Medicare’s proposed demonstration project to test new ways to pay for drugs covered by Part B has generated considerable controversy. A largely Republican House group has urged the Centers for Medicare & Medicaid Services (CMS) to withdraw the proposal, while AARP and other
Frozen vegetables are a staple in many diets, so a huge recall of them has us peering at the packages in our freezers.
On Tuesday evening, the U.S. Centers for Disease Control and Prevention announced an outbreak of the Listeria monocytogenes bacteria and frozen vegetables and fruits are believed to be the cause.
More than 350 products like green beans, broccoli, peas and blueberries sold under 42 brands at U.S. and Canadian grocers including Safeway, Costco and Trader Joe’s have now been recalled.
Here are the four things to know about listeria and this massive recall:
Listeria is deadly.
Listeria is the most lethal of foodborne pathogens. Most healthy immune systems can keep an infection at bay, but if the bug makes it into the bloodstream, it causes listeriosis and kills one in five victims.This KHN story also ran on NPR. It can be republished for free (details).
Older adults, pregnant women, newborns and those with weakened immune systems are at higher risk of infection. People 65 and older are four times more likely to get sick from listeria than the general population, and pregnant women — who may not develop listeriosis themselves but whose babies could be threatened — are 10 times more likely.
So far, the CDC knows of eight people who have been sickened — six in California and one each in Washington and Maryland. The Washington and Maryland patients died, but listeria was not considered the ultimate cause of death. The patients were between 56 and 86 years old.
New tools led to this recall.
The outbreak making headlines today began in 2013 with one illness, followed by five in 2015 and two in 2016. It may seem as if this outbreak is unfolding in slow motion, but that is because the CDC has a new tool to track the bacteria’s spread: the sequenced genome of listeria.
While investigating a small cluster of 2016 illnesses, the CDC searched its database of previously sequenced listeria genomes and found matches from bacteria that sickened people in previous years.
CDC’s venture into whole-genome sequencing has allowed the agency to identify more listeria outbreaks, especially more that span longer periods of time. Last year, they announced two outbreaks that began in 2010.
Listeria gets around — and stays around.
The CDC said that frozen vegetables produced by CRF Frozen Foods in Pasco, Washington, are the “likely source” of the illnesses.
Michael Doyle, professor of food microbiology at the University of Georgia and director of the school’s Center for Food Safety, said he thinks that “resident” listeria caused the outbreak. Rather than “transient” bacteria that contaminates a food and moves through the processing system with it, resident bacteria establishes itself somewhere in the machinery and persists over several years.
“The organism’s quite hardy,” he said.
Listeria has been known to plague ready-to-eat deli meats and soft cheeses made with unpasteurized milk, but it’s popped up in surprising foods in recent years.
Last year, Blue Bell Creameries recalled all of its ice cream products after 10 people were sickened by it. One reason listeria differs from other pathogens is that it can grow in cold temperatures.
In 2014, 35 people were sickened by caramel apples, and officials determined that listeriosis contributed to at least three of the seven deaths reported.
And cantaloupe was behind the largest listeria outbreak in U.S. history which sickened 147 people in 2011 and killed 33.
It’s time for a freezer check.
CRF has recalled all organic and traditionally grown frozen vegetable and fruit products processed at its Pasco facility since May 2014 and suspended operations there last week.
Check the UPC codes and “Best By” dates on the vegetable packages in your freezer against the FDA’s list. If they match, you can return the recalled food to the store for a refund or simply discard it.
Either way, don’t eat the recalled foods.
If you did eat them and have symptoms such as fever, stiff neck, confusion, loss of balance and convulsions seek medical care. Sometimes listeriosis symptoms develop up to two months after eating contaminated food, but they usually start within several days.
If you’re expecting, you might want to do some homework before choosing the hospital where you’ll have your baby. According to a report released Thursday, most hospitals overuse some medical interventions that can create health risks for both mother and child, while falling short in meeting other safety standards.
The report comes from the Leapfrog Group, a nonprofit organization that rates hospitals and emphasizes patient safety, working in conjunction with San Francisco-based Castlight Health, a company that compares quality and price among health care providers.
Researchers surveyed 1,750 hospitals, or about 46 percent of hospitals across the country, and rated them in four areas to gauge how safe women are when giving birth. Leapfrog’s maternity care expert panel devised the nationally standardized metrics, which outside experts also said aligned with reasonable best practices.
