More on Ottumwa

From the Cedar Rapids Gazette

Federal officials said they plan to revoke Ottumwa Regional Health Center’s Medicaid and Medicare reimbursements next month even though the hospital is appealing a ruling that it mishandled an emergency psychiatric patient.

The U.S. Centers for Medicare and Medicaid Services determined that the hospital improperly discharged an emergency room patient with an unstable medical condition.

Ottumwa Regional CEO Lynn Olson denied the allegations.

David Werning, spokesman for the Iowa Department of Inspections and Appeals, said the Ottumwa case “is an extraordinary circumstance.”

“I can understand the hospital trying to minimize or put their best spin on this thing, but I don’t think it’s necessarily fair for them to try to downplay the seriousness of these particular episodes,” he said.

An April inspection at the hospital resulted in an allegation that it had repeatedly failed to take night-time referrals of psychiatric cases from other hospitals.

The answering service for the hospital’s psychiatrists was allegedly under instructions to “hold all calls” from referring hospitals between the hours of 10 p.m. and 10 a.m. One of the psychiatrists allegedly explained to inspectors, “We were getting tired of receiving so many calls during the night.”

Hospitals Becoming More Hospitable

From the Nashua Telegraph

A Beanie Baby that Michelle Fagan’s daughter received during a visit to the emergency department at St. Joseph Hospital for stitches several years ago led to a new hospital practice: St. Joseph-blue stuffed bears with white T-shirts for every child who is a patient.

“We give out thousands of bears a year,” said Fagan, director of service assurance at the hospital. “It’s a good business thing, but also good for patient care. You get good outcomes when people feel comfortable. At the end, it’s about delivering good health care in our community.”

It turns out the stuffed bears represent an ongoing trend in hospital marketing. Across the country, hospitals are vying for market share by offering amenities – frills such as room service, valet parking, Internet access and more that are typically associated with a visit to a hotel.

Hospitality, which comes from the root word hospital, is becoming increasingly important at hospitals. Health-care analysts say that during the last five years, competition in markets where there are several hospitals of equal stature has become focused on amenities – concierge services for patients and modern technology for physicians and other clinicians.

More on the WI Supreme Court Med Mal Ruling

Excerpted from the ABA Journal eReport

Wisconsin Damage Cap Wiped Out in Rational Basis Review

As any constitutional law student knows, rational basis review is the lowest of the low.

But it was high enough for the Wisconsin Supreme Court to wipe out as an equal protection violation a cap on some medical malpractice damages. And it was enough to leave the state’s medical establishment reeling.

The court also cut off federal appeals by deciding the case solely under the Wisconsin Constitution, effectively painting physicians and their legislative allies into a corner as they pondered a fix.

“We had just figured out how to deal with the legislative branch, and now the supreme court comes along,” complains Mark M. Grapentine, a lobbyist for the Wisconsin Medical Society, which filed an amicus brief along with the American Medical Association.

Moreover, the highly detailed and carefully crafted opinion also caught the attention of plaintiffs lawyers outside Wisconsin who are searching for arguments to fend off looming homegrown damage limits that doctors say will curb their malpractice insurance premiums.

“This is huge,” says medical malpractice plaintiffs lawyer Thomas A. Demetrio in Chicago, where a cap Illinois lawmakers passed this spring awaits Gov. Rod Blagojevich’s signature.

Bad News fror Ottumwa Regional

Excerpted from the Ottumwa Courier

Medicare will cut off Ottumwa Regional Health Center on Aug. 11, even if the hospital appeals the decision.

Thomas Lenz, with the Centers for Medicare and Medicaid Services in Kansas City, said that hospitals have 60 days to indicate they will appeal termination decisions. The appeal does not freeze the clock, though.

“Whenever there is an adverse action taken … the provider has an opportunity to appeal that determination. They have 60 days to indicate their desire to appeal the action that was taken. But in all cases it does not stop that action from moving forward. So our termination date of Aug. 11 is still there,” Lenz said in an interview with The Courier Friday.

That leaves the hospital with few options for preventing the Medicare cutoff. John Webber, ORHC’s legal counsel, said the hospital might seek a court injunction against termination if necessary.

Lenz’ comments contradicted hospital officials’ earlier statements that the termination date came as a surprise. The initial complaint came in early April and spurred a fast response.

“It was considered an immediate, serious risk to beneficiaries’ health and safety,” Lenz said. “At that point in time the hospital was placed on a 23-day correction plan or termination track.”

Performance Improvement Resources on the Website

We’ve added two new resources to the ACUTE CARE website:

TEN COMMON ERRORS IN EMERGENCY MEDICINE, A RISK MANAGEMENT SUMMARY, adapted from a lecture by Dr. Christine Duranceau, our Medical Director at Platteville, WI


Emergency Physician ED Practice Pearls by Dr. Ken Schultheis, our Chief Medical Officer.

Both are accessible from the Iinformation section at the bottom of the “What’s New” page.

More on Ottumwa’s EMTALA Challenge

The following is a press release from Ottumwa Regional Health Center regarding ORHC’s possible removal from the Medicare program. The statement from ORHC read as follows:

For the past two months, Ottumwa Regional Health Center has been the subject of an on-going Federal Emergency Medical Treatment and Active Labor Act (EMTALA) investigation. EMTALA was enacted to combat the discriminatory practice of some hospitals transferring, discharging, or refusing to treat indigent patients coming to the emergency department because of the high cost of diagnosing and treating patients with emergency medical conditions. While the Act applies to all Medicare participating hospitals, it protects anyone coming to a hospital seeking emergency medical services, not just Medicare beneficiaries. EMTALA imposes strict penalties, including fines and exclusion from the Medicare program for violations of the Act. The Act imposes requirements on Medicare participating hospitals that provide emergency medical services.

