Friday, December 11, 2009

Newborn baby died after staff at 'chaotic' British government hospital ruled out caesarean

A newborn baby died after receiving 'chaotic' care at an understaffed maternity unit, an inquest heard yesterday. Ebony McCall died shortly after she was born after medical staff failed to spot her erratic heartbeat, it was alleged.

Her mother, Amanda McCall, 18, had been admitted in severe pain to the Milton Keynes General Hospital's maternity unit the day before she gave birth.

Doctors missed two chances to save Ebony's life at the hospital - which was criticised earlier this year for blunders which led to the death of another baby. Miss McCall and her parents had asked for an emergency surgical delivery because of the pain she was in, but doctors ruled against it. Then they failed to spot Ebony's erratic heartbeat and so did not order an emergency caesarean.

Staff were overstretched as 12 mothers gave birth at the unit that night - and only four midwives were on duty, the court heard. Miss McCall was only given a caesarean section after her mother Breda became so concerned about the heart monitor reading that she pressed a panic button. Ebony was born at 3.21am on May 9 this year weighing 7lbs 4oz. She died at 3.54am from lack of oxygen.

Miss McCall was 40 weeks pregnant when she was admitted to the hospital with abdominal pain, the inquest in Milton Keynes heard. After her admission she, her mother and her father Terry, a police sergeant, begged doctors for a caesarean because of the pain. Midwife Tamara Jackson agreed as Miss McCall's state was 'distressing for the baby'. But doctors decided it was not strictly medically necessary, the inquest heard.

After the baby was born, only to die shortly after, Miss McCall's mother confronted Dr Nandini Gupta in the delivery room. Glenna Murray, a senior nurse, recalled: 'She kissed the baby and told the baby it wasn't her [the baby's] fault. She then asked Dr Gupta why didn't she have a caesarean section when she asked for it. 'Dr Gupta said she had spoken to her consultant colleagues and said there was no indication for caesarean section at that time.'

Paul Wood, a consultant obstetrician, reviewed notes of the labour as an expert witness. He said Miss McCall should have been 'the highest priority' due to her health problems including a faulty heart valve, only one working kidney and curvature of the spine. Mr Wood said Miss McCall should have had a midwife by her at all times and one-to-one care would 'probably' have saved Ebony's life.

By 10.30pm, Miss McCall was diagnosed as in labour and 'she was rolling in pain'. Mr Wood said: 'At that point, due to the pressures on the maternity unit, the management of labour from there on was somewhat chaotic.'

An official report earlier this year criticised the hospital for low staffing levels which led to the death of another baby, Romy Feast, in 2007.


Simple test shows whether cancer drug will work - but NHS does not use it

British cancer patients are missing out on the latest and best drugs because the NHS lacks the capacity to exploit them, one of the country’s most senior medical scientists has told The Times.

The introduction of a new generation of powerful cancer therapies is being held up by poor access to critical genetic tests, according to Sir John Bell, Regius Professor of Medicine at Oxford University and President of the Academy of Medical Sciences. The new medicines, such as Iressa (gefitinib) for lung cancer and Erbitux (cetuximab) for colorectal cancer, can be highly effective, but against tumours only with a particular genetic profile. DNA tests are needed before they can be prescribed.

While several of these drugs are licensed in Britain, they are rarely used by the NHS because there is no system for commissioning the genetic tests, Sir John said. The science and technology were “ready to rock’n’ roll” and it was time for ministers to “get with the programme”.

“Genomic medicine is going to change the way we use drugs and that’s already starting with cancer,” he said. “We’re increasingly able to define cancer by its molecular pathology rather than its site of origin, and to prescribe drugs accordingly. That’s taking us from drugs that are effective in 10 per cent of patients, to drugs that work in 80 to 90 per cent of the population with a particular genetic type. “The big question is where is the NHS in all of this. Mostly, it is unprepared. It doesn’t have the testing capacity. With all these drugs coming through, you would imagine that all the clinical genetics labs would be ready to offer the tests they require. None is.”

Sir John’s criticisms come six months after a House of Lords inquiry found that the NHS was not ready to take advantage of genetic advances in healthcare. He said that scientific developments since the report was published had made action more urgent.

Iressa was licensed this summer after trials showed impressive results against lung cancers that carry a mutation in a gene called EGFR. As it does not work against tumours without that mutation, a test is required before it is used.

Another example is Erbitux, which can be effective against bowel and head and neck tumours but fails to work when a gene called KRAS is mutated. A test for the gene costs about £150. Erbitux is approved by the National Institute for Health and Clinical excellence, though Iressa will not be appraised until next year.

Glivec (imatinib), which has transformed chronic myeloid leukaemia from an incurable to a treatable disease, has been found to work against gastrointestinal stromal tumours with a particular genetic profile. Early trials of a drug made by the company Plexxikon have also suggested marked effects against malignant melanomas with a certain mutation in the BRAF gene.

