Intensive care unit professionals use a number of devices and catheters to deliver intravenous fluids and medications to patients. There is risk of bloodstream infection anytime a worker handles a catheter, and the key organisms linked to these infections are commonly found on the patients’ skin, or sometimes on healthcare workers’ hands.

In the United States, an estimated 50,000 bloodstream infections occur in ICUs each year related to central catheters, with approximately half these cases resulting in patient death.

“When it comes to patient safety, we need teams of healthcare workers to foster excellent care,” said Richard P. Wenzel, M.D., professor and chair in the Department of Internal Medicine in the VCU School of Medicine and president of the International Society for Infectious Diseases, the largest professional organization related to infectious disease.

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In state after state, the tide has turned in one of the most protracted, hard-fought political struggles of the past two decades—the battle over so-called tort reform. Few other business issues have generated more controversy, polemics, and campaign spending than the effort to scale back the types of lawsuits people can file and how much they can recover. In a speech on Nov. 20, for example, Treasury Secretary Henry M. Paulson Jr. charged that “the broken tort system is an Achilles’ heel for our economy” and exhorted his audience to tackle “one challenge that will take a concerted effort over the long term to correct—the need for reform of our legal system.”
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Plaintiffs’ firms say “poisoned” jury pools, and limitations on jury awards and attorneys’ fees have caused them to turn down most potential lawsuits against medical providers. Only $335,000 in plaintiffs’ verdicts had been awarded through October 2006, compared to $2 million in all of 2005. Some older cases, governed by pre-tort reform statutes, are still working their way through the court system.

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The report was issued in response to a state law passed in 2004 that requires public disclosure of hospital infections, a leading cause of death in the United States. Missouri is the third state in the United States to publish a report on hospital-acquired infection rates. The report is available at http://www.dhss.mo.gov/HAI.
“For too long, patients have been kept in the dark about the growing rate of hospital infections,” said Lisa McGiffert, director of Consumers Union’s Stop Hospital Infections Campaign (http://www.stophospitalinfections.org/). “This report will enable Missourians to see whether their local hospital is doing a good job keeping patients safe. We hope it will also spur hospitals to re-double their efforts to improve care and prevent infections.”

Parents Magazine, owned by the Meredith Corporation, has taken up the cause of medical malpractice reform, claiming now that expectant mothers are losing access to their doctors because of frivolous claims agains ob-gyns and resultant rising insurance rates.  The article, appearing in the December 29, 2006 issue, can be read at http://www.parents.com/parents/story.jhtml?storyid=/templatedata/parents/story/data/1166567779265.xml.

The email address of the author is  ‘Jeannette.Moninger@meredith.com’, and if you have an inclination to email her, as I have, we might be able to convince her to write an article with the true facts.

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At New York dialysis centers, those being treated are more likely to suffer from anemia and are less likely to have enough impurities and excess fluid removed from their blood, allowing more damage to their bodies, according to the records.

Experts say the disparity is caused in part by the fact that New York is dominated by small dialysis providers, many of them run by people with little background in medicine who entered the business to meet the surging demand.

Many of the smaller centers provide good care, experts say, but a lot also lack the money and staff training to compete on a quality-of-care basis with the national dialysis chains that dominate the market across the rest of the country.

Newly released patient data show that people who receive their dialysis from a national chain generally fare better than those treated by an independent provider.

But the chains are largely blocked from operating in New York by a state law that effectively bars publicly traded companies from owning health care facilities in the state.

“With the need for dialysis on the rise, the department is questioning whether it makes sense not to allow these large corporations to participate,� said Jeffrey W. Hammond, a Department of Health spokesman.

In 1980, fewer than 50,000 people in the United States needed dialysis to do the work of their kidneys; today, there are more than 350,000, including roughly 24,000 in New York. In 1980, diabetes was the primary cause of kidney failure for fewer than 6,000 dialysis patients; today, the figure is about 150,000.

Survival for them is an ordeal, at best.

At a typical dialysis center, patients come in three times a week, typically for four hours at a time. They sit in rows of recliners, dozing, watching television — anything to take their minds off the machines, needles and tubes that siphon blood from their bodies, clean it of impurities like urea, and pump it back in. It is surprisingly quiet; patients are so beset by side effects like fatigue, cramps or thirst, that mere conversation seems like an effort.

For all but a few, holding a job is out of the question. Most will never be healthy enough to qualify for a transplant that would free them of this burden, and there are far too few donated kidneys, anyway.

New drugs and dialysis techniques have improved their chances of survival since the 1980s, despite the fact that patients today are older, heavier and sicker. Even so, the average dialysis patient spends 15 days a year hospitalized, and the death rate is about one in five each year.

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In addition to “playing down� the health risks associated with its Zyprexa drug, Eli Lilly also promoted unapproved use of the drug to physicians. Lilly’s files showed that sales representatives encouraged physicians to use Zyprexa for patients who had neither schizophrenia and bipolar disorder, the conditions that it primarily treats. The “Viva Zyprexa� marketing campaign had sales reps suggest that physicians prescribe the drug to elder patients with dementia. Because adverse drug reactions are a leading cause of death for individuals 65 and older, this drug company must be held accountable, according to the Illinois Medical Malpractice blog.  

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Malpractice companies, like other insurance companies, essentially have a license to steal.  They have a pure profit motive; collect as high premiums as possible while paying out the least possible benefits.  They tend to carry excessive reserves, because these reserves are easy ways to hide actual profits.  Large executive compensation packages also are not registered as profits.  Unfortunately these companies are shielded from free market self-regulation because they are oligopolies; there are considerable barriers to entry, so each state has few companies from which to choose.  For an analogy, just look at the “big three” automakers in the 1970’s.

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Though the public can regularly compare price, quality and safety data on cars, facial moisturizers or even macaroni and cheese, in most states, including Wyoming, they cannot do the same thing for a commodity that often is a matter of life or death: hospitals.

One measure, in particular, is frustratingly hard to find. Hospital-acquired infections - or health-care-associated infections, as they are sometimes called - are infections that patients get during the course of receiving treatment for other conditions.

Each year, 2 million people contract infections while staying in a health-care facility, often a hospital, according to the Centers for Disease Control and Prevention. Ninety thousand will die. The cost: $4.5 billion.
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Article from the Miami Herald shows the importance of keeping doctors above-board about the relationships they have with those whose devices or treatment they recommend:

 

When a doctor gives advice to a patient, there should not be even a smidgen of doubt that the advice is based primarily on what is best for the patient. Yet conflict rules are so lax that doctors often have relationships — personal or financial — with laboratories, drug companies, medical suppliers and others that could affect their advice to patients or, heaven forbid, the medical outcome of the drugs or procedures they recommend.

Girlfriend hired

This is why the situation with University of Miami cardiologist Alberto Interian Jr., who is romantically involved with a sales representative of a company that sells heart-implant devices, is so disturbing. A Miami Herald story last week described how Dr. Interian asked vendors of different brands of the device to hire his girlfriend — and appeared to shift business to the company that agreed. Audits by UM and by Jackson Memorial Hospital, where Dr. Interian also practices, documented a sharp rise in sales of the device to the company the woman represented.

Investigators for the Miami-Dade County Commission on Ethics and Public Trust found that the relationship constituted ”unethical behavior.” However, the commission didn’t file a formal complaint because it lacks jurisdiction to discipline a UM employee. As for UM, the school has demoted Dr. Interian and has since tightened its ethics rules. UM’s policy now discourages personal relationships that can create a potential conflict.

In a telephone conversation, Dr. Interian adamantly defended his behavior, saying that he disclosed the personal relationship to Jackson officials. Besides, he said, ”Most of my patients know about the relationship . . . and they haven’t said a thing about it.” Dr. Interian is a well-known and highly regarded expert in cardiac-rhythm ailments. His situation points out how difficult it can be to separate a doctor’s personal interests from the interests of patients.

Patients are likely to develop a bond with their doctor, and to trust him, long before they ever become aware of a doctor’s financial connections or personal ties with vendors and drug companies.

Financial reward

This is why it is important for medical gatekeepers — hospitals, medical associations, healthcare providers, state and federal governments and the doctors themselves — to identify and discourage potential conflicts and require that doctors disclose their personal and financial ties.

UM is not alone in trying to fashion policies — albeit belatedly in this instance — that regulate doctors’ behavior. Reformers and healthcare providers nationwide worry that a doctor’s advice might be influenced more by the potential of a financial reward than what is best for patients. Doctors interact with patients when they are desperate, sick, in pain or otherwise vulnerable.

Patients need the protection of greater disclosure and tougher ethics rules.

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