Thursday, August 27, 2009

News Clipping Archives

 

 

Maryland / Regional

Baltimore to share budget pain (Baltimore Sun)

Md. Approves $454 Million Cut to Fill Latest Gap (Washington Post)

Questions linger over O'Malley budget cuts (Annapolis Capital)

Health Dept. hit hard by state layoffs (Daily Record)

Budget cuts to mental health programs ‘horrible,’ Md. secretary says  (Baltimore Business Journal)

Md. legislative leadership announces furlough plan (Associated Press)

Health Department Announces Vaccine Schedule (Baltimore Afro-American)

Needed: Process for prioritizing of patient safety (Daily Record)

Weakened Economy Linked to Mental Illness Issues in the District  (Baltimore Afro-American)

Developers agree to pitch in to maintain homeless encampment outside city  Church (Baltimore Sun)

Straightforward facts on dietary fat and health (Baltimore Sun)

Health care myths obscure the much tougher decisions (Baltimore Sun)

Jane B. Wiley dies at 79 (Baltimore Sun)

Radiation tests are questioned (Baltimore Sun)

After Ordeal, Va. Couple United With Girl Adopted From China  (Washington Post)

More Retirees Find Facilities Speaking Their Language (Washington Post)

 

National / International

Fruits and vegetables, good for the bones? (Baltimore Sun)

H1N1 Flu Sends More African Americans, Hispanics to Hospitals (Wall Street Journal)

 

Opinion

Homeless Female Veterans (New York Times Letter to the Editor)

 

 

Maryland / Regional

Baltimore to share budget pain

Dixon plans layoffs, might reduce services after Md. approves cuts

 

By Annie Linskey and Laura Smitherman

Baltimore Sun

Thursday, August 27, 2009

 

Mayor Sheila Dixon said Wednesday that Baltimore residents might see a "change in services" and city workers will face furloughs and layoffs to close a $60 million spending gap opened by the most recent state aid cuts and slumping tax revenues.

 

"We are looking at a number of areas," Dixon said. "There will be layoffs."

 

The city laid off more than 150 workers in June when it adopted its $2.3 billion budget.

 

City Council members said yesterday that they would take voluntary furlough days to show solidarity with city workers.

 

"Right now, we are in this economic crisis," said Councilman Bernard "Jack" Young. "We can't expect people to take furloughs and we are not included."

 

One money-saving option under consideration is curtailing or reducing the city's bulk trash pickup program, according to a City Hall official not authorized to speak about budget matters. The current bulk pickup service, which allows residents to call to have three bulk items hauled away each month, costs about $1 million.

 

State officials in Annapolis are cutting by $35 million the money that Baltimore had been expecting, part of $211 million in reduced aid to local governments.

 

City finance officials have also revised Baltimore's revenue projections downward by about $25 million.

 

Dixon said she is still "digesting" news of state budget reductions approved Wednesday by Maryland's Board of Public Works, and will not announce the extent of layoffs or other budget measures until she meets with City Council members and union officials. Some of those meetings are set for today and Friday.

 

The Board of Public Works approved Gov. Martin O'Malley's proposal to cut Maryland's $13 billion budget by $454 million to ensure that it remains in balance as tax collections slide. The proposal includes furloughs and layoffs for state workers as well as reductions in aid for Baltimore and the 23 counties.

 

Dozens of state employees will be laid off with the closure of a psychiatric unit at the Upper Shore Community Mental Health Center in Chestertown. Maryland Health Secretary John M. Colmers said the move fits in with the state's larger goal of shifting care to private institutions. More layoffs would come from shutting down two wards at Spring Grove Hospital in Catonsville.

 

"This is not an easy time," Colmers said. "I can't sugarcoat it."

 

Layoffs of state employees are spread among other agencies, including 26 workers at the Department of Transportation.

 

Meanwhile, Chief Judge Robert M. Bell of the Maryland Court of Appeals said in a letter to judicial branch employees that they would be subject to cutbacks "similar and consistent" to those faced by executive branch employees who are facing pay cuts through furloughs and the closure of government offices.

 

The state's university system also is crafting a plan to require that employees take unpaid days off. Chancellor William E. Kirwan, in an e-mail letter to his campuses on Wednesday, said state budget cuts would force reductions in financial aid, maintenance budgets and student services. Kirwan said he expects that the university system will implement a tiered furlough plan and other salary adjustments.

 

Other details of state budget cuts emerged yesterday, including a $7.5 million reduction in state funding for cancer research at the University of Maryland and the John Hopkins University, and a more than $4 million cut to cancer screening for low-income residents and to smoking- prevention programs.

 

Bonita Pennino, a government relations director for the American Cancer Society, said she expects smoking rates and deaths from cancer to increase as a result. "We recognize the governor was in a box, given the state of the economy," she said. "But this action is penny-wise and pound-foolish."

 

Local governments are grappling with the expected loss of state money for road maintenance, health care, community colleges and other needs. In Baltimore, Dixon said the pain of those cuts will be felt across all city agencies.

 

The Baltimore budget passed in June included 153 layoffs, eliminated hundreds of vacant positions, shut two Police Athletic League centers and a recreation center, reduced trash pickup to once a week, shortened library, pool and rec center hours, and made steep reductions in public safety overtime.

 

The plan included deep reductions to Fire Department overtime, and up to four fire companies are closed on any particular shift. Union officials expressed concerns that further budget cuts would mean that more fire companies would be closed each day.

 

"No matter how you characterize it, you are playing with fire," warned Capt. Stephan Fugate, the head of the fire officers' union. "It is inevitable if we continue as we are that there is going to be a tragedy."

 

Fugate said he will propose to his members giving up four to six vacation days to solve the department's manpower shortages. Fire Chief Jim Clack said he plans to meet with Dixon on Friday.

 

Baltimore police spokesman Anthony Guglielmi said the department is already "at bare bones" and that there have been "no discussions about furloughs or layoffs for police."

 

Due to incorrect information provided to The Baltimore Sun, the number of layoffs at the Department of Transportation was misstated in an earlier version of this article.

 

Baltimore budget woes

$60 million: Current city shortfall

 

$35 million: From state aid reduction

 

$25 million: From lower tax and other revenues

 

$2.3 billion: Overall city budget

 

Baltimore Sun reporter Childs Walker contributed to this article.

 

Copyright © 2009, The Baltimore Sun.

 

Md. Approves $454 Million Cut to Fill Latest Gap

 

By Aaron C. Davis

Washington Post

Thursday, August 27, 2009

 

To close its latest budget shortfall, Maryland will shut down a state-run psychiatric hospital, nearly eliminate money for county road projects, slash funding for cancer research, reduce reimbursements for health-care workers and facilities caring for Medicaid patients, and close a minimum-security prison.

 

On Wednesday, the panel of three Democrats charged with making midyear budget cuts unanimously approved Gov. Martin O'Malley's plan to carve away $454 million to close the spending gap that emerged last month. As in the rest of the Washington region, lower-than-expected tax collections and rising unemployment have battered state revenue projections.

 

The cuts by the Board of Public Works, along with $280 million in spending reductions it approved last month, amounted to just 5 percent of the state's $13.4 billion general fund. But after prior reductions, the latest action lifted Maryland's list of spending cuts since 2007 to more than $4 billion. It also made clear that these and any future cuts would affect direct state services that many taxpayers consider entitlements.

 

The cuts also include 205 layoffs, furloughs of 70,000 state workers and measures ranging from reductions in firearms training for park rangers to encouraging state workers to use generic cholesterol drugs.

 

O'Malley (D), a member of the board, cast the actions as the kind of tough decisions that governors are elected to make.

 

"Some of these cuts will no doubt challenge us as we've never been challenged before," O'Malley said. "Ultimately, we're mindful that we have to make decisions . . . to get our state through this recessionary storm."

 

He said it will probably be tougher for Maryland to manage an expected swine flu outbreak this fall and to keep crime and other problems in check as state government downsizes.

 

Advocates for the developmentally disabled and a smattering of state workers wearing T-shirts emblazoned with union insignias squeezed into Wednesday's standing-room-only board meeting and later criticized the package as unfair and detrimental to the public.

 

Of the $223 million in cuts estimated to come from the state's general fund, roughly $90 million, or 40 percent, will come from the state's Department of Health and Mental Hygiene. Advocates said that was disproportionately large, nearly twice the size of its share of the general fund.

 

"People are going to be less safe, and their health and quality of life are going to be affected by these cuts," said Laura Howell, executive director of the Maryland Association of Community Services. The facilities that provide care for 22,000 developmentally disabled residents have an average profit margin of 1.6 percent, she said. "A 2 percent cut is going to drastically affect our services."

