Sunday, November 30, 2008

Fears that more dentists will quit NHS as thousands billed over missed targets

Dentists will be required to refund 120 million pounds to the health service because they failed to treat enough NHS patients last year, The Times has learnt. About half of dental practices have fallen short of targets for NHS treatment agreed with local health authorities, meaning dentists will have to pay back tens of thousands of pounds each.

In the latest repercussion of the troubled dental contract, clawbacks are threatening to put some practices out of business and may persuade many more dentists to leave the NHS, the British Dental Association (BDA) says.

Thousands of patients across England are still said to be struggling to find NHS treatment, and yet about five million fewer treatments were carried out in 2007-08 than were budgeted for by the health service, figures show. This represents a 5 per cent rise in the amount that dentists will be expected to pay back, in the second year of a new pay contract that has been heavily criticised for creating a "drill and fill" culture and failing to improve access to NHS treatment.

In the past dentists were paid a fee for each treatment they provided but, under the dental contract introduced in 2006, they receive an annual income for carrying out an agreed amount of NHS work, measured in "units of dental activity" (UDAs).
Dentists, however, say that the only way to reach targets is to take on quick jobs, such as extracting a tooth rather than carrying out root canal surgery to save it, because both treatments have the same UDA value. [Amazingly idiotic!]

About 1,000 dentists opted out of providing NHS services when the new contract came into force, meaning that 900,000 fewer patients were seen in 2006-07 than under the old system, a report by MPs found this year. The Health Select Committee suggested that dentists were being set unrealistic targets for NHS work and that a failure to meet targets in the first year of the contract meant a loss of revenue for the second.

The latest figures, obtained under the Freedom of Information Act by DPAS, a company that provides private dental plans, suggest that some regions have experienced particular problems. In Leicester, for example, more than 50 per cent of UDAs have not been delivered and 21 dental practices face repayments of 50,000 pounds or more. Across the country, 89 per cent of primary care trusts responded to a survey that found a total of 411 contracts where targets were missed by 50,000 or more.

Peter Ward, the chief executive of the BDA, said that dentists who failed to meet their targets in the first year were likely to have failed to do so again last year, creating a "roll-over effect". He said: "Once again this highlights problems with a target-driven contract that contains one crude measure of performance, which has long been criticised by the profession and patient representative groups."

Quentin Skinner, the chairman of DPAS, said: "For those dentists who fell rather short of the mark, the future for them in the NHS certainly looks bleak."

Barry Cockcroft, the Chief Dental Officer for England, said: "The Government is committed to growing NHS dental access year on year. This is why increasing the number of patients seen has been made a national priority for the NHS - and backed up by an uplift in funding of 11 per cent (209 million) this year." "The increased focus and funding is already starting to show results, with 655 more dentists working in the NHS in 2007-08 than the previous year and 36 million courses of treatment delivered compared with 35.1 million in 2006-07," he added.

Mike Penning, a Conservative health spokesman, said: "It is extraordinary that [these clawbacks are] happening at a time when over one million people have lost access to their NHS dentist in the last two years. These figures show, yet again, why we need to rip up Labour's botched contract and move towards a registration system based on clinical need, one that is targeted at preventing dental ill health rather than reacting to it."


Saturday, November 29, 2008

Britain: Negligent Muslim doctor sanctioned

Paediatrician who failed to detect Baby P's broken bones is suspended. Thank goodness someone is sanctioned over the matter

The doctor who failed to detect Baby P's injuries and concluded that he was just "cranky" two days before he died has been suspended from practising medicine. Yesterday the General Medical Council said that Dr Sabah al-Zayyat, a locum paediatrician who examined Baby P at St Ann's Hospital in London, had been suspended pending the outcome of an investigation into her conduct. Baby P died in Haringey, North London, after suffering months of appalling abuse in his family home.

The GMC had already placed temporary conditions on the registration of Dr al-Zayyat at a hearing in August 2008, which meant she could work only under supervision. But those conditions have now been upgraded to a full suspension. The GMC said it would hold a full public hearing if its investigation merited it. If it proceeds to that stage it can then either strike Dr al-Zayyat off the medical register, suspend her, put conditions on her registration or simply not impose any penalty.

Dr al-Zayyat, who qualified in Pakistan and worked in Saudi Arabia before coming to Britain in 2004, saw bruises to Baby P's body but decided not to carry out a full systemic examination because the boy was "miserable and cranky". A post-mortem examination revealed a broken back and ribs, and a host of previous injuries. "Our priority is to protect the public interest, including patient safety," the GMC said in a statement. "When an interim order has been imposed, we keep the details under close review. The Interim Orders Panel decided on Friday, 21 November to suspend Dr al-Zayyat's registration. Our investigations are continuing and it would be inappropriate to comment further at this stage."

Two social workers involved in the case are being investigated by the General Social Care Council. Maria Ward, Baby P's social worker, and Gillie Christou, her manager, face an investigation, which could result in both of them being struck off. The GSCC is "conducting preliminary inquiries into the actions of social workers in the case". Haringey Council is being investigated by HM Inspectorate of Constabulary, Ofsted and the Healthcare Commission, with their preliminary report due to be handed to ministers on Monday. Thousands of letters from the public calling for the resignation of the social workers involved in Baby P's case were taken to Downing Street yesterday, in advance of the report.

There was also anger among MPs and charities after Martin Narey, chief executive of Barnardo's, said that had he lived to become a teenager, Baby P might have turned into a "feral, parasitic yob". Mr Narey used the case to focus attention on the need to tackle causes of abuse. But charities and MPs said they were astounded by his "provocative" comments. Michele Elliott, chief executive of the children's charity Kidscape, told The Times: "Barnardo's seem to feel that by making these kind of comments that the public is going to support them. I find these comments extremely offensive in view of the fact that the child is dead."

David Laws, the Liberal Democrat children's spokesman, said the terms used by Mr Narey were unwise. "It would be better not to use such provocative language about this particular baby who has died," he said. "[He is trying to] throw some light on the circumstances in which thousands of young people in Britain grow up today, and the need to break these cycles of deprivation."

Camila Batmanghelidjh, the founder of Kids Company, a charity for young people in inner cities, said it was wrong to presume that all abused children went on to be abusive adults.


British bureaucrats trying to "get" NHS whistleblower

A nurse who exposed appalling neglect of the elderly at an NHS hospital began a fight to save her career today. Margaret Haywood, 58, faces a series of disciplinary charges over a secret film she made for a BBC Panorama programme. If a Nursing and Midwifery Council panel finds against her, she could be struck off the nursing register.

The veteran nurse was hired to help investigate concerns about the Royal Sussex County Hospital in Brighton. She and reporter Shabnam Grewal gathered evidence of failures to give even basic care to frightened and dying elderly patients. One was left to die alone while others spent hours in their own filth or with nothing to drink. Some were in agony from a lack of pain relief. After one shift Haywood said: 'I can honestly say it is the worst ward I have ever, ever worked on.'

The documentary ' Undercover Nurse', shown on BBC 1 in July 2005, sparked an investigation by Sussex University Hospitals NHS Trust, which issued a public apology admitting 'serious lapses in the quality of care'.

The Central London hearing was told that Haywood admitted breaching confidentiality by passing contact details for patients and their families to programme makers. She told interviewers: 'That is a chance I am willing to take for things to improve. Hopefully I will not lose my registration. If I do, it is a small price to pay for things to get better.'

Haywood, from Liverpool, denies that her fitness to practice is impaired by reason of misconduct. She also denies an allegation that she raised concerns about patient care in the documentary instead of following 'whistleblowing' policy and reporting the issues to the Trust. Haywood further denies failing to assist colleagues when a patient was having a seizure.

Rachel Birks, for the NMC, said Haywood worked 28 shifts between November 2004 and April 2005 while secretly filming for Panorama. She said: 'She had not sought consent from the patients involved when she filmed them and the NMC's case is that from patient charts and records she would have been able to provide documentary makers with the contact details for patients and their families.'

The Royal Sussex County Hospital, which then had the lowest rating of zero stars and an œ8million deficit, had received a number of complaints before filming started. The panel heard a senior nurse deny that pensioners were victims of neglect. But Philip Kemp, a lead nurse in professional standards, admitted care was 'substandard' and that management knew patients were going without food or drink.


Friday, November 28, 2008

Negligence by NHS doctors perpetuated gross sexual abuse

Doctors treating two daughters who were made pregnant 19 times by their abusive father failed repeatedly to follow professional guidelines on alerting the authorities to suspected rape. Failings by the authorities in the case of a Sheffield father who forced his daughters to bear him nine children included breaches of medical codes and ignoring the recommendations of an inquiry into a recent incest case.

Gordon Brown spoke of the nation's outrage yesterday as he vowed that lessons would be learnt from the “unspeakable” abuse. The Prime Minister said that any necessary changes would be made to the system as a result of the case, in which the 56-year-old businessman — known in court as Mr X to protect his daughters' identities — received 25 life sentences for rape. His crimes against his daughters, committed over at least 25 years, have been compared with those of the Austrian rapist Josef Fritzl.

“The whole country will be outraged by those unspeakable events that have been reported as happening in Sheffield and in other parts of the country and will be utterly appalled by the news of the systemic abuse of two sisters by their father over such a long period,” Mr Brown told MPs at Prime Minister's Questions. “People will want to know how such abuse could go on for so long without the authorities and the wider public services discovering it and taking action.”

The Times has learnt that the repeated failure of health professionals, social workers and the police to intervene, breached a key recommendation of an official review four years ago into an case of rape and incest with disturbing similarities.

