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31 October, 2008

Pennsylvania Is Driving Its Doctors Away

Blame Gov. Rendell if you can't find a physician



Gov. Ed Rendell is holding the legislature, physicians and patients of Pennsylvania hostage. His ransom is a universal health-care program that he wants to create and force doctors to pay for.

Health-care reform debates often center on how to make insurance affordable for patients. But in Pennsylvania we've had to confront how to make malpractice insurance affordable enough to keep doctors in the state.

Six years ago, prior to Gov. Rendell assuming office, Pennsylvania addressed that issue by passing tort reform. It also created M-Care (Medical Care Availability and Reduction of Error), a supplemental malpractice insurance program that every doctor in the state must pay into, but which pays malpractice claims that exceed the required basic liability coverage. M-Care replaced a state fund designed to pay judgments in excess of physicians' liability coverage.

The tort reforms have reduced the number of suits filed by preventing venue shopping, and by requiring an expert to certify the legitimacy of a malpractice suit. But they have not significantly reduced malpractice premiums. M-Care has helped lower the total burden only because the legislature has abated the supplemental premium in its entirety for high-risk specialists (neurosurgeons, orthopedic surgeons, obstetricians and general surgeons), and by half for all other physicians. Premiums for some specialties had risen to as high as 55% of a doctor's annual income. The reformed system came with a public benefit -- before receiving the subsidy a doctor had to promise not to move to another state within the next year.

M-Care was able to abate its premiums because there is a surplus of more than $500 million in reserves in a separate retention account (funded by a tax on cigarettes and fees on some traffic violations) that is growing by about $15 million a month. Money in the retention account is used if and as needed to abate physician premiums in M-Care.

Enter Mr. Rendell. He was a supporter of M-Care abatements in 2003. But now he's desperate to punch his health-care reform ticket by creating a universal health-care program, in hopes of landing a cabinet post if Barack Obama is elected president. He wants a program that would provide health insurance to individuals whose income is less than 300% above the poverty level, and to fund it he proposes raiding the surplus in M-Care's retention fund. The governor calls his program "Cover All Pennsylvanians." It will increase the cost of practicing medicine, make health care more expensive, and drive doctors out of the state.

And that will only continue a trend that M-Care may have slowed down, but hasn't stopped. The state Department of Health reported earlier this year that the number of practicing physicians in Pennsylvania is down 6% from a few years ago. Younger doctors just are not as willing to settle down in a state where liability payouts are twice the national average and physician income is 44th out of the 50 states. Today, about 7%-9% of our doctors are under 35. A few years ago, the number was 15% and in some specialties more than 40% of the practicing physicians are more than 50 years old. And less than 80% of physicians with active licenses are engaged in patient care.

Newly minted doctors educated here are setting up their practices elsewhere. In 1992, 60% of residents stayed in Pennsylvania when they finished their training. Now only 20% do so.

These trends will be exacerbated if M-Care funds are siphoned off. M-Care is not an inexhaustible source of revenue. It was created to help doctors afford the skyrocketing price of insurance, something it will not be able to do as effectively as it has in the past if it must also subsidize a new health-insurance program. I can say that because doctors are already paying more thanks to Mr. Rendell -- even though his health-care plan is still on the drawing board.

Why? Because Mr. Rendell wants his health-care program to be funded by the premiums doctors paid into M-Care, and he has threatened to veto any legislation that would block him from doing so. That's put M-Care in limbo. It can't offer doctors the same abatement it gave them the past four years without first getting authorization from the legislature. But the legislature doesn't have the votes to pass such an authorization over Mr. Rendell's veto threat.

The Republican-controlled State Senate passed legislation authorizing the subsidies for this year three times, but so far the Democratically controlled House hasn't. What's more, House leaders are planning to return after Election Day and may vote to give Mr. Rendell his health-care program. The end result is that this year my total liability premiums increased 40% over what I paid last year, when the M-Care portion was abated.

Pennsylvania's physicians are willing to provide health care for those who can't afford it. More than 90% of us accept Medicaid despite reimbursements that are obscenely low and have not been raised since 1989. But what I, and other doctors, object to is being extorted to fund the governor's sociopolitical agenda.

I hope the legislature resolves this unseemly debacle appropriately by directing M-Care to start spending its funds on the program's stated purpose (cutting the cost of liability insurance) before year's end. But in the meantime, if you are a woman with a high-risk pregnancy who is unable to find an obstetrician in the rural areas between Philadelphia and Pittsburgh, or if you can't find a neurosurgeon on trauma call in the two-hour drive from Pittsburgh to Erie, call Mr. Rendell. He can tell you about his plans to "cover all Pennsylvanians."

Source




Australia: "Targets" followed by government cancer screener set to kill woman

Breastscreen patients who get letters stating their mammograms show "no visible evidence of breast cancer" cannot be sure they are risk-free until they see a GP or have an ultrasound, a court has found. In a "controversial and far-reaching" case, Christine Ann O'Gorman, 57, was awarded almost $406,000 damages in the Supreme Court in Sydney yesterday after she sued BreastScreen NSW - an arm of the Sydney South West Area Health Service - for failing to diagnose a cancerous tumour that spread to her lungs and brain.

Ms O'Gorman, who is terminally ill, had mammograms every two years from 1994 at BreastScreen but radiologists failed to detect that a lump in her left breast had almost doubled in size between her 2004 and 2006 scans, Justice Clifton Hoeben found. After each scan, the single mother from Moorebank was issued with a letter stating her results showed "no visible evidence of breast cancer".

In his judgment, Justice Hoeben said a letter from BreastScreen was not enough for women to rely on. "I am sure that many women who participate in the BreastScreen program believe that when they receive the pro-forma letter, the presence of cancer is excluded," he said. "That is clearly not the case. The documents which those women sign before undergoing a mammogram and the pamphlets available make it clear that there are significant qualifications applicable when a 'no visible evidence of cancer' result is communicated to them."

Justice Hoeben found that, had radiologists compared O'Gorman's 2004 and 2006 scans, the change in appearance of the lump would have been detected and would have prompted further tests. Instead, Ms O'Gorman felt the cancerous tumour herself in January last year. After seeing her GP and undergoing further tests, she was diagnosed with breast cancer and after chemotherapy her left breast was removed in August last year. The cancer has subsequently spread to her lungs and brain.

Supported in court yesterday by her partner Glen and daughter Kristy, Ms O'Gorman wept when Justice Hoeben awarded her $405,990.15. Outside court, she said she did not want her negative experience with BreastScreen to discourage women from having their breasts checked regularly through the service. But she said compliance standards that urge clinics to "keep down" the numbers of women recalled to less than 5 per cent should be abolished to allow "case by case assessments". "The system has to be changed because even if they miss just one person it's wrong," she said.

In a statement, the SSWAHS said they would be "considering the judgment very carefully".

Source





30 October, 2008

HEALTH CARE SHOULDN'T BE LINKED TO EMPLOYMENT

By Jeff Jacoby

"The choice you'll have," said Barack Obama during last week's final presidential debate, as he told voters what to expect if John McCain's health-insurance proposal becomes law, "is having your employer no longer provide you health care. "Don't take my word for it," he added. "The US Chamber of Commerce, which generally doesn't support a lot of Democrats, said that this plan could lead to the unraveling of the employer-based health care system."

If only. An end to employer-based health insurance is exactly what the American health-care market needs. Far from being a calamity, it would represent a giant step toward ending the current system's worst distortions: skyrocketing premiums, lack of insurance portability, widespread ignorance of medical prices, and overconsumption of health services.

With more than 90 percent of private health care plans in the United States obtained through employers, it might seem unnatural to get health insurance any other way. But what's unnatural is the link between health care and employment. After all, we don't rely on employers for auto, homeowners, or life insurance. Those policies we buy in an open market, where (as a rule) numerous insurers and agents compete for our business. Health insurance is different only because of an idiosyncrasy in the tax code dating back 60 years -- a good example, to quote Milton Friedman, of how one bad government policy leads to another.

During World War II, federal wage controls barred employers from raising their workers' salaries, but said nothing about fringe benefits. So firms competing for employees at government-restricted wages began offering medical insurance to sweeten employment offers. Even sweeter was that employers could deduct those benefits as business expenses, yet employees didn't have to report them as taxable income. For a while the IRS resisted that interpretation, but Congress eventually enshrined the tax-exempt status of employer-based medical insurance in law.

Result: a radical shift in the way Americans paid for medical care. With health benefits tax-free if they were employer-supplied, tens of millions of Americans were soon signing up for medical insurance through work. As tax rates rose during the postwar decades, so did the incentive to keep expanding untaxed health benefits. No longer was medical insurance reserved for major expenditures like surgery or hospitalization. Americans who would never think of using auto insurance to cover tune-ups and oil changes grew accustomed to having their medical insurer pay for yearly physicals, prescriptions, and other routine expenses.

We thus ended up with a health care system in which the vast majority of bills are covered by a third party. (For most workers, that third party is an insurance company paid by their employers; for the poor and elderly, who rely on Medicare and Medicaid, it's the government.) With someone else picking up the tab, Americans got used to consuming medical care without regard to price or value. After all, if it was covered by insurance, why not go to the emergency room for a simple sore throat? Why not get the name-brand drug instead of a generic?

Unconstrained by consumer cost-consciousness, health care spending has soared, even as overall inflation has remained fairly low. Nevertheless, Americans know almost nothing about the costs of their medical care. (Quick quiz: What does your local hospital charge for an MRI scan? To deliver a baby? To set a broken arm?) When patients think someone else is paying most of their health care costs, they feel little pressure to learn what those costs actually are -- and providers feel little pressure to compete on price. So prices keep rising, which makes insurance more expensive, which makes Americans ever-more worried about losing their insurance - and ever-more dependent on the benefits provided by their employer.

De-linking medical insurance from employment is the key to reforming health care in the United States. McCain proposes to accomplish that by taking the tax deduction away from employers and giving it to employees. With a $5,000 refundable health care tax credit, Americans would have a strong inducement to buy their own, more affordable, insurance, rather than relying on their employer's plan. As millions of empowered consumers began focusing on price, price competition would flourish. And as employers' health care costs declined, most of the savings would return to employees as higher wages.

For 60-plus years, a misguided tax preference for employer-sponsored health insurance has distorted America's health care market. The price of that distortion has been paid in higher costs, fewer choices, and mounting anxiety. The solution is to restore market forces by fixing the tax code, and liberating Americans from an employer-based system that has made everything worse.

Source





29 October, 2008

Almost Everyone Would Do Better Under the McCain Health Plan

His tax credit is larger than the current tax subsidy for insurance

There has been a lot of rhetoric and misstatements, but what exactly does Sen. McCain have in mind? He would replace the current income tax exclusion for employer-sponsored health insurance with a refundable tax credit -- $5,000 for those who purchase family coverage and $2,500 for individual coverage. Mr. McCain would also reform insurance markets to stem the growth in health insurance premiums.

What many may not realize is that the federal government already "spends" roughly $300 billion to $400 billion through the tax code to encourage people to pay for their health care through employer-sponsored health insurance. This subsidy takes the form of the exclusion for employer-sponsored health insurance from both income and payroll taxes.

Still, some 45 million Americans are uninsured; and the growth in health-care spending continues to outpace the growth in incomes and the economy, which portends further increases in the number of uninsured. The employer-based system itself is eroding. Voters should be wondering whether there is a better approach than this subsidy.

Consider the current exclusion. Its value rises with how much someone spends on health care, and how much of this spending is funneled through employer-sponsored health-care coverage. This creates an incentive for people to purchase policies with low deductibles, or which cover routine spending. These policies look a lot less like insurance and more like prefunded spending accounts purchased through employers and managed by insurance companies. Consider homeowners and auto insurance policies. Do these cover routine spending on cleaning the gutters or tuning up a car?

The subsidy encourages people to buy bigger policies that cover more, and leads to greater health-care spending. Moreover, lower deductibles and coverage of routine spending dulls consumers' sensitivity to price. Reducing the tax bias should result in insurance that is more focused on catastrophic coverage and less on routine spending.

By replacing the income tax exclusion with a fixed, refundable credit, the McCain proposal reduces the tax bias for large insurance policies. Because the credit is for a fixed amount, regardless of how much you spend on health care, it helps break the link between the existing tax subsidy and how much is spent on health care. This improves incentives in the health-care market by reducing the bias that has contributed to such a high level of health-care spending.

Moreover, the credit provides a powerful incentive for people to purchase insurance. The two tax provisions -- the new credit and the repeal of the income tax exclusion -- on net provide a substantial tax cut of $1.4 trillion over 10 years. Not only do most Americans receive a tax cut under the McCain proposal, but the tax cut is directed toward low and moderate income taxpayers.



Consider the family of four shown in the chart nearby, assumed to purchase a $14,000 health insurance policy. The straight line reflects what the family would get under the $5,000 McCain tax credit. The lower line shows the value of the current income tax exclusion, which rises and falls with a taxpayer's tax rate.

What is striking about this picture -- and contradicts Mr. Obama's public comments -- is that the McCain tax credit for the purchase of health insurance exceeds the value of the current exclusion for all income levels shown. Indeed, it generally provides more resources to purchase health insurance than the existing exclusion. The total subsidy for health care would rise from about $3.6 trillion over 10 years today to roughly $5 trillion under his proposal.

How large an effect does this proposal have on the number of uninsured? Based on estimates by career economists in the Treasury Department's Office of Tax Analysis of similar proposals discussed in the Washington Beltway several years ago, the McCain health-care tax credit can be expected to increase the number of insured by 15 million and probably more. The Lewin Group, a respected private health-care research outfit, recently estimated that the McCain credit would increase the number of insured by as much as 21 million. It is true that many may no longer get their insurance through their employer, but they will be given the resources to purchase insurance on their own.

Will the insurance that is purchased be a generous plan with first dollar coverage or low deductibles? It is much more likely to be a plan with higher deductibles that is more focused on providing true insurance against catastrophic losses rather than a more generous plan that includes a lot of prepayment for routine and predictable medical expenses. But this is precisely one of the objectives of the policy: to reduce the current tax bias that encourages people to funnel routine health expenses through insurance policies.

Finally, the credit has important implications for the nation's finances down the road. This is perhaps the most important aspect of the proposal.

There is an enormous unfunded liability associated with the major entitlement programs of Social Security, Medicare and Medicaid. If left unchecked, the growth in these programs will nearly double the size of the federal government by 2040, consuming roughly 40% of the nation's output rather than the 20% today. While the growth in Social Security is largely the result of demographics, the growth in Medicare and Medicaid is also driven by the rapid growth in health-care spending. This is where a proposal like Sen. McCain's can be so important.

The elimination of the income-tax exclusion should reduce private health-care spending; to the extent this reduces the cost of health care, it should also put downward pressure on the growth of Medicare and Medicaid costs. Thus, by removing the tax bias for more generous health coverage, the McCain health credit also has the potential to provide important dividends to the entitlement problem down the road.

Source





28 October, 2008

Widow, 71, died after uncaring NHS doctors ignored penicillin warning

A grandmother died after hospital doctors gave her penicillin even though her medical notes and drug chart made clear she was allergic to it. June Cutmore was even wearing a red wristband to draw attention to the allergy. The 71-year-old widow went into anaphylactic shock and died after being injected with Augmentin - a form of the drug.

St Bartholomew's Hospital in London admitted that 'human error' caused the death. Her family believe a catalogue of mistakes by medical staff led to the tragedy in May 2007. The grandmother of three from Basildon, Essex, was admitted to St Bartholomew's to have a heart valve replaced, and undergo a double bypass.

Shortly before this Mrs Cutmore had some teeth removed at a hospital in Basildon. While there she was given penicillin and went into anaphylactic shock. She recovered from that reaction but it was written on her medical notes that she should never be given the drug again. Daughter Denise Hajduga, 48, and her husband Peter, 50, say they repeatedly told staff at St Bartholomew's about the allergy. Mrs Hajduga said: 'We told a nurse about it when we went into hospital with my mother for her pre-operation tests, then we told another nurse about it when my mother was actually admitted a few days later. They gave her a red band to wear on her wrist which said she was allergic to penicillin. 'It was also written on her medical notes after they discovered it in Basildon, and on her drug chart.' In a copy of Mrs Cutmore's drug chart seen by the Daily Mail the word penicillin is written in big capital letters with stars next to it in a box labelled 'drug allergies'.

Mrs Cutmore's heart operation was deemed a success, and after two days in intensive care the retired cook was transferred on to a ward. But the pensioner, who lived alone after the death of her husband Cliff, suffered complications. Mrs Hajduga, from Romford, Essex said: 'When she had the heart operation they had to break her sternum bone to reach her heart, and it became infected. The doctors had a meeting about what to do, and prescribed the antibiotic Augmentin - which contains penicillin.'

Mrs Hajduga's husband was there when the nurses gave her the drug. She said: 'He could see my mother was distressed immediately - within seconds of it being given to her she started getting short of breath and was pointing to her arm.' She says that her husband told the nurse three times to stop injecting it. 'But the nurse said she was just panicking a bit and carried on injecting it. She died shortly after.'

Mrs Cutmore had been in hospital for three weeks before she died. Mrs Hajduga said: 'They just didn't follow procedures. A number of health professionals failed to pick up that allergy.' She claims staff failed to even check her mother's wristband. 'They killed somebody and I think people should know about it. We have waited 18 months and now we just want answers to why it happened.' Her husband added: 'June worked hard all her life. She was loved by everyone. It is unbelievable what happened.'

A spokesman for the hospital said: 'Barts and The London NHS Trust is deeply sorry for the failure of the safeguards that should have protected Mrs Cutmore. The Trust's medical director and chief nurse met Mr and Mrs Hajduga soon after their mother's death to apologise unreservedly for the medication error. 'The staff members involved in this tragic incident are very upset and the Trust is committed to ensuring that the whole organisation learns the lessons from the tragedy.' [Bullsh*t, Bullsh*t, Bullsh*t]

Source




Australia: Rapist doctor to practise again

Your regulators will protect you -- NOT. They say he is OK to work again because he is only dangerous when he goes mad, which he periodically does. Follow that logic!



A rapist doctor banned indefinitely amid public outcry over his serial misconduct has won the right to treat patients again, despite a history of relapses. Dr Sabi Lal, 49, can work in Victorian clinics or hospitals, even though the Medical Practitioners Board opposed his return and considers him unfit to practise. A tribunal ruled this month the GP be reinstated to the medical register, overturning the board's decision that Dr Lal should remain struck off.

The suburban doctor, who suffers obsessive compulsive disorder, was struck off in December 2003 for assaulting two female drug company representatives. Dr Lal was also convicted and given a suspended jail term in Victoria's County Court in 2002 for digitally raping a patient.

The Medical Practitioners Board had previously found him guilty of more than 40 misconduct offences involving seven women. The board strongly opposed Dr Lal being allowed to work again and fought his appeal to VCAT last month. But a three-member Victorian Civil and Administrative Tribunal panel ruled this month that Dr Lal could resume seeing patients, subject to strict conditions. He is not allowed to treat females or children under 16 and must be strictly supervised and monitored. Lawyers for the Medical Practitioners Board argued that the need to impose such strict conditions indicated Dr Lal was unfit to work.

The Fijian-born doctor had previously been subject to similar conditions and offended again within a year of them being lifted. The VCAT panel noted in its ruling on October 10 that Dr Lal's rehabilitation was "less than complete". They noted there was a risk he might have a relapse of mental illness, which could result in aggressive and inappropriate behaviour towards women. "We acknowledge Mr Lal's character flaws . . . but in our view these can be addressed by the imposition of a range of conditions on his registration," the panel said.