 

Bonnie Nicholson, 64, a Motor Vehicle Administration employee who wore her forest-green American Federation of State County and Municipal Employees T-shirt, said some of the cuts seem short-sighted. Furloughs -- as much as 10 days of unpaid leave -- will hit tens of thousands of middle-class public servants harder than it might seem, she said.

 

"If you short-staff a revenue-collecting agency . . . you can't bring in money for the state," Nicholson said. "When you decrease [workers'] salaries, it makes it harder for them to meet their expenses . . . and their own family mortgages."

 

Republicans also blasted O'Malley's package as minor one-time fixes that will do little to drive down ongoing expenses and insulate the state from a projected deficit of more than $1 billion next year. O'Malley's budget chief acknowledged that more than $350 million of the $454 million in cuts will not help the state in future years.

 

Republican state Sen. E.J. Pipkin, who represents a northeastern district where the 40-bed Upper Shore Community Mental Health Center will be closed, said the governor has lacked the backbone to look at big-ticket changes such as shifting some of the state's $600 million in teacher pension costs to counties.

 

"How do I go home tonight and tell people we're going to close the mental health facility but we found over $1 million to go out and buy speed cameras?" Pipkin said.

 

Some of the 119 employees on duty Tuesday night at Upper Shore were called to a meeting and told that the facility, one of Kent County's biggest employers, will close by February.

 

Secretary of Health and Mental Hygiene John M. Colmers said the $12 million, or 2 percent, the state is cutting in rates for thousands who care for Medicaid patients roughly equals the pay cut that state workers are being forced to take through furloughs.

 

Wilson H. Parran, president of the Maryland Association of Counties, told the board that the $159 million in cuts to county transportation funding will be felt by millions of residents. In Calvert County, where Parran is president of the board of commissioners, the state allotment of $6 million for road funding last year has shriveled to less than $300,000 this year. "We will be able to pave less than two miles of roads in Calvert," he said.

 

State cancer research funding for the University of Maryland and Johns Hopkins University will be slashed 75 percent, or $7.5 million.

 

The state will also close the 350-inmate Herman L. Toulson Correctional Facility in Jessup, in Anne Arundel County. Once a boot camp designed to rehabilitate young offenders, the site had been reduced to a regular prison through previous cuts that eliminated health care and other follow-up services, said Gary D. Maynard, secretary of public safety and correctional services. Now, he said, it's just "time to close."

 

Staff writer Ashley Halsey III contributed to this report.

 

Copyright 2009 Washington Post.

 

Questions linger over O'Malley budget cuts

Health bears brunt, but tuition spared again

 

By Liam Farrell

Annapolis Capital

Thursday, August 27, 2009

 

Gov. Martin O'Malley remains steadfast that his budget cuts are encroaching upon government's main priorities, but critics want him to go further by ending an in-state tuition freeze and targeting huge spending like teachers' pensions.

 

The state Board of Public Works approved $454 million in reductions and transfers yesterday, including a $210.7 million hit in local aid and a $14.8 million cut to Anne Arundel County.

 

"We are facing the same challenges every business and every family in Maryland is facing," O'Malley said. "There is very little to cut at this point that does not impact core mission."

 

Health is one of the areas that took a big hit. The board reduced provider rates and grants 2 percent to save $22 million, cut $7.5 million from cancer-research funding to the University of Maryland and Johns Hopkins University, and decided to close the inpatient psychiatric unit at the Upper Shore Community Health Center to get an additional $2.7 million.

 

Also, the state Department of Health and Mental Hygiene will lay off 160 employees, the majority of the 202 positions being eliminated.

 

"We are going to have to work closely with our colleagues in the private sector," said John Colmers, the secretary of the state health department. "In the best possible of worlds, we wouldn't do this."

 

The budget actions also went into more obscure areas of state government, such as anticipating $480,000 in overtime savings by reducing recreational activities for inmates and $175,000 from Natural Resource Police efficiencies such as slicing firearms training and large-vessel patrols.

 

Almost $2 million, or two-thirds, of the money in the new Special Fund for the Preservation of Cultural Arts in Maryland was also raided, just months after it was created to hold revenue from a new tax on instant-bingo machines in jurisdictions like Anne Arundel County.

 

The local aid cuts show only what will hit Maryland's 23 counties and Baltimore City. Depending on how Anne Arundel County decides to make up for the loss, Annapolis could receive less state aid, as well.

 

Despite the breadth of the cuts, two members of the board - Treasurer Nancy Kopp and Comptroller Peter Franchot - said it is time to consider ending the freeze on in-state college tuition, one of O'Malley's signature initiatives.

 

The University System of Maryland lost $16 million in federal stimulus money and $20 million of its fund balance yesterday and is expected to find $10 million of savings in operational expenditures.

 

Franchot wondered if tuition should be raised instead of hitting areas such as mental health and whether the system could start losing ground on its academic mission.

 

"It strikes me we are beginning to have a fairness issue," he said.

 

University officials, however, were circumspect even when asked directly whether a tuition increase is needed. P.J. Hogan, a former state senator and the system's associate vice chancellor for government relations, said the breaking point will be "when we feel that quality is taking a back seat."

 

"It's got to be high-quality (education), it's got to be affordable, it's got to be accessible," he said.

 

During the past few rounds of budget cuts, O'Malley has emphasized how fiscal 2010 general fund spending is now below fiscal 2007 levels. But some Republicans said they are still not satisfied.

 

State Sen. E.J. Pipkin, R-Elkton, said his phone "has been ringing off the hook" about the mental health facility closing, and that he was dismayed the board had just approved $1.2 million to purchase speed cameras for construction zones.

 

"Does that make any sense?" he said.

 

Pipkin also said the cuts represent "micromanaging" of state agencies while ignoring the big policies driving state spending, such as the omnipresent issue of whether to shift some of the cost of teachers' pensions - estimated around $1 billion next year - to local governments.

 

"We continue to apply a Band-Aid approach to something that is hemorrhaging," he said. "All we are hearing about is things on the margin."

 

The Associated Press contributed to this report.

 

Copyright 2009 Annapolis Capital.

 

Health Dept. hit hard by state layoffs

 

Associated Press

Daily Record

Thursday, August 27, 2009

 

ANNAPOLIS — Maryland's health department absorbed 160 of 202 state employee layoffs approved unanimously by the Board of Public Works on Wednesday as part of $454 million in budget cuts, reductions that are taking a toll on health facilities.

 

The Upper Shore Community Mental Health Center in Chestertown will close its inpatient psychiatric units in February, cutting 90 jobs and saving $2.7 million. Two wards at Spring Grove Hospital in Catonsville also will be closed, eliminating 50 jobs.

 

"Cuts that we had made in previous rounds, which I thought were bad, now look easy," Maryland Department of Health and Mental Hygiene Secretary John Colmers told the board.

 

A 2 percent cut in funding for community service providers is another tough jolt, affecting providers who serve Medicaid patients and the developmentally disabled to save about $21.7 million.

 

Advocates for the developmentally disabled, who rallied outside the statehouse last week against the cuts, said the reductions will force providers to reduce staffing levels and consider discharging people with higher needs because of an increase in uncompensated care.

 

"That's a very fragile system, because it's been under-funded for years, and this just is making a critical situation even worse," said Stephen Morgan, executive director of The Arc of Baltimore, an advocacy group for the disabled.

 

Colmers noted that he's long been out of easy choices to make, and anxiety is rising that the reductions could persuade health providers to avoid serving Medicaid patients.

 

"The providers are not indentured servants," Colmers said. "They don't have to participate in the program, and we're fearful of reaching a point where providers drop out of the program and thereby reduce access to needed services for the poor and the disabled and the most vulnerable."

 

It was the sixth time the Board of Public Works has made midyear budget cuts since Gov. Martin O'Malley took office. O'Malley, who is on the board with Treasurer Nancy Kopp and Comptroller Peter Franchot, said previous rounds of reductions have left little to cut without serious pain.

 

"Some of these cuts will no doubt challenge us as we've never been challenged before ... to make progress even though we have less money," O'Malley, a Democrat, said.

 

But Republicans criticized the governor and Democratic leadership in the legislature for failing to act sooner.

 

Sen. Allan Kittleman, R-Howard, said everyone in Annapolis knew the state was facing serious budget problems earlier this year, and the administration and legislative leadership failed to make more cuts during the session to prepare.

 

"Despite all those warnings, the governor and, frankly, the leaders of the legislature, haven't made the tough decisions, and it causes more hardship for Maryland residents and employees because of their failure to lead."

 

E.J. Pipkin, R-Cecil, said there was a chance to make the cuts. "What happened is the stimulus money came in from the federal level and all discussions about fiscal responsibility went out the window," he said.

