Hillary and Her Cough

Updated:  Well, she faints, coughs, spazzes out, can't recall, gets tired, falls and hits her head ... I have a vague memory of Democrats attacking Reagan because he was too old and couldn't remember ....  She can't for sure.  The video of her being pushed into the van, watch her feet.  She isn't even acting under her own volition, they lifted and shoved her into the van.  It's all ok though right.  Her incessant cough that has plagued her almost every single time she opens her mouth, her famous video of a spaz attack, which those defending her said was her reaction to being caught unaware ... ha.  Lie.

Look at the video from 9/11 ... the same spaz attack just prior to being dumped into the van.  

We deserve A LOT more information, by doctors she doesn't know or control.  She needs to be evaluated.  She can't remember things.  She faints, she falls, she trips, she stumbles ... and she does all that in the same week.  THAT is A LOT.  

How does it feel to work for someone who is medically impaired and should not by reason of medical issues be a serious contender ... that she may not last 4 years yet you all foisted her ... do you ever wonder about that? 

Can we just stop talking about Hillary Clinton’s health now?

 Can't we, please!  I would ask that if I was Chris or anyone at WP or for that matter ... pretty much any news outlet.

I remember, and I went back and looked, more than 47 stories about McCain and his age, more than 93 stories about the cancerous spot on his nose, 13 stories about his age ... 

I have listened to, watched, or read articles or stories about - Reagan, Bush, Clinton, Bush, Obama ... Biden, Gore, Cheney ... and never have I witnessed anyone cough or hack away as much as Hillary.

Now the author of the WP article above goes on to say - "if suffering an occasional coughing fit" ... OCCASIONAL?  I remember watching dozens of Bill's speeches or lectures, however we define them ... he never went into a coughing fit and only a couple times went for water.  Bush never had a coughing fit.  Biden never has.  Obama never has.  So, whats with the OCCASIONAL ... apparently its not all that occasional.  The WP author continues - " ... is evidence of a major health problem, then 75% of the country must have that mystery illness."

 Ha ha.  Use faulty logic to divert the attention  and dismiss the issue.  After all, who hasn't once or twice had a coughing fit.  Few people would ever say they haven't, yet Hillary isn't asking to be the head chef at Nabu.  She isn't asking to be selected as America's Best Talent ... she wants a job that ... well, that we have a right to delve deeply into any of her issues we feel important, and NO, she isn't have an occasional ... it is nearly everytime she breaks down hacking.  And hacking is different than a simple cough.  

 

She hacks and wheezes and coughs, and sputters away.  We have a right to know.  And Tim Caine - we have a need to know everything in his life and closet, because Hillary is seemingly one of the least fit people running for office, and Caine is a heartbeat away.

 

Oh but her doctor gave her an all clear - really, remember with the Clintons - the meaning of is!

We need to ask her doctor very narrowly focused questions.  Very specific.  Not broad and general.  Broad and general allow FAR TOO MUCH wiggle room and for the Clinton's - that wiggle room is the world they inhabit!

Obamacare: Running Out of Doctors?

Burning Question

Is America running out of doctors?

ObamaCare is set to expand the number of insured Americans, but an apparent shortage of doctors could make it difficult to treat them all

Published July 31, 2012, at 7:54 AM

The primary objective of President Obama's overhaul of the health-care system is to extend coverage to the tens of millions of Americans currently without insurance. "But coverage will not necessarily translate into care," because there may not be enough doctors to treat everyone, say Annie Lowrey and Robert Pear at The New York Times. The U.S. is already facing a severe shortage of doctors, particularly in rural areas of the country, and the problem is only expected to get worse as more Americans gain insurance. Here, a guide to America's dearth of doctors:

Why aren't there enough doctors?
The pool of new doctors hasn't kept pace with several factors boosting the number of people seeking care: Population growth, the ObamaCare expansion, and an aging Baby Boomer generation that requires additional medical attention. Enrollment in Medicare, the government-run insurance program for the elderly, is expected to swell to 73.2 million in 2025, up from 50.7 million in 2012. Furthermore, the U.S. is facing an acute shortage of primary-care physicians, leaving many patients without access to general practitioners, pediatricians, family doctors, and other providers of basic medical care.

How will the shortage affect patients?
"A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients," say Suzanne Sataline and Shirley S. Wang at The Wall Street Journal. The shortage will likely most affect those on Medicaid, the insurance program for the poor and disabled, since Medicaid's rolls are expected to expand significantly under ObamaCare. The shortfall of doctors could reach 100,000 by 2025. (There are currently about 1 million doctors in America.)

Why do so few doctors choose to go into primary care?
The main reason is money. Medical school graduates can expect to make an average of $3.5 million more over the course of their careers if they choose to enter a specialized field, such as anesthesiology or radiology. The difference in pay is enough that primary-care physicians carry a stigma within the medical community of being less talented and intelligent. The trend has huge implications for ObamaCare: "It is no exaggeration to say that the success of the health-care law rests on young doctors choosing to do something that is not in their economic self-interest," says Sarah Kliff at The Washington Post.

What can we do about it?
ObamaCare contains modest provisions increasing Medicaid primary-care payments and incentives for medical students to become primary-care physicians. The number of primary-care residencies climbed 20 percent between 2009 and 2011, but it's still not enough. Communities have been encouraged to create more walk-in clinics, and to allow more nurses to provide primary care. In addition, the U.S. could alter its immigration policies to attract doctors from overseas, "which should be very easy to do since doctors in the U.S. earn on average about twice as much as their comparably trained counterparts in Western Europe and Canada," says Dean Baker at Business Insider.

Sources: Business Insider, The New York Times, The Wall Street Journal, The Washington Post

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Obamacare: Running Out of Doctors Before We Begin

The New York Times

July 28, 2012

DoctorShortage Likely to Worsen With Health Law

By ANNIE LOWREY and ROBERT PEAR

RIVERSIDE, Calif. — In the Inland Empire, an economically depressed region in Southern California, President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now.

Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems. The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.

Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.

“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region’s doctor shortage. “We’ll have a 5,000-physician shortage in 10 years, no matter what anybody does.”

