Saturday, February 28, 2009

Australia: Deadbeat State government hospitals

The Auditor-General has damned the financial management of the NSW health system, saying area health services had failed to pay bills on time and had routinely misused trust funds. Peter Achterstraat said the financial audits for 2007-08, which were made public yesterday, showed that some health services had classed bills as "in dispute" to buy time because they did not have the funds to pay small businesses.

His report noted that health services had dipped into trust accounts to pay bills and wages and the worst offender was Northern Sydney and Central Coast, which had 1000 trust accounts that were $9.9 million overdrawn in November 2007. The overdraft coincided with desperate attempts by the former health minister Reba Meagher to improve operations at Royal North Shore Hospital after a patient, Jana Horska, miscarried in a hospital toilet. The incident became the subject of a parliamentary inquiry.

Mr Achterstraat said bills totalling $312 million were outstanding at June 2008, and $75 million of that was more than 45 days overdue. A year earlier $174 million had been owing, none of it more than 45 days late. He found that only two of the eight area health services paid their bills within the benchmark of 45 days. "From a financial point of view this is not a particularly good report card," he said. "They are not paying their bills on time, they're not managing their budgets properly, they didn't get their annual statements in on time and they are using trust fund money for reasons they were not intended."

He recommended that the Treasurer, Eric Roozendaal, or the Health Minister, John Della Bosca, order area health services to pay interest on late bills as an incentive to clean up their act. "I am concerned about the $320 million in trusts and special purpose accounts. They need to make better use of these funds. In some cases these funds have been there for a long time and the department is not clear what they can be used for," Mr Achterstraat said. "Some funds have been used to subsidise overexpenditure in other areas."

Yesterday Mr Della Bosca said he would consider interest payments but pointed out that the data was more than eight months old. "Let me be clear, I want creditors paid on time. No question. But we are getting on top of the problem," he said. "In November last year, more than $15 million was owed to small businesses across the state. That figure has dropped by more than 80 per cent to just $3.4 million this week."

The Premier, Nathan Rees, said there was a plan to reduce all of the debt to creditors "to acceptable levels" by June. "Things are better than reflected in that report, and there is a plan to continue to drive down those creditor issues," he said.

The Opposition spokeswoman on health, Jillian Skinner, said the Government was financially irresponsible and reckless. "We have a $380 million health budget deficit, more than $300 million in unpaid bills on top of that and donated money in trust funds being used for recurrent expenditure instead of the hospital projects they were given to build," she said.


Thursday, February 26, 2009

Huge lawsuit payouts awarded against obstetricians have caused many obstetricians to quit and less qualified doctors are now doing their jobs

Erin Hawe's contractions were five minutes apart when she called Cape Cod Hospital at 11 o'clock on a recent Friday night, wondering whether it was time to head in to deliver her second child. A doctor called her right back, but it wasn't her longtime obstetrician-gynecologist. It was a total stranger - Dr. Luisa Kontoules, one of a new breed of hospital-based physicians who deliver babies for other doctors' patients.

Hawe, a 23-year-old from Dennis, was surprised that Kontoules would be delivering her infant, but immediately relaxed after meeting her at the hospital. Kontoules later sat in Hawe's room answering questions for nearly a half-hour before Hawe was discharged. "I have never spent that much time with any doctor," Hawe said.

Called laborists or OB hospitalists, specialists such as Kontoules are helping fill a void created by the growing number of obstetrician-gynecologists who have stopped delivering babies because of grueling on-call schedules and high malpractice insurance costs. The Boston-based ProMutual Group, the largest malpractice insurer in the state, said about 65 of the 120 obstetrician-gynecologists it insures have quit delivering babies.

For expectant mothers, who traditionally have carefully hand-picked their obstetricians to see them through pregnancy and delivery, the advent of laborists means they typically won't meet the doctor attending the birth until they arrive at the hospital. But some physicians believe the practice will be safer, because laborists can begin caring for pregnant women as soon as they arrive at the hospital. Laborists also work defined shifts, so they generally don't suffer chronic sleep deprivation from repeated on-call shifts. That could lead to fewer mistakes, though there are no data yet.

Nobody tracks how many laborists are employed in hospitals in Massachusetts or nationwide, but the number is clearly rising, particularly in community hospitals. Ob Hospitalist Group, a company based in South Carolina, said it has placed 60 doctors as laborists across the country and is looking for jobs for another 340 physicians interested in being laborists. The new specialty is part of what some doctors said is an unavoidable shift in medicine: Fewer doctors have time to care for their patients when they are in the hospital.

Many primary care doctors - who must squeeze more and more patient appointments into the day to make ends meet - infrequently set foot in the hospital; a growing cadre of hospitalists now care for these patients during hospital stays. In other specialties, like obstetrics, surgery, and orthopedics, physicians no longer want to be on call for emergencies because of the disruption to their practices and personal lives.

Dr. Jim Butterick, chief medical officer of Cape Cod Hospital, said the Hyannis hospital decided to hire Kontoules after four of the hospital's eight obstetrician-gynecologists stopped delivering babies, and those remaining "were getting pulled out of their offices and out of the OR all the time." Kontoules had worked in private practice in Peabody, but when eight obstetrician-gynecologists on Boston's North Shore gave up delivering babies over a two-year period, she had no one to help cover her laboring patients on nights and weekends. For a year, she saw patients in her office all day Monday through Friday and answered pages at all hours to deliver 300 babies and tend to emergencies at two nearby hospitals. Exhausted and burned-out, she, too, gave up delivering babies in October 2007. "I physically could not keep up a private practice," said Kontoules, 50.

But she missed ushering tiny infants into the world and last August she took the job at Cape Cod Hospital, where she works every other weekend, from Friday night to Monday morning, so the hospital's four remaining obstetricians can have a break. Being a laborist has "returned the joy" to delivering babies, Kontoules said, though she worried, at first, about how expectant mothers would react. "I knew what it was like in private practice and how much patients bond to their obstetricians," she said. "I have not had a single woman say, 'I don't want you, I don't know who you are.' They want to feel cared for and have a safe birth and that might overwhelm any disappointment they have." Besides, she said, many pregnant women are prepared for the possibility that another obstetrician in their doctor's practice might deliver their babies - although often women have met those doctors.

Another Massachusetts hospital, Morton Hospital and Medical Center in Taunton, has hired two laborists over the past two years, and Brigham and Women's Hospital in Boston is considering employing them as well. The hospitals pay laborists $125 to $150 an hour and cover their hefty malpractice insurance premiums.

An obstetrician-gynecologist in Massachusetts generally pays between $75,000 and $100,000 a year for malpractice insurance; that amount drops to between $30,000 and $50,000 when a doctor gives up obstetrics and sees patients only for gynecological problems, said Dr. Angela Aslami, chair of the practice committee for the Massachusetts chapter of the American College of Obstetrics and Gynecology. The group plans to survey the state's 900 to 1,000 obstetrician-gynecologists to determine how many have stopped, or plan to, in the next two years.

Dr. Louis Weinstein, chair of obstetrics and gynecology at Thomas Jefferson University in Philadelphia, coined the term laborist five years ago, and promoted the practice as a way to provide safer deliveries. He proposed having four laborists working 10- to 14-hour shifts to cover all of a hospital's deliveries. He believes that employing laborists for entire weekend shifts is dangerous because the doctors may get little rest. But doctors at community hospitals vigorously disagree, saying the number of deliveries is small enough that they get plenty of sleep. Kontoules said that in between delivering two to eight babies per weekend shift and seeing emergency room patients with gynecological problems, she always gets "plenty of sleep."

Overall, said Dr. Robert Barbieri, chair of obstetrics and gynecology at the Brigham, having doctors in the hospital 24 hours a day is a safety improvement, and at smaller hospitals, a weekend-long shift is generally not dangerous. The Brigham, which like most teaching hospitals has obstetricians and physicians in training on-site at all times, is considering hiring laborists for 12-hour weekend shifts to relieve off-site obstetricians of call duty during busy periods.

Dr. Kirti Patel, an OB hospitalist at Morton Hospital who works every other weekend, gave up her traditional practice two years ago because she felt her family life was suffering. Now, the 36-year-old is home with her two young children during the week; her husband cares for them when she's working. Patel - who in addition to delivering one or two babies a day, manages post-operative gynecology patients and provides consultations in the ER - said she feels it's safer for patients because she's less distracted and less exhausted. "I'm really there for just that patient," she said.


Wednesday, February 25, 2009

War hero defeated by NHS after hospital stay left him with three infections and fractured pelvis

He survived the vicious conflict with the Japanese in the jungles of Burma. But veteran Albert Marriott has been reduced to a wheelchair-bound shell by a spell in the care of the NHS. Mr Marriott, 90, was admitted to hospital after a fall at home. He then picked up superbugs Clostridium difficile, E.coli and MRSA - and fractured his pelvis in a fall from a hospital bed.

By the time he was finally released 20 months later and transferred to a nursing home, he was unable to even get dressed without help. There is little chance he will get better. His daughter, Sue Davies, 57, told how the independence her father once cherished had been 'taken away by the inadequate standards of cleanliness and care in the NHS' at two separate hospitals. He must now use his pension and savings - and may have to sell his home - to pay for his weekly 384 pounds care home bill.

