Wednesday, March 23, 2011

Things that make me grumpy

All right, this just pisses me off. Here's a doctor who's been suspended for re-using prostate biopsy supplies on patients. NOT re-sterilized. Just using the damn things until they get "too bloody" to keep using. And we all know how clean that area is.

Wanna get angry, too? Here's the link. (Thank you, Andrew, for sending this in).

Stories like this aren't new. Since we invented money some people have always tried to find ways to rip others off.

But in health care it somehow seems worse. Nurses have done it, too. And pharmacists.

Why the hell would anyone do this? Especially after all the damn training we go through?

I'd like to think they're just stupid. It doesn't make it better, but it's somehow easier to accept than the more likely option: greed.

If the doctor keeps re-using the biopsy equipment, it's good for his overhead. He has to buy fewer supplies to do the same number of billable procedures. He may even be charging the insurance for a new kit each time he uses the old one.

The pharmacist knew what he was doing. Just greedy.

The nurse is a little less clear. Maybe she's just lazy. But who knows? Maybe she took the fall for a greedy hospital that secretly condoned such a practice. Maybe they were paying under-the-table bonuses to staff who found illicit ways to save money.

Regardless, ANY doctor, nurse, pharmacist, or other health care person, who does ANYTHING for personal gain at the expense of a patient, should never be allowed to do this job again. These people come to us for care, and screwing them over for your profit line is absolutely unforgivable.

To me, this is worse than fraudulant billing (example: charging for taking off a mole when you really didn't). They're both wrong, but when you intentionally put it a patient in harm's way just to make a buck, you should be banned from medicine forever (provided you haven't already been locked up).

In medicine the prime directive is "do no harm". This is a balanced statement, because obviously we DO harm: Surgeons cut people open. Chemotherapy can make you horribly ill. I do procedures with needles. The issue is that in these cases we're doing harm with the overall end result being (hopefully) for the better.

But when you cross to the dark side, and knowingly hurt a person to make some extra dollars, you should be hung out to dry.

And if you're in this field, and disagree with that, then get out of it now.

Medical students: I'm a PGY-18. And some fires never go out. And I hope they never do.

50 comments:

Old MD Girl said...

That is so repulsive, I don't even know what to say.

Anonymous said...

OMFG!
Even the neanderthals made fresh flint tools for every trepanning operation.
I hope he gets sued by every patient who he ever treated for fraud and reckless endangerment and mental suffering and anything else they can think of.

OldSquid said...

In Grand Rapids, MI where I live we have this POS...

http://www.mlive.com/news/grand-rapids/index.ssf/2010/04/robert_stokes_fraud_case_to_be.html

"Dr." Stokes was to be featured in an episode of "American Greed" on MSNBC.

Cape Cod Step Mom said...

I'm not given the nurse a pass. Maybe her actions weren't for personal financial gain but I believe her behavior was just as bad. I'm not in the medical field but have done personal care work and she violated the most basic rule.

Reuben said...

For the non medical people, what does PGY mean? My guess is it's a formal qualification or position that you've been doing for 18 years.

Grumpy, M.D. said...

Post Graduate Years- time since medical school declared me a Menace to Decency.

My school had a 1 year curriculum, but required 500 box-tops to pass.

Cheryl said...

The nurse knew better. There is no excuse for this behavior.

Anonymous said...

I have observed that Asina nurses tend t this kind of thing - I think they see it as wasteful to use single use as directed - Im not being racist but stating a fact having worked with many Asian nurses - they reuse stuff in their countries...

Mr Mobius said...

Unfortunately already in medical school I sense some people are only in it for the financial gain, but at least in the UK NHS the financial burden of hospital expenses doesn't affect Dr wages by any great amount.

Watercolor said...

omgosh. I'm stunned. Horrible, just horrible. omgosh. Horrifying.

Sassy said...

As if getting a prostate biopsy wasn't bad enough already.

Not House said...

Disgusting.

That's just terrible, terrible practice. I hope all three of those guys lose their jobs.

Alex Dreamz said...

Go, Grumpy!!!! If more people felt like you (and were as willing to be outspoken about it) the world would be a much better place!

Ellie said...

