PART 16. “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.”

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.

“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.”

PART 16. June 21, 2019. The Trump administration is slashing support and services for unaccompanied minors who cross the US-Mexico border.

“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.” (S)

[conditions]

A. Migrant Children Sleep Outside Due to Lack of HHS Resources, by JACK CROWE, https://www.nationalreview.com/news/migrant-children-sleep-outside-due-to-lack-of-hhs-resources/

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, https://www.snopes.com/ap/2019/06/07/us-opens-new-mass-facility-in-texas-for-migrant-children/

C. Trump administration cancels legal aid and English classes for unaccompanied minors in further crackdown on migration, by Rosie Perper, https://www.businessinsider.com/us-cancels-legal-aid-english-classes-for-unaccompanied-migrant-minors-2019-6

D. Migrant Children May Lose School, Sports and Legal Aid as Shelters Swell, by Miriam Jordan, https://www.nytimes.com/2019/06/05/us/migrant-children-services.html?smid=nytcore-ios-share

E. Border Patrol is confiscating migrant kids’ medicine, U.S. doctors say, byCaitlin Dickson, https://news.yahoo.com/border-patrol-is-confiscating-migrant-kids-medicine-us-doctors-say-225354608.html

F. ARE THERE MORE MIGRANT MINORS WHO HAVE DIED IN GOVERNMENT CUSTODY?, by JACK HERRERA, https://psmag.com/social-justice/are-there-more-migrant-minors-who-have-died-in-government-custody

G. Doctors Alarmed That Flu Killed Migrant Teen Detained In Texas, by NOMAAN MERCHANT, https://www.houstonpublicmedia.org/articles/news/2019/06/07/336037/doctors-alarmed-that-flu-killed-migrant-teen-detained-in-texas/

H. Flu cases at San Diego migrant shelter reach 81, County confirms 22 new cases, https://www.kusi.com/flu-cases-at-san-diego-migrant-shelter-reach-81-county-confirms-22-new-cases/

I. Why Children Keep Getting Sick At Detention, Processing Centers, by BONNIE PETRIE, https://www.tpr.org/post/why-children-keep-getting-sick-detention-processing-centers

J. Editorial: Migrant kids are dying in U.S. custody. We can’t let this stand, https://www.statesman.com/opinion/20190525/editorial-migrant-kids-are-dying-in-us-custody-we-cant-let-this-stand

K. It may take 2 years to identify thousands of migrant children separated from families, by William Cummings, https://www.usatoday.com/story/news/politics/2019/04/07/immigration-family-separations-may-take-2-years-identify-children/3393536002/

L. Migrants in Custody at Hospitals Are Treated Like Felons, Doctors Say, by Sheri Fink, https://www.nytimes.com/2019/06/10/us/border-migrants-medical-health-doctors.html?smid=nytcore-ios-share

M. Teen Mother & Her Premature Newborn Neglected For A Week In Border Patrol Custody, by ALEJANDRA SALAZAR, https://www.refinery29.com/en-us/2019/06/235508/teen-mother-newborn-baby-neglect-border-patrol-texas-immigration

N. The Number Of Immigrants Who Died In ICE Custody Is Only Part Of The Picture, by MONICA BUSCH, https://www.bustle.com/p/the-number-of-immigrants-who-died-in-ice-custody-is-only-part-of-the-picture-17988861

O. Data shows more than 5,800 migrant children are living in Texas shelters, by Salina Madrid, https://cbs4local.com/news/local/data-shows-more-than-5800-migrant-children-are-living-in-texas-shelters

P. MARIAN WRIGHT EDELMAN: Immigrant Children are Still Children, by Marian Wright Edelman, https://washingtoninformer.com/marian-wright-edelman-immigrant-children-are-still-children/

Q. Attorneys: Texas Border Facility Is Neglecting Migrant Kids, by The Associated Press, https://www.usnews.com/news/us/articles/2019-06-20/lawyers-claim-dangerous-situation-at-border-detention-site

R. “Inhumane” Conditions At Texas Border Site, Lawyers Say, by SETH MILLSTEIN, https://www.bustle.com/p/migrant-children-are-detained-in-inhumane-conditions-at-texas-border-site-lawyers-say-18134453

S. Are US child migrant detainees entitled to soap and beds?, https://www.bbc.com/news/world-us-canada-48710432

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PREQUELS

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.” (C)

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.  http://doctordidyouwashyourhands.com/2018/06/tender-age-immigrant-children-they-need-bilingual-workers-some-kids-speak-indigenous-languages-so-thats-an-issue-as-well/

PART 7. June 25, 2018. Trump’s policy “could be creating thousands of immigrant orphans in the U.S.”, http://doctordidyouwashyourhands.com/2018/06/trumps-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”, http://doctordidyouwashyourhands.com/2018/06/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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PART 12. June17, 2019. “Three cases of EBOLA have emerged in Uganda, a neighboring country to the Democratic Republic of the Congo.”

In a “worst-case scenario,” the current Ebola outbreak in the Democratic Republic of Congo may take up to two years to end….

San Antonio found itself ill-prepared to handle a sudden influx of refugees from the Democratic Republic of Congo.