The panel -- which comprised tribunal vice-president Judge Iain Ross and members Dr Elaine Fabris and Dr Dorothy Burge - noted Dr Lal's previous offences were "very serious". "The serious nature of the offences and the limited extent of Mr Lal's rehabilitation would ordinarily warrant findings that . . . it is not in the public interest to allow the applicant to practise," they said. But Dr Lal's culpability was reduced because he suffered a mental illness at the time of the offences, they said. "We are not persuaded that Mr Lal's suitability to practise is likely to be affected because of the offences of which he has been found guilty," they said.

Experts told the hearing Dr Lal's obsessive compulsive disorder appeared to have subsided, but there was dispute about the risk of relapse. VCAT heard the GP previously suffered relapses of the disorder, with symptoms including sexual obsessions, compulsive counting of money and an obsession with "lucky" numbers.

Experts told the VCAT hearing the GP continued to display a lack of empathy and remorse for his past actions and denied the factual basis of some offences. The panel said: "Mr Lal's deficits in terms of empathy and remorse are troubling. But they must be viewed in the context of the evidence as a whole." The tribunal heard Dr Lal had "significant community involvement" and had made a pro bono contribution to the training of overseas doctors.

Members of the Medical Practitioners Board are privately concerned that Dr Lal is able to practise again, but are unable to do anything further. Board spokeswoman Nicole Newton said yesterday: "The board has reviewed the tribunal's decision closely and does not believe there are grounds for appeal. As such, the board accepts the VCAT decision."

Lawyers for Dr Lal argued he had attended treatment sessions diligently and was engaged in every aspect of his treatment. He sold his Boronia practice, but is listed as the director of a company called Lal Medical Pty Ltd. A man who answered the door at the GP's Doncaster address yesterday said "yes" when asked if he was Dr Lal. But when asked for comment about the case, the man said, "Oh, he is not here" and shut the door.

Source





27 October, 2008

NHS dream of equality trumped by reality

Up to 10,000 patients will pay to top up their care when Alan Johnson, the health secretary, lifts the ban next month on National Health Service patients buying drugs that the state does not fund. Johnson’s U-turn, reported in last week’s Sunday Times, will end the policy of withdrawing NHS care from cancer patients who pay privately for life-prolonging drugs. It follows a campaign by the paper to end the practice. Until now the government has resisted pleas for top-ups to be allowed by claiming that the system will create a two-tier NHS.

The controversy is also expected to force Johnson to ask the National Institute for Health and Clinical Excellence (Nice), the government’s drug rationing body, to review the way it calculates whether life-prolonging cancer drugs should be funded by the taxpayer. Thousands of NHS patients are denied drugs that could prolong their lives because Nice has ruled that they are not good value for money.

In August Nice ruled that four life-prolonging kidney cancer drugs should not be funded on the NHS because, although they could halt the spread of the cancer for six months, this would be at a cost of up to $70,000 a year. Nice will now be asked to take greater account of how precious this extra time is for terminally ill patients.

At the moment, patients who have chosen to use their savings to pay for drugs to give them extra months of life with their families have their NHS care withdrawn. Johnson will argue that by ordering Nice to make more of these drugs available on the NHS, it will reduce the number of patients who need to pay to top up their care.

Healthcare at Home, a private company, says it is already selling cancer drugs to 1,000 patients from about 30 NHS trusts that have broken ranks and allowed patients to buy additional drugs while receiving NHS care. A company spokesman said that once the ban was lifted and more than 170 hospital trusts in England allowed top-ups, up to 10,000 patients could decide to supplement their NHS care with additional drugs.

Johnson’s change of policy follows an inquiry launched by the government in June after The Sunday Times revealed the tragedy of Linda O'Boyle, 64, a grandmother from Billericay, Essex, who died in March after her NHS care was withdrawn because she had paid privately for cetuximab, the bowel cancer treatment. At least three other cancer patients have died after their NHS care was withdrawn because they had paid for drugs.

Source




Unused building leased by Australian "free hospital" organization costs $1.5m while hospitals lack funds

And the guy principally responsible for that seems unrepentant

QUEENSLAND Health has wasted almost $1.5 million of taxpayers' money while renting a Brisbane building that has stood empty for almost a year. The inner-city offices, earmarked to house IT staff trained to "optimise efficiency", will remain vacant until at least early 2009. As the state's cash-strapped hospitals cry out for staff and equipment, the wasted rent money could have paid for:

More than 1400 hospital bed nights;

The annual salaries of 20 nurses;

More than 1600 chemotherapy procedures;

672 eye operations, or

3118 renal dialysis procedures.

After The Sunday Mail revealed the chronic waste to Health Minister Stephen Robertson, he last night ordered a full investigation. A shocked Mr Robertson said he would make sure all Queensland Health buildings were audited to ensure even more vital funds were not being squandered.

Queensland Health began a seven-year lease on the 3200sq m Spring Hill property, tucked away in the dead end of Gloucester St, from December 1 last year. It was previously rented to Telstra. The annual rent on the building is $1,472,000. Property owner Draconi Pty Ltd will receive more than $10.3 million in rent for the term of the lease.

The health department has blamed the delay in occupying the building on problems with a contractor hired to refurbish the offices, needing an upgrade to accommodate improved technology. The deal was terminated in April after the contractor allegedly did not meet State Government requirements. The department said it was considering "options of recourse" to recoup funds and had employed a second contractor. It declined to reveal how much had been paid to the first contractor, saying specific financial information would not be available until tomorrow. A department spokesman said Queensland Health was unaware of any other leased buildings in a similar situation.

Queensland Health chief information officer, Dr Richard Ashby, said the building would house 250 Information Directorate staff "to optimise efficiency and drive key Queensland Health ICT projects, including e-health". "The cost of the premises is $460 per square metre, which has been deemed fair and reasonable under State Government guidelines," Dr Ashby said in a statement. "The building was a shell when the lease commenced, and accordingly the fit-out has been a major undertaking." As well as the contractor problem, there had been "power, access and other technical issues", he said.

Deputy LNP leader and Opposition health spokesman Mark McArdle said that in these tough economic times, it did not make sense to pay high rent for a building just so the Bligh Government could display its logo. "This empty building is a colossal waste of money that should be going toward making sick people well and reducing elective surgery waiting lists," he said. "This is another example of the Government's poor planning and bad management. "Queenslanders would be horrified to learn that this much money was going down the drain, while sick people are languishing on trolleys in overcrowded emergency department corridors waiting for a hospital bed."

Mr McArdle said the $1,472,000 per year rent could help pay for additional improvements to the Caboolture Hospital Emergency Department (estimated to cost $700,000) or deliver special-care-nursery cots at Ipswich and Toowoomba Hospitals ($470,000).

Mr Robertson said his department was "trying to get to the bottom of what is going on", but he could guarantee that the money spent on the building had not been diverted from other health service areas. He said he was angry about the handling of the matter. "I have asked for an urgent briefing and a more detailed investigation."

Source





26 October, 2008

The Election Choices in Health Care

The candidates differ on the merits of tying insurance to a job

In few policy arenas are the choices as fundamental as they are for health care. Barack Obama favors increased federal control to build a "universal" system in stages. John McCain prefers to maximize the incentives for individuals and families to buy private health insurance on their own.

* Government options. The core of Mr. Obama's reform is a new government insurance program, open to nearly everyone, including the young and even the affluent. His goal is to have everyone insured by 2012. According to the Lewin Group, independent health-care consultants, the number of Americans with private coverage would drop by nearly 22 million from 157 million starting the first year, as people shifted toward the public option. People with coverage either through Mr. Obama's plan, Medicaid or the federal-state children's program (Schip) would increase by about 48 million.

Mr. Obama estimates the cost between $50 billion and $65 billion a year when fully phased in, though others say it would be far more. To fund it, he would impose a "pay or play" tax on employers. This would require all but the smallest employers either to provide insurance for their workers, or pay a tax on some portion of their payroll.

Mr. Obama hasn't said what the tax rate would be. If it's high, government costs would be lower and more employers might offer coverage, paying for it out of wages. If it's low, many employers would dump their coverage and pay the tax instead, transferring workers to the public option. Mr. Obama has also not elaborated on how the government would reimburse providers under his plan. The rates could be used to undercut private insurers. According to Lewin estimates, these undefined variables could boost the exodus to government to more than 60 million.

* Tax bias. Mr. McCain wants to reallocate the current federal tax breaks for health insurance. These cost the equivalent of $246 billion in 2007, yet only people who buy insurance through their employers receive this dispensation. Mr. McCain would extend tax benefits to all Americans, regardless of where they acquire their coverage, gradually replacing the workplace deduction with a refundable tax credit of $2,500 for individuals and $5,000 for families.

According to the Tax Policy Center, the McCain plan will cost $1.3 trillion over the next decade (vs. $1.6 trillion for Mr. Obama's), while the average household will be better off by $1,241 in 2009.

Some would stick with the coverage they currently enjoy, as one choice among many. Others (including of course the uninsured) would apply their credit outside their workplace, rather than taking whatever their boss offered. Though the individual market now covers only 9% of the population, equalizing the tax treatment for health care would stimulate the demand for new, more affordable insurance. With more decision-making power concentrated in the hands of individuals, Mr. McCain argues the plan would ease the third-party payer problem, where health-care dollars are laundered through insurers or the government, thereby inflating health spending.

Mr. Obama charges that the McCain tax credit would undermine the employer-based system. It would, though probably much less than Mr. Obama's government option. In any event, even some of Mr. Obama's advisers have argued against tying insurance to any specific job, and Mr. McCain's tax credit would follow the worker, rather than the job.

* Insurance mandates. Mr. Obama would impose new nationwide rules on insurance companies to prohibit "cherry picking," where companies sometimes reject applicants on the basis of pre-existing conditions. Instead, he supports "guaranteed issue," which forces insurers to accept all comers. Mr. Obama would also require every carrier's benefits to be similar to those that federal employees now receive.

Mr. McCain believes such regulations are one reason health coverage is so expensive. To that end, he would allow consumers to buy into any health plan in any state, which is currently prohibited. Though this would pose some logistical and regulatory difficulties, Mr. McCain argues it would amplify competition among insurers as well as allow people to seek out the policies that best suit their needs.

* Health-care costs. Federal spending on Medicare and Medicaid is already exploding, even without Mr. Obama's new plan. Over the past three decades, national health spending has more than doubled as a share of GDP, and, according to the Congressional Budget Office, it will double again by 2035. Medicare and Medicaid, which account for 4% of GDP today, are expected to rise to 9% in the same year.

Both candidates support such cost-control reforms as electronic recordkeeping and more coordinated and preventative care. But these are not likely to have a significant effect. Mr. Obama's wager is that savings can be realized by increasing the size of the government insurance pool, thus promoting "efficiency." The reality would probably be cost controls on providers and services, which is what Medicare began to impose in the 1980s as its costs soared.

Mr. McCain's bet is that costs can be brought down by giving people more control over their health-care dollars, thus restoring price signals to the health-care marketplace. Mr. Obama's approach is the going favorite with Democratic majorities in Congress.

Source




British government aims to make IVF less successful

When all the world wants the opposite

IVF success rates will fall by up to 20 per cent because of a government policy designed to cut the number of damaging twin pregnancies, research has suggested. An initiative to limit multiple births by persuading IVF patients to use only one embryo at a time will cause a "significant reduction in treatment success", according to an analysis of a clinic's patients.

The Human Fertilisation and Embryology Authority strategy, which aims to cut the twin birthrate by 2012 from one in four to one in ten, would in practice reduce the IVF success rate at St Mary's Hospital in Manchester from 21 per cent to 17 per cent, the study found. Daniel Brison, of the University of Manchester, said that the strategy was right to encourage single-embryo transfer because a multiple birth was the greatest IVF risk to mothers and babies, but its implementation needed to be backed by better NHS access to IVF, especially for follow-up courses using frozen embryos. Evidence from Scandinavia and King's College London has indicated that some women's chances of conceiving are just as high with one embryo as with two, if a second frozen-embryo cycle is available.

About a third of NHS trusts do not offer frozen back-up treatment and 85 per cent do not provide the three full cycles that the National Institute for Health and Clinical Excellence recommends. "Single-embryo transfer is the right way forward, but we have to fund more than one cycle," Dr Brison said. "It is very difficult to ask patients to accept any reduction in success rates if they have only one shot. Embryo freezing is also crucial, as is careful selection of patients who are suitable for a single embryo."

IVF produces a higher rate of twins and triplets because multiple embryos are often used to maximise the chances of pregnancy. Such babies, however, are more likely to be stillborn, die in their first year, suffer disabilities or be born prematurely. There are also risks to mothers.

In the study, published in the journal Human Reproduction, Dr Brison and his colleagues Stephen Roberts and Cheryl Fitzgerald constructed a model of what would happen to their clinic's success rates under the single-embryo strategy. To achieve the target of 10 per cent multiple births, about 55 per cent of patients would have to have single-embryo transfer. The current rate is about 10 per cent. This would bring the success rate down by about 20 per cent. If women were selected carefully, the decline would be slightly smaller but the live birthrate would still fall to 18.5 per cent.

The paper suggests ways that women could be selected, including analysis of their embryos as well as their age and hormone levels. Such measures would be essential to limit the policy's impact on pregnancy success, the scientists said. The St Mary's success rate is below the national average of 31 per cent for women under 35 who use their own fresh eggs. It is an NHS centre with a waiting list of up to three years, so couples with a good prognosis often conceive spontaneously while waiting for treatment, leaving the clinic to treat harder cases.

Professor Peter Braude, of King's College London, led the group that drew up the single-embryo strategy. He said that patients could be chosen who would not be disadvantaged by the policy. "It doesn't reduce pregnancy rates in women who are most likely to get pregnant, and who are also most likely to have twins," he said. "We have never said that a single embryo is right for every woman and the 10 per cent target is an aspiration. A very small proportion of patients give rise to most of the twins and by identifying them, we can reduce multiple births but not the pregnancy rate."

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25 October, 2008

Affordable Health Care

One of the campaign themes this election cycle is "affordable" health care. Shouldn't we ask ourselves whether we want the politicians who brought us the "affordable" housing, that created the current financial debacle, to now deliver us affordable health care? Shouldn't we also ask how things turned out in countries where there is socialized medicine?

The Vancouver, British Columbia-based Fraser Institute's annual publication, "Waiting Your Turn," reports that Canada's median waiting times from a patient's referral by a general practitioner to treatment by a specialist, depending on the procedure, averages from five to 40 weeks. The wait for diagnostics, such as MRI or CT, ranges between four and 28 weeks.

According to Michael Tanner's "The Grass Is Not Always Greener," in Cato Institute's Policy Analysis (March 18, 2008), the Mayo Clinic treats more than 7,000 foreign patients a year, the Cleveland Clinic 5,000, Johns Hopkins Hospital treats 6,000, and one out of three Canadian physicians send a patient to the U.S. for treatment each year. If socialized medicine is so great, why do Canadian physicians send patients to the U.S. and the Canadian government spends over $1 billion each year on health care in our country?

Britain's socialized system is no better. Currently, 750,000 Brits are awaiting hospital admission. Britain's National Health Services hopes to achieve an 18-week maximum wait from general practitioner to treatment, including all diagnostic tests, by the end of 2008. The delay in health care services is not only inconvenient, it's deadly. Both in Britain and Canada, many patients with diseases that are curable at the time of diagnosis become incurable by the time of treatment or patients become too weak for the surgical procedure. British Prime Minister Gordon Brown plans to introduce a "constitution" setting out the rights and responsibilities of its health care system. According to a report in the Telegraph (02/01/2008), "What this (Gordon Brown's plan) seems to amount to in practice are the Government's rights to refuse treatment, and the patient's responsibilities to live up to what the state decides are model standards." That means people who have unhealthy habits such as smoking, heart sufferers who are obese or those who fall ill because of failure to take regular exercise might be refused medical care, even though they pay taxes to support government health care.

Government health care can become ghoulish as reported in a Human Events (1/17/08) article "Gordon Brown Wants Your Organs" written by Susan Easton. As in the U.S., many Brits die while on the waiting list for organ donations. The prime minister has a solution called a "Presumed Consent Scheme." Mrs. Easton says, "If you don't specifically carry a card saying 'leave my corpse alone' -- known as the 'opt out option', or unless one's family is on hand to object, one's remains are considered fair game for an organ harvest festival." Supporters of the scheme argue that what is done with people's organs after their death should not be up to the next of kin. Such a vision differs little from one that holds that after one's death he becomes the property of the state.

Of course, if socialized medicine becomes a reality here, Americans can do as many Brits do. Mrs. Easton says, "more than 70,000 Britons -- known as 'health tourists' -- have gone as far as India, Malaysia and South Africa for major operations. This figure is expected to rise to almost 200,000 by the end of the decade."

We have health care problems in the U.S. but it's not because ours is a free market system of health care delivery. Well over 50 percent of all health care expenditures are made by government. Where government spends, government regulates. It's truly amazing that Americans who are dissatisfied with the current level of socialized medicine in the U.S. are asking for more of what created the problem in the first place. Anyone thinking that an American version of socialized health care will differ from that found in Canada, Britain, Sweden, France and elsewhere are whistling Dixie.

Source




Australia: The notorious Cairns Base hospital again

Cairns in a major international tourist destination. The hospital does not create a good impression of Australia! The hospital serves an area roughly the size of England

An aged pensioner is appalled she was sent home from Cairns Base Hospital to cope alone with an undiagnosed broken pelvis. "They just dropped me in the gutter to wait for a taxi," Betty Rasmussen, 66, told The Cairns Post. She could not walk on crutches and had to be wheeled to the taxi rank outside the Emergency Department. "I kept saying I live on my own, but they didn't care," Ms Rasmussen said. "How heartless can you be?"

For the next few days, she had to sleep on a recliner chair at her Woree unit because she could not lower herself into her bed. The hospital's medical services executive director, Dr Kathy Atkinson, yesterday admitted doctors failed to diagnose Ms Rasmussen's injury in X-rays taken on October 3 and her office deeply regretted the pain and inconvenience this had caused. Ms Rasmussen's treatment and the way she was discharged were being reviewed and she would be given a detailed written response. The hospital has also reported the case for entry into Queensland Health's clinical incident management database.

Dr Atkinson said on receipt of Ms Rasmussen's complaint, the X-ray was magnified and the break detected. "We are very sorry that this was not picked up earlier," she said.

Ms Rasmussen said she was appalled a hospital could treat people in their senior years that way. "There was no follow-up, not even to arrange Meals on Wheels to come around," she said. "My family doctor said I should have been put into hospital for two or three days so that I had a monkey bar to lift myself up with and a bed that could be lowered up and down."

During that first week at home, struggling on crutches to care for herself, Ms Rasmussen said there were days when she cried in unbearable agony. "I felt like doing myself in," she said. "I'm a person who always has a smile on my face, nothing bloody worries me, so for me to get to a point where I want to end my life it's . just unbelievable how down you can be."

The first she knew she had a broken pelvis was almost two weeks later when her physiotherapist - worried about the pain she was in - ordered a second batch of X-rays.

Source





24 October, 2008

The desperate British medical bureaucracy

Family doctors paid bonuses to NOT send you to hospital. It could cause you to have an avoidable amputation but who cares?

GPs are to be paid cash bonuses in return for not sending patients to hospital, raising concerns that financial gain will be put before patients' needs. Doctors' practices stand to earn thousands of pounds extra under the initiative, already said to have been adopted by health authorities across the country. In a variety of schemes, which differ from region to region, GPs are said to have been offered unprecedented cash incentives for deciding not to refer a patient for specialist treatment. Surgeries are given a target of how many patients they should refer to hospital each year and will receive a windfall payment if they meet the quota. Conversely, the money is lost if the surgery sends more patients to hospital than allowed for under the health authority target.

