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Sunday, July 12, 2009

News Clipping Archives

Maryland / Regional
Shot girl's neighborhood among worst off (Baltimore Sun)
State grant helps county (Baltimore Sun)

National / International
Study: Clozapine may have saved schizophrenics (Washington Post)
Sebelius: All options on table for health plan (Baltimore Sun)
Officials push for health care in spite of delay (Washington Post)
Scrub tech causes major hepatitis scare in Colo. (Washington Post)

Opinion
Best medicine: competition (Baltimore Sun Commentary)


Maryland / Regional
Shot girl's neighborhood among worst off
Health rankings put Southwest Baltimore in bottom third

By Olivia Bobrowsky
Baltimore Sun
Sunday, July 12, 2009

The neighborhood where a 5-year-old girl was hit by a stray bullet is among the bleakest areas of Baltimore, based on community health statistics.

Of the 55 city neighborhoods, Southwest Baltimore's life expectancy ranks third worst, at 64.2 years, a 2008 health profile found. Most of the other health indicators knock Southwest Baltimore into the lowest third.

Caroline Fichtenberg, the Health Department's chief epidemiologist, said that although other neighborhoods share Southwest Baltimore's dire circumstances, that area's poverty level - about 19 percent of the population - heavily contributes to its poor health. Carrollton Ridge, the neighborhood within Southwest Baltimore where the injured girl lives, is even worse, at 42.6 percent.

Genevieve Birkby, the city's deputy director for community programs, is heading a new program to improve environmental health in the community, covering housing, trash, pests and access to transportation and food. The initiative focuses on Southwest Baltimore because of its historical issues of lead poisoning and pollution.

This is a sample of data on Southwest Baltimore from a 2008 community health profile (all numbers cover 2002 to 2006, except where noted):

	Southwest Baltimore	Citywide
Accident deaths per 10,000 residents	4.6	2.8
Drug deaths per 10,000 residents	7.7	3.7
HIV/AIDS deaths per 10,000 residents	9.8	5.2
Percentage of children ages 0-6 with elevated lead levels*	11.8	4.6
Percentage of babies born to girls age 15 to 19	27	19
Percentage of residents age 16 to 64 unemployed**	43	34

* 2006 ** 2000

Source: Baltimorehealth.org/neighborhoodmap.html


State grant helps county
Alternative program for some offenders is revived

By Larry Carson
Baltimore Sun
Sunday, July 12, 2009

A Howard County alternative sentencing program for minor offenders eliminated July 1 in a budget cut is being revived, thanks to an $85,000 state grant and the interest and ingenuity of a host of officials and K. Frank Turban.

The County Council is scheduled to vote on approving the grant July 30. Turban, 62, a retired drunken-driving probation agent and a recovering alcoholic who founded a 12-step program called Serenity Center in Columbia, hopes to get the county program running again in August.

"A tremendous number of nonprofits use community service for a lot of labor," Turban said. When he read newspaper stories about the 14-year-old program formerly run from the county sheriff's office ending July 1, he contacted County Executive Ken Ulman to propose a revival.

"I listened to County Council members who expressed concern about losing that program," Ulman said. Then he attended an event at the Serenity Center in Oakland Mills.

"I'm excited that it looks like the program will work."

Councilwoman Jennifer Terrasa, a North Laurel-Savage Democrat who pushed with others to revive the program, said she's also gratified.

"This piece of our justice system was really important," she said. The new program won't deal with juveniles, but Terrasa is hopeful that will be revived, too. Anne Towne, director of the Association of Community Services, an umbrella group for county human service nonprofits, said her organization is trying to find a way to solve that problem.

People convicted of drunken driving, disorderly conduct, traffic offenses or who were given alcohol citations were sometimes ordered by county judges to perform community service instead of paying fines or going to jail. Cash-strapped nonprofits and county agencies benefited.

Circuit Court Judge Louis A. Becker said sometimes judges use the program for people who can't afford to pay fines, but can stay out of jail or afford to pay restitution to victims if they are sent to do community service.

"I'm really glad to see it back. Most of my colleagues want to see a program," Becker said.

Although the sheriff-run program would have cost $466,743 to operate in fiscal 2010, including $289,743 in county funds helping to pay for four full-time workers, Turban expects to get by with one full-time and one part-time employee, he said. The new version will more heavily depend on help from state parole and probation agents, he said.

