Medical, support network lacking for returning National Guard, reservists
National Guardsmen and reservists returning from duty in Iraq and Afghanistan “have been hastily channeled through a post-deployment process that has been plagued with difficulties, including reliance on self-reporting to identify health problems,” according to an investigation by graduate students in Northwestern University’s Medill School.
Photo by The National Guard via Flickr
“Hidden Surge” found members of the National Guard must navigate disparate health care and support providers, made more difficult by the fact that many of them live in rural areas. Three of the stories were published in The Washington Post.
The reporters also found that, in the immediate aftermath of 9/11, most reservists were medically unready to deploy – an assessment made by a private contractor. “More than 2,400 Army Reserve soldiers were held back, at least temporarily, because of inaccurate assessments by the contractor, according to data provided by the Army Reserve Medical Command.”
Meanwhile, some soldiers with behavioral problems that could be aggravated by the stress of deployment and combat were improperly sent overseas.
The project, done by 10 students, was directed by faculty member Josh Meyer, who covered national security for the Los Angeles Times for 20 years. Students used video and interactive graphics to help tell the stories. A “How We Did It” sidebar says the students interviewed more than 150 people, reviewed documents and reports and traveled to nine states to do the reporting.
According to a press release, the Hidden Surge project is part of Medill’s National Security Journalism Initiative, funded by the McCormick Foundation.
CMS-ordered report, withheld by hospital, reveals hundreds of deficiencies
Filed under: Hospitals, Hot Health Headline, Public health, Public records
When Ryan McNeill of The Dallas Morning News recently wrote for AHCJ about that paper’s investigation into patient care and safety at Parkland Memorial Hospital, he noted that the institution narrowly avoided being shut down by the federal government by agreeing to a rare form of oversight.
That oversight included a requirement that the hospital undergo outside monitoring that was carried out by the Alvarez & Marsal Healthcare Industry Group and paid for with about $7 million in taxpayer money.
When Parkland received the federally mandated report, dated Feb. 2, its governing board refused to release it to the public, “citing a fear that it could be used against the embattled public facility in court.”
Now we know why it was loathe for people to see its contents.
The Dallas Morning News has independently obtained a copy of the report and posted it online. It details hundreds of problems throughout the hospital.
Among the findings: Patient rooms were found to contain overflowing trash bins, excrement and blood. Hundreds of medications were improperly administered to patients. Dozens of beds remained empty despite crushes of patients seeking emergency care. Senior leaders kept critical information from the hospital’s board of managers. One patient died, apparently after receiving a drug without doctors’ orders.
Even after the hospital came under scrutiny, patients continued to be harmed, according to the 315-page report: “Considering that Parkland knows it has been under intense scrutiny by the State, CMS and the ICE for the past few months, the number of negative patient events that have occurred just since November 8, 2011 is surprising.”
Perhaps the most disturbing thing about the report is the conclusion that hospital employees do not share a sense of urgency and that “Large parts of the organization still operate in a business-as-usual mode.”
A CMS representative described the report as a “chilling account.” Monitors said Parkland’s “culture has failed in accountability, from top to bottom.” A Morning News editorial says the report is “scathing in its indictment of a once-respected safety-net hospital.”
Brutally honest accounts of caregiving yield insights
We’re all going to hear a lot more about the trials and tribulations of caregiving in the years ahead, as Baby Boomers struggle to care for increasingly frail, ill parents.
Judith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.
If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.
But I promise you none of the stories on this subject will be quite like Sandra Tsing Loh’s piece, “Daddy Issues,” in the March 2012 issue of The Atlantic.
It’s a rip-roaring, no-holds-barred look at the upside-down world of caregiving, where children become parents to their elderly moms or dads and emotions can run wild.
Loh is a writer and a performer who’s appeared regularly on NPR’s “Morning Edition” and Ira Glass’ “This American Life.”
She’s among the growing numbers of caregivers turning to blogs, websites, newspapers, magazines and books to tell the world “you won’t believe what I’ve been through – or what I’m going through – and how crazy it is.”
