Gov.-elect Charlie Baker is choosing someone he worked with in the Weld administration to lead the largest agency in the state — the Department of Health and Human Services. Baker said Friday he tapped Marylou Sudders for the post in part because of her collaborative spirit.
Several groups are praising his choice, citing Sudders’ work as the former state mental health commissioner and former head of the Massachusetts Society for the Prevention of Cruelty to Children.
WBUR’s Deborah Becker spoke with Sudders and started by asking her why she wants to take over an agency facing several challenges. Their lightly edited conversation is below.
Marylou Sudder: I’m a public servant at heart. In many ways I feel like my entire professional career has been preparing me for a position such as secretary of Health and Human Services. I believe in the tremendous opportunities in the commonwealth. I’ve never shied away from challenges and I have tremendous faith in really good people fixing these problems.
Deborah Becker: Let’s talk about some of those problems, some of which were raised in a recent survey from the National Alliance for Mental Illness. They want to know what the Baker administration will do about hospital emergency rooms holding patients with a mental illness because they can’t find beds in treatment facilities, or over incarcerating folks with mental illness. Are those your priorities?
These are issues I’m very familiar with. I have every confidence that this administration will be looking at the full health needs, and health will be defined as both the physical and behavioral health needs in this administration.
With the many challenges in this field, what do you hope to accomplish?
As I think about the broad scope of health and human services, it’s to maximize the commonwealth’s precious resources to ensure that individuals, families and communities get the services and support they need to be healthy. That’s a broad, aspirational mission. Most important, that we have a child welfare system in the commonwealth that we can all be proud of, that we have strong leaders in our public agencies who inspire folks who come to work every day to carry out the mission of those agencies.
For me it’s about strong leadership, clear leadership, strong managers and providing the supports to our line workers so that social workers can carry out their jobs to keep kids safe and ensure they get the services and supports they need.
So is child welfare a main priority?
Everyone would say child welfare is a main priority. We need a commissioner of child welfare, we need to resolve the lawsuit, we need to implement the Child Welfare League of America’s blueprint for change, that is a priority.
There’s many priorities in Health and Human Services. I will provide the leadership so that state agencies can carry out their missions. We need to ensure that we treat all individuals who come to our agencies with dignity and respect. We can’t solve every problem. We need to partner with hospitals, businesses, and community providers to ensure that the commonwealth’s Health and Human Services are what we expect.
Is that a real issue, that folks are not treated with dignity and respect?
No, it’s just a basic mantra of mine.
Who will be most worried about you taking over this agency?
My husband? [laughs]
People who know my history know that my door is open. I listen to many different perspectives and bring individuals to the table to hear those perspectives and really tackle complex issues. So I hope that most folks will at least give me the benefit of the doubt.
What about the licensing of medical marijuana dispensaries — is there anything you might do to facilitate that process?
That issue and several others are ones that, as we transition into this administration, are ones that I need to understand before I comment on.
What about increasing payments for behavioral health, a long standing issue that probably dates back to your last stint in state government. Any ideas about how to address that?
There’s been a lawsuit filed against the commonwealth around rates for providers. I know this administration is committed to resolving that lawsuit and that will be one of my early initiatives.
Gov.-elect Baker has a plan to deal with the opioid epidemic in Massachusetts. A lot of that plan deals with the prescription of pain medications. How about you?
The research is pretty clear that addiction to prescription drugs leads to heroine addiction. The Department of Public Health has regulated prescription drugs. We will work to partner with all prescribers in the understanding of what the prescription of narcotics does for the potential to other addictions.
That’s before we start talking about the possibility of increasing treatment?
Sudders resigned Friday from all board positions she holds except on the Health Policy Commission. She was appointed to that board as a mental health advocate by Attorney General Martha Coakley. She will eventually leave that seat but will stay on the HPC in the seat reserved for the secretary for Health and Human Services.
A group of Wall Street analysts predicted Friday that enrollment in health law insurance plans will be higher than the 9 million projected by the Obama administration because insurers are aggressively courting new customers and more small businesses are likely to send workers to the online exchanges in 2015.