In 2003 a man from Swindon was jailed for 15 years after fathering six children by his eldest daughter during 30 years of abuse. The inquiry into the failure to halt the abuse found serious failings in the way the agencies worked together and shared information despite growing suspicion about the origin of the children. It recommended that in future cases of suspected rape within the family, agencies should prepare a family tree and a chronology of significant events.

Details of the case involving the sisters from Sheffield show that, after one of them had given birth, doctors began questioning whether the baby's father was also the father of the newborn's mother. They failed to follow procedures set out by the General Medical Council dictating that authorities should be alerted in such cases.

Doctors in hospitals in South Yorkshire and Lincolnshire who became aware of the family's history of recurrent genetic disorders also advised the sisters on separate occasions not to have more offspring with the man fathering the children. Two of the nine children died within hours of being born because of conditions caused by genetic defects. Nicholas Campbell, QC, for the prosecution, told Sheffield Crown Court this week: “Someone in the hospital asked whether the father of the child was her own father. The daughter was terrified and she denied it. “Her mother was present and she collapsed on the floor crying out, 'no, it can't be true', but at no time did she ask her daughter questions about the identity of her child's father.”

A Serious Case Review is being carried out into why social services in Sheffield and Lincolnshire, and the police in both counties, failed to protect the girls despite warnings. Lincolnshire Social Services admitted yesterday shortcomings in the work of their staff, which allowed the abuse to continue for 25 years. Peter Duxbury, director of children's services at Lincolnshire County Council, said that the way information was shared between the authorities had changed since the family lived there and that nowadays the case “would have been dealt with in a different way”.

The role of schools and teachers will also be examined as part of the case review. On one occasion in 1988, burn marks on the face of one of the girls were spotted at their school but were put down to bullying. The other daughter suffered a broken arm but stayed off lessons to conceal her injuries.


Australia: NSW public hospitals in crisis: report

A landmark report into the state of NSW public hospitals says they are "in a period of crisis" and on the brink of demise unless radical reforms are made. Commissioner Peter Garling, SC, said in his report, tabled in Parliament today, that cultural change was needed from the top down. "To start with, a new culture needs to take root which sees the patient's needs as the paramount central concern of the system and not the convenience of the clinicians and administrators," Mr Garling said. "Given the demographic changes and rising costs, it is the case that we have entered into a period of crisis for a public hospital system which has always been free and accessible to all. We are on the brink of seeing whether the public system can survive and flourish or whether it will become a relic of better times," he said.

The NSW Health Minister John Della Bosca said the first report into NSW public hospitals, released today, was a "landmark report" that would improve the way health care is delivered. Mr Garling, SC, has made 139 recommendations in his report, which focus on improving patient care and safety, Mr Della Bosca said. He said it was critical to take pressure off emergency departments and staff. He has recommended several changes in the way emergency departments operate, including that patients who do not require treatment within 30 minutes be seen by a doctor other than an emergency specialist.

Mr Garling has also recommended the Federal Government fund emergency "primary care centres" that should be set up in all hospitals to treat less urgent cases. "In my view, if it is all right for you to wait for an hour or more to be seen in an emergency department then you probably didn't need to be seen by an emergency specialist. "Many other well qualified doctors can help you." He said patients who were in the more urgent categories of one, two and three should be channelled through the emergency department and patients in categories four and five should be channelled to "primary care centres" to be set up within hospitals.

Mr Della Bosca said the Government would respond formally by March. "The Government will carefully consider this report. It is a first and important document," he said.

Mr Garling has also recommended that hospitals should have a "safe assessment room" for mental health patients close to the emergency departments. Mr Garling said a culture of bullying was "endemic" in the health system. "Almost everywhere I went, I was told about incidents of bullying. Many witnesses asked to be allowed to give their evidence in private."

He said NSW Health should establish a casual medical workforce within 12 months through a centralised register and annual performance reviews for all doctors. Mr Garling said a single health service, called NSW Kids, should be set up within six months for newborns and children needing acute care to "ensure that children of Walgett get as good care as do the children of Woollahra and Wollongong".

He has also said that all hospital staff should wear colour-coded uniforms or vests identifying in large print the role of the health professional" after the inquiry repeatedly heard that patients were confused about who was responsible for their care or even if they were a doctor or nurse.

Other recommendations include that NSW Health refund patients the cost of medication to treat hospital-acquired illness after discharge after the inquiry that only about 60 per cent of medical staff adequately washed their hands.

He said there should be an audit system for measuring how hospitals compile patient records many complaints were heard about poor record keeping and note taking.

The inquiry was called after scathing criticism from Deputy State Coroner Carl Milovanovich that systemic problems had contributed to the unnecessary death of teenager Vanessa Anderson at Royal North Shore Hospital. Vanessa, who was hit by a golf ball in 2005, died from respiratory arrest due to the depressant effects of opiate medication after a doctor misread her chart.


Thursday, November 27, 2008

NHS lost patient details 135 times in two years

Losing government files on people is one way in which British bureaucrats are world leaders. It makes the news about once a month and all departments seem to be affected. The article below shows, however, that the news reports are just the tip of the iceberg

The NHS has lost the confidential medical records and personal details of thousands of patients in a "catalogue of errors" uncovered by an investigation into how the health service handles data. A "fundamental re-examination" of how the NHS deals with personal data was demanded last night after research showed that a series of losses and thefts had potentially exposed the private details of 10,000 patients around the country. A total of 135 cases were reported, including the loss or theft of diaries, briefcases, CDs, laptops, memory sticks and, in one case, a vehicle containing patient records.

A back-up tape of an entire system was stolen from a general practice in the East of England this year. In another case, a laptop containing the records of 5,123 patients was stolen from the outpatients' department of a hospital in the West Midlands.

The revelations will cast renewed doubt over the Government's ability to handle personal data after a series of high-profile losses by Revenue & Customs and the ministries of Justice and Defence in the past year, and will raise further questions about the scheme to create a computerised national patient database to allow easier communication between GPs and hospitals.

The Liberal Democrats, who carried out the series of Freedom of Information requests, called for the Government to scrap its plans for a national computerised database. Norman Lamb, the party's health spokesman, has also written to Alan Johnson, the Health Secretary, with four other recommendations, including prohibiting the use of mobile devices to store patient records and publishing a set of minimum data protection standards.

Mr Lamb said: "These reports show utterly shocking lapses in security. Patients have a right to expect their personal information to be treated with the utmost care. "The degree of negligence in some cases is breathtaking, given the absolute sensitivity of patient data. There must be a fundamental re-examination of how the NHS deals with personal data. The NHS should regard lapses of standards of care as potential serious misconduct."

The details, obtained through requests made to strategic health authorities, revealed incidents of data loss dating back as far as 2006. In some cases, private patient notes were found in public places or deserted buildings, or had been dumped in bins and skips. One loss of records was so serious that police and an NHS manager became involved. The incident occurred in January, when a district nurse took home activity sheets with patients' names and addresses, which were stolen during a burglary.


Wednesday, November 26, 2008

U.S. Government Pays for Bad Drugs

(Washington) About 72 million prescriptions for unapproved drugs are filled every year with a cost to Medicaid, and the American taxpayer, of at least $200 million.
The availability of unapproved prescription drugs to the public may create a dangerous false sense of security. Dozens of deaths have been linked to them, records show.

The medications date back decades, before the Food and Drug Administration tightened its review of drugs in the early 1960s. The FDA says it is trying to squeeze them from the market, but conflicting federal laws allow the Medicaid health program for low-income people to pay for them. The FDA says there may be thousands of such drugs on the market.

The FDA and Medicaid are part of the Health and Human Services Department, but the FDA has yet to compile a master list of unapproved drugs, and Medicaid -- which may be the biggest purchaser -- keeps paying.
Since the FDA hasn't even been able to compile a list of bad drugs, what confidence can we have that the FDA is capable of identifying good drugs?

So, we have an anecdote which strongly hints at what we can expect if the government takes over the entire health care system in the U.S.

However, the demonstrated inability to properly administer the Medicaid program will be insignificant when the U.S. government displays its incompetence with a nationalized medical care system. Expect to be wishing for the good old days.
What Tennessee Is Doing About Health Insurance: Coverage with limits is better than no coverage at all

By Phil Bredesen, Democrat governor of Tennessee. He seems to have unusual realism for a Democrat

Three years ago, I realized something about health care. I've taken part in uncounted policy discussions about America's uninsured, both as governor of Tennessee since 2003 and before that as CEO of Nashville-based HealthAmerica Corp. Everyone regularly criticizes the unfairness of the system. But we don't make progress.

What I realized was this: Everyone proposing solutions or criticizing unfairness was doing so from the comfortable vantage point of having good health insurance. While we work to build a better system, wouldn't it also be responsible to find a way to get something -- not a perfect solution, not even a long-term solution -- into the hands of the more than 46 million uninsured Americans who don't share our good fortune?

Dottie Landry is one of those uninsured Americans. She lives in Nashville and is self-employed. She makes and sells jewelry. Over the years, she has been generally healthy but uninsured. In 2000 she got very sick -- from a tick bite -- and had to spend about $9,000 for medical care. She put most of it on her credit cards, which took years to pay off.

We all want to help Ms. Landry, but here's the problem: a comprehensive health-insurance policy for her costs about $5,000 a year, and someone has to pay that. That's a real number that won't go away with group purchasing or by beating up insurance companies. Ms. Landry can't afford that, and in a world of trillion-dollar deficits it's hard to see how the federal government can either.

