Open Hearts Gives Marie a Second Chance

Open hearts give Haitian patient a 2nd chance - The Naperville Sun couriernews.suntimes.com/lifestyles/200… via @napervillesun
— John A. Carroll (@haitianhearts) May 22, 2013

Marie Goes Home

Marie goes home....blogs.pjstar.com/haiti/2013/05/…
— John A. Carroll (@haitianhearts) May 22, 2013

Monsignor Rohlf's Threat

In 2003 Monsignor Rohlfs threatened to go to the media against Haitian Hearts if I petitioned for a tribunal court against OSF. I could not hardly believe he was saying this to me and Patricia Gibson was standing in his office agreeing with him. I told him I would anyway and spoke to Bishop Jenky that afternoon.

After reading the article tweeted below, I am now not surprised about Monsignor Rohlf's threat against Haitian Hearts. (The article below has a typo...it is "Rohlfs" not "Wallace".)

Mother of Alleged Abuse Victim Says Archbishop Myers Threatened Her Family njtvonline.org/njtoday/video/… via @njtvonline
— John A. Carroll (@haitianhearts) May 21, 2013

Attitudes

Photo by Maria King Carroll

"Attitudes are more important than abilities. Motives are more important than methods. Character is more important than cleverness. And the heart takes precedence over the head."

Denis Parsons Burkitt, 1911-1993

(Dr. Burkitt was an Irishman who drove across sub-Saharan Africa in his beat up Ford pick up truck. He found many African kids between the ages of 5 and 8 years who had deadly facial tumors. He biopsied the tumor and it was found to be caused by a virus. Who would have thought that a virus could cause a cancer now called Burkitt's lymphoma?)

Will OSF Follow Through With Hannah?

Forum: Will OSF follow through with Hannah? shar.es/lwL3N via @sharethis
— John A. Carroll (@haitianhearts) May 6, 2013

Social Injustice in Medicine

Science has revolutionized medicine but there was no revolution and no plan for ensuring equal access. Excellence without equity is what you now inherit. It’s the chief human rights problem of twenty-first-century medicine, and only when we’re all under general anesthesia of the soul will we be able to ignore it as the century marches on.

Farmer, Paul (2013-03-02). To Repair the World (p. 18). University of California Press. Kindle Edition.

More than Technology

Our View: A life-saving moment for Hannah, and a landmark for Peoria - Peoria, IL - pjstar.com pjstar.com/opinions/ourvi…
— John A. Carroll (@haitianhearts) May 1, 2013

Korean Toddler Gets New Trachea at OSF-CHOI...OSF's Haitian Patients Denied Care

Toddler youngest in world to get lab-made windpipe in Peoria operation shar.es/lpMUZ via @sharethis
— John A. Carroll (@haitianhearts) April 30, 2013

Can You Speak Out Without Getting Fired...Be Careful

Can You Speak Out Without Getting Fired? medscape.com/viewarticle/78…
— John A. Carroll (@haitianhearts) April 24, 2013

Illness as a Moral Experience

Looking at medicine this way reinforced my belief that the structure and demands of medical schools and hospitals create obstacles to caregiving. How to revivify caregiving in medicine became the issue. Teaching about illness experiences remains important. Yet the moral–emotional core of those experiences deserves greater primacy — as does the social suffering that affects everyone, but especially marginalized people already injured by poverty, isolation, and other forms of structural violence.

Another orienting issue is the lived relationship between patient (and family) and clinician. Here the anthropological model of exchange based in reciprocity can counterbalance the market model's infiltration into even the most intimate parts of health care. The anthropological perspective suggests that care resembles gift exchange between individuals whose relationship to each other really matters. Stories and meanings are exchanged, but also the raw experience of responsibility and emotional sensibility. Over time, caregiving changes the moral life of both caregiver and care receiver. Ultimately, caregiving is about doing good for others, and doing good in the world, as naive as it may sound, is what medicine is really about. That's what draws people to its practice, even if it's also about technology, biomedical science, and markets. That moral core of medicine may seem abstract, until you see health professionals passionately struggling to be useful, compassionate, responsive, and responsible while working with the indifference of bureaucratic rules, the cold counting and costing of institutional audits, and hard-to-balance personal demands on their time and concern.

Modern medical practice's greatest challenge may be finding a way to keep caregiving central to health care. That way will turn on structural and economic developments, technologies, and therapeutic models, but also on the importance that professionals ascribe to patients' deep experience and to such enduring moral practices of caring as the laying on of hands, the expression of kindness, the enactment of decency, and the commitment to presence — being there for those who need them. This is the embodied wisdom medical students need to learn and we all must remember. It is the lesson for the art of living and the art of medical practice that emerges from my 40 years of rethinking and reliving this subject.

Arthur Kleinman, M.D.

New England Journal of Medicine 2013; 368: 1376-1377

Good Friday in Haiti

It is very early Good Friday morning.

Marie just texted me: "Dr mwn pa kapab respire bien ni donmi" ("Doctor I cannot breathe well or sleep.")

Jesus actual cause of death as He hung on His cross was suffocation. Marie is having fluid from her heart backing up into her lungs, which floods her alveoli and impairs oxygen transfer. Marie is suffocating on her cross like our Lord did on His.

Jesus could text no one. Marie can.

Jesus had to die. Marie doesn't.

Our response hasn't changed much in two thousand years.


John A. Carroll, MD
www.haitianhearts.org

More ER Crowding Means More Inpatient Deaths

See this abstract from the online version of Annals of Emergency Medicine, December 2012.

"They are going to let me die..."

