Dallas hospital changes story — admits docs knew patient arrived from Liberia

Late Friday officials at Texas Health Presbyterian Hospital said that the nurses and doctors who initially treated and released an Ebola patient knew that the man, Thomas E. Duncan, had recently arrived from Liberia.

Earlier the hospital claimed the its electronic health record used separate workflows for physicians and nurses so that the travel history in the nursing section “would not automatically appear in the physician’s standard workflow.”

In its latest statement “the hospital effectively retracted that portion of its statement, saying that ‘there was no flaw‘ in its electronic health records system. The hospital said ‘the patient’s travel history was documented and available to the full care team in the electronic health record (E.H.R.), including within the physician’s workflow…’

The hospital’s initial account triggered significant discussion of potential problems with EHRs.

The hospital offered no explanation for the conflicting accounts.

Har. Anyone can be guilty of a screwup but doctors. Nurses may have known and didn’t tell the doctors. The updated electronic health records system required by Obamacare must have been flawed – and therefore the doctors didn’t know the patient may have been exposed to Ebola.

Hogwash! One can only presume by Monday the hospital administration will have come up with a new and creative excuse for sending Thomas Duncan away the first time he arrived at the ER.

Obamacare does at least 21 things that you may not know about


Click to enlarge

Obamacare is the law that extends health insurance coverage to millions of Americans.

It is also the law that requires restaurants to post calorie labels, employers to provide adequate break times for breast feeding and starts funding programs meant to train people for adulthood (seriously).

Tucked inside the Affordable Care Act’s 2,000 pages of legislation are hundreds of new programs that have little, if anything, to do expanding insurance coverage. Some are pet favorites of legislators, who tacked a tiny provision into a very large law. Others raise small amounts of revenue to help pay for the insurance expansion. And others are just… weird. There are 21 programs that are, indeed, part of Obamacare.

1. Obamacare makes funds available for “training for adulthood.” True story…

2. And it imposes a 10 percent tax on indoor tanning…

5. Discrimination against plans and providers not offering assisted suicide is explicitly prohibited.

Physician-assisted suicide is an incredibly controversial topic, and different states have different laws about the practice. A federal law in 1997 prohibited federal funds appropriated by Congress from being used to pay for assisted suicide.

Accordingly, the Affordable Care Act contains language prohibiting discrimination against insurance plans and health care providers who refuse to provide physician-assisted suicide. The law appears to be silent on whether insurers discriminate against providers who do offer physician-assisted suicide.

6. The law authorizes funding for grants that target postpartum depression.

The Secretary of HHS is authorized to make grants available for treating individuals who have postpartum depression and psychosis (conditions that occur in women following childbirth). The law also encourages the National Institute of Mental Health to conduct long-term study from 2010-2019 on how pregnancy affects women’s mental health…

7. And it created the Elder Justice Act.

Over 500,000 elderly adults are victims of “elder abuse”—this can take the form of physical, sexual, or psychological abuse, as well as neglect, abandonment, and financial exploitation. As the Boomers reach retirement age and the population’s share of elderly individuals grows, so will this problem…

13. Employers are required to provide reasonable break time for nursing mothers.

Employers must provide a reasonable amount of break time — and a private place that isn’t a bathroom — for an employee to express breast milk for up to one year after giving birth. Breastfeeding the first six months, at a minimum, is recommended by the American Academy of Pediatrics. Prior to health reform, there was no federal law that protected nursing mothers; state laws on the issue tended to be very general…

19. It’s easier for students going into primary care and nursing to get loans.

There is a shortage of doctors who practice primary care, which has been attributed to the high cost of medical school and the low compensation for primary care physicians (relative to physicians who specialize). Health reform eased several rules that govern federal loans to medical students who commit to practicing primary care…

Loan limitations have been used by the Feds – at the behest of the American Medical Association – for decades to limit the number of doctors in the United States. An outdated guild solution guaranteeing the highest income in the world for doctors. Like any Congressional mandate it is out-of-date and the Party of NO wasn’t about to respond even to requests from the AMA to join the 21st Century.

Obamacare will significantly increase the number of people with health insurance coverage. It does that by overhauling the individual insurance market — where people buy their own policies — and expanding Medicaid, a public program that covers low-income Americans.

Like the best of legislation coming from Washington DC, Obamacare supersedes much of States Rights. That credo being the last resort of reactionaries especially those of the Confederate persuasion. Fools who fear modern practices simply because they aren’t what granddad enjoyed adore States Rights. Racists adore States Rights. Conservative Libertarians adore States Rights – they needn’t update their philosophy to account for any understanding of a changing world beyond Henry Clay and the cheapskates’ standard version of tax avoidance.

