More on Ottumwa

From the Cedar Rapids Gazette

Federal officials said they plan to revoke Ottumwa Regional Health Center's Medicaid and Medicare reimbursements next month even though the hospital is appealing a ruling that it mishandled an emergency psychiatric patient.

The U.S. Centers for Medicare and Medicaid Services determined that the hospital improperly discharged an emergency room patient with an unstable medical condition.

Ottumwa Regional CEO Lynn Olson denied the allegations.

David Werning, spokesman for the Iowa Department of Inspections and Appeals, said the Ottumwa case "is an extraordinary circumstance."

"I can understand the hospital trying to minimize or put their best spin on this thing, but I don't think it's necessarily fair for them to try to downplay the seriousness of these particular episodes," he said.

An April inspection at the hospital resulted in an allegation that it had repeatedly failed to take night-time referrals of psychiatric cases from other hospitals.

The answering service for the hospital's psychiatrists was allegedly under instructions to "hold all calls" from referring hospitals between the hours of 10 p.m. and 10 a.m. One of the psychiatrists allegedly explained to inspectors, "We were getting tired of receiving so many calls during the night."

Hospitals Becoming More Hospitable

From the Nashua Telegraph

A Beanie Baby that Michelle Fagan’s daughter received during a visit to the emergency department at St. Joseph Hospital for stitches several years ago led to a new hospital practice: St. Joseph-blue stuffed bears with white T-shirts for every child who is a patient.

“We give out thousands of bears a year,” said Fagan, director of service assurance at the hospital. “It’s a good business thing, but also good for patient care. You get good outcomes when people feel comfortable. At the end, it’s about delivering good health care in our community.”

It turns out the stuffed bears represent an ongoing trend in hospital marketing. Across the country, hospitals are vying for market share by offering amenities – frills such as room service, valet parking, Internet access and more that are typically associated with a visit to a hotel.

Hospitality, which comes from the root word hospital, is becoming increasingly important at hospitals. Health-care analysts say that during the last five years, competition in markets where there are several hospitals of equal stature has become focused on amenities – concierge services for patients and modern technology for physicians and other clinicians.

More on the WI Supreme Court Med Mal Ruling

Excerpted from the ABA Journal eReport

MED-MAL RULING HAS DOCTORS REELING
Wisconsin Damage Cap Wiped Out in Rational Basis Review

As any constitutional law student knows, rational basis review is the lowest of the low.

But it was high enough for the Wisconsin Supreme Court to wipe out as an equal protection violation a cap on some medical malpractice damages. And it was enough to leave the state’s medical establishment reeling.

The court also cut off federal appeals by deciding the case solely under the Wisconsin Constitution, effectively painting physicians and their legislative allies into a corner as they pondered a fix.

"We had just figured out how to deal with the legislative branch, and now the supreme court comes along," complains Mark M. Grapentine, a lobbyist for the Wisconsin Medical Society, which filed an amicus brief along with the American Medical Association.

Moreover, the highly detailed and carefully crafted opinion also caught the attention of plaintiffs lawyers outside Wisconsin who are searching for arguments to fend off looming homegrown damage limits that doctors say will curb their malpractice insurance premiums.

"This is huge," says medical malpractice plaintiffs lawyer Thomas A. Demetrio in Chicago, where a cap Illinois lawmakers passed this spring awaits Gov. Rod Blagojevich’s signature.

Bad News fror Ottumwa Regional

Excerpted from the Ottumwa Courier

Medicare will cut off Ottumwa Regional Health Center on Aug. 11, even if the hospital appeals the decision.

Thomas Lenz, with the Centers for Medicare and Medicaid Services in Kansas City, said that hospitals have 60 days to indicate they will appeal termination decisions. The appeal does not freeze the clock, though.

"Whenever there is an adverse action taken ... the provider has an opportunity to appeal that determination. They have 60 days to indicate their desire to appeal the action that was taken. But in all cases it does not stop that action from moving forward. So our termination date of Aug. 11 is still there," Lenz said in an interview with The Courier Friday.

That leaves the hospital with few options for preventing the Medicare cutoff. John Webber, ORHC's legal counsel, said the hospital might seek a court injunction against termination if necessary.

Lenz' comments contradicted hospital officials' earlier statements that the termination date came as a surprise. The initial complaint came in early April and spurred a fast response.

"It was considered an immediate, serious risk to beneficiaries' health and safety," Lenz said. "At that point in time the hospital was placed on a 23-day correction plan or termination track."

Performance Improvement Resources on the Website

We've added two new resources to the ACUTE CARE website:

TEN COMMON ERRORS IN EMERGENCY MEDICINE, A RISK MANAGEMENT SUMMARY, adapted from a lecture by Dr. Christine Duranceau, our Medical Director at Platteville, WI

and

Emergency Physician ED Practice Pearls by Dr. Ken Schultheis, our Chief Medical Officer.

Both are accessible from the Iinformation section at the bottom of the "What's New" page.

More on Ottumwa's EMTALA Challenge

The following is a press release from Ottumwa Regional Health Center regarding ORHC's possible removal from the Medicare program. The statement from ORHC read as follows:

For the past two months, Ottumwa Regional Health Center has been the subject of an on-going Federal Emergency Medical Treatment and Active Labor Act (EMTALA) investigation. EMTALA was enacted to combat the discriminatory practice of some hospitals transferring, discharging, or refusing to treat indigent patients coming to the emergency department because of the high cost of diagnosing and treating patients with emergency medical conditions. While the Act applies to all Medicare participating hospitals, it protects anyone coming to a hospital seeking emergency medical services, not just Medicare beneficiaries. EMTALA imposes strict penalties, including fines and exclusion from the Medicare program for violations of the Act. The Act imposes requirements on Medicare participating hospitals that provide emergency medical services.

On Tuesday, July 26 ORHC was notified (via fax with original to be mailed) by the Centers for Medicaid/Medicare Services (CMS) that ORHC participation in the Medicare program would be terminated effective Aug. 11., as a result of the ongoing investigation. Quoting the fax:

"Our review of the Iowa Department of Inspections and Appeals visit determined that the hospital discharged a patient with an unstable emergency medical condition for family observation, in a inappropriate care setting and as a result, the patient remained in an unstable condition."

Lynn Olson, President and CEO of ORHC responded:

"Ottumwa Regional Health Center believes according to the requirements of EMTALA and our own high standards of care, that the patient was managed appropriately and was not discharged in unstable condition.We believe the patient in question was assessed, evaluated, treated, and had plan for the follow-up care that was discussed between the physician, the nurse, the patient and the family and was discharged appropriately."

ORHC is continuing to work on the appeal process and will keep the public informed of the proceedings.

