The blogspot version of this blog is HERE. The Blogroll. My Home Page. Email John Ray here. Other mirror sites: Greenie Watch, Political Correctness Watch, Dissecting Leftism, Australian Politics, Education Watch, Gun Watch, Recipes, Immigration Watch, Tongue Tied and Food & Health Skeptic. The archive for this site is accessible here or here. For a list of backups viewable in China, see here. (Click "Refresh" on your browser if background colour is missing)
************************************************************************************



31 March, 2009

Prohibitionists threaten to force pain patients to live in agony

A Southern Nevada lawyer told the Nevada Supreme Court this month that pharmacists, at the least, had a duty to call physicians to voice their concerns before dispensing a narcotic painkiller to a woman who killed a man in a 2004 vehicle crash in Las Vegas. Lawyer Phil Aurbach told justices that Nevada pharmacists continued to fill prescriptions for Patricia Copening even after being warned by a state task force that she might be a prescription drug abuser. Copening killed 21-year-old Gregory Sanchez Jr. in a June 4, 2004, crash on U.S. Highway 95.

Aurbach asked justices to reinstate the wrongful death case he seeks to file against seven chain-store pharmacies that filled Copening's prescriptions. District Judge Douglas Herndon earlier threw out the case on the grounds that the pharmacies were not legally liable in the crash -- pretty much a no-brainer.

The Supreme Court made no decision, though Justices Mark Gibbons and Jim Hardesty made comments seemingly in support of Aurbach's position. Justice Gibbons, for instance, offered a hypothetical in which a doctor mistakenly prescribes strychnine that would kill the user. He then posed the questions: "Does the pharmacist just fill it and let someone die? Or does the pharmacist call the doctor to see if that is what you intended?"

Sanchez had pulled his vehicle off U.S. 95 after it had a flat tire. His vehicle was struck by a vehicle driven by Copening, who was found to be under the influence of hydrocodone, a narcotic pain reliever. Another motorist, who had stopped to help Sanchez, was seriously injured. Copening spent nine months in jail.

An investigation found many different pharmacies had filled prescriptions for 4,800 tablets of the drug for Copening in the 13 months before the crash. Aurbach said the pharmacies continued to fill her prescriptions even though the Nevada Prescription Controlled Substance Abuse Task Force notified them that Copening was "taking an unusual amount of these narcotics." Aurbach wants to sue Wal-Mart, Longs Drugs, Walgreen Co., CVS Pharmacy, Rite-Aid, Sav-On and Lam's Pharmacy.

Defending the pharmacies, lawyer Mike Wall said Aurbach had been shopping around for "deep pockets" to sue. Wall said the pharmacists have the same protection as bartenders. Under court decisions and the state "dram shop" law, bartenders are not liable if the people to whom they serve drinks are later involved in crashes in which others are injured or killed, he pointed out. Wall said a pharmacist is not there to "second-guess a registered physician."

Judge Herndon's initial decision -- that the pharmacies are not liable -- was correct both in law and in common sense. It's understandable that Aurbach would seek to go after the deepest available pockets on his clients' behalf, but for the courts to adopt his reasoning would be both dangerous and absurd.

Presume the state Liquor Control Board has notified a local supermarket chain that one of their liquor customers has also been buying bottles of wine at other groceries and liquor stores. What should the manager do? Make sure every one of his cashiers, on every shift, can recognize the perpetrator? At which point they should do what, precisely, the next time Mrs. Jones -- not visibly inebriated -- tries to buy a perfectly legal bottle of wine? Quiz her on how many she's bought elsewhere this week? Refuse to sell to her?

If grocery stores were to be held liable for traffic accidents caused by customers who buy their wine or liquor, their accountants' and lawyers' advice is not hard to guess: stop selling alcohol, entirely. ("But painkillers are a more serious problem on the highways than alcohol!" someone will doubtless object. Wrong, Budzilla.)

Similarly, the main job of a pharmacist is to make sure we're sold the actual drug or medicine requested, in the proper dose and at proper purity. (Sponsors of the Harrison Narcotics Act of 1914 insisted that's all the federals wanted to control -- dose and purity -- and that they would never try to actually restrict what we could buy.)

The American Cancer Society reports chronic cancer pain is already substantially under-medicated in this country, due to the fear of doctors and pharmacists that they could well lose their license or even be thrown in jail should they stand accused of writing "too many" painkiller prescriptions. (The former actually happened to Las Vegas' own pain specialist Dr. Dietrich Stoermer, a fine man and a fine doctor, despite the fact his jury unanimously acquitted him on all charges.)

How is a pharmacy clerk supposed to know which customer "looks like she might get stoned and drive"? The person responsible for driving after consuming excessive quantities of drugs that come in little bottles labeled "Warning: May cause drowsiness; do not operate heavy machinery" is the adult consumer, no one else.

What magic confers on a 24-year-old, newly handed his or her M.D. or pharmacy license, the wisdom to play "mommy" or "daddy" to a 50-year-old patient, treated in this model as a willful and irresponsible infant -- instructing us as to how much analgesic plant extract we should be "allowed" to buy and use?

We would be better off getting rid of this whole "doctor's prescription" rigmarole, entirely -- freeing physician from the parade of patients demanding scrips for the latest drug to be written up in Reader's Digest or advertised on TV, allowing them instead to go back to what they do best, which is diagnostic consultation.

But yes, so long as the "prescription" bureaucracy remains in place, pharmacists are also bound by law to determine to the best of their ability that a prescription has actually been written by a legitimate, licensed doctor. Beyond that, leave it alone.

In case you haven't noticed, the "small-town corner pharmacy" has just about given up the ghost. Today, the industry is concentrated in fewer and fewer hands. Threatened with legal liability for traffic deaths caused by those taking prescription drugs, what if one and then more major pharmacy and grocery chains simply told their pharmacists to stop selling any prescription pain-killers, at all? What would that do to the already pathetic -- even tragic -- struggles of small-town sufferers of chronic pain to get the analgesics they need to live out their lives free of suicide-inducing agony?

SOURCE




Australia: Logan Hospital staff quit after government ignores complaints

ONE of Queensland's busiest public hospitals has lost five of its most senior doctors and managers, with no signs of them being replaced. Logan Hospital has been seconding staff from other public hospitals in Brisbane to cover the shortfall of experienced medical staff.

Deputy Premier and new Health Minister Paul Lucas confirmed the worrying turnover, but noted that three of the staff remained within Queensland Health at other hospitals.

Mr Lucas will today begin a two-month "health listening tour" across the state to "see first-hand the challenges facing the health network". Acknowledging major problems at Logan Hospital, Mr Lucas said the Government had to do more - something it promised during and after its successful election campaign. "Senior doctors are often harder to recruit and retain, and I'll be listening to the thoughts of medical professionals about how best to retain expert staff on my statewide listening tour," he said yesterday.

The Sunday Mail first highlighted problems at Logan Hospital last May in a frank open letter from Dr Michael Cameron, then the senior staff specialist in emergency medicine at Logan Hospital. Five months after being asked to talk to Premier Anna Bligh and then health minister Stephen Robertson about the issues Dr Cameron left Logan, saying it was "too dangerous and too dysfunctional". "Everyone is overworked and overwhelmed ... the pressure definitely got on top of me," Dr Cameron said last September.

He stayed with Queensland Health, but took his emergency skills to the newer Redland Hospital in January. Dr Cameron's position at Logan Hospital had not been filled as of last week. Sources said the director of emergency services had also left Logan Hospital last month to take up an identical position at Royal Brisbane and Women's Hospital. Three other senior staff had resigned in the past year because of the workload and pressure. Sources said Queensland Health had moved doctors in from around southeast Queensland hospitals to fill the gaps.

"Logan has degenerated even further," a senior public hospital doctor told The Sunday Mail last week. "They have got major problems there. Lucas has got an uphill battle."

The Minister - handed the poisoned chalice by Ms Bligh last week - said more people would be put into frontline services. "Queensland Health tells me that since 2005, we've hired an extra 100 doctors for Logan Hospital and almost 220 extra nurses - an increase of 66 per cent and 41 per cent respectively in less than four years," said Mr Lucas, who kicks off his tour with a visit to Dr Cameron's Redland Hospital.

"I know Dr Cameron is very highly thought of and I am very keen to meet him and to understand his perspectives on the health system. "Dr Cameron is one of more than 6600 doctors employed by Queensland Health, and I'm undertaking this tour to see what's happening on the ground, and speak to professionals like him and others right across the health network."

Mr Lucas said he would visit hospitals in Cairns, Townsville and southeast Queensland this week. He also promised to visit health facilities on the Torres Strait islands to ensure repair work on sub-standard nursing accommodation had been completed. Mr Robertson was stripped of his responsibilities during the election campaign after it emerged that the housing had not been fixed. He was ultimately banished from the Health portfolio.

"I want to see every part of our health system at work - from the kitchens, to the wards, to our emergency departments and doctors out there delivering services in the community," Mr Lucas said. "Health impacts on many aspects of people's lives and I'm determined to see what's happening on the frontline and how we can improve the services Queensland Health delivers." Mr Lucas said he would also visit a hospital emergency department in action during a peak period.

Dr Cameron said he would be keen to help the new Bligh Government health regime. He said he was enjoying work under different conditions in Redland Hospital.

SOURCE





30 March, 2009

Bungling NHS hospital overdose leaves girl, 3, fighting for her life

A girl of three is fighting for her life after doctors allegedly gave her a massive overdose by accident. Renee Healey was given double the prescribed dose of drugs by doctors treating her kidney condition at the Royal Manchester Children’s Hospital in Pendlebury, her family claims.

Renee, from Wythenshawe, in south Manchester, was transferred to the intensive care ward on Wednesday and is now in a critical condition after her kidneys failed and she was put on dialysis. Her parents, Tina and Clive, are staying with her in the hospital, where she is on a life-support machine to help her breathe.

Renee was diagnosed 18 months ago with a condition in which tiny filtering units in the kidneys are damaged. Renee’s grandmother, June McKerrall, said her granddaughter was given an overdose of a drug that helps purify the blood, causing her lungs to fill up with fluid which nearly killed her. She said: ‘We can’t understand how someone could make a mistake like that with a child’s life.’

A spokeswoman for the hospital said that the incident was being investigated.

SOURCE




UK: NHS told to curb staff sickness

The NHS should be doing more to tackle staff sickness and promote workplace health, a think tank says. Reform, a right-of-centre group, said the health service was "shooting itself in the foot" by not making more use of the expertise it has in its workforce. Figures show NHS staff take on average nearly 12 days off sick a year, while the rate is 7.2 in the private sector.

Unions said services could be improved, but there were valid reasons why NHS workers took more time off. A spokeswoman for Unison said: "Occupational health is certainly lacking in places, but the NHS is a unique workplace. "For example, we can't have staff going on the wards after they have had things like vomiting bugs."

But Reform said there was still a lot more the health service could be doing. The group highlighted the work done by private firms such as BT which has introduced 24-hour counselling services, lunchtime exercise classes and workplace health advisers. Over the past four years, sickness rates have fallen by a sixth among its 100,000-strong workforce. The think-tank said if the NHS followed the lead of private firms it could reduce its £3bn annual sickness bill by a third.

Reform's report said as the biggest employer in Europe the NHS should be taking a lead and helping its 1.3m staff get back into work when they are ill. But instead it has one of the worst records in the public sector and has long-term absence rates that were two-thirds higher than the private sector.

The report comes after the annual NHS staff survey found nearly half felt they were overstretched and unable to do their jobs properly. Helen Rainbow, one of the co-authors of the study, said: "Stress is a big factor in NHS sickness. There is a lot more it could be doing to help its staff and this in turn will improve its productivity. "The problem is the culture in the NHS is quite reactive, it is shooting itself in the foot when you think of the kind of people it employs."

A Department of Health spokesman said: "The government takes the health of NHS staff seriously. "In January, we announced a review to examine the health of NHS staff and gather evidence to start delivering improvements across the board."

SOURCE





29 March, 2009

NHS bosses award themselves inflation-busting 7.5pc rises (but nurses get just 1.9pc)

The socialist version of Wall St.?

Top NHS managers awarded themselves inflation-busting pay rises last year, as private sector staff faced a pay freeze. Average pay for trust chief executives soared by 7.5 per cent in just one year to £142,450, while nurses are having to make do with just 1.9 per cent. And this was despite guidance from the Department of Health that raises for senior managers should be no higher than 1.3 per cent.

The best-paid hospital boss is on £230,000 - enough to pay for more than ten nurses, while two saw their pay rise by more than 30 per cent. Since Labour came to power, Health Service chief executive pay has almost doubled (up 98 per cent).

The shocking details of pay hikes given to senior bureaucrats in the NHS between 2007 and 2008 comes a day after it was revealed that the number of managers has soared quicker than the number of nurses. There are now 39,900 managers in the NHS - up 9.4 per cent in one year. But there are 6,000 fewer GPs and 15,00 fewer midwives than managers. Meanwhile the number of health visitors and nursing assistants also fell.

Michael Summers, of the Patients Association, said: 'The news keeps getting worse. Yesterday we found out there are an ever increasing number of managers and today we find out their pay is climbing. The NHS needs pay increases for nurses, not managers.'

Conservative health spokesman Stephen O'Brien said: 'Why is it that NHS bosses think it is acceptable to award themselves generous perks and inflation-busting pay rises while hard-working nurses are being forced to take what is effectively a pay cut?' 'Labour needs to think again whether now is really an appropriate time for them to be playing fast and loose with taxpayers' money.'

LibDem health spokesman Norman Lamb said: 'Those at the top who have benefited in the past have got to lead from the front. There has to be a sharing of the pain.'

The salaries were revealed in the NHS Boardroom Pay report from research group Incomes Data Services. Average chief executive pay is £142,450, up from £132,500 the year before and £72,000 in 1997. Elite foundation trust chief executives earn even more - £157,000 on average. Other directors on NHS trust boards have seen their pay go up by 6.4 per cent. Finance directors earned £102,850 on average, while medical directors were on £165,000.

The report also found that pay increases in England were much higher than in Scotland or Wales. The highest paid chief executive was Robert Naylor at University College Hospital trust in London. His pay soared to £230,000 - a rise of 30 per cent in a year. Other high earners were the chief executives of the Heart of England trust's Birmingham hospital and Newcastle upon Tyne hospital, on £227,500 and £222,500 respectively. The biggest rise was seen at the Airedale trust in West Yorkshire, where chief executive Adam Cairns' pay soared 33 per cent to £137,000.

Steve Tatton, editor of the report, said: 'The earnings of NHS trust directors are continuing to move ahead at a faster pace than the rest of the economy. 'In the current climate the remuneration of NHS directors, like any top executives working in the public sector, is subject to intense public scrutiny, particularly when unease about the widening gap between senior executives and the rest of the workforce is growing in both the public and private sector.'

SOURCE




Australia: Fraud and loathing in disastrous NSW public hospitals

Patients sent to imaginary beds and a doctor who complained about it gets persecuted!

ON APRIL 28, 2006, Shellharbour Hospital boss, Michael Brodnik, distributed an email. A decision had been made, he wrote, to set up a new unit within the emergency department. "The unit will be … four beds, conceptually down the right hand wall of ED but using the concept of 'virtual beds'," he told colleagues. Patients who arrived at emergency and needed admission would be assigned a virtual bed if no official in-patient bed was available, remaining physically in emergency. Brodnik said he had no control over the change, reassuring staff: "It really is a paper exercise."

The rationale was to get patients off the emergency department's books within eight hours of arrival - a watershed imposed by government as a so-called "key performance indicator" or KPI, amid political pressure over backed-up hospitals and ambulances unable to offload patients.

At Shellharbour Hospital, an outpost serving the cookie-cutter sprawl that straggles down the coast from Wollongong, that target was hard to achieve, because some patients had to be transferred for diagnostic tests.

By May, Shellharbour was still processing emergency patients too slowly, and emails were flying. The head of the hospital's emergency department, Dr Simon Leslie, sent a measured one to Sue Browbank, Brodnik's boss: "We are being asked to run our health service on the basis of the need to treat one statistic," he wrote. "Doctors have not been ignorant or uncaring of the need to manage our resources appropriately … but are driven firstly by patient care and community needs."

For a while, Leslie continued a vocal opposition to the imaginary beds. The directive to reclassify patients "according to any objective look at it was fraudulent", he told the Herald last week. "It required staff in my emergency department to write down records that were incorrect." Later he tired of battling the fait accompli and settled back to running front-line health care in the hard-to-staff hospital.

That could have been the end of it, but then Peter Garling, SC, came to town. On April 14 last year, at one of the inquiry's 34 public hearings, "Dr Leslie told me the 'virtual ward' was a fiction to compensate for the fact that Shellharbour Hospital does not have a short stay unit," Garling recounted in his report. Leslie's evidence resulted - finally - in the ward's abrupt termination, though this, as he had previously observed to Browbank, was, "easy because it doesn't actually exist".

Three weeks later, Browbank informed Leslie of the appointment of a Southern Hospitals Network Director of Emergency Medicine - which, according to Garling's later deconstruction, "both technically and in reality … effected the abolition of Dr Leslie's position". Leslie was ordered to stop calling himself director of the emergency department and told he could instead apply for a part-time position. "How is it possible," he asked a human resources manager, "to remove me from the role for which I have a contract and in which I have been acknowledged and satisfactorily functioning for over two years?"

The vaporisation of his job and claim it had never really existed were normal practice during "amalgamations and clinical reviews," the manager soothingly responded. "In many cases roles and responsibilities have changed, staff displaced and new position descriptions written."

Leslie's was a story Garling could not resist. A microcosm of the poisonous malaise he had observed on a statewide road-trip to 61 public hospitals, it comprised four elements the senior counsel had noticed repeatedly: a bottleneck between emergency and in-patient beds; inflexible performance criteria imposed from on high, then middle-management sleights-of-hand to meet those demands; and a yawning gulf of alienation between clinicians and administrators.

So when Leslie updated the inquiry on the personal fallout from his testimony, Garling in late September 2008 ordered five people as well as Leslie to four gruelling days of extra hearings, devoted to the doctor's treatment. They included Debora Picone - in 2006, chief executive of the South Eastern Sydney Illawarra Area Health Service, but elevated in 2007 to director general of NSW Health.

That won Leslie no respite. On the contrary, shortly after Garling's summonses landed on managers' desks, Leslie was cut out of meetings and told to hand back his pager and vacate his office - though ultimately he did not do so, successfully arguing both were essential to his work.

In her sworn evidence, Browbank acknowledged Leslie's job description was signed by a doctor expressly delegated to work out his role and title. Yet she maintained the position could not exist, because the doctor had no authority to create it. Garling rejected the semantic contortion. Browbank's stance "flies in the face of the obvious facts revealed by the evidence and is wholly untenable," he concluded. Because Leslie's treatment was "unreasonable, repeated, unwelcome, unsolicited, offensive, intimidating, humiliating and threatening," Garling wrote, "I find it amounted to bullying and harassment in accordance with NSW Health's own guidelines."

Leslie is an unlikely poster boy for victimhood. Affable and easygoing, it is hard to imagine him having the sleep disruptions and obsessive thoughts he says beset him at the time. He simply carried on going in to work. "At heart," said the 52-year-old, "I'm a doctor who likes to look after patients."

Doctors who like to look after patients are the backbone of the health system, but are massively disenfranchised. Re-engaging them would be the most critical step in reforming NSW Health, Garling said, proposing a Clinical Innovation and Enhancement Agency - under which clinicians would determine protocols for patient care. As well, he proposes an independent Bureau of Health Information to monitor hospital performance, freeing doctors like Leslie from political pressure to fudge the loathed KPIs.

The toughest challenge is how to make hospitals gentler. "The workplace culture in NSW public hospitals is characterised by lack of respect and trust, absence of empathy and compassion, inability to celebrate the success of others, failure to communicate, and a lack of collaboration," was Garling's damning verdict after his journey to the heart of the health system. Its anti-bullying policy had failed, dissent was quashed and persecution was rife.

Garling recommends making individual employees - all 118,000 of them - more directly responsible for their behaviour, reorienting the system away from blame towards constructive criticism and strengthening complaints procedures.

Last July, Leslie lodged a formal complaint about his treatment. Eight months later he has not been told how it will be resolved. Terry Clout, the area health service's chief executive, told the Herald he was seeking more information and would consider "any actions that may be required". He declined to comment further, citing, "procedural fairness" in the "personnel matter".

Leslie said the delay was "a process to wear me down". He understands deliberations will not privilege Garling's account of events - despite the evidence the commissioner collected under unmatched statutory powers.

Perhaps that is unsurprising. Garling said Leslie's situation went unresolved because Shellharbour managers "did not demonstrate … the slightest knowledge of what constituted bullying and unacceptable behaviour".

When is a bed not a bed? Leslie has paid a price for trying to reconcile the internal logic of NSW Health's storytelling with empirical reality, and no one has ever apologised. He will now take his case to the NSW Industrial Relations Commission. If Leslie - with the inquiry's weight behind him - cannot bring NSW Health managers to account, possibly nobody can. "Mr Garling's put a fairly heavy burden on me," he said. "I feel an obligation not to let that go to waste."

