Unfortunately, the answer may be no, according to a study published in The Journal of Pediatrics.

The study makes it appear that insurance coverage may play a vital role in the care children get.

Researchers from Children’s Hospital Boston found:

• compared to children with private insurance, those with public insurance (Medicaid or CHIP) or no insurance were 22% less likely to be tested or have a procedure when they went to the emergency room, and
• children who didn’t have insurance were less likely to receive any medication than those with public or private insurance.

However, these findings didn’t hold true for children diagnosed with a significant illness.

The study was based on an analysis of emergency department (ED) visits recorded in the National Hospital Ambulatory Medical Care Survey from 1999-2008. It’s based on approximately 33,000 annual visits.

So what’s the reason for the treatment disparity?

The study authors gave some possible explanations for it:

First, children with private insurance are 11 times more likely than children without insurance or with public insurance to have a primary care physician (PCP). Therefore, when children with insurance go to the emergency room (ER) they are usually referred there by their PCP with instructions from the PCP for a specific workup, including extra tests and procedures.

Secondly, children with PCPs are less likely to go to the ER for non-emergency care.

Finally, parents who don’t have insurance or their children have public insurance are more worried about money and request fewer tests and treatments.

So are ERs skimping on care to uninsured and publicly insured kids because private insurance pays more so those kids get more attention?

It’s highly unlikely. The clinicians that work in the ER don’t know whether a child has private insurance, Medicaid or no insurance.

What do you think is the behind the treatment disparity in these patient populations? Share your opinions in the comments area below.

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Thanks to the skilled medical professionals who perform these surgeries, along with advanced medical technologies, mortality rates and complications have been significantly reduced. But despite ongoing medical advancements, there are still procedures that present high risk for complications during the procedure or recovery period.

Here’s a list of the 10 riskiest medical procedures:

10. Bariatric surgeries/Gastric yypass

As with many other major surgeries, there are risks that patients take when electing to undergo them, but these patients’ excessive weight poses even more threats. Surgeons have a harder time operating and must use special instruments because internal organs are often hard to separate and have may layers of slippery fat surrounding them. These patients also have an increased risk for complications with anesthesia, because it’s often difficult to insert the tube into their airways, and drugs or anesthetic gases may need to be given in higher dosages because they are easily absorbed by fat. Breathing must also be closely monitored before, during and after the surgery, as these patients have a higher risk of developing of pneumonia.

9. Septal Myotomy

This surgical procedure is performed to reduce the thickening of the heart muscles, a symptom of patients diagnosed with advanced stages of a complex type of heart disease called hypertrophic cardiomyopathy (HCM). This is a complicated procedure because it requires the patient to be placed on cardiopulminary bypass, or the “heart-lung machine”, so that the surgeon can work on a still heart. In total, this surgery can last anywhere from 3 to 6 hours, and the recovery period requires a stay in the Intensive Care Unit.

8. Pancreatectomy

This procedure comes along with a fairly high risk of complications. In fact, a Johns Hopkins study documented complications in 41% of pancreatectomy cases. These include serious problems like post-operative bleeding, delayed gastric emptying — a condition in which food and liquids are slow to leave the stomach — internal anastomatic leaking. The good news is that in recent years, the mortality rate for this procedure has decreased to a range of 5-10%.

7. Thoracic Aortic Dissection Repair

Aortic dissection, or a tear in the innermost layer of the heart, can trigger a number of high-risk complications like heart failure, stroke or even a rupture of the aorta, making its repair vital to the survival of the patient. Immediate treatment is required and this often results in the surgeon removing the area of dissected aorta and rebuilding the blood vessel with a synthetic graft.

6. Esophagectomy

This is a major surgery which carries a lot of risk because of the reconstruction of the area between the stomach and the healthy part of the esophagus. Three different methods of this surgery can be performed depending on the patient’s condition, but they all carry with them serious risks, such as a leakage of the fluid from the stomach or esophagus where the new connection was made. Despite the risks, most patients recover well and have few complications.

5. Bladder Cystectomy

This procedure is most often performed to remove a part of, or the entire urinary bladder, in patients diagnosed with bladder cancer. The major risks for this procedure are the highest for an infection of the intestine which can lead to peritonitis or the inflammation of the membrane lining the abdomen. For procedures that remove only a part of the bladder, there is a high risk for urine leakage from the bladder incision site, which can cause a number of other internal problems.

