More Fishing …

Last month it was for a business trip. This time it’s a gen-u-wine vacation for the WhiteCoats before the WhiteCoat children start school again.

Be gone through the weekend and not taking the computer. But I will take the camera

You’ll see a “kinder gentler” me next Tuesday … I hope.

Idiocy - Alive and Well in Los Angeles

As reported in the Wall Street Journal (with a hat tip to Kevin, MD), Los Angeles has created a city ordinance making it a crime to transport a patient anywhere other than that patient’s residence without the patient’s written consent.

The intent of the ordinance is noble - to prevent hospitals from discharging homeless patients and then dumping them in the gutter with nothing but a gown and a hearty handshake.

The problem is that keeping patients in the hospital - even if there is nothing wrong with them - costs hospitals an estimated $1,350 per patient per night. So while LA is imposing the mandate, the funding is nowhere to be found.

Implementing the requirements that this new ordinance imposes upon the hospitals shows that the people in the Los Angeles city government have the foresight of a goldfish.

Medi-Cal is cutting payments to hospitals by 10%.
The “safety net” that cares for California’s indigent population is “stretched thin.”
The low Medi-Cal payments make it difficult to find specialty care for patients.

Now LA is going to impose what amounts to a $1,350 per night penalty on each and every hospital that cannot find a shelter for a homeless person.

So explain to me … the money to care for these patients is going to come from … where?

Who cares?

Cold in the winter? Go to a hospital and complain of chest pain. Really bad chest pain. Better yet - scratch up your wrists with a rock or something and tell the registration clerk that you’re suicidal. You’ll get admitted. They’ll feed you meals every day. You’ll get free television. You might even score some pain medications if you complain loud enough. A nurse will wait on you hand and foot. Clean linens every day. Everything but a mint on your pillow. You won’t have to leave until the next La Niña if you don’t want.
If you want to get a Big Mac from Mickey D’s or if the hospital finds a way to get you discharged, no problem. Just walk down the street to the next hospital and make the same complaint all over again. Cha-CHING!

Want a free trip to an island somewhere? Walk into any Los Angeles hospital and complain of severe abdominal pain. Get admitted. When it’s time for discharge, tell them that you live right next door to the Sandals Resort in Antigua and you only want to go there. Then the hospital has to make a value judgment - spend an average of $1350 per night to keep you admitted or pay for the taxicab and plane flight send you to your “home” in Antigua. Don’t forget to mention that you’ll have to pay for cab fare in Antigua, too - cabs cost a lot down there. Oh, and the tip for the Antigua cabbie. Can’t forget that.
Don’t think the hospital will front the costs? Look at this article in the August 3, 2008 New York Times - after spending more than $1.5 million to care for one patient over several years, a Florida hospital paid $30,000 and got an air ambulance to transport a patient back to Mexico. First class tickets from LA to Aruba would be a bargain compared to that.

Enterprising homeless people might even tell an administrator that they’ll agree to sign the discharge papers for $100 cash. No, that’s not enough. Make it $1,000. Small bills. And get me a pair of those new Nike ID shoes while you’re at it.

Los Angeles City Attorney Rockard J. Delgadillo is investigating about 50 suspected dumping cases right now. LA has already settled “patient dumping” lawsuits with several hospitals. At $1 million per settlement plus costs, the city is in a win-win situation: It can cut the funding for homeless shelters and use the settlement money instead. If the hospitals don’t toe the line, sue them. A $1 million settlement can get some good city contracts, I bet.

If you live in Los Angeles and think that you won’t be affected by this goofy ordinance, you’re wrong. Anyone with a medical emergency who needs to be admitted to the hospital is going to find it that much harder to get necessary care. Less beds. Less staff to take care of the patients with legitimate medical needs.

It’s time for the LA hospitals to put up or shut up. The city wants your hospital to become a glorified homeless shelter. Call it what you want. Mission creep. Shortsightedness. Idiocy. What are you going to do about it?

