Thursday, August 31, 2006


A doctor who operates Canada's largest private hospital in violation of Canadian law was elected Tuesday to become president of the Canadian Medical Association. The move gives an influential platform to a prominent advocate of increasing privatization of Canada's troubled taxpayer-financed medical system. The new president-elect, Dr. Brian Day, has openly run his private hospital in Vancouver even though it accepts money from patients for procedures that are available through the public system, which is illegal.

Dr. Day, who will assume the presidency in August next year, advocates a hybrid health care system similar to those in many European countries. Opponents argue that a fee-charging private component would divert resources from public health and lead to a lack of access to medical treatment for many lower-income citizens.

But opposition to private health care has diminished in Canada, in part because waiting times have more than doubled for certain procedures during the last 13 years, according to the Fraser Institute, a conservative research group. Debate has been especially heated since a ruling by the Supreme Court in June 2005 gave residents of Quebec the right to pursue private treatment if the province could not provide services in a reasonable time.

Since then, Quebec's premier and the leaders of British Columbia and Alberta have expressed a willingness to consider solutions that include privately paid medical services, in part because of the court decision but also because of the rising cost of providing free health care. On average, provinces spend nearly 45 percent of their budgets on health care. In the meantime, private health clinics are opening at an average rate of one a week in Canada.

"The Canadian health system is at a point in history right now where it's going to be reformed in the wake of the Supreme Court decision," Dr. Day said Tuesday in a telephone interview. "The concept that the status quo is something that we should maintain is wearing thin, with frustrated doctors and frustrated patients."

Since its formation in the 1960's, Canada's publicly financed health insurance system has been at the core of the national identity. But in recent years, with waiting times growing and costs skyrocketing, the merits of a larger private component to the health care system has not been the taboo topic it once was.

Experts say there is no better example of that evolution than the election of Dr. Day to head the organization that represents Canada's 62,000 doctors. "There has been a change in what is feasible and what is permissible in public debates," said Antonia Maioni, a McGill University political scientist who specializes in health care. "Five years ago someone like Brian Day would never have been elected president of the Canadian Medical Association. Five or 10 years ago there was much more of a consensus about the sustainability of the public system."



The Democratic-controlled Legislature is on the verge of sending Gov. Arnold Schwarzenegger a bill that would create a state-run universal health care system, testing him on an issue that voters rate as one of their top concerns in this election year. On a largely party-line 43-30 vote, the Assembly approved a bill by state Sen. Sheila Kuehl, D-Santa Monica, that would eliminate private medical insurance plans and establish a statewide health insurance system that would provide coverage to all Californians. The state Senate has already approved the plan once and is expected this week to approve changes that the Assembly made to the bill.

Schwarzenegger has said he opposes a single-payer plan like the one Kuehl's bill would create, but the governor has not offered his own alternatives for fixing the state's health care system. As many as 7 million people are uninsured in the state, and spiraling costs have put pressure on business and consumers. "We know the health care in place today is teetering on collapse," said Assembly Speaker Fabian Núñez, D-Los Angeles. "We need to do something to improve it, to reform it, and this is what we are bringing to the table."

Schwarzenegger's office said it had no official position on the bill. The governor has said he would propose solutions to the state's health care crisis in his State of the State address next January if he is re-elected. "I don't believe that government should be getting in there and should start running a health care system that is kind of done and worked on by government," Schwarzenegger said in July at a speech at the Commonwealth Club. "I think that what we should do is be a facilitator, to make the health care costs come down. The sad story in America is that our health care costs are too high, that everyone cannot afford health care."

The governor hosted a health care summit earlier this year, but no concrete proposals came from the meeting. If he vetoes SB840, the governor will be reminded of his decision come election day in November, Kuehl said. "I hope that the people of California will hang the albatross of bad health care around the governor's neck," she said. Nunez said that while the governor has worked with Democrats on many issues this year, he is on the wrong side of this one. "The biggest issue facing California today is health care," Nunez said. "This legislation represents yet another and the most important opportunity we have to say to the governor that he needs to embrace the Democratic agenda, just as he has done on prescription drugs and minimum wage."

Labor unions and Democrats will take part in a rally on Wednesday to urge Schwarzenegger to sign the bill. Democratic gubernatorial candidate Phil Angelides is not supporting the Kuehl bill. "He supports moving toward universal health care by first covering all children and then requiring businesses to cover their employees," said Angelides spokesman Nick Pappas.

Kuehl called the passage of the bill historic because it was the first time both houses of the Legislature have passed a universal health care bill. SB840 must return to the Senate, which approved it once, 25-13, for concurrence before going to Schwarzenegger's desk. "Every advance you can make for any cause is important," Kuehl said. "Most important, it gives hope for the people of California that this can be done." SB840 would provide comprehensive medical, dental, vision, hospitalization and prescription drug coverage to every California resident. Anyone could see any doctor or go to any hospital. "SB840 creates a system of comprehensive health insurance benefits for all Californians that guarantees free choice of doctors and hospitals," Kuehl said. "It creates access for all Californians by steeply reducing administrative overhead and emphasizing preventative and primary care instead of endlessly cutting coverage and access to care or increasing consumer spending."

Republicans and insurance groups oppose the bill, saying it will create an inefficient government bureaucracy. "This takes us in the wrong direction," said Assemblyman Greg Aghazarian, R-Stockton. "This creates a government-run system akin to the Department of Motor Vehicles. Do we want health care taken care of by another bloated bureaucracy?"

The bill does not account for the costs of the program since it would take several years before any plan was up and running. The plan would create a commissioner and a blue-ribbon commission to examine how the structure would work. An analysis by the Lewin Group, an independent health care consulting firm, said the plan could be paid for with all of the money now being spent on health care. That would mean combining all state and federal funds, along with business contributions and participant payments and co-payments. The report suggests that funding could come through an 8 percent payroll tax and a 3 percent individual income tax.

SB840 allows California to use its purchasing power to negotiate bulk rates for prescription drugs and durable medical equipment, such as wheelchairs, thus realizing an additional $2 billion in savings, Kuehl's office said. But eliminating health care insurance plans would eradicate the groups that have the most experience with getting people insured and to doctors, said Chris Ohman, president and CEO of the California Association of Health Plans. Ohman said other places that are trying universal health care -- such as Massachusetts and San Francisco -- are using health care plans to help facilitate the implementation. He said the insurance companies are in the best position to manage costs. "If there isn't the focus and drive for advancing preventative programs, the sky's the limit in terms of what the costs will be," he said. "That's what health plans do."

A Public Policy Institute poll from September 2004 showed that 71 percent of likely voters said they are at least somewhat concerned about being able to afford health care. A slim majority of Californians, 53 percent, said they would be willing to pay more -- either through higher health insurance premiums or higher taxes -- to increase the number of people who have health insurance.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Wednesday, August 30, 2006

The California threat to drug research

Last November, 61 percent of California voters decisively defeated Proposition 79, which would have forced drug companies to give discounts to poor and middle-income residents. At the time, Gov. Arnold Schwarzenegger vigorously opposed the measure.

So, it may come as a surprise that -- just nine months after it was roasted in the polls -- Arnie is now serving up the same legislative turkey he helped send back to the kitchen. The new measure is just like Proposition 79, in that it calls upon drug manufacturers to offer huge discounts on prescription medications -- up to 40 percent on brand-name drugs and a whopping 60 percent on generics. Specifically, the discounted drugs would be available to uninsured Californians with incomes less than $29,400 -- or about $60,000 for a family of four. Certain Californians -- such as a family earning less than $70,626 -- with significant un-reimbursed medical expenses would also qualify. Schwarzenegger is touting his plan as "voluntary" -- the implication being that drug companies should offer these discounts out of the goodness of their hearts. But in fact, it's the same old ham-fisted attempt to impose price controls.

Drug companies that don't "voluntarily" sell at government-imposed discounts will be bludgeoned into submission. They'll have just three years to comply, after which they'll be kicked out of selling drug to Medi-Cal, the $2 billion health-coverage system for low-income Californians. Imposing price controls on prescription drugs has always been a terrible idea. That's because, unlike our politicians, economic gravity does not reverse direction in an election year.

