SOCIALIZED MEDICINE

2008-07-08T00:12:00.000+11:30

Private drug helps cancer man left to die by NHS

Aint socialized medicine wonderful?

A cancer patient sent home to die by the National Health Service has seen his health improve after he cashed in his pension and used funds raised by friends to pay privately for an expensive drug. Andrew Crabb, 49, a father of three from Abingdon, Oxfordshire, was told by doctors in October that there was no treatment available on the NHS for his advanced kidney cancer. His wife Diane, 57, was told that he had months to live.

The couple refused to accept the death sentence and have raised enough money to pay for the drug Sutent, at a cost of about 3,000 pounds a month. Oxford Radcliffe Hospitals NHS Trust has agreed to allow Crabb, a former bricklayer who has nine grandchildren, to pay for the medicine privately while continuing to receive NHS care. The hospital is one of at least six trusts in England and Wales which are ignoring government guidance that patients who pay for drugs privately must forfeit NHS treatment.

Alan Johnson, the health secretary, claimed that the arrangement, known as “top up” or “co-payment”, creates a two-tier health service. But he has been forced to order an inquiry into the ban after a revolt by the medical establishment, which is outraged that NHS cancer patients are being turned away after paying privately for drugs recommended by doctors. Nottingham University Hospitals NHS Trust, ABM University NHS Trust in Bridgend, the University Hospital Birmingham NHS Foundation Trust, Weston Area Health NHS Trust in Somerset and the Royal Marsden NHS Foundation Trust in London have also allowed some of their patients to pay for drugs privately.

If Crabb was forced to pay for all his care, including scans, consultants’ appointments, nursing care and blood tests, his bills could double. This weekend his wife, who works part-time as a sales assistant, revealed how she had refused to accept the NHS advice. “They said there was nothing they could do,” she recalled. “I just begged the doctor. I said, ‘You are not telling me that there is not a drug available for my husband?’ “I told her that my sister was diagnosed with cancer 10 years ago and she is still here. I was begging her to find a drug.”

Crabb has Sutent delivered to his house by a private firm, Healthcare at Home, while he continues to be treated by doctors at Churchill hospital, part of Oxford Radcliffe Hospitals NHS Trust. He is halfway through his second six-week course of the drug and doctors have observed an improvement in his condition.

Diane Crabb said: “Everything has continued within the NHS except the Sutent. There has been a vast improvement in my husband. He is walking into town, which he couldn’t do before. One day he walked for 4½ hours.”

As Crabb can no longer work, the couple have cashed in two pensions to help to pay for their living costs, while the drug is being funded by donations from friends and family. “One of my husband’s friends started the fundraising and it just escalated,” said Diane Crabb. “A friend of Andrew’s mum and dad gave 2,000 pounds. An old lady stopped Andrew’s mum in the street and gave 5 pounds. She said, ‘That’s all I can afford’.”

Karol Sikora, an oncologist at Hammersmith hospital in west London and medical director of CancerPartnersUK, a private cancer treatment company, said: “It is outrageous that this patient was sent home to die. His ability to top up his care by sacrificing his pension to buy the drug is a scandalous reflection of our times, but may save his life.”

Baroness Ilora Finlay, president of the Royal Society of Medicine, said doctors should tell patients about private drugs from which they could potentially benefit, even if the cost appeared prohibitive.

Last week Johnson promised to tackle the cancer drug “postcode lottery” by ordering the government’s rationing body, the National Institute for Health and Clinical Excellence (Nice) to speed up its assessments of whether new drugs should be funded by the NHS. He also reiterated that patients have a right to drugs once they have been approved for prescription on the NHS. Nice has yet to decide whether Sutent should be funded. However, some NHS trusts have already chosen to offer it to patients, which campaigners believe makes a mockery of government promises.

The Sunday Times has been campaigning on behalf of cancer patients who have had their NHS care withdrawn because they have chosen to pay for private drugs recommended by their doctor. A spokesman for Oxford Radcliffe Hospitals NHS Trust said: “We would have no reason to withhold treatment if a patient purchases other drugs from outside the NHS.”

Source

2008-07-07T00:06:00.000+11:30

MORE MEDICAL MAYHEM IN AUSTRALIA

Three current articles about Australian public medicine below:

NSW paramedics being worked to death

An inquiry into the New South Wales Ambulance Service has heard many paramedics feel so stressed and overwhelmed by their workloads they are contemplating suicide. The Upper House inquiry has heard Three in Four ambulance officers feel over worked in the job, while a number of submissions have raised serious concerns about bullying.

Phil Roxbrough, Ambulance station manager in Moruya on the NSW south coast, told the hearing bosses needed to do more to address the problems associated with stress. "I hear stories from so many people who have come so close to attempting suicide or have gone through some really horrific experiences and someone needs to be a voice for these people, to care for these people," he said.

Source

Tasmanian public hospital bed shortages

Ongoing pressures at the Royal Hobart Hospital have surfaced again with staff and patients reporting issues across a number of departments yesterday. Australian Nursing Federation state secretary Neroli Elis said up to five ambulances were ramped outside the Emergency Department yesterday because of a drastic shortage of staff and beds. She said one patient in emergency had arrived at 8pm on Thursday and had not received a bed by 4.30pm yesterday. It follows an emergency meeting between staff and management last weekend after complaints that emergency patients were being left to wait on trolleys in corridors for up to 36 hours before beds were found.

Ms Ellis said the hospital was admitting elective surgery patients in order to meet its Commonwealth targets while emergency patients were left in crowded waiting rooms.

RHH spokeswoman Pene Snashall said the emergency department had not been abnormally busy. "I cannot find any evidence to substantiate their claims," Ms Snashall said. "The individual patient they refer to is not in (the emergency department) -- not on a trolley -- she is actually in the short-stay facility of ED under the care of neurosurgery specialists. "It is mischievous to suggest this person waiting in a waiting room or sitting in a chair for that amount of time."

Meanwhile a pregnant woman rang the Mercury yesterday to complain of overcrowding in the antenatal ward. "There are some very tired ladies here with heavy bellies and children running around and there are no seats for anyone," the woman said. "Staff have said we can look forward to a wait of one to two hours."

Last week, RHH chief executive Craig White admitted conditions in the hospital's maternity outpatient clinic were unsatisfactory but said there were limited options for improvement because of space constraints in the ageing hospital.

Source

Bulgarian doctor repeatedly botched surgery

While the regulators sleepwalked about it

A doctor accused of wrongly operating on patients and lying about the mistaken removal of a woman's ovary has just re-registered to practise. Dr Ivan Lubenov Popov is alleged to have lied to patients and misled staff about his procedures in an attempt to cover-up botched and potentially illegal medical procedures.

Documents filed to the Health Practitioners Tribunal registrar reveal a string of women have suffered complications and heartache since December 2006 because of the alleged negligent practices of the obstetrician and gynaecologist, who worked at the Caboolture Hospital. In one case he allegedly removed a woman's ovary that was meant to be preserved during a hysterectomy, and while admitting the surgical mistake to his superiors, continued to lie to the woman about the reason for its removal.

Four other women suffered complications following "inappropriate" surgery, which the Medical Board of Queensland claims should not have been performed at a provincial hospital given the women's medical history and potential for the operations to be complicated. In another case he is alleged to have consented to a medical procedure on a pregnant woman which he knew would result in a termination of her pregnancy, which she had earlier told him was unwanted.

But the Medical Board of Queensland said a termination was outside Queensland Health guidelines and Dr Popov deliberately tried to obfuscate the intent to perform the termination and misled his superiors and colleagues in the case.

The obstetrician is accused of negligence in a seventh instance, when he left a woman in labour with twins under the supervision of junior staff only, after ordering the top-up of an epidural. Dr Popov was able to continue his alleged cowboy operations on patients until he left his practice in July last year. It took another 11 months for the Medical Board of Queensland to place restrictions on his practice. It has now lodged action in the Health Practitioners Tribunal to have disciplinary action taken against him.

Dr Popov has re-registered to practise as a doctor from July 1 this year. But Queensland Health said he was no longer working for them and under Medical Board of Queensland guidelines, he has not been able to practise privately since the middle of last month. Queensland Health has also referred the matter to the Crime and Misconduct Commission and the Health Quality and Complaints Commission.

Spokesmen for both Queensland Health and the Medical Board of Queensland said they were unable to provide any more information on the doctor, who is understood to have moved to South Africa. Lawyers listed as a contact for Dr Popov in a Medical Board of Queensland document last month said yesterday they no longer represented him and were unable to assist with any further information. Neighbours at his last known address at Redcliffe said Dr Popov packed up and moved to South Africa last week. Dr Popov received his Diploma of Medicine from a University in Varna, Bulgaria, in 1990.

Source

2008-07-06T00:21:00.001+11:30

Kennedy leads renewed effort on universal healthcare

Presses for bipartisan support before new president takes office

Senator Edward M. Kennedy's office has begun convening a series of meetings involving a wide array of healthcare specialists to begin laying the groundwork for a new attempt to provide universal healthcare, according to participants. The discussions signal that Kennedy, who instructed aides to begin holding the meetings while he is in Massachusetts undergoing treatment for brain cancer, intends to work vigorously to build bipartisan support for a major healthcare initiative when he returns to Washington in the fall.

