Reform may worsen ER crowding
Filed under: Health care reform, Health data, Health journalism, Health policy, Hospitals, Hot Health Headline, Member news, Studies
Associated Press medical reporter Carla K. Johnson has found that, contrary to common assumptions, emergency rooms could become even more crowded with the passage and implementation of health care reform. Popular wisdom has it that, with more access to insurance thus to primary care, folks will be less likely to go to the emergency room for minor complaints or to allow illness to progress to the point where an emergency visit is necessary. Johnson, an AHCJ board member, gives three big reasons why it’s not that simple:
- There are not (will not) be enough primary care physicians in America to deliver that preventative care.
- At present, the uninsured are no more likely to use the ER than patients with insurance coverage.
- “The biggest users of emergency rooms by far are Medicaid recipients,” Johnson writes. “And the new health insurance law will increase their ranks by about 16 million.”
ERs are crowded, Johnson writes, not only because of a lack of insurance but also because of obstacles inherent in their structure and mission, such as an aging population, more people with chronic illnesses, the closures of many ERs in the 1990s and the demand for beds for both emergency patients and patients scheduled for elective surgeries that bring more money.
AHCJ Immediate Past President Trudy Lieberman praised Johnson’s story and linked it to reporting by The Boston Globe on the impact of that state’s reform law upon emergency room use. So far, events in Massachusetts reinforce Johnson’s predictions.
The Boston Globe revisited Massachusetts’s ER conundrum last week, and reported pretty much what it did last year—that despite the state’s reform law, which mandated everyone have coverage beginning in July 2007, emergency room use is rising. Last year, the state’s Division of Health Care Finance and Policy cautioned that it was too early to draw any conclusions from the seven percent rise in ER visits between 2005 and 2007. Now the agency is saying that expanded coverage may be one reason for the 9 percent rise from 2004 to 2008. According to commissioner David Morales, many studies have shown that expanding coverage does not reduce emergency room visits. That’s because the uninsured “are not really responsible for significant ER use,” he told the Globe.
J-S settles records suit; docs rebel against COI rules
Filed under: Conflicts of interest, Health journalism, Hot Health Headline, Public records
As a result of the Milwaukee Journal Sentinel’s now-settled lawsuit against the University of Wisconsin, John Fauber was able to review newly public e-mails which show just how angry a segment of the faculty became when faced with the university’s new, stricter conflict of interest regulations. The regulations came, of course, in the wake of Fauber’s investigative reporting on the subject.
The newspaper’s lawsuit argued that the faculty comments were public records under Wisconsin law and sought a court order to obtain them. To settle the lawsuit, the newspaper agreed to accept the 41 e-mails with the names of the doctors blacked out. The foundation also provided a separate list with the names of the 28 doctors who wrote the e-mails.
The (UW Medical Foundation) also agreed to pay the newspaper’s attorneys’ fees of about $12,400.
The e-mails make for good reading, and Fauber wastes no time in deploying the liveliest phrases in his story.
For example, some physicians complained about the 18-month exemption for orthopedic surgeons and other implanters of medical devices, including one who said “Allowing our docs to shill for device companies is a complete perversion.” An orthopedic surgeon responded with a different take, saying it was “clearly ridiculous” to limit his hourly take from device makers to just $500.
For an explanation from Fauber on how he has been able to consistently produce groundbreaking stories on the conflict-of-interest beat, see the article he wrote for AHCJ.
How prescription drugs dethroned heroin in Seattle
Heather Bosch, of Seattle radio station KIRO, dedicated a five-part series to explaining why “Prescription drugs - used incorrectly - are killing more people in King County than all other illegal drugs, combined.”
It’s the latest in a string of prescription drug localizations; one which distinguishes itself with an emphasis on the move from heroin to prescription pills.
In part one, Bosch explains how prescription opiates overcame their illicit cousin, heroin, to become the drug of choice in the Seattle area. In part three, she talks to a recovering opiate addict about the toll the pills took on his life and psyche. And in part four, Bosch looks into how ready access has made it easier for teens to become addicted to prescription drugs.
