Midland Medal of Honor Winner Dies

Via MyWestTexas.com

George H. O’Brien Jr., a U.S. Marine Corps veteran, died Friday following a hospital stay. He was 78.

“He was one of the finest men I’ve ever had the honor of getting to know,” said Russell “Rusty” McInturff, director of development of the Commemorative Air Force, where a new addition will bear O’Brien’s name. “He was honest in all dealings, a gentleman. I don’t know of a person who has a better reputation in this town.”

The CAF is currently constructing a hall that will recognize the 82 Texans who received the Medal of Honor. The CAF announced the hall would be named after O’Brien in the fall of 2003.

O’Brien received the Medal of Honor from President Eisenhower following heroic actions during the Korean War.

O’Brien was a 2nd lieutenant and platoon leader who successfully fought off the enemy to maintain a strategic position. O’Brien was seriously injured, but he continued the fight and tended to other wounded Marines before he allowed himself to be treated.

This incident is indicative of O’Brien’s character, said long-time friend Frank Cahoon. He wasn’t just doing his job as a Marine; he was a real hero, Cahoon said.

Born in Fort Worth, enlisted in Big Spring, and died in Midland. I suppose he liked Highway 80.

There are now three living Texans who hold the Medal of Honor.

Well-done writeups of his actions, the official citation, and a photo of him with Eisenhower can be found here.

UAW screws USMC

In case you wondered how Organized Labor supports the Marines: WXYZ: Local News

…Some U.S. Marines say they were surprised by the decision made by Detroit auto workers about parking. It all started with the cars some Marines drove, and what was on them.

The words that have some U.S. Marines in shock came from the man in charge of security at the UAW Solidarity House, on Jefferson in Detroit. For a number of years now, dozens of Marine reservists have been thankful to park in the UAW’s lot for weekend training with no problem at all – until now.

Marines at nearby Marine Corps Reserve Center say on Tuesday morning, the director of security at the UAW told them that while they support the troops, Marines driving foreign vehicles or sporting a President George Bush bumper sticker were no longer welcome to park there…

Well, it’s their parking lot, and they can do with it what they want.

It’s just interesting they can’t support the troops without applying their biases first. And more than a little depressing.

via Indepundit

Update: GoogleAds has a sense of humor:

I wonder if this is what they had in mind
Click image to see full sized irony

Update 2: UAW reportedly sees light, relents. Damage still done.

Another Nail in the Head

I don’t know if I am just sensitive to these, or if I’m seeing more than others, but we had another nail to the skull recently:

That's gotta hurt

oh, man, it does hurt

This poor fellow had a 2×4 fall from a height and just impale itself in his head. Fire cut the board off the patient, and sent him to us.

Yes, on the CT (sorry, no photo) it does penetrate the dura and tickles the brain. The patient was awake and alert, and after a trip to the OR (presumably with either a slide-hammer or vise grips) and did well.

Bankruptcy

I haven’t been keeping up with this issue, but now it looks like the proposed bankruptcy reform legislation is going to go through. Here’s the part I found most interesting:

Forbes.com: Bankruptcy Bill Passes In The Senate…The most significant section of the legislation makes it more difficult for individuals to file for bankruptcy under the more lenient Chapter 7 of the bankruptcy code. Currently, about 70% of personal bankruptcies are filed under Chapter 7.

Under Chapter 7, individuals essentially wipe out most unsecured debt (save for alimony, child support, student loans and tax obligations), after making a fair distribution to creditors of whatever non-exempt property the debtor has. The most significant exemption is for protecting a debtor’s primary residence; the specific rules that apply to any debtor’s situation vary from state to state. Chapter 7 allows the individual debtor to make a fresh financial start through the discharge of his or her existing financial obligations in bankruptcy.

