CLOSING THE GATE AFTER HORSE IS OUT

1-12-2015 CMS is terminating its Medicare agreement

Cameras in operating rooms insure protocols followed    ...NOT IGNORED.
Citing dozens of deficiencies,  with Yorkville Endoscopy, the surgery center where Joan Rivers stopped breathing. (LINK)

In a Jan. 9 letter to the surgery center, CMS has determined Yorkville Endoscopy "no longer meets the Conditions for Coverage (CFC) for a supplier of Ambulatory Surgical Center (ASC) services. Therefore, CMS is terminating the Medicare Health Benefits Agreement between Yorkville Endoscopy and the Secretary, effective January 31, 2015. As of January 31, 2015 Yorkville Endoscopy will no longer be eligible to receive federal funds for services provided to Medicare and Medicaid beneficiaries." Yorkville has 60 days to appeal the decision.

In 3 statements of deficiencies (here, here and here), CMS details numerous shortcomings, including failures to

ensure that post-anesthesia evaluations for all patients are completed and documented by the anesthesiologist before patients are discharged;
develop and carry out a quality-improvement program;
ensure that all equipment is maintained and operated according to manufacturers' recommendations and federal guidelines;
post a written notice of patient rights in a conspicuous place and make patient rights clear to non-English speaking patients;
adequately investigate and address patient grievances; and
adequately protect patient confidentiality.

CMS also cited the clinic for inadequate fire protection and alarms, and improper oxygen tank storage.

WHO IS HOLDING THE CAMERA?

Radiology technician qualifications state by state.  Vary from, fogging mirror with your breath, to strict certifications... 

 No way for the public to know, and they are certainly not told.American Association of Radiology Technologists

Misdiagnosis is Pervasive in Healthcare and Radiology is Part of the Problem 
Imaging touches nearly every patient and disease category at hospitals today and is a big part of the diagnostic process. And despite its critical role in the patient care continuum, radiology lags substantially behind other healthcare practices in terms of quality standards 

2013 North Carolina is one of five states with no radiologic technologist licensure requirements, but Brenda Greenberg, RT(R)(CT), chair of the North Carolina Society of Radiologic Technologists (NCSRT) board of directors, intends to make a change.

Most of the larger North Carolina teaching hospitals have registered technologists on staff, a situation that Greenberg says is mostly due to reimbursement requirements. 
“However, if you go to specialty clinics such as chiropractic, podiatry, or even dental offices, you don’t know if that person has a consistent educational background, or any clinical competencies whatsoever,” she says. “In many places, they have secretaries taking these images.” 


2015, diagnosis huge problem, radiology huge problem... hodgepodge of qualifications for radiology healthcare providers~?
This is just intentional stupidity 

DUKE UNIVERSITY HOSPITAL COVER-UP?

We all remember the 60 Minutes scandal over falsified cancer research dubbed "The largest scandal ever". But now there is more to the story.. a high ranking cover-up



Jan 9 2005  link to story Duke Officials Silenced Med Student  Who Reported Trouble in Anil Potti's Lab

Documents obtained by The Cancer Letter show that Duke’s deans were warned about Potti’s misconduct in late March and early April 2008, at the time when clinical trials of the now discredited Duke genomic technology were getting started.

The three-page document was penned by Bradford Perez, then a third-year medical student and a Howard Hughes Medical Institute scholar.
The Perez memo and internal emails that are being published here for the first time directly contradict the claims made by Duke officials that they had received no whistleblower reports.

Duke officials said they were blindsided by the events that reached a crescendo in 2010, more than two years after the Perez memo, following The Cancer Letter’s reporting that Potti had misrepresented his credentials, claiming, among other things, to have been a Rhodes Scholar (The Cancer Letter, July 16, 2010).

The medical student’s memo, titled Research Concerns, is a key element in a lawsuit filed on behalf of the patients who were enrolled in the three Duke clinical trials testing the discoveries from the program run by Nevins and Potti. Altogether, 117 patients were enrolled in the trials.

In addition to claiming harm, the patients’ lawsuit alleges that Duke officials engaged in a civil conspiracy. The case is expected to go to trial at the Durham County Superior Court on Jan. 26..

