PART 2. Conflict of Interest. MSK continued & top executives at the University of Maryland Medical System have resigned amid investigations into accusations of self-dealing among the hospital network’s board members

ASSIGNMENT: Identify other health care conflicts in the news then identify Best Practices of Boards of Trustees.

New PART 2 after old PART 1.


ASSIGNMENT: Profile the University of Maryland Medical System COI challenge.

DISCLOSURE. I am a member and Interim Chairman of the IRB* at Stevens Institute of Technology.

“There are many varieties of conflicts of interest, and they appear in different settings and across all disciplines. While conflicts of interest apply to a “wide range of behaviors and circumstances,” they all involve the use of a person’s authority for personal and/or financial gain. Conflicts of interest may involve individuals as well as institutions. Furthermore, individuals, in certain circumstances, may have conflicts occurring on both an individual and an institutional level, as may be seen among members of an Institutional Review Board (IRB).

Conflicts of interest are broadly divided into two categories: intangible, i.e., those involving academic activities and scholarship; and tangible, i.e., those involving financial relationships.” (A)

“In an article in the May 2014 issue of Compliance Today, Bill Sacks, Vice President and co-founder of HCCS, a HealthStream company, describes how new NIH regulations are forcing academic medical centers (AMCs) to examine and update their conflict-of-interest policies. He lists the 15 best practices for management of conflicts of interest that have been proposed by the Pew Charitable Trust and discusses how some of these recommendations are enjoying wide acceptance, as others are being met by serious objections. The Pew “Best Practice” recommendations are summarized below.

1. No gifts or meals should be accepted from industry sales representatives…

2. Faculty must disclose all conflicts of interest. All academic medical centers must have a process in place to manage conflict of interest (COI) disclosures.

3. Industry-funded speaking should not be allowed…

4. Industry-funding of continuing medical education (CME) should be severely limited or prohibited…

5. Faculty, students, and trainees should not attend industry-supported promotional or educational events…

6. Limit or prohibit pharmaceutical sales representative access in academic medical centers…

7. Limit medical device representative presence in academic medical centers to what is necessary…

8. Conflict-of-interest education should be required for all clinical staff and students

9. Conflict-of-interest policies should apply to everyone with a relationship to the academic medical center—paid, volunteering, affiliated, etc…

10. Industry-supported clinical fellowships should be available for scientific training only…

11. Ghostwriting and honorary authorship are strictly prohibited…

12. …Consulting arrangements must require written contracts with clear deliverables, to ensure that inappropriate payments are not involved…

13. Consulting relationships for marketing purposes are prohibited.

14. Pharmaceutical samples can be accepted and used only when they don’t become marketing tools.

15. Members of pharmacy and therapeutics committee cannot vote on formulary or treatment changes involving a company or product in which they have a financial interest… (B)

“Open Payments gives the public more information about the financial relationships between physicians and teaching hospitals and applicable manufacturers and GPOs. Specifically, the program:

Encourages transparency about these financial ties

Provides information on the nature and extent of the relationships

Helps to identify relationships that can both lead to the development of beneficial new technologies and wasteful healthcare spending

Helps to prevent inappropriate influence on research, education and clinical decision making. (C)

“Community Catalyst offers this Policy Guide to Academic Medical Centers and Medical Schools to assist leaders, faculty, staff and medical students in successfully adopting and improving policies to address conflicts of interest and interactions with the pharmaceutical and device industries. Policies such as these and their effective implementation are of critical importance to the integrity of medical education and patient care…

Toolkit on Transparency and Disclosure. Toolkit on Relations with Sales Representatives. Toolkit on Promotional Speaking. Toolkit on Continuing Medical Education. Toolkit on Ghostwriting and Name-Lending. Toolkit on Samples. Toolkit on Pharmaceutical and Therapeutics Committees. Toolkit on COI Policy Implementation. Conflict of Interest Curriculum Toolkit (D)

“Papers in medical journals go through rigorous peer review and meticulous data analysis.

Yet many of these articles are missing a key piece of information: the financial ties of the authors.

Nearly two-thirds of the 100 physicians who rake in the most money from 10 device manufacturers failed to disclose a conflict of interest in their academic writing in 2016, according to a study published Wednesday in JAMA Surgery.

The omission can have real-life impact for patients when their doctors rely on such research to make medical decisions, potentially without knowing the authors’ potential conflicts of interest…

They did this by sampling 10 large surgical and medical device manufacturers. This list includes Medtronic, Stryker Corp., Intuitive Surgical, Covidien, Edwards Lifesciences Corp., Ethicon, Olympus Corp., W.L. Gore & Associates, LifeCell Corp. and Baxter Healthcare.

The researchers also pinpointed the 10 physicians who received the highest compensation from each company. They then searched for articles published by these physicians between Jan. 1 and Dec. 31, 2016, and reviewed the full text of each article for COI disclosure.

According to their findings, those 10 companies paid more than $12 million in 2015 to the 100 doctors included in the study. The median payment to these physicians was $95,993.” (E)

“Memorial Sloan Kettering Cancer Center launched a conflict of interest task force in the wake of the resignation of its chief medical officer, Dr. José Baselga, who failed to disclose connections to medical industry…

The Manhattan-based cancer center said the task force will assess its internal policies and processes for reporting and managing outside activities and industry-supported clinical trials.

The task force was announced by President and Chief Executive Officer Dr. Craig Thompson. It will be chaired by Debra Berns, MSK’s Senior Vice President and Chief Risk Officer.

Among its objectives, the task force will: Review MSK’s policies, procedures, and training on conflicts of interest; Identify best practices in COI, including monetary and commitment limits; Assess new or improved processes to support timely and thorough disclosure; Identify medical societies and journals with whom to partner in improving public disclosure at meetings and in publications. (F)

“One of the world’s top breast cancer doctors failed to disclose millions of dollars in payments from drug and health care companies in recent years, omitting his financial ties from dozens of research articles in prestigious publications like The New England Journal of Medicine and the Lancet.

The researcher, Dr. José Baselga, a towering figure in the cancer world, is the chief medical officer at Memorial Sloan Kettering Cancer Center in New York. He has held board memberships or advisory roles with Roche and Bristol-Myers Squibb, among other corporations; has had a stake in start-ups testing cancer therapies; and played a key role in the development of breakthrough drugs that have revolutionized treatments for breast cancer.

According to an analysis by ProPublica and The New York Times, Baselga did not follow financial disclosure rules set by the American Association for Cancer Research when he was president of the group. He also left out payments he received from companies connected to cancer research in his articles published in the group’s journal, Cancer Discovery. At the same time, he has been one of the journal’s two editors in chief.

At a conference this year and before analysts in 2017, he put a positive spin on the results of two Roche-sponsored clinical trials that many others considered disappointments, without disclosing his relationship to the company. Since 2014, he has received more than $3 million from Roche in consulting fees and for his stake in a company it acquired.” (G)

“Dr. José Baselga, the chief medical officer of Memorial Sloan Kettering Cancer Center, resigned on Thursday amid reports that he had failed to disclose millions of dollars in payments from health care companies in dozens of research articles…

Thompson echoed comments he made to the hospital staff on Sunday, saying that the cancer center had “robust programs” in place to manage employees’ relationships to outside companies, but that “we will remain diligent.” He added, “There will be continued discussion and review of these matters in the coming weeks.” (H)

“An artificial intelligence start-up founded by three insiders at Memorial Sloan Kettering Cancer Center debuted with great fanfare in February, with $25 million in venture capital and the promise that it might one day transform how cancer is diagnosed.

The company, Paige.AI, is one in a burgeoning field of start-ups that are applying artificial intelligence to health care, yet it has an advantage over many competitors: The company has an exclusive deal to use the cancer center’s vast archive of 25 million patient tissue slides, along with decades of work by its world-renowned pathologists.

Memorial Sloan Kettering holds an equity stake in Paige.AI, as does a member of the cancer center’s executive board, the chairman of its pathology department and the head of one of its research laboratories. Three other board members are investors…

Hospital pathologists have strongly objected to the Paige.AI deal, saying it is unfair that the founders received equity stakes in a company that relies on the pathologists’ expertise and work amassed over 60 years. They also questioned the use of patients’ data — even if it is anonymous — without their knowledge in a profit-driven venture.” (I)

“…The AAMC is continuing to work with member institutions, other associations and societies, journals, and the continuing education community to develop tools and resources to help institutions and individuals manage the disclosure of conflicts of interest.

Institutions looking for immediate steps to take could:

Remind faculty of the importance of full disclosure, not only to your institution, but in other writing, speaking and teaching situations, as well as grant applications.

Use relevant current events as an opportunity to recommit to the institution’s obligation to facilitate transparency about the ways in which faculty and industry may be collaborating, and the processes that are in place to review and manage those relationships.

Encourage faculty to review the information posted about them publicly on the Open Payments website, and to ensure its accuracy as well as consistency with complete disclosures in all aspects of their professional responsibilities.” (J)

* “Under FDA regulations, an IRB is an appropriately constituted group that has been formally designated to review and monitor biomedical research involving human subjects. In accordance with FDA regulations, an IRB has the authority to approve, require modifications in (to secure approval), or disapprove research. This group review serves an important role in the protection of the rights and welfare of human research subjects.

The purpose of IRB review is to assure, both in advance and by periodic review, that appropriate steps are taken to protect the rights and welfare of humans participating as subjects in the research. To accomplish this purpose, IRBs use a group process to review research protocols and related materials (e.g., informed consent documents and investigator brochures) to ensure protection of the rights and welfare of human subjects of research.” (K)

“A vice president of Memorial Sloan Kettering Cancer Center has to turn over to the hospital nearly $1.4 million of a windfall stake in a biotech company, in light of a series of for-profit deals and industry conflicts at the cancer center that has forced it to re-examine its corporate relationships…

The move to hand over his stake is one of several steps now underway as the cancer center tries to contain a crisis that has already led to the resignation of its chief medical officer and a review of its conflict-of-interest policies. Several board members and some executives of the nonprofit institution have maintained close ties to the health and drug industries at a time when stunning cancer breakthroughs are generating excitement among investors and spawning a flurry of biotech startups.

At other cancer centers and research institutions, employees are barred from accepting personal compensation when they represent their institution on corporate boards. But Memorial Sloan Kettering had no such prohibition until now.” (L)

PART 2. Conflict of Interest continued. Memorial Sloan Kettering/ University of Maryland Medical System

“In forging partnerships with a New Jersey hospital and a data analytics startup, Memorial Sloan Kettering Cancer Center has created a web of interlocking financial interests and conflicts that, ethics experts told STAT, raise doubts about whether the prominent New York City hospital can always put its patients’ interests first while using information in their medical records to make money.

In late 2016, Memorial Sloan Kettering signed a deal with Hackensack Meridian Health, one of New Jersey’s largest hospital systems, giving the cancer center access to a larger pool of patients and a bulwark against encroaching competition from other national players in cancer care.

Within a year, MSK launched another collaboration with a data analytics startup called Cota, and invested $1.4 million in the company. Its founder: a Hackensack Meridian executive and oncologist named Dr. Andrew Pecora, who was Hackensack’s lead negotiator in striking the blockbuster 2016 partnership and serves on the board overseeing the hospitals’ joint venture…

The cancer center is also collaborating with IBM in the development and sale of Watson for Oncology, a product that combines its clinical expertise with artificial intelligence to deliver cancer treatment recommendations. The cancer center receives royalties on the sale of IBM’s product.

Ethics experts said these deals fall into a regulatory gray area in which hospitals and other private companies are trading on patient data in novel ways that may cross ethical lines and trigger a backlash among patients.”  (A)

“Hundreds of doctors packed an auditorium at Memorial Sloan Kettering Cancer Center on Oct. 1, deeply angered by revelations that the hospital’s top medical officer and other leaders had cultivated lucrative relationships with for-profit companies.

One by one, they stood up to challenge the stewardship of their beloved institution, often to emotional applause. Some speakers accused their leaders of letting the quest to make more money undermine the hospital’s mission. Others bemoaned a rigid, hierarchical management that had left them feeling they had no real voice in the hospital’s direction.

“Slowly, I’ve seen more and more of the higher-up meetings happening with people who are dressed up in suits as opposed to white coats,” said Dr. Viviane Tabar, chairwoman of the neurosurgery department.

“The corporatization of this institution is clear to many of us who have been here a long time,” said Dr. Carol L. Brown, a gynecologic cancer surgeon, according to an audio recording of the meeting.

The meeting ended after several doctors advocated an immediate no-confidence vote in the hospital’s senior leadership. The turmoil followed reports by The New York Times and ProPublica that the hospital’s chief medical officer, Dr. José Baselga, had been paid millions by drug and health care companies and failed to disclose those ties more than 100 times in medical journals, and that hospital insiders had made lucrative side deals that stood to earn them handsome profits, sometimes for work they had done on the job.

The day after the meeting, the hospital’s chief executive, Dr. Craig B. Thompson, promised greater openness with rank-and-file doctors about decision-making. He also committed to doing the “root-cause analysis” requested by the doctors of how “egregious conflicts of interest,” as one physician put it, had been allowed to happen…

The predicament of Memorial Sloan Kettering also reflects a shift in its own culture. Its prior chief executive, Dr. Harold E. Varmus, a Nobel-prize winning scientist, personally kept companies at arm’s length, while Dr. Thompson, also a respected cancer researcher, has more fully embraced such relationships. The new approach has been applauded by some for expanding access to the cancer center’s discoveries, even as others have worried that the hospital may be losing sight of its mission…

Even as Memorial Sloan Kettering leaders have promised greater transparency, they have engaged a public affairs firm, SKDKnickerbocker, to manage their message and have aggressively pushed back against the idea that the hospital’s leaders are too close to industry.” (B)

“Memorial Sloan Kettering Cancer Center, one of the world’s leading research institutions, announced on Friday that it would bar its top executives from serving on corporate boards of drug and health care companies that, in some cases, had paid them hundreds of thousands of dollars a year.

Hospital officials also told the center’s staff that the executive board had made permanent a series of reforms designed to limit the ways in which its top executives and leading researchers could profit from work developed at Memorial Sloan Kettering, a nonprofit with a broad social mission that admits about 23,500 cancer patients each year.” (C)

“While MSK’s situation has drawn the most attention for its ties to industry, leaders of nonprofit health systems commonly lead pharmaceutical companies at the same time, a BioPharma Dive review from November found.

From that analysis, about two-thirds of the industry’s largest drugmakers had at least one board member who was also leading a nonprofit, creating a potential financial conflict of interest between the two roles.

The typical compensation package from the pharma companies to these directors was worth more than $475,000, while the average director also held roughly $1.7 million in stock of the particular drugmaker they helped to lead.

This MSK memo from Debra Berns, the cancer center’s senior vice president and chief risk officer, establishes some new limits the organization will put in place on its leaders.

The five highest-ranking roles will not be permitted to serve on boards of external, for-profit health- or science-related companies, the memo stated. These roles are the chief executive, chief operating officer, chief financial officer, physician-in-chief and director of MSK.

However, these five leaders can be exempt from the ban if they provide a compelling institutional reason for board service and obtain approval from the executive committee of MSK’s board of managers, according to the document.

Another new policy will limit the relationship with for-profit spin-off companies that MSK officers can have. MSK officers cannot serve on boards of spin-off companies, and the Board of Overseers and Managers cannot invest in or serve on these boards.”  (D)

“Top officials at Memorial Sloan Kettering Cancer Center repeatedly violated policies on financial conflicts of interest, fostering a culture in which profits appeared to take precedence over research and patient care, according to details released on Thursday from an outside review.

The findings followed months of turmoil over executives’ ties to drug and health care companies at one of the nation’s leading cancer centers. The review, conducted by the law firm Debevoise & Plimpton, was outlined at a staff meeting on Thursday morning.

It concluded that officials frequently violated or skirted their own policies; that hospital leaders’ ties to companies were likely considered on an ad hoc basis rather than through rigorous vetting; and that researchers were often unaware that some senior executives had financial stakes in the outcomes of their studies.

In acknowledging flaws in its oversight of conflicts of interest, the cancer center announced on Thursday an extensive overhaul of policies governing employees’ relationships with outside companies and financial arrangements — including public disclosure of doctors’ ties to corporations and limits on outside work…

Scott Stuart, chairman of the cancer center’s Boards of Overseers and Managers, said in an emailed statement: “We took a deep and honest look at what went wrong at our own institution, examined what was occurring in the wider cancer research community, and are putting in place best practices that will not only allow us to learn from our mistakes, but will contribute to best practices for the wider research community.”..

The policy changes that Memorial Sloan Kettering announced on Thursday include the creation of a board committee to focus on overseeing conflicts, an existing hospital policy that the law firm learned had not been carried out.

The hospital also said it would disclose financial interests of faculty members and researchers on its website and create a more centralized review of conflicts between employees’ work at the hospital and their outside duties.

Other changes included new limits on how income is distributed from research discoveries that originate at Memorial Sloan Kettering, and regular audits to ensure the hospital is complying with its own rules. The cancer center reinforced its earlier statements that many profits from outside work should flow back to M.S.K. research.” (E)

“Dr. José Baselga, who resigned his position as the top doctor at Memorial Sloan Kettering Cancer Center after failing to disclose millions of dollars in payments from drug companies, is now going to work for one of them.

AstraZeneca, the British-Swedish drug maker, announced on Monday that it had hired Dr. Baselga as its head of research and development in oncology, a newly created unit that reflects the company’s shift toward cancer treatments, one of the hottest areas in the drug industry.

In a statement, AstraZeneca’s chief executive, Pascal Soriot, described Baselga as “an outstanding scientific leader.” “José’s research and clinical achievements have led to the development of several innovative medicines, and he is an international thought leader in cancer care and clinical research,” he said…

In December, the American Association for Cancer Research said that Baselga, at its request, had resigned his post as one of two editors in chief of its medical journal Cancer Discovery because he did “not adhere to the high standards” of conflict-of-interest disclosures that the group expects of its leaders. Some of his omissions involved articles that were published in Cancer Discovery while he was an editor in chief.” (F)

“Two more members of the University of Maryland Medical System’s board of directors have resigned amid intense scrutiny over the system’s contracting practices — and as the hospital network announced a “comprehensive review” of its business deals.

Stephen A. Burch, chairman of the University of Maryland Medical System board of directors, said Tuesday that he has accepted the resignations of board members John W. Dillon and Robert L. Pevenstein.

 “I take very seriously the concerns raised regarding Board members that have business relationships with UMMS,” Burch said in a statement. “Addressing this issue is of the highest priority for me and the organization. There is nothing more important than the trust of those who depend on our leadership.”

Dillon reported in both 2017 and 2018 that his health care consulting firm, Dillon Consulting, generated more than $150,000 a year through a contract with the system for “capital campaign and strategic planning.” He reported the contract was paying his firm $13,000 a month.

Pevenstein, the founder of technology companies, reported that in 2017 his firms pulled in more than $150,000 through system contracts, including more than $108,000 in pay for himself. In 2018, Pevenstein reported his son also made more than $100,000 from the system.

In tax forms, Maryland hospital system labeled book purchase from Baltimore mayor a ‘grant’ to city schools

The resignations follow Baltimore Mayor Catherine Pugh stepping down from the board Monday. Pugh resigned from the system’s board of directors as Baltimore school officials acknowledged that 8,700 copies of children’s books the medical system purchased from her are sitting unread in a warehouse.

The three departures from the board came after The Baltimore Sun reported nine members of the University of Maryland Medical System’s Board of Directors have business deals with the hospital network that are worth hundreds of thousands to millions of dollars each.

Board chair Burch said Tuesday he also has asked board members who currently have relationships with the medical system to immediately take a voluntary leave of absence during a review of the system’s governance practices. Those members are: August J. Chiasera, Francis X. Kelly, James A. Soltesz and Walter A. Tilley Jr…

Medical system CEO Robert Chrencik has said some of the contracts went through a competitive bidding process, while others did not. The medical system has thus far declined to release a list detailing which of the deals went through a bidding process.” (G)

“The president and chief executive of the University of Maryland Medical System will take a leave of absence amid a growing scandal surrounding its board of directors, several of whom have profited from contracts with the hospital network they oversee.

Robert A. Chrencik, who has led the system since 2008, will be on leave beginning Monday, board chairman Stephen A. Burch announced Thursday. Burch said the board asked Chrencik to step aside and unanimously agreed at an emergency meeting Thursday to engage an independent accounting and legal firm to conduct an audit of the board’s contracts.

Several of the board’s 27 members — including Baltimore Mayor Catherine Pugh (D), who resigned this week from the board — have had business deals with the hospital system they oversee, in some cases worth hundreds of thousands of dollars. The deals, first reported last week by the Baltimore Sun, have been sharply criticized by Gov. Larry Hogan (R) and the Democratic leaders of the General Assembly.” (H)

Several of Maryland’s largest hospitals engage in business transactions with members of their governing boards while avoiding — for the most part — the type of political dealings that ensnared the University of Maryland Medical System in management turmoil this week.

The medical system has faced intense scrutiny since The Baltimore Sun revealed last week that a third of its 27-member board of directors have business dealings with the health care network…

The Baltimore Sun’s review of state disclosure records and federal tax forms for MedStar Health, LifeBridge Health, Mercy Medical Center, Greater Baltimore Medical Center and St. Agnes Hospital showed all have some dealings with board members.

GBMC said it always uses competitive bidding when awarding contracts.

LifeBridge Health officials said in a statement that board members with “conflicts may be required to be recused from any discussion where the potential conflict may influence their vote and are recused from any vote where a conflict may exist.” In addition, they said, an “audit and compliance committee also oversees conflicts of interest to ensure that there is no undue influence on any contract or vote.”

MedStar Health, which has seven hospitals in Maryland, reported business transactions with board members at five of its hospitals: Franklin Square Medical Center, Good Samaritan Hospital, Union Memorial Hospital and Harbor Hospital in the Baltimore area and St. Mary’s Hospital in Leonardtown in Southern Maryland.

Dr. P. Justin Tortolani, who serves on Union Memorial Hospital’s board and is director of MedStar’s spine program, reported receiving royalties of nearly $155,000 last year from contracts with two companies he is associated with.

At LifeBridge, relationships ranged from catering services with no reported value provided by Miss Shirley’s owner David Dopkin, a Sinai Hospital of Baltimore board member, to $9.2 million in leasing and construction services from the company of Thomas Obrecht, who serves on the boards of LifeBridge Health and Northwest Hospital Center Inc. In an email, Obrecht said he joined the board to use his experience in business and real estate to help guide “an organization focused on helping people in Baltimore and across Maryland.”.. (I)

“Legislation to overhaul the University of Maryland Medical System board was amended to require all current board members be fired.

The bill has bipartisan support and has significantly changed since it was first introduced. The measure, as amended, is headed to the House floor.

A House committee voted unanimously Friday in favor of legislation to completely overhaul the UMMS board. The board remains under fire following reports nine of its 30 members benefited from business deals with the hospital system, including a children’s book contract with Mayor Catherine Pugh.

Pugh returned $100,000 she made in profits, resigned from the UMMS board and recently made a public apology.

The legislation calls for the termination of all the current board members.

“They will be terminated in two different batches, so that we separate some in June and some in October,” House Health and Government Operations Committee Chairwoman Shane Pendergrass said.

The committee adopted an amendment mandating that no elected officials can serve on the board. Committee members paid close attention to ways to find out how these no-bid contracts happened…

The bill covers much ground, including limiting the number of board members to 25, prohibiting members from using their position for private gain and prohibiting sole source contracts. Financial disclosure statements and notification of any potential conflicts of interest would become a requirement by law.” (J)

“On the last day of Maryland’s General Assembly session, lawmakers gave final approval to sweeping legislation that would reform the University of Maryland Medical System’s board of directors amid revelations of single-source contracts for some board members.

The legislation — which comes after Baltimore Sun reporting sparked an outcry over the board’s practices, including a $500,000 deal to buy Mayor Catherine Pugh’s self-published “Healthy Holly” books — would bar no-bid contracts for board members, force all members to resign and reapply for their positions (if they want to return), and mandate an audit of contracting practices.

By a vote of 46-0, Maryland’s senators approved the legislation sponsored by Baltimore Democratic Sen. Jill P. Carter.

The bill now goes to Republican Gov. Larry Hogan for his consideration; he supports reforms for UMMS. (K)

“After weeks of mounting pressure, Mayor Catherine Pugh of Baltimore resigned on Thursday amid a widening scandal involving hundreds of thousands of dollars worth of children’s books that she wrote and that the University of Maryland Medical System paid for while she was serving on its board of directors.

Her resignation comes days after the Baltimore City Council proposed amending the city charter to make it possible to remove her, and after the F.B.I. raided her two homes and her office at City Hall…” (L)

“Robert A. Chrencik, president and CEO of Baltimore-based University of Maryland Medical System, has resigned, effective April 26, according to the Baltimore Sun.

The health system’s board placed Mr. Chrencik on a leave of absence March 25, as a scandal unfolded involving board members profiting from contracts with hospital networks they oversee.” (M)

“The University of Maryland Medical Center has requested a $75 million rate increase from state regulators, a nearly 5 percent increase.

