A medical equipment company has issued a voluntary recall of a line of infant bassinet warmers, stemming from a 2008 flash fire that burned a newborn.
In its July 20 recall, Draeger Medical, Inc.—which is based in Germany and has U.S. offices in Telford, PA—targets Stabilet infant warmer models 200, 300, 1250, 1500, 200/3000, 2000, 2200/3200, 3000, and 3200.
Draeger wants hospitals with Stabilets to take the following actions:
Plan to remove the models from service and replace them with alternate warmers if available
If Stabilets are the only available warmers in-house, hospitals should begin budgeting for replacements, limit Stabilet use to infants not requiring oxygen therapy, and clearly warn nurses about the recall of the models. Hospitals can use an infant incubator for babies who need warming and are receiving oxygen services.
Once removed from service, remove the heating element from the Stabilet warmers and sever the power cords
The fire in question occurred January 22, 2008, at Mercy Hospital in Coon Rapids, MN. A day-old baby was in an open-topped bassinet under a warmer and using an oxygen hood when something ignited, burning the boy. Nurses attending to the infant quickly extinguished the flames.
The ECRI Institute, a healthcare research company in Plymouth Meeting, PA, investigated the fire and determined a Hill-Rom Stabilet radiant warmer was the source of the fire.
Stabilets were originally manufactured by Hill-Rom Company, Inc., in Batesville, IN, and it discontinued the line in 1998 and stopped serving the products in 2003. Draeger acquired the Stabilet line from Hill-Rom in 2004.
Microscopic investigation revealed several sites of overheating in the warmer that were the likely source of the particle that fell into the bassinet and caused the fire. Maintenance activities wouldn't have picked up such damage because it was invisible to the naked eye, according to Mercy Hospital.
Draeger wasn't allowed to test the warmer involved in the incident, says Glenyce Scott-Hoglund, a marketing communications manager for the company.
"Only the hospital's hired experts, ECRI, have been given access to test and evaluate the evidence collected concerning the incident," Scott-Hoglund says. "This is the decision of the hospital."
She would not comment on the ECRI Institute's conclusions. "However, Draeger determined to err on the side of caution, and has initiated this voluntary recall," she says.
Allina Hospitals & Clinics, which owns Mercy Hospital along with 10 other medical centers, agrees with the ECRI Institute's conclusions, says David Kanihan, Allina's director of public relations.
"We had to take five warmers out of service, and had actually done that some time ago," Kanihan says.
The infant survived the fire, but suffered burns of varying degrees on 17% of his body, according to a 2008 report provided from the Minnesota Department of Health, which also investigated the incident.
The state found the facility properly completed preventive maintenance on the equipment prior to the incident.
The United States is spending as much as $147 billion each year for obesity-related healthcare–representing nearly 10% of all annual medical costs–and that figure is expanding along with the nation's waistline, according to a joint study by the Centers for Disease Control and Prevention and the Research Triangle Institute.
The study titled–Annual Medical Spending Attributable to Obesity: Payer- and Service-Specific Estimates—was released on Monday, the opening day of the CDC's Weight of the Nation conference in Washington, DC.
"Although bariatric surgery and other treatments for obesity are increasing in popularity, in actuality these treatments remain rare," says Eric Finkelstein, director of RTI's Public Health Economics Program and the study's lead author. "As a result, the medical costs attributable to obesity are almost entirely a result of costs generated from treating the diseases that obesity promotes. Thus, obesity will continue to impose a significant burden on the healthcare system as long as the prevalence of obesity remains high."
The study reports that obesity increased by 37% between 1998 and 2006 and that increase is responsible for 89% of the overall increase in obesity costs that occurred during that period. In addition, the proportion of all annual medical costs that are due to obesity increased from 6.5% in 1998 to 9.1% in 2006. This total includes payment by Medicare, Medicaid, and private insurers, and includes prescription drug spending.
