Monday, March 31, 2008

Australia: Sydney's killer hospital strikes again

And nothing is being done about the gross negligence concerned

A major [public] hospital has admitted that it failed to properly treat a disabled woman who died while in its care. Karen Stone, 41, was admitted to Sydney's St George Hospital in October 2004, with acute leg pain. She died a few days later from pulmonary thromboembolism after an undiagnosed clot in her leg travelled to her lung, the State Coroner found the following year. Now her mother wants to know why doctors at the hospital failed to give her routine preventative treatment.

Lynette Stone said both she and her daughter repeatedly asked hospital staff to investigate if the pain was caused by deep vein thrombosis. Their concerns were dismissed, even though Ms Stone was a high-risk patient. Mrs Stone questions if her daughter's disability meant she received less care and attention from staff. Ms Stone had a rare medical condition called Prader-Willi Syndrome that causes an obsession with food and eating, poor muscle tone and learning difficulties.

Debora Picone, who was in charge of the hospital at the time and is now the Director-General of NSW Health, said in a letter to the Health Care Complaints Commission soon after the autopsy that there was no excuse for the failure. "A satisfactory explanation was not documented in the clinical record nor was the caring medical team able to provide one when questioned," she wrote. She admitted the hospital should have provided anticoagulant therapy. The simple, but life-saving, injection was finally ordered by a professor who was taking a group of medical students on tour of the ward two days later, but the treatment was still not administered for another 24 hours. Ms Stone died the next day.

"It cannot be ascertained why the omission of treatment occurred," Professor Picone wrote. The Health Care Complaints Commission did not investigate the death, instead offering conciliation - an informal discussion with no power to make any decisions. Lorraine Long from Medical Error Action Group said government departments set up to deal with complaints had proved to be "ineffective" and a "waste of time" for bereaved families. "I have not encountered a person to be satisfied with a health-care complaints commission anywhere in the country," she said. "They want you to conciliate a death - it's obscene."

Mrs Stone said her daughter was a "wonderful soul" who brought endless joy to her family and friends. "In my heart I feel she should still be with us. If only they had taken more care, questioned more about why the pain wouldn't go away, she would not have died," she said. "If she'd been 'normal' would they have taken more notice of her?"

Venous thromboembolism, which refers to deep vein thrombosis and pulmonary embolism, causes 10,000 deaths each year in hospitals - more than lung and breast cancer combined. Professor Beng Chong, a hematologist at St George Hospital and head of the Department of Medicine at the University of NSW, said many hospitals did not assign the task of venous thromboembolism risk assessment to particular doctors or nurses, while many simply forgot.


Absurd: Firefighters answering medical emergencies

FIRE crews in Queensland [Australia] have been used as a first response in medical emergencies for several years, despite denials by authorities. Documents obtained under Freedom of Information laws reveal that crews have been diverted from fires to attend medical matters because of a shortage of ambulances. In one case, a Cairns fire crew had to abort a fire call and attend a person who had been knocked unconscious in a nightclub fight.

In an exclusive Sunday Mail report in December, sources said fire trucks would soon be known as "red ambulances" in a radical plan to have firefighters attend more medical emergencies. The vehicles were to be fitted with life-saving defibrillators and used as a first response while the crisis-hit Queensland Ambulance Service struggled to cope with soaring life-threatening emergency calls.

Emergency Services Minister Neil Roberts, Fire Commissioner Lee Johnson and then Ambulance Commissioner Jim Higgins strenuously denied the claims. Mr Roberts said there was "no current plan" to convert fire trucks into red ambulances. But in a letter from the United Firefighters Union in July 2006, Mr Johnson and Mr Higgins were advised of "inappropriate requests" to use fire trucks as first responders.

Union state secretary Mark Walker said members were told the Queensland Fire and Rescue Service would not be used in this capacity - but it happened regularly. "Clearly, the QAS communications centre has requested QFRS attendance to provide a first-responder role . . . (when) there is no agreement with QAS for such a role," he said. Mr Walker said TV footage had shown an incident in the Brisbane CBD where a cyclist hit a pedestrian, with firies in attendance and no ambulance. A Charters Towers fire crew had been placed on standby for medical calls one weekend due to unavailability of QAS crews.

"We have serious concerns with our members being exposed to additional risks by being called upon to do the work of the ambulance service," Mr Walker said. "We also have concerns regarding the additional risks to the community when 13-tonne fire appliances are responded to any number of other incidents that do not warrant our attention." Mr Walker sought reassurance from the commissioners that the QAS would not dispatch fire crews "to incidents for the sole purpose of providing medical assistance".

In subsequent correspondence last year, the union said it was prepared to discuss an emergency medical service role for firefighters, but there needed to be a restriction on the number and type of incidents attended plus appropriate training.


Sunday, March 30, 2008

Your regulators will protect you

A fine example from Australia

Controversial GP Michael Tait is under investigation over allegations he diagnosed a woman as a hypochondriac even though she was keter found to be riddled with tumours, and tried to put her on a $2000-a-month anti-ageing therapy. For 15 months, Elizabeth Orchard consulted the New Zealand and British-trained GP - now facing deregistration over his unconventional treatment of 150 terminally ill cancer sufferers - as her health deteriorated after she collapsed on the family farm in the Gold Coast hinterland. Dr Tait, who ran a GP practice alongside his Gold Coast anti-ageing clinic, was the only doctor they could find on the day of her February 2002 collapse.

According to the 57-year-old former businesswoman - who Sydney doctors later discovered had a 7.5cm-wide benign brain tumour and seven breast tumours - Dr Tait was more interested in putting her on human growth hormones, which he has since been convicted of illegally importing and selling. Despite having paralysis in one of her legs, increasingly blurred vision, bleeding from her breasts and memory loss - even forgetting her son's name - Ms Orchard said the only tests Dr Tait ordered during scores of visits were a back X-ray and an abdominal ultrasound, at her request.

Ms Orchard said she was required by her income protection insurer to have Dr Tait oversee her treatment and provide progressive reports for her benefits. In 2003, Dr Tait ruled her fit for work, leading to her benefits being cut off despite her being bedridden. "I sought opinions from other doctors but unbeknown to me, they were consulting Dr Tait, because he was my official doctor for the insurance policy," she told The Weekend Australian. "He was telling them that I had already had every necessary test possible and nothing abnormal had showed up. So no one took me seriously. He was repeatedly dismissive of my problems, my symptoms and called me a hypochondriac."

Ms Orchard said that, in June 2004, her mother paid for her to undergo a brain scan in Sydney. "They found a massive tumour in my brain and the doctors told me I had about two weeks to live, without surgery, because it had reached critical mass," she said. "The doctors told me it was an old tumour, probably 10 years or older. "I then underwent a 9 1/2-hour operation for the brain tumour and had a later operation to remove 5kg of breast tissue." Ms Orchard said she faced further operations and had ongoing seizures and a shortened life expectancy.

She is currently receiving legal advice over her treatment and last year made a complaint to the Medical Board of Queensland, but she said she was disappointed it was yet to take action. A spokesman for Dr Tait yesterday refused to comment. Authorities last week filed an action in Queensland's Health Practitioner's Tribunal against Dr Tait over his "unconventional" therapies. Some of his patients - including the late soccer legend Johnny Warren - allegedly paid up to $20,000 for treatment. In 2006, Dr Tait was convicted on nine charges of obtaining and selling a restricted drug, for which he was fined $9600.


Australia: 'Deadly' government health-care system slammed by doctors

TASMANIA'S healthcare system is dangerous and is putting lives at risk, says the Australian Medical Association's state president. Haydn Walters says unless the $25 million bonus hospital funds promised by the Federal Government this week are spent opening beds, people will die. He said the money must be used to make the state's deadly healthcare system safe. "We have a very ragged, degraded healthcare system and it puts lives at risk," he said.

Dr Walters said surgeries were delayed because there were not an adequate number of beds to admit patients post-operatively. He said the equivalent of two wards of beds were closed at the Royal Hobart Hospital. "Beds have closed because we can't afford to open them, so without question the extra funding has to be spent on opening beds," he said.

Dr Walters said people with gall-bladder disease should have surgery within four to six weeks, but public patients in Hobart were waiting between nine to 12 months. "People with arthritis are forced to put up with the pain because they can't get in for surgery and gynaecology patients who are incontinent can't get in for reconstructive surgery at all," he said. "It is uncomfortable and unsafe in Tasmania at the moment if you don't have private health."

Dr Walters believes if beds were made available and proper staffing levels provided, the health system would be safer. "It will take the pressure off nursing staff, the emergency ward, the waiting lists -- and if we treat staff with respect, we will start to build a better public hospital system," he said.

Premier Paul Lennon said the allocation of the $25 million was a decision for Health Minister Lara Giddings and her department. Ms Giddings welcomed the additional funding but did not elaborate on how the money would be spent. Both Mr Lennon and Ms Giddings expressed disappointment that Tasmania receives only 31 per cent funding from the Commonwealth compared with 40 per cent received by Victoria. Ms Giddings said if Tasmania were to receive the same funding as Victoria, public hospitals would be $111 million better off each year. Tasmania will receive $217 million from the Commonwealth over 2007-08 with the state contributing $492.6 million, 36 per cent of the state's total Budget.