The request was made before news broke of the University of Maryland Medical System’s inside deals with its board members.

Since then, Catherine Pugh resigned her position on the board and as mayor of Baltimore, and the system’s CEO Robert Chrencik stepped down.

“The rate increase requested by UMMC is necessary to provide funding for ongoing investment in operations and mission-driven goals – vital initiatives that enable the hospital to deliver first-class care to our patients,” a UMMS spokesperson said in a written statement. “Ultimately, this is about UMMC being able to meet the complex needs of our patients while continuing to serve as a safety net provider for the West Baltimore community.”

State Sen. Jill Carter, (D-Baltimore City) said the timing of the request could not be worse.

“Right now, of course, there’s going to be a perception that this rate massive rate increase somehow is a result of the self-dealing,” Sen. Carter said. “Maybe they should hold off until some of the investigations are done or the internal or external audits are done, that the legislation called for that.”” (N)

“The chairman of the embattled University of Maryland Medical System board of directors announced his resignation Tuesday — along with two other board members — as an additional contract with one of the departing board members was revealed.

Board Chairman Stephen Burch, who attended a contentious meeting in March with Republican Gov. Larry Hogan and Democratic state Senate President Thomas V. Mike Miller over the board’s contracting practices, announced his resignation effective July 1.

Burch, who also served as a member of Democrat Catherine Pugh’s transition team when she became mayor of Baltimore, was joined in resigning from the UMMS board by Kevin O’Connor and Dr. Scott Rifkin.

O’Connor’s resignation is effective July 1, while Rifkin’s takes effect immediately.

The system said in a statement that Rifkin and the hospital network had an “active agreement” in which his company “provides software for a pilot program designed to reduce hospital readmissions.”..

Federal, state and local investigations are underway.

System President and CEO Robert Chrencik — who was paid $4.3 million in total compensation in 2017 — resigned last month. Pugh resigned last week from her office as mayor of Baltimore.” (O)

“Former Baltimore mayor Catherine Pugh and her colleagues on the University of Maryland Medical System board were not the only ones who profited from business deals with the hospitals they oversaw.

At least two dozen people who sit on boards of smaller, affiliated institutions in the massive system had contracts with those institutions, in some cases worth hundreds of thousands of dollars annually, according to financial disclosures.

The contracts show the pervasiveness of the kinds of deals that led to Pugh’s resignation as mayor this month and, lawmakers say, point to challenges that remain as they grapple with how to make the system more accountable.

Among those who had deals with hospitals they oversaw were a Harford County veterinarian who has made nearly $3 million since 2013 from rental leases; a vascular surgeon whose Bel Air practice made $2.4 million since 2013; and the former president of an ambulance company whose contracts were worth at least $1.3 million since 2010.

Michael Schwartzberg, a spokesman for UMMS, said those relationships are “all appropriate and consistent with fair market value.” Some of the contracts predated members’ service on the boards, he said; others were signed after members joined their respective boards. He said some deals were competitively bid and did not provide information about others.

There were at least two dozen local board members who had contracts with the hospitals they oversaw, according to the disclosure forms, which in some cases listed the specific amount their contracts were worth but in others required a range, such as “greater than $100,000.” The commission said it was missing forms from UM Rehabilitation & Orthopaedic Institute.” (P)

Gov. Larry Hogan has decried contracts that board members of the University of Maryland Medical System held with the organization they were tasked with overseeing and promised to “clean house.”

But state law long has called for housecleaning along the way, specifying that board members can’t serve more than two consecutive five-year terms. Hogan (R) and his predecessors, who appoint the board members, allowed some to stay well past a decade.

A spokesman for the governor, who took office in 2015, said Thursday that term limits will be enforced from now on.

“These practices were handed down from both Republican and Democratic administrations,” spokesman Michael Ricci said in an email. “Governor Hogan is working to put an end to them so we can help restore public trust in UMMS.”

Members who lingered on the board include former state senator Francis X. Kelly, whose insurance company held some of the largest contracts that are under review as part of a broad investigation of the hospital board.

Kelly, who did not respond to requests for comment, joined the board in 1986 and most recently was reappointed by Hogan in 2016. He took a voluntary leave of absence from the board while auditors probe the contracts.” (Q)

“The University of Maryland Medical System (UMMS) Board of Directors reviewed and voted unanimously to approve a new Conflict of Interest Policy. This is another milestone as the organization continues to improve Board governance and oversight while managing conflicts of interest appropriately. The new Policy is adherent to recently passed Maryland legislation and is effective July 1, 2019.

“This is another major step forward as we improve Board governance, change corporate culture and put UMMS on a strong path forward,” said Interim President and CEO John Ashworth. “We thank the legislators for their work in guiding this policy during the session and helping us focus on providing a sound, long-term foundation for a sustainable, effective Board.”

Of note, the Policy includes:

A prohibition on sole source contracting with any UMMS Board member

Requirements for the recusal of non-independent Board members from certain deliberations and decision-making activities

Provisions that restrict relevant Board leadership positions to independent Board members

Detailed procedures for the disclosure of interests by UMMS Board members, officers and management level employees

The process for identifying and addressing conflicts of interest

The process for handling violations of the Conflict of Interest Policy

A requirement that every Board member attest to compliance with the Conflict of Interest Policy

The new Conflict of Interest Policy was delivered to Governor Hogan and the presiding officers of the Senate and House of Delegates today, as required by Maryland law. The Policy will also be presented to the UMMS affiliate boards for review and approval within 60 days.” (R)

“Four top executives at the University of Maryland Medical System have resigned amid investigations into accusations of self-dealing among the hospital network’s board members, the system announced Thursday.

Those resigning are Megan Arthur, the system’s primary lawyer; Jerry Wollman, the chief administrative officer; Christine Bachrach, the system’s chief compliance officer; and Keith Persinger, the chief performance improvement officer.” (S)

“Maryland Gov. Larry Hogan named Wednesday his initial batch of new appointees to the troubled board of directors at the University of Maryland Medical System, the first step toward reorganizing the board following a scandal over board members having lucrative contracts with the 13-hospital system.

The volunteer board came under fire in March when The Baltimore Sun reported a third of its 30 members or their companies had deals with the hospital system, some of which were not competitively bid. They included then-Mayor Catherine Pugh of Baltimore, a Democrat who made hundreds of thousands of dollars selling children’s books in a sole-source arrangement with UMMS. She later resigned from the board and as mayor amid multiple investigations into the book deals.

In a separate action Wednesday, the hospital board elected new leadership from among its current members and invited four members who voluntarily took leaves of absence to return.

The new appointments to the board are required under a law state legislators passed this year that mandated several reforms at the hospital system. All previously appointed board members must step down by the end of the year, to be replaced or reappointed by the governor.

All new board members are subject to confirmation votes by the state Senate, but can serve until the Senate votes on their appointments. They will take office July 1.

Board members can serve up to two five-year terms. In the past, board members often stayed past the end of their terms if a governor didn’t replace them.

“I pledged that I would appoint new board members who will serve with integrity and accountability, and today, I am delivering on that promise,” Hogan, a Republican, said in a statement. “This is another critical step as UMMS works to restore public trust.”

The medical system board met Wednesday morning and elected James “Chip” DiPaula Jr. as chairman and Alexander Williams Jr. as vice chairman. They’ll serve in those roles for the remainder of the year. Former Chairman Stephen A. Burch was among several board members who resigned amid the scandal.

DiPaula, who Hogan appointed to the board in 2016, is a former state budget secretary and chief of staff to then-Gov. Robert L. Ehrlich Jr., a Republican. DiPaula later founded an e-commerce firm.

Williams is a retired federal judge who has been tapped for other leadership roles, including chairman of the state’s Commission to Restore Trust in Policing and co-chairman of a commission on redistricting that drew up a proposed map for Maryland’s 6th Congressional District. Hogan appointed Williams to the hospital system board in 2015.

In a statement released by UMMS, DiPaula said members of the board “regret the actions and poor decisions which have jeopardized confidence in the system.”

The new board members nominated by Hogan are:

» Eliza Basnight, senior vice president of supply chain for the American Red Cross. Previously, she was chief of staff for the U.S. Mint under the Obama administration and head of the Center for Women Veterans at the U.S. Department of Veterans Affairs.

» Kathleen A. Birrane, an attorney with the firm DLA Piper who previously was the top lawyer for the Maryland Insurance Administration.

» Dr. Joseph Ciotola, health officer for Queen Anne’s County and medical director for that county’s Department of Emergency Services.

[Most read] As Maryland leaders condemn expected ICE enforcement in Baltimore region, Gov. Hogan ‘monitoring the situation’ »

» Matthew Clark, Hogan’s chief of staff. Clark will hold a seat that is reserved for the governor or the governor’s designee.

» Wanda Queen Draper, former director of the Reginald F. Lewis Museum of African-American History and Culture in Baltimore.

» Jason Frankl, senior managing director of FTI Consulting, where his work includes helping companies defend against activist investors and takeover attempts.

» Glenn T. Harrell, retired senior judge of the Maryland Court of Appeals.

» Dr. Joyce M. Johnson, a physician who retired from the U.S. Public Health Service, where she held the rank of rear admiral and was director of health for the U.S. Coast Guard.

» Bonnie Phipps, senior vice president and group operating executive for Ascension Health, a Catholic health system that operates in 21 states and the District of Columbia, including Southwest Baltimore’s St. Agnes Hospital, where she was president from 2005 to 2015.

» Joseph T.N. Suarez, a director at Booz Allen Hamilton, a business consulting firm.

» John T. Williams, chairman and CEO of Jamison Door Company in Hagerstown. He previously served as a newspaper and TV executive.

In addition to mandating a gradual replacement of the current board and requiring term limits, the new law banned no-bid contracts for board members and required a state audit of the hospital system’s contracting practices.” (T)

“Francis Kelly Jr., the former Maryland state senator whose insurance company benefited from contracts with the University of Maryland Medical System while he served on the hospital network’s board of directors , announced Friday that he will give up that seat.

“It has been a tremendous honor for me to have served on the UMMS Board for nearly 35 years, under six different Governors,” Kelly wrote in a resignation letter to board chairman Stephen Burch. “I have decided it is time to move on, and allow someone else the fantastic opportunity of serving.”

Kelly and his sons, John and David, who served on UMMS-affiliated boards, took voluntary leaves of absence in April as probes were opened to review the health system’s contracts with businesses affiliated with board members.

In the resignation letter, Kelly said his sons have also decided not to return to their board positions.

The UMMS board voted Wednesday to ask Kelly and three other members on leave to rejoin the board, after an outside probe of the contracting scandal placed most of the blame with former hospital system chief executive Robert Chrencik, who resigned in April.

Several state lawmakers raised concerns about the board’s decision, however, and said board members who had contracts with the system should not return to the board.

“[W]e feel that the best way to serve the system and its affiliated hospitals at this time is not come back onto these boards,” Kelly wrote in a letter to John Ashworth III, the interim president and chief executive.

Kelly & Associates Insurance Group has had multimillion-dollar transactions with the medical system since at least 2005, the first year for which financial disclosure records are available, handling more than $100 million in premiums.” (U)

“A review of contracts the University of Maryland Medical System had with members of its board of directors and their companies revealed more no-bid and self-dealing practices — including that executives pressured staff to use board members’ products — and blamed former CEO Robert Chrencik and other system leaders.

“Many of these contracts were not competitively bid, were not declared to be necessary by the board or senior leaders, and, if vetted, were without full transparency to the entire board,” concluded the review by Nygren Consulting, which was hired and paid by the 13-hospital network.

The report released Wednesday reviewed business deals with nine board members and found:

» Seven of nine of the deals were entered into without competitive bids;

» In four cases, the board of directors was not properly informed of the business relationships;

» The board member who was in charge of auditing financial dealings himself had a no-bid deal;

» In at least two instances, staff felt pressured to promote the use of software from companies that would have benefited individual board members financially.

The report focused its harshest criticism on deals with four board members that hospital officials described as “personal services” contracts: Former Baltimore Mayor Catherine Pugh, who was paid $500,000 for her self-published children’s books; Robert Pevenstein, a consultant who was paid more than $100,000 a year; John W. Dillon, who was paid $892,000 since 2013 for providing “healthcare consulting services;” and Dr. Scott Rifkin, who runs a health care software company.

The system commissioned the review in response to revelations in The Baltimore Sun, beginning in March, about the contracting practices.

“These arrangements reflect a pattern by management of making decisions without full board approval,” the report found of members’ contracts. “The board was insufficiently informed and, for the most part, had no specific advance knowledge that would have caused the board to consider alternatives that would have forestalled or eliminated perceived and real self-dealing.” “ (V)

“The report on self dealing among UMMS board members comes after the departures of the system’s CEO and board members, including former Baltimore Mayor Catherine Pugh. Controversy arose over board members — including Pugh — who made money in business deals with the system.

Regarding Pugh’s “Healthy Holly” book arrangement, Nygren wrote, “Our review has determined that management did not present the book purchases to the board or any committee for prior approval, as required by then-in-effect Conflict of Interest policies, and the purchase was not subject to any competitive bidding process.”

The report concluded that then-CEO Robert Chrencik “agreed to enter into an agreement with Ms. Pugh without consent of the board.”

Between 2010 and 2018, UMMS agreed to pay a total of $500,000 for the self-published books Pugh authored. She repaid $100,000.

The report also investigated other former board members and found similar violations of board policies.

UMMS said in a statement that the report details “both management and various board members share responsibility for the lack of transparency and strong, modern governance policies that resulted in improper relationships.”

UMMS said the following recommendations have been or will be adopted:

A new, comprehensive Conflict of Interest Policy was authored by Nygren and accepted by the Board of Directors. The policy was delivered to Maryland’s governor, Senate president and Speaker of the House on May 31.

A Governance Committee will be chartered as a permanent Committee of the Board, and tasked with overseeing all board practices, policies and relationships. All appropriate guiding documents will be authored.

A new, research-based “competency” model will be implemented to ensure the makeup of the board is determined based on two levels of competencies: those required of each individual member, and those required by the Board as a whole. This will ensure the board is representative of the communities it serves and has the experience and skills necessary to advance the organization’s strategic direction and mission.

The education process related to disclosures and conflicts will be redesigned and will include an official “Code of Conduct” to ensure all board members and senior management are acutely aware of compliance requirements moving forward.

Board committees will be restructured so chair positions of the Finance Committee and the Audit and Compliance Committee are held by separate individuals, and the chair of the latter maintains no financial or contractual relationship with the organization.

“While Nygren confirmed that outside business interests between a board member and a nonprofit Board of Directors are not uncommon or illegal, great care and caution must be given to ensure there is proper vetting and no real or perceived conflicts of interest. To that end, any proposed professional services agreements with board members will be revealed to the full board, carefully vetted with the Board’s Audit and Compliance Committee and reported to the Compliance Officer. The new Conflict of Interest Policy will be strictly adhered to in all cases. Additionally, the system will no longer allow any board member to engage in a personal services agreement, regardless of circumstance,” the UMMS statement read.”  (V)

“The recent ethical lapses within the University of Maryland Medical System and its board have been appalling, with much of the focus on former Baltimore Mayor Catherine Pugh, state legislation passed to improve board oversight and resignations of certain board members.

Scant attention has been paid, however, to an elephant in the room: Most of the board members were, as required by statute, appointed by Gov. Larry Hogan, with some improperly reappointed beyond the two-term legal limit. And many of them, including several of the 11 newly appointed board members, donated to his campaign as individuals or through affiliated businesses — some in apparent excess of campaign finance limits — for a combined total of over $115,000.

While donors receiving appointments isn’t inherently unlawful, it undermines public confidence, particularly when combined with the fact that some of these donor-appointees, including former state Sen. Frank Kelly Jr., appear to have received generous “insider” contracts from UMMS.

And, despite the governor’s professed outrage over UMMS’ dealings, he recently vetoed an important bill that would improve transparency and strengthen accountability of the Governor’s Appointments Office, whose primary purpose is to vet political appointees to represent Mr. Hogan on boards and commissions and in a small handful of high-level leadership positions in state agencies.

The governor prefers to point the finger at UMMS for its failed internal controls, but he, too, should have known that many of his appointees had business dealings with UMMS. His appointments office requires all appointees to complete a form that probes for conflicts of interest and problematic affiliations.

In examining the governor’s campaign finance records, publicly available from the State Board of Elections, I found at least eight UMMS board members — Stephen Burch, R. Alan Butler, John Coale, James “Chip” DiPaula Jr., Barry Gossett, Mr. Kelly, Robert Pevenstein and Walter Tilley Jr. — who donated to Governor Hogan the $6,000 maximum permitted by law.

Businesses apparently connected to Mr. Tilley, James Soltesz, Mr. DiPaula and Robert Rauch also contributed a combined $16,000 to Governor Hogan’s campaign.

Four board members or related businesses appear to have contributed above the $6,000 legal limit in total over a four-year period:

Kelly Integral Solutions LLC, contributed $11,000 — all while Kelly & Associates received a lucrative UMMS contract reportedly worth $16 million. (Mr. Kelly is among those who recently announced his resignation from the board.)..

In order to boost accountability, and in response to numerous complaints of politicization of the state workforce, I introduced and passed legislation (Senate Bill 751) during this past session that would increase transparency regarding the information gathered by the appointments office by requiring annual aggregated reporting back to the General Assembly. The governor vetoed it.” (X)

“For its report, Nygren reviewed system documents and interviewed about 60 people, including current and former board members, executives and staff. Here are some of the firm’s key findings:

1) Blaming the old boss.

Chrencik was blamed for cutting deals with individual board members without the full board’s approval. In four cases, the board was not properly informed of the deals…

2) Most deals with board members weren’t competitively bid.

Seven of nine of the deals with individual board members were entered into without competitive bids…

3) Who’s doing oversight?

The board member who was in charge of monitoring financial dealings himself had a no-bid deal. Robert Pevenstein, who was chairman of both the audit and finance committees, had several arrangements with the system, including for-profit relationships for the firms Profit Recovery Partners and Optime, as well as a consulting deal. He was paid more than $100,000 a year…

4) Staff felt uncomfortable.

In at least two instances, UMMS employees felt pressured to promote the use of software from companies that benefited individual board members financially…”  (Y)

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A public health approach will enable the United States to address culture, firearm safety, and reasonable regulation


– Dig deeper in defining mass firearms killings as a public health issue.

– Profile hospital Rapid Response preparedness for receiving injured from a mass shooting.

– How can hospitals prepare for an “active shooter” situation in the hospital?

“Shortly after the November 2018 publication of the American College of Physicians’ policy position paper on reducing firearm injury and death (1), the National Rifle Association tweeted: Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves…

In 2015, several of our organizations joined the American Bar Association in a call to action to address firearm injury as a public health threat. This effort was subsequently endorsed by 52 organizations representing clinicians, consumers, families of firearm injury victims, researchers, public health professionals, and other health advocates (2). Four years later, firearm-related injury remains a problem of epidemic proportions in the United States, demanding immediate and sustained intervention. Since the 2015 call to action, there have been 18 firearm-related mass murders with 4 or more deaths in the United States, claiming a total of 288 lives and injuring 703 more (3).

With nearly 40 000 firearm-related deaths in 2017, the United States has reached a 20-year high according to the Centers for Disease Control and Prevention (CDC) (4). We, the leadership of 6 of the nation’s largest physician professional societies, whose memberships include 731 000 U.S. physicians, reiterate our commitment to finding solutions and call for policies to reduce firearm injuries and deaths. The authors represent the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American College of Surgeons, American Medical Association, and American Psychiatric Association. The American Public Health Association, which is committed to improving the health of the population, joins these 6 physician organizations to articulate the principles and recommendations summarized herein. These recommendations stem largely from the individual positions previously approved by our organizations and ongoing collaborative discussion among our leaders (1, 5–10)…

Our organizations support a multifaceted public health approach to prevention of firearm injury and death similar to approaches that have successfully reduced the ill effects of tobacco use, motor vehicle accidents, and unintentional poisoning. While we recognize the significant political and philosophical differences about firearm ownership and regulation in the United States, we are committed to reaching out to bridge these differences to improve the health and safety of our patients, their families, and communities, while respecting the U.S. Constitution.

A public health approach will enable the United States to address culture, firearm safety, and reasonable regulation consistent with the U.S. Constitution. Efforts to reduce firearm-related injury and death should focus on identifying individuals at heightened risk for violent acts against themselves or others (20). All health professionals should be trained to assess and respond to those individuals who may be at heightened risk of harming themselves or others.

Screening, diagnosis, and access to treatment for individuals with mental health and substance use disorders is critical, along with efforts to reduce the stigma of seeking this mental health care. While most individuals with mental health disorders do not pose a risk for harm to themselves or others (21), improved identification and access to care for persons with mental health disorders may reduce the risk for suicide and violence involving firearms for persons with tendencies toward those behaviors.

In February 2019, 44 major medical and injury prevention organizations and the American Bar Association participated in a Medical Summit on Firearm Injury Prevention. This meeting focused on building consensus on the public health approach to this issue, highlighting the need for research, and developing injury prevention initiatives that the medical community could implement (22). Here we highlight specific policy recommendations that our 7 organizations believe can reduce firearm-related injury and death in the United States.

Background Checks for Firearm Purchases; Need for Research on Firearm Injury and Death; Intimate Partner Violence; Safe Storage of Firearms; Mental Health; Extreme Risk Protection Orders; Physician Counseling of Patients and “Gag Laws”; Firearms With Features Designed to Increase Their Rapid and Extended Killing Capacity” (A)

“There were three high-profile shootings across the country in one week: The shooting in Gilroy, Calif., on July 28, and then the back-to-back shootings in El Paso, Texas, and Dayton, Ohio, this past weekend.

That’s no surprise, say scientists who study mass shootings. Research shows that these incidents usually occur in clusters and tend to be contagious. Intensive media coverage seems to drive the contagion, the researchers say.

Back in 2014 and 2015, researchers at Arizona State University analyzed data on cases of mass violence. They included USA Today’s data on mass killings (defined as four or more people killed using any means, including guns) from 2006 to 2013, data on school shootings between 1998 and 2013, and mass shootings (defined as incidents in which three people were shot, not necessarily killed) between 2005 and 2013 collected by the Brady Campaign to Prevent Gun Violence.

The lead researcher, Sherry Towers, a faculty research associate at Arizona State University, had spent most of her career modeling the spread of infectious diseases — like Ebola, influenza and sexually transmitted diseases. She wanted to know whether cases of mass violence spread contagiously, like in a disease outbreak.

“What we found was that for the mass killings — so these are high-profile mass killings where there’s at least four people killed — there was significant evidence of contagion,” says Towers. “We also found significant evidence of contagion in the school shootings.”

In other words, school shootings and other shootings with four or more deaths spread like a contagion — each shooting tends to spark more shootings…

Peterson and other researchers who study mass shootings think the media should avoid showing the shooters’ images and dwelling on their life histories and motives. “The fact that we give them that notoriety is problematic,” says Peterson.” (B)

“The country is splitting into the gun law-haves, and the gun law have-nots, and deadly statistics are now revealing the impact those policy decisions have on people’s lives.

It happened again. This time, gunmen in El Paso, Texas, and Dayton, Ohio, murdered 31 people and injured at least 50 more in separate mass shooting attacks within 13 hours of each other Saturday night and Sunday morning. It was, in many ways, just another weekend in America, the only nation in the developed world where horrific gun massacres regularly occur. Though nothing new, the frequency of such public mass shootings appears to have accelerated over the past five years, along with larger and more tragic death tolls. According to one recent analysis by The Washington Post, a mass shooting event has claimed the lives of four or more people every 47 days since June 2015. In the mid-’90s, such attacks happened just twice a year, on average.

But this surge in public executions has not swept across all corners of the country equally. Hawaii, for instance, hasn’t seen a mass shooting since 1999. Florida, on the other hand, has had six such incidents, defined by the US government as four or more people killed by a single individual, in the past three years alone, according to data from the nonprofit Gun Violence Archive. And like other forms of gun violence—including homicide, suicide, and unintended accidents—researchers are finding that mass shooting events happen more often in states with looser gun laws.

Because while Congress may not have passed any national gun laws in the aftermath of past mass shootings, individual state legislatures have. And as the disparity between states with weak gun laws and those with tough ones has widened, so too has the gap in mass shootings. Which means that terrorist acts like those committed in El Paso and Dayton over the weekend are more likely to keep happening to people who live in places where it’s easy to buy, sell, and carry guns. The country is splitting into the gun law haves and the gun law have-nots, and deadly statistics are now revealing the impact those policy decisions have on people’s lives.

