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Maine Quarantines Travelers From France Citing Risk of Body Odor Transmission.

Augusta, ME -- Jaz Fedor became the first victim Wednesday of Maine's mandatory 21 day quarantine for travelers returning from body odor stricken areas of Western France.  Two state officials escorted  Mr Fedor from his flight to his home for involuntary house arrest to be monitored twice daily for signs of body odor.  Maine's latest segregation efforts, signed into law yesterday by Governor Paul LePage, were based on public outcry and not on sound scientific principles.

"The citizens of Maine have a right to walk the streets without getting infected with body odor," said Mr. LePage,  who considers BO a major public health issue after a personal scare while stranded on a runway several years ago.

The announcement comes less than a day after  nurse Kaci Hickox  refused to self quarantine herself upon returning to Maine from Ebola stricken West Africa.  Maine Governor Paul LePage began enforcing a mandatory 21 day Ebola quarantine for healthcare workers risking their lives to help victims in Africa.

"I don't get it.  I'm a metrosexual.  I'm probably the cleanest guy in Maine," said Jaz, who promised to fight his quarantine from his bathroom, where he showers at least four times a day.

CNN and Fox News, competing with nonstop coverage of the French BO outbreak on their CNN-2 and Fox News Light sister sites, say the smells are especially noxious and mutations could lead to spread by human contact.

"Until we know more about this strain of body odor, I am not willing to risk an outbreak of BO in my great State of Maine," said Governor LePage.

Although nobody believes them, The Centers for Disease Control and Prevention says there is no current evidence in support human-to-human transmission of body odor.  "We do not support the Maine quarantine of travelers to Western France," said CDC Director Thomas Frieden.


Ebola Like Physician Signature Forces Hospital Into Quarantine

Sacramento, CA --  Just days after New York and New Jersey announced strict new quarantine procedures for healthcare workers returning from West Africa, California Governor Jerry Brown upped the ante by signing legislation that requires all healthcare professionals to report anything that looks, sounds, acts, feels, tastes or smells like Ebola.

Hours later, the sixth floor surgical ward at Bayside Hospital was quarantined by The Centers for Disease Control and Prevention after a veteran nurse reported seeing an unidentified physician signature that looked strikingly similar to Ebola.

"As soon as I saw that signature, I started singing that Ebola song,"  said Carly Sandoz,  the goto nurse for deciphering physician signatures on the sixth floor.   Carly contacted the CDC after her concerns were brushed off by hospital officials. "They told me just to add an extra loop on the signature so it longer resembled Ebola."

CDC officials believe they have narrowed down the signature to a new surgeon who is writing all his notes in pink this month to show support for Breast Cancer Awareness Month instead of donating money.
Ebola Virus Signature Found On Patient Chart

Promising a full investigation,  CDC hired local handwriting experts to determine if the Ebola like signature poses any threat to public safety.  "At this time, we don't think Ebola can be spread through signatures, but I can't say we've really ever checked," said Dr. Thomas Frieden, Director of the CDC.

As a result of Proposition 72, California's new Ebola Law, The CDC is preparing for an onslaught of calls for help from healthcare providers.  In less than 24 hours since the legislation was signed into law, state healthcare practitioners have reported over 3,000 Ebola sightings, including a hairball in the sink at a local nursing home, a gallbladder removed at an outpatient surgical center and a bezoar removed during an urgent upper endoscopy in the ER.


Illinois Entrepreneurs and Small Business Need SHOP Employee Choice

Illinois is one of 18 states recently granted a delay by the Department of Health and Human Services for the employee choice feature of the small business health options program marketplace, or SHOP.

But what exactly is employee choice, and why is this important to small business owners? Below are some frequently asked questions and answers to help small employers learn more about this crucial provision of the SHOP.

Q: Just what is employee choice?
A: Employee choice is a feature of SHOP that allows small business workers to choose from a number of plans from different insurance carriers. The employer chooses a healthcare plan tier level (bronze, silver, gold and platinum), and the employee then chooses among a variety of health insurance carriers within that tier.

The healthcare plan tier level is based upon what percentage of healthcare costs a plan will cover. For bronze plans, insurers pay 60%. For silver plans, insurers pay 70% of healthcare expenses. Gold plans pay 80% and platinum plans pay 90%. The employee choice option is important to employers and their workers because it allows employees to pick a plan and carrier that works best for their needs, instead of the business owner choosing for them.

Q: Why is the employee choice feature important to small businesses?
A: By including employee choice in the SHOP, the Affordable Care Act reverses a longstanding market trend that left small employers on unequal footing. These kinds of benefits have historically been reserved for large businesses and public employees, while small businesses often have to offer a “one-size fits all” plan with added cost and fewer benefits.

Based on Small Business Majority’s opinion polling, it is clear small business owners want to offer this to their employees. The Small Business Majority found two-thirds of small employers believe allowing employees to choose from multiple carriers is an important element of the SHOP. And for small businesses, this component is fundamental in distinguishing the new SHOP marketplace from the outside health insurance market.

Q: What impact does the delay of employee choice have on Illinois’ small businesses?
A: The HHS final rule allowing states to opt out of employee choice for yet another year harms small businesses because it puts them at a competitive disadvantage to large firms that are able to offer a choice of plans to their employees. In states like Illinois, where the SHOP marketplace is run by the federal government, allowing further delay of employee choice puts small businesses at a competitive disadvantage to small employers in other states where marketplaces have employee choice.

Q: When will Illinois small businesses have access to employee choice through SHOP?
A: Barring any further delays, Illinois will implement employee choice in 2016. Employers will then be able to offer the additional benefit of allowing their employees to choose which insurance carrier they’d prefer to use for their health insurance.

