Thursday, September 29, 2005


From the McCook (NE) Daily Gazette:

A new service, called "teletrauma," is now available at Tri Valley Health System in Cambridge to allow instant consultation on trauma cases.

In a front page article, the Indianola News reports that the new video conferencing equipment has been installed and is ready for use whenever needed. A special camera has been set up in Tri-Valley's rural trauma room to send images to the emergency room at Good Samaritan Hospital in Kearney.

Through that connection, and a hands-free microphone worn by the attending physician, decisions can be made concerning treatment and transport.

This is another example of the dramatic changes taking place in health care. As a result, residents of rural areas are gaining more direct access to the latest technology in the medical field

Concerns About Length of Stay


A Kentucky man who was reportedly frustrated with slow service at a hospital now faces multiple charges after police say he opened fire in the emergency room. It happened Wednesday afternoon at a hospital in Hazard.

Kentucky State Police say Eddie Grubbs was taken by ambulance to the Hazard ARH Medical Center emergency room. KSP says he then pulled out a gun and fired two shots. No one was hurt.

Grubbs was reportedly upset about how long he had to wait to be treated. One account quotes him as saying, "I just wanted to get their attention."

Robotics Use in Mexican Medical School

From Medgadget:

Faced with a growing number of medical students and few training hospitals, this Mexican university is turning to robotic patients to better train future doctors.

The robots are dummies complete with mechanical organs, synthetic blood and mechanical breathing systems.

"The country's rapid increase of medical students has not kept up with the number of medical facilities," said Joaquin Lopez Barcena, an associate dean at the university's medical school. "This a very a good learning opportunity for our students."
The $1.3 million facility has 24 robotic patients and a computer software program that can simulate illnesses ranging from diabetes to a heart attack.

For Paola Mendoza Cortez, a first-year medical student, the robotic patients offer peace of mind.

"I would feel nervous if this was (a) real patient," said Mendoza after drawing blood from a plastic arm. "With this (dummy patient) I can practice many times."
With close to 15,000 enrolled students, UNAM has one of the largest medical school in Latin America. There are about 70,000 medical students enrolled in Mexico, according to the Mexican association of medical schools.

Bill proposes funding to promote apologies to patients

A new bill would create a voluntary federal program to help hospitals negotiate fair compensation with patients harmed by medical errors as an alternative to lawsuits.

The bill, introduced by Sens. Hillary Clinton (D-N.Y.) and Barack Obama (D-Ill.), is modeled on an initiative called "Sorry Works!" in which hospitals own up to errors and apologize to the patients affected.

There is no companion bill in the House. Apologies can reduce malpractice lawsuits against providers and lower the compensation sought by patients, the senators said at a news conference.

Under the bill, federal grants would be available to help hospitals set up negotiation programs, hire patient-safety experts and track patient-safety trends. At deadline, the cost of the bill had not been estimated.

Participating hospitals and malpractice insurers would be required to use part of any savings to reduce physicians' malpractice premiums. In addition, the bill would create a national medical-errors database and set up an Office of Patient Safety and Health Care Quality within HHS.

A new law signed this summer already authorized HHS to establish a medical-errors reporting system and a national network of databases. At deadline, it was unclear how the database provisions of the Clinton-Obama bill relate to the new law.

Wednesday, September 28, 2005

Iowa Doctors March In D.C. Over Emergency Care

From the Iowa Channel:

Iowa emergency room physicians Tuesday joined doctors and nurses from around the country to march on the nation's capitol.

The group's goal is to improve the emergency medical care that it gives to patients.

An ambulance rushed to Mercy Medical Center with a trauma patient. It's part of a busy day's work for the doctors and nurses.

"We take care of the people. That's our first priority," said Dr. Rob Hatchitt, of Mercy Medical Center.

Hatchitt has seen the challenges grow in emergency medical care. He said challenges include overcrowding and a growing number of uninsured people seeking care.

"A lot of people don't have primary doctors. They come here. When you have 30 people waiting, that can lead to problems," he said.

Hatchitt also said Iowa hospitals face among the lowest re-imbursements in Medicare cases. Doctors also said many physicians no longer practice medicine because of high malpractice insurance costs, which also adds to the burden for hospitals.

Those issues brought thousands of doctors and nurses to march on Washington, D.C, to ask Congress to ask members to pass the Public Access to Emergency Medical Care Act.

The Emergency Medical Services Act would extend liability protection to emergency room physicians.

Dr. David Stilley, of Mercy, led the state delegation.

"It was pretty exciting to see all these people in white coats -- asking for support of all Americans," Stilley said.

Among other things, the measure would provide supplemental funding for emergency departments and financial incentives for hospitals that can reduce the time patients remain in the emergency room.

"We're saying something needs to be done before things get worse," Hatchitt said.

Mo. settles antitrust probe of two ambulance companies

From Modern Physician

Missouri signed its second antitrust settlement with an ambulance company in the past two weeks, recovering $2 million from Medical Transportation Management, St. Louis, for alleged overbilling and $400,000 for costs of the investigation.

MTM also agreed not to collect $17.4 million already billed to the state Medicaid program. The company, which provides services in 12 states, did not admit wrongdoing and said it settled to avoid prolonged litigation.

Attorney General Jay Nixon was investigating whether MTM and a rival company, LogistiCare, College Park, Ga., rigged a state Medicaid contract for nonemergency medical transportation. LogistiCare won the state contract in 2004, but Missouri canceled the agreement only a few months later.

MTM, which had held all the previous state contracts since 1997, was the only bidder for the next contract and subcontracted a portion to LogistiCare. The companies had planned to merge at the time the contract was awarded, but their letter of intent expired without a merger in June.

Both companies are eligible to bid for a new Medicaid contract, which the state expects to award shortly. LogistiCare settled its part of the investigation earlier this month by agreeing to pay $150,000 and drop a suit against the state over the contract cancellation.

LogistiCare President and Chief Executive Officer John Shermyen said the company viewed the settlement as a "vindication" of its conduct because the state said it could bid on the new contract and took no action against the company.

Tuesday, September 27, 2005

College Students, Health Care Insurance, and ED's

Not exactly non-urban, but it caught my eye as it was published in the Iowa State Daily (ISU's student newspaper):

Avoiding trips to the emergency room - or avoiding health insurance altogether - could lower students' healthcare costs as insurance rates rise across the nation.

Health insurance premium rates are up 73 percent since 2000, far outpacing the rate of inflation and wage growth, which grew 3.5 percent and 2.7 percent respectively, according to the 2005 Annual Employer Health Benefits Survey.

Todd Holcomb, ISU associate vice president for student affairs, said some students are opting not to have insurance because they think they're young, invincible and the odds are with them.

