Even FDA approval does not protect a drug company
The Supreme Court botches a drug preemption case. Even when a drug is used in a way contrary to the company's instructions, the company is still liable!
The Supreme Court handed down its decision this month in the case of Wyeth v. Levine, ruling that federal law did not bar plaintiff Diana Levine from suing pharmaceutical maker Wyeth over allegedly insufficient drug safety warnings, even though the warnings had been approved by the Food and Drug Administration (FDA). This decision establishes the troubling precedent that a sympathetic jury can now supersede the expert opinions of the FDA on what qualifies as adequate safety labeling. Ultimately, that means drug firms face higher costs and greater uncertainty. Both are bad for patients.
Levine lost an arm to gangrene after a physician's assistant injected the Wyeth drug Phenergan in such a way that it came into contact with oxygen-rich arterial blood. Although the drug's label explicitly warned that doing so poses a high risk of tissue damage, Levine claimed that the label should have instructed physicians not to use this intravenous "IV-push" method at all. A Vermont jury agreed, and awarded Levine $7.4 million, which the court reduced to $6.7 million.
On appeal, Wyeth could not challenge the jury's fact finding, but argued that the FDA's extensive regulation of drug labeling should preclude claims of negligent failure to warn. The Supreme Court held, by a 6-3 majority, that federal law does not preempt Levine's claim.
According to Justice John Paul Stevens' majority opinion, "The history of the [Food, Drug, and Cosmetics Act] shows that Congress did not intend to preempt state-law failure-to-warn actions." Although true in a general sense, the Court failed to recognize that this is not a typical failure-to-warn case. As Justice Samuel Alito's dissenting opinion notes, Levine conceded that, in 1988, Wyeth proposed a label change that "if followed, would have prevented the inadvertent administration of Phenergan into an artery," but the FDA rejected that language.
Nevertheless, Levine alleged not only that the warning on Phenergan's label wasn't strong enough, but that Phenergan was "not reasonably safe for intravenous administration"—and that the label should have said so. That, however, poses a question regarding FDA's approval of the product for that use, not Wyeth's alleged negligence in drafting the label.
The FDA first approved Phenergan in 1955. And, as the risk of arterial injection became apparent over the years, the agency approved several changes to the drug's label, which now contains six statements (two in all capital letters and bold face type) warning doctors about the exact nature of that risk.
The doctor and physician's assistant who treated Levine nevertheless administered a dose twice as high as indicated, injected it into the inner crook of her arm where the risk of accidental arterial injection is very high, and continued to push in the syringe's plunger despite Levine's protestations of pain, each in direct contravention of explicit label warnings. It was this negligent administration that caused the massive tissue damage that led to the amputation of her arm.
Levine settled a claim against the physician's assistant and the prescribing doctor, then turned her sights on Wyeth. At trial, Levine's attorney argued that, despite the FDA's approval of Phenergan's label, the drug firm acted negligently by failing to add even sterner warnings or changing the label to rule out intravenous injection altogether. But doing the latter would have overruled a FDA decision that permits IV-push injections when that method could provide more benefits than the alternative.
Justice Stevens's majority opinion asserts that the FDA can't keep track of all safety issues that arise after a drug is approved and that the agency never specifically made a determination regarding the safety of IV-push administration. Consequently, Wyeth could have changed its label without the FDA's pre-approval upon receiving information regarding the risk of arterial injection of Phenergan. But that assertion is plainly wrong. The case record shows that the FDA repeatedly and intensively investigated this exact question and determined that IV-push injection provided important medical benefits.
Furthermore, there are no allegations that Wyeth hid any information about the risks of IV injection, nor has any new information regarding the risks arisen that would call the FDA's decision into question. So, the decision in Levine is tantamount to letting a group of laymen overrule the FDA's expert opinion regarding safety. In his closing arguments at trial, Levine's attorney told the jury, "Thank God we don't rely on the FDA to...make the safe[ty] decision...The FDA doesn't make the decision, you do."
A majority of the Supreme Court agreed, concluding that FDA regulation should be seen as a floor, but should not preempt stricter state tort laws. That, however, conflicts with longstanding Court precedent regarding implied pre-emption of state laws that conflict with federal regulatory decisions. As Justice Alito's dissent notes, "the ordinary principles of conflict pre-emption turn solely on whether a State has upset the regulatory balance struck by the federal agency." That is exactly what has happened here.
The Supreme Court could have and should have held in Wyeth's favor with a narrowly tailored opinion confined to the facts of this case. Doing so would not have insulated wrongdoers from punishment, but would have recognized that Congress gave FDA statutory authority over questions of safety and efficacy because it believed a federal expert body could most effectively balance the benefits and risks of new medicines. Empowering lay juries to override those decisions means that fewer patients will benefit from important medicines in the future. Not only is the majority's decision bad law, it's very bad for patients.
SOURCE
Shocked British mother sent 100 miles to have her baby
A PREGNANT woman was sent nearly 100 miles away to have her baby after being told the city's maternity ward was full. Sophie Jacobs, 22, was rushed to the Royal Devon & Exeter Hospital when her waters broke. She was terrified for the health of her baby, which was not due for another six weeks. But to her dismay, Miss Jacobs learned the maternity unit at the hospital was already full and she would have to be sent elsewhere.
Staff at the ward gave her a steroid injection to try to develop the baby's lungs and stop the labour. Others frantically phoned to try to find her a bed elsewhere with facilities for a premature baby. She was devastated when she learned the nearest place was The Royal Gwent, in Newport, South Wales — 96 miles away.
She said: "My pregnancy was all straightforward until the last few weeks, when I started developing signs of pre-eclampsia. "When I got to the RD&E, they gave me an injection to try to stop labour. "They didn't know if it was going to work. They had to find somewhere with a bed. "They tried everywhere from Cornwall up, and said the nearest place they could find was Newport."
She said: "They put me in an ambulance and I was driven up there. Jason, my partner, had to make his own way there. "It took ages in the ambulance because of the traffic. I didn't want to go up there, but I didn't have a choice. "I had the second injection in Newport but it didn't stop the labour and I got more severe signs of pre-eclampsia."
As previously revealed in the Echo, the RD&E has closed its maternity unit twice since 2006 because of overcrowding or staffing issues.
Miss Jacobs ended up having a Caesarean section, and Zachariah was born weighing 4lb 6oz. She added: "I ended up with a very small baby and we had to stay there for 10 days. Because Zachariah was so small and early he needed to be monitored and cared for on the special care baby unit. "He was also a little jaundiced so had to spend a few days under the UV light. The staff were lovely but it was horrible because it was such a long way from home. I wanted to be home and close to my friends and family. They kept ringing to see if there was room for us in Exeter, but there never was. After being let down so many times about being transferred back, we put our efforts into concentrating on getting discharged and eventually managed to get home."
Miss Jacobs, a secretary, said her partner Jason North, 36, had been able to stay locally while she was in Newport. Zachariah, who has a 10-year-old half-sister, Olivia, was born in September and, months on, is healthy and well.
A spokeswoman from the RD&E said: "The incident was the only one of its kind in the last three years and the transfer happened despite our very best efforts to provide more local care. "It was unfortunate that in the four-hour window that the maternity unit was closed, a patient had to be transferred to another hospital but all the decisions were made with patient safety being our priority," she said.
SOURCE
Saturday, March 21, 2009
Friday, March 20, 2009
Victims Of Socialism
Deadly Rationing: The gatekeeper for Great Britain's national health care system is denying cancer patients drugs that would extend their lives. Why? Because the medication is considered too expensive.
What's a life worth? Apparently not much in Great Britain. The National Institute for Health and Clinical Excellence, the government agency that decides which treatments the National Health Service will pay for, has effectively banned Lapatinib, a drug that was shown to slow the progression of breast cancer, and Sutent, which is the only medicine that can prolong the lives of some stomach cancer patients.
Banning beneficial drugs due to cost is nothing new in Britain. NICE, which has to be one of history's most ironic acronyms, forbade the use of Tarceva, a lung cancer drug proven to extend patients' lives, and Abatacept, even though it's one of the only drugs that has been shown in clinical testing to improve severe rheumatoid arthritis. Once again, we have to ask: Do we really want to use the British system as the model for a U.S. health care regime?
Promises of an effective, cost-effective health care system operated by the federal government are cruel fabrications. The British system shows that the state makes a mess of health care. So does the Canadian plan, which is plagued with unhealthy and often deadly waiting times for treatment.
The Swedish government system is no better. It also refuses to provide some expensive medication and, inhumanely, refuses to let patients buy the drugs themselves. Why? According to a Journal of American Physicians and Surgeons article, bureaucrats believe doing so "would set a bad precedent and lead to unequal access to medicine." Like Canadians, Swedes are subjected to long waits. They also have denial-of-care problems that sometimes lead to death.
A reasonable person would see the record of repeated failures in government-run medicine as evidence that such a system is not sustainable. Yet every central planner thinks he or she - or his or her immediate group - is smart enough to correct the flaws of socialist programs and therefore has the moral authority to force others to participate in his experiments. It is the same thinking that will move a person to say we are the ones we've been waiting for.
Medicine needs experimentation to progress. But experiments need to stay in the laboratories, not spread to the domain of public policy. Americans are not lab rats. They deserve to be treated with dignity and not shoved aside as expendables to be sacrificed in deference to a sacred totem of the political left.
SOURCE
Why does the NHS hate the elderly so much?
One day, when I was touring a North London hospital, I stopped in horror in front of an old lady in a blue bed jacket. Her face was a mass of bruises. I assumed she'd been brutally mugged, but the matron I was shadowing looked embarrassed. The old lady was, indeed, a victim - but of the NHS and its dreadful treatment of the elderly. First, a wrong prescription from her GP had left her so dizzy that she had tripped over and broken her hip. Then she had fallen out of her hospital bed and bashed her face.
I asked why the NHS bed lacked the cot sides available in private hospitals. 'We believe physical restraint is inappropriate to our patients' dignity,' reproved the matron. It is a case that sums up why the NHS is failing our elderly through misdiagnoses, ignorance and a culture that neglects and even despises them, putting Government targets over compassion and common sense.
I remembered that poor bruised woman when I read the horrific results this week of the Healthcare Commission's investigation into conditions at Staffordshire General Hospital. Hundreds of patients there, most of them elderly individuals who in any civilised society would expect to be treated with dignity, respect and compassion, may have died because of 'appalling' care, the commission suggested. The litany of complaints from families of the hospital's victims should shame us all: patients so thirsty they were forced to drink out of flower vases; wards described as war zones; people given wrong medication or none at all while others had to lie in soiled sheets and sick people left in A&E for hours, covered in blood and without pain relief. True, the problems did not apply exclusively to the elderly, but they were by far the most numerous among patients to be treated with such callous disdain.
And perhaps the most disturbing fact is that, far from being an isolated incident, if you are old and a health service patient anywhere in the country, you suffer more than any other patient.
Why does the NHS seem to hate the old so much? A recent survey of 201 doctors by the British Geriatrics Society found that seven out of ten specialists believe the elderly are less likely to receive a proper diagnosis and essential treatment than younger patients. Almost half believe the health service is 'institutionally ageist' and more than half admitted they were worried themselves about how the NHS would treat them in old age.
Most staff strive to treat patients with care and skill and there is a huge number of them whose dedication and professionalism we can only admire. But I spent a year researching a report on the NHS and I witnessed how the service betrays the elderly at every level. It sees neither they nor their most common illnesses as a priority. This is extraordinary because the elderly are the core business of the NHS. They occupy nearly two-thirds of general and acute hospital beds and account for half of the recent growth in emergency admissions.
And Britain is getting older. By 2025, the number of people over 80 will have increased by about 50 per cent. But simple demographics aside, it seems almost beyond comprehension that those who enter the NHS, those who choose a career caring for others, are actually denying civilised treatment to an entire swathe of the population. Surely we should, as a society, care properly for those who in earlier years have nurtured us and who now need our help. What kind of people have we become that we simply discard our elderly as an inconvenience because they get in the way of Government cost-cutting and performance targets?
As in other areas of political life, Government policy in the NHS has placed the emphasis on vote-winning targets such as waiting times and extended surgery hours for GPs. This has been at the expense of the patients who most use the NHS and are the least able to protest - the elderly. The problem is well known. A staggering 1,600 health service managers in a major national survey, reported in the Journal of the Royal Society of Medicine, believe that the elderly have benefited least from Government reforms.
But common conditions in old people - osteoporosis and incontinence, for example - still don't attract the Government's attention and spending. Meanwhile, free breast screening stops at 73, despite powerful evidence that it should continue for much longer, and anyone suffering from mental health problems is refused specialised treatment after 65.
It is not all the Government's fault. Discrimination against the elderly is prevalent throughout the medical profession. 'Old people deserve proper diagnoses and treatment,' says Dr David Oliver, a senior lecturer in elderly care medicine. 'But they are just not getting it.' Many doctors will blame symptoms such as confusion and falling on old age. But, in fact, points out Dr Oliver, acute confusion can be brought on by a change in the patient's circumstance, a bladder infection or a new medicine - and not always age at all.
Medical staff are often not helped by their training. Despite the increase in elderly patients, half of medical schools lack a geriatric medicine department. Doctors and nurses get only four or five weeks' training in caring for the elderly. As Dr Oliver says, old people are 'core users of NHS services, but they are still not high up on the agenda'. Nor are they popular with many members of medical staff. In surveys for the Royal Society for Medicine, medical students declare openly that they do not wish to work with old people. But the sheer number of old people using the NHS means that most of them will have to. How many of us want to be cared for by a doctor who has little or no interest in our ailments?
General neglect on the ward is another major problem. People in their 70s and 80s come from a generation that respects authority and hates to complain. And in a busy hospital, the quiet old lady in the corner can be safely overlooked. In a corridor of an A&E department in a London teaching hospital, I came across one old lady lying on a trolley. She had arrived at 10.30pm the previous evening and it was now lunchtime the following day. 'It's very hard on the bones,' she said, trying to smile. 'I wouldn't recommend it.' She had not been given anything to eat. 'And I haven't had a wash either. Of course, they try their best,' she said. A few hours later I returned. She was still there, but a nurse had brought her a blanket. Every time she turned over, however, it fell on the floor.
The old-fashioned matron used to be the patient's advocate. She had the power to oversee all elements of a patient's care, and take responsibility for their well-being. But the modern matron, an invention of the current Government, lacks clear authority at ward level. Some, through sheer force of personality, do an excellent job. But too many fail to ensure that even basic care is provided - and it is the elderly patients who suffer. Busy ward staff don't consider helping an elderly person to eat a priority - and so six out of ten older people are at risk of becoming malnourished while in hospital.
Patients complained to me all the time about the food. In one ward, I saw an old man wearing an oxygen mask and sitting in bed staring disconsolately at a wash bowl sitting on a bedside table covered in detritus. Next to the wash bowl lay his uneaten breakfast. A nurse, who should have helped him to wash and eat, had simply abandoned him. Indeed, many of the nurses I saw seemed indifferent or helpless. And the fact that so many of our elderly are going hungry on our wards, unnoticed, is an appalling indictment of the NHS and its attitude to the old.
No one is asking that old people should get privileged treatment. But they should get their fair share of resources and care. As the case of Staffordshire General Hospital shows all too graphically, this simply is not happening.
SOURCE
Deadly Rationing: The gatekeeper for Great Britain's national health care system is denying cancer patients drugs that would extend their lives. Why? Because the medication is considered too expensive.
What's a life worth? Apparently not much in Great Britain. The National Institute for Health and Clinical Excellence, the government agency that decides which treatments the National Health Service will pay for, has effectively banned Lapatinib, a drug that was shown to slow the progression of breast cancer, and Sutent, which is the only medicine that can prolong the lives of some stomach cancer patients.
Banning beneficial drugs due to cost is nothing new in Britain. NICE, which has to be one of history's most ironic acronyms, forbade the use of Tarceva, a lung cancer drug proven to extend patients' lives, and Abatacept, even though it's one of the only drugs that has been shown in clinical testing to improve severe rheumatoid arthritis. Once again, we have to ask: Do we really want to use the British system as the model for a U.S. health care regime?
Promises of an effective, cost-effective health care system operated by the federal government are cruel fabrications. The British system shows that the state makes a mess of health care. So does the Canadian plan, which is plagued with unhealthy and often deadly waiting times for treatment.
The Swedish government system is no better. It also refuses to provide some expensive medication and, inhumanely, refuses to let patients buy the drugs themselves. Why? According to a Journal of American Physicians and Surgeons article, bureaucrats believe doing so "would set a bad precedent and lead to unequal access to medicine." Like Canadians, Swedes are subjected to long waits. They also have denial-of-care problems that sometimes lead to death.
A reasonable person would see the record of repeated failures in government-run medicine as evidence that such a system is not sustainable. Yet every central planner thinks he or she - or his or her immediate group - is smart enough to correct the flaws of socialist programs and therefore has the moral authority to force others to participate in his experiments. It is the same thinking that will move a person to say we are the ones we've been waiting for.
