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Archive for the 'Hospitals' Category

Why Rob a Bank When You Can Make More Money by Counterfeiting Drugs?

Want to make millions of dollars quickly while risking only a few months in prison if (and that’s a big IF) you’re caught?  It’s not difficult at all. Just set yourself up as a distributor of counterfeit drugs in the United States.

This week’s announcement by the FDA that a counterfeit version of Avastin, a chemotherapy drug that is used for several kinds of cancers and tumors (lung cancer, kidney cancer, colon and rectum cancers – but no longer for breast cancer since approval was removed last year) has been found across the country, infused into the national drug supply, raises plenty of questions about how that could possibly happen.

It was followed by an interesting article in USA Today which partially answers the question.  Counterfeiting is a multi-billion dollar business that is on the rise because it’s so lucrative, and because the penalties are so… well… inconsequential.  I mean – would you be willing to spend no more than six months in jail if you could make millions of dollars for use when you got out?  (Even if you would answer no! I don’t want to go to jail!…  I’ll ask you this…. what if your child had treatable cancer and you had no insurance?  Just sayin’ …)

Avastin isn’t the only drug that may be counterfeited.  Any high cost drug that can be watered down, or manufactured to “look” right even if it is manufactured without its expensive ingredients, is a target for counterfeiters.  Lipitor and Viagra are probably the most apt to be counterfeit, but others like drugs used to treat HIV and AIDs, or diabetic drugs, or weight loss drugs, are likely targets for counterfeiters, too.

So what happens if you are somehow treated using a counterfeit instead of the real drug?  Maybe nothing. Or maybe you die. Or anything in between. The problem is, for the most part, we patients have very few ways we can detect whether a drug is real or fake.

Katherine Eban, in her book, Dangerous Doses, tells the stories of people who died from receiving infusions of counterfeit Procrit.  The conventional wisdom on this most recent discovery of fake Avastin is that there was nothing in the counterfeit version that was dangerous, and it’s difficult to tell within a regimen of 18-20 doses a cancer patient might receive over six months whether one “missed” infusion of the active ingredients has a long-term effect.

The bigger picture problem is that our drug supply is not being well enough protected by the FDA, which is tasked with protecting us. The FDA has no backbone when it comes to protecting us from bogus, counterfeit drug distributors who appear to be selling “real” drugs, but target greedy doctors, pharmacies and hospitals that are so willing to buy “discounted” drugs for their patients, knowing that there will be more profit in their reimbursements.  Experts estimate that about 1% of our drug supply is counterfeit.  That means that 1 out of every 100 administered drugs may be counterfeit, too.

One answer to this is an electronic pedigree system, meaning, from the time the drug is manufactured, until it is given to the patient, it is followed and logged using a bar code type system. If such a system was in place, then even us patients would have a way to double check that the drugs being given to us are the real drugs they are supposed to be.

So why doesn’t the FDA insist on the development of such a system?  Well, actually, they have. But again, they have no teeth, and so far, no backbone.  Every time they raise the issue, the drug companies and drug distributors begin to wail about the added cost to the system.  (Surprise!  Follow the money!)  And so, nothing gets done.

Like other issues in healthcare, it looks like little will happen to improve this system until something horrible befalls someone famous; someone who can actually override the special interests in Washington and insist on development of this electronic pedigree system.

Until then, here is information to help us patients do what we can to protect ourselves from counterfeit drugs.

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Choosing a Safer Hospital

Please note that this column first appeared in the Syracuse Post Standard on September 27, 2011

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In my last column I shared an open letter to our local hospitals which resulted from my review of their most recent “report cards.”  These report cards score hospitals on their quality of service and safety records. Despite a few improvements, problems were exposed at all of them – problems that continue to put us patients in danger or simply make us miserable.

Think about that. Danger! Too many of us patients enter the hospital with an expectation that, whatever our medical problem is, it will be improved because we have been hospitalized.  Instead we find ourselves the victims of deadly infections, drug errors, falls, surgical mistakes, even crimes.

And think about the second part.  Misery!  When we are at our most vulnerable, perhaps unable to walk on our own, or even stay conscious, we may be at the mercy of staff who ignore our complaints about everything from intense pain, to the need to use the bathroom.

