At 10:45 p.m. on Nov. 28, 2009, Joaquin Rivera went to the ED at Aria Health’s Frankford campus complaining of pain on the left side of his chest. At 10:56 p.m., security cameras show he stopped moving.

At 11:03 p.m., a hospital staffer went to the door of the waiting room, called his name and noticed that he was “staring” at the opposite wall.

No medical staff checked on his condition until another patient told a staffer that Rivera was dead — and his body had been robbed by a loiterer in the waiting room.

A state investigation determined that hospital staff weren’t properly trained on appropriate protocols for triaging and processing emergency patients.

Aria Health agreed to make a number of changes, including retraining staff on procedures, providing 24/7 security in the waiting area, and setting a time frame for recalling patients. The hospital will also mark with tape the spot in the waiting area to which staffers must walk when they’re checking on patients.

Stoned staffers roaming the halls present more than just the obvious risks to patients.

A recent case shows exactly how insidious the problem of an addicted employees can be to health care organizations.

A former surgery technician has pleaded guilty to product tampering and obtaining controlled substances illegally. The tech, formerly employed at Rose Medical Center in Denver, injected herself with Fentanyl — then reloaded the syringes with saline and put them back in the anesthesia carts. It was later proven that her actions infected 17 patients with Hepatitis C.

It’s no secret that a few troubled health care workers help themselves to the pharmacy stock when they have the chance. But some argue that having an automated dispensing unit (ADU) on every floor actually makes it harder to check the misuse of drugs.

ADUs are fairly secure — if they are frequently monitored and audited for discrepancies. The problem is they can give a busy workforce a false sense of security since all access is recorded. If too much time passes between audits, it can be hard to identify the root of the problem. And all the while, abuse of prescription drugs continues in hospital halls.

Another potential loophole for drug-seeking staffers: wasted meds. While these “returned” doses are tracked, they often are treated less securely since they can’t be put back on the pharmacy shelves. Unusual volumes or patterns of waste should be examined as closely as any other drug discrepancy is.

Do you think your organization has adequate controls in place to prevent/identify drug diversion tactics? Sound off in the comments.

The procedures took place at St. Joseph Medical Center in Towson, Maryland. The hospital is currently under investigation for health care fraud.

At federal investigators’ request, the hospital reviewed patient records and uncovered several hundred patients with “variances” in their medical histories. Essentially, they had minimal blockages for which stents were not an appropriate treatment. (Some of the patients appeared to have no blockages at all.)

According to the hospital, all of the unnecessary procedures were performed by Dr. Mark G. Midei. He stopped practicing and lost his hospital privileges last summer. Neither Midei nor the hospital have commented on the case, although Midei issued a statement saying he expects to be exonerated and resume his practice.

Not surprisingly, most patients aren’t pleased.

Patients who received the stents unnecessarily were exposed to risks from the actual procedure, and will have to take blood thinners for the rest of their lives — leaving them open to a number of additional risks. On top of that, many have said they’ve suffered adverse psychological effects from being deceived about having a serious cardiac condition.

However, some patients who received word that their blockages were smaller than they were told stand by the doctor, saying their symptoms have improved.

An estimated 275,000 people will die in the next decade because of a lack of health insurance. That’s the conclusion of a new report by Families USA.

The report is in line with other research that pinned deaths due in part to lack of health insurance at 18,000 in 2000 (Institute of Medicine), and 22,000 in 2006 (Urban Institute).

The reason: Uninsured patients are less likely to get regular check-ups and screenings that can catch serious conditions when they’re more treatable. The uninsured are also more likely to forgo or skip treatments, like getting prescriptions refilled, due to the extra costs.

The report is likely a conservative estimate — it calculated that uninsured patients’ mortality rates are 25% higher — but other, more recent research shows death rates increasing by closer to 40%.

According to the report, roughly 64% of the deaths are projected to be in just 12 states. They are:

• California (34,600)
• Texas (31,700)
• Florida (25,400)
• New York (13,900)
• Georgia (11.500)
• North Carolina (9,600)
• Illinois (9,400)
• Ohio (8,900)
• Louisiana (7,700)
• Michigan (7,600)
• Pennsylvania (7,500), and
• Tennessee (7,500).

BJC HealthCare, a St. Louis-based affiliate of the Washington University School of Medicine, was looking to significantly increase the number of staffers who got the flu vaccine. In 2006, 54% of BJC employees were vaccinated — higher than the national average, but far below the hospital’s goal of 80%.

