Texas psych clinics take Medicare’s millions without oversight
Filed under: Health care reform, Health data, Health policy, Hospitals, Hot Health Headline
The Houston Chronicle’s Terri Langford reports that for-profit outpatient psychiatric clinics in the state, most located around Houston, are collecting millions in Medicare dollars yet “require no license to operate in Texas.”
She writes that, despite access to significant federal funds, the clinics are subject to little oversight from any level of government, especially when it comes to patient care.
…other than a one time inspection conducted by Medicare when clinics start operating - these programs have no detailed standards or “conditions of participation,” that must be met before filing claims and collecting taxpayer money.
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The U.S. Department of Health and Human Services flagged the problem earlier this year, saying “no regulatory basis exists to ensure basic levels of quality and safety” for CMHC care.
The loopholes, including the lack of an established means to kick poorly performing centers out of the medicare system, apply nationwide, but their exploitation remains localized.
Records show that in 2009, Medicare paid $287 million on these programs nationwide, 74 percent of them located in the three states that have no state licensing requirements: Florida, Louisiana and Texas.
Hospital sues to block release of records
Filed under: Hospitals, Hot Health Headline, Public records
Parkland Memorial Hospital in Dallas, the subject of recent reports that patients were at risk, has sued the Texas attorney general in an attempt to prevent the release of records requested by The Dallas Morning News.
Parkland filed the latest lawsuit — its fifth against the AG related to the newspaper — on Monday. This time the goal is to block release of Parkland police department records dealing with the psychiatric emergency room. The News is not seeking medical records.
Related:
- Reports detail Dallas hospital on brink of losing federal funds
- Dallas Morning News hospital investigation required extensive use of public records
Reports detail Dallas hospital on brink of losing federal funds
Filed under: Government, Health data, Hospitals, Public records
Late Friday, a damning federal report declaring that patients were at risk at Parkland Memorial Hospital in Dallas was released. Even later that same day, Dallas Morning News reporters Miles Moffeit, Sue Goetinck Ambrose, Reese Dunklin and Sherry Jacobsen published their first report online (available to subscribers only).
The reporters write that the inspectors’ findings were released in response to a reform plan the hospital submitted just before its Friday deadline, a plan they report “involves hiring new nurses; rewriting some policies; retraining staff; retiring outdated medicines, supplies and equipment; and launching an intensive series of daily or weekly performance audits over at least the next five months.” According to those who have viewed the 600-page release, they have a lot to overcome.
“It appears safety was routinely relegated to a lower priority by other pressures,” said Vanderbilt University professor Ranga Ramanujam, a national expert in health care safety. “The CMS action is extraordinary. I am hard-pressed to think of an example of a similarly high-profile hospital facing the very real possibility of losing their CMS funding as a result of safety violations.”
The paper’s speedy, thorough response to the release shouldn’t be entirely surprising, considering that they’ve been out ahead of the story from the very beginning.
The top-to-bottom July inspection of Parkland was sparked by a News report of the death of a Parkland psychiatric patient in February. The hospital didn’t report the death to the Texas Department of State Health Services or to CMS, both of which then investigated the case. CMS regulators later determined that the rights of the patient, George Cornell, had been violated repeatedly by Parkland.
The hospital has until Sept. 2 to get its correction plan approved by CMS and to pass inspections, otherwise it could lose the Medicare and Medicaid funds on which it so heavily depends.
Reporter predicts Houston to emerge as global health hub
Jaclyn Schiff, writing for the UN Dispatch, makes the case that journalists should look to Houston as the emerging hub of the global health universe, predicting that it may even supplant hotspots like Washington, D.C. and Seattle.
The foundation for Houston’s emergence, she writes, will be built on its already powerful medical community, built on Baylor College of Medicine, the mammoth Texas Medical Center and the MD Anderson Cancer Center, all of which are stepping up their global health efforts.
Photo by Houston TranStar via Flickr
Beyond that pedigree, the particular catalyst for her story is Dr. Peter Hotez’ move from D.C. to work with Baylor and the Texas Children’s Hospital. Hotez is a bit of a global health rock star (Wikipedia bio), known for his work with vaccines and tropical diseases, and he’s bringing his work to Houston with him.