 

The Department of Public Safety and Correctional Services will move 88 jobs to other facilities, resulting in the closing of the minimum-security Herman L. Toulson Correctional Facility in Jessup by March 1. Its 300 inmates will be transferred to other facilities.

 

The department also will reduce the number of inmates at the Metropolitan Transition Center in Baltimore by moving them to other facilities to save money.

 

Sheila Hill, a correctional officer at the Patuxent Institution in Jessup, said a furlough plan that will force officers to take three to five furlough days could make some of them decide to leave state facilities for county facilities, where there are no furloughs.

 

"The counties didn't take a reduction in their salary, so that will make them look a lot more attractive to correctional officers," Hill said.

 

The state's transportation department will lose 22 filled jobs and 44 vacant positions.

 

The state's Board of Revenue Estimates will meet Sept. 17 to provide a better picture of where the state's revenues are.

 

Franchot said he was far from sure if the state has turned a corner to better fiscal conditions, citing personal credit card delinquency, home foreclosures and unemployment as bad signs.

 

"So I think that we're going to be back here a seventh, eighth, ninth time," Franchot said, referring to budget cuts the board is authorized to make when the legislature is not in session. "It's a very bleak picture as far as state revenues."

 

The board has cut $736 million in the first two months of the current fiscal year. The state is facing a $1.5 billion deficit in the next fiscal year.

 

T. Eloise Foster, O'Malley's budget secretary, said about $100 million in the cuts approved Wednesday will carry over into fiscal year 2011.

 

Copyright 2009 Daily Record.

 

Budget cuts to mental health programs ‘horrible,’ Md. secretary says

 

By Julekha Dash

Baltimore Business Journal

Thursday, August 27, 2009

 

State mental health facilities are getting a $7.2 million cut as part of a new round of statewide $484 million budget cuts.

 

The Upper Shore Community Mental Health Center mental health inpatient facility will close Feb. 28 and 90 workers will lose their jobs, Department of Health and Mental Hygiene Secretary John Colmers said.

 

The Chestertown center’s Department of Juvenile Services Program and two units providing substance abuse services will remain open.

 

Additionally, two mental health facilities for children and adolescents will close. One is in Baltimore City and the other is in Montgomery County.

 

An inpatient facility at Spring Grove Hospital in Catonsville will close and 50 patients from the facility will be moved to Clifton T. Perkins Hospital Center in Jessup.

 

“All of the cuts are horrible,” Colmers said in an interview late Wednesday. This is the fifth round of cuts for the department since June of last year. “As you go through the process it becomes more and more difficult. When we’re making cuts it’s not because I want to but because I have to.”

 

Colmers said that the budget cuts — ratified Wednesday by the Maryland Board of Public Works — highlight the need for serious federal health reform. Many people in the affected health facilities are uninsured or under-insured and have to rely on the state for assistance.

 

“The need for national reform remains as strong as ever,” Colmers said.

 

Copyright 2009 Baltimore Business Journal.

 

Md. legislative leadership announces furlough plan

 

Associated Press

Thursday, August 27, 2009

 

ANNAPOLIS, Md. (AP) — Maryland legislative leaders have announced a furlough plan mirroring one that affects the executive branch.

Advertisement

 

Senate President Thomas V. Mike Miller and House Speaker Michael Busch announced the plan on Thursday.

 

Legislative offices will close for five days around holiday weekends. The plan also includes additional furlough days based on salary that could add up to five additional days.

 

The plan affects a total of 633 Maryland General Assembly and Department of Legislative Services employees and will save $1.1 million.

 

Salaries of state lawmakers cannot be reduced, but they can give back up to 10 days pay. Busch and Miller are contributing the maximum.

 

Last year, 85 percent of lawmakers participated in a voluntary giveback when furloughs were implemented.

 

Copyright 2009 Salisbury Daily Times.

 

Health Department Announces Vaccine Schedule

 

By Dorothy Rowley

Baltimore Afro-American

Wednesday, August 26,2009

 

(August 26, 2009) - WASHINGTON – Parents and guardians whose children will be enrolled this fall at District of Columbia Public Schools are reminded that vaccination requirements must be met by Sept. 8.

 

The District of Columbia Department of Health (DOH) has announced four temporary vaccination clinics as well as extended hours at its immunization facility.

 

The extra clinics are located in the city’s public schools and parents should bring their children’s immunization cards with them at the time they are vaccinated.

 

“The best way to protect your children from entirely preventable diseases such as measles, mumps or chicken pox is to get them vaccinated,” said Health Department Director Dr. Pierre N.D. Vigilance.  “Every child that goes unvaccinated increases the chances that an outbreak will occur.”

 

Required immunizations that have already been in place include shots for polio and hepatitis B. The new requirements include shots for chicken pox.

 

According to DOH, children ages 4 and younger must get both the hepatitis A and pneumococcal vaccines.

 

Students in sixth through 12th grades must have the meningococcal vaccine, a DTaP booster if five years have passed since their last dose of DTP/DTaP/Td, beginning at age 11, and the human papillomavirus vaccine, also known as HPV, for female students enrolling for the first time in the sixth grade.

 

“We know that parents and families are extremely busy preparing for the new school year, and we want to do everything in our power to make things easier,” said Schools Chancellor Michelle Rhee.  “These temporary clinics located conveniently inside DCPS schools, will provide families with one more opportunity to ensure that their children meet the new requirements.”

 

Vaccination clinics have been scheduled as follows:

 

From 2-10 p.m. on Thursday, Aug. 20 visit:

Kelly Miller Middle School, 301 49th St. N.E.

Ballou High School, 3401 4th St. S.E.

Kramer Middle School, 1700 Q St. S.E.

Coolidge High School, 6315 5th St. N.W.

 

From 9 a.m.-7 p.m. on Friday, Aug. 21 visit:

DOH Immunization Clinic, 6323 Georgia Ave., N.W., Suite 310

 

From 8 a.m. -4 p.m. on Sat., Aug. 22 visit:

Kelly Miller Middle School, 301 49th St. N.E.

Ballou High School, 3401 4th St. S.E.

Kramer Middle School, 1700 Q St. S.E.

Coolidge High School, 6315 5th St. N.W.

 

The Department of Health provides free vaccines for healthcare providers that serve Medicaid eligible children and the uninsured.  The DOH also provides free immunizations for uninsured and under-insured District residents at its express clinic.

 

For more information about immunizations or for a list of the express immunization clinics, contact the Citywide Call Center by dialing 311

 

Copyright Baltimore Afro-American.

 

Needed: Process for prioritizing of patient safety

 

By Danielle Ulman

Daily Record

Thursday, August 27, 2009

 

Which scenario sounds worse: A hospital patient falling and breaking a limb or doctors accidentally removing the wrong limb?

 

The usual reaction is wrong-side surgery, said Ruth R. Faden, executive director of the Johns Hopkins Berman Institute of Bioethics, but since falls occur much more often and cause a much higher burden of disease, doctors might have a hard time deciding which is more important to prevent.

 

Patient safety has come a long way in the last decade, but Faden and her colleague Peter J. Pronovost, director of the Johns Hopkins Quality and Safety Research Group, say that more research is needed to prioritize the importance of preventable accidents.

 

The two wrote a commentary published Wednesday in the Journal of the American Medical Association that calls for national leadership from Health and Human Services and the White House Office of Health Reform to develop a formal process to prioritize patient-safety efforts.

 

Faden said the attention given to increasing patient safety has helped improve outcomes, but more needs to be done.

 

“The challenge however, is we can only move forward with patient safety as quickly as we can go, and we can’t work on all patient safety at the same time,” she said. “We need to set national priorities for which patient safety efforts we should work on first.”

 

In their article, Faden and Pronovost suggest that efforts to set priorities should include an ethical framework for making those decisions, accountability among medical professionals and public engagement and participation.

 

Jim Conway, senior vice president at the nonprofit Institute for Healthcare Improvement in Cambridge, Mass., called the ideas set forth in the commentary “a very important contribution.”

 

“I believe they absolutely have it right that the public has to be part of the conversation in a way that they haven’t been before,” he said.

 

Patient safety first got the attention of policymakers in 1999, with the publication of “To Err is Human: Building a Safer Health System,” which highlighted the issue of medical errors. Conway said people often ask if hospitals are safer now than they were then, but he said each hospital has implemented a different level of patient safety controls.

 

“What Peter and Ruth are trying to figure out is, how do we go deeper and figure out what has been exceedingly successful in improving safety, and what has been a whole bunch of stuff that hasn’t done much?” he said.

 

But William Munier, director of the Agency for Healthcare Research and Quality’s Center for Quality Improvement and Patient Safety, said he would be a “little uncomfortable” with setting up a list of priorities that might put wrong-side surgery, bedsores or infections at the bottom of the list.

