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31 March, 2008

Australia: Sydney's killer hospital strikes again

And nothing is being done about the gross negligence concerned

A major [public] hospital has admitted that it failed to properly treat a disabled woman who died while in its care. Karen Stone, 41, was admitted to Sydney's St George Hospital in October 2004, with acute leg pain. She died a few days later from pulmonary thromboembolism after an undiagnosed clot in her leg travelled to her lung, the State Coroner found the following year. Now her mother wants to know why doctors at the hospital failed to give her routine preventative treatment.

Lynette Stone said both she and her daughter repeatedly asked hospital staff to investigate if the pain was caused by deep vein thrombosis. Their concerns were dismissed, even though Ms Stone was a high-risk patient. Mrs Stone questions if her daughter's disability meant she received less care and attention from staff. Ms Stone had a rare medical condition called Prader-Willi Syndrome that causes an obsession with food and eating, poor muscle tone and learning difficulties.

Debora Picone, who was in charge of the hospital at the time and is now the Director-General of NSW Health, said in a letter to the Health Care Complaints Commission soon after the autopsy that there was no excuse for the failure. "A satisfactory explanation was not documented in the clinical record nor was the caring medical team able to provide one when questioned," she wrote. She admitted the hospital should have provided anticoagulant therapy. The simple, but life-saving, injection was finally ordered by a professor who was taking a group of medical students on tour of the ward two days later, but the treatment was still not administered for another 24 hours. Ms Stone died the next day.

"It cannot be ascertained why the omission of treatment occurred," Professor Picone wrote. The Health Care Complaints Commission did not investigate the death, instead offering conciliation - an informal discussion with no power to make any decisions. Lorraine Long from Medical Error Action Group said government departments set up to deal with complaints had proved to be "ineffective" and a "waste of time" for bereaved families. "I have not encountered a person to be satisfied with a health-care complaints commission anywhere in the country," she said. "They want you to conciliate a death - it's obscene."

Mrs Stone said her daughter was a "wonderful soul" who brought endless joy to her family and friends. "In my heart I feel she should still be with us. If only they had taken more care, questioned more about why the pain wouldn't go away, she would not have died," she said. "If she'd been 'normal' would they have taken more notice of her?"

Venous thromboembolism, which refers to deep vein thrombosis and pulmonary embolism, causes 10,000 deaths each year in hospitals - more than lung and breast cancer combined. Professor Beng Chong, a hematologist at St George Hospital and head of the Department of Medicine at the University of NSW, said many hospitals did not assign the task of venous thromboembolism risk assessment to particular doctors or nurses, while many simply forgot.

Source




Absurd: Firefighters answering medical emergencies

FIRE crews in Queensland [Australia] have been used as a first response in medical emergencies for several years, despite denials by authorities. Documents obtained under Freedom of Information laws reveal that crews have been diverted from fires to attend medical matters because of a shortage of ambulances. In one case, a Cairns fire crew had to abort a fire call and attend a person who had been knocked unconscious in a nightclub fight.

In an exclusive Sunday Mail report in December, sources said fire trucks would soon be known as "red ambulances" in a radical plan to have firefighters attend more medical emergencies. The vehicles were to be fitted with life-saving defibrillators and used as a first response while the crisis-hit Queensland Ambulance Service struggled to cope with soaring life-threatening emergency calls.

Emergency Services Minister Neil Roberts, Fire Commissioner Lee Johnson and then Ambulance Commissioner Jim Higgins strenuously denied the claims. Mr Roberts said there was "no current plan" to convert fire trucks into red ambulances. But in a letter from the United Firefighters Union in July 2006, Mr Johnson and Mr Higgins were advised of "inappropriate requests" to use fire trucks as first responders.

Union state secretary Mark Walker said members were told the Queensland Fire and Rescue Service would not be used in this capacity - but it happened regularly. "Clearly, the QAS communications centre has requested QFRS attendance to provide a first-responder role . . . (when) there is no agreement with QAS for such a role," he said. Mr Walker said TV footage had shown an incident in the Brisbane CBD where a cyclist hit a pedestrian, with firies in attendance and no ambulance. A Charters Towers fire crew had been placed on standby for medical calls one weekend due to unavailability of QAS crews.

"We have serious concerns with our members being exposed to additional risks by being called upon to do the work of the ambulance service," Mr Walker said. "We also have concerns regarding the additional risks to the community when 13-tonne fire appliances are responded to any number of other incidents that do not warrant our attention." Mr Walker sought reassurance from the commissioners that the QAS would not dispatch fire crews "to incidents for the sole purpose of providing medical assistance".

In subsequent correspondence last year, the union said it was prepared to discuss an emergency medical service role for firefighters, but there needed to be a restriction on the number and type of incidents attended plus appropriate training.

Source





30 March, 2008

Your regulators will protect you

A fine example from Australia

Controversial GP Michael Tait is under investigation over allegations he diagnosed a woman as a hypochondriac even though she was keter found to be riddled with tumours, and tried to put her on a $2000-a-month anti-ageing therapy. For 15 months, Elizabeth Orchard consulted the New Zealand and British-trained GP - now facing deregistration over his unconventional treatment of 150 terminally ill cancer sufferers - as her health deteriorated after she collapsed on the family farm in the Gold Coast hinterland. Dr Tait, who ran a GP practice alongside his Gold Coast anti-ageing clinic, was the only doctor they could find on the day of her February 2002 collapse.

According to the 57-year-old former businesswoman - who Sydney doctors later discovered had a 7.5cm-wide benign brain tumour and seven breast tumours - Dr Tait was more interested in putting her on human growth hormones, which he has since been convicted of illegally importing and selling. Despite having paralysis in one of her legs, increasingly blurred vision, bleeding from her breasts and memory loss - even forgetting her son's name - Ms Orchard said the only tests Dr Tait ordered during scores of visits were a back X-ray and an abdominal ultrasound, at her request.

Ms Orchard said she was required by her income protection insurer to have Dr Tait oversee her treatment and provide progressive reports for her benefits. In 2003, Dr Tait ruled her fit for work, leading to her benefits being cut off despite her being bedridden. "I sought opinions from other doctors but unbeknown to me, they were consulting Dr Tait, because he was my official doctor for the insurance policy," she told The Weekend Australian. "He was telling them that I had already had every necessary test possible and nothing abnormal had showed up. So no one took me seriously. He was repeatedly dismissive of my problems, my symptoms and called me a hypochondriac."

Ms Orchard said that, in June 2004, her mother paid for her to undergo a brain scan in Sydney. "They found a massive tumour in my brain and the doctors told me I had about two weeks to live, without surgery, because it had reached critical mass," she said. "The doctors told me it was an old tumour, probably 10 years or older. "I then underwent a 9 1/2-hour operation for the brain tumour and had a later operation to remove 5kg of breast tissue." Ms Orchard said she faced further operations and had ongoing seizures and a shortened life expectancy.

She is currently receiving legal advice over her treatment and last year made a complaint to the Medical Board of Queensland, but she said she was disappointed it was yet to take action. A spokesman for Dr Tait yesterday refused to comment. Authorities last week filed an action in Queensland's Health Practitioner's Tribunal against Dr Tait over his "unconventional" therapies. Some of his patients - including the late soccer legend Johnny Warren - allegedly paid up to $20,000 for treatment. In 2006, Dr Tait was convicted on nine charges of obtaining and selling a restricted drug, for which he was fined $9600.

Source




Australia: 'Deadly' government health-care system slammed by doctors

TASMANIA'S healthcare system is dangerous and is putting lives at risk, says the Australian Medical Association's state president. Haydn Walters says unless the $25 million bonus hospital funds promised by the Federal Government this week are spent opening beds, people will die. He said the money must be used to make the state's deadly healthcare system safe. "We have a very ragged, degraded healthcare system and it puts lives at risk," he said.

Dr Walters said surgeries were delayed because there were not an adequate number of beds to admit patients post-operatively. He said the equivalent of two wards of beds were closed at the Royal Hobart Hospital. "Beds have closed because we can't afford to open them, so without question the extra funding has to be spent on opening beds," he said.

Dr Walters said people with gall-bladder disease should have surgery within four to six weeks, but public patients in Hobart were waiting between nine to 12 months. "People with arthritis are forced to put up with the pain because they can't get in for surgery and gynaecology patients who are incontinent can't get in for reconstructive surgery at all," he said. "It is uncomfortable and unsafe in Tasmania at the moment if you don't have private health."

Dr Walters believes if beds were made available and proper staffing levels provided, the health system would be safer. "It will take the pressure off nursing staff, the emergency ward, the waiting lists -- and if we treat staff with respect, we will start to build a better public hospital system," he said.

Premier Paul Lennon said the allocation of the $25 million was a decision for Health Minister Lara Giddings and her department. Ms Giddings welcomed the additional funding but did not elaborate on how the money would be spent. Both Mr Lennon and Ms Giddings expressed disappointment that Tasmania receives only 31 per cent funding from the Commonwealth compared with 40 per cent received by Victoria. Ms Giddings said if Tasmania were to receive the same funding as Victoria, public hospitals would be $111 million better off each year. Tasmania will receive $217 million from the Commonwealth over 2007-08 with the state contributing $492.6 million, 36 per cent of the state's total Budget.

Source





29 March, 2008

Arbitrary NHS rules stop help for tragically infertile woman

A woman who went through the menopause in her teens has been refused fertility treatment on the NHS.

Catherine Storey was left infertile at 18 when she had a premature menopause. She is now 20 but has been refused IVF on the NHS because her boyfriend Martin Sear already has children - even though they live 300 miles away.

The couple took out a bank loan and travelled to a clinic in Barcelona. But after spending 13,000 pounds on two rounds of IVF, Miss Storey, an administrative assistant with a fire alarms company from Cramlington, Northumberland, is still not pregnant and has run out of money.

She said: "If I had fallen in love with a different man or lived in a different part of the country I could have been able to have IVF for free."

A Newcastle Primary Care Trust spokesman said: "The local NHS policy says to have access to IVF treatment, couples must have no other living children in this or any previous relationship for either partner, have had a minimum of three years unexplained infertility and no history of failed sterilisation reversal in either male or female partner."

Source





28 March, 2008

The unfolding superbug disaster in Britain

Superbugs kill at least 10,000 people in Britain each year - 20 times the number who die of Aids. Why is the British government funding AIDS research much more than superbug research? And why are known preventive measures not being taken?

Like many, Brian Clinch was under the impression that, despite the failures of the past, the British health service was tackling the frightening epidemic of antibiotic-resistant superbugs. That was before a visit to Norway made him realise that this record-breaking tide of resistant infections is far from under control and is also a problem of our own making. Clinch, a former RAF pilot from Dorset, has kidney failure and needs dialysis three times a week. It was only when he went for dialysis treatment in the Norwegian city of Stavanger three months ago that he discovered he was one of the tens of thousands of Britons unwittingly infected with the deadly superbug methicillin-resistant Staphylococcus aureus (MRSA).

The day after arriving in the oil-refining port on Norway's Atlantic coast, he went to the city's university hospital. Dialysis had been arranged on the understanding that he had been tested for MRSA in the UK. But a routine throat swab in Stavanger showed Clinch was carrying MRSA. "All hell broke loose," he says. "The results of the MRSA tests arrived after they'd given me one session of dialysis. They were angry and deeply unimpressed with the dialysis centre in England. "I felt like a complete pariah. I was taken into an isolation room and everyone put on gowns, masks and bootees before they came anywhere near me. It's obvious they are frightened to death of getting these infections in Norway, and are doing everything they can to keep them out."

He is right. Norway, with its population of 4.7m, had only 332 cases of MRSA in 2006, and has the lowest rate of antibiotic-resistant bacteria in Europe. About 1 in 200 of the infections found in patients' bloodstreams in Norway is caused by a treatment-resistant "superbug", while in Britain, getting on for half of all infected patients have been colonised by strains of bacteria that normal antibiotics cannot treat.

Norway, which, like Britain, runs a publicly funded health service free at the point of delivery, prides itself on its "search and destroy" policy for killer infections. But the contrast between its health services and our chaotic hospital system is a stark reflection of a difference in approach that has much more to do with attitude than money.

The public area of Stavanger's 950-bed hospital resembles nothing so much as an up-market hotel. Leather armchairs are arranged around a virtual log fire; seemingly relaxed visitors sip coffee and nibble pastries. The town is comparable to Ipswich in size and affluence, but first impressions of the hospital suggest it is wealthier. But beyond the reception, the 1970s-built wards tell a different story. Norway's cash-limited national health service is suffering exactly the same colossal pressure as our own NHS.

In the infectious-diseases unit there are 19 people on trolleys in the corridor. At least 11 more lie in the corridors of other departments. The wait may be long, and patients may end up temporarily in the wrong department as staff struggle to allocate beds. It is a sight familiar to anyone who has observed the treatment lottery of the British NHS, and the enormous battle between restricted supply and limitless demand for healthcare. But even under the pressure of winter infections, Stavanger's problems with capacity are not reflected in infection rates.

The atmosphere is busy but calm. The gleaming corridors are populated with cheery cleaners; there is a sense of belonging among the workforce that is often absent among the clock-watching agency workers who increasingly maintain large chunks of our own hospitals.

Stavanger has a policy of not moving infected patients around; if they have several conditions, doctors from different specialities come to them, not the other way round. And isolation rooms are available, complete with negative air pressure to prevent infections from being wafted outside. Barrier nursing methods involving gloves, aprons and scrupulous hand-washing are strictly applied with infectious patients.

Jon Sundal, the head of infectious diseases at Stavanger, complains of a relentless battle to keep his unit under control. "There is a shortage of nurses - the five new single rooms cannot be staffed," he says. Nevertheless, even with bed occupancy running at over 100%, conditions in his hospital offered a stark contrast to the grime of most of Britain's healthcare facilities. "We saw the writing on the wall early on with antibiotic resistance," says Olav Nataas, head of medical microbiology at Stavanger. "We had one serious outbreak in the 1980s, and since then we just haven't allowed it to happen, except when we sent some waiting-list patients to Britain for hip replacements and they came back infected. "I don't think hospital cleaning has much to do with it. What works is screening. You test everyone, and you isolate and treat everyone you find with it. In England you can't do that now because you have too many cases."

It is legitimate to ask if Britain's NHS has lurched into a ruinously expensive crisis that may yet see the entire service implode. It is also legitimate to ask how our microbial surveillance system, let alone our hospital cleaning services, has failed us so badly: why did scientists not warn us of this disaster in the making, and is it too late to do anything about it?

The global use of antibiotics since the 1940s has achieved a simple Darwinian consequence: the fittest bacteria survive. Antibiotics work by disrupting the production of components needed to create new bacterial cells. Penicillin, for example, selectively interferes with the construction of bacterial cell walls, which have a different structure to the cell tissue of humans and other mammals. By the end of the 1940s, about half of the Staphylococcus aureus strains tested in hospitals had adapted to produce an anti-penicillin toxin called penicillinase. Within months of the launch of the antibiotic methicillin in 1960, the first resistant strains of Staphylococcus aureus were emerging. Shortly after that, bacteriologists began finding strains impervious to up to four common antibiotics.

Warnings about the dangers of antibiotic overuse started to emerge from laboratories, but because relatively few patients were affected and nobody knew what to do about it, the situation was ignored. Antibiotics continued to be consumed in ever-growing quantities by sick humans and farm animals alike.

The problem took off in 1991, when Britain contributed its own supercharged strain to the world lexicon of multi-drug-resistant superbugs. MRSA-16 first appeared in Northamptonshire, rapidly infecting 400 patients and 27 staff in three hospitals. Within 18 months it had been reported in 135 more hospitals. Nobody knows how it spread. Along with another British strain, MRSA-15, it went on to infect patients around the world, a pattern that continues. A meticulous Health Protection Agency study, mapping how the new strains popped up unexpectedly in new hospitals, was published in the Journal of Clinical Microbiology in 2004. But it was too long after the event to shed any light on how the infection had carried. Now research funding is focused on firefighting - casting around for ways to damp down the effects of the pathogens.

It is not just MRSA that is sweeping across Britain like a plague. Streptococcus, enterococcus and Escherichia coli (E coli) are among a host of bugs emerging in resistant forms and causing everything from pneumonia to tuberculosis, bone destruction and lethal damage to the heart. In addition, we are facing "hyper-virulent" new strains of the bacteria Clostridium difficile (C diff), which have colonised the sites left free by the effect of antibiotics, which kill off many harmless bacterial colonies in their path. Although C diff is not resistant to treatment, its spores linger indefinitely and, until recently, NHS staff were largely unaware of how to kill them. Consequently, it is the biggest killer of the current superbugs.

In 2006 it was mentioned on the death certificates of 6,480 people, against 1,652 deaths officially attributed to MRSA. However, these figures are recognised to be underestimates, as many superbug deaths are never identified. Mandatory surveillance of MRSA bloodstream infections is a recent innovation, the number of people carrying it with no symptoms is not recorded, and the formal collection of figures for death and disease associated with C diff (which causes unstoppable diarrhoea or gut perforation) only began in April 2007. The government estimates the annual cost of treatment for such cases to be over œ1 billion.

Officially, the total number of MRSA infections is 7,000-8,000 a year, while C diff is running at an annual 55,600 cases. Many experts believe the real total for all superbug infections is nearer 300,000 - how many are fatal is believed to be vastly higher than the official figures suggest. There is no way of knowing the true figure, as relatively few people are tested.

Meanwhile, a variety of new resistant pathogens are waiting in the wings. In September 2006, a variation of Staphylococcus aureus that produces a toxin called Panton-Valentine leukocidin (PVL) claimed its first British victims. Since then, anxiety over this threat has escalated. The pathogen selectively attacks the young rather than the old; it gets into bones and joints, causing crippling damage.

A multi-drug-resistant version of a common food-poisoning bug, ESBL (extended-spectrum beta-lactamase) E coli, is also causing anxiety. First identified in the 1980s, it has spread steadily to cause an average of 30,000 cases of blood poisoning and urinary-tract infections a year. Although it has officially been blamed for 57 deaths so far, the true total is believed to be many thousands. Government scientists think the source is meat and milk, colonised by superbugs as a result of overuse of agricultural antibiotics.

Jodi Lindsay, a senior expert at St George's hospital, London, and a world authority on superbugs, says: "It is inevitable things will get much worse. We don't know enough about how these bacteria behave, because not enough research is being done. We have increasing numbers of surgical operations, elderly people with long-term serious disease, and diabetics. All these patients have compromised immune systems and are at risk. Not only that, there is potential for new, really virulent strains of bacteria, capable of attacking healthy people."

Mark Enright, professor of molecular epidemiology at Imperial College London, says the real number of deaths in the UK from MRSA and C diff is "easily more than 10,000". He shares the concern that reservoirs of superbug infection in hospitals will increasingly spill out to attack otherwise healthy people: "You could be carrying a resistant form of MRSA and it could then get in through a superficial injury."

There is evidence that such a problem is already occurring in other parts of the world. A new form of MRSA, USA300, has emerged not in hospitals but in the wider community in America. It is killing 18,000 a year - considerably more than the number killed by HIV/Aids, and, most worryingly, the victims include a number of otherwise healthy children. The latest flurry of anxiety was in Brooklyn, New York, in October, when Omar Rivera, a previously fit 12-year-old, suffered the telltale crop of pus-filled spots associated with USA300. Within days he was dead. In other parts of America, three other children, aged 4, 11 and 17, died the same month.

A team at the University of California in San Francisco has been tracking the infection. Last month they published a study showing that a variant of USA300 was spreading in gay communities on the East and West Coasts. And a new "community" strain of C diff in the US has targeted children, pregnant women and new mothers, with fatal results. There has been at least one similar death in the UK, but testing was not available to confirm if it was the same pathogen.

Europe also has a "community" MRSA: ST80. Officially it is considered less of a threat because, it is argued, levels of poverty in western Europe are not as severe as in the US. Without the immune-system damage caused by malnutrition, the infection is less likely to cause an epidemic.

All that is known about USA300, and other virulent community-acquired strains of staphylococcus, is that they generally include Panton-Valentine leukocidin, and that this lethal toxin can jump between different types of bacteria. If a PVL-carrying bacterium infects someone already carrying a cold virus, it can spur the onset of a deadly form of necrotising or tissue-killing pneumonia, which kills 60% of those who develop it. Although guidelines for GPs to alert them to this new threat to public health are being issued later this spring, Lindsay and other scientists complain that Britain persists in spending too little on basic research to tell us more about the nature of these brand-new infectious agents.

Many scientists have also attacked our slow and patchy response to the problem of antibiotic resistance. "In the early 1990s, microbiologists were divided," says Hugh Pennington, emeritus professor of bacteriology at Aberdeen University. "For everyone who argued the case for containment, there'd be many more who maintained that Staph aureus had been with us for ever, and it did not make much difference if strains were methicillin-resistant or not."

As a result, investigating how microbes developed their resistance, how infections spread, why particular resistant strains appeared in some areas but not in others, did not seem that important to healthcare planners. Microbiology began to feature less and less in medical training. According to the Royal College of Pathologists, there are now only 645 fully qualified hospital microbiologists in Britain, of whom only 387 are working in the NHS in England. Up to 10% of hospital microbiology posts are unfilled because of a shortage of qualified applicants.

