Health officials in the central Massachusetts town of Westminster say they will not hold another public hearing on their proposed first-in-the-nation town-wide ban on tobacco sales, after a rowdy crowd of hundreds forced Wednesday night’s meeting to end in just 20 minutes.
Board members began the hearing with warnings that if the crowd couldn’t remain calm and respectful, they would end the meeting.
The hearing was dominated by opponents of the ban, such as Westminster resident Kevin West.
“I find smoking to be one of the most disgusting habits anybody could possibly do. On top of that, I find this proposal to be even more of a disgusting thing that anybody could ever give any town in the United States of America,” he said.
When repeated efforts to calm the crowd, which erupted into applause a number of times, failed, the meeting was ended and health board members were escorted out by police.
Instead of another meeting, the board will accept written comments through the end of the month.
Millions of low-income children are failing to get the free preventive exams and screenings guaranteed by Medicaid and the Obama administration is not doing enough to fix the problem, according to a federal watchdog report.
The report, released Thursday by the Department of Health and Human Services’ Office of Inspector General (OIG), says the administration has boosted rates of participation but needs to do more to ensure that children get the regular wellness exams, dental checkups and vision and hearing tests. The report notes that 63 percent of children on Medicaid received at least one medical screening in 2013, up from 56 percent in 2006, but still far below the department’s 80 percent goal.
Only Iowa and California exceeded that standard last year. Alaska and Ohio were below 40 percent. Five more states — Mississippi, Montana, North Dakota, Oregon and Wyoming — were between 40 percent and 45 percent.
Child health advocates cite several factors for the low rates, including a shortage of doctors treating Medicaid patients, states’ low pay for providers and parents’ lack of awareness about the importance of the visits.
Both children and taxpayers pay a steep price when children’s health problems are not caught early.
“We end up with kids who are sicker, with more long-term, serious medical issues that are more expensive to treat,” said Jennifer Clarke, executive director of Public Interest Law Center of Philadelphia.
Some experts say that state officials — not the federal government— bear most of the responsibility for low screening rates because they administer Medicaid, the state-federal program for the poor. They say states need to step up oversight over the private Medicaid health plans that many contract with to cover children in the program.
“The federal government is working hard on this, but the only power they have over states is to take away their funding and that is highly unlikely,” said Jane Perkins, legal director of the National Health Law Program.
Congress introduced the Medicaid benefit, known as the Early and Periodic Screening, Diagnosis and Treatment program, or EPSDT, in 1967 so that children would get age-appropriate diagnostic tests, including for vision and hearing, preventive services such as immunizations and treatments. About 32 million children on Medicaid were eligible for the benefit in 2013.
The preventive care program is more generous than those offered by the Children’s Health Insurance Program (CHIP) or private health insurers because it guarantees coverage not just for a wide range of tests, but also the treatments to address health problems. Most states follow the guidelines of the American Academy of Pediatrics, which calls for 13 preventive visits in first three years of life followed by mostly annual visits until age 21.
Boston pediatrician Michael McManus, a member of the academy’s state government affairs committee, said he is saddened by the fact that more than a third of children on Medicaid are not getting at least one regular preventive exam. “We have a lot of work to do,” he said.
Low participation rates have plagued the program for years, according to previous reports by the inspector general’s office and the U.S. Government Accountability Office.
A 2010 OIG report found that 76 percent of children in nine states did not receive all required medical, vision, and hearing screenings, 41 percent of children nationwide did not receive any of the screenings, and more than half did not receive any vision or hearing screenings. All states are required to provide the benefit.
The latest OIG report praised the U.S. Centers for Medicare & Medicaid Services for working to increase screening rates, such as by distributing guides that enable states and providers to share their best ideas. The guides show, for instance, how some states used websites to educate providers and parents. Some states such as New York require Medicaid health plans to educate members about the benefit and what it covers. Neighborhood Health Plan of Rhode Island boosted adolescent screening rates by 40 percent by offering gift certificates for pizza and movie tickets, according to a 2014 CMS report.