The Mail on Sunday has established that in Oxfordshire each surgery will be given a target of how many patients it should refer to hospital every year. If it meets those quotas, it will be eligible for a bonus payment of up to $20,000. GPs in the region will be paid a similar amount to set aside additional time to review decisions on whether patients should be given hospital appointments. It was reported last night that under another local scheme, doctors in Torbay in Devon could make $120 for every patient not referred. Practices in London, Essex and Wiltshire were said to be in line for $9 for every patient on their list if they meet targets which include a curb on the number of referrals.

The bonus money will be paid into the coffers of GPs' practices, from which they draw their income, giving clinicians for the first time a direct financial incentive to refuse further treatment to patients.

The initiative will cause deep unease, even among doctors who could profit from it. Commenting on the Oxfordshire scheme, Dr Laurence Buckman, chairman of the British Medical Association's GP Committee, told The Mail on Sunday it was `morally dubious, ethically disturbing and quite wrong'.

The schemes are seen as an attempt by NHS managers to direct patients away from the overloaded hospital system towards cheaper health workers, such as physiotherapists. But Stephen Cannon, a consultant surgeon at the Royal National Orthopaedic Hospital, said last night that potentially fatal tumours had already gone undiagnosed because of the scheme.

He said: `I recently encountered two cases in which patients referred to physiotherapists later turned out to have a malignant tumour. In one, a young man was referred to a physiotherapist because of sudden knee pain. Had he come to a specialist the symptoms should have been recognised and he should have been urgently referred to an oncologist. In this case, after the delays, the outcome was amputation. It was devastating for the patient and his family.' ....

Dr Buckman said: `The idea that we should pay doctors to behave in a particular way is worrying. There is a huge difference between paying GPs to increase vaccination levels - which is public health policy and therefore perfectly reasonable - and rewarding them for not referring a patient. `Many patients are referred for further investigation rather than treatment and it would be incredibly dangerous if these patients failed to get hospital appointments simply because GPs decided they weren't sure if a referral was strictly necessary. `The reason for a rise in referrals is very complicated and this isn't the way to deal with it. We should be trying to understand the reason for the referrals.'

Oxfordshire Primary Care Trust insisted it is not paying GPs not to refer but to review their practices, and that every patient who needs to be referred to hospital will get an appointment. Alan Webb, director of commissioning, said the Trust hoped the savings made would go back into patient care.

Source




Australian public hospital doctors 'tired and dangerous'

This appalling system has been going on for ages. No-one seems willing to stop it -- on cost grounds presumably

Overworked young doctors are close to burn-out from working 20-hour shifts and are getting less than six hours sleep a night. Patients' lives are being put in "danger", with stressed young doctors confessing their "unsafe" workloads were affecting their quality of medical care. These were two key findings in a national survey of 1000 young doctors by the Australian Medical Association released yesterday.

It paints a distressing picture of junior medical staff trying to cope in hospital systems that are underfunded and understaffed. Almost half believe their excessive workload runs the risk of compromising patient safety, while a third reported they regularly worked unsafe hours. Fifty hours a week is common with short turnaround times between shifts, while some said 90 to 100-hour weeks were not uncommon. Alcohol was another worrying method young doctors were using to cope with stress and fatigue, with the survey finding almost 10 per cent drank daily.

Sydney's Westmead Hospital intensive care resident Katherine Jeffrey, who confessed to working 60 hours a week, said more younger doctors were urgently need to improve quality care and prevent patient tragedies. "There is a danger of mistakes if you don't monitor yourself and if you don't get the sleep," said the 35-year-old critical care resident, who lives at Cheltenham. "Generally most of us are doing 50-60 hours a week which also included rostered overtime."

Dr Jeffrey, who said she sailed to ease her stress, said sleep-deprived young doctors, aged between 26 and 35, were also taking out their frustration on other medical staff. "They are short with the nurses, they're short with the patients - they are intolerant of little things." Dr Jeffrey confessed to once being awake for a 21-hour shift, which was "rare", due to a doctor shortage. "I could feel that I was fatigued."

AMA Doctors In Training Council chairwoman Dr Alex Markwell said it wasn't unusual for young doctors to be on call 24 hours a day for three weeks straight. "We do need urgent assistance in the public health system," she said. Dr Markwell said the survey showed junior doctors were "really struggling to meet all of the demands that are put upon them. Doctors are people too, they are not superhuman," she said. Dr Markwell suggested establishing an internal clinic for medical staff inside hospitals.

AMA president Dr Rosanna Capolingua said the problem must be addressed by governments by having more doctors in hospitals, safer working hours and better rostering.

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23 October, 2008

Obama's False Medicare Claim

He accuses McCain of proposing to cut benefits. Not true.

Summary: In a TV ad and in speeches, Obama is making bogus claims that McCain plans to cut $880 billion from Medicare spending and to reduce benefits.

* A TV spot says McCain's plan requires "cuts in benefits, eligibility or both."

* Obama said in a speech that McCain plans "cuts" that would force seniors to "pay more for your drugs, receive fewer services, and get lower quality care."

These claims are false, and based on a single newspaper report that says no such thing. McCain's policy director states unequivocally that no benefit cuts are envisioned. McCain does propose substantial "savings" through such means as cutting fraud, increased use of information technology in medicine and better handling of expensive chronic diseases. Obama himself proposes some of the same cost-saving measures. We're skeptical that either candidate can deliver the savings they promise, but that's no basis for Obama to accuse McCain of planning huge benefit cuts.

Analysis: The Obama campaign began the Medicare assault with a 30-second TV ad released Oct. 17, which it said would run "across the country in key states." The ad quotes the Wall Street Journal as saying McCain would pay for his health care plan with "major reductions to Medicare and Medicaid," which the ad says would total $882 billion from Medicare alone, "requiring cuts in benefits, eligibility, or both." Obama elaborated on the theme Oct. 18 in a stump speech in St. Louis, Mo., claiming flatly that seniors would face major medical hardships under McCain:

Obama, Oct. 18: But it turns out, Senator McCain would pay for part of his plan by making drastic cuts in Medicare -$882 billion worth. Under his plan, if you count on Medicare, you would have fewer places to get care, and less freedom to choose your doctors. You'll pay more for your drugs, receive fewer services, and get lower quality care.

But in fact, McCain has never proposed to cut Medicare benefits, or Medicaid benefits either. Obama's claim is based on a false reading of a single Wall Street Journal story, amplified by a one-sided, partisan analysis that piles speculation atop misinterpretation. The Journal story in turn was based on an interview with McCain economic adviser Douglas Holtz-Eakin. He said flatly in a conference call with reporters after the ad was released, "No service is being reduced. Every beneficiary will in the future receive exactly the benefits that they have been promised from the beginning."

Twisting Facts to Scare Seniors

Here's how Democrats cooked up their bogus $882 billion claim: On Oct. 6, the Journal ran a story saying that McCain planned to pay for his health care plan "in part" through reduced Medicare and Medicaid spending, quoting Holtz-Eakin as its authority. The Journal characterizes these reductions as both "cuts" and "savings." Importantly, Holtz-Eakin did not say that any benefits would be cut, and the one direct quote from him in the article makes clear that he's talking about economies:

Wall Street Journal, Oct. 6: Mr. Holtz-Eakin said the Medicare and Medicaid changes would improve the programs and eliminate fraud, but he didn't detail where the cuts would come from. "It's about giving them the benefit package that has been promised to them by law at lower cost," he said.

Holtz-Eakin complains that the Journal story was "a terrible characterization" of McCain's intentions, but even so it clearly quoted him as saying McCain planned on "giving [Medicare and Medicaid beneficiaries] the benefit package that has been promised."

Nevertheless, a Democratic-leaning group quickly twisted his quotes into a report with a headline stating that the McCain plan "requires deep benefit and eligibility cuts in Medicare and Medicaid" - the opposite of what the Journal quoted Holtz-Eakin as saying. The report was issued by the Center for American Progress Action Fund, headed by John D. Podesta, former chief of staff to Democratic President Bill Clinton. The report's authors are a former Clinton administration official, a former aid to Democratic Sen. Bob Kerrey and a former aid to Democratic Sen. Barbara Mikulski.

The first sentence said - quite incorrectly - that McCain "disclosed this week that he would cut $1.3 trillion from Medicare and Medicaid to pay for his health care plan." McCain said no such thing, and neither did Holtz-Eakin. The Journal reporter cited a $1.3 trillion estimate of the amount McCain would need to produce, over 10 years, to make his health care plan "budget neutral," as he promises to do. The estimate comes not from McCain, but from the Urban-Brookings Tax Policy Center. McCain and Holtz-Eakin haven't disputed that figure, but they haven't endorsed it either.

Nevertheless, the report assumes McCain would divide $1.3 trillion in "cuts" proportionately between the two programs, and comes up with this: "The McCain plan will cut $882 billion from the Medicare program, roughly 13 percent of Medicare's projected spending over a 10-year period." And with such a cut, the report concludes, Medicare spending "will not keep pace with inflation and enrollment growth-thereby requiring cuts in benefits, eligibility, or both."

"Savings" vs. "Cuts"

For the record, Holtz-Eakin said in a telephone conference call with reporters Oct. 17, after the ad was released, that any shortfall in McCain's health care plan could be covered, without cutting benefits, by such measures as reducing "Medicare fraud and abuse," employing "a new generation of treatment models" for expensive chronic diseases, speeding adoption of low-cost generic drugs, and expanding the use of information technology in medicine.

Interestingly, Obama proposes to pay for his own health care plan in part through some of the same measures, particularly expanded use of I.T. and better handling of chronic disease. Whether either candidate can achieve the huge savings they are promising is dubious at best. As regular readers of FactCheck.org are aware, we're skeptical of Obama's claim that he can achieve his promised $2,500 reduction in average health insurance premiums, for example.

But achievable or not, "savings" are what McCain is proposing. It's a rank distortion for Obama's ad to twist that into a plan for "cuts in benefits, eligibility or both," and for Obama to claim in a speech that seniors will "receive fewer services, and get lower quality care."

Source




Australia: Mother turned away by public hospital - so baby born by road

The hospital had a midwife and obstetrician on duty but it was still preferable for her to give birth by the side of the road, apparently. There's nothing like that "caring" socialist medicine

A WOMAN gave birth on the side of the road after a hospital forced paramedics to put her back in an ambulance and take her to Nepean Hospital owing to a shortage of medical staff. The 35-year-old gave birth to her third baby on the Great Western Highway at Glenbrook about half an hour after being examined by a midwife and obstetrician at Blue Mountains District Anzac Memorial Hospital.

An ambulance spokesman said that when the woman was picked up from her Katoomba home at 5.41am on October 9 her waters had broken and contractions were a minute apart. Maya Drum, network director of women's health and newborn care at Blue Mountains Hospital, yesterday said the woman had phoned to say she was on her way, was 10 days overdue and had been in labour for three hours.

The Herald understands the woman was distressed at being told she could not deliver at the hospital because there was no anaesthetist available and that paramedics had argued against taking her to Nepean because her labour was so advanced. It is also understood that the baby, delivered by a midwife in the back of the ambulance, needed to be ventilated until they reached Nepean Hospital.

Ms Drum said the woman arrived at Blue Mountains at 6.10am and was judged to be "high risk". At that time, the hospital "could not provide anaesthetist cover due to unavoidable staffing shortages and the clinical decision was made to transfer the woman immediately by ambulance to Nepean Hospital, where more comprehensive services were available to provide specialist services to mother and baby", she said in a statement. "During the transfer at 7am, the midwife, assisted by the two ambulance officers, successfully delivered the baby in the ambulance on the side of the Great Western Highway at Glenbrook." She said the mother and baby returned home from Nepean the next day and were well.

There was a public outcry after pregnant women in the Blue Mountains were given just a few days' notice that the birthing unit was closing temporarily on July 21 because of a lack of obstetricians, anaesthetists and midwives. It was reopened on September 1 but had since closed temporarily at least twice because of staff shortages. The State Government has promised before to maintain birthing services in the Blue Mountains but yesterday the Health Minister, John Della Bosca, appeared to back down. "The decision about the continued operation of the service is one for clinicians. The minister will rely on advice from expert staff at NSW Health and the area health service," a spokesman said. The incident highlighted the difficulties in attracting medical staff to some regions.

Meanwhile, expectant mothers in the Bega Valley have also been left in limbo after two of the four Pambula GP obstetricians said they would not deliver babies at Bega Hospital from mid-December. They are angry at the Greater Southern Area Health Service for insisting they travel to Bega after birthing services at Pambula were closed about a month ago because of midwife shortages. A spokeswoman for the area health service said there were no plans to reopen a birthing service at Pambula.

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22 October, 2008

Rough NHS nurses

I knew my mother Norma's 81st birthday would be poignant. She had been diagnosed with lung cancer six months earlier - a terrible twist of fate considering she never smoked - and was not expected to survive the year. But at least, I reasoned, she was being treated at the world-renowned Royal Marsden Hospital in West London. There she would not only receive the best possible treatment but be cared for by dedicated nurses accustomed to looking after the terminally ill. Or so I thought.

But when I arrived on Horder Ward on the morning of my mother's birthday, she was distressed and disorientated. Instead of wearing the white linen pyjamas she had gone to bed in, she was wrapped in an NHS gown. Gradually it emerged that she had woken up in the middle of the night in a pool of blood, terrified she was haemorrhaging. She had rung the bell next to her bed but there was no response. Eventually a nurse turned up to discover my mother's cannula - a tube inserted into her vein and attached to a saline drip - had fallen out of her arm.

The nurse bustled around changing the sheets while my mother sat covered in blood, shivering beside the bed. When she asked for a blanket, the nurse told her to put on her flimsy cotton dressing gown, an offer she declined as she didn't want it covered in blood. Finally she was dressed in a hospital gown, put back into bed and left alone until I arrived in the morning. 'Where are her pyjamas?' I asked the nurse. 'I don't know,' she shrugged.

Not only was it a terrible start to my mother's birthday but an omen of things to come. For the next three weeks, our illusions about palliative care were shattered. We're all familiar with the problems facing the NHS: the chronic shortage of nurses, the drain on funding, target-orientated managers, government edicts. And earlier this year the Royal Marsden had to contend with an additional disaster, a fire that destroyed its top floor. But there's one question that cannot so easily be dismissed: when did hospital nurses stop caring?

My mother's battle against cancer began in January when she went to see a respiratory consultant at Cheltenham General, 15 miles from her home in Cirencester, Gloucestershire, and was diagnosed with cancer of the lower left lobe of her lung. 'A surprise and a shock,' she wrote in her diary, with typical understatement.

Until then she was fit and healthy. We'd spent New Year's Eve together at Somerset House in London, watching the fireworks and walking several miles back to my house in South-West London. Everybody had wished her Happy New Year - she was the oldest person on the streets.

Around 38,300 people are diagnosed with lung cancer each year - 90 per cent of them are smokers. My mother had adenocarcinoma, a cancer commonly found in non-smokers. But there were no signs it had spread. Determined to fight the disease, we asked for her to be referred to the Royal Marsden, a specialist cancer hospital and conveniently close to my home. There she underwent a six-week course of radiotherapy. Her consultant was sensitive and caring, and my mother handled the treatment well, walking a couple of miles to the hospital nearly every day. We were hopeful she would go into remission, and soon she was able to go back to her own home.

However, within a month, she began to get breathless and was taken by ambulance back to Cheltenham General. My brother Justin went with her and described the hospital as vile. Some nurses were disrespectful, unfriendly and unhelpful, others were downright aggressive. On a large mixed ward, my mother had to sleep next to the nurses' station, which was noisy all night. 'A terrible night due to nurses talking, laughing and searching records,' she wrote on July 3. The following night she recorded the name of a nurse who was 'frighteningly angry and shouting because I asked if it would be possible to be quieter'.

How terrible it was to see such a strong woman feeling so vulnerable. The next day I took her back to her home in Cirencester, vowing that when she had to return to hospital, we would get her into the Royal Marsden. Her condition deteriorated and my brother brought her back to London. First she went to the Royal Brompton where we had the most amazing experience of care in the NHS. The Brompton stood out as a beacon of hope. The ward was clean and modern, the consultant gave us his mobile number and the nurses were caring and cheerful. But they couldn't get her sickness under control and my mother was transferred to the Marsden.

Her three-week stay on Horder Ward began on July 25. Walking on to the ward, used for patients in palliative care, our faces fell. The contrast was incredible. Dark and gloomy, it hadn't been renovated for years. It was also incredibly stuffy. Despite a security buzzer, the door was constantly propped open to allow air into the ward. I had to buy my mother a fan on the hottest day of the year. When I complained, I was told she should have asked for one. Dozens of flies were buzzing around the ward but every time she mentioned them the nurses treated her as if she was being precious.

Apparently, Horder Ward had been next in line for renovation when the fire broke out. But why were dying patients being put on the worst ward in the hospital? Had they already been written off? Certainly, morale on the ward was low - on several days there were only three nurses for 13 patients - but that doesn't excuse unfriendliness or lack of caring. I had to remind the nurses repeatedly to call my mother Mrs Joseph, rather than Norma. Shouldn't that be automatic for a woman of 81?

One of the most disturbing things was their total lack of understanding that time is precious for terminally ill people. Staff took ages to come when bleeped - understandable when they were busy with other patients but not when they were in 'meetings' or during staff changeovers. One night my mother lay in agony in for two hours waiting for pain relief. Other nights the bed bells were out of reach and she had to wait until a nurse heard her cries.

During the days she became increasingly upset that nurses took so long to get her up and dressed. It was bad enough that the only bath on the ward was broken during her entire stay, but her showers got later every day. Sometimes she was not washed before lunch. Elderly people like routine, though this seemed to take second place to the nurses' convenience. Once my mother had to finish wrapping her own bandage, presumably because a nurse got distracted. Another day they forgot to give her a mouthwash. She was supposed to get one four times a day.

My mother wasn't the only patient being ignored. I fetched water for the woman in the bed opposite who was thirsty and a blanket for another woman who was freezing. My mother told me that, on one occasion, a male visitor had to help her when she was being sick.

One afternoon I finally lost my temper. A staff nurse had told my mother she had to keep her arm straight because the machine for her saline drip kept bleeping while she was asleep. When I argued that it was unreasonable to expect an 81-year-old woman with terminal lung cancer to sleep with her arm straight all night, she shrugged: 'What do you expect me to do?' 'I expect you to rectify it,' I said. 'It wasn't bleeping before you changed the saline.' Her response: 'She has to work with me.' But as my mother pointed out, she was the one doing all the work.

Another staff nurse, barely out of college, insisted on making my mother's bed the way she had been taught - even though she was not comfortable - due to health and safety rules, and bristled if I tried to help her lift my mother. She also had this infuriating habit of talking to patients in baby language saying things like: 'Let me lift your leggies.' My mother had lung cancer. She hadn't lost her mind.

We finally managed to take my mother back to my home on August 19. Her diary entry for that day says it all: 'At last I can come home to Claudia. A daughter does things far better!'

But that was not the end of our ordeal. In the early hours of August 30, my mother was taken by ambulance to Chelsea and Westminster Hospital because she had a ruptured bowel and was given only hours to live. Even then nurses did not make her a priority. Instead of allowing us to stay with her, they insisted we wait in the visitors' room while they settled her.

Finally we had to wait six hours for an ambulance to bring her home. Thankfully, the prediction was wrong. She did not die that day in hospital. She survived another week, dying on September 7 in my bedroom.

My mother came from a generation that believed hospital nurses were 'angels' ruled over by a strict but warm matron. Well, not any more. We met a few nurses who were brilliant, some who were passable but too many who just didn't seem to care at all. They may as well have been factory workers on a production line. We were hoping to make my mother's last birthday as special as we possibly could, yet the nurses managed to give her - and us - the worst one of her life.

