Friday, November 13, 2009

British veteran dies after NHS doctors fail to spot broken neck and send him home with painkillers

This case should have been highly manageable

A Royal Air Force war veteran was sent home from hospital after doctors failed to diagnose his neck was broken. Hugh Jackson, 87, tripped over while picking up litter in his garden and fell head-first into an apple tree before knocking himself unconscious in May this year.

He died one month later. The great-grandfather, who had been awarded the British Empire Medal for rebuilding Vulcan planes in the RAF, spent two days in agony before deciding to call an ambulance. Mr Jackson was told his injuries were not a "blue light emergency" by a nurse over the telephone, and he instead decided to attend the Boston Pilgrim's Hospital in Lincolnshire in person.

The inquest in Boston, heard how the pensioner was sent home with painkillers after arriving at the hospital on a Bank Holiday Monday. He was told to come back the following day so he could be checked over because doctors had noticed tenderness at the top of his spine.

Mr Jackson, a widower, only discovered his neck was broken when a specialist radiologist from another hospital saw the break on the x-rays the following day. He informed frantic staff at Pilgrims Hospital, who rushed an ambulance to Mr Jackson's home the following day after realising they had missed the potentially life-threatening break. Mr Jackson had also been to see his GP just before the ambulance arrived - and she too had failed to find the broken neck.

He was eventually diagnosed with an odontoid peg fracture, placed in a stable position on his back for five days in the hospital's orthopaedic ward. A catalogue of blunders followed and Mr Jackson died from a lung infections in the hospital's intensive care ward nearly a month later.

His health had gradually deteriorated amid claims from his family that staff at the hospital were not looking after him properly. Speaking after the inquest on Tuesday, Mr Jackson's eldest son, electrician Jim, 67, from Wimblington, Cambridgeshire, said his father 'deserved better.' He claimed nurses had forgotten to replace his father's drip and left him strapped to a spine board for five days staring at the ceiling. He was not taken to the toilet regularly and also fell out of his bed - something that could have proved lethal with his broken neck.

Jim said: 'My father had a terrible accident and from that point onwards the hospital just did not care for him properly. "First they missed his broken neck and when they did finally diagnose it they strapped him to a board and left him on his back for five days so he couldn't eat or drink. 'He was meant to be fed through a drip but when that fell out of his hands the nurses failed to replace it - it was like a third world hospital.'

The inquest heard from Dr Rajeshwar Ranganathan, who was the first doctor to examine Mr Jackson. He said he had not seen the break on Mr Jackson x-rays and had consulted two doctors from the orthopaedic department who had also failed to spot the break.

The consultant in charge of the Pilgrim Hospital's accident and emergency department, Mr Hussain Hassan said all possible steps were taken to treat Mr Jackson correctly. He said: 'In my opinion all possible steps were taken to provide the right course of action. 'Mr Jackson's injuries were insufficient to highlight the problem and his neck had been stable for two days previously otherwise the fracture would have led to immediate death. 'Sixty to seventy per cent of accident and emergency procedures involve an x-ray but that does not mean our doctors are x-ray experts.'

When questioned whether he thought the two orthopaedic doctors had checked Mr Jackson's x-rays properly Mr Hassan said it would be 'grossly negligent' if they had not.

The hospital's risk manager Rick Dickinson said following the death of Mr Jackson they were reviewing some of their procedures. But he added: 'I don't believe anything we have identified as a problem could have changed the outcome of death overall.'

Coroner for Boston and Spalding Paul Cooper said the primary cause of death was a lung infection but said the neck break would have contributed to his death. He said: 'This all started with Mr Jackson hitting his head and breaking his neck. 'While it was not the neck break which actually killed him - the pathologist does admit immobilising a person with a lung disease would have increased the risk of death.'


Four-hour Emergency Room target is putting patients at risk, warn British nurses

Nurses are being 'pressured' into manipulating data and falsifying information to meet Government targets, the Royal College of Nursing has claimed. The four-hour target for staff to get emergency patients treated and admitted, or discharged, means many nurses are 'pushed into practices' that are risky for patients, it warned. It says there are 'negative consequences' for patient care, especially those needing treatment in accident and emergency wards.