Perhaps Schwarzenegger could use a quick refresher course in why he opposed a price-control plan the first time. For starters, most drug companies already have programs offering discounted -- or even free -- medicines for those in need. Schwarzenegger might argue that beneficiaries of these existing discount programs must apply individually with every pharmaceutical company whose drugs they require. But that's because drug companies aren't legally allowed to combine their individual plans into one simple-to-join program. Anti-trust laws prohibit them from doing so. That's right: It's illegal for private companies to work together to set prices -- even discount prices for poor people.

Schwarzenegger's plan might make sense if government price controls worked. But they almost always have the exact opposite of their intended effect. In this case, pharmaceutical companies would need to compensate for the forced discounts by raising prices on those people who don't qualify. A family of four with a household income of $72,000 and a child with cancer might see its drug bills increase to offset discounts on hyperactivity medicines available to a family making $70,000.

Over the long term, Schwarzenegger's price controls would have an even more perverse effect. They would lead to fewer new medicines, particularly if other states follow California's example. Today, it costs between $800 million and $1 billion to bring a new drug to market. Cancer patients have hope precisely because companies are willing to risk that money in developing drugs such as Avastin, Erbitux, Gleevec, Herceptin, Nexavar, Sutent and many others.

Ironically, if Schwarzenegger's plan had been implemented across the country 25 years ago, very few of these drugs would have been invented. There would be no life-saving medicines to discount.

If state governments make breakthrough drugs unprofitable, companies will simply stop trying to invent them. Researchers at the University of Connecticut's Center for Healthcare and Insurance Studies found that, since 1960, government interference in drug pricing resulted in $188 billion in lost spending on research and development. The "lost" medicines that might have been developed with that money would allow more people to have lived longer.

Once upon a time, the governor understood this: "I adamantly oppose efforts to impose price controls on prescription drugs because they will have a chilling effect on the research and development of life-saving medicines." Except in an election year.


Criminal doctors OK by the "regulators"

It was a brutal crime, committed by a drug addict with a long history of erratic behaviour. The accused had already lost several jobs as a result of his drug addiction, and he was allegedly becoming increasingly violent. On November 3, 2000, the Queensland man dragged a woman into a bedroom, bashing her as she screamed and attempted to escape. He forcibly removed her clothes and raped her. In 2002 he pleaded guilty to rape, deprivation of liberty and assault and was sentenced to five years' jail.

However, the case stands apart from other cases of sexual assault because the rapist is a doctor, and last month the Medical Board of Queensland renewed his registration. James Samuel Manwaring had previously been struck off the register in the mid-1990s after a psychiatric evaluation found "he constitutes a significant danger to any patient he may have to look after".

However, Manwaring is not the only doctor in Australia with a criminal conviction. Two weeks ago, another Queensland doctor had his registration cancelled after it was revealed he failed to disclose a previous rape conviction. In 1981 Eugene Sherry and two other doctors were convicted of raping a nurse in the US. Sherry was imprisoned for six months and moved to Australia in 1984, and worked in Sydney for 20 years. His 2004 application to work in Queensland was approved under a process that allows doctors to be mutually registered in other states. Sherry disclosed the conviction to the NSW Medical Board, but when he moved to Queensland the NSW board did not inform its Queensland counterpart, and nor did he.

The cases illustrate weaknesses in Australia's fragmented medical registration system and raise the question: should doctors convicted of sexual assault be allowed to practise? In many instances, medical boards allow doctors found guilty of sexual assault to continue to practise if they are closely supervised, or a "chaperone" is present during consultations.

The NSW Medical Board decided last year that a cosmetic surgeon charged with aggravated sexual assault on a patient could continue to practise as long as a nurse was present when he examined female patients. However, Joanna Flynn, president of the Australian Medical Council - which assesses overseas-trained doctors and accredits medical colleges - told The Australian that doctors who cannot be trusted to treat patients unsupervised should be struck off the register. Flynn, who also is president of the Medical Practitioners Board of Victoria, says "if a determining body believes it is necessary to have a doctor chaperoned because they are not confident the patient would be safe, in my view that doctor should not be registered. "Patients must be able to trust their doctor. They may want to question the doctor on medical information, but they need to be able to trust they won't be mistreated by the doctor."

The Australian Medical Association's Queensland president Zelle Hodge says the idea of supervising doctors with a criminal past is fine in theory, but almost impossible to implement. She says medical boards and organisations that employ medical staff don't have the time to consistently monitor doctors. "The medical boards simply do not have the resources to go out and police these restrictions," Hodge says. "It's up to the doctor's employer to monitor the doctor's performance and make sure they are supervised, and sometimes that doesn't happen."

In a case currently before the Medical Practitioners Board of Victoria, a GP is facing suspension for a second time over allegations he conducted a pap smear that was more "sexual than medical", while making sexually suggestive comments to the patient. The GP, Richard George Young, had his licence suspended for 15 months in 2001 after engaging in sexual relationships with two vulnerable female patients. His licence was renewed on the condition a chaperone be present when he examined female patients.

NSW Medical Board chief executive Andrew Dix defended the use of chaperones to monitor doctors who had committed serious offences. But he admitted the system did not guarantee the doctor would not re-offend. "We have a comprehensive chaperoning protocol which requires the regular submission of the chaperone's reports to the board," he said. "But if doctors are determined to be dishonest, some will manage to get away with things." Dix says it's a balancing act to ensure the patient's right to the best possible care and the right of doctors to be given the opportunity to rehabilitate themselves. He says each case is assessed individually and there are no offences that automatically lead to a doctor being struck off the register. "There are doctors who have been struck off a long time ago who periodically apply for restoration who are denied. "But historically the system has been based on the idea that people are able to redeem their character. And there are no black and white rules about what constitutes good character."

However, some argue that while doctors may have the right to a second chance, the public has a right to know if their doctor has a criminal record, or restrictions placed on their registration. Merilyn Walton, an associate professor of ethical practice at the University of Sydney's school of medicine, says patients should be notified if their doctor has been disciplined by a medical board. "Doctors should be required to put a notice in their waiting room saying they are supposed to be supervised," she says. "If I was a patient of that doctor, I would want to know."

Flynn believes all the details of a doctor's registration should be easily assessable to the public. However, Australia does not have a national medical register. Rather, each state has its own slightly different system of assessing and registering medical staff. In April 2004 all the state health ministers announced that a nationally consistent medical registration system, called the Australian Index of Medical Practitioners, would be introduced. The ministers agreed the new model should provide greater public access to medical register information, including an online index of medical practitioners. Two years later the states still operate independently and there's been little progress in improving public access to medical board information. Currently only the medical boards in Queensland, South Australia and the ACT have websites that provide detailed information about doctors' registration.

Walton says most medical boards have failed to inform patients about the medical registration process. "The big challenge for medical boards is to improve the level of transparency of their processes so the community understands how and why they make decisions. The public need to be engaged in the discussion about what standards they want."

The failings of the state-by-state system were highlighted in March this year, when it was revealed that the Hunter New England Area Health Service in NSW waited almost 18 months before investigating an overseas-trained doctor banned elsewhere in the state for misdiagnosing 208 patients in 2004. Farid Zaer, a pathologist trained in India and the US, was banned by the Illawarra Area Health Service in April 2004 after a review of 6300 patient records found he had failed to correctly analyse tests for many diseases, including cancer. In late 2004 it notified the Hunter New England Area Health Service, where the doctor had worked between 1999 and 2001, that it was investigating him. The Hunter service did not begin to review the records of 7300 patients diagnosed by Zaer until March this year.

The doctor has since moved to Queensland, where he is registered to practise unsupervised as a GP and as a pathologist under strict supervision. The case again prompted calls for the establishment of an Australian index of medical practitioners that would record whether doctors have been disciplined by any of the state medical boards, or had any restrictions placed on their practice.

Walton believes the mutual recognition process allows doctors of questionable character or ability to move interstate and continue to practise. "We have mutual recognition, but it caters to the lowest common denominator," she says. "So if one state is weak around disciplinary matters, then that person can be registered in other states based on a weak disciplinary structure. There is also a lack of exchange between regulatory boards and the community. I can't believe we don't have a national registration system yet."

In July, the Council of Australian Governments meeting announced medical boards would be abolished and replaced with a single national registration scheme covering nine health professional groups. For the plan to proceed, each state and territory would have to introduce legislation. The proposal overrides the Australian Medical Council's plan to revamp the existing medical board registration system. The AMC had wanted to give every doctor an identifying number that would allow their details to be accessed through a national register.

