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			Sunday, June 21, 2009 News Clipping Archives *Maryland / Regional* Dangers of oral cancer to be noted (Cumberland Times-News) *National / International* Nestle recalls Toll House cookie dough products (Baltimore Sun) Nestlé Recall Leaves A Mystery in Its Wake (Washington Post) Drug industry to defray Obama health plan costs (Baltimore Sun) Hot workout hints: Don't let heat ruin your fitness routine (Baltimore Sun) At V.A. Hospital, a Rogue Cancer Unit (New York Times) *Opinion* Health reform needed (Carroll County Times Editorial) A Public Health Plan (New York Times Editorial) Legislation needed in Maryland to prevent more drowning deaths (Baltimore Sun Commentary) *Maryland / Regional* Dangers of oral cancer to be noted Cumberland Times-News Sunday, June 21, 2009 BALTIMORE - About 600 Marylanders will be diagnosed with oral cancer this year -and only half of them will be alive five years later, according to recent data from the Maryland Department of Health and Mental Hygiene. June 21-27 is Oral Cancer Awareness Week in Maryland. This week is aimed at educating the public about the risk factors, signs and symptoms of the disease. “We can prevent mouth cancer and save more lives by taking a few simple steps,” said DHMH Secretary John M. Colmers. “We know good oral health is the first step to good overall health. As Maryland expands dental care to more children, it’s important for them, their parents and every adult to understand that oral cancer doesn’t have to strike you or those you love.” Preventing mouth cancer is another front in Maryland’s extensive campaign to prevent oral disease in children and adults. Recent progress on preventing tooth decay in children, as a result of the recommendations of Gov. Martin O’Malley’s Dental Action Committee, is a primary example of this effort. Nine out of 10 people diagnosed with oral cancer use tobacco products, according to Maryland cancer data. Quitting tobacco use is the best action anyone can take to prevent oral cancer. For smokers, other risk factors like heavy alcohol use, being over age 40, and becoming infected with the human papillomavirus can greatly increase the likelihood of developing oral cancer. “The survival rate for oral cancer, unlike most other cancers, hasn’t improved much over the past 50 years because most people are diagnosed with oral cancer at a late stage,” said Dr. Harry Goodman, director for the DHMH Office of Oral Health. “Whether you smoke or not, ask your physician or dentist for a yearly oral cancer exam.” An oral cancer exam is a painless, two-minute exam that can be performed by a dental or medical provider. This can easily be done during your regular check-up or cleaning. The exam looks for unusual red or white skin patches or sores inside the mouth or on the lips and swelling in the head and neck region. Oral cancer is most successfully treated when these often-unnoticed skin changes are found early in the course of the disease while still painless. Other ways to reduce your risk of oral cancer include limiting alcoholic drinks, using a lip balm with an SPF of at least 15 anytime you are outdoors, and having a diet rich in fruits and vegetables. If you have any of the following signs or symptoms for more than two weeks, see your dental or medical provider immediately: •A white or red patch in the mouth. •A sore, irritation, lump or thickening of the mouth. •Hoarseness or feeling that something is caught in the throat. •Difficulty moving the tongue or jaw. •Numbness of the tongue or other areas of the mouth. •Swelling of the jaw that causes dentures to fit poorly or become uncomfortable. Tobacco users who need help with quitting can get free counseling and medication by calling The Maryland Tobacco Quitline at 1-800-QUIT-NOW (1-800-784-8669). This program provides phone based counseling and up to a four-week supply of nicotine patches or gum to tobacco users who are age 18 and over and meet basic health requirements. This free program is available to all callers regardless of income or how long they have smoked. The nicotine patches and gum are available only while supplies last and are provided on a first come, first served basis. For more information about oral cancer prevention and programs in your area, call your local health department or visit www.maryland-oralcancer.org Copyright © 1999-2008 cnhi, inc. *National / International* Nestle recalls Toll House cookie dough products Associated Press By Lauren Shepherd Baltimore Sun Saturday, June 20, 2009 NEW YORK - Federal authorities are investigating a new outbreak of a bacteria-triggered illness, this time related to a sweet treat treasured by the heartbroken and children-at-heart -- packaged raw cookie dough. The federal Centers for Disease Control said its preliminary investigation shows "a strong association" between eating raw refrigerated cookie dough made by Nestle and the illnesses of 65 people in 29 states whose lab results have turned up e. coli bacteria since March. About 25 of those people have been hospitalized, but no one has died. E. coli is a potentially deadly bacterium that can cause bloody diarrhea, dehydration and, in the most severe cases, kidney failure. Nestle USA voluntarily recalled all of its Toll House refrigerated cookie dough products after the U.S. Food and Drug Administration advised consumers to throw away any Nestle Toll House cookie dough products in their homes and asked retailers, restaurateurs and other foodservice operations not to sell or serve any of the refrigerated cookie dough products. Customers also can return any recalled product where they bought it for a full refund. The recall does not affect other Toll House products, including ice cream that contains raw Toll House dough. "This has been a very quickly moving situation," said Roz O'Hearn, spokeswoman for Nestle's baking division, adding the company took action within 24 hours of learning of the problem. Spokeswoman Laurie MacDonald for Nestle USA in Glendale, Calif., a unit of Switzerland-based Nestle SA, said the company has temporarily stopped making the refrigerated dough products while the FDA investigates its factory. "We hope to resume production as soon as possible," she said. Nestle holds a 41 percent share of the prepared cookie