Geneology International

Category: Health News

  • First Edition: March 28, 2022

    First Edition: March 28, 2022

    Today’s early morning highlights from the major news organizations.

    KHN:
    Big Pharma Is Betting On Bigger Political Ambitions From Sen. Tim Scott

    Sen. Tim Scott, a rising star in the Republican Party with broad popularity in his home state of South Carolina, is getting showered with drug industry money before facing voters this fall. Scott was the top recipient of pharma campaign cash in Congress during the second half of 2021, receiving $99,000, KHN’s Pharma Cash to Congress database shows, emerging as a new favorite of the industry. Though Scott has been a perennial recipient since arriving in Congress in 2011, the latest amount is nearly twice as much as his previous highest haul. (Pradhan and Knight, 3/28)

    KHN:
    Climate Change May Push The US Toward The ‘Goldilocks Zone’ For West Nile Virus 

    Michael Keasling of Lakewood, Colorado, was an electrician who loved big trucks, fast cars, and Harley-Davidsons. He’d struggled with diabetes since he was a teenager, needing a kidney transplant from his sister to stay alive. He was already quite sick in August when he contracted West Nile virus after being bitten by an infected mosquito. Keasling spent three months in hospitals and rehab, then died on Nov. 11 at age 57 from complications of West Nile virus and diabetes, according to his mother, Karen Freeman. She said she misses him terribly. (Bailey, 3/28)

    KHN:
    Nurse Convicted Of Neglect And Negligent Homicide For Fatal Drug Error 

    Vaught was acquitted of reckless homicide. Criminally negligent homicide was a lesser charge included under reckless homicide. Vaught’s trial has been closely watched by nurses and medical professionals across the country, many of whom worry it could set a precedent of criminalizing medical mistakes. Medical errors are generally handled by professional licensing boards or civil courts, and criminal prosecutions like Vaught’s case are exceedingly rare. (Kelman, 3/25)

    KHN:
    ‘An Arm And A Leg’: A Fight For The Right To Help

    Americans get sued over medical debt. A lot. And — no surprise — many folks getting sued can’t afford lawyers. But for a non-lawyer to give even basic advice in a lawsuit is a crime. Such a helper could go to jail. Some New Yorkers are waging a legal fight to change that. A nonprofit called Upsolve wants to train people like pastors, social workers, and librarians to help others understand their rights and prepare them to represent themselves in court. In the Bronx, pastor John Udo-Okon wants to be one of those helpers. (Weissmann, 3/28)

    KHN:
    Journalists Recap Coverage Of The Ongoing Pandemic And Lead Risks In Schools’ Drinking Water 

    KHN Midwest correspondent Lauren Weber discussed how the covid-19 pandemic has affected home health care and those with disabilities on WBEZ’s “Reset With Sasha-Ann Simons” on March 21. … KHN Montana correspondent Katheryn Houghton discussed the high levels of lead in drinking water across Montana schools on WBUR’s “Here and Now” on March 18. … Dr. Céline Gounder, KHN senior fellow and editor-at-large for public health, discussed the difficulty of fighting covid amid political divisions in the U.S. on WBUR’s “On Point’s Coronavirus Hours” on March 17. (3/26)


    The New York Times:
    Concerns Rise As A U.S. Reimbursement Fund For Testing And Treating The Uninsured For The Virus Stops Taking Claims

    As the White House pleads with Republicans in Congress for emergency aid to fight the coronavirus, the federal government said that a fund established to reimburse doctors for care for uninsured Covid patients was no longer accepting claims for testing and treatment “due to lack of sufficient funds.” Some U.S. health care providers are informing uninsured people they can no longer be tested for the virus free of charge, and will have to pay for the service. (Barry, 3/28)


    The Boston Globe:
    Cuts To COVID-19 Testing, Treatment, And Vaccination Worry Health Care Leaders

    Dr. Adam Gaffney is worried. Massachusetts is shutting most of its free COVID-19 testing sites in the coming days and the federal government will no longer pay for COVID care and vaccinations for the uninsured. While the winter’s blizzard of Omicron cases may be a fading memory for those who have peeled off their masks and moved on with their lives, the risk of COVID infection and serious complications for others remains all too real. There are still hundreds of new infections reported every day in Massachusetts, with those with chronic health problems, a weakened immune system, or not fully vaccinated or boosted most vulnerable to serious illness. (Lazar, 3/26)


    ABC News:
    Free COVID-19 Tests Ending For Uninsured Americans

    Americans who don’t have health insurance will now start to see some of the free COVID-19 testing options disappear, even if they are showing symptoms. Quest Diagnostics, one of the largest testing companies in the country, told ABC News that patients who are not on Medicare, Medicaid or a private health plan will now be charged $125 dollars ($119 and a $6 physician fee) when using one of its QuestDirect PCR tests either by ordering a kit online or visiting one of the 1,500 Quest or major retail locations that administer the tests, such as Walmart or Giant Eagle. More than 30 million Americans had no insurance during the first half of 2021, according to CDC estimates. (Breslin, 3/26)


    Stat:
    FDA Limits Covid Therapy As Ineffective Against Omicron BA.2 Variant

    U.S. health officials on Friday stopped the further deployment of the Covid-19 treatment sotrovimab to places where the BA.2 coronavirus variant is now causing the majority of infections, given laboratory studies showing the treatment likely doesn’t work against the variant. States in New England, as well as New York, New Jersey, Puerto Rico, and the Virgin Islands, will no longer receive shipments of the monoclonal antibody therapy made by Vir Biotechnology and GSK, officials said. (Joseph, 3/25)


    The New York Times:
    New Antiviral Pills Help Treat Covid. Here’s How To Get Them

    Earlier this month, President Biden announced an initiative called “test to treat,” which would allow people to visit hundreds of qualified pharmacy-based clinics, community health centers and long-term care facilities across the country to get tested for the coronavirus and, if positive, receive antiviral medication on the spot. Here are some of the most common questions about the new antiviral pills, and how the new program works. (Sheikh, 3/25)


    CBS News:
    Omicron Deaths Of Johnson & Johnson Recipients Were Double The Rate Of Other Vaccinated Americans, New Data Show

    Recently published figures … suggest that COVID-19 deaths among Johnson & Johnson recipients may have peaked at more than double the rate of other vaccinated Americans during the Omicron variant wave. For the week of January 8, COVID-associated deaths among Americans who were vaccinated with Johnson & Johnson reached a rate of more than 5 out of every 100,000, according to the CDC’s figures. That’s higher than the rate among recipients of the Pfizer or Moderna vaccines, which was around 2 deaths per 100,000 people. (Tin, 3/25)


    ABC News:
    Officials Expected To Offer 2nd Booster Shot For Those Over 50 Years Old 

    As soon as Tuesday, the U.S. Food and Drug Administration could authorize COVID-19 booster shots for Americans over 50 years old, two officials familiar with the matter told ABC News, though the fourth shots are likely to be only offered and not formally recommended. The officials stressed that the details are still under discussion and could change in the next few days. (Haslett and Strauss, 3/27)


    The Washington Post:
    FDA Expected To Authorize Second Coronavirus Booster For 50 And Older 

    The Food and Drug Administration is poised to authorize a second coronavirus vaccine booster for anyone 50 and older, a bid to provide an extra layer of protection amid concerns Europe’s rise in infections from an omicron subvariant could hit the United States, according to several government officials. The authorizations for second Pfizer-BioNTech and Moderna boosters could be announced as soon as Tuesday, according to the officials, who spoke on the condition of anonymity because they were not permitted to discuss the situation. They said talks continue, and it was possible, but unlikely, that major changes could occur. (McGinley and Sun, 3/26)


    USA Today:
    COVID Vaccine For Kids Under 5: Will They Get Shots Before BA.2 Surge?

    After enduring months of confusion and multiple setbacks, parents of young children were elated to find out Moderna plans to request the Food and Drug Administration to authorize a COVID-19 vaccine for kids under 6. Although parents welcomed the much-anticipated news, the BA.2 strain of the omicron variant continues to gain ground in the U.S., and access to these life-saving vaccines for 18 million of the nation’s youngest is still weeks away. (Rodriguez, 3/25)


    Detroit Free Press:
    COVID-19 Vaccines For Kids With Autism Present Challenges For Families

    Autism, which affects as many as 1 in every 44 kids in the U.S., causes difficulties with communicating, social interaction and sensory processing. It can make things like wearing a mask or going to a crowded pharmacy or a vaccine clinic to get a shot challenging. Health leaders say those unique obstacles could be among the reasons the COVID-19 vaccination rate for people with autism isn’t high enough in Michigan. The state health department said it doesn’t collect that data and there isn’t even a census of the number of people in Michigan who have an autism diagnosis. But Jill Matson, health education manager for the Autism Alliance of Michigan, said the alliance has anecdotal evidence that shots aren’t getting to enough people. (Jordan Shamus, 3/28)


    Bloomberg:
    Supreme Court Says Navy Can Curb Deployment For Unvaccinated

    A divided U.S. Supreme Court said the Navy can limit deployment and training for 35 Seals and other special operations forces who are refusing on religious grounds to get vaccinated against Covid-19. Granting a Biden administration request over three dissents, the justices partly blocked a federal judge’s order that required the Navy to assign and deploy the sailors without regard to their unvaccinated status. The order will apply while litigation over the Navy’s vaccine mandate goes forward. (Stohr, 3/25)


    Fox News:
    Long COVID Symptoms May Depend On The Variant A Person Contracted

    Different variants of SARS-CoV-2, the virus that causes COVID, may give rise to different long COVID symptoms, according to a study that will be presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2022) in Lisbon next month. Italian researchers suggested that individuals who were infected with the alpha variant of the virus displayed different emotional and neurological symptoms compared to those who were infected with the original form of SARS-CoV-2, an early release from the ECCMID regarding the study. (McGorry, 3/27)


    CIDRAP:
    Different Variants Produce Varied Long COVID Symptoms, Study Suggests

