British government hospitals to pay for harming patients
A big step forward for Britain but it is a pity the taxpayer will be paying. What about the negligent managers, doctors and staff?
All hospitals should be fined if patients contract superbug infections or are harmed by medical errors while in their care, the Government's Chief Medical Officer said yesterday. Setting out a radical plan to tackle the NHS's record on patient safety, Sir Liam Donaldson said that the taxpayer should not foot the bill for treating patients who had suffered bad or unsafe care.
Instead, NHS hospitals and clinics involved in botched surgery, prescribing errors or superbug infections such as MRSA or Clostridium difficile should be penalised for the extra treatment required. The proposals - which are to be put before Lord Darzi of Denham, Health Minister, in his ongoing NHS review - are designed to reduce the rate of error and death. More than 733,000 "patient safety incidents" occurred last year, causing the deaths of more than 3,000 patients.
Sir Ian Carruthers, who stepped down as chief executive of the NHS last year, agreed that urgent action was needed to end a culture of sweeping safety issues under the carpet. He added that only a "miniscule" amount of energy in the NHS was currently focused on the issue. Safety errors currently cost the NHS an estimated 3.4 billion in extra treatment and compensation. The recommendations follow a damning report by MPs which branded the National Patient Safety Agency (NPSA), the watchdog charged with monitoring and improving the safety of care, as "dysfunctional". Sir Liam said that there were now signs of progress in the monitoring of incidents - with more logged by the NPSA that in other countries - but avoidable and often "incredulous" mistakes were still being made in a range of areas, from radiotherapy to patient falls.
"Why should the health service, funded by the taxpayer, pay for the care of a patient that's had bad or unsafe care?," Sir Liam said. "In any other walk of life if you receive very bad service then you don't pay for it, you get a refund, and I don't think it should be any different in the health service. "If someone develops MRSA and has to stay in hospital longer to be treated, why should it be funded?"
Under the plans, hospitals responsible for harming patients will have a portion of their budget withheld to cover the cost of treatment to remedy the mistake. Hospitals would likely face set tariffs for different types of blunder or infection. Sir Liam said that while withholding money was a controversial strategy, it was the a very powerful "lever for change". "You can't have enough incentives to improve patient care and primary care trusts hold most of the budget for the NHS. They fund hospital care and as such are a great lever for change."
Of the 733,070 safety incidents in the year to this June, more than half a million occurred in hospitals. The errors resulted in 3,006 deaths, caused "severe harm" to 6,144 patients, and "moderate harm" in 42,047 cases. MRSA, or methicillin-resistant Staphylococcus aureus, infected a further 6,381 patients last year while the more virulent C. Difficile caused 55,000 infections.
Sir Liam's comments came as the Government published its Operating Framework for the NHS, which makes tackling hospital infections and hitting waiting targets key priorities for the coming year. The framework suggests penalising hospitals for failing to meet two high-profile targets in 2008 - halving MRSA rates by April and ensuring patients are treated within 18 weeks. However the NHS is expected to miss the three-year MRSA target by a long way.
Sir Ian Carruthers, who is now head of NHS South West, said that urgent action was a must and financial penalties were a welcome driver for change. "Our culture is to pretend things don't happen or to recognise they do but try to deal with them outside any processes. If we continue to do that, we won't make the impact in making the changes we require. "Even with best practice and best evidence, somebody argues against it."
In the United States, some states require hospitals by law to report so-called "never events" - a list of medical errors that are considered so preventable and so serious that they should never happen. One hospital in Rhode Island, was recently fined $50,000 for performing "wrong site" surgery on a patient for the third time this year. Sir Liam said similar fines should be brought in to the NHS to act as a "hard-nosed financial incentive" for hospitals to provide better care.
Source
Saturday, December 15, 2007
Friday, December 14, 2007
Moral Health Care vs. "Universal Health Care"
Contrary to claims that government-imposed "universal health care" would solve America's health care problems, it would in fact destroy American medicine and countless lives along with it. The goal of "universal health care" (a euphemism for socialized medicine) is both immoral and impractical; it violates the rights of businessmen, doctors, and patients to act on their own judgment-which, in turn, throttles their ability to produce, administer, or purchase the goods and services in question. To show this, we will first examine the nature and history of government involvement in health insurance and medicine. Then we will consider attempts in other countries and various U.S. states to solve these problems through further government programs. Finally, we will show that the only viable long-term solution to the problems in question is to convert to a fully free market in health care and health insurance.
Although health care and health insurance are often conflated, there is a crucial difference between the two. Whereas health care consists of the actual goods and services necessary for medical care, health insurance is one means of affording such care. The two are closely related but distinct, as are the services of an auto-body repair shop and an automobile insurance company.
Unlike those in more openly socialist countries who obtain health insurance directly from the government, Americans typically purchase health insurance from increasingly government-controlled insurance corporations, giving health insurance in America the veneer of a free-market industry. Behind the veneer, however, the industry is subject to countless state and federal laws, regulations, and taxes-which do not apply to all insurance companies equally.
In addition to taxing insurance companies on the premiums they collect, states typically require them to set aside monetary "reserves" to cover future claims. But some companies have been exempted from these taxes and requirements. During the Great Depression, hospitals and doctors organized their own insurance companies, known respectively as Blue Cross and Blue Shield (or "the Blues"). The Blues lobbied and convinced the states to treat them as nonprofit charity corporations rather than "for-profit" insurance companies, on the grounds that they were organized by doctors and hospitals. The Blues also requested and received tax-exempt status from the federal government. In return for their nonprofit status, the Blues agreed to offer health insurance on the basis of "community rating," which meant that every customer would pay the same premium, regardless of age, sex, health history, lifestyle choices, or regional demographics.11 (This was occasionally modified to reflect different premiums for age and location and was then called "modified community rating.")
Commercial insurers-who were still required to pay taxes, establish reserves, and adhere to other state insurance regulations-had difficulty competing with the Blues, which, by the 1950s, together were the largest provider of health insurance in America.12
The primary goal of the Blues was to obtain steady income for their member doctors and hospitals by guaranteeing that they received payment for all the services they provided. Their strategy was to provide coverage for all expenses-even routine, ordinary, easily affordable medical services. In contrast to the original purpose of health insurance-which was to protect against rare, unforeseen, catastrophic expenses that could bankrupt a family-the Blues turned health insurance into a form of pre-paid medical care in which the insurance company (rather than patients) would pay doctors and hospitals for all medical services-catastrophic, routine, and everything in between-on a cost-plus basis. In an effort to compete with the Blues, more and more for-profit insurance companies offered similar plans, and the model of third-party insurance plans paying the providers directly with little or no input from the patient-and paying for routine care through insurance-became entrenched. This new model was a disaster in the making. In addition to minimizing incentives for insured customers to comparison shop for medical services, it also minimized incentives for doctors and hospitals to compete on price.13
The model created by the Blues and followed by commercial insurers was not the result of free-market thinking and competition. It was a direct result of government meddling and intervention, giving preferential treatment and economic advantages to one insurer (and its health plans) over others. This initial distortion of the health insurance market was exacerbated by the 1942 Stabilization Act, passed during World War II. This act froze wages nationwide but allowed employers to provide or increase employee benefits such as health insurance, since benefits were not considered wages under the Act. In 1943, in response to the Act, the IRS decreed that health insurance premiums paid by employers are not taxable income to employees and are therefore exempt from federal income tax. The IRS further decreed that health insurance premiums are a legitimate cost of doing business and can be deducted from the employer's taxable income.14 These decrees were later codified into the Internal Revenue Code of 1954.
These income tax laws are largely responsible for the explosive growth in employer-purchased health insurance. In 1939, only 6 percent of the population had health insurance of any kind, and only a small fraction of those insured had employer-sponsored health insurance.15 By 1960, 18 percent of the population was insured under an employer group plan, and that percentage grew to almost 70 percent of the insured by 1980.16 The percentage has since declined, but even today about 60 percent of insured Americans obtain health insurance through their employer.17
This preferential government treatment of Blue Cross and Blue Shield over other insurance plans, combined with the tax breaks to recipients of employer-sponsored health insurance plans, has wreaked havoc in the American health insurance industry in myriad ways.
When employers pay for health insurance, employees tend to remain largely unaware of the costs involved. And even if they are aware of the costs, because the insurance is paid for with pretax dollars, employees cannot as easily compare its value to that of other benefits such as vacation time, personal days, or retirement savings. Further, because employer-paid health insurance premiums are not taxed as income, many employees come to think of them as a normal condition or an entitlement of employment and feel shortchanged when the employer tries to shift part of the cost to them.
Because employees do not own their plans, and because the employer is insuring a group without regard to any one individual's condition, individuals with employer-purchased policies have little or no say about the policy under which they will be insured. As the Joint Economic Committee of the U.S. Senate reports, nearly four out of ten workers with employer coverage have no choice of health plans, and less than half have a choice of more than two plans.18
Having not been in charge of evaluating, comparing, or selecting their health insurance plans-having paid little or no attention to the various costs involved or the types of benefits offered-many employees, when given a choice, opt for "smaller" out-of-pocket costs and "greater" benefits, and grumble when the former increase or the latter decrease.
Whereas people generally keep the same auto or homeowners insurance for many years, employees rarely have the same health insurance for more than two or three years, even while remaining with the same employer, because the employer chooses and changes the plans at his discretion, usually with an eye toward minimizing premium costs. Unlike auto insurance policies, under which the insurers often give significant discounts to safe owner-drivers in order to retain them as long-term customers, under employer-sponsored health insurance, the employers, not the employees, are the customers, and there is little, if any, financial incentive for insurers to build long-term relationships with the employees.
Another drawback to employer-paid insurance policies is that they make it difficult for employees to keep sensitive health issues from employers. Many large employers are self-insured, which means that the employer sets aside money it would have paid as insurance premiums, and, instead, directly pays the claims of its employees (and their families). Generally, the employer buys a catastrophic policy or a reinsurance policy for losses in excess of a huge deductible. In those cases, the employer/insurer is very much aware of every dollar that is spent for any claims, and, because it is paying the bills, may even have access to all of an employee's (or his family's) medical information.
Additionally, the tax waiver for employer-paid health insurance has tied workers to their employers in a damaging way. Many workers with preexisting conditions or serious chronic illnesses-or who have spouses or children with such conditions and illnesses-stay in less than desirable jobs solely to avoid the risk of changing or losing their health insurance. Currently, one out of seven Americans says he needs to remain in his current job rather than take a new job in order to keep his health insurance benefits.19
Employer-paid insurance has also been hard on employers. As health insurance costs have risen faster than other costs, premium increases amount to an increase in wage costs disproportionate to revenue increases and independent of employee productivity. This is the reason that many employers are cutting back the amount of money they spend on health insurance, trimming benefit packages, increasing employee co-pays, and requiring employees to pay a larger portion of the actual insurance cost.
Further, as indicated earlier, employer-sponsored insurance treats a large minority of the population unfairly through unequal tax laws. Whereas employees with an employer-paid health plan get their benefits tax-free, individuals who purchase health insurance on their own do so with after-tax dollars. Consequently, a person buying an individual policy may pay up to 30 percent more (depending on his tax bracket) for the same policy benefits.
Given the existing tax burden on Americans and their justified efforts to legally shield their money from tax collectors, the tax-exempt nature of employee-paid health insurance further raises the costs of health insurance. To understand this, consider that homeowners generally pay for their own house maintenance such as lawn work, painting, and remodeling. Routine maintenance is not covered by homeowners insurance; only damages resulting from a tornado, fire, vandals, or some other catastrophic event are covered. But suppose the government suddenly decreed that it would exempt from income taxes any money spent on homeowners insurance. This would reduce taxes for insurance-paid repairs. Accordingly, people would seek insurance policies that cover routine home maintenance, such as painting, carpet replacement, and fence and deck maintenance-and insurers would provide them. Although these new policies would cost more, they would seem on the surface to be a bargain because homeowners would be spending untaxed dollars. Demand for home repairs would skyrocket. More money would be spent on home maintenance, and the cost of home insurance would quickly outpace that of other goods and services. To remain in business, home insurers would limit coverage for more expensive repairs. Simultaneously, to curry favor with their constituents, politicians would seek mandates to expand coverage, and, of course, they would demand further regulations to make sure that poor homeowners had "access" to homeowners insurance. This is precisely what has happened with health insurance.
Just as spending money in that way would make economic sense under that tax law, so using employer-sponsored health insurance to pay for small claims makes sense under the current tax laws. David Henderson, who served on President Reagan's Council of Economic Advisers as a senior economist for health care policy, observes:
The employee is better off to charge a $50 doctor bill to the insurance company-even if the [insurance] company spends $20 to process it-and have the employer pay the extra $70 in a higher premium to cover the bill and the processing cost. The alternative-having the employer pay [the employee] an extra $70 in cash-yields the employee only about $42 [because of federal income, social security, and Medicare taxes] and costs the employer $75.36 ($70 + $5.36, the employer's portion of the social security and Medicare tax on $70).20
The current system of employer-sponsored health insurance is a catastrophe, and it is a result of government intervention in the free market. Such intervention violates the rights of insurance companies, employers, and consumers by granting special government favors to certain insurance companies or plans, by forcibly eliminating options that would exist in a free market, and by forcibly seizing money from insurers and the insured. It artificially places employers and insurers between doctors and patients and leads to innumerable economic distortions. Employers and insurers dictate everything from which doctors and specialists employees will be permitted to visit under the plan, to the kinds of benefits that will and will not be provided, to the co-payments and deductibles that will be paid. Because third parties are paying for both insurance and health care, the employee-patient-customer has little choice in what kind of insurance or who provides the health care he receives-and plenty of incentive to visit a doctor anytime he has a runny nose. The fact that third parties pay for all health care increases the administrative costs for doctors as well as insurers, and those costs are passed on to consumers.
These problems were further exacerbated in the mid-1960s with the creation of two federal insurance programs: Medicare (for the aged) and Medicaid (for the poor). Both had major effects on the private insurance market. When Medicare was proposed, advocates claimed that it would not interfere with the doctor-patient relationship or patient choice-it would merely pay the bills. In fact, however, it has drastically changed the doctor-patient relationship and sharply limited patient choice. Medicare determines what procedures and treatments are "appropriate" and "medically necessary." It also determines the monetary "value" of a diagnosis, treatment, or procedure. Both patient and doctor must abide by Medicare's decision; and, despite low Medicare reimbursements, doctors cannot accept any money from a patient beyond what Medicare pays, even if the patient so desires.21
Doctors are paid so poorly by Medicare and burdened by so much paperwork that about 28 percent are turning away some or all new Medicare patients.22 Hence, newer Medicare patients often cannot find a doctor in their area who will treat them at all. Such "insurance" does these patients no good. Nor do they have any private insurance alternative. With the insignificant exception of Medigap policies, Medicare has eliminated the private insurance market for the elderly, and many elderly patients are left with no way to seek medical treatment except through hospital emergency rooms or charity. (A person who purchases a private policy prior to turning sixty-five may be able to retain it after turning sixty-five, but such a policy will then only supplement Medicare.)
Medicaid is a bigger problem. Medicaid reimbursement rates for doctors and other providers are generally even lower than they are for Medicare, and many doctors opt out of treating Medicaid patients. Only about 52 percent of doctors accept new Medicaid patients, whereas 99 percent will accept new private insurance patients.23 Moreover, many doctors who do take Medicaid patients limit the number of Medicaid patients they see each week so that they can control their income loss. It is not unusual for a Medicaid patient to have no family doctor because he cannot find a nearby doctor who will treat him, a problem that is especially severe in rural areas. As a result, for years Medicaid patients have used emergency rooms as their regular source of treatment: Emergency rooms charge no co-pay or deductible; they perform tests right away; they generally provide high-quality health care; and they cannot refuse patients. (We will elaborate on this last point later.)
In financial terms, Medicare and Medicaid are bankrupting our state and federal governments. These two federal insurance programs compose nearly 20 percent of the federal budget, and the percentage keeps rising. In addition, for most states Medicaid is the largest single budget item, averaging 22 percent of states' spending. Medicaid is generally administered by the state, with matching federal tax dollars. As a result, states seek to expand Medicaid coverage and other medical programs such as SCHIP (State Children's Health Insurance Program) in order to reap more of the matching federal dollars. Eligibility for these programs continues to expand, and, in some states, families with incomes as high as $55,000 are now eligible for Medicaid benefits. Federal, state, and local governments now pay 50 percent of every dollar spent on health care, even though government health insurance covers only 27 percent of the population.24
By tying health insurance to employment through the income tax law-by providing preferential legal status and tax treatment to nonprofit companies and their payment plans for routine services-and by establishing government health insurance for the aged and the poor in the form of Medicare and Medicaid, the government has created a system that violates individual rights and fosters an entitlement mentality.
Much more here
Contrary to claims that government-imposed "universal health care" would solve America's health care problems, it would in fact destroy American medicine and countless lives along with it. The goal of "universal health care" (a euphemism for socialized medicine) is both immoral and impractical; it violates the rights of businessmen, doctors, and patients to act on their own judgment-which, in turn, throttles their ability to produce, administer, or purchase the goods and services in question. To show this, we will first examine the nature and history of government involvement in health insurance and medicine. Then we will consider attempts in other countries and various U.S. states to solve these problems through further government programs. Finally, we will show that the only viable long-term solution to the problems in question is to convert to a fully free market in health care and health insurance.
Although health care and health insurance are often conflated, there is a crucial difference between the two. Whereas health care consists of the actual goods and services necessary for medical care, health insurance is one means of affording such care. The two are closely related but distinct, as are the services of an auto-body repair shop and an automobile insurance company.
