One afternoon this fall, as Dr. Ian Sklaver was coaching his 13-year-old daughter’s soccer team, one of the players suddenly collapsed and stopped breathing. Her skin took on a blue pallor, and her pulse was thready, barely there.
Sklaver, who practices at Garden City Pediatrics in Beverly, Massachusetts, immediately started CPR and called 911. We need an ambulance, he told the dispatcher urgently, giving the name of the school he was at and the street it was on.
The dispatcher asked him a question or two, he recalls, “and then asked me the bewildering question of ‘What town are you in?’ And I told them, and then they reconnected me to another person to re-tell the same story again — which seemed to be taking a lot of time away from doing CPR.”
Fortunately, the player was fine — but Sklaver was left mystified.
He has Google Maps, Find-My-iPhone and other free apps, he said, “that can find me to the exact street address. And I call 911, the most important call one could potentially make,” and he’s asked what town he’s in.
So — if apps like Google Maps and Uber seem to know just where your phone is, why doesn’t the 911 system?
The answer is sadly simple. The 911 system “is based on technology that was developed almost 40 years ago,” said Brian Fontes, CEO of the National Emergency Number Association, a nonprofit that focuses on 911 issues.
“And it was designed for a wired-only world where you have your wired phone tethered to a fixed address,” he explained. “Much has changed, obviously, over the years, and today roughly 75 or 80 percent of 911 calls come in from wireless devices.”
Back when cellphones were new, the 911 system could only map which tower had relayed a given call. In recent years, with GPS, the system has gotten much better at locating cellphone calls. But it is still behind commercial apps.
“The system that we’re using now is essentially using 10- to 20-year-old technology that was really good at the time it was implemented but has been overtaken by the technology that’s in smartphones,” said David Furth, deputy chief of the Public Safety and Homeland Security Bureau at the Federal Communications Commission.
“The problem is that bringing the 911 system up to the same technological level as all of our smartphones is something that takes time,” he said, “because you can’t just flip a switch and change out the technology overnight.”
Nationwide, there are more than 6,000 centers that take 911 calls, Furth noted, along with a complicated network infrastructure to deliver the cellphone calls and try to locate them to within 50 meters.
“All of that has to be changed” and upgraded, he said, to realize the potential of using smartphone information. That work is under way, Furth said, as part of a national push toward what’s called Next Generation or NG911: “Our goal is to bring the 911 system into the 21st century,” he said.
The technology exists, he added — the trick is to connect the sprawling 911 system to it.
So why doesn’t the FCC just do that? Well, the FCC regulates the wireless carriers that the public uses to call 911, but does not regulate the 911 call centers. Control and funding of those call centers lie at the local and state levels.
The FCC can — and has — set new rules for the carriers to improve cellphone location accuracy in the next few years, but it cannot, say, set a timeline for technology upgrades by 911 call centers. It can only create incentives and call for advances, as FCC Chairman Tom Wheeler did recently in a New York Times editorial: “The 911 System Isn’t Ready For The iPhone Era.” Sounding frustrated, he wrote:
“NG911 links 911 call centers to the latest Internet Protocol-based networks, uses mapping databases and software to route calls and pinpoint the real-time location of 911 callers, and supports voice, text, data and video communication …The bottom line is that NG911 will make our 911 system more accessible and more reliable, and it will dramatically improve emergency response.”
So why don’t the local 911 powers just upgrade?
For one thing, they need money to do it. Wheeler calls on Congress to allot federal money for the big shift.
“You have to understand that to deploy this technology requires funding,” said Brian Fontes of the National Emergency Number Association. And it takes leadership, he said, “at the federal, state and local level to place this as a priority, to ensure that citizens in our nation or within our state or community have available to them the latest and best technology when they place a 911 call.”
So meanwhile, what can you do? Here in Massachusetts, the 911 system is already undergoing a major upgrade this year that will let you text to 911 — and eventually, you’ll be able to send them photos and videos. Massachusetts is one of the more advanced states, Fontes said, but many others are doing the same.
