Archive for the ‘Healthcare’ Category
Michael Grabell and Howard Berkes have an important story in ProPublica:
DENNIS WHEDBEE’S CREW WAS RUSHING to prepare an oil well for pumping on the Sweet Grass Woman lease site, a speck of dusty plains rich with crude in Mandaree, North Dakota.
It was getting late that September afternoon in 2012. Whedbee, a 50-year-old derrickhand, was helping another worker remove a pipe fitting on top of the well when it suddenly blew.
Oil and sludge pressurized at more than 700 pounds per square inch tore into Whedbee’s body, ripping his left arm off just below the elbow. Coworkers jerry-rigged a tourniquet from a sweatshirt and a ratchet strap to stanch his bleeding and got his wife on the phone.“Babe,’’ he said, “tell everyone I love them.”
It was exactly the sort of accident that workers’ compensation was designed for. Until recently, America’s workers could rely on a compact struck at the dawn of the Industrial Age: They would give up their right to sue. In exchange, if they were injured on the job, their employers would pay their medical bills and enough of their wages to help them get by while they recovered.
Over the past decade, state after state has been dismantling America’s workers’ comp system with disastrous consequences for many of the hundreds of thousands of people who suffer serious injuries at work each year, a ProPublica and NPR investigation has found.
The cutbacks have been so drastic in some places that they virtually guarantee injured workers will plummet into poverty. Workers often battle insurance companies for years to get the surgeries, prescriptions and basic help their doctors recommend.
Two-and-a-half years after he lost his arm, Whedbee is still fighting with North Dakota’s insurance agency for the prosthesis that his doctor says would give him a semblance of his former life.
The changes, often passed under the banner of “reform,” have been pushed by big businesses and insurance companies on the false premise that costs are out of control.
In fact, employers are paying the lowest rates for workers’ comp insurance since the 1970s. And in 2013, insurers had their most profitable year in over a decade, bringing in a hefty 18 percent return.
All the while, employers have found someone else to foot the bill for workplace accidents: American taxpayers, who shell out tens of billions of dollars a year through Social Security Disability Insurance, Medicare and Medicaid for lost wages and medical costs not covered by workers’ comp.
ProPublica analyzed reams of insurance industry data, studied arcane state laws and obtained often confidential medical and court records to provide an unprecedented look at the unwinding of workers’ comp laws across the country.
Among the findings: . . .
What they found is sobering indeed. I have to think that ultimately this sort of government action is due to citizen indifference: the low voting turnouts (in the current race in LA, the turnout is about 8% of voters) means that legislators no longer respond to the public at large and are free to ignore the public welfare. If all vote, then the issues of most concern to the public will get the attention they deserve.
Perhaps the US could adopt the Australian practice of levying a fine (in the $100 range) on those who fail to vote. Since early voting and absentee ballots are readily available, I don’t see a reason that would stop eligible voters from casting a ballot—other than indifference, of course.
Darcy Lockman writes in the NY Times:
The phone call came two billing cycles after Ben and I had increased his session frequency to twice a week. A woman identifying herself as “an independently licensed care advocate” with a large insurance company left a message asking me to call back. My neck tightened. No psychologist wants to hear from an insurer. Like some ne’er-do-well relative, insurers call only when they want money — or rather, when they want to keep money they’d once promised to disburse.
With Ben’s approval, I called back. The problem turned out to be the addition of the second session. I explained that Ben had become suicidal in the aftermath of his father’s death. He had recently purchased bullets, though so far he owned no gun.
“Well, how much longer will you need to see him twice a week?” the woman asked.
Ben had a long history of abuse at his father’s hands. Though his father’s death had brought on this bout of suicidal ideation — the first he’d had in the year we’d been working together — Ben had been considering killing himself off and on since getting sober 10 years back. He needed extra support now, certainly, but realistically I didn’t see this changing for some time.
My response was measured: “He has a history of trauma and addiction. It’s hard to say how long.”
“We don’t really pay for that,” the woman said. “Twice a week is only for a crisis.”
I told her that her statement was in violation of the mental health parity laws, which prohibit outright session limitations, and she told me she’d be passing me along to the next level of investigation: the peer review. The peer reviewer would be the one to decide whether two sessions were really necessary. He’d be in touch.
In the meantime, I revisited the issue with Ben. Sharing the particulars of a treatment with a third party requires consent. Like many survivors of childhood abuse, Ben felt deep shame about his past, and though I’d offer as few details as possible to the peer reviewer, Ben could choose to forgo reimbursement to protect his privacy. He told me to proceed.