While the Administration’s decision to allow states to delay employee choice for an additional year was a letdown for small business owners, the SHOP still helps small employers compare and evaluate health insurance options and get the small business tax credit to help with employee premiums.

Learn more about the SHOP, employee choice and enrollment by reading the Small Business Majority’s Health Coverage Guide which contains a wealth of information for small business owners regarding enrollment, the Affordable Care Act, and the healthcare system.

Jesse Greenberg
Director, Midwest and West
Small Business Majority


Funny Ebola Shirt: Perfect for Public Transportation.

The Happy Hospitalist is proud to present the perfect shirt for public transportation.    Ebola is no laughing matter, but funny Ebola shirts are.  Are you a New Yorker in a hurry?  Hop onto your local subway and stand proud while onlookers scatter.  Need a night out bowling with your buddies?  Get the lane of your choice with the power of Ebola.   In a hurry to get through checkout?   Whip out your Ebola shirt and you'll move to the front of the line.

Is your ER waiting room crammed full at 2 a.m. with non urgent nonsense that can wait until you're off shift?  Casually remove your scrub top and take a nice leisurely stroll through triage.   Bam.  Problem solved.   Are you a hospitalist who needs to round on 42 patients before noon?  Make sure to "forget your scrubs" and wear this shirt with pride.  Are you a nurse who needs help silencing the call light?  Casually  explain to the patient that distribution is getting you a new pair of scrubs while you wear this shirt with confidence.

With your very own funny Ebola shirt, you are in control.   Buy yours today, only from  The Happy Hospitalist Zazzle site below.  You can find the complete collection of Zazzle humor for sale at this link here.

"I just got back from a West Virginia conference about healthcare in Africa and all I brought home was this Ebola shirt"







Secret Service Agent No Match For Little Old Ladies at Local Hospital.

San Antonio, TX --  When hospitalist Tony Gibano hired off duty White House Secret Service agent Frank Sieve to stand guard outside Memorial Hospital's Emergency Department, he thought he had concocted the perfect no-hitter plan on his final night shift before vacation.

"I thought nobody would get through his badge and gun, but it turns out all his buddies call him Leaky Sieve,"  said Dr. Gibano, who ended up with 22 admissions, including one lady who's Cardiologist son demanded she be admitted while her house was being painted.

Using patient profiling criteria, Mr. Sieve was given explicit instructions to prevent entry to ER triage of all possible hospitalist admissions, but that didn't stop one family from walking right past him  with a note that said 'Took grandpa off hospice.  Will be back after Christmas to pick him up.'"

"The guy was terrible.  I watched him waive EMT through with an incontinent 95 year-old demented nursing home woman patient in the middle of her colonoscopy prep yelling 'Help me!  Help me!'"  said ER nurse Janice Fleming, who found out later the nursing home was too short staffed to clean poo, as usual."

"Eye-balling that lady from my work station, I'd say she had at least seven admission criteria.  The ER doctor was calling the hospitalist before we even checked her in."

Rarely at his post, Mr. Sieve spent most of the night at the nursing station trying to get a date for Saturday night.  "He kept flashing his badge yelling 'Wanna hear a secret?', hoping one of the nurslings would pay attention," said Janice, who admitted this show was even better than watching Frank the security guard get hurt during a code assist on a seven year-old last year.

At his busiest, Dr. Gibano cried out loud when he got called to admit Too-Old-To-Go-Home, Too-Angry-For-Discharge and Too-Healthy-To-Answer-A-Yes-No-Question-Without-Telling-A-Story while Mr. Sieve was preoccupied calling a cab for two patients leaving AMA with their PCA Dilaudid pumps in tow.

Dr. Gibano gave up on any chance of a decent night when he watched Mr. Sieve wave through an armed man demanding a turkey sandwich and a shot of Demerol, because he was too busy talking to Trixie, a local street hooker hired by the hospital to improve patient satisfaction scores among dirty old men, which is most of them.



How To Make a Doctor or Nurse Cry: The Tragic Trinities.

The Happy Hospitalist asked Facebook fans to describe three diseases or patient and family characteristics  that lead to tragedy for healthcare providers when seen in combination with each other and the results were remarkable.   If you are not yet a fan of The Happy Hospitalist Blog Facebook Page, make sure to join now and never miss another status update again.   Every doctor or nurse has their own  tragic trinity combination that brings tears to the very psyche of their soul.

For example, some doctors have pseudoseizures when they see  the tragic trinity of pelvic fracture + observation status + angry daughter watched the 60 Minutes episode on demanding physician write inpatient order.  Some hospital floor nurses cry uncontrollably when they see naked crazy guy in ER +  5 minutes to end of shift + phone ringing with ER ready to call report.  Exposure to these deadly combinations will help doctors, nurses and other healthcare providers survive should they ever find themselves in these dangerous situations.

Dionysus
Is this humor dark and tasteless?  Yes.  So is burned tofu, but you never hear anyone complaining about that.  If you are not in healthcare, you won't understand the crude humor presented here.  If you have a weak stomach, I suggest you stop reading immediately and get some Pepcid.  However, if you are a healthcare provider and you want to learn about potentially deadly combinations you may encounter in your career, I suggest you keep reading.  Study these tragic trinities.  Memorize them and prepare yourself for the day when they show up in your clinic, ER, nursing home or hospital floor.

