Monday, August 31, 2009

The nightmare nurses of the NHS

By Minette Marrin

‘Dreadful, neglectful, demeaning, painful and sometimes downright cruel.” Those are the words used by Claire Rayner, herself a former nurse, to describe the way many nurses today treat elderly patients. Introducing a report by the Patients Association last week, she described shocking standards of nursing care in hospitals up and down the country.

The stories are horrifying — old people neglected, lying in their own faeces and urine, hungry, thirsty and afraid, while nurses chat callously at the nursing station, indifferent to the suffering around them.

Since the report was published the Patients Association has been flooded with hundreds of calls of support. “I am sickened,” Rayner said, “by what has happened to some parts of my profession, of which I was so proud.” One can only agree.

What is also particularly sickening is that none of this is remotely new. It has been a long time since anybody with any knowledge of National Health Service nurses could be that proud of them. For many years past, a significant number of them have been every bit as bad as this report now claims. I apologise, of course, to all those excellent nurses whose good name has been compromised by the bad and cruel nurses and also by those nurses who, although not bad, are badly trained and incompetent.

Recently I spent a lot of time over three weeks on a busy ward at the Gloucestershire Royal hospital, with several very sick old people, and the nursing care could not possibly have been better — highly professional, attentive and good-humoured and above all extremely kind. It can be done.

But there is no shortage of nightmare nurses. I know from many personal visits to hospitals over 20 years, and from many hundreds of heartbreaking readers’ letters over 15 years, that NHS nursing horror stories are legion. Whenever I’ve written an article about them, I get in response a collection of anecdotes that would disgrace a Third World country. And, as the Patients Association report points out, most of these stories are about old people. It is so late in the day for the country to sit up and take notice. Why has everyone been so determinedly deaf to the obvious truth?

Nearly 12 years ago I wrote an article for another newspaper headlined “The devil nurses of the health services”. I hated the sensational headline but it does make the point inescapably clearly that Britain’s quasi-religious belief that the NHS is the envy of the world and its nurses are angels was — and is — far from true.

Nurses’ personal standards would have horrified Florence Nightingale. It struck me forcibly how slovenly many nurses were, with loose hair trailing and hanging over patients’ wounds, with unkempt nails and hands all too rarely washed between patients. Many were just mean: they ignored and patronised the patients.

“They bring them to the operating table unwashed, leave them frightened and unfed, distressed by loud music, overflowing catheter bags and bed sores, by dirty sheets and filthy lavatories with blood in the sinks and excrement on the floor,” I wrote. “These are horrors caused not by shortage of money, but by personal laziness, indifference, lack of self-discipline or of any discipline at all.” And so on. There was total silence from the Royal College of Nursing and the General Nursing Council. Yet not only patients but also many nurses and doctors wrote to me in agreement, describing even worse things. So why didn’t nurses and doctors protest?

When Professor Lord Winston publicly complained about the terrible mistreatment of his elderly mother in hospital in 2000, I thought how late in the day it was for a distinguished and powerful doctor to bring this up. Surely he cannot have been the first consultant to notice the disgusting wards and vile treatment in many hospitals? Surely countless other top consultants knew about this scandalous state of affairs (or should have done), and should have brought it up?

Given the abysmal standards of nursing hygiene on many hospital wards, it is hardly surprising that we have had a growing number of scandals which no one can ignore. Poor basic hygiene was a factor in the recent disaster at the Mid Staffordshire NHS Foundation Trust hospital where at least 400 patients died needlessly; the official report of 2007 blamed “shocking and appalling” standards of care. But two years on, it emerged earlier this year that 10 NHS health trusts have even worse death rates than Mid Staffordshire had. As a spokesman for the Patients Association said at the time: “We are amazed that trusts could have these high mortality rates and yet not automatically face any action.” Quite.

To be fair, one ought to query the Patients Association’s figures in its new report. It says that its horror stories affect about 2% of patients which, it calculates, would mean 1m patients. But the total number of patients admitted to hospital each year is about 10m and 2% of 10m is 200,000. However, even 200,000 is far, far too many and I personally feel convinced that the real number — if people weren’t too terrified or exhausted or dead to complain — would be very much higher.

There are people far more knowledgeable than me, right across the health service, who know all about it, although not many of them seem to think clearly about what has caused this terrible cultural collapse in nursing. It is for them to speak out.

One of the problems is that the NHS is a monopoly — any patient knows there is nowhere else to be treated and any nurse or doctor brave enough to blow the whistle runs the risk of never working in medicine again; there is no alternative to the state medical monolith. Perversely, it is only for whistle-blowing that NHS staff are punished or dismissed; otherwise there seem to be no sanctions for bad practice. The unions have seen to that.

Another institutionalised error is the politically correct folly behind Nursing 2000, the so-called reform of nursing. In an attempt to give nurses professional status with a university degree, Nursing 2000 has all too often undermined their existing high standards of professionalism by taking students off the wards and belittling the status of old-fashioned bedside nursing care.

Yet another problem may, sadly, be a widespread fear and dislike of old people as a constant and unwelcome memento mori. But whatever the explanation, this bad and cruel nursing is completely unacceptable. Is there no one bold enough to do something?


NHS: Novices do nurses’ job after week’s training

HEALTHCARE assistants in the National Health Service with as little as one week’s training are performing technical nursing tasks on patients, including heart tests, blood checks and changing dripfeeding bags. The service is also relying on unqualified nursing staff to carry out basic duties such as washing patients and taking them to the toilet.

Despite being responsible for such intimate treatment, the 150,000 healthcare assistants and nursing auxiliaries working in the NHS are not registered with any professional body. The unregulated staff have been brought into hospitals partly to cut costs. However, criticism has also been levelled at ambitious nurses who perceive more menial tasks to be “beneath them”.

Peter Carter, general secretary of the Royal College of Nursing, said that supermarket shelf-stackers receive more instruction than healthcare assistants. Now he is demanding a substantial minimum training period, as well as the introduction of a code of conduct. “Hospitals take well-meaning people off the street, give them a uniform and put them on a ward,” said Carter. “Supermarkets give all of their staff training. They wouldn’t dream of taking someone on, not even someone stacking the shelves, by just saying ‘find your way around’.”

One healthcare assistant, who received only a week’s training before starting work at an Essex hospital, told The Sunday Times how unqualified nurses are being relied on to wash and feed patients. They are also used to adjust the amount of food that patients receive through a nasal tube and can even be asked to carry out echocardiograms (ECGs), which test the function of the heart.

The whistleblower, who did not want to be named, said she often felt inadequately trained for the tasks she performs. “You only get about a week’s training and that is to train you how to take blood pressure and to take blood sugar levels,” she said. “You are shown how to wash patients, how to manually handle the patients and how to use a hoist. “There are things I come up against that I am very unsure of. I did not get trained in how to carry out ECGs. “We are supposed to put the patients onto the ECG machine and get a [heart] tracing. The other day I was asked to do one and I wasn’t up to doing it because I haven’t been trained. I didn’t want to do it wrong.”

Last week the Patients Association published a report detailing the lack of basic nursing care received by NHS patients. It revealed how patients were often being left in soiled bedclothes, deprived of sufficient food and drink and having repeated falls.

Katherine Murphy, director of the association, said it had received calls from healthcare assistants and auxiliaries complaining that they are being left to carry out duties they are not qualified to perform. “Healthcare assistants are being asked to do a lot of the work that trained nurses should be doing,” she said. “We had healthcare assistants phoning us up who were put on a high-dependency unit with no introduction to the technology and no understanding of what they were meant to do.”

Unison, the public services union, claims the training of healthcare assistants and nursing auxiliaries is “patchy”. Many opt to complete national vocational qualifications, but this is not obligatory.

The union is concerned that nurses and healthcare assistants do not have standard uniforms across the NHS, leading to confusion among patients about whether or not they are being cared for by a qualified professional. One nurse, writing on the Nursing Times website, said that even she has found it difficult to distinguish between qualified and unqualified nurses. The nurse wrote: “I may be being cynical, but the reason why employers are going to resist this is so that they can continue to confuse patients and relatives about the true staffing levels on wards. “Even though I am a nurse, when I have visited relatives in hospital I have found it extremely difficult to identify the qualified from the unqualified staff.”

The healthcare assistant who spoke to The Sunday Times said qualified nurses fill out paperwork while healthcare assistants wash and feed patients. She explained that on one occasion, when a qualified nurse had been assisting with the washing of patients, she was called away to sign paperwork by another nurse who said: “Washing isn’t your job, that is not part of your job description.”

Claire Rayner, president of the Patients Association and a former nurse and newspaper agony aunt, admitted that such views were widely held by nurses. “It is an appalling attitude to say it is not your job to wash patients. I am afraid this is spreading widely and I disapprove of it strongly. Unfortunately, today’s nurses think it is too menial,” Rayner said.

Frank Field, the former Labour welfare reform minister, said: “It is a terrible indictment if the most qualified nurses on the ward are filling in the paperwork and the least qualified are doing the nursing. “Cleaning people is an essential nursing function. At the same time nurses are talking to the patients and finding out what the patients’ worries are.”