Saturday, March 29, 2008

Arbitrary NHS rules stop help for tragically infertile woman

A woman who went through the menopause in her teens has been refused fertility treatment on the NHS.

Catherine Storey was left infertile at 18 when she had a premature menopause. She is now 20 but has been refused IVF on the NHS because her boyfriend Martin Sear already has children - even though they live 300 miles away.

The couple took out a bank loan and travelled to a clinic in Barcelona. But after spending 13,000 pounds on two rounds of IVF, Miss Storey, an administrative assistant with a fire alarms company from Cramlington, Northumberland, is still not pregnant and has run out of money.

She said: "If I had fallen in love with a different man or lived in a different part of the country I could have been able to have IVF for free."

A Newcastle Primary Care Trust spokesman said: "The local NHS policy says to have access to IVF treatment, couples must have no other living children in this or any previous relationship for either partner, have had a minimum of three years unexplained infertility and no history of failed sterilisation reversal in either male or female partner."


Friday, March 28, 2008

The unfolding superbug disaster in Britain

Superbugs kill at least 10,000 people in Britain each year - 20 times the number who die of Aids. Why is the British government funding AIDS research much more than superbug research? And why are known preventive measures not being taken?

Like many, Brian Clinch was under the impression that, despite the failures of the past, the British health service was tackling the frightening epidemic of antibiotic-resistant superbugs. That was before a visit to Norway made him realise that this record-breaking tide of resistant infections is far from under control and is also a problem of our own making. Clinch, a former RAF pilot from Dorset, has kidney failure and needs dialysis three times a week. It was only when he went for dialysis treatment in the Norwegian city of Stavanger three months ago that he discovered he was one of the tens of thousands of Britons unwittingly infected with the deadly superbug methicillin-resistant Staphylococcus aureus (MRSA).

The day after arriving in the oil-refining port on Norway's Atlantic coast, he went to the city's university hospital. Dialysis had been arranged on the understanding that he had been tested for MRSA in the UK. But a routine throat swab in Stavanger showed Clinch was carrying MRSA. "All hell broke loose," he says. "The results of the MRSA tests arrived after they'd given me one session of dialysis. They were angry and deeply unimpressed with the dialysis centre in England. "I felt like a complete pariah. I was taken into an isolation room and everyone put on gowns, masks and bootees before they came anywhere near me. It's obvious they are frightened to death of getting these infections in Norway, and are doing everything they can to keep them out."

He is right. Norway, with its population of 4.7m, had only 332 cases of MRSA in 2006, and has the lowest rate of antibiotic-resistant bacteria in Europe. About 1 in 200 of the infections found in patients' bloodstreams in Norway is caused by a treatment-resistant "superbug", while in Britain, getting on for half of all infected patients have been colonised by strains of bacteria that normal antibiotics cannot treat.

Norway, which, like Britain, runs a publicly funded health service free at the point of delivery, prides itself on its "search and destroy" policy for killer infections. But the contrast between its health services and our chaotic hospital system is a stark reflection of a difference in approach that has much more to do with attitude than money.

The public area of Stavanger's 950-bed hospital resembles nothing so much as an up-market hotel. Leather armchairs are arranged around a virtual log fire; seemingly relaxed visitors sip coffee and nibble pastries. The town is comparable to Ipswich in size and affluence, but first impressions of the hospital suggest it is wealthier. But beyond the reception, the 1970s-built wards tell a different story. Norway's cash-limited national health service is suffering exactly the same colossal pressure as our own NHS.

In the infectious-diseases unit there are 19 people on trolleys in the corridor. At least 11 more lie in the corridors of other departments. The wait may be long, and patients may end up temporarily in the wrong department as staff struggle to allocate beds. It is a sight familiar to anyone who has observed the treatment lottery of the British NHS, and the enormous battle between restricted supply and limitless demand for healthcare. But even under the pressure of winter infections, Stavanger's problems with capacity are not reflected in infection rates.

The atmosphere is busy but calm. The gleaming corridors are populated with cheery cleaners; there is a sense of belonging among the workforce that is often absent among the clock-watching agency workers who increasingly maintain large chunks of our own hospitals.

Stavanger has a policy of not moving infected patients around; if they have several conditions, doctors from different specialities come to them, not the other way round. And isolation rooms are available, complete with negative air pressure to prevent infections from being wafted outside. Barrier nursing methods involving gloves, aprons and scrupulous hand-washing are strictly applied with infectious patients.

Jon Sundal, the head of infectious diseases at Stavanger, complains of a relentless battle to keep his unit under control. "There is a shortage of nurses - the five new single rooms cannot be staffed," he says. Nevertheless, even with bed occupancy running at over 100%, conditions in his hospital offered a stark contrast to the grime of most of Britain's healthcare facilities. "We saw the writing on the wall early on with antibiotic resistance," says Olav Nataas, head of medical microbiology at Stavanger. "We had one serious outbreak in the 1980s, and since then we just haven't allowed it to happen, except when we sent some waiting-list patients to Britain for hip replacements and they came back infected. "I don't think hospital cleaning has much to do with it. What works is screening. You test everyone, and you isolate and treat everyone you find with it. In England you can't do that now because you have too many cases."

It is legitimate to ask if Britain's NHS has lurched into a ruinously expensive crisis that may yet see the entire service implode. It is also legitimate to ask how our microbial surveillance system, let alone our hospital cleaning services, has failed us so badly: why did scientists not warn us of this disaster in the making, and is it too late to do anything about it?

The global use of antibiotics since the 1940s has achieved a simple Darwinian consequence: the fittest bacteria survive. Antibiotics work by disrupting the production of components needed to create new bacterial cells. Penicillin, for example, selectively interferes with the construction of bacterial cell walls, which have a different structure to the cell tissue of humans and other mammals. By the end of the 1940s, about half of the Staphylococcus aureus strains tested in hospitals had adapted to produce an anti-penicillin toxin called penicillinase. Within months of the launch of the antibiotic methicillin in 1960, the first resistant strains of Staphylococcus aureus were emerging. Shortly after that, bacteriologists began finding strains impervious to up to four common antibiotics.

Warnings about the dangers of antibiotic overuse started to emerge from laboratories, but because relatively few patients were affected and nobody knew what to do about it, the situation was ignored. Antibiotics continued to be consumed in ever-growing quantities by sick humans and farm animals alike.

The problem took off in 1991, when Britain contributed its own supercharged strain to the world lexicon of multi-drug-resistant superbugs. MRSA-16 first appeared in Northamptonshire, rapidly infecting 400 patients and 27 staff in three hospitals. Within 18 months it had been reported in 135 more hospitals. Nobody knows how it spread. Along with another British strain, MRSA-15, it went on to infect patients around the world, a pattern that continues. A meticulous Health Protection Agency study, mapping how the new strains popped up unexpectedly in new hospitals, was published in the Journal of Clinical Microbiology in 2004. But it was too long after the event to shed any light on how the infection had carried. Now research funding is focused on firefighting - casting around for ways to damp down the effects of the pathogens.

It is not just MRSA that is sweeping across Britain like a plague. Streptococcus, enterococcus and Escherichia coli (E coli) are among a host of bugs emerging in resistant forms and causing everything from pneumonia to tuberculosis, bone destruction and lethal damage to the heart. In addition, we are facing "hyper-virulent" new strains of the bacteria Clostridium difficile (C diff), which have colonised the sites left free by the effect of antibiotics, which kill off many harmless bacterial colonies in their path. Although C diff is not resistant to treatment, its spores linger indefinitely and, until recently, NHS staff were largely unaware of how to kill them. Consequently, it is the biggest killer of the current superbugs.

In 2006 it was mentioned on the death certificates of 6,480 people, against 1,652 deaths officially attributed to MRSA. However, these figures are recognised to be underestimates, as many superbug deaths are never identified. Mandatory surveillance of MRSA bloodstream infections is a recent innovation, the number of people carrying it with no symptoms is not recorded, and the formal collection of figures for death and disease associated with C diff (which causes unstoppable diarrhoea or gut perforation) only began in April 2007. The government estimates the annual cost of treatment for such cases to be over œ1 billion.

Officially, the total number of MRSA infections is 7,000-8,000 a year, while C diff is running at an annual 55,600 cases. Many experts believe the real total for all superbug infections is nearer 300,000 - how many are fatal is believed to be vastly higher than the official figures suggest. There is no way of knowing the true figure, as relatively few people are tested.

Meanwhile, a variety of new resistant pathogens are waiting in the wings. In September 2006, a variation of Staphylococcus aureus that produces a toxin called Panton-Valentine leukocidin (PVL) claimed its first British victims. Since then, anxiety over this threat has escalated. The pathogen selectively attacks the young rather than the old; it gets into bones and joints, causing crippling damage.

A multi-drug-resistant version of a common food-poisoning bug, ESBL (extended-spectrum beta-lactamase) E coli, is also causing anxiety. First identified in the 1980s, it has spread steadily to cause an average of 30,000 cases of blood poisoning and urinary-tract infections a year. Although it has officially been blamed for 57 deaths so far, the true total is believed to be many thousands. Government scientists think the source is meat and milk, colonised by superbugs as a result of overuse of agricultural antibiotics.