"This is a great opportunity for students to understand policy decisions on the national level and how it affects them as individuals paying taxes," he said. "Students don't fully understand health costs, health insurance and how voting, or not voting, plays out in their individual lives."

There are other reasons costs have increased.

Some of the factors driving costs up are the increasing cost of delivering health care as well as prescription drugs, new technology and the number of times people use the emergency room.

Ashley said if people never use the emergency room, the cost to use one will go down.

"Try not to go to the emergency room because it costs far less to go to the doctor," Feig said.

"I wouldn't go to the emergency room if you get home from work and just can't stand your ear ache."

Monday, September 26, 2005

MP3 First Aid Tips

From Medgadget:

St. John Ambulance from the United Kingdom introduced iFIRSTAID, a website from which you can download first aid tips onto MP3 players, phones and CDs. Guidance available for people when they need it, where they need it, in the format they need it.

The charity said it was prompted by the 25% increase in inquiries about first aid courses it received immediately after the July bombings in London.

"Now that MP3 players are so popular our iFIRSTAID downloads will make first aid guidance available for people when they need it, where they need it, in the format they need it," said Andrew New, senior training officer at St John Ambulance.
Users can access information about identifying and treating burns, bleeding, shock and fractures, giving rescue breaths and chest compressions and putting someone in the recovery position.

The charity plans to develop the scheme to offer advice for further scenarios, first aid podcasts and seasonal first aid advice.

St John Ambulance stressed that the information was no substitute for first aid training, but was useful as a quick reminder to give people confidence and reinforce their knowledge.

Sunday, September 25, 2005

Earthquake Preparations in Montana

From the Helena Independent Record:

As the country watches the Gulf Coast recover from hurricanes Katrina and Rita, are we ready for our own disaster?

Planners: We're ready Disaster and emergency officials certainly hope so.

"When I started my job 25 years ago, I would have said, ‘No, we probably aren't,' " says Paul Spengler, Lewis and Clark County disaster and emergency services coordinator. He's responsible for beating the drum of earthquake preparedness. "(But) we have raised a couple generations of schoolkids...(on) how to take protective cover in an earthquake," he says. "People are far more aware of the earthquake hazard." Many have criticized the response to Hurricane Katrina and what emergency personnel did and didn't do. Depending on the size and scope, here's how local officials hope a local disaster would play out:

The Emergency Operations Center — a plain basement next to the County Courthouse — would become a hive of activity, with elected officials, department heads and others figuring out what's left standing. Hospitals, nursing homes, and the Law Enforcement Center would be top priorities.

Once they dig out and check on their own families, up to 50 police officers would patrol streets, secure sites, look for looters and direct traffic.

The city's 36 firefighters would likely be tied up fighting one large building fire, or searching for victims. The first 48 hours after a disaster are the "golden hours" to find trapped victims.

The area's four ambulances would quickly become overwhelmed. As in most big disasters, victims would stagger to the emergency room the best they could.

Dams fail incrementally, so evacuation warnings could be broadcast for Missouri River-side dwellers. Sheriff's deputies would race downstream and warn people to head for higher ground. A siren would sound in Wolf Creek. Great Falls residents would have 10 hours to clear out.

The Red Cross would establish emergency shelters.

The City Public Works Department would assess damage to buildings and services, with the help of a dozen local architects.

Assuming all sent well, work crews would soon clear streets, restore water, sewer, gas and power in a matter of days.

237,000 tons of debris would need to be hauled away.

It's Tough Being A Rural Hospital These Days...

From Planet Jackson Hole:

Insiders and longtime observers of St. John's Medical Center ­ such as SJMC Chief of Staff Dr. Robert "Buz" Bricca, 23-year veteran Jackson physician Dr. Brent Blue, and former Board of Trustee Jonathan Schechter ­ describe the hospital as something resembling Hamlet caught in a Catch-22. Hamlet, for those too busy to remember, had trouble figuring out what he wanted to be. Throughout much of Shakespeare's play, he wanders around saying noble things while remaining paralyzed by circumstance and inaction and constantly being upstaged by Fortinbras' easy success in accomplishing whatever he desires.

Medical excellence, charitable good works, and nobility of purpose aside, St. John's Medical Center, by virtue of operating in America's ritziest zip code, is obligated to decide what kind of hospital it wants to be, lest it remain upstaged by Idaho's and Utah's bigger more successful 'Fortinbras hospitals', a half day's ride away.

Does SJMC want to be a good rural hospital, or a regional referral hospital with an expanded menu of quality specialties?

That, for many, is the question.

Saturday, September 24, 2005

Out Of The ED, Into Urgent Care

From News Channel 3 (Memphis):

Efforts are underway to shift 20,000 Shelby Countians kicked off of TennCare to 11 "quick-care" clinics county-wide, said Shelby County Mayor AC Wharton in a news conference Friday.

Wharton announced the county received a $2.4 million "one-year demonstration project" grant to provide primary medical care and social services to what he called TennCare "disenrollees" and to alleviate overcrowded conditions at The Med, the state's largest government-funded charity hospital.

"It will clear folks out of the emergency room, and get them into urgent care or primary care away from the emergency room setting," said Wharton, "thereby freeing up the emergency room for those individuals who have to be there."

The Quick-Care Medical Clinic at 880 Madison Avenue will expand its hours to 8am-10pm Monday through Friday. Its weekend hours are 10am-6pm. Clinic staff will refer uninsured patients to permanent "medical homes," either at Federally Qualified Health Clinics (FQHC's) in the network or at faith-based clinics like the Church Health Center at 1115 Union Avenue.

"Big Game" = Low ED Volume

From ABC News:

Physicians at Children's Hospital Boston, who collected data from emergency rooms in Boston during the Red Sox's run to the World Series in October 2004, found that patient volume dipped significantly during the most important postseason contests.

The authors used the Nielsen television ratings to determine the magnitude of a sporting contest: the higher the rating, the more important they considered the game. The findings, published in today's edition of Annals of Emergency Medicine, indicate that the games with the highest Nielsen television ratings — Game 4 of the World Series and Game 7 of the American League Championship Series, both of which were series-clinching contests for the Red Sox — were associated with lower emergency department volume than games with lower television viewership.

Based on their data, the authors believe that one can predict how busy an emergency room will be based on how "big" the game is. This does not come as a surprise to many emergency medicine physicians, who have found they see far fewer patients in their hospitals at times when there is a major sporting event being played.

"That seems to hold true in many occasions," said Dr. Guillermo Pierluisi, an emergency medicine physician at the Medical College of Georgia. "Folks with nonemergent conditions — sometimes even those with emergent conditions such as chest pain — tend to wait until the televised event is over to visit the emergency department."