On his blog, Field recalls how he had resorted to feeding the patient in the bed next to his mother, who had had a stroke, because nurses had failed to help her. He wrote: “The woman was paralysed and unable to reach her food. It was regularly placed there at meal times and then simply taken away uneaten. The nurses commented how kind it was of me to feed the old lady. “I didn’t have the courage to tell them that it was their job; and that they had stood in a group gossiping, watching what I was doing. I was fearful that they would take it out on my mother if I did so.”

Department of Health spokesperson said: "The NHS is in a very healthy position regarding recruitment and retention, with supply broadly matching demand in most areas. Since 2007 we have seen a rise of 8,563 more qualified nurses. "Local NHS organisations need to plan and develop their workforce to deliver the right staff with the right skills to meet the needs of their local populations and ensure high quality care for patients." [Meaningless codswallop1]


What’s the Canadian word for ‘lousy care’?

By Jeremy Clarkson, writing from England. He thinks CanadaCare is even worse than the NHS. He regularly uses humorous exaggeration to enliven his writing but there is no mistaking his serious points. He is probably Britain's most popular TV personality

Some say America should follow Canada’s lead, where private care is effectively banned. But having experienced their procedures while on holiday in Quebec, I really don’t think that’s a good idea at all.

A friend’s 13-year-old son tripped while climbing off a speedboat and ripped his leg open. Things started well. The ambulance arrived promptly, the wound was bandaged and off he went in a big, exciting van.

Now, we are all used to a bit of a wait at the hospital. God knows, I’ve spent enough time in accident and emergency at Oxford’s John Radcliffe over the years, sitting with my sobbing children in a room full of people with swords in their eyes and their feet on back to front. But nothing can prepare you for the yawning chasm of time that passes in Canada before the healthcare system actually does any healthcare.

It didn’t seem desperately busy. One woman had lost her face somehow — probably a bear attack — and one kid appeared to have taken rather too much ecstasy, but there were no more than a dozen people in the waiting room. And no one was gouting arterial blood all over the walls.

After a couple of hours, I asked the receptionist how long it might be before a doctor came. In a Wal-Mart, it’s quite quaint to be served by a fat, gum-chewing teenager who claims not to understand what you’re saying, but in a hospital it’s annoying. Resisting the temptation to explain that the Marquis de Montcalm lost and that it’s time to get over it, I went back to the boy’s cubicle, which he was sharing with a young Muslim couple.

A doctor came in and said to them: “You’ve had a miscarriage,” and then turned to go. Understandably, the poor girl was very upset and asked if the doctor was sure. “Look, we’ve done a scan and there’s nothing in there,” she said, in perhaps the worst example of a bedside manner I’ve ever seen.

“Is anyone coming to look at my son?” asked my friend politely. “Quoi?” said the haughty doctor, who had suddenly forgotten how to speak English. “Je ne comprends pas.” And with that, she was gone.

At midnight, a young man who had been brought up on a diet of American music, American movies and very obviously American food, arrived to say, in French, that the doctors were changing shift and a new one would be along as soon as possible.

By then, it was one in the morning and my legs were becoming weary. This is because the hospital had no chairs for relatives and friends. It’s not a lack of funds, plainly. Because they had enough money to paint a yellow line on the road nine yards from the front door, beyond which you were able to smoke.

And they also had the cash to employ an army of people to slam the door in your face if you poked your head into the inner sanctum to ask how much longer the wait might be. Sixteen hours is apparently the norm. Unless you want a scan. Then it’s 22 months.

At about 1.30am a doctor arrived. Boy, he was a piece of work. He couldn’t have been more rude if I’d been General Wolfe. He removed the bandages like they were the packaging on a disposable razor, looked at the wound, which was horrific, and said to my friend: “Is it cash or credit card?”

This seemed odd in a country with no private care, but it turns out they charge non-Canadians precisely what they would charge the government if the patient were CĂ©line Dion. The bill was C$300 (about £170).

The doctor vanished, but he hadn’t bothered to reapply the boy’s bandages, which meant the little lad was left with nothing to look at except his own thigh bone. An hour later, the painkillers arrived.

What the doctor was doing in between was going to a desk and sitting down. I watched him do it. He would go into a cubicle, be rude, cause the patient a bit of pain and then sit down again on the hospital’s only chair.

Seven hours after the accident, in a country widely touted to be the safest and best in the world, he applied 16 stitches that couldn’t have been less neat if he’d done them on a battlefield, with twigs. And then the anaesthetist arrived to wake the boy up. In French. This didn’t work, so she went away to sit on the doctor’s chair because he was in another cubicle bring rude and causing pain to someone else.

Now, I appreciate that any doctor who ends up working the night shift at a provincial hospital in Nowheresville is unlikely to be at the top of his game, and you can’t judge a country’s healthcare on his piss-poor performance. And nor should all of Canada be judged on Quebec, which is full of idealistic, language-Nazi lunatics.

But I can say this. If private treatment had been allowed, my friend would have paid for it. He would have received better service and in doing so, allowed Dr Useless to get to the woman with no face or ecstasy boy more quickly. Though I suspect he would have used our absence to spend more time sitting down.

The other thing I can say is that Britain’s National Health Service is a monster that we can barely afford. But in all the times I’ve ever used the big, flawed giant, no one has ever pretended to be French, no one has spent more time swiping my credit card than ordering painkillers and there are many chairs.


Australia: More public hospital negligence -- woman dies

Her dangerous condition was known but nobody cared

DAVID Cuthbertson cannot find the words to explain to his three-year-old daughter Alyssa why her mother was never able to hold her, and never will. In June 2006, having given birth by caesarean section at Nepean Hospital, Petah Kimm's blood pressure dropped suddenly. Staff failed to recognise the danger. Two hours later, at age 39, she was found dead in her hospital bed.

On Wednesday, Mr Cuthbertson will front an inquest in Sydney. ''I want this inquest to bring about change so nobody ever has to go through this again," he told The Sun-Herald. "I will not let the NSW Government sweep this under the carpet. I want them to own up."

Mr Cuthbertson and Ms Kimm were single parents when they met on the sidelines at Little Athletics near their home town of Mudgee in 2003. They became friends and gradually fell in love, creating a blended family with his son Luke and her children Steven and Nicole. "Initially I was against the idea of children because it involved IVF. But then one day I looked on as Petah nursed my brother's baby. The moment I saw the look on her face I melted. We pushed ahead with the IVF. She conceived straight away."

Alyssa was born without complication before Ms Kimm's blood pressure fell. A student midwife failed to inform senior medical staff. A Sydney West Area Health Service internal report later found that, during a changeover in nursing shifts, nobody flagged her as unwell. "Two hours passed before anyone on the next shift bothered to look. That was when Petah was found lying in bed dead," Mr Cuthbertson said.

"I've suffered with guilt. I was at the hospital until 9.30pm that night and then I went home thinking Petah was just tired. Had I stayed, maybe I could have changed this."

Last month, nurses at Nepean Hospital learnt 155 positions were being axed, including senior staff from the post-natal ward in which Ms Kimm died.

Fighting back tears, Mr Cuthbertson said: "Alyssa says 'goodnight mummy' and 'I love you' before going to bed each night." He said recently, after a family friend arrived ahead of them at their house, "I said to Alyssa, 'Guess who's going to be at our place when we get home?' She replied: 'Did you go to heaven and get mummy?' I hope one day she will understand.''

NSW Health made an out of court settlement but Mr Cuthbertson called their treatment of him during that process ''disgusting''. ''Petah and Alyssa should have been here today, playing in the park together. I want justice for them both."


Shattered Lives: 100 Victims of Government Health Care: Soon-to-Be Released Book Tells Dark Side of Public Health Care

A timely new book, Shattered Lives: 100 Victims of Government Health Care, abolishes the myths of public health care by telling the personal, real-life stories of 100 people who live in nations with government-run health care systems. Due to the topic's timeliness, an electronic (PDF) pre-release version of the complete book is being made available now for download to journalists, broadcast media, columnists, bloggers and the public at

Authors Amy Ridenour, president of the National Center for Public Policy Research, and Ryan Balis, a National Center policy analyst, tell 100 agonizing, real-life stories of victims in Great Britain, Canada, Australia, New Zealand, Sweden and elsewhere who struggled to access government health services and sometimes died stuck on long government waiting lists. "Some 16 years after Washington last attempted to nationalize health care, some politicians in Washington are at it again," said co-author Amy Ridenour. "But if Americans choose to adopt a public health care system, as the stories in this book attest, they will soon regret the decision."

Shattered Lives puts a face on frustrated citizens fed up with having surgeries repeatedly cancelled, medicines ruthlessly denied and patients herded like animals onto gigantic government waiting lists. In Shattered Lives, the grim reality of what proponents falsely bill as 'free health care for all' is told through the stories of actual victims of government health care programs.

Stories include:

* Lindsay McCreith, a 66-year old Canadian, crossed the border to a Buffalo hospital for diagnosis when he was told it would take over four months for the Canadian system to do an MRI brain scan to determine if the tumor was malignant. Once U.S. doctors confirmed the tumor was cancer, McCreith was told there would be an 8 month wait for treatment in Canada. Rather than risk his life, he returned to the U.S. and paid $40,000 of his own money for treatment.