Those involved in the discussions said Kennedy believes it is extremely important to move as quickly as possible on overhauling the healthcare system after the next president takes office in January in order to capitalize on the momentum behind a new administration. Kennedy was an early endorser of Senator Barack Obama, the presumptive Democratic presidential nominee who is also a member of the Committee on Health, Education, Labor and Pensions, which Kennedy chairs.

Obama's Senate staff has attended the roundtable discussions. If Obama is elected, Kennedy's effort to identify points of agreement among senators could smooth the way for the new administration to press ahead on universal healthcare, which Obama has promised to implement within four years.

The last time a national healthcare plan was attempted, under President Clinton in 1993, the presidential panel charged with devising a proposal was widely criticized for not consulting enough with Congress, and protracted disagreements erupted, delaying its progress for months and ultimately resulting in its demise. Kennedy's effort appears to be designed to identify areas of common ground between Democrats and Republicans, business and labor, providers and insurers, and others before the new president takes office.

"The senator is trying to learn from health reform attempts in the past and to build a fair amount of consensus among his Senate colleagues, House colleagues, and the Obama campaign . . . and find a strategy that could carry with some momentum into the new administration," said Dr. Jay Himmelstein, a health policy specialist at University of Massachusetts Medical School and a former Kennedy staff member who has been involved in the talks.

The initiative also suggests that Kennedy, who has made healthcare his signature issue in his 45-year Senate career and who is fighting an aggressive brain tumor, is considering his legacy as a new administration arrives in Washington - a moment many see as the best chance for widespread changes in the healthcare system in 15 years....

Kennedy played a critical role in helping Massachusetts create a healthcare overhaul proposal in 2006 by aiding the state in obtaining the federal money needed to subsidize it. It appears he is now looking to Massachusetts to help shape the debate in Washington. Earlier this year, Kennedy recruited John McDonough, executive director of Health Care For All in Boston and a major player in the Massachusetts healthcare overhaul debate, to lead the new health initiative.

Aides to Kennedy have also assembled a network of Massachusetts advisers, including healthcare lawyers, economists, nonprofit leaders, doctors, and health insurers who may be asked to work on specific aspects of a national plan. At a recent meeting in Boston, the group discussed how different elements of the Massachusetts approach might work on a national level.....

Intraparty disputes were one reason Clinton's 1993 proposal foundered. Back then, Daniel Patrick Moynihan, the Democratic chairman of the Senate Finance Committee, dismissed the financing of Clinton's plan as "fantasy" just before the president presented it to Congress.....

Even though health costs have soared along with the number of uninsured over the past 15 years, the defeat of the Clinton health overhaul plan was so politically devastating to the administration and to efforts to enact universal health insurance law that nothing approaching such a large-scale effort has been tried since. One purpose of the roundtable discussions, participants said, is to educate Senate staff on broad issues that have not been seriously debated in years.

Source

Bad British teeth

The new NHS constitution outlined this week in the Darzi report promises an NHS accessible to all, free at the point of use, and provided on the basis of need, not ability to pay. No aspect of the service falls short of this ideal by a bigger margin than dentistry. The Health Select Committee, with a majority of Labour members, did not set out to spoil the NHS's 60th birthday. But its report certainly puts those promises into perspective.

For decades, most adults of working age have paid a substantial part of their dental costs - just the same kind of co-payment which, we are told, would undermine the whole ethos of the NHS if it were to be allowed in paying for cancer drugs. Yet in spite of this, NHS dentistry has a terrible reputation. Americans are said to recognise British people at 100 yards by the poor quality of their teeth. The old "fee per item of service" contract rewarded NHS dentists for the amount of drilling and filling they did.

The new contract was supposed to put all this right. But its implementation was left to a succession of junior ministers who never carried enough clout to make it work. The British Dental Association pulled out of the negotiations, but the Department of Health did not take the hint. It remained convinced it was right and brought in the new contract regardless. This simplified the scale of charges, but in such a crude way that it further distorted dental practice. No pilots were carried out to see if it worked. It would be all right on the night, critics were told. It was not.

The department and the Chief Dental Officer remain convinced that these are, well, teething pains. Meanwhile, private dentistry has overtaken NHS dentistry in the number of patients treated, and millions who cannot afford to go private let their teeth deteriorate. Can NHS dentistry be rescued? It seems unlikely. But the attempt made by this Government has made a bad situation worse, at greater cost. Next time it should try listening to the dentists.

Source

2008-07-05T00:15:00.001+11:30

NHS bosses grumpy about new EU rights

The Government interrupted its week-long celebration of the NHS yesterday to issue a sharp warning to anyone tempted to desert it. Rather than welcoming a new EU Directive that codifies the rights of patients to travel abroad for treatment, the Department of Health gruffly announced that "health tourism" would not be funded by the NHS. This assertion missed the point so spectacularly that one wonders if anybody was awake in Richmond Terrace, the DoH's headquarters. The new directive - the result of several years of negotiation in which the Government has been fully involved - does not confer any new rights on EU citizens to become health tourists. Nor does it impose any new costs on health systems.

It simply says what is already EU law, though now codified in a far more comprehensive fashion. People have the right to travel and to have treatment abroad. If they do so, they will be reimbursed by the exact amount that their treatment would have cost in their home country. Nobody stands to gain or lose. Suppose a British patient decides he wants his hip implant done in Spain. If the local cost exceeds the NHS price (5,587 pounds for a straightforward cemented implant) he will have to pay the difference. If the cost is less, then the operation will have cost the NHS less than if he had stayed in Britain for it, and he will have reduced the queue by one. What's to worry about?

Now let's imagine the reverse scenario. An EU national, attracted by the paeans lavished this week on the NHS, decides he would like to come here for the same operation. Unlikely, but bear with me. If the NHS cost is higher than the cost in his country of origin, he will have to fund the difference. If it is less, the NHS will be reimbursed its normal tariff cost. The NHS will have to find room for another patient, but it will have been fully reimbursed for treating him. EU officials expect just one in 300 European patients to take advantage of the rules. The great majority will live on the mainland with attractive hospitals just over the border.

With a Channel to cross, the odds are that an even lower proportion of British patients will choose to travel. Anybody hoping to take advantage of a few weeks in a German spa - generously provided by the German healthcare system - will be disappointed. The NHS does not do spas. So it is not obliged to pay for anyone travelling to one. In any case, there is an opt-out clause. Should the numbers of British patients wanting to travel abroad become so large that they threaten the future of a service or a hospital here, they can be required to obtain a "prior authorisation" that would not in those circumstances be granted.

The new directive, it should be made clear, is distinct from the case law established by Yvonne Watts, who won the right to be reimbursed for having a hip operation in France when waiting lists in Britain were long. The judges at the European Court ruled that she was entitled to reimbursement if she had suffered undue delay in treatment. Under the Watts ruling, full costs would be reimbursable, not just the NHS tariff cost. But now that maximum English waiting times for elective operations are down to six months, it is unlikely that anyone would qualify under the Watts criterion - and they would have to go to court to prove undue delay.

The directive seems unlikely to create a flood of patients in either direction. In any case, there is a safeguard. The department's anxiety appears misplaced.

Source

NYTs Practice Of Medicine

In another one of those long, in this case 4278 words, articles by the New York Times, "Weighing the Costs of a Look Inside the Heart," it again demonstrates its failure to conduct or convey elemental journalistic research. And, again, an agenda appears at work. The result is that certain key facts and distinctions are omitted, which surely could have found space within this long article, that would have conveyed more and important information.

The agenda is rationing of health care. Rationing is inherent in the various schemes for "universal" or "single-payer" or "government-run" or "nationalized" health care. There's no doubt that some degree of rationing already occurs for those relatively few who truly can't afford insurance or co-pays but earn a bit too much to benefit from government programs. But, by shifting their earnings and taxes to the benefit of those few, the schemes would subject everyone else to rationing.

I'm a decades-long participant in HMOs, and even advocate them in areas like mine where their panels are so large and inclusive of the quality providers that there's nothing material to be gained by not being in one. However, most prefer more freedom of choice, as in PPOs, though their premiums are higher, and polls consistently show overwhelming majorities not favoring government-run health care. The fear is tangible and sometimes real that in case of an extreme circumstance or particular set of facts they will be denied covered care.

It's true, as the NYTs article says, that we collectively overuse medical care, and that costs. The problem is that, first, most of that is a personal decision and, second, the only way to drastically cut that cost would be wholesale imposed rationing that would often discriminate against many cases where the extra measure would save lives or make them more salutary. Third, many of the treatments proposed for rationing show demonstrated benefits but are, while not 100% proven - whatever that means, if even possible, discriminated against due to their cost. In that case, it's ironic that those who advocate greater preventive medicine, also advocate against preventive medicine.

The gist of the NYTs article is that overuse of heart CT scans is expensive, deliver large doses of radiation, may be spurred by self-interest profits by some doctor owners of CT machines, and the test and diagnoses not certain. As generalizations, that may be so. But, the NYTs fails to mention there are large-scale, reputable studies of those cases where it is proper and beneficial.

