Democrats offer a new budget of lies



In the final push to pass a health care overhaul, Democratic leaders on Thursday sought to sway anxious party members with a new $940 billion plan that cuts the deficit, raises Medicare revenue with a new tax on the investment income on wealthier Americans and placates unions by slashing the tax on high-end insurance plans.

The concept, backed by President Obama, is designed to build positive momentum ahead of a Sunday vote on the landmark health care overhaul, which would extend insurance coverage to more than 30 million Americans, fill the Medicare prescription drug "doughnut" hole of limited coverage and curb insurance industry abuses. It swung two former "no" votes to the "yes" column.

Majority Leader Steny H. Hoyer called the plan "the biggest deficit reduction bill that any member of Congress is going to have an opportunity to vote on" with hopes of swaying fiscally minded Democrats to support it.

Republicans remain steadfastly opposed to the plan, leaving Democrats to come up with all of the support themselves. "The reason House Democrats don't have the votes is because the American people know this is a government takeover of health care," said Rep. Mike Pence of Indiana.

The 153-page bill released Thursday represents repairs that Mr. Obama and House leaders requested in exchange for voting for the Senate's health care plan. If passed, the "repair" bill would also have to pass the Senate through complicated reconciliation procedures that can circumvent a Republican filibuster.

Critics of the plan already spotted two provisions that they say are tightly focused on specific states, possibly in exchange for support of the legislation similar to the now infamous "Cornhusker Kickback." They plan to rally against the bill as the final vote nears.

White House spokesman Robert Gibbs said Thursday that Mr. Obama would postpone his Asia trip, originally scheduled to start Sunday, to help corral votes for his chief domestic agenda item.

The Congressional Budget Office analysis found that the plan would reduce the deficit by $138 billion over the next 10 years - $20 billion more than the House's original plan - and continue to drive down the deficit in later years.

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Slaughter House Rules

How Democrats may 'deem' ObamaCare into law, without voting



We're not sure American schools teach civics any more, but once upon a time they taught that under the U.S. Constitution a bill had to pass both the House and Senate to become law. Until this week, that is, when Speaker Nancy Pelosi is moving to merely "deem" that the House has passed the Senate health-care bill and then send it to President Obama to sign anyway.

Under the "reconciliation" process that began yesterday afternoon, the House is supposed to approve the Senate's Christmas Eve bill and then use "sidecar" amendments to fix the things it doesn't like. Those amendments would then go to the Senate under rules that would let Democrats pass them while avoiding the ordinary 60-vote threshold for passing major legislation. This alone is an abuse of traditional Senate process.

But Mrs. Pelosi & Co. fear they lack the votes in the House to pass an identical Senate bill, even with the promise of these reconciliation fixes. House Members hate the thought of going on record voting for the Cornhusker kickback and other special-interest bribes that were added to get this mess through the Senate, as well as the new tax on high-cost insurance plans that Big Labor hates.

So at the Speaker's command, New York Democrat Louise Slaughter, who chairs the House Rules Committee, may insert what's known as a "self-executing rule," also known as a "hereby rule." Under this amazing procedural ruse, the House would then vote only once on the reconciliation corrections, but not on the underlying Senate bill. If those reconciliation corrections pass, the self-executing rule would say that the Senate bill is presumptively approved by the House—even without a formal up-or-down vote on the actual words of the Senate bill.

Democrats would thus send the Senate bill to President Obama for his signature even as they claimed to oppose the same Senate bill. They would be declaring themselves to be for and against the Senate bill in the same vote. Even John Kerry never went that far with his Iraq war machinations. As we went to press, the precise mechanics that Democrats will use remained unclear, though yesterday Mrs. Pelosi endorsed this "deem and pass" strategy in a meeting with left-wing bloggers.

This two-votes-in-one gambit is a brazen affront to the plain language of the Constitution, which is intended to require democratic accountability. Article 1, Section 7 of the Constitution says that in order for a "Bill" to "become a Law," it "shall have passed the House of Representatives and the Senate." This is why the House and Senate typically have a conference committee to work out differences in what each body passes. While sometimes one house cedes entirely to another, the expectation is that its Members must re-vote on the exact language of the other body's bill.

As Stanford law professor Michael McConnell pointed out in these pages yesterday, "The Slaughter solution attempts to allow the House to pass the Senate bill, plus a bill amending it, with a single vote. The senators would then vote only on the amendatory bill. But this means that no single bill will have passed both houses in the same form." If Congress can now decide that the House can vote for one bill and the Senate can vote for another, and the final result can be some arbitrary hybrid, then we have abandoned one of Madison's core checks and balances.

Yes, self-executing rules have been used in the past, but as the Congressional Research Service put it in a 2006 paper, "Originally, this type of rule was used to expedite House action in disposing of Senate amendments to House-passed bills." They've also been used for amendments such as to a 1998 bill that "would have permitted the CIA to offer employees an early-out retirement program"—but never before to elide a vote on the entire fundamental legislation.

We have entered a political wonderland, where the rules are whatever Democrats say they are. Mrs. Pelosi and the White House are resorting to these abuses because their bill is so unpopular that a majority even of their own party doesn't want to vote for it. Fence-sitting Members are being threatened with primary challengers, a withdrawal of union support and of course ostracism. Michigan's Bart Stupak is being pounded nightly by MSNBC for the high crime of refusing to vote for a bill that he believes will subsidize insurance for abortions.

Democrats are, literally, consuming their own majority for the sake of imposing new taxes, regulations and entitlements that the public has roundly rejected but that they believe will be the crowning achievement of the welfare state. They are also leaving behind a procedural bloody trail that will fuel public fury and make such a vast change of law seem illegitimate to millions of Americans.

The concoction has become so toxic that even Mrs. Pelosi isn't bothering to defend the merits anymore, saying instead last week that "we have to pass the bill so that you can find out what is in it." Or rather, "deeming" to have passed it.

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Landmark Legal Foundation readies constitutional suit if Obamacare passes with Slaughter Solution

Landmark Legal Foundation president and Talk Radio powerhouse Mark Levin promised today that his foundation will file suit in federal court challenging the constitutionality of Obamacare if it is approved in the House using the Slaughter Solution.

“Landmark has already prepared a lawsuit that will be filed in federal court the moment the House acts. Such a brazen violation of the core functions of Congress simply cannot be ignored. Article I, Section 7 of the Constitution is clear respecting the manner in which a bill becomes law. Members are required to vote on this bill, not claim they did when they didn’t. The Speaker of the House and her lieutenants are temporary custodians of congressional authority. They are not empowered to do permanent violence to our Constitution," Levin said.

Even if Landmark never does another good thing for the Republic, what it has been doing for more than a decade to expose the facts about the partisan political partnership between the National Education Association and the Democratic Party makes it an invaluable asset. You can check that out here.

Landmark also has done superb work in exposing how federal bureaucrats at the EPA have funneled billions of tax dollars to radical environmental groups that lobby on behalf of more regulatory power, bigger budgets and expanded staffing for ... EPA. Check that out here.

Levin may be best known for his New York Times best-seller, "Liberty and Tyranny: A conservative manifesto." I knew something remarkable was bubbling "out there" among the American people last year when Levin's book zoomed to the top of the best-seller's list and people lined up for blocks in places like Fairfax County, Va., to buy signed copies of the book and to meet him.

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Into the twilight zone

Nancy Pelosi has scheduled a vote for Sunday, maybe to vote by not voting. The president has canceled his trip to Asia and the atmosphere in Washington grows surreal and surrealer. The speaker yearns to be a suicide bomber, blowing up her party's November prospects, or at least the leader of the Democratic squadron of kamikaze pilots.

No one can quite remember when a party in power has been so determined to self-destruct, with the speaker as provocateur, egging everyone on. Rep. Mike Honda, a Californian of Japanese descent, objects to some of the metaphors applied to Mzz Pelosi's mission of death by obsession, but to neutral observers - assuming any are left - her execution of the president's obsession looks like the Bataan death march, or at least a ride to the gallows in a Toyota.

Everything the Democrats are doing is turning to mud, or maybe even the smelly stuff wives accuse husbands of tracking into the house. Barack Obama even chose this week to pick an unnecessary fight with Israel, our only true friend in the Middle East. When Joe Biden quickly wore out his welcome in Jerusalem, he was brought back to Washington to employ his considerable Irish charm to entertain the Irish prime minister, Brian Cowen, who dropped in for a St. Patrick's Day visit to the White House. Nobody could mess up such a jovial occasion, even with beer dyed green for the occasion.

Good old Joe, ever the bumbling uncle we've come to love (so far the president hasn't consigned him to the attic where crazy aunts and uncles usually live), nevertheless pronounced obsequies on the prime minister's ailing mother: "God rest her soul." Good old Joe quickly learned that the elderly Mrs. Cowen's soul is still among us. Never mind. He rewrote his benediction to "God bless her soul," and recalled the Irish proverb that "a silent mouth is sweet to hear." To the relief of all he turned the podium over to the president's teleprompter, and no further harm was done. No need for the media's Gaffe Patrol even to fire up the engines on their ancient Jennies.

