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			Sunday, March 15, 2009 News Clipping Archives *Maryland / Regional* City to launch national search for Sharfstein replacement (Baltimore Sun) County considers new site for senior center (Hagerstown Herald-Mail) Richmond woman with dementia dies in pond (Salisbury Daily Times) *National / International* Mysterious Psychosis (New York Times) HIV/AIDS Rate in D.C. Hits 3% (Washington Post) Health insurance industry works on image makeover (Washington Times) Budget woes cut health care for illegal immigrants (Washington Post) Bill Proposes Restrictions on Raw Milk Sales (New York Times) Massachusetts Faces Costs of Big Health Care Plan (New York Times) President Promises to Bolster Food Safety (New York Times) *Opinion* Pathogens in Our Pork (New York Times) How to Pay Less for More Health Care (New York Times) Re-Entry: What has changed since 2007? (Cumberland Times-News) *Maryland / Regional* City to launch national search for Sharfstein replacement Baltimore health chief named to FDA post By Matthew Hay Brown and Kelly Brewington Baltimore Sun Sunday, March 15, 2009 The city will launch a national search to replace Dr. Joshua M. Sharfstein, the health commissioner tapped by President Barack Obama yesterday to serve as the No. 2 official at the nation's principal food and drug watchdog. "President Obama chose an experienced advocate with a proven background in health policy," Mayor Sheila Dixon said after Obama announced Sharfstein's appointment as deputy commissioner of the Food and Drug Administration. "The people of the United States are fortunate to have Dr. Sharfstein looking out for their best interests." The Harvard-trained pediatrician will serve under Dr. Margaret A. "Peggy" Hamburg, the former New York City health chief whom Obama nominated yesterday to head the FDA. "Dr. Sharfstein has been recognized as a national leader for his efforts to protect children from unsafe over-the-counter cough and cold medications," Obama said yesterday in his weekly radio address. "And he's designed an award-winning program to ensure that Americans with disabilities had access to prescription drugs." Hamburg and Sharfstein take over a troubled agency criticized most recently for what critics have called an inadequate response to the salmonella outbreak that contaminated peanut butter in hundreds of products, reviving widespread calls for reform of the way the federal government safeguards the nation's food supply. "In recent years, we've seen a number of problems with the food making its way to our kitchen tables," Obama said. "In 2006, it was contaminated spinach. In 2008, it was salmonella in peppers and possibly tomatoes. And just this year, bad peanut products led to hundreds of illnesses and cost nine people their lives - a painful reminder of how tragic the consequences can be when food producers act irresponsibly and government is unable to do its job." Obama also announced a "food safety working group" that would bring together Cabinet secretaries and other senior officials to advise him "on how we can upgrade our food safety laws for the 21st century." In a letter to friends and colleagues, Sharfstein said yesterday that he would be leaving the Health Department at the end of next week to take the FDA job. Dixon, who had anticipated the departure of the official she called a "superstar" within her administration, said Assistant Health Commissioner Olivia Farrow would take over as interim commissioner while the city searches for a permanent replacement. Dr. Peter L. Beilenson, who preceded Sharfstein as Baltimore's health commissioner, said Sharfstein's successor should be a passionate advocate who can work with numerous city agencies. "You have got to be willing to look across services, not just health, if you want to affect issues," said Beilenson, who now heads the Howard County Health Department. Police Commissioner Frederick H. Bealefeld III, who worked closely with Sharfstein on an anti-crime program run out of the Health Department, said the city needs "a Josh Sharfstein clone." "Beyond being smart and a good doctor, we need someone who is committed to a whole lot of action," he said. "You have to be down in the dirt and personally involved." Sharfstein, who came to Baltimore in 2005, emerged as a candidate for the FDA after leading an assessment of the agency for the Obama transition team. As city health chief, he convinced the FDA there was little evidence cold and cough medicines worked in children younger than 4, created a 24-hour system to ensure access to prescription drugs during the transition to Medicare Part D and led a ban on the use of lead in candy, cosmetics and jewelry sold in the city. Copyright 2009 Baltimore Sun. County considers new site for senior center By Heather Keels Hagerstown Herald-Mail Sunday, March 15, 2009 HAGERSTOWN - The Washington County Commission on Aging is pushing to establish a permanent senior center in a West Franklin Street building, but the Washington County Commissioners say they aren’t sold on the location yet. The five-story Aspiring to Serve building, at 140 W. Franklin St. in downtown Hagerstown, currently houses several nonprofits, including REACH on the third floor and the Commission on Aging offices on the fourth floor. By leasing vacant space on the fifth floor and working out space-sharing agreements on other floors, the commission would have a total of about 14,500 square feet to use for a senior center, said Commission on Aging Executive Director Susan J. MacDonald. The new location would replace the temporary senior center that has operated since September in the Girls Inc. building at 626 Washington Ave. in Hagerstown, she said. A senior task force picked the Aspiring to Serve site because of its prime downtown location, low cost, and convenience to the agency’s existing offices and other social services, MacDonald said. The church ministry that owns the building has offered the first two years rent-free and after that would charge about $73,000 per year, including parking and utilities, MacDonald said. There would also be an up-front cost of about $670,000 for renovations, she said. Several of the Washington County Commissioners said they weren’t convinced the site was worth that much of an investment. Commissioner James F. Kercheval said to justify spending more than $600,000 to renovate a rented space, the senior center would have to stay there for at least 10 or 15 years. Kercheval said the site has several drawbacks, including limited parking and the use of upper floors, as opposed to the ground floor. “It’s not an optimum spot for me,” he said. Kercheval suggested the commission survey area seniors to find out what they think of the Aspiring to Serve building as a permanent location. Commissioner William J. Wivell said he would prefer to put a senior center at Hagerstown Community College, where seniors could take advantage of the walking trails and gymnasium, and mingle with a younger crowd. MacDonald said the commission ruled out HCC because an expansion of its Athletic, Recreation and Community Center isn’t scheduled until 2019. Seniors who have been using the center in the Girls Inc. building want a permanent location much sooner than that, MacDonald said. The main problem with the Girls Inc. space is that it is only available for seniors when school is in session, MacDonald said. The youth organization has priority use of the space in the evenings, on weekends and holidays, and during the summer. “As cooperative and as welcoming as Girls Inc. has been, it is their space, and I think our seniors deserve a space of their own,” MacDonald said. About 300 seniors are registered to use the current center, and it has had about 1,900 visits since it opened, she said. MacDonald’s vision for the Aspiring to Serve building includes a gym, classrooms, computer labs, restrooms, a lounge, a cafe and a kitchen on the fifth floor, which has about 7,600 square feet of space. In addition, the seniors could use a social hall and kitchen on the second floor except on weekends, when they are sometimes used by the neighboring Christ Reformed United Church of Christ, MacDonald said. The center would host line-dancing and ballroom-dancing classes, fitness classes, health education and screenings, support groups, crafts and more. It would also be available for club meetings and open as a social gathering spot. All of the spaces would