Rio Grande Regional Hospital in McAllen, TX, has been given a Level III trauma designation from the Texas Department of State Health Services—becoming one of only four hospitals in South Texas to receive certification for this level of care, the HCA Gulf Coast Division affiliate announced.
"Rio Grande Regional Hospital is already known for its excellent trauma care and our commitment to pursuing excellence in care," said Greg Seiler, CEO of the 320-bed acute care hospital. "By receiving the Level III designation, we continue to meet the needs of our growing community by providing quality trauma intervention and treatment."
Trauma surgeons and hospital staff are available 24 hours a day at the hospital. Specially trained nurses attend each trauma patient throughout the day for care advancement and coordination. Trauma data is collected and entered into a registry database for quality improvement and injury prevention initiatives. The trauma coordinator provides trauma education throughout the hospital.
HCA affiliated facilities in the Gulf Coast Division include 12 hospitals, seven ambulatory surgery centers, four free standing emergency centers, five imaging centers, five cancer care programs and a Regional Transfer Center. The Regional Transfer Center provides ground and air patient transportation to and from any HCA Houston Affiliated Hospital and any other healthcare facilities.
The Texas Medical Association is hailing a state judge's announced intention to impose limits on chiropractors' rights to diagnose medical conditions.
Texas District Judge Stephen Yelenosky said last week in a letter to lawyers handing the case that he would invalidate the Texas State Board of Chiropractor Examiners rules that would have allowed chiropractors to diagnose all medical conditions.
Yelenosky had earlier ruled that a chiropractic license does not authorize chiropractors to perform manipulations under anesthesia and needle electromyography procedures. The judge upheld chiropractors' authority to diagnose conditions that do fall within their scope. A final ruling is expected in a couple of weeks.
The judge's letter follows a ruling in November in which he granted a TMA and Texas Medical Board request for a partial summary judgment against the chiropractic board and the Texas Chiropractic Association. He said then that the wording of state law is ambiguous, but that a review of the legislative debate over the issue "clearly reveals" that lawmakers "intended to prohibit the Board of Chiropractic from allowing any chiropractor to perform MUA."
TMA sued in 2006 to block the chiropractic board's rules because, the association said, the MUA and need EMG constitute the clinical and legal practice of medicine.
Broward General Medical Center in Fort Lauderdale has been granted a Certificate of Need by the Florida Agency for Health Care Administration to continue its six-year-old adult liver transplantation program. With the approval Broward General will have its own stand alone program.
In June 2003, Broward General Medical Center and Jackson Memorial Hospital were granted permission by AHCA for the first-of-its-kind shared servicearrangement for transplant surgery. The first transplant took place in February 2004. Since then, Broward General has performed between 35 to 40 liver transplants each year.
"The program is a critical component in our list of healthcare services to the community we serve," says Frank Nask, president/CEO of Broward Health. "By teaming up with the University of Miami physicians, Broward Health can continue to offer our patients liver transplant services."
Broward Health is one of the 10 largest public health systems in the nation, Broward Health includes Broward General Medical Center, North Broward Medical Center, Imperial Point Medical Center, Coral Springs Medical Center, Chris Evert Children's Hospital, Broward Health Weston and more than 30 facilities of the Community Health Services and Broward Health Physician Group.
The best part of my job is the people I get to meet—particularly the frontline, hands-on medical professionals who see their work as a calling. It sounds corny, but these people are healers in the noblest sense. In a world full of silliness and superficiality, selfishness, and cruelty, it's therapeutic and a great perspective adjuster to be around these well-grounded people.
So, it was with great sadness when I read last week that David Nichols, MD, a lifelong family physician in Virginia and dedicated healthcare professional confirmed that he is suffering from terminal cancer and has only a few months to live.
"I actually feel very well, but I know it's coming," Nichols, 62, told the Associated Press, in a piece you should post on the break room bulletin board. "I feel very blessed to have lived the life I have."
