Erroneous Death Certificates: The True Epidemic Exposed …..Direct From The Disgusted Doctors

There is a blogger here in our WordPress family that I have great admiration and respect for. You see, she is a Mom whose adult son died under very suspicious circumstances. She firmly believes her son was murdered and is looking for justice to be done in his name. But the medical examiner did not rule his death  a possible homicide or even suspicious. The police report states UNATTENDED DEATH, and six sentences of explanation.  The case was closed in 1.5 hours.  No investigation into cause of death.

She reports, “It has been five years and still the local coroner refuses to release all of the autopsy report or allow an investigation into the strange circumstances surrounding his death – or the poison that was in his blood.It has taken all these years to discover that NO ONE oversees the coroner, they are not required to have a medical degree (only high school diploma or equivalent) and do not have to account for their findings to anyone.

It is because of her courageous, exhausting, and unrelenting fight to find answers into the death of her beloved son that I paid very close attention to the article below posted on the exclusive website Medscape. Shirley, this one is for you. Yet, it really concerns us all.


Cause of Death: 50% of Medical Residents Fib

by Diedtra Henderson

Some 48.6% to 58.4% of residents from more than half of the residency programs in New York City have knowingly entered the incorrect cause of death on death certificates — errors that have implications for epidemiology, public health research, and disease surveillance — according to result from a recent study.

Barbara A. Wexelman, MD, MBA, from St. Luke’s–Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York City, and coauthors report their findings in an article published in the May 9 issue of Preventing Chronic Disease, published by the Centers for Disease Control and Prevention.

As fewer autopsies are performed, Dr. Wexelman and coauthors note, death certificates have become even more important sources of information about how Americans die. Public health researchers rely on death certificates to gauge the leading causes of death and to identify disease outbreaks, and the certificates also influence funding policies and research priorities.

In most teaching hospitals, it falls to resident physicians to complete the forms. To examine their experiences and opinions, the researchers conducted an anonymous, Internet-based, 32-question survey of New York City’s 70 internal medicine, emergency medicine, and general surgery residency programs in May and June 2010. Some 521 residents from 38 residency programs responded to the survey; 178 of the residents were termed “high-volume” respondents, meaning they had completed 11 or more death certificates in the previous 3 years.

Forced to Do It

“Almost half of all respondents (48.6%) and 58.4% of high-volume respondents reported they had identified a cause of death on a death certificate that did not represent the true cause of death. More than half of the residents (54.0%) reported they were unable to list what they felt to be the correct cause of death after guidance from the admitting department in their hospital,” Dr. Wexelman and colleagues write.

“Of all respondents, 70% believed they were forced to identify an alternate cause of death when the patient died of septic shock (compared with 83.5% of high-volume respondents), and 34.2% believed they were forced to identify an alternate cause when the patient died of acute respiratory distress syndrome (compared with 44.3% of high-volume respondents),” the researchers continue.

Only 20.8% of respondents knew they could hedge the death determination by calling it “probable,” “presumed,” or “undetermined.” When the death certificate system would not accept the true cause of death or hospital admitting staff overruled them, 64.6% of respondents reported cardiovascular disease, 19.5% pneumonia, and 12.4% cancer as the cause of death.

Study participation was voluntary, and residents with stronger feelings about the accuracy of death certificates may have been more interested in participating. Other study limitations include the potential for recall bias.

“Residents routinely reported diagnoses on death certificates that did not match their medical judgments. These errors may have lasting effects on the public health priorities of the community. Reform is needed both in the training and education of residents and in the system itself,” the authors conclude.


What! Seriously!

Okay, so as a PhD candidate for a Doctorate of Natural Medicine, I find this sickening and disturbing. But what about all the doctors, nurses, administrators, and other licensed healthcare practitioners who deal with this on a frequent and regular basis? What do they think about all this? Below are just a small handful representative of  the comments received about this finding. I have tried to present a wide cross-section of respondents from various locations in the US and even a few international. These comments blow my mind, and I hope they give you pause for thought.

