Divemedic

Costs of Care

I had a tough week recently. You wouldn’t believe how tiring it is to use your brain at a high level, with lives in the balance, for 12 hours straight. It’s a high stakes, high stress endeavor. When I work and the day is especially stressful, I am in bed asleep within an hour of getting home, and I sleep until it’s time to go back to work. Let’s look at one of the patients I had on one of those days:

A woman decided that she was going to kill herself by taking every pill she could find in her house. Three hours later, she changed her mind and called 911. She was a frequent visitor to the emergency room and had been placed on involuntary psych holds (called a Baker Act) a few times before, due to suicide threats that turned out to be cries for attention.

She was my patient.

EMS handed me a bag of empty pill bottles, all of which the woman claimed to have taken. A final count of the pills revealed that she had taken most of a 90 day supply of Digoxin, Wellbutrin, Sotalol, Xarelto, and a few other drugs. I think we finally estimated 50-60 pills of each were unaccounted for.

I asked the doctor if he wanted to do a gastric lavage. He said he didn’t want to, because it had already been 3 hours and any pills she had taken were likely digested by now. He also pointed out that her vital signs were unchanged, and this was a good sign that she was again acting out, but hadn’t actually taken anything.

I told him that, since the drugs she had claimed to have taken were mostly extended release, we would be looking at some real trouble in about another hour. He told me to watch her and call him if anything changed.

I had three other patients, including another Baker Act. Those involuntary admissions require a lot of paperwork, so I was busy.

About an hour later, I got a call from the telemetry operator that the woman’s heart rate had suddenly dropped from 62 to less than 35. I ran into the room and found her in a junctional escape rhythm at 32 beats per minute. I called the ED doc, who was on the other side of the department, and told him what I had. I recommended Atropine and Glucagon and asked for the order. He concurred and said he was on his way.

By the time he got to me, I had called a Resuscitative Medical Alert. That gets me the ED rapid response team, including a charge nurse, three other nurses, two techs, a respiratory therapist, and Xray tech with a portable Xray machine, and the ED doctor. I gave her two doses of Atropine and two of Glucagon. It didn’t do a bit of good.

I suggested that we start pacing immediately. He agreed, and we started external pacing. Her blood pressure was shit, so as the Dr prepared to intubate, we got orders for and hung an Epinephrine drip. Then it was Ketamine, Rocuronium, intubation, and a Ketamine infusion. By then the ICU doctor and a dose of Digifab had arrived. We got the Digifab running and took her to ICU.

She lived for 5 days in the ICU. That was 1 of the 22 patients that I had that day. She was also 1 of the 7 suicide patients I had that week, and the only one that didn’t survive. In fact, I had 81 patients that week and only 3 of them didn’t survive.

While she was there, she received over $300,000 in medication. The Digifab alone was almost $100,000 of it. They tried dialysis, it didn’t work because the Digitalis molecules were too large to dialyze out. Her total bill was well over a million bucks.

Some of the drugs she got were specialized and aren’t given to many people, so they are costly.

She isn’t going to pay that bill, because she is dead. So who pays it? We all do. The hospital spreads those costs out across every patient. It’s like going to a restaurant where everyone gets to eat whatever they want, they can order one of everything on the menu, and about a quarter of them don’t pay, so everyone else has to pony up the difference.

It’s an ethical conundrum. Who decides what treatments will be offered? If we leave it up to the hospital, does the patient get a choice? Does the insurance company? There are pitfalls to each answer, and trust me, it’s one that healthcare workers debate frequently.

Someone has to pay for all of the education and experience of the providers. Not only while they are actually providing care, but also for UHU reasons. Now UHU is a concept that originated with EMS, but applies to the ED as well. UHU stands for “Unit Hour Utilization” and symbolizes the amount of time in each hour, on average, that an asset is busy treating a patient.

If the UHU is too low, you are spending money to have expensive assets sitting around. If your UHU is too high, there is a chance that someone will need their help and it won’t be available because it’s being used elsewhere.

All of that must be paid for, and that’s the issue.

Americans demand the best of everything. They want to have top notch care, they want it available at a whim, they won’t tolerate errors, and that is expensive. Every one of the actions taken in that woman’s case were areas where mistakes could have been made. They have to be done every time, without error, and it must be the right thing at the right time, no exceptions.

Now multiply that by the 200-500 patients a day in that ED. That isn’t cheap.

That’s the issue- Americans want it perfect and they want it on demand. The best of everything. Cost is no object. Sure, Americans complain that healthcare is expensive, but mention a system where an official controls cost by denying your claim, or as in the case of Canada, recommending euthanasia, and see people howl.

So you could control costs by making it easier to be a medical professional, but that would mean lowering standards, more medical errors, worsened medication quality controls, and more frequent things like hospital acquired infections.

Or make it cheaper through rationing. You could wait 2 years for an MRI.

I’m not saying that there aren’t examples of waste and fraud. I know there are. I also have a problem with hospitals not disclosing their rates up front. You should know that it’s going to cost $20,000 for a CT scan, another $1500 for the radiologist to read it, etc. Trump tried to do that, and the hospital lobby shut it down through Congress.

