California Senator Wants to Make it Harder to Catch Bad Doctors. How Cool is That?

(Steve Lopez reports in the LA Times)

Sen. Ricardo Lara

By introducing State Senate Bill 641, Lara will be able to say he succeeded in putting up yet another wall of protection for criminal physicians. 

The prescription drug epidemic is a serial killer, claiming thousands of lives in the U.S. each year.

Opioid pill mills, trading in dangerous narcotics like oxycodone, have been shut down in Southern California and beyond, but investigators say there’s more work to be done.

Doctors have been arrested and prosecuted, including a Rowland Heights physician convicted of murder a year and a half ago in the deaths of three patients who overdosed on prescription meds.

So here’s a quiz.

A bill pending in Sacramento would:

A) Strengthen protections for patients and the general public
B) Stiffen sanctions against offending doctors
C) Make it easier to prosecute dirty doctors
D) Make it harder to prosecute dirty doctors

Hard to believe, but the answer is “D”.

As the law stands now, officers who investigate tips about doctors who write questionable prescriptions can check a monitoring database maintained by the California Department of Justice. There, they can look for patterns, or connections to criminal enterprises. including big-time distributors and gang operations.

This database, which goes by the unfortunate name of the Controlled Substance Utilization Review and Evaluation System (CURES), is a vital resource, law enforcement officials say.

Is this (Bill) helping patients or doctors?

Under Senate Bill 641, by Sen. Ricardo Lara (D-Bell Gardens), law enforcement officials would need a search warrant before using CURES to check on a doctor.

Why the change?

“Given the sensitive and confidential nature of the information within this system, there is a need to strengthen patient privacy protections,” Lara said in a statement emailed to me by his staff.

Lara, who is running for state insurance commissioner and is the author of California’s pending single-payer healthcare bill, said New York and Oregon require judicial permission before investigators can access their prescription-monitoring systems.

The patient privacy spin is also coming from the bill’s biggest cheerleader — the California Medical Association, a powerful lobbying force on behalf of doctors.

“People expect their medical records to be kept private,” Joanne Adams, associate director of communications for Cal Med, said in a statement. “But the law does not currently hold medical information in CURES … to the same standards that protect medical records in hospitals and doctors’ office.”

Well, if it’s such an invasion of patient privacy, why hasn’t there been an outcry from patients in the decade or so that CURES has been in use?

Critics argue this isn’t at all about protecting patients. Rather, it’s about protecting doctors by trying to keep investigators out of their business. In a somewhat related matter, there’s a case before the state Supreme Court right now in which a doctor is arguing that the state medical board violated his patients’ privacy in using information obtained from CURES to suspend him for three years.

Why make it harder to catch bad doctors?

Prosecutors aren’t going after good doctors, but the tiny minority of those who shouldn’t be in practice. So why do we need this bill at all?

Lara’s staff denies it has anything to do with $11,000 in campaign donations to Lara from the California Medical Association. He’s received loads more from other medical industry sources, by the way.

Lara’s staff claims the senator is trying to find a fair balance between investigative authority and privacy rights. The bill has already been amended and may come in for more fine tuning in the future. Lara has been at odds with Cal Med in the past, his staff notes. Last year, the doctor lobby was no fan of a Lara bill (SB 482) that required doctors to check the state’s prescription monitoring database before writing scripts for opioids.

Some people are confused about where Lara really stands.

“I’m very surprised he is carrying this bill,” said Bob Pack, a Bay Area man who worked with Lara on SB 482.

Pack, who has written two letters to Lara’s office protesting the current bill, has a personal connection to the issue. His two children, 10 and 7, went out for an ice cream with their mother in 2003 and were struck and killed by a driver who was under the influence of alcohol and prescription drugs. Pack, who works in tech, helped design CURES. And he isn’t buying the patient-privacy argument.

“Law enforcement has to get a warrant in order to investigate a patient. That’s already required,” said Pack. “Why would you try to inhibit looking for and catching a bad doctor who is going to cost lives or has cost lives?” 

Continue reading.

It seems very much as though Senator Lara’s motivation for this bill is the $11,000 he received.

Our Observation:

Send a note to this confused state senator and let him know that Senate Bill 641 absolutely does NOT protect the citizens of California – which just happens to be a key component in his swearing in as a senator in the first place.

http://www.ricardolara.com/contact

(We thank Steve Lopez for forwarding this revealing case, of how state politics damage healthcare by protecting criminals)

New Orleans Fires Team Doctors After Serious Player Misdiagnosis

Over the weekend the NFL sports world learned via several insider reports that the New Orleans Saints looking to trade cornerback Delvin Breaux . The essence of the story was that coaches and team owners were frustrated, because Breaux seemed to have a problem healing from injuries that appeared to be minor. Most recently, he missed an entire week of training camp because of what the team doctors swore was a leg bruise.