Unlike those in more openly socialist countries who obtain health insurance directly from the government, Americans typically purchase health insurance from increasingly government-controlled insurance corporations, giving health insurance in America the veneer of a free-market industry. Behind the veneer, however, the industry is subject to countless state and federal laws, regulations, and taxes-which do not apply to all insurance companies equally.
In addition to taxing insurance companies on the premiums they collect, states typically require them to set aside monetary "reserves" to cover future claims. But some companies have been exempted from these taxes and requirements. During the Great Depression, hospitals and doctors organized their own insurance companies, known respectively as Blue Cross and Blue Shield (or "the Blues"). The Blues lobbied and convinced the states to treat them as nonprofit charity corporations rather than "for-profit" insurance companies, on the grounds that they were organized by doctors and hospitals. The Blues also requested and received tax-exempt status from the federal government. In return for their nonprofit status, the Blues agreed to offer health insurance on the basis of "community rating," which meant that every customer would pay the same premium, regardless of age, sex, health history, lifestyle choices, or regional demographics.11 (This was occasionally modified to reflect different premiums for age and location and was then called "modified community rating.")
Commercial insurers-who were still required to pay taxes, establish reserves, and adhere to other state insurance regulations-had difficulty competing with the Blues, which, by the 1950s, together were the largest provider of health insurance in America.12
The primary goal of the Blues was to obtain steady income for their member doctors and hospitals by guaranteeing that they received payment for all the services they provided. Their strategy was to provide coverage for all expenses-even routine, ordinary, easily affordable medical services. In contrast to the original purpose of health insurance-which was to protect against rare, unforeseen, catastrophic expenses that could bankrupt a family-the Blues turned health insurance into a form of pre-paid medical care in which the insurance company (rather than patients) would pay doctors and hospitals for all medical services-catastrophic, routine, and everything in between-on a cost-plus basis. In an effort to compete with the Blues, more and more for-profit insurance companies offered similar plans, and the model of third-party insurance plans paying the providers directly with little or no input from the patient-and paying for routine care through insurance-became entrenched. This new model was a disaster in the making. In addition to minimizing incentives for insured customers to comparison shop for medical services, it also minimized incentives for doctors and hospitals to compete on price.13
The model created by the Blues and followed by commercial insurers was not the result of free-market thinking and competition. It was a direct result of government meddling and intervention, giving preferential treatment and economic advantages to one insurer (and its health plans) over others. This initial distortion of the health insurance market was exacerbated by the 1942 Stabilization Act, passed during World War II. This act froze wages nationwide but allowed employers to provide or increase employee benefits such as health insurance, since benefits were not considered wages under the Act. In 1943, in response to the Act, the IRS decreed that health insurance premiums paid by employers are not taxable income to employees and are therefore exempt from federal income tax. The IRS further decreed that health insurance premiums are a legitimate cost of doing business and can be deducted from the employer's taxable income.14 These decrees were later codified into the Internal Revenue Code of 1954.
These income tax laws are largely responsible for the explosive growth in employer-purchased health insurance. In 1939, only 6 percent of the population had health insurance of any kind, and only a small fraction of those insured had employer-sponsored health insurance.15 By 1960, 18 percent of the population was insured under an employer group plan, and that percentage grew to almost 70 percent of the insured by 1980.16 The percentage has since declined, but even today about 60 percent of insured Americans obtain health insurance through their employer.17
This preferential government treatment of Blue Cross and Blue Shield over other insurance plans, combined with the tax breaks to recipients of employer-sponsored health insurance plans, has wreaked havoc in the American health insurance industry in myriad ways.
When employers pay for health insurance, employees tend to remain largely unaware of the costs involved. And even if they are aware of the costs, because the insurance is paid for with pretax dollars, employees cannot as easily compare its value to that of other benefits such as vacation time, personal days, or retirement savings. Further, because employer-paid health insurance premiums are not taxed as income, many employees come to think of them as a normal condition or an entitlement of employment and feel shortchanged when the employer tries to shift part of the cost to them.
Because employees do not own their plans, and because the employer is insuring a group without regard to any one individual's condition, individuals with employer-purchased policies have little or no say about the policy under which they will be insured. As the Joint Economic Committee of the U.S. Senate reports, nearly four out of ten workers with employer coverage have no choice of health plans, and less than half have a choice of more than two plans.18
Having not been in charge of evaluating, comparing, or selecting their health insurance plans-having paid little or no attention to the various costs involved or the types of benefits offered-many employees, when given a choice, opt for "smaller" out-of-pocket costs and "greater" benefits, and grumble when the former increase or the latter decrease.
Whereas people generally keep the same auto or homeowners insurance for many years, employees rarely have the same health insurance for more than two or three years, even while remaining with the same employer, because the employer chooses and changes the plans at his discretion, usually with an eye toward minimizing premium costs. Unlike auto insurance policies, under which the insurers often give significant discounts to safe owner-drivers in order to retain them as long-term customers, under employer-sponsored health insurance, the employers, not the employees, are the customers, and there is little, if any, financial incentive for insurers to build long-term relationships with the employees.
Another drawback to employer-paid insurance policies is that they make it difficult for employees to keep sensitive health issues from employers. Many large employers are self-insured, which means that the employer sets aside money it would have paid as insurance premiums, and, instead, directly pays the claims of its employees (and their families). Generally, the employer buys a catastrophic policy or a reinsurance policy for losses in excess of a huge deductible. In those cases, the employer/insurer is very much aware of every dollar that is spent for any claims, and, because it is paying the bills, may even have access to all of an employee's (or his family's) medical information.
Additionally, the tax waiver for employer-paid health insurance has tied workers to their employers in a damaging way. Many workers with preexisting conditions or serious chronic illnesses-or who have spouses or children with such conditions and illnesses-stay in less than desirable jobs solely to avoid the risk of changing or losing their health insurance. Currently, one out of seven Americans says he needs to remain in his current job rather than take a new job in order to keep his health insurance benefits.19
Employer-paid insurance has also been hard on employers. As health insurance costs have risen faster than other costs, premium increases amount to an increase in wage costs disproportionate to revenue increases and independent of employee productivity. This is the reason that many employers are cutting back the amount of money they spend on health insurance, trimming benefit packages, increasing employee co-pays, and requiring employees to pay a larger portion of the actual insurance cost.
Further, as indicated earlier, employer-sponsored insurance treats a large minority of the population unfairly through unequal tax laws. Whereas employees with an employer-paid health plan get their benefits tax-free, individuals who purchase health insurance on their own do so with after-tax dollars. Consequently, a person buying an individual policy may pay up to 30 percent more (depending on his tax bracket) for the same policy benefits.
Given the existing tax burden on Americans and their justified efforts to legally shield their money from tax collectors, the tax-exempt nature of employee-paid health insurance further raises the costs of health insurance. To understand this, consider that homeowners generally pay for their own house maintenance such as lawn work, painting, and remodeling. Routine maintenance is not covered by homeowners insurance; only damages resulting from a tornado, fire, vandals, or some other catastrophic event are covered. But suppose the government suddenly decreed that it would exempt from income taxes any money spent on homeowners insurance. This would reduce taxes for insurance-paid repairs. Accordingly, people would seek insurance policies that cover routine home maintenance, such as painting, carpet replacement, and fence and deck maintenance-and insurers would provide them. Although these new policies would cost more, they would seem on the surface to be a bargain because homeowners would be spending untaxed dollars. Demand for home repairs would skyrocket. More money would be spent on home maintenance, and the cost of home insurance would quickly outpace that of other goods and services. To remain in business, home insurers would limit coverage for more expensive repairs. Simultaneously, to curry favor with their constituents, politicians would seek mandates to expand coverage, and, of course, they would demand further regulations to make sure that poor homeowners had "access" to homeowners insurance. This is precisely what has happened with health insurance.
Just as spending money in that way would make economic sense under that tax law, so using employer-sponsored health insurance to pay for small claims makes sense under the current tax laws. David Henderson, who served on President Reagan's Council of Economic Advisers as a senior economist for health care policy, observes:
The employee is better off to charge a $50 doctor bill to the insurance company-even if the [insurance] company spends $20 to process it-and have the employer pay the extra $70 in a higher premium to cover the bill and the processing cost. The alternative-having the employer pay [the employee] an extra $70 in cash-yields the employee only about $42 [because of federal income, social security, and Medicare taxes] and costs the employer $75.36 ($70 + $5.36, the employer's portion of the social security and Medicare tax on $70).20
The current system of employer-sponsored health insurance is a catastrophe, and it is a result of government intervention in the free market. Such intervention violates the rights of insurance companies, employers, and consumers by granting special government favors to certain insurance companies or plans, by forcibly eliminating options that would exist in a free market, and by forcibly seizing money from insurers and the insured. It artificially places employers and insurers between doctors and patients and leads to innumerable economic distortions. Employers and insurers dictate everything from which doctors and specialists employees will be permitted to visit under the plan, to the kinds of benefits that will and will not be provided, to the co-payments and deductibles that will be paid. Because third parties are paying for both insurance and health care, the employee-patient-customer has little choice in what kind of insurance or who provides the health care he receives-and plenty of incentive to visit a doctor anytime he has a runny nose. The fact that third parties pay for all health care increases the administrative costs for doctors as well as insurers, and those costs are passed on to consumers.
These problems were further exacerbated in the mid-1960s with the creation of two federal insurance programs: Medicare (for the aged) and Medicaid (for the poor). Both had major effects on the private insurance market. When Medicare was proposed, advocates claimed that it would not interfere with the doctor-patient relationship or patient choice-it would merely pay the bills. In fact, however, it has drastically changed the doctor-patient relationship and sharply limited patient choice. Medicare determines what procedures and treatments are "appropriate" and "medically necessary." It also determines the monetary "value" of a diagnosis, treatment, or procedure. Both patient and doctor must abide by Medicare's decision; and, despite low Medicare reimbursements, doctors cannot accept any money from a patient beyond what Medicare pays, even if the patient so desires.21
Doctors are paid so poorly by Medicare and burdened by so much paperwork that about 28 percent are turning away some or all new Medicare patients.22 Hence, newer Medicare patients often cannot find a doctor in their area who will treat them at all. Such "insurance" does these patients no good. Nor do they have any private insurance alternative. With the insignificant exception of Medigap policies, Medicare has eliminated the private insurance market for the elderly, and many elderly patients are left with no way to seek medical treatment except through hospital emergency rooms or charity. (A person who purchases a private policy prior to turning sixty-five may be able to retain it after turning sixty-five, but such a policy will then only supplement Medicare.)
Medicaid is a bigger problem. Medicaid reimbursement rates for doctors and other providers are generally even lower than they are for Medicare, and many doctors opt out of treating Medicaid patients. Only about 52 percent of doctors accept new Medicaid patients, whereas 99 percent will accept new private insurance patients.23 Moreover, many doctors who do take Medicaid patients limit the number of Medicaid patients they see each week so that they can control their income loss. It is not unusual for a Medicaid patient to have no family doctor because he cannot find a nearby doctor who will treat him, a problem that is especially severe in rural areas. As a result, for years Medicaid patients have used emergency rooms as their regular source of treatment: Emergency rooms charge no co-pay or deductible; they perform tests right away; they generally provide high-quality health care; and they cannot refuse patients. (We will elaborate on this last point later.)
In financial terms, Medicare and Medicaid are bankrupting our state and federal governments. These two federal insurance programs compose nearly 20 percent of the federal budget, and the percentage keeps rising. In addition, for most states Medicaid is the largest single budget item, averaging 22 percent of states' spending. Medicaid is generally administered by the state, with matching federal tax dollars. As a result, states seek to expand Medicaid coverage and other medical programs such as SCHIP (State Children's Health Insurance Program) in order to reap more of the matching federal dollars. Eligibility for these programs continues to expand, and, in some states, families with incomes as high as $55,000 are now eligible for Medicaid benefits. Federal, state, and local governments now pay 50 percent of every dollar spent on health care, even though government health insurance covers only 27 percent of the population.24
By tying health insurance to employment through the income tax law-by providing preferential legal status and tax treatment to nonprofit companies and their payment plans for routine services-and by establishing government health insurance for the aged and the poor in the form of Medicare and Medicaid, the government has created a system that violates individual rights and fosters an entitlement mentality.
Much more here
Thursday, December 13, 2007
British government body decides that it can afford to prevent blindness after all
Thousands of people at risk from blindness may have access to a sight-saving drug after a U-turn by NICE, the body that decides whether NHS treatments are cost effective. Reports last night said that NICE will change guidelines that restrict the drug Lucentis to only a fifth of NHS patients. The treatment helps those with wet age-related macular degeneration, the main cause of blindness in Britain.
Source
NPR does not know what "socialized medicine" means
Or so it seems from the article below. They like crazy Kucinich, though
In the debate over health care on the campaign trail, the term "socialized medicine" is getting thrown around more and more often. It is almost never a compliment. But the politically loaded phrase means different things to different people. For example, when Democratic Sen. Hillary Clinton unveiled her health plan in September, it included a requirement that all individuals have health insurance.
Republican rival Mitt Romney labeled the plan "socialized medicine" in his critique. "It's a European-style socialized medicine plan," he said. "That's where it leads, and that's the wrong direction for America." Romney's fellow Republican candidate Rudolph Giuliani extends that label to all of the Democratic front-runners' plans, even though Sen. Barack Obama's wouldn't require everyone to be insured. "Whether it's HillaryCare or ObamaCare or EdwardsCare, the idea that it's not socialized medicine is a trick," Giuliani said. "It's a massive growth of government control of medicine."
But what is socialized medicine? "The term socialized medicine, technically, to most health policy analysts, actually doesn't mean anything at all," says Jonathan Oberlander, a professor of health policy at the University of North Carolina. Oberlander says the phrase actually dates back to the American Medical Association's fights against national health insurance in the early decades of the 1900s. "The AMA used it to mean any kind of proposal that involved an increased role for the government in the health care system," he says. "They also used it to mean things in the private system that they didn't like. So, at one point, HMOs were a form of socialized medicine."
In terms of government programs, Oberlander says it was used against Medicare in the 1960s, and prenatal care in the 1920s and 1930s. "It really is a term that is very flexible, and because it means nothing precisely, you can define everything by it." These days, there is one potentially accurate use of the phrase, Oberlander says. It can be used to make the distinction between a so-called single-payer health care system - where the government pays all the health care bills - and a truly government-operated health system, he says. "When you talk about Europe, and you talk about a British system where the hospitals are owned by the government and the doctors are directly employed by the government, then you might say that's socialized medicine," Oberlander says. But that is different from what most single-payer proposals would do. "There, you would essentially have government financing, just like you do with Medicare, but you would continue to have private practicing physicians and private hospitals," Oberlander says.
None of the leading Democratic candidates, however, has proposed anything like a single-payer system, much less a fully government-run program like Britain's National Health Service. One candidate, Rep. Dennis Kucinich, does support the leading single-payer proposal in Congress. But that bill would also give the federal government authority to determine the number and location of health facilities. So, it would go quite a bit further than other single-payer systems like Medicare in the U.S., or even like Canada's system.
In a forum with health reporters earlier this fall, Kucinich was asked directly if that meant what he supports wasn't more like England's government-operated system than Canada's single-payer plan. "Is it like the U.K.'s? Somewhat similar. And it's similar in form to many of the industrial democracies of the world where they provide health care to their people," Kucinich responded.
Source
Thousands of people at risk from blindness may have access to a sight-saving drug after a U-turn by NICE, the body that decides whether NHS treatments are cost effective. Reports last night said that NICE will change guidelines that restrict the drug Lucentis to only a fifth of NHS patients. The treatment helps those with wet age-related macular degeneration, the main cause of blindness in Britain.
Source
NPR does not know what "socialized medicine" means
Or so it seems from the article below. They like crazy Kucinich, though
In the debate over health care on the campaign trail, the term "socialized medicine" is getting thrown around more and more often. It is almost never a compliment. But the politically loaded phrase means different things to different people. For example, when Democratic Sen. Hillary Clinton unveiled her health plan in September, it included a requirement that all individuals have health insurance.
Republican rival Mitt Romney labeled the plan "socialized medicine" in his critique. "It's a European-style socialized medicine plan," he said. "That's where it leads, and that's the wrong direction for America." Romney's fellow Republican candidate Rudolph Giuliani extends that label to all of the Democratic front-runners' plans, even though Sen. Barack Obama's wouldn't require everyone to be insured. "Whether it's HillaryCare or ObamaCare or EdwardsCare, the idea that it's not socialized medicine is a trick," Giuliani said. "It's a massive growth of government control of medicine."
But what is socialized medicine? "The term socialized medicine, technically, to most health policy analysts, actually doesn't mean anything at all," says Jonathan Oberlander, a professor of health policy at the University of North Carolina. Oberlander says the phrase actually dates back to the American Medical Association's fights against national health insurance in the early decades of the 1900s. "The AMA used it to mean any kind of proposal that involved an increased role for the government in the health care system," he says. "They also used it to mean things in the private system that they didn't like. So, at one point, HMOs were a form of socialized medicine."
In terms of government programs, Oberlander says it was used against Medicare in the 1960s, and prenatal care in the 1920s and 1930s. "It really is a term that is very flexible, and because it means nothing precisely, you can define everything by it." These days, there is one potentially accurate use of the phrase, Oberlander says. It can be used to make the distinction between a so-called single-payer health care system - where the government pays all the health care bills - and a truly government-operated health system, he says. "When you talk about Europe, and you talk about a British system where the hospitals are owned by the government and the doctors are directly employed by the government, then you might say that's socialized medicine," Oberlander says. But that is different from what most single-payer proposals would do. "There, you would essentially have government financing, just like you do with Medicare, but you would continue to have private practicing physicians and private hospitals," Oberlander says.