If Ben was worried about his insurer knowing too much, he needn’t have been. The peer reviewer, when I spoke with him by phone, seemed less interested in hearing about Ben than in finding a sanctioned justification for cutting off reimbursement. Denial of treatment is allowed under a handful of conditions, and the reviewer moved down a list of them: I should have referred Ben out for something more cost effective (he suggested electroshock therapy); I should have been measuring Ben’s progress quantitatively in order to determine when to discharge him (by asking him, for example, to rate his depression on a scale of 1 to 10).
Finally, the reviewer implied that it was Ben himself who was the problem. After all, hadn’t Ben decided against a medication consultation despite my suggestion of it? “He’s noncompliant,” the reviewer declared, triumphant. With this he seemed to be offering me an out: Let’s attack him and then we can spare you. I thought of Ben’s mother, who never took a stand against her husband’s abuse of their son.
I clarified to the reviewer that I’d never insisted Ben go on medication; Ben had not defied me. Thwarted, the reviewer went back to his list: I’d given Ben the wrong diagnosis; he wasn’t making any progress; if I really thought he needed two sessions a week, then why wasn’t he in the hospital, and if he didn’t need to be in the hospital, then why were we doing two sessions a week?
I got off the phone knowing I’d lost a contest rigged from the start. . .
Nearly 1 in 7 schools have measles vaccination rates below what’s adequate for immunity, @usatoday reports
Look at the first link for a roll-call of investigative stories.
The blurb: “I drove from one of the healthiest counties in the country to the least-healthy, both in the same state. Here’s what I learned about work, well-being, and happiness.” The article is by Olga Khazan:
nald Rose has no teeth, but that’s not his biggest problem. A camouflage hat droops over his ancient, wire-framed glasses. He’s only 43, but he looks much older.
I met him one day in October as he sat on a tan metal folding chair in the hallway of Riverview School, one of the few schools—few buildings, really—in the coal-mining town of Grundy, Virginia. That day it was the site of a free clinic, the Remote Area Medical. Rose was there to get new glasses—he’s on Medicare, which doesn’t cover most vision services.
Remote Area Medical was founded in 1985 by Stan Brock, a 79-year-old Brit who wears a tan Air-Force-style uniform and formerly hosted a nature TV show called Wild Kingdom. Even after he spent time in the wilds of Guyana, Brock came to the conclusion that poor Americans needed access to medical care about as badly as the Guyanese did. Now Remote Area Medical holds 20 or so packed clinics all over the country each year, providing free checkups and services to low-income families who pour in from around the region.
When I pulled into the school parking lot, someone was sleeping in the small yellow car in the next space, fast-food wrappers spread out on the dashboard. Inside, the clinic’s patrons looked more or less able-bodied. Most of the women were overweight, and the majority of the people I talked to were missing some of their teeth. But they were walking and talking, or shuffling patiently along the beige halls as they waited for their names to be called. There weren’t a lot of crutches and wheelchairs.
Yet many of the people in the surrounding county, Buchanan, derive their income from Social Security Disability Insurance, the government program for people who are deemed unfit for work because of permanent physical or mental wounds. Along with neighboring counties, Buchanan has one of the highest percentages of adult disability recipients in the nation, according to a 2014 analysis by the Urban Institute’s Stephan Lindner. Nearly 20 percent of the area’s adult residents received government SSDI benefits in 2011, the most recent year Lindner was able to analyze.
According to Lindner’s calculations, five of the 10 counties that have the most people on disability are in Virginia—and so are four of the lowest, making the state an emblem of how wealth and work determine health and well-being. Six hours to the north, in Arlington, Fairfax, and Loudoun Counties, just one out of every hundred adults draws SSDI benefits. But Buchanan county is home to a shadow economy of maimed workers, eking out a living the only way they can—by joining the nation’s increasingly sizable disability rolls. “On certain days of the month you stay away from the post office,” says Priscilla Harris, a professor who teaches at the Appalachian School of Law in Grundy, “because that’s when the disability checks are coming in.”
Just about everyone I spoke with at the Grundy clinic was a former manual worker, or married to one, and most had a story of a bone-crushing accident that had left them (or their spouse) out of work forever. For Rose, who came from the nearby town of Council, that day came in 1996, when he was pinned between two pillars in his job at a sawmill. He suffered through work until 2001, he told me, when he finally started collecting “his check,” as it’s often called. He had to go to a doctor to prove that he was truly hurting—he has deteriorating discs, he says, and chronic back pain. He was turned down twice, he thinks because he was just 30 years old at the time. Now the government sends him a monthly check for $956. . .