    Pre–Delta variant data to be presented next month at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) meeting in Portugal suggest that different variants of COVID-19 may produce different symptoms in people who develop long COVID. … The authors found a change in long COVID symptoms when comparing patients who had Alpha variant to those infected with the original, wild-type strain. Myalgia, insomnia, brain fog and anxiety and depression significantly increased with the Alpha strain, while anosmia (loss of smell), dysgeusia (difficulty in swallowing), and impaired hearing were less common. (3/25)


    AP:
    Scientists: COVID-19 May Cause Greater Damage To The Heart

    Scientists now believe that COVID-19 patients suffer more than respiratory issues. Several studies have revealed that the virus can also damage the heart. For those with a heart condition, the threat is even greater. A September 2020 study found that the risk of a first heart attack increased by three to eight times in the first week after a COVID-19 infection was diagnosed. The study, published by medical journal The Lancet, followed nearly 87,000 people in Sweden infected over an eight-month period. Their risk of stroke increased up to six times. (O’Donnell, 3/27)


    The Washington Post:
    How Covid Brain Fog May Overlap With ‘Chemo Brain’ And Alzheimer’s 

    People with “chemo brain” and covid brain fog could not seem more different: Those with “chemo brain” have a life-threatening disease for which they’ve taken toxic drugs or radiation. Many of those with covid brain fog, in contrast, describe themselves as previously healthy people who have had a relatively mild infection that felt like a cold. So when Stanford University neuroscientist Michelle Monje began studies on long covid, she was fascinated to find similar changes among patients in both groups, in specialized brain cells that serve as the organ’s surveillance and defense system. (Cha, 3/27)


    CIDRAP:
    Delta, Omicron COVID-19 Variants Caused More Cases In Pregnant Women

    The highly transmissible Delta and Omicron SARS-CoV-2 variants caused triple and 10 times the rate of COVID-19 infections in pregnant women compared with other strains, with most cases among unvaccinated mothers and their newborns, finds a prospective study yesterday in JAMA. University of Texas researchers studied the outcomes of pregnant women diagnosed as having COVID-19 at a Dallas healthcare system. The study spanned the pre-Delta period (May 17, 2020, to Jun 26, 2021), the Delta period (Jun 27 to Dec 11, 2021), and the Omicron era (Dec 12, 2021, to Jan 29, 2022). COVID-19 vaccines became available in December 2020. (3/25)


    AP:
    California Schools Prepare To Spot Post-Break COVID-19 Cases

    California’s 7 million students and school employees are getting free at-home COVID-19 tests to help prevent outbreaks at their school when they return from spring break. The state has shipped or delivered more than 14.3 million antigen tests, enough for two tests per person, to counties and school districts as part of a massive push to limit infections and avoid classroom closures after the break, Gov. Gavin Newsom’s office announced Saturday. (Nguyen, 3/26)


    AP:
    Ducey Extends Medical Licenses, Key To Virus Emergency End 

    Arizona Gov. Doug Ducey has signed legislation that will prevent temporary medical licenses issued under his coronavirus executive orders from immediately becoming invalid if he ends the state of emergency he issued two years ago. Friday’s action extends temporary licenses issued since the Republican governor first declared a state of emergency on March 11, 2020. They will be valid until the end of the year if they were active at the start of this month. (Christie, 3/25)


    Los Angeles Times:
    Guests And Crew Members Test Positive For COVID-19 Aboard Princess Cruise Ship

    Passengers and crew members tested positive for COVID-19 aboard a 15-day Princess Cruise trip to the Panama Canal that returned Sunday to the Port of San Francisco. Those affected aboard the ship the Ruby Princess were either asymptomatic or showed mild symptoms of COVID-19 and were isolated and quarantined, Princess Cruises said in a statement. The cruise line did not say how many guests and crew members tested positive, or at what point in the trip they did so. The ship has since departed San Francisco for a 15-day cruise to Hawaii. (Shalby, 3/27)


    Fox News:
    NYC Won’t Rehire Unvaccinated Workers, Mayor Says

    New York City Mayor Eric Adams said Thursday that his administration would not rehire unvaccinated city workers. Around 1,400 city employees were fired earlier this year for failing to comply with the city’s COVID-19 vaccine mandate. Adams said, during a news conference at Citi Field, he did not plan to rehire them. “Not at this time,” he said, according to The Wall Street Journal, “We are not reviewing if we are going to bring [them] back. (Musto, 3/25)


    Stateline:
    Health Worker Shortage Forces States To Scramble

    Top Hawaii officials last week received an urgent warning: If they didn’t act, the state would lose the services of hundreds of health care workers who have been essential in confronting the COVID-19 pandemic. The state had not extended a waiver of licensing requirements that had been in place for the past two years, noted Hilton Raethel, head of the Healthcare Association of Hawaii, which represents the state’s hospitals, skilled nursing centers, assisted living facilities and hospices. “This will place a materially increased burden on our existing workforce which has been stretched and strained dramatically during the pandemic, and we risk losing even more of our current permanent workforce which will have a significant impact on the ability of our hospitals and other healthcare institutions,” Raethel wrote to state officials. (Ollove, 3/25)


    USA Today:
    Caregiver Fatigue’s Signs Are Abundant, But Resources Can Be Minimal

    As the world marked the two-year anniversary of the COVID-19 pandemic, research found that among the 53 million Americans serving as caregivers, many battle fatigue. More than 1 in 5 Americans are caregivers for either an adult family member or a child with special needs. The number of family caregivers has increased since 2015, and there has been an increase of nearly 8 million caregivers for adults age 50 or older, according to AARP. A study in Gerontology and Geriatric Medicine found that the pandemic worsened the burden on Americans caring for a parent, the self-rated burden increasing 3 percentage points compared with pre-pandemic scores. (Elbeshbishi, 3/27)


    USA Today:
    Families Suing Over COVID Nursing Home Deaths Face State Restrictions

    With coronavirus cases circulating through Fair Acres Geriatric Center nursing home in June 2020, Christopher Beaty had alarming news for his family. His roommate at the Lima, Pennsylvania, nursing home had become sick with symptoms of COVID-19. Yet the roommate shared a room with Beaty for another 24 hours, continuously exposing him to the virus until he was relocated after testing positive, according to a federal lawsuit. It was too late for Beaty. The 63-year-old developed a fever and struggled to breathe. He was transferred to a nearby hospital on June 3 and tested positive for COVID-19. He died three days later. (Alltucker, 3/27)


    AP:
    Former Nurse Guilty Of Homicide In Medication Error Death

    A former Tennessee nurse is guilty of criminally negligent homicide in the death of a patient who was accidentally given the wrong medication, a jury found Friday. She was also found guilty of gross neglect of an impaired adult in a case that has fixed the attention of patient safety advocates and nurses’ organizations around the country. RaDonda Vaught, 37, injected the paralyzing drug vecuronium into 75-year-old Charlene Murphey instead of the sedative Versed on Dec. 26, 2017. Vaught freely admitted to making several errors with the medication that day, but her defense attorney argued the nurse was not acting outside of the norm and systemic problems at Vanderbilt University Medical Center were at least partly to blame for the error. (Loller, 3/25)


    Modern Healthcare:
    Feds Join Lawsuit Against EHR Vendor ModMed

    The federal government will intervene in a False Claims Act lawsuit against electronic health records vendor Modernizing Medicine and its co-founders that became public Friday. The lawsuit alleges the company falsely attested to complying with certification requirements for its EHR products, provided illegal kickbacks to doctors and upcoded diagnoses entered into its EHRs. The Justice Department notified the U.S. District Court for the District of Vermont that it will partially intervene in the case and intends to file its own complaint within 90 days. (Goldman, 3/25)


    Modern Healthcare:
    Hospitals Worry As More Drugmakers Limit 340B Discounts 

    UW Medicine is getting nervous about the future of its 340B discounts as more drug manufacturers restrict discounts for drugs dispensed at contract pharmacies. “We’re seeing our savings be eroded dramatically,” said Sumona DasGupta, assistant director of pharmacy audit and compliance. UW Medicine, which operates two 340B hospitals, has lost about two-thirds of its contract pharmacy savings, she said. Safety-net providers across the country expect more lost savings from drugmaker restrictions on 340B discounts to contract pharmacies, as sixteen drugmakers have announced plans to limit the discounts since summer 2020, despite ongoing lawsuits. (Goldman, 3/25)


    The New York Times:
    F.D.A. Rushed A Drug For Preterm Births. Did It Put Speed Over Science? 