 

“[They’re] suggesting here that we set priorities and we establish at the federal level some kind of commission … and I think in many senses we know what the priorities are, and what we need to do is continue to be more effective in addressing the problems,” he said.

 

Munier suggested that instead of ranking problems, medical institutions should focus on reporting problems in a standardized way. At AHRQ, a federal agency that is part of the Department of Health and Human Services, Munier said the organization has set up “common formats” to make reporting patient safety problems more uniform.

 

He said the system will allow hospitals to aggregate data on patient safety and review it to make changes.

 

“They won’t have to wait for a message from Washington to get busy fixing problems in their local institution,” Munier said. “The care is delivered locally and if there’s going to be a safer care delivered tomorrow it’s got to be done by the doctors and nurses on a local level.”

 

Conway, from the Institute for Healthcare Improvement, said his experience has been that when “you try to do everything, you do nothing.”

 

“The focus on prioritization is absolutely important,” he said. “At the same time we cannot stop doing what we’re doing. We can’t suggest that we have to wait for a committee to tell us what to do.”

 

Copyright 2009 Daily Record.

 

Weakened Economy Linked to Mental Illness Issues in the District

 

By Dorothy Rowley

Baltimore Afro-American

Wednesday, August 26, 2009

 

(August 26, 2009) - Despite the legacy of slavery and discrimination, which has long had a significant influence on their social and economic standing, African Americans have traditionally been highly regarded for their resiliency in the face of adversity. But for many African Americans living in the District of Columbia, the effort to exist with a high level of mental acuteness remains a day-to-day struggle.

 

“You have a lot of people here in the District whose parents didn’t have the education and the exposure and business opportunities to give their children a legacy [other than slavery],” said Silver Spring psychologist Dr. Shane Perrault.

 

However, “I think we’re extremely resilient and the fact that we’re not flipping ourselves out at higher rates is absolutely amazing.”

 

A member of the Washington, DC-based national Association of Black Psychologists, Perrault added that,” Although many of our families were splintered and separated in several ways that have affected us, we’ve still come a long way with just a little and survived.”

 

In the District, where the majority African-American population exceeds 500,000 residents, the lack necessities that include opportunities for education and health insurance, often leads to poverty. With the city’s unemployment rate having escalated to more than 10 percent this summer, that can also account an increased need in the city for mental health care programs and services.

 

The Center for Disease Control (CDC) in Atlanta has stated that African Americans, who in the past decade have comprised about 40% of the homeless population and who are more likely to experience a mental disorder than their white counterparts, are also less likely to seek treatment. CDC also said that when they do, African Americans are more likely to seek it at a hospital emergency room.

 

To that end, the National Center for Health Statistics adds that each year approximately 20 percent of the U.S. population is affected by mental illness – and that with major depression listed as the leading cause of disability – no one - including African Americans -- is immune.

 

Dr. James Savage who operates three mental health clinics in the District and surrounding Maryland areas, agreed But he blames the large rate of unemployment among the District’s Blacks and the subsequent surge in requests for mental health care, on the economy.

 

He said that only when the economy rebounds, will there be a noticeable decline in the number people under mental health care.

 

“Unemployment was drastically high, even before the economy weakened, said Savage. “It’s been high unsustained employment that has kept many of our families in the District on [edge] and when you’re on something as shaky as that, your mental health is in a precarious position.”

 

He further stated individuals who haven’t displayed a resilience for trials of the past have been left to deal with the devastating effects. “We see many people on the streets who are homeless and in need of mental health care and we can see people who might not be homeless,” said Savage. “But they are dependent upon certain kinds of entitlements to keep them from being homeless because of mental illness.”

 

Perrault said that meanwhile, the District’s homeless individuals frequently tend to have a lot of problems. Chief among them are depression and substance abuse. He said that in turning to drugs and alcohol as coping strategies that they are merely self-medicating untreated disorders.

 

“When people have depression, they often turn to drugs and alcohol,” so as to not shrink for instance, from the responsibilities of raising a family, Perrault said.

 

“They will use alcohol and drugs to mute the depression, to help move them out of it.”

 

A new mental health facility at St. Elizabeth’s Hospital is slated for opening next year but it reportedly has a shortage of beds for overnight patients. Two years ago the hospital offered 420 beds for its psychiatric patients. The new wing will accommodate about 293 beds. But while hospital spokeswoman Phyllis Jones told the AFRO there will not be a bed shortage, its director of mental health services said in an earlier statement that the facility is prepared to meet the needs of District residents.

 

Stephen Baron, who cited a drop in inpatient care to about 15 percent since last fall, added that the hospital plans to continue to use existing buildings after the new mental health component opens.

 

Nevertheless, because of a crackdown on the amount of benefits that can be paid from health claims in general, Savage said many mental health care providers are moving their practices away from the District.

 

“We have Medicare and Medicaid to help for those people who don’t have private insurance and then there are people who have been documented in the city who don’t have any insurance,” Savage said. As a result, “There have been lots of complaints about not having adequate health care,” he said, alluding differences in benefits allotted Maryland mental health providers, compared to their peers in the District.

 

“A certain part of Medicare is mostly controlled by the non-HMOs and have been cut at least two to three times in terms of mental health care,” Savage said. “For a 45-minute session, Maryland would pay $100 for a child, whereas DC would pay just $50. This is a growing dilemma.”

 

Copyright 2009 Baltimore Afro-American.

 

Developers agree to pitch in to maintain homeless encampment outside city  church

 

By Julie Bykowicz

Baltimore Sun

Thursday, August 27, 2009

 

A project to clean up a homeless encampment outside a church in downtown Baltimore recently received an infusion of cash from two developers who have long complained about the area.

 

Khaled Said and Sanket Patel, who are developing hotels along the Fallsway, have committed $30,000 to nearby St. Vincent de Paul Church. The church's park, at the Jones Falls Expressway and Fayette Street, has been a destination for the homeless for four decades. In recent years, tents, lean-tos and leftover food collected on the lot, making it particularly unsanitary and angering neighbors.

 

After years of resistance, church officials agreed this summer to beautify the property and as of Aug. 1 closed it to the homeless. When it reopens next month, the park will be cleaned daily by the Downtown Partnership and church volunteers.

 

But that's expensive. The pastor, the Rev. Richard Thomas Lawrence, expects to pay about $30,000 for the initial renovation and $15,000 per year to the Downtown Partnership for upkeep.

 

Lawrence called the hoteliers' contributions "very generous and much-needed" because the annual church budget is about $250,000.

 

Brick pillars and a fence are under construction. Then the lot will be filled in with mulch, flowers and trees. The homeless will be able to sleep in the park but must leave, with all belongings, each morning from 7 to 9.

 

Said's Holiday Inn Express in the 200 block of N. Gay St., in the Old Town National Bank building, is slated to open within weeks. Patel is developing a Sleep Inn inside the former Furncraft building at 301 Fallsway.

 

J. Kirby Fowler, president of the Downtown Partnership, said the developers were happy to contribute.

 

"They, on the one hand, wished to be a good neighbor," he said. "And on the other hand, they want the best possible environment for their new properties."

 

Copyright © 2009, The Baltimore Sun.

 

Straightforward facts on dietary fat and health

It's actually an essential nutrient, and our obsession with dietary cholesterol is misguided, experts say

 

Special to the Tribune

By David Feder

Baltimore Sun

Thursday, August 27, 2009

 

We've become a culture where a serving of fettuccine Alfredo is nicknamed " heart attack on a plate" and french fries are frequently mentioned with the prefix "artery-clogging."

 

Rarely does an article about dietary fat inform us that fat is an essential nutrient without which we would surely die. However, for most of us, fretting over dietary fat and cholesterol is unnecessary.

 

For generations, experts have prescribed a set of rules for everyone based on risk factors of illness in only one segment of the population.

 

"The results of cholesterol and heart disease research was not meant to be applied to healthy people or the world at large," said Dr. Donald McNamara, a cholesterol research scientist and director of Eggs for Health Consulting in Laurel, Md. He compares such an approach to "prescribing the same pair of glasses to everyone."

 

Few experts argue that for those with cholesterol levels outside the norm, or with high risk factors for cardiovascular disease, dietary change often can be a valid intervention. But when it comes to high-fat foods such as burgers, cheese, butter and cream being liberally shunned by those bent on lowering their cholesterol intake, it's time to lard the conversation with a little straightforward science on dietary fat and health.

 

Your body knows how to handle dietary fat, and if you're not overweight and have no other high-risk conditions, your risk of heart disease is probably low. That means even if you occasionally eat several slices of pizza with a Haagen-Dazs chaser, you needn't punish yourself with guilt and worry. The stress will probably do more damage than the Super Bowl special you just ate. According to Mark Anthony, nutrition science instructor at St. Edward's University, Austin, Texas, and author of "Gut Instinct: Diet's Missing Link," analysis of the research into cholesterol and disease is bearing this out.