But what other explanation for Mr. Obama's damn-the-torpedoes strategy could there be other than a suicide wish? The only outcome worse for him than losing the health care vote would be winning the health care vote. The debacle in Massachusetts has taught him nothing, but it has surely taught the public a lot. Gallup now puts the president's approval rating at 46 percent, the lowest yet, and his disapproval at 47 percent. These are dreadful numbers for any president, and particularly for a messiah who arrived at the White House little more than a year ago with approval ratings in the high 70s.

The debacle in Massachusetts will be small stuff if Mzz Pelosi proceeds with the aptly named "Slaughter solution," the bright idea of Rep. Louise M. Slaughter of New York, to dispense with actually voting for the Senate bill and declaring that the House "deems" the Senate measure enacted. This would avoid a voice vote and guilty congressmen could go home to tell credulous constituents that they should deem them as having voted against the monstrosity that almost nobody wants. Such a solution is so nutty that only Nancy Pelosi and Harry Reid would have imagined using it. But if they succeed Congress will have opened up vast new avenues of chicanery, deceit and dishonesty. A husband caught staying out all night can tell his angry wife that she should "deem" him to have slept on the sofa discarded in the garage; a schoolboy who wouldn't dare claim the dog ate his homework can now tell a teacher that she should "deem" the homework done.

Mr. Obama, who long ago perfected the verbal sleight of hand that has served him well until now, got particularly flustered and visibly irritated when he sat down for an interview with Fox News and learned for the first time how uncomfortable a real interview can be. The more interviewer Bret Baier pressed the more the president wiggled and the more the interviewer persisted. Soon it descended into presidential argle-bargle. The president doesn't have an opinion on "deeming" because "I don't spend a lot of time worrying about what the procedural rules are." He's not concerned about "the Louisiana Purchase" or the "Cornhusker Kickback" - special deals for Louisiana and Nebraska to buy Senate votes - because special deals "also affect Hawaii, which just went through an earthquake." It did?

But maybe it was a slip of the tongue and he meant Haiti. But surely he doesn't think Haiti is one of the 57 states. We can't be sure.

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Hiding the true cost of Obamacare

President Obama keeps saying America needs the Democrats' health care bill to reduce costs. In reality, the government takeover of health care will raise costs and cause a large number of people to lose their health insurance.

"Well, if [the health care bill] doesn't pass, I'm more concerned about what it does to families out there who right now are getting crushed by rising health care costs and small businesses who were having to make a decision, 'Do I hire or do I fix health care?' " Mr. Obama claimed to Fox News on Wednesday.

Saying his bill will reduce costs doesn't make it true. Take the legislation's huge $500 billion cuts in Medicare. The government already reimburses hospitals and doctors less than their costs. Further cuts mean even more cost shifting to privately insured patients to cover deeper Medicare losses. Private insurance won't cover all of these exorbitant losses, which will force many doctors and hospitals out of business.

This week, the New England Journal of Medicine released a survey of doctors showing that 46.3 percent of "primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine." Not only will doctors leave medicine, but "27 percent [of physicians] would recommend medicine as a career but not if health reform passes." The survey is merely suggestive, but if the real reduction in the number of doctors is even 5 percent or 10 percent, medical costs will rise significantly. A lower supply of doctors amid rising demand for care means higher medical prices.

Another example is the ban on insurance companies charging different premiums based on pre-existing health conditions. Imagine what would happen if motorists could buy auto insurance after an accident and were allowed to drop it once a car was fixed. People would wait until they were in an accident to buy insurance, and insurance premiums would skyrocket. The same will happen if insurance companies can't charge higher premiums for sick people.

Even the few purported cost-reducing measures in the Senate bill are being gutted by the president's proposal. The reconciliation bill delays a tax on high-quality insurance, dubbed Cadillac plans. The idea was if the cost of insurance was raised, fewer people would want such extensive medical coverage and thus would not seek medical care as often. Reduced demand therefore would reduce the price of medical care. But after striking a deal with unions, Mr. Obama decided to delay the tax for eight years, until he's out of office.

The Democrats' plan will destroy American health care. Obamacare will dramatically raise the cost of medical care, forcing many Americans to drop their insurance. Responsible members of Congress have to vote this down.

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The unbelievable NHS again

Bungling foreign nurse can KEEP his job... despite barely speaking English and 'worrying' lack of competence

An Indian nurse who could barely understand English and refused to learn the language was told yesterday he could return to his hospital and carry on working. The decision by the Nursing and Midwifery Council came despite despite the watchdog commenting on his ‘worrying’ lack of competence.

Biju John, 38, had insisted he was able to understand instructions and wrote to the council stating: ‘I never be confused at all.’ But staff felt they were ‘carrying’ him and did not feel safe leaving patients in his care, an NMC hearing was told.

Mr John also had a limited knowledge of basic nursing skills and did nothing when a patient was struggling to breathe, it was claimed. The NMC heard Mr John should have started basic airway management as the man gasped for breath after coming round from an operation. But instead he had to be helped by a colleague who rushed over when she heard the man’s wheezing from the other side of the anaesthetic unit at Leicester Royal Infirmary.

On another occasion Mr John almost caused a patient to go into shock when he wore latex gloves to treat him despite being told he was allergic to the material. The hospital then devised a set of objectives for the nurse, including meeting the required standard of English so he could effectively communicate with staff and colleagues. But he failed to reach the targets and was kept on supervised practice.

A further incident on October 20, 2004 led to Mr John being suspended and a disciplinary meeting was scheduled for January 20, 2005, but he quit seven days before. He was later reported to his regulating body. Mr John, from Cambridge, was found guilty of seven charges relating to his lack of competency when he worked at the hospital between July 2003 and December 2004. These include failing to complete basic skills required of a nurse, not demonstrating his English was sufficient to communicate with colleagues effectively – which gave rise to the incident with the latex gloves – and failing to take appropriate action when a patient’s oxygen levels dropped. He was cleared of mistaking the Surgical Assessment Unit for the Surgical Acute Care Unit.

NMC chairman David Kyle said his lack of competence was ‘worrying’ but ‘not irremediable’. He added: ‘Although the registrant was a caring nurse, he lacked confidence, was reluctant to act on his own initiative and could not be trusted to work unsupervised. ‘Other nurses felt they were carrying him. ‘Anaesthetists were nervous about leaving their patients in his care and adopted a practice of returning to check on their patients because they were concerned about them.

‘The panel has heard evidence of a worrying lack of competence demonstrated over a considerable period of time and that lack of competence, in some basic areas of practice for any registered nurse, particularly in communication, is still present.’

But the panel ruled Mr John could return to work subject to conditions. Mr John must tell the NMC where he is working, remain supervised, complete a personal development plan and an English language test he complies with the conditions he will be allowed to return to normal practice after 18 months.

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SOCIALIZED MEDICINE IN PRACTICE

Below are five reports from just ONE DAY in Britain

Terrifyingly inept foreign doctors are a symptom of a sickness in the NHS - not the cause

By Professor Karol Sikora

When a supposed cure has instead become a new kind of sickness, then surely something is badly wrong. Yet that is what has happened in the modern NHS. The target culture brought in to benefit patients is having fatal consequences. A system that originally aimed to improve performance and efficiency is now threatening patients' lives, distorting clinical priorities and encouraging the use of foreign doctors, who may be too inexperienced or unqualified for the jobs they have been given.

The tragic case of 94-year-old Ena Dickinson is a heart-rending example of what can go wrong in a health service that puts compliance with political requirements above the real needs of patients. Mrs Dickinson, a Lincolnshire grandmother, died in 2008, soon after she underwent a hip replacement operation which was carried out at Grantham Hospital by a German locum surgeon, Dr Werner Kolb. In an appalling series of errors, Dr Kolb cut through the wrong muscle, severed an artery and used the wrong cutting tool, with the result that Mrs Dickinson lost almost half her blood in an operation that should have been routine. One witness, another doctor from the hospital, said he was 'horrified by what I saw', while an expert surgical witness, Professor Angus Wallace, told the inquest on Tuesday that he 'could not believe the level of neglect in the operation'.

The episode raises troubling questions about the NHS's increasing reliance on foreign doctors, both from the European Union and from further overseas, a practice that has been driven partly by the Government's fixation with meeting targets and partly by an inadequate supply in the number of domestic trained doctors.

We do not, of course, live in an insular world and overseas doctors have long been an integral part of the NHS. Indeed, when I first worked in the NHS in the early Seventies, I saw that the service would not have been able to function without the support of doctors from Asia. And, whether we like it or not, Britain is part of the European Union, one of whose guiding principles is the free movement of labour throughout the member states. So, without drastic political changes to the very nature of our society, we would not be able to adopt a siege mentality when it comes to employment in the NHS.

Nevertheless, the disastrously botched operation that Mrs Dickinson suffered highlights a worrying trend, where too often foreign doctors have been imported to provide cover in the NHS, without any proper checks on their background, their ability to speak English, their experience or their competence.

According to reports about Dr Werner Kolb, he had actually performed few hip operations during his career and had spent most of his recent years giving lectures, hardly a record to inspire confidence in the operating theatre. Dr Kolb's negligence may be particularly graphic, because of the way he sawed through the wrong muscle, like some grotesquely inept carpenter.