ASSIGNMENT: What immediate actions should be taken in the United States?

PARTS 1-11, May 15, 2017 to August 30, 2018, after new PART 12. 

PART 12. June17, 2019. “Three cases of Ebola have emerged in Uganda, a neighboring country to the Democratic Republic of the Congo.”

“Dr. Jeremy Farrar, director of Wellcome Trust, a UK medical research charity, said that while Uganda was well-prepared to cope with the disease, global health authorities should be ready for more cases in the Democratic Republic of Congo and other neighboring countries.

“This epidemic is in a truly frightening phase and shows no sign of stopping anytime soon,” he said in a statement.

“There are now more deaths than any other Ebola outbreak in history, bar the West Africa Epidemic of 2013-16, and there can be no doubt that the situation could escalate towards those terrible levels.”..

WHO is likely to come under pressure to declare the outbreak an international health emergency. In April, the health body said it did not constitute a “public health emergency of international concern.”

WHO defines a public health emergency of international concern as “an extraordinary event” that constitutes a “public health risk to other States through the international spread of disease” and “to potentially require a coordinated international response.”’’

“A step up in the national response with full international support is critical if we’re to contain the epidemic and ensure the very best protection for the communities at risk and for the health workers working to protect lives,” Farrar said. “This needs to be championed at the highest political levels, including at the UN and the upcoming G20.” (A)

“Three cases of Ebola have emerged in Uganda, a neighboring country to the Democratic Republic of the Congo (DRC), officials said.

On Tuesday, the World Health Organization (WHO) announced that a 5-year-old boy had been diagnosed in Uganda, apparently after crossing over from the DRC. WHO officials said it was the first Ebola case in Uganda during the ongoing outbreak in the DRC.

Then, early Wednesday, Uganda’s health ministry said two additional cases had been diagnosed — the boy’s grandmother and a 3-year-old sibling, now in an isolation unit. The ministry also said the 5-year-old had died.

In an all-too-familiar scenario when it comes to infectious diseases, the cases appear to be travel-related. When the 5-year-old became ill, the family sought care at a hospital in Bwera, Uganda, which is less than a mile from the DRC’s eastern border. Ebola was identified as a potential cause of illness, the WHO said.

“This is a sobering development that everyone has been working to avoid, and highlights the complexity of the Ebola outbreak in the Democratic Republic of the Congo,” said CDC director Robert Redfield, MD, in a statement about the first case.

Uganda was not entirely unprepared for imported Ebola, as about 4,700 health workers in the country have already been vaccinated in 165 health facilities. The WHO and the country’s Ministry of Health have dispatched a rapid response team to identify, monitor and care for those who might be at risk. In addition, those who have come into contact with the patient, as well as at-risk previously unvaccinated health workers, will be vaccinated, they said…”  (B)

“Twenty-seven people are said to have been in contact with the three confirmed cases in Uganda. They have been restricted to their homes and will be vaccinated against Ebola.

The people who fled from a hospital isolation unit had been found to have high temperatures when they crossed the border from DR Congo to the Ugandan district of Kanungu, which is about 150km (93 miles) south of Kasese. Medical workers did not get a chance to take samples of their blood to send for testing before their escape.” (C)

“Over the weekend and through today the Democratic Republic of the Congo (DRC) reported 23 new Ebola cases, 2 of them in healthcare workers and one involving a reintroduction of the virus into an earlier affected area…

The cases involving healthcare workers are in Mabalako. One worker is a vaccinated nurse who agreed to be taken to an Ebola treatment center after she tested positive for Ebola, marking the second case at the same clinic following the admission of several Ebola patients. The other is also a vaccinated health worker, raising the cumulative number of cases in healthcare workers to 113.” (D)

“The World Health Organization warned Friday that it may not be possible to contain Ebola to the two affected provinces in eastern Congo if violent attacks on health teams continue.

The ominous statement comes amid escalating violence nine months after the outbreak began, crippling efforts to identify suspected cases in the community and vaccinate those most at risk. Earlier this week, Mai-Mai militia fighters attacked the town of Butembo at the epicenter of the crisis.

The update also noted that a burial team had been “violently attacked” after they interred an Ebola victim in the town of Katwa. The corpses of victims are highly contagious, requiring special precautions to ensure the disease is not transmitted at funerals…

David Miliband, president of International Rescue Committee, has met with health workers in the regional capital of Goma this week. Some fear it could take another year to get the disease under control, he said.

“There is a real concern to make sure it doesn’t spread to Goma,” he said. “And so this is, I think, a more dangerous situation than is widely recognized outside the country.”..

In addition to the risks posed by militias there also has been widespread community mistrust in eastern Congo, a byproduct of years of conflict and grievances with the government. WHO said it was aiming to have the of majority vaccine teams comprised of local health workers by the end of the month in an effort to reduce tensions.” (E)

“In a “worst-case scenario,” the current Ebola outbreak in the Democratic Republic of Congo may take up to two years to end, a World Health Organization official said Thursday.