Lane Longo|  Health Business/Administration

 1 day ago
 “Dear Sirs,
Let me say, at the outset, that the  the title of this article would be more properly worded by removing the innocuous sounding euphemism “fib” with the  correct word  “lie”.  That is, to deliberately mislead by falsehood.
Further, the article stated that residents were “forced” by hospital admitting staff or because the program would not accept he actual cause.  While I do not have direct knowledge of the death certificate program used, I assure you that the program did not design the criteria.  Some governing board, after throwing out any sense of .ethics,  weeded out any possible incriminating causes which might redound to the hospital or physicians account. Do you imagine that because the patient is dead that the cause doesn’t matter to the family or the state?

And the final insult…”Study participation was voluntary, and residents with stronger feelings about the accuracy of death certificates may have been more interested in participating.”  This implies that there are many more who do not give a damn about the truth.  Who are you people?

One would think that the much vaunted medical community would eschew debauched ethics.  If you do it in the smaller things, you will blunt your conscience to the larger ones.”


Dr. WOOD DEMING|  Cardiology, General

 2 days ago
 “It does not sound like a resident training problem , but rather administrators bent on falsifying records to make billing more enriching or to portray the hospital in a different light .  I would also guess that this issue is discussed openly at meetings for hospital managers..”
Sal Campo|  Other Healthcare Provider

 11 days ago
 “I believe this is happening much more due to hospital errors and trying to avoid law suits. More inspections should be used for larger institutions and the state should not just shrug off family complaints when there family member dies.”
Dr. stephen c

 12 days ago
 “Why does no one mention the elephant in the room? When older patients are admitted with known pathology it is all too easy to let them die of iatrogenic causes such as acute respiratory failure due to over prescription of opiates. When my mother was admitted in light coma with a moderate middle cerebral bleed at 83, I arrived 24 hours later to find she was on regular morphine and already cheyne-stokeing. Apparently, she had groaned on being turned and a relative had asked for pain relief. I got the morphine stopped, she woke up and is now at home with no neuro deficit and only mild confusion enjoying her grandchildren for another year or two. Her death certificate would have read “Cerebro-vascular Accident”. It would have been a lie.”

Dr. Raymond Vergne|  Cardiology, Interventional

 12 days ago
 “For the living, medical “coders” love “NSTEMI” and “congestive heart failure”.  NSTEMI is the choice diagnosis for anyone with a minimal elevation of troponin levels, regardless whether it is due to sepsis, stroke, acidosis, respiratory failure,  pancreatitis, pulmonary embolism or atrial fibrillation.  Congestive heart failure is preferred over COPD, acute lung injury, thyroid storm, acute bronchitis or idiopathic pleural effusion.  NSTEMI and CHF yield better reimbursement from Medicare.  One learns fast not to argue with the coders.”
Dr. Anton-Lewis Usala|  Pediatrics, General

 13 days ago
 “This is an excellent description of what happens in the absence of quality systems.  Medicine is the last major industry that doesn’t have quality system assurance built into the delivery of its service.  While pharmaceutical companies are required to have design-reviewed processes in place, with point-of -process quality systems to assure they were completed as intended, the only part of drug development that does NOT require quality system enforcement is the clinical trial portion involving human subjects.  Many hospitals have quality departments, but they review after the fact events, and are not the same as industry quality systems that assure each step in process occurs as intended to prevent an unqualified product at the end.  I think such an approach would be initially difficult to implement (as they are when first applied to any service or industry) but would have profound beneficial effects for our patients, our institution, and our profession.”
Dr. Michael Dubriwny

 May 13, 2013
 “Aside from public health priorities, inaccurate reporting of cause of death is related to health grades and ultimately hospital reimbursement.”

I could go on and on, with many more comments, but I think you see the pattern and general consensus emerging. For anyone who wants to view all 79 and counting comments, let me know and I will send them to you. See, I can’t just post the link and have you look it up yourself because it is part of a private, members by subscription only site. All I can do is “Select All”, then ” Copy”, and then “Paste”. What does this mean? Well for one thing it means the news media and ethical investigative journalists of this world probably do not have access to this information to bring it to the public’s attention. And what does this revelation mean when it comes to all the data collected by various organizations that track the rise and or fall in the number of deaths related to a certain disease? Or to biologic family members that might be left in the dark about a possible genetic time bomb in their lineage that was inaccurately stated as the cause of death? The system is broken folks. How are we going to fix it?






