Sustained Outrage

Convicts and nursing homes

As ProPublica.org pointed out, the Office of Inspector General just released a study that found that 92 percent of nursing homes employ a person with a criminal conviction, and almost half employ five or more people with convictions.

Now, not all of these convictions were of the sort that preclude a person from working at a nursing home, such as having abused, neglected or mistreated a nursing home resident. (These can vary from state to state.) The study broke the convictions down by broad category: 43.6 percent were crimes against property; 26.4 percent were “other”; 20.3 percent were DUIs; 16.2 percent were drug-related; 13.1 percent were crimes against persons; 11.9 percent were driving crimes besides DUIs. (Those numbers don’t add up to 100 percent because some people qualified in more than one category.)

The study noted:

Our estimate of the number of nursing facility employees with criminal convictions relies entirely upon the accuracy of the information contained in FBI’s Interstate Identification Index. Because the Interstate Identification Index relies on local, State, and Federal law enforcement agencies to report criminal records, it is possible that not all criminal history record information was accurate and up-to-date.

The criminal history record information we received from FBI suggested that the records did not contain all of the convictions for particular employees. For example, criminal history record information contained notations of probation violations (suggesting that a conviction occurred), but the record did not contain the convictions leading to the imposition of probation periods. In addition, many charges had no corresponding disposition information (e.g., conviction, dismissal), so we could not determine whether a conviction occurred. Finally, it is possible that some individuals’ records did not contain convictions because they were removed following a judicial diversion program (e.g., completion of an alcohol and substance abuse education course).

Our estimates are conservative because we did not include criminal convictions if we could not conclusively identify the individual (e.g., if identifiers were similar but did not exactly match). Also, we could not confirm that the information that nursing facilities provided us was accurate or that the information the employees provided to the nursing facilities was accurate.

FBI-maintained criminal history records do not contain detailed information (i.e., whether the victim of a crime was a nursing facility resident) to determine whether a conviction disqualifies an individual from nursing facility employment under Federal regulation.

West Virginia is one of 33 states that requires a statewide criminal background check, but not one of the 10 that requires both a federal and statewide check.

The study recommended that the Centers for Medicare & Medicaid Services (CMS) develop background check procedures:

To ensure that States conduct background checks consistently, CMS should (1) clearly define the employee classifications that are direct patient access employees and (2) work with participating States to develop a list of State and local convictions that disqualify an individual from nursing facility employment under the Federal regulation and periods for which each conviction bars the individual from employment.

Pharmaceutical drugs and suicide attempts

Here’s yet another reason to be extra careful with what’s in your medicine cabinet: When young adults try to kill themselves, the suicide attempt almost always involves pharmaceutical drugs.

More than 92 percent of suicide attempts by people between the ages of 18 and 24 included some kind of pharmaceutical drug use, according to this new analysis of emergency department visits in 2008 by the Substance Abuse and Mental Health Services Administration.

Which is not to say that the pharmaceuticals were the method that every young adult used to try to kill him or herself (most likely herself: 57.6 percent of drug related suicide attempts in this age group were by women). But it does put drugs into the mix, with potentially devastating results. According to the study, suicide was the third leading cause of death in this age group in 2006. This age group was three times more likely to attempt suicide than adults in other age groups, with 1.2 percent of adults between the ages of 18 and 25 having made an attempt.

Of the 600,000-plus emergency room visits by adults aged 18 to 24 in 2008, more than 38,000 — or 6.3 percent — involved a suicide attempt. Of the suicide attempts, the combination of alcohol and drugs is involved roughly three times out of ten.

You can read more about other SAMHSA reports here, here and here.

Drug use and pregnant teens

A recent report by the Substance Abuse and Mental Health Services Administration highlights some interesting trends among pregnant teenagers who seek treatment for drug and alcohol abuse. The report compared admissions from 1992 and 2007, and boy, has a lot changed over 15 years.

First of all, the demographics have shifted. In 1992, 54.5 percent of the pregnant teens admitted for treatment were white, 24 percent were black, and 15.7 percent were Hispanic. By 2007, those percentages were 50.3, 14.7 and 21.4, respectively.

The real eye-opening figures are in the primary substance abused. (A solid majority of pregnant teens admitted to treatment programs reported abusing multiple substances: 60.6 percent in 1992 and 62.5 percent in 2007). Alcohol, by far the dominant substance in 1992 at 44.1 percent, dropped to 20.3 percent in 2007. It was largely supplanted by marijuana, which jumped from 19.3 percent to 45.9 percent. Cocaine (20.2 percent to 6.8 percent) and heroin (4.5 percent to 3.1 percent) trended downwards. But the percentage of pregnant teens abusing methamphetamine more than quadrupled, from 4.3 percent in 1992 to 18.8 percent in 2007.

I also find it interesting that fewer teens are self-reporting (28.5 percent to 17.2 percent), or being referred by alcohol/drug abuse care providers (11.9 percent to 7.6 percent) other health care providers (15.1 percent to 4.7 percent) and schools (6.8 percent to 4.1 percent). Instead, many more are getting caught up in the criminal justice system (21.6 percent in 1992 to 43.3 percent in 2007).