Source




British mothers-to-be offered gift vouchers and beauty treatments to quit smoking

Rewarding bad behaviour? The NHS plans to offer treats to pregnant women who smoke so as to encourage them to quit. Pregnant women who smoke are to be offered gift vouchers and beauty treatments to encourage them to quit. The incentives, which also include baby goods, will go to those women who can prove they have kicked the habit.

Telford and Wrekin NHS Trust in Shropshire plans to begin a pilot scheme soon, having already agreed to the idea in principle. But it has been warned that the move could be seen as the Health Service rewarding bad behaviour.

Expectant mothers who agree to the trials will have various examinations, such as carbon monoxide monitoring, to show if they have recently smoked. Samples may also be taken to prove their bodies are free of nicotine and other harmful substances found in cigarettes.

Dr Kevin Lewis, director of Shropshire's Help 2 Quit service, said the plan could help improve live birth rates, result in better health for newborn babies and cut NHS treatment costs. He added: 'We are dealing with an addiction and we are dealing with human behaviour and we know from studies that people are often not as motivated by the benefits to future health as they are by the here and now.'

Last year, 466 women - equal to 23 per cent of maternities in Telford and Wrekin - were still smoking up to delivery.

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21 October, 2008

British health boss in U-turn over patients’ top-up care

After at least four deaths and a year of protests about top-up payments, Alan Johnson, the health secretary, is expected to declare that National Health Service rules allowed them all along. In an announcement which is due to be made to parliament at the beginning of November, Johnson is expected to “clarify” government policy, claiming that patients are already permitted to pay for private drugs while continuing to receive NHS care. He will state that the problem arose because of a misinterpretation by some NHS hospitals.

Although it represents a victory for the campaign, led by The Sunday Times, it will be heartbreaking for the families of cancer patients who died after their NHS care was withdrawn because they topped up their treatment. This weekend one family made public an emotional letter telling of the anguish and outrage caused by the NHS decision to withdraw care. The letter, written by Linda Linton, a mother of three who died from bowel cancer at the age of 57, tells how she asked to be discharged from hospital because she feared her rising treatment bills.

Linton had her routine treatment withdrawn by Maidstone and Tunbridge Wells NHS Trust because she paid privately for the drug cetuxi-mab which was recommended by her NHS consultant. Linton, from Sittingbourne, Kent, wrote: “I wanted to go home because I was worried about the mounting costs of my treatment, room and food. I was told that if I discharged myself I was at risk of multiple organ failure.”

Linton, who wrote the letter four months before her death in October 2006, explained how the scandal was draining her energy: “It is six in the morning and I should be resting and trying to recover from my ordeal, but I am too upset and angry about what has happened to me . . . “I thought that I could pay for this drug and resume treatment but this is not the case. I have been forced to become a private patient and pay for everything. Could you please inform me who is responsible for the decision to force me out of the NHS?”

Linton was one of dozens of cancer patients who have been told by the NHS that if they top up their care with a private drug recommended by their consultant they will forfeit the rest of their health service care.

John Baron, constituency MP of Linda O’Boyle, who died in March aged 64 after her NHS care was withdrawn because she paid for the cetuxi-mab drug, said of Johnson’s expected announcement: “That will clearly be a U-turn by the government. This position will not fool anybody.” Patients who have been denied NHS care because they bought private drugs are suing for the treatment which has been withdrawn.

Although dozens of NHS trusts have told cancer patients that they cannot buy private drugs while simultaneously receiving NHS care, The Sunday Times revealed in July that numerous others have been allowing top-ups.

Johnson is expected to announce a solution that will avoid creating a two-tier NHS, with patients in the same ward receiving different standards of care according to their ability to pay. The University Hospitals Birmingham NHS Foundation Trust treats patients who supplement their NHS care by paying private hospitals or companies for extra drugs. Professor Nick James, a consultant oncologist at the trust, expects Johnson to endorse this approach nationally. “I don’t think they are going to like the spectacle of patients in adjacent beds getting different treatments and one of them getting better at the end of it. They will try to partition it off so that it is invisible to the NHS patients,” James said.

The Department of Health said: “We know there is variation in how individual trusts are applying the current guidance and that is why the secretary of state asked Professor Mike Richards, national clinical director for cancer, to lead a review.”

Source




British heart attack victims face longer journey for surgery as only 54 hospitals can now operate

Unrealistic theory threatens lives

Thousands of heart-attack patients will be forced to travel further for emergency treatment because of a change in the techniques used to save their lives. The Department of Health will announce tomorrow that balloon angioplasty – administered to treat heart attacks caused by blocked arteries – will be made available to nearly every eligible patient. But the procedure is available at only 54 centres across England – about one in every four hospitals – which means instead of being taken to the nearest accident and emergency department, as now, about 25,000 patients will be taken straight to their nearest specialist angioplasty clinic, which could be many miles away.

One of the concerns is that, in practice, patients could still be taken to A&E before being transferred to a specialist unit, which may increase the time it takes to get lifesaving treatment. However, paramedics are to be given training to spot heart attacks that have been caused by blood clots so that patients can be taken directly to an angioplasty centre. Angioplasty is used to treat patients whose heart attacks have been caused by blocked arteries.

About 25,000 of the 60,000 heart attacks treated each year are of this type, and a quarter of those patients are, at present, given the procedure, in which a tiny balloon is inserted into the artery and inflated to clear the blockage. The Government says it aims to treat 97 per cent of eligible heart-attack patients by using angioplasty within three years.

But experts admitted that although the number of centres offering the specialist treatment had risen from 35 in 2006/07 to 54 this year, a further increase was not likely. Cardiologists have described the proposal as a ‘challenge’, as specialist angioplasty units will have to be staffed by an expert team 24 hours a day, seven days a week. For the treatment to be effective it should be given within two hours of the heart attack, meaning some hospital trusts may need to double their number of cardiology consultants.

The proposals are the latest stage in the centralisation of NHS care. The Government has long pushed for the creation of ‘superhospitals’ – vast regional centres with specialist clinics catering to population areas of up to two million. Maternity services also face being moved from local hospitals to larger regional units and GPs could move from local surgeries to multi-purpose health centres, or polyclinics.

But Katherine Murphy, spokeswoman for The Patients Association, said the Government had got it ‘completely wrong’. She added: ‘What the Government always fails to consider is the convenience of access for patients. They should be providing a service at local level because that is what patients want.’

At the moment, most patients whose heart attacks have been caused by a clot are treated using thrombolysis – an injection of drugs to dissolve blockages. Professor Peter Weissberg, medical director of the British Heart Foundation, said the NHS had to commit ‘sufficient resources’ to turn the proposals into reality, especially for people in rural areas. He added: ‘We must not replace a first-class thrombolysis service, which is proven to save lives, with a second-class angioplasty service, which might not.’

The Department of Health said: ‘It is preferable to travel further to achieve a better outcome. However, if the journey time is too long, then early thrombolytic treatment is given instead.’

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20 October, 2008

A truly toxic British ambulance bureaucracy

Woman left to die by the roadside after ambulance bosses refused to let crew cross a county boundary

A student was left dying by the side of a road after an air ambulance 20 miles away was refused permission to cross a county boundary, it has been revealed. Rebecca Wedd, 23, had to wait 42 minutes for medical help after she was hit by a car as she walked with a group of college friends to a summer ball. Police arrived in seven minutes, but it was almost three quarters of an hour after the 999 call when paramedics finally appeared. The national target for answering such a call is eight minutes. Miss Wedd was eventually flown to a nearby hospital but died of her injuries the following day.

It has emerged that an air ambulance crew three minutes away from the scene of the accident was initially refused permission to answer the call from the A433 in Gloucestershire, because it meant crossing a county boundary from Wiltshire. The emergency controller contacted the Wiltshire Air Ambulance after the accident but was told the helicopter could not fly outside the county at night. This was said to be part of a pre-existing arrangement between WAA and Wiltshire Police, which shared the helicopter. The controller then contacted Wiltshire Police directly and persuaded them to bend the rule because of the emergency. Permission was given and the aircraft was finally dispatched at 12.02pm, and arrived at the scene at 12.05am - 43 minutes after the initial 999 call.

Only a minute beforehand, the student graduate was being tended by a paramedic whose ambulance had been flagged down by police. Miss Wedd eventually arrived at hospital an hour and 18 minutes after the accident, and died of her injuries the next day.

The shocking delay in flying the air ambulance was revealed after an internal investigation into the tragedy was made public under the Freedom of Information Act. Miss Wedd's father said he believed his daughter might have been saved but for the delay. Peter Wedd, of Harston, Cambridgeshire, 53, said: 'I cannot understand why that rule applies and why that air ambulance could not fly. 'The bureaucracy that stopped the helicopter from flying that night is unbelievable. Why are these rules there when someone's life is in severe danger? 'The report is a catalogue of disasters. The resources available were not properly managed and someone could have attended to my daughter far, far quicker. 'It's hard to know if that would have made a difference. In my heart of hearts I believe it would.'

The report also highlighted other failings by the Great Western Ambulance Service that night. A nearby ambulance dealing with a less urgent call was not diverted to Rebecca's aid and no ambulances were available in nearby Cirencester because of staff sickness.

At the time Rebecca was killed, Mr Wedd had been rebuilding his life after his wife Carol, 46, died of breast cancer. He has one other daughter Caroline, 22. Rebecca was on her way to the ball at the Royal Agricultural College in Cirencester in May last year when she was struck.

Source




A truly toxic Australian ambulance bureaucracy

After a decade of wall-to-wall inquiries, the NSW Ambulance Service still fails its noble undertaking on care, at least to its own workers. As health mottos go, the NSW Ambulance Service's Excellence in Care is an efficient mantra. But once the service had loftier ambitions. "Together," said its old motto, "we will be the world leader in ambulance services, providing a shield of protection to our community." Now its ability to deliver excellence and protection has been questioned. How can it deliver to the community, when it cannot guarantee a protective work culture for its employees?

The ambulance service has been the subject of 11 inquiries since 2001; the latest, expected to hand down its findings on Monday, has been inundated with hundreds of disturbing stories of abuse, bullying and harassment. Barely 24 hours before the NSW upper house inquiry began in July, a Premier's Department review of the service concluded serious operational and workforce issues were harming the welfare of ambulance officers.

In opening the upper house inquiry, the chairwoman Robyn Parker said it was called in response to concerns "raised by ambulance officers and the community with members of Parliament and in the public domain regarding, in particular, bullying, harassment, intimidation and occupational health and safety issues". Parker said this week that a decade of ignoring the issue had to stop. "I guess what I really feel personally now is that I see an ambulance officer and I want to go up and hug them . We call triple-0 and we expect them to turn up and we don't expect that they're not treated well. "The community holds them in such high regard yet the services and the structure and the government is not matching that with the resources they need to do the job. The ambulance service has got to breaking point."

The inquiry heard tales of officers unable to endure the lengthy complaints management system - criticised by the Health Services Union as being so aggressive it was a form of bullying in itself - who gave up and went on stress leave.Others obtained apprehended violence orders against officers; some committed suicide. For too many officers, management's repeated failure to even address their problems exacerbated their pain.

The service has responded. A harassment taskforce was set up last year, and a healthy workforce summit was held last May. Still, ambulance service research shows 75 per cent of the 3105 paramedics are unhappy and the rate of sick leave outstrips the average for other health department employees, including nurses.

Officers have inquiry fatigue and say significant cultural change in dealing with bullying and harassment will not occur without an overhaul of the executive. They are also critical of the union for apparent inaction. They hold out some hope this inquiry will be different, given its independence from ministers and ambulance bureaucrats, but acknowledge implementation of recommendations depends on government.

Carlo Caponecchia, a University of NSW psychologist, told the inquiry that bullying and harassment were unsurprising, given the stress in ambulance officers' jobs. "Things like fatigue, rostering, being stationed in the country without ever knowing when you are going to leave, lack of career progression - all these kinds of things . need to be dealt with." Caponecchia said there was no evidence to suggest bullying and harassment in the ambulance service was worse than elsewhere. But workers' health and wellbeing were affected, regardless of the individual's personality.

The director-general of NSW Health, Professor Debora Picone, told the inquiry the ambulance service tended to operate on an old-fashioned "command and control type structure from the military" that was at the root of some of its bullying and harassment problems. Picone believes that bullying and harassment are "in pockets rather than widespread". Bullying and harassment are compounded by workplace and operational problems. Officers complained of the difficulty of getting holidays or transfers approved, of the lack of counselling after traumatic events, and how overtime was essential to a satisfactory wage, yet it caused fatigue.

Face-to-face counselling was used 544 times in the past 12 months, but Picone told the inquiry post-traumatic support was employed only once. This raises questions about the adequacy of "debriefing" services, particularly as international research shows stress is one factor increasing the likelihood of workplace bullying.

The ambulance service's chief executive, Greg Rochford, concedes that officers have traditionally been promoted to management without being trained in people skills or conflict resolution. And Picone says it is planned to have all 400 operational managers trained in complaints handling by the end of the year.

But Dennis Ravlich, a Health Services Union official, was scathing at the inquiry about the service's inability to turn things around. "The Premier's Department review and a number of reviews that we have participated in over the previous eight or nine years consistently identify issues that the service needs to do better. Yet no one is accountable, 10 or eight years later." He said that in investigating complaints or disciplinary matters the service's professional standards and conduct unit "has almost institutionalised a rather aggressive approach to staff - indeed, almost to the point of being harassing in itself", and that reports on bullying allegations "drop into a big black abyss".

Parker told the Herald on Thursday: "This has gone for so long, and the chief executive officer [Greg Rochford] and the Government has been clearly aware of this issue for more than 10 years now, and a broom needs to be swept through the service, starting at the top. "Ambulance officers painted a bleak picture of their workplace. It was just so dysfunctional, the morale so low. There was so much unresolved conflict and time and time again we heard about this nepotistic old boys' club; it just has to change."

More here





19 October, 2008

Hawaii Ending Universal Child Health Care After 7 Months

Big surprise! Offer something valuable for free and people will rush it!

Hawaii is dropping the only state universal child health care program in the country just seven months after it launched. Gov. Linda Lingle's administration cited budget shortfalls and other available health care options for eliminating funding for the program. A state official said families were dropping private coverage so their children would be eligible for the subsidized plan. "People who were already able to afford health care began to stop paying for it so they could get it for free," said Dr. Kenny Fink, the administrator for Med-QUEST at the Department of Human Services. "I don't believe that was the intent of the program."

State officials said Thursday they will stop giving health coverage to the 2,000 children enrolled by Nov. 1, but private partner Hawaii Medical Service Association will pay to extend their coverage through the end of the year without government support. "We're very disappointed in the state's decision, and it came as a complete surprise to us," said Jennifer Diesman, a spokeswoman for HMSA, the state's largest health care provider. "We believe the program is working, and given Hawaii's economic uncertainty, we don't think now is the time to cut all funding for this kind of program."

Hawaii lawmakers approved the health plan in 2007 as a way to ensure every child can get basic medical help. The Keiki (child) Care program aimed to cover every child from birth to 18 years old who didn't already have health insurance - mostly immigrants and members of lower-income families. It costs the state about $50,000 per month, or $25.50 per child - an amount that was more than matched by HMSA.

State health officials argued that most of the children enrolled in the universal child care program previously had private health insurance, indicating that it was helping those who didn't need it.

The Republican governor signed Keiki Care into law in 2007, but it and many other government services are facing cuts as the state deals with a projected $900 million general fund shortfall by 2011.

While it's difficult to determine how many children lack health coverage in the islands, estimates range from 3,500 to 16,000 in a state of about 1.3 million people. All were eligible for the program. "Children are a lot more vulnerable in terms of needing care," said Democratic Sen. Suzanne Chun Oakland. "It's not very good to try to be a leader and then renege on that commitment."

The universal health care system was free except for copays of $7 per office visit. Families with children currently enrolled in the universal system are being encouraged to seek more comprehensive Medicaid coverage, which may be available to children in a family of four earning up to $73,000 annually. These children also could sign up for the HMSA Children's Plan, which costs about $55 a month.

"Most of them won't be eligible for Medicaid, and that's why they were enrolled in Keiki Care," Diesman said. "It's the gap group that we're trying to ensure has coverage."

Source




Australia: More deadbeat public hospitals

How disgraceful that it takes big publicity in order to get a hospital to pay its bills

Shoalhaven Hospital, on the South Coast, came close to halting all surgery recently because it had just a day's worth of sterilisation solution left due to unpaid bills, a senior doctor says. The head of surgery, Associate Professor Martin Jones, told the Herald the hospital was also put on "stop supply" 10 days ago for cataract lenses - the second time in two months - by a supplier tired of waiting for bills to be paid. "We just haven't paid our bills," he said. "All the sterilisation in theatre was coming to an end and we didn't have the supply to go for more than 24 hours. "The hospital would have to close . because nothing would be sterilised."

He said the bill was paid urgently and the supply ban lifted after he had wasted considerable time chasing management about the problem. "We who are working on the ground in getting the simple operations done to look after the rural people of the health service just don't need that as a frustration," he said. "We do run very close to the bone in a large number of supply goods."

The Herald understands tens of millions of dollars are owed to medical suppliers by four area health services - Northern Sydney Central Coast, Greater Southern, South Eastern Sydney Illawarra and Greater Western. The NSW Health Department has refused to reveal how much it owes and has gagged its area health services. South Eastern Sydney Illawarra Health did not respond to Professor Jones's claims.

The state Opposition health spokeswoman, Jillian Skinner, said she had been contacted by several businesses over recent months complaining about unpaid bills. One company, Leeton Diagnostic Imaging, confirmed yesterday it was owed $35,752 from May until two weeks ago. Yass air-conditioning mechanic Touie Smith was owed $18,386.50 for accumulated bills from April until the end of August, when they were finally paid.

Roger Christie, who owns Merimbula Taxi Service, said he has been owed $4423.65 since July for transporting patients and blood from Pambula to Bega hospital. As he has the only taxi service in the area he said he felt obliged to continue servicing the health department. "Obviously, I would prefer the money was in my bank and not their's. It's an ongoing thing. I got a call at 1.30 this morning to take blood . because someone had a car accident. It was an emergency so I can't really say no," he said.

The State Government has had to release $11 million urgently in the past few weeks to cover debts to suppliers after many refused to grant credit to NSW hospitals.

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18 October, 2008

Two out of three British public hospitals fail on hygiene and nearly half miss MRSA targets, claims new report

Almost two out of three hospital trusts are failing to tackle dirty wards and deadly infections, a study has revealed. Nearly half missed the target to cut MRSA superbug rates last year and too few are achieving good hygiene standards, according to a Healthcare Commission report.

The independent watchdog's annual 'health check' of the NHS shows improving levels of services but warns that there are still major areas for concern in tackling infections such as MRSA and C.diff. Six out of ten acute and specialist trusts are not meeting government standards on managing infections and cutting MRSA rates. Just 67 of 169 of these trusts complied with all three hygiene standards and met MRSA superbug targets. In total, 48 per cent of hospitals failed to reach a target to cut MRSA infections by at least 60 per cent over three years.

Failures are occurring on one or more of three basic standards on infection control in 114 trusts overall - a quarter of the NHS - up from 111 trusts in the previous year. Of the trusts that failed on basic hygiene, 42 are acute hospitals, 62 primary care, eight mental health and two are ambulance trusts.

For the first time, the watchdog is planning spot checks throughout the NHS, rather than just inspecting hospitals. Under a new system, trusts that cannot show that they are meeting standards on infection control face conditions on their registration when the Care Quality Commission takes over as regulator next April. Healthcare Commission chief executive Anna Walker said NHS trusts also needed to pay attention to other infections. She said: 'We must not take our eye off the other infections such as norovirus, which are as significant for patients if they catch them in hospital.'