I worked in a place where medical equipment was reused, but out of necessity (medical missionary work in central america) and EVERYONE was fanatical about cleaning and sterilizing the equipment after use. Even extreme poverty and bad conditions isn't an excuse for not sterilizing. And that pharmacist should be drawn and quartered. Do not mess with medicines that are used to save someone's life. Mess with their viagra, mess with their zit cream, but don't mess with their damn chemotherapy. Bastard.

Outraged in KCMO said...

Sadly, the pharmacist article hit home in a very personal way. One of my mother's long-time friends passed away from cancer. The death could have been prevented, or at least postponed. She used the pharmacy in question to get her chemotherapy drugs. There is no way to 'prove' it after the fact, but we are all convinced the pharmacist's greed killed her. She had recently passed on when this news broke. Unforgivable.

JoAnna said...

Kudos to the people (staff members, I'm assuming) who blew the whistle on these nutcases.

terri c said...

Appalling. How on earth do people sleep at night doing this stuff?

Jon said...

I just had a prostate biopsy last week. I asked the Dr. if he had a good lunch and plenty of rest, but not if his procedural equipment was clean. I wonder if he was using an artis anal ultrasound probe?

KarateSocks said...

I worked as a phlebotomist before I started medical school, and I was always hearing stories about how people used to reuse the butterfly needles because the hospital issued a limited amount per month.

RehabRN said...

Idiots all. I worked in a clinic and all our multidose vials were used for exactly one patient. They were all left capped when the patient came in to see them (rest was on the doc's sealed sterile tray) and even the IV kits and saline flushes were left wrapped. All this (meds and supplies) was unwrapped in front of the patient.
If they were unwrapped and unused for a particular patient (i.e. the med, IV or the syringe), they were pitched. The doc was very adamant about this.

It's disposable, single use only equipment for a reason!

Med Student said...

Grumpy - I'm a first year medical student and was following a rural doctor today. He has a patient that (on top of being mentally slow) doesn't have insurance and has a suspicious nodule on his xray that they need to get a CT of - the rural hospital charges an extra $900 for the CT than the town thats 15 miles west. The doctor told me that when they hired him they told him that he cant tell patients about that price difference (even when they dont have insurance) or they would fire him. It made me sick.

Dafeenah said...

I saw this earlier, but it's nice to hear you say that. When I was 13, I got some very bad care at a hospital. Was rehospitalized 3 yrs later for the same thing but at a different hospital. When those doctors found out, they had the licenses pulled of my previous doctors. I know there are bad apples in every barrel, but it's nice to know there are still some good ones there too.

Anonymous said...

there was a string of unusual bacteremias in surgical patients where i trained because a pharmacist was stealing from the fentanyl bottles and replacing it with deionized, but non-sterile, water.

Anonymous said...

Let's just not go there (where we're 'blaming' any particular medical professional). Eh? Let's just say that we in medicina all trained in aseptic handling of drugs and specimens, and we all know full well how much billing twice or providing substandard care affects the care we provide??

When a medical professionals only risk factor is practicing in the medical field for aquiring hepatitis, or other diseases contracted by contaminated equipment, we're all involved in an arena of neglect for standards of care. Any of it is deplorable.

Packer said...

Grumpy: It is the human condition. My departed old man used to say, "Beware the human condition." I would say what is that , and he would say," we all screw up" and then he would tell me "Whatever you do don't screw up."

Greed is on the list of the 7.

ER's Mom said...

Sickens me as a doctor to think that anyone who has the privledge of caring for others would do that.

Loren Pechtel said...

This is even more shocking because the Desai case (colonoscopy clinic where they were reusing the syringes.) is still in the news here. How can the doctors not learn???

Anonymous said...

It's wrong, to be sure, but the article says they "found that Dr. Kaplan's staff attempted to clean and disinfect the needle guides prior to reusing them, but these needle guides were not designed or intended to be reused."

They WERE cleaning the equipment, but it's not the kind that is allowed to be cleaned. I have my doubts that there's much/any difference between the needles that can be cleaned and the ones that can't, other than the ones that can be cleaned probably cost much much more. There are packages of gum that are "Not labeled for individual resale," but they're the same as the other pieces of gum.

Outre said...

I got blepharitis very suddenly a few years back and was pretty much convinced it was due to the multi-use dye the optho clinic I went to was using.

That was the first time I saw an optho clinic use multi-use vial, not those single-use dye sticks.