Presently, Ottumwa Regional continues to schedule all patients including Medicare beneficiaries.

ResQPump in the Twin Cities

This is a famous case in resuscitation lore. It's interesting that they're going to try again. From Yahoo News.

For a clinical trial, paramedics in St. Paul and Minneapolis will be testing experimental suction devices on heart attack patients without their prior consent.

While informed consent is a staple of most medical research, exceptions are allowed when the consent impedes potentially lifesaving research that can't be completed any other way.

Hospital and emergency medicine leaders believe the devices will increase the number of survivors of heart attacks.

The tests will begin in September in St. Paul, Minneapolis and three other cities across the country.

"The survival rate from cardiac arrest has remained stagnant for the last 40 years," said Dr. Keith Lurie, a professor of medicine at the University of Minnesota who co-invented the device. Lurie formed Advanced Circulatory Systems Inc., an Eden Prairie company that now makes the two devices that will be tested in the study.

One is the ResQPump, which works somewhat like a household plunger and increases blood flow by manipulating the chest cavity.

The other is the ResQPod, which fits atop the device that paramedics place over a patient's mouth during CPR. The pod expedites the flow of blood into the lungs by regulating how oxygen is exhaled and inhaled during resuscitation.

St. Paul paramedics were testing an early version of the ResQPump in 1992. But the trial was stopped when federal officials discovered that paramedics were testing the devices without gaining informed consent.

The St. Paul case inspired new regulations in 1996 that allowed waivers of consent in crisis scenarios.

AutoPulse Controversy

I blogged about this aparatus a couple of months back.
From the LA Times

Riverside County health officials have suspended use of a federally approved CPR machine after a man who was treated with the device suffered cracked ribs and internal injuries and later died, authorities said.

Paramedics from the Palm Springs Fire Department used the "AutoPulse" cardiac support pump to resuscitate Fang Joon Yun, 77, after he was pulled from a swimming pool July 14. After Yun was revived, he was taken to a local hospital, where he was pronounced dead, Riverside County sheriff's officials said.

A Riverside County medical examiner found that "something was not right" while performing Yun's preliminary autopsy, said Sheriff Bob Doyle, who oversees the county coroner's office.

"We put the device back on the individual, and it lined up exactly with where the broken ribs and other injuries he had suffered," Doyle said, stressing that Yun's cause of death had yet to be determined.

Six hundred AutoPulse devices are being used by rescue providers in San Francisco, Fremont, Calif., and other cities throughout the country, although it is not in use in Los Angeles or Orange counties, company officials said.

Because of the medical examiner's findings, the Riverside County Emergency Medical Services Agency suspended use of the device in the county until Yun's case could be further investigated. Michael Osur, director of the agency, said he had alerted emergency agencies using the device throughout the state.

Getting "Chipped"

From Fox News. Emphasis added.

Getting chipped means having a radio frequency identification (RFID) chip implanted in your body. The chip — about the size of a large grain of rice — lies dormant until a special scanner is passed within six inches of the implant. Then it emits a radio signal that beams a 16-digit number to the scanner.

For security uses, that 16-digit number acts like an electronic key. For medical uses, the number is linked to medical records. Doctors to whom you've granted access — emergency room doctors, for example — can use the key to quickly get hold of your medical records.

EMTALA Problems in Ottumwa, IA

From KOTV

Ottumwans woke to shocking news Wednesday morning, a notice that Medicare coverage could be cut at Ottumwa Regional Health Center.

The notice, in the Ottumwa Courier's classified section, stated that ORHC is not in "substantial compliance with medicare regulations," according to the Centers for Medicare and Medicaid Services.

The notice went on to say that Medicare payments would not be furnished for patients at Ottumwa Regional after August 11.

The notice came as a surprise to hospital leaders. They tell KTVO that Ottumwa Regional has been in an ongoing investigation in accordance with federal regulations for the past two months, but the termination notice comes from a separate issue unrelated to that original investigation.

"This is an extreme action based on a case that was not even identified in their original complaint," ORHC President & CEO Lynn Olson said.

Medblogs

Forbes' choices in the their Best of the Web. I've visited several and will investigate the rest. My favorites this far, GruntDoc, Symtym and Medgadget, are linked into this blog at the right.

Medical advice, suspect or not, has long been available on the Web. Now, you can add medical blogs to the list. Of course, the information here is no substitute for a visit to the doctor, but those posting articles and commentary on these blogs can help you to become more informed and ask the right questions when you do visit the doctor. While there are plenty of blogs not written by qualified experts, the ones reviewed here come from doctors, professors and scientists. True, some blogs are written at a high level and intended mostly for other doctors. Often, doctors use their blogs to ramble on about difficult patients, malpractice lawyers and pushy drug companies. But you'll also find insightful thoughts on topics such as drug warnings, treatments and analysis on the latest medical news

Another Survey: tPA for Stroke

From ACEP

Forty percent of emergency physicians reported that they were not likely to use rt-PA for acute ischemic stroke, according to a random survey of 2,600 ACEP members published in the July edition of Annals of Emergency Medicine. About two-thirds of these physicians said symptomatic intracerebral hemorrhage risk prevented their use, and about a quarter cited the relative lack of benefit.

ED Overcrowding Survey

From Modern Physician

About seven of every 10 Americans believe hospital emergency rooms are approaching a crisis of overcrowding, a conclusion already reached by most of the doctors who work in them, according to the American College of Emergency Physicians, which has focused much of its work on relieving ER overcrowding.

The survey by the trade group for ER doctors queried 800 registered voters earlier this month. More than half of the survey respondents said they were also concerned about ambulance diversion because of overcrowding, with 32% saying they felt diversions were happening "too often."

The problems of overcrowding "will only worsen unless we can develop and implement effective solutions," said Robert Suter, D.O., president of the ACEP.

Between 1993 and 2003, visits to the nation's emergency rooms increased by about 26%, ACEP officials said. During the same period, the number of hospital ERs fell by about 14%, the officials said.

In a separate survey of about 340 ER physicians, also conducted by the ACEP, about 70% of the doctors said they have experienced or heard about local instances of "boarding," the practice of holding patients in the emergency department until space in the hospital is available.

The Application of "Critical Care" Codes in the ER Setting

ACUTE CARE's ER Coding Manager, Eileen Clausen, CPC, has prepared an overview and analysis of The Application of "Critical Care" Codes in the ER Setting, which we've posted to our website.

An excerpt:

Current Procedural Terminology 2005 gives us a clear understanding of the application of critical care codes 99291 and 99292. I will synopsize this information for you.

