Author Archives: Andrew Van Dam

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.

Investigation: Peace Corps health system failing to provide for volunteers

In recent years, there has been a steady drumbeat of troubling news about federal support for Peace Corps volunteers, including a GAO report, federal legislation, and even a statement from the Corps’ acting director. Over at FairWarning, Lilly Fowler has worked with former volunteers to organize this steady stream of negative press into a report that the Peace Corps is not providing adequate health coverage to its volunteers, both past and present.

Fowler’s report dives deep into the bureaucracy surrounding the Corps’ treatment of health care claims, but the heart of the matter is quite simple:

Interviews by FairWarning with more than a dozen former Peace Corps personnel – about half of them members of Health Justice for Peace Corps Volunteers, an advocacy group – highlighted the struggles of harmed volunteers. Many failed to gain government-paid medical care when they returned to the U.S. because they couldn’t find doctors registered with FECA. What’s more, they say, claims for medical insurance reimbursements often bog down or are rejected because of bureaucratic bottlenecks and the lack of information provided to volunteers.

There have been many attempts to reform the system in recent years, Fowler finds, but none have led to comprehensive or lasting change.

Standalone emergency rooms generate profit, controversy

When a local hospital opened up a free-standing emergency room in a part of the county traditionally served by its competitors, The Palm Beach Post‘s Bill DiPaolo took a look at the economic motivations behind this move and similar ones around the country.

Standalone emergency rooms, which offer more options than urgent care facilities but still must transfer patients to full-size hospitals for more serious treatment, started cropping up in rural areas about two decades ago, DiPaolo writes. They are attractive to hospitals because they allow them to expand their coverage area at a fraction of the cost of building a full new facility. There are six in Florida alone, partly because hospitals can build them without acquiring the state “certificate of need” required for the construction of a full hospital.

The hospital that opened the ER in Palm Beach County says it is filling a local need and increasing its competitiveness, but its rivals claim the new facility could bring higher costs — because patients may be taken there instead of to urgent-care facilities — and lower quality — because transit times may increase for patients who arrive at the ER but must then be moved to a full hospital for further treatment.

Hospitals to workers: Get flu shot or get fired

In a story that could be replicated in many areas, The Morning Call‘s Tim Darragh writes that hopitals, both locally and nationally, are pushing hard for workers – both medical and otherwise – to get flu vaccines, as the Joint Commission moves toward stiffer requirements and CMS threatens to cut reimbursement rates for non-compliant hospitals.

Photo by Lance McCord via Flickr

Some of the Lehigh Valley region’s hospitals…. are mandating employees get flu vaccines if they have contact with patients — even if the employees don’t want the shots. If they don’t comply or get a valid exemption, they will be fired.

The list of staff affected by the policy is broad. It includes not only doctors and nurses and others directly involved in patient care but also housekeeping and maintenance workers.

Across the country, the stricter regulations seem to be making a difference, Darragh reports. A health system in Ohio has already issued termination notices to non-vaccinated workers, and even civil rights advocates known for taking the workers’ side admit that it is difficult to argue that hospital workers shouldn’t be vaccinated.

The ever popular (and quotable) Dr. Arthur Kaplan agrees.

Without greater compliance, the work environment won’t attain a level of immunity that will provide sufficient protection to the sick, said Dr. Arthur Caplan, a bioethicist at New York University’s Langone Medical Center. “You don’t get the ‘herd immunity’ until you hit 90 percent,” said Caplan, a proponent of mandatory vaccinations.

Pediatric MS on the rise in the northwest, drawing research attention

As part of a collaboration between KOUW and Investigate West, Carol Smith examined the rise of pediatric multiple sclerosis in the Pacific Northwest, a region that already has one of the highest rates of MS in the world.

Hard numbers are difficult to come by because the diagnosis is so complicated, but Smith writes that “current estimates suggest that between 18,000 and 25,000 children nationally either have MS, or have experienced symptoms suggestive of MS – some as young as age 5.”