These discoveries run counter to ministers’ claims that the benefits of genomic medicine lie in the future, Sir John said. “The past six months have proven that to be so wrong. We are running into this now. All the big centres in the US have got this sort of molecular profiling in place, but it doesn’t happen here. Come on guys, let’s get with the programme.

“There are some very talented people in the NHS, but it needs to get powered up. We are so in a position to do this. We’ve got the technology base and the scientific underpinning to do this, we’re ready to rock’n’ roll. The real problem is it runs into the sand because the commissioning isn’t right, or because of lack of willingness to accept the unknown.”

Sir John’s criticisms were supported by Peter Johnson, chief clinician for Cancer Research UK. “The provision of testing is fragmentary. There are some private labs doing it, there are some research laboratories doing it, and there are some NHS pathology departments doing it. But it isn’t at the moment subject to any overarching plan or co-ordination, which means that although it can be done, it’s more difficult than it needs to be. As is often the case, moving from research to routine practice is proving awkward. “There is definitely a need for a concerted programme to put in place testing for the things we know about, and to get ready for things we haven’t yet discovered but are about to,” he said.

The Department of Health said: “Our response to the House of Lords report on genomic medicine will address this. We know that the ability to develop sophisticated diagnostic approaches, and use them well, is central to achieving ever better outcomes for patients.”



Three current reports below

Pregnant mum and bub fall down ancient lift shaft at hospital

EIGHT weeks' pregnant and with her toddler daughter in her arms, Shavaun Nemere could do nothing but scream as she plunged down a Kingaroy Hospital elevator shaft after its doors malfunctioned. The screams continued as they lay seriously injured at the bottom of the shaft, with a young staffer coming to their rescue before the lift could descend and crush them.

Shavaun, 17, and daughter Izabella, 14 months, face more surgery for the horrific injuries sustained in the accident six weeks ago. They have made almost daily trips to hospitals in Toowoomba, Brisbane and Caboolture from their Benarkin home in the South Burnett to be treated for multiple fractures and gashes so bad they needed plastic surgery. Shavaun is still too distressed to talk about what happened.

Her mother Julie Nemere has spoken for the first time about the ordeal because she wants the hospital's 68-year-old elevator to be replaced. "The hospital has been asking for a new lift for years but their requests have fallen on deaf ears," she said.

Ms Nemere said her daughter was visiting a sick relative at the hospital and decided to go up a floor to make an antenatal appointment. With Izabella in her arms, she opened the exterior polished doors to the elevator and then pushed back the inside metal security doors and stepped forward - into space.

Desperately trying to protect Izabella, she fell 1.6m to the bottom of the lift shaft landing on her left hip, arm and cheek, while the little girl hit the concrete floor with her face. A staff member heard their screams and jumped down the shaft handing the baby up to a doctor and rescuing Shavaun.

Both were airlifted to Brisbane where Shavaun was treated for multiple fractures to her left arm, shock, concussion and amnesia. Izabella's badly gashed face needed stitches and plastic surgery. If the injuries had been a few millimetres higher, she could have lost an eye. Ms Nemere said there had also been bleeding complications with Shavaun's pregnancy and doctors were still monitoring a small haematoma behind her uterus.

The executive director of the Darling Downs-West Moreton Health Service District, Ray Chandler, said the lift had been tested by engineers and was safe and fully operational. "It undergoes a service check every month," he said. [A very cursory check, obviously]


Blame dodged in public hospital death case

TEARS and anger have followed a coroner's finding that no one was to blame for the death of a Mareeba mother-of-five twice turned away in pain from her local hospital. Coroner Kevin Priestly yesterday said Mareeba Hospital did not have the staff or equipment to save Sharon Con Goo, who died of bacterial septicemia in January 2007. But he cleared its doctors of any negligence, finding it was unlikely they could have done anything to save her life.

Relatives reacted angrily yesterday after Mr Priestly found there was "no missed opportunity for medical intervention that would have affected the outcome" of Ms Con Goo’s case. Ms Con Goo was not admitted to the hospital on January 7 nor January 9 after presenting on both dates with serious pain caused by a septic leg. On one occasion she was sent home with Panadol to ease her suffering. [No missed ipportunity???] She returned to the hospital on January 10 and was transferred to Cairns Base Hospital, where she died on January 11.

During the inquest in August, Mareeba Hospital doctor Asif Majeed said he offered to admit Ms Con Goo during her second visit, but she refused. But her husband, Andrew Con Goo, testified that his wife was not given the option of being admitted, despite having her bags packed to stay overnight.

Ms Con Goo's mother, Faye Rigg, broke down outside court yesterday, telling reporters that her daughter was in such a poor state of health, family members had to carry her to the hospital. She said she was upset at the verdict, labelling it ""bulls---''.

