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31 August, 2008

Why Healthcare is not a Right

By "Daily Danet"

Recently, Oprah, had an episode about healthcare. Oprah, Michael Moore and other guests continued to refer to healthcare as a right. Many people disagree with this fundamental issue, but have difficulty articulating why. So here is my best effort to explain why it is I believe that healthcare is not a "right."

The classic response is that a right is not something someone gives you, but something that no one can take away. This a good bumper sticker, but it is not terribly instructive if you're not already convinced. I don't presume to solve the problem of escalating healthcare costs. Due in part to rapid advances in medical treatments, ordinary people are being forced to choose between lifesaving treatments that didn't exist only a few years ago and bankruptcy. Rampant lawsuits, anti-healthcare provider forces and those evil profit seekers can be left for another time. A more basic question, however, is whether you (and I) have a right to healthcare.

Rights are not unlimited. Rights can be restricted or even taken away. For example, you have the right to liberty (to walk freely wherever you please). But others can restrict that right in certain circumstances. You cannot, for example, walk freely through your neighbors bedroom at night. That would violate their right to privacy. If you commit a crime and are tried and convicted, your liberty can be revoked completely.

Rights really only make sense in the context of a lawful society. Governments are instituted, as a basic matter, to determine where one person's rights end and another's begins. For example, you have a right to free speech, but others have a right against defamation. If you say something untrue and defamatory about someone, the government can determine whose right trumps.

From the perspective of the government, a right is something that can be ensured to one citizen without taxing (in the broadest sense) another citizen. For example, the government can ensure your right to free speech without any cost to anyone else. No one has to listen (you do not, for example, have the right to be listened to). Nor does anyone have to publish your work. You do not, however, have the right to a full-page spread in the Wall Street Journal. If, however, you can afford to, you can purchase one (or the Wall Street Journal) and say pretty much whatever you want. (Subject, of course, to others' rights to be free from defamation and other torts).

In a (mostly) free and (mostly) just society like ours, rights are plentiful. You have, to name a few, the right to bear arms, the right to your life, your liberty, the pursuit of your happiness. To be sure, however, this does not mean the government must buy you a gun. Nor does it mean government must purchase the things that make you happy. It only means that government cannot restrict these rights without due process of law.

This is the crux of the issue: there is a difference between a right and a need. For example, you need food, clothing and shelter. You have a right to pursue these needs; the government will not prevent you from buying a home, buying food or buying a new pair of jeans. The government does not, however, owe you a house, food or clothing. You have no right to housing, no right to food and no right to clothing.

Consider a small society of 100 people, with laws not too dissimilar to ours. Let's assume 2 of these people are unable, for whatever reason, to afford their own home. Among the other people are a carpenter, a logger, a blacksmith, a painter and a plumber. If the government is to provide those two people with housing, it has to either (i) tax everyone to pay the workmen to build the house or (ii) compel the workmen to build the house for free. Either way, the government must take something of value to provide this need to those who cannot obtain it on their own.

So it is with healthcare. You need healthcare. Everyone does. But in order to provide you with that need, the government has to take from someone else. They either have to tax those who can afford it or compel the doctors, pharmacists and hospitals to provide it for free. You may think, as clearly many do, that this is not such an evil thing. Think back to that "free" house, though. Think how hard those workmen would work if they knew that they either weren't being paid for their efforts, or that some nebulous body called "taxpayers" were paying them. Also, consider how many people would voluntarily buy their own house when they knew that others had gotten one for free. Imagine the standard of construction and innovation that would develop if housing were treated as a right; as something the government needed to provide.

Of course, governments do this all the time. They tax one citizen to pay for another's welfare (literally and figuratively). They tax me to pay for your social security. They tax you to pay for my passport. They tax all most of us to provide for our common defense. The point, however, is that that does not make it a right.

Governments have many purposes. The common defense is one that most people agree on as a valid rationale for taxes. Saving the spotted owl, however, is debatable. So too is providing healthcare.

Source




Top doctors slam NHS drug rationing

Britain's top cancer consultants have accused the government's drugs rationing body of ignoring the plight of patients forced to sell their cars and remortgage their houses to pay for cancer treatments freely available in Europe. Twenty-six professors blame the severe restrictions imposed by the National Institute of Health and Clinical Excellence (Nice) on its failure to "get its sums right".

Nice refuses, on grounds of cost, to recommend some drugs for patients with advanced kidney cancer. The consultants, who include the directors of oncology at Britain's two biggest cancer hospitals, the Royal Marsden in London and Christie hospital in Manchester, claim there is enough money in the NHS to pay for the drugs.

Their letter to The Sunday Times states: "We now spend similar amounts to Europe on health generally and cancer care in particular, but less than two thirds of the European average on cancer drugs. It just can't be that everybody else around the world is wrong about access to innovative cancer care and the NHS right in rationing it so severely." They say: "The time has come for a radical change in how the NHS makes rationing decisions for cancer."

This weekend Andrew Dillon, the chief executive of Nice, and Sir Michael Rawlins, the chairman, challenged the cancer experts to explain which acutely ill patients should be sacrificed to free resources for cancer sufferers. They said: "There is a finite pot of money for the NHS, which is determined annually by parliament. If one group of patients is provided with cost-ineffective care, other groups - lacking powerful lobbyists - will be denied cost-effective care for miserable conditions like schizophrenia, Crohn's disease or cystic fibrosis."

This week patients from the Kidney Cancer Support Network will demonstrate outside the Nice offices in London against the refusal to fund the kidney cancer drugs Avastin, Sutent, Nexavar and Torisel.

Source




The Real Census Story

Every August, the Census Bureau's release of the latest income and health insurance figures results in a political uproar, but this year the political class seems almost embarrassed by the good news. Median household income rose slightly in 2007, the poverty rate held steady and the number of uninsured even dropped slightly. Even so, a closer inspection of the numbers shows some dark clouds around the silver lining -- though not of the sort that those warning of another Great Depression usually find.

Begin with health insurance coverage. Census found that 45.7 million people, or 15.3% of the population, were uninsured in 2007, down from 47 million or so in 2006. While total enrollment in private insurance remained stable -- due to population growth -- it eroded slightly in percentage terms, continuing a downward trend. The growth in coverage was mostly concentrated in public programs -- partially due to an aging population shifting to Medicare, but especially in Medicaid. Democrats are already claiming vindication of their post-2008 priority of moving even more people onto the federal balance sheet.

Yet the Medicaid increase isn't exactly a shocking revelation. Each year, a significant portion of the uninsured qualifies for government assistance but hasn't signed up. In spite of 2007's uptick, 24.5% still earned under $25,000 and are probably eligible for help. Some 22% made over $50,000, which is hardly rich, but enough to afford coverage in most states. Meanwhile, about 54% are between the ages of 18 and 34, and many of them voluntarily choose (risky as it may be) to forgo coverage. In other words, the latest batch of data shows, again, that the policy problem of the uninsured isn't as large as election-year opportunism would have it.

This isn't to deride the genuine hardships that the fragmented health-care system metes out to many families. Rather, it's that insurance is more expensive than it needs to be thanks to regulation and other market interference. Many get priced out of coverage, while others -- especially the young -- are induced to gamble on going uninsured.

Most of the gaps in coverage owe to the way the tax code creates problems for the insured while shortchanging everyone else. People who are covered through their employers -- 59.3% in 2007 -- pay no taxes on the value of the benefit, encouraging them to launder their health dollars through third-party insurers while burdening business with increasing medical costs. Meanwhile, the size of the subsidies are smaller for lower-wage workers -- who typically have less generous plans as part of their compensation -- and nonexistent for individuals.

In a lot of ways, the new figures probably underestimate the effects of the tax code distortions. The Census counts people who were insured for only part of the year as "insured." But other studies have shown that the number that are uninsured at some point during prior years -- usually because their coverage lapsed while switching jobs -- reaches as high as 69 million. Restoring the tax parity of health dollars would allow individuals to buy policies themselves, rather than rely on their employers, and take those policies with them wherever they work. It would increase access and affordability for everyone.

In 2007, President Bush proposed doing just that. His reward was to receive no thanks or even credit, though John McCain has picked up and amplified some of his best ideas. Since the Census report points to some deterioration of the artificial job-based system we have now, this is a good moment for the Republican candidate to focus on the improvements that his plan would bring to middle-income and working-class families, as he started to do yesterday.

Source





30 August, 2008

Britain: Deaths linked to hospital infection Clostridium difficile double in two years

The number of deaths linked to the hospital infection Clostridium difficile has more than doubled in the last two years, official figures show. Last year in England and Wales 8,324 people died either from C. diff or were infected with it when they died from other causes - this is a rise of 28 per cent in just one year. The infection which particularly affects elderly people has increased four times over since 2001 when 1,804 deaths were linked to the superbug, data from the Office of National Statistics shows.

Deaths linked to MRSA rose steadily between 2003 and 2005 but have levelled off. In the last year there has been a slight drop of 3.6 per cent in deaths either directly from MRSA or linked to it to reach 1,593.

Andrew Lansley, the shadow health secretary, said the 'vast majority' of these deaths could have been avoided with better prescribing of antibiotics and proper isolation of infected patients. Critics say Labour's waiting list targets have encouraged hospitals to rush through patients leaving wards overcrowded with time for cleaning patient areas between cases.

The data is collected from death certificates where doctors note down one underlying cause of death and can mention any number of other factors that may have contributed. In recent years doctors have been encouraged by Sir Liam Donaldson, the Chief Medical Officer, to mention hospital infections on death certificates where patients have them even if it was not the underlying cause of death. The figures show of the 8,324 death certificates that mentioned C.diff, around half noted it as the underlying cause of death.

C.diff is mainly a disease that affects the elderly who have been in hospital for other reasons and who have received broad spectrum antibiotics. These drugs cut the natural flora in the stomach allowing C.diff to multiply and produce a toxin which causes diarrhoea. The ONS figures there was one death per million people aged under 45 but 2,000 deaths per million people aged 85 and over. The number of actual cases of reported cases of C difficile in the over-65s - the main age group affected - fell by nine per cent from 55,635 in 2006 to 50,392 in 2007.

The Clostridium difficile bacteria is a major cause of antibiotic-associated diarrhoea and the intenstinal infection colitis. In most cases the infection is mild and a full recovery is made. Although elderly and vulnerable patients may become seriously ill through dehydration caused by severe diarrhoea. The more serious symptoms include ulceration and intenstinal bleeding and it can be life-threatening.

Source




The tragedies that prompted `our massive wake-up call'

Bacteria will be present in hospitals as long as people are, but vital lessons in infection control have been learnt since outbreaks of Clostridium difficile caused the death of at least 90 patients at Maidstone and Tunbridge Wells NHS Trust in Kent.

Sara Mumford, formerly of the Health Protection Agency, the watchdog for infectious diseases, helped to bring attention to how much bad hygiene and poor staffing had contributed to hundreds of infections during the outbreaks of 2005 and 2006, which were later the subject of a high-profile investigation by the Healthcare Commission.

Now the director of infection control at the trust, Dr Mumford has an array of tools and procedures to keep superbugs at bay, she told The Times yesterday. "Unlike MRSA, there is no way of screening for C. difficile, so the most important thing to get right is cleanliness," she said. "Patients, staff and visitors can carry the bacteria into a hospital without knowing it, or become infected in the community. That's why handwashing is so important."

After an infection had been identified, soap and water were not enough, she said. "We use chlorine-based cleaners and have antimicrobial disposable curtains that we remove after an infected patient has been in a ward. During the `deep clean' we evacuated every ward and subjected everything to ultra-sonic baths or other cleaning. "It was so thorough that afterwards the wheels on the beds seized up - they would not run properly because they'd been cleaned of oil. "The most important thing when you suspect an infection is to isolate the patient quickly - even before you get the test results back from the lab," she said.

The isolation facility at Maidstone - introduced only after the notorious outbreaks - is a dedicated 12-bed ward. Dr Mumford said it helped recovery if patients with the same condition could talk to each other. Patients with a C. difficile infection required specialist nursing and treatment, she said, because other factors could also cause avoidable illness. "Antibiotic use in particular is really, really important," Dr Mumford said. "If you give patients broad-spectrum antibiotics designed to kill all bacteria, they get rid of even the types that help keep C. difficile at bay."

The three hospitals run by Maidstone and Tunbridge Wells Trust are now reporting rates of C. difficile that are below the national average. "Maidstone has had a tragic wake-up call and had to undertake a crash-course in infection control, but some trusts still have work to do - it's something that they ignore at their peril," Dr Mumford said.

Source




Australia: Surgery freeze call over public hospital beds crisis

A ban on elective surgery is being called for as a desperate solution to the chronic shortages of public hospital beds in Queensland's health system. Frustrated emergency specialists have called for a two-week statewide ban on surgery to free up beds. The situation is so critical at hospital emergency departments some patients are forced to sit in waiting rooms for more than 24 hours before being admitted.

Australasian College for Emergency Medicine Queensland chairwoman Sylvia Andrew-Starkey said: "We try really hard not to put elderly people in chairs ... but we've had a situation recently where we've had to put elderly people with pneumonia in chairs for 12 hours or so because we didn't have a bed. "It's awful. It's the worst it's been for years. We're powerless to do anything."

In the past fortnight, some of the state's largest public hospitals - including the Royal Brisbane and Women's Hospital, the Princess Alexandra and Logan - have been forced to go on bypass and redirect ambulances to other facilities because they could not cope with the numbers of patients needing a bed.

In the state's north, a backlog of trolleys and people filled the corridors at Townsville Hospital yesterday as 23 patients waited to be transferred from the emergency ward to beds. Australian Medical Association North Queensland president Dr Sam Baker said Townsville Hospital was overcrowded and in "meltdown" and backed calls for a suspension of elective surgery. "We've got no beds," Dr Baker said. "Staff are being pushed to the limits. It is a bottleneck. It is a shambles. And it is only going to get worse."

Queensland hospitals are so overcrowded that private facilities have also been redirecting patients. "We haven't been able to get a private patient into a private hospital for weeks - they're full too," said Dr Andrew-Starkey, who is based at the RBWH. Freezing elective surgery for a period would free up beds for other patients, taking pressure off emergency departments which are stretched during the traditional winter flu season. "The system needs resetting," Dr Andrew-Starkey said. "I'm not sure suspending elective surgery for a week would be enough. It might take two."

Specialists admit a freeze on elective surgery is a radical step, given lengthy public hospital waiting lists. Queensland Health Minister Stephen Robertson said an elective surgery freeze was unnecessary, but individual hospitals might need to suspend elective surgery from time to time to cope with emergency department demand. "What I do expect is hospital management to make decisions on a daily basis about what is in the best interests of providing safe patient care," Mr Robertson said. "If that means they've got to temporarily suspend elective surgery, then unfortunately, if that decision is made in the interests of patient safety, I support that. I would rather that not be the case, but that's the reality of the very busy times we are experiencing at the moment."

Townsville Hospital staff were yesterday forced to set up makeshift wards in X-ray waiting rooms and lounges. Ten operations were postponed, feeder hospitals at Ingham and Ayr were full, and every nursing home bed in the north Queensland city was occupied. It is the fourth "code yellow" - a complete lack of beds - activated by the hospital in the past two months. Townsville Hospital Acting Director of Medical Services Dr Isaac Seidl said they were working to reduce the likelihood of "ramping" where patients wait outside in ambulances.

Mr Robertson said the situation in Townsville had been exacerbated by 22 nurses calling in sick with "flu-like symptoms", with another 49 off on sick or family leave the day before.

Source

Update:

PATIENTS have fallen off trolleys in overcrowded hospital emergency wards which overworked doctors describe as the worst they have experienced. The Royal Brisbane and Women's Hospital's emergency department was in "gridlock" yesterday, forcing hospital administrators to redirect ambulances to other facilities for more than two hours, The Courier-Mail reports. As the bypass was declared, 22 patients were sitting in chairs in an overcrowded corridor. Some had been waiting more than 24 hours to be admitted, with no guarantee when a bed would become available.

Australasian College for Emergency Medicine Queensland chairwoman Sylvia Andrew-Starkey said hospital emergency departments were at crisis point. "People don't get fed properly, people get sleep deprived. The staff get frustrated as well. It leads to a whole snowball effect," she said. "I can give you three instances of elderly people falling out of trolleys because they were confused. They should never have been on trolleys in the emergency department." "Increasing the amount of time that patients spend in an emergency department leads to deaths," she said. "The number of long-stay patients in Queensland emergency departments has skyrocketed in the last couple of months."

Health Minister Stephen Robertson said the State Government was moving towards "quarantining" hospital emergency departments from elective surgery to alleviate problems. Opposition Leader Lawrence Springborg said the "entire health system in Queensland is in danger of collapse".

Source





29 August, 2008

Kindly old NHS decides not to let people go blind after all

Thousands have gone blind while the authorities spent over two years dithering, though

For the first time a drugs company will pay to top up patients' treatment where the level of care paid for by the Health Service is not enough. In a decision that marks a climbdown for the National Institute for health and Clinical Excellence (NICE), the first 14 injections of the sight-saving drug Lucentis will be paid for by the NHS. If the patient still needs further treatment then Novartis, the manufacturer, will pay for any additional doses.

The ruling overturns previous draft guidance that patients would have to go blind in one eye before receiving treatment with Lucentis, which costs more than $20,000 per eye, on the second. It also paves the way for other new drugs for which top-up doses may be required to be funded in the same way in future.

