Medical News

Liability Shield

Just as many so-called “conspiracy theorists” have been telling us, at least one government has admitted that it has been withholding data that may link the COVID jab to excess deaths. Of course, this news is nowhere near new. We knew they were hiding data at least three years ago:

So-called “scientists” who receive all of their funding from the government called those who made these claims “disinformants” and called this opinion “misinformation.” Study after study was published about the dissemination of false narratives concerning the COVID vaccine. Every one of those studies was based upon the “fact” that COVID vaccines were safe and effective.

We were lied to.

Those who released information that COVID itself was manmade or that the vaccine was ineffective were summarily deplatformed, fired, and otherwise had their lives destroyed. There is nothing so evil that our government won’t do it.

By Divemedic, ago

Free

This article in the Daily Mail had me shaking my head. This is night and day from the US system.

  • They called EMS. It took EMS an hour and 28 minutes to arrive.
  • When they got to the hospital, the ambulance had to wait 30 minutes to offload their patient
  • There was a Four hour wait to see a doctor who ordered a CT scan
  • Another hour to get the CT
  • yet another hour to get the results and confirm that the woman had had a stroke

My iPhone log tells me I called 999 at 10.51am. My mum was finally settled in a bed on a ward at 1.30am the next day. All in all, it had indeed taken almost 15 hours between me reporting the symptoms of a stroke in my mother, to her receiving the correct care for it.

At the end of it all, they had to pay out of pocket to see a private specialist. The issue is that by then, it is too late and the damage from the stroke is mostly permanent. Free healthcare, my ass.

Now let’s contrast that with the US:

  • Here in the US, an ALS ambulance arrives in 10 minutes or less 80% of the time (that is the standard). Still, the average 911 call to arrival at the hospital is 36 minutes in the US.
  • From hitting the door, patients have 10 minutes to see a doctor.
  • 15 minutes to see the stroke team. (every nurse in my ED is certified by the NIH as a stroke team member)
  • Door to CT time is 25 minutes.
  • Door to results of the CT being reported is 45 minutes.
  • Door to needle time (time from entering the hospital until receiving clot busting drugs) 60 minutes.

My hospital beats every one of those metrics. The times I have given tNK or tPA were less than half of that. When someone with these symptoms enters our facility, the CT is done as quickly as we can move them to the CT room. The doctor and the ED stroke team are nearly instant. Our door to needle time is 27 minutes, on average.

The drugs must be given within 3 hours of symptom appearance or they simply don’t work very well, although some studies suggest that there is SOME benefit in getting the drugs up to 24 hours after symptoms appear. Time is brain.

Now tell me how cool it is to have ‘free’ healthcare.

By Divemedic, ago

Quiet

I’ve been quiet for a few days. The old saying that you can’t fill someone else’s cup if your own well is dry has been true for me this week. Let me explain:

As you all know, I work three days a week. Day one, I had four rooms and a parade of really sick patients in them. One of my patients had leukemia and didn’t know. The doctor and I had to tell her. Still other patients had a host of problems- one guy had a 100% blockage in two cardiac arteries, another had lost so many fluids from a week of diarrhea that his blood pressure was only 70/42. A long day.

The second day saw me treat two coworkers: one a doctor who had a seizure at work. The second, a fellow nurse with SVT and a heart rate of over 200.

The third day was by far the worst. We had a critical incident. Let me explain. EMS brought in a woman who was in cardiac arrest. She was also 38 weeks pregnant, and had been down for about 40 minutes when she came in. I was the team leader.

When you work a cardiac arrest in the emergency department, what we call a “Code,” there are numerous jobs.

  • There is the recorder, whose job it is to write down every single lifesaving act we take, drugs given, etc. That person also is the time keeper. Things like “Two minutes to the next pulse check, three minutes to the next dose of epi,” things like that. This is always an RN.
  • There is at least two compressors. Their job is to perform chest compressions, and there are two so they can switch places when they get tired. Literally anyone who works in the ED can do this job.
  • A Respiratory therapist, who is in charge of ventilating the patient and maintaining the patient’s patent airway.
  • One nurse or paramedic who is in charge of IV access.
  • A doctor, who is in charge of making all decisions.
  • The team leader, who runs the defibrillator and handles all of the drugs. This is always an RN, and usually a well experienced, senior one. They work with the doctor to ensure that the patient gets the proper treatment.