The potential for even more danger and distress is growing, too.  The numbers of hospitalized patients are growing as baby boomers age, and as healthcare reform provides more patients with access to healthcare. As time goes on, the ability of hospital personnel to keep us safe and relatively comfortable will be taxed even further.

So how can we patients ensure our own safety and comfort?  We’ve previously looked at important safety precautions to take during a hospital stay. But the best approach is to begin with safety and satisfaction in mind.  That means reviewing hospitals’ track records before we ever need hospitalization, and making our best choice based on what a hospital has already demonstrated it can do.

Which is why those report cards mentioned in my last column are important.  They are tools we patients can use to help us choose the best hospital.

Let’s use them!

The latest New York Hospital Report Cards can be found at  http://www.myhealthfinder.com/newyork11/ .  Medicare’s website, http://www.hospitalcompare.hhs.gov also offers information about hospital safety and satisfaction levels.

Finally, if you’ve been hospitalized, there’s something you can do to help future patients make hospital decisions.  After a hospital stay, some patients are surveyed about the safety, communications and quality of their care.  By answering and returning the survey, you’ll be contributing to hospital ratings of the future, and providing valuable feedback to help our local hospitals improve their service, too.

……………… ADDITIONAL RESOURCES ON THIS TOPIC ………………

More Hospital Report Cards (more states)

How to Choose the Best Hospital for You

A Patient’s Guide to Hospital Infections

How to Prevent Hospital Infections

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An Open Letter to Hospitals

Please note that this column appeared in the Syracuse Post Standard on September 13, 2011.  It addresses the recently issued New York State Hospital Report Card.  You don’t need to be a resident of Central New York, or even New York State to gain benefit from this column.  Resources for you are found below.

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Dear Central New York Hospitals:

It’s report card time.  That time when we patients get the opportunity to learn whether or not you’ve improved your patient care and outcomes since last year.

I was hoping to find glowing reports. After all, you know exactly what will be measured and what needs to be done to earn the highest grades.  No one’s expecting miracles; just safe and timely care, a clean environment, pain management and effective communications.

But did I find stellar reports?  No.

Granted, the report card says I have less of a chance of catching pneumonia at St. Joes.  And, Community General, congratulations on your infection rate which is lower than the average hospital in New York State.  Both St. Elizabeth’s and Faxton in Utica are doing quite well avoiding Pulmonary Embolisms and Deep Vein Thromboses.

But those are only three high grades among almost four dozen measurements.  My real concerns are for those that registered lower than statewide averages – so low that some patients are dying, acquiring infections, suffering pain, and leaving your facility in worse condition than when they were admitted.  Each one of you earned the lowest possible score in at least three categories.

According to news reports, one official blamed bad scores on outdated statistics. Sorry – that’s no excuse! Your patients are human beings, not statistics.  Perhaps their pain, debilitation or death took place a few years ago, but many of those patients are still in pain, still debilitated and yes, still dead today.

As you know, beginning next year, Medicare will take patient satisfaction survey scores into account when it comes to determining reimbursements. We patients don’t require much to score you highly on those surveys.  We expect only the basics: communicate with us respectfully, prevent infections, avoid mistakes, keep us as pain-free as possible, and send us home with instructions we understand and can carry out.

Put another way:  treat us the way you would treat your own loved ones. Provide for us what you would provide for them.

Such an approach is bound to land you in the top tier on next year’s report card.

Best regards,
Trisha Torrey
Every Patient’s Advocate

PS:  Patients can find New York State hospital report cards by linking to http://www.myhealthfinder.com/newyork11/. Pay particular attention to patient safety and satisfaction measures. Then use those scores to choose where you want to be hospitalized. Your life may depend on it.

……………… ADDITIONAL RESOURCES ON THIS TOPIC ………………

More Hospital Report Cards (more states)

How to Choose the Best Hospital for You

A Patient’s Guide to Hospital Infections

How to Prevent Hospital Infections

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Informed Consent Requires Clarity – Do You Have It?

