Tagged Public Health

Viewpoints: Nursing Homes And Hurricanes; Winning The War On Drugs

A selection of opinions on health care from around the country.

Miami Herald: Protect Nursing Home Residents, Not Bad Facilities
When they get together in Tallahassee on Friday, the members of Florida’s nursing-home industry can either circle the wagons or lay the groundwork to take a deep, honest look at how best to confront the one the worst tragedies the industry seen. The Florida Health Care Association has called a “summit” to address emergency preparedness. This comes after eight, then nine and, as of Thursday, 10 elderly residents in a Hollywood Hills nursing home were left to suffer and die because they were in an stiflingly hot facility that lost electricity as Hurricane Irma blew through. (9/22)

USA Today: In Hurricane Irma, Why Did Nursing Home Patients Have To Die?
The deaths have set off the predictable round of finger-pointing among the nursing home, the electric utility, state agencies and the governor over responsibility for decisions and ineptitude that turned deadly. This blame game avoids the real problem. The facility had one operable backup generator, which did not run air conditioning. And no one — not the federal government, not the state and not the county — required the facility to have an emergency generator dedicated to keeping fragile residents cool in a state that regularly experiences hurricanes, flooding and sweltering heat. (9/21)

USA Today: Florida Health Care Association: We’re Dedicated
As caregivers dedicated to helping Florida’s frail elders, all of us at Florida Health Care Association grieve the loss of nine elderly residents of a single, non-member South Florida nursing home in the wake of Hurricane Irma. Our members accept the enormous daily responsibility of caring for Florida’s frailest residents. Ever since Florida’s horrendous storm season of 2004, we have committed to ongoing intensive disaster response training — most recently, the week before Hurricanes Harvey and Irma struck. (Emmett Reed, 9/21)

Bloomberg: Tom Price Flies Blind On Ethics
Under the lax ethical standards President Donald Trump brought to the White House, rampant conflicts of interest are treated with casual indifference. This disregard has sent a message to his entire administration that blurring lines — between public and private, right and wrong — will be not just tolerated but defended. At least one cabinet member appears to have taken the message to heart. (9/21)

The New York Times: How To Win A War On Drugs
Decades ago, the United States and Portugal both struggled with illicit drugs and took decisive action — in diametrically opposite directions. The U.S. cracked down vigorously, spending billions of dollars incarcerating drug users. In contrast, Portugal undertook a monumental experiment: It decriminalized the use of all drugs in 2001, even heroin and cocaine, and unleashed a major public health campaign to tackle addiction. Ever since in Portugal, drug addiction has been treated more as a medical challenge than as a criminal justice issue. … Portugal may be winning the war on drugs — by ending it. Today, the Health Ministry estimates that only about 25,000 Portuguese use heroin, down from 100,000 when the policy began. (Nicholas Kristof, 9/22)

The New England Journal Of Medicine: The Fate Of FDA Postapproval Studies
Both Congress and the Food and Drug Administration (FDA) have sought to accelerate the availability of new drugs by allowing sponsors to wait to resolve many questions about safety and benefit until after their drugs receive marketing approval. As a result, most approval letters require phase 4 studies to address issues such as optimal dosing, potential long-term side effects, and use in children or to confirm the clinical benefit of drugs that receive conditional approval on the basis of preliminary evidence. (Steven Woloshin, Lisa M. Schwartz, Brian White, and Thomas J. Moore, 9/21)

Chicago Tribune: Will Rauner Complete A ‘Full Obama’ On Abortion Rights?
Common usage notwithstanding, a flip-flop is actually a double inversion: First the flip — a reversal on an earlier position — then the flop — a return to the original position. A 360, to put it geometrically. A classic example is Barack Obama on same-sex marriage. In February 1996, when he was running for the state Senate, he expressed unequivocal support for gay marriage in candidate questionnaires, writing that he “would fight efforts to prohibit such marriages.” … A big question in Illinois these days is if Gov. Bruce Rauner will end up performing a “Full Obama” on the issue of Medicaid and state-employee health insurance funding of abortion services. (Eric Zorn, 9/21)

The New England Journal Of Medicine: A Nicotine-Focused Framework For Public Health
With the tools provided to the Food and Drug Administration (FDA) under the Family Smoking Prevention and Tobacco Control Act of 2009, the agency has taken consequential steps to prevent sales of tobacco products to children, expand the science base for understanding traditional and newer tobacco products, and conduct public education campaigns. But the agency needs to do more to protect Americans; in particular, we must shape a regulatory framework that reduces their use of combustible cigarettes. (Scott Gottlieb and Mitchell Zeller, 9/21)

Chicago Tribune: Cook County’s ‘Health’ Lie, In Black And White
Let Michael Bloomberg spend his millions to defend Cook County’s hated sweetened beverage tax. Opponents don’t need to pay a dime for advertising. That’s because taxpayers get a written reminder of this brazen cash grab every time they make a purchase. County Board members who are on the fence about next month’s vote to repeal the tax should keep that in mind. (9/21)

The New England Journal Of Medicine: Tuberculosis Elimination In The United States — The Need For Renewed Action
Once called “the captain of all these men of death,” tuberculosis continues to kill 1.8 million people globally each year. In 2014, the World Health Assembly embraced an ambitious resolution to reduce deaths from tuberculosis by 95% by 2035. But despite such global concern, tuberculosis has all but vanished from the U.S. public’s mind as a perceived threat. Although this lack of attention is understandable, given the substantial decrease in disease burden over the past several decades, it jeopardizes the prospect of tuberculosis elimination in the United States — a goal established by the Department of Health and Human Services in 1989. Critical ethical and policy questions must be addressed if elimination is to be pursued in earnest. (Ronald Bayer and Kenneth G. Castro, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Research Roundup: Hospital Transportation; Medicaid Expansion; Obesity Treatment

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Urban Institute: The Affordable Care Act Medicaid Expansions And Personal Finance 
Results demonstrate financial improvements in states that expanded their Medicaid programs as measured by improved credit scores, reduced balances past due as a percent of total debt, reduced probability of a medical collection balance of $1,000 or more, reduced probability of having one or more recent medical bills go to collections, reduction in the probability of experiencing a new derogatory balance of any type, reduced probability of incurring a new derogatory balance equal to $1,000 or more, and a reduction in the probability of a new bankruptcy filing. (Caswell and Waidmann, 9/17)

Health Affairs: Networks In ACA Marketplaces Are Narrower For Mental Health Care Than For Primary Care
Using data for 2016 from 531 unique provider networks in the Affordable Care Act Marketplaces, we evaluated how network size and the percentage of providers who participate in any network differ between mental health care providers and a control group of primary care providers. Compared to primary care networks, participation in mental health networks was low, with only 42.7 percent of psychiatrists and 19.3 percent of nonphysician mental health care providers participating in any network. (Zhu, Zhang and Polsky, 9/1)

Pediatrics: Cost-Effectiveness Of Family-Based Obesity Treatment 
We translated family-based behavioral treatment (FBT) to treat children with overweight and obesity and their parents in the patient-centered medical home. … For families consisting of children and parents with overweight, FBT presents a more cost-effective alternative than an IC group. (Quattrin, Cao, Paluch et. al., 9/1)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: In Calif., Gubernatorial Candidates Try To Prove Health Care Street Cred; Death Toll Rises In Fla. Nursing Home Tradgedy

Media outlets report on news from California, Florida, Texas, Illinois and Pennsylvania.

