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



30 September, 2008

Patient to sue NHS over top-up drug

A woman's fight to halt the withdrawal of her free care could shatter goverment rules on drugs. But fancy having to sue to get the healthcare you have already paid for! I guess that's what's called socialist compassion

A WOMAN cancer patient is taking a landmark legal action against the National Health Service for withdrawing treatment because she has chosen to pay for a drug that the NHS does not fund. Sue Bentley, a potter, has had her NHS care withdrawn after paying privately for the drug Avastin to increase her chance of fighting lung cancer. The legal action will put pressure on the government to change its policy of penalising patients who try to improve their chances of survival by buying additional drugs.

An inquiry into the scandal, to be published at the end of October, is widely expected to propose that patients should be allowed to pay for additional drugs without losing their NHS care. Ministers will then consider changing the rules but patients such as Bentley say they do not have time to wait. Bentley, 67, from Monmouthshire, who was diagnosed with the disease last December, said: “We were told there was no way we would be allowed to top up and that we would need to opt out of the NHS and pay for everything. “It is quite frightening because, if I become ill, I know that we will need to pay up to $900 a day for me to go into hospital, as well as all the treatment costs.”

In addition to the Avastin, Bentley is also receiving two other drugs, cisplatin and gemcitabine, which are normally available on the NHS. She is now being charged for these drugs which are free to other NHS patients. She added: “Everyone else is getting the cisplatin and the gemcitabine for free. I am sitting beside them and I am being billed. It is horrendous.”

Bentley will challenge in court the decision by her hospital, Velindre NHS Trust, Cardiff, to refuse to allow her to pay for an additional drug without losing her NHS care. In previous legal challenges, the NHS has capitulated either by agreeing to fund the additional drug or by the hospital allowing co-payment. This is unlikely to happen in Bentley’s case.

Bentley’s solicitor, Melissa Worth, of Halliwells, the Manchester-based law firm, has a QC’s opinion stating that the NHS has no legal right to prevent Bentley paying for a private drug while continuing to receive her state-funded care. Worth said: “Ms Bentley has paid for her NHS care through insurance contributions and there is no bar to a patient purchasing a drug not ordinarily available on the NHS, bringing that to a hospital and having the NHS administer that drug. “These patients are not taking anything away from the NHS.”

Halliwells is not charging Bentley for its representation. Doctors for Reform, a group of 1,000 doctors, has a $70,000 fighting fund to pay any legal costs awarded to the NHS if Bentley loses her case.

Bentley’s companion of 24 years, Steve Rogers, 52, a conservationist, has paid for Avastin, which costs about $6,600 a month, from savings. He found trials on the internet showing that patients who add Avastin to their treatment are more likely to see their tumours shrink and will increase the time before their cancer returns.

The couple must also pay for the cost of the chemotherapy drugs, which would otherwise have been available to Bentley on the NHS, and the charges for administering them. Bentley’s oncologist, who is backing their decision to pay for Avastin, has waived his fees.

Velindre NHS Trust defended its decision to withdraw NHS care. Malcolm Adams, medical director, said: “Velindre’s policy is that patients cannot switch between NHS and private healthcare within a particular treatment episode. “The Trust awaits the outcome of this [Department of Health] review with considerable interest.”

Source





29 September, 2008

Nasty British bureaucrats surrender! They knew that their petty harassment of private medicine would not stand up in court

IVF watchdog lifts ban on Mohammed Taranissi to avoid challenge in High Court. He was so successful he made the NHS look stupid: Unforgiveable!

Mohammed Taranissi, Britain’s most successful fertility doctor, has been cleared to continue running his London clinic by the IVF watchdog, after it agreed to rescind a disciplinary ban imposed last year. The Human Fertilisation and Embryology Authority (HFEA) will annul its ruling that Mr Taranissi was unfit to be in charge of his Assisted Reproduction and Gynaecology Centre (ARGC), to avoid a judicial review.

The doctor, who has long boasted Britain’s highest IVF success rates, was stripped of his right to be “person responsible” for the clinic last July, after an HFEA committee found that he had been practising without the proper licence.

Mr Taranissi, however, was granted permission to challenge the decision in the High Court, on the ground that the panel could have appeared to be biased against him. Rather than risk a defeat that would have been highly damaging to the authority, it will set aside the decision and pay his legal costs. The climbdown is the latest of a string of costly legal embarrassments for the HFEA over its handling of the doctor. In June last year the High Court ruled it had illegally obtained a warrant to search Mr Taranissi’s clinic, leaving the regulator facing a legal bill that could reach $2 million.

It was also forced to clarify in court comments made by Angela McNab, then its chief executive, in a BBC Panorama programme broadcast last January. Mr Taranissi is suing the BBC for libel over allegations in the documentary that his clinic put pressure on patients to pay for unnecessary treatments.

The HFEA’s climbdown will also encourage the doctor as he prepares to defend a General Medical Council hearing into complaints from two unnamed patients, which begins on Monday. One of the women alleges that the ARGC put inappropriate pressure on her to have particular treatments, and the other claims he failed to examine her properly and was insensitive to her husband. In both cases, he is also accused of failing to keep proper records. Mr Taranissi denies the allegations, which the HFEA investigated in 2003 and 2004 without ruling against him.

The HFEA’s action against Mr Taranissi followed Panorama’s claim that he treated patients during 2006 at a second London clinic, the Reproductive Genetics Institute, while it did not have the correct licence. Mr Taranissi has always rejected the charge, contending that he had been given special permission to continue therapy after the licence expired. He appealed against the sanction, which is among the toughest that the HFEA can impose, and which has been used only once before. The decision to strike out the licence committee’s ruling means that appeal will now not be heard. Instead, Mr Taranissi has been cleared to continue practising while he applies for a fresh licence. The agreement between the parties still has to be sealed by a judge, but this is expected to be a formality.

His application will be considered by six new members of the authority, who were appointed this month at the request of Dawn Primarolo, the Public Health Minister. It was agreed that authority members who had deliberated on the doctor’s case before could not be involved without the appearance of a conflict of interest.

Mr Taranissi said yesterday: “I always maintained that the decision was wrong, and I am delighted it has been set aside. I hadn’t done anything wrong and I wouldn’t accept it.” He said his case had highlighted serious flaws in the HFEA’s appeals process. “It is impossible to complain about their decisions to anyone apart from the HFEA, and that cannot be right,” he said. “I was fortunate enough to be able to afford to take legal action, but most people won’t be. There needs to be a way for people to appeal to a third party, without having to go to court.”

Source





28 September, 2008

Sleepy British paramedic service kills woman

The evening of May 25 last year had all the makings of a great night for Rebecca Wedd. She had turned 23 the day before and was on her way to a summer ball to celebrate finishing her final year at college. Instead, it ended in her death.

Ms Wedd was knocked down by a car near Coates on her way to the party at the Royal Agricultural College in Cirencester, Gloucestershire. An ambulance was called but it took 42 minutes to arrive. By the time she reached an A&E department, almost 40 minutes later, "it was too late", her father said.

Peter Wedd, 53, from Cambridge, said that his daughter had been let down in the worst possible way. "I had always thought that Britain's ambulance services were the best in the world. Clearly, I was wrong. I could blame anybody for her death. Becky was clearly in a position she shouldn't have been. The car driver didn't see her. But the fact is . . . Great Western Ambulance Service did not do its job."

The service's target response time for life-threatening emergency calls is eight minutes. "They missed it by 34 minutes," Mr Wedd said. "It's appalling."

The Healthcare Commission investigated Great Western Ambulance Trust over Ms Wedd's death. It found that the trust had "learnt lessons" from the case and made improvements to its service.

Mr Wedd said: "People should be aware of how the ambulance service failed that night. Services . . . should sit up and say, `This is not going to happen here'."

Source




Emergency NHS patients still waiting too long to see doctor, review says

Patients who need emergency medical care are facing unnecessary delays in seeing a doctor, despite government targets to speed up urgent treatment, a review says today. In the most comprehensive review yet of NHS emergency and urgent care, the Healthcare Commission found significant variations in how patients are treated across England, particularly on evenings and at weekends.

In some hospitals only 40 per cent of patients were seen by a doctor or nurse within an hour of arrival at the accident and emergency department, while others achieved 100 per cent. The proportion of children with a broken arm or leg who attended A&E and were given pain relief within one hour varied from 20 per cent in some hospitals to 100 per cent elsewhere.

The review, which measured the performance of local ambulance trusts, accident and emergency departments, out-of-hours GP and telephone services and walk-in centres, found that patients were often confused over where to seek help. Overall, emergency care services were "least well performing" or only "fair" in four out of ten areas, with some patients facing delays in transfers to hospital, which are not covered by existing targets.

A new national target is needed to measure how quickly patients receive care from the moment they call an ambulance to the point of admission to casualty departments, the commission suggests. This would provide a more accurate assessment of patients' experience than existing measures, which only cover ambulance response times or stipulate a maximum four-hour waiting time in A&E.

In some A&E departments, for 95 per cent of the time, ambulances are back on the road within 15 minutes of delivering a patient, but in other departments this figure is as low as 10 per cent. This could reflect delays because of a lack of staff or beds to admit a patient, the commission said.

Its review found on average, that services in rural areas performed better than those in urban areas, such as London.

In total, out of 152 primary care trust areas, a third were ranked "best performing" in urgent and emergency care; 41, or 27 per cent, were better performing; 33, or 22 per cent were fair-performing; and 28, or 18 per cent, were categorised as least well performing. Services in the North East performed best overall, with all of the region's trusts rated as "best" or "better performing".

Anna Walker, chief executive of the Healthcare Commission, said there had been improvements in performance on government targets, with 97.9 per cent of A&E patients being treated within the four-hour target in 2007-08, up from 91.2 per cent in 2003-04.

Mike Penning, Conservative MP for Hemel Hempstead, said the Government was "hitting self-imposed targets, but missing the point in providing care. Patient outcomes are being neglected."

Source





27 September, 2008

Canada: Man dies after 34-hour wait in ER

Despite him being drawn to the attention of hospital personnel several times and despite the presence of staff employed to check up on waiting patients. Basically, no-one gave a sh*t

It's an unacceptable tragedy that a man waited 34 hours in a Winnipeg hospital emergency room and was dead for several hours before he was finally brought to the attention of medical staff, Premier Gary Doer said yesterday. Although the 45-year-old man - who CTV Winnipeg identified as a double amputee named Brian Sinclair - was "a regular" at the emergency room, regional health officials say he was never registered or seen by triage nurses over the weekend until it was too late.

"The bottom line is we are not making an excuse for this," Doer said yesterday following a grilling over the incident in the legislature. "This is a tragic incident and it shouldn't have happened."

Sinclair was dropped off at the hospital by a taxi Friday afternoon after visiting a downtown health clinic, which is part of the regional health authority. Some hospital staff did speak with the man at some point, but it was not until shortly after midnight on Sunday that he was examined and pronounced dead. The cause of death has not been released.

CTV Winnipeg quoted a man who did not want to be named as saying he had been in the emergency room on the Friday night and had seen Sinclair sitting in his wheelchair, looking like he was asleep. When the man came back the following night, he noticed Sinclair's position had not moved so he told nurses and security workers, who responded they were too busy to check on Sinclair. He also told a security officer of Sinclair's condition, but the guard told him the case would be "too much paperwork." "The nurse said we'll go and check, (but) nobody ever went and checked on him," said the man. "We waited another hour or so and we told another nurse twice to go and check."

Doer said the province followed the recommendation of an earlier task force and hired reassessment nurses who are required to check up on registered patients waiting in the emergency department, but Sinclair was never even registered with the triage nurses.

"This system broke down and there were tragic circumstances," Doer said. The hospital wasn't short-staffed at the time and a re-assessment nurse was on duty, he added. Brock Wright, chief medical officer of the Winnipeg Regional Health Authority, said he's baffled about how Sinclair could have fallen through the cracks. When the man was finally discovered by emergency room staff, Wright said he "had been dead for some time." "It's hard to imagine how somebody could be in the department for 34 hours and somehow it not be apparent that the individual was waiting for care," Wright said yesterday.

On cold nights, Wright said it's not unusual for homeless people to take shelter in the emergency room. But he said any potential confusion that may have arisen from that practice doesn't explain why Sinclair died without treatment.

Source




Australia: Lots of surgery on wrong patients in Queensland public hospitals

THIRTY-three public hospital operations have been performed on the wrong patient or body part in a year, with four of the bungles killing or permanently impairing patients. The deaths and permanent impairments were among 127 identified as being due to bungles in the hospital system. Queensland Health today released the latest patient safety report revealing a 30 per cent spike in reported incidents within the department to 46,990 cases.

Almost a quarter of those cases involved patient harm. Three patients died or were permanently impaired after surgical tools were left inside them while six patients suffered the same fate after being given the wrong medication. Seven patients died or were permanently impaired after delays caused by long waiting lists or the department's failure to order or sanction procedures.

Queensland Health strongly defended the results, saying the increase showed more staff were reporting incidents. The report covered 2006-2007 and was compiled as part of recommendations which came from the Bundaberg Hospital Inquiry report which called for greater transparency. However, Queensland Health Patient Safety centre director Dr John Wakefield was unable to exactly how many deaths occurred during the period.

The report showed 127 patients died or suffered permanent impairment, but did not provide a break-down of deaths or impairment. Dr Wakefield said Queenslanders should have confidence in the health system, saying the figures showed it was getting safer. "Sharing information in an open and honest way is fundamental to improving patient safety and building trust in the community and our staff."

Source





26 September, 2008

Charming NHS worker abuses woman for needing a Caesarian

Go NHS and get treated like cattle

A pregnant woman about to have a Caesarean after a difficult three-day labour was sworn at by a hospital worker who demanded to know why she couldn’t give birth naturally, a hearing was told today. Samantha Shepherd was told that her baby’s life would be in danger if she didn’t have a Caesarean. But the conversation with her doctor was interrupted when Nigel Baglin, a surgery assistant, stormed into the room and shouted “F****** hell, why can’t women in this hospital give birth naturally?”

Mr Baglin, an anaesthetic support agency worker at Newham University Hospital, East London, crashed his trolley into the door of the room during the outburst, the competence committee hearing heard. The worker said he made the comments because he was “aghast” at the number of Caesarian sections being carried out at the hospital. “It was like every patient on the ward wanted one and had consented to them. “As a personal opinion, I did not think this was natural. It was a sarcastic comment aimed at the doctor and it was a mistake on my part,” Mr Baglin, who now works in Derby, said.

Mrs Shepherd, a mother of three, said she already had reservations about the Caesarean and was left devastated by the confrontation. “I felt I was a complete failure,” she said. “I was really nervous about having the baby. I had two previous births naturally. Every woman has a plan and this labour was not going along as hoped,” she said. “The doctor was explaining that I needed to have a second epidural when he (Mr Baglin) entered the room and banged the door with his trolley.” She said everyone in the room heard his outburst. “He stormed out and everyone was in shock. I felt worthless and told my husband I was a complete failure.” She said she would not use the hospital if she fell pregnant again.

Mr Baglin said the outburst was not intended personally. He said: “It was an off-the-cuff comment. I admit it was inappropriate but I was being rushed around.” But a witness said Baglin’s comments were directed straight at Mrs Shepherd. The woman said: “He was so angry you could see the veins in his neck. He wanted to be an exhibitionist and he wanted it to be heard.”

After the incident in February last year, the hospital reported Mr Baglin’s outburst to his agency, and said it would not employ him in future. Mr Baglin told the inquiry at Park House, Kennington Park Road, south east London, he resigned from his work at the hospital the day after the incident when a formal complaint had been made against him. A panel on the committee will rule whether Mr Baglin’s fitness to practise is impaired. The hearing continues.

Source




Australia: Deadly danger of hospital overflow

TASMANIANS could die because of ambulance delays and paramedics say there is nothing they can do about it. Angry paramedics parked their ambulances outside the Royal Hobart Hospital's Argyle St entrance yesterday to highlight the problem of "ramping". Ramping refers to when patients are forced to stay on an ambulance stretcher because there are no hospital beds free. "Overnight we had crews who were ramped for nine hours out of a 14-hour shift," one paramedic said. "They just get snowed under."

Another said ambulance officers were "baby-sitting" seriously ill patients because there were no beds for them. "We're getting ramped even with people with chest pains," he said. "There is no doubt people will, or already have, died because of this problem," another ambulance officer said.

The Health and Community Services Union said there were 36 patients in 33 cubicles in the RHH emergency department early yesterday. Nineteen of those patients were waiting to be admitted and some were given intravenous antibiotics in the waiting room. "This situation is nothing short of appalling," said HACSU assistant state secretary Tim Jacobson. "Some months ago the RHH established a committee to look at reducing the incidence of ramping. This committee has not produced any results."

He said providing extra nurses and opening beds would solve the problem. But Health Minister Lara Giddings said it was not that easy. "We are asking staff to work overtime to ensure that beds are not closed, but when you've got staff sick as well and you're already having to stretch your resources to cover the existing beds, it's certainly not an easy thing to just simply open up more beds," Ms Giddings said.

She said a flu outbreak was exacerbating the problem. "At the moment we've got around 35 nurses who are away on sick leave and we have increased admissions to our medical wards as well," Ms Giddings said. "This is putting strain on the hospital and it is impacting on ambulance ramping too."

RHH spokeswoman Pene Snashall confirmed the emergency department experienced "high demand" on Tuesday night. "There's no rhyme or reason," she said. "Saturday night was our quietest Saturday in months."

Source





25 September, 2008

NHS midwives deal with three births at once

Midwives are "overworked and overstretched", sometimes caring for three women in labour at the same time, according an expert.

Since 2001 there has been a 16 per cent rise in birthrates yet there are vacancies for midwives in every part of the country, according to the Royal College of Midwives. The Government has pledged 3,400 extra full-time jobs (4,000 including part-time workers), but research for the Darzi review into the NHS shows a shortage of 4,288 midwives. The shortfall is estimated after comparing it with the NHS "gold standard" for safer childbirth, which demands one midwife per 28 births. London has the worst shortages with 1,150 more midwives needed to meet a 20 per cent rise in the birthrate.

Louise Silverton, deputy general secretary at the RCM, said: "Women keep hearing about Government policy statements, such as one-to-one care from a midwife, but they are not getting that sort of treatment in many areas. "Our members are telling us that they are overworked and overstretched and are running between beds dealing with, in some cases, three women at once." The RCM added funding for maternity services has been cut by $110 million. Miss Silverton added: "The maternity services have long been described as a postcode lottery - but our regional NHS responses paint a shocking picture of just how loaded that lottery for maternity care is."

