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 May, 2009

NHS Doctors have cashed in on new bonus scheme but it 'has not helped patient care'

A lucrative bonus scheme for GPs has done nothing to improve patient care, a study claims. Performance-related pay could even be detrimental to the NHS, with GPs chasing targets 'at the cost of the quality of care given to patients'. The bonus scheme was included as part of GPs' 2004 contract, which has seen pay rocket by 55 per cent to almost £108,000.

Ministers introduced the scheme, which accounts for a third of doctors' salaries, with the aim of driving up the quality of care. But a study in the British Medical Journal indicates that in some cases it has made no difference whatsoever - despite costing taxpayers millions.

Researchers at Birmingham University compared the level of diabetes care at 147 surgeries covering one million patients across the country. They found that while there were significant improvements every year in the three years up to the start of the bonus scheme, these improvements then stagnated after it began. It is suggested this could be because GPs stop trying for further improvements once they have achieved the maximum amount of money allocated to diabetes patients.

Under the scheme, known as the Quality and Outcomes Framework, points are awarded for the management of diabetes, including targets for controlling blood pressure, cholesterol and blood glucose levels. There are 1,000 points available annually for each practice, covering a wide range of different illness achievement targets. Each point is worth up to £124 and is then shared between GPs in that practice.

But experts say it is too easy for GPs to gain the maximum number of points and suggest targets need to be more challenging if patients are to see better care. Last year 96.8 per cent of doctors gained the maximum number of points and more than 600 practices achieved 100 per cent.

Dr Melanie Calvert, lecturer at Birmingham University's college of medicine and dentistry, said: 'Our work and that of others highlights the potential unintended consequences of the scheme and raises concerns that it may not have been as efficient in reducing inequalities in health in diabetes as was hoped. 'Although the management of patients with diabetes has improved since the 1990s, the impact of the pay-for-performance initiative on care is not straightforward.' She went on: 'If anything, improvements in care appear to have plateaued since the introduction. 'This may reflect increasing difficulties in target attainments in poorly- controlled patients, but could also suggest that targets for practices need to be more challenging if patients are to benefit.'

Last year a study by the Civitas think-tank found some GPs were putting more effort into treating conditions, including asthma and high blood pressure, that attract points while neglecting dementia and osteoporosis, which do not. Dr Calvert said: 'There is a risk that doctors are focusing on patients they can achieve incentives with and are not focusing on things like osteoporosis which isn't captured in the QOF. 'There is a risk GPs are focusing on tick boxes to meet targets but not focusing on other aspects of care.'

A Department of Health spokesman said: 'Independent research has shown that care for people with diabetes improved more rapidly after the introduction of the QOF. 'We want to see continuous improvements in QOF to support GPs in delivering high quality care for patients.'

SOURCE




Tasmania, Australia: Nasty Health Dept. bureaucrat trying to destroy a popular and hard-working family doctor

Bureaucrat George Cerchez tried to get the doctor for wrongly treating 4 patients but when that failed Cerchez suddenly came up with another 19 allegations. No patients have complained and the other doctors in the area disown all knowledge of the complaints. It's just Georgy boy at work. A fine example of government regulation at work

PAUL McGinity is an old-style country doctor, so dedicated to his 3000 patients that he is berated by colleagues for working too hard, never refusing a home visit in the early hours and taking too few holidays. After 32 years of service to the rural community around Scottsdale, a timber town in Tasmania's northeast, Dr McGinity's career has come to a humiliating halt.

He has been linked to the death of seven patients after complaints to the Medical Council of Tasmania, which has suspended the general practitioner's registration pending an investigation. However, far from being treated as a pariah, Dr McGinity has the unwavering support of his patients, including at least one whose treatment forms the basis of a key allegation.

What's more, Dr McGinity is turning the tables on what he claims are "vexatious" accusers. He claims his chief accuser -- Department of Health and Human Services primary health adviser George Cerchez -- has a potential conflict of interest. Dr McGinity and his supporters claim his only crime is to be a thorn in the side of plans for a new $1.2 million clinic for Scottsdale.

A recording of a telephone conversation obtained by The Weekend Australian reveals DHHS secretary David Roberts saying Dr Cerchez was "not acting for the department" -- casting doubt on comments made in parliament by Health Minister Lara Giddings. While most politicians would run a mile from a doctor facing such serious allegations, the state Opposition said there was such a "stench" about the case that it should be subject to an independent review.

There are complaints against Dr McGinity relating to 23 patients, but unusually none is made by them or their families. Dr McGinity has been led to believe that all but four complaints were submitted by Dr Cerchez. Dr McGinity was notified of the further 19 cases at the same time his suspension over the first four was being successfully challenged on a technicality in the Supreme Court. The suspension was later reinstated.

Dr Cerchez, with whom Dr McGinity has a history of dispute, is also on the board of local doctors' group GP North. GP North has obtained federal funding of $500,000 to build a $1.2million medical complex in Scottsdale. Dr McGinity is not interested in joining the new clinic, preferring his old style of solo operation. The other four complainants are GPs at Scottsdale's other practice, despite their insistence yesterday that they had "nothing to do with" the allegations. It is expected the four will move to the new medical centre, which -- if Dr McGinity loses his registration -- will take his 3000 patients.

The 68-year-old told The Weekend Australian he was confident he had not made "any mistakes". And while accepting the medical council's obligation to investigate the complaints, he believed there should be an inquiry into the manner in which the allegations were made. He was "very concerned that there is an ulterior motive behind this" and that Dr Cerchez had a potential conflict of interest: "There are three factors: he is on the board of GP North; GP North wants to build a clinic; I've got lots of patients -- 3000; they haven't asked me to join the clinic but they need those patients." He said he also had a long history of "disagreements" with Dr Cerchez, including a dispute over the management of a case at the Scottsdale hospital in February last year. Dr Cerchez had transferred a patient against his direction, undermining his position, he said.

In the recording of his conversation with Dr McGinity, Mr Roberts says Dr Cerchez was "absolutely ... not" acting for the department in making the allegations. This appears to be a direct contradiction of advice given by Ms Giddings to parliament that Dr Cerchez "made the complaints as the longstanding medical adviser". Yesterday, Ms Giddings deferred to Mr Roberts, who said he had never meant to suggest Dr Cerchez was not acting for the department's primary health section. Instead, he had simply meant to convey that the "central department", which had to be divorced from such operational matters, was not involved. "The department is not trying to distance itself from Dr Cerchez ... I have been strongly supportive of the actions George has taken," he said.

Questions to Dr Cerchez were answered by DHHS deputy secretary Alice Burchill, who suggested concerns about a potential conflict of interest were "without foundation". "Dr Cerchez ... does not practise in the northeast and cannot personally benefit from the development," she said. "There is no underlying professional dispute between Dr McGinity and Dr Cerchez."

The Weekend Australian has a document naming the four GPs from Scottsdale's Victoria Street surgery who raised allegations against Dr McGinity: Linda Clow, Jim Wilson, Natalie Burch and Gretchen Stone. However, when asked to comment yesterday, Dr Clow said on behalf of the practice, they had "nothing to do with" the issue. "I don't know where you got that idea from, but we've got no comment," she said. "On behalf of the whole practice, we have not and will not make any comment. We've got nothing to do with this and we want to stay out of it." She would not say whether she and the other doctors at the surgery intended to shift to the new medical centre.

GP North chief executive Phil Edmondson would not say whether the four Victoria Street doctors had indicated a willingness to join the new medical complex. Nor would he say how many patients the new centre required to be viable. When asked whether he was confident the allegations against Dr McGinity were not related to plans for the new centre, he said: "I have no knowledge of the nature of the complaints against Dr McGinity. From the perspective of GP North, there is absolutely and categorically no link whatsoever between the matters."

The medical council, negotiating with Dr McGinity on conditions under which he might be allowed to return to practise while the allegations are investigated, could not be contacted yesterday. However, it has previously insisted its handling of the case has been appropriate.

Opposition health spokesman Brett Whiteley said Ms Giddings should address the "possible conflicts of interest" and order an independent review. "They came up with 19 new allegations -- they didn't say they came from one bloke, and they said 'they include seven people who died'," he said. "How alarmist is that? Who are these dead people? When did the first person die? Were there inquests? And if there were, why didn't the coroner report them? This whole decision needs a new set of eyes cast over it."

SOURCE





30 May, 2009

New cost-cutting NHS guidelines on back pain 'will lead to more surgery'

Thousands of patients could undergo unnecessary spinal operations because of new NHS guidelines on treatments for lower back pain, warn experts. Dozens of hospital consultants say the ‘cost- cutting’ restrictions mean more patients will end up having major surgery. They claim less risky procedures using spinal injections have been wrongly dismissed as ineffective, even though they help hundreds of thousands of patients with chronic back pain each year.

Guidelines issued earlier this week by the National Institute for Health and Clinical Excellence (NICE) set out permitted treatments for patients whose back pain has lasted for at least six weeks but less than a year. They endorsed widespread use of ‘alternative’ therapy, letting patients opt for a three-month course of acupuncture, manual therapy such as physiotherapy, or exercise.

Described as a ‘sea-change’ for back pain sufferers, the guidelines also told doctors not to recommend therapies with ‘little evidence’ to support them, controversially including injections of small amounts of steroids into the back, MRI scans, X-rays and ultrasound. Now, many patients who fail to respond to initial treatment could miss out this intermediate stage and proceed straight to risky spinal fusion operations.

NICE estimates the NHS will make annual savings of £33million on back injections and £11million on MRI scans. However, it will spend £24million extra on acupuncture and £16million extra on manual therapy, making the cost-cutting aspect negligible.

Around 50 specialists belonging to the Interventional Pain Medicine Group of the British Pain Society are writing to NICE, claiming it has dismissed good evidence about spinal injections, which do not cure pack pain but give a period of relief from chronic pain. Dr Ron Cooper, past chairman of the group and a consultant pain specialist in Northern Ireland, said: ‘I have never known so many pain medicine specialists to be so furious. More patients will end up having more expensive surgery, which is unnecessary, risky and has worse results.

‘NICE made it difficult for us to submit evidence to a committee on which there was not one experienced pain physician. [Very suggestive of a non-medical agenda] ‘The guidelines will make us the laughing stock of Europe, Australia and the U.S. where pain specialists will continue to have full access to a wide range of treatments.’ Dr Raj Munglani, a consultant in pain medicine at West Suffolk Hospital, Bury St Edmunds, said: ‘There could be as many as 400,000 patients (a year) who will be eligible for spinal fusion – when it should be a last resort. ‘There is a lot of concern that this is actually a way of banishing waiting lists for some procedures, because they will no longer be available.’ Dr Serge Nikolic, a chronic pain specialist at Bart’s hospital in London, said any savings made from the guidelines would be a false economy if they led to more spinal surgery.

A NICE spokesman said: ‘The guideline sets out... those approaches which either don’t work as well as alternatives, or for which there is little evidence of benefit. ‘The guideline recommends that new research is needed to decide if injections into the back are, or are not, effective.’

SOURCE




Australia: There is some accountability in government health systems after all

Nurse fired over baby left at Airport, though it seems that the aircraft pilot was also partly to blame. Any repercussions for him? None that we know of

A NURSE has been sacked and another has resigned over leaving a five-day-old baby with a stranger at regional airport in South Australia. In January, The Advertiser revealed the two nurses were suspended after they left the premature baby with a young woman at the Port Augusta Airport instead of delivering him to the hospital. The baby's father, Shahzad Hassan, said at the time that it had happened on Christmas Eve because the nurse was "in a hurry" to get back to Adelaide.

The baby, Rayaan, was left for about 10 minutes before hospital staff arrived. He was born six weeks early, which put him at risk of a range of complications and he had been sent home to Port Augusta by plane with the nurse while his parents drove.

The Government Investigation Unit confirmed last night that the nurse had resigned, while her superior – who gave her permission to leave the baby and return to Adelaide – was dismissed.

Child, Youth and Women's Health Service chief executive Gail Mondy said the staff had failed to follow proper procedures for the transfer of a baby, putting it at risk, and that they had apologised to the parents.

"We've taken steps to learn from this serious incident," she said. "We have apologised to the baby's parents and we very much regret that on this occasion the two staff involved failed to follow the hospital's and the Department of Health's patient-transfer procedures, which are designed to protect patients' safety and wellbeing."

When the plane landed in Port Augusta at about 7.40am, there was no one to meet the nurse accompanying the baby and the pilot told the nurse he needed to return to Adelaide immediately. The nurse became upset, at which point a young woman – believed to be a teacher – offered to mind the baby.

Mr Hassan said he welcomed the resolution of the case. "I can't really say anything else," he said. "I can only say that they did what they thought was right." Asked whether he was upset at the five months it took to finalise the case, he said: "I think they had to make sure of what they were doing."

SOURCE





29 May, 2009

Providing Coverage For All Americans Through Private Health Insurance

The United States is unique in the developed world in that the majority of Americans have private health insurance that they receive through the workplace. This is not the result of a deliberate decision but rather policy that evolved as the unintended consequence of a World War II ruling. Factory owners were competing to lure and keep good workers and wanted to offer health insurance as a benefit, but they needed the government’s assurance that this wouldn’t violate wartime wage and price controls.

The Office of Price Administration allowed the benefit, and this has evolved into a policy that later was codified into the Internal Revenue Code allowing employers to offer health insurance as a tax-free benefit.

This system of tying health insurance to employment has worked tolerably well for half a century during a time when people had stable jobs and health costs were manageable. Now, it is breaking down in an economy where people change jobs much more often and where rising health costs are straining company budgets.

But there are many other reasons to rethink the current system of subsidizing health insurance through the workplace to see if it is adequate for a 21st century economy. Tying health insurance to the workplace leaves out an estimated 45 million people because they don’t receive or can’t afford coverage at work. And, most importantly, it provides very generous subsidies for the most affluent workers and little or nothing for those at the lower end of the income scale.

There is a better way. We could provide direct subsidies to individuals to purchase health insurance of their choice – policies that they can own and keep with them as they move from job to job. This would give them continuity of coverage and more control over selecting health policies that fit their needs, pocketbooks, and values.

How the current subsidy works: When people get health insurance through their jobs, the part of their compensation package that they receive in the form of health benefits is exempt from federal, state, and payroll taxes.

The open-ended tax subsidy for employment-based health insurance is now the largest single tax break in the federal budget. Edward Kleinbard, the top economist for the Joint Tax Committee in Congress, says that tax subsidies for private health insurance now total more than $300 billion a year.1 These subsidies are invisible to most people, and they lead people to believe that health insurance is a gift from their employers. That provides incentives for people to demand more and more generous health insurance policies, generally at the expense of higher cash wages.

Why it isn’t working any more: Four in ten workers change jobs every year, according to the Labor Department.2 Tying health insurance to the workplace means that more and more people lose their health insurance when they lose or change jobs. An estimated 45 percent of the uninsured are without insurance for four to six months,3 largely because they are between jobs or have not yet qualified for insurance at their new place of work. This situation will only get worse in a faltering economy.

Providing people with other options for portable insurance would go a long way toward solving the problem of the uninsured. A survey by the Council for Excellence in Government found that 78% of Americans say they want portable health insurance that they can take with them from job to job.

But the current subsidies for job-based health insurance are unfair in other significant ways, particularly in the way they discriminate against those with lower incomes.... As Senate Finance Committee Chairman Max Baucus (D-MT) wrote in a recent policy paper, the current system gives “larger subsidies to higher-income workers, instead of to the lower-income Americans who need more help buying insurance.”

Further, this invisible tax preference for generous insurance for the most affluent workers drives up the cost of health insurance, often pricing it out of range for people of more modest means who must purchase insurance on their own with after-tax dollars.

Next steps: Much of the action in Congress and the incoming Obama administration will be around expanding access for lower-income uninsured Americans to government health programs such as Medicaid, Medicare, and the State Children’s Health Insurance Program. But that leaves decisions about health care in the hands of politicians and bureaucracies, not individuals and families. As we have seen, that means they will be in public programs that pay for contraception, sterilization, and abortion.

Other proposals involve forcing employers to provide and pay for health insurance for their workers, likely causing marginal companies even greater economic distress and surely forcing many to lay off workers rather than provide health benefits they can’t afford.

Providing greater access to health insurance doesn’t have to involve mandates on employers or putting more people into government programs where politicians and bureaucrats, not patients and families, are making health care decisions. There is a better way.

What we should do instead: Congress and the new administration could dramatically expand access to private health insurance that protects freedom of conscience and that allows people to select policies that are in keeping with their beliefs and values. It involves three key steps:

1. Providing new subsidies to individuals to purchase private health insurance and achieving universal coverage

2. Creating new markets for affordable, portable insurance

3. Protecting those with pre-existing conditions so they can purchase and maintain insurance coverage.

Much more here




AUSTRALIAN GOVERNMENT HEALTH SERVICES AT WORK

Three current articles below

Publicity squeezes some decency out of NSW Health

NSW Health will pay for the accommodation costs of a Melbourne family forced to quarantine themselves in a Sydney high-rise apartment at $300 a night.

The D'Arcy family were on board the Pacific Dawn, which berthed in Sydney on Monday despite suspicions two young boys on board had the swine flu virus. The ship is now en route to Port Douglas, after skipping scheduled stops in the Whitsundays. Passengers will be unable to disembark until test results are known.

Nicholas D'Arcy, 6, was diagnosed with influenza A while on board the vessel, but was allowed to disembark with his family on Monday with other cruise passengers despite the possibility he had swine flu.

At 8.30pm (AEST) that day his parents Fiona and John were eventually told by NSW Health that Nicholas had the A(H1N1) virus - after a day spent taking in Sydney tourist attractions such as the Opera House, Chinatown and Paddy's Markets.

The family of four are now quarantined in their World Square apartment in central Sydney, where they have complained of having to pay the $300 a night bill and $150 for room service. NSW Health had refused to help them, the family told The Daily Telegraph.

However, NSW Chief Health Officer Kerry Chant apologised to the D'Arcys today for their treatment, and offered to pay for the next four nights. “Last night we had contacted the family to indicate that we would pay for the next four nights accommodation,” Dr Chant said. “(We said) we would obviously pay for room service or groceries, and that we'd also look into some special requests in relation to toys for the young child.”

NSW now has a total of 18 confirmed swine flu cases, with a further 265 people awaiting test results. NSW health authorities are under fire for letting passengers disembark from the Pacific Dawn. Eighteen swine flu cases have now been recorded from that cruise ship, including six Queensland residents who have returned home.

SOURCE

Broke NSW government hospitals

SOME of Sydney's largest public hospitals frequently run out of medical supplies because they have debts of millions of dollars and the consultants PricewaterhouseCoopershave been called in to help stop the problem deteriorating. The authority running western Sydney's public hospitals owes suppliers nearly twice as much as previously acknowledged, according to internal figures that reveal for the dire state of its true financial position.

Doctors say unpaid bills mean hospitals frequently run out of supplies such as pathology chemicals and glucose tests for pregnant women, putting further stress on overworked staff. As of Tuesday, the troubled Sydney West Area Health Service - which runs Westmead, Nepean and other hospitals across western Sydney and the Blue Mountains - owed $43.7 million in invoices unpaid for at least 30 days. This included $14.6 million invoiced 90 days or more earlier, according to the figures obtained by the Herald.

The amount is far in excess of the $27 million a spokeswoman said remained unpaid at the end of April. About 400 suppliers are understood to have negotiated arrangements with the service, allowing them to be paid later than normal 30-day trading terms.

PricewaterhouseCoopers had been appointed to "provide financial management support", an area spokeswoman acknowledged yesterday, in a sign that administrators' are struggling to control their budgets.

The medical equipment supplier Synthes, which provides plates and pins for orthopedic surgery, the heart device supplier Medtronic and medical imaging company Olympus, are understood to be owed hundreds of thousands of dollars, and in one case more than $1 million. None of the companies would comment yesterday. A Medical Technology Association of Australia spokeswoman confirmed Sydney West was still paying 54 per cent of its invoices after the 30-day due date - compared to a 43 per cent state average - though this had improved since January, when the Government ordered all area health services to reduce their debts.

The appointment of external financial management is in addition to an external inquiry into the management of Westmead Hospital and the area health service, ordered by the Government after doctors complained their clinical expertise was being overridden by bureaucrats. According to a submission to that inquiry by Westmead's medical staff council, obtained by the Herald, staff morale was "at its worst point in the 30-year history of Westmead" as doctors and nurses distrusted management and were excluded from high-level decisions.

Andrew Pesce, chairman of Westmead's medical staff council, said the hospital frequently ran out of important supplies, such as reagent chemicals for diagnostic tests and bottles of glucose to test for diabetes in pregnant women, after unpaid suppliers refused new orders. "There's no more fat left in the system. We can't make any more progress by trimming here and there and drawing out creditor payments," Dr Pesce said.

Nepean Hospital was forced to suspend elective surgery yesterday morning when it ran out of supplies of essential anaesthetic equipment. But the area spokeswoman said this was caused by, "inadequate stock management" that did "not relate to the withholding of stock by suppliers." An inadequate supply of props to hold open patients' airways during surgery led doctors to halt surgery, resulting in several operations being delayed and one cancelled.

Dr Patrick Cregan, Nepean's clinical director of surgery, said the hospital was operating, "on paper-thin margins". Supplies of equipment necessary for patient safety were constantly on the verge of running out and doctors were unable to get authorisation to order new stock, he said.

SOURCE

Go to hospital. Catch swine flu

Queensland Health in its usual fine form

POTENTIAL swine flu victims are mingling with other out-patients at the first specialist clinic set up by Queensland Health to deal with the H1N1 flu crisis. The clinic, which opened yesterday at the Gold Coast's Robina Hospital, is in an area separated from the main accident and emergency ward only by a room divider.

While medical staff and paramedics wear full bio-suits and protective masks when dealing with potential swine flu victims, general outpatients enter through the same door as those visiting the flu clinic and are not issued with masks. The flu clinic waiting area is only a few metres from the outpatient waiting room. Queensland Health yesterday refused to let the media film inside the flu clinic because of the risk of infection.

Lee Daley, who was taking her 11-year-old daughter Taleea to the ward to have a broken arm checked, was frightened they could be exposed to swine flu. "I just think the clinic should be in an isolated room, not in the accident and emergency ward where people who might have swine flu are mixing with other outpatients," she said. "Everyone knows how germs can be spread through air-conditioning." Mrs Daley and her daughter opted to wait outside the hospital and were given face masks only after they requested them.

Queensland's Chief Health Officer, Dr Jeannette Young, said the clinic had been established to take the concentration of people with flu-like symptoms away from the Gold Coast Hospital emergency department. Dr Young said individuals will be asked to go to separate waiting rooms when presenting with flu-like symptoms. She said the clinic's waiting room was "appropriately signed to ensure individuals presenting with flu-like symptoms are in a contained area".

SOURCE





28 May, 2009

NHS negligence: Thousands of medical records lost

Tens of thousands of medical records have been lost by the NHS (National Health Services) due to a series of data security leaks. The health organization has been asked by the Information Commissioner now to tighten their data security. This year, 140 security breaches took place in NHS between January and April, which exceed the total number of cases put together from the local authorities and the central government.

14 NHS institutes have been observed to have broken the data regulations. According to Mick Gorrill, assistant information commissioner, NHS has offended laws by losing such confidential information. In one instance, the database of 10,000 people was downloaded onto an insecure laptop and the laptop was said to have been stolen from the home of the NHS employee.

In another such case of negligence, a memory stick, which was carrying medical histories of ex-inmates of Preston prison and other 6,360 prison patients, was lost earlier. The password for obtaining the data was written on the device itself.

Gorill said that it is a matter of great concern that the data has been lost. It would cause obvious distress to the patients since the data is a confidential piece of information. Plus, he added, many insurance companies sometimes hire private detectives to find out vital information about the policy holder’s medical history etc. He said that it is well understood what may happen if the data falls into the wrong hands.

According to Gorill, since the loss of data is inexcusable, the body will be fined accordingly for such incidences.

To examine how the medical data is stored in various hospitals in Britain, Richard Thomas, the information commissioner, plans to send a crack team of inspectors. Thomas has written a letter to a senior civil servant in the Department of Health for taking necessary steps for improvements. A spokesperson of the department said that they will soon reply to Thomas’s letter.

SOURCE




Swine flu family slams treatment at an Australian government hospital

A GOLD Coast family struck down by swine flu has slammed Queensland Health's handling of their plight as "Third World". Newlyweds Nik and Kiralea Campbell, who contracted the disease on the P&O cruise ship Pacific Dawn during their wedding voyage, said the Gold Coast Hospital was "totally unprepared" for the 13 suspected swine flu patients who arrived on Monday night. "Dogs would have received better treatment," Mrs Campbell said last night from her Oxenford home where she and her family were under quarantine.

She hit out as it was revealed the number of swine flu cases in Australia doubled to 50 in just 24 hours.

The Campbells fell ill on the cruise the day after they were married in Vanuatu last week. They flew home to the Gold Coast on Monday after the Pacific Dawn docked in Sydney and were later taken by ambulance to hospital as the Pacific Dawn swine flu crisis deepened. Mr and Mrs Campbell, their sons Trae, 2, Jordan,15, and Josh, 16, and Mr Campbell's mother Gloria, 67, were put into a small room at the hospital with one bed and a chair.

