Dr. Val continues to set the bar, this time with Governor Mike Huckabee. The power of a blogger.
Archives for May 2008
The wreck of the good ship, EMTALA at edwinleap.com
EMTALA, the Emergency Medical Treatment and Active Labor Act, was passed in 1986. For those who aren’t familiar with yet another acronym, EMTALA is a federal law that was enacted to keep poor, uninsured patients from being ‘dumped’ on indigent-care hospitals, or any other facility, for financial reasons. Although it was a good idea, it soon grew fangs, tentacles, claws, rose up to several hundred stories in height and developed a surly attitude and bad breath. It is, in fact, one of the largest unfunded mandates the US legislative branch has ever gifted on its subjects.
Dr. Leap, speaking the Truth. Read it.
Economy’s Woes Prod Many
Who Left Field to Return;
Brushing Up on Anatomy
By CONOR DOUGHERTY
May 7, 2008
With house prices falling and the cost of gasoline and food rising, many nurses are going back to work, in some cases to make up for the income of a spouse who has lost a job. Hospitals say part-time nurses are taking on extra shifts. And nursing schools are seeing an increase in people applying for refresher courses on the ins and outs of modern hospitals. Some older nurses are putting off a planned retirement.
“We are seeing a temporary lessening of the nursing shortage,” says Jane Llewellyn, vice president of clinical nursing affairs at Rush University Medical Center in Chicago. But, she says, “as soon as the economy turns up we’ll see them staying home again.”
So, it’s a WAGE shortage, not a nursing shortage. There are nurses out there, but for the current wage structure they’d rather stay home.
Demography is destiny:
Japan Steadily Becoming a Land Of Few Children – washingtonpost.com
The number of children has declined for 27 consecutive years, a government report said over the weekend. Japan now has fewer children who are 14 or younger than at any time since 1908.
The proportion of children in the population fell to an all-time low of 13.5 percent. That number has been falling for 34 straight years and is the lowest among 31 major countries, according to the report. In the United States, children account for about 20 percent of the population.
European and Japanese non-immigrant populations have fallen well below replacement, and that means they’ll be substantially different in 20-30 years.
Suture for a Living: Grand Rounds 4:33
I had no theme for this Grand Rounds, but thought I would share some links and photos of Arkansas. This first one is of the Trail of Tears (photo credit). This first post may well bring tears to your eyes —
The near-perfect Grand Rounds.
May 2nd was the SIXTH anniversary of GruntDoc. I’m getting old, and missed my own blog birthday. Here’s last years’ remembrance:
Starting May 2, 2002 and continuing, irregularly, to this point has been a lot of entertainment for me, and hopefully for you, too.
I’ll put it on the calendar for next year…
Updated, because apparently not only did I forget the date, but I forgot how to count, as well!
“It is irrational to believe that an emergency system that is already overwhelmed by the day-to-day volume of acutely ill patients would be able to expand its capacity on short notice,” said Dr. Roger J. Lewis, a professor in the Department of Emergency Medicine at Harbor-UCLA Medical Center.
All the ED’s I’m aware of work at or above capacity daily. There’s room for maybe a 6 hour surge, but that’s only if most of the patients brought in the surge go home from the ED. I don’t want to think about pandemic flu, let alone some weaponized bug.
AMNews: May 12, 2008. Oregon still stands alone: Ten years of physician-assisted suicide … American Medical News
There is no tidal wave of patients moving to Oregon to die, and there is no evidence of a slippery slope toward involuntary euthanasia there, as opponents once feared. At the same time, there is no sign that many states will rush to follow Oregon’s lead on physician-assisted suicide, as supporters still hope.
Though Oregon’s law remains seldom used and unduplicated, its impact on physicians, patients and the movement to improve end-of-life care cannot be overstated.
A well written, balanced article.
For the record I’m for it. Also for the record, as an EM Physician I’ll never ever be in a position where that opinion matters one whit.
AMNews: May 12, 2008. Harvard offers discount on med school tuition … American Medical News
In March, Harvard announced that students whose families earn $120,000 or less a year will get up to $12,500 off the annual $65,000 cost of tuition and living expenses. The program will start with the 2008-09 academic year.
Wow. How long does it take to pay off that debt? Does anyone know Harvards’ percentage of grads going into primary care? I think there’s be a correlation…
Congrats to TBTAM, and it’s another worthy effort.
It’s a cynical way to look at life, but it’s also somewhat realistic. It happened again last night.
It was about 0300 while I was traveling home from work. On a 4 lane undivided surface street I saw the following: a person lying in the #2 lane* Eastbound, a pickup parked about 150 feet behind said person, and two men with flashlights directing traffic. One other vehicle in the #2 lane Westbound, even with the person in the street. I was going West but did a quick U, pulled up between the pickup and the person on the ground, turned on the hazards, etc.
As I exit my car I can tell the situation is under good control. The first Samaritan is on his cellphone, getting PD and EMS to come. I ask what’s going on with the ground person, and he states the individual was staggering on the other side of the road, then walked over and collapsed there. He stopped to keep them from getting run over. (I’ll skip my brief assessment of the person on the ground, but medically needed nothing from me).
The second Samaritan is waving traffic through, and concurred with the assessment of #1. Good, think I, soon EMS will take this person to a hospital, and all will be fine.
That’s when a new SUV hit the back of Samaritan #2’s SUV. Hard, glancingly but hard. Hard enough to deploy the airbags and come to a stop within about 30 feet. Now it was considerably more interesting. The people in the car were all mobile (I stayed with the person on the ground), then Fire arrived. It seems an easy explanation, but it’s got to be a little confusing to get to one scene where there are actually two different problems. Fire took charge, about 6 PD cars arrived. I awkwardly helped EMS get the grounded person onto a gurney, they wanted no information from me, a very polite Policeman asked for ID and a phone number. He confirmed what the others had told him with me, and then politely suggested that I go.
So I did.
I feel really terrible for the Samaritan with the crashed car, though.
No good deed…
* Lanes are numbered from the one nearest the center stripe outward.
I kid, but that’s what they say these new carts look like, too:
An unintended consequence of these new gadgets: much slower driving. They’re about 5 feet tall at the top of the rotisserie there, and that’s taller than several of our cleaning pros, so they now do a lot of bob and weave while pushing them. (They like them though).
Celebrity-snooping ex-UCLA Medical Center staffer is indicted – Los Angeles Times
Celebrity-snooping ex-UCLA Medical Center staffer is indicted
Lawanda Jackson, who has since resigned after admitting to peeking at the hospital records of stars, was indicted by a federal grand jury on a charge of obtaining identifiable health data for profit.
Innocent until proven guilty; we’ll see.
08:01 AM CDT on Thursday, May 1, 2008
Dallas Morning News staff report
A man has been accused of attempting to pass a $360 billion check, which he claims was given to him by his girlfriend’s mother to start a record business, Fort Worth police said.
Charles Ray Fuller, 21, of Crowley, was arrested April 22 on an accusation of forgery, police said.
Police responded to a report of a man attempting to pass the check about 4 p.m. that day at the Chase bank in the 8600 block of South Hulen Street, Fort Worth police Lt. Paul Henderson said.
The personal check was not made out to Fuller and when the bank contacted the check owner, the woman said she did not write a check for $360 billion.
Hmm. I wonder how much 360Bn would weigh? And, did he think any bank on earth would just have that much cash?
An inauspicious beginning to his record company career.