be accessible by elevator, MacDonald said. The building is owned by Aspiring to Serve Inc., a ministry of Christ Reformed United Church of Christ. In addition to REACH and the Commission on Aging offices, it also houses Potomac Case Management Services and the Washington County Health Department’s Women, Infants and Children program. The building is across West Franklin Street from the site planned for the county’s new transit system transfer center. Copyright 2009 Hagerstown Herald-Mail Richmond woman with dementia dies in pond Associated Press Salisbury Daily Times Sunday, March 15, 2009 RICHMOND, Va. (AP) — Richmond police say an 85-year-old Richmond woman with dementia died in a pond near her home. Police say Frances Hodges Jones' body was found Saturday. She'd been reported missing that morning after apparently wandering away from the home she shared with her daughter, son-in-law and grandchildren. Daughter Betty Jones Ellis says Jones was suffering from dementia and was confused about whether she was home after moving in last September. Police say they're still investigating and Jones' body was sent to the state medical examiner to determine how she died. Copyright 2009 The Associated Press. All rights reserved. *National / International* Mysterious Psychosis Diagnosis By Lisa Sanders, M.D. New York Times Sunday, March 15, 2009 1. SYMPTOMS The patient lay on the bed, her eyes wide with fear as she struggled for breath. The nurse at the bedside looked almost as scared. She turned as Dr. Kennedy Cosgrove entered the hospital room and said, “I can’t get a blood pressure, doctor — her pressure is too high for me to measure.” Cosgrove felt his own blood pressure soar. Most patients in this psychiatric ward of Stevens Hospital in Edmonds, Wash., were physically healthy, and Cosgrove, a psychiatrist, hadn’t managed this type of emergency since his internship. He ordered an EKG and quickly phoned the internal-medicine doctor on call. Ten days earlier, the patient was taken to the hospital’s emergency room by the police. According to their report, she phoned her teenage son to say goodbye — she was going to take her life. He and the police found her at home, shouting, incoherent, weeping. When Cosgrove met her later that day, his first thought was that despite her erratic behavior — which wasn’t unusual in this ward — she looked different from his other patients. Her hair was well cut. Her nails were clean and manicured. She looked tired and disheveled, but she didn’t look chronically mentally ill. After introducing himself, Cosgrove asked the patient if she knew why she was there. Tears filled her eyes. She couldn’t take the disappointment of life anymore, she told him. He nodded sympathetically. She shifted restlessly on the bed. “I’ve had seven death attempts on me — by the police!” she shouted, suddenly angry. Her eyes narrowed suspiciously. “Have you heard this?” There was a conspiracy against her — organized by the state of Washington and the Boeing Company. Sometimes she could even hear them talking to her — their voices coming from inside her own brain. She laughed giddily and then became angry again. “Get out! Get out! Get out!” In the nursing station Cosgrove reviewed the information collected on the patient in the emergency room. She was 39. Divorced. Lived alone. She took two medications for high blood pressure, as well as an antidepressant and a stimulant, Concerta, a long-acting form of Ritalin, for a diagnosis of attention-deficit disorder. 2. INVESTIGATION It wasn’t clear how long she had been on any of these medications, but Cosgrove quickly focused on the stimulant. Psychosis and mania were rare but documented side effects of Concerta. Was that the cause of her symptoms or was this simply a manic episode in an underlying bipolar disorder? Cosgrove stopped the stimulant and tried to start the patient on antipsychotic and mood-stabilizing medications. She refused to take them, so he gave the medication by injection. Slowly her behavior began to change. The wild swings of emotion and outbursts of anger became less frequent. But strangely, her disordered thinking and paranoid delusions persisted. Usually these symptoms improved and worsened together. And now she had this significant spike in blood pressure. Were the high blood pressure and the psychosis linked? Dr. Michelle Gordon, the internist on call, hurried to the patient’s bed. She took her blood pressure. It was critically high — 240/110. She quickly transferred the patient to the intensive-care unit. Gordon ran through the short list of possible causes of this kind of rapid elevation of blood pressure in a young woman already on antihypertensive medications. By far the most common was illegal drugs. It seemed unlikely that she would have access to them in a locked ward, but Gordon would check. A narrowing of the arteries that deliver blood to the kidneys could also cause this kind of intermittent hypertension. While this was usually a disease of the elderly, sometimes, for reasons that are not well understood, it could be seen in younger women as well. The third possibility on Gordon’s list was a tumor that was secreting too much of one of the hormones that raise blood pressure. Most of these hormones are made in the adrenal glands — tiny organs that sit on top of the kidneys. One hormone, aldosterone, controls the amount of salt in the body. Too much salt causes blood pressure to rise — sometimes significantly. Or could the patient have a pheochromocytoma — a rare tumor that causes the adrenal gland to produce too much of its namesake hormone — adrenaline. An excess of this fight-or-flight hormone can also send blood pressure soaring. In the I.C.U. Gordon started the patient on an intravenous medication that brought her blood pressure back into the normal range. Then she ordered an ultrasound to assess the blood flow to the kidneys and measure the size of the adrenal glands.These tumors often cause the gland to enlarge.Gordon stood by the patient as the ultrasound technician ran the transducer over the slender woman’s abdomen. He pointed out the blood flowing to the kidneys. It wasn’t completely normal, but the arteries didn’t appear narrow enough to affect the blood pressure. The fuzzy picture on the monitor shifted as the tech tried to get a good view of the kidney. “Will you look at that?” the tech exclaimed. The right kidney he pointed at looked normal, but the adrenal gland on top of it was hugely enlarged. Gordon sent off samples of blood and urine to identify which of the key hormones was the culprit. She suspected this was a pheochromocytoma. Though these are very rare tumors and the patient had not complained of the headache, sweating and rapid heart rate that are their hallmarks, the surges of adrenaline seen in this disease could account for the spikes in blood pressure. When the results came back the following day they showed that Gordon’s hunch was correct — she did have this rare adrenaline-producing tumor. 3. RESOLUTION As soon as Cosgrove heard about his patient’s diagnosis he began to wonder if her psychiatric symptoms could also be caused by the excess adrenaline. He had taken her off Concerta, the stimulant, because he knew that it sometimes causes psychosis and mania. That drug works, in part, by causing an overproduction of adrenaline. If the drug could sometimes cause psychosis and mania, could this adrenaline-producing tumor do the same thing? Cosgrove found several papers describing patients who, like this woman, had pheochromocytomas as well as mania and psychosis. The symptoms resolved once the tumor was removed. It was unusual, but it had been reported. The patient was transferred to a larger hospital for the delicate operation to remove the tumor. When she returned to the psychiatric unit, she was still paranoid, still delusional. But Cosgrove was patient — in the papers he read, recovery took time. Over the next several weeks, the patient’s thinking began to clear. Her paranoia ebbed. The mania disappeared. By the time she was discharged, a month after her operation, her blood pressure was normal, and so was she. Her doctors slowly peeled away the medications for her hypertension and mental illness. And finally, after a year and a half, she was medication free and remains so to this day, three years after her surgery. In speaking with the patient now, it seems clear that symptoms of this tumor started several years before she ended up in