You probably have never heard of Doc Nichols. That's not surprising. Unless you're one of the thousands of people he's treated over the decades there is no reason to know him. People like Doc Nichols don't usually draw attention to themselves. They're too busy.
I was fortunate to interview him almost four years ago in a piece on rural physicians. He had just been named the 2006 Country Doctor of the Year by physician recruiters Staff Care, having been nominated on the sly by his colleagues.
Doc Nichols told me about his 90-hour work weeks, and his tiny three-physician practice in White Stone, near the mouth of the Rappahannock River in coastal Virginia. And he told me about his life's work as a volunteer physician on Tangier Island, about 25 miles out in Chesapeake Bay. For the last three decades, Nichols has flown himself and colleagues to the island every Thursday to provide the 600 or so residents of the tiny fishing community with, often, their only access to healthcare. This island is so remote that linguists claim the inhabitants still speak a dialect similar to Elizabethan English.
Doc Nichols was the subject of a piece I was writing about the good old fashioned family doctor in rural America, and what we're going to do when they're gone.
He said at the time that many younger physicians are talented and dedicated, but aren’t willing to put in the long hours that senior colleagues like him simply assumed came with the territory.
“The next generation of family practice doctors doesn’t want to work as hard as we did, so it’s probably going to take two of them to equal what one of us has been doing. I can see that happening right now,” he said. “I don’t fault them for that. They have a different perspective, and it’s pretty logical what they are saying. They put a greater emphasis on family and time off and less emphasis on working all the time.”
He said all of this with no rancor, and acknowledged that he and his kind were a dying breed, adding "I know I am a dinosaur."
Doc Nichols said the working climate for primary care physicians isn’t helping, with Medicare reimbursements facing cuts and malpractice liability rising every year. The more time needed to complete paperwork, meet OSHA requirements and address other business-side concerns means less time with patients, reducing the quality of care, and revenue.
With all of those distractions, though, he had no immediate plans for retirement before the bad news came last month that melanoma he'd fought six years ago had returned and spread to his liver.
"He's been coming here since I was a little girl," island resident Jamie Bradshaw told AP, wiping her eyes after hugging Nichols. "I don't know what we'd do without him. I can't even describe in words what he's meant to all of us."
The terrible news comes as the island is readying-this week-the grand opening of a new $1.7 million medical clinic, five times bigger than the 1950s-era clinic that Nichols has staffed for more than 30 years.
Nichols told AP he'd hoped to stick around a little longer, but the cancer has other ideas, and he has accepted his fate with dignity. He plans to be buried in the church yard-a stone's soft toss from the new clinic. "It's the journey that's counted for me," Nichols told AP. "Sure I'll miss being able to do all those things I'd planned to do, but, gosh, this was so rewarding."
Trauma care in the United States is so fragmented and underfunded that the survival of people who suffer major injuries often depends on where they are when they're hurt, says Brent Eastman, MD, chairman of the Board of Regents of the American College of Surgeons.
Writing in the current issue of the Journal of the American College of Surgeons, Eastman said high death rates in rural areas, a growing shortage of trauma surgeons and a disconnect between existing trauma systems and regional disaster preparedness plans add to a bleak picture of trauma care in the nation.
Eastman is a general, vascular and trauma surgeon and CMO of Scripps Health and N. Paul Whittier Chair of Trauma at Scripps Memorial Hospital La Jolla, CA. His article in the journal's August edition—Wherever the Dart Lands: Toward the Ideal Trauma System—is the first time his findings have been published for public review. Eastman initially voiced his findings during his "Scudder Oration on Trauma" at the 2009 Clinical Congress of the ACS in Chicago.
"Coordinated, regionalized and accountable trauma systems are proven to get the right patients to the right hospital at the right time," Eastman wrote. "For victims of major trauma, access to timely, optimal care during the first "golden" hour has been proven to save lives, restore function and prevent disability."