Studying mass shootings, which make up only a tiny fraction of all gun deaths, has long been tricky, because of their historical rarity and a general dearth of data on guns or gun deaths. (That’s because of research-stifling federal legislation that was only recently overturned.) But one ironic effect of there being more mass shootings lately is scientists now have enough data to start to see trends emerging…

What the researchers found was that over time states have dug themselves into a bimodal distribution. That is, they’ve self-clumped into two distinct groups—a smaller one made up of eight states scoring between 5 and 25, and another, much larger, one clustered around scores from 70 to 100. “One of the most interesting things about this data is that we aren’t seeing a full spectrum, because there just aren’t that many states directly in the middle,” says Paul Reeping, the study’s lead author.” (C)

“…Two policies exist today that if properly designed, widely enacted, and adequately implemented would likely have saved these lives and could potentially save many more in the future. Their benefits would extend far beyond reducing the incidence of mass shootings (see map and the interactive graphic, available at

The better known of these policies is the requirement that firearm sales involve background checks on purchasers. Background-check policies work at the population level to prevent firearm purchases by felons, people convicted of certain violent misdemeanors, and others who are at increased risk for violent behavior (specifics vary from state to state). Using background checks to prevent such persons from acquiring firearms is associated with a reduction of at least 25% in their incidence of arrest for a firearm-related or other violent crime.1

The second policy that could prevent firearm-related deaths is to allow courts to have firearms removed temporarily from people who pose an imminent hazard to others or themselves but are not members of a prohibited class. Again, provisions vary; in California, family members and law-enforcement officials can follow procedures based on those established for domestic violence to petition for a firearm to be removed. Physicians can play an important role in these cases by notifying eligible petitioners when intervention is warranted; disclosure of otherwise-confidential information is expressly permitted by Health Insurance Portability and Accountability Act regulations when an imminent hazard exists.” (D)

“Here are 10 of the most talked-about strategies that have been floated to stop mass shootings, and how likely they are to work.

Assault weapons ban. High-capacity magazine ban. Funding CDC research into gun violence. Universal background checks. Gun violence restraining orders or red flag laws. Arming teachers. Active shooter drills. Having students, faculty, and staff report potential threats. Banning violent video games. ‘Hardening schools’” (E)

“In our work at the School of Public Health we are making gun owners part of the solution. My colleague Cathy Barber is working with gun owners, gun advocates, gun trainers, and gun shop owners. Together they are finding common ground and developing solutions. The first area where they have found much common ground is around suicide. The evidence is overwhelming that a gun in the home increases the risk of suicide. More people die from gun suicide than gun homicide, and the people dying are gun owners and their families. Cathy has helped get gun shops in 20 states to play a role in reducing suicide. One grass-roots education effort includes guidelines on how to avoid selling or renting a firearm to a suicidal customer. To activate gunners, you need the right message and the right messenger. And the right messenger isn’t Harvard or public health professionals, it is responsible gun owners themselves. She is hoping to expand her focus to work on preventing guns from moving from the licit to the illicit market. Gun advocates have great ideas; they know about guns; and they are big into safety, so there are large potential benefits to get them to work together with public health professionals. That’s the goal.” (F)

“Following two mass shootings last weekend that ended the lives of 31 people, seven leading medical organizations have said “enough” and called for action to prevent gun-related injuries and deaths.

In the aftermath of the back-to-back mass shootings in Ohio and Texas that shook the country, the leaders of the physician and public health organizations called for immediate action to prevent gun violence in a special article published Wednesday in the Annals of Internal Medicine, the publication of the American College of Physicians (ACP).

“We are living in a world where gun violence is becoming increasingly common, and as physicians, we have a responsibility to address this public health crisis and to keep our patients safe and healthy,” said ACP President Robert McLean, M.D., in a statement.

In addition to the ACP, the article was authored by the physicians who lead the American Academy of Family Physicians, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Psychiatric Association, and the American Public Health Association…

“We, the leadership of 6 of the nation’s largest physician professional societies, whose memberships include 731,000 U.S. physicians, reiterate our commitment to finding solutions and call for policies to reduce firearm injuries and deaths,” the doctors wrote. The leaders of the physician organizations were joined by the American Public Health Association.

In the article, they suggest numerous steps to ending gun violence including addressing high-capacity magazines and firearms. “The magnitude and frequency of mass attacks are unacceptable to our organizations. A common-sense approach to reducing casualties in mass shooting situations must effectively address high-capacity magazines and firearms with features designed to increase their rapid and extended killing capacity,” the physician leaders wrote.” (G)

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PART 3. Hopkins All Children’s Hospital/ North Carolina Children’s – pediatric cardiac surgery debacles.

ASSIGNMENT: What are the Lessons Learned from the Johns Hopkins All Children’s Hospital and North Carolina Children’s Hospital pediatric open cardiac surgery program failures? What are the regulatory implications?

New PART 3 after PARTs 1 and 2.

PART 1. February 26, 2019. Johns Hopkins All Children’s Hospital (St Petersburg, Florida) – problems in the hospital’s heart surgery unit

PART 2. June 1, 2019. “The situation that the New York Times described in North Carolina parallels that at Johns Hopkins All Children’s Hospital in St. Petersburg, which stopped performing heart surgeries after the Tampa Bay Times reported on problems in the unit

PART 1. February 26, 2019. Johns Hopkins All Children’s Hospital (St Petersburg, Florida) – problems in the hospital’s heart surgery unit

“The Patient Safety and Healthcare Quality Masters program is a fully online, interdisciplinary degree offered by Johns Hopkins University. It is a first-of-its-kind collaboration between the Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, Johns Hopkins School of Nursing and the Armstrong Institute for Patient Safety and Quality. It combines coursework from JHU’s top ranked schools and the Armstrong Institute’s pioneering advances in patient safety-educating students in the transformative mechanisms and evidence-based protocols that reduce preventable patient harm and improve clinical outcomes.

Renowned, industry-shaping experts lead this exciting new program designed for working adults. The program focuses on: Measurement of safety and quality; Designing safer systems; Organizational and cultural change. ” (A)

“Patient Safety and Quality at Johns Hopkins Medicine.

Each day in a hospital, staff members undertake complicated tasks caring for patients. Johns Hopkins Medicine’s patient safety efforts aim to ensure that all of these steps work together to deliver high-quality, compassionate care to all patients across our health system.

Johns Hopkins Health System hospitals and services consistently receive awards and honors for patient safety and quality, including Top Performer on Key Quality Measures by the Joint Commission, Magnet designation for nursing, HomeCare Elite and Delmarva Foundation Excellence Awards. The Johns Hopkins Hospital has been ranked No. 1 in the nation by U.S. News & World Report for 22 years of the survey’s 25-year history, most recently in 2013.

Patient Safety and Quality Measures

This website shares data for the Johns Hopkins Health System. Here, you will find information about key safety issues and the patient’s experience of care, including:

Patient Experience – Based on survey results from previous patients, you can see how others rated their experience of care from a Johns Hopkins Medicine hospital or home health care provider.

Infection Prevention – These measures include the rate of CLABSIs, a bloodstream infection caused by a central line (large IV) that are considered preventable and hand hygiene, the percentage of medical staff members observed washing their hands or using hand sanitizer before and after caring for a patient.

Core Measures – These measures are national standards of care and treatment processes for common conditions. Core measure compliance shows how often a hospital follows each of these steps.

Surgical Volumes – Studies have shown a strong relationship exists between the number of times a hospital performs a specific surgical procedure and the outcomes for those patients. In 2016, we started sharing our hospitals’ surgical volumes for many common and high-risk procedures.

Quality of Care Ratings – The quality of patient care star rating is a summary of how well the Johns Hopkins Home Care Group and Potomac Home Health Care perform on nine quality measures such as ambulation.

Pediatrics – These measures include national standards of treatment for common conditions, infection prevention, pain management and emergency department wait times for Johns Hopkins’ pediatric divisions.

Hospital Readmissions – Patients are most vulnerable for readmission to a hospital immediately following discharge. This measure tracks how many Medicare patients with specific conditions were readmitted to the hospital within 30 days for any reason.

Our Commitment to Transparency

Patients and their loved ones deserve to be informed about the quality of their heath care. At Johns Hopkins Medicine, we are dedicated to sharing our performance and how we work to provide the best care with past, present and future patients. The Johns Hopkins Armstrong Institute for Patient Safety and Quality coordinates safety and quality improvement efforts and training across our health system.

We hope you will find this website a valuable resource and encourage you to ask your health care team if you have any questions or concerns. (B)

“Patient Trust, Confidence Built on Interprofessional Innovation

Medical errors and preventable patient infections and injuries together make up the third-leading cause of death in the United States, a startling statistic.

The Johns Hopkins School of Nursing understands that an increasing focus on patient safety and quality of care depends upon a healthcare workforce that knows the risks and the proper responses from patients’ arrival to their safe discharge.

The Helene Fuld Leadership Program for the Advancement of Patient Safety and Quality (The Fuld Fellows Program) emphasizes interprofessional education and training, simulation, and service-learning experiences involving nurses, medical students, pharmacists, and other health professionals whose collaboration is critical for reducing preventable harm to patients.

Nurses, as the primary contact with patients, play a key role in their safety. Hopkins Nursing, as part of an interprofessional team that includes the Armstrong Institute for Patient Safety & Quality and the Johns Hopkins Health Systems, works to prepare nurses ready to communicate, cooperate, innovate, and lead on issues of patient safety and quality of care.” (C)

“Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality

A roadmap for patient safety and quality improvement

This month the Agency for Healthcare Research and Quality (AHRQ) published a new report that identifies the most promising practices for improving patient safety in U.S. hospitals.

An update to the 2001 publication Making Health Care Safer: A Critical Analysis of Patient Safety Practices, the new report reflects just how much the science of safety has advanced.

A decade ago the science was immature; researchers posited quick fixes without fully appreciating the difficulty of challenging and changing accepted behaviors and beliefs.

Today, based on years of work by patient safety researchers-including many at Johns Hopkins-hospitals are able to implement evidence-based solutions to address the most pernicious causes of preventable patient harm. According to the report, here is a list of the top 10 patient safety interventions that hospitals should adopt now.

Top 10 Recommended Patient Safety Strategies

1. Preoperative checklists and anesthesia checklists to prevent operative and postoperative events.

2. Bundles that include checklists to prevent central line-associated bloodstream infections

3. Interventions to reduce urinary catheter use, including catheter reminders, stop orders, or nurse-initiated removal protocols

4. Bundles that include head-of-bed elevation, sedation vacations, oral care with chlorhexidine, and subglottic-suctioning endotracheal tubes to prevent ventilator-associated pneumonia

5. Hand hygiene

6. The do-not-use list for hazardous abbreviations

7. Multicomponent interventions to reduce pressure ulcers

8. Barrier precautions to prevent healthcare-associated infections

9. Use of real-time ultrasonography for central line placement

10. Interventions to improve prophylaxis for venous thromboembolisms…

Even with a list of sound strategies, creating a plan to implement all or even half of them may sound like a daunting task. The Armstrong Institute for Patient Safety and Quality has created a checklist to help you get started.

1. Identify priorities and assess readiness for change.

2. Establish engagement and accountability at all levels of the organization.

3. Communicate constantly (the good and the bad).

4. Measure, measure, measure… and then measure some more. (D)

“Johns Hopkins All Children’s Hospital provides expert pediatric care for infants, children and teens with some of the most challenging medical problems in our community and around the world.

Named a top 50 children’s hospital by U.S. News & World Report, we provide access to innovative treatments and therapies. Taking part in pediatric medical education and clinical research helps us to provide care in more than 50 specialties.

With more than half of our 259 beds devoted to intensive care level services, we are the regional pediatric referral center for Florida’s West Coast. Physicians and community hospitals count on us to care for critically ill patients and perform complex surgical procedures.

Parents count on us, too. Our philosophy of family-centered care means family members are an important part of our health care team. We include parents in making decisions and plans for their child’s care. We also include patients who are old enough to take part in these discussions.

To help us design our hospital that we opened in January 2010, we asked patients, parents and our staff to share ideas. The result was a spacious and bright hospital with individual rooms where parents can comfortably spend the night. With the latest technology and our commitment to family-centered care, our hospital provides an ideal environment for healing.” (E)

“Quality, Outcomes and Patient Safety at Johns Hopkins All Children’s

We are committed to treating you and your child with compassion and respect. We believe that you deserve honesty in our communication about the plan for your child’s care and we will demonstrate uncompromising integrity to earn your trust. We will be responsible for including each family as a part of our care team that is committed to safe and innovative care practices. Our goal is to inspire hope for you and your child through our focus on inquiry, collaboration, and team work.

Johns Hopkins All Children’s Hospital believes in Creating healthy tomorrows… for one child, for All Children. Our focus on Quality assures that we are continually improving our processes in an effort to achieve this vision. Using a team approach we tap into the know-how of our expert medical staff and employees to improve the quality and safety of the care we provide.

Our Quality Model provides the basis for understanding patient needs, measuring and using data, and achieving real improvement. Improving continuously is our goal. To do this we encourage each member of our team to find ways to do their work better and to make patient safety a priority. Together we are focused on pursuing perfection for All Children.

Quality Measures

There are many ways to look at and measure quality. Our data uses information from key areas to help families, healthcare providers, and others learn about our progress in pursuing perfection for All Children.” (F)

“Sandra Vázquez paced the heart unit at Johns Hopkins All Children’s Hospital.

Her 5-month-old son, Sebastián Vixtha, lay unconscious in his hospital crib, breathing faintly through a tube. Two surgeries to fix his heart had failed, even the one that was supposed to be straightforward.

Vázquez saw another mom in the room next door crying. Her baby was also in bad shape.

Down the hall, 4-month-old Leslie Lugo had developed a serious infection in the surgical incision that snaked down her chest. Her parents argued with the doctors. They didn’t believe the hospital room had been kept sterile.

By the end of the week, all three babies would die…

The internationally renowned Johns Hopkins had taken over the St. Petersburg hospital six years earlier and vowed to transform its heart surgery unit into one of the nation’s best.

Instead, the program got worse and worse until children were dying at a stunning rate, a Tampa Bay Times investigation has found.

Nearly one in 10 patients died last year. The mortality rate, suddenly the highest in Florida, had tripled since 2015…

Times reporters spent a year examining the All Children’s Heart Institute – a small, but important division of the larger hospital devoted to caring for children born with heart defects…

They discovered a program beset with problems that were whispered about in heart surgery circles but hidden from the public.

Among the findings:

All Children’s surgeons made serious mistakes, and their procedures went wrong in unusual ways. They lost needles in at least two infants’ chests. Sutures burst. Infections mounted. Patches designed to cover holes in tiny hearts failed.

Johns Hopkins’ handpicked administrators disregarded safety concerns the program’s staff had raised as early as 2015. It wasn’t until early 2017 that All Children’s stopped performing the most complex procedures. And it wasn’t until late that year that it pulled one of its main surgeons from the operating room.

Even after the hospital stopped the most complex procedures, children continued to suffer. A doctor told Cash Beni-King’s parents his operation would be easy. His mother and father imagined him growing up, playing football. Instead multiple surgeries failed, and he died.

In just a year and a half, at least 11 patients died after operations by the hospital’s two principal heart surgeons. The 2017 death rate was the highest any Florida pediatric heart program had seen in the last decade.

Parents were kept in the dark about the institute’s troubles, including some that affected their children’s care. Leslie Lugo’s family didn’t know she caught pneumonia in the hospital until they read her autopsy report. The parents of another child didn’t learn a surgical needle was left inside their baby until after she was sent home.

The Times presented its findings to hospital leaders in a series of memos early this month. They declined interview requests and did not make the institute’s doctors available to comment.

In a statement, All Children’s did not dispute the Times’ reporting. The hospital said it halted all pediatric heart surgeries in October and is conducting a review of the program.

“Johns Hopkins All Children’s Hospital is defined by our commitment to patient safety and providing the highest quality care possible to the children and families we serve,” the hospital wrote. “An important part of that commitment is a willingness to learn.” (G)

The top three leaders of Johns Hopkins All Children’s Hospital in Florida resigned Tuesday following a Tampa Bay Times investigation that revealed increasing mortality rates among heart surgery patients.

The resignations from the 259-bed teaching hospital in St. Petersburg included CEO Jonathan Ellen, M.D., and Vice President Jackie Crain, as well as Jeffrey Jacobs, M.D., who is the heart institute’s deputy director, the Tampa Bay Times reported. Paul Colombani, M.D., stepped down as chairman of the department of surgery but will continue working in a clinical capacity, a statement from the health system said.

“Losing a child is something no family should have to endure, and we are committed to learning everything we can about what happened at the Heart Institute, including a top-to-bottom evaluation of its leadership and key processes,” a statement from Johns Hopkins read. “The events described in recent news reports are unacceptable.”

Johns Hopkins, which owns and operates the hospital, said it would install Kevin Sowers, who is president of the Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine, to lead the hospital in a temporary capacity while a plan for interim leadership is put into place.

George Jallo, M.D., who is medical director of the Institute for Brain Protection Sciences and chief of pediatric neurosurgery, will serve as interim vice dean and physician-in-chief, and Paul Danielson, M.D., who is chief of the Division of Pediatric Surgery at Johns Hopkins All Children’s Hospital, will serve as interim chair of the surgery department.

Johns Hopkins’ board also said it commissioned an external review to examine the heart surgery program and said it would share its lessons from the review to help hospitals around the country avoid the same mistakes.

The moves come following the Tampa Bay Times investigation that highlighted a growing number of heart surgery deaths at the hospital amid warnings about safety from staffers that went unheeded. (H)

“Three additional senior administrators have left Johns Hopkins All Children’s Hospital in the wake of a Tampa Bay Times investigation into high mortality rates at the hospital’s Heart Institute, the hospital announced Wednesday.

A total of six senior officials have left since the Times report, including the hospital’s CEO, three vice presidents and two surgeons who held leadership roles at the Heart Institute. A seventh official stepped down as chairman of the surgery department but remained employed at the hospital as a doctor.

The resignations announced Wednesday included vice presidents Dr. Brigitta Mueller, the hospital’s chief patient safety officer, and Sylvia Ameen, who oversaw culture and employee engagement and served as the hospital’s chief spokeswoman.

The hospital also said Dr. Gerhard Ziemer, who started as the Heart Institute’s new director and chief of cardiovascular surgery in October, would leave the hospital. The hospital never publicly announced Ziemer had been hired, and he had not yet obtained his Florida medical license when the Times investigation was published at the end of November. At that point, the hospital said the Heart Institute had already stopped performing surgeries.

“While Dr. Ziemer is not responsible for the current state of the program, we agreed that a fresh start was needed to ensure success for the program,” Johns Hopkins Health System President Kevin Sowers said in a letter to the hospital’s staff.” ..

In his letter to the staff, Sowers said that several hospital executives had been tasked with leading “critically important work around advancing our culture of safety.”

“As we work to rebuild the trust of our community, we must also work to fully embrace and support a culture where we are each empowered and encouraged to speak up and speak out if we see or hear something that concerns us,” he wrote. “This commitment applies to clinical concerns as well as inappropriate workplace behavior.”

Sowers also announced that Johns Hopkins had hired external experts to develop a plan to restart heart surgeries at All Children’s.

That is a separate effort from an external review of the problems in the Heart Institute, which Johns Hopkins announced its board had commissioned last month, spokeswoman Kim Hoppe said…

Johns Hopkins is one of the most prestigious brands in medicine and is internationally renowned for developing innovative patient safety protocols that are used at hospitals across the world. But last weekend, the Times published a story detailing a series of safety problems at hospitals across its network. In response, the health system pledged to “do better.” (I)

“The Johns Hopkins Medicine Board of Trustees has appointed a former federal prosecutor to lead its investigation into the Johns Hopkins All Children’s Hospital’s heart surgery unit, the health system announced late Tuesday.

F. Joseph Warin, of the global law firm Gibson Dunn, and his team will review the high mortality rates and other problems at the hospital’s Heart Institute and report back to a special committee of the board of trustees by May, the health system said.

Once the review is complete, the health system said it would also name an independent monitor at All Children’s to “make sure that the hospital is being held accountable for taking corrective action where necessary.”

The announcement was accompanied by a video of Johns Hopkins Health System president Kevin Sowers, who acknowledged for the first time that the hospital had been warned about problems by frontline workers.

“I know personally that many of you courageously spoke out when you had concerns but were ignored or turned away,” he said. “That behavior is unacceptable and will not be tolerated going forward.”

Sowers, who is also interim president at All Children’s, said he hoped to meet with the families of patients affected by problems in the Heart Institute in the coming days to share his “profound sadness for the failures of care they experienced.” (J)

“The external review was prompted by multiple reports by the Tampa Bay Times about problems at the center which could have contributed to its mortality rate tripling between 2015 and 2017…

Health News Florida’s Stephanie Colombini talked about what could come next with Kathleen McGrory, one of the lead reporters.

One of the big problems you uncovered in your reporting was the lack of available data about mortality rates at a lot of these heart surgery programs…

Officials have either refused to release it or they only release four-year averages, which could mislead families about the current state of the program they’re choosing.

How is the state looking at making these programs more transparent?

There were some problems at another pediatric heart surgery program in 2015 in Palm Beach County (St. Mary’s Medical Center), and after those problems surfaced, the legislature put together a panel (Pediatric Cardiology Technical Advisory Panel) tasked with looking at transparency and ways we could, as a state, make these programs better and more accountable.

That panel is in the middle of doing its work right now and in fact has come close to finalizing some recommendations.

The panel would like all of these heart surgery programs to be reporting their one-year data (on mortality rates) rather than their four-year data because that four-year data can sometimes hide serious problems…

So the state is looking into making heart surgery programs more accountable, but is anyone calling for change when it comes to the government’s role in this?

You reported that multiple times state and federal regulators were alerted to problems at All Children’s and yet little, to no action was taken.

We saw U.S. Reps. Kathy Castor and Charlie Crist put some really tough questions to federal regulators asking what they had investigated and when. We haven’t heard back yet on that front but we know it’s something they’ll be looking into.

The state told us that they did the best they could do with the information that they had, same thing with the federal government.

But ACHA has a new chief (Mary Mayhew). We haven’t gotten a chance to connect with her yet and see what her thoughts are on this, but we certainly will do that in the new year. (K)

“State and federal inspectors descended on Johns Hopkins All Children’s Hospital this week, following sharp calls for an investigation into problems in the hospital’s heart surgery unit, the Tampa Bay Times has learned.

The scope of the inspection is unclear. But hospital regulators had been criticized in recent weeks for their lax response to early signs of an increase in mortality at the hospital’s Heart Institute.

A Florida Agency for Health Care Administration spokeswoman said her agency had been at the facility.

A spokeswoman for the hospital confirmed federal inspectors had been there, too.

“We appreciate the oversight role that our regulators play and we will, as always, be fully cooperative and collaborative as they conduct any reviews necessary,” a statement from the hospital said.

A spokeswoman for the federal Centers for Medicare and Medicaid Services declined to comment beyond saying the matter remained “an ongoing review.”

In November, the Times reported that the mortality rate for heart surgery patients at All Children’s tripled from 2015 to 2017 to become the highest rate in Florida. The increase occurred after staff members warned the hospital’s leaders about problems with two heart surgeons, the Times found.

State and federal regulators knew the institute was having problems months earlier. In April, the hospital’s CEO told the Times that the institute had “challenges” that led to an uptick in mortality, and acknowledged the hospital had left surgical needles inside two children.

In May, state regulators cited the hospital for not properly reporting two medical mistakes, which is required by state law. Days later, a spokeswoman for the federal agency told the Times that it would perform its own investigation.

But state regulators didn’t fine the hospital, and overlooked several subsequent warnings that its surgical results had been poor.

And federal inspectors later changed course and decided not to undertake a comprehensive review of the heart surgery program, the Times reported last month. One reason was that state inspectors hadn’t found any violations of federal rules, a spokeswoman said. Another was that a nonprofit hospital accreditor was due to perform a scheduled review.” (L)

Two Omaha surgeons filed a lawsuit Friday against Children’s Hospital & Medical Center, alleging that they were wrongfully suspended and forced to resign privileges there after they raised patient safety concerns.

In the suit, Dr. Jason Miller and Dr. Mark Puccioni say that the hospital suspended their privileges to practice at the Omaha facility after they raised concerns about the death of a 7-month-old during an operation. That operation was performed this fall by another surgeon, Dr. Adam Conley, the suit says.

In their communications, according to the suit filed in Douglas County District Court, the two also questioned Conley’s “skill and ability.”

In addition to the hospital, the lawsuit names as defendants Conley, as well as Dr. Richard Azizkhan, who took over as Children’s president and CEO in October 2015.

Children’s officials said in a statement that the hospital does not comment on pending litigation “other than to say we strongly disagree with these allegations…

Children’s has faced other issues in recent months.

In late November, a former pharmacy director at the hospital was accused of funneling more than $4.4 million from the organization into her personal account over six years. She was terminated in June and faces a hearing regarding possible disciplinary action later this month.

About three weeks ago, the Nebraska Medical Association sent a letter to the board of Children’s Hospital expressing concerns about “patient care, safety and quality” at the Omaha hospital, in addition to the loss of longtime physicians.

In the Dec. 11 letter, the president of the group, Dr. Britt Thedinger, wrote, “We as physicians are concerned about the summary suspensions, terminations and resignations of long-time outstanding physician colleagues.” The letter also expressed concern that children were being transferred to outside institutions because of “complications” and inadequate staffing at the Omaha hospital.

Thedinger said the organization did not intend for the letter to become public. The intent, he said, was to bring issues that had been raised by members to the hospital board and administration.” (M)

“The New Jersey Department of Health is investigating four Acinetobacter baumannii cases in the neonatal intensive care unit (NICU) of University Hospital in Newark, authorities announced Thursday evening.