Some might argue, therefore, that it is particularly dangerous to let foreign doctors carry out surgery without rigorous monitoring. But this would be a fallacy. Every branch of medicine, from general practice to pathology, has the potential to do mortal harm because of its intimate connection with the delicate structure of the human body. In my own field of cancer care, disasters can occur because of a misdiagnosis or the administration of the wrong dosage of drug.

The calamitous risks of incompetence by GP locums were illustrated in early 2008 by Dr Daniel Ubani, who flew in from Germany to Cambridgeshire to provide weekend cover for a local practice, only to end up killing one pensioner, David Gray, by accidentally giving him ten times the maximum dosage of diamorphine. The coroner then said Mr Gray's death had been caused by 'gross negligence', words that carry a chilling echo in the Dickinson case.

One of the key problems is that, under an EU directive of 2004, doctors who qualify in any EU country can move to work in any other EU state without even the most limited examination of their skills, aptitude or language. In contrast, foreign doctors (ie from outside the EU) must pass a skills and English language test - yes, even the Australians and Americans.

EU countries are also not forced to provide information on their doctors' professional histories - for example, whether they have been struck off for committing a criminal offence or killing a patient through negligence.

There are estimated to be around 20,000 EU doctors registered to work in the NHS, a quarter of them from the former Eastern Bloc countries.

Now the vast majority of them are certainly perfectly competent, but, even so, difficulties will inevitably arise over language and culture. Every nation, for instance, has its own medical hierarchies, differing relationships between doctors and nurses, or unique approaches to patient care.

Moreover, foreign doctors without a sound grasp of English will not understand what their patients are telling them, something that is a particular concern in GP services.

It is telling that EU doctors are twice as likely to face disciplinary hearings before the General Medical Council as their British counterparts, in which foreign doctors from outside the EU are three times as likely to be struck off the medical register - statistics that point to the laxity of checks.

We cannot blame foreign doctors for wanting to work in the NHS. Britain has one of the best-rewarded medical professions in the world, with GPs earning on average over £100,000-a-year and leading consultants far more. These are incredible riches for doctors from the old Soviet sphere of influence. In Poland, where my family has some of its roots, a doctor is likely to earn around £500 a month or £6,000-a-year, a sum that can be made with a few weekend or holiday stints in Britain. As a consequence, one in six of Poland's doctors now works abroad.

Nor is the NHS management entirely to blame for the catalogue of controversies that has arisen from the employment of foreign staff. NHS bosses are under tremendous pressure to meet waiting lists targets set by the Government, so they will take any action, bear almost any cost, to achieve this. So rather than postpone operations during periods when staff are on leave, they bring in foreign doctors to keep the conveyor belt moving.

In Ena Dickinson's case, it would not have mattered if her hip replacement operation had been delayed by a week or two, but no doubt the management of Grantham Hospital was appalled at the idea of slipping behind the Government's arbitrary 18-week deadline for such routine surgery. So, in a disastrous misjudgment, Dr Kolb was brought in so the needs of bureaucracy, if not the patient, could be met.

The problem has been compounded by the Government's failure to assess correctly the needs of the NHS for doctors, with the result that foreign doctors have been brought in to cover gaps in supply. It must be admitted that the demands on the NHS have grown enormously in recent years as a consequence of increasing numbers of elderly patients, a growth in the British population and advances in medical care. Twenty years ago, the idea of carrying out a hip replacement operation on a 94-year-old grandmother would have been unthinkable.

Moreover, the EU working time directive drastically reduced the number of hours that any doctor could be on duty, which meant that more staff had to be made available. But the need to increase the supply of doctors only emphasises the need to scrutinise their competence more vigorously. What we need, therefore, is an assessment of their skills by practical and verbal demonstration, accompanied by checks on their background and a basic language test. We're doing it for our own graduates, after all. That is what our NHS patients deserve. We cannot allow any more tragedies like that of Ena Dickinson.

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Killer Muslim doctor with repeated disregard for patients is suspended for just FOUR MONTHS by British regulators

A doctor with a 'disregard' for patient safety was suspended for just four months today for sending home a baby girl who died the next day from blood poisoning. Dr Salawati Abdul-Salam failed to spot little Aleesha Evans' deadly condition and sent her home saying she had a viral infection that needed only Calpol and Nurofen. She died the next day.

A year before the baby's death, another of Abdul-Salam's patients died after a wrong diagnosis, while a pensioner suffered a collapsed lung under the trainee's care. GMC panel chairman Professor Denis McDevitt said the doctor's actions demonstrated a 'total lack of attention to detail' and a 'serious degree of carelessness.'

Colin Perriam, 66, had died after Abdul-Salam analysed six-month old blood samples, then wrongly diagnosed a ruptured ulcer as constipation. Mr Perriam was discharged from Cardiff's University Hospital of Wales on December 15, 2004 with a prescription of laxatives.

Widow Pamela Perriam had told the hearing: 'She said that he was suffering from constipation. 'We were given some powders that you mix with water for mild constipation and we were not given any other instructions. 'We were not given anything else except to say that it was mild constipation and mild laxatives should deal with the problem.'

But the next day Mr Parriam could not get out of bed and when his stomach appeared swollen and blotchy the following evening, his wife called an ambulance. By the time it arrived her husband was unconscious. Mr Parriam underwent emergency surgery but never recovered and died the next day on February 5, 2005.

A month earlier, Abdul-Salam gave a 79-year-old woman an unnecessary chest drain after reading the wrong x-ray. She had to apologise after the elderly woman's lung collapsed.

On August 9, 2006, Aleesha Evans was rushed to the Royal Gwent Hospital in Newport, Wales, vomiting with a rash and a temperature of 37 degrees. But the trainee specialist registrar did not even examine the baby and discharged her two hours later after noting her condition was 'unremarkable.' The doctor had seen the patient by this stage and noted she appeared to be better than she had been and that she was playing. But her heart rate was still high and her temperature had risen to 39 degrees, the hearing was told. The baby was discharged at 11pm with a diagnosis of viral illness.

But she was suffering from meningococcal septicaemia - blood poisoning - and died the following day. Abdul-Salam was placed under supervision at the Princess of Wales Hospital in Bridgend after Aleesha's death. She was only allowed to perform three hours of clinical work a day and had to sign every patient off with a supervisor. But within three weeks Abdul-Salam had broken the terms of her training and more than a third of her patients had been discharged without her superior's consent.

One of these patients was a 10-year-old girl with a broken wrist who attended A&E on 22 September 2008. The child required treatment under anaesthetic but Abdul-Salam discharged her to the outpatient fracture clinic.

Prof McDevitt told Abdul-Salam: 'The panel has concluded that you have not yet fully appreciated the magnitude of your deficient performance and misconduct. 'You demonstrated poor judgment when under pressure. Your lack of careful clinical method resulted in the inadequate assessment and management of patients and you failed to appreciate fully the discordance between the patients' clinical condition and the results of investigations. 'The panel considers there remains of risk of you repeating errors and exercising poor judgment, particularly if you were to return to work in a more pressures environment than you are currently exposed to.'

Prof McDevitt said the panel had considered imposing conditions on Abdul-Salam's practice but concluded her actions involving baby Aleesha Evans were too serious: 'Taking all the factors into account, the panel concluded that your registration should be suspended for a period of four months. 'Your misconduct was sufficiently serious to undermine public confidence in the profession. It is also important that you, and the medical profession, are left in no doubt that such behaviour, which clearly had consequences for patient safety, is unacceptable.'

The doctor had been working as a locum at the Kent and Sussex Hospital in Tunbridge Wells, Kent for the last five months, but she will now be unable to keep her job.

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British doctors who wouldn't listen allow little girl to die

An eight-year-old girl with an acute fear of dentists who starved to death after her milk teeth were taken out under anaesthetic died because of a “lack of communication” between health agencies, an investigation has concluded.

Sophie Waller refused to open her mouth even to eat after the operation. She had developed her phobia at the age of four when her tongue was scratched during a routine check-up. When she refused treatment after cracking a tooth on a boiled sweet her parents became so concerned they took her to their GP who referred her to the Royal Cornwall Hospital in Truro.

Surgeons decided to remove eight remaining milk teeth under anaesthetic to avoid problems in future. But she was left so traumatised by it she refused to open her mouth to eat or drink.

A report by the Local Safeguarding Children Board has now found there was a “lack of clarity” from the agencies responsible for Sophie’s care after her discharge from hospital. She was sent home despite her condition and her parents did not know who to turn to when her health deteriorated.

By the time of her death in December 2005 Sophie, from St Dennis in Cornwall, was severely malnourished and weighed just 22kg. Her parents had been feeding her a diet of yoghurt and mashed fruit and tried to get help from their GP and the hospital but were instead referred to a child psychologist.

She was found dead in bed by her mother four weeks after her discharge and the cause of death was given as kidney failure as a result of starvation and dehydration. An inquest in February 2009 found there was no blame attached to her parents who had tried to get help for their daughter.

The serious case review found of a lack of communication between all the health agencies involved in her care. The report says: “No clear written plan was made on discharge and there was lack of clarity about responsibility for medical review following discharge.

“The clinical psychologist made telephone contact with the child’s parents in the week after discharge but did not see her again. “There was a lack of clarity over the open door arrangement which was intended to allow the child’s parents to bring her back in the week following discharge. When they phoned for advice on the seventh day, they were referred back to the psychologist for support.”

