When Guns are Outlawed, Only Outlaws will have Hospital Infections

Consider, if you will, the unfortunate case of Andrew Lane. He is suing a hospital in the UK for what happened to him when he went there for surgery.

Cancer patient Andrew Lane, 61, contracted the potentially fatal infection necrotising fasciitis following an operation to remove his prostate gland at Southend Hospital in Essex.

So how bad is that? Real bad.

He was left fighting for his life and, although he survived, his genitals were so badly damaged that he lost most of his penis and is no longer able to have sex.

They quote him saying several ways that that is a big deal, and one gets the impression the reporter was trying to convince him it wasn’t really.

For the record, yeah. That’s a big deal. But it wasn’t the end of his woes by any means.

So much diseased tissue had to be removed that it also left him with a protruding stomach, where the outer tissue had been “eaten” away.

He was forced to use a catheter and colostomy bag for two years and has had to have a special device fitted to help him urinate.

Hey, but in England the “health care” is “free.” As it happens, just like the VA in more ways than one!

26 thoughts on “When Guns are Outlawed, Only Outlaws will have Hospital Infections

  1. loren

    It’s doubtful he could have had sex in any event. That surgery is/can be a poor option for that disease. Some cures aren’t worth the treatment.
    They do help with the docs Mercedes payments though.

  2. Aesop

    If you think govt.-subsidized health care is great, just wait until it’s “free”.

    Immutable Rule Of Life:
    You always get exactly what you pay for.

    He’s nominally lucky to be alive.
    In most cases, nec. facs. is a terminal case, within a couple of days.
    Shame about the plumbing.

    1. Y.

      Are there any numbers to back that assertion, that tax-funded healthcare systems have more dangerous hospitals, or is that just a casual, non-rigorous unexamined assumption you happen to have?

      You always get exactly what you pay for.

      Uh-huh.

      Ever heard of the ‘just-world fallacy’? Or luck, chance, chaos?

      It seems you believe you live in a just, orderly & sensible world.

      1. Aesop

        Yeah, after a paltry twenty-five years or so actually doing healthcare firsthand for fun and profit, I must have just pulled that straight out of my fourth point of contact. Because it’s purely anecdotal, and whatinhell would I ever actually know about the subject of infection control? (I mean, if we put my bedside medical experience into pilot terms, that means I only have somewhere between 45,000 and 70,000 hours in my “logbook”, so being such a relative medical novice – “Sully” has 20,000 flight hours, Chuck Yeager has 17,000 or so – clearly there’s nothing I could add to a discussion related to my primary field of employment, right?)

        Oh, wait, at the risk of being accused of self-plugging, maybe there was something kicking around on my blog:
        http://raconteurreport.blogspot.com/2016/12/snark-easy-mathematics-hard.html

        Bear in mind that was just half an hour’s casual observation in a remarkably similar vein, this very day, without going all Brookings Institute/RAND Corp. white paper on it. To do so would require one to have the temperament to club baby harp seals. NTTAWWT.

        Or, we could look no farther than this recent article from Canada,
        http://news.nationalpost.com/health/infected-and-undocumented-thousands-of-canadians-dying-from-hospital-acquired-bugs?__lsa=d0ca-e5dd
        noting that they don’t even track the incidence of such problems in their vaunted national health care. It also notes how rare NF is, and how you have to generally pull some level of stupid from before the age of Louis Pasteur to instigate it nosocomially. Like, f’rinstance not scrubbing the patient adequately pre-op.

        We’ll spare the deceased equine the impacts of a plethora of articles on the slipshoddiness of the UK’s National Health Service both overall and in fine detail, though I’m sure somewhere there’s someone (or more likely somemillion) as rat-on-a-terrier about it as our hognosed host is about our own VA, but only because you can’t swing a dead cat on the internet without finding those news stories, going back only as far as the day after NHS was instituted.

        Mind you, I’ve only personally cared for a few thousands of the millions of people that come here to the US for health care, and read about everyone, including those who view this country as the Great Satan, doing the exact same thing going back to forever (when they’re not going to someplace like Costa Rica to pay for it with straight cash). But do go on about how other countries’ policy of robbing Peter to pay for Paul’s health care is anything other than two crimes for the price of one.

        You might also Google TANSTAAFL.
        It’s probably better mental exercise than leaping to conclusions about whether and how casually non-vigorous and unexamined my assumptions are.

        Just saying.