Richard Barker, director general of the Association of British Pharmaceutical Industry suggested other medicines the NHS cannot afford to pay for in full could be provided through cost sharing schemes between the NHS and the drugs industry. A similar approach has been suggested for kidney cancer drug Sutent, which costs $48,000 a year, and three other drugs after Nice issued draft guidance saying that they were not "cost effective" despite extending life by two months.

NICE has been severely criticised in recent months by health campaigners, who have accused them of condemning patients to "an early grave" by denying them the drugs. It has also been at the centre of a previous controversy over its decision to deny the $5-a-day drug Aricept to victims of Alzheimer's in the early stages of the disease.

Lucentis can stop the deterioration in sight caused by the condition wet age related macular degeneration (AMD), which affects about 250,000 people in the UK including 26,000 new cases each year. It can cause blindness within three months. Up until now around 40 per cent of primary care trusts have refused to fund the drug while others have approved its use only in 'exceptional cases' although the drug was approved in Scotland last year.

Nice has taken over two and a half years to issue its final guidance on the drug in which time many thousands of people have already gone blind as a result of the condition. The drug has no effect on the condition once the patient has gone blind.

Andrew Dillon, NICE Chief Executive, said the decision would be justified by both the improved quality of life for patients and cost savings in the long run. "Lucentis is an expensive drug, costing more than $20,000 for each eye treated," he said. "But that cost needs to be balanced against the likely cost savings. AMD results in reduced quality of life and increased risks of illness, particularly in relation to accidents - especially falls - and psychological ill-health. "Studies have also demonstrated that patients with visual impairment tend to have longer hospitalisations, make greater use of health and community care services and are more likely to be admitted to nursing homes.

"It has been estimated that the costs related to sight impairment for patients treated with Lucentis are around $16,000 cheaper than for patients who receive best supportive care over a 10 year period. Our guidance means that patients who are suitable for this treatment will have the same access to it, irrespective of where they live."

Steve Winyard, Head of Campaigns at Royal National Institute for the Blind, said: "We've been waiting for this for over two years. It is a victory for thousands, bringing overwhelming relief to desperate people across the country. Finally the torment faced by elderly people forced to either spend their life savings on private treatment or go blind, is over. "NICE's guidance will finally bring an end to a cruel postcode lottery." Primary care trusts in England and Wales now have three months to fund the treatment for all eligible patients....

The ABPI's Mr Barker said drug companies were being flexible and suggesting cost sharing schemes but Nice had to be flexible also.

The decision comes after Health Secretary Alan Johnson ordered an investigation into the policy of denying NHS services to patients in England who top up their care with private treatment. Currently, anyone who pays for any private care can be barred from receiving the normal package of NHS care but the review will look at whether such co-payments should be allowed in future.

In July, RNIB also backed three pensioners in landmark High Court action against Warwickshire PCT for denying them treatment. Tom Bremridge, chief executive of The Macular Disease Society said: "Those responsible for NICE should be aware that during the cumbersome two year review process 152 PCTs have individually had the power to decide whether to let patients go blind or to save their sight. The resulting stress and suffering has been cruel and unnecessary. "Many hundreds of vulnerable patients have been subjected to an appalling emotional rollercoaster ride for the past two years - during which many of them have lost their remaining sight."

He called for Nice to speed up drug appraisals in order to avoid primary care trusts around the country making different decisions on funding drugs that have not yet been through Nice....

Dr Rafiq Hasan, Director of Market Access and Ophthalmics at Novartis said the new agreement was "an innovative approach which shows how pharmaceutical companies can work together with Nice and the Department of Health to ensure patients do get access to treatments on the NHS." He said: "Wet AMD is a debilitating eye condition that can result in a rapid loss of sight if left untreated. Lucentis is a treatment for a key unmet medical need and it has the potential to save many peoples' sight. "Rapid implementation of the guidance is now needed to ensure that patients receive the treatment they need as soon as possible."

Source




FOI investigation into Sydney public hospital conditions

A Seven News investigation has revealed hospital blunders have led to dozens of serious injuries or deaths. Secret internal documents detail the errors in Western Sydney hospitals, and outline a two year review of investigations into blunders that can mean the difference between life and death. 61 people have died following serious mistakes over the past two years. The reasons for these deaths have until now been kept under wraps, because the information is not made public. Those reasons include surgical material or instruments left inside patients, procedures performed on the wrong patient or wrong body part, and incorrect diagnosis.

Furthermore, a report in 2006 led to a raft of recommendations, but 40 percent of them were ignored, and 20 percent were implemented after serious delays.

Warren Anderson's 16 year old daughter died after a bungled treatment for a fractured skull. "Vanessa should have been walking out of that hospital totally healthy," he said. He added, "Change the system that killed my daughter to make it a safe system. That's the apology I want from Reba Meagher." Health Minister Reba Meagher wouldn't comment, but she apologised to Mr Anderson.

Shadow Health Minister Jillian Skinner said, "I'm shocked with the extent of these deaths, given the government has denied them, is not reporting them, is failing to come clean with the extent of problems in our hospitals."

Source




Tasmanian hospitals festering, warns doctors' boss

ACUTE staff shortage in the Launceston General Hospital's emergency department is part of a problem festering across the entire hospital system, the Australian Medical Association says. Outgoing AMA state president Haydn Walters said hospitals appeared likely to suffer across-the-board staff shortages, making them extremely expensive to run - and warned that the state's health bureaucracy needed to become more doctor friendly.

Prof Walters said the department was about 10 years late in realising that doctors were not ratbags who needed to be kept in line. He said the LGH risked following the Mersey and Burnie hospitals, reliant on $2500 a day specialist locums and overseas-trained doctors - and parts of the Royal Hobart Hospital were also at risk. Prof Walters said doctors were voting with their feet.

His criticism of the department's "can't-do culture" was rejected by Health and Human Services Department secretary David Roberts. Mr Roberts, who was lured to Tasmania from the UK in January, said he was impressed by the department's innovative "can-do culture". He said he had witnessed a long hard slog of reform in the UK that enabled its hospitals to get a grip on similar emergency department problems. He said a key innovation in emergency departments - already embraced by LGH doctors - was a new acute physician's role where doctors were trained to deal with a broad range of medical problems, not unlike a general practitioner.

Mr Roberts said he had an open door policy, regularly meeting with doctors and nurses: "Doctors are coming with ideas on how we can reform ... I'm pleased to back them." Mr Roberts said Prof Walters' gloom and doom scenario - and his view that North-West hospitals had become dependant on locums - was wrong, but conceded the Mersey hospital had struggled. "It will pick up," he said.

Mr Roberts said apart from some hard-to-fill posts, Tasmanian hospitals were not having major difficulties recruiting doctors. "Our doctor shortage is not as severe as some of the mainland states," he said. [THAT'S a consolation!]

Prof Walters said the ranks of doctors who were committed to living and working in Tasmania for the long term, continued to thin. He said among those bearing the brunt of the LGH crisis were interns - doctors just out of medical school who were feeling exposed and vulnerable - as a growing number of experienced professionals who supervised them voted with their feet. Prof Walters, also from the UK, said he had nothing against overseas-trained doctors, but for the sake of stability and cost control, they needed to be balanced by local doctors.

He will step down in two weeks to begin a sabbatical.

Source





28 August, 2008

Health care: Unions lie; choice dies

Who would support a self-serving political agenda at the expense of your health, wealth, and job mobility? AFL-CIO president John Sweeney and Colorado executive director Mike Cerbo. In a recent Denver Post commentary, they perpetuate the big lie behind politician-controlled medicine: "that the free market is not working," and that consequently, "costs have been spiraling out of control." But costs have been increasing largely because of what unions defend: a tax code that favors employer-sponsored insurance. It penalizes buying an individual or group policy through a membership organization like AAA.

In a free market, government respects your right to buy and sell according to your own judgment. Not so with medical insurance in America. If your company buys you a $10,000 policy, it pays no tax on those dollars. But you'd face a stiff tax penalty for buying your own policy with that money. Rather than using your own judgment of what's best for you and your family, politicians punish you for not choosing employer-sponsored insurance.

Because politicians favor employer-sponsored insurance, you have companies who are not invested in pleasing you, fewer choices of plans and jobs, lower pay, and escalating medical and insurance costs. Employer-sponsored insurance coddles insurance companies. They need not compete for our business as they would in a truly free market. You aren't their customer, your employer is. So why should they please you?

Insurers know you're essentially stuck with the one or two plans most employers offer. To buy a competitor's product you must change jobs or pay a stiff tax penalty. Economists call this "job lock." Business Week reports that "fear of losing coverage keeps people at jobs . many workers will keep hanging on to jobs they hate." "Single-payer" government-controlled insurance is not the answer. If you don't like the government's insurance plans, changing jobs is not enough. You must move to another state or country!

Employer-sponsored insurance also contributes to high medical costs. Tax-discounted insurance encourages us to buy more costly coverage than we probably need, hence penalizing savings for future medical expenses.

We consume medical care like a business traveler dining on the company's expense account: Since someone else pays the bill (insurance companies), patients need not shop around, so providers don't compete on price. "Yeah," you say, "but my company is paying for it," so isn't it better than buying it myself?" No. As a Cato Institute study summarizes: "an employer that does not offer health benefits must offer higher cash wages to compete for workers. Workers who choose the job with health coverage bear the cost of that benefit in the form of higher cash wages forgone."

But the AFL-CIO defends subsidizing employer-sponsored insurance. A union-backed Colorado ballot initiative pushes further. The "employer mandate" would empower government to punish companies for not offering insurance to their employees.

Given its harmful consequences, why do unions support employer-sponsored insurance? Shouldn't they also support buying, say, our auto insurance and cell phone plan through our employers? Imagine how much negotiating power unions would have then!

Labor unions of course back politicians who support employer-sponsored insurance and politically-controlled health care. Sweeney and Cerbo write that Obama is correct to be "skeptical of the idea that the market is the right entity to put in charge."

But what is "the market"? It's when you choose what's best for you and peacefully trade with others doing them same. Both parties win. For union bosses, politicians are the "right entity to put in charge" of your medical choices - not you. But you should be in charge. Politicians should not dictate whether you buy insurance on your own, through a membership group, or through your employer. Legislators should eliminate the tax break and lower tax rates commensurately.

Second-best would be to extend the tax break to all medical insurance and expenses. Health Savings Accounts are a step in this direction, but they should be eligible to everyone regardless of their insurance plan. Such "Large HSAs" would allow consumers to buy medical care and insurance with tax-free earnings. McCain's tax-credit proposal, though convoluted, is also on the right track.

Unions should be ashamed of promoting self-serving policies that make medical care and insurance so expensive.

Source




Senior British doctor accuses Government of destroying NHS

One of Britain's most senior doctors has criticised the Government for leading the NHS into "catastrophic meltdown". Professor Paul Goddard, a former president of the Royal Society of Medicine, said Labour's obsession with bureaucracy and political correctness had resulted in dire care for patients. The radiology specialist also hit out at the National Institute for Clinical Excellence, NICE, claiming the organisation put finances first.

Prof Goddard, 58, said: "If they think a patient will gain an extra year of life, but it will cost more than $40,000 they think it is not cost-effective. Yet if the patient wants to pay for it themselves they are denied NHS treatment. It's an outrage."

The senior doctor, who has quit the NHS, claimed the Government had lost sight of the basic principles of a national health service. "The NHS was built on the foundation of caring for the community. It was designed to help those who needed help, care for those who needed care and treat those who needed treatment. "Those basic principles have been lost as the Government takes us down a dangerous path that can only be a catastrophic meltdown of the system."

But a spokesman for the NHS said record levels of investment had led to dramatic improvements in areas like waiting times. "Ten years ago waits of 18 months were not uncommon, but by the end of this year no-one should wait longer than 18 weeks. None of this would have been possible without the hard work and dedication of everyone working into he NHS."

It comes after a group of 26 professors wrote to a Sunday newspaper claiming NICE had "poorly" assessed a decision to deny patients four kidney cancer drugs. Earlier this month Nice issued guidance rejecting the drugs Sutent, Avastin, Nexavar and Torisel even though trials found the treatments could prolong life in kidney cancer patients by up to two years. Nice said the drugs were too expensive and would mean the health service was less able to afford more cost-effective drugs for other illnesses.

But the professors, who include directors of oncology at Britain's two biggest cancer hospitals, said the latest guidance would force patients to re mortgage their homes, give up pensions and sell cars to fund their own treatment

Source





27 August, 2008

British cancer patients kept in dark about `too expensive' drugs

Doctors are deciding against telling cancer patients about expensive new treatments to avoid causing distress when they find out that the NHS is unwilling to pay for them. A quarter of specialists questioned in a survey admitted to hiding the facts about new drugs for bone marrow cancer that may be difficult to obtain on the NHS. According to the poll, nearly all the doctors who chose not to mention such expensive drugs said that they did so because it might "distress, upset or confuse" their patients.

Three quarters said that cost issues were a consideration, 40 per cent cited "lack of evidence" and 29 per cent argued that there was "no point" discussing treatments that their patients were unlikely to receive.

It is believed that thousands of patients with various types of cancer could gain extra months or years of life from the latest, most effective drugs. In many cases they are being denied the treatments on the NHS because of a lack of approval by the National Institute for Health and Clinical Excellence (NICE), which assesses the cost-effectiveness of new medicines in England and Wales.

The poll, by the charity Myeloma UK, comes after patients with advanced kidney cancer were denied four treatments on the NHS under guidelines issued by NICE. These and other new drugs for cancers of the lung, pancreas, colon and breast, and for multiple myeloma, are available widely throughout Western Europe, and in some cases in Scotland, but campaigners say that patients in England are being "left to die" if they cannot persuade their local trusts to fund treatment.

A total of 103 myeloma specialists in England, Wales and Scotland took part in the survey, with a quarter admitting that they avoided telling patients about licensed drugs that were still awaiting approval by NICE, which local health authorities were reluctant to pay for. Myeloma affects about 3,800 people each year in Britain and, of these, 2,600 are likely to die from it. NICE is reviewing treatments for the disease, including the drug Revlimid, which in clinical trials was found to be able to extend the life of some patients by up to three years.

The drug obtained its UK licence in June last year and is available across Europe, but NICE is not expected to make a final decision on whether it should receive NHS funding in England and Wales until early next year. The drug, which costs $72,000 for one year of treatment, has been rejected as not cost-effective by the Scottish Medicines Consortium, NICE's counterpart north of the Border.

NHS trusts have a legal obligation to provide treatments that are approved by NICE. In the absence of such approval, if a doctor thinks someone would benefit from a new medication, the patient can appeal to a committee at the local trust. Those who are refused must settle for less effective treatments or pay for the drugs.

In a statement, the Department of Health said that it had "issued guidance to the NHS which makes it clear that funding for a treatment should not be withheld simply because NICE guidance does not exist".

Source




Treatment blocked despite years of pain: Case study

Colin Ross, 55, of Horsham, West Sussex, found that he had multiple myeloma, a cancer of the blood cells, in May 2004, and has been told that unless he is given the drug Revlimid he will not survive beyond the autumn. Mr Ross, a former engineer in the oil and gas industry, has suffered years of pain and disability because of the disease, which has been slowly eating away at his vertebrae and other bones, making them brittle.

Despite the exhortations of doctors treating him at the Royal Marsden Hospital in London, Britain's leading cancer hospital, Mr Ross's local NHS primary care trust in West Sussex has refused repeatedly to fund the treatment, even though patients in East Sussex and elsewhere have access to the drug on the NHS. "I've broken bones several times, feeling very weak and tired all the time. It's got to the point where my bone structure can't support my own weight, it takes ten minutes just to get out of bed and I can't stand unsupported in front of the mirror to clean my teeth," he told The Times yesterday. "I was told from the start that it was incurable, that treatment could only hold it at bay, but it now seems that Revlimid is my last resort."

Although the drug is readily available to patients across Europe and in the United States, it has not yet been granted approval for use throughout the NHS in England and so is being provided only by some NHS trusts in "exceptional circumstances".

Source




Australia: Storm over 'ghost' public hospital wards

VICTORIAN Health Minister Daniel Andrews is at the centre of a growing political storm over claims that hospitals have been falsifying patient records to win government funding. The State Opposition, the Australian Medical Association and an independent health policy institute have expressed dismay at Mr Andrews' refusal to investigate the claims, which are believed to involve some of the state's leading public hospitals. "This is an unconscionable state of affairs and must be investigated," Australian Health Policy Institute director Stephen Leeder said.

Federal Health Minister Nicola Roxon last night intervened in the row, warning that evidence of "fudged" patient data would be of serious concern to the Government as it negotiates new funding agreements with the states and territories. Mr Andrews last night was refusing to launch an investigation, repeating that he did not believe the allegations.

The row erupted after The Age revealed that Victorian hospitals had been accused of manipulating patient data, creating "phantom wards" and inconsistently measuring waiting times to meet State Government benchmarks for bonus payments. A survey of 19 emergency department directors by the Australasian College for Emergency Medicine found almost 40% of hospitals had been "admitting" patients when they were, in fact, still languishing in emergency department waiting rooms, corridors or on trolleys. The "virtual wards" were used purely for "creative accounting", the doctors said.

Similar allegations about NSW hospitals falsifying patient data to rort funding were investigated by the NSW Health Department last year and have been referred to the state's Independent Commission Against Corruption.

Australian Medical Association president Rosanna Capolingua said allegations of hospitals acting fraudulently should be investigated to ensure new health care agreements were not rorted in the same way. Dr Capolingua said benchmarks should not encourage rorting that would undermine efforts to improve the health system. ''We need to make sure there is transparency, honesty and no perverse incentives in the benchmarks," she said.