Without further delay, here is the definitive list of The Tragic Trinities of Healthcare.  If you happen to think of any that may have inadvertently been left off the list, make sure to add them to the comments so all doctors, nurses and other healthcare professionals can  prepare themselves.
  • 93 years old + family no longer allowing ativan to be given + patient thinking they're in combat.
  • Frequent flyer overdose (found down naked in her yard again) + schizophrenia + doctor who thinks its funny/appropriate to order 0.5MG haldol!
    •  I might as well spritz it in the air and ask her to inhale! Jeesh! It's 5mg per dose or don't bother ordering it!
  • Pancreatitis + npo + walking off to eat in cafeteria, always back in room when pain meds due with pain and vomiting.
    • Yells at staff to push Dilaudid 4mg and phenergan 50 mg faster (and you were 3 minutes late with the meds). 
  • Moving in with lamp, bath rug, own cordless phone, and pumpkin to carve (along with knife) + on Medicaid + has lawyer, and mother on speed dial and brags about getting disability due to his back issues.
  • Explosive diarrhea + non ambulatory + family left so they 'wouldn't be in the way'.
  • Dementia + UTI + daughter who has spent a little too much time on Web MD.
  • Sleeping meds + bowel meds + unable to transfer without ceiling lift.
  • 91 year old LTAC patient with chronic peg and trach + failure to wean or thrive + full code.
  • Missed period + wants pregnancy test + brought all 5 kids under the age of 4 because couldn't afford a babysitter.
  • 95 years old + fall resulting in hip fracture, SAH and fractured ribs + momma will be fine!
  • Bath salts OD + severe agitation on ketamine drip on a vent + the mom that claims "my baby would have never done those he if knew they were drugs!
  • Viagra + nitro + wife and girlfriend at the bedside.
  • Child with fever for 3 days, no meds + used EMS to come in + no ride home + needs a work note for a shift that starts in 30 minutes.
  • Missed last 2 dialysis treatments + increased SOB + going to leave AMA once emergent dialysis treatment is over.
  • Psych patient on the medical  floor with 1:1 sitter + poops in his hands and rubs it in his leg wounds so he can " die from infection" + decides to walk the unit and has blood dripping from leg wounds + is farting and pooping as he is walking through unit with gown dragging and butt hanging out. 
  • Severe COPD + chronic trach + kicked out if LTAC for smoking through the trach.
  • Confusion + C. diff + family who won't wear the isolation gowns and stand over your shoulder telling you how to take care of the patient.
  • Chronic pain + Substance abuse history + "allergic" to NSAIDS. 
    • But that Dilaudid stuff worked pretty good.
  • Hillbilly trifecta: Hillbilly + ATV + Alcohol/Narcotics.
  • ESRD + severe sepsis + has  son who is a doctor in another state that wants everything done for his mother who is 96 years old.
  • ETOH + GIB + family in denial.
    • "What did you do to make dad crazy.   He doesn't drink!"
  • End stage disease + pain/anxiety + spouse refuses all benzos and  narcs because he'll get better if he's not sedated.
  • Child with mild rash + stay at home mom with multiple rings and Coach purse + cancelled Zumba class.
  • Ivy League grad student + too drunk to go to jail +  JCrew sweater/shorts = douchebag trifecta.
  • Gangbanger with a GSW +  3 baby mommas all showed up at the same time and are not happy with each other + a couple of suspicious looking characters stalking the hallways trying to find this idiot so they can finish the job.
  • Fibromyalgia + ETOH + expert at knowing how to abuse the system.
  • Metastatic disease + comfort care + crazy daughter wants IVF antibiotics, solumedrol and accuchecks.
  • Fainted at home + didn't call doctor + on five blood pressure meds + anemic from chemo + lives alone.
  • Missed probation appointment + dirty urine + "If I'm not admitted, I'll kill myself".
  • Patient npo sneaking water from the faucet + profusely vomiting + legitimately sick with pancreatic issues and a high BAC.
  • Chronic pain + 7 medication and 4 food allergies + 3 Service animals for "stress disorder".
  • Status post five rounds salvage chemotherapy + Hypotensive and tachycardic in oncology clinic + Direct admitted for goals of care discussion and hospice placement.
  • Fibromyalgia + neuropathy + bipolar
  • Middle age divorce + Bipolar + quack diagnosis of adult onset ADHD + dexamphetamine prescription + internet testosterone injections.
  • A non-compliant diabetic, frequent flyer + who does drugs and comes in only to vomit every where because of the DKA + when feeling better demands all sorts of things than signs out AMA!
  • Intubated/near extubation pneumonia + psych patient in which doctor discontinued all psych meds + sedation "holiday".
  • Patient with TIA symptoms that left AMA and came back after you filled out AMA paperwork + wanted TPA when he returned and physician ordered it and you had to administer it + leaving AMA again 3 hours later.
  • Hasn't taken any insulin or done a finger in a month ( cuz they didn't feel like it) + ate whatever they felt like + blood glucose over 1000 + an enabling significant other....
    • I think we could actually keep this one going.
  • Large, former military man + new neuro checks ordered from a fall + extreme Sundowner's with paranoia. 
  • Pre syncope + 35 medications + 93 years old, with very very concerned children if patient will survive the night.
  • On a balloon pump + stands up to poop + what a wonderful day, 
    • Called the cardiologist and they say "Huh, bet you never saw that before!"
  • Multiple fractures + DT s+ Laculose.
  • Trach + pseudomonas + head injury.
  • Numbness/tingling + 15 "allergies" (ranging from vanilla flavor to morphine) +  history of anxiety or headache.
  • Patient with spouse of 8+ years at bedside for hyperglycemia with stated signs and symptoms of high blood sugar being a swollen vagina with blisters + husband also reporting same symptoms when his blood sugar is elevated + RN notes herpes outbreak during straight cath.
  • Patient observed throwing themselves out of their wheelchair + they really didn't need it +  then screaming for help while you are trying to triage a walk in MI
  • Inpatient with severe asthma + walked out on own after less than 24 hours with IV in arm "to brush teeth" +  readmitted to ER via ambulance less than half-hour later.
  • Goody powder + pradaxa + anything.
  • Chronic dizziness + drug "allergies" + borderline personality disorder.
  • Severe DTs + "allergies" to Haldol, Ativan, and Librium + enabling daughter at bedside that says that shes going to take daddy for a smoke and a drive just as soon as he gets released. 
    • And of course, he "don't drink but 6 days a week!"
  • Dementia + chronic fatigue + only daughter is a lawyer in New York.
  • Fibromyalgia + 8 drug allergies + TID Xanax = 3 vials of propofol for anesthesia induction and a rough emergence.
  • Sepsis + DTs/withdrawal + combative and wanting to spit at everyone + RN making it to the back of his head to put a mask on his face while others are restraining his wrists = him spitting on himself.
  • Allergic reaction to lisinopril + steroid allergy + no mental capacity to appreciate the irony.
  • Uncontrolled pain + daily office visits + incomplete documentation, coding and compliance queries provider for documentation. (The coder's perspective)
  • Dialysis + patient is a tree stump (mostly amputated bilateral legs and arms) + unstable arrhythmias.
  • 92 year old family matriarch + full code + 37 family members with sudden onset of acute tachylordia with multiple JC's--except the two that "done fell out".
  • Gastroparesis + narcotic dependence + morbid obesity or anxiety.
  • Acute respiratory failure + acute on CRF + worse CHF = circling the drain.
  • Nausea and vomiting + no IV access+ new resident.
  • Smoker + COPD on home O2 + family keeps leaving room to go on smoke breaks.
  • 600 pounder + refuses the bariatric room + is max assist.
  • OD + opiate addiction + EMS administered Narcan.
  • Gastroparesis + no veins + no brains.
  • Weakness/dressing change/uses a walker + certified by psych for inpatient mental health + unfunded status needs to go to state hospital = 5 month hospitalization.
  • Non-English speaking + terminal illness +family 'wants everything done'.
  • 8 medication allergies + fibromyalgia + on Seroquel.
  • Morbid obesity + chronic joint pain + poor surgical candidate.
  • CHF + advanced COPD + on a ventilator.