Health sector analyst Carl McDonald of Citi Investment Research said he expects about 11 million people to enroll in individual health plans, based on his firm’s survey of clients in October.
“I’m more optimistic,” McDonald said at the 19th annual “Wall Street Comes to Washington” roundtable, sponsored by the Jayne Koskinas Ted Giovanis Foundation for Health and Policy.
More aggressive outreach by insurers and fewer glitches with the online marketplaces will create a “robust 2015,” agreed Ralph Giacobbe, an analyst at Credit Suisse.
But the analysts noted continuing challenges for insurers, from improving what McDonald called a “pretty poor” first-year effort to inform consumers about which doctors and hospitals are in their networks, to controlling spending as high-priced drugs hit the market.
Insurers are also projecting that this year’s enrollees will be younger and healthier than those who signed on in 2014, when the average age was 41, McDonald said. That was a problem for insurers who based this year’s premium rates on the expectation they would see younger customers, he said.This KHN story can be republished for free (details).
The analysts agreed that enrollment would be unaffected by the Supreme Court’s decision to hear a lawsuit challenging the provision of subsidies to residents of states that are relying on the federal exchange. Only 14 states ran their own marketplaces this year.
Nick Leventis, an independent health care sector analyst, said concerns about the case are overblown because the government “could easily give some type of waiver to the states to shift from the federal to the state exchange.”
But McDonald was less sanguine, although he said insurers are already discussing workaround ideas with state insurance officials. Still, he said that not all of the states would act if the court invalidated the subsidies. Some governors and state legislators would be unlikely “to do anything to help reform,” he said.
Giacobbe predicted that governors and lawmakers in such states would be under great pressure, not only from the hospital and insurance industries, but also from consumers, to find ways to keep the subsidies flowing.
It’s hard to take away a program once people are using it, he said, predicting, “This is not going to derail the ACA.”
Should subsidies be cut off by a ruling from the Supreme Court, the marketplaces where the subsidies were no longer available would essentially cease to function since all but the sickest customers would likely drop coverage, the analysts said.
When Eli Davis was 15, his ski popped off in the middle of a steep, bumpy slope and he went suddenly airborne, then landed hard, the back of his head slamming down against unyielding ice. That was his first concussion.
A few months later, at soccer camp, he was defending the goal when a breakaway player took a shot from just five feet away and it rocketed right into his face. He finished the game, but he remembers thinking, “Oh…That was not a normal hit.” Another concussion, a worse one.
So far, so familiar. Efforts to expand awareness about the risks of concussion have exploded in the last few years, changing youth sports that had long been more cavalier about hits to the head. Coaches and parents take courses on identifying and treating concussion. Most know to err on the side of caution with head injuries — “When in doubt, sit ‘em out” — and watch for the telltale symptoms that may follow, from dizziness to headache to brain fog.
What fewer know, however, is that while most concussions clear within several days or weeks, a small minority of cases last much longer — like Eli’s.
For months after the soccer injury, he suffered a mild headache that would not subside; grogginess and fatigue; sensitivity to light and noise; an inability to think hard that made learning impossible. He found himself stuck on the couch at home, feeling ever more “cabin sick,” when he wanted desperately to be back at school and on the soccer field.
“You can only watch so many seasons of ‘Lost,’ ” he says.
Dr. Neal McGrath, a neuropsychologist and nationally known expert on concussion, estimates very roughly that perhaps 10 to 15 percent of kids with concussions have “longer, tougher recoveries,” often when they’ve accumulated too many concussions, or their injuries have come too close together. That probably amounts to thousands of American children living through prolonged concussion recoveries each year, he says.
Now, Eli’s parents, Robin Friedman and Al Davis of Brookline, Massachusetts, are creating an online venue where those kids and their families can connect, learn from each other and from authorities like Dr. McGrath, and gain support for the long haul they may face.
