Doctors say pressure on ERs may rise, give U.S. failing grade
The draft guidance proposals, which Department of Health officials have said is just a clarification of the law, state there will be no legal requirement for a woman to visit a doctor before undergoing a termination. The document says that it is “not a legal requirement” for women to visit a doctor, it is “good practice”. According to ministers supporting the move,more than 96,000 abortions a year in England and Wales are given approval without the woman seeing a doctor in the flesh. It also states that doctors should have”turned their minds to the particular facts of the case”, but it is not legally enforced. The new guidelines also state it is not a legal requirement for doctors to give individual requests any consideration before granting an abortion. The proposals say nurses can carry out terminations and gives examples of nurses administering drugs for medical abortions. It does not rule out nurses carrying out surgical terminations. For reasons of privacy, the paper states women should be free to “expel” the foetus at home, after taking abortion pills. The proposals are being contained in a government consultation which was opened before Christmas, with no publicity. It closes in two weeks, which has led to opponents accusing the law of being reinterpreted “clandestinely”. However, MPs and campaign groups have condemned the plan, saying it trivialised abortion into being a simple procedure and rendered the central components of the 1967 Abortion Act meaningless. The legislation states that two doctors must authorise a termination, having agreed the physical or mental health of the woman and foetus is threatened.
While the physician’s report does not factor in all of the effects of the law — its grades are based on data from early 2013 — emergency rooms could be used even more as more Americans gain insurance coverage under Obamacare, it said. Some health experts have predicted that increasing the number of insured patients should reduce pressure on hospital emergency rooms because access to regular doctor care will improve, something that is hoped would prevent chronic conditions from spiraling out of control or help catch other problems before they worsen. But insurance coverage could also lead those who might have held off going to the emergency room to seek care, said Jon Mark Hirshon, an emergency medicine doctor and researcher at the University of Maryland who oversaw the group’s report card. Newly insured people also may have a hard time finding a regular doctor who accepts their plan, he said. “On top of that, emergency departments are open 24 hours a day, seven days a week. If I have a primary care provider but it’s 9 o’clock at night on a Friday and they’re closed, then people come to the emergency department,” Hirshon told Reuters. The group is asking for congressional hearings to probe whether the law puts “additional strains” on emergency rooms. Already, beds for patients have fallen from a rate of 358 per 100,000 people four years ago to about 330 beds per 100,000 people now, the report said. Wait times have increased to a median of 4.5 hours compared to four hours in 2009. Despite the dismal U.S. grade given by the group, it noted that policies and infrastructure varied widely by state. States with the best emergency care include Massachusetts, Maine, Nebraska and Colorado, while Kentucky, Montana, New Mexico and Arizona rounded out the bottom, just above Wyoming.
Doctor ‘laughed at’ plea to help girl who died in hospital
A junior doctor in Kingston Hospital was laughed at by a senior colleague when she suggested a consultant should examine a four-year-old Freya Wells, from Wallington , who died hours later after suffering a severe infection, West London Coroner’s Court heard. Little Freya died in the hospital after being admitted for breathing difficulties, vomiting and diarrhoea. Dr Hilary Towse, a paediatric senior house officer (SHO), told the court she tried to convince paediatrics registrar Dr Rosita Ibrahim to call for a consultant in the early hours of November 22, 2012. She said she thought Freya should be given rapid fluids through a bolus and IV drugs rather than oral, but Dr Ibrahim disagreed with her. Kingston Hospital Dr Towse said: “I specifically said that she needed to have a bolus, I specifically said that she needed to have IV antibiotics and I specifically said that she would need intensive care. “She thought what I was saying was ridiculous. Dr Towse began to cry and added: “I do recall that she laughed.” When asked why she did not contact the consultant herself, she said: “It will always be something I’ll regret for the rest of my life. “It would never normally be the role of the SHO to do that. Probably I had some experiences where I’ve been entirely appropriate to speak to a consultant but they would not want to speak to me because I was the SHO.” Nurse Kate Lynch, who also cared for Freya at the hospital, told the hearing that she disagreed with Dr Ibrahim that the youngster should be given intravenous rather than oral antibiotics. Richard Baker, representing Freya’s family, asked her: “Are you saying on this occasion the doctor was wrong?” Ms Lynch replied: “I felt that she should have had intravenous antibiotics.” The inquest, that is due to finish tomorrow, continues.