"How to make a nurse cry:  chronic pain + 14 food allergies + 3 service animals for stress disorder."


How to make a nurse cry: chronic pain + 14 food allergies + 3 service animals for stress disorder photo humor meme.



Lasix Changes Name to Lasixtoeight. "Lasts Six Hours" Called False Advertising.

Bridgewater, NJ -- Sanofi-Aventis was forced to change the brand name of its loop diuretic furosemide from Lasix to Lasixtoeight yesterday after the drug maker admitted knowing all along Lasix lasts six to eight hours and not six hours as the name implied.

Attending nurses, pharmacists and physicians have been telling students for decades that  Lasix stands for "lasts six hours".  This teaching moment has helped propel brand name Lasix to cult drug status, unmatched by any other medication in the pharmaceutical world, except perhaps the excitement of the adenosine pause.

Generic furosemide is rarely prescribed because the story of brand name Lasix has been universally enjoyed on rounds by medical, pharmacy and nursing students for decades.   As most students mature, they naturally prefer Lasix over furosemide and all other diuretics.

"What the Hell is furosemide.  Never heard of it," said Dr Mark Fleming, Director of the Internal Medicine Residency Program at Harvard Medical School, who also admits telling the 'lasts six hours' story at least seven thousand times during his tenure at Harvard.  "Sometimes I'll order Lasix on a patient just so I can tell the story again," said Dr Fleming.

Very few attending pharmacists and nurses are comfortable dispensing furosemide because of their lack of familiarity.


"If our 3 a.m. chart checks discover an order for furosemide, I have instructed our floor nurses to call the doctor immediately and get conversion dosing to Lasix before the morning dose is due hours later on the next shift,"  said Nancy Parkman, Director of Nursing at Lakeview Nursing Home in Bridgewater, New Jersey.  

As students mature, most tire quickly of the excitement attending physicians display in telling Lasix lore.  "As a resident, I only write for furosemide, out of spite," said Sandy Wigham, a first year intern who also enjoys going straight to 12 mg of Adenosine inside of 6 mg.  

Internal documents obtained from the US Food and Drug Administration confirm the drug maker has known for  decades that using the name 'Lasix' would give the drug an unfair marketing advantage over competing loop diuretics, Bumex and Demadex.

"Who's going to order Lasixtoeight?  I can't even pronounce it," said Pamela Stevens the Sanofi-Aventis drug rep who lost her job selling Lasix as a result of the name change.  "Most doctors won't presecribe something they can't pronounce."

Feeling the heat from investors, Sanofi called $4-a-month generic furosemide a garbage drug and responded by offering a one month supply of  Lasixtoeight for $80 instead of the normal $300 charged for brand name Lasix.  

Shortly after the Lasix name change, Roche Labs, owner of competing diuretic Bumex, filed an FDA application to change the name of Bumex to Lasix after fudging data to show diuretic activity was actually just six hours instead of six to eight hours like Lasixtoeight. They are hoping nobody at the FDA will notice the change. 



CDC Ebola Isolation Protocol Deficiency Discovered

Atlanta, GA --  The Centers for Disease Control and Prevention (CDC) apologized Monday for blaming a protocol breach as the source of hospital acquired Ebola infections in two healthcare workers at Texas Presbyterian Hospital in Dallas, Texas shortly after discovering major deficiencies in their own Ebola isolation protocols.