Los Angeles Times: The Push For Single-Payer Health Care Just Went National. What Does That Mean For The California Effort?
When Vermont Sen. Bernie Sanders visited Beverly Hills last May, he made a full-throated appeal for California to “lead the country” and pass a pending state proposal to establish single-payer health care. On Friday, he’ll return here for a San Francisco speech trumpeting his own higher-stakes plan — a bill to drastically overhaul the nation’s health-care system by covering everyone through Medicare. (Mason, 9/22)

Los Angeles Times: Two Top Candidates For California Governor Have Been Touting Their Healthcare Wins. Here’S What They Really Did
Gavin Newsom and Antonio Villaraigosa are depicting themselves as Democratic healthcare visionaries as they campaign to become California’s next governor. To prove his healthcare mettle, Newsom points to Healthy San Francisco, a first-of-its-kind universal system adopted while he reigned as the city’s mayor in 2006. Newsom’s work on the program helped him land an endorsement from the influential California Nurses Association, and a boast or two will surely punctuate his speech at their convention on Friday as hyper-partisan politics intensify over efforts to repeal the Affordable Care Act and implement a national single-payer plan. (Willon, 9/22)

Reuters: Death Toll From Overheated Florida Nursing Home Rises To 10
A 10th elderly patient at a Miami-area nursing home has died after she was exposed to sweltering heat in the aftermath of Hurricane Irma, police said on Thursday. The resident of the Rehabilitation Center at Hollywood Hills died on Wednesday, police in Hollywood, Florida, said in a statement, without giving details. (Simpson, 9/21)

Los Angeles Times: Multiple Cases Of West Nile Virus In Glendale Prompt Education Campaign
With eight cases of West Nile virus reported in Glendale so far this year, health officials took part in a door-to-door education campaign Wednesday, informing residents of what they can do to protect themselves from infection. Conducted by the Greater Los Angeles County Vector Control District, the effort informed residents in Glendale, Los Feliz and Atwater Village about the preventive measures they can take to reduce the risk of being bitten by mosquitoes. Levy Sun, a spokesman for vector control, said wearing insect repellent and dumping out any stagnant water near homes are measures people should take regularly. (Nguyen, 9/21)

Houston Chronicle: Residents Near Houston Superfund Site Await Answers After Hurricane Harvey
Bonner and others in Channelview, Baytown and Highlands neighborhoods along this industrial stretch of the river south of the Lake Houston dam worry about the toxicity of murky water, white dust and the foul-smelling sludge covering their properties. The question for dozens of people, who a week after the storm still guard wrecked riverfront properties from marauders seeking scrap, is whether their neighborhoods are now too contaminated to recover. (Olson, 9/22)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Football Player Who Was Convicted Of Murder Found To Have Severe Brain Damage

The severity of former NFL player Aaron Hernandez’s CTE, a degenerative disease believed to be caused by concussions, is usually found in players in their 60s. He was 27 when he committed suicide in jail.

The New York Times: Aaron Hernandez Found To Have Severe C.T.E.
The brain scan came as a surprise even to researchers who for years have been studying the relationship between brain disease and deaths of professional football players. Aaron Hernandez, the former New England Patriots tight end and a convicted murderer, was 27 when he committed suicide in April. Yet a posthumous examination of his brain showed he had such a severe form of the degenerative brain disease C.T.E. that the damage was akin to that of players well into their 60s. (Belson, 9/21)

Los Angeles Times: Disgraced Ex-Patriots Player Aaron Hernandez Found To Have CTE And Early Brain Atrophy
In an announcement Thursday, Boston University’s CTE Center said doctors diagnosed Hernandez with Stage 3 CTE. Stage 4 is the most serious. Both stages, usually found in much older former players, are associated with aggressiveness, impulsivity, depression and memory loss. The effort, led by Dr. Ann McKee, also found he had “early brain atrophy” and “large perforations” on a central membrane in his brain. (Fenno, 9/21)

The Boston Globe: Learn The Symptoms In The Four Stages Of CTE
A statement released by the BU CTE Center stated that Hernandez was found to have Stage 3 CTE, with Stage 4 being the most severe. According to a 2012 BU study, CTE begins with simple symptoms such as headaches and difficulty concentrating, but as the disease progresses, other, much more worrying conditions appear. (Ortiz, 9/21)

Dangers of such diseases put the spotlight on how schools handle young players —

San Francisco Chronicle: How California Puts High School Athletes At Great Risk
According to a recent study published in the Orthopedic Journal of Sports Medicine and conducted by the University of Connecticut’s Korey Stringer Institute, a nonprofit dedicated to minimizing preventable death on the playing field, California ranks second to last in the nation — ahead of only Colorado — when it comes to implementing policies that help prevent the leading causes of sudden death in high school athletes. (Saracevic, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Hospital Cracks Down On Inconsistencies With Prescribing Opioids As It Tries To Battle Crisis

Anne Arundel Health System joins hospitals across the region and the state of Maryland in attempting to eradicate a problem medical institutions now realize they helped create. Meanwhile, the Senate HELP Committee will plan on a hearing to address the epidemic next month.

The Hill: Senate Health Committee Schedules Hearing On Opioid Crisis
The Senate Health Committee will hold a hearing on the opioid crisis next month. The committee will focus on the federal response to the crisis and conduct oversight of the Comprehensive Addiction and Recovery Act, a law passed in 2016 that supports efforts to address the issue. (Hellmann, 9/21)

And in other news —

The Associated Press: Opioid Epidemic Laws Lead Panel To Revisit Recovery Schools
A fire led to the eventual end of Phoenix — a groundbreaking Maryland public school program for children with addiction that closed in 2012 — but the state could see institutions like it rise again from the ashes. Recent spikes in the Maryland heroin and opioid epidemic have triggered calls for substantial changes in education systems statewide, and a state work group is weighing the return of recovery schools after a Sept. 7 meeting. (Slater, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Massive Data-Gathering Project Strives To Be Inclusive Where So Many Studies Have Failed In Past

The National Institutes of Health’s wide-sweeping data-gathering project, called “All Of Us,” has set a goal of ensuring that more than half of the participants come from communities that are historically underrepresented in biomedical research. In other public health news: brain science, diabetes-related amputations, kidney disease and more.

Stat: To Advance Precision Medicine, NIH Turns To Long-Mistreated Communities
The National Institutes of Health would like six vials of your blood, please.Its scientists would like to take a urine sample, measure your waistline, and have access to your electronic health records and data from the wearable sensor on your wrist. And if you don’t mind sharing, could they have your Social Security number? It is a big ask, the NIH knows, and of an equally big group — the agency eventually hopes to enroll over 1 million participants in the next step of what four researchers referred to in a 2003 paper as “a revolution in biological research.” (Facher, 9/22)

Stat: Zapping The Brain For Stroke Rehab: Pivotal Clinical Trial Begins
Despite being forced by Hurricane Irma to close its outpatient facilities for several days, the Mayo Clinic in Jacksonville, Fla., is expected to forge ahead this month with a pivotal clinical trial testing whether an electrical implant can rewire the brains of stroke patients so they can use their arms and hands again. (Begley, 9/22)

Los Angeles Times: UC Irvine To Debut Brain Research Center With Advanced MRI Machine
UC Irvine’s Campus Center for Neuroimaging will have a grand opening next month for its new research center that aims to make breakthroughs in human brain research. The centerpiece of the center — dubbed FIBRE, or Facility for Imaging & Brain Research — is a $3-million Siemens Prisma 3T magnetic resonance imaging, or MRI, machine noted for its technology that collects higher-quality images in a shorter time. It came to UCI with help from Siemens and the National Institutes of Health. (Zint, 9/21)

inewsource: Diabetes-Related Amputations Increase In California — And San Diego
Clinicians are amputating more toes, legs, ankles and feet of patients with diabetes in California — and San Diego County in particular — in a “shocking” trend that has mystified diabetes experts here and across the country. Though they often prolong lives, diabetes-related amputations deprive patients of independence, increase the need for social services and add to disability and medical costs.Explore the rate of amputations in California.Statewide, lower-limb amputations increased by more than 31 percent from 2010 to 2016 when adjusted for population change. In San Diego County, the increase was more than twice that: 66.4 percent. (Clark, 9/20)

