per CNN:

NEW ORLEANS, Louisiana (CNN) — A New Orleans grand jury will decide if a doctor and two nurses intentionally killed patients with injections before the hospital was evacuated in the wake of Hurricane Katrina, Orleans Parish coroner Frank Minyard said Tuesday.

The Orleans Parish District Attorney’s Office would not officially confirm the report, saying only that the matter is still being investigated.

“We won’t confirm it, but I’m not going to deny it either,” Assistant District Attorney George Bourgeois said.

Minyard offered no details and refused to comment on whether he had completed his review of the four patients who died at New Orleans’ Memorial Medical Center in September.

After looking at these booking photos, I’m not having any problems choosing sides.

I’m with these three.

I got home from another day at the ED to this headline on CNN: SI.com: NFL quarterback loses game, then spleen

First thought?  Wow, he signed a really bad contract.  The article cleared some things up:

TAMPA, Fla. (AP) — Tampa Bay quarterback Chris Simms had his spleen removed after taking several hard hits in 26-24 loss to the Carolina Panthers and was resting comfortably in a hospital Sunday night.

There was no immediate word on how long the fourth-year pro might be sidelined. The recuperation time for a normal person is four to six weeks, though it’s unclear how long it might take to heal enough to play football.

“Chris is doing well and we anticipate a full recovery,” team physician Dr. Joe Diaco said in a brief statement, adding the 26-year-old son of former New York Giants quarterback Phil Simms was in stable condition…

He took a good hit according to the article, and that might have been what did it (speculation). 

For those who wonder what a ruptured spleen might look like, here’s a CT illustration (mouse over for the text explanation (requires java)):

To get an appreciation of what is involved in a laparoscopic splenectomy (I’m guessing that’s what he had, the article didn’t say, but it makes sense) here’s a demonstration.

A quick recovery to Chris Sims, and prayers for his family.

Or, the Insurance Company won’t be picking up the tab…

It’s probably not a surprise that a disproportionate number of patients involved in Traumas are under the influence of alcohol, and/or drugs. However, once they’re injured and in the Trauma system, every effort is made for them, just like you’d want if it were you who were injured.

In an interesting article on MedScape, Dr. Larry M. Gentilello of the UT Southwestern Medical School (Parkland Hospital) in Dallas was interviewed about alcohol screening and intervention with trauma victims, and barriers to that screening. Interestingly but not surprisingly, it’s money.

Turns out there’s a law called the UPPL, and:

The Uniform Accident and Sickness Policy Provision Law (UPPL), first adopted by most U.S. state legislatures in 1947, allows insurers to deny payment of medical bills if records document any amount of alcohol consumption, even if the condition being treated is not causally related to alcohol use.

Yeah, read that again. I didn’t know either, and it’s the law in 42 states.

Unsurprisingly, guess what? The insurance companies do know and they aren’t shy about denying claims on these grounds. This cheats the hospital and the treating doctor, as hospital care isn’t free and trauma care is particularly expensive.

The denial of care they’re focusing on in the article is access to alcohol intervention and treatment programs for alcoholism, and they cite a study done at Harbor View in Seattle that had good short and long-term results. But, docs aren’t going to go fishing for information that allow insurance companies a fully legal but morally fishy loophole to wriggle out of their medical bill.

The American Public Health Association has an unambiguous statement against the UPPL from 2004:

Therefore APHA:
1. Calls upon state legislatures and state insurance commissioners to adopt the 2002 National Association of Insurance Commissioners UPPL amendment that prohibits insurers from denying reimbursement on the basis of patient intoxicant use; and
2. Calls upon state legislatures that did not adopt the original 1947 UPPL Model to pass a statute that specifically prohibits insurers from engaging in this practice.

Dr. Gentiello has been working to get this law repealed for a while. Here’s a speech of his from 2002 on the subject.

Read the article (it’s about 30 short paragraphs), and it’s good information. Now I’m not happy about getting all those ‘routine’ BAL’s.

I received a thoughtful email the other day, and though I only have partial answers, I wanted to share it and give my response.

I follow health care issues in the newspaper and on radio. I am as far from understanding the complexities of medicine and patient care as Pluto is from Mars. But, I often ask myself the question, where are the docs? The issues concerning health care: rising costs and the uninsured, sharpen with each day. Can the medical community organize among themselves and take a leadership role in implementing solutions for these issues? Can physicians be more than influential advocates? Can the medical community take the initiative to develop a health care system that is responsive to all, regardless of financial circumstances? By applying their culture of excellence, they can be valued by all who seek relief, not only by those who can afford it.

This is a good (series of) questions, and one I’m not terrifically well equipped to answer, as my role in medicine is in the practice and not the administration of medicine. However, I’ll give my grunts’-eye view.

Can the medical community organize themselves and take a leadership role? Well, probably not, but for several reasons. Some of that has to do with the analogy that getting more than three docs to agree on a policy is like herding cats, but also with the realization that there isn’t any one, or even series of answers to the major questions of reimbursement or access that a majority of docs agree on. Single Payor has its proponents, and they make impassioned arguments. Those opposed to a single payor system (and I’m one of them) are not willing to take the chance that the unknown devil is better then the one we have, and there’s not much middle ground there.

Can physicians be more than influential advocates? Not unless there’s a considerable shift in the focus of an awful lot of physicians who decide to embark on a career in politics. The solution to health care and costs isn’t in the hospital, or the state medical society, or with the AMA, though all are active in their respective legislative domains.

Ultimately, the ‘answers’ are political ones, they aren’t easy, and they aren’t made exclusively or even largely by docs. They’re going to be made by politicians, and ultimately by the voters (our patients).

via Doc around the Clock:

Four children have been infected with the virus, although none has become paralyzed. The Amish typically decline to vaccinate their children. The last large outbreak of polio occurred in numerous Amish communities in several states in 1979

.

Why worry about Bird Flu when we still have Polio to worry about? Eternal vigilance.