Feds bust 50 for Medicare fraud in South Florida – part of 90 nationwide

It was a textbook operation for veterans of law enforcement’s endless war on Medicare fraud in South Florida: 50 suspects busted over two days on charges of trying to steal almost $66 million from the federal program.

But this take-down was different from so many others in the past: 37 of those arrested were patient recruiters accused of collecting thousands of dollars in bribes for supplying Medicare beneficiaries to crooked home healthcare agencies, mental health clinics and pharmacies.

On Tuesday, U.S. Attorney Wifredo Ferrer condemned the “pay to play culture” that he said fuels the nation’s capital of Medicare fraud with “kickbacks.” He said the underground business of patient recruiting has become so competitive that brokers are demanding increasingly higher prices for patients, who also receive bribes in exchange for their valuable Medicare cards.

Ferrer said the accused all used the taxpayer-funded Medicare program “like an ATM machine,” robbing the elderly and disabled of costly services. “And they all had one thing in common: greed.”

As in the past, South Florida’s arrests accounted for the majority of Medicare fraud suspects busted in a coordinated nationwide take-down. In total, 90 doctors, nurses, clinic operators, patient recruiters and patients were charged with collectively filing $260 million in false Medicare claims…

The most prominent name among South Florida’s newly arrested Medicare fraud suspects belonged to Dr. Barry Kaplowitz.

The Aventura psychiatrist served as the medical director of an outpatient mental health facility in Hollywood that federal prosecutors say generated $7.5 million in false claims for Medicare patients who did not need psychiatric treatment…

“I think it’s worse for a doctor to be involved in healthcare fraud,” White declared Monday, when he first considered Kaplowitz’s bond. “It’s outrageous.”

Total fracking scumbags. Yeah, yeah, innocent until proven guilty. Meanwhile, Jay Weaver’s article in the Miami Herald makes it clear that South Florida is mecca for Medicare Fraud.

And please, please, don’t waste too much breath on defending the Republican governor of Florida. Before the silliest voters in the US elected him his clinic set the record for fines paid for fraud.

Belgium’s parliament legalizes child euthanasia


Decision made after long, difficult debate – no matter what anti-choice moralists say

Parliament in Belgium has passed a bill allowing euthanasia for terminally ill children without any age limit, by 86 votes to 44, with 12 abstentions.

When, as expected, the bill is signed by the king, Belgium will become the first country in the world to remove any age limit on the practice.

It may be requested by terminally ill children who are in great pain and who have no treatment available.

Opponents argue children cannot make such a difficult decision. Which presumes opponents have the right to make the decision today – for the children.

In the Netherlands, Belgium’s northern neighbour, euthanasia is legal for children over the age of 12, if there is parental consent.

Under the Dutch conditions, a patient’s request for euthanasia can be fulfilled by a doctor if the request is “voluntary and well-considered” and the patient is suffering unbearably, with no prospect of improvement…

Supporters of the legislation argue that in practice the law will affect an extremely small number of children, who would probably be in their teens…

The law states a child will have to be terminally ill, face “unbearable physical suffering” and make repeated requests to die – before euthanasia is considered.

Parents, doctors and psychiatrists would have to agree before a decision is made

Church leaders argued the law is immoral…

Some paediatricians have warned vulnerable children could be put at risk and have questioned whether a child can really be expected to make such a difficult choice.

But opinion polls have suggested broad support in Belgium for the changes.

Not an easy debate. No more or less than the discussion between doctors, psychiatrists, parents and children facing the question. In a very small number of cases where even the possibility for such a decision is lawfully allowed.

None of which seems to matter to the Christian moralists who have no inhibition about lying about the debate which took place. No matter to the moralists of any philosophic conviction who depict the debate as a conspiracy to murder hundreds and thousands of inconvenient children. They deserve to be shamed for the liars they are.

Once again the leadership of movements against choice care no more for truth than they do for individual liberty.

Don’t get sick in July – really!

With almost no experience, newly graduated medical students enter teaching hospitals around the country every July, beginning their careers as interns. At the same time, the last year’s interns and junior residents take a step up and assume new responsibilities.

In addition to developing their nascent clinical skills, each entering class of interns must grasp the many rules and standards for operating in this “new” hospital structure.

More experienced physicians share a joke about this changing of the guard: Don’t get sick in July

“The good news for patients is that in most cases, it’s very difficult for a physician to make a mistake that results in a patient’s death,” said Anupam Jena, HMS assistant professor of health care policy and of medicine at Massachusetts General Hospital and lead author of the study. “But for severely ill patients, health can be very tenuous. A small error or a very slight delay in care is potentially devastating…”

Overall, they found that patients at teaching hospitals had a lower risk of dying than at non-teaching hospitals, but in July, the risk at teaching hospitals rose to the same level that patients at non-teaching hospitals faced. For high-risk patients who came to the teaching hospitals with heart attacks, the risk of death in hospital went from 20 percent to 25 percent. They also found that among teaching hospitals, the difference between outcomes in May and July is greatest in institutions with the highest percentages of trainees.