The New York Times: Air Pollution Tied To Kidney Disease
Add a new potential ill to the list of problems linked to air pollution: kidney disease. Previous studies have linked high levels of the fine particulate matter known as PM 2.5 to cardiovascular disease and stroke. A new analysis, in The Journal of the American Society of Nephrology, followed 2,482,737 veterans for an average of eight and a half years. The Department of Veterans Affairs database includes information on glomerular filtration rate, or G.F.R., a measure of kidney function. (Bakalar, 9/21)

The Washington Post: She Chose To Die So She Could Give Birth. Now Her Newborn Is Dead, Too.
The headaches began in March. The couple didn’t think much of them — until Carrie DeKlyen began vomiting. An initial scan showed a mass in her brain. More tests showed that it was a form of cancer, possibly lymphoma, but treatable. But a pathology exam revealed a more grim diagnosis. The 37-year-old mother of five from Wyoming, Mich., had glioblastoma, an aggressive form of brain cancer. If lucky, she could live for five more years. (Phillips and du Lac, 9/21)

California Healthline: FDA Approves Scope With Disposable Part Aimed At Reducing Superbug Infections
Seeking to prevent superbug outbreaks, federal health officials said they have approved the first gastrointestinal medical scope with a disposable cap for use in the U.S. The Food and Drug Administration said that the design of the new duodenoscope by Japanese device maker Pentax should make it easier to remove dangerous bacteria that can become trapped inside these reusable instruments. (Terhune, 9/22)

NPR: Pee In The Pool Can Cause Breathing And Eye Irritation
Water parks can be fun, but they also can pose unexpected health risks – in this case, eye and respiratory problems. And that shower you never take before you get in the pool plays a role. In July 2015, patrons at an indoor water park resort in Ohio started to complain about eye and respiratory problems. Local health officials surveyed patrons and water park employees, who reported issues like eye burning, nose irritation, difficulty breathing and vomiting. The Centers for Disease Control and Prevention then stepped in to investigate. (Jochem, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

VA Steps Up Efforts To Screen And Treat Veterans For Hepatitis C

With a higher rate of infection reported among vets than the general population, the Department of Veterans Affairs started taking proactive measures three years ago to cure patients. Meanwhile, Agent Orange exposure and a wrongful death case are also in veterans health news headlines today.

KQED: In The Battle Against Hepatitis C, The VA Takes The Lead
The VA has implemented an aggressive effort to screen and treat all veterans under their care for the virus. Hepatitis C experts and advocates have praised the VA for its proactive approach, and say it should be a model for other government health programs, and even private insurers. (Klivans, 9/2!)

Kansas City Star: VA Medical Center In Kansas City Focus Of Wrongful Death Suit Alleging Allergic Reaction
An 84-year-old patient developed pustular lesions on his face and died after a Veterans Affairs hospital in Kansas City treated him with a drug he was allergic to, according to a lawsuit filed Wednesday. The suit filed in federal court by Kansas City lawyer Leland Dempsey alleges that staff at the VA Medical Center on Linwood Boulevard caused Mark Beemer’s death last year by giving him Ceftriaxone, and the death could easily have been prevented. (Marso, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Viewpoints: The Promise And Price Tag Of A New Cancer Drug; Medicaid In Indian Country

A selection of opinions on health care from around the country.

JAMA: FDA Approval of Tisagenlecleucel: Promise and Complexities of a $475 000 Cancer Drug
Unlike most cancer therapies that are identical from patient to patient, CAR-T therapies are made by removing the T cells of a patient, genetically modifying them to respond to certain targets expressed on the patient’s cancer cells, and then reinfusing the cells. When the T cells come into contact with the relevant target (for instance, CD19 in the case of ALL), they proliferate while secreting a number of programmed substances including inflammatory cytokines that destroy the cancerous cells. Targeted killing of tumor cells by lymphocytes was first suggested by the graft-vs-leukemia effect in bone marrow transplantation, but that effect and the infusion of donor T cells more generally has no effect on solid tumor malignancies or most hematologic cancers. The innovation underlying CAR-T involved exploiting the specificity of antibody-mediated recognition of tumor antigens, and then engineering CAR-T cells to have the relevant antibody fragment fused to the T-cell receptor. Thus, the “living drug” infused into the patient is the patient’s own T cells altered to express a receptor that is specific for the target antigen on the tumor. (Peter B. Bach, Sergio A. Giralt and Leonard B. Saltz, 9/20)

High Country News: How Will Medicaid Cuts Affect Health Care In Indian Country?
In the legislation introduced by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., on Sept. 12, federal Medicaid and health insurance subsidy dollars would be given as a lump sum to states, which would have wide discretion in how they were spent. Nowhere would this be more devastating than in Indian Country. … In Medicaid expansion states, from Alaska to Maine, the Affordable Care Act has meant that the Indian Health Service, which provides care to 2.2 million of the nation’s 5.3 million American Indians and Alaska Natives, has been able to provide preventive services. Those include screenings for breast and colon cancer, never before available to non-elderly adult patients. Now IHS can provide those services and get reimbursed by Medicaid, instead of having the cost of the services come out of IHS’s grossly inadequate budget. (Tanya H. Lee, 9/20)

The Charlotte Observer: Protests At Charlotte Abortion Clinic Go Too Far
Our government has a responsibility to protect people’s First Amendment right to assemble and peacefully protest. It is also incumbent on government to enforce people’s right to make their own decisions about their medical care. At A Preferred Women’s Health Center in east Charlotte, these two fundamental rights are clashing. Anti-choice protesters are harassing and obstructing people who attempt to perform and to gain access to abortions. And the city is giving an unfair boost to the protesters, compromising the health and safety of thousands of women. (Lisa Levenstein, 9/20)

Bloomberg: Defying Ethics Norms Flies With Trump
Health and Human Services Secretary Tom Price has been taking fancy charter flights when previous secretaries flew commercial. Well, what do you expect? Just think about the incentives in a normal administration and in this one. Normally, the president sets a reasonable example of good ethics practices. Oh, there are sometimes controversies, but normal presidents avoid conflicts of interest, follow the guidelines of ethics officials and other best practices, and generally act as if they care about the appearance, at least, of playing by the rules. This president has basically ignored ethics laws and norms from the beginning. It must be hard to care about saving the government a few dollars when the president is using his office to, for example, advertise his business interests. (Jonathan Bernstein, 9/20)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: Texas Bill To Curb ‘Surprise Medical Bills’ Now In Effect; Blue Cross Will Continue To Run N.C.’s State Health Plan

Media outlets report on news from Texas, North Carolina, Maine, Florida, California, Nevada, Colorado, Michigan, Missouri, New Hampshire, Louisiana and Minnesota.

