Adventures in medical malpractice...

FYI - EMTALA the emergency medical treatment active labor act - passed in 1986 is essentially says:

"Any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination" to determine if he is suffering from an "emergency medical condition". If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute's directives." - regardless of ability to pay/insurance. 

Here are EMTALA ramifications for individual physician liability. The following are a couple of cases that have set precedents that have guided practice protocols.

If the patient is erroneously diagnosed, and the physician mistakenly believes that he does not have an "emergency medical condition", when in fact he does, several courts have held that [EMTALA] does not apply to that case. Urban v. King, 834 F Supp 1328 (1993). There could, of course, be a claim for professional negligence for failure to make a diagnosis under State malpractice law in this situation.

The court in Jones v. Wake County Hospital System, Inc., 786 F.Supp. 538 (E.D.N.C. 1991) stated that EMTALA requires only that a medical screening procedure be established and that it be followed in every case, without regard to ability to pay, and that EMTALA is not violated even if the screening procedure is insufficient under state malpractice law.

Some of the cases have suggested otherwise, however. There was a brief mention in Deberry v. Sherman Hospital Association, 741 F. Supp. 1302 (N.D. Ill.1990), to the effect that a hospital could be found to be in violation of EMTALA for failure to diagnose an emergency medical condition through an inadequate screening procedure. This principle is at least implicitly recognized in other cases as well. See, for example, Power v. Arlington Hospital, 42 F3d 851 (4th Cir 1994) (failure to order CBC, leading to missed diagnosis of sepsis).

The most prominent case on this point is Summers v. Baptist Medical Center of Arkadelphia, 69 F.3d 902 (8th Cir. 1995), rev on reh en banc 91 F.3d 1132 (1996). In that case, an examination of a patient who had fallen from a tree stand while hunting was allegedly incomplete because a chest x-ray had not been included when a set of spinal x-rays was ordered. The physician did not believe that the patient had any fractures, and discharged him home, with instructions. There was no transfer to another facility involved. The patient presented at another hospital two days later, and he was diagnosed with an acute comminuted vertebral fracture, a sternal fracture, and bilateral hemopneumothoraces secondary to untreated rib fractures.

This is a great video!!!!!

Thanks keonepax!!

Tchaikovsky = ridiculously good

I don't know what it is about classical music, it just hits me in a way that says- anything is possible.

Just dream it, and figure it out. It makes me feel incredibly small on one hand (true) but paradoxically;

Free to try whatever, you know just because something has always been a certain way, it doesn't mean

that it always will. A pioneer knows this implicitly,

There has to be a vision, who ever thought of anything thats in existence, just do it already right?

Big Mac, combustion engine, PCR, foam hands, MBA's, Batman, just think of something and do it already!!!

Can you imagine how the time passes? We sit around unaware, heaven forbid watching television, when

its right there, these guys figured it out. I'll bet they only cared about music and maybe

one other thing! How nice, these were real McCoys, not given to materialism or greed, or

fame (maybe I'm romanticizing) but my schema of who these people are as interpreted

through their music fits my philosophy- when you put out quality, its not with $$$ in mind,

its above that

Take Bach, Jesu, joy of man's desirin, my current favorite, who do you think he was

talking to with this one? The big kahuna on the next floor up? I'll bet he didn't write it with the charts

in mind. Thats why 400 hundred years later he lives on and his spirit (as conveyed by

his choice of notes) reaches people in the future and who knows where, long after we're 

dead and gone?

he couldn't have possibly foreseen his music playing in little magic boxes called PC's and ipods

on the "internet", known to pretty much everyone.

do you think he would have cared how he would be viewed today? i don't,

hence he tapped that paradox of getting only when you no longer want, succeeding

when you're TRULY ready to fail, feel pain; freedom when you accept the truth, he tapped those 

timeless wisdom mcnuggets rather nicely

bach, beethoven, mozart

i hear you loud and clear, find that higher calling, that thing that makes the world a

beautiful place (depsite mexican gangland decapitations, wars in iran, cancer, fear etc...),

tchaikovsky- i hear you man - just give me time to do the work, where did you find the strength

to get up every morning and really truly say, i don't care what happens, this is all i can do.

i've done all i can do.

i'm telling you i'm getting it, i'm starting to understand, i'm starting to 'get it'

and if nothing excites me??? than i'm just a big

softy in my latter day couch potato culture, taking my chances, blowing in the wind

fattened for the...

what is with this formatting

Learning insight

Here

Activity in the right frontal cortex prior to the "aha" sensation.

Gamma wave mainly from the right hemisphere.

This is where its at, i love this topic

Learning Photoshop

In my effort to learn photoshop I present my first try; a tribute one of my favorite chemists, and my favorite quote of his. I'm ok on the rainbow gradients.

ahem - after further review he could not have possibly been my favorite chemist because he was not a chemist. hahahaha!