Early this morning Marie texted me: "They are going to let me die, Doctor Carroll."

I quickly called her on Skype. She does not sound good. Marie cannot breathe well or sleep well. She seems to be dying of congestive heart failure due to her mitral valve which has been destroyed.

I have e mailed multiple people in the States and in Haiti requesting help for Marie. She needs to be hospitalized for oxygen and aggressive diuresis. And then she needs valve replacement.

@micheljmartelly Please help young lady with heart problem. She was operated in Illinois...needs help today..Marie at 47735075. Thx.
— John A. Carroll (@haitianhearts) March 26, 2013

OSF Please Follow Your Philosophy

Please, OSF, follow your Mission Philosophy....blogs.pjstar.com/haiti/2013/03/…
— John A. Carroll (@haitianhearts) March 25, 2013

Sounds Like Peoria to Me

Lyons: U.S. patients the victims of health care profiteers shar.es/ezQUa via @sharethis
— John A. Carroll (@haitianhearts) March 20, 2013

Pope Francis

Clearly defining his vision of his own role, he quoted from scriptural texts to say that as Bishop of Rome, he was endowed with “a certain power.”

But he went on: “Let us never forget that authentic power is service and that the pope too, when exercising power, must enter ever more fully into that service which has its radiant culmination on the Cross.”

“He must be inspired by the lowly, concrete and faithful service which marked St. Joseph and, like him, he must open his arms to protect all of God’s people and embrace with tender affection the whole of humanity, especially the poorest, the weakest, the least important, those whom Matthew lists in the final judgment on love: the hungry, the thirsty, the stranger, the naked, the sick and those in prison.”

New York Times--19 March 2013

Social Sin

"We live in the most unequal part of the world, which has grown the most yet reduced misery the least. The unjust distribution of goods persists, creating a situation of social sin that cries out to Heaven and limits the possibilities of a fuller life for so many of our brothers."

Cardinal Jorge Mario Bergoglio
2007

Can You Imagine?

Can you imagine?livefromhaiti.blogspot.com/2013/03/can-yo…
— John A. Carroll (@haitianhearts) March 9, 2013

With the Greatest Care and Love

OSF-Saint Francis Medical Center (OSF-SFMC) is the largest medical center in Illinois south of Chicago. It used to be called St. Francis Hospital.

OSF's bills are sent to patients from OSF HealthCare Patient and Accounts and Access Center from 7134 Solution Center in Chicago.

After you read what your "total amount due" is there is a statement that says:

"Thank you for choosing OSF HealthCare and OSF Saint Francis Medical Center as your health care provider where we serve persons with the greatest care and love. The balance on this statement is now your responsibility."

When OSF-SFMC was St. Francis Hospital it did serve patients with the greatest care and love.

Advanced Medical Transport Takes Over in Chillicothe

Fire chief joins with AMT for Chillicothe ambulance service shar.es/YQ3b5 via @sharethis
— John A. Carroll (@haitianhearts) February 18, 2013

Rural EMS in Peoria Area Allowed to Administer Narcan...Hope the Peoria Fire Department Can Too

Lifesaving overdose treatment now available to volunteer EMTs shar.es/YUFm4 via @sharethis
— John A. Carroll (@haitianhearts) February 18, 2013

Haitian Hearts has Two Patients Accepted

Memose--October, 2012
(Photo by John Carroll)

Thirty-four year old Memose was just accepted by a medical center in the United States for reconstructive surgery of her jaw.

Thirteen years ago Haitian Hearts brought Memose to this same medical center for cancer of her right lower jaw. The cancer was resected and her fibula was used as a bone graft to make her a new jaw bone.  It is held together by a titanium plate and screws. After surgery Memose underwent radiation therapy and did very well and returned to her family in Haiti.

Unfortunately, after the 2010 earthquake Memose was lost to follow up. However, she resurfaced on Facebook and let her host family in the States know that she was not doing well. She said that she had a hole in her jaw with recurrent infections at the site of her previous surgery.

In October of 2012, I examined Memose in Port-au-Prince. She looked well aside from her right jaw. As the photograph shows, she has a five centimeter opening over her right mandible which exposes the plate and screws. Memose has radiation induced osteonecrosis, a known complication of radiation exposure.

After my exam, I sent photos and a history and physical to her surgeon in the States. He immediately responded and said he would do all he could to reconstruct Memose's jaw. And the medical center agreed to accept Memose as well. Her wonderful host family from thirteen years ago has her room in their home ready for her. We are working on obtaining her visa now for return to the United States.

I really don't care for Facebook but Facebook is how Memose communicated with her host family and  is the main way we communicate with her. Facebook played a big role in the Egyptian revolution and is playing a big role in saving Memose's life.
-----------

Woodson and Mom--January, 2013
(Photo by John Carroll)

The second patient is Woodson.

Woodson is a three year old toddler who lives on the outskirts of Port-au-Prince. In February of 2012, his mother carried him into the pediatric clinic in Cite Soleil.

My exam revealed a very loud murmur over his chest and an echocardiogram proved he had a ventricular septal defect. This is the most common congenital heart disease and is a hole in the wall of the heart that separates the two man pumping chambers.

I put Woodson on some medication which helps rid his lungs of excess water which can collect due to this hole which should not be there.

Woodson has been accepted by a group called CHADASHA which takes Haitian kids to the Dominican Republic for heart surgery. And Woodson will leave for the Dominican Republic with his mother in two weeks for surgery to patch the hole.

Thank you CHADASHA!


