Wednesday, November 18, 2009

British Alzheimer’s patients neglected and come out of hospital 'worse than when they went in'

Half of Alzheimer’s patients come out of hospital in worse health than when they went in because of poor care, a hard-hitting new report warns. One in three never go back to their own homes and are discharged to a nursing home instead, the Alzheimer’s Society found. More than three-quarters of relatives say that they are dissatisfied with the treatment dementia patients receive in hospital and one in three has made an official complaint.

Poor care leads them to spend weeks or even months longer than necessary in hospital, according to the charity, which called for a target to cut the average time to discharge by a week.

The report come just days after an independent investigation found that almost 2,000 dementia patients a year are being killed by ‘chemical cosh’ drugs given to keep them quiet. A survey of relatives and NHS staff shows that almost half, 47 per cent, of dementia patients left hospital in worse physical health than when they went in. In an even greater number of cases, 54 per cent, the patients’ dementia was judged to have deteriorated while in hospital.

The charity warned that patients were being left unfed, with nothing to drink or sitting in their own urine because staff did not realise Alzheimer’s patients need extra help with simple tasks. Patients suffered weight loss, dehydration, pressure sores, incontinence and were even left unable to walk because they had been confined to bed for too long. One distressed patient was found beside a written note telling her “Don’t bang the table”, despite the fact that her condition meant she could no longer read.

Neil Hunt, chief executive of the Alzheimer’s Society, said: “We are talking about an issue that is vast and staring the NHS in the face. “We believe that the NHS is failing disgracefully on this. “And it is creating very serious outcomes for people with dementia and their families.”

People with dementia occupy up to one in four NHS hospital beds at any one time, the charity estimates. Cutting the average length of hospital stay by one week could save the NHS at least £80 million a year.

Official figures show that while the average length of stay for a hip fracture was one week, almost one in eight dementia patients with hip fractures stayed in hospital for more than two months.

The charity insisted that while in some cases it was right that patients with the condition should spend longer in hospital in many there were being delayed unnecessarily, harming their health. The charity surveyed 1,291 friends and relatives caring for a patient with dementia, 657 nursing staff and 479 ward managers.

Around 700,000 people in Britain have dementia, 400,000 with Alzheimer’s, the most common for, of the condition. That figure is predicted to increase to 1.7 million by 2051, in part because of an ageing population.

Dr Peter Carter, general secretary of the Royal College of Nursing, said: “For the majority of patients with dementia to leave hospital in a worse condition than when they arrived is simply unacceptable. "It is vital that the government invests in better dementia training for all healthcare staff to ensure these patients receive good quality care."

Rebecca Wood, chief executive of the Alzheimer’s Research Trust, said: “This is a wake-up call for a health system that has failed to take the challenge of dementia seriously. “We must tackle dementia by investing in research to find new preventions, treatments and cures, as well as reforming the way hospitals deal with dementia patients.”

A spokesman for the Patients' Association said: "The findings in this report are scandalous. "Not enough help with eating. Not enough help with drinking. Not enough help with personal hygiene. Not enough help with continence. “There is now an overwhelming amount of evidence that elderly patients are being neglected in hospitals across the NHS. "Whether they have dementia or not, if they are in need of help with personal care many of them won’t get it. “Ensuring patients receive essential personal care doesn’t tick any of the target boxes. Is it any surprise that it has slipped so dramatically?”

Phil Hope, the care services minister, said: "We have set priority areas for all hospitals to take urgent action, including appointing a senior member of staff to improve quality of care for people with dementia, proper training for all staff, and specialist older people's mental health teams working in hospitals.”


Bureaucratic madness: British IVF couples face disease tests before each cycle

Couples undergoing IVF could face higher bills after European regulators said they should be screened for diseases between each treatment cycle. The EU Commission wants couples to be screened before each treatment cycle instead of just when they start their course. British doctors said it was extremely unlikely new cases of infections like HIV and syphilis would be picked up between cycles and it will add to the cost of treatment, which is currently around £4,000 for IVF. The move could mean couples needing to be tested every one or two months for HIV, hepatitis, Human T-lymphotropic virus and syphilis.

Dr Luca Gianaroli, chairman of the European Society of Human Reproduction and Embryology (ESHRE), said that at a recent meeting, the EU Commission had said all patients must be tested before each treatment and that all European countries "must comply with this and that it was not open for national interpretation". He has written to ESHRE members urging them to take action over the "quite alarming signals" over interpretation of its 2004 tissue and cell directive.