For example, the American Heart Association and American College of Cardiology Foundation in 2007 examined all the literature and studies to reach a "Clinical Expert Consensus Document on Coronary Artery Calcium Scoring By Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain." Patients who either score low or high (high already evident for additional treatment) on risk predictors are not indicated for the test. Patients who are scored intermediate risks are indicated for the test, as "such patients may be reclassified to a higher risk status based on high CAC score, and subsequent patient management may be modified". Many other peer journal articles affirm this finding. This test, calcium scoring, is - as the NYTs mentions only briefly in passing - "a less extensive form of scanning," but is grouped in with the NYTs negativity toward coronary CT scanning in general.

The NYTs article ends with a quote from an opponent of CT scanning, "We're spending a lot of money on technology of unclear benefit and risk." The NYTs want us to forfeit individual or independent expert judgments to centralized government-run entities whose track-record on cost-benefit analysis is proven repeatedly faulty and causing higher risks. No thank you to a British National Health Service.

Source

2008-07-04T00:06:00.000+11:30

EU good for something after all?

Every NHS patient is to be given the right to go abroad for free treatment. They will be able to escape queues and the fear of superbug infections and head anywhere within Europe under a blueprint for 'health tourism'. In almost all cases, they will be able to send the bill to the NHS - prompting fears that its finances could be thrown into chaos. Previously, patients who chose to pay for better treatment in France, Germany, or other EU countries had to mount legal action to make the NHS reimburse them.

But an EU directive on cross-border healthcare, to be published on Wednesday, will let patients shop around freely in all 27 member states. The move is designed to ease congestion in countries with long waiting lists and give patients greater freedom. They would have the right to seek any treatment offered by the NHS - such as cancer care or hip replacements - anywhere which would provide it more quickly.

Patients would have to pay upfront where they were treated, but as long as the cost was lower than in the NHS, they could reclaim it in full. However, patients are likely to have to pay for their travel and accommodation, if they stay outside hospital.

The attractions of EU treatment for Britons are clear. NHS waiting times have fallen dramatically as Labour has poured billions into the system, but they are still longer than in many other countries. The UK also has a higher incidence of hospital superbugs and poorer survival rates for many conditions, including some cancers. For the same reasons, experts say, there is unlikely to be an influx of foreigners to the NHS. Procedures are more expensive and queues longer here, although world-renowned facilities such as the Royal Marsden cancer hospital are potential draws.

The plan could threaten the stability of NHS finances, however, as the health service will lose revenue to hospitals overseas. Budgets could be thrown into chaos by patients jumping queues and then billing the NHS. There is also serious concern about Britons living abroad charging the NHS for all their medical care. Currently, many rely on private medical insurance to cover local treatment.

Keith Pollard, director of Treatment Abroad, a company which helps patients get care overseas, said last night: 'This is the first step to creating a truly European market in healthcare. 'It could revolutionise the way we experience healthcare in this country and throughout Europe. It's very good news for the fast-developing medical tourism industry. The directive will take the concept of patient choice to a new level.'

The Tories predicted that many patients would take up the offer to travel abroad. The party's health spokesman in Brussels, former health minister John Bowis, said: 'We will see people voting with their feet on the Government's handling of the NHS. 'People have been travelling abroad for treatments for years and the procedure needs to be formalised.'

Under the draft proposals, member states will be able to impose the same conditions on cross-border care as they do for domestic treatment - for instance, a requirement to consult a GP or a hospital specialist. The NHS would be obliged to fund all overseas outpatient treatment - such as scans and minor operations - even where patients do not seek authorisation beforehand.

But Health Secretary Alan Johnson is fighting for the right to make patients obtain NHS permission in advance for major operations, which mean a stay in hospital. The health department said: 'We are absolutely committed to ensuring that the NHS retains the ability to decide what care it will fund.' The EU, however, is understood to be insisting that funding for major procedures can be refused only if the NHS can show that services here will suffer as a result. And Britain does not have a veto to stop the plan becoming EU law if a majority of countries back it.

Doctors' leaders said the move would be a spur for the NHS to improve standards - but warned that the well-off and well-educated would be more likely to travel. Dr Terry John, chairman of the BMA's international committee, said: 'Patient mobility must not be just for the wealthy and educated. 'Standards of care for people who choose to stay in their home country, or are unable to travel abroad, must be maintained.' Some doctors are also warning that there could be problems in providing follow-up care, particularly for patients returning from countries where surgical techniques and procedures are different.

Source

Another comment on the latest NHS reforms -- as drafted by Lord Darzi

The management structure of the NHS has always reminded me of a huge pile of spaghetti. The shape is generally conical, like almost every management structure, but so convoluted are the workings between apex and base that trying to track where the money goes or how the ideas move is like tracing the strands of spaghetti as they wind in-out, up-down and around. Some strands are long, some small, some thickly coated with sauce, some almost bare, and no one can possibly work out how the strands interweave without taking the whole thing apart. It is a complete mess and mangle.

Today we learned of Lord Darzi's new plan for the NHS. Not surprisingly much of it is just window dressing wrapped in management speak: "personal care plans", "dashboard", "quality accounts". We know the result of this nonsense already - more form-filling for doctors and nurses, more managers required to audit the forms, more number crunching from Whitehall and an annual statement from the government that things have improved since this time last year. There is no wide-ranging proposal to address the biggest problem with the NHS - government interference in a professional service for political purposes.

We recently saw the most blatant example of this type of interference that i can remember, the Deep Clean. No less than 57million pounds of additional money was promised to pay for all hospitals to be cleaned thoroughly in an attempt to counter the spread of MRSA and c. difficile infections. True though it is that 57m is a drop in the NHS ocean, it is still 57m quid thrown at a gimmick designed purely to show that the government was doing something. Not surprisingly the Treasury did not fund the whole 57m as it had originally promised and the total spent on the project was more than 65m, only about 60% of which was spent on cleaning, the balance being sucked into the bottomless pit of administration. Little effect on infection rates appears to have resulted but a big dent was made in existing hospital budgets. It was, like all such knee-jerk gimmicks, counterproductive. Even if infection rates had been cut substantially it was a one-off exercise and did not look to the main causes of the problem.

Of far greater benefit would have been the introduction of simple old-fashioned accountability. The person in charge of a hospital ward should be accountable for its cleanliness. Ask any nurse with 30 years' experience and he or she will tell you that when they started work the wards were spotless. Matron was responsible. She could lose her whole career if the state of her ward caused illness or death and she made sure that those under her command cleaned everything thoroughly every day. Now who is responsible? The chief nurse no longer has control because he or she is given priorities based on government diktat by the ward manager, complying with the latest priority from Whitehall takes priority over other spending. The ward manager no longer has control because he or she is simply doing what has been passed down the chain; the same for the department manager, the hospital chief executive and the area trust. By the time we reach that level everything is so remote from the dirty ward that it doesn't matter how many more people can pass the buck up the chain. No one is directly responsible so one possible incentive to cleanliness is missing.

There is, of course, a simple solution; move cleanliness of wards to the top of the list of priorities and then apportion the remaining budget between the many other competing claims for funding. That is how things are done in private hospitals and the levels of infection are negligible. But to approach it in that way is impossible because the government has set targets for waiting times and failure to meet those targets will cost votes. Because the government might suffer, so heavy sanctions can be applied to a hospital or trust which misses the targets. Again political interference gets in the way of doing things properly.

Every private sector business which provides goods or services to the public looks to delivery first and tailors its operation to suit the needs of the customer. A company which manufactures hospital beds must make beds which hospitals want to buy, namely beds which have the features required by clinicians for the benefit of the patients. The customer is asked what is needed and the manufacturer must make it in order to stay in business. If the bed maker operated like the NHS the managing director would decide on the design and require that everyone should have access to just that one design. It is a recipe for commercial disaster but within the NHS it would be claimed to be a great improvement because there is no "post-code lottery" over which patients get the best beds.

Lord Darzi goes a small way to addressing this problem in his proposal for a pilot scheme by which people with long-term health problems are given control over their own "personal care budget" (another ghastly slogan, but the benefit is in the substance not the slogan). We wait to see just how much control the patient will have but it is a welcome first step towards making the service respond to the needs of the customer rather than the political interests of the governing party.

Much more will be needed before the NHS turns from a pile of spaghetti into an efficient organisation ... from little acorns etc.

Source

2008-07-03T07:19:00.001+11:30

Study: Downside of No Family Doctor in Canada

(Toronto, Canada) According to a previous report, approximately 15% of Canadians aged 12 and older do not have a family doctor. A new study assesses the impact of not having a primary care physician.

A new report from the Institute for Clinical Evaluative Sciences (ICES) reveals that not having a family doctor leads to more emergency room visits and hospital admissions for those who have chronic diseases in Ontario.

The report comes on the heels of a report from the Ontario Medical Association (OMA) that found since 2003, doctors have helped provide care to 630,000 patients who didn't have a doctor previously, leaving 850,000 Ontarians without a doctor.

