Maryland / Regional
Sheppard
Pratt to offer depression event
(Baltimore Sun)
Sharfstein has made his
mark
(Baltimore Sun)
House
votes help for lower-income patients
(Baltimore Sun)
Md. House
OKs pollution, safety measures
(Baltimore Sun)
National /
International
Study:
Cholesterol drug lowers blood clot risk
(Washington Post)
Taxes on booze
and smokes draw anger
(Baltimore Sun)
At
Clinic, Tales and Health Concerns of Hispanics
(New York Times)
Opinion
Gun bill won't
help victims of abuse
(Baltimore Sun)
Seeking a voice on
group homes
(Baltimore Sun)
Maryland / Regional
Sheppard
Pratt to offer depression event
By Scott Calvert
Baltimore Sun
Sunday, March 29, 2009
The public is invited to a free event on depression Monday at
the Sheppard Pratt Health System in Towson. The event is to run
from 3 p.m. to 6 p.m. and will feature three 45-minute
discussions on topics including cultural issues around
depression and new developments in treatment. At 4:15 p.m.,
Douglas M. Duncan, the former Montgomery County executive who
ran for governor, will give a talk, "Don't Run for Governor
While You're Depressed: There IS Life After Depression." The
sessions will be held at the Conference Center at Sheppard
Pratt, 6501 N. Charles St. Advance registration is required.
Information: 410-938-3157 or e-mail
ifisher@sheppardpratt.org
Copyright 2009 Baltimore Sun.
Sharfstein has made his
mark
City health commissioner engaged the broad community in public
issues
By Matthew Hay Brown
Baltimore Sun
Saturday, March 29, 2009
When he took over as Baltimore health commissioner, Dr. Joshua
M. Sharfstein says, he was unsure whether he would last three
days.
Recalling that beginning in a letter to friends and colleagues
this month, he described the public health challenges facing the
city as "awesome" and named a few: young mothers unable to get
needed support before, during and after pregnancy; thousands of
residents who can't access drug treatment; tens of thousands
shut out of preventive health care.
Sharfstein made it three years as health commissioner. Now he
leaves to become principal deputy commissioner of the federal
Food and Drug Administration. While Baltimore didn't unravel
what he described as a "tangled web of problems" during his
tenure, it did achieve some measurable change: a citywide ban on
lead in children's jewelry and the nationwide withdrawal of
over-the-counter cough and cold medicines linked to the deaths
of four city children; declines in drug overdose deaths and
increases in immunizations.
His department enlisted hundreds of local college students to
help the poor get access to health services, worked with
pediatricians to distribute tens of thousands of books to
children, and partnered with police to take on violence as a
public health issue. Governing magazine named him a 2008 Public
Official of the Year; Mayor Sheila Dixon calls him a
"superstar."
Now the city must find a way to replace him. Dixon has named
Olivia Farrow, the city's assistant commissioner for
environmental health, to head the department pending a national
search for a new commissioner.
Dr. Peter L. Beilenson, who preceded Sharfstein as health
commissioner, says the city should look for "passion" in
choosing a successor; Police Commissioner Frederick H. Bealefeld
III wants "a Josh Sharfstein clone."
Ask Sharfstein whom he would want as a successor, or the public
health priorities Baltimore should pursue, and he demurs.
Beilenson didn't burden him with public comments about the job
when leaving, he notes. Sharfstein wants to extend the same
courtesy to the next commissioner.
He is similarly reluctant to discuss his achievements in the
city. To a degree unusual for a public official - and
particularly one so widely lauded - the Harvard-trained
pediatrician deflects the credit to others: To Mayors Martin
O'Malley and Dixon, for what he says was their insight and
support; to Beilenson, for broadening local perceptions of what
public health can encompass; to the officials and academics and
volunteers who make the programs work.
"I think that we have engaged so many different partners in a
wide range of positive efforts, and I can see that they will
continue to pay dividends for the city in the future," says
Sharfstein, 39. "I mean, there are enormous challenges still,
but I do think that things are improving."
Sharfstein had already affected national policy when he arrived
in Baltimore. As a volunteer with the FDA, he wrote and edited
portions of the agency's legal argument to regulate tobacco as
an addictive drug. As a policy adviser to Rep. Henry A. Waxman,
he initiated and helped to write legislation requiring the FDA
to regulate colored contact lenses not as cosmetics but medical
devices.