At the same time that the superbugs were taking hold, those with the expertise to tackle them were keen to work instead in Aids research, with its support from glamorous figures such as Princess Diana and Elizabeth Taylor. The pattern inexplicably continues. According to the Department of Health, 3.8m pounds has been spent by the government since 2002 under the umbrella of "clinical microbial research", while 14m a year is spent on Aids, which kills fewer than 500 here annually. And it has become clear that a recently allocated 16.5m that microbiologists believed was for research into antibiotic resistance will be shared with research projects on sexually transmitted diseases and hepatitis. "Asking why we put so much money into Aids research is a very good question," said Brian Duerden, government inspector of microbiology and infection control. "Medical research is highly political and highly fashion-driven."

Dr Peter Dukes, programme manager of the Infections and Immunity Research Board at the Medical Research Council (MRC), blamed the paucity of research proposals and the shortage of researchers in the field of antibiotic resistance: "When the MRC offered to fund a research project six years ago, 20 proposals were received and only one was good enough to sponsor." Given America's sinister new USA300 infection, our persistent preoccupation with Aids may soon look very misguided indeed.

Microbiologists who have remained in the NHS are dismayed that their warnings of disaster from antibiotic resistance have been ignored by hospital managers focused on performance indicators and productivity targets, which concentrated on waiting times. "We needed to do more screening, but there were never the resources. Even now they are cutting back," said a consultant intensive-care specialist at a large provincial hospital. "There used to be two consultant microbiologists here, but one left and was not replaced. So we had no expert on intensive-care ward rounds to advise on appropriate antibiotics and infection control."

New government directives require hospitals to carry out MRSA screening on patients being admitted - though not those having outpatient or day-surgery procedures. The consultant said the extra testing burden, without any extra staff to do it, had meant that vital surveillance for other new infections was not happening.

In addition, as pressure has been ratcheted up to channel funds into meeting a range of "patient episode" productivity targets, basic hospital cleaning has been scaled back and contracted out. Those working in healthcare seem increasingly ignorant of the basics of hygiene. Healthcare workers increasingly fail to wash their hands as they race between beds, which are meant to be kept 100% occupied. Increasing numbers of patients are unnecessarily admitted to wards from accident-and-emergency departments, simply to avoid breaking the maximum four-hour permitted A&E wait. In December it was reported that the hotel costs of caring for extra patients who were not actually sick enough to need treatment had wasted 2 billion over the past five years.

Many microbiologists point to the decline of attention to hygiene as a basic function of healthcare as nurse training has become increasingly academic and classroom-based. "The only infection-control procedure proven to work is scrupulous hand-washing, a basic approach explained by Florence Nightingale during the Crimean war and seemingly lost in the intervening 150 years," said Richard Wise, former chairman of the government's specialist advisory committee on antimicrobial resistance, and adviser to the Health Protection Agency Board. "Not washing the hands between patients should be made a disciplinary offence."

Most hospitals have bottles of alcohol-based hand disinfectant by their doors, but Duerden says that until recently their inefficacy against C diff spores was "not common knowledge" outside microbiology circles - an unacceptable level of ignorance, insists Wise, who said it had been known about "for donkey's years".

Olav Nataas, however, insists the search-and-destroy process is key: "We know hand-washing is never 100%," he says. "This preoccupation with cleaning is not the main issue. It is identifying the infection as rapidly as possible and treating it in a way that does not risk others."

It is this uncertainty among Britain's scientists, healthcare administrators and politicians that has led to the latest disagreement about hospital cleaning. This month, every hospital in Britain is meant to have completed a special "deep clean", for which an extra 57m has been allocated. How exactly a deep clean is performed is less clear. There are no prescriptions for cleaning materials, training for cleaners, or methods of checking whether things are actually clean.....

Many patients have paid a high price for our confused health policies. In Britain's worst outbreak of superbug infection, there were 90 deaths and 1,170 C diff infections across three hospital sites in Maidstone, Kent, between April 2004 and September 2006. A report on the disaster by the Healthcare Commission in October described patients being left to lie in their own infection-laden excrement, a shortage of nurses and an ignorance of the risks of moving infected patients between wards. There were a further 33 avoidable deaths from C diff between 2003 and 2005 at Stoke Mandeville hospital in Buckinghamshire. An inquiry found that managers ignored advice to isolate those infected and instead concentrated on shutting down more beds to cut costs.

The cost of compensating superbug victims is also soaring. The NHS Litigation Authority has paid out 12.5m for 287 cases, plus a record-breaking 5m in January to the actress Leslie Ash, 49, whose career has been ruined. An anticipated 1m will go to Shaun Franks, 39, who underwent surgery for a broken ankle. His leg was taken over by an immovable colony of MRSA, which could only be eradicated from his body by amputation of the leg. During his treatment, staff at Northampton general hospital unwittingly used an antibiotic that accelerated the growth of the MRSA. "It has been a nightmare," said Franks. "I lost my job, my relationship - everything. Every time I thought I was getting better, it would come back again."

There is no question that ignorance of good practice has played a significant part in the spread of superbugs in Britain. A study in the late 1990s by Otto Cars, an expert in infectious diseases at Uppsala University, Sweden, compared antibiotic use across Europe. British doctors were administering over 18 daily doses per 1,000 people, compared with 13 in Germany and Sweden and 11 in Denmark. Most of the prescriptions were for coughs and colds - 90% of which are caused by viruses, not bacteria.

Duerden admits that the first comprehensive campaign to educate GPs and the public about the overuse of antibiotics only got off the ground eight years ago with the launch of a cartoon character, Andybiotic. But a survey of almost 11,000 adults published in the British Medical Journal last year indicated that most people still did not understand the risks.

Hajo Grundmann, now a senior infection-control adviser to the Dutch government, worked for seven years in Britain's NHS before returning home in 2001. He runs the Eurosurveillance database, monitoring levels of antibiotic-resistant infections in 31 countries. Britain has the highest rate in western Europe. "It is connected with the high workload," he says. "I worked in Nottingham. We were able to isolate MRSA cases at first, but when the waiting-list initiative came in, there was huge pressure on beds. As soon as the pressure goes up, hand-washing goes down. But the British problem is also due to people's attitudes. It just has not been taken seriously enough." ....

There are, however, measures being launched by the government: to increase the number of hospital matrons to 5,000 to oversee hygiene by May, and make available 270m a year for hygiene campaigns, extra infection-control nurses and pharmacists to tackle over-reliance on antibiotics.

But that does not explain why we continue to invest in areas such as Aids research, or the hypothetical risk of pandemic flu, yet hope that drugs developed in the middle of the last century will protect us against new infections that are killing thousands each year.

More here





27 March, 2008

Scotland: NHS admits it is failing thousands suffering chronic pain

Thousands of patients living with incurable pain are being let down by the Scottish NHS, according to a hard-hitting report by the health service's own watchdog. Despite four official investigations in the past 14 years highlighting worrying gaps in care, the research reveals there has been very little improvement.

Specialist support for people who suffer chronic pain is patchy and inadequate, patients are confused and clinicians are frustrated, say the authors. They are demanding action from the Scottish Government and health boards to ensure patients, who can wait years for the treatment they need, get faster access to the right medical help.

It is estimated that 18% of the population, 900,000 people, suffer some form of chronic pain. This is discomfort from injury or disease which persists beyond the typical healing process. One-quarter of people diagnosed are unable to continue working because of the condition, yet just 3% of sufferers are sent to the specialist clinics.

NHS Quality Improvement Scotland, which monitors standards in the health service, has published the latest report. It notes the Scottish Office first described services as patchy in 1994 and further documents published by very experienced people in 2000, 2002 and 2004 raised the same issues. "Despite all of this, very little progress has been made. Access to specialist services is poor." NHS QIS found not one health board could accurately describe the services they did offer.

Dr Pete Mackenzie, who worked on the report, said: "There are major blackspots around the country where there is almost a complete lack of service. The chances of (being told there is no hope) are much greater if you live in an area like that." Dr Mackenzie said, there was frustration about the pace of progress, adding: "It is fair to say many of us, and particularly the patients with chronic pain, feel reports come and go and nothing much happens."

A Scottish Government spokeswoman said: "We are considering the recommendations relating to the Scottish Government, and the Health Secretary will use her address to the national conference organised by the Pain Association Scotland on May 20 to set out her response. "We have for a number of years been encouraging the development of a managed clinical network approach to chronic pain."

Source




Canada's Health Care System Cannot Survive Mass Immigration

A cynic might characterize Canada's medicare system as the universal, free, democratic and egalitarian access to a two-year waiting list. You jump the queue only if you have the bucks and the referral to jump over the 49th, unless a life-threatening emergency sends you to the OR. America's health care system, on the other hand is discriminatory and expensive, but it offers immediate access to the best medical treatment in the world. In both cases timely care for everyone is an elusive goal.

In any event Michael Moore's take on Canada is superficial, euphoric and unrealistic. New technology, abuse and the insatiable demands of an ever expanding clientele of elderly relatives sponsored by Third World immigrants is breaking the bank. It has been calculated that each sponsored immigrant in that age group will cost the Australian medical system $250,000. Since roughly 75% of Canadian immigrants and refugees, drawn from largely "non-traditional" sources, in fact consist of their unskilled dependent children, a terrifying portrait of the toll that Canadian immigration policy is taking on medicare could no doubt be drawn.

A recent article featured in the London Free Press (Thursday, March 13, 2008 "Hospitals forecast deficits") recognized population growth as one principal reason why the Canadian health system was on the brink of deficit financing, with half of Ontario's hospitals facing service cuts to meet the legal requirement for a balanced budget. Seventy percent of Canada's population growth is driven by immigration.

It was economist Milton Friedman who commented a decade ago that "It's just obvious that you can't have free immigration and a welfare state." As Robert Rector explained, to be properly understood, Friedman's observation should be viewed as applicable to the entire redistributive system of benefits, subsidies and services that lower income groups disproportionately enjoy at the expense of higher income groups.

Unfortunately, this superstructure of benefits and services rests not only on an economic foundation but a cultural one as well. A people that is very much alike is more inclined to trust one another, and this trust translates into a willingness to vote for redistributive policies. But we are no longer a mostly ethnically homogeneous society with a shared respect for institutions and a shared sense of civic obligation. When a significant portion of the population is from another hemisphere, another culture or even another generation with different values, the welfare state is perceived as an unlocked candy store with services to be exploited to the maximum.

Redistributive policies like medicare are inversely correlated to cultural diversity. Rather than confront this reality, Canadian leftists demand yet more financial IV injections into the morbid body of the health care system. They refuse to acknowledge that even the Swedish Social Democrats, their role models, were forced to discover the "Laffer curve". That is, push the tax rate up beyond a certain level and tax revenues fall in response. Tax payers will not keep working and producing if they can't keep enough of their income. There are limits to what can be funded. The Canadian model is not sustainable. It works only if there is enough public money to fund it and not enough patients with doctors to help them abuse it. Those days are gone forever.

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26 March, 2008

MRSA and C difficile superbug deaths at 10,000 a year in Britain

Dirty NHS hospitals at fault

The number of patients in British hospitals dying from superbug infections has reached more than 10,000 every year, according to an expert. The new figure is about 20% higher than the official toll of 8,000 a year. Mark Enright, professor of molecular epidemiology at Imperial College London, said that the real number of those succumbing to methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C difficile) in the UK is higher than the government's records show. "I think it is at least 10,000 a year," he said. "A lot of people are never tested for these infections and their deaths are put down to something else."

"Antibiotic-resistant bacteria are now so well established here, we will never get rid of them," said Hugh Pennington, emeritus professor of bacteriology at Aberdeen University and a world expert.

Latest European figures show that Britain's hospitals are still teeming with treatment-resistant bacteria. While strict hygiene measures have ensured low infection rates in other countries, microbiologists here are privately admitting that Britain's problem is so out of control, it will be impossible to prevent the high level of deaths from continuing. The government's pledge to reduce rates of MRSA to half the 2004 level is unattainable, they say.

According to figures from Eurosurveillance, at least 42% of MRSA bacteria in British hospitals are "superstrains", compared with rates of 20% or lower elsewhere. In the 31-nation European antisuperbug league table, Britain lies close to the bottom, with an infection-control performance better than those of only Malta, Greece, Portugal and Romania.

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Australia: More cooking the books in NSW hospitals

NSW Health appointed a nurse whose job was to massage triage data in the emergency department of a Sydney hospital to make it look favourable, emergency doctors say. The nurse, appointed just before the state election, was there specifically to ensure computer data met triage targets, the vice-president of the Australasian College of Emergency Medicine, Sally McCarthy, said yesterday.

This follows revelations in the Herald yesterday that managers at Gosford and Ryde hospitals were so under pressure by the health department to meet targets that some had falsified "time seen" data - the record of when treatment began on a patient.

On the nurse, Dr McCarthy said: "They had somebody looking at that, basically harassing other staff and putting in data themselves. That's not somebody to provide care for patients. That's simply someone to click off on the computer to basically show that patients were seen within benchmark times. It was really just an attempt to get the data looking good."

While the NSW Minister for Health, Reba Meagher, insisted the Gosford case was isolated, Dr McCarthy said the doctoring of data was more widespread and was made easier after the department about 18 months ago widened the definition of when treatment began to include nursing care in several instances. An emergency physician at Prince of Wales Hospital, who could not be named because she was prohibited from speaking to media, said yesterday that "there have been numerous verbal directives from hospital administrators to change data". "This is not an isolated instance. Most other hospitals, and I'm aware of Liverpool and Nepean hospitals being asked to do the same thing," she said. Another emergency physician said he witnessed the same thing at Blue Mountains Hospital last year: "There was a huge amount of pressure . to enter data to meet benchmarks."

Ms Meagher rejected the claims. "There is no evidence to suggest that inaccurate reporting is widespread," she said in a statement. "Hospitals in NSW have been performing well."

Triage data is highly political and used as one of the performance indicators of health bureaucrats. The chief executive officer of Northern Sydney Central Coast Area Health Service, Matthew Daly, admitted a manager at Gosford Hospital had falsified triage data early last year and had been disciplined. "She was altering figures that had previously been entered," he said. He said new recommendations had since been implemented "about the clarity of nurse-initiated protocols - when the clock starts". Mr Daly said no pressure was placed on her to alter data and it was "just absurd to do, and simply dishonest". Another recommendation was to limit access to data.

The director of performance improvement at NSW Health, Tony O'Connell, said it was an outrageous claim that data doctoring was widespread and due to pressure from the department. "There's no evidence that I have that it has happened anywhere else [other than Ryde and Gosford]," Dr O'Connell said. "It's really quite perverse of the college to say on one hand people around Australia should be seen within recommended times . and then turn around and say the department is bullying people to deliver them

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Australia: More health bureaucrats who don't give a damn

They should all be fired

AT LEAST 13 Queensland Health bureaucrats - including the new boss of the Torres Strait district- allegedly received a damning report into staff safety that was left to gather dust. A briefing note prepared for Health Minister Stephen Robertson claims new district manager Cindy Morseu was emailed the Torres Strait Risk Assessment report early last year. The audit report was undertaken in late 2006, 16 months before a nurse was allegedly raped by an intruder in her living quarters on remote Mabuiag Island last month.

The inaction in implementing the report's recommendations and who was responsible have been referred to the Crime and Misconduct Commission. Mr Robertson forwarded the case to the CMC after former district manager Phillip Mills, the uncle of Ms Morseu, denied he ever saw the document because he was posted to Cairns at the time. According to the briefing note, Torres Strait workplace health and safety officer Tom Sanderson claimed the report was sanctioned by the region's director of corporate services, Ashley Frost. There are conflicting versions over events but Mr Sanderson told the department the final report was sent to the Torres Strait in January 2007. "As far as I know it went to Ashley initially as the requester," Mr Sanderson said in the briefing note.

However, the briefing note warns of a lack of evidence because of a policy to delete emails after a certain time. Ms Morseu has refused interviews but Mr Frost, now working for QH on the Sunshine Coast, last night said she was acting manager while her uncle was in Cairns. "I know it went to the district manager, whoever that was at the time, and then it would have ended up at the executive meeting . . . but I can't remember when I would have seen it," Mr Frost said.

Opposition Leader Lawrence Springborg questioned whether there was more damning briefing material. "The minister is either incompetent or dishonest so either way people should be very worried and so should the Premier," Mr Springborg said. Premier Anna Bligh said she could not guarantee work to upgrade security measures at centres would be completed before the nurses' union deadline this Friday.

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25 March, 2008

Women in labour turned away by NHS maternity units

Women in labour are being refused entry to overstretched maternity units and told to give birth elsewhere, NHS hospitals admitted yesterday in response to an application under the Freedom of Information Act. They disclosed that maternity wards in almost 10% of trusts closed their doors to new admissions on at least 10 days last year. One trust in North Yorkshire closed 39 times between October and January because it did not have enough staff to provide a safe service.

The NHS encourages mothers planning a hospital delivery to make a booking early in pregnancy and get to know about the facilities during regular check-ups with a midwife. Most mothers discuss a birth plan with a consultant obstetrician, including choice of pain relief. These preparations are made on the assumption that the hospital will have enough capacity to deal with unpredictable peaks in demand when women go into labour. But information disclosed to the Conservative party under the FoI Act showed 42% of trusts could not get through last year without turning women away at least once.

Andrew Lansley, the shadow health secretary, said the results showed large maternity units closed most often. The University Hospitals of Leicester NHS trust - the second largest unit in England, with 9,470 births last year - shut 28 times. The North Bristol NHS trust closed its doors 17 times. It said the problem was caused by a high birth rate at its Southmead hospital, the largest maternity unit in the south-west, which delivers about 5,500 babies a year. The trust that closed the maternity unit most often was Scarborough and East Yorkshire Health Care, which had only 1,615 births last year. Overwhelmingly, the trusts with most closures were dealing with double that number of births.

Lansley said: "Labour are fixated with cutting smaller, local maternity services and concentrating them in big units. But women don't want to have to travel miles to give birth. And they certainly don't want to have to travel even further because they're turned away by the hospital of their choice. Conservatives are committed to supporting smaller maternity units because the evidence shows they do better."

Lansley's disclosure coincided with a decision by an independent panel to reject NHS plans to close maternity services at Horton general hospital in Banbury. The Independent Reconfiguration Panel - set up by the government to take responsibility for unpopular decisions away from ministers - said access to services would be "seriously compromised" if Oxford Radcliffe Hospitals NHS trust went ahead with plans to centralise its paediatric, gynaecological and obstetric departments.

The Royal College of Obstetricians and Gynaecologists said the increasing frequency of maternity unit closures emphasised the need for more resources. Richard Warren, the honorary secretary, said: "Our current calculation is that 400 extra consultants are immediately required across England and Wales."

Louise Silverton, deputy general secretary of the Royal College of Midwives, said: "The key issue here is what the women want. Women want to know and develop a relationship with their midwife and not feel as if they are on a production line. Midwives want to be able to deliver the best possible individualised care and not feel like they are working in a baby factory."

A spokeswoman for the Department of Health said: "It is difficult precisely to predict when a mother will go into labour and sometimes, at times of peak demand, maternity units do temporarily divert women to nearby facilities. When this does happen, it is often only for a few hours and to ensure mother and baby can receive the best care possible."

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Australia: Hospitals cook the books

NSW Health says altering hospital records to show better treatment times in emergency departments is not a widespread practice. Falsified records from Gosford Hospital showing faster emergency treatment times had been forwarded to the Independent Commission Against Corruption (ICAC), NSW Health director of performance improvement Dr Tony O'Connell confirmed today. But audits of numerous public hospitals revealed that the practice was not widespread, he said.

"We've been doing both internal and external audits of numerous hospitals and there's no evidence that this is widespread," Dr O'Connell told AAP. "In fact it was from an internal audit at Gosford hospital that it was discovered that there was one person who was doctoring results, and that was reported to ICAC and ICAC were satisfied with the actions which the area health service proposed to take to address that issue."

Dr O'Connell denied that NSW Health had been covering up the results of the audits and said they had not been released because they were "standard" reports. "We haven't released them because they're kind of standard ... that any big organisation would do and they don't show anything wrong with the way that the data is collected," he said. "So we haven't released it, but gosh I think we should now."

Dr O'Connell said any staff caught altering hospital records would be dealt with under the department's fraud guidelines. "Any behaviour by staff which corrupts data deliberately is fraudulent behaviour and would be addressed in the department's fraud guidelines, which all staff when they start work are made familiar with," he said.

Hospital staff understood they needed to treat patients in emergency departments quickly and better hospital resources would assist them, Dr O'Connell said. "Our intent is to get patients through our (emergency departments) in the clinically appropriate time. We want patients not to be queueing, we want patients not to be waiting an inappropriate length of time."

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24 March, 2008

Massive NHS payout for 'malingerer' mother wrongly blamed for death of her newborn baby

A grieving mother accused of contributing to the death of her newborn baby by ' malingering' during labour has been awarded hundreds of thousands of pounds in compensation. Hospital staff blamed Kerry Jones after her daughter Bron was starved of oxygen and left brain-damaged. The claims were made after life-support was removed from the day-old child following a traumatic delivery.

At a "hostile" inquest, a hospital lawyer called Miss Jones a "malingerer", criticised her for bringing a birth partner and said her failure to communicate with staff helped cause Bron's death. A midwife accused her of "burying her head in the pillows" and staff complained they "couldn't make somebody do something they don't want to".

The Royal Devon and Exeter Hospital later admitted doctors were negligent in failing to carry out a caesarean. Despite this, bosses then pulled out of a compensation meeting. But the High Court yesterday awarded 37-year-old Miss Jones compensation after hearing she had endured the "nightmare of feeling responsible" for the tragedy in 2002.

Mr Justice King said: "She suffered the trauma of hearing that Bron had severe brain damage, the trauma involved in withdrawing life-support, the trauma caused by the fact the trust felt she might be responsible for Bron's death. "Eighteen months later, the inquest she experienced was hostile, accusatory and blaming." "She was 'bright and personable' before her ordeal, he said, but had since 'shrunk in stature and personality'."

