Child Fatality Task Force in the Crosshairs – Again
By Rose Hoban
Karen McLeod spent the late afternoon Thursday knocking doors at the General Assembly.
McLeod, who is the co-chair of the legislative Child Fatality Task Force, was looking for Republican lawmakers to help keep the panel from being eliminated as written into the annual “technical corrections” bill.
That bill, which had it’s debut Thursday morning, is usually reserved for changing grammatical errors deep in statutes or repealing obsolete local laws. But lawmakers often insert small “poison pill” pieces of legislation into the bill: for example, last year’s technical corrections bill changed the structure and completely changed the board of the North Carolina Institute of Medicine, making all of the members political appointees.
This year’s bill repeals the statute establishing the Child Fatality Task Force, sunsetting the body in July 2015.
The body has been in existence since 1991.
“It’s a 55 page bill,” said Rep. Paul Stam (R-Apex), when McLeod asked him to help her save the body. “You can’t fault me for missing a line.”
The task force’s elimination was contained in an innocuous line in the bill that reads: “SECTION 22.(a) G.S. 7B‑1401(4), 7B‑1402, 7B‑1403, and 7B‑1412 are repealed.” and striking through references to the Task Force in other lines of statute.
Stam has been a member of the CFTF for the past two years and he gave McLeod a nod.
The bill will be heard on the House floor Friday morning.
“This was very unexpected,” McLeod said.
During the closing days of the 2013 session, there was also an measure floated to eliminate the task force. But that effort was opposed by several members of the House, including the late Rep. Jim Fulghum (R-Raleigh) who died last week. Fulghum, a physician, was also on the task force.
“Last year we thought that the legislature had decided that it was of value, when the decision was made to continue,” McLeod said. “We were just very surprised to see this language come back.”
McLeod rattled off a list of legislative accomplishments since the creation of the committee in 1991, including regulations around bicycle helmets, seat belts, strengthening the child-abuse response system, anti-poisoning measures and programs to reduce the infant mortality rate.
“It has helped crate a tremendous focus on improving outcomes for kids and reducing fatalities,” she said.
McLeod made the point that all of the members of the task force – including McLeod, who leads a group that advocates for policies to help children and families – are volunteers. The only expenses for the task force are one employee who has a salary of $62,585.
“We have been able to harness experts from all over the state that give of their time to look at systems and policies and practices to determine what changes are needed to continue to drive down fatalities,” she said. “It would be a huge loss for us to lose the task force.”
Despite a precipitous drop in deaths of children under 17 years old and historically low infant mortality rates, North Carolina continues to lag behind other states in child death.
“To lose the momentum and the energy and the focus that has been created over the years of the task force would be a tragic loss,” McLeod said.
McLeod also bemoaned the loss of Fulghum, who fought to save the task force last year.
“He was a brilliant man who understood from a medical perspective what was in the best interest of children. IN addition, he understood the political as well as the policy components that across a myriad of services that drive outcomes,” McLeod said.
“He understood that there’s no silver bullet, you need multiple approaches to change the rate of fatalities in kids.”
Rep. Jim Fulghum Dead at 70
The retired neurosurgeon was a freshman representative who spent most of his time in the legislature focused on health care issues.
By Rose Hoban
Several weeks ago, word started floating through the General Assembly on Jones St. that Rep. Jim Fulghum (R-Raleigh) was seriously ill. But no confirmation of the rumors came until a member of the House of Representatives asked on the floor about Fulghum’s condition.
“He is ill, and I would ask you to keep him in your prayers,” responded House Speaker Thom Tillis (R-Cornelius).
The same day, July 3, Fulghum filed a letter with the state board of elections withdrawing his candidacy for this fall.
This weekend, Fulghum’s family announced he died from complications related to cancer. He was 70 years old.
“As a medical doctor, Jim had a professional and personal passion for helping those in his community and state. Wake County and all of North Carolina lost a great man today,” wrote Gov. Pat McCrory in a statement Sunday.
Fulghum was instrumental in pushing through the House a number of bills related to health care, in particular children’s health, which included a bill to assure newborns are tested for heart disease and one restricting access to electronic cigarettes. He also helped save the state’s Child Fatality Task Force from elimination during last year’s budget fight.
In a statement, Tillis wrote that Fulghum’s “leadership as a legislator was second only to his compassion and expertise as a doctor serving his constituents and the state of North Carolina.”