Now, I’m even more convinced that it was the (bacteria infested) dye vial that left me crusty-lided forever. Symptoms are much better but for a while, I wanted to take some sandpaper to my lids and eyeballs whenever they got extremely itchy. Had to melt the dried up crusts away in the mornings to prevent severe eyelash loss too... ick.

Anon @ 5:09, there are plenty of differences between needles and needle guides that are single vs. multi use. Most single use needles and guides will suffer structural breakdown with heat sterilization or chemical/gas might not reach all the nooks and cranies that can harbor crap. Plus chemical can be retained in the plastic parts. So attempting to clean by lets say...soaking the stuff in alcohol or betadine might be what they attempted, which is laughable. In addition, lots of single-use sharps have safety mechanism that engages to prevent accidental sticks -- these can be ‘disengaged’ for re-use (ugh) but essentially by doing so you are breaking parts of the medical equipment which could pose additional risk.

Don’t get how multi-pack gum analogy makes any sense though, sorry...

Nurse Shannon said...

I am hanging this on my locker at work tomorrow!

kg said...

No excuses for the nurse or pharmacist, but as far as reusing, I remember from clinical rotations in 95, the standard procedure for (whatever level of) disinfection for foley catheters was soaking them in Nolvasan for 30 minutes. And despite the "wrongness" of a doc reusing something not labeled to reuse, I think if the office properly used "high level disinfection" then the patients are safe. Well, safe from that instance, anyway.

Think Of It This Way said...

@Outre:

Yeah....I didn't get the gum analogy either. Comparing medical equpiment to gum is preposterous. Besides, it didn't fit.

Using that analogy, buying multiple single-use needles (all the same) at one time for a volume discount instead of one at a time would fit the "individual resale" analogy better.

The grossness of several people reusing the same gum (ABC gum being passed around from stranger to stranger on a bus, say) would have been a more accurate analogy.

So, if you think reusing single-use needles is "like" buying one piece of gum at a time, go on ahead and go to Dr. Kaplan's office for a rectal biopsy. And ask the guy on the subway next to you if you can have the gum he is chewing before you go in to relax you during the procedure. Just be sure to blow on it first so all the germs will fly away!

WV: enjoye WTF???

jenniferarb said...

"Regardless, ANY doctor, nurse, pharmacist, or other health care person, who does ANYTHING for personal gain at the expense of a patient, should never be allowed to do this job again. These people come to us for care, and screwing them over for your profit line is absolutely unforgivable."
I'd like you to add hospital administrators to that statement. Do you know it is common to get bonuses for keeping staffing levels down? Do you know how many studies prove that better ratios equals better patient outcomes? I don't see how that practice is any different. I am not defending the examples you gave at all I am just saying that I am tired of nurses, docs and pharmacists getting all the flak while administrators get away scott free.
I was working a floor once with me and ONE other nurse. The phone rang while we were both in pt rooms and it took probably 5 minutes or more for me to get to the phone. I answered it to a yelling doctor because he had to wait so long to get an answer. I yelled back that there were only two of us and we had no secretary. He stopped yelling. But did he speak to the administrators about it? Did he let anyone know that we needed a secretary? Nope. He sent us another patient. This hospital that couldn't afford to give us an $8 hour secretary had a CEO who lived in a $850,000 house (in our city the median home price is $150,000). Our Director of Nurses hadn't worked a floor in 30 years.
I think it should be a law that only people with clinical backgrounds and current (not 30 years ago) clinical experience can be administrators. And I think the doctors need to start speaking out about this issue as well. Since you "bring the money" to the hospital you have more pull than we do. Thanks for listening to my rant.

kim said...

I am in disbelief reading this, I mean as a pre-med student and current intern at the community hospital I see some Doctors who seem a little heartless at times but I could never see them being that careless to a patient's health. That is just so sickening.

PGY-18!! I hope your fire never goes out Dr. Grumpy.. your stories make my day and make me keep loving the excting yet sometimes wacky medical world:)

ERP said...

Ah... Capitalism at its worst.

MOJITOGIRL said...

"NUFF SAID, Grumpy! Do it right or get the hell out!

Texas Pharmacy Chica said...

Personal gain at the expense of the patients is deplorable. Sadly, Jenniferarb is right. While orking in the CorpoRetail world, I would spend many weekends (10 hr Saturdays, 7 hr Sundays) simply alone in the pharmacy in the back of the grocery store because we could not scedule techs. Makes it hard to get a bathroom break!!!!

