Key speech on medical errors
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Misdiagnosed Coma for 23 years
I remember reading The Butterfly and the Diving Bell some years ago and then seeing the movie last year. Similarly, an episode of House involved a patient with locked in syndrome.
Here is a real life story of a man, injured in a car accident, who was misdiagnosed in a persistent vegetative state for 23 years. Doctors relied in part on a frequently over rated diagnostic technique called the Glasgow Coma Scale to conclude that the man was no longer viable. Newer scanning tests revealed the man's mind was completely normal except for his inability to express himself.
A leading European neurologist has said many cases of brain injury around the world are wrongly diagnosed as 'coma' after discovering that a car-crash victim thought to have been in coma for the past 23 years was conscious all the time.
Steven Laureys, head of the Coma Science Group and Department of Neurology at Liege University Hospital, spoke after writing about the astounding case of Rom Houben, a Belgian who was thought to have slipped into a persistent vegetative state 23 years ago.
The paralysed Houben had no way of letting doctors know that he could hear every word they were saying.
'I dreamed myself away,' Houben, now 46 and able to tap out messages on a computer screen, told the Daily Telegraph. 'I screamed, but there was nothing to hear.'
Doctors in Zolder, Belgium, routinely used the internationally-accepted Glasgow Coma Scale to assess his eye, verbal and motor responses to conclude that his consciousness was 'extinct'.
But he was graded incorrectly each time - until three years ago a re-examination at the University of Liege using new hi-tech scans showed his brain was still functioning almost completely normally, the paper reported.
Houben, although physically paralysed, was fully aware of what was happening around him.
'Medical advances caught up with him,' said Laureys, whose recently account in a medical paper has brought the case to light.
Laureys plans to use the case to highlight what he considers may be similar examples around the world.
'In Germany alone each year some 100,000 people suffer from severe traumatic brain injury. About 20,000 are followed by a coma of three weeks or longer. Some of them die, others regain health.
'But an estimated 3,000 to 5,000 people a year remain trapped in an intermediate stage - they go on living without ever coming back again.'
Although Houben is never likely to leave hospital, he now has a special device above his bed which lets him read books while lying down.
Houben told the Daily Telegraph: 'I shall never forget the day when they discovered what was truly wrong with me - it was my second birth.
'I want to read, talk with my friends via the computer and enjoy my life now that people know I am not dead.
'All that time I just literally dreamed of a better life. Frustration is too small a word to describe what I felt.'
IANS 2009-11-23 18:30:00
BIAA Update November 20, 2009
Here is the latest from Sarah D'Orsie at the Brain Injury Association of America
Health Care Reform Update
This week, The Senate released and began debate on their Health Care Reform leadership measure. As many of you may know, originally, rehabilitation was not included in the Senate Finance bill as a minimum benefit. Due to the lobbying efforts of BIAA, largely supported and funded by our Business and Professional Council, we have been able to ensure that rehabilitation is a part of the minimum benefits package of the final product now being debated in the Senate.
Specifically, the Patient Protection and Affordable Care Act being considered would:
(Democratic leadership summary)
- Include immediate changes to the way health insurance companies do business to protect consumers from discriminatory practices and provide Americans with better preventive coverage and the information they need to make informed decisions about their health insurance.
-Uninsured Americans with a pre-existing condition will have access to an immediate insurance program to help them avoid medical bankruptcy and retirees will have greater certainty due to reinsurance provisions to help maintain coverage.
-New health insurance Exchanges will make coverage affordable and accessible for individuals and small businesses.
-Insurance companies will be barred from discriminating based on pre-existing conditions, health status, and gender.
-Expand eligibility for Medicaid to include all non-elderly Americans with income below 133 percent of the Federal Poverty Level (FPL), with substantial assistance to States for the cost of covering these individuals.
- Make long-term supports and services more affordable for millions of Americans by providing a lifetime cash benefit that will help people with severe disabilities remain in their homes and communities.
- Eliminate lifetime insurance limits in all new individual and group plans for plan years beginning 6 months after enactment.
Today, as the Senate opened a two-day debate on the bill, Congressional Quarterly reported that Majority Leader, Harry Reid is closing in on the 60 votes needed to overcome an anticipated filibuster and bring the measure to the floor. Reid has filed cloture the bill and the vote on the motion to proceed to the bill is expected to occur on Saturday at 8:00 pm.