Friday, September 23, 2005

Telehealth in Montana

From the Missoulian:

Every morning while Katy Jourdonnais reads her newspaper, she is interrupted by a semi-robotic female voice.

It's time to take your vital signs, the voice reminds Jourdonnais.

The reminder is essential, as Jourdonnais suffers from congestive heart failure, a serious condition that weakens the heart over time. There is no cure, but with proper monitoring and treatment, patients can live long full lives.

The box, more of an electronic nurse, directs Jourdonnais, 89, through the process. It takes her blood pressure, monitors her weight, heart rate and even her oxygen level. Then the information is beamed via a telephone line to a central nursing station.

If there is a sudden change in Jourdonnais' vitals, a nurse gives her a call or pays her a visit.

The new telehealth monitor has given health care providers a third eye in caring for their patients. Telemedicine - sometimes called distance medicine - is one of the newest forms of communication between clinicians and patients.

Using telecommunications technology, health care providers can prevent uncomfortable delays, travel expenses and family separation by bringing specialized medical care directly to the people who need it - or, as in Jourdonnais' case, can simply monitor a patient's day-to-day status.

American Telemedicine Association reports that telemedicine is being practiced in rural areas, school districts, home-health settings, and nursing homes, and on cruise ships and NASA space missions.

By monitoring a patient's vital signs every day, nurses are able to watch for trends and make any needed treatment or medication changes.

Jourdonnais was the first person in Missoula County to receive a telehealth monitor, and she likes it, even though she said it's a little bossy.

"You feel like there is somebody watching over your shoulder," she said. "And I can call them up in a minute if I need to."

Stroke Centers, tPA

Tipped off by Symtym: A very comprehensive article about the controversy in emergency treatment of CVA's, from Sign On San Diego (a small excerpt of a much larger article):

Some doctors avoid using t-PA because of its potential downside. The drug can cause bleeding in the brain if not given to the right patients.

The American College of Emergency Physicians says t-PA should be considered, but doesn't think its members should be required to make judgments on stroke care without backup from neurologists and neuroradiologists.

Much of the resistance is the concern that hospitals would lose patients if they don't become stroke centers.

"Having brain-attack centers is a big economic issue and a big expense," said Dr. Richard Stennes, who has worked at Paradise Valley Hospital in National City and was former president of the national and state chapters of the American College of Emergency Physicians.

"If paramedics determine this person is a potential stroke patient and take (him or her) to a designated place . . . a whole lot of people will be taken to hospitals where they don't need to go," said Stennes of San Diego. "There's an economic issue here."

He and others estimate that for every patient who did have a stroke, paramedics would divert as many as 10 patients who didn't have a stroke or had one that occurred too long ago for treatment. Migraines, seizures, metabolic problems, drug reactions and hypoglycemia all could resemble symptoms of stroke.

Both of New Orleans' public hospitals to be condemned

From the Monterey Herald:

New Orleans' two public hospitals will have to be condemned, according to Don Smithburg, who runs the state's public hospital system.

That decision will prevent the reopening of the city's only trauma units capable of handling the most serious car accidents, gunshot wounds or construction mishaps that any city is bound to have.

Charity and University hospitals were also the backbone of the state's public hospital system and of the medical schools in New Orleans.

"We're still taking on water at both hospitals," Smithburg said Thursday. "We don't know if the water table is rising or what, but water is still seeping - no, not seeping, pouring - into the basements."

Farm Safety

From the Coon Rapids (MN)Herald:

Keeping kids safe on the farm

Accidents happen. They can happen anywhere—in the home, on the road, on the job, in the schools and—on the farm.

Farming is one of the most dangerous occupations in the country. According to the National Safety Council, in 2002, agriculture came in second in the number of work-related deaths—second only to the mining/quarrying industry. As reported that year, agriculture in the United States had 21 fatalities per 100,000 workers, or approximately 730 deaths.

Some suggestions to keep everyone safe on the farm include:

• Children, especially visiting children, should not be allowed to roam freely around the farm. Instead, designate a safe play area;

• Equip all barns, shops, storage areas, livestock pens, etc. with latches that can be locked or secured so that children cannot enter;

• Always turn equipment off, lower hydraulic and remove the key before leaving equipment unattended;

• Inspect all equipment and correct any hazards before operating;

• Make certain a 20 lb. fire extinguisher is handy;

• When around farm animals, be calm, move slowly, avoid making sudden jerks or movements and always approach them from the front so they can see what is going on; and

• Never permit young children to work with poisons, chemicals or fertilizers.

Thursday, September 22, 2005

Emergency Medicine Simulation Lab - On Wheels

They have an EMSLRC in Florida (just like we do in Iowa). It seems that they have a nicer "bus":

On May 12, 2005, the Emergency Medicine Learning & Resource Center launched the State of Florida’s only emergency medicine simulation lab on wheels featuring SimMan® and SimBaby®. The lab, which features realistic emergency room and ambulance settings is built within a 45-foot coach and will take a realistic emergency medicine feel to physicians, nurses, and paramedics/EMT’s in rural parts of Florida.

This “Mobile Simulation Lab” will be targeted to the rural emergency medicine providers in the State of Florida. There are 33 counties in Florida deemed “rural” with more than one million residents of those counties. This educational tool is an essential part of getting those in the profession hands-on training in the ever evolving field of emergency medicine.

EMS Medical Director of the Year

From the Mount Pleasant (Iowa) News:

Dr. Linwood Miller of Mt. Pleasant was recently named as the recipient of the Richard Ferneau EMS Medical Director of the Year Award.

This honor is awarded through the National Association of Emergency Medical Technicians, and recognizes Dr. Miller for his leadership skills, dedication to improving the quality of emergency medical care, and innovation in system development and clinical care.

Dr. Miller began as the volunteer medical director of Henry County Health Center Emergency Medical Services over 20 years ago.

Under his medical direction, HCHC EMS has grown from a small local Basic Life Support, EMT level service, to a regional Advanced Life Support, Paramedic level system, with progressive offline medical direction that now includes critical care.

"Even while working fulltime as a family practice physician with Family Medicine of Mt. Pleasant, P.C., and as a member of HCHC's medical staff, Dr. Miller always finds the time to be a mentor, colleague, and educator," said HCHC EMS manager Jerry Johnston. "As a medical director, he is an EMS administrator's dream.

"He has allowed me the latitude to grow the system clinically and is continually supportive of thinking 'outside the box' for the betterment of patient care."
After finishing medical school and his residency, Dr. Miller began practicing medicine in Mt. Pleasant in 1981 with Dr. James Widmer. In 1990 they and four other physicians formed Family Medicine of Mt. Pleasant, P.C. which has grown to include several more physicians.

