Articles Posted in Certification and Licensure

hjobs-300x174It’s unlikely to surprise anyone who has visited friends or loved ones at a nursing home that such facilities too often are woefully staffed.

But why have federal regulators allowed themselves to be gulled about nursing home personnel levels, and how will not just these care-giving sites but also others, notably hospitals, deal with the growing need for and imbalances in health care staff, including a tilt toward “astonishingly high” numbers of costly administrative staff folks who don’t provide direct patient care?

Jordan Rau, a reporter for Kaiser Health News Service, deserves credit for digging into daily payroll records that Medicare only recently has gathered and published from 14,000 nursing homes nationwide. Rau found that:

SCImaginvestigation-300x147The federal Food and Drug Administration has turned a blind eye to tens of millions of dollars paid by Big Pharma to doctors who play crucial roles in advising the nation’s prescription drug watchdog on the safety and effectiveness of medications sold for billions of dollars annually to the American public.

Science magazine deserves credit for its investigation of conflicts of interest it found by examining readily available public records on payments received by more than 100 physician advisers to the FDA over a four-year period.

Reporter Charles Piller and graphics editor Jia  You took an important and different look at records, scrutinizing doctors disclosed drug company funding after their service on elite panels that assist FDA staff in the review and approval of products before they can go to market. Under fire by drug safety and other public advocates, and with intense peer pressure, doctors — grudgingly — have come to accept the notion that they should avoid conflicts of interest before sitting on such influential oversight groups.

CMS-300x105As many as 2 million already ailing Americans will acquire an infection while hospitalized, with 90,000 of them dying as a result. Hospital acquired infections (HAIs) will add to the cost of an individual patient’s care anywhere from $1,000 to $50,000, while they will impose a direct hit of anywhere from $28 billion to $45 billion for institutions’ bottom lines. If HAIs seem like a problem for U.S. health care, they certainly are —  why is Uncle Sam suddenly proposing to retreat on regulations to crack down on them?

USA Today reported that patient safety advocates are sounding alarms about new rules, set to take effect in November, from the Centers for Medicare and Medicaid Services (CMS). The agency, which wields great sway over hospitals because so many patients’ medical costs are covered by Medicaid and Medicare, plans to slash the information it provides to the public on HAIs involving: “super bugs” like MRSA (methicillin-resistant Staphylococcus aureus), post-operative sepsis and surgical site infections, as well as accidents and injuries ranging from bedsores to respiratory failure after surgery.

CMS also would stop informing the public about “never events,” medical mistakes committed in hospitals and considered so ghastly that they “never” are supposed to occur.

coveredcalif-300x169Although Republicans have ripped at the health insurance offered under the Affordable Care Act, a less known but also important aspect of Obamacare may soon benefit Californians. This West Coast ACA-related move also may be worth watching by patients and medical safety advocates, as well as employers and insurers.

The Golden State, the San Francisco public radio station KQED reported, soon will tell hospitals that “time’s up” for them to improve their care, and, if they fail to hit new quality and safety targets that will be part of an impending three-year contract with Covered California, the ACA marketplace operator, they will get the boot from Obamacare coverage.

Because bluer-than-blue Democratic California has gone all-in in supporting and putting ACA coverages in place, the state’s Obamacare exchange is big (more than 1 million customers and 11 approved companies) and lucrative — so much so hospitals and insurers can’t ignore the quality demands. They’re neither extreme nor should they be surprising, because state officials emphasize they have consulted with key parties for several years now in the “Smart Care California” collaborative about the plans they intend to put in place.

ivf-300x271Equipment failures in two clinics in Cleveland and San Francisco not only resulted in the loss of thousands of frozen human embryos and eggs, the incidents also have raised new concerns about safeguards and regulation of booming and costly fertility programs.

Experts said the mishaps were uncommon, and they were hard pressed to explain how advanced refrigeration systems, with rigorous checks and back-ups, could have malfunctioned at large, respected facilities, leading to a likely boom of lawsuits by women and couples against the University Hospitals Ahuja Medical Center’s Fertility Center in Cleveland and the  Pacific Fertility Center in San Francisco.

The centers serve different types of women and couples, with the San Francisco facility dealing with younger, career-driven, and international patients eager to freeze eggs and embryos in hopes of starting families later in life. It has attracted public notice, partly because high-tech firms in the nearby Silicon Valley offer financial assistance to women employees who want to freeze their eggs. The Cleveland center, meantime, seeks to assist women and couples in the city’s western suburbs with infertility issues, especially through in vitro fertilization.

NPDB-300x128When doctors get in trouble for repeatedly malpracticing on patients, what do they do? Many mosey down the road and practice elsewhere. That’s because the professional licensing system is a state-by-state patchwork, with a lax and unworkable national reporting system.