Uh, not quite, doc.

After finally being more thoroughly examined, poor Mr. Breaux  actually had an excellent reason for all the pain he was describing: his leg was broken. Specifically, he had suffered a fracture of the fibula. The fibula – for those interested – is a leg bone located on the outside of the tibia, with which it is connected above and below. It is the smaller and weaker of the two lower leg bones.

According to Nick Underhill of The Advocate, the Saints’ management was so highly irritated at the doctors’ misdiagnosis – and embarrassed by their stance that Breaux’ injuries were not as serious as he let on – that they fired orthopedic specialists, doctors Deryk Jones and Misty Suri, this morning.  The termination of the two doctors happened immediately after another doctor proved that the normally non-complaining Breaux actually did indeed have a broken leg. 

It wasn’t exactly rocket surgery. All it took was a – now hold your ponies here – an X-RAY.

Breaux is not exactly known as a whiner when it comes to football-inflicted pain. He has started and was a key player in 21 of the last 22 games for the Saints, over the last two seasons. He is now scheduled for orthopedic surgery and the recovery time is about 6 weeks.

We wish him well.

Observation:

This case reminds us of an epitaph we once saw on a tombstone in Billings Montana:

Dear Folks. I Told You I was Sick. Did you Listen? Noooooooo.

 

Virginia MD, Charged With Nurses’ Murder, Released From Jail Pending Trial

In the city of Richmond a doctor believed to have killed his girlfriend will soon be released from jail because his murder trial has been delayed.

Dr John Gibbs

Dr John Elmore Gibbs

Doctor John E. Gibbs, age 39, is scheduled for release on September 1, because his murder trial in Chesterfield Circuit Court has been pushed back 90 days. According to the prosecution, the trial needed to be rescheduled so that an important witness will be available to testify against him. 

Gibbs, a pain management specialist, was arrested on March 14 at a ski slope. He has been charged with the murder of a nurse named Zulma Pabon, a coworker who disappeared in 2014 while living with the doctor. Ms. Pabon’s body was never found.

Zulma Pabon, age 26, was last seen alive on June 6, 2014, according to the Chesterfield County Police Department. The licensed practical nurse was leaving her job at Commonwealth Fertility and Women’s Health at St. Francis Medical Center.

Zulma Pabon

The missing nurse Zulma Pabon

At the bail hearing for the doctor on April 11 the prosecution revealed numerous strange details discovered during the investigation – all of which lead them to believe the physician killed the nurse: 

  • In the weeks before Ms. Pabon disappeared,  Gibbs performed searches on his home computer regarding the use of ether to cause unconsciousness.
  • In the days after the nurse went missing, the doctor went to a local Lowes home supply store and purchased 23 bottles of acid drain cleaner and a large trash container.
  • While Gibbs was unaware he was being followed by undercover law enforcement, detectives witnessed him driving to a large dumpster, miles away from his home, and dropping a large black trash bag. When police retrieved the bag, they found bedsheets from his home. 
  • After Gibbs moved from the home he’d shared with Pabon to another apartment, the doctor trashed his girlfriend’s belongings, including her jewelry, clothing and pictures of them together.
  • Detectives told the grand jury that even though the doctor referred to himself as Ms. Pabon’s boyfriend, he never reported her missing and refused to cooperate with police when they wanted to ask him questions about her disappearance. This, according to  reports CBS affiliate WTVR.

Investigators are convinced Ms Pabon is dead, although her body has not been found. They say the case is now classified as a ‘No Body’ Homicide.

NO BODY HOMICIDE (2)The murder trial – originally scheduled for July 31 – is expected to begin November 1.

Here’s more:

http://www.cbsnews.com/news/virginia-doctor-charged-with-killing-his-long-missing-girlfriend-nurse-zulma-pabon/

 

 

 

 

Press Release: “The Paramedic Heretic” Exposes Curious Conundrums within EMS

The author was not even out of medical school before he witnessed his first doctor commit murder. It would not be his last – Lord, no – but he can recall that night as vividly as though it happened last week. Few medics forget their first physician homicide.

PR URGENT art

FOR IMMEDIATE RELEASE

heretic-cover-1When Patrick McDonald began rescue training in the 1970s, he was among the first paramedics in the nation, filled with the zeal to save lives in ways not imagined even a decade before. More than 20,000 911 calls later however, pride in his profession has eroded. So he turned to his three-decades of note-taking to scribe an imminently readable, jaw-dropping assessment of the power struggles within the cloistered world of rescue – a battle that sometimes has fatal consequences. He also defines what he calls the “Immutable Laws” that reign supreme in the business of saving lives.