Professor Leeder of the Health Policy Institute said the Victorian emergency doctors' claims could be more widespread than thought and must be investigated by the State Government. "If you do not have a person going around checking on what people are doing when they are recording and coding information, all evidence suggests there will be errors, random, systematic and perverse," he said.

Opposition health spokeswoman Helen Shardey said the allegations must be investigated to ensure Victoria's health system was measured properly and did not jeopardise its position under the new health care agreements. "It's extraordinary that a health minister would not want to investigate this immediately," she said. "It displays ignorance and it says he does not trust the people running our hospitals."

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26 August, 2008

Government experiments in health care

Back in January 2007, I wrote a column taking Colorado legislators to task for sponsoring a bill that would have forced parents of girls 12 and older to either vaccinate their daughters with a HPV "vaccine" or "opt out." Social conservatives argued that the bill would lead to promiscuous behavior in children. My concerns were different.

Not only is this bill an invasion of privacy and an implicit endorsement of the vaccine, the law has the potential to encourage many parents to give the vaccine to their children without educating themselves properly beforehand. After all, shouldn't parents "opt in" instead of being forced to "opt out"? Trust me, if in 10 years we learn that the HPV vaccine causes toe cancer, not a single lawmaker will be held responsible.

The same bill had been peddled in states across the nation. The reason I mention my column (which isn't online anymore), is that I remember receiving a rather large number of angry emails and calls. One nurse practitioner, in an agitated letter that ran in the Denver Post, scolded me: "We have the potential to drastically reduce the incidence of cancer with the introduction of the HPV vaccine. To cloak this discussion in the "government forcefeeding parents" debate is an affront to the health and well-being of the public."

How could I oppose the HPV drug? Did I hate children? (Well, some children.) Was I willing to put the lives of these poor creatures at risk for an ideology? The answer, of course, is yes. Freedom and choice is an ideology worth risking lives over. But, even more than that, there was no convincing proof that HPV vaccines were effective. Nor did we know enough about the side effects. Individuals, I argued, with detailed knowledge of their own situation, will, on the whole, make smarter and healthier choices for their children than detached government officials.

Now, the New York Times runs a story titles "Researchers Question Wide Use of HPV Vaccines." The article quotes two New England Journal of Medicine articles that conclude, the "Two vaccines against cervical cancer are being widely used without sufficient evidence about whether they are worth their high cost or even whether they will effectively stop women from getting the disease ."

So will all those states that endorsed these vaccines through legislation now "educate" parents about the potential pitfalls? Highly unlikely.

Source




Prominent Australian surgeon accused of botched work

Only 12 years late. Those good ol' "regulators" and government "watchdogs" were asleep as usual

A PROMINENT surgeon accused of performing botched, incompetent and unethical operations over more than a decade could face disciplinary action. Toowoomba surgeon Darryl Wayne Bates is also accused of engaging in dishonest behaviour. The Medical Board of Queensland has referred Dr Bates to the Health Practitioners Tribunal alleging a pattern of misconduct by him.

Board documents filed in the District Court of Queensland reveal Dr Bates, who is on the Toowoomba and Darling Downs Medical Association executive committee, was found in an audit of patients by St Vincent's Hospital, Toowoomba, and the Royal Australasian College of Surgeons to have performed "suboptimal" surgery as far back as 1996.

In one operation it is alleged "a loop of intestine was mobilised from the pelvis and left without blood supply and attachment to the gut". The patient, who deteriorated and required further treatment at the Toowoomba Base Hospital, was found to have a 1cm-wide cut in their mid-small bowel by another surgeon.

Further incompetence allegedly took place between August 2003 and September 2005 in four cases at Toowoomba's St Andrew's Hospital, which filed a complaint against Dr Bates to the medical board. On August 14, 2006, he signed an undertaking to have restrictions placed on him by the medical board and later that month was told his conduct was being referred to a Professional Conduct Review panel. He is then alleged to have carried out four operations in January and February this year, contrary to his agreed restrictions.

When contacted by The Courier-Mail, Dr Bates deferred comment to his solicitor Harry McCay. Mr McCay chose not to provide a statement to The Courier-Mail. A directions hearing into Dr Bates's case has been set down for September 1 in the Health Practitioners Tribunal.

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25 August, 2008

Stark Revelation

So government auditors have uncovered evidence of fraud in Medicare. Or rather, more fraud. The politicos lingering around Washington can barely keep a straight face as they claim to be shocked.

A draft report by the inspector general of Health and Human Services -- circulating on Capitol Hill and leaked this week -- determines that Medicare may have paid $2.8 billion in improper or fake claims for medical equipment in 2006. That's an error rate of 31.5%, in a single corner of this colossal entitlement. "This report doesn't surprise me," fumed Democrat Pete Stark.

Glad to hear the Congressman is catching on, given that dozens of studies have come to similar conclusions. But he aims his real outrage at the Bush Administration, which says it has stepped up its efforts to combat fraud and reined it in more than the inspector general alleges. "To look better to the public, you cook the books," Mr. Stark continued. "This agency is incompetent."

We're speechless. Mr. Stark and his ilk consistently claim that Medicare is a model for government-run "universal" health care because it spends less on overhead than the private sector. True, Medicare's administrative costs are just 3% of total spending, while the private sector hits 11% to 14%.

But insurance companies spend money to screen their claims for fraud. Medicare automatically pays more than 95% of the bills it receives. This lack of scrutiny reduces overhead, but it makes the program highly vulnerable to abuse. In June, a high-school dropout pleaded guilty to conning Medicare out of $105 million by submitting over 140,000 bogus claims before auditors noticed. It was the biggest health-care fraud in American history.

The real reason liberals like Mr. Stark are outraged is because they want to claim one of Medicare's vices as a virtue, to help along their health-care ambitions. The inspector general's report makes their argument poorer politically. It also shows that taxpayers will be literally poorer if Mr. Stark gets his way.

Source




Deadbeat public hospitals in Australia

But their army of clerks and "administrators" still get their pay on time, of course. Clerking is the one ESSENTIAL activity in all public hospitals

Public hospitals are threatening the livelihood of small businesses across New South Wales by failing to pay their bills. Suppliers have been forced to suspend services or pursue legal action until tens of thousands of dollars worth of outstanding invoices are paid. Companies struggling to recoup unpaid bills range from a bakery, hardware store, taxi service and dairy supplier to fuel stations, a tyre dealer, software supplier, grower's market and confectioners. Medical providers - including pharmacists, physiotherapists and psychiatrists - have also been left as much as $40,000 each out of pocket.

Hospitals in the Greater Southern, Greater Western, South Eastern Sydney Illawarra and North Coast areas have among the biggest debts. "Most hospitals never pay their bills for months and most of the suppliers are too scared to create problems because they are threatened with losing their contracts," a NSW Health source said.

Belinda and Wayne Morrison, owners of Bels Gordon St Bakery in Port Macquarie, have supplied the town's hospital for nine years. But, in the past six months, the hospital's unpaid invoices have mounted to as much as $7000. "We are a small business and we do need cash flow," Mrs Morrison said. "It's frustrating having to chase money - especially when I give them goods and they get money back on the same day." The buns and cakes that her bakery supplies are sold at a profit by the hospital's cafeteria. "They sell them for quite a healthy profit." she said.

NSW Opposition health spokeswoman Jillian Skinner said the Government had an obligation to pay bills on time. "It's the lowest of the low for a big government agency to make suppliers hold out for payment of services and goods that they have supplied," she said. "It's mean and it's jeopardising some of those small businesses that have to pay their bills and staff on time - they struggle to stay afloat."

The Sunday Telegraph has learned of a case in which a fuel station refused to fill up area health service vehicles in the South Eastern Sydney Illawarra area because of unpaid hospital bills. Colin Richardson, managing director of Global Direction software suppliers, suspended services to Dubbo Base Hospital's pathology service in May after accounts of more than $22,500 were unpaid. "Now we have put them on pre-pay so they pay in advance," Mr Richardson said.

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24 August, 2008

Infertile couples to be priority for NHS IVF treatment

A complete turnaround. Up until now there has been a pervasive attitude in the NHS that infertility is not a "real" problem. I suspect that Britain's socialists have decided that they need to breed all the little future taxpayers that they can

Infertile couples could soon be offered wider and more consistent treatment on the NHS under the first proposals from the government panel that has the task of ending the IVF postcode lottery. NHS trusts should give IVF a much higher importance when drawing up spending plans, by taking into account the effects of infertility on mental health and general wellbeing, the influential group will say today.

The advice from the Expert Group on Commissioning NHS Infertility Provision, which was convened by health ministers this year, will put fresh pressure on the 95 per cent of primary care trusts (PCTs) that do not offer the three cycles of IVF recommended by the National Institute for Health and Clinical Excellence (NICE).

Its interim report, which suggests several measures designed to improve access to IVF, comes as an NHS regional health authority has agreed for the first time to implement the NICE guidelines across all 14 of its trusts. The decision by NHS East of England means that infertile couples in Essex, Suffolk, Norfolk, Cambridgeshire, Hertfordshire and Bedfordshire will be entitled to three cycles of treatment from next April, provided that they meet eligibility criteria.

Infertility is a problem for between one in six and one in seven couples. Almost 45,000 cycles of IVF are performed in Britain each year, but limited NHS provision means that about 75 per cent of these are conducted privately, at an average cost of o2,000 per cycle. NICE, the value-for-money watchdog, recommended in 2004 that PCTs should provide three cycles to infertile couples in which the woman is aged between 23 and 39. It added that these should be full cycles, including the replacement of frozen embryos, should a couple fail to conceive with fresh ones.

A Department of Health survey published in June found, however, that just 9 out of 151 PCTs in England meet this standard. About two thirds offer only one cycle, and half of these do not replace frozen embryos. Three trusts offer no IVF at all.

In March, Dawn Primarolo, the Health Minister, asked an expert group to recommend ways of encouraging more trusts to implement the NICE guidance in full. Its first advice, seen by The Times, will be published today. It found that the main barrier to wider provision was the low priority that many trusts give to IVF. This needed to be reassessed in the light of evidence about links between infertility and depression, stress, relationship breakdown and quality of life. "The provision of infertility treatment has not been seen as a traditional NHS service and, therefore, is often viewed as a relatively low priority compared to more visible conditions whose impact is well established," the report will say.

"The group's final report will seek to consider the often unseen consequences of infertility, including the impact on mental health and general wellbeing, which may draw on other NHS services for treatment, as well as the positive benefits of IVF." The group has also identified a "lack of knowledge and understanding of infertility and its treatment" among commissioning managers, and a poor grasp of what the NICE guidelines actually mean.

In the light of the group's advice, Ms Primarolo will write today to all PCTs to clarify that NHS IVF cycles should include the replacement of frozen embryos as well as fresh ones. If trusts acted on this, it would significantly improve some infertile couples' chances of a baby.

Ms Primarolo's letter will also confirm that NICE will not review its guidance until 2010-11. Many trusts had been holding off from offering three cycles, as NICE had been due to reassess its policy as early as this year.

The expert group, made up of five NHS commissioning experts and a patient representative, will also recommend that the NHS set a fixed price that PCTs would pay for IVF. Such national tariffs already exist for dozens of medical procedures, such as heart bypasses, and help managers to plan their spending. A spokesman for the Department of Health said that it was receptive to this idea. "It is appropriate for IVF to be considered carefully for inclusion on the national tariff," he said.

Mark Hamilton, chairman of the British Fertility Society, which represents medical professionals in the field, said that it was right for PCTs to consider the wider health impact of infertility. "This is a positive development," he said. "Clinicians and practitioners involved in infertility services are all aware that we are not just dealing with a physical pathology. "Infertility is a disease, but it also has fallout beyond that for a significant proportion of couples, causing mental health problems, depression, stress-related illnesses and so on."

Dr Hamilton welcomed the East of England decision, though he questioned whether other parts of the country would match it unless the Department of Health provided more dedicated funds. "It is a tremendous step forward that a region has seen the value of doing this, and I would hope that others will do the same. But there is certainly a view in the sector that central funding would solve an awful lot of problems."

Source




Nod for 'top-up' drugs

Dozens of NHS hospitals are allowing patients to "top up" their treatment with medicines bought privately. These are often expensive cancer drugs the health authority refuses to fund.

Topping up or "co-pay" is against NHS regulations, according to the Department of Health. But there is nothing in NHS regulations that prohibits patients buying in treatment if they wish, according to senior legal opinion obtained by health insurer Western Provident Association.

John Barron, Conservative MP for Billericay, discovered the hospitals' "top-up" figures through freedom of information laws.

The subject is relevant to expats returning to the UK seeking to switch from NHS to private care, or the other way round, because under many policies cover is capped at certain cash levels.

Source





23 August, 2008

Obama's Health-Care Tipoff

'If I were designing a system from scratch, I would probably go ahead with a single-payer system," Barack Obama told an audience in Albuquerque on Monday. He was lauding the idea of a health-care market -- or nonmarket -- entirely run by the government.

Most liberals support single payer, aka "Medicare for All," because it would eliminate the profit motive, which by their lights is the reason Americans are uninsured. The Democratic Presidential candidate takes a more moderate campaign line, though we suppose just about everything is "moderate" compared to a total government takeover. While preferring that option in theory, Mr. Obama continued, his health-care plan is designed to "build up the system we got," and over time, "we may . . . decide that there are other ways for us to provide care more effectively."

The Senator has expressed similar sentiments before, including throughout his combat with Hillary Clinton. But repetition doesn't make it any less telling, especially about his political instincts and the breadth of his ambitions. Mr. Obama's health-care plan includes a taxpayer-funded insurance program, much like Medicare but open to everyone. The goal, like HillaryCare in the 1990s, is to displace current private coverage and switch people to the default government option. What's new is Mr. Obama's smoother political packaging.

With good reason, critics often call this a back-door route to a centrally planned health-care bureaucracy. For all his lawyerly qualifications, Mr. Obama has essentially admitted that his proposal is really the front door.

Source




Disorganized British paramedics kill woman

A Midland widower whose wife died after alleged delays by paramedics in getting her to hospital has criticised the ambulance service for not apologising four years after her death. Roger Bereza, who lives in Coventry, spoke out after West Midlands Ambulance Service (WMAS) paid an undisclosed six-figure-sum in an out of court settlement earlier this month.

His 41-year-old wife Tracey had suffered asthma since childhood but on April 11, 2004 she had an acute attack and her condition continued to worsen, so Mr Bereza dialled 999 for an ambulance.

As well as complaints about the way the ambulance crew treated his wife at the scene, he said they had to ask him for directions to the nearest hospital and went the wrong way. A crew of two paramedics arrived at the family home at just after 9.20pm but, he said, it took more than 75 minutes to take his wife to hospital during which time she went into respiratory arrest.

Mr Bereza, a 47-year-old RAC patrolman, claimed there was a series of shortcomings in the way his wife's care was handled and once in the ambulance she suffered a respiratory arrest. He said he could only watch as his wife vomited blood, turned blue and arrested in front of him, as his three daughters looked on from the house. "By now I knew I had to do something, so I started doing chest compressions on Tracey's chest while one of the paramedics tried to get the defibrilator to work. Monitors were showing her pulse was at zero, and we were still on the driveway. I couldn't give up on her, even though I realised it was the beginning of the end."

They arrived at Coventry & Warwickshire A&E at 10.35pm. Mrs Bereza never regained consciousness and died four days later after her family took the difficult decision to turn off her life support machine. The couple, who had three daughters aged 20, 19 and nine, were due to celebrate their 21st wedding anniversary in June 2004.

Despite the pay-out from WMAS, the family said they had yet to receive a formal apology or admission of liability. A trust spokesman said: "WMAS first became involved in the treatment of Mrs Bereza on the evening April 11, 2004 when her husband called for an ambulance. Mrs Bereza had suffered an asthma attack after inhaling polish fumes. "The trust wrote to Mr Bereza on July 22, 2008 in regard to his claims about the level of care given to his wife and expressed its `sincere regret'. "WMAS is always learning from its experiences and strives constantly to find ways of improving patient care. "In light of this case, further inquiries into the trust's protocols were undertaken to ensure that the training and actions of staff are appropriate at all times."

Mr Bereza added: "I am still extremely angry. This tragedy should never have happened. "Although Tracey had suffered from asthma since childhood, it was controlled most of the time. We knew that if she had a severe attack we had to get her to hospital as soon as possible. Even though we live just 10 minutes from the nearest A&E, I had always been told to call an ambulance and not to attempt to drive there myself in case we got stuck in traffic or Tracey required emergency oxygen for her nebuliser. "I wish I'd ignored this advice and taken Tracey to hospital myself."

Lindsay Gibb, a medical negligence expert with Birmingham-based law firm Irwin Mitchell, said: "This is a hollow victory for the family because despite agreeing to pay a significant sum by way of compensation, the trust has not apologised to the family or accepted that its paramedics were negligent in any way. "The relevant guidelines state that: .'in a life threatening or acute severe asthma attack - do not delay transportation. Load and go to nearest suitable receiving hospital and provide nebulisation en route'. "This clearly was not the case on this occasion and the evidence suggests these delays were responsible for the fatal outcome."

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22 August, 2008

Thousands of NHS operations cancelled

Thousands of NHS operations were cancelled last year, many because of shortages of staff, beds or equipment, figures suggest. One in three hospital trusts cancelled surgery for the same patient at least three times, and up to 7,014 patients had operations cancelled or rescheduled more than once, data obtained by the Conservatives shows.

