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A hero in more ways than one. “What can the healthcare industry learn from “Miracle on the Hudson” pilot  “Sully” Sullenberger?”

“These were some of the intriguing questions explored last week at the inaugural Forum on Emerging Topics in Patient Safety, jointly sponsored by the Johns Hopkins Armstrong Institute for Patient Safety and Quality and the World Health Organization.”

“Sullenberger talked about how the same critical skills of team communications, simulation-based training, and documented procedures that saved many lives that day can and should be applied to the healthcare industry to help improve patient safety.  He indicated that one person’s heroic efforts aren’t enough and that a “team of experts” needs to be replaced by an “expert team.”

“Each of the speakers described safety-related challenges in their own fields, and encouraged discussions as to how they might be applied to the clinical environment, with a focus on:

  • Designing safe and highly reliable systems of care delivery
  • Ways to quickly disseminate and incorporate best practices in the areas of safety and quality
  • Developing performance measures that are meaningful to patients, providers, payers, and regulators”

Excerpted from:  Captain 'Sully' Sullenberger and Johns Hopkins Tackle Patient Safety by Robert J. Szczerba (Contributor) Forbes 10-2-13


One out of 20. “Americans could save billions of dollars in health care costs each year if hospitals did a better job of curbing preventable infections, according to a new study.”

“Research released today by JAMA Internal Medicine found that infections acquired during the course of medical treatment cost $9.8 billion annually. Researchers reviewed published data from 1998 through April 2013 and adjusted the costs for inflation in 2012 dollars.”

“The problem is so common that it has its own acronym: healthcare-associated infections, or HAI.”

Excerpted from: Study: Hospital infections cost $9.8 billion a year, CBS News 9-2-2013


All we can say is, WASH YOUR HANDS! “At North Shore University Hospital…, motion sensors,… go off every time someone enters an intensive care room. The sensor triggers a video camera, which transmits its images halfway around the world to India, where workers are checking to see if doctors and nurses are performing a critical procedure: washing their hands.”“This Big Brother-ish approach is one of a panoply of efforts to promote a basic tenet of infection prevention, hand-washing, or as it is more clinically known in the hospital industry, hand-hygiene.”

“Studies have shown that without encouragement, hospital workers wash their hands as little as 30 percent of the time that they interact with patients.”

Excerpted from: With Money at Risk, Hospitals Push Staff to Wash Hands, By ANEMONA HARTOCOLLIS, The New York Times , May 28, 2013


Haphazard. “For the first time, the federal government will release the prices that hospitals charge for the 100 most common inpatient procedures. Until now, these charges have been closely held by facilities that see a competitive advantage in shielding their fees from competitors. What the numbers reveal is a health-care system with tremendous, seemingly random variation in the costs of services."

“A Washington Post analysis of the 10 most common medical procedures showed certain patterns by state. Hospitals in six states — California, Florida, Nevada, New Jersey, Pennsylvania and Texas — routinely had higher prices than the rest of the country.”

Excerpted from: One hospital charges $8,000 — another, $38,000 by Sarah Kliff and Dan Keating, Washington Post, May 8, 2013


There's no MD in 'Team.'  “Despite all the work in the last decade to improve patient safety and raise awareness of preventable medical errors, physicians by and large have been slow to support the movement, a leader in patient safety said here.”

"The fact of the matter is a number of physicians are not involved, are a bit skeptical about it, and have really not participated as they should," Lucian Leape, MD, adjunct professor of health policy and management at Harvard University…”

“Recent studies … haven't been able to show a big drop in deaths.”

“One of the reasons why is the lack of doctor support, Leape said, suggesting several explanations for why such support is lacking.”

"Doctors tend to feel they have an individual veto over safe practices," said Leape, who is sometimes called the father of patient safety. "If they don't agree with something, they feel they don't have to follow it."

“In addition, most of the practices to increase patient safety are team-driven and involve nurses. "We don't do teams well," Leape said. "Doctors aren't trained to work in teams."

Excerpted from: Doc Support for Patient Safety Movement Lags, By David Pittman, MedPage Today March 19, 2013


What goes up must come down. Apparently not!  “Hospitals’ fast-rising sticker prices are adding to the financial burdens of the 49 million Americans without insurance…”
“So-called full charges at hospitals grew

an average 10 percent a year between 2000 and 2010, according to Gerard Anderson, a Johns Hopkins University professor who analyzed hospital financial reports. The charges went up at four times the pace of inflation, and faster than hospital costs, which Anderson said increased an average 6 percent a year.”

While the charges appear on hospital invoices across the U.S., the amounts people actually pay vary widely, depending on their health coverage. The system is so irrational that those without any insurance can get stuck owing the most money, said David Himmelstein, a professor at City University School of Public Health at Hunter College in New York.

“It’s unconscionable,” said Himmelstein, who co-authored a 2009 study that found illness and medical debt was a factor in more than 60 percent of personal bankruptcies. “It adds to the already grave suffering of the uninsured.”

Excerpted from: Uninsured Americans Get Hit With Biggest Hospital Bills By Charles R. Babcock, Bloomberg 3-11-13


Caveat Emptor!  “A quarter-century after the nation’s plastic surgeons received what amounted to carte blanche to perform liposuction, a new analysis suggests that the procedure is no safer...”

