ANS

Hospital administrations have a wealth of administrative acronyms. One of my favorites is the acronym “ANS,” standing for “administrative nursing supervisor,” “assistant nursing supervisor,” etc.— commonly known as the “house supervisor” or “who’s on the house.” As any parent knows in chosing the name of their child, they must look for the pronounciation abuse and misuse potential of that name in the years to come. Shame, those that came up with “ANS” didn’t consider a wee bit of anatomy prior to utilization. It sure lifts the spirits in the harried ER to ask to speak with the ANuS on call.

Too hot to blog…

Rock, Paper, Scissors

†Rock, Paper, Scissors

via How Appealing

Judge orders lawyers to play game | CNNMoney | 6.7.06

Acrimonious attorneys told to settle dispute by playing a round of ‘rock, paper, scissors.’

NEW YORK (FORTUNE) - Faced with the inability of two bickering attorneys to resolve even the most innocuous scheduling questions without his intervention, a Florida federal judge yesterday ordered the two to meet on the steps of the federal courthouse and resolve their latest quarrel by playing “one (1) game of ‘rock, paper, scissors.’”

Judge Gregory A. Presnell of Orlando ordered the unusual measure, which he characterized as “a new form of alternative dispute resolution,” after the two Tampa attorneys had proven unable to agree upon where to hold a deposition, even though both of their offices are just four floors away in the very same building in Tampa.

Order of the court | CNNMoney | 6.7.06

Case No. 6:05-cv-1430-Orl-31JGG: Avista Management v Wausau Underwriters | M.D. Fla. | 6.6.06

UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF FLORIDA
ORLANDO DIVISION

AVISTA MANAGEMENT, INC., d/b/a Avista Plex, Inc.,
Plaintiff,
-vs-
WAUSAU UNDERWRITERS INSURANCE COMPANY,
Defendant.

ORDER

This matter comes before the Court on Plaintiff’s Motion to designate location of a Rule 30(b)(6) deposition (Doc. 105). Upon consideration of the Motion—the latest in a series of Gordian knots that the parties have been unable to untangle without enlisting the assistance of the federal courts—it is

ORDERED that said Motion is DENIED. Instead, the Court will fashion a new form of alternative dispute resolution, to wit: at 4:00 P.M. on Friday, June 30, 2006, counsel shall convene at a neutral site agreeable to both parties. If counsel cannot agree on a neutral site, they shall meet on the front steps of the Sam M. Gibbons U.S. Courthouse, 801 North Florida Ave., Tampa, Florida 33602. Each lawyer shall be entitled to be accompanied by one paralegal who shall act as an attendant and witness. At that time and location, counsel shall engage in one (1) game of “rock, paper, scissors.” The winner of this engagement shall be entitled to select the location for the 30(b)(6) deposition to be held somewhere in Hillsborough County during the period July 11-12, 2006. If either party disputes the outcome of this engagement, an appeal may be filed and a hearing will be held at 8:30 A.M. on Friday, July 7, 2006 before the undersigned in Courtroom 3, George C. Young United States Courthouse and Federal Building, 80 North Hughey Avenue, Orlando, Florida 32801.

DONE and ORDERED in Chambers, Orlando, Florida on June 6, 2006.

Copies furnished to: Counsel of Record

Unrepresented Party

iPot

†Parody of actual product: iCarta

Humpty Dumpty

Crisis Seen in Nation’s ER Care | WP | 6.15.06

Capacity, Expertise Are Found Lacking

Emergency medical care in the United States is on the verge of collapse, with the nation’s declining number of emergency rooms dangerously overcrowded and often unable to provide the expertise needed to treat seriously ill people in a safe and efficient manner.

That’s the grim conclusion of three reports released yesterday by the Institute of Medicine, the product of an extensive two-year look at emergency care.

Long waits for treatment are epidemic, the reports said, with ambulances sometimes idling for hours to unload patients. Once in the ER, patients sometimes wait up to two days to be admitted to a hospital bed.

As a system, U.S. emergency care lacks stability and the capacity to respond to large disasters or epidemics, according to the 25 experts who conducted the study. It provides care of variable and often unknown quality and depends on the willingness of doctors and hospitals to lose large amounts of money.

Fixing the problems is likely to cost billions of dollars and will require the leadership of a new federal agency, which Congress should create in the next two years, they wrote.

“This is a crisis that could jeopardize everyone in this room, and all their loved ones,” A. Brent Eastman, a surgeon and chief medical officer of the ScrippsHealth hospitals in San Diego, said at a daylong conference on the reports, which were prepared by the National Academy of Sciences’ Institute of Medicine.

…

From 1993 to 2003, the U.S. population grew by 12 percent but emergency room visits grew by 27 percent, from 90 million to 114 million. In that same period, however, 425 emergency departments closed, along with about 700 hospitals and nearly 200,000 beds.

