A new book and a “60 Minutes” report have brought back into the news the case of the killer nurse who murdered at least dozens of patients in New Jersey and Pennsylvania with drug overdoses and may have killed many more. There’s plenty of blame to go around among hospitals and others, but readers of this site will recall reason Cullen’s career went on so long: “When hospitals checked Cullen’s resume and previous jobs, they were given positive or neutral reports by his former employers, who feared getting sued if they provided a negative one.” [Asbury Park Press] Earlier here, here, etc.
Compounding pharmacies, which mix medications to order, are a corner of the drug business that has been much less heavily regulated than mass-manufacturing drug companies. As a result, the compounders began expanding their market presence as against the mass manufacturers, and even get into mass manufacturing methods themselves. The process accelerated in the past few years after tightened FDA control of conventional makers’ production practices (under GMP, or Good Manufacturing Practice, regulation) began to result in widespread production-line suspensions; for hospitals and other users, the availability of compounded alternatives is often the only fallback in the face of shortages.
Unfortunately, poor quality control at some compounders resulted in a series of fiascos culminating in a meningitis outbreak. Now the Washington Post reports that major drug companies are seizing the chance to hobble their competition by pressing for maximally burdensome regulation of compounders, including the addition of regulations unrelated to safety, such as rules aimed at restricting the compounding of formulas that imitate the action of patented products. Hospitals, which sometimes engage in compounding themselves to obtain medication for their patients, say overregulation could worsen the problem of drug shortages. [Kimberly Kindy and Lena Sun, Washington Post] Earlier on drug shortages here, here, etc.
“So we now have a politician directly dictating medical policy to doctors at city hospitals.” [Radley Balko]
P.S. In the mayor’s view, just as you can’t make an omelet without breaking eggs, so you can’t fight painkiller abuse without overriding doctors’ judgment: “so you didn’t get enough painkillers and you did have to suffer a little bit…. there’s nothing perfect.” [Colin Campbell, Politicker]
“In the topsy-turvy world of health care, doctors and hospitals have a very powerful influence on how you are treated,” he [a university investigator] said. [San Jose Mercury-News] Topsy-turvy indeed — who would have guessed such a thing? (& InsureBlog)
Title VI of the Civil Rights Act of 1964, which prohibits discrimination by recipients of federal education spending and other programs, does not currently allow private litigants to sue demanding punitive (as distinct from compensatory) damages, nor do the courts entertain private suits complaining of “disparate impact” under it. Some trial lawyers and advocates of expansive discrimination law have long wanted to change that, and now Hans Bader of the Competitive Enterprise Institute is warning that there are efforts afoot to slip an expansion into law by attaching it to some “must-pass” piece of legislation. An effort by Democratic senators to attach it to the Defense Authorization Act appears to have fallen short, but it may be back as a rider on other bills, with serious courtroom consequences, Bader warns, for schools and colleges and also for doctors and hospitals.
“Delano Regional Medical Center in Kern County defended its English-only policy as necessary for patient care.” Nonetheless, without admitting wrongdoing, it yielded to a complaint from the U.S. Department of Justice and the Asian Pacific American Legal Center that it had improperly penalized Filipino-American workers for communicating with each other in their own language. The suit had alleged, among other things, that the hospital had been more liberal in permitting the use of other languages other than English, and that it had not prevented workers from making fun of accents and expressing ethnically-based hostility. [L.A. Times, ABA Journal]
Thousands die while waiting for kidneys, while thousands of sound donated kidneys are thrown out. Among culprits, per the New York Times: “an outdated computer matching program, stifling government oversight, the overreliance by doctors on inconclusive tests and even federal laws against age discrimination.” One federal initiative, for example, penalizes institutions whose transplant success rate is less than stellar. What could go wrong?
…dozens of transplant specialists said the threat of government penalties had made doctors far more selective about the organs and patients they accepted, leading to more discards … [Toledo transplant surgeon Michael] Rees still bristles at the trade-off. “Which serves America better?” he asked. “A program doing 100 kidneys and 88 percent of them are working, or a program that does 60 kidneys and 59 of them are working? It’s rationing health care under the guise of quality, and it’s a tragedy that we are throwing away perfectly good organs.”
Meanwhile, Europe has had success with the practice of matching donors with recipients within the same age bracket, but a similar proposal in the U.S. “died quickly after federal officials warned that discrimination laws would prohibit the use of age to determine outright who gets a transplant.”
The site My OB Said WHAT?!? sums up a paradox that many hospital visitors have noticed:
“You’re not ready to leave until you can walk out of here.” – L&D Nurse to mom being wheeled out upon discharge.
Many hospitals do hold to a formal policy on the subject. Thus Methodist Hospital of Houston: “When your doctor has discharged you and you are ready to leave, you will be escorted out in a wheelchair by hospital staff.” Why necessarily in a wheelchair, when you may be perfectly capable of walking?
The Chamber-backed Southeast Texas Record has a theory. It’s the same theory endorsed at Yahoo Answers. As for whether patients actually fall and hurt themselves on the way out of the hospital, it appears from this Eastern District of Pennsylvania case (PDF) that, yes, it happens.
On July 12 New York Times columnist Jim Dwyer wrote an extensive story about the death of a 12-year-old boy who had been brought to an emergency room with fever and rapid pulse, sent home, and died of septic shock. Lab test results and other indicators of distress allegedly went unheeded, and the boy’s family is represented by Thomas Moore, perhaps the city’s premier medical malpractice lawyer. Some legal blogs had a field day citing Dwyer’s article as an example of flagrant medical malpractice, as they depicted it; other reactions, some gathered in a Dwyer follow-up column, were more mixed.
White Coat, the blog at Emergency Physicians Monthly, has been resistant to the Dwyer-Moore narrative of the case. Its blog posts can be found here,
here, here, and here.
“Several hospitals in New York City are eliminating or trimming malpractice insurance, and at least two of them have no further reserves to pay claims. Some hospitals in other cities, particularly jurisdictions known for large malpractice awards, are also going uninsured, the New York Times reports.” [ABA Journal]
I’ve got a piece in today’s New York Post on why doctors and medical providers should be interested in New Hampshire’s first-in-the-nation “early offers” experiment in malpractice reform. Earlier here, etc. Note also that Christopher Robinette at TortsProf has added to his illuminating series of posts on the idea with new contributions here and here (& Allen McDuffee, Washington Post “Think Tank”.)