    By the time Brittany Bonds gave birth to her third son in the back of an ambulance 10 weeks before he was due, she no longer trusted the drug Makena. The drug was intended to forestall preterm birth and improve the health of a baby. But it did not work for Mrs. Bonds, whose son Phoenix ended up in a NICU for 83 days. At 2, he still has a host of health problems. (Jewett, 3/25)


    Miami Herald:
    Recall: Major Pharmaceuticals Milk Of Magnesia, Pain Drug 

    Ten lots of three oral drugs shipped to hospitals, nursing home and clinics nationwide have been recalled for “microbial contamination and failure to properly investigate failed microbial testing.” That’s in the FDA-posted recall alert from Plastikon Healthcare, manufacturer of the medications for the Major Pharmaceuticals brand. Here’s what you need to know. (Neal, 3/27)


    The Washington Post:
    How Medicare Can Make It Harder For End-State Dementia Patients To Use Hospice 

    Janet Drey knows how hard it is to predict the future, especially the future of someone who lives with dementia. In 2009, a neurologist diagnosed her mother, Jean Bishop, then age 79, with frontotemporal dementia, a disorder that irreversibly damages the front and sides of the brain. When Jean could no longer walk, speak or feed herself a year later, doctors confirmed that she had less than six months to live, Drey recalls. The prognosis fit Medicare’s definition of being terminally ill. That prognosis qualified her for hospice care, an interdisciplinary approach that prioritizes comfort and quality of life in a person’s final months. (Harris, 3/26)


    The New York Times:
    In Difficult Cases, ‘Families Cannot Manage Death At Home’ 

    Where do people most want to be when they die? At home, they tell researchers — in familiar surroundings, in comfort, with the people they love. That wish has become more achievable. In 2017, according to an analysis in The New England Journal of Medicine, home surpassed the hospital as the most common place of death — 30.7 percent of deaths occurred at home, compared with 29.8 percent at the hospital. (Span, 3/26)


    Modern Healthcare:
    Florida Suspends Centene’s Medicaid Enrollment, Fines Insurer Over Tech Error

    Florida’s healthcare agency has immediately suspended Medicaid and long-term care enrollment in a Centene subsidiary and fined the insurer nearly $9.1 million, after a computer glitch led Sunshine State Health Plan to mistakenly deny medical claims for more than 121,100 lower-income adults and children. The $125.9 billion insurer must pay the fine within 30 days, according to a state Agency for Health Care Administration letter sent to Sunshine State Health Plan’s CEO on Wednesday. Centene’s Florida arm must also submit a plan for how it aims to reprocess all provider and patient claims within 21 days, demonstrate within 30 days that future claims are paid promptly and participate in weekly phone calls with the agency’s senior executives about how the process is going. (Tepper, 3/25)


    Houston Chronicle:
    Feds Give Texas A Short-Term Reprieve In Impasse Over Billions In Medicaid Funding

    The Biden administration on Friday approved new frameworks for reimbursing Texas hospitals that provide indigent care, though it has yet to sign off on individual transactions or say what will happen this fall when billions in federal aid to the state is set to expire. The decision, sent to state health officials as part of a pending lawsuit, is a short-term relief for hospitals. The Democratic administration and Republican state leaders have been at odds for months over how Texas pays for its share of the cost. Hospital and state health officials welcomed the announcement. (Blackman, 3/25)


    Columbus Dispatch:
    Ohio Bill Helping Patients Fight Health Insurers Ready For Approval

    A bipartisan bill that would help patients meet health insurance copays may finally move after sitting dormant for more than a year following unanimous passage by the Ohio Health Committee. A Dispatch story earlier this month described how House Bill 135 was mysteriously stalled after questions were raised by Cincinnati Rep. Bill Seitz, the No. 3 GOP House leader. Dozens of advocacy groups – such as the American Cancer Society, The AIDS Institute, and Ohio State Medical Association – support the measure. Only organizations representing health insurers and pharmacy benefit managers openly opposed the bill. (Rowland, 3/25)


    AP:
    Georgia Mental Health Bill Faces Sudden, Vocal Opposition

    A bill to improve access to mental health treatment in Georgia that appeared to be sailing through the state Legislature is now facing vocal opposition, with some critics claiming it would protect pedophiles and threaten Second Amendment rights. State lawmakers supporting the bill have blasted some of the criticism as outlandish. (3/26)


    Georgia Health News:
    Bill In Legislature Targets Dangerous ‘Surgical Smoke’ 

    In operating rooms, the smoke created by surgery can be a health hazard for those breathing it in. Such “surgical smoke’’ is a byproduct of the thermal destruction of human tissue by the use of lasers or other devices. According to the CDC, the smoke has been shown to contain toxic gases, vapors and particulates, viruses and bacteria. A bill that has passed the Georgia Senate and is now before the House would address this issue. It would require hospitals and surgery centers in the state to implement policies to reduce surgical smoke. It’s sponsored by Sen. Matt Brass, a Newnan Republican whose wife is a nurse. (Miller, 3/25)


    Atlanta Journal-Constitution:
    Cobb 911 Operator Answers 20,000 Calls, Shatters County Record

    A Cobb County 911 specialist was recently honored for handling more than 20,000 emergency calls in less than a year. County leaders paid tribute to Dana Bell, a call taker for the past 2½ years, during a commission meeting Monday. Commissioner Keli Gambrill presented Bell with a certificate of recognition that indicated she set a new county record for answering the most calls at Cobb’s Emergency Communications Center.“ E-911 call takers are crucial first responders during an emergency,” Gambrill said, reading from the proclamation. “(Dana) calmly provides a correct response and dispatch assistance during a dangerous time or serious situation, making our agency one of the best in the country.” (Bruce, 3/27)


    USA Today:
    Las Vegas Program To Fight Health Disparities One Household At A Time

    When Marie Antoine was diagnosed with lupus and kidney failure, she was overwhelmed by the complexities of her illnesses. But that changed when a team of health sciences students and a professor started visiting her home in North Miami Beach. With their help, the 57-year-old Hattian immigrant said she was able to make sense of the health resources available to her and finally understand “what’s going on to my body.” “They will go through the lab results with me, and the professor explained what I needed to do to keep up with my health issues,” Antoine said of the team from Florida International University, who helped her navigate a kidney transplant and recovery. (Hassanein, 3/28)


    The Boston Globe:
    As Some States Seek To Limit Reproductive Freedoms, BU Opens ‘Plan B’ Vending Machine

    When they arrived at Boston University, Molly Baker and Charlotte Beatty didn’t expect their educational paths to lead them to the American vending machine industry. They did not envision growing familiar, for instance, with the intricacies of vending credit card systems. But after overseeing the launch of a new machine on campus that distributes emergency contraception, the co-presidents of BU’s Students for Reproductive Freedom have found themselves a sudden toast of the vending world. “We made it into Vending Times!” Beatty said of their project’s recent write-up in the trade publication. The so-called “Plan B vending machine” is among the first of its kind in the United States, offering students a generic version of what is known as the “morning after” pill for $7.25, significantly less than some over-the-counter options and with privacy not afforded by a trip to the pharmacy. (Arnett, 3/27)


    NPR:
    Addiction Recovery Has Money But Not Enough Workers In Oregon 

    Like many people who work in the field of addiction, Staci Cowan is herself in recovery. She slid into heroin use years ago after she started taking opioids for an injury. The loss of her job and apartment followed. She found herself homeless when her mom was forced to draw a firm boundary. No more sleeping at her house. “The people on the streets, you think they’re there for you,” says Cowan. “But you quickly realize that no one is there for you except for yourself.” Now, as a peer mentor at an addiction and recovery facility called Club Hope in the Portland suburb of Gresham, Cowan’s job is to be there for other people. She celebrated four years in recovery recently. Listening to people is a big part of her job. She remembers what it was like to feel invisible. (Riddle, 3/28)


    Chicago Tribune:
    Advocates Aim To Decriminalize Psychedelic Plants In Illinois 

    Marine Corps veteran Justin Wigg was suffering from anger issues and other symptoms of post-traumatic stress disorder, but traditional medicine had been little help. So last fall, he traveled to Peru for a treatment that isn’t legal in Illinois — at least not yet. It was a psychedelic, tea-like drink called ayahuasca, brewed from two tropical plants, and it produced hallucinations that Wigg, a Chicagoan, compared to “‘Alice in Wonderland’ meets ‘Fantasia.’” On the second of four ceremonial sessions, he said, he met a spirit figure called Mother Ayahuasca who lifted his burden. “I asked her to help with anger, and it was like the snap of a fingers, just gone,” he recalled. “I wasn’t angry anymore, which I know sounds crazy, but that’s the best way I can describe it.” (Keilman, 3/28)


    AP:
    Friends With Paws Placing Therapy Dogs In Some WVa Schools 

    Some West Virginia schools will have a new face joining students this year: therapy dogs to offer companionship and comfort. Friends With Paws will be a partnership between the governor’s office, West Virginia Communities in Schools Nonprofit and the state Department of Education. The dogs will be placed in schools in counties where students are disproportionately affected by poverty, substance misuse or other at-risk situations, Gov. Jim Justice’s office said. (3/28)


    AP:
    Court Eyes Appeal Over Mentally Ill Inmate Put In Solitary 

    A federal appeals court is set to hear arguments in a lawsuit filed by a Delaware prison inmate who claimed he was deprived of his constitutional rights by being placed into solitary confinement because of his mental illness. The appeals court will hear arguments Wednesday in the case of Angelo Lee Clark, who also claimed he was deprived of his rights to adequate medical care while in solitary confinement. (3/27)


    AP:
    Vermont Officials Seek More Time To Test Schools For PCBs 

    Vermont state officials have asked the legislature for more time to test older schools for PCBs, a harmful group of chemicals commonly used in building materials and electrical equipment before 1980.The PCB testing program is part of a law passed by the Legislature last year. It requires every school constructed or renovated before 1980 to test their indoor air for PCBs by July 1, 2024. The legislation came after the closure of Burlington High School two years ago because of the discovery of PCB contamination in air samples. (3/27)


    Bangor Daily News:
    No One Knows How Many Gallons Of ‘Forever Chemicals’ Are Flowing In Maine’s Waters

    Treatment plants release millions of gallons of wastewater into Maine’s waterways each day that could contain elevated levels of so-called forever chemicals that are used in a wide variety of consumer products and have been linked to long-term health and environmental risks. But as Maine races to better understand how widespread its PFAS contamination problem is, particularly on farms and in landfills, there’s little known about the level of contamination in the wastewater these plants are releasing, nor about the concentration of forever chemicals building up in the Maine rivers onto which it’s released. (Loftus, 3/28)


    CIDRAP:
    Reported TB Cases Drop In US Amid COVID-19 

    Reported tuberculosis (TB) diagnoses in the United States fell 20{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} in 2020 and remained 13{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} lower in 2021 than TB diagnoses made prior to the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) reported yesterday, while a study today highlights disparities in at-home COVID testing. Before the pandemic, TB diagnoses declined by 1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} each year. Mask use and distancing measures—aimed at preventing COVID spread—likely also limited TB transmission, the CDC said. TB infections were also likely missed as healthcare visits dropped during the first months of the pandemic. (Soucheray, 3/25)


    The New York Times:
    When Will Men Get Birth Control Pills? Your Questions, Answered 