        1. Y.

          Gee, there’s something like 150+ years of experience practicing medicine in my immediate and once removed family. Haven’t heard of medical tourism directed here, but that might be because publicly operated hospitals wouldn’t do it. I expect it’ll take off though, we don’t have lawyer infestations and for the same amount of money you can get better people bc of lower cost of living and no guild-like practices. (I was amazed to read US has put limits on numbers of certain medical specialists graduating per year)

          And as far as I know, no one is going against specialized hospitals around here. Best way of not getting an infection is not having sick people around – which is why you should never get serious, elective surgery at a major hospital, but rather in a small, specialized one which only does that one thing. What I’ve heard is that in such places you’re less than 20% as likely to catch

          I recall reading in Reason magazine or somewhere how US healthcare system, contrary to expectations, is biased against such establishments.

          You might also Google TANSTAAFL.

          Why should I need to google it. You think old men have a monopoly on reading old books?

          But do go on about how other countries’ policy of robbing Peter to pay for Paul’s health care is anything other than two crimes for the price of one.

          Isn’t that the basis of insurance?

          1. Mike_C

            >US has put limits on numbers of certain medical specialists graduating per year
            That may be correct, but my understanding is that the limit is the number of physicians entering any given subspecialty each year. The net effect is essentially the same, but the gate-keeping mechanism is not.

            But what really burns my butt about bars to entering the medical profession in the US is how we handle foreign medical graduates (FMGs, in our parlance). You need to take the US board exams to get a US license, which is fine and appropriate. But you also need to graduate from a US training program. (Only in rare instances, like a internationally-prominent academic being recruited to be director of research at Major Academic Hospital, is this waived.)

            So we’ve got fully qualified MDs from an advanced country having to completely retrain. As an example, if fully-qualified-in-Denmark cardiologist Dr Erica from Copenhagen wanted to practice clinical cardiology in the US, Erica would have to do SIX years of internship, residency, and fellowship, starting at under 60kUSD to work 80-hour weeks. (The trainee work week may be less these days — I went through the last hard class, of course ;-).

            So we don’t get a lot of Ericas from Copenhagen, or Charlottes from The Karolinska Institutet, or Wolfgangs from the Deutsches Herzzentrum München, or Nigels from the Royal Brompton Hospital, even though they’d like to live and work in the US, because the suckage of being an indentured servant (again!) for six years (or so, depends on specialty) outweighs the ‘Murrica! factor. Now some of you might be saying, hey, $60k is not a trivial sum, and no, it absolutely isn’t. But $60k per annum over an average of 60 hours/week works out to about $20 an hour. And you’re often working nights and holidays, which ain’t great if you’re in your 40s and have little kids. More to the point, your spouse has already put up with this shit back in your home country during your first set of training, and s/he ain’t going to be happy when you announce you want to cut your salary to a half, third, or less of what you currently make, so you can be chronically sleep-deprived and cranky for another six years. So bottom line, we put up high bars* to highly-trained, qualified physicians from advanced countries that share our western values and ethos (mostly).

            But we do get (in the lower tier community-hospital programs) a LOT of FMGs from third world countries. Most are fine people: intelligent, hard working, want to fit in. But some non-negligible fraction of others are to our standards, lazy, unethical, disparaging of women as naturally inferior, and so forth. Basically anti-western in outlook and ethos. As with immigration in general in this country, our priorities and standards are seriously screwed up when it comes to medical professionals.

            *bars to entry: yes, compared to being deployed in a shithole, medical residency is a cakewalk. Absolutely.

          2. Aesop

            Forgive me for not knowing that you had osmotically and genetically become an expert on healthcare. Silly me, I actually had to do it personally, and have no no ability nor claim to have somehow absorbed it through my DNA.

            If, despite your genetic absorption, you can’t conjure any acquaintance with medical tourism to a place with socialized medicine, I’d venture a guess that it’s because it generally doesn’t happen. Unless perhaps from someplace with something far worse by comparison. I shudder to imagine.

            But those limits on specialties here? That was part of ObozoCare. Seems under the old capitalist system, those bastards at the top of the academic performance curve who voluntarily bargained away decades of their lives in education, in return for debt large enough to afford luxury apartments in Tokyo, wanted some chance of repaying their student loans before their own Medicare kicked in, so they kept opting for more lucrative specialties. But preventing that sort of selfish nonsense, courtesy of our version of socialized medicine, was supposed to be a feature, not a bug.
            Also, those med school grads had some vague but clearly misguided notion that under our country’s Thirteenth Amendment to the Constitution, such involuntary servitude was expressly outlawed. But it seems that since 2009, there was an exception discovered for medical school graduates. And under a black president, no less. Who knew?

