From Democracy Now, August 30th:

AMY GOODMAN: I’m here in the Lower Ninth Ward… Hurricane Katrina flooded about 80% of New Orleans and killed well over 1,600 people, displacing another one-and-a-half million people from the Gulf Coast. Only two-thirds of the region’s population has returned home.

Few areas in New Orleans were as hard hit by Hurricane Katrina as the Lower Ninth Ward, where we’re broadcasting from today. This predominantly African American working-class neighborhood remains largely in ruins two years later.

In a moment, we’ll be joined by Malik Rahim, cofounder of the Common Ground Collective, and Alice Craft-Kerney of the Lower Ninth Ward Health Clinic…

ALICE CLARK-KERNEY: …Charity was the safety-net provider for the medically indigent patients in the community, and with that being destroyed, with that infrastructure being destroyed, we knew that many people were going to be caught – the uninsured were going to be caught without any type of medical care. We saw people really just dying on both sides of the street, just because they didn’t have access to medical care. And we decided we weren’t going to wait. We saw people dying at Convention Center Boulevard, the Superdome, just waiting for the bus, and we decided we weren’t going to wait for the healthcare bus. So we determined we were going to open this clinic.

And the clinic was opened by people giving their time, their talent. And what happened was we had folks from all over the country who came to renovate the building, and we had supplies, medical supplies and equipment that was sent down to us, contributions from folks like yourself, as well as some foundations, that got us started. And so, that’s how the clinic actually started and opened.

AMY GOODMAN: What do you need now?

ALICE CLARK-KERNEY: Right now we need money for operating funds. We’re dealing with a scarcity of healthcare professionals, because, just like my family left the region, many of the healthcare providers left the region.

AMY GOODMAN: Did I see a figure, something like 90% of doctors gone?

ALICE CLARK-KERNEY: I’m not going to say 90%, but there was a large number that actually left, never to come back again. And we’re not just talking about doctors, we’re talking about nurses, nurse practitioners, physical therapists, pharmacists, anybody in the healthcare field. All of these folks are gone, and many of them are not going to return. So that leaves us here with a few healthcare professionals, and they can basically name their salary. So we’re competing against hospitals with wonderful fringe benefit packages, sign-on bonuses. And it’s very difficult at this point. So we need funds so that we can actually attract good people to the clinic.

Check out the rest of the interview, it’s powerful. Also, here’s the website of the Common Ground Collective. Support them as you can.

CalorieLab published a map of rates of obesity in the US by state, from data from the Centers for Disease Control and Prevention. Check it out:

Colorado is the leanest state (by 3 year average of BMI’s), Mississippi is the state with the highest prevalence of obesity, and California stayed exactly the same, dropping a few points as a result (as most other states became fatter). So a question to you all: what do you make of this map?

One the first glance, the news that Medicare will not pay for the cost of hospital errors such as line infections and may seem logical, and it may achieve what it sets out to do: reduce the number of errors. But is it the best way? I guess in a way it hits hospitals where it hurts: hard cash, probably the best incentive for businesses. It will probably create an surge in cutting down on dangerous practices. But it seems to make the assumptions that we (health care providers) can be perfect. But we can’t. We can be better.

Leaving sponges or other objecs in the patients or ‘wrong patient wrong side procedures’ occur, but they are relatively rare. So are severe transfusion reactions. What is common are catheter sepsis and other hospital acquired infections.

Fact: if a patient does not need a central venous catheter, she/he should not have one.

Fact: if a patient has a central venous catheter, there will be a proportion of patients who develop complications. These events can be reduced, but not eliminated.

So instead of requiring hospitals to conduct more expensive tests (will we now need to draw a blood culture with every catheter insertion just to cover our backs?), shouldn’t we rather mandate surveillance programs and safety procedures, like they are in place in many hospitals already? If the savings are as great as they are claimed to be (and they probably are), then the system should pay for itself. Procedures in the hospitals I attend call for contact isolation of every patient that ever had an MRSA or VRE infection, on every admission. Check lists are in place to make sure that sterile procedure is followed while inserting central lines and their need has to be assessed daily. Should the hospital be punished for an infection that was not preventable? Health care is not free and they need to compensate for the money elsewhere – at another hospital I used to work, a popular cost cutting measure was to restrict indigent care…

Eventually, all this will probably achieve the same goal. It will force health care providers to practice like they should: with the best interest of the patient in mind. I would have welcomed a pilot project to test this method before widespread implementation.