DOH officials stated:

“The department first became aware of this bacterial infection on Oct. 1 and two department teams have been closely monitoring the situation. Those department teams, which have been at the facility last week and this week, have been ensuring that infection control protocols are followed and are tracking cases of the infection. The department’s inspection revealed major infection control deficiencies.”

According to the DOH, a premature baby with the bacteria who had been cared for at University Hospital was transferred to another facility and passed away toward the end of September, prior to the department’s notification of problems in the NICU.

“Due to the other compounding medical conditions, the exact cause of death is still being investigated,” DOH officials said.

The department has ordered a Directed Plan of Correction that requires University Hospital to employ a full-time Certified Infection Control Practitioner consultant, who will report to the DOH on immediate actions taken in the coming days.

DOH officials said they are also exploring further actions the agency may need to take in the coming days to “ensure patient safety.” (N)

“Four New Jersey pediatric care facilities and one hospital are now under the state’s microscope after nine children died and 26 people were sickened by a deadly virus over the past month.

A Department of Health team of infection control experts and epidemiologists will visit University Hospital in Newark and four pediatric long-term care facilities in November to conduct training and assessments of infection control procedures, Commissioner Dr. Shereef Elnahal has announced.

The team of experts will visit University Hospital, the Wanaque Center for Nursing & Rehabilitation in Haskell, Voorhees Pediatric Facility in Voorhees and Children’s Specialized Hospital in Toms River and Mountainside. The department reached out to the facilities last week to schedule visits in November.

The decision comes after nine children at a Wanaque facility have died since an outbreak of the adenovirus was declared there. Victims became sick between Sept. 26 and Oct. 22. Authorities confirmed that the virus killed eight of the nine kids.

Twenty-six kids and a staff member, who has since recovered, have become ill as part of the outbreak, state health officials said. Laboratory tests confirmed the 26th case. (O)

“Two decades ago, the Institute of Medicine shook the medical profession with its “To Err is Human” report which said nearly 100,000 people a year lost their lives to preventable medical errors…

During the 7th Annual World Patient Safety, Science & Technology Summit over the weekend, the Patient Safety Movement Foundation released a new tool on its website to help with the training.

The patient safety curriculum is one of 17 Actionable Patient Safety Solutions (APSS) made available to organizations for free to help train health professionals in systems science so they can help find ways to reduce preventable patient deaths, officials said.

“The goal is to get every health professional to think in a system way,” said Steven Scheinman, M.D., the president and dean of Geisinger Commonwealth School of Medicine. He led a Patient Safety Movement working group which included experts from Geisinger, San Diego State, University of Pittsburgh Medical Center, Johns Hopkins Health, and MedStar Georgetown to develop the curriculum over an 18-month period.

The Patient Safety Movement was founded in 2013 to help reduce preventable deaths in healthcare and in 2015 set a goal of zero preventable deaths by 2020. More than 90,000 patients who might have died as a result of medical errors were saved in 2018 due to efforts made by more than 4,700 hospitals that committed to patient safety efforts, according to figures released by the foundation. In all, a total of 273,077 lives have been saved since the first summit, officials said.

The newly released safety curriculum can be adapted to any healthcare profession including medicine, nursing, pharmacy, and behavioral health and can be used for student training, as well as training for experienced professionals.

“We want to train every health professional to take ownership of the patient’s safety and experience so they understand safe communication and know when they are telling another person about the patient or handing them over or referring them over, how to make sure they get all the critical information there,” Scheinman said…

“The airline industry solved safety by creating the right systems,” Scheinman said. “Medical errors are very widespread. But they usually aren’t a doctor making a mistake. They can be. But they’re more often the system failed to pick something up or allowed something bad to happen.”

And with this training, he said, those medical professionals might be that much more likely to help figure out a new solution to make sure something bad doesn’t happen again.” (P)

“.. experience showcases the promise of a much-touted but little understood collaboration in health care: alliances between community hospitals and some of the nation’s biggest and most respected institutions.

For prospective patients, it can be hard to assess what these relationships actually mean – and whether they matter.

Leah Binder, president and chief executive of the Leapfrog Group, a Washington-based patient safety organization that grades hospitals based on data involving medical errors and best practices, cautions that affiliation with a famous name is not a guarantee of quality.

“Brand names don’t always signify the highest quality of care,” she said. “And hospitals are really complicated places.”..

To expand their reach, flagship hospitals including Mayo, the Cleveland Clinic and Houston’s MD Anderson Cancer Center have signed affiliation agreements with smaller hospitals around the country. These agreements, which can involve different levels of clinical integration, typically grant community hospitals access to experts and specialized services at the larger hospitals while allowing them to remain independently owned and operated. For community hospitals, a primary goal of the brand-name affiliation is stemming the loss of patients to local competitors…

In some cases, large hospital systems opt for a different approach, largely involving acquisition. Johns Hopkins acquired Sibley Memorial and Suburban hospitals in the Washington, D.C., area, along with All Children’s Hospital in St. Petersburg, Fla. The latter was re-christened Johns Hopkins All Children’s Hospital in 2016…

Although affiliation agreements differ, many involve payment of an annual fee by smaller hospitals. Officials at Mayo and MD Anderson declined to reveal the amount, as did executives at several affiliates. Contracts with Mayo must be renewed annually, while some with MD Anderson exceed five years…

“It is not the Mayo Clinic,” said Dr. David Hayes, medical director of the Mayo Clinic Care Network, which was launched in 2011. “It is a Mayo clinic affiliate.”

Of the 250 U.S. hospitals or health systems that have expressed serious interest in joining Mayo’s network, 34 have become members.

For patients considering a hospital that has such an affiliation, Binder advises checking ratings from a variety of sources, among them Leapfrog, Medicare and Consumer Reports, and not just relying on reputation.

“In theory, it can be very helpful,” Binder said of such alliances. “The problem is that theory and reality don’t always come together in health care.”

Case in point: Hopkins’ All Children’s has been besieged by recent reports of catastrophic surgical injuries and errors and a spike in deaths among pediatric heart patients since Hopkins took over. Hopkins’ chief executive has apologized, more than a half-dozen top executives resigned and Hopkins recently hired a former federal prosecutor to conduct a review of what went wrong.

“For me and my family, I always look at the data,” Binder said. “Nothing else matters if you’re not taken care of in a hospital, or you have the best surgeon in the world and die from an infection.” ” (Q)

PART 2. June 1, 2019. “The situation that the New York Times described in North Carolina parallels that at Johns Hopkins All Children’s Hospital in St. Petersburg, which stopped performing heart surgeries after the Tampa Bay Times reported on problems in the unit

“Johns Hopkins All Children’s Hospital in St. Petersburg, Fla., has been given another extension from federal regulators to correct its problems. The pediatric hospital came under fire in late 2018 after the Tampa Bay Times uncovered widespread problems at the facility, including a rising death rate in the pediatric heart unit.

The reporting from the Times led to the resignation of several high-profile executives at the hospital and a federal investigation from CMS that led to a series of corrective actions with the government.

Now, the hospital still needs more time to meet the demands of inspectors, the Tampa Bay Times reported. Inspectors found problems with All Children’s infection control unit, which the hospital must fix by “early May.” The agreement with CMS to meet corrective actions underscores how the hospital has been at risk of losing public funding, which covered more than 60% of its patients in 2017, according to the Times.” (A)

“Care in a special heart surgery unit at Johns Hopkins All Children’s Hospital in St. Petersburg, Fla., became so troubled that last year one in 10 patients died and others suffered devastating complications before procedures were halted, a year-long investigation by the Tampa Bay Times found.

The investigation found that staff raised safety concerns as early as 2015 but the hospital, led by administrators sent by Hopkins, disregarded warnings and didn’t stop performing the most complex procedures until early last year. All surgeries were curtailed eventually and a review launched. The status of two surgeons connected to most of the complications is unclear…

In a statement to the Tampa Bay Times, All Children’s said it “is defined by our commitment to patient safety and providing the highest quality care possible to the children and families we serve. An important part of that commitment is a willingness to learn. When we became aware of challenges with our heart institute we took action to address them.”

The hospital said it initially stopped performing complex cases and brought in a surgeon from Baltimore. Then it halted all surgeries after that surgeon left. The hospital said it is currently reviewing the program and recruiting new surgeons with aid from Hopkins and plans to resume surgeries “when all involved are confident that the care being delivered meets the high standards set by this organization.”

A statement from Johns Hopkins Medicine to The Baltimore Sun said, “We are devastated when children suffer, and losing a child is something that no parent should have to endure. We are continuing to take a very close look at the program, and will not resume open heart surgeries until we are confident this program at Johns Hopkins All Children’s Hospital delivers care that meets the highest standards.”” (B)

“Johns Hopkins All Children’s Hospital posted an operating loss in the three months ended March 31, as the St. Petersburg pediatric hospital dealt with the fallout of federal and state probes into its practices.

The hospital had an $11.5 million quarterly operating loss, according to a May 13 financial report from The Johns Hopkins Health System Corp. and affiliates. Operating revenue dropped 7.1 percent to $119.9 million, while operating expenses climbed 10.5 percent to $131.4 million.

The operating loss was attributed to closing the hospital’s Heart Institute. The facility closed after an investigation by the Tampa Bay Times found seven children had died or were permanently injured due to substandard care in the cardiovascular surgery program…

“The decrease in income from operations and operating margin percentage was mainly driven by lower net patient service revenue at [Johns Hopkins All Children’s Hospital] as a result of the closing of the Heart Institute,” the May 13 report said.” (C)

“Tasha and Thomas Jones sat beside their 2-year-old daughter as she lay in intensive care at North Carolina Children’s Hospital. Skylar had just come out of heart surgery and should recover well, her parents were told. But that night, she flatlined. Doctors and nurses swarmed around her, performing chest compressions for nearly an hour before putting the little girl on life support.

Five days later, in June 2016, the hospital’s pediatric cardiologists gathered one floor below for what became a wrenching discussion. Patients with complex conditions had been dying at higher-than-expected rates in past years, some of the doctors suspected. Now, even children like Skylar, undergoing less risky surgeries, seemed to fare poorly.

The cardiologists pressed their division chief about what was happening at the hospital, part of the respected University of North Carolina medical center in Chapel Hill, while struggling to decide if they should continue to send patients to UNC for heart surgery…

That March, a newborn had died after muscles supporting a valve in his heart appeared to have been damaged during surgery. At least two patients undergoing low-risk surgeries had recently experienced complications. In May, a baby girl with a complex heart condition died two weeks after her operation. Two days later, Skylar went in for surgery.

In the doctors’ meeting, the chief of pediatric cardiology, Dr. Timothy Hoffman, was blunt. “It’s a nightmare right now,” he said. “We are in crisis, and everyone is aware of that.”

That comment and others – captured in secret audio recordings provided to The New York Times – offer a rare, unfiltered look inside a medical institution as physicians weighed their ethical obligations to patients while their bosses also worried about harming the surgical program.

In meetings in 2016 and 2017, all nine cardiologists expressed concerns about the program’s performance. The head of the hospital and other leaders there were alarmed as well, according to the recordings. The cardiologists – who diagnose and treat heart conditions but don’t perform surgeries – could not pinpoint what might be going wrong in an intertwined system involving surgeons, anesthesiologists, intensive care doctors and support staff. But they discussed everything from inadequate resources to misgivings about the chief pediatric cardiac surgeon to whether the hospital was taking on patients it wasn’t equipped to handle. Several doctors began referring more children elsewhere for surgery.

The heart specialists had been asking to review the institution’s mortality statistics for cardiac surgery – information that most other hospitals make public – but said they had not been able to get it for several years. Last month, after repeated requests from The Times, UNC released limited data showing that for four years through June 2017, it had a higher death rate than nearly all of the 82 institutions nationwide that do publicly report…

The best option, Dr. Kelly said, was to combine UNC’s surgery program with Duke’s. For years, physicians at both children’s hospitals talked informally about joining forces, but nothing came of it. They were “basically destroying each other’s capacity to be great,” Dr. Kelly said, by running competing programs less than 15 miles apart. But even combining the programs wasn’t an instant fix: It would take at least a year and a half, he said…

At a conference last fall, Dr. Backer, the Chicago heart surgeon, urged fellow surgeons to consider “rational regionalization,” or joining forces in an effort to reduce mortalities nationwide for congenital heart defects, potentially saving hundreds of lives.

Reaching adequate case volumes to keep up skills is a challenge because so many hospitals are competing for patients – surgical programs are an important driver of revenue. The Orlando, Fla., and San Antonio metropolitan areas, for example, each have three hospitals doing pediatric heart surgeries. Cleveland has two about a mile apart. A study last year by Dr. Backer and other physicians found that 66 percent of hospitals doing the surgeries were within 25 miles of another one.” (D)

“The situation that the New York Times described in North Carolina parallels that at Johns Hopkins All Children’s Hospital in St. Petersburg, which stopped performing heart surgeries after the Tampa Bay Times reported on problems in the unit.

A Tampa Bay Times analysis found that the death rate among pediatric heart surgery patients at All Children’s had tripled from 2015 to 2017…

UNC Health Care only made some of its death rate data public to the New York Times after numerous requests from the newsroom. The statistics showed that UNC’s children’s heart surgery program had one of the highest four-year death rates in the country.

The newspaper said it is suing the health system for more data.

UNC Health Care told the New York Times that the physicians’ concerns had been handled appropriately.

After the New York Times started reporting, the hospital ramped up efforts to find a temporary pediatric heart surgeon and reached out to families whose children had died or had unusual complications to discuss their cases…

The turmoil at UNC underscores concerns about the quality and consistency of care provided by dozens of pediatric heart surgery programs across the country. Each year in the United States about 40,000 babies are born with heart defects; about 10,000 are likely to need surgery or other procedures before their first birthday.

The best outcomes for patients with complex heart problems correlate with hospitals that perform a high volume of surgeries – several hundred a year – studies show. But a proliferation of the surgery programs has made it difficult for many institutions, including UNC, to reach those numbers: The North Carolina hospital does about 100 to 150 a year. Lower numbers can leave surgeons and staff at some hospitals with insufficient experience and resources to achieve better results, researchers have found.

“We can do better. And it’s not that hard to do better,” said Dr. Carl Backer, former president of the Congenital Heart Surgeons’ Society, who practices at Lurie Children’s Hospital of Chicago. “We don’t have to build new hospitals. We don’t have to build new ICUs. We just need to move patients to more appropriate centers.”

North Carolina Children’s Hospital, part of the University of North Carolina medical center, performs about 100 to 150 pediatric heart surgeries a year.

Studies show that the best outcomes for patients with complex heart problems correlate with hospitals that do a higher volume of surgeries – several hundred a year.

At least five pediatric heart surgery programs across the country were suspended or shut down in the last decade after questions were raised about their performance; a Florida institution run by the prestigious Johns Hopkins medical system stopped operations after reporting by The Tampa Bay Times in 2018. At least a half-dozen hospitals have merged their programs with larger ones to achieve more consistent results. And more institutions are considering such partnerships.” (E)

“UNC Health declined a CBS 17 request for an interview. Phil Bridges, UNC Health’s Integrated Communications Executive Director issued a written statement:

We are proud of our pediatric congenital heart surgery program, and our current team is receiving top results that would place us among the best in the nation. We have been engaged in continuous quality improvement efforts for decades and have made significant improvements in the past 10+ years.

As the state’s leading public hospital, the UNC Pediatric Congenital Heart Surgery program often receives the most complex and serious cases. For many of these very sick children, we are often parents’ last hope.

As we shared with the New York Times, there were team culture issues back in 2016. They were handled appropriately. That, combined with decades of continuous quality improvement (CQI) efforts, have led us to today in which we have a very strong program. For our team, and each family, even a single death is too many, and we will continue our CQI work.

To characterize today’s program as anything but strong, would not only be misleading, but not factual. To say we ignored issues would also be false.” (F)

“First and foremost, we are physicians who have dedicated our lives to caring for and caring about patients. We celebrate with families the joys of curing illness; and we are deeply impacted by any death, particularly that of a young child. We lead our respective areas of surgery and pediatrics with the mindset of always doing what is right for children and families. Caring for these children is a privilege. Children and families are always our top priority. Our mission is to provide the best care for all children across North Carolina. We and our colleagues live this mission every day.

Regarding this week’s story from The New York Times (“Doctors Were Alarmed: Would I have my children have surgery here”): We are proud of the medical care provided to all patients at UNC Children’s. They become part of our family, and as providers we wouldn’t hesitate to bring our own loved ones here for treatment. Any negative outcome or death is taken incredibly seriously and we strive to constantly look for ways to improve the care provided.” (G)

“North Carolina’s secretary of health on Friday called for an investigation into a hospital where doctors had suspected children with complex heart conditions had been dying at higher than expected rates after undergoing heart surgery.

Dr. Mandy Cohen, the secretary, said in a statement that a team from the state’s division of health service regulation would work with federal regulators to conduct a “thorough investigation” into events that occurred in 2016 and 2017 at North Carolina Children’s Hospital, part of the University of North Carolina medical center in Chapel Hill.

“As a mother and a doctor my heart goes out to any family that loses a child,” Dr. Cohen said in the statement. “Patient safety, particularly for the most vulnerable children, is paramount.”

The investigation is in response to an article published by The New York Times on Thursday, which gave a detailed look inside the medical institution as cardiologists grappled with whether to keep sending their young patients there for surgery.

The article included discussions among doctors that were captured on secret audio recordings provided to The Times, in which the physicians talked openly about their concerns, including that some might not feel comfortable allowing their own children to have surgery at the hospital. The physicians also discussed unexpected complications with lower-risk patients.

While the doctors could not pinpoint what might be going wrong, they considered everything from inadequate resources to misgivings about the chief pediatric cardiac surgeon to whether the hospital was taking on patients it was not equipped to handle.” (H)

The 2018-19 Best Children’s Hospitals Honor Roll (I)

1. Boston Children’s Hospital

2. Cincinnati Children’s Hospital Medical Center

3. Children’s Hospital of Philadelphia

4. Texas Children’s Hospital

5. Children’s National Medical Center

6. Children’s Hospital Los Angeles

7. Nationwide Children’s Hospital

8. Johns Hopkins Children’s Center (BALTIMORE)

9. Children’s Hospital Colorado

10. Ann and Robert H. Lurie Children’s Hospital of Chicago

North Carolina Children’s Hospital at UNC. Pediatric Cardiology & Heart Surgery Scorecard.

Duke Children’s Hospital and Health Center. Pediatric Cardiology & Heart Surgery Scorecard.

PART 3. Hopkins All Children’s Hospital/ North Carolina Children’s – pediatric cardiac surgery debacles.

“Johns Hopkins All Children’s Hospital has begun implementing some of the dozens of recommendations from a law firm hired to identify deficiencies at the hospital and its parent organization, Johns Hopkins Medicine, in the wake of high death rates in the St. Petersburg hospital’s pediatric cardiology program…

The recommendations focus on four key areas, said Dr. Kevin Sowers, president of Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine.

He outlined those four areas in a video posted online. They are: strengthen the management and culture at Johns Hopkins All Children’s Hospital; improve processes for evaluating patient clinical quality and safety; clarify and streamline the reporting structure between the six Johns Hopkins Hospitals and the Johns Hopkins Health System; and review the ways in which the boards of Johns Hopkins All Children’s Hospital and Johns Hopkins Medicine should advance their governance responsibilities…

…In the coming weeks, the board of Johns Hopkins Medicine will appoint a monitor to track and report regularly back to them on the hospital’s progress.” (A)

“The recommendations for improvement include:

Prioritize a culture of absolute commitment to patient safety and of raising and addressing problems and concerns, including throughout the process of hiring and evaluating senior executives

Give physician leaders a stronger voice, create a more robust check-and-balance on the president

Better educate staff and faculty about JHM’s commitment to transparency and a culture of “see something, say something” and to improve channels to submit complaints and provide for independent review

Separate the medical staff office responsibilities from the patient safety and quality department responsibilities, which previously were overseen by a single vice president of medical affairs…

In the coming weeks, the board of Johns Hopkins medicine will appoint an external monitor to track and report back regularly to them on the hospital’s progress,” he said.

The initial focus will be on the St. Petersburg hospital, a team will go to the other five hospitals in the network to ensure the changes are taking place.” (B)

“The review recommended a commitment to patient safety and said the “see something, say something” culture is a vital part of that.

The hospital published the report on its website along with a video of Sowers talking about the results.

“Above all, we must work each and every day to support a culture in which each of us is supported and empowered to speak up and speak out,” Sowers said in the video.

He provided a toll free number where employees can anonymously report any issues: 1-844-SPEAK2US.

“If you have any concern about a patient safety issue, misconduct, a legal or unethical behavior or anything else, please call the Johns Hopkins medicine hotline,” Sowers said.

Problems with the hospital’s heart institute did not come to light until they were reported in the Times. The stories prompted inquiries by federal and state regulators and led to the resignation of six top officials.” (C)

“The changes include new checks and balances on the hospital’s president, more rigorous evaluations for top executives, better tracking of internal complaints, more thorough vetting of doctors and improved monitoring of patient safety and quality metrics.

Top executives will now report to both the hospital president and Johns Hopkins Health System leaders in Baltimore. And officials in Baltimore will be more involved in hiring, firing and discipline in St. Petersburg…

System leaders will analyze whether the same steps are needed at the five other Johns Hopkins hospitals, Sowers said.

Sowers said the firm discovered a culture of “fear of retaliation and retribution” across the hospital but determined that the quality and safety issues were limited to the heart unit…

Other recommendations addressed key findings in the Times report.

One example: The Times reported that procedures started going wrong after All Children’s became part of the Johns Hopkins network and hospital leaders made a series of personnel changes within the Heart Institute.

The firm recommended “more strategic planning” when changing clinical programs and more quality monitoring during transitions, especially for units that handle complex procedures.

It made the point bluntly: “In making personnel decisions, consider the effect on team dynamics.”..

As All Children’s carries out the policy changes, it will also work to address systemic problems flagged by the federal government. Hospital leaders recently agreed to hire an external consultant to oversee improvement for 12 months in order to maintain public funding.

Separately, a team of national experts has been working on a plan to restart the heart surgery program. Sowers said the team had drawn up recommendations and given them to the board. But he said he did not have a timeframe for surgeries beginning and that the program would first need to hire another surgeon.” (D)

“Children’s heart surgery departments across Florida will soon be subject to more oversight.

Gov. Ron DeSantis signed a bill late Tuesday that will let physician experts visit struggling programs and make recommendations for improvement…

The bill signed into law Tuesday makes significant changes.

It lets a committee called the Pediatric Cardiac Technical Advisory Panel appoint physician experts to visit Florida’s 10 children’s heart surgery programs. They will be able to examine surgical results, review death reports, inspect the facilities and interview employees.

Dr. David Nykanen, the chairman of the advisory panel and a pediatric cardiologist at Arnold Palmer Hospital for Children in Orlando, called site visits “crucially important,” especially when departments are having problems.

He said visits could start within the next six months…

The hospital has not yet resumed heart surgeries. The results of a review commissioned by the Johns Hopkins Medicine board are expected soon.” (E)

“A state regulatory process that limited the number of hospitals and some specialty services like transplant programs are going away on July 1.

Despite attempts by two hospitals, Central Florida doesn’t have a pediatric heart transplant program. But that could change in the coming years because a state regulatory process that limited the number of hospitals and some specialty services like transplants is going away on July 1.

For nearly five decades, the program known as certificate of need has required hospitals to get authorization from the state before building new facilities or offering new or expanded services — a complicated process that’s costly, includes reams of paperwork and potential challenges from competitors, and can take months or years…

Starting July 1, general hospitals are no longer required to obtain a certificate of need to build a facility or to start services such as pediatric and adult open heart surgery, organ transplant programs, neonatal intensive care units and rehab programs…

The second part of the bill goes into effect on July 1, 2021, when the certificate of need requirement will be eliminated for certain specialty hospitals such as children’s and women’s hospitals, rehab hospitals, psychiatric and substance abuse hospitals and hospitals that offer intensive residential treatment services for children.” (F)

“It’s unclear how long a state health department team will take to investigate questions raised in The New York Times about pediatric heart surgeries performed at the North Carolina Children’s Hospital in Chapel Hill.

State regulators were at the UNC Medical Center on Monday as part of an inquiry launched last week by Mandy Cohen, secretary of the state Department of Health and Human Services…

Cohen announced late last week that she had assembled a team from the state Division of Health Service Regulation, which licenses and oversees health care facilities, to “conduct a thorough investigation into these events.” They are coordinating with the U.S. Centers for Medicare & Medicaid Services, a federal oversight agency…

Kelly Haight Connor, a spokeswoman for the state health department, said Monday it’s difficult to know how long an investigation will take. In other DHHS investigations, a team often interviews a range of people, from caregivers, staff and those in their care.

Wesley Burks, CEO of UNC Health Care since December 2018 and dean of the UNC School of Medicine, sent a five-paragraph email to staff on May 30 at 10:16 a.m. and attached the Times’ article he described as “critical of UNC Medical Center’s pediatric congenital heart surgery program.”

