The U.S. Government Push for Electronic Medical Records

The economic stimulus plan currently being considered by Congress allocates $20 billion to health information technology such as electronic medical records (EMRs). Recent postings on Medscape Physician Connect (MPC), a physicians-only discussion board, offer frank opinions about the utility of EMRs in clinical practice -- opinions that are decidedly mixed. "EMR is the worst thing that has happened to me professionally in over 25 years of practice. My care of patients is impeded and the quality of my care is worse as a direct effect of the introduction of EMR," says a MPC contributor who championed the installation of an EMR system for his physician group.

"I absolutely love our EMR," says a nephrologist. "It has improved the quality of our practice immensely. I spent a lot of time customizing for our practice, but it was worth it. Everything is point and click. To improve care and cost, all patients need a Web-based collection of medical records that include hospitalization, lab reports, x-rays, as well as office notes. That would be the ultimate care."

Physicians who are dissatisfied with EMR systems cite loss of productivity, the negative impact on patient care, and high maintenance requirements. Physicians who have embraced EMRs cite the increased efficiency the systems have brought to their practices. EMRs tend to get high marks from subspecialists and low marks from primary care physicians.

Some of the MPC physicians least satisfied with their EMR systems are those practicing at large healthcare companies or medical centers. "My hospital solicited medical staff support for EMR," says one MPC contributor. "After implementation, administration took over and now EMR is solely for the benefit of medical records as a storage device. To hell with the medical and nursing staffs. RNs are input clerics rather than beside nurses." "The very few efficiencies were all on the administrative side," says a regional medical director who helped bring an EMR system to a nationwide healthcare company. "A good sales pitch with nice graphics and testimonials sell it, then the clinical staff is left to suffer." "EMRs need to address work flows and clinical efficiencies and not seek to provide administrative support," says a general practice physician. "Unfortunately, the administrators are the ones with the time and energy. The rest of us are seeing patients."

In smaller practices, issues of EMR maintenance and support infringe upon patient care. "In my clinic," says a family medicine physician, "provider meetings are completely dominated by EMR issues and problems. There is virtually never time left for discussing topics pertinent to improving patient care."

In speaking about their day-to-day experience with EMRs, primary care physicians complain that entering patient information is cumbersome and time consuming, often because of a template-based system that does not reflect the patient encounter. "The assumption of the EMR is that you already know the diagnosis when the patient arrives." says an MPC contributor. "This may be better for specialty care, but in primary care, patients come in with fatigue, rash, insomnia, diarrhea, and cough. It's difficult to enter all this until after the visit."

An internist who describes herself as "tech savvy" says that her system's scripted entries for patient information are inadequate. "If you free-text, it is much more time consuming. And we are discouraged from free-texting by our administration because it doesn't trigger adequate billing codes. Not only has it reduced my time with patients, it has added an extra 2 to 3 hours of work each night from home."

"My advice to practitioners," says one MPC contributor, "is wait for a decent EMR that produces useful notes that accurately describe a patient encounter in a way that helps a clinician."

Waiting may not be an option for much longer, however. One provision of the government stimulus plan would impose reduced payments on physicians who are not "meaningfully using" information technology. Whatever is meant by the provision's phrasing, one thing is clear: the push is on to go electronic. Physicians must learn how to make information technology work for them. One EMR expert says that it starts with the choice of systems. "Primary care practices should stay away from templates and stick to a new program by Praxisr [Infor-Med Medical Information Systems, Inc., Woodland Hills, California] that uses pattern recognition of similar cases as well as rare cases. It decreases the workload immensely. For specialty practices, I recommend templates, and VisionaryT Dream EHR [Visionary Medical Systems, Inc., Tampa, Florida] is excellent in being very user friendly," says an MPC contributor whose research in medical management focuses on EMR systems.

Another MPC contributor notes that the technologically adventurous can customize an EMR system by using open-source software. In open-source systems, he explains, the source code needed for programming is included in the software, making the program infinitely adaptable. "When you buy most proprietary software, you have to accept the functions that come with it, as designed by the developers. With open-source systems, you can modify the software to your heart's content."

For some physicians, however, EMR systems remain a nonissue, and the heavy government funding of healthcare information technologies is nothing more than a smokescreen obscuring the real issues in primary care. "The government and the public are not able to deal with the real problems facing medical practice and the real solutions necessary to turn it around (ie, reasonable reimbursement rates, malpractice reform, regulation of the unscrupulous practices of the insurance industry)," says an otolaryngologist. He adds that once healthcare information technology is "fully implemented and solves nothing, we can start to talk about real reform and real answers."

