Tuesday, July 21, 2009

News Clipping Archives

 

 

Maryland / Regional

Hospitals Tally Their Avoidable Mistakes (Washington Post)

China releases some Md. teens from flu quarantine (Baltimore Sun)

Howard now leads the state in Lyme disease (Baltimore Sun)

Reaching out to city's uninsured (Baltimore Sun)

O'Malley to cut agency budgets (Baltimore Sun)

O'Malley plans cuts to stem cell funding, tourism and advertising (Daily Record)

Apartments updated after carbon monoxide illness (Baltimore Sun)

A camp for health care wannabes (Baltimore Sun)

Coxsackieviruses may cause conjunctivitis, herpangina and hand, foot and mouth disease (Baltimore Sun)

Judge to decide if mother was insane (Annapolis Capital)

Obama's drug chief looks to Baltimore for ideas (Baltimore Sun)

Md. Doctor's Life Unravels Amid Drug, Assault Charges (Washington Post)

BWMC named one of nation's top hospitals (Annapolis Capital)

 

National / International

Drink lots of water to avoid kidney stones (and other tips!) (Baltimore Sun)

Medical marijuana science, through the smoke (Baltimore Sun)

Should schools close for swine flu? (Baltimore Sun)

Lupus drug passes key test, researchers say (Baltimore Sun)

Doctor's Orders (Washington Post)

Health insurance tips for young adults  (Washington Post)

The Do-It-Yourself Funeral (New York Times)

Free clinics hit with more patients, less funding (Daily Record)

S.C. case looks on child obesity as child abuse. But is it? (USA Today)

 

Opinion

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Maryland / Regional

Hospitals Tally Their Avoidable Mistakes

 

By Lisa Rein

Washington Post

Tuesday, July 21, 2009

 

Surgery on a patient with a debilitating spinal-cord disease went terribly wrong in a District hospital last year: The patient was discharged only to be readmitted a few days later complaining of severe leg pain. The surgeon, it turned out, had operated on the wrong part of the spine.

 

A 44-year-old man who came to the emergency room of a Maryland hospital with painful swelling in his groin received a hernia diagnosis from a physician's assistant, who operated without consulting a physician. Fifteen minutes later the man went into cardiac arrest and died.

 

Meanwhile, over the course of the year, patients at one hospital in Northern Virginia developed life-threatening blood infections at a rate of 2.1 for every 1,000 times doctors inserted an IV tube to deliver medication.

 

These are among the hundreds of incidents of death or serious medical harm disclosed in the past year by hospitals in the Washington region, preventable errors that until recently have not required public reporting. Under laws that took effect last year in Virginia and a few years earlier in the District and Maryland, hospitals must report to health regulators many serious injuries that patients suffer in the course of treatment.

 

The laws are different in each jurisdiction. For example, Virginia's public records identify the hospitals by name, while Maryland's and the District's do not. But they all allow the public to glimpse the breadth of mistakes that health experts dub "never events" (because they should never happen): sponges left inside patients after surgery, operations on the wrong limb, medication errors, falls that lead to needless deaths. At least 20 states require hospitals to report every incidence of hospital-acquired infection.

 

Picking Up Steam

 

Patients, insurers and regulators are beginning to use this information to prod health-care providers to ensure that such events really never happen.

 

It used to be that if a doctor, nurse or technician was responsible for injuring you, your insurance company was billed for the action that caused the injury as well as what might be needed to treat it. Maryland health regulators estimate that insurance companies paid $522 million last year to cover preventable complications in hospitals, which occurred in 55,000 of the state's 800,000 inpatient cases.

 

Now, following the lead of Medicare, some other public and private insurers are starting to refuse payment -- for example, they won't pay for treatment of urinary tract infections caused by a catheter. It's on the same theory, as some put it, that if a lawn service mowed down your rosebush while cutting the grass, you wouldn't pay the company to replace it.

 

This activity is part of a patient safety movement that is picking up steam across the country, led by patients and family members who've suffered devastating errors and are pressing lawmakers to enforce accountability. One of these is Sorrel King, a Baltimore County woman whose toddler daughter Josie fell into a tub of scalding water eight years ago and was rushed to Johns Hopkins Children's Center in Baltimore with severe burns. The hospital staff missed mounting symptoms of dehydration her mother had observed. Josie died after an injection of a narcotic, despite orders that she receive no further medication.

 

Johns Hopkins acknowledged a series of errors and miscommunications and took full responsibility, although King says the hospital billed her insurance company for Josie's care.

 

Though nothing can make up for such a tragedy, King sees the denial of payment as the most effective way of getting hospitals to improve their performance.

 

"I accept that it boils down to money," she said. "It's unfortunate that it has to come to that. But you need incentives."

 

In Maryland, where hospitals have been required for five years to report errors that led to death and serious harm, the hospital association made voluntary agreements with insurance companies last year not to bill for eight medical errors, including transfusions that use the wrong blood type and surgery on the wrong side. And starting this month, the state commission that sets hospital rates is using a new system that ranks hospitals on how often they commit 52 specific mistakes, from preventable obstetrical complications to infections of wounds that develop after surgery. Hospitals that report the most mistakes from that list will be required to bill insurers at a lower rate, while those with fewer can charge more; the total amount spent should remain about the same, but more money will flow to the hospitals with fewer errors.

 

"This is an incentive to change behavior and provide better care," said Stephen Ports, principal deputy director of the Maryland Health Services Cost Review Commission.

 

Maryland also requires hospitals to come up with plans for preventing the reported mistakes from happening again. And it is instituting rules such as noting any underlying medical problems on a patient's chart at check-in, so it will be clear if a new condition arises. If the hospital is at fault, it will be denied payment for 85 percent of the cost of care to reverse the error. That 85 percent figure, Ports said, is an acknowledgment that "nothing is 100 percent preventable."

 

Fines are also part of the incentive program: Doctors Community Hospital in Prince George's County was fined $30,000 this spring after failing to notify regulators of staff errors that caused one death and serious harm to at least seven other patients. The hospital also promised to spend $65,000 on a patient safety program.

 

Sending a Message

 

A handful of other Maryland hospitals have received warnings for delays in reporting and follow-up reviews. The state Office of Health Care Quality cited Laurel Regional Medical Center in October, for example, for failing to submit an analysis of three deaths in 2007 that were caused by hospital errors: one patient in diabetic shock who died in the emergency room after a delay in treatment, an emergency Caesarean section on a 16-year-old girl that resulted in the baby's death, and the death after a delay in treatment for a patient's cerebrovascular accident. Laurel promptly submitted a plan of correction, said Renee B. Webster, assistant director of the state Office of Health Care Quality.

 

In Virginia, which so far is requiring reporting only of serious infections caused by IV insertions, the state hospital association is trying to get ahead of the curve: On behalf of the state's 95 hospitals, it reached a deal last month not to bill for several errors caused by hospital staff. "The hope is to send a message that if we make a mistake, we're going to own up and take the consequences," said Katharine Webb, the association's lobbyist.

 

Anthem Blue Cross and Blue Shield, Virginia's largest private insurer, has stopped paying hospitals for four surgical mistakes: when a wrong procedure is done; when the wrong body part is operated on; when the wrong patient is operated on, and when a foreign object is left inside the patient, requiring another incision. "We wanted to raise the profile of patient safety," said Jay Schukman, regional president and senior medical director for Anthem Blue Cross and Blue Shield's East Region.

 

In the District, which began reporting preventable errors in 2007, hospitals, clinics and nursing homes disclosed 529 mistakes from July 2007 through June 2008. Fourteen led to the death of a patient. The most commonly reported errors, most of which occurred at hospitals, were pressure ulcers, retained foreign objects after surgery and infections from IV tubes. Other mistakes included a patient who developed an arrhythmia after chest surgery had a temporary pacing wire inserted into the heart's ventricle instead of the atrium; doctors improperly put a catheter in a patient with terminal kidney disease on the same side as the patient's dialysis shunt, and the catheter had to be removed. In another case, a surgeon performing a breast biopsy made an incision to the woman's left breast instead of the right.

 

So far, the District has not tried to use financial incentives to affect the hospitals' behavior.

 

Patient safety laws like Maryland's are not designed to be punitive: For hospitals, the real price of mistakes often comes through the courts, when patients or their families take legal action. It's too early to tell if the new laws are reducing errors. Some institutions in Maryland are reporting more errors, year over year -- but for now, regulators consider this a good sign of increasingly accurate reporting rather than a reflection of more mistakes.

 

Said Webster: "Just requiring hospitals to have regular communication with us is invaluable."

 

Copyright 2009 Washington Post.

 

China releases some Md. teens from flu quarantine

 

By John-John Williams IV

Baltimore Sun

Tuesday, July 21, 2009

 

A group of Maryland teen volleyball players was released Monday from a quarantined Beijing hotel, where they had been held after taking the same flight as a person who later developed illness from the H1N1 virus, also known as swine flu.

 

Tarver Shimek, 16, a rising senior at Towson High School, said she was glad to be able to finish a trip with fellow travelers from the Maryland Junior Volleyball Club.

 

As Chinese authorities assessed her health risks, she spent more than three days in the hotel, she said, making up games like "hotel tag" with other teenagers. They played with a volleyball that a coach gave them, and held a fashion show where all of the costumes were made of surgical masks, which those who were quarantined were required to wear at all times. But as some in the hotel started to show flu-like symptoms, Shimek said she eventually avoided contact as much as possible.

 

"It wasn't really possible to have much entertainment anymore," she said. "So the last couple of days were very long. I watched a lot of movies. It was quite boring."

 

China has one of the strictest methods in the world for limiting the spread of swine flu. Officials in masks or hazmat suits will board planes with temperature guns that they point at passengers' foreheads. If a passenger later is diagnosed with swine flu, anyone seated within three rows of that person is often tracked down. Those quarantined usually get to leave if they are well seven days from the date they landed.

 

Shimek will be able to wrap up her 12-day trip with a visit to the Great Wall, and the opportunity to perfect her volleyball skills by working with top Chinese coaches.

 

"I'm glad she got out as soon as she did," said Shimek's mother, Suellen Wideman of Towson. "I'm just focusing on how much worse it could have been. Tarver remained so positive. She made lemonade out of lemons. She made friends."

 

Mother and daughter stayed in contact with a series of 50-cent text messages.

 

Shimek estimates that there were about 25 Marylanders from two different groups eventually confined to the hotel. It was unclear how many were released Monday.

 

In addition to the junior club, Marylanders from USA-China Sports & Education Exchange, based in Silver Spring, were also thought to have been quarantined. The program attracts volleyball players from throughout the region, including Maryland and Virginia, said coordinator Ray Liu. Liu said he could not provide details about the campers because he was not in his office.