The Associated Press: Lawsuit Challenges Law That Only Doctors Perform Abortions
The American Civil Liberties Union and Planned Parenthood filed a federal lawsuit Wednesday that challenges a Maine restriction common across most of the U.S. that abortions be performed solely by physicians. The two groups were joined by four nurses and abortion provider Maine Family Planning in challenging the law that prevents advanced practice registered nurses, such as nurse practitioners and nurse midwives, from performing the procedure. (9/20)

Las Vegas Review-Journal: Southern Nevada Medicare Dilemma: Pay More Or Switch Doctors
The recent decision by Southwest Medical Associates to stop covering traditional Medicare patients in Southern Nevada makes 66-year-old Anne Zarate sick to her stomach. That queasy feeling is not just because, as the Las Vegas woman puts it, she’s being “thrown out with 7,000 others in a city where access to medical care is weak at best.” She also sees Southwest’s action as an example of the inability of government to deliver quality health care in the United States. (Harasim, 9/18)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Bouncing Back From Trauma Is Possible, But Some People Have To Work Harder Than Others

Dr. Dennis Charney has spent years studying trauma. And then he joined the ranks of the patients he worked with. In other public health news, ADHD, embryo editing, effects of gender stereotypes, the science of weight loss, the flu and more.

Stat: As A Scientist, He Studied Trauma Victims. Then He Became One
Dr. Dennis Charney stepped forward to address the court here, the man who tried to kill him standing no more than 20 feet away. He stated his full name for the record and then began detailing what happened. How one morning as he picked up his iced coffee and lightly buttered bagel, he heard a shotgun boom and saw blood pouring from his shoulder and chest. How he spent five days in the intensive care unit and then was scared to sleep with the lights off. How even now, a year later, he carried buckshot in his body. (Joseph, 9/21)

The Washington Post: Could ADHD Be A Type Of Sleep Disorder? That Would Fundamentally Change How We Treat It.
Over the past two decades, U.S. parents and teachers have reported epidemic levels of children with trouble focusing, impulsive behavior and so much energy that they are bouncing off walls. Educators, policymakers and scientists have referred to attention-deficit/hyperactivity disorder, or ADHD, as a national crisis and have spent billions of dollars looking into its cause. They’ve looked at genetics, brain development, exposure to lead, the push for early academics, and many other factors. But what if the answer to at least some cases of ADHD is more obvious? (Cha, 9/20)

NPR: Embryo Editing Yields DNA Clues To Early Human Development
For the first time, scientists have edited the DNA in human embryos to make a fundamental discovery about the earliest days of human development. By modifying a key gene in very early-stage embryos, the researchers demonstrated that a gene plays a crucial role in making sure embryos develop normally, the scientists say. (Stein, 9/20)

Minnesota Public Radio: The Science Of Weight Loss
We’ve all heard the conventional wisdom on how to lose weight: eat less and exercise more. But new research shows that shedding pounds and keeping them off may be more complicated than a “one-size-fits-all” approach. (Miller and Franz, 9/20)

Chicago Sun-Times: Mother Says Insurers Failed Her Suicidal Son
It was a year ago this week that Joseph “Joey” Dailidas took his own life with an intentional overdose of prescription medicine. … Despite laws intended to require insurers to provide parity between coverage for mental health treatment and other medical conditions, many believe mental health and addiction treatment are still getting short shrift. (Mark Brown, 9/20)

Baltimore Sun: Mosquito Emoji: A Pair Of Public Health Workers Have An Itch To Make It Happen
Why shouldn’t people who hate the little blood suckers in the backyard, as well as those who love them in the lab, be able to express their feelings about them in a single character via text or on social media, ask Marla Shaivitz, a digital communications manager at the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs, and Jeff Chertak, a senior program officer for malaria advocacy and communications at the Bill & Melinda Gates Foundation. (Cohn, 9/20)

Kaiser Health News: Caregivers Draw Support By Mapping Their Relationships
Every time Jacque Pearson tried to devise a plan to move her 81-year-old dad, who has Alzheimer’s, from his home in Boise, Idaho, to hers in Denver, she felt stuck. Then, two weeks ago, she had a breakthrough. It happened at an AARP-sponsored session in which Pearson created a “CareMap” — a hand-drawn picture showing all the people she cares for as well as the people surrounding those individuals and her own sources of support. (Graham, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Florida Closes Nursing Home Tied To 9 Patient Deaths, Issues Rebuke For False Patient Records

Staff at the home entered normal vital signs into the medical records of several residents after they had already been evacuated, Florida officials said.

The Associated Press: Florida Suspends License Of Nursing Home Over Irma Deaths
Florida officials have suspended the license of a nursing home that had nine patients die after Hurricane Irma knocked out its air conditioning. The Agency for Health Care Administration said Wednesday that it suspended the license of the Rehabilitation Center at Hollywood Hills. The agency previously banned the facility from admitting new patients and from receiving Medicaid. The home filed a lawsuit trying to block those orders. (9/20)

Miami Herald: Irma Aftermath: Nursing Home Where 9 Died Shut Down By State
The Hollywood Hills nursing home that became a sweltering deathtrap for nine seniors after Hurricane Irma was shut down Wednesday. … A statement released by the Agency for Health Care Administration said the center’s license was suspended, and unveiled new details about the nursing home, which has a history of poor inspections by state regulators. (Madan, 9/20)

The New York Times: Florida Nursing Home Listed Dead Resident As ‘Resting In Bed,’ State Says
A state agency has found that the Florida nursing home where eight residents died after it lost air-conditioning following Hurricane Irma “presents a danger to every person on its premises” and must close after staff at the facility failed to call 911 for its overheated patients, even as their temperatures began spiking as high as 109.9 degrees Fahrenheit. The agency also rebuked the nursing home for entering normal vital signs, or mildly elevated temperatures, into the medical records of several residents after they had already been evacuated or, in one case, had already died. Those entries, it said, were made “under dubious circumstances.” (Yee and Fink, 9/20)

The Wall Street Journal: Florida Suspends License Of Nursing Home Tied To Eight Deaths
The latest order comes a day after the Rehabilitation Center at Hollywood Hills filed a lawsuit against the state to block two previous orders, both of which effectively shut down the home, claiming the orders weren’t justified. Under direction from Gov. Rick Scott, the state has taken several steps to stop operations at the Hollywood, Fla., facility following the deaths last week. The nursing home’s residents “did not receive timely medical care because the trained medical professionals at the facility overwhelmingly delayed calling 911,” Florida’s Agency for Health Care Administration said, citing initial findings from an ongoing investigation. (Evans and Kamp, 9/20)

And in a look at other medical services affected by natural disasters —

Stat: Mobile Dialysis Could Save Lives In A Disaster. But Is There A Cost To Safety?
The calls started coming in the days after Hurricane Sandy. Flooded dialysis centers had shuttered across New York and New Jersey. Some patients and practitioners didn’t know where to turn. So they dialed Anita Chambers. “It was difficult to hear stories of patients being driven four to eight hours to find a center that could take them,” Chambers, said recalling the 2012 superstorm. “There were centers open that had all the patients in the day — seeing these patients in the middle of the night.” (Blau, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Open Your Mouth And Say Goo-Goo: Dentists Treating Ever-Younger Patients

Allen Barron scrunches up his tiny face and wails as his mother gently tips him backward onto the lap of Jean Calvo, a pediatric dental resident at the University of California-San Francisco.

Allen’s crying may be distressing, but his wide-open mouth allows Calvo to begin the exam. She counts his baby teeth and checks for dental decay.

“Nothing I am going to do will hurt him,” Calvo tells Allen’s mother, Maritza Barron, who is holding her son’s hands.

To some, the 20-month-old toddler may seem far too young for a dental exam. In fact, he’s on the late side, according to leading dental and pediatric professional associations.

To stave off a lifetime of dental problems and make sure parents learn how to prevent children’s tooth decay, babies should have their first exam when they get their first tooth, or no later than their 1st birthday, according to guidelines from the American Academy of Pediatric Dentistry.