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Australia: Useless public hospital emergency department

With his foot aching from serious burns, Norman Daw was forced to find other care after waiting five-and-a-half hours for treatment at Caboolture's emergency department. A hot bolt had dropped into his boot during an industrial accident last month, causing an injury which needed a skin graft.

Despite the pain, he drove home to Springfield, on Brisbane's southside, to see his own doctor. He said his doctor referred him to the burns unit at Royal Brisbane Hospital where he had the burnt flesh removed and skin grafted into the wound the next week.

"I wouldn't take a dead cat to the place (Caboolture)," he said. "I'm not saying the staff were at fault. "They mustn't have the numbers to see how the nurses on duty did not have the knowledge to recognise a severe burn." He was angry that although emergency department staff had put cream on the wound and dressed it, he was not offered pain relief or referred immediately to the burns unit in Brisbane.

A Queensland Health spokesman said a nurse assessed all patients who arrived at the emergency department. Category 1 and 2 patients usually were experiencing a life-threatening situation. In non-urgent cases, patients are stabilised, treated and referred to facilities as required.

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Sweden's Government Health Care

Government health care advocates used to sing the praises of Britain's National Health Service (NHS). That's until its poor delivery of health care services became known. A recent study by David Green and Laura Casper, "Delay, Denial and Dilution," written for the London-based Institute of Economic Affairs, concludes that the NHS health care services are just about the worst in the developed world. The head of the World Health Organization calculated that Britain has as many as 25,000 unnecessary cancer deaths a year because of under-provision of care. Twelve percent of specialists surveyed admitted refusing kidney dialysis to patients suffering from kidney failure because of limits on cash. Waiting lists for medical treatment have become so long that there are now "waiting lists" for the waiting list.

Government health care advocates sing the praises of Canada's single-payer system. Canada's government system isn't that different from Britain's. For example, after a Canadian has been referred to a specialist, the waiting list for gynecological surgery is four to 12 weeks, cataract removal 12 to 18 weeks, tonsillectomy three to 36 weeks and neurosurgery five to 30 weeks. Toronto-area hospitals, concerned about lawsuits, ask patients to sign a legal release accepting that while delays in treatment may jeopardize their health, they nevertheless hold the hospital blameless. Canadians have an option Britainers don't: close proximity of American hospitals. In fact, the Canadian government spends over $1 billion each year for Canadians to receive medical treatment in our country. I wonder how much money the U.S. government spends for Americans to be treated in Canada.

"OK, Williams," you say, "Sweden is the world's socialist wonder." Sven R. Larson tells about some of Sweden's problems in "Lesson from Sweden's Universal Health System: Tales from the Health-care Crypt," published in the Journal of American Physicians and Surgeons (Spring 2008). Mr. D., a Gothenburg multiple sclerosis patient, was prescribed a new drug. His doctor's request was denied because the drug was 33 percent more expensive than the older medicine. Mr. D. offered to pay for the medicine himself but was prevented from doing so. The bureaucrats said it would set a bad precedent and lead to unequal access to medicine.

Malmo, with its 280,000 residents, is Sweden's third-largest city. To see a physician, a patient must go to one of two local clinics before they can see a specialist. The clinics have security guards to keep patients from getting unruly as they wait hours to see a doctor. The guards also prevent new patients from entering the clinic when the waiting room is considered full. Uppsala, a city with 200,000 people, has only one specialist in mammography. Sweden's National Cancer Foundation reports that in a few years most Swedish women will not have access to mammography.

Dr. Olle Stendahl, a professor of medicine at Linkoping University, pointed out a side effect of government-run medicine: its impact on innovation. He said, "In our budget-government health care there is no room for curious, young physicians and other professionals to challenge established views. New knowledge is not attractive but typically considered a problem (that brings) increased costs and disturbances in today's slimmed-down health care."

These are just a few of the problems of Sweden's single-payer government-run health care system. I wonder how many Americans would like a system that would, as in the case of Mr. D. of Gothenburg, prohibit private purchase of your own medicine if the government refused paying. We have problems in our health care system but most of them are a result of too much government. Over 50 percent of health care expenditures in our country are made by government. Government health care advocates might say that they will avoid the horrors of other government-run systems. Don't believe them.

The American Association of Physicians and Surgeons, who published Sven Larson's paper, is a group of liberty-oriented doctors and health care practitioners who haven't sold their members down the socialist river as have other medical associations. They deserve our thanks for being a major player in the '90s defeat of "Hillary care."

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Surgery delay in Australian public hospital causes man to lose finger

A Brisbane man who had to make his own way to hospital after a work accident - because an ambulance did not arrive - ended up waiting two days for surgery and lost a finger. Wayne Rogerson, 42, of Manly West, severed the middle finger on his left hand in a workplace accident at Rocklea on Friday. He waited in agony for an ambulance but after 90 minutes decided to get himself to hospital with the digit packed in ice.