About 60 percent of hospitals give too many women cesarean sections, Leapfrog found. That meant hospitals performed the procedure on more than 24 percent of low-risk new mothers, exceeding the federal recommendations that Leapfrog’s panel used to determine its standard. Meanwhile, almost 7 in 10 hospitals used episiotomies — a surgery that widens birth canals — for more than 5 percent of women, the maximum amount the expert panel deemed reasonable. That’s also contrary to recommended best practices against the procedure’s routine use. And just under 80 percent didn’t have clinicians practiced in delivering babies who weigh less than 3.5 pounds.Use Our Content This KHN story can be republished for free (details).
For expectant mothers, “this can be a cause of concern,” said Erica Mobley, a spokeswoman for Leapfrog. For instance, “If you are looking at a few different hospitals, and one or two have a high risk of C-section, you are at a greater risk of having a C-section when it may not be needed.”
That matters. Public health advocates have noted the number of women opting for unnecessary C-sections is climbing — a trend that poses risks for both mothers and children. Almost 1 in 3 women had C-sections in 2014, most of which experts say would not be considered medically necessary. (2014 is the most recent year for which the Centers for Disease Control and Prevention has data.) That’s compared with about 20 percent in 1990. For particularly risky pregnancies, the surgery can be helpful, but it also exposes mothers to the risk of infection and blood loss, and puts children at risk for chronic illnesses.
“This is a major surgery,” said Terrie Inder, a neonatologist who chairs the department of pediatric newborn medicine at Boston-based Brigham and Women’s Hospital. “I do think there is a gap in knowledge.”
The report did highlight some positives. Far fewer hospitals — 16 percent — are choosing to deliver babies before they’ve reached 39 weeks, a practice that doctors say can increase risks to a baby’s health. Six years ago, 17 percent of babies were delivered before this point, though doing so wasn’t medically necessary. That number’s now shrunk to about 3 percent.
Meanwhile, where women go for care can have a marked impact on that care’s quality, the Leapfrog report notes. Even within the same city, one hospital may be five times as likely as another to deliver C-sections. That variance also means women can shop around to find the hospital most likely to take good care of them, Mobley said.
“What is great about maternity care is it is truly a shoppable health care service,” Mobley said. “You have nine months or a little less to think about where you want to give birth.”
But that assumes someone’s insurance plan includes hospitals with low rates of C-sections or episiotomies. That, Mobley acknowledged, isn’t always the case — though she added that insurance companies should consider these kinds of quality metrics when deciding which hospitals to include in their networks.
Some are starting to. Covered California, the state’s health insurance exchange, announced in April that future plans won’t include hospitals that fail to meet the federal guidelines for C-section rates.
There are also other efforts underway to curb unnecessary C-sections, noted Katy Kozhimannil, an associate professor of health policy and management at the University of Minnesota, who specializes in women’s health.
Historically, hospitals have been paid much more for the surgeries than for traditional vaginal birth. Payers are starting to shift away from that, she said.
At the same time, Mobley said, regulations shouldn’t go so far as to keep people from getting procedures that could help. That’s a real concern, argued Helen Haskell, a patient safety advocate.
Curbing unnecessary surgeries matters, she said, but “the only problem is nobody is measuring the consequences of that. So you don’t really know if you’re causing harm — If there are people not getting C-sections who should be.”
The Leapfrog report highlights other concerns. Women with high-risk pregnancies don’t always have options for getting the best treatment. In Missouri, for instance, none of the hospitals responding to the survey met the expert panel’s standard for taking good care of women in this category. That’s not true in Massachusetts or Ohio, where between 30 and 50 percent of hospitals did meet the expert panel’s standards. And that access problem is exacerbated in rural areas, Kozhimannil noted, where it’s harder for women to get to the best facilities.
But there is widespread interest in addressing those gaps, she said.
“Some of the risks women are facing are issues that, as a health care delivery system, we can reduce,” she said. “There are many great clinicians working to make sure that experience is better and safer for more women.”
Starting June 9, terminally ill Californians with six months or less to live can request a doctor’s prescription for medications intended to end their lives peacefully.
If that sounds simple, it won’t be.
California’s End of Life Option Act creates a long list of administrative hurdles that both patients and their doctors must clear.
For instance, you must make multiple requests for the drugs, orally and in writing, and provide a written attestation within 48 hours of taking the medication (you must be able to take the drugs yourself, without help, to qualify).
Two doctors must confirm your diagnosis, prognosis and ability to make medical decisions, and you must prove you’re a California resident.