Sheriff James Fitzgerald told the council in May that the program was rarely being used by county judges, and that he had turned juvenile offenders over to the state Department of Juvenile Services more than a year ago. He recommended ending the program as a way of saving money, and Ulman took the suggestion to help squeeze through a tight budget year.

But Neil Dorsey, the 13-year director of the program who retired just before Fitzgerald took office in December 2006, accused the new sheriff of intentionally undermining the program - a charge Fitzgerald denied.

If the council accepts the renewed Governor's Office of Crime Control grant, the money would be administered by Jack Kavanagh, county director of corrections. He said he's been meeting with Turban and county judges to work out the details, though not everything is yet clear.

People entering the program must be screened for criminal records before being placed in community service jobs, for example, and not every participant will be under the authority of state probation agents.

"Everybody has to realize it's down to one and one-half people running this thing. We all have to agree on who's going to be in this program, who does the screening and background checks." Kavanagh said his own staff at the detention center may help.

County budget director Raymond S. Wacks said the state grant is a continuation of support from past years. Fees paid by participants plus county funding paid the remaining costs of the original program.

If the County Council approves the grant, Wacks said the county would advance Turban some money to get the program started quickly. The old, more-expensive program was "bloated," he said.

"This is going to be a leaner, more effective program."

Turban is a Navy veteran who battled alcoholism through much of his life, until an incident in 1986 at age 40 when he nearly crashed into a herd of cows and several county police cars coming home from a local bar, he told The Sun in a 1999 article. He'd had three DWI arrests since 1975, and had run up heavy debts during alcoholic blackouts.

He was sentenced to alcohol monitoring, and straightened his life out. He founded Serenity Center in 1993, and became a probation agent working with alcoholics the next year, retiring in January 2008, volunteering his time running Serenity Center. On Basket Ring Road in the Talbott Springs neighborhood, the center has four meeting rooms and a kitchen and hosts dozens of 12-step program meetings for substance abusers every month.

Turban said he's already working to get the program ready to start.

"I will personally visit every one of the judges," he said, to encourage them to order defendants to participate. He hopes the program will have 700 to 1,000 clients a year.


National / International
Study: Clozapine may have saved schizophrenics

Associated Press
By Maria Cheng
Washington Post
Sunday, July 12, 2009

LONDON -- Thousands of people with schizophrenia worldwide could have been saved if doctors had prescribed them the anti-psychotic drug clozapine, a new study says.

Clozapine was introduced in the 1970s, but was banned for about a decade because of a rare but potentially deadly side effect: up to 2 percent of patients lose their white blood cells while taking the drug.

It was brought back to the market in the 1980s with warnings about its use, and is sold generically as Clozaril, Leponex, Denzapine, Fazaclo, among other names.

In most developed countries, guidelines recommend clozapine only as a last resort, if patients have already tried two other drugs but still aren't better.

In a study examining the death rates of about 67,000 schizophrenic patients in Finland versus those of the general population between 1996 and 2006, Jari Tiihonen, of the University of Kuopio in Finland, and colleagues found that patients on clozapine had the lowest risk of dying, compared to other patients with schizophrenia. The study was published online Monday in the medical journal, Lancet.

James MacCabe, a consultant psychiatrist at the National Psychosis Unit at South London and Maudsley Hospital, called the research "striking and shocking." He was not linked to the study.

"There is now a case to be made for revising the guidelines to make clozapine available to a much larger proportion of patients," he said.

Tiihonen and colleagues found that even though the use of anti-psychotic medications has jumped in the last decade, people with schizophrenia in Finland still die about two decades earlier than other people.

The researchers concluded that newer drugs including quetiapine, haloperidol and risperidone increased the death risk by 41 percent, 37 percent and 34 percent respectively, when compared to older drugs. In contrast, patients on clozapine had a 26 percent lower chance of dying. The study was paid for by Finland's Ministry of Health and Welfare.

Experts said the Finnish findings could be extrapolated to most other developed countries. MacCabe suggested doctors might give their schizophrenic patients clozapine after trying one other drug, as opposed to two.

MacCabe said clozapine is particularly effective in reducing suicidal tendencies in schizophrenic patients, in whom suicides account for about 40 percent of unexpected deaths.

"We should find ways to get more people on this medicine," said Lydia Chwastiak of the department of psychiatry at Yale University, who was not connected to the research. A study at the University of Maryland found that African-American patients in particular are treated less often with clozapine.

"If this drug can help people live longer, we need to look seriously at the barriers to using it," she said.

