There’s nothing I hate more than a sensational media circus surrounding a sensitive medical ethics issue — and that’s exactly what ensued when New Orleans police arrested a doctor and two nurses recently for allegedly euthanizing chronically ill patients during Hurricane Katrina.
Many of the patients left behind during the evacuation of New Orleans were elderly and in fragile health; they were stuck in hospitals for the wrong reasons. This tragic situation might have ended differently if Memorial Medical’s ICU had not been full of patients who should not have been there.
Unlike the deaths in New Orleans, the release of The Dartmouth Atlas Project’s “The Care of Patients with Severe Chronic Illness: A Report on the Medicare Program” generated very little media attention. Yet the report, released in May, provides potentially incendiary information about some of the most contentious issues in the US healthcare system: Medicare spending and the management of chronic illnesses and end-of-life care.
The Dartmouth Atlas Project analyzes health care costs across geographic areas by interpreting the information in gigantic healthcare information databases. It is an undertaking of the Center for Evaluative Clinical Sciences at Dartmouth Medical School, and is funded by grants from the foundations connected with some biggies in the world of health insurance: WellPoint, Aetna, and UnitedHealth Group. Which is an interesting fact to keep in mind while you digest the following information.
According to the report (pdf file), almost a third of Medicare expenditures for the treatment of the chronically ill is unnecessary. The report examined the medical records of some 5 million Medicare enrollees who died between 2000 and 2003 (and who had at least one chronic illness).
The study’s principal investigator, John E. Wennberg, M.D., M.P.H., says, “The majority of acute care hospitals are applying their standard forms of ‘rescue medicine’ to people who are in advanced stages of diseases that can’t be cured. Patients don’t benefit - they can’t be rescued - and the costs of such care are very high, both in dollars spent and in providing care that the majority of chronically ill patients might not want, such as admissions to intensive care and being sent to specialist after specialist.”
The Dartmouth Atlas study practically demands that doctors, hospitals, administrators, and health insurance providers rethink treatment strategies for people with chronic illnesses nearing the end of their lives. I can’t help but think that some of the tragic deaths in New Orleans could have been avoided had the patients in question not been in the hospital wasting taxpayer dollars in the first place.
And in related news, the embattled Tenet Healthcare is selling Memorial Medical and two other New Orleans-area hospitals to Ochsner Health System.
Comments
Morrissey Says:
September 13th, 2006 at 3:06 pm
How do you know those people weren’t sick? What an arrogant assumption. I can’t help but think that some of the tragic deaths in New Orleans could have been avoided if a competent government was in charge. The fact that you quote a Smiths song makes this post even more sickening.
Daysha Taylor Says:
November 12th, 2006 at 2:48 pm
It would be a wonderful utopia if the problems that plagued New Orleans could have simply been avoided by the placement of a “competent” government (Does that even exist?). Most people like to find one central organization to blame rather than grasp the complexity of the problem (and the forces that created stain on systems in the first place). While the social element associated with the news is indeed sickening, debating on whether terminal patients need a seperate care system from critical patients during times of disaster shouldn’t be discounted….even if its a heated subject. With the large increase in the number of emergency patients that flooded N.O. hospitals during the hurricane, how can you expect ER doctors to assign priority? How will a “competent” government be able plan allocated resources for disaster relief without identifing the ratio of critically ill vs. terminally ill patients?
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