One of the sights that I will never forget is what that lifeless baby looked like when they cut her mother open to rescue her. Another sight that I won’t forget is looking across the patient and seeing the nurse who was the compressor continuing to do her job as tears poured down her face. It was heart wrenching.

In total, we worked on that mother and her baby for over an hour.

We wound up getting mom’s pulse back. We lost the baby. We still had six more hours to go in our shift, and we still had patients to take care of. The most jarring thing about it was that you would walk out of a room where you just spent an hour trying to save a dead baby, only to hear your patient demand a turkey sandwich. Codes involving the death of a child are always hard. In fact, it was one such call years ago that had me seeing a shrink for a couple of years.

Emergency nurses are some of the most jaded people I have ever known. They are used to seeing tragedy on a daily basis. It isn’t unusual for us to work several codes in a shift. What is unusual is to work a code on a child or on a pregnant mother. In fact, we only do that once or twice a year. Add to that, many of our nurses are recent or expecting mothers. Adults dying? That hasn’t bothered me in years, but when a child dies, it’s like a little piece of you dies with them. It’s heart wrenching and it takes weeks to get over it.

For the rest of the day, you would enter a medication room or a storage closet to find a nurse in there crying. Two of the nurses were doing so poorly that they had to be sent home for the day.

Me, I did OK for the remainder of the shift, even though I was on the verge of tears. I held it together and went home. As soon as I saw my wife, that was when it hit me. I sobbed like it was my own child that I had lost, and did so for about 20 minutes. Then I drank some booze and went to bed. I didn’t speak very much to my wife for a couple of days. I didn’t blog, except to post some posts that I had already written and was saving for later. I ate very little.

I feel better now, but you can’t imagine how hard it is to hold a dead baby. I still see that child’s face at night. The only thing that enables me to sleep is the knowledge that we did our job well, and managed to save the mother. I can’t think of a single thing we could have done differently that would have made a difference, and that is what will enable me to go back to work.

By Divemedic, ago

Market Forces

Ron DeSantis is taking heat for a statement that he made. He said that people under age 50 largely don’t need health insurance. He is correct. People under age 50 are healthier than those over 50, and their premiums largely pay the freight for those who are older and sicker.

Our nation’s healthcare system gets crapped on a lot. Even though the United States has only 9% of the world’s doctors and 3% of the world’s hospitals, half of the innovation in healthcare of the entire world is being created right here in the United States. We are punching far above our weight class:

  • New drug development: The US was responsible for the development of 43.7% of new molecular entities (NMEs) and has seen a surge in new drug approvals.
  • Biotechnology patents: U.S. firms filed nearly 38% of global biotechnology patents from 2015–2020.
  • Research funding: The US accounts for a significant share of global medical and health R&D, at around 44% of the world’s medical research funds.
  • Clinical research: The US leads the world in the number of active clinical trials, supported by its advanced infrastructure and large population.

There are plenty of people who would slam the US medical field because of costs, then drag out statistics claiming that the US lags the world. In many cases, those statistics are misleading. For example, the US says that a child is stillborn if it dies before birth, but some other countries will count a child as stillborn if the child dies up to 30 days after it is born. This is important, because this means a 29 day old infant who dies does not count towards infant mortality. For that reason, use health statistics with a healthy grain of skepticism.

This means that the chief reason for claiming the US healthcare is trash is that it can be expensive. After all, we always hear about how Canada has better healthcare because it is free. Of course, you have to wait weeks to get something as simple as a CT scan or an MRI, while here in the US you can get a CT scan in less than 10 minutes, and an MRI can be done in a matter of hours.

So why do things here cost so much? Let’s use my recent trip to the emergency department as an example. My itemized bill showed that I received 5 bags of normal saline over a 12 hour period. The charge for this was a total of about $11,000. This seems a bit high for 5 liters of salt water, mostly because it is. Take a closer look, and you see a couple of things:

The saline is charged out at $35 per liter. That’s not TOO unreasonable. Then you see that there is an additional charge of about $900 per hour for “monitoring while fluid replacement is taking place.” This is how hospitals pad the bill. They give you a couple of liters early, then run in what is called “maintenance fluids” at a rate of 50 ml per hour. They then bill you almost a grand an hour for that nurse monitoring you while you got those fluids. It’s just a way that the hospital pads the bill, because that nurse is also billed to you as part of the daily room charge. They also bill $50 a day for cardiac monitoring, plus you get billed for every doctor who even glances at your chart.