Flynn says she is unclear about the details of the proposed specialist registers and what impact they would have on the AMC's plan. Whatever plan is eventually implemented, she is adamant that it must give patients better access to doctors' details. "The public has a right to know if there are conditions on a doctor's registration or if there have been serious disciplinary or criminal offences proven against the doctor," Flynn says. "It's long overdue."



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Tuesday, August 29, 2006


Three women who met as cancer patients are planning a joint legal action to win access to Velcade, a drug for treating multiple myeloma. The "Velcade Three" - Jacky Pickles, Janice Wrigglesworth and Marie Morton, from Keighley in West Yorkshire - are among hundreds who will be denied access to the drug if the National Institute for Health and Clinical Excellence (NICE) sticks to its ruling that it is not cost-effective. Velcade is the first new treatment for multiple myeloma in more than ten years and has been licensed for more than two years for patients who have relapsed.

The drug is available in Scotland, Wales and Northern Ireland and throughout the rest of Europe. Health insurers such as BUPA and PPP pay for it because they believe that it is effective. But primary care trusts in England take their cue from NICE, whose appraisal committee will hold its final meeting next week. Its consultation document, published last month, shocked specialists in the disease.

The International Myeloma Foundation said that the ruling was "ill-informed, unjust and unfair". Eric Low, the chief executive of the British branch, said at the time: "This is an extremely disappointing decision that has sent shockwaves through the myeloma community. Failure to have this preliminary recommendation overturned would represent a catastrophic blow."

Mrs Pickles, 44, said yesterday: "We're waiting for the final guidance from NICE. Hopefully it will change its mind. But if it doesn't, we're going to look to legal action. "We're going to go as far as we can, for each other's lives and for every other myeloma sufferer. Velcade is the best thing for myeloma for four decades. Mrs Pickles, a midwifery sister at Bradford Royal Infirmary, had the disease diagnosed five years ago and has undergone chemotherapy, a bone marrow transplant and a course of thalidomide, the drug that caused birth defects in the 1960s but which has been reborn as a myeloma treatment. All worked for a while before her condition worsened again. Last October she was put on a trial of Velcade, which costs 18,000 pounds for the full eight cycles, and was restored to normal. "That trial did well for me, but I could need the drug again at a later stage," she said. She met Mrs Wrigglesworth, 59, and Mrs Morton, 57, while having treatment and they are giving each other support. "We're in this together," Mrs Pickles said.

The NICE analysis found that the claims made by the drug's manufacturer, Janssen-Cilag Ltd, were not justified by the evidence. One trial showed a 41 per cent reduced risk of death in the first year of treatment. But the NICE view was that the benefits did not meet criteria set for NHS prescription.


Now it's a radiology scandal in Queensland public hospitals

Peter Beattie's major health promise of the election campaign - a new $700 million children's hospital - has been marred by a fresh scandal affecting thousands of patients. Mr Beattie yesterday said a re-elected Labor Government would build a new 400-bed children's hospital next to the existing Mater Children's, with most of the services now offered by the Royal Children's Hospital to move to the new facility from 2011.

But the announcement has been overshadowed by news that a prominent doctor who starred in Government advertising on plans to fix Queensland's ailing health system has now turned whistleblower, exposing deep flaws in the state's radiology services. Royal Australian College of Radiologists president Liz Kenny has revealed thousands of X-rays, ultrasounds, MRI and CT scans ordered for public hospital patients are never seen or assessed by a radiologist. Dr Kenny, who works for Queensland Health, has told The Courier-Mail that critical radiology workforce shortages mean thousands of X-ray results are only seen by GPs, most of whom are untrained at assessing and diagnosing the results. The situation means patients are at risk of having conditions, such as cancers, tumours or fractures left undiagnosed.

The revelations about the state of the hospital system threatens to derail Labor's so-far trouble-free election campaign. Coalition health spokesman Bruce Flegg said the situation was putting lives at risk. "With these sorts of numbers going through you are going to miss things that cost people their lives," he said.

Health Minister Stephen Robertson said there was an international shortage of specialists, especially radiologists. "But through the $1 billion worth of salary improvements, Queensland is now competitive in the recruitment market for radiologists and Queensland Health is working to fill vacant positions," he said.

Dr Kenny said about 500,000 scans were "unreported" at any one time and the extent of those never seen by radiologists only became evident in the past three months. "The magnitude of what is unreported is staggering." Dr Kenny said patients whose scans are not seen by a radiologist did not benefit from their expertise. "It leaves a substantial hole in the management of the patients," she said. Official hospital figures obtained by the Coalition reveal the problem is widespread in both urban and regional areas.

Toowoomba Hospital is the worst in the state with 80 per cent of x-rays and other scans never reported on by a radiologist. Other hospitals which have significant numbers of unreported scans include Gold Coast (56 per cent), Hervey Bay (66 per cent), Royal Brisbane Womans Hospital (49 per cent), Townsville (35 per cent) and Warwick (50 per cent).

A recent survey of 270 Queensland Health radiographers also found 63 per cent plan to resign within six months, a move likely to cause a blowout in waiting times for routine X-rays by Christmas. "With the staffing levels already under pressure, this reduction in professional numbers will result in significant cutbacks in all services, such as x-rays, breast screening and diagnostic imaging for cancer at the majority of Queensland public hospitals," he said. One radiographer said: "We just don't have the people to help all those trapped on the waiting lists."



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Monday, August 28, 2006


More than 300 babies a year are being left with brain damage because of oxygen starvation caused by lack of proper care at birth. The National Health Service litigation authority, which handles damages claims from hospital patients, has for the first time released data from every hospital in England showing the number of babies damaged by botched deliveries. The accidents are being blamed on staff shortages leading to inadequate monitoring.

In the 12 months to April more than 300 families began legal action for severe injuries suffered by their babies. In most cases the damage means children are unable to walk, talk, feed themselves or have any hope of independent life. In the same period medical staff reported a further 174 incidents through a system to help budget for legal claims.

Legal costs and damages for victims reached a high of nearly 175m pounds in the last financial year, but the real costs are said to be much higher because special education, nursing care, continuing health problems and social services are not included. In the five years covered by the data there were 2,763 claims. Of the total, 6%-10% are estimated to be from mothers whose reproductive organs were damaged. Another small group relates to failures to diagnose conditions such as Down's syndrome. Most are children whose brain damage was caused because hospital staff did not deliver them fast enough when the babies were suffering oxygen deprivation.

The figures, released under the Freedom of Information Act, come days after a report condemned childbirth services at Northwick Park hospital near Harrow, northwest London, for failures that led to 10 new mothers dying between 2002 and 2005. The new figures show the Northwick tragedies are not an isolated problem.

Jane Rodrigues, 34, from Dartford, Kent, blames the damage suffered by her two-year-old son Louis on the fact that midwives had failed to recognise that her 4ft 10in frame would have difficulty delivering the 10lb baby she was about to produce. She almost bled to death when her uterus ruptured. Her baby was classed as stillborn but was resuscitated.

He has been left mentally handicapped, unable to walk or talk. "I am sad and angry for him," she said. "He is going to be dependent on other people for the rest of his life." She is pursuing a complaint against Darent Valley hospital in Dartford. The trust has apologised but denies liability.

The cost of such accidents is exemplified by cases such as that of Nathan Hughes. In May he was finally awarded 1.65m pounds, plus 315,000 pounds a year for life, to pay for his needs because the medical team delivering him 14 years ago at Rush Green hospital, northeast London, failed to notice he was being strangled by his umbilical cord. "These disasters happen again and again," said Eve, his mother. "I found out later that the hospital where he was born was known by doctors as the `spastics factory' because of the number of birth injuries."

Others believe the real number of children affected is even higher than the statistics show. "I have certainly met people with damaged babies who have said they don't have the strength to take on the NHS," said Karita Massara, whose son Jack, 9, was awarded 850,000 pounds this year for injuries suffered during a botched delivery at the Chelsea and Westminster hospital, London. "When you are looking after a disabled child, it is physically and emotionally exhausting."

Scope, the charity that works for cerebral palsy sufferers, estimates that up to 13,000 people or 10% of Britons affected by this form of brain damage suffered avoidable birth trauma.

More here

Australia: Underqualified nurses recruited by a desperate government hospital

Hundreds of British nurses due to start work in Queensland hospitals as soon as October may be not be up to scratch by standards here.