His frustration continued at Princess Alexandra Hospital where he was prepped for surgery three times in two days. On each occasion the operation was postponed because of other emergencies. When Mr Rogerson finally made it into theatre on Sunday morning the finger had been thrown out. Trilby Misso senior managing lawyer Luke Short said the digit was discarded because by that stage it was unable to be reattached. "The surgeons had to cut below the first knuckle to repair the finger correctly," Mr Short said.

Mr Rogerson said his frustration with the health service and distress at losing part of his finger was made worse by election advertisements featuring Premier Anna Bligh promoting the PA Hospital. "I nearly kicked the TV when I saw the ad with the Premier saying how great it was at the PA. I am so angry about how the health system has let me down the first time I've had to use it," he said.

Mr Rogerson was equally frustrated by the lack of explanation from the Queensland Ambulance Service for not showing up at his workplace. "All they could confirm was that my case had been logged as call number 956," he said. But yesterday the QAS said it had experienced an unusually high demand at the time of the accident, just after 10am on Friday, responding to 80 emergency cases in an hour. "An ambulance was immediately dispatched. Four minutes into the journey, this ambulance was diverted to a life-threatening cardiac case," a QAS spokesman said.

A second ambulance sent a short time later was diverted to another life-threatening case. "At 10.44am the QAS received a further call from a man at the scene who reported the patient was becoming anxious," the spokesman said. "The closest resource became available at 10.54am and was en route to the scene, when the Communications Centre was advised that alternative transport had been arranged."

A PA spokeswoman said it was unable to comment because it had not been given permission by Mr Rogerson.

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Schizophrenic stabbed four people after NHS ignored his pleas

A schizophrenic killer who murdered four people in three days was failed repeatedly by an ineffective NHS, an inquiry has found. The treatment of Daniel Gonzales was full of missed opportunities that could have prevented him stabbing three pensioners and another man to death. Despite nearly 60 appointments with doctors and psychiatrists and his own pleas to be admitted to a hospital, Gonzales was free to fulfil his ambition of becoming a serial killer resembling the film character Freddy Krueger, from the Nightmare on Elm Street series.

Gonzales's mother, Lesley Savage, had written to her MP begging for help, saying that she feared her son would only get the treatment he needed if he killed someone. An independent investigation found that the work of Surrey and Borders Partnership NHS Foundation Trust had been hampered by human errors, a lack of funds, system failure and bad luck. Doctors had concluded that Gonzales was either making up claims of hallucinations and self-harm or was suffering from the effects of illegal drugs.

A report said that it was not possible to predict the murders, but that good practice was not followed. "Responsibility for this has to be shared by many of those who worked with, or were responsible for, Mr Gonzales." It said that doctors had not overlooked his capacity for serious violence and there were no "missed clues" that he would carry out the knife attacks.

Brenda Cutmore, Gonzales's grandmother, welcomed the report's findings and said that his care was catastrophic. Gonzales was sentenced to six life sentences for four murders and two attempted murders. The killings took place in London, Hampshire and Sussex in 2004. He was held in Broadmoor top-security hospital and was found dead in his cell in 2007 after slashing his wrists with broken CDs.

Fiona Edwards, chief executive of Surrey and Borders trust, said: "The trust accepts that more should have been done to engage Mr Gonzales while he was being cared for. We offer our profound apologies to the victims, their families and Mr Gonzales' family for the missed opportunities revealed in the report."

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Huge negligence episode by the NHS being ignored by the British government

Report just released on use of contaminated blood by the NHS. HIV and Hep C were the contaminants concerned. The following quote from the Archer Report tells you most of what you need to know. "By the mid 1970s it was known in medical and Government circles that blood products carried a danger of infection with Hepatitis and that commercially manufactured products from the USA were particularly suspect. By the mid-1980s there were warnings of a similar situation in respect of HIV. But the products continued to be imported and used, often with tragic consequences."

For the victims and their families who have had their lives decimated by ill-health for up to two decades because of contaminated blood, an apology is long overdue and much wanted. But the bottom line, which successive governments have done their utmost to avoid, is the need for compensation.

The Archer inquiry does not put a figure on the financial support needed by people who have lost their jobs, lost their health insurance and, as has so often been the case, lost the breadwinners in their families. But the report concludes that compensation equivalent to that offered by the Irish Government — which equates to around 400,000 Euros a person — should be a starting point. Money should not be assessed on a means tested basis, but on the facts of each individual’s case, it states. With more than 4,000 people affected by ‘bad blood’, the current Government’s silence is perhaps understandable. The compensation required would be in the billions. But that is no excuse for trying to sweep the issue under the carpet.