4. Coronary Revascularization

Also known as coronary artery bypass grafting (CABG), this procedure reroutes the blood around one or more clogged coronary arteries to help improve blood flow to the heart. New connections are made using arteries or vein grafts taken from another part of the patient’s body. For some patients whose ventricular function is failing too quickly, this surgery may not be an option because the risks are too high.

3. Spinal Osteomyelitis Surgery

There are a number of treatments that patients may undergo before requiring surgery to correct this spinal infection, but for those with spinal instability, significant deformity and/or neurological deficit, a paravertebral abscess causing sepsis, or any sized epidural abscess, emergency surgery is often needed. Infections of the spine are extremely destructive, and any surgical procedures performed on this area comes with a lot of risk, such as complete or partial paralysis, or other serious infections.

2. Surgical Ventricular Restoration

This procedure is done to treat congestive heart failure as a result of a heart attack in order to improve its function by restoring it to its normal size and shape. This, like any other heart-related surgery, is very risky because the patient is put on the heart-lung machine and major repairs are done to a very sensitive part of the body. Improvements in techniques have been made and the hospital readmission rate for a SVR is only 8.8%.

1. Craniectomy

Any type of brain surgery presents a high risk to the patient because the brain controls every function in the body. But a craniectomy presents even more risks. This procedure requires that the piece of skull removed to access the brain is not replaced after the surgery is complete, leaving fully recovered patients the risk of brain damage after the surgery if they do not properly protect their head. Depending on the area of the brain where this procedure will be performed, other serious risks like changes or loss in the functions of vision, mobility, speech, memory, coordination, and more can be permanent. Excessive build up of fluid in the brain, stroke, seizures, spinal fluid leakage, swelling of the brain, and more can also occur after the procedure, making this one of the highest risk surgeries.

Sources: surgery.com
mayoclinic.com
clevelandclinic.org
hopkinsmedicine.org

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Anna Brown had gone to three hospitals in the course of a week seeking treatment for a sprained ankle that had gotten increasingly painful — to the point that she was using a wheelchair to get around.Within hours of being kicked out of the last ER as a “drug-seeker,” she was found dead on the floor of her jail cell. Cause of death: blood clots that had traveled from her legs to her lungs.

Now her family would like to know just what went wrong.

Here first hospital visit, to St. Louis University Hospital, began last September 13. She stayed for two days for additional testing, but hospital officials said there was no indication at that point that she had a blood clot in her leg.

Four days after she was discharged, she arrived on crutches for what would turn out to be her final visit with her children, ages 11 and 2.

On Sept. 20, she went back to SLU Hospital complaining of knee and ankle pain. Doctors there said X-rays were negative and she was given painkillers — but she refused to leave the hospital, claiming that they hadn’t sufficiently treated her. After police arrived, she wheeled herself to a nearby pediatric hospital. Doctors there found she had significant tenderness in both legs. Eventually she was taken by ambulance to St. Mary’s Hospital in Richmond Heights, Missouri.

Doctors there said that ultrasounds of both legs were negative for blood clots. A social worker at the hospital gave her a list of local shelters and a number to call for transportation. Brown left, but returned within a few hours, complaining of continued pain. The hospital discharged her at 7 a.m., but Brown refused to sign the papers.

Shortly after, the hospital called police to have her arrested for trespassing. Brown complained repeatedly that she was in severe pain, could not stand and needed further medical care. Instead, a doctor at the hospital issued a “Fit for Confinement” report, indicating that Brown was well enough to be arrested.

Police had to literally pull Brown from the patrol car and into jail. Notes in her booking report listed “suspected drug use” and “unknown leg pain.” Brown was carried into a cell and left on her back on the floor of the cell.

An officer monitoring the cell by camera noted that she was moaning and moving slightly — until she stopped moving around 2 p.m. The officer thought she had fallen asleep. Fifteen minutes later, she was found unresponsive and attempts to revive her failed. She was taken back to St. Mary’s where she was declared dead.

Autopsy results showed no drugs in her system.

Brown had gone through a rough patch in life in the year leading up to her death: One home was destroyed by a tornado, she lost her job and then her second home was condemned. She was left homeless, and unable to care for her two children who were taken in by her mother.(State child protective services were supervising the children, and wouldn’t allow Brown to live in the home with them).

