Obama's address to the AMA

In the wake of President Obama’s remarks to the American Medical Association on Monday, it seems that everyone has an opinion about what should be done with the healthcare system in America.  Unfortunately, there is no consensus , even within the house of medicine.  The president was very clear about his intent, and very little of it surprised those in the audience.  The president led with a condemnation of the status quo, complete with touching stories of patients struggling with tragic circumstances, both medical and economic.  His arguments were the standards in the healthcare debate – providing medical care is too expensive, too complicated, and too poor in quality to continue.  He did stop short of blaming the current state of affairs entirely upon the physicians, perhaps in deference to the audience.

 

President Obama followed his indictment of the status quo with a description of elements of the reform package that he has long championed:  the electronic health record, comparative effectiveness research, dissolution of healthcare disparities, and universal coverage.  He assured the audience that anyone partaking of a private health insurance plan who was satisfied with that plan would be able to keep it.  However, as he stated long ago on the campaign trail, he supports a government-supported public plan, now called the Health Insurance Exchange.  The president believes that a public option would provide an alternative for Americans who currently cannot obtain affordable health insurance.  He also stated that the public plan would provide “healthy competition” for private insurers. 

 

There were two things that I noticed today that were a change from the president’s usual discourse on health system delivery.  First, he stated today that all Americans would be required to purchase health insurance of some kind.  In the past, especially during his campaign, he only espoused a requirement  for insurance for children.  Secondly, he stated that he is opposed to caps on damages recovered in malpractice litigation, but that he is “open to consideration of” any number of other methods to  appease physician concern over professional liability.  He said that he has drawn criticism from members of his party over his willingness to consider any changes to the tort system. 

 

No doubt the president is looking to trade vague, lukewarm promises to consider changes in the tort system for some Republican support of his health system reform plans.  Will it be enough?

Tap Water Medicine?

"Tap Water Healthcare" is a term coined by Dr. Arthur Kellerman, MD, FACEP, Professor and Associate Dean for Health Policy, Emory School of Medicine.  It is the concept of a basic health plan that is the equivalent of community tap water.  The goal of community water treatment plants is to provide safe drinking water for the entire community.  In recent years, many have decried the taste of mass purified water, the low standards for solutes, and the lack of easy portability.  For these reasons, many people prefer to purchase bottled water.  Some even prefer fancy bottled waters from "natural" springs, from foreign countries, or with special additives like flavor or bubbles.  

     As the debate over health care proceeds, is it possible to develop basic health coverage that resembles tap water - available, inexpensive, and safe?

Representative Cuellar Signs On HR 1188

Gordon Wheeler and I met with Representative Henry Cuellar (D-TX) this morning, and he agreed to become a co-sponsor of HR 1188.  Representative Cuellar is actively involved in the current healthcare reform efforts, and was very receptive to our comments about the importance of emergency medicine in the lives of all Americans.  Thank you, Representative Cuellar, for your support. 

Swine flu

The American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA) today issued a joint statement about the cases of swine flu in the United States and offered recommendations to the public about when to seek emergency care.

Saying the nation’s emergency departments are on the front lines of any public health emergency, the two organizations urged the public to apply the “prudent layperson standard” to any illness or injury: If the average prudent person would think you have the symptoms of a medical emergency, then you need to seek emergency care.

“Emergency physicians and nurses are specially trained to assess your symptoms and treat you, and if you have any doubts about your medical condition, we are there for you,” said Dr. Nick Jouriles, president of ACEP.  “While news reports about the swine flu may have raised alarm, remember there are still very few actual cases of the illness in the United States.  And if you have no symptoms, then you do not need to seek emergency care.  If you do not have a fever or cough, it is extremely unlikely that you have the swine flu.”

Emergency physicians and nurses in different parts of the country are seeing people who do not have symptoms, but are simply seeking information and reassurance that they are not ill, which both organizations say is understandable, given the widespread news coverage.  To help people understand this disease and get the information they need, the Centers for Disease Control and Prevention (CDC) is maintaining up-to-date web pages about the symptoms of swine flu and when to seek immediate medical care (www.cdc.gov/swineflu).