To date, the Government has offered no financial support to the inquiry, which has fought hard to keep its cost down to under 75,000 pounds. Lord Morris of Manchester, who first called for an inquiry in December 1988, set up the privately-funded review after successive governments resolutely resisted holding a public inquiry — preferring in-house inquiries at the Department of Health, dealing only with narrowly-defined aspects of the disaster, with no opportunity for afflicted patients, bereaved families, or even former ministers to be heard.

Lord Morris felt an independent inquiry, held in public, was the only way for the views of those most affected to be heard, and the only way to restore public confidence in the safety of blood product supplies. He petitioned potential donors — who gave anonymously — and raised sufficient funds for it to be carried out. The results — a 112-page document summarising two years of evidence — is now with Alan Johnson, the Health Secretary. The inquiry has no legal status compelling action from the Government (it was not even able to compel witnesses to come before it, as shown by the ever-absent Department of Health).

But the haemophilia community, and the wider public, are rightly concerned about how the most horrific of NHS treatment errors is addressed, the chapter closed, the lessons learnt. And to do this requires — demands — a positive, forthright and active government response.

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Australia: 5000 left without cancer treatment in NSW

Cancer patients are being denied lifesaving treatment, with New South Wales and Federal Government "buck-passing" blamed for leaving up to 5000 people a year without radiotherapy. In some parts of the state, dying patients are being forced to pay up to $8000 through private radiotheraphy units or wait up to two months for a public facility because the State Government is underinvesting in equipment and services. At the same time the Federal Government is permitting private units to have a monopoly in rural areas.

Cancer Council NSW has slammed the governments for placing patients' lives at risk. Today it will hold a call-in for patients to describe their horror stories so a database can be compiled to lobby governments. Chief executive officer Dr Andrew Penman said some people were foregoing the treatment because it was too costly. "There is a Medicare coverage but it doesn't pay the full cost if you go private," he said. "Some patients are waiting longer than the 21 days recommended to start treatment. Radiotherapy prolongs survival." In St George, in Sydney's southeast, patients are sometimes waiting up to eight weeks.

Radiotherapy is used on various cancer patients who doctors believe have a great chance of recovery. It also reduces the size of tumours that need to be operated on and lowers the chance of tumours recurring after being removed. NSW only has 42 machines to treat the 19,000 cases a year that require radiotherapy, but the Cancer Council claims at least 5000 are missing out because of lack of machines and exorbitant private fees. The Cancer Council wants the Government to provide at least 20 radiotherapy units by 2011.

On the Central Coast, only one private radiotherapy unit is available. If patients, such as mother-of-four Elizabeth Bratby, can't afford the up-front cost, they are either forced to travel to Newcastle or Royal North Shore for treatment. Ms Bratby was first diagnosed with colon cancer in 2001, but three years later tumours returned in her pelvis. Told her treatment would cost $8000, the now 53-year-old was forced to beg the doctors to waive the fees. "I could not have paid it," she said. "I know of an elderly woman who needed radiotherapy but just didn't do it because she couldn't pay and she couldn't afford to travel the long distances."

Opposition health spokeswoman Jillian Skinner said other areas including Wagga Wagga were also badly hit by the funding shortfall. "It is heartbreaking for patients to be told the radiotherapy treatment they need is either inaccessible or unaffordable," she said. The Cancer Council's radiotherapy call-in will be held all this month.

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Medical Care in Italy and Germany Highlights Problems with Universal Healthcare

It's easy to want to try something new and different, especially when we are unsatisfied with what we already have and wish to exchange it for something we don't have. The assumption of course is that what we don't have - can only be better. Case in point: "Universal Healthcare".

As a U.S. citizen who lived overseas for over 30 years in Europe, and as a sickly patient who has been through the Italian and German health care systems, I am very well acquainted with Universal Healthcare and wouldn't wish it on my worst enemy. But perhaps for someone who has never experienced socialized medicine first hand, these brief stories of what happened to me might provide some better insight into what lies in our future, in order to be prepared for social medicine.

In 1982, I worked the summer in a German Castle with a restaurant, hotel, antique furniture store and general tourist site in Bonn, Germany. One day while a co-worker and I were working in the antique furniture store just upstairs - we found a hollow spot on the wall. We picked at it and it turned out to be a hidden weapons room from medieval times that was walled in. It was common practice to hide weapons and supplies when about to become overrun by the enemy.

To express his gratitude, the owner of the castle told us we could each sort through the ancient weapons and pick one for keeps. I picked a sword and my co-worker picked a spiked ball chained to a stick. I wrapped my sword in multiple layers of plastic bags and went home.