BIAA will continue to monitor the bill's progress closely as debate continues. Also, documents relating to the Senate leadership bill can be found on BIAA's website under the Health Care Reform Library section:
http://www.biausa.org/policyissues.htm#library
Veteran's Health Omnibus Bill
On Thursday, November 19, 2009, The Senate voted to pass a package of veteran's bills (S1963) that included both S. 801 and S. 252, both important Veteran's health care measures supported by BIAA.
The bill would expand services in rural areas and ensure that veterans who are catastrophically disabled or who need emergency care in the community are not charged for those services. It would also authorize VA hospitals to contract with non-VA providers to ensure that our returning service members have access to the care that they so desperately need and deserve.
Understanding Depression
Americans do not believe they know much about depression , but are highly aware of the risks of not receiving care, according to a survey released today by the National Alliance on Mental Illness (NAMI).
See full survey results at http://www.nami.org/depression. .jpg)
The survey provides a "three dimensional" measurement of responses from members of the general public who do not know anyone with depression, caregivers of adults diagnosed with depression and adults actually living with the illness.
- Seventy-one percent of the public sample said they are not familiar with depression, but 68 percent or more know specific consequences that can come from not receiving treatment-including suicide (84 percent).
- Sixty-two percent believe they know some symptoms of depression, but 39 percent said they do not know many or any at all.
- One major finding: almost 50 percent of caregivers who responded had been diagnosed with depression themselves, but only about 25 percent said they were engaged in treatment.
- Almost 60 percent of people living with depression reported that they rely on their primary care physicians rather than mental health professionals for treatment. Medication and "talk therapy" are primary treatments-if a person can get them-but other options are helpful.
- Fifteen percent of people living with depression use animal therapy with 54 percent finding it to be "extremely" or "quite a bit" helpful. Those using prayer and physical exercise also ranked them high in helpfulness (47 percent and 40 percent respectively).
- When people living with depression discontinue medication or talk therapy, cost is a common reason, but other significant factors include a desire "to make it on my own," whether they believe the treatment is actually working and in the case of medication, side effects.
"The survey reveals gaps and guideposts on roads to recovery," said NAMI Executive Director Michael J. Fitzpatrick. "It tells what has been found helpful in treating depression. It can help caregivers better anticipate stress that will confront them. It reflects issues that need to be part of ongoing health care reform."
Back Injury Second Leading Military Disability
Interestingly, back injury is reported second to psychiatric injury as a leading cause of military personnel non-return to duty.
Military personnel evacuated out of Iraq and Afghanistan because of back pain are unlikely to return to the line of duty regardless of the treatment they receive, according to research led by a Johns Hopkins pain management specialist.
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In a study published in the Archives of Internal Medicine, researchers found that just 13 percent of service members who left their units with back pain as their primary diagnosis eventually returned to duty in the field. Women, officers, those deployed in Afghanistan and those with previous back pain had better outcomes, but only marginally. Aside from combat injuries sustained during battle, the return-to-duty rate for spinal pain and other musculoskeletal disorders is lower than for any other disease or non-combat injury category except for psychiatric illness, the researchers said.
Read more here.
BIAA Health Care Reform Update
The Brain Injury Association of America's Sarah D'Orsie reports:
Health Care Reform Update
On November 7, 2009, the House of Representatives approved their health care reform overhaul package by a vote of 220-215. The bill includes the provisions below: (provided by Congressional Quarterly, CQ Today)
Coverage Requirements
Individual Mandate
* Requires nearly all individuals to obtain health care coverage beginning in 2013.
* Permits individuals to keep their current health plan as a "grandfathered" plan.
* Excludes from the mandate those exempt from filing income tax returns and others who receive a hardship waiver.
* Subjects those who do not obtain coverage to a penalty tax of 2.5 percent of adjusted gross income above a threshold.
Employer Mandate
* Requires employers to offer their employees health care insurance, or make an insurance contribution on their behalf, starting in 2013.
* Exempts firms with payrolls of $500,000 or less.
* Subjects businesses that fail to provide coverage to penalties of up to 8 percent of their payroll.
Purchase of Coverage
Health Insurance Exchange
* Creates a federal exchange, to begin operation in 2013, that would allow individuals and small businesses to purchase health insurance from insurers participating in the exchange.
* Allows states to apply to operate their own state-based health insurance exchanges.
Public Option
* Requires the establishment of a public health insurance option within the insurance exchange by 2013.
* Directs the Health and Human Services Department to run the public option and negotiate with providers to determine rates.
* Requires those rates to be no lower than those under Medicare and no higher than the average for private plans.
Additional Options
* Authorizes loans to entities that want to create health insurance cooperatives.
* Permits states to enter into compacts that allow for the sale of insurance across state lines.