We need a national health-insurance solution, but isn't it sensible in the meantime to make sure everyone has a basic health plan before we give a few more people a perfect but expensive one? Shouldn't we make sure everyone at least has a Chevy rather than providing a Cadillac to a few and letting the rest walk? We're trying that in Tennessee with CoverTN.

CoverTN, which began in 2006, is a health-insurance plan for those who are self-employed, or who work for small businesses that can't afford a traditional policy.

It is not free health care. Rather it is a limited plan with shared costs. In devising this plan, we didn't start out the usual way -- by defining what benefits we wanted -- but instead set how much we wanted to pay. And then we began a competitive-bidding process to see how much health care we could buy. We initially set the amount we would pay at an average of $150 a month, and split the responsibility for that premium three ways. The company would be responsible for $50, the individual for $50, and the state for the final $50.

The bidding was vigorous. It was ultimately won by BlueCross BlueShield of Tennessee with a benefit package that meets a great many -- not all -- of the real needs of the uninsured at a cost far below conventional plans.

At these premium levels -- less than half of what a conventional plan might cost -- the benefits are limited. But the benefit structure is also different than in a conventional plan. Most limited plans achieve their savings with high front-end deductibles, requiring a person to spend often thousands of dollars out-of-pocket before benefits kick in. But when we asked our customers -- uninsured Tennesseans -- what they actually wanted, we found that they were most interested in some help with the more common things; a doctor's visit, prescriptions, a short hospital stay.

CoverTN emphasizes covering these front-end costs. It features free checkups, free mammograms and $15 doctor visits without deductibles, for example. And it achieves its savings on the back end, with relatively low limits on hospital stays and an overall $25,000 benefit limit in any one year. It does not cover truly catastrophic events. This makes medical sense. Good access to a doctor and a drugstore when you first have a problem can avoid a lot of cost and heartache later.

One thing that has been unexpected is the success of a generics-only prescription drug program. We needed to cover medications, but because of the high prices and aggressive marketing of branded prescription drugs, we were concerned that the costs would overwhelm the program. With some misgivings, we required our bidders to propose a largely generic prescription program. It's worked surprisingly well. Physicians have typically been able to select suitable medications for their patients, and patient satisfaction has been high and complaints few.

Having been badly burned by uncontrolled growth in costs in Tennessee's Medicaid program (TennCare once gobbled up a third of the state's budget), we proceeded cautiously with CoverTN and have been rewarded with good control of costs. This fall we added some benefits: The number of primary care visits doubled from six to 12, for example. Best of all, we added them without increasing rates. When did you last hear of a health-insurance plan whose annual update was a benefit improvement but no rate increase?

An obvious and valid criticism of health insurance such as this is what happens when a patient exceeds the benefit limits. What we're finding is that even in health care, when people know that there are limits, they work to manage their costs. This year, as of the first nine months, only four people out of the more than 15,000 people covered had hit the maximum overall limit of $25,000, and only three had exceeded the separate in-patient hospital limits. A larger number, under 4%, hit the quarterly pharmacy limits during those first nine months. Even those who go over the benefit limits get the significant advantage of being able to piggyback their personal expenditures on the contracts CoverTN has negotiated. By doing this, they often can cut their costs on uncovered health care in half.

Ms. Landry, to continue her story, has joined CoverTN and is very happy with it. About a year and a half ago, right after she joined, she had a bad dog bite that put her in the emergency room with several follow-up visits. The cost for this episode was about $4,000, and CoverTN paid for almost all of it.

The Chevy plans certainly have their critics, and I don't offer CoverTN as the perfect or ultimate answer, but it sure has worked for Ms. Landry and thousands of other Tennesseans.


Britain: A volunteer testing a new treatment died after doctors `missed' a side effect

No vigilance for known serious side-effects

A young widow has revealed that her husband died in a government-funded drug trial - the second victim to be identified. Gareth Kingdon, 39, who was father of a seven-month-old boy, was poisoned by one of the drugs being tested as a new treatment for testicular cancer. His widow Victoria, also 39, from Tunbridge Wells, Kent, said this weekend that he might still be alive if doctors had withdrawn the medication, bleomycin, when signs of side effects first emerged.

She argued that doctors at the Royal Marsden hospital, London, should have noticed signs of lung damage and stopped the drugs. He developed a persistent dry cough, a sign of damage caused by bleomycin, yet they continued to administer the drug for about another month. He was transferred to a critical care unit shortly after the last dose in November 2006.

Two months ago The Sunday Times reported that Gary Foster, 27, had died after he was given an overdose of bleomycin at University College London hospital (UCLH) in 2007. The publicly funded Medical Research Council, which is running the trial at several hospitals across Britain, has admitted that two other men were given overdoses. After Foster's death the trial was suspended at UCLH - where there had been a computer error in setting up the dosage control. The revelation that another patient had died a year earlier raises questions about whether it should be continued at other hospitals.

The deaths also raise broader safety concerns two years after the "elephant man" case, which was supposed to have led to tighter supervision. Six men nearly died when their bodies swelled horrifically after taking an experimental drug in trials conducted on the site of Northwick Park hospital, London, by Parexel, the testing company. All the men suffered multiple organ failure.

Kingdon, who was a senior tax executive at the Ford motor company, was diagnosed with testicular cancer in the summer of 2006. His family were given documents that put the normal survival rate at 50%. They say doctors told them that his chance of beating the cancer if he took part in the trial of a new treatment was about 90%. The trial, TE23, is testing whether a combination of five existing chemotherapy drugs, including bleomycin, is better at treating testicular cancer than the standard treatment of three drugs.

Victoria Kingdon, a former marketing manager, said her husband joined the trial in August 2006 and developed a cough two months' later: "Gareth was showing signs of toxicity from the bleomycin. He had a dry persistent cough from early October. I even have the cough medicine he was prescribed. "The last cycle of chemotherapy was early to mid-November 2006. They should have stopped his entire last cycle. If they had done that, Gareth may very well have been with us today."

She added: "Gareth was so sick, I said to him, `How can they think you are well enough to have chemotherapy today?' but they went ahead with the last round," she said. "Gareth went into the critical care unit shortly after the last dose was administered."

The couple's son, Gus, was seven months old when Gareth Kingdon died. Victoria Kingdon was fighting breast cancer at the time, which, she said, had hindered her ability to seek justice for her husband. After having a mastectomy she is clear of the disease and is seeking legal advice.

Kingdon acknowledges that bleomycin is an effective drug if monitored closely. Between 1%-2% of patients taking bleomycin die of the damage it causes to their lungs.The Medical Research Council has declined to disclose how many of the 59 patients in the TE23 trial have died from toxicity caused by bleomycin.

Kingdon said: "We were, like the Foster family, delighted that Gareth got invited to participate in the trial. There is a contract of trust between patient and doctor, however, and where I think mistakes may have been made is in the vigilance to look for symptoms like the dry cough that both Gary Foster and Gareth suffered and to act on them quickly."

Mark Bowman, a solicitor with the law firm Field Fisher Waterhouse, who had acted for Foster, said: "As soon as someone develops toxicity, doctors should stop giving bleomycin. That appears not to have happened, which is of concern."

The Royal Marsden NHS Foundation Trust said: "We would like to again pass on our sincere apologies to Mr Kingdon's family for their sad loss." It declined to comment on the cause of his death. The Medical Research Council has reviewed its trial procedures and introduced additional checks since the deaths. It pointed out that deaths from cancer drug toxicity are an acknowledged hazard. It added that the trial had been monitored by an independent committee and that it would be stopped early if there were concerns about a higher number of deaths than had been expected.


Tuesday, November 25, 2008

90% of British hospitals are failing the superbug test despite the Government's hygiene code

Nine in ten hospitals are failing to comply with rules designed to control the spread of superbugs, a watchdog reports today. Spotchecks at 51 NHS trusts by the Healthcare Commission found only five had fully implemented the Government's hygiene code. Mattresses and surgical implements were not decontaminated properly, and some wards were so cluttered it was impossible to clean properly. On top of that, some hospitals were not able to isolate infected patients to stop bugs spreading.

In today's report, the commission says it was forced to intervene in three trusts where standards were so low that patients could have been put at risk. The three, Bromley, South-East London, Ipswich, and Ashford and St Peter's in Surrey, are all said to have taken action to remedy the problems.

Overall, inspectors said trusts were improving their performance on tackling superbugs and official figures show that rates of MRSA and C.diff in hospitals have started to come down. MRSA kills almost 2,000 hospital patients a year.

Commission chief Anna Walker said the hygiene lapses were 'important warning signs'. Liberal Democrat health spokesman Norman Lamb said: 'It is very disturbing that adequate systems are still not in place in very many of our acute hospitals.'


Australia: Red tape in government hospital denies dying boy a chance

Power-mad bureaucrats again

A SIX-year-old boy with only half a heart is dying as red tape prevents Melbourne's Royal Children's Hospital surgeons giving him an operation and a chance to save his life. As well as hypoplastic left heart syndrome, Nathan Garcia suffers from scoliosis - a condition that has deformed his spine and now places so much pressure on his arteries and lungs he is unable to undergo life-saving surgery to re-rout his half a heart before it stops beating.

Royal Children's orthopaedic surgeons had planned to place a new type of metal rod in Nathan's back to ease his scoliosis, improve his heart and lung function, and hopefully make him healthy enough to undergo the heart surgery. However, the hospital's New Technologies Committee has refused permission for the operation. It says processes have not yet allowed it to evaluate and approve the French-designed Phenix Rod for safe use, and instead Nathan has been placed in palliative care.