dough market. The recall includes refrigerated cookie bar dough, cookie dough tubs, cookie dough tubes, limited edition cookie dough items, seasonal cookie dough and Ultimates cookie bar dough. Nestle said about 300,000 cases of Nestle Toll House cookie dough are affected by the recall, which covers chocolate chip dough, gingerbread, sugar, peanut butter dough and other varieties. The FDA said consumers should not try to cook the dough, even though it would be safe to eat if cooked, because the bacteria could move to their hands and to countertops and other cooking surfaces. Raw cookie dough is so popular that it has spawned more than 40 groups on Facebook, complete with postings that read like love notes. Stacey Oyler, a 33-year-old San Francisco resident, called it her "secret indulgence" -- a treat that became irresistible when she was pregnant with her second child last August. She said she still indulges occasionally. "I love the combination of the salt and sweet," she said. "You can't get that from a piece of chocolate." But no raw cookie is necessarily safe. The eggs in Nestle Toll House's dough are pasteurized, which eliminates most of the risk of salmonella infection from raw eggs. But other ingredients could contain pathogens or bacteria, and the company warns in product labels not to eat the dough raw. Several recent food recalls have been related to bacterial contamination, including a salmonella outbreak last winter traced to a peanut company that sickened more than 600 people and that was blamed for at least nine deaths. A separate outbreak of salmonella last year linked to jalapeno peppers from Mexico led 1,400 people to become ill. Sarah Klein, staff attorney in the food safety group at consumer advocacy group Center for Science in the Public Interest, called the cookie dough news disheartening. "Unfortunately, I don't think that people who have been working in food safety for years can be surprised at this point and sadly, I don't think the American people are surprised either," Klein said. ___ AP Business Writer Michelle Chapman contributed to this report. Copyright 2009 Associated Press. All rights reserved. Nestlé Recall Leaves A Mystery in Its Wake Officials Probe E. Coli Link to Cookie Dough By Lyndsey Layton and Valerie Strauss Washington Post Sunday, June 21, 2009 Federal microbiologists and food safety investigators have descended on the Danville, Va., plant that makes Nestlé's refrigerated cookie dough, trying to crack a scientific mystery surrounding a national outbreak of illness from E. coli 0157, a deadly strain of bacteria, which has been linked to the product. Health officials and food producers puzzled yesterday over how E. coli 0157, a bacterium that lives in the intestines of cattle, could have ended up in a product that seems so unlikely to contain it. "It's a fascinating outbreak," said Craig Hedberg, an expert on food-borne diseases at the University of Minnesota. "By just looking at package labeling, there is no reason you would expect an event like this to occur." The outbreak, which has sickened at least 65 people in 29 states, is the latest worry for consumers in the Washington area and across the country unnerved by a wave of food-borne illnesses, including botulism associated with canned chili and infections from salmonella linked to peanut products. With cookie dough, like peanut butter, being a favorite of children, the latest outbreak is particularly alarming because the young and the elderly are more likely to develop severe complications if infected with E. coli 0157. More than two-thirds of the 65 victims are younger than 19, according to the federal Centers for Disease Control and Prevention. None has died. Two of the victims live in Maryland, and two live in Virginia, the CDC reported. Their identities have not been revealed. In supermarkets yesterday, Nestlé products had been pulled from the refrigerated section, and consumers were left to ponder the safety of the U.S. food system. "When I heard about the recall, I thought, 'Is nothing safe anymore?' " said Carole Feld, a D.C. resident who has a 13-year-old child, pushing a shopping cart through a Glover Park Whole Foods Market yesterday. "If bacteria has gotten into Nestlé's Toll House cookie dough, then everything is suspect." David Evans, who was shopping in a Safeway in McLean with stepdaughter Kelly Ready, said that when he heard about the recall, he immediately checked to see whether there was any of the suspect cookie dough -- which Kelly, 14, said she sometimes eats raw -- in his home. There wasn't. "I think [the food supply] is basically safe," Evans said. "But we need tighter controls, though I'm not a believer in big government." The outbreak comes as the federal government is attempting to revamp the nation's outdated food safety system. President Obama has identified food safety as a priority, and Congress is moving legislation that would place new requirements on food manufacturers while beefing up the Food and Drug Administration's inspection and enforcement powers. A key House committee passed legislation last week that could be voted on as early as this week, and a companion bill is pending in the Senate. Nestlé has a solid reputation within the food industry for manufacturing practices designed to prevent contamination. The company has cooperated fully with the investigation, said David Acheson, assistant commissioner for food safety at the FDA. Nestlé recalled all its refrigerated Toll House cookie dough products, or about 300,000 cases, on Friday, within 24 hours of being notified by the FDA that it suspected a problem, said Laurie MacDonald, a vice president at Nestlé USA. The company also suspended operations at the Danville plant that day, she said. About 500 people work at the plant, which is a major employer in the small community near the North Carolina border. Nestlé, which has a 41 percent share of the prepared cookie dough market, has not estimated the cost of the recall, MacDonald said. Investigators have not confirmed the presence of E. coli 0157 in any Nestlé product; they are testing samples of dough collected from the plant as well as from victims. But William E. Keene, chief epidemiologist for the state of Oregon, said he was "100 percent" certain that the culprit was the cookie