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New Boston Globe Spotlight series: Closing psychiatric hospitals seemed humane, but . . .

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I just watched the movie Spotlight, which is excellent and shows how the Spotlight team at the Boston Globe works. Just yesterday Spotlight began a new series on how the government has failed to provide care and support for the mentally ill, a vulnerable population that has been abandoned.

The article begins with some effective graphics, so I urge you to click the link and compare what the Spotlight team is finding in Massachusetts and how that might compare to what they would find in your own state. The article notes, “This story was reported by Michael Rezendes, Jenna Russell, Scott Helman, Maria Cramer, and Todd Wallack. It was written by Rezendes.” (Rezendes was played by Mark Ruffalo in the movie.) The text begins:

Nancy Chiero was making a cup of mint tea in the kitchen of her Uxbridge home that January morning.

It was a small, characteristically kind gesture toward her 35-year-old son, Lee, who had always worried her, and sometimes scared her, too. Also, unfathomably, it was a fatal one.

Lee’s life had been ruled by severe mental illness, the pattern of his repeated unravelings devastatingly familiar to his mother and family. A psychotic episode would send him to an emergency room. Once released, he would refuse to take his medications, the delusions would return, and the cycle would repeat. And repeat again.

Through it all, Nancy had remained devoted and unimaginably patient with him. There was no one else who would. He had been living in a basement bedroom of her home; he had nowhere else to go.

The cycle was repeating again now, in 2007, she could see, and in even more alarming form. Lee had been videotaping his conversations with her, suspecting her in a plot against him.

He suspected everyone. Lately, Lee had disconnected computers and even the electric power in the house to prevent his imagined enemies from spying. He made his mother drive him hours from home for grocery shopping to elude his pursuers. He’d come to believe he’d been abducted by aliens and abused by animals, and feared he would be again.

Finally, just before Christmas, Nancy had Lee rushed by ambulance to Boston’s Tufts New England Medical Center at the urging of his primary care doctor, who agreed that he had become dangerous. But at the hospital, Lee insisted he was fine and a Tufts psychiatrist released him after four days, concluding that he “did not seem to present a danger to himself and others.”

Now, alone in her kitchen, Nancy faced her son’s fevered imaginings armed only with a cup of tea. Mint is soothing, she said, adding that even animals took pleasure in the fragrant herb.

With little warning, Lee lunged at her, knocking her down the basement stairs, convinced that her casual comment referred to the animals that would sexually assault him after his abduction.

He pulled out the knife he carried for protection and began stabbing his mother in the eyes, demanding she confess.

“That’s what you get for following me around,” he said, ranting on, with his camcorder running.

Then, it was over.

In the sudden quiet Lee began to doubt that Nancy was really part of the conspiracy that had taken control of his life. She hadn’t confessed. And if the house was bugged, if his every move was being watched, why hadn’t anyone intervened? Why hadn’t anyone stopped him? Why was he suddenly so alone in the overwhelming silence of his mother’s home?

In the instant of her death at the hands of her son — a deeply troubled man discharged without restrictions from hospital care — Nancy Chiero wasn’t merely failed by the state mental health care system. She was her son’s mental health care system — or at least the only one he could rely on.

In a state that prides itself on leadership in human services and compassionate government, it has come to this, a Spotlight Team investigation has found: threadbare policies, broken promises, short-sighted decisions, and persistent underfunding over decades. As a result, the seriously mentally ill, including those at greatest risk of harming others or themselves, are far too often left in the care of parents, police, prison guards, judges, shelter workers, and emergency room personnel — almost anyone, in fact, but professionals trained to deal with their needs.

Families of these sufferers find themselves up against obstacles that earlier generations didn’t have to face. Fifty years ago, Lee Chiero might have been treated — and locked away — in one of the public psychiatric hospitals that once dotted Massachusetts.

