Hospitals

May 27, 2019

High court leaves it to Congress to restore service members’ basic rights

The U.S. Supreme Court has left it up to Congress to decide if service members may pursue in the civil justice system claims that they have suffered harms while seeking medical services, a fundamental civil right now denied to military personnel.

Justices Clarence Thomas and Ruth Bader Ginsburg — who rarely agree on much — both wanted but were unsuccessful in getting their high court colleagues to revisit an inequitable, 69-year-old Supreme Court ruling involving the Federal Tort Claims Act. That act governs who can bring a claim for negligence at a military or other government health care facility.

Active duty military personnel cannot bring a medical negligence claim for care at a military facility. This is called the “Feres doctrine,” after the Supreme Court decision, Feres v. United States, 340 U.S. 135 (1950). Under the Feres doctrine, members of the United States armed forces are barred from making a claim against the United States for personal injury or death arising “incident to service.” Military medical treatment received by a service member, while on active duty, has been held by the courts to be “incident to service,” and, thus not actionable, even if that treatment was for a purely elective procedure, and even if the procedure was performed negligently.

May 24, 2019

Walmart sees a bigger picture with costly imaging: frequent misdiagnosis

by Patrick A. Malone

As Walmart tries to work with its 1 million-plus U.S. employees in controlling health care costs, the retailing giant has not only struck a blow for quality medical treatment, it also has raised key questions about a costly and booming specialization in health care: medical imaging.

Walmart decided to shake up this diagnostic field by telling its employees to pay more themselves or to first seek CT scans and MRIs at one of 800 imaging centers that a company-retained health care consulting firm has identified as providing high-quality care. Covera Health, a New York City-based health analytics company, “uses data to help spot facilities likely to provide accurate imaging for a wide variety of conditions, from cancer to torn knee ligaments,” Kaiser Health News Service reported.

KHN reporter Phil Galewitz said Walmart targeted improved imaging based on the giant retailers’ experiences already in funneling workers to select facilities its research has found to offer efficient, high-quality care in specific areas, such as organ transplantation, back and knee surgeries, and heart and cancer treatment.

May 21, 2019

Preventable hospital deaths’ terrible toll: at least 160,000 lives each year

by Patrick A. Malone

Although the fatalities have declined, preventable hospital deaths kill more than 160,000 Americans annually — four times as many lives as were lost to vehicle wrecks in 2017, more than twice the deaths attributable to opioids and drug overdoses that year, and more than the toll of stroke or Alzheimer’s disease.

The disturbing new report on hospital deaths comes from Johns Hopkins Medicine’s Armstrong Institute for Patient Safety and Quality and the Leapfrog Group, a national nonprofit founded by large employers and others concerned and focused on safety and quality in health care.

May 19, 2019

Terps draw new fire for staying mostly mum about a fatal viral outbreak

by Patrick A. Malone

Just as the nation grapples with the worst measles outbreak in a quarter century, the University of Maryland and public health officials are drawing fire for the way they handled the strange confluence of mold infections in dorms and the spread of an contagious virus among students on the College Park campus.

The university and its advisers tried to keep a lid on public information about the dual problems, leading students and parents to assail the school and to blame its sluggish response and silence for the death of an immune-compromised coed.

Her death late last year — following the fall heat-stroke fatality involving Jordan McNair, a 19-year-old football player — has renewed concerns that the university and its staff may lack the expertise, training, and sensitivity to protect vulnerable young people, the Washington Post reported as part of its investigation of the confused health scenario involving Olivia Shea Paregol.

May 16, 2019

Hospitals rip employer health plans with prices up to 3 times what Uncle Sam pays

by Patrick A. Malone

Big businesses, which beat on their employees to be more cost-conscious, efficient, and productive, may need to take a page out of their own books if they hope to better control the soaring health care costs that they’re also shoving off onto their workers.

That’s a key takeaway from new research by the independent, nonprofit RAND Corporation into prices paid in 25 states to 70 hospital systems by job-provided health insurers in 2017. They provide coverage for most Americans, more than 180 million of us, and RAND found that private employer-sponsored health plans paid hospitals on average twice or even three times as much as Uncle Sam did through the Medicare program for the same services at the same hospitals.

Hospitals bellyache about tight-fisted Medicare prices that Uncle Sam can negotiate due to big dollars and huge number of patients covered under its senior health care plan. Although hospitals call the government-negotiated prices too low and an unfair benchmark, they provide realistic insights into hospitals’ bottom-line charges in what is one of the biggest areas of Americans’ health care costs. As RAND researcher Christopher Whaley told Modern Healthcare, an industry-covering news organization:

May 10, 2019

Modern medicine may be great at making money but not at making sense

by Patrick A. Malone

Spending’s askew when billions go for unproven surgical robots while lack of affordable care leads thousands of poor, black, and brown patients to need diabetic amputations

If U.S. health care leaders look ahead to 2020 and wonder why their sector of the economy will be one of the key concerns of presidential candidates and voters, they can only blame themselves for allowing the public to conclude that the industry’s big money and big profit drives have gone haywire.