Experts describe a doctor shortage as an “invisible problem.” Patients still get care, but the process is often slow and difficult. In Riverside, it has left residents driving long distances to doctors, languishing on waiting lists, overusing emergency rooms and even forgoing care.

“It results in delayed care and higher levels of acuity,” said Dustin Corcoran, the chief executive of the California Medical Association, which represents 35,000 physicians. People “access the health care system through the emergency department, rather than establishing a relationship with a primary care physician who might keep them from getting sicker.”

In the Inland Empire, encompassing the counties of Riverside and San Bernardino, the shortage of doctors is already severe. The population of Riverside County swelled 42 percent in the 2000s, gaining more than 644,000 people. It has continued to grow despite the collapse of one of the country’s biggest property bubbles and a jobless rate of 11.8 percent in the Riverside-San Bernardino-Ontario metro area.

But the growth in the number of physicians has lagged, in no small part because the area has trouble attracting doctors, who might make more money and prefer living in nearby Orange County or Los Angeles.

A government council has recommended that a given region have 60 to 80 primary care doctors per 100,000 residents, and 85 to 105 specialists. The Inland Empire has about 40 primary care doctors and 70 specialists per 100,000 residents — the worst shortage in California, in both cases.

Moreover, across the country, fewer than half of primary care clinicians were accepting new Medicaid patients as of 2008, making it hard for the poor to find care even when they are eligible for Medicaid. The expansion of Medicaid accounts for more than one-third of the overall growth in coverage in President Obama’s health care law.

Providers say they are bracing for the surge of the newly insured into an already strained system.

Temetry Lindsey, the chief executive of Inland Behavioral & Health Services, which provides medical care to about 12,000 area residents, many of them low income, said she was speeding patient-processing systems, packing doctors’ schedules tighter and seeking to hire more physicians.

“We know we are going to be overrun at some point,” Ms. Lindsey said, estimating that the clinics would see new demand from 10,000 to 25,000 residents by 2014. She added that hiring new doctors had proved a struggle, in part because of the “stigma” of working in this part of California.

Across the country, a factor increasing demand, along with expansion of coverage in the law and simple population growth, is the aging of the baby boom generation. Medicare officials predict that enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year.

“Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the Association of American Medical Colleges. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”

The pool of doctors has not kept pace, and will not, health experts said. Medical school enrollment is increasing, but not as fast as the population. The number of training positions for medical school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement.

Physician compensation is also an issue. The proportion of medical students choosing to enter primary care has declined in the past 15 years, as average earnings for primary care doctors and specialists, like orthopedic surgeons and radiologists, have diverged. A study by the Medical Group Management Association found that in 2010, primary care doctors made about $200,000 a year. Specialists often made twice as much.

The Obama administration has sought to ease the shortage. The health care law increases Medicaid’s primary care payment rates in 2013 and 2014. It also includes money to train new primary care doctors, reward them for working in underserved communities and strengthen community health centers.

But the provisions within the law are expected to increase the number of primary care doctors by perhaps 3,000 in the coming decade. Communities around the country need about 45,000.

Many health experts in California said that while they welcomed the expansion of coverage, they expected that the state simply would not be ready for the new demand. “It’s going to be necessary to use the resources that we have smarter” in light of the doctor shortages, said Dr. Mark D. Smith, who heads the California HealthCare Foundation, a nonprofit group.

Dr. Smith said building more walk-in clinics, allowing nurses to provide more care and encouraging doctors to work in teams would all be part of the answer. Mr. Corcoran of the California Medical Association also said the state would need to stop cutting Medicaid payment rates; instead, it needed to increase them to make seeing those patients economically feasible for doctors.

More doctors might be part of the answer as well. The U.C. Riverside medical school is hoping to enroll its first students in August 2013, and is planning a number of policies to encourage its graduates to stay in the area and practice primary care.

But Dr. Olds said changing how doctors provided care would be more important than minting new doctors. “I’m only adding 22 new students to this equation,” he said. “That’s not enough to put a dent in a 5,000-doctor shortage.”

Annie Lowrey reported from Riverside, and Robert Pear from Washington.

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Obamacare: Prescription Rationing

It has begun already, but more details will become available more readily in greater numbers as the countdown to a cataclysmic failure begins.

Rationing Begins: States Limiting Drug Prescriptions for Medicaid Patients

By Melanie Hunter

July 30, 2012

(CNSNews.com) – Sixteen states have set a limit on the number of prescription drugs they will cover for Medicaid patients, according to Kaiser Health News.

Seven of those states, according to Kaiser Health News, have enacted or tightened those limits in just the last two years.

Medicaid is a federal program that is carried out in partnership with state governments. It forms an important element of President Barack Obama's health-care plan because under the Patient Protection and Affordable Care Act--AKA Obamcare--a larger number of people will be covered by Medicaid, as the income cap is raised for the program.

With both the expanded Medicaid program and the federal subsidy for health-care premiums that will be available to people earning up to 400 percent of the poverty level, a larger percentage of the population will be wholly or partially dependent on the government for their health care under Obamacare than are now.

In Alabama, Medicaid patients are now limited to one brand-name drug, and HIV and psychiatric drugs are excluded.

Illinois has limited Medicaid patients to just four prescription drugs as a cost-cutting move, and patients who need more than four must get permission from the state.

Speaking on C-SPAN’s Washington Journal on Monday, Phil Galewitz, staff writer for Kaiser Health News, said the move “only hurts a limited number of patients.”

“Drugs make up a fair amount of costs for Medicaid. A lot of states have said a lot of drugs are available in generics where they cost less, so they see this sort of another move to push patients to take generics instead of brand,” Galewitz said.

“It only hurts a limited number of patients, ‘cause obviously it hurts patients who are taking multiple brand name drugs in the case of Alabama, Illinois. Some of the states are putting the limits on all drugs. It’s another place to cut. It doesn’t hurt everybody, but it could hurt some,” he added.

Galewitz said the move also puts doctors and patients in a “difficult position.”

“Some doctors I talked to would work with patients with asthma and diabetes, and sometimes it’s tricky to get the right drugs and the right dosage to figure out how to control some of this disease, and just when they get it right, now the state is telling them that, ‘Hey, you’re not going to get all this coverage. You may have to switch to a generic or find another way,’” he said.

