Archives for December 2008

Happy 19th Anniversary

…to my wife, who no doubt deserves better.


Thanks, honey!

The Flu: No, I haven’t seen any either…

From the CDC:

During week 51 (December 14-20, 2008), a low level of influenza activity was reported in the United States.

  • One hundred three (3.4%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
  • The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • The proportion of outpatient visits for influenza-like illness (ILI) was below national and region-specific baseline levels.
  • Two states reported regional activity; six states reported local influenza activity; Puerto Rico and 36 states reported sporadic influenza activity; five states reported no influenza activity; and the District of Columbia and one state did not report.

In case you wondered what that looks like, in graph form:

Flu2008 160 cases, Nationwide, week 50.  Lucky so far.

Somebody got a new ED

Postscript: Three Cheers For Middlesex Hospital’s New E.R.

Hartford CourantBy JOSH KOVNER

December 29, 2008

MIDDLETOWN — – Middlesex Hospital’s new $31 million emergency department, which opened in March, has settled into a groove.
The waiting room is usually empty and people are seeing doctors in a third of the time, even though the patient caseload has risen 4 percent since March — in what has been one of the busiest emergency centers in the state.
Memories of a crowded waiting room and patients on gurneys in the hallway are fading.
The largest renovation project in the history of the hospital increased the number of emergency beds from 26 to 44 and added new technology that has streamlined patient care.

Up 4% already.  If you build it, they will come.  I give it 6 months until the waiting room is full again.

Yes, I’m jealous.  Rumor had it our ED was next for an expansion.  Until the economy acted up, which has everything on hold.

Congrats, Middletown, wherever you are.

How to know

…when your patient realy has pseudotumor cerebri:

Doctor says: we need to do a lumbar puncture.

Patient says: Oh, thank god, and isn’t at all sarcastic.


California Medicine Man: ER Docs Feel the Police Use Excessive Force

California Medicine Man: ER Docs Feel the Police Use Excessive Force
ER Docs Feel the Police Use Excessive Force
To me, this story should be filed under the category of “There’s less to this than meets the eye”.

Amen, Brother.

Growing our own…

This was sent by one of our nurses (and a frequent commenter) with her title “Growing our own Nurses”.


When she originally showed it to me, she said this is how to treat doctors: the pacifier does the trick.

I’m not saying she’s wrong…

You’ve got to be alive to be inconvenienced

That’s one of my favorite medical aphorisms, taught to me by Dr. Peacock in El Paso.  He was one of the trauma surgeons there, and it nicely summed up an approach to medical care in the acutely traumatized.


I thought that when I read this:

Army halts use of battlefield first aid item after test found it might cause blood clots

By PAULINE JELINEK | Associated Press Writer

10:25 PM CST, December 23, 2008

WASHINGTON (AP) — Until more testing can be done, Army medics are being told to stop using a new product just sent to the war front to help control bleeding among wounded troops.

Officials were in the process of distributing some 17,000 packets of WoundStat, granules that are poured into wounds when special bandages, tourniquets or other efforts won’t work. But a recent study showed that, if used directly on injured blood vessels, the granules may lead to harmful blood clots, officials said Tuesday.

To recap: a medication to be used as essentially a last resort when a trauma patient is bleeding to death cannot be used because …it might cause blood clots.  Bleeding that cannot be controlled with direct pressure, tourniquets or the newer ‘combat gauze’ with pro-coagulants built in. 

I have to say that, were it me in that situation, I’d risk some clots elsewhere to get clots to keep me from literally bleeding out.  But that’s just me.

It’s commendable the Army takes the medical care of its troops seriously, but there’s a disconnect in this case.

Movin’ Meat: I’m Impressed

Movin’ Meat: I’m Impressed

So am I!

More on the California Good Samaritan debacle

Thanks to fellow medblogger Symtym I’ve read the decision in the execrable event blogged about yesterday.

