Why don’t patients ask questions of their doctor?

My wife came back from a doctor’s appointment the other day, and immediately, I noticed that she looked puzzled and somewhat confused. So, I asked her about her appointment.  She went over her discussion with the doctor as I kept probing with questions about their conversation.  I found myself asking the following question more than any other: “Well, did you ask him about…?” Before too long, doing what I do for a living, I could not help but wonder why patients aren’t more inquisitive. Is there something about the patient-doctor relationship that makes patients not want to ask questions of their physicians?

Surely, the primary responsibility for gathering information about the patient’s medical conditions is and should be with the physicians. After all, their knowledge of medicine is vastly superior to that of the average patient. Still, when a patient has questions, there is often no good reason not to ask them. Consider a physician who orders hormone replacement for a female patient with a history of blood clots or hypercoagulability of which the physician is unaware. Consider another patient who develops a series of complications after a surgical procedure but who decides to tough-it- out and not ask any questions during follow-up appointments with the physician. In both of these examples, the patient risks developing potentially life-threatening conditions, and, if the patient knows or suspects that possibility for whatever reason, it is probably not a good idea to assume that the doctor will be the one to ask the right questions. So, why are patients sometimes reluctant to ask more questions about their medical care or condition?  I don’t presume to know the answer, but I suspect, in part, it has to do with the patient’s expectations.

For example, when I am pain, I don’t really want to have an extensive Q & A session with my doctor. I just want treatment!  It is simply mentally relaxing to just let go and have someone else take care of me. In addition, my knowledge of medicine is superficial at best. I don’t feel comfortable asking questions if I don’t know what I am talking about. My ego would rather have me in pain than allow me to question a doctor at the risk of looking like a fool.

On a subconscious level, I am probably also dealing with preconceived notions about doctors.  As long as I can remember, I have been told that doctors are intelligent and in control. After all, who else is capable of getting into medical school and then have the stamina to survive some seven to ten years of medical training? All of this makes me think that my doctor can only make the right decisions about my medical care. And then there is the medical office or the hospital. The smells, the patients (most with problems far worse than I have), the complicated machines that look like they belong in a sci-fi movie don’t exactly add-up to a familiar, comfortable environment.  I am in pain, uncomfortable, and somewhat intimidated – not exactly an environment conducive of critical thinking.

Well, if this is how other people feel, I think that might explain why patients are sometimes not as inquisitive as they should be.  What do you think?  If you are a patient or a physician, your feedback is much appreciated. Of course, everyone is welcome to comment.

Contributing author: Jon Stefanuca

Editor’s Note: This piece was written by Jon Stefanuca. My own wife has an advanced degree in pathology, did surgical pathology and autopsies. She DOES ask questions! Do you really need a medically-related degree, however, to ask the basic questions so that you have a clue what you’ve just agreed to by way of medical care? I think not. Moral of the story: be your own patient advocate! If you need help, then have a family member or a close friend accompany you if you have any doubt.

Florida’s doctor discipline system not tough enough, critics say

As a Florida-licensed attorney who spent 15 years working in consumer justice law firms in the ‘Sunshine State,’ I keep a watchful eye on trends and developments within various personal injury practice areas in Florida.  There is currently a real, legitimate concern regarding the system that is responsible for disciplining doctors who are licensed to practice medicine in Florida.  The Orlando Sentinel recently published an article how some believe there is much to be desired when it comes to how the  Florida Department of Health handles these matters.  

Consumer group Public Citizen last month ranked Florida the eighth most-lenient in the nation for disciplining doctors. The ranking stems from the number of serious actions per 1,000 doctors last year, when the state revoked the licenses of 94 and suspended 18 others. The toughest state disciplined doctors at rates three times as high. The trend has been true for a decade, the group said.

Critics contend the state does not act fast enough or toughly enough against the small share of practitioners accused of substandard care, negligence, crimes or improper behavior. Too often, they say, the state lets professionals such as Lan continue practicing while officials probe allegations of crimes or serious violations and injuries.