Overall, obese people spent $1,429 (42%) more for medical care in 2006 than did normal weight people. These estimates were compiled using national data that compare medical expenses for normal weight and obese people.
Much of the costs to Medicare are a result of the added prescription drug benefit. The study shows that Medicare prescription drug payments for obese individuals are roughly $600 more per year than drug payments for normal weight beneficiaries. The researchers also found that 8.5% of Medicare expenditures, 11.8% of Medicaid expenditures, and 12.9% of private payer expenditures are attributable to obesity.
In addition to the study, CDC has issued its first comprehensive set of evidence-based recommendations to help communities tackle the problem of obesity through programs and policies that promote healthy eating and physical activity. The report–Recommended Community Strategies and Measurements to Prevent Obesity in the United States–and a companion implementation guide, appear in CDC's MMWR Recommendations and Reports, and are also available on the CDC Web site.
CDC partnered with the International City/County Management Association to pilot test a set of obesity prevention measures in 20 communities. The resulting 24 recommended strategies and suggested measures are now being pilot tested by Minnesota and Massachusetts state health departments to gauge their success. The strategies include locating schools within easy walking distance of residential areas, and improving the availability of affordable healthier food and beverages.
Bariatric surgery in California is three-and-a-half-times more expensive than in Maryland, according to a new HealthGrades study that also found wide variations in the quality of outcomes at hospitals that perform the elective weight-loss procedures.
The HealthGrades Fourth Annual Bariatric Surgery Trends in American Hospitals Study, released today, found that California was, on average, the most expensive of the 19 states evaluated for bariatric surgery, with an average charge per procedure of $52,224. Maryland was the least expensive with an average charge per procedure of $14,577.
Consistent with other studies, HealthGrades also found that high bariatric surgery volumes correlate with better outcomes. Hospitals with more than 375 bariatric cases in three years had a 32% lower risk of in-patient complications than lower-volume hospitals with less than 75 cases over three years.
Golden, CO-based HealthGrades evaluated 153,355 bariatric procedures performed during 2005-2007 in 19 states that provide all-payer information. The study analyzed outcomes for the most common gastric bypass procedures, such as less-invasive laparoscopic procedures including gastric banding, malabsorbtive procedures, and combined malabsorbtive/restrictive procedures.
"Due to the wide gap in quality we see among bariatric surgery programs, we encourage patients to carefully evaluate the volume and in-hospital outcomes of the bariatric program they are considering," says Rick May, MD, a senior physician consultant with HealthGrades and a co-author of the study.
The study also found that:
Bariatric surgery patients treated at top-rated hospitals have, on average a 67% lower chance of experiencing serious complications compared to patients who receive treatment at poorly rated hospitals.
Patients having surgery at five-star hospitals spent, on average, more than half a day less in the hospital (2.15 days) compared to patients having surgery in one-star hospitals (2.72 days).
Of the 19 states studied, more than 61% of all procedures were performed in five states: New York, Texas, Pennsylvania, California, and Florida.
Patients in Vermont, on average, spent the most time in the hospital (3.26 days), while patients in Nevada, on average, spent the least amount of time in the hospital (1.56 days).
The number of inpatient procedures during the study years 2005 through 2007 showed no significant increase, but an increasing percentage of surgeries are being performed outpatient.
More Center of Excellence bariatric surgery programs earned a five-star rating (29.5%) than non-COE programs (12.3%).
Laparospcopic bariatric surgery procedures account for 79% of all procedures, up from 54% in last year's study.
Patients had a three times lower in-hospital death rate associated with a bariatric surgery if they had it performed at a five-star hospital versus a one-star hospital.
The states included in the study were: Arizona, California, Florida, Iowa, Maine, Maryland, Massachusetts, Nevada, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Vermont, Virginia, Washington, and Wisconsin.
The Congressional Budget Office (CBO) said on Saturday that the Obama administration's proposal to give an independent panel--which it called the Independent Medicare Advisory Council (IMAC)--the power to control Medicare costs would only save about $2 billion over 10 years.