“…Throw into the mix an ample supply of seemingly unscrupulous physicians and state regulators who do not appear ready to crack down on them, and the result is a recipe for a national disaster.”

“Selma Calmes, MD, consultant in anesthesiology for the Los Angeles County Coroner/Medical Examiner, has begun to dig behind the details of patient death during liposuction—and she does not like what she’s finding.”

“There are hazards to liposuction that most people do not even realize,” Dr. Calmes said. “…tissue is traumatized by a trocar, and fat cells can be picked up by open blood vessels and carried to the heart and lungs.”

“Local anesthetic toxicity also is a real risk factor, …. Infection also is a concern during liposuction.”

“Yet liposuction can be risky even when anesthesiologists are providing care.”

Excerpted from: As Liposuction Deaths Mount, Study Exposes Cracks in Safety, by Michael Vlessides, Anesthesiology News Oct 2012


Surprise, Surprise, Surprise…Texas is last & first!  “Texas ranks last in the nation on a new federal government report card on health care quality.”

“The 2011 State Snapshots report is based on 155 quality measures gathered by the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.”

“Overall, Texas scored 31.61 out of 100 points. Texas has the nation's highest rate of uninsured people, which probably affects the rating, Moy [Dr. Ernest Moy, a medical officer at the agency's Center for Quality Improvement and Patient Safety] said. "With that many uninsured, there is less money to go around."

Excerpted from: Texas last in nation on health care report card, by Mary Ann Roser, Austin American Statesman, July 5, 2012


Whose standard of care? “If Dr. Lindner had not performed the endoscopy, clearly Mr. Rooks' cardiorespiratory arrest would not have occurred and he would not have died,” Kenneth Hammerman, M.D."

“It's possible to meet the standard of care and still have a bad outcome.” Leigh Hopper, spokeswoman for the Texas Medical Board.”

“Those two statements lie at the heart of the case of David Michael Rooks. The 50-year-old died more than two years ago following a diagnostic endoscopy.”

Excerpted from: A key is what constitutes 'standard of care', By O. Ricardo Pimentel, Express-News columnist, 5-30-12.


The TBME is supposed to be policing doctors and protecting the public but... “Top secret meetings, back-door deals and confidential complaints are all a part of the Texas Board of Medical Examiners. The state board is supposed to be policing doctors and protecting the public but some patients complain the system is a prescription for failure.”

“In 2003 Texas lawmakers put caps on medical malpractice lawsuits but promised to keep a tight rein on doctors by beefing up the Texas board.”

“Since 2003 the number of complaints rolling into the board has skyrocketed from 4,900 to more than 8,000 last year. But investigations are down to only 25 percent.”

“Cases are also taking much longer to resolve. That number is up to 328 days.” Excerpted: News Station Investigation: Medical Board by Becky Oliver, FOX DFW, May 8, 2012


Dentists drilling for gold.  “Texas toddlers being held in restraints as dentists at corporate-run clinics performed unnecessary root canals were among the dental horror stories told Wednesday at a House Public Health Committee hearing at the state Capitol.”

“The Texas State Board of Dental Examiners… was the subject of criticism by members of Texans for Dental Reform and unaffiliated residents, who called for legislative reform while levying accusations of ineptitude, a pattern of withholding or obscuring negative information about dentists, and failure to act against corporate-run dental clinics committing Medicaid fraud and harming patients.”

“The clinics in question often serve only Medicaid patients and pay one dentist to act as a prop by claiming ownership. The real owners of the clinics — usually private equity firms — are in the dental business for profit…” Excerpted from: Texas Dental Board is Accused of Ineptitude, by Becca Aaronson, Texas Tribune, April 12, 2012


It happens far too often. “Filthy, dangerous medical implements have been showing up in hospitals and outpatient surgery centers with alarming regularity.”

“It is difficult to know exactly how often dirty instruments are to blame for the infections that plague hospitals, since bacteria can hide anywhere from a doctor’s unwashed hands to a nurse’s dirty scrubs. But experts say it happens far more often than generally understood. “The cases we hear about,” said Dr. Melissa Schaefer, a CDC medical officer, “are only the tip of the iceberg.” Excerpted from: How dirty medical devices expose patients to infection, by Joe Eaton, iWatch News by The Center for Public Integrity 2-22-2012


Privileged from disclosure? “Parkland Memorial Hospital’s decision not to release a taxpayer-funded performance report, despite its subsequent leak to the press, has raised the ire of patients’ rights advocates…”

“Patients deserve as much information as they can get,” said Alex Winslow, executive director of consumer group Texas Watch, which monitors patient safety issues. “They have to make decisions about where they’re going to seek care, and they need to know if there are any dangers or pitfalls that they need to be aware of as they’re making those decisions.”  Excerpted from: Parkland's stand makes sense to some, not others, by Bill Hethcock, Dallas Business Journal,
2-15-12


Predatory Capitalists.  “Though few people are aware of it, the nursing home industry is a classic example of a sector where "vulture capitalism" is destroying lives. With the graying of America, Wall Street is finding the nursing home sector to be increasingly attractive. Private equity firms are displacing public corporations and mom-and-pop operators… This trend has proven disastrous for nursing home residents…”

“These private equity investors cum "health care providers" seek to improve profitability by cutting costs, most notably labor costs.”