Critical Care is the evaluation and management of the critically ill or critically injured patient; the first 30-74 minutes is coded with 99291. (Any care given under 30 minutes is coded as a regular Evaluation and Management) Each additional 30 minutes above 74 are coded 99292 and is listed separately from the primary service of 99291.

To further clarify, Critical Care is the direct delivery by a physician of medical care for a critically ill or critically injured patient, either as an outpatient or inpatient, or in the emergency department. This care must involve high complexity decision making to assess, manipulate, and support vital system function(s) to treat single or multiple vital organ system failure and/or to prevent further life threatening deterioration of the patient’s condition. Examples would be but are not limited to: central nervous system failure, circulatory failure, shock, renal, hepatic, metabolic and/or respiratory failure. This care typically requires interpretation of multiple physiologic parameters and/or application of advanced technology. Critical care is used to report the total duration of time spent by a physician providing services to this type of patient. The time does not have to be continuous, but must be documented in the chart, “the physician must devote their full attention to the patient and, therefore, cannot provide services to any other patient during this same period of time”. Your time should include work directly related to this individual’s care, at the bedside, elsewhere on the unit, with the nursing staff, reviewing test results, consulting other physicians, recording or documenting information, and discussions with the family provided that the conversation bears directly on the management of this incident. Time spent outside the unit or off the floor is not included in critical care time allowance.

Rural Education Steers Doctors to Rural Practice

From Modern Physician

Graduates from two medical schools who participated in rural education programs were more likely to work in rural areas than graduates from the same schools who didn't take part in the programs, according to two articles in the August issue of Academic Medicine, the Association of American Medical Colleges' journal.

The results from one study indicate that since 1989, about 26% of 86 students who participated in the rural medical education program at the State University of New York's Upstate Medical University practiced in rural areas in 2004. Meanwhile, 7% of 1,307 nonparticipants reported practicing in a rural area.

In the other study, authors queried 1,937 students who graduated from 1978 to 1986 from Jefferson Medical College. They found that in 2002, 68% of 38 students who participated in the college's physician shortage area program were still practicing family medicine in the same rural area in which they started. Only 46% of 54 graduates who didn't participate in the program were still practicing in the same rural areas in 2002.

Central Iowa Rescue

From the Des Moines Register

Watercraft rider is saved by patrol duo's first CPR test

First, Bill Wineland and Matt Bruner spotted the empty Waverunner-style watercraft Saturday on Saylorville Lake.

Then Bruner thought he saw a stray life jacket floating nearby.

It was a life jacket, and Nickolas Evans was wearing it. The state water-patrol officers discovered the 26-year-old floating face down, lifeless. He had a quarter-size wound on one temple.

The officers turned Evans onto his back, then used the boat to tow him close to shore because of the difficulty of hauling someone into the large patrol boat. When Evans' legs started dragging on the bottom of the lake about 20 feet from shore, Bruner jumped into the chest-high water.

Wineland and Bruner administered CPR for about a minute. "We got a pulse back, and we got breathing back," Wineland said. "He vomited at least two cups of water."

By this time, Ankeny rescue workers had arrived. Evans was airlifted to Mercy Medical Center, where he initially was in critical condition. By Monday afternoon, he was out of intensive care and breathing on his own.

Doctor Sued in Alcohol Death

From the York Daily Record, excerpted below.
Of additional interest is a Symtym comment on the case.

"The complaint alleges Amy S. Gebhardt died after being discharged by the doctor"

A Hanover woman died from alcohol poisoning last year hours after being released from the hospital where police had taken her for a blood alcohol test, according to a complaint filed Tuesday in York County Common Pleas Court.

The woman's mother, Susan Bilbo, is suing Dr. Michael R. Denney, his employer and Hanover Hospital, alleging negligence and wrongful death. …

A blood test showed her blood-alcohol level to be 0.332 percent, more than four times the legal limit for driving.

Bilbo's complaint states that "despite obvious signs of intoxication," Denney discharged Gebhardt back into police custody at 2:24 a.m. with his "okay for incarceration."

Gebhardt was released without bail to her boyfriend after her 3 a.m. arraignment on DUI charges, the complaint states.

The 39-year-old woman was found dead at 7:30 a.m. and, according to the lawsuit, the York County Coroner identified the cause of death as ethanol toxicity. …

Apologies

From the Boston Globe

"Hospitals study when to apologize to patients"

Harvard Medical School's major teaching hospitals are considering adopting a sweeping disclosure policy that would establish detailed procedures for physicians to openly acknowledge medical errors and other bad results to their patients, and provide for training in apologizing.

A group of physicians, patients, and executives from the hospitals, led by Dr. Lucian Leape, a national specialist on patient safety, began drafting the policy last year. In recent months, the group circulated a 50-page first draft among hospital leaders, who responded favorably to its broad goals but have suggested numerous revisions, which the group is now implementing.

If Harvard's largest teaching hospitals -- Massachusetts General Hospital, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Dana-Farber Cancer Institute, and Children's Hospital Boston -- adopt the policy, it would create a uniform response across the Harvard system to some of medicine's most difficult situations. The Harvard hospitals also would join a growing number of US medical centers and malpractice insurers that are embracing immediate and open disclosure and apology to patients when medical care goes wrong.

''I'm trying to get all the Harvard hospitals to adopt the policy," said Leape, a professor at the Harvard School of Public Health. ''The time has come to be open with our patients."

How Low Can You Go?

From Crain's Detroit

St. Joseph Mercy of Oakland plans to up the ante in emergency-room wait-times, the latest battlefront in hospital marketing.

The Pontiac hospital owned by Trinity Health plans to roll out a 20-minute emergency-room guarantee Aug. 1 in a series of billboards and radio ads.

Five years ago, Dearborn-based Oakwood Healthcare System sparked the trend by promising emergency-room patients a pair of movie tickets if they were not seen by a physician within 30 minutes. Detroit Medical Center followed in 2004 with a 29-minute guarantee and St. Joseph Mercy of Macomb, also owned by Trinity, instituted a 30-minute guarantee during February of the same year.

“The time a patient waits to see a physician is precious time lost,” said Jack Weiner, CEO of St. Joseph Mercy of Oakland and former CEO of the Macomb location, in an e-mailed statement. “We do believe that we will see more volume as a result; however, it is more than just a numbers game. This new process allows us to provide better access to patients that need care.”

Diversion Moves to Non-Urban America

From the Morning News

The practice of asking ambulance drivers to take patients elsewhere when a hospital's emergency room cannot take the patient, or when a hospital cannot provide a service the patient will need at the time they need it is called diversion.

The growth train in Northwest Arkansas is clickety-clacking at the heels of area emergency rooms, and the typically urban phenomenon of ambulance diversion is increasing locally.