None of the leading Democratic candidates, however, has proposed anything like a single-payer system, much less a fully government-run program like Britain's National Health Service. One candidate, Rep. Dennis Kucinich, does support the leading single-payer proposal in Congress. But that bill would also give the federal government authority to determine the number and location of health facilities. So, it would go quite a bit further than other single-payer systems like Medicare in the U.S., or even like Canada's system.
In a forum with health reporters earlier this fall, Kucinich was asked directly if that meant what he supports wasn't more like England's government-operated system than Canada's single-payer plan. "Is it like the U.K.'s? Somewhat similar. And it's similar in form to many of the industrial democracies of the world where they provide health care to their people," Kucinich responded.
Source
Wednesday, December 12, 2007
British elderly to get control of their own care budget
An amazingly sensible innovation by British standards. Will this be extended to ALL healthcare one day? We should hope it is
Elderly people will be given money to pay for their own care as part of a radical shake-up of the welfare system, Alan Johnson, the Health Secretary, will announce today. The new personal care budgets will give millions of pensioners and younger disabled people the power to decide what kind of care they want and where they buy it. Currently, elderly people are at the mercy of social workers who dictate the services they need to live in their own homes.
Under the new system, which will be introduced next April, older people or their families will set up bank accounts into which councils will pay a monthly sum. Beneficiaries will be means-tested to assess their needs before they are able to shop around for the best "personal care" packages, which will include help with getting dressed or washed, meals on wheels, cleaning services and cooking.
Mr Johnson will announce that councils in England and Wales will be given 520 million pounds over the next three years to fund the new system. "Our commitment that the majority of social care funding will be controlled by individuals through personal budgets represents a radical transfer or power from the state to the public," he will say. "Everyone, irrespective of their illness or disability has the right to self-developments and maximum control over their own lives."
Charities campaigning for better services for the elderly welcomed the move. "We welcome any move to give elderly people more choice about the services they receive in their home," said Mervyn Kohler, a special advisor for Help the Aged. "But we want assurance that they will be given guidance on the services out there. For example, who are the reputable companies? What are the different prices?" Gordon Lishman, the director general of Age Concern, said: "It is absolutely right to put older people's needs at the centre of the care system and to place a clear emphasis on preventive services. "Older people and their families will continue to need information and support to help them negotiate the best care package at the best price with care providers."
The Government devised the new system after becoming convinced that the "baby boomer" generation moving towards retirement would demand more control over the care they received. Ivan Lewis, the minister responsible for care services, admitted earlier this year that social care was one of the greatest challenges facing our society. "People are living longer and developing conditions that we've never known before. Disabled people now have, and rightly want, full and longer lives," he said. "We need a new consensus for a settlement that's fair and sustainable. We need to redefine the relationship between the state, family and citizen."
Under the changes, care homes and agencies providing high-quality home care and day services would be rewarded, while poorer performers would no longer be used by councils and the NHS.
Source
Big California hospital ditches Medi-Cal
In a move that reflects growing frustration over insufficient state reimbursement for health care, Sutter Roseville Medical Center has severed its contract with Medi-Cal, California's insurance program for the poor and disabled. The decision, which took effect Dec. 1, means Medi-Cal patients no longer are being admitted to the 270-bed hospital for elective surgeries. Sutter Roseville is the 15th hospital statewide that has discontinued its Medi-Cal contract since 2002; two of those hospitals have since renegotiated their contracts with the state. A total of 207 hospitals in California continue to provide the full range of services to Medi-Cal patients. The move does not affect Sutter Health's other hospitals in the region.
"Unfortunately, it's not all that uncommon," said Jan Emerson, spokeswoman for the California Hospital Association. "It's a reflection of the very, very low reimbursements that Medi-Cal pays. On average, we get about 50 cents of the dollar amount, and most hospitals can't sustain that level of loss for that amount of time."
Under the new arrangement, Medi-Cal patients will still be seen in Sutter Roseville's emergency room and trauma center, but those patients will be transferred to other facilities as soon as they are stable enough to be moved. Medi-Cal patients also will be able to get surgeries or other treatment on an outpatient basis, as well as to access laboratory, physical therapy or other ancillary medical services. State reimbursements for emergency and outpatient care use a different fee structure, according to health officials.
Sutter Roseville CEO Patrick Brady said the decision to end the contract for inpatient surgery was made after five months of negotiations in which the hospital wanted to get a much higher reimbursement rate. He said the hospital had been getting, on average, 47 percent of what its surgical care to Medi-Cal patients actually costs. "It represents quite a financial drain," he said. "We have complex patients who are very costly."
The contract change will affect an estimated 10 to 12 patients per day who would normally be in the hospital for a surgical procedure, Brady said. Those patients will be referred to other local hospitals still under contract with Medi-Cal. Those include Sutter Memorial and Sutter General hospitals, UC Davis Medical Center, Mercy San Juan Medical Center and Mercy Folsom Hospital. Each hospital negotiates separately with the state to determine reimbursement rates; the negotiated rates are kept confidential for four years.
"Our concern is for access for these recipients who are some of the most vulnerable in the state," said Tony Cava, a spokesman for the state Department of Health Care Services, the agency that oversees Medi-Cal. "We are confident they will be able to continue receiving the services they need and deserve."
The news was not very comforting to Evelyn Smith, 66, of Sacramento, whose husband landed at Sutter Roseville after collapsing on Thanksgiving. He is being evaluated for an operation to remove his gallstones. Since her husband relies on Medi-Cal, Smith said she was bothered to think he might not get the care he needs at the hospital where he was admitted. "They should treat us just as much as anyone else," she said as she was leaving the hospital Thursday. "We can't help it if we can't get insurance. We worked all our lives. We're entitled to something."
The hospital association's Emerson expects the decision at Sutter Roseville to have a significant effect on Medi-Cal patients in the Roseville area who need operations. "Especially for those who may or may not have access to transportation," she said. "They may also have to change doctors, because Sutter doctors don't necessarily have admitting privileges at Mercy or UC Davis."
Preventing other hospitals from following Sutter Roseville's dramatic move will require an infusion of money to bolster Medi-Cal and trigger a larger federal contribution for the program, said the state's Cava. He touted Gov. Arnold Schwarzenegger's stalled health care proposal as part of the solution. "The governor realizes we have to work with the hospitals and provide across-the-board increases in Medi-Cal reimbursement rates," he said.
The funding crunch in California, which ranks last in the nation in terms of its reimbursements to hospitals and doctors, has a ripple effect through the entire health care system, Emerson said. "Last year, hospitals statewide had $8.6 billion in uncompensated care and of that, $2.1 billion was directly related to Medi-Cal underfunding," she said. "When we are losing this much money, our premiums are going up because the state isn't paying its fair share."
Source
An amazingly sensible innovation by British standards. Will this be extended to ALL healthcare one day? We should hope it is
Elderly people will be given money to pay for their own care as part of a radical shake-up of the welfare system, Alan Johnson, the Health Secretary, will announce today. The new personal care budgets will give millions of pensioners and younger disabled people the power to decide what kind of care they want and where they buy it. Currently, elderly people are at the mercy of social workers who dictate the services they need to live in their own homes.
Under the new system, which will be introduced next April, older people or their families will set up bank accounts into which councils will pay a monthly sum. Beneficiaries will be means-tested to assess their needs before they are able to shop around for the best "personal care" packages, which will include help with getting dressed or washed, meals on wheels, cleaning services and cooking.
Mr Johnson will announce that councils in England and Wales will be given 520 million pounds over the next three years to fund the new system. "Our commitment that the majority of social care funding will be controlled by individuals through personal budgets represents a radical transfer or power from the state to the public," he will say. "Everyone, irrespective of their illness or disability has the right to self-developments and maximum control over their own lives."
Charities campaigning for better services for the elderly welcomed the move. "We welcome any move to give elderly people more choice about the services they receive in their home," said Mervyn Kohler, a special advisor for Help the Aged. "But we want assurance that they will be given guidance on the services out there. For example, who are the reputable companies? What are the different prices?" Gordon Lishman, the director general of Age Concern, said: "It is absolutely right to put older people's needs at the centre of the care system and to place a clear emphasis on preventive services. "Older people and their families will continue to need information and support to help them negotiate the best care package at the best price with care providers."
The Government devised the new system after becoming convinced that the "baby boomer" generation moving towards retirement would demand more control over the care they received. Ivan Lewis, the minister responsible for care services, admitted earlier this year that social care was one of the greatest challenges facing our society. "People are living longer and developing conditions that we've never known before. Disabled people now have, and rightly want, full and longer lives," he said. "We need a new consensus for a settlement that's fair and sustainable. We need to redefine the relationship between the state, family and citizen."
Under the changes, care homes and agencies providing high-quality home care and day services would be rewarded, while poorer performers would no longer be used by councils and the NHS.
Source
Big California hospital ditches Medi-Cal
In a move that reflects growing frustration over insufficient state reimbursement for health care, Sutter Roseville Medical Center has severed its contract with Medi-Cal, California's insurance program for the poor and disabled. The decision, which took effect Dec. 1, means Medi-Cal patients no longer are being admitted to the 270-bed hospital for elective surgeries. Sutter Roseville is the 15th hospital statewide that has discontinued its Medi-Cal contract since 2002; two of those hospitals have since renegotiated their contracts with the state. A total of 207 hospitals in California continue to provide the full range of services to Medi-Cal patients. The move does not affect Sutter Health's other hospitals in the region.
"Unfortunately, it's not all that uncommon," said Jan Emerson, spokeswoman for the California Hospital Association. "It's a reflection of the very, very low reimbursements that Medi-Cal pays. On average, we get about 50 cents of the dollar amount, and most hospitals can't sustain that level of loss for that amount of time."
Under the new arrangement, Medi-Cal patients will still be seen in Sutter Roseville's emergency room and trauma center, but those patients will be transferred to other facilities as soon as they are stable enough to be moved. Medi-Cal patients also will be able to get surgeries or other treatment on an outpatient basis, as well as to access laboratory, physical therapy or other ancillary medical services. State reimbursements for emergency and outpatient care use a different fee structure, according to health officials.
Sutter Roseville CEO Patrick Brady said the decision to end the contract for inpatient surgery was made after five months of negotiations in which the hospital wanted to get a much higher reimbursement rate. He said the hospital had been getting, on average, 47 percent of what its surgical care to Medi-Cal patients actually costs. "It represents quite a financial drain," he said. "We have complex patients who are very costly."
The contract change will affect an estimated 10 to 12 patients per day who would normally be in the hospital for a surgical procedure, Brady said. Those patients will be referred to other local hospitals still under contract with Medi-Cal. Those include Sutter Memorial and Sutter General hospitals, UC Davis Medical Center, Mercy San Juan Medical Center and Mercy Folsom Hospital. Each hospital negotiates separately with the state to determine reimbursement rates; the negotiated rates are kept confidential for four years.
"Our concern is for access for these recipients who are some of the most vulnerable in the state," said Tony Cava, a spokesman for the state Department of Health Care Services, the agency that oversees Medi-Cal. "We are confident they will be able to continue receiving the services they need and deserve."
The news was not very comforting to Evelyn Smith, 66, of Sacramento, whose husband landed at Sutter Roseville after collapsing on Thanksgiving. He is being evaluated for an operation to remove his gallstones. Since her husband relies on Medi-Cal, Smith said she was bothered to think he might not get the care he needs at the hospital where he was admitted. "They should treat us just as much as anyone else," she said as she was leaving the hospital Thursday. "We can't help it if we can't get insurance. We worked all our lives. We're entitled to something."
The hospital association's Emerson expects the decision at Sutter Roseville to have a significant effect on Medi-Cal patients in the Roseville area who need operations. "Especially for those who may or may not have access to transportation," she said. "They may also have to change doctors, because Sutter doctors don't necessarily have admitting privileges at Mercy or UC Davis."
Preventing other hospitals from following Sutter Roseville's dramatic move will require an infusion of money to bolster Medi-Cal and trigger a larger federal contribution for the program, said the state's Cava. He touted Gov. Arnold Schwarzenegger's stalled health care proposal as part of the solution. "The governor realizes we have to work with the hospitals and provide across-the-board increases in Medi-Cal reimbursement rates," he said.
The funding crunch in California, which ranks last in the nation in terms of its reimbursements to hospitals and doctors, has a ripple effect through the entire health care system, Emerson said. "Last year, hospitals statewide had $8.6 billion in uncompensated care and of that, $2.1 billion was directly related to Medi-Cal underfunding," she said. "When we are losing this much money, our premiums are going up because the state isn't paying its fair share."
Source
Tuesday, December 11, 2007
Your bureaucrats will protect you (NOT)
Nor will California judges who think that bureaucracy is the only fount of wisdom. Nothing replaces the power to take your business elsewhere
Hazel Adams' lawsuit alleging understaffing in numerous Sacramento-area nursing homes got tossed out recently for an odd reason: The state's failure to honor its own law. A Sacramento Superior Court judge ruled that the state passed a law eight years ago, then ignored a key portion of it, placing courts in an untenable position for evaluating staffing. Judge Loren E. McMaster blasted state health officials for failing to comply with a mandate that they write regulations relating to minimum-staffing requirements in nursing homes.
Without such a yardstick, he concluded, courts are in no position to determine whether a skilled nursing facility is meeting the law's standard of 3.2 nursing hours per patient day. "State departments do a grave disservice to the general public when, as here, they fail to comply with statutes directing that they take action," McMaster wrote last month in a ruling similar to that of a Los Angeles appellate court in a separate suit against nearly two dozen nursing homes.
Suanne Buggy, spokeswoman for the state Department of Public Health, said the public is not being shortchanged and the agency does not agree that a regulation is needed. The staffing standard is specific, written guidelines exist to measure compliance, and regulators are enforcing the law, Buggy said. "We see this statute as being clear and self-implementing," she said.
McMaster wrote that he cannot order the state to act because it was not a party in the suit. But departments are not above the law and should not "pick and choose" which statutes to obey, he added.
Statistics are not readily available on how many, if any, nursing homes are cited and fined annually for understaffing. In an audit of 248 nursing homes this year, 189 were issued what amounted to "fix-it" notices for failing to meet the staffing standard during at least one of 24 days studied, records show.
Mike Connors, of California Advocates for Nursing Home Reform, said understaffing often leads to low-quality patient care. "Where do consumers go to get these standards enforced if the courts won't do it?" he asked.
Roughly one of every five freestanding nursing homes - not tied to hospitals - reported staffing levels in 2005 that were below the state standard, according to a report this year by the California HealthCare Foundation, a nonprofit research group. Significant improvement has occurred since 2001, when 49 percent of freestanding nursing homes filed reports with the state indicating they did not meet the standard of 3.2 nursing hours per patient day, the foundation reported.
Adams' lawsuit is one of many in recent years that have pressed for greater accountability and higher standards in an industry providing long-term care to about 150,000 Californians, many of them elderly and frail. Betsy Hite, of the California Association of Health Facilities, representing nursing homes, said a key problem for many years was extremely low reimbursement rates by Medi-Cal, which serves more than half of the long-term patients in nursing homes. Legislation passed in 2004 significantly boosted payments, she said. "Every year the Legislature tends to add more regulation," she said. "We said, 'We don't have a problem with regulation. We don't have a problem with you requiring more staff. But give us the money and the tools, give us a system that rewards good behavior, and we promise you we're going to turn it around.' That is, in fact, exactly what's happened."
Adams, a former nursing home resident, claimed in her class-action suit that understaffing in numerous facilities was hindering care, violating patient rights and being obscured by misleading promises of an "abundance of support." McMaster, who dismissed the suit because the state failed to write regulations, did not rule on Adams' accusations. Adams' attorney, Stephen Garcia, declined comment on McMaster's decision.
The suit targeted a state law, passed in 1999, that required health officials to adopt regulations mandating that skilled nursing facilities provide at least 3.2 nursing hours per patient day, which would involve calculating and averaging daily staffing levels. The statute allowed "nursing hours" to include patient services provided by aides, nursing assistants or orderlies. Briefs in the Adams case argued that failure to write interpreting regulations left many questions unanswered, such as whether dietary, social service and other activities should count in calculating nursing hours.
McMaster, citing the appellate decision, said the Legislature clearly intended state health officials, not judges, to fill any gaps. The Adams suit, he wrote, is asking "courts to resolve disputes that should have been resolved by the timely enactment of regulations."
Attorney Mark Todzo, of San Francisco, said that judges in years past - before the appellate ruling - did not necessarily dismiss staffing challenges. He filed similar suits that sparked improvements from dozens of nursing homes, he said. "Different trial judges can see things differently," he said. The issue soon could be moot. State health officials, under court order, have proposed staff-to-patient ratios to replace the current minimum. The goal is to enable consumers to better track deficiencies: A staff-to-patient ratio would mandate a specific number of employees per clients at all times, not a daily average.
Legislation passed six years ago ordered health officials to issue staff-to-patient ratios by August 2003, which they failed to do. San Francisco Superior Court Judge Peter J. Busch, responding to a lawsuit by Todzo for the Sacramento-based Foundation Aiding the Elderly, ordered the state in July to act immediately. An emergency regulation has been unveiled by the state Department of Public Health, but it would not take effect unless funding is appropriated. State costs are estimated at $208 million, primarily from Medi-Cal, at a time when the state budget faces a projected $10 billion shortfall.