"We apologize to all healthcare workers personally offended by our protocol breach accusation resulting in Ebola transmission.  It turns out it our protocol needed updating,"  said Tom Frieden, CDC director since 2009.

Mr Frieden came clean after a CDC intern discovered a copy of the The Official CDC Ebola Isolation Protocol on Google and reported his concerns to Mr. Frieden immediately.

The CDC hopes to have an updated Ebola isolation protocol available for all healthcare workers early next year.  Until then, they are requesting all hospital workers, who come into contact with an Ebola patient, draw a giant E in permanent black marker on their right shoulder so everyone around them can act accordingly.


Official CDC Ebola Isolation Protocol for Healthcare Workers
Official Ebola Isolation Protocol for Healthcare Workers 

You can buy your own isolation protocol shirt or other assorted isolation protocol gifts only from The Happy Hospitalist's Zazzle store.


ER Ebola Quarantine Screening Tool: A CDC Guide for Healthcare Workers

Atlanta, GA --  Just one day after the viral release of Who To Blame When You Get Ebola, the CDC has released a follow up ER Ebola screening tool to help emergency departments determine which patients need to be quarantined immediately.  Fear continues to grip the country after two nurses at a Dallas, Texas hospital contracted Ebola virus in the course of their normal workday activities.

"We know, without a doubt, this  all inclusive and fail proof ER Ebola screening tool will help healthcare workers know when to immediately initiate quarantine protocols.  There's no way anyone will be missed if this protocol is not broken,"  said Tom Frieden, Director of the CDC, being careful to avoid use of the word 'breached'.

The CDC has been under constant attack after blaming a breach in protocol as the cause of Ebola  transmission at Texas Health Presbyterian Hospital.  The White House has since responded by  organizing Ebola SWAT teams ready to travel anywhere in the country and hunt down healthcare workers who call in sick after Ebola strikes their hospital.    The White has even appointed a lawyer, Ron Klain, as this nation's  Ebola Czar to help triage lawsuits against community hospitals for failing to keep their yellow gown supply closet fully stocked during an outbreak of Ebola.

Not everyone is convinced the quarantine tool goes far enough.  "They should have just quarantined the whole country of Texas," said Rusty Bender, a college graduate living with his mother despite a Bachelor of Fine Arts degree.

EBOLA ER QUARANTINE TOOL photo.



BREAKING NEWS UPDATE!

In response to public criticism, the CDC has updated their Ebola ER quarantine tool to yield a greater net of protection.

"Retrospectively, we realized our original protocol failed to account for the possibility of some folks traveling out of Dallas to other communities, which we just didn't think of at the time," said Tom Frieden, in a hastily called news conference while wearing full barrier protection at his home.

The CDC is asking healthcare professionals to ask ER patients if they have come in contact with Ebola in the last 3 weeks.  The CDC understands most patients will have no idea and have accounted for this possibility in their updated guidelines.

"We want to be as thorough as possible and not have people who may have Ebola infecting our planes, trains and automobiles." said Mr. Frieden.

The CDC offered little guidance regarding the risk of coming into contact with Ebola, except to say anyone who witnesses a healthcare worker wearing scrubs at a grocery store should keep a large perimeter distance and to yell 'EBOLA", then call 911 if they see them coughing or sneezing.


Updated ER Ebola Quarantine Screening Tool from the CDC (algorithm)



Ebola Halloween Hazmat Costumes Sell Out: CDC Found Hoarding Them.

Atlanta, GA --  Hours after Mark Zuckerberg donated $25 million dollars to the Centers for Disease Control and Prevention (CDC) to fight Ebola virus, Amazon sold out of Ebola hazmat costumes and thousands of Halloween shops from Los Angeles to New York confirmed brisk sales for Ebola gear ranging from age 3 months to XXXL.

After telling reporters his agency must 'rethink the way we address Ebola infection control', CDC Director Tom Frieden has confirmed he authorized spending all 25 million dollars on over-the-counter Ebola costumes.

In a news conference yesterday, the CDC proudly announced their well planned protocol to protect healthcare workers using Ebola costumes, describing them as 'full barrier protection gear with a Tyvek suit, eye protection, 2 Surgical masks, 2 Pairs of gloves, booties, Duct tape and plastic bin for easy storage.'

"We want doctors and nurses to be like, 'Damn. love your Ebola gear!" said the reliable source high inside the ranks of the CDC.

Some CDC employees knew a major policy shift was planned days before details were confirmed at the news conference.   Sarah Stenson, a CDC employee laid off yesterday for saying the word 'Ebola' out loud during work, a no-no, confirmed seeing several employees playing with bright yellow Ebola Hazmat outfits that looked identical to the ones she bought her 3 and 8 year-old boys for Halloween.

Ebola Halloween Costumes Seen Helping Hospitals
"My boss asked me last week how to sign up for Amazon Prime and now these Ebola costumes  show up on his desk complete with goggles, air mask, gloves and full body suit.  Coincidence?  I think not."

The CDC has acknowledged a need to better protect hospital workers against Ebola as a second healthcare worker at Texas Presbyterian Hospital tested positive for Ebola virus after caring for Eric Thomas Duncan, the Liberian who has since passed away of this deadly disease.

Rapid response teams within the CDC are now prepared to travel anywhere at a moment's notice to drop off enough Ebola costumes for 14 of the required 21 days of isolation.  However, due to the national shortage in Ebola costumes, the CDC is asking hospitals to recycle the gloves and suits by "turning them inside out' when supplies run low.