    A buzzy new animal study offers another contender in the search for a male form of birth control. Researchers at the University of Minnesota created a birth control pill for male mice, which proved 99 percent effective in preventing pregnancy. The contraceptive targets a protein in the body that receives a form of vitamin A, which is involved with sperm production and fertility. Researchers gave this compound, referred to as YCT529, to male mice for four weeks; the animals showed drastically lower sperm counts. Four to six weeks after they stopped receiving the contraceptive, the mice could impregnate a female mouse again. (Blum, 3/25)


    CNN:
    Nostalgia Can Reduce Perception Of Pain, Study Shows

    The next time you feel pain, you might consider skipping the ibuprofen and reaching instead for an old photo. Nostalgia — that sentimental feeling of longing for the past — can reduce pain perception, according to new research published in the journal JNeurosci. Researchers at the Chinese Academy of Sciences and Liaoning Normal University asked study participants to rate their level of pain from heat stimulation while looking at pictures that were nostalgic — depicting old cartoons, childhood games or retro candy — compared with more modern pictures. During the tasks, an MRI machine also scanned the 34 participants. Researchers found that observing pictures that triggered childhood memories was linked to participants reporting weaker feelings of pain. (Kent, 3/28)


    AP:
    First Lady Jill Biden Visits St. Jude, Meets Ukrainian Kids 

    First lady Jill Biden traveled to St. Jude Children’s Research Hospital in Tennessee on Friday to meet with Ukrainian children with cancer and their families fleeing the war and seeking treatment in the U.S. Biden was greeted when she arrived at the Memphis hospital by president and CEO James Downing; Rick Shadyac, CEO of ALSAC, which raises funds for St. Jude; and actress Marlo Thomas, the daughter of hospital founder and late actor Danny Thomas. (Sainz, 3/25)


    The New York Times:
    Public Health Catastrophe Looms In Ukraine, Experts Warn

    A convoy of five vans snaked slowly on Friday from the battered Ukrainian capital, Kyiv, toward Chernihiv, in the northeast of the country. On board were generators, clothes, fuel — and medications needed to treat H.I.V. With a main bridge decimated by shelling, the drivers crept along back roads, hoping to reach Chernihiv on Saturday and begin distributing the drugs to some of the 3,000 residents in desperate need of treatment. (Mandavilli, 3/26)


    The Atlantic:
    Is Ukraine Barreling Toward A COVID Surge?

    With its 35 percent vaccination rate, Ukraine was especially vulnerable even before the invasion forced 10 million people from their homes. That much of the population must now cram together in packed train cars and basement bomb shelters will not help matters. For many in Ukraine, though, such concerns are not top of mind. “Their priority is just to flee and survive,” Paul Spiegel, the director of the Center for Humanitarian Health at Johns Hopkins University, told me. In his research, Spiegel has found a strong connection between conflicts and epidemics. But assessing the interplay between disease and violence in Ukraine is difficult right now: After the invasion, reporting on case counts slowed to a trickle. (Stern, 3/25)


    AP:
    US-Backed Group Gets Lifesaving Meds To Ukrainians Amid War 

    Thousands of patients in Ukraine are receiving lifesaving medicines to treat HIV and opioid addiction through a U.S.-funded group still operating despite the Russian invasion. Supplies are running short and making deliveries is a complicated calculus with unpredictable risks. Officials say the quiet work of the Alliance for Public Health shows how American assistance is reaching individuals in the besieged nation, on a different wavelength from U.S. diplomatic and military support for the Ukrainian government. (Alonso-Zaldivar, 3/27)


    AP:
    Shanghai Starts China’s Biggest COVID-19 Lockdown In 2 Years

    China began its most extensive lockdown in two years Monday to conduct mass testing and control a growing outbreak in Shanghai as questions are raised about the economic toll of the nation’s “zero-COVID” strategy. China’s financial capital and largest city with 26 million people, Shanghai had managed its smaller, past outbreaks with limited lockdowns of housing compounds and workplaces where the virus was spreading. But the citywide lockdown that will conducted in two phases will be China’s most extensive since the central city of Wuhan, where the virus was first detected in late 2019, first confined its 11 million people to their homes for 76 days in early 2020. Millions more have been kept in lockdown since then. (3/28)


    AP:
    British Museum To Remove Sackler Name From Galleries

    The British Museum will remove the Sackler name from galleries, rooms and endowments following global outrage over the role the family played in the opioid crisis. The museum is the latest cultural institution to cut ties with the Sacklers. The Sackler name has been removed in recent years from wings and galleries at institutions including the Louvre in Paris and the Serpentine Gallery in London. (3/26)


    This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

  • How Many Doctors Have Left Mission? HCA Won’t Say

    How Many Doctors Have Left Mission? HCA Won’t Say


    By Barbara Durr and Sally Kestin, for Asheville Watchdog

    Two prominent physician groups quit the Mission Health system in the first two weeks of the year, the latest in an exodus from the hospital since its sale three years ago to for-profit HCA Healthcare.

    The seven doctors at Asheville Ear, Nose & Throat “decided to no longer provide medical or surgical care at Mission Hospital or Asheville Surgery Center,” as of Jan. 1, they wrote in a letter to their patients.

    Also on Jan. 1, the 10 surgeons at Carolina Spine & Neurosurgery Center parted ways with Mission and joined UNC Health’s Margaret R. Pardee Memorial Hospital in Hendersonville. They retain privileges to practice at Mission.

    HCA declined repeated requests for the number of doctors who have left the Mission system since it took over in February 2019 and refuses to say how many doctors are on staff today, other than that the number is “relatively the same.” 

    But Asheville Watchdog identified 223 doctors who appear to be no longer practicing there; their names were on the Mission Find a Doctor website as of August 2019 but had been removed as of February 2022. 

    Another 57 doctors still on the website are no longer listed as employed or affiliated with Mission. 

    Asheville Mayor Esther Manheimer, who was among a group of elected officials signing a scathing public letter in February 2020 over concerns about patient care and staffing at Mission, said of Asheville Watchdog’s analysis,“It seems unavoidable that Asheville, Buncombe County and Western North Carolina will see a deterioration in healthcare as a result of Mission-HCA hemorrhaging doctors.”

    “It seems unavoidable that Asheville, Buncombe County and Western North Carolina will see a deterioration in healthcare as a result of Mission-HCA hemorrhaging doctors.”

    Asheville mayor Esther Manheimer

    State Sen. Julie Mayfield said,“The loss of these doctors represents collectively hundreds of years of experience, long-standing relationships within and outside the hospital, and consistency of and confidence in care for patients.”

    “These physicians were a key part of what made Mission a world-class hospital system that prioritized patient care,” Mayfield said, “and it is truly unfortunate that HCA chose from the start to prioritize its profit over its people.” 

    Nancy Lindell, director of public and media relations for HCA Healthcare’s North Carolina Division, which includes Mission Hospital, said in a statement to Asheville Watchdog, “Mission Health is grateful to our team members who provide quality care to our community every day … It is expected that the transition to HCA Healthcare, life events, effects of a global pandemic, and the increasing demand for healthcare services, etc., would lead to both some additions and departures.”

    HCA refuses to give numbers

    The 223 doctors no longer on Mission’s Find A Doctor site include 33 family medicine physicians, 25 surgeons, and 15 pediatricians or pediatric specialists. More than 100 doctors moved out of the state or region; others are listed as affiliated with hospitals in Hendersonville, the Charles George VA Medical Center in Asheville, or private practices, according to the North Carolina Medical Board and Internet searches. 

    Lindell said many of the doctors still in the region continue to practice at Mission and “are still part of our medical staff and hospital teams, making the number of physicians on medical staff relatively the same.” 

    Lindell said the Find a Doctor site does not include open positions or doctors in the process of being hired and is not meant as a tool “for tracking the medical staff.” Mission has an office dedicated to medical staffing, but Lindell declined to provide even basic information about the number of doctors at Mission before and after HCA took over.

    Asheville Watchdog sent Lindell the names of the doctors who are no longer on Find A Doctor or listed as employed or affiliated with Mission. She declined to comment beyond her statement and reiterated, “We continue to have approximately the same number of providers on the medical staff to serve the needs of our community.” 

    Providers include others besides doctors, including nurse practitioners, physician assistants, psychologists and dentists.

    Doctors Frustrated

    In interviews, doctors who left Mission cited concerns about declining patient care, job burnout, and frustrations with HCA’s emphasis on profits. Five of the doctors said some of their patients needing hospitalization were asking to be treated at hospitals other than Mission. 

    One doctor who remained in the area and spoke to Asheville Watchdog on the condition of anonymity because he said he feared retribution from HCA said, “I get asked every day by a patient if I can treat them elsewhere than Mission.”  

    Dr. Martin Palmeri

    Dr. Martin Palmeri, an oncologist who left Mission in December 2019 to join Messino Cancer Centers, said the hospital system before HCA “was run primarily by doctors and nurses and now it’s being run by businessmen.”

    “Bedside care is knowing what patients and families are suffering,” Palmeri said. “Patient suffering is off their (HCA management’s) radar.”

    He said the hospital needs more doctors in leadership. “We need the right balance between bedside care and corporate benchmarks and revenue,” said Palmeri, who was recently elected president of the North Carolina Oncology Association.   

    Dr. Ben Aiken, a primary care physician employed by Mission until January 2020, said many patients are skeptical “that HCA has their best interests in mind as a for-profit company.” 

    Aiken, who piloted a subscription fee direct primary care practice under Mission’s former leadership, said Mission used to employ more primary care doctors even though that specialty is less profitable. HCA shuttered two primary care practices in 2020, in Biltmore Park and Candler, and sold Aiken’s pilot program, now called Lantern Health, to him. 

    Dr. Ben Aiken

    “Primary care generally is not an emphasis in HCA,” Aiken said.