While crossing at an intersection, I casually bumped into a street pole with my wrapped sword causing the tip of it to twirl and stab me in the leg. A few days later I became very ill with a serious fever but couldn't see a physician because I didn't have health insurance as a seasonal worker. I was 17 years old and still covered under my father who lived in Milan, Italy. Because I was getting worse by the day, I resigned, boarded a train to Milan (a 12-hour trip), met up with my father and checked into Milan's Niguarda Hospital.

I was to spend the 4 months fighting for my life afflicted by what was later to be determined as Sepsis from Staphylococcus. Although I survived and paid absolutely nothing upon discharge, the old adage "you get what you pay for" really came into play. At the time, Italy's socialized medical system was administered by a government agency called Unita' Socio-Sanitaria Locale, or USSL for short (in English, the local social-sanitary unit). I found both the hospital and the universal healthcare system (socialized medicine) to be much worse condition than I was.

For starters, we had a "Turkish Bathroom" on the wing floor - not to be confused with a "Turkish Bath". A Turkish bathroom is basically a bathroom without a toilet. Instead of a toiled, there are two ceramic footprints with a hole in the middle. The proper way to "use" this type of facility is to completely remove your pants and underwear, place your feet on the designated footprints and "release" your feces. In practice, it never works that way because of several "hygienically" challenged complications.

There is no place to hang your pants and underwear, so you have to lay them on the floor. Experts ball it all up and hold them under their armpits. Then, there is the splash-back caused by the tall drop of feces into the hole, causing a nasty mess on the exposed legs.

To make matters worse, these facilities weren't sanitized, but simply kept clean with a worn out broom leaning in a corner. This is what the facility looked like early in the morning right after the cleaning lady left and nearly every patient who could walk would storm in.

As the hours of the day passed, no one would dare to go back again because of the horrors that would escalate the situation. Many sick patients didn't have what it took to aim correctly. Many would miss the target (the hole), thereby causing the feces to splatter all around including on the positional footprints. No cleaning lady would dare to come back during the day to clean up such messes simply because they felt they weren't paid enough to deal with such monstrosities. Despite all this, no one would loose their appetites because skipping meals kept us constantly hungry.

For breakfast we were served "caffelatte" (coffee with milk), or at least in theory. Far from Starbucks, the caffelatte was 100% white and tasted like milk only. The word on the ward was that the nurses who were in charge of preparing breakfast stole the coffee. The milk was hot, in a large pot on a cart and served from room to room. I was scooped out with a ladle and poured into a bowl, for each patient.

Occasionally, the attendant would run out of caffelatte (they kept on calling it that to perhaps create at least a mental image that there was actually coffee in it), so the last patients would have to do without in exchange for a promise that the attendant would start from the other end of the ward the following day. So we drank hot milk every morning and ate. absolutely nothing. No donuts, no croissants and of course no cornflakes.

Lunch and dinner were almost just as bad, but at least we had choices. For lunch and dinner the kitchen prepared two large pots for the attendant to distribute. One with pasta and the other with rice. The attendant would go from room to room and ask each patient whether they wanted pasta or rice. Sometimes, to make it seem as if we had more options, the follow-up sentence contained the same two choices in reverse order. The pasta was nearly white because - again, someone on staff was taking home all the cans of tomato sauce. The rice was bland, and there was never even a trace of any condiments. This was it.

For 4 months, I ate pasta or rice for lunch and pasta or rice for dinner, 7 days a week. Eventually, I was put in a room dubbed "the room for the dying" (the moribondi) by the patients on the wing because the only way out was on a stretcher headed to the morgue.

Once, a nearby patient who insisted he was supposed to be on another floor due to his heart condition felt really bad and asked me to buzz the nurse (many buzzers didn't work). No one came, so I continued to buzz the nurse approximately every 10 minutes, for roughly the next 3 hours. I tried to cheer the guy a little by cracking some jokes but he seemed to ignore my little humor. When the male nurse finally came (the same one who painted my feet black when I was asleep a few weeks earlier), he seemed very upset and screamed at me "what the hell do you want". I told him I was buzzing for the gentleman to my left who didn't have a working buzzer and felt really bad. So the nurse stormed over to my neighbor and asked him literally "what's your f***ing problem pal", several times. Not having received an answer, he took the guy pulse and simply said "oh". I asked what was going on and I was told not to worry about it because it wasn't my problem.

I tried to make some small talk later and asked my neighbor how he was doing. Still he ignored me. I had a gut feeling something was wrong at this point, but thought perhaps that he was sound asleep, so I discontinued talking. About an hour later, an intern came in with the male nurse and an EKG machine and made a recording of the man's heart that seemed to have slept through the procedure. They whispered a few things to each other and left the room. About another hour after that and right before dinner - two orderlies came in with a stinky, rusty metal casket on wheels.