            As far as small, specialized hospitals, do tell how that works in practice. For instance, when you’re getting a coronary valve replacement at the Number One Coronary Valve Replacement Center, and you have a stroke during the procedure, what’s the morbidity and mortality related to the delay in transferring you to the Number One Cerebro-Vascular Accident Center across town, or even farther? Do people mind dying, or do they just put appropriate warnings on some boilerplate signage at the sign-in desk?

            I’m thinking it’s the patients here that are biased against such establishments, though we keep getting a steady stream of folks at the E.D. in ambulances from outpatient surgery centers like you describe, that are under-trained, under-staffed, and generally ill-equipped to deal with things – like medical emergencies – when anything not on their dance card happens. Which is what major hospitals call “what happens in medicine everyday, pretty much since before Hippocrates”.

            And in countries that have socialized medicine, like for instance Canada, when they only have 100 or so MRI machines in the whole country (because they cost money), unlike where I live, where we have one in nearly every hospital,(there are probably more MRI machines in nearby Los Angeles County than there are in all of Canada) what happens when someone needs an MRI and the nearest one is only 2 provinces and a time zone away?
            Do you assign appointments by distance, or alphabetically, or just start with the ones who survive the trek, and work through them all in order of arrival/survival? (Pretty much how our own VA gives out appointments too, by no coincidence.)

            But your idea about avoiding infections by not being around sick people is genius!
            I’m totally putting that one up on the board in the break room at work.

            Reading old books is a fine thing. Grasping the contents, even better. Applying the lessons to new situations, and one is dangerously on the verge of becoming educated. Which is why TANSTAAFL – applied to healthcare, or damned near everything – is why You always get exactly what you pay for never goes out of style, while every argument for socialized medicine has proven the idea to be a nostrum with a success rate too low to be recorded with existing instrumentation, and a absolute failure rate that both Murphy and the Keystone Kops would envy.

            And no, insurance doesn’t rob Peter to pay for Paul’s health care, because no one holds a gun to your head to force you to purchase that insurance.
            Oh, except for countries with socialized medicine.

            The usual name for shaking someone down like that is called a “protection racket”.
            E.g. “Hey, you seem to have a healthy, happy family there. It would be a shame if something were to happen to them. Why don’t you cough up three grand a month to us forever, so your entire life doesn’t burn down.

            Would that be
            a) Al Capone
            b) Bugsy Siegel
            c) every country with socialized medicine

            Until recently, I never had a single insurance policy against my will, nor was in any peril of life, limb, nor livelihood for deciding against the purchase of same beyond the ordinary risk (i.e. “sh*t happens”) of being alive, in and of itself.

            Now, if I don’t buy something I neither want nor need, the government has empowered itself(!) to confiscate my wages and throw me into prison simply for ignoring their ceaseless efforts to spend my money for me better than I do myownself.

            That’s not insurance; it’s terrorism.
            Thus socialized medicine is nothing but Al Qaeda, except with a scalpel instead of a sword.
            And this time, in service of bureaucrats instead of Mohammed.
            Both of which, being naught but endlessly greedy baby-raping goat-humpers, amount to just about the exact same thing.

            My head, in either instance, ends up in exactly the same place.

          3. Y.

            @Aesop

            Do try to explain the reasons why, if the US system is so clearly superior, life expectancy isn’t.

  3. John Distai

    Nosocomial infections (infections from hospitals) – one of the few lessons I remember from Microbiology class. That and “sterility” is a statistical concept, not an absolute absence of bad things.

  4. Tom Stone

    Nosocomial infections only kill 100K or so a year here in the USA, a trivial problem.
    Actually requiring Physicians to wash their hands between dealing with patients would be grossly insulting, it might reduce these deaths by a third or so but it’s clearly too high a price to pay.

  5. Bill Robbins

    Perhaps the safest way to undergo an inpatient surgical procedure is to bring your own brand-new, still-sterile-sealed endoscope to the hospital. That, a few pints of your own blood, and then, don’t touch anything, and try not to breath.

    1. Cap'n Mike

      I read lately that Cubans bring their own linens to the hospital.
      Maybe Fidel was providing world class health-care.