    At least 30 primary care or family medicine doctors and 10 internists have left Mission’s employment, Asheville Watchdog found in its analysis of the Find A Doctor website. 

    Aiken said Mission long was able to recruit high-quality physicians to Asheville, considered a desirable place to live and practice. But he said, “The type of physicians that were attracted to Mission may not be attracted to HCA. The business approach is very different.”

    “Exact same doctors,” then-CEO pledged

    An emergency room doctor, who spoke on condition of anonymity, said Mission before HCA “could be choosy” about the doctors it brought on staff because so many wanted to work there. “Now they just fill the gaps.”

    The doctor said that nurses in the emergency room are caring for more patients while management concentrates on meeting minimum standards and “metrics” such as how long a patient waits to be seen. 

    “When HCA came in, there were so many emails on metrics,” he said. “We’ve gone from providing amazing care to mediocre care.”

    Aiken said he wants to see a high-quality hospital in Asheville but believes Pardee UNC Health and AdventHealth, both in Hendersonville, are likely to expand if skepticism about Mission continues.

    Lindell said Mission patients “continue to receive outstanding care at our hospitals by our clinical teams and board-certified physicians.” She said Mission recently passed a state inspection with no deficiencies, and a national accreditation review measuring 1,600 points of care did not produce “a single finding that required corrective action or a repeat visit.”

    She said hospitals nationwide are struggling to hire and retain doctors, a shortage exacerbated by the pandemic, but that the Mission system in western North Carolina “welcomed almost 60 new physicians to our staff in 2021.”

    In May 2018, before the sale of the hospital system, Dr. Ronald A. Paulus, then president and chief executive officer of Mission Health, told a local business group that Mission Health under HCA would still have “the exact same people and exact same doctors and exact same nurses” and provide similar or even superior care.

    Paulus received a multimillion-dollar payout from Mission and joined HCA as a strategic advisor just days after the sale was concluded.

    Staffing is key concern

    A common complaint among doctors, nurses and patients is that Mission under HCA has skimped on staffing, among the largest costs for hospitals. In 2018, the year before the sale, Mission Health System reported more than 12,000 staff. The website now lists 10,500. Lindell said some employees formerly included under Mission, such as those working in billing and “our supply chain team,” are now counted under different entities.

    But doctors and other employees told Asheville Watchdog there are fewer people in direct patient care, including certified nursing assistants (CNAs), health unit secretaries and mental health professionals, as well as support positions such as housekeeping, dietary services, and the morgue.

    A source of many complaints about care, patients told Asheville Watchdog, is Mission’s emergency room.  

    HCA contracts with TeamHealth, a national physician staffing company owned by the private equity group Blackstone, to staff its emergency rooms. 

    Dr. Mitchell Li, an emergency medical specialist and the founder of Take Back Medicine, an organization that raises awareness about the dangers of the corporatization of medicine, told Asheville Watchdog that such staffing companies often replace ER physicians with nurse practitioners and physician assistants, a practice he observed first-hand while a resident at a Detroit area hospital staffed by TeamHealth. Li did not work at Mission or HCA.

    “HCA and corporate ER staffing groups figure [they] can get away with a minimum of physicians,” said Li, who now operates a private, direct primary care practice serving Asheville, Black Mountain and nearby communities. 

    Asked whether emergency room doctors have been replaced with lesser trained staff such as nurse practitioners, Lindell said, “Most hospitals throughout the nation contract with ER provider groups … We also augment their care with other staff in addition to these ER physicians when further care providers are needed.” 

    Patients in “excruciating pain”

    In interviews, doctors said staffing turnover and reductions have affected nurse-to-patient ratios and quality of care at Mission.

    Palmeri said he was “horrified” to find on more than one occasion his patients at Mission in “excruciating pain” because nurses responsible for seven to eight patients each could not administer pain medications on time. 

    Dr. Ken Zamkoff, a retired hematologist in Asheville, said, “When a patient is lying in a bed, it’s not just the doctor, it’s the whole team that cares for the patient. If you don’t have nurses, CNAs, and the whole ancillary staff, you can’t do it properly. When you decimate the team, the patient suffers.”

    Another former Mission doctor, who still has privileges there, said the reduced staffing places a burden on those still practicing at Mission and leads to an “erosion in quality.” 

    Before HCA, he said the staff included many longtime employees who had worked together for years, but “now there’s no consistency.”

    Vote of no confidence

    In their letter to patients, the doctors at Asheville Ear, Nose & Throat did not specify a reason for their departure from Mission but said, “All of our doctors will continue to provide medical and surgical care for our patients at both Pardee Hospital and Park Ridge Hospital (now known as AdventHealth Hendersonville). We also now offer outpatient surgical care at Western Carolina Surgery Center.”

    The surgeons at Carolina Spine & Neurosurgery Center declined requests for comment. Phil Bridges, spokesman for UNC Health, confirmed that the doctors have affiliated with UNC Pardee, and said current and new patients can expect a seamless transition. 

    Some doctors have cited pay and management issues in their decisions to depart Mission, including attempts by HCA to cut some physicians’ compensation by as much as 25 percent, according to interviews and published reports. Lindell said that Mission Health compensates physicians in accordance with fair market rules. 

    But HCA’s approach to healthcare has led many to depart.

    Palmeri, the oncologist, said he concluded that HCA’s approach to cancer treatment was, in his opinion, “focused on return on investment.” 

    “There’s a lot of aspects of oncology that are not that profitable,” Palmeri said, such as cancer care in small communities.” He said he saw “HCA pulling away from that.”

    Palmeri said he wanted to ensure access to cancer care throughout the region. His practice, Messino Cancer Centers, has six locations, including Asheville. “I grew up here in Western North Carolina. It was critical for me to do that for our community,” he said.

    Lindell said that Mission Health recently partnered with the Susan Cannon Cancer Institute of HCA Healthcare, known for its research, to expand its services across Western North Carolina.  

    The doctor who asked not to be named, and who said patients ask every day about alternatives to Mission, told Asheville Watchdog he left after being asked to take a salary cut, and seeing that “the patient experience was declining.”

    “Concern for the community” at Mission, he said, “turned into care for the shareholder.”

    A hematologist, who was on the medical staff at Mission and requested anonymity, said that the Mission oncologists last year were increasingly hearing from patients that they were “resistant to going to Mission.”

    In June, the oncology team, troubled by quality of care and other concerns, took a no confidence vote in HCA management, he told Asheville Watchdog. “We brought up the issues again and again,” the doctor said, but little changed. Shortly after, he said he concluded that Mission “was more business oriented, not patient oriented,” and left.

    Asked about the no confidence vote, Lindell said, “We have full confidence in our management team. We regularly gather feedback from physicians, nurses, patients and the community … The feedback raised at these meetings has been addressed.”

    But two current oncology providers, who asked not to be named, told Asheville Watchdog that patient care concerns continue. They said nurse-to-patient ratios remain inadequate to provide needed care for the sickest patients, including providing pain medications on time; there are too few certified nurses for chemo treatments, which forces delays in administering the needed drugs; and there are too few CNAs. 

    While some patients may be seeking care elsewhere, Lindell said, “We continue to see patients choosing to come to our hospitals.”

    Doctors have also left HCA-owned hospitals in other states for similar reasons. In Rochester, N.H., for example, 12 of the 14 primary care doctors at Frisbie Memorial left within 15 months after HCA acquired the local nonprofit community hospital in 2020. Some of them cited a lack of support for medical staff and a focus on profits rather than patients.

    Top doctor departs

    Mission’s highest-ranking doctor, Chief Medical Officer Dr. William Hathaway, announced on Jan. 6 that he, too, was leaving to become chief executive at MAHEC, the Mountain Area Health Education Center in Asheville, where he has been chairman of the board.

    Dr. William Hathaway

    Hathaway told Asheville Watchdog that “my acceptance of the job was purely in relation to the retirement” of MAHEC’s CEO, Dr. Jeff Heck, which was announced last summer. Hathaway started as chief medical officer under nonprofit Mission and was the most senior of the previous Mission leaders under HCA. 

    In an interview with Asheville Watchdog, Hathaway acknowledged that his departure created an additional strain on the hospital. At the time, the Mission system was experiencing record COVID-19 cases and admissions, staffing shortages, a pending lawsuit over alleged price gouging, and an untold number of patient complaints.

    But Hathaway, a cardiologist and third-generation physician, said he was excited to start at MAHEC, an organization he described as having a tremendous reputation. “It’s all about care for the patients,” he said.

    HCA profits soar

    North Carolina Attorney General Josh Stein reviewed and approved the sale of Mission to HCA, requiring 15 conditions, of which the most significant are restrictions on closing or selling facilities, continuing to provide certain services, and continuing Mission Hospital’s charity care policy. Separately, HCA made certain capital expenditure commitments.  

    Quality of care and staffing levels were not among the 15 stipulations added by Stein.Stein, however, is “extremely concerned about healthcare in western North Carolina,” said Laura Brewer, Stein’s deputy chief of staff.

    “Healthcare facilities must be adequately staffed to ensure patients get the treatment they need,” Brewer said. “While the pandemic has exacerbated healthcare shortages all over the nation, reports of acute shortages at HCA are concerning.”

    She added that the Attorney General will “continue to ask questions about HCA’s policies and commitments.” 

    An independent monitor, Gibbins Advisors, is responsible for ensuring HCA lives up to the Mission asset purchase agreement and the additional 15 conditions.

    In April, Ronald Winters, a principal at Gibbins Advisors, said in a virtual public forum that Gibbins would examine the issue of physician departures. “To the extent those departures impact services at hospitals, that’s certainly something we’re going to look at and inquire about,” Winters said.

    Winters told Asheville Watchdog last month that the evaluation is ongoing but declined further comment. 

    Mission has become a valuable asset in the portfolio of HCA, the largest hospital corporation in the nation. In January, the company reported a near doubling of profits during the full pandemic year of 2021, from $3.75 billion in 2020 to $6.96 billion in 2021.  