The Milwaukee Journal-Sentinel and MedPage Today deserve credit for digging into medical boards across the country to find at least 500 hop-scotching and problematic practitioners including:

  • A Colorado doctor, whose care of a multiple sclerosis patient causes four other MDs to complain to the state medical board when the patient died in 2011. The board and the doctor agreed he was “permanently inactivating” his license in 2014, meaning he can’t ever get it back. But the doctor also practices in Florida, where he works with no restrictions, despite malpractice lawsuits from seven other patients in two states, all accusing him of MS misdiagnoses.

precise-223x300Although billions of dollars and lots of positive public attention have been lavished on the promise of genetic-based “precision medicine,” this therapeutic approach to treating cancer and other serious diseases may need more scrutiny for basics of quality control.

National Public Radio deserves credit for airing some less-heard experts’ worries about the roles of at least two groups of little-seen and often-ignored medical specialists — pathologists and med techs — and how their common practices may undercut the potential of efforts to target disease treatments to individual patients based on maps of their genes.

Despite its powerful and progress-promising name, precision medicine relies on some old-fashioned, unchanged, and possibly problematic medical techniques, experts told NPR. Blood and tissue samples, which later will be analyzed with costly and supposedly state-of-the-art equipment, still get taken by med techs with limited training. Little attention typically gets paid to how they collect samples and how carefully they get handled before arriving in labs. They may sit on carts for hours, and they may be dragged through different parts of hospitals where temperatures vary widely and can hit extremes.

blkmom-300x222The bad news for expectant black moms isn’t confined to those living in the nation’s capital: A new investigation has found higher risks of harm for women in New York, Florida, and Illinois when they deliver at hospitals that disproportionately serve black mothers.

ProPublica, a Pulitzer Prize-winning investigative site, analyzed two years of hospital inpatient discharge data from the three states to “look in-depth at how well different facilities treat women who experience one particular problem — hemorrhages — while giving birth.” Reporters found negative patterns that underscored big woes identified by other research before:

[B]lack women … fare worse in pregnancy and childbirth, dying at a rate more than triple that of white mothers. And while part of the disparity can be attributed to factors like poverty and inadequate access to health care, there is growing evidence that points to the quality of care at hospitals where a disproportionate number of black women deliver, which are often in neighborhoods disadvantaged by segregation. Researchers have found that women who deliver at these so-called ‘black-serving’ hospitals are more likely to have serious complications — from infections to birth-related embolisms to emergency hysterectomies — than mothers who deliver at institutions that serve fewer black women.

probe-300x195With more than 10,000 boomers retiring each day and more seniors ending up at some point in their lives in nursing homes, regulators need to step up their oversight of elder care facilities. But there’s disturbing information they’re failing at this crucial task, allowing terrible abuses of older Americans who also may be evicted unfairly from facilities and who may be insufficiently protected when natural calamities occur.

The Minneapolis Star-Tribune deserves credit for its multipart investigation of abuses in nursing homes. As the news organization has reported of its findings:

Every year, hundreds of residents at senior care centers around the state are assaulted, raped or robbed in crimes that leave lasting trauma and pain for the victims and their families. Yet the vast majority of these crimes are never resolved, and the perpetrators never punished, because state regulators lack the staff and expertise to investigate them. And thousands of complaints are simply ignored. … Last year alone, the Minnesota Department of Health received 25,226 allegations of neglect, physical abuse, unexplained serious injuries, and thefts in state-licensed homes for the elderly. Ninety-seven percent were never investigated. That includes 2,025 allegations of physical or emotional abuse by staff, 4,100 reports of altercations between residents and 300 reported drug thefts. When the Health Department did investigate, records show that it often neglected key steps in a criminal probe. In dozens of those cases, for instance, no one interviewed the victims, and no one called the police. Health Department documents contain dire tales of residents being choked, punched, smothered with pillows, fondled and forcibly restrained.

bowser-240x300Even as District of Columbia officials struggle with deepening woes at the United Medical Center (UMC), advocates from a national, independent, and nonprofit group have offered a dim review of hospitals in the DC area.

The bad news keeps piling on at UMC, a leading provider of medical care for communities of color in the District’s Southeast area and in Prince George’s County, Md.

To its credit, the sometimes locally slumbering Washington Post has put out a disturbing, well-documented report about the death of a 47-year-old HIV-AIDS patient in UMC’s nursing home care. As others witnessing the scene clamored for them to help, UMC nurses, the Post says, let the patient fall to the floor, where he sprawled in his own waste for 20 minutes while his caregivers argued with a security guard. When the patient finally was returned to his bed, he was dead.

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