Of course, insurance companies see right through this, and they refuse to pay. The hospital knows this, and in fact they plan on it. The hospital has an agreement with the insurance companies, and they actually only collect about 35% of what they bill out, on average. The hospital’s total average costs are usually equal to about 31% of what they bill. That 4% difference is the hospital’s profit.

In my case, the entire visit to the hospital was billed out at $43,000. Out of that bill, my insurance paid $2,500, I paid about $700, and the rest was simply waived away. The full bill of $43,000 is what they bill to those poor suckers that don’t have insurance. The hospital knows that what they did for me was in no way, shape, or form worthy of $43,000. The insurance company knows it, too. In fact, everyone involved knows that no one is actually going to pay that much.

Why, then, do they do it that way? Because that is what the insurance companies want. They want medical expenses to be so high that people pay for insurance out of fear. That’s the problem with US healthcare. Not the care, not the cost, but the insurance companies scaring people into buying their products through punitive pricing models.

The answer then isn’t to have more people insured- it’s to get insurance companies out of the equation, or to at least prohibit hospitals from charging the uninsured more than 20% over what insurance companies pay. Market forces will then take care of the rest. It isn’t a problem with healthcare, it’s a problem with insurance companies. If the hospital can turn a profit on what they pay the insurance company, they can turn a profit on 20% more than what the insurance company pays. There is no legitimate need to charge the uninsured 1,400% more than the insured.

By Divemedic, ago

News from the ED

During the past week or two, I had a few notable incidents:

Of the more than 100 nurses who work in my hospital’s Emergency Department, only 9 of them are board certified in Emergency Medicine. Only three of us are board certified in a second specialty. For that reason, I now spend most of my days in the critical care zone.

For starters, this being the tail end of summer/start of fall, there are almost zero cases of Flu/COVID/RSV coming into the ED, but there are quite a few cases of pneumonia and sepsis, mostly in our older population. Of our patients, I would say that the biggest reasons for visits are people who are sick because they are old, abusing intoxicants, homeless, having a mental health crisis, or a combination of those.

One of my patients had come in having some mild stroke symptoms. He had my undivided attention for the first 30 minutes he was there. It turned out, no stroke. It was a complicated migraine. So while we were waiting for further testing and for the migraine cocktail to kick in, we suddenly were inundated with some very sick patients. Four cardiac arrests, and 3 other patients who required intubation in less than a two hour timespan. It happens like that sometimes- things are calm, then it is like a bus full of sick people pulls up. As the only nurse in the critical care zone who is certified to insert IV lines by ultrasound that day, I was busy for that two hours. One case in particular, I had to start an ultrasound line, then stick around to give Etomidate and Succinylcholine for the rapid sequence intubation. After that, I was in a cardiac arrest for another 30 minutes.

In the middle of all of this, the patient with the migraine had pushed his nurse call button. When I was finally able to get to him, he was indignant: “I pushed this button 20 minutes ago. This is ridiculous.”

Me: “I’m sorry for the delay, sir. I was busy with some very sick people. I’m sure that you understand, it’s just how things work in the Emergency room sometimes.”

Him: “Where were you? Are you really that incompetent?”

Me: “Sir, I am sure you heard the announcements. I was literally doing CPR on someone for the past half an hour.”

Him: “I don’t care about that, I called for you and you should come. I am never coming to this shitty hospital again. I want to see your boss, you should be fired.”

My charge nurse enters the room, and the man goes on a rant. The charge tells him what happened, and he still keeps complaining.

All of that. Do you know what he wanted? Some water and a warm blanket.

Working in emergency medicine has convinced me that far too many people have Main character syndrome.

Later, I had another 34 year old patient come in complaining of a severe headache and nausea. He reeked of weed. When I asked him about that, he said “Oh, I have a weed card. It’s medicinal.” He then told me that he smokes 6 or 7 joints a day. We tested him fully, finding nothing. Did I mention that he was covered in tattoos, had green hair, a septum ring, and two lip piercings? He was telling me how he is too poor to afford a ride home, and wanted the hospital to make arrangements to get him home. Uh, you can afford all of that ink, those piercings, and weed, but you can’t afford an Uber? Medical marijuana is bullshit 99% of the time, by the way. It isn’t for medical reasons, they just want to get high. If it were medicinal, wouldn’t there be a prescribed dose and schedule, like with every other medication? What other medication says “take however much you want, as often as you want?”