Source
Nor will California judges who think that bureaucracy is the only fount of wisdom. Nothing replaces the power to take your business elsewhere
Hazel Adams' lawsuit alleging understaffing in numerous Sacramento-area nursing homes got tossed out recently for an odd reason: The state's failure to honor its own law. A Sacramento Superior Court judge ruled that the state passed a law eight years ago, then ignored a key portion of it, placing courts in an untenable position for evaluating staffing. Judge Loren E. McMaster blasted state health officials for failing to comply with a mandate that they write regulations relating to minimum-staffing requirements in nursing homes.
Without such a yardstick, he concluded, courts are in no position to determine whether a skilled nursing facility is meeting the law's standard of 3.2 nursing hours per patient day. "State departments do a grave disservice to the general public when, as here, they fail to comply with statutes directing that they take action," McMaster wrote last month in a ruling similar to that of a Los Angeles appellate court in a separate suit against nearly two dozen nursing homes.
Suanne Buggy, spokeswoman for the state Department of Public Health, said the public is not being shortchanged and the agency does not agree that a regulation is needed. The staffing standard is specific, written guidelines exist to measure compliance, and regulators are enforcing the law, Buggy said. "We see this statute as being clear and self-implementing," she said.
McMaster wrote that he cannot order the state to act because it was not a party in the suit. But departments are not above the law and should not "pick and choose" which statutes to obey, he added.
Statistics are not readily available on how many, if any, nursing homes are cited and fined annually for understaffing. In an audit of 248 nursing homes this year, 189 were issued what amounted to "fix-it" notices for failing to meet the staffing standard during at least one of 24 days studied, records show.
Mike Connors, of California Advocates for Nursing Home Reform, said understaffing often leads to low-quality patient care. "Where do consumers go to get these standards enforced if the courts won't do it?" he asked.
Roughly one of every five freestanding nursing homes - not tied to hospitals - reported staffing levels in 2005 that were below the state standard, according to a report this year by the California HealthCare Foundation, a nonprofit research group. Significant improvement has occurred since 2001, when 49 percent of freestanding nursing homes filed reports with the state indicating they did not meet the standard of 3.2 nursing hours per patient day, the foundation reported.
Adams' lawsuit is one of many in recent years that have pressed for greater accountability and higher standards in an industry providing long-term care to about 150,000 Californians, many of them elderly and frail. Betsy Hite, of the California Association of Health Facilities, representing nursing homes, said a key problem for many years was extremely low reimbursement rates by Medi-Cal, which serves more than half of the long-term patients in nursing homes. Legislation passed in 2004 significantly boosted payments, she said. "Every year the Legislature tends to add more regulation," she said. "We said, 'We don't have a problem with regulation. We don't have a problem with you requiring more staff. But give us the money and the tools, give us a system that rewards good behavior, and we promise you we're going to turn it around.' That is, in fact, exactly what's happened."
Adams, a former nursing home resident, claimed in her class-action suit that understaffing in numerous facilities was hindering care, violating patient rights and being obscured by misleading promises of an "abundance of support." McMaster, who dismissed the suit because the state failed to write regulations, did not rule on Adams' accusations. Adams' attorney, Stephen Garcia, declined comment on McMaster's decision.
The suit targeted a state law, passed in 1999, that required health officials to adopt regulations mandating that skilled nursing facilities provide at least 3.2 nursing hours per patient day, which would involve calculating and averaging daily staffing levels. The statute allowed "nursing hours" to include patient services provided by aides, nursing assistants or orderlies. Briefs in the Adams case argued that failure to write interpreting regulations left many questions unanswered, such as whether dietary, social service and other activities should count in calculating nursing hours.
McMaster, citing the appellate decision, said the Legislature clearly intended state health officials, not judges, to fill any gaps. The Adams suit, he wrote, is asking "courts to resolve disputes that should have been resolved by the timely enactment of regulations."
Attorney Mark Todzo, of San Francisco, said that judges in years past - before the appellate ruling - did not necessarily dismiss staffing challenges. He filed similar suits that sparked improvements from dozens of nursing homes, he said. "Different trial judges can see things differently," he said. The issue soon could be moot. State health officials, under court order, have proposed staff-to-patient ratios to replace the current minimum. The goal is to enable consumers to better track deficiencies: A staff-to-patient ratio would mandate a specific number of employees per clients at all times, not a daily average.
Legislation passed six years ago ordered health officials to issue staff-to-patient ratios by August 2003, which they failed to do. San Francisco Superior Court Judge Peter J. Busch, responding to a lawsuit by Todzo for the Sacramento-based Foundation Aiding the Elderly, ordered the state in July to act immediately. An emergency regulation has been unveiled by the state Department of Public Health, but it would not take effect unless funding is appropriated. State costs are estimated at $208 million, primarily from Medi-Cal, at a time when the state budget faces a projected $10 billion shortfall.
Source
Monday, December 10, 2007
Looking at the pesky realities of different health care systems
There are those who will not be happy until they see the best health-care system in the world dragged down to the unacceptable levels of the systems in Canada and the United Kingdom. These socialized medical systems are horrible and getting worse every year. Wait times for treatment now exceed 41⁄2 months for nearly every mode of care including radiation for cancer patients and even psychiatric care. The Canadian Association of Radiologists says that up to half of all radiology services in Canada could be shut down unless outdated, dangerous equipment is replaced immediately. There are more MRIs in Washington state than in all of Canada because of budget limitations.
Men are 10 percent more likely to die of prostate cancer in the U.K. than in the Netherlands, a country that has seen the light and has been backing out of socialized medicine for some time. American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared to 56 percent for European women and only 53 percent for women in the U.K. American men have a five-year survival rate from cancer of 66 percent compared to only 47 percent for European men and 45 percent for men in the U.K. These are incontestable statistics that the proponents of socialized medicine deliberately hide from the public. These same unfavorable mortality statistics would apply to Americans if we were foolish enough to adopt universal health care. We all know that the most important factors in cancer survival are early diagnosis and time to treatment. No country in the world is better in this regard than the U.S., and our survival rates prove it.
Socialized medicine has failed everywhere it has been instituted. Even our senior version of socialized medicine, Medicare, is in a financial tailspin with premiums and coinsurance increasing while benefits decrease.
If our state lawmakers would simply find the courage to deal with the special interests and eliminate state-mandated insurance benefits, reduce health-insurance fraud, reduce medical malpractice, reduce medical errors and institute tort reform, health-insurance costs could be reduced by 50 percent or more. Health-insurance premiums would be much more affordable for those who want coverage, and our Medicaid cost burden would be greatly reduced. All of this could be accomplished while maintaining the highest standard of medical care in the entire world. Let’s fix the problems in our present system and leave socialism and it’s well-known problems to the socialists.
Source
There are those who will not be happy until they see the best health-care system in the world dragged down to the unacceptable levels of the systems in Canada and the United Kingdom. These socialized medical systems are horrible and getting worse every year. Wait times for treatment now exceed 41⁄2 months for nearly every mode of care including radiation for cancer patients and even psychiatric care. The Canadian Association of Radiologists says that up to half of all radiology services in Canada could be shut down unless outdated, dangerous equipment is replaced immediately. There are more MRIs in Washington state than in all of Canada because of budget limitations.
Men are 10 percent more likely to die of prostate cancer in the U.K. than in the Netherlands, a country that has seen the light and has been backing out of socialized medicine for some time. American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared to 56 percent for European women and only 53 percent for women in the U.K. American men have a five-year survival rate from cancer of 66 percent compared to only 47 percent for European men and 45 percent for men in the U.K. These are incontestable statistics that the proponents of socialized medicine deliberately hide from the public. These same unfavorable mortality statistics would apply to Americans if we were foolish enough to adopt universal health care. We all know that the most important factors in cancer survival are early diagnosis and time to treatment. No country in the world is better in this regard than the U.S., and our survival rates prove it.
Socialized medicine has failed everywhere it has been instituted. Even our senior version of socialized medicine, Medicare, is in a financial tailspin with premiums and coinsurance increasing while benefits decrease.
If our state lawmakers would simply find the courage to deal with the special interests and eliminate state-mandated insurance benefits, reduce health-insurance fraud, reduce medical malpractice, reduce medical errors and institute tort reform, health-insurance costs could be reduced by 50 percent or more. Health-insurance premiums would be much more affordable for those who want coverage, and our Medicaid cost burden would be greatly reduced. All of this could be accomplished while maintaining the highest standard of medical care in the entire world. Let’s fix the problems in our present system and leave socialism and it’s well-known problems to the socialists.
Source
Sunday, December 09, 2007
Britain's MRSA clear-up target is shelved
A target to cut the number of MRSA infections in hospitals appears to have been shelved in advance of a failure to achieve it. The three-year target to halve rates of MRSA by next April is widely regarded to be unachievable, given the slow progress made in fighting the superbug. The deadline has been postponed for three years to 2010-11, the period covered by the latest Comprehensive Spending Review agreement with the Treasury. The Government has also set a new target to reduce rates of Clostridium Difficile by 30 per cent by 2011.
Alan Johnson, the Health Secretary, announced the measures last month, but they received no further publicity. The Department of Health insisted that the original MRSA target could be met by April. However, Health Protection Agency figures show that cases of bloodstream MRSA fell by only 10 per cent to 6,381 in the last financial year.
Source
Australia: THE WONDERS OF GOVERNMENT HEALTH CARE AGAIN
Two current reports below
Lazy and indifferent public hospital staff (1)
QUEENSLAND Premier Anna Bligh is demanding to know how a woman was left to give birth in a hospital car park north-west of Brisbane. Jennifer Gold said nurses watched as she gave birth to her son Sonny last Friday morning in a car parked outside the Miles Hospital on the Darling Downs. Ms Gold said that instead of being admitted, she and her partner were left outside. "Malcolm ran inside and pressed the buzzer to try and get some help and one of the staff has said we weren't allowed to go in there because they weren't a midwife," Ms Gold told Network Ten news.
"Malcolm finally came out, they gave him a towel and he delivered the baby himself," she said. "I just watched and it was very scary. "I don't know whether he (Sonny) was going to be alive." Photographs taken by her partner showed Sonny was born in the footwell of the family's four-wheel drive and that the boy was blue. He and his mother were finally allowed inside the hospital but left later the same day because Ms Gold said she felt unwanted.
She took her child home and an ambulance later took both mother and baby to Toowoomba Hospital, 200km away, where the child has since been in intensive care. "I think in another day he would have been gone because he got so dehydrated from the stress and the trauma," Ms Gold said.
An angry Ms Bligh said the matter would be investigated thoroughly. "This issue will be the subject of a very thorough investigation, I can assure the people involved," Ms Bligh said. "We take these sorts of issues very seriously." The child was expected to be able leave hospital within the next few days.
Source
Lazy and indifferent public hospital staff (2)
HEALTH authorities have been accused of not properly checking the credentials of two Pakistani-trained doctors who failed to save a woman's life. Coroner Michael Barnes yesterday handed down the findings of his inquest into the death of Deborah Burgen, a 49-year-old mother at the Mount Isa Hospital on February 28, 2005.
Ms Burgen was operated on for a twisted bowel but died of complications as she was pumped with fluids two days later. The inquest, which opened earlier this year, followed a long-running public inquiry into the "Dr Death" scandal surrounding Indian trained Dr Jayant Patel. Dr Patel has been linked to the deaths of 17 patients at Bundaberg Base Hospital where he was director of surgery until he fled to the United States in April 2005.
Mr Barnes said in his report that had Ms Burgen been operated on before the obstruction caused her large intestine to perforate "her chances of surviving the procedure were quite good". "Ms Burgen should not have died," Mr Barnes said. The inquest had been told that when she was admitted to hospital on February 25, 2005, Ms Burgen was in the care of general surgeon Frederick Rowland, who was a consultant specialist with the British Royal Navy and had worked in Saudi Arabia and Fiji.
Mr Barnes' report found that Queensland Health did not adequately scrutinise the qualifications and experience of Pakistan-trained Dr Naseem Ashraf and Dr Anilkumar Tirumalai. All three doctors have since left the hospital.
The inquest heard that Ms Burgen died in excruciating pain after her weight ballooned 31kg in two-and-a-half days after her admission to the hospital. "Mt Isa Base Hospital (MIBH) clinical managers failed to provide Dr Ashraf and Dr Tirumalai with any orientation in relation to the policies and procedures at the Mt Isa Base Hospital and failed to have their scope of practice delineated by a credentialing and privileging committee in a timely fashion," Mr Barnes said. "None of the doctors who saw Ms Burgen on the six occasions that she attended the MIBH Emergency Department between February 16 and 25 adequately responded to her complaint. "By failing to operate on Ms Burgen for two days after her emergency admission, Dr Rowland allowed her large intestine to perforate."
Mr Barnes said the inquest had been told Dr Ashraf was apparently the Director of Anaesthesia and Intensive Care but neither he nor Dr Tirumalai had post-graduate training in anaesthesia that would be recognised in Australia. "The Medical Board of Queensland did not adequately scrutinise the suitability of Dr Ashraf and Dr Tirumalai before registering them to practice."
Mr Barnes said there was no basis to suspect that doctors trained in countries other than Australia were any less competent than those trained here. "However, the Medical Practitioners Registration Act 2001 also creates another pathway for registration for those seeking to practice in a geographic region that the minister for health has decided is an area of need. "This assessment is made on the basis that there are insufficient medical practitioners practising in that area to meet the needs of the people living there. "Prior to Ms Burgen's death, Mt Isa had been stipulated to be such an area and Drs Rowland, Ashraf and Tirumalai were registered under the area of need regime.
"Because such registration is not dependent upon the doctor meeting the Australian Medical Council standards it is essential that the employer, in this case Queensland Health, and the Medical Board ensure that the proposed registrant has appropriate qualifications and experience for the position under consideration."
Source Further details here.
A target to cut the number of MRSA infections in hospitals appears to have been shelved in advance of a failure to achieve it. The three-year target to halve rates of MRSA by next April is widely regarded to be unachievable, given the slow progress made in fighting the superbug. The deadline has been postponed for three years to 2010-11, the period covered by the latest Comprehensive Spending Review agreement with the Treasury. The Government has also set a new target to reduce rates of Clostridium Difficile by 30 per cent by 2011.
Alan Johnson, the Health Secretary, announced the measures last month, but they received no further publicity. The Department of Health insisted that the original MRSA target could be met by April. However, Health Protection Agency figures show that cases of bloodstream MRSA fell by only 10 per cent to 6,381 in the last financial year.
Source
Australia: THE WONDERS OF GOVERNMENT HEALTH CARE AGAIN
Two current reports below
Lazy and indifferent public hospital staff (1)
QUEENSLAND Premier Anna Bligh is demanding to know how a woman was left to give birth in a hospital car park north-west of Brisbane. Jennifer Gold said nurses watched as she gave birth to her son Sonny last Friday morning in a car parked outside the Miles Hospital on the Darling Downs. Ms Gold said that instead of being admitted, she and her partner were left outside. "Malcolm ran inside and pressed the buzzer to try and get some help and one of the staff has said we weren't allowed to go in there because they weren't a midwife," Ms Gold told Network Ten news.
"Malcolm finally came out, they gave him a towel and he delivered the baby himself," she said. "I just watched and it was very scary. "I don't know whether he (Sonny) was going to be alive." Photographs taken by her partner showed Sonny was born in the footwell of the family's four-wheel drive and that the boy was blue. He and his mother were finally allowed inside the hospital but left later the same day because Ms Gold said she felt unwanted.
She took her child home and an ambulance later took both mother and baby to Toowoomba Hospital, 200km away, where the child has since been in intensive care. "I think in another day he would have been gone because he got so dehydrated from the stress and the trauma," Ms Gold said.
An angry Ms Bligh said the matter would be investigated thoroughly. "This issue will be the subject of a very thorough investigation, I can assure the people involved," Ms Bligh said. "We take these sorts of issues very seriously." The child was expected to be able leave hospital within the next few days.
Source
Lazy and indifferent public hospital staff (2)
HEALTH authorities have been accused of not properly checking the credentials of two Pakistani-trained doctors who failed to save a woman's life. Coroner Michael Barnes yesterday handed down the findings of his inquest into the death of Deborah Burgen, a 49-year-old mother at the Mount Isa Hospital on February 28, 2005.
Ms Burgen was operated on for a twisted bowel but died of complications as she was pumped with fluids two days later. The inquest, which opened earlier this year, followed a long-running public inquiry into the "Dr Death" scandal surrounding Indian trained Dr Jayant Patel. Dr Patel has been linked to the deaths of 17 patients at Bundaberg Base Hospital where he was director of surgery until he fled to the United States in April 2005.
Mr Barnes said in his report that had Ms Burgen been operated on before the obstruction caused her large intestine to perforate "her chances of surviving the procedure were quite good". "Ms Burgen should not have died," Mr Barnes said. The inquest had been told that when she was admitted to hospital on February 25, 2005, Ms Burgen was in the care of general surgeon Frederick Rowland, who was a consultant specialist with the British Royal Navy and had worked in Saudi Arabia and Fiji.
Mr Barnes' report found that Queensland Health did not adequately scrutinise the qualifications and experience of Pakistan-trained Dr Naseem Ashraf and Dr Anilkumar Tirumalai. All three doctors have since left the hospital.
The inquest heard that Ms Burgen died in excruciating pain after her weight ballooned 31kg in two-and-a-half days after her admission to the hospital. "Mt Isa Base Hospital (MIBH) clinical managers failed to provide Dr Ashraf and Dr Tirumalai with any orientation in relation to the policies and procedures at the Mt Isa Base Hospital and failed to have their scope of practice delineated by a credentialing and privileging committee in a timely fashion," Mr Barnes said. "None of the doctors who saw Ms Burgen on the six occasions that she attended the MIBH Emergency Department between February 16 and 25 adequately responded to her complaint. "By failing to operate on Ms Burgen for two days after her emergency admission, Dr Rowland allowed her large intestine to perforate."