 

The U.S. Embassy's spokeswoman, Susan Stevenson, told the Associated Press that she did not have a total number of Americans quarantined in China, but said they were "aware of several cases at the moment." About 1,800 Americans have been quarantined in China since the swine flu measures began in early May, according to Stevenson. Of those Americans quarantined, 200 have tested positive for swine flu.

 

Copyright © 2009, The Baltimore Sun.

 

Howard now leads the state in Lyme disease

Figures from 2008 show county rise, statewide drop

 

Columbia Flier

By Heather Carney

Baltimore Sun

Monday, July 20, 2009

 

Howard County had the highest number of reported cases of Lyme disease in the state in 2008, according to a recent report from the Maryland Department of Health and Mental Hygiene.

 

There were 369 confirmed and probable cases reported in Howard County  in 2008, according to the report, 11 more than in 2007.

 

Montgomery County, which had been tops in the state, was second to Howard in 2008 with 314 cases, down from 475 the previous year.

 

Statewide, the total decreased from 2,576 cases in 2007 to 2,216 in 2008.

 

No data is available yet on the number of cases reported in 2009.

 

Lyme disease is caused by a bacteria transmitted by an infected tick, according to the state health department. It is treatable if caught early, but if not treated may cause chronic symptoms that can include joint pain, heart palpitations and neurological problems.

 

Howard County Health Officer Peter Beilenson attributed the increase here to the county’s growing development.

 

“We’re developing more in areas that were originally woodland, decreasing the distance between the forests where ticks are more prevalent and where people live,” Beilenson said.

 

Elizabeth Bohle, director for the county Health Department’s division of communicable disease, said Lyme disease is better-reported now because people are much more informed about the disease.

 

Since 2006, the number of reported cases in the county has tripled.

 

“In the county, we’ve really had it as a priority to follow up on Lyme disease through education, and devoting many of our resources to tracking each reported case,” Bohle said. “We’ve just created a much more heightened awareness in the clinicians and the public.”

 

She added that Howard County is a particularly good breeding environment for Lyme disease because of the high numbers of deer and white-footed mice, both of which are carriers of the black-legged tick that transmits the disease.

 

Bohle also noted that the county is plentiful in parks, forests, lakes and other moisture-rich locations, where ticks flourish.

 

Beilenson said the best approach to prevention is educating the public about ticks and teaching people to check for ticks after they’ve been outside and to remove the ticks quickly if they find any. He added that in most cases, a tick must be attached to the skin for 24 hours for the disease to be transmitted.

 

“I use the mentality, what would I do if I found a tick on my child? I would automatically take them to the doctor to get them checked,” Beilenson said.

 

The county health department, which held a series of sessions on Lyme disease in March and April, is planning another session  near the end of August.

 

Lyme primer:

 

How Lyme disease is transmitted: Through the bite of an infected black-legged tick.

 

Symptoms: From three to 30 days after a tick bite, a gradually expanding rash occurs at the site of the bite in three-quarters of infected people. Other symptoms may include fever, headache and fatigue. If untreated, symptoms include a loss of muscle tone in the face, severe headaches and neck stiffness, shooting pains, heart palpitations, dizziness and joint pains.

 

How to treat: Most cases are cured with antibiotics, especially when caught early. See your doctor.

 

How to prevent: Use insect repellent when outside, and if possible, wear long sleeves and long pants tucked into your socks. After being outside in wooded areas, check yourself, your children and your pets for ticks.

 

To remove ticks: Using fine-tipped tweezers, grab the tick close to the skin and gently pull it straight up until all of the tick is removed. Do not use petroleum jelly, a hot match, nail polish or other products to remove ticks.

 

For more information: Go to edcp.org/vet_med/lyme_disease.html.

 

Source: Maryland Department of Health & Mental Hygiene

 

Copyright 2009 Baltimore Sun.

 

Reaching out to city's uninsured

HealthCare teams go to people on stoops, at markets

 

By Angela Bass

Baltimore Sun

Tuesday, July 21, 2009

 

Baltimore City health officials say full health coverage is just an application away for nearly half of the city's 100,000 uninsured residents. But a surprising number of them are not applying.

 

"Many people just don't know about it," said Kathleen Westcoat, president and chief executive officer of Baltimore HealthCare Access Inc., a city health agency connecting eligible families, singles and kids to seven free or low-cost managed care plans housed under the Medicaid roof.

 

The agency enrolled 9,074 residents of its target 10,000 in one of its Medical Assistance for Families programs by the end of June, not counting those enrolled in its other programs, for which the agency said it does not have figures.

 

Because of the recession, the agency can't always afford the kind of advertising it needs to attract more applicants. Using grant money, agency officials adopted an aggressive ad campaign, with an eye toward Greenmount East, Druid Heights, Sandtown-Winchester and other neighborhoods that have been ravaged by preventable diseases and infant mortality, and whose residents have little to no access to managed care.

 

Agency officials hired Jeff Rasmussen, owner of In-Motion Advertising, to add a few "guerrilla marketing tactics" to its more traditional billboards approach. Rasmussen said the tactics are meant to "reach people while they're sitting on their stoop, walking to work and living their lives," adding that billboards on the sides of buildings don't mean as much to people from urban areas, where billboards are everywhere.

 

"If that's what it takes in this media-saturated society we live in, then that's what we'll do," Rasmussen said. "It's my job to get them to this point."

 

Agency outreach workers reached thousands in the targeted neighborhoods with informational door hangers shaped like Band-Aids, inviting people to attend an insurance enrollment health fair inside Lexington Market last month. Others saw Rasmussen's canary yellow trucks flanked by giant scrolling ads roving the busiest blocks of their community. And some residents simply found the fair while shopping for groceries, with staffers from radio station 92Q Jams enticing shoppers with free prizes. Hospital workers were also on hand, screening for high blood pressure, diabetes and prostate cancer, among other common ailments.

 

"Everyone has to grocery shop," said Therese McIntyre, the agency's director of communications and legislative affairs. "We were reaching people who wouldn't necessarily be in health settings." A second fair was held in the parking lot of Santoni's Super Market two weeks later.

 

Charles Lowther, 44, showed up at the Lexington Market fair after outreach workers he met on the street handed him one of the door hangers. The Baltimore native was laid off in October from his job as a lumberyard forklift driver, leaving him without health coverage and easy access to treatment for the acid reflux disease he suffers from. He's training to become a certified mechanic in hopes of getting a job with benefits. "Honestly, I'm the type that don't like handouts," said the single father of two daughters in their 20s and an 8-year-old son. "I like to earn what I have."

 

June marked Lowther's second attempt, however, to apply for the Primary Adult Care program, which covers prescriptions, mental health care and dental services. Enrollment in all programs - including the Medical Assistance for Families Program and the Maryland Children's Health Program - is free.

 

With Lowther's first attempt, he never paid the $12 fee to obtain a copy of his birth certificate, one of the few documents agency staffers need to determine eligibility.

 

For more information on insurance plans and health fairs, call Baltimore HealthCare Access at 410-649-0500 or 311.

 

Copyright © 2009, The Baltimore Sun.

 

O'Malley to cut agency budgets

$300 million is first step; more furloughs possible

 

By Laura Smitherman

Baltimore Sun

Tuesday, July 21, 2009

 

Gov. Martin O'Malley plans to outline about $300 million in budget cuts today that will mostly fall on state agencies. But future rounds of cutbacks could include furloughs of state employees, officials said.

 

O'Malley, a Democrat, briefed legislative leaders on his proposed budget cuts over a two-hour dinner meeting at the governor's mansion in Annapolis Monday night. The governor must pare about $700 million from the $14 billion budget for the fiscal year that began this month because the recession has caused tax receipts to slump.

 

The governor will submit some spending cuts for approval by the Board of Public Works Wednesday, and those will target health care and higher education programs, lawmakers said. The balance of budget cuts are expected later this year.

 

"We're going to look to state agencies first, and at some point in time we're going to have to go back to furloughs," said Sen. President Thomas V. Mike Miller after emerging from the meeting. He added that state leaders are mindful of trying to save state employee jobs.

 

"They're trying to keep people employed," said House Speaker Michael E. Busch, who also attended the briefing. "The recession's not their fault."

 

O'Malley began talks with labor union officials Monday about the potential impact of budget cuts on state employees, and he plans to hold discussions with local leaders before reducing aid to local governments. State workers were required to take up to five furlough days earlier this year.

 

Copyright © 2009, The Baltimore Sun.

 

O'Malley plans cuts to stem cell funding, tourism and advertising

 

By Andy Rosen

Daily Record

Tuesday, July 21, 2009

 

Gov. Martin O’Malley said Tuesday he plans to cut spending on the state’s stem cell program, tourism promotion and lottery advertising in a proposal he will bring before the Board of Public Works Wednesday.

 

The about $281.5 million in cuts will result in 39 worker layoffs throughout various state agencies, and the elimination of about 18 unfilled positions. They also contain a $3 million cut to the Stem Cell Research Fund (leaving $12.4 million), a $1.1 million reduction the Maryland Tourism Development Board (leaving $4.9 million) and a $5.5 million reduction in the Maryland State Lottery’s advertising budget (leaving $11.8 million).

 

Many of the largest cuts come from the state’s health care budget, including a $75 million move to use federal Medicaid money instead of state dollars for some expenses.

 

The cuts are just the first part of an up to $750 million reduction in spending that O’Malley says he plans over the course of the year. He plans to bring the rest of the cuts to the Board of Public Works by early September. Some of the toughest decisions appear to lie ahead.

 

O’Malley said he is not submitting all of those cuts now because he needs more time to negotiate with state workers and local governments, because the state needs to reduce spending on worker compensation and local aid. He stopped short of outlining cuts he is considering in those areas, and did not say if worker furloughs would be a part of any new package of cuts.

 

However, O’Malley did say he is hoping to avoid widespread layoffs as part of his budget solution.

 

“We are striving in all of this to avoid the sort of massive layoffs that contribute to unemployment that we’ve seen other states have to revert to,” he said. “But having said that, when there are cases where the efficiency and the effectiveness of state government call for an elimination, an abolishment of some jobs, sadly that are already filled, unfortunately we have to do that.”

 

More furloughs would add to the up to five days that about 67,000 state workers have already been told they will have to take off without pay this year. O’Malley instituted the furloughs late last year as a measure intended to fill a budget gap for fiscal 2009.

 

But though fiscal 2010 began just this month, the state is already facing a significant gap as revenues fall well short of expectations. Last week, Comptroller Peter Franchot said state revenue in June came in 12 percent below 2008 collections. Revenue for the entire fiscal 2009 were down 5.7 percent so far, Franchot said in a report to legislative leaders, but emphasized that more money will come in before final numbers are available next week.

