It is now 2:42 in the morning and I am just getting home

after being up since a little before 7 am and going into work early due to my schedule being adjusted so I could go get an allergy shot after work, which I did. I then picked up some toilet paper from my apartment and ran it over to my friends' as they were out, ate some Morningstar Farms tomato basil pizza burgers and macaroni and cheese, watched a few things with YKWIA, and took A on a very long and grueling run to the grocery store (it was a two-cart run). I fixed YKWIA some dinner, and we watched some 'Grace and Frankie' and the beginning of the second season of 'House of Anubis'. Then YKWIA and I made four (count them, four) traditional derby-style pies for A's picnic tomorrow. We just finished a short while ago. They're in the pantry cooling on racks.

So now I'm home, and very, very tired. I am also very poor at the moment, and just raided a coin-collecting book that had about $5 worth of state quarters in it so that I could pay for parking tomorrow, as I need to go visit my mom, who's in a hospital here in Lexington. My stepfather called me earlier to let me know. I'm worried about her; this is the second hospitalisation in two months. Hopefully everything will be alright.

Okay, I have a little spinach-artichoke hummus and pita in me now. I'm heading to bed, after one more short post. Good night.

Wow. That's awful.

Grandmother wrongly declared dead, frozen alive in hospital freezer before struggling to escape

Maria de Jesus Arroyo was moved into a morgue freezer while she was still alive, court documents claim. She froze to death while trying to break free from her body bag. The family intends to sue.

There is nothing quite

like coming home and finding a past due hospital bill in your mailbox that is an error to the tune of nearly $10,000, a bill has been sent for review supposedly, and then to find that they close their customer service department down early on Fridays and you've just missed them. Grrrr.... I hope they haven't reported it to a credit bureau yet, as it really is a mistake. They took the part that is written off due to their insurance contract after my insurance paid them and then tried to bill me for it. My part is a co-pay that I already paid on the day of my surgery. They have officially annoyed me.

In the last couple of days, I've read two selections

from the same book. I must say, I think it would be good to read it, not just you or I, but the people who make policy, run hospitals, and generally have a business with health care.

The book is by Dr Marty Makary, is called Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care, and it was published this month.

Here is one excerpt:

How to Stop Hospitals From Killing Us: Medical errors kill enough people to fill four jumbo jets a week. A surgeon with five simple ways to make health care safer.

and here's the other:

Are Hospitals Less Safe Than We Think?

This is why those of us who work in hospitals go through the drills

At hospital hit by twister, panic but also professionalism: Dozens sought protection; some staff 'were hurt, but they worked all night long'

"I spent most of my life at that hospital," emergency room physician Dr. Jim Roscoe said, his voice cracking. "It's awful. I had two pregnant nurses who dove under gurneys. I had staff who showed up. They were hurt, but they worked all night long. It's a testimony to the human spirit."

In the terrifying minutes before the twister struck, the hospital declared a "Condition Gray," and patients, relatives and staff members were told to leave their rooms and go into stairwells and other protected interior parts of the building.

Despite what hospital officials said was at least 10 minutes' warning inside the building before the tornado hit, Roscoe said at least five of the 116 people who died in the tornado in Joplin were killed at St. John's. He said he did not know if the victims were patients or staff members.

At our hospital, we call it a tornado warning rather than giving it a colour code. I think that's more direct and gives patients, visitors, and families better information. Like most hospitals, we have drills and specific policies to help guide us in case of various disasters, and we receive continual training to protect those in the building. But we're also a very small hospital--50 beds and primarily patients are in our outpatient clinic; I can't wrap my head head around getting everyone to evacuate to the hallways in a multi-storey hospital with over 100 patients, not to mention the number of staff and visitors. What about the multi-building hospitals like Central Baptist here in Lexington? That must be a logistics nightmare. I don't envy their risk management team.

It sounds like the hospital did an excellent job under the circumstances. I'm sure in months to come (assuming they can rebuild), they will go through and analyze what happened and how things could be improved. Although some patients and a visitor (according to another report I saw) did die, it could have been so much worse.

Charities in this oeconomy struggle to provide care to those who need it

Caring for poor, hospitals reach brink of closure: Rising costs, budet cuts and recession dooming safety net hospitals

Two charity hospitals in Illinois are facing a life-or-death decision. There's not much left of either of them — one in Chicago's south suburbs, the other in impoverished East St. Louis — aside from emergency rooms crowded with patients seeking free care. Now they would like the state's permission to shut down.

The institutions, which have served low-income people in the state for more than 100 years, represent a significant development that's gone largely unnoticed as the nation climbs out of the recession. Many charity hospitals, already struggling with rising costs, are on the brink of failure because of looming budget cuts, increasing numbers of uninsured patients and a slow economic recovery.