Fulghum also co-sponsored a bill banning tanning bed use by teens and one to provide epinephrine pens in North Carolina schools. Both bills passed the House last year but continue to languish in the Senate.
“Not only did we lose the expertise of our only physician legislator, we lost a strong advocate for North Carolina’s children,” said Annaliese Dolph, a lobbyist who represents advocates for children and people with disabilities. “Rep. Fulghum was a very kind person and will be sorely missed.”
Fulghum was planning a run for the state Senate to replace long-serving Sen. Neil Hunt (R-Raleigh), who is retiring this year. After Fulghum’s withdrawal, Wake County Republicans chose John M. Alexander Jr. as a replacement candidate.
Walking to D.C. to Save Belhaven Hospital
What seemed to be a promising agreement between Vidant Health Systems, the NAACP and the town of Belhaven to keep Vidant Pungo hospital open has failed. Efforts are now underway to re-open the hospital in Belhaven.
By Hyun Namkoong
Adam O’Neal is a man on a mission. The Republican mayor of Belhaven walked for almost 20 miles in the pouring rain yesterday from Plymouth to Merry Hill to get to Washington, D.C., where he hopes to talk to lawmakers about the June 1 closure of the Vidant Pungo hospital.
If everything goes as planned, his 14-day, 273-mile trek on foot will put him in the nation’s capital on July 28.
What had been championed as a “historic agreement” between the NAACP and Vidant Health System to transfer ownership of the hospital from Vidant to a community-based board has fallen through, and the NAACP has re-filed a Title VI complaint to the U.S. Department of Justice.
Both phone and email inquiries to several Vidant representatives were unanswered Tuesday evening.
The NAACP asserts in the re-filed Title VI complaint that the closure of the hospital would affect “poor African American and Latino residents of Beaufort and Hyde counties.”
Title VI of the 1964 Civil Rights Act “prohibits discrimination on the basis of race, color, and national origin in programs and activities receiving federal financial assistance.”
During a press call on the second day of O’Neal’s walk to D.C., he and Rev. William Barber, president of the N.C. chapter of the NAACP, said that people will die as a result of the hospital’s closure. They asserted that 48-year-old Portia Gibbs was the first person to die from delayed care since the hospital’s doors shut.
“A lady spent an hour in the back of a paramedic’s ambulance in Swan Quarter, North Carolina instead of being transferred to Belhaven,” O’Neal said. He said it would have taken 25 to 30 minutes to get the woman to Belhaven.
According to O’Neal and Gibbs’ family’s statements on a YouTube video, she died waiting for a helicopter to airlift her to Norfolk, Virginia.
With the closure of the hospital in Belhaven, the nearest emergency room to Gibbs’ home in Hyde County is 75 miles away. There is no hospital in Hyde County.
Barber cited delays in both delivering information and the $1 million grant from Vidant to facilitate the transition process, as well as Pantego Creek LLC’s unexpected decision to not cooperate with the transfer of ownership, as key reasons for re-filing the Title VI complaint on June 24.
Pantego Creek LLC is the organization created in 2011 that entered into an agreement with Vidant to assume control of the hospital. The LLC informed the community-based board on June 16, two weeks before the date of the mutually agreed upon transfer of ownership, that it would not transfer control of the hospital to the board.
Barber said that he and O’Neal have signed and sent letters to state leadership including Gov. Pat McCrory and Speaker of the House Thom Tillis asking for help, but have yet to receive a reply.
O’Neal said that he supports Medicaid expansion and that it would’ve helped the hospital and the residents of Belhaven.
“We are serious about this issue,” Barber said. “We are asking for the federal government to use its muscle and stop [Vidant] from doing what will cause irreparable damage onto this community.”
What Bites In St. Lucia Doesn’t Stay In St. Lucia
By Hyun Namkoong
Chikungunya virus is as foreign as it sounds, but the Centers for Disease Control and Prevention has already confirmed seven cases of this unwelcome guest in North Carolina.
Chikungunya outbreaks have been largely confined to Africa, Asia and Europe. But in 2013, the virus made its way over to the Americas, first showing up in the Caribbean and then latching onto unwitting American tourists least expecting a case of chikungunya on their holiday. According to the Pan American Health Organization, the Caribbean outbreak is now at about 355,000 suspected and confirmed cases centered primarily in Haiti and the Dominican Republic, Guadeloupe and Martinique, as well as a handful of cases each in Trinidad and Puerto Rico.
