Tag Archives: indiana

Reporter finds causes of infant mortality in Indiana are complex

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

Giles Bruce, who covers health for the Times of Northwest Indiana, did deep reporting into infant mortality in Indiana, work that was recognized in AHCJ’s Awards for Excellence in Health Care Journalism this year. He started with a disturbing number – 623 babies died before their first birthday in Indiana last year.

In a new “How I Did It” essay, he explains more about his series. He looked at factors ranging from air pollution to ignorance about safe sleep practices for infants, and examined some of the potential solutions, including the role of expanded health insurance coverage, often under Medicaid expansion. Continue reading

New report raises concerns about Indiana dental chains

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

A new federal report raises questions about the billing practices of nearly 100 Indiana Medicaid dentists, as well as the quality of care provided by several dental chains that serve poor children in the state.

While the report, produced by the U.S. Department of Health and Human Services’ Office of Inspector General, does not explicitly name specific dentists or clinics, the authors note that two-thirds of the dentists whose billing practices raised concerns worked for four dental chains. Three of the chains have been the focus of state and federal scrutiny, they observed.

Photo: Pia Christensen/AHCJ

Photo: Pia Christensen/AHCJ

“One chain has been under scrutiny in several States for providing unnecessary services,” the authors wrote. “Thirty-one dentists whom we identified with questionable billing worked for this chain,” they added. The remark was footnoted with a reference to a June 2012 report, “The Business Behind Dental Treatment for America’s Poorest Children,” by David Health and Jill Rosenbaum for the Center for Public Integrity and Frontline that focused on the Georgia-based Kool Smiles dental chain. (See ‘Dollars and dentists:’ Investigating the dental care crisis in the U.S. and Complaints to attorneys general yield sources for dental investigation.)

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Ind. parents ‘abandon’ children so they can get mental health care

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.

Reporting for The Times of Northwest Indiana, Marisa Kwiatkowski found that Indiana’s child mental health services are so lacking that, she writes, “some region parents told The Times they were advised to ‘abandon’ their children to obtain mental health services.” Kwiatkowski doesn’t put it quite so bluntly, but the process she describes is something akin to a “strategic default”… only you’re walking away from your own children instead of an underwater mortgage.

There are 30 state agencies that cover children’s issues in the state, which makes for a whole lot of potential cracks for any one case to fall through.

The National Center for State Courts report found a lack of communication among key agencies that causes duplicated efforts, divisiveness and extra costs to taxpayers. It also found that most people are unclear about the purpose of each entity.

The result is a tangled network of agencies that can be difficult to navigate…

Thus the legal “abandonment,” in which parents essentially accept a charge of neglect in exchange for a clear path to treatment for their children. To fully understand the ramifications of the practice, I strongly recommend reading Kwiatkowski’s report. Her analysis is frank, and her anecdotes are chilling.

The story is part of a yearlong Times series called “Children in Peril,” which looks at children whose health or circumstances make them vulnerable, and what state and local agencies are doing — or not doing — to help.

Researchers surprised by concussion study

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.

Writing for Sports Illustrated, David Epstein tells the story of a small-scale Indiana football concussion study in which in which the youth in the control group unexpectedly became the headliners. The researchers were using functional MRIs and the popular ImPACT test, along with helmet-mounted accelerometers, to figure out what sort of hits cause concussions and how the consequences of such hits vary.

helmet

Photo by Les_Stockton via Flickr

Their first discovery? That “no particular magnitude of hit correlated with a concussion.” In fact, the youth they studied were suffering from very few concussions. It wasn’t until they started testing the unconcussed youth, as a sort of control, that they started seeing the results that have come to define their study, the full text of which is available online. Epstein again:

Of those eight [unconcussed youth], four nevertheless showed significant declines in visual memory. In fact, the players with the most impaired visual memory skills were not coming from the concussed group but from a group that in the week preceding the test had taken a large numbers of hits—around 150—mostly in the 40 to 80 G range

If the test scores were accurate, the researchers had inadvertently documented, in real time, a new classification of high school athlete: a player who was never concussed, was not verbally impaired and was asymptomatic even as far as his parents could tell, but whose visual memory was more impaired than his amnesic, headachy, light-sensitive, concussed teammates.