that emergency room. But her symptoms were odd and intermittent — a sharp pain in her arms and in her chest, anxiety, transient high blood pressure. The mania and delusions that ultimately led to her hospitalization and diagnosis began after she started taking the medication for attention-deficit disorder the year before. After that, her life became chaotic — her three children could no longer live with her. The double dose of stimulants — from her tumor and the drug — seemed to trigger her psychotic break. The patient says she can barely recognize the person she was before the tumor was removed. After she left the hospital, she sent Cosgrove a note: “Thank you for giving me my life back.” Copyright 2009 The New York Times Company. HIV/AIDS Rate in D.C. Hits 3% Considered a 'Severe' Epidemic, Every Mode of Transmission Is Increasing, City Study Finds By Jose Antonio Vargas and Darryl Fears Washington Post Sunday, March 15, 2009; A01 At least 3 percent of District residents have HIV or AIDS, a total that far surpasses the 1 percent threshold that constitutes a "generalized and severe" epidemic, according to a report scheduled to be released by health officials tomorrow. That translates into 2,984 residents per every 100,000 over the age of 12 -- or 15,120 -- according to the 2008 epidemiology report by the District's HIV/AIDS office. "Our rates are higher than West Africa," said Shannon L. Hader, director of the District's HIV/AIDS Administration, who once led the Federal Centers for Disease Control and Prevention's work in Zimbabwe. "They're on par with Uganda and some parts of Kenya." "We have every mode of transmission" -- men having sex with men, heterosexual and injected drug use -- "going up, all on the rise, and we have to deal with them," Hader said. In addition to the epidemiology report, the city is also releasing a study on heterosexual behavior tomorrow. That report, funded by the CDC, was conducted by the George Washington University School of Health and Health Services. Among its findings: Almost half of those who had connections to the parts of the city with the highest AIDS prevalence and poverty rates said they had overlapping sexual partners within the past 12 months, three in five said they were aware of their own HIV status, and three in 10 said they had used a condom the last time they had sex. Together, the reports offer a sobering assessment in a city that for years has stumbled in combating HIV and AIDS and is just beginning to regain its footing. A more accurate accounting of the crisis offers a chance to contain what is largely a preventable disease. So urgent is the concern that the HIV/AIDS Administration took the relatively rare step of couching the city's infections in a percentage, harkening to 1992, when San Francisco, around the height of its epidemic, announced that 4 percent of its population was HIV positive. But the report also cautions that "we know that the true number of residents currently infected and living with HIV is certainly higher." The District's report found a 22 percent increase in HIV and AIDS cases from the 12,428 reported at the end of 2006, touching every race and sex across population and neighborhoods, with an epidemic level in all but one of the eight wards. Black men, with an infection rate of nearly 7 percent, carry the weight of the disease, according to the report, which also underscores that the District's HIV and AIDS population is aging. Almost 1 in 10 residents between the ages of 40 and 49 has the virus. The report notes that "this growing population will have significant implications on the District's health care system" as residents face chronic medical problems associated with aging and fighting a disease that compromises the immune system. Men having sex with men has remained the disease's leading mode of transmission. Heterosexual transmission and injection drug use closely follow, the report says. Three percent of black women carry the virus, partly a result of the increase in heterosexual transmissions. "This is very, very depressing news, especially considering HIV's profound impact on minority communities," said Anthony Fauci, director of the National Institutes of Health's program on infectious diseases. "And remember: The city's numbers are just based on people who've gotten tested." Ron Simmons, who is black, gay and HIV positive, said he's not shocked by the study's findings. "You have a high incidence of HIV among African Americans, and a lot of African Americans live in the city," said Simmons, who is a member of a black gay support group. "D.C. also has a high number of gay men, and HIV is high among gay black men." Charlene Cotton, a D.C. resident who got an HIV positive diagnosis five years ago, said breaking the taboo on discussing HIV is the key to moving forward. "You need to start at home and talk about it," Cotton said. "It's so hush-hush." Mayor Adrian M. Fenty (D) said he is aware that some advocates have called on elected officials and others to more aggressively and publicly address the crisis. He praised the city's recent efforts, however, and expressed his frustration about the struggle ahead. "In order to solve an issue as complex as HIV and AIDS, you have to step up," he said. "It's the mayor and certainly other elected officials. But it's also the community. You have this problem affecting us, and you tell people how serious it is and it literally goes in one ear and out the other." David Catania (I-At Large), chairman of the D.C. Council's health committee, said that although the District's testing and monitoring have improved in the past two years, the AIDS office is still playing catch-up. The city was in the forefront of the crisis when it created the office in 1986, but it fell far behind. Hader took control in 2007. She is its 12th director and the third in five years. "Frankly, there can be no excuse for the state of the HIV/AIDS Administration that I found in 2005," Catania said. "I cannot speak to why it was not a priority previously. For years prior to 2005, mayors and previous individuals allowed things to exist in an unacceptable way. And I do blame this government for part of the epidemic we're confronting." Until recently, the District's AIDS office lacked a fully staffed surveillance unit to collect, analyze and distribute data. Inevitably, the office lost credibility, and although it has received millions in federal and local funds -- $95 million this year -- some care providers questioned whether resources were being properly allocated. Critics also say congressional control over the District had restricted the AIDS office's ability to combat the virus among drug injection users by banning the use of local tax dollars for a needle exchange program. After almost a decade, the ban was lifted last year. The study is the most precise count to date, according to the authors. The document is an update of a breakthrough 2007 report, which brought into clearer focus a picture of a city in the grip of a complex and "modern epidemic" that had traveled from a mostly gay population to the general one and disproportionately hit blacks. For years, District HIV/AIDS workers depended on estimates that put the rate at 1 of 20 living with HIV and 1 of 50 living with AIDS. The current study notes that its tracking occurred as the city made a switch from a code-based counting system to a name-based one. The surveillance unit interviewed medical providers to find unreported cases, pressed providers who did not consistently report to the administration and searched databases for unreported cases. More than 4 percent of blacks in the city are known to have HIV, along with almost 2 percent of Latinos and 1.4 percent of whites. More than three-quarters -- 76 percent -- of the HIV infected are black, 70 percent are men and 70 percent are age 40 and older. Heterosexual sex was the principal mode of transmission for blacks with the disease, 33 percent. Men having sex with men was the chief mode of transmission for white residents, 78 percent; and Latinos, 49 percent. Black women represent more than a quarter of HIV cases in the District, and most, about 58 percent, were infected through heterosexual sex. About a quarter of black women were infected through drug use. The companion study, "Heterosexual Relationships and HIV in Washington, D.C.," is a detailed look at those whose social networks include individuals at high risk of infection and aims to