SOURCE





28 March, 2009

More NHS incompetence

IVF mother died during caesarian birth after 'doctors starved her brain of oxygen'. The NHS relies heavily on overseas doctors who are often poorly trained. "Prasad" is an Indian surname

A mother who spent years undergoing IVF treatment died after a bungled birth and never saw the baby she longed for, an inquest was told yesterday. Joanne Lockham had a Caesarean operation to deliver baby Finn but her brain was starved of oxygen for up to 30 minutes, it was claimed. Within moments of the birth she suffered a heart attack and she died two days later after sustaining massive irreversible brain damage. Her husband Peter is now bringing up Finn on his own.

The inquest jury heard that Mrs Lockham, a 45-year-old nurse from Wendover, Buckinghamshire, had been through countless rounds of failed IVF treatment when she finally became pregnant. Her baby was six days overdue when she went into Stoke Mandeville Hospital to have her labour induced on October 9, 2007.

Because doctors were concerned about the slow progress of the labour, they decided to perform a Caesarean with the assistance of an epidural anaesthetic. But later Mrs Lockham was told that further complications involving foetal distress meant she needed a general anaesthetic. She sobbed as she was told of the change of plan but midwives assured her that she would soon be holding her first child.

Jacqueline Hall, a consultant in obstetrics and gynaecology, said she did not anticipate any complications when she 'strongly' advised the Caesarean at 6pm. However, problems arose in the operating theatre. The jury heard that three attempts were made by anaesthetist Dr Prasad to insert a tube to give Mrs Lockham oxygen before it was eventually believed to have been successful.

Dr Prasad broke down in the witness box as he told how he repeatedly tried to intubate Mrs Lockham. He told the jury that on the first occasion on which he tried to provide a tube to get air to her lungs, he was unable to do it sufficiently. On the second try, the equipment was not working as he believed it should. Dr Prasad then made a third attempt to insert a tube using a mask and thought he was successful. Dr Prasad said: 'I was doing my job, but I was in a complete state of shock, I couldn't think, I was trying to be useful in anything I could. 'I went in at that point in time with a particular plan and it didn't happen. 'It was completely out of the blue and the equipment was not giving way, so I didn't know what to do, it completely numbed me, it was not what I was expecting.'

The inquest was told that just before 7pm the obstetrician started the operation and the baby was delivered. Then Mrs Lockham went into cardiac arrest. When consultant anesthetist Dr Bogdanov arrived at the hospital at 7.30pm after being paged because of the complication, he was unhappy with the placement of the intubation tube and removed it. He used the same piece of equipment that Dr Prasad believed was faulty to re-intubate Mrs Lockham.

When Dr Prasad was asked if he was blaming the equipment for his own inadequacy, he replied: 'No, I am not.' Mrs Lockham was transferred to intensive care but following brain stem tests, the decision was made to switch off her life support machine.

SOURCE




National Health Preview

The Massachusetts debacle, coming soon to your neighborhood

Praise Mitt Romney. Three years ago, the former Massachusetts Governor had the inadvertent good sense to create the "universal" health-care program that the White House and Congress now want to inflict on the entire country. It is proving to be instructive, as Mr. Romney's foresight previews what President Obama, Max Baucus, Ted Kennedy and Pete Stark are cooking up for everyone else.

In Massachusetts's latest crisis, Governor Deval Patrick and his Democratic colleagues are starting to move down the path that government health plans always follow when spending collides with reality -- i.e., price controls. As costs continue to rise, the inevitable results are coverage restrictions and waiting periods. It was only a matter of time.

They're trying to manage the huge costs of the subsidized middle-class insurance program that is gradually swallowing the state budget. The program provides low- or no-cost coverage to about 165,000 residents, or three-fifths of the newly insured, and is budgeted at $880 million for 2010, a 7.3% single-year increase that is likely to be optimistic. The state's overall costs on health programs have increased by 42% (!) since 2006.

Like gamblers doubling down on their losses, Democrats have already hiked the fines for people who don't obtain insurance under the "individual mandate," already increased business penalties, taxed insurers and hospitals, raised premiums, and pumped up the state tobacco levy. That's still not enough money.

So earlier this year, Mr. Patrick appointed a state commission to figure out how to control costs and preserve "this grand experiment." One objective is to change the incentives for preventative care and treatments for chronic disease, but everyone says that. It sometimes results in better health but always more spending. So-called "pay for performance" financing models, on the other hand, would do away with fee for service -- but they also tend to reward process, not the better results implied.

What are the alternatives? If health planners won't accept the prices set by the marketplace -- thus putting themselves out of work -- the only other choice is limiting care via politics, much as Canada and most of Europe do today. The Patrick panel is considering one option to "exclude coverage of services of low priority/low value." Another would "limit coverage to services that produce the highest value when considering both clinical effectiveness and cost." (Guess who would determine what is high or low value? Not patients or doctors.) Yet another is "a limitation on the total amount of money available for health care services," i.e., an overall spending cap.

The Institute for America's Future -- which is providing the intellectual horsepower (we use the term loosely) for reforms like those in Massachusetts -- argues that the cost overruns prove the state must cap how much insurers are allowed to charge consumers and regulate their profits. If Mr. Patrick doesn't get there first, that is. He reportedly told insurers and hospitals at a closed meeting this month that if they didn't take steps to hold down the rate of medical inflation, he would.

Even the single-payer cheerleaders at the New York Times have caught on to this rolling catastrophe. In a page-one story this month, the paper reported on the "expedient choice" that Mr. Romney and Democrats made to defer "until another day any serious effort to control the state's runaway health costs. . . . Those who led the 2006 effort said it would not have been feasible to enact universal coverage if the legislation had required heavy cost controls. The very stakeholders who were coaxed into the tent -- doctors, hospitals, insurers and consumer groups -- would probably have been driven into opposition by efforts to reduce their revenues and constrain their medical practices, they said."

Now they tell us. What really whipped along RomneyCare were claims that health care would be less expensive if everyone were covered. But reducing costs while increasing access are irreconcilable issues. Mr. Romney should have known better before signing on to this not-so-grand experiment, especially since the state's "free market" reforms that he boasts about have proven to be irrelevant when not fictional. Only 21,000 people have used the "connector" that was supposed to link individuals to private insurers.

Which brings us to Washington, where Mr. Obama and Congressional Democrats are about to try their own Bay State bait and switch: First create vast new entitlements that can never be repealed, then later take the less popular step of rationing care when it's their last hope to save the federal fisc.

The consequences of that deception will be far worse than those in Massachusetts, however, given that prior to 2006 the state already had a far smaller percentage of its population uninsured than the national average. The real lesson of Massachusetts is that reform proponents won't tell Americans the truth about what "universal" coverage really means: Runaway costs followed by price controls and bureaucratic rationing.

SOURCE





27 March, 2009

FDA - ending the atrocities

They block badly needed drugs and approve dangerous ones. They are a sort of public medicine Mafia, judging from their behaviour

A startling number of reports reveal the FDA is in far worse shape than originally thought. Few people comprehend that they are likely to suffer and die prematurely as a result of FDA’s failures.

The media does a decent job reporting on FDA disasters. The apathetic public, however, often forgets what they read the next day. That is, until they are diagnosed with a serious illness. Then they go into a panic mode to find an effective treatment. All too often, however, the cure does not exist because of FDA bureaucratic roadblocks. In other cases, the FDA-approved drugs available induce horrific side effects.

It is our mission to memorialize these tragedies to demonstrate the urgent need to radically reform the FDA. This “state-sponsored” carnage of the American citizenry must be stopped!

FDA Disseminates Fraudulent Safety Data

Ketek (telithromycin) is a drug the FDA approved to treat mild-to-moderate pneumonia. Ketek can also cause sudden and serious liver damage. In some cases, complete liver failure develops necessitating the need for a liver transplant. Some patients die before a liver transplant can be performed.1-5. The risks of liver failure (and other toxic side effects) were known before the FDA approved Ketek. In order to convince an outside scientific advisory committee to recommend that Ketek be approved, the FDA knowingly allowed a fraudulent safety study to be presented. Here is what the Senate Investigative Committee uncovered:6

* FDA accepted the resubmission of a new drug application, which included safety data that were fraudulent, in whole or in part.

* FDA employees presented the fraudulent study data to the advisory committee that was tasked with recommending Ketek’s approval or disapproval.

* FDA instructed its employees preparing to appear before the advisory committee that they should present these fraudulent safety data.

* FDA approved a pediatric clinical trial of Ketek, involving infants as young as six months old, despite concerns related to known toxicities affecting the heart, eyes, liver, and vascular system.

* FDA continued to knowingly cite the fraudulent study data in publically released safety information on Ketek.

How fraudulent were these data? While the FDA was presenting these fake data, a criminal investigation was simultaneously being conducted that found the clinic where the “safety” study allegedly occurred was closed during the time the study was supposed to have taken place. It was also determined that documents relating to the safety study had date modifications and signature inconsistencies.

Shortly after the advisory committee meeting where the fake safety data were presented by FDA employees, the person who conducted the study was criminally indicted, pled guilty, and was sentenced to almost five years in jail.

It is even more shocking that the FDA continued to cite this safety study long after the principal investigator admitted it was fraudulent. While the perpetrator of this “safety” study was in prison for falsifying the data, the FDA used the very same study to issue a Public Health Announcement stating:

“Based on the pre-marketing clinical data it appeared that the risk of liver injury with telithromycin [Ketek] was similar to that of other marketed antibiotics.”7

The “pre-marketing clinical data” FDA cited to mislead the public about Ketek was the fraudulent study, a study that may never have actually occurred. According to the Senate Investigative Committee report, “it defies explanation why the FDA would continue to cite” this fraudulent study to the American public to imply that Ketek is safe.8

The Senate Committee report concluded by stating that, “Retaliation against these individuals, or any other FDA employees who communicate with the committee with reference to Ketek will not be tolerated.”8 Based on the tone of the Senate investigative report, it would appear that the FDA functioned as a continuous criminal enterprise in this instance.8,9

The Revolving Door

You may wonder why certain officials in the FDA would go to such extreme lengths to get a lethal drug like Ketek approved. Look no further than the gargantuan economic benefits drug companies reap when a patented compound like Ketek receives the FDA seal of approval. When we first exposed the revolving door of FDA employees going to work for companies they regulate, virtually no one believed us. Back in the 1980s, most Americans were deceived by FDA propaganda stating that the agency “is responsible for protecting the public health by assuring the safety…of human drugs.”12

The harsh reality is that the FDA functions primarily to protect the financial interests of the pharmaceutical industry, not the public’s health. If anyone ever questioned this, look no further than the FDA’s attempts last year to ban the safest form of estrogen (estriol). The FDA has no qualms about publically stating that its ban on estriol was based on a petition filed by Wyeth, the maker of dangerous estrogen drugs like Premarin and Prempro.

There are a number of estrogen drugs that have not been shown to increase stroke or breast cancer risk.13 The FDA, however, has done nothing to remove Premarin or Prempro. Instead, the FDA openly seeks to protect Wyeth’s market share by denying American women access to natural estriol. According to the FDA, “bioidentical hormone products are unsupported by medical evidence and are considered false and misleading by the agency.”14 The truth is that bioidentical hormones are far less expensive and pose a major competitive threat to Wyeth, ergo the FDA’s aggressive attempts to disallow them.

In a report issued by the Associated Press just last year, it was revealed that a record number of FDA employees are leaving the agency to go to work for pharmaceutical companies. According to the Associated Press, these FDA staffers are resigning in order to go into “the more lucrative side of the business…”15

The FDA’s Brain Drain

As experienced FDA scientists leave the agency to work for Big Pharma, the remaining staff is leaner and less competent to approve new life-saving medications. As reported by the Associated Press, a consequence of FDA employees going to work for pharmaceutical companies is a clogging of the drug approval pipeline.

As long time Life Extension members know, the FDA drug approval process has always been a bureaucratic quagmire, where life-saving medications languish for years, decades, and sometimes forever. The drug pipeline has been “clogged” for almost 50 years. We are deeply disturbed that it is now taking even longer for life-saving medications to become available to those in need.

The Wall Street Journal continues to support our position with blistering exposes describing human beings who suffer horrendously and die while potential life-saving therapies languish at the FDA. An article published last year titled “Sick Patients Need Cutting-Edge Drugs” disclosed heart-wrenching reports of young cancer patients who were denied compassionate-use access to experimental drugs. The Wall Street Journal article raised the logical questions: “Why do terminally ill patients have to wait so long to get access to the only treatments that hold any promise of saving their lives? And why is it not their right to decide?”16

These very issues have been discussed in Life Extension’s publications for nearly 30 years. We have analogized in previous articles how it is perfectly legal to engage in all kinds of risky activities, such as parachuting from high bridges, but it is illegal to make experimental medications available to terminally ill people without the FDA’s permission.

According to the Wall Street Journal, the drug delay problem is getting much worse. The problem has been magnified in recent years as the number of new drug approvals has fallen dramatically. The FDA approved just 16 new drugs in 2007 and 24 in 2008.17,18 That’s down from 139 in 1996.

With the approval of life-saving drugs grinding to a snail’s pace, the moronic cruelty of denying experimental drugs to terminal patients must stop. Each day a life-saving drug is delayed, human beings perish. The case for radical reform of the Food, Drug, and Cosmetic Act and the FDA itself has never been stronger.

SOURCE




Negligent NHS hospital nearly gets healthy baby aborted



Baby Deacon Lewis is a lively, healthy baby who sleeps right through the night and is a joy to his proud parents. But Deacon, who is now six months old, was almost aborted after doctors told his mother he almost certainly suffered from a chromosome disorder that would eventually kill him.

Dawn Lewis, 26, says she was advised to have an abortion when a routine 12-week scan showed her child had Edward's syndrome. The condition causes serious heart and kidney problems with less than half of babies surviving beyond eight weeks.

After four years of trying for a baby, Miss Lewis and her partner Jonathan Blemmings, 26, a construction worker, were devastated. But Miss Lewis, a childminder, refused to have an abortion and decided to seek a second opinion on her baby's condition. She was referred to the specialist maternity hospital where a more sophisticated test found no evidence of the disorder. She said: 'I was absolutely delighted to find my baby was healthy but also horrified that I could have had him aborted. 'I was shocked that I had been advised to have a termination without first being offered a second scan and further tests. 'Thankfully we decided to pursue a second opinion because if we hadn't then Deacon may not have been here today.'

The couple have now made an official complaint to Rochdale Infirmary in Greater Manchester over the severe distress caused by the alleged mistake. They also want to warn other prospective parents that medical advice to terminate a pregnancy may not always be correct.

Miss Lewis, who has a six-year-old daughter Ayla, said: 'Many people would have taken the doctors' advice and never have known they had aborted a healthy child. It is only because of our determination to have another child that our son is with us today. 'We are really shocked that the experts we trusted got this so badly wrong and we think it's important to let other people know they don't always get things right.'

The saga began in March last year when Miss Lewis, of Rochdale, went to the hospital for a routine 12-week scan. As well as checking the baby's heartbeat and size, the scan also measures the amount of fluid at the back of the baby’s neck. Known as the nuchal translucency test, the measurement, along with the mother's age, the age of the baby and the presence or absence of the baby's nasal bone, can calculate the likelihood of the baby having a chromosomal abnormality.

'The doctor told me he was 99 per cent sure my baby had a chromosome 18 abnormality which was Edward's syndrome,' Miss Lewis said. 'He told me there would be absolutely no quality of life for my baby and told me the best thing to do would be to have a termination. 'But Jonathan and I had been trying for a baby for four years and we were not going to have an abortion so we sought a second opinion.'

A scan at St Mary's Hospital in Manchester followed four days later. She added: 'Because my pregnancy was too early for a amniocentesis test, doctors tested a tiny sample of tissue from the placenta. After a nail-biting two days the results came back that my baby did not suffer from the abnormality.'

The boy was born in Rochdale in September without complications and is now doing well

Edward's syndrome is a genetic disorder caused by the presence of all or part of an extra chromosome resulting in heart abnormalities, kidney malformations, and other internal organ disorders. It affects around one in around 3,000 babies with less than 10 per cent of sufferers surviving beyond their first year.

Mr Blemmings said: 'Even after the tests at St Mary's it was always in the back of our minds that our baby might be seriously ill, even when he was born we were really anxious. It took me a few weeks to accept he was really okay.' Deacon was born at Rochdale Infirmary and the couple have no complaints about their treatment during the birth.

A spokesman for Pennine Acute Hospitals, which runs Rochdale Infirmary, said: 'We will be conducting a full investigation into this complaint. We will make a formal response to Miss Lewis when our investigation is completed.'

SOURCE





26 March, 2009

Six die as vulnerable patients 'failed' by 'appalling' NHS

Six vulnerable people died in NHS care in a system which has demonstrated a litany of "significant and distressing failures", an official report has concluded. One man died as a result of failings in his care and it is likely that a second man's death could have been avoided, the Health Service and Local Government Ombudsmen ruled. Patients with learning difficulties were treated less favourably than others, resulting in "prolonged suffering and inappropriate care", their report said.

When their relatives complained about the care given to their loved ones, they were left "drained and demoralised and with a feeling of hopelessness".

The charity Mencap said the conclusions were a "damning indictment" that confirmed an "appalling catalogue of neglect". The investigation was launched after Mencap made a complaint on behalf of the families of six vulnerable people who died in NHS or local authority care between 2003 and 2005.

The two ombudsmen called for an urgent review of health and social care for those with learning disabilities. They found that Mark Cannon, 30, died as a consequence of public service failure by the Barking, Havering and Redbridge Hospitals NHS Trust and Havering Council in east London. Mr Cannon, of Romford, Essex, was epileptic and had a severe learning difficulty which meant he had very little speech. In June 2003 he broke his leg at a council care home and, despite receiving hospital treatment, died eight weeks later.

The ombudsmen concluded that he had been left in severe pain and great distress for prolonged periods, and was twice discharged from hospital without due concern for his safety. They also upheld a complaint against the Healthcare Commission, finding that the regulator's review of a complaint by Mr Cannon's parents was "unreliable and unsafe".

The report - entitled Six Lives - found it was "likely" that the death of Martin Ryan, 43, another patient with learning disabilities, could have been avoided had his care and treatment not fallen so far below the required standard. Mr Ryan, of Richmond, south west London, who had Down's syndrome and epilepsy, went without food for 26 days while in hospital after suffering a stroke in November 2005.

The Health Service Ombudsman, Ann Abraham, concluded that Kingston Hospital NHS Trust gave him less favourable care because of his disability. She found the failure to feed Mr Ryan for nearly four weeks "undoubtedly placed him at considerable risk of harm".

The investigation also looked at the care given to four other people with learning disabilities whose cases were highlighted in a March 2007 Mencap report called Death By Indifference. Ms Abraham said: "The recurrence of complaints across different agencies leads us to believe that the quality of care in the NHS and social services for people with learning disabilities is at best patchy and at worst an indictment of our society. "Six Lives has highlighted distressing failures in the quality of health and social care services for people with learning disabilities.

Local Government Ombudsman Jerry White added: "Six Lives shows that on many occasions basic policy and guidance were not observed, the needs of people with learning disabilities were not accommodated and services were unco-ordinated."

Mark Goldring, chief executive of Mencap, said: "The ombudsman's reports are a damning indictment of NHS care for people with a learning disability. "They confirm the findings in Mencap's Death by Indifference report of the widespread failure by health professionals to provide the proper level of care and highlight an appalling catalogue of neglect of people with a learning disability."

Care Services Minister Phil Hope said: "Preventable deaths of people with learning disabilities are absolutely unacceptable. "We are taking action to ensure that people with learning disabilities get the equal access to the health care that they deserve."

David Rogers, chairman of the Local Government Association's community wellbeing board, said: "There must be no room for complacency and a relentless focus on attempting to continually improve the services we provide to some of the most vulnerable members of society. "Health and social care organisations are already reviewing the services for those with learning difficulties because they are determined to ensure the needs of these people are put first."

SOURCE




NHS lets down injured solier

Albert Thomson was only six days into the war in Iraq when he lost his left leg after a Warrior armoured vehicle accidentally opened fire on him. He was treated in an NHS hospital in Roehampton and, though he praises the care he receives, he says that the civilian system did not have the right resources. "I was in the same queue as everybody else," he said. "The NHS couldn't supply what I needed."

Eventually he went private, buying a 25,000 pound state-of-the-art prosthetic limb with his insurance money.

He remains self-conscious about his injury, saying: "I wouldn't wear shorts in the UK." He still doesn't like having to exercise in a civilian environment, where he can't hide his amputation. "I wouldn't go to the gym. I feel uncomfortable about it."

He left the Army in 2005, and started a company, Action Amps, that uses amputees in role play to train medics, soldiers and emergency services in how to respond to serious accidents. In January, he won the Radar Disabled Entrepreneur of the Year award.