 

Legislative analysts warned this month that the state budget could be out of balance by $700 million, and likely more if revenues continue to decline. O’Malley has warned that budget reductions of that magnitude are certain to be felt in all areas of state government. Overall, the state’s General Fund budget this year comes to $13.8 billion.

 

Copyright 2009 Daily Record.

 

Apartments updated after carbon monoxide illness

 

By Nick Madigan

Baltimore Sun

Tuesday, July 21, 2009

 

In what they called "an abundance of caution," the owners of a Northeast Baltimore apartment building in which nine people were sickened by a carbon monoxide leak said Monday that they would replace water heaters in four of the complex's 803 units.

 

Sawyer Realty Holdings LLC issued a statement saying the Sunday leak at the Dutch Village Townhomes appeared to have come from a faulty water heater in a vacant unit. The carbon-monoxide detector in that unit went off and alerted tenants in a neighboring apartment.

 

Seven children and two adults were treated at two medical facilities and "were able to return home," the statement said.

 

Hours after that incident, an adult and three children were taken to a Howard County hospital about 5 a.m. Monday after another apparent carbon monoxide leak in Columbia.

 

In that incident, firefighters were unable to locate the source of the contamination, according to Battalion Chief Eric Proctor of the Howard County Department of Fire and Rescue Services. He said the American Red Cross was trying to find shelter for the family until staff at the apartment complex on the 10300 block of Twin Rivers Road "figures out what the problem is."

 

In the Baltimore incident, firefighters and medics arrived at the apartment in the 6900 block of McClean Boulevard, near Perring Parkway, shortly after 3 p.m. and found seven children and two adults complaining of feeling ill, said Chief Kevin Cartwright, a spokesman for the Baltimore Fire Department.

 

Firefighters and a Baltimore Gas and Electric Co. crew traced the leaking carbon monoxide to a malfunctioning gas-operated water heater on the first floor and shut it down, he said.

 

Cartwright said low levels of the gas also were found in two adjacent, vacant apartments.

 

The owners of the apartment complex, built in 1953, also own Cove Village in Essex, which has a history of carbon monoxide problems, including two incidents that sent eight people to the hospital last month. In July 2005, three people - a 48-year-old man and his two stepdaughters, ages 14 and 15 - died after inhaling the gas in their home at Cove Village.

 

A Sawyer Realty spokesman said Monday in an e-mail that the company had spent more than $2 million on renovations at the Dutch Village Townhomes complex. Most of the work was done in 2004, according to the property's Web site. All the units have carbon-monoxide detectors, the company says.

 

Sawyer Realty's statement said that fire department officials did not detect "any immediate health hazards" in tests at adjoining units. However, just to be safe, the company said, water heaters in two occupied units were replaced Sunday night and the heaters in two vacant units - including the one in which the problem arose - were to be replaced on Monday.

 

Copyright © 2009, The Baltimore Sun.

 

A camp for health care wannabes

At this camp, teens learn the daily lives of health professionals

 

By Angela J. Bass

Baltimore Sun

Tuesday, July 21, 2009

 

Ashley Jones was set on becoming a professional soccer player. But by the end of a local summer health camp for teens, she was chasing a career in nursing.

 

Jones, now 21, participated in the first annual Camp ECHO (Exploring Careers in Healthcare Organization), a five-day summer immersion program - now in its sixth year at St. Agnes Hospital - that exposes state high school students to the many sides of the health care professions.

 

Participants - seven girls this year - spend five hours a day peeking in on surgeries in the operating room, training for adult and child CPR certification or shadowing physicians and nurses, dieticians and radiologists, and other staff.

 

Jones, who is one year shy of earning her bachelor's degree in community health from Hofstra University on Long Island, N.Y., liked the camp so much she is back to help while she is interning this summer in St. Agnes' administrative department. "I'd always thought about being a nurse, helping people and giving back to the community," she said "This program sealed it for me."

 

Each year, the program accepts the first 12 applicants. Eighty dollars covers meals, materials, a medical scrub top and the CPR registration fee. Applicants, who come from all over the state, are asked to write a short essay about why they want to be in the program.

 

"In our initial planning stages there was a contest in the nursing department to name the camp," said Michelle Slafkosky, the camp's co-founder - with former colleague Deborah Mello - and the hospital's manager of volunteer services. "Since we want students to see all the careers in a hospital, we didn't want it to sound like a nursing camp."

 

Like the rest of her peers at last Tuesday's intensive CPR training, 15-year-old Rebecca Rose, a home-schooled sophomore from Baltimore, was dressed in a blue scrub top and beige khaki pants - attire similar to what health care professionals wear everyday on the job.

 

Rose's aunt and uncle work as a pediatric nurse and an anesthesiologist, respectively. Growing up around them inspired her to consider a career in health care. But Camp ECHO, she said, also opened her eyes to some of what she considers the more gruesome realities of the profession.

 

"The O.R. is cool, but I don't think I want to work there," said Rose while taking a short break from her CPR training. "I can't deal with all the blood. It's just not for me." She enjoyed visiting the orthopedic floor during another group tour of the hospital, she said.

 

For Sade Handy, 15, nursing seems to run in the family. "Some of my aunts are nurses," said Handy, a sophomore at Reach Partnership in Baltimore. "I like being in the camp. It's fun going to the different units, learning different things. I haven't seen anything that I don't like or that isn't interesting."

 

Shannon Cummins' mother is a cardiac nurse at St. Agnes. The 17-year-old Arundel High School senior is seriously considering becoming an emergency room nurse. "I like the idea of caring for people I don't even know, and just helping people," Cummins said.

 

Many of this year's participants have yet to declare a college major, but the program's directors and volunteers said one of the goals is to lure students into the health care field early by showing them the rewards and challenges of working on behalf of others - and to steer some toward a different profession better suited to their talents and interests.

 

"We had one student who saw the O.R. room and decided she never wanted to step foot in there again," said Joyce Hall with a chuckle. A longtime registered nurse and the hospital's patient relations coordinator, Hall has worked with the camp since 2004 and now coordinates the program with Slafkosky. "That student went on to become a social worker.

 

"Everything we do here is optional," said Hall, adding that participants can choose not to witness a live birth, view in-progress knee surgeries or visit the morgue - activities offered at past camps. Hall prepares the curriculum, arranges hospital tours and chooses guest presenters such as Vonda Barber, last Tuesday's CPR instructor from Health Quest Inc.

 

"I use the same lessons with these high schoolers that I use with adults," said Barber between drills, which involved performing procedures on a T-shirted rubber dummy. Campers learned how to properly pump its chest, perform mouth-to-mouth and check for consciousness by shaking its shoulders and shouting, "Are you OK?" using real-life scenarios.

 

"What's the first thing you need to do when deciding whether to do CPR on someone?" Barber asked the group during one of their drills. Although they gave the correct answer - to check that "the scene is safe" - they sounded like whispering angels, and needed to be told by Nyuma Harrison, an ER nurse at St. Agnes and program volunteer, to speak up.

 

"You have to say it!" said Harrison from the side of the room. Harrison teaches clinical skills courses at the Catholic University of America in Washington and brought her lesson plan to the campers last Friday.

 

"You usually hear kids say they want to be a surgeon or a pediatrician because that's what they see on TV," said Harrison. "It was good for them to see the food service area where we prepare patients' meals. Every job at a hospital is important."

 

Since 2004, 43 students have completed the program. Slafkosky said she plans to contact past campers to see how many chose the health care profession, one of few industries still thriving since the recession hit in late 2007.

 

"It was very beneficial for me,"said Jones, who plans to return to school for a second degree in nursing.

 

Copyright © 2009, The Baltimore Sun.

 

Coxsackieviruses may cause conjunctivitis, herpangina and hand, foot and mouth disease

 

Expert advice

 

Ask the Expert: Robert Ancona, St. Joseph Medical Center

 

Baltimore Sun

Tuesday, July 21, 2009

 

Coxsackieviruses can cause many clinical syndromes that overlap with other viruses, including common cold symptoms, fever, sore throat, rashes, eye infections and diarrhea, says Dr. Robert Ancona, chief of pediatrics at St. Joseph Medical Center.

 

He writes that the three most identifiable syndromes caused by coxsackieviruses are: acute hemorrhagic conjunctivitis, herpangina and hand, foot and mouth disease.

 

•Preschool-age children, especially those 1¿ to 3 years old, are most at risk to catch these viruses, though any age group can be affected, especially with acute hemorrhagic conjunctivitis. These viruses are often passed around by a fecal-to-mouth route or direct contact with infected secretions from the mouth or eyes. Therefore, good hand washing, as with many infectious illnesses, is extremely important in preventing infections.

 

•The symptoms of acute hemorrhagic conjunctivitis are painful red eyes, tearing and swelling of the eyelids, usually within one to three days of swimming in a communal pool. Outbreaks with numerous cases usually occur. Symptoms can last a week to 10 days.

 

•Herpangina usually produces a high fever (101 to 104 degrees), irritability, decreased appetite and multiple blisters or ulcers in the back of the throat. Younger children often drool more than normal and their symptoms can last up to seven days, though older children may recover in three days.

 

Hand, foot and mouth disease has similar symptoms, plus a blistering rash on the hands, feet, and/or buttocks, usually below the skin's surface and which may begin as papules. The blisters are usually not painful.

 

•There is no specific treatment for any of the coxsackie syndromes. But the symptoms can be treated, for example, with analgesics for fever and pain and with fluids, especially cool ones, that may relieve throat pain. For conjunctivitis, try cool compresses for relief.

 

•Complications from these infections are uncommon, but for younger infants who refuse to drink due to blisters in their throats, dehydration is a risk, so proper fluids are very important. In rare cases, the abrupt onset of high fever can trigger a febrile seizure in those who are susceptible. Most importantly, children are contagious throughout the entire illness and must not be in a school or communal setting until all symptoms go away, which can be as long as a week.

 

Copyright © 2009, The Baltimore Sun.

 

Judge to decide if mother was insane

Attorneys: Kent Island woman told nurse practitioner she planned to kill her daughter

 

By Scott Daugherty

Annapolis Capital

Tuesday, July 21, 2009

 

A Kent Island woman knew it was wrong last December when she killed her 3-year-old daughter and tried to kill herself, but she was so depressed she couldn't stop herself, according to a psychiatrist hired by her defense attorney.

Courtesy photo Victoria A. Sparrow, Stevensville mother charged with killing her 3-year-old daughter, Laci.

 

But in the first day of a two-day trial yesterday in Queen Anne's County Circuit Court in Centreville, two state-paid psychiatrists testified that Victoria Sparrow planned how she was going to kill the girl - even laying out those plans six weeks earlier to a nurse practitioner at the family doctor's office. They said Sparrow was able to control her actions in almost every other aspect of her life.