John A. Carroll, MD
www.haitianhearts.org

Archbishop John Myers

Cardinal Mahony, Archbishop Myers keep the scandal alive shar.es/YD1Fh via @sharethis
— John A. Carroll (@haitianhearts) February 17, 2013

Silent Doctors

Why Doctors Remain Silent nyti.ms/12pTk17
— John A. Carroll (@haitianhearts) February 15, 2013

Emergency Department Overcrowding

Rise in ED crowding tied to sicker patients needing more tests - amednews.com ama-assn.org/amednews/2012/…
— John A. Carroll (@haitianhearts) February 14, 2013

OSF Blinks Regarding Rescue 33

Rescue 33 care remains a main concern - Peoria, IL - pjstar.com pjstar.com/news/x10375016…
— John A. Carroll (@haitianhearts) January 29, 2013

Peoria's Medical Mafia Alive and Healthy

Confidential document gives detailed information on Rescue 33's problems - Peoria, IL - pjstar.com pjstar.com/news/x15038071…
— John A. Carroll (@haitianhearts) January 25, 2013

Discernment

It is just never a good idea if someone is going to "discern" whether you will receive medical care or not.

George Hevesy Resigns at OSF

George Hevesy, MD resigned last month (December, 2012) as Medical Director of the Emergency Department at OSF.  George is still employed at OSF as an attending physician in the Emergency Room.

He still works for OSF and collects his paycheck.

See this post from November, 2011.

Call OSF (309-655-2000) and ask for the OSF-SFMC spokesperson. Call OSF and ask for the Human Resource Department.

Call OSF to find out why George resigned as Medical Director of the Emergency Department.

I doubt you will get too far, but give it a try. (OSF records some phone calls so be careful.)

Call OSF and ask why George resigned.

-----------

Addendum: In the past George was Chairman of the State of Illinois Disciplinary Review Board and also Illinois Region 2 EMS Medical Director for the Illinois Department of Public Health.

It Doesn't Make Much Difference

It doesn't make much difference if you are poor and uneducated in Peoria or Port-au-Prince. You don't have much of a chance.

If you, or your equally poor neighbor, or the local mafia, or the "good guy" at your community center, doesn't throw up barriers, someone else will.

And for the rest of us silence and keeping one's head buried in the sand is golden.

More EMS Fun in Peoria

John A. Carroll ‏@haitianhearts

More EMS fun in Peoria...Chillicothe council to choose between AMT and Rescue 33 http://shar.es/46cQi  via @sharethis

2012 is Almost History

Medic Command Calls Slowed a Dysfunctional OSF Emergency Department

While working in the ER at OSF in Peoria the medic command calls rolled in all day long. The calls were from medics in the field who knew what they were doing and their care was protocol driven.

I thought it was largely a waste of time for physicians to answer these calls. And sick patients in the ER and the ER waiting room waited longer because of these calls.

And there was pressure to answer these calls. The number of medic command calls answered by each physician was tallied and distributed at the end of each month.

Why?

EMS in the Peoria Area was based at OSF and still is. And the idea was for OSF to keep control of the Peoria Area EMS. It's all about money as we know. 

The letter to the editor below describes my feelings quite well. 

John 

Emergency Medicine News:

January 2013 - Volume 35 - Issue 1 - p 4

doi: 10.1097/01.EEM.0000425855.74142.40

Letter to the Editor

Letter to the Editor: EMS an EM Mess

Editor:

Maybe it's just me, but has anyone wondered about the efficacy and effectiveness of providing on-line medical command to prehospital care providers?

To me, the medic command calls are just one more senseless interruption, (along with signing crutch forms, signing the PA's charts, and looking at urine culture sensitivities for discharged patients). Having become increasingly aware of the potential for interruptions during a busy shift to wreak havoc with “door-to-doctor time” and “length-of-stay” statistics, I am seeking new ways to stay focused on minimizing “task stacking,” and actually to finishing something I start. Our CEO was witnessed recently sitting in the ED waiting area with a stopwatch. No joke!

So when the radio or phone goes off and the nurse or secretary calls out, “Medic command!” (my Pavlov's bell), I am rarely actually interrupting my current task for any logical reason. Most prehospital arrivals at my shop are, in effect, primarily horizontal rides to the hospital. The vanishing minority of calls that are true medical emergencies are almost all protocol-driven (e.g., hypoglycemia, chest pain, respiratory distress, seizure activity, hemorrhage, stroke), so why am I even being asked to give command?

And if the medics are only calling to notify our ED of an imminent arrival, why can't the secretary or nurse answer the call and make a bed available?

Drs. Michael Callaham and Brian Bledsoe have been strident and eloquent iconoclasts on the mythology of the EMS system and its protocols.

Lights and sirens, MAST trousers, helicopters, most cardiac medications, home AEDs, merit-badge courses, and even ambulance transport itself are of little or no benefit. What's up with medic command?

David M. Lemonick, MD

Pittsburgh, PA

Breaking News: AMT to Take Over Ambulance Service in Chillicothe...Are You Surprised?

Rescue 33 rejects consolidation offer shar.es/hsw3H via @sharethis
— John A. Carroll (@haitianhearts) December 18, 2012

Medical Repatriation

New York Lawyers for the Public Interest and the Center for Social Justice at Seton Hall University School of Law Release Report Documenting Hundreds of Cases of Coerced Medical Repatriation of Undocumented Immigrants by U.S. Hospitals

Medical repatriations of undocumented immigrants likely to rise as result of federal funding reductions to safety net hospitals under Affordable Care Act

_____________________________________________________________________________________

New York, NY, and Newark, New Jersey, December 17, 2012 − Today, the Center for Social Justice (CSJ) at Seton Hall University School of Law and New York Lawyers for the Public Interest (NYLPI) released a report documenting an alarming number of cases in which U.S. hospitals have forcibly repatriated vulnerable undocumented patients, who are ineligible for public insurance as a result of their immigration status, in an effort to cut costs. This practice is inherently risky and often results in significant deterioration of a patient’s health, or even death.  The report asserts that such actions are in violation of basic human rights, in particular the right to due process and the right to life.