Overall, this is a tiny blip compared to the bill's cost of $1 trillion-plus price. However, that did not faze Office of Management and Budget Director Peter Orszog, who said in his White House blog, that the point of the proposal was "never to generate savings over the next decade."
In particular, under the administration's approach, the IMAC system would not even begin to make recommendations until 2015, he said. "Instead, the goal is to provide a mechanism for improving quality of care for beneficiaries and reducing costs over the long term," Orszag added.
In other words, in the "terminology of our 'belt and suspenders approach' to a fiscally responsible health reform, the IMAC is a game changer not a scoreable offset," he said.
However, if the legislation were to provide an independent advisory council with "broad authority, establish ambitious but feasible savings targets, and create a clear, fall back mechanism for instituting across the board reductions in net Medicare outlays," CBO said "such a council would identify steps that could eventually achieve annual savings equivalent to several percent of total spending on Medicare."
Achieving these savings, in addition to those resulting from the provisions in HR 3200, would govern Medicare's payment rates. This would probably require significant changes in the program's coverage, benefit design, and payment and delivery systems--and a council with the clear mandate, independence, and resources to propose such changes, according to CBO.
In the health reform debate, U.S. Health and Human Services Secretary Kathleen Sebelius has been talking a lot lately about personal responsibility. During a recent appearance on the Daily Show, she jokingly admonished host Jon Stewart to "have a lettuce sandwich" instead of a Snickers bar.
"There's personal responsibility in all of this," she said.
So why are so many health providers not in sync with her message? Far too many practitioners who are supposed to model good health habits and counsel their patients about getting to a healthy weight don't think their messages need apply to themselves.
That's the concern from a growing number of providers who worry that excess weight on the trusted healer may be one reason seriously overweight patients don't take seriously any advice to slim down. If the doctor or the nurse or the physician's assistant thinks it's okay to be that way, then it must be okay for the patient too.
One such physician who worries a great deal about the expanding girth of those in the health professions is Nick Yphantides, M.D., now consulting medical director for San Diego County Health and Human Services Agency.
In his new role, he speaks to and attends a lot of medical conferences. "And all around I see a disproportionate number of obese and overweight physicians. And to me, the rate of obesity among health professionals, subjectively, is at least a bad if not worse than in the general population," he says.
"You go to a hospital or an outpatient setting, and the first people you see are the nurses stuffed into scrubs, like 10 pounds of groceries in a 5-pound bag."
"We have to walk the walk and talk the talk," Yphantides said. "Unfortunately, in this area of fitness and weight, the majority of the time, we are saying one thing and doing another. And it really is unacceptable."
Yphantides is an evangelist on the subject because he too used to be morbidly obese, a self-proclaimed "board certified medical hypocrite" One day in 2001, he was trying to counsel an obese patient when he realized the absurdity.
He decided to prove that he could change, and send a message for his patients as well.
He took a leave from his then job directing a community clinic and launched a year-long campaign to tour the country to see baseball games in 50 stadiums, one in each state. Along the way, he absorbed a high protein liquid diet, exercised and lost enough weight to become a shadow of his former self. He shed 270 pounds.
In his role with San Diego County, he hopes to persuade health providers as well as patients that weight is at the heart of health reform. But it must start with the the role models in healthcare. The doctors and nurses.
"I really think that there needs to be a meaningful investment into the health and well-being of those at the bedside," he says.
"An overweight doctor is like a skinny Santa - nobody really trusts either one," he once wrote in his blog.
While there is little research on the rate of obese and overweight physicians, some studies are starting to appear on the tendency among nurses.
Last year, a study in the Journal of the American Academy of Nurse Practitioners reported on the results of a questionnaire mailed to a sample of nurses in six states. Nearly one in five of those who responded disclosed a BMI corresponding with obesity, and one in 20 revealed their BMI qualified them as morbidly obese.