By next year ministers have promised women will be able to choose whether to have their child in hospital, at home or in a midwife-led birth centre. The Government has promised $660 million of extra funding for maternity services over three years.

But, according to Miss Silverton, research shows nine out of 10 maternity units do not know where their share of the œ330 million had gone, and it could have been diverted into other services. She said: "It is not enough for the Government to say it has put money into maternity services, but then fail to make sure the money actually goes where it is supposed to." The Department of Health said: "Our maternity services are the safest they have ever been. We are committed to improving outcomes for both mothers and babies."

Source




'Pointless' NHS complaints system to be made less rigid

The Department of Health has promised to overhaul the system for making complaints about NHS care after a survey found that more than two thirds of patients think that the process is pointless. The report by the Patients Association described the NHS complaints system as "cumbersome, variable and takes too long". Of nearly 500 patients polled, 69 per cent said that they had wanted to complain about the healthcare they had received in the past five years.

For those who complained, 29 per cent described the process as totally pointless, 20.5 per cent as pointless and 19 per cent as slightly pointless. Only 2 per cent said that the experience had been "very useful". More than four fifths (81 per cent) believed that there was not a culture of openness in the NHS when errors occurred and that staff were not encouraged to report mistakes.

The association's report concludes: "While patients will always accept that errors will occur in any health service, what they will not accept is the fact that staff are not open about admitting such errors occur."

On the matter of recent MRSA outbreaks and other healthcare-acquired infections, 47 per cent of patients blamed NHS trust managers. Nurses and cleaning staff were blamed by 16 per cent of respondents, and 10 per cent believed that doctors were responsible.

Three quarters of respondents felt that trust in doctors and nurses has decreased compared with five years ago. As a result, 96 per cent said they believed that patients questioned the actions of doctors and nurses more than they used to.

The Department of Health said it would be reforming the system so that patients' concerns were taken seriously. An official said: "We know that people find the current complaints system confusing. Some may also avoid complaining because they feel too intimidated or worry about damaging their relationship with their GP or social worker. This must change. "We are introducing a streamlined approach that will remove the need to follow a rigid set of procedures and replace them with a more open, flexible and personal service." If patients fail to resolve complaints at a local level they can forward their concerns to the Healthcare Commission, the NHS regulator.

The Patients Association called for NHS trust boards to be publicly accountable for an "open, transparent and timely resolution of complaints". It also wants an end to system where standard complaint responses vary depending on the region. Katherine Murphy, the group's communications director, said: "Every complaint matters. Ignoring complaints results in wasted resources, frustrated patients and cynicism about the system."

Source





24 September, 2008

Bureaucratic NHS control freaks quite happy to let patients die rather than lose any control

Bosses in the National Health Service have refused to administer a drug to a patient with advanced kidney cancer even though the medicine is being provided free. Barrie Clark, 61, was told in May that he could receive a free supply of a new kidney cancer drug on compassionate grounds from the pharmaceuticals company that makes it. Clark was then astonished to be told by the NHS that he could not take up the offer at his local hospital because it was against management policy. He could receive the drug, which has been approved as safe, only by paying for nurses to administer it privately.

Clark is in a similar predicament to patients being denied NHS care if they choose to pay for drugs that the health service does not fund. Campaigners are outraged that the ban on allowing NHS patients to pay for private drugs has now extended to letting them receive additional medicines for free.

In a letter of complaint to NHS Grampian, which runs Aberdeen Royal Infirmary where Clark is being treated, the father of four said: "I have been denied a free drug for a long time when there was no alternative treatment. "We find this appalling and demand that the drug be offered free of charge immediately. How many other people has this happened to? You have jeopardised my life and caused great anguish to me and my family. That is disgraceful."

The medicine, temsirolimus, which has the brand name Torisel, was granted a licence for the European Union in November. The European Medicines Agency (EMEA) has ruled that its benefits outweigh the risks. Dozens of NHS patients have received it on compassionate grounds from Wyeth, the manufacturer, in advance of its commercial launch in Britain. The National Institute of Health and Clinical Excellence (Nice) is assessing whether Torisel is cost-effective enough to be prescribed on the NHS.

Managers at NHS Grampian told Clark that he could not receive it because it was not yet on its list of prescribed drugs, known as the hospital formulary. The trust says it will not be placed on the formulary until it is assessed by Nice or the Scottish Medicines Consortium. Clark, a manager in the oil industry, has been helped by Kate Spall, a cancer drugs campaigner with the Pamela Northcott Fund. Spall said: "I have never heard such rubbish. They are saying this medicine cannot be given because it is not on a drug list, but patients elsewhere across the country are getting it. Are we now in a position where a terminally ill patient is denied a free medication?"

Cancer professors dismissed the explanation as "bureaucratic nonsense". Will Steward, a consultant oncologist at Leicester Royal Infirmary, said: "I really do not understand the decision not to allow a free drug to be administered from the hospital. We do this frequently. "Many trusts have allowed this in the past and this decision is perverse." Jonathan Waxman, a consultant oncologist at the Hammersmith hospital in London, added: "This is an effective treatment. This shows the mess we are now in."

After Clark told the hospital he was going to speak to the media, managers said he could pay to have the drug administered privately. He would need to pay about $2,000 a month as it is taken intravenously. Clark said that, although appalled at his treatment by the NHS, his own oncologist had done his best. NHS Grampian declined to comment on the individual case.

The Sunday Times has been campaigning to end the ban on NHS patients paying for private drugs that the state does not fund. Last week two patients won appeals to receive cancer drugs on the NHS after they featured in the Sunday Times Right to Pay campaign.

Sheila Norrington, 59, a cancer patient from Maidstone, Kent, was denied NHS care after paying privately for Erbitux, which costs about $6,000 a month. After the paper highlighted her case, the Peggy Wood Foundation, a charity, agreed to pick up the bills, but last week West Kent Primary Care Trust reversed its decision.

Barry Humphrey, 59, from North Walsham, Norfolk, was told that if he paid for Nexavar, the only available treatment for his advanced liver cancer, he would be billed for his NHS care. His local trust refused to fund the drug but neighbouring Suffolk Primary Care Trust has recommended that the NHS should provide it.

The British Medical Association and the NHS Confederation, which represents hospital managers, support a patient's right to co-pay for cancer drugs without losing NHS care.

Source




NHS clinics to be built `where they are not needed'

Is anybody surprised?

The Government is planning to build dozens of new NHS clinics in areas where they are not required, independent research seen by The Times suggests. Ministers have told each of the 152 local health authorities in England to build at least one "GP-led health centre" in a $500 million scheme to improve patient access to doctors. The 1 million pound walk-in clinics will combine surgeries with services such as dentistry and chiropody.

Local primary care trusts (PCTs) are proposing sites for the health centres that would result in many being built in the wrong areas, analysts say. More than 1.3 million people have signed a petition against the clinics, which doctors' leaders and the Conservatives say could close hundreds of surgeries.

Demographic research by CACI, a market research firm, says that inner-city areas may need up to four health centres while rural locations might need none at all. The Department of Health said that the centres were intended to complement, not replace, existing practices.

Source





23 September, 2008

Another drug trial disaster in Britain

A 27-YEAR-OLD man has died in a government-funded medical trial, in which at least two other patients were given overdoses. Gary Foster, a graphic designer who was planning to get married this month, was on seven occasions given double the amount of chemotherapy he should have been prescribed. His mother, Colleen Foster, said: "Gary was slowly poisoned to death."

The mistakes raise questions about the safety of medical trials in Britain two years after the notorious "elephant man" trial, which was supposed to have led to tighter supervision. Six men nearly died after their bodies swelled horrifically after taking the experimental drug TGN1412.

University College London Hospitals NHS Trust (UCLH), one of Britain's largest trusts, has been forced to suspend the trial although it is continuing at other UK hospitals. Foster's death was due to a fundamental error in the setting-up of the trial on the hospital computer system. A second UCLH patient was affected by the same error, but survived.

Another patient, who died at a different hospital, and whose name has not been disclosed, also received an overdose of the drug bleomycin. In that case, the overdose was due to an error by a nurse or doctor rather than a basic flaw in the setting-up of the trial. According to the Medical Research Council (MRC), the government-funded organisation which ran the trial, the drug was not the direct cause of his death.

When the MRC suspected that patients had been given overdoses, instead of calling UCLH immediately, it posted a letter on October 3, 2007. An inquest into Foster's death heard that a nurse failed to open the letter until October 16, two days after his death. The family concede that by October 3 it was too late to save Foster because he was already dying of organ failure caused by the overdoses.

Foster, from Waltham Abbey, Essex, was eager to join the medical trial in June 2007. He had just been diagnosed with testicular cancer, and he had a 60% chance of survival. The disease has a survival rate of about 95% if caught early. Doctors told Foster that, if he was accepted for the trial, his chances of survival would increase.

Colleen Foster said: "The trial sister said: `Good news, Gary, you have been selected for the trial.' At UCLH they said, `Don't worry, testicular cancer is curable. We will monitor Gary for 10 years - you don't have to worry.' They made us feel so confident." His fiancee, Paula Collins, 35, added: "When Gary became involved in the trial, we thought it was fantastic news because we thought Gary's chance of survival would be greater and the care would be better."

The trial, called TE23, was testing whether a combination of five existing chemotherapy drugs was better at treating testicular cancer than the standard treatment of three drugs. Foster was in the group receiving the new therapy. From June until mid-September 2007 he made regular trips to UCLH in central London, to receive the drugs. On seven occasions between July and September last year, he received 30,000 units of one of the drugs, bleomycin, instead of 15,000. Foster and his family had no idea the drugs they believed were saving his life were killing him. Colleen Foster said: "We just thought Gary was getting tired because of the chemotherapy."

Eventually Foster developed a dry cough, a symptom of lung damage, caused by an overdose of bleomycin. An inquest heard that the cough should have been recognised by doctors and nurses as a warning sign that the bleomycin was damaging his lungs. Despite the cough, Foster was given a final dose. The coroner ruled that Foster died as a result of lung damage caused by an overdose of bleomycin. The coroner also found that the instructions for the trial had been wrongly set up on the electronic prescribing system at UCLH.

Colleen Foster said: "An overdose gives the impression that it was a one-off. It was seven times. Every week my poor Gary was going into hospital, we thought he was getting better but, actually, he was being slowly poisoned and poisoned to death." Eventually he became so ill that he was transferred to intensive care and put on a ventilator, but attempts to save him were in vain. Foster's family blame his death on a trial they say was set up in a hurried and piecemeal manner.

Collins said: "Checks should have been carried out. It is incomprehensible that they were dealing with the most dangerous medicines and they were so blase. It was so slapdash. "We had dreams and lots of plans together," she said. "Gary also had his own ambitions. We were supposed to be getting married on Saturday September 6, instead, on the Tuesday before, we were at the inquest. He was such a lovely person. He was so well liked and had so many friends."

"We do need trials but there need to be more controls," Collins added. "I would encourage other people thinking about taking part in trials to proceed with caution. I would hate to think of anyone else going through what we have gone through." .....

The MRC said it had reviewed its trial procedures as a result of the tragedy and introduced additional checks. It said it followed its normal procedures by posting its concerns rather than making an emergency phone call. "During the processing of the forms for the UCLH patients, a possible dosing error for these two patients was spotted. A query form was then returned to the hospital." Dr Stephen Harland, who was in charge of the trial at UCLH and supervised Foster's care, declined to comment....

Source




Australia: A bigger hospital is better?

Public hospitals are impersonal and bureaucratic enough as it is and a bigger hospital is going to be even more so. And the bigger the bureaucracy the more error-prone it is. But both in Australia and in Britain the move is to phase out lots of small hospitals and build a few huge ones

A NEW children's super hospital in Brisbane would save lives, foster research and improve training opportunities, says a respected specialist. As a turf war intensified between doctors over the merger of the Royal Children's and Mater Children's hospitals, Melbourne intensive care specialist Frank Shann said having a single facility was overwhelmingly the best choice for patients.

Professor Shann, who has consulted on children's hospital care worldwide, said bigger institutions delivered better quality care and at lower cost. "Very large centres that do a lot of work have lower mortality rates," he said. "The more you do, the better at it you get." Professor Shann said the existing public children's hospitals were both too small to offer advanced intensive care training for doctors. "Queenslanders who want to train in intensive care of children have to train in other states," he said.

Although some doctors have warned of an exodus of specialists from Queensland if the merger goes ahead, Professor Shann predicted it would attract better qualified staff.

A group of University of Queensland researchers last week warned the pending closure of the Royal Children's Hospital at Herston, in Brisbane's inner north, would cripple research into a vast array of diseases. But Professor Shann said the existing children's hospitals generated far fewer research papers than stand alone facilities in other states. "There'll be a bigger group of people working together rather than having two small groups. You can bounce ideas off each other," he said. "If you have an interest in a particular group of patients ... you'll also double your exposure to those patients."

The Queensland Government has pledged to build a $100 million research facility close to the new hospital but has yet to secure funding. Acting Premier Paul Lucas yesterday accused critics of being afraid of change. "The Government is not doing this to annoy people. The Government is doing this for all the mums and dads out there who expect to have world's best practice in our children's hospital," he said. Mr Lucas defended the current plans, saying all the evidence and analysis showed the Government was on the right track.

Source





22 September, 2008

THE PUBLIC HOSPITAL CHAOS CONTINUES IN AUSTRALIA

Three articles below

No meat at debt-ridden NSW hospitals

MEAT is off the menu at two NSW hospitals because the health service hasn't paid its butchers' bills, a State MP claims. Kevin Humphries has offered to pick up the tab so Gilgandra and Coonabarabran hospital patients, and local Meals on Wheels recipients, can have their meat supply restored. The Greater Western Area Health Service - which has already been accused of failing to pay a Sydney software supplier $22,500 for five months - has conceded it owes money to a number of creditors and has apologised.

Mr Humphries said he was appalled when he found cooks at Gilgandra and Coonabarabran hospitals were forced to provide meatless meals. "Our patients deserve better. It is a sad day when staff are forced to compromise patient care with a reduced and inadequate diet," he said. "I have even heard stories of staff buying meat for their patients out of their own pockets."

Murray-Darling MP John Williams said he knew of several cases of unpaid bills from the western health service. One Broken Hill business was owed almost $2000 and another business in his electorate had been owed more than $12,000 since May. "It's a bleeding ulcer for them - they are all suffering from the drought and they don't need this," Mr Williams said.

Greater Western Area Health is not the only one unable to pay suppliers. Yass air-conditioning mechanic Touie Smith said he is owed $18,386.50 by the Greater Southern Area Health Service for work at Yass and Goulburn hospitals. Part of the debt related to work done as far back as April and Mr Smith said it was putting a strain on his business. Most annoying was the fact that the health service would not return calls to discuss the problem. "We've been shunned," he said. "We are a small business with quite a low turnover - we have to be careful with our money management and outstanding amounts of this size can be very stressful." Mr Smith said the local hospital administrators were embarrassed by the situation caused by their head office.

It's understood Leeton Diagnostic Imaging is owed more than $30,000 by the Greater Southern Area Health Service. Part of that debt dates back to May and the business cannot get any answers about when it will be paid.

Health Minister John Della Bosca said it was reasonable for businesses to expect to be paid "in a fair and timely manner". "Since 2004-05, the department has set a benchmark that creditor payments should not exceed between 35 and 45 days from receipt of invoice," he said. "I believe the benchmark is being met in the majority of cases but I have asked the department to work closely with health services to ensure they're paying suppliers within the set time. "It is important these benchmarks are met as late payments can hurt small businesses."

Source

North QLD Health Services Third World Despite Billions in Mining Royalties

The mismanagement of the Queensland Health service in rural & regional Queensland is a disgrace. In the home of resource rich North Queensland all surgical proceeds now have to be performed at Townsville Hospital which is in crisis. Just 2 weeks ago the ABC `World Today" reported:

"In recent days, Brisbane's biggest hospitals have closed their doors to ambulances and the hospital in the major regional centre of Townsville has resorted to using conference rooms to accommodate patients."

TWO regional north Queensland hospitals at Richmand and Hughenden will close their fully equipped operating theatres. These theatres have not operated for 18 months after the QLD Labor government pulled the plug on funding the popular and very successful flying surgeon service to the centres. The Richmond and Hughenden communities had been waiting and hoping that the service which had operated successfully for many years would be re-instated. Hughenden & Richmand are 400 and 500kms by road from Townsville.

Following on from last months announcement of the closure of the Aramac hospital the people of north-west Queensland are shocked and angry after the latest Bligh Labor Government health plan had promised to close the gap in regional health care. In an email to Agmates QLD Shadow Health Minister Mark McArdle is scathing of the QLD Labor governments treatment of rural and regional Queenslanders:

"The Townsville Hospital is already at crisis point and this incompetent Health Minister is just making it worse instead of taking stress off the Townsville Hospital by de-centralising demand for surgical facilities," The Health Minister's claim that the operating theatres were closed because they didn't provide any surgical procedures as dishonest and arrogant. The reason these surgery theatres wasn't performing surgical procedures is because it didn't fund them.

This is another example of the Beattie-Bligh Government's systemic withdrawal of health services from rural areas. The Beattie-Bligh Government is killing off opportunities for accessible regional health services now, while it is spending millions of dollars on glitzy ad campaigns about what proper health services in 2020."

North West, North and Central Queensland is home to the vast fortunes generated by Queenslands resources boom. Last year the QLD state government collected $1.027 billion in coal mining royalties alone from the region. That figure this year is budgeted to explode to $3.213 billion yet the people of North Queensland have what can only be described as third world health services.

Those mining royalties have made QLD along with resource rich Western Australia the two financial powerhouse states that have largely insultated Australia against the world economic down turn caused by the credit crisis. Yet North Queenslands have seen there health services largely disappear.

It's no wonder that the WA Nationals are the King Makers after the recent state election. They campaigned on a "royalties for regions" policy that promised to return 25% ($700 million a year) of mining royalties too the regional communities of WA. If that policy was adopted in Queensland that would be $800 million just from coal royalties which would be invested into infrastructure & services in rural and regional Queensland each year just from coal royalties.

Source

Nurse backs reports of chaos at a major Brisbane hospital

A SENIOR nurse who recently resigned from Logan Hospital has backed up comments by emergency department doctor Michael Cameron that the hospital is "too dangerous and too dysfunctional". Bill Atkinson, a nurse for nearly 20 years, worked in the same high-pressure emergency department as Dr Cameron. He said his pleas for support were also ignored by hospital bosses and Queensland Health. "I have a lot of respect for the man," Mr Atkinson said. "He had the courage to step up and voice his concerns."

