Military Medicine

November 13, 2017

First-responders, trauma response wins praise in Texas church shooting

In 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.

October 9, 2017

Las Vegas tragedy helps highlight what’s right with nation’s health care system

by Patrick A. Malone

Caregivers and the community in Las Vegas, Nev., deserve a salute for their response to the gun violence last week, which could have overwhelmed a less-prepared community’s medical system.

Las Vegas isn’t a giant metropolis (pop. 2 million in its metro area), and, due to the high costs to operate such a facility, it has just one Level 1 trauma center. That’s a facility staffed and equipped to provide a “gold standard” of emergency care. In the state of Nevada, the only such center is at the 541-bed University Medical Center of Southern Nevada.

It was slammed with more than 100 critical patients, many with life-threatening or fatal gunshot wounds. A torrent of patients also was routed to the hospital, some for treatment of injuries they suffered while fleeing Stephen Paddock’s rampage. First-responders soon were flooding another facility, Sunrise Hospital and Medical Center in Las Vegas—a Level II trauma facility—with hundreds more.

August 25, 2017

Can VA’s struggles, successes help improve health care for us all?

by Patrick A. Malone

Despite the barrage of terrible headlines about reported problems in its care, the VA, aka Veterans Affairs, “continues to perform as well as, and often better than, the rest of the U.S. health-care system on key quality measures [including] patient safety, patient satisfaction, care coordination, and adherence to evidence-based medical practices,” a new study of the embattled agency concludes.

The work, issued by the American Legion and conducted by health care journalists with affiliations including Johns Hopkins University and the University of California, San Francisco, is part of a growing, continuing, and urgently needed re-examination of one of the nation’s major medical providers.

The VA’s struggles, past, present, and into the future, are driven in part by its size and the scope of its mission and commitment, as a recent, detailed article in Foreign Affairs points out:

April 18, 2017

Hospital safety and access are still big problems

by Patrick A. Malone

Hospitals can be risky, troubled, and even downright scary spots, as some recent news and other reports indicate:

Inspector general slams DC VA Medical Center

Almost 100,000 patients of the VA Medical Center in Washington, D.C., have been put at unnecessary risk because hospital staff and administrators, a government watchdog said, failed to “ensure that appropriate medical supplies and equipment were available to providers when needed; that recalled supplies or equipment were not used on patients; and that sterile supplies were stored appropriately.”

December 5, 2016

Psychedelic drugs gets serious clinical consideration in PTSD, cancer care

by Patrick A. Malone

Mental health experts aren’t suffering Sixties flashbacks. But they are seeing a new day for Molly (aka MDMA, Ecstasy, or 3,4-Methylenedioxymethamphetamine) and magic mushrooms (psilocybin). These hallucinogenic drugs are getting serious consideration in helping those with post-traumatic stress disorder (PTSD) and depression and anxiety due to cancer.

The federal Food and Drug Administration, which won’t comment on the matter, has approved Phase 3 clinical trials (large-scale human research) of MDMA for treatment of PTSD, according to Multidisciplinary Association for Psychedelic Studies (MAPS).

MAPS is a nonprofit research and educational organization that “develops medical, legal, and cultural contexts for people to benefit from the careful uses of psychedelics and marijuana.”

October 17, 2016

Baltimore confronts an epidemic of gun violence

by Patrick A. Malone

A lethal epidemic is sweeping Baltimore neighborhoods, costing taxpayers millions of dollars, as well as demoralizing caregivers who struggle with its casualties daily. Researchers, tragically, are barred from developing detailed data about this scourge to try to curb its increasingly deadly harm.

Kudos to the Baltimore Sun and reporter Justin George for investigating for a year the gun violence that torments the city, sending at least 200 patients to area hospitals already just in 2016. The Sun says hospitals in the poor city have spent in five years more than $80 million caring for patients involved in gun crimes. Hospitals have seen their gunshot caseload double, and the costs of this care increase by 30 percent. Taxpayers end up footing most of the bill under Medicaid, the federal-state insurance for the poor.

The Sun’s multi-part series looks at gun violence from many aspects but the violence’s effects on the city’s health care is tragic and distressing.

July 10, 2016

A little Rx for all the awful headlines: four stories of remarkable resilience

by Patrick A. Malone

The events of recent days ─in Texas, Louisiana, and Minnesota─ have been so tragic that it’s easy to despair. Here are four health-related people stories worth reading to remind us of humanity’s enduring better side:

In the horrors of Syrian combat, medical Samaritans strive to maintain some kind of care

First, let’s stipulate that there’s almost as much barbarous conduct as can be imagined in this recent New Yorker report about the struggle to maintain medical care in combat-ravaged Syria. President Assad’s predation on his own people has become an international abomination, including his forces unleashing snipers to maim emergency medical personnel, and their dropping barrel bombs, laden with lacerating shrapnel, on hospitals or known care-giving sites (February, 2016, photo of a bombed hospital from Doctors Without Borders/Medicins san Frontieres).

July 1, 2015

Waiting List for Vets Seeking Health Care Grows

by Patrick A. Malone

Last year the country was shocked to learn the extent of the systemic problems the Department of Veterans Affairs had in delivering adequate health care generally, and, specifically, the grossly long periods vets had to wait to get an appointment.

It’s not getting better.

Department officials told the New York Times that the number of vets on waiting lists of at least one month is 50% higher than it was during the height of last year’s problems.

May 15, 2015

VA Illegally Substituted Cheaper Drugs in Psychiatric Care

by Patrick A. Malone

Substituting one drug for another – say, a generic version for a brand name – often is perfectly fine in terms of what’s best for the patient. But when a Veterans Affairs hospital in West Virginia replaced certain psychotropic drugs with older versions, it put patients at risk, because the priority wasn’t good care, it was cheaper care.

As told by the Washington Post, a federal investigation last month concluded that the drug switch was a violation of VA policy, and that it resulted in a “substantial and specific danger to public health and safety,” according to the VA’s Office of Medical Inspector. The probe was aided by a whistle-blower within the department.

The U.S. special counsel acknowledged the important role of the whistle-blower, which is doubly interesting, given that so often, as we wrote recently, people working in military medicine who identify its shortcomings often are ignored at best, and suffer retribution at worst.

April 26, 2015

The Military Hides Medical Errors from the People It Harms

by Patrick A. Malone

We’ve learned a lot in recent years about how the impact of medical mistakes and malpractice can be somewhat less devastating when the parties who commit them cop to the bad outcome. But like so many other medical providers,the U.S. military, apparently, has decided such acknowledgment is not its mission.

In a story called “Service Members Are Left in the Dark on Health Errors,” the New York Times illuminated how 1.3 million active-duty service members are particularly vulnerable to the ravages of medical error because they are ” virtually powerless to hold accountable the health care system that treats them.”

When members of the service are ill or injured, unless they get specific approval, they must get care through the military system, even if they believe that care is substandard or dangerous. They’re doubly jeopardized because if that military care causes harm or death, they and their survivors have no legal right to challenge it or file malpractice suits.