Arkansas, California, Kansas, Kentucky, Louisiana, Maine, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah and West Virginia have all placed caps on the number of prescription drugs Medicaid patients can get.

“Some people say it’s a matter of you know states are throwing things up against the wall to see what might work, so states have tried, they’ve also tried formularies where they’ll pick certain brand name drugs over other drugs. So states try a whole lot of different things. They’re trying different ways of paying providers to try to maybe slow the costs down,” Galewitz said.

“So it seems like Medicaid’s sort of been one big experiment over the last number of years for states to try to control costs, and it’s an ongoing battle, and I think drugs is just now one of the … latest issues. And it’s a relatively recent thing, only in the last 10 years have we really seen states put these limits on monthly drugs,” he added.

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The Amateur - He certainly is.

After fleeting Supreme Court victory, Obama remains the amateur

By Edward Klein

Published July 02, 2012

 FoxNews.com

In ancient Rome, whenever a general was given a victory parade, he would be accompanied in his chariot by a slave who whispered into his ear, “Heed not the call of the crowds, for all glory is fleeting.”

Someone ought to be whispering that advice into Barack Obama’s ear right now, for if ever there was a fleeting victory, it was the Supreme Court’s ruling that ObamaCare is constitutional—a decision that will lead to the largest tax increase in American history and leave Obama and the entire Democratic ticket vulnerable at the ballot box in November.

But don’t count on David Axelrod, the president’s top political strategist, to perform the duty of the prudent Roman slave. These days, Axelrod isn’t whispering; he’s shouting from the rooftops that the Supreme Court ruling is proof that a new, politically skillful Obama has replaced the callow, arrogant incompetent that I describe in my book "The Amateur."

And Obama has joined this chorus of self-congratulation. Minutes after the Supreme Court’s ruling, he got on his smart phone and tweeted: “Still a BFD”—a reference to Vice President Joe Biden’s “big f—king deal” comment when Obama signed the health care legislation.

The notion that Obama has changed his stripes, that he is actually a better and more effective president than any of us suspected, is pure hogwash.

Talk about a “New Obama” reminds me of the effort on the part of Richard Nixon’s PR people in the 1960s to repackage him as the “New Nixon.” During the presidential election of 1968, voters were treated to TV commercials and carefully planted stories claiming that the old, mean-spirited Nixon had matured, and that a more tolerant, magnanimous “New Nixon” had taken his place. It was a brilliantly orchestrated campaign, but as we learned during Watergate and the subsequent release of Nixon’s Oval Office tapes, there never was a “New Nixon.”

The example of Richard Nixon’s non-makeover makeover should tell us something about the efforts of the Obama political team to reframe his image and resell him to voters. The entire story of ObamaCare—from inception to Supreme Court—reeks of amateurism.

It is the hallmark of a political amateur to ignore the advice of wise men and women who tell him what he doesn’t want to hear and, instead, embrace those who cater to his inexperience, vanity, and worst instincts. This has been the pattern of the Obama presidency. And that was exactly what happened in the case of ObamaCare.

Early in his presidency, Barack Obama received ample warning that he was headed for disaster if he went for broke on health care. His then chief of staff Rahm Emanuel urged the president to push for a smaller bill with popular items, such as expanding health coverage for children and young adults. Both his vice president, Joe Biden, and his top political adviser, David Axelrod, sided with Emanuel and raised a red flag.

But Obama wouldn’t listen to his wisest and most experienced advisers. Instead, he chose to listen to his wife Michelle and to Valerie Jarrett, his powerful behind-the-scenes confidante. It was Michelle Obama and Valerie Jarrett who persuaded the president to side with Speaker of the House Nancy Pelosi and her gaggle of far-leftwing Democrats and push for an enormously complex Rube Goldberg health-care bill.

Obama’s arrogance, his sense of superiority, and his air of haughtiness—but above all, his amateurism—led him astray and encouraged him to focus initially on a “public option” in his health care bill. Rick Scott, the health care executive who launched and ran the successful campaign to kill the public option in 2009, parlayed that victory into winning the governorship of Florida in 2010.

When Scott and his group, Conservatives for Patients Rights, defeated the public option, Obama was then stuck with going along with an “individual mandate,” which he had vigorously campaign against during the Democratic primaries. He denied time after time that the mandate was a tax, only to allow his Solicitor General to argue before the Supreme Court that it is, in fact, a tax.
Only a rank amateur could have turned months and months of debate over a widely unpopular health care bill into something even worse—an onerous tax on the middle class.

Only a rank amateur could have turned a government-run health care system that suffers from hundreds of billions of dollars in annual fraud, and is already on life support, into a $1.5 trillion Rube Goldberg machine that will destroy American medicine and deliver a poorer quality of health care to millions of people.

Only a rank amateur could conceive of a “solution” to our health care problems that cuts benefits to seniors by $500 billion and established rationing boards known as “death panels.”

Only a rank amateur could threaten to turn America into Sweden—and possibly even Greece—by passing an ill-conceived piece of legislation whose major goal is to earn him a place in history.

Only a rank amateur could levy a series of new taxes on America’s small businesses, under the guise of ObamaCare, that will raise unemployment and stall an already anemic recover.

Only a rank amateur could hand his Republican opponent, Mitt Romney, an electoral game changer.

Yes, Barack Obama is still The Amateur.
















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WSJ Chief Economist: 75% of Obamacare Costs Will Fall on Backs of Those Making Less Than $120K a Year

By: Jim Hoft
6/30/2012 11:44 AM

Take Your Medicine, America…

Stephen Moore, Senior Economics Writer with the Wall Street Journal, told FOX and Friends this morning that nearly 75% of Obamacare costs will fall on the backs of those Americans making less than $120,000 a year.

“It’s a big punch in the stomach to middle class families.”

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The Debt and Obama's Contributions

Cannot be understated.  He has more than doubled the debt in almost four years.  And according to claims, the Republican Budget Committee have unconvered nearly 17 trillion in unfunded liabilities for his medical system.

The Republicans used the White House figures, Congressional documents, and Obama's health care program.  They did not discover new funding issues based upon their own magical incantations.  They used the White House incantations.