The legislation establishes a needs-based system for qualifying for Chapter 7 treatment. In particular, the bill requires any individual with an annual income higher than the median in his state of residence and with an ability to pay at least $6,000 over five years ($100 per month), to file for bankruptcy under the less forgiving provisions of Chapter 13. Such a filing would mandate a court-sanctioned repayment plan for existing debts (including medical costs and credit card payments). Critics contend that the revised system will make it more difficult for individuals to get the fresh financial start that bankruptcy protection is supposed to facilitate.

Those seeking bankruptcy protection would be required to participate in credit counselling (at their expense) for six months prior to making a bankruptcy filing.

Florida, Iowa, Kansas, South Dakota and Texas have unlimited homestead exemptions that allow anyone, including the affluent, to file for bankruptcy and shelter a primary residence, regardless of its value, from creditors. The Senate bill now limits this homestead exemption to $125,000 if the person in bankruptcy bought the residence less than three years and four months before filing for bankruptcy. Homes purchased prior to that cut-off would still qualify for the full exemption allowed in that particular state.

I wonder how ‘medical costs’ got added to the list of things that have to be paid off? This should cause the false medical bills cause bankruptcy meme to regenerate quickly.

Also, the credit card companies will now decrease their interest rates, right?

Credit card companies? Anyone? Bueller?

Acronym Testing

I’m trying out a little MT plugin that should make my life easier, by automagically adding the explanations for medical acronyms. This is take 2 for those of you reloading every 3 minutes.

PID
GOMER

(PID)

MI, CHF, COPD
ACLS

I’m just testing various formats. Sorry to have to do this ‘live’ but I have no choice.

For those who try this plugin, I’m modifying the acronym database using Word. Seems like overkill, but it works.

OK, enough with the tryouts. It works! Now all I have to do is make an acronym entry for every medical acronym I know. Yikes.

ACLS, IDDM, EOA

Can’t leave it alone. Sorry.

Update: the acronym plugin was interfering with my future posting, so it’s outta here. That’s why the acronymys don’t work, sorry.

Texas MedMal in the News

Well, what to believe. A couple of days ago an analysis of Texas Medmal verdicts was released, finding basically that Texas had no crisis of skyrocketing Medmal verdicts. That this goes against the conventional wisdom in my field is a given. Symtym has quotes from several of the Usual Suspects. Reflecting my skepticism with an eloquence I lack, Ted Frank at PointofLaw has questions for the authors, and points out some fairly basic flaws in the paper.

Then, comes this news:

TMA Action

Citing the 2003 liability reforms and passage of Proposition 12, two more professional liability insurers announced last month they plan to cut their rates.

Physicians who hold policies written by The Doctors Co. should see an average 14-percent drop in premiums. The company has asked the Texas Department of Insurance (TDI) to approve its plan to give rate reductions of up to 30 percent to most of its 1,100 customers in Texas. The change would be for new policyholders effective April 1 and for renewing policyholders effective June 1.

American Physicians Insurance Exchange said it will cut rates for about 2,200 Texas physicians by an average of 5 percent.

The cuts are the latest reductions announced by insurers in the wake of the 2003 reforms. The Texas Medical Liability Trust (TMLT) has reduced its rates by 17 percent. TMLT President Tom Cotten called the reduction “indicative of the triumph of medical liability reform in Texas.”

OK, I’ll give you that 5-15% cuts aren’t terribly dramatic, and the days of $2000 coverage are gone forever. However, I know which of these I believe. If insurers are voluntarily lowering rates after a historic run-up, that tells me that medmal reform works to lower rates.

The real solution to this situation is for people to realize no-one is perfect and that accidents happen. I’m for actual victims of real malpractice being appropriately compensated. I’m against the current adversarial/lottery system, and I’m against medmal being used as disability insurance by patients with bad outcomes.

JAMA article on CPOE

JAMA — Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors, March 9, 2005, Koppel et al. 293 (10): 1197

Context Hospital computerized physician order entry (CPOE) systems are widely regarded as the technical solution to medication ordering errors, the largest identified source of preventable hospital medical error. Published studies report that CPOE reduces medication errors up to 81%. Few researchers, however, have focused on the existence or types of medication errors facilitated by CPOE.

