Tag Archives: texas tribune

America’s border towns are often health care black 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.

Colonias, underserved, poverty-riddled communities along America’s southern border populated mostly by American citizens of Mexican descent, have long remained uncomfortably disconnected from mainstream government and social services. In a two-part series in the Texas Tribune, Emily Ramshaw takes stock of life in the colonias, then focuses on the health issues created by their unique circumstances.

Ramshaw paints a vivid picture of these forgotten settlements, home to at least 400,000 folks in Texas alone, and no summary would do her writing justice. Here’s an excerpt from the first installment.

In Del Mar Heights, on the outskirts of Cameron County, residents live on a devastated stretch of scrubland littered with dilapidated trailers and dotted with listing telephone poles. There are no paved streets or sewers, basic infrastructure that developers promised the Mexican immigrants who purchased land here 30 years ago and often live three families — and several bleating goats — to a lot. Floodwaters and wayward hurricanes routinely sweep through the area, battering roofs patched with tarps and campaign signs.

Despite hundreds of millions of dollars of local, state and federal investment in infrastructure and services in the colonias, they still clearly lag behind much of the country. As a curious aside, some of the areas Ramshaw profiles happen to sit just miles from the notorious health care consumers of McAllen, Texas, yet the care they are offered could hardly be any more different.

At last count, nearly 45,000 people lived in the 350 Texas colonias classified by the state as at the “highest health risk,” meaning residents of these often unincorporated subdivisions have no running water, no wastewater treatment, no paved roads or solid waste disposal. Water- and mosquito-borne illnesses are rampant, the result of poor drainage, pooling sewage and water contaminated by leaking septic tanks. Burning garbage, cockroaches, vermin and mold lead to high rates of asthma, rashes and lice infestations. And the poor diet so intrinsically linked to poverty contributes to dental problems, diabetes and other chronic conditions, which residents of the colonias rarely have the health insurance, money or access to regular health care to treat.

Ramshaw writes that cultural and geographic barriers, as well as a general distrust of the federal government in a community where not all residents are legal migrants, have hampered adoption of available programs, but there have been signs of improvement in recent years.

The series was made possible by a grant from the Dennis A. Hunt Fund for Health Journalism, and produced as part of the California Endowment Health Journalism Fellowships, a program of the Annenberg School for Communication & Journalism at the University of Southern California.

Why Texas is failing to privatize 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.

In 2003, Texas passed a law that sought to turn mental health care in the state into a competitive marketplace. It’s 2010, and that marketplace still hasn’t materialized. The Texas Tribune’s Brian Thevenot tried to find out why. Thevenot describes it as “a textbook case of legislative intent crashing on the rocks of bureaucratic maneuvering and logistical realities.”

The state’s local Mental Health and Mental Retardation authorities are supposed to become “providers of last resort,” who turned most direct medical services over to networks of private providers. Instead, the state has remained among the nation’s worst in terms of mental health funding and, as Thevenot reports, the prison system and not the mental health infrastructure, has served as the real provider of last resort for Texas’ mentally ill.

Whooping cough: Not just a problem for kids

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.

Maryn McKenna, AHCJ board member and self-proclaimed “most vaccinated person on the planet,” writes about her own bout with whooping cough. She’d had her shots back in the day, but apparently whooping cough immunity conferred by childhood vaccines fades, and anyone over the age of 12 probably needs a booster. vaccinationThis is relevant because, while whooping cough is not generally fatal to adults, it’s easily transmitted to more vulnerable folks. And in California and across the country, it’s on the march and vaccine supplies are limited.

The worst news in this upsetting trend is this: We’re doing it to ourselves. As far as anyone can tell, the rise in pertussis is not due to any change in the organism, or to any mysterious error among the manufacturers who make pertussis vaccines. It’s due to vaccine refusal, to parents turning away from vaccines because they think the vaccines are more harmful than the diseases they prevent — or, more selfishly, because they think the wall of immunity created by other vaccinated children will protect their unimmunized ones.

That wall of immunity, McKenna says, hasn’t been helping the unvaccinated kids, who are 23 times more likely to pick up the disease than their immunized peers.

The Texas Tribune’s Ben Freed learns, through conversations with public health experts, that the “entirely preventable” disease can be stopped with vaccination rates between 80 percent and 85 percent. Unfortunately, adult rates are nowhere close to those numbers, though the state is taking steps to increase adult vaccinations.

California officials are urging people to get vaccinated as that state has now seen a six-fold increase in whooping cough this year.

Rural Texas hospitals seek lifeline from state

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 Texas Tribune‘s Elizabeth Titus reports that rural hospitals in the scores of Texas counties without tax bases strong enough to support a full, modern facility are struggling to find a sustainable model. The latest effort is a push to allocate $50 million on the state level to renovate or replace as many as 42 rural hospitals.