In a massive recruitment drive, executives from Cairns Base Hospital are scouring Britain for nurses, offering thousands of dollars in relocation assistance. And they say they'll take on anyone who applies. "There's no way I'll be turning anyone away," Cairns Base Hospital nursing director Glynda Summers said.

However, a former Cairns Base nurse who now works in the UK said British nursing standards were not a patch on those practised in Australian hospitals. She said many of the British nurses would not have had the same basic training. Skills such as intravenous drug administration, catheterisation and the use of cardiographs were standard requirements for Australian nurses, but in Britain they were considered extra qualifications. "Most of them won't have that training. Basically, skill levels are much lower," she said.

The nurse said she believed many of the workers entering Queensland hospitals would be those deemed not good enough for the British National Health Service. "Many new recruits may fall short of the proficiency mark," said the nurse, 40, who did not wish to be named. "The British National Health Service has drastically reduced the number of nursing positions, but it would be fair to say any good practitioner who wanted to remain working in the UK wouldn't have a problem. "There will be a few who want a lifestyle change, but what about the others?"

After placing advertisements in the UK press, Ms Summers leaves for Britain tomorrow with nurse manager Denise Wilds and intensive care nurse Carol Martheze on a three-week recruitment campaign. "We'll take them all. The opportunities are limitless because we're recruiting for the state," Ms Summers said. A Cairns Base Hospital statement said more than 180 applications had already been received. The hospital has 51 nursing vacancies and a further 90 nursing jobs expected to open up soon. Telephone interviews have been conducted and new recruits had been enticed with packages including $3000 toward relocation costs, visa application expenses, salaries of up to $53,000 and free medical cover.

Admitting she was capitalising on widespread nursing job losses throughout Britain, Ms Summers said: "Why not?" "It's good for us and it's good for the nurses who don't have jobs." A Queensland Health spokesperson said all checks and procedures would be followed before applicants could register with the Queensland Nursing Council.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Sunday, August 27, 2006


They're not fussy: Mothers, kids, who cares? Everybody still gets their salary and nobody is ever penalized significantly

Ten women died during childbirth or shortly afterwards in a hospital that suffered from a lack of clinical leadership, a poor working culture and an overloaded maternity unit. The deaths, at Northwick Park Hospital in northwest London, occurred between April 2002 and April 2005, and involved women giving birth or within 42 days of birth. The Healthcare Commission publishes a detailed account today of each of the deaths.

In April 2005 the commission recommended "special measures" to restore good standards at the hospital, which included calling in an outside team to safeguard women. In today's report it says that these measures are working. But the report lays out in painful detail what can happen in a maternity unit that has inadequate systems. In nine out of the ten cases, the report says, there are grounds for criticism. It summarises these as:

* Insufficient input from a consultant or a senior midwife (in five cases), with difficult decisions often left to junior staff.

* Failure to recognise and respond quickly when a woman's condition changed unexpectedly.

* Inadequate resources to deal with high-risk cases: there were too few consultant obstetricians and midwives; not enough dedicated theatre staff; a reliance on agency and locum staff without adequate support; and a lack of a dedicated high-dependency unit.

* A culture that led to poor working practices.

* Failure to learn lessons on the unit, leading to mistakes being repeated.

* Failure by the North West London Hospitals NHS Trust board to appreciate the seriousness of the situation. It was aware of the number of deaths, and should have acted sooner.

Two aspects of the service are singled out for praise. The report says the anaesthetists and the haematology department, which provided blood for the patients, responded well under difficult circumstances.

Of the women who died, six were Asian, two African, one Afro-Caribbean and one European. The hospital serves half a million people in Brent and Harrow, two boroughs with large black and minority ethnic populations.

The causes of death varied. Strokes following pre-eclampsia (very high blood pressure) were the cause in three cases, with bleeding after giving birth in four other cases. One women died of viral encephalitis, one of a cardiac arrest.

The hospital investigated the deaths from a predominantly legal point of view, as if seeking to defend itself, the report says. Common factors were not found, but the commission says that they did exist and should have been identified.

Marcia Fry, the commission's head of operational development, said: "We hope this report gives some answers to the families involved. "We expect trusts across the country to read this report. Most women give birth safely. But there are risks and the NHS must ensure it does all it can to reduce them. There can be no excuse for failing to learn the lessons from tragedies of this kind." Since April 2005 three additional consultants and 20 more midwives have been recruited. The inspectorate also believes there is a better team working among consultants, obstetric staff and midwives.


Another incompetent foreign doctor in an Australian State government hospital

Up to six people might have died because a pathologist in northern New South Wales misdiagnosed their tests, the state government said today. NSW Health Minister John Hatzistergos and the chief executive of Hunter New England Health, Terry Clout, today announced the results of a review of 7350 anatomical pathology tests taken by Dr Farid Zaer. The review was conducted in March this year after concerns that Dr Zaer, who worked at Tamworth Hospital from 1999 to 2001, may have failed to correctly analyse tests for diseases, including cancer.

Mr Clout said that of the 7432 tests re-examined, 38 cases had significant variations which would have a serious impact on patient care. Of these, he said, five or six people had since died. "It may or it may not have been the case (that the misdiagnosis caused death) and because we don't have a parallel universe we will never know," Mr Clout said.

Mr Hatzistergos said he would willingingly refer the matter to further authorities if the families of the deceased wanted him to. "Obviously this is a dreadful thing to have happened," Mr Hatzistergos said. "I am very concerned by the results that have been revealed."

Three independent pathology laboratories conducted the review and advised the government that 97 per cent of Dr Zaer's tests were accurate. Of 217 people who were found to have had variations, Mr Clout said all but four had been contacted. "Those doctors have confirmed that in 179 of those cases there was no impact on the care provided to the patients," he said. "But that does regrettably leave some 38 patients where the significant variation in the test has meant that there was a less than desirable treatment provided." As a result of the misdiagnosis, the patients had either been over-treated or under-treated, including a small number who underwent unnecessary surgery. "We have undertaken a few operations that were not necessary, I have been quite clear about that," Mr Clout said. "Regrettably there have been cases where there appears to have been an error in the original diagnosis, (that) if known at the time, might have meant the patient received different care." But he refused to say if patients had lost arms, legs or breasts as part of the procedures, saying he did not want to identify people in a small rural community who "have already gone through anxiety in relation to this issue".

Dr Zaer, who was trained in India, has been banned from practising as a pathologist in NSW. Mr Hatzistergos said Dr Zaer was no longer working in that field, but was believed to be working in Queensland, possibly as a general practitioner.

Mr Clout said there was no way of knowing if the five or six people who had died in the past seven years had done so because they had been "significantly misdiagnosed". "We can't draw conclusions from that," he said. "Just because two things happen in the same window of time does not mean that one is a causal link to the other." But Mr Hatzistergos said he would refer the matter to the coroner for further investigation. "I am happy to refer anything to any further authority if required to," he said. Asked if he anticipated action by distressed family members, he replied: "We neither expect nor rule it out, it's obviously a matter for the families to make a decision in relation to that."

Concerns about the quality of Dr Zaer's work first surfaced in 2004 while he was working at the Illawarra Health Service. Despite this, thousands of patients were not tested until this year. Mr Hatzistergos said he was disappointed it had taken so long to get the results. "The only thing I do regret is that it has taken as long as it has," he said.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Saturday, August 26, 2006


Final clearance has been given for women in England and Wales to be given Herceptin for early-stage breast cancer. NICE, the National Institute for Health and Clinical Excellence, dismissed an objection to its draft guidance from Newbury and Community Primary Care Trust. As a result, all PCTs will be expected to provide Herceptin.

Several women have gone to court to establish their right to a drug that trials have shown can cut their risk of a recurrence of cancer by up to 50 per cent. Draft guidance was issued by NICE in June, but Newbury PCT said that it was a perverse interpretation of the data. Today's ruling dismisses the PCT's case and reiterates the advice that women should get the drug if they have the type of breast cancer against which it is effective, and their heart function is monitored.

Andrew Dillon, chief executive of NICE, said: "Our assessment of Herceptin shows that it is clinically and cost effective for women with HER2-positive early breast cancer. The guidance has been issued rapidly to ensure consistent use across the NHS." Newbury PCT said that it had wanted NICE to consider whether shorter courses of Herceptin could be as effective as the 12 months recommended. The PCT also raised questions about exactly who should be chosen for treatment.