C. J. Chivers has a somewhat depressing article in the NY Times today. It’s a lengthy article, but it’s definitely worth reading.
Daniel Mould’s sense of abandonment was profound.
An Air Force staff sergeant wounded in a chemical weapon accident in 2004, he willingly helped the military study his wounds. From his bed in a Philadelphia burn ward, as blisters from sulfur-mustard agent erupted on his skin, he signed a waiver allowing doctors to gather his body fluids to experiment with new laboratory methods for confirming chemical exposure.
Over the next 18 months, as the military gave him attentive care and doctors prepared peer-reviewed journal articles about his case, another branch of the service, the Army, concluded that it needed to be exhaustive in tracking troops exposed to chemical warfare agents: Citing Sergeant Mould’s burns, it called for monitoring victims for life.
The case seemed a welcome example of the military’s working closely with a patient to improve understanding of a rare battlefield risk and to develop practices to learn from patients’ medical experiences. Then came the shift.
When Sergeant Mould accepted medical retirement in 2006, he was suffering a cascade of health problems, but he said he had been assured of long-term monitoring. Instead, he said, “the Air Force never contacted me again. I’ve never been tracked.”
In October, reacting to an investigation by The New York Times, the Army surgeon general’s office announced that it would begin monitoring the long-term health of all veterans exposed to nerve or blister agents during the American occupation of Iraq. The victims had been kept secret as long as a decade, and the Army’s treatment guidelines had not been followed.
For Mr. Mould, 45, who had never spoken publicly about the accident, the irony of the Army’s announcement was startling. Even the person whose wounds spurred one branch of the military to call for tracking exposed veterans had not been enrolled in long-term monitoring — by either the Pentagon or the Department of Veterans Affairs.
The origins of his case span almost a century of American chemical-warfare policies, and like the experience of Iraq — where troops were wounded by abandoned chemical weapons — his example speaks to the persistent dangers presented by discarded or forgotten munitions.
Almost all of the military’s previous chemical-exposure victims had been World War I veterans or human subjects in classified military tests during World War II and the Cold War. The latter group, tens of thousands of enlisted men, were systematically exposed to nerve and blister agents in gas-chamber tests, field exercises or other efforts to evaluate protective equipment and human reactions to chemical-warfare agents.
Often the human subjects were sworn to silence. The Pentagon denied their existence for decades, until victims came forward with medical claims, prompting a 1993 review of the military’s conduct by the National Academies’ Institute of Medicine, which noted “a well-ingrained pattern of abuse and neglect” of the human subjects, some of whom had been duped into consent.
That review also found enduring negligence: “No formal long-term follow-up medical care or monitoring was provided” for exposure victims, even though follow-up, the authors said, “could have provided a wealth of information on the effects of these war gases.”
Tracking exposure victims is important, military and health officials say, because blister and nerve agents can carry long-term effects. Sulfur mustard, for example, can cause lingering respiratory difficulties and is carcinogenic, although precise risks have proved hard to measure in the limited studies to date.
That legacy of squandered opportunities appeared to change by 2004, when Sergeant Mould was burned.
His wounding was like a case study in the long-lasting dangers of modern weapons. In 1917 and 1918, the United States brewed chemical agents for use on Europe’s front lines, only to find it had little storage capacity for thousands of tons of chemical artillery shells that had not been fired before the armistice in 1918.
The Army found a solution: Dump them off the East Coast. “War Gas Dumped Far Out At Sea,” read the headline on a New York Times article in 1919, which noted that one vessel dropped 200,000 shells overboard between 60 and 100 miles out.
Little is known of the locations of many shells, which were scattered by multiple ships. But out of sight did not mean out of reach. One shell intersected with Sergeant Mould more than eight decades later, after the police found a rusted artillery projectile at a chicken farm in Delaware in the summer of 2004.
The projectile had been brought ashore by a fishing vessel and delivered to the farm with a load of crushed clamshells to be used as roadway fill.
Sergeant Mould, at the time assigned to an explosive ordnance disposal team on Dover Air Force Base, was dispatched to pick up the shell and bring it back the base. There, he said, he and a more senior noncommissioned officer misidentified it as a conventional, high-explosive 75-millimeter round.
The next day, Sergeant Mould’s team was assigned to destroy the shell. The plan was to breach it with a small shaped charge, causing its suspected contents to burn out and minimizing the risk of a larger blast or fragmentation.
After the team detonated the shaped charge, Mr. Mould recalled later, something was clearly wrong: The shell was leaking a “liquid about the consistency of vegetable oil and black as the ace of spades.” The liquid, he said, smelled like hot asphalt.