The ultimate goal is to keep the hospitals in line with state and federal safety codes, which must be met in order to receive Medicare and Medicaid reimbursements. Urban lawmakers are skeptical, and there are questions as to whether the one-time fee would really help in the long term, as codes and technology are continually evolving. “For example, a state or federal mandate that all hospitals have sprinkler systems could bust their budgets,” Titus wrote.

For a stupendous primer on covering rural health issues, AHCJ members can check out presentations from Rural Health Journalism 2010. Washington University Professor Timothy D. McBride’s guide to understanding rural health disparities in context should be particularly useful to reporters looking for stories like Titus’.

Ex-employees tell of Texas workers’ comp troubles

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 Texas Tribune’s Elise Hu has found that the Texas Department of Insurance’s Division of Workers’ Compensation has more than its share of dirty laundry, much of which is finally starting to see the light of day. The division is in charge of sanctioning physicians who are defrauding the state’s worker’s comp system by overbilling and overtreating patients. A recent spate of firings and resignations, along with a review by the Texas Sunset Advisory Commission, have helped illuminate just how dysfunctional the whole thing has become.

The crux of the matter: Staff recommended sanctions against almost 70 physicians, Hu wrote, “Yet since 2005, division records show, the state has sanctioned just five doctors with removal from the workers’ comp system — and only in cases involving paperwork violations rather than harm to patients.”

The broken enforcement system, the former employees say, stems from [Commissioner Rod Bordelon]’s insistence on putting the due process rights of accused doctors ahead of the rights of their allegedly abused patients. That misplaced focus, the employees believe, results in part from political pressure on Bordelon.

Hu discovered that the cases that were unceremoniously shuttered by Bordelon involved millions and millions of dollars in workers’ comp claims, and that the system didn’t have sufficient safeguards against abuse.

Lockhart, Watts, Nemeth and Ford (the employees who either resigned or were terminated) say they left with great disappointment at the lack of enforcement. “You can make a lot of money if you’re a doctor practicing in the workers’ comp system, if you are so inclined,” Ford says. “If you’re dishonest, or if you learn how to game a system, there’s lots of money — I mean, millions of dollars to be made.” The agency document that details investigations into the nine doctors showed that, during the one-to-two year monitoring period, seven of them billed insurers more than $1 million, two billed more than $2 million, and one billed $3.2 million.

It’s a convoluted story heavy with details and angry quotes, but if you’re just looking for a summary of how the terminated employees feel, this seems to be a pretty good one:

“[The office’s] focus since late 2005 has been to protect wealthy doctors who have learned how to game the system and take advantage of injured claimants,” Ford says. “The motives for this protection are open to speculation. Money, political pressure, and career advancement are at the top of the list.”

Public records shed light on Texas blood samples

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 Texas Tribune‘s Emily Ramshaw got her hands on almost a decade of public e-mails that help show the thoughts and intentions behind the state’s decision to store infant blood samples without parental consent. She also uncovered a previously undisclosed “transfer of hundreds of infant blood spots to an Armed Forces lab to build a national and, someday, international mitochondrial DNA (mtDNA) registry.”

baby-heel

Photo by valleyboy74 via Flickr

Ramshaw published PDFs of the e-mails alongside her story (E-mails, part 1 | E-mails, part 2).

Ramshaw’s report follows officials’ intricate dance around the issue of parental disclosure, as well as their reluctance to publicize the warehousing of the blood samples. Here’s her summary:

For decades, the state has screened newborns for a variety of birth defects, pricking their heels and collecting five drops of blood on a paper card. Until 2002, the cards were thrown out after a short storage period. But starting that year, the state health department began storing blood spots indefinitely, for “research into causes of selected diseases.” Four years later, DSHS began contracting with Texas A&M University’s School of Rural Public Health to warehouse the cards, which were accumulating at a rate of 800,000 a year. State health officials never notified parents of the changes; they didn’t need consent for the birth-defect screening, so they didn’t ask for it for research purposes. The agency’s rationale was that it let parents who asked opt out of the newborn blood screening and de-identified all of the samples before shipping them off.

According to Ramshaw’s sources, baby blood spots are “incredibly valuable” to researchers, and can be useful even when stripped of all identifying information. Yet public perception doesn’t line up with this scientific value in part, Ramshaw says, because scientists are unwilling to even try to explain the use of blood spots because it’s such a controversial topic.

Fortunately, Ramshaw writes, the first steps toward educating the public are now being taken. Parents are being asked for their informed consent when the blood samples are taken, and the state health agency has made a clean break with the past by destroying the earlier blood spots collected without full consent.