Results We found that a widely used CPOE system facilitated 22 types of medication error risks. Examples include fragmented CPOE displays that prevent a coherent view of patients? medications, pharmacy inventory displays mistaken for dosage guidelines, ignored antibiotic renewal notices placed on paper charts rather than in the CPOE system, separation of functions that facilitate double dosing and incompatible orders, and inflexible ordering formats generating wrong orders. Three quarters of the house staff reported observing each of these error risks, indicating that they occur weekly or more often. Use of multiple qualitative and survey methods identified and quantified error risks not previously considered, offering many opportunities for error reduction.

Conclusions In this study, we found that a leading CPOE system often facilitated medication error risks, with many reported to occur frequently. As CPOE systems are implemented, clinicians and hospitals must attend to errors that these systems cause in addition to errors that they prevent.

Well, now, that seems terrific, doesn’t it? I’m not a Luddite, and believe that, in general, computerization and data pushing can make medicine safer and more efficient. However, It’s a long-term project, not “OK, here’s your system, where’s the check”?

I’m told that our parent organization has already paid an astounding sum to buy an integrated, hospital-wide EMR, which would include CPOE. (Here comes 2 more weeks of EMR ads on Google again. Oh, well). They’re rolling it out in one of the smaller hospitals in the chain, with the intent to ‘work out the bugs’ there, but I’m a big believer in bugs being everywhere.

We’re going to get very dependent on our new computer overlords, and the one thing that’s assurred is that the computers will go down, usually when the tech people are asleep / away.

Color me skeptical.

via Medpundit

Update: Symtym is thinking along the same lines (I think).

Compliments

In the ED we don’t get many compliments. It goes with the job, I suppose, and with an ever-coarsening, ‘Me’ centered society which expects to live in perfect health, forever.

That’s not to say we don’t get any compliments. There’s a board in the Nurses’ lounge with nice cards and letters from patients who were happy with their care. These generally praise their nurse (who deserves the most praise), then their doc, and the techs, etc). This is one of the nice things about working in Texas, there are still some folks who are appreciative and will express it.

I have had a couple of compliments recently, which is always a nice surprise: two patients recently asked me “for my card” and inquired as to whether I’d be their doctor. I’ve had this happen before, and it always makes me a tiny bit guilty that I’m just an ER doc, but then I remember I’d just be miserable in longitudinal patient care. So, I tell them I’m just an ER doc, I only work here, but when they come in I’ll be glad to take good care of them.

As an aside, they’re usually patients I spend about two minutes with, presenting their problems and prognosis in an ‘unvarnished truth’ sort of way. Interesting.

MedBlogs Grand Rounds XXIV

Hospice Blog: Grand Rounds: Edition 24

Welcome to the 24th edition of Grand Rounds! I am not a doctor, nor am I good looking enough to play one on TV, so my knowledge of what rounds are like comes from my addiction to the TV show “Scrubs”. Since I’m not funny enough to make this post like that, I’m going to do the thing that hospice workers do best. I’m going to tell you the truth, give you your options, and let you decide what you want to do next.

I count 21 different blogs included, with terrific posts. Enjoy!

Madhouse Madman has a Baby

Chronicles of a Medical Mad House: The longest 36 hours of my life, only the beginning of hers. Future Intern Is Born.

Go and wish the new parents all the luck you can spare.

ER doc, rescue celebrated; Drilled hole in patients’ head with Power tool

I’m late to this story, but as I Googled around it hadn’t gotten much press, so it might be news to you, too.
Idaho Mountain Express : ER doc, rescue celebrated: Improv procedure saves the day

St. Alphonsus Life Flight paramedics Tammye Erdmann and Blaine Patterson first met Ben King on Dec. 5, 2003, as he was dying on a stretcher in a church parking lot in Shoshone.

The next time they saw him was Friday, April 23, at a reception at St. Luke’s Wood River Medical Center in Ketchum. The event was organized by the hospital to recognize Dr. Kieth Sivertson, St. Luke’s emergency department director, and the extensive medical effort that went into saving King’s life.