The Complicated Problem Of Receiving Good Mental Health Care: Part 1

When it comes to illness or injury, many of us are able to find good treatment within a relatively short time frame. There certainly are problems and challenges with the universal health care systems, but in the industrialized world most of us can and do find treatment providers in short order. That does not seem to hold true when we examine one aspect of health…..that of mental health. Laws and policies are enacted, psych drugs are promoted, yet the task of receiving quality mental health care treatment is still a daunting task for most. A recent poll being undertaken here in the blogosphere by Mental Health Writers Guild gives us a small snapshot by showing that the largest percentage of respondents waited over one year before getting an acceptable mental health diagnosis. This is admittedly a very complicated problem that belies a quick solution. But to solve this problem, we need to look at all the different factors that contribute to it. I present here one aspect of the problem…..that of insurance companies putting up roadblocks or even denying mental health care treatment. Attention is now being drawn to this issue by way of a class action lawsuit against one of America’s largest insurance companies…..United Health.



UnitedHealth Sued Over Mental Health Parity

By Kathleen Struck, Senior Editor, MedPage Today
Published: March 13, 2013

Health insurance giant UnitedHealth Group has been sued in a class action for alleged violations of federal and state parity laws that mandate coverage for mental health claims on a level comparable to medical and surgical benefits.

“Despite United’s duty to adhere to these anti-discrimination safeguards, United has systematically implemented unlawful and deceptive practices designed to create the illusion of impartiality, fairness, and due process while simultaneously undermining access to treatment for the most vulnerable segment of our society,” stated the suit filed Tuesday on behalf of the New York State Psychiatric Association and three patients.

The plaintiffs allege that the defendants — UnitedHealth, UHC Insurance, United Healthcare of New York, and United Behavioral Health, referred to collectively in the suit as “United” — engaged in unlawful and deceptive practices that include “undisclosed algorithms to identify high-use beneficiaries” and coverage decisions based on “internal policies that violate federal mental health parity laws.”

The suit, filed in the U.S. District Court for the Southern District of New York, in New York City, asked that United be made to comply fully with the parity laws and reimburse any claims that were unfairly denied, with interest.

Co-counsel Meiram Bendat said United “applies disparate medical necessity definitions” and “reserves unfettered discretion for itself to reject mental health claims.” Bendat, an attorney and psychotherapist in Los Angeles, said he helps patients fight insurer denials of mental health treatment.

United has “developed its own standards of care for mental health treatment that are inconsistent with prevailing, national standards and those adopted by specialty groups within the mental health community,” he said.

United had no comment on the specifics of the lawsuit. “We are committed to helping people with mental health issues reach long-term recovery,” said United spokesperson Brad Lotterman, in Minneapolis, Minn. “We recently received the complaint and are currently reviewing [it].”

Bendat called the case “monumental … by virtue of being the first to invoke the federal parity law. It is also on an enormous scale because it potentially impacts most, if not all, [United] policyholders — and that’s in the tens of millions.” United insures more than 70 million people in the U.S., according to its corporate website.

The suit alleges federal violations of the Affordable Care Act (ACA) as well. United failed to pay for concurrent care claims while internal insurer appeals were being determined, as the ACA mandates, the suit alleged.

The ACA also mandates time frames for beneficiaries to contest adverse insurance decisions, he said, and United ignored those parameters.

Bendat, founder of a California-based mental health insurance advocacy service, Psych-Appeal, said insurers rely on the psychological vulnerabilities of mental health beneficiaries. “They are the easiest group to railroad when it comes to denying care. That’s built into United’s model in doing business with respect to mental health,” he said.

Seth Stein, executive director of the New York State Psychiatric Association, in Garden City, N.Y., said the association received several complaints about recent changes in CPT [Current Procedural Terminology] codes for physician services for which United was not properly reimbursing physicians. Stein said the complaints related to “noncompliance with state and federal parity laws.”

