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CA Surgeon Explains Proposed ObamaCare

California surgeon Linda Halderman reports that Congress’ version of ObamaCare will feed the federal deficit and “cause small businesses to hemorrhage and carve a pound of flesh from patients forced to navigate the new bureaucracy it creates.”

H.R. 3200 rewards middlemen paid to deny medical care recommended by a patient’s physician. These political appointees, charged with “Comparative Effectiveness” determinations, would make treatment recommendations far from the exam room without ever having examined the patient whose treatment is denied…
Patient choice is another casualty of H.R. 3200. The effect of the bill’s new bureaucracy, a public (government-controlled) health plan, is described by The Lewin Group. Over 88 million workers would be shifted to the public plan from private coverage. Yearly premiums for individuals with private coverage would increase as the result of cost shifting from the government-sanctioned plan…
To the needs of older Americans, the bill mandates an “Advanced Care Planning Consultation” in which senior citizens must meet at least every five years with a doctor or nurse practitioner to discuss “dying with dignity.” (more here)

Medical Care Confusion

Thomas Sowell writes:

The confusion of “health care” with medical care is the crucial confusion. Years ago, a study showed that Mormons live a decade longer than other Americans. Are doctors who treat Mormons so much better than the doctors who treat the rest of us? Or do Mormons avoid doing a lot of things that shorten people’s lives?

The point is that health care is largely in your hands. Medical care is in the hands of doctors. Things that depend on what doctors do – cancer survival rates, for example– are already better here than in countries with government-run medical systems…

Nursing Union Buster or Bête Noire?

Imagine finding flyers posted all over a hospital sounding the “alert that a professional union buster was on site”, and that flyer used to identify a nearly 70 year old great grandmother who has to use an electric scooter to get around.  What power this person must have to send the California Nurses Association (CNA) in paroxysm’s of fear and panic and to engage in their usually tactics of lies and misinformation.  I was met with just such exhibitions fear-mongering and hysteria by CNA recruiters, representatives and supporters when I made a recent visit at the invitation of a fellow nurse from Cy-Fair Hospital in Houston.
Their flyer identified me as a professional union buster, which I guess is a recognition of how much they fear my presence; but truth be told I’m not a professional union buster, and in particular I’m not a nursing union buster.  The CNA and many other pro-union people love to use the word union-buster since it tends to invoke images of a Simon LeGreed character replete with requisite black hat and clock and evil laugh.
I have nothing against unions for the blue-collar worker, but I’m far from convinced that professionals such as registered nurses need unions to represent them.   So when nurses contact me for my opinion and advise about how to speak for themselves I am always happy to help my fellow RN in advocating for our profession and for themselves.  I’m happy to help in the effort of showing nurses they can and do have a strong voice as both an individuals and as a group without paying a nursing union dues of upwards to $80.00 a month for the favor.
In the case of two recent nursing union attempts, one nursing staffs attempt to stay free from the CNA and one nursing staff attempt to decertify from the CNA.  As fate would have it, I was in a position where I could help both in spirit and in person so I did.  At the first hospital my fellow nurse and I found CNA representatives playing shenanigans with hospital elevators so that the floor where a “No to the CNA” nurse had been given a meeting room was locked out.  This malfunction only affected the one floor that we had to reach on both days, what a coincidence.  You may wonder why I think CNA representatives capable of such underhanded techniques.  Simple, I still haven’t forgotten a CNA strike in the San Fernando Valley where pro-CNA nurse locked out much need medical equipment, hiding/destroying manuals, etc., so that the relief nurses were hard pressed to provided nursing care to patients many of whom were in intensive care; and the CNA strike was suppose to be all about their concern for patient safety  — go figure!  And at the second hospital I got treated to the experience of being stalked by not one, not two, but upwards to three CNA representatives at a time.  The situation became of such concern that hospital HR and security had to become involved; but I guess I should feel honored that the CNA felt the need to have so many people watching my every move.
Whether or not nurses chose a union to represent them or not should be up to the nurses themselves but this seems to rarely be the case these days.  As in the case of the Tenet Healthcare/CNA neutrality agreement Houston nurses that had opposing views to the CNA material, propaganda or message had no one to turn to; at least that’s what the CNA representatives thought, except they overlooked a grassroots network of informed RNs that were available for these nurses to reach out to; which they did and we responded.  One would think that the CNA representatives would be excited to learn that nurses were empowering one another, oh that’s right it only counts if the nursing unions are doing the empowering.    So sorry, we didn’t get that memo. One would also think that the CNA would invite and encourage an open and lively discussion about the benefits of a nursing union, but they couldn’t be bothered to even accept the invitation extended by one group of nurses to present their viewpoint in an open debate.  Instead they skulked about passing out flyers full of misstatements and lies since it so much easier to insult the intelligence of nurses rather than respect them.
In the case of the flyer they suggested that the nurses ask me a set of questions, and I responded with an open letter.  One pro-CNA nurse chose to mark up my open letter with graffiti instead of addressing me nurse to nurse.  But then again it’s become common practice for pro-nursing union nurses to engage in such childish behavior.  It’s a sad day when our honorable profession is marred by such immature behavior.  However, I see these as indicators of how much the organizational structure of the CNA fears nurses who chose to take back or carry on with their own voice.  In the past several years their membership has been declining (their last official report in 2008 has their membership at just over 72,000 almost a full 8,000 or 13,000 drop depending on which CNA official report you read).  I think it’s this drop that has them scrambling for new members in the other 49 states.
But in some parts of our country nurses don’t want anything to do with them, and even when Tenet handed the CNA the proverbial keys to the kingdom providing CNA organizers unfettered and unprecedented access to RNs on the floor, scheduling information and even home addresses and telephone numbers; the CNA has found resistance to their siren song.  They couldn’t even gather enough cards at Park Plaza and Northwest Hospitals in Houston to even call an election and they slunk out of Houston so quietly that few even knew they had abandoned their organizational efforts.  They accused one, that’s right ONE, nurse of trying to take away the union at Cy-Fair Hospital.  What power this one nurse must have, I guess the well over 30% of eligible nurses that signed decertification cards meant nothing, it was all that one nurse’s fault.  And this morning we learned that Hahnemann Hospital (another victim of the nefarious Tenet/CNA neutrality agreement) had rejected the union.  The CNA had such access to the RNs at Hahnemann that nurses that opposed the CNA had to get the NLRB to intervene just so they could get a meeting room in the bowels of the hospital and finally a table in the cafeteria (shortly before election day) and the union spokespeople whined that this was unfair.
So if our network of nurses, and me, in particular can help our fellow nurses when confronted with such behavior and that makes us professional nursing union busters in the eyes of the union then I guess that’s a cross we’ll just have to bear.  I see it as the desperate actions of an organization that knows that people have begun to look behind the curtain that is the California Nurses Association/National Nurses Organizing Committee and they don’t like what they see.  The more they howl about RNs empowering each other the more I know that I’m their bête noire and that’s a role I think I shall relish.
Geneviève Clavreul RN Ph.D is President and Founder of the National Nurses Professional Association.  She also blogs at The Nurse Unchained.

