A new study of Texas hospitals found that hospitals are actually getting paid money to perform faulty surgeries.  In cases where preventable mistakes occur during surgery, hospitals are getting paid more money by insurance providers, resulting in an over $30,000 additional price tag. In these cases, a preventable mistake, such as a patient contracting pneumonia, or their incision becoming infected, the patient often must stay in the hospital for additional time. What once was a three and a half day hospital stay turns into a fourteen day stay, with a much more substantial price tag that comes at the expense of the patient’s insurance. While insurance companies do provide quite a bit of revenue for preventable mistakes, they do have a ‘never’ list of things that they will not pay for. This list includes leaving a sponge/instrument in a patient, or operating on the wrong body part.   See articles at Politico, Kaiser, and NY Times.

The researchers say that they don’t believe hospitals are intentionally allowing preventable mistakes to occur to gain income, but they do believe that there is no incentive for hospitals to improve their quality of care. If a patient catching pneumonia results in a $30,000 bonus to the hospital, why would the hospital want to reduce the chance of patients catching pneumonia?

To combat these preventable mistakes, some hospitals and doctors are now using checklists. These checklists sound obvious, including tasks like double checking the patient’s identification, body part being operated on, and if they’re allergic to any medications. By using these checklists, doctors and nurses ensure that they know who their patient is, what they need operated on, and what medication they should or shouldn’t have.

Since 2004, the Joint Commission, which accredits American hospitals, has required doctors and nurses to use a short checklist to increase surgical safety and to decrease preventable mistakes. If this checklist didn’t work, how is another supposed to help?
Read More →

Dr. David Hilfiker is writing a blog at Watching the Lights Go Out about his Alzheimer’s.  He is attempting to chronicle his journey until he is no longer able to do so, at which point he has enlisted a friend who has agreed to take over. His perspective on the disease is invaluable.  It’s a unique insight into a disease that afflicts many.
 

 

The Smithsonian Magazine had an interesting article on Thane Rosenbaum’s new book called Payback: The Case for Revenge.  Fordham University law professor Rosenbaum argues that the “desire to get even is an indelible part of our nature, and that it’s nothing to be ashamed of.  In fact, he says, we’d all be better off if society makes a place for revenge in our legal system, accepting it as an integral part of justice.”  Roosenbaum uses history, mythology, popular culture and recent events to “give revenge a chance.”

Rosenbaum argues “To me, there’s a greater moral outrage in not taking an eye for an eye, or in taking less than an eye for an eye. It’s the moral outrage that comes when people feel they can get away with something. We’ve been taught that vengeance is an artifact of our primitive past. But there is no justice unless people feel avenged. Criminals and wrongdoers should be made to pay back what is owed.”

Vengeance by definition is proportional to the wrongdoing.  Courts need to allow “permissible, legal pathways” for vengeance.  “But I do know that to under-punish, to shortchange, is a kind of moral violation that we should find intolerable. I write about the woman in Iran who was blinded by a classmate, with acid thrown in her face. Originally the sentence was that a doctor would put acid in the eyes of the person who did that—truly an eye for an eye. This woman has been blinded and disfigured for the rest of her life, and why should the other person not experience the same thing? In the end, both the court and she decided not to go through with that remedy. Some people were relieved. But I think it at least sends a message that she was entitled to that.”

He asserts “If the principles of the Constitution applied equally to protect victims as much as the accused, I would say that it is “cruel and unusual punishment” to deny victims the right to experience the reclaiming of honor that comes with punishing those who have done them harm.” He continues “People come to the law when they’re at their most vulnerable, their most emotional, their most morally injured. We have to respond to them at that level. Vengeance has a purpose. It has an emotional purpose, a moral purpose, a therapeutic purpose.

A Thane Rosenbaum courtroom is a much messier courtroom—it’s emotionally open. It’s not as clipped and canned and sanitized. It gives people an opportunity to express their grief, their loss, to speak to their pain. We don’t do that now. What I’m talking about is a much more tearful expression of justice. It’s much more honest; it’s therapeutic. There’s something very powerful in standing before your community and speaking to your loss.”

 

 

 

The Tampa Bay Times had a great article on remodeling your home to avoid entering a long term care facility.  “For many elder Americans, growing older often means uncomfortable changes in the ability to do day-to-day tasks and even basic mobility. One aspect of aging that millions of seniors are clear on is that they do not want to move out of familiar surroundings and into a nursing home. One alternative that is becoming increasingly more popular is to adapt the home to make it more user-friendly as we age. There are now even experts in the aging-in-place concept who can assist in these modifications.”

Some examples include putting night lights along the path from your bed to your bathroom or placing foam rubber around posts and footboard.  There are a dozen or more modifications that professionals recommend consumers consider, according to their specific needs and budgets:
–Grab bars in the bathroom over the tub and/or in the shower;
–For people in wheelchairs or using a walker, consider a ramp over the stairs. This would apply even for an apartment or condo with a low threshold.
–Reduce the step-up on stairs from the traditional 7 inches to 4 inches.
–Take out the tub and put in a shower — with the proper safeguards. (65,000 serious injuries happen in showers each year.)  A roll-in shower for people in wheelchairs can be built, with no lip or step and a drain slightly below floor level.
–Keep the tub and turn it into a walk-in. There are replacement walk-in tubs that can be expensive.
–Standard bathroom doors are 24 inches wide; the doorway can be widened to 30 or 32 inches by using off-set hinges.
–Replace round door knobs with levers. A lever door knob is much more practical and paddle levers for faucets.
–Tables and kitchen counters can be made to accommodate residents in wheelchairs. Exact measurements are made with the customer in his or her wheelchair.
–Kitchen ranges can be installed with controls in the front. Microwaves can be mounted lower for easier access.
–For residents with walkers or wheelchairs, vinyl or wooden floors are clearly better.
–Dead bolt locks can be installed with a remote button, similar to what is used on many new cars, along with the traditional key.