Orlando shootings raise health care concerns

ormc_tower_00a_1024_web300x600wHere’s hoping that the mass shooting in Orlando will focus attention on some health care issues that the event flushed into open view:

bloodGay activists and others have denounced anew these restrictions. They say these rules unnecessarily stigmatize members of their community, who were bitterly reminded of them when donors sought to assist the many wounded in the Orlando gay club.

The federal Food and Drug Administration in December changed its blood donor rules, giving gays and others a new path to donate but under some stringent guidelines. Advocates criticized these new measures, which had lifted a lifetime ban for gays wishing to donate, as unrealistic, allowing the giving of blood, for example, only if gay men had abstained from sex, especially with male partners, for a year.

The FDA and the American Red Cross, the nonprofit with major sway over U.S. blood supplies, adopted rigorous rules about donation at the height of the HIV-AIDs crisis, when much less was known about transmission of viral infections and many recipients were infected by transfusion. Critics say science since has made major advances in blood testing and treatment of HIV-AIDs so that shunned groups should be allowed to donate, especially given the chronic shortage of blood supplies.

A controversy erupted almost immediately after the Orlando shootings when officials sought to inform the public about victims and their care, and whether to do so they needed a formal waiver of the federal Health Insurance Portability and Accountability Act of 1996. Orlando’s mayor, perhaps acting in abundance of caution, said he had asked for a HIPAA waiver; the President, by declaring a federal emergency, apparently allowed for more open discussion about the dead and wounded in care without formally waiving the federal law.

This incident raised some tough issues for caregivers and hospitals: They can face criminal penalties and fines up to $50,000 per incident for wrongly disclosing patient information. The Orlando shooting posed challenges because it affected the lesbian, gay, bisexual, transgender, and queer community, where some shooting victims may have kept private to many their sexual orientation. Committed partners may not have had formal, legal standing to learn about the medical care of loved ones.

Although health and public officials in Orlando appear for now to have navigated horrifying circumstances and great pressures with grace and sensitivity, privacy issues remain huge for all patients.

The Orlando mayhem occurred, fortuitously, near a major regional trauma center. And the facility, like many nationwide, had prepared for medical horrors even beyond a far norm. It’s a grim commentary on the tragic prevalence of gun violence that emergency caregivers now routinely undergo drills to ready themselves to treat victims in mass shootings. This all started to ramp up after the 1999 incident at Columbine High School in suburban Denver, a bloody spree that left 13 dead and at least 20 wounded.

Since then, and even now, communities across the country have struggled as hundreds of emergency  rooms and trauma centers have shut their doors. Emergency services are among the costliest and least efficient in health care, and hospitals have claimed they can’t keep them up.

I’ve written recently about a significant, troubling trend in health care economics, with hospitals, in the name of cost and efficiency, are merging, consolidating, and closing. The critics see this step as increasing costs and decreasing access−ERs are among the items to go when the hospital bean counters rule.

Bigger and fewer may make business sense to hospitals but it doesn’t necessarily lead to better, more coordinated care, Austin Frakt, a health care economist and columnist for the New York Times Upshot feature has noted.

  • What are the glimmers of good in nightmarish situations like Orlando?

k-9-screenshot (1)I write a lot about bad doctors and deficient hospitals. I have to salute everyone for their caregiving and public safety roles in a terrifying, tragic, chaotic, and stressful event whose carnage will continue on for many for some time.

Kudos, too, to an Illinois charity for rushing to the scene some four-legged comfort−a dozen golden retrievers specially trained to help patients, caregivers, and others with healing. If a picture says a thousand words, photographer John Taggart’s shot in the New York Times is moving.

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