* Britain's government managed National Health Service (NHS) withheld powerful anti-cancer drugs from Barbara Moss because of their cost but willingly paid for Tanya Bainbridge's 20,000 pound (about $33,000) sex-change operation and the removal of Bainbridge's unladylike forearm tattoo.

* Dunil Almeida, 42, was suffering from colon cancer but was told he was "imagining" the pain in his stomach over the course of over 50 examinations by the British NHS, which failed to test him for cancer for nearly two years. It was only when Almeida visited Sri Lanka that doctors told him he had cancer. By then, it was too late.

Among the other 97 outrageous stories Shattered Lives documents is a woman in labor castigated by a hospital nurse for not giving birth at home; numerous elderly patients losing their sight because cataract surgery or drugs were withheld; patients resorting to do-it-yourself dentistry and much more.

"Few disagree on the need for health care reform, but imitating failing health care systems abroad by adopting a so-called "public option" will bring Americans pain, misery, fear and death," said Ridenour. "Some government treatment lists are so long, getting on one is essentially a death sentence. This is no model for politicians in Washington to emulate."

Ridenour added, "Washington should be promoting a transparent and competitive market for health care, freeing Americans at the individual level to choose the insurance and medical services most appropriate for themselves and their families. There are ways to improve our health care system, but public health care isn't one of them."


Gaps in Obama's Rhetoric Start to Add Up

By Rich Lowry

The Obama team is saddled with a foundering health-care strategy. But it has a fallback plan - relying on the sheer dimwitted gullibility of the American public. How stupid do they think we are?

Stupid enough to think that a new $1 trillion health-care entitlement is just the thing to restore the country to fiscal health.

Stupid enough not to know that almost every entitlement known to man has cost more than originally estimated, with a congressional committee in 1967 underestimating by a factor of ten Medicare's cost by 1990.

Stupid enough not to realize that it is through budget trickery - the taxes begin immediately, the spending is put off for a few years - that the program in the House shows "only" a $239 billion deficit over the first ten years.

Stupid enough not to focus on how the gap between the House plan's revenue and spending steadily grows after the first ten years, making it a long-term budget buster.

Stupid enough to think increased preventive care will save the government money, just because Pres. Barack Obama constantly repeats it, despite all the independent studies to the contrary.

Stupid enough to believe that a program with no cost controls that can be discerned by the Congressional Budget Office will control costs.

Stupid enough not to worry that Obama's proposed superteam of technocrats operating outside normal political controls - the so-called Independent Medicare Advisory Council - will resort to rationing when costs continue to spiral upward.

Stupid enough to consider it wise to use several billion dollars in cuts from Medicare to create a new entitlement rather than to forestall Medicare's own looming insolvency, currently projected for 2017.

Stupid enough not to notice that the "public option" was explicitly designed by the Left as a stealthy path to single-payer, even as liberals continue to talk and write about its ultimate purpose openly.

Stupid enough to believe that we'll be able to keep our current health-care arrangements if we like them, even though the public option could throw tens of millions of people out of private insurance.

Stupid enough to trust the same people who came up with the public option as stealth single-payer to craft a co-op provision that isn't a stealth public option.

Stupid enough to credit Obama's assurances that the Democrats' reform isn't about government intervention in the health-care system when - even without the public option - it all-but-nationalizes health insurance.

Stupid enough not to see through Obama's sudden insistence on calling his plan "health-insurance reform" as empty poll-tested phrase-making.

Stupid enough to consider Obama's reform a good deal when its insurance regulations would increase premiums for most healthy people.

Stupid enough to think that the very real problem of people with pre-existing conditions locked out of the insurance market can't be alleviated short of a 1,000-page bill reordering the entire health-care system.

Stupid enough to buy Obama's cockamamie stories about unnecessary tonsillectomies and amputations - undertaken by greedy doctors to pad their profits - driving health-care costs.

Stupid enough to get gulled by rhetoric attacking special interests when almost all the special interests are backing Obama's plan for cowardly and self-interested reasons.

Stupid enough to consider new taxes on employment - imposed by the so-called employer mandate - a good idea during a weak economy with a 9.4 percent unemployment rate.

Stupid enough to condemn ordinary people angry and frightened enough to show up at town-hall meetings in every corner of the country as the product of an "astroturfing" conspiracy.

Stupid enough to blame nefarious Republicans for the faltering public support for an expensive, ungainly and contradictory health-care program passed out of four congressional committees on strict party-line votes.

Stupid enough to trust the good faith and public-spiritedness of an administration operating on Chief of Staff Rahm Emanuel's ram-it-through-now credo that a crisis should never go to waste.

And stupid enough not to be offended at how contemptibly stupid they think we are.


Sunday, August 30, 2009

More NHS negligence

"The 32-hour delay that cost my baby his life": Mother may sue over failure to examine sick child. "Rules" invoked despite urgent situation

A baby born with known health problems died at two days old after doctors waited more than 24 hours before examining him. A scan during pregnancy showed Tobias Taylor had a dilated loop in his bowel, a potentially serious condition that needed careful attention. But despite clear medical records detailing the problem, medical staff not only waited 32 hours before fully examining him, but also let his mother Marie, 36, go home soon after the birth.

When he was finally examined, he was immediately rushed to a specialist unit where he died soon after of septicaemia. Now Mrs Taylor, a police community support officer, and her husband Simon, 39, are considering legal action against the hospital, claiming Tobias was given inadequate medical attention. Mrs Taylor, who visits her son’s grave every day, also claims she was not urged to remain in hospital the night after she gave birth, a charge the hospital denies.

She said: ‘If the hospital had acted as they should have and looked at my son straight away, he would be alive. ‘His graveside is the only place I feel at peace. I sit there for hours sometimes.’

National guidelines say doctors should wait 24 hours to give newborns a routine examination because this is when any heart defects can be spotted. But in letters to the family, the chief executive of East Surrey Hospital in Redhill admitted there had been staff ‘confusion’ and medics ‘did seem to lose sight of Tobias’s particular individual needs’.

Gail Wannell conceded: ‘Tobias did not fall into the category of babies who required the routine 24- hour examination.’ She added: ‘It would have been prudent for Tobias to be examined to see if there were signs of his condition deteriorating.’

Mrs Taylor, who lives in Redhill with her husband and sons Aden, seven, and Nicholas, 12, had been trying for a third child for six years when Tobias was conceived. But she became concerned when a scan on April 17 revealed that her unborn child had an enlarged bowel loop in his intestines, which can be an indicator of cystic fibrosis, which her son Nicholas has. It can also mean the intestines are blocked and need surgery. This should have been investigated straight after birth, but when Tobias was born at 2am on May 17, a note on Mrs Taylor’s records said: ‘Baby check not due till baby is 24 hours at 2am on May 18.’

Mrs Taylor said: ‘I asked for my baby to be checked, no one would even look at him. They told me I had to wait 24 hours, it was policy. ‘They didn’t tell me not to discharge myself in the meantime. If they had, I would have stayed.’ Mrs Taylor said she went home at 5.30pm and returned the next morning at 8.55am – but Tobias was not examined until 10.25am.

Soon after he was rushed to paediatric intensive care at St George’s Hospital in Tooting, South London, but died the next day. Mr Taylor said: ‘One of the hardest things we had to do was register the birth – then register the death straight afterwards. It was awful.’

A hospital spokesman said: ‘The medical teams discussed with Tobias’s mother their preference for Tobias to remain in hospital for monitoring and observation but the family chose to take Tobias home.’


Dean says Obamacare Authors Don't Want to Challenge Trial Lawyers

Whatever else he said Wednesday evening at the town hall hosted by Rep. Jim Moran, D-VA, former Democratic National Committee chairman and presidential candidate Howard Dean let something incredibly candid slip out about President Obama's health-care reform bill in Congress.

Asked by an audience member why the legislation does nothing to cap medical malpractice class-action lawsuits against doctors and medical institutions (aka "Tort reform"), Dean responded by saying: "The reason tort reform is not in the [health care] bill is because the people who wrote it did not want to take on the trial lawyers in addition to everybody else they were taking on. And that's the plain and simple truth,"

Dean is a former physician, so he knows about skyrocketing medical malpractice insurance rates, and the role of the trial lawyers in fueling the "defensive medicine" approach among medical personnel who order too many tests and other sometimes unneeded procedures "just to be sure" and to protect themselves against litigation.

Texas Gov. Rick Perry recently described in an Examiner oped the medical-malpractice caps enacted by the state legislature at his urging that reversed a serious decline in the number of physicians practicing in the Lone Star state and the resulting loss of access to quality medical care available to Texas residents. Mississippi Gov. Haley Barbor also shared some of his successes in this area in a recent Examiner oped.

Credit goes to the American Tort Reform Association's Darren McKinney for catching this momentary outbreak of political honesty by Dean. McKinney has conveniently posted an audio recording of Dean speaking here, so you can listen for yourself. Mckinney has also offered more comment here, helpfully even including a link to the Examiner's recent analysis of the degree to which trial-lawyer political contributions go to Democrats in Congress.