Miss Jones, of Crediton, Devon, had opted for a home birth with minimal medical intervention for her first child but agreed to go to hospital because her baby was three weeks overdue. She told staff she wanted a caesarean if necessary, but the request was ignored when there were complications. Bron was born at 4.35pm on September 8, but her mother was told she would not recover from the effects of oxygen starvation and she followed advice to turn off life-support at 6pm the following day. Within hours she was told the case would have to be reported to the coroner over "maternal matters".

At the inquest in 2004, the hospital barrister asked her more than 60 questions about decisions she took during labour. Midwives claimed they were "undermined" by the birthing attendant she had hired to provide emotional support, but the hearing heard staff had 'clear instructions' how to deal with such companions. The coroner ruled Bron could have survived if born by caesarean and recorded a verdict of accidental death, complicated by "difficulties in communication and monitoring".

Miss Jones split up from Bron's father, Marcus Bawdon, 34, after the inquest. Last night Mr Bawdon, of Exeter, said: "The ordeal was a nightmare. We were treated horrendously. "I haven't spoken to Kerry in a long time and this is something I don't want to discuss. It is still very painful."

The hospital admitted negligence in 2005 and apologised in 2006. But the case went to the High Court after it pulled out of a settlement hearing. Miss Jones's solicitor, Magi Young, said it was "one of the worst cases of injustice" she had seen in 20 years as a clinical negligence lawyer. "As a result of Bron's death and the fact she was blamed for it by the NHS, her life changed beyond recognition. "She was prevented from grieving because of the hospital's attitude towards her and because of the delay in her finally being told it was not her fault. "She developed serious problems including a pathological grief reaction. Her relationship broke up and she had to leave the job she loved as she could no longer function at work."

A hospital spokesman said: "We need to reflect on the views expressed by Mr Justice King and consider whether there are any lessons to be learned."

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Australia: Lack of beds delays public hospital surgery

DOZENS of life-saving operations are being cancelled every day in southeast Queensland public hospitals because no intensive care unit beds are available. Nine major surgeries were put off at Brisbane's Princess Alexandra Hospital on just one day last week due to the lack of post-operative ICU beds. Health sources said that was happening every day at the PA - despite a huge injection of extra funding from the State Government in January for this very problem.

The PA received a $10.4 million boost after the mid-year budget review, after the hospital had been forced to turn sick people away last year. A $15 million budget blowout led to 60 beds being closed in October and 20 per cent of operating theatre procedures cancelled. Premier Anna Bligh stepped into the non-surgery crisis and delivered the life-saving funds. "The PA Hospital will progressively reopen beds and restore theatre lists. This will enable the hospital to return to full activity within a few weeks," Ms Bligh said at the time.

But it would appear little has changed. On Tuesday, nine operations were cancelled or postponed because no ICU beds were available. For one cancer patient needing a life-saving Whipple operation, which involves the removal of the head of the pancreas, a portion of the bile duct, the gallbladder and the duodenum, it was the second time in two weeks that surgery was put off. His operation has been rescheduled for Tuesday, but it will go ahead only if there is a spare bed in intensive care for the following two days. Another patient was referred from Ipswich Hospital to the PA last week for heart surgery, but was sent home because no ICU bed was free.

A senior Queensland Health employee, who declined to be identified, told The Sunday Mail that operations were cancelled at the last minute because beds were taken by trauma patients. The source said a spate of major accidents had produced victims with severe injuries at the same time. As a result, patients waiting in hospital wards for serious surgery were sent home. He claimed the Government was reluctant to invest more money in ICU beds, which cost $10,000 a day to run.

A Queensland Health spokesman said there were 568 critical-care beds in Queensland including ICU, coronary, pediatric and neonatal units. More would come on line as new hospitals were built on the Gold and Sunshine coasts. The spokesman said Queensland Health did not collate statewide figures on the number of operations cancelled or postponed because of ICU bed unavailability.

Queensland Health's Public Hospital Performance Report for the 2007 December quarter revealed many patients were still waiting longer than recommended for critical surgery as record numbers presented to emergency departments. The report found that Category 1 patients who had waited longer than the recommended 30 days for surgery had almost doubled to 13.9 per cent in 12 months.

Opposition health spokesman John-Paul Langbroek slammed the Government for not fixing the problem at the PA. "Where has all the money gone? The PA is not allowed to say 'We cannot take people'. It begs the question: What is happening at all the other hospitals?" Mr Langbroek said.

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23 March, 2008

Australia: Man sues over amazing 13-hour ambulance wait

A grandfather who will spend the rest of his life in a vegetative state is suing Victoria's ambulance service after waiting 13 hours for help after hitting his head. Katrina Marinovic is bringing the Supreme Court action - believed to be potentially worth more than $1 million - on behalf of her father, Ilija, who now has little brain function and is fed through a tube. Ms Marinovic says her father fell and hit his head at 8pm on October 26, 2006, but was forced to wait until 9.30am the next day for treatment after a mix-up meant an ambulance was sent but then cancelled.

"He was such a big character and such a strong person, it's hard for us to see him now compared to what he was before," Ms Marinovic said. "Thinking that he was left for all those hours, it really affects us. "He would give you the shirt off his back - he was that sort of man." The plasterer, 56, lost his balance outside his Preston home and fell down steps on to concrete. A neighbour immediately called 000.

The statement of claim alleges an ambulance was dispatched then cancelled and the matter was handed over to police to investigate whether medical help was needed - which did not occur.

The Marinovic family, who are represented by law firm Arnold, Thomas and Becker, are suing the Metropolitan Ambulance Service, the Emergency Services Telecommunication Authority and the State of Victoria. The writ alleges that the ambulance service and its dispatcher, along with the police who were contacted after the 000 call, were negligent in failing to follow up the request for help. It claims police did not comprehend the urgency or send an officer to check whether an ambulance was needed.

Father of three Mr Marinovic, who also has two grandsons, had emergency skull and brain surgery but was left in a vegetative state, with his family claiming the lengthy delay made his injuries worse. He is living in a nursing home near his family in South Morang, where he needs constant medical attention. The family are seeking medical costs, damages for loss of earnings and loss of life expectancy and for pain and suffering. A spokesman for the ambulance service said they were awaiting further details from court documents.

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Australia: Yet another safety report ignored by Health Department

The Torres Strait Islands are rather idyllic places. Some good pictures here. It takes a government to make a hell of them

A THIRD report detailing how the safety of nurses in the Torres Strait was compromised has emerged, placing renewed pressure on embattled Health Minister Stephen Robertson. This latest report warns how the personal safety of health staff was at risk throughout the archipelago because of rapidly deteriorating buildings, including on Mabuiag Island where a nurse was allegedly raped last month. The report has further exposed a culture of inaction as it was written in October 2005 - a year before a damning risk report warned of the need for urgent action. Another report, commissioned in the weeks after the alleged rape, has also prompted criticism the Government still failed to act.

Amid Opposition calls for his resignation, Mr Robertson yesterday spoke of his frustration that another warning had been ignored by his department. "This is clearly just another case where a report has been commissioned and very little work has been done on it," said Mr Robertson, who again refused to accept responsibility. It comes as a walkout of nurses in the Torres Strait looms amid revelations they had written to former health director-general Uschi Schreiber in 2006 and 2007 highlighting their plight.

The newly uncovered report - conducted predominantly for workplace health and safety purposes - identified problems on all 14 islands visited. On Mabuiag, the report warned issues "revolve around personal safety and environmental issues", including lattice slats that were a ready-made ladder to the upstairs accommodation. "A duress alarm does not work in the toilet and, after visiting several other facilities, it was found there were similar problems at other facilities with the same system," it said.

Mr Robertson said it was not acceptable that neglect of the accommodation had placed staff at risk. However, the minister said he had seen Queensland Health's commitment to the area first-hand on his tour of four islands on Thursday. "Generally the standard of accommodation is pretty good," he said.

In a bid to hose down a growing furore over whether the Government acted after the alleged rape, Mr Robertson will today release the briefing notes he received after the incident on February 5. The notes - released to The Courier-Mail last night - said the incident had "reignited issues around the security and safety of staff". They also detail how assaults on Thursday Island nurses in 2007 had prompted a risk-assessment by occupational health and safety officers and the cycle was repeated after the Mabuiag Island incident.

Deputy Opposition Leader Fiona Simpson said the minister should take responsibility for his inaction and resign. But Mr Robertson rejected the call and insisted he had also acted on problems in the region highlighted by local Labor MP Jason O'Brien. "They know as well as anyone else that right throughout this whole episode, on not one occasion have I been found wanting in terms of my response when matters have been brought to my attention," he said.

Premier Anna Bligh said the Health Minister retained her full confidence. "Mr Robertson will do whatever is necessary to ensure the right response for staff and patients," Ms Bligh said.

Source

A government that can't

Nurse strike on Torres Strait Islands likely. I suppose it is very optimistic to expect promptness and efficiency from a government

A NURSE has abandoned a condemned Torres Strait health centre as frenzied repair work throughout the islands appears unlikely to be completed in time to prevent a district-wide strike next weekend. The Courier-Mail has been told it would be "almost impossible" for maintenance workers to fix all the problems which have come to light since a nurse was allegedly raped on Mabuiag Island last month. Locksmiths and carpenters have been shuttling between the islands for the past fortnight, frantically fixing broken locks, windows and doors and addressing years of unresolved maintenance requests.

On Wednesday, a nurse walked off the job after being forced to live in a condemned building on Darnley Island while a new, purpose-built clinic sat empty nearby. Sources said the nurse refused to keep working on the island until power was connected to the new building.

Queensland's Health Minister, Stephen Robertson, flew to the Torres Strait on Thursday in a bid to diffuse growing anger over worker safety in the remote region. During the trip, Mr Robertson visited several islands - including Mabuiag - to meet with Queensland Health workers. The State Government is under fire for failing to act on a report completed in late 2006 which warned about problems at work and accommodation facilities in the Torres Strait. The Queensland Nurses Union has set a March 28 deadline for the Government to fix the security issues or nurses will walk off the job across the region. QNU secretary Gay Hawksworth welcomed Mr Robertson's visit and hoped it would prompt faster repairs. "I'm pleased that he's gone there to see it first-hand and talk to nurses directly," Ms Hawksworth said. "But our deadline remains March 28."

Nurses working on 11 islands in the region have raised repeated concerns about poor security, lighting, faulty duress alarms, generators, fire and smoke alarms, broken locks and problems with sewerage systems. Premier Anna Bligh said she hoped the issues could be resolved quickly. "The most urgent matters in relation to security are being attended to first and then work is being prioritised," she said. Ms Bligh also defended Mr Robertson's handling of the issue: "The Minister for Health . . . has had what can only be described as unreliable advice out of the Torres Strait on these issues in the past, so he is personally going to satisfy himself on the progress of work and ensure that it is proceeding in the fastest possible place."

Mr Robertson said Queensland Health had to demonstrate that it was seriously addressing the problems but he urged nurses to remain. "I am hopeful that as we address these issues the level of frustration and angst and anger will reduce," he said.

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22 March, 2008

Britain: Proposal for super-surgeries ‘may result in worse care’

Plans to build 152 doctors’ “super-surgeries” in England are confused and there is limited evidence that they will be effective, according to an expert in primary care. Martin Roland, director of the National Primary Care Research and Development Centre at the University of Manchester, said that primary care trusts were already being required to develop polyclinics, or multi-doctor centres, but there was “little clarity about their purpose”.

Lord Darzi of Denham, the Health Minister, has yet to produce the final report of his NHS review, but the Department of Health has indicated that it expects all 152 primary care trusts in England to have at least one poly-clinic. Private companies will provide many of them, although the department has promised GPs that they will get a level playing field in tendering for the contracts.

Professor Roland wrote in the British Medical Journal that the Government champions patient choice, but extending choice means more high-quality practices, not fewer, as the polyclinic model suggests. He said: “On average they [small practices] achieved slightly higher levels of clinical quality than the larger practices.”

Polyclinics may also have specialists working in them, but he claims that there is evidence that consultants work less efficiently outside hospitals.

Polls show that GPs are strongly opposed to polyclinics. Richard Vautrey, deputy chairman of the British Medical Association GPs’ committee, said: “This is a government plan that is potentially going to waste hundreds of millions of pounds of scarce NHS resources, creating very large health centres that many areas of the country don’t need or want.”

The medical newspaper Pulse has begun a campaign called Save Our Surgeries, and reported that polyclinics would force GP practices to close or merge, and patients to travel further.

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Socialized Medicine in Europe...Woman Goes for Leg Operation, Gets New Anus Instead

A German retiree is taking a hospital to court after she went in for a leg operation and got a new anus instead, the Daily Telegraph is reporting.

The woman woke up to find she had been mixed up with another patient suffering from incontinence who was to have surgery on her sphincter.

The clinic in Hochfranken, Bavaria, has since suspended the surgical team.

Now the woman is planning to sue the hospital. She still needs the leg operation and is searching for another hospital to do it.

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21 March, 2008

Minorities, whites get equal care in U.S. hospitals

A University of Maryland study of whether people receive different quality of hospital care because of their race or ethnicity found that when whites and minorities are admitted to a hospital for the same reason, they receive the same quality care in that hospital.

The study led by Darrell Gaskin, health economist in the University of Maryland's department of African American Studies, appears in the March 11 issue of Health Affairs. The study of 1841 hospitals in 13 states compares the quality of treatment for blacks, Hispanics and Asians to that of whites over a broad range of services. It found that only a few hospitals provide lower quality care to minorities than to whites.

"The good news," said Gaskin, "is that if you come to the hospital for care, you're probably getting the same quality as everyone else in that hospital."

The study also may help pinpoint where improvements need to be made to reduce the significant health care disparities that are known to exist because of race, ethnicity and income. "Our study confirms that all patients in low performing hospitals are at higher risk for mortality and complications. We need to focus on improving those low performers as opposed to hospitals nationwide," Gaskin said. "Our results also suggest that we need to look more carefully at other areas to find where disparities are originating, such as getting access to the good hospitals in the first place."

Surprised at Findings

Gaskin admits he was surprised at the results of the three-year study. Earlier studies that looked at only a few specific conditions, such as cardiac care, and used general estimating equations, have shown quality differences based on race.

What made this study different, Gaskin said, is that "we compared a broader range of services and directly compared hospital-specific quality indicators for racial and ethnic groups. We examined rates of mortality and complications - whether something bad happened in the hospital because of the care."

Gaskin's group looked at hospitals in 13 states that report patients' race and that collect the specific data the researchers needed to compute quality measures. Forty-four percent of the U.S. population live in these states, with 36 percent of Asians, about 50 percent of Hispanics, 46 percent of African Americans and more than 44 percent of whites residing in the areas studied. The study covered more than 45 percent of urban hospitals and 28 percent of rural hospitals.

"The findings indicate that the systems in place in the hospitals do work to deliver equal quality to patients in that same hospital. It's difficult for one person's bias to make a difference in treatment that would show in mortality rates," Gaskin said.

Gaskin is now working on a study to examine minorities' access to quality medical care, particularly how primary care affects equal access. "We have a tremendous problem with minorities, especially blacks and Asians, getting access to the good hospitals or being referred for care when it could make the most difference. The access problem isn't going to be solved in the hospital. It has to be solved in communities."

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More revelations about a disgusting Australian health bureaucracy

QUEENSLAND Health Minister Stephen Robertson is in the Torres Strait today to get a first-hand look at security for health workers. Nurses are threatening to strike from March 28 if security does not improve in the state's remote north. A nurse was raped on remote Mabuiag Island in the Torres Strait last month and was told to return to work after the attack, receiving no help to leave the island. Mr Robertson has been under fire this week over his handling of health workers' security issues. A spokesman said the minister was visiting a number of islands in the region to inspect progress on security improvements.

Yesterday remote area nurse Janine Evans, 43, broke her silence to reveal how health authorities exposed her to danger by failing to tell her about a written threat to her safety while working at Hopevale, on Cape York; and later heartlessly hauled her through the courts over taking a work vehicle to escape another community.

It took at least three weeks before a Cairns-based manager informed Ms Evans about the letter, from the family of a patient, which warned she should never work with Aboriginal people again and "if we see her on her days off she should watch out". In an extraordinary admission last night, Queensland Health said it had no specific policy for staff if they received written or verbal threats. "Anyone with fears for their safety should contact police," a spokeswoman said. Ms Evans said: "I just think it's terrible to leave me in there when they knew about the threats," she said.

Ms Evans was later taken to court over a work vehicle she used to escape Coen, on Cape York. She fled because she was struggling to cope, blaming a lack of support. The latest allegations show that the crisis in remote health is not just confined to the Torres Strait, where nurses are threatening to strike from March 28 if conditions do not improve.

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20 March, 2008

More dangerous NHS hospitals

High death rates at a Staffordshire hospital trust are to be investigated by the Healthcare Commission. The watchdog said that data showed the death rates at Mid Staffordshire NHS Foundation Trust were “out of normal range”. The inquiry will focus on what appear to be higher than normal death rates for emergency admissions. The commission will also investigate the quality of care provided across the trust, in particular to older people.

The trust, which serves 300,000 people, said yesterday that it believed its death rates were normal for a trust of its size. Martin Yeates, the chief executive, said that the trust and the Strategic Health Authority had investigated the trust’s higher than average standardised mortality rate and concluded that it was due to “problems in recording and coding information about patients”. He said this had improved in the past year.

Nigel Ellis, of the Healthcare Commission, said that it was important to “bring clarity” to the situation. “If we thought the trust was unsafe we would have already taken action,” he said.

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Australia: 'More clerks than nurses' in NSW health system

The NSW health system employs more clerks than nurses, and continues to obstruct desperately needed reform, the former director-general of the Premier's Department said yesterday. Ken Baxter, who ran the agency under Labor premier Bob Carr, yesterday released an Australian Centre for Health Research report calling for a federal takeover of public hospital funding, saying the scale of state bureaucracies, cost-shifting and woefully inadequate reporting data justified the overhaul. He cited annual report data that showed more than a third of NSW's 90,997 health staff were classified "administrative or other". "In the NSW health system, there are more clerks than there are nurses," Mr Baxter said, estimating nurse numbers at 30,000.

In Tasmania, the system was even more heavily weighted towards office workers, with 45 per cent of the 8992 full-time equivalent staff classified as administrative or other, his figures show. Administrative jobs accounted for a quarter of positions in the Northern Territory and a fifth in Queensland and the ACT, with data from Victoria, South Australia and Western Australia non-existent or incomplete. "A number of the states can't give you accurate figures and certainly none of them (are) comparable," Mr Baxter said.

Many of the jobs in health had gone to IT support, despite the fact that more than $2 billion had been spent on IT systems throughout the Australian health sector "without delivering any real improvements" in performance data or services, he said.

The ACHR report into the future of Australia's federal-state healthcare agreements argues for a slimmed-down system where area health services and local boards run public hospitals, directly funded by the commonwealth based on their success in meeting performance indicators. The states would be left as owners of the hospitals, but would relinquish their current roles as co-funders and sole administrators.

Mr Baxter said more direct lines of responsibility would help reduce cost-shifting estimated at up to $500 million a year. "If we want that same level of service and we want the same standard, then some of these changes have got to be made," he said. "And none of them are going to be comfortable. But if you ask (NSW Health Minister) Reba Meagher, life is not comfortable for Reba at the moment."

Ms Meagher has faced off several scandals over substandard services at hospitals such as the busy Royal North Shore in Sydney while leading resistance to commonwealth calls to sign up to nationally consistent performance data for state hospitals. But she defended herself against Mr Baxter's claims, saying frontline clinical staff, including doctors, dentists, ambulance workers and allied health professionals, as well as nurses, outnumbered administrative staff and made up two-thirds of the system's workforce. "NSW Health has been actively restructuring the health system to shift resources away from administration into frontline health services," she said.

She also defended NSW's record in reporting on hospital performance, citing emergency and surgery data by hospitals published quarterly. But "we won't support benchmarks that are simply reporting for reporting's sake or have the potential to act as a disincentive for medical staff to report adverse events," Ms Meagher said.

Mr Baxter called the arguments against the release of hospital scorecards "nonsense". The NSW Government had surrendered in the face of bureaucratic resistance, he said.

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19 March, 2008

Australia: Scum Muslim doctor still registered to practice

A doctor who was able to continue practising after sexually assaulting two patients, lied about his indiscretions in an attempt to become an eye surgeon, the Medical Tribunal has heard. Dr Fahreed Bahrami, 44, was found guilty in 2002 of rubbing his penis against a one female patient and of touching the breasts, buttocks and thighs of another female patient before placing her hand on his penis. However the former Iranian refugee was able to continue practising on the condition he have a chaperone present during intimate examinations, after the NSW Medical Tribunal in 2003 found he was unlikely to reoffend.

Bahrami was again before the NSW Medical Tribunal yesterday, accused of altering his medical registration to "conceal that his practice was conditional," according to counsel for the Health Care Complaints Commission, Philip Strickland. Mr Strickland told the tribunal that Bahrami had tried to apply for membership to the Royal Australian and New Zealand College of Opthalmologists and in doing so had falsified his registration certificate to appear that he had general registration. Bahrami then signed a false statutory declaration and submitted the false registration card to the college, the tribunal heard. False applications were submitted and rejected three times before the college became aware of the discrepancy, Mr Strickland told the tribunal.

Mr Strickland said in lying about his registration status Bahrami's conduct had been "dishonest" and "deceptive" and he should be deregistered. He said Bahrami was guilty of unsatisfactory professional misconduct and that in falsifying the documents and later withholding that information from the tribunal that he was not of good character.