Washington Regional Medical Center in Fayetteville in the first six months of 2005 spent more time on diversion than it did in all 12 months of 2004, according to information provided by the medical system. Diversion has also increased at other area hospitals.

Gun in the ED

From Local 6 News

"Gun In Emergency Room Forces Winter Park Hospital Lockdown"

The Winter Park Hospital was placed in lockdown early Saturday after a gun was found in the hospital's emergency room, according to Local 6 News.

Police said two groups of men were involved in an argument at about 2 a.m. Saturday at a gas station in Casselberry, Fla.

During the confrontation, a man pulled a weapon to defend his friend and ended up shooting himself.

The injured man and several others went to the Winter Park Hospital after the shooting.

Authorities said the gun was found in the emergency room and a second gun was found by police in a car outside the facility.

More on Helicopter EMS Safety

This is really discouraging for someone who flew with two outstanding services. Excerpted from US Today:

Since 2000, 60 people have died in 84 crashes--more than double the number of crashes during the previous five years. During that period, more than 10% of the U.S. air ambulance helicopter fleet crashed. If commercial airlines lost the same proportion of large passenger jets as air ambulance companies lost helicopters, 90 airliners would crash each year.
Despite the surge in the number of crashes, however, air ambulance companies and the federal agency that oversees them failed time and again to take steps that might have averted tragedy and saved lives, a USA TODAY investigation shows.

The newspaper reviewed hundreds of pages of documents and interviewed dozens of pilots, aviation experts, federal officials, and executives with the companies that operate the flights. Because government statistics on air ambulance crashes are sparse, USA TODAY also created its own database of 275 accidents since 1978.

Unlike passengers on commercial jets, the people being transported by air ambulances--many critically ill or injured in accidents far from hospitals--had no choice but to make the flights.

The crashes that killed them often involved egregious errors by pilots and crew. In one case, a helicopter carrying an 11-day-old child and her mother slammed into the side of a mountain at night. In other crashes, pilots flew into thick fog even after other air ambulance pilots had refused to fly.

Wisconsin Supreme Court Ruling - PIC Wisconsin's View

MADISON, Wis. - Physicians Insurance Company of Wisconsin, Inc. (PIC WISCONSIN) William Montei, CEO of PIC WISCONSIN, commented today on the Wisconsin Supreme Court ruling in Ferdon v. Wisconsin Patients Compensation Fund.

“We are disappointed that the Wisconsin Supreme Court, by a 4-3 vote, failed to uphold the constitutionality of a cap on non-economic damages,” stated Montei. “Until we have completed our analysis of the Court’s decision it is difficult to know exactly what the impact on rates will be, however, it is our judgment that rates in Wisconsin will increase. We have worked hard to help maintain Wisconsin’s effective medical liability tort reforms, including caps, over the years, and have taken numerous cases to the Wisconsin Supreme Court to defend them. The cap has been important in maintaining a stable market for professional liability insurance in our state, which is why the decision is of such concern.

PIC WISCONSIN was founded nearly 20 years ago to help ensure that there would be affordable coverage for Wisconsin health care providers. Since then, we have taken great pride in accomplishing our mission. In fact, until now, Wisconsin has been one of only six states that the AMA considers stable in this regard. We will continue to work hard every day to maintain pricing stability, but there is no doubt that the Court’s decision will make that job much more difficult.“

Wisconsin Supreme Court Strikes Down Malpractice Cap

Multiple sources...

From MedLaw.com

Wisconsin's cap on medical malpractice awards for noneconomic damages such as pain and suffering is unconstitutional, a split state Supreme Court ruled today. (7/13/05)

The court ruled 4-3 that the Legislature's rationale for implementing the caps on noneconomic damages was too broad and speculative, and ruled the law violated the Wisconsin Constitution's equal protection guarantees.

The court said its decision does not strike down all caps under Wisconsin law in medical malpractice cases. Rather, its decision applies only to those for noneconomic damages, awards meant to compensate for mental distress, loss of enjoyment of normal activity and loss of society and companionship.

From the Green Bay Press-Gazette

The Wisconsin Supreme Court’s decision to remove the cap on settlements in medical malpractice cases — based on the case of an 8-year-old town of Abrams boy — has medical officials forecasting higher costs and a greater shortage of physicians.

“I think the ruling is extremely damaging to the medical fabric of the state of Wisconsin,” said Jeff Mason, chief executive officer of Bay Care Clinic in Green Bay. “Malpractice premiums will have to go up and this will make physician recruitment and retention even more difficult than it is.”

U.S. Will Offer Doctors Free Electronic Records System

Excerpted from the New York Times


...Medicare, which says the lack of electronic records is one of the biggest impediments to improving health care, has decided to step in. In an unprecedented move, it said it planned to announce that it would give doctors - free of charge - software to computerize their medical practices. An office with five doctors could save more than $100,000 by choosing the Medicare software rather than buying software from a private company, officials say.

The program begins next month, and the software is a version of a well-proven electronic health record system, called Vista, that has been used for two decades by hospitals, doctors and clinics with the Department of Veterans Affairs. Medicare will also provide a list of companies that have been trained to install and maintain the system.

Extreme Response to Waiting Times

From the Morning Call

An Allentown man who threatened to shoot emergency room employees at Lehigh Valley Hospital in Salisbury Township faces disorderly conduct and other charges, police said.

Luis G. Rosario, 35, of 617 Turner St. allegedly threatened to shoot someone at the hospital's emergency room about 5:20 p.m. Friday if his daughter was not given a room. Rosario's daughter was being treated for a BB gun wound on her neck, court records say.

Police found a crack pipe with residue on Rosario, according to police records. He was also charged with making terroristic threats and possessing drug paraphernalia, police said.

If You Measure It, They Will Improve...

From CNN.com

"Study: Hospitals better under monitoring"

Hospitals put under the microscope by new industry monitoring are doing a better job of treating three potentially deadly conditions, with the worst hospitals improving the most, researchers found.

Meanwhile, a second study found disparities in the quality of hospital care around the country, with hospitals in the Northeast and Midwest, not-for-profit hospitals and teaching institutions doing slightly better than the rest.

From July 2002 through June 2004, the hospitals improved as much as 33 percent on 18 indicators of quality care, though some went up just 3 percent, the Joint Commission on Accreditation of Healthcare Organizations found.

Those indicators include urging patients to quit smoking; giving heart attack victims aspirin and clot-busting drugs quickly; promptly prescribing antibiotics to people with pneumonia; and checking how well the heart's main pumping chamber was working in heart-failure patients.