Eastman is a co-founder of San Diego County's trauma system, which has reduced preventable deaths in San Diego from 22% when it was deployed in 1984 to approximately 2% today.
Eastman wrote that many parts of the country, especially rural areas, are not served by trauma systems.
He compiled a map of the United States showing death rates due to trauma per 100,000 population, travel times to the nearest trauma center and populations of surgeons. It shows a shortage of surgeons and gaps in regional trauma systems, which Eastman says has stymied access to timely, appropriate trauma care in many areas of the country.
As a result, Eastman wrote, death rates due to trauma are unnecessarily high in those areas, contributing to the fact that trauma is the leading cause of death for people 45 and younger in the United States and in developing countries.
His survey of trauma surgeons in each state shows that 38% of states reported having no statewide trauma system. Of the 62% of states that have a statewide trauma system, for most, funding to sustain these systems is in jeopardy.
"Everyone living or traveling in the U.S. should be able to expect prompt transport to the appropriate level of care proportionate with their injuries," Eastman wrote. "That's the vision when I say that wherever the dart lands on a map of the U.S., there should be a system to take care of your traumatic injury."
Eastman wrote that the sophisticated military trauma systems in Iraq and Afghanistan are an ideal trauma model, and he called on surgeons to advocate for trauma systems in states or regions where developed systems are still lacking.
Lengthy contract talks between the California Nurses Association and Sutter Health's California Pacific Medical Center, and St. Luke's Hospital in San Francisco turned toxic last week when the union filed a grievance with the city claiming that Sutter had imposed a hiring ban on Filipino nurses.
At a press conference, CNA and Filipino community and church groups have asked the San Francisco Human Rights Commission to investigate their allegations of "systematic" employment discrimination on the basis of race, ethnicity, and national origin.
"St. Luke's and CPMC RNs, many of them Filipino, have been outspoken in defense of their patients, and in opposition to Sutter and CPMC's plans to reduce services to the largely lower income, minority community depending on St. Luke's from SOMA to the Excelsior," said CNA Co-president Zenei Cortez, RN.
"Rather than respond to the concerns of the community, CPMC and Sutter have chosen instead to retaliate by carrying out a punitive, illegal, and immoral campaign of discrimination," said Cortez. "There can be no excuse for racial or ethnic discrimination. A hospital should be a center of therapeutic healing for patients, not a model of bigotry."
CPMC CEO Warren Browner, MD, called the accusations "false and designed to cover up the union's own failure to win a contract despite three years of negotiations."
"We pride ourselves on our diverse hiring policies and our longstanding commitment to promoting equal opportunity employment," Browner said. "The allegations of discrimination made by the California Nurses Association are dishonest and without merit."
CNA said the hospitals' hiring data supports the discrimination complaint, and details a major demographic shift among the nurses being hired at St Luke's that began in early 2008. Before February 2008, 65% of St Luke's RNs were Filipino. After February 2008, only 10% of RNs hired were Filipino.
Browner said the hospital's data tells a different story. "In 2007, 63% of our nurses at St. Luke's were Asian. Today that number is 66%," he said. "We do not have any way of identifying what percentage of our nurses are Filipino because we don't break down these categories by ethnicity or country of origin. In fact, the only data we have on ethnicity are self-reported by our employees using categories approved by the Federal government such as Asian, Hispanic or Latino, Black or African American or White (non-Hispanic)."
More than two dozen Filipino and other community leaders joined with CNA and sent a letter to CPMC this week demanding a meeting with Browner and Diana Karner, the Sutter West Bay vice president of nursing, and that CPMC publicly renounce its discriminatory practices.
At the press conference, CNA offered testimony by former nursing supervisors at CPMC and nurses who have faced the discriminatory practices. Chris Hanks, a former director of Critical Care Services at CPMC, said Karner told him on a number of occasions, "you are not to hire any Filipinos."