However, many dentists are uncomfortable treating babies, and that has created a significant gap in dental care for infants and toddlers of all backgrounds, experts say. The shortfall is hard to quantify because professional organizations, such as the American Dental Association, do not survey their members on whether they care for infants.

“People think that children are afraid of dentists, but really it’s that dentists are afraid of children,” said Pamela Alston, who is a dentist and dental director of the Oakland-based Eastmont Wellness Center, a publicly funded clinic that is part of the county-run Alameda Health System.

Hoping to narrow the gap in care, the public health agencies of San Francisco and Alameda counties are launching pilot programs to train dentists to treat babies. About 70 dentists will learn over the next three years how to coax infants into cooperating and help parents guard against tooth decay. The first training session in Alameda County is scheduled for early November; San Francisco will begin its training in January. The American Dental Association was not aware of any similar programs in other states.

The guidelines calling for earlier dental visits stemmed from a growing awareness that cavity-causing bacteria can be passed from parents to babies, through shared utensils, for example. Giving babies bottles of fruit juice or sugar water also can cause cavities. Decay in baby teeth has been linked to adult tooth decay.

“By the time children are age 3, they are often so far down the road that prevention is no longer an option,” said Ray Stewart, a pediatric dental professor at UCSF, who has treated infants for more than 15 years and is among the professionals enlisted by Alameda and San Francisco to train the dentists.

Communicating directly with children during dental exams can help reduce their stress, Stewart says. (Robert Durell for Kaiser Health News)

Dentists don’t regard exams of very young children as a means of boosting their income, said Alicia Malaby, spokeswoman for the California Dental Association. “Denti-Cal reimbursements are below actual costs for many procedures,” she said. Rather, they want to help “improve community health outcomes.”

Low-income children, who are more at risk of dental decay and have less access to care than their affluent peers, present the greatest need for early oral exams, dental professionals say.

A portion of the revenue from California’s new tobacco tax will be earmarked to help very young children from low-income families get the dental care they need. The money will be used to give dentists a 40 percent increase on top of the standard reimbursement for services to Denti-Cal patients, including oral exams of children age 3 and under. Denti-Cal provides dental care to beneficiaries of Medi-Cal, California’s version of Medicaid.

Alameda County will offer dentists an extra $20, on top of that statewide increase for appointments with Denti-Cal-covered children that include a thorough exam of the baby’s mouth, a fluoride varnish if needed, a talk with parents about prevention and a demonstration of how to brush their baby’s teeth.

The Alameda and San Francisco training programs, funded by grants from Medi-Cal, could be replicated throughout California if they are successful, according to the Department of Health Care Services.

Maritza Barron came to UCSF after her own dentist — despite the best of intentions — was unable to examine her baby’s mouth. “He tried to say ‘open up’ to him but he wouldn’t do it,” Barron said of the failed attempt, which left her son in tears.

Alston, the Oakland dentist, once faced similar challenges treating very young children, but she has since undergone a transformation. She blames dentists’ wariness of young patients on a lack of experience. When she graduated from dental school in 1982, she said, she had no training that prepared her to work with children younger than 6.

“I didn’t feel like I could manage their behavior,” Alston said.

Over time, however, it became increasingly clear to her that she wasn’t seeing children early enough.

Almost all of the kids who came to her for their first dental visit at age 6 had mouths riddled with tooth decay, Alston said. She had to refer them to specialists for treatment that required sedation. She kept lowering the minimum age for a first visit in her practice, then left it at age 3 for a long time.

But even 3-year-olds were coming in with cavities. Ultimately, she learned how to treat infants and toddlers through a program run by Alameda County’s public health department — not unlike the training to be offered by the new pilot programs.

Today, Alston is passionate about treating very young children and has lined up pediatricians to refer infants to her. And she has revised her guidance on when kids should get their first oral exam, advising parents to bring their children in when their first tooth starts to erupt.

People think that children are afraid of dentists, but really it’s that dentists are afraid of children.

Pamela Alston, Eastmont Wellness Center

She also trains dental students to examine infants. An important trick she teaches them is how to avoid being bitten: “Put your finger behind the last tooth!”

Communicating directly with children during dental exams can help reduce their stress, saod both Alston and Stewart, the UCSF dental professor.

At a recent visit to UCSF’s Pediatric Dentistry Faculty Clinic, 18-month-old Sebastian King scrutinized the dental mirror Stewart handed to him.

“That’s what I’m going to put in your mouth to look at your teeth!” Stewart told him exuberantly.

He asked the young boy to show him where his mouth was. Sebastian smiled with delight as Stewart handed him a blue exam glove he’d blown up into a balloon, and the young boy remained calm throughout the exam.

Helping parents understand their role is also critical, dentists say.

In addition to advising parents not to share eating utensils with their children, Stewart urges them not to let their kids fall asleep with a bottle of milk and to limit their consumption of fruit juice. He also says they should wipe their infants’ gums and teeth with a cloth after feeding them to remove residue that can cause cavities.

That’s the message Calvo, the dental resident, gave to Barron, whose baby sat happily on his mother’s lap after his exam. The boy had cavities because he had been falling asleep with his bottle.

Barron said she recognized that weaning Allen from the bottle at night would be a challenge.

But “it’s really logical,” she told Calvo, adding that she was determined to give it a try.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN’s coverage of children’s health care issues is supported in part by a grant from The Heising-Simons Foundation.

Categories: California Healthline, Cost and Quality, Health Industry, Public Health

Tags: , ,

Viewpoints: Returning To Work After A Psychotic Break; The Fiscal Responsibility Of Legalizing Weed

A selection of opinions on health care from around the country.

The New York Times: The ‘Madman’ Is Back In The Building
For my first day back to work I dressed in a sober navy sweater and a pair of dark slacks. Normal haircut, neatly trimmed beard. I got there early to avoid the morning rush and the inevitable stares and whispers. I had been “away with some issues” — that was the official company line, but offices are gossip hotbeds, and I wondered how much of the real story had filtered through. Did they know that I’d marched through the city for 12 hours — manic, psychotic and convinced I was being videotaped by secret TV producers, the star of my own reality show? That the police had found me later that evening shirtless, barefoot and crying on a subway platform? That I’d been involuntarily committed to Bellevue, the notorious psych ward to which we at Legal Aid routinely sent our most mentally ill clients? (Zack McDermott, 9/20)

Bloomberg: Marijuana Sales Can Make U.S. Tribes Richer And Poorer
“This is going to be bigger than bingo,” James Billie told CNN over the summer. A former chief of the Seminole, whose company MCW gives financing and legal counsel to American Indian tribes to help them grow and sell marijuana on their land, Billie could barely contain his excitement about this new venture. (Naomi Schaefer Riley, 9/19)

Louisville Courier-Journal: Repeat After Me: Yes. We. Cannabis.
Let me be blunt: I used to smoke weed. I have notebooks filled with very profound and original observations about the interconnectedness of all beings to prove it. But, I haven’t burned one down for more than a decade. So, when I suggest that Kentucky legalize recreational marijuana, it’s not because I have a toke in this fight. Instead, Kentucky lawmakers should stop puffing and start passing legislation to legalize weed for two reasons: It’s the right thing to do, and it’s the fiscally responsible thing to do. (Ben Carter, 9/19)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: States, Localities Face High Costs For Retiree Health Benefits; Hepatitis A Outbreak Declared In Los Angeles

Media outlets report on news from Illinois, California, the District of Columbia, Delaware, Maryland, Connecticut, Arizona, Ohio, Kansas, Florida, Minnesota, Colorado and Texas.