Misdiagnosis, don't document it, it never happened right?

Millions of people are subjected to hospital infections and dangerous procedures for conditions they don't even have. But always pay for.. sometimes with their lives.
If physicians' diagnostic accuracy were like air travel, one in 20 planes would not land when or where it should, and one in 40 flights would put passengers at risk of significant harm, or even crash.
 Diagnostic errors. In addition to the severe issues they cause patients, diagnostic errors are the most common....Frank Seidelmann, DO, co-founder, chairman and CMO of Radisphere, a national radiology practice, says diagnostic errors are largely an issue in radiology due to substandard operating models. "To date, there is still no established set of standard best practices that radiologists, patients, health systems and payers can use to gauge the quality of radiology services," Dr. Seidelmann says. "What is needed, at the very least, is a better clinical operating system that ensures routing of images to the right subspecialty and a consistent practice of blinded peer reviews. This will significantly increase quality of care, reduce costs and enable radiologists to practice at the top of their license."
Cheating on radiology exams: For years, doctors around the country taking an exam to become board certified in radiology have cheated by memorizing test questions, creating sophisticated banks of what are known as "recalls," a CNN investigation has found.

Those are estimations from an April 2014 report from Houston Veterans Affairs and Baylor College of Medicine researcher Hardeep Singh, MD, and colleagues who say that 12 million U.S. outpatient adults may be given incorrect or delayed diagnoses every year. Singh says reducing misdiagnosis must be a major quality focus for 2015 because providers and patients should not tolerate error rates this high.

This casts a huge problem for the integrity (admissibility in court) of operative records (legal business records), especially when harm or death is the outcome. 

Ghost Surgeries the common deception

Some patients painstakingly vet their surgeons to find a highly skilled professional to perform their operation, only to discover later that they didn't get the person they wanted or expected.

A different physician can step in for many reasons, not all good..
It's not clear how often such "ghost surgeries" occur, because they are not tracked or studied. But lawsuits provide a glimpse into the allegations of unhappy patients who had bad outcomes, started to look into what went wrong, and learned they were mistaken about which doctor performed the procedure.

Ghost Surgery Legal Definition: "To have another physician operate on one's patient without the patient's knowledge and consent is a deceit. The patient is entitled to choose his own physician and he should be permitted to acquiesce in or refuse to accept the substitution. The surgeon's obligation to the patient requires him to perform the surgical operation: (see more)

"We can go into the operating room, be sedated and have a different person we know nothing about cut into our bodies," said Dr. Julia Hallisy, a dentist who is president of The Empowered Patient Coalition, based in San Francisco. "It's alarming and disconcerting on so many levels, not just from a medical or legal standpoint, but from a trust and ethical standpoint."

1996 Journal of Health Law. Surgery by an Unauthorized Surgeon as a Battery Thomas Lundmark

House Bill 742 Introduced by Honorable Leuis R. Villafuerte Ghost Surgeries.
This practice has become prevalent in many hospitals .. the grave consequences of this unethical practice are addressed in this bill.

We don't count screw-ups so we cant report them ...right?

Don't document mistakes of any kind.. they never happened!

2012 Propublica article points to a review of medical records by the U.S. Health and Human Services Department’s inspector general found that in a single month one in seven Medicare patients was harmed in the hospital, or roughly 134,000 people.
“An estimated 1.5 percent of Medicare beneficiaries experienced an event that contributed to their deaths,” the IG found, “which projects to 15,000 patients in a single month.”
“You really can’t improve what you don’t measure,” said Dr. Julia Hallisy, president of the Empowered Patient Coalition. “How do you know where to focus your improvement efforts if you haven’t measured what’s happening in the first place?”

Has Your Health Professional Received Drug Company Money?

CDC: More drug overdoses from prescription meds than illegal drugs. 

(Dollars for Docs) Has Your Health Professional Received Drug Company Money?  4 BILLION DOLLARS. In recent years, drug companies have started releasing details of the payments they make to doctors and other health professionals for promotional talks, research and consulting. As of 2013, 17 companies published the information, most because of legal settlements. Use this tool to search for payments 

So now many people who have REAL pain, real debilitating life long injuries are being cut off. Sometimes viewing suicide as the only release for their psychical pain.