A survey of its members found nine out of ten accident and emergency nurses claimed they have been unduly pressured to meet the four-hour targets. Three out of four nurses say patients were regularly admitted to inappropriate wards just to get them out of A&E departments within the time limit set by the targets.

RCN chief executive and general secretary Dr Peter Carter said targets had played a positive role in the NHS, but patients must come first. He added: 'We know of certain instances where nurses have been pressurised to manipulate information and who are pushed into meeting targets ahead of patient care. 'We are worried these cases represent the tip of the iceberg and we want to find out the true extent of pressures to meet targets - we are determined to bring this out into the open.'


British National Health Service Penalizes Woman for Supporting Her Own Cancer Treatment

Colette Mills of North Yorkshire, England was up against a rigid National Health Service policy that at the time would have taken away her taxpayer-provided health care if she purchased a life-extending cancer drug beyond the dosage the government provided for her.

Mills has fought breast cancer for over a quarter century. Though the last roughly 20 years were "blissfully" clear of cancer, she says, it returned in 2003 and spread throughout her body. The 58-year-old former NHS nurse was given Taxol, a chemotherapy drug, as part of her publicly-financed health care. But, following the advice of her hospital specialist, Mills decided to spend her own money to boost her treatment with the so-called wonder drug, Avastin. Drug trials show Taxol is perhaps twice as effective when combined with Avastin, and, when coupled, the drugs could slow advanced breast cancer.

Mills believed that combining the drugs "would probably give me a longer life and a better quality of life." She added, "Avastin may only increase your lifespan by six weeks or six months but, believe me, when it's your life, you're not picky."

The rub at the time was even if Mills paid out-of-pocket to supplement her care, the NHS would begin to bill her for the entire cost of treatment because she would be considered a private patient. "If a patient chooses to go private for certain drugs they elect to become a private patient for the course of their treatment for that condition. That is trust policy," said a statement by South Tees Hospitals NHS Trust, Mills' local health care provider.

Though Avastin was publicly available elsewhere in the UK, South Tees Hospitals NHS Trust would not fund Avastin because of its high cost. In Britain, the wide disparity of drugs and services made available depending on locality is informally termed the NHS 'postcode lottery.'

Mills was willing to pay the estimated £4,000 a month to get the expensive drug and have it administered - but she did not want to be stuck with the tab for her entire treatment. "The costs would increase from £4,000 a month to about £10,000 to £15,000 for all my care. I would need to pay charges for seeing the consultant, for the nurses' time, for blood tests and scans," Mills explained.

Thus, by doing what she thought necessary to improve her chances of survival, Mills would be responsible for paying some £15,000 (~$24,400) to the government. "The policy of my local NHS trust is that I must be an NHS patient or a private patient," said Mills. "If I want to pay for Avastin, I must pay for everything. It's immoral that the drugs are out there and freely available to certain people, yet they say I cannot have it."

The rationale for the bizarre policy that restricted how citizens spent their own money for health care was rooted in the NHS's belief that care should be equal and not based on a patient's ability to pay. "The Government is committed to a publicly funded NHS, free at the point of use and available to all regardless of income," explained a spokesman for Britain's Department of Health. "Co-payments would risk creating a two-tier health service and be in direct contravention with the principles and values of the NHS."

The health care provider, therefore, rejected Mills' request because it considered her buying an extra drug to be an "add on" to her existing NHS treatment. Mills' pleas to the NHS health trust were rejected, and she and husband, Eric, abandoned their challenge. "I can't go private..." said Mills. "This decision is totally unjust... this drug would prolong my life."

Mills recognized there naturally may be cost prohibitions for some care. But, she argued, "The whole concept of the NHS is that it's free at the point of need. Why should that stop because I want to pay for something?" She also pointed out the NHS's apparent double standard. "It is already a two-tier NHS," said Mills. "I'd had a scan privately when there was a two-week wait on the NHS... If I go to the dentist I can mix my NHS and private treatment."

Professor Karol Sikora, a medical expert who advises the World Health Organization, sided with Mills. "For health bosses to say Mrs. Mills cannot top up her NHS treatment is ideology gone mad. It is medical communism and utterly immoral," he charged. "This is unfair to taxpayers who are entitled to NHS care. If this patient wishes to pay for another drug, that should be her choice."