"We are also asking hospitals to return their Ebola costumes to CDC headquarters once the coast is clear so we can wash them out and give them to other hospitals that are in dire need of barrier protection," said Mr. Frieden proudly.



Who To Blame When You Get Ebola: A CDC Guide For Healthcare Workers

Atlanta, GA -- The Centers for Disease Control and Prevention (CDC) announced new flowchart guidelines Monday to help healthcare workers understand who they could  blame once they contract Ebola in the hospital setting.  The new recommendations follow declarations by Dr Thomas Friedman, Director of the U.S. Centers for Disease Control and Prevention, that nurse Nina Pham in a Dallas, Texas hospital contracted Ebola due to 'protocol breach' while caring for the now deceased Ebola victim Thomas Eric Duncan.

Nurses are used to getting blamed for everything.  In fact, most nursing programs teach nurses how to take one for the team when bad things happen.  Getting blamed for spreading Ebola is naturally accepted by most nurses as business as usual.

"After speaking with representatives from the American Nurses Association, everyone agreed blaming nurses for spreading Ebola was just the easiest thing to do," said Jason Fenster, a CDC spokesman who blamed his nurse last year for undercooked eggs while hospitalized for an undisclosed infection contracted at a CDC laboratory.

Following the release of these CDC guidelines,  officials at the Dallas, Texas hospital confirmed they are probably going to blame three or four nurses for spreading Ebola while taking care of Mr. Duncan, including one on maternity leave for the last six weeks.

"I've been in the hospital CEO business for 30 years.  Whenever bad things happen in a hospital setting,  we can count on at least one nurse to take the fall.  In fact, I'm so confident that a nurse is always at fault, we built an entire section into our hospital rules and regulations titled 'How To Blame a Nurse For Anything Bad That Could Lead To A Lawsuit," said Jed Brainer, CEO of Texas Presbyterian Hospital.

A spokesman at the CDC, who wished to remain anonymous, says guidelines to be released next week  for non-healthcare workers and pets who contract Ebola will likely blame nurses as well.

You can purchase this original algorithm as a t-shirt at The Happy Hospitalist Zazzle store here. It's also available as a coffee mug too! 


"Who to Blame When You Get Ebola:  A CDC Guide for Healthcare Workers"

Who to blame when you get Ebola. A CDC guide for healthcare workers flowchart humor photo.


Make sure to check out the complete collection of original Ebola humor memes, stories and commentary only from The Happy Hospitalist.


Respiratory Rate of 20 Charted In Dead Patient Leaves Hospital Officials Baffled.

Babylon, NY --  Death pronouncements at most hospitals require a bedside patient evaluation to verify the absence of spontaneous respirations, but a death last week with a final respiratory rate of 20 documented in the electronic medical record (EMR)  has officials at Methodist Hospital scrambling for answers.

"We have no idea how a dead person could have a respiratory rate of 20 documented in our EMR,"  said Lance Dugan, the Methodist Hospital CEO with no experience in medical documentation.

An outside consulting firm with specialized training in after-death EMR documentation has been  hired to lead the investigation, but hospital nurses believe they already know the answers.

"If you look at the drop down menu for respiratory rate it says, 'You have set your default respiratory rate to 20.  Would you like to change it?'", said a nurse at the hospital who wished to remain anonymous because diagnosing EMR issues was not within her scope of practice.

"Most nurses created a default respiratory rate during EMR orientation last year.    Some nurses chose 16.  A few chose an odd number like 17 to make it seem believable.  But, I'd say 90% of us chose 20  like we did on the old paper charts."

Many EMR systems allow automation of daily charting activities.    A closer look at the Methodist Hospital EMR discovered a glitch that doesn't prompt the nurse to change her default respiratory rate vital sign field in the event of a death pronouncement, a critical error I.T. officials said would be fixed by the end of the day.

"We have asked our vendor to modify the respiratory rate field to include a default option for death pronouncements,"  said Mary Jennings, an I.T. representative with no experience in medical documentation.

Respiratory rate of 20 in deceased patients is quite common.
"In addition, some nurses have suggested we change default respiratory rate settings to simply low or high and that change is currently under serious consideration."

The New York State Nursing Board has come out in support of default respiratory rate settings in EMR vital sign fields and feels Methodist Hospital is to blame for not providing respiratory rate death options in their electronic record.

"Our New York nurses are simply too busy to count to 20.  We will continue to push for all technology that provides for more automated charting opportunities and less bedside activities for our members,"  said Nancy Schneider, a nurse with no experience in medical documentation.

"Your charting shows a respiratory rate of 20.  The lie detector determined that was a lie."

Your charting shows a respiratory rate of 20. The lie detector determined that was a lie humor meme photo.



Pre-Hospice Cardiac Clearance Recommended By American College of Cardiology.

Nashville, TN  --  The American College of Cardiology (ACC) created havoc Wednesday with  a landmark position paper recommending all patients considering hospice undergo pre-hospice cardiac clearance prior to initiating comfort care measures.  The College's expansion into pre-hospice evaluations coincides with Medicare's announcement of another 20% cut in reimbursement for cardiac services by 2016.

"While the A.C.C. doesn't have any hard data to prove this hypothesis, we believe hospice candidates who undergo thorough cardiac clearance prior to starting a comfort care program will really appreciate knowing their ejection fraction, the health of their heart valves, whether they are at risk for myocardial infarction  and the potential for any rhythm issues that could complicate their hospice program," said Raj Chopra, M.D, M.P.H, F.A.C.C, Chair of the Task Force on Clinical Expert Consensus Documents.