    Just months after the consummation of the sale of Mission Health, HCA raised prices across the Mission system by an average of 10 percent. By the end of the first year, net patient revenue increased $548 million compared to the 12-month period before the sale, Greg Lowe, president of the North Carolina Division of HCA Healthcare, wrote in a letter to Attorney General Stein on April 30, 2020. The letter was obtained by Asheville Watchdog under a public records request.

    With annual net patient revenue exceeding $1 billion, Mission Hospital ranked No. 2 among more than 180 HCA hospitals in both 2020 and 2021, according to the consulting firm Definitive Healthcare. 

    “Healthcare should be the least transactional business in the world,” said the doctor who was asked to take a salary cut, but HCA’s “approach is very transactional.” 

    He said the upshot at Mission, where he said collegiality and community commitment were once hallmarks, is “the pride is gone. It’s just sad.” 

    Peter H. Lewis contributed to this report.

    Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Barbara Durr is a former correspondent for The Financial Times of London. Contact her at [email protected]. Sally Kestin is a Pulitzer Prize-winning investigative reporter. Email [email protected]. Peter H. Lewis is a former senior writer and editor at The New York Times. Email [email protected].

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    by Asheville Watchdog, North Carolina Health News
    March 26, 2022

    1

  • The Case of the 9,000 Air Ambulance Ride

    The Case of the $489,000 Air Ambulance Ride

    Sean Deines and his wife, Rebekah, have been road-tripping just after he lost his task as a bartender when the pandemic hit. But when browsing his grandfather in a distant portion of Wyoming, Sean began to truly feel incredibly ill.

    Rebekah insisted he go to an urgent care center in Laramie.

    “‘Your white blood count is as a result of the roof. You need to get to an ER suitable now,’” Deines, 32, recollects a staffer indicating. The North Carolina couple in the beginning drove to a healthcare facility in Casper but were speedily airlifted to the University of Colorado Hospital in the vicinity of Denver, in which he was admitted on Nov. 28, 2020.

    There, specialists confirmed his prognosis: acute lymphoblastic leukemia, a rapidly-expanding blood most cancers.

    “Literally inside of 12 hours, I necessary to figure out what to do with the following action of my life,” stated Deines.

    So, following he was commenced on intravenous solutions, including steroids and antibiotics, in Colorado to stabilize him, the pair determined it was prudent to return to North Carolina, in which they could get help from his mother and mother-in-regulation. They chosen Duke University Medical Heart in Durham, which was in his insurance plan community.

    His relatives called Angel MedFlight, section of Aviation West Charters of Scottsdale, Arizona, which instructed Rebekah Deines that it would acknowledge regardless of what the couple’s insurer would pay out and that they would not be held responsible for any remaining harmony.

    Sean Deines was flown to North Carolina on Dec. 1, 2020, and taken by floor ambulance to Duke, where he expended the following 28 days as an inpatient.

    By his discharge, he felt much better and items ended up seeking up.

    Then the expenditures came.

    The Affected individual: Sean Deines, 32, who bought protection as a result of the Affordable Care Act market with Blue Cross Blue Protect of North Carolina.

    Health-related Company: A 1,468-mile air ambulance flight from Colorado to North Carolina, along with floor transportation among the hospitals and airports.

    Services Provider: Aviation West Charters, carrying out enterprise as Angel MedFlight, a health-related transport business.

    Total Invoice: $489,000, most of which was for the flight from Denver, with roughly $70,000 for the ground ambulance assistance to and from the Denver and Raleigh-Durham airports.

    What Provides: Insurers generally get to come to a decision what care is “medically necessary” and thus protected. And that is generally in the eye of the beholder. In this case, the debate revolved initial all over irrespective of whether Deines was stable more than enough to properly get a three-plus-hour commercial flight to North Carolina in the course of a pandemic or essential the intensive care the air ambulance provided. 2nd, there was the problem of no matter whether Deines really should have stayed in Denver for his 28-day cure to get him into remission. Insurers have a tendency not to take into account client stress or family usefulness in their selections.

    Also, both equally air and ground ambulance providers have been heart stage in the nationwide fight more than substantial surprise expenses, considering the fact that the for-profit providers that operate them often do not take part in insurance policies networks.

    Angel MedFlight, which was not in Deines’ insurance plan community, sought prior authorization from Blue Cross Blue Protect of North Carolina. The request was dated Nov. 30, but the insurance provider reported the fax arrived in the predawn hours the similar working day as the flight, Dec. 1, 2020.

    On that working day, Angel MedFlight flew Deines to North Carolina in an plane, together with a nurse to oversee his IV medications and oxygen stages.

    Angel MedFlight spokesperson Kimberly Halloran did not remedy a unique penned query from KHN about why the flight went forward without the need of prior approval often medical interventions are postponed until eventually it has been acquired. But in an emailed statement, she said the business “satisfied each action in the well being insurance coverage approach and transported Sean to his very long-expression wellness care suppliers in very good religion.”

    In accordance to the evaluation of the circumstance completed months later on by an unbiased evaluator, Blue Cross on Dec. 3 denied protection for the air ambulance expert services for the reason that medical records did not help that it was an emergency and Deines was previously in an acceptable medical facility.

    At the close of December, an attractiveness was submitted versus that determination on behalf of Deines by Angel MedFlight.

    Then, in March 2021, Blue Cross sent Deines a examine for $72,000 to cover aspect of the $489,000 invoice, which he forwarded to the air ambulance firm. The rationalization of benefits showed the the greater part of the rates have been ruled “not medically important.”

    Sean Deines is seen sitting on the left side of a table with his wife, Rebekah, sitting to the right. The two are holding and looking over stacks of medical bills.
    Sean and Rebekah Deines search about professional medical costs at household in Hendersonville, North Carolina.(Maddy Alewine for KHN)

    Angel MedFlight, via a revenue administration company it hires identified as MedHealth Partners, continued to charm to Blue Cross to overturn the denial of the flight part of the invoice.

    Then, three months just after Blue Cross despatched the verify that Deines then despatched on to Angel MedFlight, the insurer demanded Deines pay back back the $72,000.

    “The initial considered was ‘I simply cannot think this is going on,’” said Deines.

    Healthcare necessity standards are established by insurers, with North Carolina Blue Cross covering air ambulances in “exceptional situations,” this kind of as when wanted cure isn’t obtainable locally.

    When Deines, who was nonetheless unemployed and going through treatment, couldn’t spend, the debt was despatched to collections.

    In late June, Deines’ associates at Angel MedFlight took the next phase authorized less than the Very affordable Treatment Act, pleasing the insurer’s inside perseverance that the flight was not medically essential to an unbiased 3rd bash by way of the point out.

    On July 29, the evaluator dominated in favor of Blue Cross.

    Commonly, such a flight would be appropriate because the affected person was “medically unfit to vacation through industrial airflight,” the assessment noted. But, it went on to say, there was really no need to have to vacation, as the University of Colorado Medical center — a member of the Countrywide Complete Most cancers Network — could have managed Deines’ cure.

    His wellness approach “clearly stipulates their indications for health care flight protection and, sad to say, this case does not meet that requirements,” the critique concluded.

    Resolution: The monthly bill disappeared only following the push obtained associated. Shortly just after a KHN reporter contacted the communications representatives for the two the insurance provider and Angel MedFlight, Deines read from the two of them.

    The $72,000 payment was made in error, claimed Blue Cross spokesperson Jami Sowers.

    “We apologize for putting the member in the center of this complex problem,” she stated in an electronic mail that also observed “the air ambulance company billed more than $70,000 just for floor transportation to and from the airport — far more than 30 times the common expense of medical floor transportation.”

    These types of a situation would “typically” be flagged by inner programs but for some rationale was not, Sowers claimed.

    “I have in no way listened to of a floor transportation that prices that a great deal. That’s stunning,” mentioned Erin Fuse Brown, director of the Heart for Regulation, Wellness & Modern society at Georgia Condition College Higher education of Legislation, who scientific studies client billing and air ambulance costs.

    Even now, there’s good information for Deines: Both of those the insurer and the air ambulance business explained to KHN he will not be held liable for any of the charges. (None of the costs stemmed from his first air ambulance flight from Casper to Denver, which was coated by the insurance provider.)

    Rebekah Deines sits on the left side of a couch, smiling at her husband, Sean. Sean smiles back, sitting on the right, as their dog, Maddi, sits between them.
    Sean and Rebekah Deines pet their pet, Maddi, at household in Hendersonville, North Carolina.(Maddy Alewine for KHN)

    “Once North Carolina Blue engages in our formal inquiries about its refund ask for, the position of the cash will be settled,” the ambulance spokesperson wrote in her e-mail. “One point is particular, Sean will not have to shell out for North Carolina’s wavering coverage conclusion.”

    In an email, Sowers said Blue Cross experienced “ceased all recoupment efforts” similar to Sean’s case.

    The Takeaway: If the flight had transpired this 12 months, the pair might have received a lot more price information and facts prior to they took the flight.

    A regulation termed the No Surprises Act took result Jan. 1. Its principal thrust is to protect insured individuals from “balance bills” for the change involving what their coverage pays and what an out-of-community provider charges in emergencies.

    It also handles nonemergency cases in which an insured affected individual is taken care of in an in-community facility by an out-of-community service provider. In these situations, the client would pay only what they would owe had the service been absolutely in-community.

    Another component of the legislation, called a fantastic religion estimate, could have delivered Deines with additional transparency into the expenditures.

    That portion states health care companies, which includes air ambulances, should give upfront expense estimates in nonemergency circumstances to sufferers. Had the regulation been in outcome, Deines may well have figured out prior to the flight that it could be billed at $489,000.

    Insured clients in very similar circumstances these days should really usually test initial with their insurer, if they are ready, to see if an air transport would be protected, specialists said.

    Even if the legislation experienced been in impact, it most likely would not have aided with the major dangle-up in Deines’ situation: the disagreement over “medical necessity.” Insurers nevertheless have leeway to outline it.