Here’s the actual text of California’s Good Samaritan Law:

California Health And Safety Code Section 1799.102

No person who in good faith, and not for compensation,
renders emergency care at the scene of an emergency shall be liable
for any civil damages resulting from any act or omission.  The scene
of an emergency shall not include emergency departments and other
places where medical care is usually offered.

I have to tell you, that seems pretty straightforward to me. You help (not for profit), you’re covered.

Now, for the problem: the decision is here (.pdf file), and it exemplifies why normal people don’t trust lawyers.

Here’s the crux of their reasoning (page 2 of the ruling):

We hold that the Legislature intended for section 1799.102 to immunize from liability for civil damages any person who renders emergency medical care. Torti does not contend that she rendered emergency medical care and she may not, therefore, claim the immunity in section 1799.102. Accordingly, we affirm the judgment of the Court of Appeal.

Why do they believe that to be the correct reasoning?

One can infer from the location of section 1799.102 in the Emergency Medical Services division, as well as from the title of the act of which it is a part, that the Legislature intended for section 1799.102 to immunize the provision of emergency medical care at the scene of a medical emergency.

This is remarkably obtuse; where does health and safety legislation go, except into H&S legislation.  Thank goodness it wasn’t in a farm bill, else it’d only apply on farms.

To say I disagree with this interpretation (as a non-lawyer) is a bit of an understatement.  Read the whole decision to see the tortured logic involved.

I find myself in agreement with the dissent by Baxter J (at the bottom of the decision).  He’s supposedly a liberal activist judge, but no matter, he’s right on here.

Health and Safety Code section 1799.1021 states that “[n]o person who in good faith, and not for compensation, renders emergency care at the scene of an emergency shall be liable for any civil damages resulting from any act or omission.” (Italics added.) Nothing in this clear statement limits or qualifies the kind of emergency aid — medical or nonmedical — that an uncompensated lay volunteer may provide without fear of legal reprisal from the person he or she tried to help.

He goes on to point out the absurdity of the majority decision:

Thus, in the majority’s view, a passerby who, at the risk of his or her own life, saves someone about to perish in a burning building can be sued for incidental injury caused in the rescue, but would be immune for harming the victim during the administration of cardiopulmonary resuscitation out on the sidewalk. A hiker can be sued if, far from other help, he or she causes a broken bone while lifting a fallen comrade up the face of a cliff to safety, but would be immune if, after waiting for another member of the party to effect the rescue, he or she set the broken bone incorrectly. One who dives into swirling waters to retrieve a drowning swimmer can be sued for incidental injury he or she causes while bringing the victim to shore, but is immune for harm he or she produces while thereafter trying to revive the victim.

The legislature wrote what it meant, in plain language.  The California Supreme Court says the plain language isn’t correct, that their intent was clearly different than that written.

Nothing good will come of this.  I can only hope the California Legislature doesn’t go broke before they can clarify their very plain language so even lawyers can understand it.

(The defendant is going to go to trial over whether her actions were negligent, which is pretty much unavoidable.  I’m told that she’ll probably win, as juries are made of more reasonable people than lawyers.  That doesn’t change the problem this decision will make for all society.)

California gets even more screwed up: predictably, Good Samaritans (Decent People) hardest hit

I cannot believe this is happening in a civilized society (even California):

California Supreme Court allows good Samaritans to be sued for nonmedical careLos Angeles Times

The ruling stems from a case in which a woman pulled a crash victim from a car ‘like a rag doll,’ allegedly aggravating a vertebrae injury.

By Carol J. Williams
December 19, 2008

Being a good Samaritan in California just got a little riskier.
The California Supreme Court ruled Thursday that a young woman who pulled a co-worker from a crashed vehicle isn’t immune from civil liability because the care she rendered wasn’t medical.

The divided high court appeared to signal that rescue efforts are the responsibility of trained professionals. It was also thought to be the first ruling by the court that someone who intervened in an accident in good faith could be sued.

This will have a chilling effect on all Good Samaritans, and not just in California.

In case you didn’t get the message, here’s a Professor of Constitutional and Bioethics Law at USC:

Noting that he would be reluctant himself to step in to aid a crash victim with potential spinal injuries, Shapiro said the court’s message was that emergency care "should be left to medical professionals."