Still, the report said, “the underutilization of medical screenings is an ongoing concern.” CMS has done “very little” to encourage providers to complete all five components of an EPSDT medical screening— physical exam, medical history, immunizations, lab test and education, the report said.
CMS had no immediate comment on the report.
Medical screening rates fall off dramatically as children get older, according to federal data that track states’ efforts. For example, about 90 percent of children below the age of 1 get at least one screening. But screening rates drop to 77 percent for kids between the ages of 1 and 2, and 56 percent for those between 10 and 14.
Ohio, which had the lowest rate of children getting regular exams in 2013, attributed its problems to getting Medicaid managed care plans to report their data to the state.
Neva Kaye, interim executive director of the National Academy for State Health Policy, said data collection is an issue for some states but it doesn’t explain most of the low rates. In addition to the shortage of doctors participating in Medicaid, parents often face transportation and language barriers getting children in for the exams, she said.
Dr. David Kelley, chief medical officer for Pennsylvania’s Medicaid program, said that state is working to boost the number of children getting checkups in part by paying bonuses to doctors to do them. He said that the rate of Pennsylvania kids getting the screenings is “in the middle of the pack” and “that is not good enough.”
Clarke, with the Public Interest Law Center, said low Medicaid reimbursement to pediatricians means fewer doctors are available to see poor children and parents face long delays getting their kids in for preventive visits and treatment, if they can get to see them at all.
The center filed a federal class-action lawsuit in 2005 against the state of Florida on behalf of 2 million children in Medicaid saying low reimbursement for Medicaid pediatricians prevented children from getting the health services to which they are entitled. A judge is expected to rule later this month on the case.
Today’s interview is with Stephen Wesson. He’s an educational resources specialist at the Library of Congress. Stephen manages a number of the Library’s K-12 initiatives and blogs for Teaching with the Library of Congress. He does a fantastic job of providing teachers with information about Congress.gov and other areas of overlapping interest such as Magna Carta. He also previously did a guest post on In Custodia Legis, Teaching with the Raw Materials of the Law: Primary Sources and the Legislative Process.
Describe your background.
I moved to Washington from Austin, Texas, which has many things in common with the District: a population of avid readers, a river running through town, and an outsize dome looming over the skyline and over public life. The comparison breaks down when you look at taqueria quality, though, or tolerance for sandals in business meetings.
What is your academic/professional history?
My first career was in educational publishing, where I worked for many years in a number of disciplines. I was fortunate enough to enter that field during a period of transition and was able to collaborate not only with longtime experts in print publishing but also with new arrivals exploring emerging media–the best of both worlds.
How would you describe your job to other people?
In the Educational Outreach division of the Library of Congress, we develop tools and professional development resources that support the effective educational use of the Library’s online collections. Primary sources have tremendous educational power, and as the world’s largest repository of historical artifacts, the Library has great potential for changing the lives of teachers and students. It’s exciting to get to play a part in unlocking that potential every day.
Why did you want to work in the Library of Congress?
The Library has been part of my life since I discovered Alan Lomax recordings in my local public library, and the prospect of helping the greatest cultural institution on the planet reach one of its most important audiences was irresistible. My daily work lets me collaborate with colleagues from a dizzying array of fields and learn from some of the nation’s most creative teachers and students. I discover something new every day, and I can’t imagine that happening any place else.
What is the most interesting fact you have learned about the Law Library of Congress?
I continue to be amazed by the staff of the Law Library of Congress–not only the depth of their subject-matter expertise, but their commitment to supporting the Library’s audiences. Every time I turn around, I discover a new project or a new resource that the Law Library offers. I don’t know when they sleep.
What’s something most of your co-workers do not know about you?
Updated 5:43 p.m.
BOSTON — A town in north-central Massachusetts is considering banning the sale of all tobacco products — the first such sweeping measure in the country.
The proposal has Westminster businesses up in arms, while the town’s health board says it’s concerned about the effects of smoking and minors having access to tobacco products.
At a public hearing tonight, the board of health will hear comments about the proposed ban. The town’s health agent, Elizabeth Swedberg, was unavailable for comment today.