dough. "Virtually everyone [who got sick] ate the same brand of cookie dough," he said. "I have absolute confidence in the conclusion." Because the appearance of E. coli 0157 in cookie dough is so unusual, investigators are looking at a broad range of possible factors, analyzing the ingredients, the plant's equipment and interior, the health of workers and whether the facility is located near cattle. Federal officials are also considering whether the dough might have been intentionally contaminated. State health officials first noticed cases of E. coli 0157 emerging in March. Initially, they suspected ground beef or strawberries. But after interviewing victims, state officials and the CDC compared notes during a conference call Tuesday and settled on the refrigerated cookie dough as the prime suspect. The risk usually associated with cookie dough is salmonella, a bacteria that can be found in raw eggs contained in the dough. Nestlé's cookie dough is packaged with labels warning consumers not to eat it raw. But people tend to disregard the warning -- 39 percent of consumers eat raw cookie dough, according to Consumer Reports. It has become such a popular snack that many ice cream makers have developed a cookie dough flavor. William Marler, a prominent food safety lawyer in Seattle who is representing six of the E. coli 0157 victims, said Nestlé's warning label is not a defense. "It doesn't absolve them of liability," he said. E. coli refers to many kinds of bacteria, most of which are harmless or even beneficial. But certain types, including E. coli 0157, produce a toxin that can cause severe illness and even death in humans. The E. coli 0157 bacterium lives in the intestines of cows and other animals -- goats, sheep, deer and elk -- and is found most often in ground beef. But over the past decade, a number of E. coli 0157 illness outbreaks have been associated with green, leafy produce, such as spinach. "Food-borne diseases are generally a moving target," Hedberg said. "We can't get too comfortable thinking we know how these organisms behave." Copyright 2009 Washington Post. Drug industry to defray Obama health plan costs $80 billion deal will cover half the price of brand-name drugs for 'doughnut hole' seniors Associated Press Baltimore Sun Sunday, June 21, 2009 WASHINGTON — The pharmaceutical industry agreed Saturday to spend $80 billion over the next decade improving drug benefits for seniors on Medicare and defraying the cost of President Barack Obama's health care legislation, capping secretive negotiations involving key lawmakers and the White House. "This new coverage means affordable prices on prescription drugs when Medicare benefits don't cover the cost of prescriptions," Sen. Max Baucus, chairman of the Senate Finance Committee, said in a statement announcing the accord. The deal marked a major triumph for Baucus as well as the administration. Obama praised the deal. "The agreement by pharmaceutical companies to contribute to the health reform effort comes on the heels of the landmark pledge many health industry leaders made to me last month, when they offered to do their part to reduce health spending $2 trillion over the next decade," Obama said. "We are at a turning point in America's journey toward health care reform." Baucus, a Montana Democrat, has been negotiating with numerous industry groups for weeks as he tries to draft legislation that meets Obama's goal of vastly expanding health coverage, has bipartisan support and does not add to the deficit. Baucus' announcement said drug companies would pay half of the cost of brand-name drugs for seniors in the so-called doughnut hole - a gap in coverage that is a feature of many of the plans providing prescription coverage under Medicare. Other officials said wealthier Medicare beneficiaries would not receive the same break, but there was no mention of that in the statement. In addition, the entire cost of the drug would count toward a patient's out-of-pocket costs, meaning their insurance coverage would cover more of their expenses than otherwise. "The existence of this gap in coverage has been a continuing injustice that has placed a great burden on many seniors," Obama said. "This deal will provide significant relief from that burden for millions of American seniors. "Key sectors of the health care industry acknowledge what American families and businesses already know - that the status quo is no longer sustainable," the president said. Billy Tauzin, president and CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA), said, "Millions of uninsured and financially struggling Americans are depending on us to accomplish comprehensive health care reform this year. Today, America's pharmaceutical research and biotechnology companies are signaling their strong support for these critically important efforts." While none of the changes in the prescription drug program would directly lower government costs, several officials also said the industry agreed to measures that would give the Treasury more money under federal health programs. In particular, officials said drug companies would likely wind up paying pay higher rebates for certain drugs under Medicaid, the program that provides health care for the poor. Those funds would be used to help pay for legislation expanding health insurance for millions who now lack it. One official said the deal was agreed to late Friday night when Tauzin called Baucus. The senator's statement said the White House was involved in the agreement. It was not clear what leverage the agreement would give Baucus with other health care providers with whom he is in negotiations. But at a minimum, the agreement served as an effective counter to impression that the drive to enact health care legislation was sputtering. Copyright © 2009, The Baltimore Sun. Hot workout hints: Don't let heat ruin your fitness routine Don't let heat ruin your fitness routine Daily Press (Newport News, Va.) By Alison Johnson Baltimore Sun Sunday, June 21, 2009 The thought of trying to sweat in the heat and humidity can keep some people on the couch. Here are ways to make hot-weather workouts more appealing. Pick a good time. Exercise in the early morning or evening, when temperatures are cooler. A recent study by London researchers showed people do best in the morning