Today, nearly all of those institutions have been bulldozed or boarded up — and many had to be, having evolved into inhumane asylums for people who are, in the great majority, no threat to anyone. But the hospitals were not replaced with anything resembling a coherent care system, leaving thousands of people with serious mental illness to navigate a fragmented network of community services that puts an extraordinary burden on them to find help and to make sure they continue getting it.

Even those beset by the most ferocious inner demons, such as Lee Chiero, are routinely pinwheeled from hospital to hospital, therapist to therapist, court to court, jail to jail, then sent off into the world with little more than a vial of antipsychotic medications and a reminder to take them. Chiero was hospitalized at least 10 times in a half-dozen hospitals over two decades before he killed his mother.

“I can’t tell you how many emergency rooms we visited to try and get him in,” said his sister, Gina.

This is the choice Massachusetts has made, a choice with deadly consequences. . .

Continue reading.

And yet the public (at least, the public not directly affected) and the legislators have deliberately ignored this situation and shirked the state responsibility to support the most vulnerable.

Written by LeisureGuy

27 June 2016 at 8:29 am

Health Care Costs Grow Dramatically Slower Than Expected After Obamacare

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Tierney Sneed reports at TPM:

The study, released Monday, compares what the government anticipates the country will spend on health care through 2019 in its forecast released in 2015 versus what was expected through that period in 2010. The more recent forecast numbers take into account the actual spending from 2013, as well as the legislation passed by Congress in 2015 to permanently fix a major gap in Medicare funding. They also reflect how sequestration, the stunted economic recovery and a Supreme Court ruling that made Medicaid expansion optional for states affected overall health care spending. . .

Continue reading.

Written by LeisureGuy

21 June 2016 at 12:00 pm

A common pattern in the military: Denial of problems, repeated lies, disdain for troop safety

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Dave Philipps has a long and interesting article in the NY Times on a particular instance of a very familiar military phenomenon: The refusal to acknowledge something that went wrong, including lies, even though what happened was harmful to the troops. The article begins:

Alarms sounded on United States Air Force bases in Spain and officers began packing all the low-ranking troops they could grab onto buses for a secret mission. There were cooks, grocery clerks and even musicians from the Air Force band.

It was a late winter night in 1966 and a fully loaded B-52 bomber on a Cold War nuclear patrol had collided with a refueling jet high over the Spanish coast, freeing four hydrogen bombs that went tumbling toward a farming village called Palomares, a patchwork of small fields and tile-roofed white houses in an out-of-the-way corner of Spain’s rugged southern coast that had changed little since Roman times.

It was one of the biggest nuclear accidents in history, and the United States wanted it cleaned up quickly and quietly. But if the men getting onto buses were told anything about the Air Force’s plan for them to clean up spilled radioactive material, it was usually, “Don’t worry.”

“There was no talk about radiation or plutonium or anything else,” said Frank B. Thompson, a then 22-year-old trombone player who spent days searching contaminated fields without protective equipment or even a change of clothes. “They told us it was safe, and we were dumb enough, I guess, to believe them.”

Mr. Thompson, 72, now has cancer in his liver, a lung and a kidney. He pays $2,200 a month for treatment that would be free at a Veterans Affairs hospital if the Air Force recognized him as a victim of radiation. But for 50 years, the Air Force has maintained that there was no harmful radiation at the crash site. It says the danger of contamination was minimal and strict safety measures ensured that all of the 1,600 troops who cleaned it up were protected.

Interviews with dozens of men like Mr. Thompson and details from never before published declassified documents tell a different story. Radiation near the bombs was so high it sent the military’s monitoring equipment off the scales. Troops spent months shoveling toxic dust, wearing little more protection than cotton fatigues. And when tests taken during the cleanup suggested men had alarmingly high plutonium contamination, the Air Force threw out the results, calling them “clearly unrealistic.”

In the decades since, the Air Force has purposefully kept radiation test results out of the men’s medical files and resisted calls to retest them, even when the calls came from one of the Air Force’s own studies.