Regulators dismiss 90 percent of complaints that patients or others file against practitioners, more than 95 percent of those against doctors. When action is taken, the state rarely imposes serious punishments, such as revoking or suspending licenses.

There is ‘the other side’ of the story.  According to the article, some of the advocates for the way the system works take the following position:

State officials and some attorneys defend the system and say the criticisms are overstated. They say any system can be improved, but contend the state focuses on protecting the public from professionals who commit the most serious wrongs, and demands remedial training for professionals who make errors.

“I don’t see the evidence to support [the criticism]. We believe we are doing a good job,” said Lucy Gee, the health department’s director of medical quality assurance.

Gee said the process moves deliberately so it can be thorough. Cases remain secret because laws aim to keep baseless complaints from becoming public and unfairly tarnishing professionals, she said.

What about the doctors and individuals within the medical profession that repeatedly cause harm to patients or are charged with serious crimes (felonies) but are permitted to continue practicing medicine?  What about these same individuals within the profession, who do not receive ANY form of discipline whatsoever, or are allowed to continue practicing, while the investigation against them is pending. Here are just a few examples of such real world cases:

Dr. Stuart F. Tillman, a Tallahassee anesthesiologist arrested in July and charged with soliciting sex online from a police officer posing as a girl of 14.

Dr. Joseph M. Hernandez, formerly of Fort Lauderdale, who was arrested in Lake City in February and charged with trafficking narcotic pain pills and prescribing drugs for monetary gain. In 2006, records show the state banned him from doing surgery and temporarily suspended his license because his vision was severely impaired. In 2007, he was fined $5,000 for leaving part of an IV tube in a patient’s chest.

Dr. John N. Mubang, an internist in the Tampa suburb of Seffner who was arrested and charged in July 2008 with drug trafficking and prescribing controlled substances for monetary gain.

All three have pleaded not guilty, with trials pending. Hernandez and Mubang are practicing, according to their offices. Hernandez declined to comment. Mubang and Tillman could not be reached for comment, despite calls or messages left at their offices.

What does this say about the system that disciplines doctors in Florida?  Sure, there are many great doctors in Florida, but for the ones who put their patients’ lives at risk (through negligent treatment or otherwise) or are charged with serious crimes that may have an impact on their practice/medical license, the question remains: Would YOU want to have a surgical procedure performed by a doctor that has a criminal investigation pending against him or her that may land them in jail? I suspect you would prefer your doctor to be completely focused on your surgical procedure and not thinking about other ‘outside distractions.’  Shouldn’t there be additional aggressive safeguards in place that will IMMEDIATELY prevent the medical provider from committing more harm?

We leave you with this: Yes, emergency suspensions were put into effect 248 times in 2009.  However, compare that with the approximate 24,000 complaints that were filed against doctors and other members of the medical profession the same year, by both individuals and other agencies.  Are we really to believe that only 248 of those 24,000 cases required emergency suspension of one’s practice…??

Actor Dennis Quaid sues drug maker

Last month, we reported in a blog through our website, how actor Dennis Quaid is involved as a patient advocate, after his newborn twins nearly lost their lives back in 2007, from a medical error that could have very easily been prevented.  Put simply, the precious twins were given two doses of Heparin instead of Hep-lock (an anti-coagulant medication widely used for children).  Why is this significant?  Heparin is a drug one thousand times stronger than what the twins were supposed to have received.

Earlier this week, it was reported in the Contra Costa Times, that Mr. Quaid has filed a lawsuit on behalf of his children.  As far as the extent of his children’s injuries, the article states “The children suffered internal injuries and shock, but the extent of what happened to them will probably not be known for years, according to the suit.”  The lawsuit alleges that vials of the 10,000 unit Heparin should have been recalled previous to what happened to his children, because other infants had already died from similar medication errors.  The suit also claims that the company responsible for making the drug, Baxter Healthcare, “was obligated to warn healthcare providers of the previous medication mistakes.”