The most common reported reason for cancellation was problems with theatre bookings, responsible for 16,617 cases. Other causes included: 400 operations cancelled because the patient's notes had been lost, more than 10,000 cancelled because of bed shortages, nearly 4,000 because of equipment failure and more than 11,000 because of staffing shortages.

Data from 124 trusts - more than three quarters of those in England - responding to requests under the Freedom of Information Act, suggested that 77,302 operations were cancelled for "non-clinical reasons" in 2007-08. However, the trusts with the highest reported cases of cancelled surgery apologised yesterday for providing inaccurate data.

Kingston Hospital NHS Trust, which reported 10,351 operations cancelled last year, said that this figure was incorrect. "This was an error on our part and we apologise for any confusion this mistake has caused," the trust said, adding that only 190 operations were cancelled in 2007-08. Other trusts reporting more than 3,000 cancellations included hospitals in York and Brighton and Great Ormond Street Hospital for Children in London. They also said that the figures were erroneous or had been misinterpreted.

Many cases could have been cancellations by patients themselves or have been logged as changes by hospitals before the patient was notified of a date for surgery, NHS staff said.

A spokesman for Brighton and Sussex University Hospitals Trust said: "Over six hundred of the operations that were `cancelled' were in fact brought forward to an earlier date and around 1,000 were administrative cancellations, which are about how the hospital schedules its work."

Andrew Lansley, the Shadow Health Secretary, said: "Having an operation cancelled can cause huge distress for patients and their families. It's simply unacceptable that these figures are so high."

Government figures show that the number of cancelled operations has increased by 14 per cent since 1997. There were 57,350 cancelled operations in 2007-08, compared with 50,505 in 1997-98, official records state, but they include only operations cancelled 24 hours in advance or less.

Richard Collins, a spokesman for the Royal College of Surgeons, said that the figures would almost certainly relate to elective, planned surgery rather than urgent care. "The shortage of ICU [intensive care unit] beds for major surgery patients is a common problem, especially in winter," he added. "Notes are also lost on a worryingly frequent basis."

A Department of Health spokesman said: "The number of cancelled operations needs to be set against the huge increase in the number of patients that the NHS is treating. "Between 1997 and 2008, the number of elective admissions has increased by over 1.5million while the number of operations cancelled at the last moment remained at less than 1.5 per cent."

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21 August, 2008

Reform Needed at the Food and Drug Administration

One-Size-Fits-All Mandates Don’t Work for Individual Patients

In order to best serve the interests of the nation’s patients and doctors, the structure of the Food and Drug Administration desperately needs to be systematically reformed, according to a new study published by the Competitive Enterprise Institute.

In FDA’s Bad Medicine: How the Dispersed Knowledge Problem Affects Drug Safety Analysis, authors Jerome Arnett, M.D., and Gregory Conko argue that the very structure of the FDA prevents it from doing its job—making sure safe and effective medical treatments reach patients in need.

“Every day, thousands of physicians and patients make myriad choices from available drug options,” write Conko and Arnett. “They take into account differences in effectiveness, side effects, and drug interactions for each individual patient. FDA scientists may know a lot about the drugs they evaluate and their average effects on thousands of users, but they know nothing about the individualized physiology of each patient. On the other hand, intensively trained clinical physicians, who do have knowledge of individual patients, are best able to advise them if a drug is appropriate.”

Because the FDA uses the blunt tool of completely banning drugs that aren’t safe for all patients, there will almost always be those who lie outside the average, and for whom unapproved treatments are not just appropriate, but medically necessary. The government should be encouraging a more personalized approach to treatment, with physicians utilizing multiple sources of information and guidance in tailoring the best possible strategy for each individual patient.

“A market-based approach to drug safety information, combined with technological advances in diagnostic science, will lead to a more vibrant medical marketplace—and better outcomes for patients,” conclude Arnett and Conko.

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20 August, 2008

Hospital Infections: Preventable and Unacceptable

On July 30, a jury awarded over $2.5 million to James Klotz and his wife Mary in a medical malpractice lawsuit against a heart surgeon, his group practice and St. Anthony's Medical Center in St. Louis, Mo. In 2004 Mr. Klotz, now 69, was rushed to the hospital with a heart attack and a pacemaker was surgically implanted. He developed a drug-resistant staph infection called methicillin-resistant Staphylococcus aureus (MRSA). It was so severe that he underwent 15 additional operations, spent 84 days in the hospital and lost his right leg, part of his left foot, a kidney and most of his hearing.

This verdict should send a warning to physicians, hospitals and hospital board members. Until recently, infection was considered an unavoidable risk. But now there is proof that nearly all hospital infections are avoidable when doctors and staff clean their hands and rigorously practice proper hygiene and other preventive measures.

Hospital infections will cause the next wave of class-action lawsuits, bigger than the litigation over asbestos. The germ that Mr. Klotz contracted, hospital-acquired MRSA, infects about 880,000 patients a year and accounts for only 8% of all hospital infections. Hospital infections caused by all kinds of bacteria sicken millions.

The Klotz verdict is not the first sign that hospitals are in a new legal environment. In 2004, Tenet Healthcare Corporation agreed to pay $31 million to settle 106 lawsuits by patients who contracted infections after heart surgery at Palm Beach Gardens Medical Center in Florida. Since then, numerous lawsuits have been filed against hospitals in Florida, Kentucky and elsewhere by infected patients. Hospitals being sued are saying that their infection rates are within national norms. But for most infections, the only acceptable rate is zero.

Medicare calls certain device-related bloodstream infections, urinary tract infections and surgical infections after orthopedic and heart surgery "never events." Starting in October, Medicare will stop reimbursing hospitals for treatment of these infections. Hospitals will be barred from billing patients for what Medicare doesn't pay, forcing them to take a loss. Next year Medicare will add other types of infections to the list of "never events."

The evidence justifying Medicare's new policy is compelling. Central line bloodstream infections, caused by the contamination of certain devices, are preventable. Hospital patients in intensive care are commonly medicated through a tube inserted into a vein. The risk is that bacteria will invade the tube and enter the bloodstream. Rigorous hygiene, including clean hands, sterile drapes, and careful cleaning of the insertion site with chlorhexidine soap, can keep bacteria away from the tube.

Beth Israel Medical Center in New York City reports that it hasn't had a central line bloodstream infection in the cardiac intensive care unit in over 1,000 days. Dr. Brian Koll, chief of infection control there, explains that the key is using a checklist that doctors and nurses must follow. Implementing the checklist cost $30,000 and saved $1.5 million in treatment costs. Lives saved: priceless.

Other hospitals -- from Johns Hopkins Medical Center in Baltimore to Sutter Roseville Medical Center in Sacramento -- have reached the goal of zero central line bloodstream infections. No wonder Medicare calls these infections "never events." Why should jurors reach a different conclusion in a lawsuit?

We have the knowledge to prevent infections. What has been lacking is the will. A recent survey from the patient-safety organization Leapfrog found that 87% of hospitals fail to consistently practice infection prevention measures. Insurance companies that sell liability coverage to hospitals could change that by offering lower premiums to hospitals that rigorously follow infection-prevention protocols.

To be sure, lawsuits are not the best way to improve patient care. Many verdicts are unjustified, and few truly injured patients find a lawyer to take their case. Still, the coming wave of lawsuits, as well as financial incentives from Medicare and insurers, will fight complacency about hospital hygiene.

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19 August, 2008

NHS watchdog to tell patients how to buy medicine unavailable on health service

Patients are to be given advice on drugs rejected by the NHS - so they can choose to buy them privately.

The National Institute for Health and Clinical Excellence (NICE) is drawing up plans to provide patients with independent medical guidance on treatments for diseases such as cancer. The advice would include drugs that NICE has ruled the NHS should not use because they are too expensive. For the first time patients would be able to receive impartial guidance on the health benefits of unapproved treatments and compare them with those available on the NHS. They could then decide if they want to pay for them privately rather than opting for the free drugs, which can be less effective.

The development follows growing public anger over the number of drugs and treatments being blocked by the Nice because they are not 'cost effective'. Many are available abroad and can offer people longer life expectancy or health benefits. Last week the watchdog ruled that four kidney cancer drugs costing around o24,000 a year per patient did not represent value for money.

Under current health service rules patients who choose to buy drugs that the NHS deems too expensive are made to pay for the rest of the care. But ministers are expected to end this following a review of the system which is due to report in October. It is expected this will give the green light for patients to 'top up' their treatment. As a result, NICE - which is currently only responsible for deciding which treatments are available free on the NHS - is preparing to publish guidance on drugs they have ruled against.

Speaking to The Daily Telegraph, Andrew Dillon, the chief executive, revealed his organisation was preparing to play a central role if the Department of Health give the go-ahead to so-called "co-payments" in the autumn. He said: "If the Government wants to go in that direction we are absolutely the right organisation to support the process for doing so. "One of the things we think we could do really well would be to provide entirely independent objective information for individuals to make up their own mind. We think we could do that very well and would be happy to do that."

NICE has faced criticism for rejecting a series of drugs widely available in Europe and America - sparking allegations that it is putting financial considerations above medical benefits. The disclosure that it is now preparing to offer advice to patients buying their own drugs will underline concerns that the development of expensive new drugs is leading to the emergence of a "two-tier NHS".

There are also fears that patients unable to afford 'top ups' will be angered at learning they may not be receiving the best treatment available.

It is understood that the information will largely be provided on-line via a new website called "NHS Evidence". The site is being established to offer advice to NHS doctors and hospitals but could be extended to provide patients with clear information on different treatments and drugs available. If co-payments are permitted the medical benefits of privately-available drugs will also be set out. The NHS will also be able to detail the likely costs of a prescription.

Norman Lamb, the Liberal Democrats' health spokesman, welcomed the move. "One of the big dangers of allowing people to top-up their treatment is that consumers aren't informed and they can be susceptible in a moment of crisis to pressure from pharmaceutical companies," he said. "These drugs can be very expensive and I would welcome the provision of a source of independent, reliable advice."

Medical experts and patient groups said the development may also put more pressure on NICE to approve drugs which have medical benefits which are currently unavailable on prescription. Christoph Lees, an NHS consultant and founder member of the Doctors for Reform group, said: "The fact that NICE are preparing to offer advice shows that the realisation is finally filtering through that you can't withhold information on good drugs which are out there and what they can do, even if the NHS can't afford it. "But that has got to be balanced with some sort of mechanism to make sure that people can afford access to these treatments."

Michael Summers, vice chairman of the Patients Association said: "Any information which is available is obviously valuable. But people would have less need to top-up if NICE did not reject cancer drugs available elsewhere."

Andrew Lansley, the shadow Health Secretary, said: "It seems that the Government is intent on pre-empting the outcome of its own consultation on top-up payments and that it wants to assist people to buy their own drugs, rather than have them provided on the NHS. "But Labour are still avoiding two key questions: if patients buy top-up drugs, will that prejudice their access to NHS treatment? Secondly, why is access to new cancer medicines worse in the UK than in the rest of Europe and America?"

NICE is under mounting pressure after barring four kidney cancer drugs available in other countries last week. Charities and patients are preparing to make official complaints about the approval process with one sufferer claiming he was "patronised and bullied" by the process.

Sutent, one of the drugs rejected, can double life expectancy to 28 months for people diagnosed with kidney cancer. A report has claimed that more than 1,000 patients had been turned down for cancer drugs over the past two years because of a "postcode lottery" in treatment.

Patients are also being forced to mount legal action to get hold of drugs that NICE have not yet approved. A grandfather told he only has two months to live has mounted a legal challenge to gain access to a drug that could possibly extend his life expectancy by up to three years. Colin Ross, 55, of Horsham, West Sussex, who has multiple myeloma, a cancer of the blood cells is fighting for the drug Revlimid after being refused it by West Sussex Primary Care Trust because it has not yet been granted approval by NICE.

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18 August, 2008

Drug companies fed up with blundering British bureaucracy

So Brits don't get new drugs

One of the world’s leading drug companies is threatening to withdraw some of its new cancer treatments from the process by which they are approved for use in the National Health Service. Cancer patients in Britain will consequently be denied more effective drugs that are available to sufferers in other countries.

Roche, the Swiss pharmaceutical giant, has already refused to supply economic data on its drug Avastin for treatment of lung and breast cancer to the National Institute for Health and Clinical Excellence (Nice), the authority that evaluates the cost-effectiveness of medicines for the NHS. This means Avastin will not be available on the NHS for those diseases. Avastin is said to double the time a breast cancer patient’s condition remains stable when compared with existing treatments. Studies have also shown improved survival rates for lung cancer victims.

Roche said last week it will consider withdrawing from other evaluations rather than submit products only for them to be rejected by Nice as too expensive. The statement is the latest twist in the growing row over decisions by Nice. Earlier this month Nice caused an outcry in a preliminary decision when it rejected the use of Avastin (also known as bevacizumab), Sutent (sunitinib), Nexavar (sorafenib) and Torisel (temsirolimus) as too expensive to treat kidney cancer.

“The alternative to these drugs for many patients is death,” said Jonathan Waxman, professor of oncology at Imperial College, London. “Nice is making terrible mistakes.” The survival rates for cancer in Britain are already among the lowest in Europe — on a par with Poland, Slovenia and the Czech Republic, according to data published last year. However, cancer charities acknowledge there has been significant improvement in rates since the government made the issue a priority with its NHS Cancer Plan, first launched in 2000. Some consultants argue, however, that Britain already spends less on cancer drugs than many other European countries and that it is “crazy” to reject drugs proven to prolong life.

Richard Barker, director- general of the Association of the British Pharmaceutical Industry, which represents the drug companies, said: “Nice does a tough and necessary job, but is making errors because of a very mechanistic approach. It relies too much on arithmetic and not enough on clinical judgment.”

Nice was created in 1999 with the aim of ensuring that decisions on the best and most cost-effective drugs for the NHS were made at a national level, were transparent and could be challenged. When the drug companies scrutinised the economic modelling used by Nice, they realised that the estimated costs of their drugs and effectiveness could vary widely. Even more seriously, some of the calculations were wrong. There was an outcry in the medical community in February 2006 when Nice stated that Temodal (temozolomide) — declared as the biggest breakthrough in treating brain tumours for decades — did not offer value for money. Temodal had won approval from the European regulator in 2004, but many British patients were denied treatment as Nice wrangled over costs.

Peter Davison, 48, a manager for Cambridge University Press, was among the few British patients who received the drug — because he was diagnosed with a brain tumour while working in Singapore. “I was lucky to be abroad,” said Davison, who is now in remission. “Four months after I had the operation to remove the tumour, I was running and climbing mountains.” When Schering-Plough — the pharmaceutical company which markets Temodal — prepared its appeal against the Nice decision, it identified an error in the modelling. Once corrected, the model showed the drug was cost-effective — and as a result it was ultimately approved for NHS use.

Not surprisingly, the drugs companies now want full access to the economic models, with the chance to check the accuracy of the calculations. In May, the High Court ruled that Pfizer and Esai, the companies which market the Alzheimer drug Aricept, should be given full access to these models. “We believe this modelling might not be fit for purpose and we want to check it,” said a Pfizer spokesman last week. Nice said it was seeking leave to appeal to the House of Lords after the High Court decision.

Even where the models are correct, consultants and patients’ groups say Nice fails to give proper weight to the evidence from clinicians and patients’ groups. The Sunday Times has highlighted the fact that NHS patients do not even have the option of paying for the drugs privately because of government ban on “co-payments”. The government has said it will review the issue.

Professor Sir Michael Rawlins, chairman of Nice, said the evaluation process was recognised internationally and Nice had been commended by the World Health Organisation for the quality of its work. He said: “We have a finite amount of money to spend on healthcare and we have to divide it up in as fair and as equitable a way as we can. We can’t say to yes to everything. It’s awkward, it’s difficult, it’s unpleasant.”

Source




Arrogant Australian drug regulator to cause taxpayers MORE pain

And the crooked bitch mainly responsible is still in her job! Australia's version of the FDA shows how badly such organizations can go off the rails

A class action against the federal Government is set to be launched next week after the $55million payout to Pan Pharmaceuticals founder Jim Selim. The Government could be liable for another multi-million-dollar payout because of the action taken by the Therapeutic Goods Administration in 2003 to cancel Pan's licence. The Weekend Australian has also uncovered further evidence of what occurred in the lead-up to the decision to cancel Pan's licence - including a senior TGA officer shredding notes taken at a crucial meeting.

Mr Selim claimed the government had breached its duty and abused its power of public office, and his Federal Court case was settled on Thursday in his favour. More than 300 people lost their jobs, shareholders lost tens of millions of dollars and hundreds of businesses were affected by Pan's closure in 2003.

In January that year, people reported hallucinations and vomiting as a result of taking travel sickness drug Travacalm. The TGA then investigated Pan and meetings were held to decide what action to take. On April 23, 2003, the TGA organised for an expert advisory group to decide whether the public was at "imminent risk" of death, serious injury or serious illness from Pan's products. It was a statutory requirement that the government believed this "imminent risk" existed before it could take the action to cancel Pan's licence. The EAG was later to report back to the TGA that there was no "imminent risk", although it did find there was a lack of confidence in the quality of Pan's products.

Pages of notes taken by the members of the EAG were later taken by the TGA and destroyed at the direction of senior bureaucrat Fiona Cumming. Dr Cumming is the director of the office of complementary medicines. At the same time, the EAG was meeting at the Qantas Club at Sydney Airport to discuss the risks of Pan's products, media officer Kay McNeice was in the TGA's Canberra office putting the finishing touches to a media release - announcing the cancellation of Pan's licence.