Dr Cameron, senior staff specialist in emergency medicine at Logan Hospital, revealed exclusively in The Sunday Mail last week that he had quit because staff were "overworked and overwhelmed". He had first spoken out about problems in Queensland's besieged health system in a frank open letter published in The Sunday Mail in May. The letter from Dr Cameron prompted Premier Anna Bligh and Health Minister Stephen Robertson to meet with him and appoint him as a special adviser to the Government. But he was largely ignored and the problems at Logan only got worse. "It had got to the point where I dreaded going to work each day," he said last week.

Mr Atkinson, who was a registered nurse and then a clinical nurse in the Logan Hospital emergency department's short-stay unit, had a similar story to tell. He kept detailed records showing a doubling of the number of patients pushed through the short-stay unit, which had a $7.5 million upgrade last year. "However, with this increase in patient turnover, there was no increase in the level of staffing or support," he said. "Like Dr Cameron, I too was dreading coming to work to the job I loved to do. I would often go home feeling overstressed and burnt out from a day's work." He asked the nurse unit manager about the possibility of increasing staff numbers. "I was bluntly informed that it was not going to happen as there was no budget for it," he said.

Mr Atkinson said he wrote to the director of nursing for medical services seeking a meeting. "I stressed that the pressure was overwhelming and that there was not enough staff and support to address the current issues . . . that it was not about me, it was about the quality of care that we were not able to provide to the community of Logan." Mr Atkinson resigned two months ago and said he was not the first experienced emergency nurse to leave Logan Hospital this year. "I know of four other clinical nurses leaving emergency before I did and a clinical nurse and clinical nurse consultant leaving after I resigned," he said.

Ms Bligh last week acknowledged the "very high-stress, high-pressure environment" at Logan but told staff there was "light at the end of the tunnel". The Premier said the State Government had bought nearby Logan Private Hospital and would refurbish it to provide extra beds by 2010. Mr Atkinson, who now works at Redland Hospital, will be joined there by Dr Cameron in emergency.

Source





21 September, 2008

Thousands of British elderly ‘denied best thinning bones treatment’

Thousands of women with thinning bones are being denied the best available therapies because of “unethical and shortsighted” NHS rationing, senior osteoporosis specialists say today. Guidelines from the National Institute for Health and Clinical Excellence (NICE) are unfairly restricting access to osteoporosis drugs that can prevent pain, disability and even death, leading doctors and charity executives say.

In a letter to The Times, a group of 36 experts has called on NICE to revise restrictive draft guidance, which is the subject of an appeal that begins today. They urge NICE to widen access to alendronate, the cheapest generic osteoporosis drug, which costs only £50 a year, and to ease strict eligibility criteria for slightly more expensive options. NICE approves alendronate only for patients older than 75. It is also unsuitable for a quarter of patients.

Source





20 September, 2008

Another black eye for arrogant medical regulators

The TGA is Australia's version of the FDA. I don't blame the TGA for disliking alternative therapies (though some of the things they have approved -- such as statins -- are arguably no better) but that does not excuse ruinous Gestapo-type attacks on a law-abiding businessman and the destruction of his business. And the two devious feminazis at the heart of the TGA action -- Fiona Cumming and Rita Maclachlan -- are apparently still in their jobs! Since their hatreds have already cost the taxpayers huge sums, they should be relegated immediately to clerk-typist duties only. Their involvement in the destruction of records should in fact lead to criminal charges being laid against them

The Commonwealth Director of Public Prosecutions has dropped four criminal charges against former alternative medicine tycoon Jim Selim. Mr Selim, the founder of Pan Pharmaceuticals, had been charged with failing to disclose material information relating to four separate board meetings. Last month, Mr Selim won a $55 million compensation payment from the Federal Government over the collapse of his company.

Pan Pharmaceuticals went into liquidation in 2005 after a decision in 2003 by the Therapeutic Goods Administration (TGA) to suspend its licence and withdraw 219 of its products.

Outside the court, Mr Selim said he felt vindicated by today's decision and he would push ahead with preparations for a $200 million class action against the TGA over the collapse of the company in 2003. "It's good because here everything's over, nothing's left, there's no deal or anything," Mr Selim said. "That's the end of it."

He said an apology from the Federal Government would mean a lot to him, following his "persecution" over the past five years. "I think so," he said, when asked whether an apology should be forthcoming. "I was disappointed with the TGA from the start."

His solicitor, Andrew Thorpe, said there was a "high degree of interest" from former customers and creditors of Pan Pharmaceuticals in pursuing a class action. "We believe that the sort of value of the class action will be in the order of $200 million and perhaps greater than that," Mr Thorpe said. There would most probably be hundreds of parties involved and a claim would be made on behalf of companies which lost money as a direct result of the TGA's handling of the Pan matter, he said.

Mr Selim said it had been a "hard five years", with today's case the latest in a long series of court actions involving Mr Selim and Pan Pharmaceuticals. "We hope justice will be done and we hope people who were damaged and hurt by the TGA action will get compensation, will get justice," he said.

Source

Note: The firm was convicted of offences to do with disregard for government paperwork requirements but those offences were some years before the matters referred to above. And in the paperwork case the judge found no individual culpable but rather a firm-wide indifference to government paperwork. That attitude may have contributed to the TGA animus against the firm but does not excuse their reckless shutting down of the firm. The paperwork matters should have been and were dealt with by a court





19 September, 2008

Re persecution of "Dr Scot Jnr":

Further to my recent reports about NHS attacks on free speech by doctors, I thought it fair to make clear that the whole of the NHS should not be tarred with this. Below are particulars of the very senior feminazis actually involved

Professor Elisabeth Paice saw the scatological comment on the forum about Prof. Black and reported it to Prof. Black. Paice is Dean Director, Postgraduate Medical and Dental Education for London; Chair of the Conference of Postgraduate Medical Deans; Chair of the forum for Modernising Medical Careers.

From a recent anonymous blog comment: "Readers may be interested to learn that the London Dean involved is also implicated in copying material from DNUK in order to report another doctor to the GMC. This doctor has sadly committed suicide. Whilst cause and effect are hard to prove, the involvement of Elisabeth Paice in yet another tragic abuse of power has caused much anger amongst doctors, as is her unaccountability."

Professor Dame Carol Black. Either Black or Paice called Needham to get Scot suspended. She is National Director for Health and Work, Chair of the Academy of Medical Royal Colleges and Chair of the Nuffield Trust. From Wikipedia: "Junior NHS Doctors were upset when Dame Carol Black was re-elected Chairperson of the Academy of Medical Royal Colleges (unopposed) in 2008. One junior surgeon launched a scatological attack on Dame Carol on the doctor discussion forum Doctors.net.uk which resulted in Dame Carol's colleage, Professor (Dean) Elizabeth Paice complaining to the junior's dean in Highland (Professor Gillian Needham). The junior doctor was suspended. This caused outrage in the medical blogging and discussion forums, with many authors calling this an abuse of power by the Deans as Carol Black is a public figure and many juniors were justifiably very upset by the problems with the Modernising Medical Careers changes to junior doctor training and held that Dame Carol Black should accept responsibility for the problems that occurred."

Professor Gillian Needham is Post Graduate Dean of Medical Studies, Aberdeen University; Head of the Highland Deanery which is responsible for overseeing Dr Scot Jnr's surgeon training. (Note, she is NOT his employer so has no legal right to suspend/sack him. She allegedly prevailed upon Garry Coutts, Chair of NHS Highland (Scot's employers) to do the deed).





18 September, 2008

NHS bullies trying to silence another doctor who dared to criticize low standards

Report from Dr Rant this morning that another doctor has been sacked for speaking out about low standards/lack of funding. The article from the local paper is here.

What isn't reported here is just as important as what is: the newspaper piece does not mention the actual reason for Dr Shirine Boardman's dismissal, except to say that "... it does not relate to any issues of patient safety or clinical competence."

This utter failure to report the real reasons for such disciplinary action and clinicians' real reasons for speaking up is almost tantamount to a 'D notice' - where editors are not allowed even to report that they are not allowed to report....

What is it that NHS chiefs are so desperate to hide?

Source

Newspaper article follows:

Specialist doctor sacked by hospital

A Warwick Hospital consultant who set up a health project to help combat diabetes in and around Leamington has been sacked. Dr Shirine Boardman worked at the Lakin Road site as a diabetologist for eight years and established a clinic for Asian people at Leamington's Queensway Community Centre last year. She was sacked by the hospital's bosses on July 22, but is appealing against the decision.

Hospital chief executive Glen Burley said: "Dr Shirine Boardman was dismissed following an internal hearing carried out in accordance with our disciplinary procedures. "We are not going to comment in detail on the nature of the misconduct, but we can say that it does not relate to any issues of patient safety or clinical competence." Dr Boardman declined to comment until after the appeal, but said she was "passionate" about her job.

Chairman of the South Warwickshire Diabetes UK support group David Gent said: "She was our vice-president and we hope that she will continue in that role. "Her loss is going to be great. She will be very difficult to replace because she had a passion for what she did. "She gave us her full support in what we were trying to do - get better services for diabetes patients in this area. "We will have to await the outcome of the appeal, but we hope it will be in her favour and ours."

Dr Boardman was featured in the Courier in June calling for Warwickshire Primary Care Trust to improve services. She said more specialist services in the community, closer working with GPs and greater public consultation could help "transform" it. The Apnee Sehat clinic was created with Warwick University to try and reduce high levels of diabetes, heart disease and stroke in the Asian population. The research clinic, where doctors and nurses have been involved in teaching Sikhs and Hindus about managing and preventing the illnesses, was heralded by the NHS's director of GPs Professor David Colin-Thome as "the start of a new era in community care". Funded by the university and charitable grants, it has been nominated for a number of awards including the NHS's Reducing Health Inequalities social care award.

The Primary Care Trust's former director of public health Dr Tim Davies has said the clinic's future would be reassessed this year based on whether it had achieved better results than the hospital service.

Source




"Dr. Scot" update

Re: Silencing attempt noted here on 15th.

Dr Scot Jnr. was reinstated and went back to work on 16th. The powers that be had managed to keep the story of his dismissal out of the national newspapers/television, incredibly. But bloggers and others took up the story. Once it went global, it's likely that the game was up for the young doctor's bullies.

The story doesn't end there exactly because there has been a formal complaint to the General Medical Council about these senior medical women's behaviour. This is likely to roll on interminably as state bureaucracies do. But there will be a story in that - a sort of test case even.





17 September, 2008

NHS productivity falls as spending rises by billions under Labour

The National Health Service has become less efficient despite Labour pumping millions into its budget. Official figures compiled by the Office for National Statistics show that the amount of treatment the NHS delivers is lagging behind the pace of increase in the service's budget. Critics said the statistics showed the NHS had absorbed huge amounts of money with very little to show for it and the Government must reform its management instead of pumping in ever more funding.

NHS productivity fell by 2.0 per cent a year between 2001 and 2005, according to the Centre for the Measurement of Government Activity, the ONS unit that monitors public spending. That was the period of the biggest funding increase in NHS history. From 2005 to 2006, productivity fell less quickly, by 0.2 per cent. From 1995 to 2006, the NHS annual budget more than doubled from 39 billion to 89.7 billion.

Andrew Lansley, the Conservative shadow health secretary, said the figures proved that Labour's approach to the NHS had failed. "Spending more money if it's not spent well doesn't necessarily deliver the services you are looking for," he said, accusing Labour's use of centralised targets and management of undermining the delivery of healthcare. As an example, Mr Lansley cited the latest central NHS contract for GPs' surgeries. A Whitehall audit earlier this year found that the contract had lead to family doctors earning 58 per cent more for doing 5 per cent less work.

The Department of Health said it was more important to focus on improvements in the quality and availability of treatment. A spokesman said: "Ten years ago people died waiting for operations, today waiting lists are at the lowest ever. The NHS is treating more patients, treating them faster and treating them more safely "It is also easier to access NHS treatment - through NHS Direct, walk in centres and at A&E where over 97% of people are now seen within four hours. And it is easier to see your GP because of extended opening hours in the evening or at weekends "There are 280,000 more doctors, nurses and other essential staff working for the NHS than in 1997 and all NHS staff have enjoyed well deserved pay rises. "Most importantly when people are asked, their experience of the NHS has improved.

Source





16 September, 2008

Nasty British socialists determined to grind everyone's medical care down to a low level

A naval commander's wife is being billed for all her NHS care after paying for a drug privately

A LIEUTENANT-COMMANDER awarded an MBE for services to the Royal Navy is preparing to hand back his decoration in protest after his terminally ill wife had her free NHS cancer care withdrawn for buying a drug privately. Diane Winston, 53, who has kidney cancer, is being billed by her local trust for all her NHS care, including scans and hospital appointments, after paying privately for the drug Nexavar, which her health service consultant recommended.

Winston's husband, Lionel, 57, is so disappointed at the way his wife has been treated that he is prepared to give up the MBE, which he hangs with pride on his wall. "If this situation is not changed, in protest, I will formally return my MBE," said Lionel. "I am so disgusted by the government, and the nation that I have given the last 37 years of my life to, and for which they have awarded me the MBE, that I would give it back."

The Winstons have fallen victim to the government ban on "co-payment", under which a patient who pays privately for any treatment cannot receive free state care for the same condition.

Lionel Winston was awarded his Member of the Order of the British Empire decoration by the Queen in 1994. The ceremony was attended by his proud wife and their two sons, Sonny, now 30, and Tel, 28. Lionel, who was born in Dominica, worked his way up from the lower decks to become an officer. "From extremely humble beginnings, Lionel has come a very long way and for him to have that medal is hugely important to him. I am extremely proud of what he has achieved," said Diane. "To even think about giving it back shows the extent of his disgust."

In addition to the Nexavar, which costs about 3,000 pounds a month, Portsmouth Hospitals NHS Trust, where Diane is being treated, has also issued bills for scans costing up to 480 each. Diane's consultant is so sympathetic to her plight she has given her time for free, but the trust charges an administrative fee for every appointment.

Last week, the couple, from Gosport, Hampshire, discovered that a deposit they had paid of about 3,700, which they believed had contributed to the cost of the drugs, had been used to pay for NHS care such as scans and appointments.

Kate Spall, campaigner at the Pamela Northcott Fund, a kidney cancer group, said: "This couple have had to rely on family, friends and fundraising to buy drugs to keep Diane alive. They are now in a position where they need to pay not only for the drug their NHS consultant desperately wants Diane to have, but also for NHS services, which is absolutely scandalous."

The trust insists it advised the Winstons that their deposit would be used to pay for scans and hospital appointments and not medication. A spokeswoman said the trust was following guidelines by charging for the routine treatments.

On October 2, Lionel will hold a fundraising dinner and auction on HMS Victory in Portsmouth to raise more money for his wife's care. Diane is one of thousands of patients with advanced kidney cancer who have been denied medication on the NHS that could prolong their lives. Last month, the National Institute for Health and Clinical Excellence (Nice), the government's drugs rationing body, ruled that four drugs to treat kidney cancer, Sutent, Nexavar, Avastin and Torisel, are not good value for money despite admitting they are effective.

The decision prompted 26 leading professors of cancer medicine to write, in a letter to The Sunday Times, that the current system for assessing new drugs was not working. The Sunday Times has been campaigning to end the government ban on co-payments.

Public outrage at the way patients have been treated prompted a review of the policy. The inquiry, by Professor Mike Richards, the national cancer director, is widely expected to allow patients to top up their care. Leading health insurers are preparing to offer policies that would enable patients to buy life-saving drugs not funded by the NHS. Axa PPP and Saga are drawing up plans for the policies in anticipation of an end to the NHS ban on patients "topping up" free care by paying for private treatment.

One company, WPA, has already launched its health top-up policy, showing that the NHS ban on co-payment has begun to crumble in the face of patients demanding the right to buy the latest drugs. Fergus Craig, commercial director for Axa PPP healthcare, one of Britain's biggest medical insurers, said: "We are considering introducing policies to enable people to top up their NHS care with privately funded treatment." A spokesman for Saga added: "We are looking at how Saga health insurance might be able to provide payment for drugs that the NHS won't pay for."

Source




Australian public hospital blamed for woman's death

ROYAL Darwin Hospital forgot to X-ray the bowel of a grandmother who died days later of septicaemia when the bowel burst, her family says. Alma June Green, 83, was admitted to the hospital after complaining of bowel pain, family members told the Northern Territory News. But while she was waiting to have an X-ray she fell out of a wheelchair and broke her leg. Doctors operated on the broken leg before sending Ms Green home. Her son-in-law, Jim Egan, said he believed the hospital staff had forgotten to X-ray Ms Green's bowel.

Ms Green died at her Palmerston flat on November 11 when her bowel burst, causing blood poisoning. Royal Darwin Hospital spokeswoman Michelle Foster said the death was reported to the coroner's office, but she could not comment further.

Mr Egan, 63, of Bakewell, said what started as a complaint of bowel pain at RDH around November 9, 2007, ended in disaster. He said his mother-in-law went in for a bowel obstruction and was admitted and booked for an X-ray. Although she could walk, she was given a wheelchair before a nurse allegedly left her waiting for the radiographer. When called to be X-rayed, Ms Green stood up and the weight of the chair pulled it over, knocking her to the ground and breaking a bone at the top of her right leg near the hip. She was taken to theatre where doctors put "all the plates and pins in".

Mr Egan said he suspected hospital staff forgot to X-ray Ms Green's bowel before she was released from hospital. "Two days later, her bowel burst and she died of blood poisoning," he said. "As far as I am concerned, it is neglect - she should have had a nurse with her. "I think they let the bowel X-ray go and it killed her."

Mr Egan said despite the great-grandmother being aged 83, she was healthy. "There was nothing wrong with her other than the bowel obstruction," he said. "I was wild, she wasn't just a mother-in-law, but a friend for over 30 years."

Justice Department spokeswoman Lorelei Fong Lim said the matter was with the coroner's office. "A decision about whether it will be an inquest or not, has not been made," she said.

Source





15 September, 2008

Free speech punished by senior NHS doctors

The NHS is just another nasty bureaucracy

A junior doctor made a rude comment on a doctors' only forum about one of the top bananas who masterminded the plan to 'improve' doctors' training and 'career paths'. 'Modernising Medical Careers', as it's called, is very widely disliked. Its benefits seem to be mostly for employers and the government - not doctors or patients.