According to the report, the U.S. is responsible for this situation by failing to appropriately reform immigration and health care laws and protect those within its borders from human rights abuses. The report argues that medical deportations will likely increase as safety net hospitals, which provide the majority of care to undocumented and un- or underinsured patients, encounter tremendous financial pressure resulting from dramatic funding cutbacks under the Affordable Care Act.

The report cites more than 800 cases of attempted or actual medical deportations across the country in recent years, including: a nineteen-year-old girl who died shortly after being wheeled out of a hospital back entrance typically used for garbage disposal and transferred to Mexico; a car accident victim who died shortly after being left on the tarmac at an airport in Guatemala; and a young man with catastrophic brain injury who remains bed-ridden and suffering from constant seizures after being forcibly deported to his elderly mother’s hilltop home in Guatemala.

According to Lori A. Nessel, a Professor at Seton Hall University School of Law and Director of the School’s Center for Social Justice, “When immigrants are in need of ongoing medical care, they find themselves at the crossroads of two systems that are in dire need of reform—health care and immigration law. Aside from emergency care, hospitals are not reimbursed by the government for providing ongoing treatment for uninsured immigrant patients.  Therefore, many hospitals are engaging in de facto deportations of immigrant patients without any governmental oversight or accountability.  This type of situation is ripe for abuse.”

         

“Any efforts at comprehensive immigration reform must take into account the reality that there are millions of immigrants with long-standing ties to this country who are not eligible for health insurance.  Because health reform has excluded these immigrants from its reach, they remain uninsured and at a heightened risk of medical deportation,” added Shena Elrington, Director of the Health Justice Program at NYLPI. “Absent legislative or regulatory change, the number of forced or coerced medical repatriations is likely to grow as hospitals face mounting financial pressures and reduced Charity Care and federal contributions.”

Rachel Lopez, an Assistant Clinical Professor with CSJ stated, “The U.S. is bound to protect immigrants’ rights to due process under both international law and the U.S. Constitution.  Hospitals are becoming immigration agents and taking matters into their own hands.  It is incumbent on the government to stop the disturbing practice of medical deportation and to ensure that all persons within the country are treated with basic dignity.” 

More information about this issue can be found at medicalrepatriation.wordpress.com, a NYLPI- and CSJ-run website that monitors news and advocacy developments on the topic of medical deportation.

About New York Lawyers for the Public Interest

New York Lawyers for the Public Interest (NYLPI) advances equality and civil rights, with a focus on health justice, disability rights and environmental justice, through the power of community lawyering and partnerships with the private bar. Through community lawyering, NYLPI puts its legal, policy and community organizing expertise at the service of New York City communities and individuals.

About the Center for Social Justice at Seton Hall University School of Law

The Center for Social Justice (CSJ) is one of the nation’s strongest pro bono and clinical programs, empowering students to gain critical, hands-on experience by providing pro bono legal services for economically disadvantaged residents in the region. The cases on which students work span the range from the local to global. Providing educational equity for urban students, litigating on behalf of the victims of real estate fraud, protecting the human rights of immigrants, and obtaining asylum for those fleeing persecution are just some of the issues that CSJ faculty and students team up to address.

_______________________________________________

Andrew Rand's Letter to Chillicothe 33

Letter to Ambulance Rescue 33 From Advanced Medical Transport of Central Illinois

Haitian Hearts/Peoria

It's all the same.

Many good people on the ground that care.

Many good people who invoke Jesus's name all the time. Peoria version of "Si Bon Dieu vle".

Way more good here than bad.

It's all the same.

Young men smoking cigarettes talking through second floor open window of project housing to a woman that doesn't want to be bothered on sidewalk below.

United Against Violence on blue strap hanging from her neck.

John 3:16 carved in cement.

It's all the same.

Emergency Department Overcrowding Causes Patient Deaths

Please read this article from Annals of Emergency Medicine.

Physicians Fired for Questioning the Boss

---

November 30, 2012

A Hospital War Reflects a Bind for Doctors in the U.S.

By JULIE CRESWELL and REED ABELSON

For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments.

But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons.

Today, Boise is a medical battleground.

A little over half of the 1,400 doctors in southwestern Idaho are employed by St. Luke’s or its smaller competitor, St. Alphonsus Regional Medical Center.

Many of the independent doctors complain that both hospitals, but especially St. Luke’s, have too much power over every aspect of the medical pipeline, dictating which tests and procedures to perform, how much to charge and which patients to admit.

In interviews, they said their referrals from doctors now employed by St. Luke’s had dropped sharply, while patients, in many cases, were paying more there for the same level of treatment.

Boise’s experience reflects a growing national trend toward consolidation. Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe growing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay.

In Boise, just a few weeks ago, even the hospitals were at war. St. Alphonsus went to court seeking an injunction to stop St. Luke’s from buying another physician practice group, arguing that the hospital’s dominance in the market was enabling it to drive up prices and to demand exclusive or preferential agreements with insurers. The price of a colonoscopy has quadrupled in some instances, and in other cases St. Luke’s charges nearly three times as much for laboratory work as nearby facilities, according to the St. Alphonsus complaint.