That over the course of 75 years, the liability for Obama's medical system would be over 82 trillion.















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If you are losing, try rebranding your product

The Obama administration is now referring to Obamacare as a “bi-partisan bill” and calling the unpopular individual mandate “a Republican idea,” following three days of tough questioning by the Supreme Court.

“The Affordable Care Act is a bipartisan plan and one that we think is constitutional,” Deputy White House press Secretary Josh Earnest told reporters on Wednesday afternoon.

No Republican voted for the Affordable Care Act on final passage.

He also referred to the individual mandate as the “individual responsibility” clause of the bill, in an attempt to distance the administration from the term individual mandate.

“The administration remains confident that the Affordable Care Act is constitutional; one of the reasons for that is that the original personal responsibility clause…was a conservative idea,” he said.

Conservatives have blasted the administration for the individual mandate and only one Republican voted for Obamacare in both houses of the legislature.









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Chronicling coming Obamacare crash

By Phil Kent

The Washington Times
Thursday, January 5, 2012


In 2011, instead of being heralded for its popularity, President Obama's expensive and tyrannical health care law faced its unraveling, month by month.

Last January, Kansas became the 26th state suing the federal government to block implementation of the health care overhaul. By the end of t hat month, a second federal judge had declared the law unconstitutional. The U.S. Supreme Court now decides whether part or all of Obamacare is unconstitutional, and it should rule sometime around early June.

It was also last February when Health and Human Services Secretary Kathleen Sebelius made the embarrassing announcement that the CLASS Act, a key portion of the law that was supposed to "save" $70 billion, was "totally unsustainable." And the bad news kept on coming.

The law turned a year old March 23, the same day the House Committee on Energy and Commerce reported that the temporary Early Retirement Reinsurance Program would spend its allotted $5 billion far earlier than its January 2014 expiration date. By the end of March, the nonpartisan Congressional Budget Office estimated Obamacare will ultimately cost more than $1.1 trillion an increase of $90 billion from its February estimate.

Last May, the media reported that 20 percent of Obama administration waivers from the law were going to gourmet restaurants, nightclubs and swanky hotels in Democratic House Minority Leader Nancy Pelosi's district. The AARP, which betrayed members with its shameless cheerleading for Obamacare, was also granted a waiver from the law along with various Obama-supporting labor unions.

When June rolled around, a McKinsey & Co. survey of more than 1,300 private-sector employers found that 30 percent of employers would definitely or probably stop offering insurance to their employees if the law is fully implemented by 2014. At the end of June, another embarrassment in the law emerged: A glitch allowed middle-class Americans to get subsidized health care intended for poor people and Medicare's chief actuary flatly declared the section in question "doesn't make sense."

By mid-September, Republican lawmakers said, "We told you so," accusing congressional Democrats who voted for the law of recklessness for promoting the CLASS Act stipulation despite knowing it would eventually blow up the budget. By October, officials from Obama's Department of Health and Human Services acknowledged they "do not have a path to move forward" and announced they were giving up on pursuing CLASS (although that law section remains on the books).

Last November, dozens of congressmen wrote to the Internal Revenue Service commissioner objecting to a new IRS rule authorizing subsidies for participation in the yet-to-be-created federal health care exchange program. They argued that the agency was seeking to rewrite Obamacare, and experts noted the IRS was attempting to cover up a glitch in the original law that provides subsidies for people enrolled in state exchanges but not federal exchanges. That problem is still unresolved.

On Nov. 10, Belmont Abbey College, a Roman Catholic school, filed a lawsuit claiming violation of its religious freedom if forced to buy contraceptives for its students. It specifically objects to a Department of Health and Human Services ruling outlawing all insurance plans that don't fully cover the cost of all contraception, including pills that cause abortions.

Then came another shocker that month. On the heels of a Gallup poll showing almost half of the American people favor repeal of Obamacare, even ultraliberal Rep. Barney Frank, Massachusetts Democrat, joined the effort to repeal the unaccountable Independent Payment Advisory Board, a key portion of the law that would recommend levels at which Medicare recipients, including seniors, can be reimbursed for health care expenses.

As Christmas arrived, The Washington Post reported that health care exerts doubted the law's federal insurance exchange program would be fully operational by the Jan. 1, 2014, deadline. That's because many states have refused to implement the state exchange program, hoping the Supreme Court will rule Obamacare unconstitutional.

As 2012 dawned, sticker shock was becoming evident. Seniors looking at Medicare Part B costs found that the per person Medicare insurance premium will increase from the present monthly fee of $96.40, rising to $104.20 in 2012, $120.20 in 2013, and $247 in 2014. That's an increase of 156 percent in just three years. Those provisions are embedded in Obamacare but were delayed by the Democratic bill writers until after the 2012 election in order to hide them from voters.

In light of this oncoming train wreck, it will indeed be a happy new year if the Supreme Court declares the whole law unconstitutional. It would save Congress the time and trouble of defunding or repealing it.

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Men: 20 Years of Progress Undone (How many must die)

About a year ago, a panel of 'experts' determined it was un necessary for women to get pap smears done regularly.  The reason - unnecessary costs and since the cancer caused by unchecked and untested women is as low as it csan get, the panel found it a wasteful process.

Now, a panel has determined that men should not get a simple test for prostate cancer.

20 years of progress would be undone for men and women and that low cancer rate noted for women, will rise dramatically (the same for me) and we will die off. 

How coincidental to Obama's health and death plan - the funding is not available for EVERYONE to be checked and tested, so ... cut out those areas deemed unnecessary!

Death panels indeed.








Healthy men don’t need PSA testing for prostate cancer, panel says




By Rob Stein, Published: October 6
Washington Post

Most men should not routinely get a widely used blood test to check for prostate cancer because the exam does not save lives and leads to too much unnecessary anxiety, surgery and complications, a federal task force has concluded.

The U.S. Preventive Services Task Force, which triggered a firestorm of controversy in 2009 when it raised questions about routine mammography for breast cancer, will propose downgrading its recommendations for prostate-specific antigen (PSA) for prostate cancer on Tuesday, wading into what is perhaps the most contentious and important issue in men’s health.