Our Dr Scot Jnr, who works in a Highlands hospital, made some forthright comments (which included some 'Anglo-Saxon' words) about one of the MMC architects who is a career medical politician.

He was immediately suspended from work: a high-powered London close friend of the top banana architect had seen the comment and called another chum, another big tamale medical woman, up in the Highlands. A plot - allegedly unlawful - was hatched between them, Chinese-whisperish, to silence and punish Dr Scot Jnr forthwith.

This summary activity has deep implications for the freedom of doctors to speak out against diktats they don't agree with, and it demonstrates how bullied and harassed clinical staff are. One in four junior doctors report being bullied and intimidated by senior doctors (figure from BMA report). Ultimately it has deep implications for the quality of care and treatment doctors are allowed to give patients.

Fundamentally, this silencing and intimidatory activity is an onslaught on freedom of speech for all of us. In the NHS particularly, this toxic culture is so deeply entrenched that it goes barely noticed by most, it's part of the environment like targets or management suite shagpile. This hidden culture of intimidation and fear is also the reason that so many patients are not able to get the treatment they need or the apologies they deserve when things go wrong.

Source




Australia: Senior doctor quits 'dangerous' public hospital

A SENIOR emergency department doctor has quit one of Queensland's busiest public hospitals because it is "too dangerous and too dysfunctional". Dr Michael Cameron, senior staff specialist in emergency medicine at Logan Hospital, on Brisbane's southern outskirts, said the Bligh Government continued to ignore the problems in the health system.

He said doctors, nurses and other medical staff were under extreme pressure and patients' lives were at risk - but the Government was doing nothing to solve the crisis. "Everyone is overworked and overwhelmed . . . it had got to the point where I dreaded going to work each day, to a job I loved and was good at," he said yesterday.

Dr Cameron first spoke out about problems in Queensland's besieged health system in a frank open letter published in The Sunday Mail in May. At the time, he asked to remain anonymous, fearing that going public could have severe ramifications for himself, colleagues, patients and Logan Hospital. In his letter, Dr Cameron, who has worked for 25 years in the state's public hospitals, revealed the chaotic life in a typical hospital emergency department at Logan. His insightful words about sickness, accidents, drunken abuse, overdoses, death and miracles touched many Queenslanders.

The letter also drew an immediate response from Premier Anna Bligh and Health Minister Stephen Robertson, who met with Dr Cameron and discussed the most serious issues. Ms Bligh said at the time Dr Cameron had much to offer the Government as it continued to implement its $10 million health action plan and she vowed to turn to him for help as her special adviser. But Dr Cameron has been largely ignored since the May meeting, with neither Ms Bligh nor Mr Robertson speaking to him since.

He said one of Ms Bligh's staff had contacted him and sought his comments on proposed health funding and spending outlined in the June State Budget. Dr Cameron told him there was inadequate funding for Logan Hospital - but no extra money was provided when Mr Robertson announced a $1.2 billion boost for health for 2008-09. The doctor had also asked the Government to urgently address mental health issues at the hospital, but measures were put off for several years.

Dr Cameron said another flu-hit winter - with Logan's emergency department inundated with sick and elderly patients - was the straw that broke the camel's back. "We have seen it for eight years . . . the winter crisis. Every year the Government promised they would fix it. They said it again this year, but nothing was put in place. "It all fell over again. Every year it starts earlier, it lasts longer and is more intense. "The pressure definitely got on top of me. I just could not go through it again. I could not go through another year of that."

Dr Cameron said he decided it was time to quit, which went against all his beliefs. He even contemplated leaving the public health system altogether and finding another career. "Logan Hospital has become the dumping ground. Hospitals on the Gold Coast and in Brisbane are overflowing . . . if they are blocked they just send them to Logan. "We were overwhelmed. We could not cope. Logan (Hospital) needs to be twice the size with twice the number of staff."

Dr Cameron said other senior staff had also resigned from Logan and he felt shame for leaving the hospital in the middle of a crisis. "I felt it was personal failure . . . I should have been able to take it." He spoke to colleagues who had worked at other public hospitals in Queensland, interstate and overseas and they offered their support. "Everyone there recognises that Logan is under extreme pressure. It is too intense, too dysfunctional, too dangerous. "They had all experienced the same pressures as me. I have been there for nine years . . . I felt I could move on without any shame."

Dr Cameron confirmed reports of a system in crisis: of patients left hours without being treated, left on trolleys in corridors because there were no beds, and people dying. "The Government needs to address these problems urgently . . . but that is never going to happen, at least not in my working lifetime," he said. Dr Cameron said there had been a major recruitment program at Logan this year "but it has not had a very good response".

He has decided to stick with public health and take his emergency medical skills to Redlands Hospital, which has just undergone a $20 million upgrade. "It has a new emergency department . . . it is the right size with the right numbers . . . with limited population growth in the Redlands, it is more controlled . . . it is more closely aligned to demand. "I am looking forward to it," he said of the senior role that he will start in January.

Source





14 September, 2008

AUSTRALIA'S PUBLIC MEDICINE CHAOS CONTINUES

Two articles below

Doctor fatigue a problem in public hospitals, says coroner

A CORONER has slammed the Medical Board of Queensland for not stopping doctors working long hours, warning fatigue is a problem in many hospitals. Brisbane Coroner's Court was told yesterday that failures in the health system meant that a 10-year-old girl who had fallen from a bunk bed had very little chance of survival.

Elise Susannah Neville died on January 9, 2002, from an extensive extradural haematoma and a fracture to the left side of her skull after falling 1.4m from a top bunk bed with no guard rails in a Caloundra holiday unit two days earlier. She was taken by her parents to Caloundra Hospital but was sent home an hour later by a junior doctor who was in the 19th hour of a 24-hour shift. Elise was rushed back to hospital and then flown to Brisbane, where she later died, mainly because of delays in medical treatment, the Brisbane Coroner's Court found.

Brisbane coroner John Lock said Elise had died because Dr Andrew Doneman at the Caloundra Hospital failed to assess and diagnose the child's injuries correctly. Mr Lock yesterday also criticised the Medical Board of Queensland for failing to deliver its promised policy to regulate doctors' working hours in hospitals around the state, saying doctor fatigue was a significant problem. "The Medical Board of Queensland accepted responsibility to develop a standard or other policy alternative on doctors' working hours," he said. "It has not completed its work and should do so with priority."

He also criticised the Office of Fair Trading for dragging its feet on work to ensure all bunk beds in domestic and commercial settings were compliant with safety standards.

Outside court, Elise's parents, Gerard and Lorraine Neville, said they were relieved that the inquest was finally over and they were satisfied with most of the coroner's findings. "We believe the doctor should have been charged; the coroner doesn't feel there is evidence to support that," her father said.

But Mr Neville said he was staggered that Caloundra Hospital still would not be getting until August next year a CT scanner - which could have helped diagnose his daughter's injuries and save her life.

In 2004, Dr Doneman pleaded guilty to unsatisfactory professional conduct before Queensland's Health Practitioners Tribunal and he was ordered to be stringently supervised for one year.

Dr Lock said Queensland Health should review the capacity of rural or remote hospitals to perform emergency neurosurgical and vascular surgical procedures which may have saved Elise's life. Queensland Health director-general Michael Reid said Queensland Health had worked hard to address the issues raised by the inquest, with work still continuing.

Source

Public hospital coverup

Some cancer patients at the Royal Adelaide Hospital are believed to have had their lives shortened by up to two weeks because of a radiation treatment bungle. An independent report into the error warns of the possibility of "a reduction in survival of up to two weeks for (five) patients who were receiving radiotherapy for high-grade brain tumours". Health Minister John Hill has ordered a second investigation into the decision by the then RAH management "to not notify patients" or the Government.

The report, tabled in Parliament yesterday, labels the error "significant" and "serious" and states 869 patients were exposed to an under-dose of radiation treatment of about 5 per cent. "In terms of error, this incident is considered significant because of the volume of patients exposed to the error," the report states. "Although . . . the overall clinical impact might be small, an error such as this can provide significant warning for a potential more serious error in the future and should be considered serious."

A review panel led by NSW radiation oncologist Professor Geoff Delaney found the under-dose on a malfuctioning radiotherapy machine at the RAH between July 28, 2004, and July 21, 2006, would not have an impact on the "vast majority" of patients. However, the panel said its "educated estimate" was the under-dose had shortened the lives of a group of brain tumour sufferers by up to a fortnight. This was said to be a "best guess". The panel also said it was not able to study every individual case or assess individual risk because that would take months. Rather, the panel consulted international literature before generally reviewing patients' diagnosis and treatment.

They then identified seven patients in three different tumour groups who may have had a "small but real" clinical impact. Aside from the five brain tumour patients, there was one head and neck cancer patient who "may have had their cancer compromised" and another prostate cancer patient who requires follow-up care. Health Department chief executive Dr Tony Sherbon said he was trying to contact the seven patients yesterday. He said 14 other patients in high-risk categories had since died. "We are not in a position to say whether the under-dosing affected their survival," he said.

The Government has accepted the report's 14 recommendations, including to hire six more staff. When the error was discovered two years ago the dosage was rectified. But the then RAH general manager Virginia Deegan, currently employed by the University of Adelaide, and the hospital's director of cancer services, Professor Dorothy Keefe, decided it was not significant enough to alert the public, the department or the minister.

Dr Sherbon only found out about the error on July 16 this year, after a complaint. He took up his position as Health Department chief executive just weeks after hospital management found out about the error. "I would have liked to have been briefed on it, yes, I would have liked to have known," he said. Dr Sherbon said that in 2006, Ms Deegan was notified by Professor Keefe, who advised "the under-dosing was not signficant and the manager (Ms Deegan) took that advice".

Although he will await the outcome of a second inquiry, by former Premier's Department chief Ian Kowalick, into the hospital's handling of the matter, Dr Sherbon said he will take any action recommended against Professor Keefe. "Mr Kowalick will make reference to the standards of public sector management," he said.

But RAH medical staff society chair Dr James Moore last night warned Dr Sherbon not to "overstep the mark". "He runs a very real risk of making it impossible to attract people to come and work in this state," Dr Moore said. "If he believes that all problems are going to be reported now, he's living in cloud cuckoo land. "The Government had been warned a good 12 months before this emerged that there was a risk of something like this happening because of the staffing problems.

Opposition health spokeswoman Vickie Chapman said the investigation should be widened to include the department.

Source





13 September, 2008

British watchdog's $9 million PR budget: NICE spends more on 'spin' than drug tests

The health rationing watchdog has come under attack for spending more money on spin than on evaluating drugs which could save patients' lives. The National Institute for Health and Clinical Excellence (NICE), which has been widely criticised for banning drugs from NHS use as too expensive, squandered 4.5million pounds on 'communications' last year. This was 1.1million more than the 3.4million the controversial organisation spent on assessing new medicines.

The money forked out on press officers, marketing executives and consultants included 25,000 on top public relations firm Weber Shandwick to defend NICE's ban on Alzheimer's drugs. It could have paid for 5,000 Alzheimer's sufferers to get 2.50-a-day drugs for a year. Alternatively it would have funded nearly 200 patients with advanced kidney cancer to have a drug for 12 months that would double their life expectancy. Tens of thousands of people across the country are waiting for NICE to assess drugs that could extend their lives or alleviate conditions such as rheumatoid arthritis and thinning bones.

MPs, patients groups and medical organisations branded the amount spent on communications as a 'scandalous waste of money'. Myeloma sufferer Jacky Pickles, one of the 'Velcade Three' - three mothers who launched a campaign after being denied anti-cancer drugs - said: 'It is disgraceful that money which could provide drugs that make the difference between someone living and dying is being spent on communications.' Mrs Pickles, 46, of Keighley, West Yorkshire, added: 'NICE should either use the money to improve their evaluation process, or give it back to the NHS to spend on people who are ill.'

Shadow Health Minister Mark Simmonds, who uncovered the budget breakdown tucked away in NICE's annual report, said: 'These figures typify New Labour's approach to Britain's health service. 'Thousands of patients across the country who are still waiting for NICE to evaluate new medicines will rightly be asking why Labour insists on spending more on spin than on speeding up people's access to lifesaving drugs.'

NICE has an annual budget of 34.4million pounds, and spends 1 in every 8 pounds on communications. In contrast, 1 in every 10 is spent on evaluating new drugs. The rest is spent on such things as salaries - NICE's annual report for 2006/07 revealed that wages accounted for almost 37 per cent of the budget - accommodation (eight per cent) and external contracts. Almost 300 full-time staff are employed in London and Manchester.



The watchdog looks at whether drugs are cost-effective for the NHS, with the annual cost threshold set between 20,000-30,000 pounds, above which they are considered too expensive. The 'value-for-money' calculation, which does not take into account factors such as severity of a disease, means British patients are denied drugs that are freely available abroad.

NICE was condemned recently for handing a 'death sentence' to 1,700 patients with advanced kidney disease each year who will be deprived of four life-extending drugs. One, Sutent, which costs around 24,000 a year, can double the life expectancy of patients to 28 months.

NICE has also been accused of 'dithering' over the evaluation process. It has taken several years for the watchdog to approve the use of some drugs. Chief executive Andrew Dillon was forced to make a grovelling apology last month for a two-year delay in approving a new treatment for blindness during which time many Britons lost their sight.

Michael Summers, vice-chairman of the Patients Association, said spending 4.5million on communications was 'immoral and indefensible'. He said: 'If NICE has reached the situation where it is so unpopular that it has to spend money improving its image, maybe it should be less dilatory and improve its performance.'

Nick Rijke, of the National Osteoporosis Society, said: 'I would have thought that an organisation that spends so much on communicating would be rather better at listening to the views of clinical experts and patient societies.'

NICE said the majority of its communications budget was spent informing doctors about which drugs had been approved and new guidelines for treatments, although it admitted that it had a 'small' marketing budget.

Mr Dillon said: 'The actual cost of assessing new drugs for the NHS includes money spent on NICE's behalf by the Department of Health. When you add them together, the total cost of the NICE technology appraisal programme far outstrips the cost of NICE communications.'

Source




Australian public hospitals kill as many as the roads do

The number of deaths caused in Australian hospitals by emergency department overcrowding is equal to the road toll, a new report has revealed. The report by the University of New South Wales, in preparation for a Friday summit on emergency department access block in Melbourne, also revealed that patients face up to 30 per cent more chance of dying if they attend an over crowded emergency department. Children and the elderly are among those most likely to be affected. Queensland hospitals are among the most overcrowded in the country.

The report, prepared for the Australasian College of Emergency Medicine, suggested that increasing hospital bed numbers is the only method to reduce access block. Access block is when patients are left to wait longer than eight hours for a bed in an emergency department. "A large amount of human suffering (in emergency departments) is preventable," the report said. "There is a 20-30 per cent excess mortality rate every that is attributable to access block and ED overcrowding in Australia. "This equates to approximately 1500 deaths per year, which is similar to the road toll."

The report criticised a lack of extra hospital beds in recent years despite enormous growth in emergency department patient presentations. Bed occupancy rate should not be higher than 85 per cent. "There are not enough available beds to meet demand," the report said. "This results in access block and ED overcrowding. "This is associated with significant mortality and human suffering."

The report claimed that telephone hotlines and after-hours GP clinics did little to improve access block. It also criticised methods of treating patients in non-treatment areas such as hospital corridors and waiting rooms. "Access block and overcrowding have also been associated with increased return rates of hospital re-admissions, return visits to the ED, and inappropriate follow-up care," the report said.

Source





12 September, 2008

Cancer patient with months to live wins court order for last-chance drug on NHS

A cancer patient yesterday won a legal battle against the NHS to be given a drug that doctors say could prolong his life by up to three years. Colin Ross, 55, of Horsham, West Sussex, has multiple myeloma, a cancer of the blood cells, and was not expected to survive to see Christmas unless he was given a drug described as his “last chance”. The High Court overruled the decision by West Sussex Primary Care Trust that treatment would not be cost-effective, and said that Mr Ross should receive Revlimid as an exceptional case.

Mr Ross had incurable cancer diagnosed in May 2004. In an interview with The Times last month he said that he was “sickened” that he was being denied the $60,000-a-year treatment even though the drug was available to patients living only a few miles away in East Sussex. But despite the exhortations of doctors treating Mr Ross at the Royal Marsden Hospital, the specialist cancer hospital in London, the trust had, since March, repeatedly refused to fund the drug, raising the issue of a so-called postcode lottery for NHS treatments.

However, Judge Simon Grenfell, sitting in London, condemned the trust’s decision yesterday as “one which no reasonable authority could have made on the application before it”. Revlimid is among the most expensive of new cancer treatments and is readily available to patients across Europe and in the United States and Scotland. But it has not yet been granted approval by the National Institute for Health and Clinical Excellence (NICE) and, because of the cost, is likely to be rejected. It is provided by only some trusts in England and then only in exceptional circumstances.

The case is likely to encourage other cancer patients who may have been denied expensive drugs on the NHS, but experts emphasise that the case does not set a legal precedent and that decisions will be taken case by case in other areas. The judge issued an emergency injunction to enable Mr Ross to begin treatment today, but the ruling was made on an interim basis pending a further appeal and not as the start of permanent treatment.

Mr Ross was too ill to attend court for the ruling but his long-term partner and carer, Wendy Forbes-Newbegin, 52, who has breast cancer, cried after the victory. She said after the judgment that the family’s treatment by the NHS had been “appalling”. “The mental anguish that we have been through has at times been unbearable, and wholly unacceptable in this day and age,” she said. “Colin’s diagnosis and recent prognosis have been so awful in the first place, but to have to endure all the months of waiting for this life-prolonging treatment has been nothing short of shameful in the first degree.”

Mr Ross, who has two children and four grandchildren, told The Times that he feared that delays incurred by his appeals to the trust and ensuing legal action may have reduced the effectiveness of the treatment. “Depending on what the judges say, I could start treatment with Revlimid, or the doctors will simply refer me to start receiving palliative care,” he said last month. “My bed in the hospice is already booked. I realise the drug is expensive for the NHS, but to think that I could have a few extra months or years to spend with my daughters and watch my grandchildren grow up – I’ve never wanted anything more.”

The former engineer in the oil and gas industry had suffered years of pain and disability from the disease, which made his bones brittle and prone to fracture. He had already been prescribed other drugs on the NHS for myeloma, Thalidomide and Velcade, but was forced to stop taking them because of painful side-effects. Before yesterday’s ruling he was taking a cocktail of painkillers and other drugs “just to keep my head above water”, and was advised that Revlimid was now the only option.

