Death at hands of Nigerian doctor prompts out-of-hours shake-up for Britain

Doctors applying to work as weekend and evening cover for GPs will be put on a national database that will highlight all alerts over their competence, the Government said yesterday. The measure comes as part of a series of tighter controls on out-of-hours services after a coroner ruled that a patient given a fatal overdose by a underqualified locum was unlawfully killed.

The death of David Gray, 70, amounted to gross negligence and manslaughter, William Morris, Cambridgeshire North and East Coroner, said. He added that Daniel Ubani, the stand-in doctor who was carrying out his first GP shift in Britain, was “incompetent and not of an acceptable standard”. Mr Gray died after he was injected with 100mg of diamorphine — ten times the recommended daily dose. He was suffering from severe pain from kidney stones when he was treated by Dr Ubani, a German doctor, at his home in Manea, Cambridgeshire, in 2008.

Mr Morris said: “If he did not know the properties or the size of the drug he was administering he should not have administered it. If he had any doubts or queries I am satisfied he could seek advice. Nonetheless, he went ahead and injected the fatal overdose.” Referring to the standard of out-of-hours services offered to patients, Mr Morris added: “Weaknesses remain in the system.”

Dr Ubani, a specialist in cosmetic medicine based in Witten, Germany, had flown into England the day before and had a few hours’ sleep before starting a 12-hour shift.

Speaking after the coroner’s ruling yesterday, Mike O’Brien, the Health Minister, said that lessons would be learnt from the tragedy. He said that legal requirements for trusts to provide quality care would now be enforced with tougher regulations. These will include a shared database of doctors performing out-of-hours shifts, including alerts on those that have been refused work for failing competency assessments.

Dr Ubani failed a language test with the NHS in Leeds but managed to get on a performers’ list in Cornwall with fewer tests — allowing him to work in Cambridgeshire.

An official review ordered by the Government and published yesterday concluded that patients were being put at risk by out-of-hours services that were poorly monitored, chosen for ease rather than quality and delivered without guidance from local doctors. It said that, while there were robust requirements in place, there was “unacceptable variation” in how these were implemented and monitored.

Mr O’Brien said that all 24 recommendations made by the review, led by David Colin-Thomé, clinical director for primary care at the Department of Health, and Steve Field, chairman of the Royal College of General Practitioners, would be implemented.

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Australia: Shortage of public hospital operating theatres means tired surgeons operating late at night

HOSPITALS must stop the dangerous and inefficient practice of squeezing in emergency surgery in the middle of the night due to a lack of theatre space, surgeons say. Describing the situation as a "developing crisis in emergency surgery", the Royal Australasian College of Surgeons has called for hospitals to immediately restructure resources so that emergency surgery can be properly planned. "The current practice of performing cases unnecessarily in the evenings or late at night (simply because theatres become available) must cease," it said.

Patrick Cregan, the chairman of the NSW Surgical Services Taskforce, which recently developed a similar policy for the health department, agreed. Dr Cregan, who is also a surgeon at Nepean Hospital, said this week it was safer for patients if they were operated on in daylight hours rather than at night by fatigued surgeons, who were often junior. There was enough theatre space in NSW hospitals, he said, and it would not necessarily mean delaying elective or semi-urgent surgery.

He said developing an extra emergency surgery operating list, to manage conditions such as fracture repairs or appendix removals, would cost a hospital up to $500,000. "Manage the money, manage the staff, manage the resources so that patients get a safer, more effective outcome," Dr Cregan said. "The patient outcomes is significantly better. It's not money going down the toilet. At some stages we are running two or three theatres in the middle of the night at Nepean. It's crazy stuff."

Dr Cregan said emergency surgery was "the most predictable form of surgery around", and could be easily planned. "There's surges in demand every now and then but overall you know there's going to be 20 fractures a week," he said.

Several hospitals in Sydney, including Prince of Wales and Westmead, were developing acute surgery units but most of NSW has been slow to act.

The college said that unnecessarily operating overnight carried both a human cost - in terms of increased patient errors and fatigued clinicians - and a financial cost to the community from overtime payments of staff. "Regularly health workers face a choice between delaying an emergency surgical patient's treatment, thereby prolonging suffering (a potential for harm), and disrupting elective surgery - which unfairly prolongs the waiting time of a patient who may already have waited weeks."

This meant staff worked through the night on "less time critical emergencies" to clear the backlog of emergencies that could be days overdue.

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Obama admits health care overhaul may die on Hill

No, maybe he can't. President Barack Obama, who insisted he would succeed where other presidents had failed to fix the nation's health care system, now concedes the effort may die in Congress.

The president's newly conflicting signals could frustrate Democratic lawmakers who are hungry for guidance from the White House as they try to salvage the effort to extend coverage to millions of uninsured Americans and hold down spiraling medical costs. Obama's comments Thursday night came hours after Republican Scott Brown was sworn in to replace the late Edward M. Kennedy, leaving Democrats without their filibuster-proof majority in the Senate, and Obama's signature health legislation with no clear path forward.