“The irony is that few people have been enablers of these practices more than Gingrich and Perry, who under the guise of "tort reform," have fostered policies that ensure that corporate predators are not required to fully account for their wrongdoing. Governor Perry's Texas is home to some of the nation's more draconian tort reform measures and Gingrich has long been a champion of similar policies...” Excerpted from: How vulture capitalism endangers America's elderly By Ken Connor


Patients or Commodities? “So-called hospitalists are medical personnel who contract with hospitals to manage large numbers of patients – sometimes two dozen or more in a shift. They are typically compensated per patient “encounter,” an incentive to maintain a high volume of patients.”

“IPC, the country’s largest publicly-traded hospitalist practice, has been named in seven unrelated, local malpractice lawsuits…[Some] involve allegations that hospitalists failed to review medical histories or consult with primary care physicians before authorizing powerful drugs. Many studies say these types of deaths are preventable. But institutional change is needed across corporate health care, which often regards patients as commodities, making some doctors more accountable to shareholders than the Hippocratic Oath. This is exacerbated in Texas with tort reform, which often means families…can never expect medical justice.” Excerpted from: Reliance on high-tech and high-turnover leading to lawsuits in ‘hospitalist’-heavy San Antonio, by Robert Crowe, San Antonio Current, December 7, 2011


Over and Over (and Over) Again...“…a comprehensive review of the impact of the 2003 law by The Associated Press concludes that the growth in physicians tracks population increases.”

“The AP also found that most new doctors have opted to practice in urban areas that weren't facing a doctor shortage rather than underserved communities that most need those new physicians.”

“Health care costs at both the family level and the overall system level are up dramatically since 2003.”

“The fact is that so-called tort "reform" has done nothing to improve patient safety.”
“While special interest groups… and the insurance industry crow, Texas patients continue to struggle under a broken health care system.” Excerpted from: Spin-doctoring by doctors, by N. Alex Winslow (Texas Watch)/Contributed, Corpus Christi Caller Times, 11-30-11


Eight years later. “An analysis of Perry's tort reform initiative in Texas reveals a more complicated bottom line than his campaign rhetoric on the issue would suggest. State medical data show that the number of physicians practicing in Texas has increased since the initiative passed in 2003, though by considerably less than the total Perry cites. And the bulk of that influx has come in larger cities where health care was already abundant, leaving large rural swaths of Texas still without doctors.”

“The statistic Perry most often cites — 23,000 newly licensed doctors after tort reform — includes about 10,000 who sought licenses in Texas but took jobs elsewhere and physicians practicing telemedicine in other states.” Excerpted from: Doctor gaps in Texas persist despite Perry's stats, by CBS News (Associated Press) 11-8-11.


Hogwash! “After analyzing thousands of records, the I-Team found Texas ranks second to last in the nation when it comes to nursing home staffing.”

“An advocate for the elderly says she has seen Texas nursing homes flat out lie about their workforce.”

“It’s hogwash. It is hogwash,” said Gay Nell Harper, with Advocates for Nursing Home Residents (TANHR). "I've seen them count the cooks. I’ve seen them count the maids. I've seen them count the office staff.”

“But that's not direct care," she said.” Excerpted from: Texas nursing homes rank near bottom for staffing, by Jeremy Rogalski, KHOU 11 News 8-25-201


WAKE UP!  “Maybe this will finally jolt people into understanding what happens when a state severely reduces a hospital’s accountability for negligence.”

“Parkland Memorial Hospital (Dallas, Texas)… has now become such a "serious threat" to patient safety that government is considering throwing it out of the Medicare program.“

“In addition to the state’s severe “cap” on compensation and other restrictions on patients’ legal rights… cases involving medical malpractice in emergency rooms have been knocked out almost completely, making Texas ER’s some of the most dangerous in the country.”

“…you wonder how this happens "The 15 largest donors to Texas politicians and PACs gave a total of $4.7 million in the first six months of 2011, according to a Texas Tribune analysis of Texas Ethics Commission filings. The biggest beneficiary of their largesse: the Texans for Lawsuit Reform Political Action Committee." Excerpted from: Tort Reform and the Risky Perils of Texas Hospitals, www.thepoptort.com, 8-11-11


It's kind of shocking, the lack of care and attention. “It took three days for the MRSA infection to spread throughout Barbara McCornack's body, shut down her vital organs and kill the 95-year-old grandmother.”

“After she died April 16, the hospital advised McCornack's relatives to alert the assisted living center. But they say the facility's staff was not responsive to their concerns.”

“Despite the threat posed by MRSA infections…community-based facilities in Texas are not required to report such cases to local, state or federal health officials.”

“Nor are hospitals required to report cases or notify residents of the same facility.”