In the watchdog's rating of the 391 NHS trusts across England for 2007-08, 42 trusts were ranked excellent on both the quality of services and their use of resources compared with 19 in 2006-07 and two the previous year.

But Derek Butler, chairman of MRSA Action, said some hospitals were making virtually no headway in getting on top of healthcare infections. He said 'Why are we allowing any hospitals not to comply with the hygiene code, we should be sending inspectors in. 'We know 17 hospitals actually had more MRSA cases last year than in 2004, since when they are supposed to have halved their rates.'

Shadow Health Secretary, Andrew Lansley, said 'It's encouraging to see that overall standards are improving in many NHS Trusts, but there are still some disturbing gaps in performance.'

Steve Barnett, Chief Executive of the NHS Confederation which represents over 95 per cent of NHS organisations, said 'While the Annual Health Check shows a trend of improvement in healthcare acquired infections, we support a zero tolerance approach and we know NHS organisations are fully committed to achieving this.'

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17 October, 2008

Deadbeat Australian public hospital getting supplies from a veterinary practice!

It has been known for months that this hospital cannot pay its bills but the problem continues

A doctor has dipped into his own pocket to buy equipment for patient tests as supply shortages reach crisis point at a western New South Wales hospital. The doctor bought the equipment so a diagnostic blood test could be processed at Dubbo Base Hospital, while nursing staff say they are tired of sourcing medical supplies from the local vet.

Dubbo medical staff council chairman Dr Dean Fisher said there had been ongoing problems at the hospital, but patient care was now threatened. The hospital's pathology department had recently advised staff not to order blood tests because the associated equipment stocks were running low. "It is the first time that I'm aware that a doctor has had to buy supplies and that stems mostly from bills unpaid by GWAHS (Greater Western Area Health Service), which stopped supplies being sent up to us to use," Dr Fisher said. "In the past it's been unpaid food bills, unpaid transport bills, now it's affecting patient safety and that's of extraordinary concern."

On Monday, medical staff cast a vote of no-confidence in hospital management. Staff now want to meet with management and ask that NSW Premier Nathan Rees and Health Minister John Della Bosca visit the hospital to discuss supply shortages. "We've had enough of nursing staff having to go down the the local veterinary clinic to get bandages and urinary dip sticks to be able to continue patient care," Dr Fisher said.

"Every six to 12 months we have a crisis here. "We are short from a workforce point of view, both medically and with nursing personnel. They (GWAHS) bring in a external auditor at great expense to look at the problems. That money could be so much better spent."

The Australian Medical Association (AMA) said rural hospitals urgently needed state government funds to boost patient care. "If there are funds available to be spent, rural hospitals should be the first in line," AMA NSW president Dr Brian Morton said in statement today.

Mr Della Bosca, appointed health minister last month, has said previously he planned to visit hospitals in rural NSW. A spokeswoman for his office could not confirm when the minister would visit Dubbo. Mr Della Bosca last month could not confirm reports from Independent Dubbo MP Dawn Fardell that businesses were waiting for $150,000 worth of bills to be paid by the area health service. But he admitted there was a systemic problem and the service had "cash flow problem".

Source

State health boss pledges to fix "broke" public hospital

The blowhard is "investigating" it. Why not get the checkbook out first so suppliers are paid and can resume supplies?

NEW South Wales Health Minister John Della Bosca has promised to fix a "systemic failure" that forced doctors at a hospital in the state's west to buy their own medical supplies. Mr Della Bosca today said he had launched an investigation into cash-flow problems at the Greater Western Area Health Service which led to shortages of medical gear at Dubbo Base Hospital. "The direct answer is cash flow, and it is totally unacceptable for doctors and nurses to be paying for supplies out of their own pocket,'' he told Fairfax Radio Network. "It is totally unacceptable, if it is true, that doctors and nurses are having to borrow bandaging from local veterinary scientists. "I'm immediately having that investigated as of today.''

Mr Della Bosca said before medical staff went public with their concerns, he had held a meeting with the GWAHS's chief financial officer a week ago. The meeting had led to the payment of about 5000 outstanding accounts. "Those creditors are now satisfied and supplies have been restarted,'' Mr Della Bosca said. '(But) we need to fix the system, there's a systemic failure here and I'm getting to the bottom of it. "I expect to have it fixed and fixed very quickly.'' ....

The GWAHS has brought forward to Monday a meeting with the staff council originally scheduled for next month.

Source




Australian doctor-training catches the British disease

Britain too turns out thousands of medical school graduates who are given no chance of completing their training. That great government "planning" again, of course

Andrew Hobson isn't bad at maths, a factor contributing to his selection as a first-year medical student at the University of Queensland. So when he compares the 734 students to be awarded Queensland medical degrees in 2011 and the 667 hospital internships on offer in 2012, he worries. The numbers don't compute. Everyone sits there and says: 'Wow.' All of a sudden there's added pressure, almost competition, between the students because most of us know that as of 2012, here in Queensland, we no longer have that guaranteed intern spot."

Hobson is a product of a belated government realisation in the late 1990s that Australia was about to run out of doctors. In the years that followed, it did, to the point where it now draws 36 per cent of its general practitioners from overseas. That figure jumps to 41 per cent in the bush. Canberra was forced into a hasty rethink of its earlier policies aimed at limiting over-servicing by doctors. Its complaints about too many GPs and blow-outs in Medicare billing costs were replaced by a hefty catch-up investment in medical schools. By 2012, 19 medical schools - almost double the number operating throughout the '90s - will struggle with record throughput. Domestic graduate numbers will total almost 3000, an 86 per cent increase on last year's output. But although one problem seems solved, another has emerged.

Australia may have students in the pipeline, but a lack of training places before and after graduation - in hospitals, in general practice and the specialties - threatens to block the workforce flow just as it starts. The country's medical deans warned earlier this year the number of young doctors was starting to exceed the capacity of some clinics, hospitals and medical colleges to give them on-the-job training and access to patients. "The situation is becoming critical," they said.

The cracks first appeared in 2005, however. That year, the Australian Medical Workforce Advisory Committee concluded the country was short of 800 to 1300 GPs. It was also the year that a Medical Journal of Australia study revealed teaching hospitals in the University of Newcastle medical school catchment had started to fall behind on clinical placements for the next generation of doctors. The school's student population outnumbered patients available on any given day by two to one.

It reminds Australian Medical Students Association president Michael Bonning of the British debacle, where a dearth of National Health Service training positions left thousands of young doctors jobless. "That's exactly what we're worried about," Bonning says. "The situation here hasn't yet reached those dire projections that we've seen in the UK, but what we want to do is learn from the mistakes over there."

After years of importing doctors, Britain earlier this year announced it was shutting the door to applicants from other Commonwealth countries, including Australia. Australia, which also has counted overseas-trained doctors among its biggest imports for many years, could start engaging in its own form of exclusion as soon as next year. Queensland, for example, may have to start limiting hospital internships to Australian graduates of its medical schools from the end of next year, when applicants start surpassing demand, Bonning notes. Bar a change of policy, by the time Hobson graduates, virtually none of the 67 overseas students awarded medical degrees from his and other Queensland universities are likely to find a home at the state's hospitals....

Australian medical graduates aren't able to go into independent practice straight out of university. Instead, they are put through long years of supervised training, first as hospital interns and postgraduate trainees, then through vocational training. The country's biggest vocational training program is one designed to turn graduates into GPs, who provide most of Australia's out-of-hospital health care. The Australian General Practice Training Program for next year, however, is already vastly oversubscribed. As of June 30 this year, there were 600 training spots and 733 applications.

The lack of certainty over future placements frustrates Bonning, who wants another 100 places added annually to the program during the next three years. "I think it's very unlikely and very much out of line with the Government's current push in primary care to think that they won't look at increasing the number of people in general practice," he says....

It's where the commonwealth, eight states and territories and about 20 medical colleges overlap that things get messy. The states and territories provide initial training for medical graduates in their teaching hospitals, in the form of a one-year internship and pre-vocational training. For each young doctor, cash-strapped public hospitals have to find the time and resources to supervise training while tending to their growing patient workloads. The Victorian Department of Human Services reportedly has gone as far as charging for clinical placements for students, according to the deans of the country's medical schools. This year, they called on governments to include explicit funding streams for medical education in hospital budgets as part of the next federal-state health funding agreement, to be signed within three months.

"Public hospitals have been able to shift much-needed funds away from teaching and research to meet the increasing costs of service delivery," they told the commonwealth's health reform adviser. "This has placed an increasing burden on medical schools to ensure adequate and quality clinical training placements."

Bonning, who graduates from UQ in seven weeks, has secured a hospital internship for next year. But his later years of vocational training, which qualify doctors for independent practice, are still not assured. The process of entry to general practice or a specialty involves not just multiple governments and agencies but the medical college that young doctors aspire to join. "It's just more complicated because there are more parties involved and any one of them can cause some problems," Bonning says. The relationship between the different parties has often been a strained one....

Successive federal governments have tried to unclog the bottlenecks and expose doctors to non-traditional practice by expanding areas in which training takes place to private hospitals, community medicine and public health. But the federal Department of Health and Ageing, too, has been overwhelmed bydemand. As of July this year, it had received about 500 applications for the 180 places it had funded for its 2009 program, which aims to give specialists experience working outside of public hospitals.

Bonning says Canberra needs to continue looking for placements beyond state hospital settings if it is to make its grand experiment in medical workforce planning work. "No matter how many students you put into a system, you essentially have to train them all the way through to independent practice," he says. "If we stop or neglect their training at any stage, you won't get the full pay-off that the community demands."

Source





16 October, 2008

NHS wants to spend $800,000 on a yacht

An NHS primary care trust has come up with a novel - and expensive – approach to improving public health. The East Yorkshire trust, now known as NHS Hull, is proposing to spend $800,000 on buying a yacht. The trust believes that the purchase of the vessel, which would be funded from its surplus of $80 million, would help it to raise standards of public health in the area, which includes the constituency of the Health Secretary, Alan Johnson.

Critics of the plan say that the money could be better spent on more conventional needs, such as improving hospital facilities In a briefing paper to explain the proposal, the trust says that “the NHS is no longer just about providing care to those who are sick”. It argues that “we need to tackle the reasons for illness rather than just tackle the outcomes of ill health”.

A suitable vessel has already been identified. It would sail with a crew of unemployed teenagers into the North Sea and around Scandinavia, as part of a training programme to help them into work. The idea is that they would return from the high seas not only with skills such as navigation and engineering, but an understanding of the benefits of healthy living.

The health authority says that over three years this welfare-to-work scheme would help 450 teenagers to lead healthier lives. The scheme would be funded by One Hull, a body that includes the heads of the council, the police service and NHS Hull, as well as representatives from businesses and voluntary groups. One Hull would be expected to cover the estimated $900,000 a year needed to run the scheme for the next three years.

The plan has come under fierce attack. Steve Brady, the opposition leader on Hull City Council, told The Times: “First of all, you would think that there were other problems, such as single-sex wards, to be addressed in Hull. Secondly, the government quan-go is spending public money running the yacht, when for a comparable amount of money it could be delivering hundreds of apprenticeships in skills that Hull needs.”

The proposal has met with derision in the local community. “I did not know that NHS money was for this sort of thing,” wrote a contributor on one of Hull’s online message boards. “I thought it was to provide medical services when you are ill and needing medical care – not to provide a few youngsters with freebies.”

Kath Lavery, chairman of NHS Hull, defended the scheme. “It’s a massive programme of intervention in young people’s lifestyles and choices,” she said. “It’s about showing young people in Hull there’s something good in life and they can make lifestyle choices which hopefully mean they will go into higher education.”

Hull’s primary care trust has in previous years lent money to struggling health authorities. A sum of $80 million has now been returned to the trust, all of which has to be spent in the next two years. About $20 million has been ploughed into the purchase of a local hospital previously run by a charity [They needed to reduce its standards, I guess] , and $240,000 has been used to refurbish existing hospital buildings.

NHS Hull says that the vessel it is proposing to buy is of the type used in the round-the-world clipper yacht race, which was conceived in 1995 by Sir Robin Knox-Johnston. The boats used in the first races were known as Clipper 60s and named after the old tea clippers. In 2004 new Clipper 68s, which are 68ft long, were designed and built in Shanghai. The mast is 81ft tall.

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15 October, 2008

NHS dentists accused of unnecessary check-ups

Dentists are calling patients back for routine appointments far sooner than they need to, in an effort to maximise profits, according to the Government's chief dental officer. NHS dentists earn significantly more since new contracts were introduced in England two years ago but officials believe this could be because some are “playing the system”.

The National Institute for Health and Clinical Excellence (NICE) suggests that most healthy patients do not need a check-up more than once every two years. But Barry Cockcroft, the Chief Dental Officer, believes that many patients are being called back for unnecessary appointments as often as every six months, or paying extra for repeat visits for fillings, crowns or other treatments that could be given in one go. Evidence compiled by the Department of Health suggests that as many as 800,000 appointments - one in ten - could be freed up for more needy patients.

NHS dentists saw 27 million patients in England during the past two years - 1.1 million fewer than than in the two years before the new contracts. In the first year of the new system dentists' average annual income rose from 87,000 to 96,000 pounds. For dentists who own their practice, earnings jumped 35 per cent to an average of 172,000.

Treatment costs are now divided into three bands: 16.20 for a check-up or minor treatment; 44.60 for fillings, root canal work or if your dentist needs to take out one or more of your teeth; and 198 for crowns, dentures or bridges. Children and some adults are exempt from the charges and patients should have to pay only once, even if they need several appointments during one course of treatment. But dentists could abuse this by postponing additional treatments until after a subsequent check-up.

Recently, officials have compared NHS returns by dentists, which give each individual patient a code, to see how many people are attending repeat appointments. Mr Cockcroft is now discussing with local health authorities how to amend the contract so that patients are not overcharged.

A Department of Health source said: “Many patients have been seeing their dentist at six-month intervals for years, but there is no evidence to support this as clinically necessary.” Abuse of the system is believed to be more prevalent in the South, where access to NHS dentists is more difficult. “These dentists are seeing the same healthy patients a lot. Instead of recalling them every year or two years they are coming back every three or four months.”

There were no plans to prosecute dentists, the source said. “We don't want to get into trying to court martial people. We just want to stop it.” Peter Ward, chief executive of the British Dental Association, which represents dentists, said it had noted no evidence that patients were being seen more regularly than they had to be.

The Department of Health said: “Dentists are required by law to provide the best possible healthcare to their patients. If a patient has reason to believe that this has not happened then they can report them to their local primary care trust.”

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14 October, 2008

Innovate to Cut Health Costs

We've been hearing a lot about universal healthcare. But before you give up on market competition, consider that government regulation of hospitals and medical professionals makes medical care much more expensive than it need be.

We seldom hear about difficulties in finding a doctor, rationing of services and poor-quality care under universal healthcare schemes -- even though such problems are already happening in government-run programs in California. Individuals insured by state Medicaid programs have "insurance," but because of low reimbursement rates, they are too often unable to find physicians and specialists who will care for them.

It's even less often that we hear about another option, the only good option: Using innovation to make healthcare cheaper and more accessible. When I say cheap healthcare, I don't mean we should pay physicians less. I mean delivering high-quality care in less-expensive ways. Annual physicals don't need to be done in a high-priced medical office, for example. And we need to oppose the move requiring audiologists to have doctorates. Patients should have low-cost options when it comes to getting a simple hearing test. Likewise, we need to repeal laws that require physician assistants, physical therapists and nurse practitioners to have master's degrees.

One of the reasons healthcare costs are growing is that lobbyists for medical professionals and hospitals use such laws to protect their members from competition. If they keep blocking cost-saving innovations, it could backfire on them. The public will get so frustrated with the high cost of care that they will demand universal healthcare, which won't be a picnic for the industry or the rest of us.

The success of retail clinics across the country gives us a glimpse of what innovation can do for patients. Those "convenience clinics" are popping up in CVS pharmacies, at Wal-Mart and Target. Wal-Mart's new retail clinics will be "co-branded" with local hospitals. Staffed by nurse practitioners, convenience clinics provide routine care at affordable prices. (You don't need an MD to diagnose pink eye or an ear infection.)

The innovations will keep on coming -- but only if we let them. Advances in software and other diagnostic tools can dramatically improve medical diagnosis and treatment. They also will make medical care more affordable by allowing less-expensive, mid-level clinicians to diagnose and treat more illnesses.

The physician lobby fights those innovations, and many doctors argue that software will miss some diagnoses. Do they mean that they never miss anything? The experts disagree. "Studies of autopsies have shown that doctors seriously misdiagnose fatal illnesses about 20% of the time," writes David Leonhardt in the New York Times. "Misdiagnosisis killing thousands of Americans every year."

For all its faults, America's healthcare sector has its advantages. It produces some of the highest survival rates in the world for cancer and other serious illnesses. Patients generally don't have to wait a year for a hip replacement. Being 70 doesn't make you ineligible for a kidney transplant. And U.S. medical innovations benefit other countries that suffer from the lack of them in their government-run schemes.

Rather than give up on all that, let's deregulate medical care so that providers can find innovative ways to deliver high-quality care cheaply. Let's eliminate the increasingly strict education requirements for clinicians and let medical professionals offer walk-in physicals or other services at competitive prices. Like Wal-Mart and MinuteClinic, they will rely on brand name and reputation to assure quality.

We also need to better promote health savings accounts, which put spending in the hands of consumers and encourage them to shop around for low-cost alternatives.

Retail clinics are only the first step. My hope is that the increased access and reduced costs will quickly become evident and will build support for additional innovations -- and the deregulatory policies necessary to make them possible.

Universal coverage sounds appealing, but it means government will be running the trains. Here and abroad, government does not have a good record when it comes to access, oversight or innovation. Before we give up on free markets, let's actually give them a shot

Source




Harefield (London) transplant deaths review

Heart transplants at Harefield Hospital are being reviewed after four people died within a month of surgery, its NHS trust said. They died after four consecutive operations, conducted by three different surgeons, between July and September. Fifteen transplants have been performed this year at the northwest London hospital. Four people died within 30 days, two inside 90 days and one after 90 days. Last year there were 24 transplants, with no deaths under 30 days. An independent surgeon and cardiologist will carry out the review.

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13 October, 2008

Australia: Triple-0 blunder

Ambulance gets wrong address for hurt man (In Australia, 000 is the equivalent of the U.S. 911). This seems to happen a lot. Making it a firing offence for a blundering dispatcher would make it happen a lot less often, I fancy. I note that in a U.S. case the dispatcher was at least suspended

A worker who sliced his arm on a power tool was kept waiting for an ambulance because a communications operator sent out the wrong address. Told an ambulance was still an hour away after a wait of 40 minutes, the injured man's employer drove him to hospital.

Emergency Services Minister Neil Roberts admitted there had been a delay in dispatching an appropriate ambulance after a mistake about the address. "It resulted from an inadvertent highlighting of an incorrect address during the dispatch process," Mr Roberts said.

Wheelchair user Val Hughes, of Glenore Grove near Laidley, called Triple 0 about 8.45am on September 18 after a contractor cut his arm with a grinder and fainted at their gravel business. She said her husband was out and she did not want to ask a 17-year-old employee to drive the man to hospital.

Mrs Hughes said a Southport ambulance communications centre worker seemed confused about her location. When the worker fainted a second time, Mrs Hughes called the emergency number again at 9.05am and was told an ambulance would be there soon. "We waited, but we were starting to get very agitated," she said.

When Mrs Hughes called again at 9.25am, she said she was told an ambulance would be sent from Toogoolawah. "I reacted a bit and said that would take an hour," she said. She was then told an ambulance would be sent from Lowood. By then her husband, who had just returned home, decided to drive the injured man to Laidley Hospital, where he received 17 stitches.