Miss Davies said the family had made formal complaints about his care at both Clay Cross Hospital in Derbyshire and the Royal Chesterfield Hospital and may seek compensation. 'It has beaten him. He used to be active, read the papers and have a view on things and now he is a shell and does nothing,' she said. 'Hospital is a place you go in to be looked after, not where you go to get fractures and infections. It's so hard for him, he's a man of dignity and pride and I feel it's all been taken away from him.'

Mr Marriott fought in Burma during the World War II before working as a joiner. A father-of-two, with four grandchildren and three great grandchildren, he has lived alone since his wife Lillian died at 63 in 1981. In June 2007 he was bruised after a fall at home and was admitted for three weeks to Clay Cross community hospital. However, his health began to deteriorate. He developed pancreatitis and had to have a catheter because of other problems. He was then struck by the first of a series of infections and ended up going backwards and forwards between the two hospitals.

According to Miss Davies he had E.coli and C.diff at the same time. After a month of treatment in the Royal he was well enough to return to Clay Cross. But in January 2008 he fractured his pelvis falling from a bed and was sent back to the Royal. The fracture was missed by doctors, who believed he was simply bruised. Miss Davies said: 'He was in so much agony he was crying.' The pensioner was sent back to Clay Cross with morphine to help with the pain and two days later the fracture was diagnosed by another doctor and he was sent back to Chesterfield.

Once on the ward again his condition deteriorated fast. 'He was so poorly I was asked if I wanted him to be resuscitated if anything happened. He became delirious.' Miss Davies said she believes his deterioration was down to the infections. 'He looked like he was dying and we were told more or less that he was,' she added. She claimed he had another bout of C.diff and later had a minor MRSA infection too.

Eventually Mr Marriott was moved to a ward which had just had a 'deep clean' and his health improved. He went back to Clay Cross and after months of looking for a suitable nursing home he was discharged.

Miss Davies said: 'He can't do anything for himself now, apart from feed himself. The NHS hospitals are responsible for this and should pay for his care.' Tracy Allen of Derbyshire Community Health Services said: 'We are very sorry that Mr Marriott and his family feel that we have let him down.' She insisted he only had one episode of C.diff, was known to have E.coli 'on admission' and was 'colonised' with MRSA while in hospital. The Chesterfield Royal Hospital said Miss Davies' complaint would be investigated


Tuesday, February 24, 2009

Creating a real healthcare market

MASSACHUSETTS healthcare costs are a problem. The state has virtually the highest costs in the country and insurance premiums that rise more rapidly than national rates. The state's near-universal health coverage shows that no good deed goes unpunished: As the state lowered the number of uninsured, costs increased.

After the Globe reported that Partners hospital system attained higher prices based primarily on its clout with insurers, Attorney General Martha Coakley began an anti-trust investigation. But the remedies will be a long time coming should she decide to prosecute and then win her case.

To spur more immediate solutions, a memo written last summer by former governor Michael Dukakis urged the return of the halcyon days of the 1970s and 1980s, when Massachusetts regulated hospital fees for services and construction. Although most economic reviews of this regulation had reached negative or uncertain conclusions about its impact, and these regulatory schemes have been mostly dismantled, some argue that the problem may not have been with the regulation per se, but rather in its limitation only to hospitals. The memorandum advocated that the state regulate all health insurance premiums - essentially a single payer system. It concluded that ". . .it should be unmistakably clear by this time that market forces don't work in healthcare."

Nothing could be further from the truth. Real markets, like those for computers or cars, feature many competitors who offer differentiated products, and consumers who search for the best value. Innovators easily enter the market. Consumers separate the good from the bad with readily available information about quality and prices. They use it to reward the good guys and penalize the bad. That is why the Digital Equipment Corporation is no longer among us.

These conditions are absent in the Massachusetts healthcare market. Boston hospitals form an oligopoly, dominated by an almost monopolist Partners Healthcare, which last year earned around half a billion dollars in profits. As for health insurance, many employers offer a choice of one - or a choice of firms with virtually identical policies. And if you need an operation, there's no way to learn about histories and prices of potential surgeons. If this is a market, I am Angelina Jolie.

In the long run, the appropriate role for governments in controlling healthcare costs is to use their existing powers to correct these problems through vigorous prosecution of antitrust and the provision of relevant information.

There is a more immediate solution, however. Insurers could require integrated hospital systems to give fixed price bids for providing all the care needed for specific chronic diseases or disabilities, such as Type II diabetes and high-risk pregnancies. Insurers would offer these bids to consumers. They could, for example, choose hospital A's diabetic team in preference to hospital B's, which costs $500 more a year. The effectiveness of such integrated networks is illustrated by Duke Medical Center's congestive heart program. In one year, it lowered costs by an astonishing 40 percent by improving the health of its patients through innovative procedures that decreased the number of hospital visits.

Our oligopolistic hospitals could create these teams. After all, they own all the resources needed to provide this care, and they have sprawled into convenient neighborhood locations. These integrated facilities (which I call focused factories) are feasible even in small areas. For example, if 10 percent of a town is diabetic and the average diabetic costs $10,000 a year, an area of only 50,000 residents could support $50 million of competitive diabetes-focused factories. In addition, transparency about the quality of care for a disease or a disability could be more easily attained from these focused teams eager to demonstrate the competitive excellence of their care. Accordingly, consumers, armed with relevant information, would pick those facilities that give them the best value for their money.

And here's another bonus. Because these teams would effectively and efficiently treat those with chronic illnesses, which normally account for at least 75 percent of healthcare costs, this would give the Commonwealth a shot at finally controlling expenses while improving quality - a potent combination. What do you prefer: giving more power to the state government, which fiddled while Massachusetts healthcare burned, or a transparent consumer-based healthcare system based on real market forces?


Monday, February 23, 2009

NHS blunders are behind a spate of 'vaccine overloads'

Children are being given the wrong vaccinations and repeat doses of jabs they have already had due to mix-ups at GPs' surgeries. Nearly 1,000 safety incidents involving child immunisations were reported in a single year. Of those studied in detail, more than a third involved babies and children given a different vaccine to the one they were supposed to have. Other blunders included delays to children having important vaccinations, infants given drugs that were out of date and allergic reactions. It is said all of the incidents could have been avoided if doctors or nurses had checked medical records or drug details thoroughly.

Last night campaigners said these mistakes were the `tip of the iceberg' and expressed fears of a `vaccine overload' from Britain's growing childhood immunisation schedule. A report by the National Patient Safety Agency (NPSA), the watchdog which monitors NHS errors, looked at 949 incidents involving jabs reported in 2007. A detailed study was made of 138 of these cases, picked at random. Eight caused children `moderate harm'.

In 36 per cent of cases a child was given the wrong vaccination. If the sample is representative, it means that hundreds are given the wrong immunisation every year. And, as the reporting of incidents by medical professionals is voluntary, the true number could be much higher.

In 23 per cent of incidents there were errors in documenting the vaccine, while there were delays in 17 per cent of cases. Other problems included incorrect storage of the jabs or out-of-date vaccines having to be thrown away.

GP Dr Richard Halvorsen, of the Babyjabs clinic in Central London, said: `These cases are probably the tip of the iceberg. It's worrying when children are getting the wrong vaccines at the wrong times but it's an inevitable consequence of the vaccination schedule, which is one of the most complex in the world. `Of course things are going to go wrong - it's a recipe for mistakes.'

Children receive 32 immunisations before they reach four. And the Government is now discussing whether also to give chickenpox and flu jabs. The most controversial vaccine is combined measles, mumps and rubella (MMR).

Jackie Fletcher, of campaign group Justice, Action, Basic Support (JABS), said: `Children are sometimes given MMR when they go to get their pre-school booster for diphtheria, tetanus and whooping cough, even if parents have explicitly said they do not want them to have it. To think mistakes occur time and time again is horrendous.'

Previously healthy Jodie Marchant, who is now 17, was left severely brain-damaged and with a gut disorder after being given seven vaccines in a single jab at 14 months. Her parents, Bill and Pat, from Southampton, had requested that she was given only MMR. A claim for damages failed because there was not enough research into the vaccines. The Marchants are now suing their GP practice. Mr Marchant, 68, said: `To think so many other children suffer vaccine mix-ups is appalling.'

The NPSA said new packaging guidelines for jabs would `eradicate' errors. The Department of Health said: `Staff are trained to administer vaccines safely, follow the childhood immunisation schedule and to record it all.'


Nannystate medicrat care

So you want to grant government hegemony over your health, huh? What is it about voters who forever treat politicians like battered wives treat their abusive husbands? "Well, he punched me in the face for the seventeenth time and knocked out four of my teeth but I still love him and he said I can trust him now so I'm going to give him another chance." You actually want government to take over and dictate your personal well-being? You do know, don't you, that you're putting your blind faith in the same politicians who are bankrupting the Social Security and Medicare ponzi schemes and bilking you out of trillions of tax dollars so they can "stimulate" their politically-connected billionaire banking buddies, right?