Why is this arbitrary ordinance singling out hospitals? Why not impose the same requirements on City Hall or Denny’s Restaurants? Heck, you won’t find an order from the court offering to leave the courtroom benches open 24/7 so homeless people have a place to stay, will you?

If I were a hospital administrator, I would force this issue. Give the city one week’s notice and then close shop.

Put all your medical personnel on leave of absence.

Take your ball and go home.

Homeless people need a place to stay, but this ordinance isn’t the way to go about finding housing.

Perhaps the next Los Angeles ordinance should require that Los Angeles City Council members pass an IQ test before taking office.

Picture credit here

WhiteCoat Challenge #3 Winner

There were a lot of funny entries for the WhiteCoat Challenge #3, but the $25 gift card goes to Medic3 - because I was that kid many moons ago.

Please e-mail me your contact information and I will get the card out to you.

Thanks to everyone who contributed.

With This Ring …

What do you do when you can’t get a ring off your finger?

I learned a trick in medical school that always stuck with me and I got to use it again a few days ago with another mark in the “success” column.

About 5 or 6 times per year we see someone who can’t get their ring off. The patient puts the ring on when the finger is small and then some event makes the finger larger so the ring gets stuck.

So was the story of the patient that we saw. She was very upset at the thought of having her grandmother’s wedding ring cut off, but her finger was so swollen that the ring was stuck.

So how do I get a ring off of a swollen finger?  Here’s my secret trick:

You’ll need some lubrication (vaseline or something similar) and a rubber tourniquet. A large rubber band or even a shoelace might work in a pinch. If you know how to do one, performing a digital block may keep the patient out of pain.

Starting at the top of the finger and winding your way down, wrap the rubber band/tourniquet tightly around the finger so that it squeezes all of the blood out of the finger.

Leave the tourniquet on the finger for about 10 minutes.
Take the tourniquet off and immediately lube up the ring and entire finger.

There are two ways to work the ring off. My preferred method is to untwist the ring like a bottle cap - pulling the ring off while twisting. I have also seen the “rocking” method where the ring is rocked back and forth while pulling it off. Personally, I have had more success with the first method.

Any other ideas for saving the rings from the evil ring cutters?

Gone Fishin’

Going to be away on a business trip for this week.

Have already programmed posts on WordPress to be posted through Wednesday, but will have limited internet access, so I’ll have to answer all the comments when I get back Friday.

Of course if something really fun happens, you all will be the first ones to know.

Medicare Saver Program

Someone recently e-mailed me a link to a site that helps people calculate their most cost-effective Medicare Part D plan.

I don’t regularly deal with Medicare benefits, but thought that those who do might want to give it a whirl. That Max Headroom guy yapping at you in the upper left hand corner of the web site gets a little annoying, but the concept for saving money is neat.

Let me know your impressions in the comments section.

Just in case you were wondering - I’m not getting paid for referrals to the site. I earn nothing but (hopefully) your good will.

Crazy or Clairvoyant?

Weird night last night.

One of the patients named Deborah Peel was from out of town and had never been registered before in our hospital. She wasn’t tended to immediately, so she started floor throwing from severe abdominal pain. While on the floor, ol’ Debbie began yelling out that no one helped her from the door to the bed. While rolling their eyes, the registration clerk and the nurse dutifully helped her into bed.

I have to admit that it was quite busy and because of her antics, I wasn’t wearing my usual warm fuzzy smile. Remember - Ms. Peel is a new patient to our hospital.

I walked into the room and started to ask her what the problem was. She looks up at me, then gets this look of dread in her face.

“Oh NO! Not YOU again!”

Then she gets up off the bed and walks out the door.

Um … ahhh …

Bye?

What Did You Say Was Wrong With Me?

A study just published in the Annals of Emergency Medicine showed something else that I’m sure the Joint Commission grunts and the Never Never Land fairies will soon pick up upon: people are either “too dumb” to understand instructions or they don’t listen to what they’re told. In this study, 78% of English-speaking patients did not fully understand their ED discharge instructions. If non-English speaking patients were included, I’m sure that the results would be even worse. An ABC News article on this study titled “ER Patients Don’t Understand Doc’s Orders” is here.