“Although Texas approved an information reporting system for hospital-acquired infections in 2007, it was never funded.” Excerpted from: Family cries foul after fatal bacterial infection in Grapevine, By Jan Jarvis, Fort Worth Star Telegram 4-27-11


A sobering statistic. “More than 90 percent of nursing homes employ one or more people who have been convicted of at least one crime, federal investigators said…in a new report. In addition, they said, 5 percent of all nursing home employees have at least one criminal conviction.”

“The report was issued by Daniel R. Levinson, inspector general of the Department of Health and Human Services, who obtained the names of more than 35,000 nursing home employees and then checked with the Federal Bureau of Investigation to see if they had criminal records.” Excerpted from: Study Finds Criminal Pasts of Nursing Home Workers by Robert Pear, NYT 3-2-11


437 Bad Apples. “The Texas Medical Board was among 33 nationally that did not discipline a high percentage of doctors who either lost their hospital privileges or were restricted in their hospital practices, according to the report by Public Citizen’s Health Research Group.”

“In Texas, 60.4 percent of 725 doctors during the two decades escaped medical board action, according to the group’s state-by-state breakdown.”

“One unnamed Texas doctor who did not receive discipline by the state board had 22 medical malpractice payments totaling $2.6 million between 1996 and 2008 that included claims that he operated on the wrong part of the body and damaged three patients permanently, the report said.” Excerpted from: Report: Texas fails to discipline doctors hospitals have punished by Mary Ann Roser, Austin American Statesman March 16, 2011


Probation Violation.  “An emotionally troubled 16-year-old living in a Manvel residential treatment center died after a restraint was applied in a closet by a staffer — just four days after the home was placed on probation by the state…”

“Michael Keith Owens’ death on Friday night occurred after a Daystar Residential Inc. staff worker tried to physically restrain him.”

"DPFS officials released a report by a Daystar monitor who was after hired by the state after a Tribune/Chronicle investigation in June found some 250 abuse incidents at residential treatment centers…"

“The monitor, Jeff Enzinna…left the facility two months ago. In his Sept. 2 report, Enzinna noted shortcomings with children’s care and pointed out the reliance on restraints. “From reviewing incoming documentation,” Enzinna wrote, “my impression was there was a frequent use of emergency personal restraint and emergency medications.”

“Enzinna also noted that Daystar relied upon a one-size-fits-all type of treatment for children at the facility. “Based upon chart reviews, the treatment plans for behavior problems are essentially the same for all clients,” Enzinna wrote.”
Excerpted from: After Monitor Departs, A Teenager Is Killed by Emily Ramshaw, Texas Tribune and Terri Langford, Houston Chronicle, November 9, 2010 


Doping. “A Houston Chronicle review of medical board records from the past 2½ years showed that of 27 Houston-area doctors disciplined by the medical board for enterprises that authorities say resemble "pill mills," 17 have not been charged with crimes.”

“On the DEA website, the agency has posted a list of doctors across the U.S. it has investigated who were later convicted of drug scams since 2003. Only seven Texas physicians are cited, including two from Houston.”

“Federal investigators declined to comment on why charges had not been filed on other doctors recently disciplined by the medical board. In many cases, law enforcement has chosen the more expedient route of closing down a suspected pill mill by filing a complaint with the Texas Medical Board rather than seeking criminal charges…”
Excerpted from: Why so few 'pill mill' prosecutions? By CINDY HORSWELL, HOUSTON CHRONICLE August 15, 2010


Fair and Objective or Weak and Ineffective.  “…the failure to seriously discipline rogue doctors [by TDI’s Division of Workers Compensation] over a period of several years has resulted in an open revolt by staff. The spiked cases are just a sample of the hundreds of cases reviewed over the years by physician fraud investigators Bill Nemeth, the worker's comp division's former medical advisor, and Ken Ford, its former assistant medical advisor. Nemeth quit serving as medical advisor in 2007, citing frustration over what he termed a lack of action on valid fraud cases. Ford resigned in March, after the termination of Lockhart and a nurse paralegal, Ronnie Glenn, who also was fired for “clandestine” research, records show. In April, the current medical advisor, Howard Smith, notified Bordelon he would be resigning at the end of May. Also leaving is Clark Watts, a doctor and attorney who reviewed cases as a consultant for the division.” Excerpted from: The Workers' Comp Whistleblowers, Texas Tribune 5-12-10


May I have some regulation with my salad?  “Food-borne illnesses cost the United States $152 billion a year…an average cost of $1,850 each time someone gets sick from food, a report by a former Food and Drug Administration economist says.” [Robert Scharff, a former FDA regulatory economist and now a professor of consumer science at Ohio State University.]

“The costs include medical services, deaths, lost work and disability. They are based on data from the U.S. Department of Agriculture, the Centers for Disease Control and Prevention and the FDA.”

“Scharff hopes policymakers can use his methodology to determine which regulations would give the biggest bang for the buck…," he says.”

“…consumers are spending $85 billion on the consequences of unsafe food for every $1 billion the government is spending to prevent it," says Caroline Smith DeWaal, food safety coordinator for the Center for Science in the Public Interest.”
Excerpted from: USA pays price for food-borne illness: $152B a year by Elizabeth Weise, USA Today, March 4, 2010


No end in sight.  “The number of middle-class Texans without health insurance increased 41 percent between 2000 and 2008, with nearly 500,000 middle-class workers no longer covered through their job or private insurance, according to a study released today by the nonpartisan Robert Wood Johnson Foundation”.