Mr Barnes said the inquest had been told Dr Ashraf was apparently the Director of Anaesthesia and Intensive Care but neither he nor Dr Tirumalai had post-graduate training in anaesthesia that would be recognised in Australia. "The Medical Board of Queensland did not adequately scrutinise the suitability of Dr Ashraf and Dr Tirumalai before registering them to practice."
Mr Barnes said there was no basis to suspect that doctors trained in countries other than Australia were any less competent than those trained here. "However, the Medical Practitioners Registration Act 2001 also creates another pathway for registration for those seeking to practice in a geographic region that the minister for health has decided is an area of need. "This assessment is made on the basis that there are insufficient medical practitioners practising in that area to meet the needs of the people living there. "Prior to Ms Burgen's death, Mt Isa had been stipulated to be such an area and Drs Rowland, Ashraf and Tirumalai were registered under the area of need regime.
"Because such registration is not dependent upon the doctor meeting the Australian Medical Council standards it is essential that the employer, in this case Queensland Health, and the Medical Board ensure that the proposed registrant has appropriate qualifications and experience for the position under consideration."
Source Further details here.
Saturday, December 08, 2007
Brainless British medical bureaucrats
How they hate private medicine! And being nearly twice as successful as many of your competitors is just not playing the game!
Britain’s most controversial fertility doctor has also been named its most successful, by the IVF watchdog that wants to ban him from running his clinic. Mohammed Taranissi’s Assisted Reproduction and Gynaecology Centre in London has the highest success rate of any British centre offering IVF, according to figures released by the Human Fertilisation and Embryology Authority (HFEA).
Almost two thirds of Mr Taranissi’s IVF patients who were aged under 35 and used their own eggs had a baby in 2005, his best result and one of the highest success rates of any clinic in the world. His clinic’s birth rate of 60.7 per cent was twice the national average of 29.6 per cent, and easily outstripped the next best performer, the Lister Fertility Clinic in London, which achieved a rate of 43.1 per cent for the same patient group.
The doctor’s second clinic, the Reproductive Genetics Institute, was fourth in the league table. His position will embarrass the HFEA, which decided in July to strip him of his right to be “person responsible” for the Assisted Reproduction and Gynaecology Centre after saying that he treated patients at the Reproductive Genetics Institute without a licence. The Reproductive Genetics Institute has been closed and Mr Taranissi has been issued a temporary licence to operate until the middle of next month, when his appeal is expected to be heard. If it fails, he is likely to bring the issue to judicial review.
The High Court recently found that HFEA used unlawful warrants to raid the two clinics in January this year for evidence. Mr Taranissi is also suing the BBC programme Panorama for libel.
Critics of Mr Taranissi claim that he has achieved his high success rate by transferring multiple embryos. Mr Taranissi’s two clinics figure highly in the table for multiple births, which are the biggest side-effect of IVF treatment. The Reproductive Genetics Institute was third in the multiple births table, with 33 per cent of its births twins and 1 per cent triplets; the Assisted Reproduction and Gynaecology Centre was fourth, with 32 per cent of its births twins and 1 per cent triplets. The Salisbury Fertility Centre had the highest twin rate at 38 per cent, followed by the Peninsular Centre for Reproductive Medicine in Exeter, at 36 per cent. The HFEA is trying to reduce the multiple birth rate from 24 per cent to 10 per cent.
Mr Taranissi said yesterday that high twin and triplet rate was the result of a higher embryo implantation rate in general. “We have a system where we work seven days a week, 24 hours a day, and it shows that you can get outstanding results by doing every stage of the procedure at the right time,” he said. “It would be odd if we did not have a high twin rate. It is a reflection of our higher implantation rate.”
The 2005 HFEA figures support this, as both IVF success rates and multiple births rose in spite of fresh controls on the number of embryos that doctors may transfer. The national success rate was 29.6 per cent for women under 35 and 21.6 per cent overall, up from 28.1 per cent and 20.6 per cent the previous year. The proportion of multiple births rose from 22.7 per cent to 24 per cent.
The new figures are published today as part of the HFEA’s new Find a Clinic website (guide.hfea.gov.uk/ guide), which includes details of every licensed fertility centre in Britain. Alan Doran, the HFEA’s interim chief executive, said: “Good and comprehensive information is vital for any patient making choices about their treatment options. “Statistics are just one of the many things patients need to consider when choosing a clinic. Their age, location, which treatments are available and what the clinic offers to support them are also absolutely key to helping them make informed decisions.” He added: “Multiple births continue to be a concern because of the increased risk to mothers and babies. That is why we announced this week that we will be working with the professional bodies to develop a strategy to reduce multiple births.”
Source
How they hate private medicine! And being nearly twice as successful as many of your competitors is just not playing the game!
Britain’s most controversial fertility doctor has also been named its most successful, by the IVF watchdog that wants to ban him from running his clinic. Mohammed Taranissi’s Assisted Reproduction and Gynaecology Centre in London has the highest success rate of any British centre offering IVF, according to figures released by the Human Fertilisation and Embryology Authority (HFEA).
Almost two thirds of Mr Taranissi’s IVF patients who were aged under 35 and used their own eggs had a baby in 2005, his best result and one of the highest success rates of any clinic in the world. His clinic’s birth rate of 60.7 per cent was twice the national average of 29.6 per cent, and easily outstripped the next best performer, the Lister Fertility Clinic in London, which achieved a rate of 43.1 per cent for the same patient group.
The doctor’s second clinic, the Reproductive Genetics Institute, was fourth in the league table. His position will embarrass the HFEA, which decided in July to strip him of his right to be “person responsible” for the Assisted Reproduction and Gynaecology Centre after saying that he treated patients at the Reproductive Genetics Institute without a licence. The Reproductive Genetics Institute has been closed and Mr Taranissi has been issued a temporary licence to operate until the middle of next month, when his appeal is expected to be heard. If it fails, he is likely to bring the issue to judicial review.
The High Court recently found that HFEA used unlawful warrants to raid the two clinics in January this year for evidence. Mr Taranissi is also suing the BBC programme Panorama for libel.
Critics of Mr Taranissi claim that he has achieved his high success rate by transferring multiple embryos. Mr Taranissi’s two clinics figure highly in the table for multiple births, which are the biggest side-effect of IVF treatment. The Reproductive Genetics Institute was third in the multiple births table, with 33 per cent of its births twins and 1 per cent triplets; the Assisted Reproduction and Gynaecology Centre was fourth, with 32 per cent of its births twins and 1 per cent triplets. The Salisbury Fertility Centre had the highest twin rate at 38 per cent, followed by the Peninsular Centre for Reproductive Medicine in Exeter, at 36 per cent. The HFEA is trying to reduce the multiple birth rate from 24 per cent to 10 per cent.
Mr Taranissi said yesterday that high twin and triplet rate was the result of a higher embryo implantation rate in general. “We have a system where we work seven days a week, 24 hours a day, and it shows that you can get outstanding results by doing every stage of the procedure at the right time,” he said. “It would be odd if we did not have a high twin rate. It is a reflection of our higher implantation rate.”
The 2005 HFEA figures support this, as both IVF success rates and multiple births rose in spite of fresh controls on the number of embryos that doctors may transfer. The national success rate was 29.6 per cent for women under 35 and 21.6 per cent overall, up from 28.1 per cent and 20.6 per cent the previous year. The proportion of multiple births rose from 22.7 per cent to 24 per cent.
The new figures are published today as part of the HFEA’s new Find a Clinic website (guide.hfea.gov.uk/ guide), which includes details of every licensed fertility centre in Britain. Alan Doran, the HFEA’s interim chief executive, said: “Good and comprehensive information is vital for any patient making choices about their treatment options. “Statistics are just one of the many things patients need to consider when choosing a clinic. Their age, location, which treatments are available and what the clinic offers to support them are also absolutely key to helping them make informed decisions.” He added: “Multiple births continue to be a concern because of the increased risk to mothers and babies. That is why we announced this week that we will be working with the professional bodies to develop a strategy to reduce multiple births.”
Source
Friday, December 07, 2007
Twins banned in Britain
Reducing the usefulness of what you do makes sense only to socialists. Post below lifted from Don Surber. See the original for links
Brits save money, improve health stats. England will ban test tube twins and triplets. Instead, mothers using IVF will be given only one embryo at a time to se if it leads to pregnancy, the London Daily Mail reported. This will save the National Health Service money - and we all know the purpose of the NHS is to save money, not patients. As a bonus, this will make the health statistics look better. Twins and triplets cost more to birth and have a greater chance of dying, thus increasing the infant mortality rate.
The downside is this sucks if you want to have children. "Under plans that could spell heartache for thousands of childless couples, regulators want to cap the number of multiple births," the London Daily Mail reported.
This drew complaints from Keith Reed, chief executive of the Twins and Multiple Births Association. "If they carry through their plans, then they could shatter the dreams of thousands of patients," Reed said.
But when you run a monopoly, who cares about unsatisfied customers, right? Government-run health care is a lot like government cheese.
Reducing the usefulness of what you do makes sense only to socialists. Post below lifted from Don Surber. See the original for links
Brits save money, improve health stats. England will ban test tube twins and triplets. Instead, mothers using IVF will be given only one embryo at a time to se if it leads to pregnancy, the London Daily Mail reported. This will save the National Health Service money - and we all know the purpose of the NHS is to save money, not patients. As a bonus, this will make the health statistics look better. Twins and triplets cost more to birth and have a greater chance of dying, thus increasing the infant mortality rate.
The downside is this sucks if you want to have children. "Under plans that could spell heartache for thousands of childless couples, regulators want to cap the number of multiple births," the London Daily Mail reported.
It is estimated that if all IVF children were single births, 126 fewer babies would die each year. Critics claim, however, that limiting the number of embryos would reduce the chances of a successful pregnancy and make fertility treatment even more costly for desperate couples. Health Service funding usually covers just one cycle of treatment, explaining why three out of four couples pay thousands to go private - and have more embryos implanted.
This drew complaints from Keith Reed, chief executive of the Twins and Multiple Births Association. "If they carry through their plans, then they could shatter the dreams of thousands of patients," Reed said.
But when you run a monopoly, who cares about unsatisfied customers, right? Government-run health care is a lot like government cheese.
Thursday, December 06, 2007
OVERSTRETCHED NHS NOT TOO BUSY TO PANDER TO RELIGION -- Guess which one?
Overworked nurses have been ordered to stop their work five times a day - and move Muslim patients' beds to face towards Mecca. The procedure is creating turmoil among staff on NHS wards already struggling through a lack of beds. But Mid Yorkshire NHS Trust says the rule must be implemented whenever possible to ensure Muslim patients have "a more comfortable stay in hospital".
A taxpayer-funded training programme for hundreds of hospital staff has already begun to ensure they are familiar with the workings of the Muslim faith. The scheme is initially being run at Dewsbury and District Hospital, West Yorks, but is set to be expanded to other areas. It comes after the introduction in some NHS hospitals last year of Burkha-style gowns for Muslim patients.
Last night the move was slammed with critics saying the NHS would be much better off spending cash on tackling MRSA. One nurse at Dewsbury said: "It would be easier to create Muslim-only wards with every bed facing Mecca. Some people might think it is not that big a deal but we have a huge Muslim population in Dewsbury. "If we are having to turn dozens of beds to face Mecca five times a day, plus provide running water for them to wash before and after prayers, it is bound to impact on the essential medical service we are supposed to be providing."
The changes have been introduced by Dewsbury and District Hospital's chief matron Catherine Briggs. She said: "Some of our former Muslim patients suggested that a more informed understanding of the Islamic cultures would help staff to further improve their service. We always do our best to listen to our patients and are willing to adapt our nursing practices where possible to help patients uphold their cultural beliefs. "After this training our staff will have a greater understanding of different cultures and will be in a better position to do this." The Mecca proposal will be widened to hospitals in Pontefract and Wakefield in the New Year.
Outraged Tory Monmouth MP David Davies said: "Hospitals should be concentrating on stopping the spread of hospital infections which are claiming the lives of hundreds of patients every year than kowtowing to the politically correct brigade." And Philip Davies, Tory MP for Shipley, West Yorks, and anti-political correctness campaigner and added: "I'm sure nurses and medical staff have got far better things to do with their time than constantly move beds around so patients are facing the right way. "This seems a totally unnecessary burden to their workload."
A spokeswoman for the Mid Yorkshire Trust added: "This is all part of our holistic approach to treating patients of all faiths. "Where it is safe and practical to do so we will move the beds of seriously ill patients so that they face towards Mecca five times a day should a patient request it. "But we also are keen to accommodate all faiths, for example if a patient is Roman Catholic then we would try and ensure they can receive Holy Communion.
Source
Overworked nurses have been ordered to stop their work five times a day - and move Muslim patients' beds to face towards Mecca. The procedure is creating turmoil among staff on NHS wards already struggling through a lack of beds. But Mid Yorkshire NHS Trust says the rule must be implemented whenever possible to ensure Muslim patients have "a more comfortable stay in hospital".
A taxpayer-funded training programme for hundreds of hospital staff has already begun to ensure they are familiar with the workings of the Muslim faith. The scheme is initially being run at Dewsbury and District Hospital, West Yorks, but is set to be expanded to other areas. It comes after the introduction in some NHS hospitals last year of Burkha-style gowns for Muslim patients.
Last night the move was slammed with critics saying the NHS would be much better off spending cash on tackling MRSA. One nurse at Dewsbury said: "It would be easier to create Muslim-only wards with every bed facing Mecca. Some people might think it is not that big a deal but we have a huge Muslim population in Dewsbury. "If we are having to turn dozens of beds to face Mecca five times a day, plus provide running water for them to wash before and after prayers, it is bound to impact on the essential medical service we are supposed to be providing."
The changes have been introduced by Dewsbury and District Hospital's chief matron Catherine Briggs. She said: "Some of our former Muslim patients suggested that a more informed understanding of the Islamic cultures would help staff to further improve their service. We always do our best to listen to our patients and are willing to adapt our nursing practices where possible to help patients uphold their cultural beliefs. "After this training our staff will have a greater understanding of different cultures and will be in a better position to do this." The Mecca proposal will be widened to hospitals in Pontefract and Wakefield in the New Year.
Outraged Tory Monmouth MP David Davies said: "Hospitals should be concentrating on stopping the spread of hospital infections which are claiming the lives of hundreds of patients every year than kowtowing to the politically correct brigade." And Philip Davies, Tory MP for Shipley, West Yorks, and anti-political correctness campaigner and added: "I'm sure nurses and medical staff have got far better things to do with their time than constantly move beds around so patients are facing the right way. "This seems a totally unnecessary burden to their workload."
A spokeswoman for the Mid Yorkshire Trust added: "This is all part of our holistic approach to treating patients of all faiths. "Where it is safe and practical to do so we will move the beds of seriously ill patients so that they face towards Mecca five times a day should a patient request it. "But we also are keen to accommodate all faiths, for example if a patient is Roman Catholic then we would try and ensure they can receive Holy Communion.
Source
Wednesday, December 05, 2007
British ‘Transplant tourist’ aims to buy time
A former champion surfer who has waited more than four years for a kidney transplant is preparing to fly to the Philippines to buy one. Mark Scholfield, 43, a father of two children, aged 16 and 13, has saved 40,000 pounds for the operation in Manila, where it is legal for people to sell their kidneys.
He defended his decision to become a “transplant tourist”, saying that he wants to see his children grow up and that if people want to take the moral high ground he would be more than happy to trade places with them. “I’m not prepared to lie down and play dead. I’ve got to take a gamble, I can’t just sit here and do nothing,” he added.
Mr Scholfield, managing director of a surf-wear company, spends several hours a day on a dialysis machine at his home in South Wales. He contracted a kidney disease 20 years ago and although his mother donated one of her kidneys it has failed and must be replaced. More than 6,500 people in Britain are awaiting a kidney transplant but, according to the British Medical Association, one of them dies every day.
Source
How to beat the high cost of living
Government prohibitions against purchase of private medical care compromise patient health.
The move by the U.S. government to restrict the ability of Medicare patients to spend their own money on medical care is denying these patients an elemental right: the right to save their own lives.
That is the conclusion of Kent Masterson Brown in the Cato Institute policy analysis "The Freedom to Spend Your Own Money on Medical Care: A Common Casualty of Universal Coverage."
"Over the last 20 years, the Medicare bureaucracy — and to a lesser extent, Congress itself – has limited the freedom of Medicare beneficiaries to purchase medical services with their own money," Brown writes.
"Those limitations violate beneficiaries' right to privacy, undermine a tool that could reduce the burden Medicare imposes on taxpayers, and may deny care to Medicare beneficiaries outright, or deny them access to the highest quality care available."
As the Canadian health system – vaunted by proponents of socialized medicine as a smashing success – moves away from self-pay restrictions for medical care, the United States, in its effort to provide universal coverage, is moving in the opposite direction, toward a system of treatment by tribunal.
The danger of universal coverage, Brown argues, is when the government fails to meet the needs of patients, then prohibits them from purchasing medical care on their own, locking patients in a situation much like the cell of little ease, a torture device in which the prisoner can neither stand, nor sit, nor lie down.
This is not merely something that is occurring under foreign systems of socialized medicine. Instead, it exists today, in the United States, under the federal Medicare system.
Critics of self-pay argue that allowing patients to opt out of Medicare on a service-by-service basis would create a two-tiered health care system in which only the wealthiest seniors would have access to free choice.
But stripped of soundbites and reduced to its essence, the main argument against denying the practice of private payment is this: a self-governing people should not have to await the approval of a tribunal before making private decisions about their own health care.