Although the notes of the EAG's deliberations were destroyed, lawyers were able to unearth a transcript of the meeting, which had been recorded at the behest of the TGA. "We don't have much evidence do we," one member noted. "We're having trouble getting to 'imminent risk'," said another. The findings of the EAG did not justify an immediate suspension of Pan's licence, a proposition agreed to in court by the TGA's director of the office of devices, blood and tissues Rita Maclachlan, who spent several days being cross-examined by Mr Selim's barristers. Immediate suspension meant Pan could not dispute the issue in the courts, a fact the TGA was aware of.

Ms Maclachlan, second in command at the TGA, was also present when then health minister Kay Patterson and prime minister John Howard were briefed in late April. "Why didn't you speak up and say, 'Look, even though it's not my call ... we are about to implement the largest recall in the history of the Western world, unlawfully, because we are going to deny the company its statutory requirement to natural justice'. Why didn't you say that?" Mr Selim's barrister, Justin Gleeson SC, asked. "I don't have a recollection, Mr Gleeson" Ms Maclachlan replied.

When Ms Maclachlan gave evidence that she was concerned that one batch of Pan products - manufactured in August 2000 and not part of the 2003 recall - could cause severe allergic reactions in the public, the judge hearing the case, Arthur Emmett asked a few questions of his own. "You weren't prepared to recall this product back then but that was the reason you were going to call the other 6000 products back (in 2003)?" "I don't have a particular recollection as to what happened with this product," Ms Maclachlan replied.

"But you've just told me ... that you were concerned that this product was still out in the community," Justice Emmett said. "You didn't take any steps to have it recalled? I just find that quite unbelievable." Ms Maclachlan declined to comment yesterday.

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17 August, 2008

HEALTH WOES IN TROPICAL AUSTRALIA

Cairns is the centre of one of Australia's major resort areas. There is a constant stream of planes landing with loads of tourists at Cairns International airport. The planes seem to roar in every ten minutes or so during the day. So you would think that health services there would be at a standard to create a good impression of Australia. Sadly, it is not so. And note that Cairns Base Hospital serves an area approximately the size of England -- in addition to treating tourist mishaps. Four current articles below

Paramedics dangerously overworked in Cairns

Twenty-four hour shifts and bullying are among a rash of new complaints outlined by stressed ambulance officers. Following a series of exclusive reports by The Cairns Post, more Queensland Ambulance Service paramedics yesterday came forward to detail the staffing shortfalls and other problems plaguing the service across the Far North.

They said overworked staff were sometimes too tired to even fill in their time-sheets properly at the end of shifts that extended to 24-hours in smaller centres with an overnight on-call component. "Everyone's being flogged to death but what choice do you have when there aren't enough staff and you've got a moral obligation to the community?" one paramedic said. Others told of a culture of bullying when complaints were made to management.

The paramedics who rang The Cairns Post yesterday said they felt compelled to speak out before a patient's life was "put on the line". Their complaints come after revelations this week that a student paramedic was left in charge of the entire Cardwell region for seven hours on Monday. The nearest qualified paramedic was more than 40km away in Tully.

Their concerns also follow the death last month of a Cairns World War II Digger who waited more than two hours for an ambulance to come from Kuranda the day he died. One paramedic described that situation as a "regular problem", saying he knew of a recent case where a Code 1 job outside the Cairns casino needed to be responded to by Kuranda and another less serious case where Gordonvale's unit had to be sent to Yorkeys Knob.

Queensland Ambulance Service's new Far Northern assistant commissioner Peter Cahill denied there was a shortage of ambulance officers and said he had not been briefed on any bullying issues. Mr Cahill said he would look into incidents if he had firm evidence. But he said the Far North region had a good record for response rates, with 50 per cent of Cairns and coastal region cases being responded to in 7.4 minutes, which was under the state average. He conceded 24-hour shifts were a long-standing practice for smaller stations but said staff were only on-call overnight for emergencies.

Opposition spokesman Ted Malone called on Emergency Services Minister Neil Roberts to "stop covering up staff shortages".

Source

Cairns paramedics told to put names to complaints

Given the well-known bullying of paramedics by management, this is just stonewalling

The Queensland Ambulance Service will only investigate allegations by paramedics that they are being overworked and bullied by superiors if staff are willing to come forward. The bosses say they will also only investigate alleged unsafe work practices where students were put into positions alone without trained paramedics to back them up if officers will put their names to the complaints.

The response comes after revelations that a student paramedic was left in charge of the Cardwell region for several hours earlier this week. The Weekend Post has since been inundated with calls from paramedics, students and people in senior QAS roles, voicing concerns over practices they believe are "putting lives at risk". But all fear being named, saying they will be sacked or moved on.

"If we are given instances where people felt intimidated or they believe they are going to be sacked I would like to know about them," QAS deputy commissioner Russell Bowles said. "Apart from gross misconduct I have never seen anyone sacked.'' But one highly placed person in the service said there were often directives from the State Government banning staff from speaking out. QAS assistant commissioner Peter Cahill said he would investigate any incident raised through formal channels

Source

Cairns ambulance bosses say sorry for wrongful and fatal delay

Ambulance bosses admit a series of blunders may have contributed to the death of World War II digger Bob Mutton and have apologised to his family. An investigation into the circumstances surrounding the Changi prison camp survivor's death found a series of "operational deficiencies", including an unacceptable response time. Staff involved will be officially counselled.

The inquiry was launched after an exclusive report in The Cairns Post revealed Mr Mutton waited more than two hours for an ambulance. Releasing the outcome of the investigation yesterday, Queensland Ambulance Service deputy commissioner Russell Bowles told The Weekend Post: "It is very unfortunate and I am sorry that it happened and my heartfelt condolences go out to Mr Mutton's family."

On the day Mr Mutton died in late July, it took almost an hour for the first ambulance to be dispatched to his Cairns home after his doctor called to report the 88-year-old was struggling for breath. That ambulance was diverted four minutes into the job. After another 71 minutes, an ambulance arrived from Kuranda before taking him to Cairns Base Hospital where he later died. At the time, ambulance bosses blamed delays in reaching the war veteran on the number of ambulances delivering patients to Cairns Base Hospital. But the investigation found crews were in fact available to respond to Mr Mutton.

The investigation found the initial call was classified correctly but it was not actioned correctly. It also found there was an unacceptable initial response time and diversion, and that standard procedures were not followed when responding to calls made by Mr Mutton's doctor. "Standard operating procedure required a response to this case within 20 minutes," Mr Bowles said. "This did not occur as it took paramedics two hours and five minutes to respond.''

Mr Bowles added: "While some crews were waiting to admit patients at CBH, there were other resources available that should have been redirected. "Mr Mutton's case was urgent enough to require the attendance of one of those crews."

Mr Bowles said while some of the staff involved had been debriefed on the incident, others would soon be and they would be "officially counselled regarding this matter''. "We are human. We do 60,000 cases a year and now what we have to do as these cases come up is - and we don't always get it as right as we want - is not to have a witch-hunt," he said. Mr Bowles said as a result of the incident he had also directed the assistant commissioner Peter Cahill to reiterate to all staff the importance of following QAS policy and procedures. He said the QAS was trying to contact Mr Mutton's family to take them step-by-step through what happened on that fateful day.

Source

Two-day emergency department stay in Cairns public hospital

Cairns Base Hospital is again at bursting point, with patients being kept overnight in the emergency department because of bed shortages. Cairns Private Hospital has also been near capacity for the past two weeks, and has been forced to turn away some patients transferred from state facilities. Both hospitals have blamed the flu season and an ageing population for the capacity problems.

Victorian grandmother Lynette Thompson, who is visiting family in Cairns, said she was kept in the emergency department at Cairns Base for two days because staff were unable to find her a bed. The 72-year-old said while she had nothing but praise for hospital staff, she "did not dream the doctors could not find me a bed" in the main part of the hospital. Despite having private health cover, and the best efforts of doctors at Cairns Base, she said no bed could be found at the private hospital either. "I was absolutely horrified there was nowhere to go," Ms Thompson said.

Ms Thompson, who is from Ballarat and spends about two months in Cairns each year visiting her three sons, said she was "appalled" by the situation. "We would never consider living here permanently as we have such good health care in Ballarat and Melbourne."

Both Queensland Health and Ramsay Health said the reasons for the ongoing capacity problems were the ageing population [And that could not be planned for??] and the flu season. Ramsay Health boss Mark Page said Cairns Private had not turned away any booked patients but there had been cases in the past few weeks when it had been unable to accept some transfer patients. "All five operating theatres are also operating at capacity," he said.

A Queensland Health spokesman said no patients requiring admission had been turned away from Cairns Base Hospital. "However, once admitted to the emergency department, some patients may experience a delay in being transferred to a ward due to a shortage of beds in the main hospital at the time they are admitted," he said.

Cairns Base Hospital executive director of medical services Dr Kathleen Atkinson said the hospital had implemented a number of strategies to cope with the rush. She said those strategies included more efficient discharging of patients who were ready to go home and the transfer of patients who were no longer acutely ill, but still needed to be in hospital, to a smaller, rural health facility. Dr Atkinson also urged people to consider if a visit to their general practitioner was more appropriate for their condition than presenting at the emergency department and to undertake health precautions such as having a flu vaccination.

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16 August, 2008

NHS discriminates against the old

i.e. those who need medical care most. Great system!

Hospitals have been accused of age discrimination after a study found that they failed to provide basic standards of care to many patients aged 50 and over. Health experts found shortfalls in the quality of care offered to patients with conditions such as osteoarthritis, incontinence and osteoporosis. They also found that doctors paid particular attention to assessments that earned them extra money, including heart disease, diabetes and high blood pressure.

Nick Steel, senior lecturer in primary care at the University of East Anglia, who led the study, said: "One of the conditions that came out worst was osteoarthritis, where we asked people if they'd received basic advice such as doing exercises to control the condition, and whether they had effective pain relief. "At the more severe end of the scale, for those with severe osteoarthritis, we asked if they had been given the opportunity to see a specialist to talk about joint replacement. There were also issues around whether elderly patients had been asked the reason for their falls. These types of areas did not fare so well in the study."

The research, published in the British Medical Journal, found that the quality of healthcare for people with common health conditions "varied substantially by condition". The researchers quantified what treatments for 13 different conditions - including heart disease, diabetes, stroke, depression and osteoarthritis - could be expected. In total, these numbered more than 19,000 different opportunities for care to be delivered to people, but actual care was given only in 11,900 (62 per cent) of those cases. Scores on the quality of care ranged from 83 per cent for heart disease to 29 per cent for osteoarthritis.

The researchers found that substantially more care was provided for general medical conditions (74 per cent) than for geriatric conditions (57 per cent), including falls, osteoarthritis, urinary incontinence, cataract problems, hearing problems and osteoporosis.

Campaigners said that patients with arthritis were often being "fobbed off" by GPs and accused the NHS being guilty of a degree of ageism. Gordon Lishman, director-general of Age Concern, said: "These figures show that age discrimination within the NHS is still rife. "The rewards system for GPs to treat particular conditions has worked - but this hasn't included health problems older people particularly suffer from like depression, falls and vision and hearing problems. The system is therefore clearly failing thousands of older people."

The study involved a series of questionnaires and face-to-face interviews with 8,688 people.

Kate Jopling, head of public affairs at Help the Aged, called the results depressing. "This is extremely shortsighted in an increasingly ageing society," she said. "This kind of ageist treatment is precisely why legislation against age discrimination is needed."

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15 August, 2008

Amazing: Patients 'should not expect NHS to save their life if it costs too much'

The NHS should not always attempt to save someone's life if the cost is too much, the medical regulator has ruled. The National Institute for Health and Clinical Guidelines (Nice) has ruled for the first time that saving a life cannot be justified at any cost, in a review of its ethical guidelines.

The ruling - made by the board of the controversial organisation - contradicts advice it received from its own 'Citizens Council' which offers advice from a representative sample of the general public. Nice is facing growing criticism over the number of drugs it is now rejecting which are available throughout Europe and in America. Last week, it refused to sanction four kidney cancer drugs which can double life expectancy.

It has now rejected the so-called "rule of rescue" which stipulates that people facing death should be treated regardless of the costs. The rule is based on the natural impulse to aid individuals in trouble.

In a report on "social values judgement" the regulator says: "There is a powerful human impulse, known as the 'rule of rescue', to attempt to help an identifiable person whose life is in danger, no matter how much it costs. When there are limited resources for healthcare, applying the 'rule of rescue' may mean that other people will not be able to have the care or treatment they need.

"Nice recognises that when it is making its decisions it should consider the needs of present and future patients of the NHS who are anonymous and who do not necessarily have people to argue their case on their behalf.The Institute has not therefore adopted an additional 'rule of rescue'."

The ruling contradicts the advice of Nice's Citizens Council, which said that a rule of rescue was an essential mark of a humane society. The report said that where individuals are in "desperate and exceptional circumstances" they should sometimes receive greater help than can be justified by a "purely utilitarian approach".

Doctors have also criticised the ruling. Tony Calland, chairman of the ethics committee of the British Medical Association, said: "We would be opposed to ignoring a rule of rescue when it introduces a degree of flexibility around extreme cases. So what if you waste a few pounds if you are doing your best for humanity?"

Nice defended its ruling last night saying that the Citizens Council provided useful input to its decisions but that the organisation's role was to determine how best to allocate the health service's limited resources.

Nice is facing increasing accusations that it is giving undue weight to financial considerations - rather than medical benefits - when making decisions on whether to allow drugs or other treatments on the NHS. Doctors and patients have alleged that they are treated with contempt by the organisation and that life-saving drugs are being unfairly denied.

The Daily Telegraph disclosed yesterday that Nice is preparing to offer patients advice on the medical benefits of drugs that are not available on the NHS. The disclosure is likely to anger patients who face paying tens of thousands of pounds for expensive drugs which may prolong their lives.

Source




MEDICAL TOURISM: HEALTH CARE FREE TRADE

Global competition in health care is allowing more patients from developed countries to travel for medical reasons to regions once characterized as "third world." Many of these "medical tourists" are not wealthy, but are seeking high quality medical care at affordable prices. To meet the growing demand, entrepreneurs are building technologically advanced facilities in India, Thailand, Latin America and elsewhere, and are hiring physicians, technicians and nurses trained to American and European standards to run them, says Devon Herrick, a senior fellow at the National Center for Policy Analysis.

Fees for treatments abroad range from one-half to as little as one-fifth the price in the United States, depending upon the destination country and type of procedure performed. For example:

Apollo Hospital in New Delhi, India, charges $4,000 for cardiac surgery, compared to about $30,000 in the United States.

A rhinoplasty (nose reconstruction) procedure that costs only $850 in India would cost $4,500 in the United States. [See the figure.]

An MRI in Brazil, Costa Rica, India, Mexico, Singapore or Thailand costs from $200 to $300, compared to more than $1,000 in the United States.

One reason why medical costs are lower abroad is that labor costs are cheaper, says Herrick:

In the United States, labor costs equal more than half of hospital operating revenue, on the average.

Yet, Indian physicians often earn only 40 percent as much, and many Indian nurses earn only one-tenth as much, as their American counterparts.

As more insured patients begin to travel abroad for low-cost medical procedures, medical tourism will result in sorely needed competition in the American health care industry, says Herrick.

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14 August, 2008

Ambulance insanity in Australia: Paperwork more important than patients

Up to eight paramedics were doing office jobs in Cairns' regional headquarters on Monday when a student paramedic was left in charge of the entire Cardwell area, a Queensland Ambulance source has said. The source told The Cairns Post an increasingly "top-heavy" ambulance service was to blame for causing a "potentially life-threatening" situation.

Queensland Ambulance Service Far Northern assistant commissioner Peter Cahill yesterday described Monday's rostering of an unqualified paramedic to a seven-hour solo shift in the Cardwell district south of Tully as "not ideal". "But our regular officer called in sick 20 minutes before the shift and it put us in a situation where we needed to find someone very quickly, we tried a number of staff members and the officer available to assist us was the student paramedic," Mr Cahill said after receiving a briefing on the incident.

The worried Queensland Ambulance source, who did not want to be named, said there were "any number" of qualified paramedics working in off-road jobs from management to training on Monday. The source said several were officers-in-charge whose positions had included on-road duties until about six months ago. "We're short-staffed but we're also top-heavy and for one-off occasions qualified people could cover a position," the source said.

Mr Cahill confirmed the student paramedic usually worked under supervision. He said other ambulance officers would have "been doing their roles at their stations". "We have certain numbers of staff to meet demand at certain stations. When these staff are busy doing their work, it is sometimes a bit tricky to relocate them," he said.

Ambulance Employers Association's Bob Lackey described Monday's situation as risky for both the student paramedic and the public with the nearest paramedics 44km from Cardwell at Tully. Emergency Services defended the student as one who has worked with the QAS for more than two years and is expected to be an advanced care paramedic by December.

Source




South Australian public hospital 'to refuse' referred patients

Patients referred to specialist clinics at Flinders Medical Centre will be denied appointments unless they are classified as high priority under a plan to reduce staff workloads, the Public Service Association says. Under the proposal that the PSA yesterday said was being considered by hospital management, only the most urgent cases would be booked into outpatient consulting clinics. To make an appointment, patients need a referral from an emergency department or their GP or medical specialist. Those referrals are then triaged by senior medical staff.

The PSA's chief industrial officer, Peter Christopher, said clerical staff had been told the hospital was examining "how to manage the workloads" because an internal funding request for two extra administration workers was still being negotiated. "Patients who don't fit the highest priority category simply won't get booked into any of the clinics to see the specialists they've been referred to when they present," he said.