Here’s the conclusion reached by the report:

First, the increased proportion of Hispanic pregnant teen admissions indicates a need for culturally sensitive substance abuse prevention and intervention programs, including culturally appropriate messaging, outreach, and engagement. Second, the quadruple increase in primary methamphetamine abuse highlights the need for educating teachers, primary care physicians, and obstetric and gynecologic specialists about the increased use among pregnant teens, especially in areas where methamphetamine abuse is a large problem or emerging concern, so they can provide the screening, counseling, and interventions necessary to help ensure the delivery of a full-term, healthy infant and the long-term health and well-being of the mother.

Pain pills and ER visits

Here’s another obvious indicator that prescription drug abuse is running rampant (as if we really needed another): emergency room visits attributed to narcotic pain relievers have doubled in just four years.

In 2004, 144,644 people went to the ER for treatment following non-medical use of pain pills, according to this study from the Substance Abuse & Mental Health Services Administration‘s Drug Abuse Warning Network, or DAWN. In 2008, that number was 305,885, an increase of 111 percent.

And here’s a frightening aspect of DAWN’s findings: no one age group or gender seems to account for the spike. The increase is roughly the same for men (110 percent), women (113 percent), people under the age of 21 (113 percent) and 21 and over (112 percent).

The study also breaks the numbers down further, including increases by drug:

— oxycodone, up 152 percent

— hydrocone, up 123 percent

— methadone, up 73 percent

— morphine, up 106 percent

— fentanyl, up 105 percent

— hydromorphone, up 259 percent

The study also splits the numbers down by drug and gender, which reveals some interesting comparisons. Again, these figures reflect an increase in ER visits.

— oxycodone for men, up 148 percent, for women, up 158 percent

— hydrocodone for men, up 137 percent, for women, up 114 percent

— methadone for men, up 59 percent, for women, up 95 percent

— morphine for men, up 124 percent, for women, up 92 percent

— fentanyl for men, up 131 percent, for women, up 87 percent

— hydromorphone for men, up 303 percent, for women, up 234 percent

The study adds:

Among patients younger than 21, the overall increase in ED visits involving the nonmedical use of narcotic pain relievers was driven by increases in visits involving hydrocodone and oxycodone products. Similar to the patterns in ED visits made by patients aged 21 or older, visits by patients younger than 21 that involved hydrocodone products increased 157 percent and those that involved oxycodone products increased 147 percent. Data for visits involving fentanyl products, hydromorphone products, morphine products, and methadone for the younger than 21 age group were either suppressed because of low precision or had percent changes that were not statistically significant (data for drug involvement by age group are not shown).

Pain pills and other narcotic medication were the second leading form of drug abuse in 2008 among Americans 12 and older, behind marijuana, according to the report. The study concludes:

The findings reported here highlight the need to strengthen prevention and education programs designed to reduce the misuse of prescription drugs. Increased efforts are needed to educate the public about the risks of misusing narcotic pain relievers and how to recognize possible symptoms of abuse. Prevention and education campaigns should continue to focus on the dangers of sharing prescription medications, the importance of preventing others from having access to personal prescription medications, and methods for properly disposing of remaining dosage units once the need for medication has passed. Additionally, ongoing efforts are needed to keep doctors and other health care professionals informed about emerging drug problems and to help them understand the importance of exercising care in prescribing pain relievers and monitoring their patients or clients for signs of misuse.

And, just to remind folks, more Americans are dying from drug overdoses than ever before; drug abuse in rural areas is deadlier than in its urban counterpart; and older Americans seem to be abusing drugs more than ever.

Health care fraud convictions help recover billions

U.S. Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius announced today that joint efforts by the Department of Justice and Health and Human Services recovered more than $2.5 billion for the Medicare Trust Fund during the fiscal year 2009. This represents an increase of more than $500 million from the previous year.

“Over the years, we’ve seen that as long as health care fraud pays and goes unpunished, our health care system will remain under siege,” Holder said at a press conference. “These crimes harm all of us — government agencies and programs, insurers and health care providers, and individual patients. But we are fighting back.”

The Department of Justice also won or negotiated $1.6 billion in judgments and settlements, Holder said.

The Justice Department’s Criminal Division and our U.S. Attorneys’ Offices opened more than 1,000 new criminal health care fraud investigations and had more than 1,600 health care fraud criminal investigations pending. We reached an “all-time high” in the number of health care fraud defendants charged, with more than 800 indictments in nearly 500 cases and close to 600 convictions. And the Justice Department’s Civil Division opened nearly 900 new civil health care fraud investigations and had more than 1,100 pending cases.

The Health Care Fraud and Abuse Control Program’s annual report, which you can read here, does not break the money or cases down by state, so we don’t know how much of that may have come from West Virginia. But last November, in announcing that his office had recovered $8 million in the last fiscal year, Charles Miller, U.S. Attorney for the Southern District of West Virginia, said that nearly $1 million came from frauds against federal health care programs such as Medicare and Medicaid.