The Wall Street Journal: States Need $645 Billion To Pay For These Promises, And That’s Not Counting What They Owe In Pensions
When Aurora, Ill., closed its books in December, about $150 million disappeared from the city’s bottom line. The Chicago suburb of 200,000 people hadn’t become poorer. Instead, for the first time it recorded on its balance sheet the full cost of health care promised to public employees once they retire. States and cities around the country will soon book similar losses because of new, widely followed accounting guidelines that apply to most governments starting in fiscal 2018. (Gillers, 9/20)

Los Angeles Times: Health Officials Declare Hepatitis A Outbreak In L.A. County
Los Angeles County health officials declared a hepatitis A outbreak Tuesday, days after a public health emergency was announced in San Diego County, where at least 16 people have died of the highly contagious virus. Case numbers are still small in L.A. County, with only 10 people infected as part of the outbreak, said Dr. Barbara Ferrer, director of the L.A. County Department of Public Health. By comparison, almost 450 people have contracted the virus in San Diego. (Karlamangla, 9/19)

The Washington Post: Poor, Sick And Still Traveling Long Distances For Health Care In D.C.
The District’s poorest residents are still forced to travel far outside their neighborhoods for their health care, according to a report released Tuesday by Mayor Muriel E. Bowser. Less than 25 percent of Medicaid patients living east of the Anacostia River see a primary-care doctor in their Zip code. Despite efforts to expand services in Wards 7 and 8, many still call 911 emergency services for their basic health needs. And residents needing specialty care must commute downtown where most of the medical specialists are clustered. (Itkowitz, 9/19)

The Associated Press: New Delaware Law Will Expand Cancer Treatment Options
Cancer patients in Delaware will soon have more treatment option under legislation being signed by Gov. John Carney. A bill to be signed Wednesday requires health insurers to cover any medically appropriate drug that has been approved by the Food and Drug Administration for the treatment of stage 4 metastatic cancer and other cancers without requiring proof that the patient failed to respond to a different drug or drugs. (9/20)

The Baltimore Sun: Baltimore Health Department Seeks To Double Buprenorphine Treatment 
Baltimore health officials want to double the number of people in the city who can get access to the addiction treatment drug buprenorphine, help they say heroin addicts desperately need. Officials estimate that 25,000 people in the city are addicted to heroin or other opioids. Numbers on how many people are currently getting buprenorphine in Baltimore were not available, but officials said that even doubling the number of patients with access would not close the gap entirely. (Duncan, 9/19)

The Wall Street Journal: Doctor’s Defamation Suit Highlights Online Patient Reviews
A defamation lawsuit filed by an Ohio plastic surgeon that is slated to go to trial early next year could have far-reaching consequences for disputes between doctors and their patients over online reviews about the quality of medical care, according to legal experts. Dr. Bahman Guyuron, former chairman of the department of plastic surgery at Case Western Reserve University School of Medicine, sued Marisa User in 2015 over anonymous reviews she had posted on the cosmetic-surgery website RealSelf and other sites where patients swap information about doctors. (Palazzolo, 9/19)

KCUR: Southeast Kansas County Among Eight U.S. Communities Awarded Culture Of Health Prize 
Residents of Allen County in Kansas are getting some national recognition for their health-improvement efforts. The county is one of eight 2017 winners of the Culture of Health Prize awarded by the Robert Wood Johnson Foundation, the nation’s largest public health philanthropy.  Richard Besser, the foundation’s president and CEO, traveled to Iola, the county seat, to make the announcement in person Tuesday. (Mclean, 9/19)

Health News Florida: Preventing Mosquito Infestations After Irma
With restoration continuing this week after Hurricane Irma, Florida Department of Health officials are warning residents about standing water left by the storm as a thriving environment for mosquitoes. Containers like garden pots, birdbaths, tires and cans, when filled with standing water, can host mosquitoes laying up to 200 eggs. (Riggins, 9/19)

The Star Tribune: St. Paul Considers Restricting Sale Of Menthol Tobacco
The City Council is considering adding menthol, mint and wintergreen-flavored tobacco to the list of products that can only be sold at tobacco shops. The council will hold a public hearing Wednesday night on the proposed change, which is similar to one the Minneapolis City Council approved last month. (Van Berkel, 9/19)

Columbus Dispatch: Legionnaires’ Cases Involving Ohio State Under Investigation
Columbus Public Health is investigating two separate Legionnaires’ disease cases with ties to Ohio State: one a student at the Drackett Tower dormitory and a Columbus resident who is employed at the university’s Newark campus. A statement released by Ohio State University said Columbus Public Health informed them late Tuesday afternoon that they believe there is no connection between the two cases. (Woods, 9/20)

Denver Post: These Services For Developmentally Disabled Residents Have Grown Because Douglas And Araphoe Voters Approved A Tax In 2001 
In the last 15 years, nonprofits and programs serving people with developmental disabilities have multiplied across Douglas and Arapahoe counties. Much of that growth can be traced to 2001, when voters in both counties approved a tax to fund those operations. …Wellspring Community opened in 2009 with a mission to provide work, education and enrichment opportunities to adults with special needs. Today, the growing organization has an art studio in downtown Castle Rock, a fully operational bakery in the Emporium and cooperative work/education programs at four locations around town. (Mitchell, 9/19)

Texas Tribune: For Some Transgender Texans, Bathroom Bill Fight Spurs Bids For Office
Four people in two years are hardly a speck in a state of nearly 28 million, but that number means Texas currently has more transgender candidates than any other state, according to Logan Casey, a Harvard researcher who studies LGBTQ representation in politics. And it’s a disproportionately large group — Texas carries just under 9 percent of the country’s population, but about 14 percent of its current transgender candidates. (Platoff, 9/20)

Chicago Tribune: Centegra Health To Eliminate, Outsource Hundreds Of Jobs
Financially troubled Centegra Health System plans to eliminate 131 jobs and outsource another 230 positions, the northwest suburban hospital system announced Tuesday. The layoffs and outsourcing come amid a time of financial stress for many hospitals nationwide and follow a year of steep losses for Centegra, which has hospitals in McHenry, Woodstock and Huntley. (Schencker, 9/19)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Health Warnings On Soda Ads Suppresses Free Speech, Judges Rules

A San Francisco ordinance would have required a warning on sodas and sugary beverages, but Ninth U.S. Circuit Court of Appeals Judge Sandra Ikuta writes in the ruling that the label is “not purely factual” and “unduly burdens and chills protected commercial speech.”

The Associated Press: Appeals Court Blocks San Francisco Warning Law For Soda Ads
A federal appeals court on Tuesday blocked a San Francisco law requiring a health warning on soda ads, saying the measure was misleading and would suppress free speech. A unanimous, three-judge panel of the 9th U.S. Circuit Court of Appeals stopped the 2015 ordinance from going into effect until a lawsuit filed by the American Beverage Association and other groups is resolved. (Thanawala, 9/19)

The Wall Street Journal: Appeals Court Blocks San Francisco Law Requiring Soda Health Warnings
The three-judge panel of the Ninth U.S. Circuit Court of Appeals found the ordinance stifles commercial speech and unfairly targets soda over other potentially unhealthy food and drinks. The panel blocked the rule from going into effect. The San Francisco ordinance, passed in 2015, requires advertisements for certain sugar-sweetened drinks to include a disclaimer that says “WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay. This is a message from the City and County of San Francisco.” (Randazzo, 9/19)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Critics Worried $200M Donation To Calif. University Lends Credence To Trend Of Unproven Therapies

Philanthropists Susan and Henry Samueli just donated a huge sum to UC Irvine, and some are concerned it will lead the institution to focus on alternative therapies that have no basis in science at a time when they’re gaining in popularity. In other public health news: domestic violence, lupus, smoking, and strange health events in Cuba.