Southern Health chief executive Cathy Miller said it was not an official policy but advice to staff from some hospital managers on how to cope with increased demand. "That's one way of categorising patients, but there are other interventions and approaches you can use in managing the workload," she said.

The clinics' administration staff, including ward clerks, last month introduced work bans in protest over "extraordinary" workloads. The work bans and limitations were suspended after a fortnight, but Mr Christopher said they could be "back on within a week or so". But Ms Miller said an extra staff member had been temporarily assigned to the clinics.

Opposition health spokeswoman Vickie Chapman said PSA members were frustrated because the long-running dispute had not been resolved. But a spokeswoman for Acting Health Minister Jay Weatherill said demand for services was rising across every city hospital.

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13 August, 2008

Australia: A great emergency call system

This woman is lucky to have received treatment after two 000 calls for help were directed to the wrong cities. Manunda worker Lance Laverty saw the woman lying beside Anderson St with her head in the gutter about 11.45am on Saturday. He called 000 twice but still had to flag down passing police to get the woman help.

The "stuff up" comes just weeks after a World War II Digger died after waiting more than two hours for an ambulance. "She (the woman) had now been laying in the sun for about 40 minutes," Mr Laverty said. "Imagine if that lady was elderly and having a heart attack or a stroke, what the consequences may have been."

Mr Laverty said he tried to phone Cairns police but eventually hung up and called 000, which transferred his call to Beenleigh police [about 1,000 miles South of Cairns].

"I observed what appeared to be three young men hovering around another person lying on the ground," he said. Mr Laverty said he was reluctant to approach the men, fearing a confrontation, so decided the best action was to call police. After waiting 15 minutes for police to arrive, Mr Laverty again called 000 but was this time transferred to Townsville. [about 200 miles South of Cairns].

"I do not blame the police or QAS, all praise on these people and all other emergency service workers at the coal face, but I blame the system that we keep being told is the best in the world," Mr Laverty said.

A police spokesman last night said when a 000 call was received at a police communication centre experiencing a high volume of emergency calls it was transferred to an available call-taker at another police communications centre. This was the reason calls were diverted from Cairns. The woman was taken to Cairns Base Hospital but her condition is not known.

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12 August, 2008

Over 1,000 cancer patients refused drugs by NHS managers

More than 1,000 patients been turned down for cancer drugs in the last two years because NHS managers judged they were not "exceptional" cases, according to a new report. The Rarer Cancers Forum, which compiled the data, called on ministers to intervene to end a "bizarre and demeaning" postcode lottery, which it said was leaving patients to die. Their analysis shows that almost all patients in some areas were given the often expensive drugs, while in other areas no patient received them.

The call comes just days after patients groups and doctors reacted angrily to a decision that four kidney cancer drugs were not cost effective enough to be provided on the NHS. The National Institute for Health and Clinical Excellence (Nice) judged that the drugs, which can prolong the average sufferers life for around five or six months, did not provide enough benefits for their cost of up to $48,000.

Primary Care Trusts have a duty to make the drugs available if they have been approved by the watchdog. But NHS managers can also choose to fund drugs which have yet to be approved or have been turned down by Nice if they think a patient's case is "exceptional". The report shows that while the majority of the 5,000 requests to be exceptional cases were approved, 1,300 were turned down. It also reveals wide variations in how some trusts judge what is "exceptional", for example some take into account a patient's wider family situation, whereas others look only at their medical case. Earlier this year a High Court judge ordered an NHS panel to reconsider its decision to refuse one of the kidney cancer drugs, called Sutent, to a woman who is the sole carer of her seriously ill husband, claiming it had not looked at her circumstances "in the round".

The figures, obtained under the Freedom of Information Act, show that more than 5,000 patients asked for their cases to be considered by their local healthcare authorities, since October 2006. While 96 per cent of patients in living in Mid Essex had their requests approved, all those in South West Essex who asked to be considered "exceptional" cases were turned down.

The committees who made the decisions were often controlled by NHS managers rather than doctors, the charity, which received detailed answers from 104 of the 152 PCTs across the country, a total of 68 per cent, claims. The Forum plans to submit the report, Taking Exception, to the Department of Health. Penny Wilson-Webb, from the charity, said: "The NHS should be available to all who need it. "Yet 1,300 cancer patients were denied the treatment that could have made all the difference to them. This audit shows that the exceptional cases process is in chaos and patients are suffering. In the last 20 months, 5,000 cancer patients have been forced to plead for their lives. There has to be a better way. We urge the Government to ... end this bizarre and demeaning lottery."

A spokesman for the Department of Health said: "We have heard from patients that one of their major concerns is the perceived "postcode lottery" in access to drugs – that there are too many variations around who gets access to prescribed drugs and that these variations are a lottery depending on where you live. "The draft NHS Constitution will address this by making it explicit that patients have the right to NICE-approved drugs if clinically appropriate. We will also speed up the national process for appraising new drugs and make more transparent and consistent the process for local funding of drugs not appraised by NICE or where NICE has yet to issue guidance."

Roche, the pharmaceutical company, provided funding for the new research, but the charity insisted it retained editorial control.

Source



11 August, 2008

Another desperate attempt to get NHS computers working

A confectionery and soft drinks executive and the man in charge of programming the nation's pensions have been appointed to take charge of the largest civilian IT project in the world, the Government has announced (David Rose writes).

The Department of Health has named Christine Connelly, formerly of Cadbury-Schweppes, and Martin Bellamy, of the Department for Work and Pensions, jointly to head the mammoth $24.9 BILLION overhaul of NHS computer systems, formerly the highest-paid job in Whitehall. As The Times reported in April, the previous head of the project, Richard Granger, earned $540,000 to $570,000 a year.

Mr Granger, the former director-general of NHS IT, resigned last year after five years. The Government has split his job into two - each advertised for around $400,000 - costing the taxpayer potentially 40 per cent more in managerial wage bills for the project.

The NHS National Programme for IT, designed to link 300 hospitals with thousands of GP surgeries, is running up to two years late in parts and has been repeatedly criticised by auditors, doctors and patients.

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Australia: Old lady waits 40 hours in public hospital corridor for surgery

A 40-hour wait for emergency surgery has made health the most important West Australian election issue for pensioners Cathy and Arthur Wardle. Mrs Wardle, 73, arrived at Royal Perth Hospital's emergency department with gallstone pains at noon last Saturday. She did not have surgery until Monday afternoon.

Most of her time was spent waiting on a trolley in a hospital corridor. "I was calm and collected until a nursing co-ordinator told me I was privileged to be lying in a corridor," Mrs Wardle said. "It's not good enough what is happening to people in our hospitals."

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10 August, 2008

A bipartisan horror future for medicine coming up

Senators Bob Bennett (R-UT) and Ron Wyden (D-OR) might be calling for "bipartisan" health care in a May 22 letter to the Wall Street Journal, along with lots of others in many forums. As if doubling a bad idea could somehow make it right!

Since well before the massive 1993 Clinton effort to "re-design" American "health care," we have had many Democratic, Republican, and bipartisan schemes-including the piecemeal enactment of an enormous chunk of the Clinton Plan: the criminalization of medicine; the State Children's Health Insurance Program (SCHIP), and "administrative simplification." Nobody dares to suggest that things have gotten any better.

The reformers are all supposed to have good intentions of "fixing" or "transforming" our "broken health-care system." What they are actually doing is trying to break up the working institutions and relationships that we have and force them into a monolithic, centrally engineered system. "Systemness" is the new primary virtue-not competence or compassion, and certainly not ingenuity or inventiveness.

What will the new system look like? I saw a photograph of it recently. There were no faces in the picture, and no suffering, sick patients. Instead, there were the backs of six uniformed "health care workers," possibly once called "nurses," lined up along a wall, faces buried in a row of portable computer monitors. They were presumably interacting with the interactive electronic medical record (EMR) or computerized physician order entry system (CPOE). Who, if anyone, was attending to patients? Answering call buttons, puzzling over symptoms, holding hands, observing response to treatment-all that is mere reality. It is being replaced by the virtual reality of documentation. If it wasn't documented, it didn't happen, and if it is in the record, it stays forever.

The computer is the key piece in all those bipartisan or unipartisan proposals. It is the net that ties everything into one giant interoperable virtual system. The mere human beings who make diagnoses, prescribe or administer treatment, or make the thousands of split-second clinical decisions that occur every day are the ones who have "broken the system." They make errors. They do too little, or else too much. They treat some patients differently than others (that's called "disparity"). They spend too much of "our precious resources" on the seriously sick and the injured-relieving pain, binding wounds, removing tumors, curing infections, staunching hemorrhage, dissolving clots. That's called practicing medicine, and it's what is (or was) taught in medical school.

What all this medicine is breaking is the bank. Neither party is willing to admit that the federal government has made promises that cannot possibly be kept, and incurred debts that cannot possibly be paid. That's not the fault of either party, both of which promised to just pay the bills and not interfere. It must therefore be the fault of those sending the bills. Accordingly, it is they who must be "fixed." The system must "contain" costs, and that means it must control everything. And that means it must know everything; hence, those ubiquitous computers.

The bipartisan fix is to impose a centrally determined order on all that chaos of trying to fix broken human beings. An elite committee will determine "best practices" for each and every situation, "suggest" the proper action to the workers, and monitor compliance. The desired outcome is the optimal health of the system, or population. That's why it's called "health care." And why it gives a higher priority to the healthy taxpayer over the sick or disabled, and to "health maintenance" as opposed to healing. The bipartisan systems engineers don't lay hands on patients-that would be a distraction. Anything with "partisan" in it is about money and control. Its "fix" for medicine is a wrecking ball. Patients (and noncompliant or "disruptive" doctors and nurses) just get in their way.

The next question is always: So you're complaining about the sorcerer's apprentice, but what's your plan for fixing medicine? The question itself is a symptom-socialist central planning is so ingrained in our consciousness that we aren't even aware of it. The American answer-try freedom!-doesn't seem to ring any more.

In medicine, if you have a desperately sick patient, doing nothing is better than radical surgery that you know will fail. Better still-try stopping some of the poisonous drugs he has been taking. Let's make a list of some toxic laws, and repeal them. If surgery is indicated, let's identify the tumor (big government) and work on that instead of cutting off the patient's healthy legs (doctors and nurses attending patients).

Source





9 August, 2008

Scottish government hospital faces criminal charges over 18 superbug deaths

Sad that patients have to die before negligence is noted

Criminal charges could be lodged over "appalling and completely unacceptable" conditions at a hospital where there were 18 deaths linked to Clostridium difficile after a damning independent report was passed to the Procurator Fiscal, the public prosecutor in Scotland. The report into infection control at the Vale of Leven hospital, Dunbartonshire, ordered by the Scottish government and published yesterday, describes inadequate facilities, poor practice and lack of leadership. Fifty-five patients contracted C.difficile at the hospital between last December and June and the bug was recorded as the underlying or contributory cause of death in 18 cases.

The hospital had insufficient handwashing facilities or single rooms, beds were too close together, patients were transferred frequently between wards and the building was rundown. The report also found a lack of leadership and supervision with regard to infection control, and a lack of clarity of roles and responsibilities. It noted that the hospital, which had been under threat of closure for ten years, had a lower priority than others in implementation of policies, surveillance systems and staff development.

Cairns Smith, Professor of Public Health at Aberdeen University, led the independent review team that visited the hospital five times last month and, on one occasion, walked round the wards affected by the outbreak.

Nicola Sturgeon, the Health Minister at Holyrood, said that she had passed the report to the Lord Advocate, who had in turn asked the area Procurator Fiscal for Argyll and Clyde to consider any further action.

Ms Sturgeon said: "Let me be absolutely clear that the picture painted by the review team report is appalling and completely unacceptable. The absence of clear lines of professional responsibility has fostered an environment where there was an inadequate management of a cluster of cases at ward level, or awareness at higher levels. There were also inadequacies and inconsistencies in advice to relatives and in management of patients."

Ms Sturgeon said that she had apologised to families of the victims when she met them yesterday morning and that the health board at NHS Greater Glasgow and Clyde owed them "a direct and unconditional apology for the serious failings on its part". The minister demanded "a clear and unequivocal commitment" to the future of the Vale of Leven hospital and the sustainability of its services. Ms Sturgeon pointed to a "history of neglect" at the hospital. The debate must no longer be about what services were to be withdrawn, she said, but about how the board could create a "modern, fit-for-purpose hospital".

A report from Health Protection Scotland yesterday into levels of C.difficile across the country from last December to June found that there were 3,174 cases, of which 285 patients died with the bacterium an underlying cause or a contributory factor. There were no clusters or outbreaks that had not been identified or reported.

Tom Divers, chief executive of Greater Glasgow and Clyde Health Board, apologised to patients and families. He said: "I recognise the concerns of relatives of patients that they were not properly informed every step of the way of the infection and how to help protect themselves and others from the risk of infection." Mr Divers said that he had ordered immediate improvements to, among other things, hand-washing facilities and bed spacing. A system of infection surveillance across all hospitals had been introduced. "As a result of today's recommendations we will take forward further actions to reinforce leadership, accountability and empowerment both at the ward and hospital level and ensure clear lines of communication and responsibility to the board's medical and nurse directors," he said.

"The uncertainty over the future of this local hospital has undoubtedly been a factor in the lack of major modernisation investments. I can give a commitment that this board will bring forward proposals in August and September that will set out a clear vision for the future of the site."

Syed Ahmed, Consultant in Public Health Medicine at NHS Greater Glasgow and Clyde, said: "The Vale of Leven certainly had more cases of C.difficile than one would expect during the first six months of 2008. Sadly, C.difficile is a germ that is in the community and there will always be sick and vulnerable patients, especially among the elderly, who will develop C.difficile-associated diseases."

Richard Simpson, the Labour public health spokesman, and Jackie Baillie, the local Labour MSP, called for a public inquiry into the deaths. They were joined by Ross Finnie, the Scottish Liberal Democrat health spokesman, while Jackson Carlaw, of the Scottish Conservatives, said that NHS Greater Glasgow and Clyde could not avoid responsibility for the "appalling" loss of life.

Source




Australian health boss caught misrepresenting hospital waiting lists

Nice to have such a bright spark running public hospitals

HEALTH Minister Stephen Robertson has been caught massaging hospital waiting list figures as his department fails to treat the sickest patients in time. Mr Robertson bungled his attempt to laud the latest quarterly public hospital report card for elective surgery waiting lists as a significant achievement. The report showed Queensland Health treated a record 33,732 patients during the June quarter, up from 28,416 for the same period last year. However, the number of patients stuck waiting on lists grew from 34,454 to 34,703.

Having used the annual change to show the record numbers treated, Mr Robertson then moved the goal posts and used the quarterly change for category breakdowns. The number of category one patients not receiving surgery within 30 days had blown out by 35 per cent, from 188 to 254 patients, over the year.

Mr Robertson repeatedly claimed the list was decreasing but was eventually forced into an embarrassing backdown. "Oh, I beg your pardon. There has been a slight increase in cat ones," Mr Robertson said of the 35 per cent rise. "Yes, it has slightly gone up."

The report also showed the Princess Alexandra Hospital and Royal Children's Hospital as among the most under pressure with list backlogs. Opposition health spokesman John-Paul Langbroek said it was not good enough for the sickest patients to wait for more than two weeks longer than they should. "Queensland Health is continually failing to meet these (doctors') time recommendations for surgery," he said.

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8 August, 2008

British public hospitals infested with rats, fleas and bed bugs

Hygiene standards in NHS hospitals have been called into question after it emerged they are routinely dealing with infestations of vermin

Outbreaks have included rats in maternity wards, wasps and fleas in neo-natal units, bed bug infestations, flies in operating theatres and maggots found in patients' slippers. The data, uncovered using Freedom of Information rules, include hospitals with maggots, "over-run" with ants and mice "all over" wards; cockroaches in a urology unit and a store for sterile materials infested with mice. The figures raise questions over standards of cleanliness and hygiene in hospitals although the healthcare regulator said complaints about pests were 'negligible'.

The Conservatives asked all 171 hospital trusts in England for details of pest control incidents for the last two years. Of those, 127 Trusts responded and almost all had experienced problems and 100 of them collected detailed information about pest infestations. In total there were almost 20,000 reports of pest problems and seven out of 10 trusts that responded reported they had called in pest control officers more than 50 times since January 2006 - an average of once a fortnight.

Maidstone and Tunbridge Wells Hospital Trust, the trust at the centre of Britain's biggest superbug scandal when more than 300 patient deaths were linked to Clostridium difficile, reported more than 50 pest incidents in two years. A spokesman for Maidstone and Tunbridge Wells NHS Trust said: "Most incidents relate to old buildings which have now been demolished at Pembury Hospital. There is no specific problem."

Of the trusts that collected detailed information 80 per cent had problems with ants, 66 per cent had rats, 77 per cent had mice, 59 per cent had problems with cockroaches, 65 per cent had biting insects or fleas, 24 per cent had problems with bed bugs and 6 per cent had maggots.

Shadow health secretary Andrew Lansley said: "Labour have said over and over again that they will improve cleanliness in our hospitals but these figures clearly show that they are failing. It is difficult for health service estates to maintain a completely pest free environment but the level and variety of these infestations is concerning. "We need greater transparency in NHS infection control, and publishing data like this is one way in which we can drive up overall hygiene standards."

Eight hospitals trusts called in pest control officers more than 500 times, with Nottingham University Hospitals NHS Trust having the most severe problem with 1,070 incidents in two years.