Medicine needs experimentation to progress. But experiments need to stay in the laboratories, not spread to the domain of public policy. Americans are not lab rats. They deserve to be treated with dignity and not shoved aside as expendables to be sacrificed in deference to a sacred totem of the political left.
SOURCE
Why does the NHS hate the elderly so much?
One day, when I was touring a North London hospital, I stopped in horror in front of an old lady in a blue bed jacket. Her face was a mass of bruises. I assumed she'd been brutally mugged, but the matron I was shadowing looked embarrassed. The old lady was, indeed, a victim - but of the NHS and its dreadful treatment of the elderly. First, a wrong prescription from her GP had left her so dizzy that she had tripped over and broken her hip. Then she had fallen out of her hospital bed and bashed her face.
I asked why the NHS bed lacked the cot sides available in private hospitals. 'We believe physical restraint is inappropriate to our patients' dignity,' reproved the matron. It is a case that sums up why the NHS is failing our elderly through misdiagnoses, ignorance and a culture that neglects and even despises them, putting Government targets over compassion and common sense.
I remembered that poor bruised woman when I read the horrific results this week of the Healthcare Commission's investigation into conditions at Staffordshire General Hospital. Hundreds of patients there, most of them elderly individuals who in any civilised society would expect to be treated with dignity, respect and compassion, may have died because of 'appalling' care, the commission suggested. The litany of complaints from families of the hospital's victims should shame us all: patients so thirsty they were forced to drink out of flower vases; wards described as war zones; people given wrong medication or none at all while others had to lie in soiled sheets and sick people left in A&E for hours, covered in blood and without pain relief. True, the problems did not apply exclusively to the elderly, but they were by far the most numerous among patients to be treated with such callous disdain.
And perhaps the most disturbing fact is that, far from being an isolated incident, if you are old and a health service patient anywhere in the country, you suffer more than any other patient.
Why does the NHS seem to hate the old so much? A recent survey of 201 doctors by the British Geriatrics Society found that seven out of ten specialists believe the elderly are less likely to receive a proper diagnosis and essential treatment than younger patients. Almost half believe the health service is 'institutionally ageist' and more than half admitted they were worried themselves about how the NHS would treat them in old age.
Most staff strive to treat patients with care and skill and there is a huge number of them whose dedication and professionalism we can only admire. But I spent a year researching a report on the NHS and I witnessed how the service betrays the elderly at every level. It sees neither they nor their most common illnesses as a priority. This is extraordinary because the elderly are the core business of the NHS. They occupy nearly two-thirds of general and acute hospital beds and account for half of the recent growth in emergency admissions.
And Britain is getting older. By 2025, the number of people over 80 will have increased by about 50 per cent. But simple demographics aside, it seems almost beyond comprehension that those who enter the NHS, those who choose a career caring for others, are actually denying civilised treatment to an entire swathe of the population. Surely we should, as a society, care properly for those who in earlier years have nurtured us and who now need our help. What kind of people have we become that we simply discard our elderly as an inconvenience because they get in the way of Government cost-cutting and performance targets?
As in other areas of political life, Government policy in the NHS has placed the emphasis on vote-winning targets such as waiting times and extended surgery hours for GPs. This has been at the expense of the patients who most use the NHS and are the least able to protest - the elderly. The problem is well known. A staggering 1,600 health service managers in a major national survey, reported in the Journal of the Royal Society of Medicine, believe that the elderly have benefited least from Government reforms.
But common conditions in old people - osteoporosis and incontinence, for example - still don't attract the Government's attention and spending. Meanwhile, free breast screening stops at 73, despite powerful evidence that it should continue for much longer, and anyone suffering from mental health problems is refused specialised treatment after 65.
It is not all the Government's fault. Discrimination against the elderly is prevalent throughout the medical profession. 'Old people deserve proper diagnoses and treatment,' says Dr David Oliver, a senior lecturer in elderly care medicine. 'But they are just not getting it.' Many doctors will blame symptoms such as confusion and falling on old age. But, in fact, points out Dr Oliver, acute confusion can be brought on by a change in the patient's circumstance, a bladder infection or a new medicine - and not always age at all.
Medical staff are often not helped by their training. Despite the increase in elderly patients, half of medical schools lack a geriatric medicine department. Doctors and nurses get only four or five weeks' training in caring for the elderly. As Dr Oliver says, old people are 'core users of NHS services, but they are still not high up on the agenda'. Nor are they popular with many members of medical staff. In surveys for the Royal Society for Medicine, medical students declare openly that they do not wish to work with old people. But the sheer number of old people using the NHS means that most of them will have to. How many of us want to be cared for by a doctor who has little or no interest in our ailments?
General neglect on the ward is another major problem. People in their 70s and 80s come from a generation that respects authority and hates to complain. And in a busy hospital, the quiet old lady in the corner can be safely overlooked. In a corridor of an A&E department in a London teaching hospital, I came across one old lady lying on a trolley. She had arrived at 10.30pm the previous evening and it was now lunchtime the following day. 'It's very hard on the bones,' she said, trying to smile. 'I wouldn't recommend it.' She had not been given anything to eat. 'And I haven't had a wash either. Of course, they try their best,' she said. A few hours later I returned. She was still there, but a nurse had brought her a blanket. Every time she turned over, however, it fell on the floor.
The old-fashioned matron used to be the patient's advocate. She had the power to oversee all elements of a patient's care, and take responsibility for their well-being. But the modern matron, an invention of the current Government, lacks clear authority at ward level. Some, through sheer force of personality, do an excellent job. But too many fail to ensure that even basic care is provided - and it is the elderly patients who suffer. Busy ward staff don't consider helping an elderly person to eat a priority - and so six out of ten older people are at risk of becoming malnourished while in hospital.
Patients complained to me all the time about the food. In one ward, I saw an old man wearing an oxygen mask and sitting in bed staring disconsolately at a wash bowl sitting on a bedside table covered in detritus. Next to the wash bowl lay his uneaten breakfast. A nurse, who should have helped him to wash and eat, had simply abandoned him. Indeed, many of the nurses I saw seemed indifferent or helpless. And the fact that so many of our elderly are going hungry on our wards, unnoticed, is an appalling indictment of the NHS and its attitude to the old.
No one is asking that old people should get privileged treatment. But they should get their fair share of resources and care. As the case of Staffordshire General Hospital shows all too graphically, this simply is not happening.
SOURCE
Thursday, March 19, 2009
No Miracle in Massachusetts
It was only a matter of time before this story appeared, as it did in yesterday's New York Times. Having promised lavish subsidies for expansive health insurance, it seems state officials in Massachusetts have finally begun to admit that their health-care reform program, passed in 2006, is unaffordable for the state's taxpayers.
This should surprise no one. Whatever else might be said about the Massachusetts plan, it was clear from the get-go that it would overwhelm the state's budget - it was just a matter of time. All the state really did was buy hundreds of thousands of residents into heavily regulated insurance plans by moving around some existing pots of money and raising taxes. They didn't build a functioning marketplace with cost-conscious consumers, nor did they pursue - initially - the kinds of heavy-handed, government-imposed cost controls that many Democrats actually favor. In short, there was never any reason to expect health-care premiums in the state to escalate less rapidly after the "reform" than they did before the plan was adopted.
But, just as predictably, now that it is difficult to turn back and start over (hundreds of thousands of Massachusetts households are now enrolled in newly-subsidized insurance), the state wants to impose cost-controls. There is much talk of new whiz-bang systems for paying doctors and hospitals, devised by government officials, which reward more efficient ways of delivering care. Don't count on it. Inevitably, when the government tries to micro-manage payments and prices, the result is indiscriminate, across-the-board cuts, protection of incumbents, and strong disincentives for innovation. Indeed, Massachusetts' Democratic Governor Deval Patrick has already signaled where this is all likely to head: state-imposed caps on private health insurance premiums.
There are lessons here for the unfolding debate in Washington. The Obama team is essentially pursuing the Massachusetts political strategy - cover everybody first with a massive new entitlement program and worry about imposing cost-controls later. In fact, Sen. Ted Kennedy's top lieutenant assigned to pulling together a health-care bill was a principal architect of the Massachusetts's approach. And, on costs, the Obama administration keeps touting the same benign-sounding initiatives - like expanded use of health information technology - that Massachusetts officials used to cite, even though the Congressional Budget Office (CBO) has already said these kinds of steps won't come close to solving the cost problem. It is obvious that the administration is hoping it can get a bill passed without endorsing the kinds of measures which would rightly be attacked as rationing care.
But make no mistake: If President Obama succeeds, he and the Congress will be back in a year or two or three - when the coverage train has already left the station - to say the financial future of the country depends on agreeing to government-imposed cost constraints, just as Massachusetts officials are doing today.
Even the Times story hints at what's really at stake here. If we don't rely on market principles to allocate health-care resources, the country will inevitably turn to the government to keep premiums in line with income. And, as some anonymous "experts" candidly admit in the Times piece, government-written "payment practices" are highly unlikely to do the trick. Instead, these "experts" say, "the state and federal governments may need to place actual limits on health spending, which could lead to rationing of care."
SOURCE
Baby dies from infection days after two NHS midwives tell mother to ignore prescribed antibiotics
A newborn baby died from an infection just days after two midwives told the mother not to bother giving him antibiotics, a misconduct hearing was told today. Andrea Street, 34, and Jennifer Ansell, 39, told the new mother - a research doctor - it was not necessary to feed her baby boy vital medication, the Nursing and Midwifery Council heard. But the small youngster's body could not fight off an umbilical cord infection and he died two days after leaving the Royal Sussex County Hospital, Brighton, in January 2006. It is claimed Ms Street and Ms Ansell, both employed by Brighton and Sussex University Hospital NHS Trust, failed to properly care for the infant, referred to as Baby L.
The infant had been prescribed antibiotics by a hospital doctor after he developed a suspected umbilical cord infection a few hours after birth. Clare Strickland, for the NMC, said: 'Shortly after his birth there had been two episodes where he had turned blue so there were concerns about his respiratory function and there were concerns about his feeding as his blood sugar level was low. 'The first time it appeared there were any concerns about his umbilical cord were on Friday, January 27. 'A nursery nurse noticed Baby L's cord seemed wet and mucusy so she took a swab and sent it for analysis.' A doctor then prescribed antibiotics the following day, the NMC heard.
'Although there were no signs of active infection, because he had problems following birth and he was a vulnerable baby, she took a cautious approach and prescribed a five-day course of antibiotics,' added Miss Strickland. But when Ms Street discharged the mum - referred to as Dr B - she told her 'the cords look fine, don't worry about them', the hearing was told. The mother took her baby son home and put the unopened medication in the fridge.
Miss Strickland said: 'She didn't give them the option to ask questions and left them with the impression they didn't need to give the antibiotics at all. 'Because the medication was clearly prescribed by the doctor, it was the responsibility of midwife Miss Street as the discharging midwife to ensure that the patient knew about the drug, the dosage and the administration. 'She shouldn't have said or done anything that would have suggested the antibiotics should not be given.'
When community midwife Ms Ansell saw Baby L at home the next day, the mother was worried about the antibiotics. But Ms Ansell brushed off her worries and left without inspecting the antibiotics. Miss Strickland added: 'Having found out about this unusual position, if she was not sure, she should have checked with medical staff and the hospital and should certainly have checked the medication and the dosage. 'Whether this would have made a difference to his outcome, this can never be answered. 'There was due to be another visit from the community midwife the next day but Baby L died before then.'
Baby L was born on January 25, 2006 and died five days later from a bacterial infection. Miss Strickland added: 'A post mortem was carried out and the report concluded that on the balance of probabilities his death was due to a staphylococcus aureas infection. 'The Council says there was a failure to provide an appropriate level of care for this infant.' Andrea Louise Street, from Wick, Littlehampton, West Sussex, and Jennifer Maria Ansell, of Shoreham-By-Sea, West Sussex, both deny failing to provide inadequate care.
SOURCE
It was only a matter of time before this story appeared, as it did in yesterday's New York Times. Having promised lavish subsidies for expansive health insurance, it seems state officials in Massachusetts have finally begun to admit that their health-care reform program, passed in 2006, is unaffordable for the state's taxpayers.
This should surprise no one. Whatever else might be said about the Massachusetts plan, it was clear from the get-go that it would overwhelm the state's budget - it was just a matter of time. All the state really did was buy hundreds of thousands of residents into heavily regulated insurance plans by moving around some existing pots of money and raising taxes. They didn't build a functioning marketplace with cost-conscious consumers, nor did they pursue - initially - the kinds of heavy-handed, government-imposed cost controls that many Democrats actually favor. In short, there was never any reason to expect health-care premiums in the state to escalate less rapidly after the "reform" than they did before the plan was adopted.
But, just as predictably, now that it is difficult to turn back and start over (hundreds of thousands of Massachusetts households are now enrolled in newly-subsidized insurance), the state wants to impose cost-controls. There is much talk of new whiz-bang systems for paying doctors and hospitals, devised by government officials, which reward more efficient ways of delivering care. Don't count on it. Inevitably, when the government tries to micro-manage payments and prices, the result is indiscriminate, across-the-board cuts, protection of incumbents, and strong disincentives for innovation. Indeed, Massachusetts' Democratic Governor Deval Patrick has already signaled where this is all likely to head: state-imposed caps on private health insurance premiums.
There are lessons here for the unfolding debate in Washington. The Obama team is essentially pursuing the Massachusetts political strategy - cover everybody first with a massive new entitlement program and worry about imposing cost-controls later. In fact, Sen. Ted Kennedy's top lieutenant assigned to pulling together a health-care bill was a principal architect of the Massachusetts's approach. And, on costs, the Obama administration keeps touting the same benign-sounding initiatives - like expanded use of health information technology - that Massachusetts officials used to cite, even though the Congressional Budget Office (CBO) has already said these kinds of steps won't come close to solving the cost problem. It is obvious that the administration is hoping it can get a bill passed without endorsing the kinds of measures which would rightly be attacked as rationing care.
But make no mistake: If President Obama succeeds, he and the Congress will be back in a year or two or three - when the coverage train has already left the station - to say the financial future of the country depends on agreeing to government-imposed cost constraints, just as Massachusetts officials are doing today.
Even the Times story hints at what's really at stake here. If we don't rely on market principles to allocate health-care resources, the country will inevitably turn to the government to keep premiums in line with income. And, as some anonymous "experts" candidly admit in the Times piece, government-written "payment practices" are highly unlikely to do the trick. Instead, these "experts" say, "the state and federal governments may need to place actual limits on health spending, which could lead to rationing of care."
SOURCE
Baby dies from infection days after two NHS midwives tell mother to ignore prescribed antibiotics
A newborn baby died from an infection just days after two midwives told the mother not to bother giving him antibiotics, a misconduct hearing was told today. Andrea Street, 34, and Jennifer Ansell, 39, told the new mother - a research doctor - it was not necessary to feed her baby boy vital medication, the Nursing and Midwifery Council heard. But the small youngster's body could not fight off an umbilical cord infection and he died two days after leaving the Royal Sussex County Hospital, Brighton, in January 2006. It is claimed Ms Street and Ms Ansell, both employed by Brighton and Sussex University Hospital NHS Trust, failed to properly care for the infant, referred to as Baby L.
The infant had been prescribed antibiotics by a hospital doctor after he developed a suspected umbilical cord infection a few hours after birth. Clare Strickland, for the NMC, said: 'Shortly after his birth there had been two episodes where he had turned blue so there were concerns about his respiratory function and there were concerns about his feeding as his blood sugar level was low. 'The first time it appeared there were any concerns about his umbilical cord were on Friday, January 27. 'A nursery nurse noticed Baby L's cord seemed wet and mucusy so she took a swab and sent it for analysis.' A doctor then prescribed antibiotics the following day, the NMC heard.
'Although there were no signs of active infection, because he had problems following birth and he was a vulnerable baby, she took a cautious approach and prescribed a five-day course of antibiotics,' added Miss Strickland. But when Ms Street discharged the mum - referred to as Dr B - she told her 'the cords look fine, don't worry about them', the hearing was told. The mother took her baby son home and put the unopened medication in the fridge.
Miss Strickland said: 'She didn't give them the option to ask questions and left them with the impression they didn't need to give the antibiotics at all. 'Because the medication was clearly prescribed by the doctor, it was the responsibility of midwife Miss Street as the discharging midwife to ensure that the patient knew about the drug, the dosage and the administration. 'She shouldn't have said or done anything that would have suggested the antibiotics should not be given.'
When community midwife Ms Ansell saw Baby L at home the next day, the mother was worried about the antibiotics. But Ms Ansell brushed off her worries and left without inspecting the antibiotics. Miss Strickland added: 'Having found out about this unusual position, if she was not sure, she should have checked with medical staff and the hospital and should certainly have checked the medication and the dosage. 'Whether this would have made a difference to his outcome, this can never be answered. 'There was due to be another visit from the community midwife the next day but Baby L died before then.'
Baby L was born on January 25, 2006 and died five days later from a bacterial infection. Miss Strickland added: 'A post mortem was carried out and the report concluded that on the balance of probabilities his death was due to a staphylococcus aureas infection. 'The Council says there was a failure to provide an appropriate level of care for this infant.' Andrea Louise Street, from Wick, Littlehampton, West Sussex, and Jennifer Maria Ansell, of Shoreham-By-Sea, West Sussex, both deny failing to provide inadequate care.
