A Congress.gov Interview with Kelly Yuzawa, Specialist in Legislative Information Systems Management
Kelly Yuzawa is a specialist in legislative information systems management within the Congressional Research Service (CRS) of the Library of Congress. Kelly works with Amy, who was interviewed last week, in CRS. This continues our Congress.gov interview series that also included Meg, Rich, Barry, Rohit, Andy, Val, and Stephen.
I grew up in California and Oregon. I was a Japanese/Asian Studies major and spent my senior year of college and thirteen subsequent years living in Japan. I worked at a law firm library while getting my master’s degree in library and information science (MSLIS) from The Catholic University of America, then got a job as a contractor working with Japanese material here at the Library of Congress. I was in the Northeast Asia section of Acquisitions and Bibliographic Access before coming to CRS on a detail to work on the Congress.gov team in 2013.
How would you describe your job to other people?
My job centers around Congress.gov, the new legislative database. Legislative data has many moving parts, and much of my work is checking to make sure that all the parts arrive in the correct form and in a timely manner from our data partners. Since it is a new system that is still being developed, users are getting familiar with it and have lots of questions. I work with the team to answer those questions and provide training to information professionals and Congressional users.
What is your role in the development of Congress.gov?
I help the CRS point person and other team members in planning and implementing improvements. As new functionality is added, I test the system to see that it behaves in the expected manner and provide examples and feedback to the developers if it doesn’t. I also help create and maintain resource pages and do cleanup work on records to make them more accessible in the new system.
What is your favorite feature of Congress.gov?
I love the durable URLs. You can build a search in Congress.gov and email it to someone who can open the results page and see how the search was put together on the search form.
Another favorite thing is that each member of Congress has a landing page with links to biographical information, committee assignments, and contact information. The landing page also collates bills sponsored or cosponsored by the member. Users can click on the policy area subject facet to see what kind of legislation their senator or representative is supporting.
What is the most interesting fact you’ve learned about the legislative process while working on Congress.gov?
I think the “commemorative” legislation is fascinating, both for the volume of it and for the range of its content. Until I worked on Congress.gov, I hadn’t realized that there are hundreds of bills introduced each year to honor historical figures, name post offices, commend sports teams, and mark every kind of anniversary imaginable.
What’s something most of your co-workers do not know about you?
I write a weekly English conversation column for a Japanese newspaper. I’ve been doing it for 20 years, and I’m running out of ideas. What my coworkers don’t know is that I sometimes borrow their names and bits of their conversations to use in my dialogues.
Maura Healey will inherit several thorny issues Wednesday as she becomes the next state attorney general. Near the top of her list: the agreement that would let Partners HealthCare acquire at least three more hospitals in exchange for some limits on price and staff increases.
During the campaign, Healey raised questions about whether the deal was enough, both in scope and in duration.
So now that she’s in charge, will she urge Judge Janet Sanders to approve the agreement, suggest changes, or start over? In an interview before her swearing-in, WBUR’s Bob Oakes put these questions to Healey. Here’s the sum total of her response:
This is a matter that I’m reviewing and being briefed on now. The perspective I come from, as attorney general, is to drive down health care costs. So I’m considering my options. Right now, the matter is before the court, as you say. There was a proposed consent judgement filed, and we’ll just have to see on that.
In short, stay tuned.
Sanders suggested back in November, at the last hearing on the Partners deal, that she’d like to speak to Healey before issuing a ruling. She may also be waiting for Partners to name a new CEO, a decision some sources expect in the next four or five weeks. Sanders could call the parties in for a status conference at any time. Healey and Partners have that option as well.
Who will make the next move? Any bets?
You can hear all of Bob’s conversation with the new AG here.Related:
Brigham and Women’s Hospital in Boston said it’ll review its safety measures and protocols Wednesday after the fatal shooting of a doctor there Tuesday. The doctor, Michael Davidson, 44, was pronounced dead late Tuesday.