Two current articles below

Government dentist HIV positive

Up to 500 people are to be tested for HIV after a female dentist working for Queensland Health tested positive for the virus. Clinics at Bowen and Collinsville hospitals will be open from today to test people treated by the dentist since December 15. The dentist, employed by Queensland Health last year, was the only public dentist employed in the region. She worked in clinics in both hospitals and also treated a small number of patients at school dental clinics in the region and a small number of patients at Ayr hospital.

Queensland chief health officer Dr Jeannette Young said the HIV test being offered would give people a response within 48 hours. Dr Young last night reassured patients that the risk of contracting HIV from the dentist was "very very low". She said there was no known case of transmission of HIV in Australia between a dentist and patient.

Queensland Health last night revealed few details of the dentist who started work for Queensland Health "some time last year". Dr Young said it was believed she contracted the disease in late December and ruled out that it was caught from one of her patients. Queensland Health yesterday began going through all medical records to trace former patients who will be contacted and offered a HIV test. A 1800 hotline has been established and more information is available on the Queensland Health website.

Dr Young said Queensland Health required all staff who undertook exposure-prone procedures to be aware of their HIV, Hep C and B status. "Dentists put their hands into people's mouths . . . They could potentially cut themselves and there is a risk blood could go into a patient's mouth."

Dr Young said Queensland Health protocols required dentists to wear gloves and a mask when treating patients and all medical equipment was sterilised after use.

Australian Dental Association Queensland president Dr Robert McCray last night said former patients of the dentist should not be alarmed as the risk of infection was "almost zero". "Dentistry within Queensland is performed under a set of guidelines," Dr McCray said. "The likelihood of transmission from patient to dentist or dentist to patient is very low in the extreme unless standard operating procedures were not followed. There has been no known case in Australia. "The public should have total confidence that the likelihood of transmission from dentist to patient is virtually zero."


Truth penalized by corrupt government

A health whistleblower who was demoted after exposing the "Jayant Patel" of dentistry is demanding his job back, claiming he has been vindicated. Former Gold Coast Health Service District principal dentist Dan Naidoo was disciplined last year after speaking out about the alleged rogue dentist and the poor state of public dental services on the tourist strip. The dentist he exposed - accused of botching procedures and "torturing" patients to the point of tears - had strict conditions placed on his practice by the Dental Board of Queensland and has since been sacked. One female patient was left with a hole in her jaw and needed nasal reconstruction after a procedure in what she described as the dentist's "torture chamber".

But after suspending the dentist and alerting the media, Dr Naidoo was demoted and sent to a suburban dental clinic in what former health inquiry commissioner Tony Morris described as a classic case of Queensland Health's "shoot the messenger" culture. Now working for NSW Health, Dr Naidoo says he has been vindicated and wants his senior Gold Coast job back. "I just feel cheated and I feel a great sense of injustice," he said yesterday. "I stopped this dentist from torturing patients and yet I was punished and demoted."

An internal Queensland Health email obtained by The Courier-Mail reveals a decision was made in April last year to remove the dentist from clinical work "in the interests of patient safety". But Dr Naidoo said the dentist was allowed to continue operating despite complaints from patients and staff. He later suspended the dentist after hearing one of his patients "screaming in pain".

Surfers Paradise Liberal MP John-Paul Langbroek, himself a dentist, has raised Dr Naidoo's plight in State Parliament and said he should have had whistleblower protection. "He was trying to protect patients and he was cast adrift by Queensland Health," Mr Langbroek said.

But in a letter to Mr Langbroek, Premier Peter Beattie said Dr Naidoo was disciplined for making "inflammatory and untrue" statements which had "undermined public confidence" in Gold Coast dental services. Mr Beattie said Dr Naidoo had been warned that he could be disciplined for speaking out, and was given an opportunity to defend himself. Dr Naidoo had not appealed against the decision or sought legislative protection afforded to "true whistleblowers", Mr Beattie said.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Friday, August 25, 2006


President Backs Disclosure of Medical Costs

"President Bush signed a measure Tuesday ordering federal agencies to do more to inform beneficiaries about the cost and quality of their health-care services, which federal officials hailed as a major step toward bringing greater efficiency to the nation's medical system. The executive order requires four federal agencies that oversee large health-care programs to gather information about the quality and price of care, and to share that information with one another and with program beneficiaries. The initiative underscores Bush's belief that the nation's health-care system would be more efficient if consumers could shop for the best care at the best price, administration officials say. . . . With the federal government paying for about 40 percent of the nation's spiraling health-care bill, administration officials said the order requiring federal agencies to develop and share information about the quality and price of care should help bring greater transparency to the business of medicine."


Public hospital negligence kills in New South Wales

The family of a Sydney teenager have demanded to know why health officials said she did not need medication that might have prevented her death from meningococcal disease. Jehan Nassif, 18, from Yagoona in Sydney's south-west died from the disease in Bankstown Hospital last Friday.

Her boyfriend George Khauzame had recently returned from a holiday to Greece with his cousin Elias. Elias was diagnosed with meningococcal upon returning to Australia, while Mr Khauzame was given antibiotics as a precaution. Worried his girlfriend might also contract the disease, Mr Khauzame today said he asked a public health official if Jehan was at risk. He said he was told she would be fine. "I asked the lady at public health should Jehan be treated because I had made contact with her for three hours on Monday nights," he told reporters. "She said Jehan was safe and didn't need to be treated. "I asked again and she said she she would be fine."

Mr Khauzame said his concerns for Jehan's health were further inflamed when the pair went to visit Elias in hospital. He said Jehan had asked if she needed a face mask but was told by the nurses that she didn't need to wear one, even though the nurses were.

Jehan's father, Tony Nassif, is now demanding to know what happened to his daughter. "I want to know why she died," he told reporters. "She was beautiful, she wanted to be a teacher." Mr Nassif said his daughter wanted to go to hospital last Friday morning but was told by ambulance officials it would be a two to three hour wait at Auburn Hospital. After she lost her vision, her ability to walk and a purple rash broke out on her body, the family called the ambulance again and she was rushed to Bankstown Hospital, where she died a short time later.

NSW Ambulance operations director Michael Willis today said ambulance officers who were called to Jehan's home at about 3am on Friday had said she refused to be transported to hospital. "The two officers that attended that case have recorded that they found a female patient suffering with vomiting and diarrhoea and after an examination with the family, in fact that patient refused transport," he told reporters. The ambulance officers had not been aware Jehan had been in contact with a person with meningococcal and had not diagnosed her with the condition, Mr Willis said. "They were unable to detect any signs of meningococcal at that stage," he said.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Thursday, August 24, 2006


Equipment rule-breaking plus anaesthetist incompetence kill a healthy kid. And why did a cut finger need a general anyway? I have often had plastic surgery on my face done under a local! And no-one was penalized of course -- AND the abuses continue

Earlier this month, leading orthopaedic surgeon Simon Moyes, who put patients at risk of infections by re-using surgical equipment, escaped punishment after it was claimed such practices are widespread in the NHS due to cost cutting. It was news that shattered the Clowes family, whose nine-year-old son Tony died exactly five years ago this month after breathing apparatus was reused in what should have been a minor operation. Here, Tony's father George Clowes, 49, who works for a pharmaceutical company and lives in Dagenham with his wife Carol, a housewife and children Dion, 22 and Andrew, 13, explains why it's vital that lessons are learned.

He says: "After reading about Simon Moyes in the newspaper last week, I was left feeling as though I'd been run over by a truck. July is always a difficult month for my family and I because it marks the end of another year without our son Tony. And to hear at the same time that the very practices that killed our son are still going on was shattering. After Tony's death, we were promised that lessons would be learned, which, given this latest investigation, we find difficult to believe.

One of the consultants who gave evidence in support of Mr Moyes said it was common practice to reuse equipment because the NHS is so short of funds. To us, the thought of doctors still risking people's lives for the sake of a little penny pinching feels like a slur on Tony's memory. All fathers dote on their eldest son, and Tony was the apple of my eye. He was a caring boy, who enjoyed things like cooking and playing on his bike. He also had a thirst for knowledge, and I'd forever be finding him curled up on his bed with a book. At the time of his death, he was in perfect health. He wouldn't have ended up in hospital at all had he not lacerated his right index finger while trying to repair the chain of his bike.