 

"She was able to delay acting," said Dr. Annette Hanson, a forensic psychiatrist at the state's Clifton T. Perkins Hospital Center in Jessup. "This was someone who thought about it ... and carried it out."

 

All three doctors testified as part of an extended nine-hour hearing to determine if Sparrow, 43, of Stevensville, was legally insane Dec. 18 when she poisoned her daughter, Laci, inside their home.

 

Sparrow pleaded guilty yesterday to first-degree murder in the death, but argued she was "not criminally responsible" for her actions because she could not control herself, prompting the rare, contested hearing, which focused entirely on the doctors, their opinions and how they reached those opinions.

 

Prosecutors and defense attorneys this morning began their closing arguments before Judge Thomas G. Ross, but neither attorney expected him to issue an immediate ruling.

 

"There is just so much information," said Queen Anne's County State's Attorney Lance Richardson, echoing the comments of defense attorney Peter S. O'Neill.

 

Ross - not a jury - will make the final decision.

 

If found responsible, Sparrow, who is being held at the Queen Anne's County Detention Center, faces up to life in prison.

 

If found not criminally responsible, Sparrow can be held at a state hospital until a doctor decides she is no longer a danger to herself or others.

 

Sparrow, a Severna Park High School graduate and a clerk for Anne Arundel County Circuit Court in Annapolis, admitted yesterday that she ground up numerous prescription drugs, including codeine and Ambien, and mixed them into her daughter's food. She then tried to kill herself with the same drug mixture, according to court testimony.

 

All three experts diagnosed Sparrow with major depressive disorder, a relatively common mental disorder characterized by general sadness and malaise lasting several weeks or months. They said Sparrow was depressed because her marriage was falling apart and she was having trouble at work.

 

The experts were surprised to learn about a Nov. 5 doctor's appointment in Stevensville. They said Sparrow told a nurse practitioner she was considering using sedatives to kill herself, her daughter and her dog, but that medical professional did not contact the authorities or otherwise try to get Sparrow committed to a psychiatric hospital.

 

After hearing Sparrow had just stopped taking the antidepressant Prozac for fear it was causing the suicidal thoughts, the nurse practitioner let her go home with the instruction to come back if she didn't feel better, the doctors said.

 

"I think they misjudged the level of malignance," said Dr. David Williamson, the forensic psychiatrist hired by the defense.

 

Officials with the doctor's office could not be reached for comment this morning.

 

But the two state experts disagreed with the defense expert on why Sparrow decided to kill her child. Dr. Monica Polk, another forensic psychiatrist, said Sparrow did it to hurt her husband, Jeffrey.

 

"I believe it was primarily a revenge killing," Polk said.

 

That motive, coupled with the facts that Sparrow planned the homicide in advance, didn't act immediately and was otherwise able to live a normal life, led the two psychiatrists to conclude that Sparrow was capable of controlling herself and was therefore legally responsible for her actions.

 

Williamson, however, said Sparrow had altruistic motives when she killed her daughter. He believed the homicide was a misguided attempt to protect the girl from a life without a mother.

 

"She felt the child would have suffered if she was not there," he said, arguing she was not criminally responsible.

 

Paramedics and police were called to Sparrow's home shortly before 3 p.m. after her 18-year-old son called 911 and reported that his mother was sick and disoriented.

 

Medics arrived, searched the home and found Laci alone and unconscious in the master bedroom. The girl and her mother were taken to Anne Arundel Medical Center in Parole, where the child died at 3:40 p.m.

 

According to court testimony, Sparrow almost died as well. She was on a ventilator for several hours at the hospital before she ultimately woke up and confessed to what she had done.

 

Sparrow came to court yesterday wearing mismatched prison scrubs - green pants and a dark brown shirt over a white, long-sleeved thermal T-shirt. She sat quietly next to her attorney for most of the hearing, not moving or speaking to anyone.

 

A handful of friends and family sat behind Sparrow in the courtroom, some supporting the defense and others supporting the prosecution. After the hearing ended, Sparrow's detractors said Richardson had made his case.

 

"Laci will get her justice," said Heather Sparrow, the slain girl's half-sister.

 

Copyright 2009 Annapolis Capital.

 

Obama's drug chief looks to Baltimore for ideas

City's drug court is object of 3rd visit since May

 

By Tricia Bishop

Baltimore Sun

Tuesday, July 21, 2009

 

Barack Obama's newly appointed drug czar is looking to Baltimore to help set the nation's strategy, focusing on the city's 15-year-old drug treatment court, which emphasizes therapy over incarceration.

 

Gil Kerlikowske, director of the Office of National Drug Control Policy, met with legislators and a drug court judge Monday to discuss the program and collaborative efforts between city, state and federal agencies. It was Kerlikowske's third visit to the city since his May swearing-in.

 

Released prisoners "almost invariably go back to the neighborhood from whence they came," he said after the briefing during a news conference held in the lobby of the Baltimore Central Booking and Intake Center. Without treatment, "all we're doing is recycling people throughout the system. It makes no sense."

 

The words underscore early suggestions that the Obama administration will focus on drugs as a public health issue, rather than just a law enforcement problem. And in Baltimore, drug addiction and the resulting crime "is the most significant public health crisis" there is, said Greg Warren, president of Baltimore Substance Abuse Systems Inc., which sets the city's drug strategy.

 

Each year, the prison system returns 9,000 convicts to Baltimore streets, and, for most of them, to the drug abuse that led them to incarceration in the first place. Most of the city's criminal activity is drug-related, with 80 percent of those arrested here - four out of five people - failing their initial drug tests.

 

The first drug treatment court was developed in Florida in 1989, as crack cocaine use was labeled an epidemic and the "war on drugs" ratcheted up arrests. The idea was to lessen the burden on courts and jails by trying treatment before imprisonment.

 

The courts quickly grew in popularity, and today, there are more than 1,000 of them across the country, according to a 2005 University of Maryland report that studied the effects of Baltimore's version, which was created in 1994 in response to a city Bar Association claim that 85 percent of Baltimore crimes were addiction-driven.

 

In many ways, it resembles other such federally funded programs throughout the country. Participants must live in the city and be at least 18, and they can't have violent offense convictions on their records. They're also supervised and regularly drug-tested during their treatment.

 

But Baltimore's intensive probation supervision, and the significant participation of the Division of Parole and Probation, are atypical, the university report said.

 

According to statistics presented yesterday by Rep. Elijah E. Cummings, who called for the gathering, Baltimore's drug treatment court participants are more than three times as likely as other convicts to be employed after the program, and they're a third as likely to use drugs during treatment.

 

"We want Baltimore to be a model," Cummings said during the conference, which was also attended by Mayor Sheila Dixon and Sen. Benjamin L. Cardin.

 

In an interview afterward, Cummings stressed the need for more resources and the role the federal government has in providing them. That's the main reason he wanted Kerlikowske to become familiar with Baltimore's system.

 

"You want the federal government to be sensitive to things that are working," Cummings said. That ensures that "the city has a better chance at getting the resources it needs."

 

Kerlikowske said he got the message and "absolutely" plans to incorporate Baltimore's efforts into the country's policy.

 

Copyright © 2009, The Baltimore Sun.

 

Md. Doctor's Life Unravels Amid Drug, Assault Charges

Reports of Erratic Behavior Set Stage for 2 Trials

 

By Dan Morse

Washington Post

Tuesday, July 21, 2009

 

There was a time when Bethesda doctor Eric Greenberg had a loyal following of more than 100 patients. "The best diagnostician I ever saw," said one. "Brilliant," recalled another.

 

On Tuesday, though, Greenberg faces trial on drug possession charges linked to an April raid of his home office, where police said they found cocaine, powdered Ritalin, a meth pipe and the doctor in a dazed state with needle marks on his arms so fresh they were still bleeding. All the while, police said, patients were trickling in for their appointments.

 

Greenberg faces a second trial next month related to dust-ups just outside the office.

 

A next-door neighbor alleges that the internist barreled over a set of potted plants in his Mercedes-Benz and, when confronted, knocked the neighbor's tooth out. Police who showed up to ask questions said Greenberg took a swing at one of them, had to be shocked with a stun gun, and was charged with two counts of assaulting an officer.

 

"This is a tragedy," said Dianne Ferris, wife of Michael Hazlett, the man who said he lost a tooth.

 

Ferris, a veterinarian whose office is next to Greenberg's, said longtime patients of Greenberg's still show up, even though he has halted his practice and faces criminal charges.

 

"He's got some very normal people looking for him," Ferris said.

 

James Papirmeister, Greenberg's defense attorney, said his client denies assaulting the officers or his neighbor. He said Greenberg also intends to plead not guilty to the drug possession charges. "We intend to establish that he didn't possess or use any illegal drugs," Papirmeister said.

 

"We feel he is being treated much more harshly because he is a medical doctor," Papirmeister said.

 

On April 16, after the raid, the Maryland Board of Physicians suspended Greenberg's medical license. James Charles, a lawyer who represented Greenberg in two previous matters before the Board of Physicians, declined to comment.

 

Greenberg, who was born in Baltimore, received a medical degree from the University of Maryland in 1993, according to the school and court records. For a time, he practiced near White Flint Mall, said a patient from those days, Edwin Mills, 50.

 

"He's smarter than regular people. It's not even a race," Mills said.

 

By 2004, Greenberg was practicing at his home office on Old Georgetown Road when a patient complained to the Board of Physicians that during an appointment, Greenberg wobbled, seem to be falling asleep and had dried blood under his nose.

 

Regulators found that in 2004, he had sped through a parking lot at Suburban Hospital in Bethesda, nearly hitting two police officers standing outside their cruisers, on his way to see a patient at 11:20 p.m. Another time, he appeared at the hospital's emergency room desk, looking dazed and holding on to a desk as if he was unsteady, according to Board of Physicians records.

 

The regulators paid an announced call to Greenberg's office, finding him dazed and with sores on his hands and ankles, records indicate. Greenberg told them that he was working seven days a week, 20 hours a day.

 

The regulators asked Greenberg to see a psychiatrist, who diagnosed deficits in attention, organization and speech, board records say. "These conditions are consistent with and provide an explanation for the complainant's observations," the psychiatrist reported to the board.

 

The Board of Physicians placed Greenberg on probation. The probation was lifted quickly after he took a drug test, according to the Board of Physicians records.

 

Ferris said she rarely interacted with Greenberg. Several years ago, at about 6:30 a.m., she looked out a window and saw Greenberg, wearing a T-shirt, making snow angels on the hood of his car, she said.

 

State medical regulators received another complaint in 2006. They subpoenaed records of six patients from Greenberg, according to a Board of Physicians summary of the investigation. He was prescribing excessive amounts of Ritalin for a relative and "more than usual amounts" of oxycodone to another patient, according to the Board of Physicians.

 

The board ordered Greenberg to take classes on writing prescriptions for pain management and on keeping records, told him to see a psychiatrist and placed him on three years' probation.