The outbreak, which began Aug. 1, is “not under control,” Mike Ryan, executive director of WHO Health Emergencies Programme, said during a press briefing. “We may end up dealing with this outbreak for a long time.”..

Dr. Ryan said that numbers have stabilized and even fallen in the last two weeks, yet he also said there’s still “substantial transmission” in some health zones. While there is a smaller geographic footprint, the spread of disease is rampant within affected zones, he added.” (F)

“The World Health Organization is considering whether to declare the current Ebola outbreak in central Africa a global health crisis after new cases spread to Uganda from neighboring Democratic Republic of the Congo, where the disease has already killed nearly 1,400 people…

A WHO expert committee on the outbreak was scheduled to meet for a third time, this time on Friday in Geneva, where it will discuss whether to declare a global health emergency.

The latest Ebola outbreak, centered in northeastern Congo, was declared in August. It is “by far the largest” of 10 such outbreaks in the country in the past 40 years, according to Doctors Without Borders.

Meanwhile Rwanda, which neighbors both the DRC and Uganda, says it is tightening its borders with both countries and the government is urging people not to travel to affected areas, according to the state-backed newspaper The New Times.

Earlier this year, Rwanda said it would begin issuing front-line health workers an experimental Ebola vaccine in an effort to keep the disease from crossing into its territory. And Uganda’s health ministry has been encouraging its public to get the vaccine, assuring them of the vaccines safety and effectiveness, Aceng said in a statement.”..(G)

.

“We are entering a very new phase of high impact epidemics and this isn’t just Ebola,” Dr Michael Ryan, the executive director of the WHO’s health emergencies programme told me.

He said the world is “seeing a very worrying convergence of risks” that are increasing the dangers of diseases including Ebola, cholera and yellow fever.

He said climate change, emerging diseases, exploitation of the rainforest, large and highly mobile populations, weak governments and conflict were making outbreaks more likely to occur and more likely to swell in size once they did.

Dr Ryan said the World Health Organization was tracking 160 disease events around the world and nine were grade three emergencies (the WHO’s highest emergency level).

“I don’t think we’ve ever had a situation where we’re responding to so many emergencies at one time. This is a new normal, I don’t expect the frequency of these events to reduce.”

As a result, he argued that countries and other bodies needed to “get to grips with readiness [and] be ready for these epidemics”.

It took 224 days for the number of cases to reach 1,000, but just a further 71 days to reach 2,000.” (H)

High impact disease outbreaks such as Ebola could become the “new normal”, the World Health Organization has said…

 “We are entering a new phase in terms of high impact epidemics and this isn’t just Ebola. You look at cholera, yellow fever, many other diseases – we’re seeing both re-emergence and resurgence,” Dr Ryan said.

He added that 80 per cent of such epidemics were occurring in fragile, conflict-affected states such as DRC.

“So we’re seeing a very worrying convergence of risks. Areas of high biodiversity, high population density, high population mobility, weak governance, conflict and many other things layered on top of each other,” he said.

WHO is currently monitoring 160 different disease events around the world, including 33 emergencies, nine of which are grade three, requiring the highest level of operational response.” (I)

“When West Africa was declared Ebola-free in January 2016, the international community — having realized how the world’s weakest health systems threaten global health security — vowed that never again would we let such a health crisis fester until it became a calamity. A period of unprecedented attention to global health security began.

We had learned the importance of a rapid mobilization after the World Health Organization’s (WHO) egregious failure to sound the alarm until months into outbreak. We saw the necessity to declare the highest level of global emergency to secure political commitments and mobilize scarce resources.

We discovered that distrust of government often obstructed the response, and that every means must be sought to vest the affected populations, enlisting traditional leaders, priests, imams, midwives, youth leaders, civil society, local journalists, anyone with a trusted voice.

And it was the United States that led the global scale-up, including the deployment to Liberia of the 101st Airborne.

Three years later in the Democratic Republic of the Congo (DRC), it feels like many of the lessons learned were learned in vain — and with the White House decision to bar U.S. officials, including the Centers for Disease Control (CDC), from entering the worst-affected zones as well as a strict interpretation of the Trafficking Victims Protection Act resulting in the withholding of non-humanitarian assistance, we have an unprecedented sidelining of U.S. expertise that — until now —has been on the frontlines for every Ebola outbreak…

Ebola was defeated in West Africa when a global declaration of emergency created the conditions for charities and frontline healthcare workers to get ahead of the Ebola transmission curve. The disease was brought under control only after it was acknowledged that you don’t isolate the communities, you work with them, to isolate the virus. And it was defeated with U.S. leadership.” (J)

“This outbreak has featured organized attacks on the response efforts, specifically targeting medical facilities and healthcare personnel in violation of humanitarian laws, reported Annie Sparrow, MBBS, MD, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues…

“These attacks arouse concern that armed groups are exploiting the epidemic for broader military or political ambitions, and they have resulted in recurrent temporary suspension of response activities in affected areas,” the authors wrote…

Sparrow and colleagues agreed, writing, “Even in the middle of intractable conflicts, success in controlling Ebola must be achieved. We have the tools of global disease surveillance, rapid-response systems, and biomedical solutions — if there is the political will to protect health workers in conflict zones.”