Federal and state officials have also joined the fray. In one of a handful of similar cases, the Federal Trade Commission and the Idaho attorney general are investigating whether St. Luke’s has become too powerful in Boise, using its newfound leverage to stifle competition.

Dr. David C. Pate, chief executive of St. Luke’s, denied the assertions by St. Alphonsus that the hospital’s acquisitions had limited patient choice or always resulted in higher prices. In some cases, Dr. Pate said, services that had been underpriced were raised to reflect market value. St. Luke’s, he argued, is simply embracing the new model of health care, which he predicted would lead over the long term to lower overall costs as fewer unnecessary tests and procedures were performed.

Regulators expressed some skepticism about the results, for patients, of rapid consolidation, although the trend is still too new to know for sure. “We’re seeing a lot more consolidation than we did 10 years ago,” said Jeffrey Perry, an assistant director in the F.T.C.’s Bureau of Competition. “Historically, what we’ve seen with the consolidation in the health care industry is that prices go up, but quality does not improve.”

A Drive to Consolidate

An array of new economic realities, from reduced Medicare reimbursements to higher technology costs, is driving consolidation in health care and transforming the practice of medicine in Boise and other communities large and small. In one manifestation of the trend, hospitals,private equity firms and even health insurance companies are acquiring physician practices at a rapid rate.

Today, about 39 percent of doctors nationwide are independent, down from 57 percent in 2000, according to estimates by Accenture, a consulting firm.

Many policy experts praise the shift away from independent practices as a way of making health care less fragmented and expensive. Systems that employ doctors, modeled after well-known organizations like Kaiser Permanente, are better able to coordinate patient care and to find ways to deliver improved services at lower costs, these advocates say. Indeed, consolidation is encouraged by some aspects of the Obama administration’s health care law.

“If you’re going to be paid for value, for performance, you’ve got to perform together,” said Dr. Ricardo Martinez, chief medical officer for North Highland, an Atlanta-based consultant that works with hospitals.

The recent trend is reminiscent of the consolidation that swept the industry in the 1990s in response to the creation of health maintenance organizations, or H.M.O.’s — but there is one major difference. Then, hospitals had difficulty managing the practices, contending that doctors did not work as hard when they were employees as they had as private operators. Now, hospitals are writing contracts more in their own favor.

“Hospitals are constructing compensation in ways that are based on productivity and performance,” said Steve Messinger, president of ECG Management Consultants, which advises on physician acquisitions.

But the consolidation of health care may be coming at a hefty price. By one estimate, under its current reimbursement system, Medicare is paying in excess of a billion dollars a year more for the same services because hospitals, citing higher overall costs, can charge more when the doctors work for them. Laser eye surgery, for example, can cost $738 when performed by a hospital-employed doctor, compared with $389 when done by an unaffiliated doctor, according to national estimates by the independent Congressional panel that oversees Medicare. An echocardiogram can cost about twice as much in a hospital: $319, versus $143 in a doctor’s office.

Conflicts over the changes are numerous. One Florida primary care physician said he could earn a $5,000 bonus for keeping patients in the hospital for less than three days, according to a lawsuit he filed this year. Hospitals, which are typically reimbursed a fixed amount of money for treating a specific illness, can make more money if patients stay for shorter periods of time.

Last month, the Justice Department reached a $9.3 million settlement with Freeman Health System, a hospital group in Joplin, Mo., which was rewarding doctors it employed partly based on how many tests they ordered. Freeman says that it alerted regulators to the potential violations and that patient care was not affected.

Recently, the Office of Inspector General at the Health and Human Services Department sent a letter to emergency physicians across the country asking for information about inappropriate admissions. Federal regulators are also examining the higher numbers of physician contracts being created, searching for violations of laws that prevent hospitals from rewarding doctors for admitting patients or for ordering lucrative tests and procedures.

Health Management Associates, a for-profit hospital chain; EmCare, a Dallas-based emergency room staffing company for hospitals; and other hospitals have disclosed that they are the subjects of federal investigations. Regulators are looking into whether the hospitals improperly pressured physicians to admit patients.

Pumping Up Admissions

According to two emergency room doctors who worked at Carlisle Regional Medical Center in Pennsylvania, the message could not have been clearer: more patients needed to be admitted.

The doctors were employed by EmCare, whose parent company was later acquired by the private equity firm Clayton, Dubilier & Rice in 2011 as part of a $3.2 billion deal. EmCare, in turn, was under contract to provide emergency room doctors for the hospital, which is owned by Health Management Associates. In interviews, doctors said that hospital administrators created targets for how many patients they should admit. More admissions translated into more dollars for the hospital.

Dr. Jean-Paul Romes, one of the physicians, recalled getting phone calls in the middle of the night questioning why he had not admitted an older patient whose hospitalization he could easily have justified. “The pressure to admit was so high,” he said. Dr. Romes left the hospital last year.

After another physician, Dr. Cloyd B. Gatrell, raised concerns that the hospital had too few nurses to keep patients safe, an EmCare executive warned him to “back off,” according to a lawsuit Dr. Gatrell filed last year. EmCare later fired him at Carlisle’s request, according to the suit. Dr. Gatrell’s wife, Kathryn, a nurse at Carlisle, had been fired earlier and also filed a lawsuit. Both Gatrells maintained they were fired for bringing up patient safety concerns, according to Dr. Gatrell’s lawsuit.

Health Management, which operates 70 hospitals, said United States attorneys’ offices in seven states were investigating physician referrals, including financial arrangements and the “medical necessity of emergency room tests and patient admissions.”