You know it means becoming completely dependent upon the same kinds of bureaucrats who couldn't get FEMA off its fat, inefficient office chairs after Hurricane Katrina punched New Orleans in the face, right? Knocking out most of her teeth. Have you seen the Queen of the Mississippi lately, over three years after her near death experience? You're talking about trusting your very life to a class of beings responsible for spawning the likes of Rod Blagojevitch, the grafting governor of Illinois, and Eliot Spitzer, the whorehumping governor of New York.

Sort of like begging a mountain lion to rip out your throat to keep the grizzly bear from killing you. Sort of like voting the fascists out of office and replacing them with socialists. Or kicking the big government Republican hacks out the door while holding it wide open for the big government Democrat hacks to waltz right in. Not a very high IQ play, that, swapping one set of power-lusters for another.

Don't you know yet that there's a much better option available to you? How about not being brunch for the bear or lunch for the lion? How about not being the favorite chew toy of fascists or socialists?

"The art of taxation consists in so plucking the goose as to obtain the largest possible amount of feathers with the smallest possible amount of hissing" (Colbert, 1665)

How about not being the goose for the Republican and Democrat feather pluckers? How about owning yourself? How about becoming a libertarian? But wait. That would require internal fortitude and personal integrity. And knowledge. When you find those things please call the libertarians. They'll happily welcome you.


Sunday, February 22, 2009

NHS now kicking patients out too early

The number of hospital patients being discharged only to be readmitted as emergencies just days later has soared in the last few years, figures reveal. Statistics released by the National Centre for Health Outcomes Development show hundreds of patients are being rushed back to hospital days after being assessed as fit for release. The statistics will fuel criticism of the health service for being too target driven at the expense of providing long-term care.

Roger Goss co-director of Patient Concern, said that hospital trusts were always looking for ways to cut the number of days in hospital for operations. 'Readmissions are the inevitable consequence of so-called "bed-blocking", often a euphemism for high quality care,' he said. 'At the same time, hospital acquired infection rates are so bad that patients want to get out as fast as possible. Better yet, not go in the first place.'

The data reveals that the problem of adult patients having to be brought back to hospital for emergency treatment has risen by almost 20 per cent in the past four years. The figures show that in 2002-03 around 1 in 9 patients aged 75 or over was brought back to hospital as an emergency readmission within 28 days of first being discharged. But by 2006-07 the readmission rate had risen to almost 1 in 7. For adults under 75 the rate has also increased with 8.82 per cent of patients being readmitted in 2006-07, compared with 7.39 per cent in 2002-03. Children's readmission rates have also risen - but not at the same rate - seeing the ratio rise from 1 in 12 patients to 1 in every 11. In total it is estimated that the number of people who are readmitted to hospital as an emergency within 28 days is around 400,000 people per year.

A spokesman for the Department of Health said there were often a number of reasons why patients were readmitted which had nothing to do with poor standards of treatment or care. 'It is in the nature of some conditions, that repeated emergency single admissions will occur,' he said. 'For example, for children a sequence of readmissions is often preferable to a longer stay in hospital. 'Over the last few years patients requiring simple procedures or, in the case of chronic conditions, routine treatment or observation, are increasingly being treated in local and community settings rather than being admitted to hospital.' He added this often made it difficult to interpret readmission rates.


NHS apology over 100-mile birth journey

A woman was forced to give birth more than 100 miles from where she lived because of a lack of suitable cots for premature babies, it has been revealed. Natalie Page, 20, was transferred from hospital in her home town of Leicester to Birmingham, but then from Birmingham to Liverpool where she gave birth prematurely to a daughter on Sunday.

The hospitals involved apologised to Miss Page for the situation which has left her in Liverpool while the rest of her family are in Leicester. David Yeomanson, from Leicester's Hospitals, said: "We are sorry Miss Page had to be transferred via ambulance to Birmingham to deliver her baby, but it was important that she was in the best place to receive the best care for her very premature baby. "The decision to transfer her was made by her consultant as she was about to deliver her baby 11 weeks prematurely due to a pregnancy-related complication. "Unfortunately, we did not have a suitable cot available in our neonatal unit to take her very poorly baby. "We transferred her to Birmingham where they had the specialist neonatal facility for her new baby."

He said they did not have to do it very often, but are part of a neonatal network and transfer babies to a centre able to deliver the level of care and expertise needed for a premature baby. He added: "Whilst this is unfortunate it is not a unique event and all Maternity Units would take the same action in these circumstances."

A spokeswoman for Birmingham Women's Hospital said: "We are very sorry that Natalie Page was unable to give birth in our hospital last week."


Saturday, February 21, 2009

NHS blunders set schizophrenic patient free to stab woman 21 times

Health workers caring for a paranoid schizophrenic who stabbed a woman in a supermarket 21 times have admitted a series of failings, her family revealed. Samuel Reid-Wentworth was yesterday ordered to remain at Broadmoor high security mental hospital indefinitely for his 'premeditated' and ' frenzied' attack on Lucy Yates, 20.

The news came as it emerged that Sussex Partnership NHS Foundation Trust has implemented stringent changes in its care for mentally ill patients. Senior managers admitted a series of blunders during a tense meeting with Miss Yates's parents, Hugh and Debbie. Although no staff have been sacked, bosses insisted 'lessons have been learned'.

However, Mr Yates said: 'Everyone has been let down by the mental health system, and that includes the attacker and his family. 'The trust might say things have improved, but it doesn't change what has happened. I want better answers but I'm not hopeful.'

He spoke after the frightening psychiatric problems of Reid-Wentworth, 22, were laid bare at Lewes Crown Court yesterday. Reid-Wentworth stabbed Miss Yates repeatedly in the confectionery aisle at Somerfield in Littlehampton, West Sussex, while screaming: 'I'm a ******g psycho!' He later told police: 'I'm a schizo. I did it and I'm proud of it.' And when he discovered that Miss Yates had miraculously survived, he told officers: 'S***, I should have stabbed her more. If they hadn't dragged her away I would have carried on.'

Miss Yates was highly critical of the health chiefs who discharged Reid-Wentworth. She said: 'How was he left free to roam around and stab me and all but kill me? 'I'm disgusted with the people who decided he could be at large. This is partly their fault. 'I hope they can look at me and feel bad about those decisions, then maybe it will stop this happening to someone else in future.'

After the hearing Lisa Rodrigues, the health trust's chief executive, said her staff would learn everything they could from the attack. She added: 'There are always lessons to be learned both for the trust concerned and more widely and I readily acknowledge that the independent review we commissioned after this case offers some clear pointers for care and service improvements in the future. 'We have learned lessons from this case and we will share them with other trusts.'

But warning bells should have sounded when Reid-Wentworth was admitted to the Centurion mental health unit in Chichester, West Sussex, in August 2007 after being given two cautions by police for two random attacks on young women. He told staff he wanted to drink the blood of attractive young women and had been told to kill two people by God, Jesus and MI5. But the trust decided he would be cared for in the community. After a year, he persuaded his carers that his condition had improved and he was discharged. He stabbed Miss Yates six weeks later, having planned the attack by hiding a sword in bushes and slashing a door with a knife 50 times as 'practice'. Before leaving his flat in Bognor Regis, West Sussex, he scrawled 'I'm going to become a killer, ha ha ha' on the wall. Four days before the attack, he wrote to the psychologist who had treated him telling of his plans to 'kill an attractive woman'.

The court heard how Reid-Wentworth took a bus to Littlehampton, where he selected Miss Yates at random after spotting her walking through the town. He followed her into Somerfield where he stabbed her from behind with a 9cm flick knife. When she fell to the ground, he pinned her down and repeatedly plunged the blade into her.

Miss Yates, of Pulborough, West Sussex, received severe spinal damage and a punctured liver, and both her lungs collapsed. As paramedics fought to save her in the ambulance, the sales assistant's heart and breathing stopped three times. But after eight days in intensive care, she pulled through.

Yesterday, Judge Anthony Scott-Gall described the attack as 'horrific and wholly irrational'. 'This terrible attack was premeditated in that you planned for some time to kill a woman,' he said. 'She has been blighted for her whole life. You pose a genuine risk to members of the public, in particular to young women. 'Over some years you have felt the urge and need to drink women's blood. You also have fantasies about decapitating women.'


Friday, February 20, 2009

The moral hazard problem of socialized healthcare

Ezra Klein quotes approvingly a section of Michael Pollans In Defense Of Food on the high level of diabetes in those eating a Western-style diet. In response, he almost seems to be suggesting that there's a moral hazard problem of socialized healthcare:
A diagnosis of diabetes subtract roughly twelve years from one's life and living with the condition incurs medical costs of $13,000 a year (compared with $2,500 for someone without diabetes).

This is a global pandemic in the making, but a most unusual one, because it involves no virus or bacteria, no microbe of any kind - just a way of eating. It remains to be seen whether we'll respond by changing our diet or our culture and economy. Although an estimated 80 percent of cases of type 2 diabetes could be prevented by a change of diet and exercise, it looks like the smart money is instead on the creation of a vast new diabetes industry.