"Recently, there has been some progress made in getting more people access to a family doctor, but it is clear that we must stay vigilant with our efforts or else we will continue to drain precious health resources and force patients to suffer unnecessarily," noted Dr. Ken Arnold, a family physician from Thunder Bay and President of the OMA.

"The lack of access to a family doctor, especially for those with chronic diseases, negatively impacts the quality of life of patients and places unnecessary stress on our hospitals and emergency rooms."

Frankly, I believe a study was not necessary to conclude that people without family doctors go to emergency rooms. That's obvious.

2008-07-03T00:22:00.001+11:30

Callous and crooked city-run NYC hospital

Vote Obama and you too can get treated like this

Shocking surveillance camera footage shows a [black] woman collapsing and dying on a hospital emergency room floor and then lying for an hour while staff walk past. The video has been released to the media as evidence by lawyers suing the hospital for neglect and the alleged abuse of mental health patients. The lawsuit will also allege that staff have falsified medical charts to cover up their inaction because during a period that Green is seen thrashing on the floor, her medical chart claims she was "awake, up and about, went to the bathroom", New York's Daily News reports.

The video shows 49-year-old Esmin Green keeling forward in a psychiatric emergency room in Kings County Hospital in Brooklyn, New York, where she was admitted to treat agitation and psychosis on June 19. Green is shown clutching at her stomach, thrashing on the floor before lying face-first on the tiled floor with her upper body lodged in the corner space between two sets of chairs.

Two other patients move around the room, security guards walk past and one even stares at Green for about 20 seconds but the woman is left prone until one of the patients gets help after about an hour has elapsed.

The two security guards shown in the video and four other hospital workers have been fired over the incident. The hospital had a lawsuit filed against it last year alleging horrific neglect and abuse of mental patients. There were claims patients who could not fight for themselves were left without care in unsanitary conditions, which prompted an investigation by New York City officials.

In reponse to the damning video and the other claims, the hospital says it is increasing staffing and bringing in new protocols, including that patients in the emergency room have to be checked every 15 minutes.

Source

Australia: Ambulance computer system fails yet again

We were orginally told it just needed oiling (or some such). For those who follow government computer systems, the initial description of it as "innovative" was all that was needed to predict the outcome

THE statewide rollout of the Emergency Services computer system has been put on hold after it went offline for a fourth time. Again ambulance and fire officers were forced to write incoming jobs on a whiteboard.

Yesterday morning's crash was the worst to date. All but two ambulance and fire communication centres were left without their computers for more than two hours, from before 3am until after 5am. Three previous system failures were put down to human error and the Department of Emergency Services said "early advice" was that human error was again to blame.

However Emergency Services Minister Neil Roberts said the system's rollout to the remaining Central and South-eastern regions would be "put on hold" pending advice from the system's American supplier, who had been asked to analyse yesterday's outage. "I am advised that triple zero telephone and emergency services radio communications were not affected by this incident. Communication centre staff dispatched ambulance and fire crews using a manual back-up system," Mr Roberts said.

Fire officers have been highly critical of the new system, which they say has only been "half implemented" by the department making it ineffective. "The system is meant to locate the closest vehicle to an incident and dispatch that vehicle. But they're yet to install the automatic vehicle locaters in our trucks so it can do this," an officer said.

He said vehicles from two or three stations away were being sent to jobs instead and even driving past these manned stations on the way. "The most ridiculous example we had was when the computer tried to dispatch a vehicle from Capalaba station to a job on the Sunshine Coast," the officer said.

Fire communications centre staff have also raised concerns about screen freezes in the new system which can take valuable seconds off a job. "You're trying to talk to a coms centre operator and they're like, `Oh, wait a minute, the screen's frozen'. It happens every time," the officer said.

Mr Roberts said the "state of the art" computer-aided dispatch system was in use in communication centres across the world, including Australia and all of New Zealand's emergency services. "DES remains confident that its full implementation will result in improved response to calls for service from the community," he said.

Source

2008-07-02T00:10:00.001+11:30

NHS bosses still dreaming

After 60 years, the NHS has signalled the end of cheap-and-cheerful, any-colour-so-long-as-it's-black healthcare. That's about 30 years after manufacturing, retailing, telecommunications and the rest of the service sector embraced the idea that the customer is king, and what he (or she) wants is quality service. But let's not quibble. Lord Darzi's review sets quality of care first, and everything else a distant second. Almost all the detailed changes he proposes are designed to raise standards. Doctors and hospitals will be measured by the quality of care they deliver, and rewarded accordingly. Patients will be asked their opinion, and other more specific outcome measures - such as how many patients die - will be used to determine just how good their care has really been.

In general practice, the Minimum Practice Income Guarantee (MPIG) will go. Income will instead depend more on the Quality and Outcomes Framework, which measures what GPs do, rather than what their historic income has been.

Hospitals that deliver a classy service will be paid more than the rest, under the tariff that determines the cost of every procedure. Everybody will publish annual Quality Accounts, equivalent to their yearly financial accounts.

Primary Care Trusts will be forced to pay for treatments passed cost-effective by the National Institute for health and Clinical Excellence, and Strategic Health Authorities given a legal duty to encourage innovation. Patients will get enhanced rights of choice over where they are treated, harnessing market power to raise standards. The theme is clear. "This whole report is about quality," Lord Darzi said. David Nicholson, chief executive of the NHS, said: "Quality is to become the organising principle of the NHS".

But can the service deliver? Historically, it has always valued shifting large numbers of patients through their episodes of care as a greater good than ensuring they were as well-treated as medical knowledge makes possible. Central targets enshrined this principle, to the fury of clinicians.

Lord Darzi now claims to have listened to the clinicians, and shaped his report from what he heard. "This is not a document pulled together by a small group of people in the Department of Health" insisted Mr Nicholson, as if we might possibly have suspected it.

At issue is whether the levers are strong enough to bring about change. The document assumes that quality improvement will have no victims. But better quality can only come about by chasing out bad: that means eliminating poor GPs, closing failing hospital services, or even entire hospitals. Otherwise there won't be the money to reward the good. These changes are painful. Lord Darzi envisages them being driven locally, but his chosen instrument, the primary care trusts, are weak reeds. Hitherto most of them have been easily managed by ingenious GPs and popular local hospitals. Most patients don't even know what PCTs are: and if PCTs try to do anything tough, they are easily characterised as "NHS bosses" cutting services.

There are also some spectacular gaps in the promises the documents make. The NHS Constitution - a "declaratory document" said Lord Darzi, for which read the usual well-meant pieties - makes only one new promise, that of universal patient choice. But when pressed, the Health Secretary, Alan Johnson, seemed unsure how that would apply to popular GPs whose lists are full, and Lord Darzi disabused anybody of the idea that it means you could choose a particular surgeon - for instance, him.

In his team of colorectal surgeons at St Mary's Paddington, all were equally good, he insisted. But if choice doesn't mean the right to choose a particular GP or a particular consultant, what does it mean? And if you can't really choose, how can bad practitioners be driven out to make way for better ones? Competition is a bloody business, as a million corner-shops run out of business by the supermarkets can attest.

Lord Darzi's report lacks any acknowledgement of this. It simply envisages an NHS aspiring ever upwards to unimagined levels of quality and care, leaving nobody behind: no victims, no bankruptcies, no tears. Life isn't like that.

Source

Australian public hospitals slower to see patients

Public hospital emergency departments are seeing a smaller proportion of patients within the recommended time than they did eight years ago - and the federal Government has admitted that "much work lies ahead" to fix the system. More than 6.7 million people sought treatment at Australia's emergency departments in 2006-07 - the equivalent of one-third of the population - and 30 per cent of these patients were not seen within the minimum recommended times laid down by the Australasian College of Emergency Medicine.

The figures, contained in the latest annual State of Our Public Hospitals report released by the federal Government, have prompted a chorus of protests from health organisations who say it shows the system has been starved of funds, even though overall spending on hospitals hasnearly doubled over the past decade.

Releasing the report yesterday, federal Health Minister Nicola Roxon said it illustrated "11 years of Liberal neglect". She said all states and territories except NSW were seeing a smaller proportion of emergency patients punctually in 2006-07 than they were eight years previously, in 1998-99. Over the same time frame, the number of people presenting to emergency departments rose by 34 per cent, up from five million in 1998-99.

The report showed there were 4.7 million admissions to public hospitals in 2006-07. Ms Roxon said the latest report showed admissions were growing by about 3 per cent a year - more than double the rate of population growth - and hospitals were "under severe strain". "While it will take time to turn around a decade of neglect, the Rudd Government is determined to deliver dramatic improvements in healthcare," she said.

The proportion of elective surgery patients seen within recommended times in 2006-07 ranged from 68.6 per cent in the Northern Territory, and 67.6 per cent in Tasmania, to 85.9 per cent in NSW. Longest waits are for knee replacement (162-day median wait), a type of nasal surgery called septoplasty (113 days) and hip replacement (106 days).

Between 1998-99 and 2005-06, the amount of commonwealth money provided for state hospitals rose from $6.1 billion to $9.2 billion. But over the same period, that money as a proportion of the total spending on state-run hospitals fell from 48.1 per cent to 42.7 per cent.