 “While this program faced culture challenges in the 2016-2017 timeframe, we believe the Times’ criticism is overstated and does not consider the quality improvements we’ve made within this program over many years,” Burks wrote in the email. “As the State’s leading public hospital, UNC Medical Center often gets the most complex and serious cases in its pediatric congenital heart program. For many of these very sick children, we are often parents’ last hope…

On Monday, UNC Health Care spokesman Phil Bridges released a “timeline of Continuous Quality Improvement within the program over the past 10 years.”

The timeline mentions a four-month period from June to September in 2016 in which “concerns and allegations against specific individuals in the Congenital Heart Program” were “independently investigated and reviewed” by the dean’s office and the chief medical officer.

“Allegations of misconduct and concerns determined to be unfounded,” the document states, adding “allegations against specific individuals and results of the investigations constitute personnel records, which may not be disclosed,” citing public records law.

An ongoing initiative, according to the document, calls for a Department of Pediatrics review after every death in the Pediatric Intensive Care Unit, including pediatric cardiac patients, to assess the care provided and evaluate any opportunities for improvement.” (G)

“UNC Health Care officials announced Monday they are halting the most complex pediatric heart surgeries following a report that raised serious safety concerns over a number of child deaths at UNC Children’s Hospital…

Officials from UNC HealthCare said in a statement they plan to create an advisory board of external medical experts and “pause the most complex heart surgeries” until that board and regulatory agencies review the program.

The external advisory board, which is expected to have members from the University of Southern California, the University of Michigan, University of Pittsburgh Medical Center and Nationwide Children’s Hospital, will examine the efficacy of the UNC Children’s Hospital pediatric heart surgery program and make recommendations for improvement. The group will report to the UNC Health Care Board of Directors.

UNC Healthcare officials said they are also developing a new structure to support internal hospital reporting and plan to publicly release Society for Thoracic Surgeons’ (STS) patient outcome data, make a $10 million investment in new technology and bring in new specialists as part of their efforts to “restore confidence” in its pediatric heart program.

“Our pediatric heart program cares for very sick children with incredibly complex medical problems, and our clinical team works tirelessly to help those patients return to normal, healthy and productive lives,” Wesley Burks, M.D., CEO of UNC Health Care said in a statement. “We grieve with families anytime there is a negative outcome and we constantly push to learn from those tragic instances.

UNC Health Care’s board also endorsed the creation of a pediatric heart surgery family advisory council to provide a voice for patients, family members and staff directly to hospital leadership…

Most recently, Johns Hopkins’ All Children’s Hospital came under fire for increasing mortality rates among heart surgery patients at the 259-bed hospital following a Tampa Bay Times investigation. Top leaders of that hospital ultimately resigned and Johns Hopkins’ board also said it commissioned an external review to examine the heart surgery program.

In 2015, St. Mary’s Medical Center in Florida closed it’s pediatric heart surgery program after a CNN investigation revealed it had a mortality rate of more than three times the national average. In 2009, Massachusetts General Hospital suspended its pediatric surgery program in the wake of surgical errors.” (H)

“The actions are in response to a New York Times investigation last month into the medical institution, where cardiologists, department leaders and even the former head of the children’s hospital expressed concerns about patients faring poorly after heart surgery there. Secret audio recordings provided to The Times captured doctors talking openly, some even saying they might not feel comfortable allowing their own children to have surgery at the hospital.

The Times sued for the program’s mortality data and was still in a yearlong legal battle to obtain it when UNC Health Care released previously undisclosed statistics on Monday. The data shows that the mortality rate for heart surgery patients continued to rise after doctors warned administrators several years ago of possible problems.

The data, for four years through December 2018, showed that the hospital’s mortality rate for pediatric heart surgery was higher than those of most of the 82 hospitals in the United States that publicly report such data. The death rate at the North Carolina hospital was especially high among children with the most complex heart conditions — nearly 50 percent, the data shows. Those are the types of cases that some doctors had urged the hospital to temporarily stop handling in 2016 and 2017.

UNC administrators previously denied that there were any problems affecting patient care in the heart surgery program, saying only that there had been difficult team dynamics at the time of the doctors’ warnings, and that they had since been resolved by staffing and leadership changes.

Concerns about the quality of pediatric heart surgery programs have been noted at hospitals across the country. At least five programs were suspended or shut down in the last decade after questions were raised about their performance. At least a half-dozen hospitals have merged their programs with larger ones to achieve more consistent results. And more institutions are considering such partnerships.

After the Times article was published, the North Carolina secretary of health opened an investigation into the children’s hospital. In addition to an on-site investigation that finished on Friday after more than two weeks, state regulators have reached out to former UNC medical staff, asking to meet and interview them about concerns they had while employed there.

A spokeswoman for the state health department said it would submit a report to federal regulators from The Centers for Medicare & Medicaid Services within 10 business days.

In the statistics released on Monday, UNC Health Care included for the first time the hospital’s risk-adjusted data. Risk-adjustment helps account for prematurity, some genetic abnormalities and other factors that could make a child less likely to survive, and to more fairly assess hospitals that take on the most compromised patients. The statistical method also helps evaluate if hospitals are losing patients who wouldn’t be expected to die.

The health system first told The Times it was “critically important” to use risk-adjusted data, but then later released only raw, unadjusted numbers. The hospital subsequently said that no current risk adjustment adequately accounted for the breadth and severity of its patients’ medical issues.

The hospital’s overall mortality rate for pediatric heart surgery in the four years ending in 2018 was 5.4 percent, compared with a national average of 2.8 percent. The hospital’s risk-adjusted mortality rate was 5.6 percent…” (I)

“UNC Children’s Hospital should merge its pediatric heart surgery program with the same work being done at Duke Health’s Children’s Hospital, just 10 miles away. A common program would greatly enhance the treatment of children and babies in need of complex heart surgery.

As it is, UNC Children’s does 100 to 150 pediatric heart surgeries a year, a rate considered low volume. That makes it harder to recruit and retain surgeons and limits surgeons ability to hone their skills. It also makes it harder to maintain the other parts of the program, cardiologists, anesthesiologists and staff for a pediatric heart intensive care unit.

East Carolina University’s hospital faced similar challenges as it provided pediatric heart surgery at a low-volume level of 50 to 75 surgeries a year. Eighteen months ago, ECU started sending all its pediatric heart surgery patients to Duke. The change helped boost Duke’s volume to where it has done more than 800 surgeries in 18 months. During the same period, Duke has posted a 1 percent mortality rate, despite a caseload in which a third of the operations are high risk.

Unfortunately, UNC Children’s Hospital appears uninterested in combining resources despite overtures from Duke. In a statement Thursday, the hospital said, “While there have been discussions with Duke Health over the years about ways to collaborate across various pediatric specialties, there are no plans to combine our programs. Patients in this region benefit from having two world-class medical institutions located so close together. Our clinicians frequently collaborate with colleagues at Duke. We sometimes transfer patients to them and vice versa.

UNC Children’s would prefer to run its own pediatric heart surgery program as a matter of institutional pride and money — the most complex operations can cost a half-million dollars. But pride and money aren’t — or shouldn’t be — the primary concerns. What matters most is how to get the best care for children in this highly specialized and high-stakes area of medicine. To do that, North Carolina’s best hospitals should combine their resources and expertise.” (J)

“Two Triangle hospitals showed up on the list of Best Children’s Hospitals from U.S. News & World Report released on June 18.

The report broke out 10 different pediatric specialties and ranked the top 50 hospitals in each. Duke Children’s Hospital & Health Center and the North Carolina Children’s Hospital at UNC were the lone Triangle representatives that ranked in the top 50 in any of the categories…

The only pediatric category where a Triangle hospital did not appear in the top 50 was cardiology & heart surgery.” (K)

U.S. News & World Report ranked Johns Hopkins All Children’s Hospital No. 44 out of 50 on the 2019-20 Best Children’s Hospitals list for the two programs.

“Our cancer and pulmonology specialists care for some of the region’s most medically complex children, and we are grateful for this recognition of their hard work,” interim hospital president Tom Kmetz said in the hospital’s blog.

The hospital received an overall score of 73.3 out of 100.” (L)

Johns Hopkins Children’s Center ranked ninth overall and No. 1 in Maryland in U.S. News & World Report’s annual list of the top-ranked children’s hospitals in the United States, which was released earlier today.

The Children’s Center also earned a spot on the U.S. News Best Children’s Hospitals Honor Roll, a list of the 10 pediatric hospitals with the highest point totals in the survey. This marks the Children’s Center’s eighth appearance since the Honor Roll was established 11 years ago…

Founded in 1912 as the Children’s Hospital at Johns Hopkins, the Children’s Center offers one of the nation’s most comprehensive pediatric medical programs, with almost 110,000 patient visits and nearly 9,000 admissions each year. With 295 beds, it is Maryland’s largest children’s hospital and is the only state-designated trauma service and burn unit for pediatric patients. Since 2012, the Charlotte R. Bloomberg Children’s Center Building has been its home.” (M)

Typically, with complex medical procedures, outcomes are strongly correlated with volume. That means that if a program does more procedures, it has more expertise, the healthcare team has more experience working together — and as a result, patients have better results. Larger programs often have better equipment and more personnel. Sadly, the pediatric surgery program at North Carolina Children’s Hospital was a low-volume center…

Powerful forces stand in opposition to the closure of low-volume centers. Low-volume centers are attractive because they are geographically convenient; patients do not have to travel long distances for their care. Some insurance coverage is regionally-restricted, and families without resources are unable to access high-volume centers. Low-volume centers are often staffed by entrepreneurial physicians who don’t want restrictions on their right to practice medicine. And their goals are often closely aligned with those of local political officials, who would like to imagine that low-volume programs can replicate the results at large medical centers. Perhaps most importantly, hospital administrators at low-volume centers do not wish to see their revenues slashed — and their leadership positions eliminated.

So the problem of decentralized medicine and low-volume centers is getting worse, not better. To an increasing degree, a larger and larger proportion of specialized procedures in the United States are being done at low-volume centers…” (N)

“One in four hospitals that participate in The Leapfrog Group’s annual patient safety grades survey do not meet the national healthcare quality group’s standard for handling serious reportable events that should never happen to a patient.

Leapfrog’s 2019 Never Events Report is based on findings from its 2018 Leapfrog Hospital Survey with data voluntarily submitted by more than 2,000 U.S. hospitals. It is aimed at highlighting official hospital policies for responding to the 29 serious reportable events as identified by the National Quality Forum as never events.

Those events include errors and accidents that hospitals should always prevent, such as surgery on the wrong body part, foreign objects left in the body after surgery or death from a medication error…

The Leapfrog standard for hospital policies includes steps such as offering an apology to the patient, not charging for the event, conducting a comprehensive root cause analysis, reporting the event to appropriate officials and implementing a protocol to care for the caregivers involved.

“Patients and payors alike expect that 100% of hospitals will adhere to these basic principles, but unfortunately, we are not seeing that yet, with only 75% of reporting hospitals meeting Leapfrog’s standard,” Leah Binder, president and CEO of The Leapfrog Group, said in a statement.”..

In the report, released with the Johns Hopkins Armstrong Institute for Patient Safety and Quality, officials estimated that 160,000 people died from avoidable medical errors in 2018.” (O)

“Affiliation with a top-ranked cancer hospital appeared to offer no robust advantage for complex cancer surgery, a new study found…

“A favorable mix of hospital characteristics associated with safety at affiliate hospitals appeared to contribute to this mortality advantage,” they wrote in JAMA Oncology. “Thus, affiliate status appears to be a marker, but not a robust, independent predictor of favorable outcomes.”

For their study, the group examined cancer surgery outcomes at 338 hospitals affiliated with a top-50 cancer hospital and 2,729 hospitals that were not.

“This study helps to further our understanding of patient safety after major cancer surgery at hospitals affiliated with top-ranked cancer centers,” Lesly Dossett, MD, MPH, of the division of surgical oncology at the University of Michigan in Ann Arbor, told MedPage Today.

Dossett, who was not involved in the study, pointed to the important fact that the researchers compared outcomes at non-affiliated hospitals with the affiliates of top hospitals, rather than the flagship hospitals themselves.

“While the study does show that outcomes at affiliated centers are better than at non-affiliated centers, these differences are explained by other hospital characteristics known to be associated with patient safety,” Dossett said. “In the end, the study suggests that top-ranked hospitals selectively affiliate with safer hospitals, rather than having an independent effect on their outcomes.” (P)

“Rochester, Minn.-based Mayo Clinic has added Saudi German Hospital Cairo in Egypt to the Mayo Clinic Care Network, a select group of independent health systems that have access to Mayo Clinic’s knowledge and medical expertise.” (Q)

“The announcement Thursday that Jewish Hospital would suspend its heart transplant program was a blow to an institution that once led the nation as an esteemed leader in heart care and innovative medical procedures.

The decision directly affects 32 people on the hospital’s waiting list for new hearts. Once the program is halted next month, officials at Jewish Hospital are expected to help them transition to other transplant programs — and there’s only one other program for adults in the state at the University of Kentucky.

Jewish’s president Dr. Ronald Waldridge told staff on Thursday morning that patients who’ve already had transplants at the downtown Louisville hospital would continue to receive care, and that those who are awaiting the procedure would get help transitioning to another program.

“Though our heart transplant program will not be able to perform transplants or take new physician referrals, we will continue to provide physician coverage to manage care of our current heart transplant program patients,” Waldridge wrote, adding that as volumes of available hearts dropped, Jewish also lost heart transplant cardiologists…

KentuckyOne officials said Thursday that Jewish was in danger of falling out of compliance with federal regulations after its transplant numbers fell far short of required minimums — with just one procedure so far this year.

They blamed the drop on new rules that revised how donated organs are allocated nationwide and, as a result, delivered fewer hearts to Jewish starting last October.” (R)

From the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality:

“If there was a wonder drug to save the lives of infants with serious heart abnormalities, doctors would be sure to prescribe it. Parents would insist that their children get it. The company that invented it would get rich.

But there already is something that can have as dramatic an impact on these young lives as a blockbuster pill: having complex heart surgery performed in a high-volume hospital.

Surgical volume — the number of certain procedures that a hospital performs each year — has far greater impact on whether these patients, most of whom are infants or children, survive than infection rates, readmissions or other publicly reported measures. As U.S. News’ Steve Sternberg reported, the risk of dying was 26 percent lower if a complex congenital heart operation was performed at a high-volume hospital rather than at low- and medium-volume hospitals. Yet, few parents know to ask about volumes, let alone know how to find and evaluate the data.” (S)

“The American Nurses Credentialing Center (ANCC) named Johns Hopkins All Children’s Hospital as a Magnet® designated hospital today. The recognition is considered the highest nursing honor a hospital can receive. There are only 498 Magnet hospitals across the world and fewer than eight percent of U.S. hospitals have received the designation.” (T)

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Slow down Bernie…….Lessons Learned from a local government buying a failing not-for-profit hospital

“I will be very soon introducing legislation in the Senate to establish a $20 billion emergency trust fund to help states and local communities purchase hospitals that are in financial distress,” Sanders said. “In my view, any time a hospital is put up for sale in America, the local community or the state must have the right to buy it first with emergency financial assistance.”

Bernie Sanders to propose $20 billion bailout fund for struggling hospitals, by Ryan Nobles,

ASSIGNMENT: After reading about Hoboken, N.J., find and critique other NFP to local government ownership hospital conversions and local public hospitals on the edge of sustainability.


Project Management. The hardest part of getting started….is getting started

PART 3. April 23, 2019. San Francisco General, a public hospital with San Francisco’s only trauma center, all commercial insurance is “out-of-network.”

Stop the name games! University hospitals and regional medical centers should live up to their billing *

Here’s what happened when the town of Hoboken, New Jersey “bought” a failing NFP hospital.

January 8, 1863

This facility was founded as St. Mary Hospital, which was opened on the 8 January 1863 in Hoboken as a community hospital by the Poor Sisters of St. Francis, a religious congregation founded in 1845 in Germany.

The hospital was opened during the American Civil War as a location to treat the returning wounded and was the second hospital ever to open in the State of New Jersey.

December 13, 2006

When the owner, the Bon Secours Health Care System, a Maryland company run by an order of Roman Catholic nuns, announced this spring that it planned to close the hospital, city officials, including the mayor, David Roberts, state legislators and the governor’s office pieced together an unusual plan to keep it afloat by having the city take it over and pumping in an infusion of public funds (with the City guaranteeing $52 million in bonds)

January 29, 2007

Bon Secours Health System put another struggling operation on the block last week.

The planned sale of its Michigan operations is the latest move in Bon Secours’ bid to improve finances and operations through divestiture after the system’s expansion earlier in the decade (Feb. 14, 2005, p. 6). Since 2004, Bon Secours has sold or announced plans to sell operations in Florida, New Jersey, Pennsylvania and Virginia, divestitures that boosted its cash by $70 million and cut its debt load by $192 million, according to Moody’s Investors Service.

Bon Secours agreed to sell its last New Jersey healthcare facility, 313-bed St. Mary Hospital in Hoboken to the Hoboken Hospital Authority in a deal expected to close by Jan. 31.

February 7, 2007

In a ceremonial handing over of keys today, the ownership of St. Mary Hospital in Hoboken was transferred from the private Bon Secours New Jersey Health System (BSNJHS) to the City of Hoboken. To reflect a new beginning for the 144-year-old hospital, it was given a new name:  Hoboken University Medical Center

April, 2007

The hospital was acquired debt-free and the agreement provided for a $13 million cash payment from Bon Secours. Concurrent with the agreement’s negotiations, the Hoboken Municipal Hospital Authority worked toward the issuance of two series of bonds totaling $51,635,000. The bonds were guaranteed by the City of Hoboken and sold in February after the asset transfer agreement was executed.

But residents here who are skeptical of the proposal say it is also missing other important pieces of information. Among their concerns are these:

¶How will Hoboken pay off the bonds if the hospital fails and the city’s real estate market continues to soften?

¶How will the city fill the hospital’s budget gap if the anticipated federal aid does not materialize?

¶Who will cover the high pension and severance costs if the hospital has to be closed…?

Governance/ Management Structure:

Hoboken Municipal Hospital Authority (HMHA) – the Governing Board

Hudson Healthcare Inc. (HHI) – legislatively mandated NFP management company

Hoboken University Medical Center (the Hospital)

July, 23, 2009

Hoboken Mayor Peter Cammarano has been arrested by the FBI as part of a wide-reaching investigation that is swooping up dozens of people, including other politicians and rabbis, according the WNBC-TV, Hudson County Now is reporting.

July 31, 2009

HOBOKEN — Hoboken has an acting mayor.

City Council President Dawn Zimmer was sworn in Friday after Peter Cammarano III resigned in the wake of federal corruption charges.

September 2009

New Mayor (Mayor Zimmer) inherited..

Licensed for 364 beds; operating 150 ; Average Daily Census of 125; with appropriate Average Length of Stay ADS would be about 100

$52 million dollar City bond guarantee with $10 million already converted to taxable bonds and squandered on operations

$23 million operating loss in 2008 but hidden in delayed certified audit until September of 2009

The Hoboken Hospital Authority Board had abdicated its oversight responsibility to the legislatively-required Management Company and the CEO was making $800,000 a year.

$52 million dollar City bond guarantee with $10 million already converted to taxable bonds and squandered on operations

$23 million operating loss in 2008 but hidden in delayed certified audit until September of 2009

The Hoboken Hospital Authority Board had abdicated its oversight responsibility to the legislatively-required Management Company and the CEO was making $800,000 a year.

Finance Committee does not keep minutes.

Quality Committee is chaired by a practicing M.D. Commissioner who gets referrals from other physicians (really a “Hospital” Committee not an “Authority” Committee) – using out-of-date metrics

The HMHA Board does not get the Management Company Audit and there seem to be no Management Company Committee Board and/ or Committee minutes

The Authority “reports” to the Management Company! (ratifies everything  it is asked to ratify)

September, 2009

The Ordinance establishing the Hoboken Municipal Hospital Authority names the Mayor as the Class I ex officio Authority member and permits the Mayor to name a designee.

I am appointing Jonathan M. Metsch, Dr.P.H., as the Mayor’s designee to the Authority, effective immediately.

I have instructed Dr Metsch to focus on my immediate expectations for the Hospital Authority, which are:

– Complete transparency on financial results using generally accepted hospital industry accounting standards, without any annual city subsidy.

– Ability to services the $50 million+ in city guaranteed bonds using these funds for capital projects only, and not for recurring operating expenses.

– Designation by the State of New Jersey as an Essential Safety-Net Hospital.

– High scores on external evidenced-based hospital quality Report Cards and patient satisfaction surveys.

– A strategic plan developed with strong community input to identify the appropriate scope of clinical programs.

– Ongoing successful recruitment of new members to the medical staff, and

– Increasing use of the hospital by Hoboken residents.

The new “mantra”

“City ownership was always meant to be a ‘bridging’ strategy, not a permanent remedy.”

Mayor’s Zimmer’s Corrective Action Plan

Appointed 5 new Authority Boards members

–  a former hospital system CEO

–  an EVP compliance/ regulatory lawyer at a major investment bank

–  a University of Chicago finance MBA with bond underwriting experience

–  a Managing Director of a Health Care Investment Banking firm  

–  and a respected City Hall “watchdog

 then elected a new Chairman. All new members live and own property in Hoboken!

The Finance Committee was the only Board Committee and did not keep minutes. Added an Audit & Compliance Committee and a Strategic Planning and Government Affairs Committee.

The Board had been refused access to the Management Company’s annual certified audit. The Management Company and Hospital Authority audits are now done together by the same firm under the supervision of the new Finance Committee chairperson.

Suspended further approvals of major capital projects to conserve the remaining $9,000,000 of capital funds, until projects are properly analyzed and approved or perhaps to pay down the bond principal to reduce the City’s guarantee obligations.

Financial Uncertainties  (with virtually no “cash on hand”)

1.   ’09 audit result of $15 million loss is the same as ‘08 (after $9 million ’08 revenue adjustment is taken out)

2.   Charity Care funding needs to keep pace with Charity Care volume (and still pays less than 70 cents on the dollar compared to costs)

3.   Hospital Relief Fund money has to be actually awarded to the Hospital by the State

4.   Proposed Medicare cuts ($800,000 impact) need not to happen

5.   Hospital Stabilization Fund money of at least $5,000,000 needs to be granted

6.   DSH needs to be in the State budget to get the federal match

7.   Better managed care rates need to be negotiated but this is unlikely until current contracts expire

8.   Additional volume from ER needs to have positive impact on payer mix (more private admissions) and higher acuity, combined with much lower length-of-stay on all admissions

9.   Good results from Medicare and Medicaid audits (no take-backs)

10. Challenge to meet payroll and payroll taxes when negative cash flow occurs several times in current sixteen week cash flow projection

11.  State could cut Medicaid rates in final ’10 budget negotiations

12.  Navigant Report about hospital needs in Hudson County to be neutral

13.  No big surprises from PWC operational audit

14.  Vendor “payment plans” could become strangulating ($25 million in AP issue must be resolved)

15.  Viable contingency plans that can be implemented immediately in $5 million chunks

16.  Inappropriate co-mingling of funds and use of one-time money for operations must be avoided

17.  Union negotiations cannot increase deficit

Administration’s Hospital Goals

     A.  Ensuring that Hoboken University Medical Center (HUMC) remains open as a full service, acute care hospital providing access to quality medical care for all Hoboken residents

     B.  Respecting the commitment of the Hospital’s medical staff to the Hospital over the recent challenging years

     C.  Maintaining the 1000 jobs of our valued hospital staff

     D.  Addressing the Commissioner of Health and Senior Services regionalization objectives of reducing excess capacity and Hudson County hospitals’ reliance on extraordinary State financial subsidies

     E.  Relieving the City of Hoboken from the financial obligation of the bond guarantee.

Governor-elect Christie transition team report –

“On December 22, 2009, the Corzine Administration announced $40 million in Health Care Stabilization awards to 9 hospitals,” the memo says.” … at least one hospital, Hoboken University Medical Center, will close in the next few months even given this grant funding. We view this as a misuse of limited state resources for health care stabilization.”

July 30, 2010

In another step toward privatization, the Hoboken Municipal Hospital Authority unanimously approved a Request for Proposal Wednesday night to solicit plans for the potential transfer of the hospital from city sponsorship, the mayor’s office said.

“Mayor Zimmer inherited a complex set of legacy hospital issues and has aggressively addressed them,” said Authority Chairperson Toni Tomarazzo in a press release. “The Mayor developed a consensus around privatization as a shared vision for maintaining access to hospital care, and making quality metrics as important as financial performance.”