We wish the best for the Quaid family, and hope that the discovery in this case shines a light on not only finding out exactly what happened in this case, but also makes information available that may be able to save the lives of other children from future similar medical errors.  We will continue to monitor the course of this case.

Child Health: Labels Urged for Food That Can Choke

Earlier this year, we posted a blog on our website in regard to the American Academy of Pediatrics (AAP) policy statement in regard to the prevention of choking among children.  Earlier this week, the New York Times featured an in-depth story on an issue that is very much a part of this policy statement:  food choking hazards among small children.  The article discusses the advocacy efforts to place warning labels on foods, which pose a choking hazard to small children, as well as the proposition that small children should not be allowed to eat certain foods at all.  The article starts with an all too familiar setting that ended in tragedy:

On a July afternoon in 2006, Patrick Hale microwaved a bag of popcorn for his two young children and sat down with them to watch television. When he got up to change the channel, he heard a strange noise behind him, and turned to see his 23-month-old daughter, Allison, turning purple and unable to breathe.

As a Marine, he was certified in CPR, but he could not dislodge the popcorn with blows to her back and finger swipes down her throat. He called 911, but it was too late: by the time Allison arrived at the hospital, her heart had stopped beating. An autopsy found that she had inhaled pieces of popcorn into her vocal cords, her bronchial tubes and a lung.

Does this story make you think twice before giving your little ones popcorn?  On a personal note, I called my wife immediately after reading this story, and we discussed the fact that we should no longer allow our son, who is now two and a half, to have any popcorn. Ironically, she was on her way to take him to a movie that was going to be serving….you guessed it, popcorn.

Now, some of you may say “Well, little kids can choke on anything.”  Well, that is true.  However, there are some foods that pose an increased risk of choking.  Consider the dynamics of how a small child eats, as well as the size of their airway:

Children under 4 are at the highest risk, not only because their airways are small (the back of a toddler’s throat narrows to the diameter of a straw) but also because of the way their eating abilities develop. Front teeth usually come in at 6 or 7 months — so babies can bite off a piece of food — but the first molars, which grind food down, do not arrive until about 15 months, and second molars around 26 months.

“Between the ages of 3 and 4, they’re developing their ability to chew adequately and prepare for swallowing,” said Dr. Nisha Kapadia, a pediatric resident at Johns Hopkins Children’s Center.

When young children chew foods like peanuts, raw carrots and popcorn, some is ground down and some is not, and they tend to swallow unchewed bits of food that can block the airway or be inhaled into the bronchial tubes and lungs.

This concern and the tragic deaths associated with this concern have prompted several organizations to propose various options to attempt to prevent these injuries and deaths.  One such organization is the Center for Science in the Public Interest:

Some advocates say the government should put hazardous foods off limits to young children.

“The F.D.A. needs to set a uniform standard for cautionary information on food that should not be consumed by children under 5,” said Bruce Silverglade, legal director of the Center for Science in the Public Interest, an advocacy group that lobbied unsuccessfully in 2003 for a bill to require the Food and Drug Administration to develop food labeling regulations.

Where this debate will end up, we don’t know.  However, to think that in 2001 there were 17,500 children 14 years old and younger treated in emergency rooms for choking, with 60% of those events caused by food, there must be a way to create a safer environment for our children when they are eating.  Any suggestions?

Cardiac Health: Implantable Cardiac Devices – number of procedures on the rise, but is the technology really there to handle this boom?

It is reported that an estimated 650,000 people in the United States currently have implanted cardiac devices (ICD’s) designed for defibrillation (cardiac electro-shock therapy) or combination defibrillation and heart pacing.  For you  Baby Boomers rounding (or having passed) the 60’s bend, these numbers are expected to grow exponentially.  Cardiovascular Business posted an article on April 20 advising that hospital admissions for implantation of ICD’s increased ten-fold from 1990 to 2005.