Nathan's distraught mother, Monique Garcia, said her son would be dead or too crippled for the operation before the red tape cleared, and was appealing for the decision to be reversed for a one-off operation. "They say it might be OK to use in a few months, but I'm terrified he'll be dead in two months," Ms Garcia said. "Normally I would accept the process of approval, and it is warranted, but it doesn't have a place in this situation - he is going to die anyway. "We have a surgeon who is wanting and trying to save his patient's life, but on the other side we have red tape, and I don't think anything should get in between a doctor and the welfare of their patient. He will die if he does not have this operation - and soon."

Royal Children's orthopaedic surgeon Dr Ian Torode and director of cardiac surgery Dr Christian Brizard met the Phenix Rod's inventor, Arnaud Soubeiran, in Paris last month to discuss Nathan's case.

Royal Children's spokeswoman Julie Webber said the committee was examining the use of the Phenix Rod and a decision about its suitability as a treatment for Nathan would be made in his best interests. "The decision will be made around what is in the best interests of the child," she said. [Dying is in his best interests?]


Monday, November 24, 2008

British hospital bureaucrats don't want funding from volunteers

And they lie about it to justify themselves

Volunteers at a seaside town's hospital have spent decades baking cakes to raise money for equipment the NHS cannot afford. But now the hospital has banned home-made cakes from its fundraising events - because of health and safety fears. Officials at West Cumberland Hospital in Whitehaven, Cumbria, claim the League of Friends' sponge cakes and tea loaves contravene guidelines.

Linda Davey, 64, a former nurse and vice-chairman of the League of Friends, said: `This is health and safety gone mad. We are a group of ladies who've been baking cakes for years, which we then sell in the hospital. It was just a way to raise funds. `The Women's Institute were told they had to wrap their pies in Cellophane - and now this is happening to us. The world's going mad.'

The hospital blames the ban on strict rules over packaging and labelling from the Food Standards Agency - although the FSA maintained last night it made no such demands on the ladies' cakes. Alan Davidson, the hospital's director of estates and facilities, said: `We appreciate the support volunteers give to our hospitals but there are strict guidelines in place, enforced by the FSA, over food sold to the public. 'This means all food should be packaged appropriately, date-stamped and ingredients listed. `This is in the interests of maintaining and protecting the health of the public.'

However, an FSA spokeswoman said: `There is nothing in our guidelines that prevents the sale of home-made cakes at fundraising events. A common-sense approach and care that the cakes are stored properly should be taken.'

She added that the FSA insisted only that the volunteers followed `basic food hygiene principles' - such as ensuring hands, utensils and surfaces were clean, food was properly cooked and chilled and cross-contamination of foods was avoided.


Sunday, November 23, 2008

Socialism and Medicine

If the financial popularity of Michael Moore’s latest “documentary,” called Sicko, is an indication of popular sentiment in this country, then the United States seems to be ready for what once was called socialized medicine, but today is better known as “single-payer medicine.” All of the candidates running for the Democratic nomination for president of the United States this year promised programs similar to what exists in countries such as Canada, France, and Great Britain. The Republicans are promising “socialism lite.” Both parties promise that the government will be paying much, much more.

Any discussion of medical care and its availability can stir emotions like nothing else. Any time I write on this subject in a public venue, I am assured of receiving strong hate mail from people who are convinced that I want only the rich to receive health care. Other people try to defend what exists in the United States today, which is not easily defended, at least not from a free-market point of view.

As I see it, the subject of medical care is extremely complex, not because of the nature of health care, but rather because of the vast number of government regulations and policies that already govern what currently exists. Government intervention into nearly every aspect of our lives is so common that people often lose sight of how things would operate absent the intervention. Furthermore, people seem to be convinced that government really is the answer when it comes to medical care.

Since the country seems to be barreling headlong to full government-run medical care, I find it necessary both to explain why such a system is and will continue to be disastrous, resulting in costly, substandard care, and to explain the virtues of something that no longer exists in this country: free-market health care. It does no good to criticize the former but ignore the latter, especially since most people are led to believe that the current system of intervention plus “private” employer-based health insurance somehow is free-market medicine. Nothing could be further from the truth, but since there are few people speaking up for free markets these days, we should not be surprised when people confuse a thoroughly interventionist market with free exchange.

In this article, I first will explain what exists in this country today and why the “horror stories” that Moore showcased in Sicko have occurred. I also will point out how we have come to the current situation and why government intervention is the reason. Second, I will examine socialist medical care, both the “single-payer” socialism (such as that which exists in Canada) and the more “traditional” socialist model that exists in Great Britain, where the government owns the medical facilities and employs medical personnel.

Third, and last, I will explain how a free-market health-care system would operate and, more important, why it would provide the best care for people. Although the present political climate does not bode well for free-market anything, let alone something as government-controlled as medical care, nonetheless it is important that we understand why free markets are the best solution.

The world of Sicko

Earlier this week, I visited a local chiropractor to have treatment on my ailing back. My insurer covers chiropractic care, so I did not pay the doctor directly for services. In fact, the vast amount of medical care in the United States is paid by third parties, be they insurance companies or governments, and that is the root of the problematic situation that exists today in medical care.

Keep in mind that the “solution” that always is touted is the “third-party” system, but that the third party must be the central government and no one else. However, that arrangement simply transfers the problems that already exist; it does nothing to deal with the central problems in health care.

Third-party payers were not always dominant in medical care. Until the post–World War II era, medical services were pay-as-you-go affairs. Those who could not afford the best care depended on charity hospitals or doctors who were willing to stretch out the payment structure. In other words, people purchased medical care the way that they purchased most other goods: directly and in close relationships with those people who provided the services.

The first real break in that system came during World War II, when the government had strict wage-price controls. Employers making war goods (the only real game in town) were faced with chronic labor shortages, yet could not offer higher pay in order to attract workers. Thus, they turned to providing tax-free “benefits” such as health insurance.

I have talked to people who were involved in those early programs. For the most part, employers offered insurance plans to employees in order to provide protection from catastrophic illnesses or accidents. The idea at that time that an insurance company would pay for regular doctor visits and the like was seemingly far-fetched.

However, the social effects of the Great Depression and World War II would have an enormous impact on medical care in this country and elsewhere. First, following the war, Great Britain embarked upon an ambitious program of socialism, not only “nationalizing” the railroads and many businesses, but also creating the British National Health Service in which all medical care, from doctor visits to other medical procedures, would be provided free of charge to anyone living in Great Britain. Other Western European nations quickly followed, urged on by social reformers who said that socialization of medical care would serve as a powerful antidote to the lure of communism on the eastern side of the Iron Curtain.

Intellectuals in this country latched upon the medical socialism across the Atlantic Ocean and soon became a background political force that kept this issue in the public eye. At the same time, American labor unions (and especially the United Auto Workers) were pushing the corporate welfare state as an American example, and health care was front and center.

Insurance plans that once were employer-paid and meant to ward off catastrophic illness expenses became a means by which employees had all of their medical expenses paid. Granted, only a minority of American workers had this privilege, but health insurance as a means of increasing de facto income without increasing tax liability became increasingly popular.

(As employers turned to benefit packages such as health insurance as a means for giving raises without placing employees into higher income-tax brackets, the Internal Revenue Service began to look more closely at health insurance as a source of new revenues. However, every time the IRS has tried to move in this direction, a public outcry has beaten back the agency. Even today, medical benefits are not taxable.)

Furthermore, the welfare state “ideal” was growing quickly, and in 1965 Congress passed a number of welfare measures as part of the Great Society package that Lyndon Johnson was demanding. Among the measures that passed was the Medicare Act, which made the government the “single payer” for health-care services for persons 65 and older.

At the time, I recall vividly that many doctors complained of “socialized medicine,” and predicted Medicare would doom their profession. However, in at least the short term, Medicare has been an income boon to physicians, who quickly found out that the government would pay almost anything doctors charged for their services. Thus, instead of the dreaded “socialized medicine,” doctors were given the Great Sugar Daddy, and the race was on.

In 1965, the U.S. economy was unquestionably the most productive and vibrant in the world. Doctors and hospital administrators were enjoying high revenues, and at that time health insurers generally did not worry about such things as “cost containment.” Life in the medical field was a big party, and people were paying the bills without asking, especially those with deep pockets.

It is no surprise, then, that all of this new-found largess would attract a number of new entrants into the medical field. Doctors discovered their incomes rising, but a number of other people also discovered that the lure of profits into the field was a big draw for drug companies and creators of medical devices. The once semi-sleepy world of county hospitals and quaint doctors who made home visits with their medical bags had leaped into the modern age.

There are two aspects of new potential profits that one must recognize. First, as more entrants come into a particular field of business, they compete for the existing resources, which drives up the prices of those resources, or what we in economics call factors of production. This is a fancy way of saying that in the short term new entrants will drive up the costs.

Second, entrepreneurs do not simply do business the way everyone else does; instead, they find new resources or take existing resources and change them to create new goods or to enhance existing services. Over time, in a free-market setting, entrepreneurs lower real costs to customers, especially when one examines the entire picture.

Consider the MRI (magnetic resonance imaging) device by which doctors are able to “take pictures” inside the human body without invading it. This device is much more versatile than an X-ray machine, which is far more limited in what it can detect.

Thanks to the MRI, doctors can engage quickly and painlessly in exploratory surgery to find damaged tissues without having to engage in “invasive” procedures (i.e., cutting someone open). While the MRI is expensive both to purchase and to maintain, nonetheless it is a cost-saving device because it shortens the time for critical examinations and requires fewer people to perform more medical assessments.

