Hospital maneuvers: UW Medicine soon could include Valley Medical Center

King County’s major medical centers continue jockeying for position in the emerging new health-care world.

U.W. Medicine and Valley Medical Center proposed this week what they call a “strategic alliance.” Valley wants to retain its name, although the news release says Valley would become “part of U.W. Medicine.”

Earlier this year, U.W. Medicine took over running Northwest Hospital (in north Seattle), without actually owning the hospital.

As Dean Radford writes in the Renton Reporter:

Public Hospital District No. 1, which owns [Valley] medical center and neighborhood clinics, would still exist. Its five commissioners would sit on a larger board that would oversee management of Valley Medical. The Valley board would continue to oversee the hospital district itself.

In essence Valley Medical Center would become part of the UW Medicine system, which owns and operates Harborview Medical Center and the University of Washington Medical Center. UW Medicine also shares ownership and governance of Seattle Cancer Care Alliance, Children’s Hospital and Medical Center and Fred Hutchinson Cancer Research Center.

The bigger picture: U.W. Medicine and Swedish Medical Center are competing to be top-dog in the greater Seattle area. All the other hospitals are nervously watching, trying to decide if they can survive independently, or if they need to affiliate. I alluded to this in an article last spring, as the same pressures are reflected in the mad scramble to build new Emergency Departments all over King County.

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Gunshot wound might have killed Clemmons anyway

You might have been wondering, How could Maurice Clemmons have survived so long with a gunshot wound right in the belly?

He managed to last nearly two days  – after one of the Lakewood police officers (Greg Richards) shot him during the coffee shop ambush on Sunday.  Clemmons was hit just above the belly button, said Pierce County Sheriff spokesman Ed Troyer.  He later died in Seattle after another officer shot him two or more times on a city street.  Clemmons was found with duct-tape and cotton gauze covering the wound.

Police handgun, similar to the one used in battle at a coffee-shop near Lakewood, Wash. (photo by Clyde Armory)

We may never know why he lasted.  The King County Medical Examiner says autopsy reports are not public documents.  The autopsy is considered “protected health information.”  In other words, it’s private, and the next of kin must consent to any public release.  The public report will only confirm the cause of death.

I asked the chief trauma surgeon at Seattle’s Harborview Medical Center for some speculation.  Harborview is the hospital where nearly all gunshot victims end up in the Seattle area.

Dr. Jerry Jurkovich says most gunshot wounds to that region would be fatal without surgery, since “it would almost certainly have injured some segment of the intestine.”  But, it might take several days for the infection to get bad enough to kill.  Bleeding to death is unlikely (and would happen very quickly).

It’s possible the bullet hit Clemmons from a sideways angle and did not penetrate major organs.

Does it matter? Not really, except as it sheds light on how much the “assistance” from his friends and family kept Clemmons alive.

MORE INFO [12/16/09] — Here’s some speculation.  Okay, it’s from unnamed sources, but credible enough to share, with caveats.  A friend of mine was discussing the case with a buddy in the FBI.  They came up with this:  One reason Clemmons might have survived that initial gunshot wound was if he was shot by one of his own guns, instead of the officer’s gun.  His .38 caliber revolver packs a smaller impact than the .40 caliber Glock (pictured above).

If so, that also reveals a little about how the events might have unfolded.  After the other three officers had been shot, Ofc. Richards was struggling with Clemmons, who still could have had a revolver in each hand.  Perhaps, one went off and hit Clemmons in the belly, but Clemmons might have used the other hand to shoot Richards in the head.  In this scenario, Richards’ gun was never pulled.  Clemmons would have taken it off his body before he ran.

To mammogram, or not to mammogram

I’m not surprised there’s so much confusion about the new mammogram recommendations from the U.S. Preventive  Services Task Force.  The findings are counter-intuitive.  And the message is coming from data people, who can’t communicate it in a way that makes sense.

What’s more: There are a lot of people with a vested interest in the current mammogram regime.  I don’t mean to impugn their motives.  They have the best of intentions.  But, if your medical career, or your clinic, is built on the premise that all testing is good and early diagnosis is the Holy Grail, then it’s hard to be objective.  And, if you are affiliated with a non-profit advocacy group, trying to raise awareness and money to battle breast cancer, then it’s going to be hard to swallow the idea that not everyone needs to be tested.

A young woman lines up for her mammogram (at Baylor Medical Center)

This is intuitive:  Cancer starts small, and if you test for it, you might find it before it spreads and becomes lethal. If everyone gets tested, we’ll catch most cancers before they can kill.  Period.

This is not intuitive:  If we test people, and get a lot of false-positives, that causes anxiety and unnecessary biopsies.  So, it’s better to do less testing and risk a few deaths.