Her mother Janet Waller, a nursery school teacher who has two other children, said the report highlighted how their pleas should have been heard. She said: “All we’ve wanted all along is for people to listen to us. People ask me how many children I have, I say three, but technically I haven’t any more. I’ve got to live with this for the rest of my life.”

At Sophie’s inquest in February last year the Cornwall coroner, Dr Emma Carlyon, said that the Royal Cornwall Hospital was guilty of a number of failings which led to Sophie’s death. She said: “The severity of her malnutrition and dehydration was not recognised. This prevented her from receiving the medical support that could have prevented her death.”

Dr Ellen Wilkinson, Medical Director of Royal Cornwall Hospital Trust, said: “We would like to apologise to the family of Sophie Waller. Everyone involved in her care was saddened by her tragic death. This was a very unusual case. “There were shortcomings in the communication between the health organisation and Sophie’s parents.”

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'Blood-spattered walls and mouldy equipment': How a quarter of British government hospitals fail to meet basic hygiene tests

A quarter of NHS hospital trusts are failing to meet basic hygiene standards, with some treating patients on blood-spattered wards or with dirty equipment, a damning report has found. A third of ambulance trusts have also missed the targets set, according to the Care Quality Commission. The watchdog's report follows the introduction of tough new hygiene standards after a series of scandals at hospitals in Maidstone, Basildon and Stafford.

It also came as a survey of NHS employees found many are too overstretched to do their jobs properly because of staff shortages.

On hygiene, the CQC found 42 out of the 167 NHS trusts inspected were in 'breach' of registration requirements by failing to meet standards, with some hospitals being warned over blood-spattered wards and dirty equipment. In Basildon, where at least 70 patients died as a result of poor hygiene last year, investigators found a commode soiled under the seat and 'procedure trays, used by staff to carry equipment when they take blood samples or give injections, had blood spattered on them'.

At children's hospital Alder Hey, in Liverpool, the inspection revealed dirty toys, hair stuck to medical equipment and 'nappy changing mats stored on the floor next to a toilet'. Water 'ran brown' from taps in patient areas.

A total of 36 trusts did not provide areas to decontaminate instruments, three trusts failed to flush unused water regularly to control legionella outbreaks, and a dozen failed to keep clinical areas clean. The situation was so bad at four ambulance trusts that they were given written warnings about the state of their vehicles and stations.

Nigel Ellis, the CQC's head of inspection, said: 'We have on rare occasions found evidence of a direct risk to patients and have intervened using our enforcement powers to ensure swift improvements were made. 'In over half of trusts we have made some suggestions or requirements for improvements to ensure their practices are the best they can be.'

A spokesman for the Department of Health said: 'There's no doubt that the trusts rose to the challenge --we've seen swift and tangible improvements in their performance, and on follow-up meetings all met the required standards.'

Meanwhile, half of NHS workers claim that staff shortages are stopping them doing their jobs properly. Of the 160,000 workers questioned by the CQC, 46 per cent said they were unable to do a proper job.

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One in ten doctors in Britain is foreign and untested

Almost one in ten doctors on the medical register comes from the EU and has not had to take any language or competence tests before working in Britain. The shocking figure exposes the lax controls over European locums taking up hospital posts in the NHS and providing out-of-hours GP cover. Unlike doctors from elsewhere in the world - who are forced to prove language skills and medical knowledge before being registered - such testing is forbidden for doctors qualified in Europe and Switzerland.

Campaigners want a complete overhaul of the system after the death of a grandmother following appalling blunders by a German surgeon flown in by the NHS. Ena Dickinson, 94, lost nearly half the blood in her body during what was meant to be a routine hip operation at Grantham Hospital in Lincolnshire. Werner Kolb, who had been working in the NHS for three weeks, severed an artery and became so flustered he started speaking German in the operating theatre.

An expert witness described it as the worst case of negligence he had come across - yet Dr Kolb, pictured today for the first time, was left free to work in the UK for a further eight months before being suspended by the General Medical Council.

Dr Kolb, who had been mainly lecturing for four years before the tragedy, refused to attend the inquest and denied his conduct had anything to do with Mrs Dickinson's death eight weeks later from pneumonia. Last night a colleague at Bethesda Hospital in Stuttgart insisted: 'I find it hard to reconcile the words said against him in Britain with the precise surgeon I know.'

But Mrs Dickinson's daughter Kathy Ingram, 57, said: 'The system is disgraceful and clearly isn't working. NHS trusts have to assume that locum doctors' qualifications from Europe are reliable without doing their own checks. 'You trust your doctor because he's in authority but if he hasn't been verified and isn't monitored, you never know what standard of treatment you'll get. The law has to be changed so that there is closer monitoring.'

Figures show there are more than 230,000 doctors on the GMC register of which 21,451 - almost 10 per cent - gained their qualifications in other EU countries. The ban on checks comes from a European directive ordering member states to allow workers free movement. This means the GMC is forced to accept qualifications at 'face value', according to its chief executive Niall Dickson.

The GMC has protested about the rights of doctors to work freely across Europe being put ahead of a patient's right to safe treatment. In a presentation to the EU's Green Paper on the European Workforce for Health, it said: 'Legislation must be amended to allow healthcare regulators across Europe to establish that a doctor has the level of language proficiency necessary to practise safely. 'We are also prevented from adopting a general requirement to prove competence and cannot specify the standard of acceptable competence. 'The current situation is profoundly at odds with the pursuit of safe and high quality health care.'

Dr Vivienne Nathanson, head of science and ethics at the British Medical Association, said: 'Whilst it is essential doctors are able to communicate with their patients and the regulatory authorities are able to assess fitness to practise, it is also important we don't make it impossible for those that do have the appropriate skills to work in the UK.'

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Health care bill can be beaten

House passage of the Democrats' health care bill is not a foregone conclusion despite their 75-seat majority in the chamber. While party leaders such as Speaker Nancy Pelosi and White House spinmeister David Axelrod bravely express confidence, Rep. James E. Clyburn of South Carolina, the House majority whip, conceded on NBC's "Meet the Press" that Democrats don't have enough votes yet.

The all-out effort to ram through the legislation before Easter recess is telling. If members of Congress merely risked being confronted by Potemkin crowds that don't represent the majority of voters, there would be nothing to fear. However, Democratic strategists know these crowds are very real and very mad, and the mobs will rattle wavering congressional votes, especially in vulnerable districts. The latest Rasmussen poll shows that independents oppose the mass of new regulations and taxes by a wide margin of 64 percent to 32 percent.

Despite the barrage of political attacks on insurance companies over the past year, 76 percent of Americans with insurance still rate their coverage as "excellent" or "good." Rasmussen Reports notes that this group has "proven to be a major obstacle for advocates of reform." Last year, Mr. Obama repeatedly promised he wouldn't interfere with the insurance of those who liked their current policies, but that vow has been broken. It's no wonder a constant trickle of Democrats is expressing concern about the party's policy agenda.

According to the latest vote count, released early Tuesday morning by the Hill newspaper, 37 Democrats are either firm "no" votes or "leaning no." Add a wavering Rep. Timothy H. Bishop, New York Democrat, and the number is 38. That is the exact number needed to defeat the bill, and it is up from the 25 firm "no" or "leaning no" votes on Thursday. Of the 38, 28 voted against the bill in November. In total, 55 Democrats reportedly are undecided. If the nays hold and just two of those undecided votes switch, the bill will be defeated.

According to Rep. Bart Stupak, Michigan Democrat, special deals were offered recently to peel off one or two of the 11 Democrats who stood with him against government-funded abortions. He accused his party's leadership of never having had any intention of fixing the abortion language, a posture he attributed to the leaders' belief that the votes of the 12 pro-life Democrats wouldn't be needed. "We'll probably have to wait until the Republicans take back the majority to fix this," Mr. Stupak told National Review, almost sounding wistful for that day.

Democrats are full of a lot of false bravado. Through July, August and October, they kept claiming the votes to pass the health care takeover were imminent. They were wrong.

Democrats still may be able to cobble together enough backroom payoffs or use various tricks and pressure for passage. On Intrade, the largest prediction market, the betting is swinging in favor of the health care takeover, with the latest odds giving Democrats a 70 percent chance of passing it. Stopping this travesty depends on voters expressing their outrage to Democrats on Capitol Hill.

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With Medicaid Cuts, Doctors and Patients Drop Out

If America can't afford to pay for Medicare, how can it afford Obamacare?

Carol Y. Vliet began chemotherapy to treat her cancer, but lost her doctor because he stopped seeing Medicaid patients. As she began a punishing regimen of chemotherapy and radiation, Mrs. Vliet found a measure of comfort in her monthly appointments with her primary care physician, Dr. Saed J. Sahouri, who had been monitoring her health for nearly two years. She was devastated, therefore, when Dr. Sahouri informed her a few months later that he could no longer see her because, like a growing number of doctors, he had stopped taking patients with Medicaid.

Dr. Sahouri said that his reimbursements from Medicaid were so low — often no more than $25 per office visit — that he was losing money every time a patient walked in his exam room. The final insult, he said, came when Michigan cut those payments by 8 percent last year to help close a gaping budget shortfall. “My office manager was telling me to do this for a long time, and I resisted,” Dr. Sahouri said. “But after a while you realize that we’re really losing money on seeing those patients, not even breaking even. We were starting to lose more and more money, month after month.”