  6. Docduracoat

    A Semmelweis reference!!
    He is one of my heroes!
    He was so obsessed by the thought of all the women dying from unwashed hands that they had him committed to an insane asylum
    Where he died
    Removing the prostate gland is a routine operation here in the states, and with nerve sparing surgery there is a 75 % chance of remaining potent
    Viagra will help another 15% to achieve erections
    Infection rates are extremely low with routine antibiotic prophylaxis
    Nosocomial infections are not all caused by doctors
    There are nurses, technicians and patient family members in hospitals
    Any of them can cause hospital acquired infections
    Don’t just blame us doctors

    1. Hognose Post author

      Hey, you know how it is. You get the lion’s share of the money, the glory… and the blame. (Although the administrators are making a run at the money, aren’t they?)

  7. Quill_&_Blade

    I knew a big guy that looked healthy. He was carrying a large mirror in his house, which somehow dropped, broke, and cut him badly. He was admitted to a hospital, where he caught a bug and died. Be careful with glass.

    1. John M.

      Someone I know got MRSA in a hospital, one of many injuries and insults the medical profession in our country imposed on him while he was on his way to an early grave.

      -John M.

      1. Aesop

        Unless you know that they screened him for MRSA before he entered the hospital, all you or anyone else know is that he was diagnosed with MRSA while in the hospital. It frequently only makes a curtain call because while you’re in the hospital, you’re debilitated, but you’ve been carrying it around in your nose and on your skin for ages while you had a functional immune system.

        Last I looked, post hoc, ergo propter hoc is still a logical fallacy, despite the earnest efforts of the tort lobby to pretend otherwise.

        And MRSA is endemic in society, particularly among certain populations, as precisely such pre-hospital screenings are disclosing year after year, and thus were presumably so prior to such investigations.

        In short, the whole world needs to firstly wash its own nasty ass (and rest of body) with hot soapy water, more often than once a year, which seems to be the avg. among hospitalized patients.
        Just like your mother probably told you.

        1. Loren

          post hoc, ergo propter hoc
          Or you could have said:
          Correlation is not causation as we say in the fraudulent world of anthropocentric global warming.

          1. Aesop

            I also could have gone into the dubious statistical basis (“…and then, a miracle happens…“, or equally probable, some reliance on the timely appearance of the Underpants Gnome) for what is likely entirely manufactured “data” on the prevalence of nosocomial infection leading to deaths.

            Should there be anything like actual scientific data in support of same, it would qualify as mirabile dictu!.

            Far likelier is some @$$hole at CDC, if not he National Trial Lawyers’ Association, throwing darts at a board, and tallying up the points, then adding enough zeroes to sound good at parties.

          2. Aesop

            That took 0.02 seconds:
            https://www.cdc.gov/hai/surveillance/
            When the two most prominent words are “Estimated” and “about” when speaking of the number of deaths, you have the same “science” used to justify Anthropogenic Global Warming BS.

            I commend to one and all the difference between that sort of hogwash, and actual science, elucidated by no less a light at both science and medicine than the late Michael Crichton, in his Michelin Lecture at Caltech back in 2003:
            Aliens Cause Global Warming
            http://www.s8int.com/crichton.html

            Enjoy.

        2. John M.

          Interesting. I did not know that. I’ve only ever even heard of MRSA as being attached to hospitals.

          I can state with some level of confidence that he washed pretty regularly before entering the medical system. His overall system had been on the ropes with serious kidney issues for some months before he was diagnosed with MRSA, so it’s odd that it would’ve chosen that moment to strike.

          -John M.

  8. Mike_C

    In response to, well, really Aesop’s recent post on his own blog, I’ve taken care of more than one Canadian physician who crossed the border for the privilege of paying cash to get a cardiac procedure done in the States instead of back home. And it’s not for lack of good physicians in Canuckistan — the problem lays elsewhere in the system.

