Vermont hospital Southwestern Vermont Medical Center is under investigation after a patient death.  The patient came to the ED complaining of back pain and was found dead after the initial assessment.  The patient was found dead by a non clinical person who notified the nurses who did not respond.  A physician was later told.  An autopsy will be done.  The state said the hospital did not follow its own policies.  The hospital admitted this and said it has taken steps to insure it does not happen again.  There was a shakeup in the ED nursing leadership and the nurses initially responsible are no longer at the hospital.

California has fined Contra Costa County Health Plan, a Medicare HMO, $210,000 for not having enough money relative to the risk for nine years.  Then they said they would forgive $150,000 of the fine if the HMO would promise to provide financial reports for two years and keep a large reserve.  This makes no sense since they had no money to begin with how will they pay the fine.

California has also fined nine hospitals for screwing up with patient care.  The hospitals and fines are Alvarado Hospital in San Diego for not having fall prevention policies $50,000, Antelope Valley Hospital for not following surgical procedures $50,000, Community Hospital in Fresno was fined $75,000 for not following cardiovascular procedures and an additional $100,000 for not having adequate staffing, Harbor UCLA was fined $50,000 for not monitoring patients, Mercy Hospital in Merced was fined $50,000 for not following patient care policies, Mission Hospital was fined $100,000 for central line catheter mishaps, Santa Clara Valley Hospital was fined $100,000 for medication errors, Sharp Memorial Hospital was fined $100,000 for not following surgical procedures and St. Jude Hospital was fine $100,000 for not following fall procedures.


It is expected that the Senate debt ceiling bill will include a delay in the Obamacare tax on reinsurance for one year.  This has been a union priority and therefore a Democratic one.  The President had already denied the union plea.  This is in place of the Obamacare tax on medical devices that all had hoped would be removed.

The Senate bill omitted the union request and instead passed a short term opening of the government and debt increase.  The Democrats surrendered the sequestration battle and the funding will be at the 2011 level.  Also the Republicans got income verification of applicants for Obamacare.  Now it is up to the House and Obama who will sign anything at this late date.  Of course both passed the bill and the country is safe for a whole two months.

Then there is the Obama appointed person to fix the flawed website.  He is a political appointee and has minimum experience with websites.  He stated, without much belief, that the site would be functional for the majority of users by the end of November.  If what he says is true it would leave people only several weeks to get insurance before the start of the year when their current insurance lapses.  The one good thing that he has done so far is to get the government out of the position of coordinating the contractors.  The new coordinator is a subdivision of United Healthcare.  

Democrats are now lining up to delay the onset of the individual mandate for one year due to the problems with the website.  Yes, the feds screwed up but the states have not.  Most of the state sites are functioning with minor glitches.

The contactors testifying in Congress all agreed that the final tests of the web site were done just days prior to the October 1 opening.  They testified that this is usually done months earlier.  This was at the HHS direction.

As Sebelius testified and said she was the cause of the website screw-up, a new problem with the website came to light.  There is a potential problem with security for the people who use the site.  The site is not yet considered safe and will not be for six months. 

Obama stated that he is to be held responsible for fixing the site.  Hold him to it.

With all the problems with the website the administration has given the public an additional six weeks to buy health insurance without having to pay a penalty (whoops, I meant a tax).  

As of the third week in October the feds have announced that 700,000 people have completed their applications on the web site but refused to state how many have enrolled. During the last week of October the site crashed again and has a new happy face.

A new law suit may still render Obamacare void.  The basis is that the law did allow the federal government to set up exchanges but did not allow them to offer money to people to subsidize the premiums.  This was only to be done by the states.  Those who state that Obamacare is the law of the land may be in for a surprise or not.  Time will tell.  

The independent Kaiser Health News reported that over a million people are having their insurance cancelled due to Obamacare.  The major reason is that the old insurance does not come up to the mandates of Obamacare.  This includes people with pre-existing conditions.  Some of the new insurance being offered will be cheaper for the person than their present insurance and have more benefits but many will also be much more expensive, especially if the people do not qualify for subsidies.  Of course, this directly contradicts Obama's promise that  "if you like your doctor you will be able to keep your doctor.  If you like your healthcare plan, you'll be able to keep your healthcare plan, period. No one will take it away, no matter what." Later he said "Again, (the Affordable Health Care Act) is for people who aren't happy with their current plan.  If you like what you're getting, keep it.  Nobody is forcing you to shift."

Then there are the staffers on Capitol Hill.  They are supposed to get their healthcare via the DC exchange.  Now the Reps and Senators are considering making them not "official" and therefore they can stay on the FEHBP, the same insurance as they and the pols had before and will keep. So far, the GOP has for the most part put their people on the exchanges.  The Dems are not being as forthright.  After voting for the law they are looking at every way possible to get out from the exchanges for themselves and their staffs. 

The Des Moines, Iowa, Register has a story on how the IRS can not do anything to anyone if they do not sign up for Obamacare.  They might send a strongly worded letter but they can not do much else.

Kaiser Health News had another story about the physicians and hospitals in Texas not knowing which plans they are participants in and which have excluded them.   Texas Oncology, one of the largest cancer treatment groups in the state has decided not to participate in any exchanges due to the unknown cancer coverage.

Remember co-ops, those pesky Senate created entities that were to create competition and lower insurance costs.  They are now in danger.  To date one has folded and others are in serious financial difficulties.  Obama had cut off their legs by making sure funding was small and had to be repaid quickly.  CMS has said that this will be great for millions of people to get insurance.  Even though the co-ops are nationwide only 24 have begun to sell insurance policies on the exchanges.  They are now in a death spiral.  

California has stated they released the provider directory prematurely and recalled it.  They did not verify the providers would be on each plan.  The plan also does not use any on-line brokers as it is doing it all themselves.

California may get a $70 million reprieve from Obamacare for prisoner healthcare.  This is how much is paid to providers outside the prison system per year.  The money saved by the use of Medicaid would go toward prison healthcare.

England has okayed Medivation for prostate cancer only if they get a discount on the price of $4,400 for a 28 day supply.  This is government medicine at its finest.


Pennsylvania is now allowing medical professionals to apologize to patients for errors without this being used against them in court.  This is already in place in 36 other states.  


The Baltimore Sun reports that IMRT therapy for prostate cancer has mushroomed with urologists owning the delivery machines.  They report that the New England Journal article author reported that the treatment does not extend patient lives over other less expensive methodology.  The study was funded by the American Society of Radiation Oncology who has seen their cash cow being taken from them.  This is the same type argument that the American Hospital Association made when they found their community hospitals were being decimated by the more efficient and cheaper physician owned hospitals.  The study did not study how much money actually went to urologists who own the machines, only the total paid.  There is not a question as to whether or not it is better than conventional radiotherapy.  It works better and has less side effects.  The study also said IMRT was being done for those patients without spread of their disease who could have been treated with hormones (not indicated) or watchful waiting (possible but many patients do not want this) or surgery (with the potential even if unlikely complications of incontinence and impotence).  The article was funded and done by an organization in a turf war.