Researchers discovered one other surprise: The players who were asymptomatic but had impaired visual memory had suffered hits to the upper forehead, “which houses the dorsolateral prefrontal cortex – where linemen get hit, play in and play out,” as opposed to the heavy hits to the side of the helmet that most of us associate with concussions.

It’s a very small-scale study – only 21 boys completed the study conducted over one football season – but the researchers are expanding their work this season. Nevertheless, Epstein indulges in some speculation:

Consider this: Concussions as we know them involve a hit that rattles a part of the brain involved in language processing or motor skills. Hits to the forehead that might be every bit as damaging hide their nefarious effects in the frontal lobe, a part of the brain primarily involved in visual memory, planning and cognition, rather than motor or sensory function, and thus not taxed by sideline concussion exams. Indeed, it’s possible that all along, while brain trauma questions have focused on concussions, the real damage is being inflicted by minor impacts that chip away at the brain.

In another piece in Sports Illustrated, Peter King looks at recent violent hits in the National Football League that have attracted attention, the NFL’s attempts to make the game safer and the fans’ and players’ attitudes about the game.

Online guide focuses on covering medical studies

Covering Medical Research

Reporters are inundated with lures to cover the latest medical study or scientific conference paper. And there are some significant milestones being reached in medical research. But, more often, the information reaching the public is way too preliminary or even misleading, say those behind a new AHCJ reporting guide on covering health studies.

The guide will help journalists analyze and write about health and medical research studies. It offers advice on recognizing and reporting the problems, limitations and backstory of a study, as well as publication biases in medical journals and it includes 10 questions you should answer to produce a meaningful and appropriately skeptical report. This guide, supported by the Robert Wood Johnson Foundation, will be a road map to help you do a better job of explaining research results for your audience.

 

Indiana numbers show preventable errors down

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.

The Indianapolis Star‘s Daniel Lee reports that, according to the state’s newly released 2009 numbers, preventable medical errors are down in Indiana. There were 94 reported errors last year, down from 105 each in 2007 and 2008.

Part of the decline can be attributed to the health department’s Indiana Pressure Ulcer Initiative, which appears to have helped bring bed sore occurrences down 33 percent from 2008.

The initiative, which began in June 2008 and runs through September, focuses on improving hospitals’ systems for assessing risk factors for patients developing bed sores. Efforts have included in-person and online prevention training for hospital personnel.

The real story is the Indiana error numbers, which are wonderfully extensive. They’re broken down by condition (28 different serious errors), location and specific facility.

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Ind. TV station uncovers underground ‘dentist’

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.

Bob Segall of WHTR-Indianapolis chronicles the results of an investigation in which the station uncovered a “dentist” who has been operating under the radar in the United States without a license for 14 years. The man in question, who said his name is Alex Galiano, said he received dental training in Honduras before he left that country at age 22 and worked out of his apartment, charging rock-bottom prices and catering to Hispanic immigrants who did not have health coverage.

Segall talked to a patient named Julia who had been hospitalized with a bone infection related to the phony dentist’s handiwork. Julia said the man’s apartment didn’t even have dental chairs or lights: “‘He opened the window to be able to look at my tooth because there weren’t any other lights,’ she said.” Lights weren’t the only thing missing from the office of a man who said he cleaned his instruments with cotton balls:

Julia says during the procedure, the dentist did not wear gloves and did not give her water to rinse blood from her mouth. Bleeding heavily, she was told to spit into a garbage can filled with food scraps. The dentist tried to stop her bleeding by using napkins he got from the apartment’s kitchen.

Julia has filed an official complaint against the rogue dentist, who said he also operates in Kentucky.

An undercover WHTR producer who visited Galiano saw dental instruments and vials of liquid anesthetic. Galiano told the producer that he sterilizes everything using cotton balls and alcohol – a procedure that is not considered adequate by experts. The producer also purchased a prescription antibiotic that is not approved in the United States.