SOURCE
Wednesday, March 18, 2009
Socialized Obamacare for all Americans -- except veterans???
American Legion Strongly Opposed to Obama's Plan to Charge Wounded Heroes for medical Treatment
The leader of the nation's largest veterans organization says he is "deeply disappointed and concerned" after a meeting with President Barack Obama today to discuss a proposal to force private insurance companies to pay for the treatment of military veterans who have suffered service-connected disabilities and injuries. The Obama administration recently revealed a plan to require private insurance carriers to reimburse the Department of Veterans Affairs in such cases.
"It became apparent during our discussion today that the President intends to move forward with this unreasonable plan," said Commander David K. Rehbein of The American Legion in a news release early this evening. "He says he is looking to generate $540-million by this method, but refused to hear arguments about the moral and government-avowed obligations that would be compromised by it."
Commander Rehbein, clearly angered as he emerged from the session said, "This reimbursement plan would be inconsistent with the mandate `. to care for him who shall have borne the battle.' given that the United States government sent members of the armed forces into harm's way, and not private insurance companies. I say again that The American Legion does not and will not support any plan that seeks to bill a veteran for treatment of a service connected disability at the very agency that was created to treat the unique need of America's veterans!"
Commander Rehbein was among a group of senior officials from veterans service organizations joining the President, White House Chief of Staff Rahm Emmanuel, Secretary of Veterans Affairs Eric Shinseki and Steven Kosiak, the overseer of defense spending at the Office of Management and Budget (OMB). The group's early afternoon conversation at The White House was precipitated by a letter of protest presented to the president earlier this month. The letter, co-signed by Commander Rehbein and the heads of ten colleague organizations, read, in part, "There is simply no logical explanation for billing a veteran's personal insurance for care that the VA has a responsibility to provide. While we understand the fiscal difficulties this country faces right now, placing the burden of those fiscal problems on the men and women who have already sacrificed a great deal for this country is unconscionable."
Commander Rehbein reiterated points made last week in testimony to both House and Senate Veterans' Affairs Committees. It was stated then that The American Legion believes that the reimbursement plan would be inconsistent with the mandate that VA treat service-connected injuries and disabilities given that the U.S. government sends members of the armed forces into harm's way, and not private insurance companies. The proposed requirement for these companies to reimburse the VA would not only be unfair, says the Legion, but would have an adverse impact on service-connected disabled veterans and their families. The Legion argues that, depending on the severity of the medical conditions involved, maximum insurance coverage limits could be reached through treatment of the veteran's condition alone. That would leave the rest of the family without health care benefits. The Legion also points out that many health insurance companies require deductibles to be paid before any benefits are covered. Additionally, the Legion is concerned that private insurance premiums would be elevated to cover service-connected disabled veterans and their families, especially if the veterans are self-employed or employed in small businesses unable to negotiate more favorable across-the-board insurance policy pricing. The American Legion also believes that some employers, especially small businesses, would be reluctant to hire veterans with service-connected disabilities due to the negative impact their employment might have on obtaining and financing company health care benefits.
"I got the distinct impression that the only hope of this plan not being enacted," said Commander Rehbein, "is for an alternative plan to be developed that would generate the desired $540-million in revenue. The American Legion has long advocated for Medicare reimbursement to VA for the treatment of veterans. This, we believe, would more easily meet the president's financial goal. We will present that idea in an anticipated conference call with White House Chief of Staff Rahm Emmanuel in the near future.
"I only hope the administration will really listen to us then. This matter has far more serious ramifications than the President is imagining," concluded the commander.
SOURCE
The NHS hospital where 'at least 400' could have died needlessly
Unacceptable standards of patient care could have led to hundreds of deaths at a single hospital in a three-year period. A damning report to be released tomorrow by the Healthcare Commission will outline a catalogue of failings at a hospital trust blinded by a drive to save money and abide by Government waiting-time targets. An advance copy of the report seen by the Daily Mail estimated 'at least' 400 deaths between 2005 and 2008 could not be accounted for by 'other factors or by chance variation'. Sources close to the investigation into the Mid Staffordshire NHS Foundation Trust said the true figure could be as high as 1,300 patients.
The report found that mortality was 'found to be high across a range of conditions including those involving the heart, blood vessels, nervous system, lungs, blood and infectious diseases', and added: 'These findings were indicative of systemic problems across the trust's system of emergency care.' The Mid Staffordshire trust runs Stafford Hospital and Cannock Chase Hospital but it is believed the Healthcare Commission found there was no cause for concern at Cannock Chase.
Health campaigners said they feared the findings at Stafford reflect problems with the NHS nationally where targets have distorted basic care. The commission found that the A&E department was understaffed and poorly equipped; a shortage of nurses meant receptionists were left to assess patients; nurses were not trained to read cardiac monitors; patients received incorrect medication, or none at all, and were left for hours in wet or soiled bedding; there were too few specialist beds for stroke patients; essential equipment such as defibrillators was missing or not working and accepted standards of practice in infection control were not maintained.
Tory MP Bill Cash, whose Stone constituency relies on Stafford Hospital, said he had been inundated with complaints from constituents. 'I wrote to the Healthcare Commission a few months ago asking for a whole range of complaints by my constituents to be looked into. 'The report findings tally with what they have told me, especially about patients being left in dirty bedding. The Government has poured money into the hospitals but this just shows that money on its own will not solve the problems. 'There is far too much bureaucracy and too little front-line service in the NHS.'
The report said a shortage of doctors meant they 'were moved from treating seriously ill patients to deal with those with more minor ailments, in order to avoid breaching the four-hour waiting time target.' It was also critical of the trust's axing of 150 jobs - many of them nurses - over 2006/07 as part of a plan to save 10million to meet national cost-saving targets.
The commission launched an investigation in March last year after figures revealed high mortality rates for patients admitted as emergencies, which the trust had failed to investigate adequately. The trust's standardised mortality rate (SMR) was 127 in 2005/06, way above the national rate of 100, making it the fifth-highest in England. The rate is not the actual number of deaths, but an expression of the link between registered deaths and those expected from the number of diagnoses. Over the following two years, the rate at one point jumped to 145.
A source said the reference to the scandal being the likely cause of 'at least 400 deaths' was removed from the final version of the report summary yesterday morning amid concerns about the way the figure was calculated. 'Regardless of this, the report makes it obvious that the hospital had serious shortcomings. 'The fact that this trust was only the fifth-worst in England, in terms of its SMR, does not bode well for the rest of the country's hospitals.'
The period the hospital trust was under investigation coincides with the reign of the current NHS chief executive, David Nicholson, as chief executive of the West Midlands Strategic Health Authority, which covers Staffordshire. Mr Nicholson left in 2006 and was replaced by Cynthia Bower, who is the new head of the Care Quality Care Commission, which will replace the Healthcare Commission at the end of this month. Last week, it was announced that the Mid Staffordshire Trust's chairman, Toni Brisby, and chief executive, Martin Yeates, had resigned ahead of the commission's report. But sources close to the investigation believe the pair were ' sacrificed' as scapegoats to deflect attention away from Mr Nicholson and Mrs Bower's proximity to the Staffordshire scandal.
'DREADFUL, ABYSMAL, INEXCUSABLE'
Arthur Peacham, 68, had been retired for just two weeks when he was admitted to Stafford Hospital with back pain following a hernia operation. After a week he was about to go home when staff told his wife, Gillian, that he had caught the C.difficile superbug. After that, Mrs Peacham said, a series of 'horrendous' blunders helped lead to her husband's death on March 19, 2006, including failing to give him food and leaving him on 'filthy' wards.
'What happened to him was horrific,' said Mrs Peacham, 69. 'When they told me he had caught C. difficile they admitted they had known 11 other people on the ward were already infected but they had nowhere else to put him. 'They told us it wasn't contagious but my son checked on the internet and saw that it was highly contagious and could result in death. 'My husband went downhill from there. He was having trouble keeping food down and they were supposed to give him a special drink but they didn't feed him most of the time. 'Either they would forget to get a prescription from the doctor or they were too short- staffed to care for him.
Mr Peacham, an agronomist who had two sons and four grandchildren, was eventually moved to New Cross Hospital in Wolverhampton in early March. His widow said: 'There it was amazing. He was so clean and well looked after. 'Unfortunately by then it was too late. The C.diff had ravaged his body.' She added: 'The care at Stafford Hospital was dreadful, abysmal, inexcusable.'
SOURCE
Child died after Australian public hospitals sent him home three times
Calling this kid's problem "croup" is absurd. Croup has a frequent cough and there is no mention of that. And croup is very common so the doctors should have known that. The negligence is gross
Timothy Wood's parents knew something was terribly wrong with their son, but they could not get the help they were sure he needed. Desperately straining for air and with swelling around his neck, the 19-month-old was sent home from hospital on July 16, 2005, for the third time in four days. The next afternoon, he was rushed back to hospital, where he died two days later.
Anthony and Robyn Wood hope a coronial inquest will give them some answers. Their solicitor Kathryn Booth, of Maurice Blackburn, said outside the Victorian Coroners Court yesterday: "Mr and Mrs Wood have been waiting a very long time to have this inquest and it's been important to them to get answers as to why Timmy died after three presentations to two different hospitals."
Mr Wood said: "The last thing we want to have happen is the same thing happen to another child - it was bad enough to go through it. "You're not meant to outlive your children and it will be something that we will take to our grave."
In statements tendered to the court, Mr Wood said he believed the Austin Hospital should have done things differently when he took his son there on July 16, 2005. "I do not believe that Timothy should have been discharged from the hospital that evening," he said. "The medical staff was not in a position to accurately diagnose the extent of Timothy's problem or make a decision to discharge him as he had not been closely monitored and examined during his time at the hospital." Giving evidence, Mr Wood was even more direct. "We thought the observation levels (at the Austin Hospital) were pathetic. They weren't there," he said.
Timmy became sick on Thursday, July 14, 2005. By about 2am on the Friday, his breathing was badly restricted and his parents called an ambulance. He was taken to the Royal Children's Hospital, where he was diagnosed with croup, observed for four hours and given medication before being sent home. On the Saturday morning, the Woods were still concerned and took him back. When they saw the triage nurse they were told if they waited in emergency for a doctor it would be unlikely that the treatment plan would change.
They went home, but Timmy did not improve and they called a 24-hour maternal health nurse help line. The nurse could hear Timmy's laboured breathing and told Mr Wood to call an ambulance immediately and prepare for an overnight stay. But when they got to the Austin hospital - the Royal Children's was full - Timmy was not admitted. Instead, he was given more medication and sent home.
The next day, he stopped breathing. Mr Wood administered CPR until an ambulance arrived and Timmy was rushed to the Royal Children's Hospital, where he died two days later. Mr Wood wrote in a letter to the coroner in August 2005: "It was said to us by some of the (intensive care unit) team at the Royal Children's Hospital that they are amazed that a child can die from croup these days. "The Austin Hospital and medical team simply let us down."
The inquest, before coroner David Drake, continues.
SOURCE
American Legion Strongly Opposed to Obama's Plan to Charge Wounded Heroes for medical Treatment
The leader of the nation's largest veterans organization says he is "deeply disappointed and concerned" after a meeting with President Barack Obama today to discuss a proposal to force private insurance companies to pay for the treatment of military veterans who have suffered service-connected disabilities and injuries. The Obama administration recently revealed a plan to require private insurance carriers to reimburse the Department of Veterans Affairs in such cases.
"It became apparent during our discussion today that the President intends to move forward with this unreasonable plan," said Commander David K. Rehbein of The American Legion in a news release early this evening. "He says he is looking to generate $540-million by this method, but refused to hear arguments about the moral and government-avowed obligations that would be compromised by it."
Commander Rehbein, clearly angered as he emerged from the session said, "This reimbursement plan would be inconsistent with the mandate `. to care for him who shall have borne the battle.' given that the United States government sent members of the armed forces into harm's way, and not private insurance companies. I say again that The American Legion does not and will not support any plan that seeks to bill a veteran for treatment of a service connected disability at the very agency that was created to treat the unique need of America's veterans!"
Commander Rehbein was among a group of senior officials from veterans service organizations joining the President, White House Chief of Staff Rahm Emmanuel, Secretary of Veterans Affairs Eric Shinseki and Steven Kosiak, the overseer of defense spending at the Office of Management and Budget (OMB). The group's early afternoon conversation at The White House was precipitated by a letter of protest presented to the president earlier this month. The letter, co-signed by Commander Rehbein and the heads of ten colleague organizations, read, in part, "There is simply no logical explanation for billing a veteran's personal insurance for care that the VA has a responsibility to provide. While we understand the fiscal difficulties this country faces right now, placing the burden of those fiscal problems on the men and women who have already sacrificed a great deal for this country is unconscionable."
Commander Rehbein reiterated points made last week in testimony to both House and Senate Veterans' Affairs Committees. It was stated then that The American Legion believes that the reimbursement plan would be inconsistent with the mandate that VA treat service-connected injuries and disabilities given that the U.S. government sends members of the armed forces into harm's way, and not private insurance companies. The proposed requirement for these companies to reimburse the VA would not only be unfair, says the Legion, but would have an adverse impact on service-connected disabled veterans and their families. The Legion argues that, depending on the severity of the medical conditions involved, maximum insurance coverage limits could be reached through treatment of the veteran's condition alone. That would leave the rest of the family without health care benefits. The Legion also points out that many health insurance companies require deductibles to be paid before any benefits are covered. Additionally, the Legion is concerned that private insurance premiums would be elevated to cover service-connected disabled veterans and their families, especially if the veterans are self-employed or employed in small businesses unable to negotiate more favorable across-the-board insurance policy pricing. The American Legion also believes that some employers, especially small businesses, would be reluctant to hire veterans with service-connected disabilities due to the negative impact their employment might have on obtaining and financing company health care benefits.
"I got the distinct impression that the only hope of this plan not being enacted," said Commander Rehbein, "is for an alternative plan to be developed that would generate the desired $540-million in revenue. The American Legion has long advocated for Medicare reimbursement to VA for the treatment of veterans. This, we believe, would more easily meet the president's financial goal. We will present that idea in an anticipated conference call with White House Chief of Staff Rahm Emmanuel in the near future.
"I only hope the administration will really listen to us then. This matter has far more serious ramifications than the President is imagining," concluded the commander.
SOURCE
The NHS hospital where 'at least 400' could have died needlessly
Unacceptable standards of patient care could have led to hundreds of deaths at a single hospital in a three-year period. A damning report to be released tomorrow by the Healthcare Commission will outline a catalogue of failings at a hospital trust blinded by a drive to save money and abide by Government waiting-time targets. An advance copy of the report seen by the Daily Mail estimated 'at least' 400 deaths between 2005 and 2008 could not be accounted for by 'other factors or by chance variation'. Sources close to the investigation into the Mid Staffordshire NHS Foundation Trust said the true figure could be as high as 1,300 patients.
The report found that mortality was 'found to be high across a range of conditions including those involving the heart, blood vessels, nervous system, lungs, blood and infectious diseases', and added: 'These findings were indicative of systemic problems across the trust's system of emergency care.' The Mid Staffordshire trust runs Stafford Hospital and Cannock Chase Hospital but it is believed the Healthcare Commission found there was no cause for concern at Cannock Chase.
Health campaigners said they feared the findings at Stafford reflect problems with the NHS nationally where targets have distorted basic care. The commission found that the A&E department was understaffed and poorly equipped; a shortage of nurses meant receptionists were left to assess patients; nurses were not trained to read cardiac monitors; patients received incorrect medication, or none at all, and were left for hours in wet or soiled bedding; there were too few specialist beds for stroke patients; essential equipment such as defibrillators was missing or not working and accepted standards of practice in infection control were not maintained.
Tory MP Bill Cash, whose Stone constituency relies on Stafford Hospital, said he had been inundated with complaints from constituents. 'I wrote to the Healthcare Commission a few months ago asking for a whole range of complaints by my constituents to be looked into. 'The report findings tally with what they have told me, especially about patients being left in dirty bedding. The Government has poured money into the hospitals but this just shows that money on its own will not solve the problems. 'There is far too much bureaucracy and too little front-line service in the NHS.'
The report said a shortage of doctors meant they 'were moved from treating seriously ill patients to deal with those with more minor ailments, in order to avoid breaching the four-hour waiting time target.' It was also critical of the trust's axing of 150 jobs - many of them nurses - over 2006/07 as part of a plan to save 10million to meet national cost-saving targets.
The commission launched an investigation in March last year after figures revealed high mortality rates for patients admitted as emergencies, which the trust had failed to investigate adequately. The trust's standardised mortality rate (SMR) was 127 in 2005/06, way above the national rate of 100, making it the fifth-highest in England. The rate is not the actual number of deaths, but an expression of the link between registered deaths and those expected from the number of diagnoses. Over the following two years, the rate at one point jumped to 145.