Task force chairwoman Virginia Moyer said the group based its draft recommendations on an exhaustive review of the latest scientific evidence, which concluded that even for younger men, the risks appeared to outweigh the benefits for those who are showing no signs of the disease.

“The harms studies showed that significant numbers of men — on the order of 20 to 30 percent — have very significant harms,” Moyer, a professor of pediatrics at Baylor College of Medicine, said in a telephone interview Thursday.

The 16-member independent panel is organized by the Department of Health and Human Services to regularly assess preventive medical care. Its recommendations have a widespread impact, especially on what services Medicare and private insurers pay for. The group’s influence was enhanced by the new federal health-care law, which will base some of its requirements for coverage on the group’s ratings.

The proposed recommendations come as doctors, researchers and policymakers are increasingly questioning whether many tests, drugs and procedures are being overused, unnecessarily driving up health-care costs and exposing patients to the risks of unneeded treatment.

Prostate cancer strikes more than 218,000 U.S. men each year. About 28,000 die of it, making it the most common cancer and second-leading cancer killer among men.

Although prostate cancer can be detected with a physical examination of the prostate, PSA testing has become the most common way that a diagnosis is made. The test measures a protein in the blood produced by prostate tissue and has significantly increased the number of prostate cancer cases being diagnosed at very early stages. But it has been a matter of intense debate whether that translates into a reduction in the death rate from the disease. Prostate cancer often grows so slowly that many men die from something else without knowing they had it.

Because it is not clear precisely what PSA level signals the presence of cancer, many men experience stressful false alarms that lead to unnecessary surgical biopsies to make a definitive diagnosis, which can be painful and in rare cases can cause serious complications.

Even when the test picks up a real cancer, doctors are uncertain what, if anything, men should do about it. Many men are simply monitored closely to see whether the tumor shows signs of growing or spreading. Others undergo surgery, radiation and hormone treatments, which often leave them incontinent, impotent and experiencing other complications.

In its last report, in 2008, the task force began to back away from PSA testing, saying that the potential harms clearly outweighed the benefits for men older than 75 and that there was insufficient evidence to recommend for or against the testing for younger men. Other groups have also increasingly been questioning the value of PSA testing.

The proposed recommendations were reported Thursday by CNN, the New York Times and the Cancer Letter, a Washington newsletter that tracks federal developments related to cancer.

As part of the task force evaluation, a team of researchers at the Oregon Health and Science University conducted an exhaustive review of the scientific literature about PSA testing, including five studies of screening and 26 studies of treatment.

“After about 10 years, PSA-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary,” the 116-page review concluded.

The task force plans to recommend downgrading of PSA testing to a “D” rating. The D rating means that “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits,” according to the task force Web site.

The task force’s new proposed recommendations drew immediate criticism from those convinced that routine screening is necessary.

The “decision of no confidence on the PSA test by the U.S. Government condemns tens of thousands of men to die this year and every year going forward if families are to believe the out-of-date evidence presented by the USPSTF,” said Skip Lockwood, chief executive of Zero, a patient-advocacy group. “A decision on how best to test and treat for prostate cancer must be made between a man and his doctor. This decision is coming from a panel that doesn’t even include a urologist or medical oncologist.”

Several other experts agreed.

“The bottom line is that we should encourage screening because it will give men the full range of options to avoid death from prostate cancer,” said William J. Catalona of the Northwestern University Feinberg School of Medicine.

J. Brantley Thrasher of the University of Kansas Medical Center said, “It appears to me that screening is accomplishing just what we would like to see: diagnose and treat the disease while it is still confined to the prostate and, as such, still curable.”

But others praised the new report, saying it would save many men from unnecessary suffering.

“Unfortunately, the best evidence is that while some men might be helped by screening, others would be harmed, and on balance the test is not useful overall,” said Howard Brody of the University of Texas Medical Branch in Galveston.

Otis Brawley, chief medical officer at the American Cancer Society, would not comment on the task force’s recommendations but said: “I have long been concerned, and it has been very apparent for some years, that some supporters of prostate cancer screening have overstated, exaggerated and, in some cases, misled men about the evidence supporting its effectiveness. We need balanced, truthful information to be made widely available to physicians and patients when making important health decisions. Sadly, that has not happened with this disease.”

Staff writer Brian Vastag contributed to this report.





 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
medical

Lies my Government told me. - Stand in line or you are unpatriotic.

We were told we would not have to wait in lines.  We were told there would be no rationing.  We were told this plan was not like the European or Canadian or French or German system.  We were told ... a lie.


No Mr. Moore, we will not wait in line, and do not question our patriotism unless you want us questioning your patriotism living in New York in that condo, so high up, looking down on all us regular folk.  Perhaps you should stand in line.




Michael Moore: "Patriotic Americans" Will Wait Longer For Healthcare


9/24/11
Real Clear Politics

Michael Moore defends Obamacare and healthcare programs similar to it around the world. Moore says the only "things you maybe have to wait for" are a knee replacement surgery or cataracts.

"Things that are not life-threatening," Moore said on HBO's "Real Time" with host Bill Maher. "The reason why you have to wait sometimes in those countries is they let everybody in the line. We make 50 million people out of the line so the line is shorter, so sometimes you have to wait as long. If you are a patriotic American, you want every American to be covered the same as you. No, not 'I'm going to get ahead because I have health insurance and they don't,'" Michael Moore explained.

 
 
 
 
 
 
 
 
 
 
 
 
 
idiots on parade

Obama Care = Obama Death Plan. Wait and Priority Lists

He stated, categorically - that no panel or committee would exist that would determine your care or lack of - except they have them in England, and have to, because everyone can't get the same care.  It is just not feasible and they know it.  Everyone knows it.  And so, we will have death panels deciding our care.  I sure hope the Obama voters are the group most in need of serious medical care - and get denied.

Cataracts, hips, knees and tonsils: NHS begins rationing operations

Almost two-thirds of trusts affected as cuts bite

 

By Oliver Wright, Whitehall Editor

Thursday, 28 July 2011

The Independent


ANDREW HASSON

Anne Ball, 71, a retired business consultant: 'I have bilateral cataracts and under the original NHS criteria I was entitled to have at least one of mine treated - but then the West Sussex health authorities decided to change the threshold level to save money'

Hip replacements, cataract surgery and tonsil removal are among operations now being rationed in a bid to save the NHS money.