As health commissioner, Sharfstein led a succession of
high-profile campaigns. In 2006, after the deaths of four city
children under the age of 4 in the previous six years, he led a
group of prominent state pediatricians in warning parents away
from over-the-counter cough and cold medicines and asked the FDA
to take action. "The bottom line is that there is no evidence
that the products are effective, and we know they've harmed
children," he said at the time.
Last year, the FDA issued a public health advisory urging
parents to stop giving the products to children under 2, warning
of serious and potentially life-threatening side effects, and
the agency announced a broad review of related regulations, a
process likely to take years. The makers of the remedies,
meanwhile, agreed to stop marketing them for children under 4.
Children's health has occupied much of Sharfstein's attention.
Also in 2006, the Health Department tested jewelry for children
from six city merchants and found 17 products with unacceptably
high levels of lead content. Young children who mouth or swallow
products containing the heavy metal can suffer brain damage or
death. Declaring that the federal government had failed to
protect children from the hazard, he initiated a citywide ban on
the sale of the products.
Such efforts won the praise of Ruth Ann Norton, executive
director for the Coalition to End Childhood Lead Poisoning.
"Sharfstein really has taken the Health Department to another
level," she says. "He has done a lot of the groundwork that
hadn't been done before. It had been a neglected department in
terms of infrastructure."
Sharfstein's training had suggested a future at the intersection
of public health and health policy. He was a student at Harvard
Medical School when he published his first article in the New
England Journal of Medicine, an analysis of political
contributions made by the American Medical Association he
co-wrote with his father, the psychiatrist Steven S. Sharfstein.
At the time, he was also rallying classmates to reject the free
books offered by pharmaceutical companies.
As a postgraduate, he visited poor neighborhoods in Boston to
produce reports documenting how unsafe housing was threatening
children's health. He also showed that mentally ill youngsters
were languishing in emergency rooms for days because there were
no beds available in psychiatric hospitals, prompting
Massachusetts to act.
In Baltimore, Sharfstein has seen his role in part as
coordinating local resources - hospitals, universities,
nonprofit and advocacy groups, other city agencies - to tackle
public health challenges. Examples include Project Health, which
has sent hundreds of college students into the community to help
connect low-income adults with medical care, housing and
education; and Operation Safe Streets, which has enlisted
ex-offenders in canvassing troubled neighborhoods, mediating
conflicts and mentoring young men at risk of succumbing to
violence.
"One strategy that we've been pursuing is to support community
institutions to really do frontline work in their communities on
public health problems," Sharfstein says. "Oftentimes, it's not
the public health department that needs to do the work. We're
moving in the direction of supporting community institutions,
and that has all sorts of extra positive effects for those
communities."
Sharfstein, who is married with two young sons, plans to
continue living in Baltimore while working at FDA headquarters
in Silver Spring. As he turns to national issues, he says he
will remain available to the city.
"I just have really grown to love the city," he says. "I'm going
to think about this time as a time where I tried to put
everything I had into a really challenging job to move the city
- to move my city - forward."
Baltimore Sun reporter Kelly Brewington contributed to this
article.
Copyright © 2009, The Baltimore Sun.
House votes
help for lower-income patients
Measure restricts debt-collection practices
By Laura Smitherman
Baltimore Sun
Sunday, March 29, 2009
Lower-income patients who lack insurance would be guaranteed
free care at Maryland hospitals, which also would have to follow
consumer-friendly debt-collection policies, under legislation
adopted by the House of Delegates on Saturday.
The bill would require that hospitals develop a financial
assistance policy for uninsured and underinsured patients that
includes free care for those with incomes of less than 150
percent of the federal poverty level, or about $33,000 for a
family of four. It would also prohibit hospitals from charging
interest on overdue bills before creditors obtain a court
judgment.
"It's one thing to end up sick in the hospital; it's another
thing to be given a hospital bill that you can't afford," said
Del. Peter A. Hammen, a Baltimore Democrat and chairman of the
Health and Government Operations Committee. "It's devastating
and affects a large segment of our population."