Investigators say the gunman, identified by police as 55-year-old Stephen Pasceri, of Millbury, deliberately targeted Davidson. Police say Pasceri died from an apparent self-inflicted gunshot wound.
It’s the type of situation the hospital’s chief operating officer, Dr. Ron Walls, says all hospital staff have been carefully trained to address.
“There is no amount of preparation anyone can do that completely eliminates the prospect of this kind of tragic event happening,” Walls said. “But we do believe we have a responsibility, and we’re working hard to meet that responsibility to have all of our people completely prepared in the best way we can so that when something like this happens — if it happens, and whatever happens– our staff is able to respond.”
John Erwin, the executive director of the Conference of Boston Teaching Hospitals, joins Morning Edition to discuss safety measures at area hospitals.
To hear the full interview with Erwin, click on the audio player above.Related:
Communicate with Your Congregation, Schedule Rooms, and Track Finances More Easily
While Republicans cannot expect a full repeal of the health law while President Barack Obama remains in office, the GOP intends to “strike away at it, piece by piece,” Senate Finance Committee Chairman Orrin Hatch, R-Utah, said Tuesday.
But in a speech at the U.S. Chamber of Commerce, Hatch also said he expected that Republican and Democratic lawmakers would work together on several other key pieces of health legislation.
Hatch said there may be more bipartisanship in some “must pass items,” including continued funding for the Children’s Health Insurance Program and overhauling the way Medicare pays physicians, known as the “sustainable growth rate.” On CHIP, Hatch said the Finance Committee has “heard from a number of governors from red states and blue stakes alike that they want to see this program extended. It has been a marvelous program. It has worked very, very well. I’m optimistic that we can work on a bipartisan, bicameral basis to extend CHIP in a responsible way.”
Hatch also said he wants the Finance panel “to address the SGR challenge once and for all.” Last year he co-sponsored legislation that would move physicians from the traditional system in which they are paid for volume and instead use financial incentives to encourage them to move to alternative payment models emphasizing quality care. Finance must also act “sooner rather than later” to strengthen Medicare, Medicaid and Social Security, he said, noting that in the last Congress he supported several significant changes to Medicare, including raising the eligibility age and simplifying cost-sharing in the program.
In his remarks, Hatch said his committee would work on several measures to repeal elements of the health law — including its medical device tax and employer mandate — even though Obama would be likely to veto the measures.
“We can send them all to the president’s desk and have him try to explain to the American people why he’s right and they’re wrong,” Hatch said.
While House Republicans have passed dozens of measures to repeal or weaken the health law, the Senate has not voted on many of those bills because until this month, Democrats controlled the chamber. With Republicans now in charge with 54 seats, odds are better that some of the repeal measures will see floor consideration. But the GOP will still need some Democratic support to reach 60 votes to avoid a filibuster, and they are unlikely to garner enough Democratic support for the 67 votes needed to override a presidential veto.This KHN story can be republished for free (details).
In a wide-ranging speech that also touched on tax reform, trade and pensions, Hatch said the first health-related bill the Finance Committee will consider is legislation the House passed earlier this month. It allows employers to exempt workers who received health coverage through the Defense or Veterans Affairs departments from the tally used to determine whether the employer is meeting the health law’s requirements for providing coverage.
Hatch said Republicans need to be ready with an alternative to the health law if the Supreme Court later this year strikes down the provision that provides premium subsidies for low- and middle-income people buying coverage on the federal exchanges. If that happens, “we’ll need to act to mitigate the additional damage Obamacare will inflict on the health care system,” he said, but he offered no specific remedies. Along with Sen. Richard Burr, R-N.C., and former Sen. Tom Coburn, R-Okla., Hatch last year co-sponsored a health law alternative that, among its provisions, would repeal the health law’s individual and employer mandates.
Hatch said while he prefers to find bipartisan solutions on health care and other topics, he did not rule out a procedure known as budget reconciliation that allows legislation to pass with 51 votes in the Senate rather than the 60 needed to stop a filibuster. A number of Republicans have suggested that reconciliation could be used to repeal major portions of the health law.
