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31 August, 2006

CANADIAN REBELLION SPREADS

A doctor who operates Canada's largest private hospital in violation of Canadian law was elected Tuesday to become president of the Canadian Medical Association. The move gives an influential platform to a prominent advocate of increasing privatization of Canada's troubled taxpayer-financed medical system. The new president-elect, Dr. Brian Day, has openly run his private hospital in Vancouver even though it accepts money from patients for procedures that are available through the public system, which is illegal.

Dr. Day, who will assume the presidency in August next year, advocates a hybrid health care system similar to those in many European countries. Opponents argue that a fee-charging private component would divert resources from public health and lead to a lack of access to medical treatment for many lower-income citizens.

But opposition to private health care has diminished in Canada, in part because waiting times have more than doubled for certain procedures during the last 13 years, according to the Fraser Institute, a conservative research group. Debate has been especially heated since a ruling by the Supreme Court in June 2005 gave residents of Quebec the right to pursue private treatment if the province could not provide services in a reasonable time.

Since then, Quebec's premier and the leaders of British Columbia and Alberta have expressed a willingness to consider solutions that include privately paid medical services, in part because of the court decision but also because of the rising cost of providing free health care. On average, provinces spend nearly 45 percent of their budgets on health care. In the meantime, private health clinics are opening at an average rate of one a week in Canada.

"The Canadian health system is at a point in history right now where it's going to be reformed in the wake of the Supreme Court decision," Dr. Day said Tuesday in a telephone interview. "The concept that the status quo is something that we should maintain is wearing thin, with frustrated doctors and frustrated patients."

Since its formation in the 1960's, Canada's publicly financed health insurance system has been at the core of the national identity. But in recent years, with waiting times growing and costs skyrocketing, the merits of a larger private component to the health care system has not been the taboo topic it once was.

Experts say there is no better example of that evolution than the election of Dr. Day to head the organization that represents Canada's 62,000 doctors. "There has been a change in what is feasible and what is permissible in public debates," said Antonia Maioni, a McGill University political scientist who specializes in health care. "Five years ago someone like Brian Day would never have been elected president of the Canadian Medical Association. Five or 10 years ago there was much more of a consensus about the sustainability of the public system."

Source



CALIFORNIA CAREERING INTO TROUBLE

The Democratic-controlled Legislature is on the verge of sending Gov. Arnold Schwarzenegger a bill that would create a state-run universal health care system, testing him on an issue that voters rate as one of their top concerns in this election year. On a largely party-line 43-30 vote, the Assembly approved a bill by state Sen. Sheila Kuehl, D-Santa Monica, that would eliminate private medical insurance plans and establish a statewide health insurance system that would provide coverage to all Californians. The state Senate has already approved the plan once and is expected this week to approve changes that the Assembly made to the bill.

Schwarzenegger has said he opposes a single-payer plan like the one Kuehl's bill would create, but the governor has not offered his own alternatives for fixing the state's health care system. As many as 7 million people are uninsured in the state, and spiraling costs have put pressure on business and consumers. "We know the health care in place today is teetering on collapse," said Assembly Speaker Fabian Núñez, D-Los Angeles. "We need to do something to improve it, to reform it, and this is what we are bringing to the table."

Schwarzenegger's office said it had no official position on the bill. The governor has said he would propose solutions to the state's health care crisis in his State of the State address next January if he is re-elected. "I don't believe that government should be getting in there and should start running a health care system that is kind of done and worked on by government," Schwarzenegger said in July at a speech at the Commonwealth Club. "I think that what we should do is be a facilitator, to make the health care costs come down. The sad story in America is that our health care costs are too high, that everyone cannot afford health care."

The governor hosted a health care summit earlier this year, but no concrete proposals came from the meeting. If he vetoes SB840, the governor will be reminded of his decision come election day in November, Kuehl said. "I hope that the people of California will hang the albatross of bad health care around the governor's neck," she said. Nunez said that while the governor has worked with Democrats on many issues this year, he is on the wrong side of this one. "The biggest issue facing California today is health care," Nunez said. "This legislation represents yet another and the most important opportunity we have to say to the governor that he needs to embrace the Democratic agenda, just as he has done on prescription drugs and minimum wage."

Labor unions and Democrats will take part in a rally on Wednesday to urge Schwarzenegger to sign the bill. Democratic gubernatorial candidate Phil Angelides is not supporting the Kuehl bill. "He supports moving toward universal health care by first covering all children and then requiring businesses to cover their employees," said Angelides spokesman Nick Pappas.

Kuehl called the passage of the bill historic because it was the first time both houses of the Legislature have passed a universal health care bill. SB840 must return to the Senate, which approved it once, 25-13, for concurrence before going to Schwarzenegger's desk. "Every advance you can make for any cause is important," Kuehl said. "Most important, it gives hope for the people of California that this can be done." SB840 would provide comprehensive medical, dental, vision, hospitalization and prescription drug coverage to every California resident. Anyone could see any doctor or go to any hospital. "SB840 creates a system of comprehensive health insurance benefits for all Californians that guarantees free choice of doctors and hospitals," Kuehl said. "It creates access for all Californians by steeply reducing administrative overhead and emphasizing preventative and primary care instead of endlessly cutting coverage and access to care or increasing consumer spending."

Republicans and insurance groups oppose the bill, saying it will create an inefficient government bureaucracy. "This takes us in the wrong direction," said Assemblyman Greg Aghazarian, R-Stockton. "This creates a government-run system akin to the Department of Motor Vehicles. Do we want health care taken care of by another bloated bureaucracy?"

The bill does not account for the costs of the program since it would take several years before any plan was up and running. The plan would create a commissioner and a blue-ribbon commission to examine how the structure would work. An analysis by the Lewin Group, an independent health care consulting firm, said the plan could be paid for with all of the money now being spent on health care. That would mean combining all state and federal funds, along with business contributions and participant payments and co-payments. The report suggests that funding could come through an 8 percent payroll tax and a 3 percent individual income tax.

SB840 allows California to use its purchasing power to negotiate bulk rates for prescription drugs and durable medical equipment, such as wheelchairs, thus realizing an additional $2 billion in savings, Kuehl's office said. But eliminating health care insurance plans would eradicate the groups that have the most experience with getting people insured and to doctors, said Chris Ohman, president and CEO of the California Association of Health Plans. Ohman said other places that are trying universal health care -- such as Massachusetts and San Francisco -- are using health care plans to help facilitate the implementation. He said the insurance companies are in the best position to manage costs. "If there isn't the focus and drive for advancing preventative programs, the sky's the limit in terms of what the costs will be," he said. "That's what health plans do."

A Public Policy Institute poll from September 2004 showed that 71 percent of likely voters said they are at least somewhat concerned about being able to afford health care. A slim majority of Californians, 53 percent, said they would be willing to pay more -- either through higher health insurance premiums or higher taxes -- to increase the number of people who have health insurance.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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30 August, 2006

The California threat to drug research

Last November, 61 percent of California voters decisively defeated Proposition 79, which would have forced drug companies to give discounts to poor and middle-income residents. At the time, Gov. Arnold Schwarzenegger vigorously opposed the measure.

So, it may come as a surprise that -- just nine months after it was roasted in the polls -- Arnie is now serving up the same legislative turkey he helped send back to the kitchen. The new measure is just like Proposition 79, in that it calls upon drug manufacturers to offer huge discounts on prescription medications -- up to 40 percent on brand-name drugs and a whopping 60 percent on generics. Specifically, the discounted drugs would be available to uninsured Californians with incomes less than $29,400 -- or about $60,000 for a family of four. Certain Californians -- such as a family earning less than $70,626 -- with significant un-reimbursed medical expenses would also qualify. Schwarzenegger is touting his plan as "voluntary" -- the implication being that drug companies should offer these discounts out of the goodness of their hearts. But in fact, it's the same old ham-fisted attempt to impose price controls.

Drug companies that don't "voluntarily" sell at government-imposed discounts will be bludgeoned into submission. They'll have just three years to comply, after which they'll be kicked out of selling drug to Medi-Cal, the $2 billion health-coverage system for low-income Californians. Imposing price controls on prescription drugs has always been a terrible idea. That's because, unlike our politicians, economic gravity does not reverse direction in an election year.

Perhaps Schwarzenegger could use a quick refresher course in why he opposed a price-control plan the first time. For starters, most drug companies already have programs offering discounted -- or even free -- medicines for those in need. Schwarzenegger might argue that beneficiaries of these existing discount programs must apply individually with every pharmaceutical company whose drugs they require. But that's because drug companies aren't legally allowed to combine their individual plans into one simple-to-join program. Anti-trust laws prohibit them from doing so. That's right: It's illegal for private companies to work together to set prices -- even discount prices for poor people.

Schwarzenegger's plan might make sense if government price controls worked. But they almost always have the exact opposite of their intended effect. In this case, pharmaceutical companies would need to compensate for the forced discounts by raising prices on those people who don't qualify. A family of four with a household income of $72,000 and a child with cancer might see its drug bills increase to offset discounts on hyperactivity medicines available to a family making $70,000.

Over the long term, Schwarzenegger's price controls would have an even more perverse effect. They would lead to fewer new medicines, particularly if other states follow California's example. Today, it costs between $800 million and $1 billion to bring a new drug to market. Cancer patients have hope precisely because companies are willing to risk that money in developing drugs such as Avastin, Erbitux, Gleevec, Herceptin, Nexavar, Sutent and many others.

Ironically, if Schwarzenegger's plan had been implemented across the country 25 years ago, very few of these drugs would have been invented. There would be no life-saving medicines to discount.

If state governments make breakthrough drugs unprofitable, companies will simply stop trying to invent them. Researchers at the University of Connecticut's Center for Healthcare and Insurance Studies found that, since 1960, government interference in drug pricing resulted in $188 billion in lost spending on research and development. The "lost" medicines that might have been developed with that money would allow more people to have lived longer.

Once upon a time, the governor understood this: "I adamantly oppose efforts to impose price controls on prescription drugs because they will have a chilling effect on the research and development of life-saving medicines." Except in an election year.

Source



Criminal doctors OK by the "regulators"

It was a brutal crime, committed by a drug addict with a long history of erratic behaviour. The accused had already lost several jobs as a result of his drug addiction, and he was allegedly becoming increasingly violent. On November 3, 2000, the Queensland man dragged a woman into a bedroom, bashing her as she screamed and attempted to escape. He forcibly removed her clothes and raped her. In 2002 he pleaded guilty to rape, deprivation of liberty and assault and was sentenced to five years' jail.

However, the case stands apart from other cases of sexual assault because the rapist is a doctor, and last month the Medical Board of Queensland renewed his registration. James Samuel Manwaring had previously been struck off the register in the mid-1990s after a psychiatric evaluation found "he constitutes a significant danger to any patient he may have to look after".

However, Manwaring is not the only doctor in Australia with a criminal conviction. Two weeks ago, another Queensland doctor had his registration cancelled after it was revealed he failed to disclose a previous rape conviction. In 1981 Eugene Sherry and two other doctors were convicted of raping a nurse in the US. Sherry was imprisoned for six months and moved to Australia in 1984, and worked in Sydney for 20 years. His 2004 application to work in Queensland was approved under a process that allows doctors to be mutually registered in other states. Sherry disclosed the conviction to the NSW Medical Board, but when he moved to Queensland the NSW board did not inform its Queensland counterpart, and nor did he.

The cases illustrate weaknesses in Australia's fragmented medical registration system and raise the question: should doctors convicted of sexual assault be allowed to practise? In many instances, medical boards allow doctors found guilty of sexual assault to continue to practise if they are closely supervised, or a "chaperone" is present during consultations.

The NSW Medical Board decided last year that a cosmetic surgeon charged with aggravated sexual assault on a patient could continue to practise as long as a nurse was present when he examined female patients. However, Joanna Flynn, president of the Australian Medical Council - which assesses overseas-trained doctors and accredits medical colleges - told The Australian that doctors who cannot be trusted to treat patients unsupervised should be struck off the register. Flynn, who also is president of the Medical Practitioners Board of Victoria, says "if a determining body believes it is necessary to have a doctor chaperoned because they are not confident the patient would be safe, in my view that doctor should not be registered. "Patients must be able to trust their doctor. They may want to question the doctor on medical information, but they need to be able to trust they won't be mistreated by the doctor."

The Australian Medical Association's Queensland president Zelle Hodge says the idea of supervising doctors with a criminal past is fine in theory, but almost impossible to implement. She says medical boards and organisations that employ medical staff don't have the time to consistently monitor doctors. "The medical boards simply do not have the resources to go out and police these restrictions," Hodge says. "It's up to the doctor's employer to monitor the doctor's performance and make sure they are supervised, and sometimes that doesn't happen."

In a case currently before the Medical Practitioners Board of Victoria, a GP is facing suspension for a second time over allegations he conducted a pap smear that was more "sexual than medical", while making sexually suggestive comments to the patient. The GP, Richard George Young, had his licence suspended for 15 months in 2001 after engaging in sexual relationships with two vulnerable female patients. His licence was renewed on the condition a chaperone be present when he examined female patients.

NSW Medical Board chief executive Andrew Dix defended the use of chaperones to monitor doctors who had committed serious offences. But he admitted the system did not guarantee the doctor would not re-offend. "We have a comprehensive chaperoning protocol which requires the regular submission of the chaperone's reports to the board," he said. "But if doctors are determined to be dishonest, some will manage to get away with things." Dix says it's a balancing act to ensure the patient's right to the best possible care and the right of doctors to be given the opportunity to rehabilitate themselves. He says each case is assessed individually and there are no offences that automatically lead to a doctor being struck off the register. "There are doctors who have been struck off a long time ago who periodically apply for restoration who are denied. "But historically the system has been based on the idea that people are able to redeem their character. And there are no black and white rules about what constitutes good character."

However, some argue that while doctors may have the right to a second chance, the public has a right to know if their doctor has a criminal record, or restrictions placed on their registration. Merilyn Walton, an associate professor of ethical practice at the University of Sydney's school of medicine, says patients should be notified if their doctor has been disciplined by a medical board. "Doctors should be required to put a notice in their waiting room saying they are supposed to be supervised," she says. "If I was a patient of that doctor, I would want to know."

Flynn believes all the details of a doctor's registration should be easily assessable to the public. However, Australia does not have a national medical register. Rather, each state has its own slightly different system of assessing and registering medical staff. In April 2004 all the state health ministers announced that a nationally consistent medical registration system, called the Australian Index of Medical Practitioners, would be introduced. The ministers agreed the new model should provide greater public access to medical register information, including an online index of medical practitioners. Two years later the states still operate independently and there's been little progress in improving public access to medical board information. Currently only the medical boards in Queensland, South Australia and the ACT have websites that provide detailed information about doctors' registration.

Walton says most medical boards have failed to inform patients about the medical registration process. "The big challenge for medical boards is to improve the level of transparency of their processes so the community understands how and why they make decisions. The public need to be engaged in the discussion about what standards they want."

The failings of the state-by-state system were highlighted in March this year, when it was revealed that the Hunter New England Area Health Service in NSW waited almost 18 months before investigating an overseas-trained doctor banned elsewhere in the state for misdiagnosing 208 patients in 2004. Farid Zaer, a pathologist trained in India and the US, was banned by the Illawarra Area Health Service in April 2004 after a review of 6300 patient records found he had failed to correctly analyse tests for many diseases, including cancer. In late 2004 it notified the Hunter New England Area Health Service, where the doctor had worked between 1999 and 2001, that it was investigating him. The Hunter service did not begin to review the records of 7300 patients diagnosed by Zaer until March this year.

The doctor has since moved to Queensland, where he is registered to practise unsupervised as a GP and as a pathologist under strict supervision. The case again prompted calls for the establishment of an Australian index of medical practitioners that would record whether doctors have been disciplined by any of the state medical boards, or had any restrictions placed on their practice.

Walton believes the mutual recognition process allows doctors of questionable character or ability to move interstate and continue to practise. "We have mutual recognition, but it caters to the lowest common denominator," she says. "So if one state is weak around disciplinary matters, then that person can be registered in other states based on a weak disciplinary structure. There is also a lack of exchange between regulatory boards and the community. I can't believe we don't have a national registration system yet."

In July, the Council of Australian Governments meeting announced medical boards would be abolished and replaced with a single national registration scheme covering nine health professional groups. For the plan to proceed, each state and territory would have to introduce legislation. The proposal overrides the Australian Medical Council's plan to revamp the existing medical board registration system. The AMC had wanted to give every doctor an identifying number that would allow their details to be accessed through a national register.

Flynn says she is unclear about the details of the proposed specialist registers and what impact they would have on the AMC's plan. Whatever plan is eventually implemented, she is adamant that it must give patients better access to doctors' details. "The public has a right to know if there are conditions on a doctor's registration or if there have been serious disciplinary or criminal offences proven against the doctor," Flynn says. "It's long overdue."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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29 August, 2006

ANOTHER LIFESAVING DRUG DENIED TO NHS PATIENTS

Three women who met as cancer patients are planning a joint legal action to win access to Velcade, a drug for treating multiple myeloma. The "Velcade Three" - Jacky Pickles, Janice Wrigglesworth and Marie Morton, from Keighley in West Yorkshire - are among hundreds who will be denied access to the drug if the National Institute for Health and Clinical Excellence (NICE) sticks to its ruling that it is not cost-effective. Velcade is the first new treatment for multiple myeloma in more than ten years and has been licensed for more than two years for patients who have relapsed.

The drug is available in Scotland, Wales and Northern Ireland and throughout the rest of Europe. Health insurers such as BUPA and PPP pay for it because they believe that it is effective. But primary care trusts in England take their cue from NICE, whose appraisal committee will hold its final meeting next week. Its consultation document, published last month, shocked specialists in the disease.

The International Myeloma Foundation said that the ruling was "ill-informed, unjust and unfair". Eric Low, the chief executive of the British branch, said at the time: "This is an extremely disappointing decision that has sent shockwaves through the myeloma community. Failure to have this preliminary recommendation overturned would represent a catastrophic blow."