Mr Thomson, who received compensation from the Ministry of Defence, feels no sense of bitterness. He said: "If it's going to happen to you, it's going to happen."

SOURCE




Australia: Single-sex hospital wards return in NSW

HOSPITALS are to be radically reformed in New South Wales, with single gender wards returning, under major changes to be announced by the State Government. The Daily Telegraph can reveal the Government will restructure hospitals - with some services possibly shutting - when it officially responds next Monday to the Garling inquiry, held last year into NSW hospitals. Mixed-gender wards will be wiped out where possible, with men and women returning to single-sex rooms or separate ward bays.

It follows Commissioner Peter Garling SC's disgust at men and women sharing wards when he handed down his 1100-page report last November. The move back to gender wards will cost $12 million over four years and was approved by Cabinet last night. Health Minister John Della Bosca said public hospitals needed to have greater resources to place men and women in separate rooms.

Under the new plans, elderly patients would be treated in their homes rather than in hospitals in order to alleviate pressure on the system. In his report, Mr Garling said hospitals were not a suitable environment for the elderly. "My recommendations are designed to encourage models which deliver as much care as possible in the home and not in the hospital, which is a very alienating place for older citizens," Mr Garling said. Other reforms include:

* THE sacking of doctors who repeatedly fail to wash their hands;

* BEDSIDE briefings by doctors and formal shift handovers;

* BETTER supervision of junior doctors; and

* EMERGENCY response teams within hospitals.

The Garling inquiry began a year ago and was aimed at restoring the ailing health system. The landmark 10-month investigation followed a string of mishaps and the death of teenager Vanessa Anderson. The 15-year-old died at Royal North Shore Hospital in November 2005 after being given the wrong medication for a brain injury after she was struck in the head by a golf ball.

Mr Garling's controversial report made 139 recommendations, some of them regarded as radical. At least 10 hospital emergency departments were deemed "unsafe" or unnecessary. The Government has been considering whether to endorse Mr Garling's recommendation to close Manly, Ryde, Sydney, Mt Druitt, Auburn, Camden, Bulli and Kurri Kurri's emergency departments.

SOURCE





25 March, 2009

Children's lives put at risk by poor care at specialist British hospital

Children's lives were put at risk by the poor standard of care at a specialist hospital, according to the second damning report into health provision to be published this week.

An investigation by the Healthcare Commission found that there was a shortage of beds at Birmingham Children's Hospital NHS Foundation Trust as managers "struggled" to meet rising demand for treatment. This meant that seriously ill young people were admitted late while others were sent to different hospitals miles away from their families. Surgeons warned that theatre staff were poorly trained, handed them the wrong instruments and even knocked their hands during critical operations.

In addition, managers failed to act when they were warned of the dangers by consultants, the report said. Paul O'Connor, the hospital's chief executive, resigned two weeks ago.

It comes just days after another report by the watchdog found that as many as 1,200 patients may have died needlessly at Mid-Staffordshire NHS Foundation Trust, as managers put targets and cost-cutting ahead of care.

Describing the situation in Birmingham, Anna Walker, the chief executive of the Healthcare Commission, said: "While we have no evidence of serious incidents causing harm to patients, the standard of care has not been as good as it should have been in some cases. "The response to safety concerns has been slower than ideal. It is deeply concerning that serious issues were raised but not properly or rapidly addressed over several months. While I would not say there were 'third-world' conditions, there were serious potential risks in the way care was provided."

Birmingham Children's Hospital is one of only four specialist hospitals for young people in England, caring for 140,000 patients in 2007-8. Last year it was rated "excellent" for use of resources by the Healthcare Commission although only "fair" in terms of quality of services.

Senior staff at nearby University Hospital Birmingham NHS Foundation Trust met managers from the children's hospital last June to discuss their concerns about standards of care. They then wrote a highly critical report that was obtained by a Sunday newspaper under the Freedom of Information Act before it had even been seen by the children's hospital, prompting the Government to order an official investigation in December.

The Healthcare Commission found that because of increasing demand for treatment at the hospital, average bed occupancy was running at more than 98 per cent. This led to 28 per cent of admissions being cancelled on the day and 70 children a month being sent to other hospitals for treatment because there was no room for them in Birmingham. The report said this is a "special concern" for patients with liver problems, who need to be seen urgently.

Many members of staff also warned it was "very challenging" to get access to operating theatres for urgent but not life-threatening cases. There are only two days on which neurosurgery sessions take place, meaning that children admitted after Wednesday have to wait until the following Monday for treatment unless they are put on the emergency list. This situation was said to have led to several "near misses" and was a risk to patients.

The watchdog found that "almost all" consultants were worried that they could not use interventional radiology to diagnose patients because demand was so high. Surgeons said theatre staff did not always know what instruments were required for operations, and sometimes consultants brought their own equipment because the hospital did not have it. Leadership of the neurosurgical ward was said to be inadequate, driving nurses to resign.

The watchdog concluded that it was "deeply concerning" that serious concerns had been raised but not dealt with properly, causing "alarm and anxiety" among patients and their families. It made 12 recommendations about how the children's hospital can improve, including monitoring demand better and working on its relationships with consultants.

SOURCE




More NHS authoritarianism

SOME NHS hospitals are banning mothers from collecting umbilical cord blood from their babies to use as a possible source for their future medical treatment. Parents seeking to reserve the blood for themselves so that they can derive stems cells from it in the future are being told they must instead donate it to public blood banks.

The alternative is to give birth in private hospitals, which are prepared to reserve it for the child's or family's own use. A family's chance of a successful treatment with the stem cells is much higher if there is a personal match. Doctors have already used such cells to treat children with leukaemia and believe they could cure many common conditions in the future.

The row highlights the growing tension between individuals' desire to pay for advanced treatment for their own families and the state's duty to provide free healthcare for all.

King's College hospital in south London and Watford General in Hertfordshire have banned parents from collecting stem cells from the umbilical cord blood even if they hire a private technician to carry out the procedure. Watford General asks women to give to the NHS cord blood bank and King's College encourages women to give the blood to the Anthony Nolan Trust. Other trusts, such as Wirral University teaching hospital and University College London hospital, ban personal collection of stem cells but do not donate to public banks. If the women donate to the public banks, the stem cells become available for whoever is a suitable match.

Shamshad Ahmed, managing director of Smart Cells, a commercial stem cell bank storing families' personal supplies, said: "It is an injustice that certain hospitals will participate in the collection of umbilical cord blood if parents agree to give it away to a public bank but not for their own use. "It is clear these hospitals believe in the technology but are denying individuals this important opportunity to store their own baby's stem cells."

The NHS cord blood bank website compares the advantages and disadvantages of private versus public cord blood storage but it suggests women have a choice. It says: "A public donation is made as a purely altruistic act, solely for the benefit of others. It has the potential to save the life of any person for whom the unit is a good match, including the person who donated it, if it is still available. Private cord banks store a unit solely for use by the donor or their family."

Sophie Isachen, 37, from southeast London, has a history of illness in her family and her younger sister, Rosalind, died aged 26 from a rare blood disorder. Her parents offered to pay 1,600 pounds to store the umbilical cord blood stem cells from her daughter, Freya, when she was born in December. King's College hospital refused to allow the collection. Isachen said: "We decided to go down the private route because of a family history of illness. My parents were going to pay for this because, tragically, my sister died at an early age. "We are in the fortunate position that we can afford it but the unfortunate position that we have a medical history that would make us think it is something that could help us."

A spokesman for King's College hospital said: "At King's, all donations of cord blood are made on an altruistic basis. We are committed to the scheme and the potential it has to help save the lives of thousands of people in need of stem-cell transplants."

SOURCE





24 March, 2009

NHS hospital scandal: missed warnings

The shocking extent of the failures at an NHS hospital where hundreds of patients died unnecessarily can be disclosed today. Senior managers at Stafford Hospital were told repeatedly that the standard of care they were delivering was not good enough but each time the warnings were ignored. The disclosures follow the publication last week of a damning report by the NHS regulator, the Healthcare Commission, that found that hundreds of patients died at the hospital because of the "appalling" treatment they received.

Today, The Sunday Telegraph can disclose that executives at Stafford Hospital were warned as early as 2002 by the commission's predecessor that it had problems with the standard of its emergency care services and that it was not adequately staffed. However, they failed to act on the warnings. In 2006, a former government adviser warned the hospital about the standards of hygiene in A&E. Again, the warning was ignored. It was only when alerts were issued over the high mortality rate at the hospital that alarm bells rang.

At that stage an investigation by the Healthcare Commission began, resulting in the publication of last week's report and the suspension on full pay of Mid Staffordshire NHS Foundation Trust's chief executive, Martin Yeates, and the resignation of its chairman, Toni Brisby.

The Sunday Telegraph launches a campaign today for a series of measures to ensure that the crisis in Staffordshire is never repeated in the NHS. The Heal Our Hospitals campaign demands the establishment of an independent inquiry into the regulation and supervision of NHS hospitals. This has been endorsed by the Patients Association and the Cure the NHS campaign group, which worked to expose the crisis at Stafford Hospital. The two groups today launch a petition demanding an inquiry.

Richard Branson, the vice-president of the Patients Association, said: "The most important thing is that patients are happy and safe. I've signed the petition because I think patients need to have confidence that they will be. Inquiries are not about laying blame, they are about finding answers to important questions." This newspaper is also calling for:

* A review of hospital targets to ensure that they work to improve quality of care.

* Nurses to focus on patient care - not form-filling - as their central duty.

* Routine publication of comprehensive death rates for hospitals.

* Patients to be given a stronger voice in the running of hospitals.

* Assurance that senior hospital staff will not be rewarded for failure.

In an interview with The Sunday Telegraph yesterday, the chairman of the Healthcare Commission condemned the board at Mid Staffordshire NHS Foundation Trust and bosses at the strategic health authority for failing to act. Sir Ian Kennedy said it was clear that serious problems at the hospital were evident as far back as 2002, yet no action was taken by managers. Sir Ian said board members and managers who had not already left should "examine their consciences". "Anybody who had any responsibility for leadership and management must ask how they allowed this place to get into the state where patients were dying," he said.

Terry Deighton, an expert in risk assessment who carried out the inspection of A&E in February 2006 that led to another warning for Stafford Hospital, described the conditions as "absolutely disgusting". He found blood encrusted on seats, puddles of urine on the lavatory floors and doctors and nurses washing their hands in sinks encrusted with grime. Mr Deighton's report said standards of cleanliness risked placing patients in danger of infection but Mr Yeates insisted that Stafford Hospital was "very clean" and refused to meet Mr Deighton for over a year.

The commission has also criticised standards of care at Birmingham Children's Hospital NHS Foundation Trust (BCH) after it struggled to meet rising demands.

The commission is also investigating allegations that West London Mental Health Trust did not do enough to prevent patients harming themselves and other people.

The disclosures have led to concern about standards of care in the NHS and calls for a change in the target-driven culture that many emergency care specialists believe is distorting clinical priorities within A&E departments.

The Sunday Telegraph's campaign has received the backing of health experts and practitioners. Claire Rayner, the president of the Patients Association, said: "The target culture has led to a dreadful waste of professional time and extra layers of management." John Heyworth, the president of the College of Emergency Medicine, said: "The lack of doctors and nurses identified in Stafford is a dramatic example of what can happen when the focus on care in departments is lifted." Dr Peter Carter, the chief executive of the Royal College of Nursing, said: "Many of the catastrophic failings identified at the Mid Staffordshire trust could have been avoided if there were simply enough nurses to care for patients."

The Conservatives will set out their own plan to put patient safety first this week. It includes giving patients power to hold failing hospitals to account, an end to the target culture and tougher inspections to root out failure. Andrew Lansley, the shadow health secretary, said: "I welcome The Sunday Telegraph's campaign. We need to make sure that patients are listened to and give responsibility to doctors and nurses."

A survey for Channel 4's Dispatches programme to be broadcast tomorrow indicates that many nurses believe that the lives of patients were being placed in danger by a lack of training, staff shortages and long hours. It also indicates that more than a third (37 per cent) think that patient care in the NHS has become worse in the past five years. Mr Yeates refused to comment but his replacement, Eric Morton, said: "Care standards fell below those that our patients had a right to expect of their hospital and we regret this. We would like to offer our very sincere apology. "We would like to reassure the local community that our focus is, and will remain, on providing high-quality, efficient and safe health care for the people of Staffordshire. "We have put in place effective governance structures to address the key issues."

The Department of Health responded to the launch of The Sunday Telegraph campaign by insisting that the problems in Mid Staffordshire were down to "a complete failure of management" at a local level, which had been revealed through a "meticulous" inquiry by the Healthcare Commission.

A spokesman said the system of regulation and management would be reviewed; trusts were expected to monitor mortality rates, and there was no secrecy over the figures; and the system of targets set minimum standards which patients would expect.

SOURCE




Just move on: What boss of careless NHS hospital told boy's parents after missing fatal injury

The boss of Stafford Hospital, where appalling treatment may have killed hundreds of patients, sent a `callous and arrogant' letter to the grieving family of one victim. Chief executive Martin Yeates told the parents of 20-year-old John Moore-Robinson it was time to `move on'.

Mr Moore- Robinson died because doctors at the hospital failed to discover he had ruptured his spleen in a cycling accident. They sent him home with painkillers - and he bled to death. A year later, an inquest told the hospital to improve its standard of care. But it was another nine months before Mr Yeates wrote to the family. He told them: `I hope that the way the matters have been resolved speedily will go some way to help and your family feel that it's time to put the matter behind you and move on. `Please accept my apologies and regret for the death of your son.'

Mr Yeates is suspended on full pay - 15,000 pounds a month - after a damning report from the Healthcare Commission found that his NHS Trust board prioritised Government targets over basic patient care. An inquiry has been launched into his role in the scandal. Last night, Frank and Janet Robinson, both 57, branded his words ` despicable' and `insulting'. Mr Robinson said: `It makes my blood boil to think that Martin Yeates has got away with it and he's living it up it on full pay. `We can't possibly start to move on when we know that John lost his life needlessly. We've lost our boy and he thinks he can make everything OK with a letter. 'The arrogance of it is despicable. The letter is an insult. I don't for one minute think that he's truly sorry. `He was in charge of the hospital and he's at least partly responsible.'

Mr Moore-Robinson, a telecommunications worker, was thrown over the handlebars of his mountain bike on a day trip to Cannock Chase, Staffordshire, with friends in April 2006. He was taken to Stafford Hospital A&E department where an X-ray revealed broken ribs. He was vomiting and in agony but doctors prescribed pain medication and discharged him, his family said.

Friends drove him back to his home in Coalville, Leicestershire, but within hours his family called 999 because he was still in severe pain. He died minutes before paramedics arrived. His father said last night: `It's every parent's worst nightmare to lose their child but when somebody's incompetence is to blame it becomes worse. `John's treatment was shambolic and I am demanding that senior management be brought to account for the shocking waste of life.' Mr and Mrs Moore-Robinson plan to join other grieving families in suing the Mid-Staffordshire NHS Trust.

Health Commission investigators uncovered a shocking series of failings between 2005 and 2008, including staff shortages and unqualified receptionists carrying out initial checks on A&E patients. More than 100 people told them that patients were ignored as they called for help on filthy wards covered in blood and excrement. Staff showed a general lack of compassion, dignity and respect, the commission's report said. As many as 1,200 patients may have died as a result of the appalling treatment they received.

SOURCE




U.S. health care overhaul may cost about $1.5 trillion

Your lungs may work just fine, but the estimated price for universal health care could take your breath away. Health policy experts say guaranteeing coverage for all Americans may cost about $1.5 trillion over the next decade. That would be more than double the $634 billion 'down payment' President Barack Obama set aside for health reform in his budget. About 48 million people are uninsured, and the problem is only expected to get worse because the cost of coverage keeps rising.

Still, administration officials have pointedly avoided providing a ballpark estimate for Obama's fix, saying it depends on details to be worked out with Congress. "It's impossible to put a price tag on the plan before even the basics have been finalized," said White House spokesman Reid Cherlin. "Here's what we do know: The reserve fund in the president's budget is fully paid for and provides a substantial down payment on the cost of the reforming our health care system."

The potential for runaway costs is raising concerns among Republicans and some Democrats as Congress prepares to draft next year's budget. The U.S. spends $2.4 trillion a year on health care, more than any other advanced country. And some experts estimate that a third or more of that goes for tests and procedures, rather than prevention and treatment. "We shouldn't just be throwing more money on top of the present system, because the present system is so wasteful," said Sen. Judd Gregg of New Hampshire, the ranking Republican on the Budget Committee.

The health care plan Obama offered as a candidate would have cost nearly $1.2 trillion over ten years, according to a detailed estimate last fall by the Lewin Group, a leading consulting and policy analysis firm. The campaign plan would not have covered all the uninsured, as most Democrats in Congress want to do. But it is a starting point for lawmakers.

John Sheils, a senior vice president of the Lewin Group, said about $1.5 trillion to $1.7 trillion would be a credible estimate for a plan that commits the nation to covering all its citizens. That would amount to around 4 percent of projected health care costs over the next 10 years, he added. The cost of covering the uninsured is "a difficult hurdle to get over," Sheils said in an interview. "I don't know where the rest of the money is going to come from," he added.

Some of the leading advocates of coverage for all use cost estimates around $1.5 trillion. "Honestly ... we can't do it for the $634 billion the president put in the reserve fund," John Rother, public policy director for AARP, told an insurance industry meeting in Washington last week. "In all likelihood, it will be over $1 trillion," he added, citing his own estimate of $1.5 trillion.

Economist Len Nichols, who heads the health policy project at the New America Foundation, said guaranteed coverage will cost $125 billion to $150 billion a year when fully phased in.

White House budget director Peter Orszag told the House Budget Committee earlier this month that the president's $634 billion fund is "likely to be the majority of the cost." Roughly half of the money would come from spending cuts, and the other half from tax increases. But whether the $634 billion represents 50 percent, 60 percent or 70 percent of the cost "will depend on the details of whatever is finally done ... as we move through the legislative process," Orszag added.

The overall cost matters because the expansion of health coverage is meant to be a permanent reform. That means future generations will have to bear the cost. "We are dealing with huge numbers," said David Walker, a former U.S. comptroller general and now head of the Peter G. Peterson Foundation, a group that promotes fiscal responsibility. "We need to have a much better sense of what we are talking about doing, and whether or not it's affordable and sustainable over time."

SOURCE





23 March, 2009

Logic problems for the single-payer cabal

Believe it or not, Jay Leno is not the biggest clown with that particular last name. No, really, he’s not. That dubious honor instead falls to my State Senator, Mark Leno. Leno’s latest clown move is again introducing a single-payer health care measure that would impact all Californians:

The new version of the bill, SB 810, would provide medical, dental, vision, hospitalization and prescription drug benefits to every California resident and make state government the single payer of all benefit claims. Both employees and employers would be required to contribute to pay for the coverage.

So, in Leno’s California, every person would be dependent on a single agency to get health care. He sidesteps the issue by saying the following:

“It is not socialized medicine. Your doctor doesn’t change. Your hospital doesn’t change. Your clinic doesn’t change. The only thing that changes is who pays for the health care provision.”

That’s wonderful. It really is. I can choose my doctor, my hospital, my clinic, my medical marijuana club, and anything else. But to actually pay them and get anything in return, I have to crawl to a bureaucrat in Sacramento. That sure sounds like socialized medicine to me. However, I don’t just want to argue semantics about what is and isn’t socialized medicine. I want to take a look at how single-payer health care squares with some other sacred cows of the political left.

First, let’s take a trip back to the late 1990s. The fashionable thing among the left was to bitch about the big, evil corporation Microsoft and their monopolistic behavior with their operating system. I don’t dispute that monopolistic behavior is bad, but it must be remembered that this monopoly dealt with bits in a computer and was never complete. The fact that I’m typing this from Mac OS X is proof enough of that.

In comparison, the Leno bill comes off just a bit worse. Where the maligned Microsoft monopoly allowed other OS players in the space, the Leno bill creates a true, iron-clad monopoly. This brings up logic problem number 1: Why is a quasi-monopoly on computer software evil while a real monopoly on medical services is good?

Next, let’s come back to the present day and talk about the death penalty. Even after all the appeals and reexaminations of the evidence, innocent people still wind up on death row. The left, along with libertarians, argue that systems composed of human beings cannot justly hold the power of life and death in their hands.

However, the Leno bill would require that the State of California to hold the power of life and death in its hands in the form of authorizations and declinations of medical care. Here’s logic problem number 2: Why is it unjust for the courts to decide whether criminal defendants should die but just for a bureaucrat to decide whether an innocent person should die?

Finally, let’s visit a topic rarely touched on the pages of the Liberty Papers–abortion. The left argues that it is a woman’s right to choose what to do with her own body. There are legitimate questions about when a life begins, and that’s part of why the debate continues to rage.