He said after 30 years of IVF, 15 million treatments and around three million children born, there had been no examples of viruses being transmitted in the areas covered by the directive. In Dr Gianaroli's letter he added: "All in all, this implies a major additional allocation of resources. "The consequence of this testing practice is that many couples living intimately together at home will have to be tested every one to two months."

At present, couples are generally tested for HIV and hepatitis before they undergo their first treatment but are then considered virus-free for the rest of their course.

Professor Peter Braude, head of the Department of Women's Health at King's College London, said: "This new interpretation of the EU directive is of extreme concern to fertility practitioners, as it will have substantial implications for the costs of fertility treatment to individual patients and for the NHS.

"Whilst we already comply with the bizarre EU idea that sperm samples from couples who have been married or cohabiting for many years are treated as 'partner donation', and men have to have infection screens done at least annually, this interpretation would mean that both partners in the relationship would now have to be tested for HIV, hepatitis, HTLV and syphilis every time they underwent an IVF or even an IUI (insemination) procedure, which could be two or three times a year or even more often. "Repeat infection or new infection during or between treatments would be extremely rare, if ever."

Dr Allan Pacey, secretary of the British Fertility Society and senior lecturer in andrology at the University of Sheffield, said: "The British Fertility Society (BFS) has some concerns about this interpretation of the EU directive and the impact it may have on infertility treatments within the UK and across Europe. "Whilst there are a number of reasons to screen patients for some infectious agents, including HIV, it is important that the timing, frequency and screening strategy is evidence-based. "A blanket screening policy applied uncritically is unhelpful and inappropriate."


Canadian Patient Flies to India for immediate treatment of painful disability

Flying to a faraway country for medical care did not seem too outrageous an idea for Canadian Raghav Shetty - at least, in comparison to the alternative. The 61-year-old Calgary, Alberta man's bum hip had effectively immobilized him. Yet he faced several years of waiting in distress for surgery in Canada's "universal" Medicare health system.

Shetty had developed severe osteoarthritis in his left hip joint. He was in so much pain that, even with the aid of painkillers, each step was tormenting. "I'm in extreme pain," he admitted. "I'm stuck at home, I can't work. It is difficult for me to provide financial support to my family and the quality of my life is very bad." "He can barely walk. He drags his legs everywhere he goes," added daughter, Shilpa Shetty.

Shetty, a 20-year resident of Calgary, discovered the wait for partial hip replacement surgery would be up to two years. At the time, in 2004, some 25,000 patients were on waiting lists for surgery or diagnostic scans in Calgary's hospitals.

Facing a bedridden wait on Medicare [Canada's public health system], Shetty and his wife, Prema, looked elsewhere for quicker treatment. They discovered a private facility in Chennai, India offering immediate care. The entire out-of-pocket cost for the operation and for both to fly to India would be $15,000 (CAD), but the couple believed waiting up to two years for care locally was not a realistic option. "I had no choice but to try elsewhere for my surgery due to the long waiting period and severe pain in my hip joint," Shetty said. "I could not walk more than a few meters. Under these conditions, waiting for one to two years was simply not possible for me."

In September 2004, the Shettys traveled to Apollo Specialty Hospital for a successful five-hour surgery. Shetty, an Indian immigrant, said returning to his native country for a medical procedure was not something he would have considered had it not been for the excessive wait. "Of course, my first choice would have been always Canada," he said. "However, in recent years, the waiting period for major surgeries is too long for patients suffering from severe pain and serious medical conditions."

Daughter Shilpa objected to the tedious wait her father would have endured if he stayed in Canada. "We've given up on our health care system. Why don't they understand that some people are in so much pain that they just can't wait?" she asked. "We don't have any options and can't wait anymore."

Though the long wait forced Shetty to look outside Canada, the health department in the province of Alberta rejected his claim for reimbursement for his care in India. Generally, the government reimburses only such patients who go abroad when treatment is unavailable locally or if the patient's life would be in jeopardy while waiting.

As published in a 2007 Fraser Institute survey, an estimated 5,029 people in Alberta were waiting for hip or knee replacement surgery as of March 31, 2007. According to the same report, nationwide some "estimated 523,600 Canadians had difficulties getting to see a specialist, 200,000 had difficulties getting non-emergency surgeries, and 294,800 had difficulties getting selected diagnostic tests."