in hot conditions, because the core body temperature starts out lower. Hydrate early. Have plenty of water before you work out to help spare yourself the misery of thirst. Pick a good place. Look for shaded, grassy areas rather than hot pavement, especially if you work out midday. Of course, air-conditioned gyms and living rooms also are good choices. Wear the right clothes. You'll be much happier in loose, light-colored duds made of cotton or mesh-like fabrics that keep the skin drier. Dark clothes absorb more heat. Plan it out. Try the "if ... then" method to schedule exercise for the next day: As in, "I will jog at 8 a.m., but if it's already [too hot], then I will go to the 8:30 aerobics class instead." Reconsider likes and dislikes. Maybe you didn't like swimming or aerobics 20 years ago, but why not try again when it's too hot to run outside? Ask about gym discounts. Check for cool deals or add-ons with your membership, such as a free trial session with a personal trainer or on-site child care. Be knowledgeable. Instead of fearing heat-related illnesses, learn about them. For example, if you develop a headache, clammy skin, dizziness or nausea, you have to stop and cool down. Copyright © 2009, South Florida Sun-Sentinel. Copyright 2009 Baltimore Sun. At V.A. Hospital, a Rogue Cancer Unit By Walt Bogdanich New York Times Sunday, June 21, 2009 For patients with prostate cancer, it is a common surgical procedure: a doctor implants dozens of radioactive seeds to attack the disease. But when Dr. Gary D. Kao treated one patient at the veterans’ hospital in Philadelphia, his aim was more than a little off. Most of the seeds, 40 in all, landed in the patient’s healthy bladder, not the prostate. It was a serious mistake, and under federal rules, regulators investigated. But Dr. Kao, with their consent, made his mistake all but disappear. He simply rewrote his surgical plan to match the number of seeds in the prostate, investigators said. The revision may have made Dr. Kao look better, but it did nothing for the patient, who had to undergo a second implant. It failed, too, resulting in an unintended dose to the rectum. Regulators knew nothing of this second mistake because no one reported it. Two years later, in 2005, Dr. Kao rewrote another surgical plan after putting half the seeds in the wrong organ. Once again, regulators did not object. Had the government responded more aggressively, it might have uncovered a rogue cancer unit at the hospital, one that operated with virtually no outside scrutiny and botched 92 of 116 cancer treatments over a span of more than six years — and then kept quiet about it, according to interviews with investigators, government officials and public records. The team continued implants for a year even though the equipment that measured whether patients received the proper radiation dose was broken. The radiation safety committee at the Veterans Affairs hospital knew of this problem but took no action, records show. One patient was the Rev. Ricardo Flippin, a 21-year veteran of the Air Force. “I couldn’t walk and I couldn’t stand,” he said, citing rectal pain so severe that he had to remain in bed for six months, losing his church job and his income. Pastor Flippin first learned of what his doctors called a radiation injury not from the V.A., but from an Ohio hospital where he underwent rectal surgery in 2006 to treat the damage. “There are times when I don’t have control over my bowels,” he said one recent Sunday, after excusing himself during a service at a church in West Virginia where he now preaches. The 92 implant errors resulted from a systemwide failure in which none of the safeguards that were supposed to protect veterans from poor medical care worked, an examination by The New York Times has found. Peer review, a staple of every good hospital, in which colleagues examine one another’s work, did not exist in the unit. The V.A.’s radiation safety program; the Nuclear Regulatory Commission, which regulates the use of all nuclear materials; and the Joint Commission, a group that accredited the hospital, all failed to intervene; either their inspections had been limited or they had not acted decisively upon finding problems. Over all, the implant program lacked a “safety culture,” the nuclear commission found. Dr. Kao and other members of his team, the commission said, were not properly supervised or trained in what constitutes a substandard implant and the need to report it. Dr. Kao declined to comment for this article. Virtually none of the substandard implants in Philadelphia were reported to the nuclear commission, meaning errors went uninvestigated for weeks, months and sometimes years. During that time, many patients did not know that their cancer treatments were flawed. Federal investigators are continuing to look into the flawed implants as well as those at other V.A. hospitals. The Philadelphia prostate unit was closed after problems began to surface in mid-2008, and it has yet to reopen. The V.A. has also suspended the implants, known as brachytherapy, at hospitals in Jackson, Miss., and Cincinnati, though neither had problems on a scale of Philadelphia’s. The V.A. has yet to fully account for how these substandard implants affected veterans, though no one is believed to have died from them. No patient names have been made public. Veterans officials said Dr. Kao was no longer at the Philadelphia hospital and would not be allowed to return. The officials acknowledged that they had failed to supervise the unit. A lawyer for Dr. Kao, Jack L. Gruenstein, said The Times’s account of the doctor’s role was “false,” but he declined to elaborate. A nuclear commission consultant, Dr. Ronald E. Goans, reviewed about a quarter of the substandard implants and reported that “erratic seed placement caused a number of cases to have elevated doses to the rectum, bladder or perineum.” After learning of the problems, the V.A. flew seven patients treated in Philadelphia to its most experienced brachytherapy program in Seattle for additional implants. “I’m not easily shaken,” Dr. Leon S. Malmud, chairman of a nuclear commission advisory committee, said last month after investigators briefed the panel on their findings in Philadelphia. “But this is a very anxiety-provoking story.” Clues That All Is Not