I'd just add a question: How many discrete interest groups would save money from a sweeping policy initiative aimed at reducing chronic disease through nutrition, exercise, and other low-cost lifestyle changes? How many discrete interest groups would make money from a sweeping policy initiative aimed at increasing the number of insured Americans able to purchase cutting edge medical care in response to the onset of chronic disease?

The questions asked are quite instructive, and thus I wonder if he is being facetious here.

Undoubtedly Americans would be best served by changing our diets and behavioral patterns to more "sustainable" options. As a libertarian, of course, I favor doing this through the freedom rather than bans of bad foods or mandates of exercise - and certainly support anyone wealthy enough to pay for the medical treatment being willing to abuse their body as much as their bank account can pay for the damage. I'm sure Ezra's "policy initiative" is probably a mix of advertisement, tax policy, and the other sort of "libertarian paternalism" ideas championed by Cass Sunstein.

But what will happen if we do go for a "sweeping policy initiative" aimed at increasing the number of insured Americans able to purchase cutting-edge diabetes treatments? When we offer such "health bailouts", does this not result in a moral hazard where individuals can make bad, risky decisions knowing that they won't feel the full effect? This is no different from the corporate world, where CEO's can embark upon ultra-risky business strategies knowing that the cost of failure will be blunted by federal bailout. Note also that this is a feature of all third-party payment system where the individual care-user is not even charged premiums based upon their risk-profile - it doesn't matter if it's an individual mandate plus a huge push towards company-paid insurance (the Massachusetts model) or a fully socialized system (the British model). The end result will be skyrocketing costs as the individual is not strongly incentivized to avoid poor health.

America, when it comes to "healthcare systems", would be far better off breaking the employer-payment link and moving to a more free system. In this sort of a system, premiums would be somewhat tied to a risk profile (as makes sense for an insurance product), paid individually (so the individual has an incentive to adopt healthy practices), and [probably] would be more tailored to protection from high-cost services rather than pay for day-to-day health care needs. This is post-1930 America, so undoubtedly there'd be a safety net, but I'd rather see the government pay for healthcare for the indigent than for everyone - especially since the system will work better.

In fact, a free market would help bring about Ezra's goal (healthier people who eat better and exercise) while avoiding his worry (a giveaway to the big healthcare corporations subsidizing bad decisions). Maybe someone should tell him that there's an answer outside of government on this one.


NHS hospitals fail to do routine checks on suspiciously injured children

Two thirds of hospitals fail to conduct routine checks on injured children despite warnings after the death of Baby P, The Times has learnt. A poll of NHS trusts conducted by the Conservative Party suggests that staff at many accident and emergency departments are not able to check whether children are in contact with social services or subject to a child protection plan, even when they have suspicious injuries.

Doctors' failure to detect evidence of non-accidental harm and poor links between health and social services were identified last year as key failings contributing to the death of Baby P in Haringey, North London, in 2007. But few hospitals can check databases of children at risk, while one in ten clinical staff has not had child protection training, the survey suggests.

The Conservatives, who received responses from 120 out of 171 hospital trusts under the Freedom of Information Act, said that problems identified by the independent report into Baby P's death appeared to be systemic. Only one in seven hospitals claimed to be able to make any sort of online check on whether social services were involved in the care of an injured child, the Tories said. Some trusts said that it was not permitted for staff routinely to check whether children were subject to child protection plans.

Last month the Government announced the setting up of a database of 11 million juveniles in England for professionals working with children. The Tories have attacked the œ224 million ContactPoint as "another expensive data disaster waiting to happen". "A far better solution would be to make sure basic checks are maintained in A&E and that other hospitals learn from those that are doing well so that children who are really at risk are identified before it's too late," Andrew Lansley, the Shadow Health Secretary, said. "The NHS is doing its best, but many hospitals are getting incoherent messages about what to do to prevent tragedies like the Baby P case from happening again."

John Heyworth, president of the College of Emergency Medicine, said that although A&E departments could be overwhelmed because of staff shortages or a need to see patients within a government four-hour target, trusts had a "major responsibility to find out whether the child is on a protection plan or in a family that is in contact with social services". "Access to and use of databases varies widely across the country," he said. "In some areas links between A&E and social services are sub-optimal while in other areas there are next to no links at all."

Ben Bradshaw, the Health Minister, said that rules on child protection applied to all trusts, including arrangements for checking if a child was subject to a child-protection plan, and staff training. "The Conservatives are confusing the requirement to check if a child is subject to a child protection plan with accessing details of the plan itself," he added. "That is not a requirement and not something we would expect NHS staff to do."

Rosalyn Proops, child protection officer for the Royal College of Paediatrics, said that all A&E professionals should have an awareness of child protection and be able to check quickly with social services if they had concerns. However, there was a danger that routine checks on child-protection status could override clinical judgment about whether injuries were suspicious. "There has never been a system of routine checks on children coming to A&E and any such system would be at best unhelpful and at worst dangerous to the child," she said. "If children were formally screened, it could provide a false sense of security." The Healthcare Commission, the NHS watchdog, is expected to publish a review of the matter shortly.


Thursday, February 19, 2009

UK: Millions opt for DoItYourself dentistry

Millions of people in England have resorted to DIY dentistry, a survey by consumer magazine Which? suggests. The poll, of 2,631 adults, found 8% had tried to fix their own dental problems - and a similar number knew somebody who had tried. Of those who admitted trying the DIY approach, one in four had tried to pull out a tooth using pliers.

Since a new dental contract was introduced in 2006 there has been growing concern over access to care. But the government said the findings of the survey were unreliable, and said access to NHS dentistry was improving. Ministers have announced an independent review of NHS dentistry in England, which will report back later this year.

Which? will be making a submission to this review and is currently carrying out detailed research to build an accurate picture of the state of NHS dentistry. The latest survey found 12% of those who had tried DIY techniques had tried to extract a tooth by using a piece of string tied to a door handle. Some 30% of DIY dentists had tried to whiten their teeth with household cleaning products. Other DIY procedures people admitted to included:

Using household glue to stick down a filling or crown (11%)

Popping an ulcer with a pin (19%)

Trying to mend or alter dentures (8%)

Trying to stick down a loose filling with chewing gum (6%)

Which? health campaigner, Jenny Driscoll, said: "This research shows the desperate measures people will resort to. "Everyone should have access to good quality dental treatment so it's worrying to see so many people resorting to doing it themselves."

Susie Sanderson, of the British Dental Association, said: "While worries about accessing or paying for dental care can clearly be a concern, it really isn't advisable to resort to do-it-yourself care. "We hear too many horror stories about people pulling out the wrong tooth, or causing themselves to have an infection, and urge anyone considering this path to think again. It is all too easy to make the problem worse, rather than solve it. "If you are having trouble accessing NHS dental care then contact your local primary care trust."

Mike Penning, the shadow health minister, said: "It is a scandal that millions of people are resorting to pulling out their own teeth as a result of Labour's disastrous mismanagement of NHS dentistry. "These survey results are a direct consequence of the introduction of Labour's botched dental contract which has left millions without an NHS dentist."

But Barry Cockcroft, the chief dental officer for England, gave the Which? survey very short shrift. He said: "These findings come from an online multiple choice survey that has no statistical credibility. It is ludicrous to suggest that three million people are doing DIY dentistry. "DIY dentistry is dangerous and unnecessary. Thanks to our investment of over 2bn pounds in NHS dentistry, there are now lots of new NHS dental practices expanding and opening around the country."


Wednesday, February 18, 2009

'We ran out of shavers': Doctors' extraordinary excuses for axing 1,000 NHS operations a week

More than 1,000 NHS operations are being cancelled at the last minute each week because of avoidable mistakes at hospitals. Lost medical records, broken equipment and a lack of beds were among the excuses given to patients whose surgery was called off. But the survey of 110 Health Service trusts also revealed the extraordinary decisions behind some of the cancellations. One hospital claimed it was unable to prepare patients for surgery because it had run out of shavers, while another cancelled an operation because the surgeon had disappeared after a fire alarm. In another case, medics simply forgot about a patient who had been left in a side room awaiting surgery.

The Department of Health figures, revealed by a Freedom of Information request, revealed that the number of operations cancelled for non-clinical reasons in 2007/08 was 57,382 - 10 per cent higher than the year before. Experts now predict that the figures could top 64,000 for the first six months of this financial year.

Leeds Teaching Hospital was the worst trust for cancelling operations at the last moment, closely followed by Plymouth Hospitals Trust (1,346). At the Pennine Acute Trust, which runs hospitals in Oldham, Bury, Rochdale and Manchester, six procedures were cancelled because the surgeon was on holiday. At Plymouth Hospitals Trust, 197 were halted because of a lack of staff in theatre. Two were cancelled at Southampton University Hospitals Trust because of inadequate blood supplies, while at London's St George's Healthcare seven procedures were called off because patients' records had been lost. The Epsom and St Helier Trust was forced to cancel 58 operations because its sterilisation unit was out of action for a week. And at the George Eliot Trust, near Nuneaton, nine were halted because of a chemical spill, three because the surgeons had disappeared in a fire alarm and one because the surgeon refused to use the equipment provided. The Gloucestershire Trust cancelled ten operations because of an infection outbreak on a ward and another 23 because of a flood in the operating theatre. It also halted 53 procedures as a result of a broken lift. At Newham University Hospital Trust in East London, bosses admitted a lack of shavers resulted in operations being cancelled.