"They were totally unprepared for us – we were given no blankets, no food or medication," Mrs Campbell said. "Our three sons had to lay on the floor. It was terrible, especially the way we were feeling. Queensland Health should have been far better prepared."

Mrs Campbell said they were "filthy" that P&O had allowed them and other passengers to leave the cruise ship. "We were tested for swine flu on board but no one stopped us leaving," she said. Mr Campbell feared his sons and mother also had swine flu but had to wait until today for results. His Gold Coast friend Stephen Till and three members of his family, had also tested positive for swine flu after also going on the cruise.

Queensland Health yesterday said the five who had tested positive for swine flu at Gold Coast Hospital were all passengers on Virgin flight DJ531 from Sydney to Coolangatta on Monday and advised other passengers on that flight to call 13Health (13 432584) for advice.

SOURCE





27 May, 2009

NHS criticised by Harley Street doctor for 'missing Jade Goody's cancer diagnosis'

A Harley Street consultant who treated Jade Goody has attacked the NHS for allegedly failing to spot her cancer earlier. Jade Goody died in her sleep at home on Mother's Day

Dr Ann Coxon, a doctor introduced to Goody last year was said to be "very angry" over an alleged failure to spot her illness earlier. Dr Coxon will speak in the E4 documentary Jade: As Seen On TV to be broadcast on Thursday night, according to Max Clifford, her publicist.

He said "Her doctor was very upset and very angry with the way the NHS looked after her and failed to diagnose the cancer that was growing for such a long time," he said. Goody, who died on Mother's Day earlier this year, was given a diagnosis of cervical cancer while taking part in the Indian version of Celebrity Big Brother last August.

The mother-of-two and former dental nurse, who was originally from Bermondsey, south London, first came into the public spotlight in 2002 when she appeared in the third series of the Channel 4 reality programme Big Brother.

In an interview in September, Goody said she had no plans to sue the NHS hospital she claimed was late in diagnosing her illness. "They (the hospital) should have actually spotted that there was something wrong a long time ago," she said. "I don't hate them, I'm not angry with them. Sorry - I don't hate them, I don't want to start suing them or stuff like that, because personally I don't think it's morally right to sue an NHS hospital. "All that's gonna do is take more money out of it and then more people are gonna suffer." She added: "I just think: it's not going to get my womb back, it's not going to get my health back. So what's the point?"

SOURCE




Australia: NSW government hospital chaos as man lay dying

An inquiry has been launched into how a patient died while one of the nation's most experienced emergency doctors was in a nearby office and junior doctors attended a training session and were not available to help clear the crowded emergency department.

Distressed nurses at the Prince of Wales Hospital, Randwick, told the Herald they pleaded for registrars attending an educational talk to help them after the department reached capacity last week, with all beds full, 23 people waiting to be seen and 11 ambulances in the waiting bay. They say the doctors were not available, forcing them to beg the department head, Sally McCarthy, to put the hospital on "code yellow" to stop more ambulances arriving.

The nurses also claim Dr McCarthy, who is the president of the Australasian College for Emergency Medicine, was not available and could not leave her office immediately. [No doubt she had a lot of important paperwork to do] The elderly man, thought to be dehydrated and suffering a severe infection, had arrived conscious at about 3.30pm last Wednesday, but given the busy state of the emergency department he had to wait "some time" in the bay and later became unresponsive, nurses said. He could not be resuscitated.

But the hospital's general manager, Andrew Bernard, yesterday disputed the nurses' claims, saying the man had left the bay and had undergone blood tests and cardiac monitoring before dying 2½ hours later. Dr McCarthy has refused to comment.

There is no suggestion the man would have survived if the department had not been busy, but nurses who contacted the Herald said they felt traumatised. "Several nurses contacted us and all were very distressed," the general secretary of the NSW Nurses Association, Brett Holmes, said yesterday.

An investigation into the incident has been ordered by the hospital. A spokesman for the Ambulance Service said no more than seven ambulances should have been at the hospital at the time.

SOURCE





26 May, 2009

Insane: NHS practices quack medicine but denies patients drugs that do work

There have been several well-controlled studies which show that acupuncture has placebo effects only

Acupuncture is to be made available on the NHS at a cost of ?1.4bn a year despite little scientific evidence that the 'mumbo jumbo' medicine works. The Government's rationing watchdog NICE will also announce on Wednesday that patients can demand other unproven treatments like osteopathy and chiropracty. This is despite the fact that NICE has turned down drugs for people with cancer and dementia, describing them as 'not cost effective'.

Experts have slammed the new ruling as tantamount to the official endorsement of 'mumbo jumbo' medicine which works no better than a placebo. It is the first time the rationing body has backed the use of alternative therapies on the NHS. Their guidance comes just weeks after a large scientific study found that the traditional Chinese practice of acupuncture was no better at relieving pain than simply sticking toothpicks in different parts of the body.

The research, by the Centre for Health Studies, in Seattle, found that 60 per cent of patients given acupuncture for back pain felt better a year after treatment, compared with 40 per cent of those who were not given the treatment. But the trial found that a third group of patients given 'simulated acupuncture' using toothpicks which did not penetrate the skin, was just as effective as when needles were used. Professor David Colquhoun, pharmacologist at University College London, said this indicated that all acupuncture did was create a 'theatrical placebo', which fooled recipients into believing their condition had improved.

He said of the new guidance: 'This is an official endorsement of mumbo jumbo and the implications of that are terrible, for the NHS, and for the taxpayer. 'We will not only be subsidising an industry of acupuncturists and chiropractors, but worse still spending money on standards and regulation of something which I do not believe the evidence supports.'

On Wednesday, NICE will tell GPs to offer patients with back pain courses of complementary therapies costing the NHS at least 400 pounds a time, as an alternative to exercises they can carry out on their own or in class. The draft guidance says up to 10 sessions of acupuncture, worth between 35 and 50 pounds a session, or nine visits to an expert in 'spinal manipulation' - osteopaths, chiropractors and physiotherapists - should be offered.

Four million people consult their GP about back pain every year and if all of them took up acupuncture or chiropracty, it would land the NHS with an annual bill of more than 1.4 billion.

The guidance says anyone whose pain persists for more than six weeks should be given a choice of several treatments, because the evidence of what works best is so uncertain. There were no randomised controlled trials which showed the benefit of exercise, while on complementary therapies the evidence was mixed, with some showing small benefits. Therefore, any decision on which treatment to try should be left with the patient. NICE say that no one should be referred for X rays or MRI scans until other treatments have been tried.

Supporters of acupuncture say it works because needles are inserted into points in the body identified as 'meridians' through which 'energy' flows. But there is no anatomical basis for belief in 'meridians', and acupuncturists cannot state what the 'energy' they claim to be harnessing actually is.

Paul Robin, chairman of the Acupuncture Society, said the therapy worked 'fantastically well' in relieving back pain. He said the mystery about how acupuncture worked made it difficult for trials to demonstrate that its results were not caused by a placebo effect. Mr Robin said: 'There have not really been enough studies into acupuncture. For example, we know that it works even when the needles are not in the right places, which could be because the needles themselves create an endorphin effect, which gives pain relief. 'That doesn't mean acupuncture doesn't work.'

Chiropracty, invented in the late nineteenth century, works on the unscientific principle that diseases are caused by faulty alignment of the bones. Practitioners manipulate the spine in an attempt to relieve pain.

NICE's green light for alternative medicine comes despite the fact that two years ago it turned down drugs for people with moderate Alzheimer's disease, costing just 2.50 a day. It also turned down bowel cancer drugs Avastin and Erbitux. Ian Beaumont, campaigns director of Bowel Cancer UK, said: 'We hope NICE is not funding complementary therapy at the expense of mainstream drugs which have a more proven benefit - but often are not made available to patients on the NHS.'

Neil Hunt, chief executive of the Alzheimer's Society, said: 'We have consistently stated that NICE's decision to deny people with dementia access to drugs in the moderate stages of the condition is unethical and based on flawed calculations. NICE must tackle these flaws to ensure people with dementia can get access to effective treatments.'

SOURCE





25 May, 2009

Dozens of NHS patients left to repeat surgery after botched work by Swedish doctors

An interesting commentary on the quality of treatment Swedes receive from THEIR socialized medicine system

Dozens of elderly people were left in pain and requiring further surgery after botched work by Scandinavian surgeons brought in to reduce NHS waiting lists, an investigation has found. An audit of hundreds of patients sent to the "flying doctors" for knee operations found that one in three suffered a poor outcome, with one in five cases so bad that the operation needed to be redone.

Lawyers are considering at least six cases involving patients treated at a centre in Weston-super-Mare, Somerset, which hired surgeons from Sweden, Denmark and Finland and to cut waiting times for orthopaedic procedures.

The review of their treatment comes amid increasing concern about the risks posed by EU laws which allow medics to work in any member state, without checks on their competence or language skills. Earlier this month, the case emerged of a [black] German doctor who killed a Cambridgeshire pensioner by administering ten times the required dose of painkillers. Dr Daniel Ubani said he was not familiar with diamorphine, a drug commonly used by GPs in this country.

Under an EU directive passed in 2004, doctors can work in any member state without tests of their language skills or clinical competence. Since then, the number of EU doctors registered to work in Britain has risen by 4,000 – an increase of 24 per cent – at a time when the number of UK-trained doctors fell. Meanwhile, the amount of serious disciplinary action taken against European medics by the General Medical Council has doubled.

Last year, 30 were struck off, suspended, given a warning or had conditions imposed on their practice, compared to 15 cases in 2005. But under current rules the GMC is unable to demand information from its counterparts abroad showing whether a doctor has been previously disciplined or struck off in another country.

The Somerset treatment centre, run by Weston Area Health Trust, hired surgeons from Scandinavia in order to cut local waiting lists, and boost the trust's income by attracting patients who faced long delays elsewhere. Patients from Wales were among those encouraged to travel to the centre, despite concerns from local orthopaedic specialists that they could not guarantee the quality of the doctors, who had been contracted from a private company in Sussex.

Now, an audit of more than 200 patients who underwent knee surgery between 2004 and 2006 has revealed that the number of operations which were botched was ten times the national average.

The paper, published in the Journal of Bone and Joint Surgery, found that 37 per cent of the knee operations carried out on 224 patients had an unsatisfactory result, with dozens of patients left in pain. Twenty two per cent of the operations to replace knees were so bad that they had to be redone – a rate ten times the normal figure in NHS hospitals – while the review warns that yet more patients might need surgery redone in the future.

Orthopaedic surgeon Stephen Cannon, former president of the British Orthopaedic Association, attacked the Government's use of foreign doctors to fill gaps in locum services, and achieve waiting targets. "These guys were brought in as carpenters," he said. "They didn't see their patients postoperatively. They flew in to do the operations, and the doctors in South Wales were left to pick up the pieces."

South West Strategic Health Authority is due to publish a review of the outcomes at the centre, which is no longer staffed by doctors from Scandinavia. The inquiry, ordered in January 2007, will compare results for all patients sent to the centre with national data on outcomes.

Dr Paul Callaghan, medical director of Scanloc, the recruitment company which provided the surgeons, said it examined their surgical outcomes in their own countries before they were hired, and found results similar to those in this country. "We are a recruitment bureau, and we were not responsible for how the centre was set up. The doctors were experienced knee surgeons who had shown good results when they came to us."

Mr Cannon attacked the legislation giving "equivalence" to medical qualifications from 27 EU member states, despite the fact each country's medical education is tailored to its health care system. "The systems are very different in each country – for example, there are countries like Italy where doctors qualify while barely seeing a patient," he said.

An amendment making it mandatory for countries to share information will be put to the European Parliament next month, but the British Government plans to block the move. Professor Sir Donald Irvine, former president of the GMC said a "gaping hole" had now been revealed in the protection of patients. He criticised the Government for failing either to block the original EU laws which had created dangers to the public, or adapt British regulation systems to ensure more rigorous assessment for every doctor before they were allowed to work.

Sir Donald said: "This is an unsafe system; the holes in it are gaping. The problem is the starting point always seems to be 'What do the lawyers say?' – not 'What is best for patients?'"

The Department of Health said it did not believe the legislation being discussed next month, covering the rights of patients in Europe, was an "appropriate mechanism" to introduce changes making information sharing between regulators mandatory. A spokesman said the Government had no plans to press for changes by any other route, and said a voluntary scheme was already in existence.

SOURCE




The Obamacare to come

Drip by painful drip, the details of the Democratic health-care-reform plan have been leaking out. And from what we can see so far, it looks like bad news for American taxpayers, health-care providers, and, most important, patients.

The plan would not initially create a government-run, single-payer system such as those in Canada and Britain. Private insurance would still exist, at least for a time. But it would be reduced to little more than a public utility, operating much like the electric company, with the government regulating every aspect of its operation.

It would be mandated both that employers offer coverage and that individuals buy it. A government-run plan, similar to Medicare, would be set up to compete with private insurers. The government would undertake comparative-effectiveness and cost-effectiveness research, and use the results to impose practice guidelines on providers. Private insurance would face a host of new regulations, including a requirement to insure all applicants and a prohibition on pricing premiums on the basis of risk. Subsidies would be extended to help middle earners purchase insurance. And the government would subsidize and manage the development of a national system of electronic medical records.

The net result would be an unprecedented level of government control over one-sixth of the U.S. economy, and over some of the most important, personal, and private decisions in Americans' lives. Let's look at some of the most troubling ideas in detail.

An employer mandate. Employers would be required to insure their workers through a "pay or play" mandate. Those who did not provide "meaningful coverage" for their workers would pay a penalty, equal to some percentage of their payroll, into a national fund that would provide insurance to uncovered workers. Such a mandate is, of course, simply a disguised tax on employment. As Princeton University professor Uwe Reinhardt, the dean of health-care economists, points out, "[That] the fiscal flows triggered by mandate would not flow directly through the public budgets does not detract from the measure's status of a bona fide tax." Estimates suggest that an employer mandate could cost 1.6 million jobs over the first five years.

An individual mandate. As is the case with an employer mandate, an individual mandate is essentially a disguised tax. It is also the first in a series of dominoes that will lead to greater government control of the health-care system.

To implement an insurance mandate, the government will have to define what sort of insurance fulfills it. As the CBO puts it, "an individual mandate . . . would require people to purchase a specific service that would have to be heavily regulated by the federal government." At the very least, deductible levels and lifetime caps will have to be specified, and a minimum-benefits package will likely be spelled out. This means the oft-repeated promise that "if you are happy with your current insurance, you can keep it" is untrue. Millions of Americans who are currently satisfied with their coverage will have to give it up and purchase the insurance the government wants them to have, even if the new insurance is more expensive or covers benefits the buyer does not want.

A "public option." The government would establish a new universal-health-care program, similar to Medicare, that would compete with private insurance. Regardless of how it is structured or administered, such a plan would have an inherent advantage in the marketplace because it would ultimately be subsidized by taxpayers. It could, for instance, keep its premiums artificially low or offer extra benefits, then turn to the U.S. Treasury to cover any shortfalls. Consumers would naturally be attracted to the lower-cost, higher-benefit government program.

A government program would also have an advantage because its tremendous market presence would allow it to impose much lower reimbursement rates on doctors and hospitals. Government plans such as Medicare and Medicaid traditionally reimburse providers at rates considerably below those of private insurance. Providers recoup the lost income by raising prices for those with private insurance. It is estimated that privately insured patients pay $89 billion annually in additional insurance costs because of cost-shifting from government programs. If the new public option would have similar reimbursement policies, it would result in additional cost-shifting of as much as $36.4 billion annually. Such cost-shifting would force insurers to raise their premiums, making them even less competitive with the taxpayer-subsidized public plan. Lewin Associates estimates that as many as 118.5 million Americans, nearly two out of every three people with insurance, would shift to the government program. The result would be a death spiral for private insurance.

Given that many of the most outspoken advocates of the "public option" have, in the past, supported a government-run single-payer system, it is reasonable to suspect they support a public option precisely because it would squeeze out private insurance and eventually lead to such a system. President Obama himself has said that if he were designing a health-care system from scratch, his preference would be a single-payer system "managed like Canada's." He has also said that, while his proposal is a less radical approach, "it may be that we end up transitioning to such a system."

Comparative- and cost-effectiveness research. In an attempt to control health-care costs, the government would undertake research to determine which health-care procedures and technologies are most effective and, more ominously, cost-effective. Of course, there is a great deal of waste in the U.S. health-care system, and if the government's goal were simply to provide better information there would be little cause for concern. But there is every reason to believe such research would be used to impose restrictions on how medicine is practiced. For example, some reform advocates have said that when an insurance company fails to comply with government practice guidelines, workers should no longer be able to exempt the value of that company's plans from their taxable income.

There is no doubt that other countries use comparative-effectiveness research as the basis for rationing. For example, in Great Britain, the National Institute on Clinical Effectiveness makes such decisions, including a controversial determination that certain cancer drugs are "too expensive." The U.K. government effectively puts a price tag on each citizen's life — about $44,305 (£30,000) per year, to be exact, under NICE's guidelines. That's just a baseline, of course, and, as NICE chairman Michael Rawlins points out, the agency has sometimes approved treatments costing as much as $70,887 (£48,000) per year of extended life. But such treatments are approved only if it can be shown they extend life by at least three months and are used for illnesses that affect fewer than 7,000 new patients per year.

The final health-care-reform bill is likely to include a number of other bad ideas: a host of new insurance regulations that will drive up costs and limit consumer choice (under one leaked proposal, Americans would be limited to a choice of four standardized insurance plans); subsidies for middle-class families (a family of four earning as much as $83,000 per year would receive subsidized care under one proposal); and government preemption of private investment and research into health IT. All of this would come at a cost to taxpayers of at least $1.5 trillion over the next ten years.

The American people are right to demand health-care reform. The current system is broken. But taken individually, most of the ideas currently being considered by Congress would make the problems we face even worse. Taken together, they amount to a complete government takeover of the American health-care system. That is not the type of reform most Americans seek.

SOURCE





24 May, 2009

Coroner's fury as great-grandfather, 86, dies after being dumped on NHS emergency trolley for 19 hours TWICE

Oh no! NOT a Royal Marine. How disgusting. The neglect below should not happen to anybody but Royal Marines are heroic men who should be treated with special honour

A Normandy veteran died after being abandoned on a hospital trolley for 19 hours - on two separate occasions. Walter Gibson, 86, suffered an agonising death from infected bedsores caused by his ordeal. Yesterday a coroner condemned the 'gross failings' and 'neglect' that contributed to the great-grandfather's death.

Mr Gibson, who had Parkinson's disease, was admitted to Queen's Hospital in Romford, Essex, in December 2007 with a chest infection. But the flagship £200million, three-year-old hospital did not have enough beds to accommodate him, an inquest heard. Instead Mr Gibson was left on an A&E trolley - designed to be used for up to 12 hours - for 19 hours. By the time he returned to his care home after treatment Mr Gibson had developed painful bedsores.

Days later, on New Year's Day 2008, he was admitted to the hospital again with pneumonia. Astonishingly, he was forced to endure another agonising 19 hours on a trolley as he waited for a bed. When Mr Gibson was finally seen by locum consultant physician Dr O A Elegbe, it was clear the bedsores - also called pressure sores - had become far more severe and were infected. One of the sores had developed into a 'grade four' ulcer - deep enough to expose tendon and bone. The wounds were dressed, but it was another 12 hours before he was moved to a ward where he could be placed on a pressure-relieving mattress.

By then, however, it was too late. Mr Gibson died on January 12 of septicaemia as a result of the open bedsores. Bronchial pneumonia was also found to be a contributing factor in his death. Yesterday coroner Dr Fiona Wilcox passed a verdict of death by natural causes, contributed to by neglect.

Dr Wilcox told Walthamstow Coroner's Court in East London: 'It is quite clear from the evidence I've heard that the length of time Mr Gibson waited at A&E both the first and second time - the second time added insult to injury to a man already completely dependent - made a significant contribution to his death.' She added: 'He was at very, very high risk of pressure sores and he should have been provided with appropriate protection against worsening of the pressure sores.'

Mr Gibson's wife Pheobe, 82, lives in a care home in Dagenham. The couple had three daughters, six grandchildren and six great-grandchildren. Mr Gibson served as a Royal Marine during the Second World War and was involved in the D-Day landings.

Two of his daughters, Jacqueline With and Kay Newton, and his granddaughter Vicky Newton were in court to hear the coroner's criticisms of the hospital. Mrs With, 62, said after the inquest: 'We were angry and upset when we found out that the bedsores were a factor in his death, they had got infected and he got septicaemia. 'If he hadn't had to wait so long on the trolley he wouldn't have got the bedsores and may have survived longer.' She added: 'I know hospital A&E is a busy place but I feel the elderly should be fast-tracked through. 'It's a hard task for the doctors and nurses trying to treat people but something needs to be done. More money needs to be put into emergency care or there should be a specialist unit for the elderly.'

The coroner urged Queen's Hospital to increase training for nurses, step up risk assessment of patients likely to develop pressure sores and provide more air mattresses.

Mrs With, of South Ockendon, Essex, said: 'I genuinely hope the recommendations go through so that no one else has to suffer the terrible way my poor dad did.' The Daily Mail's Dignity For The Elderly campaign has highlighted how vulnerable older patients are sometimes not given the care they deserve in hospital.

A spokesman for Barking, Havering and Redbridge University Hospitals Trust, which runs Queen's Hospital, said: 'Our sympathies are with Mr Gibson's family at this difficult time. 'Over the past year, the trust, in partnership with the primary care trusts, has reviewed and streamlined the processes for patients attending A&E to ensure that they can be admitted and cared for in the right setting to meet individual needs. 'A list of recommended actions from the coroner will be submitted to the trust for implementation and response. 'The trust takes very seriously what lessons can be learnt in order to prevent a similar occurrence in the future.' [Bullsh*t, Bullsh*t, Bullsh*t]

SOURCE




Australia: Rapist Indian doctor still allowed to practice in Victoria!

It is acknowledged that he has a mental illness so who knows what else he may do? Is Australia so short of doctors that the government has to take a risk on this guy?

VICTORIAN Health Minister Daniel Andrews is examining the case of rapist doctor Sabi Lal after he was permitted to continue practising. But Mr Andrews won't say if he has the power to overturn the decision.

Dr Lal retained his registration after the Court of Appeal upheld a ruling by the Victorian Civil and Administrative Tribunal (VCAT) allowing him to treat patients. The doctor was refused registration by the Medical Practitioners' Board because of prior sexual assault convictions and appealed to VCAT.

VCAT granted Dr Lal registration on the condition he see only male patients aged over 16. The tribunal ruled that he had a low moral culpability because an obsessive compulsive disorder contributed to his offending.

"This is a complex matter, it's a serious matter, I'm getting advice from my department in relation to the ruling of the Court of Appeal," Mr Andrews said today. He said he was yet to read the judgment but would take "action appropriately" once he had been briefed. Mr Andrews said he planned to meet with the head of the Medical Practitioners Board, Dr Bob Adler.

"I believe that the vast majority of medical practitioners...across our Victorian community do a fantastic job, have the best interests of their patients at heart and act in a totally appropriate way. "There is a system for those that do not."

SOURCE





23 May, 2009

NHS Maternity services being ‘pushed beyond their limit’

That great government "planning" again

Two thirds of NHS trusts are unable to cover the cost of providing maternity services as the birthrate rises, with little evidence that £330 million of extra funding is improving care for mothers and babies, The Times can disclose. Chronic underfunding of midwifery and obstetrics care has produced deficits that run into millions of pounds in some trusts. Money is being taken from other hospital departments to cover the shortfall. Other trusts have the opposite problem, with up to £15 million of maternity funding remaining on their balance sheets at the end of each financial year. The figures, obtained by The Times under the Freedom of Information Act, come as statistics show that the birthrate is at its highest level for 36 years.

Medical leaders warned that the quality of care for mothers and babies could be the first to suffer as the NHS is asked to make £15 billion of “efficiency savings” in the next three years. The extra money pledged by the Government to improve maternity care over three years risks being squandered because of inefficient NHS accounting or could be diverted to fund other loss-making services, the Royal College of Midwives (RCM) said. The £330 million funding was announced by ministers in January last year. But anecdotal reports to the college suggest half of the local heads of midwifery in England have yet to see the extra money make an impact.

Louise Silverton, the RCM deputy general-secretary, said that the continuing baby-boom was piling pressure on midwives and “pushing maternity services beyond their limit”. “The effects of this on the quality of service for women and babies are obvious,” she said. “The Government is putting money into maternity services but still this is too often not reaching the front line. I am pointing the finger at the people who control the purse-strings at the regional and local level.

Overall, the health service is enjoying a period of record funding and achieved a surplus of £1.7 billion in 2007-08, yet the share of the NHS budget spent on maternity has fallen from 3 per cent to 2 per cent since 1997.

The Times questioned 148 trusts that provide obstetric and maternity services in England about their funding in recent years. A total of 87 trusts replied, a 58 per cent response rate. Of these, 60 trusts (68 per cent) reported an overspend on their budgets in 2007-08, creating a total deficit of more than £103 million. A total of 24 reported a surplus, totalling £65 million, while three trusts broke even.