A source said the reference to the scandal being the likely cause of 'at least 400 deaths' was removed from the final version of the report summary yesterday morning amid concerns about the way the figure was calculated. 'Regardless of this, the report makes it obvious that the hospital had serious shortcomings. 'The fact that this trust was only the fifth-worst in England, in terms of its SMR, does not bode well for the rest of the country's hospitals.'
The period the hospital trust was under investigation coincides with the reign of the current NHS chief executive, David Nicholson, as chief executive of the West Midlands Strategic Health Authority, which covers Staffordshire. Mr Nicholson left in 2006 and was replaced by Cynthia Bower, who is the new head of the Care Quality Care Commission, which will replace the Healthcare Commission at the end of this month. Last week, it was announced that the Mid Staffordshire Trust's chairman, Toni Brisby, and chief executive, Martin Yeates, had resigned ahead of the commission's report. But sources close to the investigation believe the pair were ' sacrificed' as scapegoats to deflect attention away from Mr Nicholson and Mrs Bower's proximity to the Staffordshire scandal.
'DREADFUL, ABYSMAL, INEXCUSABLE'
Arthur Peacham, 68, had been retired for just two weeks when he was admitted to Stafford Hospital with back pain following a hernia operation. After a week he was about to go home when staff told his wife, Gillian, that he had caught the C.difficile superbug. After that, Mrs Peacham said, a series of 'horrendous' blunders helped lead to her husband's death on March 19, 2006, including failing to give him food and leaving him on 'filthy' wards.
'What happened to him was horrific,' said Mrs Peacham, 69. 'When they told me he had caught C. difficile they admitted they had known 11 other people on the ward were already infected but they had nowhere else to put him. 'They told us it wasn't contagious but my son checked on the internet and saw that it was highly contagious and could result in death. 'My husband went downhill from there. He was having trouble keeping food down and they were supposed to give him a special drink but they didn't feed him most of the time. 'Either they would forget to get a prescription from the doctor or they were too short- staffed to care for him.
Mr Peacham, an agronomist who had two sons and four grandchildren, was eventually moved to New Cross Hospital in Wolverhampton in early March. His widow said: 'There it was amazing. He was so clean and well looked after. 'Unfortunately by then it was too late. The C.diff had ravaged his body.' She added: 'The care at Stafford Hospital was dreadful, abysmal, inexcusable.'
SOURCE
Child died after Australian public hospitals sent him home three times
Calling this kid's problem "croup" is absurd. Croup has a frequent cough and there is no mention of that. And croup is very common so the doctors should have known that. The negligence is gross
Timothy Wood's parents knew something was terribly wrong with their son, but they could not get the help they were sure he needed. Desperately straining for air and with swelling around his neck, the 19-month-old was sent home from hospital on July 16, 2005, for the third time in four days. The next afternoon, he was rushed back to hospital, where he died two days later.
Anthony and Robyn Wood hope a coronial inquest will give them some answers. Their solicitor Kathryn Booth, of Maurice Blackburn, said outside the Victorian Coroners Court yesterday: "Mr and Mrs Wood have been waiting a very long time to have this inquest and it's been important to them to get answers as to why Timmy died after three presentations to two different hospitals."
Mr Wood said: "The last thing we want to have happen is the same thing happen to another child - it was bad enough to go through it. "You're not meant to outlive your children and it will be something that we will take to our grave."
In statements tendered to the court, Mr Wood said he believed the Austin Hospital should have done things differently when he took his son there on July 16, 2005. "I do not believe that Timothy should have been discharged from the hospital that evening," he said. "The medical staff was not in a position to accurately diagnose the extent of Timothy's problem or make a decision to discharge him as he had not been closely monitored and examined during his time at the hospital." Giving evidence, Mr Wood was even more direct. "We thought the observation levels (at the Austin Hospital) were pathetic. They weren't there," he said.
Timmy became sick on Thursday, July 14, 2005. By about 2am on the Friday, his breathing was badly restricted and his parents called an ambulance. He was taken to the Royal Children's Hospital, where he was diagnosed with croup, observed for four hours and given medication before being sent home. On the Saturday morning, the Woods were still concerned and took him back. When they saw the triage nurse they were told if they waited in emergency for a doctor it would be unlikely that the treatment plan would change.
They went home, but Timmy did not improve and they called a 24-hour maternal health nurse help line. The nurse could hear Timmy's laboured breathing and told Mr Wood to call an ambulance immediately and prepare for an overnight stay. But when they got to the Austin hospital - the Royal Children's was full - Timmy was not admitted. Instead, he was given more medication and sent home.
The next day, he stopped breathing. Mr Wood administered CPR until an ambulance arrived and Timmy was rushed to the Royal Children's Hospital, where he died two days later. Mr Wood wrote in a letter to the coroner in August 2005: "It was said to us by some of the (intensive care unit) team at the Royal Children's Hospital that they are amazed that a child can die from croup these days. "The Austin Hospital and medical team simply let us down."
The inquest, before coroner David Drake, continues.
SOURCE
Tuesday, March 17, 2009
Hospital waiting lists will soar due to European laws, British surgeons warn
Patients face a significant increase in waiting times for operations as 'insane' European rules mean doctors' hours are cut so much medics will not be able to cope, surgeons have warned.
The key pledge of Labour's NHS reform has been to reduce waiting lists and now the majority of patients are treated within the target of 18 weeks from seeing their GP. However this will be reversed as junior doctors will be limited to working a 48-hour week, from their current 56 hours, it is claimed. The extension of the European Working Time Directive will effectively result in the loss of thousands of doctor shifts, John Black, President of the Royal College of Surgeons said. And the Government fears there will be a lack of locum doctors available to step in and help fill the gaps, following changes in doctors' recruitment.
It means patients will have to wait months for routine operations as surgeons prioritise emergencies rather than scheduled cases. The Royal College of Surgeons wants trainee surgeons on a 65-hour working week in order to produce safe, properly trained doctors and cover the workload required by hospitals.
Mr Black said: "If the 48 hour limit is enforced, surgeons will have to make a hard choice between caring for emergency cases and dealing with elective cases as there will not be the time available to do both. Surgeons will put patient safety first and focus on looking after emergency patients. "All the progress on reducing waiting lists will go out of the window. Forty eight hours for surgeons is currently insane if we want maintain surgery in the NHS."
Doctors have calculated an average hospital trust outside London will lose the equivalent of three trainee surgeons and other specialities such as paediatrics, trauma, and intensive care are likely to be similarly affected. Smaller surgical units may have to shut or be merged in order to comply with the Directive, Shadow Health Secretary Andrew Lansley warned.
It is understood the Department of Health is considering increasing the length of time it takes to qualify as a consultant surgeon from seven years to eight or nine so doctors can gain enough experience and also comply with the limited working week.
Vanessa Bourne of the Patients Association said: "How can this be happening in a supposedly patient-centred service? Access to high quality safe care is the paramount requisite for patient and clinician alike and this muddle needs sorting out before patients are put at risk."
The new regulations come into force on August 1 at the same time hospital trusts are trying to cope with organising the new intake of junior doctors. The shake-up of doctors' training, which caused a fiasco in 2007, means more trainees are in longer-term posts so there are now fewer candidates looking for locum posts and temporary jobs.
Remedy UK, the junior doctors pressure group, has calculated that switching all juniors from a 56 hour to a 48 hour working week is the equivalent of losing one working day per doctor per week, or up to 70,000 doctor days per week across the UK. Dr Matt Jameson Evans, co-founder of Remedy UK, said: "In many key specialties the system is already massively overstretched. "Just imagine the impact of a blanket reduction in doctors' hours by one full day a week. A creaking system will collapse. And yet most doctors want the freedom to choose to opt-out of 48 hours. "We're begging for some common sense - an official endorsement by Government of the individual opt-out for trainee doctors would go a long way."
Mr Lansley said: "NHS staff have been absolutely clear that if the 48 hour working week is imposed on them it will leave many junior doctors with insufficient experience from their training. It will also threaten the care that patients receive because there will not be the same continuity of care and because smaller surgical teams will have to be shut down."
Dr Andy Thornley, chairman of the British Medical Association's Junior Doctor Committee warned that the doctors' training will lose out because there will be an 'all hands on deck' culture to delivering patient care. He said: "Doctors will work hard to ensure that patient services are maintained, but the potential for disruption exists. The NHS will not be sustainable if we do not equip our junior doctors with the necessary training to be the consultants of tomorrow."
The Department of Health wants to delay the introduction of a 48-hour week for some specialities and is expecting an answer from the European Commission by the end of May. However this would only mean some doctors could remain on 56 hours until 2012 and will not solve the problem in the long-run, experts have said.
A spokesman for the Department of Health said: "Most UK doctors in training already comply with the Working Time Directive, and the overwhelming majority will do so by 1st August this year. However, we have notified the European Commission that we intend to operate a derogation for a small number of services involved in delivering urgent and emergency patient care."
The Working Time Directive is already in force in most areas of business, limiting the working week to 48 hours and setting minimum rest periods. Individual workers can choose to opt-out although some professions such as the Armed Forces are not covered.
SOURCE
Australia: Claims that public hospital waiting lists are "doctored"
THE Opposition wants the state government to launch an inquiry into allegations hospitals are fudging figures to avoid fines. The Victoria Police fraud squad is investigating claims many hospitals manipulate waiting list data to cash in on government bonuses and avoid paying fines.
Opposition health spokeswoman Helen Shardey said the practice showed the health system was "at crisis point". "The fact that these revelations have been sent to the police, the fact that the upper house is starting an inquiry to look into all of these matters of hidden waiting lists, I believe, is proof that the Brumby government is covering up, is not prepared to investigate and is concealing the truth." Ms Shardey said hospitals were forced to fudge figures to maximise every opportunity for funding because the health system had been mismanaged. "The Brumby government needs to investigate what is going on in our hospitals, where waiting lists are being fudged and where they are being altered to hide the true state of the time that people are waiting for procedures in our hospitals."
A computer expert who wrote a file carrying the alleged information - but who wants to remain anonymous - was employed to analyse patient data systems at several major Victorian hospitals. "Many of the hospitals and health services I have consulted with over the last year have admitted to me that they fudge the figures to avoid the fines and cash in on the bonus funding for meeting the reporting requirements," the file stated. The effect of the practice would mean a patient could be waiting up to a year for surgery but the file would show a much shorter wait, Fairfax reported today.
The file also alleges hospitals use two sets of waiting lists, where one is kept "in the drawer", used when beds become available or when a patient is clinically ready for surgery. Senior hospital staff privately admitted administrators want to avoid fines for not treating patients within required times and want to claim bonuses from the Victorian government for meeting targets, the file said.
The "ghost ward" claims follow allegations that a doctor at Angliss Hospital in Ferntree Gully was sacked after he submitted concerns about hospital data manipulation to an opposition-led upper house inquiry in January.
SOURCE
Patients face a significant increase in waiting times for operations as 'insane' European rules mean doctors' hours are cut so much medics will not be able to cope, surgeons have warned.
The key pledge of Labour's NHS reform has been to reduce waiting lists and now the majority of patients are treated within the target of 18 weeks from seeing their GP. However this will be reversed as junior doctors will be limited to working a 48-hour week, from their current 56 hours, it is claimed. The extension of the European Working Time Directive will effectively result in the loss of thousands of doctor shifts, John Black, President of the Royal College of Surgeons said. And the Government fears there will be a lack of locum doctors available to step in and help fill the gaps, following changes in doctors' recruitment.
It means patients will have to wait months for routine operations as surgeons prioritise emergencies rather than scheduled cases. The Royal College of Surgeons wants trainee surgeons on a 65-hour working week in order to produce safe, properly trained doctors and cover the workload required by hospitals.
Mr Black said: "If the 48 hour limit is enforced, surgeons will have to make a hard choice between caring for emergency cases and dealing with elective cases as there will not be the time available to do both. Surgeons will put patient safety first and focus on looking after emergency patients. "All the progress on reducing waiting lists will go out of the window. Forty eight hours for surgeons is currently insane if we want maintain surgery in the NHS."
Doctors have calculated an average hospital trust outside London will lose the equivalent of three trainee surgeons and other specialities such as paediatrics, trauma, and intensive care are likely to be similarly affected. Smaller surgical units may have to shut or be merged in order to comply with the Directive, Shadow Health Secretary Andrew Lansley warned.
It is understood the Department of Health is considering increasing the length of time it takes to qualify as a consultant surgeon from seven years to eight or nine so doctors can gain enough experience and also comply with the limited working week.
Vanessa Bourne of the Patients Association said: "How can this be happening in a supposedly patient-centred service? Access to high quality safe care is the paramount requisite for patient and clinician alike and this muddle needs sorting out before patients are put at risk."
The new regulations come into force on August 1 at the same time hospital trusts are trying to cope with organising the new intake of junior doctors. The shake-up of doctors' training, which caused a fiasco in 2007, means more trainees are in longer-term posts so there are now fewer candidates looking for locum posts and temporary jobs.
Remedy UK, the junior doctors pressure group, has calculated that switching all juniors from a 56 hour to a 48 hour working week is the equivalent of losing one working day per doctor per week, or up to 70,000 doctor days per week across the UK. Dr Matt Jameson Evans, co-founder of Remedy UK, said: "In many key specialties the system is already massively overstretched. "Just imagine the impact of a blanket reduction in doctors' hours by one full day a week. A creaking system will collapse. And yet most doctors want the freedom to choose to opt-out of 48 hours. "We're begging for some common sense - an official endorsement by Government of the individual opt-out for trainee doctors would go a long way."
Mr Lansley said: "NHS staff have been absolutely clear that if the 48 hour working week is imposed on them it will leave many junior doctors with insufficient experience from their training. It will also threaten the care that patients receive because there will not be the same continuity of care and because smaller surgical teams will have to be shut down."
Dr Andy Thornley, chairman of the British Medical Association's Junior Doctor Committee warned that the doctors' training will lose out because there will be an 'all hands on deck' culture to delivering patient care. He said: "Doctors will work hard to ensure that patient services are maintained, but the potential for disruption exists. The NHS will not be sustainable if we do not equip our junior doctors with the necessary training to be the consultants of tomorrow."
The Department of Health wants to delay the introduction of a 48-hour week for some specialities and is expecting an answer from the European Commission by the end of May. However this would only mean some doctors could remain on 56 hours until 2012 and will not solve the problem in the long-run, experts have said.
A spokesman for the Department of Health said: "Most UK doctors in training already comply with the Working Time Directive, and the overwhelming majority will do so by 1st August this year. However, we have notified the European Commission that we intend to operate a derogation for a small number of services involved in delivering urgent and emergency patient care."
The Working Time Directive is already in force in most areas of business, limiting the working week to 48 hours and setting minimum rest periods. Individual workers can choose to opt-out although some professions such as the Armed Forces are not covered.
SOURCE
Australia: Claims that public hospital waiting lists are "doctored"
THE Opposition wants the state government to launch an inquiry into allegations hospitals are fudging figures to avoid fines. The Victoria Police fraud squad is investigating claims many hospitals manipulate waiting list data to cash in on government bonuses and avoid paying fines.
Opposition health spokeswoman Helen Shardey said the practice showed the health system was "at crisis point". "The fact that these revelations have been sent to the police, the fact that the upper house is starting an inquiry to look into all of these matters of hidden waiting lists, I believe, is proof that the Brumby government is covering up, is not prepared to investigate and is concealing the truth." Ms Shardey said hospitals were forced to fudge figures to maximise every opportunity for funding because the health system had been mismanaged. "The Brumby government needs to investigate what is going on in our hospitals, where waiting lists are being fudged and where they are being altered to hide the true state of the time that people are waiting for procedures in our hospitals."
A computer expert who wrote a file carrying the alleged information - but who wants to remain anonymous - was employed to analyse patient data systems at several major Victorian hospitals. "Many of the hospitals and health services I have consulted with over the last year have admitted to me that they fudge the figures to avoid the fines and cash in on the bonus funding for meeting the reporting requirements," the file stated. The effect of the practice would mean a patient could be waiting up to a year for surgery but the file would show a much shorter wait, Fairfax reported today.
The file also alleges hospitals use two sets of waiting lists, where one is kept "in the drawer", used when beds become available or when a patient is clinically ready for surgery. Senior hospital staff privately admitted administrators want to avoid fines for not treating patients within required times and want to claim bonuses from the Victorian government for meeting targets, the file said.
The "ghost ward" claims follow allegations that a doctor at Angliss Hospital in Ferntree Gully was sacked after he submitted concerns about hospital data manipulation to an opposition-led upper house inquiry in January.
SOURCE
Monday, March 16, 2009
Mother of rugby suicide damns NHS
Slothful care left her son paralysed
JULIE JAMES, whose son Dan was paralysed in a rugby training accident and took his own life in a Swiss clinic last autumn, has spoken for the first time of her anger at the “disgraceful” care he received from the NHS in the hours after the accident. James believes the indifference with which her son was treated at two hospitals in the Midlands wasted 30 vital hours after the accident, in March 2007, which led to the 23-year-old becoming paralysed from the neck down. “If he had been treated differently perhaps Dan would have ended up with an injury he could have lived with,” she said.