BJC already offered the vaccine for free to employees and also had an education/incentive program in place to encourage them to make use of the program.

The health system took a series of steps each year that gradually increased the number of employees who got vaccinated:

In 2007, employees who declined to get the shot were asked to sign a form indicating  they knew the risks that presented to them, their families and patients. That year the vaccination rate shot up from 54% to 71%.

In 2008, BJC made vaccinations mandatory for any employee who didn’t get a medical or religious waiver. At the same time, the hospital stepped up its education campaign. That year, 98.4% of employees were vaccinated.

Among those who didn’t get the vaccine, 0.3% had a religious waiver, and 1.2% received a medical waiver  — usually due to a history of either allergic reactions or Guillain-Barre syndrome.

Interestingly, many of the people who applied for a medical waiver were confused about their actual risk: Several employees cited asthma or a suppressed immune system as reasons to skip the vaccine. Of course, those are two conditions that put people in the high-risk group for flu and make it even more important to get vaccinated.

According to a Jackson Healthcare poll of physicians conducted by Gallup, 73% of doctors said they had practiced defensive medicine in the past year by ordering tests or procedures that could protect them from frivolous malpractice lawsuits.

The respondents indicated those extraneous procedures accounted for 26% of total health care spending.

The poll was co-sponsored by the Center for Health Transformation.

Of course, one person’s “frivolous” procedure is another’s way of investigating all possible diagnoses. And while unneeded procedures may give physicians an apparent safety net, all procedures and tests carry some risk to the patient. A negative outcome from a less-than-necessary test could actually open the door to a malpractice lawsuit.

Are you seeing widespread defensive medicine in your organization? If you are — do you think it’s understandable and ethical? Share your experiences in the comments.

According to the latest numbers from the Bureau of Labor Statistics, in 2009, 13.6% of workers in the “Healthcare Practitioner and Technical Occupations” group were union members. That’s more than 960,000 workers. In 2000, 12.9% of health care workers (approximately 693,000 total) were union members.

The “healthcare”  group includes doctors, dentists, veterinarians, nurses, and other therapists and technicians. But most of the growth in union membership has been among nurses and other non-physicians employed in hospitals.

Looking at the numbers, it’s clear that some of the growth comes from the health care sector simply adding a lot of jobs. But current economic and political trends are making union membership more attractive to many workers.

Between the cost-cutting measures that often ask workers to do more work for the same pay and uncertainty about how health reform may affect their jobs/salaries, workers are more likely to see union protections as appealing.

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That’s the conclusion of a new study by the Robert Wood Johnson Foundation. The researchers studied 69 million discharge records from 2006 for hospitals in 40 states.

According to the study, patients who developed pneumonia stayed in the hospital an average of 14 extra days. Their increased treatment costs were approximately $46,000 per patient. Of those patients, 11% ultimately died from the infection.

Patients who acquired sepsis stayed in the hospital an extra 11 days, at a cost of an additional $33,000. The infection was fatal for 20% of patients.

The study was published in the Archives of Internal Medicine.

An Arkansas doctor has been charged with planting a car bomb intended to kill the chair of the review board. The accused doctor had previously tangled with the board regarding over-prescribing of patients. 

On the morning Feb. 4, 2009, Dr. Trent Pierce, the chair of the Arkansas State Medical Board walked to his car to drive to work. A stray spare tire had been mysteriously placed next to the driver’s side door. When Pierce moved it out of the way, a homemade bomb detonated.

Pierce was left with multiple shrapnel wounds, broken bones, and severe burns. He also lost his left eye, the hearing in his left ear, and his sense of smell. He now walks with a cane.

A grand jury indicted Dr. Randeep Mann for the bombing and related charges of illegally possessing 98 grenades. A secondary charge for possessing contraband chloroform in prison was recently added. Mann is a licensed weapons dealer/collector and also legally owned a grenade launcher, 110 machine guns and a variety of other weapons.

Prosecutors allege that Mann targeted Pierce after a series of hearings in front of the medical board had gone against him.

In 2003, Mann’s license to prescribe was suspended for one year for over-prescribing. In 2006, the license was indefinitely suspended. By then, a total of eight patient deaths had been linked to inappropriate or over-prescribing of painkillers by Mann.

At a 2007 hearing in which Mann attempted to have his license restored, Pierce bluntly told him that further efforts to have his license reinstated would be fruitless.

If convicted, Mann faces up to life imprisonment and fines of up to $250,000 on the weapons charges.