"I think it's very important for us to have a methodical, open process over the next several weeks, and then let's go ahead and make a decision," Obama said at a Democratic National Committee fundraiser. "And it may be that ... if Congress decides we're not going to do it, even after all the facts are laid out, all the options are clear, then the American people can make a judgment as to whether this Congress has done the right thing for them or not," the president said. "And that's how democracy works. There will be elections coming up, and they'll be able to make a determination and register their concerns."

It appeared to be a shift in tone for the issue the "Yes we can" candidate campaigned on and made the centerpiece of his domestic agenda last year. In a speech to a joint session of Congress in September, Obama declared: "I am not the first president to take up this cause, but I am determined to be the last. ... Here and now we will meet history's test."

Sweeping health legislation to extend medical coverage to more than 30 million uninsured Americans passed the House and Senate last year and was on the verge of completion — though there were still disagreements between the two houses — before Brown's upset victory last month in a special election in Massachusetts. Since then it has been in limbo, and Obama has not publicly offered specifics to help lawmakers move forward. Congressional aides felt his remarks Thursday did not clarify matters.

"The next step is what I announced at the State of the Union, which is to call on our Republican friends to present their ideas. What I'd like to do is have a meeting whereby I'm sitting with the Republicans, sitting with the Democrats, sitting with health care experts, and let's just go through these bills. ... And then I think that we've got to go ahead and move forward on a vote," Obama said Thursday shortly after a White House meeting with Democratic congressional leaders that produced no apparent progress on health care. "I think we should be very deliberate, take our time. We're going to be moving a jobs package forward over the next several weeks; that's the thing that's most urgent right now in the minds of Americans all across the country."

White House spokesman Reid Cherlin said the president's position has not changed and he will not walk away from health care reform. "He used his remarks last night to motivate Democrats to come together and get this done, noting that the public will judge their leaders on what they accomplish," Cherlin said.

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Has Obamacare Already Won? Existing Government Programs to Take Over Health Care by 2012

For the past several months, Washington has exhausted every possible method to pass a health care bill designed to increase government’s control over health care. They haven’t been successful yet, but that may not matter: even without Obamacare, government health spending is set to increase far faster than private health expenditures, surpassing the private sector as soon as 2012.

Today the Centers for Medicare and Medicaid Services released its projections of national health expenditures for the next ten years. The report shows that spending by the public sector grew much faster in 2009 at 8.7 percent, compared to the private sector which only grew at 3.0 percent. Though public spending was heightened by the recession, as unemployment caused more Americans to lose employer-sponsored coverage and enroll in Medicaid, the trend is expected to continue into the next decade.

What is more, the report bases its projections on current law. In the case of Medicare, this underestimates future spending. Under current law, Medicare is set to reduce physician reimbursement rates by 21.3 percent in 2010. This would lead to growth in Medicare spending of just 1.5 percent in 2010. However, the likelihood of these cuts coming to fruition is slim to none, as every year, Congress votes to suspend them. 2010 will likely be no different. A report by Health Affairs cites that, if physician payment rates are held constant, the more likely growth in Medicare will be 5.1 percent in 2010. Whether or not these physician cuts occur is no small matter—with them, overall health spending growth would be 3.9 percent. Under the more likely scenario, health spending growth would be 4.7 percent.

Thus far, the debate on health care reform has focused on increasing government spending to reduce the number of uninsured. But government spending should be moving in the opposite direction. With government spending growing at a fast clip, rather than overhaul the entire system, lawmakers should channel reform towards high-cost (and largely cost-inefficient) government programs, like Medicare and Medicaid.

Medicare, Medicaid, and Social Security, the three entitlements big spenders, are duly in need of attention from Congress. These programs will be responsible for unsustainable growth in government spending in the years to come, and will quickly become insolvent. By reforming entitlement programs, Congress could kill two birds with one stone: achieve long sought-after health care reform and bend the cost curve in health care spending, all the while addressing the fiscal crisis facing the nation due to out-of-control spending.

Rather than increase government’s role in the health care system, Congress should see the current trend for what it is: a cry for reform of existing government health care programs. Getting public health spending under control would have a monumental effect on overall spending, directly and indirectly reducing costs for all Americans.

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Overwhelming Majority Say ObamaCare bills are ‘Unfair’

An overwhelming majority of Americans oppose the “marriage penalty” that currently exists in the House and Senate versions of ObamaCare, according to a new Zogby International poll conducted Jan. 19-21.

The Zogby Poll asked: "Both the House and Senate versions of the health care bill include a new tax whereby married couples making a combined annual income of $50,000, and who do not receive insurance through their employer, would have to pay up to $2,000 more per year for health insurance than an unmarried couple making the same combined income. Supporters say this will help pay for insurance for many that currently do not have it, while opponents say it is a penalty on marriage. Do you think this is fair or not?"

A strong 79 percent majority of American voters say that ObamaCare’s marriage penalty is not fair, while just 12 percent think it is fair. Among Independent voters, 85 percent think ObamaCare’s marriage penalty is unfair, and only 8 percent think it is fair.

A majority of married voters (86 percent) think the ObamaCare marriage penalty is not fair, and just 8 percent think it is fair. Even 65 percent of single voters say the penalty is unfair, while only 18 percent call it fair.

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