Professional Web and video content creators who specialize in patient education sites, Friedman and Davis are in the midst of shooting videos like the one above and the others in this post for a site they’ll call Connect2Concussion. They’re trying to fill a void they found as parents groping their own way through post-concussion recovery and all the dilemmas it entails.
Though Eli is thriving now as a sophomore at the University of Massachusetts, his parents still vividly remember how frightening and confusing his condition was in high school. They were worried at first by each day of school Eli had to miss, Friedman says, then scared by how long his symptoms lasted.
“We just didn’t get it,” she says. “With a broken bone or a sprain, you can take an X-ray and you can see it’s healed, and then you know what to do,” she says. “With concussion, they just send you home. It could really be two days or it could be two years, and everything in between, because every child is different, every injury is different and every recovery is different.”[Watch on YouTube]
“It gets crazy,” Davis adds, “because every day that goes by, it’s like sand going through an hourglass. You have no idea. You don’t know if he’s going to be OK on Friday, next Monday or two months from now. And what we’ve learned subsequently is that two months from now is actually a reality for people. A year from now is a reality for people. Or it could be three days and everything is good to go.”
Concussion is very manageable, McGrath emphasizes. “But there are do’s and don’ts, if you will, many involving regulation of physical and cognitive activity, that people should understand, going into recovery. And when symptoms are ignored or mismanaged, there’s the risk that the person in recovery can feel stuck, or actually have symptoms become more intense.”
Eli was prescribed the standard treatment: rest, particularly “cognitive rest,” which his parents learned meant he should limit or avoid activities like texting, computer work, even reading. Cognitive rest is the universally accepted recommendation for the first stage of recovery, McGrath says. But it can be very challenging in practice.
“You can’t take a teenager and put them in a dark room or suspend them in animation until they get better,” Davis says. The situation calls for the art of compromise often familiar to parents of teens, he says: “You have to say, ‘Maybe your friends can come over tonight for a couple of hours.’ or ‘You can watch “Lost” but just don’t get too involved in it!’ You have to find a way to mediate the recovery.”
This balancing challenge is the kind of area where the website in the works can really help, McGrath says. Visitors will hear stories about “the person who tried to do too much. You hear about the person who balanced it well. You hear about the person who maybe even went too far in the direction of rest and withdrawal from normal activities.”
“You hear extreme stories about people thinking, ‘If I have a concussion, I have to go home, I have to stay in a dark room until all symptoms are gone. I can’t even look at my phone or a TV, as if it’s Superman and Kryptonite. And nothing could be further from the truth. In fact, if you put someone in those extreme circumstances — particularly an adolescent, for whom it’s extremely important to stay connected to their peers — you often get a lot of other difficulties you didn’t count on.”
Perhaps the hardest dilemma for parents of a child recovering from a concussion is deciding when it’s safe enough to return to the sports arena.
Eli had dreamed of playing on the high school’s varsity soccer team his whole young life, Friedman says, and insisted on trying out soon after his goalkeeping injury. He made the junior varsity team, but within weeks, she says, he confessed to her that he just wasn’t feeling well enough to play.
She faced the decision: “If I pull him off the team, he’s done. If I don’t, I’m jeopardizing everything: his academics, his possible recovery.” She hopes the Connect2Concussion project will help empower other parents as they make such decisions about what’s best for their children, she says. As for her, she told Eli he was off the team.
“You are staying home,” she said, “and you’re going to recover.”
Davis confesses that he was a bit slower to let go of soccer for Eli; he knew quitting the team would hurt Eli in the coaches’ eyes. But his son helped him along, he says: “At some point, he looked at the two of us and said, ‘I don’t care about soccer. I care about the rest of my life.’ ”
Eli was lucky in that his school, Brookline High School, already had a program to help returning students with medical or emotional problems who can’t handle the full onslaught of a big, hard-driving high school. It offers them a safe and quiet retreat at school, staffed by social workers.[Watch on YouTube]
But as Friedman and Davis have been gathering interviews, they’ve heard that not all school systems are as accommodating. In the video above, one mother whose daughter is still recovering describes the resistance she ran into at school.
