A surgeon with a history of complications, a felony past

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Toumbis' booking photo and an excerpt from the police report.

Toumbis’ booking photo and an excerpt from the police report.

by Marshall Allen and Olga Pierce
ProPublica

Officer Richard Walter looked out the window of his patrol car and saw two young men trading punches outside Sutter’s Saloon.

It was 2 a.m. on what should have been a forgettable night shift in 1989. Sutter’s was near the State University of New York at Buffalo 2013 a student hangout, not a rough dive. Walter, now a seasoned detective, still can’t shake the bizarre and bloody memory of that night.

The men didn’t notice the cop pull into the parking lot. Walter grabbed his baton and approached, then saw a glint of metal. One of the men held a knife, the blade protruding three inches from his clenched fist.

Instantly a geyser of blood spurted from the unarmed man’s neck onto Walter’s uniform 2013 10 feet away. The man collapsed, his neck slashed open “from his ear to his Adam’s apple,” Walter said, recalling what he wrote in the police report. Blood pulsed onto the pavement from his severed carotid artery and jugular vein.

Walter drew his gun and pointed it. The attacker dropped the knife and clasped his hands around his victim’s gashed neck to stanch the bleeding.

“I’m a medical student,” the attacker said. “I know what I’m doing.” Continue reading

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How to get the best care for ‘medically complex’ kids

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Finding a Formula for ‘Medically Complex’ Kids

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Five-year-old Lakota Lockhart, who has a complex medical condition, works on an art project with a volunteer at St. Joseph’s Children’s Hospital in Tampa, Florida. A few hospitals in the U.S. have managed to deliver better care to kids like Lockhart for less money. (St. Joseph’s Children’s Hospital)

By Christine Vestal
Stateline

TAMPA, Florida — Five-year-old Lakota Lockhart talks about Batman nonstop. When his mom, Krystal, can wedge in a word, she describes what life has been like since Lakota was born with a rare central nervous system disorder that causes his breathing to stop every time he falls asleep.

She says they’re lucky Lakota was born across the street, at Brandon Regional Hospital, or she might never have known about the Chronic Complex Clinic at St. Joseph’s Children’s Hospital.

The brainchild of Dr. Daniel Plasencia, the St. Joseph’s clinic was created 14 years ago to improve care for kids with chronic conditions affecting more than one organ system.

“Their treatment was too complex for most pediatricians . . .”

“Their treatment was too complex for most pediatricians,” Plasencia said. “They needed a medical home and we provided it for them.”

Approximately 3 million children in the U.S. are medically complex, meaning they require intensive treatment from a wide array of specialists. That number is expected to reach nearly 5 million in the next decade as medical advances improve life expectancy for kids with congenital heart defects, sickle cell anemia, cerebral palsy and cystic fibrosis.

Kids like Lakota who have rare conditions, those born extremely prematurely and survivors of near drownings, auto accidents and other catastrophic events are also living longer thanks to new technology.

Research shows that programs like St. Joseph’s save Medicaid and commercial insurers money by reducing emergency room visits and hospital stays. But while a few complex care units in places like Little Rock, Arkansas, Milwaukee and Cleveland have cropped up around the country, the idea has not caught on nationwide. Continue reading

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How much does it cost to have a baby? Hospital study finds huge price range

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pregnant-money-570By Michelle Andrews
KHN

Which hospital parents pick to deliver their baby can have serious cost consequences, according to a new study.

Hospital costs for women who had no maternal or obstetric risk factors to complicate childbirth ranged from less than $2,000 to nearly $12,000, the analysis of discharge data found. The wide variation in cost means that for expectant parents, it can pay to shop around. Continue reading

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Medicare rates home health agencies

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Star full faceHome Health Agencies Get Medicare’s Star Treatment

By Jordan Rau
KHN

The federal government released on Thursday a new five-star rating system for home health agencies, hoping to bring clarity to a fast-growing but fragmented corner of the medical industry where it’s often difficult to distinguish good from bad.

Medicare applied the new quality measure to more than 9,000 agencies based on how quickly visits began and how often patients improved while under their care. Nearly half received average scores, with the government sparingly doling out top and bottom ratings.

The elderly tend to be less familiar with the reputation of home health agencies than they are with hospitals and other institutions.