In Loh’s case, she lets it all hang out at the beginning of her piece, wailing to a radio station colleague “I WAAAAAAAANT MY FATHERRRRRR TO DIEEEEE!!!”
Yes, it’s shocking, an attention-grabbing stunt, but Loh follows through in spades after the first half of her article, which looks at recent books on caregiving by Jane Gross and Gail Sheehy.
Then, we get to Loh’s own story, told with a mordant sense of humor that feels manic at times. It’s her contribution to a phenomenon that she dubs “Elderschandenfreude … the secret pleasure of hearing about aging parents that are even more impossible than yours.”
Here are the basics: Loh’s father is a notoriously cheap, difficult man. His second, younger, Chinese immigrant wife was supposed to take care of him in his dotage but she develops dementia. He almost dies of dehydration but roars back full of life and unexpected needs. As Loh puts it:
“Now I have a wheelchair-bound but extremely active 91-year-old who greatly enjoys getting bathed and diapered and fed ice cream and crashing UCLA science lectures and, oh, by the way – every day he calls me now; he wants SEX.”
As resentment builds and caregiving bills for her father and his wife top $10,000 a month, Loh articulates what many caregivers might feel sometimes but never admit publicly:
“I rant to myself: He is taking everything! He is taking all the money. He’s taken years of my life (sitting in doctors’ offices, in pharmacies, in waiting rooms) … He’s taken the serenity I fought for – and won – in 1,000 hours of therapy centered on my family. In fact, he’s destroyed my belief in “family” as a thing that buoys one up. Quite the opposite: family is like the piano around Holly Hunter’s ankle, dragging me implacably down.“
Read the rest of this writer’s astonishingly frank story here.
For health care journalists, these kinds of personal narratives are a potential gold mine of insight about the complexities of caregiving. They are also an important counter-point to the antiseptic “10 steps to care for your loved one” advice that too often is passed off as caregiving wisdom.
You can find similar stories, which can yield potential ideas, material and sources for your own work, all over the Internet, with just a bit of searching.
Look for a tip sheet on caregiving here, AHCJ’s aging site, in the months to come.
Patients’ ‘leap of faith’ make stories possible, prompt changes
Filed under: Health journalism, Hot Health Headline
Pamela Fayerman of The Vancouver Sun has been writing about a genetic counselor who has been “relieved of her duties” at the BC Cancer Agency, part of the Provincial Health Services Authority, for allegedly failing to document cases.
Part of the counselor’s duties included making arrangements for genetic testing for people who fit the criteria for having a predisposition to cancer. But patients told Fayerman that “tardiness and lack of communication was part of a disturbing pattern” that led to the personnel action.
Fayerman, through one woman’s story, explains how the delays and lack of communication have affected patients and their families and the decisions they have made while waiting for testing. In the case of one patient:
If she had received results of genetic testing right after being diagnosed, she said, she would have been in a better position to make a decision about having her breasts removed or whether a lumpectomy (which she had) was sufficient. And her other organs might have been spared from damage due to chemotherapy treatment, she says. In addition, she would know sooner about whether her daughter faces an increased risk of breast cancer.
In a blog post, Fayerman says the stories wouldn’t have happened if patients had not called her to tell her their stories. She discusses the “leap of faith” such sources must make and how she handles patients who decide to step forward and share their stories publicly.
Komen’s funding of research drops; writer looks at charity’s message vs. science
Amid the controversy over the Susan G. Komen for the Cure foundation’s changes in funding for Planned Parenthood, Reuters’ reporters Sharon Begley and Janet Roberts took a look at the organization’s financial statements.
Their analysis shows that the charity has “cut by nearly half the proportion of fund-raising dollars it spends on grants to scientists working to understand the causes and develop effective new treatments for the disease.”
In 2008, it spent 29 percent of its donations on research awards. In 2011, that number was down to 15 percent.