RFP requirements:

A party interested in acquiring the Hospital must provide the Authority with a written proposal (“Proposal”) which includes the following:

A. Proposed use of the Hospital facilities, including level of service;

B. Proposed transaction structure, including price and form of payment;

C. Proposed distribution or allocation of funds;

D. Proposed liabilities to be assumed by acquirer;

E. Planned capital investment programs;

F. Required financing for the proposed transaction;

G. Status of financing;

H. Identity of acquirer;

I. Prior health care experience of principals;

J. Proposed capital structure of acquirer;

K. Prior acquisitions or investments in the health care industry;

L. Time table for due diligence, execution of a letter of intent, and execution of an asset purchase agreement;

M. Conditions to completion of transaction, required approvals and permits; and

N. Identity of financial advisor and legal counsel for acquirer.

August, 2010

1.   In every administration there is a DHSS “liaison” with the Governor’s Office. That is probably Deputy Commissioner O’Dowd. Assistant Commissioner Conroy’s role seems to be expanding; he reports to DC O’Dowd

 2.   Deputy Commissioner (Dr.) Susan Walsh is on the Public Health side so it is a little surprising to see her involved with the Navigant Project.  COS Gabrielle Charette handles some policy issues and has the Commissioner’s ear

  3.   Might be good just to assume that “O’Dowd, Walsh and Charette comprise the Commissioner’s Policy Team. Typically O’Dowd’s slot is the #2 even though Walsh has the same DC title

4.   Other key health policy “front office” players we need to get to know:  

A.  Wayne Hasenbalg, Deputy Chief of Staff for Policy and Planning.

B.  Robert Schwaneberg, (health) Policy Advisor – reports to Wayne Hasenbalg

C.  Lou Getting, Cabinet Secretary – formerly VP, Administration at UMDNJ

D.  Claudia Marchese, Assistant Counsel – deals with health care legislation

E.  Deputy Attorney General Jay A. Ganzman – handles NFPs in AG’s office (e.g., Meadowlands’ sale)

F.  State Health Planning Board – Ms. Judy O’Leary Donlen RN  (reviews CN for “change of ownership)

G  Mark Hopkins is likely to be replaced as head of HCFFA when they get around to it. Steve Fillebrown, now the #2, provides continuity and has been there at least 20 years

H.  DCA Commissioner Lori Grifa & Marc Pfeiffer, Division of Local Government Services

I.   Lt Governor’s role in economic development??

October 8, 2010

Mayor Z –

“Deals” get done when key critical elements are in alignment – when there is a “window of opportunity”

 Right now we have this alignment for selling the hospital, on or close to our  goals and terms. Here’s why:

– You have made excellent appointments to the Hospital Authority Board. The Authority has taken back its authority from the Management Company.

 – Your relationship with the Governor, and our relationship with the Department of Health are very good.

 – A new round of hospital mergers has started (Newton joining Atlantic; SOCH and Bayshore joining Meridian….. probably more to follow)

 – For-Profits are welcome now in NJ (e.g. Bayonne, Meadowlands, Hackensack/Pascack)  giving us a broader spectrum of possible “buyers”   

 – Jersey City Medical Center is no longer a major teaching hospital, rather it is now a large community hospital with a a few important regional services (trauma, cardiac surgery)

– Christ Hospital is struggling now more than H.U.M.C. (admissions are way down and doctors are leaving)

– “Buyers” see 30 million Americans getting insurance

Windows” close and here’s what could happen to us –

– “Time is our greatest enemy” and moving too slowly  may cause interested parties to drop out (as they focus on other opportunities, or their financing expires)

– Christ could do a deal before we do or be force merged into Jersey City Medical Center by the State

– We fail to produce a timely 2090 Audited Financial Statement and potential buyers cannot finish their due diligence

– The State stops giving the hospital cash advances and it misses a payroll 

– The Navigant Report could be made public – word is it calls for closing Christ or Hoboken

– The Management Company has a Trenton lobbyist, we don’t – they know more than we do 

So we need to move thoughtfully, with transparency, and quickly –

– There can be no confusion that the Authority owns the hospital and is the seller

– The Management Company’s role in the sale must be clearly defined by the Authority, in writing (and monitored)

– We need to talk directly to the medical staff leadership, e.g. pick the right physicians for the RFP Committee   

April 21, 2011

After months of private negotiations the Hoboken Municipal Hospital Authority unanimously approved a contract with HUMC Holdco LLC on Wednesday night, to sell the Hoboken University Medical Center for $90 million.  

The proposed sale would relieve the city of its nearly $52 million bond obligation on the hospital.


“Re-Privatizing” the Hospital will bring it stability, access to capital, and the ability to compete in the hospital marketplace without dependency on state subsidies and cash advances.

It will also relieve the City of the bond guarantee, freeing up bond capacity for other necessary and immediate infrastructure improvements.      

This Essential Safety-Net Hospital management transformation initiative – hospital sustainability through privatization – will be a “self-sufficiency” model for replication elsewhere in New Jersey.

Summary of APA between Authority, as Seller, and HUMC Holdco, as Purchaser
The Authority is selling the assets of HUMC.

The Purchaser is paying for the assets by:

(a) assuming post-closing obligations under certain contracts and assuming Medicare and Medicaid obligations,

(b) defeasing the bonds guaranteed by the City of Hoboken,

(c) paying $2 million to be used to settle claims of unsecured creditors,

(d) paying $8 million for HUMC’s accounts receivable,

(e) paying up to $4 million for tail insurance,

(f) paying up to $2.5 million for pension withdrawal liabilities related to the two union pension funds, and

(g) paying the Authority 50% of the EMR funds, up to $1.9 million, received after the closing. 

Purchaser will

(a) offer employment to no less than 75% of the employees and will assume 75% of the outstanding amount of accrued vacation and sick time, and

(b) assume 80% of the accrued vacation and sick time of senior management and 80% of the severance payments related to senior management up to a cap of $677,000.  Purchaser will not assume any pension obligations.

In order for the sale to close:

(a) Purchaser must obtain a certificate of need (the application has been filed),

(b) Seller must obtain the settlement and release of at least 90% of the aggregate dollar amount of all unsecured creditors’ claims, and (c) the Hoboken Parking Utility must enter into a new parking agreement with the Purchaser

Seller agrees to use its best efforts and assist Purchaser:

to obtain a property tax abatement, payment in lieu of taxes, reduced assessment or similar arrangement

to have the entity that is the Public Service Dispatch Point for 911 calls in Hoboken be the Purchaser

to obtain a transit hub tax credit

to receive DSH payments after the closing. 

(No liability will result to Seller if Purchaser is unable to obtain any of these items)

Purchaser will not seek indemnification from the City of Hoboken.

Purchaser agrees:

to continue to operate the Hospital as a general acute care facility and to maintain the clinics operated by the Hospital for at least 7 years

that it may make available, in its discretion, up to $20.9 million for working capital and capital expenditures for the Hospital

to use its commercially reasonable best efforts to negotiate in-network hospital agreements with various health insurers, including Horizon Blue Cross

to negotiate in good faith to enter into agreements prior to closing with the City of Hoboken, the Hoboken Board of Education, the Hoboken Housing Authority and HUMC so that the employees will be able to use HUMC as though it were in-network

to negotiate in good faith with existing unions at the Hospital

The significance of this plan

“Re-Privatizing” the Hospital will bring it stability, access to capital, and the ability to compete in the hospital marketplace without dependency on state subsidies and cash advances.

It will also relieve the City of the bond guarantee, freeing up bond capacity for other necessary and immediate infrastructure improvements. 

This Essential Safety-Net Hospital management transformation initiative – hospital sustainability through privatization – will be a “self-sufficiency” model for replication elsewhere in New Jersey.

June 26, 2011

‘If this sale doesn’t go through…the hospital will close.’ – Mayor Dawn Zimmer

“Hoboken University Medical Center is bleeding money and if this sale to HUMC Holdco (Bayonne) does not go through, the hospital will close,” Zimmer said. “We will lose our hospital and the vital services it provides our community, and the taxpayers will be obligated for a $52 million bond guarantee. For this reason, the sale to [HUMC Holdco] is crucial to saving our hospital and protecting our taxpayers.”

July 5, 2011

Hoboken University Medical Center stands to lose $11 million in federal funding under Gov. Chris Christie’s 2012 budget.
The State of New Jersey will cut the federal matching funds it allots the Medical Center, according to the State’s budget summary.
Once government owned, the summary cites the facility’s sale to a non-government agency — which no longer makes them eligible for the funds — as a reason for its discontinuing the aid.

July 12, 2011

Will hospital cancel insurance contracts?
Public documents provided to The Reporter reveal that the new buyers do not plan to keep any existing insurance contracts, as they are negotiating with insurance companies for new rates.
Some observers have been concerned because when Holdco took over Bayonne’s hospital, they canceled the hospital’s contracts with various insurance companies in order to negotiate better reimbursement rates. That caused some customers to have to pay out-of-network fees.
The potential owners have responded, “HUMC Opco, LLC has no intentions of assuming any of the existing managed care agreements. Their reimbursement rates are below industry standards and are not adequate to sustain the operations at HUMC.”

July, 29, 2011

State department staff tells state Health Planning Board to recommend sale of Hoboken’s hospital

A staff report from the Department of Health and Senior Services has recommended to the state Health Planning Board that they endorse the sale of Hoboken University Medical Center to HUMC Holdco, the same group that owns Bayonne Medical Center.
For the first year of ownership, the new owners would also be required to assume the contracts of the current Health Maintenance Organizations (HMO) and insurance contracts, according to the staff report.

The owners have said in their questions with the state that they wish to negotiate new contracts with insurance companies when they take over the hospital.

Buyer says proposed “stand-still” condition is a deal-breaker!

August 4, 2011

State Health Planning Board approves sale of Hoboken University Medical Center
The state Health Planning Board voted unanimously today in Trenton to approve the sale of Hoboken University Medical Center to HUMC Holdco, a company whose principals also own the Bayonne Medical Center.

Health Commissioner Mary O’Dowd, however, must approve the sale before it becomes official.

Staff Proposed Condition is deleted: For the first year of ownership, the new owners would also be required to assume the contracts of the current Health Maintenance Organizations (HMO) and insurance contracts, according to the staff report

August 4, 2011

Deep inside the 285-page budget was an $11 million earmark to help Hoboken complete a controversial sale of the city-owned Hoboken University Hospital, whose operator filed for bankruptcy protection on Monday.

The $11 million earmark shines a spotlight on Christie’s efforts at building alliances in the Democratic stronghold of Hudson County, whose turnout can often tilt elections. It also reveals the political underbelly of a divisive deal to once again keep the troubled hospital open.

August 4, 2011

Hoboken University Medical Center property has been sold by the prospective owner, HUMC Holdco, to Medical Properties Trust, the same real estate investment trust that purchased the Bayonne Medical Center property.

Medical Properties Trust, the real estate investment trust (REIT) that purchased the Bayonne Medical Center land, has now bought the Hoboken University Medical Center property from HUMC Holdco for $70 million, the company said on its website.

September 22, 2011

Hoboken University Medical Center may close as soon as Oct. 7 as the result of the Hoboken City Council last night, in a 5 to 4 vote, rejecting an ordinance that would have provided a $5.5 million bond to meet some of the hospital’s obligations to creditors.

The bond was key to a bankruptcy settlement that was considered pivotal to the sale of the hospital to the ownership group of the Bayonne Medical Center.

September 22, 2011

Gov. Chris Christie announced today that the state will put up $5 million – if necessary — to help save the Hoboken University Medical Center from possibly closing.

“It is completely unacceptable that the city council placed local politics ahead of the 1,300 employees at the Hoboken University Medical Center and the people in the community who rely on the critical services provided by this hospital. This Administration is not going to allow political bickering to put this hospital in jeopardy and potentially have a negative and irresponsible impact on the city’s finances, which is why the state will contribute the $5 million, if needed, to ensure the Hoboken University Medical Center deal closes and the hospital stays open.“

October 14, 2011

Zimmer says city layoffs will happen if council doesn’t approve parking agreement and bond refinancing

“It is important that every City Council member fully understand the ramifications of these matters for our city, its residents and its employees,” Zimmer said in the Oct. 14 memo. “If the Parking Agreement, requiring 5 votes, and the bond refinance, requiring 6 votes, are not passed, then unfortunately the city will be forced to begin implementing layoffs immediately.”

October 19, 2011

Hoboken City Council rejects refinancing parking garage bond

In a 5 to 4 vote, the Hoboken City Council voted down an ordinance to refinance the bonds on the Midtown garage, which is currently used in part for Hoboken University Medical Center employee parking

October 21, 2011

State Approves Hospital Sale

A certificate of need was issued on Friday afternoon. Transaction scheduled to be completed in next couple of days.

October 30, 2011

An agreement to allow the City Council Minority to designate an appointee to the new hospital board. This appointment shows the buyer’s commitment to increasing community participation in the future of the hospital and allows all residents to have a voice.

October 30, 2011


“Since my first day as mayor more than two years ago, the saving of our hospital has been my number one priority. The effort to save our hospital has been a long road, but today our community saved it together. I thank everyone who contacted Council Members and turned out to raise their voices – hospital and City employees, taxpayers and concerned citizens, and members of the Hoboken Municipal Hospital Authority. I thank all members of the City Council for doing the right thing for Hoboken – the majority members for their support all along and the minority members for being willing to reconsider and change their votes.

Today’s vote clears the way for saving Hoboken University Medical Center, the jobs of 1,200 employees, and averts a financial catastrophe for our City.”

November 4, 2011

The money just hit the account.  Congratulations to all of you. The deal is closed, and the bonds are paid!

Mayor Z to JMM –

“Jonathan, you made this happen and whenever I talk about this success I will always thank you first!

(This never happened. Politically there was always someone else who had to be acknowledged.)

On November 4th there was going to be a closing

  • Either closing the sale
  • Or closing the doors (we didn’t have money to meet payroll that day)

November 5, 2011

Sighs of relief are heard in Hoboken as sale of hospital to owners of Bayonne Medical Center is completed, saving 1,200 jobs and freeing city from $52 million in bond debt
Hoboken University Medical Center officially has a new owner and the city is out of the hospital business.

City officials announced yesterday that HUMC Holdco LLC, the group which owns Bayonne Medical Center, completed the purchase of the Hoboken hospital, relieving the city of its $52 million bond debt.

“Today is a great day for all of Hoboken and New Jersey. Our state’s oldest hospital will remain open as a full-service acute care facility,” said Hoboken Mayor Dawn Zimmer.

October 29, 2012

Hospitals Evacuate Ahead of Hurricane Sandy

Ambulances lined the streets of Hoboken, N.J. in the relative calm before Hurricane Sandy last night as Hoboken University Medical Center evacuated patients in the predawn darkness.

The Hoboken hospital evacuated because of fears that surges from Sandy could breach Hoboken’s seawall, causing several feet of flooding. The Emergency Room and OB-GYN services for emergency deliveries remained open.

Imagine the consequences if the City still owned the hospital!  It would have never reopened and the City would have been responsible for the $50 million bonds.

December 11, 2013
HOBOKEN ISSUED AA+ CREDIT RATING BY STANDARD & POORS – Expected to Result in Immediate Additional Cost Savings
The credit rating agency Standard & Poor’s has assigned a credit rating of AA+ to the City of Hoboken, a dramatic and unprecedented improvement from the City’s prior near junk bond rating. In assigning their second highest obtainable rating, S&P cited Hoboken’s “very strong economy,” “strong management,” “very strong budget flexibility,” “very strong liquidity,” “very strong debt and contingent liabilities profile,” and “good financial management practices.”
Under Mayor Zimmer’s Administration, the City has established and maintained a responsible surplus for the first time in years, maintained a low debt level, consolidated and restructured departmental operations, eliminated the use of one-time budget gimmicks, and privatized Hoboken University Medical Center in order to relieve the City of a $52 million hospital bond guarantee.


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Stop the name games. University hospitals and regional medical centers should live up to their billing

Assignment: Develop an evidence based continuum of hospital “monikers”, then apply them to hospitals in your region.

Or use this list of Hudson County, NJ hospitals (FYI, I was President and CEO of LibertyHealth/ Jersey City Medical Center from 1989-2006) 

CarePoint Health – Christ Hospital

CarePoint Health – Hoboken University Medical Center

Hudson Regional Hospital

CarePoint Health – Bayonne Medical Center

Hackensack Meridian Health Palisades Medical Center

Jersey City Medical Center – RWJBarnabas Health



August 18, 2008

Stop the name games. University hospitals and regional medical centers should live up to their billing, By Jonathan Metsch, Modern Healthcare

Remember when a hospital was just a hospital, and its reputation spoke for itself?

Now we have a plethora of self-named healthcare institutions such as clinics, community hospitals, institutes, medical centers, memorial hospitals, specialty hospitals, and teaching hospitals.

My home state of New Jersey, for example, started with one children’s hospital in Newark, followed by a few more designated under state Health Department competitive certificate-of-need guidelines, followed by a few politically designated by the Legislature, followed by a bunch of sound-alikes such as a “children’s medical center” mischievously bypassing the fact that “children’s hospital” is a legislatively restricted name.

For the most part these appellations are used to define the hospital to its community and publicly compare it most positively to other nearby competitors.

However, more and more hospitals are now calling themselves regional medical centers and university hospitals. These are very robust terms, sometimes used interchangeably or together, and imply characteristics such as comprehensive critical-care services, cardiac surgery/interventional cardiology, comprehensive stroke care, an academic environment, the latest cutting-edge technology, and a full-time cadre of 24/7 on-site super-specialist physicians, including intensivists.

And the not-so-subliminal message is that when you are very sick or injured you should bypass your local hospital.

The reality is that in New Jersey a hospital can call itself whatever it wants—there is no name regulation or oversight by state authorities. A few years ago Robert Wood Johnson University Hospital challenged and lost, when St. Peter’s Hospital added “University” to its name. Since then a number of other hospitals have added “University” as well, and more will follow. Certainly this phenomenon is not limited to New Jersey.

The Association of American Medical Colleges states: “Teaching hospitals are providers of primary care and routine patient services, as well as centers for experimental, innovative and technically sophisticated services. Many of the advances started in the research laboratories of medical schools are incorporated into patient care through clinical research programs at teaching hospitals.”

I believe a university hospital/regional medical center should have most of the following characteristics typical to “major league” hospitals:

First and foremost, it should have a written affiliation agreement with a medical school that includes the rotation of medical students to the hospital for required third-year clinical rotations in internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery.

The hospital should have full-time chairmen in the core clinical departments (e.g., medicine, pediatrics, surgery) selected by a joint hospital-medical school search committee, and not as a reward for seniority or admitting a lot of patients.

There should be at least three physician residency-training programs under the supervision of the medical school.

All physicians teaching students and residents should qualify for faculty appointments at the affiliated medical school.

A dean’s committee composed of senior medical and administrative staff from the hospital and school should meet regularly to jointly set strategic priorities and evaluate program efficacy and performance.

The hospital’s medical staff bylaws should mandate automatic removal from the staff of any physician who does not achieve board certification after a given period of time, such as five years.

The hospital should have at least three state-designated critical-care services such as trauma center, regional perinatal center (high-risk obstetrics), stroke center, children’s hospital or cardiac surgery. There should be full-time intensivists in all ICUs.

The hospital should be a member of all major statewide multihospital clinical-care quality projects such as the New Jersey Hospital Association’s ICU and pressure-ulcer collaboratives. It should participate in clinical trials that the medical school has undertaken, and be a training site for students in nursing, pharmacy, physical therapy and other health professions.

It should have a full-time chief medical officer, a senior physician preferably with a master’s degree earned through the American College of Physician Executives (or equivalent) and a chief nursing officer with an appropriate doctoral degree.

Finally, the hospital’s board, administration and medical staff must have a demonstrable unwavering “safety net” commitment to the medically underserved.

These steps are, of course, easier said than done, so here are some initial steps for the states to consider:

State hospital associations should set up task forces to develop a policy and strategy to make sure hospital names are educational to the public, not exaggerations of capability.

A state could pass a law or the health department could promulgate regulations defining the requirements to be designated a university hospital or regional medical center. These designations should be subject to periodic state review.

Obtaining the appropriate and best hospital care should not be complicated by creative and clever hospital marketing but by easily understandable evidenced-based standards and metrics—and names.

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PART 3. (Chief Fourth of July Officer)…the term “CEO” is not long for the world… we should do the business world a huge favor and decide, ahead of time, what term should replace “CEO”

“What does a Chief Happiness Officer actually do?” (A)

ASSIGNMENT: Find out which NFP mega-hospital system in your region has the most C-Suite titles and then develop a “reporting relationships” Table of Organization.

For example, here are some corporate leadership pages from New York/ New Jersey*:  **

*Hospital Presidents may or may not be included


PART 1. Chief Fourth of July Officer

PART 2. Is Chief Innovation Officer an oxymoron? Innovation is cultural not structural.

PART 3. …the term “CEO” is not long for the world… we should do the business world a huge favor and decide, ahead of time, what term should replace “CEO”

“Everyone’s a Chief “Something” Officer. We used to run companies with a CEO, a president, a CFO, and a few VPs. Then we got COOs, CTOs, CMOs, CIOs, and CAOs. Now we have chief revenue officers, chief strategy officers, chief communications officers, chief performance officers, chief compliance officers, chief creative officers, chief diversity officers, chief visionary officers, it goes on and on. The C-suite can hardly hold all those chiefs and their giant egos. Better build a C-warehouse…

Corporate title inflation. Apple, the world’s most valuable company, has a CEO, a CFO, seven senior vice presidents, and about 70 vice presidents. That’s it. I know companies that are a tiny fraction of Apple’s size with more VPs. Some have several layers of VPs, presidents of divisions, more managers than workers, and every kind of Chief Whatever Officer you can think of. Ever heard “keep it simple, stupid?” It works for organizations, too. Organizational complexity kills companies.” (B)

“What’s driving the expansion of C-suite titles

Erica Seidel, founder of The Connective Good, a recruiting firm specializing in executive marketing, technology and analytic positions, says some of the new titles she has seen include Chief Customer Officer, Chief Growth Officer, Chief Data Officer and Chief AI Officer (AI for artificial intelligence).

Seidel believes the growing list of new C-level titles within B2B marketing reflects a growing professionalism and specialization among business leaders.

“The proliferation of these ‘Chief XXX’ titles is due to a combination of candidates having more clout than employers in a strong economy, titles being free, and talent managing their personal brand as they look ahead to the next step,” says Seidel, “In other words, candidates will often shape how their role is defined and in some cases ask for different titles, and get them as part of the negotiation process.”..

While there is no exact science to determine how the C-suite will continue to grow and expand, it appears businesses are more than happy to embrace new C-level titles. The most confusing aspect may be knowing exactly what the chief officer’s role is within the company as more chief-officer-acronyms are created.

To help, we’ve put together the following list of C-suite titles that fall outside the traditional leadership roles.

CAAO — Chief Applications Architect Officer; CAO — Chief Analytics Officer; CAO — Chief Automation Officer; CBO — Chief Behavioral Officer; CBO — Chief Brand Officer; CCO — Chief Customer Officer; CDO — Chief Data Officer; CDO — Chief Digital Officer; CEO — Chief E-commerce Officer; CEO — Chief Ecosystems Officer; CGO — Chief Growth Officer; CHRO — Chief Human Resources Officer; CIE — Chief Internet Evangelist; CIO — Chief Innovation Officer; CISO — Chief Information Security Officer; CITO — Chief Information Technology Officer; CKO — Chief Knowledge Officer; CLO — Chief Learning Officer; CMTO — Chief Marketing Technology Officer; CPO — Chief Product Officer; CPO — Chief Privacy Officer; CRO — Chief Risk Officer; CRO — Chief Revenue Officer; CSO — Chief Security Officer; CSO — Chief Strategy Officer; CSO — Chief Sustainability Officer; CXO — Chief Experience Officer (also referred to as the CUEO — Chief User Experience Officer). (C)

Another trend in title inflation is the actual growth of the title itself. Where three words used to be sufficient, we found hundreds of examples of Chief titles with four or more words.

Our longest title in the C-Suite was the Chief Human Resources and Civil Rights Officer role at Oregon Institute of Technology. (Suzette Yaezenko got the nod.)

Runners up for longest Chief titles were: Chief Corporate Communications and Development Officer; Chief Development, Marketing, & Communications Officer; Chief Facilities Design & Construction Officer; Chief Licensure And Field Experiences Officer; Chief Patient Safety and Experience Officer; Chief U.S. Pretrial Services and Probation Officer.

These more detailed titles indicate a level of specificity for the C-suite that is new in recent years. Whereas Chief Officer roles were historically broader with a purview across the entire firm, these very narrow duties combined with a lofty title indicate the importance of the role to the business or organization despite its smaller span of control.

So with that rather exhaustive review of the field, it’s worth asking: why? And why now?

It’s cheaper to give a title than give a raise. Perhaps the most cynical explanation for the ever-expanding grandeur in titles is the economic rationale. For a boss, giving a bigger title costs a lot less money than giving a raise, and may make the recipient just as happy.

We’re status-driven. It’s no secret that humans like to know where they are in the pecking order. A fancy-sound title feels like making it. The sense of having reached the upper echelons can be intrinsically rewarding. And beyond your corporate colleagues, it’s affirming to hear Mom, Dad — and maybe your siblings — be impressed with your new and lofty title… (D)

“Vint Cerf is called many things: a “computer scientist,” one of the “fathers of the Internet,” maybe even occasionally a “smarty pants.” So he wasn’t all that surprised when Google leaders Larry Page, Sergey Brin and Eric Schmidt came up with a new, never-been-used title for him: VP and Chief Internet Evangelist of Google.

