In the United States most hospitals operate for profit so it’s a bit disturbing when a report says that complications actually work to increase the profits of a hospital. In other words, as complications increase, profits increase.

Not that anyone is intentionally increasing the complication rate, but the Boston Consulting Group reports that patients on Medicare or private insurance who experience complications after surgery may provide higher profits for that hospital.

Published in the Journal of the American Medical Association (JAMA), researchers from Harvard Medical School found when a patient experiences a blood clot, stroke, septic shock or cardiac arrest the hospital’s profit margin jumps 330 percent higher when compared to a patient with no complications.

That translates to $56,000 for a privately insured patient compared to $17,000 when the outcome is complication-free. For a Medicare patient hospitals will receive $3,600 for a patient with complications versus $1,800 for a complication-free surgery.

When a hospital has fixed costs for patients covered by Medicaid or the patient covers their own care, the hospital will make less money if it has to cover the costs of a complication.

One co-author believes the incentive process is backward.  Instead of rewarding a hospital with fewer complications, those with the most problems actually make more money on patients who have to stay in the hospital longer and receive additional care.

The Boston Consulting Group analyzed data from more than 34,000 surgeries performed at the 12-hospital system of Texas Health Resources. Among those 5.3 percent of patients or 1,820 experience some type of types of complications.

While it’s always been known there is no incentive system for quality hospitals it was never understood before just how badly things had swung in the opposite direction. An investment in reducing risk may not help underwrite hospital costs but it goes a long way in improving patient confidence and outcomes and underscores the need to focus on payment reform in conjunction with healthcare reform.

The Food and Drug Administration (FDA) is cracking down on compounding pharmacies after a nationwide fatal outbreak of fungal meningitis was found in contaminated steroid injections made at the New England Compounding Center (NECC).

Now a Georgia compounding pharmacy, Clinical Specialties Compounding Pharmacy (CSCP) of Augusta, has voluntarily recalled all lots of sterile syringes loaded with the cancer drug Avastin. The recall was undertaken after an FDA inspection revealed sterility concerns.

At least five people have serious eye infections associated with the Avastin drug that was repackaged from vials into syringes by CSCP. The condition is called endophthalmitis, which the FDA reports occurs inside the eyeball and can lead to permanent blindness. The link to the syringes was brought to the federal agency’s attention by the Centers for Disease Control and Prevention (CDC).

The FDA is playing catch-up after 48 people died from a contaminated epidural steroid injection. Over 700 patients continue to be treated for fungal infections and hundreds of lawsuits have been filed against NECC, which has filed for bankruptcy.

Historically, compounding pharmacy regulation has fallen outside of FDA radar and states have not been picking up the slack. There is a move to increase the FDA’s authority over compounders and the surprise plant visits are part of the plan.

Meanwhile the voluntary recalls continue with three announced during one week in March.

Med Prep Consulting of Tinton Falls, New Jersey voluntarily recalled 83 types of antibiotics and drugs used during surgery because of a possible mold contamination, which was visible to the eye. Regional hospitals in New Jersey, Connecticut, Delaware and Pennsylvania received the infusion bags, glass vials and plastic syringes linked to the mold.

An inspection at Pallimed Compounding Pharmacy of Massachusetts led to the recall of all sterile products made at the plant in an “abundance of caution” even though there had been no injuries reported. The FDA inspectors indicated there were “deficiencies” but the recall does not include the facility’s non-sterile products.

The state took the next step and issued a “limited Cease and Desist Order” to prevent the sale of 16 sterile compounded products. Last December, the Boston Globe reports the company had been ordered to stop compounding Viagra because of “improper components.”

Originally, compounding pharmacies were developed to mix small batches of custom ordered drugs. Depending on the individual state’s regulations, they were not intended to become full-blown mini-pharmaceutical manufacturing facilities, but that is the role many have undertaken.

State laws vary and the FDA is seeking additional authority over the growing industry, however, as we’ve seen so many times, the agency does not have enough funding to oversee about one-quarter of the consumer products used by Americans.

One proposal has the compounding companies pay a user fee to cover the cost of FDA inspections.

