The Rise of TB in Africa

A bit of a stretch, given the theme of the blog, but I thought it particularly interesting given the fact the movie “The Constant Gardener” opens this week. The film, based on the excellent le Carre’ novel, deals with a pharmaceutical scandel involving TB in Kenya. Excerpted from the Independent:

The World Health Organisation is ready to announce a regional emergency over levels of tuberculosis throughout Africa. African health ministers and WHO officials met in Mozambique this week to discuss how to halt the spread of HIV, malaria and tuberculosis in Africa.

By declaring the rising rates of TB infection to be an emergency, it is hoped to unlock extra money from the G8 nations and the Global Fund, which helps developing countries fight disease.

Rates of tuberculosis are rising alarmingly in Africa, where it is linked to the spread of HIV/Aids. HIV weakens the immune system and makes sufferers more susceptible to infectious diseases such as tuberculosis and pneumonia, which they cannot afford to treat.

Tuberculosis is now believed to be the single biggest killer of adults and young people in the world and accounts for a third of Aids-related deaths. In Africa, it kills more than 500,000 people a year

Court says police may enter emergency room without warrant

An interesting development in Vermont, as reported in the Boston Globe:

Law enforcement officers may enter a hospital emergency room without a warrant when they suspect a patient was a drunken driver, the Supreme Court ruled on Friday.

The court rejected an appeal by Adam Rheaume, who was charged with drunken driving after an accident in Highgate on May 19, 2002.

Justice Marilyn Skoglund, writing for a unanimous court, said that patients cannot expect full privacy in the emergency ward of a hospital. Such wards, she said, are open to emergency workers, medical staff and other hospital workers not involved in direct patient care, families and other patients, extinguishing any claim to privacy.

Besides, Skoglund said, Rheaume did not take any steps to protect any privacy he may have wished.

“Once the officer entered the trauma room, defendant did not ask him to leave or suggest the room was private or inaccessible in any way,” she said. “Defendant did not attempt to leave or limit contact with the officer.”

Rheaume was taken to Northwestern Medical Center in St. Albans for treatment of injuries after the accident in Highgate. State Trooper Jeffrey Smith went to the hospital to investigate the crash after he was told by rescue workers that they believed Rheaume was drunk.

The Supreme Court said nurses gave him permission to see Rheaume and he walked into a trauma room whose door was open. Rheaume had cuts to his lip and tongue and his bleeding hands were wrapped.

Smith told Rheaume of his rights and asked if he would agree to be interviewed. Rheaume refused, saying he was in too much pain. Smith advised Rheaume of his rights under state law and asked whether he would agree to provide a blood sample to determine his drunkenness. Rheaume refused and Smith then cited him for drunken driving.

Skoglund wrote that before Rheaume was taken from the room for X-rays, he yelled out that he knew the trooper was there to charge him with drunken driving and “he would not have been drinking and driving were it not for a fight at a party he attended before the accident.”

Rheaume asked District Court Judge Michael Kupersmith to suppress those statements, but the judge refused. So Rheaume agreed to a plea agreement that preserved his right to appeal to the Supreme Court.

The high court determined Friday that Kupersmith’s ruling was appropriate and dismissed Rheaume’s appeal.

Car Seat Efficacy

I imagine this will be rather controversial in the safety community. An excerpt from a New York Times article posted to the Freakonomics website (which supports the best selling book of the same name):

Perhaps the single most compelling statistic about car seats in the NHTSA manual was this one: ”They are 54 percent effective in reducing deaths for children ages 1 to 4 in passenger cars.”

But 54 percent effective compared with what? The answer, it turns out, is this: Compared with a child’s riding completely unrestrained. There is another mode of restraint, meanwhile, that doesn’t cost $200 or require a four-day course to master: seat belts.

For children younger than roughly 24 months, seat belts plainly won’t do. For them, a car seat represents the best practical way to ride securely, and it is certainly an improvement over the days of riding shotgun on mom’s lap. But what about older children? Is it possible that seat belts might afford them the same protection as car seats? The answer can be found in a trove of government data called the Fatality Analysis Reporting System (FARS), which compiles police reports on all fatal crashes in the U.S. since 1975. These data include every imaginable variable in a crash, including whether the occupants were restrained and how.

Even a quick look at the FARS data reveals a striking result: among children 2 and older, the death rate is no lower for those traveling in any kind of car seat than for those wearing seat belts. There are many reasons, of course, that this raw data might be misleading. Perhaps kids in car seats are, on average, in worse wrecks. Or maybe their parents drive smaller cars, which might provide less protection.

IL Governor Signs Med Mal Law

From Modern Physician

Illinois Gov. Rod Blagojevich has signed a medical malpractice law that caps noneconomic damages at $500,000 in cases against physicians and increases regulatory oversight of medical liability insurers in the state. The legislation includes a $1 million cap for hospitals, and allows physicians to apologize for errors without such statements being used against them in court.