I don't remember hearin about this?

Irish pork crisis of 2008

A real lottery ticket

The latest candidate for Werner Sombart's creative destruction

Scene, cut to: Neighborhood grocer

Last night the groceries came to this many dollars and $.04 - "hold on let me see if I have four cents I said..." Nope, take it out of the twenty." Oh darn, I hate when this happens - now I carry around 96 cents. What can I do with this? Well, I could buy a share and a half of GM now. I'm all for second chances and reinventing the self etc which is exactly what GM has to do if it wants to survive. Why not take a chance its cheap and the change was just going to sit in my pocket. Imagine that you can purchase shares in an American institution now for pocket change... What does that say? How the mighty have fallen, we are truly witnessing history. Times will be tough for GM during their day of reckoning - and they have been humbled, but that doesn't mean its over... 

ps- i forgot, there's just one more thing. the taxpayer bailed out GM to the tune of $20 billion. the government is not in the private equity business and really has no place doing distressed buyouts- now GM is bankrupt - i wonder where all that money went, physically- where is it? just the latest example of government passing on the losses to the taxpayer

Right rudder

I am beginning to enjoy my preflight inspection. It has become a true ritual; a slow methodical pouring over of every inch of the aircraft. It is satisfying to get to know your plane, cataloguing every little scuff, flap actuator pin, rudder cable etc... On the third day I practiced liftoffs. Clean (no flaps) liftoff speed for the Cessna 172 is around 60 knots. Basically after you announce your takeoff intentions, you firewall the throttle (take about three seconds to go from open an 1/8" to full), and head down the runway. Pull back on the yoke to rotate (means pull nose up). You have to use a firm pressure on the yoke at the initial liftoff, shortly into the ascent the pressure breaks on the yoke and you can let it forward a bit. I learned that you have to jam the right rudder basically the whole time during the takeoff. "Why?" I asked. American made propellors turn clockwise from the perspective of the cockpit. The downswing of the propellor produces more thrust than the upswing which pulls the aircraft to the right. In order to keep a straight course you have to balance your thrust so having the right rudder out creates a yawing force to the opposite side  equalizing the increased thrust. Interestingly, British aircraft have propellors that turn in the opposite direction, so if you step on the right rudder during takeoff in one of these planes you will taxi off the runway.

I practiced takeoffs, straight and level flight, ascent, ascent while turning, constant speed descents and descents while turning. I have a tendency to watch the gauges (heading and vertical speed indicator) a little too much, and should use the horizon and engine noise to determine my power, pitch, and attitude. I'm just trying to get the feel of what happens to the gauges when I do pull back throttle, decrease angle of attack etc... 

After takeoff or when you want to land you have to fly the pattern. This consists flying in a circle composed of roughly of four legs. Depending on the winds all traffic usually goes through the runway with a particular directional orientation. Poplar grove has two runways 27 and 30 for 270 and 300 degrees (orientation of the runway). Airport runways are laid out so that the most frequent winds are head-on to the runway. This is determined by a wind rose. Check it out, here is the wind rose for  One always wants to takeoff and and land into the wind, but cruise with a tailwind. 

This shows the strength and frequency of the winds on an annual basis, so it makes sense for airports to consult this when picking an orientation for the runways. Anyway you can google this for the details but basically the faster winds are toward the ends of the radials, and the larger the bar the more frequently the winds are out of that direction (a southernly wind means that its coming from the south, NOT heading south). 

So back to the pattern- you takeoff into the headwind and turn left (normally most patterns are left turning, it is easier for the pilot to see when turning to the side that he's sitting on). After you turn left you are on the crosswind leg, then turn left again and you are parallel with the runway but heading downwind (meaning you have a tailwind). Next you make a left and this the base leg. If you make another left you've come full circle and are now on the approach leg heading upwind toward the runway. It is customary to enter the pattern on the downwind leg, and depart the pattern from the upwind. You have to enter the pattern at the proper altitude as well because you don't want to come in on top of someone, pattern altitude at Poplar Grove is a thousand feet above ground. Or 1,858 feet on the altimeter, because poplar grove is at an altitude of 858' above sea level. Announce you entry and final approach. 

Finally, there are different types of aviation gasoline (AVGAS). They are normally color coded by octane. You can go up in performance but never put a lower rated fuel into your engine because lower rated fuels combust at lower pressures and this could cause inefficient combustion and excessive engine heating. The C-172 takes 100LL (low lead). As of this entry, the cost of fuel is $3.85 a gallon, and we go through about 6 gallons during an hour of flight. 

Takeoff is cool, but for me I will not be happy until I can land the thing myself. Because from my current vantage point I can see that anyone can takeoff but landing is the proper closure, is more of an art and requires skill.