Monday, September 19, 2005

ACEP Action Alert

This is slick. The American College of Emergency Physicians has an web-based "Action Alert" application that allows one to compose a mail or e-mail letter of concern directed to legislators. "Talking points" are supplied and one can enter them into the text of the message with one click. A tabbed entry provides information about the membership of the US Congress and the Senate. Very impressive!

Some data:
Will Lifesaving Emergency Care Be There When You Need It?

More than 2,000 emergency departments have closed their doors since 1992. During that same period, Americans dramatically increased their dependance on the emergency care system and in 2003 made more than 114 million visits to hospital emergency departments, resulting in dramatic increases in patient volumes and waiting times.

Overcrowding causes prolonged pain and suffering for patients, long emergency department waits, and increased transport times for ambulance patients, according to a report from the U.S. General Accounting Office.

The health care system is in crisis due to a lack of hospital inpatient beds; a shortage of on-call medical specialists; an increasing elderly population; and nationwide shortages of nurses, physicians, and support staff.

Emergency physicians provide care to all who need it, regardless of their ability to pay, but the cost of treating the uninsured is passed on to all Americans through higher hospital bills, insurance premiums and taxes.

Skyrocketing jury awards and frivolous lawsuits are causing physicians to retire early or stop performing high-risk procedures, leading to a lack of medical specialists willing to provide lifesaving emergency medical care.

Sunday, September 18, 2005

Bottlenecks and Traffic Flow

Excellent article from the Connecticut Post Online, excerpted below:

"Hospital emergency departments are the ultimate safety net for the public"

Against the backdrop of years of double-digit increases in medical insurance premiums, the managed care industry pitched itself as a savior of the nation's ailing health-care system. "Managed car comparison, over an even shorter timespan, Connecticut's hospital emergency rooms treated 1.4 million patients last year — 27.2 percent more than they did in 1996 when they saw 1.1 million.

Meanwhile, hospitals increasingly face bottlenecks transferring patients from emergency departments to hospital rooms. Sometimes there just aren't enough nurses to oversee the beds.

To observers, untrained in the ways hospitals funnel patients through their system, none of this makes any sense. It's hard for them to square seemingly crowded emergency rooms, with vacant beds elsewhere in the hospital.

Initially, hospitals triage patients in their waiting room to ensure that the most critical see doctors first. Once inside the ER, doctors examine the patient and order diagnostic tests if warranted. Then they work to stabilize the patient, either for discharge or transfer to a hospital bed. In some cases, patients end up waiting on gurneys in an ER's hallway hooked up to monitors. This happens for a couple of reasons: their condition may require very close monitoring; the nurse-to-patient ratio may be too low to adequately supervise all of them on a regular floor; or there just isn't an empty bed available.

It's all about traffic flow. And while hospitals everywhere lament the balancing act they must conduct, trying to forecast how much nursing staff they will need to treat the patients they expect to be admitted, the exercise has a steep downside.

According to the American Hospital Association, when hospitals allow logjams in their ERs that delay transferring patients to critical care units and force sick or injured people to wait longer for treatment, that inefficiency costs each hospital on average $1.74 million annually in lost revenue.

Saturday, September 17, 2005

Face Transplant

The Cleveland Clinic, no less. And I thought the Travola / Cage movie Face/Off was fiction. Excerpted from AOL News:

Doctor Pushes for First Face Transplant

In the next few weeks, five men and seven women will secretly visit the Cleveland Clinic to interview for the chance to have a radical operation that's never been tried anywhere in the world.

They will smile, raise their eyebrows, close their eyes, open their mouths. Dr. Maria Siemionow will study their cheekbones, lips and noses. She will ask what they hope to gain and what they most fear.

Then she will ask, "Are you afraid that you will look like another person?"

Because whoever she chooses will endure the ultimate identity crisis.

Siemionow wants to attempt a face transplant.

... face will be removed and replaced with one donated from a cadaver, matched for tissue type, age, sex and skin color. Surgery should last 8 to 10 hours; the hospital stay, 10 to 14 days.

Friday, September 16, 2005

Wisconsin Found Costliest for Physician Services

From AOL News

U.S. Rep. Paul Ryan said Thursday that action must be taken quickly after a report found eight of the 10 priciest U.S. cities for physician services - relative to local rents and wages - were in Wisconsin.

The report released this week by the U.S. Government Accountability Office showed La Crosse topped a list of 319 U.S. metro areas in relative physician prices at 48 percent above the average, followed by Wausau at 46 percent, Eau Claire at 42 percent and Madison at 41 percent.

"I think this serves as a wakeup call to Wisconsin policymakers and consumers," Ryan said. "We have an emergency situation with regard to health care costs and we need to act quickly."

The study said higher prices generally resulted from weak competition - more beds controlled by few health care providers - and the lack of ability of Health Maintenance Organizations to pay doctors flat fees, which tend to control costs.

Katrina: Nurse Heroes

I'd blogged that physicians and EMT's were emerging as heroes in the Katrina story. Well, nurses, too. From

"When Katrina got tough, nurses got inventive"

The 3,000 people packed into East Jefferson General Hospital just outside New Orleans could not stay away from the windows, fascinated to see Hurricane Katrina blow over trees and batter buildings.

"By morning we saw the water rising. That was when we saw the nursing home across the street was still occupied," said Beverly Marino, a nurse in the hospital's emergency department.

Marino and her fellow emergency department staff have heard the horror stories of 34 frail patients left in a nursing home to drown, of looting and of murder in their hometown.

But their own tales are of heroism and inventiveness.

The distressed East Jefferson staff had to wait until the water stopped rising to wade through chest-deep water and get the elderly residents and their caretakers out of the one-story apartment-style building across the street from the emergency department ramp.

"They had one fan. They had a dog over there. They had the one fan on the dog," Marino said.

"We bathed them, changed them and got them on a bus," Marino added.

"One lady said 'I'm going on a bus, I'm going on a bus -- I have to get my good dress on.' They (the rescuers) were rooting around in her closet for the good dress."

Of 12 New Orleans area hospitals, three main suburban centers were not shut down by the August 29 hurricane.

Staff at East Jefferson, the West Jefferson Medical Center and the Ochsner Clinic have worked without a break since they were locked in by Katrina's furious winds and the fast floods that followed when the levees broke.

Wednesday, September 14, 2005

Rescue In New Orleans

From the Houston Chronicle, an interestring story of a California team's rescue of a person left found in his home during search and rescue efforts in New Orleans.

'Like a ghost,' man nearly left for dead opens his eyes

NEW ORLEANS — This was just another body in the growing number of bodies that they encounter every day.

A human foot arching at an odd angle was visible through the front window of a locked and dark home.