 

In fall 2008, pharmacists told authorities about suspicions that Greenberg was writing prescriptions for drug addicts, according to the state board. Montgomery County and federal narcotics agents closed in, arriving at his office April 1. At the time, Greenberg, his wife and his brother-in-law were upstairs, in the residence above the office.

 

Agents reported that Greenberg had needle marks on his arms and feet and that he tested positive for cocaine, state medical records show.

 

Papirmeister said his client denies injecting drugs. "Those are not track marks," he said of the assertions made in the physician board's report on the drug raid. "He has a number of skin conditions," including neurodermatitis, that cause him to itch and scratch constantly.

 

Greenberg's wife, Jaquenette I. Fischman, told agents that she had grown concerned about her husband's track marks and had been trying to hide injectable drugs from him, according to Board of Physicians records filed in court. She admitted inhaling Ritalin and said she had seen her husband doing so, according to the records.

 

Police charged Fischman with drug possession. Her trial was scheduled for Thursday, but her attorney, John Kudel, wants it advanced to Tuesday. He expects her to plead not guilty.

 

Her husband also faces the August trial on charges of assaulting the officers. During the altercation, police said, he called one officer a "murdering Nazi" and called another officer "giggle google man." Greenberg allegedly also told the second officer that he was lucky that Greenberg had left his meat cleaver in the house and spared the officer's life.

 

Copyright 2009 Baltimore Sun.

 

BWMC named one of nation's top hospitals

Magazine ranks facility for care of neurology, digestive disorders

 

By Allison Bourg

Annapolis Capital

Tuesday, July 21, 2009

 

Baltimore Washington Medical Center has been named to U.S. News and World Report's annual list of America's top hospitals in two separate categories of care.

Advertisement

 

The Glen Burnie hospital ranks 43 out of 50 hospitals in neurology and neurosurgery and in digestive disorders, according to the report released Thursday.

 

It's the first time BWMC has made the list, which the magazine has compiled for the past 20 years. In April, U.S. News and World Report named BWMC one of the country's 65 best community hospitals.

 

"It wasn't something we were striving to be in," said Dr. Larry Linder, senior vice president of the hospital and its chief medical officer. "We're just trying to provide excellent customer service and be a place where the staff wants to come to work."

 

U.S. News and World Report looked at 4,861 hospitals in 16 specialties. To be a candidate for the ranking, a hospital first had to meet any one of three criteria: Be a teaching hospital, have at least 200 beds, or have at least 100 beds and at least four out of eight important medical technologies, such as current-generation CT scanners and precision radiation therapies.

 

This year, 44 percent of all hospitals met that test, according to the magazine. Each of those hospitals were scored from zero to 100, based on reputation, death rate, patient safety and care-related factors such as nursing and patient services.

 

The hospitals that made the top 50 in at least one of the 16 specialities were included in the final report.

 

BWMC received a ranking of 23.8 for neurology and neurosurgery and 18.9 for digestive disorders, putting it several points ahead of two other major area health-care providers in both specialties.

 

It was the only community hospital in the county to make the list.

 

Anne Arundel Medical Center in Parole ranked 19.3 in neurology and 12.8 in digestive disorders, while Harbor Hospital in Baltimore ranked 19.6 in neurology and 16.1 in digestive disorders. Neither made the top 50.

 

Johns Hopkins Hospital in Baltimore, consistently named the best hospital in the country, scored at the top of the list in six separate categories.

 

Diane Bartoo, program director for health care administration at the University of Maryland's graduate school of management and technology, said the annual report contains much useful information for both patients and doctors. "Some of the information is hard data - for example, the mortality index. Some of the information, such as reputation, is based on surveys of specialists in the field," Bartoo wrote in an e-mail. "The detail in the rankings offers a reference point to begin an important discussion with one's physician or health care provider."

 

Dr. Cliff Solomon, a neurosurgeon at BWMC as well as Johns Hopkins, said in a prepared statement that BWMC's neurosurgery program is a multi-faceted one.

 

"We work closely on a multidisciplinary approach with orthopedic spine, ear nose and throat and neurology specialists and have collaborative arrangements with tertiary care facilities to ensure the best care for patients," Soloman said.

 

"The nurses and support staff are excellent, making quality care and patient safety a top priority with each procedure."

 

Linder said he's particularly proud of BWMC's ranking because reputation counts for 30 percent of the final score. U.S. News and World Report gave BWMC a ranking of zero in that category, something not unexpected because it's a small community hospital.

 

"It's not surprising that we're not known in, say, California," Linder said. "So we had to do better in the other categories."

 

Linder said one of the 311-bed hospital's biggest strengths is its close-knit staff.

 

"Hospitals in Maryland have an average (job) vacancy rate of 10 to 13 percent," he said. "At BWMC, it's 1 to 2 percent, and we get worried when it gets up near 2 percent."

 

Nurses and other employees tend to stick around for years, Linder said. The hospital's former CEO, James R. Walker, retired last year after nearly 40 years at BWMC. His replacement, Karen Olscamp, has been with BWMC for more than two decades.

 

"That's typical for almost all our employees," Linder said. "It's a cycle that feeds on itself."

 

Dr. George Kurian, BWMC's chief of gastroenterology, also had words of praise for the staff.

 

"I've been here for more than 20 years. The work environment is excellent," Kurian said. "We have a dedicated, competent staff, especially the nursing staff. They deserve a lot of credit."

 

Kurian said upgrades to the technology in his department and an increase in services likely landed BWMC a spot on the list. The hospital also serves a much wider population than it did just a few years ago, he said.

 

The complete report can be viewed online at http://usnews.com/besthospitals.

 

Copyright 2009 Annapolis Capital.

 

National / International

Drink lots of water to avoid kidney stones (and other tips!)

 

Daily Press (Newport News, Va.)

By Alison Johnson

Baltimore Sun

Tuesday, July 21, 2009

 

Those solid masses that form in the kidneys can grow big enough to cause severe pain and even infection as they pass into the urinary tract.

 

Here are some tips from doctors on preventing stones from developing:

 

Drink lots of water. Kidney stones are made of salts and minerals in urine that stick together. Extra fluids help keep urine clear -- it should be clear-colored or light yellow; dark yellow means you're not drinking enough. Sip water throughout the day, not just in occasional binges.

 

Lose excess weight. Studies show people who are overweight are significantly more likely to get kidney stones.

 

Control diabetes. The chronic disease interferes with healthy kidney function. Note: Kidney stones can be a sign of diabetes, as well as high blood pressure and osteoporosis. If you get a stone, ask your doctor for further testing.

 

Be a detective. Different substances cause kidney stones in different people, so recommended dietary changes can vary widely. Work with your doctor to determine your situation. Some people, for example, do well by focusing on getting enough calcium and fiber, reducing protein intake and avoiding salt.

 

Avoid grapefruit juice. In general, citrus juices seem to help reduce the acidity of urine. The exception is grapefruit juice, which studies show increases the risk of stones. Also be careful not to go above daily recommendations for vitamins C and D.

 

Exercise regularly. People who aren't active may be at higher risk. Get out and do something, even if it's just a short walk every day.

 

Ask about medicine. Depending on what substances are in a kidney stone, drugs can help control its growth, dissolve it or prevent new stones from forming.

 

Copyright © 2009, South Florida Sun-Sentinel.

 

Medical marijuana science, through the smoke

Support for medical use of cannabis is growing; research is mostly favorable, but there is some caution.

 

Health Sense

By Judy Foreman

Baltimore Sun

Tuesday, July 21, 2009

 

Marcy Duda, a former home health aide with four children and two granddaughters, never dreamed she'd be publicly touting the medical benefits of pot.

 

But marijuana, says the 48-year-old Ware, Mass., resident, is the only thing that even begins to control the migraine headaches that plague her nine days a month, which she describes as feeling like "hot, hot ice picks in the left side of my head."

 

Duda has always had migraines. But they got much worse 10 years ago after two operations to remove life-threatening aneurysms, weak areas in the blood vessels in her brain. None of the standard drugs her doctors prescribe help much with her post-surgical symptoms, which include nausea, vomiting, loss of appetite and pain on her left side "as if my body were cut in half."

 

With marijuana, however, "I can at least leave the dark room," she says, "and it makes me eat a lot of food."

 

The culture wars over marijuana, for recreational and medical use, have been simmering for decades, with marijuana (cannabis) still classified, like heroin, as a Schedule I controlled substance by the U.S. government, meaning it has no approved medical use. (There is a government-approved synthetic form of marijuana called Marinol available as a prescription pill for treating nausea, vomiting and loss of appetite, though advocates of the natural stuff say it is not as effective as smoked pot.)

 

Some critics of marijuana use, such as David Evans, special advisor to the Drug Free America Foundation of St. Petersburg, Fla., applaud the government's view, saying marijuana has not gone through a rigorous U.S. Food and Drug Administration approval process.

 

But that skepticism frustrates leading marijuana researchers such as Dr. Donald Abrams, a cancer specialist at San Francisco General Hospital.

 

"Every day I see people with nausea secondary to chemotherapy, depression, trouble sleeping, pain," he says. "I can recommend one drug [marijuana] for all those things, as opposed to writing five different prescriptions."

 

The tide seems to be turning in favor of wider medical use of marijuana. The Obama administration announced in March that it will end the Bush administration's practice of frequently raiding distributors of medical marijuana. Thirteen states, including California, Vermont, Rhode Island and Maine, now allow medical use of marijuana, according to Bruce Mirken, spokesman for the Marijuana Policy Project, which advocates legalization of pot. Earlier this month, however, New Hampshire Gov. John Lynch vetoed legislation that would have legalized medical marijuana in that state.

 

A growing body of research supports the drug's medical usage, but some of it is cautionary. As Abrams puts it, "you can find anything you want in the medical literature about what marijuana does and doesn't do."

 

With that in mind, here's an overview of what the research says about the safety and effectiveness of using marijuana to treat various ailments.

 

Pain: Marijuana has been shown effective against various forms of severe, chronic pain. Some research suggests it helps with migraines, cluster headaches and the pain from fibromyalgia and irritable bowel syndrome because these problems can be triggered by an underlying deficiency in the brain of naturally occurring cannabinoids, ingredients in marijuana. Smoked pot also proved better than placebo cigarettes at relieving nerve pain in HIV patients, according to two recent studies by California researchers.

 

Marijuana also seems to be effective against nerve pain that is resistant to opiates.

 

Cancer: The active ingredients in cannabis have been shown to combat pain, nausea and loss of appetite in cancer patients, as well as block tumor growth in lab animals, according to a review article in the journal Nature in October 2003. But there's vigorous debate about whether smoking marijuana increases cancer risk.