The legislation comes in response to articles in The Baltimore
Sun on hospital debt-collection practices. Gov. Martin O'Malley
called for the Health Services Cost Review Commission to
investigate, and his administration worked with lawmakers to
craft a bill replacing voluntary guidelines from the Maryland
Hospital Association with a minimum standard of eligibility for
charity care.
The House passed the bill unanimously. A companion Senate
measure awaits action.
The hospital association supports the initiative. The bill
largely standardizes the association's recommended best
practices, including the 150 percent income standard that has
been suggested since 2005, said Nancy Fiedler, a spokeswoman.
"The vast majority of hospitals have been following these
guidelines," Fiedler said. "Hospitals are committed to helping
people qualify for whatever assistance they can qualify for, and
to doing the best they can by them in terms of billing
practices."
The Sun's investigative series found that Maryland, unlike some
other states, lacks uniform standards and practices regarding
free or reduced-price care. Some patients ended up facing court
judgments or getting liens placed on their homes even though
they had little means to pay their bills.
Maryland has a unique system under which hospitals received
nearly $1 billion last year to cover the costs of charity care
and unpaid bills; the funding comes from higher rates that all
patients pay. The concern is that hospitals were reimbursed
while patients who qualified for assistance weren't getting the
benefit.
Hospitals are currently required to conspicuously post notices
about the availability of financial assistance. But they need
not necessarily inform patients directly or provide charity care
applications. Under the bill, hospitals must develop
informational sheets on financial assistance, which must be
given to patients and referenced on the hospital bill.
Hospitals also would be required to employ trained staff to help
patients understand billing issues and how to apply for Medicaid
and other programs that may help them pay charges. Lawmakers
took out a provision that would have prohibited hospitals from
placing liens on primary residences for unpaid debt, as some
worried about high-income individuals avoiding that penalty.
Copyright 2009 Baltimore Sun.
Md. House OKs
pollution, safety measures
Preliminary steps taken on Chesapeake phosphorus, baby bottles
By Gadi Dechter
Baltimore Sun
Sunday, March 29, 2009
The Maryland House of Delegates gave preliminary approval
Saturday to measures aimed at removing phosphorus from the
Chesapeake Bay, mercury from old cars and toxins from baby
bottles.
Over nearly four hours of debate on scores of bills, lawmakers
also gave final approval to a measure requiring police agencies
to improve record-keeping on SWAT teams in light of a Berwyn
Heights police raid last summer in which the town mayor's dogs
were killed. A similar bill has already passed the state Senate.
The weekend session was necessary because legislative rules
dictate that bills must clear at least one General Assembly
chamber by Monday in order to be guaranteed a hearing in the
other before the 90-day session ends next month.
While the SWAT bill passed overwhelmingly and without
discussion, contentious measures on early voting and suburban
sprawl prevention faced Republican objections and extended
debate.
Del. Christopher B. Shank, the minority whip from Washington
County, urged lawmakers to reject a bill setting procedures for
voting before Election Day because the measure would tap a fund
specified for campaign financing. "The fatal flaw in this bill
is the funding source," said Shank.
The bill - which was authorized by a strong majority of voters
in a constitutional amendment last year - was approved by a
100-to-36 vote.
Lawmakers also gave preliminary approval to a bill that would
give the state more authority to curb development in suburban
areas. Under the proposed law, counties must show "incremental
progress" on encouraging new residential development primarily
in "priority" areas or face denials of development permits by
the state.
Delegates rejected an amendment by Del. Wendell R. Beitzel, a
Western Maryland Republican, to remove economically distressed
counties from the proposed law's purview. The bill still
requires final approval from the House and Senate.
The House gave preliminary approval to a bill prohibiting the
sale of baby bottles and cups made with bisphenol A, a component
of some plastics linked to a range of health problems when
exposed to infants.
A more expansive measure failed to pass the Senate in 2008, but
the bill's sponsor, Del. James W. Hubbard, said he was
optimistic that his more narrowly drawn measure will reach Gov.
Martin O'Malley's desk this year.
Meanwhile, the effort to ban trans fat in restaurant cooking
statewide appears dead again this year. Hubbard, a Prince
George's County Democrat, introduced the bill following similar
bans in localities such as Baltimore City, but it failed to get
out of committee.