    For his part, Deines stated he’s happy he took the flight to be nearer to residence and family, in spite of the later on monetary shock.

    “I would not adjust it, simply because it supplied guidance for myself and my spouse, who needed to get treatment of me she was retaining my sanity,” he reported.

    Stephanie O’Neill contributed the audio portrait with this tale.

    Monthly bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains health-related costs. Do you have an attention-grabbing professional medical invoice you want to share with us? Inform us about it!

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  • Report: 2020 saw a record number of deaths in NC jails

    Report: 2020 saw a record number of deaths in NC jails


    By Elizabeth Thompson

    North Carolina jails saw a record number of deaths due to suicide or substance use in 2020, according to a new report from Disability Rights North Carolina (DRNC).

    There were a record number of 56 deaths in North Carolina jails in 2020, despite estimates that nationwide lockups reduced their populations by a quarter in just months due to the COVID-19 pandemic, the report found. Of those deaths, 32 were due to suicide or related to substance use, an increase from previous years.

    By comparison, there were 30 people who died from suicide or substance use in the state’s jails in 2019 and 22 in 2018.

    The rise in deaths by suicide occurred despite new regulations requiring jails to have suicide prevention programs. Jails are required under state law to “be operated so as to protect the health and welfare of prisoners and provide for their humane treatment.”

    “This report demonstrates North Carolina needs more stringent oversight of our jails,” said Susan Pollitt, Criminal Justice Supervising Attorney at DRNC, in a press release.

    “That the number of deaths by suicide actually increased during the same year jails were required to put in place suicide prevention programs should be an emergency wake up call to legislators, sheriffs, jail administrators, and our communities.”

    Oversight over jails

    Unlike the North Carolina prison system, which is controlled by the state government, jails across the state are controlled by individual, elected sheriffs. Comprehensive oversight and monitoring of jails is hard to come by.

    Even statewide records that DRNC collects to track jail deaths take a long time to receive, and a number of reports are required to determine the actual cause of death, NC Health News previously reported. It’s almost impossible to track non-fatal drug overdoses or attempted suicides.

    State Rep. Carla Cunningham (D-Charlotte) filed a bill at the state legislature in May which would have required the state Department of Health and Human Services to conduct compliance reviews following reports of an attempted suicide.

    Cunningham started looking into jail oversight after a 17-year-old died in the Mecklenburg Jail North Juvenile Detention Center.

    “I started looking at it closely and saw that yes, these things were happening in facilities,” Cunningham previously told NC Health News in an interview. “And that it really is not a lot of oversight or a collection of the data … The information is there, but you’ve got to dig for it.”

    The bill didn’t pass during the legislative session. Cunningham said one reason it may not have moved ahead is because some legislators didn’t want to put “additional stressors” on sheriffs.

    As a former nurse, Cunningham said data is key in the medical field, and jails often become safety nets for medical and mental health crises. Mental health issues are personal to Cunningham, whose son has an intellectual disability and has been diagnosed with schizophrenia and bipolar disorder.

    Health crises in jails

    People with serious mental illness are 3.5 times more likely to be sent to a jail or prison compared to a hospital. 

    This is partly because some illnesses, such as substance use disorder are criminalized. Police are also often called to respond to people in mental health crises and transport them to the hospital in handcuffs, a practice known as involuntary commitment. NC Health News previously reported on this practice and its consequences.

    Jails, especially smaller jails, often do not have the resources to help people with medical conditions. Local jail deaths due to drugs or alcohol intoxication have more than quadrupled across the country from 2000 to 2018, according to national data compiled by the federal Bureau of Justice Statistics. Experts expect these numbers to only get worse, as more powerful drugs such as fentanyl take over the drug supply.

    North Carolina reported a 40 percent increase in overdose deaths statewide in 2020 compared to 2019, a recent report from the state Department of Health and Human Services found.

    ​​”A single life lost to an overdose is a life we should have saved,” DHHS Sec. Kody Kinsley said in a press release. “Stress, loss of housing and loss of employment for those in recovery caused by the COVID-19 pandemic has led to a backslide in our fight against substance use disorders.”

    In order to prevent future deaths, DRNC recommended that jails:

    • Require sweeping state-wide suicide prevention measures in the state jails.
    • Give incarcerated people “adequate medical care.”
    • Improve transparency about conditions in the state’s jails.
    • “Adequately fund” NCDHHS’s jail regulation unit.
    • Take part in Stepping Up campaigns which fight mental illness with treatment instead of incarceration.

    The North Carolina Sheriffs’ Association did not immediately respond to a request for comment from NC Health News.

    It released an update of its Report on Law Enforcement Professionalism in January, which recommended funding to “increase and make mental health and substance abuse resources more readily available in North Carolina” and making mental health professionals, instead of police, responsible for the transportation of an individual in a mental health crisis.

    “These appalling in-custody deaths are the direct result of NC’s continued failure to improve mental health and substance use services in NC jails and communities,” Pollitt said in the press release. “We cannot allow this inhumane suffering and loss of life to continue when there are remedies that can be affordably and effectively implemented.”

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    by Elizabeth Thompson, North Carolina Health News
    March 25, 2022

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  • Vaccines show promise in reducing long COVID : Shots

    Vaccines show promise in reducing long COVID : Shots

    Reseach is showing that folks who are vaccinated, even with just one particular dose, are likely to have lessen premiums of lengthy COVID after catching the virus than all those who are unvaccinated.

    Justin Sullivan/Getty Photos


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    Justin Sullivan/Getty Pictures

    Reseach is showing that individuals who are vaccinated, even with just a single dose, have a tendency to have decreased costs of prolonged COVID soon after catching the virus than people who are unvaccinated.

    Justin Sullivan/Getty Visuals

    The likelihood of even a gentle situation of COVID-19 turning into a very long-time period, debilitating clinical affliction is one particular of the biggest fears of Americans trying to navigate the pandemic, which is yet again having a transform as new data show the BA.2 subvariant is using hold in the U.S.

    Unfortunately, the only absolutely sure way to stay away from extensive COVID is not to capture the virus in the 1st put.

    But there is now a expanding overall body of investigation which is giving at the very least some reassurance for these who do close up finding contaminated — staying entirely vaccinated looks to considerably slice the possibility of later establishing the persistent signs that characterize prolonged COVID.

    Whilst many of the results are nevertheless preliminary, the handful of studies that have emerged in the previous 50 {fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} year are telling a fairly constant tale.

    “It may well not eradicate the indicators of extended COVID, but the protecting outcome looks to be very robust,” says epidemiology professor Michael Edelstein, of Bar-Ilan University in Israel, who’s studying lengthy COVID.

    Edelstein’s analyze was just one of these incorporated in a new analysis of the evidence on very long COVID and vaccination finished by the United kingdom Health Security Agency. That overview observed vaccinated persons are inclined to have lessen premiums of very long COVID immediately after an an infection than those who are unvaccinated.

    There is a managing list of theories about why persons get lengthy COVID. Everlasting tissue destruction from the infection, harm to blood vessels and the enhancement of microclots, a lingering viral reservoir in components of the overall body, or an autoimmune issue are some of the tips remaining explored in the investigate.

    But even without the need of a obvious sense of what is actually particularly driving prolonged COVID, there’s very good reason to believe that vaccines would assist guard in opposition to the problem, says Dr. Steven Deeks, a professor of medication at the University of California, San Francisco.

    You will find too much to handle proof that an individual who’s vaccinated has a lot less virus in their body for the duration of an infection, he states, “so it would make good feeling that the quantity of virus-connected difficulties around time would also be decreased.”

    Appears to be good… but how excellent?

    One particular of the ongoing difficulties with extended COVID investigation is simply just defining the condition — with every single analyze taking a little bit different techniques as to what signs and symptoms depend and how very long they want to final right after the first an infection.

    People with 'medium COVID' are caught in a gray area of recovery with little support

    This inconsistency would make it hard to pull with each other a solitary estimate for how a great deal vaccines restrict very long COVID.

    Commonly, even though, Deeks says vaccinated men and women feel to have a 50{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} reduce normal risk of acquiring lengthy COVID than unvaccinated men and women. This is in the assortment of what many reports in the U.K., Israel and the U.S. have uncovered.

    Ideally, extensive COVID should not be calculated only a several months right after the preliminary an infection, he states. “A whole lot of men and women are nevertheless gradually obtaining superior, so you have to hold out at the very least 4 months to type of determine out irrespective of whether or not these indicators will persist.”

    The Israeli review, conducted by Edelstein and his colleagues, adopted quite a few thousand individuals who were unvaccinated, partly vaccinated and thoroughly vaccinated. Those people who tested favourable had been requested to self-report their signs and symptoms in between four and 8 months after their original infection.

    Contributors who had two or 3 doses of the vaccines ended up about 50{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 80{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} fewer probable to report seven of the 10 most typical signs, which include shortness of breath, headache, weak point and muscle pain.

    Edelstein suggests these benefits are not essentially surprising, since they are suitable with other modern reports. “It gives us a very little bit of reassurance that if you’re vaccinated, you lessen your possibilities of prolonged COVID rather significantly.”

    In fact, some researchers have uncovered equivalent final results by combing through electronic information from health and fitness treatment suppliers in the U.S. That substantial review concluded that sufferers who had at the very least one particular vaccine dose ended up seven to 10 instances a lot less likely to report two or a lot more long COVID signs when compared to unvaccinated folks involving 12 and 20 weeks soon after their infection.

    How long COVID sheds light on other mysterious (and lonely) chronic illnesses

    On the other hand, the proof isn’t really solely conclusive. Some experiments have not observed as significant a reduction. For example, the preliminary findings of a key review of digital well being information of U.S. veterans analyzed the health-related difficulties influencing diverse organ units at 6 months pursuing coronavirus infection.