Mr Priestly said he reviewed a range of expert medical opinions to conclude it was unlikely Mareeba Hospital staff could have prevented Ms Con Goo`s death. But he also found the hospital was "not properly equipped with the resources or medical professionals required''.

Former Tablelands MP Rosa Lee Long, who attended the inquest, said yesterday's findings should prove worrying for people who rely on Mareeba Hospital. "She packed her bags to be admitted, and what did they do? They turned her away,'' Ms Lee Long said. "Everyone should be frightened, everyone should be concerned.''


Rudd fails to deliver on 35 GP super clinics

KEVIN Rudd's promise to build 35 GP super clinics across the nation appears to be in tatters, with only one completed centre in operation after two years of Labor government. The Australian can reveal that despite the Prime Minister's claims that six more centres are partially complete, at least two are offering little more than conventional GP services. And one centre claimed by Health Minister Nicola Roxon as a partially functioning GP super clinic -- in Darwin -- is in fact being fully funded by the Northern Territory government.

Mr Rudd campaigned for the 2007 election promising to spend $275 million on super clinics -- medical one-stop shops in areas struggling with inadequate medical services. The centres were to offer after-hours general practitioners, specialists, mental health services, chronic disease management, allied health practitioners and training for medical students and trainee specialists.

Yesterday, as the opposition savaged the scheme as a politicised con, Mr Rudd refused to answer questions from The Australian as to whether the scheme was on target and exactly how many clinics he expected to deliver by the end of his three-year term. Instead, the Prime Minister, who was criticised earlier this week by health sector groups for taking too long to deliver promised reform to the health system, blamed the Howard government for being negligent on health.

Last month, Ms Roxon told parliament the GP super clinic program was being well received, with the nation's first super clinic -- at Ballan, in Victoria -- already operating and another six offering "early services".

Inquiries by The Australian yesterday revealed that at least two of the partially complete super clinics -- at Palmerston in Darwin and at Woongarrah in NSW -- were offering simple GP services. The Palmerston facility was offering after-hours, bulk-billed GP consultations. Local mayor Robert Macleod said he was pleased with the extra services. But the super clinic is not due to begin operating until March next year.

Despite Ms Roxon claiming the Palmerston facility as evidence of the success of the program, Health Department officials told a Senate budget estimates committee earlier this year that it was funded by the Northern Territory government and was not a super clinic. The Woongarrah clinic also offers limited services and the super clinic is not due to open for a year.

The opening of the Ballan super clinic has resulted in the previous two GPs being increased to three and the addition of four-day-a-week dental services as well as a range of allied health services. Ballan Bush Nursing spokesman Glenn Rowbotham told The Australian the GPs did not operate out of hours but that one was on-call for emergencies.

Opposition health spokesman Peter Dutton said the government had used the scheme to curry favour in marginal electorates but had failed to deliver. "Mr Rudd was tricky during the election campaign by not putting a deadline on the provision of these clinics," Mr Dutton said. "But most people would have expected they would have been delivered in the first term of government."

Australian Medical Association national president Andrew Pesce said he did not know whether the scheme was running behind schedule because the government had never consulted his organisation at any stage of the program. Dr Pesce said the AMA had always argued it was wiser and more cost-effective to offer grants to existing medical practices to broaden their services rather than building a new system "from the ground up".

Earlier this week, The Australian sent written questions to Mr Rudd asking why the six GP super clinics were operating only partially and whether he would explain the hold-up. His spokesman responded with a written statement that ignored these questions. However, the spokesman said "several more" clinics would begin operating within the next 12 months. "Some GP super clinics have begun providing services while their full infrastructure is being completed in order to allow them to provide a wider range of services," the spokesman said. "The procedures for delivering many of these clinics involves tender processes."


Senate kills off Obama plans for major healthcare reforms

So Americans will still get a vast expansion of bureaucracy -- for what?

BARACK Obama's ambitious plan for a government-run health insurance scheme to cover millions of uninsured Americans was killed off last night, after a deal in the US Senate to abandon it. Legislation to reform US healthcare is expected to be passed, but it will be a much scaled-down version that sees private insurance companies still in charge.

The dumping of a government-run health scheme to compete with private companies from legislation being considered by the Senate is a serious blow to the US President after he had rated reform of health his No 1 domestic priority.

While disappointed, the White House is expected to play down the impact of removing a proposed scheme that is common to almost all developed countries but has provoked heated debate across the US. Mr Obama will argue that many people previously denied health cover will gain access for the first time under the compromise deal, even if the numbers fall far short of the national scheme he had in mind.

