Tag Archives: associated press

Faced with shortages, paramedics turn to expired drugs

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Reporting on how drug shortages are impacting paramedics, The Associated Press’ Jonathan Cooper discovered things had deteriorated to the point that, he writes, “Paramedics reported asking some of those facing medical emergencies: ‘Is it OK if we use this expired drug?’

Based in Oregon, Cooper found that, in fact, paramedics around the northwest have been forced to dig up supplies of expired drugs to meet critical needs. He writes that, while manufacturers don’t seem to be willing to discuss drug effectiveness beyond declared lifespans, “Medications are only guaranteed to work as intended until their expiration date. When stored properly, most expired drugs won’t be harmful to patients but will become less effective with time, according to medical professionals.”

State public health officials, who license ambulances and in some cases dictate the medications they must carry, are loosening their rules to help emergency responders deal with the various shortages. Oregon health officials last week began allowing ambulances to carry expired drugs, and southern Nevada has extended the expiration dates for drugs in short supply. Arizona has stopped penalizing ambulance crews for running out of mandated medications.

Some agencies have reported keeping their drug kits fully stocked by substituting alternative medications, some of which have additional side effects or higher costs, or by diluting higher dosages to get the less-concentrated dose needed.

Past shortages have included key painkillers and sedatives. Current critical needs include epinephrine and morphine – and you don’t have to be a pharmacist to imagine why a shortage of those might be problematic for front-line medics.

Manufacturing quality lapses, production shutdowns for contamination and other serious problems are behind many of the shortages, according to manufacturers and the FDA. Other reasons include increased demand for some drugs, companies ending production of some drugs with small profit margins, consolidation in the generic drug industry and limited supplies of some ingredients.

AP puts numbers on the prescription drug epidemic

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The Associated Press’ Chris Hawley has worked through the latest numbers on the prescription painkiller boom, helping to illustrate the ongoing toll the opiod abuse epidemic is taking on traditional hotspots like Appalachia and emerging ones like the American Southwest and parts of New York City. Nationally, numbers continue to hit new heights.

Nationwide, pharmacies received and ultimately dispensed the equivalent of 69 tons of pure oxycodone and 42 tons of pure hydrocodone in 2010, the last year for which statistics are available. That’s enough to give 40 5-mg Percocets and 24 5-mg Vicodins to every person in the United States.

Hawley writes the numbers can be distorted by things like clinics for returning servicemembers, whose ranks have greatly increased in the past decade, as well as by mail-order clinics, but they still paint a detailed picture of where the opiods are going. Absent federal regulation, there is currently only a patchwork of state prescription drug tracking systems, many of which are not fully interoperable, but Hawley’s federal numbers help fill in the gaps.

The AP analysis used drug data collected quarterly by the DEA’s Automation of Reports and Consolidated Orders System. The DEA tracks shipments sent from distributors to pharmacies, hospitals, practitioners and teaching institutions and then compiles the data using three-digit ZIP codes. Every ZIP code starting with 100-, for example, is lumped together into one figure.

Medicare providers get reinstated when feds fail to attend hearings

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Using data obtained through a public records request, Associated Press reporter Kelli Kennedy (@kkennedyap) reviewed federal Medicare fraud reports from between 2006 and 2009 and found that “Regulators fighting an estimated $60 billion to $90 billion a year in Medicare fraud frequently suspend Medicare providers, then quickly reinstate them after appeals hearings that government employees don’t even attend.”

Officials revoked the licenses of 3,702 medical equipment companies in the fraud hot spots of South Florida, Los Angeles, Baton Rouge, La., Houston, Brooklyn, N.Y., and Detroit between 2006 and 2009, according to data provided to the AP under a public records request. Those areas represent the highest concentrations of Medicare fraud in the country, according to federal authorities who have set up task forces there.

Of the providers who lost their licenses in those cities, about 37 percent, or 1,371, were eventually back in business, sometimes within days and often within months.

Furthermore, she writes, officials have not taken advantage of security bonds put in place two years ago to provide redress should a fraudulent provider vanish from the map. “Officials blame the delay on personnel changes,” she writes.

The gaps in the system grow out of poor communication between one set of contractors paid to inspect Medicare providers and alert officials to suspicious activity; a separate set of contractors that handles payments; and the agency that runs Medicare.

Kennedy’s report dives deep into the Medicare fraud reinstatement program, and reporters looking to better understand the system would be well served to read the full investigation.

Mason wins NASW award for drug resistance series

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

AHCJ member and Associated Press reporter Margie Mason won the science reporting category of the National Association of Science Writers’ Science in Society awards for “When Drugs Stop Working,” a five-part series on drug resistance she wrote with Martha Mendoza. Charles Duhigg’s “Toxic Waters” series in The New York Times tied for the honor.

When Drugs Stop Working

Outpatient inspections show serious lapses

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

cms2567

AP medical reporter and AHCJ board member Carla K. Johnson used FOIA requests to uncover a wealth of infection-control violations at outpatient clinics in Illinois. The majority of Illinois ambulatory centers have yet to be inspected under the tough new rules, but 76 percent of those which have been inspected also have been cited. The inspections are part of a national push to increase the oversight of ambulatory care centers.

Previously, inspectors from the Illinois Department of Public Health visited the centers about every seven years. But the state last year began more vigorous and frequent inspections of outpatient surgery centers, following directives from national health officials. The state now plans to inspect a third of Illinois centers each year, said Karen Senger, a supervisor in the Health Department’s Division of Health Care Facilities and Programs.

The crackdown resulted from a hepatitis C outbreak in Las Vegas believed to be caused by unsafe injection practices at two now-closed clinics.