Is Healthcare Asleep at the Wheel?

Dateline: Redding California, 2002 – A jetliner carrying 700 passengers crashed into Mount Shasta killing 69 and injuring most of the remainder. Pilot error caused the crash. The FAA ignored the incident.
If this story were true, we would be outraged and demand a full government investigation of the FAA’s negligent failure to investigate. Yet the story is partially true: all the “passengers” were patients at Redding Medical Center in Redding, California between 1993 and 2002. The two “pilots” were Drs. Fidel Realyvasquez, a cardiac surgeon, and Chae Moon, a self-proclaimed cardiologist.
In late 2002, the FBI “busted” this conspiracy of negligence. The two physicians have lost their license to practice in California.  The hospital administrators who helped hide the doctors from public scrutiny have relocated to foreign countries to find work.
But “busting” the “bad guys” for unnecessary heart procedures and surgery on healthy patients was not good enough for my team, or for the people, so we set out to discover how this gross and near criminal medical negligence could possibly be tolerated for 10 years at a well respected, accredited, and licensed hospital.
Based on our investigation and report gleaned from public documents and private testimony, we found that government officials failed to enforce our laws: laws necessary to assure hospitals are safe for the public.
Both State and federal health care officials knew as early as 1999 that RMC and its medical staff could not assure patient safety for cardiac services. These officials knew the hospital and medical staff provided no oversight or review of the quality of care provided by Moon and RV. In fact, both of these physicians were in charge of their own reviews. Moreover, our main hospital accreditation organization, the Joint Commission, also knew in 1999 of the danger Moon and RV posed to patients because their patient care services were hidden from review by their peers. The JC accredited RMC anyway. The first peer review provided for Moon and RV was performed by outside medical experts hired by the FBI in 2002.
Now that we know hospital peer review requirements are not enforced, the California legislature refuses to give our enforcement agency, Licensing and Certification, the power it needs to enforce our laws.
Professional stakeholders, but not the public, oppose law enforcement penalties that would compel effective peer review. L&C does have the power to impose fines of $50,000 to $100,000 against hospitals for allowing imminent danger to patients. But the absence of peer review is not an imminent danger, even though hundreds of patients can be harmed over time.  Patients at many California hospitals are vulnerable to unmitigated medical negligence which can only be prevented by brave conscientious physicians who have the professional courage to voluntarily identify physicians who allegedly endanger patients and hold them accountable through the peer review process. In hospitals where peer review is absent or ineffective, there is no mechanism to cull out negligent physicians until after many patients are damaged.
When peer review is properly performed, suspected physician errors are discovered timely, through analysis of various triggers, such as unexpected return to the operating room or unexpected blood loss. Promoted by these triggers, specific patient cases are reviewed by other physicians at the same hospital. The care provided may be acceptable or problematic. If physician negligence is discovered, corrective action is taken. A physician may be instructed to take more education, limit performance of certain services, or could be discharged from the medical staff for egregious acts. The result is safer care for future patients.
The California Legislature ordered a report on California peer review and hired Lumetra, a private company to write it. Lumetra published its report in 2008. Lumetra found that peer review in California is unacceptable, inadequate, and ineffective: patient safety cannot be assured. RMC is the “poster child” for what goes wrong too often. Now, seven years after the FBI “busted” Moon and RV, and after the Department of Justice and CMS kicked RMC out of the Medicare Program, our peer review laws remain unenforced throughout California. 
In the 2009 legislative session, the California Legislature has taken up the peer review issue (SB 58, SB 700, AB 120, AB 245, and AB 834). But current proposals will not enact penalties L&C requires to enforce our laws. Experts believe L&C needs the power to impose intermediate sanctions against hospitals and medical staffs for repeat failure to conduct peer review. Currently, the only power L&C has is to revoke the license of the entire hospital, which the Agency rarely does. By contrast, intermediate sanctions could remove the license of a hospital for certain elective services only in those clinical departments (e.g. cardiac services) where peer review is not provided or is ineffective on repeat audit. With this power, a negligent hospital and medical staff would face huge financial losses and, therefore, would provide the missing peer review immediately. Without the enforcement power of intermediate sanctions, hospitals and medical staffs can continue to flaunt our laws knowing the State has no power to enforce them.
In other words, currently peer review is self-administered, not audited for effectiveness, and when not done, there is no power to enforce the requirement. Self-administered peer review in hospitals works as well as self-administered regulation compliance did on Wall Street in 2008. Doctors who need help are not identified, and future patients continue to suffer the consequences.
In 2009, patient safety will remain a goal, not a reality; except, perhaps, in a few self-proclaimed centers of quality. To change this unacceptable situation, you must write to your California legislator and demand enactment of intermediate sanctions to enforce the peer review laws in California.
Good luck next time you are admitted to a hospital in California. You will need it because patient safety cannot be assured. It is safer to fly.
Dr. Rogan is a family and emergency physician who served as the Medicare Medical Director in California from 1997-2003. In 2002, he assisted law enforcement with the RMC investigation. Currently, he is an
independent consultant to health services companies.
 