“They first asked me what title I wanted, and I said ‘Arch Duke,’” Cerf told me, laughing. “They said, ‘Why don’t you be our Chief Internet Evangelist?’ Anytime you get a chief something it is a measure of respect.”

Cerf says the designation is fairly accurate, as he travels the world speaking with others about Internet connection, investment, policies and developments. He often hears: “That’s the most interesting title I’ve ever heard!” It has, however, backfired. On a trip to Russia, Cerf was asked four times in five days if he believed in God. He soon realized that they understood the term “evangelist” as a religious preacher. “I’m Geek Orthodox,” Cerf replied.” (E)

“… Some companies like to craft new positions with fancy titles just in order to appear like they’re paying attention to a particular business function. Others use C-level titles to combat the shortage of high-level talent in sought-after fields. CEOs and recruiters figure that if they give someone a “Chief Something” title, instead of a more-traditional VP or SVP role, an on-the-fence job candidate might be more likely to sign on the dotted line.

There are definite downsides to making everyone in your organization a chief. First, it can easily slow down decision making. Give someone a grandiose title, and you increase the risk that a needlessly large department or sub-organization will bloom underneath them to justify their high title. Bureaucracy sets in.,,

Naming too many C-level executives can also muddy a company’s focus. According to this write-up on online-education site, for example, the role of a corporate “chief listening officer” is “monitoring both external and internal communications about organizations,” including social-media channels. The role’s “primary focus is on gathering information from customers and employees in order to develop ways for an organization to enhance their relationships with both.”..

Finally, C-level fever can make corporate cultures sick, too. If CEOs hand out “chief” titles like candy in response to every new business trend, how will that make everybody else feel? Whenever I’ve done this myself as a CEO, hoping to cement a great performer in their role, it’s just led to more people coming to me with their hands out, looking for their own shiny titles. Plus, the trickle-down effect can make an otherwise logical org chart look more like a bank’s, where everyone’s a vice president and titles mean little… (F)

“When it comes to job titles, we live in an age of rampant inflation. Everybody you come across seems to be a chief or president of some variety. Title inflation is producing its own vocabulary: “uptitling” and “title-fluffing”. It is also producing technological aids. One website provides a simple formula: just take your job title, mix in a few grand words, such as “global”, “interface” and “customer”, and hey presto…

Does any of this matter? Title inflation clearly does violence to the language. But isn’t that par for the course in the corporate world? And isn’t it a small price to pay for corporate harmony? The snag is that the familiar problems of monetary inflation apply to job-title inflation as well. The benefits of giving people a fancy new title are usually short-lived. The harm is long-lasting. People become cynical about their monikers (particularly when they are given in lieu of pay rises). Organisations become more Ruritanian. The job market becomes more opaque. How do you work out the going rate for “vision controller of multiplatform and portfolio” (the BBC)? Or a “manager of futuring and innovation-based strategies” (the American Cancer Society)?

And, far from providing people with more security, fancy titles can often make them more expendable. Companies might hesitate before sacking an IT adviser. But what about a chief scrum master? The essence of inflation, after all, is that it devalues everything that it touches.” (G)

“Left to the chaos of a non-standardized organization (especially with a decentralized HR function), everyone does their own thing (which is to give out titles without much structure or consistency).   Then someone in the org runs a report, and discovers the mailroom services guy is an AVP (Associate Vice President for all you non-title inflators out there).

You know the drill, especially if you have spent time in a larger company.  What follows the AVP of Mailroom Services discovery is a title standardization campaign leaving many (and I mean many) employee relations issues (hard feelings) as titles are stripped away and replaced by more realistic tags describing what the employees actually do (or as close as they can get).

Been through some of that – it’s always much better to provide a little resistance up front and make sure all in the org are on board before handing out inflated titles.  Best place to start?  No manager titles if the person doesn’t manage direct reports, and no Director or VP titles if the person doesn’t manage managers who have direct reports (multiple layers in their organization).” (H)

“Especially in big companies, Campbell says, too many title promotions can lead to cynicism about what these new titles really mean. “A company does need to be frugal. Not everyone can be above average. Firms should be deliberate about how they give these title awards out to employees, because each additional person who gets a C-level title dilutes the currency” of the title structure…

Stevenson offers one final explanation for title inflation. She wonders whether the people pushing for higher titles are “the same ones who, as students, pushed for ‘A’s and caused grade inflation. Now they are making it into the corporate world and they want big titles.” She recalls a psychological study that looked at students from 1970 through today and concluded that the more recent entrants into the job market are significantly more spoiled and self-absorbed than their predecessors. The people who are getting inflated titles, she says, “could be part of what is an increasingly narcissistic generation.”(I)

“Today, there are signs that the “CEO” title is losing its luster. First, many CEOs are tacking “President” and “Chairman” onto their business card, as if they felt that “CEO” wasn’t special enough. Second, there’s been an explosion of bargain-basement “C-level” executives like “Chief Marketing Officer”, “Chief Sales Officer”, “Chief Ethics Officer”, “Chief Environmental Officer”, and so forth. That cheapens the “CEO” title, just like the “VP” explosion cheapened the “President” title.

We must therefore conclude that the term “CEO” is not long for the world. Since it’s absolutely critical to the success of a corporation that the top executive feel as if he were a god among mortals (hence the obscene pay packages), we should do the business world a huge favor and decide, ahead of time, what term should replace “CEO.”” (J)


Some examples of C-Suite title inflation in  health care:

Becker’s Hospital Review is pleased to recognize 32 chief population health officers at hospitals and health systems across the country.

The individuals featured here lead initiatives for their organizations focused on improving the health and wellness in their communities. Many of their efforts have served as models for other organizations nationwide, effectively working with at-risk populations to reduce preventable disease, manage chronic illness and overcome negative social determinants of healthcare.

As the role of digital technology has grown in hospitals and health systems in recent years, so too has the need for a dedicated executive to oversee all things digital…

In a health system, the CDO is responsible for overall digital transformation. Whereas a CIO oversees the technical implementation and operation of information systems, clinical systems, revenue cycle, analytics and more, the CDO operates on more of a cultural level, developing a digital strategy for an organization, fostering innovation and bringing automatization and other digital initiatives to the health system.

Though the CIO and CDO may experience some overlap in their roles and should certainly work in close partnership to further a health system’s digitalization, many experts recommend that the roles remain separate, rather than being combined into one position.

Tamarah Duperval-Brownlee is Ascension’s first chief community impact officer, which means she is in charge of helping guide the hospital operator’s new strategic vision to reimagine the best way to care for those in communities across the country. Duperval-Brownlee, a family physician, is responsible for helping Ascension pivot away from its focus on hospital campuses to better care for patients outside hospital settings.

The University of Texas MD Anderson Cancer Center in Houston has selected David Jaffray, PhD, to serve as its inaugural chief technology and digital officer.

In his new role, Dr. Jaffray will be responsible for the strategic design, acquisition, management and implementation of a technology infrastructure enterprisewide as well as data governance and data management.

The American Medical Association has selected Aletha Maybank, MD, to serve as its inaugural chief health equity officer.

As chief health equity officer at the AMA, Dr. Maybank will establish the organization’s Center for Health Equity, which will focus on ingraining the notion of health equity within the AMA as part of its processes, innovation and organizational performance.

The county’s dominant health system is creating a new executive position in response to safety violations at its flagship hospital.

In one incident, a cognitively impaired patient wearing staff scrubs walked out of Lancaster General Hospital at night and was found across town at UPMC Pinnacle Lancaster.

The Pennsylvania Department of Health report said after the Feb. 15 citation — the hospital’s third in a year — Penn Medicine Lancaster General Health president and CEO Jan Bergen called an emergency meeting of system leaders…

The report also says Bergen decided to create a new position of Chief Operating and Integration Officer to oversee all clinical operations, and a national search is being conducted to fill it.

LGH given 3rd citation in a year after patient wandered across town, by HEATHER STAUFFER,

Wilmington, Del.-based Christiana Care Health System tapped Lisa Maxwell, MD, to serve as chief learning officer.

As chief learning officer, Dr. Maxwell will lead Christiana Care’s Institute for Learning Leadership and Development as well as oversee learning efforts across the system.

Susan Fuehrer, VA Northeast Ohio Healthcare System director and CEO, is retiring from that job to become the MetroHealth System’s president of social determinants of health and health equity.

Fuehrer, 56, will lead MetroHealth’s initiatives to address the root causes of health disparities and eliminate barriers that keep people from accessing high-quality health care. Her job will involve engaging MetroHealth’s community partners to connect Clevelanders to health care with the goal of ending health disparities.

As Chief Clinical Transformation Officer at Horizon Blue Cross Blue Shield of NJ, it’s my responsibility to work with New Jersey’s doctors and health systems to develop innovative strategies that improve health care quality, affordability and the experience for our members.

Dr. Divya Paliwal, M.D.

Kaylan A. Baban, MD MPH is Chief Wellness Officer and Assistant Professor of Medicine at the George Washington University School of Medicine and Health Sciences, and Director of the Lifestyle Medicine program at the GW Medical Faculty Associates. She is board-certified in Preventive Medicine and Lifestyle Medicine with a focus on holistic care and patient empowerment.

Dr. Baban’s research and curricular efforts address mindful provision of healthcare and digital health for prevention, patient empowerment, and optimized health outcomes. She currently leads a mixed methods evaluation of individualized lifestyle management for primary and secondary prevention of non-communicable conditions.

Dupuy, Maud”

Cleveland Clinic has appointed Semih Sen chief business development officer, a newly created position.

In his new role, Mr. Sen will identify and drive new business opportunities, develop plans for new growth initiatives and build strategic partnerships and alliances. He will also head Cleveland Clinic Innovations, the commercialization arm of Cleveland Clinic.

Cleveland Clinic selects Semih Sen as first chief business development officer: 4 things to know, by Anuja Vaidya,

**I am on the faculty of the Icahn School of Medicine at Mount Sinai

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PART 17. July 1, 2019. A federal judge has ordered a mediator to move swiftly to improve health and sanitation (FOR MIGRANT CHILDREN) at Border Patrol facilities in Texas

ASSIGNMENT: You are the head of the Department of Public Health Sciences, The University of Texas at El Paso and have been “volunteered” to develop a Rapid Response “shadow” licensing program for the new Carrizo Springs, Texas “emergency” shelter which will house as many as 1,600 teens.

“What are the basic rules that determine how immigrant children are treated in U.S. immigration detention?”..

In the 1980s, the Reagan administration aggressively used detention of Central Americans as a device to deter migration from that region, where violent civil wars had caused tens of thousands to flee…

One suit was filed by the American Civil Liberties Union in 1985 on behalf of Jenny Lisette Flores, a 15-year-old from El Salvador. She had fled violence in her home country to live with an aunt who was in the U.S.

But Flores was detained by federal authorities at the U.S. border for not having proper documentation permitting her to stay in the U.S…

But the primary legacy of the case was the subsequent settlement, to which both the Clinton administration and the plaintiffs agreed in 1997.

The Flores settlement established basic standards for the treatment of unaccompanied minors who were in the custody of federal authorities for violating immigration laws.

It requires the federal government to place children with a close relative or family friend “without unnecessary delay,” rather than detaining them; and to keep immigrant children who are in custody in the “least restrictive conditions” possible. Generally speaking, this has meant migrant children can be kept in federal immigrant detention for only 20 days…”  (A)

“Bleak scenes of tearful, malnourished children reeking of filth and jammed into frigid, overcrowded quarters have emerged in new accounts from immigrant rights lawyers, who conducted dozens of interviews with children inside Border Patrol stations across Texas…

Immigrant rights lawyers, just hours after the tour, petitioned a federal judge to order additional oversight of Border Patrol holding facilities across Texas, where migrant children are being held.

The filing asked the court to require immediate inspections of the facilities by public health experts and accused the federal government of violating standards for detained migrant care established in a court settlement. The advocates also sought to have detained children released to parents or other relatives living in the U.S…

On Friday, U.S. District Judge Dolly Gee ordered the court monitor overseeing the settlement to bring the migrant lawyers and the federal government together for mediation. She said the monitor may appoint “an independent public health expert” to address conditions in facilities, if she deems that is necessary. Both parties are to file status reports by July 12.” (B)

“Citing the Flores Settlement Agreement, which requires the U.S. government to ensure “safe and sanitary” conditions for migrant children in federal custody, attorneys…. “the children need immediate access to emergency care and improved living conditions to prevent more illness and even death.”..

In an interview with The Washington Post, Peter Schey, who has been litigating the ongoing case since its initial filing in 1985, said Wednesday’s filing represented the first time attorneys have felt the need to seek emergency relief from a judge.” (C)

“Lawyers are particularly concerned about the spread of illness inside Border Patrol facilities, which can sometimes turn fatal. Five children have died in Border Patrol custody since December, some of whom were initially diagnosed with a common cold or the flu. The processing center in McAllen, known as Ursula, recently quarantined three dozen migrants who were sick after a 16-year-old died of the flu at the same facility…

Dr. Julie Linton, the co-chair of the American Academy of Pediatrics, previously told HuffPost that children can’t recover from illnesses in Border Patrol facilities. These centers are described as “hieleras” ― Spanish for iceboxes ― because of their freezing temperatures, and migrants describe sleeping on floors under bright lights that shine 24/7, with nothing but Mylar blankets to keep warm…” (D)

“More than 200 migrant children detained in a remote Border Patrol station in southwest Texas without adequate food, water and sanitation have been moved after news of the conditions became public last week…

A law professor who recently visited the facility, Warren Binford of Willamette University, described the conditions for children in an interview with NPR’s Lulu Garcia Navarro.

“Many of them are sleeping on concrete floors, including infants, toddlers, preschoolers. They are being given nothing but instant meals, Kool-Aid and cookies — many of them are sick. We are hearing that many of them are not sleeping. Almost all of them are incredibly sad and being traumatized. Many of them have not been given a shower for weeks. Many of them are not being allowed to brush their teeth except for maybe once every 10 days. They have no access to soap. It’s incredibly unsanitary conditions, and we’re very worried about the children’s health.””  (E)

“U.S. government officials say they’ve moved more than 100 kids back to a remote border facility where lawyers reported detained children were caring for each other and had inadequate food, water, and sanitation.

An official from U.S. Customs and Border Protection said Tuesday that the “majority” of the roughly 300 children detained at Clint, Texas, last week have been placed in facilities operated by the Office of Refugee Resettlement.

The official, who briefed reporters on the condition of anonymity, wouldn’t say exactly how many children are currently detained there. But the official says Clint is better equipped than some of the Border Patrol’s tents to hold children…”  (F)

“About half of the roughly 2,300 children confined in a privately run Florida facility intended as a temporary shelter for migrant teenagers have been there for more than 20 days and many of them for months, despite legal standards that require children who cross the border to be speedily released or sent to state-licensed shelters that are equipped to offer longer-term care.

The Homestead center near Miami, the only one in the government’s large network of shelters run by a private, for-profit corporation, is intended to keep children for only a few days, but has been holding them for much longer as a result of the unusually large number of unaccompanied children arriving in recent months along the southwest border…

Children living at Homestead have complained that it is extremely crowded and noisy, and that they enjoy no privacy, according to reports filed with a federal court. They report feeling increasingly despondent because they have no idea when they will be released, lawyers said. Rules prohibit them from listening to music or writing in a journal. Some reported having suicidal thoughts.

Amy Cohen, a psychiatrist who has visited the facility, said the noise level was extremely high, especially in a tent with no soundproofing where “children are crammed” and teachers must use microphones to be heard above the noise…

Immigrant advocates have gone to court to argue that Homestead should be required to meet the rigorous standards established for detaining migrant children — though government officials argue that the facility, operated as a temporary “influx” shelter, not a detention center, is not legally required to do so.

Under those standards, established under a 1997 consent decree, children must generally be released within about 20 days, or transferred to a licensed shelter that has comfortable living accommodations and a full education program.

Costing over $1 million a day to operate, Homestead opened in February… “ (G)

“Maintenance reportedly eats up most of the $775 daily cost per child for the tent camps, since it’s difficult to keep temporary structures suitable for humans in a desert. In permanent facilities run by Health and Human Services, the cost is $256 per person per night, and NBC News estimates that even keeping children with their parents and guardians in Immigration and Customs Enforcement facilities would only cost $298 per night…

“…Southwest Key Programs, a nonprofit that set up a boys’ shelter in the husk of an old Walmart, reportedly netted $955 million in federal contracts between 2015 and 2018, according to The New York Times. A network of nonprofit groups, BCFS, reportedly received $179 million in the same time period. BCFS is the same contractor that held migrant kids in parked vans for 39 hours earlier this year, as ICE slowly did the paperwork to reunite the children with their families”  (H)

“Hundreds of migrant children being transferred from squalid, overcrowded Border Patrol detention centers are heading into the custody of a federal refugee agency that’s already struggling to feed and care for tens of thousands of minors…

The refugee office’s shelters have taken in more than 52,000 children since October — a 60 percent jump from the previous year, driven by a record influx of migrants and complicated by the Trump administration’s aggressive border policies. Its parent agency, the Department of Health and Human Services, is pursuing strategies to cope with the surge, which include freezing money for anti-trafficking efforts and services for survivors of torture, and possibly furloughing employees.

The crunch is also slowing HHS’s oversight of shelters, efforts to expand the number of beds and attempts to unite migrant children with sponsors in the United States…

“This historical influx is challenging the capacity of the federal government to shelter UAC [unaccompanied alien children] and presents child welfare concerns beyond the treacherous journey that these minor children take across the southern border,” said an HHS spokesperson in an emailed statement…

“It’s a very difficult time,” an HHS official told POLITICO. “The program grew faster than we were ready.” (I)

“A federal judge has ordered a mediator to move swiftly to improve health and sanitation at Border Patrol facilities in Texas, where observers reported migrant children were subject to filthy conditions that imperiled their health.

Judge Dolly M. Gee of the Central District of California asked late on Friday that an independent monitor, whom she appointed last year, ensure that conditions in detention centers are promptly addressed. She set a deadline of July 12 for the government to report on what it has accomplished “post haste” to remedy them…

The new order stopped short of directly ordering the government to take action but referred the issue to the monitor to take action for the “prompt remediation” of conditions at the facilities, included the retention of an independent public health expert…

In her order, Judge Gee said that the court had detailed previous violations by the government of a 1997 consent decree, called the Flores settlement agreement, which established standards for the care of migrant children in its custody. A monitor had been appointed last year over the government’s objections after plaintiffs in the Flores case successfully argued that there had been egregious violations of the agreement…

The “emergent” nature of the recent reports “demands immediate action,” the judge added…

The motion for a temporary restraining order asked the court to mandate immediate inspection of facilities in McAllen, Clint and Weslaco, all in Texas, by a public health expert. It also requested that medical professionals obtain access to those facilities and that the government speed up the release of children detained at the facility to sponsors — mainly parents or relatives in the United States.”  (J)

“A federal judge has ordered U.S. Customs and Border Protection (CBP) to allow medical professionals into detention facilities holding migrant children, CNN reported Sunday.

U.S. District Judge Dolly Gee ordered that health professionals be allowed in the facilities to ensure the conditions are “safe and sanitary” for children being detained there and to assess the children’s medical needs.

The order pertains to all of CBP’s facilities in the El Paso and Rio Grande Valley sectors in Texas, CNN reported. The centers are the subject of a lawsuit regarding the 1997 Flores Settlement Agreement and reports of unsafe and unsanitary conditions at detention centers.” (K)

“By the time Dr. Roberto “Bert” Johansson saw the toddler in the emergency room, she was vomiting, feverish, dehydrated and desperately ill with acute gastroenteritis.

The girl had been in Border Patrol custody for two days before agents rushed her to El Paso Children’s Hospital. Johansson told CNN he admitted her and put her on an IV line, fluids and other treatment.

“She lived, but her illness had been missed,” he said of that day three months ago. “We need to get to these kids earlier.”..

But Johansson, a pediatrician who specializes in emergency medicine and intensive care, says there’s another pressing problem: The medical screening the Border Patrol gives to undocumented children is “absolutely, unequivocally inadequate.”” (L)

BREAKING NEWS. “Health officials at the University of New Mexico are designing a program to help treat sick migrants – many of them seeking asylum – being detained in crowded government facilities near the border.

Dr. Sanjeev Arora, director of Project ECHO – Extension for Community Healthcare Outcomes – at the University of New Mexico Health Sciences Center, said that an ECHO program to help treat migrants in facilities near the Mexican border is being developed and should be up and running in the coming weeks.

“There are children and people (at the border) who are housed in government facilities who need health care, and there isn’t enough expertise there,” Arora said. “We are going to bring our existing resources to bear and start an ECHO for them.”..

ECHO programs, which now total in the hundreds and reach worldwide, are essentially video teleconferences where specialized experts of a topic share knowledge with health care providers in areas where health officials don’t have the same expertise, especially rural areas.

Instead of one doctor being able to treat one patient through videoconference, the sharing of knowledge allows the number of patients helped to grow exponentially, Arora said.” (M)

PART 16.  June 21, 2019. “The federal government is opening a new MASS FACILITY TO HOLD MIGRANT CHILDREN, a temporary emergency shelter that will not be subject to state child welfare licensing requirements.”

“Are you arguing seriously that you do not read the [Flores] agreement as requiring you to do anything other than what I just described: cold all night long, lights on all night long, sleeping on concrete and you’ve got an aluminum foil blanket?”

HHS..”instructed officials to cut programs “not directly necessary for the protection of life and safety,” a spokesperson for the HHS said, according to the Washington Post. These services include English classes, recreational programs like soccer, and legal aid,…”

Statement from the American Public Health Association and Trust for America’s Health

“As public health professionals we know that children living without their parents face immediate and long-term health consequences. Risks include the acute mental trauma of separation, the loss of critical health information that only parents would know about their children’s health status, and in the case of breastfeeding children, the significant loss of maternal child bonding essential for normal development. Parents’ health would also be affected by this unjust separation.

“More alarming is the interruption of these children’s chance at achieving a stable childhood. Decades of public health research have shown that family structure, stability and environment are key social determinants of a child’s and a community’s health.

“Furthermore, this practice places children at heightened risk of experiencing adverse childhood events and trauma, which research has definitively linked to poorer long-term health. Negative outcomes associated with adverse childhood events include some of society’s most intractable health issues: alcoholism, substance misuse, depression, suicide, poor physical health and obesity.” (T)

 “Migrant children are increasingly resorting to sleeping outside of border patrol stations because the agency charged with sheltering them, the Department of Health and Human Services, has been overwhelmed by the influx of asylum-seekers, NBC News reported Tuesday.

HHS, which is reportedly operating at 97 percent capacity, is responsible for caring for the record number of migrant children that are arriving at the border each day until they can be placed with a sponsor. As reports of a humanitarian crisis at the border continue to mount, HHS officials have urged Congress to provide more resources for the provision of medical care and shelter.

As of May 31, 1,448 unaccompanied migrant children have remained in border patrol custody for at least 72 hours, the maximum time allotted by law, while waiting to be transferred to HHS, according to NBC News.

In total, 1,402 unaccompanied migrant children have been processed by border patrol and are now waiting to be transferred to a HHS facility, where are they supposed to receive a bed and support from a social worker.

The children often resort to sleeping on concrete slabs or outside the border patrol stations while they await transfer to an HHS facility that corresponds to their gender and age. The influx of women and children arriving at the border in recent months has delayed this process as HHS lacks adequate housing to accommodate a population that is no longer comprised mostly of single adult males as it once was.” (A)

“The federal government is opening a new mass facility to hold migrant children in Texas and considering detaining hundreds more youths on three military bases around the country, adding up to 3,000 new beds to the already overtaxed system.

The new emergency facility in Carrizo Springs, Texas, will hold as many as 1,600 teens in a complex that once housed oil field workers on government-leased land near the border, said Mark Weber, a spokesman for Office of Refugee Resettlement.

The agency is also weighing using Army and Air Force bases in Georgia, Montana and Oklahoma to house an additional 1,400 kids in the coming weeks, amid the influx of children traveling to the U.S. alone. Most of the children crossed the border without their parents, escaping violence and corruption in Central America, and are held in government custody while authorities determine if they can be released to relatives or family friends.

All the new facilities will be considered temporary emergency shelters, so they won’t be subject to state child welfare licensing requirements, Weber said. In January, the government shut down an unlicensed detention camp in the Texas desert under political pressure, and another unlicensed facility called Homestead remains in operation in the Miami suburbs.” (B)

“The Trump administration is scaling back services for unaccompanied minors who cross the US-Mexico border, citing budget constraints after a surge in crossings not seen in over a decade.

The Trump administration is struggling to deal with the number of migrants entering the US, and has placed much of the blame for insufficient services and even several recent deaths of migrant children onto migrants themselves.

According to new data released by Customs and Border Protection, 109,144 people were taken into custody last month, nearly 9,000 of them unaccompanied children.

The Trump administration is slashing support and services for unaccompanied minors who cross the US-Mexico border, citing budget constraints after a surge in crossings not seen in for more than a decade.

The Office of Refugee Resettlement (ORR), which is part of the Department of Health and Human Services (HHS) and provides housing and resources for migrant children, has instructed providers to suspend funding for certain programs.