Two-thirds of health trusts in England are rationing treatments for "non-urgent" conditions as part of the drive to reduce costs in the NHS by £20bn over the next four years. One in three primary-care trusts (PCTs) has expanded the list of procedures it will restrict funding to in the past 12 months.

Examples of the rationing now being used include:

* Hip and knee replacements only being allowed where patients are in severe pain. Overweight patients will be made to lose weight before being considered for an operation.

* Cataract operations being withheld from patients until their sight problems "substantially" affect their ability to work.

* Patients with varicose veins only being operated on if they are suffering "chronic continuous pain", ulceration or bleeding.

* Tonsillectomy (removing tonsils) only to be carried out in children if they have had seven bouts of tonsillitis in the previous year.

* Grommets to improve hearing in children only being inserted in "exceptional circumstances" and after monitoring for six months.

* Funding has also been cut in some areas for IVF treatment on the NHS.

The alarming figures emerged from a survey of 111 PCTs by the health-service magazine GP, using the Freedom of Information Act.

Doctors are known to be concerned about how the new rationing is working – and how it will affect their relationships with patients.

Birmingham is looking at reducing operations in gastroenterology, gynaecology, dermatology and orthopaedics. Parts of east London were among the first to introduce rationing, where some patients are being referred for homeopathic treatments instead of conventional treatment.

Medway had deferred treatment for non-urgent procedures this year while Dorset is "looking at reducing the levels of limited effectiveness procedures".

Chris Naylor, a senior researcher at the health think tank the King's Fund, said the rationing decisions being made by PCTs were a consequence of the savings the NHS was being asked to find.

"Blunt approaches like seeking an overall reduction in local referral rates may backfire, by reducing necessary referrals – which is not good for patients and may fail to save money in the long run," he said. "There are always rationing decisions that have to go on in any health service. But at the moment healthcare organisations are under more pressure than they have been for a long time and this is a sign of what is happening across many areas of the NHS."

According to responses from the 111 trusts to freedom-of-information requests, 64 per cent of them have now introduced rationing policies for non-urgent treatments and those of limited clinical value. Of those PCTs that have not introduced restrictions, a third are working with GPs to reduce referrals or have put in place peer-review systems to assess referrals.

In the last year, 35 per cent of PCTs have added procedures to lists of treatments they no longer fund because they deem them to be non-urgent or of limited clinical value.

Some trusts expect to save over £1m by restricting referrals from GPs.

Chaand Nagpaul, a member of the British Medical Association's GPs committee, said he was concerned about PCTs applying different low-priority thresholds and rationing access to treatments on the basis of local policies.

He said the Government needed to decide on a consistent set of national standards of "low priority" treatments to help remove post-code lotteries in provision. "Patients and the public recognise that with limited resources we need to make the maximum health gains and so there needs to be prioritisation. What is inequitable is that different PCTs are applying different thresholds and criteria," he said.

A Department of Health spokesman said: "Decisions on the appropriate treatments should be made by clinicians in the local NHS in line with the best available clinical evidence and Nice [National Institute for Health and Clinical Excellence] guidance. There should be no blanket bans because what is suitable for one patient may not be suitable for another."

Bill Walters, 75, from Berkshire, recently had to wait 30 weeks for a hip operation instead of the standard 18. "I believe that the Government is doing this totally the wrong way," he said.

Case study: 'They changed the rules to save money'

Anne Ball, 71, is a retired business consultant who used to work in electronics

"I have bilateral cataracts and under the original NHS criteria I was entitled to have at least one of mine treated – but then the West Sussex health authorities decided to change the threshold level to save money.

"It's like looking through gauze. Everything is foggy, and I've got quite a large 'floater' in my left eye. The consultant was as distressed as me, having to tell me, and he thought with my eyesight he wouldn't be able to function.

"I've appealed because the cataracts are having a significant impact on my quality of life and it's left me depressed and fearful about my low vision, which will continue to deteriorate. The new guidelines mean that people who fall below the standard set by the DVLA still do not qualify to have surgery. My vision is not good enough to drive at night.

"I'm not a cranky old lady. I'm the chair of a local village charity and I do a lot of computer work that is affected.

"It will just store up costs for future years, putting a strain on resources as more patients will end up in falls clinics. The longer you put it off the more complex the operation becomes and the riskier it is for the patient."

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
health care

Obama's Health Care

Amazing what we learn each day, drip drip ... it isn't about health care for all, it is about refilling the treasury for the unions and supporters of the Democratic party.  How?  Those companies and unions are exempt from having to provide the health care we are all supposed to have.  They get waivers on taxes and waivers on required coverage ... one after another thee entities walk away from the White House with the waiver card signed.

Most recently it is SEIU.

More than 700 companies have been given waivers. 

Translated that means - those companies and entities do not have to do what the rest of us have to do.  Isn't that fair and a refreshing change.














obama

NHS: English Health Care

What the woman in the article is a little off on, is a massive entity like the NHS doesn't feel a change in expenditures in a week or month, and the funding for NHS went through December 31, 2010, under budgets set forth by Mr. Brown.  David Cameron has not ruined NHS as his efforts are yet to be felt and I doubt an entity the size of NHS opts to fall apart pre-implementation, just for fun.

Otherwise, the rest of the article about covers it.  Given the two dozen or so other postings about the NHS - none pose any different scenario than this, it is probably a very accurate reflection of the health services in England.




Sickening horror of how health cuts are affecting patient care revealed

by Krissy Storrar, Daily Mirror 22/01/2011


Debbie Pope is so desperately worried about the care her sick dad is receiving she spends all day by his hospital bed.

The 47-year-old former council worker has witnessed some horrific scenes while tending to her father Fred Corbett, 71 – and blames the devastating ConDem cuts for the misery she witnessed on the front line.

After he was admitted to Darent Valley Hospital, in Dartford, Kent at Christmas with a urinary infection, ex-carpenter Fred has lost three stone, his condition has worsened and he has developed an abscess on his spine.