analyze people's choices and actions before they set foot in a clinic or get HIV. The 750-participant study targeted four areas in wards 1, 2, 5, 6, 7 and 8 with both high rates of AIDS and poverty. Salaries of a majority of participants -- 60 percent -- were under $10,000 yearly; a similar percentage had never been married; and 43 percent were unemployed. The survey's methodology -- interviewing those with connections to high-risk networks rather than those who exhibit high-risk behavior themselves -- highlights a shift in the direction by the CDC, which developed the survey protocol. There is good news in the AIDS office's report: More people are getting HIV diagnoses early, while they are still healthy, as a result of a policy of routine testing implemented by the city in mid-2006. Publicly supported HIV testing expanded by 70 percent. Walter Smith, executive director of the DC Appleseed Center for Law and Justice, praised the study but also lamented that it did not offer more current data on new infections. The report said that detailed information on new HIV cases is not included because the transition from the code-based tracking system to a name-based one takes five years to be mature, according to the CDC. "I'm not criticizing them for that," he said. "But we've had more testing, more needle exchange programs. We don't have, at this moment, any understanding about what impact the new programs have had." Staff writers Jon Cohen and Jennifer Agiesta contributed to this report. Copyright 2009 Washington Post. Health insurance industry works on image makeover Associated Press By Ricardo Alonso-Zaldivar Washington Times Sunday, March 15, 2009 WASHINGTON (AP) - The health insurance industry is working on a transformation that could come right out of "Extreme Makeover." Long cast as villains for denying coverage or refusing to pay for treatment, insurers now are representing themselves as indispensable partners in health care overhaul. In their pitch to lawmakers, the companies say they are in a unique position to help improve quality and root out waste, saving money so everyone can be covered. "They are making inroads," said John Rother, public policy director for AARP. "They are getting past the rhetoric and starting to talk about more concrete ideas for improving quality and getting value." In a big change from three or four years ago, insurers are writing bigger campaign checks to Democrats, now the party of power in Washington. The insurance industry gave $10.7 million to Democratic candidates for federal office in the 2006 elections, according to OpenSecrets.org. Last year, it was $20.7 million. The stakes are high. If the industry's pitch succeeds, insurers will be guaranteed many more customers. The industry wants all people in the United States to be required to carry medical coverage, with government providing financial help for those who cannot afford it. Even if insurers end up making less per customer because of anticipated consumer safeguards, they still could come out ahead. But if the overhaul that President Barack Obama has promised goes against them, insurers could find themselves trying to compete against a new government-run health plan offering cut-rate premiums to middle-class families. That's exactly what many liberal Democrats want, and Obama hasn't taken the option off the table. "No one is naive enough to believe that insurers aren't going to have problems with parts of this," Rother said. "But they are pushing back in a rather quiet way." Said Karen Ignagni, president of America's Health Insurance Plans and the industry's top strategist in Washington: "We understand we need to come to the table with very specific solutions." Ignagni is hedging her bets by building ties to groups such as small businesses, whose conservative outlook and grass- roots clout could be crucial. Yet the industry has won a measure of respect from some longtime adversaries. "I have seen very few groups, including the insurance industry, that are willing to exercise the nuclear option and torpedo reform," said Ron Pollack, executive director of Families USA, a liberal advocacy group. "They have participated in a good faith manner." Others on the left are not convinced. "Private insurance is the problem," said Carmen Balber of Consumer Watchdog, a California-based group. "Individuals can't afford to be forced into buying private insurance." If insurers have come to see government as a partner, that's not as strange as it may seem. Employer coverage has dwindled in recent years, but government programs for older people, children and the poor have grown into a vital business. The Medicare prescription drug benefit is delivered by private insurers. Also, about 10 million older people are signed up in Medicare managed care plans. Many states operate their Medicaid programs through private insurers. The same goes for the federally backed State Children's Health Insurance Program. Government programs "are a significant contributor to growth for us," said Angela Braly, chief executive of Wellpoint, which covers 35 million people in 14 states. "We think we can be a significant part of the solution for the uninsured." Insurance companies can do more than just pay claims, Braly said. They can use the data in their files to monitor whether doctors and hospitals are providing the right level of care _ not too little, not too much. For example, a soon-to-be released study by Wellpoint looks at treatment of back pain, a condition that costs roughly as much as cancer or diabetes to treat. Most back pain clears up in about six weeks, and national guidelines recommend postponing surgery and sophisticated imaging tests. But the study found that 35,000 patients had imaging tests and an additional 1,000 had surgery before the six weeks were up. Potential savings over a 12-month period: $23.6 million. In the future, insurers could use such findings to cajole doctors into changing the way they practice. "We think we can play a central role in delivering value," said Braly. Wellpoint says such studies don't always endorse the low-tech option. Its research also found that a costly medication for multiple sclerosis was worth the investment, because it helped patients avoid relapses. But there's concern that insurers and government could one day use such studies to deny coverage for expensive new treatments and diagnostic tests. It's hard to tell whether the industry's makeover will work. So far, the Obama administration doesn't seem to be sold. While Obama invited Ignagni to the White House health care summit, he's also asking Congress to slash payments to private insurance plans in Medicare. Far from being efficient, Obama says the plans get 14 cents more on the dollar than it costs to care for older people in the traditional program. On the Net: White House health care agenda: http://www.whitehouse.gov/agenda/health_care/ Copyright 2009 Washington Times. Budget woes cut health care for illegal immigrants Associated Press By Juliana Barbassa Washington Post Sunday, March 15, 2009 SACRAMENTO -- Graciela Barrios, an undocumented immigrant, has long relied on her Sacramento County health clinic for the advice, medication and tests that keep her diabetes under control. But next month, Barrios and thousands like her will be on their own as communities cut non-emergency health services to illegal immigrants and more local governments are forced to make similar decisions. Nearby Contra Costa County will vote Tuesday on whether to cut services to the 5,000 illegal immigrants they serve each year. "The general situation there is being faced by nearly every health department across the country, and if not right now, shortly," said Robert M. Pestronk, executive director of the National Association of County and City Health Officials. Data on health care for unauthorized immigrants is hard to come by, because community clinics and hospitals usually do not ask patients for their immigration status. But the Pew Hispanic Center estimates that of the 11.9 million illegal immigrants living in the United States, about 59 percent have no health insurance. That accounts for about 15 percent of the nation's approximately 47 million uninsured. As the financial crisis takes a toll on local health systems and job losses spike the number of uninsured, health care providers are finding it increasingly difficult to meet the needs of those they serve, said Pestronk. More than half of local