Loopholes in Supreme Court Judgment of hospital providing free services

Health Care, Medicine, Social Health Community 266 Comments
  1. The definition of a person “from economically weaker section of the society” is not clear. It is definitely not BPL. Anybody whose income is less than minimal wages will qualify to be included in the economically weaker section of the society. The government will have to come out with clear guidelines as to who all would be included into this category. It seems the government has appointed nodal officers who will classify these people. If that happens no emergency admissions may be taken directly by the hospitals as the cases may need to be routed through the nodal officer who obviously will not be available for 24 hours and on holidays.
  2. Medical establishments will prefer medical cases over surgical cases to fill the beds. Will the government consider fixing the beds for different specialties as there are no directions from Supreme Court? Unless the government acts, this will never happen.
  3. Will there be discharge guidelines? Normally, any private hospital wants the patients to be discharged as early as possible so that the next patient can be admitted. This is based on the findings that maximum earning to the hospital is in the first 2 to 3 days of admission. After this period, the earning is only from room rent and doctor’s fee. Hospitals may not discharge these free bed patients for days together to prevent admission of new surgical patients.
  4. For the same reason, it is likely that a free ward patient may not get a prime time in the OT list. After getting admitted, he or she may have to wait for days together to get the turn for surgery.
  5. Same thing could take place in getting dates for investigations.
  6. A patient for bypass who is normally discharged in 4 to 5 days may end up being hospitalized for up to 3 weeks to get the same surgery done.
  7. As there are no clear cut guidelines, it is possible that these free bed patients will be treated with generic drugs and with only minimal basic investigations. Most of the treatment will be based on clinical judgments.
  8. The guideline does not specify if the patient has to be put on stent or pacemaker. Will this be the indigenous cheapest one available in the market or the standard imported one? It is likely that these patients will get bare metal indigenously made stents and not the drug eluting standard stents. Same thing could also apply to other appliances and devices.
  9. The normal practice is to look for indications for doing the surgery. For free bed patients, efforts will be made to find indications for not doing surgery. For example, there is a current recommendation that a patient should get an ICD (pacemaker with electrical shock device), if the pumping fraction of the heart is less than 30%. For a private patient, a 31% ejection fraction would be written as 29% and for poor patients, a 29% ejection fraction will be labeled as 31%.
  10. Many of the rooms may get blocked with patients requiring long term care which are normally not encouraged to be admitted in private wards. Everyday, the internal auditors of most major hospitals review as to why a particular patient is staying in the hospital after five days of admission. The unwritten policy is to ask the consultants to discharge a patient if the stay is for more than 5 days. Will the same guideline apply for free beds?

FDA Warning: Test kidney function before prescribing Zoledronic acid

Health Care, Medicine 230 Comments

FDA  has updated a warning regarding kidney failure and use of zoledronic acid. Kidney failure is a rare but serious condition associated with its use in patients with a history of or risk factors for kidney impairment.

Doctors are being warned to check patient kidney function before prescribing zoledronic acid and to check those who are already taking the drug.

The new warning indicates that patients with creatinine clearance of less than 35 mL/min or evidence of acute renal impairment should not be given zoledronic acid for osteoporosis.

The warning also lists risk factors including advanced age, concurrent treatment with other nephrotoxic drugs, and dehydration secondary to fever, sepsis, gastrointestinal losses, or diuretic therapy.