Brown passed required drug tests, but results of a screen for mental or behavioral illnesses was inconclusive. She resisted a court-ordered psychological evaluation because, according to her caseworker, she didn’t understand how it differed from the other tests she had undergone.

It’s debatable if Brown, homeless and seemingly mentally unstable was simply pigeon-holed as yet another drug-seeking scam artist in the ER. For it’s part, St. Mary’s says a review of her medical records indicates that it did everything correctly in terms of trying to diagnose and treat her and that is simply a case of a missed diagnosis.

Brown’s family is less certain. They’ve hired a lawyer to investigate the matter, but as of yet have not filed suit. The family feels strongly that Brown’s complaints were not taken seriously by at least some of the health care professionals who treated her. Her sister, Krystle Brown said in a statement to the local media: “My sister is not here today because people passed judgment.”

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A Texas nurse was sentenced to life in prison after being found guilty of killing five of her patients with bleach injections.

Kimberly Saenz, a former nurse at a dialysis clinic in Lufkin, Texas, was convicted on five capital murder charges. She was also sentenced to three 20-year terms for aggravated assault related to other patients who were injured in similar attacks.

Saenz’s attorney had argued during the trial that the deaths were the result of chronic problems with improper cleaning of equipment at the clinic, and that Saenz was being used as a scapegoat.

Jurors deliberated for 45 minutes before agreeing on a sentence. Saenz’s lawyer claimed that the jurors opted for a life sentence instead of the death penalty at least in part because prosecutors failed to show that she was at any risk of committing future violence. He pointed to the fact that she had “behaved” in the past four years since the deaths as evidence that she was not a threat.

Prosecutors had said earlier that they would seek the death penalty, but didn’t specifically call for it during the sentencing phase. However the prosecution did make a point of reminding jurors that she had a history of stealing drugs from previous employers and had faked the results of some of her employment drug tests.

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For those who can afford it, privately paid, virtually made-to-order medical care isn’t a luxury, it’s a necessity. But it’s out of reach of most people: Membership fees alone to get access to a concierge practice can start at $1,500. With additional services such as round-the-clock access to doctors, house calls, overseas care, top-of-the-line equipment (at the practice and in the patient’s home if treating chronic illness) can easily bring the cost to $30,000 or more per year.

All of it out of pocket.

Expensive as it is, its growing quickly, as those with the means to pay for it say it’s worth the cost to know that they have quick and easy access to the best medical care possible. And some admit to enjoying the feeling of exclusivity. Patients at a concierge practice don’t have to worry about long ER waits for less-urgent problems or trying to hound an office for test results.

That exclusivity does create other problems though. Because of the intense level of time and attention provided to these patients, doctors in concierge practices by necessity have to limit the number of patients they can take on — hence the steep fees. But we’re already in the grips of a physician shortage — one that shows no sign of improving any time soon.

When concierge practices limit the number of patients they can see, less deep-pocketed patients have to scramble to be seen by already busy doctors in more accessible practices.

Do you think concierge care benefits those who can afford it at the expense of everyone else? Or is it just a basic market response to a need for more personalized attention? Share your thoughts in the comments.

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HCA, one of the largest for-profit hospital chains, has adopted such a policy. The outcome? More than 80,000 ER “patients” left the hospitals without being treated. How many left because of a lack of funds or from the realization that the visit wasn’t worth the $150 charge is impossible to say.

But HCA hospitals aren’t the only ones requiring cash before patients get treated. Fees can run as high as $350 a pop for the uninsured at some hospitals. And while it’s hard to argue that emergency medical care can’t be more efficient in general, not everyone agrees that this is a good way to handle patients.

Some ER docs and patient advocates say it hurts some patients, with little benefit to the hospitals. For example, patients with less serious illnesses are usually processed relatively quickly and without expensive tests or taking up needed beds.

What it does do is scare off the most indigent of the uninsured, who may have little other recourse for basic medical care. (Non-urgent patients with insurance would only have to pay their usual co-pay and whatever fees are associated with the treatment they eventually get.) Without timely treatment, uninsured patients may well end up back in the emergency department — this time with the type of urgent illness that allows them to bypass the “admission” fee.

Is it just plain good business to charge up-front fees for non-urgent care? Or is it just one more example of how the health system allows some people to fall through the cracks? Sound off in the comments.