health departments across the country laid off or lost employees in 2008, according to a survey in January by the health officials association. About one-third predicted layoffs in 2009. In Sacramento County, such cuts at first meant closing three of six clinics. In February, with less money and more patients, county supervisors and health officials had to decide: close one more clinic _ laying off up to 40 staffers to save $2.4 million _ or cut services to the approximately 4,000 illegal immigrants treated annually. "It was very difficult ethically for me," said Keith Andrews, head of primary health services at the county's Department of Health and Human Service. "People I've been caring for for years will be hurt." Contra Costa County officials are doing the same hard math: if they vote to cut services, they will save about $6 million. After letting go of social workers, cutting mental health services and watching a delivery room built to handle 120 births a month accommodate 240, there were few other options, said Contra Costa Health Services Director William Walker. "We've never had this crisis before," said Walker, who submitted the plan being voted on Tuesday. "We've tried to carefully slice what we thought we could without cutting off our ability to respond. Now we're looking at bad choices among bad choices." Counties may legally cut services to illegal immigrants. Although hospitals receiving Medicaid funds must provide emergency care for anyone who needs it, there is no law requiring health care providers to offer primary care. Health officials and immigrant advocates say they do not know how many local health systems provide primary care to undocumented immigrants. Officials note that many hospitals and clinics do not ask a patient's immigration status, in part because treating chronic conditions such as asthma and hypertension keeps patients from emergency room visits that are far less effective and more expensive. The fraying of the safety net provided by local health systems could have serious consequences _ not only for illegal immigrants, who are among the most vulnerable, but for the rest of the population, said Sonal Ambegaokar, health policy attorney at National Immigration Law Center. "Cutting care, you save $100 today, but you may end spending $500 tomorrow when that person shows up in the emergency room because you didn't provide them with basic medication," said Ambegaokar. "It's shortsighted." Asking local health officials to verify immigration status also is problematic, said Julia Harumi Mass, staff attorney with the American Civil Liberties Union of Northern California. "The devil's in the details. Asking county workers to act as immigration officials puts them in a difficult position," she said. For Barrios, the economic crisis has already hit home. The same economic forces that slashed Sacramento County's sales and property tax revenues also took her husband's job in a landscaping firm, and the family's bills are piling up, she said. "I have no insurance, no resources, nothing to fall back on," said Barrios, who has one daughter. "I have no idea what I will do." © 2009 The Associated Press. Bill Proposes Restrictions on Raw Milk Sales By Jan Ellen Spiegel New York Times Sunday, March 15, 2009 CONNECTICUT’S Department of Agriculture had learned to live with raw milk — the unpasteurized, unhomogenized milk that enthusiasts believe is good for you but that health officials have long warned can put humans at risk of disease-carrying bacteria. The state’s raw milk regulations have been among the most liberal in the nation. But officials proposed stricter regulations after an outbreak of E. coli last summer, which the State Department of Public Health investigators traced to a dairy in Simsbury that has since closed. The department confirmed seven illnesses — including two toddlers who ended up on kidney dialysis — and said there were another seven probable cases. “We felt we had to do something,” said Wayne Kasacek, assistant director of the Agriculture Department’s Bureau of Regulation and Inspection. A bill under consideration in the Environment Committee of the General Assembly would restrict raw milk sales to the farm where it is produced and farmers’ markets, which would put the state’s laws on par with most of the nearly 30 states that allow raw milk sales. The bill would eliminate raw milk sales in stores. The bill has sparked a spirited clash over food safety, freedom to choose what you eat, and small business economics. “The Department of Agriculture seems absolutely bent on putting the raw milk farmers out of business,” said Representative Diana Urban, Democrat from Stonington, environment committee member and a lifelong raw milk drinker. “I do understand,” she said referring to the health concerns, “but I believe we have adequate safeguards in place.” Erin Barringer of West Hartford, whose daughter contracted E. coli from a child who drank raw milk, according to health officials, is helping to campaign for the stricter legislation. “It can be frustrating at times because I think everybody’s lost sight of who the victims are,” said Ms. Barringer, whose daughter, Emma, was 2 years and 10 months old when she got sick, even though she herself never drank raw milk. Ms. Barringer believes raw milk poses a public health threat and has solicited support from national organizations like the Center for Science in the Public Interest, which sent a letter backing the legislation. Raw milk is produced in 14 Connecticut dairies and accounts for about one-third of 1 percent of all milk produced here. Currently a dozen or so small stores in the state sell it. Whole Foods in West Hartford stopped carrying it after some of the tainted milk was bought there. The proposed bill would require stronger warning labels advising of dangers to children and the elderly. A provision that would have required farmers to pay for increased pathogen testing was scrapped after a contentious public hearing last month. Health and agriculture officials have tried to persuade lawmakers to ban the sale of raw milk altogether, but those attempts have gone nowhere in the past. “This legislation is going to kill me,” said Lisa Santee, owner of Foxfire Farm in Mansfield Center, who said that she sells all her 100 gallons a week through 10 retail stores and that she had no place to put a store. “If you don’t want to drink it, don’t drink it.” In trying to galvanize supporters for the February public hearing, the dairies started a blog and sought assistance from the Weston A. Price Foundation, a national organization that supports the retail sale of raw milk. The dairies are also in the early stages of forming a nonprofit organization to seek grant money for independent monthly testing and writing a best-practices manual for raw milk production. “This is not a bribe, this is something we feel strongly about,” said Chris Newton, owner of Baldwin Brook Farm in Canterbury, who said plans would proceed even if the legislation is not approved. Mr. Newton and his wife, Mavis, bottle about 125 gallons of raw milk a week, selling about half in stores. They said they could not sell all of it out of their farm. Other dairy owners said selling only on the farm might actually be good for their business because they wouldn’t have to transport the product. “I spend six days a week driving milk around to stores and a heck of a lot of stuff doesn’t get done around here while I’m driving around,” said Chris Hopkins of Stone Wall Dairy in Cornwall Bridge, which sells two-thirds to three-quarters of its milk in stores. Kim Piccioli, of West Hartford, who said her son drank raw milk from the Simsbury dairy, said doctors told her that he may have permanent kidney damage. She said that she had not been aware of the dangers of raw milk and that the milk she bought did not have its required health warning label. “No one’s taking it away,” she said. “We’re just putting some limitations on it.” Copyright 2009 New York Times. Massachusetts Faces Costs of Big Health Care Plan By Kevin Sack New York Times Monday, March 16, 2009 BOSTON — Three years ago, Massachusetts enacted perhaps the boldest state health care experiment in American history, bringing near-universal coverage to the commonwealth with Paul Revere speed. To make it happen, Democratic lawmakers and Gov. Mitt Romney, a Republican, made an expedient choice, deferring until another day any serious effort to control