I’m not a specialist, and I won’t make any claims to know what all women should do.  But, the panel making the new recommendation deserves to be respected.  And their conclusion is not unprecedented.  Other researchers have been arguing for years that we do too much breast and prostate cancer screening.  European countries with the most advanced health systems do not recommend annual mammograms under the age of 50.

And as I talk to middle-aged women, I hear a lot of stories of false positives, or hard-to-read mammograms, and unhappiness with what feels like a treadmill of testing and worry. (Not to mention the mammogram procedure itself ….)

Back in the 1990’s, as CT scanning machines became more common (and less expensive),  “full body scans” became the rage.  Remember the ads?  They promised to find the diseases lurking in your body that hadn’t yet shown up in symptoms.  The medical profession roundly condemned these scans.  Why?  Because they lead to a lot of false positives, further useless testing, and possibly procedures that are unnecessary.  In the end, for most people, they do more harm then good.

If the government or medical profession is recommending that everyone should get a certain test or vaccine, then they need good evidence that the benefit outweighs the risks.

One fact we don’t like to think about:  We are all carrying around parasites and growths and abnormalities all the time.  Most of these are kept in check by natural systems.  If we tried to intervene on all of them, we’d create chaos in our bodies.

I imagine as this story evolves, we’ll see two sets of recommendations emerge–one for women with a family history of cancer (or other higher-risk status), and one for everyone else.

Schools ready for swine flu?

Soon after kids return to school, in the coming few weeks, we may see  the H1N1 swine flu come back with sudden swiftness.  That’s based on what’s happened during past pandemics, such as in 1957, and on the virus’ behavior in the southern hemisphere.  Are the schools ready?

It’s hard to tell.  They basically are continuing where they left off when the first wave of sickness passed through last spring.

My colleague, Jennifer Wing, reports on discussions between Public Health Seattle & King County and school districts.  They don’t plan to close schools this time, and sick kids won’t have to stay home for as long (it was a full week last spring).  But, from what we’ve heard so far, it doesn’t seem like anyone’s making contingency plans for absentee rates that might range in the 30-50% range.

The Virus: H1N1

The Virus: H1N1

Epidemiologists are concerned with getting timely updates on the numbers of absent students.  This is essential for monitoring when and where outbreaks are happening, and last spring some schools were better than others about reporting.

Don’t be surprised if outbreaks begin as early as September.  The evidence keeps mounting that wherever kids congregate in large numbers, that’s where you’ll see rapid transmission of flu virus.  In 1957, it took just 3-6 weeks after school started before  many cities saw a surge of illness.

What about a vaccine, to prevent illness?  The first doses may not be available until after the first wave of sickness.  But, there may be additional outbreaks long into winter, and the vaccine will protect against those.

On the other hand, swine flu infections still appears to be mild, unless you have an underlying sickness or medical condition.

Flash-forward, the flu of December 09

Here are four interesting items I learned yesterday from King County’s chief epidemiologist, Jeff Duchin, MD.

  1. Lesson learned:  Closing individual schools is not effective for limiting flu transmission in a community.  Next time — if the virus appears to be more deadly — the health department will close all schools in the county, perhaps for 8 weeks or longer.
  2. Lesson learned #2: This virus spread far more rapidly than planning scenarios had predicted.  Basically, flu virus can be widespread before we know what’s hit us.
  3. Who’s first in line for a vaccine, if there’s a limited supply? Heavy-duty planning is underway for how to distribute an A-H1N1 (swine flu) vaccine next winter, assuming it’ll be available.  This will be in addition to the normal, annual flu shots.   First-responders, and most medical workers, are clearly at the top of the list.  Pregnant women, and people with compromised immune systems.  After that, it might be all children under 18, given signs that they’re being hardest hit so far.  (Normally, the elderly are considered most at risk, but not in this case.)
  4. If the virus remains less severe?  Expect simply a lot of people to be out sick, especially in schools, as everyone who didn’t get sick this spring, gets it on the second pass.   But, it wouldn’t be much different from what we’ve seen this past month.

And one note to the King County Board of Health:    Anyone watching (the meeting was recorded by King County TV) might be disappointed at the level of questioning by board members, as Dr. Duchin and other staff testified.  They asked thoughtful questions to clarify the facts.  But, nobody on the Board asked the simple questions, What parts of the “pandemic plan” did not work?  What surprises did the staff face? What needs to be improved before we face a severe pandemic?   (The lessons learned above came from a private interview, after the meeting.)

Washington’s “Swine Flu Six”

I’ll offer a few posts here, shortly. First, for those of you craving detail during these anxious times, here is full text of the radio stories for KPLU:

Version one:  Six Local Cases of Swine Flu Called “Probable”

The swine flu outbreak has officially reached Washington state. Last night, the state health department announced it’s identified six people as probable cases. They’re in Seattle, Snohomish County and Spokane. More from KPLU science and health reporter Keith Seinfeld:

We have the most details about the three from Seattle. They include:

A 33-year-old female doctor, whose husband and two children are also likely infected. They’re being treated at home.