The genius of this machine is not simply in what it does, but rather that someone had the foresight to recognize its medical potential. That is the heart of entrepreneurship, and it is as active in the health-care field as it is elsewhere.

When people make economic decisions, they weigh costs and benefits, something that is hardly profound. However, the ability to accurately examine costs and benefits depends on having accurate information, and the presence of third-party payers changes that situation considerably.

For a simple example, let us assume that I am purchasing a house. In one scenario, I must make the payments myself, with no help from anyone else. In the other scenario, someone else is making all of the payments for me, and no hard-and-fast cost constraints are given. It is obvious that I would be much more careful in the first scenario than in the second. In both situations, I would be purchasing a house, but the economic calculus in the two cases would differ greatly.

If I were building the house, it is obvious that in the different scenarios I would approach all of the various factors that go into the house differently. If I had unlimited funds, I could purchase all of the finest materials, hire an architect, and generally build a luxury villa. However, if I am paying for it, I will go with what I can afford, given my other obligations in life.

It is clear that economic calculation is much clearer and more exact if one is not depending on third parties for payment, so it is not surprising that when insurance companies and government officials realized they did not have bottomless pits of cash to pay to medical professionals, they began to limit what they were willing to pay. Despite the claims of economist Paul Krugman, who writes a column for the New York Times, and others who advocate socialist medical care, all third-party payers, be they insurance firms or governments, face cost constraints and have sought to limit their own exposure.

At the same time, the system has worked to make things more costly on the supply side. For example, state legislatures are fond of mandating new programs requiring all private insurers to provide certain benefits, such as yearly mammograms or mental-health coverage. Invariably, as health care becomes increasingly politicized, politicians seek to force insurers to carry the programs that are politically popular, even if they drive up costs and make insurance less affordable for private customers.

Third-party dependency has another drawback, and that is that the entities paying the bills also try to narrow the choices to familiar practitioners and treatments. Ordinarily, the presence of more choices also means more competition and lower costs, but in the heavily regulated field of medical care, things often are turned upside down.

To give a personal example, in the summer of 2004 doctors found three 90 percent blockages in my arteries. In a normal situation of choice, I could have gone with stents (what my doctor wanted to do) or tried alternative remedies, such as chelation therapy or taking vitamins. However, my insurer would pay for only one remedy, and that was the placement of stents. Thus, my insurer ultimately was billed for $31,000 (stents placed in July and December 2004). I paid nothing. Had I chosen a different treatment, it would have meant thousands of extra dollars from my pocket. Free was better, even if it might not have been better, medically speaking.

Was that the most cost-effective treatment? Who knows? Was it the correct treatment? Again, who knows? Between the political pull of the American Medical Association and the various state and federal regulations that govern nearly everything that doctors, nurses, and hospitals do, it is difficult to know which treatments work and which do not work. (The doctors’ lobby historically has referred to any kind of alternative medicine, be it homeopathy, chiropractic, or the like, as “quackery,” and insurers do not like to pay for “quacks.”)

Likewise, I, like other patients, do not find incentives for making cost-effective decisions. In fact, it is safe to say that in medical care, I and other direct health-care consumers do not make many choices at all. I pay a fixed amount to the insurer and, while there are some co-pays for doctor visits, there is no incentive for me to spend less than what I have paid in premiums. The incentives in such a situation obviously are skewed, creating a situation that is ripe for abuse. Moreover, when economic calculation no longer makes sense, we then see situations in which someone has to choose between which fingers to have sewn back on his hand, as Moore points out in his documentary Sicko.

This is the world of insurer-led medical care that Moore calls “free-market.” It clearly is not. American medical care is heavily regulated on all fronts, and is dominated by third-party payers who are under pressure to keep from giving away the store. (That includes government payers and providers of medical care, which also face real cost constraints and often are stingier than private insurers.)

Given the frustration that people have with the present third-party system, some are declaring that it is the fault of private enterprise. Give government the full reins of medical care, and we will see an improvement both in quality of care and overall costs, a message that Krugman has trumpeted from his position at the New York Times and Princeton University, where he serves on the economics faculty.

If we wish to gain a sense of what to expect with government-sponsored medicine, we should look to Canada to see why the system there has its detractors – and defenders. However, before looking at our neighbor to the north, perhaps we should look at the United States, especially since government payments account for nearly half of all medical expenditures in this country and governments at state and federal levels strongly regulate all facets of medical care.

In other words, while we can draw comparisons with Canada, we are not comparing a free-market system of care to “socialized medicine.” Instead, we are comparing two systems dominated by third-party payments, the Canadian being 100 percent tax dollars, and the American system a combination of taxes and private dollars. The heavy regulation of private insurers, including the many mandates that are placed on insurance companies by all levels of government, guarantees that the medical system in existence here will be semi-socialistic – and costly.

Much more here

Saturday, November 22, 2008

10,000 Britons die needlessly every year as NHS doctors with out-of-date training miss vital cancer symptoms

More than 10,000 people die needlessly each year because their cancers are not diagnosed in time, a study says. The charity Cancer Research UK found GPs too often miss symptoms or do not send enough patients for tests. In some cases their training is simply out of date. The report says some people are deterred from seeking treatment by the difficulty of getting an appointment.

And there is too little public awareness about cancer symptoms, meaning many victims do not see their GP until it is too late to save their lives. The result is that Britain's survival rates for cancer are still the worst in Western Europe, despite the billions poured into the Health Service by Labour. Only 53 per cent of women and 42 per cent of men with cancer survive for more than five years.

Of 14 major countries compared by the charity, Britain came 11th for women and 12th for men, alongside Poland and Slovenia. If our rates were as good as the best in Europe, the report says, there would be 10,744 fewer deaths a year.

Lead researcher Professor Michael Coleman said: 'We know many cases are being diagnosed too late and this is a major reason for our poor survival rates.' He said many GPs were not up to date on cancer treatment, and family doctors with an average practice size saw only around eight new cancer cases a year. 'Some GPs would benefit from guidance on identifying patients more successfully,' he said.

Another problem was access, said Professor Coleman. 'Patients find it difficult to make appointments or park their cars, and many are worried about taking time off work and losing money.' Only a half of GP practices see patients outside working hours - and even these open for an average of only three more hours a week.

The failure of GPs comes despite their pay soaring by more than 50 per cent - to over 100,000 pounds - since a new contract was agreed in 2004. They are also working fewer hours a week.

Better survival rates in Europe are partly due to the fact that patients in many countries can have direct access to a specialist, while in Britain they must go through their GP.

The Government's cancer 'czar', Professor Mike Richards, said: 'We want to work with GPs to find out which patients and which symptoms they are most likely to miss. They need to be more alert and send people for tests much earlier.'

Britain's poor record has also been blamed on drug rationing by NICE - which can take up to 18 months to decide whether the NHS should fund new treatments - and low spending on cancer drugs, 76 pounds a head a year, compared to 143 in Germany and 121 in France.

Professor Karol Sikora, professor of cancer medicine at London's Imperial College, said last night the low survival rates were a failure of the whole NHS, not just GPs. He said: 'People have to wait too long for scans and biopsies. There is undercapacity in radiography and chemotherapy. 'We don't get access to the drugs they get in Europe. Huge amounts of money have been thrown at cancer over the past decade so it is surprising to see these problems are still here. 'The main culprit is the NHS itself - it's a bureaucratic monolith.'


Friday, November 21, 2008

Pharmacists Writing Prescriptions Proposed

(Toronto, Ontario) Forget the doctor. The Health Professions Regulatory Advisory Council says that Ontario pharmacists can write and fill prescriptions. It's recommended that the local pharmacy be the "first stop for prescription extensions, drug adjustments and medication monitoring through pharmacist-ordered lab tests."
"We're very happy (to) collaborate with other health professionals and really play our role in delivering health care to patients in Ontario," says Dennis Darby, head of the Ontario Pharmacists' Association.

"The good news is the advisory council agreed ... that pharmacists should be tasked with a higher level of care to patients."
Ontario doctors' groups have taken the proposal under advisement. Their comments will follow a complete analysis of the issue. The Ontario College of Pharmacists is similarly reserved about the proposal.

It's worthwhile to mention that the Health Professions Regulatory Advisory Council is comprised of seven members of the general public who advise the Ministry of Health and Long-Term Care. It's not known whether it's required that the council members know how to spell pharmacy.
Doctors' fear of lawsuits tied to added costs of $1.4b

A vast majority of physicians in Massachusetts say the fear of being sued is driving them to order unnecessary tests, procedures, referrals, and even hospitalizations, a phenomenon that is adding at least $1.4 billion to annual healthcare costs in the Bay State, according to a study released yesterday. The Massachusetts Medical Society reported that 83 percent of physicians surveyed said they have practiced so-called defensive medicine and that an average of 18 to 28 percent of tests, procedures, referrals, and consultations, and 13 percent of hospitalizations, were ordered to avoid lawsuits. The society said its findings, the first it has compiled on the issue, probably underestimate the cost of the problem because the 900 physicians surveyed, including family doctors, obstetricians, gynecologists, and general surgeons, accounted for only about 46 percent of the doctors in the state.

