A woman in need of a lung transplant died this week after her family said they tried repeatedly to have her transferred from a West Kendall medical center to Miami-Dade's taxpayer-owned Jackson Memorial Hospital, the only facility in South Florida capable of transplanting lungs and a designated safety net for uninsured county residents. The woman's family says Jackson Memorial officials denied her transfer first because they believed she was an undocumented immigrant, then because she was uninsured – and ultimately, after a week of denials because she was too critically ill to move. Jackson Memorial officials would not address the woman's case, citing patient privacy laws.
If a deadly flu epidemic hit Maryland, the governor could decide which patients would be put on life-saving ventilators — and which wouldn't. Maryland's attorney general issued an opinion in December that found that the Catastrophic Health Emergencies Act of 2002 gives the governor the authority to ration the machines that support breathing in flu patients suffering respiratory complications. That doesn't mean the governor would decide personally who gets a ventilator. Rather, he or she would declare a public health emergency and hospitals would rely on a set of criteria to allocate resources. Those criteria, however, don't exist yet.
The scenarios are grim: A pandemic influenza swamps the availability of hospital ventilators. A chemical spill exhausts antidote supplies and decontamination abilities. A terror attack overwhelms ambulances and trauma centers. A big earthquake, wildfire or hurricane throws emergency rooms into crisis. At the prodding of the federal government, state health departments nationwide are hurrying to complete "Crisis Standards of Care" plans to guide medical professionals in such catastrophes and determine what should trigger them. It's no easy task: Plan architects must navigate the ethical and legal minefields that would arise if there are more patients than providers at hospitals, clinics and other medical settings are set up to handle in usual fashion.
I wish the subject of this week's column existed before I underwent a root canal a decade ago. The dentist attacked the wrong tooth. He found the correct one a few days later, after I returned feeling like Mike Tyson had KO'd me. Medical mistakes: B-Line Medical is about catching them before they happen. The company, nestled in a corner building a block off Dupont Circle, sells kits to medical and nursing schools so educators can film future doctors and nurses practicing on people or on wired-up dummies. Educators use the recordings, from B-Line's "SimCapture" platform, as a teaching aid.
Despite questions raised by groups such as the American Medical Association and the American Chronic Pain Association, data shows physicians hold favorable views of the guidelines, which are expected to have some of the strongest impact on use of opioids in the U.S. From MedPage Today.
Nearly nine of 10 physicians support the CDC's draft guidelines on opioid prescribing, according to a survey from the physician networking site SERMO.
A total of 87% of 1,617 doctors surveyed said they would welcome or use the guidelines, which have been caught up in a controversy over whether the CDC was too secretive about its development process.
Despite questions raised by groups like the American Medical Association and the American Chronic Pain Association, physicians hold favorable views of the guidelines, which are expected to have some of the strongest impact on use of opioids in the U.S., even though they are not legally binding.
SERMO, which is a partner of MedPage Today, conducted the survey via email in a random selection of its U.S. membership. It also created an infographic of the findings.
The survey also found that half of doctors said they knew someone personally who has been addicted to opioids; the same proportion felt that the opioid overdose reversal agent naloxone should be offered over the counter.
Most respondents (82%) supported mandatory registration and use of Prescription Drug Monitoring Programs (PDMPs), and 63% said they were registered with their state's PDMP.
"I am frequently approached by patients with 'acute' complaints of pain," said one urgent care physician. "Since these patients are usually unknown to me, it is difficult to tell if these are truly acute issues versus drug seeking. PDMP is extremely helpful in differentiating these groups and making appropriate decisions."
But nearly 60% of respondents still believed opioids should be used to treat chronic pain that's not cancer or palliative care.
SERMO also conducted an additional survey of which tactic would be the most successful at curbing opioid abuse, posting the question on their network in addition to the email survey to garner a total of 1,961 responses.
Making PDMPs interoperable across state lines was seen as the most useful strategy (43%), followed by more education for physicians on proper opioid prescribing practices (20%).
"While there are some patients that need pain medications, there are several that have now become addicted and I think physicians need more training in not only how to prescribe pain meds properly but also how to cut back appropriately as well," said one internal medicine physician.
The same proportion chose increased access to medication-assisted treatment programs and more education for patients at risk (14%). Only 7% chose increased access to naloxone, and just 2% voted for needle exchange programs.
A New Hampshire hospital that discovered its vaccines were stored at inconsistent temperatures is asking more than 800 children to get revaccinated. State public health officials say the affected vaccines from Alice Peck Day Memorial Hospital in Lebanon aren't harmful but might have lost some potency. That means they could provide less immunity to disease. The problem occurred over the course of 14 months, from September 2014 to October 2015. The hospital is offering to revaccinate 827 patients at no cost to them or their insurance companies.