However, how do you control that in a nation as large as ours? Anyone who says there is an easy answer is being childishly naive or doesn’t really understand what’s going on.

If you passed a law mandating that anyone could have dinner at any restaurant they wish, could order whatever they want, and the restaurant couldn’t demand payment up front, and people could buy “dinner insurance” to pay for it, what would people eat, where would they eat, and how much would dinner cost?

By Divemedic, ago

Walz Wants Your Guns

He claims that Australia and Scotland are “just as free as we are.” Let’s check into that.

Police Scotland has warned the public not to spread misinformation after a 12-year-old girl was charged for brandishing weapons in Dundee when she was being attacked. Police can arrest you for “spreading misinformation.”

In Australia, people who have COVID or have been exposed to COVID were sent to internment camps until late in 2022. If you escape, you were arrested. Democrats in the news media denied this, saying that camps in Australia aren’t technically internment camps because they were only for the quarantine of travelers, even though that’s exactly what the Aussies were calling them. As to the claim that it was a quarantine camp for arriving travellers, well, let’s hear from one of the internees:

Go ahead, Tim. Start sending police to confiscate people’s guns. Light that match and see what happens.

By Divemedic, ago

Healthcare

As I have said before, since there are only so many doctors and other medical professionals, there are only a couple of ways to manage a healthcare system:

  • You can tinker with supply. That is, you can increase supply by making it easier to be a doctor, which carries its own liabilities, like lowering the skill level of the professionals performing brain surgery and the like; or
  • You can tinker with demand. There are two ways to do this, as far as I can see. You can either allow price to control demand, or you can let a government official set quotas and a waiting list.

The US has chosen to (mostly) control demand by allowing prices to dictate what people can afford. Canada has gone the route of price controls and government setting quotas with waiting lists. Let’s check to see how that is going:

Meanwhile, patients who need an ultrasound get one at my hospital within 30 minutes of it being ordered. An MRI takes a bit longer- we usually can get someone in within a day or two.

By Divemedic, ago

In Case You Missed It

Justice Jackson, in a recent dissent, complained that SCOTUS is favoring only rich litigants. That’s especially ironic, considering that she has received $3 million for writing her autobiography. Does anyone really think that the publisher will sell enough copies to pay that? Of course not, this is how payoffs are done:

An investor wants to pay off a high-ranking political figure. They make a deal that, on its face, looks like a legitimate business deal. That’s how the Cattle Futures market worked for the Clintons, it’s how the paintings for Hunter Biden sold for so much, it’s how Chelsea Clinton was being paid $300,000 a year by NBC while she was still in college, and how she had a net worth of $30 million before she was 40 years old.

Both parties are corrupt. They are stealing us blind.

By Divemedic, ago

The Feds and Terrorism

I just finished reading the book Blowback: The Untold Story of the FBI and the Oklahoma City Bombing. The book is filled with documented links between the FBI, the CIA, Secret Service, and the ATF. The entire story of the OKC bombing is filled with witnesses who committed suicide in front of malfunctioning video cameras, witnesses disappearing so completely that their SSN was deleted, missing documents, and other odd “coincidences” that it seems almost incredible.

There is missing video, supposedly hidden because it is classified, of multiple people exiting the Ryder truck just before the bomb went off. Body parts that don’t match any DNA of any known victim. Mystery fingerprints that couldn’t be matched to any known suspect. A second Ryder truck. FBI agents seen trying to use radio direction finders in the OKC area in the lead up to the explosion- the author alleges that they had a tracking device on the truck, but couldn’t locate it.

The names that are part of the investigation come up again and again- Larry Potts, Merrick Garland, and other familiar names. At least 6 witnesses either disappeared or were killed. There were explosives experts in town on mysterious orders, including Air Force EOD, but the logbooks are unexpectedly missing. At least one alleged CIA operative fled to Germany. It’s hinted in the book that the Southern Poverty Law center is an FBI front operation for hiding the sources of illegally obtained evidence and intelligence.

After reading it, I am firmly convinced that McVeigh was up to his ears in this bombing. However, I also think that there were numerous other players, and some of those players were government assets. If even half of this book is true, the OKC bombing is proof that the Federal Intelligence community has been pulling the strings of all sorts of lone wolf attacks.

As I read the book, I thought about the mysterious ties to the Vegas shooting, COVID, Antifa, the 2020 election, and the Epstein “suicide.” It’s enough to make you question everything and begin to feel paranoid.

The book could stand to be better organized, and you almost need to take notes in order to follow all of the details, and this makes it a long, difficult read. There are enough ties and names that are named that it is difficult to follow and connect the dots. Even with that, this is a story that would read like a cheap novel with an implausible plot if it weren’t for the events that have happened since 2019, and I still recommend reading this book.

The disclaimer: I don’t advertise, and receive nothing for my reviews or articles. I don’t think that I ever will. I have no relationship with any products, companies, or vendors that I review here, other than being a customer. If I ever *DO* have a financial interest, I will disclose it. Otherwise, I pay what you would pay. No discounts or other incentives here. I only post these things because I think that my readers would be interested.