Roger Goss, of Patient Concern, said: 'Wasting patients' time and making a stressful experience even worse clearly doesn't matter. 'Contrast this with the complaints from doctors about patients missing appointments. 'Perhaps we should fine hospitals for cancelling operations at the last minute. We are the customers yet only the time of clinicians matters.'

Meanwhile, a report by the Healthcare Commission has revealed that the NHS is failing to respond properly to patients' complaints. Last year, 7,827 complaints were sent to the watchdog for independent review. Half were upheld or sent back to the trust because the initial response was not good enough. One in five of the complaints was about treatment or a wrong diagnosis, while the remainder mainly concerned the behaviour of NHS staff or a lack of information about their care.

Patients were most likely to complain about their GPs. One in eight were about family doctors - double the number complaining about nurses. The commission said the report showed that some trusts were still not responding to complaints effectively. Each year, the NHS delivers 380 million treatments and receives 135,000 complaints. Anna Walker, the commission's chief executive, said: 'It is concerning that complaints raised with us continue to be about the same basic aspects of healthcare, such as poor communication and failure to diagnose conditions.'


Australia: Dentists lash out at socialization plan

If you knew what socialized dentistry is like in Britain -- with people reduced to pulling out their own teeth with pliers -- you would run a mile from this. "Free" dentistry just leads to massive waiting lists -- sometimes even leading to death when serious problems are left untreated. There are in fact "free" dental hospitals in capital cities already but you can wait years to access them

Dentists have condemned a Medicare-style system for free universal dental care being considered by the Rudd Government as impractical, and massively expensive. The Denticare plan is part of the National Health and Hospitals Reform Commission's sweeping makeover in hospital and health services, including for indigenous people, the aged and young people with mental illness. Denticare would be financed by a 0.75 per cent income levy.

In its interim report released yesterday, the commission raised three options for reshaping state and federal governments' running of the health system. The proposals range from an improved version of the existing system, through to the development of a European-style social insurance scheme financed by the Commonwealth under which people could choose from health fund plans which would purchase services on their behalf. The commission is to decide which scheme it would favour in its final report to the Government expected by midyear.

The Health Minister, Nicola Roxon, said the Government was happy to have a debate about the possibility of a new tax to finance Denticare, which she described as a "fairly radical proposal . but we are interested in the community's response to this".

But Dr Neil Hewson, the president of the Australian Dental Association, representing private dentists, slammed the Denticare proposal, saying it could nearly double to $11 billion the cost of dentistry to the government and individual patients. "The recommendation . for a universal Denticare scheme is impractical, nonsensical, overly simplistic and flies in the face of much of the deliberations that have taken place on this issue over the past decade," he said. "It shows no appreciation of the real problems facing dental delivery in Australia."

The association believed the Government should target the 35 per cent of the community who could not access or afford proper dental care and said it would be fiscally irresponsible to introduce a universal scheme for dentistry.

The chief executive of the Australian Health Insurance Association, Dr Michael Armitage, said insurers would consider the dental care proposal and other recommendations and compile a response to the reform commission. "The industry would support any plan to improve access to dental care for Australians but it is about more than that - it's about quality, safety and achieving better health outcomes - not just health financing," he said.

The Opposition's health spokesman, Peter Dutton, said taxpayers would pay billions of dollars in extra taxes for a national Denticare scheme. "Almost 11 million Australians or 50 per cent of the population would pay more than they currently do to meet the costs of the Denticare scheme," he said.


Tuesday, February 17, 2009

NHS criticised in half of complaints reviewed

One in five NHS complaints sent for independent review relates to poor treatment or a wrong diagnosis.

The Healthcare Commission said that trusts were at fault or could have done more in almost half of the 8,939 complaints it investigated last year. Eleven per cent concerned treatment, 9 per cent delayed or wrong diagnosis and 8 per cent waiting or problems having treatment. Nearly half of complaints were upheld or referred back to trusts. The NHS receives about 135,000 complaints annually. It provides about 380 million treatments. In April unresolved complaints will be passed to the Parliamentary and Health Service Ombudsman, as the Healthcare Commission is replaced by the Care Quality Commission, covering health and social care.

The new system relies on more complaints being resolved locally but the Healthcare Commission said some trusts were still not responding to complaints effectively enough for the new arrangement to work.


Australian public hospitals have triple the baby deaths of private

Poor people tend to have worse health but the gap here seems too large for that to be the main factor. And the grave problems often reported with public hospital obstetric services leave little room for doubt about where the main fault lies

For every baby that dies soon after birth in an Australian private hospital, three die in the public system, alarming new figures reveal. Women who give birth in public hospitals are also more than twice as likely to suffer tearing, or that their babies will need resuscitation, according to the alarming findings of a new study. Associate Professor Steve Robson and colleagues examined the outcomes of almost 790,000 births which took place over four years, and about a third were in the nation's private hospitals.

Dr Robson said he was shocked not only by the "striking difference" between the two systems, but also by the results that contradict a common criticism of births in private hospitals. "There is often a lot of criticism in the medical press of rates of caesarean birth and rates of the induction of labour - everybody says 'Wow they're so much higher in private hospitals,"' says Dr Robson, of the Australian National University Medical School. "And if you take the literature at face value ... all of those things ought to up the complication rate, (but) it was lower. "We found that quite staggering."

Dr Robson says the study raises questions about the view that some in the medical fraternity hold that "increased rates of obstetric intervention are bad for women and their babies". "Our study suggests these things could be beneficial because the rate of babies dying is about half in the private hospital, and the rate of serious maternal injury is less than half," he said. Dr Robson said differences in the health and socio-economic status of the mothers alone could not explain the performance gap between public and private hospitals, and that further research was needed. "And it's not as though we've taken a small sample, we basically looked at every birth in the country (over four years)," he says.

The study, to be published in the Medical Journal of Australia, reported women giving birth in public hospitals had more than twice the rate of "severe perineal tearing", and their babies were more than twice as likely to require "high-level resuscitation" at birth. The neonatal death rate was one for every 1,000 babies born in private hospitals, compared to three in 1,000 in public hospitals.

The study was also undertaken by Elizabeth Sullivan and Paula Laws from the Perinatal and Reproductive Epidemiology Research Unit, at the University of NSW. Australia's rate of caesarean sections has risen from a single digit per cent in the 1980s to now account for more than 30 per cent of all births.


Monday, February 16, 2009

More medical socialism hidden in the “spendulus” bill

The writer below is one of the alternative medicine crowd but there are a lot of those and they could give the Obama crowd significant opposition. What she says about the authoritarian provisions in the new bill seems correct from any viewpoint, however

I first read Betsy McCaughey’s commentary, Ruin Your Health With the Obama Stimulus Plan a couple of days ago; and again, in not wanting to focus overmuch on federal doings (nor wanting to turn this place into a wall of rantings) I refrained from commenting. But some of the stuff coming down the road is just too outrageous to let it pass by....

Some context from McCaughey’s essay first (one link preserved below):
[N]o one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department. Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version [that is not a link to a PDF]).

The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.” Keeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far.

Yowza! But is McCaughey scare-mongering here? I clicked through to try to find the relevant sections in the bill myself—and in the process, discovered that because it’s still being hammered out, the search results are frequently updated. Thus, I can’t provide a better link than the one in the quoted text above.
Anyway, she is not engaging in hyperbole, as the bill stands now. The current form—it has already changed once since I began this post—reads as follows (formatting not retained):

(a) Establishment- There is established within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology (referred to in this section as the `Office'). The Office shall be headed by a National Coordinator who shall be appointed by the Secretary and shall report directly to the Secretary.

(b) Purpose- The National Coordinator shall perform the duties under subsection (c) in a manner consistent with the development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information and that--

(1) ensures that each patient's health information is secure and protected, in accordance with applicable law;

(2) improves health care quality, reduces medical errors, and advances the delivery of patient-centered medical care;

(3) reduces health care costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information;

(4) provides appropriate information to help guide medical decisions at the time and place of care;

(5) ensures the inclusion of meaningful public input in such development of such infrastructure;

(6) improves the coordination of care and information among hospitals, laboratories, physician offices, and other entities through an effective infrastructure for the secure and authorized exchange of health care information;

(7) improves public health activities and facilitates the early identification and rapid response to public health threats and emergencies, including bioterror events and infectious disease outbreaks;

(8) facilitates health and clinical research and health care quality;

(9) promotes early detection, prevention, and management of chronic diseases;

(10) promotes a more effective marketplace, greater competition, greater systems analysis, increased consumer choice, and improved outcomes in health care services; and

(11) improves efforts to reduce health disparities.