The Real Issue is the "Public Option"

On Saturday, November 7th Nancy Pelosi secured the votes she needed to pass ObamaCare by allowing the controversial Stupak Amendment--which made it illegal for taxpayer-subsidized insurance plans to cover abortions--to be included in the bill.

More than 30 House Democrats had signed a letter stating they would not vote for the bill if it contained even a cent of federal funding for abortions. In the end, more than 60 members voted to strip the funding from the bill.

Unfortunately, when the Stupak Amendment passed, it provided enough political cover for vulnerable Democrats, many of whom are running in districts with strong pro-life constituencies--to then vote for the overall bill.

Given the success of the tactic, the Senate now appears poised to try the maneuver again as debate unfolds there. This leaves Senate Republicans and fiscal hawks like Senator Joe Lieberman with a daunting challenge.

To prevent Senate passage of the bill, they must effectively communicate to their colleagues—and the American people—that the Stupak Amendment is not the issue. Because even with the Stupak Amendment, this is still a bad bill. A very bad bill.

It still is a government health care takeover that will dismantle the finest health care system on the face of the Earth. It still opens the door for a single payer system. It still rations care away from seniors. It still would increase health premiums. It still would put bureaucrats between doctors and patients. It still would break the public treasury and leave taxpayers with a deepening debt that can never be paid.

Most Americans oppose this legislation, which Americans for Limited Government estimates will cost more than $2.1 trillion over ten years once fully implemented. According to Rasmussen Reports, 52 percent of voters want their representatives to vote “no.”

In order to overcome “public option” proponents, opponents of ObamaCare must be wary of political maneuvers that make it easier to pass this abomination. There is too much at stake.

That is not to say that pro-life Senators should not move to strip out abortion funding. But the Senate majority should not be allowed to use that maneuver to provide cover for the bill’s final passage. Their Senate colleagues—and their constituents—must hold their feet to the fire to hold the line on a successful filibuster. The point is to kill the bill, not just a single provision.

If government dismantles America’s health care system, it’s not just the lives of the unborn at stake. It’s the lives of the young and old, as well.


A Health-Insurance Criminal Pleads His Case

Why I will ignore the mandate

If mandatory health insurance goes through, it will turn me into a criminal. I don’t have health insurance. I don’t want it. And I will refuse to buy it even though I can afford it. Before they lead me to the cells, perhaps the prisoner may be allowed to say a few words in his defense.

It’s understandable that politicians are eager to eliminate the medically uninsured. For years they’ve been told that we are the flies in the ointment of health care policy. It is said we are either a) wrecking the system by using services we don’t pay for, or b) we are deprived of needed medical care and therefore objects of pity and subsidy.

These points may apply to some uninsured but not to all. Some of us belong in what might be called the “successfully uninsured” category. We are not freeloaders. We believe we have an obligation to pay for the medical care we receive, and we always pay for it. I put no financial burden on doctors, hospitals, or taxpayers, and politicians are wrong to assume I am part of the country’s health care problem.

Politicians are also wrong to assume that I am an object of pity. Like many Americans, I have significant savings and can afford medical expenses out of pocket. (Census Bureau figures for 2000 show that over 18 million households had assets in excess of $250,000). Our savings make it possible for my wife and me to decline both private insurance and Medicare (we are 70). Those without savings are in a different situation: They probably need insurance, or a subsidy, or charitable help. My point is that if you can handle your own medical bills through savings and personal responsibility, this is a sound approach. Politicians should encourage this state of self-reliance, not make it a crime.

There are many advantages to being insurance-free. The first is flexibility. Several years ago, my wife had a serious bout with cancer. The successful treatment involved surgery and local radiation therapy. After much study she refused the more massive radiation treatment recommended by the doctor and pursued alternative therapies, including acupuncture, nutritional therapy, massage, and naturopathic medicine. Every decision was made in terms of what seemed best to treat this illness. We were not drawn into using inappropriate therapies because they were “free,” nor did we pass up desirable therapies because they were “not covered.”

