Articles Posted in Certification and Licensure

Nursing-home-holding-hands-300x200Federal regulators need to ramp up their oversight of nursing homes, big time, with recent news reports and studies finding persistent abuses of elderly patients, including during crackdowns on problem operators, and facilities failing to care for vulnerable charges so they don’t lapse into emergency or hospital care.

Jordan Rau and the independent Kaiser Health News Service deserve kudos for digging into Uncle Sam’s “special focus status,” in which the nation’s “most dangerous” nursing homes get an ultimatum to correct major and continuing harms to patients or they may lose crucial Medicaid and Medicare funds from the federal government.

Rau found that more than half of the 528 homes deemed since 2014 to require the supposedly stringent “special focus” from regulators and that still are operating have since harmed patients or put them in jeopardy in the last three years.

doc-sleep-300x225Must doctors be absolutely impervious to common sense improvements in the way they train their own? Their bullheadedness has reemerged with the revisited decision by a major academic credentialing group to allow medical residents yet again to work 24-hour shifts.

The Accreditation Council for Graduate Medical Education clearly was on the defensive when it issued its memo on residents’ learning and working hours, guidance that academic medical centers and hospitals nationwide will rely on in setting workplace standards for the young doctors in whose hands so many patients will put their lives. The council noted that it had established a high-level task force to reconsider criticisms of residents’ stress and overwork and how this might imperil patient care, responding to an early rollback of shift hours:

“… The Task Force has determined that the hypothesized benefits associated with the changes made to first-year resident scheduled hours in 2011 have not been realized, and the disruption of team-based care and supervisory systems has had a significant negative impact on the professional education of the first-year resident, and effectiveness of care delivery of the team as a whole. It is important to note that 24 hours is a ceiling, not a floor. Residents in many specialties may never experience a 24-hour clinical work period. Individual specialties have the flexibility to modify these requirements to make them more restrictive as appropriate, and in fact, some already do. As in the past, it is expected that emergency medicine and internal medicine will make individual requirements more restrictive.”

d magazineJust how difficult can it be to stop a highly credentialed but dangerous doctor from hop-scotching around a metropolitan area to perform brutal spinal surgeries in different hospitals, including a respected academic medical center? Just ask crippled patients, neurosurgeons, medical licensing officials, and prosecutors in Dallas what it took to derail Dr. Christopher Duntsch.

As detailed well in the latest edition of the upscale city magazine D, Duntsch was a high-flying physician who moved from Tennessee to Texas, carrying with him an excellent reputation, which later would be challenged, as a medical scientist. Although established as a cancer stem cell-researcher, the neurosurgeon also morphed himself into a spinal surgeon based on training earlier in his career.  He eventually won privileges to operate at three Dallas area hospitals, including the well-regarded Baylor Regional Medical Center at Plano, Texas.

He was a loner and boastful, though colleagues liked him at first. They  quickly were horrified by his surgeries. Among the damages he is criminally accused of inflicting: amputating a patient’s spinal nerve, causing paralysis; cutting another patient’s vertebral artery and ignoring the major bleeding that occurred; installing a too-long screw so that it punctured a big vein, causing extensive bleeding and nerve damage; slashing a patient’s esophagus and a neck artery, leaving the man struggling to eat, breathe, and with blood loss to the brain.

SupremeCourtSealSouth Dakota’s highest court has been asked to reject hospitals’ attempts to keep secret why a doctor, who also is a convicted burglar with a checkered medical past that could have easily been uncovered, passed a peer review that permitted him to perform brutal, excruciating, and unnecessary spinal surgeries on dozens of patients.

A lower court rejected the sweeping claims by the hospitals that the reviews can never be disclosed. The judge said that indications of crimes or fraud, as raised by evidence-based malpractice lawsuits, are sufficient reason to breach confidentiality protections shielding vital insights into how hospitals judge physician performance and permit doctors to practice in their institutions.

More than 30 patients have sued surgeon Allen Sossan. He is a convicted felon, who had changed his name, and who apparently has fled to Iran. Patients assert he caused them great pain and maimed them with unnecessary, complex back procedures. Further, patients have sued more than a dozen doctors who reviewed his credentials and granted him privileges at Avera Sacred Heart and Lewis & Clark Specialty Hospital, both in Yankton, S.D.

michlawblogA Michigan lawyer may write about the untruthful testimony of an “expert” medical witness because his online blog post and his comments are protected speech under the First Amendment, officials from the Michigan Bar have decided. That’s good news for the lawyer, who had his law license challenged by the witness─a psychiatrist who also happens to be a member of Michigan’s lawyer licensing board. She had demanded that either his post about her or his license be pulled. Now neither will happen.

The case still leaves a lingering odor around that board, the doctor who served as a so-called Independent Medical Examiner (IME), and the process in which she sought sanctions against a legal professional, instead of receiving public condemnation when she got caught, on videotape, fabricating statements about a severely injured plaintiff.

Hired guns

A major health maintenance organization says it wants to start its own medical school.  Will this change the culture of medical education for the better? The need is definitely there, as young doctors increasingly report burnout from the medieval training practices they experience. Whether the HMO’s approach is the cure, though, remains to be seen.

Kaiser Permanente, an organization many know for its huge, nationwide footprint in delivering HMO-style care, has raised eyebrows in Southern California by pledging to open its own medical school to provide more and more diverse physicians who also are more adept at adopting the latest technologies and practicing a more evidence-based kind of medicine. Kaiser hopes to launch its first class in 2019, although it has yet to finalize exactly where students would be schooled and at what cost, the Los Angeles Times reports.

The paper says that the medical school is part of the ambitions of Kaiser’s CEO, who sees his company’s approach to coordinated care as beneficial to what ails the huge, expensive U.S. health system. But critics worry that Kaiser’s cost-consciousness will unduly influence doctors who study in the HMO’s medical school, lessening the quality of future patients’ care.

Let the patient beware is an adage that may need to be extended to yet another realm of healthcare: dentistry. Kudos to a reporting team in Texas for their recently published investigation, disclosing that dentists all too frequently are involved in procedures in which their patients die and that ineffectual regulators fail to halt dodgy practices and feckless practitioners, some of whom hopscotch across the country with impunity.

The seven-part Dallas Morning News series finds that at least 1,000 dental patients have died in the last five years due to questionable oral healthcare. The report says the numbers may be greater but that regulatory laissez-faire prevents the public from understanding the severity of the issue.

Patients who go to dental practices for issues as minor as tooth decay and as significant as oral surgery all have ended up dead, often after undergoing poorly supervised anesthesia, the paper says.

Several years ago, the New York State Health Department began publishing physician profiles consumers could review to help determine the doctors’ competence. In December, NYDoctorProfile.com was visited 35,000 times, clearly a popular resource for info seekers. But last week, Gov. Andrew Cuomo lopped the program from his proposed budget, claiming that the information it offered was now available on other websites.

But as the civil justice website PopTort made clear, the governor’s effort to compile a responsible budget is misguided and possibly disingenuous. The doc-dissing site isn’t budgetary fat, it’s sustenance for the peoples’ right to know.

According to PopTort, the program was born after the New York Daily News published an exposé in 2000 that discovered that “hundreds of New York State doctors, dentists and podiatrists – ranging from modest practitioners to prominent surgeons – have amassed extensive hidden histories of malpractice, yet continue to treat patients.”

Texas has about 28,000 licensed X-ray technicians, but if the state follows the recommendation of an advisory commission, the piece of paper that certifies that they’re qualified to dose you with radiation won’t be necessary.

The state, according to the Texas Tribune, might decide that radiologic technologists, as well as several other categories of health professionals, no longer need a license to do their jobs. What the members of the Department of State Health Services’ Sunset Advisory Commission don’t seem to understand is that licensing the people with the potential to cause serious harm is a measure of protection against lack of training and ability. (See our backgrounder on radiation overdose injuries.)

The commission, which is charged with identifying inefficiencies in state government, believes licensing is regulatory redundancy because people receive X-rays, MRIs and CT scans in health-care facilities that themselves are highly regulated. By that logic, no hospital that surpasses all oversight measures ever grants practice privileges to a surgeon who – oops! – leaves a sponge inside a patient.

When a celebrity “has work done” and the job goes wrong, it’s splashed all over the tabloids. When it happens to you, it doesn’t make the news, but the results are equally devastating.

Dr. Patrick Hsu, a plastic surgeon, recently wrote on KevinMD.com that the number of people having plastic surgery is increasing, and that the number of bad outcomes is increasing right along with them. Hsu wants potential patients for plastic surgery, whether the procedure is elective or medical, to know how to find the right surgeon.

As always, it’s best to get more than one opinion about a nonemergency medical procedure, and plastic surgery is no different. To enhance your chances of getting the best outcome, Hsu advises all patients to ask prospective plastic surgeons these questions:

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