This same article was quite alarming in its lack of scientific data on factors that determine the best results.  While it may be comforting to know that several large patient-studies have recently shown that centers performing the greatest numbers of procedures have the lowest rates of procedural complications, it is important to also note that authorities in this area of medicine warn that more data and study are needed on individual operator volume, specialty identification, training, performance and outcomes.

Cardiovascular Business News released a feature on April 20, 2010, citing an article published in 2009 by the Journal of the American Medical Association.  The data suggest that your odds of having procedural complications were greater if the device was implanted by a non-electrophysiologist. In short, does this mean you have better odds with an electrophysiology cardiologist? What about a general cardiologist? Or a thoracic surgeon? The study data apparently did not adjust for underlying health conditions or patients who are more ill. Why not? Are we to assume the latter groups of patients may have merely been more prone to complications? Or do the non-electrophysiologists just have less experience and training in implanting ICD devices? As of this time, Boomers, the medical profession has not published answers to these questions.

Perhaps we should be encouraged that Medicare is requiring implant and performance outcome data. As of June 2009, the agency had collected information on more then 380,000 implants.  Yet almost a year later, with many more procedures entered into that same database, the medical specialty communities are still unable to let us know which are the safest specialists and hospitals performing ICD implant procedures.  Physicians say longer term outcomes are needed.

In the meantime, are Medicare and other payors paying for all procedures regardless of the quality of practitioner or hospital performance?

More alarming, on May 17, 2010, Dr. Westby G. Fisher, a cardiologist at North Shore University Hospital Health System wrote in medcitynews.com that the medical system currently can no longer sustain the volume to maintain the implanted devices safely. He complains that physicians are unable to re-program ICD devices remotely.  Is this true? Due to the growing volume of implanted devices now occurring, technicians with no medical degree are programing patient devices from remote locations with sometimes no documentation or notification to the patient’s physician. Physicians are supposed to be overseeing the process according to Dr. Foster. However, he is of the opinion that due to the high maintenance these devices require, along with the growing number of patients, managing the technology will be of great concern to the boomer population and their physicians.  Once again, how are the pressing issues of quality, safety, and cost going to be timely addressed in this burgeoning aspect of our healthcare?

Finally, perhaps we can be comforted by the recent news release from the Heart Rhythm Society. Apparently, the medical profession had never previously determined parameters on how and when to stop these devices at the end of one’s life.  The study cited a dying patient whose defibrillator went-off  greater than 12 times, causing the patient needless suffering. Several groups of medical societies have now have published a consensus statement outlining ethical and legal issues, a decision-making algorithm for withdrawing/deactivating the device(s), and rights/responsibilities for those physicians who have ethical conflicts. The Heart Rhythm Society is encouraging and educating physicians and patients on what needs to happen in this algorithm for ending ICD-sustained life.

One can only hope that a physician is not placed into a remote call-waiting voicetree for dying boomers when the time comes to deactivate. It’s bad enough that we don’t yet know how to choose the best physician and/or hospital to have these devices implanted. Now there is growing concern that simple but critical issues of maintenance, remote re-programming and the like will get out-of-hand due to the ever increasing volume of these devices being implanted.

Contributor: Sharon M. Stabile

Allergic to Dairy? Read Before Eating Those Sunflower Seeds!

Ryt-Way Industries, LLC, a food packaging company, is immediately recalling some of the sunflower seed products that they have packaged, as they contain undeclared dairy ingredients.  The recall, which includes products that have been distributed nationwide, is a voluntary recall, and is being done in conjunction with the FDA:

Ryt-way Industries LLC of Lakeville, MN is voluntarily recalling select BIGS ® Original Salted & Roasted Sunflower Seeds because they may contain dairy ingredients that were not declared on the packaging.  The product is packaged in 5.35oz plastic bags with BEST BY Dates of 30MAY2011 and 31MAY2011 with an individual bag UPC code 896887002196.  People who have an allergy or severe sensitivity to dairy run the risk of serious or life-threatening allergic reaction if they consume these products.