Mrs Pickles, 44, said yesterday: "We're waiting for the final guidance from NICE. Hopefully it will change its mind. But if it doesn't, we're going to look to legal action. "We're going to go as far as we can, for each other's lives and for every other myeloma sufferer. Velcade is the best thing for myeloma for four decades. Mrs Pickles, a midwifery sister at Bradford Royal Infirmary, had the disease diagnosed five years ago and has undergone chemotherapy, a bone marrow transplant and a course of thalidomide, the drug that caused birth defects in the 1960s but which has been reborn as a myeloma treatment. All worked for a while before her condition worsened again. Last October she was put on a trial of Velcade, which costs 18,000 pounds for the full eight cycles, and was restored to normal. "That trial did well for me, but I could need the drug again at a later stage," she said. She met Mrs Wrigglesworth, 59, and Mrs Morton, 57, while having treatment and they are giving each other support. "We're in this together," Mrs Pickles said.

The NICE analysis found that the claims made by the drug's manufacturer, Janssen-Cilag Ltd, were not justified by the evidence. One trial showed a 41 per cent reduced risk of death in the first year of treatment. But the NICE view was that the benefits did not meet criteria set for NHS prescription.

Source



Now it's a radiology scandal in Queensland public hospitals

Peter Beattie's major health promise of the election campaign - a new $700 million children's hospital - has been marred by a fresh scandal affecting thousands of patients. Mr Beattie yesterday said a re-elected Labor Government would build a new 400-bed children's hospital next to the existing Mater Children's, with most of the services now offered by the Royal Children's Hospital to move to the new facility from 2011.

But the announcement has been overshadowed by news that a prominent doctor who starred in Government advertising on plans to fix Queensland's ailing health system has now turned whistleblower, exposing deep flaws in the state's radiology services. Royal Australian College of Radiologists president Liz Kenny has revealed thousands of X-rays, ultrasounds, MRI and CT scans ordered for public hospital patients are never seen or assessed by a radiologist. Dr Kenny, who works for Queensland Health, has told The Courier-Mail that critical radiology workforce shortages mean thousands of X-ray results are only seen by GPs, most of whom are untrained at assessing and diagnosing the results. The situation means patients are at risk of having conditions, such as cancers, tumours or fractures left undiagnosed.

The revelations about the state of the hospital system threatens to derail Labor's so-far trouble-free election campaign. Coalition health spokesman Bruce Flegg said the situation was putting lives at risk. "With these sorts of numbers going through you are going to miss things that cost people their lives," he said.

Health Minister Stephen Robertson said there was an international shortage of specialists, especially radiologists. "But through the $1 billion worth of salary improvements, Queensland is now competitive in the recruitment market for radiologists and Queensland Health is working to fill vacant positions," he said.

Dr Kenny said about 500,000 scans were "unreported" at any one time and the extent of those never seen by radiologists only became evident in the past three months. "The magnitude of what is unreported is staggering." Dr Kenny said patients whose scans are not seen by a radiologist did not benefit from their expertise. "It leaves a substantial hole in the management of the patients," she said. Official hospital figures obtained by the Coalition reveal the problem is widespread in both urban and regional areas.

Toowoomba Hospital is the worst in the state with 80 per cent of x-rays and other scans never reported on by a radiologist. Other hospitals which have significant numbers of unreported scans include Gold Coast (56 per cent), Hervey Bay (66 per cent), Royal Brisbane Womans Hospital (49 per cent), Townsville (35 per cent) and Warwick (50 per cent).

A recent survey of 270 Queensland Health radiographers also found 63 per cent plan to resign within six months, a move likely to cause a blowout in waiting times for routine X-rays by Christmas. "With the staffing levels already under pressure, this reduction in professional numbers will result in significant cutbacks in all services, such as x-rays, breast screening and diagnostic imaging for cancer at the majority of Queensland public hospitals," he said. One radiographer said: "We just don't have the people to help all those trapped on the waiting lists."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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28 August, 2006

NHS: NOW IT'S OBSTETRICS THAT GRIEVOUSLY DAMAGES THE BABIES

More than 300 babies a year are being left with brain damage because of oxygen starvation caused by lack of proper care at birth. The National Health Service litigation authority, which handles damages claims from hospital patients, has for the first time released data from every hospital in England showing the number of babies damaged by botched deliveries. The accidents are being blamed on staff shortages leading to inadequate monitoring.

In the 12 months to April more than 300 families began legal action for severe injuries suffered by their babies. In most cases the damage means children are unable to walk, talk, feed themselves or have any hope of independent life. In the same period medical staff reported a further 174 incidents through a system to help budget for legal claims.

Legal costs and damages for victims reached a high of nearly 175m pounds in the last financial year, but the real costs are said to be much higher because special education, nursing care, continuing health problems and social services are not included. In the five years covered by the data there were 2,763 claims. Of the total, 6%-10% are estimated to be from mothers whose reproductive organs were damaged. Another small group relates to failures to diagnose conditions such as Down's syndrome. Most are children whose brain damage was caused because hospital staff did not deliver them fast enough when the babies were suffering oxygen deprivation.

The figures, released under the Freedom of Information Act, come days after a report condemned childbirth services at Northwick Park hospital near Harrow, northwest London, for failures that led to 10 new mothers dying between 2002 and 2005. The new figures show the Northwick tragedies are not an isolated problem.

Jane Rodrigues, 34, from Dartford, Kent, blames the damage suffered by her two-year-old son Louis on the fact that midwives had failed to recognise that her 4ft 10in frame would have difficulty delivering the 10lb baby she was about to produce. She almost bled to death when her uterus ruptured. Her baby was classed as stillborn but was resuscitated.

He has been left mentally handicapped, unable to walk or talk. "I am sad and angry for him," she said. "He is going to be dependent on other people for the rest of his life." She is pursuing a complaint against Darent Valley hospital in Dartford. The trust has apologised but denies liability.

The cost of such accidents is exemplified by cases such as that of Nathan Hughes. In May he was finally awarded 1.65m pounds, plus 315,000 pounds a year for life, to pay for his needs because the medical team delivering him 14 years ago at Rush Green hospital, northeast London, failed to notice he was being strangled by his umbilical cord. "These disasters happen again and again," said Eve, his mother. "I found out later that the hospital where he was born was known by doctors as the `spastics factory' because of the number of birth injuries."

Others believe the real number of children affected is even higher than the statistics show. "I have certainly met people with damaged babies who have said they don't have the strength to take on the NHS," said Karita Massara, whose son Jack, 9, was awarded 850,000 pounds this year for injuries suffered during a botched delivery at the Chelsea and Westminster hospital, London. "When you are looking after a disabled child, it is physically and emotionally exhausting."

Scope, the charity that works for cerebral palsy sufferers, estimates that up to 13,000 people or 10% of Britons affected by this form of brain damage suffered avoidable birth trauma.

More here



Australia: Underqualified nurses recruited by a desperate government hospital



Hundreds of British nurses due to start work in Queensland hospitals as soon as October may be not be up to scratch by standards here.

In a massive recruitment drive, executives from Cairns Base Hospital are scouring Britain for nurses, offering thousands of dollars in relocation assistance. And they say they'll take on anyone who applies. "There's no way I'll be turning anyone away," Cairns Base Hospital nursing director Glynda Summers said.

However, a former Cairns Base nurse who now works in the UK said British nursing standards were not a patch on those practised in Australian hospitals. She said many of the British nurses would not have had the same basic training. Skills such as intravenous drug administration, catheterisation and the use of cardiographs were standard requirements for Australian nurses, but in Britain they were considered extra qualifications. "Most of them won't have that training. Basically, skill levels are much lower," she said.

The nurse said she believed many of the workers entering Queensland hospitals would be those deemed not good enough for the British National Health Service. "Many new recruits may fall short of the proficiency mark," said the nurse, 40, who did not wish to be named. "The British National Health Service has drastically reduced the number of nursing positions, but it would be fair to say any good practitioner who wanted to remain working in the UK wouldn't have a problem. "There will be a few who want a lifestyle change, but what about the others?"

After placing advertisements in the UK press, Ms Summers leaves for Britain tomorrow with nurse manager Denise Wilds and intensive care nurse Carol Martheze on a three-week recruitment campaign. "We'll take them all. The opportunities are limitless because we're recruiting for the state," Ms Summers said. A Cairns Base Hospital statement said more than 180 applications had already been received. The hospital has 51 nursing vacancies and a further 90 nursing jobs expected to open up soon. Telephone interviews have been conducted and new recruits had been enticed with packages including $3000 toward relocation costs, visa application expenses, salaries of up to $53,000 and free medical cover.

Admitting she was capitalising on widespread nursing job losses throughout Britain, Ms Summers said: "Why not?" "It's good for us and it's good for the nurses who don't have jobs." A Queensland Health spokesperson said all checks and procedures would be followed before applicants could register with the Queensland Nursing Council.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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27 August, 2006

NHS KILLS MOTHERS TOO

They're not fussy: Mothers, kids, who cares? Everybody still gets their salary and nobody is ever penalized significantly

Ten women died during childbirth or shortly afterwards in a hospital that suffered from a lack of clinical leadership, a poor working culture and an overloaded maternity unit. The deaths, at Northwick Park Hospital in northwest London, occurred between April 2002 and April 2005, and involved women giving birth or within 42 days of birth. The Healthcare Commission publishes a detailed account today of each of the deaths.

In April 2005 the commission recommended "special measures" to restore good standards at the hospital, which included calling in an outside team to safeguard women. In today's report it says that these measures are working. But the report lays out in painful detail what can happen in a maternity unit that has inadequate systems. In nine out of the ten cases, the report says, there are grounds for criticism. It summarises these as:

* Insufficient input from a consultant or a senior midwife (in five cases), with difficult decisions often left to junior staff.

* Failure to recognise and respond quickly when a woman's condition changed unexpectedly.

* Inadequate resources to deal with high-risk cases: there were too few consultant obstetricians and midwives; not enough dedicated theatre staff; a reliance on agency and locum staff without adequate support; and a lack of a dedicated high-dependency unit.

* A culture that led to poor working practices.

* Failure to learn lessons on the unit, leading to mistakes being repeated.

* Failure by the North West London Hospitals NHS Trust board to appreciate the seriousness of the situation. It was aware of the number of deaths, and should have acted sooner.

Two aspects of the service are singled out for praise. The report says the anaesthetists and the haematology department, which provided blood for the patients, responded well under difficult circumstances.

Of the women who died, six were Asian, two African, one Afro-Caribbean and one European. The hospital serves half a million people in Brent and Harrow, two boroughs with large black and minority ethnic populations.

The causes of death varied. Strokes following pre-eclampsia (very high blood pressure) were the cause in three cases, with bleeding after giving birth in four other cases. One women died of viral encephalitis, one of a cardiac arrest.

The hospital investigated the deaths from a predominantly legal point of view, as if seeking to defend itself, the report says. Common factors were not found, but the commission says that they did exist and should have been identified.

Marcia Fry, the commission's head of operational development, said: "We hope this report gives some answers to the families involved. "We expect trusts across the country to read this report. Most women give birth safely. But there are risks and the NHS must ensure it does all it can to reduce them. There can be no excuse for failing to learn the lessons from tragedies of this kind." Since April 2005 three additional consultants and 20 more midwives have been recruited. The inspectorate also believes there is a better team working among consultants, obstetric staff and midwives.

Source



Another incompetent foreign doctor in an Australian State government hospital

Up to six people might have died because a pathologist in northern New South Wales misdiagnosed their tests, the state government said today. NSW Health Minister John Hatzistergos and the chief executive of Hunter New England Health, Terry Clout, today announced the results of a review of 7350 anatomical pathology tests taken by Dr Farid Zaer. The review was conducted in March this year after concerns that Dr Zaer, who worked at Tamworth Hospital from 1999 to 2001, may have failed to correctly analyse tests for diseases, including cancer.

Mr Clout said that of the 7432 tests re-examined, 38 cases had significant variations which would have a serious impact on patient care. Of these, he said, five or six people had since died. "It may or it may not have been the case (that the misdiagnosis caused death) and because we don't have a parallel universe we will never know," Mr Clout said.

Mr Hatzistergos said he would willingingly refer the matter to further authorities if the families of the deceased wanted him to. "Obviously this is a dreadful thing to have happened," Mr Hatzistergos said. "I am very concerned by the results that have been revealed."

Three independent pathology laboratories conducted the review and advised the government that 97 per cent of Dr Zaer's tests were accurate. Of 217 people who were found to have had variations, Mr Clout said all but four had been contacted. "Those doctors have confirmed that in 179 of those cases there was no impact on the care provided to the patients," he said. "But that does regrettably leave some 38 patients where the significant variation in the test has meant that there was a less than desirable treatment provided." As a result of the misdiagnosis, the patients had either been over-treated or under-treated, including a small number who underwent unnecessary surgery. "We have undertaken a few operations that were not necessary, I have been quite clear about that," Mr Clout said. "Regrettably there have been cases where there appears to have been an error in the original diagnosis, (that) if known at the time, might have meant the patient received different care." But he refused to say if patients had lost arms, legs or breasts as part of the procedures, saying he did not want to identify people in a small rural community who "have already gone through anxiety in relation to this issue".

Dr Zaer, who was trained in India, has been banned from practising as a pathologist in NSW. Mr Hatzistergos said Dr Zaer was no longer working in that field, but was believed to be working in Queensland, possibly as a general practitioner.

Mr Clout said there was no way of knowing if the five or six people who had died in the past seven years had done so because they had been "significantly misdiagnosed". "We can't draw conclusions from that," he said. "Just because two things happen in the same window of time does not mean that one is a causal link to the other." But Mr Hatzistergos said he would refer the matter to the coroner for further investigation. "I am happy to refer anything to any further authority if required to," he said. Asked if he anticipated action by distressed family members, he replied: "We neither expect nor rule it out, it's obviously a matter for the families to make a decision in relation to that."

Concerns about the quality of Dr Zaer's work first surfaced in 2004 while he was working at the Illawarra Health Service. Despite this, thousands of patients were not tested until this year. Mr Hatzistergos said he was disappointed it had taken so long to get the results. "The only thing I do regret is that it has taken as long as it has," he said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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26 August, 2006

NHS APPROVES LIFESAVING DRUG ONLY UNDER VAST PRESSURE FROM LAWSUITS AND PUBLICITY

Final clearance has been given for women in England and Wales to be given Herceptin for early-stage breast cancer. NICE, the National Institute for Health and Clinical Excellence, dismissed an objection to its draft guidance from Newbury and Community Primary Care Trust. As a result, all PCTs will be expected to provide Herceptin.

Several women have gone to court to establish their right to a drug that trials have shown can cut their risk of a recurrence of cancer by up to 50 per cent. Draft guidance was issued by NICE in June, but Newbury PCT said that it was a perverse interpretation of the data. Today's ruling dismisses the PCT's case and reiterates the advice that women should get the drug if they have the type of breast cancer against which it is effective, and their heart function is monitored.

Andrew Dillon, chief executive of NICE, said: "Our assessment of Herceptin shows that it is clinically and cost effective for women with HER2-positive early breast cancer. The guidance has been issued rapidly to ensure consistent use across the NHS." Newbury PCT said that it had wanted NICE to consider whether shorter courses of Herceptin could be as effective as the 12 months recommended. The PCT also raised questions about exactly who should be chosen for treatment.

Source



THE QUEENSLAND MEDICAL MELTDOWN CONTINUES

Two current articles below

Government dentist HIV positive

Up to 500 people are to be tested for HIV after a female dentist working for Queensland Health tested positive for the virus. Clinics at Bowen and Collinsville hospitals will be open from today to test people treated by the dentist since December 15. The dentist, employed by Queensland Health last year, was the only public dentist employed in the region. She worked in clinics in both hospitals and also treated a small number of patients at school dental clinics in the region and a small number of patients at Ayr hospital.

Queensland chief health officer Dr Jeannette Young said the HIV test being offered would give people a response within 48 hours. Dr Young last night reassured patients that the risk of contracting HIV from the dentist was "very very low". She said there was no known case of transmission of HIV in Australia between a dentist and patient.

Queensland Health last night revealed few details of the dentist who started work for Queensland Health "some time last year". Dr Young said it was believed she contracted the disease in late December and ruled out that it was caught from one of her patients. Queensland Health yesterday began going through all medical records to trace former patients who will be contacted and offered a HIV test. A 1800 hotline has been established and more information is available on the Queensland Health website.

Dr Young said Queensland Health required all staff who undertook exposure-prone procedures to be aware of their HIV, Hep C and B status. "Dentists put their hands into people's mouths . . . They could potentially cut themselves and there is a risk blood could go into a patient's mouth."

Dr Young said Queensland Health protocols required dentists to wear gloves and a mask when treating patients and all medical equipment was sterilised after use.

Australian Dental Association Queensland president Dr Robert McCray last night said former patients of the dentist should not be alarmed as the risk of infection was "almost zero". "Dentistry within Queensland is performed under a set of guidelines," Dr McCray said. "The likelihood of transmission from patient to dentist or dentist to patient is very low in the extreme unless standard operating procedures were not followed. There has been no known case in Australia. "The public should have total confidence that the likelihood of transmission from dentist to patient is virtually zero."

Source



Truth penalized by corrupt government

A health whistleblower who was demoted after exposing the "Jayant Patel" of dentistry is demanding his job back, claiming he has been vindicated. Former Gold Coast Health Service District principal dentist Dan Naidoo was disciplined last year after speaking out about the alleged rogue dentist and the poor state of public dental services on the tourist strip. The dentist he exposed - accused of botching procedures and "torturing" patients to the point of tears - had strict conditions placed on his practice by the Dental Board of Queensland and has since been sacked. One female patient was left with a hole in her jaw and needed nasal reconstruction after a procedure in what she described as the dentist's "torture chamber".

But after suspending the dentist and alerting the media, Dr Naidoo was demoted and sent to a suburban dental clinic in what former health inquiry commissioner Tony Morris described as a classic case of Queensland Health's "shoot the messenger" culture. Now working for NSW Health, Dr Naidoo says he has been vindicated and wants his senior Gold Coast job back. "I just feel cheated and I feel a great sense of injustice," he said yesterday. "I stopped this dentist from torturing patients and yet I was punished and demoted."