The researchers ruled out two potential factors that they suspected may have accounted for some of that difference — the prevalence of percutaneous coronary intervention (i.e. cardiac stents) and of complications from the use of blood thinners.

Without evidence for specific procedures or protocols that could prevent increased deaths, the researchers said that their findings suggest that, especially during the early months in the training cycle, oversight should be intensively focused on high-risk cases rather than across cases overall. In July, doctors with more experience should play a greater role in the care of high-risk patients than has typically been the case.

I never ran into this dicho before. Though it has been at least 40 years since I worked in a teaching hospital. And it was one of the very best.

Still – remind self not to have a stroke or heart attack in July. Especially since the only hospital in town is known as Saint Victims.

Pharma giant Johnson & Johnson to pay $2.2 billion settlement

Pharma company Johnson & Johnson has agreed to pay over $2.2 billion to resolve criminal and civil allegations in the US that it promoted powerful psychiatric drugs for unapproved uses in children, seniors and disabled patients.

The allegations include paying kickbacks to doctors and pharmacies to recommend and prescribe Risperdal and Invega, both anti-psychotic drugs, and Natrecor, which is used to treat heart failure…

The figure includes $1.72 billion in civil settlements with federal and state governments as well as $485 million in criminal fines and forfeited profits.

The agreement is the third-largest US settlement involving a drug-maker, and the latest in a string of legal actions against drug companies allegedly putting profits ahead of patients.

These companies lined their pockets at the expense of American taxpayers, patients and the private insurance industry,” said Attorney General Eric Holder, at a news conference…

“Every time pharmaceutical companies engage in this type of conduct, they corrupt medical decisions by health care providers, jeopardise the public health and take money out of taxpayers’ pockets,” the Attorney General said…

In a separate civil complaint, the government alleges Janssen Pharmaceuticals also promoted the drug as a way to control behavioural problems in children and mentally disabled.

The drugmaker allegedly downplayed Risperdal’s side effects while also paying kickbacks to the nation’s largest long-term care pharmacy to recommend the drug to prescribers.

Please, please – in addition to the cash settlement, throw the creeps in jail who made the decision to pursue criminal fraud to maximize profits. That is the polite definition of corporate theft, right?

Doctors aid torture at US military prisons

Doctors and nurses working under US military orders have been complicit in the abuse of terrorism suspects, a new independent US report says.

The study says medical professionals helped design, enable and participated in “torture and cruel, inhumane and degrading treatment” of detainees.

The report was compiled by an independent panel of military, health, ethics and legal experts.

Both the CIA and the Pentagon have rejected the report’s findings…

That last sentence ain’t exactly a surprise. I doubt if they care one way or the other.

The report says the collusion began at US prisons in Afghanistan, Guantanamo Bay in Cuba and at CIA secret detention sites after the 11 September 2001 attacks in the US.

Co-author Leonard Rubenstein told the BBC’s Newsday programme that the report revealed “the legacy of torture and detainee abuse at Guantanamo and elsewhere on the medical community”.

“What we found was that the department of defence and the CIA actually changed core ethical standards to facilitate participation by health professionals in the abuse of detainees. And those distortions still exist,” he said…

The report calls on the US Senate Intelligence Committee to fully investigate medical practices at the detention sites.

Pentagon spokesman Todd Breasseale said that none of the critics of prisoner care had access to the detainees, their medical records, or the procedures at Guantanamo.

He described the doctors and nurses working at Guantanamo as “consummate professionals“.

And Mussolini got the trains in Italy to run on time.

As for access to prisoners? That’s a function of the isolation imposed by the screws in charge of US prisons holding detainees illegally to begin with. What meager judicial processes the prisoners have been allowed violate all core international treaties on war crimes. And even though a significant number of prisoners have been judged free of crime they haven’t been allowed repatriation.

Nope. The whole process stinks on ice – just like Obama’s so-called legalising of Bush’s crimes. Same shit, different day is all. The doctors who worked for Himmler and Hitler in Nazi death camps were consummate professionals, too.

You can download the full report [.pdf] over here – hosted by the Institute for Medicine as a Profession.

Can’t modify a schoolchild’s environment – modify the child!


Peanut butter on the top shelf, drugs down below

When Dr. Michael Anderson hears about his low-income patients struggling in elementary school, he usually gives them a taste of some powerful medicine: Adderall.

The pills boost focus and impulse control in children with attention deficit hyperactivity disorder. Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools.

“I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

Dr. Anderson is one of the more outspoken proponents of an idea that is gaining interest among some physicians. They are prescribing stimulants to struggling students in schools starved of extra money — not to treat A.D.H.D., necessarily, but to boost their academic performance.