The healthcare watchdog inspects hospital trusts against a strict hygiene code and has the power to shut down wards, departments or even a whole hospital if there is a risk to patients. Christine Braithwaite, head of healthcare associated infection programme at the Healthcare Commission said: "We receive a wide range of information on hygiene from different sources. However, concerns around pest control have, to date, been negligible. "Clearly, it may be necessary to take action against pests in these large public buildings from time to time. "However, it is important for hospital trusts to have robust procedures in place to deal with any pest problems and if they persist, trusts should question whether they have the right systems in place. "If we were concerned that the safety of patients was at risk, through poor hygiene standards or in any other way, we would take immediate action."

Health Minister Ivan Lewis said: "Hospitals must be responsible for ensuring their buildings are clean and that patient safety is not compromised. The Hygiene Code requires NHS bodies to have a pest control policy that anticipates and manages this issue. "Trusts should take rapid action and follow through with surveillance in place to avoid pest incidents and minimize hazards. Use of pest control is a sign of good proactive management. "The claim that insects spread hospital acquired infections is entirely unproven. There is no evidence of their carriage of antibiotic resistant bacteria being a hazard to patients. Despite this we expect hospitals to take continued action to tackle pest problems"

Nottingham University Hospital had the most pest control incidents of any that responded to the Conservatives' request for information. John Simpson, Director of Estates and Facilities Management at Nottingham University Hospitals, said: "These figures must be put into context. It goes without saying that as the fourth largest trust in the country, our hospitals are bigger than most others around the country and therefore our figures should be compared with trusts with similar-sized estates rather than smaller acute trusts. "It is also worth bearing in mind that trusts are likely to have recorded and reported figures differently and therefore the table may not be comparing like-for-like data."

Source





7 August, 2008

A wonderful story about a very good man -- and a big failure of socialized medicine

Only the extraordinary personal efforts of a dedicated doctor saved the life of a baby

A newborn baby was saved from kidney failure after a paediatrician built a dialysis machine for her in his garage. Millie Kelly was given little chance of surviving her first weeks when she suffered kidney failure after a lifesaving operation. At 6lb 2oz (3.3kg), she was too small to use the NHS dialysis machine that would do the work of her failed kidneys. It was not until Malcolm Coulthard, a paediatrician at the Royal Victoria Infirmary, Newcastle, built the machine that she began to recover. Millie is now a fit two-year-old and her mother is supporting Dr Coulthard's campaign for hospitals across the country to have dialysis machines for small babies.

Rebecca Kelly, a 21-year-old student, admitted to misgivings the first time she saw the machine that represented her child's last chance of survival. "It looked handmade in the garage," she said. "It did not look like it was a professional NHS thing. He had made it out of metal and there were a few paint splodges on it. "I did not know what to think really, but I knew it was the only hope. It was touch and go and I went along with it."

Despite its rough-and-ready appearance, it was the product of hours of painstaking work by Dr Coulthard. Millie was attached to the machine for seven days before she began to show signs of recovery. She had suffered kidney failure after an emergency operation for gastroschisis, a condition that causes the intestines to protrude from an opening near the umbilical cord.

Ms Kelly, from Middlesbrough, was convinced that her daughter would survive. "When she was ill, I knew she wouldn't give in. I was devastated when they said she wouldn't make it, but she's a fighter and I knew she would pull through," she said. "If it was not for that machine then she would not be here today. Words cannot describe how grateful my family are to Dr Coulthard. Not only is he a great consultant but now also a great friend and inspiration to Millie, my family and I. "Afterwards, the doctors and nurses didn't know if she would make a full recovery, but she's just turned 2 and she's a normal, happy baby now."

Ms Kelly is calling for more funding to build new machines, as the baby dialysis machine in Newcastle is the only one in the country. "It saved my daughter's life and other babies should have the same chance," she said.

Dr Coulthard, who designed the machine with Jean Crosier, the senior children's kidney nurse, also hopes to build on the success. "This machine is only being used on the tiniest, earliest babies where there is nothing else that can be done," he said. "But if we had a machine that we could use much more freely, then we would be able to deal with many more babies and have a much greater chance of saving lives." The machine allows haemodialysis, the process that cleans the blood through an artificial kidney, to be carried out on babies with renal failure. Underweight newborn babies usually cannot undergo the treatment.

Source





6 August, 2008

Australia: More on another dangerous public hospital doctor

Hundreds of patient files are being reviewed after a damning report into a foreign-trained doctor found he performed surgery beyond his capabilities. The Health Quality and Complaints Commission report found Egyptian-trained doctor Abdalla Khalafalla was allowed to operate on patients at the Mackay Base Hospital without supervision despite "red flags" over many years about his competence.

Dr Khalafalla worked in Mackay from April 2004 to August 2006. An audit of 1000 unsupervised surgical procedures he performed between 2001 and 2006 has been launched in the wake of the HQCC probe. Queensland Health said the audit would include operations he performed in Townsville, Mount Isa, Proserpine and Mackay.

Dr Khalafalla's contract was terminated in August 2006 after the Medical Board of Queensland deregistered him, but the board acted only after former Nationals MP De-Anne Kelly raised the matter in Federal Parliament.

Health Minister Stephen Robertson said Dr Khalafalla, believed to be living in Victoria, was unlikely to face criminal charges. But he admitted the case raised similar questions about clinical practices to that of Indian-trained surgeon Jayant Patel. "There have been incidents where clinicians have not reported where they have witnessed harm to a patient as a result of another surgeon conducting his or her work," Mr Robertson said.

Cabinet meanwhile endorsed a plan yesterday to introduce mandatory reporting by doctors if they saw patients being harmed by colleagues. "We cannot allow these circumstances to keep going on where doctors witness harm, serious harm on some occasions, and not have it reported," he said. The two-year HQCC investigation found the Royal Australasian College of Surgeons supported Dr Khalafalla's appointment in Mackay despite receiving notifications about his competence dating back to 2002.

It said a review of his surgical performance at the Mackay hospital in September 2005 found six out of 26 cases involved a "potentially dangerous technique". The review found two of the patients could have died if action had not been taken and recommended a national reporting system for tracking the performance of registered health professionals.

Source




Incompetent doctor report 'like reliving nightmare'

THE former head of an inquiry into former surgeon Jayant Patel says a report handed down yesterday into another Queensland surgeon was like "reliving a bad nightmare". Barrister Tony Morris, QC, headed the initial 2005 inquiry into Dr Patel, the former director of surgery at Bundaberg Base Hospital now on manslaughter charges, before stepping down five months later over claims of bias.

Queensland's Health Quality and Complaints Commission (HQCC) yesterday released the results of a two-year investigation into surgeon Abdalla Khalafalla, who allegedly performed at least 27 major operations beyond his credentialled level of skill. Egyptian-trained Dr Khalafalla, who has previously worked in Townsville and Victoria, worked at Mackay Base Hospital from 2004 to 2006. In August 2006, former Nationals MP De-Anne Kelly outlined to Federal Parliament four cases where Queenslanders allegedly were injured in operations conducted by the unsupervised doctor and the HQCC began its investigation.

Mr Morris said today he had read the report and found it "absolutely terrifying". "It's like reliving a bad nightmare," Mr Morris told ABC radio. "You read the report and it's almost a complete replication of what happened in Bundaberg. "And the really terrifying part is it's still the same attempt by the bureaucracy to say 'It's not our fault - let's blame the doctors'. "But Queensland Health are to blame and the only change I've seen is that the bureaucrats are now smarter about how they get back at whistleblowers." He said the health department needed to be rebuilt from scratch.

Health Minister Stephen Robertson said the commission's report dealt with issues that occurred two to three years ago and improvements had been made. "They (the commission) do make the observation that the changes made would have gone a long way to stop this thing that happened in Mackay from occurring again," Mr Robertson said. He said it was unfair to blame health bureaucrats. "What occurred in Mackay was a doctor not being properly supervised by who? Not a bureaucrat, a senior doctor," Mr Robertson said. "That senior doctor was reporting to another senior doctor."

An audit is under way into all cases of major surgery performed by Dr Khalafalla at Mackay Base Hospital without direct supervision. The Government is also proposing new laws to force doctors to report cases of patient harm by colleagues. Dr Khalafalla is living in Victoria but is no longer registered to practise. The commission report has been passed on to Victorian and other authorities around Australia.

Source

Comment from a political reporter:

QUEENSLAND Health Minister Stephen Robertson has put in a woeful performance in the wake of the damning Health Quality and Complaints Commission report into how the department handled allegations of incompetence against surgeon Abdalla Khalafalla. Yesterday I wondered how the Government was going to spin its way out of trouble on this one. Robertson has provided the answer _ blame the doctors. Surely with an 69-strong army of PR flacks at Queensland Health, he could have come up with a better line.





5 August, 2008

Huge monetary costs of NHS negligence

Despite the fact that most Brits are effectively discouraged from claiming and despite the fact that awards in Britain are usually only a tiny fraction of the equivalent in the USA

For Dr Spencer at his Norfolk surgery, the whoops-a-daisy moment came when he dosed a woman with bismuth. Startled by her dyspeptic response, and eager to reassure her increasingly agitated husband, he swallowed a spoonful of the stuff himself. "See? Perfectly safe!" Two things then happened: Dr Spencer vomited, fell down and lay writhing on the floor. His patient died.

The explanation was simple. As the doctor explained to the coroner, bismuth and strychnine look remarkably similar in the bottle and, well, mistakes do happen. At the subsequent trial for manslaughter, Mr Justice Willes agreed. A simple blunder, he said, was not in itself a criminal act. To secure a conviction, the crown would have to prove that the doctor's medicines were in such chaotic disorder that it was impossible for him to know which was which. Not guilty, said the jury.

That was in 1867. Legal actions against clinical killers then were exceedingly rare, and would remain so. By 1989 only six more doctors had been fingered for manslaughter - an average of one every 20 years. Then something changed. In the 1990s, 17 were prosecuted, and since 2000 there have been 11 more. One or two of them, like the Spencer case, were tales of startling improbability. A woman under anaesthetic was connected to an oxygen cylinder instead of to a ventilator and inflated like a balloon (the anaesthetist got six months' jail, suspended for 18 months). Mostly, however, they were mundane tragedies of misread notes, wrong drugs or lethal doses administered by exhausted, inexperienced or occasionally negligent practitioners who failed in the most basic of their responsibilities.

This relatively small number of headline cases, however, was only the tiny tip of a legal iceberg. It wasn't just the police and Crown Prosecution Service who were taking a more critical look at wards and clinics - it was the patients themselves. In England between 1990 and 1998, the rate of civil negligence claims against hospitals doubled, reaching a peak in 1998-9 of 6,168. If we didn't know them to be true, the numbers would strain credibility. The cost to the NHS of claims settled in 2006-7 was 579.3m pounds. In the same year it was hit by 5,426 new cases. The NHS Litigation Authority (NHSLA) estimates that the combined cost of settling all outstanding claims, including incidents so far unreported, will be 9.09 billion pounds.

Some of the settlements are whoppers - the actress Leslie Ash made headlines in January this year when she was awarded 5m pounds for the paralysing effects of the hospital "superbug" MRSA. The all-time record is the 12.4m paid last year to a professional dancer, Kerstin Parkin, who suffered brain damage from a heart attack during childbirth. Others by comparison are trifling - "a few hundred pounds for someone scratched during an operation" is one example offered by the NHSLA. But there is an important common factor, and it affects us all.

Paralysing tentacles of fear are now putting the squeeze on medical practice, and changing the way we are treated. Type the words "clinical negligence" or "no win, no fee" into Google and you'll see why - a clamorous pack of legal agencies and law firms who trade on the idea that every accident must be someone's fault. Some websites even provide interactive body maps showing the value of everything from an injured finger (1,000 to 75,000 pounds) to serious brain damage (millions). The come-on to patients is the promise of "no win, no fee". If the lawyer wins your case for you, he collects his fee in costs from the other side and you walk away with your damages in full. If he loses, he charges nothing. So, come on! What are you waiting for? Sue the doc!

Many cases in the past have been the medical equivalents of the time-honoured "slips and trips" actions against local authorities with bumpy pavements. Anyone coming out of hospital with a bruise or a sore eye they didn't go in with was encouraged to call a solicitor. The result was that lawyers' fees were often higher than the damages they won, and these in turn could be eroded by extra costs - medical reports by independent experts, for example - so that even successful litigants wound up out of pocket. According to the National Audit Office, legal and administrative costs exceed money paid to victims in most claims under 45,000. This is why Citizens Advice in 2004 published a 59-page report on personal-injury compensation under the title No Win, No Fee, No Chance.

As so often with the NHS, vice is the bastard child of virtue. "No win, no fee" deals, known in law as conditional-fee arrangements, were introduced by an amendment to the Courts and Legal Services Act in 1995. It was meant to be a double benefit. The courts would be opened up to those in the income trap who were ineligible for legal aid but unable to afford lawyers. The government itself would save money by effectively privatising legal aid. On the surface it looked like the long-overdue democratisation of civil justice.

But law firms are not charities. Working for nothing - pro bono - is not unknown, but it hardly stands as an ideal business model. If lawyers were to drop their fees when they lost, then they would need a bonus when they won. Recognising this, the law allows a "success fee" of up to double the normal scale. In clinical- negligence cases, when judgment favours the patient, this must be paid by the NHS, otherwise known as the taxpayer.

Given all this, the one surprise is that the number of cases each year is actually going down, albeit very slowly. The cost to the NHS nevertheless continues to rise. How can this be? Ironically, it is due in part to improvements in medicine that allow seriously damaged people - especially children - to survive for near-normal life spans. For this reason, courts are awarding much higher damages. Thirty years ago, for example, children suffering cerebral palsy in birth accidents might be expected to die. Now they can reach late middle age. Damages in such cases, which account for 60% of all claims the NHSLA faces, can run to 5m or more....

Walsh does not buy into the idea that avaricious lawyers alone are to blame for the escalating costs of clinical negligence, or even that the costs are excessive. "They come to well under 1% of the NHS budget," he says, "so the notion that claims are bleeding the NHS dry doesn't hold water." Furthermore, it's entirely reasonable for claimants' solicitors to charge more than their opponents do.

Apil's Amanda Stevens agrees. "It's much more costly to prepare evidence to prove a claim than it is to assemble evidence to knock it down," she says. The British public, too, is very far from the writ-happy mob of gold-diggers that the headlines often suggest. "They do not like making a claim." Every year, she says, around 800,000 "adverse clinical events" are recorded in the NHS, and many more - at least 20% - go unreported. Yet only 1% of the victims make a claim, and only 10% of these - ie, 0.1% of the total - get damages.

Thus if the NHSLA believes it is shelling out too much in costs, the remedy is in its own hands. It is a legal catch-22. The NHSLA is duty-bound to keep expense to a minimum, and therefore to challenge costs awarded against it. This means that more cases go to appeal and legal costs escalate. Peter Walsh invites the NHSLA to draw the obvious conclusion. "Stop arguing, admit fault and settle earlier without drawn-out legal wrangling," he says. "That alone would save millions of pounds."

Of all the ways to cut the costs of medical negligence, one stands out way above the others: avoid being negligent in the first place. The NHS needs literally to clean up its act. Here are some figures reported by Sir Liam Donaldson in 2003: 10% of hospital admissions may result in something going wrong; 5% of the entire population report "some adverse effects" of medical care; 18% of patients say they have been victims of "medication error" within the past two years. On top of all the traditional foul-ups - missed diagnoses, poor or inadequate treatment, slipped scalpels and lethal drug doses - now looms the utterly modern phenomenon of the drug-resistant hospital infection. As recently as February, the Department of Health thought it necessary to launch a national campaign against the over-prescription of antibiotics. "The more we take antibiotics when they are not necessary," said Donaldson, "the more bacteria will become resistant to them." Yet patients with runny noses still think they can be cured by them, and - for all that they know better - some doctors still go on doling them out.

The other thing that bacteria love is filth, and the ideal place to look for it is in an NHS hospital. The result is that there are now law firms claiming to specialise in hospital "superbug" cases, and the number of claims is multiplying like bacteria on a Petri dish. One of the most notorious cases involved the three hospitals administered by the Maidstone and Tunbridge Wells NHS Trust where, between April 2004 and September 2006, more than 1,170 patients were infected with Clostridium difficile. According to the Healthcare Commission's official report, about 90 people "definitely or probably died as a result of the infection". The commission's inspectors found that the hospitals were epidemics waiting to happen. Supposedly clean bedpans were contaminated with excrement. Nurses were not washing their hands, emptying commodes, cleaning mattresses and equipment, or wearing aprons and gloves. If there was a parlour game called "pass the bacteria", this is how you'd play it. The health secretary, Alan Johnson, described the episode as "scandalous", and Kent police are still weighing the possibility of prosecution.

Another NHS trust in trouble was Bromley, against which the commission issued an "improvement notice" in February. Inspectors found an absence of routine cleaning around beds in the wards; sterilising equipment not being properly used; dirty commodes marked clean and ready for use; a blood-culture bottle trolley thickly covered in dust, and more. One is always wary of generalising from the particular, but there is no reason to suppose that these two trusts are wholly out of the ordinary. In fact, there is every reason to think otherwise. In June the Healthcare Commission reported that 103 of the 391 primary-care and hospital trusts in England were not meeting statutory hygiene standards - a failure rate of over 25%. The nurses might not be washing their hands, but the lawyers sure as hell are rubbing theirs.