“If you have symptoms that would not ordinarily take you to the emergency department but are considering going because you are afraid you have swine flu, you probably do not need to go,” said Bill Briggs, RN, president of ENA.  “Remember that many illnesses – not just swine flu – are transmitted in public places and very often the best way to avoid the spread of disease is to stay home until your symptoms subside.”

In the current push for health care reform, policymakers must recognize the unique role that emergency physicians and emergency nurses play, especially in times of crisis.  Emergency departments are the nation’s safety net, a point driven home this week with the threat of pandemic swine flu filling ERs with patients fearing they are infected.  The safety net is under extraordinary stress in the best of times, never mind the worst.

“Even those ‘worried well’ who have primary care physicians are being directed to the emergency department because of our specialized expertise,” said Dr. Jouriles.  “We stand on the front lines of any disaster and when all other doors are closed, our doors are always open.  That is why true health care reform must strengthen America’s health care safety net – emergency departments.’

ACEP is a national medical specialty society representing emergency medicine with more than 27,000 members. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. 

ENA is the only professional nursing association dedicated to defining the future of emergency nursing and emergency care through advocacy, expertise, innovation and leadership.  Founded in 1970, ENA serves as the voice of 37,000 members and their patients through research, publications, professional development, injury prevention and patient education.  Additional information is available at ENA’s website www.ena.org.

Swine Flu Outbreak

The United States has seven confirmed cases of Swine Influenza A/H1N1, five in California and two in Texas, and nine suspect cases.  All of the seven confirmed cases had mild Influenza-Like Illness (ILI).  No deaths have been reported. 

 

Mexico reports three separate event locations – Mexicali, San Luis Potosi, and the Federal District of Mexico.  The government of Mexico began surveillance of ILI March 18, 2009.  Since then, 854 cases of pneumonia have been reported in Mexico City, with 59 deaths.  San Luis Potosi, in central Mexico, reports 24 cases of ILI, with three deaths.  Mexicali, near the border with the United States, has had four cases of ILI, with no deaths.  The majority of these cases have been in healthy young adults.

 

Of the Mexican cases, 18 are confirmed Swine Influenza A/H1N1.  Twelve of the 18 are identical to the Swine Influenza A/H1N1 viruses isolated from the patients with confirmed cases in California.  Swine flu viruses do not normally infect humans.  However, sporadic human infections have occurred in persons with direct exposure to pigs and in health care workers caring for persons with swine flu.  The Centers for Disease Control and Prevention (CDC) report 12 cases of human infection with swine flu between December 2005 and February 2009. 

 

The Swine Influenza A/H1N1 viruses isolated in this outbreak appear to be a strain not previously detected in pigs or humans, although these reports are preliminary.  Because there is reported spread of an animal virus in humans, and because of the geographical spread of multiple community outbreaks, these events are of concern, and the CDC is working to further characterize the viruses and provide guidance for treatment and prevention.

 

The symptoms of swine flu in humans are expected to be similar to the symptoms of seasonal human influenza, and include fever, malaise, lack of appetite, and coughing.  Some patients with the swine flu have reported runny nose, sore throat, nausea, vomiting, and diarrhea.  The H1N1 swine flu viruses are antigenically different from human H1N1 viruses, and vaccines for the human seasonal flu are not expected to provide protection from the swine flu viruses. 

 

To diagnose swine influenza A infection, a respiratory specimen must be collected and sent to the CDC for testing.  The specimen must be collected in the first 3-4 days of the illness, when the virus is shedding.  Testing may require an additional 3-4 days.  The CDC has not yet made recommendations for treating patients with an antiviral medication while the testing is pending, although these recommendations are expected later today. 

 

There are four different antiviral medications available for use in the United States for influenza:  amantadine, rimantadine, oseltamivir and zanamivir.  The most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine.  At this time, the CDC recommends the use of oseltamivir or zanamivir for the treatment of infection with swine influenza viruses. 

 

The outbreak of “swine flu” in North America is a growing cause of concern in the World Health Organization (WHO) and in scientists worldwide concerned with pandemic prevention.  Recent improvements in pandemic preparedness may be tested by this emerging threat.   