 

In 2006, scientists at the University of Surrey in Guildford, England, published a comprehensive analysis of multiple studies on dietary cholesterol and serum cholesterol in the British Nutrition Foundation Nutrition Bulletin. Their conclusion was emphatic: "The idea that dietary cholesterol increases risk of coronary heart disease (CHD) by turning into blood cholesterol is compelling in much the same way that fish oil improves arthritis by lubricating our joints."

 

Specifically, the team noted, "the scientific evidence to support a role for dietary cholesterol, [or the cholesterol we eat, as opposed to serum cholesterol, which is the cholesterol in our bloodstream], in CHD is relatively insubstantial in comparison with the incontrovertible link between its circulating blood relative in LDL cholesterol and CHD."

 

McNamara concurs: "No study published over the last 20 years has reported a relationship between dietary cholesterol intake and heart disease risk in the general population." He also points to data from the famous "Seven Countries Study" that analyzed subjects with the same levels of cholesterol, across different cultures. Absolute rates of heart disease varied widely. Another eye-opening statistic cited by McNamara is that roughly half the incidents of heart disease occur in people with normal cholesterol.

 

The type of fat in your diet does matter to some degree. Trans fat, derived predominantly from highly processed oils, was shown to be more strongly associated with cardiovascular disease. It was ultimately subjected to strict labeling and voluntarily removed from thousands of foods and beverages.

 

However, many research studies have shown that natural fat in foods such as eggs and dairy products has no effect on the risk for cardiovascular disease. Some studies have shown a positive effect of dairy consumption on reduction of disease risk. Saturated fats from sources other than eggs and dairy, such as from meat, once were associated with increased disease risk. Later studies are proving the issue to be more complex than that. And studies of saturated fats from plants such as coconut and palm oil are revealing positive health benefits.

 

Most important, mono- and polyunsaturated fats from olive oil, nut oils and vegetable oils, and the omega oils found in fish, flax and nuts boast thousands of studies backing their benefit to health for everything from protection against cancer, heart disease, certain birth defects, depression, cognitive decline and more.

 

Authors of the Harvard School of Public Health OmniHeart Study comparing popular diets and food intake concluded that, "in the setting of a healthful diet, partial substitution of carbohydrate [with] monounsaturated fat can further lower blood pressure, improve lipid levels and reduce estimated cardiovascular risk."

 

Simply put, the connection between the amount of fat we eat and the fat clogging our arteries and stopping our hearts turns out to be far more complicated than a blanket prescription of " low-fat diets for everyone" can address.

 

It doesn't negate the value of eating a balanced diet, with the majority of calories coming from fruits, vegetables and whole-grain foods. But it does mean that, if we have been taking care of ourselves by maintaining a healthy weight and staying active, we don't have to seek penance every time we butter our toast.

 

David Feder is a registered dietitian and director of S/F/B Communications Group, a national co-operative of food, health and nutrition experts.

 

Copyright 2009 Baltimore Sun.

 

Health care myths obscure the much tougher decisions

 

By Jay Hancock

Baltimore Sun

Thursday, August 27, 2009

 

Health care reform lies are fairly easy to dispose of. There are no "death panels" in the legislation being considered in Washington, despite continuing insistence to the contrary from people who want to incite fear and draw attention to themselves.

 

More insidious are health care reform myths: seemingly logical arguments that shrink under scrutiny and distract from the real job of controlling dangerously soaring medical expenses.

 

Here are two of the biggest, one from conservatives and the other from liberals.

 

First, the conservative myth. "Why is it ... in this grand health care debate we hear not a word about one of the worst sources of waste in American medicine: the insane cost and arbitrary rewards of our malpractice system?" syndicated columnist Charles Krauthammer asked last month.

 

Actually we hear plenty about tort reform - fixing the laws pertaining to medical malpractice and other personal injury. Talk radio is full of it. Krauthammer wrote about it again this month. I get reader e-mails all the time asking the same question.

 

There's lots to talk about. Malpractice awards and "defensive medicine," in which doctors over-scan and over-treat patients to fend off lawsuits, cost tens of billions a year.

 

Trial lawyers bring dubious cases along with deserving ones. Juries deliver nonsensical verdicts. Every few years, malpractice insurance costs drive neurosurgeons or obstetricians to retire, move to other states or otherwise withhold badly needed care.

 

There is nothing about tort reform in the Democrats' health care legislation. No accident there. Trial lawyers give millions to Dems and hardly anything to Republicans.

 

But tort reform is not the solution to the health care crisis. The absence of tort reform is not a reason to reject what's going on in Washington.

 

"Tort reform as discussed in the United States would probably have very little impact," says Gerard Anderson, a professor at the Johns Hopkins Bloomberg School of Public Health. "The states that have enforced tort reform have about the same amount of litigation - and the awards are comparable - as states that don't."

 

A more drastic malpractice makeover would deliver substantial gains - but only once. New Zealand has a no-fault medical injury system in which lawsuits are essentially banned and experts decide how much to award victims. But even such a system, which nobody is talking about in the United States, would cut health care costs by maybe 7 percent at the most, Anderson said.

 

That includes costs from defensive medicine. At a time when employers and patients often see medical costs rise by double-digit percentages every year, 7 percent is a footnote.

 

The nonpartisan Congressional Budget Office, as usual the best source for this kind of analysis, says malpractice costs make up only 2 percent of health care spending. "The evidence available to date does not make a strong case that restricting malpractice liability would have a significant effect," the CBO says.

 

Even WellPoint, the insurance giant whose CEO likes to complain about malpractice lawsuits, says litigation and defensive medicine "are not considered a recent significant factor in the overall growth of health care spending."

 

The liberal health care myth is about prevention. If only under universal care we could monitor people before they get sick, the argument goes, think how much we could cut costs.

 

Expanded insurance "will cover preventive care like checkups and mammograms that save lives and money," President Barack Obama said at his July news conference.

 

Unfortunately, it doesn't work out that way. Society-wide, investing in prevention and early detection may cost more than the expenses saved in stopping acute or chronic illness, policy experts say. Preventive care would mean lots of new tests and scans for people who never would have gotten sick anyway.

 

Studies have shown that lowering the smoking rate may increase medical costs over the long term. Why? Those who would have died of lung cancer or heart disease go on to live for decades, consuming medical services and developing other expensive diseases.

 

"You have to look at what type of preventive service you're talking about," says Anderson. "The word 'prevention' won't save money. Prevention across the board would not save money."

 

The Congressional Budget Office again delivers the verdict.

 

"The evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall," CBO director Douglas Elmendorf wrote this month in a letter to Congress.

 

That's not to say it's not worth doing. Giving people longer lives with less chronic disease might be a very good investment by society - even if it ends up costing more. A big problem with today's system is that we foot higher-than-average medical costs for lower-than-average results in wellness, longevity and other measures. More spending on prevention might at least improve the overall return.

 

Likewise, there are compelling reasons to enact tort reform, even if it doesn't end up financing peace, love, happiness and wellness for everybody forever.

 

But holding out either policy change as a solution to medical inflation only delays the day we tackle the real and much tougher problem: wasteful spending on people who are already sick.

 

Copyright © 2009, The Baltimore Sun.

 

Jane B. Wiley dies at 79

Registered nurse established Towson U. nursing program

 

By Frederick N. Rasmussen

Baltimore Sun

Thursday, August 27, 2009

 

Jane B. Wiley, a former registered nurse who helped establish the nursing program at Towson University and later earned a law degree and practiced family law for more than a decade, died Aug. 19 of a heart attack at the Edenwald retirement community in Towson. She was 79.

 

Jane Baker was born in Baltimore and raised in Waverly. After graduating from Eastern High School in 1946, she earned her nursing degree from the old Church Home and Hospital Nursing School in the late 1940s.

 

She began her nursing career in 1950, working for eight years for the Army and the National Security Agency at Fort Meade.

 

After taking several years off to raise her family, she returned to nursing in 1965 as a school nurse at the old Samuel Gompers School on North Avenue.

 

She then joined the faculty of Mergenthaler Vocational-Technical High School in 1971, where she taught aspiring nursing students for two years.

 

While teaching at Towson in the mid-1970s, Mrs. Wiley also worked part time at Maryland Shock Trauma Center to "remain connected to the craft she was teaching," said her son, Mark T. Wiley of Germantown.

 

She earned her law degree from the University of Baltimore in 1991, and after retiring from TU that year, made a career change. She established a family law practice in Towson and worked as a lawyer until 2003.

 

She volunteered for the Woman's Law Center for 15 years.

 

"She focused on helping other women who were experiencing legal issues, which she once did as a single mother of three," her son said.