King was suffering an inner-cranial [sic] bleed caused by the trauma of falling down a flight of stairs in their Hailey home. Despite the heroic efforts of his wife Melissa, who found him, and hospital staff, King needed a neurosurgeon. The nearest at the time was in Boise.

Standing around the stretcher in Shoshone, the medical personnel were preparing Melissa King for the worst. Then Sivertson decided to take a drastic measure: He relieved the pressure on King’s brain by drilling a hole in his skull with a Makita drill, a power tool found on most construction sites.

“It sounds like an outrageous cowboy move,” Sivertson said. “But, it was a calculated risk. We will risk a lot to save a life.”

“Idaho is one of the last places you can find (where) you’re entitled to do yourself harm,” he said, explaining that medical attention, especially emergency medical help can not reach victims here as quickly as it might in a large city. “If you’re counting on getting a second chance, forget it. You don’t get to choose how you die. You get a chance to choose how you live. Your life can change just that quickly,” he said, snapping his fingers.

Sivertson said, for example, if a person who is allergic to bees gets stung at the blinking light at the intersection of State Highway 75 and U.S. 20. and has a systemic reaction, he or she will die. Emergency services would not be able to get that person to a hospital in time.

As part of the reception, Makita T-shirts were exchanged, and Sivertson received a Makita drill with a plaque attached to the box for his efforts. …

In addition to a Makita T-shirt with autographs of everyone who contributed to saving King’s life, Sivertson also gave the survivor a Makita baseball cap with a bull’s eye by the temple for any future emergencies.

“I owe my life to everybody here,” King said, including his wife, the first person he saw when he awoke. “I owe my life to you. I feel fantastic.”

First off, the patient is alive, so this is a win! I don’t know enough of the circumstances to know if this was “an outrageous, cowboy move”, but clearly it worked.

I have never, and really pray I never need to, perform an emergency burr hole to relieve the pressure on a brain; this was a bold move, and Dr. Sivertson is to be commended for cool thinking and the fortitude to act.

During my training we had one of those ‘around the desk’ educational chats about emergent burrholes, and it went “three fingers above the ear, two or three fingers in front of that, and make a hole on the side of the first pupil that blows“. (This seems backwards from what you’d expect: pressure on one side of the brain should shove it away, causing the opposite side pupil to blow when the nerves gets compressed on the tentorium, you’re thinking, as did I; however, we’d be wrong. The pressure is causing an uncal herniation syndrome that starts to compress the nerves on the side nearest the lesion first; the opposite pupil dialates as a very late finding).

The article is very oddly written, and it’s not clear whether this patient was being transferred from a hospital to another when this happened (which I think is the case), or whether this was a prehospital move. If it was an interhospital transfer, Dr. Sivertson may have had a CT scan to show the hematoma, but maybe not. I’ll try to find out more.

In the mean time, here’s an article entitled, appropriately enough “The occasional burr hole“. I like their #1 under the procedure heading:

You need:
(1) A sense of historical proportion. Drilling a hole in the head is just the boring (sorry) start to most neurosurgical days. Trephination was practised safely in the Stone Age. So relax.

I wouldn’t be very relaxed, but that’s just me.

hat tip: LizDitz

Microsoft Says No New Security Patches This Month

PCWorld.com – Microsoft Says No New Security Patches This Month


Microsoft customers are informed three business days ahead of time on the rollouts, and Friday were informed that the center “is planning to release no new security bulletins” Tuesday. This would be the second time Microsoft has chosen not to issue a security bulletin for a month. The last time was December 2003…

Analysis: This is either really good, or really bad. Really good: the unfixed flaws are insignificant. Really bad: they just gave up.

Time will tell.

Man survives doctor-assisted suicide attempt; Irony Abounds

This should bring together a bunch of interesting groups:
CNN.com – Man survives doctor-assisted suicide attempt – Mar 4, 2005

PORTLAND, Oregon (AP) — A terminally ill cancer patient who tried to end his life with drugs prescribed under Oregon’s assisted-suicide law awoke three days later, alert and talkative, his wife said.