Yesterday's report also showed continuing increases in some states in the proportion of same-day procedures, and decreases in average lengths of stay. Both are techniques hospitals can use to cope with an ever-growing stream of patients needing treatment.

Australian Medical Association president Rosanna Capolingua said the report was "a wake-up call to the governments of Australia" and that doctors and regular patients "have known for a long time that our public hospitals are at breaking point".

Prue Power, executive director of the Australian Healthcare and Hospitals Association, called on the Government to increase its share of total hospital funding from its current level of 42 per cent. The annual indexation also needed to be raised from the "inadequate" current rate of 1.7per cent.

Source

2008-07-01T00:47:00.001+11:30

Britain makes unsustainable health promises

They are too busy paying hordes of clerks and "administrators" to afford the best drugs for their patients

A pledge to give patients any approved medication on the basis of clinical need rather than cost risks creating an almost limitless drugs bill, the Government has been warned. Plans for a new NHS constitution, to be unveiled by the Prime Minister today, will enshrine a universal right to treatment if clinically appropriate in an attempt to end the “postcode lottery” of access to new drugs. Experts gave warning that the pledge, one of a series of new measures in the landmark draft document, carried huge costs that could not be covered by current NHS budgets.

Publication of the new constitution comes at the start of a week of celebrations to mark the 60th anniversary of the NHS. It will set out a “right to expect local decisions on funding of other drugs and treatment to be made rationally following a proper consideration of the evidence”.

While the drive to reduce inequalities of access to drugs will be welcomed, health economists question how the Government will be able to devise a policy that delivers on such a pledge without punitive costs. Roy Lilley, a former director of an NHS trust and independent health policy analyst, said: “We have to ask ourselves the question: will drugs get more complex? Yes. Will they get more expensive? Yes. “To say that we will buy them whatever, however much they cost, you might as well give the pharmaceutical industry a blank cheque. “It’s a huge worry. There are some fantastic drugs. I’m not saying we shouldn’t have them. But there has to be a rationale behind the use of resources. You can’t say because it’s here we’re going to buy it. That’s crazy.”

The National Institute for Health and Clinical Excellence (NICE), the watchdog that determines value for money on the NHS, can currently take up to 2½ years to decide whether to approve a drug. Ministers want this cut to a maximum of six months.

Alan Johnson, the Health Secretary, said yesterday that patients would have a universal right to approved treatments “if clinically appropriate” and might resort to legal action if they were still disappointed. The moves are expected to generate at least £100 million worth of extra prescriptions a year, funded centrally by the Department of Health.

While patients’ groups and health economists welcomed the Government’s aims to provide quicker treatment, they said that the increasing cost — and sometimes modest benefits — of new drugs could not be taken out of the equation. John Appleby, chief economist of the King’s Fund health think-tank, said: “There are cases where patients have died after being denied drugs for cancer. But these medicines often cost more than ten times NICE’s threshold for achieving one extra year of life. “In a system of finite resources you have to draw a line somewhere in terms of a drug’s effectiveness — it may add extra minutes, days, months of quality years to someone’s life but how much is enough? Perhaps the Government has decided that it can avoid bad headlines by promising greater access to drugs but it will have to look into this carefully or be braced for a surge in patient demand, with the associated costs.”

The Royal Pharmaceutical Society of Great Britain agreed that “better, more comprehensive access to new treatments will not be without cost”. Alan Maynard, Professor of Health Economics at the University of York, added: “Often new drugs that haven’t been approved by NICE simply aren’t cost-effective. We have to confront this issue head on, by speeding up the NICE appraisal process but also by putting pressure on pharmaceutical companies to lower their prices.”

One of the biggest “postcode lottery” disputes has been over drugs for “wet” age-related macular degeneration, which affects more than 250,000 Britons. Barbara McLaughlin, of the Royal National Institute for the Blind, said that NICE had been considering the drugs since February 2006 and that the slowness of the processes had threatened the sight of thousands of people.

Andrew Lansley, the Shadow Health Secretary, said that comparisons of access to emerging treatments between Britain and other countries was “frankly scandalous”. “We have some of the best cancer research in the world in this country but we have among the slowest uptake of new cancer drugs. So it is not just about a postcode lottery inside the UK.”

The Department of Health said the NHS constitution would be the first of its kind in the world and would state “what patients, public and staff are entitled to expect from the NHS”. It will be presented to Parliament this afternoon as part of the year-long review of NHS services completed by Lord Darzi of Denham, the surgeon brought in as a health minister by Gordon Brown.

Source

2008-06-30T00:31:00.001+11:30

The latest craziness in Brtain's socialized medicine

Nurses to take charge of surgeries

The government will take on the medical profession this week by pressing ahead with reforms that will see greater power being transferred from doctors to nurses. Alan Johnson, the health secretary, is expected to follow up plans to introduce at least 150 large health centres, known as polyclinics, by announcing an expansion of surgeries run by nurses. The centres will replace lone GPs, many of whom the government believes are unable to provide evening surgeries or other modern patient services.

This is likely to escalate a row between the government and doctors over reform. Lord Darzi, the health minister in charge of a review of the National Health Service, has accused some doctors of being “laggards” and protecting their “professional boundaries”. Darzi has already said he wants to see nurses doing minor surgery in hospitals. This week he is expected to lay out proposals for more nurses to set up surgeries. They will be encouraged to establish not-for-profit firms to run the practices by being allowed to opt out of the NHS without losing pension rights.

Darzi will also outline plans to publish the death rates of hospital doctors so patients can compare their chance of survival according to who treats them. Death rates at NHS hospitals are available for heart surgery. Success rates for about 50 other conditions are expected to be published on the internet to allow patients to shop around.

Patients are also expected to be given personal health budgets and will decide how the money is spent on treating long-term conditions, such as diabetes and heart disease.

An “NHS constitution” will set out patients’ rights and responsibilities, including the right to be told why they have been denied a drug a doctor recommends.

Johnson has admitted that access to NHS drugs is a lottery and will order the National Institute for Health and Clinical Excellence (Nice), the government’s rationing watchdog, to assess drugs more quickly. He said: “What we have heard from patients is that one of their major concerns is the perceived ‘postcode lottery’ in access to drugs. “The draft constitution will address this by making it explicit that patients have the right to Nice-approved drugs and treatment if clinically appropriate. “We will also speed up the national process for appraising new drugs. If a decision is then taken not to fund a drug then your local NHS will have to explain that decision to you.”

Hamish Meldrum, chair of the British Medical Association, suggested the government’s plans for nurses to run surgeries would have limited impact because patients would choose to be treated by doctors. Meldrum said: “There are obviously certain things that only doctors can do. “It is all very well saying patients should have choice about where they are treated but there are certain treatments nurses cannot do, so there will be a limited choice. Patients usually prefer to see doctors.”

Peter Carter, general secretary of the Royal College of Nursing, said increasing numbers of nurses would run local surgeries in future. Carter added: “We never want to get into confrontations over territory. However, good progressive doctors recognise there are roles for nurses who do highly complex work.”

Source

2008-06-29T00:23:00.000+11:30

Founding Father of Canada's Socialized Medicine Rejects the Monster He Helped Create

If we follow Canada over the edge and into the abyss of socialized medicine, it won't be because we weren't warned of the consequences:

Back in the 1960s, [Claude] Castonguay chaired a Canadian government committee studying health reform and recommended that his home province of Quebec — then the largest and most affluent in the country — adopt government-administered health care, covering all citizens through tax levies.

The government followed his advice, leading to his modern-day moniker: "the father of Quebec medicare." Even this title seems modest; Castonguay's work triggered a domino effect across the country, until eventually his ideas were implemented from coast to coast.

Four decades later, as the chairman of a government committee reviewing Quebec health care this year, Castonguay concluded that the system is in "crisis."

"We thought we could resolve the system's problems by rationing services or injecting massive amounts of new money into it," says Castonguay. But now he prescribes a radical overhaul: "We are proposing to give a greater role to the private sector so that people can exercise freedom of choice."

Castonguay has been forced to reverse his views because authoritarianism has made such a mess of healthcare in Canada, people enter lotteries to win a doctor's appointment. Fortunately Canadians are still able to cross the border to a free country, where all you have to do to get medical attention is be willing to pay for it. But if Democrats have their way, that won't be the case for much longer.

Freedom works. Socialism doesn't work. Yet socialism means more power for the authorities, so we will have to keep fighting it off, no matter how many times it has been exposed as fundamentally dysfunctional.

Source

2008-06-28T00:43:00.000+11:30

IVF severely limited in the home of IVF

Lots of women outside Britain have 10 or more treatments to get a baby. And infertility is a very common disorder

Thousands of infertile couples are being denied IVF that should be funded by the NHS because only 9 of 151 health trusts are offering the recommended level of therapy. A total of 94 per cent of primary care trusts in England are still not providing the three free cycles of IVF that should be available under national guidelines issued in 2004, government figures have revealed.