Welcome to AHCJ’s newest members
AHCJ welcomes these new members:
- John Sepulvado, grandmaster, Capital Public Radio (@John_Sepulvado)
- Connie St Louis, independent journalist (@stlouisc)
- Kirsten Stewart, health reporter, Salt Lake Tribune (@kirstendstewart)
- Jessie Shafer, assistant editor, Diabetic Living (@DiabeticLiving)
- Trip Jennings, senior writer, New Mexico Independent (@trip_44)
- Anna Edney, Bloomberg (@annaedney)
- Chris Hepp, reporter, The Philadelphia Inquirer
If you haven’t joined yet, see what member benefits you’re missing out on: Access to more than 50 journals and databases, tip sheets and articles from your colleagues on how they’ve reported stories, conferences, workshops, online training, reporting guides and more. Join AHCJ today to get a wealth of support and tools to help you.
Members earn Annenberg grants/fellowships
The USC Annenberg School for Communication & Journalism announced the winners of its Dennis A. Hunt Fund for Health Journalism grants and National Health Journalism Fellowships this week, and multiple AHCJ members earned honors in each category. The program seeks to fund explanatory and investigative reporting in underserved communities. The winning members are listed below; see the Annenberg site for a full list. All descriptions are taken directly from the press release.
2010 HUNT GRANT RECIPIENTS
Christina Hernandez, a freelance writer for The Philadelphia Inquirer, will receive a $5,000 grant to examine a troubled health care system in a New Jersey city and local attempts to find solutions.
Emily Ramshaw, an assistant managing editor and investigative reporter at The Texas Tribune in Austin, will receive $4,000 to analyze efforts to improve public health in colonias – 2,300 unincorporated and isolated border towns.
2010 NATIONAL HEALTH JOURNALISM FELLOWS
Pedro F. Frisneda, health editor of El Diario/La Prensa in New York City, will explore several serious threats to the health of Latinos in the United States: disparities in health care access and outcomes; obesity and diabetes; and HIV/AIDS.
Heather May, a reporter for The Salt Lake Tribune, will look at why children in some racially diverse neighborhoods in Salt Lake County are more likely than their neighbors to be born with birth defects, die from prematurity or SIDS or be hospitalized for asthma.
Elizabeth Simpson (Early), the medical reporter at The Virginian-Pilot in Norfolk, Virginia, will examine the contributing factors to infant mortality in African American neighborhoods throughout the Hampton Roads region.
Carol Smith, a Seattle-based reporter for InvestigateWest, will take a look at the health of predominantly minority communities that live and work along the Duwamish River in Seattle.
Mark Taylor, a freelancer writer based in Munster, Indiana, will produce a series of stories for the Post-Tribune that will examine the high rates of disease, infant deaths and chronic health conditions in Gary, Indiana’s poorer neighborhoods.
Agreement lets disciplined nurses work in 24 states
Filed under: Health data, Health journalism, Nursing, Public records
ProPublica’s Tracy Weber and Charles Ornstein are back on the disciplined caregivers beat, this time cooperating with USA Today to expose a licensing gap that makes it easier for disciplined nurses to find work in other states. The licensing agreement in question was signed a decade ago as 24 states agreed to recognize each other’s licenses in an attempt to alleviate care shortages by allowing nurses to work where they are needed most.
In some cases, nurses have retained clean multistate licenses after at least one compact state had banned them. They have ignored their patients’ needs, stolen their pain medication, forgotten crucial tests or missed changes in their condition, records show.
Critics say the compact may actually multiply the risk to patients. There is no central licensing for the compact, so policing nurses is left to the vigilance of member states.
Outside the compact, each state licenses and disciplines its own nurses. But within it, states effectively agree to allow in nurses they have never reviewed.
Ornstein and Weber found numerous instances in which a caregiver disciplined in one state was able to work for an extended period in another without being red-flagged, and are helping spark a debate over the costs, benefits and implementations of such agreements.
Outpatient inspections show serious lapses
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Public records, Studies
AP medical reporter and AHCJ board member Carla K. Johnson used FOIA requests to uncover a wealth of infection-control violations at outpatient clinics in Illinois. The majority of Illinois ambulatory centers have yet to be inspected under the tough new rules, but 76 percent of those which have been inspected also have been cited. The inspections are part of a national push to increase the oversight of ambulatory care centers.
Previously, inspectors from the Illinois Department of Public Health visited the centers about every seven years. But the state last year began more vigorous and frequent inspections of outpatient surgery centers, following directives from national health officials. The state now plans to inspect a third of Illinois centers each year, said Karen Senger, a supervisor in the Health Department’s Division of Health Care Facilities and Programs.
The crackdown resulted from a hepatitis C outbreak in Las Vegas believed to be caused by unsafe injection practices at two now-closed clinics.