“Over that past year or so, more, we’ve brought all of these issues to the attention of United,” he said, “and we have been unable to resolve them satisfactorily. … We are very pleased we have an opportunity to … get some assistance from the court enforcing state and federal parity law.”




If you have experienced this particular type of discriminatory practice, please speak up. Acknowledging this problem is the first step toward change. Taking action is the next. Let’s keep on going.

Looking At The Glass As Half Full

Thank God for Mental Illness

Thank God for Mental Illness (Photo credit: Wikipedia)

I found this article on Medscape the other day and the contents of it are weighing heavily on my mind. Throughout my life, I have read articles and interviews that proposed highly intelligent and/or creative people were more likely deemed crazy than the general population. Having a rather high IQ myself, this generalization and it’s implications always bothered me. Being labeled “mad” or “crazy” has typically been associated with negative connotations and consequences.  Why is that, I wonder?

I propose that society stops looking at mental illness as behavioral problems and mental disorders and starts looking at them as alterations in brain circuitry. Addressing these issues from a neurological wiring standpoint will go a long way in reducing the stigma attached to the diagnosis and researching treatments that address neuro function as opposed to abnormal behavior. Some of the very factors that contribute to a diagnosis of mental disease are the same ones that contribute to what society considers giftedness.

If a patient presents with a fever, a doctor does not automatically assume ear infection and begin the recommended treatment. Why then would a patient present with say…..depression… automatically treated with antidepressants and assume a behavioral  problem instead of a brain disorder? It’s all in how you look at the glass. There is creativity and genius in what society calls madness. We need to accentuate the positive before we pounce on the so-called abnormal behavior. Let’s remove judgement and explore the neurobiology of this class of illness.

The article I am referring to is below.

Creativity and Mental Illness Link Confirmed

Caroline Cassels

 Oct 24, 2012

New research confirms that mental illness is significantly more common in individuals who are in creative professions.

A 40-year, nested, case-control study of almost 1.2 million patients and their relatives showed that bipolar disorder (BD) is more prevalent among individuals in artistic or scientific professions such as dancing, research, photography, and writing compared with individuals in the general population who are not in these professions.

Further, the study revealed that schizophrenia, depression, anxiety, and substance abuse are more common among authors, and that this group was 50% more likely to die by suicide than the general population.

“If one takes the view that certain phenomena associated with the patient’s illness are beneficial, it opens the way for a new approach to treatment,” lead author Simon Kyaga, MD, who is a consultant in psychiatry and a research fellow in the department of medical epidemiology and biostatistics at the Karolinska Institutet in Sweden, said in a release.

“In that case, the doctor and patient must come to an agreement on what is to be treated, and at what cost. In psychiatry and medicine generally, there has been a tradition to see the disease in black-and-white terms and to endeavor to treat the patient by removing everything regarded as morbid,” he added.

The study was published online October 11 in the Journal of Psychiatric Research.

Comprehensive Study

According to investigators, previous research into the potential link between creativity and psychopathology has been “hampered by sample size and lack of standardized tools to assess creativity.”

In addition, they note that to be conclusive, any study examining this association should also address patients’ relatives.

The researchers extended their previous 2011 population-based study on the link between creative occupations and schizophrenia, BD, and unipolar depression.

In this new study, the researchers also included schizoaffective disorder, anxiety disorders, alcohol abuse, drug abuse, autism, attention-deficit/hyperactivity disorder, anorexia, and completed suicide.

Because previous research suggested a high prevalence of psychopathology in authors, the researchers examined this group separately. They also attempted to validate previous findings, showing there is a familial association for creative professions with schizophrenia and BD by using a larger dataset that included patients’ first-, second-, and third-degree relatives.

Finally, they looked at whether the proposed association was influenced by IQ.

More Morbidity in Authors

The investigators analyzed data from Swedish total population registries, in which the occurrence of creative occupations in 1,173,763 patients with mental health disorders and their nondiagnosed relatives were compared with that of matched population control participants.

With the exception of BD, the investigators found no positive link between psychopathology and overall creative professions.

However, the researchers found that authors suffered from schizophrenia more than twice as often as control participants. The investigators report that authors were also more likely to be diagnosed with unipolar depression, anxiety disorders, alcohol abuse, and drug abuse and to die by suicide.