McGrath and his staff focus some of their efforts on “educating the educators,” he says, helping them strike the delicate balance needed with long-term concussion recovery.
High school teachers tend to be skilled at holding students to high expectations; but “suddenly, when you have a student with a concussion, we’re asking them to shift gears and expect less of the student for a time — even though he or she may look perfectly healthy — and recognize that too much normal academic activity for some recovering students may cause a real increase in their symptoms.”
It’s not an easy adjustment for students, either, if they’re highly motivated. “The anxiety around keeping up in school can get very high, very fast,” McGrath says. “And that’s where we want the message to the student to be, ‘Look, you can only push so hard right now. We’re going to readjust expectations for you on a temporary basis. We’re going to go at your pace, allow your concussion recovery to happen, and once it does, we’ll get back to all the normal expectations.’ ”
Students may need to hear that again and again, he says.
Through Eli’s high school years, Davis and Friedman became experts on that message, and learned volumes about concussions and recoveries in general. Willy nilly, they became “go to” experts on concussions in their community.
But they’re not in any way trying to replace the individual medical advice of a physician, they say. What they’re creating is called “peer-to-peer education,” which can have a special power all its own — but they filter it through McGrath’s expertise. Also involved in the project is Brookline recreation director Lisa Paradis, who is active in concussion programs nationally.[Watch on YouTube]
So how is he doing now?
“I’m normal — I think,” he says. “I haven’t felt any symptoms in a while, not at all.”
And, not to try too hard to make lemonade, but did he learn any valuable lessons from his concussion saga?
“Yes, I learned patience, definitely,” he says. And “I learned how to look at the big picture…”
By Richard Knox
Americans over 65 are apparently sicker than their counterparts in 10 other developed countries, according to a new international comparison.
But this raises a big question. Are American elders really sicker than those in other rich nations? Or are their illnesses just more likely to be diagnosed (or over-diagnosed) than elsewhere?
The mystery is deepened by another fact: As a group, the rising demographic of Americans over 65 are younger on average than elderly populations in the other 10 countries. But they’re three times more likely to have two or more chronic conditions than those in the United Kingdom.
Also, American elders are 21 percent more likely to have multiple chronic diseases than those just across the border in Canada, and 40 percent more likely than Germans.
“Fourteen percent of the U.S. population is over 65, versus 21 percent of the German population,” study author Donald Moulds says. “This is really quite a difference, So the fact that we have a younger population with more chronic conditions is particularly alarming.”
Alarming, he says, because of what it means for the future of Medicare, the federal program that pays medical bills for the elderly and disabled, as the U.S. population continues to age. Already, nearly half of Medicare’s $300 billion-plus budget is spent on the 14 percent of beneficiaries with six or more chronic conditions.
The new numbers come from a survey of nearly 16,000 over-65 citizens in 11 nations conducted by the Commonwealth Fund and published online Thursday by the journal Health Affairs. Other than the U.S., the U.K., Canada and Germany the countries studied are Australia, France, the Netherlands, Sweden, Norway, Switzerland and New Zealand.
Moulds says the study can’t answer why American elders report more chronic illness than those in other peer nations. Partly it may be due to the spotty access to medical care that many Americans have had before they turned 65 — and before the Affordable Care Act began to expand coverage.
“If you think about chronic conditions like diabetes and heart disease, these aren’t conditions that people wake up when they’re 65 and suddenly get them,” says Moulds, who is executive vice president of the New York-based Commonwealth Fund. “They develop over a lifetime.”
There’s another way older American are worse off than their counterparts in developed countries. They spend a lot more out of their own pockets on medical care, despite having Medicare.
One reason: American elders are the most medicated among those in the 11 countries. More than half are taking four or more prescription drugs. In Switzerland and France, only 29 percent are.
About one in five U.S. elders spends $2,000 or more out-of-pocket for care. The same proportion say cost deters them from care — from going to a doctor when they have a medical problem, from getting a recommended medical test or treatment, or from filling a prescription or taking medication as prescribed.