“Should we decide to go that route, I’ll work with my colleagues on the Budget Committee to make sure whatever we do under the Finance Committee’s jurisdiction is effective,” he said.
This post has been updated.
WBUR reports that one person has been shot inside Boston’s Brigham & Women’s Hospital.
The suspected shooter was found dead from an apparent self-inflicted gunshot wound, according to police, and the shooting victim, a doctor, has life-threatening injuries.
The shooting occurred in the hospital’s Shapiro building.
With the shooting confirmed, we can also report that hospital employees had been well-drilled for this disturbing eventuality.
In November 2013 we reported that about 1,200 Brigham doctors, nurses and other staff viewed the hospital’s new “Active Shooter Preparedness Training” video, which offers a step-by-step guide on how to handle a hospital shooter, which in some cases is called a “Code Silver.”
The plan was for about 16,000 Brigham employees to see the 10-minute video, created with help from the Boston Police Department, Boston EMS and other area hospitals. The shooter video will be part of the hospital’s annual training requirement, a Brigham spokesman said at the time.
Here’s a snippet from CommonHealth’s 2013 story:
One Brigham doctor who saw the video…said: “It was weird to see our lobby turned into a reenactment of terror,” and added that while the video may or may not help in real life, “hopefully I won’t have to find out.”
“Shots fired in the hospital — the last sound you’d expect to hear,” the video narrator says. “An active shooter situation used to be a phrase only used by law enforcement but as these are occuring more frequently, it is something that people in all types of organizations, including hospitals and health care facilities must learn about and prepare for.”
Actually, at the Brigham, this type of emergency is specifically not called a “Code Silver.” (Everyone knows “Code Blue” from medical dramas, when a patient requires emergency resuscitation or immediate medical attention.) The term “Code Silver” was considered, said Brigham spokesman Tom Langford, but was ultimately tabled.
He explained in an email:
Other hospitals may use code silver, but we specifically chose not to. Here’s why: If there ever were an active shooter and a code was broadcast, only the staff would know what the code means. In an active shooter situation, it is extremely important that patients and visitors also know what’s going on so that they can evacuate the area as quickly as possible. Using a code could put patients and visitors at risk. So we would use a plain English announcement. Something like “There is a life-threatening situation in (location), please move away from the area as quickly as possible.”
When a woman had gall bladder surgery at a Massachusetts hospital in 2013, doctors noticed something suspicious on a CT scan that they thought could be ovarian cancer. But the recommendation that the patient get a pelvic ultrasound fell through the cracks. Months later, she was diagnosed with stage 3 ovarian cancer.
Normally, this type of medical mistake could mark the start of a protracted malpractice lawsuit. But in Massachusetts, where medical, legal and consumer groups have worked together in support of a recently enacted law that tries to preempt litigation by establishing a process and timeframe for discussing mistakes, that’s not what happened, according to her attorney who recounted the case in an interview.
The law mandates that people give health care providers six months notice if they intend to sue. The woman’s lawyer notified the hospital of the mistake and the harm it had caused her: A delay in diagnosis that may have led to more extensive cancer treatment and, arguably, a higher risk that the cancer will recur.
Hospital officials, who had 150 days to respond, determined that their actions hadn’t met the standard of care. The hospital arranged a meeting between the woman and one of their physicians to talk about why the error occurred and the measures being taken to make sure it won’t happen again. The physician apologized, and soon after the woman accepted a financial settlement from the hospital.
The whole process took about a year, far less time than a drawn-out legal battle would have involved, says Jeffrey Catalano, the Boston attorney who represented the woman but declined to provide identifying details in the case.
“The hospital did the right thing,” he says. “My client felt really good about it. She felt like she was heard.”More from this series
Traditionally, medical liability reform has focused on laws that set caps on the dollar amount that plaintiffs can receive in damages. But interest in non-traditional types of medical liability reform has been growing, spurred on by dissatisfaction with so-called “deny and defend” adversarial systems that often result in lengthy and expensive legal proceedings when a medical error occurs.
