JCAHO: Ambulatory Care, Procedures Requiring Surgical Site Marking:
[Via MedWatch]
The Pennsylvania Department of Health sent a letter to all Ambulatory Surgery Centers in Pennsylvania reminding them that they are not to perform laparoscopic surgeries which:
Noting that:
My reading of the Pew report turns up no data implicating ambulatory surgery centers (ASC's) specifically in injuries from laparoscopic procedures. Nothing to suggest that eliminating most laparoscopic procedures from ASC's will improve patients safety. In an era when 'evidence based medicine' is the watchword for practitioners, this kind of blanket policy by the government is difficult for me to swallow.
I suspect (though cannot prove) that hospitals have brought political pressure to bear on the Governor and/or Department of Health to make this policy change in order to bring a very profitable class of surgery back to the hospital setting. The facility fees collected for laparoscopic surgery are considerable, and hospitals feel they've been missing out.
Another example to suggest hospitals have been active in this area is the requirement by some payors that orthopedic implant surgeries be performed in hospitals rather than free standing ASC's. For example, we used to perform rotator cuff repairs (which use an anchor suture) in the ASC, but they can no longer be done here because the insurance company will only pay for the anchors if placed in a hospital. There is just no reason I can think of for this requirement other than to force surgeries back into hospitals and away from ASC's.
12/8/04 update: it is on the state servers at: http://app2.health.state.pa.us/commonpoc/content/facilityweb/FacMsgBoardDetails.asp?msgid=819&msgindex=2&Selection=ALL
Froggy Ruminations an excellent argument for why we should Legalize It:
[Via Froggy Ruminations]
Common Good is planning a brochure for mass distribution to 'advance the concept of a special health court.' I've written about this organization before. Their proposal, which has some pretty big names behind it, calls for the creation of special health courts. Some of the details include:
Common Good is accepting donations (tax deductible) to help with the mass distribution of their brochures.
From the CDC: QuickGuide: Recommended Adult Immunization Schedule --- United States, October 2004--September 2005. (PDF)
There's (another) good reason for physicians to take an interest in who is appointed Chair of the Senate Judiciary Committee--his record suggests Specter would be bad for tort reform.
More at NotSpecter.com.
[Via Overlawyered ]
There's a movement gaining steam to allow family members of very ill patients to watch resuscitation efforts by the medical team. This Fox News article states: "Better access to information and witnessing for themselves the measures taken, they argue, often help survivors through the grieving process."
I couldn't disagree more. As an anesthesiologist, I frequently find myself in situations where family members want to be present--at cesarean sections, at surgery for their children, etc. I just don't see how being present to witness the invasiveness of a modern 'code' is 'more holistic patient care.' We cram tubes down people throats, stick them with big needles to gain venous access, shock them with lots of electricity. During all of this they are often naked, sometimes vomit and, unfortunately, don't survive a majority of the time. Plus there's frequently chaos. The person 'running the code' is usually a medicine resident whose crisis management skills are, um, developing, shall we say?
Really, really bad idea.
The New York Academy of Medicine: News & Publications: Terrorism Response Plans Will Not Protect Many Americans, New Academy Study Finds:
Bottom Line: only about 40% would actually do as they are told and go to a smallpox vaccination center for fear of a) catching the illness form the crowds there and b) concern over side effects. The public would do worse in dealing with a dirty-bomb (radiation) attack.
[Via The Atlantic Monthly]
Annals of Internal Medicine (free): Weighing the Evidence for Expanding Physician Supply
...[snip]...
"... the data, forecasts, and signals discussed earlier indicate that physician shortages are upon us and are likely to worsen over time. The picture that emerges is uncomplicated and unambiguous. In simple numeric terms, the number of physicians is no longer keeping up with population growth. The ability to fully service the population is further compromised by the increasing complexity of the care that physicians provide and the decreasing time commitment that many physicians are willing to make. These limitations collide with economic trends that predict a growing demand for physician services. Recruiters, medical leaders, and patients are already experiencing these shortages, and colleagues in other English-speaking countries see a situation in the United States that is all too familiar to them.""Missing from the article is any mention of 'malpractice', 'tort reform', or 'liability reform'. These issues do effect how long someone chooses to practice and where. If one believes that there's a physician shortage coming, states would be wise to become 'friendlier' to physicians by enacting tort reform in order to insure they remain a viable choice for physicians looking for a place to practice. Of course, Pennsylvania won't be among them, at least not while Ed [trial lawyer] Rendell is governor, as he's already been quoted as saying that malpractice reform is "the next governor's problem."
[Via Medscape]
The editors asked President George W. Bush and Senator John F. Kerry to respond to two questions regarding health care in the United States. Free full text.