Anyhow, I now have a few days off.

By Divemedic, ago

No One Knows the Cost

We talked about the high cost of healthcare. When people talk about how the US healthcare system is “broken” they are mostly complaining about cost. Getting costs down is tricky, and it’s a problem that was caused by government interference.

The Medicare Physician Fee Schedule is a 1,348-page document, and the final rule for hospital inpatient payment systems is 773 pages long. For some services, it’s impossible to know how many pages of regulations and price controls there are. For example, The Centers for Medicare & Medicaid Services (CMS) does not condense the Medicare payment rules for ambulances into a single, definitive document. The regulations for ambulance charges are spread across multiple manuals and chapters, all of which are constantly being updated and revised. A definitive page count for the rules does not exist, because no one knows for sure what all of the rules are.

All of this adds to the cost, as medical providers have to hire entire departments just to take a guess at what they can and should charge you, and even then, they often get it wrong, because the rules are contradictory.

Every time the government steps in to fix it, they add pages and chapters to the manual, but instead of fixing things, they make it more complex with carve-outs, backdoor deals that kickback money to big donors, and the need for an even larger hospital billing department.

I do want to respond to one comment, where someone said that reading a CT scan shouldn’t cost $1500 because it only takes an experienced radiologist 30 minutes or so to do it. Remember that you aren’t just paying for the radiologist. You are also paying for his malpractice insurance, the costs of compliance with government electronic charting and recordkeeping, the costs of his staff to include the billing department, and other associated administrative overhead. That radiologist is only getting a small fraction of that money, in many cases, less than a fifth of it.

  • Malpractice insurance for a radiologist is around $25,000 per year
  • Costs for electronic health records: for a smaller practice, you are looking at around $400,000 for initial costs, plus another $50,000 per year. In the case of radiologists, it will be even more to integrate with the output of proprietary CT machines.
  • Plus staff and administrative costs
  • So a radiologist is paying $200k or so a year just to read those CT scans. If he isn’t charging that kind of money, he might as well go be a plumber.

Keep in mind that an hour’s work from a plumber costs about the same as that radiologist is going to cost you.

By Divemedic, ago

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

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

Report From the ED

Working in the Emergency Department, it’s odd that each day tends to have a theme- that is, the patients who come in tend to follow a pattern of similar complaints. Some days, it is STI’s, other days, it’s heart problems. The theme of the last few days in the hospital has been mental health and substance abuse.

The last day that I worked, there was a man that was found naked, lying in the street. He couldn’t even tell us his name. His drug and alcohol screens were all negative. There was the woman we Baker Acted, because she was working with the FBI on a child trafficking case, and some one had given her a delayed reaction drug six years ago, and now they had activated it remotely to silence her. Then there was the guy who came in with a blood alcohol level of 486.

There was a guy that came in with a knife. He looked like butterbean: Bald, 340 pounds, 6 foot 4 inches tall. He looked at you like he was trying decide how he was going to kill you. His first words to the triage nurse were, “Which one of you nurses think you can take this from me?” Two security guards and a rather large doctor tackled him. He got Ketamine and Versed to no effect. So then we held him down and gave him another 200 mg of Ketamine, followed by a dose of Rocuronium. After the intubation, he still required the maximum dose for 3 different sedatives to keep him down. Since sedatives lower the patient’s blood pressure, he also required Levophed.

Flu season is over- I haven’t seen a patient test positive for Flu in weeks. COVID seems to be having a bit of a surge. In the past two weeks, I have seen perhaps half a dozen patients who were positive for COVID. Symptoms are vague, but mild. Patients complain of stomach pain, sore throat, congestion, body aches, and other assorted mild complaints. Only one of them was running a fever. We tell them to drink fluids, take Tylenol or Motrin, and get lots of rest.

We are running far busier this summer than usual, averaging 300 patients or so per day. This is our slow season, when we typically see 200 or so per day. During the busier Flu and snow bird season, we usually have about 450 to 500 per day. Overall, we usually serve 140,000-170,000 patients per year. This year will likely surpass that.

By Divemedic, ago