Hospitals

August 16, 2018

Lax oversight and safety nightmares burgeon with boom in surgical centers

An innovation in medical treatment — which was supposed to offer more affordable, accessible, and even convenient care — instead may be getting swamped with safety problems that long have plagued hospitals and academic medical centers.

USA Today and Kaiser Health News Service deserve credit for digging into patients’ nightmares with specialized surgical centers, not only those performing “routine” procedures but also those handling increasingly longer, more complex, and difficult operations. The many surgeries, once the province only of big and well-staffed hospitals, put patients at risk, the newspaper reported, saying:

[Our] investigation found that surgery centers operate under such an uneven mix of rules across U.S. states that fatalities or serious injuries can result in no warning to government officials, much less to potential patients. The gaps in oversight enable centers hit with federal regulators’ toughest sanctions to keep operating, according to interviews, a review of hundreds of pages of court filings and government records obtained under open records laws. No rule stops a doctor exiled by a hospital for misconduct from opening a surgery center down the street.

August 12, 2018

Say what? Mar-a-Lago trio acting as ‘shadow rulers’ of Trump’s VA

by Patrick A. Malone

So, see, Ike, Marc, and Bruce may be pretty swell guys. They’ve done well in business: Ike in comic books and entertainment, Marc in the law and consulting on white collar crime, and Bruce as a medical concierge who gets affluent patients in to see big name doctors.

But this odd trio —Ike Perlmutter, Bruce Moskowitz and Marc Sherman — never served in the U.S. military. They’re certainly not veterans. Perlmutter and Sherman have zero experience in health care. And Moskowitz, while a doctor, is a respected primary care practitioner — not someone known for his direct experience in running big, complex operations.

They also, however, happen to be FOT — Friends of (President) Trump. They pay him to belong to his Mar-a-Lago country club. And, apparently at his request and with the assistance of powerful partisans and the acquiescence of sheepish bureaucrats, Perlmutter, Moskowitz, and Sherman have become “shadow rulers” of the U.S. Department of Veterans Affairs.

August 9, 2018

For sick seniors, hospitals and nursing homes can be nothing but bad news

by Patrick A. Malone

In many parts of the developing world, families play a big part in patients’ hospital care. They not only sit for long hours with loved ones, supporting and encouraging their recovery. They also may help with direct services, bathing and cleaning patients, tending to their beds and quarters, and even assisting with their medications and treatments.

Such attentiveness from loved ones— once common in this country, too — may be deemed by many now as quaint and unnecessary, what with the rise of big, shiny, expensive American hospitals.

But think again: As Paula Span reported in her New York Times column on “The New Old Age,” care-giving institutions across the country have become such stressful, disruptive places that seniors, especially, not only heal poorly in them but also may be launched into a downward cycle of repeat admissions.

August 8, 2018

Shift-and-shaft: Why is it always patients’ burden to hunt for affordable care?

by Patrick A. Malone

The health policy wonks and those who purport to “reform” the U.S. health care system may be long on academic and other fancy credentials. But they also persist in demonstrating they can be short on old-fashioned common sense, especially about the way most of us lead our lives.

That’s a point emphasized in a recent column in the evidence-based “Upshot” feature of the New York Times, written by Austin Frakt. He directs the Partnered Evidence-Based Policy Resource Center at the VA Boston Healthcare System and is an associate professor with Boston University’s School of Public Health and an adjunct associate professor with the Harvard T.H. Chan School of Public Health.

Frakt looked at some recent research to dissect a question that occupies many experts: Could Americans cut their health care costs by shopping around more for medical services? This is a fond notion held by a slice of health care “reformers,” whom Frankt proceeds to disabuse.

August 5, 2018

Medical valor is on finest display as wind-whipped wildfires roar in California

by Patrick A. Malone

When a raging wildfire — feeding off blowing winds and weeks of desiccating heat, also whipped up a freak, blazing tornado-like vortex with 140-mile-an-hour gusts and a 500-yard diameter — common sense might have dictated that affected Northern Californians should flee as fast and as far as possible.

