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.

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. 

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