Those contributions are why Dean knows it would be a difficult task indeed for Obama to persuade congressional Democrats to do anything that might offend the trial-lawyers lobby. The Examiner's David Freddoso and Kevin Mooney did the reporting on this link here.


The pot calls the electric kettle Afro-American

The article below from the Left-leaning NPR claims that opponents of Obamacare are drumming up unfounded fears. Leftist would be experts about that. With all their shrill warnings about global warming, they sure have had a lot of practice at manufacturing fear (or trying to). More of that good ol' "projection" that Leftists rely so heavily upon. They assume that other people are just as disdhonest as they are

Past efforts to overhaul the nation's health care system had different proponents, different opponents and different plans that were under consideration. But they have two things in common: They all ended in failure, and in every case, opponents used fear as a key weapon in their arsenal.

So Jonathan Oberlander, a political scientist at the University of North Carolina at Chapel Hill, says he's not at all surprised to see recent claims — all thoroughly debunked — that suggest, for example, that bills under consideration would encourage senior citizens to commit suicide when they become ill or infirm.

"It's really a case of deja vu," he says. "You hear in today's debate echoes of the past that extend all the way to the early part of the 20th century. And I think the reason that people use fear again and again is that it's effective. It's worked to stop health reform in the past. And so they're going to try and use it in the present."

Oberlander says opponents used scare tactics the very first time the idea of national health insurance was broached — around 1915 — by tying would-be reformers to the nation's then-greatest international threat. "They said that national health insurance was a plot by the German emperor to take over the United States," he says.

The next effort to remake the health system came during the late 1940s. This time the opposition, led by the American Medical Association, exploited the newest fears. "They said if we adopted national health insurance, the Red army would be marching through the streets of the U.S.; they said this was the first step toward communism," Oberlander says.

By the time the Clinton administration took on the health effort, the power of the American Medical Association was fading. But now a new opponent took its place — the health insurance industry. It ran ads using an ordinary looking couple, named Harry and Louise, to raise doubts among middle-class Americans about how the Clinton plan might hurt rather than help them.

Says Oberlander, "The opponents have changed over time; the tactic of relying on fear and scaring Americans has not."

More here

Intimidation at a Waxman health care “forum”

A genuine "Brownshirt" action -- right out of 1930's Germany

Yesterday I went to a health care “forum” featuring Henry Waxman that was definitely not a townhall. The event was a sham on so many levels, and I will deal with that soon enough.... This event was a luncheon at the Luxe hotel in Brentwood. The event was kept secret, and tickets cost $50. Supporters of Mr. Waxman were given preferential treatment. This was a tightly controlled campaign rally, not a real townhall. However, my main criticism involved a thug that works for the Luxe Hotel.

Normally people just drive up, with no issues. This time, a pair of men stopped me as I pulled up. They asked what I was coming to the hotel for. I explained to them that I was there to see the Congressman, and gave them my name. They saw I was on the list, and let me through. I figured that was it.

I took my Republican Jewish Coalition tote bag, emptied the contents, and put them in my National Football League tote bag. This was before I exited my car. I simply wanted to avoid controversy. I entered the luncheon room, began to eat my salad, and was then accosted by a Vice President of the Hotel, Seth Horowitz. I have never met Seth Horowitz before. Yet he claimed to know me. He told me that he knew who I was, and that if I had any intention of making a disturbance, I should leave immediately.

I was stunned by this. I was using my fork correctly. I told him I had no idea what he was talking about, and he emphasized that he wanted to make sure I did not cause any problems. This was mind boggling to me. There is nothing in my background to suggest I would do anything improper.

He actually threatened me, and if I was anything other than a white male, I would probably have a pretty decent civil rights claim. He told me that he would refund my money if I wanted, and that if I was not satisfied, he could have the police escort me out. I asked him flat out why he was even approaching me. He would not say. In fact, he kept saying over and over that he did explain it to me, but all he did was repeatedly say that he wanted to avoid problems. (Only after insisting that I was there for peaceful purposes did he leave me alone.)

I never got an answer to a basic fundamental question. Why did he think I would be a problem? What behavior triggered his reaction? For those wondering why this matters, think about some basic things.

Everybody who registered for this event gave their name. This Seth Horowitz fellow, based on something, “knew about me.” What did he know? Were guests investigated? Did the Valet people see the political tote bag, which I carefully turned around before giving them my car? If somebody were to google my name, it would take them several pages to find something. A jazz musician who plays saxophone and lives in San Francisco gets most of the attention. I am fine with this. So to find something about me would take some serious time and effort.

More importantly, was this mere overzealousness by a hotel employee making sure his esteemed guest was happy? If so, why all the secrecy and evasiveness by Mr. Horowitz? He did not seem to be harassing most people, and was beyond rude. Another Republican in the room had somebody looking over his shoulder the entire time, checking out what the fellow was doing with his Blackberry.

For those who think I am being paranoid, explain to me how an unassuming guy minding his own business can be targeted without explanation. Mr. Horowitz was willing to have me “taken care of,” which could mean anything from being asked to leave to something more violent. He is a physically imposing guy, and got right in my face. This was assault. I cannot imagine that Mr. Horowitz acted alone. Either Mr. Horowitz acted on direct orders, or he is a liberal activist. Yet how would he know my views?

I am going to repeat over and over again that I have never at any time in my life engaged in any political behavior that could be considered dangerous or threatening to anyone. My conversations with Congressman Waxman were cordial. He is my opponent, not my enemy.

Seth Horowitz might be the second coming of Rahm Emanuel, at least from a tactical standpoint. As for why he did what he did, he will not say. I want answers. Why was I targeted? What did he mean when he said that he “knew about me?” What does that mean? Whatever he “found out,” through what means did he find out?

I have never given a political speech at the Luxe Hotel. None of my political speeches have ever been videotaped. I have never had an event occur at the Luxe Hotel that would be considered remotely controversial.

This was not a random targeting. This man had a beef with me, and is not offering an explanation. Seth Horowitz is a bully on a power trip. The only thing bullies respect is force. I will be contacting every organization I have friends with, and plead with them to boycott the Luxe Hotel. I want answers. This is America. Every citizen has the right to peacefully assemble.

Congress Waxman’s people may have had nothing to do with this, but that theory defies logic. The whole situation stinks to high heaven. Seth Horowitz must be held accountable for his behavior. Otherwise, when he targets you, I will not be there to speak up.

Update: Seth Horowitz of the Luxe Hotel just called me and was very belligerent. He insisted that Congressman Waxman did not give the order to target me. When I asked if Congressman Waxman’s people gave the order, he clammed up. He said he did it based on my behavior. I asked him “what behavior?” He would not answer. He is hiding behind his lawyers, after accusing me of trying to sue the hotel.

I called back and emphasized to the very pleasant woman in the Executive Suite offices that I had zero interest in suing the hotel. I simply want an apology and an explanation. I also called Waxman’s office to find out more. While I suspect he may have an overzealous staffer or two, I do not have any evidence at this time that Congressman Waxman was directly involved.


Native Americans and the Public Option

After decades of government-run care, some Indians are finally saying enough.

Montana Sen. Max Baucus, a leading architect of national health-care reform, visited the Flathead Indian Reservation near Pablo, Mont., in May, and he was confronted with a surprising critique. "I hope any [new health-care] plan does not forget the nation's first people," Dr. LeAnne Muzquiz told the senator. Another person in the audience, according to the newspaper the Missoulian, followed up by telling the senator that the legislation pending in Congress would in fact do just that.

Native Americans have received federally funded health care for decades. A series of treaties, court cases and acts passed by Congress requires that the government provide low-cost and, in many cases, free care to American Indians. The Indian Health Service (IHS) is charged with delivering that care.

The IHS attempts to provide health care to American Indians and Alaska Natives in one of two ways. It runs 48 hospitals and 230 clinics for which it hires doctors, nurses, and staff and decides what services will be provided. Or it contracts with tribes under the Indian Self-Determination and Education Assistance Act passed in 1975. In this case, the IHS provides funding for the tribe, which delivers health care to tribal members and makes its own decisions about what services to provide.

The IHS spends about $2,100 per Native American each year, which is considerably below the $6,000 spent per capita on health care across the U.S. But IHS spending per capita is about on par with Finland, Japan, Spain and other top 20 industrialized countries—countries that the Obama administration has said demonstrate that we can spend far less on health care and get better outcomes. In addition, IHS spending will go up by about $1 billion over the next year to reach a total of $4.5 billion by 2010. That includes a $454 million increase in its budget and another $500 million earmarked for the agency in the stimulus package.

Unfortunately, Indians are not getting healthier under the federal system. In 2007, rates of infant mortality among Native Americans across the country were 1.4 times higher than non-Hispanic whites and rates of heart disease were 1.2 times higher. HIV/AIDS rates were 30% higher, and rates of liver cancer and inflammatory bowel disease were two times higher. Diabetes-related death rates were four times higher. On average, life expectancy is four years shorter for Native Americans than the population as a whole.