The chikungunya virus is transmitted through infected mosquitoes. The virus has no known vaccine or cure, and although it isn’t lethal it can be painful. Common symptoms include fever and joint pain. Most people feel better within a week, but for some the joint pain can last months, even years.
Hopping on a plane is easier now than ever before, and public-health officials are cautioning travelers to prepare for more than an exchange of culture when they cross borders. The N.C. Department of Health and Human Services is advising North Carolinians who visit tropical islands or other nations where the virus is known to exist to see a doctor if they start feeling any symptoms of chikungunya within two weeks of returning home.
According to the Trinidad Express newspaper, James Hospedales, executive director of the Caribbean Public Health Agency, said the outbreak appears to be spreading to one new country per week.
According to DHHS, “There is no evidence that any mosquitoes in North Carolina carry the chikungunya virus,” and confirmed cases have been people who traveled to the Caribbean or other infected areas.
But it is possible for the virus to get transmitted into local mosquitoes, which could result in an outbreak of chikungunya across the state. The Aedes albopictus, better known as the Asian tiger mosquito, is commonly found in North Carolina and could transmit the virus to humans.
Though it may be unlikely that the state will be swarmed by chikungunya-infected mosquitoes, the old public-health adage “better safe than sorry” is why DHHS is advising residents to take preventative measures against chikungunya by making breeding conditions less favorable for mosquitoes.
These measures include throwing out standing water, keeping gutters clean and using screened doors and windows. People are also advised to avoid being outdoors in the morning and early evening when the Aedes mosquito is most aggressive.
UPDATE: On July 17, CDC officials announced the first confirmed case of chikungunya acquired without travel to the Caribbean. A man in Florida was diagnosed with the disease who had not recently traveled outside the country.
“CDC officials believe chikungunya will behave like dengue virus in the U.S., where imported cases have resulted in sporadic local transmission but have not caused widespread outbreaks,” said an agency press release.
“None of the more than 200 imported chikungunya cases between 2006 and 2013 have triggered a local outbreak. However, more chikungunya-infected travelers coming into the U.S. increases the likelihood that local chikungunya transmission will occur.”
Lawmakers Call for Action on Reducing Suicides
By Jasmin Singh
The North Carolina House of Representatives passed a resolution Wednesday authorizing legislative staff to study ways to prevent suicide among minors and veterans in the state.
Lawmakers listened as Rep. Carla Cunningham (D-Charlotte), one of the resolution’s sponsors, struggled to contain her emotions as she described her son’s struggle with mental illness and developmental disabilities.
“My experience of my son’s suicidal ideation and unpredictable paranoid behavior at a young age was quite difficult for a young mother like myself,” Cunningham said.
The resolution’s easy passage means it’s more likely the legislature will fund a study of the issue during the interim period before next year’s long session, which begins in January.
In North Carolina, there were a total of 3,536 suicides and 19,754 self-inflicted injury hospitalizations between 2009 and 2011, according to “The Burden of Suicide in North Carolina,” a report prepared by the state Department of Health and Human Services in 2013.
The resolution recommends requiring health care providers to complete training in suicide-assessment treatment and management as part of their continuing-education requirements. Other professionals, such as social workers, educators and coaches who are in contact with people at risk for suicide, would also have to be trained in prevention.
Cunningham said people that care for loved ones with suicidal thoughts go through difficulties on a daily basis.
“I was reminded of the loneliness and the frustration many families endure during these unpredictable times,” she said. “This journey is a difficult walk, and I still today cannot understand what my son experienced in his mind or what his thoughts were day to day.”
A complicated issue
Rep. Grier Martin (D-Raleigh), a veteran of the war in Afghanistan, addressed the issue of suicide among military personnel.
“As you expect, folks deployed to a combat zone are suffering from suicide,” Martin said. “But we are finding out that those deployed to a noncombat zone are also suffering.”
Between 2009 and 2011, a total of 505 North Carolina veterans died from suicide, with a suicide rate 150 percent that of the general population, according to the DHHS report.
Rep. Craig Horn (R-Weddington), also a veteran, said that while leading a first-aid group in the military, he saw too many lives lost to suicide.
“You lift down a guy you’ve just been on parade or maybe worked with just an hour ago,” he said. “I had to take him down from a shower stall where he had taken his own life.”
Horn said war is a terrible thing, but that there was something much worse.
