Learning from Calif.’s mental health parity law
On the Los Angeles Times Booster Shots blog, Shari Roan writes about a recent scholarly review of California’s mental health parity law that illuminates lessons that will be key to the success of the upcoming national mental health parity law. The California law has been in place for five years.
Roan summarizes the most important of these lessons, including the accuracy of price estimates and the lack of public awareness about the program. The study considers the views of consumers, insurers and providers as well as the public at large.
The national mental health parity law, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (HR 6983), is intended to prevent discrimination against patients seeking treatment for mental illness by prohibiting “insurers and group health plans from imposing treatment or financial limitations when they offer mental health benefits that are more restrictive from those applied to medical and surgical services.”
However, as MIWatch.org reports, the three federal agencies that are supposed to write the regulations to implement the act missed an Oct. 3 deadline. The law will go into effect in January.
Temp agencies a haven for problem nurses
Filed under: Hospitals, Hot Health Headline, Nursing
Calling it a “free-wheeling, $4-billion industry” fueled by the nation’s chronic nursing shortage, ProPublica reporters Tracy Weber and Charles Ornstein take on the firms that supply temporary nurses to American hospitals (Los Angeles Times version here). In the story, the reporters say they “found dozens of instances in which staffing agencies skimped on background checks or ignored warnings from hospitals about sub-par nurses on their payrolls. Some hired nurses sight unseen, without even conducting an interview.”
Although the healthcare system as a whole is increasingly regulated, the nurse staffing industry remains a Wild West. No one knows how many agencies exist nationwide; estimates range from 3,000 to 6,000.
Ornstein, AHCJ’s president, and Weber found plenty of cases to back up that ‘Wild West’ impression. In some cases, firms shift problem nurses from hospital to hospital as trouble arose and, even when a nurse was tossed from one temp firm, he or she usually had no problem finding work at another. Nurses were hired with criminal backgrounds and licenses that were revoked in other states. They often allow employees to prove their “competency” through online tests, and are sometimes fly-by-night operations run by people with no prior nursing experience.
In the end, the reporters found that while there is a clear divide between the best and worst temporary nurse staffing organizations, it’s not always easy or possible for hospitals to figure out which is which.
Calif. adopts strict rehab rules for medical workers
ProPublica reporters Tracy Weber and Charles Ornstein have filed a report (Los Angeles Times version, ProPublica version) on the fallout from their work exposing failures in California’s nurse rehab program.
The state has adopted strict new rules governing drug abusers in the health care industry, requiring that those in the rehab program be tested more than 100 times in the first year, and pulling them from practice immediately should a relapse be detected.
In addition, public Web sites will now list any restrictions to their licenses, “easing the long-standing confidentiality protections that have shielded participants and kept their patients in the dark.”
Calif. nurse rehab program full of holes
ProPublica’s Tracy Weber and Charles Ornstein follow up their investigation of California’s nursing oversight with a story about the failures of the state’s nurse rehab program (Los Angeles Times version; ProPublica version). The embattled California Board of Registered Nursing has touted the program as a safe haven where otherwise good nurses can free themselves of bad habits, but Weber and Ornstein have discovered that nurses often don’t complete the program, and sometimes continue bad behavior unabated despite the voluntary, confidential program’s required drug tests and treatment.
The team has reinforced its data-driven story with well-chosen anecdotes and observations. Program proponents argue that Weber and Ornstein are focusing on a few failures and ignoring the more numerous success stories, but the reporters show that the failures are due, at least in part, to flaws in the program. Even nurses designated as a “public risk” often aren’t investigated until more than year after earning that dubious distinction.
The reporters’ sum up the problem thus: “At the moment, the main person responsible for protecting the public from a drug-addicted nurse in California is the drug-addicted nurse. It’s a risky honor system.”
Schwarzenegger replaces nursing board members following ProPublica, LA Times investigation
Late Monday, Calif. Gov. Arnold Schwarzenegger replaced nearly everyone on the state’s Board of Registered Nursing, “citing the unacceptable length of time it takes to discipline nurses accused of egregious misconduct.” The move came a day after a ProPublica and Los Angeles Times investigation into the board’s activity was published.
He fired three of six sitting board members — including President Susanne Phillips — in one-paragraph letters curtly thanking them for their service. Another member resigned Sunday. Late Monday, his administration released a list of replacements.
Charles Ornstein and Tracy Weber of ProPublica and Maloy Moore of the Los Angeles Times joined forces to review every case between 2002 and 2008 in which a nurse faced disciplinary action — more than 2000 of them — and found that, on average, California’s Board of Registered Nursing took more than three years to take action on such cases. Many took far longer and have not yet been acted upon at all. In other large states, the reporters write, such cases are usually dealt with in less than a year.
The reporting team adds depth to their investigative work with a compelling series of anecdotes, told from the perspective of patients, administrators and even the wayward nurses themselves. They also dissect the system, finding few safeguards other than the tardy board review process, and work to discover all the factors contributing to the delays.