In March, Mr Ross’s clinicians asked West Sussex PCT to fund Revlimid for three to four courses at a cost of $10,000 a course and presented evidence to show that it could give Mr Ross up to three more years of life. He had been unable to purchase the drugs privately, he said. “Even if I could, the law states that I would have to become a private patient and forfeit the rest of my NHS care.”

Richard Clayton, QC, acting for Mr Ross, told the court during a two-day hearing: “This application for this drug is the end of the road for him. Either he gets the drug and is able to have life-prolonging treatment, or he doesn’t and treatment ceases, with inevitable consequences.” He added: “Were the claimant to live a mile and a half in either direction from where he does, he would have received the drug.” West Sussex PCT said that it was considering whether to appeal. [What total, complete and utter assholes!]

Source




Australia: Perverted doctor charged over mutilation of women

This should have been done many years ago -- when the complaints first began. Yet another regulatory failure

A FORMER New South Wales doctor has been charged in relation to alleged sexual assaults and genital mutilations of patients who were undergoing surgery. Graeme Reeves, 58, who was banned from practising obstetrics by the Medical Board in 1997, has been charged with 17 offences against 10 women, Detective Superintendent John Kerlatec said.

Mr Reeves was arrested in the Sydney suburb of Baulkham Hills this morning after extensive investigations into more than 113 allegations of patient misconduct between 2001 and 2003 at Baulkham Hills and at Bega on the state's south coast. The Daily Telegraph was on the scene when Mr Reeves was brought in to a local police station at about 6.45am (AEST) in the back of an unmarked police car.

"It's been a lengthy investigation due to the fact there have been numerous people we've had to speak to including in excess of 100 (alleged) victims and witnesses, medical professionals, plus also examine numerous medical records," Supt Kerlatec said earlier on Macquarie Radio. "We also had to engage our own medical expert to give us advice on the difference between malpractice and what we consider to be criminal action. "This is the first investigation of this size and nature conducted by the NSW Police force and officers are treating the matter very seriously," the Daily Telegraph quoted him as saying.

Police from Strike Force Tarella raided a storage unit allegedly belonging to Mr Reeves last week at Gladesville in Sydney's northwest, where officers allegedly located a raft of medical documents. Mr Reeves is expected to face court today, but police said the probe was continuing. "Today's arrest marks the first phase in this lengthy and complex investigation and inquiries are ongoing," Supt Kerlatec said.

He praised the courage of the former patients of Mr Reeves who had come forward with their allegations. "We were extremely encouraged throughout this whole matter by the strength displayed by these women," he said. "It's been a very traumatic experience for them and it's taken a great deal of courage for them to come forward."

Mr Reeves' appointment by the Southern Area Health Service in 2002 has been examined by Peter Garling SC as part of his wider investigation into the NSW public hospital system. He found that when Mr Reeves applied in 2002 there were "deficiencies" in the system that meant authorities failed to detect he had been banned from practising obstetrics. "I find that Dr Reeves' intentional and calculated dishonesty was the main reason he was recruited to a position he was legally unable to fill," Mr Garling wrote in his report.

Source




Australian public medicine at work

On a day the State Government promised to fast-track compensation for as many of 100 of Graeme Reeves' alleged victims one woman tells her story in the hope of creating a more accountable health system

MY DAUGHTER Sarah was delivered by Graeme Reeves at Hornsby Hospital in 1995 - her heart rate was falling, she was in foetal distress and he didn't care. The nurses kept coming back to me saying he wouldn't come in, he wanted them to fax through a copy of the foetal heart monitoring strip because he didn't believe them. I had visited him earlier that day and had an ultrasound and everything was OK, I went into labour that night and the nurses rang him at home and he said 'You couldn't be in labour, you're only 34 weeks'. He got me mixed up with another woman, I was 38.5 weeks.

By the time he arrived and delivered her, Sarah was dead. She was revived, it took some time before she took her first breath and I never really saw him again after that. Sarah has cerebral palsy. It is quadriplegic spasticity which means it affects all four limbs. She's blind, she has an intellectual disability and epilepsy, she is in a wheelchair, she has no communication and is reliant on me for everything. The midwives gave me my paperwork when I left the hospital and said 'you might need this one day'. It was that comment that kept in my head. At the time I was sleep deprived and Sarah was fighting to survive but they knew. That is the sad part. I know nurses complained, a lot of nurses complained but what happens to nurses who complain? They get crucified.

I don't work any more, Sarah is 24/7 care, I have equipment costs, medication costs, I have to lift her in and out of our car because I can't afford to have a wheelchair conversion done, which is about $25,000. We're in hospital at least once every year for several weeks a year. She has had six hip operations, she had more than 100 per cent scoliosis of the spine.

But as much as our family has suffered, it is Sarah who paid the ultimate price, it is her life. She has been deprived of the life she should have had and, while we're doing everything to give her the best life possible, it is nothing compared to what she should have had. She would have been one of these kids that is always running. Sarah is beautiful and we love her to death but the Government was supposed to be protecting us from people like Graeme Reeves. There is no system to provide that protection. Sarah loves life, she is a fighter, she loves music and people. Going out in the car, going for coffee and shopping are some of her favourite things, she is such a girl.

I wrote to the Health Care Complaints Commission in 1997. They wrote back to me that the public interest had been served, Graeme Reeves was no longer practising as an obstetrician and his gynaecological business was under supervision. I was happy no one else could be injured by this man but I still protested to have my individual case investigated. I did the right thing, I put in a complaint with the HCCC. That was the system and the system didn't work, it doesn't protect anyone. When it came out in the media in February, that's when I learnt they hadn't done what they had said, he had been practicing that whole time and no one had been supervising him. I felt sick.

We took action against Hornsby Hospital and Graeme Reeves and that's when we found out Reeves was theoretically uninsured and bankrupt. I had a statement of claim against Hornsby Hospital. It was at a time when the full history of Dr Reeves wasn't known and we had to withdraw from our action in 2003. I had to sign a consent judgment to release us with no costs, which means I could not make another claim. With all this new information and the fact there were 35 complaints received at Hornsby Hospital between 1986 and 1997, I wanted to apply to make another claim with the Government's insurance company. They have rejected us.

My lawyer wrote to Hornsby Hospital lawyers in July asking for their consent for the judgment in favour of the hospital from 2003 to be set aside. It was the only way I could make another claim and it was met with outright refusal.

Former health minister Reba Meagher said in February: "I want to assure the community the NSW Health system will take responsibility for any failings of public hospitals relating to Dr Reeves' practice." The Government has not fulfilled its duty to protect Sarah and cover her needs. It is not interested in my daughter. I am happy charges have been brought against Graeme Reeves for allegedly assaulting women but it should never have got to this point.

Source





11 September, 2008

More NHS bungling

How can they confuse lung disease and cancer of the liver?

When doctors told Andy Lees he had no more than six weeks to live he set about the sombre task of preparing for his death. He divided his œ18,000 life savings among his nearest and dearest, leaving enough to pay for his funeral. Then he waited for the cancer to take him. But a year later Mr Lees is still in the land of the living - and has just been told he does not have cancer after all. Now penniless, the 72-year-old is planning to sue the hospital which wrongly diagnosed the terminal illness.

He said: `The doctors told me I had cancer of the liver and the lungs, I had only four to six weeks to live and there was nothing they could do for me. `But they've now said they were wrong and, although I'm still very ill, I'm not dying. `I've given away my life savings because I didn't think I'd need it. Now I'm absolutely skint.'

Mr Lees gave his four sons and his daughter œ1,000 each and told them to use it as they wished. Two grandchildren received œ2,000 each while a further œ3,000 was divided among friends. To ensure he would not be a burden on his family after he was gone, he paid œ6,000 for his funeral and headstone. To make matters worse, the headstone was placed at the spot where he was to be buried at the cemetery near his home in Blackburn, West Lothian. He later asked for it to be removed. He said: `Discovering your own tombstone is quite an experience.'

Mr Lees was taken to St John's Hospital in Livingston last year after lapsing into a diabetic coma. Doctors carried out tests and told him he was dying of cancer, but after several return visits to the hospital they have changed their diagnosis. Now they say he is suffering from chronic obstructive pulmonary disease, which causes the airways to narrow.

Mr Lees said his family were shattered when they heard the initial diagnosis. He said: `My family and I went through hell.' Now the pensioner is housebound and unable to afford the mobility scooter he needs. NHS Lothian medical director Dr Charles Swainson said: `We have met Mr Lees and his family and apologised for any distress caused.' [Big deal!]

Undertakers William Grieve and Son said Mr Lees had specifically asked for the headstone to be put in place when he made his funeral arrangements.

Source





10 September, 2008

Revealed: The wild variation in how NHS trusts spend money on treating the same conditions

The NHS spends three times more in some areas on treating the same conditions, it has emerged. A report highlighted huge variations in amounts spent locally, even after the needs of different communities were accounted for. Spending varies by up to 3.4 times for mental health, 2.5 times for cancer and 2.2 times for heart and circulatory diseases.

The study by health charity the King's Fund analysed primary care trust spending from 2004 to 2007. Islington, North London, spent 332 pounds per head of population on mental health, while in West Kent it was just 98 - a 3.4-fold gap.

The proportion devoted to mental health ranged from 7.6 to 25 per cent of trusts' budgets. Knowsley, Merseyside, paid 118 a head on cancer, while Ealing, West London, allocated 47.

Middlesbrough spent 167 on circulatory diseases compared with 76 in Southwark, South-East London.

Professor John Appleby, of the King's Fund, said: 'It does raise questions about the consistency of the decisions PCTs make.' Chief executive Niall Dickson said: 'There are unexplained spending variations - some are almost certainly not justified.' David Stout, of the PCT Network, representing trusts, said: 'Many of these variations are expected. 'However, some are not explained. It may reveal unacceptable variation in clinical practice.'

Source





9 September, 2008

The health care mess: A free market proposal

"The right of the state to deal with the entire subject (health care) can assuredly not be gainsaid. The physician is a social instrument." This is just one of Flexner's statements that bespoke a deep socialist paternalism. It could have been made by John Dewey, the radical socialist educator and Flexner's contemporary. In retrospect, Flexner was a cog in the wheel of socialism and an authoritarian one to boot.

All socialists are opposed to anything that smacks of the profit motive, especially when someone else makes the profits. They also are never above using their reforms for their own profits. Flexner was vehemently opposed to proprietary medical education, and like all the socialist minded, he never recognized that his reforms would result in an even greater financial cost to society.

Licensing has been a disaster and does not protect the public, in any way. If anything, it institutionalizes incompetence and avarice. No matter how it begins, authority always has to be passed up the line to a higher authority. Discipline is filtered through these layers which usually acts only to protect the licensee. In addition to the examples above we have the horrors of incorrect limb amputations, and other disasters in respected hospitals.

How then to regulate the quality of medical care? Like everything else, through the marketplace. First of all, eliminate licensure.

Several decades ago, the AMA publication, Medical World News (MWN), reported that Milton Friedman spoke at a medical conference where he proposed exactly that. When challenged about quality assurance, Friedman proposed using insurance companies rather than licensure. MWN reported that physicians were 'still shaking their heads at that one' after the meeting. MWN was edited by Morris Fishbein, M.D., a long time opponent of alternative treatments, and a mouthpiece for the AMA.

But insurance companies would be the logical way to assure quality. It would be the insurance companies who would suffer the losses for poor medical care and in their best interests to make sure that poor practitioners did not continue. They would be immune from political pressure and, simply as a business decision, arrive at a decision. So who better?

Some have argued that malpractice rates are often highest for the most skilled physicians, especially surgeons. The argument is that they are the ones willing to tackle the most difficult cases and the ones trying the most innovative techniques. Maybe, but in a free marketplace, any patients in such conditions that would warrant such risky attempts, should be willing to incur the financial burden for them to compensate for the skilled attempt.

Allow proprietary medical schools. They would be most responsive to the needs of the people. As the demand for physicians increases, the schools would hire more instructors to train them. And why shouldn't the students who are going to enter a high paying profession have to pay for it themselves?

Eliminate all public funding for medical research and medical education. Let marketplace needs, rather than politics govern research projects. As it is, AIDS activists claim that there isn't enough research in this direction while others claim there's too much of it or not enough for their favorite projects. Once again, why not let the marketplace determine the direction of research? It could hardly be any worse than what we have and we'd save the millions of dollars that go into lobbying to accomplish the funding.

Some may argue that there would be protection against quackery. The response is that it's going on anyway and that licensure has failed miserably in preventing shoddy medical practice, disastrous results and practice motivated by sheer greed.

Others may argue a complete market system will not guarantee access to good care by the poor. But charity work has never been in short supply in the medical sphere in the first place. In fact, traditionally, medical care was the province of charitable, religious bodies. It might not be a bad idea to resurrect that venue as part of a re-alignment.

But there is even more of a reason to throw the entire system out. It's going to be destroyed by progress anyway and government will never be able to keep up with it. Federal and state authorities are scrambling to keep up with on-line medical practice. Some states have been able to penalize physicians who practice and prescribe on-line. The justification is that the physician is treating without examining the patient but it's a losing battle. Technology will be finding a way around all those problems.

We already have virtual endoscopy and whether people are aware of it or not, often their x-rays and laboratory reports are originating in India. The films or slides are being read by a radiologist, pathologist or technician on the other side of the world and at a cost far less than an American practitioner would charge. This is going to accelerate as technology eliminates distance as a barrier for all services, not just medical.

This scenario may seem far-fetched but it's not out of the question. You have a sore throat. You plug into the Internet and a physician in Pakistan or China comes onto your screen. He instructs you to open your mouth and insert a fibre optic attached to your computer that transmits the image of your throat to him. You take your temperature and tell him what it is. You attach a stethoscope to your chest and breathe while the sounds are transmitted. He does the entire examination without ever having been in the same room as you. Getting you the medication could be a challenge but in these days of rapid shipping that might be accomplished within twelve hours. You pay for everything by credit card.

With the introduction of remote control robots, it's also feasible that a future surgeon would operate on a patient from the same distance. Government will never be able to stop this. It will try but it's a losing game.

And if it's happening in medicine, traditionally the first licensed field and the most highly regulated, it will happen in all the others. Government, throw in the towel! Your days are numbered! Freedom cannot and will not be denied because human initiative and the human spirit cannot and will not be denied.

Source




Australia: Melbourne public hospital putting women's lives at risk

Victoria's Opposition says internal documents from the new Royal Women's Hospital show lives are being put at risk. Opposition health spokeswoman Helen Shardey has obtained a copy of the hospital's latest operational plan. She says it shows delays in accessing operating rooms and a badly-run outpatient service. She says the $250 million hospital is also suffering from a shortage of nurses.

"What these documents indicate is that the hospital is in trouble. They don't have enough staff, they are being poorly resourced and they will have to cap the number of babies they can deliver," she said. "From this report it appears that the outpatient area is not large enough to accommodate the number of patients that needs to be seen, and this report indicates the architects have been called back to redesign the outpatient area."

The Royal Women's Hospital is playing down possible risks to women and their babies at the new facility. Hospital spokeswoman Mandy Frostick says women should not be concerned about treatment being provided. "We have a yearly risk assessment process, which is a very sophisticated process at the Women's, which looks at any potential risk that could occur in any situation," she said. "And what is most important in identifying any possible risk that could occur is that we also put in place mitigation plans to prevent those risks from occurring. "There are always risks at any major hospital, We are one of three specialist maternity hospitals and we deal with very complex high-risk pregnancies. "And by that very nature we are constantly dealing with risk. We are very experienced in dealing with risk."

Source





8 September, 2008

Health Care Retail Clinics

Affordable, convenient health care has become more available to average Americans as a result of the proliferation of so-called "retail clinics."

A resurgence of the failed effort to establish "store-front clinics" in the 1980s, retail clinics are growing in number across the nation. These clinics, which offer basic acute care services and preventive care options, provide cost transparency to their customers with clearly posted prices and on-the-spot fee-for-service billing. Many clinics accept insurance, as well, charging standard co-payments for care.

Not only do retail clinics provide convenience to consumers -- they are often located in shopping centers, pharmacies, or multipurpose stores like Wal-Mart -- but they also provide a non-emergency room and non-community-clinic option for uninsured Americans to receive preventive care and treatment for minor illnesses.

Retail clinics empower people to take control of, and responsibility for, their own health needs. In-store clinics offer an excellent opportunity for health care reform; policymakers should not only acknowledge their role in health care provision but also be careful not to create laws that stifle these innovations.

Some experts believe the retail clinics are catching on because of the shortage of family physicians. Within the next 15 to 20 years, the deficit is expected to reach as many as 200,000 physicians -- 20 percent of the needed workforce, according to Dr. Richard Cooper, a professor of medicine at the University of Pennsylvania. "The success of the new retail clinics (now) is more likely because there's a doctor shortage," he said.

"[The spread of retail clinics] will mean that [family physicians] will have to evaluate how convenient their practices are for patients, and will most likely need to make some changes to be more user-friendly," said Dr. Larry Fields, president of the American Association of Family Physicians.

The number of retail clinics operating in the U.S. has surged in the past three years, from fewer than 50 in 2005 to more than 1,000 today. These clinics are expected to expand their scope of treatments in upcoming months and years to include chronic disease management, injections (some already offer influenza vaccinations and other injection services), weight loss counseling, and more.

Source




THE AUSTRALIAN PUBLIC MEDICINE CHAOS CONTINUES

Two articles below

Elderly man dies after waiting 8 hours for a public hospital bed

An elderly man has died while waiting for a ward bed at the overcrowded Townsville Hospital after being left in a corridor for more than eight hours. The man, believed to have had cancer, was monitored by medical and nursing staff during the delay to transfer him to a ward at the troubled hospital.

Health Minister Stephen Robertson yesterday said he had referred the case to the Health Quality and Complaints Commission for independent review. "I view this matter very seriously and that's why I'll be referring this incident to the independent health watchdog," Mr Robertson said. "It's my responsibility to ensure that when events such as this occur that we don't sweep it under the carpet and we get full disclosure in terms of the facts of what actually occurred and learn from them, if there are in fact lessons to be learned."

