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Everyday Medical Care - Treatment Dangers Lurk

Dangerous healthcare may mean life or death.

When we think of dangerous medical care we think of surgery gone awry or maybe hospital infections. But there are problems lurking we may never consider - from overdosing on radiation to failure to receive problematic test results. Be aware!

A few warnings:

Patient Empowerment Spotlight10

Convicted Rapist's Heart Transplant - Update and Issues

Tuesday April 26, 2011

It seems convicted rapist Kenneth Pike has decided against having a heart transplant.  Many of us will heave a sigh of relief because as long as he does not receive that heart, someone (someone far more deserving) will get it.

Your reactions have been overwhelmingly in favor of NOT letting him be transplanted with a new heart.  About 90% of you believe, as I do, that no one who has injured a child - physically and emotionally - should be given such an advantage in life.

The other 10% seem to be of the slippery slope argument, as indicated by the comments we received.  I hear that, and for the most part, I agree that slippery slopes can create problems.

So a solution seems to be somewhere in the middle.

This one incident has called into consideration many questions about organ donation, and how the decisions are made about who should get an organ.  Since these decisions are made by UNOS (United Network of Organ Sharing), it seems that it needs to be UNOS that pays attention to this uproar.  I don't doubt for a second that UNOS has always felt it made its organ donation decisions as fairly as possible.  I can't imagine they ever anticipated this kind of second-guessing.  But it's here now, and they need to pay attention.

It further calls into question healthcare services provided to convicts at the expense of law abiding citizens, many of whom can't afford insurance for themselves or their families.  We've looked before at the fact that people who can't afford insurance, but who are in desperate need of healthcare, will commit crimes just so the state will pay for their care.  There is something very wrong about this.

Some of the points made in the comments about this possible transplant to the rapist that should be considered by those in the positions to make these decisions:

It may be time to begin making some of those judgements about who is deserving vs who is not.  An idea: Why not set up a point system? Perhaps an individual gets "plus" points for the good things they have done, and "minus" points for the bad things they have done.  A convicted rapist like Kenneth Pike would get (for example) minus 100 points - the most that could be subtracted - for his crime, similar to a convicted murderer.  Maybe a second-degree murderer would get "only" 80 points subtracted.  Someone who volunteers in a soup kitchen every week for a year would get PLUS 100 points for their efforts.  None of these plusses or minuses would be affected by money donations.  Adjustments would be made for ages and opportunities to do good (obviously a child could not be included in this type of assessment - or other adjustments could be made for someone who has had a lifelong problem and could not volunteer since spending one's life in the hospital is not conducive to volunteer work.)

Other adjustments would be more difficult to determine.  Another situation raised by a commenter is the number of alcoholics who are provided with new livers or the numbers of smokers who get new lungs - then return to their drinking and smoking.  Would additions and subtractions be made for them?  Yes - probably - but within a sliding scale of some sort.

Another question asked by the slippery slope people was whether you would deny an organ to someone who stole lunch money.  Many others answered that felons that committed acts of bodily harm should be regarded very differently. Yes, there may be differences there but then, Bernie Madoff didn't commit bodily harm, yet he certainly has had a horribly negative lifelong impact on thousands.

What if Bernie Madoff needed a heart?  Such a system described above would need to account for the number of people who were hurt by an individual.

I'm just typing off the top of my head here, but you get the idea....

Additional considerations:

Some commenters say they are ready to decide to no longer be organ donors for fear that their organs would prolong the life of someone who might intentionally cause injury or death to someone else.

An interesting point was raised, too, about Christian Longo, a convicted murderer on death row in Oregon who killed his wife and three children in horribly heinous ways.  He wants to donate his organs, and that has created its own outrage.  While I don't see that fact as a part of this particular argument about who is deserving of an organ, I do see it as a part of the bigger picture of organ donation decisions in general.

My bottom line to all this is that whether or not Kenneth Pike gets a transplanted heart, these issues will not go away.  He is the lightening rod - but these bigger questions, especially when there are so many deserving people, and so few organs to go around, must be addressed by UNOS and others who work in the organ donation decision-making field.

What other issues do you see?

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Convicted Rapist to Receive Heart Transplant?

Monday April 25, 2011

(See an update to this post: Convicted Rapist's Heart Transplant - Update and Issues)

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We look at healthcare rationing frequently on this blog, but it's not often that we're faced with rationing based on an ethics question.  Today we are.