Now I knew the score; I had just spent the afternoon trying to strike up a conversation with a dead guy. I was 17, scared out of my wits and thoroughly horrified. The orderlies were engaged in a conversation about their wives, paused briefly, casually pick up the body and dropped it in the casket and then resumed the conversation about their wives. I was stunned. I knew from that moment on I wasn't going to go before my time in that filthy, raunchy, disease infested hospital. There was a time and place for everything but this place just wasn't meant for me.

The medical staff still had no idea what I had because all of my blood tests were inconclusive. To be safe, they shot me in the arm 3 times a day with 300cc's of antibiotics. This went on for nearly the entire 4 month period that I was there. My screams routinely scared all visitors away evoking the sounds one might hear when approaching a torture chamber. Eventually, my father took a sample of my blood to a private lab he paid out of his own pocket and I was found to have the sepsis from staphylococcus in my blood. The hospital's excuse was that it was such a rare occurrence that the hospital lab did not routinely test blood for blood infections from the past (the sword, the sword!).

The medical staff however told my father to prepare for the worse because at this stage, the sepsis had already infected all of my organs - a sort of point of no return. But in a nutshell, I got better and was later discharged to the amazement of the medical staff and even the resident catholic priest who had performed the last rites on me earlier. This was my experience with socialized medicine, where quality health care is substituted with quantity. Socialized medicine is free to everyone because the cost of it all is seriously brought down by taking away the motivation of going to nursing and medical school by paying medical staff little more than minimum wage.

The only benefits are the overtime pay and the night and week-end differential. It severely cripples the morale just to think that had they been born in the USA, these people would have been earning a good living. In a wing of approximately 30 patients, we always had one nurse on duty with 12 hour shifts, and patients taken care of by mostly interns and nurses while resident doctors, lead surgeons and senior charge nurses smoke cigarettes on the balcony all day together with some of the "gomer" patients who seemed to live in the hospital year-round.

Wake up America! While Italians have been trying to improve and reform health care in Italy all these years, who in their right mind would want to degrade our healthcare system in the United States of America? Of course there was always better health care available in Italy, but only for the wealthy. Italy was and still is full of private hospitals with the best of care, better salaries, sterile facilities and excellent food. But the lower and lower middle classes simply cannot afford them, so they are taught to rely on socialized medicine.

I challenge anyone who thinks that universal healthcare would retain quality to spend one week in an Italian socialized hospital, with feces splattered on floors and walls, no regard for individual special dietary needs such as diabetic meals or low carb meals, one set of bed sheets for an entire hospital stay, broken x-ray machines and no advanced technology such as computers and MRI's.

I'm not talking about a third world country of one of the former Soviet controlled countries in Eastern Europe. I'm talking about Italy - a modern (western) European democracy. A country where income tax is only the tip of the iceberg. A country that taxes everything, including death...

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Baby P: Probe details catalogue of blunders

A damning report is to identify a catalogue of errors made by NHS professionals who failed to prevent the abuse and death of Baby P.



An investigation by the Healthcare Commission will condemn blunders made by a succession of doctors and health visitors who came into contact with the toddler, but did not act on clear signs that he was at risk. The report, due to be published on Tuesday, will blame poor "joint working" between frontline staff who treated Baby P for the failure of two hospitals, a family doctor and two health visitors to protect the child from violence and eventual murder at the age of 17 months by his mother's boyfriend.

A GP who first raised the alarm about the toddler's abuse was suspended two weeks ago, as it emerged that he had seen the child at least 14 times before his death. Dr Jerome Ikwueke referred the child to hospital in December 2006, calling for a full child protection "alert" when his mother could not explain why the child had bruises and a two-inch swelling on his forehead. However, the GP saw the child on many more occasions, including once two months earlier when he accepted claims that bruises on Baby P's head and chest had been caused by a fall. The General Medical Council suspended him after a complaint from Haringey Teaching Primary Care Trust (TCPT), which oversees the area's GP and health visitor services.

A paediatrician who failed to examine the boy because he seemed "cranky," missing the fact that his back and ribs were broken, has already been suspended. Dr Sabah al-Zayyat saw bruises on Baby P when he was referred to her child development clinic, but did not carry out a full examination, 48 hours before the child died in August 2007, after suffering appalling abuse at the hands of his mother, her boyfriend and their lodger, Jason Owen.

The probe by the Healthcare Commission examines the parts played by four organisations which came into contact with Baby P: Great Ormond Street Hospital for Children NHS Trust, Haringey TCPT, North Middlesex Hospital and the Whittington Hospital, all in north London. It is expected to be most critical of the failings of the Great Ormond Street trust, which employed Dr al-Zayyat, and of Haringey TPCT, which employed two health visitors who visited Baby P.