“Insurance premiums for family coverage rose 76 percent in Texas between 2000 and 2008, while median income in the state declined 4 percent. Nationwide, costs for a family insurance policy rose 81 percent while income fell 2.5 percent”.
Excerpted from: Middle-class Texans slammed by loss of health insurance by Dianna Hunt, Fort Worth Star Telegram 3-17-10


Advice: Take your own toothbrush & toothpaste & aspirin & soap…“…a consumer advocate with Medical Billing Advocates of America, looks at medical bills for a living. Among the excessive charges she's seen: A patient in Florida was billed $140 dollars for one Tylenol pill; a patient in South Carolina was billed $1,000 for a tooth brush…”

“Consider this: For every dollar the nation spends on health care, 50 cents is wasted.”

“According to a 2008 report by Pricewaterhouse Cooper's Health Research Institute, wasteful spending accounts for $1.2 trillion of the $2.2 trillion spent on health care in the United States.” Excerpted from: Health care industry sick with medical waste, by John Bonifield, CNN Medical Producer, March 3, 2010


Preventable Harm. "Nearly 50,000 US medical patients die every year of blood poisoning or pneumonia they picked up in hospital, a study has shown...according to the study, led by researchers from the Center for Disease Dynamics, Economics and Policy at Washington-based Resources for the Future [published in the Archives of Internal Medicine.]"

"...the two hospital-acquired infections -- also called nosocomial infections -- account for about one-third of the 1.7 million infections US patients pick up every year while in hospital..."

"They are also responsible for nearly half of the 99,000 deaths a year from hospital-acquired infections reported by the Centers for Disease Control and Prevention (CDC)." Excerpted from: Infections in US hospitals kill 48,000, cost billions, UPI February 23, 2010


The cost of no oversight. When [state] investigators do cite facilities for serious problems, nursing home operators rarely face sanctions. In some cases, the state repeatedly threatened to suspend or revoke the licenses of facilities with chronic problems, yet Texas rarely took action against those nursing homes.

DADS [Department of Aging and Disability Services] also is failing to enforce a state law that requires nursing homes to report details about every resident who dies. State officials are supposed to analyze the fatality reports to publicize problems and trends, but that research isn't being done.

Meanwhile, serious complaints against nursing homes have increased in Texas . Complaints about problems that put residents in "immediate jeopardy," the most serious type of complaint, rose 26 percent since 2006, to more than 950. Complaints of "actual harm," the second most urgent type of complaint, rose by 10 percent since 2006, to nearly 6,300.
Excerpted from: Slow action on nursing home problems By Karisa King, John Tedesco & Melissa Fletcher Stoeltje, San Antonio Express News, 2-14-10


Calculating Medicine's ERA. "Electronic medical records that follow patients from doctor to doctor. Hospitals with instantaneous online access to lab results and health histories. Disease researchers with a state's worth of field data at their fingertips. It all hinges on a single question: Can Texas physicians go paperless?"

"Some doctors are embracing e-records technology on their own. Others are being brought around to it...They've got a powerful coalition...urging them on - and laying the foundation for an electronic superhighway for Texas medical records."

"Right now, baseball managers have more statistics, more data, on their players than doctors do about their patients," says Nora Belcher, executive director of the Texas e-Health Alliance, the chief advocacy group for the Texas e-records initiative. "For performance, for quality, for efficiency, for research, the doctors, the labs, the hospitals need to be able to exchange information." Excerpted from: Paperless Medicine by Emily Ramshaw, Texas Tribune 1-28-10


Technology + Radiation - Regulation = Failure to Protect Patients. "At a 2007 conference on radiation safety, medical physicists...warn[ed] that radiation oncology "does indeed face a crisis." The gap between advancing technology and outdated safety protocols leaves "physicists and radiation oncologists without a clear strategy for maintaining the quality and safety of treatment..."

"Government regulators have been slow to respond. Radiation accidents are chronically underreported, and a patchwork of laws to protect patients...are weak or unevenly applied, creating an environment where the new technology has outpaced its oversight..."

"In this largely unregulated marketplace, manufacturers compete by offering the latest in technology, with only a cursory review by the government...Radiation-generating machines are so ubiquitous that used ones are even sold on eBay."
Excerpted from: As Technology Surges, Radiation Safeguards Lag by Walt Bogdanich New York Times 1-27-10


Ah, to live in Phoenix. Or Columbus, Ohio..."Workers in all those cities - along with others - pay a lot less than Houstonians for their health care, according to the human resources consulting firm Hewitt Associates."

"Experts cite several reasons that individuals in Houston pay hundreds of dollars more each year for premiums and out-of-pocket costs. The factors include the unpopularity of managed care, a higher-than-average population without health insurance, and expensive health care providers."

"According to Hewitt, employees in the Houston area will pay an average of $4,791 next year for individual health insurance premiums as well as co-pays and deductibles."