Overall, the death rate for heart attack patients in the hospital dipped from 9 percent to 8 percent over the two years.

Friends Don't Let Friends Drive

An interesting story, excerpted from the Denver Post

Sometime after midnight, Allen hinted that he might be leaving. Richardson said his friend shouldn't drive. So he took Allen's truck key off its large keychain - in hindsight, a stroke of genius - and said, in a joking way, that by swallowing his ignition key, he'd make sure his friend didn't leave.

Richardson hurried to a nearby medical center and told an emergency-room doctor what had happened.

"He said, 'No, really, why are you here?"' Richardson recalled.

The doctor ordered an X-ray, and there it was.

Hello, pickup-truck key.

"The doctor said it would pass in about two days," Richardson said. "That's when it hit me. I was going to ... out a truck key!"

Wash. Docs Issue No-Confidence Vote Against Yakima CEO

From Modern Physician Emphasis added in the third paragraph.

A group representing 260 physicians who practice at the two hospitals in Yakima, Wash., announced a vote of no confidence against the chief executive officer of Yakima Regional Medical and Cardiac Center.

The vote, announced Monday, was the latest in a string of actions taken by doctors against Yakima Regional and its CEO, Tim Trottier. The hospital, formerly a not-for-profit, was purchased two years ago by Health Management Associates, Naples, Fla., and converted to a for-profit hospital. Since then, some doctors and nurses have been highly critical of changes made in hospital practices.

A recent investigation by the state Department of Health into allegations of patient-safety problems at Yakima Regional stemmed from complaints lobbied by all eight of the hospital's emergency room physicians who quit in June.

Details from a previous article:

Although he wouldn't admit to feeling vindicated, Yakima (Wash.) Regional Medical and Heart Center Chief Executive Officer Tim Trottier acknowledged that he was pleased by the findings of a state Department of Health investigation of his facility triggered by charges that patients were being put at risk.

"We are very grateful that we now have accurate information to present to the public about the quality of care that we offer," Trottier said.

The state publicly released its report Tuesday afternoon, and Trottier said it provided evidence that allegations of patient-safety risks were unfounded.

The eight physicians belonging to the Yakima Emergency Physicians group resigned at midnight on June 2 after citing unresolved patient-safety concerns caused by staffing cuts and difficulties with the hospital's new computerized records system. These concerns included mistakes in laboratory services and a risky patient transfer. The doctors were replaced immediately by physicians hired by EmCare, a Dallas-based emergency medicine management group.

Majority of Consumers Believe Electronic Medical Records Can Improve Medical Care

This is excerpted from an Accenture press release, posted to BusinessWire, but I thought it of interest:

Three-quarters (75 percent) of consumers surveyed said they have visited an emergency room and/or required medical attention while away from home, and about two-thirds (65 percent) said they are concerned that they might be rendered unconscious in an accident and unable to report vital information to emergency personnel. In addition, 93 percent of consumers said they would support emergency room doctors having access to their electronic medical records if it could reduce the number of treatment errors in hospitals.

Atlanta Nurse May Have Exposed 200 Patients to TB

From Modern Physician

Northside Hospital, Atlanta, has reported that a labor and delivery nurse who worked the night shift came to the hospital June 29 with symptoms of tuberculosis, prompting hospital officials to warn all patients and staff who may have come in contact with the nurse between March 1 to June 22.

Officials at the 487-bed hospital say they are working with county and state health departments to coordinate any needed screening, detection and treatment. So far, according to a media release posted on the hospital's Web site today, there are no confirmed cases of TB linked to anyone exposed to the employee, including the employee's family members.

According to a newspaper article in today's Atlanta Constitution, about 200 former patients, including 37 newborns and their mothers, may have been exposed to the nurse.

Moose checks into the ER

This is about as "non-urban" as it gets. From KTUU.com in Anchorage. (You can watch the security camera footage on the site. Pretty cool. I also appreaciate the EMTALA reference in the last paragraph.

Anchorage, Alaska - The emergency room at Alaska Regional Hospital has seen just about everything, but nobody was prepared for the patient who dropped in this morning.

It was about 6:30 a.m. and a young moose decided to check into the ER. The scene was caught on the hospital’s security camera.

Dr. Don Hudson was on duty at the time. The videotape shows him taking a quick look at the patient, then wisely going for a second opinion.

The moose spent more than a minute inside the emergency room, then quietly left the way it came in.

Alaska Regional says that, although the moose did not have insurance, they were prepared to give him a complete medical screening.

Chicago FD Uses Segway for EMS

From JEMS

In June, Chicago Fire Department (CFD) Commissioner Cortez Trotter introduced a new Special Events Emergency Response Team (SERT). The SERT initiative will strengthen emergency response at all City of Chicago major special events. Because city events grow in size each year, the department sought out innovative ways to control the increasing crowds and limit congestion during emergency responses.

One of the innovations is the six newly acquired Segway Human Transporters that will provide BLS. Each Segway is equipped with the three pouches that will contain first responder medical equipment, including an AED and basic first-aid supplies.

Access to Specialists

An outgrowth of some EMTALA research, from Medical News Today:

"US Physician Leaders Distressed by ER Specialist Shortage"

A new poll of physician leaders across the country found that a severe shortage of specialists is hurting hospital emergency rooms. In many cases, hospitals are now being forced to pay specialists extra money to be on call for emergencies.

Some physician leaders are outraged at even the mere suggestion of paying specialists to take emergency room call. A couple even went so far as to call specialist pay "blackmail" and "extortion."

"I must be old-school because I believe taking ER call is part of a physician's obligation to his/her community ... I am embarrassed to see physicians feel they are not responsible to provide any charity care to their fellow man," wrote one respondent to a recent poll by the American College of Physician Executives (ACPE).

Other physician leaders said paying for call is inevitable: "Physicians have incredible financial pressures to stay in practice. All they can sell is their time. There is no reason for physicians alone to shoulder the entire burden of community health care."

Video Robots Redefine Bedside Manner

FRom the Lincoln Journal Star, though originally published in the Washington Post:

Ries Daniel was waiting in his hospital room the morning after bladder surgery when the door finally swung open. But it wasn't his doctor. Instead, a robot rolled in, wheeled over and pivoted its 15-inch video-screen "head" toward the 80-year-old lying in his bed at Baltimore's Johns Hopkins Hospital.

"Good morning," said a voice from the robot's speaker. It was Louis Kavoussi, Daniel's urologist. His face peered down from the screen atop the 5½-foot-tall device dubbed Dr. Robot. "So, how was your evening? No problems?"