Moeti described that the Ebola outbreak in the DRC as “one of the most complex health emergencies the world has faced,” adding that juggling the dual responsibilities of protecting staff and colleagues while responding to the outbreak is no small feat.” (K)

“Though community attitudes and the decisions of individuals contribute to how outbreaks spread, a broken health system seems to be the single largest contributor to how susceptible a country might be to an outbreak, and how quickly it can be stamped out.

During the West Africa outbreak, which was considerably larger and more deadly than the outbreak in Congo, most people who fell ill never had Ebola. Early on, sick patients waited days, sometimes weeks, for laboratory tests. When someone showed symptoms of Ebola, they were sent into a “holding unit,” hastily constructed tarpaulin-walled units, where it was hot and often crowded with make-shift cots.

Unfortunately, the symptoms of Ebola resemble many other diseases prevalent in the region and all sick people with Ebola-like symptoms were held in the same room, increasing the likelihood of transmission within the facilities themselves…

One of the key reasons Ebola spread so rapidly in Sierra Leone, Liberia and Guinea was that those countries’ health systems were woefully under-resourced to respond to basic health needs, let alone an outbreak of a deadly infectious disease. In Congo, the number of people who have access to comprehensive care is not just low — it’s basically zero…

America has a role to play. One of the greatest global health funding mechanisms was implemented by President George W. Bush, who created the President’s Emergency Plan for AIDS Relief (PEPFAR), which helped millions of people dying from HIV/AIDS access treatment. We need similarly bold and comprehensive aid packages for strengthening public health systems in poor countries — ones that fund training for the next generation of doctors and nurses, improve supply chains for essential medicines and build public teaching hospitals and clinics and other essential health infrastructure. Such a program would be a long-term commitment, untethered from a specific emergency.

Some Americans may argue that we don’t have a responsibility to fix health care in far-off places. President Donald J. Trump might be among them. The afternoon after Congo declared its latest Ebola outbreak, he cut $252 million for global disease prevention funding because it was “no longer needed.”

But even people who do not see this as a moral imperative should see it as a national security issue. Epidemics should worry us more than terrorists: tuberculosis, unlike Ebola, is airborne, and Congo has among the highest TB rates in the world. That impacts us all.”  (L)

“There are 88 nations where the per capita GDP is lower than that of Guatemala, which stands at $4,471 as of 2017. That is likely well over one billion people living in similar or worse conditions than those coming to our border today, primarily from Central America. As such, it’s no surprise that once our government telegraphed the message to the world that our sovereignty no longer matters when someone invades with a child, people are now coming in large numbers from all over the world, including from the most disease-prone countries in Africa.

While Africans have been trickling over our border in recent months, on Friday, Customs and Border Protection (CBP) announced that “the first large group of people from Africa” were apprehended in the Del Rio sector of Texas. In total, 116 individuals were apprehended in this African caravan on Thursday morning, including 35 from Angola, one from Cameroon, and 80 from Congo.

This demonstrates that the global migration, at this pace, will be a bottomless pit, because even if we eventually empty out the northern triangle of Central America, there are unlimited regions in the world where poverty is pervasive and from which people will travel to seek the de facto amnesty being offered…

With family units being released within days, often within hours, how can our government be certain that Americans, not to mention Border Patrol and local health officials, are not being put in danger? This is why the law (8 U.S.C. § 1222(a)) requires the government to detain all migrants “for a sufficient time to enable the immigration officers and medical officers to subject such aliens to observation and an examination sufficient to determine whether or not they belong to inadmissible classes.” This was for all migrants. It was always presumed that we would never take in people from specific countries that were experiencing deadly epidemics.” (M)

“For the third time, the World Health Organization declined on Friday to declare the Ebola outbreak in the Democratic Republic of Congo a public health emergency, though the outbreak spread this week into neighboring Uganda and ranks as the second deadliest in history.

An expert panel advising the W.H.O. advised against it because the risk of the disease spreading beyond the region remained low and declaring an emergency could have backfired. Other countries might have reacted by stopping flights to the region, closing borders or restricting travel, steps that could have damaged Congo’s economy.

Dr. Preben Aavitsland, a Norwegian public health expert who served as the acting chairman of the emergency committee advising the W.H.O., said there was “not much to be gained but potentially a lot to lose.” ..

Experts do not expect the Ugandan outbreak to spiral out of control.

Uganda has a strong central government and a cash-starved but organized health care system. It has endured and beaten three previous Ebola outbreaks, in 2000, 2007 and 2012.” (N)

“Neighboring countries have been preparing for the possibility that the virus might jump borders in a region where the population is highly mobile and where more than a million people are displaced from their homes because of decades of ethnic conflict.

Thousands of medical personnel in Uganda, Rwanda and South Sudan have already received a vaccine to protect themselves, and border guards have screened more than 65 million people crossing through 80 ports of entry and operational health checkpoints.” (O)

“In Uganda, the battle against Ebola will be determined by the government’s ability to win the confidence of the people. The country is not strife-torn like its volatile neighbour, and has a more robust health system. For the time being, at least, there is hope the disease will be contained in Uganda.” (P)

“The isolation ward for Ebola patients is a tent erected in the garden of the local hospital. Gloves are given out sparingly to health workers. And when the second person in this Uganda border town died after the virus outbreak spread from neighboring Congo, the hospital for several hours couldn’t find a vehicle to take away the body.