In the national health care debate, the issue has been a key dividing line between Democrats and Republicans. The GOP generally supports capping damage awards as a way to rein in frivolous medical malpractice lawsuits and keep health care costs down. Democrats, supported by the trial lawyers lobby, argue that the Republican strategy is ineffective and leaves patients who have been injured with inadequate recourse. After the health law passed, President Barack Obama offered to work with Republicans on the issue. In 2010, his administration awarded $23 million in planning and demonstration grants around the country as part of a patient safety and medical liability reform initiative.
Boston’s Beth Israel Deaconess Medical Center and the Massachusetts Medical Society received a planning grant for $274,000 to develop a roadmap for a statewide communication, apology and resolution (CARe) system modeled after a successful program at the University of Michigan.
“Our effort was to take a model that had been very successful in a closed [health care] system and see if we could create an environment to implement it in a much broader way,” says Dr. Alan Woodward, a retired emergency physician who chairs the Massachusetts Medical Society’s Committee on Professional Liability.
Communication and resolution programs are gaining in popularity. Advocates emphasize moving quickly when a medical error is made to discuss it with the patient and the patient’s family, apologize and, if the standard of care has not been met, offer compensation.
In Massachusetts, six hospitals joined a pilot project to implement the model. Medical, legal and consumer groups that had participated in developing the roadmap formed a health care alliance to exchange information and develop best practices, and provide support for the hospital pilot projects.
In turn, that state law bolsters the alliance’s efforts to change how medical injuries are addressed. In addition to the six-month “cooling off” period before a suit can be filed, the law requires that patients be told when medical mistakes are made that result in unexpected complications and allows providers to apologize for unanticipated outcomes without fear their words will be used against them in court.
While many health systems and states are experimenting with non-traditional forms of medical liability reform, Massachusetts’ efforts are among the more comprehensive.
The broad-based Massachusetts’ effort is modeled after the University of Michigan’s communication and resolution program. Since the program began in 2001, it had reduced the rates of average monthly new claims and average monthly lawsuits, while cutting the time to resolve disputes and legal costs, a 2010 study published in the Annals of Internal Medicine found.
Saving money shouldn’t be the primary motivation for adopting a program, says Richard Boothman, the chief risk officer for University of Michigan health system and the man who pioneered their program. Patient safety is the goal.
“The very best risk management is to not hurt anybody in avoidable ways, and the second best [strategy] if we do hurt someone is not to do it again,” he says.
Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.
By James Morris
One of the the most exciting aspects of the recent discovery of the new antibiotic teixobactic was the way scientists discovered it — and where.
The antibiotic comes from a bacterium that was found in a sample of soil from Maine. To uncover it, scientists used a new technique that allowed them to screen bacteria for antibiotics without growing them in culture, opening the door to finding newer, more potent and less resistant antibiotics in the future.
It’s worth noting that teixobactic is not the only antibiotic that comes from a bacterium. In fact, many of our antibiotics come from bacteria and other microbes, and many of our medicines come from nature. It’s one of the benefits of biodiversity.
Recently, I was teaching a class on biodiversity to college students. To get them thinking about how we benefit from species richness, I asked the class to name a couple of medicines that derive from nature.
I thought this would be an easy question. To my surprise, the class (of 250 students) was silent. This was unusual — I usually have more trouble keeping them quiet. Finally, after maybe 20 seconds (a long time in a large lecture hall), a hand shot up. “Marijuana!” one student proudly exclaimed.
I was taken aback. Not because weed was mentioned in a college classroom. And not because the student was incorrect — she was of course correct. Marijuana comes from the plant Cannabis and it has some useful medicinal properties, for example to treat nausea caused by cancer chemotherapy, and fatigue, appetite loss and pain associated with AIDS. There is continued debate over its use, but that’s not the point.
The point is that while the class was hard-pressed to come up with more than one medicine derived from nature, the reality is just the opposite: It’s difficult to think of a medicine that doesn’t ultimately come from nature.