In its proposal, the Westminster Board of Health outlined the harmful effects of tobacco, including evidence that it leads to cancer and respiratory and cardiovascular diseases. The board also said that e-cigarettes could normalize smoking behavior and “serve as a gateway” for ex-smokers to begin smoking again. And the board expressed concern about the allure of tobacco products to minors, saying that despite state laws prohibiting sales to youths under the age of 18, the access to tobacco products by minors is “a major public health problem.”
The proposed ban would prohibit the sale of any product containing, made or derived from tobacco or nicotine that is intended for consumption. Should the ban move forward, first-time violators could be fined $300, and have board of health permits suspended or revoked for further violations.
The American Lung Association and the Massachusetts Public Health Association each said they do not have a position on this specific proposal.
Tami Gouveia, the executive director of the advocacy group Tobacco Free Mass, called the Westminster proposal an important approach to protecting public health. She said boards of health in all communities should look at different policies and approaches to keep their residents healthy.
“It’s important for us to be taking a real hard look at that and to continue to find ways to reduce youth use of cigarettes as well as adult use,” Gouveia said. “When we learned that lead was dangerous when people were exposed and when children were exposed, we removed lead from paint and we removed it from gasoline.”
Gouveia also said the Westminster proposal could help those struggling with nicotine addiction and make it easier for them to quit smoking when they realize the store they frequent can no longer sell tobacco products.
Opponents of the ban say it would hurt local businesses by driving customers — and profits — to neighboring communities.
“It’s hard to understand the point of that [proposal] because they are going to give money to another town, they’re going to crush the business here,” Sula Mello, the manager of Westminster Convenience Store on State Road, said in a phone interview.
Mello said tobacco and alcohol are what bring people into her convenience store. She, like other opponents, also expressed frustration that the decision is being made for the public by a three-person board. And she doesn’t believe the ban on tobacco sales would help people quit smoking.
“I used to smoke, I quit 14 years ago and I can tell you for sure that was my decision,” Mello said. “Nobody can decide for you to stop smoking or not because it’s something that is very hard for you to do it.”
Brian Vincent, who owns Vincent’s Country Store on Main Street, said his store sells about $100,000 a year in tobacco products, but it’s not a large percentage of his overall sales. He said, however, that his tobacco customers often pick up other items and he believes the proposed ban would greatly hinder sales on the other items that people purchase with their tobacco.
“While they’re in those other towns they’ll say, ‘Hey, why don’t I fill up my gas tank while I’m here?’ ” Vincent said. “‘Why don’t I get a takeout pizza for dinner while I’m here [or] go to the hardware store while I’m here?’ It could go on and on. It’s gonna hurt more than just tobacco retailers, it’s gonna hurt essentially every business.”
Vincent has collected more than 1,000 signatures on a petition against the proposed ban. (The population of Westminster is 7,765, according to the town.) He is also holding a rally at 4 p.m. outside his store ahead of tonight’s meeting.
“I’m hoping that enough people will stand up against this with intelligent points being made and comments and opinion that this is not a good fit,” Vincent said. “And hopefully the board of health will throw this out and go back to the town hall with their tail between their legs, so to say.”
The public hearing on the proposed ban will be held at 6:30 p.m. at Westminster Elementary School. The town is also accepting written comments on the proposal until Dec. 1.
— Here’s an Associated Press video report on the proposal:[Watch on YouTube]
It usually happens in spring, the annual back-up of mentally ill kids who need beds in Massachusetts psychiatric hospitals or residential care centers.
But Lisa Lambert, executive director of the Parent/Professional Advocacy League, which works on behalf of mentally ill children and their families, reports that already this fall, the waits are unusually long and the resulting crises severe. (Imagine: a child in severe emotional distress, stuck in an Emergency Room for days. Or stuck in a hospital far from home, because there are no local beds.)