The National Guard team of searchers was about to call in a "DB" (dead body) at 1927 Lopez St. in the Broadmoor district when Lt. Frederick Fell decided to investigate.

In the last few days, the Federal Emergency Management Agency has ordered searchers NOT to break into homes. They are supposed to look in through a window and knock on the door. If no one cries out for help, they are supposed to move on. If they see a body, they are supposed to log the address and move on. The morticians will remove the deceased later.

But Fell broke the rules and ordered his men to bash open the door, launching a series of events that would save a man's life and revitalize California Task Force 5 from Orange County, Calif. In the last two days, the 80-member task force had identified seven dead bodies in the same neighborhood, and they had rescued no one.

Difference in Access to Post-ER Followup Care

Excerpted from Reuters, describing an article in JAMA:

NEW YORK (Reuters Health) - After being treated in a emergency room for an urgent condition, Americans with private health insurance are much more likely to secure a timely follow-up appointment with a community doctor than those with Medicaid or no health insurance, a study shows.

"The bottom line is that if you're not a card carrying member of our healthcare system you're going to have a very difficult time getting access to care, " Dr. Brent R. Asplin from Regions Hospital and HealthPartners Research Foundation in St. Paul, Minnesota, told Reuters Health.

Americans will make roughly 114 million visits to hospital ERs this year alone, and more than 80 percent will be treated and discharged with a recommendation to seek follow-up care. That, however, may be easier said than done, according to Asplin and colleagues who examined access to follow-up appointments according to insurance status in nine US cities.

As they report in the Journal of the American Medical Association this week, eight research assistants called 499 ambulatory clinics and identified themselves as in need of follow-up care for pneumonia, high blood pressure or possible ectopic pregnancy -- early pregnancy implanted outside the uterus, such as in the Fallopian tube.

The same research assistant called each clinic twice using the same scenario but reporting different insurance status - no insurance, private insurance, or Medicaid -- the federal/state program for the poor.

"In our study, the callers who were trying to get appointments had potentially very serious conditions," Asplin emphasized. "These were not people trying to get an appointment for a sore throat or a cold. But despite the severity of there conditions, callers still had problems getting appointments when they didn't have the right insurance card."

Tuesday, September 13, 2005

ACEP's Katrina Resource Page

The American College of Emergency Physicians has established an excellent resource page, "After the Storm", on their web site devoted efforts at restoration and recovery after Hurricaine Katrina:

"ACEP continues to be concerned about its members and their families who have been affected by Hurricane Katrina. Now that the storm is over and the recovery phase is beginning, we will provide you with information to help you regain your footing, find employment, relocate, and other resources as you recover from this disaster."

Monday, September 12, 2005

New Coma Scale: FOUR

Excerpted from a Mayo Clinic press release:

Mayo Clinic Develops New Coma Measurement System
Tool quantifies level of consciousness, severity of brain injury

ROCHESTER, Minn. -- Mayo Clinic neurologists have created the first new, reliable and easy-to-use clinical tool in 30 years for measuring coma depth, a proposed replacement for the Glasgow Coma Scale. The new scoring system, called the FOUR (Full Outline of UnResponsiveness) Score, will be described in the October issue of Annals of Neurology, to be published online Friday, Sept. 9.

When using the FOUR Score, evaluators assign a score of zero to four in each of four categories, including eye, motor, brain stem and respiratory function. A score of four represents normal functioning in each category, while a score of zero indicates nonfunctioning.

A coma scoring system is used by physicians to initially assess a comatose patient to determine the severity of the brain injury, to monitor the patient's ongoing progress, and to determine the best treatment during a coma. Scores also help physicians determine whether a patient is likely to live, and if so, how disabled the patient might be upon recovery.

EMS Helicopters

There's been a substantial growth in the number of helicopters / bases in Iowa of late. This is an excerpt from an article from the Fort Worth Star-Telegram:

Two helicopter ambulances were attempting to land at the same time on a roof at Harris Methodist Fort Worth Hospital. Security crews were scrambling to wave the pilots off safely. And emergency-room physicians had no idea who the patients were hovering overhead.

When that occurred more than a year ago, Lillie Bigginsrealized that Tarrant County's emergency air services had been transformed.

It's an increasingly competitive landscape that reflects changes nationwide, where a rise in air-transport services is bringing more flights to rural areas and raising concerns about safety, effectiveness and expense.

Sunday, September 11, 2005

Odessa, TX Considers Hospitalists

I found this article of interest because of the detailed description of a proposal for implementation of a hospitalist program, including the rationale for the service and the economic factors in the start up phase.

From the Odessa American:

Although money is already in the budget for a hospitalist program at Medical Center Hospital, most members of the Ector County Hospital District board aren’t fully sold on the idea.

Friday, September 09, 2005

Katrina Heroes: EDPs, EMTs

From Gruntdoc, who quotes from the AP Wire:

Disasters always spawn heroes.

On Sept. 11, 2001, many of them wore dark blue uniforms that said FDNY.

On Sept. 1, 2005, many wore hospital scrubs that said MD, RN and EMT. Thousands of health care workers stayed with patients in devastated hospitals after the storm struck. Thousands more rushed in to help.

They are people like Dr. Norman McSwain, a legendary, 68-year-old Tulane University trauma surgeon who on Sept. 1 waded through fetid floodwaters to get out word that thousands of people were trapped in hospitals running out of food and water.

And Dr. Rich Tabor, a 38-year-old Bethlehem, Pa., emergency medicine physician who got partners to cover his shifts and paid $520 out of his own pocket for a plane ticket to Louisiana, where he climbed into an airboat and went door-to-door with rescue workers.

And Barry Albertson Jr., 42, a paramedic from Easton, Pa., who missed his 7-year-old son's first peewee football game to join a caravan of ambulances making the 30-hour trip to New Orleans.

And Dr. Lee Garvey, 48, an emergency room doctor at Carolinas Medical Center who dropped everything to staff a state-of-the-art mobile hospital that provided the only trauma care for seven devastated counties in rural Mississippi.

"We're here because this is what we live to do," Garvey said, "trying to offer something to these people."

HIPAA Violation in ED Case?

From HIPAA blog:

Interesting HIPAA issue: in this case in Illinois, the plaintiff sued the hospital on the grounds that the hospital did not see the plaintiff in the emergency room quickly enough to save her. In order to prove their case, the plaintiffs asked the hospital to release the time the patient checked into the ER, the time of treatment, and the "acuity" score for the patient. The plaintiffs wanted the information to show that other patients were seen more quickly than the deceased, and that it wasn't because the other patients were in a more urgent situation.

Thursday, September 08, 2005

Remember the Thumper? The HLR?

