Saturday, January 23, 2010

British woman sent to a maternity unit with no doctor despite 'disastrous' family history of birthing problems

A girl who suffered brain damage at birth after her mother was sent to a maternity unit with no doctor despite a “disastrous” family history of birthing problems has been awarded more than a million pounds. Colchester Hospital University Trust, in Essex, who have not admitted liability, have agreed to pay the child £1.25m in damages. The trust will also make annual inflation–linked payments currently set at between £96,000 and £130,000 to the girl, now aged five and named only as X.

Her mother, aged 21 when she gave birth, had a family history of troubled labours, including stillbirths and haemorrhages. She insists that she was not told about the lack of medical facilities at Clacton Hospital, which is staffed only by midwives and not doctors.

The birth was difficult and X was eventually delivered "blue and floppy" in the back of an ambulance as her mother was being rushed to Colchester General, 16 miles away, on May 5, 2004. She suffered brain damage at birth, is severely physically disabled, cannot see or talk and will require 24-hour care for the rest of her life.

A spokesman for the Trust said: “There remain significant differences between the parties, but the Trust acknowledges some failings for which it apologises and, as a consequence, made improvements. “We are sorry that this girl sustained a brain injury at birth and wish her and her family best wishes for the future."

Approving the settlement in the High Court, Mrs Justice Slade praised the child’s parents, describing them as "devoted". Late last year the chairman of the trust was fired after a health watchdog found that it was failing patients and had mortality rates 12 per cent above the national average.


British doctors repeatedly treat a healthy boy just on his mother's say-so

They clearly were not mentally involved -- just bureaucrats filling in their hours

A "SADISTIC" mother has been jailed in England for subjecting her healthy son to "24 hour-a-day torture" by pretending he was severely ill to gain publicity and cash. Lisa Hayden-Johnson, from Brixham, Devon, was said to have "reveled" in the national attention her young son received. The mother-of-two conned charities out of dream holidays and donations and secured meetings with royalty, celebrities and former UK prime minister Tony Blair. She even successfully lobbied for her son - who she falsely claimed suffered from cerebral palsy, cystic fibrosis and dysphagia among a litany of illnesses - to receive a Child of Courage Award in 2005.

The 35-year-old was jailed for three years and three months at Exeter Crown Court, having previously admitted child cruelty and perverting the course of justice.

Prosecutor Andrew Macfarlane said Hayden-Johnson "organised, orchestrated and ensured a regime of medical, physiological and psychological mistreatment amounting to 24 hour-a-day torture that touched on every aspect of his young vulnerable life".

She frequently described her son "as the most ill child in Britain", the lawyer told the court. He continued: "As a result of her sadistic fabrication of non-existent symptoms, the defendant achieved much publicity and national attention, including an encounter with royalty and the then prime minister."

Hayden-Johnson subjected the child to a total of 325 medical encounters, during which he was subjected to a series of "physical intrusions and interventions", Mr Macfarlane said. These included blood tests, intravenous treatments and a gastrostomy, and he was fed through a tube and confined to a wheelchair. He still believed he was seriously ill, more than two years after his ordeal ended, Mr Macfarlane said.


Negligent British health bureaucracy: Nigerian doctor who killed British patient 'avoided English test'

A German doctor who gave a patient a fatal overdose of drugs had failed an English test at one NHS health care trust before being accepted to work by another, an inquest heard.

Dr Daniel Ubani was told he had not passed the language exam in June 2007, but a month later successfully applied to a different trust for formal registration as a GP. The Cornwall and the Isles of Scilly PCT did not enforce the test because he was an EU doctor and subsequently placed him on the nationwide performance register. This meant Dr Ubani could work anywhere in England and Wales and never worked in the south west, accepting his first job in Cambridgeshire, the hearing was told.

On his first out of hours NHS shift on February 16, 2008, he gave 70-year-old David Gray up to 20 times the recommended dose of diamorphine, killing him within hours.

It emerged yesterday that the out of hours’ company which used Dr Ubani’s services told him to return to Germany that day after he killed Mr Gray, who had suffered from kidney stones. Dr Ubani, 67, has since been suspended by the General Medical Council in the UK but continues to practice in Germany.

At the inquest into Mr Gray’s death, held at Wisbech Magistrates Court in East Cambridgeshire, the different level of medical scrutiny between NHS trusts across the country was exposed. Dr Ubani was accepted on the GMC register in October 2006 because he held a Certificate of Good Standing in Germany. Shortly afterwards, the Nigerian-born doctor, who specialises in cosmetic surgery, applied for a place as a GP on the performance register at Leeds PCT.