More here





4 August, 2008

Shock! Some NHS hospitals do allow patients to buy expensive drugs that the NHS is too mean to give them

The government’s ban on NHS patients paying for medicines the health service does not fund is in disarray. Figures obtained under freedom of information legislation show that NHS hospitals were allowing dozens of patients to top up with private drugs before the government warned them it was not allowed under NHS rules in July last year. The evidence that top-up payments have previously been allowed, apparently without difficulties, undermines the government’s claim they are contrary to the fundamental principles of the NHS.

At one trust, the Royal Cornwall Hospitals NHS Trust, 20 patients were allowed to co-pay for cancer drugs that the health service refused to fund before the government ban was introduced.

The figures also provide further evidence that many trusts are allowing patients to top up with additional drugs without removing the remainder of their NHS care. Freedom of information data shows that Nottingham University Hospitals NHS Trust has allowed patients to pay for drugs their consultant has recommended without losing the rest of their NHS treatment. John Baron, MP for Billericay, who obtained the figures, said: “This undermines the case of those who argue co-payments cannot exist within the NHS.”

Other trusts that have allowed co-payments include the University Hospital Birmingham NHS Foundation Trust, ABM University NHS Trust in Bridgend, south Wales, and Weston Area Health NHS Trust in Somerset.

Source




Another disastrous foreign doctor in Australia

There have been some appalling cases of doctors trained in India and in Muslim countries. There should be more testing of them before they are hired

Health Minister Stephen Robertson will receive a report tomorrow into an Egyptian- trained surgeon who allegedly bungled operations he performed without supervision. Abdalla Khalifallah, who worked at Mackay Base Hospital, had his contract terminated in August 2006 after he was deregistered by the Medical Board of Queensland.

The report, by the Health Quality and Complaints Commission, is based on almost two years of investigation. The matter was raised in Federal Parliament in August 2006 by former Nationals MP De-Anne Kelly, who outlined the cases of four people she said were injured during unsuccessful operations at Mackay Base Hospital.

Mrs Kelly told Parliament Dr Khalifallah had undertaken three major operations that he was unqualified for without supervision, resulting in complications. One case. to remove a bowel tumour, resulted in fecal matter entering the intestinal cavity, she said.

"This operation was carried out in direct contravention of the decision of the (hospital's) credentials committee," she said. "In July 2005, the hospital's credentials committee determined that Dr Khalifallah must be supervised during major surgery."

Dr Khalifallah became a staff specialist at the hospital in 2004. A spokeswoman for Mr Roberston said the Minister had called for a report into the matter in 2006. "We cannot comment any further until the Minister sees what the report says," she said.

The above article by Suellen Hinde appeared in the Brisbane "Sunday Mail" on 3 August, 2008. The spelling of the name of the fool seems to vary. In this report, it was Abdalla Khalafalla





3 August, 2008

17 NHS patients with cancer wrongly get the all-clear

Seventeen cancer patients were wrongly given the allclear by a hospital after test results were misinterpreted, it was revealed yesterday. The men and women may have missed out on months of potentially life-saving treatment because of the blunders at Hereford County Hospital. In some cases the delay could have been more than two years. They have now received the devastating news that their initial diagnosis was wrong and have begun treatment. In addition 14 people were told they had cancer when they did not. Some may have needlessly undergone debilitating treatment.

The scandal came to light after concerns were raised about a consultant who examined tissue samples at the hospital. Six months ago a review of his work between May 2006 and August 2007 was started, and is now complete. The consultant, who has not been named, has been suspended and is facing disciplinary action. Legal experts said the hospital may be sued by patients.

Paul Keetch, Liberal Democrat MP for Hereford, has sent a letter to Health Secretary Alan Johnson asking him to ensure resources are made available for treating the wrongly diagnosed patients. Mr Keetch said: 'These people have not just been failed by Hereford, they have been failed by the NHS. 'Obviously there will be some patients who are undergoing speeded-up treatment for cancer, and we will be looking for other hospitals in the region to help. 'We must make sure none of the patients suffers as a result of this.'

Dr Lesley Walker of Cancer Research UK said: 'This is extremely unfortunate and distressing news. It's vital that robust systems are put in place at Hereford County Hospital to stop this happening again.'

Caroline Klage, from national medical legal firm Bolt Burden Kemp, said the NHS trust faces being sued by many of the patients. She said: 'In the very worst scenario, where someone has lost the opportunity to be given effective treatment for cancer, the outlook is now bleak and they have a number of dependents, a compensation claim is likely to be significant.'

The review looked at 5,404 tissue samples from 4,654 patients which had been worked on by the consultant in the hospital's histopathology department. Not all the cases involved cancer patients. It found the diagnosis of 102 patients was wrong and their treatment needed altering. The situation of 40 was 'more serious' than at first thought, while the remaining 62 were less serious or 'not materially different'.

Around a quarter of the department's work concerns cancer patients. It also examines samples taken from patients with other conditions, such as the bowel disease Crohn's.

Hereford Hospitals NHS Trust chief executive Martin Woodford said he wanted to apologise 'personally and on behalf of the trust' to all the patients affected. He said: 'We have acted as quickly as possible to make sure that the review was carried out thoroughly and effectively. 'I can confirm that 17 patients were initially informed, incorrectly, that they did not have a malignancy such as cancer. 'However we must emphasise that a number of these patients would have undergone precautionary treatment anyway or been subject to clinical review. 'Furthermore we can give an absolute assurance that all patients are now following the correct course of treatment.'

Source




Are the "minute clinics" about to be swallowed up?

Well, now they've done it! Now they want to insulate the danged "minute clinics"! According to a Boston Globe news story, the recent rise in low-cost walk-in clinics, sponsored by various chain-stores (Walgreen's, CVS, et alia), has attracted the interest of the HMO world, at least in Massachusetts. As the story, "Insurers to cover drugstore clinic visits," reports, both Harvard Pilgrim Health Care and Tufts Health Plan have signed contracts with CVS Caremark, and are in negotiation with Walgreen's, seeking to "cover" most of the costs of patient visits to CVS and similar "minute clinics," by offering reduced "co-pays" to those under their umbrellas who seek care at the clinics.

To some, this might seem a good thing, since the programs call for much lower co-payments from the patients than those exacted for more conventional healthcare visits (doctor's offices or emergency rooms). Instead of the $75-150 customary for ER drop-ins, the patients will likely be paying only $15-25 for a clinic appearance. The problem is, the wider effect of this could be the perpetuation of the very thing that got us into the healthcare mess in the first place: the "employee benefit," third-party payor, institutionalized model for maintaining wellness.

Arnold Kling of the Cato Institute has labeled this the "insurance as insulation" premise, and I see no reason to reinvent the terminology here. This "insulating" concept takes the position that ALL costs for health and wellness should somehow be paid for by third parties, either as "insurance coverage" or via tax deductions (for the copayments). As a result, we've come to see healthcare, not as a personal-responsibility issue (do what you can to stay well, get checkups regularly to detect problems early on . thereby minimizing the costs and even the likelihood of critical aftercare), but as a matter of "public policy."

Where this has gotten us is to the point where the "employee benefit" model has engulfed the whole arena of doctor/patient relationships. The sheer numbers of "covered" individuals, whether as workers or as their spouses and families, have overwhelmed the effect of "market forces" on healthcare costs and accountability. When there is a fairly well-guaranteed demand for something, regardless of its cost (they ain't paying for it) or efficacy (if it doesn't work, try something else as well) of that procedure, it will continue to be offered in spite of its dubious value (cf. the overuse of MRI, CAT, statins, etc.).

So now, just when one segment of private industry (chain drugstores, which have at least a peripheral interest in public wellness) is trying to encourage low-cost solutions for common maladies - catch them early, instead of after significant damage may been done to the person's body, and charge accordingly for the diagnosis - now the "providers" from the orthodox "healing community" want to make sure it's all getting "covered"!

The net effect is obvious: People with even minor ailments will now be "insulated" from even the minimal costs of keeping well, or of monitoring the little things before they grow into something serious. While the short-term good news might be a bigger reliance on such cheap clinics for diagnosis and treatment of simple illnesses (instead of glutting the ERs with their petty issues, or ignoring problems until they become critical), the fact that they'll still be largely subsidized out of "insurance" - instead of operating on an out-of-pocket cash-basis - could easily offset their value in terms of the effects on healthcare cost-reform.

Once again, the analogy can be made to the automobile-insurance game: NOBODY gets car insurance to cover oil-changes, or even routine maintenance. (As this editor recently discovered, even a brake-job can't be paid for, even under an extended maintenance contract. Compare this with "catastrophic health coverage" and you'll still fall short of the reality.) Similarly, the cost of an annual physical exam (were it to be billed only at reasonable, no-overhead rates, with fair-market prices for the 5-10 minutes a physician or NP actually physically examines you?), or a routine visit to see if that scratchy throat is more than s brief attack of the "crud" . these should be considered just part of the "normal wear and tear" of having that physical bag of skin and bones to lug around in this lifetime!

Mark my words, this latest move by the large HMOs will not improve the situation, except insofar as it encourages more people to go to the clinics. Very soon, the basic cost of a visit will go up, as these establishments are forced to spend more time on paperwork, justifying to their third-party corporate benefactors the "actual costs" and validity of the last week's spate of snifflers and sprained ankles. And before we know it, those little cheap "minute clinics" will just be another arm of the Leviathan healthcare state, instead of the good idea they began as.

Were I the paranoid sort, I might consider this an intentional move on the part of the very same AMA-driven, allopathic-only establishment that decried the drugstores' idea in the first place - if you can't squash the bug, you just tame and put a leash on it!

Source





2 August, 2008

'Women must have brittle bone drug', campaigners beg NHS

The Health Secretary must overturn 'farcical' rules that deny thousands of women medicine for thinning bones, campaigners say. In an unprecedented move, the National Osteoporosis Society, of which the Duchess of Cornwall is president, is writing to Alan Johnson asking him to intervene over the 'unfair and clinically unworkable' guidance.

Guidelines set by the Government's drug regulator mean doctors are only able to give women with osteoporosis the cheapest drug available - even though a quarter cannot take it. Those who cannot tolerate alendronate will have to prove that their condition has worsened by up to 60 per cent before they are allowed to have alternative treatment. It is unethical as some women will have to get 'significantly worse' than other patients before receiving a treatment they need, the charity said.

It is likely to affect thousands who experience crippling stomach pains as a side-effect or do not respond to alendronate, which costs $100 a year. Other drugs cost $34 a month. A woman in her early seventies who cannot tolerate alendronate would have to get 20 per cent worse - using a clinical scoring system - to qualify for medication such as risedronate or etidronate. The same woman would have to deteriorate 60 per cent to be eligible for strontium ranelate.

Doctors fear that the restrictions proposed for England by the rationing body, the National Institute for Health and Clinical Excellence, could lead to an epidemic of broken bones among older women. Osteoporosis can affect anyone because of natural bone loss caused by ageing. But women are at greater risk. Up to 14,000 a year die as a result of an osteoporotic hip fracture. Many others experience debilitating pain and disability from fractures.

Last year, the charity won an appeal against even more draconian restrictions put forward by NICE. But it says this has made little difference in practice. It has decided not to appeal again - which would result in the same NICE team reviewing drug treatments for a third time - but it wants a fresh appraisal. In a letter to Mr Johnson, chief executive Claire Severgnini said: 'The recommendations remain unnecessarily restrictive, denying many patients treatment at a point where treatment might make most difference to longterm quality of life. 'Their condition must be allowed to get progressively worse before each alternative treatment will be prescribed. 'Using barriers to limit treatment without regard to clinical or cost effectiveness is not how NICE is meant to appraise treatment options.'

Nick Rijke, of the charity, said the whole process is a 'farce', based on a computer model of pricing options in which the cost of treating hip fractures was grossly under-estimated. NICE had failed to give the charity access to the model despite a legal judgment this year which ruled against similar secrecy used in a drugs ban imposed on thou-with Alzheimer's disease. Mr Rijke said: 'We have been left with no option other than to plead with the Department of Health to secure a fresh, open-minded and fair appraisal.

A Department of Health spokesman said NICE is appraising 'a number of treatments for primary and secondary prevention of osteoporotic fractures. 'Stakeholders have recently had the opportunity to lodge appeals against NICE's revised draft guidance and I understand that NICE has now received an appeal which will be heard in public. NICE will not issue final guidance to the NHS until the appeal has been heard and considered. 'It would be inappropriate for ministers to intervene in the conduct of an ongoing NICE appraisal.'

Source





1 August, 2008

McCain Is the Radical on Health Reform

If you listen only to presidential campaign rhetoric, you might conclude that Hillary Clinton and Barack Obama proposed bold new changes for our health-care system, while John McCain is offering only small improvements. If so, you are in for a surprise. Most health-policy analysts believe that Mr. McCain is proposing the most fundamental health-care reform.

Right now the federal government encourages private health insurance primarily through the tax system -- handing out more than $200 billion in tax subsidies every year. Mr. Obama would leave this system largely intact. Mr. McCain would completely replace it with a fairer, more efficient system with a much better chance of insuring the uninsured and controlling health costs at the same time.

Under the current system, every dollar in health-insurance premiums paid by an employer is excluded from employee income and payroll taxes. Take an employee in the 25% income-tax bracket. Throw in state and local income taxes, add the 15.3% (FICA) payroll tax, and the tax exclusion for a middle-income family is worth almost 50 cents on the dollar. To make things a little better, employees can often pay their share of the premium with pretax dollars as well.

But this system is extremely arbitrary. There is virtually no tax relief for people who work for the 40% of employers who do not provide insurance, for part-time workers or people not in the labor market, or for anyone else who for any reason must buy his own insurance. The self-employed get a slightly better deal: They can deduct 100% of their premiums, but they get no relief from the payroll tax.

According to the Lewin Group, a private health-care consulting firm, families earning $100,000 a year get four times as much tax relief as families earning $25,000. In other words, the biggest subsidy goes to those who least need it, and who probably would have purchased insurance anyway. The system is also wasteful. People can always lower their taxes by spending more on health insurance, and there is no limit to how bloated a health plan can be.

Under the McCain plan, no longer would employers be able to buy insurance with pretax dollars. These payments would be taxable to the employee, just like wages. However, every individual would get a $2,500 credit (and every family would get $5,000) to be applied dollar-for-dollar against taxes owed.

The McCain plan does not raise taxes, nor does it lower them. Instead, it takes the existing system of tax subsidies and treats everyone alike, regardless of income or job status. All health insurance would be sold on a level playing field under the tax law, regardless of how it is purchased.

The impact would be enormous. For the first time, low- and moderate-income families would get just as much tax relief as the very rich when they purchase health insurance. People who must purchase their own insurance would get just as much tax relief as those who obtain it through an employer. Whereas Mr. Obama would continue the current practice of giving the vast bulk of federal help to the rich (through tax subsidies) and the poor (through spending programs), the McCain tax credit would give the most new tax relief to the middle class.

The McCain plan would also encourage all Americans to control costs. The tax credit would subsidize the core insurance that everyone should have. It would not subsidize bells and whistles (marriage counseling, acupuncture, etc.) as the current system does. Since employees and their employers will be paying for additional coverage with aftertax dollars, everyone will have an incentive to compare the value of extra health benefits to the value of other things money can buy. When they eliminate health-care waste, they would get to keep every dollar they save.

The McCain tax credit would be refundable. People could apply $2,500 per person or $5,000 per family to the purchase of health insurance, even if they do not owe any income taxes. Families would not have to wait until April 15 the following year to get their credit. They could obtain the subsidy at the time the insurance is purchased. The credit would also be transferable. Insurance companies and other intermediaries would be able to help families obtain their credit and apply it directly to health-insurance premiums.

The McCain health plan would allow people to buy insurance across state lines -- thus creating a competitive, national market for health insurance. It would provide additional federal money for people who have been denied coverage because of a pre-existing condition, making it easier for people who have lost their insurance to obtain new coverage. It would also encourage Medicare to become a smarter, more efficient buyer of care.

The McCain plan will not solve all our health-care problems. But it has a far better chance of positively reforming the system than any other plan that has been proposed in this campaign season.

Source




Great Moments in Socialized Medicine

Post below lifted from Taranto. See the original for links

Oregon is, according to an editorial in the Oregonian newspaper, "the only state that both allows assisted suicide and tries to ration health care." This embarrassed the state when 64-year-old Barbara Wagner got sick with lung cancer and the state essentially said to her, Have you considered suicide, lady?:

After her oncologist prescribed a cancer drug that would cost $4,000 a month, the newspaper reported, "Wagner was notified that the Oregon Health Plan wouldn't cover the treatment, but that it would cover palliative, or comfort, care, including, if she chose, doctor-assisted suicide."

The Oregonian editorial explains that the decision to deny coverage for the drug was based on a policy of disapproving payment "for treatment that doesn't provide at least a 5 percent chance of survival after five years." The paper does not fault the state for this decision:

In Wagner's case, administrators of the Oregon Health Plan had to make a difficult call. But that's what they do every day in performing the tough, thankless job of rationing government-paid health care to the needy. What's unacceptable, however, is that Wagner's rejection letter included the offer of payment for doctor-assisted death. Such notification creates at least the appearance of an ethical conflict: state encouragement of dying as a cost-saving measure.

The editorial notes that, the rejection of the $4,000-a-month drug notwithstanding, taxpayers have "paid thousands of dollars over the years for Wagner's cancer care, and . . . will continue to do so."

Unless, of course, she chooses suicide instead--an option that would still be open to her whether the state made the point explicitly or not. The Oregonian is troubled by the "appearance of an ethical conflict" when the state spells out the offer, but it seems not to mind the actual ethical conflict posed by the underlying assisted-suicide policy.