I remember him coming rushing in from the garden that afternoon, in tears and covered in blood. After running his finger under the tap and seeing how deep the gash was, I decided to take him to our local A&E department at the King George hospital in Goodmayes, Essex. Tony cried all the way there but soon perked up at the sight of the hospital and the doctors. Because his wound was bleeding so heavily, we were rushed straight through to see a doctor and Tony was given a painkilling injection. When the doctors said they wanted to transfer Tony to the a specialist reconstructive department at the nearby Broomfield hospital in Chelmsford in an ambulance, he could barely contain his excitement and forgot all about his cut. He'd always wanted to go in an ambulance and thought the whole thing was a fantastic adventure. We arrived at Broomfield at about 5.30pm. At that point, I was expecting they'd stitch Tony's finger back up and we'd be home in time for dinner.

But because there was no surgeon on duty, it was decided Tony would stay the night and be operated on the following morning. I offered to stay with him, but he'd spotted he had a computer and toys in his room, and confidently told me he'd be fine on his own. The next morning, I returned to the hospital while Carol stayed at home and looked after our grandson. Of course she would have been there too had we imagined anything serious would happen but we thought it was just a case of a Tony needing a few routine stitches. By the time I got there at around 8am, Tony was his usual chatty self, sitting up in bed and asking the doctor lots of questions about the anaesthetic. Then he asked me if I'd buy him the latest CD by Shaggy, to which I said yes. Tony went off for his operation at 9.30. I stayed with him in the theatre holding his hand until he was given the anaesthetic.

I said to him "See you in a hour son", kissed him on the forehead, then went off to get a cup of tea. Sitting on the chair next to Tony's bed in the ward, I had no idea that almost as soon as I'd left the room, he had encountered difficulties. I had no idea that as I flicked casually through magazines, doctors were struggling to save Tony's life. I thought in a couple of hours, Tony would be ready to go home and would be chatting away about the welcome back dinner his mother was making him. The first I knew anything was wrong was about an hour later, when a doctor and his assistant came and found me and ushered me into a side room. He looked at me and said "I don't know how to tell you this but there's been an absolute disaster."

Then he said that Tony had died. It was impossible to take in what they told me next. I listened in total disbelief as they told me that they'd discovered Tony wasn't getting any oxygen through the breathing tube they'd put down his throat while he was under the general anaesthetic. At first, after checking the breathing equipment and discovering it was all fine, they'd thought he'd had an allergic reaction to the anaesthetic drug. So they'd started injecting him with a cocktail of other drugs, including adrenaline, in order to counter the anaesthetic.

It was only after other senior anaesthetists had rushed in to examine Tony, that one of the doctors finally lifted Tony's mask and discovered one of the connectors inside it had slipped into the tubing and was blocking the airflow. Tony had suffocated to death.

I can't even begin to describe how I felt in that moment. For a start, I couldn't take it in. How could he have died as a result of a simple operation to put a few stitches in his finger? How was it possible that just an hour ago, Tony was his usual chatty and relaxed self and now he was dead? And how could they have not noticed a tube was blocked and suffocating? I don't know whether I screamed or shouted or cried. But I do remember struggling to breathe. All I wanted to do at first was see Tony. The doctors wanted to phone Carol, but I told them I'd go home and tell her myself after I'd seen my son. I remember walking along a corridor in a total haze.

I felt like pushing aside all the doctors and nurses we passed on the way so I could just get to my son, but everyone stood aside to let me walk through. I think they all already knew what had happened. Looking at Tony lying on the bed, it was impossible to believe he was gone. He looked as though he was just asleep. I half expected him to jump up, put his arms around my neck and tell me it the whole thing was some sort of joke. But it was obvious from the way the two doctors were acting, staying right by my side the entire time, ushering me up back stairs away from all the other patients and not even giving me a moment alone to gather my thoughts, that this wasn't a joke.

I could tell straight away that they knew they'd done something terribly wrong. Looking back on it, I think they were worried I'd run into the wards screaming "These two have killed my boy!" which is why they were keeping such a close eye on me. They senior doctor and his administrator even came in the taxi with me home, and stood right by my side as I walked into the house and told Carol what had happened. Like me, she also struggled to believe anything had gone so wrong. When I said to her that something awful had happened, her first thought was that they'd cut Tony's finger off, not that he was dead. Stunned, Carol and I returned to the hospital, taking Andrew and Dion with us too. We went to see Tony again. We were all too shocked to even cry and just felt totally numb.

I was also taken to see the hospital coroner, who explained to me that the police had already sealed off the operating theatre and started an investigation. His words were a blur to me though - it was far too soon for me to start thinking about a possible medical negligence case. That night, after telling the rest of our family, we sat at home and sobbed. Tony should have been back there with us chatting away about his bike and his books as usual. Instead, we were now thinking about burying him. Tony's funeral took place two weeks after his death. There was a great turn out - everyone from his headmaster to his shocked school friends and we played two tunes from the Shaggy CD Tony had asked for just before his death.

As well as grief, I think everyone there was united by a total sense of disbelief. Tony's death led to a major police operation, Operation Orcadian, during which detectives looked at 13 similar but non-fatal cases all over the country involving blocked oxygen tubes. Three members of hospital staff were arrested over the incident and a file was submitted to the Crown Prosecution Service, but in July 2002 detectives said the boy's death was not the result of a criminal act. Instead they blamed sloppy working practises by NHS staff.

In each of these 14 cases including Tony's, a tiny piece of plastic used to connect anaesthetic tubing to a patient's face mask had become wedged inside the point where the two connect where it was difficult to see. Apparently this resulted from the equipment being washed and then left jumbled up in drawers. This is despite strict guidelines issued in 2000 by the Medical Devices Agency (MDA) that breathing equipment should be used only once and then binned.

In May 2003, a jury inquest at Chelmsford Coroner's Court returned a verdict of `accident contributed to by system neglect'. The foreman of the jury cited factors including `inadequate guidelines, failure to ensure the patency of all ancillary equipment and failure to follow guidelines concerning single-use medical devices' as causes. David Scott, the consultant anaesthetist who investigated the case, told the inquest that Tony would probably have lived if doctors had disconnected the equipment and given him mouth-to-mouth resuscitation. It devastated us that his life could have been saved so easily.

Although the inquest did condemn the hospital, both Carol and I would have been happier had the individuals who attended to Tony on the day been held accountable. We still can't believe not only did they break guidelines but they didn't do something as basic as mouth-to-mouth which would have saved his life. And no verdict could really offer us consolation for Tony's death. At the time, we were told by spokes people from the hospitals concerned that changes would be put in place and equipment would no longer be reused. It was the hope that lessons had been learned that gave us some comfort and consolation during those dark days and months that followed Tony's death. That is why the recent case matters to me so much. If doctors continue to get away with such behaviour, then there will be little incentive for them to change their ways and more people will die as a result of NHS budgetary constraints.

Even five years on, we still miss Tony desperately. There is still a gaping hole in this family and although we have days now when we're able to laugh, we will never be as happy as we once were. That is why I will carry on the fight to see doctors give up their shoddy cost-cutting ways. If I don't, then Tony's death will have been in vain and he'll become just another statistic."

Source. (HT Bizzy Blog).


Below is an email received from a reader who is an anesthesiologist in a U.S. public hospital:

Local anesthesia can also be dangerous, or fatal, in the wrong hands. This boy was in the wrong hands. We have separate "ambu bags" to ventilate patients. If the machine malfunctions, we reach for the ambu bag, ventilate the patient, and then troubleshoot the machine. We have "pulse oximeters" to measure oxygen in the skin, and "end tidal carbon dioxide" to measure ventilation. Alarms are set to go offf if these become abnormal, as would occur if the ventilation circuit was blocked. In addition, the anesthetist should be observing the patient - obviously not the case here. The time of neglect must have been significant. A healthy patient has enough "reserve" oxygen that it would take a number of minutes to die even if the oxygen supply was cut off. In the USA, this would be negligence - plain and simple - and a multi million dollar out of court settlement.


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Wednesday, August 23, 2006


And an arrogant government doesn't care

For more than two decades, John Simper was resigned to a slow and painful death from multiple sclerosis. Unable to work or drive, plagued by recurrent headaches, bouts of confusion, short-term memory loss and weakness in his limbs, he feared that he would end up paralysed and in a wheelchair. Today he feels mentally and physically stronger than he has in years, after being told that MS was almost certainly misdiagnosed. Instead he has an illness that can be treated with an aspirin a day.