Under last night's deal, negotiated by Democrat Senate majority leader Harry Reid when it was clear an impasse involving senators from his and Mr Obama's party could not be resolved, a proposed government-run scheme will be replaced by a series of national insurance policies administered by private companies. These private insurance policies are to be negotiated on behalf of members by the Office of Personnel Management, the Washington authority in charge of overseeing health insurance for many federal public servants.

In one concession to widening public healthcare, the Medicare scheme that provides government-supported insurance to the over-65s age group would be expanded to allow people as young as 55 to sign up.

Last night's abandonment of government-run insurance will rile many senators on the Left of the Democratic Party who had said they would vote against legislation if it was removed. They are still likely to vent their anger at the deal over the next week, claiming the compromise is weak because it will offer no meaningful competition to the private firms. But their apparent willingness to accept the compromise is a recognition of the political reality that independent senator Joe Lieberman and up to four conservative Democrats would not budge from opposition to the government proposal because of concerns about costs and a watering-down of services.

Republicans have opposed the Democrats' health legislation as a bloc, meaning the votes of all Democrats and two independents were needed to pass legislation.

A bill with a strong government-run insurance scheme was passed in the House of Representatives last month with much fanfare, and Mr Obama made a last-ditch attempt on Sunday to persuade Democrat senators to accept a full-scale reform of health when he paid a rare visit to Capitol Hill.

After last night's compromise, the house will have to review its legislation and remove the government insurance plan so any final bill for the President to sign into law is consistent. House Speaker Nancy Pelosi is likely to raise strong objections.

The model likely to be approved by congress after all the haggling will fall far short of public health schemes operating in Australia, Britain, Canada and most European countries. It will leave many millions of Americans who cannot afford coverage without insurance reliant on hospital emergency rooms for care.


Health Care Bills Contain HUGE Marriage Penalty

By Allen Quist, a professor of political science

There is a huge middle-class marriage penalty hidden in the House and Senate health care bills. The penalty becomes evident by evaluating questions like the following:

* How much would two single people, each making $30,000 per year, pay for private health insurance if the Pelosi bill was in effect now? The answer is $1,320 per year for both individuals combined (based on the premium limits and subsidies outlined on the charts on p. 3).

* But how much would they pay for the same level of insurance under the Pelosi bill if they were to marry? Their combined cost would then be about $12,000 a year (the estimated cost for private insurance).

This extraordinary penalty people will pay, should they marry, extends all the way from a two-person combined income of $58,280 to $86,640, a spread of $28,360. A large number of people fall within this spread. As premiums for private insurance escalate, as expected, the marriage penalty will become substantially larger.

Once the income of Americans exceeds 400% of the Federal Poverty Level, there are no limits on the premiums they can be charged, and their premiums are no longer subsidized. The poverty level is much higher for two people living unmarried as compared to the same two people being married. That is why citizens in many cases will pay far more for insurance if they are married. Why should married people be subjected to financial discrimination?

The Senate bill also creates a marriage penalty, in this case by imposing a new tax on individuals who make $200,000 annually but it also applies to married couples making $250,000 each year. This marriage tax on the affluent, however, is just the tip of the marriage penalty iceberg in the Senate bill.

The Senate bill stipulates that two unmarried people, 52 years of age, with private insurance and a combined income of $60,000, $30,000 each, will pay a combined cost of $2,483 for medical insurance. Should they marry, however, they will pay a combined cost of $11,666 for insurance—a penalty of $9,183 for getting married (based on tables at:

This substantial marriage penalty applies to persons on individual insurance, but, as the Heritage Foundation’s Bob Moffit said, “if an employer has a health care benefits package that is 12 to 13 percent of payroll, and they can solve their problem by paying an 8 percent payroll tax [into the Exchange], I think they’re going to do it,” (New York Times, 9-30-09).

And Howard Dean said that, “Small businesses with payrolls of less than half a million dollars don’t have to buy health insurance anymore for any of their employees.”(FNS, 11-29-09).

Businesses will shed their employees and health care dollars into the Exchange, but the dollars that are paid back out will be directed only to those who make less than 400% of the Federal Poverty Level. Those above the Poverty Level will receive none of their previous insurance benefits from businesses. For that reason the new system is income redistribution on steroids.

“Household” is defined in both bills as including those who can be claimed as dependents for federal income tax purposes thereby clarifying that adults can avoid the marriage penalty by living together unmarried. The new system provides a huge incentive for doing so.

The bills additionally contain De Facto salary caps. How much would a married couple pay for private insurance under the House bill if their income was $58,000 per year? The answer is $2,088. But what if their income increased by $1,000? Their annual premium would then be about $12,000. The economic penalty for going off the subsidized system is so severe that it will be difficult for people to increase their earnings beyond 400% of Poverty Level. The Senate bill works essentially the same way.

Senior citizens and small businesses have already been identified as big losers in the health care bills. Married citizens in the middle class need to be added to the list.


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