Less data was supplied for 2008-09 (52 responses), but the trend looked to have continued last year, with a gross deficit of £58 million in 31 trusts and 18 trusts reporting a surplus of £41 million. This is despite having to deliver 708,708 babies in England and Wales last year — the highest number since 1972 and a rise of more than 19 per cent on 2001. Nearly one in four births were to mothers born outside the UK. In 1998, only 14 per cent of babies were born to foreign-born mothers.

The largest deficit reported in 2007-08 was £7.7 million at Barnet and Chase Farm Hospitals NHS Trust, London, although 17 other trusts overspent by more than £2 million. The largest surplus for maternity was £14.9 million at Heart of England NHS Foundation Trust, Birmingham.

Belinda Phipps, the chief executive of the National Childbirth Trust, said the findings were “extremely worrying”. She said: “It means money which is desperately needed to invest in improving maternity services is not getting through to the families who need it.”

The Department of Health has taken steps to reform the “payment by results” system of funding maternity services, under which hospitals are paid a set tariff for the different courses of treatment that they provide. But the RCM said that surpluses could be a result of unfilled staffing posts. The college says 5,000 extra midwives are needed but the Government has promised to recruit only 3,400 by 2012.

A Department of Health spokesman said: “We have increased the national tariff for maternity services for 2008-09 and 2009-10 by around 8 per cent compared to 2007-08, so the money flowing to primary care trusts is greater than ever before.”

SOURCE




Socialized Failure: Dissecting health-care data from Britain, Canada, and elsewhere

The health-care systems of all developed countries face three unrelenting problems: rising costs, inadequate quality, and incomplete access to care. A slew of recent articles, published mainly in medical journals, suggest that the health-care systems of other countries are superior to ours on all these fronts. Yet the articles are at odds with a substantial economic literature.

What follows is a brief review of the evidence. As other writers demonstrate elsewhere in this issue, the American health-care system has plenty of problems. But it is not inferior to other developed countries’ systems — and we should therefore not be looking to these systems, most of which are characterized by heavy government intervention, for inspiration.

Does the U.S. Spend More on Health Care?

Taken at face value, international statistics show that the United States spends more than twice as much per person on health care as the average developed country. But these statistics are misleading. Other countries are far more aggressive than we are at disguising and shifting costs — for example, by using the power of government purchase to artificially suppress the incomes of doctors, nurses, and hospital personnel. This makes their aggregate outlays look smaller when all that has really happened is that part of the cost has been shifted from one group (patients and taxpayers) to another (health-care providers). This is equivalent to taxing doctors, nurses, or some other group so that others may pay less for their care.

Normal market forces have been so suppressed throughout the developed world that the prices paid for medical services rarely reflect the services’ actual cost. As a result, adding all these prices together produces aggregate numbers in which one can have little confidence. One gets a better measure of how much countries spend by looking at the real resources used; and by that measure, the U.S. system is pretty good. For example, we use fewer doctors than the average developed country to produce the same or better outcomes. We also use fewer nurses and fewer hospital beds, make fewer physician visits, and spend fewer days in the hospital. About the only thing we use more of is technology. (See below.)

Spending totals aside, the U.S. has been neither worse nor better than the rest of the developed world at controlling spending growth. The average annual rate of growth of real per capita U.S. health-care spending is slightly below the OECD average over the past four decades (4.4 percent versus 4.5 percent). It appears that other developed countries are traveling down the same spending path we are.

Are U.S. Health Outcomes Worse?

Critics point to the fact that U.S. life expectancy is in the middle of the pack among developed countries, and that our infant-mortality rate is among the highest. But are these the right measures? Within the U.S., life expectancy at birth varies greatly between racial and ethnic groups, from state to state, and across counties. These differences are thought to reflect such lifestyle choices as diet, exercise, and smoking. Infant mortality varies by a factor of two or three across racial and ethnic lines, and from city to city and state to state, for reasons apparently having little to do with health care.

All too often, the heterogeneous population of the United States is compared with the homogeneous populations of European countries. A state such as Utah compares favorably with almost any developed country. Texas, with its high minority population, tends to compare unfavorably. But these outcomes have almost nothing to do with the doctors and hospitals in the two states.

It makes far more sense to look at the diseases and conditions to which we know medical science can make a real difference — cancer, diabetes, and hypertension, for example. The largest international study to date found that the five-year survival rate for all types of cancer among both men and women was higher in the U.S. than in Europe. There is a steeper increase in blood pressure with advancing age in Europe, and a 60 percent higher prevalence of hypertension. The aggressive treatment offered to U.S. cardiac patients apparently improves survival and functioning relative to that of Canadian patients. Fewer health- and disability-related problems occur among U.S. spinal-cord-injury patients than among Canadian and British patients.

Do Patients in Other Countries Have Better Access to Care?

Britain has only one-fourth as many CT scanners per capita as the U.S., and one-third as many MRI scanners. The rate at which the British provide coronary-bypass surgery or angioplasty to heart patients is only one-fourth the U.S. rate, and hip replacements are only two-thirds the U.S. rate. The rate for treating kidney failure (dialysis or transplant) is five times higher in the U.S. for patients between the ages of 45 and 84, and nine times higher for patients 85 years or older.

Overall, nearly 1.8 million Britons are waiting for hospital or outpatient treatments at any given time. In 2002–2004, dialysis patients waited an average of 16 days for permanent blood-vessel access in the U.S., 20 days in Europe, and 62 days in Canada. In 2000, Norwegian patients waited an average of 133 days for hip replacement, 63 days for cataract surgery, 160 days for a knee replacement, and 46 days for bypass surgery after being approved for treatment. Short waits for cataract surgery produce better outcomes, prompt coronary-artery bypass reduces mortality, and rapid hip replacement reduces disability and death. Studies show that only 5 percent of Americans wait more than four months for surgery, compared with 23 percent of Australians, 26 percent of New Zealanders, 27 percent of Canadians, and 36 percent of Britons.

Do Other Countries Do a Better Job of Delivering Preventive Care?

If people have to pay for care directly, it is often claimed, they will be inclined to skimp on preventive care — care that can catch diseases in their early stages, saving lives and money. Yet the proportion of middle-aged Canadian women who have never had a mammogram is twice that of the U.S., and three times as many Canadian women have never had a Pap smear. Fewer than a fifth of Canadian men have ever been tested for prostate-specific antigen, compared with about half of American men. Only one in ten adult Canadians has had a colonoscopy, compared with about a third of adult Americans.

These differences in screening may partly explain why the mortality rate in Canada is 25 percent higher for breast cancer, 18 percent higher for prostate cancer, and 13 percent higher for colorectal cancer. In addition, while half of all diabetics have high blood pressure, it is controlled in 36 percent of U.S. cases, compared with only 9 percent of cases in Canada.

Do the Uninsured in the U.S. Lack Access to Health Care?

Of the 46 million nominally uninsured, about 12 million are eligible for such public programs as Medicaid and the State Children’s Health Insurance Program (S-CHIP). They can usually enroll even at the time of treatment, arguably making them de facto insured. About 17 million of the uninsured are living in households with annual incomes of at least $50,000. More than half of those earn more than $75,000, suggesting that they are uninsured by choice.

Like unemployment, uninsurance is usually transitory: 75 percent of uninsured spells last one year or less, and 91 percent last two years or less. Although the fraction of the population with health insurance rises and falls with the business cycle, it has been fairly constant for the past two decades, despite an unprecedented influx of immigrants with an uninsurance rate 2.5 times that of the native-born population. Guaranteed-issue laws, state high-risk pools, and retroactive Medicaid eligibility make it increasingly easy to obtain insurance after becoming ill.

Are Low-Income Families More Disadvantaged in the U.S. System?

Aneurin Bevan, father of the British National Health Service (NHS), declared, “The essence of a satisfactory health service is that rich and poor are treated alike, that poverty is not a disability and wealth is not advantaged.” More than 30 years after the NHS’s founding, an official task force found little evidence that it had equalized health-care access. Another study, 20 years later, concluded that access had become more unequal in the years between the two studies.

In Canada, the wealthy and powerful have significantly greater access to medical specialists than do the less well-connected poor. High-profile patients enjoy more frequent services, shorter waiting times, and greater choice of specialists. Moreover, non-elderly, white, low-income Canadians are 22 percent more likely to be in poor health than their U.S. counterparts.

In developed countries generally, among people with similar health conditions, high earners use the system more intensely, and use costlier services, than do low earners. It seems likely that the personal characteristics that ensure success in a market economy also enhance success in bureaucratic systems.

SOURCE





22 May, 2009

Rich Democrat Uses Private Healthcare to Put Cancer in Remission. Doesn’t Want You To Do Same

Senator Edward Kennedy’s cancer is in remission. Through the wonders of the American healthcare system — the finest on earth — Senator Kennedy was able to seek life saving treatment and, through that treatment, have his cancer go in remission. The sad and tragic irony is that when Senator Kennedy returns to work, he will actively work to deny you the access to treatment he himself had. We are not supposed to be so impolite to say such things, but the truth must be spoken.

We know, from what was publicly reported, that Senator Kennedy’s condition was extremely serious. We also know that Senator Kennedy’s compatriot, Senator Jay Rockefeller, said that under Senator Kennedy’s and the Democrats’ healthcare plan the government is going to weigh the cost/benefit of healthcare choices and deny you access to treatment if the cost outweighed the benefit.

Given media reports of Senator Kennedy’s health, we can postulate that, had Senator Kennedy had access to healthcare under the system he intends to design, he would not have gotten the treatment that put his cancer in remission. We can also postulate one other thing — when Senator Kennedy does design the Democrats’ healthcare system, they will make sure people like Senator Kennedy are not subjected to it. Just you and me.

But don’t worry. People like Arlen Specter will continue raising campaign cash off the plight of those stricken with cancer even while denying those people treatments they want but the government thinks would be wasted.

SOURCE




NHS kills thousands. Compensation paltry

Thousands of haemophiliacs who contracted HIV and hepatitis C from infected blood have “only had their anguish compounded” by a new Government statement on compensation, the head of the inquiry into the scandal said today. Lord Archer of Sandwell, who conducted a two-year review of how haemophiliacs were given NHS transfusions of contaminated blood, said the response from ministers was “deeply disquieting”.

Dawn Primarolo, the public health minister, announced today that haemophiliacs who contracted HIV from infected blood will receive annual payments of £12,800, double the current sums paid through trusts set up to support victims. Some 4,670 haemophiliacs who received blood transfusions in the 1970s and 1980s were infected with hepatitis C, of whom 1,243 were also infected with HIV.

However Ms Primarolo said that The Skipton Fund - which provides lump sum payments to people infected with hepatitis C - will receive no extra funding. She added that ministers will review the situation again in 2014.

Responding to the announcement, Lord Archer said: “The Government response is a faltering step that only compounds the anguish of the afflicted and bereaved. “It is difficult to avoid the conclusion that humanitarian impulses have come a bad second to Treasury constraints.” He branded the new funding for patients with HIV, “paltry” and said the failure to increase help available to victims with Hepatitis C and to offer payment to their dependants was, “sadly lacking both in understanding and in compassion”.

For years the NHS used imported blood from the US to treat haemophiliacs. It was often collected from paid “skid row” donors such as prison inmates who were more likely to have HIV and hepatitis. Nearly 2,000 people have died as a result of exposure to the tainted blood.

The Archer inquiry heard evidence from Lord Winston describing the blood contamination as “the worst treatment disaster in the history of the NHS”. Lord Archer suggested a Government apology, a statutory advisory panel and compensation at least equal to that paid to patients in Ireland where those infected with HIV from contaminated blood received up to 101,000 euros and those who contracted hepatitis C were paid on average 853,636 euros.

But the Government rejected campaigners’ demands for substantial compensation payments, instead announcing a slight increase of funding for the Macfarlane and Eileen Trusts to allow annual payments of £12,800 to each HIV infected person. Both trusts will also be given more funding so they can make higher payments to the families and dependants of victims. Spouses of those who die as a result of the infection will still not get any financial help from the Government.

The minister also rejected calls by Lord Archer for a government advisory committee on haemophilia. Instead she said the Department of Health will invite the Haemophilia Alliance - a group of patients, haemophilia doctors, and those involved in their care - to meet with the Government twice yearly. Ms Primarolo also pledged £100,000 each year for the next five years to the Haemophilia Society. She said: “I thank Lord Archer for his very thorough report. The Government has the greatest sympathy for those who have been affected and deeply regrets that these events came about following NHS treatment."

Chris James, chief executive of the Haemophilia Society, said the Government had tried to “water down” and “ignore” Lord Archer’s recommendations and presented “a collection of half-measures”. He said he would write directly to Prime Minister Gordon Brown, Tory leader David Cameron and Lib Dem leader Nick Clegg asking for an urgent meeting because the Department of Health, he said, “have shown themselves to be incapable of the simple human compassion and understanding required to deal with the victims of this disaster”. No health minister attended the two-year inquiry, despite repeated requests. “The Government claims to accept the moral case for action but then, by not implementing the recommendations in full, it shows its contempt for the victims.”

Norman Lamb, the Liberal Democrat health spokesman, said: “The Government’s response is deeply disappointing and underlines how appallingly it has behaved over this issue. This is one of the most serious tragedies in the history of the NHS.”

SOURCE





21 May, 2009

Medical records and how the world really works

Is it a good idea to have medical records stored in electronic form rather than paper? Maybe. One argument is that if there are stored electronically, it will help us find the "best" treatments because we will have all kinds of data. This optimism may be warranted. Against it, is the consideration that "best" is often unclear, depends on the individual, depends on the cost, and is subject to political manipulation if the determination of the "best" treatment is a government decision.

Another argument often advanced for electronic records is cost-saving. It will prevent needless duplication. But of course mobilizing the medical profession to do something they don't seem to think worthwhile doing on their own will have its own costs as well.

This article in the Washington Post deserves to be read in its entirety. It explores how implementing electronic records became part of the stimulus bill. Not because it's a great idea but because the people who would profit from it lobbied like crazy. It may be a great idea. Suffice it to say that the evidence is highly biased. At the center of this picture is the proposed savings in costs of $77 billion. But as the Post reports:

The stimulus bill suggests that the government will recoup about a third of the spending allocated for electronic health records over the next decade, an assumption that some health-care observers question, in part because of a critical analysis by the Congressional Budget Office last year.

The CBO, then led by Orszag, examined the industry-funded study behind the $77.8 billion assertion, among other things, and concluded that it relied on "overly optimistic" assumptions and said much is unknown about the potential impact of health information technology.

A CBO analysis of the stimulus bill this year projected that spending on electronic health records could yield perhaps $17 billion in savings over a decade.

This is how the world really works. When Obama says that electronic record-keeping is a crucial way to control costs, it seems like a really cool idea. It may be. But I doubt it. And the real reason we're going this route isn't because a wise President sees a cost-saving opportunity. It's a lot uglier than that.

As for this being part of the stimulus plan, what a joke. The main thing that will be stimulated are the bank accounts of the people who make the products that help computerize the records.

SOURCE




Why is the NHS killing so many with drugs?

An extraordinary rise in the number of patients killed by drugs given out by the Health Service has led to calls for an investigation. The figure has more than doubled since Labour came to power, rising from 520 in 1998 to 1,299 last year. Official figures also show that the number of such deaths last year was up by more than a quarter on the figure of 1,030 recorded in 2007.

Liberal Democrat health spokesman Norman Lamb, who obtained the statistics following a parliamentary question, said: 'The Government needs to urgently investigate this extraordinary rise. 'The public needs to know why these adverse reactions are happening more frequently and why the trend appears to be increasing so much. 'Patient safety is being compromised. Ministers must ensure that better information on prescription drugs is available for patients and doctors.'

Some experts blamed the increase on failures in the training of hospital doctors and Labour's decision to hand greater prescribing powers to nurses.

The figures show that in 2008, a total of 25,424 reports of adverse reactions to drugs - both fatal and non-fatal - were made to the Medicines and Healthcare products Regulatory Agency, the government organisation in charge of drug safety. They were up by 17 per cent on 2007 and by 41 per cent in a decade. Of these patients, 4,487 had to stay in hospital for several days following side effects from medication - around the same as in 2007 but up by more than 50 per cent on 1998. The figures mainly cover drugs handed out on prescription, but they also relate to over-the-counter and herbal medicines.

Peter Walsh, of pressure group Action Against Medical Accidents, said: 'There are far too many complications resulting in harm or death. These numbers must be reduced, and it must be in the gift of a modern NHS to get them down. 'The true figure will undoubtedly be much higher, because not all incidents are reported [by hospitals and GPs]. And in many cases doctors simply do not know what caused a sudden deterioration or a death - the drugs or another cause. 'Problems with medicines are one of the biggest patient safety issues faced by the NHS.'

Mr Walsh said better reporting of adverse reactions could be the reason behind some of the rise. But there was also the problem of new drugs, and complicated therapies that include combinations of drugs. These 'cutting-edge' treatments often have unknown side effects. Adverse reactions can also occur where doctors do not know what other drugs a patient is taking, or about allergic reactions they suffer from. Errors in identifying patients - with drugs being given to the wrong patient - and in dosages, also cause numerous deaths, he said.

The Daily Mail revealed in January that the number of patients killed by hospital blunders has soared by 60 per cent in only two years. Official records show that 3,645 died as a result of outbreaks of infections, botched operations and other mistakes in 2007/2008, up from 2,275 two years before.

Critics say that the quality of NHS care has suffered as doctors and nurses come under pressure to meet Government waiting time targets. A spokesman for the MHRA said a number of factors are thought to have played a role in the rise in fatal adverse drug reactions including changes in pharmaceutical companies' reporting of the reactions and increased prescribing of drugs. 'It is not possible to pick out one single factor influencing this trend,' she added.

SOURCE





20 May, 2009

NHS doctors lied in their teeth to cover up their fatal negligence. But it's OK for doctors to lie and fabricate evidence in socialist Britain

One wonders how much of this goes on -- This only came to light because a father was savvy enough to have a clergyman witness his neglected son's medical records -- before the doctors changed them

By rights, Robbie Powell should have been celebrating his 30th birthday this year - still the apple of his daddy’s eye and almost certainly, like his two elder brothers, settled and raising a young family. But 19 years ago he died suddenly, apparently after developing a stomach complaint.

Many parents would have shut themselves away to grieve, but not Robbie’s father, Will. He vowed that he would discover what had gone so badly wrong - and has spent the past two decades trying to find out the truth. The effort has all but driven him mad, he says, as he’s battled against the cynicism and sheer indifference of officialdom. He’s been vilified as a fantasist and his family life has been destroyed - yet he has refused to give up. ‘The doctors involved believed they could wear me down - that I would give up, as most people eventually give up when making complaints about their doctors,’ he says. ‘But I didn’t.’

What he found is truly shocking. Not only did the GPs forge his son’s medical notes, but in their attempts to cover up what had happened, they also lied to an inquiry set up into Robbie’s death. Mr Powell’s investigation also unravelled a truly horrifying fact. For the story of the boy who never grew up has exposed British doctors’ best-kept secret - that they are under no legal obligation to tell the truth to a patient’s family about the circumstances surrounding a death. Indeed, it is not even clear whether doctors can be prosecuted for falsifying patients’ records.

This lack of legal obligation to tell the truth is unique in the developed world, and it may well have continued to go unnoticed were it not for Will Powell.

It would be difficult to overstate the terrier-like persistence with which the 55-year-old former car mechanic has painstakingly unpicked the doctors’ version of the events surrounding the death of his darling boy. At his semi-detached house in the small Welsh town of Ystradgynlais, near Swansea, he sits surrounded by a pile of meticulously ordered files and copies of the 2,000 and more letters he has written to the authorities.

He has turned for help to every relevant state organisation - beginning with a ten-year battle to get the coroner to hold an inquest into his son’s death, and involving local professional disciplinary bodies, civil courts, the European Court of Human Rights, the Welsh Office, the police and the General Medical Council (GMC).

What makes this story so alarming is that it exposes just how impotent families are when faced with doctors determined to cover up mistakes. Twenty years ago, the Powells were a happy, carefree family. Will, a Glaswegian, had moved to Ystradgynlais as a young man and married a Welsh girl, Diane. He became a keen angler and member of the local darts team, raising his three boys - Robbie, Justin, now 33, and Ian, 31 - in ‘an ordinary, working-class home where we worked hard to keep a roof over the boys’ heads’. Robbie was a popular, happy, outgoing little boy - ‘Someone who made you feel loved and special,’ recalls his father.

None of the children had ever had a serious illness until December 1989, when Robbie suffered a bout of stomach pain and vomiting that was so bad he was admitted to Morriston Hospital, Swansea. It later emerged that at least one hospital doctor suspected what proved to be true, that Robbie had Addison’s disease - a rare, but highly treatable disease of the adrenal glands - but he failed to tell Will and Diane, or to conduct the test that would have confirmed it. The hospital has since acknowledged this doctor was negligent.

However, it is what then happened in the weeks immediately before and after Robbie’s death that is most disturbing. Over three weeks, as the ten-year-old suffered vomiting, weight loss and stomach pains, he was seen seven times by five GPs from the local surgery. It has since been established that only one GP considered referring the boy back to hospital, but never did so. The others did not read the boy’s notes, perform a blood test or even take his blood pressure. One tried to test his blood sugar, but found his kit was out of date. None recognised that they were dealing with a very sick boy in need of urgent transfer to hospital - instead telling his distraught parents there was nothing wrong with him.

In the final two days of his life, two of the five GPs saw Robbie, but failed to refer him to hospital - even though, at the time, he could not walk and was severely dehydrated. The afternoon of his death,15 days after he’d first fallen ill, a third GP was called to his house after he had been carried to the bathroom by his mother, where he collapsed, his lips blue and his pupils dilated.

‘We didn’t know it at the time, but he was already dying,’ says Will. Yet the GP told the family that a throat infection diagnosed the day before had spread to his chest, and refused to refer him to hospital. When the parents called the surgery again an hour later, the GP returned, but refused again to send Robbie to hospital, had an argument with Will, relented, scribbled a referral note and walked angrily out of the house - leaving the parents to drive their son to hospital.

‘I remember telling Robbie over and over again to stay awake because I didn’t want the doctors to think he was just sleepy,’ says Will. In fact, his son was lapsing in and out of consciousness. When the family arrived at the hospital, staff immediately called the crash team. As they later told the family, Robbie was ‘desperately ill and close to death’ and ‘looked like someone from a concentration camp’ because he was so dehydrated. He died as they tried to revive him.

Will grasped quite quickly that his son’s death could have been avoided. ‘Addison’s disease prevents the adrenal glands from pumping vital hormones around the body, reducing blood pressure and eventually causing a heart attack. ‘It’s like a car running out of petrol - and I knew well enough from my knowledge of engines that the damage could have been halted.’ Indeed, hydrocortisone and intravenous fluids can bring an emergency Addison’s disease patient back to normal health in less than an hour.

‘I extended my compassion to the GPs who had let my son die. I felt they must be suffering, too,’ says Will. ‘But I think they misunderstood. I believe they saw me as someone with no education and thought I posed no risk to their reputations.’ When he asked the senior partner to carry out an investigation into what had gone wrong, the doctor refused point blank.

Shortly after Robbie’s death, Will had asked to see his son’s medical records - and, realising their significance, had them witnessed by a local vicar. Seven months later, when he was formally served with the paperwork for the first inquiry into Robbie’s death by the West Glamorgan family health service authority, he was alarmed to discover the notes had been changed, and that at least one letter had disappeared. Several years later, forensic tests carried out during an investigation by the Crown Prosecution Service, confirmed that some of the notes had been written at a much later date than the GPs claimed.

What is more, the magistrate who headed the West Glamorgan inquiry has said on record to the police that the GPs lied when giving evidence to the inquiry. Nonetheless, this inquiry concluded the doctors had acted correctly - apart from issuing a verbal warning to Robbie’s GP for failing to call an ambulance.

After this, Will recalls months of near-suicidal despair. ‘Diane carried on with the housework and looking after the boys, thank goodness. I took to the bedroom for weeks on end. ‘I did nearly lose my mind back then. I was making allegations of dishonesty about the local GPs. That’s a difficult position for anyone to be in - and especially someone like me who left school with no qualifications and can’t even do joined-up writing.’

The GPs put up a notice in the surgery that claimed that Will’s allegations were ‘distortions and fantasy’ - resulting in one of Britain’s longest-running defamation trials, concluded in Will’s favour just four years ago. Over the next ten years, he contacted every official body he could think of to find out what had happened to his son, and then to find out why nobody would investigate the case. Perhaps the most telling aspect of his epic campaign is that all this time, Will was being viewed as a troublemaker by the official bodies from which he sought help. Under the Data Protection Act, he has found out that the Welsh Ombudsman called him ‘vindictive’, ‘an alley cat’, ‘a caveman’ and ‘bully’.

Hardly surprising, then, that Will and Diane suffered emotionally. ‘I’ve been suicidal on more than one occasion, and our family life all but disappeared,’ he says. ‘My personality changed. I barely went out, and I haven’t worked since Robbie died. We’ve lived on benefits for years and have had to remortgage the house. ‘I was lucky to have a wonderful wife, who loved Robbie and loved me, and we’ve managed to stick together. But my relationship with my other two sons has suffered irreparable harm over two decades. Though we can talk now, that damage is permanent.’