 

Some studies that have looked for a link between cancer risk and marijuana have failed to find one, including a key paper from UCLA published in 2006. "We had hypothesized, based on prior laboratory evidence, including animal studies, that long-term heavy use of marijuana would increase the risk of lung and head and neck cancers," said Hal Morgenstern, a co-author and an epidemiologist at the University of Michigan School of Public Health. "But we didn't get any evidence of that, once we controlled for confounding factors, especially cigarette smoking."

 

But in California, the first state to legalize marijuana for medical use, in 1996, the Office of Environmental Health Hazard Assessment recently declared pot smoke (though not the plant itself) a carcinogen because it has some of the same harmful substances as tobacco smoke.

 

The active ingredient in marijuana can increase the risk for Kaposi's sarcoma, a common cancer in HIV/AIDS patients, Harvard researchers reported in the journal Cancer Research in August 2007. And British researchers reported in May in Chemical Research in Toxicology that laboratory experiments showed that pot smoke can damage DNA, suggesting it might cause cancer.

 

The federal government's National Institute on Drug Abuse says that it is "not yet determined" whether marijuana increases the risk for lung and other cancers.

 

Respiratory problems: Smoking one marijuana joint has similar adverse effects on lung function as 2 1/2 to five cigarettes, according to a New Zealand study published in Thorax in July 2007. A small Australian study published in Respirology in January 2008 showed that pot smoking can lead to one type of lung disease 20 years earlier than tobacco smoking.

 

Addictive potential: The National Institute on Drug Abuse says "repeated use could lead to addiction," adding that some heavy users experience withdrawal symptoms such as irritability and sleep loss if they stop suddenly.

 

Mental effects: Cannabis may increase the risk of psychotic disorders, according to a 2002 study in the American Journal of Epidemiology. And the national drug abuse agency warns that "heavy or daily use of marijuana affects the parts of the brain that control memory, attention and learning." A study of 15 heavy pot smokers published in June 2008 in the Archives of General Psychiatry showed loss of tissue in two areas of the brain, the hippocampus and amygdala, regions that are rich in receptors for marijuana and important for memory and emotion, respectively.

 

Vaporizing vs. smoking: The push now among proponents of medical marijuana is toward inhaling the vapor, not smoking. Vaporizing is a safe and effective way of getting THC, the active ingredient, into the bloodstream and does not result in inhalation of toxic carbon monoxide, as smoking does, according to a study by Abrams published in 2007 in Clinical Pharmacology and Therapeutics.

 

Bottom line: From a purely medical, not political, point of view, my take is that if I had medical problems that other medications did not help and that marijuana might, I'd try it -- in vaporized form.

 

Just as Marcy Duda does. "You use it as you need it. You can be normal. You can function," she says. "I don't get high. I get by."

 

Foreman writes the monthly Health Sense column. Read others at www.myhealthsense.com.

 

Copyright © 2009, The Los Angeles Times.

 

Should schools close for swine flu?

 

By Kelly Brewington

Baltimore Sun

Tuesday, July 21, 2009

 

Public health officials worldwide are preparing for the onslaught of the fall flu season, expecting swine flu to come back with a vengance. So far, the virus has killed some 700 people around the globe and drug makers are working in a hurry to have a vaccine ready by October.

 

But that's a good two months after school children -- one of the groups at highest risk for the virus, known as H1N1 -- return to their classrooms. What if an outbreak hits before vaccines are ready? Should schools be closed?

 

A study in the August issue of the British journal Lancet Infectious Diseases concludes it's a tough call and the decision to close schools depends on how severe the pandemic becomes.

 

On one hand, closing schools might slow transmission, giving more time for a vaccine to be finished while easing the burden on hospitals. But researchers also said that massive school closures are unlikely to have a major impact on the total cases. And closing schools has some serious economic and social costs, from the crush to a household's income from parents who must take off work to care for a child, to the larger economic impact on workplaces from massive absenteeism. (The economic toll alone: the cost of a 12-week school closure could be between 1 percent and 3 percent of GDP, according to the study. yikes)

 

So far, kids have been disproportionatly affected by the virus, with some 60 percent of cases occuring in people 18 or younger.

 

Back when the outbreak started in the spring, U.S. health officials played it safe, ordering schools with a confirmed case of swine flu to close for a week. But they backed off that policy after it became clear that the virus was spreading rapidly and appeared no more severe than seasonal flu.

 

Still, medical experts warn the virus may become more severe this fall. Clearly, vaccine timing will be key. While health officials say they hope to have a vaccine by October, there are more questions than answers right now about who gets it and when. Here's an interesting timeline put together by WebMD on some possibilities.

 

So, for now, what do you think? Could closing schools help stop the flu?

 

Copyright 2009 Baltimore Sun.

 

Lupus drug passes key test, researchers say

The experimental treatment Benlysta greatly reduced symptoms of the autoimmune disorder in a test, says Human Genome Sciences. The findings offer hope that a 50-year drought in new drugs may end.

 

The Los Angeles Times

By Thomas H. Maugh II

Baltimore Sun

Tuesday, July 21, 2009

 

After a 50-year drought of new drugs and a string of disappointing failures of potential treatments for lupus, researchers said Monday that they have found an experimental drug that can ameliorate the symptoms of the life-threatening autoimmune disorder that afflicts as many as 1.5 million Americans.

 

In unpublished results released by the company, a team from Human Genome Sciences said that the experimental drug Benlysta significantly reduced lupus symptoms in a randomized trial of more than 850 patients, reducing their need for debilitating steroids and improving quality of life.

 

In recent years, at least seven companies or coalitions of companies have reported failed or unimpressive results with potential lupus treatments, causing a cloud of gloom to settle over the lupus community.

 

"We have had many disappointments, so for [a drug] to make it through the door with a very significant success rate is an extraordinary accomplishment," said Margaret G. Dowd, president of the Lupus Research Institute, who was not involved in the research. Not only does the trial offer lupus patients the hope of a new treatment with fewer side effects, she said, but it should also offer encouragement to other companies with lupus drugs in the pipeline.

 

"Everybody was getting a little discouraged," added Dr. Betty Diamond, chief of the autoimmune disease center at North Shore-Long Island Jewish Health System's Feinstein Institute for Medical Research in Manhasset, N.Y., who was also not involved in the research. "It's very exciting to finally have a trial in lupus showing efficacy.

 

"We're going to have to work with it longer to understand when it should be used and exactly who is going to benefit from it . . . but we are very pleased to have a drug that looks as though it really did do something," said Diamond, who is an advisor to the Lupus Research Institute.

 

Experts cautioned, however, that because the results have not been peer-reviewed or published in a journal, it is difficult to fully assess their significance. Human Genome Sciences said the results will be presented at a meeting later this year and published after a second study is completed. A spokesman said the robust nature of the data and the 50-year drought in drugs justified releasing the data now.

 

Lupus is a chronic inflammatory disease that occurs when the body's immune system attacks its own tissues and organs. As many as 90% of patients are women, usually in their 30s and 40s when it first strikes. No two cases of lupus are identical, but symptoms can include fatigue, fever, joint pain, stiffness and swelling, rashes, skin lesions, mouth sores, hair loss and chest pain. The disease can attack many internal organs, leading eventually to death.

 

Only three drugs are approved for treating lupus -- aspirin, the steroid prednisone and the antimalarial drug Plaquenil (hydroxychloroquine) -- and all were approvedduringthe Eisenhoweradministration. All can have severe side effects, including stomach bleeding for aspirin; weight gain, bruising, high blood pressure and diabetes for prednisone; and vision problems and muscle weakness for Plaquenil.

 

Even more powerful drugs are often used off-label for treating severe cases, including the anti-rejection drugs cyclophosphamide and azathioprene, which can have even more serious side effects.

 

Benlysta is a monoclonal antibody known generically as belimumab. An immune protein produced artificially, it binds to and blocks the activity of a protein called B-lymphocyte stimulator, which was discovered by the company. Elevated levels of B-lymphocyte stimulator are believed to contribute to the production of antibodies that attack the patient's own organs.

 

The new trial was conducted in 865 patients at 90 sites in 13 countries, primarily abroad. Patients all had active lupus, although none had a severe form requiring hospitalization, and received normal care for the disease. In addition, they were randomized into three groups, two receiving different amounts of the drug and the third receiving a placebo. Patients were given an infusion of the drug at the beginning of the trial, at two weeks, at four weeks, and then every four weeks after that. They were followed for 52 weeks.

 

About 58% of patients receiving the highest dose of Benlysta showed a significant improvement on an index used to assess impact, compared with 46% of those receiving the placebo. More of the patients receiving the drug were able to reduce their prednisone intake, and most reported a better quality of life, although specific numbers were not provided.

 

About 6% of both patients receiving the drug and those on the placebo suffered side effects, including headache, joint pain and infections.

 

The patients receiving the drug showed the improvement while reducing their use of steroids, said Dr. Kenneth Kalunian of UC San Diego, who was not involved in the study. "The fact that they could taper off steroids in the drug group really speaks well for the drug." Dr. Daniel Wallace of UCLA's Geffen School of Medicine treated patients with the drug in an earlier study and has been continuing to treat them, some for as long as four years. "They keep getting better and better," he said. "This is going to be a major breakthrough, no question about it."

 

Copyright © 2009, The Los Angeles Times.

 

Doctor's Orders

Want Treatment? Just Sign This No-Complaint Contract . . .

 

By Sandra G. Boodman

Washington Post

Tuesday, July 21, 2009

 

Until recently, patients whose doctors kept them waiting for hours without explanation, brushed off their questions or seemed downright incompetent had little recourse, other than complaining to family, friends or, in egregious cases, the state medical board. That was before the Internet gave everyone with an e-mail address the ability to reach a vastly wider audience by posting -- often anonymously -- critiques of doctors, in much the same way travelers rate hotels on such Web sites as TripAdvisor.

 

In the past five years more than 40 Web sites, among them RateMDs.com, Angie's List, Yelp, DrScore and Vitals.com (motto: "where doctors are examined"), have begun reviewing physicians, providing information about one of the more difficult and important decisions consumers make routinely.

 

As these sites proliferate -- a reflection of the hunger for information about doctors in an era where patients are expected to make sophisticated decisions about their care -- questions about their usefulness, accuracy and fairness are intensifying. In some cases the freewheeling anonymity of the Internet has collided with the rights of physicians who are constrained by laws that protect patient privacy.

 

As a defensive measure, some physicians are requiring patients to sign broad agreements that prohibit online postings or commentary in any media outlet "without prior written consent."

 

Critics call the documents gag orders. Many experts say they are both unethical and unenforceable.

 

But an increasing number of doctors view them as an appropriate response to sites that not only ask detailed questions about a doctor's punctuality, availability, communication skills, office staff and the effectiveness of treatment, but also permit comments that may be untrue. Some are scathing.