After considerable public disapproval and an official Department of Health Review, the NHS reversed its supplemental treatment policy in November 2008. Alan Johnson, the then-Health Secretary, announced new guidelines that purchasing private treatment will not mean that patients forfeit their entitlement to NHS services.

Reacting to the policy change, Mills said, "This move by the Government is exactly what I've been fighting for - but it has been a long time coming." Although the government's change of policy was welcome news for patients like Mills, it came too late for Mills herself - four months after her unsuccessful effort to purchase Avastin herself, her cancer spread to such an extent that it will no longer respond to the treatment.


It’s not about health, it’s about who runs the US

Power is draining from Obama. If he can’t get his Bill through he will be at best another Clinton, at worst another Carter

A funny thing happened in Ida Grove, Iowa, last Saturday. Funny and a bit sad. Steve King missed his son’s wedding. The weather was perfect. The traffic was light. Steve really loves his son, Mick, and has no problem with his new wife, Stephanie. He wanted to be there and could have been, but instead he was in Washington voting against a healthcare reform Bill in the House of Representatives. Despite his vote, the Bill passed.

What was Mr King thinking? Did he miss the most important day in his son’s life because he believes the Democrats are wrong to try to extend health insurance cover to the 46 million who lack it, or because he thinks they are going about it the wrong way? He did not. As a fellow Republican with more in the way of name recognition said yesterday: “This is not about healthcare. This is about power and political control.”

That Republican was Dick Armey, an icon of the anti-Clinton movement of the early 1990s and a hate figure for the Left, but also a keen student of US social history. He knows full well that America’s employer-based health insurance system exists largely by accident. It started as a 50 cents-a-month scheme for teachers, offered in the 1920s by a Dallas hospital looking for ways to keep its wards full.

It grew as a result of bureaucratic accident and business opportunism — not legislation, let alone constitutional amendment — and for decades it offered superb care at reasonable prices. It doesn’t any more. It denies cover to many and doles out too much care to many more at prices employers and taxpayers can no longer afford. Few serious politicians in either main party deny that large parts of it are failing.

The central issue for Congress is not whether healthcare needs fixing or even how. It’s by whom.

Deep down, Barack Obama believes it’s his turn. He ran for President promising change, and won. “Change” could mean anything to anyone. That was its chief merit as a slogan. But this Administration believes in its soul that the many meanings of the word should include a willingness to expand the role of the State itself if nothing else works. On economic management that meant taking controlling stakes in banks and car giants to stop them failing. On healthcare, it means proving that the Federal Government can move into running a nationwide low-cost insurance programme, and not screw it up.

My father-in-law believes a screw-up is inevitable. For his generation of Eisenhower Republicans it is axiomatic that anything the private sector can do, the public sector can do only worse. Dick Armey and the army of Tea Party activists that he informally leads go much farther. They call the slightest expansion of the State a step towards Marxism. They say so politely, seriously, despairingly, on battle buses and in town halls across the country, and it is a great mistake to doubt their sincerity.

Never mind that the most progressive healthcare reforms debated on Capitol Hill since Mr Obama entered the White House are still so private sector-dependent that in Britain no right-wing Tory could advocate them without risking his seat. Never mind that the most state-phobic conservatives are also among the most enthusiastic supporters of a gigantic and reasonably effective government-run machine at the heart of American society, foreign policy and economic life — the US military. There is a new insurgency in US politics that believes the Democrats’ pursuit of a public healthcare option is politically, constitutionally, fundamentally unAmerican.

The insurgents also smell blood. As Mr Armey said, this is about power and political control. Mr Obama has staked his presidency on showing that he can win reforms that eluded Mr Clinton in 1994 and generations before that. He has majorities in both houses. Even the legal tussle for a disputed Minnesota Senate seat went the Democrats’ way, adding a self-important comedian to their caucus in the upper house and giving them, in principle, a filibuster-proof majority. Yet the President seems unable to use it.