Kenneth L. Pike, age 55, convicted in 1996 of two year's worth of rape and sodomy of a 13 year old girl, is perhaps days - if not hours - away from receiving a heart transplant in an Upstate New York hospital.  He is 15 years into serving an 18 to 40 year sentence.

Should an inmate receive a heart transplant?

Here is some background:

  • UNOS (United Network for Organ Sharing - the organization that determines who does, or does not, receive any sort of transplant) - does not recognize any "categories" of people.  There is no notation for who or what history a potential organ recipient is or has. That means an inmate (rapist, thief, murderer, any inmate) has the same status as you or me - or someone who is wealthy or famous.
  • There are (at least) 273 other people on the UNOS list in New York who need a heart transplant.
  • The cost of a heart transplant (including the before and after care) in 2008 was $787,000 - all of which will be paid for by taxpayers because Pike is incarcerated.
  • A heart transplant requires the donor to be dead, which, of course, severely limits the number of hearts that are available for transplant.
  • There have been other inmates who have received transplants in New York State, including seven bone marrow transplants, three kidney transplants and one liver transplant.  (My note:  from my understanding, no other human being had to die before those transplants could take place. I believe those are all living donor transplants.)

Here are the questions this potential heart transplant raises (you may think of more):

  • Is it right that a convicted rapist (of a child, no less) receives a donor heart before an upstanding, taxpaying citizen does?
  • Is it right that taxpayers (many of whom can't even afford health insurance themselves) should spend $800,000 to keep this man alive?
  • Is it right that taxpayers (many of whom can't even afford health insurance themselves) should also pay for the privilege of spending heaven-only-knows how much per year to keep him in prison for the extended time this heart will keep him alive, too?
  • I wonder how the young woman he raped and sodomized for two years feels about the possibility that he would receive a healthy heart, and would possibly survive long enough to be released from prison? (She would be at least 28 years old now....)
  • How would you feel if it was your loved one who died, and you learned his or her heart would be given to a convicted rapist?

I am a compassionate human being, and a taxpayer in the State of New York, but I see absolutely NOTHING right about this.

I have always planned to be an organ donor. I have designated as such on my driver's license for many years, and my family knows to donate my organs when the time comes.

But if I for ONE MINUTE thought my heart would be used to keep this rapist alive, you can be sure I would withdraw my approval.

What do you think?  Please take this poll -- and comment below.

•  Learn more about healthcare rationing.

• Learn more about being an organ donor.

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(See an update to this post: Convicted Rapist's Heart Transplant - Update and Issues)

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You Giveth - and the Republicans Taketh Away

Sunday April 24, 2011

When did you get your first job? You might have been sixteen years old, give or take a year or two.

When you got your first paycheck, do you remember the shock that it was so much less than you expected? You had multiplied the number of hours you had worked, times the amount per hour you were going to be paid. Voila! That's what you expected in your paycheck....

But, no.... it was substantially less. Then you looked to see where all that money you expected would be there had gone. Some went to federal taxes, some to state taxes, and some to unemployment taxes...

And then there was FICA. A big chunk - in fact, 7.65% of your paycheck went to FICA. What you may not know is that your employer also paid another 7.65% of your pay to FICA. That means almost 15% of your earnings, ever since you started working, over all those years, has gone to FICA.

And - whether you realize it or not - FICA was being put away for your old age, your retirement and yes - your medical care for when you retired, too. Yes, Medicare money comes from FICA.

So - figure it out - all these years later, you've paid perhaps hundreds of thousands of dollars into medical insurance in the form of Medicare.

And now - the Republicans want to take it away from you. Yes they do. That's what privatizing Medicare is all about.  House Republications have already approved, and pushed forward, Senator Paul Ryan's proposal to privatize Medicare.  For them, it's a done deal. Their bill says that even though you've paid all that money into the system, you won't be able to get the healthcare you need without paying even more of your own money.

It drives me crazy when I hear Medicare referred to as an "entitlement" program. "Entitlement" means somebody will get something they haven't earned (like welfare or even Medicaid.)

If I have saved my money all my life - then you're darn straight I'm entitled to it! It's mine! And that's how I feel about Social Security, too. Like unemployment. You have paid into it with every paycheck you've ever earned. You should be supported by it when you need it.