David Prueitt, who had lung cancer, took what was believed to be a fatal dose of a barbiturate prescribed by his doctor in January. He fell into a coma within minutes, but woke up three days later, said his wife Lynda Romig Prueitt.

Prueitt’s wife told The Oregonian newspaper that he asked, “Why am I not dead?”

Prueitt, 42, lived for two more weeks before dying of natural causes at his Estacada home, about 35 miles southeast of Portland.

Hmmm. I missed the class in pharmacology where we were told how to calculate predictably lethal doses of medicines. I’m not familiar with this Oregon law, and this isn’t an ED thing, so it’s off my scope for the most part.

Complications with doctor-assisted suicides are rare. In 2001, a patient took 37 hours to die after ingesting a lethal dose, and in 2003, a patient took 48 hours to die. Neither regained consciousness.

So, can a physician be successfully sued for a failed assisted suicide? A wrongful-life suit? Pain and suffering?

There’s an insurance company trying to figure out what to do right now. I’m betting they don’t know, either.

New Palm for me!

My old Palm Tungsten T crapped out on me last night, at work. The sense of loss, mixed with relief, was terrific. I have never really liked the T, as it required two hands to open for any real use. I’d been looking forward to replacing it, but couldn’t bring myself to toss it while it still worked. Now, it works no more, and having it fixed is half the cost of a new one, and I wanted to replace it anyway (Rationalization, call your office).

So, I’m now the ?proud? owner of a Tungsten T5, which is bigger but lighter than the one it replaces, with a much bigger screen. The screen is my only concern, as I’ve read reviews saying it’s too dim, though the demo in the store looked fine.

For the record, I looked at the Ipaq’s, hard, but cannot shake the MS fear. It’s my problem, not theirs, but I’m still a Palm guy.

For now.

Report: Smallpox Vaccination Program Fell Short

Forbes.com:

THURSDAY, March 4 (HealthDay News) — The U.S. government’s smallpox vaccination program eroded the credibility of federal health officials while leaving no clear indication of how well prepared the nation might be against a bioterrorist attack.

So said Dr. Brian Strom, chairman of an Institute of Medicine (IOM) committee which released a report Thursday on lessons learned from the 2002 vaccination effort. The panel presented its findings in Washington, D.C.

While stopping short of calling the program a failure, the report did find what appear to be serious shortfalls in how the initiative was implemented. The report, titled The Smallpox Vaccination Program: Public Health in an Age of Terrorism, is the last of seven reports providing recommendations and guidance to the Centers for Disease Control and Prevention (CDC). Unlike earlier reports, however, this one was undertaken at the IOM’s own initiative.

These lessons learned are important because “bioterrorism, unfortunately, continues to be a threat and it is likely that future programs like this will need to be initiated,” ….

At the time, the U.S. government called for a two-phase, voluntary strategy for civilians. In the first stage, roughly 450,000 heath-care and emergency workers would receive the vaccine, followed by a second round covering up to 10 million other so-called “first responders” in the event of a bioterror attack.

According to a Feb. 18 article in the Toledo Blade, very few U.S. civilians — just 40,000 health-care workers and others — ended up volunteering for vaccination. Dr. David Grossman, health commissioner for Toledo and Luca County, Ohio, said the volunteer program never really gained momentum.

“We all agree it was a party no one came to,” he told the Blade. “I doubt that 40,000 people in a nation of 300 million is enough.”

It certainly isn’t enough, and there’s plently of blame to go around.

My hospital was told we’d be getting “x” doses, and we had to decide who was going to get the vaccinations. Most of the ED crew volunteered to get vaccinated, but they did something bizarre: they wouldn’t tell us the exact date or place to get the vaccine until the last minute. I didn’t get the shot, as they had a bad phone number for me and I missed their double-secret meeting time. I still want the vaccination.

And, sounds like there’s plent of vaccine to go around. Wonder if I can get a shot?