Ellen McCarthy was scheduled to receive her monthly dose of an ovarian cancer drug at Massachusetts General Hospital last month when she got distressing news: The hospital had run out. There was a nationwide shortage of the drug, Doxil, but her medical team scrambled and after a few days of uncertainty located an extra vial at a clinic in suburban New York. The 60-year-old retiree drove with her husband and dog to Mount Kisco, NY, received the intravenous treatment, then headed back home to Martha's Vineyard -- a 10-hour round trip. This week, McCarthy received Doxil at Mass. General. But with the manufacturer writing letters to physicians warning that the drug will be intermittently available in the months ahead, McCarthy doesn't know what to expect. "And my life depends on it,'' she said. "It never occurred to me in the course of treating my cancer, I was going to deal with a lack of supply.'' Drug shortages have been on the rise in recent years, affecting everything from antibiotics to anesthesia drugs, for reasons that range from manufacturing problems to companies discontinuing a medication. But shortages are particularly harrowing with cancer drugs, when time is of the essence and substitutes aren't always available.
The Connecticut Medical Examining Board on Tuesday rejected a settlement with a doctor who health inspectors say punctured a patient's spleen during a radiological procedure at New Milford Hospital last October and sent the patient home. The patient came back to the hospital's emergency room four hours later and died. "This case troubles me more than most," C. Steven Wolf, MD, an examining board member, said of Dr. Michael E. Waldman's actions. "He knows immediately he punctured the spleen, yet he doesn't tell the patient or the family. There is a wanton disregard for patient safety here." Waldman, 46, of Brookfield, was investigated by inspectors with the state Department of Public Health. He was recommended for discipline and faced possible license revocation and a fine. In a consent order worked out between health department lawyers and Waldman on Aug. 4, the department proposed a period of probation and monitoring by a consulting radiologist. But the medical examining board at its monthly meeting Tuesday rejected the consent order. "It's insufficient," said Robert A. Green, MD, a board member. "This is completely ignoring a life-threatening situation. He should have admitted the patient to the hospital for observation."
When Judith Nakamura tried to see a surgeon to follow up on her treatment for breast cancer recently, she was told it would be a two-month wait. Colleen Sullivan-Moore stepped in and got Ms. Nakamura an appointment the following week. Sullivan-Moore, at Presbyterian Healthcare Services in Albuquerque, NM, heads a team of nurse navigators. Their job: to help steer cancer patients through the medical-system maze. Over the course of Nakamura's seven months of treatment, Sullivan-Moore helped her understand the diagnosis and overcome her fears. The Presbyterian service, with four nurses and a social worker, is part of a growing field known as patient navigation. At no additional charge, navigators help patients make informed medical decisions and assist with setting up multiple doctors' appointments and tests. Navigators also provide tips on dealing with chemotherapy, make sure patients stay on track with their treatment plan and offer emotional support.
Hospitals and radiology practices around the United States have increasingly begun using high-tech CT scans to screen people for lung cancer despite intense disagreement about whether the testing should be done widely and, if so, who should undergo the exams. The trend was triggered by a recent federal study, which found that screening certain heavy smokers and ex-smokers could slash their chances of dying from lung cancer. The finding was hailed as one of the most important advances in decades toward reducing the toll from the nation's leading cancer killer. Proponents of screening say the scans could save thousands of lives, and people at risk of lung cancer should be able to get the exams -- and insurance companies should pay for them -- in consultation with their doctors. Critics of wide-scale testing acknowledge that CT screening represents an exciting advance but argue that it remains far from clear whether the benefits will outweigh the risks in the real world.
GAO is urging the Centers for Medicare and Medicaid beef up its approach to physician quality reporting, recommending CMS be more methodical in order to make the reports more reliable. GAO also recommended CMS find out why some physicians may not have read the reports and said it should ask a sampling of physicians about the reports' usefulness and reliability. CMS officials agreed with the recommendations. The Medicare Improvements for Patients and Providers Act of 2008 directed the Department of Health and Human Services to develop a program to give physicians confidential feedback on the resources used to provide care to Medicare beneficiaries. In response, CMS, an agency of HHS, implemented the Physician Feedback Program by distributing feedback reports to an increasing number of physicians that provided data on resources used and the quality of care. The Medicare law mandated that GAO conduct a study of the program.
An outbreak strain of Clostridium difficile, a bacterium that causes diarrhea and sometimes life-threatening inflammation of the colon, is common in Chicago-area acute care hospitals, an investigation published in the September issue of Infection Control and Hospital Epidemiology suggests. In response to Illinois Department of Public Health reports of rising rates of C. difficile infection as a hospital discharge diagnosis, the Chicago and Cook County health departments surveyed 25 Chicago-area hospitals over one month in 2009. They identified 263 total cases of C. difficile illness. Of 129 C. difficile isolates cultured from these patients, 61 percent were the outbreak C. difficile strain known as BI/NAP1. The BI strain, which is known to cause more serious illness, is usually associated with large acute outbreaks of C. difficile. However this investigation suggests that BI is endemic in the Chicago area and patients could be at risk for severe disease even in the absence of a large acute outbreak.