The inspectorate has already been involved in a review of the borough's child protection system which was published in December. Its chief executive, Anna Walker, described the case as "one of the saddest and most shocking ... on which we have ever been asked to report" and identified systems which were not adequate to enable healthcare organisations to protect children.

The new report, which follows more detailed interviews with staff at all four NHS organisations which treated Baby P, is expected to highlight poor communications between staff and different agencies which came into contact with Baby P. The report will also examine staffing levels, training, and awareness of child protection procedures.

In December, Ofsted ruled that a serious case review into the circumstances leading to the death of Baby P, which was carried out by a "safeguarding children board" headed by Sharon Shoesmith, then director of children's services for Haringey Council, was inadequate. Ms Shoesmith was subsequently sacked and Ed Balls, the Children's Secretary, demanded that a fresh review, examining the blunders made by all the agencies which came into contact with the child, report to Ofsted by the end of February. Ofsted admitted that the deadline had been missed, and Mr Balls has given officials until Friday to submit their findings.

The original report had claimed there had been "appropriate communication between and within agencies", even though Baby P was seen 78 times by social services, health workers and police during months of abuse.

As the Healthcare Commission publishes its investigation on Tuesday, the Local Government Association will launch a campaign to recruit and retain social workers following criticism of the profession in the wake of the Baby P case. Council leaders fear there will be fewer people applying to work with children and more social workers leaving their jobs as a result of the affair.

Baby P's mother, 27, her boyfriend, 32, and lodger Jason Owen, 36, have all been warned to expect significant jail sentences over the death of the child, but sentencing has been delayed for legal reasons.

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Flu spread by unvaccinated NHS frontline staff

Health workers have been blamed for putting vulnerable patients at risk and worsening the winter’s flu outbreak by refusing to have flu jabs. Fewer than one in seven frontline NHS staff had a flu jab last year, The Times has learnt, despite a recommendation that they do so. The Royal College of General Practitioners called last night for hospital doctors, GPs, nurses, carers and other staff to have compulsory jabs or be banned from contact with patients other than in exceptional circumstances. Figures to be published next week by the Department of Health will show that the vast majority of health professionals ignored government advice that everyone in direct contact with patients be immunised.

Of the hundreds of patients seriously affected by staff transmission of flu, some were infected while being treated in high-dependency wards.

The health department figures show that only 14 per cent of frontline workers had a flu jab before the 2008-09 season, despite warnings from Sir Liam Donaldson, the Chief Medical Officer for England, that immunisation rates had to improve.

The flu outbreak over Christmas and the new year was the worst for eight years, with more than 60 cases per 100,000 head of population. About 2,000 deaths are attributed to flu annually – although the number can rise to more than 10,000 in bad years. The number for this winter has not yet been released. Some hospitals suffered serious flu outbreaks exacerbated by staff transmission of the highly contagious virus, while shortages of workers put pressure on accident and emergency departments. Anecdotal reports suggest that on occasion patients brought to hospital by ambulance had to wait for up to five hours because staff were so overstretched by absenteeism and higher admission rates caused by flu.

At Royal Liverpool University Hospital, nearly 100 patients caught flu, including on high-dependency wards treating blood diseases and kidney problems.

Low levels of vaccination among staff were identified by the Health Protection Agency as a significant factor in the outbreak. When health chiefs in Liverpool asked any unvaccinated staff to get a jab to help to control the outbreak, almost 1,300 came forward. All frontline workers should be offered jabs through programmes run by health trusts from early October, at the start of the annual vaccination campaign. Uptake rates, which have been low historically, rose to close to 20 per cent of NHS frontline workers in 2005 but have fallen away since.

Dr George Kassianos, the immunisation spokesman for the Royal College, said it was incumbent on ministers and health leaders to make sure that patients were not put at greater risk from contact with the NHS. Dr Kassianos said that a form of compulsory vaccination – where anyone not wishing to have a flu jab should not be put in frontline roles unless under exceptional circumstances – should be considered. “The only way to boost the effectiveness of the flu vaccine is to immunise the people who are delivering the care – in hospitals, nursing homes, residential homes and GPs’ surgeries,” he said. “We are now so hot on infections such as MRSA, so why are we not on influenza? You are placing patients’ lives at risk if you give them the flu.

“It may make sense to say that if staff want to work in contact with patients, then they need to be immunised. We have to think of the patient on the hospital bed. They have a right not to contract flu from a carer.” Under the code of practice for health-care-acquired infections issued by the NHS, and monitored by the Healthcare Commission, trusts are required to “ensure, so far as is reasonably practicable, that healthcare workers are free of, and protected from, exposure to communicable infections”.