In reaction to the story, leaders of the California Board of Registered Nurses sent a note of encouragement to its staff on Monday that points to some recent accomplishments.
Over at Off the Charts, the American Journal of Nursing blog, AJN editor-in-chief emeritus Diana J. Mason, R.N., Ph.D., weighs in on the investigation and an earlier study of recidivism among disciplined nurses. Mason suggests that the National Council of State Boards for Nursing could “work with the state boards to publicly report on a state-by-state basis a quality metric of length of time between complaints and board action.”
Update
Calif. Nursing Board executive officer resigns: On Tuesday, the longtime executive officer of the embattled California Board of Registered Nursing resigned. Ornstein and Weber report that “Terry had been the appointed executive officer for nearly 16 years and had been on the staff of the board for 25.”
Fawcett speaks out on cancer, media and privacy
ProPublica senior reporter Charles Ornstein, who is vice president of AHCJ’s board of directors, interviewed Farrah Fawcett about her fight against cancer and her accompanying struggles with media and privacy last August. A story based on the interview was released Monday in ProPublica and the Los Angeles Times. A producer who worked with Fawcett on a related upcoming NBC documentary had asked that the story be held until five days before the documentary’s Friday release.
Above all, in a firm voice that betrayed no hint of her terminal illness, Fawcett described how she was deprived of the choice that most other cancer patients have: when, and even whether, to share information with family, friends or strangers.
“It’s much easier to go through something and deal with it without being under a microscope,” she said. “It was stressful. I was terrified of getting the chemo. It’s not pleasant. And the radiation is not pleasant.”
In the interview, Fawcett talked about the private sting operation she ran to help track down the UCLA Medical Center employee who was leaking details about her medical care to a tabloid and her frustration with the hospital’s aggressive efforts to encourage her to donate money for a hospital foundation in her name.
Fawcett said she decided to speak up about the ordeal because she wants to see the Enquirer charged criminally for inducing UCLA workers to invade her records. “They obviously know it’s like buying stolen goods,” she said. “They’ve committed a crime. They’ve paid her money.”
Fawcett describes the sting to Ornstein in the video below. Ornstein will appear Tuesday on CNN’s Showbiz Tonight at 11 p.m. ET to discuss the story.
LA Times looks at H1N1’s roots, early days
Filed under: Health journalism, Hot Health Headline
Los Angeles Times reporter Tracy Wilkinson dug deeper into the story of the discovery of H1N1 in the Oaxaca hospital where the first reported death occurred. Wilkinson tells the story of a panicked hospital, an enterprising local newspaper, and a story of “atypical pneumonia” that broke a week before Mexico acknowledged a national health crisis.
In Valdivieso General’s busy emergency room, Dr. Serafin Lopez Concha was hours into his shift on the Thursday before Easter when Gutierrez staggered in. She was gasping for breath, her oxygen-starved fingers turning blue.
Gutierrez, 39, had been sick for a week. She had continued to work as a far-roaming door-to-door census-taker for the tax bureau until the Easter week break. She had seen three or four doctors, Lopez recalled. They’d told her she had a throat infection and given her medicine, but she only got worse.
“She was in very serious condition,” said Lopez, a Oaxaca native who took charge of Gutierrez’s case.
AHCJ resources for covering flu, pandemics and preparednessGutierrez died four days after being admitted to the hospital. A Canadian lab would later confirm she was suffering from H1N1. The scrappy newspaper whose reporters sneaked into the hospital to find out what all the fuss was about ended up helping to break one of the year’s biggest health stories.
And Alfredo Martinez de Aguilar, publisher of the Despertar newspaper, is feeling vindicated. The paper (its name means “to wake up”) was founded just a year ago, with $3 million from a group of investors, 100 employees and a commitment to a different kind of journalism. It has taken on inept officials, money launderers and corrupt cops.
Martinez prides himself on his “intelligence unit,” the less-than-orthodox team of staffers who might pose as something other than journalists if that’s what it takes.
And in this case, Martinez says, that is what it took. He wonders whether local health authorities would have informed the public of the emergency if his reporters had not gone into the hospital and dug up the truth.
Loophole in industry proposal for universal coverage
Filed under: Health care reform, Hot Health Headline
Los Angeles Times columnist David Lazarus points out that while, in a letter to influential senators, insurance industry executives promise, in Lazarus’ words, that “they’ll treat all people fairly in return for a government requirement that everyone buy their product,” the companies have left a significant loophole that might allow them to continue charging sicker people more money.
The key words are “benefit design,” the practice by which people can choose different levels of coverage at different prices. In a benefit design scenario, the elderly and infirm will be more likely to choose the more expensive coverage ranges while the young and healthy will choose cheap bare-bones coverage.
“It’s a very potent way of segregating sick people from healthy people,” said Karen Pollitz, a research professor at Georgetown University’s Health Policy Institute. “It’s essentially a way of continuing to charge more based on people’s health.”
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