Jodi Lindsay, a senior expert at St George's hospital, London, and a world authority on superbugs, says: "It is inevitable things will get much worse. We don't know enough about how these bacteria behave, because not enough research is being done. We have increasing numbers of surgical operations, elderly people with long-term serious disease, and diabetics. All these patients have compromised immune systems and are at risk. Not only that, there is potential for new, really virulent strains of bacteria, capable of attacking healthy people."

Mark Enright, professor of molecular epidemiology at Imperial College London, says the real number of deaths in the UK from MRSA and C diff is "easily more than 10,000". He shares the concern that reservoirs of superbug infection in hospitals will increasingly spill out to attack otherwise healthy people: "You could be carrying a resistant form of MRSA and it could then get in through a superficial injury."

There is evidence that such a problem is already occurring in other parts of the world. A new form of MRSA, USA300, has emerged not in hospitals but in the wider community in America. It is killing 18,000 a year - considerably more than the number killed by HIV/Aids, and, most worryingly, the victims include a number of otherwise healthy children. The latest flurry of anxiety was in Brooklyn, New York, in October, when Omar Rivera, a previously fit 12-year-old, suffered the telltale crop of pus-filled spots associated with USA300. Within days he was dead. In other parts of America, three other children, aged 4, 11 and 17, died the same month.

A team at the University of California in San Francisco has been tracking the infection. Last month they published a study showing that a variant of USA300 was spreading in gay communities on the East and West Coasts. And a new "community" strain of C diff in the US has targeted children, pregnant women and new mothers, with fatal results. There has been at least one similar death in the UK, but testing was not available to confirm if it was the same pathogen.

Europe also has a "community" MRSA: ST80. Officially it is considered less of a threat because, it is argued, levels of poverty in western Europe are not as severe as in the US. Without the immune-system damage caused by malnutrition, the infection is less likely to cause an epidemic.

All that is known about USA300, and other virulent community-acquired strains of staphylococcus, is that they generally include Panton-Valentine leukocidin, and that this lethal toxin can jump between different types of bacteria. If a PVL-carrying bacterium infects someone already carrying a cold virus, it can spur the onset of a deadly form of necrotising or tissue-killing pneumonia, which kills 60% of those who develop it. Although guidelines for GPs to alert them to this new threat to public health are being issued later this spring, Lindsay and other scientists complain that Britain persists in spending too little on basic research to tell us more about the nature of these brand-new infectious agents.

Many scientists have also attacked our slow and patchy response to the problem of antibiotic resistance. "In the early 1990s, microbiologists were divided," says Hugh Pennington, emeritus professor of bacteriology at Aberdeen University. "For everyone who argued the case for containment, there'd be many more who maintained that Staph aureus had been with us for ever, and it did not make much difference if strains were methicillin-resistant or not."

As a result, investigating how microbes developed their resistance, how infections spread, why particular resistant strains appeared in some areas but not in others, did not seem that important to healthcare planners. Microbiology began to feature less and less in medical training. According to the Royal College of Pathologists, there are now only 645 fully qualified hospital microbiologists in Britain, of whom only 387 are working in the NHS in England. Up to 10% of hospital microbiology posts are unfilled because of a shortage of qualified applicants.

At the same time that the superbugs were taking hold, those with the expertise to tackle them were keen to work instead in Aids research, with its support from glamorous figures such as Princess Diana and Elizabeth Taylor. The pattern inexplicably continues. According to the Department of Health, 3.8m pounds has been spent by the government since 2002 under the umbrella of "clinical microbial research", while 14m a year is spent on Aids, which kills fewer than 500 here annually. And it has become clear that a recently allocated 16.5m that microbiologists believed was for research into antibiotic resistance will be shared with research projects on sexually transmitted diseases and hepatitis. "Asking why we put so much money into Aids research is a very good question," said Brian Duerden, government inspector of microbiology and infection control. "Medical research is highly political and highly fashion-driven."

Dr Peter Dukes, programme manager of the Infections and Immunity Research Board at the Medical Research Council (MRC), blamed the paucity of research proposals and the shortage of researchers in the field of antibiotic resistance: "When the MRC offered to fund a research project six years ago, 20 proposals were received and only one was good enough to sponsor." Given America's sinister new USA300 infection, our persistent preoccupation with Aids may soon look very misguided indeed.

Microbiologists who have remained in the NHS are dismayed that their warnings of disaster from antibiotic resistance have been ignored by hospital managers focused on performance indicators and productivity targets, which concentrated on waiting times. "We needed to do more screening, but there were never the resources. Even now they are cutting back," said a consultant intensive-care specialist at a large provincial hospital. "There used to be two consultant microbiologists here, but one left and was not replaced. So we had no expert on intensive-care ward rounds to advise on appropriate antibiotics and infection control."

New government directives require hospitals to carry out MRSA screening on patients being admitted - though not those having outpatient or day-surgery procedures. The consultant said the extra testing burden, without any extra staff to do it, had meant that vital surveillance for other new infections was not happening.

In addition, as pressure has been ratcheted up to channel funds into meeting a range of "patient episode" productivity targets, basic hospital cleaning has been scaled back and contracted out. Those working in healthcare seem increasingly ignorant of the basics of hygiene. Healthcare workers increasingly fail to wash their hands as they race between beds, which are meant to be kept 100% occupied. Increasing numbers of patients are unnecessarily admitted to wards from accident-and-emergency departments, simply to avoid breaking the maximum four-hour permitted A&E wait. In December it was reported that the hotel costs of caring for extra patients who were not actually sick enough to need treatment had wasted 2 billion over the past five years.

Many microbiologists point to the decline of attention to hygiene as a basic function of healthcare as nurse training has become increasingly academic and classroom-based. "The only infection-control procedure proven to work is scrupulous hand-washing, a basic approach explained by Florence Nightingale during the Crimean war and seemingly lost in the intervening 150 years," said Richard Wise, former chairman of the government's specialist advisory committee on antimicrobial resistance, and adviser to the Health Protection Agency Board. "Not washing the hands between patients should be made a disciplinary offence."

Most hospitals have bottles of alcohol-based hand disinfectant by their doors, but Duerden says that until recently their inefficacy against C diff spores was "not common knowledge" outside microbiology circles - an unacceptable level of ignorance, insists Wise, who said it had been known about "for donkey's years".

Olav Nataas, however, insists the search-and-destroy process is key: "We know hand-washing is never 100%," he says. "This preoccupation with cleaning is not the main issue. It is identifying the infection as rapidly as possible and treating it in a way that does not risk others."

It is this uncertainty among Britain's scientists, healthcare administrators and politicians that has led to the latest disagreement about hospital cleaning. This month, every hospital in Britain is meant to have completed a special "deep clean", for which an extra 57m has been allocated. How exactly a deep clean is performed is less clear. There are no prescriptions for cleaning materials, training for cleaners, or methods of checking whether things are actually clean.....

Many patients have paid a high price for our confused health policies. In Britain's worst outbreak of superbug infection, there were 90 deaths and 1,170 C diff infections across three hospital sites in Maidstone, Kent, between April 2004 and September 2006. A report on the disaster by the Healthcare Commission in October described patients being left to lie in their own infection-laden excrement, a shortage of nurses and an ignorance of the risks of moving infected patients between wards. There were a further 33 avoidable deaths from C diff between 2003 and 2005 at Stoke Mandeville hospital in Buckinghamshire. An inquiry found that managers ignored advice to isolate those infected and instead concentrated on shutting down more beds to cut costs.

The cost of compensating superbug victims is also soaring. The NHS Litigation Authority has paid out 12.5m for 287 cases, plus a record-breaking 5m in January to the actress Leslie Ash, 49, whose career has been ruined. An anticipated 1m will go to Shaun Franks, 39, who underwent surgery for a broken ankle. His leg was taken over by an immovable colony of MRSA, which could only be eradicated from his body by amputation of the leg. During his treatment, staff at Northampton general hospital unwittingly used an antibiotic that accelerated the growth of the MRSA. "It has been a nightmare," said Franks. "I lost my job, my relationship - everything. Every time I thought I was getting better, it would come back again."

There is no question that ignorance of good practice has played a significant part in the spread of superbugs in Britain. A study in the late 1990s by Otto Cars, an expert in infectious diseases at Uppsala University, Sweden, compared antibiotic use across Europe. British doctors were administering over 18 daily doses per 1,000 people, compared with 13 in Germany and Sweden and 11 in Denmark. Most of the prescriptions were for coughs and colds - 90% of which are caused by viruses, not bacteria.

Duerden admits that the first comprehensive campaign to educate GPs and the public about the overuse of antibiotics only got off the ground eight years ago with the launch of a cartoon character, Andybiotic. But a survey of almost 11,000 adults published in the British Medical Journal last year indicated that most people still did not understand the risks.

Hajo Grundmann, now a senior infection-control adviser to the Dutch government, worked for seven years in Britain's NHS before returning home in 2001. He runs the Eurosurveillance database, monitoring levels of antibiotic-resistant infections in 31 countries. Britain has the highest rate in western Europe. "It is connected with the high workload," he says. "I worked in Nottingham. We were able to isolate MRSA cases at first, but when the waiting-list initiative came in, there was huge pressure on beds. As soon as the pressure goes up, hand-washing goes down. But the British problem is also due to people's attitudes. It just has not been taken seriously enough." ....

There are, however, measures being launched by the government: to increase the number of hospital matrons to 5,000 to oversee hygiene by May, and make available 270m a year for hygiene campaigns, extra infection-control nurses and pharmacists to tackle over-reliance on antibiotics.