 

She was an active communicant and chalicist of the Episcopal Church of the Holy Comforter, 130 W. Seminary Ave., Lutherville, where funeral services will be held at 11 a.m. today.

 

Also surviving are a daughter, Susan Wiley of Wilmington, Del.; five brothers, Everett Baker of Towson, John Baker of San Francisco, James Baker of Bangor, Maine, David Baker of Hartford, Conn., and Daniel Baker of Towson; two sisters, Joanne Warder of Canton, Ohio, and Margaret Jennings of Washington, Pa.; and four grandchildren. Another daughter, Nancy Smallwood, died in 2002. Her marriages to Edward Wiley and Jack Smallwood ended in divorce.

 

Copyright © 2009, The Baltimore Sun.

 

Radiation tests are questioned

 

By Stephanie Desmon

Baltimore Sun

Thursday, August 27, 2009

 

Skyrocketing numbers of expensive medical imaging procedures - from CT scans to nuclear stress tests - are not just straining the nation's health care system, but are exposing patients to significant amounts of potentially cancer-causing radiation even though little research has been done into whether those tests actually make people healthier, a new study suggests.

 

The tests, say the study's authors, may be doing more harm than good.

 

"One reason why these tests are being used more is they're getting better and better and they're an extremely helpful part of diagnosis and treatment," said Dr. Reza Fazel, a cardiologist at Emory University School of Medicine in Atlanta and the lead author of a study in today's New England Journal of Medicine. "But just because we have them doesn't mean we should use them. ... There's a cost with these tests, and it's not just dollars but radiation risk."

 

No one disputes that advanced medical imaging has transformed medicine by enabling physicians to detect diseases and other medical problems at early stages - and even cure them. But with a rapid rise in expenditures on these tests, one of the fastest-growing costs in health care, there have been calls to rein in the use of unnecessary imaging. CT scans alone, which expose patients to moderate amounts of radiation for each test and are many times repeated, have quadrupled since 1992, according to a 2007 study.

 

Dr. Michael S. Lauer, director of the NIH's National Heart, Lung, and Blood Institute in Bethesda, said one of the biggest obstacles to restricting the number of radiologic tests is that not enough is known about whether most of them make patients feel better or live longer. X-rays for broken bones are obvious, but high-tech CT scans of the heart haven't been medically proved to improve health and they expose patients to much higher levels of radiation. "The problem that we have here is we don't know if there are too many [tests given], too few or just right," said Lauer, who was not part of the study.

 

He says only a few imaging tests - mammograms for discovering breast tumors, ultrasound of the abdomen for diagnosing aortic aneurysms - have been scientifically proved to save lives. Many have never been studied in large-scale clinical trials. In addition to leading to high doses of radiation, some tests can find cancers so small they might never have caused problems, leading to unnecessary surgeries and psychological distress.

 

The New England Journal of Medicine study shows that some of the most popular tests performed - nuclear stress tests, CT scans of the abdomen, pelvis and chest - also provide some of the largest doses of ionizing radiation. MRI, also popular, does not use radiation. As many as 4 million adults under age 65 per year, Fazel estimates, are getting high doses of radiation that could put them in danger in the long term.

 

Although elderly patients are likely to get more tests, Fazel's study includes some striking data on how many tests even young people get. His research focused on three years' worth of United Healthcare claims data from five major cities, a population of nearly 1 million nonelderly adults. Seven in 10 of people ages 18 to 64 got at least one test over three years and nearly half of those between 18 and 34 got a test. Sometimes, patients get repeated tests by different doctors who don't know the patient has already been scanned. Newer scans - some that use reduced levels of radiation - tend not to replace older tests, just supplement them.

 

Though the annual average radiation exposure from the tests was low, researchers found about 20 percent of patients were exposed to moderate radiation doses and 2 percent were exposed to high levels. Nearly a quarter of the radiation people received came from CT scans to the heart, so-called "super X-rays" that provide 3-D pictures. And cumulative imaging-related radiation over time, researchers said, can account for 2 percent of cancers.

 

Congress enacted limits in 2006 to curtail Medicare spending on medical tests and scans, and private insurers have started requiring pre-authorization before some of the more advanced CT scans. A Government Accountability Office report last year showed a 12 percent decline in imaging spending from $13.8 billion in 2006 to $12.1 billion in 2007. But over the same period, the use of CT scans and MRIs continued to rise.

 

Jean Marshall, a health economist at Georgetown University who has studied spending patterns, said the health care system's fee-for-service model, in which doctors are paid for each service they perform, encourages unnecessary tests. Some doctors who order imaging tests own the equipment and can be reimbursed at both ends. Marshall said she wasn't surprised that the number of tests continued to rise as the reimbursements went down.

 

"The reimbursement system needs to be changed," Mitchell said, "because it's given them all the wrong incentives." Reforming the way tests are reimbursed, she said, is a touchy subject.

 

"Every dollar of health care expenditure represents income to a provider - that's why cutting costs is so hard. Do you blame them? I don't."

 

Many doctors say they order the tests because they think that's what is best for an individual patient. Also, fears of malpractice lawsuits may lead physicians to order extra tests in some circumstances.

 

"It's not that we should stop imaging," said Dr. Rebecca Smith-Bindman, a professor of radiology and epidemiology at the University of California- San Francisco and co-author of a report on medical imaging in the journal Health Affairs last year. "But the sense is that all imaging is good. Some is good. Some is harmful. We need to get appropriate imaging."

 

Many medical experts said they worried about whether imaging is used too much for managing chronic illness. Once the disease is diagnosed, in most cases, new imaging isn't needed, Smith-Bindman said. Guidelines for when tests should be used need to be developed and followed and kept current with evolving science.

 

Meanwhile, she said, Medicare continues to pay for nearly all scans. Only recently did it refuse to pay for screening colonscopies using CT, she said. "They've just been willing to pay for anything," she said.

 

Copyright © 2009, The Baltimore Sun.

 

After Ordeal, Va. Couple United With Girl Adopted From China

 

By Yamiche Alcindor

Washington Post

Thursday, August 27, 2009

 

Candace Litchford paced up and down the international arrivals gate at Washington Dulles International Airport on Wednesday night. She was frustrated that she hadn't been able to reach her adopted daughter's travel escort.

 

"Do you have the right number?" her husband, Jay Scruggs, asked while trying to contain the couple's 6-year-old son Ivan.

 

Ivan, like his parents, was growing impatient after waiting more than an hour for his new sister to arrive. "Did it take this long for me to get here?" said Ivan, who was adopted from Kazakhstan five years ago. "Maybe we should try to go back there," Scruggs said, suggesting the family sneak through the customs exit doors.

 

A family friend quickly convinced them that that probably wasn't a good idea.

 

But, the temptation to trespass was still strong when 4-year-old Harper Yue Ye Scruggs finally walked out of customs and into Litchford's arms. Litchford hugged the little girl and examined the gifts -- drawings and stickers --Harper pulled from her bright pink Minnie Mouse backpack.

 

The new siblings greeted each other in kid-speak: Ivan stuck his tongue out and Harper, unable to speak English, returned the greeting.

 

The homecoming, months in the making, was complete.

 

A month after new immigration regulations barred Harper, who had been receiving treatment for tuberculosis, from entering the United States, Litchford, 43, and Scruggs, 39, welcomed their tired and confused little girl home. The couple had been forced to leave Harper in China with an American missionary for more than two weeks until a deal could be brokered to bring her here.

 

Harper's arrival had been delayed by federal regulations aimed at limiting the number of immigrants entering the country with tuberculosis. In 2007, the Centers for Disease Control and Prevention issued new tuberculosis testing and treatment rules for immigrants older than 2. The policy applies to all immigrants, including foreign children adopted by U.S. citizens, and it outraged many adoption organizations. The guidelines went into effect July 1 in China, turning what was supposed to be a simple trip to pick Harper up into a month-long nightmare.

 

As a result, Litchford and Scruggs embarked on a worldwide campaign to call attention to their plight and that of hundreds of other parents attempting to bring children adopted outside of the United States into the country.

 

They began contacting media outlets and local organizations for help. Nancy Robertson, of the Grace Children's Foundation, a New York based charity that advocates on behalf of children in China, got involved. She acted as a liaison between the family and the agencies involved in bringing Harper home. Wednesday night, she welcomed Harper home with the family.

 

"This is not about China, this is about children," Robertson said.

 

What exactly changed in Harper's case is somewhat a mystery.

 

The CDC would not comment on Harper's case specifically, but CDC spokeswoman Christine Pearson said that the Department of Homeland Security can issue waivers like the one Harper's parents think she received. According to the CDC Web site, the agency reviews medical records and provides a recommendation to Homeland Security during the waiver process. Most likely, the CDC recommended that Harper be allowed into the country.