Affordability
Individual Subsidies
* Provides affordability credits to individuals and families with incomes of up to 400 percent of the federal poverty level.
* Requires that subsidies would be used to reduce premiums and out-of-pocket costs.
Small Businesses
* Provides tax credits for certain small businesses that offer health insurance to their employees.
Requirements for Insurance Companies
Pre-Existing Conditions
* Bars insurance companies from denying or reducing coverage based on pre-existing medical conditions, beginning in 2013.
* Restricts how long insurers can continue to limit coverage for pre-existing conditions until the full ban takes effect.
* Prohibits companies from considering domestic violence a pre-existing condition.
Coverage Caps
* Prohibits annual or lifetime coverage limits.
Premiums
* Limits variations on premiums based on the age of the beneficiary to a ratio of 2-to-1.
* Permits variations on premiums based on geography and family size.
Out-of-Pocket Expenses
* Limits annual out-of-pocket expenses to $5,000 for an individual and $10,000 for a family.
* Guarantees no out-of-pocket costs for preventive care.
Essential Benefits Package
* Requires all qualified health benefits plans to provide coverage that meets or exceeds the standards of an "essential benefits package."
* Requires an essential benefits package to, at a minimum, cover hospitalization, outpatient hospital and clinic services, professional services of physicians and other health professionals, prescription drugs, rehabilitative services; mental health and substance use disorder services; preventive services, maternity care, well-baby and well-child care, and medical equipment.
* Establishes a Health Benefits Advisory Committee, chaired by the surgeon general, to make recommendations to HHS regarding the details of covered health benefits included in the essential benefits plan.
Medicare and Medicaid
Medicaid Expansion
* Expands eligibility for Medicaid by allowing enrollment for those making up to 150 percent of the poverty level, beginning in 2013.
* Beginning in 2015, states would pay 9 percent of costs associated with the expanded coverage.
* Requires Medicaid to cover newborns during the first 60 days of life.
Medicare Advantage
* Reduces payments under the Medicare Advantage program over a three-year period beginning in 2011.
* Makes the rates for Medicare Advantage the same as those for traditional fee-for-service Medicare by 2014.
* Provides bonus payments to insurance plans in the program that offer high-quality insurance plans in low-cost areas.
As part of the debate, Congressman Bill Pascrell, Jr., Co-Chairman of the Congressional Brain Injury Task Force, offered a statement including BIAA's guiding principles for health care reform. Also included in the statement, which can be viewed by clicking on the link below, was language regarding payment initiatives such as the bundling of services.
http://www.biausa.org/elements/policy/2009/house_cr_statement_bp.pdf
The statement detailed BIAA's position that "post-acute payment systems must facilitate, not impede, improvements in functional status of individuals with brain injury and their ability to return to their homes and communities. BIAA supports a deliberative planning process and rigorous pilot testing."
Congressman Pascrell has been a true champion in the fight for securing access to care for persons with brain injury during the health care reform debate. Please take a minute to click on the link below and thank him for his dedication to this important issue:
http://pascrell.house.gov/contact/
It is also important to note that BIAA's Business and Professional Council was integral in creating the content of BIAA's health care reform guiding principles.
Now that the House has passed its measure, BIAA is monitoring Senate activity closely. Senate Majority Leader Harry Reid has alluded to Senate action on their leadership bill as soon as next week.
Update from co-bloggers
Mesquite ISD a pioneer on dealing with student concussions |
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| Program helps airmen deal with combat stress AirForceTimes.com So when Bryan — then an Air Force captain and now a civilian researcher — deployed to Balad Air Base, Iraq, as the head of the traumatic brain injury clinic ... See all stories on this topic |
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| Nanomedicine Promising For Treating Spinal Cord Injuries, Findings Show Science Daily (press release) The work has been funded by a Showalter Trust grant from Purdue and a grant from the Indiana Spinal Cord and Brain Injury Research Fund, and is partially ... See all stories on this topic |
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| Fort Hood tragedy rocks military as it grapples with mental health issues Los Angeles Times Besides PTSD, a high rate of traumatic brain injury has contributed to cognitive and psychiatric symptoms. The wars have been long and, without a national ... |
Five Myths About Medical Negligence
American Association of Justice published "Five Myths about Medical Malpractice Negligence." I reprint it below.
It is especially interesting since the Nevada Supreme Court is currently considering whether to make the "Keep Our Doctor's in Nevada" bill, passed in 2004, retroactive. A woman is suing her lawyer for taking 40% of her over $5,000,000 award for a lawsuit she retained him for in 1999. She is arguing that the attorney fee limits should apply retroactively and the attorney's fees be reduced. Interestingly she is not arguing that her recovery be limited retroactively to the current ceiling on medical malpractice cases of $350,000.