If apples and carrots are nature’s toothbrush, grapes are nature’s jellybeans, and raisins are nature’s candy, then certainly plants, animals, fungi, and microbes are nature’s medicine cabinet.
Perhaps the most famous example is penicillin.
In 1928, as the story goes, Alexander Fleming accidentally left the lid off of one of his petri dishes in which bacteria were growing. The open lid allowed fungus to grow in the dish. Fleming noticed that the bacteria were killed in an area around the fungus. He reasoned that the fungus secreted a substance that killed the bacteria, and called it penicillin after the name of the fungus.
Some time after its discovery, penicillin was synthesized in the lab. And then scientists were able to play with its structure so that it could be used against different kinds of bacteria. Derivatives of penicillin include ampicillin, methicillin and cephalosporins. But, at the heart of all of these widely used antibiotics is the chemical structure that ultimately comes from nature.
Like penicillin, aspirin was not invented by a scientist working quietly away in a lab.Instead, it too is naturally occurring. Since ancient times, it was known that an extract of the bark of the willow tree could be used to treat pain and fever. Even Hippocrates was aware of its medicinal properties.
The active ingredient in the bark is salicylic acid, which is also found in shrubs of the genus Spiraea. It is from Spiraea that we get the name aspirin. Aspirin is not only used to treat headaches, but also, in the form of “baby aspirin,” is used by millions of people to prevent heart attacks and strokes.
Aspirin and penicillin are two of the most widely used drugs in the world today. And the list of medicines from nature goes on and on. From the Pacific yew tree, we get taxol, used to treat breast, ovarian, and lung cancers; from foxglove, a common flower in English gardens, we get digitalis, used to treat congestive heart failure; from the rosy periwinkle, a flower from Madagascar, we get vincristine and vinblastine, which have changed the prognosis of certain types of cancers; and from the bark of the South American cinchona tree, we get chloroquine, long the mainstay in the prevention and treatment of malaria.
And there are organisms we are only just beginning to investigate and understand. Cone snails, known for their beautiful shells and deadly venom, are potential sources of pain medicine far more powerful than opium (which comes from poppies). The venom from the South American rattlesnake is being studied for its ability to alleviate pain. This wouldn’t be the first drug to come from snakes: The venom of the lancehead viper in Brazil served as the chemical template for ACE inhibitors, used to treat high blood pressure.
From nature, we are discovering not only medicines used to treat diseases, but also substances useful in diagnosis. For example, when surgeons remove a cancer, it is often difficult to tell where the cancer ends and healthy cells begin. Enter the Deathstalker scorpion. From its name, you wouldn’t think that it would provide us with any benefit at all. But, it was found that its venom can bind specifically to cancer cells.
Dr. Jim Olson and his colleagues at the Fred Hutchinson Cancer Research Center in Seattle took advantage of this property and engineered the venom so that cancer cells can be visualized during surgery. This “tumor paint” may one day revolutionize cancer surgery.
The importance of biodiversity to human health has been extensively and thoughtfully explored by Dr. Eric Chivian and Dr. Aaron Bernstein of Harvard’s Center for Health and the Global Environment in their recent and authoritative “Sustaining Life: How Human Life Depends on Biodiversity.”
This pharmacopeia raises a question: Why would other organisms make so many compounds that are useful as medicines in humans?
One answer has to do with defense. Bacteria and fungi defend themselves from other bacteria and fungi, so it is perhaps not surprising that they are rich sources of antibiotics.
Plants and other organisms need to protect themselves too, in some cases from mammals. Over time, they have evolved chemicals that serve just this purpose. In small doses, or modified in specific ways, they end up being beneficial since they have already evolved to interact with our cardiovascular, immune, or nervous systems.
Medicines, after all, are poisons in small doses.
Another answer is that all living things, because they share a common ancestor, are in many ways more similar than they are different. The fact that bacteria in a sample of soil from a field in Maine may help us to fight infections that have evolved resistance to other antibiotics serves as an important reminder of the unity of life.
James Morris, associate professor of biology at Brandeis University, blogs at Science Whys.