It was discovered that the sunflower seed packages at issue, as manufactured by BiGS, do not disclose the presence of dairy within them.  Ryt-Way goes on in their announcement to instruct consumers that are allergic to dairy how to handle this situation, should they be in possession of these recalled items:

Consumers who are allergic to dairy and who have purchased the recalled products are advised not to consume the product and are urged to return it to the place of purchase for a full refund.  Consumers with questions may contact 1-877-722-7556

So, if you are allergic to dairy and/or have a sensitivity to dairy products, and love those sunflower seeds, please check your home for these recalled products.  As the weather gets warmer and we try to snack on “healthier” items to get that “younger figure back for summer”, don’t let this recall pass you by!

Non-Cardiac Surgery Too Soon After Cardiac Stenting Increases Risk of Complications

According to a recent study published in Circulation: Cardiovascular Interventions (an American Heart Association journal), patients should attempt to postpone having surgeries for at least six weeks after a coronary angioplasty procedure with stenting.  Researchers found that patients who wait at least six weeks before having another surgery are less likely to develop reduced blood flow to the heart (a.k.a. heart ischemia) and heart attacks.

The study data revealed that 42 % of patients who had other surgeries within the six-week period developed these complications. Only 13 % of patients who had surgeries beyond the six-week period developed the same complications. The study focused 1,953 patients with an average age of 64 who had cardiac angioplasty with stenting between 2003 and 2007.

According to the American Heart Association:

• Over 70 percent of coronary angioplasty procedures in the United States also include stenting.
• In 2006, approximately 65 percent of PCI procedures were performed on men, and approximately 50 percent were performed on people age 65 or older.
• In 2006, an estimated 1,313,000 PCI procedures were performed in the United States.
• In 2006, approximately 76% of stents implanted during PCI were drug-eluting, compared with 24 percent bare-metal stents.
• In 2006, there were 652,000 PCI procedures with stents — 425,000 in men, 227,000 in women.

If you recently had cardiac stenting and require another surgery, make sure to ask your doctor about waiting to have the next surgery. This is particularly true if your next surgery is an elective one. If your doctor or surgeon is not a cardiologist, you may want to consider asking your doctor for a referral to a cardiologist.  You may also want to make sure that your physician or surgeon obtains cardiac clearance before proceeding with another surgery.   Don’t assume that your doctor will do these things for you. Be proactive; ask questions.

For related blogs, please see:

• Drug- Eluting Stents Found Effective at Preventing Major Amputations
• Angina: The Efficacy of Percutaneous Coronary Intervention v. the Efficacy of Non-Surgical Treatment.
• The Efficacy of Drug-Eluting Stents and Bare Metal Stents in Heart Transplant Recipients with Coronary Artery Disease
• Study Finds Stents as Effective as Surgery to Prevent Strokes; European Study Finds Otherwise
• St. Joseph Medical Center Stent Patients Now Face Another Risk: The FDA Requires a Black-Box Warning on Anti-Clotting Drug Plavix
• St. Joseph Tells 169 More Patients They May Have Had Unneeded Surgery; Total Notified Now at 538
• Bill Clinton’s Stent Procedure – What It’s All About

Contributing author: Jon Stefanuca

Best Hospital Rankings – A reply to Dr. K – what’s best for YOU?

As readers of our blog know, Dr. Kevin’s blog serves as the source for a number of our posts. Recently, Dr. Kevin posted somewhat of a spin-off –Top hospital rankings doesn’t mean the best medical care | KevinMD.com – of a post he had done earlier about “Top Doctors” does not equal (necessarily) “Best Doctors.” Then today, as I was going through my News Feed on Facebook, lo and behold, here it is again.  I agreed wholeheartedly with him then and  now, and I find myself saying “Amen” to his post.  Problem is – what is the answer, Dr. K?

Check out his blog. He identifies the issue, but does he really suggest the answer? My humble opinion: afraid not!