“We don’t really have an isolation ward,” the Bwera Hospital’s administrator, Pedson Buthalha, told The Associated Press. “It’s just a tent. To be honest, we can’t accommodate more than five people.”

Medical workers leading Uganda’s effort against Ebola lament what they call limited support in the days since infected members of a Congolese-Ugandan family showed up, one vomiting blood. Three have since died.

While Ugandan authorities praise the health workers as “heroes” and say they are prepared to contain the virus, some workers disagree, wondering where the millions of dollars spent on preparing for Ebola have gone if a hospital on the front line lacks basic supplies.” (Q)

“The Tanzanian Minister of Health issued an “alert” on Sunday following the outbreak of Ebola cases this week in Uganda, a country with which Tanzania shares a long border.“I would like to alert the public to the existence of a threat of an Ebola epidemic in our country following the outbreak of this disease in Uganda,” said Health Minister Ummy Mwalimu. She justified this warning by “the important interactions between the populations of the two countries via official borders or other unofficial channels”.” (R)

“Alexandra Phelan, a global health expert at Georgetown University, said the legal criteria for declaring Ebola a global emergency have long been met, even before the virus reached Uganda.

“I think the declaration should be made tonight,” she said. “Given that we are still seeing daily numbers of cases in the double digits and we do not have adequate surveillance, this indicates the outbreak is a persistent regional risk.”

Phelan said she was concerned WHO might be swayed by political considerations.

As the far deadlier 2014-16 Ebola outbreak raged in West Africa, WHO was heavily criticized for not declaring a global emergency until nearly 1,000 people had died and the virus had spread to at least three countries. Internal WHO documents later showed the agency feared the declaration would have economic and social implications for Liberia, Guinea and Sierra Leone.”

“It’s legitimate for countries to raise these concerns, but the basis on which WHO and its emergency committee should be looking at is the risk to public health and the risk of international spread,” Phelan said.”” (S)

“Today the U.S. Centers for Disease Control and Prevention (CDC) is announcing activation of its Emergency Operations Center (EOC) on Thursday, June 13, 2019, to support the inter-agency response to the current Ebola outbreak in eastern Democratic Republic of the Congo (DRC). The DRC outbreak is the second largest outbreak of Ebola ever recorded and the largest outbreak in DRC’s history. The confirmation this week of three travel-associated cases in Uganda further emphasizes the ongoing threat of this outbreak. As part of the Administration’s whole-of-government effort, CDC subject matter experts are working with the USAID Disaster Assistance Response Team (DART) on the ground in the DRC and the American Embassy in Kinshasa to support the Congolese and international response. The CDC’s EOC staff will further enhance this effort.

CDC’s activation of the EOC at Level 3, the lowest level of activation, allows the agency to provide increased operational support for the response to meet the outbreak’s evolving challenges. CDC subject matter experts will continue to lead the CDC response with enhanced support from other CDC and EOC staff.

“We are activating the Emergency Operations Center at CDC headquarters to provide enhanced operational support to our expanded Ebola response team deployed in DRC,” said CDC Director Robert R. Redfield, M.D. “Through CDC’s command center we are consolidating our public health expertise and logistics planning for a longer term, sustained effort to bring this complex epidemic to an end.”” (T)

“San Antonio found itself ill-prepared to handle a sudden influx of refugees from the Democratic Republic of Congo.

The Texas city was reportedly not informed by U.S. Border Patrol that the migrants, who began arriving on Tuesday, were coming, according to Interim Assistant City Manager Dr. Colleen Bridger.

“We didn’t get a heads up,” Bridger told KENS 5 on Thursday.

“When we called Border Patrol to confirm, they said, ‘yeah, another 200 to 300 from the Congo and Angola will be coming to San Antonio,’” she added.

The refugees, fleeing the Congo where an Ebola epidemic that began last year has now surpassed 2,000 cases, arrived in the Alamo city after reportedly traveling to the southern U.S. border with a group of about 350 migrants through Ecuador.

The city says Border Patrol told them earlier this week (when the city reached out) to expect 200-300 more migrants from the Congo and Angola to arrive in the coming days.

Besides the burden of processing and sheltering the migrants, the city has found an added challenge of communication, as KENS 5 reported that San Antonio is now “in desperate need of French-speaking volunteers.”

About 375 people, from a total of 450 just on Wednesday at the Migrant Resource Center, were housed at Travis Park Church that night. Another center was opened to shelter hundreds more expected to arrive, but plans to send the migrants to other cities have not yet panned out.