(as published in the Syracuse Post Standard August 16, 2011)

Recently I was chosen to participate in a new writing project. There were some basic details and responsibilities I was expected to agree to, including a specific number of articles, average number of words, and some other typical expectations.

I was given a contract to sign. After a careful reading, there were some strange differences from others I had signed in the past. I found some hedge words in the contract which could mean I would do all the work, but they could decide not to pay me, yet still have the rights to use my work. Red flags!

I didn’t jump to conclusions. Instead I asked questions. “Will you explain what this means?” “Will you give me an example of how this might work?” Eventually we clarified the fuzzy wording, worked out the terms, and I signed the contract.

But – and this is important – I didn’t sign it without making a few alterations to the descriptions. Each party initialed those changes, then signed the contracts.

So why should you, my reader, care about my writing contract?

Because every time you need certain medical tests, any medical procedure and many treatments, you are asked to sign a contract, too. It’s called “Informed Consent.” By law, those services cannot be performed unless your signature is obtained ahead of time on an Informed Consent document. That consent provides legal protection to both you and the person who performs the service.

The real question before you sign is, have you been thoroughly informed? Do you understand the risks, benefits and alternatives to whatever service is about to be performed? Do you know exactly who will perform it? Have they managed your expectations?

Sometimes Informed Consent documents will have hedge words or statements in them, like my contract did. For example, “to be performed by Dr. Serg Ury or his representatives” may mean your surgery will be performed by someone you don’t expect. Just who are his representatives? They might be his partners, or they might be students. If it is important to you, then clarify, and change the wording if necessary.

Wise patients never sign an Informed Consent document until they are very clear on what is about to happen, who will be making it happen, and what the risks, benefits and alternatives are.

Clarity will provide confidence that you understand what is about to happen, and that you’ve made the right choices for you.

……………… ADDITIONAL RESOURCES ON THIS TOPIC ………………

Understand Informed Consent

Trauma from Violations of Informed Consent

Patients’ Rights in the United States

How to Prevent Surgery Mistakes on the Day of Surgery

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July – a Potentially Dangerous Time for Healthcare

(as published in the Syracuse Post Standard
July 5, 2011)

Seven years ago this week, I found a golf ball sized lump on my torso that changed the course of my life. After its removal, I was diagnosed with a rare, terminal form of lymphoma. Subsequently I determined I didn’t really have lymphoma.  That was eventually confirmed medically, and I have never had treatment.

The fact that my tumor appeared in the month of July played a prominent role in my misdiagnosis.

Why July?

When we need medical care, we need to receive the best care possible.  That best care requires a team of professionals playing different roles, depending on what ails us.  From doctors and surgeons, to nurses, lab specialists and others, the team must conduct itself in a highly coordinated and collaborative manner to be sure we get the right answers and care. They dance a well-coordinated healthcare tango because each knows the right steps.

But sometimes there’s someone new on the team who doesn’t know how to tango.  A new dancer can cause the entire team to stumble or fall. When that happens, we patients suffer.

July brings many new team members.

First, many of the “regular” professionals take vacations beginning with the July Fourth holiday, throughout the summer. That means new, sometimes temporary replacements must step in. They may only know how to waltz.

The second set of new members are recently graduated medical students. Having just completed their studies in May and June, they begin their residencies July 1. Not only don’t they know how to function within the team, but they have barely learned the two-step.  A study reported in 2010 showed that counties with academic medical hospitals showed a 10 percent increase in medical mistakes in in July.

So how can we patients protect ourselves?

If possible, avoid medical care in July.  In particular, any care that will require you to be hospitalized should be handled either before July 1, or postponed, if possible.

If you can’t avoid medical care in July, then be sure to verify every step with an advocate’s help.  This includes double checking any lab work that yields unusual results, which – yes – was the root of my misdiagnosis.

No doubt those professionals who care for us in July have the very best intentions.  But doing a tango with someone who only knows how to waltz results in toe-stepping and bad results.  If possible, it’s a dance we patients should just sit out.

………. ADDITIONAL RESOURCES ON THIS TOPIC ………………

 Your Annual July Warning – No Time to Seek Healthcare

How the Calendar and Time of Day Affect Your Hospital Care

and

What to Do If You Must be Admitted to the Hospital Anyway

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