But that new technology won’t immediately improve cellphone location, especially indoor accuracy — because that depends on upgrades by the cellphone carriers, which are expected to take years.
Also in the works: Some Massachusetts towns are opting to take 911 calls from cellphones into their own hands, through a program called Wireless Direct.
Right now, if you call 911 from a mobile phone, your call will be routed to one of just four wireless call centers, and then transferred to a local 911 center. Unless, that is, you’re in Boston or on Nantucket, which have the ability to answer their own 911 cellphone calls.
It’s often a two-step process, said Monna Wallace, director of programs at the Massachusetts 911 department: “If you call 911 from a cellphone, it goes to a wireless 911 center — unless you’re in the city of Boston or you’re on Nantucket. And from there, they will transfer it out to the appropriate department that can provide you with the service that you need.”
But “it is quick. It is very quick,” Wallace emphasized. “They verify your location, they verify the problem, they transfer it.”
Though it may not seem quick if, like Dr. Sklaver on the soccer field, you’re in the midst of an emergency.
Beginning this year, Massachusetts 911 officials say, communities that choose Wireless Direct will be able to screen 911 cellphone calls directly in their own local call centers rather than going through the State Police centers. But Wallace and others caution that Wireless Direct may require more local staffing, and a big emergency could overwhelm a small call center.
On an individual level, 911 experts offer a couple of main tips:
• If your emergency happens indoors and you still have a landline, use it, because then the 911 dispatcher will immediately see the address you’re calling from.
• If you’re calling from a cellphone, don’t assume the 911 dispatcher will be able to see where you are; be prepared to explain your location as best you can — and possibly more than once.
Readers, your experiences calling 911 from a cellphone?
Dr. Paula Johnson is a woman of breadth: she can give a speech calling for a new movement in health care comparable to the civil rights movement — with greater access to quality health care for all — and she can also deliver compassion in the clinic with her patients. (I know, she treated my mother years ago.)
Johnson runs the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital, where she’s also the chief of women’s health. She’s also a professor at Harvard Medical School, and on Thursday she was named the new president of Wellesley College.
Johnson was a key driver behind a massive effort to end gender bias in medical research, starting with an exhaustive report on the problem (and a TED Talk that’s been viewed more than 1 million times). When the National Institutes of Health announced it would distribute more than $10 million in grants to help combat a persistent pattern of gender bias in science and medical research, Johnson called it “a significant step” but said much more needs to be done.
She was out front as a cheerleader of the benefits for women from President Obama’s Affordable Care Act; and she was passionate about the importance of the HPV vaccine for both women and men, in particular, when it comes to head and neck cancers.
I asked Johnson, who is also a cardiologist, for a list of her top 10 medical accomplishments, and here, lightly edited, is what her people sent over:
1. Founded the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital (BWH), a Center that has developed a robust interdisciplinary clinical, education, and research program that focuses on how disease is expressed differently in women and men, and integrating that knowledge into the delivery of care.
2. Elected as a member of the National Academy of Medicine (formerly the Institute of Medicine (IOM)), one of the highest honors in the field of health and medicine, and served on the IOM committee that recommended the landmark coverage of preventive services for women under the Affordable Care Act.
3. Established the Gretchen S. and Edward A. Fish Center for Women’s Health. This flagship model of integrated, gender-specific care within an academic medical center continuously applies knowledge gained in leading-edge research to transform the care of women across the lifespan.
4. Founded the Center for Cardiovascular Disease in Women, one of the first programs in the country to focus on the treatment and prevention of heart disease in women.
5. Serves as the commissioner and chair of the board of the Boston Public Health Commission, one of the nation’s leading departments of public health. Under her leadership the Commission successfully introduced a ban on trans fats, as well as the passage of several regulations restricting smoking, the sale of tobacco and tobacco products often targeted to minors, and spearheaded the development of a roadmap to improve access to and the quality of primary care in Boston that included stakeholders from all sectors of healthcare.