Right The brachytherapy program at the Philadelphia V.A. hospital began in early 2002, giving veterans an option for treating prostate cancer without major surgery. In this procedure, metal seeds the size of a grain of rice are permanently inserted into the prostate through needles. “The idea is to create a radioactive cloud that conforms to and treats the prostate,” said Dr. Louis Potters, department chairman of radiation medicine at North Shore Long Island Jewish Health System. By using ultrasound in the operating room, Dr. Potters can assess how well radiation is being distributed. “So at the completion of the case,” he said, “I can go out and tell that patient’s wife or significant other that we did a very good implant.” And good implants were what the Philadelphia V.A. expected when it staffed the new unit with outside contractors from an Ivy League institution, the University of Pennsylvania School of Medicine. One contractor was Dr. Kao. In addition to his work as a cancer researcher, he had a medical degree from Johns Hopkins and a Ph.D. from Penn. He is also on a team from Penn that won a contract this year from a NASA-financed consortium to study radiation in space. Although Dr. Kao was board certified in radiation oncology, he had limited experience in brachytherapy, according to the nuclear commission. Even so, the unit had no peer review. “In every facility that I’ve ever practiced and seen, there is some form of peer review going on,” said Dr. James Welsh, a radiation oncologist and member of the nuclear commission’s advisory board. It was not long before problems began to surface. In the first year, nine implants were substandard, including two on the same day, records show. In early 2003, the V.A. and the nuclear commission got their first solid clue that all was not right in the cancer unit. On Feb. 3, Dr. Kao mistakenly implanted more than half the seeds in a patient’s bladder. With the patient still under anesthesia, a urologist had to thread a small tube through the man’s penis to retrieve the 40 errant seeds. Because they were bloody and contaminated with urine, the seeds could not be reused, and no more were available. As a carcinogen that can burn healthy tissue as well as kill cancerous cells, radiation is supposed to be closely monitored. The hospital’s radiation safety committee handles regulatory issues. The V.A.’s National Health Physics Program oversees radiation use in all veteran facilities. But the chief regulator is the Nuclear Regulatory Commission. Serious accidents involving radioactive materials must be reported to that agency, which has the power to investigate and levy fines. Congress receives an annual list of those accidents. After learning of Dr. Kao’s error, V.A. officials thought that because he had revised his surgical plan while still in the operating room, the mistake did not exist. The nuclear commission agreed, on the ground that doctors needed freedom to revise their surgical plan depending on what they found during surgery. Yet this case did not involve a new diagnostic interpretation: it was an implant mistake, causing the patient to return for another procedure. Dr. Charles M. Anderson, who heads the V.A.’s national radiation safety committee, said it was “not good medical practice” to have to redo surgery. Asked whether Dr. Kao was trying to cover up a mistake, Dr. Anderson said, “I’m not going to look into this guy’s soul.” The Nuclear Regulatory Commission lacked the authority to challenge Dr. Kao’s revisions, said Steven A. Reynolds, director of nuclear materials safety for the commission. “The N.R.C. isn’t in the business of practicing medicine,” Mr. Reynolds said. The two incidents in Philadelphia have prompted the N.R.C. staff to propose allowing revisions to surgical plans only before an implant is done. One Patient’s Case When Pastor Flippin arrived for his implant in May 2005, he was unaware that brachytherapy errors at the Philadelphia V.A. were piling up. He had traveled to Philadelphia from West Virginia to care for his elderly mother. “I felt I had been neglectful in my relationship with my mother,” said Pastor Flippin, 68. Now he wanted to make things right. “The best way to do that was to go back and be with her,” he said. After learning that he had prostate cancer, Pastor Flippin picked brachytherapy rather than external beam radiation or surgery. The doctor’s words were especially comforting, he said. “I remember him telling me that it was a relatively safe procedure that he had done — and I was impressed with this — he had done over 600 seed implants, that there was nothing to worry about,” Pastor Flippin said in an interview last month. Pastor Flippin’s medical records show that he was counseled by the other doctor in the unit, Dr. Richard Whittington, then chief of radiation oncology at the Philadelphia V.A. and now a professor at Penn’s medical school, a V.A. official said. But Dr. Kao did the implant, the records show. Investigators say he is responsible for all but a handful of the 92 substandard implants at the Philadelphia V.A. Dr. Whittington declined to be interviewed. At first, Pastor Flippin’s implant seemed fine. But 10 months later, he said, he began experiencing bowel pain that worsened with time. Now back in West Virginia, Pastor Flippin sought treatment at a V.A. hospital in Huntington. Doctors there suspected constipation, hemorrhoids or gas. “They gave me suppositories, they gave me flushings, they gave me a rinse where you sit in and everything else,” Pastor Flippin said. “I’m saying none of this is working.” Doctors then prescribed narcotics. “It was just a succession of painkiller after painkiller after painkiller, and it got to the point where I said, ‘I don’t want any more morphine,’ ” Pastor Flippin said. His weight dropped to 109 pounds, a 20 percent loss. He had to quit his job coordinating after-school programs for a coalition of churches in Charleston, W.Va. “This is not working,” he told his doctors. “I’m barely alive, I’m wasting away and you all are not doing anything.” Increasingly desperate, Pastor Flippin sought help from the Ohio State University Medical Center, where a doctor finally made a diagnosis: “Radiation injury to anal canal,” he wrote. Surgery was performed to cover the damaged area with a tissue flap. It