Those opposed to real health care reform are flailing to come up with real, alternative solutions to our current crisis. With all the talk of death panels, government takeovers, and rationing of care, now tort reform has been thrown into the mix.
Yet it will do practically nothing to lower health care costs, and certainly will not fix our broken health care system. However, it will most definitely hurt patients injured through no fault of their own. Seemingly, the effects of legislation on real people have somehow evaporated from the discussion.
To break through all the hyperbole, lies, and distortions, the American Association for Justice today released a new report, "Five Myths About Medical Negligence." The next time a cable news pundit or opponent of health care reform starts talking about tort law changes, chances are this manual will rebut their claims.
As the health care debate moves forward, here are the key myths and facts:
Myth #1: There are too many "frivolous" malpractice lawsuits.
Fact: There's an epidemic of medical negligence, not lawsuits. Only one in eight people injured by medical negligence ever file suit. Civil filings have declined eight percent over the last decade, and are less than one percent of the whole civil docket. A 2006 Harvard study found that 97 percent of claims were meritorious, stating, "portraits of a malpractice system that is stricken with frivolous litigation are overblown."
Myth #2: Malpractice claims drive up health care costs.
Fact: According to the National Association of Insurance Commissioners, the total spent defending claims and compensating victims of medical negligence was just 0.3% of health care costs, and the Congressional Budget Office and Government Accountability Office have made similar findings.
Myth #3: Doctors are fleeing.
Fact: Then where are they going? According to the American Medical Association's own data, the number of practicing physicians in the United States has been growing steadily for decades. Not only are there more doctors, but the number of doctors is increasing faster than population growth. Despite the cries of physicians fleeing multiple states, the number of physicians increased in every state, and only four states saw growth slower than population growth; these four states all have medical malpractice caps.
Myth #4: Malpractice claims drive up doctors' premiums.
Fact: Empirical research has found that there is little correlation between malpractice payouts and malpractice premiums paid by doctors. A study of the leading medical malpractice insurance companies' financial statements by former Missouri Insurance Commissioner Jay Angoff found that these insurers artificially raised doctors' premiums and misled the public about the nature of medical negligence claims. A previous AAJ report on malpractice insurers found they had earnings higher than 99% of Fortune 500 companies.
Myth #5: Tort reform will lower insurance rates.
Fact: Tort reforms are passed under the guise that they will lower physicians' liability premiums. This does not happen. While insurers do pay out less money when damages awards are capped, they do not pass the savings along to doctors by lowering premiums. Even the most ardent tort reformers have been caught stating that tort reform will have no effect on insurance rates.
Over 98,000 people die every year from preventable medical errors. That's like two 737s crashing every day for a whole year. Instead of focusing on tort law changes that won't fix health care, let's make sure people aren't injured in the first place. Not only will that lower costs, but most importantly, will improve health care for everyone.
Read more at: http://www.huffingtonpost.com/anthony-tarricone/calls-for-tort-reform-des_b_345438.html&cp
You can view AAJ President Anthony Tarricone’s article on the Huffington Post and link to the article by clicking here.
Michelle Whitmore said these kind words...
Tim: I enjoy your updates. This "lawsuit by committee" idea is ridiculous. People just don't get it until they've been hurt. Very frustrating to see the insurance companies and corporate America pull the wool over everyone's eyes.
I've attached an article regarding the topic and will be looking for more current information as well.
Hope you and your family are doing well. Don't forget to call me if I can help out with any funding issues on your cases. I enjoy working with you:
Take care:
Michele Whitmore
Settlement Strategies, Inc.
19412A E. Mann Creek Drive
Parker CO 80134
phone: (303) 841-0420
fax: (888) 596-8273
Improving Cognitive Skills With Music
Here is a good one for all us musicians...
Regularly playing a musical instrument changes the anatomy and function of the brain and may be used in therapy to improve cognitive skills.
There is growing evidence that musicians have structurally and functionally different brains compared with non-musicians. In particular, the areas of the brain used to process music are larger or more active in musicians. Even just starting to learn a musical instrument can changes the neurophysiology of the brain.
Lutz Jäncke, a member of Faculty of 1000 Medicine, proposes using music in neuropsychological therapy, for example to improve language skills, memory, or mood. In a review for Faculty of 1000 Biology Reports, an online publication in which leading researchers highlight advances in their field, Jäncke summarizes recent studies of professional musicians
Read More.