He is one of hundreds who may have had MS, the progressive disease of the nervous system, misdiagnosed. At least 5 per cent of those told that they have MS are believed instead to have Hughes syndrome, which results in the blood becoming thick and sticky and liable to clot dangerously. Patients in whom MS was diagnosed — the disease affects about 85,000 people in Britain — have experienced seemingly miraculous recoveries on learning the true cause of their illness, in some cases after decades of ignorance. Paralysed patients have regained the ability to walk and others have overcome debilitation, headaches, confusion and short-term memory loss with treatments involving blood-thinning drugs such as aspirin and warfarin.

Mr Simper, 60, from Ipswich, a former motorcycle racer and mechanic, went to his GP after reading about Hughes syndrome in a magazine. Recognising his symptoms in the article, he asked his GP for extra tests. They showed that he had Hughes. He is campaigning to increase awareness of the condition. “I’ve got used to the idea of MS over the last 26 years. I’ve always been someone who wants what I want when I want it and I have not let my condition get in the way of that,” he said. “But people are needlessly suffering because they don’t know the truth about their illnesses, and the Government has to take notice of that.” An estimated 150,000 people in Britain suffer from the syndrome, first reported by Graham Hughes in the British Medical Journal in 1983. It has since been confirmed as the cause of one in five recurrent miscarriages, one in five strokes in younger people and one in five deep vein thromboses.

Yet Dr Hughes, now a professor at the London Lupus Centre, says that few GPs are alert to the condition and lives are still being ruined because simple tests are not offered as a matter of routine. “It is still totally under-recognised. People have been told they have MS and treated as such yet received no benefit, and the true cause has been under our nose the whole time,” he said.

Hazel Edwards, 48, a mother of two from Wrexham, North Wales, was paralysed from the neck down and received no benefit from chemotherapy and intravenous steroids after MS was diagnosed in 2001. She can now walk again, after a diagnosis from Dr Hughes. “As soon as I started warfarin, my memory improved and I found I could walk,” she said. “Professor Hughes and his team gave me back my life.” She first suffered repeated miscarriages, memory loss, confusion and a loss of coordination 28 years ago.

The Department of Health was “not aware of any evidence that population screening would be beneficial”. Yet a survey at the lupus centre indicated as many as 32 per cent of patients suffering from Hughes syndrome had been diagnosed wrongly or treated for MS. “The indications of MS and Hughes syndrome are extremely similar, even down to the MRI scans,” Professor Hughes said. “They can be extremely difficult to diagnose, but a simple blood test can make all the difference.” He recommends that two blood tests be offered routinely to any MS patient who has suffered recurrent headaches, problems with clots, a family history of autoimmune diseases, or who has had recurrent miscarriages


18,000 patients harmed by hospital mistakes in New South Wales

Thousands of patients a year are being harmed by often avoidable mistakes such as being given the wrong drugs, incorrect treatment or falling down while in the care of public hospitals or other parts of the health system. An analysis, to be released today, of the first full 12 months of data from a NSW program designed to encourage reporting of so-called "adverse events" has found there were 125,000 notifications in the year to July 2006, of which 18,750 resulted in some level of injury or harm to patients.

NSW accounts for about one-third of the healthcare episodes across Australia, so on a national basis the figures could be expected to be three times higher. But because reporting events to the system is voluntary, the true level of mistakes and problems in the public hospital system is likely to be higher still. Falls represented the biggest category of adverse events, accounting for 26 per cent of all notifications or 32,500 incidents. Medication errors -- patients given the wrong drug or the wrong dose -- came next, accounting for 18 per cent of notifications or 22,500 incidents.

Incorrect clinical management -- in cases where the patients' conditions may have been misdiagnosed, diagnosis was delayed, or the wrong treatment given -- accounted for 13 per cent of notifications, or 16,250 incidents. The figures were compiled by the NSW Clinical Excellence Commission, whose CEO Cliff Hughes will present some of the findings at today's Australasian Conference on Safety and Quality in Health Care in Melbourne. Professor Hughes told The Australian that all but about 400 to 500 incidents a year resulted in minor or no harm to the patients. About 37,000 of the 125,000 notifications were of a non-clinical nature, such as lost or stolen property, or complaints over how a patient was spoken to. However, he conceded many incidents could be prevented by better hospital procedures, and said the data was being used to change the times at which some common yet potentially dangerous drugs were given.

An example was the blood-thinning drug warfarin, which is commonly used to reduce the risk of strokes and heart attacks or for patients with irregular heart rhythm. Too large a dose could cause haemorrhage, while too small a dose meant the drug would not work, Professor Hughes said. For historical reasons, such as the fact the results of blood tests ordered in the mornings would only be available in the evening, warfarin was usually given to patients at about 8pm to 9pm. But the figures showed a three-fold spike in adverse drug events at about that time. NSW was changing procedures to have the drug administered at about 4pm, when more staff would be on duty to monitor effectiveness and handle adverse consequences, he said. "That's a pretty good example of how this data can be used to drill down and look at the trends, and make changes in healthcare to make it safer for patients."

Professor Hughes said analysing the figures showed inadequate knowledge or skills on the part of doctors or nurses was linked to about 56 of the 500 or so serious adverse events. Over three times more (170) were due to communication issues -- for example, when key details about the patient's condition were not transferred to another ward or hospital department. "Any adverse event is the end-point of some deficiency in the system," Professor Hughes said.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Tuesday, August 22, 2006


The Government's value- for-money watchdog is set to refuse approval for two new bowel cancer drugs, to the fury of patients and cancer charities. Nice, the National Institute for Health and Clinical Excellence (Nice), will recommend today that Avastin and Erbitux are not sufficiently good value to justify NHS prescription. Andrea Sutcliffe, deputy chief executive, said: "Although bevacizumab [Avastin] does show some increased benefit over standard treatment, the [Nice] Appraisal Committee was not persuaded that it was cost-effective in the treatment of metastatic colorectal cancer. "The evidence available on cetuximab [Erbitux] does not compare it to current standard treatment and we are not able to assess whether it is any better than existing treatments."

The judgment is not final and is open to appeal before guidance is issued in November. But cancer charities are preparing a challenge. They argue that the two drugs work, shrinking tumours and extending life in patients with advanced colon cancer, even if they are not a cure. They are widely available elsewhere, including across most of Europe. Hilary Whittaker, chief executive of Beating Bowel Cancer, said: "We urge Nice to reconsider. Why should patients in the UK be worse off than patients in the rest of Europe?" Michael Wickham, the chief executive of Bowel Cancer UK, said: "The NHS of 2006 is, it seems, content to fund a 10 billion pound overspend on information technology but not to give patients treatments that can help them live longer." Denise Richard, of Merck Pharmaceuticals, which makes Erbitux, said: "The UK is the only country in Europe where Erbitux has been licensed but is not routinely available to patients because the NHS will not fund it."

Bowel cancer is the third-commonest cancer in the UK, with 35,000 new cases every year and 16,000 deaths. More than half the patients will develop cancers that spread, for which the five-year survival rate is only 12 per cent. Avastin and Erbitux are new medicines that work by targeting a growth factor that stimulates the growth of blood vessels needed by tumours to grow. Both are licensed and in trials have shown effectiveness in tumours that are resistant to chemotherapy. Erbitux, used with the traditional drug irinotecan, shrank tumours by half in a quarter of patients and slowed progression of the disease by four months in half of patients. Avastin had similar effects on survival when used with other drugs.

However, the question that Nice has to answer is whether the drugs are cost-effective. Nice measures the cost per life-year saved, with a threshold of effectiveness of about 30,000 pounds. Neither passes this test: Avastin costs between 83,000 and 107,000 pounds, and Erbitux between 39,000 and 69,000. One patient who is taking Erbitux is David Taylor, 54, a journalist who lives in North London. He had colorectal cancer diagnosed in 2004. Treatment with conventional drugs began in January 2005. But the disease progressed and his consultant warned him: "We're running out of drugs."


Federal bias against sick men in Australia

Men are being denied free access to a cancer drug, even though it is available to female patients. Women fighting breast cancer can get the chemotherapy drug Taxotere (docetaxel) free on prescription under the Pharmaceutical Benefits Scheme. But men with prostate cancer who don't have private medical insurance have to pay almost $3000 for each treatment. Some patients need up to 20 treatments, making it impossibly expensive for many. Taxotere is the only chemotherapy drug proven to extend the lives of men with incurable prostate cancer.