Many men say they are suffering with the crippling effects of plutonium poisoning. Of 40 veterans who helped with the cleanup who The New York Times identified, 21 had cancer. Nine had died from it. It is impossible to connect individual cancers to a single exposure to radiation. And no formal mortality study has ever been done to determine whether there is an elevated incidence of disease. The only evidence the men have to rely on are anecdotes of friends they watched wither away.

“John Young, dead of cancer … Dudley Easton, cancer … Furmanksi, cancer,” said Larry L. Slone, 76, in an interview, laboring through tremors caused by a neurological disorder.

At the crash site, Mr. Slone, a military police officer at the time, said he was given a plastic bag and told to pick up radioactive fragments with his bare hands. “A couple times they checked me with a Geiger counter and it went clear off the scale,” he said. “But they never took my name, never followed up with me.”

Monitoring of the village in Spain has also been haphazard, declassified documents show. The United States promised to pay for a public health program to monitor the long-term effects of radiation there, but for decades provided little funding. Until the 1980s, Spanish scientists often relied on broken and outdated equipment, and lacked the resources to follow up on potential ramifications, including leukemia deaths in children. Today, several fenced-off areas are still contaminated, and the long-term health effect on villagers is poorly understood.

Many of the Americans who cleaned up after the bombs are trying to get full health care coverage and disability compensation from theDepartment of Veterans Affairs. But the department relies on Air Force records, and since the Air Force records say no one was harmed in Palomares, the agency rejects claims again and again.

The Air Force also denies any harm was done to 500 other veterans who cleaned up a nearly identical crash in Thule, Greenland, in 1968. Those veterans tried to sue the Defense Department in 1995, but the case was dismissed because federal law shields the military from negligence claims by troops. All of the named plaintiffs have since died of cancer.

In a statement, the Air Force Medical Service said it had recently used modern techniques to reassess the radiation risk to veterans who cleaned up the Palomares accident and “adverse acute health effects were neither expected nor observed, and long-term risks for increased incidence of cancer to the bone, liver and lungs were low.”

The toxic aftermath of war is often vexing to untangle. Damage is hard to quantify and all but impossible to connect to later problems. Recognizing this, Congress has passed laws in the past to give automatic benefits to veterans of a few specific exposures — Agent Orange in Vietnam or the atomic tests in Nevada, among others. But no such law exists for the men who cleaned up Palomares.

If the men could prove they were harmed by radiation, they would have all costs for their associated medical care covered and would get a modest disability pension. But proof from a secret mission to clean up an invisible toxin decades ago has proved elusive. So each time the men apply, the Air Force says they were not harmed and the department hands out denials.

“First they denied I was even there, then they denied there was any radiation,” said Ronald R. Howell, 71, who recently had a brain tumor removed. “I submit a claim, and they deny. I submit appeal, and they deny. Now I’m all out of appeals.” He sighed, then continued. “Pretty soon, we’ll all be dead and they will have succeeded at covering this whole thing up.” . . .

Continue reading.

Written by LeisureGuy

19 June 2016 at 6:24 am

Inside Louisiana’s Blockbuster Medicaid Expansion Roll Out

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Interesting how much better Louisiana is doing now that Bobby Jindal is no longer governor and the office is occupied by a Democrat. Tierney Sneed reports for TPM:

Since June 1, the first day Louisianans could sign up for the expanded program, more than 201,000 people have enrolled. The state is well on track to meet its 375,000-enrollee goal, which will save Louisiana an estimated $184 million in the next year.

Those numbers are even more remarkable given the obstacles facing the Edwards administration, namely the refusal of the GOP legislature to fund even one new employee to ease the transition to the expanded program.

“They say that necessity is the mother of invention,” Rebekah Gee, the secretary of Louisiana’s Department of Health and Hospitals, told TPM in an interview last week. “We certainly have had to think long and hard in the first weeks of the administration about how we were going to do it given that it was made clear to us that we were not going to have additional resources.”

