I want to be clear about my thesis here. My thesis is NOT that hospital administrators are sitting around conspiring to let their patients die of cardiac arrests in order to save money. I do not believe in any way this to be the case.

Rather, what I believe is that preventing sudden death is simply not a big priority in hospitals, as it is, for instance, in casinos. Inherently, preventing many of the 300,000 sudden deaths that occur each year in the United States, while entirely feasible with existing technology, would be very expensive for the healthcare system. The healthcare system, being founded on a paradigm of covert rationing (where the rationing is based not on what is most effective, equitable or efficient, but instead on what you can get away with) would rather ignore the problem. And since there is no constituency for sudden death (as there is for breast cancer and cerebral palsy, for instance), nobody is forcing the healthcare system to focus on it.

So, what with all the well-known and sundry crises that hospital administrators and their medical staffs must face each day, the “problemâ€? of poor response times to cardiac arrests in hospitals simply does not appear above the radar. This is not a conspiracy. It’s simple human nature.

I am trying to call attention to the irony. Owners of casinos have noticed a clear incentive for preventing sudden death among their customers, and this realization has led to their adoption of readily available technology (AEDs), which in turn, has led to casinos becoming possibly the “safestâ€? place for you to have your cardiac arrest. In contrast, people who run hospitals (institutions that exist for the express purpose of staving off death) have not availed themselves of this readily available technology. Instead, they seem content to rely on byzantine bureaucratic processes (that, once again, were not designed by evil cabals, but instead evolved, like all bureaucratic processes), so that first responders can often do little more than dial the phone and wait for the officially designated, properly credentialed individual to arrive and then operate the unnecessarily complex hospital defibrillator.

So there’s no conspiracy – just a deep-seated disinterest in addressing the subject. It is a disinterest that will remain unless somebody forces the issue, or unless utter embarrassment requires a change.

DrRich