Several doctors and nurses contacted The Sunday Mail late last week expressing concern at the over-crowding in the hospital. One staff member said it used to be unacceptable practice to have more than eight patients waiting to be admitted to a ward. But, he said, the hospital now had to deal with the tragedy and shame of a patient dying on a trolley in a corridor. "He was very sick, but he waited a very long time for a bed - and didn't get one," said an emergency department nurse, who asked not to be identified, about the man's death last Tuesday. "He was in the corridor with patients on trolleys in front of him and behind him ... he was rushed into the resuscitation room, but he wasn't revived. It's just terrible."

Acting Townsville Health Service District CEO Mary Bonner said the first priority for the hospital was ensuring that the patient's family was informed and supported.

The death comes a week after Mr Robertson dismissed the concerns of Dr Sylvia Andrew-Starkey from the Australasian College for Emergency Medicine. Dr Andrew-Starkey said she had referred information to Queensland Health about people dying because of bed access problems in hospitals. But Mr Robertson challenged Dr Andrew-Starkey to provide evidence of a link between wait times and harm to patients.

Professor Drew Richardson, from the Australian National University, told The Sunday Mail he could direct the minister to two major studies carried out in Australia and two more from America which showed the link. "There are cases where coroners have handed down adverse findings in relation to the outcome of patients who have had to wait for extended periods to be admitted, Prof Richardson said. "There are cases where death has been a direct result of dysfunctional environments in emergency departments."

Townsville Hospital's emergency department was designed to cater for 38,000 patients each year. Last financial year almost 62,000 sought treatment there. The demand has led to up to 24 patients each day remaining in the emergency department, some of them for up to 48 hours, until beds can be found in overcrowded wards.

Doctors and nurses in the department said they no longer provide emergency care as much as determine which patients are most able to cope with a long wait in the corridor. "We do not treat patients anymore. We run around managing an out of control department - it's not because of sick patients. It's out of control because you don't know where to put a patient on a trolley," one doctor said.

Nursing staff said the were likely to lose colleagues if access block continues at the same level. "We've coped for long enough," one nurse said. "The straw to break the camel's back is out there blowing on the breeze and it will land soon. "I've had nurses that haven't been able to come to work just because they are so distressed ... they've had to take extended time off work because of work. "We're not just going to lose a nurse in the short term in ED - we are going to lose a nurse full stop ... they will never come back to a nursing role again."

Source

Paramedics as 'Babysitters' in hospital gridlock crisis

TAXPAYERS spend an average of $70,000 a month for off-duty paramedics to babysit critically ill patients who are unable to get a bed in gridlocked emergency departments. NSW Ambulance figures show the bill rose almost 30 per cent last financial year compared with the previous period as more patients languished in the back of ambulances lined up outside hospitals waiting for a bed. Chronic overcrowding in emergency departments has forced NSW Health to create Ambulance Response Teams, made up of off-duty paramedics paid overtime rates to sit with patients in emergency queues.

Figures obtained by The Sun-Herald show the bill rose to a record $118,218 in July and doctors say it's further proof the health system cannot cope with demand. A response team is called in when one ambulance has waited more than 60 minutes or two ambulances have waited more than 30 minutes outside an emergency department, allowing on-duty paramedics to get back on the road.

Sally McCarthy from the Australasian College for Emergency Medicine said the delays were a direct result of bed shortages. Once seen, one in four patients wait more than eight hours to get moved from emergency to a ward. Last financial year the bill for response teams was up almost 30 per cent, costing $831,769. Opposition Leader Barry O'Farrell said the money would be better spent on reducing waiting times, including through boosting doctor numbers.

Source





7 September, 2008

Mythical NHS maternity money

Funding promised by the Government to improve poor standards of care for mothers and newborn babies is failing to reach maternity units, The Times has learnt. A survey of NHS trusts has showed that nine out of ten cannot identify their share of the $660 million pledged by ministers. Leading midwives and doctors say the money could be lost on the NHS balance sheet or spent on other services because it has not been properly ring-fenced. Despite record increases in spending on the health service by Labour, critics maintain that the money is still not reaching the areas most in need of reform.

Alan Johnson, the Health Secretary, announced the extra spending over the next three years in January, following several critical reviews of maternity services by the Healthcare Commission, which is the NHS regulator. "From April 2008, trusts have access to this additional money," he said.

Rising birth rates and a shortage of midwives have put huge pressure on the system, meaning mothers are often left without care during labour.

The Times submitted questions under the Freedom of Information Act to all 152 Primary Care Trusts (PCTs) in England, the local bodies that distribute 70 per cent of the total NHS budget. Of 85 trusts who responded, only eight claimed to have received additional funding for maternity this year as Mr Johnson promised. The extra money was for the implementation of "Maternity Matters", a policy that recommends that every woman giving birth in England should have one-to-one care from a dedicated midwife. Ministers also aim to give greater choice over where babies are born, with more home births and deliveries in local units staffed by midwives rather than hospital consultants expected as a result.

One head of midwifery in the South West, who did not wish to be named, said: "Despite all of the Government's announcements, we have not seen any of this additional funding. "All the staff are aware of this additional funding and expecting to see changes and improvements in maternity service provision, but I have not seen any of the money." Instead, healthcare staff have to bid for the extra funds and have had no reassurances on how it would be spent.

Louise Silverton, deputy general secretary of the Royal College of Midwives (RCM), said that new mothers would still face a postcode lottery in the quality of care as a result. "It is not enough for the Government to say they have put money into maternity services, but then fail to make sure the money actually goes where it is supposed to. "Women keep hearing these excellent policy statements, such as one-to-one care from a midwife, but they are not getting that sort of treatment in many areas." Overall, NHS spending on maternity in England was cut by $110 million in 2006-07, while the birth rate has risen 16 per cent since 2001, she said. "Some trusts have managed to increase their spending but for the most part we don't know what PCTs are spending the money on, there's a lack of transparency."

Sabaratnam Arulkumaran, president of the Royal College of Obstetricians and Gynaecologists, added: "Extra funds have been promised to improve maternity services and it is important for these to be ring-fenced within each trust. "NHS managers, clinical directors and head of services must present a case to their PCTs in order to secure more funds for their units." The RCM estimates that 5,000 extra midwives need to be recruited urgently, but the Government has promised only 3,400 full-time posts.

Of those surveyed, 33 trusts (38 per cent) could specify a figure for their projected spending on maternity services in 2008-09, but this was estimated from increases in their total budgets or from local plans agreed prior to the Government's investment. Asked what the money was being spent on, trusts' answers varied from specific numbers of posts for midwives and maternity support workers to more general promises to "increase midwifery capacity" or programmes such as sexual health services, breast-feeding support or smoking cessation for pregnant women.

"These are softer areas of care that do not address the core issue of staffing shortages," Miss Silverton added. "Large numbers of midwives are due to retire in the next few years and maternity support workers should not be used to substitute for them."

Anne Milton, a Conservative MP, added: "This Government has been more concerned with getting a good headline than delivering the services that patients need. It is unacceptable that at a time when the NHS is reporting record surpluses of nearly $4 billion that this funding is not reaching the front line, where it is so desperately needed by new mothers and their children."

Source




Waiting in pain

For women like Clare Payne, who experience complications during pregnancy, childbirth can be an agonising experience. Mrs Payne, 23, gave birth to her first son Harry in 2006 with few problems, but his brother Finley's birth last September was delayed repeatedly owing to a shortage of staff and beds.

At 18 weeks she developed SPD, a condition that causes pressure on the pelvis and extreme pain. Doctors said that she should be induced at 37 weeks, but when she arrived at hospital she was promptly sent home because there were not enough staff. "I was told I was a priority case, but every time I contacted the ward I was told I would have to wait hours, if not days."

Mrs Payne, a sales assistant from St Leonards, East Sussex, returned to hospital at least three more times. Finally she elected to have a Caesarean section after waiting for more than two weeks. "It was a totally disgusting way to treat a heavily pregnant woman," she said.

Source





6 September, 2008

Sick Patients Need Cutting-Edge Drugs

Anna Tomalis was a bright, pretty, 13-year-old girl who liked horseback riding and soccer. During the last few years, she rarely had a chance to think about those things. Since September 2005, Anna battled cancer. And, instead of wringing all she could out of childhood, this courageous teenager tried to get members of Congress to act like adults. Anna had embryonal sarcoma, a rare form of liver cancer. Surgery and chemotherapy seemed to work at first, but the tumors came back. In March of this year, doctors told her there was nothing more they could do.

She and her parents didn't give up, though. With a little research, they discovered a number of experimental drugs that show promise in treating soft-tissue sarcomas like Anna's, including one called Deforolimus, developed jointly by the drug companies ARIAD and Merck. Unfortunately, Anna was too young and too sick to be admitted to the clinical trials in which she might have gained access to one of those drugs. And the Food and Drug Administration (FDA) very rarely grants so-called compassionate-use exemptions to administer unapproved medicines outside the clinical testing process.

Just a few months before Anna Tomalis received her fateful diagnosis, this editorial page introduced readers to an Indiana woman name Kianna Karnes. Mrs. Karnes was waiting for the FDA to consider her own petition to use an experimental drug, and editors proposed a "Kianna's Law" to reform the clinical testing process for drugs to treat life-threatening illnesses. Tragically, no such law was enacted; Mrs. Karnes died the very day FDA approved her exemption.

Anna Tomalis was only barely more fortunate. It took months for her exemption to come through and for Anna to get access to one of the experimental drugs her family thought might help her. Anna's mother Liz says she "came into this process so naive, thinking that those of us who seek compassionate use of drugs actually get them. It was a shock to find out I had been seriously misled."

Her treatment regimen began at the end of July, but for Anna it was too little, too late. She passed away on Aug. 15. Of course, there is no way to know whether the experimental drug would have stopped the tumors from spreading, even if Anna was able to begin her treatment as soon as she ran out of alternatives.

Why don't we know that? Why do terminally ill patients have to wait so long to get access to the only treatments that hold any promise of saving their lives? And why is it not their right to decide? The problem has been magnified in recent years as the number of new drug approvals has fallen dramatically. The FDA approved just 16 new drugs last year, and is on pace to approve only 18 this year. That's down from a high of 53 in 1996 and 39 in 1997.

After a few high-profile drug scares, such as the 2004 withdrawal of Vioxx from the market, FDA officials have become gun-shy about approving new products. After all, the agency receives scathing criticism from Congress and the press when an approved drug turns out to be more risky than expected -- but rarely for keeping beneficial ones off the market.

Last year alone, the FDA rejected five new cancer drugs, including a breakthrough treatment for prostate cancer called Provenge. A panel of cancer experts that advises the FDA on new drug approvals unanimously agreed that Provenge was safe, and voted 13-4 that it was effective enough. But the FDA demanded still more testing that may delay approval for three years.

Despite fading health, Anna Tomalis worked closely with two patient advocacy organizations, the Abigail Alliance and A Right to Live, to change the system. Together, they have lobbied for legislation to improve the compassionate-use process for terminally ill patients, and expand access to promising treatments. In May, Sen. Sam Brownback (R., Kan.) and Rep. Diane Watson (D., Calif.) introduced a bill to do just that. The Access, Compassion, Care, and Ethics for Seriously Ill Patients Act (ACCESS) would make promising new medicines available as soon as they are shown to be safe in the first of the FDA's three-phase testing process, and once preliminary evidence of their effectiveness is established.

Anna realized that ACCESS would not be passed soon enough to help her. But she continued to fight for it. She knew that it could help save the lives of countless others. Does the U.S. Congress know this also? And will it do the right thing?

Source




America Needs a National Market for Health Insurance

Much to our surprise, the Census Bureau reported yesterday that the number of people in the U.S. with health insurance actually increased by 3.6 million last year. That's the good news. The bad news is that nearly three million of them got their coverage through government programs. The slide toward a government-dominated, taxpayer-supported health sector will continue unless the 45.7 million Americans who don't have insurance now are given more opportunities to buy private coverage.

States could help by lightening their regulatory burdens to encourage greater competition for more attractive and affordable coverage. The federal government needs to do its part by updating today's tax policies to better fit a mobile, 21st-century economy.

A new study by University of Minnesota researchers Stephen Parente and Roger Feldman shows that Congress could boost by more than 12 million the number of people who have health insurance without spending taxpayer dollars. The change required is to allow people to buy health insurance across state lines, so they can shop for less expensive policies.

The cost of health insurance varies widely, but it is closely tied to state regulations and legislative mandates dictating what services and providers must be covered. More regulation and less competition generally mean less affordable coverage, and vice versa. For example, a typical health-insurance policy in heavily regulated New York costs more than three times as much as in less regulated Iowa ($388 a month versus $98 a month for the same coverage).

Every state requires health-insurance policies to cover certain services, ranging from maternity care to bone marrow transplants and hair prostheses. Nationwide there are more than 1,900 coverage mandates in all. The Council for Affordable Health Insurance estimates that these mandates add 20% to 50% to the cost of health-insurance policies.

Each mandate can be defended in its own right. But as the burden increases, fewer people can afford to buy insurance. Usually, individuals and small businesses are the first to be priced out of the market.

Yet laws designed to make health insurance more affordable often backfire. Many states tell insurance companies they must charge similar rates to everyone; they also force insurers to sell policies to people who wait until they are sick to buy coverage. It's a little like allowing a person to wait until his house is on fire, and then requiring an insurance company to sell him a homeowner's policy at the same rate as those who paid the premiums all along.

States should be giving residents more options to buy policies that suit their budgets, not the priorities of politicians. Rep. John Shadegg, a Republican from Arizona, has proposed federal legislation that would allow people to buy health insurance across state lines.

But Congress could do more than simply knocking down the barriers to interstate health insurance. For starters, it could make health insurance more portable. One way to do that would be to change the tax subsidies already going to those who get health insurance at work and turn them into refundable tax credits. This would make the subsidies available to everyone, and help millions of people buy coverage who can't afford it now. It would also help people keep their health insurance when they lose their jobs or move.

Freeing Americans to buy health insurance across state lines would give people more choices in health care. And giving individuals a direct tax break for purchasing coverage would put armies of consumers to work to find affordable policies. That would force states to lighten their regulations or lose out to other, less regulated states. The complex problems in our health sector are best cured by a bigger dose of market competition, not more government intervention.

Source





5 September, 2008

"Nonprofits" can be MORE expensive

They can become little empires for their bosses

In 1989, the U.S. Department of Justice tried but failed to prevent a merger between nonprofit Carilion Health System and this former railroad town's other hospital. The merger, it warned in an unsuccessful antitrust lawsuit, would create a monopoly over medical care in the area. Nearly two decades later, the cost of health care in the Roanoke Valley -- a region in southwestern Virginia with a population of 300,000 -- is soaring. Health-insurance rates in Roanoke have gone from being the lowest in the state to the highest.

That's partly a reflection of Carilion's prices. Carilion charges $4,727 for a colonoscopy, four to 10 times what a local endoscopy center charges for the procedure. Carilion bills $1,606 for a neck CT scan, compared with the $675 charged by a local imaging center.

Carilion's market clout is manifest in other ways. With eight hospitals, 11,000 employees and $1 billion in assets, the tax-exempt hospital system has become one of the dominant players in the Roanoke Valley's economy. Its dozens of subsidiaries include businesses ranging from athletic clubs to a venture-capital fund.

The power of nonprofit hospital systems like Carilion over their regional communities has increased in recent years as their incomes have surged. Critics charge this is creating untaxed local health-care monopolies that drive the costs of care higher for patients and businesses. "It's a one-market town here in terms of health care," says Sam Lionberger, who owns a local construction firm. "Carilion has the leverage."

Carilion acknowledges its influence in the local community but says there is nothing untoward about it. The hospital says it doesn't have a monopoly over the Roanoke Valley health-care market because it faces robust competition from Lewis-Gale Medical Center, a hospital located in nearby Salem, Va., and owned by for-profit chain HCA Inc.

Carilion says it charges more for certain procedures because it has to subsidize operations such as an emergency department and treatment for the uninsured. Edward Murphy, Carilion's CEO, says the high cost of health care in Roanoke reflects the national increase in such costs, which he says is driven by overutilization of medical services. Carilion is converting to a clinic model, in which doctors are employees of the hospital system and work more closely together to coordinate care, in an effort to cut down on unnecessary tests and procedures, he says. "Fragmentation is the enemy of quality" and affordable care, Dr. Murphy says.

However, the clinic project has provoked a backlash from a group of local independent doctors, who say it is designed to stifle competition. Originally set up to serve the poor, nonprofit hospitals account for the majority of U.S. hospitals. They are exempt from taxes and are supposed to channel income they generate back into operations, while providing benefits to their communities. But they have come under fire from patient advocates and members of Congress for stinting on charity care even as they amass large cash hoards, build new facilities and award big paychecks to their executives.

Fueled by large, untaxed investment gains, Carilion's profits have risen over the past five years, reaching $107 million last year. Over the same period, the total annual compensation of its chief executive, Dr. Murphy, nearly tripled to $2.07 million. His predecessor, Thomas Robertson, received a lump-sum pension from Carilion of $7.4 million in 2003, on top of more than $2 million in previous pension payouts. Carilion says Dr. Murphy's compensation is in line with comparable health-care organizations and notes he doesn't receive car allowances, a spousal allowance or club memberships. It says Mr. Robertson's pension accrued over a 32-year career at Carilion. Carilion estimates it receives about $50 million a year in tax exemptions. It dispensed $42 million in charity care in 2007 and $30 million in 2006.

After the 1989 merger, Carilion continued to operate Roanoke's two hospitals separately. It later consolidated the hospital boards and in 2006, transferred most of Roanoke Community Hospital's staff and services to a renovated and enlarged Roanoke Memorial Hospital. The moves eliminated any hospital competition in Roanoke proper, enabling Carilion to raise its prices and contributing to a spike in health-insurance rates in the region, one of the least affluent parts of the state, according to local doctors and health-insurance brokers.

Alan Bayse, founder of a local benefits-consulting firm who has sold health insurance in the area for 30 years, says health-insurance rates in the Roanoke Valley used to be 20% lower than in Richmond, Virginia's capital, and the lowest in the state. Today, he says, they are the highest in the state and 25% higher than in Richmond, citing rate information from insurer Cigna Corp. Anthem, another health insurer, says its rates are 6% higher in Roanoke than in Richmond.

Mr. Lionberger, whose construction company has about 100 employees, says his health-care costs have risen 50% over the past three years, hampering his ability to compete with contractors from other parts of the state. "It's frustrating," he says.

While Carilion strengthened its power in the hospital market, Roanoke continued to be home to a community of independent doctors numbering in the hundreds.