Rural Indians fare even worse, as data from Sen. Baucus's home state show. According to IHS statistics, in Montana and Wyoming, Indians suffer diabetes at rates 20% higher, heart disease 12% higher, and lung cancer rates 67% higher than the average across all IHS regions in the country. A recent Harvard University study found that life expectancy on a reservation in neighboring South Dakota was 58 years. The national average is 77.

Personal stories from people within the system reveal the human side of these statistics. In 2005, Ta'Shon Rain Little Light, a 5-year-old member of the Crow tribe who loved to dress in traditional clothes, stopped eating and complained that her stomach hurt. When her mother took her to the IHS clinic in south central Montana, doctors dismissed her pain as depression. They didn't perform the tests that might have revealed the terminal cancer that was discovered several months later when Ta'Shon was flown to a children's hospital in Denver. "Maybe it would have been treatable" had the cancer been discovered sooner, her great-aunt Ada White told the Associated Press.

Such horror stories are common on reservations, where the common wisdom is "don't get sick after June"—the month when the federal dollars usually run out. Late last year, the Montana Quarterly interviewed Tommy Connell, a member of the Blackfeet tribe and a worker in the IHS hospital in Browning, Mont. He didn't pull any punches in his assessment of the IHS. "They're lying to us," he said of promises over the years of more funds and better care. "You can pass just about any bill you want, but to appropriate money to that bill, that's another thing."

Dismal statistics prompted Mr. Baucus to declare a "health state of emergency" on the Fort Peck Reservation in northeastern Montana and to order an investigation of the IHS's use of funds. In July 2008, the Government Accountability Office reported that the IHS simply lost $15.8 million worth of equipment such as trucks and Jaws of Life machines between 2004 and 2007. It also found that $700,000 worth of computers were ruined by bat dung.

Tribal contracting—the alternative to IHS-run hospitals and clinics—offers some hope for improvement by giving tribes more flexibility in administering their own hospitals and clinics. Kelly Eagleman, vice-chairman of the Chippewa Cree Band on Montana's Rocky Boy's Reservation, understands the effect of a top-down bureaucracy. Of his tribe, he says, "We tend to want to blame a system, but we don't look at ourselves. We all smoke. We lay on the couch. But when something happens to us, we're the first to point and say that the clinic should have fixed us."

The Chippewa Cree Band has opted to provide its own health care with funding from the IHS. Dr. Dee Althouse, a physician at the Rocky Boy's Reservation, is still frustrated by funding constraints. She told the Montana Quarterly that she often finds herself working to save lives and limbs, deferring routine health care until there is money available. Yet even with limited funds, ongoing research by the Native Nations Institute reported earlier this year that tribal management leads to better access and better quality care than relying on the IHS-run system.

The Chippewa Cree Band runs its own hospital and has hired a registered dietician who has gotten the local grocery store to implement a shelf-labeling system to improve consumer nutritional information. They've also built a Wellness Center with a gym, track, basketball court, and pool. These are small steps that won't immediately eliminate heart disease or diabetes. But they move in the direction of local control and better health.

At a time when Americans are debating whether to give the government in Washington more control over their health care, some of the nation's first inhabitants are moving in the opposite direction.


Saturday, August 29, 2009

Hundreds more report ill-treatment in British public hospitals

Health campaigners were “overwhelmed” by hundreds of e-mails and calls yesterday after publishing a report into poor care suffered by more than a dozen NHS patients. The Patients Association said that it had received a huge response from the public after publishing stories of people left lying in their own faeces and urine, having call bells taken away from them or being left without food or drink.

In a statement, the charity accused the Government of “ignoring the scale of the problem”, adding: “We’ve been inundated by hundreds of e-mails and calls from patients across the country contacting us to offer their support and relate their own experiences of poor care. “It is very clear, that whilst still representing a small proportion of the care being given by the NHS, the numbers of people receiving substandard care are not small. The NHS treats millions of patients each year. Even if 2 per cent of these are given substandard care this equates to tens of thousands of people.”

The Conservatives revealed figures that showed about 1,000 people a year were dying with pressure sores in England and Wales. The condition, linked to poor hygiene and long periods spent bed-ridden in hospital or at home, has been cited regularly on death certificates over the past five years, a response to a parliamentary question disclosed.

The Department of Health maintained that surveys show that 98 per cent of NHS patients are satisfied with their care. However, the Government’s Chief Nursing Officer said that the treatment of some of the 16 patients mentioned in the Patients Association’s report, was “clearly unacceptable”. Christine Beasley added that nurses who were accused of neglecting patients could be investigated and struck off by the Nursing and Midwifery Council (NMC). “They [the stories] make not only very distressing reading for patients but very sombre reading for the nursing profession,” she said. “I think any nurse that provides that sort of care — or in fact does not provide that sort of care — should be treated very, very seriously and if necessary, if it’s at that level, should absolutely be struck off.”

Each NHS trust implicated in the report was offered the opportunity to respond to the allegations. Many said that they had carried out their own investigations into what had happened, or said that complaints continued to be dealt with by the indepedent Health Ombudsman. There were no details about whether any individual nurses had been investigated or sanctioned by the NMC, which regulates the 600,000 nurses working in Britain.

The Council said it received more than 2,000 initial allegations from NHS employers, the police and the public in 2008-09, of which 584 went to a hearing. As a result, 216 nurses and midwives were struck off.

The Department of Health said that any patient who wished to complain about poor care should first contact the service that they were unhappy with, or the local primary care trust that commissioned the service, typically within 12 months. Where complaints cannot be resolved at a local level, or if complainants are still unhappy, they can refer the matter to the Parliamentary and Health Service Ombudsman for review.

Anne Milton, MP, the Conservative health spokeswoman, said: “NHS frontline staff are currently being overburdened by red tape and paperwork and are consistently being spread too thin and too wide across the service. They must be released to do the job that they are there to do — to help people — or risk yet more unnecessary and needless deaths.”


Britain's worst nurses 'must be struck off'

That they weren't struck off years ago is the disgrace

Nurses who neglect elderly patients should be struck off, the Government’s Chief Nursing Officer said today. Christine Beasley said that a report into the poor care of more than a dozen elderly patients, published by the Patients Association, was distressing and should make “sombre reading for the nursing profession”. A report from the charity released today includes stories of people left lying in their own faeces and urine, having call bells taken away from them and being left without food or drink.

The report was published as NHS nurses came under fire for their “cruel” and “demeaning” treatment of patients, in particularly the elderly.

The Conservatives said today that about 1,000 people a year were dying from pressure sores in England and Wales. The condition, linked to poor hygiene and long periods in hospital or at home, has been cited regularly on death certificates over the last five years, a response to a parliamentary question disclosed.

Anne Milton, MP, the Conservative health spokeswoman, said: “This is yet more evidence that the strain that Labour’s tick-box target culture is putting on NHS staff is having a devastating effect on hundreds of patients and families in the UK. “NHS frontline staff are being overburdened by red tape and paperwork and are consistently being spread too thin and too wide across the service. They must be released to do the job that they are there to do — to help people — or risk yet more unnecessary and needless deaths.

“The Government urgently needs to learn the lessons of the appalling standards of care that patients were subjected to in Mid Staffordshire. No patient should develop pressure sores while in care, let alone have them contribute to their death.”

Ms Beasley said that the care offered to some of the patients mentioned in the Patients Association’s report was clearly unacceptable. She added: “They [the stories] make not only very distressing reading for patients but very sombre reading for the nursing profession. “I think any nurse that provides that sort of care — or in fact does not provide that sort of care — should be treated very, very seriously and if necessary, if it’s at that level, should be struck off.

More here

Australia: Yet another serious government ambulance bungle

These episodes just keep coming

TAPES of a 000 emergency call reveal how a Wynnum family was put on hold by an ambulance dispatcher who bungled a response to a man suffering a stroke. Marcia Fielder, 80, said her son had to be privately transported to hospital after the Queensland Ambulance Service decided it could take up to one hour to respond.

The 44-year-old man, whom the family does not wish to name, suffered an embolic stroke in July last year and has since lost his job and become reclusive.

In a letter to Mrs Fielder the QAS admitted their response was "regrettable" and advised that the dispatcher had been removed from his position. Mrs Fielder called 000 last July after her son complained of a severe headache and not being able to see "the bottom half of the room". She said his mind then appeared to go entirely blank and he didn't even recognise her or know what room of the house he was in. "I must admit I became hysterical. I had never seen him that way before," she said.

The incident has raised more questions over the standard of training being offered to QAS dispatchers. The Courier-Mail has listened to tapes of the 000 call, which confirm the QAS dispatcher did not understand the urgency of the condition.

Mrs Fielder had to wait for her other son to drive from Salisbury to Wynnum to take them to Redlands Hospital. The next day a brain scan showed her son had suffered two strokes. He has lost his ability to read and is no longer employed.

Mrs Fielder believed her son, whom she described as a gentle giant who always cared for her, didn't want to speak out because he was embarrassed over the incident. "You have no idea how he's changed. It's like his life's lost," she said. "He stays in his room and when people ring up he says to tell them he's not home."