Bottom line – inspect the products coming from a compounding facility. In the case of the mold, a nurse, not FDA regulators, noticed the contamination problem which led to the recall.

A read a very interesting article in the Atlantic highlighting the new Johns Hopkins University School of Medicine study recently published in the British Medical Journal’s Quality and Safety Journal.

I must give these folks credit for the candor in what one could argue is an embarrassing finding for the medical community. Nonetheless, the challenging and unflattering research was still published. This study really focused on the ICU and some of the most common errors made in intensive care management.

Intensive Care Unit Room

The sad truth is that an estimated 40,000 patients may die each year from failure to properly diagnosis their conditions in the ICU. That is more than the number or people who die from breast cancer each year.

These deaths involve errors are discoverable and should be correctable. Errors in which solutions would save more lives this year without complicated and expensive new science being required.

Let’s hope it draws the needed attention. It really all boils down to lack of training and quality control. Many of us who know the medical field already know common conditions like heart attack and stroke are routinely misdiagnosed. This study proves it. The lead author, Dr. Bradford Winters, calls it “surprising and alarming”.

This study was an objective look at past literature, 31 different prior studies, as well autopsy results with confirmed diagnostic errors in adult ICU patients. Amazingly 1 in 4 (28%) had a missed diagnosis at the time of death and 8% of the time those errors are clearly linked to preventable deaths. Many times these were errors of omission, simply not doing the proper testing or ruling out of known conditions. The most common misdiagnosis were:

• Heart attacks
• Pulmonary Embolism
• Pneumonia
• Fungal infection ( Aspergillosis )

Bear in mind these mistakes were made in the ICU; the part of the hospital that typically holds the most experienced practitioners, as well as the patients’ supposedly receiving the greatest over sight and attention. Let’s hope the research and report does what the researchers intend it to do. Specifically, get the funding and attention needed in addressing ways to save lives right now with the very tools that already exist.

Kudos for bringing this to light. Realization is the first step to changing a culture of clutter, confusion, and error. Shame on hospital corporations if they do not view this as an opportunity.

It is disappointing when otherwise intelligent, insightful people simply choose to ignore facts and fail to protect the very people they have sworn to serve.

It is no secret that many industry-wed lawmakers have been working for a long time to place damage caps on injuries caused by the negligence of others.

Those same industry-owned lawmakers stand for protecting the profits of hospitals and insurance companies over the protection of citizens. These are legislators and executive branch folks who are willing to sacrifice our rights in the interests of promises to lobbyists or keeping alive their favorite bill.

Currently, Congress, state legislators and governors are busy trying to protect corporate healthcare and insurance companies on the backs of victimized patients. Add to that a concerted effort to dismantle the only attempt, albeit flawed, to fix a flawed and dysfunctional health care system. These politicians are not builders; they seek to create or enhance nothing. These lawmakers want to dismantle anything lobbyists tell them to defeat in the best interests of their corporate constituents.

Fact: It has been estimated that medical errors cause $17 – $29 billion every year in lost income, disability and healthcare.

Fact: The Department of health & Human Services estimates that medical errors result in $4.4 billion in additional Medicare costs.

Fact: Patient rights have been taken away or diminished in 48 of the 50 states already. This has done nothing to improve health care quality or costs in any of those 48 states.

Fact: In the 48 states already enacting limits on the rights of the injured there has been no tangible savings in terms of insurance reductions or health care cost reduction.

Fact: Preventable medical errors cause the death of 98,000 people each year (Institute of Medicine). Limiting the constitutional right of injured victims has done nothing to improve the quality of health care or to reduce the numbers of injured people or the number of patients killed by preventable medical care errors.

Fact: Defensive medicine is a myth dreamed up by those who desire increased corporate profits. Defensive medicine may be motivated more by a desire to increase profits to doctors and hospitals as the alleged defensive medicine.

Fact: The “lawsuit crisis” is a well conducted campaign of propaganda, spin and lies.

Fact: Lawsuits filed by injured people represent a very small percentage of the total burden on the court system. Actually, the largest numbers of lawsuits involve divorce, estates and corporations suing each other.