Part of his nonprofit organization, the Sabin Vaccine Institute, is also moving down to Houston, which Hotez calls a “gateway to Latin America.” Hotez will also be the founding dean of the first U.S.-based school of tropical medicine. Its exclusive mandate and Hotez’s track record of achievement are likely to attract some of the brightest physicians with an interest in global health, which is huge for creating a bustling global health community.
Schiff finishes with another prediction, writing that “the Houston Chronicle hasn’t traditionally been a major source of global health news, but I’d start paying closer attention. There’s too much going on for there not to be a story.” For the record, reporters interested in adding the Chronicle to their regular health reading lists can subscribe to its RSS at http://feeds.chron.com/houstonchronicle/health.
As an alternative or supplement to the Chronicle’s coverage, Carrie Feibel covers the Houston health beat for the local NPR affiliate, and you can keep up with her reporting by following her on Twitter at @KUHFHealth.
The UN Dispatch is sponsored by the United Nations Foundation, a private organization which supports UN efforts worldwide, particularly in the public health arena.
America’s border towns are often health care black holes
Colonias, underserved, poverty-riddled communities along America’s southern border populated mostly by American citizens of Mexican descent, have long remained uncomfortably disconnected from mainstream government and social services. In a two-part series in the Texas Tribune, Emily Ramshaw takes stock of life in the colonias, then focuses on the health issues created by their unique circumstances.
Ramshaw paints a vivid picture of these forgotten settlements, home to at least 400,000 folks in Texas alone, and no summary would do her writing justice. Here’s an excerpt from the first installment.
In Del Mar Heights, on the outskirts of Cameron County, residents live on a devastated stretch of scrubland littered with dilapidated trailers and dotted with listing telephone poles. There are no paved streets or sewers, basic infrastructure that developers promised the Mexican immigrants who purchased land here 30 years ago and often live three families — and several bleating goats — to a lot. Floodwaters and wayward hurricanes routinely sweep through the area, battering roofs patched with tarps and campaign signs.
Despite hundreds of millions of dollars of local, state and federal investment in infrastructure and services in the colonias, they still clearly lag behind much of the country. As a curious aside, some of the areas Ramshaw profiles happen to sit just miles from the notorious health care consumers of McAllen, Texas, yet the care they are offered could hardly be any more different.
At last count, nearly 45,000 people lived in the 350 Texas colonias classified by the state as at the “highest health risk,” meaning residents of these often unincorporated subdivisions have no running water, no wastewater treatment, no paved roads or solid waste disposal. Water- and mosquito-borne illnesses are rampant, the result of poor drainage, pooling sewage and water contaminated by leaking septic tanks. Burning garbage, cockroaches, vermin and mold lead to high rates of asthma, rashes and lice infestations. And the poor diet so intrinsically linked to poverty contributes to dental problems, diabetes and other chronic conditions, which residents of the colonias rarely have the health insurance, money or access to regular health care to treat.
Ramshaw writes that cultural and geographic barriers, as well as a general distrust of the federal government in a community where not all residents are legal migrants, have hampered adoption of available programs, but there have been signs of improvement in recent years.
The series was made possible by a grant from the Dennis A. Hunt Fund for Health Journalism, and produced as part of the California Endowment Health Journalism Fellowships, a program of the Annenberg School for Communication & Journalism at the University of Southern California.
Hot pipes lead reporter to radioactive aquifer
Filed under: Government, Health data, Hot Health Headline, Public health, Public records
Mark Greenblatt, reporter for KHOU-Houston, reports that officials in Central Texas have been alarmed to discover high levels of radiation in the pipes and related systems that provide much of the region’s drinking water.
According to local officials, the contamination comes from years of exposure to drinking water that already tests over federal legal limits for radioactive radium. Of even more concern, they say, is that any water quality testing is done before the water runs through the contaminated pipes that could be adding even more radiation.
Almost as remarkable as the waterborne radiation itself? The fact that it was only discovered when city workers dug up old piping, brought it to the recycling center and were rejected because they were “too radioactive” to recycle.
Through his sources, Greenblatt knew the documents and tests proving the connection between a radioactive aquifer and “hot” pipes existed, but getting his hands on them was a different matter.
The call (with sources) was prompted by internal documents from the Texas Commission on Environmental Quality, which identified a main source of the region’s water as radium contaminated. The TCEQ had initially refused to release the paper after a public-records request, and only did so under order from the Attorney General of Texas.