would be another year and a half before a letter from the V.A. arrived, informing Pastor Flippin in August 2008 that he had received a flawed implant. “The treatment you received did not meet V.A.’s high standard of care,” the letter said. At this point, it hardly mattered that the V.A. rendered Pastor Flippin’s first name wrong, calling him Richard, rather than Ricardo. A Discovery Leads to Others The substandard implants might never have been discovered were it not for a clerical error. In the spring of 2008, a radiation safety official at the V.A. mistakenly ordered seeds of lower strength, and they were implanted. After the error was discovered, according to the nuclear commission, the V.A.’s national radiation safety unit asked the hospital to examine 10 to 20 more cases to see if the problem had occurred before. It had not. But investigators found something more troubling: four instances where seeds were implanted in the wrong places. As more cases were examined, more mistakes were found. “Every once in a while you’re going to have a medical event because the seed will migrate, but when you see more than one or two at one place, we’re like: ‘What’s going on? Is this a pervasive problem?’ ” said Mr. Reynolds, the nuclear commission official. The hospital suspended the brachytherapy program on June 11 last year. By then, 45 substandard implants had been found. Two days later, the Joint Commission, which helps set standards in the hospital industry, surveyed the Philadelphia V.A. and on the next day accredited the hospital. “This organization is in full compliance with applicable standards,” the Joint Commission said. The commission said that it had no indications of the problems in the brachytherapy program when it arrived at the hospital and that its surveys are not detailed enough to have uncovered the flawed implants. Soon after, the N.R.C. sent its own inspectors to Philadelphia. And the more the inspectors looked, the more they found. All told, 57 of the implants delivered too little radiation to the prostate, either because the seeds missed the prostate or were not distributed properly inside the prostate. Thirty-five other cases involved overdoses to other parts of the body. An unspecified number of patients were both underdosed in the prostate and overdosed elsewhere. From December 2006 to November 2007, the nuclear commission found, 16 patients received seed implants in Philadelphia even though computer interface problems prevented medical personnel from determining whether those treatments had been successful. The V.A.’s radiation officials knew of the problem but took no action, the nuclear commission charges. Investigators said they did not know how the unit made so many mistakes or why Dr. Kao decided to rewrite only two surgical plans. The doctors, according to the nuclear commission, believed “that since the patients were not having complications, the implant quality must be acceptable.” The V.A. put too much trust in the contractors, said Darrell G. Wiedeman, a senior health physicist for the nuclear commission. “They claim they hired experts, the best that money could buy from the local university, so therefore they didn’t require a lot of training and oversight,” Mr. Wiedeman said at a recent meeting of the nuclear commission’s advisory board. Susan Phillips, a senior executive at Penn’s medical school and health system, said Dr. Kao had voluntarily given up his clinical privileges there, though he continues to do research on campus. Dr. Kao did an unspecified number of brachytherapy procedures at the campus hospital with no apparent problems. A check of state and federal records over the last decade in Pennsylvania turned up no malpractice or disciplinary actions against Dr. Kao. Back in West Virginia, Pastor Flippin said he continued to try to build up his small church while dealing with the side effects of his implant. After 21 years of serving his country, he had hoped for a better ending. “It’s not fair,” he said. “Any veteran should expect more than what we’re getting.” Andrew W. Lehren and Kristina Rebelo contributed reporting. Copyright 2009 The New York Times Company. *Opinion* Health reform needed Carroll County Times Editorial Sunday, June 21, 2009 About half the people participating in a recent poll said they were concerned that they would not be able to afford health care, but affordability is just the tip of the iceberg on the issue of health care reform. Congress this past week began work on a variety of proposals, with Democrats making some concessions and scaling back some plans in an effort to win Republican support. Up until now, the debate on health care has been pretty much limited to the extremes, with opposition Republicans uttering their well-practiced talking points about socialized medicine and putting bureaucrats between doctors and patients, much like they did when they derailed the last big attempt to reform health care. Democrats, for their part, continue to downplay or skip over how reforms will be paid for, even though it looks more and more like additional taxes is the way it will go. A poll released last week financed by the Robert Wood Johnson Foundation and performed by the University of Michigan found that about half of those surveyed said they were concerned that they would not be able to afford health care in the coming years. According to the Associated Press, 24 percent of those surveyed said they feared they would lose their health care coverage. That fear was greater among 50- to 64-year-olds. But the poll also reported that 86 percent of those surveyed said they received quality health care, and 88 percent said they had health insurance. Clearly the cost of health care and the red tape involved has gotten out of control. But as Congress continues to debate various proposals, they need to focus on major points that just about everyone agrees needs addressing, including: Reducing costs by such things as allowing Medicare to negotiate with companies for lower drug prices, something currently not allowed under reforms enacted by the Bush administration; Allowing for more preventive care, and rewarding people who get regular checkups since it is more cost-effective to prevent a disease than to treat one; Eliminating the fraud, waste and abuse that is rampant in