denied Herceptin, a new miracle drug, until enraged women fought back. Even the much-vilified managed care plans would appear to be a paragon of generosity in comparison with this.

Obama has repeatedly asked for honesty in the health care debate. It is high time he started showing some.


Let’s can the public plan

President Barack Obama wants to sign a health “reform” bill by October. Democratic congressional leaders are doing their part to satisfy the president, promoting bills that threaten to government’s role, at the expense of patients and doctors Apparently, though, they didn't consult the American public.

It's not that ordinary Americans aren't looking for reform. They simply don't want what the Democrats have effectively proposed – a government take-over of their health care. Just look at the results of a recent survey from prominent pollster Frank Luntz. Half of Americans are put off by "healthcare rationing." A third is not in favor of "one-size-fits-all health care." But under the Democratic plan, rationing and one-size-fits all coverage are exactly what the American people are going to get.

Take, for instance, the Democrats' plan to expand Medicaid, the joint federal-state health program for the poor, to any American making up to 150 percent of the federal poverty line. This is an incredibly inefficient way to expand coverage. Medicaid costs are already ballooning out of control. The Department of Health and Human Services estimates that the program's expenditures will increase by about 8 percent every year until 2017 – well above the expected rate of inflation. In the four decades since its creation, Medicaid's share of the national health budget has fattened from 5 percent to nearly 20 percent. Expanding Medicaid would push the program even closer to insolvency.

Worse, Medicaid is already a prime reason for the increasing cost of private insurance. Because Medicaid routinely underpays doctors and hospitals – by about 43 percent and 33 percent, respectively – prices for everyone else have gone up. Such cost-shifting inflates private premiums by an estimated 15 percent.

Medicare shifts costs, too – not only to private payers but to our children, as well. Despite this, the Washington politicians seek to create a so-called “public insurance plan” (actually a swamp of new, bloated government agencies) to “compete” directly with private insurers. Proponents of the idea claim that a "public option" would keep private insurers honest by forcing them to cut down on administrative waste and reduce premiums. In truth, though, the new plan would eventually crowd out all choice of health insurance.

A government-run insurance program would immediately go to the front of the line for perpetual taxpayer bailouts – a luxury that private insurers (which pay higher taxes than most other businesses, because of state insurance laws) don’t have. As more Americans who prefer private coverage suffer the increasing taxes required to feed the beast, many will have to give up the unequal struggle, and fall into its maw.

According to the Lewin Group, an economic consulting firm, a government-run insurance program would motivate two-thirds of Americans to drop the private coverage they already have. That certainly won't help reduce the number of uninsured.

A third plank in the Democratic plan is the implementation an employer mandate, under which employers would be forced to either buy insurance for their workers or pay a tax. Given the state of the economy, it's astounding that lawmakers would even consider such a move, saddling businesses with a job-killing tax at a time when many are struggling to stay afloat. Obama opposed the idea during the presidential campaign for just this reason.

Instead of spending and regulating with impunity, legislators should grant Americans greater control over their healthcare dollars. One way of doing so? Allow Americans to buy insurance policies across state lines. After all, there's no reason a 26-year old man in New York should have to pay four times as much as a 26-year old man in Indiana for a similar policy.

Lawmakers should also permit all workers to purchase insurance tax free, just like businesses do. Americans lack choice in health benefits because the government forces us to get health “benefits” dictated by our companies’ HR departments. Level the tax treatment would solve this problem. Personalized health care, lower prices, and increased consumer choice -- that's what the American people really want.


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