EmCare said in an e-mailed statement that it could not comment on continuing legal matters involving it or its clients, but that its “first concern is the well-being of the patient.”

Health Management is also the target of a suit filed last year in Florida state court by a former executive who says there were improper admissions. The executive, Paul Meyer, an officer in the company’s compliance office, was a longtime employee of the Federal Bureau of Investigation. He said in his lawsuit that he was fired from H.M.A. in 2011 in retaliation for raising questions about what he felt were improper admissions at four of the chain’s hospitals. H.M.A. said its overall admission rate from the emergency department had remained constant in recent years and that its practices were in line with those of other hospitals. It also said there was no indication that Carlisle admitted any patients unnecessarily. Admissions are “based solely on what is best for patient care,” it said in an e-mailed statement.

The company said that it had addressed all of Mr. Meyer’s concerns, and that he was fired for what the company said was a failure to cooperate in an internal investigation. Health Management fired the Gatrells, it said, “for performance issues,” an accusation Dr. Gatrell strongly denied.

Doctors at other hospitals also say they have faced pressure to meet financial targets. Dr. Manuel Abreu said his contract with All Care Medical Consultants, a practice in Clearwater, Fla., allowed him to earn a bonus as high as $5,000 if he kept patients’ hospital stays to an average of no more than three days, according to a copy of the contract included with a lawsuit he filed in Florida state court this year. The parties reached a settlement and the case was voluntarily dismissed, court records show. Calls to Dr. Abreu’s lawyer and a lawyer for All Care were not returned.

Other physicians say they are pushed to ignore what is best for patients by referring them to doctors working for the same hospital. Dr. Victoria Rentel, a family practice doctor near Columbus, Ohio, recalled feeling pressured when she was employed by a local hospital to send her patients to doctors there for tests and procedures.

“I routinely got reports about the money I kept in the system,” Dr. Rentel said, detailing how much revenue she was generating for the hospital through in-house referrals. “I tended to refer to specialists I knew who would deliver better care.” The hospital eventually closed the clinic where she worked.

Some physicians also complain about quotas. Dr. Patricia F. White, an emergency room physician who worked at Baptist Health in Jacksonville, Fla., said that starting in 2010, her compensation was partly calculated based on the number of patients she saw an hour, according to a lawsuit she filed in August against the hospital and Emergency Resources Group, which provided emergency room staffing to Baptist.

The staffing group said it had no choice but to agree to the hospital’s demands. “If we don’t comply with their wishes as good partners, there is a termination notice in our contract,” wrote Paul Davidson, administrator for the group, in a series of e-mails that were included with Dr. White’s lawsuit.

In an e-mailed statement, Baptist Health said that patients expected timely access to quality care and that an emergency room physician’s “productivity and efficiency are vital components to delivering good patient care as well as ensuring patient safety and satisfaction.” A lawyer for Emergency Resources Group echoed those sentiments in an e-mailed statement, adding that efficiency was only one component of physician compensation.

Doctors at numerous hospitals said it was often difficult to criticize the policies instituted by hospitals or investor-owned physician groups because, as employees, they could easily be fired.

“We all have families, and we have mortgages,” said an emergency room physician. “If you get fired, it looks bad and it’s hard to get another job.”

Rising Medical Costs

It was about three years ago that Dr. Julie A. Foote, who has been an endocrinologist in Boise for 18 years, began noticing the ads in the local newspaper.

Each week, another advertisement appeared, heralding the hire of a physician or a practice group by either St. Luke’s or St. Alphonsus, which is part of Michigan’s Trinity Health, one of the nation’s largest hospital systems. “The playing field wound up being divvied up pretty aggressively,” Dr. Foote said.

In the last four years, St. Luke’s acquired 22 physician practices in the area.

Dr. Mark Johnson, a family practice physician who has worked in Boise for about 25 years, was part of a five-person practice that sold itself to St. Luke’s. Among the factors behind the decision were the high cost of adopting an electronic health records system, and a concern that the group members would not be able to find younger doctors willing to buy them out of the practice.

“But probably the driving reason was the changing landscape of health care delivery and the uncertainty around that,” Dr. Johnson said. “The thought was that we were going to be in a safer position if we were aligned and affiliated with a network.”

But as St. Luke’s moved forward with its plans to acquire most of the Saltzer Medical Group — a practice of about 50 doctors in Nampa, Idaho, about 20 miles west of Boise — St. Alphonsus filed an injunction to block the purchase.

St. Alphonsus argues that St. Luke’s dominance is hurting its business because it has experienced steep declines in hospital admissions and referrals from physicians acquired by St. Luke’s.

St. Luke’s says it is positioning itself to compete better by improving its ability to coordinate patient care. It recently filed an application with Medicare officials to become a so-called accountable care organization. Hospitals designated as A.C.O.’s can usually keep a portion of any savings they generate. They cut health care costs by avoiding unneeded procedures and tests or by keeping patients out of the hospital, while still meeting quality targets.

But St. Luke’s remains under investigation by state and federal authorities for possible antitrust violations. While most physician group purchases are too small to draw regulators’ attention, concerns have been raised about whether consolidation is resulting in higher prices and fewer choices for patients.

In 2009, the F.T.C. forced the sale of two outpatient clinics that had been acquired by Carilion Clinic, based in Roanoke, Va., saying Carilion’s fee structure would have increased patients’ out-of-pocket expenses for a brain imaging test, for example, to $350 from $40.

In another case, the F.T.C. and the Nevada attorney general ordered Renown Health in Reno to release 10 cardiologists from their noncompetition agreements after the hospital system bought the two largest cardiology groups in the area, giving it 88 percent of the market.

