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  1. Alison Tonks, associate editor (atonks@bmj.com)

    Minority groups and Medicaid patients have surgery in low volume hospitals

    For many complex surgical procedures, hospitals treating a lot of patients (“high volume hospitals”) are considered better than hospitals treating just a few (low volume hospitals). Observational evidence supports this view. Even in the US, however, there aren't enough high volume hospitals to treat everyone, and a recent state-wide study from California suggests that patients with safety net insurance (Medicaid, federally funded insurance for people on low incomes) and those from non-white cultural backgrounds are missing out.

    Using routinely collected discharge data from all Californian hospitals, the authors showed that people with Hispanic, Asian, or black cultural identities are up to 60% less likely than white Californians to be treated in high volume hospitals for a range of complex procedures such as knee replacement, hip fracture repair, coronary artery bypass grafting, and carotid endarterectomy. Patients with Medicaid or no insurance are up to 80% less likely to go to these hospitals than patients with Medicare insurance (federally funded insurance for all people aged over 65). These differences are unexplained by differences in age, sex, income, comorbidity, or proximity to a high or low volume hospital.

    JAMA 2006; 296: 1973–80
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    Outbreak of hepatitis C traced to contaminated vial of radionuclide

    When two elderly residents of Maryland developed acute hepatitis C in November 2004, the local health department suspected a common source and launched an investigation. Both adults had had myocardial perfusion studies on the same day in the previous month (15 October), so investigators focused on the pre-prepared solution of technetium-99m sestamibi used in the studies. It was contaminated with hepatitis C virus. All 14 of the other patients treated from this vial were also infected: most had symptoms, 11 had jaundice, and one died of liver failure and sepsis 10 weeks after the technetium study.


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    Further investigation led the team to a nursing home patient with hepatitis C, HIV infection, and a …

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