(c) Duties of the National Coordinator-

(1) STANDARDS- The National Coordinator shall--

(A) review and determine whether to endorse each standard, implementation specification, and certification criterion for the electronic exchange and use of health information that is recommended by the HIT Standards Committee under section 3003 for purposes of adoption under section 3004;

(B) make such determinations under subparagraph (A), and report to the Secretary such determinations, not later than 45 days after the date the recommendation is received by the Coordinator;

(C) review Federal health information technology investments to ensure that Federal health information technology programs are meeting the objectives of the strategic plan published under paragraph (3); and
(D) provide comments and advice regarding specific Federal health information technology programs, at the request of the Office of Management and Budget.

First, out of all this gobbledygook, the phrase “health disparities” leapt out at me, and I just had to laugh. Given the uniqueness of each of us—uniqueness in health as well as illness—how the f*ck do these healthocrats think they’re going to reduce disparities?

That one phrase is emblematic of the fundamental problem here: their solutions call for systematizing that which cannot be systematized. People are not interchangeable cogs; we do not respond uniformly to most things outside of some basics (such as oxygen or water; and it may be the case that our metabolic pathways may be somewhat unique even here), either in mind or in body. Medicine used to be considered part art and part science precisely for the same reason: helping someone heal requires attending to his unique situation as well as placing it (to some degree) into the broader context of accumulated knowledge.

The art has been undermined for decades, replaced by systems and institutions. And now the science is revealing its cracks, too, as it has narrowed in scope, become politicized and dogmatic, and allowed many of us to think its answers are more solid than they really are. I believe it was my spirited sister Wolfie, who commented recently that for all science’s explorations, relatively few bacteria have been identified, much less understood in the context of human health or unhealth. Yet to read news reports and science mags, one would think this stuff is all figured out. It may be to a high degree, in discrete little units of information, but those bits haven’t become integrated into bytes—there’s too little generalized understanding.

So the fedgov’s effort to herd us into neat little medical categories, and to dictate to doctors and other health care providers how we should be treated, is doomed to fail. It must, given how it’s set up.

But it will cost millions, in dollars wasted, in hours of life and energy to no real purpose, and in lives unnecessarily shortened or snuffed by the medical manufacturers. This is not hyperbole—it is already happening, all around us. Too many of us—myself included, once upon a time—have ceded responsibility for our health to so-called experts who know far less than they let on, and whose biases help keep us in their grip, instead of taking responsibility ourselves. Too many of us have fallen for the seductive promise of definitive answers via scientific methods, requiring that we “understand” how something works before we’ll deign to try it. Tell me, does knowing that a pill is a beta agonist or selective serotonin reuptake inhibitor really tell you what is going on in your body if you swallow it? It sounds like we know what’s going on, when we haven’t a f*cking clue.

I have stated publicly that I will not cooperate with any mandatory health insurance Ponzi scheme. Health insurance is not necessary to obtain health care. It is a wholly unnecessary part of the current medical institution, socializing health care and vastly inflating its cost. In keeping with my desire to keep my health under my control, I will do everything in my power to avoid any health care provider who cooperates with this vast socializing of medical care. In a world that is rapidly stripping away both privacy and dignity, I will resist.


British hospital let 80-year-old man walk home to his death - because payphone was broken

A hospital has been censured by health watchdogs for letting an elderly man walk home unsupervised to his death after a blood transfusion. Novelist Aplyn Wynn-Jones, 80, was discharged from the hospital after receiving treatment for anaemia. He was found by his daughter Alison the next day at his home in his armchair wrapped in blankets, and died within hours of organ failure and a heart attack. The Healthcare Commission said it would have been 'prudent to have allowed an overnight stay, or at the very least for him to have been collected and taken home with some help and support'.

Alison's husband Patrick Storer, who was with her when she found him, lodged a complaint against Musgrove Park Hospital, in Taunton, Somerset, over the way it had dealt with Mr Wynn-Jones on May 16 last year. Speaking from his home in Blindmoor, near Chard, in Somerset, Mr Storer, 56, assistant headteacher at the Castle School in Taunton, said: 'The hospital didn't organise transport for him; they told him to make a call on a payphone, which wasn't working. 'The walk took him more than an hour, he was forced to sit on low walls to get his breath back. He is a very fit 80-year-old, and walks four miles a day, so this should not have been difficult. 'When we arrived in the morning he was clearly dying. He was conscious, but had no strength and was stone cold. He was shivering by the fire in his study and his chest was rattling.'

Mr Wynn-Jones, a widower and grandfather who was partially deaf and partially sighted, had recently had his first novel published, The Hidden Springs, dealing with the story of Bonnie Prince Charlie.

He went to the hospital as an outpatient for a series of injections but was asked to stay for several hours while being given three pints of blood by transfusion. Unable to call a taxi on the broken hospital payphone, Mr Wynn-Jones walked the one-and-a-half miles to his Taunton home. He spoke to his son-in-law by phone that night, saying he had been sick and was going to bed. The next morning Mr and Mrs Storer found him weak and shivering with his chest rattling. He was taken back to Musgrove Park Hospital where he was pronounced dead that same afternoon.

Mr Storer said: 'My wife and I were both shocked and very upset. He was healthy just two days before. 'Once over the shock, I was just very angry for 10 months. They treated this elderly gentleman terribly. They just chucked him out of the hospital. 'The thing that pained us, that really upset us, was the thought of that walk home. They made no attempt to contact us, we could have picked him up. I'm really quite outraged

Mr Storer said: 'The hospital didn't make sure he understood the procedure and the risks involved. 'We called the emergency doctor who was so appalled by his condition he advised us to make a complaint.' The Healthcare Commission has upheld Mr Storer's complaint and has since made recommendations to Taunton and Somerset NHS Foundation Trust, which runs the hospital. It said in its report that 'the nursing care fell far below the standard expected'.

Mr Storer said he would be discussing possible legal action against the Trust with his solicitor on Monday. A Trust spokeswoman said it was dealing with the recommendations made by the commission 'urgently'. She added: 'The Trust complaints manager has written to Mr Storer. Once the investigation is complete senior medical staff from the trust will meet with Mr Storer to outline the conclusion of the report and the action plan developed as a result.'


Sunday, February 15, 2009

A Catholic view of healthcare reform

Reform of the American health care sector is urgent. The current trend of ever increasing health-care spending, superimposed upon technological advancement and an aging demographic, is unsustainable. Approximately 15 percent of Americans lack health insurance and millions are underinsured or struggling with medical bills. Employer based medical care is disintegrating. Well-intentioned leaders often advocate for `comprehensive' or `universal' reform with more government or employer involvement in health care.

Yet our government has a record found wanting in the defense of human dignity. Broad mandates threaten those whose consciences are committed to the sanctity of life. Furthermore, approximately 50 percent of medical spending is already government funded and expenses continue to escalate. Medicare faces insolvency by 2019, or earlier. United States firms struggle to compete in the global marketplace against firms not similarly responsible for medical benefits.

How ought health care be reformed?

Pope John Paul II, in the 1991 encyclical Centesimus Annus, wrote that "the Church offers her social teaching as an indispensable and ideal orientation." These principles of social justice can be considered by all those of good will as guidelines for ethical health care reform.

Catholic social teaching prioritizes the dignity of the human person, created "Imago Dei" (Gen 1:27), in the image and likeness of God. We respect human dignity by recognizing both a duty to care for the sick and personal responsibility for maintaining our own health.

Cognizant of this first principle, we must improve access, affordability and quality of care for all United States citizens. Knowing the second, we are obligated to care for ourselves and family. Patients with stronger incentives to stay healthy could decrease expenditures associated with smoking, obesity, diet-controlled diabetes, atherosclerotic heart and peripheral vessel disease, strokes, alcoholism, and osteoporosis, to name a few.

If patients participated more directly in paying for their care, medical resource consumption would diminish. Patients paying at the point of service are more prudent purchasers of health care than those perceiving health-care benefits as an entitlement. They seek to be more informed. They ask more questions about quality, outcomes, and cost. Patients directly paying insurance premiums would lead to stronger demand for better service. The affluent elderly could bear more financial responsibility.

The Second Vatican Council defined the common good as, "the sum total of social conditions which allow people, either as groups or as individuals, to reach their fulfillment more fully and more easily." This precept contemplates the allocation of scarce resources. The common good would be better served with market-oriented reforms rather than expanding government or employer based health-care. Third-party responsibility for health care promotes resource overconsumption. The $250 billion federal tax subsidy for employer based health-care could be more justly deployed. Increasing insurance industry competition would improve affordability and quality, including allowing insurance purchase from states without expensive mandates.

The principle of subsidiarity places a duty on those closest to a need to provide care: "A community of a higher order should not assume the task belonging to a community of a lower order and deprive it of its authority. It should rather support it in case of need" (Catechism of the Catholic Church). Subsidiarity encourages assistance for those unable to access the health care market. It motivates care by those closer to the sick than government or employer.

Pope Benedict XVI recently stated, "we do not need a state which regulates and controls everything, but a State which .generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need." Lower order groups such as community organizations, unions, and churches could help individuals and families purchase insurance at more competitive rates than on the individual market. Insurance obtained outside the workplace would be portable. Workers would be less susceptible to the double jeopardy of income loss and health care loss with layoff or job change. The doctor-patient relationship could be strengthened with less third-party intrusion by government, employer, or insurance carrier. Primary care physicians can assist their patients and families in cost conscious decision making, in addition to encouraging lifestyle and diet changes that can have tremendous impact on preventable or modifiable chronic disease.