    As to MRSA, here is but one article on prevalence in the community, [stuff in square brackets my commentary]:

    Clin Infect Dis. 2008 May 1;46(9):1368-73. doi: 10.1086/586751.
    Epidemiology of Staphylococcus aureus colonization in nursing home residents.
    Mody L, Kauffman CA, Donabedian S, Zervos M, Bradley SF.
    Division of Geriatric Medicine, Veteran Affairs Ann Arbor Healthcare System,
    University of Michigan Medical School, Ann Arbor 48105, USA. lonamody@umich.edu

    BACKGROUND: [purpose] to determine the extent to which community-associated methicillin-resistant S. aureus (MRSA) has emerged in community nursing homes. [genetics and epidemiology stuff redacted]
    METHODS: 213 residents, with or without an indwelling device [e.g. urinary catheter, feeding tube, etc], from 14 nursing homes in southeastern Michigan. Samples were obtained from the nares [nostrils], oropharynx, groin, perianal area, wounds, and enteral feeding tube site. [microbiology stuff redacted]
    RESULTS: 131 (62%) were colonized with S. aureus (MRSA colonization in 86 [40%]). S. aureus colonization occurred in 80 (76%) of 105 residents with indwelling devices and in 51 (47%) of 108 residents without indwelling devices (P<.001). Of the 86 residents who were colonized with MRSA,
    nares culture results were positive for only 56 (65%). Eleven different strains of MRSA were identified [most people had hospital-associated strains].
    CONCLUSIONS: Extranasal colonization with MRSA is common among nursing home
    residents-particularly among residents with an indwelling device.
    PMID: 18419438 [PubMed – indexed for MEDLINE]

    Comments:
    1. although the authors have an Ann Arbor VA academic appointment, this study was NOT done in the VA. Also, the AAVA is one of the better ones (while this may be like saying that 'Peter Dinklage is a tall dwarf', I would note that AAVA faculty hold Univ of Michigan Medical School appointments, and are of the same professional caliber. Also, the residency and fellowship programs are integrated, so the same physicians in training work at both UMHS and AAVA).
    2. Yes, these are old and likely debilitated people. But consider that the caregivers at the nursing homes are exposed to these people, wipe their bottoms, etc; I can guarantee you that for the most part they do NOT practice good infection control. (How much training do you expect when they get paid $9.50 per hour — though the agency bills $24/hr.)
    3. So the MRSA carriage (=!= infected, mind you) rate in the nursing homes sampled is about FORTY percent. As noted above, the caregivers almost certainly have similar, if not higher, rates. They just don't get tested. And they have lives outside of work and contact other people. Bottom line there is a LOT of MRSA (and other concerning bugs) out there.
    4. Handwashing. Oh I have stories. As do all healthcare workers, I am sure. Same as restaurant people have their horror stories as well.

      1. Aesop

        MRSA is much like multi-drug-resistant TB, in that to ensure one is clear of it would require a prolonged course of multi[ple heavy-hitter antibiotics, and careful monitoring, to properly rid the host.
        That would be true for both the patients and staff at most nursing homes.

        Followed, in all likelihood, by burning said establishments down, with all the associated patient belongings, then rebuilding them from scratch.

        Otherwise you’d clear a person of the infection, then set them back in the same virtual MRSA cesspit them came from, and re-infect them in a matter of days to weeks.

        In short, impossible, because not going to happen.
        A crapton of health-care workers are probably also colonized, but it doesn’t matter to them nor con. home patients, as long as they have functional immune systems.
        But when they get seriously ill, all bets are off, and Death will have his due, sooner or later.

        The nec. fasc. in the OP, OTOH, generally only makes an appearance after slipshod practice and ignorance, something socialized medicine supplies out of all proportion to any care not involving chicken sacrifice and bones in the nose. Which is its true spiritual forbear.

        People who flee socialized medicine – once in a while – are thus the Boat People of medicine. The adherents of medical communism like to pretend that they don’t exist, but because they don’t actually float here or elsewhere on garbage rafts, and pay suitcase-loads of cash, they seldom get noticed.

        Much as illegal immigration here prevents revolution in Mexico, if we simply forbade that sort of thing, we’d only drive the money to places like Costa Rica, where one can have world-class medical care for cash money on the barrelhead, and probably eventually drive the stake through the idea elsewhere, as those unable to afford the steeper-costing Cadillac care would be forced to rescind it at home. Or die in batches, something socialism excels at.

        Something also under-reported is the prevalence of all those cradle-to-grave socialized medicine programs elsewhere in the throes of dismantlement through lack of funding, or simply plodding along as dead as the people they nominally care for while actually providing nothing more than a shroud, with all the compassion of the DMV, and the competence of the VA. Sic semper socialized medicine. This is what happens when you enact a Ponzi scheme, and carry it through to its inevitable conclusion, with people’s lives as the chips in the game.

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