We Are All Criminals Now : PANDA BEAR, MD

Panda has resurfaced.

This is not a Panda that eats bamboo, but from all appearances feasts on spleens. Angry ones.

In fact, I was once texting while standing at the nursing station and some supervisor of something-or-another told me that cell-phones were not allowed and then looked on in helpless fury as I laughed and took his pictures to text to my friend. This is a good way to make enemies and I’m sure I’m going to be the first one up against the wall when “Papa Doc” Press Gainey is installed as out Great Leader and Ruler for Life but I did not come through the irritating hell of medical school and residency to be scolded by a bureaucrat like some wayward candy striper.

via We Are All Criminals Now : PANDA BEAR, MD.

I wish I wrote that well.

Happy Veterans Day

We still have a lot of troops in the field, many in direct combat with our enemies. Thanks to all our veterans.

November 11, or what has come to be known as Veterans Day, was originally set as a U.S. legal holiday to honor Armistice Day – the end of World War I, which officially took place on November 11, 1918. In legislature that was passed in 1938, November 11 was “dedicated to the cause of world peace and to be hereafter celebrated and known as ‘Armistice Day.’

via Veterans Day | Military.com.

Happy Birthday, Marines!

I post this every year, and I still enjoy it…
original poster from: stores.ebay.com/WONDERFULART

The Crime is always worse than the coverup

“The coverup is always worse than the crime” assumes no coverups work, which is unlikely. It does increase the penalty: nobody likes a liar.

Apropos of nothing whatsoever.

The ED of the Future

Let’s say, hypothetically, you could design the ED of the Future. I say hypothetically as there may be a new (like New) ED in my future. Maybe; it sounds like a heck of a challenge. Considering we’re a Trauma Center and currently see nearly 100K/year in volume, and have an admission rate that’s between 18-35%,

What would that new ED look like, from the following viewpoints :

  • the patient
  • the triage nurse (is there one?)
  • the treating nurse
  • the ED doc
  • the consultant
  • the hospital admissions team (billing)
  • the OR
  • the Tele units
  • the Floor units
  • ED discharge areas
  • physical plant

I have a few ideas, but am frankly hamstrung by a lack of ‘out there’ imagination. Let’s hope you’re not similarly limited. Don’t feel like you need to answer all of these, but I’m interested in your ‘out of the box’ ideas…which you’ll get full (if ephemeral) credit for.

[AP] Doctor in nurse retaliation surrenders license | arafiles, retaliation, roberts – Odessa American Online

Update: 2 months in jail, then probation.

TO recap: Sheriff Roberts and County Attorney Tidwell got jail time for their role in this sordid misuse of power, and the doctor at the center of this mess now cannot practice medicine.

We’ll have to wait to see if he gets jail time from this.

[AP] Doctor in nurse retaliation surrenders license

November 04, 2011 4:19 PM

THE ASSOCIATED PRESS

AUSTIN A doctor accused of retaliating against two whistle-blowing West Texas nurses has agreed to surrender his medical license.

Dr. Rolando G. Arafiles signed an agreed order with the Texas Medical Board Friday stating he will stop practicing medicine.

via [AP] Doctor in nurse retaliation surrenders license | arafiles, retaliation, roberts – Odessa American Online.

Unfortunately, it’s still not over. Arafiles is still under indictment for aggravated perjury in Andrews County for his statements in the Nurse trial.

None of this restores the careers of the two nurses who were the victims of this.

Internet Exile

For my crimes against the internet, I’m going to exile myself from the digital wold for a week.

Also, I’m getting on a boat.

Please play well together, and have all the problems solved when I come back.

Xigris Pulled from Market

The irony here is that Eli Lilly has advanced sepsis care (as a prelude to using their drug), and while Xigris hasn’t panned out, aggressive sepsis resuscitation has.

Eli Lilly is withdrawing drotrecogin alfa (Xigris) from all markets worldwide after a major study failed to show a survival benefit for patients taking the drug.

Xigris should be discontinued immediately in patients currently receiving it and should not be started in new patients, the company said.

The trial with the bad news on Xigris was called PROWESS-SHOCK, a placebo-controlled study with 28-day mortality as the primary outcome and planned enrollment of nearly 1,700 patients.

via Medical News: Sepsis Drug Pulled from Market – in Product Alert, Prescriptions from MedPage Today.

At ACEP the reviewers of this study said it favored placebo over Xigris. Tough to market a very very expensive drug when not using it is better…

Guest Column: Better Care, Thanks to Tort Reform — Health Reform and Texas | The Texas Tribune

Wait, I was told this would Never Work.