Johnson’s state request turned up a laundry list of specific violations, all of which she summarized in one nifty sentence: “The five-second rule appears to be alive and well in Illinois same-day surgery centers, where medical staff were observed picking up items that had fallen to the floor and behaving as if they weren’t contaminated by germs,” Johnson wrote. In an e-mail to Covering Health, Johnson said her story should be easy to localize and explained just how she obtained the inspection reports and why they are now available.

I FOIA’d state inspection reports (CMS-2567s) for ambulatory surgery centers in Illinois that were cited for deficiencies in infection control during the past 12 months. States have been directed by HHS to use a new audit tool to look for infection control problems, following an outbreak linked to two centers in Las Vegas.

Advocates urge clear ingredient lists for cleansers

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Writing for the Associated Press, Jennifer Peltz covers a push by environmental advocates for clearer labeling that lists the ingredients of household cleansers. The article was spurred by a recent attempt by advocacy groups to get a court to use a 1971 New York law to force cleanser manufacturers into disclosing ingredients. Peltz also looks into the industry’s voluntary disclosure efforts (a trade group has linked to companies’ ingredient lists here) and various efforts to require full disclosure nationwide.

cleansers
Photo by rubberglovelover
via Flickr.

For its part, Peltz says industry representatives say “that the legal case is unwarranted, and that fears about health risks are misinformed.” Consumer advocates reply that current voluntary disclosures can be too vague, and that only government regulation will enable the sort of full disclosure necessary to ensure consumer safety.

If advocates win the New York case, cleanser contents would then have to be disclosed to the state. Other regulation efforts are significantly more ambitious.

The case comes amid growing concerns about potential toxins lurking in consumer goods, from the heavy metal cadmium in jewelry to the chemical bisphenol A in baby bottles. While lawyers argued the cleaning-products case in New York, a Senate subcommittee in Washington held a hearing to examine current science on the public’s exposure to toxic chemicals.

Some studies have linked cleaning product components to asthma, antibiotic resistance, hormone changes and other health problems. The industry’s major trade group, the Soap and Detergent Association, assails the research as flawed, says the products are safe if used correctly and notes that cleaning can itself help stop the spread of disease.

Federal environmental laws don’t require most household cleaning products to list their ingredients, though there are congressional proposals to change that. The Consumer Product Safety Commission requires hazard warning labels on some cleansers, and the National Institutes of Health offer some health and safety information for hundreds of cleaning products, drawn from data gathered for industrial use.

Related HHS product database

The National Institutes of Health maintains a database of health and safety information related to household products. It includes detailed information on ingredients and potential safety hazards, among other things.

AP looks at drug resistance worldwide

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The Associated Press has neatly wrapped up its wide-ranging look at drug resistance and the threat it poses to global health into a flash-based multimedia presentation. The presentation consists of stories, infographics, videos and a photo/audio slideshow.

The two videos explain drug-resistant strains of various infectious diseases. The first looks at the wide availability of powerful antibiotics without guidance or prescription, addresses the problem as it has emerged both in the United States and in locales like Mexico and the Philippines. The second, which is about the use of antibiotics in large-scale livestock operations, relies on just one source, Dr. Craig Rowles of Elite Pork Partnership.

The AP uses infographics to establish the spread and scope of the problem, relying heavily on various world maps. I particularly like the timeline that accompanies the malaria graphic (click “statistics” in the upper right, then “malaria”); it shows the span of time from when each malaria-fighting drug was introduced to the date at which a resistant strain emerged.

Finally, they drive the problem home with three strong anecdotes, including a Southeast Asian boy with drug-resistant malaria, a man fighting the drug-resistant tuberculosis that killed his HIV-positive partner, and a woman who lost an infant daughter to MRSA.

Stories in the series:

The package is accompanied by this video.


Doctor’s path shows licensing’s weaknesses

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The Associated Press’ Jay Reeves exposes systemic flaws in state medical licensing through the story of a physician who was twice accused of sexual misconduct and thrice fired in Tennessee, and who subsequently set up shop in Alabama, where he has been charged with rape and possession of child pornography.
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The doctor’s offenses had never been reported to regulators, and he seems to have been able to repeatedly outrun his transgressions. Reeves reports that unfortunate situations like this are not unusual:

Patient safety advocate and consultant Ilene Corina said states too often let troubled doctors move and switch jobs when they get in trouble.

“There is not sufficient oversight in many cases,” said Corina, of Long Island, N.Y., a board member of the National Patient Safety Foundation. “Is it a problem? Absolutely.”

How will health reform affect Medicare?

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The Associated Press’ Carla Johnson looks at how health care reform might affect those currently covered by Medicare, focusing on five key areas: Medicare Advantage, prevention, hospitalization, electronic medical records and prescription drug coverage. Here are the basics:

  • Medicare advantage is popular but relatively expensive. Some private insurers may leave the program if funding is cut, forcing some seniors to change providers. Cuts may also hit extras like hearing aids and health club memberships.
  • Preventative services such as mammograms and diabetes classes will be better covered under most proposals.
  • Some plans may punish hospitals with high readmission rates and encourage all hospitals to work to keep patients from coming back.
  • Any move to electronic medical records and better coordination of care would benefit Medicare patients and providers, as Medicare suffers from many of the same inefficiencies as the system at large.
  • As for the notorious prescription drug coverage “doughtnut hole,” the house democrats have proposed a plan that would fill it in by 2023.

AP finds contaminated water in schools

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The Associated Press has analyzed a decade of Environmental Protection Agency data and found that tests at thousands of American schools had shown the drinking water to be contaminated, with the water at some schools hitting unsafe levels in as many as 20 separate inspections. As part of the investigation, the AP provided an interactive map with which you can search and sort violations in your area. Although some children have become sick and some schools have resorted to bottled water, the AP found that the contaminants are generally not present in levels that would harm adults.

(Hat tip to Poynter’s Al Tompkins)

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