Finally, the principle of solidarity concerns responsibility to the less fortunate. Health care reform will be judged by our commitment to the poor and vulnerable. We ought to love our neighbor, feed the poor, cloth the naked, and care for the sick (Mt 25:40). Vouchers or tax credits could facilitate access to the medical marketplace. A safety net for immigrants, the marginalized, and those with chronic disease, is necessary for those who might have still have difficulty obtaining insurance despite market-oriented reform.

Those advocating greater government control of health care ought to reflect on Pope Benedict XVI's 2005 encyclical Deus Caritas Est: "Love-caritas-will always prove necessary. the State which would provide everything, absorbing everything into itself, would ultimately become a mere bureaucracy incapable of guaranteeing the very thing which the suffering person-every person-needs: namely, loving personal concern." These social justice principles provide a foundation for a virtuous and economically sound improvement in medical resource allocation: a Christian prescription for health-care reform.


Saturday, February 14, 2009

In digitizing healthcare, patient privacy the battleground

The naifs below have totally missed the real problem: It won't work. The British have been trying to set up a similar computerized system for years but still have not got it to work properly.

The economic stimulus bill before Congress is certain to include billions of dollars to bring electronic record keeping to the healthcare industry, moving patients' records and doctors' prescriptions out of the era of carbon-paper triplicates and undecipherable handwriting. It's an efficiency that's expected to bring down healthcare costs and add jobs. But it's also a way for researchers and others working to improve overall healthcare outcomes to gain access to millions of patients' medical records – and therein lies the rub.

Lawmakers in the House and Senate are currently waging a battle over how to ensure that a patient's very private medical history is protected, even as they allot the money for an information technology (IT) system that makes widespread sharing of that history easier. "The two overarching goals … are to improve the privacy and security of health information, and at the same time, improve research using such information," says Bernard Lo, professor of medical ethics at the University of California at San Francisco at a press conference last week on the current medical privacy law.

For President Obama, the need to spend at least $20 billion over two years for an IT upgrade at clinics and hospitals is clear. "We're still using paper. We're still filing things in triplicate. Nurses can't read prescriptions that doctors have written out," he said Tuesday during a prime-time televised press conference. "Why wouldn't we want to put that on an electronic medical record that will reduce error rates, reduce our long-term costs of healthcare, and create jobs right now?"

Few in the healthcare industry would defend the status quo. In 2001, the Institutes of Medicine called for all healthcare records to be electronic by 2010. Today, only 14 percent of medical practices use electronic health records. The reasons are many: ranging from the high cost of computerizing thousands of offices to the need for staff training to the lack of standards that allow a computer in one office to talk to main frames in another. "Health IT is an important enabler to having a better health care system, but in and of itself it will do very little," says Gail Wilensky, a senior fellow at Project Hope, an international health education foundation. "We also have to be ready to take on some of the very difficult issues with regard to standards, terminology, and ... inter-operability."

The battle in Congress is over what kind of rules should guide that change – especially over ensuring privacy while striving for efficiency. A patient's medical history is vital to a healthcare provider's ability to provide high quality, efficient care. But privacy advocates contend that individuals should be able to control who can see their medical record and when. There is concern the information could be used by insurance companies or employers to discriminate, or that companies would mine the medical data for profit.

The need for patient confidentiality could conflict with the effort to improve overall outcomes. To understand which medical interventions work best, researchers need access to large databases that include the outcomes of particular treatments for various diagnoses. "The key depends in the long run on who owns and controls the patient record," says Marc Roberts, a professor of political economy and health policy at Harvard's School of Public Health. "Many healthcare systems are now intentionally building medical record systems that are nonstandardized and noncompatible so they can own and control the data." ....

More here

Australia: Private hospital emergency rooms soon to be covered by health insurance

Medical insurance in Australia normally covers hospitalization only -- with some ancillary benefits

THE nation's largest health insurer is planning to operate its own private emergency care centres, ending the up to 10-hour waits patients face for treatment in a public hospital, Medibank Private, which insures three million Australians, wants to set up the emergency centres staffed by specialised emergency doctors to serve its own members as well as other members of the public. Health insurers currently don't provide rebates for treatment in the 30 private hospital emergency centres operating around the country. And patients who use these private services often face bills of $200-$300. The situation has left health fund members with minor ailments such as broken bones with no option but to use a public hospital.

Medibank Private chief George Saviddes told The Daily Telegraph his fund was considering importing a system used in Ireland where private clinics have been set up to deal with the minor sprains, bone breaks and cuts that make up 80 per cent of public emergency work. All patients could use the centres but Medibank Private members would get most of their costs, estimated to average about $400 per patient, covered by their health fund. The fund is also looking at whether private hospitals would want to tender to provide the services.

The nation's choked public hospital emergency departments treated 6.7 million patients in 2007 but about 35 per cent of urgent and semi-urgent patients had to wait longer than recommended for care. It is estimated 40 per cent of emergency department beds are taken up by patients waiting for a bed in a hospital ward. The privately run and privately subsidised emergency care centres would help relieve some of the pressure on public hospitals.

Medibank will also later this year extend to NSW a program offering a free midwife to new mothers for the first month after the baby's birth. Health funds are also questioning why they cannot buy generic brands of hip and knee replacements that could help cut the cost of surgery for their members. These joints will cost one third less than newer branded prostheses and result in less complications and follow-up surgery.


Friday, February 13, 2009

Authoritarian British medicine being evaded

Women should be allowed to have some say in their own risks but in Britain you are just expected to obey commands from on high. The vast majority of IVF births are fine with or without Britain's draconian restrictions

CHILDLESS British women who travel abroad to have up to four embryos implanted in their wombs have been given an official warning about the health risks. The "embryo tourists" are going overseas to circumvent rules on multiple IVF births. Some women return expecting triplets or quadruplets.

Professor Lisa Jardine, who chairs the Human Fertilisation and Embryology Authority (HFEA), says women are damaging their health and exposing their babies to harm. The authority says the women are also burdening the NHS by becoming pregnant with more than one baby. The watchdog is now investigating how to tackle the practice. Jardine said: "It is our job to make sure that this deeply felt need [for a child] does not result in people putting their health at risk. "People who seek treatment outside the UK often do so because they believe this will allow them to make choices about their treatment which are not available in the UK. These might include selecting the sex of their baby for nonmedical reasons, or having a higher number of embryos transferred, in spite of the widely recognised risks associated with multiple pregnancy. "My deep concern is that, in the belief that they are widening their choices, such people are also removing themselves from the help and protection that responsible regulation provides [That's a laugh1]. We are looking closely at whether there is more we could do to protect and inform those who choose to travel abroad for fertility treatment."

In the past few weeks, one woman has returned to Britain with quadruplets after fertility treatment in Israel, while last year a woman who returned to Leeds with triplets after fertility treatment in India lost all three babies.

Professor Alan Cameron, past president of the British Maternal Fetal Medicine Society and a consultant obstetrician at the Queen Mother's hospital in Glasgow, said: "I see the impact of this almost weekly. My colleagues in the neonatal units are going to hate me when I make that call to say we have triplets who look like they are going to appear early, and that has an impact on neonatal units and neonatal costs."

In Britain, a maximum of two embryos can be transferred to a woman below the age of 40. Women aged above 40 are allowed three embryos. The HFEA has, however, introduced quotas on the percentage of multiple births permitted at each clinic to make single embryo transfer the norm. From last month, only 24% of births at each clinic are permitted to be multiple births including twins, triplets and quadruplets. The percentage must drop to 10% in three years' time.

Adam Balen, professor of reproductive medicine and surgery at Leeds general infirmary, said: "[Multiple births] result in women coming into hospital, sometimes for many weeks on end because of threatened premature labour." Balen, who is also a spokesman for the Royal College of Obstetricians and Gynaecologists, said: "The reality of a premature delivery is babies born who need neonatal intensive care and run the risk of either sadly dying or being left with a significant handicap such as cerebral palsy."

The Medical Board of California is investigating the fertility treatment given to Nadya Suleman who gave birth to octuplets last month. Suleman, 33, who has six other children through fertility treatment, had six embryos transferred at a clinic in California. Two of them split to create the octuplets. American Society for Reproductive Medicine guidelines say only one or two embryos should be implanted in a women of Suleman's age. The octuplets, although apparently healthy, were born nine weeks prematurely by caesarian section and are expected to remain in hospital for several more weeks.

Mandy Allwood, the British mother who became pregnant with octuplets in 1996 after taking fertility drugs without medical supervision, lost all eight babies. Allwood, who has since attempted to take her own life, has spoken of her mixed emotions at the safe birth of the American octuplets.


Thursday, February 12, 2009

'Too Old' for Hip Surgery

As the USA inches towards nationalized health care, important lessons from north of the border.