But that does not explain why we continue to invest in areas such as Aids research, or the hypothetical risk of pandemic flu, yet hope that drugs developed in the middle of the last century will protect us against new infections that are killing thousands each year.

More here

Thursday, March 27, 2008

Scotland: NHS admits it is failing thousands suffering chronic pain

Thousands of patients living with incurable pain are being let down by the Scottish NHS, according to a hard-hitting report by the health service's own watchdog. Despite four official investigations in the past 14 years highlighting worrying gaps in care, the research reveals there has been very little improvement.

Specialist support for people who suffer chronic pain is patchy and inadequate, patients are confused and clinicians are frustrated, say the authors. They are demanding action from the Scottish Government and health boards to ensure patients, who can wait years for the treatment they need, get faster access to the right medical help.

It is estimated that 18% of the population, 900,000 people, suffer some form of chronic pain. This is discomfort from injury or disease which persists beyond the typical healing process. One-quarter of people diagnosed are unable to continue working because of the condition, yet just 3% of sufferers are sent to the specialist clinics.

NHS Quality Improvement Scotland, which monitors standards in the health service, has published the latest report. It notes the Scottish Office first described services as patchy in 1994 and further documents published by very experienced people in 2000, 2002 and 2004 raised the same issues. "Despite all of this, very little progress has been made. Access to specialist services is poor." NHS QIS found not one health board could accurately describe the services they did offer.

Dr Pete Mackenzie, who worked on the report, said: "There are major blackspots around the country where there is almost a complete lack of service. The chances of (being told there is no hope) are much greater if you live in an area like that." Dr Mackenzie said, there was frustration about the pace of progress, adding: "It is fair to say many of us, and particularly the patients with chronic pain, feel reports come and go and nothing much happens."

A Scottish Government spokeswoman said: "We are considering the recommendations relating to the Scottish Government, and the Health Secretary will use her address to the national conference organised by the Pain Association Scotland on May 20 to set out her response. "We have for a number of years been encouraging the development of a managed clinical network approach to chronic pain."


Canada's Health Care System Cannot Survive Mass Immigration

A cynic might characterize Canada's medicare system as the universal, free, democratic and egalitarian access to a two-year waiting list. You jump the queue only if you have the bucks and the referral to jump over the 49th, unless a life-threatening emergency sends you to the OR. America's health care system, on the other hand is discriminatory and expensive, but it offers immediate access to the best medical treatment in the world. In both cases timely care for everyone is an elusive goal.

In any event Michael Moore's take on Canada is superficial, euphoric and unrealistic. New technology, abuse and the insatiable demands of an ever expanding clientele of elderly relatives sponsored by Third World immigrants is breaking the bank. It has been calculated that each sponsored immigrant in that age group will cost the Australian medical system $250,000. Since roughly 75% of Canadian immigrants and refugees, drawn from largely "non-traditional" sources, in fact consist of their unskilled dependent children, a terrifying portrait of the toll that Canadian immigration policy is taking on medicare could no doubt be drawn.

A recent article featured in the London Free Press (Thursday, March 13, 2008 "Hospitals forecast deficits") recognized population growth as one principal reason why the Canadian health system was on the brink of deficit financing, with half of Ontario's hospitals facing service cuts to meet the legal requirement for a balanced budget. Seventy percent of Canada's population growth is driven by immigration.

It was economist Milton Friedman who commented a decade ago that "It's just obvious that you can't have free immigration and a welfare state." As Robert Rector explained, to be properly understood, Friedman's observation should be viewed as applicable to the entire redistributive system of benefits, subsidies and services that lower income groups disproportionately enjoy at the expense of higher income groups.

Unfortunately, this superstructure of benefits and services rests not only on an economic foundation but a cultural one as well. A people that is very much alike is more inclined to trust one another, and this trust translates into a willingness to vote for redistributive policies. But we are no longer a mostly ethnically homogeneous society with a shared respect for institutions and a shared sense of civic obligation. When a significant portion of the population is from another hemisphere, another culture or even another generation with different values, the welfare state is perceived as an unlocked candy store with services to be exploited to the maximum.

Redistributive policies like medicare are inversely correlated to cultural diversity. Rather than confront this reality, Canadian leftists demand yet more financial IV injections into the morbid body of the health care system. They refuse to acknowledge that even the Swedish Social Democrats, their role models, were forced to discover the "Laffer curve". That is, push the tax rate up beyond a certain level and tax revenues fall in response. Tax payers will not keep working and producing if they can't keep enough of their income. There are limits to what can be funded. The Canadian model is not sustainable. It works only if there is enough public money to fund it and not enough patients with doctors to help them abuse it. Those days are gone forever.


Wednesday, March 26, 2008

Scotland: NHS Pain Care Deemed Inadequate

The Scottish National Health Service (NHS) is being criticized for not providing adequate care for over 200,000 Scots suffering from chronic pain. As with all socialized medicine schemes, which promise everything to everybody for free but are funded by finite resources, units of health care ultimately must be rationed. One area being denied is pain management.
Thousands of patients living with incurable pain are being let down by the Scottish NHS, according to a hard-hitting report by the health service's own watchdog.

Despite four official investigations in the past 14 years highlighting worrying gaps in care, the research reveals there has been very little improvement.

Specialist support for people who suffer chronic pain is patchy and inadequate, patients are confused and clinicians are frustrated, say the authors.
To emphasize, the NHS's own watchdog is doing the criticizing.
NHS Quality Improvement Scotland, which monitors standards in the health service, has published the latest report.

It notes the Scottish Office first described services as patchy in 1994 and further documents published by very experienced people in 2000, 2002 and 2004 raised the same issues.

"Despite all of this, very little progress has been made. Access to specialist services is poor."

NHS QIS found not one health board could accurately describe the services they did offer.
So, there you go. The Scottish NHS has repeatedly been attacked for uncorrected deficiencies over the years and it's as bad now as it's ever been. Not only that, but the quality improvement people couldn't find anyone in the Scottish NHS who knew what the NHS provides.

Coming soon to America, government-run health care.
MRSA and C difficile superbug deaths at 10,000 a year in Britain

Dirty NHS hospitals at fault

The number of patients in British hospitals dying from superbug infections has reached more than 10,000 every year, according to an expert. The new figure is about 20% higher than the official toll of 8,000 a year. Mark Enright, professor of molecular epidemiology at Imperial College London, said that the real number of those succumbing to methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C difficile) in the UK is higher than the government's records show. "I think it is at least 10,000 a year," he said. "A lot of people are never tested for these infections and their deaths are put down to something else."

"Antibiotic-resistant bacteria are now so well established here, we will never get rid of them," said Hugh Pennington, emeritus professor of bacteriology at Aberdeen University and a world expert.

Latest European figures show that Britain's hospitals are still teeming with treatment-resistant bacteria. While strict hygiene measures have ensured low infection rates in other countries, microbiologists here are privately admitting that Britain's problem is so out of control, it will be impossible to prevent the high level of deaths from continuing. The government's pledge to reduce rates of MRSA to half the 2004 level is unattainable, they say.

According to figures from Eurosurveillance, at least 42% of MRSA bacteria in British hospitals are "superstrains", compared with rates of 20% or lower elsewhere. In the 31-nation European antisuperbug league table, Britain lies close to the bottom, with an infection-control performance better than those of only Malta, Greece, Portugal and Romania.


Australia: More cooking the books in NSW hospitals

NSW Health appointed a nurse whose job was to massage triage data in the emergency department of a Sydney hospital to make it look favourable, emergency doctors say. The nurse, appointed just before the state election, was there specifically to ensure computer data met triage targets, the vice-president of the Australasian College of Emergency Medicine, Sally McCarthy, said yesterday.

This follows revelations in the Herald yesterday that managers at Gosford and Ryde hospitals were so under pressure by the health department to meet targets that some had falsified "time seen" data - the record of when treatment began on a patient.

On the nurse, Dr McCarthy said: "They had somebody looking at that, basically harassing other staff and putting in data themselves. That's not somebody to provide care for patients. That's simply someone to click off on the computer to basically show that patients were seen within benchmark times. It was really just an attempt to get the data looking good."

While the NSW Minister for Health, Reba Meagher, insisted the Gosford case was isolated, Dr McCarthy said the doctoring of data was more widespread and was made easier after the department about 18 months ago widened the definition of when treatment began to include nursing care in several instances. An emergency physician at Prince of Wales Hospital, who could not be named because she was prohibited from speaking to media, said yesterday that "there have been numerous verbal directives from hospital administrators to change data". "This is not an isolated instance. Most other hospitals, and I'm aware of Liverpool and Nepean hospitals being asked to do the same thing," she said. Another emergency physician said he witnessed the same thing at Blue Mountains Hospital last year: "There was a huge amount of pressure . to enter data to meet benchmarks."

Ms Meagher rejected the claims. "There is no evidence to suggest that inaccurate reporting is widespread," she said in a statement. "Hospitals in NSW have been performing well."

Triage data is highly political and used as one of the performance indicators of health bureaucrats. The chief executive officer of Northern Sydney Central Coast Area Health Service, Matthew Daly, admitted a manager at Gosford Hospital had falsified triage data early last year and had been disciplined. "She was altering figures that had previously been entered," he said. He said new recommendations had since been implemented "about the clarity of nurse-initiated protocols - when the clock starts". Mr Daly said no pressure was placed on her to alter data and it was "just absurd to do, and simply dishonest". Another recommendation was to limit access to data.