In Boise, doctors are pressured to refer only within their own system, according to St. Alphonsus in its complaint. It reported a 90 percent drop in admissions to its hospitals by physicians employed by St. Luke’s. In one community, independent doctors often send patients 40 miles away for CT scans because prices at St. Luke’s are 60 percent higher, the complaint said.

Mr. Pate, the St. Luke’s chief executive, disputed the notion that physicians employed by St. Luke’s were prohibited from referring patients to outside doctors.

“My own wife was referred by a St. Luke’s physician to a St. Al’s physician for her particular condition because he felt the St. Al’s physician was the best for this problem,” he said. “If the wife of the C.E.O. is being referred to a physician at another hospital, that should prove that our physicians send many referrals over there.”

Mr. Pate acknowledged that prices for some services had risen, but he said this was only because they had been severely underpriced. In the long run, he argued, overall costs will decline as St. Luke’s is better able to coordinate care, avoiding expensive emergency room visits and redundant tests.

But some people remain skeptical that patients will be better served.

“I’m not certain what all this means is that patients are getting cost-effective care, which is how the nation is painting this evolution,” Dr. Foote said. “If this is better quality for less price, I want to see the less price.”

MORE IN BUSINESS DAY (3 OF 26 ARTICLES)

Retail Frenzy: Prices on the Web Change Hourly

Read More »

Luckner Doing Well After Heart Surgery in Naperville

Luckner doing well after heart surgery. Please see this Chicago Tribune article.

More on Rescue 33

Chillicothe questioning OSF's Mission statements regarding Rescue 33.

See this article.

Rescue 33 Denied

An e mail was sent to Rescue 33 from the Project Medical Director at OSF stating that Rescue 33 in Chillicothe is finished.

The meeting was held at an undisclosed location and the press and public were not allowed by OSF to attend.

See this article in today's Peoria Journal Star.

There They Go Again....

Rescue 33 in Chillicothe has been permanently suspended by OSF's physician in charge of EMS.

OSF will not disclose where the meeting deciding Rescue 33's fate is going to be and the press and public have been banned from attending. The meeting is on Monday (10/1/2012).

See this article in today's Journal Star.

Comments that follow the article do not show much trust in OSF or AMT.

I think it is a done deal already. Rescue 33 is toast and the people of Chillicothe won't even know why. That is too bad.

I would love to have to eat my words. We will see.

A Broken Heart in a Cholera Treatment Center

Luckner

In June of 2011 I was notified by a physician friend of mine, Dr. Jen in Port-au-Prince, that she had a young patient named Luckner with a serious heart problem. She wanted to know if I would examine him and evaluate him as a candidate for heart surgery through Haitian Hearts.

I agreed to do this but I was located in central Haiti about three hours north of Port-au-Prince working in a Cholera Treatment Center at Albert Schweitzer Hospital. I asked Dr. Jen if Luckner could come up to Schweitzer and I would examine him. She said he would make the trip.

At the Cholera Treatment Center we had a tiny admit room. Hundreds of sick patients were coming every day with cholera. We put IV's in the sickest cholera patients in this room and sometimes we would have six or seven very ill patients in shock slumped in their chairs or lying unconscious on cots. Sometimes the patients were even slumped against each other in these close quarters.

One day a young man showed up. Even though I had never seen him I thought he had to be Luckner. He looked too strong and healthy to be a sick with cholera.

The young man was  Luckner and he looked scared. He was scared to be around so many deathly ill appearing cholera patients. I could tell he wanted to leave the Cholera Treatment Center as fast as possible.

I examined him quickly and could hear the loud murmur coming from his leaky aortic valve.

I assured Luckner that we would help him as much as we could and that he could head back to Port-au-Prince. He seemed to be a perfect candidate for repair or replacement of his aortic valve.

So I e mailed Dr. Jen and explained to her that Haitian Hearts would do what we could to get Luckner admitted into a US medical center for heart surgery.

I sent Luckner's history and physical and his echocardiogram to Dr. Bryan Foy a heart surgeon in Illinois who has operated many Haitian Hearts patients in the past. Dr. Foy reviewed the echo and agreed that Luckner needed surgery.

Dr. Foy operates out of a number of medical centers in northern Illinois. Edward Hospital in Naperville is one of them and they accepted Luckner for surgery.

During the past year Dr. Jen and her group of friends in Port-au-Prince were able to obtain a medical visa for Luckner. And they brought him to Naperville about one month ago. He is with a wonderful host family there.

And guess what? Dr. Foy operated on Luckner several hours ago and replaced his leaky aortic valve. (As I post this Luckner is in stable condition in ICU.)

This fortunate 25 year old man just received a new lease on life. My thanks to EVERYONE for all their help with Luckner during the last year.


John A. Carroll, MD
www.haitianhearts.org

Little Problems and Big Problems in Peoria's EMS

See this article in todays Peoria Journal Star.

Sometimes it is hard to see the forest through the trees.

Chillicothe Loses Ambulance Service and AMT Takes Over...

See this article and comments.

George and Keith at OSF

George Hevesy, MD

Keith Steffen

George is just about gone. He announced his resignation a few days ago.

What will this mean for Keith who has supported George for many years?

See this post.

This could get interesting.

Stay tuned.

Palliative Care Medicine

Palliative Care Medicine is "the active total care of patients whose disease is not responsive to curative treatment".

I think Palliative Care Medicine can be good in many ways. But it should not be forced on the patient or family.