What looked like a breakthrough came ten years after Robbie died, in 2000, when an officer from West Midlands police, Detective Chief Inspector Bob Poole, brought in to review the case after intense lobbying by Will, uncovered evidence of gross negligence, forgery and conspiracy to pervert the course of justice by the GPs. His recommended charges for the GPs to answer ran to several pages. ‘It was as though a great weight had been lifted,’ says Will. ‘At long last, someone in authority was seeing these events from the same viewpoint - seeing the truth instead of accepting a mishmash of lies.’

The Crown Prosecution Service refused to press criminal charges on the grounds that the GPs had previously been assured they would not be prosecuted. The doctors also gained support from a High Court ruling that found they had no case to answer in civil law. When Will took this to the Court of Appeal in 1997, Lord Justice Stuart-Smith made the landmark ruling that doctors had no legal obligation to truthfully explain the circumstances of a patient’s death to bereaved relatives. ‘GPs can put a gloss on the cause of death without fear of litigation,’ said a GP leader, Dr Brian Goss, at the time. In some cases, honesty can be rather hurtful. You don’t necessarily want to point out to a relative that the patient would be alive if they hadn’t smoked so much.’

Will appealed to the European Court of Human Rights, but it also ruled that in Britain ‘doctors do not have to tell the truth or refrain from deliberately falsifying medical records’ - implying that they can falsify records without worry. Such a judgment seems incredible - yet the fact is, unlike doctors throughout Europe, there is no duty of candour for British doctors. ‘This is something few people realise - and yet far too many have experienced it,’ says Peter Walsh of the pressure group Action Against Medical Accidents.

In February, Mr Walsh’s charity was granted permission for a judicial review that could finally force the GMC to investigate Will’s allegations. For the past six years, the GMC has refused to investigate a formal complaint about the Ystradgynlais GPs on the grounds that too much time has elapsed since Robbie’s death.

Of course, the vast majority of doctors want to be open and honest, and many senior leaders in the NHS, including the Chief Medical Officer, have called for the medical profession to be obliged by law to tell the truth about any mistakes they make to patients or their relatives,’ says Walsh. Until as recently as two weeks ago, the NHS Litigation Authority was still warning doctors that ‘care needs to be taken in the dissemination of explanations [of what went wrong] so as to avoid future litigation risks’. This advice has only just been withdrawn from the authority’s website.

Former King’s College surgeon Tony Giddings, chair of the Alliance For The Safety Of Patients, says the culture of denial is a hangover from ‘the dark ages of medicine when so little could be done and the habit of protecting professionals and their position arose because we didn’t know any better. We do now. 'All the evidence from studies around the world has shown the importance of telling the truth if patients are to have a system they can trust, and doctors are to have the confidence of the public.’

Now, a campaign known as Robbie’s Law has just been set up by Action Against Medical Accidents to persuade the Government to introduce legislation that requires doctors to inform patients, or their next of kin, of errors or incidents in their healthcare that have caused, or may cause, harm.

For some local people, the fight has gone on too long. When the High Court ruling was reported on the local newspaper website last month, some villagers expressed the view that Will Powell should get on with his life and stop ‘persecuting’ the doctors. ‘These are people who would complain if the bus was five minutes late,’ says Will. ‘If the doctors had been honest about what had happened, we could all have got on with our lives, however painful Robbie’s death. How I wish that could have happened.’

For Will and Diane, at long last there seems a chance of happiness. ‘We’ve got three lovely grandchildren, which is a new start, and at least we’re talking as a family.’ But Will says he will never have a normal life again. ‘If they’d wanted this to be forgotten and put in the past, the GPs could have told the truth right at the beginning,’ he says. ‘Perhaps it would have helped me to move on, too. ‘But I’m stuck here, feeling Robbie’s death and the injustice of what they did as keenly as ever.’

Dr Keith Hughes, senior partner at the Ystradgynlais group practice, said the GPs had been advised not to make any comment. ‘We cannot make a statement with all these legal proceedings going on,’ he said.

SOURCE





19 May, 2009

Why the Democrats’ proposals will not work

MICHAEL F. CANNON

The key congressional committees have yet to introduce the legislation that will carry Democrats’ hopes for “universal coverage” — i.e., a government guarantee that all Americans will have health insurance, if not access to actual medical care. But the leading Democratic reform proposals — the plan on which Pres. Barack Obama campaigned, the “Call to Action” white paper by Senate Finance Committee chairman Max Baucus of Montana, and the “Healthy Americans Act” proposed by Sen. Ron Wyden (Oregon) — bear enough similarities that we can predict the shape that legislation will take. Indeed, they all bear a striking resemblance to the reforms that Republican governor Mitt Romney signed into law in Massachusetts in 2006.

That failing Massachusetts experiment, like the failed Clinton health plan of 1994, relies on coercion, mandates, price controls, and government rationing. If comprehensive health-care reform happens in 2009, it will follow suit — and perhaps go even farther, by creating a new socialized health-insurance program as an option for Americans under age 65. Tens of millions of Americans would lose their current health insurance and could also lose their current doctors, President Obama’s reassurances notwithstanding. Since there aren’t enough Americans earning more than $250,000 to finance the estimated $1.7 trillion price tag, reform would mean higher taxes for the middle class, violating another promise Obama made during the presidential campaign. Worst of all, these reforms would — through government rationing and the sclerosis that government brings to health-care delivery — reduce the quality of medical care and cost many lives.

Universal coverage is impossible without coercion; that’s why the leading Democratic proposals would force Americans to obtain health insurance, either on their own or through an employer. Those who do not obtain the prescribed level of coverage would pay a fine. Those who do not pay the fine would go to jail. During the 2008 primaries, Hillary Clinton attacked Obama’s plan for not being coercive enough: She proposed to compel all Americans to purchase coverage with a so-called individual mandate. Obama criticized this mandate, claiming that Clinton would “have the government force uninsured people to buy insurance, even if they can’t afford it” — but in reality, his plan was scarcely less coercive. He proposed an individual mandate for children’s coverage — don’t worry, only the parents would face jail time — and an employer mandate that would compel employers to provide “meaningful” coverage to their workers.

Whatever coercive power an employer mandate lacks because it exempts small businesses, part-time workers, and the unemployed, it more than makes up for in other ways. Obama’s National Economic Council chairman, Larry Summers, once wrote that employer mandates “are like public programs financed by benefit taxes”: They can increase unemployment, work against the very people they purport to help (i.e., low-wage workers and the sick), and “fuel the growth of government because their costs are relatively invisible.” Economists Kate Baicker of Harvard and Helen Levy of Michigan estimate that, by effectively increasing the minimum wage, an employer mandate could kill 315,000 low-wage jobs. Unlike the hundreds of thousands of jobs lost to the current recession, those jobs would not return: The mandate would continue to eliminate jobs as long as the growth of health-insurance costs outpaces that of low-wage workers’ productivity.

Since employers finance health benefits by reducing wages, it is practically irrelevant whether a government enacts an individual mandate, an employer mandate, or both. One way or another, the cost of any mandate comes out of the worker’s hide. Politicians such as Obama tend to prefer an employer mandate, however, for the reason Summers suggests: Employer mandates hide the implicit “mandate tax” in the form of reduced wages, where workers are less likely to notice it.

During the campaign, Obama vaguely defined “meaningful” coverage as being at least as good as what members of Congress get. That standard could end up forcing half of all those with private health insurance (roughly 100 million people) and all of the uninsured (an estimated 46 million) to get a more comprehensive plan, whether they value the added coverage or not. Whatever the meaning of “meaningful” is, the mandate tax would grow over time as a result of “mandate creep.” As they have done at the state level, patient advocates and providers will demand that Congress mandate lower deductibles and coinsurance, as well as coverage of particular services. Since the 1970s, states have gradually enacted nearly 2,000 laws requiring consumers to purchase specific types of coverage. The Congressional Budget Office (CBO) estimates that such laws increase premiums by an average of about 3 percent: less in states with few mandated benefits (such as Idaho: 13 mandated benefits) and more in states with many (Maryland: 63).

Massachusetts already had 40 such laws by the time Mitt Romney enacted an individual and employer mandate in 2006. After that, mandate creep accelerated. Bureaucrats and lobbyists imposed coverage for prescription drugs, preventive care, orthotics, prosthetics, dependent students, and domestic partners. They imposed other costly restrictions, including limits on cost-sharing such as maximum deductibles (no higher than $2,000 for individuals and $4,000 for families), a ban on per-illness or per-year caps on total benefits, and a ban on coverage providing a “fixed dollar amount per day or stay in the hospital.”

The result is absurd: There’s zero evidence that anything beyond a basic health plan actually improves health outcomes, yet the individual and employer mandates gradually make coverage less affordable by outlawing the leaner, less expensive plans. (If Congress enacts these mandates, we can say goodbye to health savings accounts as we know them.)

As a result, insurance premiums are rising rapidly in Massachusetts, as are the subsidies required to help residents — including families of four earning up to $66,000 — comply. Government spending has far outpaced projections, with the total cost of reform reaching $1.9 billion last year. Tax increases on tobacco, hospitals, insurers, and employers have failed to stanch the bleeding. Combined public and private health spending has grown an estimated 66 percent faster than it would have without the reforms. The true believers in universal coverage are so committed to this disaster that they spin the cost overruns as evidence of success. Of course, cost overruns are a success if your goal is simply to boost health-care spending. That’s why the health-insurance lobby and physicians’ groups such as the American Medical Association support an individual mandate, which opens the spigot by forcing more people to purchase more of their services. One insurer-funded study practically celebrates how the Massachusetts reforms hide the runaway spending by dispersing the burden across higher premiums, higher taxes, and lower wages.

The biggest sticking point among Democrats has been whether to create a new socialized health-insurance program. While many Democrats fear that a new government program would jeopardize health reform’s chances for passage, Obama and Baucus want such a program to be an “option” for those under age 65, within the context of a new federally regulated market that Obama calls a “National Health Insurance Exchange.” House Speaker Nancy Pelosi and four House caucuses representing more than 100 Democrats have stated that a “public-plan choice,” modeled on Medicare, is the sine qua non of reform. Sixteen Democratic senators have signed a letter signaling their support.

Not even the 1993 Clinton reforms envisioned so radical a step. One analysis by the Lewin Group, a prominent health-care-policy firm, estimated that Obama’s campaign plan would move 48 million Americans into a new government-run plan — essentially doubling the Medicare rolls. Lewin subsequently estimated that if Congress used Medicare’s payment rates and opened the new program to everyone, it could pull 120 million Americans out of private insurance — more than half of the private market — and boost the government rolls by an even larger number. Two-thirds of Americans would depend on government for their health care, compared with just over one-quarter today.

That would strike a historic blow against even the possibility of limited government. Medicare and Medicaid are the reason that the size of the federal budget will double from 20 percent to 40 percent of GDP within 80 years. Medicare’s unfunded liabilities are in the neighborhood of $80 trillion. The CBO estimates that all income-tax rates would have nearly to double by mid-century (top rate: 66 percent), and increase by nearly 150 percent by 2082 (top rate: 88 percent), just to pay for existing federal programs. If Congress creates a new government health program instead of reforming the ones we’ve got, tax increases will be inevitable and painful: The CBO estimates that by 2050, economic output could be 20 percent lower than if government remained at its current share of GDP. And tax cuts will be a pipe dream: In 1995 and 1996, Bill Clinton showed that the most effective strategy for defeating tax cuts is to paint them as a threat to voters’ health care. If two-thirds of Americans come to depend on government for their health care, whether through a new program or through subsidized “private” coverage, we can forget about limiting government within our lifetimes.

Despite Medicare and Medicaid’s failure to contain health-care costs, the Left claims that one more government program ought to do the trick. Their main strategy, which they seldom admit, is explicit government rationing. Thus the $1 billion in the stimulus bill for “comparative effectiveness” research — which would help government bureaucrats decide, e.g., whether Mom’s next round of chemo (in the words of a draft committee report on the stimulus bill) “will no longer be prescribed.” Massachusetts has created a commission to help the government develop a “common payment methodology across all public and private payers,” including the use of “evidence-based purchasing strategies” — code for explicit government rationing.

Unlike Britons, though, Americans won’t allow government bureaucrats to make their medical decisions. Neither will doctors, drugmakers, and device manufacturers, who don’t like federal agencies questioning the value of their services. That’s why Congress, at the behest of the industries, has repeatedly defunded agencies that produce industry-offending research. Even if a new comparative-effectiveness effort were to survive, the CBO estimates that after ten years it would reduce federal health spending by “less than one one-hundredth of 1 percent.” When explicit rationing fails, the government will turn to its old standby: implicit rationing, typically via price controls.

Government already controls the prices for roughly half of all health-care spending. Medicare sets somewhere close to a million different prices. In Medicaid, the states do the same. The leading Democratic proposals would vastly expand government’s role as price setter, primarily by moving tens of millions of patients into price-controlling government programs. Indeed, many reformers want a new government program to use the very prices Medicare does. Obama, Baucus, Wyden, and others seek to control private health-insurance premiums as well.

A government-controlled price is almost never right. Price controls are responsible for both the current surplus of specialists (because prices are too high) and the shortage of primary-care physicians (because prices are too low). Medicare and Medicaid price controls are generally not binding on private payers, though they do influence overall supply. That’s one reason, for example, many Massachusetts residents — particularly those newly insured under the Romney plan — are facing long waits for primary care.

Price controls enable a veiled form of government rationing: If government sets the prices low enough, many doctors won’t participate, which creates non-price barriers to access. States set Medicaid’s prices so low that nearly half of all doctors limit the number of Medicaid patients they will accept. Some 20 to 30 percent refuse all Medicaid patients. Medicaid patients often travel hours to find a participating provider.

That is not to say that price controls are an effective tool for reducing spending. When government sets prices too high — as with specialty care, agricultural price supports, and 20th-century airline regulation — spending may rise. Government can ratchet prices downward, yet providers know more than regulators about their actual costs and are difficult to monitor. Northwestern University economist Leemore Dafny thus finds that hospitals are “quite sophisticated” in their “strategies” for gaming Medicare’s price controls. Physicians likewise push back by increasing quantity and substituting higher-priced services (e.g., CT scans rather than X-rays). Even setting prices too low can sometimes cause spending to rise: In 2007, Maryland’s low Medicaid price controls kept Deamonte Driver from seeing a dentist for his toothache. (Only one in six Maryland dentists accepts Medicaid patients.) The infection in Driver’s abscessed tooth, which could have been treated with a simple extraction, spread to his brain. That led to $250,000 of medical services, including two unsuccessful brain surgeries. Price controls do not contain costs so much as pretend that certain costs don’t exist — like the loss of Deamonte Driver, who died at age 12, as the Washington Post put it, “for want of a dentist.”

If anything, Medicare errs on the side of providing too much access to care. One-third of Medicare patients looking for a new primary-care physician have difficulty finding one, but that amounts to just 2 percent of enrollees. That cannot last, particularly if Congress creates a new government program. Given the cost pressures facing these programs, Medicare and any new program will start to look more like Medicaid. There will be more Deamonte Drivers.

Price controls even allow politicians to rob producers. Wharton professor Mark Pauly notes that the government’s “raw bargaining power . . . can permit [it] to be inefficient . . . and actually incur higher true costs than other competitors, and to cover up those inefficiencies by the transfers extracted from providers.” The Lewin Group estimates that if Congress moves 130 million Americans into a new government program, physicians and hospitals would see their net incomes fall by roughly $70 billion in 2010. That pay cut, which works out to about $47,000 per physician, may just correct existing overpayments. But what about the next $47,000 cut?

Price controls on insurance premiums create another form of implicit rationing. Premium caps, which Massachusetts governor Deval Patrick is currently threatening to impose, force private insurers to manage care more tightly — i.e., to deny coverage for more services. Rating restrictions prevent insurers from pricing health insurance according to a purchaser’s risk. According to Harvard economist and Obama adviser David Cutler, rating restrictions unleash adverse selection, which drives comprehensive health plans from the market. That rations care by forcing many consumers to accept less coverage than they would prefer. Rating restrictions also encourage insurers to avoid the sickest patients or skimp on their care — another form of implicit rationing.

If those dynamics sound familiar, there’s a reason. Congress already imposes a loose form of rating restriction on most of the market by prohibiting employers from charging different employees different premiums. Some 20 states already impose rating restrictions on health insurance sold to individuals.

When the Left claims that government programs do a better job of containing costs than private insurance, what they mean is that government does a better job of hiding costs — such as the monetary and non-monetary costs it imposes on patients and providers. Pacific Research Institute economist Ben Zycher points out that the taxes required to run Medicare destroy economic activity, making that program’s administrative costs “between four and five times [those] of private health insurance.”

The greatest danger of the Democrats’ reform plans, however, lies in the fact that they would hamper and cut short thousands of lives by preventing markets from improving quality.

Though America produces more new medical technologies than any other country, the way we deliver medical care is often backward and dangerous. We lack basic conveniences present in other sectors of the economy, such as accessible electronic records. Doctors too often do not coordinate the services they provide to a shared patient. The number of medical errors is frightening — an estimated 181,000 severe errors per year in hospitals alone, resulting in up to five times as many deaths as result from a lack of health insurance. And, yes, we lack crucial comparative-effectiveness research about which treatments work better than others.

Each of these failures can be laid at the feet of government, specifically Medicare. The reason has to do with the difference between two ways of paying providers. Prepayment (also known as “capitation”) is a payment system in which providers receive a fixed budget to care for a defined patient population. It encourages providers to invest in electronic medical records (EMRs), care coordination, error reduction, and comparative-effectiveness research. Kaiser Permanente, a prepaid health plan, leads the industry in these areas precisely because prepayment allows the Permanente Medical Group to keep any money it saves — by, for example, using EMRs to avoid duplicative tests or medical errors.

Medicare’s “fee for service” payment system, on the other hand, pays providers an additional fee for each additional service or hospital admission. That actually penalizes providers that try to improve those dimensions of quality. EMRs help avoid duplicative CT scans by saving and making accessible the results of previous scans. But Medicare will pay for a second scan. And a third. And a fourth. So a provider that invests in EMRs is not only out the cost of the computer system, but also receives fewer payments from Medicare.

The story with medical errors is similar, but more horrifying. If a medical error injures a patient who then requires additional services, Medicare will pay not just for the services that injured the patient but also for the follow-up services. That’s right: Medicare pays providers more when they injure patients. Again, if providers invest in error-reduction technologies, they are not only out that initial investment, but Medicare penalizes them with fewer payments.

Rather than allow a level playing field for all payment systems, so that competition forces them all to improve, government tips the scales toward fee-for-service. Medicare is the largest purchaser of medical services in the U.S., and it operates largely on a fee-for-service basis. According to former Medicare chief Thomas Scully, “in many markets Medicare and Medicaid comprise over 65 percent of the payments to hospitals, and more than 80 percent in some physician specialties.” No wonder a recent New England Journal of Medicine study found that only 1.5 percent of non-federal hospitals use a comprehensive EMR system. Name any quality innovation that might save money by avoiding unnecessary services — EMRs, bar-code scanners for prescription drugs, surgery checklists. Medicare blocks them all. The Left bemoans the resulting quality problems, yet is desperately trying to subject even more of the market to the very stagnation Medicare introduces. Massachusetts, with its commission to develop a single payment system for its entire health-care sector, is diving head first into the cement. It makes no difference if government chooses a different payment system than Medicare’s. The problem isn’t the particular payment system, but the lack of competition from other systems.

Surgeon and scholar Atul Gawande writes: “When we’ve made a science of performance . . . thousands of lives have been saved. Indeed the scientific effort to improve performance in medicine . . . can arguably save more lives . . . than research on the genome, stem-cell therapy, cancer vaccines, and all the other laboratory work we hear about in the news. . . . Nowhere, though, have governments recognized this.” Medicare has spent four decades and billions of dollars penalizing providers who try to save those lives, or develop the tools necessary to do so.

We don’t need to go to Canada to find horror stories about government-run health care. One hundred thousand deaths each year from medical errors should be frightening enough.

Before the great health-care debate of 2009 is over, some Democrats and even some Republicans will reassure us that we can reach universal coverage without creating a new government entitlement if only we mandate “personal responsibility” the way Massachusetts did. If Massachusetts has taught us anything, it is that individual and employer mandates are a new government program. They effectively socialize health care by compelling participation in the marketplace, dictating what consumers purchase and at what price, eliminating both economical and comprehensive health plans, and raising taxes. Massachusetts shows that mandates lead ultimately to government rationing by granting government even more power to decide how providers will be paid and how they will practice medicine.

The coming debate is not just about the freedom to make one’s own medical decisions. It is about life and death. If we insist on a dynamic and competitive market, health care will be better, cheaper, safer, and more secure. If we go in the direction of new government programs, mandates, and price controls, we will see higher costs, more medical errors, more uncoordinated care, and more lives lost because people with government “insurance” nevertheless couldn’t find a doctor who would treat them.

SOURCE





18 May, 2009

The immorality of government health care

In the May 10 New York Times Sunday magazine, President Obama reflected on his elderly grandmother’s hip replacement. This episode, portrayed in a touching manner, turns out terribly enlightening about the hard questions all Americans face under his regime.

Obama’s grandmother had already been diagnosed with cancer, and the fall which broke her hip might have been caused by a mild stroke. Soon after the hip replacement, she went into serious decline, and passed away just two days short of seeing her grandson elected president. “I don’t know how much that hip replacement cost,” said Mr. Obama. “I would have paid out of pocket for that hip replacement, just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model is a very difficult question.”

“Society,” of course, cannot make decisions. Only people can make decisions. So when the powerful want to absolve themselves of the consequences of their decisions, they blame “society.” If Mr. Obama were more forthright, he would have said: “I would spend as much of my own money as necessary to pay for my grandmother’s hip replacement. But because I intend to control all health care spending in this country, I (or people I appoint) will decide whether everybody else’s grandmothers will get hip replacements. The answer is ‘no.’”

Well, those are the breaks when you accept that other people should pay for your health care. Unfortunately, that’s the way most Americans think. Consider the results of a recent survey by Frank Luntz, a Republican pollster and campaign strategist. A full 58 percent of people agreed with the statement that “decisions about my healthcare should be between me and my doctor and no one else,” and 53 percent agreed that “I should have the right to choose the healthcare that’s right for me.” However, only 9 percent agreed that “my healthcare belongs to me,” and only 12 percent agreed that “the right to spend my own money for my own healthcare must be protected/preserved.” That simply does not compute.

If you are not willing to take control of your own health-care spending, you cannot expect the person who does control it not to interfere with your relationship with your doctor or the treatments you can use. Back in World War II, the government allowed employers to give health benefits as non-taxable compensation. Even today, a worker who would prefer to buy his own health-insurance policy, instead of accepting his employer’s, would have to use after-tax dollars.

The Wall Street Journal calls this the “original sin” of American health care and “sin” is an appropriate term for such discrimination. Most libertarian and conservative health reformers focus on the fact that health costs are out of control and quality uneven because the patients don’t control payment. Of course they are right. However, the status quo also infringes on our moral choices.

If the government changed the tax-code to free every American to buy health insurance of his or her choice, instead of one chosen by an employer or the government, Barack Obama would not hold the power to decide whether anyone else’s grandmother lives or dies due to the availability of medical options.

Health insurers would differentiate their policies according to beneficiaries’ values. Some people, happy in a managed-care setting, would pay high premiums but low co-pays and deductibles to insurers like Kaiser Permanente for integrated treatment. Others would pay doctors directly, and buy low-premium policies covering only catastrophically expensive diagnoses or accidents.

More critically, pro-life citizens would not have to worry about whether this president will revoke the previous president’s “freedom-of-conscience” permission for health-care providers to decline to participate in abortions. Instead, they would buy health-insurance policies that assured them that their “network” included only pro-life doctors and allied health professionals.

People who wanted the option of hip replacements until they draw their last breath would pay the higher premiums for policies promising such replacements. Others would spend less to buy policies with carefully defined conditions under which they would not expect heroic surgery, just painkillers to help them along.

Such decisions are not easy, but neither are most moral challenges. The most immoral decision of all is to surrender our own choices in health care to the power of the state.

SOURCE




As more and more public hospital horror stories emerge, more Australians turn to private insurance

Despite the economic downturn and the Leftist government's moves to make it more expensive. Health insurance in Australia is not employer-provided but "free" government hospitals are available -- if you are prepared to wait, and wait

AUSTRALIANS are flocking to take up private health insurance, with more than 4000 people joining each week, a surge likely to undermine claims that the private system is about to be king hit by changes announced in last week's budget. A leaked report obtained by The Sunday Age reveals that 225,000 more people took up private cover during the 12 months to March this year.

The report, from the independent but publicly funded Private Health Insurance Administration Council, shows that more than 9.7 million Australians are now covered for private hospital insurance, equivalent to 44.6 per cent of the population — the highest proportion since March 2002.