The star ratings come as home health agencies play an increasingly important role in caring for the elderly.

Last year 3.4 million Medicare beneficiaries received home health services, with nurses, aides, and physical and occupational therapists treating them in the home.

Medicare spends about $18 billion on the home health benefit, which provides skilled services that must be authorized by a doctor, not housekeeping care that some elderly pay for privately. Continue reading

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VM tapped to improve UK’s NHS

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British Flag UKVirginia Mason Institute announced today it has been selected by England’s National Health Service Trust Development Authority (NHS) to implement Virginia Mason’s quality improvement system as part of a broad effort to improve safety and quality, and control costs in the hospitals.

Virginia Mason Institute team members will train and mentor health care professionals at five NHS acute-care hospital trusts to use the Virginia Mason Production System (VMPS).

The contract awarded Virginia Mason Institute is for five years and approximately $13 million.

VMPS, developed by Virginia Mason in 2002 and inspired by Toyota Production System’s lean principles, engages executives, physicians, nurses and other team members at all levels of the organization to improve safety and quality, and control costs.

The approach uses structured, standardized tools and methods for achieving operational efficiencies, eliminating waste, preventing mistakes and maintaining continuous improvement.

 

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How much acetaminophen a day is safe? Canada may decide it’s less

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Badge - Canadian flag canadaBy T. Christian Miller and Jeff Gerth
ProPublica

Canada’s top health agency is considering lowering the maximum recommended daily dose of acetaminophen, the active ingredient in Tylenol and other pain relievers.

Citing the risk of liver damage from overdosing on the popular pain medication, Health Canada announced it will review changes to labels, the creation of an educational awareness campaign and possible revisions to dosage recommendations.

Acetaminophen is considered safe when taken at recommended doses. Tens of millions of people use it weekly with no ill effect. But in larger amounts, especially in combination with alcohol, the drug can damage or even destroy the liver. In severe cases, acetaminophen overdose can cause death.

“Our goal is that we will have fewer effects on liver, less hospitalization, less instances of unintentional overdose, and we have more people that are informing themselves about all the products that they use, not just acetaminophen,” Supriya Sharma, senior medical adviser for Health Canada’s Health Product and Food Branch, told the Toronto Star, in an interview. Continue reading

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Edible pot intoxications up among kids in King County

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From Public Health – Seattle & King County

An increasing number of King County residents are being poisoned by eating edible marijuana products, and health officials warn that children are particularly at risk.

According to the Washington Poison Center (WAPC), the number of marijuana edible intoxications reported in King County in 2014 was 73% higher than in 2013, and there is an upward trend in 2015.

“Marijuana edibles left lying around on the coffee table or next to snacks can easily fall into the hands of young kids.“

Children 5 years of age and younger accounted for roughly 30% of all edible marijuana intoxication reports in 2014. Seventy-three percent of children required evaluation at a hospital.

“Edible marijuana poisoning is an emerging health risk to children in our community that demands attention,” said Dr. Jeff Duchin, Health Officer for Public Health – Seattle & King County. “Edible marijuana consumers, sellers and health care providers should all take steps to prevent children from getting access to these products.”

Most intoxications among children occur when a child finds marijuana-containing products such as candy, chocolate or baked goods left unattended in the home. Continue reading

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California, Oregon to allow hormonal contraceptives without prescription

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By Barbara Feder Ostrov
KHN

California and Oregon will be the first states in the nation to allow women to get birth control pills and other hormonal contraceptives directly from their pharmacists – without a doctor’s prescription.

As California officials were busy finalizing regulations on a state  law passed in 2013, Oregon’s governor Kate Brown signed a similar bill into law last week.

The two measures were hailed by women’s health advocates. They noted that men have long had an easier time getting birth control, simply purchasing condoms over the counter.

Ken Thai, part-owner and manager of the El Monte Pharmacy Group, says he is excited about the new regulation that will allow him to directly prescribe birth control in his pharmacies in California (Photo by Heidi de Marco/KHN).

Ken Thai, part-owner and manager of the El Monte Pharmacy Group, says he is excited about the new regulation that will allow him to directly prescribe birth control in his pharmacies in California (Photo by Heidi de Marco/KHN).