The Leno bill places the choice about what happens to my body in the hands of a bureaucracy in Sacramento. This brings us to logic problem number 3: Why is choice for abortion sacrosanct while choice for all other procedures can be sacrificed for the common good?

How can the left support single-payer health care when it seems to go against their own principles? Discuss.

SOURCE




NHS a goldmine for lawyers

While mistreated patients get peanuts

LAWYERS are earning 800 pounds an hour from the National Health Service and taking “indefensible” fees of tens of millions of pounds in legal disputes. The money is coming from a government scheme intended to compensate patients for medical blunders and inadequate care, an investigation has found.

The compensation lawyers are claiming costs and “success fees” worth about 100m pounds a year out of the scheme. In some cases the payouts claimed are 10 times more than the damages won by the patient. Health professionals warn that it could get much more expensive. There is an estimated backlog of cases against the NHS amounting to 12 billion in claims, of which lawyers could get up to 6 billion.

The NHS Litigation Authority (NHSLA), which operates the compensation scheme, has lambasted the fees in a submission to Lord Justice Jackson, the judge. He is reviewing civil litigation costs. The document warns that some “no-win, no-fee” lawyers are allowed to charge the NHS compensation scheme £804 an hour to pursue patients’ claims. It states: “The whole costs structure is indefensibly expensive in relation to the compensation awarded or agreed. It is difficult to believe that it would be sustained were it not for the lack of motivation to change it.”

Mark Simmonds, the shadow health minister, said the huge fees being earned by the lawyers would be better spent on patient care. “It is unacceptable in some cases that the legal fees are many times higher than the awarded damages,” he said.

Bertie Leigh, a lawyer who defends the NHS in litigation cases, said he regards many of the cases he sees as a “buccaneering attack on the funds of the NHS”.

In one case involving Barking, Havering & Redbridge Hospitals NHS Trust, a legal firm claimed nearly 78,000 in costs and fees, having won just 7,000 for a female patient. A Liverpool firm submitted a legal bill for £4.4m for a single case.

The figures for 2007-8 show that more than one in four NHS trusts are paying out more in legal costs than in damages. The clinical negligence scheme paid 264m in compensation in 2007-8 of which 90m was in claimants’ fees.

Compensation lawyers say the success fees help to cover the cost of fighting cases they lose.

SOURCE




NHS patients ‘died of neglect’

VULNERABLE patients with learning disabilities have died because of neglect in NHS hospitals, an official report is expected to say this week. The report by the parliamentary and health service ombudsman will find widespread failures by doctors and nurses to care properly for people who are mentally handicapped.

The inquiry began after a report by the charity Mencap, Death by Indifference, found six patients had died through neglect while in NHS care.

One man, Martin Ryan, 43, from Surrey, died after he starved for 26 days while in Kingston hospital following a stroke. Staff had failed to use a nasal feeding tube to prevent his condition from deteriorating. This left Ryan too weak to undergo surgery to have a tube inserted into his stomach. Kingston hospital NHS Trust has apologised and says it has improved care for such patients.

Another patient, Emma Kemp, 26, from Buckinghamshire, died from cancer in 2004 after doctors said she had a 50% chance of survival but delayed treatment, the charity claims. Doctors believed Kemp, who had behavioural problems, would not cooperate. Mencap did not say which hospital she was in.

The three other cases the watchdog examined follow similar patterns, with warnings ignored or problems missed until it was too late.

The watchdog is likely to find NHS failings were responsible for some but not all of the six deaths. An earlier independent inquiry by Sir Jonathan Michael, managing director of BT Health, found that although people with learning disabilities had more physical health problems than the general population, they received less effective treatment. Michael found “appalling examples of discrimination, abuse and neglect”.

Mark Goldring, chief executive of Mencap, said: “Mencap’s Death by Indifference report exposed the horrendous deaths of six people with a learning disability who suffered a catalogue of neglect while in NHS care.” Mencap is calling for disciplinary action against the doctors and nurses responsible.

A spokeswoman for the Department of Health said: “Preventable deaths of people with learning disabilities are absolutely unacceptable. We are now taking action that will lead to people with learning disabilities getting equal access to healthcare”

SOURCE





22 March, 2009

No privacy for pregnant mothers in an American community hospital?

As the head of obstetrical services at our hospital, I was sitting in a meeting one day when the idea was broached that local obstetricians should routinely perform drug screening on the urine of all pregnant women. We were told that at a community hospital such as ours, 15–20% of women would test positive for illicit drugs. At present, the obstetrical service at our institution identifies drug use in only about 5% of our patient population. Therefore, we must be missing quite a few cases that could be identified by routine maternal drug screening. Furthermore, the hospital down the road was preparing to initiate such a plan. We must, after all, keep up with the competition.

At this point in the meeting, the role of government was introduced. It was suggested that an even better plan would be for our state (Tennessee) to mandate routine maternal drug screening. This, naturally, would mean one more state-sponsored loss of dignity for all expectant mothers. And for some, the effects would be more far reaching. Once women were identified by a positive urine drug screen, the results would go to the appropriate state social service agency. Big Brother, or rather Big Sister, would then come knocking on the door for the euphemistically named “home visit.” The mother would be encouraged to mend her ways. Of course, if she did not mend her ways in a manner satisfactory to the state, her children could be removed and sent to foster care.

Maternal drug use in pregnancy creates many problems for both the infant and mother. In relation to expectant mothers, such terms as “drug problem,” “drug addiction,” and “drug abuse” have much more serious meanings than they may have for other people. Maternal cocaine use in particular results in a wide range of morbidities — low birth weight infants (infants weighing less than 2,500 grams or five and a half pounds), infants admitted to intensive care units, and infant mortality. Amphetamine is probably the next worst drug for expectant mothers, causing many of the same types of problems as cocaine, though on a somewhat reduced scale. Maternal opioid use is most commonly associated with infant withdrawal syndrome. While it is rarely lethal, it is emotionally troubling to those who witness an infant coping with this unjust inheritance. Marijuana, while not as damaging as the other drugs, has been shown to result in smaller infants with smaller head circumferences.

It might be surprising to learn that the majority of infants born to drug-using mothers actually do fairly well. One of the best determinates of neonatal health is whether the newly born infant is admitted to the neonatal intensive care unit (NICU) instead of the regular well-baby nursery. A study from the Minneapolis-St. Paul area looked at the number of NICU admissions among women who tested positive for illicit drugs (cocaine, opioids, and marijuana). This number was then compared to the remainder of mothers, who had negative tests. The results were a 20.7% NICU admission rate for mothers who were drug-test positive versus a 12.3% NICU admission rate for mothers who tested negative. One can argue whether this glass is half full or half empty. Maternal drug use resulted in a 69.7% increase in admissions to the intensive care unit. However, 79.3% of infants born to women who used drugs were admitted to the regular well-baby nursery. Perhaps the best way to look at the data is to say that maternal drug use conferred an additional 8.4% risk of bad outcomes beyond the baseline rate. In considering this drug-induced penalty, one should also note that many babies who are initially admitted to the NICU eventually have a good outcome.

Reduction of the 8.4% increase in infant morbidity among drug-exposed children is a worthy goal. Since drug-abusing mothers often lie about their habits, routine universal drug screening has been increasingly advocated. Routine urine drug screening is often touted as highly accurate and inexpensive. Once women are identified as users of illicit drugs, they can be directed towards comprehensive programs. These programs, which concentrate on drug abstinence counseling and obstetrical care, have shown progress in lessening infant morbidity. While this certainly sounds good, it can be shown that each of the premises is highly problematic.

First, maternal drug testing is not the only way to identify substance abuse. While it is true that over 50% of women who abuse drugs will not admit to doing so, there are other ways of identifying most drug-abusing women. Think of it as a type of profiling.

Several studies have shown that carefully designed questionnaires identify the majority of drug-abusing mothers. In one study from the University of California, Davis, 93% of women whose urine tested positive for drugs had one of the following three characteristics: actual admission of drug use, poor or no prenatal care, and cigarette smoking. By asking the right questions and noting salient patient characteristics, one could identify the women most likely to be using drugs.

Secondly, routine drug screening is neither straightforward nor cheap. Abstaining from cocaine and opioids for a 72-hour period prior to testing often leads to a negative drug test; consequently there is ample opportunity to beat the system. In addition, some drugs, such as amphetamines, have a high false-positive rate; i.e., the urine tests positive even when no amphetamines have been taken. Confirmatory testing with gas and liquid chromaphotography is necessary to confirm a positive drug screen. This sounds expensive, and it is. As an example, the average charge to our office for routine prenatal blood work is $77. The charge for urine drug screening is $19. But adding a confirmatory test for a positive drug screen costs another $70. By this measurement, the cost of drug screening plus confirmation exceeds the cost of routine prenatal lab work.

The most problematic idea, however, is the notion that once drug-using mothers are identified, they can be counseled, supported, and nurtured to the betterment of themselves and their infants. Several studies have been undertaken of this noble cause. The best one, perhaps, is from Brown University, and was published in 2000. This study also showed the most encouraging results. Eighty-seven women were recruited over a three and a half year period. They received extensive support from Project Link, an organization that offers patients individualized therapy, including group and individual psychotherapy, nutritional advice, home visits, and transportation services. The 87-member study group was compared to a control group of 87 substance-abusing women who received the same care but after delivery. Compared to the control group, the study group showed a reduction in the number of premature infants, low birth weight infants, and infant admissions to the intensive care unit.

This appears to provide encouragement, but a closer look at the numbers is more sobering. The obstetrical service involved in the study was delivering approximately 9,000 babies per year. If we assume a 15% rate of maternal substance abuse, the 87 women enrolled in this study represent less than 2% of the substance-abusing women delivering at the hospital. The authors also stated that each of the women in the study group self-reported their addiction and volunteered for the program. This is clearly an unusually dedicated group of women who wanted to do the best for their infants. Unfortunately, it is also a small group of women. The vast majority of substance-abusing mothers would not comply with such a program. The noncompliant mothers were aware that their behavior was harmful to their babies, yet their addiction to the drug was just too strong. Inchoately, they know what the apostle Paul knew: “I do not understand what I do. For what I want to do I do not do, but what I hate I do” (Romans 7:15). No matter how good the intentions of large hospital systems and state government, these entities cannot loosen the grip that addicting drugs have on a mother.

Of course, there is one option for drug-abusing mothers that might prove successful. In a study done through the North Carolina state penal system, pregnant inmates were followed closely throughout their gestations. Their prison-based pregnancies were compared to their other pregnancies. Specifically, infants who were delivered when their mothers were in prison were compared to their siblings, delivered when their mothers were not in prison. Pregnancies that came to term in prison resulted in the birth of larger infants with fewer premature deliveries. It was speculated that the women received more regular prenatal care and better nutrition while in prison. Also, they presumably had forced abstinence from drugs. Still, the authors of this study concluded that the benefits of slightly larger babies were overridden by problems inherent to incarceration, such as familial separation and maternal anxiety. Mercifully, there are no serious voices suggesting this level of governmental intervention.

A final argument is that routine drug screening in pregnant women might keep them from seeking prenatal care. In researching this paper, I identified no studies that quantitated the effect that routine maternal drug screening would have on attendance for prenatal care. It is a well-accepted fact that under the current system, where drug testing is usually not mandated, drug-abusing women show up less often and more sporadically for prenatal care. There is reasonable concern that mandatory drug testing, and the resultant governmental demands for drug abstinence, would still further decrease attendance at obstetrical clinics.

There is, to be sure, a fairly sizable group of women who will not commit to drug abstinence but still show up for prenatal care. Many of these women attend methadone clinics. Methadone can best be viewed as opiate-lite. It should not be viewed as a treatment for all drug-abusing women as it is only prescribed for women with opiate addictions. (Opiates include such well-known drugs as heroin, morphine, oxycodone and hydrocodone.) As an example, methadone would have little benefit for a woman with a crack cocaine problem. In general, however, methadone does seem to have three distinctive advantages over illicitly obtained opiates. First, there seems to be less morbidity for the newborn infant. Second, a user of methadone is less likely to need escalating doses of the medication to get the desired calming effect. Third, withdrawal from methadone is somewhat easier than with other opiates.

But probably the greatest good derived from methadone prescription is that it tends to keep pregnant women within the prenatal care system. There is much evidence to show that women who both receive methadone in a controlled manner and also receive enhanced prenatal care have superior outcomes to women who get their opiates off the street. The prenatal care focuses on fetal growth, which can be followed fairly reliably with ultrasound measurements. It is a general truth that babies who grow well in the womb do well in the nursery. For fetuses who do not grow well, enhanced fetal surveillance is performed. This sometimes allows the delivery of infants prior to the development of fetal compromise.

In my opinion, the way in which we care for mothers who receive methadone should be a model for how we should treat all women at high risk for drug abuse. Pregnant women should be carefully questioned at the beginning of their prenatal care. Women deemed to be at high risk for drug abuse should receive the same type of prenatal care as pregnant women who are taking methadone. The growth of their fetuses should be monitored closely with ultrasound measurements. For infants who do not grow well, more intensive testing and occasionally early delivery should be offered.

This article has outlined two basic arguments against routine maternal drug screening. One is based on human nature. The other is more pragmatic. From a practical standpoint, a positive drug screen is not a secret between a patient and her physician. The test results are routinely reported to hospital social service workers who in turn report them to the appropriate state agency. The more intrusive the state becomes in monitoring drug-using women, the more each allegation of drug use will be challenged. Routine drug testing would invariably result in expensive retesting and confirmatory testing; it would therefore lead to thousands of bitter and costly legal contests. It would also lead many women who need prenatal care to decide not to get it, for fear of the tests and consequent legal involvements.

A drug-abusing woman who discovers that she is pregnant is heavily conflicted. There is the desire to do what is the best for her baby, but there is also the pull of a strong addiction. Only a few, highly motivated, strong-willed individuals are likely to benefit from comprehensive drug abstinence programs. Such women are not waiting to be notified by a hospital or state agency that they have a problem and need help. They sign up without such prompting. But for women who are either untruthful about their drug use or unwilling to commit to drug abstinence, it is unlikely that being notified of a positive drug test will materially change their behavior, unless they are in fact imprisoned.

As mentioned previously, there is an 8.4% increase in intensive-care admissions for infants born to drug-abusing mothers (20.7% versus 12.3%, for women who are not involved with drugs). While this number is not high enough to warrant extraordinary measures (e.g., incarceration) in order to protect the fetus, it is high enough to make some recommendations for closer concern and careful medical monitoring — not for a large, new extension of state power, fraught with its own possibilities of abuse.

SOURCE




End this postcode lottery in British cancer care

The nightmare of NHS bureaucracy needs sorting out

Every person reading this article has a one in three chance of getting cancer. In the most recent year for which there are statistics, 367,000 men and women in England had cancer diagnosed.

The NHS Cancer Plan for England was published in September 2000 with the laudable ambition of reducing cancer deaths. Investment was planned to improve survival through prevention, screening, early diagnosis, better treatment, hospices and cancer networks. Investment in the NHS has risen from 4.8 per cent of GDP in 1997 to 9 per cent today.

Has this money achieved its aims? Partly. Fewer people smoke, more are screened and waiting times are shorter. But bureaucracy has been an obstacle to greater success. The National Institute for Health and Clinical Excellence (NICE) has prevented effective treatment becoming widely available; the weaving of a spider's web of administrative muddle has led to death and misery.

There remains a wide variation in the standard of care and the chances of survival. This is partly because the Government believes in local autonomy - 150 primary care trusts dictate local policy, creating a postcode lottery. Living in Richmond means that you might be prescribed a drug for cancer, while you cannot be effectively treated in the stinking black hole that is Oxford. The annual administrative budget for these trusts is £5 billion.

One of my colleagues has shown that death rates from kidney cancer are solely determined by postcode. In areas where the trusts allow the use of a particularly effective drug the average survival rate is more than two years; in those where it is refused, average survival time is six months. Many readers will know that NICE has changed its mind three times over whether these kidney cancer drugs should be available.

In 2000 the Secretary of State for Health wrote in his introduction to the Cancer Plan that “decades of under-investment alongside outdated practices mean that survival rates lag behind the rest of Europe... too many variations in the quality of care across the country leave patients frustrated by the postcode lottery.” His view is still correct. Presumably his successor now needs a hearing aid as those words ring in his ears.

Secretary of State, please could our wonderful NHS be granted the gift of sanity in prescribing and clarity in administration? The nightmare of bureaucracy needs sorting out. The rationalisation of NICE and the primary care trusts would free up funds that could be used to benefit patients.

SOURCE





21 March, 2009

Even FDA approval does not protect a drug company

The Supreme Court botches a drug preemption case. Even when a drug is used in a way contrary to the company's instructions, the company is still liable!

The Supreme Court handed down its decision this month in the case of Wyeth v. Levine, ruling that federal law did not bar plaintiff Diana Levine from suing pharmaceutical maker Wyeth over allegedly insufficient drug safety warnings, even though the warnings had been approved by the Food and Drug Administration (FDA). This decision establishes the troubling precedent that a sympathetic jury can now supersede the expert opinions of the FDA on what qualifies as adequate safety labeling. Ultimately, that means drug firms face higher costs and greater uncertainty. Both are bad for patients.

Levine lost an arm to gangrene after a physician's assistant injected the Wyeth drug Phenergan in such a way that it came into contact with oxygen-rich arterial blood. Although the drug's label explicitly warned that doing so poses a high risk of tissue damage, Levine claimed that the label should have instructed physicians not to use this intravenous "IV-push" method at all. A Vermont jury agreed, and awarded Levine $7.4 million, which the court reduced to $6.7 million.

On appeal, Wyeth could not challenge the jury's fact finding, but argued that the FDA's extensive regulation of drug labeling should preclude claims of negligent failure to warn. The Supreme Court held, by a 6-3 majority, that federal law does not preempt Levine's claim.

According to Justice John Paul Stevens' majority opinion, "The history of the [Food, Drug, and Cosmetics Act] shows that Congress did not intend to preempt state-law failure-to-warn actions." Although true in a general sense, the Court failed to recognize that this is not a typical failure-to-warn case. As Justice Samuel Alito's dissenting opinion notes, Levine conceded that, in 1988, Wyeth proposed a label change that "if followed, would have prevented the inadvertent administration of Phenergan into an artery," but the FDA rejected that language.

Nevertheless, Levine alleged not only that the warning on Phenergan's label wasn't strong enough, but that Phenergan was "not reasonably safe for intravenous administration"—and that the label should have said so. That, however, poses a question regarding FDA's approval of the product for that use, not Wyeth's alleged negligence in drafting the label.

The FDA first approved Phenergan in 1955. And, as the risk of arterial injection became apparent over the years, the agency approved several changes to the drug's label, which now contains six statements (two in all capital letters and bold face type) warning doctors about the exact nature of that risk.

The doctor and physician's assistant who treated Levine nevertheless administered a dose twice as high as indicated, injected it into the inner crook of her arm where the risk of accidental arterial injection is very high, and continued to push in the syringe's plunger despite Levine's protestations of pain, each in direct contravention of explicit label warnings. It was this negligent administration that caused the massive tissue damage that led to the amputation of her arm.

Levine settled a claim against the physician's assistant and the prescribing doctor, then turned her sights on Wyeth. At trial, Levine's attorney argued that, despite the FDA's approval of Phenergan's label, the drug firm acted negligently by failing to add even sterner warnings or changing the label to rule out intravenous injection altogether. But doing the latter would have overruled a FDA decision that permits IV-push injections when that method could provide more benefits than the alternative.

Justice Stevens's majority opinion asserts that the FDA can't keep track of all safety issues that arise after a drug is approved and that the agency never specifically made a determination regarding the safety of IV-push administration. Consequently, Wyeth could have changed its label without the FDA's pre-approval upon receiving information regarding the risk of arterial injection of Phenergan. But that assertion is plainly wrong. The case record shows that the FDA repeatedly and intensively investigated this exact question and determined that IV-push injection provided important medical benefits.

Furthermore, there are no allegations that Wyeth hid any information about the risks of IV injection, nor has any new information regarding the risks arisen that would call the FDA's decision into question. So, the decision in Levine is tantamount to letting a group of laymen overrule the FDA's expert opinion regarding safety. In his closing arguments at trial, Levine's attorney told the jury, "Thank God we don't rely on the FDA to...make the safe[ty] decision...The FDA doesn't make the decision, you do."

A majority of the Supreme Court agreed, concluding that FDA regulation should be seen as a floor, but should not preempt stricter state tort laws. That, however, conflicts with longstanding Court precedent regarding implied pre-emption of state laws that conflict with federal regulatory decisions. As Justice Alito's dissent notes, "the ordinary principles of conflict pre-emption turn solely on whether a State has upset the regulatory balance struck by the federal agency." That is exactly what has happened here.

The Supreme Court could have and should have held in Wyeth's favor with a narrowly tailored opinion confined to the facts of this case. Doing so would not have insulated wrongdoers from punishment, but would have recognized that Congress gave FDA statutory authority over questions of safety and efficacy because it believed a federal expert body could most effectively balance the benefits and risks of new medicines. Empowering lay juries to override those decisions means that fewer patients will benefit from important medicines in the future. Not only is the majority's decision bad law, it's very bad for patients.