When he was taken to hospital after a scrum collapsed on him, dislocating two vertebrae and trapping his spinal cord, James says “the terror on Dan’s face was apparent” but he still had the use of his arms and hands. Some 30 hours later, his hand function had disappeared after he had been moved unnecessarily, put last in the queue for an MRI scan and waited for four hours for an ambulance to transfer him to the spinal injuries unit at Stoke Mandeville hospital.
As she launched a fundraising drive in Dan’s memory, James, from Sinton Green, near Worcester, spoke about her “feelings of helplessness and despair” as she watched her son, who played rugby for England as a teenager, reduced to a state of “fear and loathing of his living existence”.
SOURCE
THE WRONG ANSWER TO HIGH DRUG PRICES
In state-run health care systems, cost pressures typically prompt governments to ration access to treatments for patients, often via waiting lists or low usage of medical technology. In order to provide a veneer of scientific rationale for these restrictions, governments often employ cost-benefit analyses, known as "health technology assessments" (HTAs), says the Fraser Institute.
Though these assessments may save money in the short term, they unleash a number of hidden economic consequences creating undue distress for dying patients. Many countries are increasingly turning to these types of "comparative effectiveness" reviews to restrict access to expensive new drugs, says Fraser:
* In 1988, Canada instituted a Health Technology Assessment program in Quebec; today, HTAs are widely used at the national and provincial level.
*Since 2004, Germany's Institute for Quality and Economic Efficiency in the Health Care Sector has provided "comparative effectiveness" information to health care insurers.
* Even the United States is poised to give more prominence to HTAs, as President Barack Obama has proposed to "establish an independent institute to guide reviews and research on comparative effectiveness."
But before marketing approval for a drug can occur, it must pass through 4 phases of clinical trials, says Fraser:
*( Less than 1 in 1,000 makes it past the first stage and the chance of a drug making it to approval are less than 0.03 percent.
* Moreover, every year, regulators add more mandatory tests; as a result, the average cost of bringing a new drug to market has risen from US$119 million (1975) to almost US$900 million (2003).
To solve the problem of high drug prices, it is necessary to radically overhaul the drug approval process. One solution is injecting a degree of competition. Bringing in competition could liberate innovation, speed up the development of new medicines, remove the need for expensive surgery and limit the need for costly in-patient care. This would be good for patients and health care funders alike, says Fraser.
SOURCE
Slothful care left her son paralysed
JULIE JAMES, whose son Dan was paralysed in a rugby training accident and took his own life in a Swiss clinic last autumn, has spoken for the first time of her anger at the “disgraceful” care he received from the NHS in the hours after the accident. James believes the indifference with which her son was treated at two hospitals in the Midlands wasted 30 vital hours after the accident, in March 2007, which led to the 23-year-old becoming paralysed from the neck down. “If he had been treated differently perhaps Dan would have ended up with an injury he could have lived with,” she said.
When he was taken to hospital after a scrum collapsed on him, dislocating two vertebrae and trapping his spinal cord, James says “the terror on Dan’s face was apparent” but he still had the use of his arms and hands. Some 30 hours later, his hand function had disappeared after he had been moved unnecessarily, put last in the queue for an MRI scan and waited for four hours for an ambulance to transfer him to the spinal injuries unit at Stoke Mandeville hospital.
As she launched a fundraising drive in Dan’s memory, James, from Sinton Green, near Worcester, spoke about her “feelings of helplessness and despair” as she watched her son, who played rugby for England as a teenager, reduced to a state of “fear and loathing of his living existence”.
SOURCE
THE WRONG ANSWER TO HIGH DRUG PRICES
In state-run health care systems, cost pressures typically prompt governments to ration access to treatments for patients, often via waiting lists or low usage of medical technology. In order to provide a veneer of scientific rationale for these restrictions, governments often employ cost-benefit analyses, known as "health technology assessments" (HTAs), says the Fraser Institute.
Though these assessments may save money in the short term, they unleash a number of hidden economic consequences creating undue distress for dying patients. Many countries are increasingly turning to these types of "comparative effectiveness" reviews to restrict access to expensive new drugs, says Fraser:
* In 1988, Canada instituted a Health Technology Assessment program in Quebec; today, HTAs are widely used at the national and provincial level.
*Since 2004, Germany's Institute for Quality and Economic Efficiency in the Health Care Sector has provided "comparative effectiveness" information to health care insurers.
* Even the United States is poised to give more prominence to HTAs, as President Barack Obama has proposed to "establish an independent institute to guide reviews and research on comparative effectiveness."
But before marketing approval for a drug can occur, it must pass through 4 phases of clinical trials, says Fraser:
*( Less than 1 in 1,000 makes it past the first stage and the chance of a drug making it to approval are less than 0.03 percent.
* Moreover, every year, regulators add more mandatory tests; as a result, the average cost of bringing a new drug to market has risen from US$119 million (1975) to almost US$900 million (2003).
To solve the problem of high drug prices, it is necessary to radically overhaul the drug approval process. One solution is injecting a degree of competition. Bringing in competition could liberate innovation, speed up the development of new medicines, remove the need for expensive surgery and limit the need for costly in-patient care. This would be good for patients and health care funders alike, says Fraser.
SOURCE
Sunday, March 15, 2009
Get Ready for Electronic Health Record Failures, But Don't Blame the Software
Computerized medical records are an old dream and sometimes work well enough within an individual medical practice. On a large scale, however, they seem likely to remain a dream. Britain has spent around 30 BILLION dollars in setting up such a system to cover all its hospitals -- with very poor results so far. It is common for governments and large businesses to spend many millions on custom software only to have to abandon it eventually as a failure. The article below makes the additional point that even if the software is working well, there are still large human factors making its implementation very difficult.
I have been writing scientific computer programs since 1967 so I am not anti-computer. I have however been around long enough to see a lot of very expensive failed attempts at computerization. Just as one example, the Australian government recently spent $300 million on a program to run its new submarines -- only to end up scrapping it all and buying in existing American software instead
With the Economic Stimulus Bill signed and available to subsidize EHR purchases (for more information see "The Stimulus Bill and Meaningful Use of Qualified EHRs/EMRs"), we are seeing a dramatic increase in electronic health records (EHR) buyer interest. Assuming these buyers make use of the stimulus subsidy to buy an EHR, we expect to see a lot of EHR failures over the next couple years.
Don't get us wrong! We are HUGE advocates of EHR technology. Doctors should be using EHRs. The stimulus subsidy is great. EHR software programs (and software companies) are not the problem.
Our concern is that the subsidies won't change healthcare providers' late adopter mindsets about information technology. Providers may jump at "free software" and try to avoid penalties (starting in 2015), but will they:
* Truly believe in the value of an EHR over traditional paper charts?
* Take a leadership role in advocating adoption of the new EHR in their practice?
* Change their old workflows to match the best practices in leading EHRs?
* Take part in intensive training to learn the new system?
* Ride out the difficult stages of new software adoption and change management?
Traditionally, the substantial costs of EHR systems keep the luddites from buying technology in the face of these challenges. But with "free" EHR software, we expect more than a few providers to throw caution to the wind, buy an EHR and overlook the critical implementation and change management practices that are critical to success.
The best things in life are free, but that doesn't refer to healthcare IT. We think providers would be far more serious about implementation and adoption if they had to pay dearly for the technology. Accordingly, here are our thoughts on why IT projects fail and how providers can avoid that fate while still capitalizing on this once-in-a-lifetime subsidy.
When and why do IT projects fail?
In 2007, the U.S. Office of the National Coordinator for Health IT reported that about 50% of EHR implementations failed. IT industry analysts widely agree that software implementations fail because of the customers. It's too easy to point the finger at software vendors or at the software itself, but failure usually is the buyer's fault. In a recent survey, one group identified the following top reasons for IT implementation failures:
* ~40% attribute failure to poor planning and communication;
* ~20% cite mismanagement and rejection by end users; and
* ~15% blame overspending.
Very few doctors use EHRs. In fact, most predictions put EMR market penetration at 10%-15%. We all know why this figure is so low: doctors don't want to use them, practice staff is stuck doing things "the old-fashioned way," etc. Now that Uncle Sam is willing to pay for EMRs (and telling us we had better buy!), a lot more practices are going to adopt them. The scary thing, however, is that the same feelings that have slowed the adoption of EMRs are still prevalent. Here let me present what I think are 5 critical steps for a smooth, successful EMR implementation:
1. Become a project manager. If you're a physician, you may not consider yourself a business person. However, for this project, you need to become a project manager. If you're lucky, you may have a staff member or consultant that can play the role for you, but don't count on it. First, create a project plan. Outline all the steps of your implementation so you know what changes need to occur by certain deadlines. Stay on top of the plan and hold your team accountable.
2. Rally everyone else. Recall that poor leadership and lack of user adoption are frequently cited as contributing factors to IT failures. You need to express confidence in the technology and get your staff on board before the implementation. Show how much easier their lives will be. Get them excited about it. Tell your patients that next time you see them, you will be a computer whiz with a slick EHR.
3. Buy the best training you can. The government is paying for it (laugh). Seriously though, you will need the help. It's too easy to skimp on adequate training and ongoing support. Don't risk failure of an investment because you want to save a few thousand bucks. It's worth it. Get trainers in the office, send the staff to training, implement a train-the-trainer program.
4. KISS: Keep It Simple, Stupid. No office becomes paperless overnight, so don't try to do everything at once. Ease into your new workflow as much as you can. Adopt advanced features after you learn how to turn on the computer. It is OK to implement bells and whistles after the initial dust has settled.
5. Be prepared to practice differently. As much as you don't want to admit it, you will need to adjust the way you meet with patients and how your practice operates. And if you can, make easy adjustments ahead of time. Start carrying a tablet PC or dictating with voice recognition software. It pays to work out the kinks early on.
If you follow these major guidelines - and a lot more small steps in between - you'll have a much greater chance of EHR success. Most importantly, wrap your head around being tech savvy and enjoying the new system. If you don't, you'll pay for it (one way or another).
SOURCE
Negligent NHS doctors let teenager die of cancer
A teenager died from massive cancerous tumours after his GP repeatedly failed to diagnose the disease and told him to 'grow up a bit and stop worrying', an inquest has heard. Christopher Chaffey, 19, was so worried about his failing health that he visited his doctor's surgery half a dozen times in the 15 months up to his death. His symptoms were dismissed as minor and allegedly put down to 'panic attacks'. Even when a blood test was 'significantly abnormal', the GP thought it indicated mild anaemia instead of taking it more seriously.
X Factor contestant Mr Chaffey found the same attitude at a hospital casualty department when he was taken there by ambulance with a headache, vomiting and chest pains. A doctor at Hull Royal Infirmary believed he had an anxiety-related condition and told him to consult his GP.
But the teenager's body was gradually being ravaged by cancer and he died two months later - two days after doctors finally discovered the true nature of his condition. A post-mortem examination found tumours in his neck and skull, as well as a huge tumour affecting his heart and lungs which weighed four-and-a-half pounds.
The alleged medical blunders were revealed at an inquest in Hull. Dr Sahra Ali, a consultant haematologist who was involved only at the very end of his treatment, told the hearing that the lymphoma would have taken months to develop. The doctor added: 'It's a very sad case which is treatable and potentially curable if it would have presented at an earlier stage.'
Mr Chaffey, of Coniston, near Hull, was a music fan and had been a contestant in The X Factor two years earlier, although he failed to get beyond the first round. He was forced to postpone his A-level studies in media and law because of his health problems.
The inquest heard how Mr Chaffey's GP, Joseph Austin, ordered blood tests in July 2007 after the teenager complained of excessive sweating and hair loss. The tests showed abnormalities, but were not considered important. Repeat blood tests the following April showed his haemoglobin levels had fallen, which the GP diagnosed as a mild type of anaemia.
Independent expert Bill Holmes said these blood test results should have been 'explored more actively'. He said night sweating was a well-recognised symptom of lymphoma, although GPs usually came across more innocent causes.
Mr Chaffey's mother Patricia, 40, told the hearing that when her son went back to the GP with his taxi driver father Paul, 43, they were allegedly told 'he should grow up a bit and stop worrying there's something wrong with him'. She took him back to the GP when bouts of fainting prevented him from doing voluntary work at a charity shop. Mrs Chaffey told the GP about prominent veins on her son's chest, his voice becoming hoarse, and that she sometimes had to sleep in his bedroom, but the doctor put it down to panic attacks, the inquest heard.
Dr Austin said he never suspected his patient was suffering from anything serious. Asked by coroner Geoffrey Saul whether he had ever suggested to a member of the family that the problem was in the mind, Dr Austin replied: 'No, I never told him that.'
On July 19 last year, when Mr Chaffey was taken to Hull Royal Infirmary, tests were ordered by Dr Mohammed As'Ad, who also decided there was nothing physically wrong with him.
Later, consultant Mark Higson concluded there had been 'several' missed opportunities at the A&E department when the cancer could have been picked up.
Mr Chaffey's father got in touch with the Psychosis Service for Young People, which put him on a six-month plan to cope with anxiety, but his health continued to worsen and his weight to drop. On September 17 last, the family spotted a lump on his neck and he was seen by an out-of-hours doctor. He was admitted to hospital but by then it was too late.
SOURCE
Computerized medical records are an old dream and sometimes work well enough within an individual medical practice. On a large scale, however, they seem likely to remain a dream. Britain has spent around 30 BILLION dollars in setting up such a system to cover all its hospitals -- with very poor results so far. It is common for governments and large businesses to spend many millions on custom software only to have to abandon it eventually as a failure. The article below makes the additional point that even if the software is working well, there are still large human factors making its implementation very difficult.
I have been writing scientific computer programs since 1967 so I am not anti-computer. I have however been around long enough to see a lot of very expensive failed attempts at computerization. Just as one example, the Australian government recently spent $300 million on a program to run its new submarines -- only to end up scrapping it all and buying in existing American software instead
With the Economic Stimulus Bill signed and available to subsidize EHR purchases (for more information see "The Stimulus Bill and Meaningful Use of Qualified EHRs/EMRs"), we are seeing a dramatic increase in electronic health records (EHR) buyer interest. Assuming these buyers make use of the stimulus subsidy to buy an EHR, we expect to see a lot of EHR failures over the next couple years.
Don't get us wrong! We are HUGE advocates of EHR technology. Doctors should be using EHRs. The stimulus subsidy is great. EHR software programs (and software companies) are not the problem.
Our concern is that the subsidies won't change healthcare providers' late adopter mindsets about information technology. Providers may jump at "free software" and try to avoid penalties (starting in 2015), but will they:
* Truly believe in the value of an EHR over traditional paper charts?
* Take a leadership role in advocating adoption of the new EHR in their practice?
* Change their old workflows to match the best practices in leading EHRs?
* Take part in intensive training to learn the new system?
* Ride out the difficult stages of new software adoption and change management?
Traditionally, the substantial costs of EHR systems keep the luddites from buying technology in the face of these challenges. But with "free" EHR software, we expect more than a few providers to throw caution to the wind, buy an EHR and overlook the critical implementation and change management practices that are critical to success.
The best things in life are free, but that doesn't refer to healthcare IT. We think providers would be far more serious about implementation and adoption if they had to pay dearly for the technology. Accordingly, here are our thoughts on why IT projects fail and how providers can avoid that fate while still capitalizing on this once-in-a-lifetime subsidy.
When and why do IT projects fail?
In 2007, the U.S. Office of the National Coordinator for Health IT reported that about 50% of EHR implementations failed. IT industry analysts widely agree that software implementations fail because of the customers. It's too easy to point the finger at software vendors or at the software itself, but failure usually is the buyer's fault. In a recent survey, one group identified the following top reasons for IT implementation failures:
* ~40% attribute failure to poor planning and communication;
* ~20% cite mismanagement and rejection by end users; and
* ~15% blame overspending.
Very few doctors use EHRs. In fact, most predictions put EMR market penetration at 10%-15%. We all know why this figure is so low: doctors don't want to use them, practice staff is stuck doing things "the old-fashioned way," etc. Now that Uncle Sam is willing to pay for EMRs (and telling us we had better buy!), a lot more practices are going to adopt them. The scary thing, however, is that the same feelings that have slowed the adoption of EMRs are still prevalent. Here let me present what I think are 5 critical steps for a smooth, successful EMR implementation:
1. Become a project manager. If you're a physician, you may not consider yourself a business person. However, for this project, you need to become a project manager. If you're lucky, you may have a staff member or consultant that can play the role for you, but don't count on it. First, create a project plan. Outline all the steps of your implementation so you know what changes need to occur by certain deadlines. Stay on top of the plan and hold your team accountable.
2. Rally everyone else. Recall that poor leadership and lack of user adoption are frequently cited as contributing factors to IT failures. You need to express confidence in the technology and get your staff on board before the implementation. Show how much easier their lives will be. Get them excited about it. Tell your patients that next time you see them, you will be a computer whiz with a slick EHR.
3. Buy the best training you can. The government is paying for it (laugh). Seriously though, you will need the help. It's too easy to skimp on adequate training and ongoing support. Don't risk failure of an investment because you want to save a few thousand bucks. It's worth it. Get trainers in the office, send the staff to training, implement a train-the-trainer program.