And more.Use Our Content This story can be republished for free (details).
“This will not be an on-demand service,” says Sarah Hooper, executive director of the UCSF / UC Hastings Consortium on Law, Science and Health Policy.
“The patient has to jump through a lot of hoops before accessing the prescription. Those hoops are designed to ensure that the patient has really thought about this and is making the decision voluntarily.”
California will be the fifth state to implement an aid-in-dying law, and the Golden State’s version of it is considered the most stringent, says Sean Crowley, spokesman for the advocacy group Compassion & Choices.
Rather than list every requirement, I’m going describe a few potential challenges you might face if you or a loved one is considering asking for these medications — from doctors who are unwilling to write prescriptions to the cost of the medications themselves.
Let’s start with the doctors.
This law is voluntary “every step of the way,” says Democratic state Sen. Bill Monning, co-author of the law.
That means everyone — patients, physicians, health systems and pharmacies — gets to choose whether or not to participate.
Nothing requires patients to take the drugs once they have obtained a prescription.
Since Oregon implemented its law in 1997, more than one-third of people who obtained prescriptions didn’t take the medications, according to data compiled by the Oregon Public Health Division.
“You can still at any point decide, ‘I’m not going to need this. The hospice care is effective. The palliative care is effective,’” Monning says.
But before you can make that decision, you must first get a prescription — and that might take some doing. That’s because not all health care providers will be on board with the new law. It will be up to you to find the ones who are.
“Patients and families should expect that they will have to be a little proactive in asking questions and getting educated about their care,” Hooper says.
For instance, the Kaiser Permanente system will participate, and patients will be paired with a coordinator to guide them through the process, says spokeswoman Amy Thoma.Ask Emily
A series of Q&A columns answering consumers’ questions about California’s new medical world.
Send questions for Emily to AskEmily@kff.org
If your Kaiser Permanente doctor chooses not to participate, which is his or her right under the law, your coordinator will connect you with a physician who does, Thoma says.
But U.S. military veterans who receive health care from the U.S. Department of Veterans Affairs will have to look elsewhere for participating doctors, because federal law prohibits the use of federal money for such a purpose, Hooper says.
Nor will the 48 Catholic and Catholic-affiliated hospitals in California participate, including their doctors and staff, says Lori Dangberg, vice president of the Alliance of Catholic Health Care.
Dangberg insists that those providers will not abandon any patient who chooses to end his or her own life. “We will be with that patient and continue to care for that patient throughout their diagnosis and their dying process,” she says. “We just cannot participate in any action that would intentionally hasten a person’s death.”
If your doctor doesn’t participate, ask him or her to refer you to one who does. If your doctor won’t provide a reference, “call us and we can probably help,” says Crowley of Compassion & Choices. That number is 800-893-4548.
Another potential obstacle is the cost of the drugs. Your insurance might not cover them. California’s law does not require health insurers to cover the medications, Monning says.
In Oregon, Washington and Montana — states with aid-in-dying laws in place — some health plans cover the cost and some don’t, he says. He expects the same to occur in California.
Insurers “are currently working on how they will implement this law,” says Nicole Kasabian Evans of the California Association of Health Plans.
If you have questions about coverage, she suggests you contact your insurer directly.
Medi-Cal, California’s version of the federal Medicaid program for low-income residents, will cover the cost of the drugs without relying on any federal money, says state Department of Health Care Services spokeswoman Katharine Weir.
If affordability becomes an issue, Compassion & Choices again urges you to call. “We try to work with people to find a way for them to access the law, through any challenges,” Crowley says.
If you need more step-by-step guidance about the law, tap into these resources:
- Compassion & Choices has online guides for consumers and doctors at www.EndOfLifeOption.org. You can also call the group’s help line at 800-893-4548.
- The UCSF/UC Hastings Consortium on Law, Science and Health Policy has a helpful fact sheet at http://bit.ly/248Z2l6.
- The California Medical Association, which represents doctors, has a detailed, 14-page document at www.cmanet.org/endoflife. You’ll need to register on the site to read the document.
- Once the law takes effect, or soon thereafter, you will be able to find the forms you and your physician need to sign at the Medical Board of California’s website: www.mbc.ca.gov.
The American Association of Law Libraries (AALL) Emerging Leader Award recognizes the contributions of newer members and their potential leadership and service in the profession. Law Library of Congress Legal Reference Specialist, Andrew Winston has been named one of this year’s Emerging Leaders. AALL is a national association which allows law librarians from county law libraries, law schools, law firms, and government agencies to connect and learn from each other. AALL also recognizes law librarians through various awards for “service to the profession and contributions to legal literature and materials.” Andrew will officially receive his award at the 2016 AALL annual meeting in Chicago.