Dr Paul Beaumont, an opthalmologist and mentor of Bahrami's over a two-year period said his charge was "probably" a truthful and trustworthy member of the medical profession. However he agreed with Mr Strickland that Bahrami had been "repeatedly dishonest" in his dealings with the tribunal and in regards to his medical registration.

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Markets and Medicare

Rarely in Washington does the president get to propose legislation that Congress is required to fast track. Such an opportunity exists right now, and it pertains to the most serious domestic policy problem this country faces: the rising costs of Medicare. Under a 2003 law, the Medicare trustees have certified that the program's finances have deteriorated so much that they "trigger" a required presidential response. Sadly, Washington's response is not new. The White House proposed across-the-board cuts in payments to doctors and hospitals in the budget earlier this month. Such measures do not improve care, and have not worked to contain costs in the past.

More recently, Secretary of Health and Human Services Mike Leavitt has proposed measures to promote electronic medical records, price and quality transparency, limits on malpractice awards, and means-testing of Part D (drugs) premiums. While in some respects commendable, these proposals are far from adequate.

According to the trustees, Medicare's unfunded liability is $74 trillion -- five times that of Social Security. According to the Congressional Budget Office, health-care spending is on a course that could crowd out all other government programs. Clearly the time has come for fundamental reform.

How can we control the rising cost of Medicare? There are many examples of waste and inefficiency throughout our health-care system: diseases that we fail to prevent; chronic illnesses that progress to preventable complications that are treated with duplicative and ineffective services; and too-common medical errors. There is an enormous number of people who in theory could change these practices, including the 650,000 participating doctors, the 30,000 participating facilities, and especially the 44 million enrollees and their caregivers. Perversely, however, people who try to improve Medicare are often financially penalized for doing so. This needs to change. Here's how:

- Free the Doctors. Doctors participating in Medicare must practice medicine under an outmoded, wasteful payment system. Typically, they receive no financial reward for talking to patients by telephone, communicating by e-mail, teaching patients how to manage their own care, or helping them be better consumers in the market for drugs. Medicare pays by task, and these are not reimbursable activities. So doctors who help patients in these ways are taking away from billable uses of their time.

In fact, physicians who help patients in these ways may end up with less payment from Medicare. To make matters worse, as Medicare suppresses reimbursement fees, they are increasingly unable to perform any task that is inadequately reimbursed. Other health-care providers face the same perverse incentives. All too often, high-cost, low-quality care is reimbursed at a higher rate than the alternative, and Medicare's payment rules get in the way of providers working together to improve health care.

We should be willing to reward doctors and other health-care providers who raise quality and lower costs -- including improving patient communication and access to care, and teaching patients how to be better managers of their own care. Accordingly, providers should be able to propose and obtain a different reimbursement arrangement, provided that (1) the total cost to government does not increase, (2) patient quality of care does not decrease, and (3) there is a mechanism for accountability, and a method of measuring and assuring that (1) and (2) have been satisfied.

Geisinger Health System in central Pennsylvania provides an example of what could be done. It offers a 90-day warranty on heart surgery, similar to the type of warranties found in consumer product markets. If the patient returns with complications in that period, Geisinger promises to attend to it without sending the patient or the insurer another bill.

The problem is that Geisinger doesn't get financial support from Medicare for this practice, even as it can save money for Medicare overall. This is because health-care organizations like Geisinger get paid more when patients have complications that lead to more visits, more tests and more readmissions. What is needed is a system willing to pay for such guarantees. Medicare should be willing to pay more for the initial surgery if taxpayers save money overall.

Another innovative example: Virginia Mason Medical Center in Seattle offers a new approach to the treatment of back pain, a source of considerable medical spending nationwide. Under the old system, a patient would often first receive an MRI scan or specialty consultation and other tests before referral to a physical therapist. Under the new system -- which cuts the cost of treatment in half -- patients are first seen by a physical therapist unless additional diagnostic measures are clearly indicated, and receive an MRI scan only if the therapy doesn't work and symptoms persist.

The new system improves efficiency and saves money for payers but leaves the providers financially worse off. As in the case of Geisinger, Medicare should permit a new payment arrangement -- one that is win-win for Medicare and Virginia Mason. Once one hospital or doctor group implements an arrangement with better payment for better results, there will be competitive pressures on other providers to find new and innovative ways of raising quality and lowering costs. Plus, once Medicare takes these steps, private insurers can adopt similar payment systems more easily. Medicare and the private sector will be pushing in the same direction, for better care -- not just more services.

For reform to work, however, there must be accurate measurements of quality and cost, so that these transactions can be easy to negotiate and consummate. Another essential ingredient is to allow doctors and facilities to work together as a team -- making needed improvements and profiting from those improvements.

Similarly, regulations that prohibit profitable provider arrangements should be relaxed, when those arrangements are leading to documented improvements in care. There are many low-cost, high-quality pockets of excellence just waiting for the support they need to grow. Medicare has considerable authority to implement these changes now. If health-care providers accept more accountability for the results of their care, we can start seeing the benefits right away.

- Free the Patients. Patients also suffer when payments to doctors and hospitals do not reward prevention-focused, efficient care. Many patients have difficulty getting to see primary care physicians. When they do, all too often they get inadequate information about their overall health condition and the best ways to improve it.

Studies show that diabetics, asthmatics and other chronic patients can often manage their own care as well as, or better than, conventional physician care, and at lower costs, when given the support they need. Yet to do this patients need training, easier access to information, and the ability to purchase and use in-house monitors. One way to do this is by allowing patients (especially the chronically ill) to save money when they choose less costly, high-quality care. They should be able to use the savings to purchase services that are not paid for by traditional health insurance, including telephone and e-mail consultations and patient education services.

Almost all the states now have "Cash and Counsel" programs for homebound, disabled Medicaid patients -- allowing them to manage their own health-care dollars and hire and fire the people who provide them services, instead of having these decisions made by an impersonal and outdated schedule of covered services and regulated prices. Patient satisfaction in these patient-controlled programs is almost 100%, according to government surveys. We need to build on this highly successful program by giving chronically ill Medicare patients some of the same opportunities.

Both within traditional Medicare and the Medicare private insurance plans (Medicare Advantage), this opportunity should include risk-adjusted deposits to the Health Savings Accounts (HSAs) of chronic patients. Unlike current law, these HSAs should be flexible -- allowing patients to exercise discretion where discretion is possible and desirable.

- Free the Entrepreneurs. While our health-care system has some of the most innovative treatments in the world, Medicare's payment system imposes many barriers to innovations in using those treatments efficiently and effectively. In normal markets, cost efficiencies and quality improvements mean larger net revenues when an entrepreneur finds a better way to provide products or services. By contrast, entrepreneurial efforts under Medicare all too often find their greatest reward when they exploit the system by finding ways to bill more for more services, rather than improve it.

We should welcome and encourage better ways of meeting patient needs. For example, a medical practice that uses walk-in clinics and electronic prescribing to lower overall Medicare spending for the beneficiaries it serves should get higher payments.

These are just a few of the many things that can be done to control the rising costs of Medicare, while improving care and health at the same time. These steps will not be enough by themselves to put Medicare and our health- care system on a sustainable course, but timely action by the president and Congress can make a big difference.

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18 March, 2008

Lifesaving drugs to be "cut" by the NHS

Only 4,000 people are affected so who cares? Not the NHS

A two-year-old boy suffering from a rare heart and lung condition is being kept alive by Viagra. Oliver Sherwood takes the drug four times a day to control pulmonary hypertension (PH), a condition that causes chronic high blood pressure. Viagra improves blood flow and can help open veins and capillaries to aid circulation in cases such as Oliver's. However, his future health is under threat because of proposed cuts by the National Institute for Clinical Excellence (Nice), the Government's drug rationing agency. As Oliver grows up he will need to switch to more expensive treatments to control his condition, such as Epoprostenol and Iloprost, which may not be available if the cuts go ahead.

His mother, Sarah, 34, has launched a petition to keep funding for PH treatments on the NHS. Mrs Sherwood, a part-time nurse who lives in Hucclecote, Glos, with her husband Howard, 43, and older son William, five, said: "Viagra is an expensive drug but it's actually one of the cheapest to treat PH. "When he started taking it the change was fantastic - I had my little boy back. "Cutting any of these treatments to save money is scandalous when lives are at stake."

PH causes the blood pressure in the arteries in the lungs to rise, putting strain on the heart and reducing blood oxygen levels. Oliver cannot walk more than a few steps without getting out of breath and a simple chest infection could kill him. Only 4,000 people in Britain have the condition and the survival rate for most patients is about five years. Only five children a year are diagnosed with PH - which usually affects middle-aged women and can lead to heart failure and damage to the lungs.

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Why Computers Work and Health Care Doesn't

Computers work. We complain about them, but that's because most of the time they work so fast that we don't even notice them in the background. And they get cheaper by the second. They get cheaper so fast that we can see the prices of memory and processor speed falling even without adjusting for inflation.

Health care, on the other hand, gets more expensive all the time, even for techniques that were invented decades ago. Computers get twice as fast every two years, but technology for carbon-based organisms improves at a snail's pace. Why? Biology isn't all that complex. After all, our cells only have the equivalent of about 2.8 gigabytes of (very slow) DNA memory storage. The viruses that kill us often get by with 12 kilobytes. Your cellphone has more memory than most pathogens, and cellphone design mutates more over the course of a year than the flu.

A Thought Experiment: The Federal Data Administration

Let's put medical research and biotech under the Federal computer regulatory agencies. oh, that's right, there aren't any. Meanwhile, let's see how Steve Jobs and Bill Gates would fare under. the FDA!

Yes, the FDA; the Federal Data Administration. Every processor, peripheral, program, printer, and power cord will now need FDA approval. This will take about 19 years of trials on lab rats and human nerd volunteers, at an average cost of $802 million dollars per item (according to a Tufts University study on drug approval back in 2001; the time and cost is probably less than twice that now, right?). Any change of any kind to any chip, peripheral, or line of code will of course require a complete re-approval.

And what about those guys who run the computer industry? They're. dropouts! Steve Jobs, Bill Gates, Larry Ellison. the whole industry is dominated by billionaire dropouts. How have we gotten along so long without credentialed professionals?

To make the computer industry run like the health care industry, state licensing boards will require American Mainframe Association (AMA) membership for all computer professionals. Every programmer will have to pass a four-year pre-mainframe undergraduate degree, four years of Mainframe School, then internships, residencies, and so on until they are gray enough to program responsibly (or die of old age).

Now when you have a computing need, you will have to go to one of these AMA professionals and sit in a cold waiting room full of computer viruses. Then you will receive a prescription to receive FDA-approved hardware and software (within the prescribing and cost regulations of an HMO, see below).

The IRS will make buying computers tax-deductible for employers, but not for you. Employees will be forced to buy computers through Hardware Maintenance Organizations (HMOs) run by their employers. To lose your job will mean to lose your computer, your ISP, and your primary-care AMA programmer.

The Data Enforcement Agency (DEA) will combat the smuggling of illegal data-processing paraphernalia, such as that used in so-called "video games" or "iPods." The DEA would also have the responsibility of ensuring that no unapproved data crosses our borders.

And then there would be the National Institute of Hardware (NIH), which would pour billions into the academic study of advanced vacuum tube designs.

OK. No one would really be stupid enough to try to run the computer industry like this. We love our computers too much, so we don't let government regulate them. We leave our computers to the free market, even though they control nuclear weapons, air traffic control, our cars' antilock brakes, and lots of other stuff that's more immediately dangerous to our health than medicine. The free market isn't perfect, but it's constantly driven to improve. With all its imperfections, freedom is still safer than stagnation.

Can Market Medicine Be Safe?

Most people can see that the market works best for computers. There are few calls for nationalization of Apple or Intel. But when it comes to health care, it is just assumed that only government can provide safety. in spite of its record of both approving dangerous drugs and stalling valuable therapies.

Of course we need impartial testing of drugs and medical protocols. Do we really think we get that under the current system? Is the FDA somehow exempt from the law that every regulatory agency is captured by the industry it "regulates"? I'd feel a lot better if the next Celebrex or Thalidomide were also going to be tested by competing companies and nonprofits, instead of essentially by the prospective manufacturer under the "supervision" of the FDA. Maybe Underwriters' Laboratories, the AMA, a few universities, etc. could expand into the job.

In any case, even if you think the FDA is exempt from the evolutionary laws that govern bureaucracies, there is no advantage to preventing competition. If some people wish to use only the FDA approval system, fine. That shouldn't restrict anyone else with an incurable disease from using a medicine approved by the AMA, or UL, or the Mayo Clinic. Any group should be allowed to make lists of "approved" drugs and protocols, and patients and doctors should be allowed to choose.

The FDA and the patent office have created a medical system that is driven by drug companies. Do drug companies have all the right incentives to find the downsides of their patented product pipelines? I'm not at all anti-drug-company; they do good work, but wouldn't medical systems driven by (say) life insurance companies, or hospital chains, or academic research, each have their own advantages? Again, competition is the key to progress.

Then there's biological terrorism. If the survival of our nation depends on the speed at which we develop new cures for artificially engineered viruses. do we want to bet on our current system of government agencies and committees, or on the market?

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17 March, 2008

Fatal Canadian bungling goes on for years

The Newfoundland laboratory that botched hundreds of breast cancer tests has not investigated whether results of other specialized lab work done during the same period were correct, leading experts to question whether the province's testing tragedy is more extensive than has been revealed.

The scandal has invigorated national concerns about the lack of regulations for immunohistochemistry, or IHC. The Royal College of Physicians and Surgeons of Canada and the Canadian Association of Pathologists are set to launch nationwide reviews to address critical gaps in quality assurance that put patients at risk. “The issues that have been brought to light reflect on the system,” said Andrew Padmos, chief executive officer of the Royal College of Physicians and Surgeons of Canada. “This is not a blame game. We're here to fix the problem.”

In Newfoundland, a public inquiry set to begin next Tuesday will examine how problems in the lab at St. John's Health Care Centre led to incorrect diagnoses for more than 300 breast cancer patients. However, experts set to testify told The Globe and Mail that tens of thousands more cancer patients might have been put at risk by faulty testing methods. “Because there's been an error detected in one test, there's a burden of proof on the system to show all the tests are safe,” said Michael Goodyear, an oncologist and associate professor of medicine at Dalhousie University who specializes in patient safety studies.

Nebojsa (Nash) Denic, clinical chief at Eastern Health, the lab in question, disagreed and said it would be an overreaction for his facility to do more back-checks on tests without clinical proof there is cause for concern. “You just don't go blindly asking whether a stain worked or not,” he said. “… If you buy a new car, unless you press the brakes, you don't know whether the brakes work. That's your indicator.”

In this case, the indicator seems indisputable: Many patients were misdiagnosed. And the systemic problems in the Newfoundland lab, exacerbated by a high staff turnover and strained resources, went undetected for nearly a decade. Now, they have caught the attention of lab workers and cancer specialists across Canada. “Every pathologist and pathology department in the country is examining what they do and the way they do it in light of this,” said Sylvia Asa, chief pathologist at Toronto's University Health Network. “It's opening up a lot of questions about what we do and how we do our jobs.”

IHC involves a family of complex, sophisticated tests in which tissue samples are stained with antibodies that bond to antigens in cancer cells, opening a window for pathologists who interpret the tests to examine the cell's unique molecular characteristics and issue a refined description of the cancer. Oncologists rely heavily on the pathologist's interpretations to make decisions about patient care. “The pathologist gives the clinical oncologist the correct diagnosis and correct direction for how to treat the patient,” Dr. Asa said. “Without that, you just can't navigate.”

The tests include more than 40 sensitive steps and are known for being extremely vulnerable to errors in the absence of strict quality control. For patients, that spells the possibility of getting incorrect test results, which could lead to a false diagnosis, wrong treatment plan and a compromised prognosis. “There's a potential for this sort of thing to occur anywhere,” said Carol Sawka, a medical oncologist and vice-president of clinical programs for Cancer Care Ontario.

Dr. Sawka said that over time, the field of immunohistochemistry has “outpaced the organization's ability to respond to it effectively.” The field has also outpaced regulators who have yet to set any kind of enforceable guidelines to ensure quality testing. “We don't have any gold standards,” said Emina Torlakovic, a Saskatoon pathologist who is leading a committee set up by the Canadian Association of Pathologists that is looking at developing national standards for IHC testing. “I don't think everybody understands what they're really doing. I know that everybody is trying to do their best. But what is the best isn't defined. And that's a problem.”

Leaked documents – key pieces of evidence expected to be examined at the inquiry – suggest that Newfoundland's lab, which does about 1,000 IHC tests a month, has battled problems for years. In a 2003 memo to administrators of the Health Care Corporation of St. John's (HCCSJ is the predecessor to Eastern Health) that was leaked last year, Gershon Ejeckam, the then-director of the lab, announced his decision to temporarily halt testing because of “erratic” results. He attempted to set off alarm bells about problems threatening the province's cancer care system. That year, after the lab made some changes, testing was restarted.

In his memo, Dr. Ejeckam (who now lives in Nigeria and was unavailable for comment) wrote that high staff turnover and the workload that lab staffers were shouldering made it “virtually impossible for them to devote the time required to master the intricacies of this procedure.” He pleaded with his bosses to dedicate resources for specialized staff. “To do less will simply become a gamble where you may win or lose. This obviously will spell disaster,” he wrote, adding that “crisp, reliable” results were “extremely important” in the diagnosis and treatment of several cancers. “Diagnosis based on inappropriate immuno stain will surely jeopardize patient care and may even expose the HCCSJ to litigation.” Dr. Ejeckam outlined a list of tests he viewed as having been jeopardized by problems in the lab. One was the breast cancer test for estrogen receptors at the centre of the public inquiry, also the subject of a class-action lawsuit. But he listed several more tests related to a host of other cancers.

In an interview yesterday, Eastern Health's Dr. Denic said those other tests are less vital. “It's bad practice if [the tests] are solely used in diagnostic purposes,” he said. It remains unclear whether the public inquiry will expand its mandate to explore them.

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The coming debate over health care

No matter who wins the Democratic presidential nomination, that candidate will have a significantly different prescription for the nation's health-care system than Sen. John McCain, the Republican nominee. Which is a good thing, since that means the country is in for a debate involving real substance.

Both parties agree that "the health system needs major repairs," reports Kevin Sack in a recent analysis of the candidates' proposals by The New York Times. As Sack noted, the Democrats are more interested in universal coverage, while the Republicans focus on cost containment. Those may be the points of emphasis, but McCain wants expanded access, too, while Barack Obama and Hillary Clinton claim they can rein in health-care costs.

One thing we've learned from state-based experiments in universal coverage: It's not cheap. In Massachusetts, taxpayer subsidies for its two-year-old program of mandated coverage will rise from $158 million in 2007 to $600 million this year and $870 million in 2009. Lawmakers are now scrambling to impose new cost controls. On the menu: lower payments to doctors, hospitals and drug companies. Meantime, a similar plan proposed in California died in January when the independent Legislative Analyst projected the program would cost at least $4 billion more in its first five years than proponents first suggested.

By contrast, McCain's agenda would primarily expand choices for consumers. Among other things, he would allow Americans to purchase health coverage from a licensed insurer in any state; individuals could shop nationwide for an appropriate policy and compare prices. He would also allow membership organizations (like AARP) or other non-employers to sell group policies.

Most dramatically, he would end the tax deduction that employers receive for providing health insurance; instead, individuals would receive tax credits they could use to either purchase policies or invest in Health Savings Accounts. They would no longer depend on their employers for medical coverage. Taken in combination, these proposals would give individuals more control of their health-care options..

Until the next president takes office, states would be well-advised to steer clear of comprehensive reform. But they can act on the margins. Indeed, we're encouraged to see several consumer-friendly initiatives in this year's legislature. House Bill 1061, with bipartisan sponsors, has passed both houses and would allow advanced practice nurses (who have specialized certification, such as in clinical practice or anesthesia), to provide a broader range of care - more like physicians.

Next, House Bill 1311 would establish two new, bare-bones insurance plans for any employer that does not offer its workers medical insurance. The proposal died in committee, but the lead sponsor, Rep. Spencer Swalm, R-Centennial, told us that House Speaker Andrew Romanoff has expressed interest in reviving it.

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16 March, 2008

NHS misdiagnoses woman for 23 years

A woman who was called lazy because she fainted during exercise is recovering after an operation to repair a hole in her heart that was described by cardiologists as one of the biggest they had seen. Despite Louise Banks’s suspicions that she might be suffering from a heart problem – which appeared to worsen dramatically when she tried to exercise – doctors repeatedly misdiagnosed her condition throughout her teenage years. Ms Banks, now 23, even resorted to joining a gym to prove that she was not lazy, as her school PE teacher claimed. While running on the treadmill she discovered that her heart rate went down instead of up.

However, it was only this January, seven years later, that her condition was finally identified after a new GP recorded an irregular heartbeat during a 24-hour monitoring test. The scan revealed a tear 4cm (1½in) long in the partition between the right and left side of her heart that enlarged when more blood was being pumped through. The result was lack of oxygen in the blood reaching her brain, causing her to faint. The condition could have killed her at any time in the previous 23 years.

Heart surgeons at Southampton General Hospital have now repaired the gap. She has been left with no lasting effects apart from a 25cm scar on her chest and a temporarily enlarged right side of the heart. Ms Banks is now back at her home in Exeter, Devon, with her partner Matthew Folland, 30, and their son Ben, 4, and is looking forward to catching up on all the things that she could not enjoy as a teenager, including sports and dancing. She said: “I always knew there was something wrong because I could feel my heart start and stop like a baby wriggling in my chest. I’m looking forward to my new life. It will be great to be able to dance with my friends without collapsing.”