6. Serves as a member of the National Institutes of Health (NIH) Advisory Committee on Research on Women’s Health.
7. Featured as a national leader in medicine by the National Library of Medicine.
8. Her 2013 TED talk, “His and Her Healthcare” has had almost 1 million viewers and has helped to raise awareness of the importance of sex differences to understanding women’s health.
9. Johnson conceptualized and convened “Charting the Course: A National Policy Summit on the Future of Women’s Health,” and was the lead author on a report and action plan, “Sex-Specific Research: Why Women’s Health Can’t Wait,” released in conjunction with the Summit. The summit and report provided evidence of the vast inequities that continue to exist in medical research, and outlined clear recommendations to address inequity in medical research. Over the past year, the summit and report have been a catalyst for historic progress not seen since the passage of the landmark NIH Revitalization Act two decades ago calling for equal representation for women in minorities in clinical trials.
10. She is the first African-American physician from BWH to be named a Harvard Medical School Professor in the hospital’s 100-year history. She also served as BWH’s first African American chief medical resident early in her career.Related:
This coming Monday, February 15, we will celebrate the federal holiday, Washington’s Birthday. You may be thinking, “my calendar says Monday is ‘Presidents’ Day,’ not ‘Washington’s birthday!’” Interestingly, the federal holiday is officially called Washington’s Birthday (5 US Code 6103) and is observed on the third Monday in February as established by Public Law 90-361 (82 Stat 250).
Some states also observe Washington’s birthday, but may have different names for the holiday. In some quick research I found “President’s Day,” “Presidents’ Day,” “Presidents Day.” Some states don’t celebrate this day at all and other states include additional presidents in their version of the holiday. Alabama, for example, observes “George Washington / Thomas Jefferson Birthday” and for Montana it is called “Lincoln’s and Washington’s Birthdays.” Another fact I learned was that not all states observe this holiday in February—Georgia observes Washington’s birthday in December.
You can search Congress.gov for legislation proposed to change or modify the federal holiday. Over the years various members of Congress suggested changing the name, date, or adding Lincoln’s birthday as a holiday.
Interested in what holidays your state will observe in 2016? Here is a handy list of states’ websites I compiled listing their official holidays: Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
For this Friday’s “Pic of the Week” I offer a recap of several presidents’ homes from my Virginia Dynasty series. It was a pleasure to visit these historic sites and there are many more outside Virginia. The National Park Service offers a list of presidential sites. Which site is the closest presidential home that you could visit this weekend in observance of Washington’s Birthday, Presidents Day, or whichever version of the holiday your state may observe?
In the midst of the opioid epidemic, there’s a spike in the price of injectable naloxone, the drug used to reverse an overdose.
Evzio, made by Richmond-based Kaleo, is a user-friendly, pocket-sized device. The wholesale price for a kit was $690 when it hit the market in July 2014. In November 2015, the wholesale price rose to $900. At the beginning of February, it increased 500 percent to $4,500.
Health plans in Massachusetts cover Evzio. It’s “a very important component of dealing with the heroin and opioid epidemic,” said Massachusetts Association of Health Plans CEO Lora Pellegrini. “So it’s really shocking to see these price increases and I’m not sure that they’re justified.”
Kaleo CEO Spencer Williamson says the price hike is justified by the behavior of insurance companies. He has a story that explains what he means.More Coverage Of The Opioid Addiction Crisis In Mass.
- Insurers Step In Fight Crisis
- Mass. Sober Home Certification
- Who Is Overdosing In Boston
- Drug Cocktails Fuel The Crisis
- Plans For Heroin ‘Safe Space’
A friend called Williamson last year after the friend’s daughter overdosed on heroin. She survived. The man got a prescription for Evzio, but even thought he had comprehensive insurance, his plan wouldn’t clear the purchase. Williamson says he heard too many such stories about insurance barriers like prior authorizations, high co-pays or deductibles keeping people from filling a prescription for this tool, which he says has saved 702 lives so far.
Patients could opt for the nasal spray version of naloxone, list price $80, but it is more complicated to assemble and use.