Tiihonen said the pharmaceutical industry is partly to blame for why clozapine has often been overlooked. "Clozapine's patent expired long ago, so there's no big money to be made from marketing it," he said.
---
On the Net:
http://www.lancet.com


Sebelius: All options on table for health plan

Associated Press
Baltimore Sun
Sunday, July 12, 2009

WASHINGTON -- Health and Human Services Secretary Kathleen Sebelius says the administration wants a health care overhaul this year but is still leaving the details to Congress.

Sebelius said on Sunday that a health care overhaul "needs to be owned by the House and the Senate" and won't be dictated by President Barack Obama. She says lawmakers from both parties have good ideas.

Obama has refused to outline specific proposals for his broad health care overhaul. Instead, he has left to lawmakers the give-and-take of proposals that comes before a bill is completed.

Sebelius says all options remain on the table, but she said again that someone has to pay for the overhaul.

Sebelius appeared on CNN's "State of the Union."


Officials push for health care in spite of delay

Associated Press
By Philip Elliott
Washington Post
Sunday, July 12, 2009

WASHINGTON -- Legislation to overhaul the nation's health systems is unlikely to make it through the House and Senate before the August target set by President Barack Obama and other Democratic leaders, lawmakers said Sunday.

Democrats and Republicans alike said the administration's sweeping health care proposals are moving forward on Capitol Hill but cautioned against rushing into a spending plan that could costs trillions of dollars over the next decade. Obama's health and human services secretary said she remains optimistic Congress would send the White House legislation before the year ends.

"I think everything is on the table and discussions are under way," HHS Secretary Kathleen Sebelius said.

But the White House's strategy to leave the legislative back-and-forth to Congress has produced varying and sometimes contradictory versions of health care legislation - along with delays. As the Senate turns its attention to Supreme Court nominee Sonia Sotomayor's confirmation hearings, the focus will turn away from Obama's top domestic priority.

The administration's Democratic partners in Congress hinted they would not deliver legislation before leaving town for an August recess. Sen. Debbie Stabenow, D-Mich., said Obama should be pleased with lawmakers' progress; Sen. Kent Conrad, D-N.D., said "there really is plenty of time."

And Sen. Chuck Schumer, D-N.Y., insisted that lawmakers would have the overhaul in place before leaving town in August. He does not, however, expect Obama to sign it before lawmakers return to their home states.

The delay would be a blow to the White House and to Democrats' electoral prospects.

The House and Senate are working toward legislation that would deliver on Obama's popular goals from his presidential campaign, but they are hardly in unison. House Democrats have proposed raising taxes on wealthy Americans to pay for the plan. Democratic leaders, meanwhile, have tried to calm moderate and conservative lawmakers about a proposal that could make their re-election bids more difficult.

Republicans, seizing on an issue that affects all Americans and has shown a glimmer for hope for an out-of-power political party, have lambasted the proposals as rash and irresponsible. They also see the issue as a way to win House and Senate seats in the 2010 midterm elections.

"I think the bigger issue here is why are we going to increase spending and health care by $1 trillion, $2 trillion, $3 trillion?" said Sen. Judd Gregg, R-N.H. "Most of which we can't afford, add that to the debt or add it the tax burden of the American people. Why don't we approach this horse from the other end?"

Gregg and other GOP leaders have painted the Democrats' plan as a government takeover of health care delivery systems that leads to rationing of treatment and backlogs at doctors' offices. More broadly, Republicans have tied the plan to out-of-control spending and a bloated federal government.

"There is no chance that it's going to be done by August," said Sen. Jon Kyl, R-Ariz. "President Obama was right about one thing: He said if it's not done quickly, it won't be done at all. Why did he say that? Because the longer it hangs out there, the more the American people are skeptical, anxious and even in opposition to it."

Even lawmakers absent from the Sunday morning news shows found a way to weigh in on the debate. Through his microblogging feed, Sen. Chuck Grassley, the top Republican on the Finance Committee, offered up a Twitter message to the Democrat who runs tax policy in the House, Rep. Charles Rangel, D-N.Y.

"Chr Rangel wealthy 1pc make 27pc of total income pay 40pc of income tax U hv 5pc health care surTax How hi taxes go to satisfy u?Let's talk," Grassley wrote in the abbreviated blast.

Sebelius tried to calm jittery voters who fear Democrats' plan to tax some employer-provided health care benefits as income. She said the details are far from over.