Without registration, he would not be allowed to practice medicine in the UK, the hearing was told. He was asked to take part in the International English Language Testing System (IELTS) through the West Yorkshire NHS Central Services Agency. On the form, Dr Ubani stated that his first language was Igbo, a Nigerian language, but later told officials that he had been taught in English at school. In May 2007, his results showed that he got 4.5 for his listening, 4.5 for his reading, seven for his writing and seven for his speech. This gave him an overall mark of six, but Leeds PCT demanded a pass mark of seven, the inquest heard.

Concerns were also raised about his references, one of which was from a medical professional who had never worked with him. Dr Ubani was told that his application would not be successful and so he withdrew his form on July 2.

He immediately applied for registration with the Cornwall and Isle of Scilly PCT and 16 days later, on July 18, 2007, his application was accepted. Adrian Tyas, the former director of Cornwall and Isles of Scilly Primary Care Support Agency, was responsible for placing doctors on the performance list. He said the PCT was not aware that Dr Ubani had failed a language test because he had withdrawn his application from the Leeds PCT and therefore had not been formally rejected. “The PCT did not carry out test on the competency of English for EU nationals,” he said.

David Locke, representing the Cambridgeshire PCT, responded: “But Mr Tyas, if you cannot speak English, you cannot function as a doctor in England, can you?” “That is correct,” he conceded. “Do you think you should have at checked at the least that a doctor could speak English?” Mr Tyas replied: “I think the PCT has a responsibility, but so do the people employing someone as a locum doctor.”

The inquest heard that Dr Ubani was paid by the company Cimarron, which supplied his services to Take Care Now, an out of hours’ company subcontracted to the Cambridgshire PCT.

Mr Tyas admitted that Dr Ubani had not given any detail about his experience as a GP. “You had no idea if he treated children, had any experience in palliative care, you had no idea if he had three patients or 3,000?” asked Mr Lock. “No,” replied Mr Tyas.

Sharon Brooks, from Cimarron, said Dr Ubani was told to return to Germany the day after he killed Mr Gray. She said Dr Christopher Browning, clinical governance lead at TCN, had advised the doctor to go home. Mrs Brooks told the inquest: “I got a phone call from Dr Ubani telling me that he had spoken to Dr Browning at TCN who told him it was best to go back to Germany. “I told him that if Dr Browning had told him to go home, that is what he should do.”

Mrs Brooks, who does not have a medical background, said Dr Ubani was registered with the GMC and the NHS performers' register before they employed him. However, she conceded that his specialisation in cosmetic surgery including botox, was in no way relevant to his job as a GP.


Democrats Drop Health Plan In Face of Voter Anger

Congressional Democrats are abandoning their massive health care package in the face of strong public resistance manifested in the election of Republican Scott Brown of Massachusetts to the Senate. Brown's victory Tuesday halted the intense backroom negotiations aimed at merging competing House and Senate versions of President Obama's health plan.

The bills, developed over more than a year of legislative work, would have expanded coverage for the poor, created a national health insurance plan and paid for it with increased taxes and Medicare cuts.

"Both of those bills, as they stand now, are dead," said Rep. Bill Pascrell, D-N.J., after a caucus meeting with panicked House Democrats, who characterized Brown's win and the message it sent as their party's Hurricane Katrina. "I got the sense that people want to move on and not look back at the House or Senate bill."

Democrats pulled the plug two days after Brown's shocking victory over Democrat Martha Coakley to fill the Senate seat long held by liberal icon Ted Kennedy. Brown campaigned on the pledge to be the Republicans' 41st vote in the Senate, enabling the GOP to block the president's health plan.

House Speaker Nancy Pelosi, D-Calif., confirmed Thursday that there is not enough support in the House to pass the less expensive Senate version of the Obama plan. The Senate bill does not include a government-run insurance program but would have forced all Americans to buy insurance and levied a hefty tax on expensive insurance coverage. "I don't see the votes for it at this time," Pelosi said.

Pelosi insisted that health care reform will move forward in some way, but she may have difficulty passing anything as ambitious as the now-discarded House or Senate bills. "The worst position for a politician to be in is to say to the public, 'Open wide and swallow, this is good for you,' " said Rep. Gerry Connolly, D-Va., who is president of the House's politically vulnerable freshman class. "I don't want to be in this situation and my colleagues don't either."

Democrats are now considering a drastically scaled-back plan that could be passed in smaller, separate pieces. It would not include a public option, mandatory insurance or the creation of any new entitlement programs.

Pascrell said he is proposing a plan that would address insurance malpractice reform, increase insurance competition and bring reforms to the insurance industry. The bill could be passed in pieces over the course of several weeks and would allow the House to turn its attention to job creation. "It has appeal to a lot of people," Connolly said of the idea.

Leadership aides confirmed that Pelosi is considering the piecemeal approach, but there is no agreement on what it should include. Brown's election, one top leadership aide said, "has changed the dynamic completely and now we have to regroup and choose the best way forward."