Taking the Helm

In 2001, Dr. Murphy took the nonprofit hospital system's helm. Dr. Murphy, who has a medical degree from Harvard but doesn't practice medicine, says he was convinced that the cost and quality of care in Roanoke could be improved if doctors worked in a more centralized system. In June 2006, he announced a seven-year, $100 million plan to transform Carilion into a multispecialty clinic, like the Mayo Clinic.

Carilion began approaching private physician groups, offering to buy their practices and pay their salaries. Some accepted, but others balked. Some doctors who chose to remain independent say the number of patients referred to them by Carilion physicians plummeted. Carilion controls a large proportion of Roanoke's referrals because it employs a majority of doctors who make them, such as family practitioners, pediatricians and emergency physicians.

Joseph Alhadeff, an orthopedic surgeon who is a member of a private practice called Roanoke Orthopedic Center, says the number of joint replacements he performed dropped off sharply after he stopped getting such referrals from Carilion doctors, prompting him to plan to relocate to Pennsylvania. "I spent seven years building up a practice and watched it evaporate in six months," he says. Carilion spokesman Eric Earnhart says the hospital system didn't engage "in any activity to reduce or divert" referrals from Dr. Alhadeff. Mr. Earnhart adds that Carilion continues to refer numerous cases to Roanoke Orthopedic Center.

Geoffrey Harter, an ear, nose and throat doctor at another Roanoke private practice, Jefferson Surgical Clinic, says Carilion-employed colleagues told him the hospital system asked them not to refer patients to doctors it didn't employ, calling such referrals "leakage." Keeping referrals within Carilion is lucrative for the hospital system because it ensures tests and procedures performed on patients take place at Carilion facilities.

Dr. Murphy says Carilion uses the term "leakage" in internal marketing discussions and that he would rather see its doctors refer patients to other Carilion doctors to optimize their care. But he says Carilion doesn't require its doctors to keep referrals in-house even though it would be legal to do so.

As tension between Carilion and Roanoke's independent doctors grew in 2006, a group of 200 doctors formed an organization called the Coalition for Responsible Healthcare to protest the Carilion Clinic plan. The group posted a petition on its Web site and put up billboards around Roanoke that read: "Carilion Clinic. Big Dream. Big Questions." The local newspaper, the Roanoke Times, covered the controversy in a series of articles written by its health-care reporter, Jeff Sturgeon.

A few months later, in March 2007, the Roanoke Times moved Mr. Sturgeon off the health-care beat after Carilion complained repeatedly about his coverage. Carilion says it communicated its displeasure to the paper's editors, but never asked that Mr. Sturgeon be reassigned. Carilion withdrew most of its advertising from the paper, but says it did that as part of a reallocation of its ad budget. "Any friction that exists between an organization like us and the media is entirely appropriate," Mr. Earnhart says.

Mr. Sturgeon, who now covers transportation, declined requests for comment. Carole Tarrant, the Roanoke Times's editor, said: "We're covering Carilion like we always have and always will, and have no plans to change how we cover Carilion." She declined to elaborate.

New Campus

A large part of the clinic conversion's costs have involved the construction of a new medical campus around Roanoke Memorial Hospital that began several years earlier. The lead contractor building the site is Swedish construction giant Skanska. But one of the project's biggest beneficiaries has been J.M. Turner & Co., which is owned by Carilion board member Jay Turner. Carilion says it paid J.M. Turner a total of $14.9 million in direct contracting work from 2004 to 2007.

Dr. Murphy says Carilion's board authorized "arm's length work" with J.M. Turner, but adds that "a case could be made that we shouldn't award work to J.M. Turner to avoid the appearance of impropriety."

Carilion also paid Skanska, the lead contractor, a total of $120.8 million from 2003 to 2007. Some of that money flowed back to J.M. Turner as subcontracting work, according to Skanska and J.M. Turner. The companies and Carilion declined to say how much.

In an email, Mr. Turner said he recuses himself from all Carilion board decisions that involve his company. He added that his firm passed on much of the $14.9 million in direct contracting work it received from Carilion to other subcontractors.

Mr. Turner isn't the only Carilion board member with a financial stake in the new medical campus. Another board member, Warner Dalhouse, has invested in a hotel being built on the campus to accommodate patients and their families. HomeTown Bank, a local bank Mr. Dalhouse founded and of which he was until recently chairman, is financing the hotel's construction. Dr. Murphy and Mr. Turner sit on HomeTown Bank's board.

Carilion and Mr. Dalhouse say he didn't make his $130,000 investment in the hotel until after Carilion sold the parcel to Texas developers in early 2006. "I wasn't dealing with Carilion. I was dealing with the new owners of that land who had paid fair market value for it," Mr. Dalhouse says.

Carilion says its transformation into a multispecialty clinic will eventually lower local health-care costs. But many patients say they have yet to see relief from Carilion medical bills.

The Roanoke City General District Court devotes one morning a week to cases filed by Carilion. In its fiscal year ended Sept. 30, Carilion says it sued 9,888 patients, garnished the wages of 5,478 people and placed liens on 3,920 homes. Carilion says the people it takes to court have the means to pay their bills.

On a Thursday morning in June, a Carilion representative waited outside a courtroom to intercept the half-dozen patients who had responded to summonses to appear in court. She took them to a side room to work out payment plans. A judge later called out names of close to 100 patients who didn't show and, one-by-one, entered judgments against them.

One of the patients who came to court, a 32-year-old housewife named Christie Masellis, faced a $12,137.12 bill. She had gastric bypass surgery at a Carilion facility in 2005. After developing complications, she required two more surgeries. She says her insurer covered the first surgery but not the two follow-ups because it changed its coverage policy.

Mrs. Masellis has two children. Her husband, Mark, earns about $49,000 a year working for an auto-parts distributor. Mrs. Masellis says she inquired about qualifying for hospital financial assistance, but the Carilion representative told her she was no longer eligible for charity care because her account was past due. The representative agreed to put her account on hold until Sept. 30 but offered her no discount. The bill included $2,514.82 in interest charges Carilion added to the original debt of $9,622.30. Carilion's Mr. Earnhart says Mrs. Masellis had already received more than $15,000 in charity-care discounts. The suit Carilion filed is "for the remainder of the bill," he says.

Mr. and Mrs. Masellis have begun the process of filing for personal bankruptcy. Mr. Masellis says the hospital bill was a big factor in the decision, though the couple has other debts, including a $68,000 mortgage.

When some patients don't pay their bills, Carilion places liens on their homes. Carilion says it doesn't track how many liens it has outstanding, but the close to 4,000 it filed in 2007 "is representative of a typical year," Mr. Earnhart says. Carilion doesn't foreclose on homes and only collects when properties are sold, he says. Dr. Murphy says Carilion only sues patients and places liens on their homes if it believes they have the ability to pay. "If you're asking me if it's right in a right-and-wrong sense, it's not," he says. But Carilion can't be blamed for the country's "broken" health-care system, he says.

Source




Disastrous public medicine in Tasmania

DOCTORS say they are forced to treat patients inappropriately because of long hospital waiting lists. Hazardous painkillers were being used as a stopgap, GPs said yesterday.

Anger has followed revelations that a 15-year-old Claremont boy had waited more than three years for a high-priority operation on a burst eardrum. Health Minister Lara Giddings blamed an administrative bungle for the wait, which has led to Jeremy Brewer's deteriorating hearing, speech and learning. Ms Giddings said Jeremy had fallen "through the cracks" because he was accidentally labelled category 2. But Jeremy's GP, Graeme Alexander, has a 2006 letter from the Royal Hobart Hospital saying Jeremy was category 1.

Opposition health spokesman Brett Whiteley said Ms Giddings appeared to have misled the public. "On a daily basis, GPs are managing the worsening conditions of their patients who are waiting longer and longer for elective surgery," Mr Whiteley said. "Some of those patients will present as hospital emergencies because of that wait."

Sorell GP David Dalton said often people needing simple operations were dealt with in a few months, but more complicated operations could take years. "The waits are across the board really," Dr Dalton said. "There are even greater problems with category 2 and 3, they take forever. There are delays in getting people an appointment for a clinic for a start. "Often these are for chronic painful conditions, hips and knees and chronic back conditions." Dr Dalton said that put GPs in the position of treating conditions for which surgery was the only good option. "We are forced to use inappropriate treatment with strong painkillers, when really all they need is an operation."

Meanwhile, Dr Alexander said Jeremy was not an isolated case, and told of situations where even patients with unstable heart conditions could not get into a clinic this year. "I had rung and faxed and had confirmation from the hospital about Jeremy," Dr Alexander said. "They don't even respond any more. We write urgent in 40-font on the referral and it makes no difference. "The communication between the hospital and GPs is terrible."

Ms Giddings urged people who had waited a long time to see their GPs and ask for a reassessment.

Source




Australia: Harmful surgery delay in Queensland public hospital

Socialized medicine was supposed to equalize the treatment of the rich and pooor. It has done the opposite

ELEONOR Schmitz had all the signs of bowel cancer but she was forced to wait eight agonising months to have exploratory surgery. Only then was the devastating news confirmed. The Rockhampton woman, 68, who now wears a permanent colostomy bag and is having radiotherapy and chemotherapy in Brisbane, is angry her diagnosis took so long. She believes her cancer would not have been so advanced had she been treated sooner at the Rockhampton Hospital. "I think maybe the tumour wouldn't have been so big," she said, her voice cracking with emotion. "I went twice to the emergency outpatients in too much pain. I said: 'Something has to be done.' It took too long."

By the time she was diagnosed, her cancer had spread beyond her bowel. Queensland Health guidelines recommend people in Ms Schmitz's situation should be seen within 90 days. She waited more than double that time.

Brisbane man Ken Eyre's experience with bowel cancer was vastly different. He was diagnosed after he went to his general practitioner for an annual check-up and had a test for telltale signs of bowel cancer. The test was positive and within days Mr Eyre, 76, who has private health insurance, had a colonoscopy which found cancer. Soon after, he underwent further surgery to remove the tumour, followed by chemotherapy. "I was put into treatment pretty quickly," he said. "As a result of all that, I'm clear. I had my five-year clearance just recently."

An alarming Cancer Council Queensland report to be just released shows people who live outside the state's southeast corner are much less likely to survive bowel cancer. The report found men in regional areas were 30 per cent less likely to still be alive five years after a bowel cancer diagnosis than their city counterparts. The five-year survival rate for regional women was about 20 per cent lower than for Brisbane residents.

Researcher Pip Youl said potential causes included access to medical services and whether the cancer was diagnosed at a later stage in regional areas. But Ms Youl said the news was not all bad. Overall, five-year bowel cancer survival rates had increased from 48 per cent in the 1980s to 65 per cent.

The Cancer Council has called on the Queensland Government to improve its "drastically underfunded" Patient Travel Subsidy Scheme to ease the burden on people who have to travel for treatment.

In 2005, 2601 Queenslanders were diagnosed with bowel cancer and 912 died from the disease.

Source





4 September, 2008

The Failures of Government-Run Healthcare

Democratic presidential candidate Barack Obama, in a rare moment of honesty on what he'd really like to do about health care reform, recently asserted that if we were starting from scratch he would probably choose a single-payer health care system. That's a system in which people pay higher taxes and the government pays most medical bills. Obama's not alone in that opinion. Filmmaker Michael Moore took his "Sicko" audience to England, among other places, where we learned that doctors in that single-payer system made good salaries, had nice homes and cars, and patients were very satisfied.

But anyone who reads the English press will find a different message, including waiting lines, angry patients, rationed and often subquality care. Consider these recent news stories about England's National Health Service (NHS) quoted directly from the British press.

Twice Katie asked for a [Pap] smear test, but was told she was "too young" to need one. Now 24, she is dying from cervical cancer, one of many young women who have fallen victim to a scandalous change in health policy. (London's Daily Mail, June)

A man with terminal cancer has been refused a drug by the NHS that could extend his life - despite offering to pay part of the cost himself. . . . David Swain's offer to meet the monthly $4,000 cost of Erbitux was refused, he said, because the National Institute for Health and Clinical Excellence [a government body] ruled it was too expensive. (Yorkshire Post, March, emphasis added)

Health service dentists have been forced to go on holiday or spend time on the golf course this month despite millions of patients being denied dental care. . . . Many [dentists] have fulfilled their annual work quotas allotted by the National Health Service and have been turning patients away because they are not paid to do extra work. This is despite the fact that more than 7m[illion] people in Britain are unable to find an NHS dentist. (The Times of London, March)

Does that sound like your idea of a great health care system? The British press - as well as the Canadian press and other countries - regularly runs stories like these about patients who are denied treatment because they are too old, too young, too sick or too costly. Indeed, The Times of London ran a story in 2006 asserting: "Patients are being denied appointments with consultants in a systematic attempt to ration care and save the NHS money, The Times has learnt. . . . Leaked documents passed to The Times show that while ministers promise patients choice, a series of barriers are being erected limiting GPs' [general practitioners] rights to refer people to consultants."

If you want to read these stories and others like them for yourself, just go to the "Health Care Horror Stories" at BigGovhealth.org, which regularly posts the negative press coming from those government-run health care countries (which has to be a full-time job!).

The fact is that every government-run health care system struggles to make ends meet. Money for health care in those systems has to compete with money for other government programs like education, defense and pension programs. That's why other countries spend less on health care. It's not that their systems are better or more efficient; it's because politicians control the funds and have to make trade-offs. That often means the more expensive treatments, the marginal members of society, and even preventive care and screening can get axed.

Yes, many people in those countries are satisfied with their care. And yes, everyone in those countries is "insured" - the apparent goal in the current health care reform debate. But having coverage doesn't count for much if patients can't get quality care in timely manner.

Health care reformers often claim or imply that the U.S. health care system is terrible, while countries like England provide quality care for everyone, and for less money. That's simply not a balanced assessment. U.S. health care is excellent, but it can be very expensive and, a not unrelated fact, too many people are uninsured. But copying other government-controlled systems isn't the solution. They have their problems; we have ours. Let's fix ours problems without importing theirs.

Source




THE PUBLIC MEDICINE MAYHEM CONTINUES IN AUSTRALIA

Two articles below: One from Victoria and one from Queensland. Also see a comment by conservative Australian cartoonist ZEG

Woman in labour sent home from public hospital

Why was such a risk taken? This was already a risky situation. It was just luck that all went well in the end



A woman gave birth to a baby girl at her mother's Mitcham house less than an hour after being sent home from Box Hill Hospital. Angela Valle arrived at the hospital at 9am on August 14 to deliver her second child after her water had broken at 5am that morning. Mrs Valle was having contractions every five minutes and was in a lot of pain. "The doctor came in and she said I was only two centimetres dilated so I probably wouldn't go into labour until later in the afternoon," Mrs Valle said. "I thought at the time I was already in labour because my water had broken and I was in pain."

Mrs Valle said she felt like she was rushed out of the hospital. "There was someone in full-blown labour who I was told was coming into the room directly after me," she said.

Instead of delivering daughter Amy with the safety of a doctor and nursing staff on hand at the hospital, Mrs Valle gave birth with the help of just her husband and an ambulance operator speaking down the phone to them. "She was the best help we had the lady on the phone," Mrs Valle said.

Director of nursing and midwifery Denise Patterson said Mrs Valle wasn't sent home because of a lack of beds. "This was based on a clinical assessment and not related to service capacity or bed availability," Ms Patterson said. "Sometimes women do progress in labour faster than we are able to anticipate. "We understand the distress caused in a case such as this and are regretful that this has happened to Angela and her family."

Mrs Valle said she held no animosity towards the hospital but was upset about the danger she was placed in. "After the delivery we were on a high because we had delivered our daughter, but the next day my husband and I had a bit of a cry because it hit us what could have happened," Mrs Valle said. "If the umbilical cord had wrapped around her neck we wouldn't have known what to do."

Source




Bike rider's pain as surgery for crushed hand stalled



BOB Skinner was kept waiting for four days in excruciating pain by a Brisbane hospital after his hand was mangled in a motorcycle accident. He was admitted to Princess Alexandra Hospital last Thursday night after his hand was crushed and his finger partially severed in the accident near his house at Goodna, southwest of Brisbane. However an operation was delayed three times due to higher priority patients and he was finally treated on Monday morning, four days after he was first admitted. Under surgical guidelines, Mr Skinner's injury should have been treated within eight hours of his admittance, with a maximum 24-hour wait.

"I had two morphine shots each day for the pain," the 39-year-old said. "Every time I moved, a bolt of pain would shoot from my hand and I couldn't sleep." PA Hospital defended the delay, saying resources were badly stretched on the weekend with the hospital performing more than 30 emergency operations. Clinical chief executive David Thiele said emergency trauma on weekends was "governed by saving life or limb". "Where it is unlikely that there will be a change in the outcome of an operation, an operation receives lower priority over one that will either save a life or improve the end outcome for the patient," Dr Thiele said.

"Mr Skinner's surgery was prioritised according to the nature of the injury and the likely outcome of surgery which would not have changed the end result of injury, that being partial amputation of his finger." Mr Skinner said he had only two meals during his four-day stay. "Eventually I got so fed up I got them to disconnect my drip and I was over at the fast food joint across the road in my hospital gown," he said.

Source





4 September, 2008

The Failures of Government-Run Healthcare

Democratic presidential candidate Barack Obama, in a rare moment of honesty on what he'd really like to do about health care reform, recently asserted that if we were starting from scratch he would probably choose a single-payer health care system. That's a system in which people pay higher taxes and the government pays most medical bills. Obama's not alone in that opinion. Filmmaker Michael Moore took his "Sicko" audience to England, among other places, where we learned that doctors in that single-payer system made good salaries, had nice homes and cars, and patients were very satisfied.

But anyone who reads the English press will find a different message, including waiting lines, angry patients, rationed and often subquality care. Consider these recent news stories about England's National Health Service (NHS) quoted directly from the British press.

Twice Katie asked for a [Pap] smear test, but was told she was "too young" to need one. Now 24, she is dying from cervical cancer, one of many young women who have fallen victim to a scandalous change in health policy. (London's Daily Mail, June)

A man with terminal cancer has been refused a drug by the NHS that could extend his life - despite offering to pay part of the cost himself. . . . David Swain's offer to meet the monthly $4,000 cost of Erbitux was refused, he said, because the National Institute for Health and Clinical Excellence [a government body] ruled it was too expensive. (Yorkshire Post, March, emphasis added)

Health service dentists have been forced to go on holiday or spend time on the golf course this month despite millions of patients being denied dental care. . . . Many [dentists] have fulfilled their annual work quotas allotted by the National Health Service and have been turning patients away because they are not paid to do extra work. This is despite the fact that more than 7m[illion] people in Britain are unable to find an NHS dentist. (The Times of London, March)

Does that sound like your idea of a great health care system? The British press - as well as the Canadian press and other countries - regularly runs stories like these about patients who are denied treatment because they are too old, too young, too sick or too costly. Indeed, The Times of London ran a story in 2006 asserting: "Patients are being denied appointments with consultants in a systematic attempt to ration care and save the NHS money, The Times has learnt. . . . Leaked documents passed to The Times show that while ministers promise patients choice, a series of barriers are being erected limiting GPs' [general practitioners] rights to refer people to consultants."