the current system; Minimizing the financial impact on employees and employers concerning how reforms will be paid for; And protecting the doctor-patient relationship. Leadership of both parties needs to come together with the common goal of making the system better, and if they can keep these priorities at the forefront of the discussion, there’s a fairly good chance that we could get some meaningful reform. People are concerned about health care, and they are tired of partisan bickering that results in stalemate. Democrats and Republicans need to come together to help fix the flaws in the system and enact the meaningful reform that just about everyone agrees is necessary. Copyright 2009 Carroll County Times. A Public Health Plan New York Times Editorial Sunday, June 21, 2009 As the debate on health care reform unfolds, no issue has caused such partisan rancor — and spawned such misleading rhetoric — as whether to create a new public insurance plan to compete with private plans. The nation already has several huge public plans, including Medicare for the elderly (once reviled by conservatives, it is now only short of the flag in its popularity) and Medicaid for the poor. Now the issue is whether to establish a new public plan to encourage more competition among health insurers and provide Americans with an alternative. Most Democrats and some Republicans have already accepted the need to create one or more health insurance exchanges where individuals without group coverage and possibly small businesses could buy insurance policies. Some proponents hope that big businesses could enroll their workers as well. An exchange would give the government (federal or state) a lot more power over insurers that choose to participate in order to tap a vast new market of previously uninsured people. It would determine the range of benefits that all participating plans would have to offer. It would presumably require those plans to accept all applicants, regardless of “pre-existing conditions.” What Republicans are adamantly opposed to is the idea of adding a public plan to that exchange. They portray it as a “government takeover” of the health care system, or even as socialized medicine. Those are egregious mischaracterizations. There is no serious consideration in Congress of a single-payer governmental program that would enroll virtually everyone. Nor is there any talk of extending the veterans health care system, a stellar example of “socialized medicine,” to the general public. The debate is really over whether to open the door a crack for a new public plan to compete with the private plans. Most Democrats see this as an important element in any health care reform, and so do we. A public plan would have lower administrative expenses than private plans, no need to generate big profits, and stronger bargaining power to obtain discounts from providers. That should enable it to charge lower premiums than many private plans. It would also provide an alternative for individuals who either can’t get adequate insurance from private insurers or don’t trust the private insurance industry to treat them fairly. And it could serve as a yardstick for comparing the performance of private plans and for testing innovative coverage schemes. Unfortunately, many Senate Democrats are so desperate to find a political compromise with Republicans — or so bullied by the rhetoric — that they are in danger of gravely weakening a public plan, or eliminating it entirely. That would be a mistake. Here is a look at the main proposals now under consideration: THE MOST ROBUST This approach, favored by many analysts, would allow the new public plan to piggy-back on the rate-setting powers of Medicare. As a result, it is the one most feared by Republicans, the insurance industry and doctors and hospitals. Any doctors who wanted to participate in Medicare, as virtually all do, would also have to participate in this plan and would have to accept the same payment rates as Medicare provides. With lower costs, it would be cheaper for consumers, charging its members premiums as much as 20 to 30 percent lower than premiums for comparable private coverage, a boon to hard-pressed families. It would also shave hundreds of billions of dollars from the amount needed to cover the uninsured — a crucial advantage as Congress scrambles to finance the reform effort. The risk is that if this plan, given its power, were too stingy, it might drive some financially stressed hospitals into bankruptcy. The hope is that the downward pressure on reimbursements might force them to innovate and find big savings. Republicans and private insurers fear, with some reason, that such an inexpensive public plan would entice or drive tens of millions of Americans away from private insurance, especially if big employers were allowed to enroll their workers in an exchange. The challenge is to craft rules to discourage employers from simply dropping their own subsidies entirely. The prospect of competing with a government plan terrifies the private insurers. But in our judgment, if that many Americans were to decide that such a plan is a better deal for them and their families, that would be a good thing. Innovative private plans that already deliver better services at lower costs would survive. Inefficient private plans would wither. In an effort to address some of these fears, Senator Jay Rockefeller has introduced a bill that would use Medicare provider payment rates for only the first two years and let doctors opt out after three years while remaining in Medicare. That would get the new public plan off to a good start, after which it would compete on its own. LIGHTER VERSIONS Other proposals are circulating that would level the playing field with private plans. They would require the public plan to hold the same reserves as private plans and sustain itself from premium income without drawing on the federal treasury. It would probably pay providers higher rates than Medicare but lower rates than most private plans. Its administrative costs would be far lower, allowing it to offer lower premiums. These more modest versions could be worth having, but they would save individuals and the health care system far less money. STATE-BASED PLANS A bipartisan group, led by three former Senate leaders — Republicans