The surge came despite warnings from insurers and the Opposition that changes announced in last year's budget would force people to abandon private insurance, putting more pressure on the public system. Similar claims followed last week's budget, which announced plans to means test the 30 per cent private health insurance rebate for singles earning more than $75,000, and for families earning about $150,000. The rebate will phase out completely for couples earning more than $240,000.

Opposition Leader Malcolm Turnbull has pledged that the Liberals would vote against the plan, warning that it would lead to people dropping out of insurance schemes. Family First senator Steve Fielding and Independent Nick Xenophon have also expressed concern....

A spokeswoman for the Health Insurance Association said more people were joining because people were concerned about the state of the public system and that the 2008 budget changes had been watered down.

Health Minister Nicola Roxon yesterday accused the Opposition of plotting to force people on low incomes to pay private health insurance. "The reason that Mr Turnbull wants to get rid of private health insurance measures that the Government has proposed in the budget is because he believes, and has explicitly said, that every Australian should have private health insurance," Ms Roxon said. "What that means is that every pensioner, every veteran, every family, no matter what their income, should have private health insurance."

Mr Turnbull actually said that in "an ideal world, every Australian would have private health insurance". He said the Opposition strongly supported Medicare as a cornerstone of a health system that also encouraged self-reliance.

SOURCE





17 May, 2009

NHS GP told family of meningitis death mother to 'stop fussing' three days before she died

Rushed consultation means that obvious syndrome was missed. People are just cattle to government doctors

A mother-of-two died from meningitis three days after a GP told her worried family to 'stop fussing' and she would soon be 'right as rain.' Two doctors put Karen Finan's symptoms down to a nasty stomach bug when they were called out to see her on successive days. But she became so ill she was rushed to hospital by ambulance and admitted to intensive care. Despite carrying out tests and scans, hospital doctors also couldn't correctly diagnose the problem, said husband Darren Finan.

The 37-year-old mother's brain became swollen and her life support machine was switched off after doctors said nothing more could be done for her. A post mortem later revealed she died from meningitis of the brain and septicaemia.

Mechanic Mr Finan, 44, of Wakefield, West Yorkshire, said:'We feel angry at the doctors because they dismissed Karen's condition and didn't seem to have the time to examine her properly - she could have been saved. 'We were given a card for the Meningitis Trust that lists the symptoms. Every single one Karen had on that first visit from the doctor - fever, vomiting, drowsiness, confusion, and severe muscle pain. It was just a string of errors from start to finish. 'They say with meningitis that every hour is critical - the longer they misdiagnosed Karen the more she was slipping away from us. We have been robbed.'

Mrs Finan fell ill on April 14 suffering from sickness, diarrhoea and stomach cramps. Mr Finan said they weren't too concerned at first and his wife tried to 'carry on as normal.' But she began complaining of a painful headache and the next morning he called the doctor's surgery.

On April 15 a GP from their health centre in Stanley came to the house and diagnosed gastroenteritis. 'The doctor who came to see her didn't examine her at all, he took one look at her and said it was gastroenteritis. Not even Karen's temperature or blood pressure was taken,' he said. By the evening her condition had deteriorated further.

Mr Finan said:'She kept saying "I'm red hot" but when I touched her skin it was cold, I put a fan on full blast to try and cool her down, I touched her back and she was dripping wet.' Within 24 hours she could not speak and her eyes were rolling to the back of her head.

On the Thursday another GP came out and confirmed gastroenteritis. 'The doctor was saying Karen just needed to go to bed, we needed to stop fussing and she'd be right as rain by the weekend. It took me 35 minutes to get Karen up to bed, she couldn't walk or stand on her feet - she was like a dead weight.

'When the doctor left that day I told Karen I loved her. She looked at me and was able to mouth the words "I love you more" and went to sleep. That was it.' By the next morning Mrs Finan was so ill her family dialled 999 and she was taken to Pinderfield's Hospital in Wakfield.

Tests were inconclusive and doctors said she may have had a stroke, a blood clot or a bleed on the brain. Sadly her condition deteriorated and her brain became badly swollen and she died on April 19 with her family at her bedside. The couple have two children, Stacey, 18, and Fletcher, 12.

NHS Wakefield district medical director, Mark Napper, said:'We offer our sincere sympathies to Mrs Finan's family for their loss. 'We are very concerned to hear they are unhappy with Mrs Finan's care and, although the family have not contacted us with their concerns, we take this very seriously, which is why we are initiating an investigation.'

SOURCE




Why would FDA approval cause a stock to increase ten-fold?

In the news: Vanda Pharmaceuticals won U.S. approval for its first product, a drug to treat schizophrenia, the Food and Drug Administration said. ... Vanda, which closed at $1.08 in regular trading yesterday, soared to $9.98 in extended Nasdaq trading.

It would appear, going by the jump in price, that prior to the FDA's decision, investors gave the drug at most a 1 in 10 chance of being approved. If Vanda's case is typical, then, even moments before the actual decision is made, it is hard to predict what drugs the FDA will approve.

I can understand it being difficult to predict whether a new chemical will turn out to be a useful drug when all the testing is done five or ten years down the road. But once the testing has been done, at the very least the results of those tests are fully known. There is no uncertainty about the results that have already been observed. And the FDA decision is, necessarily, based entirely on the results available at the time the decision is made.

If the FDA's decisionmaking process is

a) not arbitrary, and
b) based on the available results,

then the FDA's decision should be highly replicable, and therefore highly predictable, by any independent entity with access to the same results. And yet the FDA's decision is, apparently, hard to predict. Two possible alternative explanations are:

1) The results that the FDA bases its decision on are extremely well-guarded right up until the very moment that the FDA makes its decision. I doubt this is possible.
2) The FDA's decisionmaking process is highly arbitrary. This is my tentative conclusion.

A few anticipated objections and responses.

Objection: Vanda's case is not typical.

Answer: Could be. However, this seems not all that atypical. When I read the story it didn't really stand out as atypical.

Objection: The typical investor doesn't know how to interpret the data, doesn't know what the data is, etc.

Answer: This is true of most investors in most publicly traded companies. If it were a significant problem the efficient market hypothesis (EMH) would be not only wrong, but wildly wrong, all the time, and Vanda's case would provide a model for disproving the EMH.

Objection: Pharmaceutical companies really keep a tight lid on their results.

Answer: I have a hard time believing that. A tremendous number of people are involved in any study that gets to this stage. Even partial information should give a sense of how well a drug is working and what its side-effects are.

Objection: The cause of the unpredictability isn't that the FDA is arbitrary, but that the drug is borderline useful, and even the most predictable decision-making process will be unpredictable when it comes to borderline cases.

Answer: But surely the typical drug is not borderline.

Objection: The FDA can hardly be blamed because it is fundamentally hard to judge whether a drug is useful or not. It is unclear and/or subjective whether a given drug is useful or not.

Answer: Then why is the FDA making a decision for all of us?

SOURCE





16 May, 2009

Health-Care Reform and the 'Innovation Test'

Government-run insurance plans have curtailed access to new medicines.

Two dramas are underway in health care. The first is set in laboratories and clinics, and it is a hopeful story of how innovation may continue to improve human health. The other drama is set in Washington conference rooms and corporate boardrooms, and it concerns the reform of health-care access, financing and regulation. As a scientist who leads what I call "the last unmerged large pharmaceutical company" (more on that in a moment), I am the rare player who moves between these two stages -- and I do so with growing concern.

I've spent three decades working in or near biopharmaceutical research and development. During that time, I've witnessed breakthroughs as diverse as biosynthetic human insulin, bone-forming agents for treating osteoporosis, new cancer therapies, and a first-ever treatment for severe sepsis go from glimmers of intuition to everyday medical tools.

Inventions such as these -- and my list includes only the partial output of the company I work for -- have transformed the most basic expectations of human life in the last century. Today, the average life expectancy at birth in the U.S. is 78; when my mother was born in 1928 it was 57. (She's still in great health, by the way.)

Even in the last two decades of the 20th century, new medicines accounted for 40% of the increase in life expectancy in more than 50 countries, according to a recent study by Columbia University economist Frank Lichtenberg. In other words, for every year that life expectancy has increased, five months can be attributed to the availability of new medicines.

The progress so evident in this first drama is poised to continue and even accelerate in the years ahead. Genomics, systems biology and other basic-research streams of new knowledge are bringing forward clues about the origins of disease -- and giving drug developers fresh insights to apply to an amazing array of new targets.

Today, a record 861 new medicines and vaccines are in human trials or awaiting regulatory approval in the fight against cancer, along with more than 300 for heart disease and stroke, another 300 for mental illnesses -- including Alzheimer's disease -- and 90 for HIV/AIDS.

U.S.-based private industry is the heart and soul of this innovation drama, investing $58 billion in research and development for new medicines in 2007 alone. Virtually no discovery reaches the point of regulatory approval if it is not shepherded through clinical development by a large biotech or pharmaceutical company. This means companies too often maligned as "Big Pharma" are in fact the only entities with the right combination of expertise, infrastructure and financing to pull this off.

Yet in today's policy-reform drama -- if early clues from Washington are a guide -- the requirements of innovation may be written out of the script. Already in defensive mode, several large pharmaceutical companies are restaging the old merger play -- continuing to narrow the ranks of firms with the full-scale capacity to innovate. Meanwhile, skittish investors have retreated, leaving nearly half of all publicly traded biotech companies with less than a year of cash on hand. These trends amount to show-stoppers if they continue.

Biomedical innovation is not incompatible with the health-care reform goals of universal access, quality improvement and cost control. On the contrary, without new, more effective medicines -- along with new devices and diagnostic tools, and better treatments and surgical techniques -- it will be impossible for larger numbers of Americans to obtain better health care at a manageable cost.

So it is vital to all of us that we insist that reform proposals pass the "innovation test." Providing insurance to millions of Americans through a government-run plan would fail the test. Similar efforts around the world have led to rationing of health care and created hurdles between patients and the most advanced treatments. On the other hand, innovation would remain reasonably secure if universal access were achieved through tax credits and government subsidies that allow patients to choose from a variety of private health-financing options.

Curtailing health-care costs by allowing the federal government to dictate prices for branded medicines also would fail the test. Price controls and rebate requirements tend to be arbitrary and make it much harder for innovators to attract and recoup investments. For their part, private insurers and patients tend to control costs by insisting on value -- forcing companies to demonstrate how the effectiveness or broader savings generated by their product justifies its price. That approach maintains the incentives for innovation and is yet another reason not to crowd out the free market.

Proposed laws that could weaken the enforcement of patents on biotechnology products flunk the innovation test as well. Some in Congress want to leave the creators of new biotech medicines with only small periods of time in which to retain exclusive use of research-and-development and manufacturing-process data for these products. This might speed the arrival of copied versions of some medicines, but it would kill critical incentives to discover and develop them in the first place.

In contrast, the "Pathways to Biosimilars Act" now before Congress gets the mix right. It does this by giving innovators the time needed to recoup their research investments while defining a clear framework for legal copying of biotech products down the road. It strikes the right balance between innovation and competition.

Our legislators in Washington still have the power to keep innovation in the health-care reform script. Not doing so would be a true American tragedy.

SOURCE




Republicans and ObamaCare

Republicans? They're trying to figure out what they think. Well, not all of them. Earlier this week I ended up in the office of Oklahoma Sen. Tom Coburn, where the doctor was hosting North Carolina Sen. Richard Burr. The duo is, for the second time, crafting a comprehensive reform that would lower costs, cover the uninsured, and put Americans in control of their health care. And while the senators decline to talk GOP politics, their bill raises the multitrillion-dollar question: Will the party have the nerve or sense to coalesce behind some such conservative alternative to the Democratic product?

They'd better, because the days of Republicans winning these battles solely by spooking Americans are over. Phil Gramm, Harry and Louise might have scored with that approach in the 1990s, but the intervening years have brought spiraling costs and public unrest. Americans want a fix. Democrats promise one. The GOP can't tank the public option simply by complaining it will kill private insurance. The party has to finally elucidate how it plans to allow the private market to work.

Not that the senators don't think Republicans need to make clear to the country that the public option is, in Mr. Burr's words, "a fast track to a single-payer system." But they are also operating on the belief that Republicans must go beyond Band-Aid solutions to embrace, as Mr. Coburn puts it, a "complete transformation" of a system that is "structurally" flawed.

Their own bill overhauls the tax code, currently stacked in favor of corporate employees, to provide a tax credit to every American to purchase insurance. It expands health-savings accounts. It creates state health-insurance exchanges, where private insurers compete to cover Americans, including the uninsured. (This is partly modeled on the Medicare drug program, which has provided seniors with choice and held down costs.)

More broadly, it seeks to reorient financial incentives so that the system is no longer focused, as Mr. Coburn puts it, on "sick care," but on preventing the chronic diseases that eat 75% of health expenditures. These incentives would be used to lower costs and discourage insurers from cherry-picking patients. The bill also dives into Medicare and Medicaid reform.

Yet no small number of Senate Republicans are biding their time in Max Baucus land, waiting to see what the Democratic finance chairman produces as a "bipartisan" product. (Read: A bill the president wants.) This crowd has taken to heart Mr. Obama's accusation that they are the party of "no," and think it might be easier to be the party of Baucus, or the party of Baucus-lite, or the party of nothing whatsoever.

The White House is targeting folks like Chuck Grassley, Orrin Hatch and other Senate Republicans who back in 1997 voted for the State Children's Health Insurance Program, which was pitched by Democrats at the time as a modest program to help poor kids. It has, of course, become exactly what Democrats always intended it to be: a ballooning federal entitlement that is today transferring middle-class children from private insurance onto the federal rolls. This might be thought of as a teachable moment. But now Republican "moderates" are all ears for the administration's soothing suggestions that perhaps the "public option" can be "structured" so as to protect private insurance. Uh-huh.

Another group of Republicans are still going 50 rounds over taxes -- namely, whether a deduction isn't a more principled and cleaner way than credits to equalize the tax treatment of insurance. This is a legitimate debate, but one that should've been had 10 years ago when Republicans were in the majority. While the GOP fiddled, Democrats focused the argument on "uninsureds," which has made a tax deduction (which would only cover those who pay taxes) even less politically palatable.

Over in the House time runs on, as the Republican leadership and a health-care working group continue to noodle over platforms, policies, egos and timing. Democrats intend to be debating their bill by June.

As for Messrs. Coburn and Burr, they spent a good half hour with me enthusiastically explaining why a competitive market would improve health, provide control and choice, lower costs, and tackle entitlements. It's a good pitch. If only the rest of America could hear the party make it.

SOURCE





15 May, 2009

How ObamaCare will affect your doctor

At the heart of President Barack Obama's health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.

Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives.

Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.) While the public option is meant for the uninsured, employers will realize it's easier -- and cheaper -- to move employees into the government plan than continue workplace coverage.

The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it's open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors' incomes will decline by as much as 15% to 20% depending on their specialty.

Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins. For example, doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan. For most doctors these capital costs won't be fully covered by the subsidies provided by the plan.

Government insurance programs also shift compliance costs directly onto doctors by encumbering them with rules requiring expensive staffing and documentation. It's a way for government health programs like Medicare to control charges. The rules are backed up with threats of arbitrary probes targeting documentation infractions. There will also be disproportionate fines, giving doctors and hospitals reason to overspend on their back offices to avoid reprisals.

The 60% of doctors who are self-employed will be hardest hit. That includes specialists, such as dermatologists and surgeons, who see a lot of private patients. But it also includes tens of thousands of primary-care doctors, the very physicians the Obama administration says need the most help.

Doctors will consolidate into larger practices to spread overhead costs, and they'll cram more patients into tight schedules to make up in volume what's lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association, and as many as 30 days for specialists like obstetricians and neurologists.

Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice.

These changes are superimposed on a payment system where compensation often bears no connection to clinical outcomes. Medicare provides all the wrong incentives. Its charge-based system pays doctors more for delivering more care, meaning incomes rise as medical problems persist and decline when illness resolves.

So how should we reform our broken health-care system? Rather than redistribute physician income as a way to subsidize an expansion of government control, Mr. Obama should fix the payment system to align incentives with improved care. After years of working on this problem, Medicare has only a few token demonstration programs to show for its efforts. Medicare's failure underscores why an inherently local undertaking like a medical practice is badly managed by a remote and political bureaucracy.

But while Medicare has stumbled with these efforts, private health plans have made notable progress on similar payment reforms. Private plans are more likely to lead payment reform efforts because they have more motivation than Medicare to use pay as a way to achieve better outcomes.

Private plans already pay doctors more than Medicare because they compete to attract higher quality providers into their networks. This gives them every incentive, as well as added leverage, to reward good clinicians while penalizing or excluding bad ones. A recent report by PriceWaterhouse Coopers that examined 10 of the nation's largest commercial health plans found that eight had implemented performance-based pay measures for doctors. All 10 plans are expanding efforts to monitor quality improvement at the provider level.

Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care; or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes.

There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients.

Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans.

There are also measures available that could fix structural flaws in our delivery system and make coverage more affordable without top-down controls set in Washington. The surest way to intensify flaws in the delivery of health care is to extend a Medicare-like "public option" into more corners of the private market. More government control of doctors and their reimbursement schemes will only create more problems.

SOURCE




Big waste of money on crooked NHS doctors

Family doctors accused of misconduct are being suspended for up to four years and at a cost of up to £900,000, according to figures revealed by the NHS under the Freedom of Information Act.

Primary care trusts in England disclosed that 134 GPs have been suspended over the last three years. The trusts pay 90 per cent of the doctors’ salaries during suspension, costing the NHS £8.2 million.

Norman Lamb, health spokesman for the Liberal Democrats, described the costs as scandalous. “They involve a huge waste of public money and show that the system of pursuing allegations against doctors is failing,” he told The Guardian.

GPs suspected of misconduct are suspended by their primary care trust or by the General Medical Council, which regulates doctors. Trusts handle less serious cases and must seek approval if they last longer than six months. John Canning, of the British Medical Association, said that the disciplinary system can be “quite slow” to ensure that both sides have time to prepare. “But even bearing that in mind, too many cases take too long,” he said.

David Stout, director of the PCT Network, said that the speed of the system coulod be frustrating. “Some of the delays are excessive, very costly and benefit nobody.”

The trust for Haringey, north London, spent £1.4 million in the last three years on three GPs who were suspended. Newham, east London, spent £1.1 million on seven suspended doctors since 2006.

SOURCE




Canadian Health Care: A Killer

A Cure Worse Than the Disease

Canada's health care system too often proves a death sentence for cancer patients. Emily Morley got some very bad news in March 2006. Her cancer had spread, the doctor informed the 67-year-old Canadian. She would need to see an oncologist. Then Morley got some really bad news: She'd have to wait several months before she could get an appointment. Only after her family raised a ruckus, calling the local paper and starting a petition to demand she get care, did the government get her a specialist. Then, it was more bad news: Morley had only three months to live.

At least she had time to put her affairs in order. Had her family not intervened, noted provincial lawmaker Don McMorris, it is quite likely that Emily Morley may have died before even seeing an oncologist for the first time. But that's how a single-payer, or universal, health care system works (so to speak). Even the very ill routinely hurry up and wait.

Alarmingly, Congress is gearing up to reform American health care along Canadian lines and proponents are trying to take a short-cut to get there. According to former Medicaid director Dennis Smith, proponents of a government-run health system are hoping to enact a bill by by-passing the usual, lengthy bipartisan review process.

The goal of any reform, supposedly, would be to trigger competition between government-run health care and currently existing private health insurance plans. Yet, Smith warns, the government will inevitably tilt the playing field to favor its own plan, running private coverage out of business. Americans could be left with a single, government-run health plan a la Canada's.

So lets take a look at what such a system means for our northern neighbors. As Sally Pipes, president of the Pacific Research Institute and a former Canadian citizen, recently told Congress, today some 750,000 Canadians are on a wait-list for medical procedures. Further, 3.2 million (out of a population of 32 million) are waiting for a chance to see their primary-care physician. Once a PCP diagnoses a problem, Canadians must keep on waiting 17.3 weeks on average before they can see a specialist.

Why? The Canadian government controls costs by rationing care, Pipes explained. Canada ranks 14th out of 25 [Organization for Economic Co-operation and Development] countries in MRI machines, and 19th out of 26 countries in CT scanners. Long wait times and lack of equipment force many to seek care in the United States.

Take Member of Parliament Belinda Stronach. She strongly supports Canada's health care system. But where did she go when she was diagnosed with cancer in 2007? To California, where she paid for treatment out-of-pocket.

Then there was a mother in Calgary, Alberta, who had to be flown to Great Falls, Mont., to deliver her quadruplets. This relatively small American city had better facilities than any hospital in the wealthy province of Alberta.

Our current system is far from perfect, of course. Millions of Americans lack health insurance, prompting many to put off seeing a doctor until a small, treatable problem has become a larger, more threatening condition. But the answer isn't to try and cover everyone through a single-payer system.

We'd be better off changing how the federal tax code treats health insurance (which, illogically enough in our 21st century economy, ties it to our jobs). Such a change would foster genuine competition among insurers by allowing Americans to shop for the coverage that suits them best in an open market. Current policy provides unlimited tax breaks for health coverage provided through employers. Meanwhile, Americans who want to buy their own insurance must do so with after-tax dollars. Few can afford to do that, especially since insurers are more interested in competing for big group coverage (more lives, more money) rather than individual or family-based coverage.

Lawmakers could change this, and even provide vouchers or other forms of direct assistance to help poorer Americans buy private plans they would own and control. This would also make insurance portable when people change jobs.

Maintaining our standard of care is critical. There's a reason Canadians fly south for treatment: Our system, for all its flaws, provides superior quality and access to care. Lets ensure that policymakers, in their understandable zeal to reform health care, dont make changes that weaken the entire system.

SOURCE





14 May, 2009

Obama’s health care quackery

Countries with universal health coverage are economically worse off than the U.S.

True to the advice of his chief of staff to never let a good crisis go waste, President Barack Obama is using the current economic crisis to sell a top item on the liberal wish-list: universal health care. "You can't fix the economy," he has repeatedly said, "without fixing health care." But the president needs to take a big chill pill before committing America to a huge new entitlement: One is hard pressed to find any evidence from abroad showing that universal coverage has grown the major industrialized economies more than ours in the past—or shielded them more than us from the global slump now.

At the president's behest, Democrats are exploring ways to ramrod a health care reform bill through Congress this fall by using procedural shenanigans to avoid a Republican filibuster. In his budget, Obama has already proposed an additional $634 billion—nearly three-quarters of a trillion dollars—in health care spending over the next few years. If he gets his way, this money will be the first installment toward a government insurance plan that will compete with private plans to allegedly put affordable coverage within everyone's grasp.

But whatever else universal coverage might bring, there is no evidence that it will bring economic nirvana. If anything, contrary to what the president suggests, the correlation runs the other way for countries with universal coverage such as Canada, England, France, Germany, and Japan. On nearly every economic front, their performance has been worse than America's—even, surprisingly, in controlling health care costs.

Contrary to popular perception, even though America is at the epicenter of the financial crisis, it has suffered less than its industrialized peers in terms of economic growth. According to the latest International Monetary Fund figures two weeks ago, the U.S. economy actually grew 1.1 percent last year even as Japan's shrank by 0.6 percent. France and England's both grew 0.7 percent, and Canada's only 0.5 percent—or less than half of America's. Only Germany did slightly better at 1.3 percent.

What's more, despite all the gloom and doom about the American economy, IMF expects its gross domestic product to shrink 2.8 percent this year compared to anywhere between 3 percent (France) to 6.2 percent (Japan) for these other economies. (Figures from the U.S. since the IMF projections suggest that the U.S. economy contracted more than expected in the first quarter of this year but it is not yet clear how the other countries performed.)

Not only is America hurting relatively less now, its economic performance in the prior 18 years—from 1990 to 2007—has also been visibly better than everybody else's. Calculations based on Department of Agriculture data show that America's GDP grew at an average annual rate of 3 percent during this period. By contrast, Canada's grew 2.88 percent; England's 2.3 percent; France's 1.92 percent; Japan's 1.74 percent and Germany's 1.59 percent.

Besides experiencing lower growth rates than America in the past, with the exception of Japan, these countries have also experienced chronically higher unemployment rates. Setting aside last year, between 1997-2007 America's peak unemployment rate was below its peers by anywhere from 1 percent (Canada) to 5.7 percent (France). Japan has always had an unusually low unemployment rate, never hitting over 5.3 percent partly because of its policy of guaranteed employment in urban areas that forces workers to share jobs to keep more people employed.

All of this has made Americans much wealthier than all these countries, given that Americans' per capita income in 2006, adjusted for purchasing parity, was about $6,000 more than the next country, England.

But are these countries fiscally stronger? Not by a mile. European countries started reining in their soaring deficits in the years prior to the downturn, thanks to the European Union's requirement that these levels not rise above 3 percent of GDP. But that meant that they had to either dismantle their social spending programs—including universal health insurance—a politically difficult task, or maintain their sky-high taxes. For the most part, they have chosen the latter.

The upshot is that whereas America's 2007 taxation rate was 28.3 percent of GDP, Canada's was 33.3 percent; Germany's 36.2 percent; England's 36.6 percent and France's 43.6 percent. Japan's taxation level of about 28 percent is at par with the United States'—but only at the price of a government debt that totaled a jaw-dropping 170 percent of GDP last year, nearly three times that of America's. Such taxation rates have left these countries limited room to respond to crises, which is why European countries roundly dismissed Obama's calls to increase stimulus spending right now.