“The most terrible thing is to be without hope,” he said. “There are those out there – friends, family, neighbors, people we meet on the street – that are actually living a nightmare inside themselves.”
About a third of veteran suicide victims were receiving treatment for mental illness at the time they took their lives, the DHHS report said.
Too many young people
Rep. Beverly Earle (D-Charlotte) said an alarming number of young people are committing suicide.
“Suicide and suicidal behaviors are serious problems in the community,” she said. “They can be devastating and detrimental to the victim and to the families.”
According to the DHHS report, among young people between the ages of 10 and 24 there were 422 suicides and 5,167 self-inflicted injury hospitalizations between 2009 and 2011.
More than half of suicides among youth and young adults were carried out using firearms.
“This isn’t a bill about guns, but it is about guns,” Earle said.
“Even more disturbing, in my opinion, is a survey that shows one in every five high school students has considered suicide and one in 12 has attempted,” she said.
The most common circumstance for victims aged 10 to 24 was a crisis within the past two weeks. Mental health circumstances were also common in youth and young adults, including a depressed mood, with almost a third having a current mental health problem and around a third having had mental health treatment in the past.
‘Many others that walk this journey’
Cunningham said she is still learning from her son’s battle.
“I just know that I was allowed to walk this journey with him to a place of hope, courage, lighthearted laugher, smiles and eventually adulthood,” she said.
Cunningham said she is grateful for the help she received for her son but knows there are “many others that walk this journey.”
“Some finish the journey and survive, and others endure the hurt and loss,” she said.
Rep. Chris Whitmire (R-Rosman) said there is some good news.
“Most suicide victims do illustrate symptoms that if recognized can lead to some interventions that ultimately can mitigate or prevent the devastating effects,” he said. “This is an awareness of a means to potentially prevent great tragedy.”
Cunningham said lawmakers should become “the beacon of light” to protect those most vulnerable – youth and veterans.
“Let us seize the moment to lift the burden of suicide in North Carolina by educating as many health care providers, police officers, educators, social workers, clergy and community advocates that touch the masses of the people of our great state,” she said.
North Carolina suicides 2009-11:
Statewide – 3,536
Youth – 422
Veterans – 505
Self-inflicted injury hospitalizations 2009-11:
Statewide – 19,754
Youth – 5,167
Self-inflicted injury ED visits 2009-12:
Statewide – 38,605
Youth – 13,331
Source: “The Burden of Suicide in North Carolina”
Big Money, Big Research for Global Health at UNC
By Hyun Namkoong
The evaluation of how well public-health dollars are spent in nations across the globe received a major boost yesterday, with the announcement of the second-largest research grant UNC-Chapel Hill has ever received.
A group of deans, researchers and politicians gathered at the Carolina Inn for Chancellor Carol Folt’s announcement of a $180 million grant from the U.S. Agency for International Development.
The recipient is the university’s Carolina Population Center for its Monitoring and Evaluation to Access and Use Results Evaluation project, more commonly known as MEASURE Evaluation.
“[Funding] is for phase four of this project and it will keep the work going for another five years,” Folt said.
The MEASURE Evaluation project is the U.S. AID’s flagship program for identifying gaps in data, collecting and analyzing data and making decisions to fund projects based on data.
In the past, many projects had been funded based on political favors or hunches, according to Jim Thomas, MEASURE Evaluation project director and an associate professor of epidemiology at UNC-Chapel Hill’s Gillings School of Global Public Health. Better data has helped change that paradigm throughout the developing world.
The goal of the project is to measure and evaluate public-health programs worldwide to ensure government dollars in 80 countries are used wisely.
The overall emphasis of phase four, Thomas said, “is to build sustainability so that these [health information] systems can continue on long term without us.”
Sustainability has long been identified as a priority of public-health projects, particularly those implemented in low- and middle-income countries.
Among those attending the press conference were Rep. David Price; Aldona Wos, secretary of the state Department of Health and Human Services; and representatives from the office of U.S. Sen. Richard Burr.
The MEASURE Evaluation project began in 1997 and has received funding from a number of sources, including the President’s Emergency Plan for AIDS Relief.
The project has developed several methodologies for collecting data to better inform public-health programs and policies, especially in the areas of reproductive health, HIV/AIDS and other infectious diseases.
“Monitoring and evaluation – what’s important here is that not only are we applying a toolkit, we’re inventing the toolkit,” said Barbara Entwisle, vice chancellor for research at UNC-Chapel Hill.