Former nurse supervisor Ronald Villanueva said that he heard Karner tell another supervisor, "do not hire foreign graduate nurses"—an unambiguous reference to Filipinos.
Sutter brought forward several Filipino nurses who called the CNA complaints groundless. Emilia Maninang RN, Clinical Nurse Manager in the Skilled Nursing Facility/Sub-Acute care unit at St. Luke's, said she has worked at the hospital nearly 20 years and was never told not to hire Filipinos. "I'm Filipino and if I had heard anyone say that I would've been appalled. I think the claims are part of CNA's agenda to try and make CPMC look bad," she said.
Rose Duya RN, who has been at St. Luke's for 12 years said the allegations are false and demonstrate that the union is "desperate."
"I'm Filipino, most of my colleagues here at St. Luke's are Filipino and I have been to many of the other CPMC campuses and have seen many other Filipinos there as well, so I don't see how the union can make those claims," she said.
Federal data showing increasing demand and cost for emergency department visits for often non-emergency medical issues demonstrates the value of urgent care centers, a trade group for urgent care centers claims.
The Centers for Disease Control and Prevention's National Health Statistics Reports shows that of the 116.8 million visits covered by the 2007 Emergency Department Summary, only 16.4% were admitted to a hospital or kept for observation, while 62% were referred to their primary care provider or a specialist for follow up.
Another 35% were referred back to the ED "as needed," presumably because they did not have a regular doctor. More than one third of the patients categorized their pain levels as "none" or "mild" the chief complaints continue to be—as they were in 2006— upper respiratory issues, earache, abdominal pain, wounds, and obstetrics complications.
While in the ED, the CDC data showed that 45.5% of the patients had a procedure, the majority of which were common procedures such as administration of IV fluids, splinting or wrapping, repair of a laceration, or a nebulizer treatment.
The Urgent Care Association of America says its member clinics can treat the vast majority of issues that don't require an inpatient stay and are not life or limb-threatening emergencies—at a lower cost and usually with a shorter wait time than a hospital emergency department.
A recent Press Ganey report detailed record-long waits at the nation's EDs. Emergency physicians say waits will lengthen as health coverage expands, EDs close, and hospitals fail to improve admitting processes.
North Carolina hospital and physician leaders have announced plans to create a statewide healthcare information network to facilitate the adoption of meaningful use.
When operational, the North Carolina Healthcare Information Exchange will allow physicians to create a continuity of care record for each patient, including clinical information from all of the providers in the exchange. NCHEX will launch in seven hospitals, three freestanding emergency departments and 57 physician practices, as the first step towards a statewide health information exchange that meets the criteria for an HIE outlined in the HITECH Act for Meaningful Use.
NCHEX backers include:
The North Carolina Hospital Association; 135 members
The North Carolina Medical Society, more than 11,000 physician members;
Moses Cone Health System, in Greensboro;
WakeMed Health & Hospitals in Raleigh;
Consultants Thomson Reuters;
HIT vendor CareEvolution.
The exchange will be open to all North Carolina healthcare providers and will connect with regional health information organizations, exchanges, and technology systems using the Nationwide Health Information Network Connect and other HIE standards.
To save time and money, NCHEX will be built on the infrastructure developed for the North Carolina Hospital Emergency Surveillance System, which was created by the state in 2004 to capture real-time clinical data from 114 hospital information systems.
Compensation for practice management administrators held steady or saw only modest gains in 2009, according to Medical Group Management Association’s Management Compensation Survey: 2010 Report based on 2009 data.
Administrators with seven to 25 full-time-equivalent physicians earned 0.3% less, while their counterparts with 26 or more FTE physicians reported a 2.3% increase in compensation, the survey found.