The survey of IVF provision last year also showed that all but a few trusts have imposed tough criteria for free fertility treatment, rejecting patients who smoke or who already have children, including those from previous relationships. Most of those that offered treatment paid for one cycle, and four trusts provided none at all. The results - the first to incorporate figures from every trust in England - were published yesterday by the Department of Health. They show that a postcode lottery for IVF is flourishing despite guidance from the National Institute for Health and Clinical Excellence (NICE).

The NHS financial watchdog recommended in 2004 that three cycles should be available to infertile couples in which the woman is aged between 23 and 39. Women's chances of conceiving are considerably better when more cycles are offered, to the extent that NICE identified three cycles as cost-effective. The advice is not binding, and the Government has provided no extra funds for it to be put into effect. The Department of Health has asked trusts to provide at least one cycle, and to move towards implementing it in full.

About one in six couples is affected by infertility. Almost 45,000 cycles of IVF are performed in the UK each year, but the level of NHS provision means that more than 30,000 of these are conducted privately, at an average cost of about 2,000 pounds per cycle.

The new figures were published as doctors prepare to celebrate the 30th birthday of Louise Brown, the world's first test tube baby, who was born in Oldham on July 25, 1978. Oldham is one of the nine trusts - all in the North West of England - that provide three cycles.

Susan Seenan, of the patient support charity Infertility Network UK, said: "Thirty years after the inception of IVF treatment, in the country that pioneered IVF, and four years after the NICE guideline, it is a complete disgrace that only nine PCTs are offering three free cycles. "We are also disappointed that some PCTs are still offering no cycles at all, and that most are adding social criteria that make it difficult and unfair for patients to access the treatment they need. "There is a real need for a standard set of eligibility criteria that operate nationwide."

The survey was published on the Department of Health's website in response to a parliamentary question from Sally Keeble, the Labour MP for Northampton North. It does not include data from Scotland, Wales or Northern Ireland. It found that seven PCTs offer three cycles - Heywood, Middleton and Rochdale; Bury; East Lancashire; Stockport; Tameside & Glossop; Traf-ford; and Blackburn with Darwen. Central Lancashire offers two or three cycles, and Oldham "a maximum of three". The four PCTs that have suspended free IVF treatment were North Lincolnshire, North Staffordshire, North Yorkshire and York, and Stoke on Trent, though the latter has since resumed provision.

About two-thirds of the trusts (100) offer one cycle, while 35 offer two, and three did not provide full information. More than half (86) specify that a couple must have no children, while another 46 impose other restrictions such as no children from the current relationship, or not more than one child. The survey found that 35 trusts specify no smoking, 30 say that patients must be in a stable relationship, and 33 impose age restrictions beyond those in the NICE guidelines.

A spokeswoman for the Department of Health said: "We recognise that there are local variations in the provision of IVF and that this does cause distress to many childless couples who feel that they are not getting the treatment they need. "NICE published their guide recommendations that trusts provide up to three cycles of IVF in February 2004. But NICE and the Department of Health realised that this could not be immediately implanted and so trusts were encouraged to use this as a goal they move towards. The first step is for all PCTs to offer at least one cycle of IVF and the vast majority do so, with almost a third already offering more than one cycle."

Source

Australia: New ambulance computer system still cactus

Maybe they did not oil it enough. See my second post of the day on 23rd for background

For the second time in a week Emergency Services' $6 million computer system has crashed, forcing operators to log jobs on a "big whiteboard". The Emergency Services Computer Aided Dispatch system failed without notice at 11:30am for no apparent reason. It was back online fairly quickly - unlike last week's 90 minute outage - which was blamed on a maintenance issue.

The expensive new computer system went "live" in Brisbane on May 1 despite the concerns of fire service communications operators. Officers who contacted The Courier Mail expressed fears problems experienced in the southwest region would be repeated in the busy metropolitan area with serious consequences. The problems included delays in the system and unexplained outages, like today's crash.

Emergency Services management has previously stated its complete confidence in the escad system which was initially delayed to provide officers with extra training.

Source

2008-06-27T00:17:00.000+11:30

NHS hospital pronounces ten-month-old girl dead -- despite her being alive

An investigation has begun into how a ten-month-old girl, feared drowned in the Thames, was wrongly pronounced dead by hospital staff. It was believed that the child had died after she fell in during an outing to feed the ducks with her mother and three-year-old sister. She was airlifted to John Radcliffe Hospital, Oxford, but after efforts to resuscitate her, doctors declared her dead. Police confirmed the tragedy at 11am, more than an hour after officers were first called to the scene on the towpath at Goring-on-Thames, Oxfordshire, yesterday morning.

A faint heartbeat was discovered later, and the girl remains in hospital in a critical condition. Neither the hospital nor the police would give details of how long it took hospital staff to discover that the child was still alive, nor could they confirm how the child got into difficulty in the water.

A spokeswoman for John Radcliffe Hospital said: “A full paediatric clinical team immediately attempted to resuscitate the child in the emergency department of the John Radcliffe. “After a lengthy period of resuscitation, a unanimous decision was made by the clinical team to stop treatment, in the best interests of the child. [It's in her best interests to be dead?????]

“Subsequently, the child showed very fragile signs of life. This does occasionally happen and the child was moved to the paediatric intensive care unit of the hospital. She remains there in an extremely serious and critical condition.”

Source

Crass Australian public hospital management kills little girl

Exhausted doctor didn't notice brain bleed. What was the hospital management thinking of to assume that a doctor did not need sleep? It's a wonder this sort of disaster does not come to light more often. The hospital manager should be sued for manslaughter

DOCTOR fatigue and the safety of bunk beds are among the issues being probed by an inquest into a girl who died hours after she was sent home from hospital. Elise Neville, then 10, struck her head in a fall from a bunk bed while on a family holiday at Caloundra, in Queensland, in January 2002. Bleeding in her brain went unnoticed by Dr Andrew Doneman, who was in the 20th hour of his 24-hour shift at Caloundra Hospital. The hospital had a policy of not admitting children and the Toowong, West Brisbane, schoolgirl was discharged.

She went to sleep on her parents' bed in Caloundra but was critically ill when her family woke at 7am. An unconscious Elise was flown to Brisbane for treatment. and died days later.

The court was told that in 2004, Dr Doneman pleaded guilty to unsatisfactory professional conduct but the issue of fatigue was raised. Health Practitioners Tribunal judge Debbie Richards said then that it seemed "extraordinary" that anyone should be working such long hours. "If this tragedy does nothing else, it should lead to the abolition of such brutally long shift hours," she said.

Queensland Health's acting director of medical workforce advice Suzanne Le Boutillier said an "alert doctors" strategy was being rolled out to help make doctors aware of fatigue. "Focusing solely on the hours of work does not make patients safe," she said. "There are a whole range of other factors that contribute to fatigue." Ms Le Boutillier said the strategy had gained support among doctors. "The great successes are where doctors drive this on the ground," she said.

The safety of bunk beds will also come under the scope of the inquest and how future deaths might be prevented.

Outside court, Elise's parents Gerard and Lorraine, said they hoped the inquest would identify and improve deficiencies in the health system. "There's been changes, that's great, but I need to see more," Mr Neville said. He said many Queenslanders lived in places removed from Brisbane and the bigger centres and they needed care too. "We were only one hour from Brisbane - one hour - and this is what happens," he said. Mrs Neville said: "I want people to see how beautiful she was and she's just always going to be a part of our lives. "We're Elise's voice and we'll see it through."

Source

2008-06-26T00:42:00.001+11:30

What's at Stake in the Medicare Showdown

A friend recently asked me for advice on how to protect her father. He wants to stay in his own apartment as he recuperates from hip surgery. But the Medicare program that covers him requires that he head off to a costly nursing home. My friend was so desperate that she has also consulted a health-care lobbyist for advice.

At stake in the presidential election is whether we will all need to consult lobbyists to have our medical issues heard by a remote, bureaucratic Medicare program. Medicare's staff, members of Congress and Barack Obama are all moving to expand government influence over the medical choices we make. As early as today, the House will vote on legislation that aims to cut Medicare Advantage - a program that allows millions of seniors to use federal dollars to buy private health insurance.

Democrats hate Medicare Advantage and have been trying to cut it for quite some time, because they don't like health-care markets. Sen. Obama promises to cut $150 billion out of it in the coming years. The Senate has been haggling over cuts to the program for weeks. Why cut? For all the talk about finding health-care savings with painless "reforms" like better information technology or disease management, the only way to really control costs under our current health-care model is to control access to drugs, devices and services.

The crucial question is where the controls should be - with patients working through private plans or with government agencies. While private health insurance is imperfect, there's a misguided faith in Medicare's superiority that rests on flawed assumptions.

First, there's a mistaken belief that Medicare is better staffed than private plans, and can therefore make better decisions about patients' clinical circumstances and the access to new therapies they should have. Yet at any time, Medicare has about 20 doctors and 40 total clinicians (including nurses) inside the coverage office, and fewer than a dozen in the office that sets the rates that doctors are reimbursed for the care they provide. Private insurers employ thousands of doctors, nurses and pharmacists, many experts in new technologies.