BUT!
Let's not forget CEO's like Rick Scott who managed to get fined 1.7 BILLION dollars for Medicare fraud (you wonder why it is broke and they refuse so many procedures) and after that the good people of Florida decided he was the best candidate for the job and elected him governor.

arzt4empfaenger said...

It's disgusting behavior like this that made me question med school many times. Greed like this has no place in medicine.

Mary said...

Horrible, deplorable behavior, and I couldn't agree more about hospital administrators.

BTW, I live in Florida and I'm hoping that our voters truly are the effen stupidest in the country. Otherwise, we're in worse shape than even I thought.

Kat's Kats said...

Gah!!! And people wonder why medicine costs so much. ::head:laptop:: If only it were possible for those many medical professionals who give heart and soul and the gift of their mind and body to their patients to be able to not only do so freely and without the restraints caused by those who are... idjets... but for those who do not actually keep their oath whether they are physician, nurse, pharmacist etcetera to be actually prosecuted and/or not allowed to pretend to practice medicine again rather than be passed from place to place as many of them are today.

I salute the many good medical professionals it has been my pleasure to have as part of my medical team over the nearly 50 years of my life. My pediatrician, Joe Strayhorn, MD, trained me well. He was magnificent and came out of retirement for a number of years due to the demand of his patients. He was my mother's pediatrician as well as mine & my youngest brother's (though, since mom was 19 years when I was born & I was 20 when Dave was born he wasn't Dave's for long).

I have sung the praises of good medical personnel loud and wide, to others in the community and to the insurance companies with whom I deal, pointing out how much they save them due to the care they take when diagnosing etcetera. I take just as much care in denouncing those I find wanting. And yes, whenever I do, the insurance company knows just how and why I feel that person should be watched with care. I point out to them that good patient care is a hell of a lot cheaper than poor care which is much more likely to require another doctor (or doctors) to follow up later and/or more costly procedures etcetera due to issues not being caught in time... um... I'll just step off of this soapbox now.

PS Texas Pharmacy Chica? First row, third column! ::grin::

j said...

There should really be some whistleblower protection and rewards like in other fields so people wouldn't lose their career if they report a colleague doing something, but I can't even begin to think of a way to implement this.

They would have to do witness protection given how regionally close knit things are, to start. Ugh, brain 'splodes, etc.

jenniferarb said...

I like the first row second one
so true

Kat's Kats said...

@jenniferarb - I built that one while sitting with my husband before & after surgery for carpel tunnel. I just so happened to be working on medical expressions that day so it was helpful having medical staff to suggest changes or crack up... ummm... I mean approve of certain graphics.

I do need to track down my stethoscope (which should be in my first aid kit) and take a picture of Thomas with it saying, "Dammit Jim! I'm a cat, not a doctor!" Hmmmmm, that just gave me another idea. I may just end up having subsections in the TMNKH section... if I have enough space to do it.

kdoglady said...

Re: the nurse - could be dementia? The article said she'd been working as an RN for 37 years. Something changed her thinker after all that time...
Old Squid - Dr. Stokes was a real piece of work. I was glad to see his house sold for less than half of the asking price.

kdoglady said...

Law & Order: Special Fashion Victims Unit

pharmacy chick said...

when I first heard about the pharmacist, it just made me sick. Greed makes people do some deplorable things. I feel bad when somebody calls and says there were 29 instead of 30 tabs!

John Woolman said...

Even worse than the cases you cite are the health care professionals who deliberately kill for thrills, fun or profit and i have helped investigate more than a few of those. I'm now PGY-28 and, like you say, some fires never go out. Thank heavens.

The Nice Lady said...

Thank you for saying what so many of us are thinking. There are far too many people like this becoming successful in medicine. This guy was a top doc in that area and a dear friend of mine actually saw him a number of years ago and did not like him and refused procedures he wanted to perform. Now she's extra glad she did.

Anonymous said...

Get your Ya-Ya-s out; Let's hear it for Grumpy Ethics.

Cliff

vicki said...

go dr. grumpy go!
i am a dialysis patient and watch them open sterile equipment to string the machines. it makes me feel better. i asked why they didn't reuse the equipment? the answer: it's only a 10 cent difference and then patients get sterile equipment every time! what a relief for me

 
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