Stat: A Huge Gift Boosts Alternative Therapies At A Med School, Sparking Outrage
When billionaires Susan and Henry Samueli this week announced a $200 million donation to the University of California, Irvine to launch a new health program dedicated to integrative medicine, they drew a standing ovation and glowing coverage. But for those who have been watching the steady creep of unproven therapies into mainstream medicine, the announcement didn’t go over quite as well. (McFarling, 9/20)

Los Angeles Times: Domestic Violence Homicide Rate Drops With Stricter Gun Law, Study Finds
When domestic violence offenders are required to relinquish their guns, instead of simply being barred from owning firearms, the risk that those offenders may kill their partners goes down, a new study finds. The paper, described in the Annals of Internal Medicine, highlights a simple method for lowering the risk women face of being killed by an intimate partner: Enforce the laws already in place. (Khan, 9/19)

The New York Times: A Stress Link To Lupus
Psychological trauma is associated with an increased risk for lupus, a new study reports. Lupus is a potentially fatal autoimmune disease that causes inflammation of the skin, joints and internal organs. Its cause is unknown. (Bakalar, 9/20)

The New York Times: The Fatal Toll Of Cheap Cigarettes
A new study suggests that the availability of cheaper, off-brand cigarettes is associated with an increase in infant mortality. Researchers writing in JAMA Pediatrics studied the link between cigarette prices and infant mortality in 23 European countries from 2004 through 2014. During this time, there were more than 53 million live births. (9/19)

The Associated Press: Cuba Again Denies Role In ‘Health Attacks’ On US Diplomats
The Cuban government on Tuesday again denied any involvement in or any knowledge of a mysterious series of health incidents that have affected American diplomats in Havana. … At least 21 members of the American diplomatic community in Havana have suffered from symptoms, including brain damage, believed to have come from some sort of sonic attack since late last year. The most recent incident was in August. (9/19)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Following 9 Deaths At Florida Nursing Home, Task Force Formed To Push For Reforms

“We now have a chance to fix what went wrong and ensure something like this never happens again,” said one state lawmaker.

Miami Herald: Haunted By Nursing Home Deaths, Task Force Joins Rush To Make Reforms
In a crowded North Miami Beach City Hall chamber, elected officials, first responders and healthcare workers gathered to establish a task force to better regulate senior facilities, in the wake of eight deaths in Hollywood. The task force, started Tuesday, aims to combine efforts to enact national, state and local policies to ensure the safety of those in assisted living facilities in the wake of a disaster. (Ostroff, 9/19)

The Washington Post: Hurricane Aftermath: Death Toll Rises To 9 In South Florida Nursing Home That Overheated
A ninth patient from a South Florida nursing home that overheated during power outages following Hurricane Irma died on Tuesday, according to police. The death of Carlos Canal, the ninth patient, occurred nearly a week after the nursing home in Hollywood, Fla., became the focus of a criminal investigation when the air conditioning failed and eight other patients ultimately died. (Berman, 9/19)

Kaiser Health News: Nursing Home Disaster Plans Often Faulted As ‘Paper Tigers’
It does not take a hurricane to put nursing home residents at risk when disaster strikes. Around the country, facilities have been caught unprepared for far more mundane emergencies than the hurricanes that recently struck Florida and Houston, according to an examination of federal inspection records. Those homes rarely face severe reprimands, records show, even when inspectors identify repeated lapses. (Rau, 9/19)

Miami Herald: Gov. Scott Places Blame For 9 Deaths Directly On Hollywood Nursing Home
Four days after the owners of a Hollywood nursing home released a detailed time line casting blame for the deaths of eight elders on Florida health administrators and a local utility, Gov. Rick Scott’s administration issued a time line of its own — declaring that the Rehabilitation Center at Hollywood Hills “failed to do their basic duty to protect life.” (Marbin Miller and Klas, 9/19)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Nursing Home Disaster Plans Often Faulted As ‘Paper Tigers’

It does not take a hurricane to put nursing home residents at risk when disaster strikes.

Around the country, facilities have been caught unprepared for far more mundane emergencies than the hurricanes that recently struck Florida and Houston, according to an examination of federal inspection records. Those homes rarely face severe reprimands, records show, even when inspectors identify repeated lapses.

In some cases, nursing homes failed to prepare for basic contingencies.

In one visit last May, inspectors found that an El Paso, Texas, nursing home had no plan for how to bring wheelchair-dependent people down the stairs in case of an evacuation. Inspectors in Colorado found a nursing home’s courtyard gate was locked and employees did not know the combination, inspection records show. During a fire at a Chicago facility, residents were evacuated in the wrong order, starting with the people farthest from the blaze.

Nursing home inspectors issued 2,300 violations of emergency-planning rules during the past four years. But they labeled only 20 so serious as to place residents in danger, the records show.

In addition, a third of U.S. nursing homes have been cited for another type of violation: failing to inspect their generators each week or to test them monthly. None of those violations was categorized as a major deficiency, even at 1,373 nursing facilities that were cited more than once for neglecting generator upkeep, the records show.

“That’s the essential problem with the regulatory system: It misses many issues, and even when it identifies them, it doesn’t treat them seriously enough,” said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. “It’s always the same story: We have some pretty good standards and we don’t enforce them.”

In the wake of eight deaths at Rehabilitation Center at Hollywood Hills, Fla., following Hurricane Irma, heightened attention has focused on new federal disaster-planning rules, with which nursing homes must comply by mid-November. Those were prompted by nursing home and hospital deaths during Hurricane Katrina in Louisiana in 2005.

Dr. David Gifford, senior vice president for quality and regulatory affairs at the American Health Care Association, a nursing home industry group, said facilities have gotten better at handling disasters after each one. Most evacuations go smoothly, he said.

“After each one of these emergencies we’ve learned and gotten better,” Gifford said.

But advocates for the elderly say enforcement of rules is as great a concern, if not greater.

Dr. David Marcozzi, a former director of the federal emergency preparedness program for health care, said that inspectors — also known as surveyors —  should observe nursing home staff demonstrating their emergency plans, rather than just checking that they have been written down.

“If you have not implemented and exercised plans, they are paper tigers,” said Marcozzi, now an associate professor at the University of Maryland School of Medicine. “The emphasis from the surveyor has to be ‘Show me how you do this.’ ”

Gifford said pre-planning and drills, which are important, only go so far in chaotic events such as hurricanes.

“No matter what planning you might have, what we have learned from these emergencies is these plans don’t always work,” he said. Nursing homes take surveys seriously and face closure if they do not fix flaws inspectors identify, he added.

Inspection results vary widely by state, influenced sometimes by lax nursing homes or more assertive surveyors, or a combination, according to an analysis of two types of emergency-planning deficiencies. In California, 53 percent of nursing facilities have been cited for two types of emergency-planning deficiencies, and a quarter have been cited in Texas. No nursing home in Indiana, Mississippi or Oregon was issued violations for those two emergency-planning violations during the past four years.

Asked to explain the rarity of severe citations in emergency preparation, the federal Centers for Medicare & Medicaid Services, which oversees inspections, referred a reporter to its emergency-preparedness mission statement on its website.

The danger of high temperatures for elderly residents, which the Hollywood Hills case shows can be disastrous, has been well known. In a heat wave in 2000, two nursing home residents in a Burlingame, Calif., facility died and six others suffered severe dehydration, heat stroke or exhaustion.