An internal Queensland Health email obtained by The Courier-Mail reveals a decision was made in April last year to remove the dentist from clinical work "in the interests of patient safety". But Dr Naidoo said the dentist was allowed to continue operating despite complaints from patients and staff. He later suspended the dentist after hearing one of his patients "screaming in pain".

Surfers Paradise Liberal MP John-Paul Langbroek, himself a dentist, has raised Dr Naidoo's plight in State Parliament and said he should have had whistleblower protection. "He was trying to protect patients and he was cast adrift by Queensland Health," Mr Langbroek said.

But in a letter to Mr Langbroek, Premier Peter Beattie said Dr Naidoo was disciplined for making "inflammatory and untrue" statements which had "undermined public confidence" in Gold Coast dental services. Mr Beattie said Dr Naidoo had been warned that he could be disciplined for speaking out, and was given an opportunity to defend himself. Dr Naidoo had not appealed against the decision or sought legislative protection afforded to "true whistleblowers", Mr Beattie said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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25 August, 2006

A SMALL STEP IN THE RIGHT DIRECTION

President Backs Disclosure of Medical Costs

"President Bush signed a measure Tuesday ordering federal agencies to do more to inform beneficiaries about the cost and quality of their health-care services, which federal officials hailed as a major step toward bringing greater efficiency to the nation's medical system. The executive order requires four federal agencies that oversee large health-care programs to gather information about the quality and price of care, and to share that information with one another and with program beneficiaries. The initiative underscores Bush's belief that the nation's health-care system would be more efficient if consumers could shop for the best care at the best price, administration officials say. . . . With the federal government paying for about 40 percent of the nation's spiraling health-care bill, administration officials said the order requiring federal agencies to develop and share information about the quality and price of care should help bring greater transparency to the business of medicine."

Source



Public hospital negligence kills in New South Wales



The family of a Sydney teenager have demanded to know why health officials said she did not need medication that might have prevented her death from meningococcal disease. Jehan Nassif, 18, from Yagoona in Sydney's south-west died from the disease in Bankstown Hospital last Friday.

Her boyfriend George Khauzame had recently returned from a holiday to Greece with his cousin Elias. Elias was diagnosed with meningococcal upon returning to Australia, while Mr Khauzame was given antibiotics as a precaution. Worried his girlfriend might also contract the disease, Mr Khauzame today said he asked a public health official if Jehan was at risk. He said he was told she would be fine. "I asked the lady at public health should Jehan be treated because I had made contact with her for three hours on Monday nights," he told reporters. "She said Jehan was safe and didn't need to be treated. "I asked again and she said she she would be fine."

Mr Khauzame said his concerns for Jehan's health were further inflamed when the pair went to visit Elias in hospital. He said Jehan had asked if she needed a face mask but was told by the nurses that she didn't need to wear one, even though the nurses were.

Jehan's father, Tony Nassif, is now demanding to know what happened to his daughter. "I want to know why she died," he told reporters. "She was beautiful, she wanted to be a teacher." Mr Nassif said his daughter wanted to go to hospital last Friday morning but was told by ambulance officials it would be a two to three hour wait at Auburn Hospital. After she lost her vision, her ability to walk and a purple rash broke out on her body, the family called the ambulance again and she was rushed to Bankstown Hospital, where she died a short time later.

NSW Ambulance operations director Michael Willis today said ambulance officers who were called to Jehan's home at about 3am on Friday had said she refused to be transported to hospital. "The two officers that attended that case have recorded that they found a female patient suffering with vomiting and diarrhoea and after an examination with the family, in fact that patient refused transport," he told reporters. The ambulance officers had not been aware Jehan had been in contact with a person with meningococcal and had not diagnosed her with the condition, Mr Willis said. "They were unable to detect any signs of meningococcal at that stage," he said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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24 August, 2006

THE DEADLY NHS

Equipment rule-breaking plus anaesthetist incompetence kill a healthy kid. And why did a cut finger need a general anyway? I have often had plastic surgery on my face done under a local! And no-one was penalized of course -- AND the abuses continue

Earlier this month, leading orthopaedic surgeon Simon Moyes, who put patients at risk of infections by re-using surgical equipment, escaped punishment after it was claimed such practices are widespread in the NHS due to cost cutting. It was news that shattered the Clowes family, whose nine-year-old son Tony died exactly five years ago this month after breathing apparatus was reused in what should have been a minor operation. Here, Tony’s father George Clowes, 49, who works for a pharmaceutical company and lives in Dagenham with his wife Carol, a housewife and children Dion, 22 and Andrew, 13, explains why it's vital that lessons are learned.

He says: "After reading about Simon Moyes in the newspaper last week, I was left feeling as though I’d been run over by a truck. July is always a difficult month for my family and I because it marks the end of another year without our son Tony. And to hear at the same time that the very practices that killed our son are still going on was shattering. After Tony’s death, we were promised that lessons would be learned, which, given this latest investigation, we find difficult to believe.

One of the consultants who gave evidence in support of Mr Moyes said it was common practice to reuse equipment because the NHS is so short of funds. To us, the thought of doctors still risking people’s lives for the sake of a little penny pinching feels like a slur on Tony’s memory. All fathers dote on their eldest son, and Tony was the apple of my eye. He was a caring boy, who enjoyed things like cooking and playing on his bike. He also had a thirst for knowledge, and I’d forever be finding him curled up on his bed with a book. At the time of his death, he was in perfect health. He wouldn’t have ended up in hospital at all had he not lacerated his right index finger while trying to repair the chain of his bike.

I remember him coming rushing in from the garden that afternoon, in tears and covered in blood. After running his finger under the tap and seeing how deep the gash was, I decided to take him to our local A&E department at the King George hospital in Goodmayes, Essex. Tony cried all the way there but soon perked up at the sight of the hospital and the doctors. Because his wound was bleeding so heavily, we were rushed straight through to see a doctor and Tony was given a painkilling injection. When the doctors said they wanted to transfer Tony to the a specialist reconstructive department at the nearby Broomfield hospital in Chelmsford in an ambulance, he could barely contain his excitement and forgot all about his cut. He’d always wanted to go in an ambulance and thought the whole thing was a fantastic adventure. We arrived at Broomfield at about 5.30pm. At that point, I was expecting they’d stitch Tony’s finger back up and we’d be home in time for dinner.

But because there was no surgeon on duty, it was decided Tony would stay the night and be operated on the following morning. I offered to stay with him, but he’d spotted he had a computer and toys in his room, and confidently told me he’d be fine on his own. The next morning, I returned to the hospital while Carol stayed at home and looked after our grandson. Of course she would have been there too had we imagined anything serious would happen but we thought it was just a case of a Tony needing a few routine stitches. By the time I got there at around 8am, Tony was his usual chatty self, sitting up in bed and asking the doctor lots of questions about the anaesthetic. Then he asked me if I’d buy him the latest CD by Shaggy, to which I said yes. Tony went off for his operation at 9.30. I stayed with him in the theatre holding his hand until he was given the anaesthetic.

I said to him "See you in a hour son", kissed him on the forehead, then went off to get a cup of tea. Sitting on the chair next to Tony’s bed in the ward, I had no idea that almost as soon as I’d left the room, he had encountered difficulties. I had no idea that as I flicked casually through magazines, doctors were struggling to save Tony’s life. I thought in a couple of hours, Tony would be ready to go home and would be chatting away about the welcome back dinner his mother was making him. The first I knew anything was wrong was about an hour later, when a doctor and his assistant came and found me and ushered me into a side room. He looked at me and said "I don’t know how to tell you this but there’s been an absolute disaster."

Then he said that Tony had died. It was impossible to take in what they told me next. I listened in total disbelief as they told me that they’d discovered Tony wasn’t getting any oxygen through the breathing tube they’d put down his throat while he was under the general anaesthetic. At first, after checking the breathing equipment and discovering it was all fine, they’d thought he’d had an allergic reaction to the anaesthetic drug. So they’d started injecting him with a cocktail of other drugs, including adrenaline, in order to counter the anaesthetic.

It was only after other senior anaesthetists had rushed in to examine Tony, that one of the doctors finally lifted Tony’s mask and discovered one of the connectors inside it had slipped into the tubing and was blocking the airflow. Tony had suffocated to death.

I can’t even begin to describe how I felt in that moment. For a start, I couldn’t take it in. How could he have died as a result of a simple operation to put a few stitches in his finger? How was it possible that just an hour ago, Tony was his usual chatty and relaxed self and now he was dead? And how could they have not noticed a tube was blocked and suffocating? I don’t know whether I screamed or shouted or cried. But I do remember struggling to breathe. All I wanted to do at first was see Tony. The doctors wanted to phone Carol, but I told them I’d go home and tell her myself after I’d seen my son. I remember walking along a corridor in a total haze.

I felt like pushing aside all the doctors and nurses we passed on the way so I could just get to my son, but everyone stood aside to let me walk through. I think they all already knew what had happened. Looking at Tony lying on the bed, it was impossible to believe he was gone. He looked as though he was just asleep. I half expected him to jump up, put his arms around my neck and tell me it the whole thing was some sort of joke. But it was obvious from the way the two doctors were acting, staying right by my side the entire time, ushering me up back stairs away from all the other patients and not even giving me a moment alone to gather my thoughts, that this wasn’t a joke.

I could tell straight away that they knew they’d done something terribly wrong. Looking back on it, I think they were worried I’d run into the wards screaming "These two have killed my boy!" which is why they were keeping such a close eye on me. They senior doctor and his administrator even came in the taxi with me home, and stood right by my side as I walked into the house and told Carol what had happened. Like me, she also struggled to believe anything had gone so wrong. When I said to her that something awful had happened, her first thought was that they’d cut Tony’s finger off, not that he was dead. Stunned, Carol and I returned to the hospital, taking Andrew and Dion with us too. We went to see Tony again. We were all too shocked to even cry and just felt totally numb.

I was also taken to see the hospital coroner, who explained to me that the police had already sealed off the operating theatre and started an investigation. His words were a blur to me though - it was far too soon for me to start thinking about a possible medical negligence case. That night, after telling the rest of our family, we sat at home and sobbed. Tony should have been back there with us chatting away about his bike and his books as usual. Instead, we were now thinking about burying him. Tony’s funeral took place two weeks after his death. There was a great turn out - everyone from his headmaster to his shocked school friends and we played two tunes from the Shaggy CD Tony had asked for just before his death.

As well as grief, I think everyone there was united by a total sense of disbelief. Tony's death led to a major police operation, Operation Orcadian, during which detectives looked at 13 similar but non-fatal cases all over the country involving blocked oxygen tubes. Three members of hospital staff were arrested over the incident and a file was submitted to the Crown Prosecution Service, but in July 2002 detectives said the boy's death was not the result of a criminal act. Instead they blamed sloppy working practises by NHS staff.

In each of these 14 cases including Tony’s, a tiny piece of plastic used to connect anaesthetic tubing to a patient’s face mask had become wedged inside the point where the two connect where it was difficult to see. Apparently this resulted from the equipment being washed and then left jumbled up in drawers. This is despite strict guidelines issued in 2000 by the Medical Devices Agency (MDA) that breathing equipment should be used only once and then binned.

In May 2003, a jury inquest at Chelmsford Coroner’s Court returned a verdict of ‘accident contributed to by system neglect’. The foreman of the jury cited factors including ‘inadequate guidelines, failure to ensure the patency of all ancillary equipment and failure to follow guidelines concerning single-use medical devices’ as causes. David Scott, the consultant anaesthetist who investigated the case, told the inquest that Tony would probably have lived if doctors had disconnected the equipment and given him mouth-to-mouth resuscitation. It devastated us that his life could have been saved so easily.

Although the inquest did condemn the hospital, both Carol and I would have been happier had the individuals who attended to Tony on the day been held accountable. We still can’t believe not only did they break guidelines but they didn’t do something as basic as mouth-to-mouth which would have saved his life. And no verdict could really offer us consolation for Tony’s death. At the time, we were told by spokes people from the hospitals concerned that changes would be put in place and equipment would no longer be reused. It was the hope that lessons had been learned that gave us some comfort and consolation during those dark days and months that followed Tony’s death. That is why the recent case matters to me so much. If doctors continue to get away with such behaviour, then there will be little incentive for them to change their ways and more people will die as a result of NHS budgetary constraints.

Even five years on, we still miss Tony desperately. There is still a gaping hole in this family and although we have days now when we’re able to laugh, we will never be as happy as we once were. That is why I will carry on the fight to see doctors give up their shoddy cost-cutting ways. If I don’t, then Tony’s death will have been in vain and he’ll become just another statistic."

Source. (HT Bizzy Blog).

Update

Below is an email received from a reader who is an anesthesiologist in a U.S. public hospital:

Local anesthesia can also be dangerous, or fatal, in the wrong hands. This boy was in the wrong hands. We have separate "ambu bags" to ventilate patients. If the machine malfunctions, we reach for the ambu bag, ventilate the patient, and then troubleshoot the machine. We have "pulse oximeters" to measure oxygen in the skin, and "end tidal carbon dioxide" to measure ventilation. Alarms are set to go offf if these become abnormal, as would occur if the ventilation circuit was blocked. In addition, the anesthetist should be observing the patient - obviously not the case here. The time of neglect must have been significant. A healthy patient has enough "reserve" oxygen that it would take a number of minutes to die even if the oxygen supply was cut off. In the USA, this would be negligence - plain and simple - and a multi million dollar out of court settlement.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************



23 August, 2006

SADLY MISDIAGNOSED BRITS

And an arrogant government doesn't care

For more than two decades, John Simper was resigned to a slow and painful death from multiple sclerosis. Unable to work or drive, plagued by recurrent headaches, bouts of confusion, short-term memory loss and weakness in his limbs, he feared that he would end up paralysed and in a wheelchair. Today he feels mentally and physically stronger than he has in years, after being told that MS was almost certainly misdiagnosed. Instead he has an illness that can be treated with an aspirin a day.

He is one of hundreds who may have had MS, the progressive disease of the nervous system, misdiagnosed. At least 5 per cent of those told that they have MS are believed instead to have Hughes syndrome, which results in the blood becoming thick and sticky and liable to clot dangerously. Patients in whom MS was diagnosed — the disease affects about 85,000 people in Britain — have experienced seemingly miraculous recoveries on learning the true cause of their illness, in some cases after decades of ignorance. Paralysed patients have regained the ability to walk and others have overcome debilitation, headaches, confusion and short-term memory loss with treatments involving blood-thinning drugs such as aspirin and warfarin.

Mr Simper, 60, from Ipswich, a former motorcycle racer and mechanic, went to his GP after reading about Hughes syndrome in a magazine. Recognising his symptoms in the article, he asked his GP for extra tests. They showed that he had Hughes. He is campaigning to increase awareness of the condition. “I’ve got used to the idea of MS over the last 26 years. I’ve always been someone who wants what I want when I want it and I have not let my condition get in the way of that,” he said. “But people are needlessly suffering because they don’t know the truth about their illnesses, and the Government has to take notice of that.” An estimated 150,000 people in Britain suffer from the syndrome, first reported by Graham Hughes in the British Medical Journal in 1983. It has since been confirmed as the cause of one in five recurrent miscarriages, one in five strokes in younger people and one in five deep vein thromboses.

Yet Dr Hughes, now a professor at the London Lupus Centre, says that few GPs are alert to the condition and lives are still being ruined because simple tests are not offered as a matter of routine. “It is still totally under-recognised. People have been told they have MS and treated as such yet received no benefit, and the true cause has been under our nose the whole time,” he said.

Hazel Edwards, 48, a mother of two from Wrexham, North Wales, was paralysed from the neck down and received no benefit from chemotherapy and intravenous steroids after MS was diagnosed in 2001. She can now walk again, after a diagnosis from Dr Hughes. “As soon as I started warfarin, my memory improved and I found I could walk,” she said. “Professor Hughes and his team gave me back my life.” She first suffered repeated miscarriages, memory loss, confusion and a loss of coordination 28 years ago.

The Department of Health was “not aware of any evidence that population screening would be beneficial”. Yet a survey at the lupus centre indicated as many as 32 per cent of patients suffering from Hughes syndrome had been diagnosed wrongly or treated for MS. “The indications of MS and Hughes syndrome are extremely similar, even down to the MRI scans,” Professor Hughes said. “They can be extremely difficult to diagnose, but a simple blood test can make all the difference.” He recommends that two blood tests be offered routinely to any MS patient who has suffered recurrent headaches, problems with clots, a family history of autoimmune diseases, or who has had recurrent miscarriages

Source



18,000 patients harmed by hospital mistakes in New South Wales

Thousands of patients a year are being harmed by often avoidable mistakes such as being given the wrong drugs, incorrect treatment or falling down while in the care of public hospitals or other parts of the health system. An analysis, to be released today, of the first full 12 months of data from a NSW program designed to encourage reporting of so-called "adverse events" has found there were 125,000 notifications in the year to July 2006, of which 18,750 resulted in some level of injury or harm to patients.

NSW accounts for about one-third of the healthcare episodes across Australia, so on a national basis the figures could be expected to be three times higher. But because reporting events to the system is voluntary, the true level of mistakes and problems in the public hospital system is likely to be higher still. Falls represented the biggest category of adverse events, accounting for 26 per cent of all notifications or 32,500 incidents. Medication errors -- patients given the wrong drug or the wrong dose -- came next, accounting for 18 per cent of notifications or 22,500 incidents.

Incorrect clinical management -- in cases where the patients' conditions may have been misdiagnosed, diagnosis was delayed, or the wrong treatment given -- accounted for 13 per cent of notifications, or 16,250 incidents. The figures were compiled by the NSW Clinical Excellence Commission, whose CEO Cliff Hughes will present some of the findings at today's Australasian Conference on Safety and Quality in Health Care in Melbourne. Professor Hughes told The Australian that all but about 400 to 500 incidents a year resulted in minor or no harm to the patients. About 37,000 of the 125,000 notifications were of a non-clinical nature, such as lost or stolen property, or complaints over how a patient was spoken to. However, he conceded many incidents could be prevented by better hospital procedures, and said the data was being used to change the times at which some common yet potentially dangerous drugs were given.