President Obama and Congressional Democrats are inching the U.S. toward government-run health insurance. Last week's expansion of Schip -- the State Children's Health Insurance Program -- is a first step. Before proceeding further, here's a suggestion: Look at Canada's experience. Health-care resources are not unlimited in any country, even rich ones like Canada and the U.S., and must be rationed either by price or time.

When individuals bear no direct responsibility for paying for their care, as in Canada, that care is rationed by waiting. Canadians often wait months or even years for necessary care. For some, the status quo has become so dire that they have turned to the courts for recourse. Several cases currently before provincial courts provide studies in what Americans could expect from government-run health insurance.

In Ontario, Lindsay McCreith was suffering from headaches and seizures yet faced a four and a half month wait for an MRI scan in January of 2006. Deciding that the wait was untenable, Mr. McCreith did what a lot of Canadians do: He went south, and paid for an MRI scan across the border in Buffalo. The MRI revealed a malignant brain tumor.

Ontario's government system still refused to provide timely treatment, offering instead a months-long wait for surgery. In the end, Mr. McCreith returned to Buffalo and paid for surgery that may have saved his life. He's challenging Ontario's government-run monopoly health-insurance system, claiming it violates the right to life and security of the person guaranteed by the Canadian Charter of Rights and Freedoms.

Shona Holmes, another Ontario court challenger, endured a similarly harrowing struggle. In March of 2005, Ms. Holmes began losing her vision and experienced headaches, anxiety attacks, extreme fatigue and weight gain. Despite an MRI scan showing a brain tumor, Ms. Holmes was told she would have to wait months to see a specialist. In June, her vision deteriorating rapidly, Ms. Holmes went to the Mayo Clinic in Arizona, where she found that immediate surgery was required to prevent permanent vision loss and potentially death. Again, the government system in Ontario required more appointments and more tests along with more wait times. Ms. Holmes returned to the Mayo Clinic and paid for her surgery.

On the other side of the country in Alberta, Bill Murray waited in pain for more than a year to see a specialist for his arthritic hip. The specialist recommended a "Birmingham" hip resurfacing surgery (a state-of-the-art procedure that gives better results than basic hip replacement) as the best medical option. But government bureaucrats determined that Mr. Murray, who was 57, was "too old" to enjoy the benefits of this procedure and said no. In the end, he was also denied the opportunity to pay for the procedure himself in Alberta. He's heading to court claiming a violation of Charter rights as well.

These constitutional challenges, along with one launched in British Columbia last month, share a common goal: to win Canadians the freedom to spend their own money to protect themselves from the inadequacies of the government health-insurance system.

The cases find their footing in a landmark ruling on Quebec health insurance in 2005. The Supreme Court of Canada found that Canadians suffer physically and psychologically while waiting for treatment in the public health-care system, and that the government monopoly on essential health services imposes a risk of death and irreparable harm. The Supreme Court ruled that Quebec's prohibition on private health insurance violates citizen rights as guaranteed by that province's Charter of Human Rights and Freedoms.

The experiences of these Canadians -- along with the untold stories of the 750,794 citizens waiting a median of 17.3 weeks from mandatory general-practitioner referrals to treatment in 2008 -- show how miserable things can get when government is put in charge of managing health insurance.

In the wake of the 2005 ruling, Canada's federal and provincial governments have tried unsuccessfully to fix the long wait times by introducing selective benchmarks and guarantees along with large increases in funding. The benchmarks and the guarantees aren't ambitious: four to eight weeks for radiation therapy; 16 to 26 weeks for cataract surgery; 26 weeks for hip and knee replacements and lower-urgency cardiac bypass surgery.

Canada's system comes at the cost of pain and suffering for patients who find themselves stuck on waiting lists with nowhere to go. Americans can only hope that Barack Obama heeds the lessons that can be learned from Canadian hardships.


Wednesday, February 11, 2009

Rough NHS dentists kill little girl

Careless and arrogant treatment all along the line here. You are just cattle to government employees

An eight-year-old girl starved to death after developing an extreme phobia of dentists and refusing to open her mouth, an inquest has been told. Sophie Waller, from Cornwall, England, was so traumatised by a visit to the dentist that she refused to open her mouth to talk or eat.

Sophie’s extraordinary fear first developed when, at age four, a dentist accidentally cut her tongue during a check-up. Her fear became so extreme that when she needed a tooth removed four years later, she was taken to hospital. But doctors made the situation even worse by removing eight of her milk teeth. She was so traumatised by that procedure she had to be fed through a tube.

“She had blood running all down her face... It was very scary for her," her mother Janet told The Daily Mail. "She soon needed a feeding tube because she stopped eating and drinking.” “I signed a form to consent to have one tooth being removed, but not eight."

Despite her refusal to eat, Sophie was discharged from hospital. Her parent’s pleas for her to be readmitted reportedly fell on deaf ears. Doctors referred her to child psychologist Kerry Davison, who allegedly told them “not to worry”. Two weeks after leaving the hospital Sophie weighed less than 25kg. She died of acute kidney failure in December 2005, a post mortem examination revealed.


Tuesday, February 10, 2009

NHS boss Lynda Hamlyn angry at organs for foreigners

Special treatment for the rich -- exactly what the NHS was founded to eliminate

A LEADING National Health Service hospital has come under attack from the government's transplant authority for giving livers from dead Britons to overseas European Union patients in private operations. More than 40 procedures using organs from British donors have been carried out on foreigners at King's College hospital, London, over two years. According to NHS Blood and Transplant (NHSBT), the trade undermines Gordon Brown's œ4.5m attempt to increase organ donations and creates an "obvious potential conflict of interest". It accused King's of "a persistent lack of clarity" over the trade. The criticisms appear in correspondence released to The Sunday Times under the Freedom of Information Act.

Lynda Hamlyn, chief executive of NHSBT, wrote in one letter to the hospital: "This is the third specific issue of concern raised by UK Transplant [part of NHSBT] over the past four years about the transplantation of livers from deceased UK donors into nonUK residents undertaken on a private basis at King's. "People joining the organ donor register and families giving consent for organ donation need to be completely confident that UK residents . . . are treated fairly."

In one week following publication in The Sunday Times last month of figures on private transplants given to foreigners at King's, 22 people withdrew their names from the organ donor register in protest. Tim Smart, chief executive, denied King's College Hospital NHS Foundation Trust had failed to give clarity. He said EU patients had the same legal entitlement as British patients to receive donated organs.


Australia: Queensland public hospital system employed a doctor who was 'unemployable in US'

There were obviously zero checks made on his application. Queensland Health is such a noxious bureaucracy to work for that they will take anyone willing to work for them. The Queensland "free" hospital system was established in 1944 so it shows where such a bureaucracy ends up. It is a slowly metastasizing social cancer -- now with three bureaucrats for every clinical employee

Surgeon Jayant Patel was virtually unemployable in the US and lied to gain employment in Australia where he now faces criminal charges. The Magistrates Court in Brisbane heard Patel had a long history of disciplinary hearings in New York and Oregon before he was recruited as the director of surgery at Bundaberg Base Hospital. Patel, 58, who worked at the hospital between 2003 and 2005, is facing a committal hearing on 14 charges including the manslaughter of James Phillips, Mervyn Morris and Gerardus Kemps. He also faces fraud and grevious bodily harm charges.

Prosecutor Ross Martin SC recounted a history of disciplinary actions taken by American medical bodies against Patel dating back to 1984. The actions included a stayed suspension of his licence to practise and restrictions on his ability to perform certain surgery. Mr Martin said by 2001 Patel also needed to get second opinions on difficult surgery.

He said Patel had resigned from a major hospital in the American state of Oregon in September, 2001. Mr Martin said authorties in New York also reviewed Patel's status and he eventually surrendered his licence to perform surgery in New York. Patel applied for a job in a small town named Harney, Oregon, which had a hospital with just 25 beds. Patel failed to get the job.

Mr Martin then detailed how Patel was put in contact with Queensland Health authorities through a recruiting company. It was alleged Patel failed to tell the truth about his hisory in the US when gaining the necessary clearance to work in Australia. Mr Martin said it was further alleged Patel lied again when his registration in Australia was extended until he left in March 2005.

In the case of the manslaugher charge involving Mr Phillips, it was alleged Patel had not consulted a speciaist, Patel was restricted in the US on performing that type of operation, the operation was un-necessary and it was badly performed. Mr Martin said in the second manslaughter charge of Mr Morrs, Patel performed surgery when he was under USA restrictions, there had been an incorrect diagnosis, it was the wrong procedure, and there were mistakes in post operative procedures. Patel had also performed the wrong operation in the third manslaughter charge involving Mr Keeps, it was again under USA restrictions, and it had been inappropriate to perform the operation in the Bundaberg Hospital.

Mr Martin said one of the two operations on Mr Keeps had been performed in a negligent manner as Patel had not acted to stop internal bleeding. The court heard Patel had removed the bowel of a patient Ian Volwles when there was no need for the operation. Mr Martin said Patel had treated Mr Vowles for cancer but a later biopsy showed no signs of cancer. Patel faces a charge of grevious bodily harm for his operation on Mr Vowles.