A 27-year-old single man is at home.

And an 11-year-old boy has been hospitalized but is recovering. The boy’s school is Madrona, and it is staying open because the boy did not come to school at all after he became sick over the weekend.closed for a week. UPDATE – The decision was made early Thursday morning, after public health officials determined the boy may have been contagious last Friday when he was in School.   Washington Secretary of Health Mary Selecky says this all sounds alarming:

“The reason we’re being very cautious is because this is a brand new virus, and as a result there really isn’t any immunity in the population. So, we want to prevent it from spreading.”

Public health is especially on the lookout for how easily the virus spreads, and how severe the flu is once people get it. Dozens more possible cases are in early testing stages. The best way to keep it from transferring the flu, she says, is to stay home if you’re sick, cover your cough, and wash your hands. If you don’t have enough sick days? That policy, she says, is up to each employer. Keith Seinfeld, KPLU news.

More:

  • In Snohomish County, the public health department wasn’t able to get any details, as of Wednesday night, about a 6-year-old 3-year-old boy or a 34-year-old woman who are probable cases.
  • None of Washington’s six probable cases appears to have involved travel to Mexico.
  • So far, about 95-percent of the cases labeled probable by different states have proven positive at the federal labs in Atlanta. But it may take several days to get results for Washington.

Version Two: Probable cases of Swine flu in Washington

Six people in Washington are now considered to “probably” have swine flu, according to the state Department of Health. All six are recovering. Also one woman in Victoria, B.C., has confirmed she caught the swine flu while on vacation in Mexico. More details now from KPLU science and health reporter Keith Seinfeld:

Just a few hours after saying there’s no sign of any swine flu in Washington, the state health department got results from a new batch of tests. Six people have a strain of flu that is probably the new strain of swine flu – and their samples have been flown to the federal laboratory in Atlanta for confirmation.

Of the six, three are from Seattle, two from Snohomish County and one from Spokane. An 11-year-old boy in Seattle and a six-year-old boy in Snohomish were the only children. The Seattle boy’s mother is being praised for keeping him home – so his school, Madrona, won’t have to be closed. UPDATE – But Madrona was closed Thursday, for a week, because it turns out he may have been contagious last Friday when he was in School.  Dr. Jeff Duchin, chief epidemiologist for King County, spoke at a Wednesday evening news conference televised on northwest cable news.

“You shouldn’t go to school when you are sick.  You shouldn’t go to school if you have a fever or are coughing, all around the community, because if this virus has made its way to Washington state, the way to prevent it from spreading is by keeping away from one another when we’re ill.”

The Seattle boy has been hospitalized since Tuesday, with a fever and shortness of breath, but now is in good condition. None of the others required hospitalization. One case is a 33-year-old doctor from Seattle. She and her famly are being treated, but it’s not clear yet if she may have exposed others.

Public health officials say, you should expect to see more cases in Seattle and all over Washington, as more people are tested. Results from the federal labs may take several days. Keith Seinfeld, KPLU news.

More:

  • A shipment of anti-viral medicines is en route to Washington, to add to the state’s stockpile, in case the outbreak becomes an epidemic.
  • Seattle has activated its Emergency Operations Center, at the lowest alert level, to be ready should the situation change suddenly.
  • The advice to the public remains, stay home if you’re sick, wash your hands and cover your cough.

Swine flu, without Mexico

I may be gloriously wrong on this.  But, Ill go out on a limb and suggest the possibility that this H1N1 swine flu has been in Washington state, and other states as well, for quite a while.  I won’t be surprised if it turns out that many people who suffered a flu or flu-like illness over the past month actually had this strain.

And last night’s announcement of Washington’s first six “probable” cases (see this post) added some support.  I was told by both the state Department of Health and King County’s public health officials that none of the six people who harbor the suspected virus has any connection to Mexico. They didn’t travel there, nor did they contact anyone who recently did.

In fact, in King County, the three cases only came to light because they bypassed the health department.  Why?  Because the health department was only agreeing to test samples that met the criteria of severe flu symptoms PLUS some connection to Mexico.  These three, then, were tested by independent clinical laboratories, and then forwarded to the state when they proved to be a Type-A influenza virus.

(One of those labs was at the University of Washington, and I’m still trying to learn about the other two, as well as the cases in Snohomish and Spokane.)

If they had no connection to Mexico, and they caught it locally, then this suggests that there was a good-sized reservoir of infected people in Seattle by the end of last week.  It still may have come from Mexico, but perhaps  a month ago, or longer.