The trillions of dollars that this administration is spending to stimulate the economy might be a complete waste of money. But such wastage is a luxury that America can afford because of its relatively lower tax-and-spend burden.

The one remaining economic argument for universal health insurance in the United States is that it will help rein in medical costs. The rap against America is that it spends over 15 percent of its GDP on health care—more than any other industrialized country—and yet leaves upwards of 45 million people uninsured. If it had universal coverage, the theory goes, uninsured folks would get care sooner—not wait till they have a medical emergency—saving the system a ton of money.

It is a nice theory, but there is no evidence that it is true. Although America's per capita health care spending soared in the 1980s, a 2007 study by Kaiser Family Foundation found that it slowed considerably in subsequent years. Indeed, between 1990 and 2003, the rate of growth of America's per capita spending was 3.6 percent, only a little bit higher than France, Germany and Japan's—but significantly lower than England's 4.2 percent. That's striking given that England engages in the most aggressive rationing known to the free world, routinely delaying care to patients unless they are critically ill.

However, Canada, which too indirectly rations care for many specialized treatments by putting patients in queues, has succeeded in limiting per capita spending to 2.4 percent. At best, then, universal coverage has a mixed record in controlling health care spending increases, even after resorting to rationing.

All in all, there is no major industrialized economy with universal coverage that has performed as well—let alone better—than the United States in the last decade. Universal coverage might not be the cause of their inferior performance. But the crucial point is that there is zero evidence that it has put them on a more solid footing. Before applying this exotic therapy to America, Obama needs to offer more than mere hunches that it will work. He needs to offer actual evidence. Over to you, Mr. President.

SOURCE




Blood clots after surgery kill thousands because NHS staff do not appreciate the risk

Thousands of NHS patients are still dying unnecessarily because of a lack of awareness of the risk of developing fatal blood clots after an operation. The condition, venous thromboembolism (VTE), causes one in ten fatalities in British hospitals — an estimated 500 people a week, more than MRSA infections, breast cancer, HIV and road accidents combined. But only one in three NHS hospitals is properly assessing which patients are at risk, while the public are also largely unaware of the dangers, campaigners say.

As many as half of all patients going into hospital are at risk of developing VTE, which occurs when part of a deep-vein thrombosis or blood clot migrates to the lungs, heart or brain. Such clotting is common after surgery, especially in the elderly, the overweight or those confined to bed for more than three days.

The National Institute for Health and Clinical Excellence (NICE) issued guidelines for the NHS in 2007 recommending that all patients should be assessed on admission to hospital for their risk.

But MPs say that while most patients admitted for common operations such as hip and knee replacements are now assessed by a healthcare professional or treated with anti-clotting drugs before the procedure, many other patients are not offered such preventive checks or made aware of the risks.

John Smith, chairman of the cross-party parliamentary thrombosis group, said: “Despite the Health Select Committee announcing the urgent need for action to stem the number of deaths from hospital-acquired blood clots four years ago, a third of NHS hospitals is still not carrying out proper risk-assessments on their patients.”

A survey of more than 1,000 patients by the thrombosis charity Lifeblood found that fewer than one in three were concerned about the risks of VTE when going into hospital, compared to three quarters who would be concerned about contracting a “superbug” infection such as MRSA.

The Department of Health said that while routine screening of patients was not a mandatory requirement, it would consider introducing legislation if the situation did not improve.

Ann Keen, the Health Minister, said that she expected the VTE risk assessment policy to be adopted throughout the NHS and that experts were visiting every trust in England to discuss the implementation of the checks.

“We will be monitoring the position closely and formally reviewing the policy in a year’s time,” she added. “If there is inconsistency... or lack of commitment, we will consider making it mandatory to perform risk assessments.”

Professor Beverley Hunt, Lifeblood’s medical director, said that more than 70 per cent of deaths due to VTE were preventable with proper awareness and treatment. She urged all patients going into hospital for a planned operation to talk to their doctor about the risks and symptoms.

SOURCE





13 May, 2009

Ready for rationing?

By John Shadegg

Are you ready for health care rationing? Are you ready to be told what treatments, medicines, and procedures you can or cannot have? Because rationing may be coming soon to your doctor's office or a hospital near you.

Last week, Obama economic advisor, Larry Summers, expressed Democrats' desire for "changing the way in which we deliver health care in this country.[W]hether it's tonsillectomies or hysterectomies.by doing the right kind of cost-effectiveness.some experts estimate that we could take as much as $700 billion a year out of our health care system."

Do you really trust the same government that can't oversee AIG, run a hurricane recovery effort, or balance its budget to decide which drugs, procedures, or operations are cost-effective for the American people?

In the stimulus bill, Democrats already passed $1.1 billion in so-called "comparative effectiveness research." While this language sounds innocuous, it is actually quite dangerous. Here's how David Obey, Chairman of the House Appropriations Committee, explained it in the committee's own report: "those items, procedures, and interventions. that are found to be less effective and in some cases, more expensive, will no longer be prescribed" [emphasis added].

President Obama even hinted at this ominous future in a recent interview with the New York Times, noting that, "the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place." In other words, he is saying you and your doctor will no longer make the call, government will.

This is already happening in the United Kingdom, where the national health care board recently confirmed a ban on three of four life-prolonging drugs for its kidney cancer patients. Now, roughly half of those diagnosed with this cancer will not be eligible for the medical care they need.

Is it any wonder that Americans are 14% more likely to survive breast cancer, 35% more likely to survive colon cancer, and almost twice as likely to survive prostate cancer than their British counterparts?

If Washington follows Tom Daschle's suggestion to create a federal health care planning board that "exert[s] tremendous influence on every . . . provider and payer," we could face the same denial of treatment-and it will be us and our loved ones who will lose our health care freedom.

Are you ready for government health care? Are you ready for rationing?

SOURCE




Britain: A real medical hero who did what officialdom couldn't

It's a wonder that Britain's notorious health and safety bureaucracy have not prosecuted him for using an unapproved device. They would certainly have prohibited him from using it had they got wind of it in advance



There was little hope that Millie Kelly would live beyond a few weeks. Life-saving surgery on her tiny body had caused her kidneys to fail and she was too small for the hospital's dialysis equipment. But Millie was not fighting her battle to stay alive alone. Her hospital consultant, touched by her plight, went home to his garage and built a miniature dialysis machine from scratch.

After a fortnight attached to the DIY machine Millie started to show signs of improvement and is now, two years later, a fit and healthy toddler. Her consultant, paediatrician Malcolm Coulthard, is hoping a refined version of the machine he cobbled together in his garage will soon be introduced across the NHS to help other children in Millie's predicament.

She was born with gastroschisis in which the bowels develop outside the body. During surgery to return the organs to her abdomen at the Royal Victoria Infirmary in Newcastle upon Tyne her kidneys began to fail. Without them to cleanse her blood - a process called haemodialysis - she needed a dialysis machine. However, at just over 6lb, she was too small, even for the machines designed for use on children.

'I was devastated when they said she wouldn't make it,' said Millie's mother Rebecca, 21, a student from Middlesbrough. 'We thought there was no hope and that every hour she had was a bonus. So when we heard that people at the hospital were working on a new machine we had no option but to try it. It was the only hope. 'It looked handmade and there were a few paint splodges on it but I thought, if it will save my baby's life, I have to try it.



Millie is now a picture of health thanks to Dr Coulthard, pictured here with his homemade dialysis machine that helped save his young patient's life 'Millie's kidneys weren't working at all but after 15 days on the machine she started to improve. If it were not for that machine then Millie would not be here today. She is a really lovely child.' The device meant Millie's kidneys had a chance to recover and she no longer needs any form of dialysis.

Miss Kelly added: 'Words cannot describe how grateful my family is to Dr Coulthard. 'We owe her life to him. If I won the lottery I would give it all to him, we can't thank him enough. Not only is he a great consultant but now also a great friend.'

Dr Coulthard developed his idea with senior children's kidney nurse Jean Crosier and hopes to make a new version of the machine widely available on the NHS. 'At present we will only use the pilot machine on babies where it is certain that if we don't use it they will die,' he said. He added that with a 'state-of-the-art device' which has been given a European safety or CE mark, 'we will be able to ensure that any child can benefit and it becomes the treatment of choice for any baby that needs dialysis'. A team at Newcastle's regional medical physics department is developing the new machine.

One in 7,000 births is affected by gastroschisis, in which the baby develops a hole in the abdominal wall while still in the womb. Dr Coulthard's work has been recognised with the Special Award for Sustained Endeavour at the North-East's Bright Ideas and Health Awards.

SOURCE




Australia: Government mental hospital staff try to cover up dangerous negligence with a pack of lies

And they are so arrogant that they offer the whistleblower "counselling"

A MENTALLY ill man in the Royal Brisbane and Women's Hospital was "accidentally" released only hours before threatening a neighbour with a knife. The man's daughter said yesterday she was still awaiting a reply to her formal complaint about how her father was able to abscond on March 17 and how hospital staff misled her about his disappearance.

The western suburbs man, who suffers from bipolar disorder, was able to leave the RBWH's mental health unit by telling staff his daughter was waiting downstairs to take him on approved leave. He had been admitted under an involuntary treatment order two weeks earlier after suffering a psychotic episode and threatening to kill neighbours and himself.

The young woman said the hospital had contacted her the previous day to ask if she could supervise him for three hours' leave, but she had refused. "My father later told them I was waiting for him in a cab and they just buzzed him out," she said.

After another family member told her that her father was out of hospital, the woman called the mental health unit. "They told me he hadn't been released and that he was 'Here on the ward as we speak'," she said. "I thought, 'That's weird', and so I rang home and Dad picked up the phone. I then rang the hospital back to ask what's going on and was told 'His daughter picked him up'.

"When a patient is released to someone's care, that person has to be sighted, ID checked, and there is paperwork to be signed. But I never went to the hospital that day. "Then they said it was his sister who signed him out, but all of his relatives live in England except for me and his brother."

The woman arrived at her father's home just before police detained him for threatening a neighbour with a knife.

RBWH's acting mental health director, Dr Warren Ward, said Queensland Health was unable to comment on specific patients. "Risk assessments occur regularly to ascertain levels of restrictions and leave ," he said.

The man's daughter said she had an "emergency meeting" with RBWH staff the next day, but had not had a reply to her written complaint. At the meeting she had been offered counselling. "I'm very concerned at how easily someone can walk out of a secure mental health unit," she said.

SOURCE





12 May, 2009

Obamacare means nurses taking the place of doctors

Health care reform that focuses on fixing health insurance without dealing with the chronic and growing shortage of primary care physicians is likely to encounter “Massachusetts style growing pains” unless nurse practitioners are fully involved in health care reform, according to University of Miami President and former Secretary of the U.S. Department of Health and Human Services (HHS) Secretary Donna E. Shalala, Pennsylvania Governor Edward G. Rendell, and other experts brought together today by the American Academy of Nursing (AAN) and its “Raise the Voice” (RTV) campaign.

Shalala, Rendell and the others agreed that “Nurse-Managed Health Centers” – an innovative delivery model for primary and preventive care, especially for low-income and vulnerable populations – will be a vital ingredient in any plan to increase the capacity of the nation’s health care delivery system. The good news is that these nurse practitioner-led facilities are a “solution in plain sight” that already has been tested in Pennsylvania and 40 other states. Today, there already are over 250 Nurse-Managed Health Centers across the U.S. providing assistance to millions of Americans. It is estimated that these existing health centers could be expanded to reach over 20 million Americans, a significant number of the estimated 46 million Americans without health care insurance.

Experts have expressed great concern about the nation’s supply of primary care physicians, and their ability to meet the needs of patients throughout the United States. The current downturn in the number of primary care physicians is likely to increase during the next 20 years, resulting in a shortage of as many as 44,000 physicians in the fields of general internal medicine and family medicine by the year 2025. Advocates of nurse-led care point out that while the current acute physician shortage is only projected to worsen in the coming years, the number of advanced practice nurses will rise significantly.

The implications for health care reform of the doctor shortage could be staggering. In Massachusetts, for example, passage of a universal insurance plan has overwhelmed the system’s existing supply of primary care physicians. As of 2008, only 52 percent of internists in Massachusetts are accepting new patients. In the face of acute primary care physician shortages and steady reductions in the number of physicians who are willing to accept Medicaid and Medicare, it is unclear whether our existing primary care system will be able to meet the needs of a universally insured nation.

University of Miami President Donna E. Shalala, former Secretary of the U.S. Department of Health and Human Services (HHS) and Chair of the Advisory Committee of the Robert Wood Johnson Foundation funded “Raise the Voice” campaign of the American Academy of Nursing, said: “While increasing access to health insurance will help improve access to health care, our nation’s health care crisis cannot be solved by insurance alone. Enhanced nurse practitioner involvement in primary care has the potential to dramatically increase access to health care, improve care for patients with chronic diseases, and improve the efficiency of the health care system, all by maximizing the use of our existing health care resources. One option – Nurse-Managed Heath Centers need additional federal funding. Just as important, nurses need a seat at the table when true reform is being debated.”

Pennsylvania Governor Edward G. Rendell said: “The ‘Prescription for Pennsylvania’ experience, which two years ago focused on implementing innovative, non-physician models of heath care in the state has been nothing short of a major success. Our chronic care and patient centered medical home model, provides high quality health care to tens of thousands of patients that otherwise would find it difficult to access and pay for these services. By next month, we expect 400 primary care practitioners to be involved in four learning collaboratives, transforming chronic care for more than 750,000 patients. Greater nurse practitioner involvement in chronic care and rapid response is the inoculation we need to prevent rising heath care costs and ensure greater access to heath care.”

National Nursing Centers Consortium Executive Director Tine Hansen-Turton said: “Our nation’s 250 Nurse-Managed Health Centers are community-based, non-profit health centers that are staffed and run by advanced practice nurses (primarily nurse practitioners). They represent an innovative delivery model for primary and preventive care, especially for low-income and vulnerable populations. These health centers are positioned to significantly expand the capacity of our nation’s overburdened health care delivery system in a cost-effective and affordable way, but their true potential remains untapped. These centers can provide the foundation for real health care reform that will work, serving tens of millions of additional families across the United States.”

Independence Foundation President Susan E. Sherman noted: “Philadelphia may be the future vision of health care reform in the United States. Because we believe in the model’s potential, the Independence Foundation has invested millions of dollars in 12 Nurse-Managed Health Centers that provide primary care, health promotion, and disease prevention services. These Nurse-Managed Health Centers help clients manage current health problems, detect potential health problems, and reduce the risk of future health problems. We are proud of our support of this innovative model of care, but our support is not enough to sustain these centers. We need federal funding to bolster private sector support.”

More here




NHS spent £350m on management consultants

They could have hired a lot of doctors and nurses for that

The NHS paid £350 million to management consultants in England last year, according to figures released today. The Royal College of Nursing said that the spending — the equivalent of 330 fully staffed 28-bed medical wards, 9,160 experienced staff nurses or 267,647 bed days in an intensive babycare unit — was "utterly shocking”.

About £273 million of the money was not related to patient care, said Peter Carter, the RCN chief executive, who obtained the figures through freedom of information legislation. The bulk of the money was spent on increasing competition in the health service and supporting bids for foundation status by NHS trusts, he added. “These figures are utterly shocking when you consider the difference that this money could have made to patients,” Dr Carter said.

“A very significant sum of money is clearly being spent on setting up competition in the NHS and pursuing foundation status, rather than being invested in patient care. You only have to look at what happened at the Mid Staffordshire NHS Foundation Trust to see the consequences of this.” A report earlier this year into up to 1,200 deaths in Mid Staffordshire criticised the trust board for being more interested in attaining foundation status than caring for patients.

The RCN believes that the total spent on management consultants in 2008/09 may be higher, as more than 40 per cent of the NHS organisations which it contacted did not provide details of their spending.

Reducing the amount spent on management consultants could deliver 11 per cent of the £2.3 billion savings demanded from the Department of Health in last month's Budget, Dr Carter said. “Before the Department of Health and local health trusts look at cutting frontline services, training budgets or new facilities, they need to look very carefully at the money spent on external advice and what value is added to the patient experience,” he said.

“When some individual management consultants are getting more than £1,000 a day to advise on finance, we must surely be able to afford improvements to the quality of patient care. “Savings in this area could contribute a huge proportion of the savings to be made by the Department of Health, without jeopardising patient care."

According to the the RCN, 39 per cent of the money spent on management consultants was allocated to market testing designed to help providers and commissioners identify the most profitable options in the NHS market. Twenty-three per cent was used to support applications for foundation status, 13 per cent to achieve “provider separation”, and 12 per cent to buy advice on the Private Finance Initiative.

The Department of Health said: “Individual NHS organisations decide how best to invest their resources to ensure local people get the best possible care and services. We expect organisations to consider value for money and patients’ interests in all aspects of their expenditure. “All spending and investment is subject to independent audit — £350 million equates to less than half a per cent of total NHS expenditure for the last financial year.”

SOURCE





11 May, 2009

You sure can trust government with your personal information

Hackers last week broke into a Virginia state Web site used by pharmacists to track prescription drug abuse. They deleted records on more than 8 million patients and replaced the site's homepage with a ransom note demanding $10 million for the return of the records, according to a posting on Wikileaks.org, an online clearinghouse for leaked documents.

Wikileaks reports that the Web site for the Virginia Prescription Monitoring Program was defaced last week with a message claiming that the database of prescriptions had been bundled into an encrypted, password-protected file.

Wikileaks has published a copy of the ransom note left in place of the PMP home page, a message that claims the state of Virginia would need to pay the demand in order to gain access to a password needed to unlock those records:

"I have your [expletive] In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh :(For $10 million, I will gladly send along the password."

The site, along with a number of other Web pages related to Virginia Department of Health Professions, remains unreachable at this time. Sandra Whitley Ryals, director of Virginia's Department of Health Professions, declined to discuss details of the hacker's claims, and referred inquires to the FBI.

"There is a criminal investigation under way by federal and state authorities, and we take the information security very serious," she said. A spokesman for the FBI declined to confirm or deny that the agency may be investigating.

Whitley Ryals said the state discovered the intrusion on April 30, after which time it shut down Web site site access to dozens of pages serving the Department of Health Professions. The state also has temporarily discontinued e-mail to and from the department pending the outcome of a security audit, Whitley Ryals said. "We do have some of systems restored, but we're being very careful in working with experts and authorities to take essential steps as we proceed forward," she said. "Only when the experts tell us that these systems are safe and secure for being live and interactive will that restoration be complete."

She added that the department does have a page online at www.dhp.virginia.gov that lists the phone and fax numbers for various state health boards, and that the state would continue issuing health care licenses and investigating violations of the law or regulations of state health licensees.

This is the second major extortion attack related to the theft of health care data in the past year. In October 2008, Express Scripts, one of the nation's largest processors of pharmacy prescriptions, disclosed that extortionists were threatening to disclose personal and medical information on millions of Americans if the company failed to meet payment demands. Express Scripts is currently offering a $1 million reward for information leading to the arrest and conviction of the individual(s) responsible for trying to extort money from the company.

SOURCE




Australia: Preventable public hospital deaths top 180 in six months

The number of preventable deaths in NSW hospitals has risen sharply, with the majority of cases due to clinical care mistakes. The latest Clinical Excellence Commission report reveals there were 183 preventable deaths in NSW public hospitals between January and June 2008, representing more than the total number of deaths across the preceding 24 months.

"The Rees Labor government admitted to 120 deaths in the two years 2006 and 2007, we now have 183 deaths in just six months,'' opposition health spokeswoman Jillian Skinner said in a statement. "The incompetent Rees Labor government was either lying about the previous years' figures or there has been a massive increase in the number of deaths in our hospitals. "These figures show ... (the) government is failing patients."

The report showed "clinical care mistakes'' were responsible for 73 - the majority - of the 183 preventable deaths. Fifty-four suspected suicides by mental health patients were also included in the report.

NSW Health Minister John Della Bosca said the increased numbers of preventable deaths shown in the report could be partly attributed to "under-reporting'' in previous years. "I'm getting a bit tired of Mrs Skinner and her continuous harping on the skills and quality of care provided in our public hospitals,'' Mr Della Bosca told reporters in Sydney. "The simple fact of the matter is the report itself deals with that issue, speculating about under-reporting and changes in process."

The report also found that between January and June last year there were 10 cases of instruments being left inside patients, and five instances of babies getting the wrong breast milk.

Mr Della Bosca said the release of such information was important for the identification of deficiencies in need of improvement. "The NSW government is demonstrating it's leading the way in providing the most transparent and open possible reporting about our public hospital system,'' he said. "And of course we want to make sure that any problems, and mistakes, any issues in the system that lead to preventable deaths or any other incidents, are addressed. "That's why we have a system that's fully open to the public and made available to the public on an annual and more often basis, but also, we want to make sure that doctors, nurses and allied health professionals have the information they need to improve the care they provide our public hospital system.''

SOURCE





10 May, 2009

From America's medical frontline

Some emails to Hugh Hewitt from doctors:

1).

I listen to your show on pod cast, so I was unable to comment last night. An issue which you did not mention, but is critical to the situation is the accelerating doctor shortage. I am a senior physician executive who spent 31 years in the Air Force and completed my career as commander at ______ Medical Center....I am currently Sr. VP for Medical Affairs at a small hospital system in ___.

The major problem with every effort to "fix" health care is that they focus on controlling the price that the consumer pays. No one ever takes into consideration the cost of producing that care. This will have a major and increasing impact on the way forward.

Currently, the US is short of physicians and is not producing them at a rate of replacement. Add to that the fact that a 30 year old physician is a completely different animal than a 50 year old physician. Most "old" physicians came into the profession at the time it was considered a calling. Yes, they were compensated (monetarily and otherwise) very well. But for that, they accepted 100 hour work weeks and being on call for months at a time. It was part of the social contract and they just accepted it as part of the life of a physician.

The current crop of physicians do not have the same work ethic. Similar to other members of their generation, these docs expect to "have a life." They are unwilling to work the same hours as their elders - at any price. Additionally, 50% of most medical school graduates are women who statistically have a much shorter career. You can see that every time one of the old guys retires, you need more than one new graduate to cover the load.

The proposed changes that are ahead will undoubtedly encourage many of the old docs that there is no point in working beyond the point that they can retire. Yes, the fact that many of them have been hurt badly in the crash will keep some at work. But not a day longer than they have to. Then it will be harder for all of us to find a physician to take care of us.

2).

I am a pediatric neuroradiologist. I take care of children with severe neurological diseases, tumors, trauma, etc. I am an Associate Professor at the University of _________Medical School and practice at Children's Medical Center in ______. I am also a researcher using state of the art MRI. I can tell you that if we go to a single pay system, it will destroy the kind of healthcare and research which has allowed us to lead the world. Currently we have the best subspecialists in the world and free access and referral for state of the art care. As an example, I was on staff at another children's hospital in a large Midwestern city a couple of years ago and had a young boy with a large carotid artery aneurysm. We did not have the pediatric expertise in our city to treat him, but I have world class colleagues in another city who treat these things for a living, so I made some phone calls. The boy went to UT Southwestern Medical Center in Dallas, was treated and now faces a normal life. This kind of subspecialty referral care will end with rationing. This is unacceptable. Rationing would have forced that boy to "take the best available locally" or would not pay for the expensive interventional procedure which was life changing for this boy. Also, if they destroy medicine, what motivation will there be for the best and brightest to enter medicine.

3).

I am a physician (M.D.) practicing geriatric psychiatry in Texas for the last 16 years. I am a member of the Association of American Physicians and Surgeons (aapsonline.org) and am so opposed to government intervention in medicine that, although all of my patients are Medicare recipients, I have "opted out" of Medicare which means that all of my patients must pay out-of-pocket to see me and I cannot bill Medicare for any services. I can work with individual patients so that they can afford my services, and I can treat some patients for free! Under Medicare I am not allowed to do that. I have been active in legislative work in Texas on behalf of psychiatrists and their patients for about the last 13 years. You can read some of my articles at www.txpsych.org.

You asked Senator Kyl why the AMA and other physician organizations had been silent on health care rationing. AAPS mentioned above has been very vocal about government-run medicine. The AMA sold physicians out long ago with their CPT coding and constant bartering with CMS (used to be HCFA) which runs Medicare. They have always betrayed physicians so that the organization could "keep a seat at the table" which to me means getting invited to Washington parties and keeping organizational power. If you look at membership of AMA, it has been steadily declining.

Medical schools are as liberal as their undergraduate counterparts. The medical schools depend on government funding to operate (and the cost of a medical education has risen as a result), research dollars are funded through the NIH (especially now that the "evil" drug companies have been curtailed in their research), and most patients who seek care at medical schools are Medicaid, CHIP, or Medicare recipients. For that reason, these students have never had to be small business owners. At best, they go into practice for huge physician groups that act as agents for the individual physicians, paying their salaries, and speaking for them. Because of all of the bureaucratic oversight, it is difficult to practice solo. Medicare regulations alone are more complex than the IRS, and CMS has more draconian enforcement authority.

