Healthcare Update 10-17-2009


Myth or no myth? Does a full moon cause more ED visits? I don’t care what the studies say. On nights of a full moon, the freaks are out in full force. Why do you think they call it lunacy?

Suck it up, America! Why are doctors becoming slaves to patient satisfaction scores?

Great discovery request, there Perry Mason. Michael J. Trentalange, a Florida medical malpractice lawyer, requested 75 years of incident reports before having his colonoscopy performed at Florida’s St. Joseph Hospital. He wanted to know “how many people [at the hospital]get perforated colons during colonoscopy” before having his own procedure done. Oh, and by the way, he’s also representing someone who died from sepsis after sustaining a perforated colon.
He didn’t limit his request to just colonoscopies, though. He wanted every single incident report in the hospital. Why? His response: “I could have a family member contemplating another procedure.”
The hospital sued him over his request. More doctors and hospitals need to fight back against BS like this. And people wonder why lawyers get a bad rap.

Phil Howard from Common Good scores an article in the Wall Street Journal about “Why Medical Malpractice is Off Limits” in the health care reform debate. Does it have anything to do with the fact that trial lawyers are “amoung the largest contributors to the Democratic Party”? One interesting quote:

Trial lawyers also suggest they alone are the bulwark against ineffective care, citing a 1999 study by the Institute of Medicine that “over 98,000 people are killed every year by preventable medical errors.” But the same study found that distrust of the justice system contributes to these errors by chilling interaction between doctors and patients. Trials lawyers haven’t reduced the errors. They’ve caused the fear.

We can’t sue our way to better health care.

Another interesting tidbit from the upcoming book “Architects of Ruin” regarding why tort reform isn’t part of health care reform. Several trial lawyers filed a class action suit against Citibank for rejecting a black woman’s loan application. The basis of the suit was that “racial bigotry, not poor credit histories, explained high rejection rates among minorities applying for mortgages.” Four years later, the case settled. The plaintiff received $60,000. The lawyers received $950,000 – more than 15 times as much money as the plaintiff. Among the lawyers receiving those fees was a young gent named Barack H. Obama.

Paging Dr. Scumbag … An emergency department physician steals a Presidential Rolex watch off the wrist of a patient who had just died from a heart attack. Busted by hospital security cameras and fired on the spot. Also indicted by a grand jury for the theft.

Who is at fault? A patient gets sedated for brain surgery and waits on the table for the neurosurgeon … who is out of town attending to an “urgent family situation.” The head of the department refused to do the surgery in his place. Among the things that the hospital and doctors are getting cited by JCAHO for is “the doctors operating did not pause to stop and check that they were operating on the right part of the body.” Was there some transrectal approach to brain surgery that I didn’t learn about?

Insurance doesn’t equal access. Another study out about the Massachusetts “insurance for all” program shows that “unless access to health care improves, many people will continue to treat emergency rooms as a substitute for a primary care doctor” and that “access problems in the community may play a significant role in ED use in Massachusetts.” Sounds like a plan. Let’s replicate this on a national level. Just what we need as more emergency departments close nationwide. Cue grandpa talking to grandson … “Yeah, sonny, I remember back when we only had to wait 9 hours to see a doctor in the emergency department.”

A powerful article in New America Media giving personal examples of how the richest country in the world can’t provide for the care of its citizens. What’s the answer?

Grady Memorial Hospital shuts its free dialysis clinics. Ninety patients in the program have nowhere to go. Many of the patients are illegal immigrants. Now the hospital is trying to ship the patients to other states so that they can get the dialysis they need. Hospitals can only provide free care for so long. A sign of things to come.

That’s why we call them “patients.” Canadian Health Minister Maureen MacDonald encourages people in Dartmouth General Hospital to “be patient” as the government “emergency room adviser” figures out how to solve the apparently recent development of hospital overcrowding. Here’s a hint: Step one is to bring a good book with you … maybe two.

Interesting point on the health care reform debate in Maine’s Kennebec Journal. The US fares poorly in the “quality of care” categories such as infant mortality and life expectancy, but the US does very well in success of medical treatment. Additionally, according to the WHO, the US is ranked highest among all countries in “responsiveness” of health care – how fast patients receive the care they need. Don’t foresee that statistic being favorable much longer.

Today there’s a double feature. Head over to ER Stories to see the Swine Flu version of the HealthCare Update.


  1. “The plaintiff received $60,000. The lawyers received $950,000 – more than 15 times as much money as the plaintiff.”

    This is what happens when you opine about things you don’t know much about. The lawyers will almost always make more than the named plaintiff in a class action. Generally, a class action exists because of a large group of similarly harmed people have damages to small to pursue individually, but as a group they are significant.