It has not taken long for communities like Flint to feel the downstream effects of a nationwide torrent of state cuts to Medicaid, the government insurance program for the poor and disabled. With states squeezing payments to providers even as the economy fuels explosive growth in enrollment, patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage. Inevitably, many defer care or wind up in hospital emergency rooms, which are required to take anyone in an urgent condition.

Mrs. Vliet, 53, who lives just outside Flint, has yet to find a replacement for Dr. Sahouri. “When you build a relationship, you want to stay with that doctor,” she said recently, her face gaunt from disease, and her head wrapped in a floral bandanna. “You don’t want to go from doctor to doctor to doctor and have strangers looking at you that don’t have a clue who you are.”

The inadequacy of Medicaid payments is severe enough that it has become a rare point of agreement in the health care debate between President Obama and Congressional Republicans. In a letter to Congress after their February health care meeting, Mr. Obama wrote that rates might need to rise if Democrats achieved their goal of extending Medicaid eligibility to 15 million uninsured Americans.

In 2008, Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare, which are themselves typically well below those of commercial insurers, according to the Urban Institute, a research group. At 63 percent, Michigan had the sixth-lowest rate in the country, even before the recent cuts.

In Flint, Dr. Nita M. Kulkarni, an obstetrician, receives $29.42 from Medicaid for a visit that would bill $69.63 from Blue Cross Blue Shield of Michigan. She receives $842.16 from Medicaid for a Caesarean delivery, compared with $1,393.31 from Blue Cross.

If she takes too many Medicaid patients, she said, she cannot afford overhead expenses like staff salaries, the office mortgage and malpractice insurance that will run $42,800 this year. She also said she feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies, because of underlying health problems.

As a result, she takes new Medicaid patients only if they are relatives or friends of existing patients. But her guilt is assuaged somewhat, she said, because her husband, who is also her office mate, Dr. Bobby B. Mukkamala, an ear, nose and throat specialist, is able to take Medicaid. She said he is able to do so because only a modest share of his patients have it.

The states and the federal government share the cost of Medicaid, which saw a record enrollment increase of 3.3 million people last year. The program now benefits 47 million people, primarily children, pregnant women, disabled adults and nursing home residents. It falls to the states to control spending by setting limits on eligibility, benefits and provider payments within broad federal guidelines.

Michigan, like many other states, did just that last year, packaging the 8 percent reimbursement cut with the elimination of dental, vision, podiatry, hearing and chiropractic services for adults.

When Randy C. Smith showed up recently at a Hamilton Community Health Network clinic near Flint, complaining of a throbbing molar, Dr. Miriam L. Parker had to inform him that Medicaid no longer covered the root canal and crown he needed.

A landscaper who has been without work for 15 months, Mr. Smith, 46, said he could not afford the $2,000 cost. “I guess I’ll just take Tylenol or Motrin,” he said before leaving.

This year, Gov. Jennifer M. Granholm, a Democrat, has revived a proposal to impose a 3 percent tax on physician revenues. Without the tax, she has warned, the state may have to reduce payments to health care providers by 11 percent.

In Flint, the birthplace of General Motors, the collapse of automobile manufacturing has melded with the recession to drive unemployment to a staggering 27 percent. About one in four non-elderly residents of Genesee County are uninsured, and one in five depends on Medicaid. The county’s Medicaid rolls have grown by 37 percent since 2001, and the program now pays for half of all childbirths.

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Not So Fast! Will Medical “Reform” Cut Real Costs?

by William L. Anderson

It seems that the so-called health care “reform” bill will become law soon enough. (President Barack Obama has told recalcitrant Democrats in the House of Representatives that he won’t campaign for them if they vote no. Most will give into the President.)

Therefore, I am more interested in what will occur after the bill is passed, not the sordid politics behind it. Specifically, I want to take a hard look at the president’s claim (echoed by economists like Paul Krugman) that the new law will reduce costs.

According to the Congressional Budget Office, Obama’s plan will produce “savings” in medical procedures. Not surprisingly, much of the media (and especially the New York Times), has been echoing the same chorus.

However, I think this claim truly falls into the “Not So Fast” category. In my view there is no possibility that the President’s plan will even remotely cut real costs. The true legacy of this bill will be to add costs in ways we hardly can imagine.

Given that the bill imposes new mandates, further subsidizes the consumption of medical services, and orders insurance companies to cover applicants no matter their health status, one is hard-pressed to find the “cost savings.” Medicare will supposedly cost half a trillion dollars less because the government will order such a state of being into existence. The “waste, fraud, and abuse” that every preceding administration promised to root out will finally meet their match with the Obama administration.

Since the plan won’t really cut costs, medical price controls could be in our future. Without going into the various economic dislocations created by price controls, let me deal with an even more fundamental issue: the nature of costs. It is telling that economists who support the bill because of its alleged “costs savings” are exposing their own ignorance about costs. To them, a “cost” is nothing more than a monetary outlay that is paid for a certain good or service. If government orders the prices paid in those transactions to be lower, then — voila! — costs are lower.

Opportunity Costs

At best, this is a childish view of costs and certainly not a view that any serious economist would hold. Costs, according to basic economic theory, are opportunity costs, or the value to an individual of the closest forgone activity. By imposing lower prices, the government would be raising the opportunity costs to individuals taking part in the exchange. Far from lowering costs, the proposed measures ultimately would result in higher real costs.

For example, if the government forces down the price of a medical procedure below the level at which all service providers can be adequately compensated, then the procedure won’t be done at all. While that would mean no money outlays, “officially” lowering costs, the person for whom the procedure is denied would bear a real cost by having to suffer the malady that drove him or her to the doctor in the first place.

Supporters of ObamaCare claim that Canada and Great Britain have lower medical costs with their government-run systems than America does. However, many of those “savings” come about because people are denied care, or must make do with cheaper but inferior alternatives.

In other words, the “savings” come at the expense of individuals who wish to receive care. It might be possible, through accounting trickery, to show that the new medical “system” has lowered the federal deficit, but it cannot and will not lower the real costs we will pay.

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The truth about health insurance premiums and profits

In a recent Fox News debate about health insurance, Democratic political strategist Bob Beckel explained that, "The president needed an enemy, and the insurance companies are it." Proving that point in a Pennsylvania stump speech, President Obama asked, "How much higher do premiums have to go before we do something about it? We can't have a system that works better for the insurance companies than it does for the American people."

On February 20, President Obama used his weekly radio show to express outrage that a fraction of Californians buying individual Anthem Blue Cross Blue Shield (BCBS) plans "are likely (sic) to see their rates go up anywhere from 35 to 39 percent." He used those figures to justify preempting state regulation "by ensuring that, if a rate increase is unreasonable and unjustified, health insurers must lower premiums, provide rebates, or take other actions to make premiums affordable."

There was always something peculiar about this desperate effort to demonize certain health insurers. Individual plans account for only 4 percent of the insurance market. So why do they account for 100 percent of the president's fulminations about insurance premiums? Could it be because insurance premiums for the other 96percent have not been rising much?

Nonprofit BCBS plans account for a third of the private health insurance market. Michigan's nonprofit asked for 56 percent premium hike without the national media taking that Hail Mary pass too seriously. But even Obama finds it difficult to accuse nonprofits of being too profitable, so he needed to pin his enemy badge on a for-profit firm – one of Wellpoint's "Anthem" BCBS plans.

Anthem of California's requested rate increase on individual policies was actually 20-35 percent. The only way it could get to 39percent would be if a policyholder insisted on a gold-plated Cadillac plan and also happened to move up into a higher age group. Besides, requesting a rate hike means nothing. Even Obama's radio address mentioned two requests that had been cut in half. Many are denied.

So, how many Californians have actually been faced with a 39 percent increase in their premiums? Exactly zero.

How many are really "likely" to be faced with even a 35 percent increase after state insurance regulators have their say? My forecast: Zero.

The president highlighted the "likely" increases of "35 to 39 percent" to suggest insurance companies in general were asking for huge premium increases just to boost their lavish profits. He complained that in the $1.2 trillion health insurance industry, "the five largest insurers made record profits of over $12 billion." But that puny sum includes WellPoint's sale of its pharmacy benefits management company NextRX to Express Scripts for $4.7 billion last April. Adding that $4.7 billion to WellPoint profits is like saying a family's income rose by $1 million because they sold a million-dollar home.

University of Michigan economist Mark Perry calculated that without the sale of NextRX, "WellPoint's profit margin would have been only 3.9 percent, the industry average profit margin would have been closer to 3percent"— $100 per policy. Yet Obama concluded that, "The bottom line is that the status quo is good for the insurance industry and bad for America."

The media echoed the president words endlessly, and wrote as though one company's hypothetical request for increases of 35 percent-39 percent were a nationwide threat—even to those with group insurance—rather than an unique and highly unlikely request that might (if magically approved) touch a miniscule number in a hostile state for health insurers.

"It doesn't take too many 39 percent increases, like the recent one proposed in California that has garnished so much attention, to put insurance out of reach," exclaimed a New York Times report. That same paper's editorial added, "The recently announced plan by Anthem Blue Cross in California to raise annual premiums by 35 to 39 percent for nearly a quarter of its individual subscribers is a chilling harbinger of what is to come if reform fails." Really?