What’s happening? It’s not exactly clear. Might it be that state social service agencies are putting kids into residential care more than usual in the wake of the Jeremiah Oliver case? Is it a longer-term effect of having more community-based treatment for kids? Community care is widely considered a good thing, but it could mean that because children in crisis stay at home longer, their needs are more acute when they’re brought in for care. Lambert writes that the bottom line is that no one seems to be taking responsibility for alleviating the back-up, and the situation is getting dire:
At my office, the phone and emails are nonstop. Often, they spill over to the weekend. A few days ago, we heard from a mom whose 14 year old son had swallowed a bottle of Tylenol. This was his third suicide attempt. She rushed him to the emergency room and got medical treatment right away. But once that was completed, he needed inpatient mental health care. “You have to wait, his mother was told twice a day. “There are no beds.” She’s a smart and proactive parent and was trying every avenue to budge a system that told her there was nowhere to admit her son for treatment. When she called us he’d been waiting for four days and counting.
We are not the only state grappling with this issue. Last summer, the Sacramento Bee reported that hospitalizations for California children and teens had spiked 38% between 2007 and 2012. Nationally, hospitalizations have also increased but at a slower pace than California. Connecticut also reports an increase in children and teens coming to emergency rooms in psychiatric crisis. Data from the state’s behavioral health partnership shows that the number of children and teens stuck in emergency rooms rose by 20 percent from 2012 to 2013.
When a child is put in either a medical (not psychiatric) bed or waits in the emergency room, it is referred to as “medical boarding” or just “boarding.” We are hearing a new term this year: boarding at home. Parents are told their child needs a hospital or other acute care bed (which means they are a danger to themselves or someone else) and then told the child will be “boarded at home.” Unsurprisingly, parents worry both about that child and any brothers or sisters. This happened to Kelly, a mother of an 11 year old boy, Her son was aggressive, diagnosed with a mood disorder and had been hospitalized before. She would have to find someone to care for her five other children if he waited days in the ER. She agreed to “board” him at home and her worst fears were realized when he attacked his younger sister. Charges of neglect were filed against her for failing to protect her daughter and she is angry and frustrated. “I did everything that was recommended, she said. “And now this.”
Read the full post describing the current pediatric psych-bed back-up here: Acute mental health care for kids: A mirage in Massachusetts?
Letting Key Provisions of Working-Family Tax Credits Expire Would Push 16 Million People Into or Deeper Into Poverty
A growing number of doctors, nurses and public health specialists across the U.S. are putting their lives on hold and heading to Ebola-ravaged regions of West Africa. Today, and in the months to come, we bring you the story of one man who is on the ground in Liberia.
John Welch, 33, is a nurse anesthetist at Boston Children’s Hospital, and works with Partners in Health (PIH) in Haiti. At least that was his life before he opened an email from the organization in late September. It was a call for volunteers and support as PIH moved into Liberia and Sierra Leone to try and stop Ebola’s spread. Welch told a supervisor he’d be happy to help if needed.
That decision, says Welch, “was about being on the right side of history. I think I would have trouble looking back, knowing that I had an opportunity, and had not stepped up.”
Calming worried friends and family members was not so easy.
“How does your mother feel?” asks Lindsay Waller, an old friend and fellow anesthetist, who helps Welch prepare to discuss the decision with his family.
She’s upset and worried, Welch says, but “I am who I am because she’s my mother. [My parents] taught me these feelings of altruism and taking care of the people around you and helping out.”
The next day, on a quick trip from Boston to Columbus, Ohio, Welch makes a pitch he knows will resonate with his mother, aunt and sister: 70 percent of deaths from Ebola are women, the caregivers.
He asks his family to sit with him and watch a “Frontline” episode on Ebola. Fear and pain in the faces of patients with Ebola made the point for Welch.
“At first, I wanted to just say, ‘No, don’t go, it’s too dangerous,’ ” says Heidi Christman, Welch’s sister. But then, in the video, Christman says she saw “the brothers and sisters, friends and family that have been lost because of Ebola. And it made me realize that it’s not about me or my fears. It’s about helping these people. They deserve people like my brother.”
Her brother flew to Alabama for a CDC Ebola treatment training and in mid-October, three weeks after Welch said, “I’m in,” he was on his way to Liberia.