Member for Lockyer Ian Rickuss said problems were still occurring despite $6 million spent on a computer-aided communications system. He called for the Government to ensure a back-up system was in place to safeguard against further malfunctions.

The article above by Kay Dibben appeared in the the Brisbane "Sunday Mail" on October 12, 2008




Australia: Public hospital negligence causes healthy baby to be aborted

A woman aborted her healthy son because doctors told her - wrongly - the boy would die of a rare terminal genetic abnormality. Corrina, 21, and partner Brad, 25, say they have gone through hell since they ended their son's life at 12 weeks. The Melbourne couple still mourn DJ, their fetus named after Brad's father, Douglas John. They sleep beside his ashes in their bedroom.

Corrina was told her baby had rare Menkes disease - which killed her toddler brother. "I had a termination . . . I lived through it, but for a long time I wanted to die," Corrina said. Months later, she was devastated when, she says, she was told the original Menkes diagnosis was wrong. She is suing two Melbourne hospitals, an international genetic clinic and the Government of Denmark, where some tests were performed.

Corrina's lawyer, Anne Shortall, of Arnold Thomas & Becker said her case was one of the most tragic and unusual. Corrina wants the hospitals, clinic and diagnosticians to guarantee this will never happen again.

Her younger brother Shane died from Menkes disease, which causes retardation, many health problems and a shortened life span. "Shane had no life, was in pain and couldn't cry," Corrina said. "I couldn't put another child through that." Menkes disease (also called kinky hair disease) affects boys and is caused by genetic mutation or passed on by a mother as a carrier. It affects the copper levels in the body and is indicated by high coppery levels in DNA and other tests.

When Corrina became pregnant she feared for her unborn child because her mother and sisters were carriers of the disease and "there was a good chance I was too". "When I was pregnant with DJ, I thought, 'If it is a boy, I can't let him be born as sick as Shane was'," she said. "I was only three, but I remember them taking my little brother, Shane, away, zipping his little body up in a bag - he was only 18 months old.

"I asked the experts to promise me they would put in place some protocols so this mistake would never happen again. "They wouldn't, so I said 'I'll see you in court'."

Ms Shortall said that during Corrina's pregnancy the Royal Women's Hospital's genetics department carried out tests on the fetus. She said experts at a genetics institute in Denmark were consulted and a sample was taken from Corrina's fetus using a kit supplied from Denmark and locally provided saline solution. "On September 22, 2005, Corrina underwent a termination of pregnancy on the basis of the doctors' advice that the fetus was affected by Menkes disease," Ms Shortall said.

Source





12 October, 2008

TWO REPORTS FROM TWO DIFFERENT AUSTRALIAN STATES:

NSW: Hospital statistics are so disastrous that the government disowns its own statistics

They sure are desperate in the NSW government

The NSW Government has an explanation for why some public hospitals are failing to see most of their urgent patients on time -- it does not believe its own health figures. According to the data, in January only 36 per cent of patients with an imminently life-threatening condition were seen within the required 10 minutes of arriving at the emergency department of the Royal Prince Alfred Hospital, in inner Sydney.

But the NSW Health Department says this figure and those for Westmead Hospital are wrong because of problems with collecting data, even though they are included in the performance indicators it publishes to enable people to compare hospitals. Asked by The Weekend Australian why the Government had published incorrect figures, a spokesman for NSW Health Minister John Della Bosca said it was important to publish the information for the sake of transparency. "Although some of the data might reflect poorly on these hospitals, we are prepared to wear that while we try to fix the teething problems," he said.

The revelations add a bizarre twist to the string of claims about fudged figures on hospital performance in NSW and Victoria. Mostly the allegations are that data is being massaged to meet performance benchmarks. But in this case, the NSW Government claims the figures understate the true situation. State governments have responded to dissatisfaction with public hospitals by releasing data on their performances, available on health department websites.

According to former Victorian and NSW premier's department head Ken Baxter, whose consultancy prepared a report on the funding of public hospitals earlier this year, the figures, particularly in NSW, "are not worth the paper they were written on". There were serious doubts about the veracity of the data fed into them from hospitals. Nor were they necessarily the best indicators of performance. "For example, waiting times for elective surgery can be manipulated for what you want out of them," Mr Baxter said.

The report by TFG International, of which Mr Baxter is chairman, found hospital data was "inconsistent, patchy and not readily comparable on a state-by-state basis". Although the states had spent more than $2billion on information technology and data collection systems, this money had "largely been wasted".

Documents obtained by NSW Opposition health spokeswoman Jillian Skinner show that patients are not included on the waiting lists for elective surgery if they cannot be operated on within a certain period.

The problems highlight the challenge the Rudd Government faces in establishing a national system of performance benchmarks on which it will base part of its funding of hospitals under a new agreement with the states due to apply from January 1. Canberra wants to use better and more uniform data to drive improvements in hospital performance. Treasurer Wayne Swan quotes the example of New York state publishing information for hospitals on patients receiving heart bypass surgery. In the three years after the introduction of the system in 1989, mortality rates for cardiac operations fell by more than 40per cent.

The Weekend Australian asked NSW Health why only 36per cent of patients taken to Royal Prince Alfred Hospital in January with an imminently life-threatening condition were seen within the required 10 minutes, compared with the average for all hospitals in NSW of 82per cent.

The figure for the RPA rose in subsequent months and reached 71per cent in June, the latest figures to be published. But it is still below the figures for most other hospitals. The pattern was the same for patients with potentially life-threatening conditions, who are supposed to be seen within 30 minutes, and potentially serious candidates, who should be seen within an hour. The department responded that the explanation involved a "technical issue, related to how data is extracted out of the patient systems into reporting systems ... It is important to notethat clinical care delivered at this hospital remains of the highest quality, although this may not be reflected in the triage benchmarks".

What then of the figures for Westmead hospital, in western Sydney, which showed that just 36per cent of patients with potentially life-threatening conditions were seen within the required 30 minutes in March, compared with the average for all NSW hospitals of 74per cent? Low figures were also reported for Westmead in most other months this year, although they had improved by June.

The department said Westmead and other hospitals were introducing a new emergency department system and that "some initial usability and process issues associated with this new system have been experienced ... This has led to some inaccurate under-reporting against performance benchmarks ... Again, standards of care were not affected". NSW Health said both hospitals had experienced higher-than-average increases in emergency attendances.

The independent and not-for-profit Australian Council on Healthcare Standards, which collects data from hospitals, said last year that only one of the indicators of treatment in emergency departments showed satisfactory results in 2006. This was for the immediately life-threatening cases, required to be seen within two minutes, where the benchmark was met in 99per cent of cases throughout the nation.

Source




QLD: Wire from public hospital surgery left inside EIGHT children

Not just one: EIGHT! Amazing

QUEENSLAND Health has ordered checks on about 200 child hospital patients after wire from a frequently used piece of medical equipment was found inside eight of them. The children have all been treated with what's known as a peripherally inserted central catheter, commonly called a PIC line, used to deliver drugs, including chemotherapy. A PIC line is inserted in a vein in the elbow, and then advanced through increasingly larger veins, toward the heart.

Concerns were raised this week about a particular brand of PIC line after a piece of wire was discovered inside a patient at Townsville Hospital. Australia's medical regulator, the Therapeutic Goods Administration, has been notified of the problem. Queensland Chief Health Officer Jeannette Young said today Queensland Health was in the process of notifying parents of children potentially affected. She urged parents not to panic because there was no evidence of children coming to harm as a result of the wire being left in.

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11 October, 2008

Obama and Health-Care Equity

Barack defends tax subsidies for the rich

For someone running as the tribune of "change," Barack Obama showed again in last night's debate that he sure is comfortable with the status quo on health care. He continued his recent assaults on John McCain's health reform even though it is precisely the kind of plan that someone of Mr. Obama's professed convictions ought to support.

The attacks include swing-state TV spots and Joe Biden's multiple distortions, though the most over-the-top come from the candidate himself. Over the weekend, Mr. Obama called the McCain plan "radical," "out of line with our basic values" and, in case he wasn't clear, "catastrophic for your health care." Since Mr. McCain offered only a once-over-lightly defense of his plan, allow us to give it a try.

Perhaps Mr. Obama is so agitated because Mr. McCain's proposal is highly progressive. The Republican wants to readjust the subsidies that Congress channels into health coverage for business so that lower- and middle-wage workers aren't shortchanged, as they are now. Currently, people who get insurance through their employers pay no income or payroll taxes on the value of the benefit. This is revenue the government forgoes to encourage certain behavior. If those losses were direct spending, the tax exemption would have cost more than $246 billion in 2007.

But all that money props up only employer-provided insurance. For reasons of historical accident and lobbying clout, individuals who buy policies get no tax benefits and pay with after-tax dollars. Mr. McCain is proposing to make the tax benefits available to everyone, regardless of how they purchase their insurance.

He would offer a refundable tax credit of $5,000 for families, $2,500 for individuals, and the benefit isn't dependent on where people work or what they earn. Some would stick with their current job-based coverage. Given the option, others -- especially the uninsured, armed with new health dollars -- would decide to buy coverage on their own. That in turn would stimulate a market for more affordable insurance.

Mr. Obama doesn't want to let people make this choice. He even claims it would amount to "taxing your health-care benefits for the first time in history," which is a wild distortion. His point seems to be that because companies wouldn't have to pay for health care, they could raise wages and thus taxes would also increase for workers on those higher incomes. But doesn't Mr. Obama want higher wages?

All in all, workers would come out ahead with the McCain plan. According to the left-leaning Tax Policy Center, the average taxpayer would see his tax bill drop by $1,241 in 2009. On average, lower-wage workers have more limited coverage as part of their compensation, mostly from small- or medium-size businesses. But the more generous the employer health plan, the more the tax subsidies increase. According to the Joint Committee on Taxation, the current employer benefit is only worth between $600 and $3,000 for people making under $100,000. The upper-income brackets save between $4,000 and $5,000.

The most affluent -- i.e., the top quintile of earners -- would be slightly worse off after 2013 under the McCain plan, though they'd still have plenty of options. Even as he routinely promises to raise taxes on "the rich," Mr. Obama is leaping to their unlikely defense here only to frighten everyone else. The McCain plan is fairer than the status quo, which subsidizes the most expensive employer (and union) insurance plans.

But don't take our word for it. Mr. Obama's chief economic adviser agrees with the McCain critique of the current system, or at least he once did. "This massive program of tax breaks is ineffective and regressive, wasting money on those who have health insurance while doing little for those who can barely afford it and nothing at all for those without it," wrote Jason Furman in 2006 in the journal Democracy. Before he joined the Obama campaign, Mr. Furman championed a health reform that relied on many of the same tax tools as Mr. McCain's.

In contrast to Mr. McCain, the Obama plan is all about expanding government health care. Mr. Obama is proposing a "public option" that is similar to Medicare but open to everyone of any age. With this new taxpayer-funded entitlement, private insurers would be crowded out as the government gradually paid all of the country's health-care costs.

Yet according to the Congressional Budget Office, federal spending on Medicare and Medicaid already takes up 4% of GDP today and will rise to an unsustainable 9% over the next two decades. Mr. Obama wants to add even more costs to this taxpayer balance sheet. The inevitable result as spending explodes would be price controls and rationing.

On choice, portability, quality and especially equity, the McCain health plan is far superior to Mr. Obama's. The Democrat is merely offering Canada on the installment plan.

Source




Shocking public hospital delays in one of Australia's major resort areas

A retiree facing a two-year wait for a surgical specialist's appointment at Cairns Base Hospital has switched to the Townsville Hospital group - and will be seen next week. Barry Wicks, 74, is on four painkillers a day for a trapped navel hernia but is still in constant pain and suffers from nausea when he eats. Doctors have said he needs surgery. But Cairns Base Hospital staff cannot fit him in for a pre-surgery specialist's appointment for another 18 months to two years because of a massive patient backlog.

"I thought I might die before I ended up under the knife," the fed-up 74-year-old said yesterday. "My life's on hold -I can' sit at my computer or in my car for too long, the only real relief is lying flat and I'vbeen told it could get much more serious if my bowel becomes trapped in the hernia."

Mr Wicks went back to his doctor, in the small town of Cardwell south of Tully, and was transferred to the Townsville Hospital group. He will see a visiting surgical specialist at nearby Ingham Hospital next Wednesday and has been told to pack a bag in case the operation goes ahead hours later. The long-suffering retiree said he was relieved to have escaped a "two-year sentence". "I really don't know how I could have held out that long . it' scandalous," he said of the Cairns Base Hospital's surgery backlog.

A Townsville Hospital spokesperson yesterday said no category two patient had waited longer than the recommended 90 days for their "non-urgent elective surgery" in the June quarter.

But a Cairns Base Hospital spokesman confirmed two-year waits for a surgical specialist appointment were "the norm" for category two patients, with a wait of up to three extra months for surgery. "We are very, very busy," the spokesman said, adding the hospital was trying to recruit a new full-time surgical specialist. Category one patients could wait up to two months for a specialist's appointment, while less urgent category three patients were in for a two to three-year wait, he said.

Source





10 October, 2008

Incompetent NHS anaesthetist kills toddler

A toddler who died after emergency surgery for croup had been left in the care of an inexperienced doctor, an inquest has heard. Indya Trevelyan stopped breathing minutes after two consultants had carried out a complicated procedure to unblock her airway. The 20-month-old had been admitted to hospital with the common childhood respiratory infection, which causes a severe cough. But her breathing became laboured and she was given anaesthetic by staff at the Royal Alexandra Children's Hospital in Brighton.

Brighton Coroner's Court heard consultant surgeons Simon Watts and James McGilligan then carried out an emergency tracheotomy to help her breathe. The child's parents Sian, 37, and Nigel, 43, from Crawley, West Sussex, were told the operation on April 15 had been a success. But staff then informed the couple their daughter was being resuscitated.

The inquest was told the consultants had used stitches to fasten down the tracheotomy tube, which had been threaded into Indya's throat to bypass her swollen airway. They then left anaesthetist Dr David Campbell in charge after they finished - even though he had no experience of tracheotomy. The tube became dislodged when she coughed or moved, and when Dr Campbell tried to reinsert it he ripped out the stitches. Indya suffered a cardio-respiratory arrest which led to her death on April 18, after she was transferred to intensive care at the Evelina Children's Hospital in London.

An interim report from Brighton and Sussex University Hospitals NHS Trust concluded her death was 'preventable'. It found the surgeons had 'no plan for the unexpected' and that 'no one took the lead' after she stopped breathing. The report blamed 'weak communication' and stated: 'Indya's preventable death arose out of false assumptions that systems do work.' The hospital is to review doctors' training in the light of the findings.

The inquest heard that Mr McGilligan, an ear, nose and throat specialist, did not leave instructions on how he carried out the operation or how to reinsert the breathing tube. The consultant said: 'I didn't write what the sutures (stitches) were there for, but it was my presumption that anyone would follow why they were there.' He said the stitches had been dislodged by theatre staff trying to replace the tube.

When he realised the tube had blood round it and had become displaced, he moved Indya's windpipe and put the tube back in place. He added: 'In hindsight I would have let everyone in the hospital know what the sutures were there for.' Turning to Indya's parents, he said: 'I want you to know this has rocked our department to the very core. We are terribly saddened by what happened.'

Mrs Trevelyan, who had to be helped into the court by her parents, was clutching Indya's favourite cuddly toy, of the character Laa Laa from the BBC children's television programme Teletubbies. Speaking after the first day of the inquest in August, she described her daughter's treatment as 'appalling'. She said: 'I had dreamt of being a mum for so long. When she first looked up at me the intense love I felt was overwhelming. She was my beautiful angel.'

Croup is an infection of the voice box and the airway to the lungs. It is characterised by a seal-like, barking cough. It affects young children aged between six months and three years. The inquest continues.

Source




BBC's $1,000,000 legal bill for their vicious attack on a private fertility clinic

No big guesses are needed to conclude that the BBC hated the fact that he was both private and much more successful than the NHS

The BBC faces a legal bill of around 500,000 pounds after the collapse of part of its defence to allegations of misleading viewers during a Panorama investigation into a clinic owned by a wealthy fertility expert. Mohamed Taranissi, 54, claimed the flagship current affairs show tricked viewers into believing he enhanced his reputation by offering 'unnecessary and unproven' IVF treatment to wealthy couples desperate to give birth.

During the Panorama investigation into Mr Taranissi an undercover reporter posing as a patient went to one of his Central London clinics, the Assisted Reproduction and Gynaecology Centre. In the High Court, Richard Rampton QC, for Mr Taranissi, said the BBC's legal argument that it had stuck to the rules of 'responsible journalism' had 'blown up in a puff of smoke' as solicitors probed the depth of its research.

On Wednesday, Mr Justice Eady ordered the BBC to make an interim payment to Mr Taranissi, estimated at $1,000,000, covering his legal fees to date after the corporation decided to withdraw one of its defences to his libel action.

Adrienne Page QC, for the BBC, said it could still recover the costs plus extra fees if it successfully defends the libel action on grounds of justification when the full trial begins in January.

Source





9 October, 2008

Privatizing Canadian medicine

Reality creeping in

Since the first private MRI clinics opened their doors in Canada 10 years ago, there has been a national explosion of private health facilities with little policing by the federal or provincial governments, a report says.

Across Canada, there are 42 for-profit magnetic resonance imaging (MRI) and computed tomography (CT) clinics, 72 private surgical hospitals (excluding cosmetic surgery facilities) and 16 "boutique" physician clinics, the Ontario Health Coalition says in a report, entitled Eroding Public Medicare: Lessons and Consequences for For-Profit Health Care Across Canada, being released today.

Inside these clinics, the health coalition charges they found evidence to suspect 89 possible violations of the Canada Health Act in five provinces, including Ontario. Those violations include extra-billing patients for medically necessary services or selling queue-jumping services for a fee of thousands of dollars that let patients quickly access family doctors and specialists. "The contention that for-profit health care can exist along with a public system is not true," said Natalie Mehra, the report's author and director of the coalition. "It is a take-away from the public health-care system."

The deep cuts to Canada's health sector in the mid-1990s set the stage for a privatized system, she said. While the first for-profit MRI clinics opened 10 years ago, in the last five years private surgical and boutique clinics have opened. American health delivery systems are vying for a share of the market. The Cleveland Clinic, a large not-for-profit system in the United States, has a campus on Bay St. "There is a much more aggressive campaign by for-profit clinic owners to move into new territories and expand their operations," Mehra said. Federal and provincial governments have not been fast enough to respond to the changing market, she said. "We need to build the public pressure to make them do that," said Mehra. Every part of the country has been the target of for-profit clinics, except for Prince Edward Island, the Northwest Territories, Yukon and Nunavut, the report found.

The health coalition also noticed that wait times appear higher in areas with the most privatization as health-care workers stretch their time between hospital and private clinic. For instance, Montreal is one of the hardest spots to get a family doctor, yet has quite a few private "boutique" clinics selling two-tier care for wealthy executives and companies, the report notes. The vast majority of people can't afford to pay the private clinics' prices so they wait longer to see a doctor. "For-profit clinics siphon out scarce specialists' time and (schedule) medically unnecessary procedures," Mehra said.

Queue-jumpers who can afford to pay at private clinics do so, and that means people in the public system wait longer, she added. In Ontario and Manitoba, Mehra said, they found local hospitals have reduced MRI hours because technologists have gone to for-profit clinics.

Doris Grinspun, executive director of the Registered Nurses' Association of Ontario, said the federal government has simply "turned a blind eye" and not enforced the Canada Health Act. "If you close your eyes and don't enforce the act, you allow this to happen," she said. Even more of a concern is the Conservative party – clearly ahead in the election race – has yet to release its platform, said Grinspun. "A party that doesn't release a platform and gets elected has a blank cheque to go ahead with whatever they please." She said a clear promise needs to be exacted out of Liberal Leader Stéphane Dion that he will uphold and enforce the act after this election. "Governments have fallen down on it. The Harper government definitely has, but the Liberals did too. This trend needs to be reversed. They need to catch up to the reality that the for-profit clinics are moving into this country and we need to get ahead of them."