While many did, correctly heeding authorities’ emergency evacuation pleas, some courageous residents of Redding, Calif., pop. 91,000, decided to stay.

No, they were neither daring nor foolish. They were doctors, nurses, and medical personnel, who — along with first responders like police, fire fighters, and civil defense personnel — put the care and safety of others’ lives ahead of their own.

August 1, 2018

Colonoscopies carry higher infection risks than previously believed

by Patrick A. Malone

More than 15 million Americans each year undergo an invasive medical test, roughly once a decade and starting at age 50. If some medical experts had their way, more patients would get this cancer checkup, beginning at an even younger age. But as Emily Bazar, a senior editor and consumer columnist (Ask Emily) for the independent, nonprofit Kaiser Health News service, points out, physicians may want to heal themselves and their hygiene practices before pushing even more patients to get colonoscopies and endoscopies (procedures to examine the upper gastrointestinal tract).

That’s because a growing body of research shows that the switch by doctors, hospitals, and specialty centers to reusable scopes to peer into various parts of the body have resulted in rising infection rates among colonoscopy and endoscopy patients, among others.

Inspections show that the reused scopes don’t get cleaned properly and all the time. The more complex the medical device, the greater the risk, as clinicians and patients learned when complex and dirty duodenoscopes were tied to the deaths of 35 patients since 2013 and the sickening of dozens of others, leading to congressional investigations, lawsuits, and product recalls.

July 26, 2018

Watch this documentary before you let a surgeon use a robot to cut inside you

by Patrick A. Malone

Robots are the shiny new toys of surgery in American hospitals. They promise ultra-precise, tiny cuts that give patients faster healing and better outcomes. Wherever you live, your local TV news outlets have likely run uncritical, gee-whiz stories about hospitals and surgeons bringing in these robots, featuring glowing patient testimonials.

So what’s not to like? You need to watch a new documentary airing Friday night on Netflix to get the other side of the story, and there’s plenty. And also about other medical devices that promise much but deliver more pain than benefit.

July 20, 2018

When Big Pharma dives for dollars, crises erupt but dire needs go unanswered

by Patrick A. Malone

Americans should be wary lest they get in between Big Pharma and a buck.

That’s what investigators for a U.S. Senate subcommittee showed when scrutinizing how industry middlemen inundated the Show Me State with more than a billion doses of powerful prescription painkillers, making big profits but asking few questions how so many opioid drugs could be taken by so few patients.

It’s also what patients might see as drug makers retreat from research to develop needed new antibiotics and therapies for Alzheimer’s and Parkinson’s.

July 18, 2018

In health care, nursing homes not alone in confronting staffing problems

by Patrick A. Malone

It’s unlikely to surprise anyone who has visited friends or loved ones at a nursing home that such facilities too often are woefully staffed.

But why have federal regulators allowed themselves to be gulled about nursing home personnel levels, and how will not just these care-giving sites but also others, notably hospitals, deal with the growing need for and imbalances in health care staff, including a tilt toward “astonishingly high” numbers of costly administrative staff folks who don’t provide direct patient care?

Jordan Rau, a reporter for Kaiser Health News Service, deserves credit for digging into daily payroll records that Medicare only recently has gathered and published from 14,000 nursing homes nationwide. Rau found that:

July 17, 2018

ER intervention may be a key way to avert patients’ repeat suicide attempts

by Patrick A. Malone

As the nation deals with record numbers of suicides, hospital emergency rooms, with a relatively simple intervention and diligent follow-up, may be able to reduce by half the high risk that patients they treat will try to take their own lives again.

National Public Radio reported on a newly published Veterans Affairs study of more than 1,600 patients at five sites across the country treated in ERs for suicide attempts, following up on their care for six months.

Researchers found that ER doctors, nurses, and social workers — even with little training — can help prevent the “ticking time bomb” of patients’ potential repeat suicide attempts by helping them with a Safety Planning Intervention.