McDonald, having experienced the trenches of rescue for more than 30 years, offers story after story in which rules and policy corrupt paramedic efficiency. He details some success stories, but reveals dozens of cases where the consequences of protocol short-circuit rescue efforts. In one fascinating case the author himself nearly lost his medical license because he authorized a non-EMS helicopter to fly out critically injured Girl Scouts in a Palm Springs bus tragedy – until the famous Sonny Bono (who had been on the disaster scene) saved the day.

psa-flt-182-full-color
“The Paramedic Heretic” – a first-person account of San Diego’s PSA Flight #182 tragedy

“The Pedigree of a Paramedic Heretic: Immutable Laws and Ethical Illusions” reveals that time after time, saving lives is not rescue priority. Instead, following policies, ensuring team safety and avoiding lawsuits all trump patients’ lives. “Heretic” also points out numerous medical myths, such as ambulance sirens saving lives (they don’t); the “Golden Hour” of patient care (one doctor’s silly fantasy); and the futility, in many cases, of CPR. Some of the biggest problem areas, McDonald writes, are mistakes made in prescriptions; wholly unnecessary surgeries and flawed medical records.

That paramedics remain mute in the presence of incompetent or criminal physicians, for fear of losing their jobs, is a maddening reality. Saving lives, in the end, has become far more about capitalism and power struggles, than heroism.

Author K. Patrick McDonald knows of what he writes. He was appointed the first EMS supervisor for San Diego city and created one of the country’s first Special Trauma & Rescue teams. McDonald, a graduate of University of California, San Diego School of Medicine original advanced field medicine program, co-wrote the National Pool & Waterpark Lifeguard Training Manual. He has served as a consultant to the U.S. Secret Service and Super Bowl XLIX in Phoenix

L A Book Fest Art (2)

 

NYC Doctor and Wife Leap to Their Deaths in Suicide Pact

In downtown New York City a doctor and his wife jumped to their deaths from a Midtown high-rise early this morning. They each carried what is referred to by investigators as a ‘letter of intent’ that indicated they had serious financial problems, according to an NYPD spokeswoman.

DR SUICIDE PACT (2)

Doctor and wife’s bodies lay covered in the street early this morning in New York City. (photo by Seth Gottfried)

Doctor Glenn Scarpelli, age 53, and his wife Patricia Colant, age 50, apparently leaped from their 9th floor clinic, located in a 14-story business building at 33 Street and Madison Avenue. They are believed to have jumped from a window about 5:45 a.m.

“We had a wonderful life,” one of the notes said. It went on to reference to a, “financial spiral.”

Dr. Glen Scarpelli and his wife, Patricia, jumped to their deaths from a rooftop on 33rd St. on Friday.

Doctor Glenn Scarpelli

The couple worked together at Scarpelli’s chiropractic clinic, known as the Madison Wellness Center, where for a time former New York Yankees manager Joe Torre was a patient.

The ugly deaths in the street left the couple’s neighbors stunned. They were known to frequent neighborhood restaurants and bodegas and were well-liked. “He was the happiest guy you’d ever want to meet,” said Robert Bisaccia, who worked for an architectural firm in the same building.

The staff at Beckett’s Bar & Grill  was emotionally crushed by the news, the owner said sadly.

“He was a family man,” said a neighbor. “He always talked about his son and his daughter. I can’t comprehend why they did this.”

The boy is 19 and the daughter is 20. They are both college students.

The NYPD Head of Detectives, Robert Boyce, said the motives for the double suicide are not yet clear. “We just don’t know right now,” Boyce said.

NTC High-rise

The Madison Avenue Wellness center was located on the 9th floor. (photo by Marcus Santos)

 

 

 

 

 

 

California State Agency Names Surgeons with Highest Patient Death Rate

“This is the first time California has ever reported the surgical mortality results for individual doctors. It will help patients choose better surgeons and a better hospitals, and will provide an incentive to improve quality care.” (Dr. David Carlisle, Director, Office of Statewide Health Planning and Development)  

As of this month, California residents can now learn the names of both hospitals and surgeons that score higher or lower, when it comes to cardiac bypass death rates. 

CABG

The Office of Statewide Health Planning & Development, which compiles statistics, now publishes coronary bypass death rates for 300 cardiac surgeons working at 120 hospitals. That’s the good news. The bad news is the most recent information covers surgeries performed in 2003-2004. In other words, the information is 14 years old.

The study was ordered by the California state legislature in 2003 and cost just under $2,000,000. It revealed that while 95% of California heart surgeons scored at, or about the expected, mortality average of 3% patient deaths, some performed considerably better, and some measurably worse.  As an example, Doctor Alexander Giritsky at La Jolla Scripps Memorial, was one of only 4 surgeons with the lowest heart bypass mortality rates. Not one of his 126 surgical patients died.