"That's 19 percent more than the U.S. average of $4,023..."

"Houston employees and employers have paid more than the national average for health care premiums and out-of-pocket expenses every year since 2002, according to Hewitt." Excerpted from: Column by L.M. SIXEL - Health care is pricier here, Houston Chronicle 10-30-09


The Fox is Guarding the Hen House. "Seven years ago...the Texas Medical Board promised to crack down on bad doctors."

"It hasn't turned out that way."

"After its last meeting...the board announced decisions on four sex-related cases. Two involved doctors whom judges had already sentenced for crimes against children. Two involved psychiatrists found to have had affairs with adult patients...The child abusers were allowed to go on practicing medicine, though not with kids. The other two are working without restrictions."

"...Others who kept their licenses...include two doctors convicted of lucrative federal crimes that put patients in harm's way; a neurosurgeon who operated on the wrong body part four times; a cardiologist found to have performed dozens of invasive procedures with little or no cause; and at least seven physicians linked to a death." Excerpted from: Physician misconduct often tolerated by state medical board, analysis finds, by Brooks Egerton, Dallas Morning News 10¬12-09


Texas Ranks Dead Last. "Health care in Texas ranks among the worst in the nation, dragged down by large numbers of uninsured and by the nation's most porous safety net, according to a scorecard and analysis released Thursday by the health care-oriented Commonwealth Fund."

"Texas ranked 46th among the 50 states and the District of Columbia...Texas was ranked last in access to health care, and in equity - a measure of how minorities and low-income patients fared in the state's medical system. Texas has some of the nation's strictest eligibility requirements for Medicaid insurance." Excerpted from: Health care story ranks Texas 46th, by JIM LANDERS, The Dallas Morning News, 10-8-09


FLASHBACK 1995. "The Clinton plan would have imposed sweeping changes... with consequences far greater than Congress could possibly consider...lt represented a regulation¬minded, top-down, centralized approach at a time when the world was moving toward decentralization and flexibility-and when the supposed health crisis was solving itself anyway. Or so goes the conventional wisdom... The more people learned about this plan, the less they liked it, and it finally died a natural and well-deserved death."

"But suppose that what everyone knows is wrong." Excerpted from: A Triumph of Misinformation, by James Fallows, The Atlantic, January 1995


Malpractice-related hooey. "So while Texas patients lost significant legal rights and many unsafe health care providers are now unaccountable, rural communities that were exploited during the "tort reform" campaign have seen no improvement in access to physicians." Excerpted from: Medical Malpractice Myths Debunked TXs, California and Some Michigan Thrown In, www.poptort.com 9-15-09


Barely merits discussion: "After reviewing thousands of patient records, medical researchers have estimated that only 2 to 3 percent of cases of medical negligence lead to a malpractice claim. For every notorious error - the teenager who died in North Carolina after being given the wrong blood type, the 39-year-old Massachusetts mother killed by a chemotherapy overdose, the newborn twins (children of the actor Dennis Quaid) given too much blood thinner - there are dozens more. You never hear about these other cases."

"Medical errors happen more frequently here than in other rich countries, as the Robert Wood Johnson Foundation recently found. Only a tiny share of victims receive compensation."
Excerpted from: Medical Malpractice System Breeds More Waste by DAVID LEONHARDT, New York Times 9-23-09


McDreamy vs. Marcus Welby: Is the 'Cool' Factor Killing Healthcare? "All the sexy shows on TV are about ER work or surgeons,"...Whatever it may be. There is no Marcus Welby on TV --'cause it's just not cool."

"Television aside, medical specialists cite an array of reasons why more medical students aspire to be Grey's Anatomy's McDreamy neurosurgeon...than the wise family practitioner [in Marcus Welby, MD]..."

"Longer days, lower pay, less prestige and more administrative headaches have turned doctors away in droves from family medicine, presumed to be the frontline for wellness and preventive care programs..."

"The number of U.S. medical school students going into primary care has dropped 51.8% since 1997, according to the American Academy of Family Physicians (AAFP)."
Excerpted from: Doctor shortage looms as primary care loses its pull, By Janice Lloyd, USA TODAY 8-20-09


Unacceptable. "And what about us-the patients? How does a nation that might close down a business for a single illness from a suspicious hamburger tolerate the carnage inflicted by our hospitals? And not just those 100,000 deaths. In April, a Wall Street Journal story suggested that blood clots following surgery or illness, the leading cause of preventable hospital deaths in the U.S., may kill nearly 200,000 patients per year. How did Americans learn to accept hundreds of thousands of deaths from minor medical mistakes as an inevitability?"
Excerpted: How American Health Care Killed My Father, The Atlantic by David Goldhill, September 2009


Dentophobia on steroids. "An American-Statesman review of disciplinary records found that despite years of critical audits and complaints of lax oversight, the dental board... is less likely to take disciplinary action, slower to act and far less likely to impose the most severe sanction, loss of a license, than the state medical board."

"The dental board...routinely suspends dentists' licenses, then probates those suspensions in full...Since January 2007, probated suspensions have been meted out to dentists who have a license revoked in another state or who plead guilty to crimes such as Medicaid fraud or assault."