Baltimore Sun reporter Laura Smitherman contributed to this
article.
Copyright 2009 Baltimore Sun.
National / International
Study:
Cholesterol drug lowers blood clot risk
By Marilynn Marchione
Washington Post
Sunday, March 29, 2009
ORLANDO, Fla. -- Statin drugs, taken by millions of Americans to
lower cholesterol and prevent heart disease, also can cut the
risk of developing dangerous blood clots that can lodge in the
legs or lungs, a major study suggests.
The results provide a new reason for many people with normal
cholesterol to consider taking these medicines, sold as Crestor,
Lipitor, Zocor and in generic form, doctors say.
In the study, Crestor cut nearly in half the risk of blood clots
in people with low cholesterol but high scores on a test for
inflammation, which plays a role in many diseases. This same big
study last fall showed that Crestor dramatically lowered rates
of heart attacks, death and stroke in these people, who are not
usually given statins now.
"It might make some people who are on the fence decide to go on
statins," although blood-clot prevention is not the drugs' main
purpose, said Dr. Mark Hlatky, a Stanford University
cardiologist who had no role in the study.
Results were reported Sunday at the American College of
Cardiology conference and published online by the New England
Journal of Medicine.
The study was led by statistician Robert Glynn and Dr. Paul
Ridker of Harvard-affiliated Brigham and Women's Hospital in
Boston. Ridker is a co-inventor on a patent of the test for
high-sensitivity C-reactive protein, or CRP. It is a measure of
inflammation, which can mean clogged arteries or less serious
problems, such as an infection or injury.
It costs about $80 to have the blood test done. The government
does not recommend it be given routinely, but federal officials
are reconsidering that.
For the study, researchers in the U.S. and two dozen other
countries randomly assigned 17,802 people with high CRP and low
levels of LDL, or bad cholesterol (below 130), to take dummy
pills or Crestor, a statin made by British-based AstraZeneca
PLC.
With an average of two years of follow-up, 34 of those on
Crestor and 60 of the others developed venous thromboembolism _
a blood clot in the leg that can travel to the lungs. Several
hundred thousand Americans develop such clots each year, leading
to about 100,000 deaths.
However, this is uncommon compared to the larger number who
suffer heart attacks. Many doctors have been uncomfortable with
expanding statin use to people with normal cholesterol because
so many would have to be treated to prevent a single additional
case.
"I don't know that it changes the big picture very much" to say
that a statin can prevent blood clots, Hlatky said. "Where do
you draw the line? Are we giving it to 10-year-old kids that are
fat?"
AstraZeneca paid for the study, and Ridker and other authors
have consulted for the company and other statin makers. Many
doctors believe that other statins would give similar benefits,
though Crestor is the strongest such drug. It also has the
highest rate of a rare but serious muscle problem, and the
consumer group Public Citizen has campaigned against it, saying
there are safer alternatives.
Crestor costs $3.45 a day versus less than a dollar for generic
drugs. Its sales have been rising even though two statins _
Zocor and Pravachol _ are now available in generic form.
Researchers do not know whether the benefits seen in the study
were due to reducing CRP or cholesterol, since Crestor did both.
Another new analysis reported Sunday and published in the
British journal the Lancet found that the patients who did the
best in the study were those who saw both numbers drop.
Many doctors remain reluctant to expand CRP testing or use of
statins. A survey by the New England journal found them evenly
divided on the questions. Others questioned why so few people in
the study were getting other treatments to prevent heart
problems.
"If more of them were on aspirin, you would have less benefit
from the statin," said Dr. Thomas Pearson of the University of
Rochester School of Medicine and Dentistry.
Dr. James Stein of the University of Wisconsin-Madison said that
doctors examining treatment guidelines should pay close
attention to the new results.
He said the CRP test had helped him convince patients that they
need to be on a statin drug.
"There are very few times you can say to a patient, 'this
medicine is going to keep you alive.' We should try not to pick
apart studies that save lives," Stein said.
On the Net:
Heart meeting:http://www.acc.org
Medical journal:http://www.nejm.org
© 2009 The Associated Press.