Bob Dole and Howard Baker and Democrat Tom Daschle — has proposed leaving it to states to create public plans if they wish. The federal government would be able to step in after five years if a state has failed to establish an exchange with affordable insurance options. That looks like a formula for delay and inaction. COOPERATIVES Propelled by a belief that no public plan could survive a Republican filibuster, Senator Kent Conrad, Democrat of North Dakota, has proposed instead setting up private nonprofit cooperatives — run for the benefit of their members rather than stockholders — to compete with profit making insurance plans. The presumed advantage of this approach is that cooperatives might be able to charge lower premiums because they would not have to earn large profits. Their performance, too, would be a yardstick against which to measure whether profit making plans are charging fair premiums. Health care cooperatives have existed at the local or regional level for decades in this country. Many have gone belly up. A few still provide high quality care at reasonable prices. Given sufficient size, seed money and negotiating power, a cooperative organization could help transform the health care system. But Republicans seem unlikely to accept a strong national organization, so creation of cooperatives is apt to be local and spotty. They would be unlikely to deliver as much savings as a large public plan. TIGHT REGULATION Right from the start of the debate, some experts have suggested that much tighter regulation of the new insurance exchange could achieve many of the goals of a public plan. Regulators could insist that insurers not exclude people with pre-existing conditions or charge them higher premiums. The exchange could offer customers a menu of private plans and be modeled on the federal program that serves Congress and other government personnel. Several European countries, including Germany, provide better health care at lower cost than the United States without relying on a public plan. And the near-universal coverage in Massachusetts was achieved without a public plan option. We continue to believe that a public plan would be desirable. Surveys by the Commonwealth Fund have found that Medicare beneficiaries report fewer problems obtaining medical care, less financial hardship due to medical bills, and higher satisfaction with their coverage than do workers insured by private employers. If Senate Republicans block a public plan, much tighter regulation will be essential to guarantee affordable private coverage for millions of Americans. Copyright 2009 The New York Times Company. Legislation needed in Maryland to prevent more drowning deaths By Debbie Freed Baltimore Sun Commentary Sunday, June 21, 2009 Three years ago, my son became a statistic. On June 22, 2006, my 5-year-old, Connor, went with family friends to the Crofton Country Club pool. After taking off his life vest for a trip to the bathroom, Connor was found floating in the pool. My son was rushed by ambulance to the Anne Arundel County Medical Center, but it was too late. On duty were four lifeguards. Only one, a 16-year-old with just three weeks of experience, was watching the pool. Underneath an empty lifeguard chair, unnoticed, was my son, floating face down for three minutes in the waters of the shallow end of the pool. The 911 tapes played for the civil trial for my son's death spoke of even more neglect. The automated external defibrillator (AED), which could have saved Connor's life, was not deployed. Staff had been instructed by the pool management company not to use it for fear of a lawsuit. The AED was there for show, not for protection. Connor's death was not unusual in that a lifeguard was present. Almost one of five drownings happen this way. Too often, a lifeguard is poorly trained, inexperienced, overburdened or easily distracted. Drowning can happen in only one inch of water. After two minutes, a child will lose consciousness; after four minutes, irreversible brain damage occurs. Drowning is the second leading cause of death for children 14 and under, and in 18 states it is the main cause of death. Almost two-thirds of those drowning are under the age of four. Even more at risk are minority children: African-Americans are three times as likely to drown as whites due to a lack of swimming lessons. An unsettling truth came to light at the trial in Connor's death: One reason so many children die with lifeguards present is that many pools are being managed not by the best companies but by the lowest bidders. Expenses are minimized and profits maximized by keeping training costs low. The Connor Bill, named for my son, was introduced by Del. James King of Gambrills. It calls for all public pools of 2,500 square feet or more to have at least two lifeguards on duty at all times. Sen. Katherine Klausmier of Baltimore County is introducing legislation mandating AEDs at all public pools. Passing and enacting both these bills into law will prevent many tragedies. Fortunately, pool safety is becoming more of an issue across the country. In Connecticut, second-degree manslaughter charges were filed against the president of a company for the death of a 6-year old who drowned as his arm was sucked down a drain. The company, Shoreline Pools, failed to install safeguard devices required by Connecticut building codes. The protective grate for the drain was found at the bottom of the pool. At the trial for Connor's death, our lawyers sat silent for three minutes in their closing statement to demonstrate to the jury just how long that can be. While three minutes of silence spoke volumes in winning the case, that period of time will always be an eternity for anyone who loved Connor or for any parent who loses a child. Everyone has a role to play - whether it is parents in enrolling their children in swim lessons or the legislatures in passing and strictly enforcing safety legislation - if we are to prevent further tragedies at a pool. Now is the time is for all to act. Debbie Freed lives in Davidsonville. A foundation, www.connorcares.org, has been set up in her son's memory to prevent childhood drownings. Her e-mail is debbieneaglefreed@hotmail.com. Copyright © 2009, The Baltimore Sun. BACK TO TOP


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