 

 

 

Gardner's Gate: HAPPY 100TH EPISODE!

Gardner's Gate: HAPPY 100TH EPISODE!

HAPPY 100TH EPISODE!

This is my 100^th blog for the American College of Emergency Physicians.  For television shows, the 100^th episode is a cause for celebration.  One hundred broadcast episodes means that the show is a success for everyone involved, the producers, the sponsors, the actors, AND the writers. 

 

I began this “blogging” project in November of 2006, as the first official “blogger” for the American College of Emergency Physicians.  It was my idea that the leadership of the college should investigate ways to reach out to younger physicians using newer technologies and communication media.  Having a blog seemed so hip, so young, so whatever-the-word-of-the-moment is.

 

It has been a learning experience.  I learned how to host a blog.  I learned to write without an editor.  I learned that writing without an editor means everyone feels entitled to offer advice on your writing, both style and substance.  I learned that the harshest critics did not want to criticize me in the “comment” section, where others could see, but wished to make their views known via email.  I learned that being a blogger for an organization means that everyone has your email address.

 

I learned that producing three to five hundred coherent, intelligent-sounding words that will live in cyberspace forever on a consistent basis is a challenge not unlike rearing children - tedious, relentless, and unimaginably joyful.

 

I learned the distinct joy of trying on, trying out, and wearing out new technologies.  I have “pages” on every social network imaginable. I facebook, myspace, pulse/plaxo, link-in and now, I tweet on twitter.  (Writing without an editor also allows me to create brand-spanking-new verbs.)  I have thousands of friends-of-friends.  I actually believe that epidemiologists could learn a thing or two about communicable diseases from observing the spread of information through social networking devices.  I have even appeared on youtube more than once, and more than Mom watched it........or else Mom spent most of the last few months clicking and reclicking.

 

So, to my several hundred loyal readers, my occasional readers, and even my first-time readers, I say thank you.  Thank you for the chance to learn, to grow, to express myself, and to be a part of something much, much larger than myself.  Thank you for allowing me just another mature adult trying to stay connected to a rapidly changing world.  Most of all, thank you for birthing the inevitable result of 100 hundred successful episodes.......a spin-off!

 

ACEP now has bloggers from all walks of the (emergency physician) profession expressing themselves on The Central Line.  Check it out now at thecentralline.org.

 

.....and stay tuned for next season’s premiere.

 

 

 

Disclaimer:  Because I do believe in telling the truth, I have to admit that The Central Line is not my project.  It was lovingly crafted by very skillful ACEP staffers, and is written by a host of VERY talented emergency medicine professionals.  They are allowing me to link to the site and to claim credit for the idea because THIS IS MY BLOG AND THEY CAN’T STOP ME!  Seriously, they are allowing me to post to The Central Line during the debut at the Legislative and Advocacy Conference in Washington D.C. this week.  Check it out......and thanks for stopping by.     

Health Reform must include emergency medicine

ACEP members will demand that emergency medicine be addressed during health care reform.

Nearly 400 emergency physicians from across the country will be converging on the nation's capital April 19-22 to advocate for greater patient access to lifesaving emergency medical treatment. As part of their visit, these medical specialty leaders will meet with key policy and lawmakers on Capitol Hill to educate them about the nation's emergency care crisis, which was recently documented in ACEP's National Report Card on the State of Emergency Care.  The report, issued in December, assigned the nation an overall grade of C- for its support of emergency care and a D- in access to emergency care. 

Emergency physicians will urge their elected officials to hold hearings on and enact the Access to Emergency Medical Services Act (H.R. 1188 and S. 468), a bill that outlines measures to strengthen access to emergency care for patients. The meetings are part of the 2009 Leadership and Advocacy Conference of the American College of Emergency Physicians (ACEP), a key component of which is to urge members of Congress and the administration to include an array of critical emergency care issues in the discussions of health care reforms.