So Kaleo came up with a way to keep the cost to patients, at the time of purchase, between $0 and $20. The company hiked the price insurers pay for Evzio and is using most of that money for refunds or savings cards, Williamson said, “to reduce the cost to the patient. The price for individual patients has actually gone down.”
Well, momentarily, but pharmaceuticals are the fastest growing health care expense in Massachusetts. The increased use of high cost drugs is one reason health care premiums continue to rise.
Kaleo has a hotline patients can call to figure out how to get an Evzio kit for $20 or less. And Williamson says the company has distributed 7,000 free Evzio kits in Massachusetts. Two thousand went to police and fire departments. Many first responders say Evzio is great, but too expensive to keep using.
A spokeswoman for Attorney General Maura Healey says the office is aware of the Evzio price hike.Related:
As he waits on the Legislature to compromise over opioid abuse prevention strategies, Gov. Charlie Baker on Thursday detailed an agreement reached with the deans of the state’s three dental medicine schools to introduce training for opioid abuse prevention and management into their core curriculums.
The governor, who has reached similar agreements with the heads of the state’s medical schools over improved training of future physicians to deal with pain management and substance abuse, continues to take steps on his own to chip away at the substance abuse crisis and the proliferation of addictive opioids.
Baker betrayed little frustration with the pace of action in the Legislature, despite calling it “critically important” for the House and Senate negotiators to deliver a bill to his desk.
“I know that they are trading proposals. I know that it’s an active conversation that’s going on, and my hope is that it will be able to land in a place that works for both the House and the Senate sooner rather than later. I would be more concerned about this if there wasn’t any back and forth going on with respect to the issue, but there is,” Baker said.
Baker met privately before holding a press conference with representatives from the Harvard, Tufts University and Boston University Schools of Dental Medicine, as well as Massachusetts Dental Society President-elect Raymond Martin, Health and Human Services Secretary Marylou Sudders and Public Health Commissioner Monica Bharel.
“The fact is that over 80 percent of those prescriptions which are diverted or misused comes from prescriptions written by physicians an dentists,” said Dr. David Keith, a Massachusetts General Hospital oral surgeon who is also on the faculty at the Harvard School of Dental Medicine.
Keith called it a “unique opportunity” for the dental schools and the MDA to “come together to educate our dentists and advanced dental trainees in the correct prescribing of opioids,” including alternative pain management techniques and proper referral practices to other disciplines.More Coverage Of The Opioid Addiction Crisis In Mass.
- Insurers Step In Fight Crisis
- Mass. Sober Home Certification
- Who Is Overdosing In Boston
- Drug Cocktails Fuel The Crisis
- Plans For Heroin ‘Safe Space’
While the agreement will directly impact the 1,800 undergraduates and 550 graduate students studying dental medicine in Massachusetts, Sudders said the group had also discussed how to “teach up” to practicing dentists who may have become set in their prescribing practices.
Martin said dentists currently take part in continuing education programs designed for general medical professionals, including physicians, but will be working to tailor programs more specifically to dentistry and oral pain detection and management.
Baker said his administration has fully implemented 21 recommendations from his opioid task force, and is in the process of implementing 24 more. The governor said he has also invested or proposed more than $250 million in new funding for treatment and prevention, started a bulk Narcan purchasing program, launched a media campaign to raise awareness and opened the fifth recovery high school in Worcester.
Sudders said an overhaul of the prescription monitoring program to make the database easier for doctors to access and use when prescribing opioids should also be ready by summer.
A House and Senate conference committee has been negotiating a comprehensive substance abuse prevention bill since Jan. 20, reaching quick compromise on one piece to stop the civil commitment of women with drug abuse problems to a Framingham prison, and instead refer them to a hospital treatment setting.
Legislation to address the deadly opioid crisis was flagged as a priority of Republicans and Democrats at the outset of the 2015-2016 session. The Senate passed its bill on Oct. 1, 2015, Baker filed his proposal in October 2015 and the House approved its bill in January 2016.Related: