News in brief - May 22/29, 2006

Maryland law will require hospitals to report infections - Emergency department directors see specialist shortages - Doctor, nurse take part in N.C. execution - N.H. high court throws out wrongful birth verdict - N.Y. sees decline in ob-gyn supply

Maryland law will require hospitals to report infections

A Maryland law, supported by the state hospital association, that goes into effect July 1 will require hospitals publicly to report patients who acquire infections at their facilities. Hospital officials will report infections to the Maryland Health Care Commission for posting on its publicly available Web site.

Another bill would have required hospitals to test newly admitted patients for infections, but the Maryland Hospital Assn. opposed it, and it died in committee in April.

Florida, Illinois, Missouri, New York, Pennsylvania and Virginia have similar laws in place. So far, only Florida and Pennsylvania publicly have reported aggregate hospital-acquired infection figures.

The Centers for Disease Control and Prevention estimates that every year 2 million patients acquire infections while in the hospital, and 90,000 of those people die.

Emergency department directors see specialist shortages

Three-fourths of emergency department medical directors said they had inadequate on-call specialist coverage, according to a report the American College of Emergency Physicians released this month.

The survey of 1,328 emergency directors shows that on-call coverage in the nation's hospital emergency departments has deteriorated since 2004, when two-thirds of directors cited inadequate coverage, the college said.

The 2005 survey found that 73% of directors reported problems with specialist coverage, compared with 67% in 2004. It also showed that 45% of directors had patients leave without being seen, compared with 29% in 2004. The percentage of hospitals paying stipends to specialists, whether or not they saw patients, more than quadrupled to 36%, up from 8% in 2004.

The top five specialty shortages were orthopedics; plastic surgery; neurosurgery; ear, nose and throat; and hand surgery.

"The continuing erosion of the availability of medical specialists in our nation's emergency departments is growing and symptomatic of much larger problems in the health care delivery system," ACEP President Frederick Blum, MD, said in a statement. "Emergency medicine is in a state of emergency itself, and patients are suffering."

Doctor, nurse take part in N.C. execution

Over the objections of state and national medical societies, an unidentified physician and nurse in April participated in the North Carolina execution of 61-year-old convicted murder Willie Brown Jr.

The physician and nurse monitored a bispectral index monitor that was connected to Brown to ensure that he was unconscious before being injected with paralytic and heart-stopping drugs. The maker of the monitor, Aspect Medical Systems, said it never intended for the machine's use in an execution. The AMA, the American Society of Anesthesiologists and the North Carolina Society of Anesthesiologists called the physician's involvement unethical.

A North Carolina Medical Society spokesman said the group opposes physician participation in execution generally, but did not comment on the Brown case specifically.

N.H. high court throws out wrongful birth verdict

The New Hampshire Supreme Court in April reversed a $2.3 million jury verdict in a wrongful birth case against Dartmouth Hitchcock Medical Center, finding that the hospital adequately informed a couple of the increased risk that their son would have serious birth defects.

The ruling is a positive one for doctors, said New Hampshire Medical Society Executive Vice President Palmer P. Jones. "The court realized that physicians are practicing in a very complicated world with rapidly developing technology, and it is clearly more difficult for them to be able to guarantee outcomes in this way," Jones said. The medical society did not take a position in the lawsuit.

Sherry and Brad Hall sued Dartmouth Hitchcock in 2003, alleging that they would have terminated their pregnancy if the medical center's genetic counseling team had told them about their son's diagnosis with a rare chromosomal disorder.

The case marked only the second time a wrongful birth claim has reached the state's high court since a 1986 decision established the claim. In the April ruling, Justice Linda S. Dalianis noted that the standard does "not require a physician to identify and disclose every chance, no matter how remote, of the occurrence of every possible birth 'defect' no matter how insignificant."

N.Y. sees decline in ob-gyn supply

A report from the New York Center for Health Workforce Studies found that the number of ob-gyns in the state is on the decline, particularly in upstate areas. That could spell access problems for women in those regions, the report said.

Researchers examined ob-gyn practice patterns between 1995 and 2005 and discovered a 4% drop in the supply of active ob-gyns statewide from 2000 to 2004. Some upstate regions saw sharper declines. For example, the Mohawk Valley experienced a 43% drop in active ob-gyns.

In part, demographic changes in New York contributed to the change in the number of ob-gyn jobs available and the overall decline in the number of ob-gyns, researchers said.

The total number of births in New York declined more than 7% between 1995 and 2003, and the birth rate per 1,000 women of childbearing age dropped by more than 5 per 1,000. During the same period, the number of births in New York City slipped more than 5%, and the birth rate per 1,000 women of childbearing age decreased more than 8 per 1,000. The number of ob-gyn procedures being done, both same-day and multiple-day hospital procedures, also declined statewide.

Despite the downturn in the number of births and procedures performed, researchers said the number of ob-gyns in some areas in the state, such as Mohawk Valley, was shrinking so fast that women in these regions could be facing access problems soon.