Let’s explore some ‘tips and tricks’ for you to get close to the right answer. I say ‘close’ because there really is not a perfect answer. If you get great care and all goes well, then that was the best hospital for you and your problem. These after-the-fact answers are always 100% accurate when seen through the best medical instrument available – the retrospectroscope. If you are interested in some tips and tricks for picking an institution for future, non-emergent care, read on.  Let’s see if we can provide you some guidelines for your selection process.

Having been involved with issues relating to the care rendered at numerous hospitals in Washington, D.C., Baltimore and far beyond for many years, I have my own personal opinions where I would go to be treated and where I most assuredly would not go.  In fact, I have often joked that I need to get a medical alert bracelet reading – ‘in event you find me unresponsive do NOT take me to Hospital X (fill-in the blank).”

Lawyers doing medical malpractice have a pretty darn good sense of which hospitals give the best care.  Does the general public? As Dr. Kevin points out, reputation and marketing of that reputation is not the end-all-be-all of defining which hospital (also insert ‘doctor’) gives the “best medical care.”

There’s a certain hospital here in Baltimore that is constantly listed as the “Best.” While that institution does have some of the ‘best’ doctors and allied health specialists, it is also well known to provide substandard care at an alarming rate. The local maxim goes – “If I wind-up having a rare disease, that’s the place I want to go for treatment; however, if it’s garden variety, no way – no how!” Why? Just too busy, too arrogant, not patient- friendly, too willing to turn patient care over to resident-staff-only surveillance and so on. Maybe they are just bored by the ordinary health issue – not complex enough. Who knows?

But here’s the catch – just as ‘top hospital’ rankings doesn’t mean (necessarily) best medical care, nor does overblown reputation mean that there aren’t some, if not many, outstanding physicians at these same institutions. Titles, marketing banners and magazine covers simply do not answer the search for the best institution for your care.

Let’s face it, in an emergency situation you are going to the nearest available institution at least until you are stabilized medically. Whether you elect to stay there for ongoing care may well be a different issue. The more common situation you will probably face is when you are going to undergo elective procedures or care.

Since you are reading this blog, you undoubtedly have a computer. Have you done your homework? Going online to learn more about your medical condition is a good place to start. No, I’m not suggesting you check-out what ranking your doctor or his/her hospital has; that information is precisely at the heart of the problem.

Let’s take one example of putting research into the decision-making process. An obese patient determines that he/she would benefit by bariatric (weight loss) surgery. Putting aside those who see this as a quick-fix alternative to Jenny Craig or Weight Watchers, John Doe (J.D.) – our hypothetical patient – might consider researching the various forms of bariatric surgery. Does J.D. know if he should have gastric bypass surgery or gastric banding? If gastric bypass, does his doctor specialize in open procedures or laparoscopic surgery? Does he know the different approaches a doctor can take? What are the risks of malabsorption or the post-operative complications associated with that form of surgery? Had J.D. just typed in “bariatric surgery” in whatever search engine he likes, he would see there is a world of information out there about the types of bariatric surgery, the risks associated with such surgery and so on. Did that handout he received from his doctor really fully educate him on the alternatives to what was recommended to him?

Okay – let’s focus on J.D.’s surgeon. Does he/she have a ‘preference’ for doing open versus laparoscopic procedures? When is the last time, if ever, he/she did one laparoscopically? Consider: did J.D. think that might be the reason why he/she is recommending J.D. undergo an open Roux-en-Y? Is this really in J.D.’s best interest?

Let’s put you in J.D.’s shoes. Would you ask your prospective surgeon what his/her complication rate is? How about  mortality rate? If you think surgeons don’t know their morbidity/mortality rates, think again. What is the most frequent complication your surgeon  encounters following the surgery or treatment you are considering? Are you, for some reason, at greater risk than other patients for encountering this risk?

Hopefully by now you get the drift. This is your body – protect it! Last time I checked, we’re only here one time around. If your doctor makes you feel ‘uncomfortable’ because of his/her reaction to your questions or  the time it takes for  you to understand what you are agreeing to undergo surgically or medically, that might just be a telltale sign to move on.