At the age of 8 she was described as a “fainty child” after passing out at school. When it happened again she was told that she was epileptic. At 14 she complained of having palpitations up to 70 times a day. At 16, fed up with the taunts, she joined a gym. Her condition was once again misdiagnosed when she complained that her heart rate was falling instead of rising as she tried to work up a sweat. When she was 19 she almost died in childbirth when her heart started fluttering.

An ultrasound test revealed an atrial septal defect, or hole in the heart, between the two main chambers, or atria. Cathy Ross, a senior cardiac nurse with the British Heart Foundation, said that a hole in the heart just 9mm long was considered large and Ms Banks’s was more than four times that size. Mrs Ross said: “She is incredibly lucky. I’ve never heard of anyone having a hole in their heart that large.”

Ms Banks does not harbour any grudges against the doctors who misdiagnosed her condition. She said: “I don’t feel angry with the doctors for missing it. I would rather have been operated on now than 23 years ago when science wasn’t so advanced.”

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Staff flee rotting Australian public hospital

ROYAL North Shore Hospital was in such decay that the floor of its medical records room collapsed and specialists were so demoralised they were fleeing to the private sector, leaving the public health system on the brink of breaking down, a senior doctor has told an inquiry.

The hospital's professor of medicine, Stephen Hunyor, told a public inquiry yesterday his cardiology department went a year without air-conditioning - which, he said, ruined experiments because of high temperatures - and staff complained for four years about poorly functioning toilets. "We've had bricks falling from the main building, we've had a floor collapse high up in the building where the medical records are being stored," he said.

Professor Hunyor, a cardiologist staff specialist who has been at Royal North Shore for 33 years, was giving evidence at the special commission of inquiry into acute care services in NSW public hospitals. He said doctors had "review fatigue" and the inquiry was the last chance to fix problems in the system before it was too late. "Your commission of inquiry is the last stop before some really bad outcomes," he said.

There was an atmosphere of "secrecy" over the $702 million Royal North Shore redevelopment, which would not have enough specialists anyway if the exodus was not stemmed before it was built in the next five years. "Morale is a crucial issue here at the moment and I think it's true to say many of the good specialists are fleeing to the private system," he said. "It's so easy now for these dispirited, demoralised specialists just to say it's all too hard and move to the private sector where they can earn substantially more money."

Executives at Royal North Shore did not last for more than 18 months, causing "administrative Alzheimer's", he said, describing the lack of corporate knowledge as "very dangerous".

Clinicians were constantly subjected to "mindless cost-cutting", while money was wasted on consultancies and plugging staff shortages for which bureaucrats remained unaccountable. "We see $30 million spent on locum people being flown, sometimes from New Zealand, to work in the emergency department for a weekend and being paid large sums," Professor Hunyor said. "We are very concerned that the doctors have no power, no influence in substantive decisions on the operation of their hospital and the medical system." He said specialists were expected to develop clinical services plans without knowing what facilities they would have at the new hospital.

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15 March, 2008

Huge damage to children at NHS hospital

The surgeons just didn't care that their patients were dying or damaged -- and none of the many "administrators" stopped them

Families of patients with severe brain damage after heart surgery as children are preparing to sue the NHS after a profoundly disabled woman won her case for compensation in the wake of the Bristol heart babies scandal. The NHS has abandoned attempts to appeal against a landmark ruling in favour of Marianna Telles, who suffered brain damage after undergoing surgery as a newborn baby more than twenty years ago. Ms Telles, 22, is now set to receive at least a seven-figure sum in compensation. Her family solicitor said that the ruling was highly significant as there were at least seven more cases “waiting in the wings” of adults who were brain-damaged as children.

The cases all relate to the Bristol Royal Infirmary and associated hospitals from 1984 to 1995, where surgeons carried out complex heart procedures despite warnings that death and brain-damage rates of children who underwent such surgery were twice the national average.

The scandal resulted in the largest public inquiry in the history of the NHS, which in 2001 identified at least 300 families whose children died or had suffered severe injury as a result of the incompetence of surgeons at Bristol. Up to 80 families who lost a child after surgery at Bristol have previously settled legal cases out of court, in return for about 20,000 pounds compensation plus costs. Ms Telles, who suffers from severe mobility and psychiatric problems which require 24-hour care, is the first of those who survived operations to go to trial.

In 1998 the General Medical Council found two surgeons, James Wisheart and Janardan Dhasmana, guilty of serious professional misconduct. Mr Wisheart was struck off and Mr Dhasmana was banned from operating on children for four years. Both surgeons had operated on Ms Telles. Her family took the South West Strategic Health Authority to the High Court last month, claiming that doctors at the hospital were clinically negligent when treating her. After a seven-day trial, the judge ruled in Ms Telles’s favour and refused permission for the NHS Litigation Agency (NHSLA), acting for the health authority, to appeal. For two weeks the NHSLA considered applying directly to the Court of Appeal but on Wednesday confirmed it has abandoned this plan. A hearing next month will now determine an initial payment to the family to cover immediate costs of Ms Telles’s care, and set a timetable for reaching a decision on final damages.

Laurence Vick, who acted for the family and first served papers for the case in 2005, said: “We have a young woman with severe brain damage whose mother has supported her with only limited help from the NHS and local authority. We’ve attempted to negotiate for a very long time, but without success. You can only imagine what this family has gone through. “At last Marianna and her family know they will get the financial support she needs. I am confident we’ll be able to negotiate a settlement.”

Ms Telles’s mother, Anna Redman, previously gave evidence to the Bristol inquiry, which was highly critical of the clinical standards of the hospital’s paediatric heart surgery. Many more patients continue to live with severe brain injuries more than a decade after the botched surgery, Mr Vick, of the law firm Michelmores, said. He added: “We’ve settled several cases out of court and there are still seven more waiting in the wings.”

A leaked memo suggested in September that the NHS as a whole was facing 4.5 billion pounds of compensation claims over alleged blunders by midwives and doctors that have left babies suffering severe brain damage. The Corporate Manslaughter Act, due to come into force next month, is also likely to enable more compensation cases by making it easier to prosecute companies or public bodies. In a statement, the NHSLA said that it was committed to dealing with claims relating to the Bristol scandal on their individual merits.

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WHOm Are They Kidding?

Armed with supposedly objective reports showing the American medical system is among the worst in the developed world, candidates left and right -- but mostly left -- are plugging ambitious plans to "fix" healthcare. Invariably, their plans call for more government intervention. Senators Clinton and Obama both want to regulate premiums and benefits while increasing healthcare subsidies, and Clinton would go even further by requiring everyone to buy a federally-defined health insurance policy.

But is lack of government really the problem -- and if so, how would we know? Healthcare interventionists frequently cite the World Health Organization's World Health Report 2000, which studied the performance of 191 countries' healthcare systems -- and awarded the U.S. a dismal rank of number 37. While the WHO rankings are touted as an objective measure of the relative performance of healthcare systems, in reality they depend on a number of ideological or logically incoherent assumptions.

The WHO rankings are based on a constructed index of five factors. One factor is "health level," defined as a country's disability-adjusted life expectancy. Another is "health responsiveness," which includes desirable characteristics of healthcare like speed of service, protection of privacy, and quality of amenities. Both of these are sensible indicators of health quality, but they constitute only 37.5 percent of each country's score. The other 62.5 percent encompasses factors only tenuously connected to the quality of care -- and that can actually punish a country's ranking for superior performance.

Take "Financial Fairness" (FF), worth 25 percent of the total. This factor measures inequality in how much households spend on healthcare as a percentage of their income. The greater the inequality, the worse the country's performance. Notice that FF necessarily improves when the government shoulders more of the health spending burden, rather than relying on the private sector. To use the existing WHO rankings to justify more government involvement in healthcare is therefore to engage in circular reasoning, because the rankings are designed to favor greater government involvement. (Clinton's plan would attempt to improve the American FF score by capping insurance premiums.)

The ostensible reason to include FF in the health index is to account for people landing in dire financial straits because of their health needs. Yet the FF factor worsens for every household that deviates from the average percentage of income spent on healthcare, regardless of whether the deviation is on the high side or low side. That means the FF factor doesn't just penalize a country because some households are especially likely to become impoverished from health costs; it also penalizes a country because some households are especially unlikely to become impoverished from health costs.

The other two factors, "health distribution" and "responsiveness distribution," are no better. Together worth 37.5 percent of a country's score, these factors measure inequality in health level and responsiveness. Strictly speaking, neither measures healthcare performance, because inequality is distinct from quality of care. It's entirely possible to have a healthcare system characterized by both extensive inequality and good care for everyone.

Suppose, for instance, that Country A has health responsiveness that is "excellent" for most citizens but merely "good" for some disadvantaged groups, while Country B has responsiveness that is uniformly "poor" for everyone. Country B would score higher than Country A in responsiveness distribution, despite Country A having better responsiveness for even its worst-off citizens.

What if the quality of healthcare improves for half of the population, while remaining the same for the other half? This should be regarded as an unambiguous improvement: some people get better off, and no one gets worse off. But in the WHO index, the effect is ambiguous because the improvement could increase inequality.

The WHO rankings have also been adjusted to reflect efficiency: how well a country is doing relative to how much it spends. In the media, however, this distinction is often lost. Costa Rica ranks higher than the United States (number 36 versus number 37), but that does not mean Costa Ricans get better healthcare than Americans. Americans most likely get better healthcare -- just not as much better as could be expected given how much we spend. If the question is health outcomes alone, without reference to spending, we should look at the unadjusted ranking, where the U.S. is number 15 and Costa Rica is number 45. (And even the number 15 rank is problematic, for all the reasons discussed above.)

The WHO rankings implicitly take all differences in health outcomes unexplained by spending or literacy and attribute them entirely to health system performance. Nothing else, from tobacco use to nutrition to sheer luck, is taken into account. These variables were excluded largely because of underlying paternalist assumptions about the proper role of the health system.

If the culture has a predilection for unhealthy foods, there may be little healthcare providers can do about it. Conversely, if the culture has a pre-existing preference for healthy foods, the healthcare system hardly deserves the credit. Some people are happy to give up a few potential months or even years of life in exchange for the pleasures of smoking, eating, having sex, playing sports, and so on. The WHO approach, rather than taking people's preferences as given, deems some preferences better than others, and then praises or blames the health system for them.

Those who cite the WHO ranking to justify greater government involvement in the health system -- like the plans pitched by the leading Democratic presidential candidates -- are assuming what they're trying to prove. The WHO healthcare ranking system does not escape political bias. It advances ideological assumptions that most Americans might find questionable under the guise of objectivity.

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14 March, 2008

Tory peer vindicated after Norovirus shuts three wards at 'grubby' NHS hospital he attacked



Lord Mancroft: The peer, who says he is lucky to have left the Royal United hospital alive, feels he might have 'lifted the lid on something'. When a Tory peer launched a stinging attack on the "grubby and drunken" nurses he encountered in the NHS, the hospital employing them defended them to the hilt. It demanded evidence of Lord Mancroft's damning allegations and still says it has found not a shred of truth in his complaints. But yesterday it had to defend its standards once more as it dealt with its third disease outbreak in five months.

Another bout of the norovirus - the winter vomiting bug - has forced three wards to close at the Royal United Hospital in Bath. Last November, the bug forced two wards to close, and a second bout last month shut nine wards. The highly infectious virus, which causes diarrhoea and vomiting, spreads through closed communities rapidly if patients and staff fail to wash their hands.

Last month, Lord Mancroft, the 50-year-old vice-chairman of the Countryside Alliance, spoke of how appalled he had been by the "filthy" state of the wards at the Royal United, during his treatment there for gastroenteritis. He said he was dismayed at the heartless attitude of "lazy and promiscuous" staff and that apart from "one or two wonderful ones" the nurses were "mostly grubby with dirty fingernails and hair".

In a Lords debate on patient care, he said: "It is a miracle that I am still alive. The wards are filthy. "The wards, the tables, the beds and the bathrooms were not cleaned." The peer, who hunts with Prince Charles, said a splash of blood in the bathroom and a piece of dirty cotton wool under a neighbouring bed were there for the entire seven days he was in hospital. The Royal United said staff were left "extremely distressed and upset" by the peer's account, in which he said he heard a nurse say: "I really shouldn't be here because I had so much to drink last night and I feel like I'm going to be sick."

The Royal United is one of at least 40 hospital trusts to be hit by the norovirus this year. Relatives ringing the hospital or visiting its website have been told that visiting is banned unless strictly necessary, and reminded to wash their hands at all times. Last night, a spokesman for the hospital, Helen Robinson-Gordon, said: "Norovirus is extremely prevalent in the community at the moment and other hospitals have been affected by it. "Of course it is linked to hygiene and cleanliness in that we should all have clean hands at all times but it is coming into the hospital from the community. "Because it is so highly infectious, once it is here it passes from person to person very easily. "We recently had two spot checks at the hospital for cleanliness and passed both with flying colours. "We still have no factual basis for Lord Mancroft's evidence whatsoever. We have asked him for a meeting which he has agreed to but we are still awaiting a date from him."

Lord Mancroft said last night: "I am not the person to comment on this because I am the amateur - it is up to them to sort themselves out. "But I can say that subsequent to speaking out I have had the biggest postbag I have ever had since I have been in the House of Lords. "Quite a lot of those letters are relating similar stories in the same hospital. Some relate to other hospitals. "I suspect I have inadvertently uncovered or lifted the lid on something."

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Would-Be Rulers without Clothes

In her CNN debate with Sen. Barack Obama in Texas, Sen. Hillary Clinton scoffed at the idea that buying medical insurance should be voluntary. "It would be as though Social Security were voluntary [or] Medicare, one of the great accomplishments of President Johnson, was voluntary.... We would not have a social compact with Social Security and Medicare if everyone did not have to participate. I want a universal health-care plan," she said.

This is what passes for deep political thought these days. Look closely at what Clinton is saying. She wants something ("universal health care"); therefore people should be forced to give it to her. (No thought is given to how the free market could accomplish the goal peacefully.) If you and I claimed something like that in private life, we'd be branded as boors. And if we took steps to accomplish it, we'd be arrested for theft or extortion.

Why are presidents and presidential candidates exempt from the normal and reasonable rules of morality? All of us are taught as children not to hit others, not to take their belongings without permission, and not to break our promises. If we need the cooperation of other people, we are expected to rely on persuasion. Force is forbidden. These are sound principles that underpin any decent society, and we are expected to observe them when we become adults. Indeed, the core criminal and civil law embody these principles in their prohibitions against murder, assault, burglary, theft, and breach of contract.

But when a politician advocates forcing the people to go along with her grand plans, the normal rules are suspended and different rules take their place. In the political world, people who have never bothered anyone may be coerced into participating in a politician's scheme for no reason other than that the scheme allegedly won't work if there isn't universal participation. Well, excuse me, but that's not a good enough reason.

It's a measure of how far removed politics is from normal morality that even to raise this issue seems slightly peculiar. Comparing a politician to a common criminal just isn't done in polite society. But think about it. Imagine that Clinton was your neighbor and that she came up with an plan for a neighborhood association that would provide a variety of services, including medical coverage and pensions. "My plan won't work unless everyone participates," she says. She proceeds to threaten anyone who decides not to go along. What would you think of this woman? If she demanded your money at gunpoint, you would call the cops.

So why the moral exemption for presidential candidates? Force is force. Does it matter who wields it? The fact is that someone who refuses to participate in government programs - Social Security, Medicare, universal health care - has not disturbed the peace. He has simply minded his own business. Thus the government should leave him alone. The "live and let live" principle used to be valued by the American people. But it's been largely forgotten.

No one wants to face this issue. Where do government officials get the authority to compel peaceful people to finance and participate in their social programs? Some might reply that the authority comes from the people. But how can that be? We've already seen that you and I have no authority to initiate force against others. If we do it anyway, we are criminals. So how can all of us together have such authority? We can't.

Americans have let their freedom slip away because they have failed to exercise simple logic and common sense. They have overlooked the fact that politicians can have no power not possessed by private individuals. They have swallowed the propaganda that all people are created equal, but that some are more equal than others. Americans have become like the subjects who were afraid to tell the emperor he was naked for fear of being thought stupid. And the politicians intent on exploiting us like this arrangement just fine. Where is the courageous youth who shouts that the emperor - or empress - has no clothes?

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13 March, 2008

Pregnant woman injected with cleaning fluid by NHS

A BRITISH hospital that gave a woman anaesthetic contaminated with cleaning fluid as she gave birth is likely to face a multimillion-pound legal action. Angelique Sutcliffe, 47, was left paralysed after being injected in the spine with the fluid before her daughter Abigail's birth in January 2001. The anaesthetic was contaminated with chlorhexidine, which is used to clean patients before surgery. Following a caesarian, Mrs Sutcliffe went into a convulsion. She also suffered neurological damage. The incident caused a rare condition called chronic adhesive arachnoiditis - debilitating pain in the back, neck and other limbs.

Judges at London's High Court overnight rejected an appeal by Aintree Hospital in Liverpool, against a ruling it was negligent, the British Press Association reported.

Mrs Sutcliffe, who cannot use her legs, has limited use of her hands and requires around-the-clock care, welcomed the legal decision. She is now preparing to sue. The hospital's decision to appeal an April 2007 ruling increased the pressure on her family, she said. "You think you've won because the court finds in your favour and then you find that it may be taken away from you because the NHS (National Health Service) decides to appeal," she said. "I hope that today's finding will ensure that procedures in operating theatres are tightened up. "I would not want this to happen to anyone else."

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Many Brits 'driven' to treatment abroad

Avoiding infections such as MRSA and NHS waiting lists are driving people abroad for medical treatment, according to a poll. A survey of 648 patients who had treatments overseas found that 83% also wanted to save money on the cost of private procedures in the UK. Most (97%) had a good experience and would be willing to go abroad for treatment again. Saving cash was the main motivating factor, but 63% of those having elective procedures wanted to avoid NHS waiting lists while 56% were worried about infections like MRSA.

The poll was carried out for the website www.treatmentabroad.com, which estimated that 100,000 people travelled abroad for surgery and dental treatment in 2007. Around 6% of those questioned for the survey had spent more than œ10,000 on treatment. Nine out of 10 (92%) of cosmetic surgery patients were women, while 69% of those having elective surgery and scans were men. More than half of people choosing to have treatment abroad were aged between 40 and 59.

The top destinations for treatment include Hungary, mostly for dental treatment, Cyprus for cosmetic surgery, and India for surgery and scans. Spain, Belgium and the Czech Republic were also among the most popular destinations, according to the poll.

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12 March, 2008

Health-Care Cons

The economist Joan Robinson (1903-1983) wrote, "The purpose of studying economics is not to acquire a set of readymade answers to economic questions, but to learn how to avoid being deceived by economists." A better reason to study economics is to avoid being deceived by politicians; they are the far greater threat to life, liberty, and the pursuit of happiness. When you consider that the typical political campaign is little more than a series of confidence games, understanding basic economics is a matter of survival. Without such an understanding one is an easy mark.

Case in point: How would one see through the flimflam served up as health-care policy without a working knowledge of economic principles? When politicians promise "universal and affordable" medical care and insurance, how else are we to know that those promises can't be kept. Indeed, attempting to keep them would gravely damage our medical care (even more), our prosperity, our liberty.

What we call medical care/insurance is a bundle of goods and services that have to be produced. They aren't found superabundant in nature. Production of those things entails real opportunity costs in terms of resources (labor, intellectual capital, machinery, and more, which could be used in alternative ways. The people engaged in this production are (so far) free to do other things if they choose. They can't be compelled to practice medicine, run hospitals, invent medicines, or offer insurance policies. This sobering thought should be kept in mind when analyzing politicians' plans for medical "reform." Any proposal that would drive medical service providers and resources into other lines of work could hardly be said to be in the general interest.

However, one group can be compelled to participate in a government plan: the American people in their dual capacities as taxpayers and consumers of medical services. This is the key to any political "solution." That's why Hillary Clinton insists against Barack Obama that any program must be mandatory. Given the premises both candidates share, Clinton has logic on her side. Without compulsion, any government program must fail even on its own terms. You might think that's a good argument against government programs, but politicians and most other people don't believe physical force perpetrated by government is objectionable. Go figure.

Candidates who promise universal and affordable medical care don't really believe they can lower the true costs of the relevant goods and services. Instead, their plans contain methods, overt and covert, to shift some people's expenses to others. The overall price tag won't shrink -- indeed, it can be expected to grow -- but the money price to selected individuals would diminish. (Nonmonetary costs, such as waiting times, would increase.)

The problem for those who promise universal and affordable health care is that medically we are not all created equal. Because of genetics and lifestyle, some people are more likely to get sick than others, and some people are already sick. This upsets the politicians' plans, and they must do something about it. Clinton declares, "I want to stop the health-insurance companies from discriminating against people because they're sick."

One doesn't know whether to laugh or cry at a statement like that. Is it ignorance, stupidity, or demagoguery? Real insurance lets people hedge against financial ruin by pooling their risk of misfortune with others. For reasons that shouldn't need explaining, people who present a low risk for whatever is being insured against would reasonably be charged less for coverage than people who present a high risk. For one thing, low-risk customers would be unwilling to pay premiums that overstated their perceived risk. I recall reading that the first fire-insurance company, founded by Benjamin Franklin, set premiums according to how fire-resistant a building was. Was that a reasonable or outrageous thing to do?