SOURCE




Shocked British mother sent 100 miles to have her baby

A PREGNANT woman was sent nearly 100 miles away to have her baby after being told the city's maternity ward was full. Sophie Jacobs, 22, was rushed to the Royal Devon & Exeter Hospital when her waters broke. She was terrified for the health of her baby, which was not due for another six weeks. But to her dismay, Miss Jacobs learned the maternity unit at the hospital was already full and she would have to be sent elsewhere.

Staff at the ward gave her a steroid injection to try to develop the baby's lungs and stop the labour. Others frantically phoned to try to find her a bed elsewhere with facilities for a premature baby. She was devastated when she learned the nearest place was The Royal Gwent, in Newport, South Wales — 96 miles away.

She said: "My pregnancy was all straightforward until the last few weeks, when I started developing signs of pre-eclampsia. "When I got to the RD&E, they gave me an injection to try to stop labour. "They didn't know if it was going to work. They had to find somewhere with a bed. "They tried everywhere from Cornwall up, and said the nearest place they could find was Newport."

She said: "They put me in an ambulance and I was driven up there. Jason, my partner, had to make his own way there. "It took ages in the ambulance because of the traffic. I didn't want to go up there, but I didn't have a choice. "I had the second injection in Newport but it didn't stop the labour and I got more severe signs of pre-eclampsia."

As previously revealed in the Echo, the RD&E has closed its maternity unit twice since 2006 because of overcrowding or staffing issues.

Miss Jacobs ended up having a Caesarean section, and Zachariah was born weighing 4lb 6oz. She added: "I ended up with a very small baby and we had to stay there for 10 days. Because Zachariah was so small and early he needed to be monitored and cared for on the special care baby unit. "He was also a little jaundiced so had to spend a few days under the UV light. The staff were lovely but it was horrible because it was such a long way from home. I wanted to be home and close to my friends and family. They kept ringing to see if there was room for us in Exeter, but there never was. After being let down so many times about being transferred back, we put our efforts into concentrating on getting discharged and eventually managed to get home."

Miss Jacobs, a secretary, said her partner Jason North, 36, had been able to stay locally while she was in Newport. Zachariah, who has a 10-year-old half-sister, Olivia, was born in September and, months on, is healthy and well.

A spokeswoman from the RD&E said: "The incident was the only one of its kind in the last three years and the transfer happened despite our very best efforts to provide more local care. "It was unfortunate that in the four-hour window that the maternity unit was closed, a patient had to be transferred to another hospital but all the decisions were made with patient safety being our priority," she said.

SOURCE





20 March, 2009

Victims Of Socialism

Deadly Rationing: The gatekeeper for Great Britain's national health care system is denying cancer patients drugs that would extend their lives. Why? Because the medication is considered too expensive.

What's a life worth? Apparently not much in Great Britain. The National Institute for Health and Clinical Excellence, the government agency that decides which treatments the National Health Service will pay for, has effectively banned Lapatinib, a drug that was shown to slow the progression of breast cancer, and Sutent, which is the only medicine that can prolong the lives of some stomach cancer patients.

Banning beneficial drugs due to cost is nothing new in Britain. NICE, which has to be one of history's most ironic acronyms, forbade the use of Tarceva, a lung cancer drug proven to extend patients' lives, and Abatacept, even though it's one of the only drugs that has been shown in clinical testing to improve severe rheumatoid arthritis. Once again, we have to ask: Do we really want to use the British system as the model for a U.S. health care regime?

Promises of an effective, cost-effective health care system operated by the federal government are cruel fabrications. The British system shows that the state makes a mess of health care. So does the Canadian plan, which is plagued with unhealthy and often deadly waiting times for treatment.

The Swedish government system is no better. It also refuses to provide some expensive medication and, inhumanely, refuses to let patients buy the drugs themselves. Why? According to a Journal of American Physicians and Surgeons article, bureaucrats believe doing so "would set a bad precedent and lead to unequal access to medicine." Like Canadians, Swedes are subjected to long waits. They also have denial-of-care problems that sometimes lead to death.

A reasonable person would see the record of repeated failures in government-run medicine as evidence that such a system is not sustainable. Yet every central planner thinks he or she - or his or her immediate group - is smart enough to correct the flaws of socialist programs and therefore has the moral authority to force others to participate in his experiments. It is the same thinking that will move a person to say we are the ones we've been waiting for.

Medicine needs experimentation to progress. But experiments need to stay in the laboratories, not spread to the domain of public policy. Americans are not lab rats. They deserve to be treated with dignity and not shoved aside as expendables to be sacrificed in deference to a sacred totem of the political left.

SOURCE




Why does the NHS hate the elderly so much?

One day, when I was touring a North London hospital, I stopped in horror in front of an old lady in a blue bed jacket. Her face was a mass of bruises. I assumed she'd been brutally mugged, but the matron I was shadowing looked embarrassed. The old lady was, indeed, a victim - but of the NHS and its dreadful treatment of the elderly. First, a wrong prescription from her GP had left her so dizzy that she had tripped over and broken her hip. Then she had fallen out of her hospital bed and bashed her face.

I asked why the NHS bed lacked the cot sides available in private hospitals. 'We believe physical restraint is inappropriate to our patients' dignity,' reproved the matron. It is a case that sums up why the NHS is failing our elderly through misdiagnoses, ignorance and a culture that neglects and even despises them, putting Government targets over compassion and common sense.

I remembered that poor bruised woman when I read the horrific results this week of the Healthcare Commission's investigation into conditions at Staffordshire General Hospital. Hundreds of patients there, most of them elderly individuals who in any civilised society would expect to be treated with dignity, respect and compassion, may have died because of 'appalling' care, the commission suggested. The litany of complaints from families of the hospital's victims should shame us all: patients so thirsty they were forced to drink out of flower vases; wards described as war zones; people given wrong medication or none at all while others had to lie in soiled sheets and sick people left in A&E for hours, covered in blood and without pain relief. True, the problems did not apply exclusively to the elderly, but they were by far the most numerous among patients to be treated with such callous disdain.

And perhaps the most disturbing fact is that, far from being an isolated incident, if you are old and a health service patient anywhere in the country, you suffer more than any other patient.

Why does the NHS seem to hate the old so much? A recent survey of 201 doctors by the British Geriatrics Society found that seven out of ten specialists believe the elderly are less likely to receive a proper diagnosis and essential treatment than younger patients. Almost half believe the health service is 'institutionally ageist' and more than half admitted they were worried themselves about how the NHS would treat them in old age.

Most staff strive to treat patients with care and skill and there is a huge number of them whose dedication and professionalism we can only admire. But I spent a year researching a report on the NHS and I witnessed how the service betrays the elderly at every level. It sees neither they nor their most common illnesses as a priority. This is extraordinary because the elderly are the core business of the NHS. They occupy nearly two-thirds of general and acute hospital beds and account for half of the recent growth in emergency admissions.

And Britain is getting older. By 2025, the number of people over 80 will have increased by about 50 per cent. But simple demographics aside, it seems almost beyond comprehension that those who enter the NHS, those who choose a career caring for others, are actually denying civilised treatment to an entire swathe of the population. Surely we should, as a society, care properly for those who in earlier years have nurtured us and who now need our help. What kind of people have we become that we simply discard our elderly as an inconvenience because they get in the way of Government cost-cutting and performance targets?

As in other areas of political life, Government policy in the NHS has placed the emphasis on vote-winning targets such as waiting times and extended surgery hours for GPs. This has been at the expense of the patients who most use the NHS and are the least able to protest - the elderly. The problem is well known. A staggering 1,600 health service managers in a major national survey, reported in the Journal of the Royal Society of Medicine, believe that the elderly have benefited least from Government reforms.

But common conditions in old people - osteoporosis and incontinence, for example - still don't attract the Government's attention and spending. Meanwhile, free breast screening stops at 73, despite powerful evidence that it should continue for much longer, and anyone suffering from mental health problems is refused specialised treatment after 65.

It is not all the Government's fault. Discrimination against the elderly is prevalent throughout the medical profession. 'Old people deserve proper diagnoses and treatment,' says Dr David Oliver, a senior lecturer in elderly care medicine. 'But they are just not getting it.' Many doctors will blame symptoms such as confusion and falling on old age. But, in fact, points out Dr Oliver, acute confusion can be brought on by a change in the patient's circumstance, a bladder infection or a new medicine - and not always age at all.

Medical staff are often not helped by their training. Despite the increase in elderly patients, half of medical schools lack a geriatric medicine department. Doctors and nurses get only four or five weeks' training in caring for the elderly. As Dr Oliver says, old people are 'core users of NHS services, but they are still not high up on the agenda'. Nor are they popular with many members of medical staff. In surveys for the Royal Society for Medicine, medical students declare openly that they do not wish to work with old people. But the sheer number of old people using the NHS means that most of them will have to. How many of us want to be cared for by a doctor who has little or no interest in our ailments?

General neglect on the ward is another major problem. People in their 70s and 80s come from a generation that respects authority and hates to complain. And in a busy hospital, the quiet old lady in the corner can be safely overlooked. In a corridor of an A&E department in a London teaching hospital, I came across one old lady lying on a trolley. She had arrived at 10.30pm the previous evening and it was now lunchtime the following day. 'It's very hard on the bones,' she said, trying to smile. 'I wouldn't recommend it.' She had not been given anything to eat. 'And I haven't had a wash either. Of course, they try their best,' she said. A few hours later I returned. She was still there, but a nurse had brought her a blanket. Every time she turned over, however, it fell on the floor.

The old-fashioned matron used to be the patient's advocate. She had the power to oversee all elements of a patient's care, and take responsibility for their well-being. But the modern matron, an invention of the current Government, lacks clear authority at ward level. Some, through sheer force of personality, do an excellent job. But too many fail to ensure that even basic care is provided - and it is the elderly patients who suffer. Busy ward staff don't consider helping an elderly person to eat a priority - and so six out of ten older people are at risk of becoming malnourished while in hospital.

Patients complained to me all the time about the food. In one ward, I saw an old man wearing an oxygen mask and sitting in bed staring disconsolately at a wash bowl sitting on a bedside table covered in detritus. Next to the wash bowl lay his uneaten breakfast. A nurse, who should have helped him to wash and eat, had simply abandoned him. Indeed, many of the nurses I saw seemed indifferent or helpless. And the fact that so many of our elderly are going hungry on our wards, unnoticed, is an appalling indictment of the NHS and its attitude to the old.

No one is asking that old people should get privileged treatment. But they should get their fair share of resources and care. As the case of Staffordshire General Hospital shows all too graphically, this simply is not happening.

SOURCE





19 March, 2009

No Miracle in Massachusetts

It was only a matter of time before this story appeared, as it did in yesterday's New York Times. Having promised lavish subsidies for expansive health insurance, it seems state officials in Massachusetts have finally begun to admit that their health-care reform program, passed in 2006, is unaffordable for the state's taxpayers.

This should surprise no one. Whatever else might be said about the Massachusetts plan, it was clear from the get-go that it would overwhelm the state's budget - it was just a matter of time. All the state really did was buy hundreds of thousands of residents into heavily regulated insurance plans by moving around some existing pots of money and raising taxes. They didn't build a functioning marketplace with cost-conscious consumers, nor did they pursue - initially - the kinds of heavy-handed, government-imposed cost controls that many Democrats actually favor. In short, there was never any reason to expect health-care premiums in the state to escalate less rapidly after the "reform" than they did before the plan was adopted.

But, just as predictably, now that it is difficult to turn back and start over (hundreds of thousands of Massachusetts households are now enrolled in newly-subsidized insurance), the state wants to impose cost-controls. There is much talk of new whiz-bang systems for paying doctors and hospitals, devised by government officials, which reward more efficient ways of delivering care. Don't count on it. Inevitably, when the government tries to micro-manage payments and prices, the result is indiscriminate, across-the-board cuts, protection of incumbents, and strong disincentives for innovation. Indeed, Massachusetts' Democratic Governor Deval Patrick has already signaled where this is all likely to head: state-imposed caps on private health insurance premiums.

There are lessons here for the unfolding debate in Washington. The Obama team is essentially pursuing the Massachusetts political strategy - cover everybody first with a massive new entitlement program and worry about imposing cost-controls later. In fact, Sen. Ted Kennedy's top lieutenant assigned to pulling together a health-care bill was a principal architect of the Massachusetts's approach. And, on costs, the Obama administration keeps touting the same benign-sounding initiatives - like expanded use of health information technology - that Massachusetts officials used to cite, even though the Congressional Budget Office (CBO) has already said these kinds of steps won't come close to solving the cost problem. It is obvious that the administration is hoping it can get a bill passed without endorsing the kinds of measures which would rightly be attacked as rationing care.

But make no mistake: If President Obama succeeds, he and the Congress will be back in a year or two or three - when the coverage train has already left the station - to say the financial future of the country depends on agreeing to government-imposed cost constraints, just as Massachusetts officials are doing today.

Even the Times story hints at what's really at stake here. If we don't rely on market principles to allocate health-care resources, the country will inevitably turn to the government to keep premiums in line with income. And, as some anonymous "experts" candidly admit in the Times piece, government-written "payment practices" are highly unlikely to do the trick. Instead, these "experts" say, "the state and federal governments may need to place actual limits on health spending, which could lead to rationing of care."

SOURCE




Baby dies from infection days after two NHS midwives tell mother to ignore prescribed antibiotics

A newborn baby died from an infection just days after two midwives told the mother not to bother giving him antibiotics, a misconduct hearing was told today. Andrea Street, 34, and Jennifer Ansell, 39, told the new mother - a research doctor - it was not necessary to feed her baby boy vital medication, the Nursing and Midwifery Council heard. But the small youngster's body could not fight off an umbilical cord infection and he died two days after leaving the Royal Sussex County Hospital, Brighton, in January 2006. It is claimed Ms Street and Ms Ansell, both employed by Brighton and Sussex University Hospital NHS Trust, failed to properly care for the infant, referred to as Baby L.

The infant had been prescribed antibiotics by a hospital doctor after he developed a suspected umbilical cord infection a few hours after birth. Clare Strickland, for the NMC, said: 'Shortly after his birth there had been two episodes where he had turned blue so there were concerns about his respiratory function and there were concerns about his feeding as his blood sugar level was low. 'The first time it appeared there were any concerns about his umbilical cord were on Friday, January 27. 'A nursery nurse noticed Baby L's cord seemed wet and mucusy so she took a swab and sent it for analysis.' A doctor then prescribed antibiotics the following day, the NMC heard.

'Although there were no signs of active infection, because he had problems following birth and he was a vulnerable baby, she took a cautious approach and prescribed a five-day course of antibiotics,' added Miss Strickland. But when Ms Street discharged the mum - referred to as Dr B - she told her 'the cords look fine, don't worry about them', the hearing was told. The mother took her baby son home and put the unopened medication in the fridge.

Miss Strickland said: 'She didn't give them the option to ask questions and left them with the impression they didn't need to give the antibiotics at all. 'Because the medication was clearly prescribed by the doctor, it was the responsibility of midwife Miss Street as the discharging midwife to ensure that the patient knew about the drug, the dosage and the administration. 'She shouldn't have said or done anything that would have suggested the antibiotics should not be given.'

When community midwife Ms Ansell saw Baby L at home the next day, the mother was worried about the antibiotics. But Ms Ansell brushed off her worries and left without inspecting the antibiotics. Miss Strickland added: 'Having found out about this unusual position, if she was not sure, she should have checked with medical staff and the hospital and should certainly have checked the medication and the dosage. 'Whether this would have made a difference to his outcome, this can never be answered. 'There was due to be another visit from the community midwife the next day but Baby L died before then.'

Baby L was born on January 25, 2006 and died five days later from a bacterial infection. Miss Strickland added: 'A post mortem was carried out and the report concluded that on the balance of probabilities his death was due to a staphylococcus aureas infection. 'The Council says there was a failure to provide an appropriate level of care for this infant.' Andrea Louise Street, from Wick, Littlehampton, West Sussex, and Jennifer Maria Ansell, of Shoreham-By-Sea, West Sussex, both deny failing to provide inadequate care.

SOURCE





18 March, 2009

Socialized Obamacare for all Americans -- except veterans???

American Legion Strongly Opposed to Obama's Plan to Charge Wounded Heroes for medical Treatment

The leader of the nation's largest veterans organization says he is "deeply disappointed and concerned" after a meeting with President Barack Obama today to discuss a proposal to force private insurance companies to pay for the treatment of military veterans who have suffered service-connected disabilities and injuries. The Obama administration recently revealed a plan to require private insurance carriers to reimburse the Department of Veterans Affairs in such cases.

"It became apparent during our discussion today that the President intends to move forward with this unreasonable plan," said Commander David K. Rehbein of The American Legion in a news release early this evening. "He says he is looking to generate $540-million by this method, but refused to hear arguments about the moral and government-avowed obligations that would be compromised by it."

Commander Rehbein, clearly angered as he emerged from the session said, "This reimbursement plan would be inconsistent with the mandate `. to care for him who shall have borne the battle.' given that the United States government sent members of the armed forces into harm's way, and not private insurance companies. I say again that The American Legion does not and will not support any plan that seeks to bill a veteran for treatment of a service connected disability at the very agency that was created to treat the unique need of America's veterans!"

Commander Rehbein was among a group of senior officials from veterans service organizations joining the President, White House Chief of Staff Rahm Emmanuel, Secretary of Veterans Affairs Eric Shinseki and Steven Kosiak, the overseer of defense spending at the Office of Management and Budget (OMB). The group's early afternoon conversation at The White House was precipitated by a letter of protest presented to the president earlier this month. The letter, co-signed by Commander Rehbein and the heads of ten colleague organizations, read, in part, "There is simply no logical explanation for billing a veteran's personal insurance for care that the VA has a responsibility to provide. While we understand the fiscal difficulties this country faces right now, placing the burden of those fiscal problems on the men and women who have already sacrificed a great deal for this country is unconscionable."

Commander Rehbein reiterated points made last week in testimony to both House and Senate Veterans' Affairs Committees. It was stated then that The American Legion believes that the reimbursement plan would be inconsistent with the mandate that VA treat service-connected injuries and disabilities given that the U.S. government sends members of the armed forces into harm's way, and not private insurance companies. The proposed requirement for these companies to reimburse the VA would not only be unfair, says the Legion, but would have an adverse impact on service-connected disabled veterans and their families. The Legion argues that, depending on the severity of the medical conditions involved, maximum insurance coverage limits could be reached through treatment of the veteran's condition alone. That would leave the rest of the family without health care benefits. The Legion also points out that many health insurance companies require deductibles to be paid before any benefits are covered. Additionally, the Legion is concerned that private insurance premiums would be elevated to cover service-connected disabled veterans and their families, especially if the veterans are self-employed or employed in small businesses unable to negotiate more favorable across-the-board insurance policy pricing. The American Legion also believes that some employers, especially small businesses, would be reluctant to hire veterans with service-connected disabilities due to the negative impact their employment might have on obtaining and financing company health care benefits.

"I got the distinct impression that the only hope of this plan not being enacted," said Commander Rehbein, "is for an alternative plan to be developed that would generate the desired $540-million in revenue. The American Legion has long advocated for Medicare reimbursement to VA for the treatment of veterans. This, we believe, would more easily meet the president's financial goal. We will present that idea in an anticipated conference call with White House Chief of Staff Rahm Emmanuel in the near future.

"I only hope the administration will really listen to us then. This matter has far more serious ramifications than the President is imagining," concluded the commander.

SOURCE




The NHS hospital where 'at least 400' could have died needlessly

Unacceptable standards of patient care could have led to hundreds of deaths at a single hospital in a three-year period. A damning report to be released tomorrow by the Healthcare Commission will outline a catalogue of failings at a hospital trust blinded by a drive to save money and abide by Government waiting-time targets. An advance copy of the report seen by the Daily Mail estimated 'at least' 400 deaths between 2005 and 2008 could not be accounted for by 'other factors or by chance variation'. Sources close to the investigation into the Mid Staffordshire NHS Foundation Trust said the true figure could be as high as 1,300 patients.

The report found that mortality was 'found to be high across a range of conditions including those involving the heart, blood vessels, nervous system, lungs, blood and infectious diseases', and added: 'These findings were indicative of systemic problems across the trust's system of emergency care.' The Mid Staffordshire trust runs Stafford Hospital and Cannock Chase Hospital but it is believed the Healthcare Commission found there was no cause for concern at Cannock Chase.

Health campaigners said they feared the findings at Stafford reflect problems with the NHS nationally where targets have distorted basic care. The commission found that the A&E department was understaffed and poorly equipped; a shortage of nurses meant receptionists were left to assess patients; nurses were not trained to read cardiac monitors; patients received incorrect medication, or none at all, and were left for hours in wet or soiled bedding; there were too few specialist beds for stroke patients; essential equipment such as defibrillators was missing or not working and accepted standards of practice in infection control were not maintained.