The director of performance improvement at NSW Health, Tony O'Connell, said it was an outrageous claim that data doctoring was widespread and due to pressure from the department. "There's no evidence that I have that it has happened anywhere else [other than Ryde and Gosford]," Dr O'Connell said. "It's really quite perverse of the college to say on one hand people around Australia should be seen within recommended times . and then turn around and say the department is bullying people to deliver them


Australia: More health bureaucrats who don't give a damn

They should all be fired

AT LEAST 13 Queensland Health bureaucrats - including the new boss of the Torres Strait district- allegedly received a damning report into staff safety that was left to gather dust. A briefing note prepared for Health Minister Stephen Robertson claims new district manager Cindy Morseu was emailed the Torres Strait Risk Assessment report early last year. The audit report was undertaken in late 2006, 16 months before a nurse was allegedly raped by an intruder in her living quarters on remote Mabuiag Island last month.

The inaction in implementing the report's recommendations and who was responsible have been referred to the Crime and Misconduct Commission. Mr Robertson forwarded the case to the CMC after former district manager Phillip Mills, the uncle of Ms Morseu, denied he ever saw the document because he was posted to Cairns at the time. According to the briefing note, Torres Strait workplace health and safety officer Tom Sanderson claimed the report was sanctioned by the region's director of corporate services, Ashley Frost. There are conflicting versions over events but Mr Sanderson told the department the final report was sent to the Torres Strait in January 2007. "As far as I know it went to Ashley initially as the requester," Mr Sanderson said in the briefing note.

However, the briefing note warns of a lack of evidence because of a policy to delete emails after a certain time. Ms Morseu has refused interviews but Mr Frost, now working for QH on the Sunshine Coast, last night said she was acting manager while her uncle was in Cairns. "I know it went to the district manager, whoever that was at the time, and then it would have ended up at the executive meeting . . . but I can't remember when I would have seen it," Mr Frost said.

Opposition Leader Lawrence Springborg questioned whether there was more damning briefing material. "The minister is either incompetent or dishonest so either way people should be very worried and so should the Premier," Mr Springborg said. Premier Anna Bligh said she could not guarantee work to upgrade security measures at centres would be completed before the nurses' union deadline this Friday.


Tuesday, March 25, 2008

Women in labour turned away by NHS maternity units

Women in labour are being refused entry to overstretched maternity units and told to give birth elsewhere, NHS hospitals admitted yesterday in response to an application under the Freedom of Information Act. They disclosed that maternity wards in almost 10% of trusts closed their doors to new admissions on at least 10 days last year. One trust in North Yorkshire closed 39 times between October and January because it did not have enough staff to provide a safe service.

The NHS encourages mothers planning a hospital delivery to make a booking early in pregnancy and get to know about the facilities during regular check-ups with a midwife. Most mothers discuss a birth plan with a consultant obstetrician, including choice of pain relief. These preparations are made on the assumption that the hospital will have enough capacity to deal with unpredictable peaks in demand when women go into labour. But information disclosed to the Conservative party under the FoI Act showed 42% of trusts could not get through last year without turning women away at least once.

Andrew Lansley, the shadow health secretary, said the results showed large maternity units closed most often. The University Hospitals of Leicester NHS trust - the second largest unit in England, with 9,470 births last year - shut 28 times. The North Bristol NHS trust closed its doors 17 times. It said the problem was caused by a high birth rate at its Southmead hospital, the largest maternity unit in the south-west, which delivers about 5,500 babies a year. The trust that closed the maternity unit most often was Scarborough and East Yorkshire Health Care, which had only 1,615 births last year. Overwhelmingly, the trusts with most closures were dealing with double that number of births.

Lansley said: "Labour are fixated with cutting smaller, local maternity services and concentrating them in big units. But women don't want to have to travel miles to give birth. And they certainly don't want to have to travel even further because they're turned away by the hospital of their choice. Conservatives are committed to supporting smaller maternity units because the evidence shows they do better."

Lansley's disclosure coincided with a decision by an independent panel to reject NHS plans to close maternity services at Horton general hospital in Banbury. The Independent Reconfiguration Panel - set up by the government to take responsibility for unpopular decisions away from ministers - said access to services would be "seriously compromised" if Oxford Radcliffe Hospitals NHS trust went ahead with plans to centralise its paediatric, gynaecological and obstetric departments.

The Royal College of Obstetricians and Gynaecologists said the increasing frequency of maternity unit closures emphasised the need for more resources. Richard Warren, the honorary secretary, said: "Our current calculation is that 400 extra consultants are immediately required across England and Wales."

Louise Silverton, deputy general secretary of the Royal College of Midwives, said: "The key issue here is what the women want. Women want to know and develop a relationship with their midwife and not feel as if they are on a production line. Midwives want to be able to deliver the best possible individualised care and not feel like they are working in a baby factory."

A spokeswoman for the Department of Health said: "It is difficult precisely to predict when a mother will go into labour and sometimes, at times of peak demand, maternity units do temporarily divert women to nearby facilities. When this does happen, it is often only for a few hours and to ensure mother and baby can receive the best care possible."


Australia: Hospitals cook the books

NSW Health says altering hospital records to show better treatment times in emergency departments is not a widespread practice. Falsified records from Gosford Hospital showing faster emergency treatment times had been forwarded to the Independent Commission Against Corruption (ICAC), NSW Health director of performance improvement Dr Tony O'Connell confirmed today. But audits of numerous public hospitals revealed that the practice was not widespread, he said.

"We've been doing both internal and external audits of numerous hospitals and there's no evidence that this is widespread," Dr O'Connell told AAP. "In fact it was from an internal audit at Gosford hospital that it was discovered that there was one person who was doctoring results, and that was reported to ICAC and ICAC were satisfied with the actions which the area health service proposed to take to address that issue."

Dr O'Connell denied that NSW Health had been covering up the results of the audits and said they had not been released because they were "standard" reports. "We haven't released them because they're kind of standard ... that any big organisation would do and they don't show anything wrong with the way that the data is collected," he said. "So we haven't released it, but gosh I think we should now."

Dr O'Connell said any staff caught altering hospital records would be dealt with under the department's fraud guidelines. "Any behaviour by staff which corrupts data deliberately is fraudulent behaviour and would be addressed in the department's fraud guidelines, which all staff when they start work are made familiar with," he said.

Hospital staff understood they needed to treat patients in emergency departments quickly and better hospital resources would assist them, Dr O'Connell said. "Our intent is to get patients through our (emergency departments) in the clinically appropriate time. We want patients not to be queueing, we want patients not to be waiting an inappropriate length of time."


Monday, March 24, 2008

Massive NHS payout for 'malingerer' mother wrongly blamed for death of her newborn baby

A grieving mother accused of contributing to the death of her newborn baby by ' malingering' during labour has been awarded hundreds of thousands of pounds in compensation. Hospital staff blamed Kerry Jones after her daughter Bron was starved of oxygen and left brain-damaged. The claims were made after life-support was removed from the day-old child following a traumatic delivery.

At a "hostile" inquest, a hospital lawyer called Miss Jones a "malingerer", criticised her for bringing a birth partner and said her failure to communicate with staff helped cause Bron's death. A midwife accused her of "burying her head in the pillows" and staff complained they "couldn't make somebody do something they don't want to".

The Royal Devon and Exeter Hospital later admitted doctors were negligent in failing to carry out a caesarean. Despite this, bosses then pulled out of a compensation meeting. But the High Court yesterday awarded 37-year-old Miss Jones compensation after hearing she had endured the "nightmare of feeling responsible" for the tragedy in 2002.

Mr Justice King said: "She suffered the trauma of hearing that Bron had severe brain damage, the trauma involved in withdrawing life-support, the trauma caused by the fact the trust felt she might be responsible for Bron's death. "Eighteen months later, the inquest she experienced was hostile, accusatory and blaming." "She was 'bright and personable' before her ordeal, he said, but had since 'shrunk in stature and personality'."

Miss Jones, of Crediton, Devon, had opted for a home birth with minimal medical intervention for her first child but agreed to go to hospital because her baby was three weeks overdue. She told staff she wanted a caesarean if necessary, but the request was ignored when there were complications. Bron was born at 4.35pm on September 8, but her mother was told she would not recover from the effects of oxygen starvation and she followed advice to turn off life-support at 6pm the following day. Within hours she was told the case would have to be reported to the coroner over "maternal matters".

At the inquest in 2004, the hospital barrister asked her more than 60 questions about decisions she took during labour. Midwives claimed they were "undermined" by the birthing attendant she had hired to provide emotional support, but the hearing heard staff had 'clear instructions' how to deal with such companions. The coroner ruled Bron could have survived if born by caesarean and recorded a verdict of accidental death, complicated by "difficulties in communication and monitoring".

Miss Jones split up from Bron's father, Marcus Bawdon, 34, after the inquest. Last night Mr Bawdon, of Exeter, said: "The ordeal was a nightmare. We were treated horrendously. "I haven't spoken to Kerry in a long time and this is something I don't want to discuss. It is still very painful."