If you think it's hard to turn a profit in this oeconomy, keep in mind how hard it is to make it when you're a charity relying on donations and endowments. I work for a such a charity that provides tertiary health care to children. Until recently, they paid for everything without any reimbursement from insurance or Medicaid, and had done so since the 1920s, with 22 hospitals around North America. But due to a number of factors, including the oeconomy, they are trying to survive by the acceptance of insurance so they will be able to continue their mission, but still without cost to the families in terms of co-pays or deductibles, providing the same excellent care they always have. It's a rather daunting prospect.

At least we provide specialised care. I can't imagine being in a neighbourhood where the only primary care hospital is forced to close because they simply cannot afford to stay open. When that happens the people who lose the most are those without the means to seek care at other hospitals. But it seems to me that this will drive up emergency visits and care that must be written off--and therefore health costs--up even further for everyone else. So no one wins. I hope those states that are so slow on their Medicaid payments who are killing their safety net hospitals realise that.

Protocol got in the way of saving a life

Man dies feet from ER after hospital says to call 911: Heart attack victim crashed car in parking lot, had to wait for ambulance to arrive to get help

Two police officers began CPR. A third went to the ER to notify them and was told to call emergency services. The hospital says it was unclear the man was having a heart attack and protocol calls for 911 to be called because in car crashes the victim may need to extricated. Trouble is, although they say they dispatched security guards with a defibrillator and a paramedic went outside, no one apparently provided medical help until the ambulance arrived except the police officers and the man died despite their efforts.

What a shame. I hope they investigate it thoroughly. I suspect there will be a lawsuit, and to be honest, in this case going by what the report says, I can't blame them.

I haven't found an update on the Romanian babies

But I did find this...

Romania, Bulgaria have EU's sickest health systems

In a revelation sure to add to the controversy, Bucharest Mayor Sorin Oprescu told reporters Monday that only three of Bucharest's 21 hospitals have a fire alarm system. It was unclear whether any have sprinkler systems, but Giulesti hospital — one of the capital's best, where the tragedy occurred — did not.

A massive shortage of medical staff, bribes to doctors and nurses to ensure better treatment, and chronic underfunding or high debts run by hospitals are everyday obstacles that patients need to negotiate. Supply shortages mean that operations sometimes do not get performed if patients do not supply their own bandages, syringes, surgical thread and antibiotics.

Sad. Scary.

Okay, I'm putting off work. Good night.

Something to check out

Solo librarian and outreach to hospital staff using Web 2.0 technologies.

Med Ref Serv Q. 2010 Jan;29(1):75-84

Authors: Landau R

The part-time librarian at Penn Presbyterian Medical Center (PPMC) serves physicians, staff, and students. Challenged by time constraints and the need for a physical presence in the library, the librarian sought methods requiring limited manpower and maintenance to reach out to users. The librarian utilized two Web 2.0 technologies, Delicious and Bloglines, to extend library services beyond the confines of the hospital intranet. This article details the process to implement these two technologies in the hospital setting. Informational resources about Web 2.0 technologies are included in the article.

PMID: 20391167 [PubMed - indexed for MEDLINE]

Thankfully, progress

Obama orders same-sex hospital visits: Gay, lesbian couples must be allowed visitors, medical power of attorney

The rule will affect any hospital that receives Medicaid or Medicare funding, which is the majority of hospitals in America.

Officials said Obama had been moved by the story of a lesbian couple in Florida, Janice Langbehn and Lisa Pond, who were kept apart when Pond collapsed of a cerebral aneurysm in February 2007, dying hours later at a hospital without her partner and children by her side.

Obama called Langbehn on Thursday evening from Air Force One as he flew to Miami, White House officials said. In an interview, Langbehn praised the president for his actions.

"I kept saying it's not a gay right to hold someone's hand when they die, its a human right," she said, noting that she and Pond had been partners for almost 18 years. "Now to have the president call up and say he agrees with me, it's pretty amazing, and very humbling."

The new rules will not apply only to gays. They also will affect widows and widowers who have been unable to receive visits from a friend or companion. And they would allow members of some religious orders to designate someone other than a family member to make medical decisions.

It reminded me of the case of Sharon Kowalski and Karen Thompson, a lesbian couple who were separated for years until Thompson finally won the right to care for Kowalski, who had been severely injured in a car accident.

It's good to know that other couples won't have to fight draining court battles to be with their loved ones. But there is a big caveat--hospitals have to respect the wishes of their patients but those wishes must be known. That's where advanced directives/living wills are so important in determining who has say over medical care. Remember--it's easy for something to happen that prevents you from conveying your wishes in an emergency.

We made it to the national news

I don't often talk about the place I work by name or give specifics. I'm going to break that trend today. We found out about this last week, but it's made it to MSNBC now, so I feel more comfortable about writing about the specifics.

