Healthcare Update — 10-11-2012


Fascinating four-part series about how Dr. Larry Gentilello helped to bring safety measures to Dallas’ Parkland Memorial Hospital and UT Southwestern. In the end he filed a whistleblower lawsuit against the hospital. Then his career suddenly crashed.
On the day that the series was published, the managing editor for the series, Claire St. Amant, received an award for her work reporting a different story. She deserves another award for this series. Well done.

Feds sue Illinois Special Recreation Association because Association refuses to administer rectal Valium to children having seizures.
Of course, if the childrens’ parents later sue the Association for sexual assault or for administering the medication incorrectly, will the DOJ step in and defend the Association?
[crickets] Intramuscular Valium works just as effectively as rectal Valium and its administration isn’t affected by a rectum full of stool. Since when does the ADA require that patients get to dictate how they receive emergency medications?
Hat tip to Walter Olson over at

Because I’m sure that machines full of lettuce leaves and low fat yogurt would be sold out due to high demand, that’s why. Newspaper article wonders why NY hospital has junk food in the emergency department vending machines. And I’d like to check the refrigerators and kitchen pantries of the people who bash the hospital for having such food. I’m sure they’re full of Grape Nuts, rice cakes, and dried fruit.

A trio of absolutely bizarre stories from
– From the “how you know that you’re not an iguana” department.
– Then there’s the douche bandit. I’m not saying anything further.
– Finally is a 34-year-old man … from Florida … who was charged with placing others “in danger of death or bodily injury” after returning used enemas to a store for a refunds.
Now don’t get me wrong – what this guy did is twisted. But I’m trying to follow the logic, here. Stool kills? Is failing to properly wipe down a toilet seat now some type of assault with a deadly weapon? Gives a whole new meaning to calling dog poop “land mines.” Or is it only when the stool is potentially put into another person’s rectum that it becomes a deadly weapon? Dr. Mark Plaster better have a criminal lawyer on retainer after his great story about curing his mother in law’s clostridium difficile infection.
I know, I know. It’s the intent. The difference between using a medication to poison someone and using the same medication to treat someone’s medical condition is all about the intent.The story is still just bizarre, though.

Speaking about EP Monthly articles, here’s another good one about how the Broselow Tape came about. I carry one in my work bag at all times. Wouldn’t it be cool to have one signed by the Dr. Broselow?

New York seeks limits to annual doctor visits under Affordable Care Act.

Massachusetts’ St. Luke’s Hospital looking to have more of its patients die? Hospital CEO Linda Bodenmann stated that the hospital board is not satisfied with the level of patient satisfaction provided in the emergency department. Therefore, the hospital is looking for another emergency department group to take the place of the current group in order to increase satisfaction scores.
The CEO noted that door-to-physician time is substantially slower than neighboring emergency departments (which is often due to understaffing or patient flow issues created by hospital administrators) and that the “care” of the emergency physicians is also “poorer” as determined by the metrics “courtesy,” “information about treatment,” “whether doctors took time to listen to patients,” and whether doctors “showed concern” for patient comfort.
Notice that how under these scoring methods, if you were in a car accident, the doctor could miss the bleeding inside your brain, misdiagnose your fractured neck leaving you paralyzed, misdiagnose your collapsed lung, and kill you with an overdose of morphine, but as long as he was courteous, told you about your treatment, took time to listen to you and showed concern for your comfort, he would receive a perfect score on his patient satisfaction survey.
Remember the study showing how highly satisfied patients are twice as likely to die from their medical care? It’s a good thing that hospital CEOs are putting patient satisfaction first.
Sometimes makes me wonder whether emergency departments should be staffed with butlers and maids instead of doctors and nurses.
Be careful what you wish for. When you value comfort measures over appropriate medical care, that’s exactly what you may get.

Back to patients gone wild … Alabama woman goes berserk on deputies in emergency department, spitting on them, hitting them, kicking one in the face, and making terroristic threats. Have a nice vacation in the Greybar Motel, ma’am.

Des Moines emergency departments jumping on the bandwagon of limiting narcotic prescriptions to emergency department patients. “Our Emergency Department will only provide pain relief options that are safe and appropriate.” Patients may also have to provide ID to get medications and will likely be looked up on the state database for narcotic prescriptions.
Hope the hospitals don’t use patient satisfaction metrics …

25-year-old Texas man dies because emergency room allegedly didn’t test him for West Nile Virus in time.
Of course, reporter Matt Dougherty for neglected to mention that according to the CDC there is no treatment for West Nile Virus, so the patient would most likely have had the exact same outcome regardless of when he was diagnosed.
Good way to inflame the public, though, Matt. I thought Jim Dwyer had moved to Texas for a minute, there.


  1. freshly retired ER doc on

    St. Luke’s claims that a concern for quality is the reason for changing ER groups, but then the story says, “Although Southcoast is eyeing switching St. Luke’s ED provider, this wouldn’t oust the doctors, physician assistants and nurse practitioners themselves. Whichever group is awarded the contract must offer employment to any provider working through St. Luke’s Emergency Associates who wants to remain at St. Luke’s, according to a letter Bodenmann recently wrote to Southcoast medical staff.” That makes no sense, unless they are lying and there is something else going on.

    • Often hospitals will use the threat of replacing a group as a means to get the group to accede to the hospitals’ wishes. In this case, the threat is to either improve satisfaction or your group is gone. Though it doesn’t make much sense that (1) the group staffs three hospitals (and the same docs likely rotate between more than one hospital in the same system) and (2) they wouldn’t just terminate the docs who are allegedly dragging down their satisfaction scores.
      I think it’s just saber rattling.

  2. IM valium cannot be given by a layperson, though, whereas diastat can, in an emergency – there’s no getting it wrong. Tube in, squeeze, done. Only one place to put it and no breakables or sharps involved.

    Buccal midazolam might be a vastly better option than either, and is gaining popularity here in the UK.

  3. Just a thought because I’m genuinely curious… Could it be possible to use a device similar to an Epipen to inject diazepam IM? I’m sure someone else has thought of it before, so is there anything available like that?

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