If you want to read these stories and others like them for yourself, just go to the "Health Care Horror Stories" at BigGovhealth.org, which regularly posts the negative press coming from those government-run health care countries (which has to be a full-time job!).

The fact is that every government-run health care system struggles to make ends meet. Money for health care in those systems has to compete with money for other government programs like education, defense and pension programs. That's why other countries spend less on health care. It's not that their systems are better or more efficient; it's because politicians control the funds and have to make trade-offs. That often means the more expensive treatments, the marginal members of society, and even preventive care and screening can get axed.

Yes, many people in those countries are satisfied with their care. And yes, everyone in those countries is "insured" - the apparent goal in the current health care reform debate. But having coverage doesn't count for much if patients can't get quality care in timely manner.

Health care reformers often claim or imply that the U.S. health care system is terrible, while countries like England provide quality care for everyone, and for less money. That's simply not a balanced assessment. U.S. health care is excellent, but it can be very expensive and, a not unrelated fact, too many people are uninsured. But copying other government-controlled systems isn't the solution. They have their problems; we have ours. Let's fix ours problems without importing theirs.

Source




THE PUBLIC MEDICINE MAYHEM CONTINUES IN AUSTRALIA

Two articles below: One from Victoria and one from Queensland. Also see a comment by conservative Australian cartoonist ZEG

Woman in labour sent home from public hospital

Why was such a risk taken? This was already a risky situation. It was just luck that all went well in the end



A woman gave birth to a baby girl at her mother's Mitcham house less than an hour after being sent home from Box Hill Hospital. Angela Valle arrived at the hospital at 9am on August 14 to deliver her second child after her water had broken at 5am that morning. Mrs Valle was having contractions every five minutes and was in a lot of pain. "The doctor came in and she said I was only two centimetres dilated so I probably wouldn't go into labour until later in the afternoon," Mrs Valle said. "I thought at the time I was already in labour because my water had broken and I was in pain."

Mrs Valle said she felt like she was rushed out of the hospital. "There was someone in full-blown labour who I was told was coming into the room directly after me," she said.

Instead of delivering daughter Amy with the safety of a doctor and nursing staff on hand at the hospital, Mrs Valle gave birth with the help of just her husband and an ambulance operator speaking down the phone to them. "She was the best help we had the lady on the phone," Mrs Valle said.

Director of nursing and midwifery Denise Patterson said Mrs Valle wasn't sent home because of a lack of beds. "This was based on a clinical assessment and not related to service capacity or bed availability," Ms Patterson said. "Sometimes women do progress in labour faster than we are able to anticipate. "We understand the distress caused in a case such as this and are regretful that this has happened to Angela and her family."

Mrs Valle said she held no animosity towards the hospital but was upset about the danger she was placed in. "After the delivery we were on a high because we had delivered our daughter, but the next day my husband and I had a bit of a cry because it hit us what could have happened," Mrs Valle said. "If the umbilical cord had wrapped around her neck we wouldn't have known what to do."

Source




Bike rider's pain as surgery for crushed hand stalled



BOB Skinner was kept waiting for four days in excruciating pain by a Brisbane hospital after his hand was mangled in a motorcycle accident. He was admitted to Princess Alexandra Hospital last Thursday night after his hand was crushed and his finger partially severed in the accident near his house at Goodna, southwest of Brisbane. However an operation was delayed three times due to higher priority patients and he was finally treated on Monday morning, four days after he was first admitted. Under surgical guidelines, Mr Skinner's injury should have been treated within eight hours of his admittance, with a maximum 24-hour wait.

"I had two morphine shots each day for the pain," the 39-year-old said. "Every time I moved, a bolt of pain would shoot from my hand and I couldn't sleep." PA Hospital defended the delay, saying resources were badly stretched on the weekend with the hospital performing more than 30 emergency operations. Clinical chief executive David Thiele said emergency trauma on weekends was "governed by saving life or limb". "Where it is unlikely that there will be a change in the outcome of an operation, an operation receives lower priority over one that will either save a life or improve the end outcome for the patient," Dr Thiele said.

"Mr Skinner's surgery was prioritised according to the nature of the injury and the likely outcome of surgery which would not have changed the end result of injury, that being partial amputation of his finger." Mr Skinner said he had only two meals during his four-day stay. "Eventually I got so fed up I got them to disconnect my drip and I was over at the fast food joint across the road in my hospital gown," he said.

Source





2 September, 2008

Amazing NHS negligence

A traumatised mother is suing the hospital where she says she had to endure the agony of a caesarean birth without pain relief. Sarah Carberry, 27, was given an epidural injection but claims it did not work. She said she screamed in pain as she felt every stroke of the surgeon's knife until her husband Chris demanded the operation be halted. She was then offered a general anaesthetic but decided for the baby's sake to carry on.

Thankfully, her 6lb daughter Ruby was delivered safely and is progressing well. But the first-time mother says the 40-minute ordeal has destroyed her dream of having a big family because she is too afraid of giving birth again. She and her husband, a finance manager, say they have yet to receive an apology and have instructed a solicitor to sue.

It was in June that Mrs Carberry, a beauty therapist from Skelmersdale, Lancashire, was admitted to Ormskirk & District General Hospital when her waters broke two weeks early. Doctors said labour could not be induced and she would need an emergency caesarean. She was taken into the operating theatre and given an epidural - an injection into the lower spine which feeds in anaesthetic through a tube. She said she knew immediately that it had not worked. 'I said I could still feel my legs and wiggle my toes, which they said was normal. Then they pricked my arm with a pin and I felt it. I said, "This hasn't worked, I'm going to feel the knife".

They said I was just stressed. It was only when they cut my womb open and I was screaming in agony that they finally took me seriously. 'I was shaking in pain. I was convinced I would die, but no one would listen to me. They continued until my husband said, "Stop the operation".'

An epidural is administered while the patient is sitting up. It is thought that the tube kinked when Mrs Carberry lay down and the anaesthetic failed to reach her spine. Suspecting what had happened, the anaesthetist attempted to top up the solution but Mrs Carberry said the glass container which holds the liquid shattered, and he said: 'There's nothing else we can do for you.'

At that point she refused a general anaesthetic. 'My body was going into shock and my husband was livid, but the last thing I wanted was to be knocked out when I didn't trust the medical team that were operating on me,' she said. 'The female surgeon said she could see the baby and needed to get it out. I told them just to get the baby out. 'I gripped a medic's hand throughout the operation and did breathing exercises, all the time asking them how long the operation was going to take, to focus my mind on the end. It was excruciating. 'They had to stitch up muscle, tissue, layers of fat and the skin. I felt it all. It was awful. 'Then they put my baby on my chest, which I don't think they should have done. I wasn't in control of my actions. I could have hurt her.'

Mrs Carberry was allowed home with Ruby after four days but had to be readmitted a week later as the caesarean scar was infected. She spent a week in hospital while her husband looked after Ruby at home.

Two weeks later, she said, she had a meeting with the head anaesthetist and head of midwifery at the hospital, and was told an investigation had been opened into her treatment but has heard nothing more from the trust. 'No one came to see me after the operation to explain anything. A few days later a doctor came to see me and said, "We're sorry this has happened to you".

'I wanted to have a large family. My parents have both died, and I rely on my brothers because of that. 'But I can't have another child now. What happened in that operating room will be with me for ever.'

A spokesman for Ormskirk hospital said: 'Our maternity unit delivers over 3,000 babies per year. The vast majority of new mothers are very pleased with our service. We have met with Sarah Carberry and are aware of some of the allegations being made. 'As with all complaints this is being treated very seriously and we have asked her to formalise her concerns so a full investigation can take place.' [Mealy-mouthed scum!]

Source




RomneyCare: The former Massachusetts governor's signature "achievement" already looks destined for the emergency room

Bay State political observers call RomneyCare "The New Big Dig." Like downtown Boston's notorious roadway project that ran $12.2 billion beyond its $2.6 billion budget, RomneyCare is becoming a huge fiscal sinkhole.

RomneyCare has reduced Massachusetts' uninsured population from an estimated 657,000 to about 307,000. Among these 350,000 newly covered people, some 174,000 joined Commonwealth Care, a government-supported plan that insures families of four up to 300 percent of the federal poverty line, or roughly $63,000 in annual income. Another 55,000 people joined Medicaid, which is funded by local and federal tax dollars. Only about 18,000 have purchased private insurance.

Given these brigades of new beneficiaries, the Pacific Research Institute's Sally Pipes writes that "the program is in intensive care, surviving only on massive infusions of other people's money." The numbers are staggering:

RomneyCare should cost taxpayers $625 million in 2008. That's $153 million, or 32 percent, beyond this year's original $472 million appropriation. For 2009, costs may hit $869 million, or another $244 million, 39 percent premium above today's already vertiginous spending curve.

Unfortunately, Massachusetts residents love "free" and cheap healthcare, at someone else's expense. As usual these days, everybody parties, and then taxpayers spend the next morning collecting the empty bottles and cleaning the overflowing ashtrays. This mop-up will cost at least $129 million in new taxes, as Romney's Democratic successor, Deval Patrick, proposes. As the July 29 Wall Street Journal reports, this includes one-time (one hopes) taxes of $33 million on insurers, $28 million on medical providers, and another $33 million on businesses.

Some 307,000 residents remain uncovered. So, RomneyCare still is not "universal," as advertised, despite the plan's cornerstone -- a mandate that requires every individual in Massachusetts to have health insurance. ("I like mandates," Romney chirped at a January 5 GOP presidential debate.) Among these uninsured, state legislators excused about 130,000 from the mandate. Tens of thousands more either ignore this law or pay annual fines of up to $219, and rising. Why? Such penalties are cheaper than health coverage, particularly now that so many frustrated insurers have fled Massachusetts. Eventually, some of these people will get sick. Invoice the taxpayers, yet again.

Compulsion aside, RomneyCare also features subsidies, regulations, and an ominous-sounding authority called The Connector. Likewise, ObamaCare involves Johnsonesque controls, rather than market-driven choice and competition.

McCain, in contrast, wisely proposes expanded Health Savings Accounts plus tax credits ($2,500 for individuals; $5,000 for families) to help Americans purchase insurance that they -- not their employers -- would own, manage, and transport throughout their lives and careers. McCain would let Americans buy coverage across state lines. Stiffly regulated New Yorkers, for instance, could buy simpler, cheaper plans from, say, Colorado-based insurers.

McCain, to his eternal credit, opposed President Bush's needlessly extravagant Medicare drug entitlement which, like RomneyCare, marched 180 degrees the wrong way. McCain now has standing to criticize Obama's Washington-driven health reform.

Most incredibly, when Romney signed this legislation, it reserved Planned Parenthood a slot on the 15-member MassHealth Payment Policy Advisory Board. While pro-lifers have no such guarantee, abortion advocates by law have a place at the table that Romney built.

Source





1 September, 2008

NHS drugs body Nice reviews drug funding

The NHS drugs rationing body has ordered a review of its funding limit for new drugs after a series of campaigns by patients groups denied access to treatment. The National Institute for health and Clinical Excellence (Nice) has commissioned research to establish whether the threshold at which drugs are determined to be cost effective is set too low. It has not changed since Nice was set up nine years ago even thought the NHS budget has more than doubled in that time and there has been no adjustment for inflation in that time.

The results of the review will be discussed early next year and could pave the way for more expensive drugs being made available on the NHS. Campaigners may see the move to consider raising the threshold as a tacit admission that it is currently too low. The organisation has faced a storm of protest over its refusal to recommend the use of a string of drugs for use in the NHS including treatments for Alzheimer's, arthritis, eyesight conditions and cancer. Earlier this week kidney cancer patients and their carers demonstrated outside the headquarters of Nice after draft guidance on four new drugs to treat late stage cancer were turned down even though they extend life on average by four to five months.

NICE also apologised over the fact that it took more than two years to issue final guidance approving the eyesight-saving drug Lucentis after previously ruling that patients would have to go blind in one eye before receiving the drug

Figures showing that the NHS is expected to have a surplus of 1.75bn pounds this financial year sparked further concerns about funding for treatments. The Citizens Council of Nice, a representative sample of 30 members of the public, examined the calculations earlier this year and recommended "a thoughtful and penetrating review".

Nice's method involves quality of life scores which one Citizens Council member found would give her a negative score meaning she would be 'better off dead' as she is confined to a wheelchair, a report of the meeting said. The quality of life score forms part of the calculations used to determine the extra Quality Adjusted Life Years (QALY) that a new drug would give patients balanced against the extra cost. Each QALY is the equivalent of one year of perfect health, two years of 50 per cent perfect health or four years of 25 per cent perfect health. Nice has set the acceptable cost per QALY at between 20,000 and 30,000 pounds.

The more expensive a drug is the more it has to improve and/or extend life in order to meet the threshold. In exceptional cases more expensive drugs that breach the upper limit have been recommended. The calculations pay no regard to the NHS budget in any way.

Pat Hanlon, trustee of the campaign group Kidney Cancer UK, said: "We think the QALY is woefully inadequate as a measure of patient benefit. It was arbitrarily set and we think it is too low. "It will be very difficult for any new cancer drug to pass the test because they have very high research and development costs. And with the kidney cancer drugs there is a relatively small number of patients so the cost per patients to recover the R&D costs are fairly high."

Prof Karol Sikora, Medical Director of CancerPartnersUK, Professor of Cancer Medicine at Imperial College School of Medicine, said a review of the QALY was 'long overdue' because the European threshold stands at around 45,000 pounds. He added: "It is absolutely essential that some allowance is made for the increase in the NHS budget and the fact the medical inflation is running at about 10 per cent a year at the moment."

Argument has raged between academics and experts on whether the QALY it set correctly since Nice was launched in 1999, with some saying the threshold should lower so drugs would have to be cheaper or more effective to get through, while others believe it must be higher in order to take into account more sophisticated and expensive drugs that are in development.

Richard Davidson, director of policy and public affairs at Cancer Research UK, said of the threshold: "We believe it is too low in the context of other areas of government expenditure, and in comparison to the amount of money spent on new drugs by our European counterparts. "Additionally, it does not take into account inflation since the threshold was first used."

A NICE spokesperson said: "We have commissioned research to assess whether our current threshold range is reasonable or whether it should be altered; and the findings will be discussed, fully, at a workshop next January."

Source




Healthcare For All: Five Reasons Government Controlled Medicine Would Be Bad

By Dr. Melissa Clouthier

As I watch Dennis Kucinich jump around the stage and scream for "health care for all!" and then claim that his views are mainstream while Bill O'Reilly listens amused, I wonder just how mainstream universal, aka government controlled, health care actually is to average Americans. Good look finding hard data. Government controlled health care sounds good in theory, but it's terrible in reality. How do we know? Let me count the ways:

1. People would lose jobs. The very people who would stand to benefit from health care would be in trouble, because what's the plan to pay for these grandiose policies? Small businesses will pay. And how will they offset those costs? Hire less people. The people who need jobs will lose jobs.

2. It would be outrageously expensive. Beyond the cost to employers, there will be costs to American taxpayers. Someone is paying for this mess. A good analysis is here.

3. It would create more government bureaucracy. Can anyone argue that the government makes anything better? Just think IRS. Now imagine a bureaucrat deciding your health care coverage. It should send shivers down your spine.

4. Patient care suffers. Ultimately, this is about what is best for patients, right? One only has to look to countries doing what universal health care types desire to see that between waiting for procedures, being lied to about care choices, etc., government controlled health care is bad for your health.

5. Government involvement stifles innovation. America leads the world in cutting-edge technology and patient care. The innovation draws patients in dire straits who benefit from socialized medicine world powerhouses-Canadians, Britons, French, etc. Still, they come to America to get prompt, excellent, cutting-edge treatment. Will the government improve upon the efforts of the private sector where the innovation happens. Doubtful.

Source




Australian public hospitals counting chairs as beds

The State Government has been accused of fudging hospital bed figures in the troubled health system by including chairs and other furniture. The 2008-09 State Budget, released in June, said there were 10,234 beds in Queensland public hospitals. But what it didn't reveal is that almost 14 per cent of those beds are not beds at all. Figures obtained by the State Opposition show that 1370 so-called beds included chairs, trolleys, cots, stretchers and lounge suites. Sources said some patients admitted to hospital never got to lie in a bed - instead they spent hours sitting in a chair, sometimes being treated there.

Liberal National Party Deputy Leader Mark McArdle slammed the Government for playing with the figures, and claimed the number of proper beds had been cut. The Opposition health spokesman said the fine print in Queensland Health Budget documents revealed the picture on alternative beds. "This Government has been caught out deliberately fudging the true number of public hospital beds by changing the definition of 'bed'," Mr McArdle said.

In the Budget papers, in Queensland Health's service delivery statement, it records a new measure of the "number of available bed and available bed alternatives for public acute hospitals". In notes, it says the "Queensland Health Data Dictionary defines an 'available bed' as a bed which is immediately available to be used by an admitted patient if required and an 'available bed alternative' as an item of furniture, for example, trolley and cot, non-recognised beds occupied or not, which is immediately available for use by admitted patients". Further documents revealed that "available bed alternatives" included a "number of items of furniture (eg trolleys, chairs, cots, non-recognised beds, etc)".

Health Minister Stephen Robertson said the Beattie-Bligh Government had consistently recorded alternative beds in its figures and never hid them from the public. Mr Robertson said there were 1370 available bed alternatives as of June 30 and of those, 1246 were renal dialysis and chemotherapy chairs. Others included day surgery chairs, day therapy chairs, discharge lounge/transit lounge chairs, emergency department chairs, trolleys and stretchers, and non-neonatal cots. He disagreed that it was misleading the public to identify these as beds. "I don't think the thousands of people coming into our major hospitals every day for renal dialysis or chemotherapy would agree with that," Mr Robertson said. He said the figures were kept that way to remain consistent with all hospitals and other states.

Source