(Also, fires should only be fought by Firemen, so be sure and let your neighbor’s house burn down; don’t keep the mugger from beating the old lady, law enforcement is for the Police only, etc).

Did this Professor of Law not think about the lives saved by CPR every year, and how this will be interpreted by them?  Bystander CPR, and the heroic actions of many a Good Samaritan, are endangered by decisions like this.  That trust in your fellow man, and a belief that government is run by reasonable people, is perishable.  This kind of ruling will kill it, for good.  Horrible.

Prepare to burn to death in your car as people drive by, unwilling to be victimized by a legal class without scruples and a society without morals

I sincerely hope there’s an appeal, to benefit at least good sense if not human decency.

via Life in Manch Vegas

Update: HotAir got the same message:

Hot Air -- get your fillThe court has sent a signal to the people of California: don’t get involved.  If someone’s drowning, don’t jump in the lake and save them.  If someone’s trapped in a car that’s about to explode, sit there and watch the show.  Just make a phone call, and who cares that it might be several minutes before an EMS team can make it to the scene?  If you sit on your hands, no one can sue you for all you’re worth.

Predictably, their post is better than mine, making the same points and others, so make sure you read it all.

Best Social History of the Day

No kidding, today:

“I’m taking Jimmy Hendrix’ dope”.

Mr. Hendrix could not be reached for confirmation.

iowahawk: SantaCorp Pleads Case For Bailout

Well, why not; everyone else is getting one.

iowahawk: SantaCorp Pleads Case For Bailout
WASHINGTON – Flanked by officials from the United Elf Toytinkerers union, SantaCorp CEO Kris Kringle today told the House Ways and Means Committee that without immediate government financial help, his firm would be forced to declare bankruptcy, lay off thousands of elves and reindeer, and potentially cancel its annual worldwide Christmas Eve toy delivery.

Medical ‘Conscience Rule” Issued

Should last until the first week of the next Presidency…

Medical ‘Conscience Rule’ Is Issued

New York TimesBy DAVID STOUT

Published: December 18, 2008

WASHINGTON — The Bush administration, as expected, announced new protections on Thursday for health care providers who oppose abortion and other medical procedures on religious or moral grounds.

“Doctors and other health care providers should not be forced to choose between good professional standing and violating their conscience,” Michael O. Leavitt, the secretary of Health and Human Services, said in a statement on his department’s Web site.

The rule prohibits recipients of federal money from discriminating against doctors, nurses and health care aides who refuse to take part in procedures because of their convictions, and it bars hospitals, clinics, doctors’ office and pharmacies from forcing their employees to assist in programs and activities financed by the department.

As predicted.

Hit & Run – Reason Magazine: An excellent explanation of Rights vs. Entitlements

This is very relevant when the ‘right to healthcare’ comes up:

Hit & Run – Reason Magazine
…From the founding until the twentieth century, the American regime assumed that government’s purpose was to secure pre-existing natural rights—such as life, liberty, property, or association. Everyone can exercise such rights simultaneously; nobody’s exercise of his own rights limits anyone else’s similar exercise. Your right to life or to work or to vote does not take anything away from anyone else. We can all pursue happiness at once. Entitlements, on the other hand, require someone else to provide me with the substantive good that the exercise of rights pursues. The right to work, for example, is fundamentally different from the right (entitlement) to a job; the right to marry does not entitle me to a spouse; the right to free speech does not entitle me to an audience.

That’s an explanation which is both fair and makes sense to me.

Tech bleg completed

Wow, thanks to all for the quick and informative replies.

Following Phil’s advice, the Trojan Remover did an excellent job of scraping out the major trojan, which freed up the rest of the system to check out normally.

SpyBot S&D then found another trojan, a bunch of malware, and it all got scrubbed.

Taking the advice of Robin, I will make a restore point after ad-aware finishes, deleting the older versions.

I really like the 9 of you that read this blog.  Thanks.