Aetna has more than 140 physicians and about 3,300 nurses, pharmacists and other clinicians across its health plans. Wellpoint has 4,000 clinicians across its different businesses, including 125 doctors and 3,180 nurses. That works out to one clinician for every 9,000 people covered. United Healthcare employs about 600 doctors and 12,000 clinicians across all of its health plans and various health-care businesses.

Private plans use clinically trained people to establish access to new technologies and services, but they also consult with doctors on a case-by-case basis, determining whether a product or service should be covered. Competition for beneficiaries means private plans need to provide better access for appeals, modern services and more personal considerations than what's offered by Medicare, a monopoly supplier.

Recent data from Price Waterhouse Coopers found that private plans spend roughly four times more than Medicare on "consumer services, provider support, and marketing," which includes money spent answering the telephone to adjudicate individual issues. Smaller health plans use one clinician for every 10,000 beneficiaries. Medicare would need 4,500 clinicians to keep pace.

One place where the clinician disparity is most obvious is the delivery of cancer benefits. Medicare doesn't have a single oncologist on staff, yet since the year 2000 the program issued, by my count, 165 restrictions and directives on the use of cancer drugs and diagnostic tools.

A second common refrain is that Medicare is more efficient than private plans, spending less money per beneficiary to administer health services. But a lot of the money that private plans spend is on clinical specialists charged not only with reviewing individual cases, but also with ensuring that doctors and beneficiaries comply with plan contracts. Far from a selling point, not having these functions is one of Medicare's shortcomings.

Medicare doesn't need to hire doctors to weigh individual medical cases because it uses formulaic rules made in Washington to set broad and inflexible restrictions on medical practice. Nor does the program need to hire clinical staff to monitor compliance. It passes costs for that on to the broader health-care system by backing up its rules with the threat of costly civil and even criminal sanctions. Providers and medical product developers spend hundreds of millions of dollars on systems, personnel and paperwork to ensure compliance with Medicare's sticky morass of regulations - tasks made more expensive by the fuzziness of the program's regulations and the arbitrary way they are enforced.

This brings us back to Medicare Advantage. Many in Congress assume that private insurers are driven by greed, and only a government-run health program can ensure adequate access to services. But Medicare Advantage plans offer prevention and wellness benefits, care coordination and alternatives to hospitals at the end of life that traditional Medicare does not provide. The clinical staff of Medicare Advantage plans isn't just there to handle appeals, but to offer personalized services that reflect the care people want rather than benefits defined by remote staff at a monopoly supplier.

If Democrats have their way these plans could be in for big cuts. If Congress does nothing before July 1, doctors in Medicare will take a 10.6% cut in their pay. To stop that from happening Congress will likely raid Medicare Advantage and use the money saved by cutting that program to cushion the blow to doctors. What terrifies members is facing constituents over the July 4 break who will be upset about rising co-pays and uncertainty about their coverage. The question is how big of a bite the House and Senate will take out of Medicare Advantage. But cut they will, because Medicare Advantage plans enable competition that serves as a model for shaping Medicare into a privately run system.

Mr. Obama has been honest about his intentions. He wants to cut from Medicare Advantage to pay to expand "fee-for-service" Medicare programs. For those not yet eligible for Medicare, he also proposes to saddle private plans with new regulations and create a subsidized, Medicare-like public plan to "compete" against the private health-insurance market for the under-65 crowd. The idea is that the Medicare-like alternative would eventually displace a dwindling number of private plans, after many are driven away by costly new government rules. His endgame is to leave the government-administered Medicare program in a position to set decisions for the entire health-care system.

Will we stick with a "defined benefit," where everyone is promised the same government services? Or will we move toward a "defined contribution" system (favored by John McCain), where seniors can buy private health insurance? It's a fundamental question we are being asked in November.

In the end, my friend's father was transferred to a nursing home. Patients covered under Medicare Advantage have their own discomforts, but at least they can always change plans and appeal decisions. And they don't need to consult a lobbyist.

Source

2008-06-25T00:52:00.001+11:30

THE CHRONIC CRISIS IN AUSTRALIAN PUBLIC MEDICINE

Three articles below from just one day!

Doctor numbers nosedive in Australia

When there are heaps of people wanting to get into medical schools this is just plain government negligence. Why is money being spent on useless "postmodern" courses when funds for medical education are so limited?

AUSTRALIA'S doctor shortage is becoming critical, with new figures revealing a plunge in the number of GPs. A report to be released today shows the number of practising GPs fell 9 per cent between 1997 and 2005.

The release of Australia's Health 2008 will reignite tensions between doctors and the Rudd Government. Health Minister Nicola Roxon said GPs should rethink their roles as medical "gatekeepers" in light of the finding. "Why, when families struggle to see their GP, when people often end up in their local hospital because they can't get frontline care from their local doctor, do we need gatekeepers?" she said.

The Australian Medical Association argues that doctors must be the gatekeepers of the health system to ensure patient safety

Source

Dud medical regulator to be sued

RAPE victims of a deviant doctor are planning to sue Victoria's peak medical watchdog for failing to act on sex assault complaints. The women have engaged Slater & Gordon to investigate suing the Medical Practitioners Board for failing to suspend dermatologist David Wee Kin Tong after two patients said he molested them. Dr Tong was jailed in March for at least 5 1/2 years for sexually assaulting 14 patients. His last victims were assaulted three years after the first complaints were made.

The women claim inaction by the profession's watchdog left Dr Tong free to abuse up to 12 more unsuspecting victims. It is believed the board, a statutory body charged with investigating complaints and protecting the public, did not hold a formal hearing into the allegations after an investigation into Dr Tong. A second complaint to the board in 2005 led to Dr Tong being reprimanded. The board is not required to pass complaints on to police.

After a victim went to police in 2007, investigators were initially refused access to the board's records on Dr Tong and were forced to serve a warrant for the material to be released. Victoria Police's sexual crimes squad raided the board's headquarters, but had to fight a legal challenge in court to use the files. The board has since apologised publicly for its handling of the complaints, but a police source says that the board's actions were tantamount to a "cover-up".

The Herald Sun has learned the wealthy doctor tried to divest himself of his Toorak mansion before it could be confiscated to pay his victims' compensation. Victoria Police restrained Dr Tong's Toorak property, which he had sold for $2.35 million, only days before settlement. The proceeds of the sale were later confiscated. Already gone were antiques and paintings, many of which Dr Tong bought at Sotheby's and Christie's auctions.

Dr Tong, 40, pleaded guilty to seven counts of rape and seven counts of indecent assault involving 14 patients at clinics at Clifton Hill, Malvern, and Preston. The offences occurred between October 2001 and 2007 during examinations. He also lost his right to practise medicine. Another two women have since come forward with allegations against Dr Tong.

During a search of Dr Tong's home, police found 120 pictures of naked women -- some of them patients -- placed in small photo albums. Dr Tong told many of the women, aged between 22 and 34, they could get moles on their genitals and required a full-body examination.

Kay, who was the first victim to come forward, said although compensation was an issue, she wanted the board to change its investigation procedures to ensure the safety of others. "I was the first, but they just didn't follow up," she said. "I felt really violated and they (the board) hadn't listened to anything I said to them and took his word for it."

The MPB has since reviewed cases involving potential sex offences and apologised to victims. "Why the hell didn't they stop it back in 2004 when we complained," Kay said.

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Public hospital and its head surgeon facing negligence lawsuit

MELBOURNE'S The Alfred Hospital and its former head of trauma, Thomas Kossmann, are facing legal action alleging medical negligence. Law firm Slater & Gordon has told The Australian it is preparing several cases against the hospital, and possibly Professor Kossmann, for allegedly negligent surgery performed on trauma patients.

The cases come in the wake of a damning peer review into Professor Kossmann's surgical and billing practices, which were first revealed in The Australian in April. The review alleged he had exaggerated his experience on his CV, conducted risky and unnecessary surgery, and rorted government insurance agencies, including the Transport Accident Commission. It also alleged he had put lives at risk with bungled surgery that involved grave errors in more than half of the 24 cases that were examined.

Professor Kossmann has denied any wrongdoing and attributed complaints from doctors about his surgery to competitive jealousy. He condemned the peer review, led by orthopedic surgeon Bob Dickens, as a "witch-hunt", and several of his former patients have come forward to praise his surgical performance.

When the review was released last month, Jennifer Williams, the head of Bayside Health, which operates The Alfred, absolved the hospital of any legal responsibility. But Slater & Gordon medical negligence specialist Paula Shelton said her firm was preparing several cases involving allegedly unsuccessful or unnecessary surgery performed by Professor Kossmann at The Alfred. "They are all people who have got significant problems," she said. "There are certainly a couple of them that I think are serious. It's fair to say they relate to poor (surgical) outcomes." For the cases to succeed, the victim must prove at least 5 per cent physical impairment and that the surgery done was poorer than could be reasonably expected at the time. Slater & Gordon is still investigating the cases and expects to obtain the medical records from the hospital and launch action within a few months if independent advice confirms the alleged negligence.

A spokeswoman for Professor Kossmann said the surgeon was not aware of any claims against him and therefore could not comment. Ms Shelton said she was unable to give details of the cases, but The Australian has spoken with one of Professor Kossmann's patients who is not among the existing cases, but is considering joining any action against the hospital.