Studying his patient through an image beamed back to his office by Dr. Robot's video camera, Kavoussi was concerned because Daniel had run a fever overnight and developed a cough. "You're not looking as good as yesterday," said Kavoussi, zooming in the camera for a closer look after having focused on Daniel's chart moments before.

Most Wired, Small and Rural Hospitals

We're pleased to find our friends in Fort Madison, Iowa on this year's list:

Hospitals & Health Networks' 2005 Most Wired Survey and Benchmarking Study

An analysis of this year's Most Wired Survey results shows for the first time that hospitals leading the way in information technology also have better outcomes. They use a wider array of IT tools to address quality, they conduct a larger percentage of clinical transitions via IT, and a larger precentage of their physicians enter orders themselves.

New Medical Chief of Homeland Security is an EM Physician

Secretary Michael Chertoff Announces the New Chief Medical Officer for the Department of Homeland Security

Today Secretary Michael Chertoff announced the appointment of Jeffrey W. Runge, M.D. as the Department’s new Chief Medical Officer. Dr. Runge currently serves as Administrator of the National Highway Traffic Safety Administration (NHTSA) at the Department of Transportation. Secretary Chertoff issued the following statement:

Prior to serving as Administrator of NHTSA, Dr. Runge practiced and taught emergency medicine as Assistant Chairman of the Department of Emergency Medicine at Carolinas Medical Center in Charlotte. Dr. Runge has also served as Director of the Carolinas Center for Injury Prevention and Control. He is board-certified in Emergency Medicine and has served in leadership positions in various local, regional and National organizations including the American College of Emergency Physicians and the Association for the Advancement of Automotive Medicine. He earned his Bachelor’s degree from the University of the South in Tennessee and his Doctor of Medicine from the University of South Carolina.

EMTALA in the Delivery Room

From Stephen Frew's Medlaw.com

Wisconsin Upholds EMTALA Duty In Delivery Room

A hospital was obligated under federal law to do a medical screening examination on an infant born there despite doctors' belief that he was so premature he had no chance to survive, the Wiscon state Supreme Court ruled Wednesday, July 13, 2005.

Shannon Preston sued Meriter Hospital in Madison because doctors refused to treat her infant son, who was only 1 pounds when he was born 17 weeks premature in 1999. Doctors believed his lungs were so underdeveloped that he would not survive regardless of what they did.

Hospital Audit Questions Hours

From the LA Times. Not exactly "non-urban", but I thought it interesting.

Two dozen physician contractors at Martin Luther King Jr./Drew Medical Center billed for hundreds of hours this year that could not be accounted for, according to a new audit suggesting that fiscal mismanagement and possible fraud persist at the public hospital even as it struggles to reform.

In the emergency department, for instance, the six doctors working under contract billed for a combined 2,200 hours in April and May. Even after taking into account patient care, meetings and lectures, 39% of those hours could not be explained, according to a confidential report that Los Angeles County auditors sent Thursday to the Board of Supervisors.

The doctors collected a total of nearly $75,000 for those questionable billings

New Medical Director in Flora

I thought it was cool that I found this in my daily Google search. From the Daily Clay County Advocate-Press.

The county board approved a medical staff recommendation to appoint Dr. David Mooth as Emergency Room Medical Director. Dr. Mooth will replace Dr. Jim Hegmanowski who resigned the position.

Ambulances Stalled at ED's

From the East Valley Tribune (AZ)

An ambulance got Toni Poppy to Banner Baywood Medical Center in a few minutes, but it took 17 hours for her to be treated and released Wednesday from the emergency department.

Arriving by ambulance does not guarantee quick treatment in the emergency department — a lesson patients are more likely to learn now as waiting rooms packed with sick people sometimes force ambulances to wait with less critical patients, medical authorities said.

The backup, which at times has left nearly a dozen ambulances waiting several hours at one hospital, has led to a pilot program at six East Valley hospitals that aims to more evenly distribute ambulance patients among emergency departments.

Defensive Medicine in the ED

Another interesting article from Iowa this week. As reported in the Iowa City Press-Citizen:

UI study shows existence of ‘defensive medicine’

Emergency physicians who have the greatest fear of malpractice suits are more likely than their colleagues to admit and order tests for patients with chest pain or other heart symptoms, even if those patients are at low risk for actual problems, according to a study led by a University of Iowa researcher.

These findings were based on surveys of 33 emergency doctors who participated in a prospective study of 1,134 patients at two teaching hospitals. The results appear in the July 13 online issue of the Annals of Emergency Medicine.

Nearly seven million Americans seek emergency care for heart-related symptoms each year, and nearly half of these individuals are hospitalized or admitted for further evaluation. However, most of these patients are subsequently shown not to have acute coronary syndromes such as unstable angina or heart attack.

Given the vast number of patients involved, these findings have implications for understanding how the practice of "defensive medicine" may increase the cost of health care, said the study's lead investigator, David Katz, M.D., associate professor of internal medicine in the UI Roy J. and Lucille A. Carver College of Medicine.

"The fear of malpractice accounts for a significant portion of the variability in what doctors do in the emergency room," said Katz, who also is a staff physician and researcher with the Department of Veterans Affairs Iowa City Health Care System.

Suspected "Passing Out Game" Death

Very disturbing article excerpted from CNN.com

A 10-year-old boy was found dead, hanging from a tree, apparently killed while trying to get high by playing the "pass-out game," authorities said.

Dalton Eby may be the second Idaho child killed in recent months while playing a choking game, trying to cut off the oxygen supply to the brain to achieve a type of "high."

"During the course of the investigation it was learned that there is a game that is common knowledge to many of our youth. A game known as the 'pass-out game,' the 'fainting game,' the 'tingling game,' or the 'something dreaming game' -- to name a few," the statement added.

Nathan Hoiosen, a school resource officer with the Nampa Police Department, said youngsters think the choking game offers a safe buzz compared with drinking or doing drugs.

Lewis and Clark meet "ER"

From the Helena Independent Record

The Corps of Discovery achieved its remarkable success, despite the best medical treatment of the day, not because of it.

The trials and medical maladies of the Corps would have kept a host of modern day emergency room physicians busy.

Dr. David Peck, an urgent care doctor and long-time history buff, has written a page-turning chronicle of the Corps' wilderness adventures, "Or Perish in the Attempt," a story of wilderness medicine on the Lewis and Clark Expedition.

He jokingly describes his book as "Lewis and Clark meet ‘ER,'" a reference to the popular emergency room television series.

Workplace AED's

An article from our hometown Des Moines Business Record about the use of automated defibrillators (AED's) in the workplace.

Central Iowa businesses are becoming much more aware of AEDs, said Rob Schweers, a spokesman for the Iowa Heart Center, which has assisted companies in buying AEDs at discounted prices. Schweers estimates there are probably at least 1,100 AEDs in place throughout Central Iowa.

