Dan­gers could lurk in that burger,

Modern Healthcare - - NEWS -

Here at Out­liers, our sum­mer read­ing in­cludes cook­ing mag­a­zines, pop­u­lar fic­tion, the oc­ca­sional bi­og­ra­phy and epi­demi­o­log­i­cal re­ports. And it was with a stab of con­cern that we read in the CDC’s Mor­bid­ity and Mor­tal­ity Weekly Re­port of the 50-year-old man who was hos­pi­tal­ized af­ter a back­yard bar­beque.

He was dis­charged af­ter a la­paro­tomy to re­move the for­eign ob­ject seen by CT to be pro­trud­ing from his small in­tes­tine. The ob­ject “ap­peared to be a wire bris­tle from a grill-clean­ing brush,” ac­cord­ing to the weekly re­port.

Wire bris­tles were re­moved from five more pa­tients at the same hospi­tal sys­tem dur­ing the next 15 months. Three were ex­tracted af­ter be­com­ing stuck in the neck. Doc­tors per­formed emer­gency surgery on two pa­tients. All ate from a grill. The cases were pre­ceded by six oth­ers treated at the same health sys­tem in 2009 and 2010 who swal­lowed wire brush bris­tles.

Grillers, be­ware of the way­ward bris­tle. “Be­fore cook­ing, per­sons should ex­am­ine the grill sur­face care­fully for the pres­ence of bris­tles that might have dis­lodged from the grill brush and could em­bed in cooked food. Al­ter­na­tive res­i­den­tial grill-clean­ing meth­ods or prod­ucts might be con­sid­ered,” ac­cord­ing to the re­port.

So be bris­tle-aware, peo­ple! Out­liers doesn’t want your bar­be­cue to put any­one in the hospi­tal.

The case of the miss­ing heart

Imag­ine get­ting your de­ceased spouse’s body back from the hospi­tal, only to dis­cover his heart miss­ing.

And imag­ine get­ting con­clu­sive proof, eight years af­ter his burial, that the con­fis­cated or­gan was, in fact, sit­ting in a tub in a morgue locker at a dif­fer­ent hospi­tal af­ter you had won a $2 mil­lion fraud ver­dict against the hospi­tal where he died.

It’s no Edgar Allen Poe story. A July 12 ar­ti­cle by in­ves­tiga­tive news not-for-profit ProPublica re­ported that Linda Carswell re­cently got di­rect ev­i­dence that St. Joseph Med­i­cal Cen­ter in Hous­ton still has her hus­band’s heart in stor­age, years af­ter his au­topsy. The hospi­tal will not re­turn the heart, ac­cord­ing to the re­port. Carswell won a ver­dict against the hospi­tal where Jerry Carswell died, Chris­tus St. Cather­ine Hospi­tal in Katy, Texas, af­ter al­leg­ing fraud based on mis­han­dling of the au­topsy. Carswell lost on a sec­ond ac­cu­sa­tion of neg­li­gence. The hospi­tal is ap­peal­ing the case, but Texas this year passed a new in­formed-con­sent law for au­top­sies called the Jerry Carswell Memo­rial Act af­ter Linda Carswell lob­bied strongly for it, ProPublica wrote.

Mean­while, a dif­fer­ent hospi­tal still has the heart. A lawyer for St. Joseph Med­i­cal Cen­ter, whose pathol­o­gist con­ducted the au­topsy on Jerry Carswell, told the news out­let that while hospi­tal of­fi­cials un­der­stand they could be sued to turn over the or­gan, they still felt ob­li­gated to honor a judge’s or­der dur­ing Carswell’s neg­li­gence case to pre­serve ev­i­dence.

Se­na­tor ques­tions HRSA’s trop­i­cal trips

Who would have guessed that health pol­icy geeks could be an­gling for fun in the sun?

That was the con­clu­sion of one prom­i­nent con­gres­sional critic of waste­ful gov­ern­ment spend­ing when he re­viewed a re­cent Gov­ern­ment Ac­count­abil­ity Of­fice re­port on the Health Re­sources and Ser­vices Ad­min­is­tra­tion. The non­par­ti­san con­gres­sional in­ves­ti­ga­tor found HRSA did not con­sis­tently fol­low HHS reg­u­la­tions in its over­sight of Ryan White Com­pre­hen­sive AIDS Re­sources Emer­gency Act grantees. Specif­i­cally, the agency did not show it used a “risk-based strat­egy” for de­cid­ing which of its grantees would re­ceive so-called site vis­its.

That may be pretty dry pol­icy ma­te­rial to most peo­ple, but Sen. Tom Coburn (R-Okla.) smelled a trop­i­cal rat.

Coburn delved into GAO’s find­ings that 44% of grantees did not re­ceive a HRSA site visit from 2008 through 2011 while oth­ers re­ceived mul­ti­ple vis­its. The com­mon thread? Coburn con­cluded that a few trop­i­cal lo­ca­tions with lit­tle grant fund­ing were much more likely to get a HRSA visit than less ex­otic lo­ca­tions that re­ceived sig­nif­i­cant fund­ing. For in­stance, no agency of­fi­cial vis­ited grantees in nearby Mary­land, which re­ceived $40 mil­lion in Ryan White funds, while the Vir­gin Is­lands re­ceived six of­fi­cial vis­its in the same time­frame to mon­i­tor only $1 mil­lion in grants fund­ing. Puerto Rico re­ceived a more sub­stan­tial $31 mil­lion but also 12 HRSA vis­its.

HRSA in­sists the trips weren’t jun­kets. “They were work­ing site vis­its to grantees in need of help,” a HRSA spokesman says. “The grantees in both Puerto Rico and the Vir­gin Is­lands both had a long his­tory of sus­tained fis­cal and clin­i­cal chal­lenges that were life-threat­en­ing to pa­tients and had the po­ten­tial to in­crease in­ci­dence of HIV in those ju­ris­dic­tions.”

Coburn’s ad­vice: “HRSA should be set­ting travel pri­or­i­ties based on what’s best for pa­tients, not any other fac­tors.”


Who knows what dan­gers lurk in that burger? Be­ware the bris­tle!

Coburn is ques­tion­ing HRSA’s Caribbean trips.

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