During the past four years, inspectors have cited 536 nursing homes for failing to maintain comfortable and safe temperature levels for residents. Inspectors deemed 15 as serious, including two where patients were harmed, records show.

“There is undoubtedly little, if any, enforcement of the laws since we see the same tragedies repeated time and again,” said Patricia McGinnis, executive director of California Advocates for Nursing Home Reform.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation. Coverage of aging and long-term care issues is supported by The SCAN Foundation.

Categories: Aging, Medicare, Public Health

Tags: , ,

As Care Shifts From Hospital To Home, Guarding Against Infection Falls To Families

Angela Cooper arrived home from work to discover her daughter’s temperature had spiked to 102 degrees — a sign that the teenager, who has cancer, had a potentially deadly bloodstream infection. As Cooper rushed her daughter to the hospital, her mind raced: Had she done something to cause the infection?

Cooper, who works at a Chevy dealership in Iowa, has no medical background. She is one of thousands of parents who perform a daunting medical task at home — caring for a child’s catheter, called a central line, that is inserted in the arm or torso to make it easier to draw blood or administer drugs.

Central lines, standard for children with cancer, lead directly to a large vein near the heart. They allow patients with cancer and other conditions to leave the hospital and receive antibiotics, liquid nutrition or chemotherapy at home. But families must perform daily maintenance that, if done incorrectly, can lead to blood clots, infections and even death.

As more medical care shifts from hospital to home, families take on more complex, risky medical tasks for their loved ones.

But hospitals have not done enough to help these families, said Dr. Amy Billett, director of quality and safety at the cancer and blood disorders center at Dana-Farber Cancer Institute/Boston Children’s Hospital.

“The patient safety movement has almost fully focused all of its energy and efforts on what happens in the hospital,” she said. That’s partly because the federal government does not require anyone to monitor infections patients get at home.

Even at the well-resourced, Harvard-affiliated cancer center, parents told Billett in a survey that they did not get enough training and did not have full confidence in their ability to care for their child at home.

The center was overwhelming parents by waiting until the last minute to inundate them with instructions — some of them contradictory — on what to do at home, Billett said.

An external central line, which ends outside the body, must be cleaned every day. Caregivers have to scrub the hub at the end of the line for 15 seconds, then flush it with a syringe full of saline or anticoagulant.

If caregivers don’t scrub properly, they can flush bacteria into the tube, and — whoosh — the bacteria enter a major vein close to the heart, Billett said. One father, noting that the hub looked dirty, scrubbed it with a pencil eraser, sending three types of bacteria into his child’s bloodstream, she said.

Learning the cleaning steps was “very nerve-wracking,” recalled Cooper, whose 18-year-old daughter, Jaycee Gray, has had a central line since April to receive treatment for anaplastic large-cell lymphoma, a rare type of blood cancer.

“You can scrub and scrub and scrub, and it doesn’t feel like it’s clean enough,” she said. Parents must keep track of other rules, too, like covering up the central line before the child gets in the shower and changing the dressing if it gets dirty or wet.

Monitoring Infection Cases At Home

Bloodstream infections associated with central lines lead to thousands of deaths each year inside hospitals, costing billions of dollars, according to the Centers for Disease Control and Prevention. Research has also shown these infections are largely preventable: Hospitals have slashed infection rates when staff follow the CDC’s standardized safety steps.

But researchers recently discovered that more kids with central lines are getting bloodstream infections at home. In a three-year study of children with cancer and blood disorders at 15 hospitals, 716 such infections took place outside the hospital, compared with 397 inpatient infections. This is partly because children with central lines spend much less time in hospitals than not.

These hospitals belong to a national collaborative of 20 pediatric cancer centers, organized through the Children’s Hospital Association, that aims to keep kids out of the hospital by training families, visiting nurses and clinic staff on handling central lines.

At one of the hospitals, Johns Hopkins in Baltimore, researchers discovered that patients as young as 8 were cleaning their own central lines at home, even though the hospital had designed its training materials for adults.

Cooper said that when her daughter developed the fever July, she immediately started wondering if she was to blame: “It’s really hard,” she said. “I don’t want to put her in the hospital.”

When doctors confirmed that Jaycee had a bloodstream infection, Cooper asked them what caused it. Days later, after interviews and tests, no one knew for sure.

Jaycee was transferred to Children’s Hospital & Medical Center in Omaha, Neb., one of the other hospitals in the collaborative, where nurse Amanda Willits works with families to identify the likely causes of infections and practice safe techniques. Willits said the bacteria probably came through the skin, but there’s no sign Cooper is to blame, and Cooper demonstrated her line-care technique perfectly.

Jaycee spent four days in an isolated room at the hospital, two hours away from home. Doctors warned her that if the bacteria had colonized the plastic of her central line, she might have to go through surgery to have it removed and replaced.

As it turned out, Jaycee didn’t need surgery; she recovered with antibiotics. But about four times out of 10, children who get these infections do need their lines surgically removed, according to research by pediatric oncologist Dr. Chris Wong Quiles at Dana-Farber/Boston Children’s.

Looking at 61 patients there, Wong Quiles tackled basic questions that researchers don’t have national data on: When patients get these infections at home, what happens to them, what does it cost and how often do they die?

Wong Quiles found that in 15 percent of cases, children ended up in the intensive care unit. Four children died. Their median hospital stay was six days, and their median age was 3.

These episodes also cost a lot. Wong Quiles found that median hospital charges were $37,000 per infection. That’s not counting professional fees from hospital staff; the cost of going home with antibiotics and possibly nursing care; or the cost to families from losing days of work to be at the hospital with their kids.

Dan and Megan Kelley care for daughter Bridget, 8, who has leukemia, at home in Quincy, Mass. When Bridget was discharged from the hospital after treatment, it “felt like bringing a newborn baby home,” Megan Kelley says. (Melissa Bailey/Kaiser Health News)

Bringing In A Checklist Engineer

In Boston, Billett and Wong Quiles have enlisted extra staff and resources to try to help parents. The hospital hired a “checklist engineer” to clean up inconsistent messaging and created family-focused videos, flip charts and pocket-size brochures about handling central lines.

Now, patients and families start learning central line care five to 10 days before discharge, instead of just one or two days, Billett said. Parents first practice on a dummy called Chester Chest, then demonstrate their skills on their child.

Even after this training, bringing a child with cancer out of the hospital still felt scary, said Megan Kelley, whose 8-year-old daughter, Bridget, is being treated there for leukemia.

“It felt like bringing a newborn baby home — we’ve never done this before,” said Kelley, who lives in Quincy, Mass., with her husband, Dan, and their three daughters.

Bridget and her family have managed to avoid infection since she was first discharged last December.

Along the way, the family got support and was spot-checked: The hospital keeps track of who was trained and that person’s skill level, and sends a nurse home to see how the caregiver handles the line.

This approach to patient safety — helping families at home through standardized learning tools, hands-on training and tracking skill development — could have broad applications for caregivers of patients young and old, Billett said.

Some early work at Johns Hopkins has shown success: The hospital found a dramatic reduction in outpatient bloodstream infection rates after it trained families, home health nurses and clinic staff.

These infections “can exact such a harsh toll on some of our most vulnerable patients,” said Dr. Michael Rinke, who led that research and now works at Montefiore Medical Center in New York. “Preventing even one of these can help a kid have an important out-of-hospital time, and have an important being-a-kid experience.”

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.

Categories: Health Industry, Public Health

Tags: , , , ,