Invited conference speakers include former Clinton Administration senior health care advisor Chris Jennings, Rep. Pete Stark (D-Calif.), political pundit Charlie Cook, executive director of Families USA Ron Pollack and executive vice president for government affairs of the U.S. Chamber of Commerce R. Bruce Josten (final confirmations pending)

Obama Creates Office of Health Reform

Yesterday President Obama established the White House Office of Health Reform. Obama signed an executive order formally creating the new office and assigning the task of expanding and improving health coverage in America.

In March, Obama named former Clinton administration official Nancy-Ann DeParle to oversee the office. DeParle will have wide latitude in establishing a team to accomplish Obama's goals, and unlike cabinet secretaries, she will not answer to Congress.  Ms. DeParle's duties include working with Congressional leaders to enact health reform legislation, coordinating relevant activities with all executive branch agencies,  establishing working relationships with state and local officials, and eventually, supervising the implementation of health policy changes. 

EXECUTIVE ORDER:

ESTABLISHMENT OF THE WHITE HOUSE OFFICE OF HEALTH REFORM

By the authority vested in me as President by the Constitution and the laws of the United States of America, and in the interest of providing all Americans access to affordable and high-quality health care, it is hereby ordered as follows: 

Section 1. Policy. 

Reforming the health care system is a key goal of my Administration. The health care system suffers from serious and pervasive problems; access to health care is constrained by high and rising costs; and the quality of care is not consistent and must be improved, in order to improve the health of our citizens and our economic security. 

Sec. 2. Establishment. 

(a) There is established a White House Office of Health Reform (Health Reform Office) within the Executive Office of the President that will provide leadership to the executive branch in establishing policies, priorities, and objectives for the Federal Government's comprehensive effort to improve access to health care, the quality of such care, and the sustainability of the health care system. 

(b) The Secretary of Health and Human Services, to the extent permitted by law, shall establish within the Department of Health and Human Services (HHS) an Office of Health Reform, which shall coordinate closely with the White House Office of Health Reform. 

Sec. 3. Functions. The principal functions of the Health Reform Office, to the extent permitted by law, are to: 

(a) provide leadership for and to coordinate the development of the Administration's policy agenda across executive departments and agencies concerning the provision of high-quality, affordable, and accessible health care and to slow the growth of health costs; this shall include coordinating policy development with the Domestic Policy Council, National Economic Council, Council of Economic Advisers, Office of Management and Budget, HHS, Office of Personnel Management, and such other executive departments and agencies as the Director of the Health Reform Office may deem appropriate; 

(b) work with executive departments and agencies to ensure that Federal Government policy decisions and programs are consistent with the President's stated goals with respect to health reform; 

(c) integrate the President's policy agenda concerning health reform across the Federal Government; 

(d) coordinate public outreach activities conducted by executive departments and agencies designed to gather input from the public, from demonstration and pilot projects, and from public-private partnerships on the problems and priorities for policy measures designed to meet the President's goals for improvement of the health care system; 

(e) bring to the President's attention concerns, ideas, and policy options for strengthening, increasing the efficiency, and improving the quality of the health care system; 

(f) work with State, local, and community policymakers and public officials to expand coverage, improve quality and efficiency, and slow the growth of health costs; 

(g) develop and implement strategic initiatives under the President's agenda to strengthen the public agencies and private organizations that can improve the performance of the health care system; 

(h) work with the Congress and executive departments and agencies to eliminate unnecessary legislative, regulatory, and other bureaucratic barriers that impede effective delivery of efficient and high-quality health care; 

(i) monitor implementation of the President's agenda on health reform; and 

(j) help ensure that policymakers across the executive branch work toward the President's health care agenda.(h) work with the Congress and executive departments and agencies to eliminate unnecessary legislative, regulatory, and other bureaucratic barriers that impede effective delivery of efficient and high-quality health care; 

(i) monitor implementation of the President's agenda on health reform; and 

(j) help ensure that policymakers across the executive branch work toward the President's health care agenda. 

Sec. 4. Administration.

 (a) The Health Reform Office may work with established or ad hoc committees, task forces, or interagency groups. 

(b) The Health Reform Office shall have a staff headed by the Director of the Health Reform Office (Director). The Health Reform Office shall have such staff and other assistance as may be necessary to carry out the provisions of this order. 