Without any additional funding for the roll out — meaning no new state employees, no eligibility workers, nor any other new administrative tool to ensure that Louisianans were taking advantage of the expanded coverage — the state had to depend on the infrastructure of existing social service programs, whose participants were eligible for the Medicaid expansion.

The tactic had the dual advantage of saving the state money while creating an application process that was minimally burdensome for users and administrators alike. It was that creative approach, along with the assistance of non-governmental entities, that likely helped Louisiana achieve the numbers that it did. . .

Continue reading.

Written by LeisureGuy

15 June 2016 at 8:56 am

Who Makes Sure Hospital Mergers Do No Harm? Almost Nobody.

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Patrick G. Lee reports in ProPublica:

Mergers have become commonplace as hospital mega-chains increasingly dominate the American health-care market. But these deals often go unscrutinized by state regulators, who fail to address potential risks to patients losing access to care, according to a new report released today.

MergerWatch, which analyzes the hospital industry and opposes faith-based health care restrictions, surveyed health care statutes and regulations in all 50 states and the District of Columbia. It found that only 10 states require government review before hospital facilities and services can be shut down. Only eight states and the District of Columbia mandate regulatory review when hospitals enter into more informal partnerships rather than full-scale mergers, closing a loophole that exists in other states for deals to pass with minimal state oversight.

Smaller, local hospitals often agree to merge with larger chains in order to survive. The goal is to cut overlapping services, negotiate better deals with insurance companies and share in the cost savings. But without state protections, local residents can see health services disappear, sometimes without a chance to weigh in.

“In a number of states, there is no oversight at all. So hospitals are just doing what makes business sense for them,” said Lois Uttley, one of the report’s co-authors and the director of MergerWatch. “Someone needs to be looking out for the patients and the community.”

Sometimes the loss of services is ideological: As ProPublica and Mother Jones have reported, the expansion of Catholic hospitals in Washington State has led to restrictions on women’s health services and end-of-life counseling. Other times it’s just the bottom line: Expensive services such as pediatrics, obstetrics, emergency room and neo-natal intensive care may be downsized when a non-profit hospital is taken over by a for-profit one, according to the report.

Even when state regulatory programs exist, they often fail to protect consumers from reductions in health-care services. That’s because state oversight programs were largely written in the 1960s and 70s when hospitals were expanding and the main fear was duplication of facilities and services. Today, however, the opposite is happening: . . .

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Written by LeisureGuy

9 June 2016 at 1:41 pm

One Nonprofit Hospital Stops Suing So Many Poor Patients

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Maybe others will follow the lead. Paul Kiel and Chris Arnold report in ProPublica:

For years, Heartland Regional Medical Center, a nonprofit hospital in the small city of St. Joseph, Missouri, had quietly sued thousands of its low-income patients over their unpaid bills.

But after an investigation by ProPublica and NPR prompted further scrutiny by Sen. Charles Grassley, the hospital overhauled its financial assistance policy late last year and forgave the debts of thousands of former patients.

The hospital “deserves credit for doing the right thing after its practices were scrutinized,” Grassley, R-Iowa, wrote last week in a letter to his Senate colleagues, “but it should not take Congressional and press attention to ensure that tax-exempt, charitable organizations are focused on their mission of helping those in need.”

While the changes at Heartland, which now goes by Mosaic Life Care, are a boon to its poorest patients, ProPublica has found numerous cases across the country of nonprofit hospitals, which pay no income tax, filing suits by the thousands.

Some have filed more suits than Mosaic ever did. In Evansville, Indiana, for example, Deaconess Hospital filed more than 20,000 lawsuits from 2010 through 2015. Like Mosaic, Deaconess reconsidered its financial assistance policies after questions from ProPublica last week and said it would be making changes.