Tory MP Bill Cash, whose Stone constituency relies on Stafford Hospital, said he had been inundated with complaints from constituents. 'I wrote to the Healthcare Commission a few months ago asking for a whole range of complaints by my constituents to be looked into. 'The report findings tally with what they have told me, especially about patients being left in dirty bedding. The Government has poured money into the hospitals but this just shows that money on its own will not solve the problems. 'There is far too much bureaucracy and too little front-line service in the NHS.'

The report said a shortage of doctors meant they 'were moved from treating seriously ill patients to deal with those with more minor ailments, in order to avoid breaching the four-hour waiting time target.' It was also critical of the trust's axing of 150 jobs - many of them nurses - over 2006/07 as part of a plan to save 10million to meet national cost-saving targets.

The commission launched an investigation in March last year after figures revealed high mortality rates for patients admitted as emergencies, which the trust had failed to investigate adequately. The trust's standardised mortality rate (SMR) was 127 in 2005/06, way above the national rate of 100, making it the fifth-highest in England. The rate is not the actual number of deaths, but an expression of the link between registered deaths and those expected from the number of diagnoses. Over the following two years, the rate at one point jumped to 145.

A source said the reference to the scandal being the likely cause of 'at least 400 deaths' was removed from the final version of the report summary yesterday morning amid concerns about the way the figure was calculated. 'Regardless of this, the report makes it obvious that the hospital had serious shortcomings. 'The fact that this trust was only the fifth-worst in England, in terms of its SMR, does not bode well for the rest of the country's hospitals.'

The period the hospital trust was under investigation coincides with the reign of the current NHS chief executive, David Nicholson, as chief executive of the West Midlands Strategic Health Authority, which covers Staffordshire. Mr Nicholson left in 2006 and was replaced by Cynthia Bower, who is the new head of the Care Quality Care Commission, which will replace the Healthcare Commission at the end of this month. Last week, it was announced that the Mid Staffordshire Trust's chairman, Toni Brisby, and chief executive, Martin Yeates, had resigned ahead of the commission's report. But sources close to the investigation believe the pair were ' sacrificed' as scapegoats to deflect attention away from Mr Nicholson and Mrs Bower's proximity to the Staffordshire scandal.

'DREADFUL, ABYSMAL, INEXCUSABLE'

Arthur Peacham, 68, had been retired for just two weeks when he was admitted to Stafford Hospital with back pain following a hernia operation. After a week he was about to go home when staff told his wife, Gillian, that he had caught the C.difficile superbug. After that, Mrs Peacham said, a series of 'horrendous' blunders helped lead to her husband's death on March 19, 2006, including failing to give him food and leaving him on 'filthy' wards.

'What happened to him was horrific,' said Mrs Peacham, 69. 'When they told me he had caught C. difficile they admitted they had known 11 other people on the ward were already infected but they had nowhere else to put him. 'They told us it wasn't contagious but my son checked on the internet and saw that it was highly contagious and could result in death. 'My husband went downhill from there. He was having trouble keeping food down and they were supposed to give him a special drink but they didn't feed him most of the time. 'Either they would forget to get a prescription from the doctor or they were too short- staffed to care for him.

Mr Peacham, an agronomist who had two sons and four grandchildren, was eventually moved to New Cross Hospital in Wolverhampton in early March. His widow said: 'There it was amazing. He was so clean and well looked after. 'Unfortunately by then it was too late. The C.diff had ravaged his body.' She added: 'The care at Stafford Hospital was dreadful, abysmal, inexcusable.'

SOURCE




Child died after Australian public hospitals sent him home three times



Calling this kid's problem "croup" is absurd. Croup has a frequent cough and there is no mention of that. And croup is very common so the doctors should have known that. The negligence is gross

Timothy Wood's parents knew something was terribly wrong with their son, but they could not get the help they were sure he needed. Desperately straining for air and with swelling around his neck, the 19-month-old was sent home from hospital on July 16, 2005, for the third time in four days. The next afternoon, he was rushed back to hospital, where he died two days later.

Anthony and Robyn Wood hope a coronial inquest will give them some answers. Their solicitor Kathryn Booth, of Maurice Blackburn, said outside the Victorian Coroners Court yesterday: "Mr and Mrs Wood have been waiting a very long time to have this inquest and it's been important to them to get answers as to why Timmy died after three presentations to two different hospitals."

Mr Wood said: "The last thing we want to have happen is the same thing happen to another child - it was bad enough to go through it. "You're not meant to outlive your children and it will be something that we will take to our grave."

In statements tendered to the court, Mr Wood said he believed the Austin Hospital should have done things differently when he took his son there on July 16, 2005. "I do not believe that Timothy should have been discharged from the hospital that evening," he said. "The medical staff was not in a position to accurately diagnose the extent of Timothy's problem or make a decision to discharge him as he had not been closely monitored and examined during his time at the hospital." Giving evidence, Mr Wood was even more direct. "We thought the observation levels (at the Austin Hospital) were pathetic. They weren't there," he said.

Timmy became sick on Thursday, July 14, 2005. By about 2am on the Friday, his breathing was badly restricted and his parents called an ambulance. He was taken to the Royal Children's Hospital, where he was diagnosed with croup, observed for four hours and given medication before being sent home. On the Saturday morning, the Woods were still concerned and took him back. When they saw the triage nurse they were told if they waited in emergency for a doctor it would be unlikely that the treatment plan would change.

They went home, but Timmy did not improve and they called a 24-hour maternal health nurse help line. The nurse could hear Timmy's laboured breathing and told Mr Wood to call an ambulance immediately and prepare for an overnight stay. But when they got to the Austin hospital - the Royal Children's was full - Timmy was not admitted. Instead, he was given more medication and sent home.

The next day, he stopped breathing. Mr Wood administered CPR until an ambulance arrived and Timmy was rushed to the Royal Children's Hospital, where he died two days later. Mr Wood wrote in a letter to the coroner in August 2005: "It was said to us by some of the (intensive care unit) team at the Royal Children's Hospital that they are amazed that a child can die from croup these days. "The Austin Hospital and medical team simply let us down."

The inquest, before coroner David Drake, continues.

SOURCE





17 March, 2009

Hospital waiting lists will soar due to European laws, British surgeons warn

Patients face a significant increase in waiting times for operations as 'insane' European rules mean doctors' hours are cut so much medics will not be able to cope, surgeons have warned.

The key pledge of Labour's NHS reform has been to reduce waiting lists and now the majority of patients are treated within the target of 18 weeks from seeing their GP. However this will be reversed as junior doctors will be limited to working a 48-hour week, from their current 56 hours, it is claimed. The extension of the European Working Time Directive will effectively result in the loss of thousands of doctor shifts, John Black, President of the Royal College of Surgeons said. And the Government fears there will be a lack of locum doctors available to step in and help fill the gaps, following changes in doctors' recruitment.

It means patients will have to wait months for routine operations as surgeons prioritise emergencies rather than scheduled cases. The Royal College of Surgeons wants trainee surgeons on a 65-hour working week in order to produce safe, properly trained doctors and cover the workload required by hospitals.

Mr Black said: "If the 48 hour limit is enforced, surgeons will have to make a hard choice between caring for emergency cases and dealing with elective cases as there will not be the time available to do both. Surgeons will put patient safety first and focus on looking after emergency patients. "All the progress on reducing waiting lists will go out of the window. Forty eight hours for surgeons is currently insane if we want maintain surgery in the NHS."

Doctors have calculated an average hospital trust outside London will lose the equivalent of three trainee surgeons and other specialities such as paediatrics, trauma, and intensive care are likely to be similarly affected. Smaller surgical units may have to shut or be merged in order to comply with the Directive, Shadow Health Secretary Andrew Lansley warned.

It is understood the Department of Health is considering increasing the length of time it takes to qualify as a consultant surgeon from seven years to eight or nine so doctors can gain enough experience and also comply with the limited working week.

Vanessa Bourne of the Patients Association said: "How can this be happening in a supposedly patient-centred service? Access to high quality safe care is the paramount requisite for patient and clinician alike and this muddle needs sorting out before patients are put at risk."

The new regulations come into force on August 1 at the same time hospital trusts are trying to cope with organising the new intake of junior doctors. The shake-up of doctors' training, which caused a fiasco in 2007, means more trainees are in longer-term posts so there are now fewer candidates looking for locum posts and temporary jobs.

Remedy UK, the junior doctors pressure group, has calculated that switching all juniors from a 56 hour to a 48 hour working week is the equivalent of losing one working day per doctor per week, or up to 70,000 doctor days per week across the UK. Dr Matt Jameson Evans, co-founder of Remedy UK, said: "In many key specialties the system is already massively overstretched. "Just imagine the impact of a blanket reduction in doctors' hours by one full day a week. A creaking system will collapse. And yet most doctors want the freedom to choose to opt-out of 48 hours. "We're begging for some common sense - an official endorsement by Government of the individual opt-out for trainee doctors would go a long way."

Mr Lansley said: "NHS staff have been absolutely clear that if the 48 hour working week is imposed on them it will leave many junior doctors with insufficient experience from their training. It will also threaten the care that patients receive because there will not be the same continuity of care and because smaller surgical teams will have to be shut down."

Dr Andy Thornley, chairman of the British Medical Association's Junior Doctor Committee warned that the doctors' training will lose out because there will be an 'all hands on deck' culture to delivering patient care. He said: "Doctors will work hard to ensure that patient services are maintained, but the potential for disruption exists. The NHS will not be sustainable if we do not equip our junior doctors with the necessary training to be the consultants of tomorrow."

The Department of Health wants to delay the introduction of a 48-hour week for some specialities and is expecting an answer from the European Commission by the end of May. However this would only mean some doctors could remain on 56 hours until 2012 and will not solve the problem in the long-run, experts have said.

A spokesman for the Department of Health said: "Most UK doctors in training already comply with the Working Time Directive, and the overwhelming majority will do so by 1st August this year. However, we have notified the European Commission that we intend to operate a derogation for a small number of services involved in delivering urgent and emergency patient care."

The Working Time Directive is already in force in most areas of business, limiting the working week to 48 hours and setting minimum rest periods. Individual workers can choose to opt-out although some professions such as the Armed Forces are not covered.

SOURCE




Australia: Claims that public hospital waiting lists are "doctored"

THE Opposition wants the state government to launch an inquiry into allegations hospitals are fudging figures to avoid fines. The Victoria Police fraud squad is investigating claims many hospitals manipulate waiting list data to cash in on government bonuses and avoid paying fines.

Opposition health spokeswoman Helen Shardey said the practice showed the health system was "at crisis point". "The fact that these revelations have been sent to the police, the fact that the upper house is starting an inquiry to look into all of these matters of hidden waiting lists, I believe, is proof that the Brumby government is covering up, is not prepared to investigate and is concealing the truth." Ms Shardey said hospitals were forced to fudge figures to maximise every opportunity for funding because the health system had been mismanaged. "The Brumby government needs to investigate what is going on in our hospitals, where waiting lists are being fudged and where they are being altered to hide the true state of the time that people are waiting for procedures in our hospitals."

A computer expert who wrote a file carrying the alleged information - but who wants to remain anonymous - was employed to analyse patient data systems at several major Victorian hospitals. "Many of the hospitals and health services I have consulted with over the last year have admitted to me that they fudge the figures to avoid the fines and cash in on the bonus funding for meeting the reporting requirements," the file stated. The effect of the practice would mean a patient could be waiting up to a year for surgery but the file would show a much shorter wait, Fairfax reported today.

The file also alleges hospitals use two sets of waiting lists, where one is kept "in the drawer", used when beds become available or when a patient is clinically ready for surgery. Senior hospital staff privately admitted administrators want to avoid fines for not treating patients within required times and want to claim bonuses from the Victorian government for meeting targets, the file said.

The "ghost ward" claims follow allegations that a doctor at Angliss Hospital in Ferntree Gully was sacked after he submitted concerns about hospital data manipulation to an opposition-led upper house inquiry in January.

SOURCE





16 March, 2009

Mother of rugby suicide damns NHS

Slothful care left her son paralysed

JULIE JAMES, whose son Dan was paralysed in a rugby training accident and took his own life in a Swiss clinic last autumn, has spoken for the first time of her anger at the “disgraceful” care he received from the NHS in the hours after the accident. James believes the indifference with which her son was treated at two hospitals in the Midlands wasted 30 vital hours after the accident, in March 2007, which led to the 23-year-old becoming paralysed from the neck down. “If he had been treated differently perhaps Dan would have ended up with an injury he could have lived with,” she said.

When he was taken to hospital after a scrum collapsed on him, dislocating two vertebrae and trapping his spinal cord, James says “the terror on Dan’s face was apparent” but he still had the use of his arms and hands. Some 30 hours later, his hand function had disappeared after he had been moved unnecessarily, put last in the queue for an MRI scan and waited for four hours for an ambulance to transfer him to the spinal injuries unit at Stoke Mandeville hospital.

As she launched a fundraising drive in Dan’s memory, James, from Sinton Green, near Worcester, spoke about her “feelings of helplessness and despair” as she watched her son, who played rugby for England as a teenager, reduced to a state of “fear and loathing of his living existence”.

SOURCE




THE WRONG ANSWER TO HIGH DRUG PRICES

In state-run health care systems, cost pressures typically prompt governments to ration access to treatments for patients, often via waiting lists or low usage of medical technology. In order to provide a veneer of scientific rationale for these restrictions, governments often employ cost-benefit analyses, known as "health technology assessments" (HTAs), says the Fraser Institute.

Though these assessments may save money in the short term, they unleash a number of hidden economic consequences creating undue distress for dying patients. Many countries are increasingly turning to these types of "comparative effectiveness" reviews to restrict access to expensive new drugs, says Fraser:

* In 1988, Canada instituted a Health Technology Assessment program in Quebec; today, HTAs are widely used at the national and provincial level.

*Since 2004, Germany's Institute for Quality and Economic Efficiency in the Health Care Sector has provided "comparative effectiveness" information to health care insurers.

* Even the United States is poised to give more prominence to HTAs, as President Barack Obama has proposed to "establish an independent institute to guide reviews and research on comparative effectiveness."

But before marketing approval for a drug can occur, it must pass through 4 phases of clinical trials, says Fraser:

*( Less than 1 in 1,000 makes it past the first stage and the chance of a drug making it to approval are less than 0.03 percent.

* Moreover, every year, regulators add more mandatory tests; as a result, the average cost of bringing a new drug to market has risen from US$119 million (1975) to almost US$900 million (2003).

To solve the problem of high drug prices, it is necessary to radically overhaul the drug approval process. One solution is injecting a degree of competition. Bringing in competition could liberate innovation, speed up the development of new medicines, remove the need for expensive surgery and limit the need for costly in-patient care. This would be good for patients and health care funders alike, says Fraser.

SOURCE





15 March, 2009

Get Ready for Electronic Health Record Failures, But Don't Blame the Software

Computerized medical records are an old dream and sometimes work well enough within an individual medical practice. On a large scale, however, they seem likely to remain a dream. Britain has spent around 30 BILLION dollars in setting up such a system to cover all its hospitals -- with very poor results so far. It is common for governments and large businesses to spend many millions on custom software only to have to abandon it eventually as a failure. The article below makes the additional point that even if the software is working well, there are still large human factors making its implementation very difficult.

I have been writing scientific computer programs since 1967 so I am not anti-computer. I have however been around long enough to see a lot of very expensive failed attempts at computerization. Just as one example, the Australian government recently spent $300 million on a program to run its new submarines -- only to end up scrapping it all and buying in existing American software instead

With the Economic Stimulus Bill signed and available to subsidize EHR purchases (for more information see "The Stimulus Bill and Meaningful Use of Qualified EHRs/EMRs"), we are seeing a dramatic increase in electronic health records (EHR) buyer interest. Assuming these buyers make use of the stimulus subsidy to buy an EHR, we expect to see a lot of EHR failures over the next couple years.

Don't get us wrong! We are HUGE advocates of EHR technology. Doctors should be using EHRs. The stimulus subsidy is great. EHR software programs (and software companies) are not the problem.

Our concern is that the subsidies won't change healthcare providers' late adopter mindsets about information technology. Providers may jump at "free software" and try to avoid penalties (starting in 2015), but will they:

* Truly believe in the value of an EHR over traditional paper charts?

* Take a leadership role in advocating adoption of the new EHR in their practice?

* Change their old workflows to match the best practices in leading EHRs?

* Take part in intensive training to learn the new system?

* Ride out the difficult stages of new software adoption and change management?

Traditionally, the substantial costs of EHR systems keep the luddites from buying technology in the face of these challenges. But with "free" EHR software, we expect more than a few providers to throw caution to the wind, buy an EHR and overlook the critical implementation and change management practices that are critical to success.

The best things in life are free, but that doesn't refer to healthcare IT. We think providers would be far more serious about implementation and adoption if they had to pay dearly for the technology. Accordingly, here are our thoughts on why IT projects fail and how providers can avoid that fate while still capitalizing on this once-in-a-lifetime subsidy.

When and why do IT projects fail?

In 2007, the U.S. Office of the National Coordinator for Health IT reported that about 50% of EHR implementations failed. IT industry analysts widely agree that software implementations fail because of the customers. It's too easy to point the finger at software vendors or at the software itself, but failure usually is the buyer's fault. In a recent survey, one group identified the following top reasons for IT implementation failures:

* ~40% attribute failure to poor planning and communication;

* ~20% cite mismanagement and rejection by end users; and

* ~15% blame overspending.

Very few doctors use EHRs. In fact, most predictions put EMR market penetration at 10%-15%. We all know why this figure is so low: doctors don't want to use them, practice staff is stuck doing things "the old-fashioned way," etc. Now that Uncle Sam is willing to pay for EMRs (and telling us we had better buy!), a lot more practices are going to adopt them. The scary thing, however, is that the same feelings that have slowed the adoption of EMRs are still prevalent. Here let me present what I think are 5 critical steps for a smooth, successful EMR implementation:

1. Become a project manager. If you're a physician, you may not consider yourself a business person. However, for this project, you need to become a project manager. If you're lucky, you may have a staff member or consultant that can play the role for you, but don't count on it. First, create a project plan. Outline all the steps of your implementation so you know what changes need to occur by certain deadlines. Stay on top of the plan and hold your team accountable.

2. Rally everyone else. Recall that poor leadership and lack of user adoption are frequently cited as contributing factors to IT failures. You need to express confidence in the technology and get your staff on board before the implementation. Show how much easier their lives will be. Get them excited about it. Tell your patients that next time you see them, you will be a computer whiz with a slick EHR.

3. Buy the best training you can. The government is paying for it (laugh). Seriously though, you will need the help. It's too easy to skimp on adequate training and ongoing support. Don't risk failure of an investment because you want to save a few thousand bucks. It's worth it. Get trainers in the office, send the staff to training, implement a train-the-trainer program.

4. KISS: Keep It Simple, Stupid. No office becomes paperless overnight, so don't try to do everything at once. Ease into your new workflow as much as you can. Adopt advanced features after you learn how to turn on the computer. It is OK to implement bells and whistles after the initial dust has settled.

5. Be prepared to practice differently. As much as you don't want to admit it, you will need to adjust the way you meet with patients and how your practice operates. And if you can, make easy adjustments ahead of time. Start carrying a tablet PC or dictating with voice recognition software. It pays to work out the kinks early on.

If you follow these major guidelines - and a lot more small steps in between - you'll have a much greater chance of EHR success. Most importantly, wrap your head around being tech savvy and enjoying the new system. If you don't, you'll pay for it (one way or another).

SOURCE



Negligent NHS doctors let teenager die of cancer

A teenager died from massive cancerous tumours after his GP repeatedly failed to diagnose the disease and told him to 'grow up a bit and stop worrying', an inquest has heard. Christopher Chaffey, 19, was so worried about his failing health that he visited his doctor's surgery half a dozen times in the 15 months up to his death. His symptoms were dismissed as minor and allegedly put down to 'panic attacks'. Even when a blood test was 'significantly abnormal', the GP thought it indicated mild anaemia instead of taking it more seriously.

X Factor contestant Mr Chaffey found the same attitude at a hospital casualty department when he was taken there by ambulance with a headache, vomiting and chest pains. A doctor at Hull Royal Infirmary believed he had an anxiety-related condition and told him to consult his GP.

But the teenager's body was gradually being ravaged by cancer and he died two months later - two days after doctors finally discovered the true nature of his condition. A post-mortem examination found tumours in his neck and skull, as well as a huge tumour affecting his heart and lungs which weighed four-and-a-half pounds.

The alleged medical blunders were revealed at an inquest in Hull. Dr Sahra Ali, a consultant haematologist who was involved only at the very end of his treatment, told the hearing that the lymphoma would have taken months to develop. The doctor added: 'It's a very sad case which is treatable and potentially curable if it would have presented at an earlier stage.'