Grasping for confirmation of the 39 percent figure, some reporters cited a Feb. 24 memo about Wellpoint written by journalist Scott Paltrow for The Center for American Progress Action Fund. Paltrow gathered news clippings suggesting premiums are "expected to" increase by "up to" some scary number in various states. For California, however, Paltrow's source was the president's speech. This Action Fund is a is no "liberal think tank," as the Wall Street Journal put it, but a 501(c)4 lobby which can participate in campaigns and elections. Founded by Bill Clinton's former chief of staff John Podesta, it's a propaganda arm of the Democratic Party.

A Wall Street Journal story about Wellpoint's wish list for higher premiums cites the Department of Health and Human Services as its source. That means a shoddy four-page polemic at HealthReform.gov, "Insurance Companies Prosper, Families Suffer." That pamphlet, like another from the Commonwealth Fund, cites Duke Helfand, an L.A. Times reporter who wrote on Feb. 4 that, "brokers who sell these policies say they are fielding numerous calls from customers incensed over premium increases of 30percent to 39 percent."

So, the president's 39 percent figure came from Duke Helfand, who heard it from insurance brokers who, in turn, said they heard it from customers. The 39 percent figure referred to one person named Mary. After rounding Helfand's 30 percent up to 35 percent, however, that was good enough for the president's purposes.

Like Obama, the "Insurance Companies Prosper" pamphlet repeatedly confuses asking with getting. "Anthem Blue Cross isn't alone in insisting on premium hikes," it says; "Anthem of Connecticut requested an increase of 24 percent last year, which was rejected by the state." So what? If you went to your boss and insisted on a 24 percent raise, would that constitute proof that wages are rising too fast?

If Obama has been reduced to basing the redistribution of health care on the cost of health insurance premiums, he will need much better facts. Fortunately, credible statistics on health insurance premiums are readily available from the Centers for Medicare and Medicaid Services (CMS) and Bureau of Labor Statistics.

CMS statistics (Table 12) reveal that the net cost of private health insurance – premiums minus benefits – fell by 2.8percent in 2008. Furthermore, CMS Health Spending Projections predict that spending on private health insurance will rise 2.5percent in 2010, while prices of medical goods and services rise by 2.8percent.

Consumers' cost of health premiums is also part of the detailed consumer price index. After all the overheated rhetoric about "requested" or "expected" increases of "up to" 39 percent, who would have imagined that the average consumer cost of health insurance premiums fell by 3.5 percent in 2008 and fell by another 3.2 percent in 2009?

The president's health insurance proposals hoped to use stern command-and-control techniques to run the health insurance system. It was all about minimizing free choice and maximizing brute force—forcing people to buy certain kinds of politically-designed insurance, forcing insurers to cover services many consumers do not want to pay for, and forcing insurers to curb or roll back premiums even as medical costs go up. The whole shaky apparatus was built upon even shakier statistics—including the purely hypothetical 39 percent increase in premiums that Mary's insurance agent reported to Duke Helfand.

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British hospital trusts warned over poor infection control

Five health trusts were issued with warnings about serious breaches in hospital infection control by the health regulator last year.

An assessment of hospital infection standards resulted in the five warnings from the Care Quality Commission but the trusts responded quickly to all five warnings, which are no longer in a “red flag” category on the issue, the regulator said.

In last year's infection assessment 42 of 167 trusts were found by the CQC to be in "breach" of NHS registration requirements, although the regulator said all but five were minor breaches.

Ambulance services in the north-west, east of England and east Midlands were the worst offenders, and received formal warnings for the state of vehicles and stations. The regulator said all had responded and now met the requirements in follow-up assessments.

The CQC carried out the assessment as part of preparations for a new licensing regime beginning on April 1. Several trusts are expected to receive conditions in the registration process because of concerns about some core care standards.

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Incompetent butcher doctors free to work in the NHS

An elderly woman died after a German locum doctor carried out one of the “worst botched operations” seen in a British hospital, an inquest heard yesterday. Ena Dickinson, a former NHS volunteer, was left unable to walk after the locum made a series of errors during a routine hip operation at Grantham & District Hospital. Werner Kolb removed bone that should have remained intact and severed a major artery during the operation.

Mrs Dickinson, a 94-year-old former nurse and Red Cross volunteer from Barrowby, Lincolnshire, was left bleeding to death on the operating table. It was only when a consultant at the hospital stepped in that her life was saved. However, two months after the August 2008 operation Mrs Dickinson died. Kathy Ingram, her daughter, said that after dedicating her life to the NHS it had “let her down” when she needed it most.

Orthopaedic specialist Professor Angus Wallace told the inquest it was “the worst botched operation” he had seen. The professor, who is based at Nottingham’s Queen’s Medical Centre, was so concerned about the case that he reported the doctor to the General Medical Council.

Last week MPs heard how a “gaping hole” in the rules on foreign doctors working in Britain is putting patients at risk. The Health Select Committee is currently investigating out-of-hours-care following the death of David Gray in Cambridgeshire in 2008. He was killed by another German doctor, Daniel Ubani, who administered 10 times the normal dose of diamorphine. Dr Ubani had flown to Britain to provide out of hours care under a contract from the local health authority.

In 2004, ministers gave GPs a controversial new contract that allowed them to give up responsibility for out-of-hours care. The General Medical Council said it is prevented from testing the qualifications of European locums who are brought in as cover.

Dr Kolb, 51, who is based in Stuttgart, was given an interim suspension by the GMC for 18 months last year. Giving a narrative verdict, coroner Stuart Fisher described it as a “most disturbing case”.

Mrs Ingram said: “We feel let down. We don’t quite understand how he got to operate on my mother. “My mother was somebody who was involved in the NHS and supported it even into her retirement working on the tea bar at her local hospital. After all those years the NHS let her down.”

A spokesman for United Lincolnshire Hospitals Trust said: “The Trust has apologised to Mrs Dickinson’s family for mistakes made during her operation. “Errors were made by the surgeon concerned which were rectified immediately by a senior member of staff. After the operation Mrs Dickinson was recovering well and assessed to be medically fit for discharge by 25 September 2008.

“The Trust has done everything possible to learn from this incident and to prevent it happening to another patient. Changes have been made to the recruitment of medical staff, including the appointment of locums, and a new surgical safety checklist produced by the World Health Organisation has now been implemented throughout the Trust.”

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Obama hones final health care pitch

Fighting to overcome the impression of high spending and backroom deals, President Obama has honed his health care message to highlight his bill's benefits to consumers — from better Medicare prescription-drug coverage for seniors to guaranteeing insurance regardless of pre-existing conditions.

Supporters say the White House's public relations offensive has breathed new life into Democrats' last-ditch effort to pass the legislation by next week. "So much of his activity in the last few weeks has been around health care," said Karen Davenport, director of health policy at the liberal Center for American Progress. "And I think the power of the presidency drives the stories and makes a huge difference."

After months of drift, with the House and Senate arguing over competing bills, Mr. Obama has taken control of the debate, combining the two bills into a grand compromise, adding Republican ideas and dubbing it bipartisan. On Monday, both he and Democratic leaders said they were very optimistic it would become law.

Mr. Obama took his health care pitch on the road Monday for the third time in one week, traveling to Ohio to again make his case that Congress should ignore the political implications of supporting his bill and vote for it because it's the right thing to do. "The American people want to know if it's still possible for Washington to look out for these interests, for their future," Mr. Obama told a crowd in Strongsville. "So what they're looking for is some courage. They're waiting for us to act. They're waiting for us to lead. They don't want us putting our finger out to the wind. They don't want us reading polls."

Democrats don't yet have the 216 votes required to pass the bills, but House Speaker Nancy Pelosi reaffirmed Monday that they will collect them, dismissing the concerns of some House Democrats about federal funding of abortion, Medicaid funding, Medicare reimbursement rates and the exclusion of protections for illegal immigrants. She called them unfounded. "When we bring a bill to the floor, we will have the votes," she said at a press conference while surrounded by more than a dozen babies and representatives of children's groups that support the health care reform plan.

The yearlong push for health care has seen a series of starts and missteps, culminating with Republican Sen. Scott Brown's surprise victory in a special election to fill the seat of the late Sen. Edward M. Kennedy, Massachusetts Democrat. That victory denied Democrats their filibuster-proof majority in the Senate, and gave backers in both chambers pause.

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Talking Points vs. Realty

by Thomas Sowell

In a swindle that would make Bernie Madoff look like an amateur, Barack Obama has gotten a substantial segment of the population to believe that he can add millions of people to the government-insured rolls without increasing the already record-breaking federal deficit.

Those who think in terms of talking points, instead of realities, can point to the fact that the Congressional Budget Office has concurred with budget numbers that the Obama administration has presented. Anyone who is so old-fashioned as to stop and think, instead of being swept along by rhetoric, can understand that a budget-- any budget-- is not a record of hard facts but a projection of future financial plans. A budget tells us what will happen if everything works out according to plan.

The Congressional Budget Office can only deal with the numbers that Congress supplies. Those numbers may well be consistent with each other, even if they are wholly inconsistent with anything that is likely to happen in the real world.

The Obama health care plan can be financed without increasing the federal deficit-- if the administration takes hundreds of billions of dollars from Medicare. But Medicare itself does not have enough money to pay its own way over time.