From the perspective of an emergency room physician, “it’s just very important that these devices are in public places,” said Dr. Larry Baker, director of the emergency departments of Iowa Methodist Medical Center and Iowa Lutheran Hospital. “If an individual goes down with a heart-related incident, this is by far the most effective process, far better than just doing CPR.”

Transcription Errors

From ModernPhysician.com

Doctors' poor handwriting is a well-recognized source of medical errors, but their sometimes sloppy speech habits are a less well-known contributor.

A study based on a sample of 220 dictated medical records totaling 9,726 lines of transcription found 27% of the 96 more-serious flaws were attributed to the speaker, typically a physician, and not the transcriptionist. Twenty of 38 critical flaws (53%) and six of 58 major flaws (10%) were traced to the speaker.

Critical flaws include patient misidentification, medical word misuse and omitted dictation. Major flaws include misspellings and inappropriate blanks. Minor flaws include punctuation, grammar and formatting errors.

Hospital may shut ER on Tuesday

From the Daily Star

Hospital may shut ER on Tuesday

Employees of The Hospital in Sidney have received a memo stating that the facility’s emergency room could close at 7 a.m. Tuesday.

"Obviously, it’s an unpopular decision that we have no choice but to make," said Margaret Suriano, president of The Hospital’s board of trustees. "It will be a painful decision but a decision totally out of our control."

The memo was dated Saturday.

The closure is not definite, Suriano said Sunday, but is a possible scenario if negotiations for pharmacy and emergency room services do not come through in time.


The potential closure stems from a lack of a pharmacy license at The Hospital, spokeswoman Patricia Charvat said.


"If you don’t have pharmacy, you can’t have an emergency room," Charvat said Sunday. "If we can’t resolve this, we may need to make a decision to close the emergency room."


The pharmacy rule is a state regulation.


"As many of you know, the members of our pharmacy department all gave notice a few weeks ago," Kevin Haughney, chief executive officer of The Hospital, said in the memo.


The contract with NES Healthcare Group, which provides physicians for The Hospital’s emergency room, also expires today, according to the memo.


"We have been talking with the company to see if we can make arrangements to extend the contract for a short period of time. However, the money necessary to do this may be more than we can afford given our dire financial situation," the memo said. "Without this company, we cannot operate the ER."

Improvements in ED's

From SanDiego.com

"Feeling better fast"

"In markets that are very competitive, hospitals are going to be looking to the emergency department to stay competitive," said Peter Cunningham, a senior health researcher for the Center for Studying Health System Change, a research group in Washington.

The emergency room is a front door of sorts to the hospitals, which makes it a key part of the hospital business model. If they improve efficiency without sacrificing safety or raising overhead, profitability increases. This is particularly important in the ER because about 50 percent of hospital admissions are from the emergency room, according to Kirk Jensen, a patient flow expert who works with the BestPractices Institute in Fairfax, Va., and Institute for Healthcare Improvement.

Paramedic Response Time: Does It Affect Patient Survival?

From the journal Academic Emergency Medicine. I've excerpted from the abstract:

A paramedic response time within 8 minutes was not associated with improved survival to hospital discharge after controlling for several important confounders, including level of illness severity. However, a survival benefit was identified when the response time was within 4 minutes for patients with intermediate or high risk of mortality. Adherence to the 8-minute response time guideline in most patients who access out-of-hospital emergency services is not supported by these results.

Study: Prescription abuse doubled since '92

Excerpted from CNN.com

The number of Americans who admit abusing prescription drugs nearly doubled to over 15 million from 1992 to 2003, with abuse among teens tripling, according to a new study released on Thursday.

The report by the National Center on Addiction and Substance Abuse at Columbia University suggested that more Americans were abusing controlled prescription drugs than cocaine, hallucinogens, inhalants and heroin combined.

"Our nation is in the throes of an epidemic of controlled prescription drug abuse and addiction," said former health secretary Joseph Califano, chairman and founder of the Center.

"New abuse of prescription opioids among teens is up an astounding 542 percent," Califano said. "The explosion in the prescription of addictive opioids, depressants and stimulants has, for many children, made the medicine cabinet a greater temptation and threat than the illegal street drug dealer, as some parents have become unwitting and passive pushers."

Study: Med mal premium increases not justified by claims

Reported in the New York Times and other media outlets

"Study: Med mal premium increases not justified by claims"

Fifteen of the nation's biggest malpractice insurers have "price-gouged" physicians over the past several years, increasing net premiums by 120% between 2000 and 2004 while their net payments for claims from doctors rose just 5.7%, according to a new study released today.

The study by the New York-based Center for Justice and Democracy found that some insurers increased premiums while the costs of both claims payments and projected future payments were decreasing.

Jay Angoff, former Missouri insurance commissioner and the author of the study, said the data from annual statements by the insurance companies "prove that doctors have been overcharged during the last several years."

Lawrence Smarr, president of the Physician Insurers Association of America, a trade group that represents more than 60 professional liability insurance companies, criticized the study, saying it fails to take into account the fact that insurers set premiums to help build reserves to cover future claims as far as a decade or more in the future.

"Because of the long lag time between premiums collected and (claims) paid, it's really an apples and oranges comparison," Smarr said. He added that "credible entities" have demonstrated that the liability insurance industry has lost money "for the last five years."

Three of the insurers surveyed for the report are publicly traded companies whose business primarily involves physician insurance. Those three, the report said, have all seen their stock prices double over the past three years, a time when the Dow Jones industrial average has remained essentially unchanged.

Summer Risks vs. Realities

From WebMD

The news media are so full of warnings about potential summer health hazards that you may wonder, as the season wears on, how anyone ever comes through unscathed.

Recall, for instance, the summer of 2001, which Time magazine dubbed "The Summer of the Shark" after 50 swimmers were attacked off the coast of the U.S., and three died from their wounds. The next summer brought alarming reports of the rapid spread of West Nile virus. It had made its way from New York to California, infecting thousands and killing hundreds.

What you probably didn't hear, however, is that for every one unfortunate who met his end in the jaws of a shark, at least 1,000 drowned; and while 201 people nationwide died of West Nile infection in 2002, car crashes killed nearly 43,000.

The Danger: Lifetime Odds

Death by car accident
1 in 228

Drowning death
1 in 1,081

Bicycle accident death
1 in 4,857

Death by excessive natural heat
1 in 10,643

Death by lightning
1 in 56,439

Temperatures in Parked Cars

This Stanford study, published in Pediatrics, was reported in several media outlets. I've excerpted a portion of an article from Medical News Today.