How unbalanced have the nation’s health care priorities become that, on the one hand, surgeons and hospitals keep pushing to spend billions of dollars more for robotic surgeries that doctors themselves are doubting, while, on the other hand, researchers blame economic and racial disparities for playing a big role in requiring tens of thousands of patients — especially those who are black and brown and poor — to undergo diabetic amputations?

May 8, 2019

Big Pharma executives convicted of criminal racketeering with opioid sales

by Patrick A. Malone

Even as more felony charges may follow in drug epidemic, sleep med warning suggests pill popping stays too popular

Five top executives at a major drug maker have been convicted of criminal racketeering for their aggressive and deceptive marketing of a fentanyl spray in a case that prosecutors long have said may warn corporate leaders about their culpability in the nation’s opioid painkiller crisis.

Federal jurors deliberated for 15 days before finding guilty John Kapoor, founder and CEO of drug maker Insys (shown at right). Jurors also convicted Richard M. Simon, former Insys national director of sales; Sunrise Lee and Joseph A. Rowan, both former regional sales directors; and Michael J. Gurry, former vice president of managed markets. As the New York Times described the case against them:

April 30, 2019

Another front in war on opioids: Criminal charges for Big Pharma execs, MDs

by Patrick A. Malone

An estimated 400,000 Americans have died due to opioid drug overdoses between 1999 and 2017 — and the fatalities only are increasing. By 2025, according to expert forecasts, there will be 700,000 more opioid deaths. Prosecutors now are saying that at least some of the causes of this crisis are nothing less than criminal behavior by people wearing white coats and ties.

Federal and state prosecutors are bringing felony charges against doctors and Big Pharma executives as if they were street drug dealers and crime bosses.

This formal faulting for the nation’s opioid crisis hasn’t yet spread widely among drug makers, those at the pinnacle of the pharma pipeline. The legal war, however, has resulted in aggressive steps by federal prosecutors accusing not only scores of doctors across seven states with improperly prescribing painkillers for cash and sex, but also with officials filing for the first time drug-trafficking charges against a major pharmaceutical distributor and two of its former executives.

April 22, 2019

After thousands of lawsuits, FDA bans mesh used in pelvic prolapse procedures

by Patrick A. Malone

After years of patient complaints about injuries and tens of thousands of lawsuits, the federal Food and Drug Administration yanked from the market a surgical mesh widely used to repair pelvic conditions in women.

The agency has been slow to act on transvaginal mesh, which has been in use since the 1970s, with surgeons increasing its use in the 1990s. That in turn created an avalanche of complaints from safety advocates and women patients, who said the implant and procedure caused pain, bleeding, and scarring. This was not the surgical innovation, they said, that was supposed to remedy the pelvic tissue collapse that can cause the bladder or reproductive organs to slip out of place, causing pain, constipation and urinary leakage.

The FDA issued a series of increasing warnings about mesh, finally reclassifying it in 2016 as high-risk and ordering its makers to produce medical-scientific evidence about the device’s long-term safety.

April 19, 2019

Concern grows over seniors taking their own lives in long-term care facilities

by Patrick A. Malone

With 3 out of 4 Americans insisting they would prefer to age in place at home, senior care institutions already face stiff headwinds. But an investigation by two media organizations paints a glum picture of a little discussed aspect of elder life: the “lethal planning” some older residents make in nursing homes, assisted living centers, and adult care facilities — to end their own lives.

The exact suicide toll among the 2.2 million elderly Americans who live in long-term care settings is poorly tracked and difficult to quantify, reported the independent, nonpartisan Kaiser Health News (KHN) service and PBS NewsHour (see the broadcast report by clicking here). But the two news organizations found:

[An] analysis of new data from the University of Michigan suggests that hundreds of suicides by older adults each year — nearly one per day — are related to long-term care. Thousands more people may be at risk in those settings, where up to a third of residents report suicidal thoughts, research shows. Each suicide results from a unique blend of factors, of course. But the fact that frail older Americans are managing to kill themselves in what are supposed to be safe, supervised havens raises questions about whether these facilities pay enough attention to risk factors like mental health, physical decline and disconnectedness — and events such as losing a spouse or leaving one’s home. More controversial is whether older adults in those settings should be able to take their lives through what some fiercely defend as ‘rational suicide.’