However money is juggled in the short run, the government's financial liabilities are increased by adding this huge new entitlement of government-provided insurance. The fact that these new financial liabilities can be kept out of the official federal deficit projection, by claiming that they will be paid for with money taken from Medicare, changes nothing in the real world.

I can say that I can afford to buy a Rolls Royce, without going into debt, by using my inheritance from a rich uncle. But, in the real world, the question would arise immediately whether I in fact have a rich uncle, not to mention whether this hypothetical rich uncle would be likely to leave me enough money to buy a Rolls Royce.

In politics, however, you can say all sorts of things that have no relationship with reality. If you have a mainstream media that sees no evil, hears no evil and speaks no evil-- when it comes to Barack Obama-- you can say that you will pay for a vast expansion of government-provided insurance by taking money from the Medicare budget and using other gimmicks.

Whether this administration, or any future administration, will in fact take enough money from Medicare to pay for this new massive entitlement is a question that only the future can answer, regardless of what today's budget projection says. On paper, you can treat Medicare like the hypothetical rich uncle who is going to leave me enough money to buy a Rolls Royce. But only on paper. In real life, you can't get blood from a turnip, and you can't keep on getting money from a Medicare program that is itself running out of money.

An even more transparent gimmick is collecting money for the new Obama health care program for the first ten years but delaying the payments of its benefits for four years. By collecting money for 10 years and spending it for only 6 years, you can make the program look self-supporting, but only on paper and only in the short run. This is a game you can play just once, during the first decade. After that, you are going to be collecting money for 10 years and paying out money for 10 years. That is when you discover that your uncle doesn't have enough money to support himself, much less leave you an inheritance to pay for a Rolls Royce.

But a postponed revelation is not part of the official federal deficit today. And that provides a talking point, in order to soothe people who take talking points seriously.

Fraud has been at the heart of this medical care takeover plan from day one. The succession of wholly arbitrary deadlines for rushing this massive legislation through, before anyone has time to read it all, serves no other purpose than to keep its specifics from being scrutinized-- or even recognized-- before it becomes a fait accompli and "the law of the land." Would you buy a used car under these conditions, even if it was a Rolls Royce?

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The Slaughter Rule: Yet Another Reason Obamacare Would Be Unconstitutional

As written, the current health care bill before Congress already is guaranteed to face serious constitutional challenges on enumerated powers, 5th Amendment, racial discrimination, and unequal state treatment. Now the White House seems determined to add a whole new reason courts will throw out Obamacare on sight. Director of the Stanford Constitutional Law Center at Stanford Law School and former-federal judge Michael McConnell explains:

To become law—hence eligible for amendment via reconciliation—the Senate health-care bill must actually be signed into law. The Constitution speaks directly to how that is done. According to Article I, Section 7, in order for a “Bill” to “become a Law,” it “shall have passed the House of Representatives and the Senate” and be “presented to the President of the United States” for signature or veto. Unless a bill actually has “passed” both Houses, it cannot be presented to the president and cannot become a law.

To be sure, each House of Congress has power to “determine the Rules of its Proceedings.” Each house can thus determine how much debate to permit, whether to allow amendments from the floor, and even to require supermajority votes for some types of proceeding. But House and Senate rules cannot dispense with the bare-bones requirements of the Constitution. Under Article I, Section 7, passage of one bill cannot be deemed to be enactment of another.

The Slaughter solution attempts to allow the House to pass the Senate bill, plus a bill amending it, with a single vote. The senators would then vote only on the amendatory bill. But this means that no single bill will have passed both houses in the same form. As the Supreme Court wrote in Clinton v. City of New York (1998), a bill containing the “exact text” must be approved by one house; the other house must approve “precisely the same text.”

These constitutional rules set forth in Article I are not mere exercises in formalism. They ensure the democratic accountability of our representatives. Under Section 7, no bill can become law unless it is put up for public vote by both houses of Congress, and under Section 5 “the Yeas and Nays of the Members of either House on any question . . . shall be entered on the Journal.” These requirements enable the people to evaluate whether their representatives are promoting their interests and the public good. Democratic leaders have not announced whether they will pursue the Slaughter solution. But the very purpose of it is to enable members of the House to vote for something without appearing to do so. The Constitution was drafted to prevent that.

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Obama's Health Care 'Victim' Exposed

At his health care pep rally today, President Obama was introduced by Connie Anderson, sister of Natoma Canfield. The president said it was a touching letter written to him from Canfield that brought him to Ohio. (I'm sure the decision had nothing to do with rustbelt America being the source of Democrats' vote deficit at this point...)

In her letter, Canfield described her battle with cancer how she was forced to give up her health insurance after it became too costly--a sad story, to be sure. But, as Gateway Pundit reports, not likely an entirely true story:

Natoma Canfield is 50 years old. She was diagnosed with cancer 16 years ago. She quit her job or was laid off 12 years ago. She has reportedly held odd jobs cleaning homes the last few years. Natoma was paying $5,000 a year for her insurance but dropped it after it went up to $8,000. She wrote president Obama in December to tell him about it. She was worried she might lose her home. Some people might say she’s lucky to still have a home after losing her job 12 years ago.

Barack Obama came to Ohio today to prop Natoma up on stage with him. But, Natoma Canfield couldn’t make it. She is back in the hospital. (Our prayers for a quick recovery) She is getting cared for despite the fact that she has no insurance. She’s not out on the street. She’s not a statistic like Rep Alan Grayson would have you believe. Natoma is getting the care she needs.

And if Canfield were in favor of real reform, she should encourage President Obama to change the tax code to help insurers properly pool risks instead of additional taxation and government subsidies.

In addition, if the president really wanted to help people like Ms. Canfield, he would encourage the individual ownership rights over health care plans so the American people can maintain control over their health insurance, not employers or the government.

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The Health Care Plan You are Going to Get

The itsy-bitsy spider climbed up the water spout and apparently bit the Speaker of the House. Ms. Pelosi had a delusional moment the other day, but she was clear on one thing. She never intended to listen to any Republican suggestions regarding the health care bill.

Close observation of the Bipartisan Health Care Summit provided clarity within the first half hour that there was not much bipartisan here. After listening to President Obama, Harry Reid, and Nancy Pelosi, it was obvious that there was no way that they were going to overhaul their 2,400 page (or is it 2,600) health care bill.

I recently enlisted expert advice on the issue. My source was Dr. Bill Cassidy, who doubles as the Congressman from the sixth district of Louisiana and is part of the growing breed of medical professionals that refuse to leave the administration of our country to interests hostile to a cost-effective, patient-oriented, health care system. Dr. Cassidy was elected to Congress in 2008 after spending 20 years serving the uninsured in Louisiana’s public hospital system and teaching at LSU’s outstanding medical school. His specialty is gastroenterology and like many other elected physicians, he still sees patients when he’s back in his district. He is one of the very few people in Congress who truly has first-hand knowledge of those that the omnibus health care bill supposedly seeks to help.

Dr. Cassidy reminded me of an interesting exchange that confirmed President Obama’s utter ignorance of how markets function. Republicans pointed out that the Congressional Budget Office (CBO) analysis stated that premiums would rise under the existing proposals. The President initially insisted that this was not true, but then backtracked, arguing that premiums would go up because the new policies would have additional benefits. What the President doesn’t understand is that for each additional mandate – every one of which increases premiums – more and more consumers would no longer be able to afford the policy. Dr. Cassidy pointed out that the price of health care insurance is not inelastic.

Dr. Cassidy cited Senator Max Baucus as a prime example of the problem with the proposals. Other than the fact that Senator Baucus had to be tone deaf when he stated that the two sides were not really that far apart – a stunning statement unto itself – he shockingly misstated the reality of Health Savings Accounts (HSAs). Dr. Cassidy knew that a Kaiser Family Foundation study showed that because the HSA program provides an affordable health insurance alternative, 27% of new HSA participants were previously uninsured. Just think what might happen if HSAs were widely known and encouraged by the government.

But what seems to upset Dr. Cassidy the most is that the legislation does not address the largest problem with the health care system. He believes the system needs to be changed from a volume-based to a value-based system. The system has come to this gradually over the last 45 years as government has become more in involved in health care decisions. Doctors today need to treat huge numbers of patients to generate enough revenue to cover their costs. They often don’t have the ability to properly focus on their patients’ needs and may prematurely kick their patient to a specialist or order costly tests. The value-based system that Dr. Cassidy envisions would create greater synergy between doctor and patient, reduce malpractice costs, and provide higher quality service. Unfortunately, Obamacare will force doctors to see even more patients – thereby reducing individual attention even further – because it cuts physician reimbursements to the bone.

The largest single challenge centers on how to pay for the plan. The Democrats propose that everyone be required to carry insurance. They blithely assume that everyone will happily buy expensive insurance to subsidize those who have pre-existing conditions. Welcome to Dreamland; there’s no way that healthy young Americans will incur these huge costs, even with the threat of harsh (but obviously unenforceable) penalties.

Republicans have offered a far more palatable solution. Instead of arm-twisting middle-class Americans, Republicans propose to focus subsidizes on the limited market of individuals with medical challenges, and allow everyone else to buy competitively-priced products.