Benefits to the state
While the focus of MEASURE Evaluation is on global health and strengthening health information systems worldwide, Folt and Thomas believe that North Carolinians will benefit from the $180 million grant.
“It’s a global project with a lot of local influence,” Folt said. “It’s supported more than 100 jobs here in North Carolina.”
Folt also said that research at UNC has led to the creation of spinoff companies such as FHI 360, which is headquartered in Durham.
MEASURE Evaluation has worked on public-health projects for infectious diseases such as HIV/AIDS in South Africa and tuberculosis in Latin America, both of which can result in epidemics, or even pandemics.
“Epidemics that are controlled worldwide are less able to affect our own country,” Thomas said.
He also said that the Triangle has become a hub for global-health research similar to how Wilmington has become a hub for the film industry.
When asked about how phase four of the MEASURE Evaluation project might directly affect and translate into health improvements for North Carolinians, Thomas said, “We don’t have [anything] in place for making sure that it translates, but that’s something that we would be very much open to talking about.”
“For decades, I did work domestically in epidemiology in the public sector,” he said. “I would be very interested in talking to anyone who wanted [to learn] about how we could translate some of these things that we’re doing in MEASURE Evaluation to benefit, in particular, some of the rural areas of the state.”
NC Hospitals Among Those Facing Medicare Crackdown on Patient Injuries
By Jordan Rau
During a hernia operation, Dorothea Handron’s surgeon unknowingly pierced her bowel. It took five days for doctors to determine she had an infection. By the time they operated on her again, she was so weakened that she was placed in a medically induced coma at Vidant Medical Center in Greenville.
Comatose and on a respirator for six weeks, she contracted pneumonia. “When they stopped the sedation and I woke up, I had no idea what had happened to me,” said Handron, 60. “I kind of felt like Rip Van Winkle.”
Because of complications like Handron’s, Vidant, an academic medical center, is likely to have its Medicare payments docked this fall through the government’s toughest effort yet to crack down on infections and other patient injuries, federal records show.
A quarter of the nation’s hospitals – those with the worst rates – will lose 1 percent of every Medicare payment for a year starting in October. In April, federal officials released a preliminary analysis of which hospitals would be assessed, identifying 761. When Medicare sets final penalties later this year, that list may change because the government will be looking at performance over a longer period than it used to calculate the draft penalties.
Vidant, for instance, says it lowered patient injury rates over the course of 2013, and Handron praises their efforts.
The sanctions, estimated to total $330 million over a year, kick in at a time when most infections measured in hospitals are on the decline, but still too common. In 2012, one out of every eight patients nationally suffered a potentially avoidable complication during a hospital stay, the government estimates. Even infections that are waning are not decreasing fast enough to meet targets set by the government. Meanwhile, new strains of antibiotic-resistant bacteria are making infections much harder to cure.
Clifford McDonald, a senior adviser at the federal Centers for Disease Control and Prevention, said the worst performers “still have a lot of room to move in a positive direction.”
Are The metrics right?
Medicare’s penalties are going to hit some types of hospitals harder than others, according to an analysis of the preliminary penalties conducted for Kaiser Health News by Ashish Jha, a professor at the Harvard School of Public Health. Publicly owned hospitals and those that treat large portions of low-income patients are more likely to be assessed penalties. So are large hospitals, hospitals in cities and those in the West and Northeast.
Preliminary penalties were assigned to more than a third of hospitals in Alaska, Colorado, Connecticut, the District of Columbia, Nevada, Oregon, Utah, Wisconsin and Wyoming, Medicare records show.
“We want hospitals focused on patient safety and we want them laser-focused on eliminating patient harm,” said Patrick Conway, chief medical officer of the Centers for Medicare & Medicaid Services.
The biggest impact may be on the nation’s major teaching hospitals: 54 percent were marked for preliminary penalties, Jha found. The reasons for such high rates of complications in these elite hospitals are being intensely debated.
Leah Binder, CEO of The Leapfrog Group, a patient-safety organization, said academic medical centers have such a diverse mix of specialists and competing priorities of research and training residents that safety is not always at the forefront. Nearly half of the teaching hospitals – 123 out of 266 in Jha’s analysis – had low enough rates to avoid penalties.
The government takes into account the size of the hospital, the location where the patient was treated and whether it is affiliated with a medical school when calculating infection rates. But the Association of American Medical Colleges and some experts question whether those measures are precise enough.