On the other end of the scale,  Doctor Jeffrey M. Rosenburg and Doctor Leland B. Housman were among the 12 physicians with the highest patient death rates. Rosenburg operated on 12 patients – 3 of whom died. Housman performed surgeries at Scripps Mercy in San Diego. Rosenburg operated at Palomar Medical Center Escondido. Housman operated on 140 patients – 9 of whom died during the reporting period.

By contrast, at Arcadia Methodist Hospital, a surgeon named Ismael Nuno tallied just under a 90% patient death rate.

About 400 patients each week undergo bypass surgery in California. Called a “cabbage” behind closed doors, the CABG procedure normally involves taking a blood vessel from the chest or leg and using it to create a new route for blood flow within the heart. 50% of these procedures are done on emergency patients.

It is important to note that dire surgical outcomes ought not be laid solely at the feet of the physicians. Some surgeons are quick to point out – and rightfully so – that their statistics are skewed from the start, because they are treating extremely sick patients to begin with, whose chances of surviving – especially in an emergency – are poor at best. Doctor Housman said it very well. “They died mainly because I accepted a mix of people who were older and sicker than most other surgeons are willing to take.”

Here’s another look:

http://www.latimes.com/business/la-fi-heart-surgeon-database-20170714-story.html

 

Clinical Cooties: They Only Kill 100 People a Day, So Who Really Cares?

So which nifty little item commonly used in healthcare is most likely to carry nasty boogies from one sick patient to another?

STETH COOTIES

Trust us: Sloppy medical professional hygiene sickens 1,000 patients each day, and kills 10% of them. Go ahead. You do the math.

Why, the stethoscope, of course. Ask practically anybody in a lab coat (which incidentally also carries ten tons of cooties) and you’ll get the quick answer that – just like grubby doctor hands – stethoscopes can – and do – transmit millions of invisible critters, all over the hospital, every damned minute of the day.

So according to a recent study, how many doctors do you suppose bother to clean their stethoscopes between patients?

None.

Not a one. And that fact was determined to be true even after educational intervention was instituted, about how essential stethoscope hygiene actually is, in preventing infections.

Doctor Covering His Ears Over White Background

“I’m too busy to listen to facts!”

So a big fat “zero” number of doctors bother to wipe their stethoscopes with antiseptic pads between patient encounters, according to a study published in this month’s issue of the American Journal of Infection Control.

The investigation team – staffed by MDs from Yale University School of Medicine and the V/A in West Haven Connecticut – reported they already suspected the results would be poor.

But they were outright stunned to discover NO doctors were disinfecting their stethoscopes. After all, the Centers for Disease Control  guidelines mandate that reusable medical equipment must undergo disinfection between patients. That’s called a law with no teeth.

So physicians resist obeying the rules. Who knew?

The rotten study findings were especially confounding to the organizers, because second-year med students are taught early on, the importance of compliance, as one step of several that evaluate history & physical performance competency.

“Stethoscopes are used repeatedly throughout the work shift and become contaminated after patient contact. They must be treated as potential germ transmitters. Failing to disinfect stethoscopes can constitute a serious patient safety issue similar to ignoring hand hygiene.” (APIC President Linda Greene, RN)

A recent Swiss study found that stethoscopes were capable of transmitting lethally resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Pathogens cultured from stethoscopes include Staphylococcus aureus, Pseudomonas aeruginosa, Clostridium difficile and vancomycin-resistant enterococci. 

The doctors underwent a quality improvement project in which they were supposed to follow standard hygiene, using alcohol swabs or disinfectant wipes, at a teaching hospital. Most of them washed their hands. No one bothered with stethoscope cleanliness.

At the mid-point in the study, the investigators stepped in and reiterated the importance of stethoscope hygiene between patient encounters. They underscored the safe practices expectation, that the physicians follow proper protocols. It didn’t matter what they were taught, the doctors in a real-time, real-patient environment, simply refused to clean their stethoscopes. 

Results

Hand hygiene rates were lower than anticipated, 58% initially and 63% post-intervention, which was not statistically significant. Stethoscope hygiene never occurred during the 128 initial and 41 post intervention observations (see Table 1)

Table 1       Stethoscope and hand hygiene before and after the multimodal intervention
  Before   (performed) After (performed) P value
Hand Hygiene 73/126    (58%) 29/46      (63%) 0.55
Stethoscope Hygiene 0/128      (0%) 0/41        (0%)

The authors ended the study by stating that the project demonstrates routine education may not be the answer to the problem of stubborn doctors, and stronger efforts may be necessary to change the careless culture and careless habits.

To which we at Medical Miscreants say, “No shit, Sherlock.”