 

Case in point: A veteran District internist has attracted nearly 40 comments on one site, compared with the more typical one or two. Most are negative, focusing on his off-putting demeanor, dirty office and hostile staff.

 

"The worst doctor I have ever encountered in my life," one recent posting said. "Impolite, unengaged and unfocused." Said another: "Long wait, rude staff, never sent me a follow-up on my tests."

 

To Angie Hicks, founder of Angie's List, which last year added doctors to its reviews of plumbers and roofers, physician ratings are an extension of the contemporary zeitgeist.

 

"Consumers have been talking about their experiences with physicians forever," she said. "It's moved online, just as other parts of our communication with friends and family have.''

 

Unlike other sites that rate doctors, Angie's List does not allow anonymous postings (the site knows writers' identities, although the public does not) and its reviews are available only to members who pay a fee.

 

Many other sites are free and accessible to the public. John Swapceinski, a founder of RateMDs.com, one of the oldest and largest sites, said he was inspired by the success of the reviews on Amazon.com and thought consumer rankings could be applied to professors and physicians. After Swapceinski launched RateMyProfessors.com, he took RateMDs live in 2004.

 

Supported largely by ad revenue from Google, it contains ratings of more than 200,000 physicians across the country, more than 8,000 of them in the District, Maryland and Virginia. The site attracts a million unique visitors per month, Swapceinski said, as well as the ire of some doctors. RateMDs contains a link to the relevant medical board where patients can check disciplinary histories and, in some states, malpractice payments.

 

"We get threatened with lawsuits on a pretty much weekly basis," he said, adding that none has been filed. Nor, Swapceinski said, has he acceded to demands by doctors to remove comments he deems appropriate, although there is a mechanism by which doctors can respond.

 

All entries are reviewed by a staff member within 24 hours, Swapceinski said, and about 5 percent are deleted because they are irrelevant (the doctor is having an affair), suspicious (the doctor had an open bottle of vodka on his desk) or potentially libelous (the doctor touched me inappropriately).

 

"We're not just out to 'out' the bad ones, but to point out the good ones," he said. A "very positive or very negative rating opens the floodgates," eliciting additional reviews. Waiting time, he said, is a "huge issue" mentioned often, as are statements such as the doctor "never made eye contact and was out in 30 seconds."

 

But critics contend that such sites reveal little of importance.

 

"The people least capable of judging quality of care are patients," said District internist Nancy Falk, whose mostly positive ratings are offset by those calling her curt and intolerant of questions, descriptions she denies. "They don't know what we know." Falk regards doctor rating sites as just as dubious as "Best Doctors" compilations. In her view, both amount to popularity contests.

 

Orthopedic surgeon Peter Lavine, president of the Medical Society of the District of Columbia, agrees. "Doctors aren't like dishwashers or trash compactors or minivans," he said. Ratings sites "are not scientific, have a very small sample size and often attract patients who have an axe to grind."

 

Some doctors advocate an aggressive response. Retired neurosurgeon Jeffrey Segal of Greensboro, N.C., is the founder of Medical Justice, a company that for a fee starting at $495 provides sample privacy agreements and monitors online comments for its 2,000 members. He said the agreements enable doctors to ask Web sites to remove comments by patients who have signed privacy agreements, and to take legal action against patients.

 

Doctors, Segal said, need to take steps to safeguard their reputations because of the Internet's "Wild West atmosphere" and because physicians are bound by privacy laws and can't defend themselves against spurious online allegations.

 

"We've learned how hard it is to protect and preserve doctors' reputations," Segal said. He cited a 2007 California appellate court decision that upheld the right of a patient to operate Myplasticsurgerynightmare.com, a Web site her surgeon tried to shut down.

 

"We're not opposed to free speech," Segal said. "We're trying to smooth out the extremes." Some sites have removed comments as a result of privacy agreements, Medical Justice officials say, but they did not provide specific examples.

 

Assessing Ambiance

 

Arthur Levin, director of New York's Center for Medical Consumers, a patient advocacy group, and Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, are strongly opposed to gag orders. Caplan echoes many legal experts, calling them "illegal, unenforceable and silly." But the two disagree about the value of ratings sites.

 

Levin said he believes they can provide information sought by consumers, such as whether others think a doctor communicates well. Caplan thinks they are merely "a measure of ambiance" and don't reveal the most important information: outcomes.

 

"One person's brusque is another's direct," Caplan said. "It's notorious that many doctors who would score well on ambiance are not good doctors, but manage to stay in practice." As a member of the New York state medical licensing board, "I saw again and again doctors who were well beyond the border of malpractice who kept going because patients loved them."

 

"Not only can't patients judge doctors, other doctors can't judge doctors," Caplan added. Without knowing a doctor's mortality, complication and infection rates, rankings reveal "just a piece" of the data consumers require.

 

Levin agrees that outcomes data are badly needed, but he thinks ratings sites can be useful. "What you need to look for is consistency and a certain number of ratings," he said. "It's one piece of a total picture

 

Beth Nash, an internist employed by Consumer Reports, advises that patients dump a doctor who demands a privacy waiver. "While we have all had bad days," she wrote on the group's health blog, "I find it hard to believe that a doctor with multiple negative reviews has just been unlucky enough to be judged on those occasional bad days."

 

Whose Privacy?

 

Northern Virginia OB-GYN Nicolae Filipescu has 35 reviews on RateMDs, far more than many of his peers. He also has one review on Angie's List and five on Yelp, both posted in the past six months. One Yelp poster described him as "competent and professional," while the other said he was rude, kept her waiting 90 minutes and offered to perform cosmetic surgery on her nose.

 

The RateMD reviewers are similarly divided about Filipescu. One called him "the best" and said he delivered her three healthy children, while another advised, "Run as fast as you can." Several accused him of insensitivity and of telling patients, some of them pregnant, that they were getting fat. One said he ridiculed her when she told him she had fibromyalgia.

 

Filipescu, who has offices in Arlington and McLean, disputes the negative reviews. "I said, 'Please do not get fat,' " he said. Lengthy waits, he said, are not routine but may occur because of an emergency. And while he performs cosmetic surgery, Filipescu said he doesn't do nose jobs.

 

"You have to realize there are some people who are somewhat disturbed," he said. "I don't get complaints from the Medical Society of Virginia or the [state] medical board."

 

But Filipescu opposes privacy agreements. "It's a freedom-of-speech issue," he said. "Let them say what they want."

 

Denver plastic surgeon Nicholas Slenkovich couldn't disagree more. A member of Medical Justice, he regards the waivers as "self-preservation" from what he terms "garbage" on ratings Web sites that he says are riddled with factual errors.

 

"Perception is very important in my business," said Slenkovich, adding that he worries about being trashed by a jealous competitor or a disgruntled patient. "The Internet is out there and everyone's using it. This is my livelihood, and I have no ability to reply." So far, he said, none of his patients has refused to sign.

 

Although many doctors are unenthused about online ratings, Falk, the District internist, said she would support a different kind of site.

 

"I'd love to have a Web site where I could complain about patients," she said. "All doctors would."

 

Copyright 2009 Washington Post.

 

Health insurance tips for young adults

 

The Associated Press

Washington Post

Tuesday, July 21, 2009

 

Get it while you're healthy. Experts say healthy young adults can buy insurance at reasonable rates - and they should.

 

It's tougher if you have a medical condition. Some insurance companies have denied coverage for something as simple as an allergy, says Sandy Praeger. She's past president of the National Association of Insurance Commissioners and is the current insurance commissioner for Kansas.

 

Signs posted on telephone poles aren't a good source for insurance, Praeger warns. Anything that says you must "Act now!" or promises health care at discounted rates should raise suspicions.

 

Other tips:

 

-Know your insurance status. Are you still covered under a parent's policy? When will that coverage end?

 

-If you're working and your employer offers a health plan, think twice before turning it down to save money. How would you pay the hospital bill if you had an accident?

 

-If you're not working or your employer doesn't offer health benefits, ask an insurance agent about month-to-month gap coverage or high-deductible policies that cover only very serious health costs but have lower monthly rates.

 

-Read the fine print. Better yet, ask an insurance agent to help you compare policies.

 

-Some insurers have plans designed for young adults with high deductibles and low monthly premiums. For example, WellPoint offers Tonik,http://www.tonikhealth.com, in six states from $70 a month to $122 a month. Aetna offers BodyGuard in Illinois from $40 a month to $110,http://www.aetnabodyguard.com.

 

-The Web sitehttp://www.eHealthInsurance.comoffers free price quotes based on region, age and other factors.

 

-If you're laid off, find out about federal subsidies for COBRA premiums from your employer's benefits manager.

 

-Some states have their own COBRA laws that cover young adults who are nearing the age of being dropped from their parents' policies.

 

-More than 20 states allow you to stay on your parent's plan through your mid-20s. The laws don't apply to all types of employers though.

 

-If you are uninsured and have health problems, ask your state insurance commissioner's office about high-risk pools.

 

-The National Association of Insurance Commissioners offers more tips athttp://www.insureUonline.org.

 

Source: National Association of Insurance Commissioners, WellPoint Inc., Aetna Inc.

 

© 2009 The Associated Press.

 

The Do-It-Yourself Funeral

 

The New Old Age - Caring and Coping

 

By The New York Times

New York Times

Tuesday, July 21, 2009

 

Cheryl Senter for The New York Times Chuck Lakin assembling a pine coffin in April on his home workbench in Waterville, Me.

 

In a recent post on funeral expenses, reporter Sarah Arnquist noted that many families are choosing to bypass the funeral home altogether: “In all but six states, family members are not legally required to consult a funeral director at all. Home funerals are therefore a legal and less expensive — but nearly forgotten — option.” Several of you asked for more information.

 

Today The Times published an interesting article on the trend, “Home Burials Offering an Intimate Alternative, at a Lower Cost.” The number of home funerals has soared, advocate (and coffin builder) Chuck Lakin told reporter Katie Zezima, putting them “where home births were 30 years ago.” Ms. Zezima adds:

 

The cost savings can be substantial, all the more important in an economic downturn. The average American funeral costs about $6,000 for the services of a funeral home, in addition to the costs of cremation or burial. A home funeral can be as inexpensive as the cost of pine for a coffin (for a backyard burial) or a few hundred dollars for cremation or several hundred dollars for cemetery costs.

 

New York, however, is one of those states requiring that a funeral director handle the body.

 

Read Ms. Zezima’s article and Ms. Arnquist’s post. What do you think of this trend? Have you too found the mortuary experience inadequate in some way? Share your thoughts in the comments section.

 

Copyright 2009 The New York Times Company.