In that time, Debbie, from nearby Northfleet, has seen a terminally-ill cancer patient left in a makeshift bed with no light or TV point, naked dementia patients wandering around and dedicated staff nearing exhaustion. She also said her dad spent a day lying next to two dead bodies.

She said: “It is sickening. Everyone should know what is happening in our hospitals. It is so distressing to see a hospital brought to its knees. My dad and other patients are suffering because the place is overcrowded and the staff are rushed off their feet. Often there is no one to put in drips or change catheters. Dad is in so much pain he often can’t speak. He wrote on his leg ‘help me’ and said he wants to die.

“The promises of the Government can be seen for what they are. It must be happening all over the country.” Darent Valley has been over-stretched since the A&E ward at Queen Mary’s Hospital in Sidcup was closed last November. It is also facing making more cutbacks over the next three years.

Mrs Pope added: “I’m very concerned about what is happening to this hospital, the pure lack of staff and the cutbacks.

“One nurse said to me, ‘This hospital is bursting with sick people and not enough help’. We’re heading for more tragedies.”

A hospital spokesman apologised for the presence of dementia patients on the wards and added that one of the deceased bodies stayed on the ward to allow relatives to pay their last respects. The terminally-ill cancer patient has now been moved.





















nhs

Kidney Transplants

They are not ... exactly, telling the truth.  In the US the average waiting time is 1121 days (3 years).   This number is and can be misleading.  If my kidney fails and I wait six months and receive a new one, and after a year, the new one fails, I go back on the waiting list and the six months gets tacked back on ... so the 2nd time I wait a year.  Now my time is 1.5 years waiting for a new kidney.   The time on a US waiting list is, on average, 3 years.  In Canada it is 2.5 years.  Now, introduce into this mix a new medical system that will weigh the costs and benefits of you receiving the kidney just made available.  Under the old system (current) it is all based on time - under the new system, it would be based on more than just time on the list.  It would also include your age and the benefit of you receiving the kidney versus someone who is 13.

Perhaps these sorts of lists should be based upon need - those in most critical need first followed by those in less critical need. 


Oh and one more thought - as we age, we find ourselves in need of new parts.  Lungs, hearts, kidneys.  Unless we begin manufacturing these items, we tend to receive them from younger people (if a 50 year old gets hit by a bus and his kidneys are not damaged, there is a good chance they may already be worn by 50 years of living and may not end up as a permanent replacement).  yet our populace in the US and Canada is getting OLDER and there are FEWER younger people taking their place ... ... ... ... do we see a problem brewing ... ... ... you should!!










Albertans dying while waiting for kidney donors



Transplants could save lives, dollars. 2.5 year wait.


21 Jan 2011
Calgary Herald
MATT MCCLURE
CALGARY HERALD



People are dying on the waiting list.

Calgarian Didja Nawolsky sets up a dialysis machine at her home Thursday. She spends five hours a day hooked up to the unit that cleanses her blood. And giving the Calgary mother and 430 other Albertans on the waiting list a new organ would save the province $21.5 million a year in health-care costs, according to a new report.

A Canadian Institute for Health Information study released Thursday finds Albertans with failing kidneys are more likely to get a transplant than most Canadians, but a shortage of donated organs means they still wait an average of 2.5 years for surgery.

“People are dying on the waiting list,” Nawolsky says.

“I want to be there for my daughter’s graduation, to grow old with my husband, but instead we all live each day with my mortality.”

While most cases of endstage organ failure are caused by undiagnosed high blood pressure and untreated diabetes, Nawolsky suffered irreversible kidney damage after falling ill in 2002 from a rare auto-immune disease.

Since a failed transplant in 2005 of a kidney donated by her sister, Nawolsky has been forced to spend five hours a day hooked up to a home dialysis unit that cleanses her blood and removes excess fluid from her body.

“You can have all the money in the world, but time is a gift,” she says.

“I spend a lot of it hooked up to a machine.”

The report estimates the annual cost of dialysis is approximately $60,000 per patient, while the average cost of a one-time kidney transplant is $23,000, plus $6,000 a year for the medication necessary to keep the organ working.

Over five years, the savings per patient with a transplant would be $250,000. If the 3,000 people on waiting lists across Canada received a new kidney, it would result in savings of $150 million annually, the report concluded.

But performing more transplants on patients like Nawolsky requires more donated organs, something scarce.

To that end, Dr. Nairne Scott-Douglas, a Calgary nephrologist, says Canada should consider implied consent legislation — similar to laws in Sweden and Spain — that would make a deceased person’s organs available for transplant unless they opted out in writing.

In spite of ethical concerns by some physicians, Scott-Douglas says Alberta should also follow the lead of other provinces that are transplanting organs from patients who have had heart attacks as well as those who are brain-dead.

“Society has become a safer place with fewer teenagers dying in motorcycle accidents,” he said.

“Alberta has a very high organ donation rate for deceased persons of around 26 per million population, but if it weren’t for the increase in living donors we wouldn’t have been able to keep pace with the need.”

Indeed, the study found that fully half the 3,723 patients in Alberta with kidney disease had received a transplant, compared to just 41 per cent nationally.

In the last decade, 744 Albertans have received a kidney form a deceased donor, while another 494 got a transplanted organ from a living donor.

“We need more people out there to know that if they’re interested there is a real need that can be filled by making a gift of one of your kidneys,” say Joyce Van Deurzen, executive director of the Kidney Foundation of Canada’s Calgary office.

“Studies have shown that people who donate live long lives with few or no complications.”

The study also found that Alberta had the lowest rate of end-stage renal disease in the country at 989 cases per million population.

Scott-Douglas says the low prevalence is due to the province’s relatively young population and programs begun in the 1990s that proactively screen and treat thousands of patients in Calgary and Edmonton who are prone to developing diabetes and hypertension.

“If a patient comes to you with 20 per cent kidney function, there’s not much you can do because that scar tissue doesn’t heal,” he said.

“Catching people early is the key.”





 
 
 
 
 
 
 
 
 
health care

Fantasy: Obama - Helathcare for all. Reality: Not so many and more expensive. Result: Dysfunctional State

Wait, we were told that our costs would go down and EVERYONE would be covered.

Pilgrim in Boston dropped over 40,000 people - they arent covered, and I hazard a guess that after a whoppingf 40% increase, a few more won't be insured in Connecticut! 