Doctors more likely addicts than public

Old news, 2007 Impaired healthcare professional study
 Although the rates of substance abuse and dependence are similar to those of the general population, the prevalence is disturbing because healthcare professionals are the caregivers responsible for the general health and well-being of the general population. Healthcare professionals have higher rates of abuse with benzodiazepines and opiates. Specialties such as anesthesia, emergency medicine, and psychiatry have higher rates of drug abuse, probably related to the high-risk environment associated with these specialties, the baseline personalities of these healthcare providers, and easy access to drugs in these areas. Drugs and alcohol are mostly used for "recreational" purposes by medical students. Residents and attending physicians use drugs of abuse for performance enhancement and as self-treatment for various reasons, such as, pain, anxiety, or depression.


Medical care is not an island, it is a team.  For any provider to provide safe patient care, they rely on a whole host of other team members..Nurses, Radiologists, anesthesiologist, technicians, it is a long list that all need to perform for the teams outcome to provide safe effective care to any patient.. With that in mind...

2012 Archives of Surgery: 15% of U.S. Surgeons Report Drinking Problems in Survey. Those figures exceed the 8 percent to 12 percent figure typically cited for alcohol abuse rates among the public at large. Survey lead author Dr. Michael Oreskovich, a clinical associate professor of psychiatry and behavioral sciences at the University of Washington in Seattle …. 

America’s Biggest Drug Problem Isn’t Heroin, It’s Doctors  Painkillers prescribed by both well-intentioned doctors and so-called "criminals in white coats" are driving the overdose epidemic. States and cities are pioneering ways to control it.

Abuse of controlled substances?
Journal of Addiction Medicine "Stress Leads Some Doctors to Abuse Prescription Drugs, Study Says Physicians in recovery also described self-medicating for pain, depression and anxiety. The huge difference is that doctors have unique access to prescription drugs," said Boyd, who also is a former associate director of the Massachusetts PHP. Once an addiction sets in, Merlo said, doctors may need to resort to sneaky methods to get their drugs. Since they cannot self-prescribe narcotics, they can get a friend to do it or steal from patients or the hospital where they work. 
Easy Access Makes Addiction More Likely
Physicians aren't unlike many other people who turn to painkillers, antidepressants, and other prescription drugs as a way of coping with pain and life struggles. What sets them apart, however, is their access to medicines. Given their prescribing privileges, networks of professional contacts, and proximity to hospital and clinic supplies, physicians have rare access to powerful, highly sought-after drugs.
That access can not only foment a problem, it can perpetuate it, says Marvin D. Seppala, MD, chief medical officer at Hazelden, which operates 11 addiction treatment centers in the United States.
Drug diversion (providers taking patients pain meds to feed their own addictions) The problem is huge, it's growing, it's often swept under the rug or ignored, and we only know about the tip of the iceberg. Federal health officials have sounded an alarm this week about a group of healthcare workers who are surely harming patients somewhere this very minute, engaging in behaviors about which most hospital officials are unaware or choose to ignore. USA TODAY report

Why should I speak up?

 "The Wall Of Silence" In 2008, this Nation wide problem prompted The Joint Commission issued a Sentinel Event Alert
"Behaviors that undermine a culture of safety"

Root causes and contributing factors
#1. There is a history of tolerance and indifference to intimidating and disruptive behaviors in health care.

Intimidating and disruptive behaviors in health care organizations are not rare. ..A survey on intimidation conducted by the Institute for Safe Medication Practices found that 40 percent of clinicians have kept quiet or remained passive during patient care events rather than question a known intimidator. While most formal research centers on intimidating and disruptive behaviors among physicians and nurses, there is evidence that these behaviors occur among other health care professionals...

The Joint Commission Journal on Quality and Patient Safety Sixty-seven percent of the respondents agreed that disruptive behaviors were linked with adverse events; the result for medical errors was 71%, and patient mortality, 27%. 2008 The Joint Commission issued a mandate for basic safe surgery protocols to reduce patient harm.  Five year latter, enforcing these safe surgery mandates is spotty at best.

This Wall of Silence caused by intimidation keeps healthcare locked in a deadly spiral.