An example was the blood-thinning drug warfarin, which is commonly used to reduce the risk of strokes and heart attacks or for patients with irregular heart rhythm. Too large a dose could cause haemorrhage, while too small a dose meant the drug would not work, Professor Hughes said. For historical reasons, such as the fact the results of blood tests ordered in the mornings would only be available in the evening, warfarin was usually given to patients at about 8pm to 9pm. But the figures showed a three-fold spike in adverse drug events at about that time. NSW was changing procedures to have the drug administered at about 4pm, when more staff would be on duty to monitor effectiveness and handle adverse consequences, he said. "That's a pretty good example of how this data can be used to drill down and look at the trends, and make changes in healthcare to make it safer for patients."

Professor Hughes said analysing the figures showed inadequate knowledge or skills on the part of doctors or nurses was linked to about 56 of the 500 or so serious adverse events. Over three times more (170) were due to communication issues -- for example, when key details about the patient's condition were not transferred to another ward or hospital department. "Any adverse event is the end-point of some deficiency in the system," Professor Hughes said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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22 August, 2006

DON'T GET BOWEL CANCER IN BRITAIN

The Government's value- for-money watchdog is set to refuse approval for two new bowel cancer drugs, to the fury of patients and cancer charities. Nice, the National Institute for Health and Clinical Excellence (Nice), will recommend today that Avastin and Erbitux are not sufficiently good value to justify NHS prescription. Andrea Sutcliffe, deputy chief executive, said: "Although bevacizumab [Avastin] does show some increased benefit over standard treatment, the [Nice] Appraisal Committee was not persuaded that it was cost-effective in the treatment of metastatic colorectal cancer. "The evidence available on cetuximab [Erbitux] does not compare it to current standard treatment and we are not able to assess whether it is any better than existing treatments."

The judgment is not final and is open to appeal before guidance is issued in November. But cancer charities are preparing a challenge. They argue that the two drugs work, shrinking tumours and extending life in patients with advanced colon cancer, even if they are not a cure. They are widely available elsewhere, including across most of Europe. Hilary Whittaker, chief executive of Beating Bowel Cancer, said: "We urge Nice to reconsider. Why should patients in the UK be worse off than patients in the rest of Europe?" Michael Wickham, the chief executive of Bowel Cancer UK, said: "The NHS of 2006 is, it seems, content to fund a 10 billion pound overspend on information technology but not to give patients treatments that can help them live longer." Denise Richard, of Merck Pharmaceuticals, which makes Erbitux, said: "The UK is the only country in Europe where Erbitux has been licensed but is not routinely available to patients because the NHS will not fund it."

Bowel cancer is the third-commonest cancer in the UK, with 35,000 new cases every year and 16,000 deaths. More than half the patients will develop cancers that spread, for which the five-year survival rate is only 12 per cent. Avastin and Erbitux are new medicines that work by targeting a growth factor that stimulates the growth of blood vessels needed by tumours to grow. Both are licensed and in trials have shown effectiveness in tumours that are resistant to chemotherapy. Erbitux, used with the traditional drug irinotecan, shrank tumours by half in a quarter of patients and slowed progression of the disease by four months in half of patients. Avastin had similar effects on survival when used with other drugs.

However, the question that Nice has to answer is whether the drugs are cost-effective. Nice measures the cost per life-year saved, with a threshold of effectiveness of about 30,000 pounds. Neither passes this test: Avastin costs between 83,000 and 107,000 pounds, and Erbitux between 39,000 and 69,000. One patient who is taking Erbitux is David Taylor, 54, a journalist who lives in North London. He had colorectal cancer diagnosed in 2004. Treatment with conventional drugs began in January 2005. But the disease progressed and his consultant warned him: "We're running out of drugs."

Source



Federal bias against sick men in Australia

Men are being denied free access to a cancer drug, even though it is available to female patients. Women fighting breast cancer can get the chemotherapy drug Taxotere (docetaxel) free on prescription under the Pharmaceutical Benefits Scheme. But men with prostate cancer who don't have private medical insurance have to pay almost $3000 for each treatment. Some patients need up to 20 treatments, making it impossibly expensive for many. Taxotere is the only chemotherapy drug proven to extend the lives of men with incurable prostate cancer.



Leading urologist Prof Tony Costello said 3000 men died every year from the disease in Australia. "A significant proportion would be candidates for the drug," he said. Tony Gianduzzo, Queensland chairman of the Urological Society of Australasia, agreed: "It would be nice to have it available for those men who would benefit."

They agreed men were victims of their failure to lobby as effectively as women did. "Men have been pretty poor advocates for their own cancer," Prof Costello said. "It's up to people like us who have to look after these folk to lobby for the drug to be made available on the PBS."

Taxotere was made available for breast cancer patients in 1997. Two years ago, it was discovered that it could also be used to treat men with malignant prostates - the biggest cause of cancer deaths in males. The treatment has been found to extend the lives of prostate patients by an average two months more than standard treatments, and up to two years in some cases. For breast cancer patients, the average increase was 2.2 months.

Federal Labor frontbencher Wayne Swan, who was successfully treated for prostate cancer five years ago, backed the push for the drug to be made freely available. "There is a strong case for the listing of this drug. I would give the doctors all the support I possibly could," said the Member for Lilley, on Brisbane's northside. "It certainly looks like there is a double standard in its use, and you can only assume the decision was financial, not medical."

A spokeswoman for Federal Health Minister Tony Abbott said an application by the manufacturers of Taxotere for it to be added to the PBS for prostate cancer treatment had been rejected. "It's up to them to try again," she said. "The Government doesn't go touting for drug companies to apply." The Federal Government spent $157 million in 2004-05 subsidising several breast cancer treatments.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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21 August, 2006

NHS COVERUP

Labour faces allegations of trying to undermine the independence of the National Audit Office after it successfully toned down the findings of an inquiry into the 12 billion pound NHS computer system. Documents released last week show how key passages in the NAO report were changed after interventions by Department of Health officials. These included removing warnings about the difficulties of creating computerised records for every patient in the country. The Connecting for Health scheme is intended to create centralised medical record systems for 50m patients. Critics fear it could threaten patient confidentiality and make the NHS more vulnerable to damage from computer failures.

The NAO report on the scheme, published in June, was welcomed by NHS officials for its broad support of the programme. However, a draft of the report, dated January 26, 2006 and obtained by The Sunday Times under the Freedom of Information Act, warned of potential problems. It said: The Department of Health had failed to demonstrate "clear and effective leadership" to staff implementing the programme.

NHS workers were worried "the confidentiality of patient information may be at risk". The NHS lacked sufficient skills to support the delivery of the programme. Although there had been "substantial progress", the programme faced "significant challenges".

When the report was published six month later, the warning over departmental leadership had been removed; the paragraph highlighting doctors' worries over confidentiality was also missing and the claim that the NHS did not have the required skills to deliver the programme had been dropped.

Instead, headings of the report were changed which gave more emphasis to what the project "has achieved". Even the projected costs of the programme were cut from œ13.4 billion in the draft report to œ12.4 billion in the final version. The key conclusion on the challenges was unchanged. One source who has worked closely with the NAO said: "It's pretty clear the NAO were bullied into changing this report."

An NAO spokesman said: "Like any report it went through a process to ensure the presentation was fair and the facts were accurate. The overall conclusions are the same in the final report as in the provisional report. The œ1 billion fall in cost followed new information."

The health department said: "We co-operated fully with the NAO to ensure the publication of a balanced and accurate report."

Source



Another crooked overseas doctor found in a Queensland government hospital

Labor was embroiled in a new health scandal with revelations that a grandmother died after an overseas-trained doctor failed to treat her properly. Lillian Shaw, 67, died last year in Lowood, west of Ipswich, after Indian-trained GP Dr Jaideep Bali failed to diagnose a perforated stomach ulcer despite visiting her three times in 36 hours. A coronial inquest also found Dr Bali had given the mother-of-seven a potentially fatal injection of morphine 2® hours before she died, and later tried to cover it up.

Mrs Shaw's family and the Coalition yesterday said the Beattie Government had to share responsibility for the tragedy. "It's another Dr Death," said Mrs Shaw's son Karhl Earnshaw. "It goes all the way up to the Beattie Government and the Health Minister. "To say we are furious would be an understatement. If you knew the agony we've been through over the last 18 months . . ."

Mrs Shaw died on the evening of January 13, 2005, two days after she began suffering abdominal pain and vomiting. She was visited at her home in Lowood three times in 36 hours by Dr Bali, a GP from the Lowood Medical Centre. Mrs Shaw's husband, Ian - described by the coroner as "an impressive and intelligent witness" - said the doctor did not examine his wife during any of the visits.

The inquest heard that Dr Bali did not make any record of having administered morphine during his last house call and continued to tell Mrs Shaw's family for some months that he had not done so.

Coroner Matthew McLaughlin concluded that Dr Bali was not a reliable witness and said he strongly suspected the GP had "deliberately been untruthful" and, initially at least, did his best to conceal the fact he had given Mrs Shaw morphine.

Opposition Leader Lawrence Springborg said tragedies such as Mrs Shaw's death were "the Beattie Government's real record on health". He said: "The Government has run the health system down so much they have driven away Australian-trained doctors and are desperate to fill the void by giving substandard people licences to practise." Health Minister Stephen Robertson said he had directed Queensland Health to forward the coroner's report to the Medical Board for immediate assessment.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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20 August, 2006

MORE FINANCIAL INSANITY IN THE NHS

They can't fund the hospitals they have so what do they do? Build new ones! Unbelievable

Six new Private Finance Initiative hospitals will be approved by the Government today, signalling its commitment to continue what it claims to be the largest hospital building programme in the history of the NHS. But the optimistic message will meet with fury from public health specialists and training hospitals, which have been told to cut their budgets to hold down NHS deficits. Under the plans, Guy’s and St Thomas’ will lose 4.7 million pounds , Bart’s and the London 3.7 million, the Royal Free 2.1 million and St George’s 2.2 million, for example.

The money will come from budgets set aside for education and training for this year, which is already half over. “Lord knows how we are going to make these kinds of cuts when the money is already committed,” one hospital manager said yesterday. “What a way to run a business!” said another in an exchange of e-mails across the network of London teaching hospitals. The impression being given was that the hospitals would not take the cuts lying down.

Public health spending has also been targeted, according to Health Service Journal, which reported that the department’s plan is to set aside a 350 million “contingency fund” to help to bring the NHS back into financial balance. This will come from money devolved to strategic health authorities (SHAs) this year from central funds that were devoted to public health, medical education and training, clinical excellence awards, performance-related pay for GPs and services such as walk-in centres, out-of-hours services, and NHS Direct.

Public health specialists are furious. Professor Rod Griffiths, the president of the Faculty of Public Health, told Health Service Journal: “I’m very disappointed that something as important as this has been so clumsily managed. “The overspends have not been caused by community medicine. It is poor commissioning and poor management of acute services.” The department is projecting a gross deficit for the NHS in this financial year of 883 million, against 1.2 billion last year. It plans to offset this against a 135 million surplus from primary care and acute trusts, 415 million from savings by SHAs, and the 350 million contingency fund. That should achieve a net surplus of 17 million.

But these problems will be brushed aside by ministers as they announce another 1.5 billion for six new PFI hospitals to be built for University Hospitals North Staffordshire, Tameside and Glossop NHS Trust, Salford Royal Hospitals, Walsall Hospitals, South Devon Healthcare, and University Hospitals Leicester. Andy Burnham, the Health Minister, said: “We are delighted to be able to give the go-ahead for these new hospitals. This is great news for the hundreds of thousands of patients who will benefit from the modern, bright new buildings. “The new facilities will not only be the best in terms of design and quality, but they will be affordable well into the future.”

The six hospitals will have far more single rooms than traditional NHS hospitals, with up to half the beds in single rooms. The standard of accommodation and facilities will be a big leap forward, the department said. The first of the new hospitals will open in 2010. The announcement means that since 1997, more than 10 billion will have been committed to hospital building. A total of 76 schemes are open — 58 PFI and 18 built using public capital — and another 30 are under construction. Andrew Lansley, the Shadow Health Secretary, said: “The reality is that the NHS financial crisis has resulted in over 20,000 job losses in NHS hospitals, and has raised the spectre of some of these hospitals closing.”

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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19 August, 2006

MEDICARE AND VIAGRA

Government health programs require states to pay for men's erections. I'm all for men having good sex lives, but why would government subsidize that? Because our bloated government just cannot stop vomiting out the money. For years Medicaid has been spending millions of dollars on Viagra and other erectile dysfunction drugs. The Clinton administration told states they had to pay, because the law requires that Medicaid pay for any FDA-approved drug deemed medically necessary. Bush administration officials kept the policy. They wouldn't agree to a television interview about it.

Doctors are so addicted to government funding that even insane and embarrassing subsidies are passionately defended. "Erectile dysfunction is not fun, it's a disease," said Dr. Steven Lamb, who appears often on ABC. "It needs to be treated. It needs to be paid for."

I gave him a hard time about it. "Sex is a government entitlement now? Do you ever think about budgeting? What the taxpayer pays?" "What we're trained in is to be your advocate," he said. "I do not take costs into account."

Of course not. Government-funded medical programs invite doctors to declare endless "needs" -- knowing someone else will bear the cost.

Eventually there was outrage. Sadly, not merely because people woke up and realized that government shouldn't fund Viagra. No, only when money was needed for Hurricane Katrina relief and it was revealed that the government was giving Viagra to child molesters did Congress allow Medicare and Medicaid to stop paying for erections. Congress allowed states to stop. But some states still pay.

More here



Permissive doctor regulation rejected by Australian professionals

Surgeons insist that a trainee neurosurgeon will never operate again despite a medical board clearing the way for his return to medicine next year after being convicted on child pornography charges. A Medical Practitioners Board of Victoria inquiry into Abraham Stephanopoulos found his proclivity for downloading and storing "large amounts of child pornography" - including images of children between the ages of four and seven - did not make him a pedophile.

The 31-year-old doctor was suspended from practice for being caught with having 1400 pictures at his home, in his car, and on computers at Monash Medical Centre, in Melbourne's southeast, of naked children. The board said he would be able to return to medicine in March next year, but that he would be banned from treating patients younger than 18 for the following eight years.

But the Victorian president of the Australian Medical Association, Mark Yates, attacked the board's decision yesterday, saying it would bring the medical profession's image into further disrepute. "The board is there to protect the public, it says, but it's not there to maintain the good standing of the profession necessarily," he told The Australian. "Clearly this person has acted in an unethical way, has brought the profession considerable discredit."

Dr Stephanopoulos received a five-month suspended jail sentence in July last year on three charges of knowingly possessing child pornography between 2000 and 2003. A spokeswoman for the Royal Australasian College of Surgeons said the 31-year-old would not be able to practice surgery in Australia again. "He's been dismissed from our training program," she said.

Dr Stephanopoulos justified his obsession with child pornography as an avenue for coping with a heavy workload, the medical board said in the 44-page report of its inquiry, published on its website on Wednesday. It found his reason for saving the downloaded pornographic images onto his computer was because it was "exceptionally easy - just one mouse-click". "He emphatically denied that he has an attraction to children," the board inquiry said. "He noted that he also saved images of adult males and made the point that he also had no attraction to them. "He emphatically denied receiving any sexual gratification from the illegal images which he viewed and downloaded onto the hard disc on the work computer." But the board ruled the misconduct was "abhorrent". "By his addiction to such material ... he provided encouragement to the producers and purveyors of illegal material that violates the innocence of children," it said. "As a consumer of their product, he has taken his place in the chain of their criminality."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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18 August, 2006

FREE MARKET IN ORGANS WOULD SAVE COUNTLESS LIVES

Erin Herrin, the mother of the conjoined twins who were separated by pioneering surgery last week, has been roundly praised for offering to donate a kidney to her bereft daughter. We are, it seems, full of admiration for parents who risk their own health in order to provide a better future for their children. But why, then, do we condemn those who wish to donate a kidney in return for cash? After all, many would use the money to enhance the life chances of their little ones - a situation that seems identical, in all morally relevant respects, to that of Mrs Herrin.

A free market in kidneys would not only augment the wealth and autonomy of willing donors but would eliminate the chronic shortage of vital tissue. In the UK alone more than 5,500 people are on the kidney waiting list. It is estimated that 100,000 die worldwide each year while waiting in vain for a life-saving operation. It is a scandal that this mass suffering is permitted to continue when it could be eradicated with a simple change in the law.

The arguments against a free market are not merely misguided but perverse. Critics talk darkly about the wealthy jumping the queue and mutter incoherently about the exploitation of the most vulnerable. As Pope John Paul II wrote: "Buying and selling organs violates the dignity of the human person."

The truth is precisely the reverse. The prohibition on payments to living donors has driven the market underground, making it an option available only to the rich. Desperate patients have been known to pay up to 100,000 pounds to shady brokers who pocket the lion's share, leaving Third World donors with a pittance. Back-street surgeons conduct transplants with scant regard to tissue typing and histocompatibility.

In a properly regulated market the donor would receive the full price for the organ and would be interviewed to ensure that they have given informed consent. A monopsony buyer, such as the NHS, would set a price so as to eliminate shortages and then make kidneys available "free at the point of use" according to clinical need.

A market in kidneys would alleviate the needless suffering of thousands while eliminating the abuses and injustices of the black market. It is the current, failed system that is a violation of human dignity.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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17 August, 2006

So That's Why It's So Expensive

Blame insurance, not just tech, for spiraling health costs, says an MIT economist By Howard Gleckman Economists have long believed that technology is the main reason that health-care costs are rising so rapidly. The endless stream of innovation, from new drugs to delicate tools for microsurgery, the theory goes, largely explains why medical spending has exploded from 5% of the U.S. economy in 1960 to 16.5% today. According to some studies, as much as 65% of that growth could be laid at the feet of tech.