The patient, who declined to be named, claimed he had complications after Professor Kossmann operated on him in 2004 following a car accident. He claimed he suffered a post-operative infection following the original surgery. "At the time I found him to be very professional and thought the complications which arose both in the short term and long term just came with the territory; however, reading the reports coming out now makes me wonder about that," he said. "About a year or so later, my leg played up again so I went to a doctor to have a look at it and they found deep-vein thrombosis, which he attributed to the original injury ... X-rays showed that a titanium screw placed in my knee ... had snapped during that surgery and had been left there."

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2008-06-24T00:23:00.000+11:30

British doctors dubious about new treatment protocols

Nurses doing surgery?? I think I'd be dubious too

The minister in charge of a review of the NHS has accused some doctors of being “laggards” for obstructing the introduction of new treatments. Lord Darzi, who continues to work as a surgeon, says some senior medical staff are so determined to protect “professional boundaries” that, 14 years after his own practice began using nurses to do minor surgery, others have yet to follow.

He said: “In all areas of healthcare you have innovators, people who really want to change things for the better, and you also have, in other areas of the healthcare system, people who are lagging behind and need to catch up. “They will eventually catch up once they know that, if you start thinking about what really matters to patients, how you can improve the care you provide, you get over all these different obstacles.”

Darzi, who has been in bitter conflict with doctors over the introduction of polyclinics, is backed by Sir Liam Donaldson, the chief medical officer. This weekend, Donaldson accused some surgeons of obstructing changes that would make operations safer because they objected to their “professional autonomy” being eroded. He said: “The culture of medicine has been one of clinical autonomy. Doctors are trained to take decisions, to feel they are in charge, to lead teams. They want to do what they feel is best and anything that suggests that they should standardise their practice in any way is sometimes seen as degrading of their professional ethos.”

Donaldson, who as chairman of the World Health Organisation world alliance for patient safety will this week launch an airline-style danger checklist for surgeons, added that one British doctor told him such checks would reduce consultants to “factory workers”. Donaldson said: “I was talking about a way in which standard operating procedures are used in the airline industry and he said: ‘Well, if you bring that into medicine, we might as well go and work in factories.’ “I think it is a new idea for some traditional people holding traditional attitudes in medicine and I think we need to break those down and get people thinking and learning from other industries.”

Darzi, who will publish his review on the NHS at the end of this month, also says doctors and nurses must treat patients as customers. He says that if patients don’t like the quality of care they are receiving they should go elsewhere. His report will include proposals to routinely invite patients to grade the quality of nursing care they receive during their hospital stay, including how comfortable they were made to feel on the ward and if they were treated in a kind and compassionate manner. Results of these questionnaires will be published so that patients can shop around for the hospital with the most compassionate nursing care.

Darzi, who still practises his keyhole surgery specialism two days a week at St Mary’s Hospital in London, said he recently had a patient who requested a referral to his unit from outside its catchment area. He said more details of the most advanced surgery will be made available to patients as part of his review. This will make it easier for patients to find out where the latest technology is used.

Darzi said: “Have patients been treated as customers? When you go to a restaurant you look at a website and find out exactly what people said about that restaurant. In future I want to show which hospitals, doctors and nurses are actually bringing innovation into their healthcare.” Darzi is to set up a new website featuring all the latest innovations in medicine to encourage hospitals to adopt new treatments more quickly.

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Not again! Another government computer system fails

And a dangerous one: The system for an Australian ambulance service. My local Yellow cabs and Pizza Hut have great computer systems for managing customers and Bill Gates sells programs that are a thousand times more elaborate. What's wrong with the bureaucratic boneheads? Nobody gives a damn. That's what's wrong. The system was "innovative", of course. Governments should only buy tried and tested systems. They bungle anything else

A $6 MILLION computer system crashed within hours of being turned on last week, leaving Emergency Services staff using pen and paper to dispatch ambulances and fire engines. The Queensland Ambulance Service computer-aided dispatch system, known as VisiCAD, went down for six hours on Wednesday and communications centre staff said patient lives were put at risk across the state.

"Once the crash occurred the computers froze . . . Many other dangerous technical difficulties then occurred," a QAS employee told The Sunday Mail yesterday. The informant said that in the chaos and confusion, two patients with non-life-threatening conditions who had requested ambulances were overlooked. "No one died, but it definitely put lives in danger," the employee said.

He said the Queensland Fire and Rescue ESCAD system crashed for 2® hours at the same time. Queensland's Emergency Services has spent millions of dollars in the past decade trying to find a suitable computer-aided dispatch system. Sources said the new model was rushed in without being properly road-tested.

A QAS spokesman played down the system crash. "The Department of Emergency Services is currently implementing one of the nation's most innovative dispatch systems, called VisiCAD," he said. "The new system will link all QFRS and QAS communications centres with a single state-of-the-art computer-aided system." He said the cause of the "outage" of about 90 minutes late on Wednesday was related to a maintenance issue ["maintenance"? How do you maintain a computer program? Do you oil it?], not the system. "There have been no reports of any significant impact on service delivery." The spokesman said senior management was unaware of any evidence to indicate lives were put at risk.

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2008-06-23T00:24:00.001+11:30

Cancer pair win fight with NHS for top-up drugs

Two women suffering from cancer have won legal battles for the right to pay privately for life-prolonging drugs without having their National Health Service treatment withdrawn. Several hospital trusts have also broken ranks to allow dying patients to pay immediately for the additional drugs that their doctors have said they need.

The moves are a sign that the government’s ban on so-called co-payments is beginning to crumble. In the face of a campaign led by The Sunday Times, Alan Johnson, the health secretary, has already announced a review of the policy which is due to report in October.

Melissa Worth, a solicitor at the law firm Halliwells, who is representing eight patients fighting for the right to co-pay, said: “Many more NHS trusts are finding different ways of allowing patients to pay for cancer drugs. “The government has now publicly acknowledged there is a problem and people are realising that what is most important is that patients get the best possible care.”

Andrew Haldenby, director of the think tank Reform, which includes Doctors for Reform, a group of 1,000 doctors campaigning for change, said: “This is a victory for common sense. It has become clear that many doctors have rejected the bureaucratic rules of the NHS to act in the best interests of patients. They deserve praise for looking beyond the guidance to act in a way which shows the true values of medicine. These cases also show the government had to order a review as its position is unsustainable.”

One woman, who took legal action against Weston Area Health NHS Trust in Weston-super-Mare, Somerset, has been told she can pay for Avastin, the bowel and breast cancer drug, in the hospital’s private wing while receiving the remainder of her care on an NHS ward. The trust, which runs Weston General hospital, said: “This patient is having complete treatment on the NHS and has chosen to purchase separate treatment as well. Because the hospital has a unit for private patients on site, it has been agreed that the patient can receive Avastin on that unit.”

Another woman, who has bowel cancer and is taking legal action against the Royal Marsden NHS Foundation Trust in London, has been advised that she will also be able to pay for Avastin without being denied NHS care. The woman’s husband, who does not wish to be named, said the trust had told them it would not object, “provided we were not getting treatment in the private [wing] and on the NHS in the same episode of care, on the same visit. Effectively, we have won the right to pay.” The Royal Marsden has declined to comment on the case.

The Velindre NHS Trust in Cardiff faces a judicial review after refusing to allow a woman to buy a cancer drug.

Nottingham University Hospitals NHS Trust, ABM University NHS Trust in Bridgend and University Hospital Birmingham NHS Foundation Trust are also allowing some of their NHS patients to pay for additional drugs.

Many dying patients are still being denied the chance to spend their savings on cancer drugs, however, because their trust plans to retain the ban until the government review ends. Sue Matthews, 57, a former physiotherapist from Buckinghamshire and the wife of an NHS orthopaedic surgeon, says this could be too late for her. Matthews, a mother of two with bowel cancer, wants to be able to pay for the drugs Avastin or Erbitux without losing her NHS care. She said: “It could all be too late for me. “If the government turned round now and said, ‘We realise it has been happening in other areas of the NHS and we are prepared to accept it now’, that might be of some use to me. But he [Alan Johnson] is just trying to placate people and for those in my position it doesn’t help at all. “Some of these reviews go on for years. I will be dead by then.”

Another cancer patient, Jonathan Chapple, a retired company chairman from Kingston, southwest London, was asked by an NHS trust to pay £55,000 upfront for all of his cancer care when he asked to top up with the drugs that doctors said would give him the best chance. Like Matthews, Chapple, 69, was told by doctors that Avastin or Erbitux, which are not routinely funded by the NHS, were most likely to extend his life. His oncologist at the Royal Marsden told him that he could not continue to receive NHS care while paying for the drugs, however, and he was advised to transfer to the hospital’s private wing. Chapple said: “Having paid all my life for NHS services, to be put in this position feels immoral.” He is now travelling to a private clinic in Germany for treatment.

The Royal Marsden said: “In line with all private providers, we do ask for a deposit upfront and this is judged on the individual patient and their treatment pathway.”

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