Greenblatt’s story runs much deeper, and it’s worth taking the time to appreciate the scope of his dense, document-rich investigation.
Emails show Texas council’s disregard for EPA regs
Filed under: Government, Health journalism, Public health, Public records
Thanks to an order from the Texas Attorney General, Mark Greenblatt, of KHOU-Houston, obtained emails (2-page PDF) which demonstrate the state water advisory council’s conscious effort to effectively defy certain EPA water quality regulations related to radionucleotide content.
Texas Commission on Environmental Quality accomplished this trick by subtracting the counting error from otherwise dangerous test results, thus successfully dropping them below necessary thresholds. With the numbers below the threshold, there was no formal violation and authorities could get away with not warning residents about their potentially harmful water supply. The dodge continued until 2008, when it was caught by federal auditors.
Dallas Morning News hospital investigation required extensive use of public records
To understand the scope of The Dallas Morning News‘ “First, Do No Harm” series of investigations into publicly funded hospitals, take a look at the landing page. Spend a few minutes reading headlines (”Parkland CEO: ‘I did 17 amputations’ before getting medical degree” is my personal favorite), checking dates and clicking through to stories and you start to see the bigger picture. On its own, that page tells the tale of how reporters grabbed hold of a story and just wouldn’t let go.
That page ties together no fewer than 25 stories, 16 blog posts, 15 separate primary documents and three videos with a simple introductory paragraph:
UT Southwestern Medical Center and Parkland Memorial Hospital are known for their contributions to medical research and public health. But those accomplishments have come at a price. The Dallas Morning News investigates allegations of billing fraud, lax resident supervision, preferential medical treatment and patient harm at the publicly funded institutions.
Some of the material dates back to the paper’s 2007 investigation of a hospital giving special treatment to VIPs, but the vast majority of the work was done in 2010.
Of special interest to journalists: Maud Beelman, the deputy managing editor at The Dallas Morning News who leads a team of investigative and special projects reporters, wrote about the project for Nieman Watchdog. She details some of the struggles they faced to do the project, including getting public records, efforts to derail the investigation and the backlash from the hospitals.
Why Texas is failing to privatize mental health care
Filed under: Health care reform, Health policy, Hot Health Headline
In 2003, Texas passed a law that sought to turn mental health care in the state into a competitive marketplace. It’s 2010, and that marketplace still hasn’t materialized. The Texas Tribune’s Brian Thevenot tried to find out why. Thevenot describes it as “a textbook case of legislative intent crashing on the rocks of bureaucratic maneuvering and logistical realities.”
The state’s local Mental Health and Mental Retardation authorities are supposed to become “providers of last resort,” who turned most direct medical services over to networks of private providers. Instead, the state has remained among the nation’s worst in terms of mental health funding and, as Thevenot reports, the prison system and not the mental health infrastructure, has served as the real provider of last resort for Texas’ mentally ill.
Whooping cough: Not just a problem for kids
Maryn McKenna, AHCJ board member and self-proclaimed “most vaccinated person on the planet,” writes about her own bout with whooping cough. She’d had her shots back in the day, but apparently whooping cough immunity conferred by childhood vaccines fades, and anyone over the age of 12 probably needs a booster. 
This is relevant because, while whooping cough is not generally fatal to adults, it’s easily transmitted to more vulnerable folks. And in California and across the country, it’s on the march and vaccine supplies are limited.
The worst news in this upsetting trend is this: We’re doing it to ourselves. As far as anyone can tell, the rise in pertussis is not due to any change in the organism, or to any mysterious error among the manufacturers who make pertussis vaccines. It’s due to vaccine refusal, to parents turning away from vaccines because they think the vaccines are more harmful than the diseases they prevent — or, more selfishly, because they think the wall of immunity created by other vaccinated children will protect their unimmunized ones.
That wall of immunity, McKenna says, hasn’t been helping the unvaccinated kids, who are 23 times more likely to pick up the disease than their immunized peers.
The Texas Tribune’s Ben Freed learns, through conversations with public health experts, that the “entirely preventable” disease can be stopped with vaccination rates between 80 percent and 85 percent. Unfortunately, adult rates are nowhere close to those numbers, though the state is taking steps to increase adult vaccinations.
California officials are urging people to get vaccinated as that state has now seen a six-fold increase in whooping cough this year.
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