Position publications by medical societies often provide support for their members  despite a lack of strong clinical research to base their conclusions.  Many position papers contain low grade evidence or expert opinion that becomes standard of care in many communities.

"We actually prefer publishing position papers using expert opinion rather than Grade A evidence because, to the lay physician,  having the word 'expert' in the paper carries more weight," said Raj, a self proclaimed expert in the benefits of end-of-life pacemaker therapy.

Because hospitalists are frequently involved with palliative care decisions, the A.C.C. has been working closely with The Society of Hospital Medicine (SHM) to disseminate continuing medical education modules on pre-hospice cardiac clearance.  In return for their support, S.H.M. is begging A.C.C. members to stop publishing cardiac studies with acronyms that spell out words.

"The acronyms used to be cute, but now they're just annoying," said one SHM board member, who wished to remain anonymous.

The American Academy of Hospice and Palliative Care responded by recommending patients considering hospice rip off their telemetry and play dead already if any cardiologist came to their hospital room.



Illinois Granted Early Access to SHOP Marketplace

Yes, the Affordable Care Act offers individuals and families quality health insurance, but did you know small employers with less than 50 full-time equivalent employees can take full advantage of the Health Insurance Marketplace? Online functionality for the SHOP, aka the Small Business Health Options Program, is available starting later this October as part of SHOP early access, which is only available to 5 states. Illinois is one of the lucky few. Brokers and Small Businesses, check it out at HealthCare.gov!

This incremental launch will help identify issues early and assist brokers and businesses in building confidence in utilizing the SHOP online system.

During SHOP early access, Illinoisians can do the following to initiate enrollment:

  • Establish a Marketplace SHOP account
  • Establish an agent or broker to their account if they wish
  • Complete an employer application
  • Obtain an eligibility determination
  • Upload an employee roster when enrollment functionality is available
  • Starting in November, browse health plans with coverage starting in 2015

The SHOP Call Center can be reached at 1-800-706-7893 (TTY: 711) Monday through Friday, 9 a.m. to 7 p.m. EST.

While small businesses have always had group plan options, many even available online, there were challenges that got in the way of providing group coverage to their employees. Premiums were expensive and small businesses lacked the purchasing power of larger organizations. The SHOP makes some pretty substantial changes to the ways in which small businesses can buy plans.

Why SHOP?

First, financial assistance is now available in the form of a tax credit. This can substantially help employers by covering up to 50% of employer contributions towards employee premiums. This assistance provides the opportunity for businesses to offer employee coverage where it would have previously been unaffordable. Second, the SHOP helps small businesses harness the purchasing power of other small businesses, thus letting them play in the big leagues along with larger organizations.

Small businesses do not have to offer health benefits under the Affordable Care Act, but it is in their best interest to check out options and see what is possible, particularly if they are concerned with employee retention. Whether or not they decide to provide group health insurance coverage, small businesses are nonetheless required to inform employees of the Health Insurance Marketplace, so that individual coverage options can be explored.

Brokers and Small Businesses take note. The time is now to explore options, prepare, and get ready for a new system opening up possibilities for small businesses in Illinois.


Emily Gelber MSW, LSW
Health Policy Analyst
Health & Disability Advocates

TAKE OUR SURVEY HDA and Crain’s Chicago Business are teaming up to poll local small businesses about new health benefit options. Why participate? By taking this short survey about the changing healthcare landscape, you can inform policymakers, insurers and other small business owners. Results will run in a November 17 article in Crain’s. Take the survey now

The Blue Pill Reclassified as Schedule II Controlled Substance. Red and Green Pill to Follow Soon.

Silver Springs, MD -- The blue pill was reclassified  Monday as a Schedule II medication by the U.S. Drug Enforcement Agency (DEA) under the Controlled Substance Act of 1970.   Following the recent decision to change all hydrocodone combination products to Schedule II, the DEA, at the urging of FDA officials, felt the time was right to raise the bar in patient safety.

"The more we looked at the dangers of hydrocodone, the more convinced we became of the the blue pill's danger to our elderly population.  We have concluded that dependence on the blue pill is rampant and we hope reclassification will give doctors that extra incentive to overbook their  clinic to discuss the ongoing risks and benefits of blue pill therapy," said Dr Douglas Throckmorton, an FDA physician who's own mother succumbed to a blue pill addiction.

In 2013, FDA officials recommended the DEA reclassify the blue pill as a more restrictive Schedule II medication after receiving thousands of reports from patients complaining  the hospital nurse was 15 minutes late for their blue pill.

"The four times I was admitted to the hospital last month, I never once got my blue pill with my morning enema.  It's a wonder I'm still alive, " said Lilian Swanson, a completely healthy full code 98 year-old according to her 12 children, each of whom wrote a letter to the hospital CEO complaining about the average 15 minute delay in giving their mother the blue pill.

By reclassifying the blue pill as a Schedule II drug,  doctors will no longer be allowed to write refills or call in prescriptions. The blue pill joins morphine, Dilaudid, Fentanyl, Oxcycontin and hydrocodone, as drugs with a high potential for abuse.  Emergency Physicians questioned the FDA's move and said more elderly patients would simply come to the ER asking for refills of their blue pill and to have their ears checked for wax.

Blue and Red Pill changed to Schedule II 
"It's only been a day since the blue pill went Schedule II and already I've had 72 old people in my ER asking for a blue pill refill and it's not even a Saturday," said Dave Ben, an ER physician with two first names.

The transition to Schedule II has not been without difficulty.  Some hospitals misinterpreted the DEA ruling and have required physicians and non-physician practitioners to personally carry a hand written blue pill prescription to their central hospital pharmacy for all their patients currently admitted in the hospital.