I appreciate your work on this issue. I am so tired of having to explain to patients that "government health care" does not mean that they will get the same care they have now with "the government" footing the bill. It means that the government will decide what care you get and you will have no recourse. After all--you're cheaper if you're dead!

4).

I am a 66 year old Pediatrician currently transitioning into retirement. I echo the comments made by the Sr. VP for medical affairs. My junior associate who is taking over has already informed me that she will no longer go to the hospital - too much work, too great a risk, too little return for the effort, etc. The 200 bed hospital I attend at has 0NE Pediatrician left on staff my age who just had surgery and walks with a brace. A new Pediatrician hired by the hospital is one month from joining him but has yet to get her state license - ipso facto cannot see patients. There are three other Pediatricians in the community. None have staff privileges except for a half-timer. The hospital has about 700 births a year and a drawing area of 250,000. God help them.

The hospital has critical shortages of all primary care specialties, i.e. Family Practice, Internal Medicine, and Ob-Gyn. Why? Two reasons. (1)The government artificially distorts the market. 75% of my patients are Medicaid in the first year of life. Who the hell would buy insurance when the government picks up the tab? Many need it, but a lot don't. This is an industrial region, not a farming region, even if it looks rural. My parents work for large corporations. (2) Women doctors. 75% of Pediatric residents and 52% of entering medical students are female. They won't move to small towns and rural zones. They won't work as many hours or as many years. It takes 3x as many women as 2 male doctors to do the work.

SOURCE





9 May, 2009

The Islamic NHS

The NHS just tells a Muslim dentist not to discriminate, rather than penalize him in any way for doing so. Will it be different this time? Unlikely. Muslims must be treated as if they are made of spun glass. I predict a token fine which will change nothing

A Muslim dentist refused to treat patients unless they wore traditional Islamic dress, it was alleged today. Omer Butt, 32, ordered women to put on head scarves or he would not register them or their families at his NHS-funded clinic, it was claimed. At least two patients were left in pain after they declined to follow his self-imposed rules, the General Dental Council heard.

It is the second time that the dentist - who is the brother of a former spokesman of the radical Islamic group al-Muhajiroun - has appeared before the council's disciplinary panel on similar allegations. Two years ago he was reprimanded for telling an Asian mother-of-two he would not register her unless she wore the Muslim hijab. The GDC heard how Butt believed it was his duty to stop Muslim patients committing what he believed was Al-Kaba'ir, a religious sin. He even put a laminated sign on the wall of his waiting room telling patients they would have to adhere to his strict dress code or find another dentist.

John Snell, for the GDC, said: 'He sought to impose a dress code on patients attending his practice. 'He required that women cover their hair with a head scarf, or hijab, and that male patients remove any gold jewellery. 'If he had simply expressed a preference, without imposing any compulsion to adhere to this dress code, there may be no cause for complaint. 'However, he insisted - and those who did not comply were refused treatment. 'He made compliance with Islamic dress code a condition of treatment, which is entirely inappropriate under the auspices of the National Health Service. 'Patients should have access to NHS treatment regardless of their religious observance, or otherwise.'

One patient, referred to only as Mrs F, told how she went with her husband and three children to register as patients at the Unsworth Smile Clinic, in Bury, Lancashire, in 2006. While they were waiting to be seen, Butt called her husband into an office and told him he would have to tell his wife to wear a head scarf or the family would not be seen. They promptly left and made a formal complaint to the NHS.

Mrs F told the panel: 'I was extremely annoyed. It's my choice if I wear a Hijab or not. But he told my husband he wouldn't treat any of us until I did. 'He even offered to provide one for me to use, but I didn't want to wear it. I shouldn't have to wear it to get treatment. 'I had great pain in my tooth at the time, but I wasn't going to stand for that so we left.'

Another patient and her family had to leave the clinic in June 2007 because she would not wear the religious headdress after spending a year looking for a dentist in the area, the hearing was told. The woman's husband, known as Mr C, was also called into a private room at the surgery where Butt asked him to impose a dress code on his wife. His wife said: 'My husband came out and he looked quite angry and his face was red. He said 'let's go'. 'He shouldn't say to me that he can't treat me unless I wear the hijab. He said he could provide one for us, but I didn't want to wear one. I was in pain that day.'

Butt, of Prestwich, Manchester, denies charges of misconduct for his treatment of two patients at the clinic. If found guilty he faces being removed the dental register. In September 2007 Butt was formally reprimanded by the GDC for similar behaviour and found guilty of serious professional misconduct.

SOURCE




Australia: Cairns base hospital under fire again

This is a major hospital, serving a geographical area about the size of Britain. But nobody in government gives a hoot: "Just routine" is the attitude

BODIES at a Queensland Health mortuary were left with gaping wounds after autopsies, stored with medical equipment attached and allowed to decompose. Funeral directors have told of the unsavoury practices and raised a litany of other concerns over the treatment of bodies at the Cairns Hospital mortuary.

Queensland Health is investigating the complaints and the Crime and Misconduct Commission has been alerted, The Courier-Mail reports.

In letters to senior Queensland Health bureaucrats, the Queensland Funeral Directors' Association said its members' complaints about poor practices at the mortuary had fallen on deaf ears for years. "We have tried over the years to try to resolve some of the concerns but now we have received formal complaints and concerns and we now write to you hoping that some progress can be made," QFDA secretary Wayne Bell wrote.

Funeral directors said it was common for bodies to continue to bleed after autopsies because they were packed with plastic incontinence sheeting and roughly stitched up with wax string. They said bodies from the Cairns Hospital mortuary "frequently" had catheters, drains and IV access equipment attached to them, from which blood and body fluids continued to drain. Body bags were often re-used and poor controls were in place to prevent the spread of diseases, including cleaning with the general purpose product Spray N Wipe.

"I have witnessed a number of body trays that have blood and body fluids on them when presented for placement of bodies we are delivering for coronial investigation," a letter from one funeral director said.

Health Minister Paul Lucas yesterday said he expected the issues raised by funeral directors to be taken seriously.

In a statement, Queensland Health clinical and statewide services acting chief executive officer Greg Shaw said a preliminary report had found work practices were "generally satisfactory" and found no evidence of "major problems". "However, like all audits it includes suggestions for improvements," he said.

SOURCE





8 May, 2009

Starvation in the NHS again

Frail elderly patients may die because hospital staff are failing to help them to eat properly, Health Service managers have admitted for the first time.

A survey of NHS chiefs, seen by the Daily Mail, exposes the appalling standard of care which has seen the number of those dying of malnutrition on wards rising to its highest in a decade. Managers highlight the shocking state of NHS food, with one describing how he watched as his 86-year- old grandmother lost a stone after three weeks of not being fed properly. Another said the failure to help frail elderly patients to eat properly had 'potentially lethal' consequences.

And despite years of ministerial promises to improve hospital food, health workers described it as 'embarrassingly poor', ' abominable', 'unappetising', 'awful' and 'dreadful', adding that the failures are putting 'patient safety at risk'. Several said nutrition was being 'almost ignored' because there was no target or Government funding to improve the situation.

The survey, for the respected Health Service Journal, found only one in three hospitals bothered to weigh patients on admittance so they could ensure they were fed properly - even though a nutrition action plan launched with great fanfare two years ago promised this would happen.

Latest figures show that 242 people died of malnutrition in NHS hospitals in 2007 - the highest toll in a decade - and more than 8,000 left hospital more malnourished than when they arrived.

The Daily Mail's Dignity for the Elderly campaign has highlighted the scandal of old people not being fed properly in hospital. Food is often so unappetising that patients do not eat - and 11 million meals are thrown away every year. Sometimes food is placed out of patients' reach and taken away untouched, because nurses claim they are too busy to help them eat.

The Health Service Journal survey, which was carried out anonymously, involved 401 managers and health workers. It found that half believed the nutrition action plan, unveiled by ministers in 2007, had improved care 'not much' or 'not at all', and that only 38 per cent of trusts were screening all patients. Only 37 per cent of those who responded to the survey said nutritional care was a priority for hospital chief executives and boards. One said: 'Based on my experience watching my grandmother being cared for, my opinion is very low. Nutritional care was almost non-existent.'

Another manager said: 'I have recent experience of my 86-yearold grandmother losing one stone in three weeks. Disgraceful. The elderly, people with dementia, people with communication problems, are left to fend for themselves when it comes to meals and drinks.' Several managers said growing numbers of patients were dehydrated. One complained: 'Food is put out of reach and no assistance is given to those who require it.'

Many managers said the problem was caused by staff shortages and by the fact that nurses did not see nutrition as an important part of patient care. One said: 'Screening patients for malnutrition and providing assistance with eating do not happen. 'Everyone seems to think that it is someone else's job.' Another said: 'Nursing education does not give attention to it.'

Conservative health spokesman Stephen O'Brien said: 'The scandal of hospital malnutrition is completely avoidable and these extra deaths should not be allowed to happen. '[Health Secretary] Alan Johnson needs to stop dithering and take action on the scandal of malnutrition without delay.'

SOURCE




The health czar can’t calculate

Experts agree that our healthcare system is unsustainable and in need of reform to promote better coordination, accountability, outcomes, and cost effectiveness.[1] Regrettably, they also seem to agree that we need a robust central-planning authority — a health czar — to make this coordination happen.

But as economist Ludwig von Mises proved in his 1920 treatise "Economic Calculation in the Socialist Commonwealth,"[2] under central planning any rational economic calculation, that is, any method to efficiently allocate resources, is practically and theoretically impossible — not just of higher cost, lower quality, and reduced innovation; not just uncoordinated, inefficient, and ineffective; but literally impossible.

In practice, a health czar would have to evaluate the quality, revenue, and cost of complex production processes, and billions of healthcare goods, services, hospitals, pharmacies, nursing homes, surgery centers, diagnostic centers, laboratories, outpatient clinics, home health agencies, hospices, long-term-acute-care hospitals, ambulances, patients, physicians, nurses, therapists, and clinicians, all across geography and across time. The health czar must therefore consider an almost infinite number of permutations in order to correctly allocate trillions of dollars.

Reformers argue that computers and an electronic medical record will help resolve this practical calculation problem. However, even if the health czar possessed the most advanced computer systems, hospitals, physicians, and producers of healthcare services will possess similar electronic systems to manage their own operations. Together, they would be capable of generating more data than the health czar can absorb and process meaningfully. Paradoxically, computers actually make economic calculation more complex and difficult.[3]

The health czar must also consider two additional exacerbating factors.[4] First, like all goods, healthcare resources by their very nature are substitutable for one another. For some cancers, chemotherapy, radiation therapy and surgery may be substituted or complemented with one another. The health czar has to discover the natural substitutability of millions of healthcare services in accordance with the exchange relations that in a free-healthcare-market economy take place automatically, permanently, and instantaneously.[5]

Second, capital can be invested to improve the efficiency and quality of any healthcare service. Hospitals may decide between investing in robots for pharmacy or the operating room to improve the productivity and accuracy of pharmacists and surgeons; or they may hire additional pharmacists or more experienced surgeons, or varying combinations of them. Simultaneously, the manufacturer of robots would need to decide to invest capital to develop either pharmacy, operating-room, radiation-therapy, or industrial robots and varying combinations of them and direct the production chain of all the inputs necessary to develop robots, such as software, research, labor, parts, raw materials, financial services, marketing, etc. This investment in production at both provider and manufacturer levels multiplies infinitely the permutations the health czar would have to evaluate.

In addition to facing the practical economic calculation problem outlined above, health reformers misunderstand pricing theory. Unlike the weather forecaster who faces a practical problem that can be resolved by the use of better satellites, faster supercomputers, and better equations and models, the health czar faces an unsolvable theoretical problem. He cannot forecast the price for health services because, by definition, prices can only be calculated by the free and unencumbered interaction between producers and consumers.

There are two reasons why it is theoretically impossible for the health czar to arrive at meaningful prices. First, contrary to popular belief, costs of production do not determine prices of goods. Prices are determined by the instantaneous valuations made by consumers and producers bidding against one another. By a process of imputation that flows from the consumer to the producer, prices of goods impute value to the factors of production necessary to make the goods that consumers demand. This imputation of value occurs when producers and entrepreneurs bid for the factors of production (labor and materials) in response to expected future profits, which sets wages for labor and prices for materials. Prices of goods, therefore, determine costs of production.

Since its inception, Medicare planners have come up with alternative valuation methods that unsuccessfully attempt to arrive at a rational price structure for health services. Medicare recognizes that "cost-based payment methods" (in which reimbursement is determined by allowable costs supplied by providers) are complex, result in unpredictable payments and spending for providers and government, and weaken providers' incentives for efficiency.[6] Medicare claims that these methods are being substituted for "prospective payment" (in which an initial operating and capital-payment base rate is adjusted by wage indexes, medical education costs, charity burden, long lengths of stay, etc.).

But despite these recognitions and claims, Medicare still uses cost information to determine prices. This is because the initial-operating and capital-payment base rate is always determined by the operating and capital costs that a set of "efficient" providers incur.[7] When Medicare uses cost information to arrive at pricing, it uses the wrong economic cause-and-effect relationship and therefore distorts prices.

The second reason why it is theoretically impossible for a health czar to price services is that prices in a market economy are continually, instantaneously, and simultaneously created, destroyed, and recreated by the individual subjective valuations of consumers and producers facing the passage of time.

This process takes into account change in expectations, economic conditions, wants, scientific knowledge, income, needs, technological advancements, etc. But note that information about valuations is not created until after consumers and producers act in the real world by placing their respective bids. These bids are impossible to transmit to a health czar before they exist, before they are made real through human action. Until then, a central health planner has a universe of infinite possibilities stored in the minds of each of hundreds of millions of economic participants. This universe does not and can never constitute meaningful economic information until patients and providers act in the marketplace. And once bids take place and pricing information is created, transmitted, processed, and analyzed by the health czar and returned to the market place in the form of reimbursement rates and rules and regulations, it is old, distorted, and useless information that cannot possibly have any rational guiding content for patients or providers. It is wasteful, non-value-added, false, and misleading information.

At the outset of the Medicare program, its central planners were able to set their prices as parasites of the then-existing competitive private-healthcare price structure, just as Soviet central planners were forced to copy the price structure of Western economies to direct Soviet production processes and meagerly subsist for eight decades.[8] This parasitic existence of copying the free-market pricing structures continues to be the theoretical edifice of Medicare central planners. But as the proportion of Medicare, Medicaid, Veterans Administration, and other state, county, and city health expenditures grow, and as the proportion of eligible population for these payors increases relative to the rest of the population, the private-sector pricing is crowded out of the market and is distorted; a health czar has fewer and fewer free market pricing signals to copy. Inevitably, our health system will continue to descend into further and further chaos, in which actors will be unable to rationally allocate capital. This is exactly what happened to the economy of the Soviet Union.

The health czar may know what final healthcare goods and services are required to meet the government-determined needs of the US population. Indeed, in their own words, "Medicare's primary goal is to ensure that its elderly and disabled beneficiaries have access to medically necessary acute care of high quality."[9]

But this is only the first of two simultaneous equations that are necessary to allocate health resources. The second equation is the pricing valuation of the means of production to ensure that those needed goods and services are produced within a rational production process. But without the bearings of economic calculation — that is, without pricing signals derived in a free market — all patients, hospitals, physicians, and producers of healthcare services (and the health czar himself) are left, to paraphrase Mises, groping in the dark.

SOURCE





7 May, 2009

NHS trust apologises for 'under-treating' a mental patient who went on to kill a pregnant woman

Basically, they just wanted rid of him

A mental health patient stabbed a pregnant stranger to death after a string of failures in his care, a report revealed. Benjamin Holiday, a law student, killed mother-of-five Tina Stevenson, 31, in a random attack a day after missing his medication.

An independent investigation found his mental health problem was 'under-treated' and his condition should have been 'more assertively managed'. A decision by a social worker not to detain him just weeks before the killing was a vital 'missed opportunity'. Humber Mental Health Trust has now apologised to Miss Stevenson's family.

The 31-year-old had been seven months pregnant with twins when she was killed. The unborn children also died.

Holiday, now 28, was a talented undergraduate until experiments with cannabis and then ecstasy are believed to have caused his mental illness - forcing him to drop out of university. He was diagnosed as suffering from paranoid schizophrenia and was 'in and out' of psychiatric hospital for four years.

In November 2004 psychiatrists decided he was well enough to be released from a secure hospital unit after two weeks' treatment and he returned home to live with his mother Christine, taking medication every two weeks. The day before the killing a community nurse arrived at the family home in Hull by appointment to give Holiday his regular injection, but he was not there.

On January 5 2005, Holiday stole a knife from a store and stabbed Miss Stevenson as he walked home. She had been to a hospital ante-natal clinic that morning and was walking near her home when she passed him. Holiday, who had previously complained of hearing voices in his head telling him to kill, turned around and stabbed her once in the back before running off.

In 2006 he was given an indefinite hospital order after admitting manslaughter by reason of diminished responsibility.

The independent report written by NHS Yorkshire and the Humber listed a series of failings in his treatment. It said Holiday was able to 'abscond and absent himself from inpatient care too easily' and his final admission in November 2004 was 'a missed opportunity to compulsorily detain him'.

Detailing his years of treatment and problems, the report revealed how Holiday told a nurse in 2002 he thought about killing his friend and felt he could have raped a woman he went on a date with. He was admitted to hospital the following day and discharged days later.

In November 2004 he escaped after being sectioned and a consultant psychiatrist requested his social worker make a formal application for his longer term 'detention' on his return. But when he returned Holiday seemed 'calmer', the social worker decided against making the application and he was released.

The inquiry concluded Holiday's consultant psychiatrist, who had an excessive workload, was not to blame. It recommended a number of changes to procedures and staffing.

Yesterday Holiday's mother Christine said: 'It is clear mistakes were made in my son's care. There was a lack of communication, a lack of accountability, and records were not shared. 'This meant people did not realise how ill my son was and so he didn't always receive the most appropriate care.'

The same NHS trust also apologised to the family of Ivy Torrie, 82, who was killed by her mentally ill son, Michael, in Pocklington, East Yorkshire, in 2003. A separate report yesterday said the root cause of Torrie's actions was the 'rapid reduction of medication and the way this was managed in the absence of a risk assessment'.

SOURCE




Australia: NSW government refuses to reform its disastrous ambulance service

The untouchability of government employees once again

THE controversial head of the NSW Ambulance Service will not be sacked despite a damning parliamentary inquiry that found he had presided over a decade-long failure to deal with bullying and harassment within the organisation that led to at least nine suicides.

The Minister for Health, John Della Bosca, said the tenure of the ambulance chief executive, Greg Rochford, had been reviewed in January three months after an upper house committee called for an urgent investigation into his performance.

In announcing the Government's response to the 45 recommendations made in the report, Mr Della Bosca said yesterday he was committed to a statewide "culture change and improvement program" to end endemic bullying in the service. However he refused to take direct responsibility for the service or the performance of its chief executive.

Mr Rochford, whose resignation has been called for repeatedly by the Health Services Union, will keep his job, although a committee of long-time current and retired NSW public servants will be appointed to oversee his efforts to resolve disputes and address workplace behaviour. And Mr Rochford will continue to be responsible for the management of senior ambulance executives, despite the report finding they were a "nepotistic old boys' club" who swept claims of bullying and harassment under the carpet for 10 years.

Phil Roxburgh, whose revelations about bullying at the Cowra ambulance station sparked the inquiry, said Mr Rochford and other senior executives should have been removed. "To find out these people are still in the same positions, offering no more than lip service [to anti-bullying policies] is very disheartening and disappointing," said Mr Roxburgh, who is now manager of the Moruya ambulance station. "I do not want to see our only chance for a change in culture blown."

A paramedic, Christine Hodder, the first woman to work at the Cowra ambulance station, took her life in April 2005 after years of bullying. Mr Roxburgh, her former manager at Cowra, went on stress leave after he was harassed for supporting her.

Mr Della Bosca said many of the recommendations from the inquiry were already being dealt with by the Government including the appointment of an extra two investigation staff to ensure serious matters were dealt with rapidly, a "healthy workplace manager" to deal with grievances and a compulsory "respectful workplace training" program for all staff. "Change on this scale will always create workplace tensions and it's a credit to the workforce that the healthy workplace initiatives are being embraced," he said.

The committee chairwoman, Robyn Parker, a Liberal member of the Legislative Council, said some issues raised in the six-month-long inquiry, such as wages and conditions, had since been resolved following a hearing in the NSW Industrial Relations Commission. However, the Government had not explicitly accepted the majority of recommendations in its response but used "weasel words" to claim issues were already being addressed, without any evidence of change.

Ms Parker said she had been getting numerous letters from people saying "nothing has changed, the culture and the environment is as toxic as it was during the inquiry". "Unless there is a massive cultural change starting from the very top of the service, how can officers trust the Rees Government?"

SOURCE





6 May, 2009

Dangerous NHS care "after hours"



A foreign on-call doctor [above], who admitted killing an elderly patient with a morphine overdose on his first ever shift in Britain, has escaped prison because of a legal loophole. German doctor Daniel Ubani, who specialises in anti-ageing medicine and cosmetic surgery, was employed as a locum to provide out of hours care from a base in Suffolk. During his first day's cover in Britain he was called to the Cambridgeshire home of 70-year-old David Gray who was suffering from kidney pains for a routine visit. But instead of administering pethidine - a moderate painkiller - to the patient, Dr Ubani injected him with 10 times the dose of morphine, after confusing the two drugs due to tiredness. Three hours after the consultation, Mr Gray died at his home in Manea.

The death exposes the flaws in the current system of out-of-hours care which is reliant on foreign doctors who are unfamiliar with British practices and have no previous knowledge of their patients. Many foreign doctors travel for hours before starting a shift. But critics believe such a commute could leave medics tired - and put patients' health at risk.

In 2004, about 90 per cent of GP surgeries chose to stop providing night-time and weekend care - so the service is provided by external agencies in most parts of the country. In rural and deprived areas it is particularly hard to find British doctors to do the work, so foreigners increasingly fill the gaps. Nearly half of Britain's surgeries hire overseas doctors. Almost a third of practices in Northumberland, Tyneside and East Anglia employ GPs from overseas.

The NHS watchdog Care Quality Commission has launched an investigation saying: 'This is a deeply disturbing case and one that must be thoroughly looked into.'

As soon as they were informed of the death, Suffolk Doctors On Call, the agency who hired Dr Ubani, dismissed him and he flew back to his clinic in Germany. Detectives from Cambridgeshire Police began an immediate investigation and following post mortem examinations, a forensic pathologist concluded the cause of death was diamorphine poisoning. In March, the Crown Prosecution Service (CPS) issued a European Arrest Warrant to bring Dr Ubani back to the UK with the prospect of charging him with manslaughter.

But two weeks later, British prosecutors were told legal action against the doctor had been started in Germany. To the dismay of his family, he then pleaded guilty to manslaughter in front of a German Court, who sentenced him to a nine-month suspended prison sentence and €5000 (£4,500) fine.

The CPS are now likely to close their case against Dr Ubani, as under the double-jeopardy rule people cannot be prosecuted twice for the same crime unless there are specific exceptions. His son Rory Gray, said: 'We are very disappointed that no-one is going to be held responsible. We wanted him to return to Britain to face justice.'

Mr Gray's partner, Lynda Bubb, who had called the out-of-hours service, said: 'I want no-one else to go through what we have been through. They have to work out a way this does not happen again.' It is believed the family are now considering taking civil action against Dr Ubani.

Writing to the family, Dr Ubani, who has been a GP in Germany for 22 years, blamed his mistake on exhaustion and asked for forgiveness. He said: 'It is with a very heavy heart that I write you this letter to express my deepest sympathy and remorse for the fatal mistake that I made and the circumstances that led to the untimely death of your believed father.' He added: 'There is no amount of remorse, grief or explanation on my part that can satisfy or replace the life your father and head of your family. 'The circumstances arose from the confusion between the drugs pethidine and diamorphine, which was administered in a very high dosage.'

Dr Ubani said he was under 'tremendous stress' before taking over his shift. He flew in from Germany, and then took a car hire drive to Colchester to meet my job agency for instructions. He later drove to Ipswich for coaching, before heading to Newmarket Hospital where he was based. He said: 'My nerves were overstretched, I was too tired and lacked concentration and these factors played a major role in the mistake that occurred.'

Suffolk Doctors On Call, which supplies doctors for Take Care Now, one of the Britain's leading independent healthcare providers, said it has now changed its procedures.

A spokesman for Cambridgeshire Police said: 'A thorough investigation was conducted into this matter in conjunction with the Crown Prosecution Service. 'We had completed the complex process of obtaining arrest warrants for Europe and are disappointed that any subsequent prosecution was not allowed to reach its natural conclusion in this country.'

SOURCE




Australia: The killer bitch that the NSW ambulance sees no reason to fire

They had good grounds to fire her years ago -- but government employees are a protected class, of course



THE horrendous triple-0 record of the operator who took teenager David Iredale's last harrowing call includes hanging up on a desperate caller and ignoring emergency calls to read novels. The callous attitude of Stacey Dickens is revealed in the triple-0 operator's ambulance service disciplinary records, obtained by The Daily Telegraph.