The findings, which roughly mirror the experience reported by doctors in other states, come amid skyrocketing malpractice insurance premiums for doctors nationwide and a heated debate in Massachusetts and across the country about overhauling the malpractice system. Among the proposals is capping monetary awards to patients. While defensive medicine has been highlighted as a major driver of healthcare costs by other organizations, some studies, including a 2004 Congressional Budget Office review, question that finding. But Dr. Alan Woodward, past president of the medical society, said the Massachusetts study dramatically illustrates the need to transform the system to one that is more conducive to doctors admitting mistakes to patients, offering apologies, and engaging in arbitration that offers fair and timely compensation. "The current liability system is toxic to patient safety," he said. Patients who undergo unneeded imaging tests, for example, may be exposed to extra risk from radiation and allergic reaction to contrast dyes, Woodward said.

By some accounts, patients expect - and sometimes even demand - treatment that doctors deem marginally necessary. "With our increasing technology, patients want more of a work up. They want the labs, the MRI, the CT scan," said Dr. Manish K. Sethi, the study's lead researcher and an orthopedic senior resident at Massachusetts General Hospital. "You don't think it's indicated but you do it because you are afraid that if on the 1 percent chance there is something and you missed that you are going to get sued."

Concern about malpractice lawsuits has prompted some physicians to become hypercautious. Thirty-eight percent of physicians surveyed by the society said they reduced the number of high-risk services they performed, with orthopedic surgeons, obstetricians, and gynecologists topping the list.

Efforts to overhaul the malpractice system in Massachusetts and nationwide have been stymied. A number of proposals filed by state lawmakers have gone down to defeat, among them one that would mirror a closely watched program piloted at the University of Michigan Health System that encourages doctors and hospitals to acknowledge medical mistakes promptly and to engage in early offers of compensation. The aim is to significantly lessen the time and money spent on medical malpractice lawsuits, which often drag on for years and cost tens of thousands of dollars

More here

Thursday, November 20, 2008

Huge German Breasts Not Covered by Insurance

(Darmstadt, Germany) A 37-year-old German woman with massive breasts wanted the government to pay for breast reduction. A regional court ruled against her.
Having extremely large breasts is not an illness and an operation to reduce their size is therefore not covered by German state health insurance, a court said Wednesday.

However, it was ruled by a German federal court in 2004 that huge breasts causing psychological problems would typically be covered. Therefore, if one simply asks for breast reduction, the cost would not be paid for by state health insurance, but if one says that huge breasts are causing psychological problems, then the (far higher) cost would be covered by insurance.

Evidently, people desiring normally unreimbursed medical procedures would be smart to go to a psychologist first and complain about severe depression or night sweats or something. Sporting a psychological problem, state health insurers would be forced to pay the cost of the underlying medical condition.

Helluva way to run a health care system.
Canada: Treating symptoms—and feeding the disease

Anyone interested in a microcosmic view of the state of healthcare in Canada can get a fairly good perspective by visiting Brockville General Hospital (BGH) in eastern Ontario.  It isn’t the kind of place that one would go to if one were seeking medical treatment, but it would make a great case study in the intricacies of bureaucracy for anyone working on an MBA.

According to local sources, BGH recently received some $68 million in capital funding from the Ontario Ministry of Health and has begun an ambitious program of renovations designed to make the facility state-of-the-art.  The first round of renovations started with the closing off of a number of the hospital’s patient wings and a complete renovation of the entrance and the business offices.

As a result BGH has more offices than it has patients’ rooms, a true necessity in modern single-payer healthcare. The emergency department at BGH is particularly interesting in that the triage nurse is usually sequestered within the confines of the treatment area, which is secured from the waiting area by doors that can only be opened from within and is demarcated by a wall of one-way glass so that patients and family are unable to see the nursing station inside.  Patients enter and wait to be noticed.  The registration desk does have a sliding window, again made of one-way glass that is attended by a surly clerk.

The changes in the hospital’s priorities haven’t exactly been met with enthusiastic endorsements by the citizens of Brockville, as is evident by the number of signs hung up all over the hospital’s corridors and waiting rooms reminding patients that rudeness or abuse of staff will not be tolerated and could result in being ejected from the hospital.  I’m sure it’s a real morale builder for staff to have the full support of the hospital’s administration as they are dealing with people who are frightened and in pain having to routinely wait upward of seven hours or more for treatment.

For an experience that tests both the bounds of one’s dignity as well as one’s sanity, an extended stay at BGH is just what the doctor ordered.  A friend’s mother recently suffered a stroke that resulted in one side of her body being permanently paralyzed and the prognosis is not good.  Confined to BGH while waiting for an opening at a long-term care facility, this unfortunate woman spends her days gazing into the middle distance.  Her diet consists of pureed foods, all of similar color and uniform lack of texture.  In order to alter the type of food she is given the hospital requires doctors’ orders and a swallowing assessment, lest she choke on solid foods.  Problem is the doctor is almost never available to recommend a change of diet and the individual that conducts swallowing assessments doesn’t actually work for the hospital, but is an itinerant employee of the Ministry of Health who is available on a limited basis.  A change of diet can easily take upward of three weeks, as the hospital bureaucracy rolls out a plethora of ass-covering maneuvers, to ensure no one is to blame should the patient choke.

Any attempt to change or enhance the routine that governs my friend’s mother is met by hard skepticism and resistance. Voice mail messages left with administrators go unanswered for weeks.  Requests for information about the patient are denied due to “privacy regulations” and so it goes.  At one point my friend, who is her mother’s sole next of kin, asked the staff at BGH if privacy regulations permitted them to disclose whether or not her mother was still alive.

BGH is paid on the order of $999 per day to care for my friend’s mother and the hospital bills an additional $50 per day to the family (so much for ‘free’ healthcare).  Total cost of care per month is in excess of $30,000 and the Ministry of Health just pays it.  I would think for that kind of money one would get more than a drab room that doesn’t even have a phone (according to the hospital that’s an additional $150, per day). 

BGH is a classic illustration of the direction in which healthcare in Canada is headed and if the hospital in your community hasn’t quite deteriorated to the level of BGH, just give it some time, as the healthcare bureaucracy is slowly but surely metastasizing into an insatiable behemoth that only exists for its own ends.

While under the current system healthcare in Canada may be ‘free’; the outcome in many cases doesn’t justify the cost.  But it’s also illustrative of how Canada’s soviet-style healthcare system views patients.  While we never tire of the trite and specious negative comparisons to the American healthcare model, Canada’s single payer system views the patient as a drain on resources, whereas that much-vilified US-style healthcare system views patients as customers… and treats them accordingly.

The signs on the wall at BGH admonishing hospital visitors not to abuse staff amount to treating the symptoms that plague the healthcare system.  I suppose it’s a lot less work to print up a bunch of signs than to fix a healthcare system near total collapse.


Wednesday, November 19, 2008

Australia: More public hospital negligence -- and no apology

Woman wakes during surgery but is paralysed and unable to scream. Hospital admits she woke but won't talk to her. This is the second horror from the Northern Territory in the last week

A Northern Territory woman says she will have nightmares for the rest of her life after an horrific operation gone wrong at the Alice Springs Hospital. During the ordeal Rebecca Jones, 24, claims she woke up during abdominal surgery and could feel every cut of the surgeon's knife, the Northern Territory News reports. But she was unable to scream for help as the anaesthesia had paralysed her.

Ms Jones said she woke up just as doctors were about to start the full operation. She was paralysed and could not open her eyes, but could hear and feel everything. "I was very aware of what was happening to me," she said. "I thought the doctors had woken me up because the surgery was over - I quickly realised that was not the case. "It first hit me when I tried to take a breath. I couldn't move and started to panic. I could feel them cutting me open. I can't describe how it felt. I've never felt anything like it before.

"I was freaked out. Then I actually managed to move my hand and someone in the room noticed it. "He said, 'she's just moved her hand'. But they kept going. I was trying to scream, to do anything."

The hospital's general manager Vicki Taylor has refused to meet with Ms Jones over the issue and refused to be interviewed last night. In a written statement last night, Ms Taylor conceded Ms Jones had been "awake" during the operation to remove her gall bladder. She denied the hospital knew of Ms Jones' pain. [But she was AWAKE, stupid bitch!]

But an official hospital review of the case stated a second anesthetist had found "the administration of the anesthetic may not have been adequate" and adjustments were made. Ms Jones said hospital staff had been "well aware" she was in agony. "My husband was told that I'd almost died on the operating table," she said. "Doctors said the heart machine was going crazy, my oxygen levels were really low and my blood pressure was high."

Ms Jones has discussed the case with the NT Health Ombudsman and is considering legal action.


Tuesday, November 18, 2008

NHS a huge flop at maternity care

One billion pounds in compensation payments!

Errors that caused serious harm to mothers and babies have accounted for nearly half of the 2.1 billion pounds paid out as a result of medical negligence since 1995, The Times has learnt. A total of 947 million has been spent on compensation relating directly to obstetrics, reflecting the increasing cost of lifetime care for children who have suffered brain damage, cerebral palsy or developmental delay. The scale of the cost — enough to hire thousands of consultants or midwives — reveals the growing burden of claims on the health service at a time when maternity wards are short-staffed and the birthrate is rising. Medical colleges say the chances of harm to mother or baby are lower than ever, but they remain concerned that shortages of consultants and midwives leave patients at risk.

Taking into account a backlog of cases from the 1990s, the cost of maternity-related claims has risen from 163million in 2003-04 to 288 million in 2007-08. The figures, revealed by the NHS Litigation Authority in answers to parliamentary questions by Harry Cohen, the Labour MP for Leyton & Wanstead, reflect the cost of settled claims awarded under the Clinical Negligence Scheme for Trusts. But this does not include cases that preceded the authority's creation in 1995, some of which have arisen from health problems diagnosed years after birth.