Though compensation was generally static for most practice management professionals, some positions made gains in 2009 by taking on more responsibility, including:
Assistant administrator
COO
Office manager
Human resources director
Nursing services director
“Clinical integration and greater complexity in healthcare appeared to drive salary increases for certain medical practice management professionals,” says William F. Jessee, MD, MGMA president/CEO. “These professionals likely took on a broader scope of responsibility in their positions as a result of continued economic pressures and changes in the healthcare environment.”
MGMA executive members reported greater median compensation than nonmember executives, as did senior managers and office managers who held MGMA memberships, MGMA says. Office managers with an MGMA membership earned $13,272 more per year than their nonmember counterparts, and finance directors with MGMA memberships earned $942 more per year than finance directors without memberships.
When affiliated with the American College of Medical Practice Executives, the certification and standards-setting body of MGMA, several managerial positions enjoyed increased compensation as well. ACMPE-affiliated administrators in practices with seven to 25 FTE physicians, and 26 or more FTE physicians earned 21.2% and 24.6% more, respectively, than their counterparts who were not affiliated with ACMPE. CFOs experienced the greatest compensation boost based on ACMPE affiliation, earning $59,328 more than their unaffiliated counterparts.
MGMA has 21,500 members leading 13,700 organizations nationwide in which some 275,000 physicians provide more than 40% of the healthcare services delivered in the United States.
After months of bargaining with no agreement, the Minnesota Nurses Association has asked more than 900 members to turn out Wednesday to reject a contract offer from SMDC Medical Center in Duluth, and vote for a one-day walkout instead.
A key sticking point appears to be nurse staffing ratios.
"The bottom line is, the executives at the bargaining table have made it clear to us that management does not trust its nurses with the well-being and safety of our patients," said Steve Strand, an RN at SMDC. "It's ironic considering nurses are the most trusted professionals in the United States. And we are not asking for anything costly, outrageous or unusual."
Thomas Patnoe, MD, president of SMDC Health System, issued a brief statement in response to the MNA comments: "We feel we have bargained in good faith and have proposed a very good offer, which reflects our commitment to our nurses, to safe care and to the patients and families we serve. My sincere hope is that we will ultimately reach a respectful resolution and avoid a strike."
In addition to the SMDC vote, 420 RNs at St. Luke's Hospital in Duluth are bargaining for a new contract, but haven't reached an agreement. SMDC nurses have no more negotiating sessions scheduled, but St. Luke's RNs met with management Monday to try to work out an agreement.
Both groups of nurses will vote on Wednesday to either ratify their contract offers or authorize a one-day strike at each hospital.
MNA said Duluth RNs are seeking the same contractual rights to advocate for their patients that Twin Cities nurses already have: First, to be allowed to temporarily close a hospital unit when it is no longer safe to admit additional patients. Second, to be able to refuse additional patient assignments when a nurse's patient load has reached an unsafe level, MNA said in a media release.
"Business executives at SMDC are refusing to allow nurses to do our duty—as dictated by the Minnesota Board of Nursing and our profession itself—of advocating for our patients," Strand says. "What Duluth nurses are asking for is reasonable, and in our negotiations we attempted to bargain in good faith to implement some concessions that would allow the cost to be minimized for the changes necessary. Should nurses in the Northland be treated differently than our counterparts in the Twin Cities when it comes to safety issues? Should our patients, for that matter?"
Strand says SMDC nurses already dealing with staffing shortages need some kind of protection in their contract when it comes to caring and advocating for patients.
"As nurses, we live this every day," he says. "We know better than anyone when it is or isn't safe on our unit. As the people directly responsible for your well-being when you come into our hospital, we want to make sure you get the safest care possible. Doesn't that seem like a rational, reasonable thing to ask of the executives who employ us and expect us to guarantee your safety as our patients? Why can't they see that they will be patients too?"
St. Luke's RN Cindy Prout says executives there have left nurses with no option other than recommending the vote to authorize a one-day strike.
"If you listen to the stories coming out of the hospital, you know that we don't have any other choice," she said. "Our first contract is with the public—to care for them, keep them safe and advocate for them."