"The DEA is really cracking down on Schedule II compliance.  My superiors have told me not to dispense any blue pills for our inpatients unless the provider personally comes to my stock room and hands me a prescription," said Ward Jennings, a new pharmacy grad who says WTF under his breath at least 172 times a day.

In addition to blue pill restrictions, practitioners should anticipate Schedule II restriction for the red pill and green pill in the coming months.



E/M Coding Lecture Slideshow Presentation For Hospitalists

Presented here is a slideshow evaluation and management (E/M) coding lecture presentation I was asked to provide for the local Society of Hospital Medicine (SHM) chapter meeting October, 2014.  This lecture is not sponsored or affiliated with any SHM resource but is my interpretation of  numerous resources, including CPT and CMS, I have researched over many years to help physicians master correct E/M coding.  The 2015 CPT® manual is an invaluable coding resource and can by found on Amazon through the image below and to the right.

This slideshow presentation  focuses on the difference between a level 2 vs a level 3 hospital admission and a level 2 vs a level 3 hospital follow-up visit.  Because Medicare is aggressively increasing audits of E/M documentation, physicians have an obligation to educate themselves about the rules that determine the correct level of service.  I have previously provided detailed discussions for both scenarios linked above.

I chose to focus this lecture presentation on  both sets of these CPT codes (99222 vs 99223 admission and 99232 vs 99233 follow-up)  because they are a large portion of the E/M codes used by hospitalists.  Based on the rules given to hospitalists and other physicians to accurately code E/M visits, mastering correct coding documentation can appropriately help physicians get paid for the work they are providing and minimize over and under billing.

I am a practicing hospitalist with over 10 years of clinical experience.  I have written an entire collection of E/M lectures that can be found here to help guide practitioners through the  coding process.  In addition, I have created a bedside pocket E/M reference card, that I personally use every day, to  accurately determine the most appropriate level of E/M care at point of care service for most inpatient and clinic visit scenarios.

If you are unable to view the coding lecture below, here is a direct link to the slideshow presentation.

E/M CODING LECTURE SLIDESHOW 




This laminated E/M bedside pocket card below is available for purchase. All proceeds are donated to charity.


LINK TO BEDSIDE E/M CODING CARD POST
EM Pocket Reference Cards Using Marshfield Clinic Point Audit

Click image for high definition view



Facebook Changes Relationship Status Updates To Ebola Status Updates.

Palo Alto, CA --  Facebook announced Saturday they have  removed relationship status updates and replaced them with Ebola status updates in high risk groups to allow rapid communication with family, friends, and friends of friends. Relationship status currently receives over one billion views a day worldwide and is widely considered the most reliable method of disseminating public health information.

Homeland Security officials have been working with Facebook representatives for several months to implement Ebola status updates as an alternative to CDC reporting.  The changes went live after Ebola virus patient Thomas Eric Duncan was admitted to a Dallas, Texas hospital earlier this week.

Facebook Ebola Status Updates
While some public officials question the use of Facebook Ebola status updates as replacement for  formal CDC reporting,  Facebook remains confident their algorithms can focus in on groups at highest risk for contracting Ebola.

"After mining through trillions of personal data points in the last week alone, we know Facebook users who post hourly cat memes, use third person language,  and post selfies with emoticons are most at risk for contracting Ebola.  We are pushing Ebola status updates extra hard on this population," said Francis Winter, Facebook's Ebola Project Manager.

While Facebook is counting on high risk groups to self report, they are also hoping friends and family report face-to-face evidence of fever and hemorrhage on their own Facebook status updates.

"We like to call this herd immunity in social media," said Francis.



West Africa Ebola Cruise Proving Popular With Anti-Vaxxers

Liberia -- Despite the largest Ebola virus outbreak in history, Carnival Cruise Lines announced expanded Super Saver Sales destinations today by offering 25% off western Africa expeditions along coastal Liberia and Sierra Leone.  Officials say demand is especially strong this season, thanks in part to the route's popularity among anti-vaxx families.

Discounts of 50% and more are frequent during sale events, but demand from wealthy, white people who won't vaccinate their children has allowed Carnival to limit sale prices.

"Our seasonality has been strong this year for coastal West Africa, especially among anti-vaxx families excited to prove all this Ebola hype is just government propaganda," said John Stanbaugh, a Carnival spokesman and father of three unvaccinated children.

Anti-vaxxers' inability to process basic principles of immunology has allowed international cruise lines to market Ebola ravished regions as a family friendly destination experience.

"The internet says Obama created this fake Ebola scare so America could invade West Africa and take over their tropical fruit farms," said Angela Hainsworth, a mother of thirteen homeschooled children in Napa County, California.

Carnival's largest ship, Antivaxx, joins Royal Caribbean's Norwalk in the rapidly expanding market for unvaccinated vacationers.  Cruise lines say they can save hundreds of millions of dollars a year abandoning principles of basic hygiene on routes dedicated to unvaccinated vacationers.  Insurance companies even offer deep discounts on Antivaxx routes, knowing passengers and crew members are unlikely to file lawsuits for health related events.

"We only hire anti-vaxx crews to compliment our passengers. While most crew and passengers will eventually succumb to fever, diarrhea, vomiting and occasional internal hemorrhage, none of them ever complain about a virus," said Carnival spokesman John Stanbaugh, also known as the Father of Anti-vaxx Vacations.

To compliment their West Africa anti-vaxx experience, Carnival has teamed up with Liberian Ebola Tours to offer a fully authentic West Africa cultural experience.  Repeated calls to Liberian Ebola Tours went unanswered.



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