Even after the investigators omitted all authors with any psychiatric diagnosis, they found there was still a trend for authors without diagnosed psychopathology to commit suicide more frequently than control participants (odds ratio [OR], 1.45; 95% confidence interval [CI], 0.97 – 2.16; P = .07).

“Thus, regardless of psychopathology, being an author seemed to increase suicide risk,” they write.

The investigators also noted that this study confirmed results from their earlier study, which showed that family members of patients with BD or schizophrenia were “significantly overrepresented” in creative professions.

They also found a link between creative professions and being a sibling of individuals with autism and being a parent or sibling of an individual diagnosed with anorexia nervosa.

Further, the researchers report that IQ was generally higher in people with creative occupations but lower in individuals with psychiatric disorders and their relatives compared with people without a mental health diagnosis.

The authors have disclosed no relevant financial relationships.

J Psych Res. Published online October 11, 2012. Abstract                                                                  

The Internet:Changing Healthcare In A Radical Way

I’m a “baby boomer”, so I did not grow up with a cell phone attached to my thumbs. I was fortunate enough to have access to rudimentary computers in elementary school and instructed in programming languages like COBOL and FORTRAN when I was in high school. I even won first place in a science competition for programming a computer to play Monopoly with me.  As a society, we have made tremendous advances in computer science and related technology. One of the crowning achievements is the advent of the internet. And as with all advances, we have witnessed great change. One striking change is how the internet, social networking , and advanced technology has affected the field of healthcare.

Take a moment to think about this. Centuries ago, people worldwide relied on their religious leaders for all spiritual instruction and guidance. Of course, there are plenty of tales of those leaders abusing their influence over the masses. People did not yet have access to Bibles or religious material of their own. But that all changed in a huge way with the invention of the Gutenberg printing press. For the first time in history, common people had access to religious texts. Gospel was no longer knowledge closely held by the few élite. People were empowered to question, to study, to interpret on their own.  Now, think of how this situation parallels what we are experiencing today in the healthcare industry.

Social media has proven that there are great benefits to the collective consciousness of groups of people. For the first time in history, connecting with others that have the same diagnosis as you is as simple and quick as logging in to the web. Research, information, and even some (although not all yet) scholarly articles are available for anyone with internet access to view. Dr. Eric Topol…..Director of the Scripps Translational Science Institute…..has stated that in some cases, patients now trust their online peer group MORE than their own doctor when it comes to accurate and cutting edge medical issues. It seems that the era of doctors as gods is over. But that isn’t a bad thing. As with the Gutenberg press and the revolution it created in religion and knowledge, so too the internet and our revolution in healthcare will go. Religions still exist. Religious leaders are still sought for guidance. Doctors and healthcare professionals still exist. We still need them for guidance and healing. What we now have is more power…..consumer driven power.

There will absolutely be bumps along the way of this revolution. Some healthcare professionals will suffer from social smack downs at the hands of their patients. Some patients will run to their doctor armed with their ominous internet diagnosis and information provided to them by the big pharma company ad campaigns as to the “new pill” that will cure this condition…..after ten minutes of online research. Even so, I see this revolution as a very positive development. Take for example the Institute of Medicine’s report that published and compared shopping for healthcare with various other consumer driven experiences…..this report points out problems, but also urges all of us to pay attention. It challenges us to be empowered in finding our own solutions. Here is a bit of the report…..

“If banking worked like health care, ATM transactions would take days. If home building were like health care, carpenters, electricians and plumbers would work from different blueprints and hardly talk to each other. If shopping were like health care, prices would not be posted and could vary widely within the same store, depending on who was paying. If airline travel were like health care, individual pilots would be free to design their own preflight safety checks – or not perform one at all.”

Online access to our personal genomic sequence, complete with recommendations about what medicines to avoid. Ultrasound, EKG, and blood glucose levels straight from our smartphones. Databases that rank and rate hospitals, doctors, other treating professionals based on real data and not anecdotal accounts. Access to the leading experts worldwide in varying specific areas of medicine. All this…..and much more… at hand for us as consumers.

Knowledge is power. Let’s all shop smarter.