However, a study of NHS attitudes conducted by the Government last year found that most staff did not view flu as a serious illness and thought the vaccine unnecessary because they were not at risk. Trusts reported staff vaccine compliance as a “key problem area”.A conference was even held by the Department of Health last June for flu vaccine campaign organisers to improve NHS workers’ uptake.

Michael Summers, the vice-chairman of the Patients’ Association, said that the latest figures seen by The Times were “very concerning”. “NHS staff must lead by example. They know that patients are vulnerable to flu if they themselves are infected but also if they fall sick and have to stay at home, which will also affect patient care. They know the risks this is posing to patients.”

A health department spokesman said that the Government accepted that improvement was required, but mandatory vaccination was not being considered. [It should be a requirement of the job] “We want to see flu immunisation rates in healthcare workers increase because it will benefit both patients and staff. The recently published code of practice emphasises the need for NHS organisations to have an immunisation policy in place and to ensure staff’s immunisation status is reviewed and updated,” he said.

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Australia: Another glimpse of the nasty bureaucrats behind the trouble-prone Queensland Ambulance service

All they care about is power -- their own. So reasonable actions by ambulance officers that ran contrary to stupid bureaucratic directions get the officers punished. There has been nothing but trouble since the State government took the service over a few years ago. Bureaucracy always has the same deadening and stultifying effect

Two paramedics have been stood down from duty after refusing to risk transporting a sick baby to hospital because their ambulance had no child restraint. The Gold Coast case has sparked uproar in paramedic ranks, with claims of heavy-handed management by Queensland Ambulance Service bosses and "a culture of fear and intimidation".

Sources said the paramedics were called to a Tallebudgera Valley address on Thursday morning by the parents of a sick 10-month-old baby. They assessed the baby's condition as stable and the case non-urgent, and asked the communications centre to send a baby capsule so the baby could be transported safely to hospital. But sources said the paramedics were directed to take the baby to hospital anyway, which would have required the mother and child to be strapped to a stretcher together.

Instead, the mother opted to take the baby to hospital in her own car, which had a capsule. When the ambulance officers returned to the station, sources said they were told they had been stood down immediately for "disobeying a direction". "They were told to pack their things and leave and not return until further notice," a source said. "It was abysmal treatment and part of a culture of fear and intimidation in the QAS." The officers were reinstated four hours later after they contacted their union.

"It's an unbelievable way to treat caring and professional officers," said Prebs Sathiaseelan, the president of the Emergency Medical Services Professionals Association. "These paramedics were punished for acting in the patient's best interests. "There was absolutely no need to risk the baby's life by transporting it to hospital without a capsule. "The officers were given no explanation as to why they had been stood down. "They were made to feel guilty and inferior." One paramedic said the QAS was so short-staffed the decision not to send a baby capsule was likely due to manpower shortages.

A QAS spokeswoman said the two paramedics were stood down about 9am on Thursday for "disobeying a direction". She said the suspension was lifted four hours later after it was investigated. "QAS management have advised that no further disciplinary action will be taken," she said.

The spokeswoman said strapping a young child and parent in an ambulance stretcher was "standard practice" and capsules were suitable only for children aged up to six months.

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Australia: Deadbeat State government hospitals

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Creating a real healthcare market

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

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

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

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

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

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

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

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

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

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NHS blunders are behind a spate of 'vaccine overloads'

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

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

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

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

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

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

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

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

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

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Nannystate medicrat care

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

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

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

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

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

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

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NHS now kicking patients out too early

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

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

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

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

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NHS apology over 100-mile birth journey

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

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

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

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

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NHS blunders set schizophrenic patient free to stab woman 21 times

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

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

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

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

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

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

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

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

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

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

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The moral hazard problem of socialized healthcare

Ezra Klein quotes approvingly a section of Michael Pollans In Defense Of Food on the high level of diabetes in those eating a Western-style diet. In response, he almost seems to be suggesting that there's a moral hazard problem of socialized healthcare:

A diagnosis of diabetes subtract roughly twelve years from one's life and living with the condition incurs medical costs of $13,000 a year (compared with $2,500 for someone without diabetes).

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

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

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

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

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

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

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

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NHS hospitals fail to do routine checks on suspiciously injured children

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

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

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

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

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

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

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

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UK: Millions opt for DoItYourself dentistry

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

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

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

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

Popping an ulcer with a pin (19%)

Trying to mend or alter dentures (8%)

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

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

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

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

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

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

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

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

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

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

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

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

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Australia: Dentists lash out at socialization plan

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

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

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

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

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

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

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

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

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NHS criticised in half of complaints reviewed

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

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

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

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Australian public hospitals have triple the baby deaths of private

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

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

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

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

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

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

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