Doctors aren’t sure what’s driving the apparent increase. It’s likely partly from improved diagnostic techniques and increasing awareness among pediatricians that MS can occur early in life. But some also think that the growing onslaught of chemical exposures in the environment may be making immune systems more vulnerable to whatever triggers the illness.

And the pivotal role adolescence could have in the shaping of a lifetime’s susceptibility to MS makes studying young MS sufferers a particularly critical task — a task which Smith explores further in a follow-up piece.

Military’s spotty recordkeeping hurts veterans

At the Center for Investigative Reporting, Aaron Glantz dug deep into the widespread recordkeeping errors and lapses that are bedeviling the VA’s disability claims system and making it difficult for veterans of Vietnam, the Gulf wars, and the war in Afghanistan to prove they were in combat, exposed to harmful substances, or even injured. A few days later, ProPublica and The Seattle Times published a similar investigation, which focuses most on more recent conflicts.

According to Glantz, “A Center for Investigative Reporting review of the VA’s performance data reveals chronic errors – committed in up to 1 in 3 cases – and an emphasis on speed over accuracy that clogs the VA system with appeals, increasing delays for all veterans.”

A few more numbers from Glantz’s work:

  • “The VA acknowledges it makes mistakes on 14 percent of disability claims.”
  • “A CIR analysis of 18 audits published this year by the VA’s inspector general shows the problem could be much worse, especially in high-profile cases. The analysis found a 38 percent average error rate for claims involving disabilities like traumatic brain injury and illnesses linked to the Vietnam-era defoliant Agent Orange.”
  • One internal VA document … shows that during the first three months of 2008 … the agency failed to perform its duty to assist in nearly 11,000 cases.

Likewise, the Seattle Times/ProPublica reporters write that military historians found that “at least 15 brigades serving in Iraq at various times from 2003 to 2008 had no records on hand. The same was true for at least five brigades deployed to Afghanistan.”

Records were so scarce for 62 more units that served in Iraq and 10 in Afghanistan that they were written up as “some records, but not enough to write an adequate Army history.” This group included most of the units deployed during the first four years of the Afghanistan war.

As Tenn. lags in youth sports concussion laws, reporter shows delay taking a toll

The Tennesean‘s Nate Rau becomes the leader in the clubhouse for 2012’s “most viscerally disquieting use of a verb” award after opening his youth sports concussions story with “The hit that sloshed 17-year-old Joseph Lascara’s brain.” The entire anecdote, much like the hit it describes, is well-timed and jarring, and Rau then follows through with a thorough investigation of Tennessee’s legislative approach to youth head injuries, or lack thereof.

high school tackle

Photo by via Flickr

The state’s athletic association has adopted limited concussion prevention and treatment regulations, but they do not apply to nonmember schools or independent youth sports organizations. Furthermore, Rau writes that efforts to pass statewide legislation “fizzled” this year, meaning that “Tennessee is now one of only 11 states, mostly in the Southeast, without a law,” even though “doctors who specialize in youth concussion care say the issue is urgent.”

The number of youth concussions treated at hospitals in Tennessee has increased 74 percent from 480 in 2007 to 834 in 2010, according to the state’s Traumatic Brain Injury Program, which functions as a resource for Tennesseans recovering from brain injuries. Those numbers do not include young athletes who were treated by their pediatricians instead of going to the emergency room.

Journalists looking to replicate Rau’s work would do well to note how he used public records requests to access the so-called “Return to Play” forms (required by many state and local concussion-prevention laws) which doctors must file before young athletes may return to the field. While some local counties couldn’t locate the forms, the 140 he did find indicated a somewhat inconsistent implementation.

The review showed that doctors are frequently clearing athletes to return to practice or competition without following the recommended guidelines that gradually ease players back into physical activity. Of the 156 athletes who visited a doctor with concussion-like symptoms, 57 were immediately cleared to return to play.