Johnson’s state request turned up a laundry list of specific violations, all of which she summarized in one nifty sentence: “The five-second rule appears to be alive and well in Illinois same-day surgery centers, where medical staff were observed picking up items that had fallen to the floor and behaving as if they weren’t contaminated by germs,” Johnson wrote. In an e-mail to Covering Health, Johnson said her story should be easy to localize and explained just how she obtained the inspection reports and why they are now available.
I FOIA’d state inspection reports (CMS-2567s) for ambulatory surgery centers in Illinois that were cited for deficiencies in infection control during the past 12 months. States have been directed by HHS to use a new audit tool to look for infection control problems, following an outbreak linked to two centers in Las Vegas.
U. of Michigan president sits on pharma board
On The New York Times Prescriptions blog, Duff Wilson reports that while her school has taken a lead in limiting conflicts of interest, University of Michigan President Mary Sue Coleman herself sits on the board of Johnson & Johnson, a post which earns her $229,978 each year. Her defense is that she’s openly disclosed the relationship, and that the world of pharma and that of university administration rarely intersect.
Responding to questions on Ms. Coleman’s behalf Monday, Kelly E. Cunningham, a spokeswoman for the university, said the president satisfied the policy by disclosing her outside work. Ms. Coleman has never had to recuse herself from any discussion or action at the university because medical purchasing and investment decisions are so remote from her, Ms. Cunningham said.
“The same is true at J&J,” she added. “There has never been a discussion or decision at the board level that involved something related to the UM. But, of course, if there were, she would recuse herself.”
It’s not uncommon for university presidents to sit on corporate boards, Wilson found, but it appears that pharmaceutical companies are a special case given the major role universities play in medical research and health care delivery.
Thomas Donaldson, a corporate governance expert and professor of business ethics at the Wharton School of the University of Pennsylvania, reviewed the case on Monday for The Times. He said many university presidents serve on corporate boards, but biomedical company boards pose special issues because of the possible ties to university research and medical schools.
“Because of the role of research and also the entrepreneurial interest that lies behind a lot of modern advances in medicine, this is a very difficult issue,” Professor Donaldson said in a telephone interview. “We’ve been aware for decades really that this potential for conflict of interest exists, but we haven’t as a moral community or even inside universities gotten our arms around it yet.”
State snapshots make it easy to spot disparities in children’s health care
The Data Resource Center for Child and Adolescent Health has broken the 2007 NSCH Child Health and System Performance Profile into what it calls “state snapshots.” These snapshots make it particularly easy to compare all 50 states (and D.C.) across 21 categories, including dental health, access to care, insurance and several chronic conditions. Below, I’ve mapped an indicator of child access to preventative care, one which would appear to correlate strongly with population density.
The Data Resource Center is a project of the Child and Adolescent Health Measurement Initiative (CAHMI), housed at the Oregon Health & Science University.
Update
In the comments, AHCJ board member Felice Freyer noted that it “Would be interesting to compare these numbers with info on percentage of children who have coverage in each state.” So, that’s just what I did. I put together another map, again using 2007 NSCH data and attached it below.
Using public records to track elder abuse
Filed under: Health journalism, Health policy, Hot Health Headline, Public records
The Lexington Herald-Leader’s new series, Voiceless & Vulnerable, looks at nursing home abuse in the state. In the investigation (how they did it), the reporters focused on the eight serious nursing home complaints (about 7.5 percent of the total) from between 2006 and 2009 which the state attorney general has taken an unusually long time to resolve. They’ve been pending for an average of 19 months, and officials say each unresolved case can be blamed on unique factors and not on systemic issues.
In addition, investigators’ high case loads, staffing shortages and coordination with other law enforcement agencies have slowed some investigations, said (Shelley Johnson, spokeswoman for the state AG). Other factors include high turnover of nursing home staff and difficulty finding witnesses.
Overall, few such cases are prosecuted, and the ones that do go to court don’t often result in heavy sentences.
In addition to a discussion of how other states are fighting elder abuse (sidebar), the Herald-Leader package also includes graphics about the investigation process and how to report abuse, and a searchable database of serious nursing home complaints.
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Awards for Excellence in Health Care JournalismDeadline: Feb. 3
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
- Focus on freelancing: Tips for buying liability insurance
- Why do some patients get stuck in hospitals for weeks, months?
- Investigate health professionals and the boards that regulate them
- Presidents of AHCJ, SPJ call for more openness from Obama administration