    For example, physicians have filed class action lawsuits like this: and many similar ones against health insurers and HMOs. Their lawyers will handle a case involving millions of records, tens if not hundreds of thousands of physician plaintiffs, and thousands of thousands of hours of work against a very well funded defendant.

    Now, any individual physicians claim will not be anywhere near what the lawyers will get paid, which makes sense, because each individual physicians’ harm is not that large. But because they can file a class action, and because they probably couldn’t afford the fight on their own and it wouldn’t be worth it cost wise to battle individually, the class action serves a valuable purpose. And the lawyers will make a LOT more money, probably based on the TOTAL recovery, not just one individual class member.

    But hey, if you physicians want to make it harder to pay your own lawyers but not the other side, or limit how much you can recover, be my guest.

    • Matt:

      I pulled up the case. If you follow the links it gives the original case docket which you can use to further look it up. There were three plaintiffs, they got in total 60K, the attorneys over $950,000.

    • Throck, I couldn’t get the links to take me there. I am betting those are the named plaintiffs, not the whole class. A class action of three people would never get certified as a class. If you look at the physicians class action I linked I bet there are just a few named plaintiffs but thousands of class members.

    • Keep in mind: 100% of those attorney’s fees were due to the defendant, which first discriminated against the plaintiff and second refused to settle it.

      It’s Obama’s fault that it took four years of bruising litigation to get the bank to admit it discriminated against the plaintiff and compensate her? Please.

  2. “Phil Howard from Common Good scores an article in the Wall Street Journal.”

    You mean the WSJ lets a major lobbying firm for corporate interests, particularly the tobacco industry, have some column space? Shocking! And the author is appalled that money plays a factor in politics, when his firm was responsible for funneling millions of tobacco dollars to create phony tobacco studies for lobbying purposes and state tort reform groups? Really? I’m sure he is terribly offended by even the suggestion of corporate interests being subject to the judgment of the common man.

    BTW, Has anyone ever suggested we can sue our way to better health care? Is there a single malpractice case with the stated goal of “improving healthcare”? What a weak strawman.

    • Unnecessary care probably does drive up costs to some extent, though eliminating it is unlikely to suddenly make health care a much smaller component of GDP. Though annoying to you folks, lame ER visits simply aren’t that big a component of health care costs.

      The bigger problem with his argument is that it is, in essence, a plea for health care rationing, which seems to be the worst fear of most physicians.

      So, should we ration care or not?

      • Any time that you tell a patient “no” or that outside forces make a test or treatment undesirable for a patient, care has been rationed.
        We already are rationing care. The only thing that will change is how the care is rationed.
        I have always been an advocate of free market medicine. I’m happy to see patients for whatever complaints they have. The problem (to borrow Happy Hospitalist’s maxim) is that “FREE = MORE”. You can’t apply free market rules if federal law forces you to provide your product at little or no cost. When half (or more) of your patients pay you 10% or less of your charges for providing care, the business model becomes unsustainable.
        Goes back to my ELRALA post.
        Rationing is occurring and will continue to occur. Just a matter of what type of rationing we will accept. Time rationed? You can’t have your surgery for another 18 months. You can’t see an endocrinologist for 10 months. Quality rationed? You have to go through 6 months of therapy before you get an MRI of your neck. Cost rationed? Insurance will only pay for a generic version of the medication you need – if you still want the medicine your doctor prescribed, it will cost you $400/month.
        If we want to remain a bunch of cigarette-smoking, drunk driving, drug using, X-Box addicted, overeating lard-butted couch potatoes who then complain because no one can give us a pill to make everything better, we’re going to see the whole landscape change.
        Look at how few graduating physicians are willing to go into primary care medicine. Government overregulation has made the specialty increasingly undesirable.
        Quality care will soon be rationed by availability regardless of the price people are willing to pay. In some regions of the US, you can’t find a doctor to take care of you.
        Some day people will stop viewing medical care as a commodity.

      • So what are you physicians, the ones on the front lines who will be affected the most, doing to change the future you describe, and presumably do not want?

      • And when do you think physicians will stop viewing medicine as a commodity and start pricing their own services accordingly?

      • Your business model isn’t viable under free-market medicine. Chop out Medicare, Medicaid, and government subsidies and your hospital and ED need to cut back drastically, probably to the point that they can’t continue 24-hour coverage, particularly not for specialized services like trauma.

        IMHO, that’s uncivilized. Civilized nations provide emergency care to every citizen who needs it.

        But that’s beside the point: more importantly, whatever the merits of free-market rationing, it’s incompatible with the will of the voters. They want health care to be more accessible. They don’t want health care to be rationed the same way that Prada shoes are rationed.

        As such, you need to tangle with the reality that “free market medicine” won’t be a reality.