 

Harper's parents were notified Friday that she had been granted a visa to enter the country. Soon after, they booked a ticket from Guangzhou, China, to Washington for Harper and her foster mother, Denise Allen, a Christian missionary who runs an in-home orphanage in China.

 

On Wednesday, Harper's parents put aside the international debate to focus on their little girl's first taste of America: Burger King chicken nuggets.

 

The family had spent much of Wednesday preparing for Harper's arrival. Ivan sat on the family's mocha-colored sofa asking questions, his grass-colored eyes fixed on photos of a small shy Chinese girl in bright tangerine Crocs.

 

"Are we bringing baby sister home today? What is baby sister going to do"?

 

A few feet away his mother, Harper's mother, just home from work as an architect, responded, "Yes, Ivan." She had her own worries, "Is she going to recognize us?"

 

The little girl whom Ivan had heard so much about, the one he and his parents had waved to on computer video chats for weeks was coming to live with them.

 

Scruggs rushed through an Alexandria supermarket buying bananas, strawberries and watermelon, fruit the couple hoped might make the little girl's transition to the United States easier.

 

Harper's room, prepared two years earlier for the girl her parents knew they would one day adopt, would finally have someone sleeping amid its pale blue walls. The large, bright pink princess castle would finally have someone to sit inside it. The Mulan Barbie doll, which lay beside her little girl's bed, would finally be wrapped inside small fingers.

 

"It's always been Harper's room," Litchford said. The couple moved to the three-bedroom Alexandria home four years ago to begin preparing for a daughter. In June, they found out they would be adopting Harper.

 

Late Wednesday night, Harper got her first look at her new home. She didn't say much, but she smiled as she held her new daddy's hand.

 

Ivan welcomed his sister with a kiss. "I love you, Harper."

 

Litchford said that although her family's ending is a happy one, she hopes Harper's case will bring to light the problems that hundreds of other adoptive families face.

 

"There are hundreds of kids waiting to come home," Litchford said. "The bigger question is how are we going to address this problem? How do we fix it in the right way?"

 

Copyright 2009 Washington Post.

 

More Retirees Find Facilities Speaking Their Language

Senior Centers, Nursing Homes Respond to Increased Diversity

 

By Tara Bahrampour

Washington Post

Wednesday, August 26, 2009

 

Dvoira Rososhanskaya wheeled her chair through the Hebrew Home of Greater Washington, past the bathrooms that say "tuyalet" in Cyrillic letters and the bookcase full of Russian translations of Agatha Christie and Arthur Conan Doyle. A Russian writer had just read his short stories to a group of senior citizens from the former Soviet Union, and Rososhanskaya, 87, had loved it.

 

"It's very important for me to be among Russian speakers," said the onetime preschool teacher from Ukraine who earned three medals digging trenches near Stalingrad during World War II. "Everything he was telling and reading from his book corresponded with things I'd gone through in my life."

 

Rososhanskaya is one of 42 Russian-speaking residents at the Rockville facility, which is responding to what experts believe will be a growing demand for multicultural offerings at senior centers and nursing homes as America's elderly population becomes increasingly diverse.

 

In the Washington area, which has residents from 193 countries, there are retirement homes that cater to a single ethnic group, such as Chinese or Korean, serving their native foods and hiring staff who speak their native tongues. Now some general population facilities are also tailoring their services to an increasingly diverse clientele.

 

"Everyone is going to have to learn more about various ethnic and cultural sensitivities, because the marketplace of aging is getting more diverse," said Larry Minnix, president and chief executive of the American Association of Homes and Services for the Aging. "I think, over the next five to 10 years, you're going to see a lot of attention paid to this."

 

About 10 percent of people 65 and older in the United States are foreign-born. The Pew Research Center estimates that by 2050, that figure will rise to 20 percent, with the total number of elderly immigrants quadrupling to about 16 million.

 

The movement to serve this population seems to be taking root in individual facilities that see a need rather than coming as a top-down corporate decision. Representatives for large national organizations such as Leisure World and Sunrise Senior Living said they knew of no such programs in their organizations.

 

Ian Brown, chairman of the diversity and inclusion council at Erickson Living, a retirement organization with 23,000 residents nationwide, said multiculturalism sometimes begins with the employees, who increasingly come from countries such as Nigeria, India and the Philippines.

 

"They go home to their own parents and say, 'Hey, this is something that celebrates you and celebrates me, and I think this would be a great place for you to be,' " Brown said, adding that the facility where he is based, in Illinois, hosts special meals that showcase staff members' homelands.

 

In some ways, moving into a retirement facility can be a bigger culture shock than immigration itself. While younger immigrants usually learn some English and adapt to American culture for school and work, those who arrive after retirement often have less incentive to assimilate. Staying at home and communicating through younger family members, they can cling to their language and customs for decades.

 

But with fewer old-world extended families to care for them at home, many face the prospect of nursing homes where the language, food and signs are unfamiliar and where staff members and fellow residents might know nothing about their backgrounds.

 

On top of that, in many cultures, separating an old person from the family is taboo. Leaders of Muslim communities have approached Minnix's organization looking for facilities, but also expressing ambivalence. "There's a bias -- if your mother has to be put somewhere, then you're not fulfilling your responsibility," he said.

 

There are also fewer facilities catering to more recent arrivals. "If you're, say, kosher Jewish, there's plenty of places," Minnix said. "But what do you do if you're Pakistani? I don't think we've got any disciplined, well-thought-out answer to that."

 

Jasmine Borrego, president of Telacu Residential Management, which provides housing for the elderly and disabled in Southern California, said that in recent years more Hispanics are moving into retirement homes.

 

"In the past 10 years, it's evolved, and it's not so much 'We don't want Mom and Pop to live with us,' it's about what's best for Mom and Dad," she said. "It's really a cultural shift."

 

Making everyone feel comfortable can present cultural obstacles for even the best-intentioned facility, however. Minnix recalled a Native American nursing home resident who shut himself in his room and stopped eating, mystifying his caretakers until they discovered the cause.

 

"In the lobby was a picture of, I think, an owl, and that symbolized, for him, death, and it took a while to figure out that that was the problem," Minnix said. The owl was removed, and the man resumed eating. "What we don't know are the subtle barriers to culture and religion that are going to be an issue over the next few years."

 

At the same time, he said, delegations come from other countries to learn how elder care is done here. If retirement communities become more prevalent abroad, they might become more palatable for future immigrants to the United States.

 

City- and county-run organizations, as well as private ones, are increasing their multicultural offerings. At the Rockville Senior Center, Hispanic, Chinese, Korean and Iranian immigrants participate in a range of activities in their native languages, and the center is paying for staff to learn foreign languages.

 

In the center's cafeteria Friday, Chinese women rehearsed a fan dance, then joined several dozen compatriots for exercises based on chi-gong and a Chinese lunch of tofu, rice, chicken and noodles.

 

"I thought it would be harder to find Chinese culture in America," said Yi Hua Wang, 73, who moved to Gaithersburg from Beijing two years ago. "I like America; I can do the twist," she said, swiveling her hips a bit. "But I cannot forget my own culture."

 

Down the hall, women from Colombia, Bolivia, Peru, and El Salvador played bingo. Felipa Gochez, 70, of El Salvador won the game, then joined the group doing chi-gong. She could not understand the instructor on the videotape, who explained in Mandarin that slapping your face and neck prevents wrinkles and hitting your shoulder calms worries. But, she said, "It does me a lot of good."

 

At the Hebrew Home, the Russian program started in 2006 as more Russian speakers moved into the home, the result of a wave of immigration in the late 1980s and early 1990s as the Soviet Union collapsed.

 

Sophia Presman, an immigrant from the former Soviet republic of Moldova, was hired as the home's first Russian recreation coordinator. She orders Russian books and magazines; arranges for Russian-speaking guests to talk with residents about literature, history, and politics; organizes bingo in Russian; and brings in a Russian psychotherapist to meet with residents.

 

Natives of Russia, Ukraine, Belarus, Lithuania, Moldova and Armenia quickly took a new interest in their surroundings. Word spread and the Russian-speaking population there quadrupled.

 

It was something many would never have foreseen. "Nursing homes in the Soviet Union were like concentration camp," Presman said. "Well, not as bad, but almost equivalent to it. The conditions were despicable. To put someone in a nursing home, it was absolutely last resort. It meant that no one would take care of them."

 

Rososhanskaya, the former preschool teacher, agreed. Back in her home town of Zhitomir, she said, "it was absolutely inconceivable to me to consider that I would ever be placed in a nursing home." But here, "I think it's the smartest idea. I'm very comfortable, very well treated, and I feel that my life is not lost."

 

Copyright 2009 Washington Post.