Fact: Passing laws to protect one special class of Americans to the detriment of the majority of Americans is in violation of the constitution. Protecting doctors, hospitals and insurance companies while denying patients their rights, is simply unfair and unlawful.

Fact: The groups fighting the hardest to infringe on the rights of citizens of individual states are the same groups who have repeatedly told Americans that “Big Government” is bad and that the federal government should stay out of the business of the states. So much for smaller government.

Fact: People in favor of tort reform can not use facts to support their arguments. They rely on hyperbole and spin fed to them by groups supported by business interests.

Fact: Who will pay for the costs of medical care, lost income and rehabilitation caused by medical errors if the rights of victims to pursue legal remedies are taken away? You and I will pay through increased taxes to fund medicare, social security and increased insurance premiums.

Fact: Who will benefit from taking away rights? Hospitals, insurance companies and corporations.

Before you take a position on this very important constitutional battle, educate yourself, be informed, and do not blindly accept information given to you by anyone.

Read, research and rely on your own common sense.

Who is paying for all these campaigns and lobbyists who have the ears of YOUR law makers?

A 2009 study published by the New England Journal of Medicine analyzed almost 12 million Medicare beneficiaries and found:

• 20% of patients were readmitted within 30 days of discharge
• 34 % of patients were readmitted in 90 days of discharge
• 67.1% of patients percent were readmitted one year after discharge or had died

This revolving door effect cost Medicare $17.4 billion dollars in 2004 and the problem continues to escalate.

Medicare is responding by collecting data on all hospitals and will keep a running three-year average on readmission rates. Those hospitals having high rates will be financially penalized.

According to a Medicare Payment Advisory Commission study, 75 percent of all 30-day hospital readmission are preventable and if they can be avoided, the quality of patient care will improve. Higher rates of hospital readmission are associated with infections and other complications acquired by patients during hospital stays.

In a pilot project in which hospitals were paid bonuses and held accountable for better outcomes and less bounce backs, quality improved and readmission rates fell substantially.

The cause for patients having to readmit patients after a hospital stay seems to fall into one of the following categories:

1. Lack of communication between patient and doctor
2. Complete lists of medications missing from patients
3. Follow-up appointments were never made or communicated
4. Wound care or other instructions were confusing or never received
5. No official hand-off from one physician to another
6. Insufficient monitoring of patients after discharge — especially regarding medications

Medicare does not currently pay hospitals for monitoring or mentoring patients after discharge.

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Following published reports and extensive media coverage regarding egregious behaviors in the medical profession, public awareness of physician and hospital errors has increased. Despite that increased attention, data suggests that the rate of reporting by physicians is lower than it should be.

In the JAMA July 14 issue, one of the major themes covered was research articles and commentary on the Physician Peer Review process and its effectiveness. The medical peer review is the process by which a committee of physicians examines the work of a peer and determines whether the physician under review has met the accepted standards of care in rendering medical services. This process is put in place specifically to assure physicians that their statements will remain confidential when commenting on the behaviors of their colleagues (many of whom are a physician’s primary referral sources).

An original research study titled “Physicians’ Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues” found that overall, “…physicians support the professional commitment to report all instances of impaired or incompetent colleagues in their medical practice to a relevant authority; however, when faced with these situations, many do not report.

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New studies show that hospital deaths increase sharply in July causing a “July Effect”. The study illustrates the need for patients to practice caution while accepting medical care in that month or over the weekend days.

A recent study by the University of California at San Diego demonstrates that fatal medication errors rose 10 percent in July at teaching hospitals in the United States. This “July Effect,” doesn’t seem to mean that hospital staffs are running amok, but that more medication errors seem to be the culprit in teaching hospitals. The study investigated more than 62 million U.S. death certificates between 1976 and 2006. Of those, 244,388 deaths were caused by medication errors in hospitals such as dispensing the wrong medications, overdoses, and accidents involving drugs or biological agents.

The researchers examined certificates of inpatients, outpatients, and those who died in the emergency department, in which medication error was recorded as the primary cause of death. Counties containing teaching hospitals experienced a 10 percent rise in fatal medication errors in July, whereas counties lacking teaching hospitals did not experience that spike.