the state’s runaway health costs. The day of reckoning has arrived. Threatened first by rapid early enrollment in its new subsidized insurance program and now by a withering economy, the state’s pioneering overhaul has entered a second, more challenging phase. Thanks to new taxes and fees imposed last year, the health plan’s jittery finances have stabilized for the moment. But government and industry officials agree that the plan will not be sustainable over the next 5 to 10 years if they do not take significant steps to arrest the growth of health spending. With Washington watching, the state’s leaders are again blazing new trails. Both Gov. Deval Patrick, Mr. Romney’s Democratic successor, and a high-level state commission have set out to revamp the way public and private insurers reimburse physicians and hospitals. They want a new payment method that rewards prevention and the effective control of chronic disease, instead of the current system, which pays according to the quantity of care provided. By late spring, the commission is expected to recommend such a system to the legislature. If Massachusetts becomes the first state to make this conversion, health policy experts argue that it would be as audacious an achievement as universal coverage. The state faces several hurdles, including securing federal permission to impose the changes on Medicaid, a shared state and federal program, and more unusually on Medicare, which is financed entirely by Washington. Those who led the 2006 effort said it would not have been feasible to enact universal coverage if the legislation had required heavy cost controls. The very stakeholders who were coaxed into the tent — doctors, hospitals, insurers and consumer groups — would probably have been driven into opposition by efforts to reduce their revenues and constrain their medical practices, they said. Now those stakeholders and the state government have a huge investment to protect. But the task of cost-cutting remains difficult in a state with a long tradition of heavy spending on health care. Massachusetts has more doctors per capita than any state, Boston is home to some of the country’s most expensive academic medical centers, and a new state law requires comprehensive benefits like prescription drug and mental health coverage. Alan Sager, a professor of health policy at Boston University, has calculated that health spending per person in Massachusetts increased faster than the national average in seven of the last eight years. Furthermore, he said, the gap has grown exponentially, with Massachusetts now spending about a third more per person, up from 23 percent in 1980. “Just as this may have been the easiest place to do coverage, it may be the most difficult place to do cost control,” said Jonathan Gruber, a health economist at the Massachusetts Institute of Technology. But Mr. Patrick has shown signs of playing tough with the state’s hospitals and insurers. Responding in January to a series in The Boston Globe that exposed how the state’s most influential hospitals negotiate high reimbursement rates, Mr. Patrick announced that he would explore whether the state could regulate insurance premiums. “Frankly, it’s very hard for the average consumer, or frankly the average governor, to understand how some of these companies can have the margins they do and the annual increases in premiums that they do,” Mr. Patrick said in an interview. “At some level, you’ve just got to say, ‘Look, that’s just not acceptable, and more to the point, it’s not sustainable.’ ” The threat seems to have been heard. Insurers seeking to participate in the state’s subsidized insurance program, Commonwealth Care, recently submitted bids so low that officials announced last week that they would keep premiums flat in the coming year. That may provide cover for the program as the state seeks ways to fill a nearly $4 billion gap in its 2010 budget. The state expects to spend $595 million more on its health insurance programs this year than in 2006, a 42 percent increase. But about 432,000 people have gained coverage, leaving only 2.6 percent of the population without insurance, according to a recent state survey. At only one-sixth the national average, that is by far the lowest rate in any state. Massachusetts achieved its high coverage rates by mandating in its landmark law that almost every resident have health insurance, and that all but the smallest businesses make some contribution toward their employees’ costs. Those who do not enroll but are deemed able to afford insurance can be fined up to $1,068 in the 2009 tax year. To make the mandated insurance affordable, the state subsidizes premiums for those earning up to three times the federal poverty level, or $66,150 for a family of four. Massachusetts already had a law requiring insurers to accept all applicants regardless of their health status. Although nearly 60 percent of the newly insured are covered by public programs, Massachusetts also seems to be a rare state where the percentage of employers offering health benefits is actually growing. And the state government has realized substantial savings, worth about $250 million last year, from lower payments to hospitals for uncompensated care for the uninsured and underinsured. In its first full year of operation, Commonwealth Care drew higher enrollment than anticipated, and the state found itself facing an inaugural budget gap. Mr. Patrick and the legislature filled it by assessing insurers and hospitals, raising the penalty on noncompliant businesses, increasing premiums and co-payments for consumers, and raising the state tobacco tax. The fear was that such tree-shaking would become an annual ritual. But enrollment in the $820 million Commonwealth Care program peaked last May and then declined before hitting a plateau. Some modest provisions to control costs were included in the original health care bill, including a merger of the small group and individual insurance markets and new spending on electronic record-keeping and hospital infection control. More efforts were made last year in legislation that provided incentives for doctors to practice primary care, required uniform billing procedures among providers, toughened the state’s regulation of new hospital construction, and established the payment reform commission. The commission is looking at various options, but all would do away with the fee-for-service system, which provides perverse incentives by paying physicians and hospitals for each patient visit. The changes under consideration include reimbursing for episodes of care rather than individual visits and bundling payments to groups of providers who would together take responsibility for a patient’s health. Blue Cross and Blue Shield of Massachusetts, the state’s largest insurer, recently devised an innovative model that pays doctors a flat fee per patient, with adjustments for age, gender and health status, and then adds bonus payments for high standards of care. Blue Cross officials say they believe that the new plans can cut the growth of premiums in half over five years and expect them to account for 15 percent of their business by June. “We’re very committed to this path because we feel it’s the only credible place to go,” said Cleve L. Killingsworth, the company’s chairman. Some health policy experts argue that changes in payment practices will not be enough to slow the growth in spending, even when combined with other cost-cutting strategies. To truly change course, they say, the state and federal governments may need to place actual limits on health spending, which could lead to rationing of care. “Really controlling costs requires just stopping spending,” said Stuart H. Altman, a professor of health policy at Brandeis University. Because Massachusetts now requires its residents to be insured, it cannot fall back on the strategy used by other states in hard times — to simply remove people from the public insurance rolls by restricting eligibility. “It forces us to look in the mirror and say, ‘What do we do about health care spending?’ ” said Jon M. Kingsdale, executive director of the agency that administers Commonwealth Care. “And the reason that’s so challenging is that it means limiting resources for people doing really good stuff. “It’s not like the fat sits out here easily identified and you just slice it off. It’s marbled throughout the meat.” Copyright 2009 New York Times. President Promises to Bolster Food Safety By Gardiner Harris New York Times Sunday, March 15, 2009 WASHINGTON — Describing the government’s failure to inspect 95 percent of food processing plants as “a hazard to the public health,” President Obama promised Saturday to bolster and reorganize the nation’s fractured food-safety system. “In the end, food safety is something I take seriously, not just as your president, but as a parent,” Mr. Obama said in his weekly radio and Internet address. Mr. Obama announced the creation of a Food Safety Working Group, which will include the secretaries of health and agriculture, to advise him on which laws and regulations need to be changed, to foster coordination across federal agencies, and to ensure that laws are enforced. Along with Mr. Obama’s announcement, Tom Vilsack, the agriculture secretary, announced that “downer cattle,” or those that cannot walk, will be banned from slaughter. In the past, cattle that passed a pre-slaughter inspection and then became injured could be sold into the food system if an inspector certified the meat as safe. This case-by-case exception system will be abandoned. Last year, only about 1,000 out of 34 million slaughtered cattle got into the food supply with such exceptions. A bipartisan chorus of powerful lawmakers in Congress has promised to enact fundamental changes in the nation’s food-protection system. On Saturday, Mr. Obama made clear that he not only supported that legislative effort but that he also might push to expand it. A dozen federal agencies share responsibility for ensuring the safety of the nation’s food supply, an oversight system that critics and government investigators have for years said needed major revisions. A debate has erupted on Capitol Hill in recent months about whether to bolster food oversight at the Food and Drug Administration or assign those responsibilities to a separate agency that would eventually absorb the food-oversight duties of the other 11 agencies, including the Food Safety Inspection Service of the Department of Agriculture. Advocates on both sides of the issue have speculated for weeks about which approach the administration would support. Those calling for a combined food agency were heartened last month when Mr. Vilsack said that a united agency made sense and that the huge recall of products made with tainted peanuts “is a grand opportunity for us to take a step back and rethink our approach.” In his address, Mr. Obama announced, as expected, that he would nominate Dr. Margaret A. Hamburg, a former New York City health commissioner, to be commissioner of the F.D.A. and would appoint Dr. Joshua Sharfstein, the health commissioner in Baltimore, to become the principal deputy commissioner at the F.D.A. As health commissioner in New York City, “Dr. Hamburg brought new life to a demoralized agency,” Mr. Obama said. Thirty-five years ago, the F.D.A. did annual inspections of about half of the nation’s food-processing facilities. Last year, the agency inspected just 7,000 of the nearly 150,000 domestic food facilities, and its oversight of foreign plants, which provide a growing share of the nation’s food supply, was even spottier. Experts have long debated whether the F.D.A. should increase inspections or rely instead on private auditors and more detailed safety rules. By calling the limited number of government inspections an “unacceptable” public health hazard, Mr. Obama came down squarely on the side of increased government inspections. “Whenever a president uses such strong language, that’s a big, meaningful occurrence,” said William Hubbard, a former F.D.A. associate commissioner who has called for increased food inspections. “I think it’s terrific that attention is being focused on this issue.” Each year, about 76 million people in the United States are sickened by contaminated food, hundreds of thousands are hospitalized and about 5,000 die, public health experts estimate. Copyright 2009 New York Times. *Opinion* Pathogens in Our Pork By Nicholas D. Kristof New York Times Commentary Sunday, March 15, 2009 We don’t add antibiotics to baby food and Cocoa Puffs so that children get fewer ear infections. That’s because we understand that the overuse of antibiotics is already creating “superbugs” resistant to medication. Yet we continue to allow agribusiness companies to add antibiotics to animal feed so that piglets stay healthy and don’t get ear infections. Seventy percent of all antibiotics in the United States go to healthy livestock, according to a careful study by the Union of Concerned Scientists — and that’s one reason we’re seeing the rise of pathogens that defy antibiotics. These dangerous pathogens are now even in our food supply. Five out of 90 samples of retail pork in Louisiana tested positive for MRSA — an antibiotic-resistant staph infection — according to a peer-reviewed study published in Applied and Environmental Microbiology last year. And a recent study of retail meats in the Washington, D.C., area found MRSA in one pork sample, out of 300, according to Jianghong Meng, the University of Maryland scholar who conducted the study. Regardless of whether the bacteria came from the pigs or from humans who handled the meat, the results should sound an alarm bell, for MRSA already kills more than 18,000 Americans annually, more than AIDS does. MRSA (pronounced “mersa”) stands for methicillin-resistant Staphylococcus aureus. People often get it from hospitals, but as I wrote in my last column, a new strain called ST398 is emerging and seems to find a reservoir in modern hog farms. Research by Peter Davies of the University of Minnesota suggests that 25 percent to 39 percent of American hogs carry MRSA. Public health experts worry that pigs could pass on the infection by direct contact with their handlers, through their wastes leaking into ground water (one study has already found antibiotic-resistant bacteria entering ground water from hog farms), or through their meat, though there has been no proven case of someone getting it from eating pork. Thorough cooking will kill the bacteria, but people often use the same knife to cut raw meat and then to chop vegetables. Or they plop a pork chop on a plate, cook it and then contaminate it by putting it back on the original plate. Yet the central problem here isn’t pigs, it’s humans. Unlike Europe and even South Korea, the United States still bows to agribusiness interests by permitting the nontherapeutic use of antibiotics in animal feed. That’s unconscionable. The peer-reviewed Medical Clinics of North America concluded last year that antibiotics in livestock feed were “a major component” in the rise in antibiotic resistance. The article said that more antibiotics were fed to animals in North Carolina alone than were administered to the nation’s entire human population. “We don’t give antibiotics to healthy humans,” said Robert Martin, who led a Pew Commission on industrial farming that examined antibiotic use. “So why give them to healthy animals just so we can keep them in crowded and unsanitary conditions?” The answer is simple: politics. Legislation to ban the nontherapeutic use of antibiotics in agriculture has always been blocked by agribusiness interests. Louise Slaughter of New York, who is the sole microbiologist in the House of Representatives, said she planned to reintroduce the legislation this coming week. “We’re losing the ability to treat humans,” she said. “We have misused one of the best scientific products we’ve had.” That’s an almost universal view in the public health world. The Infectious Diseases Society of America has declared antibiotic resistance a “public health crisis” and recounts the story of Rebecca Lohsen, a 17-year-old New Jersey girl who died from MRSA in 2006. She came down with what she thought was a sore throat, endured months in the hospital, and finally died because the microbes were stronger than the drugs. This will be an important test for President Obama and his agriculture secretary, Tom Vilsack. Traditionally, the Agriculture Department has functioned mostly as a protector of agribusiness interests, but Mr. Obama and Mr. Vilsack have both said all the right things about looking after eaters as well as producers. So Mr. Obama and Mr. Vilsack, will you line up to curb the use of antibiotics in raising American livestock? That is evidence of an industrial farming system that is broken: for the sake of faster-growing hogs, we’re empowering