The hospital admitted negligence in 2005 and apologised in 2006. But the case went to the High Court after it pulled out of a settlement hearing. Miss Jones's solicitor, Magi Young, said it was "one of the worst cases of injustice" she had seen in 20 years as a clinical negligence lawyer. "As a result of Bron's death and the fact she was blamed for it by the NHS, her life changed beyond recognition. "She was prevented from grieving because of the hospital's attitude towards her and because of the delay in her finally being told it was not her fault. "She developed serious problems including a pathological grief reaction. Her relationship broke up and she had to leave the job she loved as she could no longer function at work."

A hospital spokesman said: "We need to reflect on the views expressed by Mr Justice King and consider whether there are any lessons to be learned."


Australia: Lack of beds delays public hospital surgery

DOZENS of life-saving operations are being cancelled every day in southeast Queensland public hospitals because no intensive care unit beds are available. Nine major surgeries were put off at Brisbane's Princess Alexandra Hospital on just one day last week due to the lack of post-operative ICU beds. Health sources said that was happening every day at the PA - despite a huge injection of extra funding from the State Government in January for this very problem.

The PA received a $10.4 million boost after the mid-year budget review, after the hospital had been forced to turn sick people away last year. A $15 million budget blowout led to 60 beds being closed in October and 20 per cent of operating theatre procedures cancelled. Premier Anna Bligh stepped into the non-surgery crisis and delivered the life-saving funds. "The PA Hospital will progressively reopen beds and restore theatre lists. This will enable the hospital to return to full activity within a few weeks," Ms Bligh said at the time.

But it would appear little has changed. On Tuesday, nine operations were cancelled or postponed because no ICU beds were available. For one cancer patient needing a life-saving Whipple operation, which involves the removal of the head of the pancreas, a portion of the bile duct, the gallbladder and the duodenum, it was the second time in two weeks that surgery was put off. His operation has been rescheduled for Tuesday, but it will go ahead only if there is a spare bed in intensive care for the following two days. Another patient was referred from Ipswich Hospital to the PA last week for heart surgery, but was sent home because no ICU bed was free.

A senior Queensland Health employee, who declined to be identified, told The Sunday Mail that operations were cancelled at the last minute because beds were taken by trauma patients. The source said a spate of major accidents had produced victims with severe injuries at the same time. As a result, patients waiting in hospital wards for serious surgery were sent home. He claimed the Government was reluctant to invest more money in ICU beds, which cost $10,000 a day to run.

A Queensland Health spokesman said there were 568 critical-care beds in Queensland including ICU, coronary, pediatric and neonatal units. More would come on line as new hospitals were built on the Gold and Sunshine coasts. The spokesman said Queensland Health did not collate statewide figures on the number of operations cancelled or postponed because of ICU bed unavailability.

Queensland Health's Public Hospital Performance Report for the 2007 December quarter revealed many patients were still waiting longer than recommended for critical surgery as record numbers presented to emergency departments. The report found that Category 1 patients who had waited longer than the recommended 30 days for surgery had almost doubled to 13.9 per cent in 12 months.

Opposition health spokesman John-Paul Langbroek slammed the Government for not fixing the problem at the PA. "Where has all the money gone? The PA is not allowed to say 'We cannot take people'. It begs the question: What is happening at all the other hospitals?" Mr Langbroek said.


Sunday, March 23, 2008

Australia: Man sues over amazing 13-hour ambulance wait

A grandfather who will spend the rest of his life in a vegetative state is suing Victoria's ambulance service after waiting 13 hours for help after hitting his head. Katrina Marinovic is bringing the Supreme Court action - believed to be potentially worth more than $1 million - on behalf of her father, Ilija, who now has little brain function and is fed through a tube. Ms Marinovic says her father fell and hit his head at 8pm on October 26, 2006, but was forced to wait until 9.30am the next day for treatment after a mix-up meant an ambulance was sent but then cancelled.

"He was such a big character and such a strong person, it's hard for us to see him now compared to what he was before," Ms Marinovic said. "Thinking that he was left for all those hours, it really affects us. "He would give you the shirt off his back - he was that sort of man." The plasterer, 56, lost his balance outside his Preston home and fell down steps on to concrete. A neighbour immediately called 000.

The statement of claim alleges an ambulance was dispatched then cancelled and the matter was handed over to police to investigate whether medical help was needed - which did not occur.

The Marinovic family, who are represented by law firm Arnold, Thomas and Becker, are suing the Metropolitan Ambulance Service, the Emergency Services Telecommunication Authority and the State of Victoria. The writ alleges that the ambulance service and its dispatcher, along with the police who were contacted after the 000 call, were negligent in failing to follow up the request for help. It claims police did not comprehend the urgency or send an officer to check whether an ambulance was needed.

Father of three Mr Marinovic, who also has two grandsons, had emergency skull and brain surgery but was left in a vegetative state, with his family claiming the lengthy delay made his injuries worse. He is living in a nursing home near his family in South Morang, where he needs constant medical attention. The family are seeking medical costs, damages for loss of earnings and loss of life expectancy and for pain and suffering. A spokesman for the ambulance service said they were awaiting further details from court documents.


Australia: Yet another safety report ignored by Health Department

The Torres Strait Islands are rather idyllic places. Some good pictures here. It takes a government to make a hell of them

A THIRD report detailing how the safety of nurses in the Torres Strait was compromised has emerged, placing renewed pressure on embattled Health Minister Stephen Robertson. This latest report warns how the personal safety of health staff was at risk throughout the archipelago because of rapidly deteriorating buildings, including on Mabuiag Island where a nurse was allegedly raped last month. The report has further exposed a culture of inaction as it was written in October 2005 - a year before a damning risk report warned of the need for urgent action. Another report, commissioned in the weeks after the alleged rape, has also prompted criticism the Government still failed to act.

Amid Opposition calls for his resignation, Mr Robertson yesterday spoke of his frustration that another warning had been ignored by his department. "This is clearly just another case where a report has been commissioned and very little work has been done on it," said Mr Robertson, who again refused to accept responsibility. It comes as a walkout of nurses in the Torres Strait looms amid revelations they had written to former health director-general Uschi Schreiber in 2006 and 2007 highlighting their plight.

The newly uncovered report - conducted predominantly for workplace health and safety purposes - identified problems on all 14 islands visited. On Mabuiag, the report warned issues "revolve around personal safety and environmental issues", including lattice slats that were a ready-made ladder to the upstairs accommodation. "A duress alarm does not work in the toilet and, after visiting several other facilities, it was found there were similar problems at other facilities with the same system," it said.

Mr Robertson said it was not acceptable that neglect of the accommodation had placed staff at risk. However, the minister said he had seen Queensland Health's commitment to the area first-hand on his tour of four islands on Thursday. "Generally the standard of accommodation is pretty good," he said.

In a bid to hose down a growing furore over whether the Government acted after the alleged rape, Mr Robertson will today release the briefing notes he received after the incident on February 5. The notes - released to The Courier-Mail last night - said the incident had "reignited issues around the security and safety of staff". They also detail how assaults on Thursday Island nurses in 2007 had prompted a risk-assessment by occupational health and safety officers and the cycle was repeated after the Mabuiag Island incident.

Deputy Opposition Leader Fiona Simpson said the minister should take responsibility for his inaction and resign. But Mr Robertson rejected the call and insisted he had also acted on problems in the region highlighted by local Labor MP Jason O'Brien. "They know as well as anyone else that right throughout this whole episode, on not one occasion have I been found wanting in terms of my response when matters have been brought to my attention," he said.

Premier Anna Bligh said the Health Minister retained her full confidence. "Mr Robertson will do whatever is necessary to ensure the right response for staff and patients," Ms Bligh said.


A government that can't

Nurse strike on Torres Strait Islands likely. I suppose it is very optimistic to expect promptness and efficiency from a government

A NURSE has abandoned a condemned Torres Strait health centre as frenzied repair work throughout the islands appears unlikely to be completed in time to prevent a district-wide strike next weekend. The Courier-Mail has been told it would be "almost impossible" for maintenance workers to fix all the problems which have come to light since a nurse was allegedly raped on Mabuiag Island last month. Locksmiths and carpenters have been shuttling between the islands for the past fortnight, frantically fixing broken locks, windows and doors and addressing years of unresolved maintenance requests.

On Wednesday, a nurse walked off the job after being forced to live in a condemned building on Darnley Island while a new, purpose-built clinic sat empty nearby. Sources said the nurse refused to keep working on the island until power was connected to the new building.

Queensland's Health Minister, Stephen Robertson, flew to the Torres Strait on Thursday in a bid to diffuse growing anger over worker safety in the remote region. During the trip, Mr Robertson visited several islands - including Mabuiag - to meet with Queensland Health workers. The State Government is under fire for failing to act on a report completed in late 2006 which warned about problems at work and accommodation facilities in the Torres Strait. The Queensland Nurses Union has set a March 28 deadline for the Government to fix the security issues or nurses will walk off the job across the region. QNU secretary Gay Hawksworth welcomed Mr Robertson's visit and hoped it would prompt faster repairs. "I'm pleased that he's gone there to see it first-hand and talk to nurses directly," Ms Hawksworth said. "But our deadline remains March 28."