Says Brown: "No issue more clearly illustrates the threat that national health insurance schemes pose to individual rights than the federal government's attempts to prohibit Americans in the federal Medicare program from spending their own money on medical care."
Brown concludes by offering suggested remedies for reform. "Congress should restore the freedom of Medicare beneficiaries to spend their own money on medical care as they see fit and prevent the federal bureaucracy from interfering in purely private and voluntary transactions between patients and their doctors.
Congress should do so immediately, before Medicare's looming financial troubles combine with this unwise policy and begin denying care to large numbers of seniors."
Editors note: The Medicare problem is especially acute in Alaska and several other states where medical care costs are above the national average because physicians are required to charge according to a government-set fee scale. Many doctors in those states usually charge more than the mandated rates and — if they accept Medicare patients — are forced to reduce rates for those patients.
Source
A former champion surfer who has waited more than four years for a kidney transplant is preparing to fly to the Philippines to buy one. Mark Scholfield, 43, a father of two children, aged 16 and 13, has saved 40,000 pounds for the operation in Manila, where it is legal for people to sell their kidneys.
He defended his decision to become a “transplant tourist”, saying that he wants to see his children grow up and that if people want to take the moral high ground he would be more than happy to trade places with them. “I’m not prepared to lie down and play dead. I’ve got to take a gamble, I can’t just sit here and do nothing,” he added.
Mr Scholfield, managing director of a surf-wear company, spends several hours a day on a dialysis machine at his home in South Wales. He contracted a kidney disease 20 years ago and although his mother donated one of her kidneys it has failed and must be replaced. More than 6,500 people in Britain are awaiting a kidney transplant but, according to the British Medical Association, one of them dies every day.
Source
How to beat the high cost of living
Government prohibitions against purchase of private medical care compromise patient health.
The move by the U.S. government to restrict the ability of Medicare patients to spend their own money on medical care is denying these patients an elemental right: the right to save their own lives.
That is the conclusion of Kent Masterson Brown in the Cato Institute policy analysis "The Freedom to Spend Your Own Money on Medical Care: A Common Casualty of Universal Coverage."
"Over the last 20 years, the Medicare bureaucracy — and to a lesser extent, Congress itself – has limited the freedom of Medicare beneficiaries to purchase medical services with their own money," Brown writes.
"Those limitations violate beneficiaries' right to privacy, undermine a tool that could reduce the burden Medicare imposes on taxpayers, and may deny care to Medicare beneficiaries outright, or deny them access to the highest quality care available."
As the Canadian health system – vaunted by proponents of socialized medicine as a smashing success – moves away from self-pay restrictions for medical care, the United States, in its effort to provide universal coverage, is moving in the opposite direction, toward a system of treatment by tribunal.
The danger of universal coverage, Brown argues, is when the government fails to meet the needs of patients, then prohibits them from purchasing medical care on their own, locking patients in a situation much like the cell of little ease, a torture device in which the prisoner can neither stand, nor sit, nor lie down.
This is not merely something that is occurring under foreign systems of socialized medicine. Instead, it exists today, in the United States, under the federal Medicare system.
Critics of self-pay argue that allowing patients to opt out of Medicare on a service-by-service basis would create a two-tiered health care system in which only the wealthiest seniors would have access to free choice.
But stripped of soundbites and reduced to its essence, the main argument against denying the practice of private payment is this: a self-governing people should not have to await the approval of a tribunal before making private decisions about their own health care.
Says Brown: "No issue more clearly illustrates the threat that national health insurance schemes pose to individual rights than the federal government's attempts to prohibit Americans in the federal Medicare program from spending their own money on medical care."
Brown concludes by offering suggested remedies for reform. "Congress should restore the freedom of Medicare beneficiaries to spend their own money on medical care as they see fit and prevent the federal bureaucracy from interfering in purely private and voluntary transactions between patients and their doctors.
Congress should do so immediately, before Medicare's looming financial troubles combine with this unwise policy and begin denying care to large numbers of seniors."
Editors note: The Medicare problem is especially acute in Alaska and several other states where medical care costs are above the national average because physicians are required to charge according to a government-set fee scale. Many doctors in those states usually charge more than the mandated rates and — if they accept Medicare patients — are forced to reduce rates for those patients.
Source
Tuesday, December 04, 2007
Universal Health Scare
An increasingly popular argument in favor of socialized medicine goes like this: "If universal health care works for the elderly under Medicare, then why not for the rest of us?" If that's true, then the Democratic nominee for President should definitely work this one into his or her acceptance speech, starting now.
But there's a tragic flaw in that argument. Universal care-socialized medicine-for the elderly does NOT "work," even on its own terms. Many services, such as my own (psychotherapy and mental health care), are only partially covered, if at all, under Medicare. It has to be this way; otherwise the program would be slated for bankruptcy even sooner than it already is. Why do you think Medicare "supplemental insurance" is commonplace, if not essential? Because "universal coverage" guaranteed by political funding is a myth. And if you think it's a myth now, wait until the baby boomers come of age and Medicare faces certain bankruptcy. And if "universal coverage for all" passes, then the price tag for the U.S. Treasury goes into the billions or trillions of dollars. And you thought the Iraq war was expensive.
None of these dollars-and-cents concerns address the deeper problem with socialized medicine: What it does to the doctor. Although politicians may applaud themselves for "giving" everyone health insurance for free, doctors pay the biggest price by being at the mercy of the bureaucracy and injustice created by this monolithic system. Also, once the private insurance sector (or what's left of it) is completely out of business, which will be inevitable if not outright mandatory, doctors will have no choice but to follow government dictates. As it stands now, medical reimbursement rates for doctors are spiraling downward, even as tax rates go up. The Governor of California even has the audacity to try and make doctors foot some of the bill for socialized medicine in that state.
Doctors, under universal coverage, won't enjoy the freedom to charge patients fee-for-service, and patients likewise will not enjoy the freedom of paying their doctors fee-for-service to get better quality care. This is what "universal coverage" truly means, whether it's written into the legislation or not. And the reason is simple: Socialized medicine, no matter what you call it, makes the private practice of medicine obsolete, just as it has severely undercut the practice of medicine under Medicare.
Does anyone know an elderly person who is actually happy with his or her doctors, by and large, under Medicare? Are any of you who already are elderly happy with the treatment you receive under Medicare? As doctors get increasingly frustrated, and the lines and the waiting times get longer, and the paperwork piles higher and the visits get shorter, doctors will no longer work directly for the patient. Many will see no need to strive for excellence, because under these programs they get patients whether they're good doctors or not. It's the only game in town.
"Universal Care" will drive a permanent wedge between the patient and the doctor. Imagine if the government took control over YOUR chosen profession, career or job and dictated your every move, including exactly what you could earn in that job-whether you do it well or not.
Remember that Medicare is only a slice of socialized medicine. Calls for universal coverage are the real thing. Under what's being proposed now, we 're going to get more of the same-only a LOT more of it.
The person who claims that "universal care worked for the elderly, so why not the rest of us?" had better check out the facts. The Government pays about fifty percent of all medical expenses today. It pays more every year. People are less and less happy with their doctors and the whole financial aspect of medicine. Gee, do you think maybe government is creating more problems rather than solving them?
Source
An increasingly popular argument in favor of socialized medicine goes like this: "If universal health care works for the elderly under Medicare, then why not for the rest of us?" If that's true, then the Democratic nominee for President should definitely work this one into his or her acceptance speech, starting now.
But there's a tragic flaw in that argument. Universal care-socialized medicine-for the elderly does NOT "work," even on its own terms. Many services, such as my own (psychotherapy and mental health care), are only partially covered, if at all, under Medicare. It has to be this way; otherwise the program would be slated for bankruptcy even sooner than it already is. Why do you think Medicare "supplemental insurance" is commonplace, if not essential? Because "universal coverage" guaranteed by political funding is a myth. And if you think it's a myth now, wait until the baby boomers come of age and Medicare faces certain bankruptcy. And if "universal coverage for all" passes, then the price tag for the U.S. Treasury goes into the billions or trillions of dollars. And you thought the Iraq war was expensive.
None of these dollars-and-cents concerns address the deeper problem with socialized medicine: What it does to the doctor. Although politicians may applaud themselves for "giving" everyone health insurance for free, doctors pay the biggest price by being at the mercy of the bureaucracy and injustice created by this monolithic system. Also, once the private insurance sector (or what's left of it) is completely out of business, which will be inevitable if not outright mandatory, doctors will have no choice but to follow government dictates. As it stands now, medical reimbursement rates for doctors are spiraling downward, even as tax rates go up. The Governor of California even has the audacity to try and make doctors foot some of the bill for socialized medicine in that state.
Doctors, under universal coverage, won't enjoy the freedom to charge patients fee-for-service, and patients likewise will not enjoy the freedom of paying their doctors fee-for-service to get better quality care. This is what "universal coverage" truly means, whether it's written into the legislation or not. And the reason is simple: Socialized medicine, no matter what you call it, makes the private practice of medicine obsolete, just as it has severely undercut the practice of medicine under Medicare.
Does anyone know an elderly person who is actually happy with his or her doctors, by and large, under Medicare? Are any of you who already are elderly happy with the treatment you receive under Medicare? As doctors get increasingly frustrated, and the lines and the waiting times get longer, and the paperwork piles higher and the visits get shorter, doctors will no longer work directly for the patient. Many will see no need to strive for excellence, because under these programs they get patients whether they're good doctors or not. It's the only game in town.
"Universal Care" will drive a permanent wedge between the patient and the doctor. Imagine if the government took control over YOUR chosen profession, career or job and dictated your every move, including exactly what you could earn in that job-whether you do it well or not.
Remember that Medicare is only a slice of socialized medicine. Calls for universal coverage are the real thing. Under what's being proposed now, we 're going to get more of the same-only a LOT more of it.
The person who claims that "universal care worked for the elderly, so why not the rest of us?" had better check out the facts. The Government pays about fifty percent of all medical expenses today. It pays more every year. People are less and less happy with their doctors and the whole financial aspect of medicine. Gee, do you think maybe government is creating more problems rather than solving them?
Source
Monday, December 03, 2007
Dental meltdown in Britain
More than a quarter of a million people have lost access to a National Health Service dentist since the system was reformed last year.
The Department of Health admits that 266,000 fewer people had NHS dental treatment since a new contract for dentists was introduced in April 2006. Many dentists decided to leave the NHS rather than work under the new contract, which was nonetheless defended by Dr Barry Cockcroft, the chief dental officer. “Changes on this scale were always going to be challenging for the NHS,” he said. “As more and more new services get up and running, we expect to see increasing numbers of patients accessing services.”
Source
Australia: Major regional hospital needs first aid
Mackay is a lovely small city in the centre of a beautiful tropical area -- but don't get ill there. This report means that all four big hospitals servicing the tropics (Cairns, Townsville, Mackay, Rockhampton) have all recently reported major problems. As tourism is a major industry in the tropics this could well be very destructive economically. Government folly can be very costly even beyond what it takes in taxes
This bursting-apart medical facility is held together with Band-Aids and broken promises. The roof of one operating theatre leaks in tropical storms, damaging vital equipment. Staff cram into shabby pre-1930 buildings and rundown demountables. If it wasn't for dongas, those makeshift construction-site sheds, the place couldn't function for lack of storage. They are everywhere. There's even one on the roof and everyone's worried it will fly off in a cyclone.
Now, this hospital of dongas is not in some remote Aboriginal community or depressed low-growth area of Australia. Not that that would make it any less deplorable. This hospital is the Mackay Base Hospital, the only public hospital that services one of Australia's fastest-growing areas, in this country's most important coal-bearing basins, where they are digging out coal as fast as is humanly possible.
The prosperity and population explosion up there is hard to comprehend. Coalmining in this state employs more than 22,000 people, generating about $15 billion in exports last year and delivering $1 billion in royalties to the State Government. Thousands of miners live in the Mackay district and rely on the hospital.
Australian Medical Association Queensland president Ross Cartmill, a Brisbane-based urologist, puts it succinctly: "The Queensland Government's income from the Mackay district in coal equals something like Tasmania's entire Budget." Hard to imagine isn't it? All that money going out. And a hovel of a hospital in return.
Now don't take my word for it. "The people of Mackay are being stiffed." The voice at the end of the phone sounds strained and like a man who's been hitting his head against a brick wall for a long while. It belongs to an experienced senior physician at the Mackay Base Hospital. "What has gone on here is a disgrace. I want to stay in this town. I like Mackay and want to deliver quality health service. But I'm at my wit's end."
Now, having an inadequate hospital has far-reaching effects. Top specialists refuse to work there or even visit. So Mackay patients must travel 381km to Townsville or 978km to Brisbane. Some go to Melbourne. Talented junior doctors in Mackay don't get proper supervision. You can't learn when you have no one to learn from. So, if you don't want your career to stall, you have to leave.
There is no cardiologist, dermatologist, urologist, neurologist or vascular surgeon or ear, nose and throat specialist. You live in Mackay and your child needs grommets, usually a basic, run-of-the-mill ear procedure? Too bad. You'll have to get on a plane to Townsville, Rockhampton or Brisbane.
Cartmill says it is embarrassing to walk through the place. "Australia is supposed to be a First World country but there are employees in the office who work in demountables without plumbing. They have to wash their coffee mugs in a plastic bowl of water on their desk." Bet you don't see too many plastic bowls of dirty washing-up water on the desks in Brisbane's Executive Building.
Now, 20 years ago when I worked at the local newspaper, The Daily Mercury, the weekly headlines were about the appalling state of the Mackay Base Hospital. Various state and federal governments have come and gone. Nothing has changed. The paper is still campaigning. The only thing keeping the Mackay Base Hospital going is its staff. Despite the terrible conditions, there are dedicated doctors, nurses and other health professionals who believe in quality health care and are prepared to pay high rents to work there.
Now, what Mackay residents don't want is more government buck-passing. There is absolutely no bank of trust left when it comes to the base hospital. The people of Mackay and staff at the hospital have been screwed by successive state and federal governments. So, here we are in 2007, with a new Premier and a new Prime Minister, both of the same politics, both banging on about fixing Australia's hospitals. Anna Bligh says she will fix Queensland's health system. Prime Minister-elect Kevin Rudd has pledged $2 billion to overhaul the nation's health system and vowed to seize control of hospitals if states fail to get reform under way by 2009.
Do you realise how little $2 billion is when stretched across the whole country's neglected health system? Take it from Cartmill. It's peanuts. Just remember, there was $30 billion lying around in the coffers for promised tax cuts alone. And 2009? Forget it. Doctors at the Mackay Base Hospital are desperate right now. They feel completely unsupported. They are driving home from their night shift this morning terrified of what they will find when they return for the next shift. They dread the next emergency that could go wrong, not because of negligence by a doctor or nurse but because of the lack of funding, training, resources and supervision. The blame lies squarely at the feet of the Federal and State Governments.
The Mackay Base Hospital does not need some quick-fix or sporadic dribble of cash for a coat of paint or the purchase of more dongas. Little grey men in suits with clipboards will talk of the "cost-effective" option of redeveloping the present site. It's a joke. There's not enough room to swing a cat on the grounds.
Want to know something jaw-dropping? Years ago a local businessman donated a large block of land that adjoined the hospital specifically for future development. Donated. It was just cow paddocks then. So what happened to it? Queensland Health flogged it off for a quick buck and it's now all houses. Do the words incompetent, short-sighted morons spring to mind? Or is that just me?
Let's not fall for bureaucratic talk of redeveloping this hovel of a hospital. No. That would all be too little, too late. Nothing less than a brand-new base hospital is acceptable. A commitment needs to be made immediately. Cartmill says State Government already owns a perfect piece of dirt, smack bang in the middle of town, the Mackay Showgrounds. It's big, flat, empty, with ideal highway access.
Cartmill's got six months left in his AMA role. "I don't want to leave without knowing we've fixed Mackay's hospital problem. I want no other legacy." Only a Federal/State solution will fix Mackay's hospital woes. Bligh and Rudd don't live far from each other in Brisbane. Maybe they could get together over coffee one morning. They are two smart people. And it's really only one little hospital. If they can't fix that, what hope the rest of the health system?
And the solution is so simple. Do I have to write it in Mandarin? Build the bloody hospital. Or it will forever be known that Anna Bligh and Kevin Rudd, in Queensland's biggest economic boom, were just another couple of politicians who couldn't fix one crooked hospital.
Source
Australia: A medical bureaucrat to be finally made accountable?
A FORMER deputy director-general who was protected by then-premier Peter Beattie has been referred to the Health Practitioners Tribunal over the Jayant Patel affair. The newly formed Office of the Medical Board filed a referral notice to the tribunal on Thursday, outlining the case against Gerry FitzGerald, who was the state's chief health officer during the Dr Patel scandal. A seven-page referral notice said that the board believed Dr FitzGerald should face disciplinary action for behaving "in a way that constitutes unsatisfactory professional conduct" between December 16, 2004 to March 25, 2005.
If the tribunal finds against Dr FitzGerald, he faces sanctions, cautioning, fines and deregistration. But former colleagues have asked how he face action when Dr Patel has yet to front a court. Dr Patel, who is living in the US, is facing charges of manslaughter over the alleged treatment of his patients.
The document outlines examples of how Dr FitzGerald was too slow to respond to queries about Dr Patel and failed to assess the serious nature of the allegations put to him. The board said Dr FitzGerald failed to recommend immediate suspension against Dr Patel. It also argued Dr FitzGerald provided a report on the hospital which was misleading and incomplete.
While Mr Beattie sacked former health director-general Steve Buckland in mid 2005, the then premier promoted Dr FitzGerald to deputy director-general despite questions being asked about why it took him so long to act against Dr Patel.