Reuters reports that, according to the 2011 financial statement, “43 percent of donations were spent on education, 18 percent on fund-raising and administration, 15 percent on research awards and grants, 12 percent on screening and 5 percent on treatment.”
Meanwhile, AHCJ member and independent journalist Christie Aschwanden writes that the real scandal lies with the organization’s “science denialism.” She says it has perpetuated the “notion that breast cancer is a uniformly progressive disease that starts small and only grows and spreads if you don’t stop it in time” – breast cancer’s false narrative.
Aschwanden points out that Komen’s insistence that women be “screened now” and that early detection saves lives, as proclaimed in its ads, “flies in the face of basic cancer biology” as well as places blame on people who have metastatic breast cancer. The piece is well worth a read, especially to find out what Komen’s own chief scientific adviser says about the organization’s message.
And, for a re-cap of the Komen saga, ProPublica has put together a handy timeline of Komen’s “Shifting Story on Planned Parenthood.”
Project follows the race to make bagged salad safer
The latest investigation by California HealthCare Foundation Center for Health Reporting’s Deborah Schoch will make you think twice before ripping into a sack of spring mix, but her work about the myriad food safety challenges posed by bagged salads examines the industry’s struggle to develop technology powerful enough to overcome the existential threat posed by E. coli and friends.
The industry has made great strides since a 2006 outbreak linked to tainted spinach, she writes, but “It’s impossible to stop all pathogens from landing on lettuce and spinach leaves.” And once they’re on the leaves, it seems as if their spread is almost inevitable. They hide in gooey biofilms and resist powerful washes.
Thousands upon thousands of salad leaves are taken to a central plant, washed together, bagged and shipped. Even if only a few leaves are tainted, harmful pathogens can spread in the wash water — the modern salad version of the old adage that one bad apple spoils the whole barrel.
“I would think of it as swimming in a swimming pool in Las Vegas with a thousand people I didn’t know,” said William Marler, a prominent Seattle-based food safety attorney.
Plenty of public and industry money has been aimed at the problem, Schoch writes. “The Center for Produce Safety at UC Davis, founded in response to the spinach outbreak as an industry-public partnership, has pumped more than $9 million into 54 research projects at 18 universities.”
Even the best research can’t reduce the risk of contaminated greens by 100%, scientists said. At Earthbound, Daniels says the ultimate goal is to achieve what scientists call a “5 log reduction,” the equivalent of pasteurizing milk. In short, if an unwashed lettuce contained 100,000 pathogens, the perfect wash system would knock off five “0s” and reduce the pathogen count to 1.
An added bonus? Schoch’s column on whether she (and the experts she talked to) feel like it’s important, or even salutary, to wash their bagged greens.
Leaded aviation fuel a threat to public health, children
Filed under: Children, Health data, Hot Health Headline, Public health, Public records
KUOW’s John Ryan used federal data and a few key sources to delve deep into issues surrounding one of the few remaining sources of airborne lead in the United States, a leaded aviation fuel known as “avgas.” In the process, he reveals damage that even low levels of lead exposure could be doing to children.
Avgas accounts for less than 1 percent of the nation’s liquid fuel use. Yet enough piston–engine planes fly enough miles on avgas to belch out half of all the lead going into the nation’s air.
Lead paint in old buildings remains a bigger threat, but even low levels of childhood exposure, one source tells Ryan, can manifest itself in “Decreases in IQ, changes in test scores, changes in attention, hearing threshold, all sorts of things like that.”
Earlier this month (January), an expert panel advising the Centers for Disease Control and Prevention cut in half the levels of lead in children that should alarm parents or doctors. Researchers have yet to find any level of lead exposure that doesn’t cause harm.
Michael Kosnett, a medical toxicologist at the University of Colorado, told Ryan, “In any one child, it’s not something that’s going to necessarily cause them to display any kind of signs and symptoms. But if you can lower the lead exposure of a population of children, you’re going to give that population more of an opportunity to have gifted children and to have children who have higher IQs, and that’s certainly a desirable public health goal.”