 

Free clinics hit with more patients, less funding

 

Associated Press

Daily Record

Tuesday, July 21, 2009

 

DANBURY, Conn. — Health insurance and doctors were unthinkable luxuries for George Anderson of Redding, laid off nearly a year ago when his book distribution company filed for bankruptcy.

 

Like countless others stripped of health insurance because of the recession, Anderson and his family were forced to turn to a free health clinic. In all, about 4 million Americans are expected to visit the nation's 1,200 free health clinics this year — a surge that comes as clinics face a drop-off in financial support.

 

"Over the last year, free clinics have seen patient load increase by 40 to 50 percent," said Nicole D. Lamoureux, executive director of the National Association of Free Clinics. "People who just last year had health coverage are now out of work and need to have their health care needs met."

 

For Anderson, 48, who had high blood pressure, and his wife, who contracted pneumonia, the free clinic was a necessity.

 

"We felt like we were teetering on the edge of a cliff with all the other bills we had to pay for and if we had to pay those hospital bills too, that would have tipped us over," said Anderson, who has since found another job.

 

Groups like the CIGNA Foundation, which funds clinics in Philadelphia and southwestern Connecticut, say they're spending less on clinics even as funding requests have jumped by 50 percent in the last year.

 

"Our spending is down by 15-20 percent since last year," spokeswoman Gloria Verrone said. "We've decided not to eliminate working with organizations that need our help, but we have had to decrease funding amounts in order to keep those relationships. We also haven't been able to accept any new groups this year but we're hopeful to start doing so again by next year."

 

In Connecticut, Stamford-based Americares, an international nonprofit relief group, operates three free clinics in Danbury, Bridgeport and Norwalk. Officials have seen patient visits increase 20 percent at the clinics this year, said Karen Gottlieb, executive director of AmeriCares Free Clinics.

 

The Danbury clinic, AmeriCares' busiest, has about 350 patient visits a month. Danbury had 3,000 unique and repeat patients visits last year, Norwalk had a little over 2,700 and Bridgeport saw 1,600 patient visits.

 

Gottlieb predicts the patient volume from all three clinics could reach around 8,000 by the end of the year.

 

The clinics, which accept walk-ins and appointments, provide physicals, lab and diagnostic testing and specialty care in cardiology, diabetes and other areas, all free of charge. Patients must have a photo ID, proof of income and cannot have medical insurance.

 

The three clinics have 350 volunteer physicians, registered nurses and Spanish and Portuguese translators to help aid patients, Gottlieb said.

 

She also mentioned that they have seen 79 new volunteers so far this year, which is up from 48 during the same time last year.

 

In cases where patients need treatment beyond what the clinics can provide, they can be transferred to a local hospital for free care courtesy of the hospital, said Gottlieb.

 

"The point of the clinics is to provide health care to people who fall through the cracks," she said. "People who have Medicaid and are uninsured have the ability to go to federally funded community health centers, but they charge on a sliding scale. So we take the patients who don't have the money to pay."

 

The clinics receive as much as $17,000 per year from the cities where they are located, but are funded primarily with donations coming from private foundations, corporations and local church and civic groups. The Danbury clinic is also helped by a partnership with Ridgefield-based Boehringer Ingelheim, a pharmaceutical company, that gives medication and medical products.

 

Gottlieb acknowledges, however, that not everything has been on the upswing.

 

"We're busier than ever at a time when donations are down," she said. "People are not giving what they used to give."

 

Services provided by the clinics are lifesaving, patients say.

 

Clarke Barre, 62, from Danbury, said he had a problem going to a free clinic; he never would have guessed that he would need such services.

 

"I am currently an uninsured person who has always been employed and always been insured, but recent events have changed that," he said.

 

Without a job and medical insurance, Barre said he did a Google search for free clinics in his area and sought out the Danbury clinic to get tested for discomfort.

 

Blood tests revealed that he had prostate cancer.

 

Barre said he would not have been able to pay for his treatments without the help of a free clinic.

 

"I haven't had to pay a nickel," he said. "My understanding is that we are in the tens of thousands at this point.

 

"I might not be alive if it wasn't for clinics such as these."

 

Copyright 2009 Daily Record.

 

S.C. case looks on child obesity as child abuse. But is it?

 

By Ron Barnett

USA Today

Tuesday, July 21, 2009

 

Jerri Gray was doing all she could to help her son lose weight, her attorney says. But something had gone terribly wrong for the boy to hit the 555-pound mark by age 14.

 

Authorities in South Carolina say that what went wrong was Gray's care and feeding of her son, Alexander Draper. Gray, 49, of Travelers Rest, S.C., was arrested in June and charged with criminal neglect. Alexander is now in foster care.

 

The case has attracted national attention. With childhood obesity on the rise across the USA, according to the Centers for Disease Control and Prevention, Gray's attorney says it could open the door to more criminal action against parents whose children have become dangerously overweight.

 

"If she's found guilty on those criminal charges, you have set a precedent that opens Pandora's box," Grant Varner says. "Where do you go next?"

 

State courts in Texas, Pennsylvania, New York, New Mexico, Indiana and California have grappled with the question in recent years, according to a 2008 report published by the Child Welfare League of America.

 

In all of those cases, except the one in California, courts expanded their state's legal definition of medical neglect to include morbid obesity and ruled that the children were victims of neglect, the report says. Criminal charges were filed only in the California and Indiana cases, but the parents weren't sentenced to jail time in either.

 

What the court can order

 

The New York case in 2007 involved an adolescent girl who weighed 261 pounds, the report says. The court ordered nutritional counseling, cooking classes and gym workouts.

 

Criminal charges should be a last resort, says Linda Spears, vice president of policy and public affairs for the Child Welfare League of America.

 

"I think I would draw the line at a place where there are serious health consequences for the child and efforts to work with the family have repeatedly failed," she says.

 

What's more often needed is a structured plan of action that's accountable to a court, she says.

 

Most of the time, the health problems tied to childhood obesity don't become chronic until adulthood, which makes it difficult to charge parents with child abuse, Spears says.

 

In the South Carolina case, Gray followed nutritional guidelines set for her son by the state Department of Social Services, Varner says, but Alexander apparently got other food on his own while not under his mother's supervision.

 

The boy has been placed in foster care, and Varner says he hasn't been allowed to speak to him. Gray has signed an agreement with a film documentary company for exclusive rights to her story and couldn't comment for this article, Varner says.

 

"There's a strong likelihood that this kid is going to school and could eat whatever he wanted to at school, because you've got friends who will help him buy food or will give him their leftovers," Varner says. "The big question is: What is this kid doing when he's not in Mom's care, custody and control?"

 

Greenville County School District spokesman Oby Lyles declined to comment.

 

"This is not a case of a mother force-feeding a child," Varner says. "If she had been holding him down and force-feeding him, sure, I can understand. But she doesn't have the means to do it. She doesn't have the money to buy the food to do it."

 

Slippery slope ahead?

 

The case could have ramifications beyond parental control over obesity to other eating disorders, and even other behaviors not related to weight, Varner says.

 

"What about the parents of every 16-year-old in Beverly Hills who's too thin? Are they going to start arresting parents because their child is too thin?" he asks.

 

Jolene Puffer, a personal trainer in Asheville, N.C., says the problem often is parents "loving their kids to death," especially in low-income families where food is one of the few things they can afford to give their children.

 

But school officials and doctors are "not sounding the alarm" when they should, she says.

 

Puffer took a local family on as a volunteer project and helped a 16-year-old boy who weighed 434 pounds lose 110 pounds, while his mother lost more than 80 and his sister shed nearly 50.

 

A social services counselor had recommended that the boy apply for Medicare, which Puffer says could have set him up as a lifelong disability case.

 

States have been taking steps to combat childhood obesity, according to a report released this month by the Trust for America's Health and the Robert Wood Johnson Foundation.

 

For example, 20 states have passed requirements for schools to do body mass index (BMI) screenings or other weight-related tests of children and adolescents, up from four states five years ago, says the report, title "F as in Fat: How Obesity Policies are Failing in America."

 

But it also says that, although every state requires physical education in schools, the requirements "are often limited, not enforced, or do not meet adequate quality standards."

 

The same report says 30% of children in 30 states ages 10 to 17 are overweight or obese, with the rate hitting a high of 44.4% in Mississippi.

 

The CDC says the number of obese children ages 6 to 11 more than doubled in the past 20 years, while the rate for adolescents more than tripled.

 

A comparison to drugs

 

Ron Jones, a corporate wellness expert based in Atlanta and Los Angeles, uses the phrase "child obesity is child abuse" in his promotional materials and says the nation has turned its head the other way when it comes to accepting that concept.

 

"If you gave your child a drug, you'd be held in the court. But if you kill them with food, that seems to be acceptable," he says.

 

The difficulty with prosecuting such cases is that most state laws require that the child's health be in imminent danger for criminal charges to be filed, and the parent must be capable of helping the child but hasn't taken the necessary action, says Richard Balnave, a professor at the University of Virginia School of Law.

 

Obesity, although potentially dangerous, does not generally put a child in imminent danger, he says.

 

Supreme Court rulings have recognized the right of parents to raise their children how they see fit, Balnave says, but not to the point that the child's health is endangered.

 

The arrest warrant in the Gray case alleges that her son's weight was "serious and threatening to his health" and that she had placed him "at an unreasonable risk of harm."

 

Virginia Williamson, counsel for the South Carolina Department of Social Services, says her agency sought custody of Alexander "because of information from health care providers that he was at risk of serious harm because his mother was not meeting his medical needs."

 

The department "would not take action based on a child's weight alone," she says.

 

Gray failed to appear at a family court hearing in which her child was to be turned over to foster care, according to a warrant issued in May.

 

Police later found her with the boy in Baltimore County, Md., and took her back to South Carolina, where she was released on a $50,000 bond, her attorney says.

 

TOP TREATS

 

Top snacks consumed by children under 6:

 

            In 1987                                   In 2007

1.         Cookies                                   Fruit

2.         Fruit                                        Cookies

3.         Milk                                         Milk

4.         Juice                                        Crackers

5.         Candy                                                 Juice

6.         Carbonated soft drinks           Popcorn

7.         Ice cream                                 Candy

8.         Crackers                                  Ice cream

9.         Cake                                        Chips

10.       Chips                                       Fruit rolls/bars/pieces

 

 

Change of taste

 

The five foods/beverages that have increased the most in the snack diet of young children today compared with young children 20 years ago:

 

1. Fruit rolls/bars/pieces

2. Yogurt

3. Crackers

4. Bars

5. Bottled water

 

The five foods/beverages that have decreased the most in the snack diet of young children today compared with young children 20 years ago:

 

1. Carbonated soft drinks

2. Ice cream

3. Candy

4. Cake

5. Fruit juice

 

Source: NPD Group

 

Barnett reports for The Greenville (S.C.)

 

Copyright 2009 USA Today.

 

Opinion

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