4. KISS: Keep It Simple, Stupid. No office becomes paperless overnight, so don't try to do everything at once. Ease into your new workflow as much as you can. Adopt advanced features after you learn how to turn on the computer. It is OK to implement bells and whistles after the initial dust has settled.
5. Be prepared to practice differently. As much as you don't want to admit it, you will need to adjust the way you meet with patients and how your practice operates. And if you can, make easy adjustments ahead of time. Start carrying a tablet PC or dictating with voice recognition software. It pays to work out the kinks early on.
If you follow these major guidelines - and a lot more small steps in between - you'll have a much greater chance of EHR success. Most importantly, wrap your head around being tech savvy and enjoying the new system. If you don't, you'll pay for it (one way or another).
SOURCE
Negligent NHS doctors let teenager die of cancer
A teenager died from massive cancerous tumours after his GP repeatedly failed to diagnose the disease and told him to 'grow up a bit and stop worrying', an inquest has heard. Christopher Chaffey, 19, was so worried about his failing health that he visited his doctor's surgery half a dozen times in the 15 months up to his death. His symptoms were dismissed as minor and allegedly put down to 'panic attacks'. Even when a blood test was 'significantly abnormal', the GP thought it indicated mild anaemia instead of taking it more seriously.
X Factor contestant Mr Chaffey found the same attitude at a hospital casualty department when he was taken there by ambulance with a headache, vomiting and chest pains. A doctor at Hull Royal Infirmary believed he had an anxiety-related condition and told him to consult his GP.
But the teenager's body was gradually being ravaged by cancer and he died two months later - two days after doctors finally discovered the true nature of his condition. A post-mortem examination found tumours in his neck and skull, as well as a huge tumour affecting his heart and lungs which weighed four-and-a-half pounds.
The alleged medical blunders were revealed at an inquest in Hull. Dr Sahra Ali, a consultant haematologist who was involved only at the very end of his treatment, told the hearing that the lymphoma would have taken months to develop. The doctor added: 'It's a very sad case which is treatable and potentially curable if it would have presented at an earlier stage.'
Mr Chaffey, of Coniston, near Hull, was a music fan and had been a contestant in The X Factor two years earlier, although he failed to get beyond the first round. He was forced to postpone his A-level studies in media and law because of his health problems.
The inquest heard how Mr Chaffey's GP, Joseph Austin, ordered blood tests in July 2007 after the teenager complained of excessive sweating and hair loss. The tests showed abnormalities, but were not considered important. Repeat blood tests the following April showed his haemoglobin levels had fallen, which the GP diagnosed as a mild type of anaemia.
Independent expert Bill Holmes said these blood test results should have been 'explored more actively'. He said night sweating was a well-recognised symptom of lymphoma, although GPs usually came across more innocent causes.
Mr Chaffey's mother Patricia, 40, told the hearing that when her son went back to the GP with his taxi driver father Paul, 43, they were allegedly told 'he should grow up a bit and stop worrying there's something wrong with him'. She took him back to the GP when bouts of fainting prevented him from doing voluntary work at a charity shop. Mrs Chaffey told the GP about prominent veins on her son's chest, his voice becoming hoarse, and that she sometimes had to sleep in his bedroom, but the doctor put it down to panic attacks, the inquest heard.
Dr Austin said he never suspected his patient was suffering from anything serious. Asked by coroner Geoffrey Saul whether he had ever suggested to a member of the family that the problem was in the mind, Dr Austin replied: 'No, I never told him that.'
On July 19 last year, when Mr Chaffey was taken to Hull Royal Infirmary, tests were ordered by Dr Mohammed As'Ad, who also decided there was nothing physically wrong with him.
Later, consultant Mark Higson concluded there had been 'several' missed opportunities at the A&E department when the cancer could have been picked up.
Mr Chaffey's father got in touch with the Psychosis Service for Young People, which put him on a six-month plan to cope with anxiety, but his health continued to worsen and his weight to drop. On September 17 last, the family spotted a lump on his neck and he was seen by an out-of-hours doctor. He was admitted to hospital but by then it was too late.
SOURCE
Saturday, March 14, 2009
Shocker! Uninsured not jamming emergency rooms
1st major study contradicts conventional assumptions and shows that it is those "insured" by the government who have no place else to go
Hospital emergency rooms are overcrowded because uninsured patients have nowhere else to turn. Right? Wrong, says a study published in the Journal of the American Medical Association. Hospital emergency rooms are, indeed, jammed. But it's not for the reason proponents of nationalized health care suggest.
The study, "Uninsured Adults Presenting to U.S. Emergency Departments: Assumptions vs. Data," found most emergency rooms are packed because more patients of all kinds – insured and uninsured alike – are choosing to visit them. Further, the study found, emergency room patients are being kept there longer than necessary when they should often be checked in or treated in a doctor's office. "This is a larger problem, and the emergency room is the canary in the coal mine," explained Carla Keirns, a contributor to the study.
In conducting the first study of its kind, researchers discovered other scholarly papers on the uninsured found that most simply assumed the uninsured are the principal cause of emergency room overcrowding. In fact, Devon Hetrick, senior fellow at the National Center for Policy Analysis, blamed those carrying government insurance for much of the overcrowding of emergency rooms.
"It's not the uninsured who burden America's emergency rooms so much as it is people who are carrying government insurance policies," he said. "The low reimbursement rates offered doctors by government programs means very few will accept taxpayer-funded insurance any more, leaving those on government plans to visit ERs for care instead of primary-care physicians."
SOURCE
1,000 British villagers wait for a dentist after just one NHS practice opens
The parlous state of NHS dentistry under Labour was exposed last night after it was revealed 1,000 people in a village ended up on a waiting list for a dentist. Nearly one in ten of the 11,500-strong population of Tadley were forced to wait after a single NHS practice opened in the Hampshire village. Their alternatives were paying privately, travelling miles to another NHS dentist - or going without treatment. Local councillor Nigel Quelch said: 'When I phoned, they said they had a waiting list of 1,000. It shows what a huge demand there is for Health Service dentistry. 'But we're very grateful to the dentist for opening in Tadley.'
In 1999, Tony Blair promised that within two years everyone would have access to an NHS dentist. Eight years later he admitted failure. A new contract, introduced three years ago to increase numbers of NHS dentists, has also been judged to have made the situation worse - with 1,000 dentists fleeing the NHS. It means the remaining NHS dentists are overwhelmed and can't take new patients - as the Tadley case shows.
LibDem health spokesman Norman Lamb said: 'We cannot continue with a postcode lottery where people like the Tadley residents can't have access to NHS dentistry.' Hampshire primary care trust confirmed the list had hit 1,000 in December but has since been cleared. It said the practice now has 7,000 patients and can't take more - meaning over 4,000 have no dentist in the village.
SOURCE
Australian government hospital fires whistleblowing doctor
Outspoken Upper Ferntree Gully doctor Peter Lazzari, a strident critic of the health system, says he was sacked today for no apparent reason. The consultant physician, an employee of the Angliss Hospital for the past 13 years, told Knox Leader he was given his marching orders earlier today and was given no reason for his dismissal.
But he had no doubt it was because of his stinging criticism of Eastern Health and the State Government.
He recently made a submission to the Upper House Parliamentary Inquiry into Public Health Data calling for tougher penalties for hospitals that fudge waiting list times.
He said bonuses for hospitals should be scrapped and negligent health executives hauled before the courts to fix the state's health system.
He is understood to be seeking legal advice following his dismissal.
Eastern Health has yet to comment.
SOURCE
1st major study contradicts conventional assumptions and shows that it is those "insured" by the government who have no place else to go
Hospital emergency rooms are overcrowded because uninsured patients have nowhere else to turn. Right? Wrong, says a study published in the Journal of the American Medical Association. Hospital emergency rooms are, indeed, jammed. But it's not for the reason proponents of nationalized health care suggest.
The study, "Uninsured Adults Presenting to U.S. Emergency Departments: Assumptions vs. Data," found most emergency rooms are packed because more patients of all kinds – insured and uninsured alike – are choosing to visit them. Further, the study found, emergency room patients are being kept there longer than necessary when they should often be checked in or treated in a doctor's office. "This is a larger problem, and the emergency room is the canary in the coal mine," explained Carla Keirns, a contributor to the study.
In conducting the first study of its kind, researchers discovered other scholarly papers on the uninsured found that most simply assumed the uninsured are the principal cause of emergency room overcrowding. In fact, Devon Hetrick, senior fellow at the National Center for Policy Analysis, blamed those carrying government insurance for much of the overcrowding of emergency rooms.
"It's not the uninsured who burden America's emergency rooms so much as it is people who are carrying government insurance policies," he said. "The low reimbursement rates offered doctors by government programs means very few will accept taxpayer-funded insurance any more, leaving those on government plans to visit ERs for care instead of primary-care physicians."
SOURCE
1,000 British villagers wait for a dentist after just one NHS practice opens
The parlous state of NHS dentistry under Labour was exposed last night after it was revealed 1,000 people in a village ended up on a waiting list for a dentist. Nearly one in ten of the 11,500-strong population of Tadley were forced to wait after a single NHS practice opened in the Hampshire village. Their alternatives were paying privately, travelling miles to another NHS dentist - or going without treatment. Local councillor Nigel Quelch said: 'When I phoned, they said they had a waiting list of 1,000. It shows what a huge demand there is for Health Service dentistry. 'But we're very grateful to the dentist for opening in Tadley.'
In 1999, Tony Blair promised that within two years everyone would have access to an NHS dentist. Eight years later he admitted failure. A new contract, introduced three years ago to increase numbers of NHS dentists, has also been judged to have made the situation worse - with 1,000 dentists fleeing the NHS. It means the remaining NHS dentists are overwhelmed and can't take new patients - as the Tadley case shows.
LibDem health spokesman Norman Lamb said: 'We cannot continue with a postcode lottery where people like the Tadley residents can't have access to NHS dentistry.' Hampshire primary care trust confirmed the list had hit 1,000 in December but has since been cleared. It said the practice now has 7,000 patients and can't take more - meaning over 4,000 have no dentist in the village.
SOURCE
Australian government hospital fires whistleblowing doctor
Outspoken Upper Ferntree Gully doctor Peter Lazzari, a strident critic of the health system, says he was sacked today for no apparent reason. The consultant physician, an employee of the Angliss Hospital for the past 13 years, told Knox Leader he was given his marching orders earlier today and was given no reason for his dismissal.
But he had no doubt it was because of his stinging criticism of Eastern Health and the State Government.
He recently made a submission to the Upper House Parliamentary Inquiry into Public Health Data calling for tougher penalties for hospitals that fudge waiting list times.
He said bonuses for hospitals should be scrapped and negligent health executives hauled before the courts to fix the state's health system.
He is understood to be seeking legal advice following his dismissal.
Eastern Health has yet to comment.
SOURCE
Friday, March 13, 2009
NHS frees another dangerous nut
A lazy "care coordinator" leads to a man being killed
A paranoid schizophrenic who killed a man and hurt five others after hearing voices ordering him to murder English people was repeatedly failed by the NHS, an investigation has found. An independent inquiry into the treatment of Ismail Dogan found that he "slipped through the safety net" of mental health care services in North London. The authors claim Barnet, Enfield and Haringey Mental Health Trust and the Haringey Teaching Primary Care Trust failed to share information about treatment, engage with his "isolated" family and assess his care in the community.
Two days before Christmas in 2004, Dogan left his family home with a knife and after driving around Tottenham and Edmonton attacked six strangers within 90 minutes. He stabbed one man to death and hurt four men and a woman. The minicab driver, originally from Turkey, later told police that he had heard a bird telling him he was the son of Allah and so should kill English people. Dogan, now 34, was convicted of killing Ernest Meads, 58, and is currently being held at Broadmoor top security hospital. He had been diagnosed as a paranoid schizophrenic three years before the killing and placed in the care of the community mental health care team after being released from a psychiatric ward.
The investigation has again renewed calls for a review of the way mentally unstable people are being cared for in the community. Marjorie Wallace, chief executive of Sane, said the findings highlighted a series of "blunders" that showed how the NHS was failing patients and putting innocent people at risk. Last week Surrey and Borders Partnership NHS Foundation Trust was criticised for its poor treatment of Daniel Gonzales, a paranoid schizophrenic who murdered four people, despite his and his family's repeated appeals for help.
Referring to the latest report, Mrs Wallace said: "Yet again the warnings and pleas of family members went unheeded, with fatal consequences. "Following so soon after the Daniel Gonzales report, it begs the question: is care in the community working? Can all patients be safely treated by a jigsaw of mental health teams which fail to communicate with each other, respond to crises, or assess and act upon the risk that some individuals may pose to themselves or others?" The charity is calling for a "red alert" system where police and mental health are called on to respond immediately to family's warning that a relative poses a threat.
The inquiry found Dogan's care was severely compromised by the lack of consistent medical management: "For this the consultant medical team must take a great deal of responsibility." The authors said that it was obvious Dogan was a "significant risk", particularly after he had been repeatedly held in police custody for acts of violence. The report adds that Dogan's risk assessments were not always coherent or complete, meaning that when his mental health reached crisis point there was nothing in place to try to identify or rectify the problem. "It is the view of the investigation team that there was a significant system failure in that a disjointed tripartite system was operating whereby inpatient services, outpatient services and community mental health teams operated separately," the report says.
"At the time that Dogan was receiving his care different Consultants led the inpatient and outpatient services thereby ensuring that there was little continuity of care. This was compounded by poor communication systems and a care coordinator who appeared to have been performing to a standard well below that expected from someone of her experience and seniority."
SOURCE
Health 'Reformers' Ignore Facts
Debunking the Democratic argument for government-run health care.
The Democrats' case to expand government health care is so full of holes that passing it quickly is their only hope. If Americans slow down and ask questions, they will be hard-put to come up with answers. In fact, if members of Congress slow down long enough to read the detailed reports of their own Congressional Budget Office (CBO) -- or even its director's recent Senate testimony -- they will understand that many of the slogans they use to justify government intervention are false.
Statist health-care reform, for example, is said to be needed to help the economy recover in a period of deepening gloom. The president has made this argument on numerous occasions, such as earlier this week when he announced Kathleen Sebelius as his pick for Secretary of Health and Human Resources. So too has Henry Waxman (D., Calif.), chairman of the House Energy and Commerce Committee. "The costly failure of our health care system affects the financial health of our businesses," Mr. Waxman said at a conference at Families USA, the national nonprofit dedicated to health care for all Americans. "It affects our competitiveness in the world . . . This isn't something to put off; this is something to do right now to help fix our economy."
Health care certainly plays a major role in the U.S. economy, and by almost any objective account a highly positive role. It employs 13 million Americans and accounts for one out of 10 jobs. But the assertion that the costs of providing health insurance cripples American corporations in the global economy is simply wrong.
CBO director Douglas W. Elmendorf explained this last week to the Senate Committee on Finance, which is chaired by Max Baucus, a leading proponent of government health care. The point is that for employers, health care is merely a part of total compensation: It reduces cash compensation for employees but it does not increase costs of employment. To argue otherwise is to argue for lower total U.S. compensation -- that is, lower wages for U.S. workers. Said Mr. Elmendorf, "the costs of providing health insurance to their workers are not a competitive disadvantage to U.S.-based firms."
Another common argument for more government insurance is that the uninsured shift costs to private payers when they avail themselves of the health-care safety net -- thus jacking up health-care premiums in the private sector. Many reform advocates make this claim, including Sen. Edward M. Kennedy (D., Mass.) and Sen. Baucus in an op-ed in this newspaper.
This is not the case. In the first place, a recent CBO report ("Key Issues in Analyzing Major Health Insurance Proposals, " December 2008) is clear on one issue: Working to achieve universal coverage through expanding government's role in health care will increase total costs and therefore either increase premiums or taxes, not reduce them. As for the argument that the uninsured shift costs, Mr. Elmendorf was quite direct dispelling this myth in his testimony before Mr. Baucus's committee. "Overall," he said, "the effect of uncompensated care on private-sector payment rates appears to be limited."
In fact, insofar as there is a cost shift, it derives from the government programs Medicare and Medicaid, which reimburse providers at rates roughly 20% to 40% lower than the private providers. This has been detailed by the widely used and quoted health consultant firm, the Lewin Group. But this is conveniently ignored by those who want to expand government health care.
Preventative care, disease management and electronic medical records are also constantly cited as big cost-savers. The idea here is that if our health-care system was set up to prevent disease rather than just treat it, and could do so without duplicative paper records, it could save money. It's a great hypothesis, but research does not indicate it amounts to much. "In many cases," as Mr. Elmendorf testified regarding such initiatives, "those studies do not support claims of reductions in health spending or budgetary reductions."
Americans like their current health care, its plethora of choice and its intensive, high tech approach to fixing our ailments. A Gallup survey in December reported that "on balance, Americans still favor maintaining the current system, 49% to 41%." But the CBO is very clear that saving money on health care involves doing less of the very things Americans like the most.
"Studies attribute the bulk of the cost of growth to the development of new treatments and other medical technologies," the CBO notes in a report issued last December, later adding, "Given the central role of medical technology in cost growth, reducing or slowing spending over the long term would probably require decreasing the pace of adopting new treatments and procedures or limiting the breadth of their application."