“Do we really believe that large academic medical centers are providing such drastically worse care, or is it that we just haven’t gotten our metrics right?” Jha said. “I suspect it’s the latter.”
Medicare assigned a preliminary penalty to Northwestern Memorial Hospital in Chicago, for instance, but Gary Noskin, the chief medical officer, said hospitals that are more vigilant in catching problems end up looking worse. “If you don’t look for the clot, you’re never going to find it,” he said.
Another concern is there may be little difference in the performance between hospitals that narrowly draw penalties and those that barely escape them. That is because the health law requires Medicare to punish the worst-performing quarter of the nation’s hospitals each year, even if they have been improving.
“Hospitals that have been working hard to reduce infections may end up in the penalty box,” said Nancy Foster, vice president for quality and public safety at the American Hospital Association.
Third leg Of Medicare’s pay-for-performance
The Hospital-Acquired Condition (HAC) Reduction Program, created by the 2010 health law, is the third of the federal health law’s major mandatory pay-for-performance programs for hospitals. The first levies penalties against hospitals with high readmission rates and the second awards bonuses or penalties based on two dozen quality measures. Both are in their second year. When all three programs are in place this fall, hospitals will be at risk of losing up to 5.4 percent of their Medicare payments.
In the first year of the HAC penalties, Medicare will look at three measures. One is the frequency of bloodstream infections in patients with catheters inserted into a major vein to deliver antibiotics, nutrients, chemotherapy or other treatments. The second is the rates of infections from catheters inserted into the bladder to drain urine. Both those assessments will be based on infections during 2012 and 2013.
Finally, Medicare will examine a variety of avoidable safety problems in patients that occurred from July 2011 through June 2013, including bedsores, hip fractures, blood clots and accidental lung punctures. Over the next few years, Medicare will also factor in surgical-site infections and infection rates from two germs that are resistant to antibiotic treatments: Clostridium difficile, known as C. diff, and Methicillin-resistant Staphylococcus aureus, known as MRSA.
Vidant is worse than average in catheter-associated urinary tract infections and serious complications from surgery in the latest statistics Medicare published on its Hospital Compare website. But in more recent data the medical center voluntarily reports on its website, the number of catheter and urinary tract infections dropped during 2013. Joan Wynn, Vidant Health’s chief quality and safety officer, said complications rates are dropping this year as well.
The prospect of penalties is “difficult when you know how much your performance is improved,” said Wynn. She said Vidant has taken many steps to reduce complications; added patients to internal committees; and now reveals on its website the number of infections, patient falls, medication errors and bed sores.
Vidant asked Handron, a retired nursing professor injured in 2009, to tell her experience to the trustees and make a video for the medical staff talking about it. She continues to advise the hospital.
“I know they’re going in the very right direction,” Handron said. “I would have absolutely zero concern about myself or a family member going to Vidant for anything now.”
Nationally, rates of some infections are decreasing. Catheter-related infections, for instance, dropped 44 percent between 2008 and 2012. Still, the CDC estimates that in 2011 about 648,000 patients – 1 in 25 – picked up an infection while in the hospital, and 75,000 died.
Rates of urinary tract infections have not dropped despite efforts. These infections are more likely the longer a line is left in, but sometimes they are not removed promptly out of convenience for the nurse or patient or due to institutional lethargy.
Swedish Medical Center in Seattle, which has higher urinary catheter infection rates than do most hospitals, has given nurses more authority to remove catheters so long as they follow guidelines for when removal is appropriate, said Michael Myint, Swedish’s vice president for quality and patient safety. “Historically, they would just wait for the physician’s order to come through,” he said.
Medicare has been pressuring hospitals for several years to lower rates of injuries to patients. In 2008, Medicare started refusing to reimburse hospitals for the extra cost of treating patients for avoidable complications. A subsequent study by Harvard researchers found no evidence that the change led to lower infection rates.
“With infections, we are moving in the right direction,” said Lisa McGiffert, who directs the patient-safety program at Consumers Union, “but I would not say we are anywhere near where we need to be.”
Patient advocates praise move
Patient advocates say the financial penalties are long overdue, given how little accountability there has been.
Gerald Guske discovered that in 2012, when he went into Martha Jefferson Hospital in Charlottesville, Va. for an artificial hip implant. Doctors later had to reopen the incision and wash out his implant. Guske, a retired electronic technician, was laid up for a month in a rehabilitation facility while strong antibiotics were pumped directly into a vein.