Medical colleges said that the total bill for litigation put the 330 million pledged by the Government to improve maternity services into sharp relief. As The Times reported in September, trusts have had trouble identifying specific funding promised over three years to help to implement a policy document, Maternity Matters, that promised all women dedicated care from a midwife by the end of next year.

Louise Silverton, the deputy general secretary of the Royal College of Midwives, said that the cost of claims “underlines what a false economy it is to cut back on maternity care”. “Women keep hearing about these excellent government policy statements such as one-to-one care in labour from a midwife,” she said, “but they are not getting that sort of treatment in many areas such as the East of England, the South West and London. Our members are telling us that they are overworked and overstretched and are running between beds dealing with, in some cases, three women at once.” Overall NHS spending on maternity in England was cut by £55million in 2006-07, while the birthrate has risen by 16 per cent — equivalent to 90,000 extra births — since 2001, Ms Silverton added.

Tristian Blomfield, 8, from Watford, Hertfordshire, received a compensation package of just over 8.26 million after suffering permanent brain damage at birth. He has cerebral palsy in all four limbs and requires constant care. West Hertfordshire Hospitals NHS Trust, which manages Watford General Hospital where Tristian was born, offered his family an unreserved apology and expressed hope that the agreed settlement would provide them with security for the future.

Sabaratnam Arulkumaran, the president of the Royal College of Obstetricians and Gynaecologists, said that only six in every 1,000 births resulted in a litigation claim. But at that rate trusts had to set aside 500 pounds for each birth as a form of insurance, he added. “In a busy maternity unit of 5,000 births or more, we believe there needs to be 24-hour consultant cover to deal with emergencies and prevent disasters better. Rather than have more negligence cases and pay out on more claims, we should spend on more consultants, better training and reduce the number of cases,” he said.

A spokesman for the Department of Health said: “The UK remains one of the safest countries in the world in which to have a baby.” [Compared with Africa, I guess]


Australia: The mayhem in North Queensland public hospitals continues

And all the managers and administrators have been no help at all. The cardiac unit at Townsville had to be closed because of infighting and now Cairns hospital seems to be going down the same road

QUEENSLAND Health faces unprecedented legal action after a report found a junior surgeon was harassed by senior Cairns Base Hospital doctors. The Royal Australasian College of Surgeons, in an independent review, cleared doctor Heng-chin Chiam, 39, of allegations of incompetence and botched surgery. The father of three, who has been off work on five months stress leave was a "cautious but safe surgeon" whose medical skill could not be faulted, the audit found. The University of Queensland-educated specialist was a victim of "harassment" allowed to "fester" by management, it said.

CBH director of surgery Christina Steffen, who stood down in defence of Dr Chiam, yesterday told The Courier-Mail the findings opened the way for legal action. She said it was a clear case of "workplace mobbing" by a group at the hospital. "This is a surgeon who has had his whole career destroyed where there is no basis and nothing proven," Dr Steffen said. She said they had both been the victims of the "virus" or "cancer" of malicious rumour and unfounded accusations.

Queensland Health did not respond to questions about the alleged workplace harassment, except to say "all appropriate action will be taken".

Dr Chiam said he had been hurt and demoralised by the claims, made in secrecy under the Whistleblowers Act, but still wanted to return to work. The medico had been investigated twice before for the same complaint but both internal inquiries found no evidence to support the allegations. Dr Chiam felt he had been denied natural justice.

Four surgical procedures a week had to be cancelled with the two full-time surgeons on stress leave. Two months ago, a separate inquiry was launched when Dr Steffen revealed concerns of a party culture at the hospital. She claims that a group of doctors held a booze-fuelled staff meeting and joked about a patient who bled to death on the operating table. "When there is a power vacuum such as at Cairns Base Hospital with a transient ... administration, it allows the formation of these powerful cliques," Dr Steffen said.


Monday, November 17, 2008

The Obama plan will kill choice

The Washington Post has a lengthy front-page story today on Barack Obama’s health care plan, which the newspaper admits contains “profound — and controversial — changes.” The Post tries to compare the Obama plan to Massachusetts’ 2006 health care legislation, asserting the only difference between the two is the individual mandate in the Massachusetts plan. This is indeed a big difference between the two plans, but it is nowhere near the most important. For all of its other problems, the Massachusetts plan did not create a new government-run health care plan that would compete side by side with private insurance plan. Obama’s plan does.

Why is this important? Because not only would the federal government be an active competitor in the health care market, but it would also set the rules for competition. Heritage’s Center for Health Policy Studies Director Robert Moffit explains what would happen next:
The likely incentives for government officials would be to set rules to advantage the government’s own health plan and to disadvantage the private health plans, including setting the government’s health plan premiums artificially low, reducing or eliminating cost-sharing requirements, or more heavily subsidizing certain benefits to make the government health plan more attractive than the private health plans. These plans would operate without incurring any of the normal financial risks that private health plans must bear.

One could easily imagine a massive crowd out of private coverage, as employers dropped private coverage and paid the requisite tax. Likewise, lobbyists for businesses or private insurance industry executives may see the government health program as a convenient “dumping ground” for high-risk individuals or families, which would reduce business and insurance industry costs but would amount to massive adverse selection against the taxpayers. … In such a political environment, the value of personal choice and anything at all resembling free market competition would mostly likely be rendered meaningless.

Obama’s preference for socialized medicine is no secret. He openly admitted earlier this year, “If I were designing a system from scratch, I would probably go ahead with a single-payer system.” The question for Obama and the left is not whether socialized medicine is desirable. They want socialized medicine. The problem Obama is trying to solve is how best to trick the American people into a policy they do not want. Obama’s health plan is the answer to that problem. Just ask New York Times columnist Paul Krugman: “The Demoplans offer choice — so that people won’t feel that they’re being forced into a government plan. Over time, I suspect, many people will choose the government plan or plans — but they’ll have the option of staying with those wonderful people from the private insurance industry.”

Krugman is undoubtedly right. But not for the reason he states. The government plan will not win because people love socialized medicine (as Krugman recently learned), but because Congress will strangle the private market to death so the American people have no choice. These are the policy options the American people are about to face. It’s high time papers like The Washington Post begin accurately reporting on them.


Sunday, November 16, 2008

NHS gives "tumour" woman 20 years of hell

For 20 years she lived under a death sentence, having been told that the tumour inside her was terminal cancer. Mary Stranack believed that her survival against such odds was a miracle. But it wasn't. The grandmother has now discovered that the tumour was in fact a harmless cyst. In a five-hour operation at Poole Hospital in Dorset, surgeons removed a one-and-a-half stone [21lb.] fibroid from her stomach. 'They told me it was a benign fibroid and not cancer - it was amazing,' said Mrs Stranack, 58. 'I came out of hospital on my birthday and began buying new clothes.'

Her years of torment began in 1988 after she went to hospital complaining of a swollen stomach. At the time her six sons were aged between three and 19 and doctors suggested she may be expecting a baby with her husband Bob. Mrs Stanack said: 'I went to see the doctor and he said I could be pregnant but I knew I wasn't so I had to go to hospital that very afternoon.

They did a scan and a blood test and it came back that I had ovarian and stomach cancer. 'They told me I only had months to live. I wasn't asked to go back for treatment - there was no chance for me apparently. I was devastated and said I would go home and pray for a miracle.' Years passed while she waited for the end to come. She was invited back to the hospital for a reassessment but says she was too frightened to attend.

She said: 'One day I told Bob: "I want everything to go on as it was before. I don't want anyone feeling sorry for me." But gradually the years passed and my weight went up and up. 'After 15 years, I was a size 24 and huge but I didn't have any pain.' It was only when she was diagnosed with anaemia and thyroid problems earlier this year that she finally asked to be examined again.

A spokesman for Poole Hospital, where Mrs Stranack was originally diagnosed as terminally ill, refused to discuss her patient history, but said: 'We are delighted to hear that Mrs Stranack is doing so well.' Mr Stranack, a crane operator, added: 'It's been 20 years of hell.'


Saturday, November 15, 2008

Britain's health service is now worse than Estonia's

Healthcare in Britain is worse than in Estonia even though we spend four times as much on each person, according to a Europe-wide league table. And despite the billions poured into the NHS by Labour, the standard of care is on a par with the former Communist states of the Czech Republic and Hungary, which spend far less on health.

Long waiting times and slow access to new cancer drugs were highlighted as major reasons for Britain's `mediocre' placing of 13th out of 31 countries. Britain came out near the bottom on cancer survival rates, waiting times, MRSA infections and the speed of access to new drugs. The Euro Health Consumer Index report found that when the cost-efficiency of the health service was taken into account, the UK came 17th.

Johan Hjertqvist, of the Health Consumer Powerhouse think-tank which compiled the report, said Britain had improved since last year on patients' rights and providing patients with information on their health. `However access for both waiting times for treatment and uptake of modern drugs, remains a problem,' he added. The report concludes: `The NHS shares some fundamental problems with other centrally planned healthcare systems. It would require some really top class management for that giant system. Superbug problems are improving, but they are still bad.'

Government health spending has doubled since 2002. This year, 96billion pounds is going into the NHS - almost four times 'the amount spent in the former Soviet republic of Estonia per head of population. The report backs up a recent Italian study, which put Britain near the bottom of a European table for the chances of its patients still being alive five years after being diagnosed with cancer.