Dr. Michael Rachlis, a Toronto-based health policy analyst, says all of this private activity has flown "under the radar" for years without proper government oversight. "With the Conservatives in power, they have no interest whatsoever in moving on this file," he said. "Even in Ontario the provincial government isn't very interested in trying to look and see what happens."

However, there are two points of light – Canadians are devoted to their public health system and the Ontario Wait Times Strategy has driven wait times down in certain areas, such as cataract and cancer surgery and joint replacements. "Almost no one in Canada has private health insurance or goes south for care," he said. "In downtown Toronto, you can phone one number and get a cataract assessment or a hip and knee assessment within a week and get your surgery usually within a month. It's quite clear if we put our minds to it, we can fix these problems."

Source




Ambulance officers call for capsicum spray for violent patients

What depths Australia's socialized medicine system has fallen to!

PARAMEDICS want capsicum spray to protect themselves from violent patients, who are forced to wait for hours outside emergency departments. Ambulance union state organiser Jason Dutton said paramedics were increasingly at risk from angry and aggressive patients left waiting for hours outside crowded hospital emergency departments - a practice known as ramping. A patient assaulted an ambulance officer outside the Cairns Base Hospital's emergency department late last month.

"Paramedics are absolutely sick and tired of being used as punching bags," Mr Dutton said. "They need to be equipped appropriately. I'm not calling for ambulance officers to be allowed to carry guns, but capsicum spray could be incorporated into the training of paramedics and very clear guidelines could be used to assist them. "We're looking at arming paramedics with an appropriate tool so that when they are confronted ... they can look after themselves."

Mr Dutton, from the Liquor, Hospitality and Miscellaneous Union, which represents ambulance officers, said that paramedics sometimes found themselves in situations where they feared for their safety. But unlike police, ambulance officers were not issued with handcuffs, batons, guns and capsicum spray to protect themselves. "Paramedics are expected to treat people - who will often lash out violently at whoever is closest to hand - with no self-defence at all," Mr Dutton said. "We need to give our paramedics adequate protection from violent members of the public."

Mr Dutton said paramedics in some overseas countries were equipped with flak jackets or body armour.

A spokeswoman for Emergency Services Minister Neil Roberts said supplying paramedics with capsicum spray came under the Weapons Exemptions Act, which was a matter for the Police Minister, Judy Spence.

Source





8 October, 2008

You can't park here! Say British hospitals

More of that socialist "compassion"

Lying in the harshly lit anaesthesia room at Great Ormond Street Hospital, my four-year-old son Jimi was frightened. So as his little body collapsed under the weight of the drugs, common sense told me this was the `good bit' - that now he was asleep he wasn't in pain. Diagnosed a year ago with juvenile arthritis - a childhood form of the disease that causes swelling in sufferers' joints, making their limbs seize up so they struggle to walk - he was having steroids injected into his ankles to make them stronger. It is the latest in a string of intrusive and gruelling treatments, including chemotherapy and a cocktail of painkillers, that he has bravely endured to combat his condition.

Forty-five angst-ridden minutes later, he came round from the anaesthetic, groggy and disorientated. We were told to keep him off his feet for at least 24 hours. Carrying him away in our arms, I thought that although Jimi, myself and my partner Simon Boswell were exhausted, at least the worst was over. But arriving back at our car, we came across yet another obstacle to an already traumatic morning. A traffic warden or, as Jimi calls them, a `green man', on account of the colour of his synthetic uniform, was putting a parking ticket on our windscreen.

Because we had arrived back 20 minutes late, we were being fined 60 pounds. I lost my temper. I have spent the past year worried sick about my son's health. I had been pacing our North London home since 4.30am and the last thing I needed was a `Civil Enforcement Officer' - as they are called nowadays - laying down the law to us. He didn't speak, other than to reel off a string of numbers - presumably our offending code - and summon his `co-officer' from across the street. The pair then repeated the numbers to each other, more inaudible machines than human beings.

As I reached in to secure Jimi's seat belt I snapped: `Do you think we're here for a cup of tea and a sodding sandwich? This is a children's HOSPITAL. Our son has just had an OPERATION. For 20 minutes you're fining us 60 pounds? Shame on you!' To their credit they had the good grace to seem embarrassed but their shame was scant compensation. This was the second fine we had received in as many weeks, and it has left both Simon and me incandescent with rage.

Surely, with the parents of a sick child, they could have exercised compassion. Shouldn't a guaranteed parking space in the proximity of any hospital be a patient's right? What are we supposed to do, call an ambulance every time Jimi needs treatment? As difficult as it is to accept sometimes, we are the lucky ones. This spring Camden Council, the London borough under whose control Great Ormond Street lies, issued us with a disabled blue badge. This allows us to park for up to three hours at a time on the single yellow line outside the hospital, which only badge-holders and ambulances are allowed to do. It is a laminated card with a cardboard clock you adjust to show when you parked.

We had arrived at the sick children's hospital at 7am one day last month, the time all youngsters awaiting an operation under anaesthetic are expected to turn up. Wardens control the area from 8.30am. At 11.20am Simon had left us in our hospital room to check on the car. He knew he needed to move it but there was nowhere to go. Parking in London is exorbitant for everyone. However, at Great Ormond Street Hospital there isn't even a car park to complain about. So, unsurprisingly, the street was packed.

Simon adjusted the cardboard clock to 11.20, assuming, wrongly, that wardens patrolling the area would understand our predicament and allow us more time. For both of us, it was the last straw.

Only a week earlier, while waiting for Jimi's pre-operation assessment, we had been fined another 60 pounds. Simon had accidently left our badge - showing the prerequisite photograph of our son's face, along with the badge details, issue number and expiry date - the wrong side up in the car. It was an innocent mistake but one the traffic warden, the same man on both occasions, was prepared to penalise us for.

Technically, of course, we were in the wrong. But isn't 120 of fines, received while clearly visiting a hospital, rather disproportionate? And is the surrounding area of a hospital, which has scandalously limited parking, really a fit zone in which aggressively to pursue council targets? We're not the only ones for whom proximity to the hospital is of paramount importance and I am sure many other parents have encountered the same problems. Nor is this solely an issue for the capital. Hospitals around Britain - ones that do have car parks - often charge an outrageous fee.

Before we were given our disabled badge, we frequented pay-and-display areas other relatives are still forced to use. It costs 20p for five minutes in these - 4.80 per hour - and the maximum stay is two hours. In the year it took for Jimi to be diagnosed we would often have to wait up to five hours to see a consultant. We were never given a precise time for these appointments. Both Simon, a composer, and I would have to take time off work simply to deal with the parking problems, spending hundreds of pounds in the process.

We thought a blue badge would afford us the simple luxury of being able to care for our son - who has been in and out of hospital up to four times a week for the past 12 months - instead of worrying about our car. Evidently, we were wrong.

As a society, we seem to have relinquished responsibility to an automated tribe of traffic wardens who don't even have the manners to offer an explanation. All individuality has been stripped away in their zealous attempts to catch out decent, taxpaying citizens so they can reach the financial targets set by their relentless bosses. They hunt like pariah dogs and relatives of the vulnerable and ill are not their only targets. They will prey on anyone who will help them increase their revenue. I admit that being a traffic warden must be a horrible job. But would it really hurt them to look us in the eye as they slap on their extortionate fines?

Needless to say, we haven't paid either fine. Simon has written to Camden Council arguing our case and asking how they can justify their employees' uncaring attitude. They say they will consider any mitigating circumstances when processing the appeal. I don't blame Great Ormond Street, who are doing a fantastic job caring for our son.

But I worry that unless the council finds more space for patients and their relatives to park in, and exercises more tolerance towards its targets, it is not just his health that will suffer. Countless other sick children will not be able to receive the medical attention they require - simply because their parents cannot park near enough to the hospital.

Source





7 October, 2008

It's amazing what you can end up with as a medical specialist in an Australian public hospital

No wonder around 40% of Australians have private medical cover

Health authorities are investigating 10 serious complaints of medical negligence and sexual assault at a northern NSW hospital by an overseas-trained obstetrician and gynaecologist living in a homeless shelter in Surry Hills. Roman Hasil's NSW medical registration was suspended in February after a damning report by New Zealand health authorities found he had botched a quarter of female sterilisations in 2005 and 2006 and drank on the job.

But the Herald has learnt that 10 former patients at Lismore Base Hospital - where he worked from June 2001 to March 2005 - lodged complaints about him with the Health Care Complaints Commission between February and May this year. Police also confirmed this week that it investigated complaints from two former patients of alleged assault, which it referred to the NSW Medical Board.

The complaints commission confirmed this week that it was investigating that Dr Hasil, who trained in the Czech Republic but was registered here despite a history of alcohol abuse, and despite being jailed in Singapore for threatening his second wife, Rose Doyle, with a knife. His third wife, Sally Hasil, also alleged on NZ television last week that he bashed her several times and broke her ribs.

Dr Hasil failed the Royal Australian and New Zealand College of Obstetricians and Gynaecologists' assessments four times.

The Herald has also learnt that a New Zealand barrister, John Rowan, QC, is preparing legal action against Dr Hasil on behalf of up to 30 women for botched operations at Wanganui District Hospital. Dr Hasil, who is staying at Edward Eager Lodge, told the Herald he was unaware of any patient complaints against him from Lismore and denied assaulting anyone. "Of course it's not [true]. I became depressed. I can't work. I'm on medication and this must stop," he said.

A spokesman for North Coast Area Health Service said that after publicity on the NZ inquiry, 10 patients had "raised concerns regarding care provided by Dr Hasil at Lismore Base Hospital", which had been referred to the complaints commission and the medical board.

However, Lismore hospital failed for five years to address the complaint of one woman, Connie Scholl. Her complaint, in September 2003, detailed shocking allegations of abuse at the hands of Dr Hasil while he stitched her after giving birth in 2002 at Lismore hospital, leaving her with "weeks of pain and a year of nightmares". In a statement to the complaints commission in May, Ms Scholl said Dr Hasil called her a "horse woman" after she kicked him in the face because he was stitching her vaginal and anal area without anaesthetic.

"As Dr Hasil was getting up off the ground I heard him say to the midwives, 'stirrup the bitch'. it was also at this time that Dr Hasil said to me, 'you Australian women don't know how to have babies'," the statement said. It alleged he forcefully put his hand on her vagina and said, "Who is the boss now?" Ms Scholl told the Herald this week she felt "tortured and traumatised" and took years to recover physically and emotionally. She made a formal statement to police in March.

In June the chief executive of the North Coast Area Health Service, Chris Crawford, sent a written apology to Ms Scholl that her 2003 complaint "was not properly investigated".

Another former patient, Tracey Robson, is considering suing Lismore Base Hospital after her daughter Chloe was born with cerebral palsy in August 2002, despite a normal pregnancy and heartbeat just hours before the birth. In a letter to the hospital last March Ms Robson described the caesarean delivery as "very rough". "A lot more pressure was used to deliver Chloe compared to the birth of my twins [also by caesarean]. I believe Dr Roman Hasil is responsible for Chloe having cerebral palsy," she wrote. Within 15 hours, Chloe was having seizures and was transferred to intensive care at Mater Mothers Hospital in Brisbane. Ms Robson said she decided to complain after reading a letter in The Northern Star in Lismore from another woman, Jodie Phillips, who said Dr Hasil had left her "traumatised and scarred for life".

The NZ Health and Disability Commissioner, Ron Paterson, said Dr Hasil had a "chequered history" in Australia from 1996 to 2005. His report also alleged he removed the ovaries of a woman without her knowledge.

Ms Doyle, who lives in Shanghai, told NZ television's One News last week that Dr Hasil left nooses on the bedside table and threatened her with a 30centimetre carving knife. "He said, 'I will kill you and cut you up into little pieces and nobody will find you and I will sell your ovaries on the blackmarket'. I was literally terrified for my life."

His third wife, Sally Hasil, with whom he later lived in Hobart for 12 years, told the TV station he repeatedly bashed her after drinking binges. "On one occasion I was left with four broken ribs. I had strangulation marks, I had a beaten face," she said. His ex-girlfriend, Sally Hock, said in the five months he lived with her in Ebenezer outside Sydney this year, she became frightened of him because he was "obsessed with knives" and went on drinking binges.

Queensland health authorities have reviewed the cases of the 17 patients Dr Hasil treated while working at Rockhampton Hospital for 3« weeks in December 2006 and January 2007 and found two had "an unexpected outcome or deviation from standard practice". It has referred them to the Queensland Medical Board.

Source




Australia: Hospital waiting list blows out in the State of Queensland

Under a Leftist government. Cutting the number of hospital beds sure is "compassionate" is it not? If a conservative government had done the same, there would have been a howl to high heaven

State Opposition Leader Lawrence Springborg says the number of people waiting more than eight hours for a public hospital bed has doubled since 2003-04. Citing leaked data, Mr Springborg described it as a "phenomenal blow-out" in access block - the delay experienced by emergency room patients who need admission to an inpatient bed.

The Queensland Health Emergency Department Access Block tables, which the Opposition claims are unpublished, show that in 2003-04, 15 per cent of people had to wait more than eight hours for a bed. In 2007-08, the figure had blown out to 31 per cent.

The data on 21 major public hospitals suggests the problem is particularly bad in the central Queensland city of Rockhampton, where 31 per cent of patients experienced access block in 2007-08 compared to three per cent in 2003-04. At Nambour Hospital, on the Sunshine Coast, 42 per cent were affected in 2007-08, up from 16 per cent in 2003-04.

Mr Springborg said the Government was failing to keep pace with growth. "Since the Beattie/Bligh Government came to power in Queensland over 10 years ago, the number of public hospital beds in Queensland has actually reduced from 10,800 to about 10,300," he said. "There has been a reduction of almost 600 public hospital beds in Queensland despite the fact that the Queensland population has grown by almost one million in that time. "It should be of no surprise to anyone that people can't get through our emergency departments into a bed if the beds aren't there."

A recent study by the Australian College of Emergency Medicine showed a 20 to 30 per cent excess mortality rate caused by access block and emergency room overcrowding, Mr Springborg said. "By 2003 figures, this is 1,300 patients, on the figures which are available to us now, it may be as many as 1,700 Queenslanders, (who) are losing their lives unnecessarily each year because the state Labor government ... hasn't been able to provide proper care and attention in our emergency departments," he said.

Source





6 October, 2008

The world's biggest computer botch-up: Take a bow NHS

Patients `at risk' from flawed $25BILLION IT system

An NHS computer system intended to revolutionise patient care has so many software flaws that seriously ill or badly injured patients are at risk of being inaccurately diagnosed, according to an internal health service document. An assessment of the system at the first hospital to launch it, the Royal Free Hampstead NHS Trust in north London, details a catalogue of software glitches and design faults. It warns that the problems pose a possible "risk to patients by underestimation of clinical condition".

According to the document, the system, which is being used in the accident and emergency department, is routinely crashing, patient information is intermittently "lost" and some staff are reverting to pen and paper. Extra staff have been drafted in to help cope.

Tony Collins, executive editor of Computer Weekly, said the document, disclosed by an NHS employee, warned that some of the problems could "continue indefinitely". He said: "This is the centrepiece of the Connecting for Health programme [the government's plan to computerise NHS records] and it isn't working properly." Hospital officials said this weekend that continuing problems were being "vigorously" pursued with the contractors while staff were being vigilant to ensure patient safety was not compromised.

The report is the latest setback for the 12 billion pound Connecting for Health programme, which was meant to provide a single nationwide IT system for the NHS containing records for every patient by 2010. While some elements of the programme have been introduced ahead of schedule, the patient record system has been beset with delays and software problems.

Last June the Royal Free became the first trust to launch the most advanced version. To protect patient confidentiality, records can be accessed only with a swipe card and a code. The launch was a key test for Connecting for Health, which has faced questions about the reliability of its systems and whether patient confidentiality could be easily compromised with computerised records. Two months after the launch there were reports of missing data and delays in booking patient appointments.

Now an assessment of the new system at the Royal Free has uncovered a series of problems, which appear to be unlikely to be fixed in the short term. The Royal Free Hampstead NHS Trust said the implementation of the new system was initially better than expected but there were continuing problems that would "take some time" to rectify.

Source




NHS child loses out as surgeon gives liver transplant to private patient from the Gulf

$$$$$$$???

A senior surgeon broke NHS guidelines by transplanting part of a donated liver into a private overseas patient instead of saving it for someone on Britain's waiting list. Professor Nigel Heaton, head of the transplant unit at King's College Hospital in London, transplanted part of the liver into a boy from one of the Gulf states.

The surgeon was the subject of a formal investigation after other doctors said that a child on the NHS organ waiting list should have been given priority. National guidelines state that, because of the acute shortage of donor organs in Britain, livers must be offered to all other NHS centres before they can be given to a patient from outside the EU. There are about 400 NHS patients on the liver transplant waiting list - 20 per cent of whom will die before a suitable organ can be found.

The incident sparked fury among surgeons at St James's University Hospital in Leeds, which first received the liver from a 40-year-old donor. After instructions from UK Transplant, which co-ordinates NHS transplant services, the Leeds surgeons sent the liver to King's for a `super-urgent' adult NHS patient on the understanding that it was to be used solely for that person. St James's only learned the following day that Prof Heaton had split the liver into two when a member of staff from King's contacted them.

Prof Heaton had used the larger right portion for an adult NHS patient and transplanted the left lobe into a seven-year-old boy who had rejected an earlier liver and was seriously ill. He later died.

A senior medical source said: `This was clearly a violation of procedure. It should have been offered back to every other hospital within the NHS and then throughout Europe before going to a non-NHS recipient. `There is no process for it to go to a non-entitled patient on compassionate grounds. It just doesn't happen.'

David Mayer, chairman of UK Transplant's Liver Advisory Group, said the Leeds doctors had been extremely concerned because they had a sick child, an NHS patient, who could have benefited if they had known the liver was to be split. He added: `If we were to provide livers for the world from the UK, then UK patients would be enormously disadvantaged.'

The procedure of splitting livers has been developed in recent years to counter the shortage of donor organs, particularly for children. Because livers are able to regenerate relatively quickly, two patients, usually an adult and a child, can be treated with one organ. Normally, livers from donors aged over 40 are considered too old to split, so UK Transplant had not expected this to happen in this case.

In a statement, King's said they had applied to have the Gulf state's child considered for priority liver transplantation on compassionate grounds and that there had been no objections. They said that the investigating panel had found that guidelines had been breached and that it had recommended that King's review its practices and ensure all staff were aware of transplant guidelines. A King's hospital spokesman confirmed that Prof Heaton had been paid for the original transplant on the private patient - which had been rejected - but had received no further fee for the second operation.

The surgeon, who lives in a 1million pound detached house in Beckenham, Kent, gave George Best a liver transplant three years before the alcoholic ex-footballer died of multiple organ failure. Earlier this year, this newspaper revealed that King's had agreed with the Greek and Cypriot governments to treat patients from those countries privately using NHS livers, charging around 85,000 pounds per operation.

King's has given livers from UK donors to 22 private patients from Kuwait and the United Arab Emirates in the past five years. The hospital has made more than 4million from performing transplants on overseas patients in that time.

Source





5 October, 2008

Single-Payer Health Care: Immoral and Deadly

The following letter on the dangers and immorality of single-payer health care was co-authored by Brian Schwartz, Ph.D. and Paul Hsieh, M.D. in response to an article in the April 2008 issue of Annals of Surgery supporting such a policy (Sarpel U, Vladeck B, Divino C, et al. Fact and Fiction: Debunking Myths in the US Healthcare System. Ann Surg 2008; 247(4):563-569; available at Medscape here, registration required [free]).