Nurses working on 11 islands in the region have raised repeated concerns about poor security, lighting, faulty duress alarms, generators, fire and smoke alarms, broken locks and problems with sewerage systems. Premier Anna Bligh said she hoped the issues could be resolved quickly. "The most urgent matters in relation to security are being attended to first and then work is being prioritised," she said. Ms Bligh also defended Mr Robertson's handling of the issue: "The Minister for Health . . . has had what can only be described as unreliable advice out of the Torres Strait on these issues in the past, so he is personally going to satisfy himself on the progress of work and ensure that it is proceeding in the fastest possible place."

Mr Robertson said Queensland Health had to demonstrate that it was seriously addressing the problems but he urged nurses to remain. "I am hopeful that as we address these issues the level of frustration and angst and anger will reduce," he said.


Saturday, March 22, 2008

Britain: Proposal for super-surgeries ‘may result in worse care’

Plans to build 152 doctors’ “super-surgeries” in England are confused and there is limited evidence that they will be effective, according to an expert in primary care. Martin Roland, director of the National Primary Care Research and Development Centre at the University of Manchester, said that primary care trusts were already being required to develop polyclinics, or multi-doctor centres, but there was “little clarity about their purpose”.

Lord Darzi of Denham, the Health Minister, has yet to produce the final report of his NHS review, but the Department of Health has indicated that it expects all 152 primary care trusts in England to have at least one poly-clinic. Private companies will provide many of them, although the department has promised GPs that they will get a level playing field in tendering for the contracts.

Professor Roland wrote in the British Medical Journal that the Government champions patient choice, but extending choice means more high-quality practices, not fewer, as the polyclinic model suggests. He said: “On average they [small practices] achieved slightly higher levels of clinical quality than the larger practices.”

Polyclinics may also have specialists working in them, but he claims that there is evidence that consultants work less efficiently outside hospitals.

Polls show that GPs are strongly opposed to polyclinics. Richard Vautrey, deputy chairman of the British Medical Association GPs’ committee, said: “This is a government plan that is potentially going to waste hundreds of millions of pounds of scarce NHS resources, creating very large health centres that many areas of the country don’t need or want.”

The medical newspaper Pulse has begun a campaign called Save Our Surgeries, and reported that polyclinics would force GP practices to close or merge, and patients to travel further.


Socialized Medicine in Europe...Woman Goes for Leg Operation, Gets New Anus Instead

A German retiree is taking a hospital to court after she went in for a leg operation and got a new anus instead, the Daily Telegraph is reporting.

The woman woke up to find she had been mixed up with another patient suffering from incontinence who was to have surgery on her sphincter.

The clinic in Hochfranken, Bavaria, has since suspended the surgical team.

Now the woman is planning to sue the hospital. She still needs the leg operation and is searching for another hospital to do it.


Friday, March 21, 2008

Minorities, whites get equal care in U.S. hospitals

A University of Maryland study of whether people receive different quality of hospital care because of their race or ethnicity found that when whites and minorities are admitted to a hospital for the same reason, they receive the same quality care in that hospital.

The study led by Darrell Gaskin, health economist in the University of Maryland's department of African American Studies, appears in the March 11 issue of Health Affairs. The study of 1841 hospitals in 13 states compares the quality of treatment for blacks, Hispanics and Asians to that of whites over a broad range of services. It found that only a few hospitals provide lower quality care to minorities than to whites.

"The good news," said Gaskin, "is that if you come to the hospital for care, you're probably getting the same quality as everyone else in that hospital."

The study also may help pinpoint where improvements need to be made to reduce the significant health care disparities that are known to exist because of race, ethnicity and income. "Our study confirms that all patients in low performing hospitals are at higher risk for mortality and complications. We need to focus on improving those low performers as opposed to hospitals nationwide," Gaskin said. "Our results also suggest that we need to look more carefully at other areas to find where disparities are originating, such as getting access to the good hospitals in the first place."

Surprised at Findings

Gaskin admits he was surprised at the results of the three-year study. Earlier studies that looked at only a few specific conditions, such as cardiac care, and used general estimating equations, have shown quality differences based on race.

What made this study different, Gaskin said, is that "we compared a broader range of services and directly compared hospital-specific quality indicators for racial and ethnic groups. We examined rates of mortality and complications - whether something bad happened in the hospital because of the care."

Gaskin's group looked at hospitals in 13 states that report patients' race and that collect the specific data the researchers needed to compute quality measures. Forty-four percent of the U.S. population live in these states, with 36 percent of Asians, about 50 percent of Hispanics, 46 percent of African Americans and more than 44 percent of whites residing in the areas studied. The study covered more than 45 percent of urban hospitals and 28 percent of rural hospitals.

"The findings indicate that the systems in place in the hospitals do work to deliver equal quality to patients in that same hospital. It's difficult for one person's bias to make a difference in treatment that would show in mortality rates," Gaskin said.

Gaskin is now working on a study to examine minorities' access to quality medical care, particularly how primary care affects equal access. "We have a tremendous problem with minorities, especially blacks and Asians, getting access to the good hospitals or being referred for care when it could make the most difference. The access problem isn't going to be solved in the hospital. It has to be solved in communities."


More revelations about a disgusting Australian health bureaucracy

QUEENSLAND Health Minister Stephen Robertson is in the Torres Strait today to get a first-hand look at security for health workers. Nurses are threatening to strike from March 28 if security does not improve in the state's remote north. A nurse was raped on remote Mabuiag Island in the Torres Strait last month and was told to return to work after the attack, receiving no help to leave the island. Mr Robertson has been under fire this week over his handling of health workers' security issues. A spokesman said the minister was visiting a number of islands in the region to inspect progress on security improvements.

Yesterday remote area nurse Janine Evans, 43, broke her silence to reveal how health authorities exposed her to danger by failing to tell her about a written threat to her safety while working at Hopevale, on Cape York; and later heartlessly hauled her through the courts over taking a work vehicle to escape another community.

It took at least three weeks before a Cairns-based manager informed Ms Evans about the letter, from the family of a patient, which warned she should never work with Aboriginal people again and "if we see her on her days off she should watch out". In an extraordinary admission last night, Queensland Health said it had no specific policy for staff if they received written or verbal threats. "Anyone with fears for their safety should contact police," a spokeswoman said. Ms Evans said: "I just think it's terrible to leave me in there when they knew about the threats," she said.

Ms Evans was later taken to court over a work vehicle she used to escape Coen, on Cape York. She fled because she was struggling to cope, blaming a lack of support. The latest allegations show that the crisis in remote health is not just confined to the Torres Strait, where nurses are threatening to strike from March 28 if conditions do not improve.


Thursday, March 20, 2008

More dangerous NHS hospitals

High death rates at a Staffordshire hospital trust are to be investigated by the Healthcare Commission. The watchdog said that data showed the death rates at Mid Staffordshire NHS Foundation Trust were “out of normal range”. The inquiry will focus on what appear to be higher than normal death rates for emergency admissions. The commission will also investigate the quality of care provided across the trust, in particular to older people.

The trust, which serves 300,000 people, said yesterday that it believed its death rates were normal for a trust of its size. Martin Yeates, the chief executive, said that the trust and the Strategic Health Authority had investigated the trust’s higher than average standardised mortality rate and concluded that it was due to “problems in recording and coding information about patients”. He said this had improved in the past year.

Nigel Ellis, of the Healthcare Commission, said that it was important to “bring clarity” to the situation. “If we thought the trust was unsafe we would have already taken action,” he said.


Australia: 'More clerks than nurses' in NSW health system

The NSW health system employs more clerks than nurses, and continues to obstruct desperately needed reform, the former director-general of the Premier's Department said yesterday. Ken Baxter, who ran the agency under Labor premier Bob Carr, yesterday released an Australian Centre for Health Research report calling for a federal takeover of public hospital funding, saying the scale of state bureaucracies, cost-shifting and woefully inadequate reporting data justified the overhaul. He cited annual report data that showed more than a third of NSW's 90,997 health staff were classified "administrative or other". "In the NSW health system, there are more clerks than there are nurses," Mr Baxter said, estimating nurse numbers at 30,000.

In Tasmania, the system was even more heavily weighted towards office workers, with 45 per cent of the 8992 full-time equivalent staff classified as administrative or other, his figures show. Administrative jobs accounted for a quarter of positions in the Northern Territory and a fifth in Queensland and the ACT, with data from Victoria, South Australia and Western Australia non-existent or incomplete. "A number of the states can't give you accurate figures and certainly none of them (are) comparable," Mr Baxter said.

Many of the jobs in health had gone to IT support, despite the fact that more than $2 billion had been spent on IT systems throughout the Australian health sector "without delivering any real improvements" in performance data or services, he said.

The ACHR report into the future of Australia's federal-state healthcare agreements argues for a slimmed-down system where area health services and local boards run public hospitals, directly funded by the commonwealth based on their success in meeting performance indicators. The states would be left as owners of the hospitals, but would relinquish their current roles as co-funders and sole administrators.

Mr Baxter said more direct lines of responsibility would help reduce cost-shifting estimated at up to $500 million a year. "If we want that same level of service and we want the same standard, then some of these changes have got to be made," he said. "And none of them are going to be comfortable. But if you ask (NSW Health Minister) Reba Meagher, life is not comfortable for Reba at the moment."