…

Emergency Care for Children: Growing Pains | IOM | 6.14.06

This report, Emergency Care for Children, offers an analysis of:

• The role of pediatric emergency services as an integrated component of the overall health system.
• System-wide pediatric emergency care planning, preparedness, coordination, and funding.
• Pediatric training in professional education.
• Research in pediatric emergency care.

Hospital-Based Emergency Care: At the Breaking Point | IOM | 6.14.06

The wide range of issues covered in this report, Hospital-Based Emergency Care: At the Breaking Point, includes:

• The role and impact of the emergency department within the larger hospital and health care system.
• Patient flow and information technology.
• Workforce issues across multiple disciplines.
• Patient safety and the quality and efficiency of emergency care services.
• Basic, clinical, and health services research relevant to emergency care.
• Special challenges of emergency care in rural settings.

Emergency Medical Services At the Crossroads | IOM | 6.14.06

By addressing the strengths, limitations, and future challenges of EMS, this report, Emergency Medical Services At the Crossroads, draws upon a range of concerns:

• The evolving role of EMS as an integral component of the overall health care system.
• EMS system planning, preparedness, and coordination at the federal, state, and local levels.
• EMS funding and infrastructure investments.
• EMS workforce trends and professional education.
• EMS research priorities and funding.

Perhaps the just released IOM reports will have as a great an impact as their 2001 release: Crossing the Quality Chasm: A New Health System for the 21st Century, else we are left with our present emergency response system as a true Humpty Dumpty .

Humpty Dumpty sat on a wall.
Humpty Dumpty had a great fall.
All the king’s horses and all the king’s men
Couldn’t put Humpty together again.

Plastique Surgeon

†plastique

Rocket Launcher, Weapons Found At NorCal Home | CBS | 6.14.06

(CBS) CARMICHAEL A massive cache of weapons including a rocket launcher has been discovered at a Sacramento County home by sheriff’s deputies investigating a doctor accused of sexually exploiting a patient.

The surprise find came Tuesday night as officers from the Sacramento County sex crimes unit went to the home of 53-year-old Dr. Scott Takasugi on Empire Way in Carmichael. They were investigating a charge of sexual exploitation by a physician, specifically, penetration with a foreign object.

When officers went into the home they discovered 30 weapons including pistols, rifles, about 10,000 rounds of ammunition, and a rocket launcher.

…

Kaiser Permanente in Sacramento confirmed to CBS that Dr. Takasugi was a plastic surgeon employed by them but had not been at work for the last couple of weeks.…

Takasugi was arrested and booked into the Sacramento County Main Jail on one felony count of sexual exploitation by a physician, five felony counts of unauthorized sale, possession or transportation of a machine gun and two felony counts of possession of a destructive device.

…

Plastic surgeon arrested on sex, weapon charges | Sacramento Bee | 6.15.06

…

Dr. Scott Takasugi, known by neighbors for his lavish Halloween parties, dapper clothes and luxury car collection, was being investigated for sexual exploitation of patients when the cache was found.

Takasugi was arrested late Tuesday night at his home, and federal and military investigators worked until dawn assessing and hauling out weapons. Among them were a shoulder-fired battlefield weapon called a LAW rocket launcher along with machine guns, guns equipped with laser sights or silencers and thousands of rounds of ammunition, said Sacramento Sheriff’s Sgt. Judd Holiday.

…

Takasugi, 53, was arrested on 11 sex and weapon counts, including suspicion of sexual exploitation by a physician, penetration by a foreign object, unauthorized possession of a machine gun and possession of a destructive device, said Davis. His bail was set Wednesday at $2 million.

…

The living room had an indoor shooting range for .22-caliber weapons, and Halloween-themed decorations were scattered throughout the house, along with guns and ammunition in every room, Holiday said.

…

“He came home every day in a suit with a starched collar,” and waved to any neighbors he saw, said the elder Fountain, a retired state worker. “His hair was perfectly coiffed. He was very professional.”

…

In the garage of the doctor’s rambling brown brick-and-stucco house, officers said he has a Rolls-Royce, a Jaguar and a Porsche. A glossy black Mercedes was parked in the half-circle driveway Wednesday, with vanity plates: “1SIK RDE.”

…

Half Baked

hat tip GruntDoc, and from their website the following “good” copy:

Special offer for new AMA members | AMA | 6.14.06

Join today for 50% off your 2006 membership dues*

This special offer is available to 2006 non-members who were also not a member in 2005. Take this opportunity to join the AMA for a special 2006 ½ off dues rate offer.

When you join the AMA as a member, your efforts touch the lives of every patient in America. United with physicians from all states and specialties, you can affect nearly every aspect of health care today. Get involved in the nations’ largest physician-activist association.

The half-year dues offer is only valid May 10 through August 30, 2006. Join today!

Last updated: May 31, 2006
Content provided by: AMA Membership

Interesting that in both the web and print ads the “*”, as a reference, points to nothing.