The depth of the lack of understanding about insurance is on stark display whenever someone demands that the terms of coverage for a sick person be the same as those for a healthy person. Risk grows out of uncertainty. But if someone is already sick, there is no uncertainty about his need for medical care. "Insurance" in this case would not be real insurance but rather a subsidy provided by others or prepayment for future expenses.

To be actuarially sound, insurance must discriminate on the basis of risk. If the government bars insurers from such price-discrimination, they really wouldn't be in the insurance business at all. It would be more accurate to call their activity a forced subsidy. We should at least call a thing what it is.

Where would the Clinton principle of nondiscrimination lead if the government seriously enforced it? If an "insurer" is allowed to charge only one price regardless of risk, it would have to set the price high in order to be able to cover the riskiest customers. But that would not honor the politicians' promise of affordable coverage. Moreover, young, healthy people would opt out, preferring to spend their money otherwise or to save it in order to self-insure. So the government could not let this stand. To "fix" things, it would compel everyone to participate and force the taxpayers to subsidize low-income people.

Even with subsidies the politicians wouldn't let insurers charge market prices for long because this would anger voters and break the budget. So inevitably, the Clinton principle must lead to price controls.

We know what price ceilings bring: shortages. Why would a company that cannot charge enough to cover its costs and earn a competitive profit continue in business? Thus the principle of nondiscrimination combined with price controls would inevitably dry up the supply of private "insurance." At that point, the politicians would declare that the "free market" failed and that government must step in to be the sole health insurer. Then government could have full control over who gets what kind of medical attention. It would be in the triage business, a terrifying prospect for sure. It would also dictate prices to doctors, hospitals, and drug companies, speeding up the exodus from that profession and those industries. As supply withered and demand inflated (because of the illusion of low prices), government would impose more and more draconian controls.

There's a lesson here. When the government seeks to enforce a counterfeit right -- such as the "right" to medical care -- no expansion of freedom results. Instead, government power expands -- to everyone's detriment.

One way for politicians really to keep their promise of lower medical costs would be to uncover all the ways the government artificially raises costs today. It does this in a variety of ways: restricting supply through licensing, boosting demand by lowering the apparent price of services, promoting third-party payment for even expected routine services, raising drug-research expenses, imposing coverage mandates on insurers, forbidding interstate competition in insurance, and on and on.

But politicians don't talk about those things. They presumably wouldn't get credit merely for repealing destructive interventions and letting the competitive free market provide universal affordable medical care -- as it has provided so many other things universally and affordably.

In fact, the politicians love those interventions. So they promise to lower medical costs through direct controls. Even a modest familiarity with how markets work reveals that this would make things worse. Is it too late for Americans to see through the con game?

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11 March, 2008

Huge payouts for NHS cancer negligence

Bureaucracies don't disgorge easily so this reveals chronic negligence on a large scale

The NHS has paid out almost 100 pounds million in negligence claims due to medical errors in cancer treatment (David Rose writes).

The Government has admitted that over the past decade there were 1,179 clinical negligence claims relating to cancer treatment alone, leading to £47 million in compensation, with 50 million still outstanding.

Doctors failed to detect at least 935 cases of cancer in the past two years, while thousands more errors were made in chemotherapy and radiotherapy treatment, figures obtained by the Conservatives show.

Andrew Lansley, the Shadow Health Secretary said that the statistics showed the Government’s “failure to provide world-class cancer services”.

Source




Australia: Terrified rape victim refused help by disgusting "Health" bureaucrats

If these moral imbeciles are allowed to stay in their jobs it will be a grave reflection on the Leftist State government

Her trembling fingers pressed the buttons to dial 000. She screamed - the phone was dead. Outside the unlocked medical centre on the Torres Strait island of Mabuiag she could hear voices, laughter and wolf-whistles from her alleged attacker and his friends. In the dark of February 5, the 27-year-old ran to the telephone connection - it had been deliberately turned off. She reconnected it, dialled the emergency number and it diverted to Cairns police, a thousand kilometres away. She revealed how she had just been raped and that the alleged perpetrator was still outside her building with several of his drunken mates. He'd also stolen a bottle of vodka and she feared he would be back.

The police officer said he would immediately ring the community police officer on the island, but reported back to the victim that the local representative of the law had responded it was raining and he was not prepared to walk around to the crime scene in the rain, even though he was told the alleged perpetrator was still on the premises. Desperate and frightened, the young woman crouched at the top of the darkened steps, gripping a crayfish spear, determined, if necessary, to stab the intruder to death when he returned to continue his cowardly assault.

The community police officer, only identified as Patterson, later rang a neighbour of the surgery and he came over to be with the nurse. Patterson turned up at 6.30am, after the rain stopped. At 7.30am the victim rang her director of nursing on Thursday Island. The woman director told her the rape and burglary was unfortunate and that she should return to work at 9am. The nurse said she wanted to be flown out and was told she could catch the only commercial flight at 11am. She replied that could not be done because police were coming (two hours by boat) from Thursday Island to inspect the crime scene and take her statement. They arrived at 12.30pm.

The nurse was told the next day when she repeated her request to be flown home to Sydney that she would be brought only to Thursday Island, no accommodation provided, no medical attention organised and that any days away would be deducted from her pay or leave. It was made clear that Queensland Health did not consider the rape worthy of reporting and they were not prepared to help her. The nurse mistakenly thought that Queensland Health, with helicopters, doctors, nurses, crisis counsellors, the Royal Flying Doctor Service on call and a Medivac helicopter available at Thursday Island, 30 minutes flight away, would activate an immediate response. In fact, they cut off her pay from that day, and did not pay out her contract until last Friday after details were published in The Australian.

Queensland Health northern area general manager Ms Roxanne Ramsey explained that the nurse's treatment was the result of "a local breakdown in communications in organising for her to be taken from the island". [Crap, crap, crap]

What actually happened was that her boyfriend, who worked on Horn Island, had to fly in by helicopter on February 5, take her by boat the 40 minutes across Torres Strait to Badu Island where she received her first medical help and examination. He then had to pay $800 to charter a plane to get her to Thursday Island by which time the Queensland Nurses Union had arranged for the department to fly her to Sydney.

Just weeks before the rape, a drunk on a nearby island punched a window and broke his wrist, and the department quite happily organised a Medivac helicopter at $13,000 an hour, to have him flown to Cairns.

Source




Australia: Dangerous ambulance shortage in NSW too

AMBULANCE officers fear lives are being put at risk because there are not enough ambulances or crew members to respond to emergency calls. The NSW population has increased by almost half a million people since 2000 but the number of ambulances available to respond to triple 0 calls in that time has been cut by six, unions say. Response times are falling, with 10 per cent of Sydney ambulances not reaching patients in the 16-minute target.

"The public would expect that if you are having a heart attack the ambulance would be there in 10 minutes. Statistics show that reaching a patient in under five minutes doubles their chances of survival but get there after 10 minutes and the patient will not survive," Health and Safety Union Hunter president Peter Rumball said. "If we cannot get ambulances to people then their lives are being put at risk," he said.

The union says NSW needs another 200 ambulances and 2000 crew members to meet the increased demand. Union figures - disputed by the NSW Ambulance Service - show that in 2000 NSW had 852 general purpose ambulances; eight years later that figure had dropped to 844 despite the population increasing by more than 400,000. In the past two years the demand for emergency "life threatening" responses by ambulances increased by 19.4 per cent.

The Ambulance Service said the number of ambulances had jumped from 834 in 2002/03 to 876 in 2006/07, with more in action thanks to a leasing deal.

The union said ambulance staff on the Central Coast were so stretched that ambulances were often dispatched from the Hunter or Sydney to deal with emergencies. Last week an ambulance from Wahroonga was sent to an emergency on the Central Coast. On Friday the union will take the Ambulance Service to the Industrial Relations Commission to help win overworked staff the right for a meal break. Ambulance stations at Cessnock and Nelson Bay still have single officer crews, which are also the subject of a forthcoming action at the commission.

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10 March, 2008

Harvard professor, economist has health care solutions

People will suffer needlessly and die before their time if lawmakers don't fix the health care system. That's not clownish propaganda from lefty filmmaker Michael Moore, producer and director of the movie "Sicko," who celebrates, among other things, Fidel Castro's health care system. It's the cold, sober warning of Harvard Business School professor Regina Herzlinger in her book, "Who Killed Health Care?"

Herzlinger's solution to the health care problem isn't to turn your future health care decisions over to a mandarin class of government-appointed control freaks. For Herzlinger, you are the answer. You need direct control over your health care dollars and the key decisions that affect this very personal dimension of your life. This idea is the polar opposite of the complicated schemes of those on the presidential campaign trail.

Herzlinger's book could not be more timely. This slim volume is targeted at ordinary Americans and is refreshingly free of academic jargon. Herzlinger explains in plain English what is wrong in American health care and how exactly to fix it. The key fix is to shift health care decision making from today's array of institutions to individuals and families. The result would be a new system driven by the familiar forces that power every other part of the American economy - personal choice and direct control over the expenditure of health care dollars.

Few Americans today exercise any significant control over their health care dollars; it is done for them, and to them, by third parties - employers, managed care executives and government officials. They decide what you buy, how much you pay and what benefits and level of quality you get. Only $3.50 out of every $100 spent on health insurance premiums is under the direct control of individuals.

Because there is little personal control in today's system, the system is not accountable to individual patients. To illustrate this point, Herzlinger posits a composite victim, "Jack Morgan," a small-business man who dies from kidney failure. His condition could have been improved and his life saved if not for the systemic flaws of a dysfunctional, anti-competitive set of institutional arrangements, desperately preserved by the major players and their academic flacks. Like most of us, Jack Morgan, a mere patient, is not a player.

Herzlinger cites numerous examples of patients done wrong by the current system's perverse incentives, and this reviewer could add many more. Many patients, for example, would benefit from easy access to "specialty hospitals" for highly specialized treatment of their conditions, but hospital lobbyists enlist allies in Congress, including champions of national health insurance, to block the growth of these new businesses, because they threaten existing providers' bottom lines.

The major players employ armies of highly paid lobbyists, lawyers and consultants to harness the regulatory power of government and manipulate the health care markets to thwart their competition, micromanage their competitive position at the expense of patients and taxpayers and fatten their bottom lines.

Thus, Herzlinger opens up a vigorous prosecution of the multiple culprits of the health care status quo, including government (Congress particularly), insurance companies, the hospital industry, employers and, most of all, the academic community and its allies in the big foundations.

Already, government spending accounts for approximately 50 cents out of every health care dollar, and the government's share of spending is rapidly growing along with its control over the delivery of care. So how can we get to a new world based on personal choice and robust competition? Many of Herzlinger's policy recommendations are controversial - for example, imposing a legal requirement that individuals buy health insurance to protect them against bankruptcy and taxpayers against the rising costs of uncompensated care.

But some proposals are generating consensus. The most important of those is giving individuals federal and state tax relief to buy health insurance regardless of where they get it. It would then be fully portable between jobs, and individuals would own and control their policies, forcing insurers to compete for their business, a novel idea.

The result would be a world where insurers depend on your judgment of their performance and medical professionals compete to provide integrated care of the highest quality in a transparent, information-driven market. Herzlinger's remedies would bring about a radically different system from what we have today, and it would be much, much healthier.

Source




Australia: A new government hospital with REDUCED facilities!

One of Australia's leading doctors has condemned the decision to demolish the hydrotherapy pool at the troubled Royal North Shore hospital. The pool, vital to spinal injury, stroke and orthopedic patients, is to close later this year and hospital administrators have admitted it will not be rebuilt during the $732 million redevelopment.

Leading spinal expert Professor John Yeo said the decision was "a grave mistake and a grave disservice to the community". "We have to make sure it is the same facility that RNS offers now and if it can't then we're going backwards. Why should we do that in this day and age?" Professor Yeo said the hospital administrators had "no knowledge of what goes on in hydro - they sit behind a desk and have probably never walked into the area and seen what's involved".

Physiotherapist Lisa Harvey said it was outrageous that the biggest health capital works project in NSW history did not include a vital piece of infrastructure. Outpatients, who make up 50 per cent of the pool's users, will be told they can travel to nearby Greenwich Hospital for hydrotherapy services. Inpatients, who make up 2 per cent of users but are the most severely injured or disabled, are yet to be offered any alternative treatment.

Australian Medical Association NSW branch president Andrew Keegan said the RNSH redevelopment threatened to end up like bungled $98 million Bathurst Base Hospital redevelopment.

Kevin Hitchcock credits two months of rehabilitation sessions in the pool for "getting me out of a wheelchair and walking again". After breaking his neck in a shallow part of the Hawkesbury River 16 years ago, the former Channel Ten news director defied predictions that he would be a quadriplegic and slowly learned to walk as his daughter Kirra, who was five weeks old at the time of the accident, was taking her first steps. "Hydrotherapy is so important for recovery from spinal injury. It gets you up and moving again," Mr Hitchcock said.

A hospital spokesperson said: "A hydrotherapy pool has not been included in the plans for the RNSH redevelopment, but suitable clinical options for inpatients will be explored in the next phase of consultation with clinicians." [Bullsh*t, Bullsh*t, Bullsh*t]

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9 March, 2008

Dead rat OK in British hospital

A PATIENT was told there was no reason why he couldn't have surgery in a British hospital, despite the smell caused by a dead rodent trapped in the building's ceiling. Andrew Cowper was due to have an operation at the Queen Elizabeth II Hospital in Hertfordshire when staff "were made aware of a dead rodent in the single storey unit's roof space", the hospital said.

The hospital said its experts concluded that the dead animal was outside the operating theatre and posed no risk. But "despite being told that the trust's infection control experts had stated that Mr Cowper was not being exposed to an infection risk, he decided not to proceed with the operation," it said.

Mr Cowper, 19, told the Sun newspaper he had waited 11 months for the operation, and the doctor told him he could go ahead despite the stench. "He said the smell didn't represent a health risk, but I was appalled," Mr Cowper said. "I asked him: 'If you were me, would you have the operation?' He looked at me and said 'no', so I decided there and then I wasn't going to go ahead."

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Young dentists desert the NHS

The boom in teeth-whitening and capping has led to a further drain on young dentists who appear to be switching from the NHS to highly lucrative private cosmetic treatment. Gordon Brown is among those who are said to have their smiles improved by professional teeth-whitening but the growth in the business could be exacerbating the lack of availability of NHS dentists. Figures produced from the NHS Information Centre showed that dentists under 35 years old in 2000-01 earned 65 per cent of their income from the NHS but, by 2005-6, that had nearly halved to 36 per cent.

That compares to dentists in the older age groups who have seen a much smaller change. Dentists aged 55 and older received 58 per cent of their income from the NHS in 2000-1 but by 2005-6 the share from the NHS had declined to 47 per cent. A note of caution was added by the dental profession who said the study was a small sample, but it reinforces fears that a new contract for dentists has failed to reverse the exodus of dentists from NHS care.

Ann Keen, the Health minister responsible for dentistry, will be questioned this morning about the figures at a hearing of the Commons select committee on health, which is carrying out an investigation into the shortage of NHS dentists.

Dr Howard Stoate, a GP and the Labour chairman of the all-party Commons primary care committee, said: "If it is true [that] a large number are switching to private care, it would be worrying. The primary care trusts take the view that there are enough dentists coming forward because it does seem that they are able to offer a dental service that does seem to be better than before."

Young dentists who are benefiting from the trend to more cosmetic treatment include Ben Atkins, 32, who has built up his own nine-dentist Rocky Lane Dental Practice. The practice earns 80 per cent of its income from NHS patients but Mr Atkins says "patients are exercising more and more choice". He said patients were prepared to pay for the extra services and time they can get through private consultations which meant they were opting out of the NHS. "Lots of people want cosmetic dentistry and that is their right," he said. "Many patients will say they do not want the silver fillings and are prepared to pay for white fillings."

But Mr Atkins denied younger dentists are wilfully turning their backs on the NHS. He believes younger dentists still want to do NHS work, but are often faced by a lack of opportunities.

Government figures last month showed that more than 500,000 fewer patients were seen in the past two years, compared to the 24 months prior to the introduction of a new contract in 2006. The new statistics were published as evidence emerged that complaints about NHS dental treatment are on the rise. A survey of primary care trusts for the Patients Association found widespread problems following the introduction of a new dental contract in 2006.

It sent questionnaires to the chairmen and dental commissioners of 150 PCTs in England, and 112 replied. The report - The New Dental Contract: Full of Holes and Causing Pain? - found problems with funding, prevention work and patient experiences. It said: "PCTs complain there is a widespread lack of funds for orthodontics and other specialist treatments and cite this funding gap as the reason for not implementing best practice. There is increasing concern for the preventive role of dentistry in detection of oral health disease."

The report found that complaints had risen, with more than half of PCTs admitting an increase in the number of complaints. Of these, 60 per cent were about charges, 37.6 per cent about access and 28.2 per cent directly about orthodontics.

Peter Ward, chief executive of the BDA, said: "The new dental contract limits the amount of NHS dentistry that primary care trusts can commission. The result is that some dentists who want to provide NHS care are unable to do so and that millions of people who wish to access NHS care cannot."

GPs are also expected today to reluctantly support changes to their new contract which will pay their practices an extra 1.5 per cent for longer opening hours at night and at weekends. The results of the ballot will be announced by the BMA, which last week said it was backing this option. One Labour MP said GPs were choosing "the least worst option".

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8 March, 2008

Nurse left to go blind by NHS

Don't you love government health insurance?



A retired nurse who worked for the NHS for decades has been denied treatment which could save her sight. Cora Slade was told the NHS would not fund the injections she needed for her condition, even though it might leave her blind within two years. The 74-year-old, who retired in 1997, 'did not meet the criteria' for the treatment, which was available to patients in other parts of the country. She said: 'They have turned their back on me.'

Mrs Slade, who cares for sick husband Don, was diagnosed with wet age-related macular degeneration in her left eye in May. She has the dry variety in the other. She spent 2,400 pounds on injections of Lucentis after being told she did not qualify for NHS treatment. The mother-of-three, from Sidmouth, Devon, said: 'They were savings for old age so we wouldn't be a burden on the state. 'If I go blind in both eyes, they will have to pay to look after my husband.'

Devon Primary Care Trust insisted its funding guidelines were generous. Board member Dr Nick D'Arcy said: 'We do all we can to ensure applications for funding are dealt with fairly, on clinical grounds.'

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Australia: Bureaucracy stymies healthcare again

An offer by 26 Queensland surgeons to fly to the Northern Territory to treat indigenous children with ear infections has been ignored because of bickering between two federal government departments, doctors claim. Harvey Coates, a clinical associate professor at the University of Western Australia and a senior ear, nose and throat surgeon at Perth's Princess Margaret Hospital, said ear disease was a silent epidemic among indigenous children in some communities, and it was tragic that offers from doctors who were willing to help were not being accepted. "It is frustrating that when a group of specialists is ready and willing to go and help, that they can't just go and get on with it," Professor Coates said.

He said a dispute between the federal Department of Family and Children's Services and the federal Health Department had meant that the offer, which was made shortly after the Howard government's intervention into the Northern Territory was launched last year, had yet to be acted on. It is believed the departmental dispute revolves around how the doctors would be organised and funded.

Since the federal intervention was launched, more than 800 doctors have volunteered to fly into remote communities in the Territory. But so far it is believed only a handful of specialists has been sent to provide follow-up care for the thousands of cases of ear disease, tooth decay and skin conditions discovered through the emergency intervention.

The Health Department said four ear, nose and throat surgery blitzes were planned for Alice Springs, starting on April 14 and providing surgery for up to 200 children. It acknowledged that the work would be carried out eight months after the intervention was launched. "Finding sufficient numbers of skilled specialists to supplement the NT specialist pool, along with accommodation, is challenging but within the next few weeks an initial cohort of health professionals will be deployed to local health services in the Alice Springs region," a spokeswoman for the Health Department said. "In relation to ear disease, there are important preparatory procedures that must be carried out before children can undergo surgery. Therefore children are currently receiving ear mopping treatment and audiological assessments in their home communities."

Professor Coates said it was especially frustrating not to be able to effectively address the huge problem of ear disease among indigenous children because the long-term effects were largely preventable. The prevalence of chronic discharging ears among indigenous children in the NT is at 94 per cent, yet the World Health Organisation says a rate of more than 4per cent is indicative of a massive public health problem. "Throughout their childhood, the average Aboriginal child will have middle ear disease and hearing loss for 36 months compared with an average of three months for the non-indigenous child," Professor Coates said.

The disease often leaves the children with hearing loss, which in turn impedes their ability to communicate and learn at school. It also leads to a "downward spiral of truancy, underperformance, early school leaving and a life-long impact on vocational outcomes", he said. The disease, which has few accompanying symptoms until the tympanic membrane ruptures and pus discharges from the ear, can be treated by a relatively simple surgical procedure.

Professor Coates, who is the chair of the indigenous sub-committee of the Australian Society of Otolaryngology Head and Neck Surgery, said he was keen to adapt a New Zealand ear disease program to suit Australia's needs. In New Zealand, a fleet of "ear buses" visit schools and towns to examine children and provide direct referrals to GPs and ear, nose and throat surgeons via video diagnosis. "Mobile operating theatres have been advocated where day surgery can be performed adjacent to a hospital," Professor Coates said. Such a bus could travel to remote indigenous communities and not only treat ear disease among young children but also perform other basic surgeries with lower risks of complication such as the removal of skin lesions.