It is not yet clear whether Dr. Anderson is representative of a widening trend. But some experts note that as wealthy students abuse stimulants to raise already-good grades in colleges and high schools, the medications are being used on low-income elementary school children with faltering grades and parents eager to see them succeed…

All the easier to come to this conclusion when decisions are based pretty much only on test scores.

Jacqueline Williams said she can’t thank Dr. Anderson enough for diagnosing A.D.H.D. in her children — Eric, 15; Chekiara, 14; and Shamya, 11 — and prescribing Concerta, a long-acting stimulant, for them all. She said each was having trouble listening to instructions and concentrating on schoolwork.

“My kids don’t want to take it, but I told them, ‘These are your grades when you’re taking it, this is when you don’t,’ and they understood,” Ms. Williams said, noting that Medicaid covers almost every penny of her doctor and prescription costs.

Some experts see little harm in a responsible physician using A.D.H.D. medications to help a struggling student. Others…fear that doctors are exposing children to unwarranted physical and psychological risks. Reported side effects of the drugs have included growth suppression, increased blood pressure and, in rare cases, psychotic episodes.

The reported prevalence of the disorder has risen steadily for more than a decade, with some doctors gratified by its widening recognition but others fearful that the diagnosis, and the drugs to treat it, are handed out too loosely and at the exclusion of nonpharmaceutical therapies.

RTFA for delightful tales of side effects, hospitalization. Diagnosis rates have gone up as Congressional beancounters and state ward-heelers have cut funding for education. Somehow, keeping the machinery of death and destruction well-oiled while our childrens’ education continues in a death spiral fits the job description for elected officials in every one of these United States.

So, the punks in Congress, drug-dealers in the medical profession, say they’re doing their best to keep life going in difficult times. No thought for planning ahead. No conscience. No reformation of an education system turned over to pharmaceutical companies and budget clerks.

Fire destroys Missouri mosque – 2nd blaze at the same center in 5 weeks


Daylife/AP Photo used by permission

A mosque in southwest Missouri burned to the ground early Monday in the second fire to hit the Islamic center in little more than a month, and investigators spent the day combing through the wreckage searching for evidence of arson.

No injuries were reported, but the Islamic Society of Joplin’s building was a total loss after the blaze…the Jasper County Sheriff’s Office said. As of late Monday, nobody had been arrested in connection with the fire.

Either fire.

Investigators from the FBI, the Bureau of Alcohol Tobacco and Firearms and the Jasper County Sheriff’s department were at the scene all day Monday, moving the rubble with a bulldozer and other equipment…

While investigators did their work, a small group of Muslims gathered for an evening prayer on the lawn of the destroyed building.

“This is what we stand for,” said Dr. Ahmed Asadullah, a member of the Islamic Society of Joplin. “Freedom of religion. Freedom of speech…”

Theoretically, that’s what all Americans stand for. Theoretically.

…A fire reported…July 4 has been determined to be arson, but no charges have been filed. The FBI has released a video of a suspect caught on surveillance video and offered a $15,000 reward for information leading to an arrest in that fire.

Michael Kaste, special agent in charge of the Kansas City office of the FBI…said it was too early to say if there was surveillance video available from the Monday fire. The Jasper County Sheriff’s office said earlier Monday the video equipment had been destroyed. The FBI was encouraging anyone with information about either fire to call authorities…

A local Christian church has offered the use of their church to the Muslim congregation while they sort out what it’s like to belong to a religion in America that’s obviously not acceptable to some local bigots.

Two doctors charged for drugs and deaths

Two South Florida doctors involved in a pill mill operation that collected $40 million and dispensed more than 20 million pain pills within two years are facing charges in the deaths of nine people, federal prosecutors said Friday.

Officials say the physicians — Cynthia Cadet, 42, of Parkland, and Joseph Castronuovo, 72, of Key Largo — worked as vital tools in the Broward- and Palm Beach County-based operation that distributed oxycodone pills to addicts without any regard for their health.

Both face the possibility of life in prison if convicted

A 34-page indictment…attributed the deaths of nine people to oxycodone parceled out at the pill mills…

The two doctors were among 32 people arrested last year on multiple charges ranging from racketeering to fraud and illegal drug sales…Twenty-eight of those arrested have already entered guilty pleas and been sentenced…

The indictment alleges the doctors often relied on preliminary radiology reports in prescribing large quantities of drugs, and knew that many of their patients came from outside Florida, where stricter controls of the pills were in place.

Just as I’ve worked with some great lawyers in my time, I’ve worked with some wonderful doctors. Going down either road, the public leaders of both professions spend more time supporting gross incomes more often than ethical standards or progressive policies.

I blame them as much as this corrupt pair on trial in Florida.

Throw away the key.