Andrew has been actively involved in law library professional organizations. He currently serves as vice chair of the Bylaws and Resolutions Committee of AALL and will become chair of the committee in July of this year. Last year, he attended AALL’s first Business Skills Clinic, and in 2014 he was selected for the AALL Leadership Academy. We congratulate Andrew on his award and look for great things from him in the future.
I was visiting my friend in the hospital and she had to pee. Walking to the bathroom was not an option: She’d been told not to get out of bed, she felt weak and lightheaded, and she was attached to an IV and a monitor.
She pressed the call button and stated her problem. A voice: They’d let her nurse know. A few minutes later, I stuck my head outside the curtain and scanned the empty hallway, feeling guilty that all I could do was share her frustration.
Then someone pulled open the curtain and smiled in at us. “I need the bedpan, we’ve already called twice,” my friend said. The woman in scrubs, who turned out to be one of the doctors, said she’d take care of it. My friend and I sighed with relief.
But the doctor slipped back out. Taking care of it meant finding someone who knew how to do it. When she returned a couple of minutes later and saw that still nobody had showed up, the good doctor offered to do it herself. She fetched a bedpan and awkwardly slid the pink plastic container under my friend, the whole time apologizing that she didn’t know which end was up.
The current U.S. nursing shortage includes licensed practical nurses and certified nursing assistants, the people who usually manage bedpans. And so hospitalized patients feeling the urge to urinate may have to wait longer than is possible.
If you’re thinking this is a minor issue, think again: Holding one’s urine can set a patient up for a urinary tract infection; the physical discomfort can be a stress on an already sick body, driving up blood pressure and pulse; and waiting with a bursting bladder is a mental stress, too.
The alternative isn’t any better: Consider the shame and discomfort of lying in cold, wet sheets until someone can change them, plus the serious health risks that include skin breakdown and infection. For patients who already have pressure sores, these complications can be life-threatening.
As a doctor myself, I was embarrassed that I didn’t know how to help. I didn’t learn bedpan basics in medical school, or at any other time during my training. I would guess that most doctors, like me, would rather volunteer to hunt for someone else to do this than just getting the job done.
No, it isn’t rocket science to place a bedpan, but it’s easy to bumble by making a mess, leaving the patient in an uncomfortable position, exposing and embarrassing, and so on.
Doing it right involves quite a few logistical steps, including knowing when to wear gloves (and when not to), lowering the head of the bed, instructing the patient to lift her hips, or, if it’s a patient who is less mobile, helping her to roll onto her side (which may involve pulling the so-called pull-sheet under the patient, just so); slipping a disposable pad underneath; draping the sheet to maintain maximum privacy; leaving toilet paper and the call button within reach; and, before leaving the room, remembering to raise the head of the bed, because it’s not easy to do one’s business flat on one’s back. (See the video below for illustrations.)
To be sure, medical students and residents have enough on their plates. If they learn how to do this, one might argue, what’s next? Changing sheets, bathing patients? Time-consuming lessons in the art of moving patients safely?
In many instances, though, helping a patient wiggle onto a bedpan is a pretty straightforward task, and medical school — perhaps during the very first hospital-based experiences — is the place to teach it. This is when medical students are eager to get hands-on experience, when having a task to accomplish is exciting and can make them feel worthy and useful.
Imagine the ripple effect, as these students advance to residency and beyond. Being willing to occasionally wedge a bedpan under a patient’s behind might show, perhaps more than anything else, that they are truly there for the patient. (Even if the next step involves finding a nursing assistant to remove the bedpan and help clean things up.)
I am not suggesting that assisting patients with bedpans should become a regular and expected duty of hospital doctors (or medical students). But in those cases — like with my friend — when a doctor (or medical student) happens to be in the room, and there’s nobody else around, the expectation should be clear. We can wait for years for the nursing assistant shortages to be solved, but there are plenty of patients at this very moment who really need to go.
Anna Reisman, M.D., is an associate professor at Yale School of Medicine and a Public Voices Fellow with The OpEd Project. The video below explains bedpan procedures.[Watch on YouTube]
New Jersey lawmakers in the coming weeks can level the playing field for small, in-state corporations competing with large multistate and multinational corporations that exploit domestic and foreign tax havens to cut their state taxes.