Dr. Cassidy is one of less than 20 health professionals in Congress able to offer realistic solutions based on their first-hand experience within the health system, but unfortunately, their sensible solutions have fallen on deaf ears. Perhaps the spider that Ms. Pelosi was speaking about had a venomous bite that has driven her to push these disastrous policies. God willing, her colleagues will listen to Dr. Cassidy and the American people.

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Big rise in complaints about NHS nursing care

But complaints are usually responded to by bureaucratic coverups and there are no apparent changes

For 12 months, while her son Kane underwent treatment for cancer, Rita Cronin sat by her youngest child's bedside. She fed him, gave him drinks, washed him and ensured he had a bedpan. And if Rita was unable to be there, husband Peter, daughter Emma or other son Matthew would take over the nursing duties.

'We'd learnt, quickly, that if we didn't carry out his basic care then we couldn't rely on the nurses to do so,' says Rita, 50, a civil servant from Balham, South-West London. 'It wasn't just Kane who was affected. We saw buzzers being left out of reach and patients missing meals, as no one had the time to feed them. 'The attitude was that patients had to wait. That nurses had other, more important, things to do. The more you asked for things, the more irritated they seemed to become. The night nurses were the worst - they were always "too busy" even to bring a bedpan. But the day ones were often unhelpful, too.'

St George's hospital, in Tooting, where Kane was a patient, 'is an award-winning hospital, yet we may as well have been in a third-world country for the nursing care my son got,' says Rita.

Strong words, but Rita is, tragically, qualified to say them. For three days after being admitted to the hospital for a hip replacement, her 22-year-old son was dead from dehydration. Kane had suffered brain cancer - while treatment was successful, the chemotherapy and radiotherapy had weakened his bones, causing him to the need the surgery. The cancer had affected his pituitary gland, which regulates the body's mechanisms, such as hydration. So, Kane was on desmopressin, medication to control the flow of fluid in his body. We later discovered that the day Kane was admitted in to hospital was the last time he took desmopressin,' says Rita.

Following his hip operation, a routine test showed Kane's sodium levels were high; his fluid levels were out of balance. A ward nurse was told this by the hospital lab, but she went off duty without sorting out treatment. He began begging for water. When his requests were turned down he became - understandably - aggressive. Inexplicably, instead of reading his notes which would have indicated the problem, nurses called security staff who restrained him.

An increasingly desperate Kane then rang the police and begged for help to get a drink. The police turned up, but were sent away by nurses who reassured them Kane was confused.

By the time Rita went to see him before work the next day, it was clear her son was very ill. 'The night nurse was standing outside the room handing over to the day nurse and I said I thought Kane was really ill,' she says. 'It was clear she thought I was being neurotic and said he was fine.'

It wasn't until the ward doctor appeared on his rounds, nearly 15 minutes later, that suddenly everything changed. He took one look at Kane and quickly called for help.'

The post mortem revealed Kane had died from dehydration. Rita has other ideas, and so, it seems, does the coroner who adjourned the inquest, calling the police in to investigate.

'Kane died because of sheer incompetence of the nurses who failed to do their job,' says Rita. 'I found out later that the nurses were offered counselling. They should have been in another job.'

Over the past few years there have been far too many similar accounts. Despite all the money poured into the NHS, and the proliferation of training, job titles and initiatives, it seems patient experience is not improving. Poor nursing care was a key factor in the 400 deaths at Mid Staffordshire NHS Foundation Trust, according to the recent official investigation. Staff numbers were allowed to fall 'dangerously low', causing nurses to neglect the most basic care. While many staff did their best, others showed a disturbing lack of compassion to patients, said Robert Francis QC, heading the inquiry.

Basic nursing care and lack of hygiene have also been blamed for 70 deaths at Basildon University Hospital, where the Care Quality Commission, the health service regulator, found, among other basic failings, blood-splattered equipment and patients lying on stained and soiled mattresses.

And statistics would suggest they are not one-offs. Complaints about nurses have risen by 18.9per cent in the past year, according to the Nursing and Midwifery Council (NMC) , the profession's regulatory body. Although the organisation points out that this figure represents just 0.2 per cent of their total membership, the fact is complaints investigated by them have risen by 30 per cent since 2005.

Experts think the problem is actually far more endemic than even these figures suggest, as many people don't know about the NMC - and instead complain through the hospital system. 'Even then, many incidents are not investigated properly,' says Vanessa Bourne, of the Patients' Association. 'Answers to complaints generally fall into one of two categories; either the letter will say: "You haven't been able to name the nurses responsible so we can't investigate". Or, "you have named the nurses responsible, but they deny any wrong-doing, so we can't take the investigation further".

'The NHS managers and nursing bodies like to say this poor treatment is from a minority of nurses, but it is more about a fundamental lack of decent nursing leadership and a refusal to admit that mistakes are being made. 'When the Staffordshire scandal broke last year, we were inundated with a deluge of heartbreaking cases where people had received careless, sloppy or even rude and cruel treatment at hospitals up and down the country, and where no investigation had ever been carried out. 'The Department of Health bring out endless guidelines and initiatives on patient satisfaction and safety, but our complaint rate doesn't drop.'

Nurses themselves are also concerned about levels of care. A recent survey for the Nursing Times found that only a third of nurses were confident the poor standards at Mid Staffordshire weren't being repeated to some degree in their own hospitals.

Last week, the government published the first comprehensive report on the profession in 40 years. The Commission into the future of nursing and midwifery made some recommendations on how nursing could be improved for the 'new challenges ahead'.

While it was initiated before the recent scandals broke, there's no doubt those events were key to its proposals. 'Events like Mid Staffs do tend to focus the mind,' says Heather Lawrence, a former nurse, now chief executive of Chelsea and Westminster Hospital and a member of the commission. 'And I would agree that in some areas of the country - not all - patient trust has been eroded. As a result there has now been an acceptance within the NHS that the way some wards have been managed has not always been in the patients' best interests.'

In order to help restore patient trust, the Commission wants all nurses to pledge their "commitment to society and service users... to give high-quality care to all and tackle unacceptable variations in standards". 'The Commission is clear that high-quality, safe and compassionate care must rise to the top of the agenda for a 21st-century worldclass NHS,' said health minister and commission chair Ann Keen.

It begs the question: if high-quality, safe and compassionate care is not a priority for some nurses, why are they nursing at all? 'We welcome the pledge, but it is a sad indictment that there is a need for one in the first place,' says Vanessa Bourne. 'Patients should expect compassion.'

'The bottom line is that in Mid Staffs - - and we believe in many other hospitals, still - - there was a culture of nurses saying "its not my job". But if everyone says that, then the job - whether it's feeding a patient, or getting them a bed pan simply doesn't get done. 'Nursing is about rolling up your sleeves and caring and too many nurses seem to forget that. 'Our response would be that if you don't want to do the nitty-gritty of spoon-feeding an elderly patient or changing soiled sheets, then don't go into nursing.

'Employers also have to accept that not everyone who comes into nursing will be cut out for the job. I was told by a university nursing tutor that some trainees on her course who were clearly not suited to nursing and not interested in caring, but it was impossible to remove them because of funding complications.

So what is the solution? The official response is that we need better leadership - giving ward sisters more authority. 'One of the things we found was that on many wards there was no one figure who had the authority to properly lead the ward,' says Heather Lawrence. 'In the Mid Staffs inquiry it was discovered that one nursing sister was in charge for three wards - an impossible task.'

Nurses acknowledge leadership is part of the problem; and the solution. The Nursing Standard magazine (the nurse's own trade magazine) is campaigning to boost the authority and status of ward sisters. 'All these NHS scandals have a common theme,' says editor Graham Scott. 'There was not a clear, identifiable person in charge of the ward. 'We have ward sisters, specialist nurses and nurse specialists, nurse consultants and modern-day matrons. No wonder people get confused about who is in charge.'

But will such a simple solution make the wards a better and safer place for patients? According to Graham Scott, it will. 'Research shows that on a ward where there is an identifiable - and, most importantly, accountable - person in charge, patients have a much better experience,' he says.

The finger of blame is also being pointed at healthcare assistants, who do the basic caring jobs, such as washing, feeding and changing bedpans. 'Some NHS Trusts do train nursing assistants properly,' explains Graham Scott. Others don't. Cleaning, washing and feeding a patient are actually quite complex tasks.'

The Commission recommended these staff need some form of regulation to ensure high-quality care. 'We have to be careful about blaming the healthcare assistants,' says Bourne. 'After all, they are supposed to be supervised by the nurses.'

But will any of this make a real --difference? It seems there will be no legal recommendations to abide by the regulations. 'We do tend to raise our eyebrows at these recommendations,' notes Bourne. 'There is a big noise about them, and then everything goes back to how it was. We still get horror stories like poor Kane's. We are told things will change and they don't.'

Indeed St George's has told Rita Cronin they've made changes to ensure what happened to her son can never happen again. 'But what exactly are these changes?' she asks. 'My son suffered a needless death. How I do know that the same thing isn't happening to someone else?'

A spokesman for the hospital said: "We are extremely sorry about the death of Kane Gorny. 'From the investigation it was clear that there had been failures in communication between clinical staff. Disciplinary action did result from our findings and a number of important changes have been introduced to help prevent such a tragic incident from happening again.'

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