"Well, the House has a version," she said, discounting any version as final. "There are a couple of different proposals being worked on in the Senate."

Sebelius, Stabenow, Conrad and Gregg appeared on CNN's "State of the Union." Schumer appeared on NBC's "Meet the Press." Kyl appeared on ABC's "This Week."


Scrub tech causes major hepatitis scare in Colo.

Associated Press
By P. Solomon Banda
Washington Post
Sunday, July 12, 2009

DENVER -- Kimberly Spencer's 9-year-old son went to Audubon Ambulatory Surgery Center last month for what was supposed to be a routine surgery. The rambunctious child stuck a BB in his ear and doctors had to operate to remove it.

What happened next shocked the family. They were notified that their son is one of 6,000 patients who may have been exposed to hepatitis C by a painkiller-addicted technician who had the disease and allegedly passed on dirty syringes to patients.

The technician has been jailed, thousands of rattled patients have been getting hepatitis C tests, and two medical facilities where she worked have been bombarded with questions about how they let it happen. Ten cases of hepatitis C have been linked to Rose Medical Center, where Kristen Diane Parker worked until April.

"It was originally a humorous child story we could write about in his baby book and now it's just gone south a little bit," Spencer said Friday as she awaited results of her son's blood test. "We're very optimistic, we think it's going to be just fine. It's still unnerving."

During a police interview videotaped June 30 that was played in court Thursday, the 26-year-old Parker told a detective that she kept dirty saline-filled syringes in her pocket and watched for opportunities when doctors and nurses left the room. She then allegedly stole syringes filled with Fentanyl from operating carts and replaced them with the used syringes.

"I didn't want to make it obvious to everyone that I was using," the 26-year-old Parker told the detective in the interview, saying she stole between 15 and 20 syringes of Fentanyl. "I knew my limit."

Health officials are conducting tests to determine if the 10 hepatitis C cases are definitively linked to Parker. Many people with hepatitis C don't know they are infected because they don't develop symptoms until years later.

Parker said she used between 100 to 250 micrograms of the drug each time, roughly enough medication for a 500-pound person, according to medical malpractice attorney Dr. Eric Steiner, a former cardiac anesthesiologist.

Thousands of former surgery patients have contacted Denver's Rose Medical Center and Audubon Ambulatory Surgery Center in Colorado Springs for free blood tests being offered by both facilities. More than 1,900 former Rose patients have been tested, said hospital spokeswoman Leslie Teegarden.

An Audubon spokesman did not return messages Friday, but state health officials said those at that facility, including Spencer's son, will be tested again in about seven weeks because it takes that long for the disease to show up in the bloodstream. Hepatitis C is a treatable but incurable blood-borne disease that can cause serious liver problems.

Despite a hopeful attitude for Spencer, mundane every day occurrences have taken on disproportionate significance, such as Thursday when her son fell off his bike and skinned his knee.

"A simple little scrape to me is, 'Oh my gosh,' we need to take care of that, wash our hands, bandage him up. It makes you think twice, for everybody; the children he's playing with, the children I have at home. At the same time I don't want to overreact for him. He's nine.

"It's probably going to be like this for six more weeks until we know for sure."

Parker's case could end up being the first in Colorado where a patient got an infection from a health care worker who was tampering with drugs, said Dr. Ned Calonge, chief medical officer for the state health department.

Nationwide, there were four documented cases of nurses and doctors infecting patients with hepatitis C between 1992 and 2003, according to the latest information from Centers for Disease Control. A 1992 case cited in the CDC study involved a surgical technician who was using anesthesia medications.

Parker gave several reasons for using Fentanyl, which is a narcotic 80 to 100 times more powerful than morphine: to deal with a custody battle with her ex-husband over her 2-year-old son; six-hour stretches of being on her feet; and back pain from the physical requirements of moving patients around the operating rooms.

She also said she had a problem with painkillers in the past and she may have gotten hepatitis C when she used heroin last summer while living in New Jersey.

"She's going to take responsibility," Parker's attorney Gregory Graf said. He had argued that Parker should be released on bail because her cooperation with investigators proves she was not a flight risk.

A key point that could lead to more serious charges is whether she knew she was infected with hepatitis C.

She tested positive for the disease before starting her job at Rose in October, but she didn't follow up when told about it because she didn't have health insurance or money for a doctor and she got distracted with her new job.