Mr Chaffey, of Coniston, near Hull, was a music fan and had been a contestant in The X Factor two years earlier, although he failed to get beyond the first round. He was forced to postpone his A-level studies in media and law because of his health problems.

The inquest heard how Mr Chaffey's GP, Joseph Austin, ordered blood tests in July 2007 after the teenager complained of excessive sweating and hair loss. The tests showed abnormalities, but were not considered important. Repeat blood tests the following April showed his haemoglobin levels had fallen, which the GP diagnosed as a mild type of anaemia.

Independent expert Bill Holmes said these blood test results should have been 'explored more actively'. He said night sweating was a well-recognised symptom of lymphoma, although GPs usually came across more innocent causes.

Mr Chaffey's mother Patricia, 40, told the hearing that when her son went back to the GP with his taxi driver father Paul, 43, they were allegedly told 'he should grow up a bit and stop worrying there's something wrong with him'. She took him back to the GP when bouts of fainting prevented him from doing voluntary work at a charity shop. Mrs Chaffey told the GP about prominent veins on her son's chest, his voice becoming hoarse, and that she sometimes had to sleep in his bedroom, but the doctor put it down to panic attacks, the inquest heard.

Dr Austin said he never suspected his patient was suffering from anything serious. Asked by coroner Geoffrey Saul whether he had ever suggested to a member of the family that the problem was in the mind, Dr Austin replied: 'No, I never told him that.'

On July 19 last year, when Mr Chaffey was taken to Hull Royal Infirmary, tests were ordered by Dr Mohammed As'Ad, who also decided there was nothing physically wrong with him.

Later, consultant Mark Higson concluded there had been 'several' missed opportunities at the A&E department when the cancer could have been picked up.

Mr Chaffey's father got in touch with the Psychosis Service for Young People, which put him on a six-month plan to cope with anxiety, but his health continued to worsen and his weight to drop. On September 17 last, the family spotted a lump on his neck and he was seen by an out-of-hours doctor. He was admitted to hospital but by then it was too late.

SOURCE





14 March, 2009

Shocker! Uninsured not jamming emergency rooms

1st major study contradicts conventional assumptions and shows that it is those "insured" by the government who have no place else to go

Hospital emergency rooms are overcrowded because uninsured patients have nowhere else to turn. Right? Wrong, says a study published in the Journal of the American Medical Association. Hospital emergency rooms are, indeed, jammed. But it's not for the reason proponents of nationalized health care suggest.

The study, "Uninsured Adults Presenting to U.S. Emergency Departments: Assumptions vs. Data," found most emergency rooms are packed because more patients of all kinds – insured and uninsured alike – are choosing to visit them. Further, the study found, emergency room patients are being kept there longer than necessary when they should often be checked in or treated in a doctor's office. "This is a larger problem, and the emergency room is the canary in the coal mine," explained Carla Keirns, a contributor to the study.

In conducting the first study of its kind, researchers discovered other scholarly papers on the uninsured found that most simply assumed the uninsured are the principal cause of emergency room overcrowding. In fact, Devon Hetrick, senior fellow at the National Center for Policy Analysis, blamed those carrying government insurance for much of the overcrowding of emergency rooms.

"It's not the uninsured who burden America's emergency rooms so much as it is people who are carrying government insurance policies," he said. "The low reimbursement rates offered doctors by government programs means very few will accept taxpayer-funded insurance any more, leaving those on government plans to visit ERs for care instead of primary-care physicians."

SOURCE




1,000 British villagers wait for a dentist after just one NHS practice opens

The parlous state of NHS dentistry under Labour was exposed last night after it was revealed 1,000 people in a village ended up on a waiting list for a dentist. Nearly one in ten of the 11,500-strong population of Tadley were forced to wait after a single NHS practice opened in the Hampshire village. Their alternatives were paying privately, travelling miles to another NHS dentist - or going without treatment. Local councillor Nigel Quelch said: 'When I phoned, they said they had a waiting list of 1,000. It shows what a huge demand there is for Health Service dentistry. 'But we're very grateful to the dentist for opening in Tadley.'

In 1999, Tony Blair promised that within two years everyone would have access to an NHS dentist. Eight years later he admitted failure. A new contract, introduced three years ago to increase numbers of NHS dentists, has also been judged to have made the situation worse - with 1,000 dentists fleeing the NHS. It means the remaining NHS dentists are overwhelmed and can't take new patients - as the Tadley case shows.

LibDem health spokesman Norman Lamb said: 'We cannot continue with a postcode lottery where people like the Tadley residents can't have access to NHS dentistry.' Hampshire primary care trust confirmed the list had hit 1,000 in December but has since been cleared. It said the practice now has 7,000 patients and can't take more - meaning over 4,000 have no dentist in the village.

SOURCE




Australian government hospital fires whistleblowing doctor

Outspoken Upper Ferntree Gully doctor Peter Lazzari, a strident critic of the health system, says he was sacked today for no apparent reason. The consultant physician, an employee of the Angliss Hospital for the past 13 years, told Knox Leader he was given his marching orders earlier today and was given no reason for his dismissal.

But he had no doubt it was because of his stinging criticism of Eastern Health and the State Government.

He recently made a submission to the Upper House Parliamentary Inquiry into Public Health Data calling for tougher penalties for hospitals that fudge waiting list times.

He said bonuses for hospitals should be scrapped and negligent health executives hauled before the courts to fix the state's health system.

He is understood to be seeking legal advice following his dismissal.

Eastern Health has yet to comment.

SOURCE





13 March, 2009

NHS frees another dangerous nut

A lazy "care coordinator" leads to a man being killed

A paranoid schizophrenic who killed a man and hurt five others after hearing voices ordering him to murder English people was repeatedly failed by the NHS, an investigation has found. An independent inquiry into the treatment of Ismail Dogan found that he "slipped through the safety net" of mental health care services in North London. The authors claim Barnet, Enfield and Haringey Mental Health Trust and the Haringey Teaching Primary Care Trust failed to share information about treatment, engage with his "isolated" family and assess his care in the community.

Two days before Christmas in 2004, Dogan left his family home with a knife and after driving around Tottenham and Edmonton attacked six strangers within 90 minutes. He stabbed one man to death and hurt four men and a woman. The minicab driver, originally from Turkey, later told police that he had heard a bird telling him he was the son of Allah and so should kill English people. Dogan, now 34, was convicted of killing Ernest Meads, 58, and is currently being held at Broadmoor top security hospital. He had been diagnosed as a paranoid schizophrenic three years before the killing and placed in the care of the community mental health care team after being released from a psychiatric ward.

The investigation has again renewed calls for a review of the way mentally unstable people are being cared for in the community. Marjorie Wallace, chief executive of Sane, said the findings highlighted a series of "blunders" that showed how the NHS was failing patients and putting innocent people at risk. Last week Surrey and Borders Partnership NHS Foundation Trust was criticised for its poor treatment of Daniel Gonzales, a paranoid schizophrenic who murdered four people, despite his and his family's repeated appeals for help.

Referring to the latest report, Mrs Wallace said: "Yet again the warnings and pleas of family members went unheeded, with fatal consequences. "Following so soon after the Daniel Gonzales report, it begs the question: is care in the community working? Can all patients be safely treated by a jigsaw of mental health teams which fail to communicate with each other, respond to crises, or assess and act upon the risk that some individuals may pose to themselves or others?" The charity is calling for a "red alert" system where police and mental health are called on to respond immediately to family's warning that a relative poses a threat.

The inquiry found Dogan's care was severely compromised by the lack of consistent medical management: "For this the consultant medical team must take a great deal of responsibility." The authors said that it was obvious Dogan was a "significant risk", particularly after he had been repeatedly held in police custody for acts of violence. The report adds that Dogan's risk assessments were not always coherent or complete, meaning that when his mental health reached crisis point there was nothing in place to try to identify or rectify the problem. "It is the view of the investigation team that there was a significant system failure in that a disjointed tripartite system was operating whereby inpatient services, outpatient services and community mental health teams operated separately," the report says.

"At the time that Dogan was receiving his care different Consultants led the inpatient and outpatient services thereby ensuring that there was little continuity of care. This was compounded by poor communication systems and a care coordinator who appeared to have been performing to a standard well below that expected from someone of her experience and seniority."

SOURCE




Health 'Reformers' Ignore Facts

Debunking the Democratic argument for government-run health care.

The Democrats' case to expand government health care is so full of holes that passing it quickly is their only hope. If Americans slow down and ask questions, they will be hard-put to come up with answers. In fact, if members of Congress slow down long enough to read the detailed reports of their own Congressional Budget Office (CBO) -- or even its director's recent Senate testimony -- they will understand that many of the slogans they use to justify government intervention are false.

Statist health-care reform, for example, is said to be needed to help the economy recover in a period of deepening gloom. The president has made this argument on numerous occasions, such as earlier this week when he announced Kathleen Sebelius as his pick for Secretary of Health and Human Resources. So too has Henry Waxman (D., Calif.), chairman of the House Energy and Commerce Committee. "The costly failure of our health care system affects the financial health of our businesses," Mr. Waxman said at a conference at Families USA, the national nonprofit dedicated to health care for all Americans. "It affects our competitiveness in the world . . . This isn't something to put off; this is something to do right now to help fix our economy."

Health care certainly plays a major role in the U.S. economy, and by almost any objective account a highly positive role. It employs 13 million Americans and accounts for one out of 10 jobs. But the assertion that the costs of providing health insurance cripples American corporations in the global economy is simply wrong.

CBO director Douglas W. Elmendorf explained this last week to the Senate Committee on Finance, which is chaired by Max Baucus, a leading proponent of government health care. The point is that for employers, health care is merely a part of total compensation: It reduces cash compensation for employees but it does not increase costs of employment. To argue otherwise is to argue for lower total U.S. compensation -- that is, lower wages for U.S. workers. Said Mr. Elmendorf, "the costs of providing health insurance to their workers are not a competitive disadvantage to U.S.-based firms."

Another common argument for more government insurance is that the uninsured shift costs to private payers when they avail themselves of the health-care safety net -- thus jacking up health-care premiums in the private sector. Many reform advocates make this claim, including Sen. Edward M. Kennedy (D., Mass.) and Sen. Baucus in an op-ed in this newspaper.

This is not the case. In the first place, a recent CBO report ("Key Issues in Analyzing Major Health Insurance Proposals, " December 2008) is clear on one issue: Working to achieve universal coverage through expanding government's role in health care will increase total costs and therefore either increase premiums or taxes, not reduce them. As for the argument that the uninsured shift costs, Mr. Elmendorf was quite direct dispelling this myth in his testimony before Mr. Baucus's committee. "Overall," he said, "the effect of uncompensated care on private-sector payment rates appears to be limited."

In fact, insofar as there is a cost shift, it derives from the government programs Medicare and Medicaid, which reimburse providers at rates roughly 20% to 40% lower than the private providers. This has been detailed by the widely used and quoted health consultant firm, the Lewin Group. But this is conveniently ignored by those who want to expand government health care.

Preventative care, disease management and electronic medical records are also constantly cited as big cost-savers. The idea here is that if our health-care system was set up to prevent disease rather than just treat it, and could do so without duplicative paper records, it could save money. It's a great hypothesis, but research does not indicate it amounts to much. "In many cases," as Mr. Elmendorf testified regarding such initiatives, "those studies do not support claims of reductions in health spending or budgetary reductions."

Americans like their current health care, its plethora of choice and its intensive, high tech approach to fixing our ailments. A Gallup survey in December reported that "on balance, Americans still favor maintaining the current system, 49% to 41%." But the CBO is very clear that saving money on health care involves doing less of the very things Americans like the most.

"Studies attribute the bulk of the cost of growth to the development of new treatments and other medical technologies," the CBO notes in a report issued last December, later adding, "Given the central role of medical technology in cost growth, reducing or slowing spending over the long term would probably require decreasing the pace of adopting new treatments and procedures or limiting the breadth of their application."

In other words, reducing costs means rationing the care of those who currently have private insurance and Medicare.

SOURCE




One million patients at risk in NHS, official figures find

One million patients a year are put at risk by hospital blunders and near misses, official figures have revealed. However experts warned many more are being swept under the carpet as healthcare staff and managers fail to report incidents. Data on the number of incidents relating to patient safety, the type and the level of harm occurring in each NHS organisation in England and Wales has been published for the first time.

Martin Fletcher, chief executive of the National Patient Safety Agency, said a high number of incidents should be regarded as a good thing because it shows the organisation is taking safety seriously and is identifying and reporting cases. He admitted it is not known at what level the number of incidents ceases to be good reporting and becomes an unacceptable number of incidents. Mr Fletcher said: "Just because one (NHS trust) has a low level of incidents that does not mean it is a safe organisation."

Overall the number of incidents being reported is increasing each year and he said he hoped that would continue but the proportion of incidents resulting in serious harm or death would decline. The figures show 370 out of 422 NHS organisations in England and Wales had reported incidents but trusts are not forced to report and 52 have declined to take part or have reported fewer than 11 incidents over six months. In total there were 439,612 patients safety incidents reported to the NPSA between April and September 2008 in England and Wales. Of those 66 per cent resulted in no harm, 33 per cent were patient accidents, 10 per cent were related to treatments or surgery and nine per cent were medication problems.

Prof Sir Bruce Keogh, Medical Director at the Department of Health, said patient safety incidents probably cost the NHS o2bn a year. He said he was 'keen' to see mandatory reporting of very serious incidents but routine reporting was still in its early stages and accuracy and completeness of data will improve.

Anna Walker, Chief Executive of the Healthcare Commission, said: "We know that a significant gap exists between the number of incidents that are reported by the NHS and the number that happen in reality. We welcome the publication of information from individual NHS trusts and increases in reporting because they bring us closer to the true picture of safety and allow a critical and honest assessment of where improvements need to be made. This is a vital part of improving the safety of patients."

Steve Barnett chief executive of the NHS Confederation said: "Patients need to be reassured that more incidents do not necessarily mean a less safe organisation. We need to get all staff actively reporting so that over time we can get to grips with making hospitals safer."

SOURCE





12 March, 2009

8,000 patients malnourished after staying in NHS hospitals

More than 8,000 patients left hospital last year after becoming malnourished while under NHS care. Despite ministers' promises, this total was a 16.5 per cent increase on the previous year - and more than double the number when Labour came to power. Critics said it was shameful the NHS was sending patients home in worse condition than before treatment.

Last year 148,946 were admitted to hospital suffering from malnutrition or another severe nutritional deficiency, but 157,175 were discharged with the same condition. It means 8,229 people arrived without nutrition problems but left hospital malnourished.

The Daily Mail's Dignity for the Elderly Campaign has highlighted the scandal of old people not being fed properly in hospital. The food is often so unappetising that patients do not eat, and sometimes it is placed out of their reach and taken away untouched. Nurses often claim they are too busy to help patients eat their food. Malnutrition has soared as 13million meals each year are thrown away by the NHS.

Age Concern says 60 per cent of older patients, who occupy two-thirds of general hospital beds, are at risk of worsening health or becoming malnourished. Gordon Lishman, the charity's director general, said: 'The malnutrition of older people is still a huge problem in hospitals up and down the country.' He added: 'Food, and help with eating, must be recognised by ward staff as an essential part of patient care.'

Alison Smith, a senior dietician at the British Dietetic Association, said: 'The biggest problem in the vast majority of hospitals is that some patients simply can't eat the food they are given without help, which they don't always get.' She added: 'Food is a form of medication and if staff begin to see it that way they will take it more seriously.'

The figures, released by the NHS Information Centre, found that in 2007-08, 3,008 were discharged with full-blown malnutrition, 139,140 had nutritional anaemia and 15,027 left with other nutritional deficiencies. The total of 157,175 is more than double the 75,431 recorded the year Labour came to power. And the 8,229 whose malnutrition was caused by the NHS is also more than double the 3,336 in 1997-98.

Under pressure from the Government, those who need help with eating are served meals on red trays. However, one in three trusts have still not implemented the system. Michael Summers, chairman of the Patients Association, said: ' Sometimes food is taken away untouched from a patient who wants to eat it but can't without assistance. 'The red trays are being ignored and as a result a very high proportion of elderly patients are leaving hospitals malnourished.' Liberal Democrat health spokesman Norman Lamb said: 'It is essential that patients are given good-quality, nourishing food.' A spokesman for the Department of Health said 'Good food is important for all patients and we have recognised this as a priority issue.'

SOURCE




NHS hospitals spend less on their patients' food than prisons on their inmates

Some hospital patients have less money spent on their meals than criminals. Last year, ten hospitals spent less on breakfast, lunch and an evening meal than the 2.12 pounds a day allocated for food by the prison service. One hospital spent just one pound.

Ministers promised action to improve the quality of hospital food two years ago, saying some elderly patients were being served nothing more than a scoop of grey mashed potato. Experts say cost-cutting hospitals are increasingly moving to soup and sandwiches to save money. Others are buying food that is prepared off site, frozen and then defrosted in the hospital.

The figures from the NHS Information Centre also expose shocking waste, with some trusts throwing away a third of meals entirely untouched. A total of 11million meals a year are thrown away uneaten.

Earlier this week it emerged that more than 8,000 patients left hospital malnourished even though they had been admitted with no nutritional problems. This was up 16.5 per cent in a year and was more than double the figure when Labour came to power.

The figures on hospital food spending have been condemned by doctors, patients groups, and opposition politicians. Dr Mike Stroud of the hospital nutrition charity BAPEN said: 'The catering budget is an easy target in trusts which are pushed for money. Some have gone to soups, cold meals and sandwiches in a bid to cut costs. 'But this is a false economy: food is an integral part of treatment, not just part of the hotel service. Studies have shown that patients who eat well recover better.'

Conservative health spokesman Stephen O'Brien said: 'More people are now coming out of hospital malnourished than went in. Is it any surprise when the Government is prepared to allow some hospitals to spend less on their patients than they spend on food for prisoners?'

The figures revealed that average daily spending on hospital food across England was 6.97, compared with 9.87 in Wales. The figures do not cover Scotland. But some are spending much smaller amounts. The figures show that the Kevin White Unit at Sefton Health Park, a mental health hospital on Merseyside, spends just 1 pound on its patients. However, the local trust said this was not a true reflection of the full cost as some meals are provided on a different site and transferred. Next is Nelson Hospital, a mental health facility in South London, on 1.53. The lowest general hospital on the league table is Hemel Hempstead on 1.93. The general hospital with the highest spending is Bristol Hospital, where 16.80 is spent per patient per day.

SOURCE




Australia: More gross incompetence from Queensland Health

Anna Bligh has abandoned Health Minister Stephen Robertson after revelations he had failed to fix dangerous health staff accommodation. The Premier today repeatedly refused to support Mr Robertson after The Courier-Mail revealed public servants were still living in 60 hazardous dwellings of the original 101 residences identified across the state. Mr Robertson had promised last May to fix the problems within a few months following the completion of a statewide audit in the wake of the sexual assault of a Torres Strait nurse in her rundown living quarters.

Campaigning in Mackay today, Ms Bligh said she was "absolutely not' happy at the failures, saying she would seek a "please explain" from Mr Robertson and his director-general Mick Reid later today. "I'm very disappointed to hear progress I thought was happening has not happened," Ms Bligh said. "I will be asking serious questions ... when I return to Brisbane. I want to know why this was the case." Ms Bligh was unable to say when the residences would be fixed but has promised to provide details later today. Asked if Mr Robertson still had her support as she had previously indicated, Ms Bligh said: "I will be asking questions about this issue when I get back to Brisbane."

Her comments came after The Courier-Mail reported the failures with five of the "extreme" dwellings still being fixed. The substandard conditions were discovered after a statewide audit - launched after a Torres Strait nurse was sexually assaulted in her rundown accommodation - found broken or missing locks, security screens, lighting and smoke alarms. Asked about the progress a fortnight ago, Mr Reid was clueless and said: "I would presume all 100 have been done."

However, Mr Robertson yesterday admitted to the failure but insisted some "improvements" had been made to the five unfinished, inhabited "extreme" dwellings. He blamed the delays on the vagueness of his own audit, bad weather and re-tendering of contracts after a poor industry response. "In May last year, I had the expectation that these renovations would, indeed, be completed within months," he said. "While work is progressing well on this rectification work, there have been a number of issues which have led to the work taking longer than I was first advised."

But Opposition Leader Lawrence Springborg said the failure showed Labor had learnt nothing as the initial assault in the Torres Strait came after damning security reports were ignored. "If they spent as much time fixing things as they do spin-doctoring and making excuses, then things would be done," he said. Mr Robertson had initially lauded his response to the housing audit, fast-tracking $10 million in funding and promising completion within "weeks and months". "This should never ever be repeated (and) I am determined to ensure that," he had said. But the money spent on the work only totals $4.06 million.

The revelations come only a fortnight after Mr Robertson refused to apologise for attacking a public servant involved in the Torres Strait case, despite being unable to produce any evidence to justify the attack.