Even on a relatively cool day, the temperature inside a parked car can quickly spike to life-threatening levels if the sun is out, researchers at the Stanford University School of Medicine have found. They hope their findings will put to rest the misconception that a parked car can be a safe place for a child or pet in mild weather.

Grants for ED Electronic Medical Record

From RedNova

"High-Tech Charting State Promotes Electronic Medical Records Systems"

Ten rural hospitals are using a $1.1 million DHH grant to implement electronic medical records systems in their emergency departments.

Assault with a Defibrillator?

From JEMS

"Virginia EMT Charged with Death of Coworker in Defibrillator Incident"

An EMT faces a charge of involuntary manslaughter in the death of a coworker, who police say succumbed after being shocked by a cardiac defibrillator, according to a story on TriCities.com. If convicted, he faces up to 20 years in prison due to negligent use of an AED.

On June 1, Joshua Martin, 24, of Bristol, Va., shocked fellow Highlands Ambulance Service EMT Courtney Hilton, 23, of Lebanon, Va. Hilton was reportedly resuscitated, transported to Russell County Medical Center and transferred to Bristol Regional Medical Center in Tennessee, where she died three days later.

Martin was with Hilton at the emergency department, where police questioned him. Hours after Hilton died, he was arrested. Martin was free after posting a $25,000 secured bond.

Authorities have released few details about the incident and the ambulance service was not ready to comment, according to the news account. The police chief was still awaiting an autopsy report a week after the incident

Repeat visitors crowd ERs

From the Boston Globe

A state study has found that about 4 percent of the people who used Massachusetts health emergency departments in 2003 accounted for 17.5 percent of total visits.

The Division of Health Care Finance and Policy study represented the first time the state examined data on those who frequent emergency rooms. Officials said gathering the information was the first step in figuring out how to provide better treatment for people who may regularly need immediate care.

''We first wanted to know who are these people and why is this a regular source of care," said Amy Lischko, the division's assistant commisioner. ''Then we can look at how to get people a real medical home and better-coordinated care."

The patients went to emergency rooms even though the facilities are more expensive and often less comfortable than a physician's office. In addition to excessive costs, healthcare analysts said, quality of care can be compromised when patients visit emergency departments instead of their regular doctors, especially if they do so frequently.

ER Volume Increase - Wisconsin

I found this investigative report interesting. The Appleton, WI Post-Crescent used the CDC ED Overcrowding stats as a jumping off point for an investigative report. A prefect fit for a "Non-Urban EM" blog. I've excerpted it below:

In researching one year of ER admission information for the five-county region’s 12 hospitals, the newspaper found, among other things:

• Residents made more than 196,000 visits to ERs, equal to about 30 percent of the population, between October 2003 and September 2004. The national rate is about 39 percent.

• Ear infection was the most common reason, accounting for about 3 percent of all visits.

Fifty-three percent of those patients were age 3 or younger.

• Fifteen percent of the visits were by Medicaid patients, and about 13 percent were by self-pay, or uninsured patients.

• The average ER visit cost $558.

Friday night in the ER

Very interesting story from Dr. Tony's blog, excerpted below...

Ashley started and glanced behind me as an agitated voice instructed, "Turn around, Doctor." I hadn't noticed the companion behind the screen as I had moved past him on my way into the room. Of course, this time I didn't miss the muzzle of the Glock he was pointing at me. What is it about these gang-bangers and their Glock's? I thought longingly of my own Glock, currently in its holster in my truck.

Records show billing concerns investigated

From the Charlotte Observer, exerpted below:

"Records show billing concerns investigated"

U.S. Attorney's Office looking into practices in ER, according to letter
The U.S. Attorney's Office is investigating concerns regarding alleged questionable billing practices at Gaston Memorial Hospital's emergency room after an anonymous complaint was made in November, according to memos and letters obtained by the Observer.

The company that runs the emergency room, Emergency & Acute Care Services, was served with a subpoena, according to a May 2005 letter that company officials sent to hospital staffers.

The letter states that government officials are seeking a range of records from Jan. 1, 2003, to March 31, 2005, related to billing or coding issues. ER physicians at Gaston Memorial assign a certain code to patients depending on their medical status, with Code 5 being the most serious.

Attorneys for EACS, which hires doctors to work at the hospital's emergency room, didn't return calls for comment.

The U.S. Attorney's Office neither confirmed nor denied the investigation.

Gaston Memorial Hospital officials issued a brief written statement Thursday when contacted by the Observer.

The statement said that after a hospital investigation, the hospital made a voluntary disclosure to the government regarding reimbursement services in the emergency department.

"This matter will not have an impact on the Hospital's commitment and ability to provide high quality care for our patients," wrote hospital CEO Wayne Shovelin. "The Hospital is cooperating fully with the government in any investigation, and in order not to hamper any investigation declines further comment."

Out for a jog...

Amazing story, excerpted from WSLS NewsChannel 10 (emphasis added)

Since Kevin's leg was still attached to the tractor, there was no way to get him to the hospital fast. Battalion Chief Dustin Campbell made the call to amputate Kevin's leg right there in the field, a procedure they'd never done before.

Battalion Chief: Dustin Campbell: We were discussing who was going to have to amputate when an ER physician out for a jog popped in and said, hi I'm a doctor can I help? And basically he was elected.

Emergency Medicine at Events

With Live 8 coming up, it's interesting to learn of the preparations of the medical teams covering the events. From the Philadelphia Inquirer's philly.com site:

"Triage on Parkway: Medical teams poised. ER staffing is up. Crews will roam Live 8, Fourth crowds."

You could say Ted Robinson has helped people find religion at rock concerts.

"There was this one concert where this guy was tripping and he thought the lights in the lobby were signs from God and he wouldn't leave," said Robinson, director of Harmony Event Medicine in Eugene, Ore.

"So we got this big, bright flashlight, and we had his friend hold it over his head and walk him all the way back to his motel room."

Such is the stuff of "event medicine," where teams of medical and mental health workers descend upon rock concerts and raves, helping out with everything from Band-Aids to bad trips.

On the West Coast, it's more about three-day festivals held in the middle of nowhere. Here on the East Coast, medical teams must handle throngs of up to a million in cramped spaces, but for hours, not days.

For this weekend's Live 8 and Fourth of July events, a crew of more than 500 emergency medical and fire personnel are anticipating the usual - heat stroke, alcohol poisoning, and the occasional trauma case.

At Live Aid in 1985, with 100,000 people in JFK Stadium, almost 700 people required medical care, according to John Mariano, the emergency medical services director who oversaw the daylong concert. A typical rock concert usually generates about 200 medical cases, he said.