Ramblings of an Emergency Physician in Texas
The Court of Appeal of the State of California, 5th Appellate District, has upheld the state’s $250,000 noneconomic damages cap, reaffirming what physicians nationwide consider the gold standard among tort reforms.
via amednews: California’s noneconomic damages cap upheld :: Sept. 26, 2011 … American Medical News.
via @amednews on Twitter
This underestimates the increased cost by a huge factor…
Remember how Obama recently waived new ozone regulations at the EPA because they were too costly? Well, it seems that the Obama administration is would rather make people with Asthma cough up money than let them make a surely inconsequential contribution to depleting the ozone layer:
Asthma patients who rely on over-the-counter inhalers will need to switch to prescription-only alternatives as part of the federal government’s latest attempt to protect the Earth’s atmosphere.
…But the switch to a greener inhaler will cost consumers more. Epinephrine inhalers are available via online retailers for around $20, whereas the alternatives, which contain the drug albuterol, range from $30 to $60.via Obama Administration to Ban Asthma Inhalers Over Environmental Concerns.
I added the bold in the quote to show where the increased cost is coming from: these people (who were buying these old inhalers without a prescription) are now going to have to see someone with a prescription pad, pay for that visit, and then go buy the more expensive inhalers.
The FDA made the prescription inhaler manufacturers take out the CFC’s a few years ago, and the prices of those inhalers went up substantially.
For the record, I think all these inhalers should be OTC: they’re safe and affective. Off the top of my head, 90% of the meds on the WalMart $4 list should be OTC as well.
There’s a quite instructive graph in a blog post from NRO yesterday (talking about Union campaign donations), but I found this one to be very instructive, and have added labels so the point cannot be missed:
In politics, generally what you give is what you get. I’ve taken to giving more to the PACs that represent me.
As an aside, it’s political malpractice to give only to one party (Teachers). Eventually that one party will be on the outs, and then where are you?
The headline is disingenuous: yes, there’s a Med School headed for Austin. Congrats, Brackendridge!
Kinda amusing tale after the quote:
Lawmakers and local leaders are hopeful a plan unanimously adopted at Thursday’s University of Texas System Board of Regents meeting means they could finally get what they’ve long been waiting for: a new medical school.
One of the elements of the plan outlined by Chancellor Francisco Cigarroa is to “advance medical education and research in Austin.” Even before Thursday’s meeting ended, state Sen. Kirk Watson issued a press release reading between the lines, calling for the creation of a flagship health science center and medical school in Austin. “Within the next 30 days, I plan to offer a path – and a challenge for our community – to build on [Cigarroa's] statement so we realize these goals that so many of us have shared for so long,” Watson said. “It’s time for Austin to come together and act, creating a flagship initiative that can fortify our future and lead the world in the fields of medical education, healthcare and bioscience.”
via Is the UT System Preparing for a New Medical School? — Higher Education | The Texas Tribune.
For those interested in the funny politics of a med school in Austin, you have to look back to the 1970′s.
In the 70′s, during a meeting of the Ledge, there was money set aside for a new Med School. It allegedly was understood by all involved that this school would go to Austin, but it wasn’t spelled out directly. Then, in one of those things that only happens when you have a strong Lieutenant Governor who happened to be from Lubbock, in the last minute a rider was stuck onto an unrelated bill attaching all the money and authorization of the MD School bill to Texas Tech.
From the tales (and I was between 7 and 13 at the time, so I’m literally blameless here), there was a great gnashing of teeth, but it was for naught. My Med School came to fruition, and I’m glad for it, as I graduated from that school several years later.
Amusing history, later corrected.
(Had Austin gotten a school earlier, would Tech ever have gotten one? I say nay).
I predict that Austin will not lack for med student applicants. I’m daring, it’s true.
Obamacare is Unconstitutional | Snowflakes in Hell.
His take is exactly correct. I’d love to post it here, but it’s short and to the point. Go, read.
In one of those things I don’t really get*, Texas requires a separate license from an unrestricted medical license to prescribe narcotics. As the price of this extra license has always seemed to be more ‘cover the cost’, nobody has seriously objected. It’s $25, in case you’re interested.