Facing hard times, Shriners may close hospitals: Donations down for organization that provides free health care to children

The hospitals being considered for closure are: Shreveport, Louisiana (the original hospital); Erie, Pennsylvania; Spokane, Washington; Springfield, Massachusetts, Galveston, Texas (a burn unit that has still not recovered from Hurricane Ike) and Greenville, South Carolina. With the exception of Galveston, all are orthopaedic hospitals.

It's going to be a tough vote, and I'm not sure they'll be able to get it. If not, then the future of the system really is in doubt. But I hate seeing the others close. I've corresponded with other librarians (the one from Greenville especially gets hit with my interlibrary loan requests, and is very prompt and nice about it) over the years, too. Shriners really is a sort of family. Unfortunately, circumstances are making it very difficult to continue to provide free care for burns, orthopaedics, spinal cord injuries, and cleft palate, the areas in which we specialise.

They're doing what they can already, including shutting down some basic research centres, reducing hospital budgets, and reducing some benefits for employees. Everything is going towards trying to fund patient care itself.

In case you're not familiar with what we do, here's a blurb from our web page:

Shriners Hospitals for Children is a one-of-a-kind international health care system of 22 hospitals dedicated to improving the lives of children by providing specialty pediatric care, innovative research and outstanding teaching programs.

Children up to the age of 18 with orthopaedic conditions, burns, spinal cord injuries and cleft lip and palate are eligible for admission and receive all care in a family-centered environment at no charge – regardless of financial need.

For more about Shriners Hospitals for Children, see the main page for the hospitals. You can take a virtual tour of our facility, or tour other hospitals in the system, including Springfield, one of those being considered for closure. And not to do a shameless plug, but if you are interested in donating to this worthy cause, you can do so via the Ways to Give page. The charity consistently scores well in terms of percentage of monies that go directly to those served (in this case, patient care) as opposed to marketing and administration.

I've spent the last 12 years of my life working in this environment, and it truly is remarkable and rewarding. But with the future of the hospitals in doubt, I have to admit I am more than a little stressed about my future as well. The last time this came up for a vote it was shot down and there were cutbacks, including in my hours. Without closing the designated hospitals, they may vote to do a 30% cut across the board, with more layoffs--but risk destroying the system's viability itself.

And if I'm stressed, you can imagine that for the employees, families, and patients at these hospitals, it is much worse. We already have patients whose families (or the volunteer Shriner drivers) drive five hours or more to be seen. I know we get people as far away as Chattanooga, for example. I can't imagine driving from South Carolina for a doctor's appointment. That's pretty stressful in itself.

Anyway, I'm hoping for the best, whatever that may be.

As much as I hear Americans complain about emergency rooms...

it pales to the situation in Japan, which has a doctor shortage:

Injured man dies after rejection by 14 hospitals: Case of 69-year-old man in Japan underscores country's doctor shortage

The worst case, according to the article, was a woman in Tokyo who was denied care 49 times. She, too, was elderly, although I don't know if that's a factor or not.

A way to judge your hospital

Hospital death rates for key conditions unveiled

Hospital Compare allows you to find out death rates for individual hospitals by condition.

They also let you compare things like patient satisfaction and number of medicare patients treated for various conditions. Ours, being a tertiary-care facility, isn't in their database, but I checked other primary care facilities in Lexington. St Joseph (the main one) seems to have the highest patient satisfaction; Central Baptist seems to have a higher percentage of meeting standards of care. UK lags behind in both, but I'm not surprised. I'm not impressed by what I've seen of the university's health care system. I have a friend who works there. He never sees the same doctor twice. Their health insurance means they go through UK HealthCare, and there seem to be an inordinate amount of hoops to jump sometimes. I like the choices I have with my insurance better.

Frankly, I think this hospital's licence should be yanked

This made the news whilst I was incommunicado, but they've released some more information, so I thought I'd mention it here. It's horrible.

Woman who died on hospital floor called 'beautiful person'

On June 19th, Esmin Green, a native of Jamaica who had been involuntarily brought to King County Hospital in Brooklyn due to 'agitation and psychosis', died on an emergency waiting room floor after waiting nearly 24 hours for a bed. Security cameras show her falling off her chair and convulsing. At no time did staff respond to her distress. Then she went still. For nearly an hour she lay on the floor dead until finally someone came up and nudged the body wit a foot and called for assistance. By that time, it was far too late. On top of that, staff falsified the records regarding the timeframe, making it seem like she was sitting quietly in her chair at the time she died.

Seven members of the staff have been fired or suspended: the chief of psychiatry, chief of security, a doctor, two nurses and two security guards. I don't think that's enough. The hospital has a history of problems, including a recent lawsuit alleging a poor standard of care and lack of basic sanitation.

Did this woman die because she was black, because she was mentally ill, or because she didn't have any money, or simply because of an environment of neglect and malpractice? I don't know. They're still investigating how she died, for that matter. But this mother of six who came to this country for better opportunities found precious little on a cold hospital floor.