Martha Jefferson told Guske it had followed proper protocols. “Unfortunately, infection is a known risk of any surgery, and even when everything is performed correctly and conditions are ideal, they can occur,” the hospital wrote him afterward. “Infection does not necessarily indicate that something went wrong.”
Martha Jefferson Hospital said it could not discuss the case because of patient privacy laws. The hospital’s infection-control specialist, Keri Hall, said infection rates have been dropping and “we are every day doing what we can to hopefully bring our rates down to zero.”
Guske said he has fully recovered, “other than taking six weeks out of my life,” but he attributes the stress around his complications to a minor stroke his wife suffered. He said state regulators told him they could not take any action because the hospital followed proper procedures. The fear of a financial penalty against a hospital, Guske said, is “the only thing that’s really going to change matters.”
This story originally appeared in Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. This article was produced by Kaiser Health News with support from The SCAN Foundation.
Legislators Reconsider Who’s Eligible for the Death Penalty
By Jasmin Singh
People with intellectual disabilities who sit on death row may find their sentences commuted to life in prison as North Carolina looks to come in line with a recent Supreme Court decision.
Lawmakers in the House Judiciary Subcommittee C worked on a heavily amended bill on Wednesday that would change a number of judicial statutes. The bill previously only considered the issue of drug testing for welfare recipients, but appeared late Tuesday with a dozen additional sections dealing with justice issues.
One of those provisions included changes to the statute prohibiting the death penalty for people who are determined to be intellectually disabled.
The proposed bill is a response to the recent U.S. Supreme Court ruling Hall v. Florida, where the court determined it was unconstitutional to use an IQ test score of 70 or below to determine whether someone was intellectually disabled because it creates the possibility that a person with intellectual disabilities could be executed by mistake.
“This act conforms our state law to that ruling,” said Rep. Ted Davis (R-Wilmington), the bill’s primary sponsor.
The bill also adjusts the language in North Carolina statute to “intellectually disabled” instead of “mentally retarded,” which was the common usage in the past.
“The term ‘intellectual disability’ is compliant with current trends nationally, so I think it’s a good move,” said Rep. Jean Farmer-Butterfield (D-Wilson).
No bright line
“You can’t use a bright line [of] 70 for the IQ score,” said legislative staff attorney Hal Pell. “This ensures that the law and our statutes specifically reflect what the Supreme Court said in Hall v. Florida.”
Pell said a standard error of measurement of plus or minus five IQ points must be taken into account according to the Supreme Court.
Gerda Stein, director of public information for the Center For Death Penalty Litigation, said the Supreme Court ruling addresses the possibility of error in determining who might or might not be intellectually disabled.
Sometimes a defendant would go to court and their lawyer would argue that the defendant was intellectually unable to understand what was happening. Some judges would ignore arguments if the defendant’s IQ score was a point or two above 70, while other judges would give more leeway.
Stein said she believes there are at least three cases in which people lost their intellectual disability claims after nonclinical standards were used to assess the defendant’s disability.
“Hopefully, people can go back and re-litigate those conditions that the Supreme Court made clear,” she said.
Stein said 17 people have been taken off North Carolina’s death row since the enactment of the state’s current statute, passed in 2005, and also because of the Supreme Court decision.
Corye Dunn, an attorney and director of public policy for Disability Rights North Carolina, said an IQ test alone isn’t enough to determine disability.
“We need a more comprehensive medical evaluation of a whole person to understand whether they meet the criteria for being eligible for the death penalty, being able to understand what they did and also participate at their defense at the trial,” she said.
Dunn also said that anytime there is a Supreme Court ruling, it governs whether the state statute changes or not.
“Even if this [statute] didn’t pass, we would still need to comply with this ruling,” Dunn said. “But our judges might have less clear guidance about how to comply with the ruling.”
Both Stein and Dunn agree that the state is moving in the right direction.
“I think we’ve made a lot of progress,” Dunn said. “Everybody is working very hard to make sure the language truly complies with the Supreme Court ruling and also works with the context of our statutory framework.”
Charlotte-Mecklenburg Will Have One Nurse in Every School
By Brenda Porter-Rockwell
After two years of emails, speeches and bake sales, a group of Charlotte-Mecklenburg Schools parents will finally get their wish: one nurse in every school.
