just kidding
April fools
April fools
Obama declares CRNAs should be able to do Pain
- Thread starter geauxg8rs
- Start date
actually this might not be a joke, but reality. I was emailed this story.....might be worth reading.
http://www.humanevents.com/search.php?author_name=Dr. Lee+Hieb
Did Natasha Richardson Have to Die?
by Dr. Lee Hieb (more by this author)
Posted 03/24/2009 ET
Liam Neeson, one of my favorite actors, experienced a great tragedy last week in the death of his wife, actress Natasha Richardson. I don't usually pay too much attention to celebrity lives, but having two teenage boys similar in age to hers, I found Natasha Richardson's death especially poignant.
As a mom, I must express my sorrow for the family's misfortune. And as a physician, I have to ask: what can be learned in this case?
For the two or three Americans who haven't read the details, Natasha's death was the result of a head injury while skiing -- not a high speed Sonny Bono-type wipe out, but apparently a fairly innocent fall during a lesson. She developed an intracranial bleed, and by the time she was able to receive the necessary level of care in Canada, her intracranial pressure was excessive and ultimately fatal.
The easiest lesson is to wear a helmet on the slopes. (As a snowboarder, I have been wearing one for years, but I notice that skiers over the age of 10 generally don't think it necessary.) But that's not the big lesson here.
As reported by the Associated Press, Montreal's top trauma neurosurgeon cited the lack of emergency helicopters as a contributing factor in the death. "Our system isn't set up for traumas and doesn't match what's available in other Canadian cities, let alone in the States," said Tarek Razek, director of trauma services for the McGill University Health Centre.
Secondly, even after arriving in Montreal, the patient had to be transported by land to yet another facility where a neurosurgeon was available. Now, this is not some podunk little community hospital area -- this is a major metropolitan center without air medevac, and apparently without adequate neurosurgical capability, or at least a system of trauma triage.
I have never been to a ski slope in America that didn't have medevac capability. And, we have a trauma system to facilitate appropriate and timely transport to those facilities which can care for head trauma.
Fifteen years ago, we had enough neurosurgeons and trauma surgeons to staff our hospitals round the clock. For most large metropolitan areas, we still do. I don't live in a major metropolitan city like Montreal. I don't work in a university center like McGill. But even in my city of 100,00 people with its community hospital, we have medevac helicopters at all hours.
We have CT scanners positioned next to the Emergency Room to scan trauma patients on the way to the Operating Room -- usually within minutes. And if this particular type of head trauma occurs, we can transport the patient to a neurosurgeon within an hour. Canada has ground ambulance and CTs which are in need of parts.
Canada has government-run medicine, which, like every other government program, is inefficient and ineffective -- especially in this sort of emergency when seconds count. It is generally true of socialized government-funded medicine that low-end care is cheap and available, but high-level care is underfunded and available only after a long wait, or to those privileged to jump the line.
Low-level care requires a minimum of technology and can be applied by less trained providers. (President Obama said that the provider gap developing in our country will be filled by Nurse Practitioners and Physician Assistants. There may have been P.A.s and Nurse Practitioners in the first hospital to which Natasha was taken, but, unfortunately, these lesser trained providers do not take the place of neurosurgeons, or any other specialists.)
Government-run medicine mostly treats ideology by emphasizing "prevention," lifestyle counseling, and free clinics for VD, abortion, and the common crud. It is free "feel good" medicine that convinces the masses -- especially young people who are generally healthy -- that government medicine is great. It treats the 90%, but woe unto you if you are the 10% who need real high tech treatment quickly.
Epidural bleeds are a very dangerous, so I cannot say with 100% conviction that Ms. Richardson would have been saved in the United States.. But, I'd sure rather take my chances on an American ski slope -- at least for now. A recent Canadian visitor to my area remarked how thankful they were to have had their heart attack in the U.S., because in Canada, they would have died. (Here, they had emergency cardiac catheterization and bypass surgery.)
So, Mr. Neeson, perhaps, when the pain of the immediate tragedy is past, if you wish to do some good in your wife's memory, perhaps you could stand up for private free market non-government medicine. Look around the world. Look in detail. Don't be fooled by the theory-spouters who don't actually see patients.
Talk to doctors outside of the big centers, such as the oncologist in Sweden who sees 12 patients a day in spite of the line of patients waiting to be seen. He doesn't get paid any more after the twelfth patient. Ask the surgeons in Canada who have too few operating rooms available to do surgery, and who spend three months a year in Florida because their income is capped. Ask the Mexican in the free government-run hospital whose hip fracture is being treated by massage because they have neither equipment nor doctors.