Now a young economics professor at the Massachusetts Institute of Technology is challenging the conventional wisdom. After studying data going back to the 1960s, Amy N. Finkelstein has concluded that the real culprit for the rapidly rising cost of health care is the massive expansion of medical insurance over the past 40 years. Sure, new technologies play a role, but doctors, hospitals, and consumers adopt them so freely largely because insurance foots the bill. ``Where does that technological change come from?'' asks Finkelstein, 32, who lives in Cambridge, Mass., with her economist husband, Ben Olken. ``I am trying to get inside that black box.''

If Finkelstein is right, her work could change the way policymakers and the companies that pay for most medical care think about costs. For example, if individuals have to pay more for their care through high-deductible health plans, they may cut spending. Her theory could also spur the drive for evidence-based medicine, the effort of some reformers to encourage the use of only those treatments that have been proven to work (BW -- May 29).

Already, Finkelstein's analysis is shaking up views across the political spectrum. ``This is pathbreaking work,'' says Joseph R. Antos, a health economist at the conservative American Enterprise Institute. Adds the more liberal MIT economist Jonathan Gruber: ``This really changes the whole landscape in the way we think about health economics.''

Why is insurance so important? One obvious reason, Finkelstein believes, is that consumers opt for more care if someone else pays for it. But the more significant effect may be that insurance guarantees a steady source of revenue for hospitals and other health providers. Such ready cash encourages them to build new cardiac-care centers and stock up on the latest high-tech equipment, knowing it will be paid for. ``If you produce expensive new things for medical care, people will buy them,'' says Paul Ginsburg, president of the Center for the Study of Health System Change in Washington. He has found results similar to Finkelstein's by looking at medical spending patterns in 12 U.S. cities.

Finkelstein's breakthrough confirms a theory first advanced almost 30 years ago by Harvard economist Martin Feldstein. At the time he didn't have detailed health-cost data to prove his case. Then in 1987 a massive Rand Corp. study concluded that technology accounted for more than half of the rise in health-care costs. Insurance, Rand figured, increased costs by just 10%.

So Feldstein's theory gathered dust until Finkelstein discovered the proof by sifting through long-forgotten paper records in MIT's library. There, she found that hospital spending soared after the federal Medicare program began in 1966. ``I thought, why am I getting such a large number,'' she remembers.

Finkelstein had the papers scanned and shipped to a company in Cambodia, where it took 18 months to turn the records into usable data. The story they told was dramatic. In regions such as the South, where most seniors had no insurance, health spending soared after Medicare. But in New England, where many already had coverage, Medicare had much less impact on costs.

Not everyone buys her conclusions. Some think she has overstated the importance of insurance. Others question whether her results apply to private coverage as well as Medicare. But she has prompted many experts to rethink their long-held views. And now that Finkelstein thinks she's figured out how much insurance has increased costs, she wants to find out whether all that extra spending has paid off with better care.

Source



Lax doctor registration in Australia again

More than a year after the State Government toughened doctor registration in the wake of the Jayant Patel scandal, a Google search has revealed another surgeon with a questionable past. Eugene Sherry has been stood down from his job at Rockhampton Hospital after it was discovered he had served six months in a US jail in 1982 for raping a nurse along with two other doctors.

Dr Sherry, who trained in New Zealand and worked in Mackay for six months before moving to Rockhampton three weeks ago, twice failed to reveal the conviction to Queensland authorities. The Medical Board of Queensland, which was tipped off to his past by the Australian Medical Association, has now asked him to show cause why his registration should not be cancelled. The Crime and Misconduct Commission is examining the case.

Health Minister Stephen Robertson yesterday ordered criminal history checks to be conducted on all 14,000 doctors working in Queensland. Mr Robertson said Dr Sherry had been working in NSW since 1983 and was automatically registered in Queensland under an agreement between the states. "We don't think it is appropriate that doctors with these serious convictions should continue to practise," he said.

Premier Peter Beattie announced that the medical board would again be overhauled to focus solely on the registration of doctors, with a police representative added to ensure there was a thorough check of credentials.

Liberal leader Bruce Flegg yesterday criticised the Government for again failing to ensure proper checking of doctors. "At the end of the day, the Government is the employer. It is up to the Government to check the staff that they employ," Dr Flegg said.

In the wake of the Patel saga, new checks were introduced to ensure overseas-trained doctors seeking registration in Queensland had not been deregistered elsewhere. The checks include a Google search, but it is understood this was not done on Dr Sherry because he was trained in New Zealand and had already worked in NSW for 20 years.

Meanwhile, federal Nationals MP De-Anne Kelly has made a series of further allegations against a Mackay Hospital doctor. Ms Kelly accused Egyptian-trained surgeon Abdalla Khalafalla of falsifying surgical notes during procedures in which he operated alone. Dr Khalafalla, whose competence is being reviewed by the Royal Australasian College of Surgeons, is supposed to be prohibited from operating alone. "The Royal Australasian College of Surgeons was well aware that the operating notes for that particular operation were false," Ms Kelly said, when referring to a particular case.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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16 August, 2006

California Democrats can't fix their highways, so want to "fix" health care in the same way

Democratic state lawmakers are embracing the one solution to spiraling health care costs that Gov. Arnold Schwarzenegger says he has ruled out: eliminating private insurance plans in favor of a single-payer system that allows the state government to buy health services for everyone. With three weeks left in the legislative session, a single-payer bill, Senate Bill 840 by Sen. Sheila Kuehl, D-Santa Monica, is heading toward the Assembly floor for a vote. The measure establishes a system that, in theory, would be funded by payroll taxes on businesses of 8 percent and individual income taxes of 3 percent. Those taxes would replace the premiums that individuals and businesses now pay to insurance companies. But SB 840 would not actually allocate funding for the new program, and the single-payer approach could not go into effect until either voters or the Legislature approved the costs separately.

At a rally of several hundred unionized school workers on the Capitol steps Wednesday, Assembly Speaker Fabian Nunez, D-Los Angeles, proclaimed his support. "I think it's good for business, and I think it's good for consumers," Núñez said after the rally. "My hope is that we can convince the governor that we think this is the right thing to do."

The Senate in June passed SB 840 by a vote of 24-14, before it was amended to contain the payroll and income tax provisions. The Republican governor has criticized the single-payer approach as a "tax increase." Schwarzenegger has said he will release his proposal for making health care more accessible to Californians in January, if he is re-elected in the November general election. He supports streamlining private insurance coverage through the use of new technology and other approaches that make private insurance coverage more affordable. "His concerns are that none of the health care proposals that have been sent to his desk have addressed health care affordability," said Sabrina Demayo Lockhart, a spokeswoman for Schwarzenegger.

Advocates of SB 840 say their plan will save consumers and businesses about $8 billion a year because the government will be able to negotiate lower prices with health care providers. "The governor just doesn't get it," Kuehl told the members of the California School Employees Association who were rallying at the Capitol on Wednesday.

Source



Part of the reality behind government hospital statistics



On the day Premier Peter Beattie called an election, this picture is a reminder that one of Queensland's most pressing problems - its health system - is far from fixed. Mr Beattie was pressing the flesh at The Ekka yesterday, and presided over what was probably his last Cabinet meeting before announcing a snap poll today. This while the parents of one-month-old Deisha Magic-Stevens were hoping their gravely ill baby did not become the latest victim of the state's health system.

Baby Deisha needs an urgent operation to repair a hole in her heart, but three times in the past two weeks doctors at Brisbane's Mater Children's Hospital have had to cancel her life-saving operation because of a lack of intensive care beds.

In desperation, her father David Stevens, 42, has written a letter on Deisha's behalf to Mr Beattie expressing dismay at the current state of Queensland public hospitals. In his letter Mr Stevens said another seven babies have "had to have their operations cancelled this week for the same reason". "They now tell me that may be next week, but they just don't know. I have been told I am a priority because I need heart surgery. Priority must have a different meaning in your state," Mr Stevens wrote. "One thing that has been positive is the support and care factor from the nurses and doctors who, I might add, quite often have to work double shifts due to staff shortages. Mr Beattie, this is not a good way to bring a new Queenslander into the world," Mr Stevens said in his letter.

He said he had read about the problems in the state's public hospitals but "it is not until it affects you that you realise how bad it is". "The doctors and staff have bent over backwards. The frustration is in their face each time the surgery is put off."

In March, The Courier-Mail revealed the unnecessary deaths of several infants because of inferior pediatric cardiac services in Queensland. A review identified shortcomings in the intensive care facilities of the three major public hospitals providing the service. In response, Health Minister Stephen Robertson set up a taskforce to assess the review. Queensland Health yesterday confirmed a further eight pediatric cardiac procedures had been postponed in recent weeks.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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15 August, 2006

NHS BILLIONS SQUANDERED

The tens of billions of extra cash poured into the National Health Service by Labour has been “largely wasted”, according to a study by the think tank Civitas to be published this week. It says that while the government has mainly succeeded in meeting its NHS targets, the underlying picture is one of “little or no evidence of improvement in NHS performance, which ranks among the worst in the developed world”. Most damningly, the Civitas report finds that any improvements in healthcare in Britain have lagged behind other countries, despite the fact that money has been injected into health in Britain at a much faster rate than elsewhere. “In the vast majority of areas improvements in the NHS have in no way increased in proportion to the vast sums of money ploughed into its coffers,” said James Gubb, the report’s author.

The study shows that spending on the NHS has almost doubled from £44.9 billion six years ago. Even allowing for inflation, the increase is still one-third. Ministers boast that the extra spending means key targets have been met on improved facilities, waiting times, cancer care and coronary heart disease. But the emphasis on targets has resulted in what the report calls “gaming” — other services being neglected in order to achieve targets. In some NHS trusts patients have been kept waiting in ambulances until managers were confident they could meet the four-hour waiting-time target inside the hospital.

The policy has also been accompanied by inefficiency. Official figures show NHS productivity has been declining by up to 0.5% a year, implying that a significant proportion of the extra funds injected have not led to improved patient care. The report also highlights the continued poor performance of the NHS compared with other countries. Britain is virtually the only advanced country not to have recorded an improvement in mortality rates from strokes in recent years, and fatalities are twice the level recorded in Australia, Canada, Japan, Sweden, Switzerland and America. Britain ranks 24th out of 27 countries in the Organisation for Economic Co-operation and Development with comparable data in terms of the number of practising doctors per 1,000 population.

Source



Another scum foreign doctor yawned at by Australian authorities

Queensland Health failed to protect a vulnerable female patient following allegations of serious misconduct by an overseas-trained doctor. Toowoomba health service district allowed Indian-trained Shamshulhague Shaikh to continue working at the hospital following the accusations, transferring him to another ward where he again came in contact with the woman. He was deregistered by the Medical Board of Queensland for "unsatisfactory professional conduct" on July 20 and a brief of evidence containing the serious sexual allegations against him will be forwarded to the Health Practitioners Tribunal in the coming weeks. Police are also investigating the doctor, but would not confirm the nature of the allegation.

Under the terms of his working visa, Dr Shaikh must leave Australia within 28 days - today - or be in breach of immigration laws. Medical Board of Queensland executive officer Jim O'Dempsey said the board "will allege unsatisfactory professional conduct by an ex-registrant in connection with a vulnerable person he treated". A spokeswoman for the board said actions against the doctor would proceed if he were overseas.

A Queensland Health spokeswoman said the district was advised of the complaints last March. No action was taken by the district until they were advised by the doctor himself in June and the district manager and executive director of medical services advised the Ethical Standards Unit. "Once the district was notified of the serious nature of the allegation, arrangements were made to transfer him and interim working conditions were put in place," she said. "At this stage there had been no determination by the (Medical) Board as to whether the allegations were substantiated."

Member for Toowoomba South Mike Horan raised the matter in Parliament last week, questioning Health Minister Stephen Robertson over the "serious complaints" originally made in 2005 and why he was allowed to continue working at the hospital in contact with the woman. Opposition health spokesman Bruce Flegg said for the doctor to have remained working while the investigation was underway was "very, very disturbing" and called for the Minister to declare what he knew.

Health Minister Stephen Robertson said the matter had been referred to the Health Practitioners Tribunal and Dr Shaikh was no longer authorised to to practice in Queensland. "Both the board and Queensland Health are taking a very active interest in this matter to ensure all of the actions that were taken in relation to this doctor were timely and appropriate," he said. A spokesman said he became aware of the allegations in July and would not comment further. "The appropriate action was taken by the District and he supports that action - he doesn't politically intervene in these things," he said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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14 August, 2006

DEADLY NHS TARGETS

If New Labour will be remembered for anything, it will be for targets — the key to its endless so-called reforms of public services. It is easy to see why the party is so addicted to them: setting targets reproduces the sense of control that its leaders experienced during those heady years when they reformed their own party and became electable. But, in the case of the NHS, target-mania is not only damaging in the long term, but also a direct threat to patient safety.

Last month’s report by the Healthcare Commission on the outbreaks of infectious diarrhoea in Stoke Mandeville hospital, in which 334 patients fell ill and at least 33 died, makes instructive reading. Managers, we learnt, overrode the advice of the expert clinicians on their own staff and thus failed to isolate infected patients to control the outbreak. This active mismanagement was driven by a need to meet targets, in particular the requirement to clear patients from the accident and emergency department within four hours. Patients in A&E with infections were admitted to open wards rather than isolation facilities, which were in short supply.

Almost equally disturbing is the sharp rise in hospital readmission rates — by nearly a quarter since 2002, according to government figures released this week. The most likely explanation is premature discharge of patients by hospital trusts under pressure of targets.

Will this kind of evidence be the death knell for targets and, more importantly, for the arrogance — political power mistaking itself for technical expertise — that lies behind them? Like many bad ideas, targets are intuitively attractive. Surely, it is argued, they enable public services to direct their efforts where need is greatest and to determine whether those needs are being met. The service can be proactive rather than merely reactive. Measurable outcomes mean that reality can be separated from rhetoric; in short, a better deal all round.

So much for the theory. In practice, the impact of targets has been damaging and must bear some of the blame for the failure of the vast and welcome increase in NHS funding to deliver a proportionate increase in care. Yes, waiting lists for operations have been dramatically reduced, but the hidden costs of targets have not been measured and their impact on overall activity have been costly and in some respects malign.

It is sometimes forgotten that if one kind of activity is prioritised then all others are “posteriorised”. For example, the initial focus on coronary heart disease meant that development of services for cardiac arrhythmias andnon-cardiac conditions was held back. Conditions that are not prioritised still have to be treated. Secondly, priorities determined by the discomfort of a minister at the dispatch box may not match clinical priorities. Thirdly, meeting targets will itself become the overall priority: resources are commandered for this even if it is not cost-effective. The collateral damage to the care of patients with non-targeted conditions will be all the greater.

The greatest damage will be to aspects of care that cannot be measured — human kindness, listening and talking that patients value enormously and that are so important in chronic disease. When targets are set the measurable always displaces the immeasurable.

There are other less obvious, but no less serious, adverse effects of centrally determined targets. The implicit contempt for the competence and motivation of the professionals in the service is profoundly demoralising. A recent study by Frank Blackler, of Lancaster University, confirmed what one might have expected — that the target culture has led to poor leadership and paralysis among hospital trust managers. And it is not difficult to imagine the impact on clinicians who are at the receiving end of its puerile simplifications, remote from the complex realities of clinical care.

The assumption that clinicians will not try to improve their services without political “incentivisation” — carrots and Semtex — is profoundly irritating, not to say exasperating, for those who have being trying to improve their services for many years and found the experience to be rather like riding a bicycle up a sand dune. To be finger-wagged into doing something that one has been endeavouring to do without support is almost as bad for morale as being forced to act on priorities determined by political rather than clinical need.

And then there is the dangerously distracting effect of changing targets — one aspect of the unending “redisorganisation” of healthcare. The Healthcare Commission criticised the management of Stoke Mandeville for “taking their eye off the ball”. More likely they were transfixed by a particular ball — the political agenda — that was in constant, unpredictable motion.

Targets are also corrupting, creating a parallel world of delivery that is remote from the real world. In the Soviet Union, when targets for screw production were set in terms of the numbers of screws produced, factories manufactured millions of screws the size of iron filings. Target met. When targets were set according to weight, the factory workers produced one massive screw. Target met. It is hardly necessary to say that this did not add to the wealth of the country.

Will the Stoke Mandeville outbreak be the beginning of the end of the micro-mismanagement of public services that has been such a feature of new Labour? It is devoutly to be wished. Though it may require the unfolding fiasco of NHS information technology — brewed in No 10, constantly exposed to political interference and rarely reality-checked with professionals expected to use the systems — to reach a climax before arrogance-inspired “reforms” come to an end. By then, I fear, the damage done may be irreversible.

Source



Another health coverup in Australia



"Queensland Health's Code of Conduct prohibits staff from releasing information to the media that has been obtained in the course of their duties without appropriate clearance. As well, there are a number of legislative and policy requirements that prevent staff from releasing information about Queensiand Health clients, staff and business affairs"

[Above is an excerpt from the] document that has gagged health staff across Queensland. While the Beattie Government boasts of a new "commitment to transparency" in Queensland Health, employees are terrified to speak out about problems for fear of losing their jobs. The Sunday Mail has been inundated with calls from doctors and nurses who want to raise concerns but say they are too afraid. Bosses insist they adhere to a code of conduct that states: "Only staff authorised by the director-general can speak on behalf of Queensland Health."

In contrast, a new Government "Keeping Our Promise" brochure, delivered to Queensland residents at a cost of $300,000, states: "We have delivered commitment to transparency."

But doctors warn the concealment culture that enabled Bundaberg surgeon Jayant Patel to botch so many operations still exists. The Australian Medical Association said staff needed to be able to speak out for the safety of patients. Queensland president Zelle Hodge said: "Despite what the Government says in its brochure, our members are telling us that this closed culture is still there. "In any organisation there is a degree of commitment to that organisation, but in health the over-riding commitment is to the patients. "If there is some adverse event happening and clinical staff are too frightened to talk about it, then obviously there is a risk to patients."

One doctor said: "The Government is hypocritical to say that Queensland Health is a transparent organisation when employees are being gagged. No one will speak out about any problems because they are running scared. Some people even think bosses will go as far as to trace calls to the media."