Asked why it has taken more than two years to come to its position, in a statement to The Courier-Mail yesterday, the board said: "The investigation into Dr Gerry FitzGerald followed standard procedures. "It took no longer than other investigations conducted by the Board that have been referred to independent external investigators." Dr FitzGerald could not be contacted yesterday.
Source
More than a quarter of a million people have lost access to a National Health Service dentist since the system was reformed last year.
The Department of Health admits that 266,000 fewer people had NHS dental treatment since a new contract for dentists was introduced in April 2006. Many dentists decided to leave the NHS rather than work under the new contract, which was nonetheless defended by Dr Barry Cockcroft, the chief dental officer. “Changes on this scale were always going to be challenging for the NHS,” he said. “As more and more new services get up and running, we expect to see increasing numbers of patients accessing services.”
Source
Australia: Major regional hospital needs first aid
Mackay is a lovely small city in the centre of a beautiful tropical area -- but don't get ill there. This report means that all four big hospitals servicing the tropics (Cairns, Townsville, Mackay, Rockhampton) have all recently reported major problems. As tourism is a major industry in the tropics this could well be very destructive economically. Government folly can be very costly even beyond what it takes in taxes
This bursting-apart medical facility is held together with Band-Aids and broken promises. The roof of one operating theatre leaks in tropical storms, damaging vital equipment. Staff cram into shabby pre-1930 buildings and rundown demountables. If it wasn't for dongas, those makeshift construction-site sheds, the place couldn't function for lack of storage. They are everywhere. There's even one on the roof and everyone's worried it will fly off in a cyclone.
Now, this hospital of dongas is not in some remote Aboriginal community or depressed low-growth area of Australia. Not that that would make it any less deplorable. This hospital is the Mackay Base Hospital, the only public hospital that services one of Australia's fastest-growing areas, in this country's most important coal-bearing basins, where they are digging out coal as fast as is humanly possible.
The prosperity and population explosion up there is hard to comprehend. Coalmining in this state employs more than 22,000 people, generating about $15 billion in exports last year and delivering $1 billion in royalties to the State Government. Thousands of miners live in the Mackay district and rely on the hospital.
Australian Medical Association Queensland president Ross Cartmill, a Brisbane-based urologist, puts it succinctly: "The Queensland Government's income from the Mackay district in coal equals something like Tasmania's entire Budget." Hard to imagine isn't it? All that money going out. And a hovel of a hospital in return.
Now don't take my word for it. "The people of Mackay are being stiffed." The voice at the end of the phone sounds strained and like a man who's been hitting his head against a brick wall for a long while. It belongs to an experienced senior physician at the Mackay Base Hospital. "What has gone on here is a disgrace. I want to stay in this town. I like Mackay and want to deliver quality health service. But I'm at my wit's end."
Now, having an inadequate hospital has far-reaching effects. Top specialists refuse to work there or even visit. So Mackay patients must travel 381km to Townsville or 978km to Brisbane. Some go to Melbourne. Talented junior doctors in Mackay don't get proper supervision. You can't learn when you have no one to learn from. So, if you don't want your career to stall, you have to leave.
There is no cardiologist, dermatologist, urologist, neurologist or vascular surgeon or ear, nose and throat specialist. You live in Mackay and your child needs grommets, usually a basic, run-of-the-mill ear procedure? Too bad. You'll have to get on a plane to Townsville, Rockhampton or Brisbane.
Cartmill says it is embarrassing to walk through the place. "Australia is supposed to be a First World country but there are employees in the office who work in demountables without plumbing. They have to wash their coffee mugs in a plastic bowl of water on their desk." Bet you don't see too many plastic bowls of dirty washing-up water on the desks in Brisbane's Executive Building.
Now, 20 years ago when I worked at the local newspaper, The Daily Mercury, the weekly headlines were about the appalling state of the Mackay Base Hospital. Various state and federal governments have come and gone. Nothing has changed. The paper is still campaigning. The only thing keeping the Mackay Base Hospital going is its staff. Despite the terrible conditions, there are dedicated doctors, nurses and other health professionals who believe in quality health care and are prepared to pay high rents to work there.
Now, what Mackay residents don't want is more government buck-passing. There is absolutely no bank of trust left when it comes to the base hospital. The people of Mackay and staff at the hospital have been screwed by successive state and federal governments. So, here we are in 2007, with a new Premier and a new Prime Minister, both of the same politics, both banging on about fixing Australia's hospitals. Anna Bligh says she will fix Queensland's health system. Prime Minister-elect Kevin Rudd has pledged $2 billion to overhaul the nation's health system and vowed to seize control of hospitals if states fail to get reform under way by 2009.
Do you realise how little $2 billion is when stretched across the whole country's neglected health system? Take it from Cartmill. It's peanuts. Just remember, there was $30 billion lying around in the coffers for promised tax cuts alone. And 2009? Forget it. Doctors at the Mackay Base Hospital are desperate right now. They feel completely unsupported. They are driving home from their night shift this morning terrified of what they will find when they return for the next shift. They dread the next emergency that could go wrong, not because of negligence by a doctor or nurse but because of the lack of funding, training, resources and supervision. The blame lies squarely at the feet of the Federal and State Governments.
The Mackay Base Hospital does not need some quick-fix or sporadic dribble of cash for a coat of paint or the purchase of more dongas. Little grey men in suits with clipboards will talk of the "cost-effective" option of redeveloping the present site. It's a joke. There's not enough room to swing a cat on the grounds.
Want to know something jaw-dropping? Years ago a local businessman donated a large block of land that adjoined the hospital specifically for future development. Donated. It was just cow paddocks then. So what happened to it? Queensland Health flogged it off for a quick buck and it's now all houses. Do the words incompetent, short-sighted morons spring to mind? Or is that just me?
Let's not fall for bureaucratic talk of redeveloping this hovel of a hospital. No. That would all be too little, too late. Nothing less than a brand-new base hospital is acceptable. A commitment needs to be made immediately. Cartmill says State Government already owns a perfect piece of dirt, smack bang in the middle of town, the Mackay Showgrounds. It's big, flat, empty, with ideal highway access.
Cartmill's got six months left in his AMA role. "I don't want to leave without knowing we've fixed Mackay's hospital problem. I want no other legacy." Only a Federal/State solution will fix Mackay's hospital woes. Bligh and Rudd don't live far from each other in Brisbane. Maybe they could get together over coffee one morning. They are two smart people. And it's really only one little hospital. If they can't fix that, what hope the rest of the health system?
And the solution is so simple. Do I have to write it in Mandarin? Build the bloody hospital. Or it will forever be known that Anna Bligh and Kevin Rudd, in Queensland's biggest economic boom, were just another couple of politicians who couldn't fix one crooked hospital.
Source
Australia: A medical bureaucrat to be finally made accountable?
A FORMER deputy director-general who was protected by then-premier Peter Beattie has been referred to the Health Practitioners Tribunal over the Jayant Patel affair. The newly formed Office of the Medical Board filed a referral notice to the tribunal on Thursday, outlining the case against Gerry FitzGerald, who was the state's chief health officer during the Dr Patel scandal. A seven-page referral notice said that the board believed Dr FitzGerald should face disciplinary action for behaving "in a way that constitutes unsatisfactory professional conduct" between December 16, 2004 to March 25, 2005.
If the tribunal finds against Dr FitzGerald, he faces sanctions, cautioning, fines and deregistration. But former colleagues have asked how he face action when Dr Patel has yet to front a court. Dr Patel, who is living in the US, is facing charges of manslaughter over the alleged treatment of his patients.
The document outlines examples of how Dr FitzGerald was too slow to respond to queries about Dr Patel and failed to assess the serious nature of the allegations put to him. The board said Dr FitzGerald failed to recommend immediate suspension against Dr Patel. It also argued Dr FitzGerald provided a report on the hospital which was misleading and incomplete.
While Mr Beattie sacked former health director-general Steve Buckland in mid 2005, the then premier promoted Dr FitzGerald to deputy director-general despite questions being asked about why it took him so long to act against Dr Patel.
Asked why it has taken more than two years to come to its position, in a statement to The Courier-Mail yesterday, the board said: "The investigation into Dr Gerry FitzGerald followed standard procedures. "It took no longer than other investigations conducted by the Board that have been referred to independent external investigators." Dr FitzGerald could not be contacted yesterday.
Source
Sunday, December 02, 2007
Still alive after 3 heart attacks -- but no thanks to a negligent Australian public health system
Townsville triple-bypass heart patient Syd Dart is considering legal action against the Townsville Hospital and Queensland Health. Mr Dart suffered three heart attacks this month waiting for his open-heart surgery to be rescheduled in Brisbane. His surgery had to be shifted south after Townsville Hospital management took the extraordinary step of closing down its cardio-thoracic unit on November 9.
"The management has a lot to be accountable for," Mr Dart said. "They are going to end up with blood on their hands." Mr Dart said once he had recovered from his surgery and returned to Townsville he would begin exploring the legal avenues open to him. "The duty of care has been broken," he said. "I fully intend to research what I can do about it and what avenues can be taken legally."
Mr Dart bravely spoke to the Townsville Bulletin earlier this month about his plight and was also interviewed for ABC Television's Wednesday edition of The 7.30 Report. "Most people are afraid to speak out," he said. "But somebody has got to speak out and I had already decided to do something." During the television interview Mr Dart called on the hospital's executive director of medical services Dr Andrew Johnson to resign. He was standing by that statement yesterday when he spoke to the Townsville Bulletin. "Instead of blaming the cardio-thoracic surgeons for the entire fiasco, you've got to include the director of medical services. The only honourable thing for Dr Johnson to do is to suspend himself from duty, step aside, resign," Mr Dart said on television.
A Townsville Hospital spokesman said Dr Johnson would not comment on Mr Dart's call for his resignation while investigations were ongoing. The hospital management said on November 9 it had no alternative but to shut the unit down after relations between the unit's staff deteriorated so much that patients' safety was at risk.
Mr Dart had a heart attack in early November before he was admitted to Townsville Hospital. "I was meant to be operated on the first or second of November," he said. "I had two more heart episodes while I was waiting in Townsville. "After the second one I was medivaced out and taken straight into pre-op." Mr Dart was flown by the Royal Flying Doctor Service on November 20 and taken to the Princess Alexandra Hospital where he had another heart attack.
On the morning of November 21 Mr Dart finally had his triple-bypass surgery. He was discharged from hospital on November 26 and is now recovering in a nearby facility in the care of his wife until doctors clear him to fly home. "I am one of the lucky ones who got out," Mr Dart said. "If I had gone home, as they had wanted me to at Townsville Hospital, I could be dead. "The community has been put at dire risk, it's not right. "Queensland Health management needs to step in to do something."
Mr Dart praised the care at the Princess Alexandra Hospital. "It was a quantum difference between the administration at Townsville and the Princess Alexandra. When they said they would do something they did it."
Source
Townsville triple-bypass heart patient Syd Dart is considering legal action against the Townsville Hospital and Queensland Health. Mr Dart suffered three heart attacks this month waiting for his open-heart surgery to be rescheduled in Brisbane. His surgery had to be shifted south after Townsville Hospital management took the extraordinary step of closing down its cardio-thoracic unit on November 9.
"The management has a lot to be accountable for," Mr Dart said. "They are going to end up with blood on their hands." Mr Dart said once he had recovered from his surgery and returned to Townsville he would begin exploring the legal avenues open to him. "The duty of care has been broken," he said. "I fully intend to research what I can do about it and what avenues can be taken legally."
Mr Dart bravely spoke to the Townsville Bulletin earlier this month about his plight and was also interviewed for ABC Television's Wednesday edition of The 7.30 Report. "Most people are afraid to speak out," he said. "But somebody has got to speak out and I had already decided to do something." During the television interview Mr Dart called on the hospital's executive director of medical services Dr Andrew Johnson to resign. He was standing by that statement yesterday when he spoke to the Townsville Bulletin. "Instead of blaming the cardio-thoracic surgeons for the entire fiasco, you've got to include the director of medical services. The only honourable thing for Dr Johnson to do is to suspend himself from duty, step aside, resign," Mr Dart said on television.
A Townsville Hospital spokesman said Dr Johnson would not comment on Mr Dart's call for his resignation while investigations were ongoing. The hospital management said on November 9 it had no alternative but to shut the unit down after relations between the unit's staff deteriorated so much that patients' safety was at risk.
Mr Dart had a heart attack in early November before he was admitted to Townsville Hospital. "I was meant to be operated on the first or second of November," he said. "I had two more heart episodes while I was waiting in Townsville. "After the second one I was medivaced out and taken straight into pre-op." Mr Dart was flown by the Royal Flying Doctor Service on November 20 and taken to the Princess Alexandra Hospital where he had another heart attack.
On the morning of November 21 Mr Dart finally had his triple-bypass surgery. He was discharged from hospital on November 26 and is now recovering in a nearby facility in the care of his wife until doctors clear him to fly home. "I am one of the lucky ones who got out," Mr Dart said. "If I had gone home, as they had wanted me to at Townsville Hospital, I could be dead. "The community has been put at dire risk, it's not right. "Queensland Health management needs to step in to do something."
Mr Dart praised the care at the Princess Alexandra Hospital. "It was a quantum difference between the administration at Townsville and the Princess Alexandra. When they said they would do something they did it."
Source
Saturday, December 01, 2007
Incompetent and negligent killer doctor OK for NHS
What the hell does it take for someone to be found too incompetent to work for the NHS?
A doctor convicted of killing a patient through gross negligence has been told that he can return to work in the NHS. Amit Misra, 37, fled to India after being found guilty of the manslaughter of Sean Phillips, a 31-year-old sales executive, who died from a common infection while recovering from routine knee surgery. A court was told that the trainee surgeon had failed to diagnose the infection and was “too proud” to ask senior doctors for help until it was too late. He was suspended from working for a year and avoided a jail term after his barrister pleaded that his career was in ruins.
Yet despite failing to prove himself in a series of medical assessment tests, the General Medical Council has ruled that Dr Misra should now be allowed to return to Britain to work, seven years after Mr Phillips’s death. Under the law all cautions and convictions given to doctors have to be examined by the governing body, but in many cases the GMC allows those convicted of serious crimes or unprofessional conduct to work again.
The case comes two years after the Shipman inquiry called for a radical overhaul of the GMC, which was accused of “looking after its own” and failing to protect patients. A fitness-to-practise panel of the GMC announced a series of conditions that Dr Misra will have to adhere to over the next three years.
But the family of Mr Phillips said yesterday that there was no way that the doctor should be allowed to work in Britain again. The father of one from Southampton had been expected to leave hospital the day after the operation on June 23, 2000. Four days later he was dead, after developing toxic shock syndrome from staphylococcus aureus, a common but virulent bacterial infection. Southampton University Hospitals Trust was fined 100,000 pounds over failures in his care. Dr Misra and a fellow doctor, Rajeev Srivastava, 40, were convicted of manslaughter due to gross negligence at Winchester Crown Court in April 2003 after it was found that they had failed to monitor the patient’s abnormal temperature and pulse. Despite checking on the patient at least four times, Dr Misra, a senior house officer with nine years’ experience, made only one note of the problems in Mr Phillips’s records, the court was told.
In an interview last year, Mr Phillips’s former partner, Annabel Grant, 33, who lives in Southampton with the couple’s son, Mitchell, 9, said that the doctors had never apologised. Ms Grant said: “I feel I deserve an apology from both doctors. Sean was everything I could have wished for – a soulmate, best friend and a fun-loving, caring partner. Losing him has torn my life apart but what makes the pain still harder to accept is knowing that his death was so unnecessary.”
Dr Srivastava, 40, of Invergowrie, Dundee, is understood to be working as a trainee registrar at Ninewells Hospital in the city, but has no contact with patients. Dr Misra sparked outrage when he began working at the Freeman Hospital in Newcastle upon Tyne just nine months after his conviction. He was banned from working in Britain for a year in November 2005. The doctors were given 18-month suspended sentences but not struck off.
Last year Dr Misra was ordered to undergo a performance assessment, but a team of senior doctors declared that many elements of his practice were still “unacceptable”. Speaking at a hearing to adjudge Dr Misra’s fitness to practise this week, Brian Gomes da Costa, its chairman, said: “It notes that knowledge gaps were identified in three out of the four areas of Dr Misra’s assessed professional performance. “The Panel has noted the gross negligence in postoperative care that led to Dr Misra’s conviction for manslaughter, but it has also heard of efforts that Dr Misra has made with his mentors in India to rectify the deficiencies in his clinical skills. “The overall conclusion of this assessment is that Dr Misra’s core clinical skills are at a minimum but acceptable level.”
The conditions on the doctor’s registration include informing the GMC as soon as he is back in the country, taking a course in basic surgical skills, working with a senior doctor and applying only for trainee posts. Dr Misra must also inform all future employers of the findings against him, is not allowed to do any private work and is not allowed to do any out-of-hours work or on-call duties.
The GMC is set to review the case in 18 months. A spokeswoman for the GMC said: “Our primary concern is not protecting doctors but patient safety. There are indicative sanctions that we refer to when doctors have a criminal conviction and in this case these have been taken into account.”
Source
Arrogant Australian public hospital again: Cancer patient refused transport, walks 30km (20 miles)
It's pretty disgraceful that only publicity humbles the hospital bureaucracies. This is not the first incident of this kind
A MAN recovering from cancer and his wife had to walk home almost 30km along dirt roads after being discharged from Maryborough Hospital in Queensland at 12.30am and refused transport. Glenn Horne and his wife Helen, both aged in their 50s, trudged for more than seven hours in sandals and thongs in the dark before finally being picked up by a neighbour about 4km from their Harris Rd property, south of Maryborough, early on Monday.