Then come back and remind whoever will listen that it is profit, and the free practice of medicine, which makes medevac possible and puts a neurosurgeon within reach.
Lee Hieb is an Orthopaedic Surgeon, in solo private practice. Her first-hand experience in medicine began in the 1950s, when she accompanied her father on his housecalls in Iowa.
http://www.humanevents.com/search.php?author_name=Dr. Lee+Hieb
Did Natasha Richardson Have to Die?
by Dr. Lee Hieb (more by this author)
Posted 03/24/2009 ET
Liam Neeson, one of my favorite actors, experienced a great tragedy last week in the death of his wife, actress Natasha Richardson. I don't usually pay too much attention to celebrity lives, but having two teenage boys similar in age to hers, I found Natasha Richardson's death especially poignant.
As a mom, I must express my sorrow for the family's misfortune. And as a physician, I have to ask: what can be learned in this case?
For the two or three Americans who haven't read the details, Natasha's death was the result of a head injury while skiing -- not a high speed Sonny Bono-type wipe out, but apparently a fairly innocent fall during a lesson. She developed an intracranial bleed, and by the time she was able to receive the necessary level of care in Canada, her intracranial pressure was excessive and ultimately fatal.
The easiest lesson is to wear a helmet on the slopes. (As a snowboarder, I have been wearing one for years, but I notice that skiers over the age of 10 generally don't think it necessary.) But that's not the big lesson here.
As reported by the Associated Press, Montreal's top trauma neurosurgeon cited the lack of emergency helicopters as a contributing factor in the death. "Our system isn't set up for traumas and doesn't match what's available in other Canadian cities, let alone in the States," said Tarek Razek, director of trauma services for the McGill University Health Centre.
Secondly, even after arriving in Montreal, the patient had to be transported by land to yet another facility where a neurosurgeon was available. Now, this is not some podunk little community hospital area -- this is a major metropolitan center without air medevac, and apparently without adequate neurosurgical capability, or at least a system of trauma triage.
I have never been to a ski slope in America that didn't have medevac capability. And, we have a trauma system to facilitate appropriate and timely transport to those facilities which can care for head trauma.
Fifteen years ago, we had enough neurosurgeons and trauma surgeons to staff our hospitals round the clock. For most large metropolitan areas, we still do. I don't live in a major metropolitan city like Montreal. I don't work in a university center like McGill. But even in my city of 100,00 people with its community hospital, we have medevac helicopters at all hours.
We have CT scanners positioned next to the Emergency Room to scan trauma patients on the way to the Operating Room -- usually within minutes. And if this particular type of head trauma occurs, we can transport the patient to a neurosurgeon within an hour. Canada has ground ambulance and CTs which are in need of parts.
Canada has government-run medicine, which, like every other government program, is inefficient and ineffective -- especially in this sort of emergency when seconds count. It is generally true of socialized government-funded medicine that low-end care is cheap and available, but high-level care is underfunded and available only after a long wait, or to those privileged to jump the line.
Low-level care requires a minimum of technology and can be applied by less trained providers. (President Obama said that the provider gap developing in our country will be filled by Nurse Practitioners and Physician Assistants. There may have been P.A.s and Nurse Practitioners in the first hospital to which Natasha was taken, but, unfortunately, these lesser trained providers do not take the place of neurosurgeons, or any other specialists.)
Government-run medicine mostly treats ideology by emphasizing "prevention," lifestyle counseling, and free clinics for VD, abortion, and the common crud. It is free "feel good" medicine that convinces the masses -- especially young people who are generally healthy -- that government medicine is great. It treats the 90%, but woe unto you if you are the 10% who need real high tech treatment quickly.
Epidural bleeds are a very dangerous, so I cannot say with 100% conviction that Ms. Richardson would have been saved in the United States.. But, I'd sure rather take my chances on an American ski slope -- at least for now. A recent Canadian visitor to my area remarked how thankful they were to have had their heart attack in the U.S., because in Canada, they would have died. (Here, they had emergency cardiac catheterization and bypass surgery.)
So, Mr. Neeson, perhaps, when the pain of the immediate tragedy is past, if you wish to do some good in your wife's memory, perhaps you could stand up for private free market non-government medicine. Look around the world. Look in detail. Don't be fooled by the theory-spouters who don't actually see patients.
Talk to doctors outside of the big centers, such as the oncologist in Sweden who sees 12 patients a day in spite of the line of patients waiting to be seen. He doesn't get paid any more after the twelfth patient. Ask the surgeons in Canada who have too few operating rooms available to do surgery, and who spend three months a year in Florida because their income is capped. Ask the Mexican in the free government-run hospital whose hip fracture is being treated by massage because they have neither equipment nor doctors.