Queensland Nurses Union secretary Gay Hawksworth said she had been in discussions with the Government about the brochure. "We want our members to know that they can voice any concerns about patient care with us," she said.

Last year's inquiry into the Bundaberg Hospital scandal found that a "concealment culture" had influenced staff to shelve concerns to protect the Government. It resulted in vital information about hospital waiting lists and key data on the performance of health facilities being concealed. A spokesman for Health Minister Stephen Robertson said the Government was providing the public with "more information on hospitals than ever before". "That's why hospitals employ PR people. We are proving we have a commitment to transparency.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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13 August, 2006

NHS drug error 'crackdown' urged

Hospitals have been told to do more to cut out medication errors after figures showed 40,000 mistakes a year are made. Most errors caused no harm, but 2,000 led to moderate or severe harm, or death, as in 36 cases. The Healthcare Commission urged the NHS to improve how it prescribed and dispensed drugs as it published ratings for all 173 hospital trusts in England. The watchdog classed 85 trusts as fair or weak. NHS chiefs said hospitals needed to be honest about the problems.

The medication errors figures, given to the Healthcare Commission by the National Patient Safety Agency, cover incidents in England and Wales the 12 months to July. They showed about 80% caused no harm, 15% low harm and 5% moderate or severe harm. Only 18 trusts in the watchdog's review of medicines management were rated as excellent, while 70 were good, 73 fair and 12 weak. The Healthcare Commission said more needed to be done to discuss side effects with patients, to give out written information as required by law, and to minimise risks from injected drugs.

Trusts were measured in 21 areas, including whether patients had had a comprehensive medicines review and if they had a complete medicine record for their stay in hospital. The review did find areas of good performance, including 40% of trusts prudently using antibiotics to help cut MRSA rates. But the watchdog said there was a need for improvement, including making sure patients understand the purpose and potential side effects of medicines.

The report said pharmacists also needed to spend more time on the wards to minimise errors, with 11 of the 12 trusts that scored weak overall performing poorly in this area. Other areas needing attention included hospital patients not being given control of their medicines, even though they managed perfectly well at home - 69% of trusts said this was not possible on a fifth of their wards.

Parkinson's disease patients were cited as a group who often preferred managing their medication as timing of dosing is vital. Commission chief executive Anna Walker said while many trusts were getting the basics right, there was still "some way to go when it comes to involving patients in decisions about medicine". "Trusts need to do more talking to patients about their medicines and their potential side effects. "They need to make sure patients feel empowered to discuss any concerns."

Steve Ford, chief executive of the Parkinson's Disease Society, added: "Difficulties could be avoided if ward staff had a better understanding of the condition and of why the timing of Parkinson's drugs is crucial."

Maria Nyberg, policy manager at the NHS Confederation, which represents NHS trusts, said there were some examples of good practice, but the publication was a positive as "identifying weaknesses or problems" helped to tackle them. "The only way the service will achieve real improvements for patients is by being frank about the problems and challenges that it faces." And a Department of Health spokeswoman added: "Hospitals are working very hard to ensure that patients are getting the most from their medicines. "There is, however, room for improvement in some areas."

Source



MORE QLD HEALTH REVELATIONS

Two current articles below

Little improvement at Queensland Health despite increased funding

Queensland public hospitals are continuing to report insufficient staff numbers, staff fatigue and reduced and restricted services, says leaked internal Queensland Health documents. The documents, dated July 21, not only identify current shortages being experienced in public hospitals, but predict these will continue into next year. In response to questions about likely future impact of current employment status and vacancies, hospital administrators have written "lack of physicians is compromising surgery; service unsustainable in current form; insufficient medical officers to support ongoing total services and sustain safe roster; and significant fatigue of core staff". Another question asking whether shortages of medical staff are anticipated in January 2007 finds that little improvement is expected.

At the beginning of the year, Premier Peter Beattie said he would quit his job by the end of the year if the crisis affecting the state's hospitals was not fixed. This pledge was later withdrawn by Mr Beattie, who in March declared his Government had "turned the corner" in its efforts and had "made very significant advances".

Health Minister Stephen Robertson said yesterday the figures, contained in minutes and attachments to Queensland Health's Central Area Medical Workforce Advisory Group, were "in line with what the Government has been saying publicly for months". "We continue to recruit aggressively, but we need more doctors as there are several vacancies that still exist. That is why the Premier and I led two separate overseas recruitment drives this year," Mr Robertson said. "Latest figures show there are 4863 doctors in our public health system - that is an increase of 311 on June 2005. "As our recruitment efforts progress, we continue to target the key medical vacancies that exist in our hospital such as emergency medicine, mental health, obstetrics and surgical specialties."

Deputy Coalition Leader and health spokesman Bruce Flegg said the documents were very significant and "remove any doubts that nothing has changed". "Mr Beattie has not fixed the system and continues to cover up the real position," Dr Flegg said. "There is a threat to services across the board because the Government has failed to reform the culture of Queensland Health. It is far too bureaucratic and there is enormously low morale."

Source



One victim of negligent Queensland Health regulators



Jack McDougall thought he was one of the lucky ones after federal Nationals MP De-Anne Kelly's claimed in Parliament that Mackay Base Hospital had allowed a surgeon to undertake operations he was not fit to perform. Mr McDougall, 45, was in pain for almost a year after about 10mm of mesh was left rubbing against his abdominal muscles.

Abdalla Khalafalla performed a double hernia operation on Mr McDougall on February 15 last year. Despite repeated post-op consultations with Dr Khalafalla, during which he was advised to "wait it out", Mr McDougall opted to pay for a private surgeon. "When they went in to do it they saw about 8 to 10mm of mesh was rubbing . . . so they nipped that, pulled the extra mesh out and I was as good as gold," he said. Mr McDougall said he considered himself lucky because his affliction was relatively minor. "Some of the other cases she (Ms Kelly) talked about sounded a lot more serious. It makes you wonder."

The Courier-Mail tried to contact Dr Khalafalla yesterday, but a Queensland Health spokeswoman said he was still "too upset" to speak publicly about the matter. But Craig Margetts, the district executive director of medical services, said the hospital had responded correctly to concerns raised by Dr Khalafalla's peers. Dr Margetts said the situation in Mackay was far removed from that of Jayant Patel in Bundaberg. "There are a number of differences (to the Patel case), the first and probably most important difference is that Dr Khalafalla himself has been very co-operative and has been working very strongly with us in terms of making sure that his range of practices are limited to very safe procedures," he said.

Dr Margetts said he was not aware of any problems with Dr Khalafalla's competence before he arrived in Mackay. Bundaberg Patients Support Group founder Beryl Crosby yesterday urged patients to come forward with their experiences at Mackay Base Hospital.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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12 August, 2006

SLOW COLLAPSE OF GOVERNMENT HEALTH SERVICES IN AUSTRALIA

Two current articles below from Queensland and two from Victoria

MP accuses Egyptian surgeon

North Queensland hospital has been accused of allowing an incompetent surgeon to perform unauthorised operations, with dangerous consequences for a host of patients. In a case certain to draw comparisons with Bundaberg's Jayant Patel affair, it has been alleged that an Egyptian-trained surgeon, known only last night as Dr Khalifallah, performed operations at Mackay Base Hospital against expert advice.

Federal Nationals MP DeAnne Kelly told Federal Parliament last night that Dr Khalifallah was employed by Queensland Health in 2004 and by July last year the hospital's credentiality committee determined he must be supervised during all major surgery. "Within four weeks he undertook three major surgical cases without supervision, with complications arising," she said. Ms Kelly said that in one case the removal of a bowel tumour resulted in faecal matter entering the intestinal cavity.

In November last year, the hospital wrote to Dr Khalifallah directing him to cease performing elective abdominal surgery altogether and emergency abdominal surgery unless he had consulted superiors. Ms Kelly said duty of care to patients was overlooked because the hospital reversed its position out of fear that Dr Khalifallah would lose his job. Earlier this year, Ms Kelly said the Royal Australasian College of Surgeons contacted the hospital again, listing a host of operating and clinical errors.

The cases detailed included: botched keyhole surgery; performing a procedure in a ward which should have been done in an operating theatre; wrongly ordering "no further visiting" for a patient, who subsequently - after intervention from staff - required five to six operations; claiming a cow kicking a patient was the cause of post-operative complications and tampering with surgical notes to "cover up" that he had operated alone.

Despite being backed by the hospital's director of surgery Raad Almehdi to return to full duties, Dr Chris Perry from the college wrote to the hospital on July 19 this year warning of serious concerns about Dr Khalifallah. A spokesman for Queensland Health Minister Stephen Robertson last night said: "We are aware of the case and appropriate undertakings have been put in place. The doctor is working under close supervision by senior doctors and he has been on restricted practice since February."

Source



Intensive care shortage in Queensland

The Queensland Government has conceded that hospital intensive care units had too many patients and not enough beds in the state's southeast on Monday night. Opposition Leader Lawrence Springborg yesterday quizzed the Government in Parliament over claims that after 8pm Monday not one intensive care unit bed was available in any ward south of Nambour on the Sunshine Coast. Mr Springborg said patients on life-support systems were put in corridors and ambulances were put on bypass. "Minister, if that is the present situation in our hospitals, isn't there going to be a major crisis when the flu season strikes in earnest and what will happen if a major incident occurs?" Mr Springborg asked.

Health Minister Stephen Robertson said he had been advised that only two patients in the whole of southeast Queensland could not immediately access a hospital intensive care bed. But he said it was true that all available staffed ICU beds in both public and private hospitals in southeast Queensland were full on the night. He said the two patients at Royal Brisbane and Women's Hospital who could not immediately access an ICU bed were kept ventilated and cared for in the emergency department.

Source



Melbourne ambulance service deteriorating

Health Minister Bronwyn Pike is under fire for claiming ambulance emergency response times are on target. The claim comes just weeks after Herald Sun reports highlighting growing delays and a state Budget report that found emergency response targets had been missed by an average of two minutes. Opposition health spokeswoman Helen Shardey accused Ms Pike of misleading Victorians and Parliament. Ambulance Employees Association boss Steve McGhie said all the evidence from paramedics and data seen by the union showed response times were getting worse.

Responding to a question from a government MP on improvements to ambulance services, Ms Pike said Melbourne's ambulance service now ranked among the best in the world. She said money provided had more than doubled to add 652 extra paramedics, 54 extra ambulances and to upgrade and build new ambulance stations. "While caseloads are up -- 64,000 additional emergency services in metropolitan Melbourne and 30,000 extra emergency services in rural areas -- response times are on target," she said.

The May Budget reported that the ambulance response time for 90 per cent of code one emergencies in metropolitan Melbourne was two minutes slower than the 13-minute target for 2004-05 and was expected to be 14 minutes in 2005-06. Statewide, response times were also two minutes slower than the 15-minute target for 2004-05 and were expected to be 16 minutes in 2005-06.

"If the Minister is referring to the past then I'm astounded she is claiming the response times have been on target because clearly they have never been met by this Government," Ms Shardey said. "And if she's referring to this current year she must looking into her crystal ball because we are only six weeks into the current year." A spokesman for Ms Pike said when the impact of lengthy industrial action in 2004-05 was allowed for, the target had been met.

In May the Herald Sun revealed ambulances called to emergencies took at least 20 minutes to respond on more than 900 occasions in Melbourne last year. Documents seen under Freedom of Information revealed Sunbury was the worst-hit suburb, with 60 delays, including one 77-minute wait for a patient with breathing problems. Leaked ambulance figures revealed that just 68 per cent of metropolitan Code One emergency calls were reached within 14 minutes in March, 74 per cent in February and only 72 per cent in January.

Source



Hospital waiting lists in Victoria

Health Minister Bronwyn Pike has attacked the Liberals for using sick people as political pawns -- but conceded the tactic could get them treatment sooner. Her comments came amid growing political controversy over the number of people on hospital waiting lists.

Ms Pike defended the handling of the case involving 11-year-old Georgia Duncan, who suffers a life-threatening illness and is fed through a tube. Georgia's family say they were told she would have to wait from six to 18 months for surgery to improve her mobility, but Labor and the Royal Children's Hospital say she had only been on the waiting list for nine days and would have to wait for up to three months.

Her case has sparked a political row, and Ms Pike accused the Liberals of using Georgia and her family as political pawns -- but then admitted the strategy could help her get treatment sooner. "When people draw public attention and the Government's attention to their particular plight it does give an opportunity, as it does when you go to your doctor, to have a reassessment," Ms Pike said. "We genuinely care that people do have the opportunity to be reassessed if they are in pain."

The Opposition has set up a phone hotline for Victorians who have been left languishing on hospital waiting lists. But Ms Pike said the Liberals are giving false hope to sick people and called on them to release the details of those who had called the hotline. "It's not up to the Opposition to set themselves up as some kind of quasi-triage operation," she said. "I . . . am open and accountable about the fact that our system doesn't always provide the most timely care for some people. "We know we have to improve it. We are committed to improving it . . . but there is a lot more work to be done."

Royal Children's Hospital spokeswoman Julie Webber said Georgia was always listed as a category two patient. "Before this time, Georgia was not on a surgical waiting list and therefore not classified," she said. Opposition health spokeswoman Helen Shardey said Georgia's case was systematic of a public health system in crisis, but she refused to detail what policies the Liberals would put forward.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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11 August, 2006

INCREDIBLE NHS BUNGLE

But what an incredible survivor the baby is!

A health board has launched an investigation after a mother underwent an operation to remove her "dead" unborn baby only to be told three weeks later that she was still pregnant. Julie Brown, 28, is considering legal action against hospital directors after she was informed wrongly that her baby had died and was given an operation under general anaesthetic to remove the child.

Mrs Brown, from Livingston in West Lothian, said yesterday that she was given a scan five and a half weeks into her pregnancy after suffering from stomach pains. She was told by medical staff that the baby's heartbeat could not be found and that the child had died inside her. The next day she checked into St John's Hospital, in Livingston, for dilation and curettage treatment to remove the dead child, a highly invasive procedure that involves scraping the uterus lining.

She said that her husband and two children had been devastated when they were told that the baby had died, especially her eight-year-old daughter. Mrs Brown, who had already suffered two miscarriages, said: "I had to explain to my two kids and my husband that the baby had died and they were in floods of tears. "Sarah was distraught because she was so much looking forward to having a baby brother or sister to look after."

However, last week Mrs Brown went to see her GP because she was still suffering from sickness and other symptoms of pregnancy. Blood tests showed that pregnancy hormone levels were still very high and she was sent to hospital for a scan this week. She said: "A scan on Monday showed my baby was still intact and growing healthily. I was confused, angry, worried and elated all at the same time." Mrs Brown, who is now nine weeks pregnant, said that she was considering legal action against NHS Lothian. "The hospital has given me no reasons or answers, they have told me absolutely nothing. I don't know how it has happened," she said. She added that she was worried because pregnant women should not be given a general anaesthetic or undergo surgery that could damage the foetus. "I will be constantly worrying until I give birth to the baby and see that it is all right because I have been given a general anesthetic, painkillers and antibiotics," she said.

Mrs Brown's husband, Dan, 28, said: "It's ridiculous that something like this can happen. It's going to be a difficult time but I'm sure we will get through it." He added: "I just don't know how this could have happened with such a violent and intrusive operation."

NHS Lothian apologised to Mrs Brown over the mistake yesterday and said that it had started an investigation. Mike Grieve, the director of operations at St John's Hospital, said: "I immediately wish to apologise for any distress to Mrs Brown and her family. "We have not yet received a formal complaint but an informal investigation was launched as soon as her case was brought to my attention." He added: "It would be inappropriate of me to comment on the specific circumstances while this is taking place."

Source



Medical Board faces multi-million-dollar payouts over bogus psychiatrist

About time

The advisory board that allowed rogue surgeon Jayant Patel to operate is now facing multi-million-dollar lawsuits over the treatment of hundreds of patients by a bogus Russian psychiatrist. In the first court case against the Medical Board of Queensland arising out of the so-called Dr Death scandal, three patients of Vincent Berg are seeking damages over his counselling and the medication he prescribed for their conditions. The lawsuits were filed this month. Mr Berg, 54, is undergoing treatment at a psychiatric ward on the Gold Coast.

A teenager who is one of the claimants in the civil action was diagnosed as having a mental condition by Mr Berg during a home visit to his mother. Mother and son have claimed they were prescribed dangerous and inappropriate drugs by Mr Berg, who treated 259 patients during his year's employment at Townsville hospital in 2000.

Despite hospital authorities learning that Mr Berg's Russian qualifications were fake in late 2002, his former patients were informed only through the Morris and Davis inquiries that arose out of the Dr Death scandal. The inquiries heard that authorities took the decision not to tell patients about Mr Berg because they feared it could lead to them stopping their medication and counselling or even attempting suicide. A Queensland Health spokesman said an immediate review was launched of "all of MrBerg's patients that could befound".

The three former patients - one of whom claims she has attempted suicide three times as a result of Mr Berg's treatment and medication - are seeking more than $1 million in damages. It is understood more of Mr Berg's former patients are also considering legal action. Any payouts would come from Queensland Government's insurance fund. The patients have been forced to file the court actions after being excluded from the special mediation process extended to former patients of Dr Patel, who is now living in the US.

Earlier this week, Queensland Attorney-General Linda Lavarch said 86 claims for compensation by patients of Dr Patel had already been settled. Almost three hundred patients are understood to be involved in the out-of-court mediation.

In the court action, the Medical Board has been accused of failing to check that Mr Berg's qualifications, purportedly from a Russian university, were "true and not forgeries". The Medical Board is charged with checking doctors' qualifications before registering them for practice. A spokeswoman for the board, which is funded by registration fees, declined to comment because the matters were now in "the hands of the insurer". The lawsuit claims that Queensland Health also failed to supervise Mr Berg adequately. Tia Cox, whose firm Connolly Suthers is representing all three alleged victims, declined to comment.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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10 August, 2006

THE NHS "LOTTERY"



Patients are being denied fair access to drugs and treatment because of wide variations in NHS spending, with some trusts providing nearly four times the amount of money for mental health and cancer care as others. A report published today by the King’s Fund, the independent think-tank, highlights “serious questions” about the postcode lottery of care across England, health economists said. Even when the socio- economic needs of local people are taken into account, there is still wide variation in primary care trust (PCT) spending on mental health, cancer and circulatory problems. After adjusting for such factors, Islington PCT spends 259 pounds a head on mental health — about four times the 66 pounds spent by Bracknell Forest PCT.