(c) As requested by the Director, each executive department and agency shall designate a liaison to work with the Health Reform Office on improving access to health care, the quality of health care, and the sustainability of the health care system. 

(d) All executive departments and agencies shall cooperate with the Health Reform Office and provide such information, support, and assistance to the Health Reform Office as it may request, to the extent permitted by law. 

Sec. 5. General Provisions.

 (a) Nothing in this order shall be construed to impair or otherwise affect: 

(i) authority granted by law to a department, agency, or the head thereof; or 

(ii) functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

 (b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations. 

(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity, by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person. 

BARACK OBAMA 
THE WHITE HOUSE, 
April 8, 2009. 

Thank You Tennessee!

Thank you to the Tennessee College of Emergency Physicians for inviting me to speak and hosting me at their annual meeting in Chattanooga, Tennessee.  My special thanks to my dear friend Sandy Herman, who organized the excellent program, and was generous enough to include me.  I gave an update on health care reform, and in a separate lecture provided a review of the latest literature affecting wilderness medicine.  My favorite part of the meeting, though, was participating in a luncheon panel discussion with Greg Henry, Todd Taylor, and David Seaberg, moderated (refereed?) by Sandy Herman.  None of are shy, and the ensuing debate was lively.  (....and just for the record, Greg, you ARE wrong.)

 

I also would like to express my appreciation to David and Carol Seaberg, who invited me into their home, treated me to wonderful food and great company, and took me to Rock City.   The Seaberg’s sons, Ryan and Tyler, showed me the secrets of the boulders atop Lookout Mountain with all the energy and enthusiasm that teenage boys have.  Who could resist the dare to follow a narrow path, appropriately named “Fat Man’s Squeeze,” between two giant boulders on the way up the mountain?  I stood near the top of that mountain, in front of a green waterfall, and saw seven states.  It doesn’t get any better than that.

 

I spoke with representatives of the Tennessee Emergency Management Agency, who expressed dismay that Tennessee ranked 51^st in disaster preparedness in the recently released National Report Card on the State of Emergency Medicine.  They presented the Tennessee disaster preparedness program to the group, vigorously defending their preparedness and their integration with physicians and hospitals.  My defense of the Report Card is based on the methodology.  Tennessee received the ranking based on the metrics chosen by a group of emergency medicine experts, and based on the data available at the time from public sources.  Their presentation revealed a disaster plan that appears cohesive and well-considered, and does have some physician involvement.  If nothing else, the controversy caused by the Report Card led to a better dialogue and a better working relationship between TEMA and the emergency physicians of Tennessee.  If the result is better disaster planning, then the Report Card has served its purpose.

 

Again, I thank the Board of the Tennessee College of Emergency Physicians, their president, Dr. Kenneth Holbert, and my many old friends from Tennessee – John Proctor, Bob Roth, Sandy Herman, Harry Severans, Jim Creel, David Seaberg, and too many others to name – for a wonderful experience.  Tennessee Rocks!

 

 

 

  

 

White House Report on Health Reform

Today the White House issued the Forum on Health Reform Report.  It is a summary of the events of March 5, 2009, and includes the remarks of President Obama, the findings of the “breakout sessions,” and a transcript of the Town Hall session.  I won’t repeat the report here.  All 54 pages are available at www.whitehouse.gov/assets/documents/White_House_Forum_on_Health_Reform_Report.  His attendees included representatives from Congress, physician groups, the insurance industry, the hospital industry, and the private/business sector. I do applaud the president on a carefully orchestrated public display of unity on a topic that is inherently divisive.  

 

Several common themes appear in the text of the breakout sessions.  The participants stressed the need for:

 

Access

Quality

Fair Payment/Reimbursement

 

Incidentally, those are three of the Priority Objectives for 2008-2009 for the American College of Emergency Physicians.

 

Not among ACEP Priority Objectives, but also stressed by participants in President Obama’s were:

 

Cost control

Expanded (insurance) coverage

Prevention of illness/Promotion of health

 

Each group expressed urgency in the need for reform to the delivery system for health care in this country.