“The plan was 350 of them would travel from San Antonio to Portland. When we reached out to Portland Maine they said, ‘Please don’t send us any more. We’re already stretched way beyond our capacity,” Bridger said. “So we’re working with them [the migrants] now to identify other cities throughout the United States where they can go and begin their asylum seeking process.”” (U)

“In Portland — the largest city in Maine, with a population of 66,417 — about 200 African migrants were sleeping on cots on Friday night in a temporary emergency shelter set up in the Portland Expo Center. The city has a large Congolese community, and has built a reputation as a place friendly to asylum seekers. It created the government-financed Portland Community Support Fund to provide rental payments to landlords and other forms of assistance for asylum seekers, the only fund of its kind in the country, Portland officials said.

Many of the recent African migrants do not have relatives in the country, so they are being released with no travel arrangements, a problem that local officials and nonprofit groups are forced to sort out.

The mayor of Portland, Ethan K. Strimling, said they welcomed African migrants, and a donation campaign for them had raised more than $20,000 in its first 36 hours.

“I don’t consider it a crisis, in the sense that it is going to be detrimental to our city,” Mr. Strimling said. “We’re not building walls. We’re not trying to stop people. In Maine, and Portland in particular, we’ve been built on the backs of immigrants for 200 years, and this is just the current wave that’s arriving.”” (V)

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PART 1. May 15, 2017. EBOLA is back in Africa. Is ZIKA next? Are we prepared?

PART 2. May 9, 2018. New Ebola outbreak declared in Democratic Republic of the Congo

PART 3. May 18, 2018 . As ZIKA and EBOLA reemerge, Trump administration cuts funding to halt international epidemics

PART 4. June 11, 2018 . “With an outbreak like this, it’s a race against time, as one Ebola patient with symptoms can infect several people every day.”

PART 5. June 16, 2018.  EBOLA, ZIKA. EMERGING VIRUSES. “ All too often with infectious diseases, it is only when people start to die that necessary action is taken.”

PART 6. June 17, 2018. ANDEMIC PREPAREDNESS. “It’s like a chain—one weak link and the whole thing falls apart. You need no weak links.”

PART 7. June 21, 2018 .D emocratic Republic of Congo’s Ebola outbreak has been “largely contained”…

PART 8. June 24, 2018.  “Slightly over a month into the response, further spread of [Ebola Virus Disease] has largely been contained,” WHO announced on June 20.

PART 9. August 10, 2018. After Ebola scare, Denver Health wishes it notified public of potential deadly virus sooner

PART 10. August 20, 2018. At least 10 health-care workers have been infected with the deadly Ebola virus as they battle an outbreak in an eastern province of Congo

PART 11. August 30, 2018.  “…(WHO) reports the next seven to 10 days are critical in controlling the spread of the Ebola virus in eastern Democratic Republic of Congo.” http://doctordidyouwashyourhands.com/2018/08/who-reports-the-next-seven-to-10-days-are-critical-in-controlling-the-spread-of-the-ebola-virus-in-eastern-democratic-republic-of-congo/

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PART 3. June 6, 2019. CANDIDA AURIS. “Antibiotic-resistant superbugs are everywhere. If your hospital claims it doesn’t have them, it isn’t looking hard enough.” (D)

ASSIGNMENT: How should a hospital respond to the New York State initiative to prevent the spread of Candida auris, when there are no evidenced based best practices?

New PART 3 after PARTS 1 & 2

ART 1. April16, 2019. Is it ethical for the public not to be notified about new “super bugs” in hospitals so they can decide whether or not to go to affected hospitals?

PART 2. May 13, 2019. CANDIDA AURIS. “In 30 years, I’ve never faced so tough a reporting challenge – and one so unexpected. Who wouldn’t want to talk about a fungus?…

PART 1. April16, 2019.  Is it ethical for the public not be notified about new “super bugs” in hospitals so they can decide whether or not to go to affected hospitals?

“Last May, an elderly man was admitted to the Brooklyn branch of Mount Sinai Hospital for abdominal surgery. A blood test revealed that he was infected with a newly discovered germ as deadly as it was mysterious. Doctors swiftly isolated him in the intensive care unit.

The germ, a fungus called Candida auris, preys on people with weakened immune systems, and it is quietly spreading across the globe. Over the last five years, it has hit a neonatal unit in Venezuela, swept through a hospital in Spain, forced a prestigious British medical center to shut down its intensive care unit, and taken root in India, Pakistan and South Africa.

Recently C. auris reached New York, New Jersey and Illinois, leading the federal Centers for Disease Control and Prevention to add it to a list of germs deemed “urgent threats.”

The man at Mount Sinai died after 90 days in the hospital, but C. auris did not. Tests showed it was everywhere in his room, so invasive that the hospital needed special cleaning equipment and had to rip out some of the ceiling and floor tiles to eradicate it.

“Everything was positive – the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump,” said Dr. Scott Lorin, the hospital’s president. “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.”” (A)

“Back in 2009, a 70-year-old Japanese woman’s ear infection puzzled doctors. It turned out to be the first in a series of hard-to-contain infections around the globe, and the beginning of an ongoing scientific and medical mystery.

The fungus that infected the Japanese woman, Candida auris, kills more than 1 in 3 people who get an infection that spreads to their blood or organs. It hits people who have weakened immune systems, and is most often found in places like care homes and hospitals. Once it shows up, it’s hard to get rid of: unlike most species of fungi, Candida auris spreads from person to person and can live outside the body for long periods of time.

Mount Sinai wasn’t the first hospital to face this task: a London hospital found itself with an outbreak in 2016, and the only way to stop it was to rip out fixtures…

Scientists still aren’t sure exactly where this happened or when. That’s one of the things they’re working on now, says Cuomo, because figuring out how the fungus evolved could help researchers develop treatments for it…

Although the “superbug” moniker might sound alarmist, Candida auris qualifies for two reasons, says Cuomo. First, all strains of the yeast are resistant to antifungals. There are three major kinds of antifungals used to treat humans, and some strains of Candida auris are resistant to all of them, while other strains are resistant to one or two. That limits the treatment options for someone who has been infected-someone who is probably already in poor health. The other reason is “this really scary property of not being able to get rid of it,” Cuomo says.” (B)

“Superbugs are a terrifying prospect because of their resistance to treatment, and one superbug that is sweeping all over the world is the Candida auris.

C. auris is a fungus that causes serious infections in various parts of the body, including the bloodstream and the ear.

While its discovery has been relatively recent in 2009, this fungus has already wreaked havoc in hospitals in more than 20 different countries, including the United States, United Kingdom, and Spain, among others.

In the United States, CDC reports a total of 587 clinical cases of C. auris infections as of February. Most of it occurred in the areas of New York City, New Jersey, and Chicago.” (C)

“The CDC issued a public alert in January about a drug-resistant bacteria that a dozen Americans contracted after undergoing elective surgeries at Grand View Hospital in Tijuana, Mexico. Yet when similar outbreaks occur at U.S. hospitals, the agency does not issue a public warning. This is due to an agreement with states that prohibits the CDC from publicly disclosing hospitals undergoing outbreaks of drug-resistant infections, according to NYT.

Patient advocates are pushing for more transparency into hospital-based infection outbreaks, saying the lack of warning could put patients at risk of harm.

“They might not get up and go to another hospital, but patients and their families have the right to know when they are at a hospital where an outbreak is occurring,” Lisa McGiffert, an advocate with the Patient Safety Action Network, told NYT. “That said, if you’re going to have hip replacement surgery, you may choose to go elsewhere.”..

The CDC declined NYT’s request for comment. Agency officials have previously told the publication the confidentiality surrounding outbreaks is necessary to encourage hospitals to report the drug-resistant infections.” (D)

“New Jersey is among the states worst affected by an increasing incidence of the potentially deadly fungus Candida auris, whose resistance to drugs is causing headaches for hospitals, state and federal health officials said on Monday.

There were 104 confirmed and 22 probable cases of people infected by the fungus in New Jersey by the end of February, according to the federal Centers for Disease Control and Prevention, up sharply from a handful when the fungus was first identified in the state about two years ago.

The state’s number of cases – now the third-highest after New York and Illinois – has risen in tandem with an increase, first overseas, and now in the United States, in a trend that some doctors attribute to the overuse of drugs to treat infections, prompting the mutation of infection sources, in this case, a fungus.

The fungus mostly affects people who have existing illnesses, and may already be hospitalized with compromised immune systems, health officials said.

Nicole Kirgan, a spokeswoman for the New Jersey Department of Health, said she didn’t know whether any of the state’s cases have been fatal, and couldn’t say which hospitals are treating people with the fungus because they have not, so far, been required to report their cases to state officials…

But Dr. Ted Louie, an infectious disease specialist at Robert Wood Johnson University Hospital in New Brunswick, said many hospitals don’t know how to eradicate the fungus once it has occurred.

Some disinfectants commonly used in hospitals have proved ineffective in removing the fungus, Dr. Louie said, so hospitals have been urged to use other disinfecting agents, although it’s not yet clear which of them work, if any.

“This is a fairly new occurrence and we are still learning how to deal with it,” he said. “We have to figure out which disinfectant procedures may be best to try to eradicate the infection, so at this point, I don’t think we have good enough information to advise.” (E)

“Adding to the difficulty of treating candida auris is finding it in the first place. The infection is often asymptomatic, showing few to no immediate symptoms, said Chauhan. The symptoms that do appear, such as fever, are often confused for bacterial infections, he said.

“Most routine diagnostic tests don’t work very well for candida auris,” he said. “They’re often misidenfitied as other species.”

The best way to identify candida auris is by looking under a microscope, which often takes time because it requires doctors to grow the fungus, Chauhan said.

As with most infectious diseases, the best course of action is good hygiene and sterilization protocol. Washing your hands and using hand sanitizer after helps to prevent transmission and infection, Chauhan said.

Doctors and healthcare workers should use protective gear, and people visiting loved ones in hospitals and long-term care centers should take proper precautions, he said.

The Center for Disease Control recommends using a special disinfectant that is used to treat clostridium difficile spores. The disinfectant has been effective in wiping out clostridium difficile, known as c. diff, and disinfects surfaces contaminated with candida auris, as well.” (F)

“Hospitals and nursing homes in California and Illinois are testing a surprisingly simple strategy against the dangerous, antibiotic-resistant superbugs that kill thousands of people each year: washing patients with a special soap.