His first deadline for a healthcare Bill to reach the Oval Office sailed by in August. Christmas is the next, unofficial, deadline. That looks likely to be missed as well. Each day of delay on healthcare is a day of delay on everything else the White House wants Congress to do, starting with once-in-a-century financial regulatory reform and the climate change legislation that has become a test for how the rest of the world judges this Administration’s break with the last one. Even Afghanistan is waiting. One reason for Mr Obama’s interminable delay over requests for more troops is his fear of splitting the liberal base on which robust healthcare reforms depend.

In truth “robust” already sounds ambitious. The Tea Party insurgency has blunted the health crusade from the Right. Democratic infighting over tax-funded abortions may do the same from the Left. Slippage deep into next year is entirely possible. So is complete failure, and if Mr Obama fails on healthcare what remains of the bubble of hope he created in his 2008 campaign will deflate faster than a blood pressure cuff in an overpriced private hospital. He will be, at best, a Clinton facsimile; at worst another Carter, undone by his own naivety and shorn of his unused majorities in next year’s mid-terms.

It is a prospect that sets Steve King’s pulse racing. That is why he came to Washington on Saturday instead of watching Mick wed Stephanie. It is also why Mr Clinton told a Democratic power lunch on Tuesday to stop bickering over details and get healthcare done. A Bill — any Bill — would silence the President’s critics and kick-start the rest of his agenda, he said. “The worst thing is to do nothing.”

Power drains from those too afraid to use it. It is draining now from the White House to a handful of senators who could make or break Mr Obama’s healthcare reforms, and thus his presidency. One is Joseph Lieberman, widely accused of being in hock to the health insurance industry that dominates his home state of Connecticut. I don’t think so. He’s our new neighbour; a modest chap who happens to hold the fate of a nation in his hands.


Pelosi's New Payroll Tax: A Whip for Socialized Medicine

Rep. Joe Barton of Texas, ranking Republican on the Energy and Commerce Committee, set out a startling scenario in floor debate Saturday before the House approved the health care bill pushed by Speaker Nancy Pelosi.

The bill would slap an 8 percent tax on the payrolls of employers who do not provide health insurance to their workers and pay at least 65 percent of the premiums for an employee who has a family insurance plan and 72.5 percent of the premiums for an employee who has an individual insurance plan. Barton spelled out what he believes will happen if this provision becomes law.

Many Americans might be tempted to casually conclude that the purpose of Pelosi's new payroll tax is to force employers to buy health insurance for their workers and that the parties hurt most by the tax would be the employers who pay it.

This is wrong on both counts. The Pelosi tax will not force employers to buy insurance for their workers, it will give them an incentive not buy insurance. The parties most hurt by the Pelosi tax will not be the employers who pay it but the workers dumped into the government-run health care system Pelosi's plan creates.

This will happen when employers discover that paying Pelosi's tax is cheaper than buying health insurance. The Pelosi payroll tax will be a whip wielded by the state to drive Americans into a socialized health care system from which there will be no escape.

In 2016, when the Pelosi plan would be in full force, the average employer-provided health insurance plan will cost $11,000 for a family and $6,000 for an individual, according to the Congressional Budget Office. Barton based his analysis on a family plan that cost only $10,000. "The employee pays $3,500 and the employer pays $6,500," said Barton. "Since there's an 8 percent payroll tax on the (employer's) average (wage) of $40,000, that would be about $3,200. Most employers, when this plan is implemented, can pay the 8 percent tax, which is $3,200, or the $6,500 premium that they pay for their employees. "They're going to stop providing health care ... and they're just going to put them in the public option," said Barton. "The employee is going to take that $3,500 that he or she was paying for their premium for a $10,000 plan and they're going to find out that when they go into the health care exchange, their $3,500 doesn't buy a $10,000 policy. It buys a $3,500 policy. It's a bad deal."

The deal looks even worse when you consider some of its technicalities -- which are also designed to drive Americans into government-run health care.

The bill that passed the House sets up a national "health insurance exchange" run by the government. Families earning up to 400 percent of the poverty level ($88,200 for a family of four) will qualify for a federal insurance subsidy that attenuates as family income rises. But families will not get this subsidy if their employer provides them with insurance, or if they buy their insurance anywhere but in the government exchange. One of the plans in the exchange will be the "public option" run by the government itself.