I mention this because over the last year or so, there have been several high-profile investigations into alleged wrongdoing at several medical facilities in West Virginia, including Justice Medical Clinic on the border of Wayne and Mingo counties and Mountain Medical Care Center in Williamson. The teeth of the Justice Medical prosecution (no criminal charges have been filed against anyone associated with Mountain Medical, although authorities raided the facility in March) was health care fraud.

It can be notoriously difficult to prove that, say, a doctor knowingly prescribed pain pills to an addict; the doctor can always argue that he or she was legitimately trying to treat a patient’s ongoing pain. If a patient lies about an ongoing pain issue, how is the doctor supposed to know? But it’s often harder for a doctor to explain why a medical facility billed a federal program for services that he or she didn’t provide, which constitutes health care fraud.

The lead investigator in the Justice Medical probe? A special agent with the U.S. Department of Health and Human Services.

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Study links domestic abuse to more health problems

abonomi.jpgA new study by Dr. Amy Bonomi (right), an associate professor at The Ohio State University’s Department of Human Development and Family Science, finds that victims of intimate partner violence have a significantly heightened risk of many medical and psychological problems. The study notes:

Compared with never-abused women, women with a past-year history of IPV had a pronounced increased risk of psychosocial/mental health diagnoses, with an almost 6-fold increased risk of clinically identified substance abuse, a nearly 5-fold increase in family and social problems, more than 3-fold increase in depression, and a more than 2-fold increase in anxiety/neuroses and tobacco use. Also of note was the more than 3-fold increased risk of sexually transmitted disease diagnoses and the 2-fold increased risk of lacerations as well as consistently significantly increased risk of diagnoses within the major categories of musculoskeletal and female reproductive conditions.

I’ve posted a copy of Bonomi’s study here, and you can read additional coverage here, here and here.

“Roughly half of the diagnoses we examined were more common in abused women than in other women,” Bonomi told Scienceblog. “Abuse is associated with much more than cuts and bruises.”

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The West Virginia Association for Justice was scheduled to recognize a Brooke County widower and his daughter on Thursday evening for their bravery and commitment to accountability involving a medical malpractice case from 2005.

David Haught and Crystal Rogerson are receiving the first ever Advocate for Justice award from the West Virginia Association for Justice at the the group’s annual convention at the Charleston Marriott.

Haught and Rogerson sued Weirton Medical Center after wife and mother Genevieve Haught died of complications associated with a surgery in 2005 to remove spots on her kidney that were thought to be cancerous.

The spots turned out not to be cancerous, but during the surgery, an assisting physician at Weirton Medical Center perforated her stomach. It was five days before she underwent a follow-up surgery.

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Swine flu: Are factory farms to blame?

pigs.jpg

During a Gazette Online Chat earlier this week, I asked Kanawha County Health Officer Dr. Rahul Gupta about possible connections between swine flu and factory farming.

Dr. Gupta responded this way:

Doubt it. In fact we have known about  this virus since 1930. However, we usually detect 1-2 cases per year and had 12 from Dec 2005 to Feb 2008. Pigs routinely get this during the fall season at farms. Somehow this time, the virus has figured out a way to jump from human to human! 

Later, when I added some additional information and a link to a public radio report on the subject, he added:

You make sense, overcrowding is a concern whether in pigs, chickens or Humans! However, I don’t know the data in this regard.

I thought I would give Sustained Outrage readers some more information, mostly from a few other media outlet reports I’ve read or heard on this subject.

First, there was a great piece on public radio’s Living on Earth called Farming the Flu.  It featured an interview with Ellen Silbergeld, teaches environmental health at the Johns Hopkins Bloomberg School of Public Health. She’s studied the connections between factory farming and disease and says that industrial-scale livestock operations are fertile ground for viruses to mutate:

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Health plans for everyone II

Back in 2006, Massachusetts went the route of requiring all state residents to buy health insurance. Those who could not afford it would get help from the state to buy low-cost options. Those who did not comply would be fined. This morning, NPR reported that the effort has created a new market for unscrupulous insurance companies. In some cases, companies sell cheap policies to Massachusetts residents, but the policies do not meet state requirements, so low-income, struggling residents are out what they paid for the insurance, they can still be fined by the state, and they still don’t have reliable coverage.

Health plans for everyone

My Saturday column listed a few of the things that West Virginia Gov. Joe Manchin proposed to extend health insurance to at least some of the 245,000 West Virginians who don’t have it. Insurance means access to timely health care. Without it, it can be hard to get through the door to see a doctor. People who don’t have it tend to put off medical care until their suffering is unbearable, and their problems are more difficult — and more costly — to treat.

Renate Pore of the West Virginia Center for Budget and Policy has been analyzing health policy in West Virginia since 1991 and has worked in community health care even longer. She has a more thorough rundown of what she thinks will work and what won’t.

Meanwhile, the Legislature’s Select Committee D created the Roadmap to Health Project. Lawmakers paid $100,000 for consultant Kenneth E. Thorpe, an Emory University professor and former health official in the Clinton Administration, to compile solutions to this enduring problem. Thorpe gave his report in January.