Five years before she ignored David's pleas for a rescue helicopter and put him on hold while he was lost and dying in the Blue Mountains, Ms Dickens was disciplined for terminating an emergency call. Like David's case, ambulance officers were having difficulty finding Riyadh Alenzi, who had collapsed and stopped breathing while working at the Leppington Pastoral Company on September 10, 2001.

When a colleague called triple-0 to ask when a lost ambulance would arrive at the Bringelly company in Sydney's southwest, Ms Dickens terminated the call and failed to try to call him back despite having the number.

The Daily Telegraph has gained exclusive access to Ms Dickens' disciplinary record, including other incidents in which she was chastised for reading novels while on the job. According to the documents, on some occasions there were triple-0 calls flooding into the Sydney ambulance operations centre while she remained engrossed in her book.

Despite her record and even after admitting at an inquest into David Iredale's death that her mind was not on the job and that she was failing to absorb what the dying teenager was telling her, Ms Dickens is still employed by the NSW Ambulance Service as a triple-0 operator.

In the Leppington Pastoral Company incident, the ambulance arrived 45 minutes after the original call, and Mr Alenzi recovered. A spokesman for Health Minister John Della Bosca refused to weigh into Ms Dickens' position with the ambulance service or whether she had been disciplined.

SOURCE





5 May, 2009

Manchester NHS Hospital Infects 7 Babies with MRSA

MRSA is generally a sign of lack of cleanliness and inattention to asepsis

SEVEN babies have tested positive for the superbug MRSA at the region's biggest maternity unit. St Mary's Hospital in the city centre has closed the three neo-natal wards on the unit to new admissions following the outbreak. It is understood MRSA was found on the skin of one baby several weeks ago. The six other cases were picked up during routine skin screening tests on Thursday. The unit cares for the sickest and most premature babies in Greater Manchester.

Doctors stress none of the babies have contracted the more serious MRSA blood infection and none are suffering any ill-effects as a result of the bacteria being found on their skin.

Staff say they have tried to isolate the affected babies in each of the three wards which are intensive care, high dependency and the special care baby unit. There are currently 27 babies on the unit.

Among those found to be carrying the bug is nine-week-old Jaylen Redshaw who was born 15 weeks early weighing just one pound eleven ounces. Today his parents, from Gorton, said they were desperately worried about their child and concerned the hospital had not informed parents soon enough. They said they were also alarmed babies had continued to be transferred from one ward to another.

Jaylen's mum Jacqui Millward, 22, who is a care assistant in an elderly residential home, said: "They told us the incubator was isolation enough, but obviously this is not the case otherwise it wouldn't have spread, would it? "It wasn't until more than six hours after the bug was diagnosed that they told us. I had taken my two-year-old daughter Kenzie on the ward earlier in the day and if other people have done the same it has probably now been spread into the community. "If people had been told earlier then obviously we would all have been able to take further precautions.

"We have now been told that we will all have to be swabbed for MRSA and cannot hold our child until the results are back. "The nurses have told us Jaylen is not in immediate danger, but he was born 15 weeks prematurely so he is obviously very vulnerable. "They told us the same nurse would be treating him and no-one else, but we later found out the same person was looking after another baby.

"There is also broken skin on his foot and on his toe, but until I raised it as an issue they had left the wounds open - that is how the condition gets into the blood. "We are so worried. We have to leave our son's life in their care. Every time the phone rings I think it is the hospital ringing to say it has got into his blood. "If us speaking out about this prompts further precautions and helps protect another child, then it has been worth it."

Hospital bosses said that premature and sick babies are now being sent to other neo-natal units a Wythenshawe, Bolton and Salford on a case by case basis. A spokeswoman for St Mary's said: "We can confirm we have temporarily restricted new admissions to the Neonatal Unit. This is due to a number of babies on the neonatal unit testing positive for MRSA. "We would like to stress however that none of these babies are currently infected; they have been identified through our weekly screening programme to be carrying the MRSA bacteria. "The infection control team is monitoring the situation very closely and, alongside our staff on the unit, have taken steps to reduce the risks to our other babies."

Last winter Salford Royal's baby unit had to be closed after two babies contracted a rare fungal infection

SOURCE





4 May, 2009

NHS 'wanted to send me home so I threatened to chain myself to the bed': British swine flu victim's hospital ordeal

He found the viral attack extremely distressing and debilitating but the NHS doctors were not concerned about how he felt and could not be bothered to do any diagnostic testing before they discharged him. Being Italian, however, he protested -- where a British person would almost certainly have done meekly what they were told. The doctors probably thought to themselves: "Bloody wop" ("Bloody" is the British version of "goddam") but it seems to me that they need more "bloody wops" to keep them on their toes. Sending very ill people home is all too common in the NHS -- with death the result on some occasions

A British victim of swine flu had to beg doctors to keep him in hospital while he was still suffering from the virus. Student Stefano Boccino, 22, was taken to hospital on Wednesday after falling ill while travelling back from the Mexican resort of Cancun. Suffering from a fever, dizziness and nausea and barely able to move, Stefano feared he might die in an isolation ward at the Royal Free Hospital in London as fears grew over a potential swine flu pandemic.

But just 24 hours later doctors told him he was being discharged because he ‘looked better’. Stefano, who still had severe symptoms of the virulent H1N1 flu, said he had to threaten to chain himself to his bed to persuade doctors to keep him in for observation. He said: ‘The doctors had told me that they had never dealt with a case like this. But then, just 24 hours later, they wanted to send me home. A doctor said I was looking a lot better, but I said, “Don’t be fooled. Someone with a tan and of Italian descent will always look healthier than most. I’m not leaving. I’ll chain myself to the bed if I have to.” ‘Eventually, they agreed to keep me in and blood tests revealed on Friday that the virus was leaving my system.’

Stefano is now recovering at the home he shares with his parents in Mill Hill, North London, where he has been told he must stay until this evening to avoid spreading the virus. His father Alberto, 50, and sister Rosamaria, 30, were also ordered to remain in the house in case they had become infected.

Stefano, who is in his third year of a human resources and business psychology degree at London Metropolitan University, started to feel ill as he returned home from a luxury two-week break in Cancun. He and his friends Anna Driscoll and Suzanne Buick, both 23, used student loans and savings to pay £1,000 each for the trip. They spent their days relaxing on Cancun’s beach with pina colada cocktails and their evenings dancing in the town’s bars and clubs.

Stefano, who is gay, said that he was mostly the ‘party pooper’, going home alone at 3am while the girls stayed out. But on his two connecting Continental Airlines flights home he began to feel unwell. He had received a text from his father warning him of a flu outbreak in Mexico City, but because it was hundreds of miles away he thought nothing of it. ‘First I developed a bad chesty cough,’ he said. ‘I was getting dizzy and feeling sick. I slept during the first leg of our journey – a two-hour flight to Houston – and I was pretty floored when we got there. Then we had a six-hour transfer window and during that time I felt like I was dying.’

He bought some flu capsules but they had no effect and, crouched in a ball on the airport floor, he asked Anna to look after him. On the flight to Heathrow, Stefano was sweating and nauseous and said that ‘every limb felt like lead’. He asked a flight attendant for water and a cold towel for his burning forehead. Despite the fact that some passengers on the flight had come from Mexico, he said that none of the crew asked him whether he had been there.

Three hours into the flight, he took his temperature with a thermometer he had packed for the trip and was stunned to see it read 40C. A normal temperature is 37C. ‘I thought it must be wrong, so I did it again and it was the same,’ he said. ‘I thought, that’s the reason I don’t feel too good.’ Barely able to walk when the plane landed on Monday, he asked an airport steward if he could use a wheelchair.

He saw posters throughout the terminal building advising passengers returning from Mexico to be vigilant of swine flu symptoms, and assumed that airport staff would be on alert. But a steward suggested only that Stefano visit his GP. ‘I should have been quarantined at the airport,’ he said. ‘Not to do that is terrible. I put so many other people at risk. ‘I didn’t tell anyone I had come from Mexico, but the staff must have had the flight details and would have known that there were people on that plane who had connected from Mexico.’

Stefano was picked up by his cousin, Vivianna, who took him straight home. A self-confessed ‘clean freak’, he began unpacking and washing clothes. But he was soon laid out on the sofa, unable to move, with his muscles in spasm. He was alone at this point. His mother, Cherry, 52, was in hospital having a disc removed from her back and his father was at work. When Alberto returned, he and Stefano’s sister Rosamaria became concerned and phoned their GP.

Alerted by the fact that Stefano had just returned from Mexico, but without a supply of protective masks, she phoned the Health Protection Agency. Staff there sent round supplies of the anti-viral drug Tamiflu and saliva test kits, and warned the family to stay inside as a precaution. Stefano’s mother was not allowed home and instead went to stay with her sister, while Rosamaria’s ten-year-old twins, a boy and a girl, had to stay with a family friend. All were terrified.

On Tuesday morning, Stefano received a phone call from the HPA. ‘A woman told me that the swabs had tested positive for influenza A,’ he said. ‘She said they had to do more tests to confirm swine flu, which is an A type, but she said it was likely I had contracted it. ‘It’s hard to say whether I was in shock or upset because I simply felt like I was dying, I honestly did. I was in a daze. Being Italian, I’m a very big eater. I love my food but I had completely lost my appetite. ‘When the HPA rang on Wednesday, they asked first if I was sitting down. By this point I was feeling really, really bad. I was feverish, dizzy and nauseous. ‘The woman said, “You’ve tested positive for swine flu. You’re the first case in London.”’

Even now, Stefano’s voice is tinged with disbelief. ‘No matter how much I’d considered I might have swine flu, the reality was a real shock,’ he admitted. ‘I kept thinking, I’m going to die, I’m going to die.’

The HPA contacted everyone Stefano had been in contact with. Officials wanted to know where he had stayed in Mexico, his and his friends’ room numbers, the people they had met and his flight details, including seat numbers.

Anna and Suzanne were put in isolation and given Tamiflu as a precaution while they were being tested for the virus. Stefano’s neighbours looked on horrified on Wednesday as was bundled into an ambulance by two paramedics. ‘They were wearing what looked like space suits with visors, goggles, gloves, aprons and jackets,’ he said. ‘The whole thing was bizarre – like something from the film ET.

‘They handed me a mask and said, “You need to put this on.” I had to wave my family goodbye. It was all rather emotional. ‘I was taken to an isolation unit at the hospital, and had to pass through three separate locked doors just to get to my room. Each door had to be opened and locked again before we could go through the next one.’

He spent the next couple of days in isolation, watching the sitcom Will And Grace on a portable DVD player, listening to his iPod and reading books. Doctors did allow him to have a mobile phone to keep in touch with friends and family.

Stefano was treated using Tamiflu, paracetamol, aspirin and anti-sickness drugs and was put on a drip to keep him hydrated. Nurses approached him with caution, appearing only briefly for a chat or to deliver food – having spent ten minutes each time dressing in full protective gear.

Gradually, his symptoms subsided. An ambulance, with paramedics again wearing protective gear, took him home on Friday evening, where his father and sister were still in quarantine. They, as well as Anna and Suzanne, had tested negative for the swine flu virus. ‘My Dad and sister were so glad to see me,’ said Stefano. ‘But I felt guilty that my mum couldn’t come home from hospital because of me. This has all been such a huge inconvenience to our whole family...

A spokesman for the Royal Free Hospital said: ‘We are unable to comment due to patient confidentiality.’

SOURCE




Australia: Another disaster looming as NSW hospitals computerize

Such projects rarely work. The British version has cost 12 BILLION pounds so far and is still not working properly after many years of trying

BY THE end of next year, every public hospital in NSW will move from paper patient notes to electronic medical records that can be accessed by any health worker, the Government has announced. The Minister for Health, John Della Bosca, said the $100 million project to digitise 250 hospitals will save money by eliminating duplicate diagnostic tests and imaging. It will also improve patient safety by alerting staff to a deteriorating patient and reduce the likelihood of errors.

Mr Della Bosca said doctors, nurses, allied health and social workers will be able to access a centralised repository of a patient's medical chart, laboratory results, prescriptions and referrals, no matter where the patient enters the health system.

Peter Garling, SC, recommended an urgent roll-out of electronic medical records (eMR) in his special commission of inquiry into acute care services, which found NSW's record-keeping system is "a relic of the pre-computer age" that puts patient safety at risk.

He said various hospitals and community health centres have established ad hoc databases but they were "spasmodic and patchy". The inability of distinct IT systems to synchronise with each other and lack of IT support staff meant clinicians had to rely on incomplete data to make important medical decisions and spent time chasing information.

Mr Della Bosca said the Government would make implementing information and communication technology within its capital works program a priority, which will make NSW Health the biggest IT user in Australia. A basic eMR system that allowed clinicians to order diagnostic tests and view results online was successfully trialled at St George, Calvary, Sutherland and Lismore hospitals last year and by last month 20 hospitals were using it.

"Prior to the introduction of eMR, some requests for medical imaging and pathology could require referral back to the requesting clinician due to incomplete or illegible hand-written records," Mr Della Bosca said. "This technology will improve the efficiency of hospital care and free up doctors and nurses to focus on patients and not paperwork, which will further improve patient safety."

The next step will link hospital-based records to primary care providers, such as GPs, by way of an electronic discharge summary. But the Health Action Plan For NSW, released in March, revealed the Government would not meet Mr Garling's 18-month deadline for a digital radiological imaging system. This is to be set up in every public hospital to electronically transmit medical images to remote locations.

And an electronic health record, which would extend patients' information beyond hospital walls to all GPs, specialists and health systems in other states, was not possible without a national e-health strategy, it said.

A report commissioned by the Federal Government last December found state and federal governments have spent $5 billion on electronic health initiatives over the past 10 years but have made little progress towards creating a national system for sharing information.

NSW Health has admitted that two previous attempts to implement electronic medical records in 1991 and 1999 had failed, at a cost of $12 million and $30 million respectively.

The National Health and Hospitals Reform Commission has recommended an individual patient-controlled electronic health record owned by the patient who decides which health care providers can access it.

SOURCE





3 May, 2009

“Health care” — government will decide when enough is enough

As you may or may not know, I just sent the last week touring the houses of Thomas Jefferson, James Madison and James Monroe - three of this nation’s founding fathers. So when I glanced through the following interview with Barack Obama I tried to picture any of these three men ever contemplating this question or a role for government in the context of the question and frankly, it’s unimaginable.

The only vision I could even begin to imagine is the three of them looking on sadly and shaking their heads “no” in unison as they tried to grasp the size of government and the depth of its intrusion into the lives of citizens the questions and answers indicated. I’m sure they’d also be trying to figure out where it all went wrong. The questions have to do with “end of life care”:

Q:…where it’s $20,000 for an extra week of life.

THE PRESIDENT: Exactly. And I just recently went through this. I mean, I’ve told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.

So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.

And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart.

I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

“…society making those decisions to give my grandmother … a hip replacment?” Above that he points to a doctor giving who that choice?

His grandmother.

Below that who is Obama talking about making that decision or having that choice? Well it isn’t his grandmother. And although he uses the term ’society’, he means government. Note he says that if someone had told him no he’d be upset, but he’s setting up the table to be ‘upset’. This is an old Obama trick - acknowledge the downside in a very personal way while still pushing for that downside.

Q: And it’s going to be hard for people who don’t have the option of paying for it.

THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right? I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

Anyone who hasn’t quite figured out the rationing model Obama is talking about with his answers to these two questions needs to take a remedial reading course. Anyone - where does he see the opportunity to “cut costs” in the medical field?

And, how will he do it. Unless you’re still hungover from celebrating Guinesses’ 250th birthday, he is talking about denial of service especially to the elderly. Government will determine whether or not you’re worth that $20,000 operation. And the “moral issue” he’s talking about is all wrapped up in egalitarianism. What he’s implying may be “immoral” is allowing those who can pay access to the service while those who can’t pay (and for whom government won’t pay) are denied it.

Again, contemplate the model Obama talks about - reducing the cost of health care - and tell me which way that “moral issue” would be decided? Got the money? Too bad - it would be “immoral” to let you buy the service others are denied.

Q: So how do you — how do we deal with it?

THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

What a question. The assumption is swallowed whole. Where was the question “what if ‘we’ don’t want others making those decisions?”

And apparently you guys in fly-over country are too emotionally involved to make that sort of a decision through “normal political channels” so government have some unelected outside group develop the “guidance.” Only the elite can answer these questions properly.

Three questions, stunning in their implications. Three answers which should make the skin of all lovers of liberty crawl. I’m again left imagining Jefferson, Madison and Monroe listening in on this with unbelieving looks of horror on their faces. The irony is, their opposition to this incredible power grab by government would again leave them in the category of “radical”.

SOURCE




The Hospital: We are all in the emergency room

Comment from Britain

Channel 4 is currently showing a documentary called The Hospital which takes a frank look at the effect that teenagers have on our nation’s health service. In this three part special they speak to the doctors working on the frontline dealing with the uneducated accidents that barrel through their doors on a regular basis. The first looked at the carnage that alcohol has unleashed, the second teenage pregnancies and the final show will examine obesity. It is an eye-opener and gives a truly shocking insight into the thinking of a sub-section of society.

Politicians have created a monster. It is clear to see that the health service in this country is having an impact on behaviour as there is little or no recognition of the consequences of actions: people have been desensitized. For example, a teenage pregnancy on the NHS typically costs around £10,000 to £15,000 due to the higher than normal risks because of the natural stresses on an under developed body. The teenagers in question have no awareness of these costs. Society as a whole would probably behave differently if only the individuals/families concerned had to bear the costs.

The politicians have created a new breed of teenager who typically come from a family that has little desire to be concerned about their offspring’s education and consequentially show little emotion towards them. This could perhaps be a reason why teens have descended upon alcohol and have such a bad relationship with it. These fault lines are a politicians’ creation, yet they will claim that only they can fix them. Sadly the time has come to shock people into behaving in a ‘normal’ manner by exposing them to the true costs of their behaviour: we should do without politicians. Or at least only hold in high regard those politicians who can say no and explain why a person will be stronger by learning from their mistakes. Until that time we are all in A&E.

SOURCE





2 May, 2009

Fabulous! NHS Hospitals must publish details of every complaint against them

All hospitals in England will have to publish the number and details of complaints that they receive. The Department of Health said that this was necessary to prevent a repeat of lapses that occurred at Mid Staffordshire NHS Foundation Trust. Between 400 and 1,200 more people died at the trust than would have been expected in a three-year period because of a “lamentable failure of clinical leadership”, two official reviews concluded yesterday. A change of culture was needed at the trust and across the wider NHS to place more emphasis on “patient and public power”, they said.

The Department of Health said that complaints received by each trust in England would be published on the NHS website.

An investigation this year by the Healthcare Commission uncovered the unusually high death rates reported by the Mid Staffordshire trust between 2005 and 2008, in particular at Stafford Hospital’s accident and emergency department. Follow-up reviews found that patients’ views were not taken seriously enough and local and regional health authorities failed to check properly on standards of care. The commission report, published in March, concluded that care and management at the hospital were so poor that receptionists were carrying out initial checks at A&E.

Ministers responded by ordering two reports — one covering the current standard of care at the hospital and the other by David Colin-Thomé, the national director for primary care. Dr Colin-Thomé said: “The events of Mid Staffordshire trust have disturbed us all. What has particularly shocked and disappointed me is that no NHS organisations, staff or representatives of the public reported any serious concerns about emergency services in the hospital.”

The other report, by Sir George Alberti, the national director for emergency care, said that while £3.8 million had been invested in new staff, recruitment and training in the past 12 months, there were still shortages of surgeons and nurses.

SOURCE




Australia. Another Queensland Health disgrace: Rodent attack on elderly patient foreseen but nothing done

QUEENSLAND Health knew about a mouse plague in a Darling Downs nursing home three months before the rodents gnawed a war veteran's head on Anzac Day. As the Federal Government demanded action on the scandal at the Karingal aged care home attached to the Dalby Hospital, it emerged that a second elderly man was also attacked at the facility last week. Queensland Health yesterday said extra staff, traps and bait had now controlled the rodents.

Staff initially began demanding action against the infestation in early February. It is another shameful episode within the embattled Health Department, highlighted by recent bungles involving staff housing security before and after a Torres Strait nurse was sexually assaulted in February last year.

The Digger [vet], 89, who served in New Guinea during World II, was resting on Saturday when his face, neck and ears were "severely chewed" by the rodents. His daughter, who only wished to be known as Julie said her father tried to brush the mice away but ended up covered in blood, with 10 cuts. She said her father was so distressed he required morphine and almost died. "You know that the inevitable is inevitable but you do not want mice to be the catalyst," Julie said.

Queensland Health last night confirmed the wife of the other patient told staff on Monday her elderly husband had been bitten on Friday. "When staff were notified they sought to treat the wound on the man's forearm but were unable to find a lesion," a Health spokeswoman said.

The revelations emerged three days after Queensland Health issued a media release about the plague which failed to mention the weekend attack. Deputy Premier Paul Lucas is the latest Health Minister to be left clueless about his department's failings. "The simple point of this is I found out about this this morning," Mr Lucas said yesterday. "I am told it happened a few days ago. It is not acceptable that I found out this morning. I would like to apologise that this incident took place."

The Digger's daughter said staff at the facility had repeatedly demanded radical action from the department against the infestation in February. "My understanding is that since the end of February staff – who have been marvellous in caring for my father – have recognised there is an issue that should be dealt with," Julie said.

She complained to Liberal National Party MP Ray Hopper, who asked Mr Lucas in a letter on Wednesday to order a neighbouring paddock be poisoned to supplement other control measures in place in the nursing home and hospital. But because the state-owned paddock has been zoned commercial/residential the use of an agricultural strength chemical lethal to mice is banned.

Queensland Health asked the Dalby Regional Council to rezone the land rural for 24 hours so the land could be sprayed, Mayor Ray Brown said. "We could not do that," he said. "Imagine the brouhaha if we bent the rules to accommodate Queensland Health." He said Queensland Health had wrongly claimed that council was responsible for the issue.

National Seniors Australia chief executive Michael O'Neill said: "Authorities need to realise our oldest citizens have been exposed to risk and someone should just get on and fix it."

SOURCE





1 May, 2009

Government and markets

This story typifies, at least to me, the problem we can expect in the health care field if government becomes even more involved than it is now:

Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans.

One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.

Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors — a difficult argument at a time of huge budget deficits.

The trend for years has been away from general practice and toward specialties. Part of that stems from the fact that specialists are paid more than generalists.

Most of us understand that most of our medical care will take place in our latter years with the obvious exception of certain genetic and chronic diseases which afflict a portion of the younger population. So Medicare, which kicks in at 65 whether you want it or not, is a major payer (and player) to family practice doctors who care for older Americans that make up the bulk of their practice.

With that being the case, we’re seeing fewer and fewer medical students option to become family practitioners, preferring the more lucrative pay specialists earn. The consequent result of low pay, huge patient loads and little recourse for changing that has seen family practice numbers in medical universities drop alarmingly. Why spend all that time and money learning a particular craft when the rewards aren’t as great as you want?

So here we have the market for family practitioners reacting to a distortion in the market created by the government refusing to pay at what the doctors feel is an adequate rate for the treatment of the majority of their patients. The market’s feedback mechanism sends the signal to the potential doctor to look at areas which would be more lucrative than family practice to receive adequate compensation. That area is specialization.

The reason I bring this particular example up is the competing proposals. One say, “hey, if you want more family practitioners, pay them more - that provide the incentive to become a generalist”. On the other hand, there’s a proposal to do that, but to accomplish that increase at the expense of specialists who take medicare.

How do you suppose specialists will react? Well if they do as two of mine have, they’ll simply say, “sorry, we don’t treat Medicare patients”.

And how do you suppose such a decision would effect the number of family practitioners. Well, that would depend on how much they’re willing to increase payments to them.

In the era of massive budget cuts and the promise by government to “decrease” the costs of health care, any increase in my estimation, would by minimal and not enough to change the tide concerning family practice. But taking that increase out of what is paid specialists certainly might be the tipping point for many of them to declare they’ll no longer treat Medicare patients.

Certainly our old friend the Law of Unintended Consequences again at work.

SOURCE




Australia: Mice attack disabled veteran in government nursing home

What Green/Left government leads to

A BEDRIDDEN war veteran was found on Anzac Day with bloody ears, hands, face and neck after being "severely chewed" by swarming mice at a southwest Queensland nursing home.

Opposition MP Ray Hopper said Queensland Health had been slow to respond to a mice plague at the Dalby Hospital, which includes a nursing home, leading to the attack on the 89-year-old man.

The man's daughter said staff found her father bleeding from bites to his head, neck, ears and hands on Anzac Day, Mr Hopper said. "The top of his ears were severely chewed and he had bites to his head and neck,'' Mr Hopper said. "His hands were covered in blood because he was trying to get the mice off him. "We are talking about a health facility overrun by vermin. It's atrocious.''

Mr Hopper said the man was so distressed that doctors had put him on morphine to calm him down. He said it was normal to see an increase in mice in Dalby and the Darling Downs at the onset of winter, and the problem was handled with chemical sprays. "But the bureaucrats said no sprays this year because it uses agricultural chemicals, and that's not allowed to happen at a health facility,'' he said.

SOURCE