Studies have shown that the average reading comprehension of patients is anywhere from 6th grade to the 10th grade (although 40% of patients in this study tested at 5th grade or lower). These studies don’t even take into account the large numbers of non-English speaking patients that are treated in some emergency departments.

While this study doesn’t lay blame, it is only a matter of time before some patient safety gurus blame the ED physicians and nurses for not doing enough to make sure that discharged patients understand everything that is wrong with them. As soon as we assign a number to something, those brilliant minds will start figuring out how to make the number “better.”

I can see it now. Soon we will be required to pull out a chalkboard and the Speak and Spell so that we can fill out some form the Medical Marijuana Advocates make up to assure that everyone who is capable of dialing 911 completely understands everything that was wrong with them, the tests that were done, and what they are supposed to do to become the epitome of health.

“Nurse, will you stop interrupting us? I know Ms. Peel in Room 4 is having a stroke, and I know that Ms. Peel in Room 6 is having an MI, and I know that Ms. Peel in Room 7 has uncontrollable crotch rot. I’ve just spent the last 45 minutes making sure that Mr. Peel here understands the importance of a Vicodin-free lifestyle and I think we’re on the brink of a ‘eureka moment.’ Those 57 patients in the waiting room will just have to wait longer.”

When the American Academy of Pediatricians deemed that parents were idiots for overdosing their children on cold medications, Congress and the FDA took action and cold medications were taken off the market. How long before EDs suffer the same fate?

After all, shouldn’t we really be protecting us from ourselves?

Picture credit here

There’s A Rift In The Force, Luke

What’s going on with medicine lately?

The Evil Empire of Congress and Medicare have officially screwed the elderly patients in this country. Even though the Bush administration instituted a temporary freeze on Medicare cuts, the freeze amounts to little more than rearranging the deck chairs on the Titanic. Sick baby boomers and other Medicare entitlees are going to sink the Rebellion. More demand and less physicians will leave many Americans with even less access to health care.

Medical transport ships are crashing left and right and left again.

Like Jedi knights getting picked off one by one in the Revenge of the Sith, some of the best medical bloggers in the business have left or are thinking about doing so. Within the past month, Graham, Panda Bear, Sid Schwab, and ER Nursey have called it quits. Hopefully MonkeyGirl is just in some kind of an evil force trance and won’t leave us, too.

Who knows - maybe those little teddy bear things with the spears and slingshots will come to the rescue.

Until then, need to get out my tin foil hat and think happy thoughts.

Think happy thoughts.

Think happy thoughts.

WhiteCoat Challenge Update

So far the responses have been great!

We got our first sponsor and a couple of prizes for this challenge.

Boardman Medical Supply Company, Inc. has generously donated two Littmann Stethoscopes for the top two responses to the challenge. I didn’t get the model numbers, but was told that one was a pediatric and one was adult.

Boardman Medical Supply provides a range of services in the Ohio area.

They carry a comprehensive line of home medical equipment including ambulatory aids, patient room equipment, wheelchairs, rehabilitation equipment, and home safety items. They’ll also help patients with submitting billing forms to Medicare, Medicaid and other insurers.

Boardman Medical Supply also has a full-service pharmacy, a 24-hour Pharmacy Hotline, and personalized consultations for all patients and customers. They even have next-day home delivery for all prescriptions, medication and medical supply orders.

Their web site is quite extensive, but I am told that it is still a work in progress. Boardman Medical Supply Company offers even more than what is listed on their web site. If you have any medical supply needs, or if you need something that isn’t on their web site, please consider giving them a call at 800-443-3390.

Thank you to Boardman Medical Supply Company for its generosity.

As a side note, we are getting so many good responses that I will personally add a $25 American Express Gift Card as one of the prizes if we hit 100 responses by Monday and will throw in an additional $25 gift card for every 50 responses we get over 100.

Keep them coming!