The journal describes itself as “the world’s most highly referenced surgery journal, provides the international medical community with information on significant contributions to the advancement of surgical science and practice.” The Editorial Board rejected it. The reviewer stated:

This is a very biased and vitriolic letter. There certainly is a broad range of opinion as to the best system of health care for the United States and open discussion is to be encouraged. However, to call a single payer system, that serves much of the Western world with equal or better results than we achieve in the United States, “immoral” and “deadly” is inappropriate and serves no purpose. Prior to consideration for publication, this letter needs to be toned down several notches.

The reviewer apparently believed that it was out of bounds to question either the morality of single-payer health care or the alleged fact that it yielded “equal or better results” than the American system. Of course, these were the very points that we believed needed to be challenged and discussed in an open fashion.

Also, as shown here, while the journal was “happy to evaluate a revised version of this manuscript,” the reviewer provided minimal guidance on appropriate revisions, and our request for more constructive feedback was ignored.

We submitted a revised version, which the reviewer found “not acceptable for publication in the Annals of Surgery.” We’d like to let readers decide for themselves. Here is the complete text of this revised version.

Single-Payer Health Care: Immoral and Hazardous to Patients’ Health

In “Fact and Fiction: Debunking Myths in the US Healthcare System”[1], Sarpel et al presume “an obligation to provide healthcare to those who need it.” This faulty moral premise underlies all forms of socialized medicine (including the single-payer system they advocate) and should be rejected by Americans as immoral and antithetical to core American values.

The only moral and proper role of government is to protect individual rights of its citizens. But health care is a need, not a right. A right is a freedom of action one possesses, such as the right to free speech. Rights are not automatic claims on goods and services produced by others — that is just state-sanctioned robbery. If a man is hungry, he doesn’t have the right to take a can of soup from his neighbor’s pantry. A man’s rights imposes only the negative obligation on others to not violate those rights, not a positive obligation on others to provide for all his needs.[2]

Whenever a government attempts to guarantee any service (such as health care) as a “right,” it must also control it. This can only be done by violating citizens’ actual rights. Under a government-run single-payer system, bureaucrats ultimately decide who receives what care and when, not doctors and patients. Doctors must work under the government’s terms and for the government’s prices. The inevitable result is a system like Canada’s, which harms both patients and doctors through its infamous waiting lists and rationing.

Canadian patients routinely suffer and die while waiting for their “free” health care. According to the Vancouver-based Fraser Institute, “Canadian doctors say patients wait almost twice as long for treatment than is clinically reasonable, …almost 18 weeks between the time they see their family physician and the time they receive treatment from a specialist.”[3] A Canadian woman with a newly-diagnosed breast cancer might wait several months before she receives the appropriate surgery and chemotherapy.[4] The Canadian Medical Association noted, “Protracted treatment delays increase mortality and morbidity rates. [In a 12-month period in Ontario], 71 patients died while waiting for CABG [and] 121 were removed from the list permanently because they had become medically unfit for surgery.”[5] The Supreme Court of Canada summarizes these injustices: “[W]aiting lists for health care services have resulted in deaths, have increased the length of time that patients have to be in pain and have impaired patients’ ability to enjoy any real quality of life.”[6]

The Canadian single-payer system takes its toll on doctors as well. According to the New York Times, significant numbers of frustrated neurosurgeons have left Canada for the US (a net loss of 49 out of a total of 241 in the entire country over a six year period). The surgeons’ primary complaint was not money but rather a government bureaucracy which “increasingly rations service because of various technological and personnel shortages,” making it impossible for them to practice according to their best medical conscience.[7]

American health care has genuine problems, but they were not caused by the free market but rather from decades of government interference in the free market, as documented in an article co-authored by one of us (PSH).[8] For example, politicians should not dictate whether consumers buy insurance on their own, through a membership group, or through their employer. But, as Sarpel et al acknowledge, the tax-exempt status of employer-sponsored insurance does just that. It locks employees to their jobs, shields insurance companies from competition, and encourages excess insurance coverage which gives patients little incentive to be cost-conscious consumers.[9]

Instead of worsening the current government-caused problems by imposing more futile controls, politicians should adopt free-market reforms that respect individual rights. At the federal level, legislators should eliminate the employer tax break and lower tax rates commensurately. A second-best solution would be to extend the tax exemption to all medical insurance and expenses. Health Savings Accounts are a step in this direction, but 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.[9]

State-level reforms to make insurance affordable include eliminating mandatory insurance benefits, community rating, and guaranteed issue. Largely because of such controls, the average price of individual and family insurance in the five most expensive states is three times the price in the five least expensive states.[10] Repealing laws that forbid purchasing health insurance across state lines would make health insurance available to millions who currently cannot afford it, while respecting individual rights.[11]

The free market has done a magnificent job in providing Americans with all other necessities of life, such as food, shelter, and clothing, and can do the same for health care if freed from government interference. Patients trust their physicians with their health and their lives. Physicians must not betray that trust by turning them over to the tender mercies of a single-payer socialized medical system that, as we contend, would be both deadly and immoral. They should instead demand free-market reforms.

Source





4 October, 2008

Unbelievably low standards in British medicine

Blood-pressure tests are about the most routine aspect of medical practice that there is -- but not in Britain, apparently. It is usually very difficult to change doctors in Britain and I myself noted a "take it or leave it" attitude among British GPs when I was there. In Australia it is as easy as pie to change doctors and Australian doctors are much more polite, attentive and obliging. Funny that! So I am not really surprised that the complacent attitude of British GPs extended to the low level of care described below. A simple blood-pressure test could have saved a life

The family of a documentary film-maker who died of heart failure at the age of 43 won six-figure damages yesterday from three doctors who failed to diagnose and treat his worsening condition. Nick Rossiter, who created the popular art programme Sister Wendy’s Odyssey, had been suffering “increasingly severe” hypertension before he had a fatal cardiac arrest in July 2004.

Mr Justice Foskett, sitting at the High Court, was told that Mr Rossiter’s death would have been avoided had Pearl Chin, Cathy Benson and Sharon Alikhani, GPs at the Westbourne Grove Surgery, West London, prescribed appropriate medication from December 2003 onwards. The three GPs, who treated Mr Rossiter between 2001 and his death, admitted to a breach of duty in having failed to spot and appropriately treat his hypertension.

Mr Rossiter left a widow, Beatrice Ballard, a celebrated television producer in her own right, and two daughters, Alice, 11, and Pandora, 9. The amount of damages was not disclosed in court but Ms Ballard, the daughter of the novelist J. G. Ballard, said: “No amount of money can replace my children’s father, but it will help in securing their future.” The judge described the loss as “almost impossible to value”.

The court was told that Mr Rossiter had visited Westbourne Grove Surgery two months before his death, but left without receiving a vital blood-pressure test. The defence had argued that Mr Rossiter may not have completed his course of medication even if he had been prescribed it. But Ms Ballard’s barrister, Henry Whitcomb, dismissed the claim on the grounds that Mr Rossiter was a highly intelligent man who had given up smoking and was “absolutely devoted to his family”.

After the decision, the family’s solicitor, John Pickering, said: “The end of this case comes as a huge relief to Nicholas’s wife, and will provide a secure future for their daughters. Doctors Chin, Benson and Alikhani . . . did not treat him with antihypertensive medication as they should have done. “His family are relieved that this matter is now closed and they can move on with their lives.”

Source





3 October, 2008

McCain Is Right On Interstate Health Insurance

It's time to modernize our market

Let's hope Democratic presidential candidate Barack Obama understands more about financial markets than he does about health-insurance markets. But the initial evidence isn't promising.

A recent kerfuffle between Mr. Obama and Republican presidential candidate John McCain concerned the interstate purchase of health insurance. Mr. McCain wants to allow people to buy health insurance across state lines. Mr. Obama, on the other hand, opposes the idea and seems to believe it would create an unsafe, unregulated health-insurance market.

Mr. McCain backs legislation sponsored by Arizona Rep. John Shadegg. Known as the Health Care Choice Act, it would allow individuals living in one state to purchase health insurance being sold to people living in other states. The policy would still have to meet the regulations of the state in which it is being sold, and would be subject to additional federal oversight.

In other words, the McCain-Shadegg reform would allow a person living in New Jersey or New York to buy health insurance that is being sold in and regulated by Pennsylvania or Connecticut. That's hardly the Wild West of health insurance.

About 18 million Americans today buy health insurance in the individual market because they don't have access to employer coverage or they aren't in a government-sponsored program (Medicare, Medicaid, etc.).

Many people in the employer-provided group market -- about 160 million Americans -- can already get health insurance across state lines. As a senator Mr. Obama, for example, lives in Illinois, but can get his health insurance through the Federal Employees Health Benefits Program, which is not located in Illinois. In addition, lots of small employers who offer health insurance through state-regulated insurers have employees who live in other states. And when my youngest daughter moved from Texas to New Jersey to go to graduate school, she remained on our family's Texas-regulated health insurance. In fact, people living in one state who buy health insurance in the individual market often move to other states, carrying their insurance policy across state lines.

Almost no problems have arisen from all of these interstate coverage options. So why are the two presidential candidates fighting about expanding interstate health-insurance options?

Mr. McCain recognizes that millions of Americans, many of them uninsured, live in states that impose numerous mandates -- there are about 1,900 mandates nationwide -- and restrictions that make health insurance unaffordable. Mr. McCain's proposal would simply let individuals faced with high prices and few options in their own state buy a regulated policy in another state. That's how other industries work. People buy just about everything across state lines, with very few problems.

Mr. Obama ignited the latest feud by telling an audience, "So let me get this straight -- he wants to run health care like they've been running Wall Street," according to the Washington Post, implying that Mr. McCain would relax insurance regulations.

Mr. Obama opposes interstate sales for two reasons. First, he doesn't believe a market can work in health insurance. He believes it is necessary for the government to look over everybody's shoulder to make sure patients are getting the care and coverage the government thinks is appropriate at a price the government considers affordable.

Second, Mr. Obama likes benefit-rich policies that cover virtually everything, but are also very expensive. He wants people to have the types of health-insurance plans that the uninsured can't afford. He will "solve" the affordability issue by imposing price controls and regulations on insurers and drug companies, and force taxpayers to subsidize the rest of the cost.

Creating an interstate option for individuals to purchase health insurance doesn't solve every problem faced by the 45 million Americans who are uninsured. But the choice isn't between a regulated or unregulated health-insurance market. The choice is between an overregulated market favored by Mr. Obama and a regulated market favored by Mr. McCain that provides more options to help individuals afford health coverage.

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2 October, 2008

British children are still being treated in adult psychiatric wards

Hundreds of mentally ill children and teenagers are being treated on adult psychiatric wards in defiance of a government promise to halt the practice. A report that lifts the lid on the desperate state of mental health services for young people says that only 15 per cent of health trusts have complied with the Government’s commitment that all young people would be treated in special units, not with adults, by this November.

The findings come from the charity Young Minds and the Children’s Commissioner, Sir Al Aynsley-Green. He has, for the first time, used his powers to force primary care trusts (PCTs) to disclose what is going on in clinics and psychiatric hospitals. The report, entitled Out of the Shadows?, says that mental health services for children and teenagers are so stretched that 72 per cent of inpatient referrals are turned away, forcing young people to travel hundreds of miles from their home or, more commonly, to be sent to adult wards.

No national figures on admissions are collected by the NHS but research by the Royal College of Psychiatrists suggests that about a third of the 3,000 or so children and teenagers admitted for inpatient psychiatric treatment each year end up on adult wards. PCTs were told more than 18 months ago that this must stop. It will become illegal in 2010 for all but the most dire emergencies under the new Mental Health Act.

The Children’s Commissioner has singled out some basic standards that adult wards must meet when young people have to be treated there. These are based on government guidelines and the UN Convention on the Rights of the Child. The standards are to ensure that young people feel safe from other patients, know why they are there, what drugs and other treatment they will receive, can maintain contact with their peers and continue with their education.

However, the report says that about half of all PCTs make no special provisions when children are admitted to adult wards. Fewer than one in four trusts allocates young people a key worker with any training in children’s mental health. The report says that is a serious concern. Less than half comply with guidance that young people must be given information on what medication they receive, for how long they will have it and possible side-effects. Only a third have facilities for education and only a quarter offer any daily activities for young people. This has been identified as a particular problem as it is very harmful to leave children and young people “watching the wall” for hours on end.

Independent advocacy, particularly important to young people who are sectioned under the Mental Health Act, is available in 75 per cent of wards and clinics but only 20 per cent advise patients of the service and only a handful have an advocate who has expertise with children. Professor Aynsley-Green said that while some of the findings were encouraging, some trusts clearly did not believe that young people’s mental health was a priority.

Lois Ward, 20, a representative from Young Minds, who helped to compile the report, said: “The young people entering mental health services have their lives ahead of them and it is essential that the environments in which they are placed are safe, supportive and serve to boost their potential in the future.”

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Australia: Paramedic assaulted after public hospital treatment delay

HOSPITAL overcrowding has been blamed for a patient assaulting a paramedic while waiting to be admitted to the Cairns Base Hospital emergency department. Queensland Ambulance union state organiser Jason Dutton said a frustrated patient kicked and punched a paramedic in the head and back as he waited to be treated by emergency specialists. He said the patient, who had been picked up by paramedics at a nightclub, had been waiting outside the hospital in an ambulance before attacking the officer in the early hours of last Thursday morning. The man was seeking treatment for non-life threatening injuries after being involved in a fight.

Bob Lackey, regional delegate for the Liquor Hospitality Miscellaneous Union, which represents ambulance officers, said hospital staff sent security guards to help ambulance officers restrain the man but it was two and a half hours before the patient was finally admitted to the emergency department. "They've got secure areas inside the hospital where they can put patients like that until they calm down," he said. "As a union, we're pretty disgusted. The man was already aggressive. Waiting to get into the accident and emergency department didn't help."

Mr Dutton said Queensland Health needed to address hospital overcrowding to limit aggression aimed at paramedics. Ambulances are frequently forced to wait outside the busiest hospital emergency departments for hours before they can offload patients - a practice known as ramping. "Our members are in the firing line when it comes to people's frustrations and anger," Mr Dutton said. "A lot of our members have been getting verbal aggression but this is the first time that I've been told, as a direct result of ramping, that an officer has been assaulted. "That's unacceptable."

Mr Roberts said the Queensland Ambulance Service continued to work proactively with Queensland Health to minimise delays in handing over patients to emergency department staff.

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1 October, 2008

Huge NHS doctor-training blunder

This is just the latest episode in a series of hugely wasteful doctor-training blunders. CREATING doctor shortages seems to be a British specialty

DOZENS of foreign doctors have been forced to abandon their training as consultants in the Scottish NHS following a bureaucratic own-goal by UK ministers. The medics were invited to Scotland under the Fresh Talent scheme to help address the chronic shortage of consultants and have had $500,000 each spent so far on their training. But new immigration rules imposed by the Home Office mean their trainiing has had to be cancelled before they make consultant. It is now feared the junior doctors will leave Scotland, robbing hospitals of badly needed skills and wasting around $12m of taxpayers' cash.

The British Medical Association (BMA), the body which represents doctors, last night branded the situation "unacceptable". Sources close to Jack McConnell, the former First Minister who introduced Fresh Talent, revealed UK officials were warned about the effect the new rules would have but failed to act. Fresh Talent was launched in 2004 to boost Scotland's population and economy. Some overseas medical students used the scheme to apply for work permits, while others used alternative visa programmes. But it has now emerged that the scheme was not accounted for under the UK Government's new immigration laws.

It means that if a trainee doctor holds a Fresh Talent work permit and wants to remain in the UK for more than two years after graduating from medical school, they must stop training, forcing them to either remain in junior doctor positions or leave the country. The revelation comes amid a huge rise in the number of consultant posts lying vacant across the NHS in Scotland. There are 4,035 consultants working in the NHS in Scotland, a record high. But the number of vacant posts, 290, is almost double that of 1997.

Last night, Dr Andrew Conway-Morris, deputy chairman of the BMA's Scottish Junior Doctors Committee, described the immigration problem as an "unacceptable" waste of taxpayers' money. He said: "These changes mean that doctors who have been educated and have begun their training in NHS Scotland could be prevented from accessing speciality training posts. "Because of this confusion, these doctors' careers are under threat. This is unacceptable for doctors who have demonstrated a commitment to the NHS in Scotland and is a waste of taxpayers' money."

One junior doctor affected by the scheme is 24-year-old Kah Fai Wong, at Aberdeen Royal Infirmary. Wong, from Kuala Lumpur, Malaysia, wants to become a consultant cardiologist. Across the NHS in Scotland, 7.4% of consultant cardiology posts are vacant. Wong transferred to Aberdeen University in 2005 to complete his studies. But despite three years of training in the NHS in Scotland, he may now have to move to New Zealand to fulfil his ambition. He said: "I was told it made sense to do the Fresh Talent scheme, and I did so, but I have now learned that there will be restrictions on my visa. This takes away my chance to apply for speciality training. "I had planned to stay in Scotland for a long time and train to a certain level, but now it looks like I will be going back to Malaysia or to New Zealand or Australia. "Colleagues of mine in other parts of the UK have the right visa and can apply for the training posts. But I know of at least six people in my area who have the Fresh Talent visa, who are from Malaysia and Kuwait. We went for the wrong visa and now we are facing problems. "Basically, I am left with no option. I could work as a locum in this country but that is not career progression. It is dreadful. I would love to stay in this country but if the visa is causing me trouble, I have no choice. My career is the top of my list."

Margaret Watt, chief executive of the Scotland Patients' Association, said: "I know there is a shortage of some consultants, such as cardiologists, because I have a heart condition myself. There are long waiting lists. "If these doctors want to fill these posts, I don't know why anyone is stopping them. We have a shortage of doctors, nurses and consultants in the NHS. "This move will deny patients access to top professionals. If we had more consultants, we would have shorter waiting lists. This is wasting doctors' time and taxpayers' money."

It is understood that senior Labour politicians were warned of the problems by the previous Scottish Government when the immigration laws were being planned. A source close to McConnell said: "This issue was raised and had been dealt with. It has obviously slipped off the radar." A spokesman for the Scottish Labour Party said: "The Fresh Talent scheme was a great achievement. The SNP Government should work constructively with the UK Government to find a sensible solution without jeopardising our new points-based immigration system." The Scottish Government declined to comment.

A spokeswoman for the Home Office said: "We are still looking at the system and the options for medical graduates."

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Australia: Dying man's wait for public hospital bed

A terminally ill man who spent 26 hours in the Caboolture Hospital's emergency department waiting for a bed does not want others to suffer the same fate. John Shea, from Bongaree, said he was admitted about 5pm on September 3 but it took until about 3pm the next day to find a bed in a public or private hospital.

Mr Shea, who has brain and lung cancers, said he spent another four hours waiting for an ambulance to take him to a private hospital in Brisbane. ``In four or six weeks I should be gone but I'd like to see other people be protected,'' Mr Shea said. ``They're understaffed and it's not good enough and I think we deserve something better from our politicians.''

Mr Shea contacted the Herald after reading last week's article on claims northside ambulance stations were understaffed. His wife Maureen said the Caboolture Hospital's emergency department was full when her husband was there. ``They had people coming and going everywhere,'' Mrs Shea said. ``It was just a bit chaotic.''

The Herald asked the Health Department to comment on the Sheas' claims but it did not respond before deadline. Earlier this month it said the Caboolture Hospital's usual occupancy rate was 90 percent.

Former local Australian Medical Association representative Dr Ray Huntley said the hospital had been running at close to capacity for three years and something should have been done to boost its capacity.

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