Best Doctor/Best Hospital? Hopefully, by doing your homework and having a meaningful discussion with your doctor and understanding better the hospital where this will all be taking place, you will determine exactly who is the “best doctor’ and which is ‘the best hospital‘  for YOU! At least this approach will give you a better chance of a good outcome and experience than making your choice based on a title, magazine cover or a banner hanging on the hospital’s facade.

By the way, the same can be said of lawyers. Are we listed as the ‘best’ and ‘super’? We sure are, but you should ask us (or any lawyer you have occasion to meet) the same type of tough questions. Be pro-active. You’ll be better-off for it.

McNeil Consumer Healthcare Announces Voluntary Recall of Certain OTC Infants’ and Children’s Products

Last week, the FDA and McNeil Consumer Healthcare launched a massive voluntary recall of certain medications for infants and children.  There is a dedicated McNeil website that addresses the recalls.  In addition, the FDA has published a press release that has some of the important information regarding the recall

The following is some basic information concerning the recall, as published by McNeil under the Product Recall Information:

McNeil Consumer Healthcare is initiating this voluntary recall because some of these products may not meet required quality standards. This recall is not being undertaken on the basis of adverse medical events. However, as a precautionary measure, parents and caregivers should not administer these products to their children. Some of the products included in the recall may contain a higher concentration of active ingredient than is specified; others may contain inactive ingredients that may not meet internal testing requirements; and others may contain tiny particles. While the potential for serious medical events is remote, the company advises consumers who have purchased these recalled products to discontinue use.

The investigation into these products, which include, but are not limited to, Infants’ and Children’s Tylenol and Motrin (Please click here for a complete listing) is ongoing.  The Commissioner of Food and Drugs, Dr. Margaret A. Hamburg, states:  “While the potential for serious health problems is remote, Americans deserve medications that are safe, effective and of the highest quality. We are investigating the products and facilities associated with this recall and will provide updates as we learn more.”

We will continue to monitor this massive recall.  Please immediately check your homes for the recalled products. We strongly recommend that you read and follow the FDA’s instructions.

Another Child Dies. Will DC EMS Improve Now?

We reported back in mid-March on our blog site on the issues surrounding an investigation of the District of Columbia’s Emergency Medical Services. Since then, DC EMS has represented that they have made positive changes to their department.  In a headline article posted on MSNBC.com at the end of this past week, D.C. Fire and Emergency Medical Services Chief, Dennis L. Rubin, represented positive changes are being made:

Rubin said he is working to drive home a key point: providers never decline transport.

His staff is developing a “patient’s bill of rights” to be posted in every ambulance and producing a new  training video underscoring that message. In addition, the policy has been expanded to cover instances in which a patient refuses to be transported, including the requirement that responders get an OK from a supervisor and have a witness, such as a police officer, confirm the patient’s decision.

We certainly hope this is the case.  Our prior post cited a troubling report from April 2009, wherein it was found that there were serious training and performance issues relating to DC EMS.  The article posted at the end of  this past week also details another tragic event that unfolded after the report in April 2009:

Stephanie Stephens died after paramedics refused to take her to the hospital Feb. 10 in the first of two visits to her home after she experienced breathing problems. Her death has prompted a rare criminal investigation and raised questions about ambulance policies in Washington and emergency care for children nationwide.

After the paramedics recommended she be taken into a bathroom to inhale steam from a running shower, Stephanie’s family called back hours later and an EMS crew took her to a hospital. The child died from pneumonia the next day.

Anyone have issue with this?  How many tragedies must we endure before there is ZERO TOLERANCE for such costly delays?!  The citizens and guests of DC are dependent upon DC EMS to provide assistance immediately; not to give bad medical advice, try to play doctor, or decide that they will just simply not transport someone.  Read the report from last year cited above, along with the relevant articles.  Then, you decide.  I wonder what Stephanie’s family thinks…