 

National / International

Fruits and vegetables, good for the bones?

For proponents of a low-acid diet, vinegar and citrus aren't the suspects -- meat and dairy products are.

 

By Elena Conis

Baltimore Sun

Thursday, August 27, 2009

 

Don't think dairy when it comes to building strong bones, say proponents of the low-acid diet. Focus instead on a diet rich in fruits and vegetables, these nutrition scientists say.

 

The low-acid diet (also called the alkaline acid diet) has been the subject of scientific debate of late, as doctors and researchers question what, precisely, it takes to keep bones strong. The thinking behind the diet goes like this: Blood is slightly alkaline, with a pH just above 7. If the diet is rich in acids, the body tries to restore alkalinity by eliminating minerals, including potassium, magnesium and calcium, which the blood essentially pulls from the bones.

 

Following a low-acid diet doesn't mean avoiding vinegar and citrus fruits. On the contrary, it means not overloading on proteins, which are made up of amino acids that, as the name suggests, are acidic in nature. Low-acid diet adherents point out that because humans did not evolve on a diet heavy in meat and dairy, the modern Western diet, which is rich in animal proteins, may be contributing to illness and disease -- including osteoporosis.

 

That's the theory. What about the science?

 

"There's good evidence to suggest that pH in diet can make a difference" when it comes to bone health, says Dr. Bart Clarke, an endocrinologist specializing in osteoporosis and an associate professor of medicine at the Mayo Clinic in Rochester, Minn.

 

However, Clarke adds, the difference is small.

 

The theory was first proposed in the 1960s by scientists who hypothesized that human bones might be giving up calcium to compensate for pH imbalances caused by protein-rich Western diets. Evidence to support the theory accumulated in the 1980s, as scientists began to show that in rats, even small shifts in pH (such as a drop to pH 7.15 from 7.25) increased bone loss up to six-fold.

 

In test tube studies, acidity was shown to ramp up the activity of osteoclasts, cells that promote bone loss, and dampen that of osteoblasts, cells involved in bone formation.

 

Small studies in humans soon began to suggest that the body excreted more calcium, or less, depending on the acidity of the diet.

 

In a 1994 study by scientists at UC San Francisco that was published in the New England Journal of Medicine, calcium levels in urine decreased in 18 post-menopausal women who took potassium bicarbonate daily to neutralize the acid in their diets. The authors concluded that taking the potassium bicarbonate reduced the women's bone loss and increased bone formation.

 

And in a 2001 study conducted by Swiss researchers and published in the journal Osteoporosis International, four people placed on a high-acid diet excreted 74% more urinary calcium than four others placed on an alkaline diet (which included lots of mineral water).

 

Larger populations also have provided support for a low-acid diet. In the late 1990s, British researchers conducting a long-term osteoporosis study in Scotland found that bone health appeared better in participants who consumed more fruits and vegetables. The researchers conducted a smaller study on just over 1,000 of the women, and found -- reporting in the American Journal of Clinical Nutrition in 2004 -- that those who consumed diets lower in protein and higher in potassium had greater bone mineral density in the spine and hip, and greater bone mass in the forearm.

 

The difference was small but significant: Lower dietary acidity reduced bone loss by 2% to 4%.

 

In a follow-up study of more than 3,000 of the women in the Scottish study, the same researchers found that bone mineral density was 2% higher in women who consumed the lowest-acid diets compared with those who ate the highest-acid diets. Among pre-menopausal women, hip bone mineral density was 8% higher and lumbar spine density 6% higher in those who consumed the most potassium compared with those who consumed the least.

 

"The Western diet . . . generates a large amount of acid. Without sufficient alkaline-forming foods in the diet, bone health may be compromised," study author Helen Macdonald and colleagues wrote in the American Journal of Clinical Nutrition in 2005. "It would appear that even subtle chronic acidosis could be sufficient to cause considerable bone loss over time."

 

The study authors concluded that the greater bone density in women on the lowest-acid diets could translate into a 30% reduced risk of fracture in old age.

 

But such a dramatic risk reduction has yet to be proven. And any shifts in blood pH brought about by dietary changes are likely to be small, says Clarke, who doesn't advocate drastic measures to achieve a low-acid diet.

 

Regulating the pH of the blood is primarily an issue for people with existing bone loss who go on extreme diets, he says. "If we knew someone with osteoporosis was following a high protein diet for weight loss, we'd have concerns about that."

 

The primary virtue of a low-acid diet may be its emphasis on fruits, vegetables and whole grains, says Joan Salge-Blake, a nutrition professor at Boston University and spokeswoman for the American Dietetic Assn. "A plant-based diet is not only good for bones, it's good for a lot of other things too," including lowering the risk of hypertension, stroke and heart disease, she says.

 

Salge-Blake says the evidence on low-acid diets is also no reason to abandon sources of calcium and vitamin D, which are still crucial for bone health. "Bones lose calcium when the diet is too high in protein," she says, "but studies suggest that if there's enough calcium in the diet to offset this, it shouldn't be a problem."

 

Copyright © 2009, The Los Angeles Times.

 

Copyright 2009 Baltimore Sun.

 

H1N1 Flu Sends More African Americans, Hispanics to Hospitals

 

Associated Press

Wall Street Journal

Thursday, August 27, 2009

 

ATLANTA -- The H1N1 virus was four times more likely to send African Americans and Hispanics to the hospital than whites, according to a study in Chicago that offers one of the first looks at how the virus has affected different racial groups.

 

The report echoes some unpublished information from Boston that found three out of four Bostonians hospitalized from the H1N1 flu were black or Hispanic.

 

The cause for the difference is probably not genetic, health officials said. More likely, it's because blacks and Hispanics suffer disproportionately from asthma, diabetes and other health problems that make people more vulnerable to the flu.

 

It's not clear if a racial or ethnic difference will hold up when more complete national data is available, one federal health official said. The findings are based on fairly small numbers of cases from the early days of the pandemic.

 

"We don't have anything definitive to say one group is more affected than another," said Daniel Jernigan of the U.S. Centers for Disease Control and Prevention.

 

The Chicago findings, released Thursday, are believed to be the first published study to detail a racial or ethnic breakdown of the flu's impact.

 

Researchers looked at more than 1,500 lab-confirmed H1N1 flu cases reported to the Chicago Department of Public Health from late April through late July.

 

Blacks with H1N1 flu were hospitalized at a rate of 9 per 100,000, and Hispanics at a rate of 8 per 100,000. For whites, the rate was 2 per 100,000, the study found.

 

Earlier this month, Boston health officials released some unpublished information that found three out of four Bostonians hospitalized with H1N1 flu were black or Hispanic.

 

"It's very disturbing," said Barbara Ferrer of the Boston Public Health Commission, speaking about the higher rates of minority H1N1 flu hospitalizations.

 

"But intuitively it's understandable, because we have tremendous inequities in most areas of health," said Ms. Ferrer, the agency's executive director.

 

Also, experts noted that the Chicago and Boston data represent limited information from only two cities and only the first two or three months of the pandemic. The unpredictable manner of flu outbreaks means some parts of the city were hit before others -- a sequence that may have little to do with race.

 

"I think it reflected more the neighborhoods the disease was first going through," said Dr. Jernigan, a CDC flu expert.

 

This fall, the government will be doing national surveys to better track H1N1 flu trends. That should provide more reliable information about how the virus is affecting different groups of people, he said.

 

Copyright © 2009 Associated Press

 

Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved.

 

Opinion

Homeless Female Veterans

 

New York Times Letter to the Editor

Thursday, August 27, 2009

 

To the Editor:

 

Re “G.I. Jane Stealthily Breaks the Combat Barrier” (“Women at Arms” series, front page, Aug. 16): Marginal living conditions, scarce employment opportunities and post-traumatic stress syndrome and other injuries add enormous challenges to veterans’ transition to civilian life. But female veterans are confronted with many additional problems, including family reunification and experiences of sexual abuse and rape during their service, which remains a widespread issue in the armed services.

 

Each night an estimated 4,000 female veterans are homeless in the United States, and perhaps twice as many are homeless at some point during the year. This statistic is expected to grow as more women return from active tours.

 

Women seeking emergency housing for themselves and for their children encounter difficulty, as a small percentage of residential programs provided by Veterans Affairs accepts female veterans and none accept children. The V.A. will need partnerships with nonprofits and the private sector to address veterans’ urgent needs.

 

Programs like HELP USA’s holistic approach of providing safe, quality housing, on-site professional case management, day care, employment and counseling services is a proven solution for homeless and at-risk veterans. This model can empower female veterans to rebuild their lives and gain self-sufficiency for their families.

 

Maria Cuomo Cole

Chairwoman, HELP USA

New York, Aug. 17, 2009

 

Copyright 2009 New York Times.

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