The second advantage of being insurance-free is we avoid bureaucracy. We don’t fill out insurance forms; we don’t make phone calls trying to find out what’s covered; and we don’t play games (with the collusion of doctors) trying to get things we need paid for by someone else. If an aching back suggests the need for a different mattress, we go out and buy one and don’t waste time and money trying to prove to some clerk that it’s covered. When the government offered a new piñata of benefits in the form of prescription drug coverage, we entirely escaped the frustration of figuring out how to deal with its staggering confusion. While other seniors were closeted with lawyers and sons-in-law trying to decide what to sign up for, we went hiking.

Refusing health insurance may have advantages, but what will happen if I face a medical problem that requires more than my savings? To understand my answer, consider a parallel question about some other commodity, say, housing. I announce that I believe in paying for housing from my own financial resources. Someone points out there might be a house I want that costs more than I can afford. That’s just too bad: I don’t get to buy it. I limit my housing consumption according to my resources.

I look at medical care the same way: If something costs too much, I do without. This position, so obvious and sensible in other areas, is considered untenable when it comes to medical care. In this realm the prevailing assumption is that everyone is entitled to all the health services he needs or wants.

It’s one thing to announce this entitlement as an ideal, but quite another to make it work. In the real world medical resources are limited, and therefore all approaches to healthcare funding employ rationing.

In tax-based systems administrators establish waiting lists so that some patients die before their opportunity for treatment comes up. They ban the use of expensive treatments and alternative therapies. And, without exactly saying so, they underfund medical facilities, so that patients wait in the halls of emergency wards, for example. In commercial insurance plans rationing is implemented by restricting coverage to specific procedures and specific doctors — and by setting upper limits to coverage.

Paying your own medical bills is simply another way of limiting consumption: If a treatment costs too much, you don’t buy it. The advantage of self-rationing is it is frank and open, and thus avoids the whining and blaming that characterize bureaucratic systems.

Paying your own medical bills also lets you see that there are more socially constructive ways to use funds than spending on health care. Suppose that to fix your limping gait requires complicated care costing hundreds of thousands of dollars. If others pay for this care, you might accept it. But suppose you are paying for it with your own savings. Now you might think twice about spending the money on yourself. You might know of a school for autistic children that could put the money to good use. Or you might have a grandchild who needs the money to start a business.

Such decisions are indeed difficult, but we need to face them if we are to make sensible choices about health care. Today we are not facing them. We are hiding behind the confusion of a tangled government/corporate system that pretends we can have all the medical care we want.

Spending my own money on health care helps me set a rational limit to medical spending, even on spending to preserve my life. Not buying health insurance and not allowing politicians to force others to fund my needs helps me keep my consumption of medical resources within fitting bounds.

This way of looking at health insurance may be old fashioned, but should it be a crime?


The health care rationing commission

Meet the unelected body that will dictate future medical decisions

As usual, the most dangerous parts of ObamaCare aren't receiving the scrutiny they deserve—and one of the least examined is a new commission to tell Congress how to control health spending. Democrats are quietly attempting to impose a "global budget" on Medicare, with radical implications for U.S. medicine.

Like most of Europe, the various health bills stipulate that Congress will arbitrarily decide how much to spend on health care for seniors every year—and then invest an unelected board with extraordinary powers to dictate what is covered and how it will be paid for. White House budget director Peter Orszag calls this Medicare commission "critical to our fiscal future" and "one of the most potent reforms."

On that last score, he's right. Prominent health economist Alain Enthoven has likened a global budget to "bombing from 35,000 feet, where you don't see the faces of the people you kill."

As envisioned by the Senate Finance Committee, the commission—all 15 members appointed by the President—would have to meet certain budget targets each year. Starting in 2015, Medicare could not grow more rapidly on a per capita basis than by a measure of inflation. After 2019, it could only grow at the same rate as GDP, plus one percentage point.

The theory is to let technocrats set Medicare payments free from political pressure, as with the military base closing commissions. But that process presented recommendations to Congress for an up-or-down vote. Here, the commission's decisions would go into effect automatically if Congress couldn't agree within six months on different cuts that met the same target. The board's decisions would not be subject to ordinary notice-and-comment rule-making, or even judicial review.

Yet if the goal really is political insulation, then the Medicare Commission is off to a bad start. To avoid a senior revolt, Finance Chairman Max Baucus decided to bar his creation from reducing benefits or raising the eligibility age, which meant that it could only cut costs by tightening Medicare price controls on doctors and hospitals. Doctors and hospitals, naturally, were furious.