Since it’s a State license, it’s required if your job could even perceivably need to prescribe narcs in a hospital. (So, Radiologists and Pathologists are usually exempted). It’s never been an issue, as long as you don’t screw up.
Until now.
From the Austin American Statesman:
The Texas Medical Association sent an email to doctors Wednesday alerting them that DPS had a backlog of 3,000 doctors waiting for certification, and 4,500 more would join that group in August. The email indicated that DPS was trying to fix a new computer program that seemed to be causing the delay.
But no one seems to be fully certain of the cause. Several doctors’ groups said they were told that phone problems, an office move and a new computer program all were factors.
DPS did not respond to questions about what might have caused the backlog or comment on the physicians’ letter to Perry. Spokesman Tom Vinger wrote in an email that DPS has processed all but 534 of the 3,064 certificate applications received this month. The rest would be processed today , he said, adding that the 4,800 doctors whose credentials expire Aug. 31 are encouraged to get their applications in “as soon as possible.”
So, mine expires at the end of August, I sent my renewal in a month ago, and it’s still not renewed. (My check was readily cashed). Hopefully the quote is correct, the computer-glitches have been tamed, and all will soon be right with the world.
*I don’t get this license, really, except as a way to allow docs with narcotic prescribing problems, or other reasons to restrict their licenses, to keep practicing. Except, I don’t get that. We’re also required to have a DEA license for the exact same purpose, so this State license is duplicative. Lose your DEA? I seriously doubt you’ll be getting a State narcotic license. Why not have a Full Unrestricted Medical, a Full Restricted Medical (no narcs), and then any other restricted ones (retired, etc).
Yes, I’m a dreamer. I dream of one license that makes sense. (No, I don’t want a National Medical License, thank you very much).
Gastroenterologist Michael Kirsch put up a post on his blog that was then reposted over at ACP Hospitalist asking where the threshold for admitting a patient to the hospital should be.
He asserts that there should be more collaboration between medical colleagues to determine whether or not a patient needs to be hospitalized…
via To Admit or Not to Admit? That is the Question. | WhiteCoat’s Call Room.
Another WhiteCoat tour de force.
Kudos to MedStar (our Fort Worth EMS provider) for their excellent work on this project:
The Community Health Program was started in 2008 after MedStar officials discovered that 21 patients were using a big chunk of ambulance and emergency department resources. Those patients triggered more than 800 ambulance calls and cost the system more than $962,000 in charges, most of which were never collected because the patients lacked health insurance.
Nine of the 21 were selected for the program. They experienced a 77 percent reduction in their need for services during a 30-day test.
via In Fort Worth, MedStar’s Community Health Program cutting costs, improving patients’ well-being ….
TALLAHASSEE — The physician groups suing to block a new Florida law that bans doctors from asking patients about guns in their homes asked a federal judge in Miami Friday for an injunction to block enforcement of the law.
Good. And, good luck with that.
If physician organizations are going to try to play in the Deep End of the pool politically (like the AAP has, endorsing outright gun control) then they need to be ready when their political opponents make docs a target (shooting joke unintentional).
via Instapundit.
Okay, it’s kind of amusing, and I hope it induces someone to learn compression only CPR. Which is WAY easier to do, and teach, than what I started with back in the day (15 compressions, 2 breaths, rinse/repeat).
But if this makes Disco come back, is it worth it?
via Ace.
Read the rest, and wonder. Others practice risk-avoidance to the ED, and then we wonder why our patients are unhappy and give us poor scores.
Man and squirrel fight it out in man’s driveway. Squirrel scratches him twice, man runs inside grabs BB gun and plugs squirrel ala Elmer J Fudd. Man then calls health department for advice about what to do. Health department tells him to go to ED for rabies shots.
via The Case of the Crazy Rabid Squirrel | WhiteCoat’s Call Room.
…Actually, statements like that do serve one purpose. They make it a pretty good bet that none of the doctors in our department will ever refer another patient to you or your your hospital…
Sing it, brother.