“We support efforts like these that remove barriers to women gaining access to birth control and other reproductive health care,” said Kathy Kneer, President and CEO of Planned Parenthood Affiliates of California,  in a written statement.

She added that hormonal contraception has been widely studied and shown to be safe – “so safe that the American College of Obstetricians and Gynecologists has recommended that it be available over the counter.“

The contraceptives won’t be available like cough drops or antacids, however. In California, pharmacists can only dispense them after providing a health screening to women and taking their blood pressure. Oregon will also require a health screening, but the state’s specific rules haven’t been developed. Continue reading

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Online scorecard helps you pick a surgeon

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surgeons performing surgery in operating roomThe independent investigative journalism website ProPublica has created online “Surgeon Scorecard” that you can use to find out a surgeon’s complication rate for eight commonly performed operations.

To learn about the complication rates of surgeons working at hospitals in Washington state go here.

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Do cell phones belong in the OR?

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Next time you’re on the operating table and you have one last look around as the anesthesiologist approaches, don’t be too sure that that person in scrubs looking at a smartphone is pulling up vital health data.

He or she might be texting a friend, or ordering a new carpet.

Cellphone use is not generally restricted in the operating room, but some experts say the time for rules has come. In interviews, many described co-workers’ texting friends and relatives from the surgical suite. Some spoke of colleagues who hide a phone in a drawer and check it when they think no one is watching.

Cellphone use is not generally restricted in the operating room, but some experts say the time for rules has come.

“Sometimes it’s just stuff like shopping online or checking Facebook,” said Dwight Burney, an orthopedic surgeon from Albuquerque. “The problem is that it does lead to distraction.” This can result in medical errors or lax safety procedures, such as forgetting to check a patient’s identity, he said.

In one 2011 incident, a Texas anesthesiologist was accused of sending text messages and e-mails while monitoring a patient. Her oxygen levels dropped, which the anesthesiologist allegedly didn’t notice for close to 20 minutes, and she died in surgery. The woman’s family sued the anesthesiologist. The case was settled before going to trial. Continue reading

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Many hospitals fail to follow guidelines for child abuse patients, study finds

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Rib fractures in an infant secondary to child abuse – NIH photo

By Alana Pockros
KHN

About half of young children brought to hospitals with injuries indicating that they have been abused were not thoroughly evaluated for other injuries, and the use of proper care is less likely to happen in general hospitals than in those that specialize in pediatrics, a study released Monday found.

The researchers examined whether hospitals are adhering to guidelines from The American Academy of Pediatrics (AAP) that all children younger than 2 years old suspected of being victims of child abuse undergo skeletal surveys, a series of X-rays used to identify broken bones that are not readily apparent, called occult fractures.

The results, published in the journal Pediatrics, reveal a significant variation in hospitals’ evaluation of occult injuries, despite the AAP’s recommendations.

“In the young population, medical providers can miss important injuries. … Skeletal surveys can help identify them,” said Dr. Joanne Wood, an assistant professor of pediatrics at the University of Pennsylvania Perelman School of Medicine and senior author of the study. Continue reading

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Bill to boost medical research comes with a catch

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United States Capitol BuildingThe House of Representatives pass a bill Friday that could give a big cash infusion to medical research, which has been struggling in recent years.

But the bill would also tweak the government’s drug approval process in a way that makes some researchers nervous.

Despite those worries, many scientists are cheering on the legislation.

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Medicare proposes paying doctors to discuss end-of-life care

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‘The care you want at a pivotal time in your life’

By Diane Mapes / Fred Hutch News Service

EKG tracingIf you were diagnosed with a terminal illness, how would you want to die? Do you know? Does your doctor?

These questions are at the heart of a new plan announced by Medicare on Wednesday to reimburse doctors for the conversations they have with patients about end-of-life choices.

The plan, which is open to the public for comment for 60 days, is expected to take effect in January. Continue reading

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Uninsured rate falls to historic low – Gallup survey finds

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The uninsured rate among U.S. adults aged 18 and older was 11.4% in the second quarter of 2015, down from 11.9% in the first quarter.

The uninsured rate has dropped nearly six percentage points since the fourth quarter of 2013, just before the requirement for Americans to carry health insurance took effect.

The latest quarterly uninsured rate is the lowest Gallup and Healthways have recorded since daily tracking of this metric began in 2008.

Full story here.

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