The proportion of PCT budgets spent on cancer also varies widely across England — from 3 per cent to more than 10 per cent of the overall budget.... But the report noted that higher spending PCTs would not necessarily offer the best quality of care, depending on how efficiently money is spent. PCTs are in charge of about 80 per cent of England’s NHS budget, about 58 billion a year.

The report, Local Variations in NHS Spending Priorities, said that the three government priority areas of heart disease, cancer and mental health consumed the largest share of PCT spending. The analysis focuses on data from 2003-04 to 2004-05 and highlighted a two-fold difference in spending on mental health a head across 90 per cent of PCTs. Mental health absorbed 7 billion — about 11 per cent of PCT spending — which was twice the amount spent on cancer care.

The report found differences in spending that appeared to be only partially explained by the different needs of their local populations, raising questions about why PCTs made different decisions about spending priorities, and whether spending variations had adverse effects on equity and efficiency. John Appleby, chief economist at the King’s Fund, said: “This new data is very revealing, and raises serious questions about the consistency of decisions PCTs make about how much they spend on different diseases. “However, a proportion of the variation in PCT spending will not be a result of deliberate choices by PCTs. “Variations in clinical decisions about who and when to treat, and what treatment to provide, and differences in the efficiency of hospitals, contribute to the variations in PCT spending.”

Nigel Edwards, director of policy at the NHS Confederation, said that the problems highlighted were common across the health systems of most developed countries. “The Department of Health’s programme budgeting initiative is one of the first times that this data has been made available and primary care trusts will need to investigate it further before it is clear what the appropriate action is. “It is right that local health services meet the needs of local patients and, therefore, important to understand that a consequence of this will always be variations in spending.”

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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9 August, 2006

"Emergency" overload

The "free" end of U.S. health care shows the usual symptoms

Demand for emergency department (ED) services at U.S. hospitals is surging. As a result of this upsurge, EDs are confronting a crisis. They do not have the capacity to deal with rising demand. Due to federal regulations that require EDs to treat any patient who enters, hospitals have struggled to manage such overcrowding. Overcrowding is most often attributed to the inability of emergency departments to transfer admitted patients to inpatient beds, according to a report by the Government Accountability Office. Therefore, hospitalwide capacity problems are driving overcrowding in EDs. There are two causes of this phenomenon:

1. Supply. Supply-side factors have exacerbated overcrowding:

-- Efficiency measures. In response to the pressures of managed care and lower reimbursement from Medicare and private payers over the past 15 years, hospitals have reduced their number of beds to improve efficiency. Hospitals have also closed less profitable units or converted them to specialized units, leaving less overall inpatient capacity to absorb ER admissions.

-- Nursing shortages. Even hospitals that have enough beds often suffer from staffing shortages.

-- Discharge. Skilled nursing facilities and home health services have seen a decrease in investment and are facing financial problems, resulting in fewer discharge options. This puts further strain on inpatient capacity.

2. Demand. Factors on the demand side are also fueling the overcrowding problem:

-- HMO management. A political backlash against health maintenance organizations (HMOs) in the late 1990s led to a relaxation of their policies on emergency care, which stimulated more ED use by HMO patients.

-- EMTALA. The Emergency Medical Treatment and Active Labor Act requires ambulance services and hospitals that receive Medicare reimbursement to provide emergency care to anyone.

-- Aging population. As baby boomers grow older and sicker, demand for emergency care is increasing.

-- Non-emergent visits. Less than half of all emergency visits are classified as "emergent" or "urgent."

-- Increased utilization. Many policymakers assume that the rising number of uninsured people is primarily responsible for driving the crisis. However, a recent study by the Center for Studying Health System Change concludes that most of the increase in ED use is due to more visits by insured patients.

Overcrowded EDs have several deleterious effects on patients and hospitals:

-- Lower perceived quality. Higher waiting times for examination and admission leave patients less satisfied with treatment.

-- Compromised care. EDs are primarily designed for emergency care. Non-emergent visits detract from this task.

-- Costs. ED treatment is expensive, relative to other ambulatory services. Increases in non-emergent visits to the ED raise costs that may spill over to all patients.

Capacity constraints highlight other related challenges facing the U.S. health care system, including:

--unchecked demand and overconsumption of health services among the insured; and

--inadequate access to primary care for the uninsured.

Individual hospitals are attempting to address issues of overcrowding by expanding EDs and raising efficiency. This should help in the short term. However, in the long run, more fundamental reform will be needed. The ED experience shows that the alternative of universal insurance coverage will not solve problems of demand. Market-oriented approaches, in combination with government-led reforms, may offer a more comprehensive solution.

The ED capacity crunch highlights the chronic problems of unchecked demand, overconsumption created by the third-party payer system of heath insurance and inadequate access to primary care by the uninsured. The pressure for a more concerted legislative attempt to reform the system will grow during the 2007-2008 Congressional term.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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8 August, 2006

ANOTHER DEATH FROM THIRST IN A NHS HOSPITAL

For many of the frail elderly, the doctors give them heroin (diamorphine) to knock them out and then leave them to die

A coroner investigating the death of a woman allegedly starved and deprived of fluids in hospital has been asked to hold an inquest into the death of a patient on the same ward. Relatives of Harold Speed believe that he died of dehydration, not pneumonia as his death certificate says. The 84-year-old former music teacher had been examined by the same doctor who treated Olive Nockels, who died after her drips were removed. “The whole of my husband’s stay in hospital was a nightmare,” Kate Speed said. “They put bronchopneumonia on the death certificate, but I believe his death was from the effects of dehydration.” She has asked William Armstrong, the coroner, to examine her husband’s death. Mr Speed and Mrs Nockels were patients on Kimberley ward at Norfolk and Norwich University Hospital.

Last month David Maisey, a consultant physician, astonished the inquest into Mrs Nockels’s death when he said that he saw people die of dehydration “all the time — two or three times a week”. The hospital has offered Mrs Speed compensation over her husband’s death. “They asked me for a figure but I was afraid it was tactical and that they would then not have to answer questions. Just pay, and I would never know the truth of what happened,” she said. She wants Mr Armstrong to investigate how many other complaints might have been lodged by patients’ families over the withdrawal of fluid and food.

Mr Speed was admitted to hospital on October 16, 2004, after suffering a heart attack. While there he developed pulmonary oedema and was given diuretic therapy to rid him of the fluid on his lungs, and marked “nil by mouth”. Mrs Speed said that when she visited her husband on October 24 his condition had deteriorated. She said that she threw “an absolute wobbly”, accused the hospital of dereliction of duty and demanded to see a doctor. “His eyes were dry, sore, flat and sunken. I tried to moisten his mouth. I asked why he was so drowsy and was told it was perhaps due to the diamorphine he had been given. The doctor said he was very dry and picked up the flesh from his neck. It was like picking up a sheet. His veins were flat and there was an absence of mucous . . . these were classic signs of dehydration. I was in tears for him. There had been such a decline from the time he was admitted, but the doctor told me he could not have an intravenous drip because it would be too painful.”

The hospital agreed on October 25 to give Mr Speed a subcutaneous infusion, where fluids are administered under the skin, and to lift the nil-by-mouth order. This was reversed on October 30 on the ground that he had aspirated liquid. Mr Speed died on November 2. Mrs Speed told the coroner in a statement that she saw Dr Maisey the day before her husband died. “I had a very terse conversation with Dr Maisey, who came to see my husband only when I dragged him out of reception. He did not physically examine my husband . . . he just turned my husband’s softly playing radio off, returned to the foot of my husband’s bed and told me Harold had had ‘the beginnings of a heart attack’ way back on October 16, and he was going to give my husband some potassium in an IV, and went. We trusted, and he trusted, that the hospital would treat him well, instead of which there was a catalogue of error and apathy that led to his death, unless of course, there had been a decision, which I had no share in, that his life should no longer be preserved.”

Mr Armstrong has adjourned his inquest into Mrs Nockels’s death. Chris West, her grandson, said in a statement to the inquest: “I said I wouldn’t treat my dog like that and [Dr Maisey] said it was easier for vets because they had alternative means and can ‘put animals to sleep’.” Gillian Craig, vice-chairman of the Medical Ethics Alliance, said: “Any hospital or ward where patients are said to die of dehydration ‘all the time — two or three times a week’ should be the subject of a police inquiry.”

In his evidence to the inquest, Dr Maisey said: “The prognosis was very poor. Mrs Nockels was almost certain to die . . . within the next few weeks. To have put any food or liquid in her mouth would have led possibly to asphyxiation.”

Yesterday the Norfolk and Norwich University Hospital NHS Trust denied that Mr Speed was dehydrated when he died. It had previously been said that he had been dehydrated after his five days without fluids. Andrew Stronach, a spokesman for the hospital, said: “Part of his treatment involved diuretic therapy to address his subsequent cardiac failure. This was necessary as fluid overload can trigger further cardiac failure. This did lead to moderate dehydration that was addressed by giving him fluids and suspending diuretic therapy. “He remained well hydrated and was being intravenously given fluids and antibiotics for his chest infection when he died. Dehydration did not contribute to his death. The cause of death was bronchopneumonia with cerebrovascular disease and [heart attack].”

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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7 August, 2006

Heart patients get fake drugs supplied to NHS pharmacies

Counterfeit copies of Lipitor, a drug taken by more than a million Britons for cardiovascular conditions, have entered the NHS supply chain. Drug regulators are attempting to track how fake versions of the statin were supplied to chemists and reached “patient level”. It is not known how many people may have taken the fakes, although the drugs in question are not thought to pose a serious risk to health.

A total of 320 fake packets, marked with an authentic Lipitor batch number — 004405K1 — have been discovered since the arrest in June of two men who are the focus of a criminal investigation. The same batch was subject to a national recall a year ago when 73 packets were discovered — the first time that counterfeits of a drug used for conditions as serious as heart disease had been detected in the legitimate supply chain.

The Times understands that there are broader concerns about the criminal network linked to the men arrested, and attempts to exploit other areas of the statin supply chain. The Medicines and Healthcare products Regulatory Agency (MHRA), which issued a second recall in the past fortnight after the discovery, is to adopt a national strategy next month to combat the trade in counterfeit medicines. Estimates from regulators in the United States suggest that 15 per cent of imported pharmaceuticals contain unapproved substances. Thousands of patients in developing countries are thought to have died as a result of medicine counterfeiting in recent years.

The Lipitor discovery is the fourth time in ten years that fakes have been detected in the drug supply chain in Britain. Experts are becoming increasingly concerned that criminal networks are exploiting the market in statins, which are taken by millions of people to lower cholesterol. The two Lipitor incidents involved the counterfeiting of a batch of 120,000 packets. Each packet contained 28 Lipitor pills of 20mg and were worth about 28 pounds. The fakes were found to contain a statin not marketed in Britain. Mick Deats, the head of enforcement and intelligence for the MHRA, said: “Our testing of the counterfeit product indicates that there is no immediate risk to patients, but we cannot guarantee its quality.”

The latest recall was sent to 20,000 chemists and shops. The two men who were arrested in June are on police bail. The discovery of paperwork at premises used by the men led investigators to a wholesaler in North London, and to pharmacy clients. Neither the wholesaler nor the pharmacists are accused of wrongdoing In a business plan published last week by the MHRA, Kent Woods, its chief executive, outlined significant concerns about counterfeit products and internet sales. Describing the “increased threat across the world”, he said that international relationships needed to be developed and “as much disruption as possible created to illegal and unsafe trade”. The report says that an anti-counterfeiting strategy will be in place by September aimed at criminals importing, distributing and supplying fake drugs. Market surveillance, co-operation among regulators, increased public awareness and more forceful prosecution are the main plans of attack.

Pfizer, which makes Lipitor, said that it was working with regulators to determine how the criminals were operating and to help to thwart them. “Pfizer’s first concern is for patient safety and takes counterfeiting of medicines extremely seriously,” it said. “[The company] has introduced a number of policies and technologies to protect the integrity of its medicines, including the phased introduction of tamper-evident packaging, and is aggressively addressing this issue to ensure that patients can remain confident that they are taking genuine Pfizer medicines. “This discovery serves as a strong reminder of the vulner-ability of the medicines supply chain in much of Europe. Patient safety can only be maintained with a secure and safe medicines supply chain, which requires anti-counterfeiting efforts by all stakeholders.”

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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6 August, 2006

Kerry offers same-old-same on healthcare

As usual, John Kerry has a pretty fair grasp on a problem, but the wrong solution. In an op-ed piece in Monday’s Boston Globe, the junior Senator from Massachusetts exhorts his readers that it’s time for “Getting moving on healthcare.” He correctly identifies the trend by big business, led by the likes of Wal-Mart and General Motors, to escape from the bondage of employee-benefit healthcare, thereby separating individual choice and responsibility from the institutionalized hegemony that has been a large contributor to the price-inflation and general misuse of wellness in our society. As he notes in the column, “it shouldn’t be a surprise. Good corporate citizens [sic] are coping with a competitive disadvantage in the global marketplace. GM pays $1,500 in healthcare costs on every vehicle it manufactures. Toyota pays only $200.”

Kerry also correctly sees the problems of the current system, declaring that, “We’re stuck with a 20th-century healthcare system that just doesn’t work for a 21st-century economy. The traditional employer-based healthcare system can no longer meet all our needs. Costs are too high, and businesses overseas are operating on a whole different playing field.” He notes the rise in healthcare costs, and that “[u]nder this administration’s watch, the number of uninsured Americans has grown by 6 million and premiums are up a whopping 73 percent.”

But now he falls off the track, calling immediately for “big ideas and bold solutions” to “make sure that all Americans benefit.” After deeming the corporate moves a bad trend, he calls for his own solution: a federal reinsurance plan to cut business costs for catastrophic care, universal coverage for all children … and more universal coverage, for everyone else who currently remains “uncovered” – whether by choice or by necessity. So much for finding a solution, instead of covering up the problem with more red-tape and bureaucracy.

Although Kerry does say he wants to bring about this latter condition by using “targeted tax credits for small businesses, middle-class families, and people between jobs,” he still seeks to socialize the process, thus benefiting the insurance industry, the Big Pharma companies, the profligate hospital-builders and the federal bureaucrats – the same sectors of society who’ve been the major players in letting the situation become the entangled mess it is today. (He does suggest that the health plan now enjoyed by members of Congress would be a good model to follow; however, his plan for paying for it is the usual “repeal Bush’s tax cuts for the rich” nostrum. Exactly who does he think those “targeted tax credits” would be going to?)

This editor is getting tired of repeating it, but the answer to healthcare reform does not lie in shuffling the deck chairs, but in shifting the entire focus from “disease care” to “wellness” – away from the insurance and chronic aftercare models of a society of helpless children, and toward the savings plans and other preventative measures that responsible adults should embrace. General Motors, and to some extent Wal-Mart, are among the companies showing the way to move in that direction, whatever their motives otherwise. On the more progressive libertarian side, Whole Foods Markets even pays its employees to encourage frugal use of health dollars, by making them their own in the amount of a deductible, allowing them to choose and pay for their own coverage policies under the company umbrella.

Meanwhile, with the encouragement of medical savings accounts, incentives promoting healthier living in general, and a focus on examinations and pre-testing (to discover ailments at their inception instead of deep into infestation) … the whole paradigm might be shifted, with at least a prayer of finding a real answer.

Kerry would do far better, if he truly wants to see a transition out of this mess, to take a page from fellow Democrat Tennessee Governor Phil Bredesen, who has at least put something a little new on the table with his Cover Tennessee approach. If nothing else, this partially subsidized program, due to begin enrollments later this year, offers working folks a portability option as well as an affordable bare-bones coverage level, instead of just another government program from the same folks who tried to bring us Hillarycare over a decade ago.

Of course Kerry never had to deal with the pilot program for that monstrosity, as Bredesen is still doing with TennCare. Maybe it took that kind of rude awakening to get someone in power to look outside the box for a change. Amazing what seeing reality up close and personal can do, even for a politician’s perspective!

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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5 August, 2006

"PAY FOR PERFORMANCE"

A Cato press release:

In response to growing concern over the quality of medical care in the U.S., Medicare is experimenting with "pay-for-performance" (P4P), a financial incentive that rewards health care providers for recommended care. A new Cato Institute working paper to be published in the Yale Journal of Health Policy Law & Ethics, however, finds that P4P is an unproven tool for improving quality and carries significant potential for harm.

In the study "Pay-for-Performance: Is Medicare a Good Candidate?" Michael Cannon, director of health policy studies at the Cato Institute, warns policymakers to take a cautious approach to P4P, especially when applying it to Medicare: "Given Medicare's patient population, size, and sensitivity to interest group lobbying, any harm that could result from a P4P scheme would be more likely to occur within traditional Medicare than elsewhere in the health care system." Cannon explains that the high incidence of chronic illness among Medicare beneficiaries "increases the likelihood that a P4P scheme would create incentives to mistreat such patients and turn them into `medical hot potatoes' that providers make an effort to avoid."

Furthermore, Medicare is a creature of the political process. This, the study asserts, not only increases the potential for error at each stage of designing, implementing, and maintaining a P4P scheme, but guarantees congressional and administrative lobbying by providers who seek to protect their own interests in shaping a P4P initiative.

According to Cannon, Congress can harness the potential of provider-focused P4P incentives while reducing the likelihood of harm by confining P4P to private Medicare Advantage plans and by encouraging greater participation in those plans.

In addition, P4P financial incentives can be targeted to patients as well as providers to allow greater transparency. "A weakness of provider-focused financial incentives," Cannon explains, "is that it can affect the quality of care, or even a patient's access to care, without the patients' knowledge. In contrast, patient-focused financial incentives would engage patients in the pursuit of quality, while allowing them to deviate from `best practices' if doing so fits their needs."