        In that reality, what kind of rationing do you propose? The author of that article suggests rationing unnecessary ED care; that’s all well and good, but it won’t make much of dent on the GDP, making it a cute, but meaningless, gesture.

  3. “Was there some transrectal approach to brain surgery that I didn’t learn about?”

    For some patients, I imagine that’s the quickest way to get to the target.

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  5. I think the full moon theory is *true*. I really do. I’ve seen it in the ED.

    It would be interesting to do a little study tho.. you know.. stats on volume and patient complaints/nature of visits.

    Also on all emergency services used (police, paramedics, etc)

    Might work better in a small community hospital. I’ve never worked in a city hospital but can imagine every night being a full night in those.

    Or … are full moon nights even worse in a city hospital?

  6. Regarding too many people showing up at the ED rather than taking 2 asprin and calling their GP in the morning.

    I know half the problem in the US is people without insurance or their insurance doesn’t cover whatever. But the other half is that people just plain don’t know what is safe to leave for a day, and what they should come in NOW for. I went to the ED for an earache recently (only waited there 3 hours or so before getting seen). Now that might sound minor, but it was quite swollen and I had no idea if it was going to get worse and I panicked that I was going to lose my hearing and it was the middle of the night and I couldn’t sleep because of the pain and I didn’t want to take painkillers because pain is the body’s way of telling you something is wrong and I wanted to be able to tell if it got worse and ahhhh.

    Normally I’m a sensible, rational person. But in the middle of the night and in pain? I know now that I should have taken some painkillers and seen my GP in the morning. Perhaps ED doctors could say “you didn’t need to come here” if it’s true. Like the nurse told the girl that came in with cramped legs being carried by a group of her friends!

    • Keep in mind that if earaches lasting a couple hours IN THE MIDDLE OF THE NIGHT!!! routinely CAUSED permanent hearing loss, earaches would be considered a “rush you back immediately” diagnosis, and the ER would be overrun with not only people with colds seeking swine flu treatment, but earacheurs too. There would be ENTs in every ER performing lifesaving earache treatment to preserve hearing.

      If anyone else says, “I didn’t want to mask my pain with over-the-counter painkillers; I just decided to come here instead [for a $700 ibuprofen]!”, I’m going to scream.

      Here’s a handy tip: If your pain is severe enough to warrant an ER visit, a couple Tylenol or ibuprofen is going to help a little, but not enough to “mask” the pain. People with appendicitis and ruptured aneurysms don’t “mask” their pain with Tylenol.

      Keep in mind that every clinic has someone on call 24 hrs a day and many insurance companies have a nurse line open 24 hours.

    • Actually there was a recent study (I think Whitecoat may have posted it) that looked at what happened to ED volumes once everyone was insured in Massachusetts. Despite having insurance more people went, not less, and the numbers were made up of more ‘minor care’ cases. I can tell you from my own experience in a pediatric ED, almost every kid I see has a primary care doc (they are covered for check ups and shots under sCHIP), yet they still show up for stupid stuff.

      Did you call your GP prior to going to the ED? I wonder if he would have told you to come in. Many outpatient docs (or their on call nursing service) just refer to the ED due to legal concerns (i.e. missing something serious that doesn’t sound serious in the middle of the night because you can’t see the patient).

      Either way, a quick visit for something like ‘ear pain’ is relatively easy to sort out, as long as the patient is reasonable; they aren’t the main culprits for backups (though it’s a waste of money. Would you have gone if you had had to pay $10 out of your own pocket?). It’s the ones who demand ‘blood tests’ for that fever which started an hour ago and the ones who demand CT scans ‘right now’ that clog the system and drive up expenses.

      • You don’t think the minimum charge of $500 or so for an ER visit drives up costs? Anything where you’re in an unnecessarily acute setting for a minor problem or get unnecessary testing drives up costs needlessly. Silly.

      • Nurse K, yes I do. Specifically I said “it’s a waste of money” but I think it’s a drop in the bucket compared to the big money losers such as trauma (especially if drugs alcohol is involved and insurance refuses to pay) and the actually sick people who can’t/don’t pay. Actually I suspect we’d lose some money if we kicked out all the minor complaints and didn’t see them at all (presuming they had insurance).

  7. Maybe the issue is not that people go to the ED for silly stuff, but that the GP’s office hourse are 9 AM to 4:30 PM. If I want to go see a GP, I have to take half the day off work. Thank God I’m in a profession where I can do that, but what about someone who works the day shift at McDonald’s?

    I really doubt that people are going to the ED just to hang out. They’re going there because THEY DON’T HAVE ANOTHER TREATMENT OPTION. Why don’t hospitals have a “non-emergency 24-hour outpatient clinic”?

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