In other words, reducing costs means rationing the care of those who currently have private insurance and Medicare.
SOURCE
One million patients at risk in NHS, official figures find
One million patients a year are put at risk by hospital blunders and near misses, official figures have revealed. However experts warned many more are being swept under the carpet as healthcare staff and managers fail to report incidents. Data on the number of incidents relating to patient safety, the type and the level of harm occurring in each NHS organisation in England and Wales has been published for the first time.
Martin Fletcher, chief executive of the National Patient Safety Agency, said a high number of incidents should be regarded as a good thing because it shows the organisation is taking safety seriously and is identifying and reporting cases. He admitted it is not known at what level the number of incidents ceases to be good reporting and becomes an unacceptable number of incidents. Mr Fletcher said: "Just because one (NHS trust) has a low level of incidents that does not mean it is a safe organisation."
Overall the number of incidents being reported is increasing each year and he said he hoped that would continue but the proportion of incidents resulting in serious harm or death would decline. The figures show 370 out of 422 NHS organisations in England and Wales had reported incidents but trusts are not forced to report and 52 have declined to take part or have reported fewer than 11 incidents over six months. In total there were 439,612 patients safety incidents reported to the NPSA between April and September 2008 in England and Wales. Of those 66 per cent resulted in no harm, 33 per cent were patient accidents, 10 per cent were related to treatments or surgery and nine per cent were medication problems.
Prof Sir Bruce Keogh, Medical Director at the Department of Health, said patient safety incidents probably cost the NHS o2bn a year. He said he was 'keen' to see mandatory reporting of very serious incidents but routine reporting was still in its early stages and accuracy and completeness of data will improve.
Anna Walker, Chief Executive of the Healthcare Commission, said: "We know that a significant gap exists between the number of incidents that are reported by the NHS and the number that happen in reality. We welcome the publication of information from individual NHS trusts and increases in reporting because they bring us closer to the true picture of safety and allow a critical and honest assessment of where improvements need to be made. This is a vital part of improving the safety of patients."
Steve Barnett chief executive of the NHS Confederation said: "Patients need to be reassured that more incidents do not necessarily mean a less safe organisation. We need to get all staff actively reporting so that over time we can get to grips with making hospitals safer."
SOURCE
A lazy "care coordinator" leads to a man being killed
A paranoid schizophrenic who killed a man and hurt five others after hearing voices ordering him to murder English people was repeatedly failed by the NHS, an investigation has found. An independent inquiry into the treatment of Ismail Dogan found that he "slipped through the safety net" of mental health care services in North London. The authors claim Barnet, Enfield and Haringey Mental Health Trust and the Haringey Teaching Primary Care Trust failed to share information about treatment, engage with his "isolated" family and assess his care in the community.
Two days before Christmas in 2004, Dogan left his family home with a knife and after driving around Tottenham and Edmonton attacked six strangers within 90 minutes. He stabbed one man to death and hurt four men and a woman. The minicab driver, originally from Turkey, later told police that he had heard a bird telling him he was the son of Allah and so should kill English people. Dogan, now 34, was convicted of killing Ernest Meads, 58, and is currently being held at Broadmoor top security hospital. He had been diagnosed as a paranoid schizophrenic three years before the killing and placed in the care of the community mental health care team after being released from a psychiatric ward.
The investigation has again renewed calls for a review of the way mentally unstable people are being cared for in the community. Marjorie Wallace, chief executive of Sane, said the findings highlighted a series of "blunders" that showed how the NHS was failing patients and putting innocent people at risk. Last week Surrey and Borders Partnership NHS Foundation Trust was criticised for its poor treatment of Daniel Gonzales, a paranoid schizophrenic who murdered four people, despite his and his family's repeated appeals for help.
Referring to the latest report, Mrs Wallace said: "Yet again the warnings and pleas of family members went unheeded, with fatal consequences. "Following so soon after the Daniel Gonzales report, it begs the question: is care in the community working? Can all patients be safely treated by a jigsaw of mental health teams which fail to communicate with each other, respond to crises, or assess and act upon the risk that some individuals may pose to themselves or others?" The charity is calling for a "red alert" system where police and mental health are called on to respond immediately to family's warning that a relative poses a threat.
The inquiry found Dogan's care was severely compromised by the lack of consistent medical management: "For this the consultant medical team must take a great deal of responsibility." The authors said that it was obvious Dogan was a "significant risk", particularly after he had been repeatedly held in police custody for acts of violence. The report adds that Dogan's risk assessments were not always coherent or complete, meaning that when his mental health reached crisis point there was nothing in place to try to identify or rectify the problem. "It is the view of the investigation team that there was a significant system failure in that a disjointed tripartite system was operating whereby inpatient services, outpatient services and community mental health teams operated separately," the report says.
"At the time that Dogan was receiving his care different Consultants led the inpatient and outpatient services thereby ensuring that there was little continuity of care. This was compounded by poor communication systems and a care coordinator who appeared to have been performing to a standard well below that expected from someone of her experience and seniority."
SOURCE
Health 'Reformers' Ignore Facts
Debunking the Democratic argument for government-run health care.
The Democrats' case to expand government health care is so full of holes that passing it quickly is their only hope. If Americans slow down and ask questions, they will be hard-put to come up with answers. In fact, if members of Congress slow down long enough to read the detailed reports of their own Congressional Budget Office (CBO) -- or even its director's recent Senate testimony -- they will understand that many of the slogans they use to justify government intervention are false.
Statist health-care reform, for example, is said to be needed to help the economy recover in a period of deepening gloom. The president has made this argument on numerous occasions, such as earlier this week when he announced Kathleen Sebelius as his pick for Secretary of Health and Human Resources. So too has Henry Waxman (D., Calif.), chairman of the House Energy and Commerce Committee. "The costly failure of our health care system affects the financial health of our businesses," Mr. Waxman said at a conference at Families USA, the national nonprofit dedicated to health care for all Americans. "It affects our competitiveness in the world . . . This isn't something to put off; this is something to do right now to help fix our economy."
Health care certainly plays a major role in the U.S. economy, and by almost any objective account a highly positive role. It employs 13 million Americans and accounts for one out of 10 jobs. But the assertion that the costs of providing health insurance cripples American corporations in the global economy is simply wrong.
CBO director Douglas W. Elmendorf explained this last week to the Senate Committee on Finance, which is chaired by Max Baucus, a leading proponent of government health care. The point is that for employers, health care is merely a part of total compensation: It reduces cash compensation for employees but it does not increase costs of employment. To argue otherwise is to argue for lower total U.S. compensation -- that is, lower wages for U.S. workers. Said Mr. Elmendorf, "the costs of providing health insurance to their workers are not a competitive disadvantage to U.S.-based firms."
Another common argument for more government insurance is that the uninsured shift costs to private payers when they avail themselves of the health-care safety net -- thus jacking up health-care premiums in the private sector. Many reform advocates make this claim, including Sen. Edward M. Kennedy (D., Mass.) and Sen. Baucus in an op-ed in this newspaper.
This is not the case. In the first place, a recent CBO report ("Key Issues in Analyzing Major Health Insurance Proposals, " December 2008) is clear on one issue: Working to achieve universal coverage through expanding government's role in health care will increase total costs and therefore either increase premiums or taxes, not reduce them. As for the argument that the uninsured shift costs, Mr. Elmendorf was quite direct dispelling this myth in his testimony before Mr. Baucus's committee. "Overall," he said, "the effect of uncompensated care on private-sector payment rates appears to be limited."
In fact, insofar as there is a cost shift, it derives from the government programs Medicare and Medicaid, which reimburse providers at rates roughly 20% to 40% lower than the private providers. This has been detailed by the widely used and quoted health consultant firm, the Lewin Group. But this is conveniently ignored by those who want to expand government health care.
Preventative care, disease management and electronic medical records are also constantly cited as big cost-savers. The idea here is that if our health-care system was set up to prevent disease rather than just treat it, and could do so without duplicative paper records, it could save money. It's a great hypothesis, but research does not indicate it amounts to much. "In many cases," as Mr. Elmendorf testified regarding such initiatives, "those studies do not support claims of reductions in health spending or budgetary reductions."
Americans like their current health care, its plethora of choice and its intensive, high tech approach to fixing our ailments. A Gallup survey in December reported that "on balance, Americans still favor maintaining the current system, 49% to 41%." But the CBO is very clear that saving money on health care involves doing less of the very things Americans like the most.
"Studies attribute the bulk of the cost of growth to the development of new treatments and other medical technologies," the CBO notes in a report issued last December, later adding, "Given the central role of medical technology in cost growth, reducing or slowing spending over the long term would probably require decreasing the pace of adopting new treatments and procedures or limiting the breadth of their application."
In other words, reducing costs means rationing the care of those who currently have private insurance and Medicare.
SOURCE
One million patients at risk in NHS, official figures find
One million patients a year are put at risk by hospital blunders and near misses, official figures have revealed. However experts warned many more are being swept under the carpet as healthcare staff and managers fail to report incidents. Data on the number of incidents relating to patient safety, the type and the level of harm occurring in each NHS organisation in England and Wales has been published for the first time.
Martin Fletcher, chief executive of the National Patient Safety Agency, said a high number of incidents should be regarded as a good thing because it shows the organisation is taking safety seriously and is identifying and reporting cases. He admitted it is not known at what level the number of incidents ceases to be good reporting and becomes an unacceptable number of incidents. Mr Fletcher said: "Just because one (NHS trust) has a low level of incidents that does not mean it is a safe organisation."
Overall the number of incidents being reported is increasing each year and he said he hoped that would continue but the proportion of incidents resulting in serious harm or death would decline. The figures show 370 out of 422 NHS organisations in England and Wales had reported incidents but trusts are not forced to report and 52 have declined to take part or have reported fewer than 11 incidents over six months. In total there were 439,612 patients safety incidents reported to the NPSA between April and September 2008 in England and Wales. Of those 66 per cent resulted in no harm, 33 per cent were patient accidents, 10 per cent were related to treatments or surgery and nine per cent were medication problems.
Prof Sir Bruce Keogh, Medical Director at the Department of Health, said patient safety incidents probably cost the NHS o2bn a year. He said he was 'keen' to see mandatory reporting of very serious incidents but routine reporting was still in its early stages and accuracy and completeness of data will improve.
Anna Walker, Chief Executive of the Healthcare Commission, said: "We know that a significant gap exists between the number of incidents that are reported by the NHS and the number that happen in reality. We welcome the publication of information from individual NHS trusts and increases in reporting because they bring us closer to the true picture of safety and allow a critical and honest assessment of where improvements need to be made. This is a vital part of improving the safety of patients."
Steve Barnett chief executive of the NHS Confederation said: "Patients need to be reassured that more incidents do not necessarily mean a less safe organisation. We need to get all staff actively reporting so that over time we can get to grips with making hospitals safer."
SOURCE
Thursday, March 12, 2009
8,000 patients malnourished after staying in NHS hospitals
More than 8,000 patients left hospital last year after becoming malnourished while under NHS care. Despite ministers' promises, this total was a 16.5 per cent increase on the previous year - and more than double the number when Labour came to power. Critics said it was shameful the NHS was sending patients home in worse condition than before treatment.
Last year 148,946 were admitted to hospital suffering from malnutrition or another severe nutritional deficiency, but 157,175 were discharged with the same condition. It means 8,229 people arrived without nutrition problems but left hospital malnourished.
The Daily Mail's Dignity for the Elderly Campaign has highlighted the scandal of old people not being fed properly in hospital. The food is often so unappetising that patients do not eat, and sometimes it is placed out of their reach and taken away untouched. Nurses often claim they are too busy to help patients eat their food. Malnutrition has soared as 13million meals each year are thrown away by the NHS.
Age Concern says 60 per cent of older patients, who occupy two-thirds of general hospital beds, are at risk of worsening health or becoming malnourished. Gordon Lishman, the charity's director general, said: 'The malnutrition of older people is still a huge problem in hospitals up and down the country.' He added: 'Food, and help with eating, must be recognised by ward staff as an essential part of patient care.'
Alison Smith, a senior dietician at the British Dietetic Association, said: 'The biggest problem in the vast majority of hospitals is that some patients simply can't eat the food they are given without help, which they don't always get.' She added: 'Food is a form of medication and if staff begin to see it that way they will take it more seriously.'
The figures, released by the NHS Information Centre, found that in 2007-08, 3,008 were discharged with full-blown malnutrition, 139,140 had nutritional anaemia and 15,027 left with other nutritional deficiencies. The total of 157,175 is more than double the 75,431 recorded the year Labour came to power. And the 8,229 whose malnutrition was caused by the NHS is also more than double the 3,336 in 1997-98.
Under pressure from the Government, those who need help with eating are served meals on red trays. However, one in three trusts have still not implemented the system. Michael Summers, chairman of the Patients Association, said: ' Sometimes food is taken away untouched from a patient who wants to eat it but can't without assistance. 'The red trays are being ignored and as a result a very high proportion of elderly patients are leaving hospitals malnourished.' Liberal Democrat health spokesman Norman Lamb said: 'It is essential that patients are given good-quality, nourishing food.' A spokesman for the Department of Health said 'Good food is important for all patients and we have recognised this as a priority issue.'
SOURCE
NHS hospitals spend less on their patients' food than prisons on their inmates
Some hospital patients have less money spent on their meals than criminals. Last year, ten hospitals spent less on breakfast, lunch and an evening meal than the 2.12 pounds a day allocated for food by the prison service. One hospital spent just one pound.
Ministers promised action to improve the quality of hospital food two years ago, saying some elderly patients were being served nothing more than a scoop of grey mashed potato. Experts say cost-cutting hospitals are increasingly moving to soup and sandwiches to save money. Others are buying food that is prepared off site, frozen and then defrosted in the hospital.
The figures from the NHS Information Centre also expose shocking waste, with some trusts throwing away a third of meals entirely untouched. A total of 11million meals a year are thrown away uneaten.
Earlier this week it emerged that more than 8,000 patients left hospital malnourished even though they had been admitted with no nutritional problems. This was up 16.5 per cent in a year and was more than double the figure when Labour came to power.
The figures on hospital food spending have been condemned by doctors, patients groups, and opposition politicians. Dr Mike Stroud of the hospital nutrition charity BAPEN said: 'The catering budget is an easy target in trusts which are pushed for money. Some have gone to soups, cold meals and sandwiches in a bid to cut costs. 'But this is a false economy: food is an integral part of treatment, not just part of the hotel service. Studies have shown that patients who eat well recover better.'
Conservative health spokesman Stephen O'Brien said: 'More people are now coming out of hospital malnourished than went in. Is it any surprise when the Government is prepared to allow some hospitals to spend less on their patients than they spend on food for prisoners?'
The figures revealed that average daily spending on hospital food across England was 6.97, compared with 9.87 in Wales. The figures do not cover Scotland. But some are spending much smaller amounts. The figures show that the Kevin White Unit at Sefton Health Park, a mental health hospital on Merseyside, spends just 1 pound on its patients. However, the local trust said this was not a true reflection of the full cost as some meals are provided on a different site and transferred. Next is Nelson Hospital, a mental health facility in South London, on 1.53. The lowest general hospital on the league table is Hemel Hempstead on 1.93. The general hospital with the highest spending is Bristol Hospital, where 16.80 is spent per patient per day.
SOURCE
Australia: More gross incompetence from Queensland Health
Anna Bligh has abandoned Health Minister Stephen Robertson after revelations he had failed to fix dangerous health staff accommodation. The Premier today repeatedly refused to support Mr Robertson after The Courier-Mail revealed public servants were still living in 60 hazardous dwellings of the original 101 residences identified across the state. Mr Robertson had promised last May to fix the problems within a few months following the completion of a statewide audit in the wake of the sexual assault of a Torres Strait nurse in her rundown living quarters.
Campaigning in Mackay today, Ms Bligh said she was "absolutely not' happy at the failures, saying she would seek a "please explain" from Mr Robertson and his director-general Mick Reid later today. "I'm very disappointed to hear progress I thought was happening has not happened," Ms Bligh said. "I will be asking serious questions ... when I return to Brisbane. I want to know why this was the case." Ms Bligh was unable to say when the residences would be fixed but has promised to provide details later today. Asked if Mr Robertson still had her support as she had previously indicated, Ms Bligh said: "I will be asking questions about this issue when I get back to Brisbane."
Her comments came after The Courier-Mail reported the failures with five of the "extreme" dwellings still being fixed. The substandard conditions were discovered after a statewide audit - launched after a Torres Strait nurse was sexually assaulted in her rundown accommodation - found broken or missing locks, security screens, lighting and smoke alarms. Asked about the progress a fortnight ago, Mr Reid was clueless and said: "I would presume all 100 have been done."
However, Mr Robertson yesterday admitted to the failure but insisted some "improvements" had been made to the five unfinished, inhabited "extreme" dwellings. He blamed the delays on the vagueness of his own audit, bad weather and re-tendering of contracts after a poor industry response. "In May last year, I had the expectation that these renovations would, indeed, be completed within months," he said. "While work is progressing well on this rectification work, there have been a number of issues which have led to the work taking longer than I was first advised."