Taxes on booze
and smokes draw anger
Associated Press
Baltimore Sun
Sunday, March 29, 2009
LAWRENCEBURG, Ky. - Faced with huge budget holes, states from
Connecticut to Arkansas are eyeing higher taxes on cigarettes
and booze, infuriating consumers who say the goods are the last
vices they've got to help cope with lost jobs, a deepening
recession and overall economic misery.
In Pittsburgh, protesters dumped beer and liquor into a river
after county officials approved a 10 percent tax on poured
drinks. Patrons in Oregon bars downed brews while writing
lawmakers to oppose a proposed beer tax increase.
And in Kentucky, protesters poured bourbon on the Capitol's
front steps to demonstrate their opposition to a 6 percent sales
tax on all booze. "The way things are going right now with the
economy, the first thing people want to do is go get a bottle or
a beer, and soak their sorrows," said Jack Weaver of Louisville,
who gathered with other Teamsters in a union hall last month to
rail against lawmakers who voted to raise the taxes as of April
1.
Sin tax increases to help balance budgets are nothing new, but
the economic meltdown has legislators proposing them even in
states such as Kentucky, where alcohol and cigarettes have long
been sacred cows. Tt is famous for its bourbon whiskey and is a
leading producer of tobacco used in cigarettes.
"Sin taxes have quickly emerged - as they did in the last
recession - as one of the popular tactics that states have
adopted to bring in the extra revenue in an environment where
raising most other taxes are still pretty politically
radioactive," said Sujit Canagaretna, a senior fiscal analyst
for the Council of State Governments.
Faced with an unprecedented $456 million revenue shortfall,
Kentucky ignored protests and raised the taxes.
Arkansas increased its cigarette tax this month, and other
states considering it include Connecticut, Florida, Michigan,
Mississippi, North Carolina and Oregon. Other states - including
California, New York and Hawaii - are also considering raising
taxes on alcohol products.
The federal government has already increased the cigarette tax
by 62 cents a pack to $1.01, and Kentucky doubled its state tax
to 60 cents a pack. Together, the taxes will push average prices
for name-brand cigarettes to as much as $44 a carton, a $10
increase.
"It's a little extreme," said Scott Harper, 63, a former
helicopter mechanic now living on Social Security and Veteran's
Administration benefits. "I'm going to quit. I'll have to."
Though some smokers and drinkers are angry, public health groups
see it as an opportunity to convince people to give up their bad
habits.
"This was an extremely popular public health initiative," said
Tonya Chang, advocacy director for the American Heart
Association in Kentucky. "When combined with the federal tax
increase, we believe this will prevent more than 50,000 Kentucky
children from becoming smokers and will help thousands of
Kentucky adults who want to quit."
Copyright 2009 Baltimore Sun.
At
Clinic, Tales and Health Concerns of Hispanics
By Denise Grady
New York Times
Sunday, March 29, 2009
MINNEAPOLIS — As in many public hospitals across the country,
the largest number of foreign-born patients at Hennepin County
Medical Center are Hispanic immigrants. They are in the
emergency room, the maternity ward, neighborhood clinics and in
a part-time clinic in the main hospital set aside for
Spanish-language patients.
The clinic, open three half-days a week, is so busy that it is
hard to get an appointment. Dr. Carmen Divertie, an internist
from Peru, founded it 15 years ago, modeling it after a clinic
for Russians at the hospital.
Many of Dr. Divertie’s patients are recent immigrants from
Mexico or Ecuador, and she assumes that virtually all are
illegal, though she does not ask. The hospital has a policy of
not considering immigration status in offering care, but the
money spent on illegal immigrants accounts for a sizable part of
the hospital’s unreimbursed tab of $45 million a year — a sore
point for people upset about illegal immigration, even in this
city with a long history of reaching out to immigrants.
Dr. Michael Belzer, the medical director at Hennepin, said
wryly, “We’ve cornered the market on the uninsured.”
The hospital’s Spanish, Somali and Russian clinics all lose
money because many insurers will not cover the cost of
interpreters and because appointments take longer with
everything being said twice, said Dr. Craig Garrett, who started
the Russian clinic and oversees all three.
Even with Hennepin’s open-door policy, hospital officials say,
getting health care is increasingly difficult for many illegal
immigrants. Previously allowed to use Medicaid, people here
illegally are no longer eligible, except for children, pregnant
women or those with emergency cases. Some illegal immigrants are
too afraid to approach a public hospital like Hennepin, fearful
that any official interaction might tip off immigration agents.