 

I witnessed the press event on March 5, 2009, and I read the report eagerly.  Both times I found something missing:  EMERGENCY MEDICINE.  One hundred and nineteen MILLION patients seek emergency care every year in this country, and the only words spoken about emergency medicine were these, “Now, keep in mind, we’re already paying for those folks. Every single person at home, the average family

is paying $900 per family in additional premiums because of the care that people are receiving in emergency rooms. So we’re paying for it, but it’s oftentimes hidden.”

 

Mr. President, if you’re paying for it, I’d like to know where the money is going.  One of the problems in emergency medicine is the fact that emergency physicians are required by EMTALA to provide care for all who present with an emergency condition, without regard for payment.  Emergency physicians are not paid for that care forty percent of the time.  I dare you to name another specialty that donates forty percent of their income to charity care. 

 

I do not care to come across as another doctor whining about not making enough money.  I love my specialty, I love the practice of medicine, and I would rather spend seven night shifts in an row in an emergency department than spend one day as ......[fill in any specialty here.]  However, if we are to have health reform in America, some unpleasant truths must be told.  One of those unpleasant truths is that the system for delivery of emergency care is strained to the breaking point.  If meaningful discussion of reform is to be had, emergency physicians must be included.   The U.S. population was 263 million at the last census, and 119 million people seek emergency care each year.  You do the math.....

 

 

 

A Day at NASA

I had the pleasure of spending a day at NASA this week.   I met Dr. Joseph P. Kerwin, M.D. (Captain, MC, USN, Ret.), the first physician astronaut to serve with the National Aeronautics and Space Administration.  Dr. Kerwin has had a long and varied career.  He logged 4500 hours flight time as flight surgeon before being selected by NASA in 1965.  He served as science-pilot for the Skylab 2 (SL-2) mission, and subsequently managed the on-orbit branch of the Astronaut Office, where he coordinated astronaut activity involving rendezvous, satellite deployment and retrieval, and other Shuttle payload operations.  He later served as Director of Space and Life Sciences at the Johnson Space Center, Houston.  In that capacity he was responsible for direction and coordination of medical support to operational manned spacecraft programs, including health care and maintenance of the astronauts and their families; for direction of life services, and for managing Johnson Space Center earth sciences research, light experimentation projects, and scientific efforts in lunar and planetary research. 

 

We compared notes on our respective fields, and on the progress that has been made in medicine in the past 50 years.  Dr. Kerwin told me, “The only difference between your specialty and mine is that I made house calls.”  I guess that’s true, but I think most people would consider a house call thousands of miles away in space an adventure.  Dr. Kerwin is the co-author of “Homesteading Space:  The Skylab Story,” a compelling tale of the Skylab from the near-disastrous launch to the descent into the Indian Ocean. 

 

I had the opportunity to tour the historic Mission Control, and I admit to developing a lump in my throat at the thought of the teams who labored tirelessly and risked their personal safety to send human beings into space.  Every mission was an exercise in learning......learning the tasks necessary to live in a weightless environment, learning the mechanical skills to manage spacecraft, learning the nuances of flight.    In the early days of the space program every person had a singular focus – get a man on the moon.  Today NASA has a new program known as Constellation.  The Constellation Program is focused on carrying a new generation of explorers to the moon, and then to Mars. 

 

In these troubled days of challenges in healthcare, economic depression and worldwide warfare, there is a bright spot in the form of Orion, NASA’s first Constellation Program vehicle.  Orion is a reminder that whatever the challenges, the human spirit will continue to seek knowledge and understanding beyond what is currently known.   

 

Thank you, Joe. 

Too big to fail: the malpractice industry?

“I will pursue tort reform in America until every state enjoys the same success as Texas,”  announced Texas Governor Rick Perry to a group of physicians gathered in Washington D.C.  In a speech eerily reminiscent of another Texas governor, Perry detailed the successes of the tort reform movement in Texas, stating, “We need tort reform, and we need it now!”  Unsurprisingly, the group of physicians gathered for the American Medical Association’s National Advocacy Conference greeted the remarks with a standing ovation. 