See also this collection of reports. The blurb:
For nearly a decade, the United States government kept secret that troops were being injured as they stumbled across aged chemical weapons that Saddam Hussein had built for his war with Iran. Explore the original Times investigation, eyewitness accounts from victims and the developments that led to the Pentagon’s response, policy changes and follow-up care.
We’ve already seen how the single supreme goal of making profits in a free-enterprise world can readily create rather than solve problems—the example in an earlier post today is how airline companies work to make economy-class service worse and worse so that people will purchase upgrades. That’s how the free market works: do whatever it takes to increase profits.
And we’ve repeatedly seen how hospitals run under a for-profit, free-enterprise model are more expensive and provide lower-quality care. Cutting costs and increasing profits are the focus, not quality of care and support of the medical and nursing staff.
While some charter schools run by private corporations may be good (at least temporarily), the drive to increase profits seems to turn some into little more than scams to bilk taxpayers of education dollars while helping students little.
Now the hospice industry is being milked of cash by for-profit corporations: Peter Whoriskey and Dan Keating report in the Washington Post:
The influx of for-profit companies into the hospice field has benefited patients, advocates say, because the commercial companies made big investments in technology, focused on efficiency and made care more accessible.
But a Washington Post analysis of hundreds of thousands of U.S. hospice records indicates that, as those companies transformed a movement once dominated by community and religious organizations into a $17 billion industry, patient care suffered along the way.
On several key measures, for-profit hospices as a group fall short of those run by nonprofit organizations.
The typical for-profit hospice:
●Spends less on nursing per patient.
●Is less likely to have sent a nurse to a patient’s home in the last days of life.
●Is less likely to provide more intense levels of care for patients undergoing a crisis in their symptoms.
●Has a higher percentage of patients who drop out of hospice care before dying. High rates of dropout are often viewed as a sign that patients were pushed out of hospice when their care grew expensive, left dissatisfied or were enrolled for hospice even though they were not close to death.
The quality of individual hospices varies widely. In some cases, for-profit hospices provide service at levels comparable to nonprofits, according to the review. But the data analysis, based on hundreds of thousands of Medicare patient and hospice records from 2013, shows that the gap between the for-profits as a whole and nonprofits is striking and consistent, regardless of hospice size.
“Unfortunately, a lot of people have come into the business for the wrong reasons,” said Michael Girard, who with his wife Deb owns the Circle of Life for-profit hospice in Reno, Nev. “A lot of the problems we have in hospice today have happened with the entry of what I call the ‘vulture capitalists.’ ”
About half of Americans of retirement age will employ a hospice service before death, but public information about the agencies is meager, and many consumers are unaware whether a hospice operates as a nonprofit or for-profit. . .
The free market does not necessarily solve problems nor deliver good services. What it does deliver is profits to the owners: that is its sole goal.
Some hospitals have outrageous policies. At ProPublica Paul Kiel describes how publicly supported non-profit hospitals work down in Alabama:
More than a century ago, Alabama enshrined a basic protection in the state’s constitution shielding its poorest citizens from being forced to pay debts they couldn’t afford.
But a public hospital in the mostly rural southeast corner of the state has found a way around the law. Before patients can receive treatment at Southeast Alabama Medical Center, they must sign a form waiving that legal protection, clearing the way for the facility to seize funds from their pay or bank accounts to cover medical debts.
ProPublica and NPR reported last week that nonprofit hospitals, which are legally required to offer discounted care to the poor, often sue low-income patients and garnish hefty portions of their pay.
But ProPublica found similar tactics are wielded by public facilities that often serve as hospitals of last resort.
About a fifth of U.S. hospitals are public, operating under a patchwork of local and state authorities and balancing two potentially competing mandates: They must provide care to those who can’t get it anywhere else while spending as little public money as possible.
Southeast Alabama Medical Center (SAMC), the only public hospital in the small city of Dothan, meets the first mandate by having a generous financial assistance policy. But it also ranks among the area’s most aggressive debt collectors, relentlessly pursuing payment even from patients who would have been eligible for reduced or free care had they applied for it.
Over the past three years, SAMC has filed more than 4,000 suits against its patients. And those who tumble through the hospital’s safety net often are stuck not only with care billed at full price, but with interest and legal fees from the court action.
Other public hospitals in Alabama and other states use similar tactics. In Missouri, two of the three hospitals that file the most debt-collection suits are public.
Chi Chi Wu, an attorney with the National Consumer Law Center, said it is “outrageous” for a public entity to take “this kind of heavy-handed action” against poor people already grappling with unavoidable health care emergencies. . .