Then come back and remind whoever will listen that it is profit, and the free practice of medicine, which makes medevac possible and puts a neurosurgeon within reach.
Lee Hieb is an Orthopaedic Surgeon, in solo private practice. Her first-hand experience in medicine began in the 1950s, when she accompanied her father on his housecalls in Iowa.
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The President does not advocate a single payer system, nor "socialized government-funded medicine." His plan makes certain that the 43 million currently uninsured are able to receive medical care.
The current system is untenable. The primary cause of the budget deficit projections going out more than 5 years are health care costs for the baby boomers.
Those that want the system to continue unchanged have their heads buried in the sand. Universal coverage, combined with unbridled current healthcare spending, will leave us with unprecedented deficits. Up till now, politicians have not have the willingness to expend their political capital to address this issue.
We need to get involved, and help shape the next system. The one we have currently in place is not financially viable, and every year we pretend it is will make the ultimate resolution that much more traumatic when implemented.
The current system is untenable. The primary cause of the budget deficit projections going out more than 5 years are health care costs for the baby boomers.
Those that want the system to continue unchanged have their heads buried in the sand. Universal coverage, combined with unbridled current healthcare spending, will leave us with unprecedented deficits. Up till now, politicians have not have the willingness to expend their political capital to address this issue.
We need to get involved, and help shape the next system. The one we have currently in place is not financially viable, and every year we pretend it is will make the ultimate resolution that much more traumatic when implemented.
I agree that the current healthcare system is running in the red. But i think we need to be more specific about where the costs are, and for who. For example, should an LSO that costs $200 or less be billed and reimbursed $1200 by Medicare? And this isnt even counting the fraud we have come to know about through the many recent busts such as HIV infusion and home health care.
I dont know much, but certain information i receive makes me think we arent the problem. FSIPP sent out an email a few months back stating something along the lines of physicians only make up a small amount of the costs, like 15% or something like that. Also we need to be clear of how we define the expensive healthcare spoken about. Is it emergency care, is it office visits, is it hospital visits, is it pharmaceuticals, is it physical therapy? I dont see how MC paying ~$150 for a 99254 initial hospital visit is going to bankrupt the system. I can however see how ER doctor's are given the support of Florida law by forcing private insurance to pay usual and customary, which was recently taken to court, and the figure agreed upon was 259% of Medicare. So now that $150 is almost triple at $450 or so for someone under 65. Of course the ER doctor doesnt need to be contracted with any private insurance company. Yet for a different patient with say medicaid, he is paid what Medicaid pays (probably around $100). And dont get me started on hospital charges/bills being what they are.
Am i wrong on this? I appreciate any education on the subject.
I dont know much, but certain information i receive makes me think we arent the problem. FSIPP sent out an email a few months back stating something along the lines of physicians only make up a small amount of the costs, like 15% or something like that. Also we need to be clear of how we define the expensive healthcare spoken about. Is it emergency care, is it office visits, is it hospital visits, is it pharmaceuticals, is it physical therapy? I dont see how MC paying ~$150 for a 99254 initial hospital visit is going to bankrupt the system. I can however see how ER doctor's are given the support of Florida law by forcing private insurance to pay usual and customary, which was recently taken to court, and the figure agreed upon was 259% of Medicare. So now that $150 is almost triple at $450 or so for someone under 65. Of course the ER doctor doesnt need to be contracted with any private insurance company. Yet for a different patient with say medicaid, he is paid what Medicaid pays (probably around $100). And dont get me started on hospital charges/bills being what they are.
Am i wrong on this? I appreciate any education on the subject.
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we can argue about specifics all night. Want to do just a little - rather than picking out the low end, what about the total cost of a trial and permanent dual lead scs system performed in a physician-owned ASC or hospital. Now multiply that by the number of guys in your community we know are doing far more than they should (most of them are the most active ASIPP members, btw). Still don;t think we contribute to the problem? You are kidding yourself. Facility fees, and overutilization, are where we, as a field, are most egregious
I would argue that the free market gave birth to SCS generators, and they(Medtronic and ANS etc) should charge whatever the free market allows. I dont do SCS anymore so i cant comment on costs. But what costs more?....the materials or the labor? Arent the generators about $20K at least? And how do you factor in that the SCS reps can make $250k/year?