Granted - many seniors who receive social security and Medicare have not earned all the money they will need to use in their old age. That's because they will live beyond those 50 or so years worth that they paid into it. Does it therefore become an entitlement past the point where they have been paid the amount they paid in (plus interest)? Yes, it does. But not everyone gets there. Hundreds of thousands of people never even make it to retirement, or don't live much past that age. Yet, the extra money they have paid into the system stays in the system.

Further - the only reason this problem even comes up now is because we baby boomers are beginning to age into the Social Security and Medicare systems. Notice that as long as we were the payers, our parents (the generations older than we) were subsidized with no problem. Now our children, the generations behind us, don't care to support us the way we supported our parents. That means we baby boomers have paid and paid and paid and if the Republicans get their way, well, then, it's just tough cookies for us. We won't benefit the way we expected to.

OK Republicans. Explain to me just how that works again? Oh - wait - that's right!  You don't want to tax the wealthy, so THAT's why we need to privatize Medicare.  Uh-huh.

I don't deny that spending needs to be reigned in. No question. But there are definitely ways it can be done that don't require robbing me of the money I have paid into the system for my entire life.

And we thought Bernie Madoff was a shyster.....

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Some perspectives on the Republican Healthcare Plan as passed by the House:

A Real Choice on Medicare from the New York Times

A Review of the Republican costs from PolitiFact

Ezra Klein / Washington Post Compares Healthcare Reform 2010 to Ryan's Medicare House Bill

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When the Doctor Is a Patient - Fear, Frustration... But Still...

Friday April 22, 2011

Twenty years ago, William Hurt starred in a movie called "The Doctor," about a physician who experienced the other side of medicine as a cancer patient himself.  He learned that all his arrogant assumptions about being a patient were entirely misguided and by the end of the movie, he was insisting that his residents, (still students), experience the patient side of medicine, too.

Today's version of "The Doctor" is an article published recently in  the Journal of Participatory Medicine.  Shared by Dr. Itzhak Brook, it is his story of being a neck cancer patient and learning, firsthand, the importance - and the difficulty -  of advocating for himself.  Twenty years later, this doctor found out that patients' experiences have grown even more challenging.

From his frustrations and fears, to the arrogance of the doctors who were tasked with helping him, to medical errors and unsanitary procedures, to lack of knowledge about his options - Dr. Brook's experience was the closest I have ever read to what a "real" patient  - a non-medically trained one - experiences.

An excerpt:

Some of the surgeons and many of the residents were very caring, attentive, and compassionate. However, there were demoralizing instances of physicians with a rushed and impatient attitude. I also encountered a few abrasive and downright rude physicians. On one occasion, I asked a senior resident to clean my obstructed tracheotomy tube. He reluctantly flushed it using tap water rather than the sterile cleaning kit that was routinely used for this purpose. The tube he wanted to place back into my trachea was still dirty, and when I asked him to use the kit and brush the mucus out, he abrasively responded, "We call the shots here," and left my room. I felt humiliated, helpless, and angry at being treated in this fashion.

In fact, his experience was so bad and so dangerous, that he concludes:

All of these events made me realize that a hospital is not a safe place for patients. Most patients lack medical education and thus may not recognize, let alone feel that they are able to prevent errors in their care. My experiences taught me that a dedicated patient advocate such as a family member or a friend is desirable for all hospitalized patients.

I truly appreciate Dr. Brook coming forward with his story and sharing it in the Journal, because his colleagues may actually read it, and better understand the experience of patients.

I fear, however,  that while we patients will embrace his story and say "Yes!  This is similar to our experiences, too!"  ... too many professionals will dismiss it believing they would never act that way, or their institutions would never treat a patient with such disregard.  (Little do they understand....)

Further, I remind you, that this was the experience of a physician, who was held in much higher regard by his fellow doctors than patients generally are.  Dr. Brook describes being treated like a second-class citizen, yet he was treated far better than he would have been, had he not had that "Dr." in front of his name.

I suggest you read Dr. Brook's narrative and see how much of it sounds just like yours - or even how much of it is different. Share your comments with us here.

•  How to Be an Empowered Patient

• How to Deal with an Arrogant Doctor

•  How to Find or Choose a Patient Advocate

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