I remember using the Heart Lung Resuscitator (HLR) and Thumper mechanical CPR devices, so I viewed this entry in the Medgadget blog with interest...

GruntDoc was waxing nostalgic about these devices recently, but it appears CPR machines are still in demand... in the UK. The Daily Mail reports on a new device, made by Lucas:

It can be used on the ground, in a bed or on a stretcher in the ambulance while it is moving. The 6,000 Sterling Pound device - known as the LUCAS CPR system - is powered by compressed oxygen or air and can keep going as long as is necessary.

Professor Douglas Chamberlain, who works in resuscitation medicine at Cardiff University, said there were some "remarkable cases" in which the machine had "very likely" saved lives.

He said: "In these cases resuscitation attempts have continued for over an hour and the patient was dependent on the LUCAS for any sort of blood flow while coronary arteries were unblocked.

"It's extremely unlikely that manual compression could have been kept up for so long, or during transportation in an ambulance and into the hospital.

"Manual CPR is not easy. It's often done too slowly or too quickly. When delivered with the right level of force, it can injure the rescuer."

Tuesday, September 06, 2005

ED Physicians: How to Volunteer

From the American College of Emergency Physicians (ACEP)

A number of emergency physicians have contacted ACEP to ask how they can assist in relief efforts for Hurricane Katrina. ACEP is contacting state and federal agencies to inquire about specific needs for assistance and will continue to post information as it becomes available.


From the Fort Wayne Journal Gazette:

“Every DMAT (Disaster Medical Assistance Team) team in this country is deployed,” said FEMA spokesman Marty Bahamonde. A dozen of the 35-person teams have been treating victims in tents at Louis Armstrong International Airport, just outside New Orleans. The Centers for Disease Control and Prevention dispatched 140 people, while the Department of Health and Human Services has more than 700 people on the ground.

The unprecedented effort to provide care to tens of thousands of people has required millions of dollars, improvised medical techniques and, in at least one case, theft by a physician who persuaded local police to help him snatch medications from a pharmacy. For one full week now, doctors have worked in MASH-style surroundings, leaning over patients on flimsy military cots, flipping through textbooks to make sense of symptoms they have never seen before.

“I’m a pathologist,” said Greg Henderson, a physician who moved to the New Orleans area two weeks ago. Roaming the streets of downtown in his surgical scrubs, Henderson was suddenly confronting rashes and illnesses he hadn’t seen since medical school. Armed with a Physicians’ Desk Reference – the pharmaceutical bible – and the stolen medicines, he administered to the sick and dying in a hotel lobby and the corridors of the city’s convention center.

Thousands – including infants, elderly and patients with existing health problems – literally sat in the sun for days with no food, water or medicine. “They basically start to rot alive,” Henderson said as he led one group of ill people to McNabb’s military helicopters.

Many landed on the track field of Louisiana State University in Baton Rouge. In an arena and an adjacent field house, volunteers from Illinois, New Mexico and the federal Public Health Service Commissioned Corps staffed an 800-bed hospital, making the gymnasium the largest acute care facility in the state.

Mobile ER, Update

A follow up to a September 4th blog, also excerpted from the Charlotte Observer:

After some bureaucratic delays, the mobile hospital that left Charlotte Friday to help victims of Hurricane Katrina began operating late Sunday in the parking lot of a demolished Kmart in Bay Saint Louis, Miss., about 60 miles east of New Orleans.

Doctors and nurses from Carolinas Medical Center and other N.C. hospitals treated about 85 to 100 patients Monday, relieving the storm-damaged Hancock Regional Hospital, said CMC spokesman Scott White, who is traveling with the crew.

Most of the patients reported minor problems, such as dehydration, cuts and bruises. A few trauma victims were treated after an automobile crash, White said.

"It's filthy here," White said by cell phone Monday. "The storm surge left all kinds of stuff."

For example, he said, before the crew could convert its two 18-wheel tractor-trailers into the mobile hospital, it waited for front-end loaders to clear the parking lot of cars that had been deposited there during the hurricane and flood.

Communication with government agencies has been difficult, White said, but "once we caught up with the right guy," the hospital was assigned to Bay Saint Louis.

The mobile hospital, called Carolinas MED-1, was designed by Dr. Tom Blackwell, a CMC emergency physician and coordinator of the relief effort. MED-1 was built with a grant from the Office of Homeland Security. It travels in a convoy that includes the two tractor-trailers that convert into a 100-patient hospital, complete with operating rooms.

Monday, September 05, 2005

Hospital Relief Efforts

AHA (American Hospital Association) has created a new Web site where hospitals can register what personnel and supplies they can provide for the relief effort in the South. The information provided by hospitals will be shared with the department of Health and Human Services, which will contact hospitals from which the agency would like assistance.

The AHA is working with the Department of Health and Human Services (HHS) and other national and state hospital associations to help coordinate medical relief efforts for hospitals and patients affected by Hurricane Katrina. The agency will mobilize up to 40 250-bed federal emergency shelters to stabilize and provide basic medical care to hospital and nursing home patients evacuated from the affected areas, as well as individuals with storm-related injuries.

In order to set up these facilities, HHS will ask for assistance from the nation's hospitals in staffing and managing the centers.

Individual health care professionals wishing to volunteer their services outside the scope of their hospital or health system can find information and sign-up at This is being coordinated by the Office of the U.S. Surgeon General.

Sunday, September 04, 2005

Mobile ER

Excerpted from the Charlottee News Observer. Sounds like what the Iowa team (yesterday's blog) will be doing.

GULFPORT, MISS. -- A team of North Carolina doctors and nurses is trying to heal the wounds of this mauled city.

In sturdy, light-brown tents next to Gulfport's Memorial Hospital, doctors, nurses, paramedics and other medical personnel are caring for hundreds.

"We are able to set up a small field hospital or emergency room in austere conditions," said Dr. Roy Alson, a leader of the Disaster Medical Assistance Team, which is based in Winston-Salem and draws volunteers from across the state.

Conditions in Gulfport, choked with its own rubble and suffused with the stench of disaster, could hardly be more austere. But the tents, despite their mesh windows and flap entrances, have just about everything a normal emergency room does except an X-ray machine. There are defibrillators and EKG machines.

The MASH-style outfit works under the auspices of the Federal Emergency Management Agency. After disasters, the 35-person group deploys and assembles the self-sufficient field hospital, which has its own power and water. The outfit can last three days without resupply.

The doctors, nurses, paramedics, pharmacist, logistical support and administrators replace a medical facility or supplement one. In this case, North Carolina volunteers are helping with a crush of patients who straggle in to the hospital.

Usually, the hospital's emergency room sees about 125 patients daily. That number surged to 400 beginning Tuesday, the day after the storm that killed more than 100 people in this state.