HOSPITAL "TOO EFFICIENT" IN BUREAUCRATIZED BRITAIN

An NHS hospital has been penalised for treating people too quickly after its local trusts refused to pay the 2.5m pound cost of clearing a backlog of patients. Ipswich Hospital had been so successful in reducing its waiting lists that it was able to meet current demand for treatment almost immediately. However, the acceleration of treatment breached rules set by the Suffolk East Primary Care Trusts (PCTs), which stated that patients must wait at least 122 days, to ensure that its own resources were not exhausted too quickly.

The Government has set tough national targets in an attempt to get hospitals to cut long waiting lists, and the Department of Health rules state that no patient should wait for more than six months for an operation.

However, hospital staff are outraged that strict adherence to budget targets means that they are being effectively penalised for putting patients first.

A union leader said: "The PCTs have been very unreasonable. They wanted the work done, we did it, and now they should pay for it. If a hospital performs the operation before the 122 days are up, primary care trusts [who pay the hospital to provide operations] are within their rights not to stump up the cash."

A report by external auditors into Ipswich Hospital's 16.7m pound debt crisis found that the trust had lost 2.4m pounds because it performed operations that the PCT would not pay it for. It states: "The trust had spare capacity and, therefore, to ensure its resources were utilised, treated a number of patients in advance of the 122-day rule." The report shows that in 2004-05 the early treatments cost the hospital 240,000 pounds. In 2005-06 the figure increased to 2.4 million pounds. The 122-day guideline was introduced by the three Suffolk East PCTs and is believed to be used by other PCTs in the country, but it is not Government policy.

Jan Rowsell, a spokeswoman for Ipswich Hospital, said: "Anyone who is deemed to be clinically urgent would be seen earlier. This rule is there for people who are waiting for planned surgery." She admitted that the hospital had effectively breached its agreement with the Suffolk East PCTs by treating people more quickly, although she added that the reasons why it had done so were understandable.

Carole Taylor-Brown, chief executive of the Suffolk East PCTs, said: "The whole principle of it is to make sure that patients are seen in turn as they go through the system and to level out waiting times. "It is also about making best use of the money that we have available throughout the year. It would be great if we were fully resourced to do everything. But we are given a certain amount for the year and it's about making sure that were using it efficiently.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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4 August, 2006

HEARTLESS NHS PENNYPINCHING AGAIN

All those bureaucrat salaries have to be paid!

The parents of a toddler who has become deaf in both ears were told by NHS bosses that he could have the hearing restored in one ear, but not in both. However, after The Times asked North Dorset Primary Care Trust (PCT) to justify the decision, it relented and agreed to operate on both ears. The trust denied that the call from The Times had any influence on the decision, which it says it had been considering carefully for some time.

Kirsten and James Harvey, from Stalbridge, Dorset, were relieved that they would not have to spend 8,000 pounds of their own money so that Matthew, who is 2, could hear in both ears. The trust had argued that one cochlear implant would meet Matthew's clinical needs, but that two was a matter of parental choice, for which it was not prepared to pay.

"The benefits of having both implants done together are immense," Mrs Harvey said. "They do this in other countries in Europe, but not universally in the UK. "Matthew's whole development depends on him being able to hear and we think the money should have been available in the first place." Yesterday she said that she was delighted by the latest decision, and said that it should be an example to other trusts around the country, many of which are unwilling to pay for both implants.

Julie Brinton, head of the South of England Cochlear Implant Centre at Southampton University, where Matthew will have his operation, said: "Cochlear implants are a wonderful, amazing technology. They transform people's lives. They're unbelievably important. And having two, rather than one, is an advantage. "They can hear where sound is coming from better, which can be important in things like crossing the road. And they can distinguish voices better against background noise. "Adults who have had two implants say that it's like being back in a three-dimensional world. If a child were simply hard of hearing, you wouldn't dream of just fitting one hearing aid. You would fit two. "We would very much like to give Matthew two implants - it's the right way to go. But we understand the PCT's position. They have difficult decisions to make and they argue that if the money is spent giving one child two implants, another may not get an implant at all."

The procedure is expensive - 36,750 pounds for one implant, of which 15,500 goes on the hardware, and the rest on the operation and diagnostic and follow-up care. If a second implant is fitted at the same time, the extra cost is about 8,000. But if it is fitted later, during a second operation, the cost is much higher.

Ms Brinton said that research in Britain had shown that adults with two implants were better able to locate the source of sounds, and had improved sound perception. The data on children came mainly from research conducted in the United States. This indicated that children given two implants before the age of 3 achieved normal language levels, whereas in the past they would have had to use sign language to communicate.

Source



Fewer procedures, longer waits in Queensland public hospitals

The number of elective operations performed by major Brisbane public hospitals has fallen 16 per cent in the past five years as new figures released yesterday showed a 150 per cent jump in people waiting longer than required. During the past five years, the Beattie Government says it has spent more than $200 million on reducing waiting lists on top of claims it has spent record amounts on health in every budget. Yesterday's figures show the increase in elective surgery funding has delivered fewer operations and longer waits.

According to the latest "Elective Surgery Waiting List Report", 314 people were waiting more than the specified 30 days for urgent category 1 surgery, up almost 150 per cent from 128 people at the same time last year. There were 2703 people waiting more than the prescribed 90 days for semi-urgent category 2 operations, up almost 110 per cent. The 6462 people waiting longer than 365 days for less urgent operations represented a 7 per cent increase on the same period last year.

Health Minister Stephen Robertson was not available to answer questions about the report yesterday. However, in a statement Mr Robertson claimed "a significant increase in demand for life-saving emergency surgery saw the total number of Queenslanders waiting for elective surgery rise by 791". "What these statistics reflect is that our hospitals are busier than ever and are treating more patients than ever before," the statement said. "However, significant on-going growth in patient demand for life-saving emergency surgery continues to affect elective surgery opportunities in our hospitals. "The Beattie Government has undertaken a number of steps to address the challenges facing public hospitals to improve elective surgery performance. "And we're starting to see positive results from the extra $20 million we provided in March to support long wait reduction initiatives."

AMA Queensland president Dr Zelle Hodge said the 16 per cent reduction in surgical activity was "consistent with what our members are telling us". "Royal Brisbane Hospital is cutting 30 elective surgery lists a week because they have insufficient theatre nurses," Dr Hodge said.

Opposition health spokesman Dr Bruce Flegg said the latest figures showed more Queenslanders are waiting for surgery and fewer operations were being done compared to last year. Dr Flegg said, compared with last year, there are 1953 more people on the waiting lists, 1336 less operations and 1970 people waiting beyond the medically recommended time for treatment. "The Government claim to have increased spending on more doctors, more beds and more operations but the figures show less operations," Dr Flegg said. "The money is being spent on appalling management and waste. They have not fixed the system in Queensland and nothing has changed."

One waiting list client, former truck driver Annette Taylor, 41, said yesterday her two-year wait for back surgery was becoming unbearable. Ms Taylor, of Thornlands, said twice in the past two months, her pain has been so severe her local GPs have called ambulances to take her to hospital for urgent treatment and on both occasions she was turned away. "I believe nobody should have to wait more than six months for any operation. I would never have felt this pain this bad if it had been done in six months," she said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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3 August, 2006

CRAP LOS ANGELES PUBLIC HOSPITAL STILL GOING

Because it's mainly black, nobody can really close it down, no matter how many it kills and injures

Federal regulators began their critical inspection of a troubled inner-city hospital Monday to determine if it has fixed the many patient-care problems that have led to patient deaths. A team of 11 inspectors from the U.S. Centers for Medicare and Medicaid Services arrived unannounced at Martin Luther King Jr./Drew Medical Center to conduct the review. The results were due in several weeks.

If the county-run hospital fails any part of the inspection, it could lose $200 million in annual federal funding - more than half its budget. Los Angeles County supervisors say that would force them to downsize the hospital, close it or turn it over to someone else to run.

County and hospital officials say they have implemented a host of reforms at the hospital, including hiring outside consultants to take over operations, recruiting a new permanent management team, disciplining hundreds of employees and spending millions on renovations. "We are cautiously optimistic that the survey will go well," said William Loos, acting senior medical officer with the county Department of Health Services

Source



FUNNY MONEY IN THE NHS

Millions of pounds intended for improving sexual health services are being diverted to pay off debts, a government advisory group said yesterday. The Independent Advisory Group on Sexual Health and HIV said that a substantial part of the 300 million pounds set aside had been absorbed by primary care trusts (PCTs).

A survey for the group found that cash set out in the Choosing Health White Paper is reaching frontline services in only 30 of the 191 PCTs questioned. Fifty-one said that they had absorbed their entire allocation into the general budget, and 33 had withheld some or most of the sexual health funding. A further 40 said that funding had not reached contraceptive services.

Baroness Gould of Potternewton, the group's chairman, said that many trusts were experiencing financial difficulties and that sexual health services were suffering problems such as recruitment freezes and clinics closing. Nick Partridge, the chief executive of the Terrence Higgins Trust, said: "It would be a great disappointment if sexual health was sacrificed on the altar of financial balance in the NHS." The Department of Health said that trusts were responsible for sexual health. "We have provided . . . more sexual health funding than ever before."

Three PCTs in Lincolnshire have closed all family planning clinics and a network of teenage advice centres to help to tackle a 13.5 million pound budget deficit. Jim Moss, of East Lincolnshire PCT, one of the trusts that is making the cuts, defended the decision. "Family planning services are available at pharmacies and GP surgeries," he said.

Source



Deadly delay for public hospital victim

A Central Queensland woman diagnosed with cancer requiring urgent treatment was put on a waiting list at the Royal Brisbane and Women's Hospital and not offered help until after she died. Lynette Williams, 46, of Rubyvale in Central Queensland, died on June 29, a month after her Emerald-based GP told her that tests revealed she had suspected cancer and needed urgent treatment in Brisbane.

Mrs Williams's husband Russell said yesterday the GP made an appointment for her at RBWH on May 31 and she took the scans and medical reports to that meeting. Mr Williams said the doctor at RBWH rang the hospital's cancer unit and was told to book her in for a liver biopsy. "We never got to see the cancer specialists at the Royal. I kept ringing every day to find out when they were going to do the test. They said 'you would get a letter'," Mr Williams said.

The RBWH also put Mrs Williams on a waiting list for an endoscopy and sent her a letter on June 16 scheduling the procedure for July 16 - two weeks after her death. Mr Williams said the hospital eventually contacted him two days after his wife's death to arrange a time for the liver biopsy.

Mr Williams said he wanted to know why doctors at Queensland's largest hospital did not provide urgent care or offer any assistance with pain management. A spokeswoman for RBWH confirmed that Mrs Williams had been referred to the hospital and "scans indicated that when Mrs Williams presented to the RBWH she had progressive secondary cancer". A communication breakdown led to a delay in the biopsy being performed. The hospital apologises to the family for this delay and has offered to meet with the Williams family to discuss the issue."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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2 August, 2006

BRITAIN'S NHS MAKES PEOPLE SO DESPERATE THAT THEY TURN TO DISHONESTY TO SURVIVE

For Roy Thayers, a pensioner in need of a life-saving heart operation, it was an easy decision to make. Either the 77-year-old could languish on the NHS waiting list, even though doctors had cautioned that he was unlikely to survive the nine-month wait. Or he could write a cheque for an 8,000 pound private treatment that he could not afford. The retired painter and decorater opted for the latter, and within three days had undergone a succesful angioplasty at Hammersmith Hospital.

The cheque bounced. After negotiations with the hospital, Mr Thayers is repaying his debt at a rate of 25 pounds a week. "Life is a great thing and you do whatever you can to survive," he said. "I've never been a debtor in my life, but it was either that, or rigor mortis - I would have been a dead man. I think every man or woman would have done the same."

Mr Thayers, who is divorced and lives in Hounslow, west London, said that he had watched his first wife die of cancer more than thirty years ago, and was determined to survive at any cost. After suffering severe chest pains, he went to a specialist who told him that two valves had become blocked, and that he was at risk of a fatal heart attack unless he had surgery.

Mr Thayers said that those on lower incomes were being deprived of the benefits of the national health service. "I've worked hard all my life," he said. "The NHS is a marvellous thing, but it is being ruined. I would recommend anybody to do what I did. Life is great and when you have got it, you hang on to it."

Source



Surgeons 'horrified' by long waits in Australian public hospitals

Surgeons say they have watched with horror as the hospital waiting lists have grown and in some cases doubled over the past decade. President of the Royal Australasian College of Surgeons Russell Stitz said yesterday the latest figures showed patients were waiting a third longer than they did 10 years ago. The study, by the Australian Institute of Health and Welfare, showed that in some areas, such as neurosurgery, the average waiting list had doubled, while the wait for vascular surgery had increased by 64 per cent.

"It is with some degree of horror that surgeons are watching waiting lists continue to climb nationally, and there are real concerns among the medical profession that governments have no interest in bringing them down," Dr Stitz said. "It is unbelievable that someone with a brain injury is being forced to wait double the time they used to; and just try telling that to your patients -- it's heart-wrenching." Coupled with a shortage of surgeons, "to say there is a crisis in the health system is an understatement", Dr Stitz said.

Surveys by the college earlier this year showed the nation's 7100 surgeons spend at least 60per cent of their time in private hospitals and are ageing, with almost half aged 55 or older. "There are solutions," Dr Stitz said. "Public hospitals need to be adequately resourced, and these resources need to be used efficiently to treat more patients and provide adequate training for future surgeons. We need to employ more nurses, open more beds and start training more doctors to become surgeons." With demand for surgery expected to grow by 50per cent in the next 20 years, he said, at least 30 per cent more surgeons were needed, but "we are nowhere near this number".

Source



Funding shortfall in Tasmanian public hospitals too

After reports of similar problems in other Australian States, maybe the Tasmanians did not want to be left out

Staff at the Royal Hobart Hospital have rejected the Tasmanian Government's assertion that the hospital receives sufficient funding. The hospital overspent its budget by $6 million last year and Health Minister Lara Giddings says there will not be any more money if the hospital exceeds this year's budget of $255 million.

The chairman of the hospital's Staff Association, Dr Frank Nicklason, says the Government is asking the hospital to provide services it cannot afford. "There isn't a recognition that the Royal is a tertiary university teaching hospital, that we're funded for around about half the State's health budget, but we are doing the complex and obviously the much more expensive cases on a state-wide basis," he said.

Meanwhile, the Greens want an independent inquiry into the Government's handling of hospital funding. Acting Greens leader Nick McKim says two years ago the Government commissioned the Richardson Report into the operation of hospitals in Tasmania. "It's time, in the view of the Greens, for there to be a performance review of how the Government has gone in implementing the recommendations in the Richardson Report," he said. "There were over 50 recommendations made by Professor Richardson and I doubt very much that the Government has done half."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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1 August, 2006

More rottenness in a government health system

Protecting themselves -- by concealment, gags, persecution and coverups if necessary -- is all that bureaucrats care about



There was this good-natured, quietly spoken guy with whom I once worked and who has since moved to distant shores. I knew he was leaving, something to do with his wife's work, but I was out of the office when he left and I never did get the chance to say goodbye and wish him well. Preoccupied with the distractions of my own immediate world, I did not spare him another thought until last week when amid the clutter of the email in-box appeared a message from him.

He had been reading this newspaper online and had emailed to compliment me on a piece I had written, a kindness which was typical of this likeable, affable bloke. It was a brief message but the sting was in the tail for in the last paragraph he revealed his reasons for leaving Australia. It had, as I had vaguely heard, been because of his wife's work. She had, not, however, been offered a better job. A health professional employed by Queensland Health, she had bravely, if naively, written a letter to the government voicing her concerns about certain practices within the department. I don't know the contents of the letter, only that it was critical of the department.

Her reward, for placing her concerns for the public ahead of self interest, was to be hounded out of her job. Her career, and the lives of her husband and young children were trashed. They were, effectively, driven out of their own country and became political refugees.....

The ripples in the pond of disasters that is Queensland Health, however, continue to spread. The president of the Australian Medical Association, Zelle Hodge, has said the Royal Brisbane and Women's Hospital was operating at 130 per cent capacity, making conditions unsafe for patients by pushing staff beyond their limits. Staff tell of patients being left on trolleys for 24 hours before a bed can be found and of people suffering cardiac arrests in hospital corridors while waiting for treatment.

Earlier this month the CEO of RBWH, Dr Thomas Ward, was removed after five weeks on the job when he all but brought the hospital to a standstill after summarily sacking the executive director of nursing services. How did he pass the selection process? How can someone who apparently had little or no understanding of how to run a hospital be placed in charge of one of the largest of such facilities in the country? Would this not indicate that the interviewing process is seriously flawed or that those conducting it should be replaced? We'll never know the full story because Queensland Health slammed a cheque for $100,000 into his hand and bundled him on to a plane and out of the country less than 24 hours after his contract was terminated.

Over the past few weeks it has been revealed that Queensland Health placed the lives of thousands of north Queensland women in jeopardy by covering up problems with breast cancer screenings. A suggestion last August, when the problem of incorrect diagnoses was revealed, to establish a hotline was rejected by Queensland Health because it could "create unnecessary anxiety". Asked to choose between anxiety and death, I'm reasonably certain most women would choose the former.

Another ripple followed the revelation that a report by an independent medical investigator employed by Queensland Health into the death of a child was censored and references critical of the department deleted. Yet another ripple was caused by the leaking of a memo from RBWH which said that "there have been ongoing elective operating sessions cancelled due to insufficient nursing and anaesthetic technical staff to provide safe patient care". Another leaked memo from the director-general of Queensland Health, Uschi Schreiber, said that in relation to lengthy waiting lists for surgery cases, "despite the additional funds in 2005-2006, the available data indicates no substantial improvement".

While this memo was being written, the Government was spending $300,000 mailing letters to householders telling them what a wonderful job it had done in creating more hospital beds and shortening waiting times, part of $2 million spent on a public relations campaign to paper over the deep fault lines running through Queensland Health. Maybe one day, someone will have the guts to truly take on the well paid bureaucrats who run the department. Then, perhaps, my quietly spoken ex-colleague and his wife and kids can come home.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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