Wednesday, December 30, 2009

UCLA Challenges The Death Panelists

The picture you're seeing is the main entrance to the newly-upgraded UCLA Medical Center. As a UC Berkely alum, I teased my son unmercifully for graduating from our junior cousin to the south. But it was always good-natured ribbing. Both have excellent medical schools, but UCLA's is better-known, and has just recently been rated one of the top three hospitals in the nation.

Of course, I've also made a few cracks about its cross-town rival which is attached to USC. Now UCLA is a public university, and USC is a private university, but everything's a little strange in California. The proudest part of the UC center in L.A. is that it is known as the Ronald Reagan UCLA Medical Center. Its much less prestigious rival became part of the Los Angeles County USC Martin Luther King, Jr. Medical Center. The County Medical Center was once an architectural wonder and a decent medical facility. As it grew older, it felt it needed both the attachment to a major university (USC) and identification with the demographic it served (Central and South Central Los Angeles). While UCLA's prestige increased every year, the County Center became a place reminiscent of the horror stories of medical practice in 19th century England.

By 2005, the care became so dangerous at the Martin Luther King Trauma Center, that it was de-certified, and ultimately closed. Four accidental patient deaths from negligent doctors and nurses in one day merely capped nearly ten years of declining and ever more incompetent treatment at the Center. Recently, the Martin Luther King Jr. Center was re-opened in a different part of town, but the County/USC Center has shown very few signs of improvement. Public university with ever-increasing accolades, versus private university with an unenviable record. So we can't always assume that public is necessarily bad, or that private is automatically better. The difference here is that the doctors and medical experts run the UCLA Medical Center, and County bureaucrats, politicians and university administrators run the County/USC Medical Center. I will admit that it's a rather unusual reversal of roles.

As interesting as that contrast may be, that is not the real purpose of this article. The real purpose is to point out that in keeping with its high reputation, UCLA has led the way in a particular area of health care of extreme interest to the majority of Americans who are watching the potential crippling of health care and death of elderly patients being jammed down their throats by the Obama administration. UCLA has published a "UCLA Medical Center at the Heart of End-of-Life Debates" series which was capped on December 23 with a front page piece largely opposing and attacking the federal government's analysis of how to ration health care, particularly for the elderly and critically ill. The study and conclusions were joined by four other western university medical schools, including UCSF.

UCLA has long had the reputation of staffing doctors who will go to any length to save a life. "If you come into this hospital, we're not going to let you die," according to Dr. David T. Feinberg, the Center's chief executive (a doctor as the executive deciding on life and death--who'd a thunk it?). The government plan (as best we can tell amidst all the confusion) decides on two factors: "Is this life capable of being saved?" and "Does the patient fit into a category which allows for extraordinary life-saving techniques?" (old folks need not apply, and money is an object).

UCLA decides on the basis of "Is the patient still alive, and is there any way known to medical science to save him?" The Obama administration and a recent Dartmouth study gives UCLA minus points for "spending the most on end-of-life care" with what they claim produces no discernible difference in the end results." The obvious question is "how do they know that?" The UCLA doctors are not spendthrifts, although their facilities couldn't be more state-of-the-art, but they say that "they recognize a difficult truth: It can be hard, sometimes impossible, to know which critically ill patients will benefit and which will not."

The Dartmouth Study considers only the costs of treating patients who have ultimately died after the life-saving treatment, but ignores the ones who survive. So their conclusion as to "no difference in results" is meaningless. But it's a government bureaucrat's dream. "Hmm, old, chronic life-endangering illness, most likely treatment too expensive. REJECT."

Good doctors consider all the factors, including alternate (and frequently less expensive) treatments. UCLA does exactly that. They cite the example (their study shows it's a typical example, not merely anecdotal) of one Salah Putrus, age 71. He was referred to UCLA for a heart transplant after at least two other hospitals and several doctors had given up any hope of his surviving the surgery, or surviving it for any appreciable period of time. The doctors at UCLA reviewed his medical history carefully, and used all those "expensive" machines that can test just about anything, and concluded the heart surgery was not only dangerous for a man in his condition, but unnecessary as well. They put him on a drug regimen to reduce the amount of water he was retaining. They removed some teeth that were potential sources of infection. Mr. Putrus has been out of the UCLA Med Center for over six months now, his health has improved exponentially, and he is no longer considered in active need of a transplant.

Rhetorical question: Which would have been more expensive--a heart transplant that would likely have killed the patient or left him with a very short life expectancy, or the use of doctors and state-of-the-art equipment which determined that the transplant wasn't even necessary. And add to that, that heart can only be used once. The doctors and the equipment can be utilized over, and over, and over.

The Los Angeles Times, a big fan of Obamacare, nevertheless picked up on the findings of the UCLA series, and concluded that in the case of heart failure patients, "the hospitals that spend the most seem to save the most lives." An obvious fact entirely missed by Obamacare and the sycophantic Dartmouth study. For those who believe that health care is a matter of mere numbers and statistics, I suggest that if they are older or suffering from a chronic life-endangering illness, they should consider being treated at UCLA Medical Center rather than at Dartmouth.

9 comments:

AndrewPrice said...

Better get used to it... once the government starts running something, the primary focus becomes budget, not service or care.

I think it's interesting that the party that has always claimed to speak for older people (and used to oppose any cut in Medicare) would now be putting seniors in a position where they will be pushed aside in the name of keeping costs down. Maybe it's time to re-evaluate that belief that the Democrats are out to help people.

LawHawkSF said...

Andrew: The Democrats have always been about lofty ideas to fool the rubes while they enrich themselves and pander to the masses. I don't expect that newborns with birth defects will get much better treatment than the oldsters. The pure fiscal model would be bad enough, but they're also counting votes. They are cynical beyond all belief. And now they are targeting those least able to defend themselves.

We have a lot of work ahead of us, don't we?

StanH said...

In the long run guys, I don’t believe America will put up with substandard healthcare, we’ll see.

LawHawkSF said...

StanH: With a little more luck, maybe America won't put up with government health care at all. I'm no longer 100% convinced that they will get anything after all, or if they do, it will be such a weak bill that we can undo it within a year. Maybe I'm just being New Year optimistic.

HamiltonsGhost said...

Lawhawk--I think that even those who laughed at the use of the words "death panels" are coming to realize that it is exactly what Obamacare will give them. And the last thing on earth the Democrats will ever admit is that lives will depend on some bureaucrat's decision rather than that of a doctor, the patient, and the family.

LawHawkSF said...

HamiltonsGhost: There is a shocked realization cropping up, even among Democrats, of how bad this bill really is and what government care will take away from them. Not just medical care, but a big part of their freedom as well, along with increased taxes and reduced returns on their investment.

There will be no government analysis on a case-by-case basis as in the UCLA studies. Democrats don't understand tangibles, let alone intangibles such as spending a little more, saving a life, and finding out in the long run that it was actually less expensive and far more humane.

Liberals, as Andrew said, spend their lives slobbering over how much they care about others, but when the rubber meets the road, the only thing they consider is "what's in it for me?"

As one conservative wag phrased it years ago, the liberal philosophy is "love humanity, hate human beings."

LawHawkSF said...

Apropos of absolutely nothing on this thread, I had to paste this part of a short interview the New York Times had with my hero, law professor John Yoo. I stole it from Ace of Spades HQ:

NYT: Were you close to George Bush?

Yoo: No, I’ve never met him. I don’t know Cheney either. I have not gone hunting with him, which is probably a good thing for me...

NYT: So you’re saying you were just one notch above an intern, you and Monica Lewinsky?

Yoo: She was much closer to the president than I ever was...

NYT: I see various groups are protesting a decision by a California government lawyer to teach a course with you that starts on Jan. 12, claiming he is legitimizing your unethical behavior.

Yoo: At Berkeley, protesting is an everyday activity. I am used to it. I remind myself of West Berlin — West Berlin surrounded by East Germany during the Cold War.

NYT: Are you saying the citizens of Berkeley are Communists, reminiscent of those on the dark side of the Iron Curtain?

Yoo: There are probably more Communists in Berkeley than any other town in America, but I think of them more as lovers of Birkenstocks than Marx...

NYT: Is there anything you regret?

Yoo: I regret agreeing to this interview. Its like shooting fish in a barrel. How could you ever think some biased classless hack scrunt interviewer from the NYT could ever think on their feet fast enough to keep up with me? Are you on drugs?


Purple Avenger (the author) admits that he made up the last question and answer (seems I have a kindred mind on that blog).

Writer X said...

It's like science fiction that we're even having this discussion: who gets to live or die?

LawHawkSF said...

WriterX: At times, I think it's more like stories about Nero or Caligula. You live or die depending on the mood of the emperor and the size of his treasury.

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