Tag Archives: los angeles times

War injuries advance treatment of brain injuries

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.

In a three-part package published this month, the Los Angeles Times‘ Melissa Healy explains recent advances in the diagnosis and treatment of traumatic brain injury, with special focus on the United States armed forces.

  • Treating traumatic brain injuries: Anecdotes from an Army National Guard medic and an equipment officer show how much lives can be changed by traumatic brain injury, an ailment that doesn’t even show up on CT scans or MRIs, and how a simple accurate diagnosis can provide patients with hope and understanding.
  • War injury leads to advances at home: Healy writes that while combat veterans with traumatic brain injury are receiving the lion’s share of the attention, they’re just the tip of the iceberg. The “silent epidemic” has hit about 2 percent of the civilian population as well, which totals up to about 11 million since the wars in Iraq and Afghanistan began.
  • Treating brain injuries on the sports field and battlefield: Finally, after tackling diagnosis and prevalence, Healy moves on to treatment. She walks through every step, from prevention to diagnosis to treatment, examining the latest in medical science along the way. It’s the longest piece in the package, and the best to start with if you’re looking for a better technical understanding of traumatic brain injury.

Health journo goes it alone without insurance

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.

Freelance health writer and AHCJ founding member Duncan Moore has gained national attention recently for his Los Angeles Times piece explaining his decision to go without health insurance at age 53. Moore quit his job and used a COBRA policy to tide him over until he found a new job. Then the economy tanked, newspapers retrenched, that new job never materialized, his 18 months of COBRA ran out and Moore was forced to ask some tough questions. The answer he found to his first question, “what insurance actually buys,” led him to rethink the entire system about which he’d been reporting for years.

After a quick self-assessment, Moore found he had a clean family history, good habits and almost no pre-existing conditions. That started him thinking.

So what does a guy like me need with health insurance? I’m the best risk in town, I thought to myself. Why shouldn’t I self-insure? In other words, why couldn’t I accept full responsibility for my own health expenses?

Moore writes that he’s ready to accept a certain amount of self-rationing when it comes to everyday care, and that, even if something catastrophic happens, he’ll likely be no worse off than he’d have been if he was insured, because “there are no guarantees that the insurance company would pay, that it wouldn’t try to weasel out of the obligation.”

Moore also made an appearance on Dr. Nancy Snyderman’s show on MSNBC on Tuesday to discuss his decision.

Calif. nurse rehab program full of holes

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.

ProPublica’s Tracy Weber and Charles Ornstein follow up their investigation of California’s nursing oversight with a story about the failures of the state’s nurse rehab program (Los Angeles Times version; ProPublica version). The embattled California Board of Registered Nursing has touted the program as a safe haven where otherwise good nurses can free themselves of bad habits, but Weber and Ornstein have discovered that nurses often don’t complete the program, and sometimes continue bad behavior unabated despite the voluntary, confidential program’s required drug tests and treatment.

The team has reinforced its data-driven story with well-chosen anecdotes and observations. Program proponents argue that Weber and Ornstein are focusing on a few failures and ignoring the more numerous success stories, but the reporters show that the failures are due, at least in part, to flaws in the program. Even nurses designated as a “public risk” often aren’t investigated until more than year after earning that dubious distinction.

The reporters’ sum up the problem thus: “At the moment, the main person responsible for protecting the public from a drug-addicted nurse in California is the drug-addicted nurse. It’s a risky honor system.”

Schwarzenegger replaces nursing board members following ProPublica, LA Times investigation

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.

Late Monday, Calif. Gov. Arnold Schwarzenegger replaced nearly everyone on the state’s Board of Registered Nursing, “citing the unacceptable length of time it takes to discipline nurses accused of egregious misconduct.” The move came a day after a ProPublica and Los Angeles Times investigation into the board’s activity was published.

He fired three of six sitting board members — including President Susanne Phillips — in one-paragraph letters curtly thanking them for their service. Another member resigned Sunday. Late Monday, his administration released a list of replacements.