The Pelosi payroll tax will be phased in for companies with annual payrolls between $500,000 and $750,000. Employers with payrolls less than $500,000 will not pay it at all. Employers with payrolls between $500,000 and $585,000 will pay 2 percent of payroll if they don't provide health insurance. Employers with payrolls between $585,000 and $670,000 will pay 4 percent. Employers with payrolls between $670,000 and $750,000 will pay 6 percent. And employers with payrolls over $750,000 will pay the full 8 percent.

An employer who has 10 employees and an annual payroll of $499,000 (or an average of $49,900 per worker) will not pay a penny of Pelosi tax if he cancels his private health insurance program and dumps his workers into the government health care system. He will also have an incentive not to give his workers a raise or to risk his own money trying to grow his business.

But assume he does give each worker a $1,000 raise at the end of the year, bringing his payroll to $509,000. In that case, he faces a choice: Either pay 65 percent of the $11,000 annual insurance premium for every one of his workers who has a family and 72.5 percent of the $6,000 premium for every worker who does not have a family -- or pay the 2 percent Pelosi tax. The Pelosi tax would only charge him a flat fee of $10,180 (2 percent of his $509,000 payroll) to offload all his workers into the government system.

Because the government-run public option would be able to undersell the government-approved private plans in the government-run insurance exchange, the government-run option would soon be the only option. Government would control our health care from womb to tomb, a time span likely to be shortened by government care.


America’s Munich: The House Medical-Care Bill

A Total Unmitigated Disaster for the Economy and for Freedom

In the wake of the euphoria that passed through Great Britain after Prime Minister Neville Chamberlain displayed the Munich Agreement and declared “peace in our time,” Winston Churchill had a different view. The agreement between France, Britain, and Hitler’s Germany, Churchill told Parliament, was a “total and unmitigated disaster.”

I thought about this exchange after seeing the euphoric comments in the media following passage of the House bill late Saturday night. Instead of “peace in our time,” we have something akin to “universal coverage in our time,” which has been the dream of leftists and left-liberals since the Great Depression. Whatever they might call it, I call it an unmitigated disaster.

There is nothing good to say about a new law that is going to raise taxes to confiscatory levels and will place a huge financial burden on people at a time when the government is actively going to war against American businesses. We are looking at totally politicized medical care in which every decision made by doctors and patients potentially can be nationalized and thrown into the maw of “public debate.”

This is a bill that relies on coercion and criminal penalties to force people to do what they never would do on their own. This is a bill that proclaims that bankruptcies due to high medical bills will be a thing of the past, but the financial burden it places on each family will increase bankruptcies as people will find it harder to pay their other bills.

Courtesy of the Washington Post (which supports this legislation) are a few items that are sure to turn into huge costs:
"The complex package would affect virtually every American and fundamentally alter vast swaths of the health insurance industry. Starting next year, private insurers could no longer deny anyone coverage based on preexisting conditions, place lifetime limits on coverage or abandon people when they become ill. Insurers would be required to disclose and justify proposed premium increases to regulators, and could not remove adult children younger than 27 from their parents’ family policies."

Like all socialistic policies, this bill contains “goals and mandates” that will become law in a few years. Like all socialistic policies, this bill is heavily backloaded with costs that will become oppressive not just for the wealthiest among us, but also others who will be inflated into higher tax brackets. (The income thresholds for the new taxes are not indexed for inflation.)

Furthermore, the bill has a stealth goal of driving private insurers out of business by overwhelming them with new costs.” To put it another way, Americans are going to have “single payer” coverage whether they want it or not.

I need to stress the point that I do not approve of our current system, which already is heavily regulated and is costlier and less-efficient than a free market in medical care would be. (Whenever we see true free markets at work, the costs for products always fall in real terms over time. Perversely, so-called economists like Paul Krugman continually claim that medical costs are rising because of the introduction of new medical capital and drugs, which is like claiming that the introduction of the microchip has driven up computer costs. That does not compute.)

For all of the talk of cutting costs and saving money, this bill will do the opposite. It flies in the face of everything we know to be true in economic analysis, and it flies in the face of natural law itself.

No matter how many people are thrown into prison for not obeying the new congressional mandates, this new policy will not have the supposed desired effect of making medical care more affordable and improving -quality. We are about to learn that hard lesson to our sorrow, but we will learn it.


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