Overall, 54% were overweight or obese, lower than the general population of adults which is 65%, but this figure was derived from personal disclosure by the participants in their mailed responses, not clinical examination of the participants, and may in truth have been much higher.
What's worse, in this sample, 71% said their professional roles included health education, but of these nurses, 18% were obese and 31% were overweight.
And 76% said that even though they acknowledged that overweight and obesity are diagnoses requiring health intervention, they do not pursue the topic with overweight and obese patients, perhaps because they did not feel prepared to discuss the problem, the survey study said.
Yes, there is an awkwardness to discuss the subject, wrote pediatrician Perri Klass, MD, in last week's New York Times. She described her own difficulty trying to counsel an 8-year-old whose rapidly increasing weight did not align with the child's age.
"How on earth, I was thinking, am I supposed to give sound nutritional advice when all they have to do is look at me to see that I don't follow it very well myself… How am I supposed to help stem the so-called epidemic of childhood obesity when not a week goes by that I don't break my own resolutions? What price the not-skinny doctor?" Klass wrote.
Another report in the Journal of the American Medical Association several years ago described the reaction from patients who were shown videotapes of a physician giving advice about diet and exercise. The patients reported that the physicians were more believable and motivating if they discussed their own personal healthy practices than if they did not.
"Physicians who have healthy personal habits are more likely to discuss related preventive behaviors with their patients," the report said.
Dr. Michael Dansinger, Obesity Researcher at Tufts-New England Medical Center, sent a video message to his fellow practitioners asking the question: "Is that white-coat feeling a little tight?"
"I know we can do much better. First, we must recognize that the human body needs at least an hour of exercise daily for optimum health, and every able-bodied physician should strive to achieve this," Dansinger said. "Second, we should eat at least five servings of vegetables and fruits daily, and third, those of us with excess body fat should literally count our daily caloric intake and aim for about 12 calories per pound of ideal body weight.
"If we can commit to these goals, both as individuals and as a medical community, imagine the example we would set! As individuals we will feel better and stronger, and as a medical community we'll serve as better role models for our patients.
"To succeed in healing others, we must also heal ourselves."
In their first unified voice on the subject, Texas Medical Center leaders sent a message to Congress as it tries to reform America's troubled health care system: slow down. Many of the medical center's biggest names said the issue is too important to rush through legislation that could have unforeseen harmful consequences.
With the Obama administration's top domestic priority struggling in Congress, supporters and opponents of the healthcare proposals are focusing on the constituency that both sides agree has become pivotal to the debate: the majority of Americans who have health insurance and are generally satisfied with their care. Although polls have consistently shown that just over half of Americans think the healthcare system is in need of reform, a substantial majority say they are satisfied with their own insurance and care. Any hope of change will require their support, according to experts and advocates across the ideological spectrum.
The government spends an estimated $12 billion a year on "potentially preventable" readmissions for Medicare patients, according to the Medicare Payment Advisory Commission, an independent congressional agency. U.S. leaders are trying to reduce such costs as they wrangle this week over how to retool the country's healthcare system. Lawmakers agree on the need to drive down readmissions, but not on how to do it.
As the debate in Washington heats up, Massachusetts healthcare and business executives warn that two goals of the Obama administration—expanding insurance coverage and controlling spending—may prove incompatible. And as Massachusetts strains to deal with the increasing costs of its successful healthcare program, they raise questions about who will pay for the projected $1 trillion cost on the federal level.
With House leaders struggling to reach agreement on healthcare legislation, a new hurdle has emerged: abortion. Some conservative Democrats are threatening to pull their support from the massive healthcare bill unless their concerns over potential federal funding of abortion procedures are met. They fear that the Obama administration will take advantage of an expanded government role in healthcare to increase the availability of abortions nationwide. Republicans, meanwhile, are trying to use the divisive issue to build opposition to the bill.