Charles Ornstein and Tracy Weber of ProPublica and Maloy Moore of the Los Angeles Times joined forces to review every case between 2002 and 2008 in which a nurse faced disciplinary action — more than 2000 of them — and found that, on average, California’s Board of Registered Nursing took more than three years to take action on such cases. Many took far longer and have not yet been acted upon at all. In other large states, the reporters write, such cases are usually dealt with in less than a year.

The reporting team adds depth to their investigative work with a compelling series of anecdotes, told from the perspective of patients, administrators and even the wayward nurses themselves. They also dissect the system, finding few safeguards other than the tardy board review process, and work to discover all the factors contributing to the delays.

In reaction to the story, leaders of the California Board of Registered Nurses sent a note of encouragement to its staff on Monday that points to some recent accomplishments.

Over at Off the Charts, the American Journal of Nursing blog, AJN editor-in-chief emeritus Diana J. Mason, R.N., Ph.D., weighs in on the investigation and an earlier study of recidivism among disciplined nurses. Mason suggests that the National Council of State Boards for Nursing could “work with the state boards to publicly report on a state-by-state basis a quality metric of length of time between complaints and board action.”

Update

Calif. Nursing Board executive officer resigns: On Tuesday, the longtime executive officer of the embattled California Board of Registered Nursing resigned. Ornstein and Weber report that “Terry had been the appointed executive officer for nearly 16 years and had been on the staff of the board for 25.”

A painful picture of rare childhood mental illness

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 Los Angeles Times’ Shari Roan tells the story of a 6-year-old girl suffering from a rare – perhaps even unique – case of early childhood schizophrenia. For months, even the most powerful medications her young body can handle don’t seem to phase her imaginary animal friends and almost-constant hallucinations. The mental illness is a serious threat to her health and that of those around her. In January she had to be moved from home to UCLA’s pysch ward. Roan uses the story, told with intense, wrenching detail and ending with a note of hope for the future, to illuminate the plight of America’s tiny population of mentally ill children.

About 1% of adults have schizophrenia; most become ill in their late teens or 20s. Approximately one in 10 will commit suicide.

Doctors and other mental health experts don’t fully understand the disease, which has no cure. Jani’s extreme early onset has left them almost helpless. The rate of onset in children 13 and under is about one in 30,000 to 50,000. In a national study of 110 children, only one was diagnosed as young as age 6.

“Child-onset schizophrenia is 20 to 30 times more severe than adult-onset schizophrenia,” says Dr. Nitin Gogtay, a neurologist at the National Institute of Mental Health who helps direct the children’s study, the largest such study in the world on the illness.

Calif. nonprofit’s conflicts of interest ‘inherent’

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.

Los Angeles Times reporter Alan Zarembo found unusually high executive pay and a tangle of additional compensation (ranging from rent to legal fees) that make executives at Tarzana Treatment Center some of the best-paid nonprofit leaders around.

The $45-million-a-year business, which has aggressively pursued lucrative government contracts, paid out salaries as high as $428,057 for the chief operating officer, a number which does not take into account deferred compensation and other activities. Part of the property leased by the center is owned by four board members, in an arrangement which nets them $2.7 million in rental fees annually. The CEO earned $330,372 for 32 hours a work a week, not including his share of the rent or the $237,965 in legal fees he earned in 2007 as part of an ongoing contract.

Frances Hill, a professor at the University of Miami specializing in nonprofit tax law, said conflicts of interest were inherent at Tarzana because the chief executive wears so many other hats: chairman of the board, lawyer and landlord.

“My jaw is dropping over this,” she said.

All of this appears to be legal, though “anathema” to a nonprofit’s mission, Zaremba found. The IRS allows this sort of self-dealing as long as the nonprofit can show that it gets better rates than it would on the open market, and government caps on executive pay for its contractors don’t apply because much of the compensation comes from non-government revenues. The leader of a nonprofit watchdog group asks “If the executives weren’t paid so much, ‘how many more services could be provided to people who need them?'”

Numbers on the rehab center’s effectiveness remain elusive, as they do for many such organizations, but Zaremba quotes a patient praising its professionalism and a positive review from a local official.