So the Montana Democrat bowed and carved out exemptions for such providers, along with hospices and suppliers of medical equipment. Until 2019 the commission will thus only be allowed to attack Medicare Advantage, the program that gives 10 million seniors private insurance choices, and to raise premiums for Medicare prescription drug coverage, which is run by private contractors. Notice a political pattern?

But a decade from now, such limits are off—which also happens to be roughly the time when ObamaCare's spending explodes. The hard budget cap means there is only so much money to be divvied up for care, with no account for demographic changes, such as longer life spans, or for the increasing incidence of diabetes, heart disease and other chronic conditions.

Worse, it makes little room for medical innovations. The commission is mandated to go after "sources of excess cost growth," meaning treatments that are too expensive or whose coverage will boost spending. If researchers find a pricey treatment for Alzheimer's in 2020, that might be banned because it would add new costs and bust the global budget. Or it might decide that "Maybe you're better off not having the surgery, but taking the painkiller," as President Obama put it in June.

In other words, the Medicare commission would come to function much like the National Institute for Health and Clinical Excellence, which rations care in England. Or a similar Washington state board created in 2003 to control costs. Its handiwork isn't pretty.

The Washington commission, called the Health Technology Assessment, is manned by 11 bureaucrats, including a chiropractor and a "naturopath" who focuses on alternative, er, remedies like herbs and massage therapy. They consider the clinical effectiveness but above all the cost of medical procedures and technologies. If they decide something isn't worth the money, then Olympia won't cover it for some 750,000 Medicaid patients, public employees and prisoners.

So far, the commission has banned knee arthroscopy for osteoarthritis, discography for chronic back pain, and implantable infusion pumps for pain not related to cancer. This year, it is targeting such frivolous luxuries as knee replacements, spinal cord stimulation, a specialized autism therapy and MRIs of the abdomen, pelvis or breasts for cancer. It will also rule on routine ultrasounds for pregnancy, which have a "high" efficacy but also a "high" cost.

Currently, the commission is pushing through the most restrictive payment policy in the nation for drug-eluting cardiac stents—simply because bare metal stents are cheaper, even as they result in worse outcomes. If a patient is wheeled into the operating room with chest pains in an emergency, doctors will first have to determine if he's covered by a state plan, then the diameter of his blood vessels and his diabetic condition to decide on the appropriate stent. If they don't, Washington will not reimburse them for "inappropriate care."

If Democrats impose such a commission nationwide, it would constitute a radical change in U.S. health care. The reason that physician discretion—not Washington's cost-minded judgments—is at the core of medicine is that usually there are no "right" answers. The data from large clinical trials produce generic conclusions that rarely apply to individual patients, who have vastly different biologies, response rates to treatments, and often multiple conditions. A breakthrough drug like Herceptin, which is designed for a certain genetic subset of breast-cancer patients, might well be ruled out under such a standardized approach.

It's possible this global budget could become an accounting fiction, like the automatic Medicare cuts Congress currently pretends it will impose on doctors. But health care's fiscal pressures will be even stronger than they are today if ObamaCare passes in anything like its current form. And that is when politicians will want this remote, impersonal and unaccountable central committee to do the inevitable dirty work of denying care.

The only way to take the politics out of health care is to give individuals more power to control medical dollars. And the first step should be not to create even more government spending commitments. The core problem with government-run health care is that it doesn't make decisions in the best interests of patients, but in the best interests of government.



Anonymous said...

Insurance companies rationing healthcare!
HP-Benjamin French was born with his right arm missing below the elbow. In his 12 years, he has been fitted with seven prostheses. His most recent replacement will cost nearly $30,000 and his doctor says he will soon grow out of it.
But, according to his insurance company, the boy is ineligible for further coverage of prosthetic devices because he has already spent his lifetime maximum benefit.
Benjamin’s family happens to live in Michigan, one of 33 states where insurance companies are allowed to set annual and lifetime caps on prosthetic coverage. The family’s policy with Blue Cross Blue Shield of Michigan covers a maximum of $30,000 per lifetime for prosthetics, plus $1,000 per year for repairs. In states such as Colorado and Maryland, the law says there can be no such cap on prosthetics.

Anonymous said...

So your objection is that other people who know nothing of the boy are not forced to pay for his care?

If you are so concerned, have you thought of putting your OWN hand in your pocket for him?