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Williams and a friend are charged with third-degree invasion of privacy and third-degree conspiracy in a case that takes tastelessness to a new low. Prosecutors claim that Williams photographed the genitals of one of her elderly patients and sent the picture to her friend Michele Walker — and Walker promptly posted it on her Facebook page.

Williams has since been fired.

Need for more training? Or better training?

This isn’t the first time health care workers have taken to social media to discuss patients — and sadly, it won’t be the last.

It’s human nature for people to want to talk about the weird, irritating and funny things that they encounter on the job — and health care workers aren’t immune to that. But HIPAA regulations, not to mention basic human decency, require health care pros show a little more tact when discussing a typical day on the job.

Hospitals and medical practices already take great pains to hammer home the importance of maintaining patient privacy and the dangers of social media in a health care setting. Indeed, some hospitals have taken draconian measures. Yet the problem of patient info getting posted on social media sites — or just shared through various and ubiquitous PDAs — continues.

What’s do you think the solution is? More training — or different? Hiring people who are more respectful in the first place? Share your thoughts in the comments.

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That’s the disturbing takeaway of a recent survey of health care workers by the Agency for Healthcare Research and Quality (AHRQ). The survey looked at data from almost 60,000 staffers at more than 1,100 hospitals to measure how well the organizations had instilled a “culture of safety.” The results aren’t promising.

Most employees reported at least some reluctance to report safety incidents for various reasons. Among the findings :

• 50% of employees said they thought their mistakes are held against them by management
• 54% said that when an adverse event is reported, it appears the person involved is “written up” instead of the actual incident or problem
• More than half of respondents said they don’t feel safe questioning the safety actions of those with more authority, and
• 37% said they are afraid to ask questions about potential safety mistakes.

The findings are troubling: An environment where workers feel safe reporting potential safety issues is vital to any hospital that wants to improve. Even worse: The results of this survey haven’t changed in any significant way since it was first asked in 2007 — which means all the time and energy spent creating a “culture of safety” hasn’t done much to actually make employees feel safe speaking up.

What would it take for hospitals to make staffers feel truly safe in reporting safety issues? Share your thoughts in the comments.

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A recent study found that as many as 30% of doctors applying to obstetrics training programs made some “mistakes” about their credentials on their applications. Specifically, they took credit for being published in research journals that don’t appear to actually exist.

And many of those who had confirmed research published wrongly identified basic research and papers as a much more rigorous “peer-reviewed” study.

Those results are in line with similar prior studies in other specialties.

The researchers who conducted the study said that they hoped many of the errors were just that — honest mistakes — and not an attempt to embellish their credentials. But even in the best case scenario, such sloppiness and/or confusion from highly trained people who are charged with life-or-death decisions is troubling.

In the worst case, the docs assumed they could pull a fast one to make their application more impressive — and they may have succeeded.

The study was published in the most recent issue of Obstetrics & Gynecology.

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Ani Chopourian, a physician’s assistant, worked at Mercy General Hospital in Sacramento, California for about two years, until she was fired in 2008. Chopourian was part of the cardiac surgery unit.

She claimed in her suit that over the years she had filed numerous complaints with human resources regarding a variety of problems, such as a lack of breaks for the PA staff and a demeaning atmosphere for female staffers in general. Chopourian said she was singled out with derisive comments made about her ethnic background, and was repeatedly grabbed — sometimes in front of supervisors who laughed when she asked them for help. Among her claims, Chopourian said one surgeon in particular would greet her daily by slapping her butt and telling her, “I’m horny.”

Chopourian was eventually fired after the hospital said she failed to show up for work one day, and claimed she had been a problematic employee for some time. (Chopourian says she was on call that day, but never notified she was needed at the hospital.)

After the firing, Chopourian filed her suit against the hospital, claiming it created a hostile work environment and fired her to shut her up. Since then, she’s been unable to find other work.

Mercy Hospital management claimed during the trial that the only person who acted unprofessionally at Mercy was Chopourian — but the jurors didn’t buy it. She was awarded a whopping $168 million in damages — the largest finding ever for a single employee in a sexual harassment case. The jury awarded nearly $43 million for lost wages and mental anguish, and another $125 in punitive damages.

The hospital says it’ll appeal the judgment.

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