Saturday, September 03, 2005

Iowa ED Physician Headed to Louisiana

From the Sioux City Journal

DES MOINES (AP) -- Dr. Matt DeHaven was busy packing Friday, running through possible scenarios in his head as he prepared to head to Louisiana to help victims of Hurricane Katrina.

"I'll do what I can and trust my training," said DeHaven, an emergency room physician at Iowa Methodist and Lutheran hospitals. "I'm one person and I'll do what one person can."

DeHaven is one of a team of about 30 Iowa health professionals being sent to the Gulf Coast by the state Department of Public Health to help hurricane victims. Members of the team are doctors, nurses, paramedics and environmental health specialists. They come from all across the state, from Dubuque County in the northeast to Woodbury County in the northwest.

Members were recruited from several state Disaster Medical Assistant Teams created after the Sept. 11, 2001, terrorist attacks.

The hurricane team was scheduled to leave Des Moines early Saturday morning for Baton Rouge, La.

From there, members will be sent to various work locations.

DeHaven admits he doesn't know what to expect.

He's seen the images on television. He's read the newspaper. But he's never experienced such devastation and human loss before.

"I know it's bad," he said.

As his children, Peter, 10, and Catie, 14, helped him pack bottled water, a sleeping bag and mosquito netting, DeHaven said he was feeling a little trepidation about heading into the disaster zone.

His concern isn't about his, or the team's ability to do their job. It's about their personal safety, a concern echoed by his wife, Karen.

"People are so desperate right now that they're taking it out, it appears to be, on even the people who are coming in to help them because they weren't there soon enough," she said.

DeHaven and his family plan to stay in daily contact, as much as possible, but they realize that may be difficult until phone service is re-established in many areas affected by the hurricane.

Peter DeHaven said he is "kind of nervous" about his dad going away for two weeks, but realizes his dad is going somewhere where his help is desperately needed.

Matt DeHaven said he could end up working in a clinic or caring for patients in a hospital or other setting. He could be called on to help carry sand bags.

DeHaven said he is prepared for the possible toll on his emotions.

"I've never experienced anything like this," he said.

Friday, September 02, 2005

New Orleans Patients Arriving in Fort Worth

A ER physician's perspective on the arrival of patients from New orleans in Fort Worth. Excerpted from gruntdoc's blog:

I worked an afternoon shift in my ED today, and the buzz was all about the New Orleans transfers we'd received, and continued to receive.

Our joint got about 12 that I'm aware of, with a very high percentage being dialysis patients and in need of that service. It was entirely appropriate that they were sent to us, as we're one of a few hospitals in the area with inpatient dialysis services available. Our nephrologists didn't bat an eye, and worked hard to get them taken care of.

The patients were flown into the JRC Fort Worth (used to be Carswell AFB), and then a team from the county hospital and the county EMS director started divvying them up.

The patients I cared for showed what you'd expect in a debilitated, chronically ill person with no adequate sanitation for 3 days. All but one showed up with their inpatient hospital chart (in the binder), and one had not just that but prior charts dating back several years!

Disaster Medical Response: Illinois

From Steve Frew's


To IHA / MCHC Member Hospitals -

As part of the emergency response to Hurricane Katrina, the American Hospital Association (AHA) held a conference call today in which Health and Human Services (HHS) Secretary Michael Leavitt addressed the hospital industry. The purpose of this e-mail is to summarize that call and tell you what the next steps will be.

HHS is going to establish emergency medical facilities throughout the disaster area. These will be very basic facilities, with 250 cots each, staffed by 100 health care personnel. HHS expects to have 10 of these facilities up and running this week and 10 more by next week. Their goal is to establish 40 of these facilities. Patients will be triaged from the affected area into these facilities, stabilized and then transferred under the National Disaster Medical System Plan (NDMS) if needed.

HHS plans to staff the initial facilities with federally employed health care personnel. However, HHS will also need volunteer health care personnel from around the country to help staff these facilities. HHS has asked that hospitals help the effort by providing teams of health care personnel.

HHS has asked AHA and the state and metropolitan hospital associations to help coordinate the hospital response. The Illinois Hospital Association (IHA) and the Metropolitan Chicago Healthcare Council (MCHC) will participate in this endeavor.

As you can imagine, there are many logistical details that need to be addressed before hospitals can respond in an organized fashion. HHS and AHA are working on those details right now, and AHA will then communicate with state and metro associations - a call for hospital associations will be held tomorrow afternoon. IHA and MCHC will update members following that call, unless more information becomes available sooner.

In short, HHS is attempting to coordinate a response to a massive and unprecedented public health crisis. We know that our hospitals, physicians, nurses, and others are ready to assist. IHA and MCHC will keep our members informed about the latest developments.

For further information, contact YOUR STATE HOSPITAL ASSOCIATION

Norman McSwain reports from New Orleans

A longer post, but an extraordinary story featuring one of the most widely respected physicians in trauma care:

"Unruly crowds disrupt, prevent hospital evacuations"

(AP) -- Doctors at two desperately crippled hospitals in New Orleans called The Associated Press Thursday morning pleading for rescue, saying they were nearly out of food and power and had been forced to move patients to higher floors to escape looters.

"We have been trying to call the mayor's office, we have been trying to call the governor's office ... we have tried to use any inside pressure we can. We are turning to you. Please help us," said Dr. Norman McSwain, chief of trauma surgery at Charity Hospital, the largest of two public hospitals.

Charity is across the street from Tulane University Medical Center, a private facility that has almost completed evacuating more than 1,000 patients and family members, he said.

No such public resources are available for Charity, which has about 250 patients, or University Hospital several blocks away, which has about 110 patients.

"We need coordinated help from the government," McSwain said.

He described horrific conditions. (Watch a report on the scenes of death and despair on the streets of New Orleans -- 4:36)

"There is no food in Charity Hospital. They're eating fruit bowl punch and that's all they've got to eat. There's minimal water," McSwain said.

"Most of their power is out. Much of the hospital is dark. The ICU (intensive care unit) is on the 12th floor, so the physicians and nurses are having to walk up floors to see the patients."

Dr. Lee Hamm, chairman of medicine at Tulane University, said he took a canoe from there to the two public hospitals, where he also works, to check conditions.

"The physicians and nurses are doing an incredible job, but there are patients laying on stretchers on the floor, the halls were dark, the stairwells are dark. Of course, there's no elevators. There's no communication with the outside world," he said.

"We're afraid that somehow these two hospitals have been left off ... that somehow somebody has either forgotten it or ignored it or something, because there is no evidence anything is being done."

Hamm said there was relief Wednesday as word traveled throughout University Hospital that the National Guard was coming to evacuate them, but the rescue never materialized.