"...the dental board requires members of the public to file an open records request to see a dentist's disciplinary record."
Excerpted from: Oversight of dentists lacks strength, by Mary Ann Roser, Austin American Statesman, July 20, 2009


The Gag Reflex. "Until recently, patients whose doctors kept them waiting for hours without explanation, brushed off their questions or seemed downright incompetent had little recourse...ln the past five years more than 40 Web sites...have begun reviewing physicians..."

"As a defensive measure, some physicians are requiring patients to sign broad agreements that prohibit online postings or commentary in any media outlet "without prior written consent." "We get threatened with lawsuits on a pretty much weekly basis," he said [John Swapceinski, a founder of RateMDs.com]"

"Some doctors advocate an aggressive response...Medical Justice, a company that for a fee starting at $495 provides sample privacy agreements and monitors online comments for its 2,000 members."
Excerpted from: Doctor's Orders, Want Treatment? Just Sign This No¬Complaint Contract, By Sandra G. Boodman, Washington Post, 7-21-09


A damning portrait. "Congressional committees heard a lot this month about the devious schemes used by health insurance companies to drop or shortchange sick patients.'

"A House oversight subcommittee took a close look at..."rescission," in which insurance companies cancel coverage for some sick policyholders rather than pay an expensive claim....When executives for the three companies were asked if they would...limit rescissions to cases where the policyholder deliberately lied on an application, all said they would not."

"...the Senate Commerce Committee was getting an earful from a former head of corporate communications for Cigna...He charged that the industry deliberately confuses its customers..."dump the sick" through rescissions and by purging small businesses whose employees' claims exceed what underwriters expected."
Editorial: Insurance Company Schemes, The New York Times, June 29, 2009


Target practice. "[Dr. Gary D. Kao] whom regulators accuse of mishandling scores of radioactive seed implants at the Philadelphia veterans' hospital told a Congressional panel...he "could have done better" with some implants, his patients over all received effective treatment for their prostate cancer."

"...investigators for the Nuclear Regulatory Commission and V.A. officials had identified Dr. Kao as the doctor who did all but a handful of the ...92 substandard seed implants out of 116 cases..."

"An N.R.C. consultant...concluded that "erratic seed placement caused a number of cases to have elevated doses to the rectum, bladder or perineum."...Dr. Kao confirmed that he had on occasion implanted seeds in the bladder."

"Did you notify the patient?" Mr. Specter [Senator Arlen Specter] asked."

"No, sir," Dr. Kao replied."
Excerpted from: Oncologist Defends His Work at a V.A. Hospital By WALT BOGDANICH, New York Times 6-30-09


Advice to the insured: Don't get sick. "The study [by Harvard University, published in the August issue of the American Journal of Medicine] found that medical bills, plus related problems such as lost wages for the ill and their caregivers, contributed to 62% of all bankruptcies filed in 2007."

"Medical insurance isn't much help, either. About 78% of bankruptcy filers burdened by healthcare expenses were insured..."

"Health insurance is not a guarantee that illness won't bankrupt you," said Steffie Woolhandler, one of the authors...

..."So you can be insured and still end up with big bills....even if you have good insurance through your employer, you can lose it if you get sick and can't work."

"Most people who filed medical-related bankruptcies "were solidly middle class before financial disaster hit," the study says. Two-thirds were homeowners, and most had gone to college."
Excerpted from: Medical bills play a role in 62% of bankruptcies, study says, By Lisa Girion, Los Angeles Times 6-4-2009


Advice to the insured: Don't get sick. "The study [by Harvard University, published in the August issue of the American Journal of Medicine] found that medical bills, plus related problems such as lost wages for the ill and their caregivers, contributed to 62% of all bankruptcies filed in 2007."

"Medical insurance isn't much help, either. About 78% of bankruptcy filers burdened by healthcare expenses were insured..."

"Health insurance is not a guarantee that illness won't bankrupt you," said Steffie Woolhandler, one of the authors...

..."So you can be insured and still end up with big bills....even if you have good insurance through your employer, you can lose it if you get sick and can't work."

"Most people who filed medical-related bankruptcies "were solidly middle class before financial disaster hit," the study says. Two-thirds were homeowners, and most had gone to college."
Excerpted from: Medical bills play a role in 62% of bankruptcies, study says, By Lisa Girion, Los Angeles Times 6-4-2009


Medicine's Culture War. "I went to dinner with six McAllen doctors...Some were dubious
when I told them that McAllen was the country's most expensive place for health care...costshave grown faster than any other market...ultimately soaring by more than ten thousand dollars per person."

"Maybe the service is better here," the cardiologist suggested...."

"Others were skeptical. "I don't think that explains the costs he's talking about," the general surgeon said."

"It's malpractice," a family physician said."

"McAllen is legal hell," the cardiologist agreed...That explanation puzzled me...Texas passed a tough malpractice Iaw...Didn't lawsuits go down?"

"Practically to zero," the cardiologist admitted."