Ms Meagher has faced off several scandals over substandard services at hospitals such as the busy Royal North Shore in Sydney while leading resistance to commonwealth calls to sign up to nationally consistent performance data for state hospitals. But she defended herself against Mr Baxter's claims, saying frontline clinical staff, including doctors, dentists, ambulance workers and allied health professionals, as well as nurses, outnumbered administrative staff and made up two-thirds of the system's workforce. "NSW Health has been actively restructuring the health system to shift resources away from administration into frontline health services," she said.

She also defended NSW's record in reporting on hospital performance, citing emergency and surgery data by hospitals published quarterly. But "we won't support benchmarks that are simply reporting for reporting's sake or have the potential to act as a disincentive for medical staff to report adverse events," Ms Meagher said.

Mr Baxter called the arguments against the release of hospital scorecards "nonsense". The NSW Government had surrendered in the face of bureaucratic resistance, he said.


Wednesday, March 19, 2008

Australia: Scum Muslim doctor still registered to practice

A doctor who was able to continue practising after sexually assaulting two patients, lied about his indiscretions in an attempt to become an eye surgeon, the Medical Tribunal has heard. Dr Fahreed Bahrami, 44, was found guilty in 2002 of rubbing his penis against a one female patient and of touching the breasts, buttocks and thighs of another female patient before placing her hand on his penis. However the former Iranian refugee was able to continue practising on the condition he have a chaperone present during intimate examinations, after the NSW Medical Tribunal in 2003 found he was unlikely to reoffend.

Bahrami was again before the NSW Medical Tribunal yesterday, accused of altering his medical registration to "conceal that his practice was conditional," according to counsel for the Health Care Complaints Commission, Philip Strickland. Mr Strickland told the tribunal that Bahrami had tried to apply for membership to the Royal Australian and New Zealand College of Opthalmologists and in doing so had falsified his registration certificate to appear that he had general registration. Bahrami then signed a false statutory declaration and submitted the false registration card to the college, the tribunal heard. False applications were submitted and rejected three times before the college became aware of the discrepancy, Mr Strickland told the tribunal.

Mr Strickland said in lying about his registration status Bahrami's conduct had been "dishonest" and "deceptive" and he should be deregistered. He said Bahrami was guilty of unsatisfactory professional misconduct and that in falsifying the documents and later withholding that information from the tribunal that he was not of good character.

Dr Paul Beaumont, an opthalmologist and mentor of Bahrami's over a two-year period said his charge was "probably" a truthful and trustworthy member of the medical profession. However he agreed with Mr Strickland that Bahrami had been "repeatedly dishonest" in his dealings with the tribunal and in regards to his medical registration.


Markets and Medicare

Rarely in Washington does the president get to propose legislation that Congress is required to fast track. Such an opportunity exists right now, and it pertains to the most serious domestic policy problem this country faces: the rising costs of Medicare. Under a 2003 law, the Medicare trustees have certified that the program's finances have deteriorated so much that they "trigger" a required presidential response. Sadly, Washington's response is not new. The White House proposed across-the-board cuts in payments to doctors and hospitals in the budget earlier this month. Such measures do not improve care, and have not worked to contain costs in the past.

More recently, Secretary of Health and Human Services Mike Leavitt has proposed measures to promote electronic medical records, price and quality transparency, limits on malpractice awards, and means-testing of Part D (drugs) premiums. While in some respects commendable, these proposals are far from adequate.

According to the trustees, Medicare's unfunded liability is $74 trillion -- five times that of Social Security. According to the Congressional Budget Office, health-care spending is on a course that could crowd out all other government programs. Clearly the time has come for fundamental reform.

How can we control the rising cost of Medicare? There are many examples of waste and inefficiency throughout our health-care system: diseases that we fail to prevent; chronic illnesses that progress to preventable complications that are treated with duplicative and ineffective services; and too-common medical errors. There is an enormous number of people who in theory could change these practices, including the 650,000 participating doctors, the 30,000 participating facilities, and especially the 44 million enrollees and their caregivers. Perversely, however, people who try to improve Medicare are often financially penalized for doing so. This needs to change. Here's how:

- Free the Doctors. Doctors participating in Medicare must practice medicine under an outmoded, wasteful payment system. Typically, they receive no financial reward for talking to patients by telephone, communicating by e-mail, teaching patients how to manage their own care, or helping them be better consumers in the market for drugs. Medicare pays by task, and these are not reimbursable activities. So doctors who help patients in these ways are taking away from billable uses of their time.

In fact, physicians who help patients in these ways may end up with less payment from Medicare. To make matters worse, as Medicare suppresses reimbursement fees, they are increasingly unable to perform any task that is inadequately reimbursed. Other health-care providers face the same perverse incentives. All too often, high-cost, low-quality care is reimbursed at a higher rate than the alternative, and Medicare's payment rules get in the way of providers working together to improve health care.

We should be willing to reward doctors and other health-care providers who raise quality and lower costs -- including improving patient communication and access to care, and teaching patients how to be better managers of their own care. Accordingly, providers should be able to propose and obtain a different reimbursement arrangement, provided that (1) the total cost to government does not increase, (2) patient quality of care does not decrease, and (3) there is a mechanism for accountability, and a method of measuring and assuring that (1) and (2) have been satisfied.

Geisinger Health System in central Pennsylvania provides an example of what could be done. It offers a 90-day warranty on heart surgery, similar to the type of warranties found in consumer product markets. If the patient returns with complications in that period, Geisinger promises to attend to it without sending the patient or the insurer another bill.

The problem is that Geisinger doesn't get financial support from Medicare for this practice, even as it can save money for Medicare overall. This is because health-care organizations like Geisinger get paid more when patients have complications that lead to more visits, more tests and more readmissions. What is needed is a system willing to pay for such guarantees. Medicare should be willing to pay more for the initial surgery if taxpayers save money overall.

Another innovative example: Virginia Mason Medical Center in Seattle offers a new approach to the treatment of back pain, a source of considerable medical spending nationwide. Under the old system, a patient would often first receive an MRI scan or specialty consultation and other tests before referral to a physical therapist. Under the new system -- which cuts the cost of treatment in half -- patients are first seen by a physical therapist unless additional diagnostic measures are clearly indicated, and receive an MRI scan only if the therapy doesn't work and symptoms persist.

The new system improves efficiency and saves money for payers but leaves the providers financially worse off. As in the case of Geisinger, Medicare should permit a new payment arrangement -- one that is win-win for Medicare and Virginia Mason. Once one hospital or doctor group implements an arrangement with better payment for better results, there will be competitive pressures on other providers to find new and innovative ways of raising quality and lowering costs. Plus, once Medicare takes these steps, private insurers can adopt similar payment systems more easily. Medicare and the private sector will be pushing in the same direction, for better care -- not just more services.

For reform to work, however, there must be accurate measurements of quality and cost, so that these transactions can be easy to negotiate and consummate. Another essential ingredient is to allow doctors and facilities to work together as a team -- making needed improvements and profiting from those improvements.

Similarly, regulations that prohibit profitable provider arrangements should be relaxed, when those arrangements are leading to documented improvements in care. There are many low-cost, high-quality pockets of excellence just waiting for the support they need to grow. Medicare has considerable authority to implement these changes now. If health-care providers accept more accountability for the results of their care, we can start seeing the benefits right away.

- Free the Patients. Patients also suffer when payments to doctors and hospitals do not reward prevention-focused, efficient care. Many patients have difficulty getting to see primary care physicians. When they do, all too often they get inadequate information about their overall health condition and the best ways to improve it.

Studies show that diabetics, asthmatics and other chronic patients can often manage their own care as well as, or better than, conventional physician care, and at lower costs, when given the support they need. Yet to do this patients need training, easier access to information, and the ability to purchase and use in-house monitors. One way to do this is by allowing patients (especially the chronically ill) to save money when they choose less costly, high-quality care. They should be able to use the savings to purchase services that are not paid for by traditional health insurance, including telephone and e-mail consultations and patient education services.

Almost all the states now have "Cash and Counsel" programs for homebound, disabled Medicaid patients -- allowing them to manage their own health-care dollars and hire and fire the people who provide them services, instead of having these decisions made by an impersonal and outdated schedule of covered services and regulated prices. Patient satisfaction in these patient-controlled programs is almost 100%, according to government surveys. We need to build on this highly successful program by giving chronically ill Medicare patients some of the same opportunities.

Both within traditional Medicare and the Medicare private insurance plans (Medicare Advantage), this opportunity should include risk-adjusted deposits to the Health Savings Accounts (HSAs) of chronic patients. Unlike current law, these HSAs should be flexible -- allowing patients to exercise discretion where discretion is possible and desirable.

- Free the Entrepreneurs. While our health-care system has some of the most innovative treatments in the world, Medicare's payment system imposes many barriers to innovations in using those treatments efficiently and effectively. In normal markets, cost efficiencies and quality improvements mean larger net revenues when an entrepreneur finds a better way to provide products or services. By contrast, entrepreneurial efforts under Medicare all too often find their greatest reward when they exploit the system by finding ways to bill more for more services, rather than improve it.

We should welcome and encourage better ways of meeting patient needs. For example, a medical practice that uses walk-in clinics and electronic prescribing to lower overall Medicare spending for the beneficiaries it serves should get higher payments.

These are just a few of the many things that can be done to control the rising costs of Medicare, while improving care and health at the same time. These steps will not be enough by themselves to put Medicare and our health- care system on a sustainable course, but timely action by the president and Congress can make a big difference.