Republicans are touting their own bill, which would forbid insurance companies to deny coverage because of pre-existing conditions and place limits on medical malpractice lawsuits. "Republicans are not going to work off of this monstrosity," Minority Leader John Boehner, R-Ohio, said of the proposal to retool the president's plan. "There's just not enough common ground."


The Snare of Incremental Heath Care “Reform”. Perilous days lie ahead

Opponents of (more) government control of health care and health insurance are breathing a sigh of relief after Tuesday’s upset senatorial election in Massachusetts. But now that the celebrations are subsiding, I feel compelled to warn that the most perilous days may lie ahead. How can that be, when Sen. Edward Kennedy’s seat is about to be assumed by a man who campaigned on a promise to vote against Obamacare, depriving the ruling majority of its critical 60th vote?

It’s simple: In place of 2,000-page omnibus monstrosities, we are likely to see a series of micro “reforms” — that is, government interventions — that may well garner bipartisan support. The new buzzword on Capitol Hill is “incrementalism.” This is a strategy to break the big House and Senate bills into several small ones — to slice the salami into manageable portions. Instead of one 2,000-page piece of legislation, we might see ten 200-pagers, or perhaps 100 20-pagers.

Will that make a difference substantively? Most likely not, because those micro bills are unlikely to be the needed repeals of the government’s impediments to free competition, such as the ban on interstate insurance commerce, the Food and Drug Administration, the patent system, and the tax-code bias toward employer-purchased insurance.

Instead we’ll probably see bills that embody most of the elements of President Obama’s, Speaker Pelosi’s, and Majority Leader Reid’s proposals. But since the series of small bills won’t look like an overambitious program to reinvent 16 percent of the U.S. economy in one unreadable fell swoop, much of the congressional opposition could be defused. Its previous talking points and photo ops regarding legislation that stacks three feet high will be useless.

Furthermore, individual elements in Obamacare have populist appeal. Many people (rightly) feel abused by big insurance companies, and being ignorant of both economics and the intricacies of current policy, they could be attracted to what appear to be modest consumer protections. (See this.) With the House of Representatives and a third of the Senate up for election this year, a preponderance of members may fear alienating those voters.

In other words, the incremental approach may be to the omnibus approach what (as the old folk warning has it) slowly cooking a frog is to tossing it into boiling water. (For the record, frogs will jump out of gradually heated water if they can.)

The majority party may kick itself for not thinking of this strategy sooner. One big bill is easy to scare people with — a bunch of smaller, less intimidating bills is not.

What might the series consist of? It seems certain that a bill will be introduced to require insurance companies to cover people who are already sick; that is, an end to the preexisting condition exclusion. Other bills will require guaranteed renewal, community rating (uniform premiums for all members of a group regardless of health status), and a limit on the difference between premiums for younger and older policyholders. (Today the premium for an older person can be six or seven times that of a young person, which is not surprising because older people tend to consume more medical services. Yet the pending legislation would permit only a two- or threefold difference. See Prateik Dalmia’s analysis here.)

Will members of the minority party go for the proposals? All indications up to now say yes. For example, as Sam Stein of the Huffington Post pointed out last November, “Many of the most respected health care voices in the GOP have historically treated the idea of eliminating pre-existing condition exclusions as an obvious plank in any reform effort…. Even deeply conservative figures like Senator Tom Coburn (R-Okl) insisted as recently as August that ‘everyone agrees’ that legislation should ‘eliminate pre-existing conditions’ as an excuse for denying coverage…. Another Senate Republican who was heavily involved in negotiating health care reform, Chuck Grassley of Iowa, has unequivocally declared that the government has ‘to prohibit insurers from denying coverage to people with preexisting medical conditions and charging higher premiums to people who are sick.’”

This, to say the least, is ominous. (And see Sen.-elect Scott Brown’s comments here.) For one thing, it won’t be enough to compel insurers to accept people who are already sick. In all likelihood, insurers would also be prohibited from charging sick customers more than well ones. (There’s no political point otherwise.) If the minority party will go for this, what won’t they go for? New taxes perhaps?

As I’ve pointed out before, coverage for an existing illness at someone else’s expense is not insurance. It is charity, or if forced through the state, subsidy and welfare. Once that intervention is enacted, others will follow.

Which brings us to the individual insurance mandate. Proponents justify the mandate on grounds that, to protect the viability of the insurance market, young healthy people must be forced to buy insurance when the companies are obliged to cover sick people at actuarially unsound premiums. From the beginning of the discussion in 2009, the majority party has insisted on the mandate (and one on employers too). It’s is an obvious violation of individual liberty, but where was the minority party’s protest? If one of the incremental bills calls for a mandate, as is most likely, will it pass the Senate? Let’s hope not, but we’ll have to wait and see.

It’s not time to breathe easy yet.


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