That article is full of inaccuracies. First of all, she was only hospitalized in one hospital in Montreal (sacre-coeur) which btw is part of the University of Montreal, not McGill. She was transferred from St.Agathe which is a small hospital in the Laurentians where they *did* do a CT scan (of course!) which is how I'm guessing they determined she needed neurosurgical/trauma intervention at a major center. The reason for the delay is that the patient in compos mentis refused to be transferred until 3-4 hours after she fell, and actually turned away the ambulance. A helicopter would have maybe saved 20-30mins at most in transportation time once the decision was made. I highly doubt that would have made a difference. Of course if she had fallen down in the center of a big city things might have been different, but it's just a fact that people in rural areas in any part of the world have less access to specialized care.
Secondly, if the Canadian health care system is so crappy, how come the average life expectancy is 3 years higher and the infant mortality rate is lower?
It was an unfortunate outcome due mainly to the nature of the injury. It's easy to use socialized medicine as a scapegoat but it really doesn't fly in this instance.
I reread the article a few times, and i cant find where they said anything about McGill and this patient except....Montreal's top trauma neurosurgeon cited the lack of emergency helicopters as a contributing factor in the death. "Our system isn't set up for traumas and doesn't match what's available in other Canadian cities, let alone in the States," said Tarek Razek, director of trauma services for the McGill University Health Centre. So he was quoted, but wasnt specifically involved in her care....nor was the McGill Univ.
The article does state she was in Montreal, but it isnt clear if she was at more than one facility in Montreal.....was there not a neurosurgeon in Montreal?Secondly, even after arriving in Montreal, the patient had to be transported by land to yet another facility where a neurosurgeon was available. Now, this is not some podunk little community hospital area -- this is a major metropolitan center without air medevac, and apparently without adequate neurosurgical capability, or at least a system of trauma triage.
The article also did not mention anything about the timing of a CT scan in her case except....We have CT scanners positioned next to the Emergency Room to scan trauma patients on the way to the Operating Room -- usually within minutes. And if this particular type of head trauma occurs, we can transport the patient to a neurosurgeon within an hour. Canada has ground ambulance and CTs which are in need of parts.
I can see where the article may seem to imply those things, but i dont see them as inaccuracies. I do agree that the article leaves out a very important detail about her refusing to be transferred.
About your other points....life expectancy and mortality are complex; it's hard to specify that the system itself has anything to do with it.
The article does state she was in Montreal, but it isnt clear if she was at more than one facility in Montreal.....was there not a neurosurgeon in Montreal?Secondly, even after arriving in Montreal, the patient had to be transported by land to yet another facility where a neurosurgeon was available. Now, this is not some podunk little community hospital area -- this is a major metropolitan center without air medevac, and apparently without adequate neurosurgical capability, or at least a system of trauma triage.
The article also did not mention anything about the timing of a CT scan in her case except....We have CT scanners positioned next to the Emergency Room to scan trauma patients on the way to the Operating Room -- usually within minutes. And if this particular type of head trauma occurs, we can transport the patient to a neurosurgeon within an hour. Canada has ground ambulance and CTs which are in need of parts.
I can see where the article may seem to imply those things, but i dont see them as inaccuracies. I do agree that the article leaves out a very important detail about her refusing to be transferred.
About your other points....life expectancy and mortality are complex; it's hard to specify that the system itself has anything to do with it.
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Medicine has not been a "free market" since Medicare was implemented. Manufacturers set prices, but reimbursement almost never reflects that, and is typically instead based on what Medicare will pay. Third party payers more and more pay a percentage of Medicare reimbursement rates.
Regardless of how they are come to, the issue is clearly not your three figure reimbursement for an E&M code. It is the 5-6 figure SCS code reimbursement.
All of us who run legit practices play within the rules of the system. The point I was trying to make is that the system is not viable as constituted. You can nit pick about one ER code in one state, but the greater issue is that the coming stresses on the overall system require that it be revamped in some way. Change is coming, whether we like it or not. This has been one of the third rails of politics, till the current administration decided to take it head on. What we can do is try and work to make the coming changes reasonable. If you chose to bury your head in the sand, and insist that the current system continue, then you will be forced to accept what is implemented in its place. I plan on voicing my opinion through legislators and the larger organized medicine entities.
Regardless of how they are come to, the issue is clearly not your three figure reimbursement for an E&M code. It is the 5-6 figure SCS code reimbursement.