It wasn’t an easy journey. There are very few flights in and out of Liberia these days. Welch had several cancellations, spent an extra day in Casablanca, and his luggage was lost in transit.
When he finally lands in Liberia, Welch must take his temperature and wash his hands in chlorine, something he’ll get used to doing at least a dozen times a day. On the drive into Monrovia, a building, all lit up, stands out from a distance. Welch realizes it’s the large Doctors Without Borders Ebola Treatment Unit that he’s read about and seen in pictures. Suddenly, his assignments feels real.
After a few hours sleep, Welch leaves Monrovia and heads inland to a clinic in rural Bong County run by the International Medical Core. Welch is here to learn what it will take for PIH to set up a similar Ebola Treatment Unit in another rural county with few roads, power lines and little running water.
The building, framed in wood, sits on a slab of cement in the middle of a dense jungle. The walls are covered with blue tarp so they can be sprayed down often. Gutters line the floor for easy cleaning. The roof is tin. There are two sections: one for patients who may have Ebola and another for the confirmed cases.
Liberian nursing students help Welch and his partner into their full body protective suits, masks and goggles. In 90-plus-degree heat, with high humidity, wearing the gear becomes uncomfortable almost immediately. The work is dangerous. No one stands around.
“You always enter the unit with a really clear plan about what you’re going into do,” Welch learns. Whether you’re cleaning up, feeding patients or treating them, “you conceptualize a plan before you go in.”
The clinic goes through about 250 protective suits a day at a cost of $50-$80 each, Welch says. Inside, the smell of chlorine mixes with every fluid the body produces. Outside, smoke hangs in the air.
“The thing that just boggles my mind is that every single thing that enters the unit, every mattress, every linen, every needle, every syringe, has to be burned,” Welch says. “Cellphones, clothes, everything a patient brings in has to be replaced.”
Everything except the bodies. On his first day at the clinic, Welch sees the graveyard, 27 new plots in the red clay earth, one for each day since the clinic opened.
“I look at little to my left and see that there are about a dozen graves that have been pre-dug. It’s really just a remarkable scene and desperately, desperately sad,” Welch recalls.
He’s moved too by the men who are digging graves, men who’ve given up jobs and gone into voluntary isolation from their families — all so they can help the country cope with and try to stop Ebola.
But the sense of desperation deepens as Welch gets to know his patients.
Welch begins seeing patients, two he’ll never forget.
One evening, he gets lab results that show two siblings, ages 6 and 14, have Ebola. He must move them from the ward of suspected patients to the ward of confirmed cases.
An older brother is already in the confirmed ward. The children’s only parent has died. A grandmother who brought the children to the clinic tested negative and can not stay with them.
“The little girl, the 6-year-old, was very scared,” says Welch. “By the time we were able to move her is was raining very hard and the rain was causing a lot of noise on the tin roof. And here I am looking like an astronaut,” speaking with a strange accent.
Welch carried the girl to a bed where she would lay with her sick brother. He gave her some cookies and a drink, but he couldn’t comfort her. She cried and cried.
“It just felt like a punch in the gut,” Welch says. “The whole thing is a horrible tragedy.”
One of the brothers died that night, in the bed with his siblings. When Welch left a few days later, the girl and her other brother were still alive. Now, back in Monrovia, working on plans to open the first PIH Ebola clinic, Welch can’t bring himself ask if the children are OK.
“I’ve seen children die, but right now, to keep going and to keep doing this work, I have to believe that those two kids, that they’re as comfortable as when we left,” Welch says, his voice drained of emotion. “I can’t bear anything other than that.”
Welch was livid when he heard about the nurse detained in New Jersey after returning from Sierra Leone.
“This response needs thousands of health care workers,” Welch says, “and I just really hope that this doesn’t discourage health care workers from coming to do this work. We need them here. We need them here now and for that to be muddied by politics is just tragic.”
Welch was joined a few days ago by eight more PIH members who plan to spend six weeks in Liberia, and perhaps, three weeks in quarantine.
“This work is not easy and it’s not glamorous,” Welch told the group, “but it is so worth doing. It may be the defining moment of your career.”
More Ebola Coverage: