Articles Posted in Emergency Medicine

medpricehikes-210x300With Americans spending more than $3 trillion annually on health care, the corrosive and crazy effects of all that big money can become almost common place. Even still, hospitals, doctors, and Big Pharma still manage to come up with plenty of, Aw, really, c’mon kinds of financial situations.

Recent news reports, for example, have focused on such dubious dollars and cents concerns like: bedside loans, disparities (price gouging) in cancer care, and, of course, skimpy health insurance plans.

Caveat emptor? Not already infuriated by some recent visual depictions of the upside-down state of costs in the U.S. health care system (see figures*) Read on:

stroke2-300x169Although medicine has made advances in treating strokes, more than 795,000 Americans suffer them annually, they kill 140,000 of us each year, and they’re a leading cause of disability. But medical experts, revising their care guidelines, say that patients with the most common kind of stroke —  a clot blocking blood flow to the brain — may be better treated in an expanded window of still urgent time.

This higher but still guarded optimism does not apply to all stroke cases and not to all ischemic strokes (the kind that come from blood vessel blockages). Doctors have known for awhile now that it is vital to bust the damaging clot — and they had thought their time to do so with drugs like tPA and surgeries was constrained to six or so hours. This led specialists to their axiom, “Time is brain,” and to crash responses.

But for many patients, the tight treatment time frame was unhelpful. They might not be discovered quickly after suffering a stroke and being incapacitated. They might have had their stroke while sleeping, and doctors had decided the timing of their care based on when they could last recall being well — often putting them outside the six-hour limit. Some patients also live far from hospitals that could provide clot-busting drugs, or, even more key, surgeries to implant stents or a thrombectomy, a procedure in which doctors use a small tool to grab the clot and remove it.

dui-300x150Politicians and policy-makers can’t ignore the rising number of vehicular deaths, and they must crack down fast and hard on the increasing road toll associated with alcohol abuse.

At the request of the National Highway Traffic Safety Administration, a blue-ribbon expert group has examined not only the overall increase in road deaths — to 37,461 in 2016, a 5.6 percent rise over the year previous. The panel from the National Academies of Sciences, Engineering, and Medicine also focused on the 10,000 deaths per year attributed to alcohol impairment. The experts called these road fatalities, which are increasing in number, “entirely preventable,” and recommended tough ways to reduce booze-related deaths.

They have recommended that a new national sobriety standard should be put in place, the Associated Press reported, reducing motorists’ allowable blood-alcohol concentration “from 0.08 to 0.05. All states have 0.08 thresholds. A Utah law passed last year that lowers the state’s threshold to 0.05 doesn’t go into effect until Dec. 30.”

intermountain-300x300Some big hospitals and  hospital chains are on the brink of expanding into another aspect of health care. Let’s give them a rare cheer, because they’re taking on Big Pharma and its skyrocketing drug prices and too frequent supply shortages.

Intermountain Healthcare, a nonprofit hospital chain based in Salt Lake City, is leading a well-publicized charge to get its peers nationwide to become part of a new nonprofit group that will make drug generics, products whose patent  protections have lapsed and, thus, are supposed to be cheaper and easier to get because buyers aren’t paying makers for brand names.

Unfortunately for hospitals and patients, Big Pharma sharks have bought up smaller companies that may be the sole makers of these off-patent drugs, which the new investors then jack up in price to reap profits that have outraged the public. Members of Congress expressed their fury in public hearings with Martin Shkreli, the former hedge fund manager and smirking so-called “Pharma Bro,” when he employed this tactic and pumped up the price of a decades-old, infection-fighting drug, Daraprim, to $750 a tablet in 2015, from $13.50.

blkmom-300x222The bad news for expectant black moms isn’t confined to those living in the nation’s capital: A new investigation has found higher risks of harm for women in New York, Florida, and Illinois when they deliver at hospitals that disproportionately serve black mothers.

ProPublica, a Pulitzer Prize-winning investigative site, analyzed two years of hospital inpatient discharge data from the three states to “look in-depth at how well different facilities treat women who experience one particular problem — hemorrhages — while giving birth.” Reporters found negative patterns that underscored big woes identified by other research before:

[B]lack women … fare worse in pregnancy and childbirth, dying at a rate more than triple that of white mothers. And while part of the disparity can be attributed to factors like poverty and inadequate access to health care, there is growing evidence that points to the quality of care at hospitals where a disproportionate number of black women deliver, which are often in neighborhoods disadvantaged by segregation. Researchers have found that women who deliver at these so-called ‘black-serving’ hospitals are more likely to have serious complications — from infections to birth-related embolisms to emergency hysterectomies — than mothers who deliver at institutions that serve fewer black women.

bullets-300x245When illness, accidents, and natural- or man-made calamities strike, victims discover in their long slog to recovery that our health insurance system only aggravates their pain and anxiety.  That’s a painful lesson that hundreds of Americans will keep struggling with in 2018, months after a madman rained gunfire from high-powered rifles down into a Las Vegas music festival crowd.

Modern Healthcare deserves credit for its follow-up of the October mayhem Nevada. It was part of what the industry publication calls an “epidemic of mass shootings,” tragedies stretching from San Bernardino, Calif., to Newton, Mass. They’re taxing hospitals’ capacities not only to provide large-scale emergency medicine but also to provide follow-up care — especially assisting survivors and their families and friends in dealing with their staggering medical expenses.

Victims in mass shootings, Modern Healthcare reported, confront a “proliferation of health plans with high deductibles and coinsurance requirements, leaving [them] exposed to many thousands of dollars in cost-sharing. Severely injured patients needing repeat surgeries may hit their out-of-pocket spending limits multiple years in a row, forcing them into bankruptcy. On top of that, even insured patients may face big balance bills if they are treated by out-of-network providers.”

usfs-thomas-fire-300x200The clock may be counting down to 2017’s end but Mother Nature isn’t giving up on whipping up calamities that wreak havoc on parts of the nation’s health care system and millions of Americans’ well-being. After swaths of the country were inundated by hurricanes and flooding, the West Coast is now battling yet more huge blazes.

Raging wildfires in Southern California not only have added big time to the billions of dollars that such blazes have caused this year in damage and suffering to people, property, and animals, they also have provided the entire coast with a harsh reminder of the importance of air quality to health.

With luck, public cooperation, and outstanding work by fire fighters, police, and other first-responders, the loss of life has been low in a series of blazes on the Westside of Los Angeles, in the city’s northern reaches, in San Diego, and most especially in Ventura and Santa Barbara. The “Thomas Fire,” burning over hundreds of acres in Ventura and Santa Barbara, has become the third largest wildfire in California record books. The Southern California blazes follow hard on the heels of disastrous infernos in Northern California’s wine country.

alive-300x115Nick Tullier once was a handsome, strapping sheriff’s deputy in Baton Rouge, La. Then, in a blink, he and five others were gunned down by a former Marine and black separatist who had come from Missouri to Louisiana to kill cops. Tullier was one of three deputies who survived the attack.

What happened next to him is part of a series worth reading in the Houston Chronicle, a year-long dig the newspaper has dubbed “Alive Inside.” The work asks whether doctors and hospitals across the country have stayed current with medical advances that maybe, just might, possibly offer greater glimmers of hope to patients like Tullier who suffer traumatic brain injuries.

Such individuals, the Chronicle carefully says, may too quickly be deemed too injured to survive. Doctors, in sincere acts of perceived compassion, may be too fast to urge family and loved ones to withhold or halt medical services for the brain-injured, partly out of the pragmatic reality that their recovery prospects remain poor.

emergency-services_overviewThe last thing Americans need to fret about as they struggle to keep down medical costs is worrying about getting hit with a  surprise bill for a ride in an ambulance.  Just how ridiculous can those bills be? Think thousands of bucks for a few miles.

The independent and nonpartisan Kaiser Health News service and the Washington Post deserve credit for their recent story on how companies slam patients with huge tabs for transporting them in dire medical circumstance. Ambulance rides, the news organizations have reported, based on a review of 350 consumer complaints in 32 states, “can leave patients stuck with hundreds or even thousands of dollars in bills and with few options for recourse.”

Lawmakers in 21 states have passed measures to protect consumers from “surprise” medical bills, many inflicted on them for “out of network services” by profit-seeking medical providers. But as much as patients would like legal protections against getting gouged by ambulance services —some run by local governments, including police and fire agencies —the issue gets complex and daunting.

traumatower2-300x205In the torrent of the relentless 24/7 news cycle, let’s not allow a new normal to prevail. We can’t forget that just days ago, a madman opened fire on a church in a small town south of San Antonio, Texas, killing at least 26 and wounding 20 or so. It was the worst mass shooting in the Lone Star State’s history, and it added to a horrific and growing toll for recent such gun-related outbreaks.

These incidents not only devastate the communities in which they occur. They also put giant strains of doctors, nurses, emergency medical technicians, and hospitals. All respond in ways that deserve a major salute, as well as empathy, compassion, and shared grief for the victims, their families, and those who seek to save and protect lives in chaotic situations.

The killing in Sutherland, Texas, posed its own unique stresses, with medical experts heaping praise on EMTs and first-responders for their heroic work at the scene, and then speeding those in need to care at hospitals at least 35 miles away.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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