DC Medical Malpractice & Patient Safety Blog

June 19, 2018

Hospitals and nursing homes need to do more to stop ‘boomerang’ abuses

Uncle Sam soon will step up what may be a positive trend: getting hospitals and nursing homes to halt the unacceptable boomeranging of elderly patients between them. But will Trump officials be as quick with health care providers as they have been with poor, sick, and old patients to employ not just carrots but also sticks to get better outcomes?

The nonprofit, nonpartisan Kaiser Health News Service deserves credit for looking ahead to this fall, when the administration aims to accelerate the end of perverse incentives that have hospitals and nursing homes shuttling the sick and elderly between them far too often. As Jordan Rau of the news service reported:

With hospitals pushing patients out the door earlier, nursing homes are deluged with increasingly frail patients. But many homes, with their sometimes-skeletal medical staffing, often fail to handle post-hospital complications — or create new problems by not heeding or receiving accurate hospital and physician instructions. Patients, caught in the middle, may suffer. One in 5 Medicare patients sent from the hospital to a nursing home boomerang back within 30 days, often for potentially preventable conditions such as dehydration, infections and medication errors, federal records show. Such re-hospitalizations occur 27 percent more frequently than for the Medicare population at large.

June 17, 2018

NIH ripped for Big Alcohol funding and advising on $100-million drinking study

by Patrick A. Malone

The National Institutes of Health, perhaps the world’s leading medical research institution, has moved fast to try to fix self-inflicted damage to its reputation caused by a controversial $100-million study on alcohol and its harms.

NIH Director Francis Collins halted the study, and an advisory group backed his action, lambasting researchers for soliciting funding and counsel from the alcohol industry for a work that purported to answer key and fundamental questions about booze but from its outset leaned toward seeing benefit in moderate drinking.

The New York Times deserves credit for digging into the dubious actions by researchers supported by the National Institute on Alcohol Abuse and Alcoholism, an arm of NIH.

June 15, 2018

San Francisco voters send strong message cracking down on kids’ vaping

by Patrick A. Malone

San Francisco voters, upholding their elected leaders’ enlightened lawmaking, bashed Big Tobacco and its interests, providing a potent primary election message to public health officials nationwide to curb the growing menace to young people posed by e-cigarettes and vaping.

By a 2-to-1 margin, Bay Area residents supported their Board of Supervisors’ tough ban — which may be the most stringent in the nation — on sales of flavored tobacco products, including vaping liquids packaged as candies and juice boxes, and menthol cigarettes.

Specialized liquids, peddled in flavors like bubble gum, chicken and waffles, and unicorn milk, are key to the youth craze for vaping, in which teens use small devices about the size of a computer flash drive to get a nicotine-fueled boost. They can, with standard hits from liquids in devices like the trendy Juul, regularly consume as much nicotine as is found in a pack of cigarettes.

June 13, 2018

For early-stage breast cancer patients, dreaded chemo may be unneeded

by Patrick A. Malone

Breast cancer patients may get a welcome respite from one of the disease’s dreaded aspects — its aggressive and costly treatments. New research suggests that thousands of women with early-stage breast cancer who now are told to get chemotherapy don’t need it, while a larger, significant number of patients can benefit by halving the time they’re told to take an expensive drug with harsh side-effects, especially for the heart.

Although this information should be taken in a positive light, patients should consult with their doctors about appropriate treatment for their individual case.

The prospective shifts in breast cancer treatment, based on new findings, may add to rumblings and criticisms about over-treatment and whether doctors have taken too lightly the toll — physically, mentally, and financially — that this and other forms of cancer inflict on patients.

June 11, 2018

Will voters recall what Trump and GOP do on health, not just what they say?

by Patrick A. Malone

As voters make up their minds about this fall’s mid-term races, they may wish to burn into their memories how the Trump Administration has dealt, so far, and especially in recent days, with government social programs that have huge effects on Americans’ health and lives.

Take, for example, the late-week, late night announcement by the U.S. Department of Justice that it will decline to defend yet another part of the Affordable Care Act, as 19 states, most red and led by Texas, attack Obamacare in the courts. The legal aspects of this decision will keep lots of law degree holders and their kindred men and women in black robes arguing, heatedly, for a while. There also may be huge political smoke clouds.

But keep in mind this basic fact from the actions by the Justice Department led by Attorney General Jeff Sessions: The nation’s crack legal team is asserting that it is unconstitutional for the ACA to bar insurers from declining coverage due to preexisting conditions.

June 10, 2018

It’s not just celebrities; CDC warns of public health crisis in suicides

by Patrick A. Malone

Uncle Sam’s sobering new report about suicide rates rising in all but one state between 1999 and 2016, with fatal increases across age, gender, race and ethnicity, became even more somber and urgent with the shock and grief expressed widely over the self-inflicted deaths of chef-raconteur Anthony Bourdain in France and fashion designer-entrepreneur Kate Spade in Manhattan.