In a letter to Mrs Fielder, Queensland Ambulance Service medical director Stephen Rashford said paramedics were struggling with a high workload on that night. "The EMD (emergency medical dispatcher) should have provided you with more assurance and empathy," Dr Rashford wrote. "It was also found that the manner in which the EMD spoke to you was extremely inappropriate. "I apologise that the level of service provided by the EMD was not at the level of your or your son's expectations." [Does this asshole thinks lack of politeness was the only problem??]


Obama Targets Medicare Advantage

Seniors would lose with health 'reform,' -- and seniors vote


President Barack Obama was wise to vacation this week on Martha's Vineyard. Not because it's one of the few places in America where his health-care plan is still popular, but because by getting out of Washington he gave staff time to repair his vaunted message machine, which was starting to break down.

Two weeks ago, White House Senior Adviser David Axelrod said in a now legendary "viral" email that, "It's a myth that health insurance reform would be financed by cutting Medicare benefits." This was sent out the day before Mr. Obama told a Montana town hall that he'd pay for health-care reform by "eliminating . . . about $177 billion over 10 years" for "what's called Medicare Advantage." And it was two days before Mr. Obama told a Colorado town hall he'd cover "two-thirds" of the "roughly $900 billion" of his plan's cost by "eliminating waste," again citing Medicare Advantage.

Who's right? As a former senior adviser, I can tell you who: the president. What's more, according to a White House fact sheet titled "Paying for Health Care Reform," Mr. Axelrod was misleading his readers. It notes the administration would cut $622 billion from Medicare and Medicaid, with a big chunk coming from Medicare Advantage, to pay for overhauling health care. Mr. Obama heralded these cuts as "common sense" in his June 13 radio address.

Medicare Advantage was enacted in 2003 to allow seniors to use Medicare funds to buy private insurance plans that fit their needs and their budgets. They get better care and better value for their money.

Medicare Advantage also has built-in incentives to encourage insurers to offer lower costs and better benefits. It's a program that puts patients in charge, not the government, which is why seniors like it and probably why the administration hates it.

Already, an estimated 10.2 million seniors—one out of five in America—have enrolled in Medicare Advantage. Mr. Obama is proposing to cut the program by nearly 20% and thus reduce the amount of money each will have to buy insurance. This will likely force most of them to lose the insurance they have now. Yet Mr. Obama promised in late July in New Hampshire that, "if you like your health-care plan, you can keep your health-care plan."

There are roughly 23,400 seniors on average in a congressional district who have Medicare Advantage, but who face losing it if Mr. Obama has his way. That's enough votes to tip most competitive House and Senate races.

Back in 2006, Mr. Obama and other Democrats railed against GOP efforts—modest though they were—to slow future Medicare spending growth. Now he and his party may reap what they have sown. As the president pushes to enact an overall cut to Medicare he will imperil Democrats in tough re-election races. Mr. Obama has a dangerous old tiger by the tail. Seniors are much more likely to vote than the population at large.

Adding to the Democrats' woes are polls that show weak support for ObamaCare among Independents and Democrats. In the new ABC/Washington Post poll, only 45% approved of Mr. Obama's plan and 50% opposed it—with 40% "strongly" opposed.

Despite Mr. Obama's barnstorming tour, last week's Fox/Opinion Dynamics poll said "the health care reform legislation being considered right now" is opposed by 21% of Democrats, 50% of Independents, and 81% of Republicans. Only 37% of Democrats and 15% of Independents think their families would be better off if it passed.

The problem for Mr. Obama is that he lacks credibility when he asserts his plan won't add to the deficit or won't lead to rationing; that people can keep their health plans; that every family's health care will be better, not worse; and that a government run plan isn't a threat to private insurance. A large number of Americans don't believe the president on this.

With this week's $2 trillion upward revision in the White House's deficit projections, August has been the cruelest month for Mr. Obama. The president is now facing a politically explosive mix of unpopular policies and an angered electorate.

It's still too early to count Mr. Obama out. His team will be back in Washington next week. They'll work on their messaging and have more than $100 million—much of it from pharmaceutical companies—to spend on ads bludgeoning reluctant Democrats and energized Republicans.

The White House will exert enormous pressure—and in the spirit of Chicago-style politics, employ threats when necessary—with Senate and House Democrats. The health-care battle, already intense, will get more so in the months ahead. ObamaCare is unpopular, but it is far from defeated.


Obama's Health Rationer-in-Chief

White House health-care adviser Ezekiel Emanuel wants to discriminate against the elderly and babies -- who are often most in need of medical help. You are just a statistic to him. He's got all the heart of a stone. So much for all that Leftist "caring" and "compassion"

Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.

The health bills being pushed through Congress put important decisions in the hands of presidential appointees like Dr. Emanuel. They will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare. Dr. Emanuel, brother of White House Chief of Staff Rahm Emanuel, has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. He clearly will play a role guiding the White House's health initiative.

Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely 'lipstick' cost control, more for show and public relations than for true change."

True reform, he argues, must include redefining doctors' ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the "overuse" of medical care: "Medical school education and post graduate education emphasize thoroughness," he writes. "This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath's admonition to 'use my power to help the sick to the best of my ability and judgment' as an imperative to do everything for the patient regardless of cost or effect on others."

In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient's needs. He describes it as an intractable problem: "Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs." (JAMA, May 16, 2007).

Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained "to provide socially sustainable, cost-effective care." One sign of progress he sees: "the progression in end-of-life care mentality from 'do everything' to more palliative care shows that change in physician norms and practices is possible." (JAMA, June 18, 2008).

"In the next decade every country will face very hard choices about how to allocate scarce medical resources. There is no consensus about what substantive principles should be used to establish priorities for allocations," he wrote in the New England Journal of Medicine, Sept. 19, 2002. Yet Dr. Emanuel writes at length about who should set the rules, who should get care, and who should be at the back of the line.

"You can't avoid these questions," Dr. Emanuel said in an Aug. 16 Washington Post interview. "We had a big controversy in the United States when there was a limited number of dialysis machines. In Seattle, they appointed what they called a 'God committee' to choose who should get it, and that committee was eventually abandoned. Society ended up paying the whole bill for dialysis instead of having people make those decisions."

Dr. Emanuel argues that to make such decisions, the focus cannot be only on the worth of the individual. He proposes adding the communitarian perspective to ensure that medical resources will be allocated in a way that keeps society going: "Substantively, it suggests services that promote the continuation of the polity—those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations—are to be socially guaranteed as basic. Covering services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic, and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia." (Hastings Center Report, November-December, 1996)

In the Lancet, Jan. 31, 2009, Dr. Emanuel and co-authors presented a "complete lives system" for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. "One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one.

"However, other things are rarely equal—whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each—is unclear." In fact, Dr. Emanuel makes a clear choice: "When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated.

Dr. Emanuel concedes that his plan appears to discriminate against older people, but he explains: "Unlike allocation by sex or race, allocation by age is not invidious discrimination. . . . Treating 65 year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not."

The youngest are also put at the back of the line: "Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. . . . As the legal philosopher Ronald Dworkin argues, 'It is terrible when an infant dies, but worse, most people think, when a three-year-old dies and worse still when an adolescent does,' this argument is supported by empirical surveys."

More here

Friday, August 28, 2009

'Cruel and neglectful' care of one million British public hospital patients exposed

One million NHS patients have been the victims of appalling care in hospitals across Britain, according to a major report released today. In the last six years, the Patients Association claims hundreds of thousands have suffered from poor standards of nursing, often with 'neglectful, demeaning, painful and sometimes downright cruel' treatment.

The charity has disclosed a horrifying catalogue of elderly people left in pain, in soiled bed clothes, denied adequate food and drink, and suffering from repeatedly cancelled operations, missed diagnoses and dismissive staff. The Patients Association said the dossier proves that while the scale of the scandal at Mid-Staffordshire NHS Foundation Trust - where up to 1,200 people died through failings in urgent care - was a one off, there are repeated examples they have uncovered of the same appalling standards throughout the NHS.

While the criticisms cover all aspects of hospital care, the treatment and attitude of nurses stands out as a repeated theme across almost all of the cases. They have called on Government and the Care Quality Commission to conduct an urgent review of standards of basic hospital care and to enforce stricter supervision and regulation.

Claire Rayner, President of the Patients Association and a former nurse, said:“For far too long now, the Patients Association has been receiving calls on our helpline from people wanting to talk about the dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment their elderly relatives had experienced at the hands of NHS nurses. “I am sickened by what has happened to some part of my profession of which I was so proud. "These bad, cruel nurses may be - probably are - a tiny proportion of the nursing work force, but even if they are only one or two percent of the whole they should be identified and struck off the Register.”

The charity has published a selection of personal accounts from hundreds of relatives of patients, most of whom died, following their care in NHS hospitals. They cite patient surveys which show the vast majority of patients highly rate their NHS care - but, with some ten million treated a year, even a small percentage means hundreds of thousands have suffered.

Ms Rayner said it was by "sad coincidence" that she trained as a nurse with one of the patients who had "suffered so much". She went on: "I know that she, like me, was horrified by the appalling care she had before she died. "We both came from a generation of nurses who were trained at the bedside and in whom the core values of nursing were deeply inculcated."