All of us who run legit practices play within the rules of the system. The point I was trying to make is that the system is not viable as constituted. You can nit pick about one ER code in one state, but the greater issue is that the coming stresses on the overall system require that it be revamped in some way. Change is coming, whether we like it or not. This has been one of the third rails of politics, till the current administration decided to take it head on. What we can do is try and work to make the coming changes reasonable. If you chose to bury your head in the sand, and insist that the current system continue, then you will be forced to accept what is implemented in its place. I plan on voicing my opinion through legislators and the larger organized medicine entities.
She may not outright say it but she implies very strongly it was McGill by referring to the university twice in the article, especially here: "I don't live in a major metropolitan city like Montreal. I don't work in a university center like McGill. But even in my city of 100,00 people with its community hospital, we have medevac helicopters at all hours".
That sentence about the CT scan obviously implies she never got one in the ER, otherwise why is the author going on about how the access to CT scans is so horrible? The patient DID get a CT scan in the ER in St.Agathe as soon as she reached it.
She was not in more than one facility in Montreal. She was in Sacre Coeur (major trauma center) and from there was sent to Lenox Hill. You can read it in the transcripts. Of course there are neurosurgeons in Montreal, give me a break.
Yes healthcare is a complicated topic, but the author makes it seem like getting treated in Canada is equivalent to a death sentence. Clearly this is not the case when the country spends way less on healthcare and has better outcomes overall.
That sentence about the CT scan obviously implies she never got one in the ER, otherwise why is the author going on about how the access to CT scans is so horrible? The patient DID get a CT scan in the ER in St.Agathe as soon as she reached it.
She was not in more than one facility in Montreal. She was in Sacre Coeur (major trauma center) and from there was sent to Lenox Hill. You can read it in the transcripts. Of course there are neurosurgeons in Montreal, give me a break.
Yes healthcare is a complicated topic, but the author makes it seem like getting treated in Canada is equivalent to a death sentence. Clearly this is not the case when the country spends way less on healthcare and has better outcomes overall.
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ASIPP Breaking News
April 14, 2009
SUPREME COURT UPHOLDS INJUNCTION IN CRNA SCOPE OF PRACTICE
We are pleased to announce that the Louisiana Supreme Court has denied the writs filed by the Louisiana State Board of Nursing (LSBN), Louisiana Association of Nurse Anesthetists (LANA) and the American Association of Nurse Anesthetists (AANA). This ruling means that the permanent injunction issued by the 1st Circuit Court of Appeal is now final.
In December 2008, the LSBN with the support of the LANA/AANA appealed the December 23, 2008 favorable ruling for the Spine Diagnostics Center of Baton Rouge by the Louisiana Court of Appeals. The case has been in the courts since 2005.
J. Michael Burdine, on behalf of the Spine Diagnostics Center of Baton Rouge, first brought the case to the courts in an effort to halt the practice of interventional pain techniques by non-physicians, specifically in this case by CRNAs. Subsequently the Louisiana Society of Interventional Pain Physicians (LSIPP) and American Society of Interventional Pain Physicians (ASIPP) became principal supporters in the case.
Over the years many organizations and individuals have supported the case through testimony, filing of Amicus Briefs, financial support , and time. Thanks to all who have worked tirelessly to see this case to the end.
ASIPP is pleased to have had the opportunity to work with the many dedicated individuals in the fight to preserve interventional pain management and most importantly, to uphold patient safety.
[email protected]
April 14, 2009
SUPREME COURT UPHOLDS INJUNCTION IN CRNA SCOPE OF PRACTICE
We are pleased to announce that the Louisiana Supreme Court has denied the writs filed by the Louisiana State Board of Nursing (LSBN), Louisiana Association of Nurse Anesthetists (LANA) and the American Association of Nurse Anesthetists (AANA). This ruling means that the permanent injunction issued by the 1st Circuit Court of Appeal is now final.
In December 2008, the LSBN with the support of the LANA/AANA appealed the December 23, 2008 favorable ruling for the Spine Diagnostics Center of Baton Rouge by the Louisiana Court of Appeals. The case has been in the courts since 2005.
J. Michael Burdine, on behalf of the Spine Diagnostics Center of Baton Rouge, first brought the case to the courts in an effort to halt the practice of interventional pain techniques by non-physicians, specifically in this case by CRNAs. Subsequently the Louisiana Society of Interventional Pain Physicians (LSIPP) and American Society of Interventional Pain Physicians (ASIPP) became principal supporters in the case.
Over the years many organizations and individuals have supported the case through testimony, filing of Amicus Briefs, financial support , and time. Thanks to all who have worked tirelessly to see this case to the end.
ASIPP is pleased to have had the opportunity to work with the many dedicated individuals in the fight to preserve interventional pain management and most importantly, to uphold patient safety.
[email protected]