But Opposition Leader Lawrence Springborg said the failure showed Labor had learnt nothing as the initial assault in the Torres Strait came after damning security reports were ignored. "If they spent as much time fixing things as they do spin-doctoring and making excuses, then things would be done," he said. Mr Robertson had initially lauded his response to the housing audit, fast-tracking $10 million in funding and promising completion within "weeks and months". "This should never ever be repeated (and) I am determined to ensure that," he had said. But the money spent on the work only totals $4.06 million.
The revelations come only a fortnight after Mr Robertson refused to apologise for attacking a public servant involved in the Torres Strait case, despite being unable to produce any evidence to justify the attack.
SOURCE
More than 8,000 patients left hospital last year after becoming malnourished while under NHS care. Despite ministers' promises, this total was a 16.5 per cent increase on the previous year - and more than double the number when Labour came to power. Critics said it was shameful the NHS was sending patients home in worse condition than before treatment.
Last year 148,946 were admitted to hospital suffering from malnutrition or another severe nutritional deficiency, but 157,175 were discharged with the same condition. It means 8,229 people arrived without nutrition problems but left hospital malnourished.
The Daily Mail's Dignity for the Elderly Campaign has highlighted the scandal of old people not being fed properly in hospital. The food is often so unappetising that patients do not eat, and sometimes it is placed out of their reach and taken away untouched. Nurses often claim they are too busy to help patients eat their food. Malnutrition has soared as 13million meals each year are thrown away by the NHS.
Age Concern says 60 per cent of older patients, who occupy two-thirds of general hospital beds, are at risk of worsening health or becoming malnourished. Gordon Lishman, the charity's director general, said: 'The malnutrition of older people is still a huge problem in hospitals up and down the country.' He added: 'Food, and help with eating, must be recognised by ward staff as an essential part of patient care.'
Alison Smith, a senior dietician at the British Dietetic Association, said: 'The biggest problem in the vast majority of hospitals is that some patients simply can't eat the food they are given without help, which they don't always get.' She added: 'Food is a form of medication and if staff begin to see it that way they will take it more seriously.'
The figures, released by the NHS Information Centre, found that in 2007-08, 3,008 were discharged with full-blown malnutrition, 139,140 had nutritional anaemia and 15,027 left with other nutritional deficiencies. The total of 157,175 is more than double the 75,431 recorded the year Labour came to power. And the 8,229 whose malnutrition was caused by the NHS is also more than double the 3,336 in 1997-98.
Under pressure from the Government, those who need help with eating are served meals on red trays. However, one in three trusts have still not implemented the system. Michael Summers, chairman of the Patients Association, said: ' Sometimes food is taken away untouched from a patient who wants to eat it but can't without assistance. 'The red trays are being ignored and as a result a very high proportion of elderly patients are leaving hospitals malnourished.' Liberal Democrat health spokesman Norman Lamb said: 'It is essential that patients are given good-quality, nourishing food.' A spokesman for the Department of Health said 'Good food is important for all patients and we have recognised this as a priority issue.'
SOURCE
NHS hospitals spend less on their patients' food than prisons on their inmates
Some hospital patients have less money spent on their meals than criminals. Last year, ten hospitals spent less on breakfast, lunch and an evening meal than the 2.12 pounds a day allocated for food by the prison service. One hospital spent just one pound.
Ministers promised action to improve the quality of hospital food two years ago, saying some elderly patients were being served nothing more than a scoop of grey mashed potato. Experts say cost-cutting hospitals are increasingly moving to soup and sandwiches to save money. Others are buying food that is prepared off site, frozen and then defrosted in the hospital.
The figures from the NHS Information Centre also expose shocking waste, with some trusts throwing away a third of meals entirely untouched. A total of 11million meals a year are thrown away uneaten.
Earlier this week it emerged that more than 8,000 patients left hospital malnourished even though they had been admitted with no nutritional problems. This was up 16.5 per cent in a year and was more than double the figure when Labour came to power.
The figures on hospital food spending have been condemned by doctors, patients groups, and opposition politicians. Dr Mike Stroud of the hospital nutrition charity BAPEN said: 'The catering budget is an easy target in trusts which are pushed for money. Some have gone to soups, cold meals and sandwiches in a bid to cut costs. 'But this is a false economy: food is an integral part of treatment, not just part of the hotel service. Studies have shown that patients who eat well recover better.'
Conservative health spokesman Stephen O'Brien said: 'More people are now coming out of hospital malnourished than went in. Is it any surprise when the Government is prepared to allow some hospitals to spend less on their patients than they spend on food for prisoners?'
The figures revealed that average daily spending on hospital food across England was 6.97, compared with 9.87 in Wales. The figures do not cover Scotland. But some are spending much smaller amounts. The figures show that the Kevin White Unit at Sefton Health Park, a mental health hospital on Merseyside, spends just 1 pound on its patients. However, the local trust said this was not a true reflection of the full cost as some meals are provided on a different site and transferred. Next is Nelson Hospital, a mental health facility in South London, on 1.53. The lowest general hospital on the league table is Hemel Hempstead on 1.93. The general hospital with the highest spending is Bristol Hospital, where 16.80 is spent per patient per day.
SOURCE
Australia: More gross incompetence from Queensland Health
Anna Bligh has abandoned Health Minister Stephen Robertson after revelations he had failed to fix dangerous health staff accommodation. The Premier today repeatedly refused to support Mr Robertson after The Courier-Mail revealed public servants were still living in 60 hazardous dwellings of the original 101 residences identified across the state. Mr Robertson had promised last May to fix the problems within a few months following the completion of a statewide audit in the wake of the sexual assault of a Torres Strait nurse in her rundown living quarters.
Campaigning in Mackay today, Ms Bligh said she was "absolutely not' happy at the failures, saying she would seek a "please explain" from Mr Robertson and his director-general Mick Reid later today. "I'm very disappointed to hear progress I thought was happening has not happened," Ms Bligh said. "I will be asking serious questions ... when I return to Brisbane. I want to know why this was the case." Ms Bligh was unable to say when the residences would be fixed but has promised to provide details later today. Asked if Mr Robertson still had her support as she had previously indicated, Ms Bligh said: "I will be asking questions about this issue when I get back to Brisbane."
Her comments came after The Courier-Mail reported the failures with five of the "extreme" dwellings still being fixed. The substandard conditions were discovered after a statewide audit - launched after a Torres Strait nurse was sexually assaulted in her rundown accommodation - found broken or missing locks, security screens, lighting and smoke alarms. Asked about the progress a fortnight ago, Mr Reid was clueless and said: "I would presume all 100 have been done."
However, Mr Robertson yesterday admitted to the failure but insisted some "improvements" had been made to the five unfinished, inhabited "extreme" dwellings. He blamed the delays on the vagueness of his own audit, bad weather and re-tendering of contracts after a poor industry response. "In May last year, I had the expectation that these renovations would, indeed, be completed within months," he said. "While work is progressing well on this rectification work, there have been a number of issues which have led to the work taking longer than I was first advised."
But Opposition Leader Lawrence Springborg said the failure showed Labor had learnt nothing as the initial assault in the Torres Strait came after damning security reports were ignored. "If they spent as much time fixing things as they do spin-doctoring and making excuses, then things would be done," he said. Mr Robertson had initially lauded his response to the housing audit, fast-tracking $10 million in funding and promising completion within "weeks and months". "This should never ever be repeated (and) I am determined to ensure that," he had said. But the money spent on the work only totals $4.06 million.
The revelations come only a fortnight after Mr Robertson refused to apologise for attacking a public servant involved in the Torres Strait case, despite being unable to produce any evidence to justify the attack.
SOURCE
Wednesday, March 11, 2009
Obama health plan: We need details
Los Angeles Times writer Bob Rosenblatt characterized President Barack Obama's strategy for his health care proposal as, "Give me a bunch of money, and we'll figure out the details later how we are going to manage this thing." In other words, the plan's key element is vagueness.
The problem with such vagueness is that any informed public policy decision has to be based on specific proposals. Absent concrete details, which is where the devil lurks, no one - including those proposing a "reform" - can judge how it would fare or falter in the real world. So when the president wants approval for a $634 billion proposal which offers too few details for evaluation, we must ask why.
Like salesmen, politicians strive to present their wares as attractively as possible. Unlike salesmen, however, a politician's product line consists of claimed consequences of proposals not yet enacted. Further, politicians are unconstrained by truth-in-advertising laws, they have fewer competitors keeping them honest, and they face "customers" - voters - far more ignorant about the merchandise involved than consumers spending their own money.
These differences explain why politicians' "sales pitches" for their proposals are so vague. However, if vague proposals are the best politicians can offer, they are inadequate.
If rhetoric is unmatched by specifics, there is no reason to believe a policy change will be an improvement, because no reliable way exists to determine whether it will actually accomplish what is promised. Only the details will determine the actual incentives facing the decision-makers involved, which is the only way to forecast the results, including the myriad of unintended consequences from unnoticed aspects. We must remember that, however laudable, goals and promises and claims of cost-effectiveness that are inconsistent with the incentives created will go unmet.
It may be that President Obama knows too little of his "solution" to provide specific plans. If so, he knows too little to deliver on his promises. Achieving intended goals then necessarily depends on blind faith that Obama and a panoply of bureaucrats, legislators, overseers and commissions will somehow adequately grasp the entire situation, know precisely what to do about it, and do it right - a prospect that, given the painful lessons of history, should attract few real believers.
Alternatively, President Obama may know the details of what he intends, but is not providing them to the public. But if it is necessary to conceal a plan's details to put the best possible public face on it, those details must be adverse. If details of a plan made a more persuasive sales pitch, a politician would not hide them; they would be trumpeted at every opportunity as proof he really had the answers.
Claiming adherence to elevated principles while keeping detailed proposals from sight also has a strategic advantage: It defuses criticism. Absent details, any criticism can be parried by saying "that was not in our proposal" or "we have no plans to do that" or similar retorts. It also allows a politician to incorporate alternatives proposed as part of his evolving reform, as if they were his idea all along.
The new administration has already put vague proposals on prominent display. However, adequate analysis cannot rest upon such flimsy foundations. That requires the nuts and bolts so glaringly absent. In the private sector, people don't spend their own money on such vague promises of unseen products. It is foolhardy to act any differently when political salesmen withhold specifics, because political incentives guarantee that people would object to what is kept hidden. So while vagueness may be good political strategy, it virtually ensures bad policy.
SOURCE
British ambulance bureaucracy kills woman
Ambulance staff were unable to save a mother-of-two who died from a heart attack after a simple trip to the dentist went tragically wrong, an inquest was told. They were not qualified to give Marian Carrick, 46, a shot of adrenaline which could have saved her life after she suffered a severe reaction to a antibiotic Amoxicillin pill. Her neighbour, Charles Gallimore a former GP with 40 years experience, begged them to give her the drug but they refused.
It was only 30 minutes later that a second ambulance arrived at her home in Wing, Rutland, with a qualified paramedic on board who administered the drug. By then it was too late and Mrs Carrick was later pronounced dead at hospital.
The tragedy happened on the the same day she had collected the medicine from her dentist in Uppingham, Rutland, an inquest in Loughborough, Leics, was told. Pathologist Dr Angus McGregor said Mrs Carrick had taken Amoxicillin before with no ill effects but on this occasion suffered a severe reaction. He said: "The cause of death was a severe anaphylactic reaction, a severe allergic reaction. "That can lead to shock. That can lead to massive circulatory failure, and the heart and circulation fails." Mrs Carrick's medical records showed no evidence of previous allergy to any drugs.
East Midlands Ambulance Service arrived to find former doctor Mr Gallimore with Mrs Carrick and he advised them to give her adrenaline to restart her heart. But the ambulance technicians, who are qualified just below the level of full paramedics, were not permitted to administer adrenaline. Her brother Steve Jones told the inquest he thought the technicians should have used adrenaline earlier to try to save his sister. He said: "There was half an hour between the first and second ambulance. "For half an hour, they carried on with giving cardio-vascular therapy, but never thought to give her adrenaline when there was a doctor of 40 years' experience begging them to do it. "The technicians weren't qualified to deal with the situation."
Dr Colin Reid, a consultant in emergency medicine for the University Hospitals of Leicester said: "This would have been a difficult situation for the attending crew. "They would have had no way of knowing if Mr Gallimore was medically trained. "They acted appropriately and professionally, and provided the best medical care they could."
SOURCE
Los Angeles Times writer Bob Rosenblatt characterized President Barack Obama's strategy for his health care proposal as, "Give me a bunch of money, and we'll figure out the details later how we are going to manage this thing." In other words, the plan's key element is vagueness.
The problem with such vagueness is that any informed public policy decision has to be based on specific proposals. Absent concrete details, which is where the devil lurks, no one - including those proposing a "reform" - can judge how it would fare or falter in the real world. So when the president wants approval for a $634 billion proposal which offers too few details for evaluation, we must ask why.
Like salesmen, politicians strive to present their wares as attractively as possible. Unlike salesmen, however, a politician's product line consists of claimed consequences of proposals not yet enacted. Further, politicians are unconstrained by truth-in-advertising laws, they have fewer competitors keeping them honest, and they face "customers" - voters - far more ignorant about the merchandise involved than consumers spending their own money.
These differences explain why politicians' "sales pitches" for their proposals are so vague. However, if vague proposals are the best politicians can offer, they are inadequate.
If rhetoric is unmatched by specifics, there is no reason to believe a policy change will be an improvement, because no reliable way exists to determine whether it will actually accomplish what is promised. Only the details will determine the actual incentives facing the decision-makers involved, which is the only way to forecast the results, including the myriad of unintended consequences from unnoticed aspects. We must remember that, however laudable, goals and promises and claims of cost-effectiveness that are inconsistent with the incentives created will go unmet.
It may be that President Obama knows too little of his "solution" to provide specific plans. If so, he knows too little to deliver on his promises. Achieving intended goals then necessarily depends on blind faith that Obama and a panoply of bureaucrats, legislators, overseers and commissions will somehow adequately grasp the entire situation, know precisely what to do about it, and do it right - a prospect that, given the painful lessons of history, should attract few real believers.
Alternatively, President Obama may know the details of what he intends, but is not providing them to the public. But if it is necessary to conceal a plan's details to put the best possible public face on it, those details must be adverse. If details of a plan made a more persuasive sales pitch, a politician would not hide them; they would be trumpeted at every opportunity as proof he really had the answers.
Claiming adherence to elevated principles while keeping detailed proposals from sight also has a strategic advantage: It defuses criticism. Absent details, any criticism can be parried by saying "that was not in our proposal" or "we have no plans to do that" or similar retorts. It also allows a politician to incorporate alternatives proposed as part of his evolving reform, as if they were his idea all along.
The new administration has already put vague proposals on prominent display. However, adequate analysis cannot rest upon such flimsy foundations. That requires the nuts and bolts so glaringly absent. In the private sector, people don't spend their own money on such vague promises of unseen products. It is foolhardy to act any differently when political salesmen withhold specifics, because political incentives guarantee that people would object to what is kept hidden. So while vagueness may be good political strategy, it virtually ensures bad policy.
SOURCE
British ambulance bureaucracy kills woman
Ambulance staff were unable to save a mother-of-two who died from a heart attack after a simple trip to the dentist went tragically wrong, an inquest was told. They were not qualified to give Marian Carrick, 46, a shot of adrenaline which could have saved her life after she suffered a severe reaction to a antibiotic Amoxicillin pill. Her neighbour, Charles Gallimore a former GP with 40 years experience, begged them to give her the drug but they refused.
It was only 30 minutes later that a second ambulance arrived at her home in Wing, Rutland, with a qualified paramedic on board who administered the drug. By then it was too late and Mrs Carrick was later pronounced dead at hospital.
The tragedy happened on the the same day she had collected the medicine from her dentist in Uppingham, Rutland, an inquest in Loughborough, Leics, was told. Pathologist Dr Angus McGregor said Mrs Carrick had taken Amoxicillin before with no ill effects but on this occasion suffered a severe reaction. He said: "The cause of death was a severe anaphylactic reaction, a severe allergic reaction. "That can lead to shock. That can lead to massive circulatory failure, and the heart and circulation fails." Mrs Carrick's medical records showed no evidence of previous allergy to any drugs.
East Midlands Ambulance Service arrived to find former doctor Mr Gallimore with Mrs Carrick and he advised them to give her adrenaline to restart her heart. But the ambulance technicians, who are qualified just below the level of full paramedics, were not permitted to administer adrenaline. Her brother Steve Jones told the inquest he thought the technicians should have used adrenaline earlier to try to save his sister. He said: "There was half an hour between the first and second ambulance. "For half an hour, they carried on with giving cardio-vascular therapy, but never thought to give her adrenaline when there was a doctor of 40 years' experience begging them to do it. "The technicians weren't qualified to deal with the situation."
Dr Colin Reid, a consultant in emergency medicine for the University Hospitals of Leicester said: "This would have been a difficult situation for the attending crew. "They would have had no way of knowing if Mr Gallimore was medically trained. "They acted appropriately and professionally, and provided the best medical care they could."
SOURCE
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