Matthew Sinclair, of the TaxPayers' Alliance, said: `For all the central initiatives and health drives launched in Whitehall, we are still lagging behind much poorer countries like Estonia. `That should teach the politicians that this centralised, micromanaged and monopolistic approach does not work.'

The index rates healthcare systems on 34 indicators before working out a total score out of 1,000. The UK scored 650 points, way behind the Netherlands in first place on 839 points. Britain was rated `poor' on nine indicators, including direct access to a specialist, quick access to operations and MRI scans, five-year cancer survival rates, MRSA infections and quick access to cancer drugs. It was rated `intermediate' on 16 indicators, such as the ability to see GPs on the same day, quick access to cancer therapy and heart attack survival rates. Only on the remaining nine indicators was it rated `good'. These include NHS Direct, the quality of hospital rating systems and IT.

The study concluded that countries with a social insurance system, in which patients take out cover with companies but receive healthcare from separate bodies, fared better than those with centrally driven systems such as the UK.

LibDem health spokesman Norman Lamb said: `We have got to attack the waste and bureaucracy that drives clinicians and the public crazy. We need to make sure that all available resources are focused on patient care.' Tory health spokesman Stephen O'Brien said: `This is further evidence of the incompetence of ministers when it comes to running the NHS.'

Health Secretary Alan Johnson said: `The European Health Consumer Index report is not anchored in any reputable academic or international organisation. It uses flawed methodology and old data.'


Doctor held liable for punitives even though he treated the patient competently

Sounds like someone gaming the system

I don't usually post about trial court decisions -- they have a high variance, that is typically narrowed on appeal. They are often the fodder for demagogic politicians of every stripe. I usually take them with multiple grains of salt.

But this New Jersey Law Journal report is, I think, worthy of larger notice. It describes a jury verdict from Hudson County, for $400,000, against a physician who treated his patient competently. His failing was to refuse to hire, at his own expense, an interpreter so that he could adequately communicate with his deaf patient. Why didn't the patient come with her own interpreter (hired at her own expense)? Because she doesn't have to, according to federal law as interpreted by the courts. Her lack of verbal skills is a disability that others must palliate at their expense.

More obscene still is that the defendant's malpractice liability insurance does not usually cover such liability, because the care actually given to the patient was quite appropriate.

The plaintiff claimed that she repeatedly asked her Jersey City rheumatologist to hire an American Sign Language interpreter. The doctor responded that as a solo practitioner, he couldn't afford the estimated $150 to $200 per visit an interpreter would cost, given that Medicare paid him $49 for each visit. He treated his patient (who declined to visit another rheumatologist, perhaps one who knew American sign language) for lupus for about 20 visits, stretched out over 20 months, occasionally exchanging written words with the patient's civil union partner [wait: if they were lovers, how come the partner didn't understand and use American sign language?] or verbal instructions via the "couple's" 9-year-old daughter (who apparently couldn't use sign language either -- it just gets stranger and stranger).

But the patient claimed she never really understood the side-effects (swelling of her treatment), and that when she insisted the doctor was obliged to pay for an interpreter (she had an interpreter phone the doctor, self-serving legal advice if ever any has been dispensed), the doctor became angry and insulted her, forcing her to seek treatment elsewhere. Her next doctor was able to communicate with her, and ceased the treatment, since it turned out that the patient didn't want the swelling and preferred a different treatment. Essentially her lawsuit sounds in battery (touching of a patient despite the lack of informed consent) -- fine, except that the patient apparently was advised to seek out other providers and insisted on returning time and again to this one. I'm not excusing poor bedside manner or countenancing insults (though I have no evidence that any insults were uttered) --

During a three-week trial (!), the rheumatologist's argument that it would have been an undue hardship to pay an interpreter who cost more than the income he received for each visit was apparently undercut by the fact that the doctor's tax returns showed he earned over $400,000 a year. Sorry, but how did this evidence get in? Unless the doctor is obliged to treat handicapped people at a loss, why is his personal wealth relevant here?

The jury obviously doesn't share my disbelief. Fully half of the $400,000 verdict against the doctor was for punitive damages. To repeat, the sum is not insurable, apparently.

So, notice to all professionals out there: don't get wealthy, or you may be obliged to "share the wealth" with a disabled person. Can't professionals post a sign in their office that reads "Sorry, we decline to treat you if we must spend more money on your visit than you or your agents will pay us"? Apparently the answer is "Yes, such a sign is OK if the patient speaks only Slovak (since that is not a "disability", at least not yet), but not if the patient is blind or deaf.


Friday, November 14, 2008


The view from Boortz

Let the talk of healthcare reform begin. And for this we are going to Democrat Rep. Pete Stark of California. He is the chairman of the House Ways and Means health subcommittee and there is no doubt that this guy will be a major player when it comes to healthcare reform.

Our federal government has grown. Big time. And with that growth has been obscene spending by politicians on both sides of the aisles. And at a time when our nation is facing record deficits, Representatives like Pete Stark think it would be a good idea to add hundreds of billions of dollars to that deficit. That's because the Democrats have no plans to cut spending when it is convenient to fund their schemes and dreams ... and in this case it would be universal healthcare. Stark says that he wants to waive fiscal rules - the pay-as-you-go rules (PAYGO) - in order to expand healthcare coverage.

There is no doubt that there have been exceptions to PAYGO ... take this $700 billion financial package. But ironically it was the Democrats who re-adopted PAYGO rules in efforts to make themselves look fiscally conservative or responsible. But once the election is over, they are already willing to scrap it in order to fund their spending programs.

Oh and as if you had any doubts ... Pete Stark also says that he approves of Obama's plan to raise taxes on the evil rich in order to help finance a new healthcare system for this country. A system that will inevitably cost hundreds of times more than originally estimated by virtue of the fact that it is a government operation and it is doomed to be plagued with bureaucracy and mediocrity.

Just know this, dear listeners: The Democrats are pushing this nationalized health care idea because they want more control over YOU. When they control your health care ... which inevitably will ... they control you. The clear solution to whatever health care "crisis" we have is the free market. Politicians have been working for generations to prevent the marketplace from working to bring about affordable health care. Their power means everything to them. If you have to wait for months for an MRI, so be it. If your health care has to be rationed, so be it. It's all about power ...THEIR power.


Americans travel abroad for crucial surgery

Before getting two artificial disks to ease the grinding pain in his back, Wayne King asked prospective surgeons where they trained and how many disk replacements they had done. Then he flew to Malaysia for the operation. Rising health costs and dwindling insurance coverage are driving hundreds of thousands of Americans to travel far to avoid potentially devastating medical bills.

Among them are King, an insurance adjuster who lives in east Sacramento, as well as a Sacramento City firefighter who underwent major dental reconstruction in Tijuana, and an Elk Grove couple heading to India for fertility treatment.

Other than organ transplants, there's little data on the safety of medical travel, but "there is no question that it is increasing," said Dr. Arnold Milstein, chief physician at Mercer Health and Benefits, a firm that advises companies on medical insurance. "In the U.S., it's getting to be pretty Darwinian in terms of who lives and who dies," said Milstein. Or who hurts and who doesn't.

King was driven by a steady, intense pressure on his midsection caused by one collapsed and one partly collapsed disk. It's like having an arthritic joint, but in the spine, said his rehabilitation specialist, Dr. Michael Hembd of Sacramento. "I was absolutely miserable," King said. "I had no life." Standing or sitting for more than a few minutes were equally tormenting. Painkillers fogged his mind. He withdrew from friends and snapped at relatives.

A standard treatment would be spinal fusion surgery, to immobilize a section of spine. An emerging alternative is disk replacement. Both have flaws, failing to cut pain in up to a fourth of the people who get them, said Dr. Serena Hu, an orthopedic surgeon at UC San Francisco who has researched disk replacement. But there is some suggestion that disk replacement may put less strain on nearby disks.

King was convinced replacement would give him better mobility and less risk of other disks degenerating. Although European surgeons have replaced two neighboring disks for well over a decade, many U.S. insurance companies will only pay for single disk replacement because success of two-disk surgeries - what King wanted - haven't been tracked as long. He appealed his insurance company's denial. He changed jobs to try to improve his coverage. He was told yes, then no just days before Hu would have operated.

"I said screw it, I'm just going to do it and file bankruptcy, but the hospital wanted $50,000 down" on the $105,000 treatment, King said. Ultimately, after months of Internet research and hiring MedRetreat, a medical travel organizer, he traveled in January to Gleneagles hospital in Malaysia. The bill - surgery, hospitalization, hotels and airfare for himself, his partner and his mother - came to $27,000. King borrowed from relatives and his 401(k).

Gleneagles is among dozens of hospitals in the developing world racking up international accreditations or affiliations with prestigious U.S. universities. Many boast English-speaking and highly trained doctors, and nursing ratios that outshine U.S. care. It isn't just lower pay for all those doctors and nurses and hospital construction workers that keep costs low in places such as Malaysia. Even supplies are cheaper. The exact same two disks that were placed in King's spine, at a cost of $3,200 each, are priced at $11,000 each in the United States. "It's an unfortunate statement of the cost of health care here," Hu said.

Ten months after surgery, King is almost pain-free. The twinges are so slight he is off pain medication. "I can go out with my friends. I can go on a drive. I'm coherent again." His post-surgical X-rays and mobility are about what a doctor would expect in someone who had had the same surgery in the United States, said Hembd, who has treated King since 2005.

Just last week, another patient told Hembd she's considering going to Germany for the same surgery, and has been quoted a price of $35,000. Still, Hembd stresses he wouldn't encourage anyone to seek care outside the United States.