SOURCE





11 March, 2009

Obama health plan: We need details

Los Angeles Times writer Bob Rosenblatt characterized President Barack Obama's strategy for his health care proposal as, "Give me a bunch of money, and we'll figure out the details later how we are going to manage this thing." In other words, the plan's key element is vagueness.

The problem with such vagueness is that any informed public policy decision has to be based on specific proposals. Absent concrete details, which is where the devil lurks, no one - including those proposing a "reform" - can judge how it would fare or falter in the real world. So when the president wants approval for a $634 billion proposal which offers too few details for evaluation, we must ask why.

Like salesmen, politicians strive to present their wares as attractively as possible. Unlike salesmen, however, a politician's product line consists of claimed consequences of proposals not yet enacted. Further, politicians are unconstrained by truth-in-advertising laws, they have fewer competitors keeping them honest, and they face "customers" - voters - far more ignorant about the merchandise involved than consumers spending their own money.

These differences explain why politicians' "sales pitches" for their proposals are so vague. However, if vague proposals are the best politicians can offer, they are inadequate.

If rhetoric is unmatched by specifics, there is no reason to believe a policy change will be an improvement, because no reliable way exists to determine whether it will actually accomplish what is promised. Only the details will determine the actual incentives facing the decision-makers involved, which is the only way to forecast the results, including the myriad of unintended consequences from unnoticed aspects. We must remember that, however laudable, goals and promises and claims of cost-effectiveness that are inconsistent with the incentives created will go unmet.

It may be that President Obama knows too little of his "solution" to provide specific plans. If so, he knows too little to deliver on his promises. Achieving intended goals then necessarily depends on blind faith that Obama and a panoply of bureaucrats, legislators, overseers and commissions will somehow adequately grasp the entire situation, know precisely what to do about it, and do it right - a prospect that, given the painful lessons of history, should attract few real believers.

Alternatively, President Obama may know the details of what he intends, but is not providing them to the public. But if it is necessary to conceal a plan's details to put the best possible public face on it, those details must be adverse. If details of a plan made a more persuasive sales pitch, a politician would not hide them; they would be trumpeted at every opportunity as proof he really had the answers.

Claiming adherence to elevated principles while keeping detailed proposals from sight also has a strategic advantage: It defuses criticism. Absent details, any criticism can be parried by saying "that was not in our proposal" or "we have no plans to do that" or similar retorts. It also allows a politician to incorporate alternatives proposed as part of his evolving reform, as if they were his idea all along.

The new administration has already put vague proposals on prominent display. However, adequate analysis cannot rest upon such flimsy foundations. That requires the nuts and bolts so glaringly absent. In the private sector, people don't spend their own money on such vague promises of unseen products. It is foolhardy to act any differently when political salesmen withhold specifics, because political incentives guarantee that people would object to what is kept hidden. So while vagueness may be good political strategy, it virtually ensures bad policy.

SOURCE




British ambulance bureaucracy kills woman

Ambulance staff were unable to save a mother-of-two who died from a heart attack after a simple trip to the dentist went tragically wrong, an inquest was told. They were not qualified to give Marian Carrick, 46, a shot of adrenaline which could have saved her life after she suffered a severe reaction to a antibiotic Amoxicillin pill. Her neighbour, Charles Gallimore a former GP with 40 years experience, begged them to give her the drug but they refused.

It was only 30 minutes later that a second ambulance arrived at her home in Wing, Rutland, with a qualified paramedic on board who administered the drug. By then it was too late and Mrs Carrick was later pronounced dead at hospital.

The tragedy happened on the the same day she had collected the medicine from her dentist in Uppingham, Rutland, an inquest in Loughborough, Leics, was told. Pathologist Dr Angus McGregor said Mrs Carrick had taken Amoxicillin before with no ill effects but on this occasion suffered a severe reaction. He said: "The cause of death was a severe anaphylactic reaction, a severe allergic reaction. "That can lead to shock. That can lead to massive circulatory failure, and the heart and circulation fails." Mrs Carrick's medical records showed no evidence of previous allergy to any drugs.

East Midlands Ambulance Service arrived to find former doctor Mr Gallimore with Mrs Carrick and he advised them to give her adrenaline to restart her heart. But the ambulance technicians, who are qualified just below the level of full paramedics, were not permitted to administer adrenaline. Her brother Steve Jones told the inquest he thought the technicians should have used adrenaline earlier to try to save his sister. He said: "There was half an hour between the first and second ambulance. "For half an hour, they carried on with giving cardio-vascular therapy, but never thought to give her adrenaline when there was a doctor of 40 years' experience begging them to do it. "The technicians weren't qualified to deal with the situation."

Dr Colin Reid, a consultant in emergency medicine for the University Hospitals of Leicester said: "This would have been a difficult situation for the attending crew. "They would have had no way of knowing if Mr Gallimore was medically trained. "They acted appropriately and professionally, and provided the best medical care they could."

SOURCE





10 March, 2009

Black box panic

If a drug has no side-effects, it will also have no main effects

President Barack Obama has designated overhauling American health care as a priority of his administration, and he has indicated that whomever he appoints to head the U.S. Food and Drug Administration (FDA) must implement "a stricter regulatory structure" and redouble the agency's focus on food and drug safety. With mounting pressure for the incoming FDA Commissioner to dramatically reform the agency, it is worth noting that when regulators are pushed to err on the side of safety, they often make society less safe, not more. A good example is the FDA's recent crackdown on prescription antidepressants, which has led to a drop in their use and a corresponding increase in suicides among teenagers and young adults.

Critics in Congress and in the news media often accuse agency regulators of having too cozy a relationship with the drug industry and favoring industry profits over patient safety. This chorus has grown in the past few years, as the agency has come under increasing scrutiny for a host of perceived blunders in approving new medicines and for being too slow to withdraw dangerous ones from the market. FDA regulates products representing approximately one-quarter of the American economy, so even small mistakes can have huge consequences.

The problem, which many critics fail to understand, is that no drug is absolutely safe. Even the most important life-saving medicines will often have potentially dangerous side effects that are not discovered until after the drugs have been approved. And many drugs later found to be dangerous provide tremendous health benefits to the vast majority of patients who use them. So, when deciding whether any given drug should be approved in the first place, or pulled from the market once potentially harmful side effects begin to emerge, the FDA must carefully balance its benefits against its risks.

Still, as early evidence of negative side effects begins to arise, politicians and the news media demand that the FDA "err on the side of caution." The agency is often called upon to issue warnings or withdraw a drug based solely on preliminary and highly suspect information. When faced with this mounting political pressure, there is a real danger that the FDA will overreact-either by warning doctors and patients away from beneficial treatments or by withdrawing a drug from the market too quickly.

SOURCE




Father died after NHS doctors failed three times to diagnose stroke

A father died after doctors and paramedics misdiagnosed his stroke three times. Jeffery Wingrove, 48, collapsed on a Saturday with severe vomiting and crippling headaches. His wife Isabelle, 52, rang an out-of-hours GP service but doctors twice refused to make a home visit. Instead they offered to fax her local pharmacy a prescription for painkillers for her to collect.

But Mr Wingrove's condition worsened and despite emergency surgery at hospital he died less than 48 hours after falling ill. His family last month won a six-figure sum in an out-of-court settlement over his treatment.

Mrs Wingrove said: 'If he had been ill on a weekday he would still be alive today. 'They held a gun to his head and they pulled the trigger. He was never given a chance of survival. 'All they had to do was come and see him, which my usual GP would have done at the drop of a hat. But it was too much trouble for them.'

Mr Wingrove, a dustcart driver from Braintree in Essex, fell ill at around 10am on December 9, 2006. The former marathon runner crawled to the bedroom with a severe headache and was unable to move his right side easily. He began sweating and vomiting. Not knowing he was already showing clear signs of a stroke his wife, who works at the local college, contacted the family GP. But because it was a Saturday she was directed to an out-of-hours service run for Mid Essex Hospital Services NHS Trust by the private firm Primecare.

A doctor called her back at 11.35am and told her to take Mr Wingrove to hospital that afternoon for anti-sickness tablets. Mrs Wingrove pleaded for a home visit, explaining he was too ill even to lift his head from the pillow and she could not move his 6ft frame herself, but she was refused. Not satisfied, she phoned the helpline NHS Direct and a nurse told her to demand a home visit from a doctor as soon as possible. At 12.20pm she called Primecare but was again refused a home visit.

By 9pm she called paramedics, who arrived but told her Mr Wingrove had vertigo and gave him paracetamol. After a sleepless night and in major pain, he fell out of bed at 2.30pm the following afternoon and began hallucinating. He was taken to Broomfield Hospital before being transferred to the neurosurgical ward at Queen's Hospital in Romford. He died the next day despite surgery.

David Kerry, the lawyer who handled the claim of clinical negligence against East of England Ambulance Service and the GP involved, said: 'Mr Wingrove was showing all the symptoms of a stroke, whereas the current TV advertising campaign to alert the public insists that a doctor should be called if the sufferer only has one. 'Yet the NHS itself actually failed to recognise any of them, and on three separate occasions. 'It's an outrageous travesty of professional care and the public have a right to wonder, when they see the warnings of strokes on TV, whether the NHS might do better spending that money on training its own staff.'

The family - Mrs Wingrove and her sons Marc, 14, and Danny, 23 - intend to make a complaint to the General Medical Council about the GP, who has not been named. It is understood the GP no longer works for Primecare.

SOURCE





9 March, 2009

Failings at NHS children's hospital put patients at risk, says watchdog

A leading children's hospital is to be censured by the NHS watchdog for endangering the safety of vulnerable young patients by offering them substandard care. The Healthcare Commission will issue a highly critical report on Birmingham Children's Hospital that will highlight numerous failings in both quality of care and management processes. The hospital announced yesterday that Paul O'Connor, the chief executive, had resigned with immediate effect.

The report will acknowledge that poorly trained staff, inadequate equipment and a lack of operating theatres led to some youngsters receiving poor care, including some whose health was put at risk. It will make a dozen recommendations for major improvements.

Gordon Brown and health secretary Alan Johnson asked the watchdog to investigate last November after the Observer published details of a secret internal NHS report. It revealed that about 20 senior doctors were deeply concerned that recurring problems at BCH were hampering the quality of treatment being offered to patients with life-threatening conditions involving their liver, kidney, heart or brain.

BCH chairman Joanna Davis yesterday confirmed that O'Connor "has tendered his resignation with immediate effect. He has not been removed from his position." She declined to comment on the watchdog's report, the result of a four-month "intervention" inquiry, until it is published. Whitehall sources say commission staff, led by its chief investigator Nigel Ellis, uncovered evidence that seemed to endorse many, but not all, the concerns aired by medical staff.

The report is also expected to confirm another key concern raised by doctors: that some patients unnecessarily underwent major surgery designed to diagnose or treat their conditions because BCH could not offer them interventional radiology, which is minimally invasive and seen as best practice in the NHS. This is despite doctors repeatedly recommending the hospital take action to address the issue.

One surgeon described the liver transplant service at BCH as so poorly run that it had become "a third-class service [that is] putting patients at risk". Another said parents were being told lies about the unnecessary procedures because they could not admit that BCH lacked the personnel and equipment to offer an alternative.

SOURCE




Bankrupt Australian public hospital partly closed down

Bed numbers have been slashed this week at Sydney's biggest hospital, in a round of ward closures aimed at reining in a $70 million blow-out in the region's health spending. Ten of 16 operating suites have been closed and elective surgery has been cancelled, with staff forced to take leave, sources said. Forty-three cardiology and heart surgery beds have shut since late last year, said medical and nursing staff, culminating last week in the closure without notice of the heart surgery ward - which staff found empty and locked when they arrived for work.

The unprecedented axing of about 70 beds comes after the Herald revealed in late January that Sydney West Area Health Service, which oversees Westmead, owed $26 million to creditors - more than any other region and almost a quarter of NSW Health's outstanding debt to suppliers at that time.

Neurosurgery and general surgery beds have also closed, said the sources, while casual nursing shifts have been curtailed across the entire hospital, as displaced permanent staff are redeployed into vacancies on the roster. The closures represent about 9 per cent of Westmead's total capacity, and are the biggest round of cuts at a single hospital to strike the beleaguered state health system. The chairman of the hospital's Medical Staff Council, Andrew Pesce, said the closures were by far the most severe the flagship teaching hospital had seen. "It's a quantum leap [compared with] the modest bed closures usually built around [public] holidays," Dr Pesce said.

Coming a month before Easter and without any promise that beds would reopen or surgery resume, the closures were the equivalent of an extra Christmas closedown, said Dr Pesce - referring to the practice of selectively suspending services during the holiday period to save money. "If things continue the way they are going, the morale of the place will become so low that doctors and nurses will start leaving," he said. Hospital managers were not solely to blame because NSW Health gave them "unrealistic budgets".

Public hospitals had traditionally been insulated from state spending cuts, Dr Pesce said, but NSW's wider financial crisis meant they were no longer receiving favourable treatment. Health accounts for about one-third of the state's spending, and had blown out by about $300 million at the time of November's mini-budget. Area health services were ordered to save $943 million over four years.

A spokesman for the Health Minister, John Della Bosca, declined to address the Herald's specific questions about closures, offering instead in a written statement: "There have been adjustments to bed platforms and relocations of some services within Westmead's overall funding base . Westmead has further capacity to improve bed utilisation and this is a priority for management attention in the relevant services as part of the operational strategy." He also did not answer a question about the number of patients whose elective operations were cancelled, instead insisting elective surgery was still available but saying the hospital was "under resource pressure and needs to ensure that its priorities are met but not exceeded and that all opportunities to ensure it operates efficiently are explored".

The president of the NSW branch of the Australian Medical Association, Brian Morton, said he understood patients would be moved to general wards under the care of "staff who don't have the same skills". Patients would be at risk if already overcrowded hospitals were further stressed. .. That's when mistakes happen."

The Opposition's health spokeswoman, Jillian Skinner, said the closures would endanger patients. "The evidence is quite clear that delayed treatment makes conditions worse and makes the hospital stay longer - and therefore more expensive."

SOURCE





8 March, 2009

Smart Health Care's privacy pitfalls

The stimulus bill's strengthened data privacy laws are raising hackles in health care

Thanks to a $19 billion kick from the Obama administration's stimulus package, electronic health records are on the way. And with them, new privacy laws, a result of fears that digital records could lead to more spillage or theft of sensitive medical data.

But now that health care's emergence from the dead-tree era has nearly become reality, some industry executives are arguing that the stimulus bill's health 2.0 push will create the opposite privacy problem: overwhelming protections that could create costly red tape for the health care industry or flood consumers with meaningless warnings that their privacy has been violated.

Under the bill, any insurance company or hospital that accepts grant money for digitizing records will become subject to new breach disclosure laws, demanding that consumers be notified if their personal health information somehow leaks beyond the company or hospital's control. And industry executives complain that unlike similar breach laws that have passed in more than 40 states in the past several years, the bill doesn't limit those breach notifications to situations that involve a "reasonable risk of harm." Many seemingly trivial breaches will now have to be formally reported to the patient.

"The privacy provisions in the new economic stimulus bill are more than overly burdensome. They're counterproductive," says Kim Gray, chief privacy officer of health insurer Highmark.

If a doctor were to send an appointment reminder to the wrong patient, for instance, Gray says that under the new laws, the intended recipient of that notice would have to be mailed a breach disclosure letter. A postcard that wasn't concealed in an envelope might constitute a breach. Or if an insurer sent a patient an explanation of benefits and it was misdirected, that too would require notifying the patient about his or her data's being violated. Even a misdirected breach notification would itself require another notification. Gray argues that none of these cases represents a real risk of medical or financial identity theft.

"You can see that we're talking about potentially millions of breach notices just for misdirected explanations of benefits," says Joel Slackman, a managing director at Blue Cross Blue Shield. "That's a concern not just because it's an expensive administrative burden, but because it desensitizes patients."

Slackman and Gray argue that the bill's privacy statutes--which will only go into effect in a month after it's approved by the secretary of Health and Human Services, likely in September--will create a wave of "fear followed by numbness," in Gray's words. Too many disclosures in situations where identity theft isn't likely could cause consumers to waste time and money shutting down bank accounts or paying for credit monitoring. And those non-risky disclosures might dilute the effect of notices in breaches that are more likely to result in fraud, like insider theft or hacker intrusions on a network.

Privacy advocates, on the other hand, are strongly in favor of the bill's data-protection statutes. Pam Dixon, executive director of the World Privacy Forum, argues that even in the "no-risk" hypotheticals imagined by insurers, there's a potential for real privacy invasion, if not identity theft. "If the wrong person gets an appointment reminder from an AIDS or cancer clinic, that is a big deal," Dixon says.

But she also argues that the rise in breach notifications that insurers and hospitals fear isn't likely. In California, she points out, a health care privacy bill went into effect on Jan. 1 that follows a similar model to the privacy elements of the stimulus bill, requiring disclosure of all health data breaches without "risk of harm" specifications. Those new laws--largely a response to news that employees at the University of California at Los Angeles Hospital had snooped on patient records--including those of Maria Shriver, Gov. Arnold Schwarzenegger's wife--haven't resulted in more than the usual number of breach disclosures in California, Dixon says.

In fact, breaches of all kinds are growing: The Identity Theft Resource Center tracked 646 data breach incidents reported in 2008, a 47% increase over 2007's total of 446 breaches. But since the California law went into effect, only one California health organization has reported leaking patient data. An employee of Hegarty Chiropractic in Rancho Cordova, Calif., left about 200 patients' files in a dumpster, where they were found by local news media.

Still, the fallout from the California bill isn't clear. With only two months since the law went into effect, most providers still don't know what constitutes a reportable data loss incident, says LaVonne LaMoureaux. "The bill is vague," she says. "We're trying to get that sorted out, and we need some language cleanup." That means the approaching impact of the stimulus bill's privacy provisions are also somewhat unknown, says Highmark's Gray. "Once everyone understands what this means, incidents that happen fairly often because of human error will have to be reported," she says. "Things that people now don't consider as breaches are going to result in a flood of notifications."

SOURCE




Australia: Huge ambulance bungle

HUNDREDS of thousands of dollars have been spent on ambulance stretchers that are too high for resuscitation and won't fit in highrise lifts. The stretchers, imported from Canada at a cost of $6500 each, are claimed to be injuring paramedics, sending WorkCover claims though the roof. "They're an absolute disaster," one ambulance officer told The Courier-Mail yesterday. "There has been no end of problems with them. They don't fit into highrise lifts, they're too high to do CPR on and they're injuring paramedics left, right and centre. It's a major stuff-up. The QAS haven't done their homework." The new stretchers are 96cm tall - 13cm higher than the existing models, which can be shortened further.

The revelation is an embarrassment for the Bligh Government in the midst of an election campaign where its economic credentials are on the line. The State Government has been trumpeting its decision to buy the stretchers, capable of carrying patients up to 228kg, as part of a $17 million roll-out of new ambulances across Queensland. "These pieces of equipment make ambulance transport safer and more comfortable for both patient and paramedic," Emergency Services Minister Neil Roberts boasted in a press release last November.

But paramedics and their union say the stretchers have been nothing but trouble since coming into service six months ago. They said WorkCover claims by paramedics had skyrocketed by millions of dollars as they struggled with the "unstable and unsteady" stretchers. "Some paramedics are refusing to use the stretchers because they're afraid of being injured, but we're being forced to use them against our will," one officer said. "The QAS is breaching its own workplace health and safety policies by making us use them. The number of handling injuries is diabolical."

He said two paramedics were needed to lift the stretchers but many rural ambulance stations were one-man operations. The QAS had designed its new ambulance fleet around the new stretchers rather than the other way around, he said.

Prebs Sathiaseelan, president of the Emergency Medical Service Protection Association, said QAS management had refused to listen to the concerns. The Department of Emergency Services yesterday did not respond to a list of questions from The Courier-Mail, with its media unit saying QAS senior managers were tied up in meetings.

SOURCE





7 March, 2009

The U.S. Government Push for Electronic Medical Records

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

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

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

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

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

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

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

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

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

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

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

SOURCE




Australia: Useless public hospital emergency department

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

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

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

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

SOURCE





6 March, 2009

Sweden's Government Health Care

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

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

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

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

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

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

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

SOURCE




Surgery delay in Australian public hospital causes man to lose finger

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

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

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

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

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

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

SOURCE





5 March, 2009

Schizophrenic stabbed four people after NHS ignored his pleas

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

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

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

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

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

SOURCE





4 March, 2009

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

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

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

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

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

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

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

SOURCE




Australia: 5000 left without cancer treatment in NSW

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

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

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

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

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

SOURCE





3 March, 2009

Medical Care in Italy and Germany Highlights Problems with Universal Healthcare

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

SOURCE





2 March, 2009

Baby P: Probe details catalogue of blunders

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



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

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

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

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

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

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

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

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

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

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

SOURCE





1 March, 2009

Flu spread by unvaccinated NHS frontline staff

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

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

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

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

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

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

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

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

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

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

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

SOURCE




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

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

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

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

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

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

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

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

SOURCE