The chatter in the hallways and waiting rooms indicates that
Minneapolis — a full 1,150 miles from the Mexican border — is
less a destination of convenience than necessity for illegal
immigrants. Some went first to California, Chicago or New York,
and then came here to get their children away from gangs or find
affordable housing, jobs, good schools and health care.
“Some have already lost a child,” Dr. Divertie said of the gang
violence in other cities.
One woman who arrived at the clinic last summer for a checkup
said she had recently paid a coyote, or human smuggler, $3,000
to cross the heavily guarded border into Arizona. The crossing
took just two hours.
“She must have had a good coyote,” Dr. Divertie said.
The patient, a widow in her 50s with five grown children, said
the trip required running and jumping. A companion fell and
broke her leg, and did not complete the trip. Dr. Divertie said
some of her patients trained for crossing the border as they
would for an athletic event.
Dr. Veronica Svetaz, an Argentine physician at a Hennepin
neighborhood clinic, treated a 13-year-old girl who had been
raped and made pregnant by a coyote. The girl was so ashamed
that she did not tell her mother what had happened until she
realized she was pregnant. The family wanted to end the
pregnancy, but by the time the decision was made, a late-term
abortion was needed, requiring a trip to Chicago. The family
could not afford it. The girl had the baby, and kept it.
“It’s overwhelming,” Dr. Svetaz said.
Teenage pregnancy is a huge problem, she said, and sometimes it
seems as if more girls, and younger ones, are showing up
pregnant every day. Some were abused, some slipped up on birth
control, and some decided that 15 was a good age to have a baby.
But what saves Dr. Svetaz from despair is what she described as
her relentless drive to push and inspire them to go back to
school and to avoid a second teenage pregnancy.
Dr. Svetaz takes care of entire Latino families, and in adults
and teenagers she sees a great deal of back pain, injuries,
diabetes, high blood pressure, depression, anxiety and stress.
“Mental health is huge,” she said. “The levels of anxiety and
depression are amazing.”
But her patients worry about being labeled crazy if they admit
to emotional problems.
“Latinos tend to somatize more,” she said, meaning that their
psychological troubles are expressed as things like back and
neck pain.
“This is where cultural competence comes in,” she said. “I’ve
seen an 18- or 19-year-old with chest pain and a headache, who
had a panic attack, but was worked up in the emergency room for
heart attack and given a head CT or M.R.I.”
Hennepin has a discount program with sliding-scale fees for the
indigent. But even the discounted fees are more than some can
afford, Dr. Divertie said, so many delay care until the need
becomes urgent. Hoping bronchitis will go away, they wind up
with pneumonia. Patients with heart failure wait until they
cannot breathe. For lack of Pap tests, women develop advanced
cervical cancer, a deadly disease that can be prevented. Breast
cancers also tend to be found late, when the odds of survival
are lower.
People with diabetes show up at Hennepin’s clinics with blood
sugar so high that they are sent straight to the hospital. Some
have severe diabetic complications, even gangrene. And it is
hard to convince Mexicans to take insulin, no matter how badly
they need it, Dr. Divertie said. Many have seen diabetic
relatives die while using insulin, and they blame the medicine
rather than the disease.
“Most of my patients are illiterate, the majority, and they’re
ashamed of it,” Dr. Divertie said. “They don’t tell you.”
Many of Dr. Divertie’s patients take antidepressants. Often,
they live in overcrowded housing to lower their rent and work
more than one job to send money back to their home country. Some
long for children left behind and worry that they are being
abused by relatives who are supposed to be looking after them.
“They come in crying,” she said.
On top of the emotional troubles are cultural beliefs and habits
that can make immigrants difficult to treat.
“Lots of my patients come in and they’ve already been taking
antibiotics that didn’t work, and that’s why they come to me,”
Dr. Divertie said.
Taking the wrong antibiotic or the wrong amount can cause
problems. But immigrants are used to dosing themselves because
antibiotics are widely available in Mexico without a
prescription, and some Hispanic stores in Minneapolis sell them
that way, too — $1 apiece for loose capsules — even though it is
illegal.