Thanks to the passage of lawsuit reforms, medical care is now more readily available in many Texas communities. For many patients, this change has been life-altering; for some, life-saving.

via Guest Column: Better Care, Thanks to Tort Reform — Health Reform and Texas | The Texas Tribune.

Libertarians, Medical Malpractice and Contract | Cato @ Liberty

Interesting think piece on pre-arranged medmal arrangements, and why they won’t currently work…


The one signal fact about the American court system is that, paternalistically, it generally refuses to enforce contractual arrangements of this sort. No matter how well spelled out in advance, courts will not enforce the disclaimer of liability or apply the agreed-on damage limit. You will instead get the malpractice coverage that courts and lawmakers deign to prescribe for you, not the coverage you and your medical provider might have chosen yourselves.

via Libertarians, Medical Malpractice and Contract | Cato @ Liberty.

Best of my ACEP 2011 Twitter feed

If you don’t follow me on twitter, you missed my play by play of the recent ACEP 2011 Scientific Assembly from San Francisco. Several of us attending twittered (and it was terrifically entertaining to meet them and socialize)!

These are trimmed from my tweets ( http://twitter.com/#!/gruntdoc ) and should you be interested, all the Scientific Assembly tweeters were using the hashtag #sa11.

My rough count for the ones I included here is 95. Some are more interesting than others. Enjoy.

Asplin says its harder to collect from high deductible/HSA pts than from self pay. Seems odd. Asplin

1% of population accounts for 30% of all spending in a given year, 5% account for HALF. 20% spend nothing. There’s your problem.Asplin

Understatement: there’s a gap between the vision and the reality of the Medical Home. Asplin

ER docs make the most expensive routine decision in healthcare: admit or home? We have little to no control over readmissions. Asplin

[Read more...]

Army seeking troops bitten by stray animals following rabies death – Army – Stripes

Wow, that is awful beyond belief.

Army seeking troops bitten by stray animals following rabies death – Army – Stripes.

SEOUL – The Army is redoubling its search for anyone who might have been bitten by a wild animal in Iraq or Afghanistan following the Aug. 31 death of a soldier from rabies, the service’s public health command stated Wednesday.

“The death of this soldier is very tragic, and we are taking actions to ensure something like this does not happen again,” Lt. Col. Steven Cersovsky, director of epidemiology and disease surveillance at the Army’s Public Health Command, said in the release.

Spc. Kevin Shumaker, 24, became the first soldier to die from rabies since 1967 after he was bitten by a stray dog in Afghanistan.

Shumaker told his parents that he received three of six necessary rabies shots in Afghanistan, but did not receive the final shots because they were expired, according to a Contra Costa Times report. Shumaker, a 10th Mountain Division soldier, died at Fort Drum, N.Y., eight months after the bite.

“I would not be without my son if the proper treatment was given to Kevin,” his mother, Elaine Taylor, told the newspaper in September.

Prayers for his family.

World’s first malaria vaccine works in major trial | Reuters

Okay, like all of us I want an effective and safe malaria vaccine, and the tone of the article is hopeful. But…

The trial is still going on, but researchers who analyzed data from the first 6,000 children found that after 12 months of follow-up, three doses of RTS,S reduced the risk of children experiencing clinical malaria and severe malaria by 56 percent and 47 percent, respectively.

Loucq said widespread use of insecticide-treated bednets in the trial — by 75 percent of people taking part — showed that RTS,S can provide significant protection on top of other existing malaria control methods.

via World’s first malaria vaccine works in major trial | Reuters.

We’ll have to read the study, but if you’re mixing a change in bednet use AND a new vaccine, well, let’s hope they were measuring what they thought they were.

Alternate Spelling?

I was recently at ACEP’s Scientific Assembly in San Francisco, and once again ACEP did a very good job of getting the whole shebang organized. I think I saw that there were about 5,800 attendees, which isn’t many compared with some meetings, but for Emergency Medicine docs it was the second-most attended (after last years’ in Las Vegas).

There are exhibitors there, and while the theme of the year was ‘win an iPad’, EMR’s and Scribes, it was a good turnout and I enjoyed talking to the vendors.

I bring this up to point out an anomalous spelling that snuck through (and it’s not ACEP’s miss, I don’t think). Right inside the main doors there’s a very cool, touch screen gadget to find a particular exhibitor by name, type, etc with an interactive map. Really Cool.

And, it had this:

Aah, well.

Meeting of the Minds

@movinmeat and myself meet with ACEP Immediate Past President Angela Gardner ( @ACEPHeadliner ).