In a vote Tuesday evening, the Mecklenburg Board of County Commissioners approved a $1.5 billion budget, which included $1.8 million in funding for 33 new CMS public-health school nurses, bringing the total number up to 161 for the 2014-15 academic year. The money will also cover another three school-nurse supervisors.
Teri Saurer, founder of N. C. Parents Advocating for School Health, the group that pushed for the increased school-nurse presence, said she couldn’t be happier.
“This is a huge success for the parents and children of Charlotte-Mecklenburg schools. The comfort to parents is invaluable. It could be potentially life saving,” said Saurer, mother of a 7-year-old daughter who was diagnosed with epilepsy at 9 months old and allergies to several types of nuts at 3 years old.
Saurer said she believes nurses are needed to both provide routine care and tend to children in crisis situations. She began researching the lack of full-time nurses in CMS after realizing a nurse was only present two or three days a week at Ballantyne Elementary, where she enrolled her daughter.
Federal guidelines recommend one school nurse for every 750 students. Charlotte-Mecklenburg Schools have one nurse for approximately every 1,100 students, according to Evelyn Stitt, the interim school health deputy division director for the Mecklenburg County Health Department, which oversees nurses in the school district. Charlotte-Mecklenburg does have full-time nurses in several schools with larger student populations.
When Saurer founded N. C. Parents Advocating for School Health two years ago, the ratio was one to 1,200. In the 2013-14 school year, the ratio increased to one to 1,100. With the new funding, the ratio will be 1 to 900 in the new school year. That’s 161 nurses for 161 schools.
This victory is a big step forward, said Saurer, pointing to the advocacy efforts of the parent group and its supporters, who include Commissioner Kim Ratliff, Mecklenburg County Health Director Marcus Plescia and County Manager Dena Diorio.
Last year, when the 2013-14 county budget passed, funding was provided for 11 new nurses and two more nurse supervisors.
Saurer said she is impressed by how much support for the group has grown since its inception. She estimated that about 10 parents were interested in 2012 and more than 100 now want to get involved. More than 300 people also “like” the group’s Facebook page.
The group is expanding its cause throughout North Carolina, including working with parents in Iredell, Union and Wake counties to bring more nurses to their school systems – and the Wake County Public School System will soon see an increase in school nurses. On Monday, its board of county commissioners approved funding for 10 additional public-school nurses as part of its $1 billion budget for 2014-15.
The new positions will bring the total number of nurses in Wake County schools up to 72, shared among 170 schools.
Study: Health Law Boosts Hospital Psych Care for Young Adults
By Jay Hancock
Kaiser Health News
Expanded coverage for young adults under the Affordable Care Act substantially raised inpatient hospital visits related to mental health, finds a new study by researchers at Indiana and Purdue universities.
That looks like good news: Better access to care for a population with higher-than-average levels of mental illness that too often endangers them and people nearby.
But it might not be the best result, said Kosali Simon, an economist at Indiana University and one of the authors. Greater hospital use by the newly insured might be caused by inadequate outpatient resources to treat mental-health patients earlier and less expensively, she said.
The health law let people under age 26 stay on their parents’ group insurance plans starting in late 2010. Other research shows the provision raised coverage for young adults. The paper by Yaa Akosa Antwi, Asako S. Moriya and Simon, based on a big national sample from community hospitals, found it also increased their hospital use.
Total inpatient visits for those aged 19 to 25 increased 3.5 percent compared with people aged 27 to 29, who couldn’t be on their parents’ plans. Mental health admissions increased much more — by 9 percent.
That’s a little puzzling. When Massachusetts broadened medical coverage with its 2006 state-based health reform law there were no big increases in mental-health hospitalizations for young adults there.
But psychiatrists, psychologists and other mental-health providers are more available in Massachusetts than elsewhere, Simon said. Perhaps community caregivers largely met the needs of newly insured Bay Staters, saving them from crisis visits to the emergency room.
In the national study, a large portion of psychiatric admissions came through the emergency department.
Neither the Massachusetts study nor the national study looked at the volume of outpatient mental-health care. But even if they had, they wouldn’t have produced a final answer on the effectiveness of expanded coverage.
That will take more research. Increasing insurance and treatments aren’t necessarily the same as helping patients.
“We eventually judge all these [insurance] expansions based on the final outcomes that we care about,” said Simon. “How did this affect the well-being of young adults? Is there a measurable improvement of health status? Does it appear that there is better mental health as a result of this increase?”
This story originally appeared in Kaiser Health News an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.