Marie Lynn Miranda, an environmental health scientist and a dean at the University of Michigan, points out that “Living close to an airport can increase your blood lead level anywhere from 2 to 4 percent,” acknowledging that is a small amount but that evidence indicates even small amounts of lead are bad. She also notes that “lead is especially a problem for the low–income families that are most likely to live near airports.”
Pilots who still use avgas say their businesses would be dead in the water if they couldn’t get the leaded fuel, an argument Ryan contrasts with quotes from a Europe-based lead-free avgas producer, who sells it for 40 cents less a gallon, but hasn’t been able to break into the U.S. market “Because no one thinks that there will be demand for an unleaded–grade aviation gasoline.”
The federal database Ryan used, The National Emissions Inventory, is posted online by the EPA.
Investigation delves into Wash.’s prescription drug problem
Filed under: Aging, Children, Europe, Government, Health care reform, Health data, Health policy, Hot Health Headline, Pharmaceuticals, Public health, Public records
Everything time we think prescription drug abuse stories have peaked, something comes along to push the story further. This time, InvestigateWest’s Carol Smith sets herself apart by starting from square one and clearly explaining the origins and dimensions of Washington’s particularly nasty drug issues, tracing back each facet of the problem to its source and spotlighting what makes the Evergreen State unique.
Washington has been one of the hardest hit states in the country, in part because of aggressive prescribing practices. That, coupled with lack of oversight of doctors who over-prescribe, has led to the spectacular run-up in the number of deaths from prescription overdoses.
The backdrop for her work is an epidemic that shows no signs of abating, despite a recently implemented state law Smith calls “a bold attempt to reduce overdose deaths by launching the first-ever dosing limits for doctors and others who prescribe these medicines.”
Prescription drug abuse is at epidemic levels throughout the state, and elsewhere in the country, despite lawmakers’ attempts to get a grip on it. Washington now has one of the highest death rates in the nation. Deaths from prescription drug overdoses in this state have skyrocketed nearly twenty-fold since the mid-1990s, and now outstrip those from traffic accidents.
Why caused it to leap so quickly? Smith tracks down several key tipping points. “There’s plenty of blame to go around for what caused the epidemic,” she writes. “Aggressive marketing of opiates by drug companies, nonexistent tracking of overprescribing, lack of insurance coverage for alternative treatments for pain, and demand by patients for quick fixes, to name a few.”
She drills down into many of those causes, with my personal favorites being two key origin stories:
- How marketing by OxyContin maker Purdue Pharma led to relaxed guidelines for chronic pain treatment and a “1999 law specified ‘No disciplinary action will be taken against a practitioner based solely on the quantity and/or frequency of opiates prescribed,’” both of which helped cause a jump in prescriptions.
- How “the rise in the death rates of Medicaid patients tracks along with the state’s cost-saving decision to move many of its poorest residents to the cheapest, most potent pain reliever available: Methadone.”
See the upper right-hand sidebar for more stories from the six-month investigation.
Article looks at reform concepts put into practice
Filed under: Health care reform, Hot Health Headline
Here’s a recent story that touches on a whole lot of themes in health reform – without getting bogged down in a lot of jargon. Value-based purchasing. Evidence-based medicine. Shared decision-making.
Jackie Crosby of the Minneapolis Star-Tribune writes about how a Minnesota insurer, HealthPartners, has introduced a new approach for patients with low back pain. Before they get surgery, they have to get a consult on nonsurgical alternatives.
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org. If they still opt for surgery, they can have it. But the thinking is (based on what other health systems have learned) that many will opt for physical therapy and rehabilitation once they learn more about the pros and cons, risks and benefits, of all their options.
“Patients can still see a surgeon if they wish. But after this visit, they’ll be better informed about all of their options, and can make decisions more aligned with their own values,” the story quoted Dr. Thomas Marr, HealthPartners’ medical director of clinical relations as saying.