While the hospital has since telephoned and apologised for their ordeal, blaming it on "a breakdown in the communication process", the Hornes said the incident was symptomatic of administrative problems still plaguing Queensland Health. Mrs Horne said she had phoned for an ambulance on Sunday for her husband, who was in agony with an infection after enduring two operations for bowel cancer less than two months ago. They arrived at the hospital about 9pm with only $20. Mr Horne said he had expected to be kept in overnight but instead was given medication and discharged at 12.30am on a rainy night. "They said we couldn't stay even though the casualty room was virtually empty," Mrs Horne said. "When I said we lived 30-40 minutes' drive away, they just said 'well, that'll be an expensive taxi ride'."
Not wanting to bother friend and neighbour Desiree Taylor at that hour of the night and with no buses available and no money for a taxi, the Hornes said they decided they would have to walk home. "It was a moonlit night, thank heavens, but it was still very spooky," said Mrs Horne, who said they had neither water nor food. "We were exhausted, pretty worn out, when Desiree's son Kieran saw us (4km from home) and then she picked us up. We finally got home at quarter-past-eight in the morning."
Mr Horne said they had not wanted to make a fuss about their ordeal but he and his wife also wanted others who might find themselves in a similar situation to realise they had rights to transport and accommodation support options. Mr Horne said their situation had not been helped by his inability to work because of illness and the fact his car had broken down.
Tiaro Mayor Linda Harris said the incident needed to be highlighted so hospital staff could be counselled to better handle such issues. Fraser Coast Health Service district manager Kerry Winsor said that although procedures were in place to handle such situations, the support options were not brought to the patient's attention in this case and "we have apologised".
Source
What the hell does it take for someone to be found too incompetent to work for the NHS?
A doctor convicted of killing a patient through gross negligence has been told that he can return to work in the NHS. Amit Misra, 37, fled to India after being found guilty of the manslaughter of Sean Phillips, a 31-year-old sales executive, who died from a common infection while recovering from routine knee surgery. A court was told that the trainee surgeon had failed to diagnose the infection and was “too proud” to ask senior doctors for help until it was too late. He was suspended from working for a year and avoided a jail term after his barrister pleaded that his career was in ruins.
Yet despite failing to prove himself in a series of medical assessment tests, the General Medical Council has ruled that Dr Misra should now be allowed to return to Britain to work, seven years after Mr Phillips’s death. Under the law all cautions and convictions given to doctors have to be examined by the governing body, but in many cases the GMC allows those convicted of serious crimes or unprofessional conduct to work again.
The case comes two years after the Shipman inquiry called for a radical overhaul of the GMC, which was accused of “looking after its own” and failing to protect patients. A fitness-to-practise panel of the GMC announced a series of conditions that Dr Misra will have to adhere to over the next three years.
But the family of Mr Phillips said yesterday that there was no way that the doctor should be allowed to work in Britain again. The father of one from Southampton had been expected to leave hospital the day after the operation on June 23, 2000. Four days later he was dead, after developing toxic shock syndrome from staphylococcus aureus, a common but virulent bacterial infection. Southampton University Hospitals Trust was fined 100,000 pounds over failures in his care. Dr Misra and a fellow doctor, Rajeev Srivastava, 40, were convicted of manslaughter due to gross negligence at Winchester Crown Court in April 2003 after it was found that they had failed to monitor the patient’s abnormal temperature and pulse. Despite checking on the patient at least four times, Dr Misra, a senior house officer with nine years’ experience, made only one note of the problems in Mr Phillips’s records, the court was told.
In an interview last year, Mr Phillips’s former partner, Annabel Grant, 33, who lives in Southampton with the couple’s son, Mitchell, 9, said that the doctors had never apologised. Ms Grant said: “I feel I deserve an apology from both doctors. Sean was everything I could have wished for – a soulmate, best friend and a fun-loving, caring partner. Losing him has torn my life apart but what makes the pain still harder to accept is knowing that his death was so unnecessary.”
Dr Srivastava, 40, of Invergowrie, Dundee, is understood to be working as a trainee registrar at Ninewells Hospital in the city, but has no contact with patients. Dr Misra sparked outrage when he began working at the Freeman Hospital in Newcastle upon Tyne just nine months after his conviction. He was banned from working in Britain for a year in November 2005. The doctors were given 18-month suspended sentences but not struck off.
Last year Dr Misra was ordered to undergo a performance assessment, but a team of senior doctors declared that many elements of his practice were still “unacceptable”. Speaking at a hearing to adjudge Dr Misra’s fitness to practise this week, Brian Gomes da Costa, its chairman, said: “It notes that knowledge gaps were identified in three out of the four areas of Dr Misra’s assessed professional performance. “The Panel has noted the gross negligence in postoperative care that led to Dr Misra’s conviction for manslaughter, but it has also heard of efforts that Dr Misra has made with his mentors in India to rectify the deficiencies in his clinical skills. “The overall conclusion of this assessment is that Dr Misra’s core clinical skills are at a minimum but acceptable level.”
The conditions on the doctor’s registration include informing the GMC as soon as he is back in the country, taking a course in basic surgical skills, working with a senior doctor and applying only for trainee posts. Dr Misra must also inform all future employers of the findings against him, is not allowed to do any private work and is not allowed to do any out-of-hours work or on-call duties.
The GMC is set to review the case in 18 months. A spokeswoman for the GMC said: “Our primary concern is not protecting doctors but patient safety. There are indicative sanctions that we refer to when doctors have a criminal conviction and in this case these have been taken into account.”
Source
Arrogant Australian public hospital again: Cancer patient refused transport, walks 30km (20 miles)
It's pretty disgraceful that only publicity humbles the hospital bureaucracies. This is not the first incident of this kind
A MAN recovering from cancer and his wife had to walk home almost 30km along dirt roads after being discharged from Maryborough Hospital in Queensland at 12.30am and refused transport. Glenn Horne and his wife Helen, both aged in their 50s, trudged for more than seven hours in sandals and thongs in the dark before finally being picked up by a neighbour about 4km from their Harris Rd property, south of Maryborough, early on Monday.
While the hospital has since telephoned and apologised for their ordeal, blaming it on "a breakdown in the communication process", the Hornes said the incident was symptomatic of administrative problems still plaguing Queensland Health. Mrs Horne said she had phoned for an ambulance on Sunday for her husband, who was in agony with an infection after enduring two operations for bowel cancer less than two months ago. They arrived at the hospital about 9pm with only $20. Mr Horne said he had expected to be kept in overnight but instead was given medication and discharged at 12.30am on a rainy night. "They said we couldn't stay even though the casualty room was virtually empty," Mrs Horne said. "When I said we lived 30-40 minutes' drive away, they just said 'well, that'll be an expensive taxi ride'."
Not wanting to bother friend and neighbour Desiree Taylor at that hour of the night and with no buses available and no money for a taxi, the Hornes said they decided they would have to walk home. "It was a moonlit night, thank heavens, but it was still very spooky," said Mrs Horne, who said they had neither water nor food. "We were exhausted, pretty worn out, when Desiree's son Kieran saw us (4km from home) and then she picked us up. We finally got home at quarter-past-eight in the morning."
Mr Horne said they had not wanted to make a fuss about their ordeal but he and his wife also wanted others who might find themselves in a similar situation to realise they had rights to transport and accommodation support options. Mr Horne said their situation had not been helped by his inability to work because of illness and the fact his car had broken down.
Tiaro Mayor Linda Harris said the incident needed to be highlighted so hospital staff could be counselled to better handle such issues. Fraser Coast Health Service district manager Kerry Winsor said that although procedures were in place to handle such situations, the support options were not brought to the patient's attention in this case and "we have apologised".
Source
Friday, November 30, 2007
NHS care 'favours middle classes'
ANY healthcare system would -- but the fact that it happens in the NHS deprives the NHS of a major part of its justification
The NHS is a "divisive influence" which favours the assertive middle classes over poorer people, a study says. The report by centre-right think-tank Civitas said the health service was not providing equal treatment to all. It pointed out that people in deprived areas were often more in need of treatment, but less likely to get hip replacements or key x-rays. The report called for more use of the private sector, but other experts said this would just widen inequalities.
Report author Nick Seddon said studies had shown that those on lower incomes made more use of primary care, but were less likely to be referred on for hospital treatment. He highlighted York University research which showed those in deprived areas were more likely to need hip replacements but less likely to get them. And the report also mentioned another study which found angiograhy - x-rays of arteries and veins - rates among the lowest socio-economic groups were 30% lower that in the highest.
Mr Seddon said this was partly attributable to the fact that middle classes were more assertive, articulate and confident in dealing with health professionals. "Much depends on where you live, how much you earn, how old you are and crucially who you know. "It has always been said in defence of the NHS that, although it was not the best in terms of quality, it was at least impressive in term of equity. Now that is no longer true. "The NHS cannot be allowed to continue as it is."
He said part of the problem for the NHS was that it had made little use of the private sector. He suggested the NHS could learn from other European countries with social insurance schemes which encouraged companies to get more involved in health. "In the NHS, private providers have only really got involved in non-emergency operations to date, but why can't they do more? What about heart and cancer care and GPs? "By introducing the private sector, you increase competition and drive up standards."
But Alex Nunns, of the Keep Our NHS Public campaign group, which represents health professionals, the public and academics, said: "The middle classes will always make the best of a system. "In fact, there is evidence to show that when you involve the private sector, it just exacerbates the situation."
Source
ANY healthcare system would -- but the fact that it happens in the NHS deprives the NHS of a major part of its justification
The NHS is a "divisive influence" which favours the assertive middle classes over poorer people, a study says. The report by centre-right think-tank Civitas said the health service was not providing equal treatment to all. It pointed out that people in deprived areas were often more in need of treatment, but less likely to get hip replacements or key x-rays. The report called for more use of the private sector, but other experts said this would just widen inequalities.
Report author Nick Seddon said studies had shown that those on lower incomes made more use of primary care, but were less likely to be referred on for hospital treatment. He highlighted York University research which showed those in deprived areas were more likely to need hip replacements but less likely to get them. And the report also mentioned another study which found angiograhy - x-rays of arteries and veins - rates among the lowest socio-economic groups were 30% lower that in the highest.
Mr Seddon said this was partly attributable to the fact that middle classes were more assertive, articulate and confident in dealing with health professionals. "Much depends on where you live, how much you earn, how old you are and crucially who you know. "It has always been said in defence of the NHS that, although it was not the best in terms of quality, it was at least impressive in term of equity. Now that is no longer true. "The NHS cannot be allowed to continue as it is."
He said part of the problem for the NHS was that it had made little use of the private sector. He suggested the NHS could learn from other European countries with social insurance schemes which encouraged companies to get more involved in health. "In the NHS, private providers have only really got involved in non-emergency operations to date, but why can't they do more? What about heart and cancer care and GPs? "By introducing the private sector, you increase competition and drive up standards."
But Alex Nunns, of the Keep Our NHS Public campaign group, which represents health professionals, the public and academics, said: "The middle classes will always make the best of a system. "In fact, there is evidence to show that when you involve the private sector, it just exacerbates the situation."
Source
Thursday, November 29, 2007
A quarter of women are abandoned by their NHS midwives during childbirth
Midwives are failing to offer proper care and reassurance during childbirth, with one in four women being abandoned during labour or soon after, a watchdog says today. As proposals are being considered for the closure of specialist maternity wards, a shortage of staff and funding is putting mothers and babies at potential risk, experts say. In the largest study of NHS maternity care, the Healthcare Commission found variations across England, with nearly half the women in some trusts reporting that they had been left alone during labour or soon afterwards.
The Government has proposed that all mothers-to-be should be supported by a named midwife throughout their pregnancies by 2009, while official guidelines state that a woman in established labour should not be left on her own, except for short periods or at her own request. Yet in 18 out of the 148 trusts inspected more than one in five women said that they were left alone at a time that worried them while they were in labour. First-time mothers felt particularly unaided.
The Healthcare Commission surveyed 26,000 women who had a baby in January or February. An analysis of the results showed wide variations among trusts. The worst-performing was Milton Keynes General Hospital NHS Trust, where almost half (49 per cent) of women were left alone at a time that worried them. At Lewisham Hospital NHS Trust, 46 per cent were left alone. At Mid Staffordshire General Hospitals NHS Trust, 39 per cent were left alone. At East Cheshire NHS Trust, in contrast, 85 per cent of mothers were never left alone. Many women surveyed also complained about postnatal care, and more than half said that the food on offer was only "fair" or "poor" and one in five said that the bathrooms were "not very clean" or "not at all clean".
Today's report comes before a wider investigation into maternity services that the Healthcare Commission is expected to publish next year. Responses to the quality of care overall were largely positive, with nine out of ten women saying it was excellent, very good or good. But the Royal College of Midwives estimates that at least 5,000 midwives are needed on top of the 24,000 already in England. Louise Silverton, deputy general secretary of the college, said: "Without this, the Government's targets will just be broken promises. We have got to aim for all women to be happy with their care but we will struggle to make this happen unless the worsening shortage of midwives is addressed."
The medical royal colleges advised last month that every woman should receive one-to-one care from a dedicated midwife as she goes through labour. Only one in five women surveyed said that she had a midwife who looked after her during labour and birth, while more than two in five said that three or more staff had cared for them at different times. Other divergences from best practice meant that 43 per cent of women were not given a choice of having their baby at home, and 36 per cent were not offered antenatal classes. The Commission also found that 57 per cent of women gave birth either lying down or with their legs supported in stirrups, despite guidance from the National Institute of Health and Clinical Excellence suggesting that women be discouraged from having their baby in these positions. Overall, two thirds of women said that they "definitely" had confidence and trust in the staff caring for them while a quarter said that they had only "to some extent".
The Government has pledged that, by the end of 2009, women expecting a normal birth will be able to choose whether to have their baby at home, in a midwife-led unit or in hospital. Norman Lamb, the Liberal Democrats' health spokesman, said that the survey had exposed "a huge gap between Government promises and the reality in maternity units across the country". "As well as being denied the option of a home birth as the Government promised, some women also have the confusion of having to deal with a series of different midwives throughout their pregnancy," he said. "There simply aren't enough midwives to deliver on ministers' promises of one-to-one maternity care."
Gwyneth Lewis, national clinical lead for maternity services at the Department of Health, said: "It is encouraging that the vast majority of respondents reported their care as being excellent, very good or good."
Source
Midwives are failing to offer proper care and reassurance during childbirth, with one in four women being abandoned during labour or soon after, a watchdog says today. As proposals are being considered for the closure of specialist maternity wards, a shortage of staff and funding is putting mothers and babies at potential risk, experts say. In the largest study of NHS maternity care, the Healthcare Commission found variations across England, with nearly half the women in some trusts reporting that they had been left alone during labour or soon afterwards.
The Government has proposed that all mothers-to-be should be supported by a named midwife throughout their pregnancies by 2009, while official guidelines state that a woman in established labour should not be left on her own, except for short periods or at her own request. Yet in 18 out of the 148 trusts inspected more than one in five women said that they were left alone at a time that worried them while they were in labour. First-time mothers felt particularly unaided.
The Healthcare Commission surveyed 26,000 women who had a baby in January or February. An analysis of the results showed wide variations among trusts. The worst-performing was Milton Keynes General Hospital NHS Trust, where almost half (49 per cent) of women were left alone at a time that worried them. At Lewisham Hospital NHS Trust, 46 per cent were left alone. At Mid Staffordshire General Hospitals NHS Trust, 39 per cent were left alone. At East Cheshire NHS Trust, in contrast, 85 per cent of mothers were never left alone. Many women surveyed also complained about postnatal care, and more than half said that the food on offer was only "fair" or "poor" and one in five said that the bathrooms were "not very clean" or "not at all clean".
Today's report comes before a wider investigation into maternity services that the Healthcare Commission is expected to publish next year. Responses to the quality of care overall were largely positive, with nine out of ten women saying it was excellent, very good or good. But the Royal College of Midwives estimates that at least 5,000 midwives are needed on top of the 24,000 already in England. Louise Silverton, deputy general secretary of the college, said: "Without this, the Government's targets will just be broken promises. We have got to aim for all women to be happy with their care but we will struggle to make this happen unless the worsening shortage of midwives is addressed."
The medical royal colleges advised last month that every woman should receive one-to-one care from a dedicated midwife as she goes through labour. Only one in five women surveyed said that she had a midwife who looked after her during labour and birth, while more than two in five said that three or more staff had cared for them at different times. Other divergences from best practice meant that 43 per cent of women were not given a choice of having their baby at home, and 36 per cent were not offered antenatal classes. The Commission also found that 57 per cent of women gave birth either lying down or with their legs supported in stirrups, despite guidance from the National Institute of Health and Clinical Excellence suggesting that women be discouraged from having their baby in these positions. Overall, two thirds of women said that they "definitely" had confidence and trust in the staff caring for them while a quarter said that they had only "to some extent".
The Government has pledged that, by the end of 2009, women expecting a normal birth will be able to choose whether to have their baby at home, in a midwife-led unit or in hospital. Norman Lamb, the Liberal Democrats' health spokesman, said that the survey had exposed "a huge gap between Government promises and the reality in maternity units across the country". "As well as being denied the option of a home birth as the Government promised, some women also have the confusion of having to deal with a series of different midwives throughout their pregnancy," he said. "There simply aren't enough midwives to deliver on ministers' promises of one-to-one maternity care."
Gwyneth Lewis, national clinical lead for maternity services at the Department of Health, said: "It is encouraging that the vast majority of respondents reported their care as being excellent, very good or good."
Source
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