Leading urologist Prof Tony Costello said 3000 men died every year from the disease in Australia. "A significant proportion would be candidates for the drug," he said. Tony Gianduzzo, Queensland chairman of the Urological Society of Australasia, agreed: "It would be nice to have it available for those men who would benefit."

They agreed men were victims of their failure to lobby as effectively as women did. "Men have been pretty poor advocates for their own cancer," Prof Costello said. "It's up to people like us who have to look after these folk to lobby for the drug to be made available on the PBS."

Taxotere was made available for breast cancer patients in 1997. Two years ago, it was discovered that it could also be used to treat men with malignant prostates - the biggest cause of cancer deaths in males. The treatment has been found to extend the lives of prostate patients by an average two months more than standard treatments, and up to two years in some cases. For breast cancer patients, the average increase was 2.2 months.

Federal Labor frontbencher Wayne Swan, who was successfully treated for prostate cancer five years ago, backed the push for the drug to be made freely available. "There is a strong case for the listing of this drug. I would give the doctors all the support I possibly could," said the Member for Lilley, on Brisbane's northside. "It certainly looks like there is a double standard in its use, and you can only assume the decision was financial, not medical."

A spokeswoman for Federal Health Minister Tony Abbott said an application by the manufacturers of Taxotere for it to be added to the PBS for prostate cancer treatment had been rejected. "It's up to them to try again," she said. "The Government doesn't go touting for drug companies to apply." The Federal Government spent $157 million in 2004-05 subsidising several breast cancer treatments.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Monday, August 21, 2006


Labour faces allegations of trying to undermine the independence of the National Audit Office after it successfully toned down the findings of an inquiry into the 12 billion pound NHS computer system. Documents released last week show how key passages in the NAO report were changed after interventions by Department of Health officials. These included removing warnings about the difficulties of creating computerised records for every patient in the country. The Connecting for Health scheme is intended to create centralised medical record systems for 50m patients. Critics fear it could threaten patient confidentiality and make the NHS more vulnerable to damage from computer failures.

The NAO report on the scheme, published in June, was welcomed by NHS officials for its broad support of the programme. However, a draft of the report, dated January 26, 2006 and obtained by The Sunday Times under the Freedom of Information Act, warned of potential problems. It said: The Department of Health had failed to demonstrate "clear and effective leadership" to staff implementing the programme.

NHS workers were worried "the confidentiality of patient information may be at risk". The NHS lacked sufficient skills to support the delivery of the programme. Although there had been "substantial progress", the programme faced "significant challenges".

When the report was published six month later, the warning over departmental leadership had been removed; the paragraph highlighting doctors' worries over confidentiality was also missing and the claim that the NHS did not have the required skills to deliver the programme had been dropped.

Instead, headings of the report were changed which gave more emphasis to what the project "has achieved". Even the projected costs of the programme were cut from œ13.4 billion in the draft report to œ12.4 billion in the final version. The key conclusion on the challenges was unchanged. One source who has worked closely with the NAO said: "It's pretty clear the NAO were bullied into changing this report."

An NAO spokesman said: "Like any report it went through a process to ensure the presentation was fair and the facts were accurate. The overall conclusions are the same in the final report as in the provisional report. The œ1 billion fall in cost followed new information."

The health department said: "We co-operated fully with the NAO to ensure the publication of a balanced and accurate report."


Another crooked overseas doctor found in a Queensland government hospital

Labor was embroiled in a new health scandal with revelations that a grandmother died after an overseas-trained doctor failed to treat her properly. Lillian Shaw, 67, died last year in Lowood, west of Ipswich, after Indian-trained GP Dr Jaideep Bali failed to diagnose a perforated stomach ulcer despite visiting her three times in 36 hours. A coronial inquest also found Dr Bali had given the mother-of-seven a potentially fatal injection of morphine 2® hours before she died, and later tried to cover it up.

Mrs Shaw's family and the Coalition yesterday said the Beattie Government had to share responsibility for the tragedy. "It's another Dr Death," said Mrs Shaw's son Karhl Earnshaw. "It goes all the way up to the Beattie Government and the Health Minister. "To say we are furious would be an understatement. If you knew the agony we've been through over the last 18 months . . ."

Mrs Shaw died on the evening of January 13, 2005, two days after she began suffering abdominal pain and vomiting. She was visited at her home in Lowood three times in 36 hours by Dr Bali, a GP from the Lowood Medical Centre. Mrs Shaw's husband, Ian - described by the coroner as "an impressive and intelligent witness" - said the doctor did not examine his wife during any of the visits.

The inquest heard that Dr Bali did not make any record of having administered morphine during his last house call and continued to tell Mrs Shaw's family for some months that he had not done so.

Coroner Matthew McLaughlin concluded that Dr Bali was not a reliable witness and said he strongly suspected the GP had "deliberately been untruthful" and, initially at least, did his best to conceal the fact he had given Mrs Shaw morphine.

Opposition Leader Lawrence Springborg said tragedies such as Mrs Shaw's death were "the Beattie Government's real record on health". He said: "The Government has run the health system down so much they have driven away Australian-trained doctors and are desperate to fill the void by giving substandard people licences to practise." Health Minister Stephen Robertson said he had directed Queensland Health to forward the coroner's report to the Medical Board for immediate assessment.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Sunday, August 20, 2006


They can't fund the hospitals they have so what do they do? Build new ones! Unbelievable

Six new Private Finance Initiative hospitals will be approved by the Government today, signalling its commitment to continue what it claims to be the largest hospital building programme in the history of the NHS. But the optimistic message will meet with fury from public health specialists and training hospitals, which have been told to cut their budgets to hold down NHS deficits. Under the plans, Guy’s and St Thomas’ will lose 4.7 million pounds , Bart’s and the London 3.7 million, the Royal Free 2.1 million and St George’s 2.2 million, for example.

The money will come from budgets set aside for education and training for this year, which is already half over. “Lord knows how we are going to make these kinds of cuts when the money is already committed,” one hospital manager said yesterday. “What a way to run a business!” said another in an exchange of e-mails across the network of London teaching hospitals. The impression being given was that the hospitals would not take the cuts lying down.

Public health spending has also been targeted, according to Health Service Journal, which reported that the department’s plan is to set aside a 350 million “contingency fund” to help to bring the NHS back into financial balance. This will come from money devolved to strategic health authorities (SHAs) this year from central funds that were devoted to public health, medical education and training, clinical excellence awards, performance-related pay for GPs and services such as walk-in centres, out-of-hours services, and NHS Direct.

Public health specialists are furious. Professor Rod Griffiths, the president of the Faculty of Public Health, told Health Service Journal: “I’m very disappointed that something as important as this has been so clumsily managed. “The overspends have not been caused by community medicine. It is poor commissioning and poor management of acute services.” The department is projecting a gross deficit for the NHS in this financial year of 883 million, against 1.2 billion last year. It plans to offset this against a 135 million surplus from primary care and acute trusts, 415 million from savings by SHAs, and the 350 million contingency fund. That should achieve a net surplus of 17 million.

But these problems will be brushed aside by ministers as they announce another 1.5 billion for six new PFI hospitals to be built for University Hospitals North Staffordshire, Tameside and Glossop NHS Trust, Salford Royal Hospitals, Walsall Hospitals, South Devon Healthcare, and University Hospitals Leicester. Andy Burnham, the Health Minister, said: “We are delighted to be able to give the go-ahead for these new hospitals. This is great news for the hundreds of thousands of patients who will benefit from the modern, bright new buildings. “The new facilities will not only be the best in terms of design and quality, but they will be affordable well into the future.”

The six hospitals will have far more single rooms than traditional NHS hospitals, with up to half the beds in single rooms. The standard of accommodation and facilities will be a big leap forward, the department said. The first of the new hospitals will open in 2010. The announcement means that since 1997, more than 10 billion will have been committed to hospital building. A total of 76 schemes are open — 58 PFI and 18 built using public capital — and another 30 are under construction. Andrew Lansley, the Shadow Health Secretary, said: “The reality is that the NHS financial crisis has resulted in over 20,000 job losses in NHS hospitals, and has raised the spectre of some of these hospitals closing.”



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.