Why Do Americans Want Government Healthcare?

Senior fellow at the Manhattan Institute David Gratzer MD asks: 

In Canada, private-sector health care is growing. Dr. Day estimates that 50,000 people are seen at private clinics every year in British Columbia. According to the New York Times, a private clinic opens at a rate of about one a week across the country. Public-private partnerships, once a taboo topic, are embraced by provincial governments.
In the United Kingdom, where socialized medicine was established after World War II through the National Health Service, the present Labour government has introduced a choice in surgeries by allowing patients to choose among facilities, often including private ones. Even in Sweden, the government has turned over services to the private sector.
Americans need to ask a basic question: Why are they rushing into a system of government-dominated health care when the very countries that have experienced it for so long are backing away?  http://forums.wsj.com/viewtopic.php?t=6173

If Bernard Madoff Were a Doctor

Dr. Kate Scannell compares disgraced financier Bernie Madoff to pharmaceutical shill, Scott S. Reuben, MD: 

In an analogous manner, the story of Dr. Scott S. Reuben tells the tale of one man who, in pursuit of personal gain, harmed huge segments of our nation’s health care system. That he could get away with falsifying pharmaceutical research and medical publications on such a massive scale over many years also tells a larger story about our nation’s medical research industrial complex. 

That complex — the enormous, poorly regulated, financially incestuous and opaque system that generates and disseminates the medical information we use to determine health care for patients — is similarly structured to allow individuals and privileged industries to profit through backroom deals. 

A few days ago, it was widely reported that Reuben, an anesthesiologist in Massachusetts and a faculty member of Tufts’ medical school, had falsified at least 21 of his 72 published research studies. He simply made them up. 

Many of those fictional studies promoted the use of painkillers — like Pfizer’s Celebrex or Merck’s Vioxx — during orthopedic surgeries, highlighting yet another layer of his disgrace. Those drugs, known collectively as “COX-2″ drugs, have been suspected of causing severe side effects like heart attacks and strokes, and Vioxx was finally withdrawn from the market in 2004. 

As was reported in Scientific American, Reuben’s work tried to encourage surgeons to abandon use of older and less expensive anti-inflammatory painkillers in favor of newer and more expensive ones called “COX-2″ drugs. 

In addition to faking research, downplaying COX-2 side effects, and jacking up the cost of medical care, Reuben also profited from financial arrangements with Merck and Pfizer. Those relationships are hard to confirm in his publications, but you find evidence of them in odd places. For example, in a conference brochure (Reuben lectured widely to disseminate his “research”) you discover that he not only received “grants” from Merck and Pfizer, but that he was also on their for-hire speaker’s bureau.  

The rest of Dr. Scannell’s commentary is found at Inside Bay Area.