On Tuesday, July 26 ORHC was notified (via fax with original to be mailed) by the Centers for Medicaid/Medicare Services (CMS) that ORHC participation in the Medicare program would be terminated effective Aug. 11., as a result of the ongoing investigation. Quoting the fax:

“Our review of the Iowa Department of Inspections and Appeals visit determined that the hospital discharged a patient with an unstable emergency medical condition for family observation, in a inappropriate care setting and as a result, the patient remained in an unstable condition.”

Lynn Olson, President and CEO of ORHC responded:

“Ottumwa Regional Health Center believes according to the requirements of EMTALA and our own high standards of care, that the patient was managed appropriately and was not discharged in unstable condition.We believe the patient in question was assessed, evaluated, treated, and had plan for the follow-up care that was discussed between the physician, the nurse, the patient and the family and was discharged appropriately.”

ORHC is continuing to work on the appeal process and will keep the public informed of the proceedings.

Presently, Ottumwa Regional continues to schedule all patients including Medicare beneficiaries.

ResQPump in the Twin Cities

This is a famous case in resuscitation lore. It’s interesting that they’re going to try again. From Yahoo News.

For a clinical trial, paramedics in St. Paul and Minneapolis will be testing experimental suction devices on heart attack patients without their prior consent.

While informed consent is a staple of most medical research, exceptions are allowed when the consent impedes potentially lifesaving research that can’t be completed any other way.

Hospital and emergency medicine leaders believe the devices will increase the number of survivors of heart attacks.

The tests will begin in September in St. Paul, Minneapolis and three other cities across the country.

“The survival rate from cardiac arrest has remained stagnant for the last 40 years,” said Dr. Keith Lurie, a professor of medicine at the University of Minnesota who co-invented the device. Lurie formed Advanced Circulatory Systems Inc., an Eden Prairie company that now makes the two devices that will be tested in the study.

One is the ResQPump, which works somewhat like a household plunger and increases blood flow by manipulating the chest cavity.

The other is the ResQPod, which fits atop the device that paramedics place over a patient’s mouth during CPR. The pod expedites the flow of blood into the lungs by regulating how oxygen is exhaled and inhaled during resuscitation.

St. Paul paramedics were testing an early version of the ResQPump in 1992. But the trial was stopped when federal officials discovered that paramedics were testing the devices without gaining informed consent.

The St. Paul case inspired new regulations in 1996 that allowed waivers of consent in crisis scenarios.

AutoPulse Controversy

I blogged about this aparatus a couple of months back.
From the LA Times

Riverside County health officials have suspended use of a federally approved CPR machine after a man who was treated with the device suffered cracked ribs and internal injuries and later died, authorities said.

Paramedics from the Palm Springs Fire Department used the “AutoPulse” cardiac support pump to resuscitate Fang Joon Yun, 77, after he was pulled from a swimming pool July 14. After Yun was revived, he was taken to a local hospital, where he was pronounced dead, Riverside County sheriff’s officials said.

A Riverside County medical examiner found that “something was not right” while performing Yun’s preliminary autopsy, said Sheriff Bob Doyle, who oversees the county coroner’s office.

“We put the device back on the individual, and it lined up exactly with where the broken ribs and other injuries he had suffered,” Doyle said, stressing that Yun’s cause of death had yet to be determined.

Six hundred AutoPulse devices are being used by rescue providers in San Francisco, Fremont, Calif., and other cities throughout the country, although it is not in use in Los Angeles or Orange counties, company officials said.

Because of the medical examiner’s findings, the Riverside County Emergency Medical Services Agency suspended use of the device in the county until Yun’s case could be further investigated. Michael Osur, director of the agency, said he had alerted emergency agencies using the device throughout the state.

Getting "Chipped"

From Fox News. Emphasis added.

Getting chipped means having a radio frequency identification (RFID) chip implanted in your body. The chip — about the size of a large grain of rice — lies dormant until a special scanner is passed within six inches of the implant. Then it emits a radio signal that beams a 16-digit number to the scanner.

For security uses, that 16-digit number acts like an electronic key. For medical uses, the number is linked to medical records. Doctors to whom you’ve granted access — emergency room doctors, for example — can use the key to quickly get hold of your medical records.

EMTALA Problems in Ottumwa, IA


Ottumwans woke to shocking news Wednesday morning, a notice that Medicare coverage could be cut at Ottumwa Regional Health Center.

The notice, in the Ottumwa Courier’s classified section, stated that ORHC is not in “substantial compliance with medicare regulations,” according to the Centers for Medicare and Medicaid Services.

The notice went on to say that Medicare payments would not be furnished for patients at Ottumwa Regional after August 11.

The notice came as a surprise to hospital leaders. They tell KTVO that Ottumwa Regional has been in an ongoing investigation in accordance with federal regulations for the past two months, but the termination notice comes from a separate issue unrelated to that original investigation.

“This is an extreme action based on a case that was not even identified in their original complaint,” ORHC President & CEO Lynn Olson said.