Nearly 70 journalists and communications officials from patient advocacy and industry groups met for a rooftop happy hour event in Washington, D.C., on June 11. Continue reading
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.
Three health-related bills moving through the Washington legislature came about as a result of articles reported by AHCJ members at The Seattle Times and InvestigateWest.
One bill is part of a “proposed overhaul of laws on long-term care of elderly adults” that was prompted by “Seniors for Sale,” a series by Seattle Times reporter and AHCJ member Mike Berens that detailed problems in the state’s adult family homes.
Another bill, unanimously approved by the state senate, will push a state agency to create standards on how to handle chemotherapy drugs. It was prompted by reporting from AHCJ member Carol Smith of InvestigateWest, a nonprofit journalism organization, that revealed that nurses who handle those drugs are exposed to health problems.
A related bill, intended to identify potential links between occupational exposures and cancer outcomes, also was unanimously approved by the senate. It would “require that a cancer patient’s occupation be reported to the registry, and that if the patient is retired, the patient’s primary occupation before retirement be reported,” InvestigateWest reports.
KUOW’s John Ryan, who has been using public records to investigate pay for nonprofit hospital executives, dove deeper into the series when he discovered a law on the state’s books that appears to limit the pay of nonprofit execs to something near that paid to equivalent employees in the public sector. On the face of it, it appears many execs aren’t satisfying this requirement, which may place their hospitals’ tax breaks in jeopardy.
KUOW has learned that 15 hospital executives in Washington made $1 million or more in 2009. That elite group includes 14 nonprofit executives and one head of a government hospital.
For their part, hospital spokespeople pointed out that there may be no equivalent in Washington’s public sector to the work they do, and that some state hospital executives do pretty well for themselves anyway. Those claims haven’t stopped legislators from taking action based on Ryan’s work.
After learning of KUOW’s findings, state senators Cheryl Pflug and Karen Keiser co-sponsored a bill that would require nonprofit hospitals to publish their top executives’ incomes each year. They’d also have to provide proof to tax collectors that the paychecks aren’t out of line with comparable pay in the public sector.
If you’re looking to re-create Ryan’s work in your neck of the woods, he’s written a nifty little “How I did it” that should get you started, although he tells Covering Health that Washington’s law requiring nonprofit executive pay to be comparable to public-sector pay might be unique. But for looking into all kinds of executive compensation stories, AHCJ members should refer to tip sheets such as:
Washington state has solidified its position as a leader in health data transparency with the publication this year of hospital surgery infection rates. The data is broken down hospital-by-hospital and includes numbers for the rates of certain infections following cardiac surgery, orthopedic surgery and hysterectomy, as well as for compliance with infection prevention numbers. For more numbers, including some which have been published for several years now, visit the state hospital association’s transparency center.
The unexpected highlight of this year’s data? A press release, pointed out by blogger and hospital executive Paul Levy, in which the Washington State Hospital Association official proudly announces that “Washington’s hospitals are enthusiastic participants in providing this new information about surgical infection rates.” Credit for this transparency lies with state lawmakers, but the hospitals deserve some props for publicly embracing the effort as well.
After analyzing 4,703 death certificates of folks who died at adult homes during a five-year span, The Seattle Times‘ Michael Berens found “at least 236 deaths that indicate neglect or abuse in these homes but were not reported to the state or investigated.”
In a sidebar, he explains that Times staff searched for cases that indicated neglect or low quality of care, and that the journalists’ careful standards and reliance on death certificates (none of which involved autopsies) means their estimate is likely on the low end.
There are almost 3,000 adult homes in Washington State. In the past decade, they’ve earned the state a national reputation for elder care innovation, but also opened a gaping hole in the regulatory fabric, as Berens has reported previously. On the whole, they’re billed as cheaper and more neighborhood-like than nursing homes. They’re also less regulated and, Berens found, more likely to fatally neglect patients. Here are his numbers:
… adult-home deaths indicating neglect occur at strikingly higher rates than comparable deaths at nursing homes:
- Pressure-sore deaths in adult homes occur at a rate more than 3.5 times higher.
- The rate of deaths from falls is four times higher.
- For choking deaths, the rate is 15 times higher.
Beyond the highlights, Berens’ piece is exhaustively researched, and most definitely required reading for anyone reporting from one of the dozens of states seeking to emulate Washington’s adult home system.
Heather Bosch, of Seattle radio station KIRO, dedicated a five-part series to explaining why “Prescription drugs – used incorrectly – are killing more people in King County than all other illegal drugs, combined.”
It’s the latest in a string of prescription drug localizations; one which distinguishes itself with an emphasis on the move from heroin to prescription pills.
In part one, Bosch explains how prescription opiates overcame their illicit cousin, heroin, to become the drug of choice in the Seattle area. In part three, she talks to a recovering opiate addict about the toll the pills took on his life and psyche. And in part four, Bosch looks into how ready access has made it easier for teens to become addicted to prescription drugs.
In a series of articles, Seattle Times reporter Michael J. Berens looks at Washington’s adult family homes – legally sanctioned facilities in which the state licenses “homeowners to provide spare bedrooms and care for the old or frail who might otherwise have to live in nursing homes.”
These private residences — called adult family homes — were marketed as opportunities for seniors to live in cozy settings and familiar neighborhoods, close to family and friends, with more freedom and superior care.
The owners were given freedom, as well. To encourage this new industry, the state imposed few regulations — no requirements for a minimum level of employees or even, for many years, liability insurance.
Through interviews with more than 250 people, documents obtained through public-records requests and analysis of computer databases and disciplinary actions, Berens found that “thousands of vulnerable adults have been exploited by profiteers or harmed by amateur caregivers” in the state’s 2,843 adult homes.
The Times uncovered accounts of elderly victims who were imprisoned in their rooms, roped into their beds at night, strapped to chairs during the day so they wouldn’t wander off, drugged into submission or left without proper medical treatment for weeks.
In part two of the project, Berens reports on one home that was cited for numerous serious violations but remained in business. Part three will be published on Tuesday.
More information about how the series was reported and a list of other people involved in the project is included in the “About the series” sidebar.
The Times posted a searchable database of the state’s adult family homes.
Carol Smith, formerly of the Seattle Post-Intelligencer, won a 2009 Casey Medals for Meritorious Journalism. The contest, presented by the Journalism Center on Children & Families, recognizes distinguished coverage of children and families, particularly the disadvantaged.
Smith’s story, “ ‘Gravely Disabled’: Broken mental health care system wastes money, chances, lives,” won in the “single story under 200,000 circulation” category.
The Journalism Center says “The writing is original, compelling and clear. The story deftly moves from a wrenching narrative of a mother grieving for her tormented son, to a news peg of a recent shooting spree, to explanatory reporting on overtaxed state resources.”
Earlier this year, Smith won an AHCJ Award for Excellence in Health Journalism for “Dangerous and Mentally Ill.”