Healthcare Update – 04-09-2010


Also see the Satellite Edition of this week’s update over at ER Stories.

Miami Medical — a successor to the “ER” series? This critic says “not”.

Another consideration for infantile seizures in the emergency department … licking the plate after mommy got done cutting up her crack cocaine for sale.

Canadian attorney calls for criminal investigation against emergency department staff after patient death waiting in the emergency department.
In other news, emergency department staff calls for criminal charges against government that won’t provide sufficient emergency department resources.

Georgia passes hospital tax to fund state’s budget shortfall with Medicaid patients. Tax hospitals more so that you can turn around and pay them a little more to take care of Medicaid patients?

How does a physician specializing in palliative care respond when she is diagnosed with terminal breast cancer? The answer might surprise you. Read the compelling story here. Also see the commentary in which the physician’s husband clears up misconceptions in the NY Times article at Buckeye Surgeon’s blog. Even more compelling. She sounded like a wonderful and compassionate lady.

Why was this man standing in a restaurant parking lot punching himself in the face before going to a hospital emergency department? Even more perplexing … he wasn’t drunk. The surgeons fixed the problem – and it wasn’t a laughing matter.

Open pricing and free market will decrease utilization. “We know how much electricity costs us and we know how much our groceries cost, but, as patients, costs of our healthcare remain vague … The complexity of the medical and billing systems have prevented consumers from understanding how best to utilize healthcare options to contain costs.” Researchers surveying 1500 Massachusetts employees determined that patients who were informed about the costs of care tended to use doctors offices more and emergency departments less. “More transparency about costs of healthcare services could help both employees and employers contain their respective expenditures on health services.”
Only fly in the ointment is access to care. How can you decrease emergency department utilization if there aren’t enough primary care providers?

Not guilty? Good. Now lets get out of here. Jury in medical malpractice case reaches verdict in 5 minutes. Plaintiff attorney complains that the quick verdict undermined the plaintiff’s right to a fair trial.

Illinois Supreme Court justices that overturned malpractice reforms now may have a new problem … keeping their jobs. Four of the seven justices are up for retention this year. Sixty percent of voters must choose to retain them or they won’t get their jobs back.

Largest medical malpractice judgment in the history of Tennessee awarded to woman and her husband last week. A jury awarded Bette Donathan and her husband more than $22 million after surgery for the woman’s fractured leg left her partially paralyzed. Medical staff inserted an epidural catheter to help the woman with post-operative pain control. Ms. Donathan was taking blood thinners at the time and the catheter caused a spinal bleed that left her paralyzed from the waist down.
This judgment tops the previous record-setting judgment in Tennessee of $12 million awarded less than 12 months ago.

With costs at 25% of the total state budget and patient loads expected to double in the next 2 years, Florida legislators try to control costs by putting all Medicaid patients into managed care programs. Legislators are considering a program that would pay private companies a set fee for covering all necessary medical services for a set patient population – similar to an HMO.
I give those companies about 6 months until they pull out. If payments to providers are abysmal, then few providers will want to take care of them. What happens when the patients can’t find a primary care physician (or don’t want to wait for a primary care appointment) and just go to the emergency department? The theory of an HMO is that there is a financial penalty if you go out of system or if you go to the emergency department. HMOs aren’t the answer when patients don’t have any financial disincentive to go outside of the system. Costs will just continue to rise.

The $2,374 bandage. Treatment for a cut in an emergency department gets a rather surprising bill. The person receiving the bill wasn’t “freaking out about it” because the insurer paid for it. The comments section to the blog has an interesting discussion about free market system in medicine.


  1. This post has been up for almost an hour and Matt still hasn’t told us that caps don’t work. Is he slipping?

  2. Actually, I found the $2,374 bandage comments discussion more interesting. Although I’m afraid until the providers transition to the free market we’re not going to have any progress.

    I didn’t realize the fact that caps don’t work (other than for insurers) was still an open question. But I’m glad to see that I’ve got some followers.

    • C’mon Matt they also irrigated the wound – clearly worth a couple grand.

      Had something similar the other day – girl came into our ED after a scan at an OSH showed an ovarian mass. Got some basic labs and after a discussion with ob/gyn arrainged for outpatient scans f/u the next week. However she was none too pleased when they gave her a $2,000 bill and wanted to talk to the doctor about it. Unfortunately I had a JCAHO mandated coffee break so I was unavailable for comment.

  3. I have often mentioned the AMA as being the leading voice for physicians, but many of you have told me I was crazy. I ran across this today from another physician and I’m interested to get your take:

    “You can disagree or criticize the AMA all you want — and some of it is warranted. But they’re the most effective lobbying body doctors have today, like it or not. If I’m wrong about that, please let me know who you think is a more visible physician voice today.”

  4. If you want to know who the money behind the tort reform movement really is, you should watch the campaign contributions in that Illinois Supreme Court race.

    You’ll have to go through some levels of PACs and such, but the truth is there. When you see state tort reform associations giving, you can be sure that’s tobacco money. Those associations were set up in the early-mid 90s through tens of millions of tobacco dollars, much of it funneled through Philip K. Howard’s law firm, Covington & Burling. But it’s all about justice for the victim, right?

  5. st vincent’s in manhattan has stopped taking new patients by ambulance this am as the first step to closing their doors. should make the emergency dept experience in the city “interesting.”

  6. That $12 million verdict in Tennessee is really more interesting than just the number. The damages were calculated at $12 million, but the verdict against the physician was only $6.1 million, as the jury only found him 51% at fault:

    There’s not much detail about the damages, but for a 33 year old with a brain injury, even with a decreased life expectancy, I bet the life care plan was the bulk of that award.

  7. Those Illinois supreme court justices are probably staying. Term limits, retirement, or the FBI Party Van are the most common ways to leave big state government offices around here. For further reference see read more about four of our last five former Governors.

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