Heroes on the front line in Italy

Their eyes are tired. Their cheekbones rubbed raw from protective masks. They don’t smile.

The doctors and nurses on the front lines of the coronavirus pandemic in Italy are almost unrecognizable behind their masks, scrubs, gloves and hairnets — the flimsy battle armor donned at the start of each shift as the only barrier to contagion.

Associated Press photographers fanned out on Friday to photograph them during rare breaks from hospital intensive care units in the Lombardy region cities of Bergamo and Brescia, and in Rome. In each case, doctors, nurses and paramedics posed in front of forest green surgical drapes, the bland backdrop of their sterile wards.

Decades ago, I worked in an historic teaching hospital associated with a world-class university. It was appropriately one of the few U.S. hospitals with a section reserved for treatment of rare, usually-imported, deadly diseases. I don’t recall the official name. The grunts I worked with – charged with maintaining essential infrastructure – called it the “Plague Ward”.

I can still recall the eerie and scary feeling we shared – electricians, structural workers, line mechanics – when we suited up in what passed for hazmat suits back in the day, surgical masks, towels wrapped over our shoes…

That feeling is back.

There’s a reason it’s called Public Health

Physicians and other healthcare workers who refuse influenza immunization at 535-bed Children’s Hospital of Philadelphia can’t work in patient care.

“If you don’t want to get the vaccine, you have two weeks of unpaid leave to think about it, and if you still don’t want to get it, you’re fired,” said Paul Offit, MD, CHOP’s Chief of Infectious Diseases and Director of the Vaccine Education Center.

There’s no provision to let workers wear a mask instead, like many healthcare facilities allow, because he said, “masks aren’t particularly effective…”

As healthcare organizations rush to comply with new federal immunization reporting requirements for their workers, many infection control experts are questioning the mask option, saying it’s an inefficient, ineffective, and dehumanizing alternative to immunization, one that gives workers an excuse not to get their annual flu vaccines.

Mask mandates are “a silly half-way measure that really doesn’t serve any useful purpose other than to identify a person as a healthcare worker who is choosing not to get vaccinated — selfishly,” Offit said. “You might as well wear a scarlet letter for all the good it does…”

The national average for vaccine refusal by hospital workers is 18%, and some hospitals report they have reduced the refusal rate to 10%, but other hospitals’ have lagged…

Bonnie Castillo, National Nurses United said…”If we in the healthcare and science communities are spreading bogus science on one hand, how do we expect to be credible on any other topic of infectious disease, or worker and patient protection? You have to be consistent.”

For Offit, a focus on getting all healthcare workers immunized is really the only solution to keeping patients safe from infection. One must remember that patients’ lives are at stake, he said…

Several years ago, a child with cancer “came into this hospital for care, but caught the influenza virus in this hospital and died from it,” he said. “She no doubt caught it from us.”

If you want a job in a science-based facility, it’s perfectly reasonable to require that you perform your work up to the standards of the science involved. If you can’t agree to that, then it’s your responsibility to find employment where your beliefs fit.

The same responsibility should apply to the facility. As Dr. Offit makes clear. You ain’t about to treat burns by spitting on them and rubbing in soot…because your patient’s shaman said that’s the appropriate traditional treatment.

Yes, I’ve been in a hospital where that question had to be answered.

243 medical “professionals” busted in $712 million Medicare fraud


Digitizing medical records tracks provider accounts as well as individual histories

The U.S. Justice Department charged 243 people, including 46 doctors, nurses and other medical professionals, with defrauding the Medicare system of $712 million through false billing.

Attorney General Loretta Lynch announced the charges…calling the case the largest sweep of individuals in the history of task forces that target such fraud.

“The defendants charged include doctors, patient recruiters, home health-care providers, pharmacy owners, and others,” Lynch said. “They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.”

The defendants were accused of money laundering, conspiring to commit health-care fraud and violating anti-kickback laws. The scams involved treatments ranging from home health care to psychotherapy. The Justice Department alleged that participants in the scams submitted claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided…

Government efforts to combat health-care fraud led to the recovery of $3.3 billion in taxpayer dollars in the fiscal year that ended Sept. 30, according to a March report. During that period, U.S. prosecutors opened 924 new criminal health-care fraud investigations, the two departments said in the joint report.

The medical-industrial complex still hasn’t learned how to steal from taxpayers with the skill and cunning of their counterparts in the military-industrial complex.

Tub-thumping politicians in Congress blather day-in and day-out that they must oppose real single-payer healthcare because the people can’t be trusted to treat the system honestly. Yet, time and again, the real crooks turn out to be the practitioners, profiteering frauds within the medical community.