By Divemedic, ago

Crashed

It looks like Big Country crashed my server. My server usually runs pretty well, using no more than 30% or so of resources. However, his posting of the recent shooter’s manifesto went viral, and he received 30,000 hits that each downloaded the file in less than an hour. The server just isn’t set up for that kind of bandwidth- more than 3.5 gb worth of downloads in less than 30 minutes.

It crashed my server, but everything looks to be OK again, at least for now.

By Divemedic, ago

Not Compassionate

The left was busy mocking Republicans all week, but in the process demonstrated that if it weren’t for double standards, the left would have no standards at all. The mayor of Minneapolis had this to say:

Anybody who is using this as an opportunity to villainize our trans community, or any other community out there, has lost their sense of common humanity.

But proving that they are true assholes, he went on to say this:

Don’t just say that this is about thoughts and prayers right now, these kids were literally praying.

Mocking prayer by saying that it does nothing as children are being shot while praying? That’s a new low.

I have made no secret of the fact that I am an atheist, but I understand the sentiment of “thoughts and prayers.” When someone says that, it’s a statement that you are in their thoughts, and they are wishing you well as they grieve with you. To turn that into an attack on the person’s religion makes you an asshole. To do that almost immediately after demanding that people ignore the shooter and his fucked up mental state is beyond the pale. This is proof that there is just no coexisting with the left. They are simply evil. There is no other way to phrase it.

Isn’t it odd that the left is heaping scorn upon the religions of the world and mocking them, all while calling the other side the “party of hate?”

By Divemedic, ago

NY and GOA: A Larger Issue?

There is a case in NY that is important, where the U.S. Northern District Court ruled in Higbie v. James that New York’s concealed carry laws are violating the Second Amendment rights of nonresidents by making it nearly impossible for nonresidents to obtain a concealed carry license. It was sponsored by Gun Owners of America.

The plaintiffs in this case argued that they each have firearms licenses which permit them to bear arms in public in their respective states “and across most of the country.” They also claimed that New York does not permit them to carry their firearms while they are in New York solely because they are not residents or employees of the State. They argued that New York’s licensing scheme is an extreme outlier among the states because at least 27 states do not even require a permit to carry a concealed firearm in public, while the vast majority that do require permits will issue permits to out-of-state residents. The US District Court agreed, and struck down NY’s complicated and overly onerous regulations as being unconstitutionally designed to deny nonresidents their constitutional rights under the Second Amendment. The court ruled that state lawmakers can not restrict concealed carry licenses to maintaining residency, property ownership, or business interests in the state.

The tyrants of NY government attempted to make the argument that their licensing measures were not entirely prohibitive for non-residential applicants, saying certain guidelines allowed for those who owned habitable property or a business stake in the state to apply for such a license. In essence, they claimed that, because they allowed one nonresident to have a permit, this excused violating the rights of the rest of them. In essence, they are relying on the “token negro” defense. The court rightly called them out on this. 

Look, this case will have no direct impact upon the reality of CCW for nonresidents in New York. We all know that, because those ass clowns will simply find another way to violate the rights of US citizens while bleating loudly about the rights of illegal immigrants to take a dump on New York city streets. Even those residents who have permits nominally have to have criminal background checks, a mental health professional sign off on the permit, and multiple references.

The reality is that New York’s scheme is all about who you know and political payoffs when deciding who gets a permit. I know someone who has a New York carry permit. He also has a state police license plate, which starts with 1SP. He began telling me that the state police union had a series of special plates made, and they are only available through Hamilton county in New York. He claimed that this plate was given to “friends” of the police union, and the lower the number was that followed the 1SP, the more important you were to the cops. He said that this plate routinely gets him out of traffic and parking tickets. Not because he paid for it, nor did he jump through hoops. It’s because he knows someone, or as he puts it, “I’ve got a guy.”

This sounded like a lload of BS to me, so I activated my Google skills. What I found was that handing out special plate numbers is a common practice in New York. and I quote:

To some recipients, special license plates issued by the Saratoga County clerk are a symbol of county pride. For others, they are an inherited treasure passed on by a family member or loved one.
For many who have them — a list that ranges from county workers to state Supreme Court judges — an unwritten rule is that a lower number may indicate a special driver.
Indeed, an examination of the recipients of the special plates, which carry an “SP” prefix, shows they are coveted by a select group of government employees and elected officials, including judges, prosecutors, town supervisors, attorneys and political party leaders. The spouses and children of those people are also among those, estimated to be in the hundreds, who have the plates.

Now the SP prefix goes to Saratoga County. The 1SP prefix, which I can find little about, belongs to the State Police. This is how things are done there, from Concealed Weapons Permits to License plates, corruption and special favors rule the day.

They claim it is for “county pride” but I am sure there are not that many people who believe that. This is a way of announcing to the police that you are politically well connected and should receive special treatment.

The real impact of the Higbie case is that the noose is closing. The era of violating people’s rights to bear arms is closing through the courts. That doesn’t mean the fight os over. Evil, corruption, and man’s quest for power to rule others never ceases. That’s why the fight can’t either.

Donate to the GOA or the FPC. They are doing the work of patriots.

By Divemedic, ago