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7 March, 2008

Average NHS waiting times have RISEN under Labour - despite billions "invested"

Hospital waiting times are longer than under the Conservatives, despite 90billion pounds being ploughed into the health service this year alone. The average wait for treatment in hospital is now 49 days, up from 41 days in 1997, the year Labour took power with a promise to "save the NHS". Ministers say they have delivered on their promise to reduce very long waits. By the end of the year no one should wait more than 18 weeks compared with the 18-month waits which were common under the Tories.

But doctors said patients with serious illnesses were among those still waiting too long, while those with comparatively minor problems were being fast-tracked to meet the Government's 18-week target. Many of the big falls in waiting have been seen in conditions such as cataracts and dermatitis and eczema. Yet the figures, obtained by the BBC from the NHS Information Centre which collates statistics on health and social care, show that for some cancers average waiting has increased slightly.

Jonathan Fielden, chairman of the British Medical Association's consultants' committee, said: "All that has happened is that the Government has put an end to the really long waits and the really short waits. "Doctors have been stopped from using their clinical judgment and pushing people through the system when they need to. "Of course, it is good that the really long waits have gone, but it is wrong to say that all patient care has improved because of shorter waits."

Katherine Murphy, of the Patients' Association, said: "These figures make us really question whether patients are getting a better deal. "What concerns me is that patients with serious conditions may be waiting longer than they used to. That is wrong."

Labour has massively increased NHS funding after Tony Blair pledged to bring health spending up to the European average. The NHS budget this year is 90billion, up from 34billion when Labour came to power in 1997. The Treasury projects the total to rise to 110billion in 2010-11. Some of the extra cash that has been ploughed into the service has gone on employing more doctors and nurses and building new hospitals, all of which should bring waiting times down.

But more than half of the money has gone on hugely increased pay for GPs and hospital consultants, more NHS managers, and higher drugs costs. Little progress on reducing waiting times was made in the first years after Labour took power. Even by 2000, there were still 125,000 people waiting more than nine months. But the extra expenditure has seen long waits almost abolished. Ministers say an unavoidable effect of the push to reduce long waits has been to slightly increase the average wait, but this figure has has been coming down since hitting a high of 52 days in 2004/05.

Health minister Ben Bradshaw said: "Our waiting time targets were specifically designed to eradicate unacceptably long waits. "Under the Tories it was not uncommon to wait 18 months or more for an operation. "Tackling long waits leads to a short-term increase in the average wait as the backlog is cleared." Latest figures show that only 72 per cent of patients are waiting less than the Government target of 18 weeks, and that waiting times are rising in a quarter of trusts.

But Mr Bradshaw says he remains confident the NHS will meet its target. Commenting on the rise in average waiting times, Liberal Democrat health spokesman Norman Lamb said: "These figures massively undermine Labour's claims to have made a substantial difference to NHS waiting times." Andrew Lansley, Tory health spokesman, said: "This shows how the bigger picture gets neglected in order to meet the Government's top-down targets. "In meeting one target, another patient misses out. It is simply unfair."

However John Appleby, of the health think tank the King's Fund, said the Government was right to target long waits. "The whole point of the targets was to change clinical priorities, because doctors seemed content to put up with long waits for their patients - while patients were not content," he said. "Despite what the BMA say, there is no evidence that vital priorities such as urgent cases have been delayed. "One would expect the average wait to go up but it is now on the way down and we can expect that to continue."

• The NHS is heading for a 1.8billion surplus in England, just months after being forced to cut jobs and close wards. Ministers say the size of the surplus is just 2 per cent of turnover and makes good business sense, but patients' groups said it was equivalent to 1p off income tax.

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Australia: Incompetent and untrained public hospital staff kill young mother

Very dangerous to have a medical emergency in a public hospital -- where responsibility stops nowhere and where supervision is minimal -- despite hordes of "managers"



REBECCA MURRAY was pregnant and healthy when she was admitted to Bathurst Hospital, but a day after delivering her third baby by caesarean the 29-year-old was dead. She had hemorrhaged, but nurses only realised when they saw her bloodied sheets.

Two weeks earlier, the 36-week-pregnant mother and her husband, Jim, had posed for this family photo with their son and daughter, Emelia and Lachlan, who were awaiting the arrival of a brother or sister. On June 24 last year, however, Mr Murray was in the waiting room of the old Bathurst Hospital, relieved that his newborn daughter, Grace, was healthy but unaware that down the corridor his young wife lay dying after a series of preventable errors.

A NSW Health incident report reveals that Mrs Murray had been transferred to a recovery ward after a routine caesarean when her blood pressure dropped dangerously low. Nurses should have called a medical emergency team but instead left her bleeding. The report admits that the nurses were so inexperienced they did not know how to recognise a postpartum hemorrhage.

It was more than 30 minutes before hospital specialists arrived, and Mrs Murray was taken back to theatre for surgery. She needed a blood transfusion after losing huge amounts of blood, but the incident report concedes that two vital blood-warming machines were faulty. Both "kept turning off for no identifiable reason". Worse still, theatre staff did not know how to use one machine and didn't know the password to operate it, the report said. Soon after, Mrs Murray suffered a cardiac arrest in theatre and doctors decided to transfer her to a metropolitan hospital. She was taken to the intensive care unit at Nepean Hospital. But, by 10.50am on June 25, she was dead.

The report concluded the "inadequate information exchange between treating clinicians contributed to a delay in recognition of the obstetric emergency" and "the rural base hospital medical records did not include an accurate record of blood loss, blood product and fluid replacement".

A new $98 million Bathurst Hospital opened in January, but surgeons suspended routine elective surgery last month, warning that serious design and construction flaws - such as an inadequate emergency alarm system and a pipe that leaked raw sewage into the maternity ward - were putting patients at risk.

Mrs Murray's death has been referred to the Health Care Complaints Commission and the coroner. But Mr Murray, left alone to raise three children, is demanding an apology from NSW Health and has not ruled out legal action. "This isn't a Third World country where a woman who is healthy goes in to have a baby and never walks out of those hospitals to kiss their kids goodnight again," Mr Murray told a news conference at State Parliament with the Opposition yesterday. "My kids have to grow up having no mother. I believe she should still be alive if things had been done properly."

The Opposition health spokeswoman, Jillian Skinner, said it was a tragic example of systemic problems. "How is it that massive blood loss goes unattended in a NSW hospital?" In Parliament, the Health Minister, Reba Meagher, said her sympathies were with Mr Murray. But she said the Opposition could not attack the entire health system because of one tragic case. "I am advised that Mrs Murray suffered acute complications following the birth of her child and was transferred to Nepean Hospital, when her condition continued to deteriorate after extensive treatment," Ms Meagher said. "While any maternal death is tragic, it is also extremely rare." Whenever Mr Murray takes his children to visit their grandparents, he says, they think they are going to visit their mother - "asleep" in the hospital.

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6 March, 2008

Hillary Taxes Breathing

It looks like Hillary is still relevant so I thought I might post this while that remains so. The article does however have implications for "mandate" plans generally

When considering tax fairness, we should ask: What exactly is a tax? Government mandates businesses to pay for their employee's unemployment insurance, workman's comp, and other benefits. These payments burden business just as surely as if the payments were made directly to the government-a tax by any other name. And if businesses fail to comply with government mandates, they can be dealt with in the same manner as any tax scofflaw. Might onerous mandates on business, especially manufacturing, be one of the reasons so many America enterprises have relocated abroad?

The Commonwealth of Massachusetts recently enacted a new "universal" health-care system, and it mandates that all residents buy health insurance if not already covered. This is known as the "individual mandate". But not only does Taxachusetts require its residents to buy health insurance for themselves, it taxes those residents so that it can provide health insurance to those who cannot afford it. A year ago California launched a plan to overhaul its health-care system, and it too featured the "individual mandate".

The states are supposed to be laboratories where we see what public programs work. But rather than wait to see if the new system in Massachusetts does indeed work and can survive legal challenges, Senator Clinton unveiled her new universal health-care plan, and it too features the "individual mandate".

Senator Clinton worries that without the "individual mandate" some folks would be getting a "free ride". But Congress created the "free ride" when it mandated that hospitals must treat the indigent uninsured, including illegal aliens. So the "free ride" will go on.

Advocates of the "individual mandate" say it is no different than states requiring car insurance. But that's a bad analogy: Driving is a privilege, not a right. Non-drivers, such as the blind, aren't required to buy car insurance. If drivers can't afford car insurance, the states certainly don't buy it for them. Also, some states allow drivers to opt out of car insurance if they put up a surety bond or some form of self-insurance. Among its highly touted plethora of choices, will the "new and improved" HillaryCare allow folks to self-insure? Will even the richest folks be required to buy health insurance?

By contrast, Senator Obama's health-care plan does NOT feature an "individual mandate" on adults. Obama stresses health-care affordability over universality. However, Obama's plan does mandate that all children be insured. Rather than the mystique of Camelot, one would hope those who voted for Obama on Super Tuesday-which so happened to be the majority of Democrats-were won over by his ideas.

In another ominous sign for Mrs. Clinton, the aforementioned California health-care overhaul died in committee January 28-it was the model for HillaryCare 2.0. A Wall Street Journal editorial 2 days later: "What the California collapse should discredit in particular is the individual mandate as a policy tool.in order to be enforceable, such a mandate inevitably becomes a government mandate, and a very expensive one at that."

Expensive? How can mandating yet another assured stream of revenue into the health-care industry do anything BUT drive up health-care inflation? What if the government mandated that everyday everyone buy a T-bone steak? Do you suppose that would affect the price of beef-on-the-hoof? I'm sure ranchers would love such a mandate.

Besides the questions of expense and feasibility, the larger issue here is one of principle: The "individual mandate" is nothing less than "socialism by proxy". In a recent Front Page interview, Regina Herzlinger, the "Godmother" of consumer-driven health-care according to Money magazine, advocated the "individual mandate". In her consumer-driven system: "Everybody would be required to buy health insurance." Despite this, Professor Herzlinger does have some very sound market-based ideas, and she favors Senator McCain's health-care plan over Clinton's and Obama's.

With the ratification of the 24th Amendment in 1964, poll taxes became unconstitutional in federal elections. And in Harper v. Virginia Board of Elections, the Supreme Court extended the ban on poll taxes to Virginia, citing the Equal Protection Clause of the 14th Amendment. Poll taxes became extinct in all state elections in 1966. But the "individual mandate" is worse than a poll tax: It's an "existence tax". It might as well be a tax on breathing.

Also, poll taxes were relatively trivial: $2 for male voters in Massachusetts. Do you think you'll be able to find health insurance for 2 bucks? If a $2 tax on the exercise of a basic right (voting) is unconstitutional, how much more unconstitutional is a tax on an even more basic right (life) that runs to the thousands of dollars?

The "individual mandate" is profoundly un-American; it is a stench in the nostrils of any who care about our First Principles. So one must wonder how the "individual mandate" could ever stand up to a legal challenge based on the Equal Protection Clause. Whether on business or the individual, a government mandate is a tax, pure and simple.

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Australia: The bloody-minded Queensland Health Dept. again

They don't even give a sh*t about their staff, let alone the patients. That's what happens when you have a bureaucracy that has been bloating up since 1944. Labor party Premier Ned Hanlon instituted in Queensland in 1944 one of the world's first "free" hospital systems

A nurse who was raped on remote Mabuiag Island in the Torres Strait was told by Queensland Health immediately after the attack that if she left the island she would have the days away deducted from her leave. The Australian has been told the nurse had to get a local islander to take her by dinghy on a 30-minute trip to Badu Island, where she was taken by plane to Thursday Island.

Since the attack on February 5, Queensland Health has refused to pay the nurse any wages or expenses, telling her that, because she was "injured" at work, it is an issue for WorkCover and the department was not responsible. This is despite Queensland Health Minister Stephen Robertson yesterday apologising for his department's not acting on a 16-month-old report that assessed the personal risk posed to nurses on the islands as "extreme".

The internal report, which Queensland Health denied existed before it was leaked to The Australian, warned that the residential quarters provided to the nurse on Mabuiag was one of the worst, having no locks on the doors or windows, and no security system or working lights.

A colleague of the nurse said yesterday she had complained about the lack of security before the rape but nothing was done. "She was sent there to quarters that were not secure, without a doctor or police officer on the island, and in quarters where there was no lighting working, no running water, and no gas for the stove," the friend said. "And when she reported the rape to Thursday Island (authorities) and said she wanted to come off, she was told she would have to have any time taken off deducted from leave owed to her. "She arrived on Thursday Island because her partner arranged for a flight, and had to get her own accommodation, and then the nurses' union arranged for her to get to Cairns, where she received medical and psychological assistance."

The colleague said the nurse gave statements to police, who arrested and charged the alleged perpetrator. "Now she has returned to her home outside Sydney and has not been paid a cent since the incident, being told it is the responsibility of WorkCover," the colleague said. "The nurses have advised the Government through the union that they will be withdrawing their labour if security of their accommodation on the remote islands is not brought up to scratch in a month."

A Queensland Health spokesman said the nurse would get "special leave on full pay, with the pay coming through WorkCover". Speaking in Cairns, Mr Robertson said the internal report, revealed in The Australian yesterday, had not been acted on because it had "sat on the desk of a former manager". "That's not acceptable and I apologise for that," he said. Mr Robertson said the Government's QBuild arm would now take over maintenance of the Torres Strait Islands buildings. New security is to be installed in facilities on Mabuiag Island.

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5 March, 2008

Amazingly erratic NHS financial management

Running the NHS is like steering a supertanker. It responds with majestic inertia to a whirl on the wheel, but before you know where you are, you are ten miles out to sea. Given a simple objective, the service seldom fails. But it can easily overcompensate. Two years ago the order went out to balance the books and save Patricia Hewitt’s job as Health Secretary. The books have been duly balanced, though Ms Hewitt was still cast to the sharks. But, having eliminated the deficits, the NHS is now heading for an embarrassingly large surplus of almost £1.8 billion this financial year.

Under Treasury rules all of this money stays with the NHS. But that is small compensation for the hundreds of patients denied access to modern drugs this year because the NHS said that it couldn’t afford them. It also makes the promise by Andrew Lansley, the Shadow Health Secretary, to spend still more on the NHS look even more ill-timed.

Where will the money be spent? The Department of Health would like us to believe that it will be invested in new and innovative services. (The art of making spending sound virtuous is to call it investment.) In practice, all that will happen is that the NHS will relax its controls. The cost savings were made in 2006-07 by squeezing emergency care, reducing the prices paid to hospitals for such care and cutting staff by 8,500 – the first fall in numbers for ten years. Staff numbers only have to begin creeping up again and the surplus will disappear. Cost-of-living salary increases have also been under tight control, which cannot last for ever.

And the whopping surpluses made by the strategic health authorities have come in part from raiding their training budgets. That is another short-term economy that cannot realistically be extended indefinitely.

So, the impression that the NHS has suddenly become much more efficient is, alas, an illusion. It has jammed on the brakes, squeezed its staff and denied some patients the care they would take for granted in other countries. As a result, it is in surplus. But it won’t last.

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Cops and Doctors

The death of actor Heath Ledger from an accidental overdose of six pain and anxiety medicines -- including the narcotics OxyContin and Vicodin -- has prompted warnings about misuse of prescription drugs, which ranks as one of the fastest growing segments of drug abuse. Nobody disputes the problem. But the strategies for tackling it aren't changing the trends, they are just hobbling doctors and patients, and may retard the development of new medications.

The Drug Enforcement Administration is, sensibly enough, targeting the small number of physicians who inappropriately prescribe drugs in violation of current laws, the "patients" who doctor shop for painkillers and hoard drugs to abuse or sell them, and the criminal diversion of these medications from pharmacies and distribution centers. But the DEA is also trying to influence clinical decisions about when these drugs are prescribed.

This is a mistake. Clinical issues are not the expertise of the DEA. Placing more restrictions on the legitimate prescribers can harm real patients and ethical physicians.

Innovative new drugs such as OxyContin that have been developed in the last two decades provide targeted relief for intractable pain. While they have helped innumerable patients, they have also been abused. The DEA response?

One was to try and get the power (now exclusively vested in the FDA) to have a final say over whether new narcotic medications should come to the market. Legislation to do so was temporarily passed in 2004 and the DEA sought its reauthorization in 2005 -- as a "rider" attached to its appropriations bill, without Congressional debate. At one time, the DEA even sent out solicitations to hire clinicians to review new drug applications for narcotics, a role reserved for the FDA. The DEA has stepped back from that effort -- at least for now.

There have also been efforts to place additional restrictions on existing drugs. The DEA is carving out a role for itself in the creation of risk-management programs that manage how new narcotics are used. These programs often place burdens on doctors and patients that can discourage legitimate prescriptions, for example by requiring additional reporting by physicians who dispense these drugs, as well as certification that they received additional training in handling them.

The DEA is leading a campaign to "reschedule" drugs like Vicodin into a stricter classification -- placing them under the same restrictions as opium, methadone and morphine. It is widely believed that the DEA has also been quietly pressuring the FDA to reach a similar conclusion. The hope is that tighter controls will help control illegal diversion -- although medical studies show that determined abusers don't typically get their drugs through legal channels.

But there's a danger that the DEA will wade into areas that involve appropriate clinical practice. There will always be some trade-off between access and enforcement -- between the docs and the cops. The ensuing tension helps ensure the right balance between enabling legitimate prescribing, and maintaining restrictions that aid in reasonable enforcement efforts. The problem is when DEA activities end up influencing legitimate prescribing.

For one thing, they prompt some law-abiding doctors to think twice before writing legitimate scripts. A 2001 study of California doctors found that 40% of primary-care physicians said fear of investigation affected how they treated chronic pain. A recent survey of physicians by the Center for Addiction and Substance Abuse found that one-third worry "a great deal" or "somewhat" about review of their own prescribing of controlled drugs by law enforcement agencies; and 44% report that this actually influences which medications they prescribe.

The expansion of DEA regulatory authority could slow development of improved medicines, by chasing away companies that fear added uncertainty about whether new products will get approved. This includes new generations of narcotics more resistant to abuse. It would actually be better for the public if the FDA made these abuse-resistant painkillers immediately eligible for priority review, which can shave time and cost off the development process.

The DEA for its part can take additional steps to curb the abuse of prescription drugs without intruding into legitimate medical practice. The agency could step up its work with individual states on prescription-monitoring programs that enable collection of information on dispensing of controlled drugs. This could help curtail doctor shopping and alert doctors to dangerous polypharmacy.

The National All Schedules Prescription Electronic Reporting Act -- which has passed but hasn't been implemented -- would create a grant program housed at the Department of Health and Human Services to fund state-run prescription drug monitoring programs. Currently 20 states have these programs, but information is not yet shared between them, so doctors can't view what other prescriptions a patient was given in another state.

Part of the barrier to getting the system started has been maneuvering by DEA's parent, the Justice Department, to create its own rival scheme -- a law-enforcement tool geared more toward monitoring doctors as opposed to irregular purchases.

As prescription-drug abuse and criminal diversion escalates, there is a need for stepped-up law enforcement. But when it comes to managing legitimate medical practice issues, the cops should step aside. The risk is a return to an era when pain often went unrecognized, treated patients were commonly undermedicated, and doctors were reluctant to prescribe powerful narcotics -- sometimes out of fear of those looking over their shoulder.

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4 March, 2008

Why Ontario keeps sending patients south to the USA

More than 400 Canadians in the full throes of a heart attack or other cardiac emergency have been sent to the United States because no hospital can provide the lifesaving care they require here. Most of the heart patients who have been sent south since 2003 typically show up in Ontario hospitals, where they are given clot-busting drugs. If those drugs fail to open their clogged arteries, the scramble to locate angioplasty in the United States begins. “They rushed me over to Detroit, did the whole closing of the tunnel,” said Eric Bialkowski, 47, of the heart attack he had on March 14, 2007, in Windsor, Ont. “It was like Disneyworld customer service.”

While other provinces have sent patients out of country – British Columbia has sent 75 pregnant women or their babies to Washington State since February, 2007 – nowhere is the problem as acute as in Ontario. At least 188 neurosurgery patients and 421 emergency cardiac patients have been sent to the United States from Ontario since the 2003-2004 fiscal year to Feb. 21 this year. Add to that 25 women with high-risk pregnancies sent south of the border in 2007.

Although Queen's Park says it is ensuring patients receive emergency care when they need it, Progressive Conservative health critic Elizabeth Witmer says it reflects poor planning. That is particularly the case with neurosurgery, she said, noting that four reports since 2003 have predicted a looming shortage. “This province and the number of people going outside for care – it's increasing in every area,” Ms. Witmer said. “I definitely believe that it is very bad planning. ...We're simply unable to meet the demand, but we don't even know what the demand is.”

Tom Closson, the Ontario Hospital Association's president and chief executive officer, said 30 per cent of Ontario's hospital medical beds are currently occupied by patients awaiting more appropriate placements, such as assisted living centres, a nursing home, a rehabilitation facility or even their own homes with proper home-care supports. That squeezes the system at both ends: Patients in intensive care units whose condition improves cannot get into step-down units, and some emergency patients can't get a bed at all, he said, adding that “everything is jam-packed at the moment.” A method for determining the right mix of beds and health services required in Ontario needs to be developed, he said, noting that that task has not been undertaken on a provincial basis for a decade.

Laurel Ostfield, press secretary to provincial Health Minister George Smitherman, said that in emergencies, where the patient goes becomes a clinical decision. It is preferable for someone with a heart attack in Windsor to be sent to Detroit, a few kilometres away, rather than on a long ride to London, Ont.

When demand has peaked, government has responded, she said. It struck a neurosurgery expert panel to study the problem and $4.1-million has been provided to stem the tide of U.S. neurosurgery patients. As well, stand-alone angioplasty services were created in Windsor in May.

