A large body of work demonstrates income-related disparities in access to coordinated preventive care in patients with diabetes and other chronic conditions. Much less information exists on associations between poverty and consequential negative health outcomes. Few studies have assessed geographic patterns linking household incomes to major, preventable complications of chronic diseases. Using statewide facility discharge data for California during 2009, we identified 7,973 lower extremity amputations in 6,828 diabetic adults. We mapped amputation events based on residential zip codes, and used US census data to produce corresponding maps of poverty rate. Comparisons of the maps show amputation “hotspots” in lower income urban and rural regions of California. Prevalence-adjusted amputation rates varied ten-fold between high-income and low-income regions. While our analysis does not support detailed causal inferences, our method for mapping complication “hot spots” using existing public data sources may help target interventions to communities most in need.

Nebulized TXA seems to be a safe, effective, and noninvasive method for controlling, or at least temporizing, hemoptysis in select patients. Nebulized TXA may be useful as a palliative therapy for chronic hemoptysis and as a tool in the acute stabilization of hemoptysis.

Patients who doctor shop are at high risk of opioid use disorder but represent a small fraction of those with dangerous opioid use. Furthermore, these individuals do not receive substantial opioids from episodic providers, which challenges the utility of prescription reduction programs in curbing use among this population. These results suggest we re-evaluate physician roles in the care of these patients and focus on referral to treatment and harm reduction strategies.

For emergency physicians, a civil monetary penalty is a feared consequence of EMTALA enforcement, as a physician can be held individually liable for fine of up to $50,000 not covered by malpractice insurance. Although EMTALA is an actively enforced law, and violation of the EMTALA statute often results in hospital citations and fines, and occasionally facility closure, we found that individual physicians are rarely penalized by the OIG following EMTALA violation. Individual physician penalties are far less common than hospital citations or fines related to EMTALA or malpractice claims or payments. The majority of penalties against individual physicians were levied upon on-call specialists who refused to evaluate and treat ED patients. Only one emergency physician was fined during the study period for a clear violation of the EMTALA statute. Physicians should be diligent to ensure appropriate patient care and that facilities are compliant with the EMTALA statute, but should be aware that settlements against individual physicians are a rare consequence of EMTALA enforcement.

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