"You can imagine how demoralizing that was," he said.

Throughout the entire city, the death, destruction and depravity deepened even as the hurricane waters leveled off.

"Hospitals are trying to evacuate," said Coast Guard Lt. Cmdr. Cheri Ben-Iesan, spokesman at the city emergency operations center. "At every one of them, there are reports that as the helicopters come in people are shooting at them. There are people just taking pot shots at police and at helicopters, telling them, 'You better come get my family."'

Richard Zuschlag, president of Acadian Ambulance Service Inc., described the chaos at a suburban hospital.

"We tried to airlift supplies into Kenner Memorial Hospital late last evening and were confronted by an unruly crowd with guns, and the pilots refused to land," he said.

"My medics were crying, screaming for help. When we tried to land at Kenner, my pilots got scared because 100 people were on the helipad and some of them had guns. He was frightened and would not land."

Zuschlag said 65 patients brought to the roof of another city hospital, Touro Infirmary, for evacuation Wednesday night spent the night there. The hospital's generator and backup generator had failed, and doctors decided it was safer to keep everyone on the roof than carry fragile patients back downstairs.

"The hospital was so hot that with no rain or anything, they were better off in the fresh air on the roof," he said.

When patients have been evacuated, where to take them becomes the next big decision.

"They're having to make strategic decisions about where to send people literally in midair," said John Matessino, president of the Louisiana Hospital Association. "It's a very difficult thing to prioritize when they're all a priority."

Knox Andress, an emergency nurse who is regional coordinator for a federal emergency preparedness grant covering the state, said it's impossible to underestimate the critical role hospitals are playing for anyone left in the city.

"They're running out of their medications, they're running out of money. They're having social issues and where do they go? They go to the hospital. The hospital is the backbone of the community because the lights are always on," he said.

When hospitals can't take care of people and the rescuers need rescued, there's no social fabric left, Andress said.

Hospitals weren't the only facilities with troubles.

Louisiana Lt. Gov. Mitch Landrieu, who has been working with search and rescue, confirmed that 30 people died at a nursing home in St. Bernard Parish and 30 others were being evacuated. He did not give any further details.

Copyright 2005 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

Inside the ER: Summit Hospital, Baton Rouge


Dave Miller, a registered nurse and the director of the emergency room at Baton Rouge's Summit Hospital, worked virtually nonstop from Sunday through Wednesday, breaking only twice—once for a two-hour nap and once to run home and turn on a generator when the power failed. Summit's waiting room was full of people who couldn't go home or be sent to shelters, which were already full. And the patients kept coming, from evacuated hospitals in New Orleans, from that city's shelters and its streets, and "from every place you can get them," says Miller

Minnesota: Health plan cuts target social issues

Excerpted from the St. Paul Pioneer Press. Emphasis added.

Circumcisions and impotence drugs such as Viagra are no longer being routinely covered by Minnesota's publicly subsidized health plans for low-income residents.

These and other benefit cuts, which took effect Thursday, were driven largely by lawmakers seeking to trim costs from this year's state budget. But the cuts aimed at some particularly sensitive social issues.

Projected savings through benefit reductions, fiscal year 2006:

$1.3 million: Require prior state authorization for non-emergency imaging (CT, MRI, etc.), hysterectomies, bariatrics, non-emergency Cesarean deliveries and other procedures.

$1.1 million: Limit coverage of emergency room visits to those involving emergencies or urgent care needs.

$216,000: Limit coverage of circumcisions to those required by religious practice.

$178,000: Deny coverage of drugs for erectile dysfunction.

$15,000: Deny coverage of sex-change operations.

Thursday, September 01, 2005

Payments to Iowa specialists draw HHS scrutiny

From Modern Physician

HHS' inspector general's office subpoenaed two health plans for information about payments to specialists at 281-bed Covenant Medical Center, Waterloo, Iowa.

Covenant Medical is part of three-hospital Covenant Health System. Chris Hyers, the system's vice president of business development, said the hospital had not received an investigative subpoena from the inspector general's office and declined to comment on the insurers' subpoenas because officials had not seen them. A spokeswoman for the inspector general's office confirmed that subpoenas were issued to John Deere Health, Moline, Ill., and Wellmark Blue Cross Blue Shield, Des Moines, Iowa, but declined further comment.

Earlier this year, local news reports questioned whether Covenant Medical's payments to a gastroenterologist and two orthopedic surgeons exceeded fair market value. The hospital paid a total of more than $5 million in compensation to the three physicians in both 2002 and 2003, while providing $1.9 million in charity care each year, according to IRS filings. Hyers said the compensation reflected how hard the physicians worked and a shortage of specialists in the area.

John Deere Health confirmed it had received a subpoena but declined to comment further. Wellmark declined to coment at all.

Illinois Governor Signs Med Mal Bill

Illinois Gov. Rod Blagojevich signed legislation on August 25 limiting damages in malpractice suits in the state.

Under the law, sponsored by state congressmen James Clayborne, Jr., and Dan Reitz, a jury is limited to awarding plantiffs $500,000 for personal pain and suffering in cases against physicians. The cap is $1 million in cases against hospitals.

The law also contains provisions that allow for greater scrutiny of malpractice insurance rates

More on Hattieburg

Everyone else is focusing on New Orleans, I'm following Hattiesburg, MS. From The Hattiesburg American:

The failure of a generator at Forrest General Hospital early today forced the shifting of patients to other parts of the hospital.

The hospital on Wednesday began transferring some of its patients to hospitals in Jackson and Mobile, Ala., as its water and food supply dwindled.

"We are in a really critical mode," said Millie Swan, hospital spokeswoman. "I hope people realize the seriousness of this. It's times like these that you learn the lesson of how important water really is."

"On Tuesday, nearly 500 people came through the emergency room," Swan said. On a normal day, the hospital usually treats about 200 in the ER.

Officials with the Federal Emergency Management Agency arrived at Forrest General Wednesday afternoon to help triage patients.

Mader said Wesley is treating about 200 patients in its emergency room each day.

"Those people who are non-trauma will have to wait," she said.

Both hospital officials said there has also been a lot of people stopping by the hospital, looking for a place to stay.

"We are not a shelter," Swan said. "Please only come to the hospital if you have an emergency."

"If you do not need immediate medical attention, please don't look to us as a place to sit," Mader said. "We are working diligently to treat our patients."

Left Without Being Seen

From the New Bern Sun Journal

The U.S. General Accounting Office reported recently that as many as 7 percent of emergency departments nationally have "leave without being seen" rates higher than 5 percent. According to the Annals of Emergency Medicine, some emergency departments have reported rates as high as 15 percent.