Are doctors ready for body cams?


Google Glass makes it into the surveillance society

Maybe you remember the famous video by Simons and Chabris. Two groups of students, one in white shirts and the other in black shirts, are passing a basketball around. You are asked to watch the video and count the number of passes made by one of the teams. You proudly count 13 (the actual number is 18). But what you didn’t notice, during all of your counting, was that midway through the video, a gorilla walked straight through the middle of the scene. Indeed about half of individuals tested in the original study missed the gorilla.

A red trauma victim is brought into the ED trauma bay by EMS. The lead paramedic provides details about the crash scene, the patient’s health status, and gives a point-by-point report about the prehospital care. Too bad that only 36% of the key information was accurately remembered by the receiving ED group.

What’s happening here?

These two examples highlight how medical care can be perceived differently, and maybe even contradicted, by doctors and patients. We aren’t aware of something we have missed — like the gorilla. You only see things you are focusing attention on. Have you ever had a patient complain “the doctor didn’t even examine my stomach” when you have performed, and documented, several serial exams? How many times have you been asked by a patient “When am I going to see the doctor?” when you’ve already had several conversations and introduced yourself as THE DOCTOR. Or, are perplexed by a family display of great disbelief when informed that their loved one is sliding towards the end of life.

We think we perceive and remember more of the world than we actually do, and different people experience the same inputs differently. We don’t see, hear, and remember alike. Hearing is passive, but listening requires concentration and focus to understand the meaning of another’s words.

Jeremy Brown has identified lots of examples where a med-cam can provide an objective view of medical reality — a sort of enhanced photojournalism — where the picture tells the truth. But we need to be ready to have our own behaviors and communications on display. After all, what’s good for the patient should be good for the doctor, too.

Questions of what’s private and what isn’t used to be decided essentially by what’s public and what isn’t. Starting with the obvious – like body cams for coppers – I can see where record-keeping is going. Not only for accurate answers to recurrent questions in an ER; but, the lawyers on retainer for the hospital are going to want this kind of recorded observation to keep a handle on liability.

The feeling changes. Your relationship with your employer changes. Doctors especially feel they’re part of the management team – even in large-economy-size urban hospital complexes. That feeling will change under observation. As much as useful qualities like those described in this article may be – in our society it’s easy to worry about office politics, petty jealousy becoming equally important to some administrator you consider to be an ignorant ass.

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.

Daylight is best medicine for nurses

In a forthcoming Cornell study…Rana Zadeh, assistant professor of design and environmental analysis, discovered nurses who had access to natural light enjoyed significantly lower blood pressure, communicated more often with their colleagues, laughed more and served their patients in better moods than nurses who settled for large doses of artificial light.

Letting natural light into the nurses’ workstations offered improved alertness and mood restoration effects. “The increase in positive sociability, as measured by the occurrence of frequent laughter, was … significant,” noted Zadeh in the paper.

Nurses work long shifts, during non-standardized hours. They work on demanding and sensitive tasks and their alertness is connected to both staff and patient safety. Past evidence indicates natural light and views have restorative effects on people both physiologically and psychologically. Maximizing access to natural daylight and providing quality lighting design in nursing areas may be an opportunity to improve safety though environmental design and enable staff to manage sleepiness, work in a better mood and stay alert, according to Zadeh…

Access to natural daylight, and a nice view to outside, should be provided for clinical workspace design, said Zadeh. In situations where natural light is not possible, she suggests optimizing electric lighting in terms of spectrum, intensity and variability to support circadian rhythms and work performance.

Yes, I know most folks would consider this an automatic goal. Tell that to some of the Scrooges who manage hospitals and clinics as if they paid for each lightbulb and window from their own pocket.

107 health care professionals busted for health care fraud

More than 100 people are charged in what authorities say is the largest one-day takedown ever for Medicare fraud. A federal health care fraud strike force conducted raids in seven cities, targeting more than $450 million in alleged false billing.

At a news conference in Washington, D.C., to announce the arrests, Attorney General Eric Holder said they “underscore the Justice Department’s determination to move aggressively in bringing to justice those who would violate our laws and defraud the Medicare program for their personal gain.”

The arrests are the latest in a three-year crackdown on health care fraud, which is estimated to cost taxpayers between $80 and $160 billion per year. Authorities recovered a record $4.1 billion last year.

The 107 people charged Wednesday include doctors, nurses and other health care professionals in seven cities: Miami, Tampa, Chicago, Detroit, Houston, Los Angeles and Baton Rouge.

In addition, the government has suspended payments to 52 provider organizations the individuals are associated with. Health and Human Services Secretary Kathleen Sebelius said the operation, including the arrests and the cutoff of payments, is part of an effort to get ahead of fraud instead of relying on the old “pay-and-chase” model.

“Now, we’re analyzing patterns and trends and claims data, instead of just going claim by claim,” Sebelius said.

Bravo. Nice to see one portion of Obama’s program for digital medical records being used to arrest the crooks gaming the system.

As nurses achieve doctorates, medical doctors start to whine


Doctor Patti McCarver meeting with a patient

With pain in her right ear, Sue Cassidy went to a clinic. The doctor, wearing a white lab coat with a stethoscope in one pocket, introduced herself.

“Hi. I’m Dr. Patti McCarver, and I’m your nurse,” she said. And with that, Dr. McCarver stuck a scope in Ms. Cassidy’s ear, noticed a buildup of fluid and prescribed an allergy medicine. It was something that will become increasingly routine for patients: a someone who is not a physician using the title of doctor.

Dr. McCarver calls herself a doctor because she returned to school to earn a doctorate last year, one of thousands of nurses doing the same recently. Doctorates are popping up all over the health professions, and the result is a quiet battle over not only the title “doctor,” but also the money, power and prestige that often comes with it.

As more nurses, pharmacists and physical therapists claim this honorific, physicians are fighting back.

An illegitimate characterization. “Fighting back” implies medical doctors are losing something. The quandary is over their ego-smitten self-worth. Standards for doctorates in most fields, medical or otherwise, allow the term “doctor” for anyone who reaches or surpasses those standards.

For nurses, getting doctorates can help them land a top administrative job at a hospital, improve their standing at a university and win them more respect from colleagues and patients. But so far, the new degrees have not brought higher fees from insurers for seeing patients or greater authority from states to prescribe medicines.

Nursing leaders say that their push to have more nurses earn doctorates has nothing to do with their fight of several decades in state legislatures to give nurses more autonomy, money and prescriptive power.

But many physicians are suspicious and say that once tens of thousands of nurses have doctorates, they will invariably seek more prescribing authority and more money. Otherwise, they ask, what is the point..?

The point is knowledge, skill and understanding. For the nurses. Obviously the point for the doctors is money and status. And money.

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U.S. arrests 111 in largest Medicare fraud bust


FBI Asst Director Shawn Henry, Eric Holder and Kathleen Sebelius behind him
Daylife/AP Photo used by permission

The U.S. government on Thursday charged 111 doctors, nurses and other defendants with Medicare crime schemes that exceeded $225 million in false billings, the largest health care fraud crackdown so far.

Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius announced the charges in the latest of a series of cases brought by the Obama administration…

Medicare reform represented a key part of the sweeping year-old health care law championed by Democratic President Barack Obama, but opposed by many Republicans in Congress.

The latest charges covered defendants in nine cities. In addition to arrests, law enforcement agents also executed 16 search warrants.

The defendants were charged with various crimes, including conspiracy to defraud the Medicare program, false claims, kickbacks and money laundering, administration officials said.

They said the alleged schemes involved various medical treatments, tests and services, such as home health care, physical and occupational therapy and medical equipment…

A top FBI official, Shawn Henry, said 2,600 health care fraud cases were under investigation and that organized crime groups have been increasingly linked to the alleged schemes.

Sebelius said $4 billion was recovered last year, and the government’s Medicare Fraud Strike Force was recently expanded to nine cities, with the addition of Dallas and Chicago.

Go get ’em! Throw a couple of insurance companies into the meatgrinder while you’re at it.

They deserve to be sorted out for their role in inflating healthcare costs. They could care less about phony costs when they know American taxpayers get stuck with the bill regardless of legitimacy.

Nurses use Colorado whistle-blower law to sue medical center

Three nurses who cared for the sickest babies at Swedish Medical Center claim they were fired for reporting what they believed was unsafe care, including a pacifier taped to a baby’s mouth.

Their lawsuit is among the first to test a 2007 state law that protects health care workers who “blow the whistle” on dangerous conditions.

The three workers — all supervisory “charge nurses” in the intensive-care nursery — allege they were terminated for clashing with supervisors about safety concerns. The women say the hospital lacked enough “level three” nurses with the skills to medicate, resuscitate and care for premature babies.

But when they complained to superiors, the nurses “were met with a brick wall,” said Penelope Clor, their attorney…

All three nurses, who each had worked in the profession for at least 15 years, have struggled to find jobs since leaving Swedish. One is working two jobs and still not earning her old salary; the others work for a temporary-placement agency.

The 2-year-old state law was passed to encourage health care workers to report legitimate safety concerns at work.

I’d hope the state would step in to back up their own law. How’s that for a daydream?