Thought Theater

More On That Alleged Best Health Care In The World - Part III genre: Do Not Resuscitate & Little Red Ribbon-Hood & Six Degrees of Speculation

There is an ongoing battle over health care in the United States. Those opposed to universal health care argue that the implementation of such a plan will result in a decline in the quality of care. Time and again, they cite the reported delays in accessing needed procedures in those countries that provide such care as evidence. They also make anecdotal assertions about the growing number of foreigners who seek medical care in the United States...while ignoring the same indications that more Americans are seeking medical care in other countries.

While there may be legitimate concerns about the implementation of a universal health care system, I've previously written about the fallacies contained in many of these arguments. I've also directed readers to studies that offer a less than stellar assessment of the health care we're currently receiving.

The recent report from Nevada on the mishandling of syringes and vials, which may have resulted in potentially exposing 40,000 patients to Hepatitis C, is further evidence that our system has its share of deficiencies.

WASHINGTON (AP) -- An outbreak of hepatitis C at a Nevada clinic may represent "the tip of an iceberg" of safety problems at clinics around the country, according to the head of the Centers for Disease Control and Prevention.

The city of Las Vegas shut down the Endoscopy Center of Southern Nevada last Friday after state health officials determined that six patients had contracted hepatitis C because of unsafe practices including clinic staff reusing syringes and vials. Nevada health officials are trying to contact about 40,000 patients who received anesthesia by injection at the clinic between March 2004 and Jan. 11 to urge them to get tested for hepatitis C, hepatitis B and HIV.

Senate Majority Leader Harry Reid, D-Nev., met Monday with CDC head Dr. Julie Gerberding, and on a media conference call after their meeting both strongly condemned practices at the clinic.

Health care accreditors "would consider this a patient safety error that falls into the category of a 'never event,' meaning this should never happen in contemporary health care organizations," said Gerberding.

"Our concern is that this could represent the tip of an iceberg and we need to be much more aggressive about alerting clinicians about how improper this practice is," she said, "but also continuing to invest in our ability to detect these needles in a haystack at the state level so we recognize when there has been a bad practice and patients can be alerted and tested."

Let me attempt to explain exactly what appears to have happened at these clinics. In performing procedures on patients with Hepatitis C, clinicians may have been reusing the syringes used in sedating these infected individuals on other patients...or they were reusing the same syringe a second time on an individual infected with the disease when drawing a sedating medication from a multi-dose vial...which was then used to draw medication to sedate other patients. The bottom line is that the disease could have contaminated either the syringe or the vial containing the sedating medication.

Look, I'm not a doctor or a scientist...but it isn't that difficult to understand that if you put something (a needle connected to a syringe containing a fluid) into a contaminated substance (blood in the tissue of an infected individual in this case), there is a risk that the infected substance can travel into any connected portion of that device (think backwash from a straw or the basic concept of osmotic transfer) or into any container that device may subsequently come into contact with.

So what does this tell us about our health care? Well, according to the representative from the CDC, these clinicians were conducting practices that are NEVER EVER acceptable. In doing so, they were violating a very basic guideline; not some complex concept beyond those capable of rudimentary rational thought. Frankly, if one can't be sedated for a colonoscopy without the risk of contracting Hepatitis C, what hope should we have that a life saving surgical procedure will follow proper protocol?

To be fair, that isn't an argument that affirms the quality of services one might expect under a universal health care system. However, it is a valid criticism of our existing system as well as a rebuttal to those who sing its praises. Truth be told, health care is only as good as the commitment of those who provide it. The argument that universal health care will make the practice of medicine less lucrative may...and I repeat may...have some merit. At the same time, are we to believe that the hippocratic oath is subject to suspension should the bottom line be diminished?

Given the incidence of malpractice and the other previously referenced negative reports on our health care system, it appears that ever increasing profits are no more a predictor of high quality health care than decreased profits would be of lesser quality care. Further, if those in the field of medicine predicate their performance upon profitability, we're all one bad bottom line away from a botched procedure.

Unless and until we restore the word "care" to our health system, it won't actually matter whether it is administered as a result of an open market construct (think 47 million uninsured) or as a function of some degree of universally mandated insurance. The provision of care ought to be a given; not an endless negotiation. It's time we choose to do the right thing. It's a matter of life and death.