That’s twice the proportion of seniors in most of the other countries who spent that much out-of-pocket or say that cost is a barrier to seeking care.
And even though the United States spends far more on health care than the other 10 countries — often twice as much per person — American elders don’t have equal access to care. Fifty-seven percent say they can get a same-day or next-day appointment for care when they’re sick, compared to 83 percent in France and New Zealand, 81 percent in Germany and 65 percent in the U.K.
Only Canadians have worse access to routine care — 45 percent say they can get timely appointments.
When they do get seen, American elders are most likely to report that their care is poorly coordinated. Almost one in four say their medical records or test results were not available or tests had to be redone. They’re most likely to say they’ve gotten conflicting information from different doctors.
But there are some ways in which the U.S. system does better. American elders have the best access to specialists. Their doctors were among the most likely to counsel them about diet and exercise.
And the U.S. system is ahead of others when it comes to end-of-life care. More than three-quarters of older Americans say they’ve talked with their caregivers about the kind of treatment they want if they can no longer make decisions for themselves. And two-thirds have appointed a health-care proxy — someone authorized to make treatment decisions when they cannot.
Marylou Sudders is poised to be named Gov.-elect Charlie Baker’s new head of health and human services, a Baker aide has confirmed to WBUR.
Sudders is the state’s former mental health commissioner.
State House News Service reports:
Sudders, an associate professor of health and mental health at Boston College’s Graduate School of Social Work, was recruited by Baker to state government in the mid-1990s and served as commissioner of mental health under Republican Govs. William Weld, Paul Cellucci and Jane Swift from 1996 until 2003. She held a similar position in New Hampshire.
Health and human services is the state’s largest executive agency.
The formal appointment is expected later Friday.
Nathan discussed the cornerstone of the exhibition, the 1215 Lincoln Cathedral Magna Carta. He spoke about its physical condition, the history of its birth at Runnymede, England and its significance through the ages.
There were over 65 individuals who attended the talk – a record gallery talk crowd for the Library! Please consider joining us for these upcoming talks:
December 3, 2014. Margaret Wood, a senior legal reference librarian in the Law Library of Congress, discusses King John and life in medieval England at the time of Magna Carta’s enactment. The program will take place in the South Gallery, on the second floor of the Thomas Jefferson Building, from 12:00 p.m. until 1:00 p.m.
December 10, 2014. James Martin, a senior legal information analyst in the Law Library of Congress, presents “The Merriman Case and the Writ of Habeas Corpus.” The program will take place in the South Gallery, on the second floor of the Thomas Jefferson Building, from 12:00 p.m. until 1:00 p.m.
January 7, 2015. Robert Brammer, Law Library, and Eiichi Ito, Asian Division, co-present on military authority and the internment of Japanese Americans during World War II. The program will take place in the South Gallery, on the second floor of the Thomas Jefferson Building, from 12:00 p.m. until 1:00 p.m.
January 14, 2015. Nathan Dorn, exhibition curator, will discuss highlights of selected items from the exhibition. The program will take place in the South Gallery, on the second floor of the Thomas Jefferson Building, from 12:00 p.m. until 1:00 p.m.
Below are photos of the exhibition space and banners.
Remember, the exhibition runs through January 19, 2015. If you cannot visit the exhibition in-person, an online exhibition is available as well.
Many People Who Auto-Enroll in Federal Marketplace Health Coverage for 2015 Could Pay More Than They Should
Freedom of peaceful assembly is a recognized right under international human rights law. This report provides a comparative review of one aspect of this right: whether advance notification or authorization is required for an assembly to take place under the law of France, Italy, Portugal, Spain, Sweden, the United Kingdom, and the United States. The report also reviews the relevant case law of the European Court of Human Rights.
Visit http://www.loc.gov/law/help/peaceful-assembly/index.php to read the entire report.
This report is one of many prepared by the Law Library of Congress available at http://www.loc.gov/law/help/current-topics.php.