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With all the hype about H1N1 and other flu and cold viruses, we have become an uber-clean society, where hand sanitizers and disinfectant wipes are as common in households as the paper towel. But is this cleanliness having an effect on our children?

Most experts conclude that our desire to be super clean and safe from germs may actually be hurting our children. While there is a legitimate cause of concern with serious illnesses, such as H1N1, we may have gone overboard when it comes to protecting our children from dirt and germs.

Thom McDade, PhD, associate professor and director of the Laboratory for Human Biology Research at Northwestern University states that, “Just as a baby’s brain needs stimulations, input, and interaction to develop normally, the young immune system is strengthened by exposure to everyday germs so that it can learn, adapt, and regulate itself.” In a recent study McDade also found that children who were exposed to more animal feces and had more cases of diarrhea before age 2 had less incidence of inflammation in the body as they grew into adulthood. This inflammation has been linked to chronic adulthood illnesses, such as heart disease, diabetes, and Alzheimer’s. The study analyzed data collected from thousands of children over two decades in the Philippines.

“We are moving beyond this idea that the immune system is just involved in allergies, autoimmune diseases and asthma, and beginning to think about its role in inflammation and other degenerative diseases,” McDade adds.

According to medical professionals, we are over sanitizing infants’ environments that may cause more harm than good. It is a parent’s desire to keep their child from germs, but in that desire, we may be depriving them the opportunity to build a strong immune system.

Hand washing is still the number one prevention of spreading infections and diseases, as discovered by Louis Pasteur and Joseph Lister more than 160 years ago. By no means is this study suggesting that we let our little ones run around covered in dirt and filth. But it is meant to serve as an eye-opener to parents that a little prevention goes a long way in preventing the spread of germs. The old adage, “everything in moderation” may apply quite well to this study. Being dirty is fun for kids, and a little dirt may actually improve their health into adult hood.

“I hope this research will promote some thinking about the potential cost of a zealous public health effort to promote hand washing and hand sanitizer use,” McDade said.

[youtube]http://www.youtube.com/watch?v=XHISh559oho[/youtube]

If you are one of the estimated 15 million Americans who will have a surgical procedure this year, pay attention, please! You and your loved ones may thank me later.

Every single time anyone has a surgical procedure performed, whether the surgery is life-saving or elective, there are risks involved. That “simple” and “routine” tonsillectomy for your five year old can actually result in death. The liposuction that your Aunt Sally has always wanted to remove those saddle bags could leave her with a pulmonary embolism. Nothing is without risk, even though most surgical procedures are much safer than they used to be – picture that bullet removal from Marshall Dillon’s chest from an old episode of “Gunsmoke” and you know what I mean.

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Is the phrase, a government “of the people, by the people, for the people” in the constitution? Popular belief is yes, but it is not actually in the constitution. Rather, this phrase comes from President Abraham Lincoln’s Gettysburg address. It is probably a concept that should have been incorporated into the constitution and certainly Lincoln included it to remind citizens that it is their country. I think politicians, and even some of us, forget that it is OUR government and the politicians are OUR employees; they are supposed to be working in OUR best interests.

Business interests are fond of complaining about the jury system and regularly claim that it is “broken”, it needs to be “fixed”. Perhaps the best word is, in fact, “fixed”; they would like to fix the civil justice system so that it can be better influenced in their direction. Should we hold it against them because they work to achieve an unfair playing field? We should not hate Big Corporations for this, but should we allow them to achieve it? Absolutely not!

I think the jury system our founding fathers borrowed from English common law works just fine in protecting the rights of individual citizens. Frankly, I want six of my fellow citizens sitting and listening to evidence in my case. I want six regular people considering what makes sense and what does not make sense. I do not want a special panel appointed to hear my case, as has been promoted by many business “political parrots”. I do not want the government inserting itself into the civil justice system anymore than they already do. I trust an impartial panel of my fellow citizens to fairly weigh the evidence and reach a decision that makes sense.

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