The Archives of Internal Medicine in 2008 found that patients who received palliative care services cost the hospital $1696 to $4908 less per admission. And insurers notice these things. And so do hospital administrators who may not care for your loved one as much as you do.

So beware if the Palliative Care team of doctors and nurses seems extra-nice. Financial concerns for their hospital could be driving them as much as their desire to help the patient.

Mindless Menace of Violence

“Our lives on this planet are too short and the work to be done too great

to let this spirit flourish any longer in our land.

Of course, we cannot vanish it with a program nor with a resolution.

But we can perhaps remember, if only for a time,

that those who live with us are our brothers and sisters;

that they share with us the same short moment of life;

that they seek, as do we, nothing but the chance

to live out our lives in purpose and in happiness,

winning what satisfaction and fulfillment we can.

Surely this bond of a common fate, this bond of a common goal,

can begin to teach us something.

Surely we can learn, at least, to look at those around us as fellow man;

and surely we can begin to work a little harder

to bind up the wounds among us and

to become in our hearts brothers and sisters, compatriots once again.”

Robert F. Kennedy      ( 1925 – 1968 )

Insignificant but Important

Whatever you do will be insignificant, but it is very important that you do it.
Let's work together for a better tomorrow...

M Gandhi

Is OSF's CEO Worth 2.2 Million Dollars?

Sister Judith Ann Duvall
Chairperson of OSF St. Francis Healthcare System
(Photo by Peoria Journal Star)

Kevin Schoeplein, CEO of OSF Healthcare System in Peoria, received a salary of 2.2 million dollars in 2009. See this article.

Yet, OSF lets their own Haitian Hearts patients die in Haiti with no medical care. And Sister Judith Ann, pictured above, told me multiple times that OSF would never turn down a Haitian child for medical care. But they have.

Sister refers to OSF as a "sacred ministry." Unfortunately, this sacred ministry is a 5 billion dollar not-for-profit enterprise that has lost its core values.



John A. Carroll, MD
www.haitianhearts.org

OSF Mission Continues...

Long Waits in ER Dangerous for Patients

Dr. Ackroyd-Stolarz found that older people who stayed longer in the emergency department were more likely to have adverse events. In her retrospective cohort study, she included 982 patients 65 and older. The average age was 77.8 years, and 75 percent of them experienced a prolonged ED stay of six hours or more. Studying the records, she found that 140 had adverse events. Adjusting for total ED stay, she found that long stays in the emergency department were associated with a higher risk of adverse events. Those who suffered an adverse event stayed in the hospital twice as long as those who did not (20.2 days versus 9.8 days). Because the patients stayed in the hospital longer, they occupied acute care beds, an increasingly scarce commodity that exacerbated ED crowding.

Even when there are readily available beds, elderly people tend to stay longer in the emergency department because they come in with more complex illnesses and require a longer workup. But by far, the lack of inpatient beds is the most significant contributor as to why they are waiting, Dr. Ackroyd-Stolarz said. There is evidence that the elderly are more likely to be admitted to the hospital. They don't want to go to the emergency department unless they are really sick because they know they will wait, she said.

The higher risk for these patients often comes from a decreased physiologic reserve. They are often sicker with comorbid conditions, she said. In the future, we need to demonstrate that this association holds true in other hospitals.

Fixing the problem requires a system approach, said Dr. Ackroyd-Stolarz, not just focusing on the emergency department. People outside of emergency medicine will say, 'If we just fix how they do their business,' but it goes beyond the doors of the emergency department, she said, noting that hospitals need to investigate bed management and what occurs in the community, such as whether services are available to help avoid ED visits. If we provide more primary care services to nursing home residents, we may prevent that transfer to an emergency department in the middle of the night because there is no physician in the nursing home, she said.

Emergency Medicine News
July, 2009

Corrupt Corporations...Large Medical Centers Not Excluded

Company executives are paid to maximize profits, not to behave ethically. Evidence suggests that they behave as corruptly as they can, within whatever constraints are imposed by law and reputation. 


New York Times
July 11, 2012

Death in Haiti Deserves Thought

Photo by John Carroll

"Death in Haiti can be cruel, raw, and often devastatingly premature. There is often no explanation, no sympathy, and no peace, especially for the poor. Death's ubiquity, however, does not mean that it deserves any less attention or thought."

New England Journal of Medicine
July 5, 2012
Antonia P. Eyssallenne, M.D., Ph.D.

Doing the Right Thing

“You don’t want to be the outsider who betrays the institution; whistleblowers are always the weirdos,” Lessig said. “There are so many ways to rationalize doing the easy thing. And it’s really easy for us to overlook how our inaction to step up and do even the simplest thing leads to profoundly destructive consequences in our society.”

I asked Cory Booker, the Newark mayor, why he ignored his security team and made a snap decision to run into a burning house to save his neighbor. He said his parents taught him to feel indebted to all the people who had sacrificed for his family. And he recoiled in law school at the idea that there was not always a legal obligation to help the vulnerable.

“We have to fight the dangerous streams in culture, the consumerism and narcissism and me-ism that erode the borders of our moral culture,” he said. “We can’t put shallow celebrity before core decency. We have to have a deeper faith in the human spirit. As they say, he who has the heart to help has the right to complain.”

Maureen Dowd

The New York Times

American Sisters Under Direction of Holy See

See this article.

Rezko: Blago Knew

Read this article.

ER Overcrowding in Canada

Please see this article.

The Greatness of a Man

Great men in Cite Soleil--May, 2012 (Photo by John Carroll)

"...the greatness of a man is measured not in his lack of faults, but in the abundance of his strength."

Emerson