 

Since the passage of Proposition 12 in September 2003, Texas has transformed from one of America’s “judicial hell-holes” into the land-of-milk-and-honey for physicians.  Neurosurgeons, obstetricians, and emergency physicians flocked to the state, seeking shelter from the litigation wars in Florida, Ohio, and Mississippi.  Malpractice insurance rates have declined by 23% overall.  There is a 2,300 case backlog for the Texas State Board of Medical Examiners, struggling to provide licensure for the litigation refugees of other states.  Seventy-two counties in sparsely populated west Texas boast physicians where there were none 5 years ago. 

 

As the debate for health care reform heats up in Washington D.C., the focus is appropriately on accessible, affordable, high-quality medical care.  Policy-makers struggle to find an economic model that will pay for the kind of care that Americans want and deserve.  Physicians make up a very small percentage of those serving as elected officials in Washington.  Perhaps that explains why lawmakers, who overwhelmingly come from another line of work, fail to see the blunt truth that is right in front of them.

 

Americans could provide the highest quality medical care to everyone in the country, conveniently and affordably, by eliminating defensive medicine. 

 

Of course, the economic cost would be borne by those involved in the litigation industry, which includes far more people than the the much maligned plaintiff attorneys.  Also securing monetary gain from the pursuit of malpractice litigation are defense attorneys, malpractice insurance companies, professional (I mean, expert) witnesses, arbitrators of all types, professional and paraprofessional case reviewers, settlement structure analysts, actuarials , courthouse personnel, and purveyors of advertising.  In fact, perhaps tort reform is not a part of health care reform discussions because the entire malpractice industry is too big to fail?

Congratulations, Dr. Jeff Runge

I am in Washington D.C. this week participating in the discussions about health care reform.  Last night I had the honor of being invited to participate in honoring one of emergency medicine’s own, Dr. Jeff Runge.  

 

Dr. Jeffrey W. Runge, MD, FACEP, received the Dr. Nathan Davis Award for Outstanding Government Service in a ceremony last evening.  Dr. Runge practiced emergency medicine for 25 years, and was assistant chairman of the Department of Emergency Medicine at the Carolinas Medical Center in Charlotte, North Carolina when President Bush appointed him administrator of the National Highway Safety Administration.  While there he implemented a combination of legislative and law enforcement initiatives, including the “Click It or Ticket” program.  Dr. Runge went on to serve as chief medical officer within the Department of Homeland Security (DHS), working as an advisor on medical and bioterrorism issues.  While there Dr. Runge founded the Office of Health Affairs, providing oversight of the Department’s biodefense and medical readiness programs.  Dr. Runge now acts as a consultant in the areas of disaster medicine, bioterrorism defense and homeland security technology.  

A Message from Dr. Nicholas Jouriles, ACEP's President

It is imperative that Congress and the Obama Administration address the escalating crisis in our nation’s emergency departments.  Every American expects emergency departments to provide expert medical care when they need it.  Emergency departments are a vital part of every community - caring for critically ill or injured patients, as well as victims of epidemics, natural disasters and acts of terrorism.  Emergency physicians also care for people who have nowhere else to turn and often are the only source of medical care available at night, on weekends and on holidays.

The consequences of our nation’s economic turmoil and mounting job losses can be seen every day in emergency departments across the country, where the newly uninsured increasingly are turning for care.  Emergency departments are the health care safety net for everyone, insured and uninsured alike, and their role in America’s health care system has never been more critical.

As Congress tackles health care reform this year, it must not ignore the issues raised in the American College of Emergency Physicians’ National Report Card on the State of Emergency Medicine, which gave the nation a near-failing D- in the category of access to emergency care.

Recognizing the important role of emergency medicine and trauma care in this country and acknowledging the critical problems patients face when these services are not readily available, the "Access to Emergency Medical Services Act" was introduced in February 2009 by Reps. Bart Gordon (D-TN) and Pete Sessions (R-TX) in the U.S. House of Representatives (H.R. 1188), and Sens. Debbie Stabenow (D-MI) and Sen. Arlen Specter (R-PA) in the U.S. Senate (S. 468).