On a Friday afternoon in September at a separate neighborhood
clinic, the Family Medical Center, run by Hennepin in a Hispanic
neighborhood in South Minneapolis, doctors treated Jesús R., a
57-year-old illegal immigrant from Mexico who did not want his
full name to be used.
Mr. R., who has diabetes, said through an interpreter that he
had run out of insulin and other medicines months before, but
had not come in sooner because his discount card for the clinic
had expired and he did not think the doctors would treat him
(the clinic director said they would have). For a while he had
been trying to make his insulin last longer by injecting smaller
doses. He had not seen a doctor in 10 months.
Though he looked a bit older than 57, Mr. R., wearing denim
shorts, sandals and a T-shirt, looked healthy and fit, only a
little overweight.
But his blood sugar was 680 (normal is 140 or lower). A level
that high essentially turns the blood into syrup, causes severe
dehydration and can knock a person unconscious. Over time it can
cause organ damage.
Dr. Ronald Yee, the third-year resident taking care of Mr. R.,
explained to him and his wife that he would be given intravenous
fluid and insulin right away at the clinic and would then be
taken to the emergency room at the main hospital for further
treatment.
Mr. R’s wife began to weep.
Doctors and nurses at the clinic said they saw so many patients
with readings like Mr. R’s that stabilizing them and sending
them off to the hospital had become a routine drill.
Dr. Jerry Potts, the director of the neighborhood clinic, said,
“This will cost thousands of dollars that could have been saved
if he had walked in the door a few months ago.”
Mr. R. spent about three hours in the emergency room that Friday
night, and returned to the clinic with his wife the following
Thursday to meet with a dietitian to learn how to help keep his
blood sugar under control.
Working through an interpreter, they spent nearly an hour with
rubbery models of tortillas, rice, beans, slices of bread,
tomatoes and chicken legs.
Mr. R. confessed to “abuse of Coca Cola” and excessive milk
drinking, but expressed great relief that he could still eat
plates full of cucumbers sprinkled with lemon and hot sauce. One
thing that really disappointed him, though, was that he would
have to limit watermelon.
“Yes,” the dietitian said, “I remember you said that when we did
this last year.”
Copyright 2009 The New York Times Company.
Opinion
Gun bill won't
help victims of abuse
Baltimore Sun Letter to the Editor
Saturday, March 29, 2009
The rationale of legislation in the General Assembly to
confiscate guns in domestic violence situations may be obvious,
but the fundamentals it is based upon are seriously flawed
("House OKs taking gun with protective orders," March 18). It
presumes that an abuser under a final restraining order will
surrender all guns and not hide any, will not go ahead and use
the gun before it is taken, or will not obtain one via illegal
means. It also assumes that a murder will not be committed by
other means.
When abusers are determined to take the life of a former
partner, this bill will be no more effective at stopping a
potential murder than waving the protective order in front of
their faces before they pull the trigger. Violent criminals
understand only one thing: brute force. When innocents are
attacked, the only thing that will save them is the threat or
use of lethal force.
James Mullen
White Hall
Copyright 2009 Baltimore Sun.
Seeking a voice on
group homes
Baltimore Sun Letter to the Editor
Saturday, March 29, 2009
It is disappointing to see continued misrepresentation of
neighborhoods' opposition to the group home legislation before
the City Council ("Treatment centers part of the solution,"
letters, March 22). We are not anti drug rehabilitation or group
home operations; we are pro communities having a voice in the
establishment of these facilities, many of which are run as
for-profit businesses, in our neighborhoods.
We can all agree that there is a need for group homes; however,
this flawed legislation would create more problems than it would
solve. There is a mistaken belief that if a group home or drug
rehabilitation facility is licensed, there is adequate oversight
to protect the residents of the facility and the community. The
city and state do not have central points of contact when
neighbors have issues with group homes and in fact continually
fail to inspect facilities regularly, leaving communities and
residents open to exploitation and abuse.
The lack of protection offered to group home residents and the
wider community is the issue that must be addressed before we
give the operators carte blanch to open these facilities at
will.
Kenneth W. Lockie
Baltimore
The writer is president of the Lauraville Improvement
Association.
Copyright 2009 Baltimore Sun
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