    Remaining thoroughly vaccinated did not show up to make a incredibly meaningful variance for several of the write-up-infection complications, besides in two specific regions, states the study’s creator Dr. Ziyad Al-Aly, director of clinical epidemiology at the Veterans Affairs St. Louis Overall health Care Procedure.

    “Persons are acquiring less lingering manifestations in the lungs and also fewer blood clotting,” he suggests.

    The analyze also identified that those who were being hospitalized for COVID-19 experienced a larger threat of very long COVID symptoms compared with these who had a delicate illness, but that vaccines continued to make a significant variation in cutting down the danger of long COVID.

    “The vaccines are supposed to secure you from staying hospitalized,” suggests Al-Aly. “But even if they are unsuccessful and you get breakthrough COVID and now you might be hospitalized, you still do greater than somebody who got COVID and was in no way vaccinated.”

    Conflicting success in the scientific studies may perhaps, in section, be owing to how they are executed, this kind of as variances in the strategies of measuring extended COVID, how indications are noted and the affected person inhabitants currently being examined.

    A excellent shield — but not great

    Even with the promising proof, extended COVID scientists warning that vaccines can only do so significantly, and that invariably some individuals will continue to put up with signs even if they are vaccinated.

    In truth, a modern analyze from the U.K. observed that vaccines led to a significantly lessen hazard of extensive COVID as opposed with people who are unvaccinated, but that nevertheless close to 10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the absolutely vaccinated members showed indicators of lengthy COVID three months later on.

    David Putrino cares for extended COVID people who match this really profile at the Mount Sinai Wellbeing Procedure in New York Metropolis.

    “I don’t believe in fantastic religion I would be in a position to distinguish concerning another person who has a breakthrough scenario of extensive COVID versus a pre-vaccine case of prolonged COVID,” says Putrino, director of rehabilitation innovation at Mount Sinai. “The indications are extremely consistent.”

    And you will find now a further unresolved dilemma dealing with scientists: How properly do vaccines maintain up towards lengthy COVID just after an omicron infection?

    For some patients, cardiovascular problems persist long after COVID

    Mainly because omicron only emerged at the end of past 12 months, there are not nonetheless knowledge on how several folks have extensive COVID from the new variant, but Deeks states there are presently some individuals who seem to be heading in that way. “Without the need of issue, there are obviously men and women — I’m hoping not a ton — who acquired COVID a number of months back and are experience unwell right now,” he states.

    Centered on what is regarded about the variant, no one particular seriously understands for certain no matter if men and women who get omicron could be more, or significantly less, vulnerable to obtaining long COVID.

    On the just one hand, omicron is adept at evading the immune defenses set up by the vaccines, so it can be probable that “we could close up with much more extended COVID,” Deeks suggests.

    Alternatively, the variant sales opportunities to a extra localized an infection and won’t spread through the system as much, which implies there could essentially be fewer occasions of lengthy COVID.

    Deeks is leaning in direction of the a lot more optimistic circumstance. “That’s my prediction, but it truly is just a prediction.”

  • Owners of troubled Thomasville nursing home avoid scrutiny

    Owners of troubled Thomasville nursing home avoid scrutiny


    By Thomas Goldsmith and Rose Hoban

    Pointed questions arose about drastically low staffing and apparent failure to plan by Kinston-based Principle Long Term Care after its facility Pine Ridge Health and Rehabilitation faced a crisis on the icy night of Jan. 16.

    By the time local EMS and government officials showed up, two residents had died at the Thomasville home and nearly a hundred were left in the care of one nurse and two assistants instead of the 13 to 15 who should have been providing care.

    In response, legislators called a state NC Department of Health and Human Services manager to testify before a March 15 meeting of the Joint Legislative Oversight Committee on Health and Human Services. Emery Milliken, deputy director of the Division of Health Service Regulation, the DHHS division that oversees licensing and regulating nursing homes in the state, laid out the scenario that led to multiple high-level penalties against Pine Ridge. 

    The citations included 13 areas of deficient practice that investigators discovered, including eight so serious as to put residents’ lives and safety in immediate jeopardy. 

    Throughout her time at the General Assembly’s Joint Legislative Oversight Committee on Health and Human Services, neither Milliken nor any legislator mentioned the name of facility owners Principle Long Term Care. The company is listed in federal records as owners of 38 North Carolina nursing homes. According to a 2021 contract bid to the state Department of Administration, Principle has been in operation since 1980. 

    DHHS information officers pointed out Tuesday that Principle is mentioned in DHSR’s comprehensive report. In fact, it is mentioned twice, on pages 150 and 155 of a 159-page report, although there are more than 100 references to “corporate” executives and staff.

    “No legislator asked about the corporate ownership during the question and answer session,” Catie Armstrong, DHHS press assistant, wrote in an email. “The focus of the presentation, as requested by the legislature, was about the investigative findings of the incident.”

    In addition, Principle did not figure in most news accounts of the Pine Ridge problems. An Associated Press item reflected a complaint from Principle that the Pine Ridge deaths had been wrongly portrayed as linked to staffing shortages. The deaths had not been medically related to low staffing, a Principle official told the AP. Calls by NC Health News to Principle’s headquarters were not returned Monday and Tuesday.

    ‘Back out of the way’

    At the legislative hearing, state Rep. Larry Potts (R-Lexington) said he had learned that icy weather prevented the transportation of bodies of two residents who had died earlier in the day.

    “So they were just pushed back out of the way,” Potts said after the meeting. “I was more concerned about the living who had to call 911. I talked with the first officer on the scene and the district attorney about the conditions there.”

    Although Pine Ridge is not located in Potts’ district, he said that local officials frequently call him when issues in the community arise as he was a county commissioner for several decades before going to the state legislature. 

    Testimony before the committee showed that a disaster plan prepared and submitted to state regulators under a previous Principle administrator was ignored under a replacement who took over the job three months after state regulators had reviewed the plan. 

    Nine days before the Pine Ridge incident, a report from the Centers for Medicare and Medicaid Services indicated that nursing homes with higher levels of turnover garnered lower overall ratings. The staffing shortage took place on a Sunday, during a weekend period identified by federal officials as critical for nursing home quality.

    “This incident happened January the 16th through the 17th and it began to unfold at Pine Ridge as the snowstorm began to hit on the morning of the 16th,” Milliken told the committee. “The Health Services Regulation investigation found that as weather conditions worsened, many staff who were scheduled to come to work that day at Pine Ridge, either didn’t show or they left early because of the road conditions.”

    On the federal Medicare.gov nursing home ratings website, Pine Ridge garners only a one-star rating out of a possible five stars, something listed as “much below average.” For the staffing metric, Pine Ridge’s rating is a scant two stars out of a possible five. 

    The January incident resulted in Pine Ridge receiving a federal designation of immediate jeopardy, denoting a situation in which a facility has put the safety and health of residents, “at risk for serious injury, serious harm, serious impairment or death,” according to the CMS compliance manual. It’s the most serious sanction a nursing home can face and can result in immediate closure of a facility or loss of the ability to bill federal payers for reimbursement. 

    Residents unfed and ungroomed

    That meant that so few Pine Ridge staff were on hand that residents were reduced to calling public emergency services. 

    “These 911 calls reported the caller needed help, that she hadn’t seen staff for hours, couldn’t reach staff, that she was wet,” Milliken said.  “She was hungry and had not had supper.”

    According to Milliken’s presentation, 98 residents had one licensed practical nurse and two nursing assistants to look after them from 2 p.m. Sunday, January 16 until emergency responders arrived to help that night. The typical staffing would involve 13 to 15 people, she said.

    Neither the administrator at the time nor the director of nursing was there to help residents, according to a 159-page Division of Health Service Regulation investigative report that included an interview with the unnamed administrator. 

    “She said she and the Director of Nursing had tried to come into the building, but they were unable to because of the poor road conditions from the inclement weather,” investigators wrote. 

    Principle’s failed bid

    This wasn’t the first time Principle had come under the state’s scrutiny. During the 2021 process to select a management company for the state’s veterans nursing homes. Principle was ruled out by an evaluation team from the NC Department of Military and Veterans Affairs, even though it offered to run the homes for the lowest percentage of revenue among three applicants. 

    The team said it found Principle lacking in part because it relied only on information only from the previous three and a half years of operation and in part because of its use of an “extensive list” of contractors to operate its facilities. In looking into a reason for a 2017 corporate reorganization, the evaluation team cited a case in which employee Douglas S. Little was convicted in Union County of second-degree forcible sex offense against a resident of Lake Park Nursing Home in Indian Trail.

    Another immediate jeopardy

    Principle also came under state sanctions in 2020 when investigators documented a threat of immediate jeopardy to a Pine Ridge resident. According to the DHHS-generated report, Pine Ridge staff failed to “document, report, assess and seek medical treatment for” a resident with severe cognitive problems who was a fall risk but was walking by herself when she fractured her forearm, wrist and the socket of her hip joint.

    A technician saw the fall and pointed it out to other staff, according to the report, which also noted that the resident “cried that she was in pain and when the nurse came into the room he told us it was our fault that she fell because we did not monitor her close enough. The nurse instructed the NAs to put her in her wheelchair and take her to her room and put her to bed.” 

    The resident, who fell at about 8:30 p.m. on Oct. 6, 2020, did not receive an assessment, treatment or pain medication until after 11 a.m. the next day, investigators found, despite the resident’s tears and complaints of pain.

    State Rep. Donna White (R-Clayton) said after the meeting that the problems of low staffing and poor planning are not unique to Pine Ridge and its horrific snow day. 

    “I can tell you that’s not the only facility in North Carolina that has those issues,” White said.

    “It could be a fire, it could be anything else, it could be a hurricane, it could be a tornado. It could be another pandemic. 

    “I understand that all these things have been spotlighted more because of the pandemic. But the underlying issues were already there.”

    Correction: This story originally stated that Rep. Donna White was a Democrat.

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    by Thomas Goldsmith, North Carolina Health News
    March 23, 2022

    1