Katherine Murphy, Director of the Patients Association, said “Whilst Mid Staffordshire may have been an anomaly in terms of scale the PA knew the kinds of appalling treatment given there could be found across the NHS. This report removes any doubt and makes this clear to all. Two of the accounts come from Stafford, and they sadly fail to stand out from the others. “These accounts tell the story of the two percent of patients that consistently rate their care as poor (in NHS patient surveys). "If this was extrapolated to the whole of the NHS from 2002 to 2008 it would equate to over one million patients. Very often these are the most vulnerable elderly and terminally ill patients. It’s a sad indictment of the care they receive.”

The Patients Association said one hospital had threatened it with legal action if it chose to publish the material.

Pamela Goddard, a piano teacher from Bletchingley, in Surrey, was 82 and suffering with cancer but was left in her own excrement and her condition deteriorated due to her bed sores. Florence Weston, from Sedgley in the West Midlands, died aged 85 and had to remain without food or water for several days as her hip operation was repeated cancelled.

The charity released the dossier to highlight the poor care which a minority of patients in the NHS are subjected to. Ms Murphy said the numbers rating care as poor came despite investment in the NHS doubling and the number of frontline nurses increasing by more than a quarter since 1996.

The personal stories were revealed to prevent their cases being ignored as only representing a small portion of patients. The report said: "These are patients, not numbers. These are people, not statistics."

Dr Peter Carter, Chief Executive of the Royal College of Nursing, said he was concerned that public confidence in the NHS could be undermined by the examples cited and it would affect morale in hardworking staff. He said: “The level of care described by these families is completely unacceptable, and we will not condone nurses who behave in ways that are contrary to the principles and ethics of the profession. "However we believe that the vast majority of nurses are decent, highly skilled individuals. “This report is based on the two per cent of patients who feel that their care was unacceptable. Two per cent is too many but we are concerned that this might undermine the public’s confidence in the world-class care they can expect to receive from the NHS."

Barbara Young, Chairman of the Care Quality Commission, the super-regulator, said: “It is absolutely right to highlight that standards of hospital care can vary from very good to poor. “Many people are happy with the care they receive, but we also know that there are problems. “I am in no doubt that many hospitals need to raise their game in this area. “Where NHS trusts fail to meet the mark, we have tough new enforcement powers, ranging from warnings and fines to closure in extreme cases. We will not hesitate to use these powers when necessary to bring improvement. "We will be asking NHS trusts and primary care trusts how they are ensuring that the needs of patients and their safety and dignity are kept at the heart of care.” [Blah, blah, blah!]

Chris Beasley, Chief Nursing Officer at the Department of Health said the care in the cases highlighted by the PA was “simply unacceptable”. She added: "It is important to note this is not representative of the picture across the NHS. "The NHS treats millions of people every day and the vast majority of patients experience good quality, safe and effective care - the Care Quality Commission's recent patient experience survey shows that 93 percent of patients rate their overall care as good or excellent.

"We will shortly be publishing complaints data on the NHS Choices website and expect trusts to publish the number of complaints they receive, setting out how these are successfully resolved."


Australia: More revelations about a rotten government-run ambulance service

Paramedics operate in 'culture of fear' because management behavior in unaccountable

THE State Government will establish a panel [A "panel" three bureaucrats! Three dedicated coverup artists, no doubt. How about a judicial enquiry?] to investigate bullying and harassment amid concerns paramedics and emergency workers operate in a "culture of fear".

The Courier-Mail can reveal an internal investigation found an Emergency Management Queensland boss guilty of victimisation, harassment and inappropriate comments, which included very harsh, sexist and intimidatory language. Documents obtained under Right to Information laws show six of 10 allegations made against the manager were substantiated and he was aggressive towards EMQ office staff.

Another EMQ officer was found guilty of swearing at Emergency Service cadets during a camp exercise last year. He referred to them as "little bastards" and told them they were "full of s--- and wouldn't survive in the bush".

Recommendations made as a result included staff training in the department's code of conduct and dealing with conflict in the workplace but it is not known whether the culprits were reprimanded.

Emergency Medical Service Protection Association president Prebs Sathiaseelan said he had received numerous complaints from his members. "EMPSA on a regular basis receives calls from our membership about some form of harassment and bullying – it isn't improving," he said. Mr Sathiaseelan said it was a "culture of fear".

In another case, a Brisbane senior officer was investigated after he "dropped his trousers, exposed his genitalia and simulated oral sex" with another employee against her will. He also made offensive comments against two colleagues in relation to race and sexuality. While at least one recipient of his comments has left the QAS, his language was deemed to be "part of his character" and "generally non-offensive". [????] But a spokesman for QAS Commissioner David Melville this week said the officer concerned was asked to "show cause" at a formal disciplinary hearing. "This officer was not counselled as the Regional Assistant Commissioner determined that the matter was of such a serious nature that this officer should be formally reprimanded." The officer was warned if his behaviour deteriorated again over 12-months he would also be docked two weeks pay.

Another senior officer, who didn't want to be named, contacted The Courier-Mail concerned the organisation was cutting corners trying to keep up with patient demand. "When you stick your hand up and say anything nowadays, you just get smashed and told to shut up," he said.

Emergency Services Minister Neil Roberts said yesterday after discussions with the Director-General, ambulance officers, firefighters, and staff in EMQ and the Department of Community Safety would be able to make complaints to a dedicated phone line and email service, which would then be referred to the panel. "It is my hope that this panel will be utilised by personnel who feel that they cannot confidently report instances of bullying, harassment or intimidation through existing channels," he said.

The panel will comprise Ministerial, Information and Legal Services branch executive director Fiona Rafter, Ethical Standards director Terry Christensen and Legal Services director Tracey Davern. "It is important that employees feel confident that their allegations will be taken seriously, properly investigated and dealt with without any personal ramifications," Mr Roberts said.


Liberal lies about national health care

By Ann Coulter

With the Democrats getting slaughtered – or should I say, "receiving mandatory end-of-life counseling" – in the debate over national health care, the Obama administration has decided to change the subject by indicting CIA interrogators for talking tough to three of the world's leading Muslim terrorists.

Had I been asked, I would have advised them against reinforcing the idea that Democrats are hysterical bed-wetters who can't be trusted with national defense while also reminding people of the one thing everyone still admires about President George W. Bush. But I guess the Democrats really want to change the subject. Thus, here is Part 2 in our series of liberal lies about national health care.

6) There will be no rationing under national health care.

Anyone who says that is a liar. And all Democrats are saying it. (Hey, look – I have two-thirds of a syllogism!). Apparently, promising to cut costs by having a panel of Washington bureaucrats (for short, "The Death Panel") deny medical treatment wasn't a popular idea with most Americans. So liberals started claiming that they are going to cover an additional 47 million uninsured Americans and cut costs ... without ever denying a single medical treatment!

Also on the agenda is a delicious all-you-can-eat chocolate cake that will actually help you lose weight! But first, let's go over the specs for my perpetual motion machine – and it uses no energy, so it's totally green! For you newcomers to planet Earth, everything that does not exist in infinite supply is rationed. In a free society, people are allowed to make their own rationing choices.

Some people get new computers every year; some every five years. Some White House employees get new computers and then vandalize them on the way out the door when their candidate loses. (These are the same people who will be making decisions about your health care.)

Similarly, one person might say, "I want to live it up and spend freely now! No one lives forever." (That person is a Democrat.) And another might say, "I don't go to restaurants, I don't go to the theater, and I don't buy expensive designer clothes because I've decided to pour all my money into my health."

Under national health care, you'll have no choice about how to ration your own health care. If your neighbor isn't entitled to a hip replacement, then neither are you. At least that's how the plan was explained to me by our next surgeon general, Dr. Conrad Murray.

7) National health care will reduce costs.

This claim comes from the same government that gave us the $500 hammer, the $1,200 toilet seat and postage stamps that increase in price every three weeks. The last time liberals decided an industry was so important that the government needed to step in and contain costs was when they set their sights on the oil industry. Liberals in both the U.S. and Canada – presidents Richard Nixon and Jimmy Carter and Canadian P.M. Pierre Trudeau – imposed price controls on oil. As night leads to day, price controls led to reduced oil production, which led to oil shortages, skyrocketing prices for gasoline, rationing schemes and long angry lines at gas stations. You may recall this era as "the Carter years."

Then, the white knight Ronald Reagan became president and immediately deregulated oil prices. The magic of the free market – aka the "profit motive" – produced surges in oil exploration and development, causing prices to plummet. Prices collapsed and remained low for the next 20 years, helping to fuel the greatest economic expansion in our nation's history. You may recall this era as "the Reagan years."

Freedom not only allows you to make your own rationing choices, but also produces vastly more products and services at cheap prices, so less rationing is necessary.

8) National health care won't cover abortions.