It instructed officials to cut programs “not directly necessary for the protection of life and safety,” a spokesperson for the HHS said, according to the Washington Post. These services include English classes, recreational programs like soccer, and legal aid, the Post said.” (C)

“The government’s plans were swiftly rebuked by civil rights lawyers representing unaccompanied children, who have been crossing the border in ever-larger numbers this year to flee poverty and violence in their home countries, mainly in Central America. And the chief of at least one large shelter operator said he would continue to offer education and sports at his network’s facilities.

Some 13,200 migrant children, including adolescents who crossed the border alone and young children who were separated from their parents, are currently housed in more than 100 shelters across the country. They receive English instruction, as well as math, civics and other classes. Most facilities have a sports field and allow children to go outside, often to play soccer, at least once a day…

Civil rights and child welfare advocates said that any move by the government to eliminate education and recreation would constitute a violation of the Flores settlement, which in 1997 established the standards for treating migrant children held in government facilities, and would prompt them to sue for reinstatement of the activities.

“If this administration goes forward with denying education, recreation and other unspecified so-called nonessential services, it would be in flagrant violation of the Flores settlement and will face immediate legal action,” said Neha Desai, co-counsel on the settlement decree, who visits government shelters to ensure compliance. She is also the immigration director at the National Center for Youth Law in Oakland, Calif.

“To those of us whose job it is to promote the health and safety of children, this is a shocking directive,” said Amy Cohen, a psychiatrist who consults for the Flores team and regularly interviews children at shelters. “It violates every tenet of basic child welfare practice and will further harm the medical and psychological health of children fleeing extraordinarily dangerous circumstances in their home countries.”…

 “We have not and we are not going to curtail recreation and education. We just can’t do that,” said Kevin Dinnin, president of BCFS, the second-largest shelter network, which houses about 1,000 children in facilities in Texas. “We will have to use reserve funds until the government figures out what they are going to do.” (D)

“For the past year and a half, Dr. Eric Russell has been traveling from Houston to McAllen, Texas, every three months or so to volunteer at the Catholic Charities Humanitarian Respite Center, a first stop for many asylum-seeking migrants who’ve been released by U.S. Customs and Border Protection in the Rio Grande Valley.

During his most recent visit to the clinic in April, when he saw more than 150 migrants, he noted a troubling new trend: a number of people reported that their medication had been taken from them by U.S. border officials.

“I had a few adults that came who had high blood pressure, who had their blood pressure medications taken from them and, not surprisingly, their blood pressure was elevated,” Russell told Yahoo News. “There was a couple of adults that had diabetes that had their diabetes medicines taken from them, and wanted to come in because they were worried about their blood sugar. And, not surprisingly, their blood sugar was elevated.”

For Russell, a pediatric emergency medicine physician, the patient who stood out the most during that visit was a boy of 8 or 9 with a history of seizures. According to his mother, the child had been on a long-term seizure medicine in their home country, but the medication had been taken from him upon entering the Border Patrol custody in McAllen and never returned…

 “My concern is, what’s going to happen if you put a 9-year-old child who has a history of seizures, without any seizure medicine on a bus for 3 days … is that he’s going to have a seizure,” Russell said.

Russell added that he can understand the need for a policy regarding the use of outside medication by detainees. However, he said, “At the end of the day, as a medical provider, as a physician, we take an oath to first do no harm. And taking somebody’s medications seems like it’s causing harm.”…

In light of these deaths, the American Academy of Pediatrics, along with other child health and welfare experts, have offered a number of recommendations for how CBP can improve the care of migrant children in its custody, which include ensuring access to screenings and treatment by medical professionals who know how to recognize and respond to the subtle yet often rapidly worsening signs of illness in children.

“The AAP has been in discussions for months with [CBP] about increasing the number of pediatric-trained providers that are at these large processing centers,” said Griffin. However, information provided by CBP officials suggests the agency has yet to heed the AAP’s advice as it expands contracted medical services across the southwest border.”  (E)

“The government agency that takes custody over all unaccompanied minors who arrive on the border has been unable to answer questions about the number of children who have died in its custody in the years since President Donald Trump took office.

When children who are traveling by themselves either ask for asylum at ports of entry or are apprehended by Border Patrol, they are eventually transferred into the custody of the Office of Refugee Resettlement. ORR—an agency within the Department of Health and Human Services (HHS)—maintains a series of shelters for the unaccompanied minors, many of which are run by independent contractors…

On May 23rd, Pacific Standard sent an email to HHS asking if, since 2016, any other children had died in ORR custody that the public had not been made aware of. A media contact in the HHS’s Administration for Children and Families office confirmed that the email had been received, and said: “[The] inquiry is with the program office for response—we’ll get the information back to you just as soon as we have it.”

HHS never got back to Pacific Standard’s inquiry, nor to two subsequent inquiries sent the next day and again on June 5th…

Jennifer Podkul, the senior director of policy and advocacy for Kids in Need of Defense—an advocacy organization for immigrant children—says it’s plausible that there are more children who have died than the public is aware of.

“It’s certainly possible,” Podkul says. “I don’t have any specific information about specific cases [that have’t been reported], but there are a few reasons why I say it’s plausible: One is that there’s no mandatory reporting requirement for ORR, unlike ICE. And the other reason, that’s really important, is that ORR doesn’t have any sort of public monitoring system.”

According to Podkul, though ORR and HHS completes reviews of the facilities they run for children—both those run by the government and those run by contractors—those sorts of audits aren’t released to the public.” (F)

“A 16-year-old from Guatemala died of complications of the flu while in U.S. Border Patrol custody, according to preliminary autopsy findings, alarming doctors who questioned whether immigration authorities missed warning signs or chances to save his life.

Carlos Hernandez Vasquez contracted bacterial infections in addition to the flu, as well as sepsis, which can lead to tissue damage and organ failure, according to a report released by Hidalgo County authorities this week. He died May 20. A full autopsy is pending.

Carlos is the sixth child in the last year to die after U.S. border agents detained him, and the second known to have died of the flu, after 8-year-old Felipe Gómez Alonzo died on Christmas Eve…

 “By the time you’re 16 years old, you have great immunity, and you shouldn’t be dying so quickly,” said Dr. Nizam Peerwani, the Tarrant County medical examiner in Fort Worth, Texas, and an adviser for the advocacy group Physicians for Human Rights.

Peerwani said Carlos’ rapid deterioration raised questions about whether he may have had potential symptoms including a fever, body aches, or breathing trouble before the Border Patrol says he reported being sick.

He should have been taken to a medical facility or clinic instead of remaining in detention, Peerwani said.

Dr. Julie Linton, co-chair of the American Academy of Pediatrics’ immigrant health special interest group, also said the prescription of Tamiflu may not have been enough treatment, especially since the medicine works best in the first two to three days of illness. While Carlos’ illness was discovered the day before his death, he may have sick well before then, she said. “We cannot treat Tamiflu as a substitute for the other care that is required,” Linton said.

Doctors who treat the flu rely on a patient telling them how long they’ve had symptoms. Linton pointed out that the processing center where Carlos was detained has the lights on 24 hours a day, which may have made it difficult for him to know how long he had been sick.”  (G)

“County health officials announced Thursday that the influenza outbreak at a local migrant shelter continues to worsen with 22 new cases of flu or flu-like symptoms.

The total number of confirmed flu and “influenza-like illness” since May 19 among asylum-seeking migrants at a shelter in Bankers Hill operated by Jewish Family Service of San Diego now stands at 81. Officials with the county’s Health and Human Services Agency confirmed 12 new cases on both Tuesday and Wednesday.

In addition, the county has quarantined 63 asylum seekers at various local hotels to try to contain the outbreak. Two asylum seekers at the shelter have been transported to the hospital due to their flu symptoms, according to the county. Health officials have screened roughly 450 asylum-seeking migrants at the shelter for symptoms since May 19.

The county defines an outbreak as one person contracted an illness and a second person contracting it and showing symptoms within 72 hours. The county first declared the outbreak May 23…

Cases of flu and chicken pox have afflicted immigrant detention facilities for months, with some detained infants and children showing fevers of up to 105 degrees. CBP agents temporarily closed processing functions at the McAllen facility last week amid a flu outbreak, during which it quarantined more than 30 detainees, according to the Washington Post.

The flu has also caused multiple deaths among detainees at the border in the last six months. Immigration officials confirmed the flu-related death of a 16-year-old Guatemalan boy at the McAllen facility last week, the fifth Guatemalan child to die in federal custody since December and at least the second to die from flu complications.

The county said it plans to continue monitoring the situation and providing updates on new flu cases at the shelter. County health officials are also treating outwardly healthy people at the shelter to prevent the flu from spreading any further.” (H)

“The recent death of a Guatemalan child after a flu outbreak at the Customs and Border Protection Centralized Processing Center in McAllen is unsurprising, according to the American Academy of Pediatrics.

Dr. Julie Linton is the co-chair of the American Academy of Pediatrics Immigrant Health Special Interest Group. She said processing facilities and detention centers are no place for children.

Linton said the Ursula Central Processing Center, which is the largest in the nation, is the type of facility that is a haven for infectious diseases like flu or tuberculosis and infestations like scabies.

“When you enclose people in close quarters and large spaces, it’s much more difficult to control the spread of illness,” Linton said. “I think what we also know, however, is that we have children who are presenting and asking for medical attention — we have families who are asking for medical evaluations for their children — and they’re being evaluated, and then after evaluation they’re being sent back to processing centers.”

Linton said a sick child is not going to do well in those conditions.

“I’m a pediatrician, and I care for sick children all the time, and I would never suggest, in healing, a child return to a cold concrete floor, covered by a silver, mylar blanket which is really more of a sheet, to heal from their illness, and certainly not in a setting where they’re exposed to constant stress,” Linton said…

The AAP has created a toolkit to help those who come into contact with immigrant children to help them get and stay healthy.

The McAllen processing center temporarily closed last week after medical staff identified 32 other migrants who were experiencing symptoms of the flu.” (I)

“The deaths of migrant children in U.S. custody raise grave humanitarian concerns and set off alarms. Medical experts, human rights groups and children’s advocates long have decried unsanitary and crowded conditions at the facilities where children and families are detained for days before they are transferred to shelters or released with notices to appear before a judge. These experts have warned that the living conditions, coupled with the physical and traumatic effects of migrants’ grueling journeys here, exact a punishing toll that endangers the children’s lives.

Castro and other members of Congress have called for a federal investigation. According to Castro, prior to the deaths over the past eight months, U.S. Customs and Border Protection had gone more than a decade without a child dying in its custody.

Federal scrutiny of the immigration detention facilities holding children and families is urgently needed. Americans deserve a full accounting of the deaths and a plan for averting more tragedies. The U.S. must guard its borders, but it must do so responsibly, ensuring the welfare of the children it holds in its custody. Detaining 10-year-olds in fenced-in pens who are not a threat to this country and who, with their families, are merely seeking protection is punitive and not what America stands for. If the administration cannot adequately care for the children in its custody, it must re-examine its detention policy.

No investigation can be complete without a thorough vetting of the administration’s hard-line border enforcement policies, which once separated thousands of children from their families, literally tearing some from their parents’ arms, a policy since discarded amid an international outcry. It may take up to two years for authorities to identify the children, the federal government said in April. It is no wonder that such a dereliction of duty leads some to question if children are merely considered collateral damage in the administration’s crackdown on immigration…

The Border Patrol needs help, agreed Marsha Griffin, a pediatrician on the South Texas border and a spokesperson for the American Academy of Pediatrics. “We need to provide them with more and better medical (staff), especially when it pertains to children,” Griffin told us.

Along with other facets of its border enforcement crackdowns, the federal government is trying to send a message to deter migrants from coming, Gilman said.”  (J)

“As the Trump administration works to address what it describes as a growing “crisis” at the U.S.-Mexico border, officials said in a court filing that it may take two years for the government to identify thousands of migrant children who were separated from their families.

The filing Friday outlined the government’s plan to use data analysis and manual reviews to sift through the cases of about 47,000 children who were apprehended by U.S. immigration officials from July 1, 2017, to June 25, 2018, to identify which children might have been taken from family members. It estimated the process “would take at least 12 months, and possibly up to 24 months.”

Last month, U.S. District Judge Dana Sabraw expanded the number of migrant families that the government may be forced to reunite under his previous order after an inspector general report revealed that the administration had an undisclosed family separation pilot program in place starting in July of 2017. The ruling was made as part of a lawsuit led by the American Civil Liberties Union.

“The administration refuses to treat the family separation crisis it created with urgency, ” the ACLU said in a statement Saturday. “We strongly oppose any plan that gives the government up to two years to find kids. The government swiftly gathered resources to tear families apart. It must do the same to fix the damage.” (K)

“Rom Rahimian, a medical student working at Banner-University Medical Center Tucson, was trying to help a 20-year-old Guatemalan woman who had been found late last year in the desert — dehydrated, pregnant and already in labor months before her due date. But the Border Patrol agents lingering in the room were making him uncomfortable.

The agents remained in the obstetrics ward night and day as physicians worked to halt her labor. They were present during her medical examinations, listened in on conversations with doctors and watched her ultrasounds, Mr. Rahimian said. They kept the television on loud, interfering with her sleep. When agents began pressing the medical staff to discharge the woman to an immigration detention facility, the doctors took action.

“It was a race against the clock to see if we can get her into any other situation,” Mr. Rahimian said. He called a lawyer and asked, “What can we do? What are her rights?”

As apprehensions of migrants climb at the southwest border, and dozens a day are taken to community hospitals, medical providers are challenging practices — by both government agencies and their own hospitals — that they say are endangering patients and undermining recent pledges to improve health care for migrants.

The problems range from shackling patients to beds and not permitting them to use restrooms to pressuring doctors to discharge patients quickly and certify that they can be held in crowded detention facilities that immigration officials themselves say are unsafe. Physicians say that needed follow-up care for long-term detainees is often neglected, and that they have been prevented from informing family members about the status of critically ill patients. Agency vehicles parked conspicuously near hospital entrances, health providers say, are also stoking fear and interfering with broader immigrant care.

Doctors typically do not know what rights they might have to challenge these practices. At Banner and several other hospital systems across the country, they have called on administrators to oppose and change security measures that they view as endangering health..

Health systems, too, maintain policies that doctors say are problematic. Banner Health, like some others, has a policy that applies equally to immigration detainees and prisoners. It disallows bathroom privileges, requires at least two limbs to be secured to beds unless medically inadvisable, gives agents discretion over whether mothers may visit newborns and obliges law enforcement officers to remain with patients.” (L)

“A premature newborn baby girl and her 17-year-old migrant mother were almost entirely ignored and neglected for an entire week while held by Border Patrol near the Texas border.

Lawyers who visited the immigration processing station in McAllen, TX, told HuffPost that the one-month-old infant was wrapped in a dirty towel and wore soiled clothing. The mother was severely underslept, wheelchair-bound, and unable to walk or lie down due to pain from an emergency C-section.

The baby was born in Mexico after the mother left Guatemala for the U.S. while eight months pregnant. Neither mother nor child has been publicly identified.

According to immigration and human rights attorney Hope Frye, the mother was taken to a hospital at least once for pain medication, but the baby had not received any medical care since being placed in Border Patrol custody.” (M)

“The Trump administration has made its position on immigration clear as day. But the executive branch’s crackdown on immigration — legal and otherwise — has come with a cost. A new NBC News analysis found that 24 immigrants died in ICE custody since President Trump took office, and that figure notably doesn’t include migrants who died while they were detained by other government agencies.

“What we’re seeing is a reckless and unprecedented expansion of a system that is punitive, harmful and costly,” Katharina Obser, a senior policy adviser at the Women’s Refugee Commission, told the news outlet. The government has filed to provide immigrants in its custody with medical and mental health care, she added.

The NBC News report comes as the number of migrant children who die after crossing the U.S.-Mexico border continues to rise. The report also indicates that the number of immigrants in U.S. custody has recently reached an all-time high, with about 52,500 immigrants currently in ICE custody per day.

In a statement provided to NBC News, ICE said that “it takes very seriously the health, safety and welfare of those in our care,” and that “any death that happens in ICE custody is a cause for concern.”

So far, at least five migrant children have died after being apprehended at or near the U.S.-Mexico border since December. A 10-year-old girl from El Salvador also died in September, although the public did not learn about her death until  May of this year, per the BBC. The five children who have died since December were all from Guatemala.” (N)

“The Texas Tribune reports more than 5,800 unaccompanied migrant children are living in 35 shelters across the state as of last month.

The U.S. government has also reported more than 144,000 migrants were apprehended or denied entry last month, which is a 13-year high.

They say more than half of the families detained had children. And 8 percent of these migrants are considered to be unaccompanied minors…

Right now, Texas has 35 state-licensed shelters. The Texas Health and Human Services Commission says combined, the 35 shelters can accommodate up to 6,423 children, meaning the state shelters are at about 90 percent capacity.

These migrant children living in federal shelters no longer have access to English classes, recreational programs, like soccer, and legal aid, after the Trump Administration decided to cancel these activities due to budget pressures earlier this month.

The Texas Tribune reported that the director of Hope Border Institute, Dylan Corbett, told them this decision was.. “a demonstration of their willingness to use children as pawns in a politically motivated plan to inflict as much pain as possible.” (O)

“……the administration is taking new steps to deprive the children it is holding in custody of basic necessities. Last week, the administration cut funding for education, recreation and legal aid for migrant children and youth in federal shelters. An estimated 13,200 minors are currently being held in shelters contracted by the Office of Refugee Resettlement (ORR). The Children’s Defense Fund recently joined more than 100 other organizations signing on to a letter to the Secretary of HHS and other federal leaders condemning the decision.

As the letter explains, “It is widely recognized in international, federal, and state law that children are unique from adults and should be afforded special protections that support their developmental needs.” That’s why the Flores settlement, the existing agreement that limits the length of time and conditions under which federal officials can detain immigrant children, requires the government to place children in the least restrictive setting that is in the best interest of the child.

It’s also why the services the administration is taking away from these children — including English, math, science and reading classes and outdoor activities such as soccer and basketball — are essential to their development…

Immigrant children are still children. They are our children. It doesn’t matter how a child came to be in our country — once they are here, in the wealthiest and most powerful nation on earth, it is our duty and our obligation to care for them, support them and give them the opportunity to grow up and thrive. Instead, we are cruelly stripping away their chance to learn, to play and to connect. And in the worst and most unforgivable cases, we are letting them die on our watch.

Even for an administration already known for its cruel treatment of immigrant children this is another heartless and disgraceful step too far. We are better than this.” (P)

“A 2-year-old boy locked in detention wants to be held all the time. A few girls, ages 10 to 15, say they’ve been doing their best to feed and soothe the clingy toddler who was handed to them by a guard days ago. Lawyers warn that kids are taking care of kids, and there’s inadequate food, water and sanitation for the 250 infants, children and teens at the Border Patrol station.

The bleak portrait emerged Thursday after a legal team interviewed 60 children at the facility near El Paso that has become the latest place where attorneys say young migrants are describing neglect and mistreatment at the hands of the U.S. government.

Data obtained by The Associated Press showed that on Wednesday there were three infants in the station, all with their teen mothers, along with a 1-year-old, two 2-year-olds and a 3-year-old. There are dozens more under 12. Fifteen have the flu, and 10 more are quarantined.

Three girls told attorneys they were trying to take care of the 2-year-old boy, who had wet his pants and had no diaper and was wearing a mucus-smeared shirt when the legal team encountered him…

The lawyers inspected the facilities because they are involved in the Flores settlement, a Clinton-era legal agreement that governs detention conditions for migrant children and families. The lawyers negotiated access to the facility with officials, and say Border Patrol knew the dates of their visit three weeks in advance.

Many children interviewed had arrived alone at the U.S.-Mexico border, but some had been separated from their parents or other adult caregivers including aunts and uncles, the attorneys said.

Government rules call for the children to be held by the Border Patrol for no longer than 72 hours before they are transferred to the custody of Health and Human Services, which houses migrant youth in facilities around the country.” (Q)

“Although the conditions in which migrant children are being detained has prompted widespread outrage, the Trump administration defended its detention centers in court on Thursday, Newsweek reports. At the 9th Circuit Court in San Francisco, a Justice Department lawyer said that denying migrant children soap and toothbrushes, and requiring them to sleep on concrete floors in cold and crowded rooms, still qualifies as “safe and sanitary” treatment. This prompted incredulity from several judges at the hearing, according to Newsweek.

“Are you arguing seriously that you do not read the [Flores] agreement as requiring you to do anything other than what I just described: cold all night long, lights on all night long, sleeping on concrete and you’ve got an aluminum foil blanket?” U.S. Circuit Judge William Fletcher asked. “I find that inconceivable that the government would say that that is safe and sanitary.”” (R)

“Fellow Judge A Wallace Tashima remarked: “It’s within everybody’s common understanding that if you don’t have a toothbrush, you don’t have soap, you don’t have a blanket, those are not safe and sanitary conditions” (S)

  1. A. Migrant Children Sleep Outside Due to Lack of HHS Resources, by JACK CROWE,
  2. B. US Opens New Mass Facility in Texas for Migrant Children. The facility in Carrizo Springs, Texas, will hold as many as 1,600 teens in a complex that once housed oil field workers by ASSOCIATED PRESS,
  3. C. Trump administration cancels legal aid and English classes for unaccompanied minors in further crackdown on migration, by Rosie Perper,
  4. D. Migrant Children May Lose School, Sports and Legal Aid as Shelters Swell, by Miriam Jordan,
  5. E. Border Patrol is confiscating migrant kids’ medicine, U.S. doctors say, byCaitlin Dickson,
  7. G. Doctors Alarmed That Flu Killed Migrant Teen Detained In Texas, by NOMAAN MERCHANT,
  8. H. Flu cases at San Diego migrant shelter reach 81, County confirms 22 new cases,
  9. I. Why Children Keep Getting Sick At Detention, Processing Centers, by BONNIE PETRIE,
  10. J. Editorial: Migrant kids are dying in U.S. custody. We can’t let this stand,
  11. K. It may take 2 years to identify thousands of migrant children separated from families, by William Cummings,
  12. L. Migrants in Custody at Hospitals Are Treated Like Felons, Doctors Say, by Sheri Fink,
  13. M. Teen Mother & Her Premature Newborn Neglected For A Week In Border Patrol Custody, by ALEJANDRA SALAZAR,
  14. N. The Number Of Immigrants Who Died In ICE Custody Is Only Part Of The Picture, by MONICA BUSCH,
  15. O. Data shows more than 5,800 migrant children are living in Texas shelters, by Salina Madrid,
  16. P. MARIAN WRIGHT EDELMAN: Immigrant Children are Still Children, by Marian Wright Edelman,
  17. Q. Attorneys: Texas Border Facility Is Neglecting Migrant Kids, by The Associated Press,
  18. R. “Inhumane” Conditions At Texas Border Site, Lawyers Say, by SETH MILLSTEIN,
  19. S. Are US child migrant detainees entitled to soap and beds?,
  20. Separating parents and children at US border is inhumane and sets the stage for a public health crisis,



PART 1. June 18, 2018 “The Trump administration’s policy of separating parents and children at the U.S.-Mexico border will have a dire impact on their health, both now and into the future.”

PART 2. June 19, 2018. “…Trump’s (family separation) policy amounts to “government-sanctioned child abuse.””,

PART 3. June 20, 2018. “If it could happen to them…why can’t it happen to us?”…separating children from their parents,

PART 4. June 21, 2018. “The business of housing, transporting and watching over migrant children detained along the southwest border is not a multimillion-dollar business. It’s a billion-dollar one…

PART 5. June 22, 2018. “The idea of pulling a child out of a parent’s arms, or identifying a parent but still keeping them separate-it isn’t right.”

PART 6. June 23, 2018. Tender-Age Immigrant Children. “They need bilingual workers. Some kids speak indigenous languages, so that’s an issue as well.

PART 7. June 25, 2018. Trump’s policy “could be creating thousands of immigrant orphans in the U.S.”,

PART 8. June 26, 2018. White House Press Secretary Sarah Huckabee Sanders said the government was starting to “run out of space” to house people apprehended crossing the border

PART 9. June 27, 2018. “…the only way parents can quickly be reunited with their children is to drop their claims for asylum… and agree to be deported.”

PART 10. June 28, 2018. “In 6 Days, Trump Admin Reunited Only 6 Immigrant Children With Their Families”,

PART 11. June 19, 2018. “Only a dead heart is unstirred by the intentional infliction of suffering on children and babies as a weapon of deterrence.”

PART 12. July 4, 2018. “President Trump has moved on from caring about the migrant children in cages

PART 13. July 5, 2018. “Most immigrants facing deportation wouldn’t climb onto a table during their court hearings. But then again, most 3-year-olds don’t go to court without parents or lawyers.

PART 14. July 7, 2018. ..The HHS needs to review thousands of case files by hand for clues to which children were taken from their parents…

PART 15. December 4, 2018. PUBLIC HEALTH administrators can transform monumental unique challenges to “rapid response” opportunities. Think: Hurricanes Florence and Michael, the California wildfires, the mysterious polio-like illness, the opioid epidemic, mass shootings, and immigrant family separation.

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