Grassley, in a floor speech announcing the results of his investigation, said litigious nonprofits should take it upon themselves to change their ways. “Let me be clear, nonprofit hospitals should not be in the business of aggressively suing their patients,” he said. “In essence, because of the favorable tax treatment these hospitals receive, they have a duty to help our nation’s most vulnerable.”

As part of Mosaic’s revamped policies, it instituted a “medical debt grace period” late last year. Typically patients who have been sued by the hospital are no longer eligible for financial assistance. But during the grace period, former patients with outstanding debts were allowed to be evaluated for assistance.

The program resulted in 3,342 people receiving a total of $17 million in debt relief, Mosaic said. The largest bill was $225,000, though the average was a more modest $5,000.

Despite those numbers, patients featured in our 2014 story had a mixed experience trying to get their bills resolved. . .

Continue reading.

Obviously, single-payer medical insurance would eliminate such problems. But this is the US.

Written by LeisureGuy

1 June 2016 at 4:10 pm

Posted in Business, Healthcare, Law

Congress Boosts Rehab, But Gives Opioid Pushers a Pass

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One problem with having a Congress that is effectively controlled by corporate interests is that it finds great difficulty in taking any action against corporate interests. The interests of the public, though, are fair game, so when actions are taken, it is often the public interest that is sacrificed. (In the book Getting to Yes, Roger Fisher and Willliam Ury point out that it is a bad idea to negotiate with anyone who lacks the power to make concessions: if only one side can make concessions, it’s clear that all concessions will be made by one side.) Lee Fang reports in The Intercept:

Lawmakers on Capitol Hill are proudly touting recently passed measures to address the nation’s growing heroin and opioid crisis, but the legislation may have handed the drug companies at the center of the epidemic a major victory.

The legislation focuses on treating addiction and does nothing to limit the role of pharmaceutical companies in fueling the opioid crisis. In fact, it instructs the federal government to review and potentially undo sweeping new guidelines that recommend less prescribing of highly addictive opioid painkillers such as OxyContin, Percocet and Vicodin.

The review panel would be made up of a range of stakeholders including pain management groups, many of whom are financially tied to the drug industry.

Four out of five people addicted to heroin began using it after trying prescription opioid painkillers, which provide a similar high. Investigations have found that drug companies orchestrated much of the epidemic by promoting claims that opioids are not addictive and by financing third party groups that promote opioid painkillers for minor pains, such as toothaches.

Now the boldest effort to curb the flow of legal opioids may face a setback.

The Centers for Disease Control issued new guidelines in March to encourage doctors to prescribe opioids with low dosages, and only after other pain relief treatments, such as ibuprofen, have been tried. Since the voluntary guidelines were first leaked online last year, the drug industry has reacted furiously, even convening regularly in Washington to discuss how to derail the proposal. A legal group funded by the makers of OxyContin threatened the CDC with a lawsuit.

The legislation, which passed the House and Senate and is currently in conference committee, calls for the prescribing guidelines to be reviewed and potentially changed by a new panel made up of representatives from a range of stakeholders, and for the revisions to incorporate “pain management” expertise from the “private sector.” The legislation calls for the task force to be convened by the end 2018, and for it to issue a report within 270 days.

“We must make sure that these guidelines are updated and reviewed regularly,” said Rep. Susan Brooks, R-Ind., who co-sponsored one of theHouse bills now being merged with the Senate version, which contains similar language instructing a new panel to review the guidelines.

The demand for pain advocacy and pain specialists to review the CDC guidelines comes as recent reports show that the leading societies for pain management have been funded and controlled by painkiller companies for years.

One leading pain advocacy group, the Pain Care Forum, is funded and largely controlled by Purdue Pharma, the makers of OxyContin. According to areport from the Associated Press, the Pain Care Forum organized a lobbying campaign last year to defeat the CDC guidelines.

A complaint filed by the City of Chicago found that . . .

Continue reading.

Written by LeisureGuy

31 May 2016 at 10:11 am

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