Just to reiterate the incredible deal GruntDoc found: “50% off” for “half-year” dues. What an incredible bargain—and from the same folks that brought us the co-branding AMA-Sunbeam fiasco. Surely this is worthy of Jay Leno’s Headlines—hey GD you’ve got to mail the ad!

GD: [n]ot a member since 1998[; n]ot likely to be, at this rate. Yes, that was the year I canceled my membership as well.

Q: when is 50% not ½?

A: when the intent is half baked!

Yob Tones

A Ring Tone Meant to Fall on Deaf Ears | NYT | 6.12.06

In that old battle of the wills between young people and their keepers, the young have found a new weapon that could change the balance of power on the cellphone front: a ring tone that many adults cannot hear.

…

The technology, which relies on the fact that most adults gradually lose the ability to hear high-pitched sounds, was developed in Britain but has only recently spread to America - by Internet, of course.

…

The cellphone ring tone…was the offshoot of an invention called the Mosquito, developed last year by a Welsh security company to annoy teenagers and gratify adults, not the other way around.

It was marketed as an ultrasonic teenager repellent, an ear-splitting 17-kilohertz buzzer designed to help shopkeepers disperse young people loitering in front of their stores while leaving adults unaffected.

The principle behind it is a biological reality that hearing experts refer to as presbycusis, or aging ear. While Miss Musorofiti is not likely to have it, most adults over 40 or 50 seem to have some symptoms, scientists say.

While most human communication takes place in a frequency range between 200 and 8,000 hertz (a hertz being the scientific unit of frequency equal to one cycle per second), most adults’ ability to hear frequencies higher than that begins to deteriorate in early middle age.

…

British newspapers described the first use of the high-frequency ring tone last month in some schools in Wales, where Compound Security’s Mosquito device was introduced as a “yob-buster,” a reference to the hooligans it was meant to disperse.

…

For most of us, we live between a YOB and an ELF. Are ELF tones coming? BTW, I’ve been tested by one of my yobs and I’m pleased to report that I’m yob-certified…

Water Herding

If you have a Border Collie, you understand. Water herding is hard work, but it has to be done.

Walking in the Tall Grass

AHA Comment Letter on CMS Interim Report to Congress regarding DRA Provisions Affecting Specialty Hospitals (PDF) | AHA | 6.12.06

…

At a minimum, CMS should recommend that Congress enact increased transparency of physician investments and limitations on physician investment in limited-service hospitals if it is going to continue allowing physician-owned, limited-service hospitals to use the whole hospital exception under the Ethics in Patient Referrals Act. Such conditions should seek to diffuse or limit the connection between a physician’s financial interest in the hospital and his or her referral patterns as was originally intended. In doing so, the AHA suggests that CMS consider the following physician investment limitations, most of which are elements of the physician investment safe harbor under the federal anti-kickback
law.

• Aggregate investment interests by physicians should be limited to 40 percent.
• Individual investments by a physician in an entity should be limited to 3 percent.
• Investments must be bona fide investments (that is, the funds used to make the investment must not be loaned to the physician by the entity or another investor).
• The investment must be available to the general public on the same terms as made available to physicians.
• The amount of payment to a physician in return for their investment interest must be directly proportional to the amount of their capital investment.
• The terms of the investment must not require that the physician actually make or influence referrals to be made to the entity as a condition of remaining an investor.
• Physicians should be required to annually report their investment interests to HHS for posting on CMS’ Web site.
• Physicians should be required to disclose their investment interests to their patients when scheduling an admission at the facility in which they have a financial interest.

…

Every physician-owned, limited-service hospital that relies on the community’s emergency services capacity should be obligated to support it. Physician-owned, limited service hospitals should be required to have agreements with the community hospitals they plan to rely on in the event that they do not have the capacity to treat a particular patient.

Specifically, those agreements should be required to address:

• Procedures for an appropriate transfer from a limited-service hospital for patients not covered under EMTALA (e.g., an inpatient or outpatient whose condition develops into an emergency beyond the capability of the limited-service hospital and consequently needs to be transferred to a full-service hospital). It is not enough to dial 911.
• Continuity of care (e.g., telephone consultation with the receiving hospital and physician, sending the patient’s medical records along when transferred, etc.). Patients who suffer from complications at a limited-service hospital should never appear in a community hospital’s ED as they do now with no warning call, no medical history, no operative report, no information on the anesthesia used and, often, no ability to reach the treating surgeon for consultation.
• Support for maintaining full-time emergency capacity at the community hospital, including on-call coverage (e.g., physician-owned, limited-service hospital physicians serve in on-call panels at the community hospital, or the physician-owned, limited service hospital provides financial support to the community hospital to maintain on-call coverage).

Quid pro quo, if you (physicians) want to walk in the tall grass with the big dogs, then to receive the benefits of cream-skimming you need to share in the burden of the acute care hospitals.

Also see here.

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