There are three certainties in life: a) death, b) taxes, and c) no health-care bill supported by Nita Lowey and Rosa DeLauro and signed by Barack Obama could possibly fail to cover abortions. I don't think that requires elaboration, but here it is:

Despite being a thousand pages long, the health-care bills passing through Congress are strikingly nonspecific. (Also, in a thousand pages, Democrats weren't able to squeeze in one paragraph on tort reform. Perhaps they were trying to save paper.)

These are Trojan Horse bills. Of course, they don't include the words "abortion," "death panels" or "three-year waits for hip-replacement surgery." That proves nothing – the bills set up unaccountable, unelected federal commissions to fill in the horrible details. Notably, the Democrats rejected an amendment to the bill that would specifically deny coverage for abortions.

After the bill is passed, the Federal Health Commission will find that abortion is covered, pro-lifers will sue, and a court will say it's within the regulatory authority of the health commission to require coverage for abortions. Then we'll watch a parade of senators and congressmen indignantly announcing, "Well, I'm pro-life, and if I had had any idea this bill would cover abortions, I never would have voted for it!"

No wonder Democrats want to remind us that they can't be trusted with foreign policy. They want us to forget that they can't be trusted with domestic policy.


Health Insurance and the Lure of Someone Else

By Jon N. Hall

Insurance is all about "someone else" paying your bills. However, if everyone's healthcare bills were the same, if our bodies failed and expired in the same way and on the same schedule, if our little lives were as predictable as those of the adult mayfly, we wouldn't have a health insurance industry. Insurance makes sense only if it's for the unpredictable.

But we are not a uniform species like the mayfly. Our bodies differ dramatically. Some folks are rarely sick; one day their bodies simply stop, incurring little if any cost to the insurance industry and government treasuries. Healthy people are all alike, perhaps a bit like the mayfly. Sick folks are all different. And the variety of ailments they suffer from beggar the imagination. Some have multiple degenerative diseases, all at the same time. Some are basket cases from birth.

If everyone had absolutely wretched health, would Congress be so intent on insuring us all? It is because there are only a few of us who have truly wretched health that health insurance is feasible. Insurance makes sense only if claims vary.

And those who make the fewest insurance claims get the worst deal from insurance. If everyone were to pay the same in health insurance premiums, the healthier half would be better off to "go it alone", i.e. be self-insured. Betsy McCaughey reports that in America "about 5 percent of the populace uses 50 percent of treatment dollars", citing the Congressional Budget Office. Could that possibly mean that 94+ percent of us would be better off financially if self-insured? (Check out Ms. McCaughey's more detailed critique of the healthcare debate here, at The American Spectator.)

Some say: "healthcare is a right". But where in the Constitution is this right conferred? Perhaps these folks are confusing "is" for "should be". The Constitution doesn't even say we have a right to be fed by the feds. If they want healthcare to be a right, there's a way to bring that about: amend the Constitution. It would be interesting to see if such an amendment could ever be ratified; I have my doubts. (During last year's campaign, I expressed my doubts about the constitutionality of the individual mandate, which is still under consideration.)

In her blog for Fox Business, Elizabeth MacDonald quotes economist Ed Yardeni: "Ask doctors and hospital administrators about Medicare and Medicaid and they will tell you that it amounts to a theft of their services because the government doesn't pay them enough to cover their expenses for the care they provide. So they pass those costs on to patients covered by private health insurance."

If the "reformers" in Congress want to create a real market for healthcare, they would enact a law that demands this: No individual nor private health insurance company can be billed more for a medical expense than what government programs pay. This would help end price discrimination, which Uwe Reinhardt describes as "the practice of charging different payers different prices for identical health care goods or services". The same should be done for drugs: No co-op, foreign government, nor bargaining bloc could be given special prices. Let's put the kibosh on the "cost shifting" that has sent the price of private insurance soaring and distorted the market.

If the "reformers" in Congress weren't in the hip pocket of trial lawyers, they would put a cap on malpractice torts. Recently, columnist Charles Krauthammer, who happens to be an MD, provided an elegant solution for malpractice: "The penalty would be losing your medical license. There is no more serious deterrent than forfeiting a decade of intensive medical training and the livelihood that comes with it."

The "reformers" in Congress claim they want to bring competition, choice and cost savings to healthcare. If so, they should enact a law that allows workers to direct their employers to drop them from company-provided health insurance and then add to their paychecks whatever their employers were paying for them in health insurance. And if these workers then elect to buy health insurance on their own, they would get the same tax break as their employers get. Or, they could pocket the money and "go it alone" -- if they're diligent about their health regimens (and lucky), they'll save money.

If the "reformers" in Congress want to overhaul America's healthcare system and erect some "comprehensive" new system, then Congress should first demonstrate to the American People that they are competent at holding down healthcare inflation. But they can't do that.

That's because Congress itself is responsible for healthcare inflation. Congress caused healthcare inflation by mandates (e.g. Medicare) that it refused to fully pay for, thus shifting costs to "someone else", i.e. the private sector; by disallowing the purchase of insurance across state lines, thereby quashing competition; by mandating that emergency rooms take everyone and then not paying for it (shifting those costs to "someone else"); by mandating that illegal aliens be treated in emergency rooms; by disallowing the purchase of drugs from Canada; by cordoning off vast chunks of the economy which they reserve for healthcare; etc; etc; etc.

Despite having run up the deficit by a factor of 10 in just 2 years, despite the recently revealed $2 Trillion bump up in the projected deficits over the next decade, despite an unemployment trend that continues to worsen, despite being in 2 wars, and despite an Iran that gets ever closer to the bomb, our brilliant Congress wants to create the largest entitlement of! This is the most irresponsible Congress in modern history. And that's a pity, because just as for the mayfly, our time is running out.


Under the Cover of a Backroom Deal

Excuse me, but weren't we just talking about health care? After scanning news this week, one might notice a startling dearth of health care stories making headlines. Surprisingly, for most media outlets--be they liberal, conservative, a major news network or a basement blog--stories regarding public options, death panels, Obama's waning support, insurance companies, and the like were nowhere to be found.

Their absence might make the average news junkie feel like he's entered a non-parallel universe. But please don't be alarmed: it is entirely calculated. Simply put, it's not that health care is no longer newsworthy; it's just that Barack Obama is deliberately making his news bigger to block it out.

As a self-described "gifted" orator, Mr. Obama has demonstrated a clear understanding and flawless execution of one of the most crucial strategies of effectively dominating the conversation: changing the subject when the discussion gets too uncomfortable. Health care, it seems, was becoming too difficult of a conversation for the gifted one to stomach. Something had to be done. So, in the past two days alone, the President and/or White House officials have announced:

* That he will appoint a special prosecutor to investigate CIA interrogation abuses.
* That he will nominate Ben Bernanke to a second term as chairman of the Federal Reserve.
* That he demands the media leave him and his daughters alone while on vacation.
* That 90,000 Americans could die from swine flu this fall (and most of them will be kids).
* That the budget deficit this year will skyrocket to an unexpected record of $1.6 trillion.
* That he will soon part the waters of the Nantucket Sound (okay, not yet – but just wait).

With such an onslaught of manufactured news fodder—all “breaking” in two days, mind you—it is no wonder the health care debate got pushed off the front page. And that’s exactly what Barack Obama intended. Some schemes are best hatched undercover.

The fact is: the national health care debate had become far too politically damaging for the Obama Administration. Ever since kicking his government-run healthcare plan into high-gear at the beginning of the summer, Mr. Obama’s poll numbers have plummeted as a direct result. According to Rasmussen Reports, Barack Obama had a +7 approval index on June 1st. As of August 25th, the President scored a -11 on the approval index. That’s an 18-point swing in three months.

What Obama clearly intended to be the sparkling set-piece of his “transformational” Administration has quickly become a burgeoning blight destroying his lofty approval rating – and already threatening his all-important legacy as well.

Moreover, Barack Obama’s minions—the multitudes of Democrat representatives, senators, and White House officials scattered across the nation during the August recess—have likewise felt the burn from hordes upon hordes of Americans upset with the Democrats’ plans for government-run health care. Despite the best—no, make that worst—efforts of the Administration and Obamaton media to paint the concerned American people as “angry racist mobs,” the embarrassment and sinking poll numbers are as plain as the lengthening nose on Obama’s face.

Their embarrassment is Obama’s embarrassment. And all of the Administration’s prevarications about “misunderstandings” aren’t going to change the hardscrabble facts. So, for Obama and Co., now is the perfect time to avert attention by changing the subject.

Abandoning their health care agenda, however, is far from the goal. Displacing health care with a barrage of other news stories needs to be seen for what it is—a cynical cover up for a backroom deal.

With both the media and the public looking the other way, the President can quietly take the health care debate off the front page and return to the kind of backroom, bare-knuckle politics he truly enjoys —those that don’t involve the American people. After all, it’s become increasingly evident that if Mr. Obama involves the American people, his sweeping government-run health care scheme would never be carried out.

So while the politically-damaging health care chaos may have been pushed from the front page, it won’t end up on the obit page—buried and forgotten. If Barack Obama has his way, it will next appear as a “Second-Coming Headline” proclaiming, “Obamacare Passed Without Debate” as America’s healthcare industry is scrapped under the obscene cover of a backroom deal.