Helpless hospitals – and weekend “worriers” Medical Legislation 911?
Nowadays, an increasing number of “hospitals” are doing exactly what you’d do in the event of a medical emergency: They’re calling 911!
According to a recent New York Times article, the U.S. is home to more than 140 small specialty hospitals (dozens more are being built right now), many of which don’t have an emergency department. Or even a doctor on the premises 24/7.
These facilities are owned and managed not by large corporations, but by groups of doctors. They usually specialize in certain kinds of medicine – like cardiac surgery, spinal operations, hip replacements, and other things. The Times piece claims that these specialty facilities are getting a lot of criticism for being set up only to be able to offer the most lucrative procedures, or that they’re servicing only the most high-end patients from each of the doctor/owners’ practices
Now, normally I wouldn’t have any problem with this kind of thing. It’s the free market, after all. If a bunch of doctors want to get together and front the money for their own private hospital so they can get rich by performing only well-paying procedures for A- credit patients, then what’s the harm? I mean, as long as it’s compliant with the law, right?
Well, therein lies the problem. Apparently, “the law” is pretty vague about what a hospital’s requirements are for on-premises emergency care. For instance, the Times article quotes federal Medicare rules as saying only that a hospital must meet patients’ emergency medical needs “in accordance with acceptable standards of practice.” Whatever that means
But clearly, in the case of small specialty hospitals that are performing spinal surgeries or other types of operations that require spending one or more nights in a bed at the facility, there should be not only an attached full-service emergency department, but at least one doctor on site 24/7. According to the Times article, one such hospital in western Texas had to call 911 to transport patients to a nearby ED-equipped hospital 15 times in less than 2 years. At least one of those patients died
As much as I hate to recommend anything that increases the scope or power of government, for the protection of patients I think there should be more – and more specific – laws stipulating that sufficient emergency care be available at anything that calls itself a “hospital.”
But that’s not to say that the emergency care at full-service hospitals is infallible. Keep reading
Cardiac patients thank God it’s Friday (not Saturday or Sunday)
A recent study conducted by a fourth-year medical student concludes that – at least in the state of New Jersey – those unlucky enough to have a heart attack on the weekend were measurably more likely to die than those who’d suffered their coronaries during the week
Reported in the New York Times and based on analysis of more than 230,000 heart attack patients admitted to Garden State hospitals from 1987 to 2002, the study found that in the latter part of this time range (1999 to 2002), 12.9% of those hospitalized for heart attacks on the weekend died, while only 12% of those brought in for heart attacks during the week perished.
The Times piece characterizes this difference as a 1% greater likelihood of dying when hospitalized for a heart attack on the weekend as opposed to during the work-week. But I think this is an analysis error on their part. Comparing ONLY the likelihood of death from heart attack (irrespective of the total number of heart attacks) on weekends vs. weekdays, I find that there is actually a 7.5% greater chance of dying (12.9/12) from weekend coronaries than from weekday events
Whether this increase in mortality is due to hospitals underestimating their weekend heart attack loads, a lack of seasoned medical staff on-site (senior docs tend to have weekends off), or differences in the way people who have weekend heart attacks act on them is not clear.
But I’m betting it’s because of the green doctors that tend to get stuck with the weekend shifts while the veterans are at home playing with their kids