Canadian Medical Association president Brian Day said he couldn't speak about the Ontario problem, but noted this country is the last in the Organization for Economic Co-operation and Development to finance hospitals with global budgets. Under that model, patients – and often doctors – are sometimes viewed as a financial drain. “We keep coming back to the same root cause,” Dr. Day said in a telephone interview from Ottawa. “The health system is not consumer-focused.”

Patients first learn of the problem when they are critically ill. Jennifer Walmsley went to Headwaters Health Care Centre in Orangeville in October and was diagnosed with a cerebral hemorrhage due to a ruptured aneurysm. That acute-care hospital does not have neurosurgery and no Ontario hospital that does could take her. She was then rushed to a Buffalo hospital. Headwater's chief of staff, Jeff McKinnon, said three neurosurgery patients have been sent to Buffalo in the past year. Others have gone to Toronto, Mississauga, Hamilton and London.

Radiologist Louise Keevil said Headwaters has an arrangement with neurosurgeons at other Ontario hospitals to send electronic images for their assessment, but “the limiting factor is availability of beds in their hospital. “The physicians are very accommodating but their hands are tied by availability of service.”

Kaukab Usman had a heart attack after a gym workout in Windsor on Dec. 9. She was rushed to hospital and given clot-bursting drugs. When they failed, she was sent to Henry Ford Hospital in Detroit, where she had angioplasty on one clogged artery and two stents inserted. “It was a miracle for me to be alive,” Ms. Usman said in a telephone interview from Somerset, New Jersey, where she is recuperating.

Aaron Kugelmass, director of the cardiac catheterization laboratory at Henry Ford Hospital, said a system is in place to get these patients the care they need expeditiously. “We try to make their length of stay in the U.S. as short as possible,” said Dr. Kugelmass, associate division chief of cardiology. “If they are stable for discharge, we discharge them to home in Windsor, with clear follow-up plans.”

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Health Insurance: Problem or Solution?

Is universal, mandatory health insurance what we want, or do we really want to provide health care to those that need it?

I am baffled that there are numerous grassroots efforts to provide health insurance for the uninsured, yet none to actually provide health care for those in need. According to recent reports from the Census Bureau, the number of uninsured increased 2.2 million in 2006 over 2005 to 47 million or 15.8% of the population. Part of this increase was due to a decline in insurance provided by employers. This decline in coverage might just be because the typical family plan offered by employers rose 7.7% to a staggering $11,480!

There has been great excitement that universal health insurance is at least part if not all of the answer to our health care woes. What is really discouraging is that even conservative, "market-based", "consumer-driven" and "individual accountability" proponents tout universal insurance coverage as the answer. I submit that "insurance" is a big part of the problem and no part of the solution. Here is why I reach that conclusion:

* "Insurance" can be defined as the equitable transfer of a (predictable) risk of a potential loss from one entity to another, in exchange for a premium and duty of care. The "potential loss" is usually of a nature that a person would not inflict it upon themselves, their property or others. I fail to see how this definition can be applied to health care any more than it can be applied to the upkeep and maintenance of a house or vehicle, (which, by the way, is why we don't have "health" insurance for cars and houses). Insurance providers are "risk-takers" not administrators.

* Somehow we managed to survive and thrive since the "beginning" without modern health care or health insurance. Why is now any different?

* Health care costs began to spiral upward at about the same time that "health insurance" was introduced during World War II as a way to sidestep wage controls. As insurance has become mandated and regulated, the spiral has accelerated. Hmm, I wonder why? There are still a few procedures and services that aren't covered by insurance AND most are still within financial reach of the average person.

* Each fix, mandate and regulation was supposed to reduce cost and/or improve quality. PPO's, HMO's, HSA'sthey were all supposed to be the great fix yet they each seem to have made the problem worse. Doesn't this tell us something? Like maybe more of the same just might possibly be counter-productive?

* There is no market for health insurance, if there were, the government would not have to force employers to provide it to their employees, rather, we'd be purchasing it of our own accord. I wonder what might happen to the employer that may choose to rid himself of the headache and give the $11,480 to the employee andheaven forbidlet the employee make his or her own decisions?

* Lack of insurance does not affect access to or quality of health care. The unimpeded access of millions of illegals to our health care services at little or no cost is proof enough.

* Just like taxes, most people have a "use it or lose it" attitude toward health insurance. There is no incentive to be prudent. Get your money's worth or more even if you don't need it. Better yet, "someone else" is paying for it, so who cares? Is "inflationary" the correct word?

* The June 2007 Reader's Digest had 220 numbered pages. Within those 220 pages were (by my count) 44 pages and inserts for 11 prescription drugs that most people would opt not to purchase (or would at least think about real hard) if "someone else" weren't paying for it.

* Why does a heart valve replacement in the US start at about $200,000, when you can go to India to an Indian doctor trained in America using American equipment and American parts and have it done for under $10,000? I argue that it boils down to insurance for 2 reasons: 1) insurance provides no incentive for "frugality" and 2) lawyers don't sue doctors, they sue insurance companies.

* And finally, the corker. San Francisco and others require that health insurance cover sex change procedures! WOW! Talk about a moving target! So what IS health care? Who decides? Who should pay for it? Why?

There is no place for health insurance in consumer driven health care, unless, of course, you want "someone else" to foot your bill. Furthermore, it is downright laughable to even consider health insurance as a part of socialized health care. The only way to socialize health care is to Federalize the health care industry and tell the insurance companies to get lost, right? I mean, aren't they supposed to make a profit? That's not supposed to happen in a socialized system, right?

The only real solution is a consumer-driven health care system where the consumer makes the decisions and pays the bills. There are many that do just that. I am a member of a group of 12,000 other families that believe it is OUR health and OUR money therefore we are, must be, and have a right to be good stewards of both. We make our own health care choices, are responsible for payment, and our needs are shared among our group.

Here's an idea. What would happen if the employee were to choose between 1) insurance coverage paid for by the employer or 2) cash payment of the $11,480 that is spent on the typical employee health insurance premium? I think we know the answer, which is why it will never happen.

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3 March, 2008

What Democrats won’t tell you about Healthcare reform

Splendid post below lifted from Doug Ross. There is some subtle bug in Doug's code which means that his links are not working. I could not find the bug either. The code looks fine. Anyway, the "missing" two links are here (Trial lawyers) and here (Coulter)

Namely, that frivolous medical malpractice lawsuits are one of the biggest causes for the rapid rise in healthcare costs. Why won’t Democrats tell you that? Because trial lawyers uniformly back Democrats in order to fight tort reform and maintain their multi-billion dollar revenue stream.

Watchdog site Trial Lawyers Inc. defines the term “tort tax”:

While [aggressive lawsuits have] been a bonanza for Trial Lawyers, Inc., it has been a drain on the American economy and a serious threat to the livelihood and lifestyle of many Americans. America’s tort system costs over $200 billion annually; even assuming that the underlying lawsuits have merit, much of this cost is wasteful and excessive—at least $87 billion, according to the president’s Council of Economic Advisors.

The overall cost of this “tort tax” on our economy over the next ten years will be more than $3.6 trillion... almost triple the size of the 2001 and 2003 Bush tax cuts combined.

Meritless lawsuits:

...Trial Lawyers, Inc.'s medical-malpractice lawsuits are legion: of the 46,000 members of the American College of Obstetricians and Gynecologists, 76 percent have been sued at least once, 57 percent at least twice, and 41.5 percent three times or more. And the litigation industry tends to file far more cases than actually have merit: nearly half of malpractice suits — 49.5 percent — are dropped, dismissed, or settled without payment. Indeed, in a study of medical-malpractice cases filed against New York hospitals, the Harvard Medical Practice Group found that in the majority of medical-malpractice claims, the plaintiff exhibited no medical injury whatsoever; the plaintiff was injured by doctor negligence only 17 percent of the time.

The High Costs of Malpractice Liability:

So if Trial Lawyers, Inc.'s suits against doctors are wide-ranging, and often meritless, just how much do they cost? By 2003, medical-malpractice liability costs in the United States had reached an astounding $26 billion annually. That staggering sum represents a 2,000 percent increase over costs in 1975. At 12 percent per year, the growth rate in medical malpractice costs since 1975 is four times the rate of inflation and twice the rate of medical-care inflation.

In jury trials, million-dollar verdicts are now the norm. Fifty-two percent of all awards exceed $1 million while the average award now weighs in at $4.7 million...

The Investments:

...PAC donations from the Association of Trial Lawyers of America (ATLA)—Trial Lawyers, Inc.'s government-relations "home office"—are perennially among the nation's highest to the Democratic Party.[224] Democrats receive 93 percent of ATLA's contributions, which helps explain why every Democratic senator opposed the president's medical-malpractice reform bill in the last Congress.[225]

PAC gifts, however, only scratch the surface of litigation-industry giving, which Trial Lawyers, Inc.'s leaders and their firms bundle and distribute directly to candidates. Senator John Edwards's presidential campaign was almost wholly funded by the lawsuit industry..

Ann Coulter adds:

...the Democratic Party treats doctors like they're Klan members. They wail about how much doctors are paid and celebrate the trial lawyers who do absolutely nothing to make society better, but swoop in and steal from the most valuable members of society.

Maybe doctors could get the Democrats to like them if they started suing their patients.

It's only a matter of time before the best and brightest students forget about medical school and go to law school instead. How long can a society based on suing the productive last?

(Has anyone else noticed the nonexistence of a charitable organization known as "Lawyers Without Borders"?)

[My ex-roomate, now a Doctor] makes $380 for an emergency appendectomy, or one-ten-thousandth of what John Edwards made suing doctors like her, and one-fourth of what John Edwards' hairdresser makes for a single shag cut.

Edwards made $30 million bringing nonsense lawsuits based on junk science against doctors. To defend themselves from parasites like Edwards, doctors now pay hundreds of thousands of dollars in medical malpractice insurance every year.

If we're going to reform healthcare, I’d suggest we start with the trial lawyers and cap every single form of medical malpractice lawsuit




British children wait years for vital dental care

"Who cares if poor children end up going through life with crooked teeth?" seems to be the attitude. But isn't that exactly the sort of attitude the NHS was designed to fix?

More than 10,000 children with severe dental problems including jaw deformities and an inability to bite properly are waiting up to seven years for corrective treatment on the National Health Service. Orthodontists have warned that in many cases the children suffer from much more serious problems by the time they are finally given treatment.

This weekend specialists claimed that in many parts of England the NHS had in effect ceased to provide corrective surgery for children. They also warned that the government’s introduction of an 18-week waiting time target for orthodontics at the end of the year would be so difficult to meet that patients would not be referred at all and treatment would be rationed further.

Evidence of the collapse in orthodontics in parts of the country is revealed in research by the British Orthodontic Society. It found that in at least seven hospital catchment areas in England, children with serious conditions were waiting more than four years for hospital treatment. In one area of the northeast children are waiting for seven years while in another the delay is 5½ years.

James Spencer, consultant orthodontist at Pindersfield hospital in West Yorkshire, said: “This is totally unsatisfactory. If we are not able to get on with the treatment conditions such as impacted teeth may cause damage to other teeth. The children may also suffer psychological damage or sleeping problems.”

Once children reach 18 they are no longer routinely entitled to NHS treatment. Orthodontists report that some children turn 18 while waiting to be assessed for care and thus lose their chance of surgery on the NHS. A Department of Health spokeswoman said: “The department is aware of the variations in provision of orthodontic treatment and has given help to primary care trusts in assessing and reviewing future orthodontic services.”

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2 March, 2008

Britain shoots the messenger

You are not supposed to tell it like it is in Britain. But if you are a peer of the realm, you are in a better position than most to do so

A Conservative peer who branded nurses "grubby, drunken and promiscuous" during a debate in the House of Lords faced a rebuke from David Cameron and fury from nursing leaders and ministers yesterday....

The row developed after Lord Mancroft claimed it was "a miracle" that he was still alive after his experience of filthy wards and "slipshod and lazy" nurses when he was admitted to the Royal United Hospital in Bath. He alleged that nurses chatted to one another about their sex lives and alcohol intake in front of patients, some of whom they regarded simply as "a nuisance". "The nurses who looked after me were mostly grubby - we are talking about dirty fingernails and hair - and were slipshod and lazy. Worst of all, they were drunken and promiscuous," he said.

"How do I know that? Because if you're a patient and you're lying in a bed, and you're being nursed from either side, they talk across you as if you're not there. So I know exactly what they got up to the night before, and how much they drank, and I know exactly what they were planning to do the next night, and I can tell you, it's pretty horrifying." The nurses were "an accurate reflection of many young women in Britain today", the peer claimed.

But, as the furore over his remarks mounted, it emerged that it was not the first time Lord Mancroft had criticised the health service. The peer was treated successfully for heroin addiction in the United States. In a Lords debate in 1991 he accused the NHS of being the "biggest supplier of addictive drugs in the world".

Lord Mancroft, chairman of the Addiction Recovery Foundation, was reported in The Times at the time as saying that his life had been governed for years by an addiction to heroin, cocaine, alcohol and pills. His family had searched everywhere for the help he needed. Eventually he was treated successfuly in Minnesota. Later, he suggested that the Health Department send a team to America to study methods of treatment.

Lord Mancroft, who went to Eton and is a member of Pratt's Club in St James's, London, told peers on Thursday night that he owed his life to the fact that his wife had "kidnapped" him from the Royal United Hospital and took him to a hospital in London where standards were higher. The Tory peer did not name the hospital involved, but the RCN said it had identified it and was in contact with the NHS trust responsible to discuss his allegations.

Peter Carter, the RCN general secretary and chief executive, said: "These comments are extremely unhelpful and grossly unfair on nurses across the UK, who work extremely hard to provide patients with the highest standards of care. "Where poor nursing exists, it should always be challenged through the proper channels. [The British just LOVE "proper channels". That way everything can be hushed up]

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British doctor shortage

In another triumph of socialist "planning", Britain has plenty of medical school graduates but no places in hospitals to allow them to complete their training!

Hospital trusts are looking abroad as they struggle to find locum doctors for emergency shifts. Leaked documents from the NHS and Department of Health reveal a national shortage, raising concerns over cancelled operations and poor patient care. Controversial changes in the training process for junior doctors have created a shortfall of qualified candidates for temporary vacancies.

Ashford and St Peter's Hospitals NHS Trust, Surrey, said that it was advertising in Polish medical journal for accident and emergency doctors, the Health Service Journal reports. The department said that "the problem has been circulating anecdotally for some time. We do take it seriously." It was talking to the NHS and others about potential solutions.

Under the Modernising Medical Careers (MMC) reforms introduced last year, experienced doctors can leave posts at any time but trainees can replace them only every August.

A leaked e-mail to regional health authorities from Steve Buggle, the MMC project leader for recruitment, said that "some trusts may be experiencing problems in finding locums". Vicky Osgood, of Severn and Wessex deanery of the NHS, replied that the problem was extensive. "We are having increasing difficulty filling any and all vacancies and locum requests."

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1 March, 2008

Woman about to give birth was left to drown in bath by British hospital staff



The husband of a pregnant woman who was left to drown in a hospital bath after going into labour is to take legal action against the local NHS trust. Lorraine Maddi, 31, was close to giving birth when she was left unattended for 45 minutes by hospital staff, despite their having been told of a condition that sometimes caused her to faint during stressful and anxious situations. The son she never saw was delivered by emergency Caesarean section and survived.

Yesterday, after her inquest, Mrs Maddi's husband, Phaninder, said that he would be claiming compensation from the Doncaster and Bassetlaw Hospitals NHS Foundations Trust. "She would have been a wonderful mum," said Mr Maddi, 29, a warehouse operative in Ipswich, who is now bringing up his healthy nine-month-old son, Jaydem. "My son will never know his mother - she never got to enjoy him. I don't know what I will say to him when he grows up and starts asking about her."

The coroner recorded an open verdict after the inquest, which was told that Mrs Maddi, an estate agent from Worksop, Nottinghamshire, had been advised to take a warm bath to ease labour pains. Her birthing partner, Paul Guthrie, left the hospital to collect some items and he told staff to keep an eye on her in the bath. A midwife knocked on the bathroom door but did not receive a reply. When Mr Guthrie came back an hour later, Mrs Maddi was still in the bathroom with the door locked. She was found submerged and unconscious in the water, turning blue. She died eight days later.

The inquest was told that Mrs Maddi had written to the hospital warning staff that her fainting had become more frequent since the recent death of her mother. Bassetlaw Hospital admitted that there were no official guidelines on whether women should be allowed to be alone, but the court heard from a number of midwives who said that it was normal practice for women in labour to be accompanied by a birthing partner or member of staff. Policy and guidelines will now be reviewed. "I hope they keep to their word and make the changes, that is all I want now," her husband said yesterday. "My son might not even have been alive if Paul hadn't come back when he did. I just hope that something good will come out of losing my wife."

The couple married in November 2006 in India, where Mr Maddi was born. Mrs Maddi had moved to her family home in Worksop to nurse her mother, who died of cancer during the pregnancy. Mr Maddi had to stay in India because of visa difficulties, and was unable to attend the birth.

Announcing the review of obstetric and midwifery procedures, the NHS trust said: "We would like to extend our sympathy to Mrs Maddi's family and friends. As soon as Lorraine was discovered, the staff did all they could to save her and her baby. Tragically, only the baby survived. Incidents such as happened to Lorraine are extremely rare. In the light of the tragedy of her death and the evidence heard at the inquest, the trust will be reviewing its practice with regard to bathing."

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The need for more specialty hospitals

Robert Besse's painful odyssey began when he checked himself into Good Samaritan Hospital in Cincinnati a year ago to get his right knee replaced. The 60-year-old retired pharmacist had worn down the joint skiing and hiking and working on his feet for years. After the surgery Besse recovered for four days in a room he shared with another gentleman who'd had stomach surgery. His roommate's four youngsters would visit for hours, creating a racket, while up to 20 hospital staff a day would come in the room to examine him, bring food or change a lightbulb. A student nurse would wake Besse up to ask if he needed a new pillow. The physical therapist would peel back a bit too far the blue brace on his knee and expose the bloody gauze.

Ten days after leaving the hospital his knee was still oozing lots of fluid. "The pain was off the scale," he says. One of his surgeons took a look and immediately had him admitted to a different hospital, where he declined rapidly. Twice during the first night he was given last rites. But he survived until the morning when the surgeon opened up his knee again and found a raging staph infection that took two rounds of surgery to clean up. "I wanted out of there. I couldn't stand it," he says. He spent the next several months on infused antibiotics and pain medication. He was barely able to celebrate his sixtieth birthday with his family in Breckenridge, Colo. He already has a strategy to celebrate future birthdays: "My plan is stay the hell out of the hospital, period," he says. (Good Samaritan can't comment on the case because of privacy laws but says it has a comprehensive infection-fighting program.)

Hospitals are still the heart of the health care industry, consuming a third of the $2 trillion U.S. health care bill. Some are very good. But many are not, brimming with infectious bugs, systemic error and negative hospitality. And because the hospital industry does all it can to thwart competition, many communities are stuck with the hospitals they have. One in 200 patients who spends a night or more in a hospital will die from medical error. One in 16 will pick up an infection. Deaths from preventable hospital infections each year exceed 100,000, more than those from AIDS, breast cancer and auto accidents combined. The presidential candidates are grappling over the plight of the uninsured, yet you're five times more likely to die from visiting a hospital than from not having health insurance, according to the not-for-profit Committee to Reduce Infection Deaths.

Patients have a choice, but it's not widespread yet. It's called the specialty hospital, a center that focuses on the care of a particular body part such as the heart, spine or joints, or on a specific disease such as cancer. There are 200 specialty hospitals in the U.S. (out of 6,000 hospitals overall), and they often deliver services better, more safely and at lower cost. A recent University of Iowa study of tens of thousands of Medicare patients found that complication rates (bleeding, infections or death) are 40% lower for hip and knee surgeries at specialty hospitals than at big community hospitals. A 2006 study funded by Medicare found that patients of all types are four times as likely to die in a full-service hospital after orthopedic surgery as they would after the same procedure in a specialty hospital.

HealthGrades is a quality review firm that ranks hospitals by their complication and mortality rates (adjusted for the health of the patient on admittance). According to HealthGrades, specialty hospitals don't always outpace traditional hospitals in quality of care, but they are overrepresented in the top tier. Three of the nation's top ten cardiac programs are at specialty hospitals in South Dakota, Indiana and Texas. Three of the top ten hospitals for total joint replacement surgery are specialty centers in Oklahoma, Ohio and Georgia.

"Specialization is a law of nature," says Robert Tibbs, a neurosurgeon and part-owner of the Oklahoma Spine Hospital. "Spine surgery is an elective procedure. One of the biggest risks to any surgery is infections. Here we don't have sick people." Last year, out of 1,773 patients who slept over at the hospital, only 7 got an infection. That's one-third to one-ninth the rate seen for similar patients at a big hospital. At Oklahoma Spine anesthesiologists are practiced in putting patients under in the prone position for back surgery. At a big hospital few anesthesiologists would be skilled in that particular task. "You don't take your Ford to the VW mechanic," says Tibbs' partner Stephen Cagle.

In most industries the lumbering, unresponsive incumbent gets wiped out by the nimble newcomer, or at least is spurred to improve its ways. The nation's public education system has the charter-school movement to keep it honest. Microsoft has Google. But over the past several years the hospital industry, through legally questionable bullying tactics and arduous lobbying, has all but stamped out expansion of the specialty hospital sector, the only real competitive threat it has ever faced.

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