Maybe others think differently – feel free to comment!!!

I recently received a letter from a company asking me to participate in a study “examining how new clinical treatments for Diabetes Mellitus (sic) are adopted within a medical community and the resulting implications for the delivery of medical education.” For the ten minutes they expected it would take for me to complete the survey, they would send me a check for $60. Presumably, that comes from “our pharmaceutical industry partners.”
Wow … $360 an hour. That’s definitely a “reasonable” honorarium for an overworked resident physician, right?

After asking me demographic information and what sources of information I trust for diabetes information, I was asked to rank the relative strengths of the various companies that make insulin products. But then I got to the meat of the survey:

Please list the hospitalists in your region and nationally that you feel are recognized as experts in the field.

Please list “up and coming” research physicians in this field.

Wow, $60 to sell out my colleagues so that they can be enticed by this company to give presentations on behalf of drug companies …

I suspect, however, that they will quickly realize that Drs. M. Mouse of Anaheim, H. Potter of the reknowned Hogwarts Institute and S.B. SquarePants of Bikini Bottoms are, perhaps, not world experts in diabetes care.

I will also not be collecting $60, as I declined to consent to that nor did I provide my contact information.

But I probably wasn’t going to get $60 regardless — there’s an asterisk on the letter that noted “the survey will be closed after we receive 125 completed questionnaires….” But since the survey doesn’t tell you if it has closed before you answer all of their questions, I suspect it is a well-spent $7500 to build a database of “respected” physicians.

Kevin Freking, Associated Press business writer, called attention in a July 18 article (AP Financial Wire) to the latest way that the Feds are planning to screw Medicaid patients. Only he understated the real potential for harm.

In its inimitable fashion, Congress decided to reform part of Medicaid to save money, and chose to do this by slipping a rider onto an Iraq War appropriations bill—virtually guaranteeing that U.S. physicians would have no clue that this was happening. Some bean-counter in CMS apparently decided that the program could save $355M over the next decade by eliminating fraudulent copying of Medicaid prescriptions, so the new law requires that as of Oct. 1, all Medicaid prescriptions be written on tamper-resistant Rx pads.

Now, as you are aware, several states have begun to require these pads (treated so as to thwart photocopying of prescriptions) for controlled substance Rx’s especially—but those states typically give physicians at least 12-18 months’ notice before the law takes effect.

Some pharmacist groups got wise to this new provision and hollered at CMS—pointing out that come Oct. 1, almost with certainty, a large number of Medicaid patients are going to go to their local pharmacies with prescriptions for medicines, in some cases life-preserving, written on the wrong pads—due to physician ignorance of the law or failure to get hold of the right pads in time. And, by law, the pharmacists will be required to not fill these prescriptions, the health consequences to the patient notwithstanding.

CMS’s compassionate conservative reply to the pharmacists was: tough.

Here’s what Freking, in his otherwise excellent article, failed to mention. We know that all NPA member physicians take very seriously their moral duty to see Medicaid patients despite the problems of low reimbursement. But we also know that there are many of our peers in the community who are increasingly unwilling to accept the pitiful reimbursement levels, and who are seriously considering getting out of Medicaid completely—in effect, looking for just one more excuse. Being required, at their own expense, to buy a new sort of prescription pad just for Medicaid patients alone, is sure to be the last straw for many of these docs. We can predict with some confidence that the number of physicians willing to care for Medicaid patients will plummet further. Is this what CMS wants? Or Congress?

On July 20, the Kaiser Daily Health Policy Report (citing CongressDaily) said that three Democratic lawmakers, Charlie Wilson (OH) and Marion Berry and Mike Ross (AK) had introduced a measure to delay implementation of the law on tamper-resistant forms. I wish them success.