"Come on," the general surgeon finally said. "We all know these arguments are bullshit. There is overutilization here, pure and simple." Doctors, he said, were racking up charges with extra tests, services, and procedures..."the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about 'How much will you benefit?"
Excerpted from: The Cost Conundrum: What a Texas town can teach us about health care by Atul Gawande The New Yorker, June 1, 2009


Pick your adjective: PREVENTABLE or NEEDLESS or AVOIDABLE. "Despite a decade of promises, little has been done to fix the problem of preventable medical errors that kill nearly 98,000 people in the United States each year..."

"Consumers Union... said lawmakers largely have failed to enact patient safety reforms recommended by a 1999 report by the Institute of Medicine or IOM that found that medical errors cost the United States $17 billion to $29 billion a year."

"...the group now projects that preventable medical errors now account for more than 100,000 deaths each year..."
Excerpted from: U.S. group sees little progress on medical errors, Reuters 5-19-09


Surly physician? Misdiagnosis? Keep it to yourself. "Some doctors have started fighting back against ugly Internet reviews by asking patients to abide by what are effectively gag orders that bar them from posting negative comments online."

"Medical Justice...For a fee, it provides doctors with a standardized waiver agreement. Patients who sign agree not to post online comments about the doctor, "his expertise and/ortreatment"

Doctors are notified when a negative rating appears on a Web site... physicians can use the signed waivers to get the sites to remove offending opinion."
Excerpted from: Docs seek gag orders to stop patients' reviews By LINDSEY TANNER, Associated Press 3-3-09


Need care? Just Google it - I did. "A healthcare company hired to manage a program for elderly Texans as part of a broad privatization plan was fined more than $1 million by the state in the past year over mounting complaints that included delayed or denied medical care.

Evercare of Texas... has drawn the ire of some powerful Austin lawmakers over its management of preventative and long-term care for the state's most vulnerable, The Dallas Morning News reported Sunday in the first of a four-part investigative series.

Steven McGee...[a] truck driver disabled by multiple sclerosis, tried to enroll after receiving a packet from Evercare in advance of a care program that was to launch Feb. 1 last year. He said the first three people he talked to didn't know what he was talking about...

After McGee convinced her [a fourth Evercare representative] that he had a company pamphlet in hand.... "She came back and said, 'I understand what you're talking about now because...I Googled it."[McGee said]"
Excerpted from: Company caring for elderly under fire from state, Associated Press 1-5-09


No life boats? Toss the patients overboard. "Doctors and hospital executives say collecting payments from insurers has become an expensive headache that is driving up the nation's healthcare costs."

"Two decades ago, the top 10 insurers covered about 27% of all insured Americans. Today, four companies...cover more than 85 million people, almost half of all those with private insurance."

"More than 30 cents of every dollar spent on healthcare goes to administration, according to a 2007 survey of insurance and medical executives. That translates to about $630 billion this year."

"Patients are often dragged into the financial tug of war...When their bills are rejected or reduced by insurers, doctors often try to recover unpaid balances from patients, even if the amounts exceed what they are responsible for paying under their insurance plans."
Excerpted from: The battle of the medical bills, By Daniel J. Costello, Lisa Girion and Michael A. Hiltzik, LA Times 10-23-08


Room for Improvement: Texas Ranks 49th out of 50th for Health Care System Performance "Politics, poverty and illegal immigration intersect here to make health care a thornier issue than in most states. And Texas, with legends of independence and gritty self-reliance, has rarely been at the forefront in creating government entitlements".

"RANKING TEXAS When it comes to health care, Texas is:
• 49th out of 50 states and the District of Columbia for the overall performance of its health care system.
• Last in the percentage of its residents covered by health insurance.
• No. 2 state in the number of people without insurance: 5.5 million.
• No. 1 state with the fastest-growing illegal immigrant population between 2000 and 2006.
SOURCES: The Commonwealth Fund; U.S. Census Bureau; U.S. Department of Homeland Security Excerpted from: Politics, poverty, immigration entangle Texas health care, Dallas Morning News, 12-5-2007


Pleeeeeeease WASH your hands! Nearly 19,000 people died in the United States in 2005 after being infected with virulent drug-resistant bacteria that have spread rampantly through hospitals and nursing homes, according to the most thorough study of the disease's prevalence ever conducted.

The government study, which is being published Wednesday in The Journal of the American Medical Association, suggests that such infections may be twice as common as previously thought, according to its lead author, Dr. R. Monina Klevens.

If the mortality estimates are correct, the number of deaths associated with the germ, methicillin-resistant Staphylococcus aureus, or MRSA, would exceed those attributed to H.I.V.¬AIDS, Parkinson's disease, emphysema or homicide each year.

The study also concluded that 85 percent of invasive MRSA infections are associated with health care treatment. Previous research had indicated that many hospitals and long-term care centers had become breeding grounds for MRSA because bacteria could be transported from patient to patient by doctors, nurses and unsterilized equipment. Numerous studies have shown that busy hospital workers disregard basic standards of hand-washing more than half the time.

This week, Consumers Union, the nonprofit publisher of Consumer Reports, called for hospitals to begin publishing their compliance rates for hand-washing.
Excerpted from: Deadly Bacteria Found to Be More Common, New York Times 10-17-2007