microbes that endanger our food supply and threaten our lives. Copyright 2009 New York Times. How to Pay Less for More Health Care New York Times (Letters to the Editor – 5 total) Sunday, March 15, 2009 To the Editor: Re “A Start on Health Care Reform” (editorial, March 8): Yes, the administration has “ducked some of the most contentious issues.” President Obama has said he wants “ideas that work.” But any plan that retains the private, multipayer insurance system that is the source of our out-of-control costs cannot possibly work. And a plan in which people keep the insurance they have will not help the growing number of Americans who find they are underinsured. The Congressional Budget Office has shown that a mandate to purchase insurance will not lead to universal coverage. It has shown, as well, that neither information technology nor chronic disease management nor comparative effectiveness analysis — all of which the administration is counting on — will significantly curb costs. Only a unified public plan, based on our successful experience with Medicare, can truly address the problems of the health care system. Leonard Rodberg Flushing, Queens, March 8, 2009 The writer is research director of the New York metro chapter of Physicians for a National Health Program and a professor of urban studies at Queens College, CUNY. **** To the Editor: As your editorial says, “someone will need to make the hard choices if health care reform and universal coverage are to succeed.” And that will include recognition that today payment by fee-for-service plans is inherently inflationary; that quality of care and cost control are the prime responsibilities of the doctor, not the insurer or payer; that the doctor should be accountable for the desired indices and rewarded for their achievement. We must also accept that the practicable road to universal coverage starts with pilot programs by Medicare. More widely applied approaches would distress so many of the players in health care that getting to yes might become impossible or take so much time that the Obama administration loses credibility as an effective agent in health care reform. Many ideas for reform are out there, some more realistic than others. More important, some are yet to be heard. Mitchell T. Rabkin Boston, March 8, 2009 The writer is a professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and director of the Washington Advisory Group, a consulting company. **** To the Editor: President Obama is right to pursue comprehensive health care reform at the same time that he is dealing with the economic crisis. Health care reform would help recovery and growth by lifting the burden of insurance from employers and shifting it to the public as a common burden and a common bond. I am an officer of a local chapter of a professional society, and I am saddened to see my unemployed counterparts spending so much time networking to find a job with health benefits. I fear that these hard-working people are wasting their time in a game of musical chairs, in which there are fewer and fewer chairs. Instead, if a public health insurance program were available to them, they could immediately get to work creating value by taking on project work and building new careers. Without the fixed cost of health insurance, employers would have more flexibility to use more workers. This is the only way our economy can recover. Joseph S. Harrington Morton Grove, Ill., March 8, 2009 **** To the Editor: What about tort reform? Anyone who practices clinical medicine knows that unnecessary health care expenditure is partly due to “defensive” medicine, which leads to overutilization of medical tests and procedures. William Ankenbrandt Chicago, March 8, 2009 The writer is a neuroradiologist. **** To the Editor: Neither your editorial nor President Obama’s recent statements mention single-payer health care, a k a “Medicare for all.” If we want to have health care that is both universal and affordable, instead of letting people go without coverage or requiring them to buy insurance they can’t afford, a single-payer system is the only answer. If we want to cut costs, we can eliminate the cumbersome bureaucracy of private insurance by turning to a single-payer system. If we want to help businesses like General Motors, single-payer would eliminate the cost of providing coverage for employees and retirees. And unlike the current system, single-payer would let patients choose their own doctors, instead of forcing them to pay extra for “out-of-network providers.” Steven Wishnia New York, March 8, 2009 Copyright 2009 The New York Times Company. Re-Entry: What has changed since 2007? Cumberland Times-News Letter to the Editor Sunday, March 15, 2009 To the Editor: This is about untruths stated by Ann Brown, director of the Veterans Administration Medical Center in Martinsburg, W.Va., towards Re-Entry Associates (“Re-Entry says it can see new veterans, while others getting care at VA clinic,” March 9 Times-News). Forty-seven West Virginia Veterans were notified in 2006 they no longer could go to Re-Entry. Veterans wrote many letters and never received answers to their concerns or needs for over a year. Hardly any received care. They decided to take a stand. Letters were written to Fee Basis, the head of Mental Health Services and the then-acting director of VA Martinsburg. Despite our efforts, all we accomplished was being lied to by everyone except Fee Basis. The VA promised veterans and two West Virginia senators a meeting that was never granted. When Maryland veterans got notice about being pulled from treatment, a cry went out and VA Martinsburg reversed its decision, allowing both West Virginia and Maryland veterans to return. Maryland Senator Benjamin Cardin applauded the VA for making the right decision, but reminded them of what they were about to do. In a press release Nov. 27, 2007, Cardin said, “This summer and fall the VA sent letters to 94 veterans in Maryland advising them their access to counseling at Re-Entry Associates, a private provider, would terminate. Many of these veterans had been participating in this program for decades and such a disruption in longstanding clinical relationships was both counterproductive and dangerous to their mental health.” My question to the VA is, what changed? People at the CBOC in Cumberland and Petersburg, W.Va., are not qualified to work with veterans suffering PTSD. They have master’s degree’s, PhDs and licenses to practice clinical social work, but no credentials or experience in PTSD. This shortcoming is evidenced by the decision to remove these men from quality PTSD care and launch a vindictive campaign of untruths against the credentialed, trained and experienced people in PTSD who have taken great care of thousands of veterans for more than 25 years. What working knowledge or credentials of the mental health field of PTSD does Ann Brown have? She said the vast majority of veterans are being cared for by the VA. Vast majority means almost everybody. That is an outright lie, and neither Brown nor Vision 5 can back it up. She mentioned 61 CBOC Units, but her area only has six. This is another misleading statement. As far as who is credentialed and trained in PTSD, that is revealed in the mishandling and abuse of these veterans, their families, and our region as a whole. Re-Entry treats veterans with dignity and hard-learned skills in PTSD, something the VA should be showcasing, but is too busy tearing down. Fifteen months ago I warned that if we did not demand an explanation of the West Virginia vets being put out, and the same attempt was launched against Maryland vets, these people would come back and do what they now have done. I asked service organizations to help, but nobody seemed to care. As one who has not had a moment’s rest since 2006 in fighting these people, I feel abandoned. Many vets and their families feel the same, as do all of Re-Entry’s fine staff. If you read this and care, contact your state representatives concerning this issue. We have already had three veterans die who were terribly distraught over this. They are gone, along with thousands of returning veterans who have taken their own lives. Stop being ashamed of your vets because of their mental needs and stand up like Americans and demand answers. We are your veterans! Eric.L. Wooddell Paw Paw, W.Va. Copyright © 1999-2008 cnhi, inc. BACK TO TOP


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