Suicide no longer should be viewed solely as a personal mental health problem but also now as a public health crisis, the federal Centers for Disease Control and Prevention warned. Anne Schuchat, the CDC’s principal deputy director, told the Washington Post: “The data are disturbing. The widespread nature of the [suicide rate] increase, in every state but one, really suggests that this is a national problem hitting most communities.”

The suicides of Bourdain, 61, and Spade, 55, hit many hard, as was reflected in the extensive media coverage and social media reactions. Both Bourdain and Spade rose from modest circumstances, with abundant hard work, talent, personality, and ambition, to lead lives in the spotlight, and with an economic comfort that others would envy and consider glamorous. They were “successes.”

June 8, 2018

Is there a doctor aboard? While flying this summer, you may hope so

by Patrick A. Malone

With tens of millions hopping on jets to get to summer vacation destinations, it’s worth noting that medical emergencies aloft aren’t as rare as many travelers might imagine — and it may be beneficial if a doctor happens to be aboard when the need arises.

The nation’s top doctor, U.S. Surgeon General Jerome Adams, of course, may have spotlighted sky-high medical care, when he answered flight attendants’ emergency page to all those aboard a Delta flight from Fort Lauderdale to Atlanta. Details are a bit sketchy. But a passenger on the early May trip apparently passed out, and worried crew needed medical assistance and an evaluation of potential next steps.

Adams said he was pleased to step up and assist the crew as the flight, which was on the tarmac, returned to the airport gate, where a crew member took the ailing passenger off for care, while the Delta plane resumed its planned trip.

June 7, 2018

Stigma inflicts harsh toll on mentally ill, but society pays too

by Patrick A. Malone

Although Americans keep making progress toward ending the stigma associated with mental disorders, including trying to put public funding for the diseases’ treatment on a more even footing, patients with serious mental illness suffer unfairly and harshly still due to their conditions.

Dhruv Khullar, a doctor at NewYork-Presbyterian Hospital and a researcher at the Weill Cornell Department of Healthcare Policy and Research, has written a painful piece for the “Upshot,” an evidence-based column for the New York Times. His article, “The Largest Health Disparity We Don’t Talk About,” reports that:

Americans with depression, bipolar disorder or other serious mental illnesses die 15 to 30 years younge r than those without mental illness — a disparity larger than for race, ethnicity, geography or socioeconomic status. It’s a gap, unlike many others, that has been growing, but it receives considerably less academic study or public attention. The extraordinary life expectancy gains of the past half-century [for most in this country] have left these patients behind, with the result that Americans with serious mental illness live shorter lives than those in many of the world’s poorest countries.

June 6, 2018

Be skeptical of cancer society’s call for earlier colorectal screenings

by Patrick A. Malone

If you’ve got a shaker of salt, you may want to empty it on recent news coverage of the American Cancer Society’s announcement about its new guidelines on the age to start colorectal screening. That’s because the organization’s advisory and more than a few health journalists show a shaky grasp of basic disease statistical math.

Cancer specialists, correctly, are concerned because they say they are seeing the disease in younger people, with more colon and rectum cancers detected in patients in their 20s and even in their teens. They’re unsure what’s causing this. But just how many diagnosed cases have there been — and do the numbers mean there’s enough hard science to support a new recommendation that patients get colorectal screening five years earlier than they do now, at age 45 instead of 50?

As Kevin Lomangino, managing editor of Healthnewsreview.org, a health news watchdog site, points out, too many reporters became too accepting of experts’ fuzzy math when describing a screening change that could result in patient harms. The society, and specialists contacted by many reporters, spoke often of “doubled risks,” or impressive seeming percentage increases in colorectal cancer diagnoses — but without providing actual numbers of cases.

June 5, 2018

With more legal pot and a raging opioid crisis, deadly drugged driving spikes

by Patrick A. Malone

There’s been a deadly side to the nation’s opioid drug abuse crisis and increasing number of states’ legalization of marijuana: A leading safety group says the number of drugged drivers killed in car crashes is rising dramatically.

The Governors Highway Safety Association reported that 44 percent of fatally injured drivers tested for drugs had positive results in 2016, which is up more than 50 percent compared with a decade ago, according to a blog post by the nonprofit, nonpartisan Pew Trusts, which added that, “more than half the drivers tested positive for marijuana, opioids or a combination of the two.”

As Pew reported, the District of Columbia and nine states “allow marijuana to be sold for recreational and medical use, and 21 others allow it to be sold for medical use. Opioid addiction and overdoses have become a national crisis, with an estimated 115 deaths a day. States are struggling to get a handle on drugged driving. Traffic safety experts say that while it’s easy for police to test drivers for alcohol impairment using a breathalyzer, it’s much harder to detect and screen them for drug impairment. There is no nationally accepted method for testing drivers, and the number of drugs to test for is large. Different drugs also have different effects on drivers. And there is no definitive data linking drugged driving to crashes.”