Where is all that hope.




Health Care Reform Blamed for Huge Hike in Premiums


By BOB CONNORS
Updated 3:22 PM EDT, Fri, Oct 15, 2010


The state has given Anthem Blue Cross and Blue Shield the go ahead to raise premiums by as much as 47 percent for some members, and says health care reform is the reason why.

Attorney General Richard Blumenthal sent a letter to Insurance Commissioner Thomas Sullivan on Oct. 6, asking what he called "excessive" increases were approved without full consideration of all the facts. His letter mentioned rate increases for both Anthem and Aetna.

The new rates took effect Oct. 1, and include increases from 19 percent all the way to 47 percent depending on the individual, the Hartford Courant reported.

Sullivan responded to Blumenthal saying the new rates included "very rich benefits" mandated by federal law.

"There is not one person in the state of Connecticut who will see an increase in their current premiums based on what the department approved for Anthem and Aetna," Sullivan said in a release. "The rates that were filed and approved reflect the current cost to deliver care and the impact of more comprehensive benefit designs required under the federal healthcare reform law. If the attorney general wants to complain to someone, he should complain to Congress."

People who were enrolled in the Anthem program prior to the increase will not see a change, according to the agency. The increased rates will be applied to new customers.

In a letter to Blumenthal, Sullivan said the rates granted were reduced from the company's original request of 39 percent to 58 percent increases.

"I find myself in an unprecedented place and time, as do my counterparts throughout the country, in overseeing one of the most far-reaching policy initiatives enacted by the federal government in recent history," Sullivan said in the letter. "It is unfortunate that this reform, while addressing insurer behavior, has provided little to no reform of the escalating costs of the health care delivery system."





 
 
 
 
 
 
 
 
obama

Greek Medical System (Just 1 of many)

Amputate to save money.  Death Panels are just another side of the coin, down the road.


Greek Health System Opts for Amputation as Money-Saver


Pericles K, special to The Daily Caller
Mon Oct 11, 9:51 am ET



.This Saturday, one of Greece’s most respected newspapers, To Vima, reported that the nation’s largest government health insurance provider would no longer pay for special footwear for diabetes patients. Amputation is cheaper, says the Benefits Division of the state insurance provider.

The new policy was announced in a letter to the Pan-Hellenic Federation of People with Diabetes. The Federation disputes the science behind the decision of the Benefits Division. In a statement, the group argues that the decision is contrary to evidence as presented in the international scientific literature.

Greece’s National Healthcare System was created in the early 1980s, during the tenure of Prime Minister Andreas Papandreou. Papandreou, an academic, won election under the slogan, Αλλαγή, which is the Greek word for Change.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
greece

Welcome to the Future: Obama's Nightmarecare for the US

'We'll do cancer scan on Monday... if she's still alive': Agony of family of dying grandmother who devoted her life to NHS



By Emily Andrews
21st August 2010
Daily Mail





As a hospital cleaner, Margaret Cummins dedicated years of her life to the Health Service.

She would keep the buildings spick and span - and go out of her way to help the sick and reassure those in distress.

But if she expected a little respect in return when she became a cancer patient, she was very wrong.

Instead, the 74-year-old's family were told that she could not have a vital scan because that particular unit was closed at weekends.

The locum doctor said: 'We'll do it on Monday - if she's still here.'

That crass remark was among 36 criticisms levelled at Northampton General Hospital, where Mrs Cummins spent 24 days.

The grandmother died in a hospice just two months after being diagnosed with a lung cancer that had been deemed treatable.

And Mrs Cummins's family claim that her appalling treatment in hospital contributed to her death.

Her daughter Julie Fordham said: 'Mum dedicated much of her life to working for the NHS. She wasn't high-profile, simply back-room, going about a menial but important job with spirit and a sense of pride. She loved the patients.

'She always believed the NHS was marvellous, but in this case its standards fell sadly short. We feel she was left to die.' The family's claims prompted the chief executive to apologise for 11 failures in her care.

Those included her walking frame being moved out of reach so she fell out of bed, being unable to ring a bedside alarm for help because it was out of reach and being left on the floor for 15 minutes.

Her medical notes were also removed from her bed, a Do Not Resuscitate order was posted before it had been discussed with her family, and she was kept waiting for 12 hours for an ambulance dressed only in a nightie and no underwear when she was transferred between hospitals.

Her family also claim she was dropped from a hoist into a bath which caused her lung to collapse. The hospital denies this.

NHS bosses met the family privately this month to apologise, insisting they had put in place procedures to ensure the blunders were never repeated.

Mrs Cummins's ordeal began in October when she was diagnosed with lung cancer. By November she had deteriorated so much she had to spend her 50th wedding anniversary in hospital. On December 5 her family were called to her bedside.

Mrs Fordham, 43, a mother of two, said: 'We were told that she was going to die. Her breathing had deteriorated rapidly and we said she needed a lung scan or Xray to find out what was wrong.

'But a locum doctor took us off into a side room at about 7pm and said she didn't need a scan because they knew it was the disease, they knew what was wrong. He said, "They don't do it at weekends as the unit's closed so we'll scan her on Monday - if she's still here."

'She had a scan on the Monday which showed her lung had collapsed. His reply was deeply offensive and insensitive. He might not have meant to hurt our feelings but he certainly did. It was crass,' added Mrs Fordham, from Bletchley, Northamptonshire.

Paul Forden, chief executive of Northampton General Hospital Trust, acknowledged 11 direct mistakes relating to Mrs Cummins' care.

Mrs Cummins, who was married to Chris, 76, had worked at Milton Keynes Hospital and St Stephen's Hospital in West London. She died on December 29.

Paul Forden, chief executive of Northampton General Hospital Trust, acknowledged 11 direct mistakes relating to Mrs Cummins' care. Of the remaining complaints, he apologised to the family for their concern over perceived failures.

His most striking admission relates to Mrs Cummins being left on the floor for 15 minutes, unable to reach the call alarm.

'It was unacceptable that a call bell should be left out of a patient's reach. It was accepted that best practice was not followed by the nurses with regards to the appropriate access to her call bell and for this I am sincerely sorry.'

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
healthcare