The medical establishment, which has sought the changes for years, said the law will reduce the cost of liability insurance and stop the migration of doctors who may be leaving the state because of high costs. “Every patient and physician in Illinois should be happy to know that positive change is on the way,” said Craig Backs, president of the Illinois State Medical Society.

Previous attempts to impose a cap have been declared unconstitutional by the state Supreme Court, and lawyers are already mounting an effort to have the legislation overturned, saying it strictly limits the rights of plaintiffs in cases where doctors have made errors.

"No Wait" ER’s

I love the title on this one, excerpted from The Journal News.

“Hospitals figure patients don’t like to wait”

Hudson Valley is hoping that yesterday’s opening of its new “no-wait” emergency room will attract patients who dread waiting a long time to be treated in other crowded facilities.

The hospital’s emergency room overhaul is the first in a wave of emergency room expansions coming to Westchester that are designed to cope with a growing patient load and, if not actually eliminate emergency room waits, then at least reduce them and make them less stressful.

Among its improvements, the million-dollar redesign at Hudson Valley doubled the number of patient rooms and eliminated the need for patients to stop at a registration desk by introducing bedside registration on a wireless computer.

“Our patients have told us what they would appreciate most is eliminating the whole waiting period,” said John Federspiel, the hospital’s president.

State’s Malpractice Cap Applies to Award in Civil EMTALA Action

From BNA’s Health Care Daily (Volume 10 Number 164, Thursday, August 25, 2005, ISSN 1091-4021)

6th Circuit Says State’s Malpractice Cap Applies to Award in Civil EMTALA Action

Noneconomic damages awarded in a failure-to-stabilize claim brought under the Emergency Medical Treatment and Labor Act must be reduced in accordance with Michigan’s limitation on malpractice awards because the federal statute incorporates state law and the claim would be considered a medical malpractice action under state law, a federal court of appeals held Aug. 18 (Smith v. Botsford General Hospital, 6th Cir., No. 04-1436, 8/18/05).

In an issue of first impression for the U.S. Court of Appeals for the Sixth Circuit, Judge Deborah L. Cook reduced the $5 million district court jury award to less than $400,000, ruling that Michigan’s malpractice cap on noneconomic damages applied to Andrea Smith’s EMTALA claim.

Smith sued Botsford General Hospital under EMTALA’s civil enforcement provision, alleging the hospital failed to stabilize her husband, Kelly Smith, before transferring him to another hospital better equipped to deal with a man of his size. Kelly Smith, a 600 pound man whose suffered a broken left femur that pierced the skin of his thigh in an automobile accident, died from extensive blood loss while being transferred, according to Cook.

Cook affirmed the jury verdict in favor of Smith, but reduced the award pursuant to Michigan’s malpractice law.

EMTALA Incorporates State Law

EMTALA’s civil enforcement provision allows individuals harmed as a result of a hospital’s violation of the federal statute to recover personal injury damages “under the law of the State in which the hospital is located,” according to Cook, quoting 42 U.S.C. §1395dd(2)(A). The plain language of the statute therefore incorporates state law, Cook said.

The next step, Cook said, is to determine whether Smith’s claim would constitute a medical malpractice action under Michigan law. A claim sounds in malpractice if it relates to an action that occurred during the course of a professional relationship and involves a question of “medical judgment beyond the realm of common knowledge and experience,” Cook said, highlighting the test the Michigan Supreme Court set forth in Bryant v. Oakpointe Villa Nursing Center, 684 N.W. 2d 864 (Mich. 2004).

Smith’s claim met the definition on both counts, Cook said. There was no dispute that Botsford’s treatment and transfer of Smith occurred within the course of a professional medical relationship. Further, Cook concluded that Smith’s claim necessarily involved questions of medical judgment, even though an EMTALA action does not require a breach of the professional standard of care.

The statute’s stabilization requirement demands a medical judgment to determine “within a reasonable medical probability” whether a patient can be transferred without risking a deterioration in his or her condition, Cook said.

Cook also addressed Smith’s challenge that Michigan’s cap on damages violated the Seventh Amendment and her right to equal protection under the constitution.

Concluding there was no Seventh Amendment violation, Cook noted that the role of jury is to determine the extent of a plaintiff’s injuries, not the legal consequences of its factual findings. As to equal protection, Cook said Michigan’s choice to limit the amount of a plaintiff’s recovery did not violate a fundamental right and served the legitimate state interest in controlling health care costs.

Full text of the decision is available at

Wasp Stings in Wisconsin

Excerpted from the Milwaukee Journal- Sentinel

“Rash of wasp attacks stings area “

Medical and emergency response officials from Milwaukee-area counties confirmed Wednesday that wasp and bee stings are on the rise and expressed concern about the severity.

“Over the last three weeks, we’ve had a tremendous increase in incidents of bee stings, and occasionally some are becoming infected,” said Bill Haselow, an emergency medicine physician at Columbia St Mary’s, Ozaukee Campus in Mequon.

On some shifts, as many as seven patients have sought treatment for stings, he said.

“It’s definitely more than I’ve ever seen,” said Thomas Dietrich, an emergency medicine physician at St. Joseph’s Hospital near West Bend.