“In general, it’s a bad thing when the doctor and patient can’t determine the treatment without interference from the insurance company or the government,” spine surgeon Jeffrey Dick was quoted as saying. But this is an exception, he said. Surgery is appropriate for only about one out of eight low back pain patients he sees. Getting them into appropriate care from the start can save money – not to mention years of lingering back pain.
“These aren’t HealthPartners criteria,” he added. “These are treatment algorithms for low-back pain that we all should be following – but maybe haven’t been by all practitioners.”
The story also noted how HealthPartners is working with stakeholders and monitoring patient reaction and satisfaction to minimize criticism and misunderstandings.
So what are those health reform themes?
Value-based purchasing – loosely translated – is paying for what works.
Evidence-based medicine is what it sounds like – and the evidence is that a lot of back surgery is unnecessary. Sounds simple but it’s not always practiced – even in those cases where the evidence is strong. Sometimes it’s even derided as “cookbook medicine.” Financial incentives are certainly one big impediment: surgeons, hospitals, etc., make money from procedures that may not always be the best choice for the patient. Practice patterns – how physicians are taught and what’s done in the medical culture of a given hospital or community – play a role. And patients often want treatments they don’t need because they don’t understand that it’s not necessary, or they think surgery is a reliable quick fix.
Some researchers exploring medical decision-making have found that physicians are a lot more likely to talk about why to have a certain procedure, including back surgery, than why not. Clinicians and researchers are beginning to develop models for “shared decision-making” and there’s even a bit of language in the health reform law to promote it.
So are there programs like this rolling out in your local hospitals or health plans? We’d like to hear more. It will be interesting, too, to watch how people react to the HealthPartners and similar ventures. Will patient/beneficiary attitudes begin to change? Will they come to understand that more isn’t always better? Will they be glad to find out they really don’t need surgery? Or will there be a backlash about choice and control. The answer may depend on whether patients feel the decision is shared, or imposed.
On balance: Lazar explains a little-discussed fundamental fact of aging
It’s not easy to write well about the nitty-gritty details of aging – the wear and tear on bones and joints, the deterioration of seeing and hearing, the gradual onset of frailty in barely observable increments.
But everyone encounters this when they’ve lived long enough; physical decline is a fundamental part of the aging experience.
Judith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.
If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.
That’s why Kay Lazar of The Boston Globe deserves kudos for her story on balance problems in older adults, a common, seemingly mundane condition that hasn’t received much attention.
The consequences can be serious: when balance is compromised, seniors become at risk of losing their mobility or falling, potentially precipitating a cascade of other medical problems.
Lazar’s explanation of why older people become unsteady on their feet is graceful and easy to understand:
“A person’s sense of balance relies on an exquisite interplay of three regions, your vision, a maze-like structure in the inner ear which includes microscopic cells that resemble little hairs, and the muscles and joints running from your feet, up through your spine, that sense your body’s position.
All three areas send signals to your brain, which processes the information, and helps give you a sense of spatial orientation - your balance.
As we age, eyesight fades, as do our muscles’ ability to sense surroundings. Meanwhile, the hair cells in the inner ear die off and do not regenerate. These declines combine to throw off the signals to your brain about your balance.”
Her description of “four flavors of dizzy” - the feeling of blacking out, unsteadiness, spinning, or lightheadness - almost surely will help older adults and their families recognize symptoms that may require medical assistance.
That’s why a story like this is valuable. By talking openly about a problem that usually passes under the radar screen, it expands our sense of alertness to older people and difficulties they may experience. It makes seniors visible, not invisible as they so often seem to others.
Next time I see an older person hesitate at a curb before stepping down or stand stiffly in a crowd, nervous about moving in tight, confined spaces, I’ll think about Lazar’s article.
-
Join us in Omaha to find untold rural health stories
New at HealthJournalism.org
- AHCJ offers financial data about nonprofit hospitals
- Diversity in aging: Putting gray in the rainbow
- Southeast journalists eligible for regional fellowship program
- AHCJ-NLM Health Journalism Fellowship offers hands-on medical research training
- AHCJ announces 2011 winners of top health journalism awards