She also said hospital officials didn't make it clear she tested positive. A federal magistrate judge disagreed and declared her a danger to the community and ordered her held without bond, saying her actions showed significant disregard for the safety of others. Her next hearing is Oct. 6.

Those infected with hepatitis C are not barred from working in health services, so long as standard precautions are taken, according to the CDC.

"She knew she had hepatitis C, she's a health care worker and she understands how this disease is spread," said Pat Criscito, 56, an author and freelance writer from Monument south of Denver. She underwent back and hand surgery at Rose last fall and spent a sleepless night worrying about hepatitis C while she waited for her test results. Criscito said a positive result would have been meant certain death because years of arthritis treatment have severely weakened her immune system.

"If I was going to die, she deserves life in prison. I can't understand how somebody can do that to another human being," Criscito said, who tested negative and is waiting the results of a second test.

Hospital and state health officials aren't sure how many people were injected with Parker's dirty needles or with saline solution contaminated when Parker allegedly dipped her dirty needles to fill bogus syringes to cover her tracks.

Denver police launched a drug investigation in April and the state health department began its investigation June 1 after former Rose surgery patients began testing positive for hepatitis C. Parker was arrested June 30 on state drug charges, but Denver police turned the case over to federal agents when they discovered the tampering.

(This version RECASTS headlines to correct that defendant is a technician, not a nurse)


Opinion
Best medicine: competition
Government meddling, such as Md.'s coverage mandates, only raises costs

By Marc Kilmer
Baltimore Sun Commentary
Sunday, July 12, 2009

Health insurance is a hot topic these days. President Barack Obama has big plans to reform it, though his ideas are a bit fuzzy. Congressional negotiators are trying to craft legislation to change it. All these efforts are premised on the notion that we need more government regulation and mandates to solve our health insurance problems. But considering that health care is already highly regulated and heavily funded by the federal and state governments, we should ask if further political involvement would reduce our health care problems or add to them.

All Americans, even those with good health insurance, know that the health insurance marketplace does not work well. Premiums are high, coverage seems arbitrary, and few understand exactly what all the health insurance forms mean. So when there are proposals to drastically reform the system - or establish a government-run insurance company as an alternative - it sounds appealing. It's got to be better than what we have, right?

What's worrisome about increased government intervention in health care is that many of the problems in the health insurance marketplace today can be traced, in large part, to other government interventions in health care. Many regulations have dubious benefits for consumers, but they drive up prices and force consumers to buy policies that cover a wide variety of services they may neither want nor need.

For example, even if you do not plan to have children, the state of Maryland mandates that all insurance plans that it regulates must provide coverage for in vitro fertilization. Likewise, Maryland requires that insurers cover contraceptives and Chlamydia testing. Many people question the scientific merits of chiropractics and acupuncture, yet Maryland requires that the insurance plans it regulates cover those practices.

These mandates are great for fertility specialists, acupuncturists and chiropractors, but they're difficult for people who want affordable health insurance that covers their needs.

Maryland politicians have imposed 66 mandates on health insurance policies. As a result, many insurers stay out of the state-regulated markets, limiting insurance choices for individuals and small businesses. That is why more than 90 percent of health insurance policies sold to individuals or small businesses in Maryland are by two companies. Even Maryland's liberal politicians recognized the problems caused by these mandates and have taken a commendable if insufficient step by allowing a limited mandate-lite insurance policy to be sold in the state.

Annapolis defends these mandates by claiming that they protect the public from insurance companies, but in reality they are doing much more to protect the health care providers who offer the mandated services. The mandates are just another way businesses try to game the political process to fatten their bottom line.

Unfortunately, any government-run insurance program would operate in much the same way. Decisions about what this plan should cover or what its rates should be would be influenced by those with the most money at stake in the process. When politicians make decisions about health care procedures, no one should be surprised that politics will play a large role in those decisions.

Before creating an expensive government health insurance program, President Obama and Congress should consider enhancing consumers' freedom in the health insurance marketplace. If Congress were to allow Americans to purchase health insurance across state lines, Marylanders could avoid the mandate and force insurers to compete more heavily on both price and coverage.

We don't need more government involvement in health insurance. Current government involvement already adds to our dissatisfaction with the current system. President Obama and Congress should take a step back, refrain from adding to our ballooning national debt, and instead give consumers the power to purchase health insurance that meets their needs, not the needs of special interest groups and politicians.

Marc Kilmer is a senior fellow at the Maryland Public Policy Institute. His e-mail is mkilmer@verizon.net.

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