The efforts – funded with roughly $8 million from the federal government’s Centers for Disease Control and Prevention – are taking place at 50 facilities in those two states.

This novel approach recognizes that superbugs don’t remain isolated in one hospital or nursing home but move quickly through a community, said Dr. John Jernigan, who directs the CDC’s office on health care-acquired infection research.

“No health care facility is an island,” Jernigan said. “We all are in this complicated network.”

At least 2 million people in the U.S. become infected with an antibiotic-resistant bacterium each year, and about 23,000 die from those infections, according to the CDC…

Containing the dangerous bacteria has been a challenge for hospitals and nursing homes. As part of the CDC effort, doctors and health care workers in Chicago and Southern California are using the antimicrobial soap chlorhexidine, which has been shown to reduce infections when patients bathe with it. Though chlorhexidine is frequently used for bathing in hospital intensive care units and as a mouthwash for dental infections, it is used less commonly for bathing in nursing homes…

The infection-control work was new to many nursing homes, which don’t have the same resources as hospitals, Lin said.

In fact, three-quarters of nursing homes in the U.S. received citations for infection-control problems over a four-year period, according to a Kaiser Health News analysis, and the facilities with repeat citations almost never were fined. Nursing home residents often are sent back to hospitals because of infections.” (G)

“The C.D.C. declined to comment, but in the past officials have said their approach to confidentiality is necessary to encourage the cooperation of hospitals and nursing homes, which might otherwise seek to conceal infectious outbreaks.

Those pushing for increased transparency say they are up against powerful medical institutions eager to protect their reputations, as well as state health officials who also shield hospitals from public scrutiny…

Hospital administrators and public health officials say the emphasis on greater transparency is misguided. Dr. Tina Tan, the top epidemiologist at the New Jersey Department of Health, said that alerting the public about hospitals where cases of Candida auris have been reported would not be useful because most people were at low risk for exposure and public disclosure could scare people away from seeking medical care.

“That could pose greater health risks than that of the organism itself,” she said.

Nancy Foster, the vice president for quality and patient safety at the American Hospital Association, agreed, saying that publicly identifying health care facilities as the source of an infectious outbreak was an imperfect science.

“That’s a lot of information to throw at people,” she said, “and many hospitals are big places so if an outbreak occurs in a small unit, a patient coming to an ambulatory surgical center might not be at risk.”

Still, hospitals and local health officials sometimes hide outbreaks even when disclosure could save lives. Between 2012 and 2014, more than three dozen people at a Seattle hospital were infected with a drug-resistant organism they got from a contaminated medical scope. Eighteen of them died, but the hospital, Virginia Mason Medical Center, did not disclose the outbreak, saying at the time that it did not see the need to do so.” (H)

“Many have heard of the rise of drug-resistant infections. But few know about an issue that’s making this threat even scarier in the United States: the shortage of specialists capable of diagnosing and treating those infections. Infectious diseases is one of just two medicine subspecialties that routinely do not fill all of their training spots every year in the National Resident Matching Program (the other is nephrology). Between 2009 and 2017, the number of programs filling all of their adult-infectious-disease training positions dropped by more than 40 percent…

Everyone who works in health care agrees that we need more infectious-disease doctors, yet very few actually want the job. What’s going on?

The problem is that infectious-disease specialists care for some of the most complicated patients in the health care system, yet they are among the lowest paid. It is one of the only specialties in medicine that sometimes pays worse than being a general practitioner. At many medical centers, a board-certified internist accepts a pay cut of 30 percent to 40 percent to become an infectious-disease specialist.

This has to do with the way our insurance system reimburses doctors. Medicare assigns relative value units to the thousands of services that doctors provide, and these units largely determine how much physicians are paid. The formula prioritizes invasive procedures over intellectual expertise.

The problem is that infectious-disease doctors don’t really do procedures. It is a cognitive specialty, providing expert consultation, and insurance doesn’t pay much for that…

Infectious-disease specialists are often the only health care providers in a hospital – or an entire town – who know when to use all of the new antibiotics (and when to withhold them). These experts serve as an indispensable cog in the health care machine, but if trends continue, we won’t have enough of them to go around. The terrifying part is that most patients won’t even know about the deficit. Your doctor won’t ask a specialist for help because in some parts of the country, the service simply won’t be available. She’ll just have to wing it…

We must hurry. Superbugs are coming for us. We need experts who know how to treat them.” (I)

People visiting patients at the hospital, and most hospitalized patients, have little to fear from a novel fungal disease that has struck more than 150 people in Illinois – all in the Chicago area – a Memorial Medical Center official said Friday.

“For normal, healthy people, this is not a concern,” Gina Carnduff, Memorial Health System director of infection prevention, said in reference to Candida auris infections.

Carnduff, who is based at Memorial Medical Center, said only the “sickest of the sick” patients are at risk of catching or spreading the C. auris infection or dying from it.

Those patients, she said, include people who have stayed for long periods at health care facilities – such as skilled-care nursing homes or long-term acute-care hospitals – and who are on ventilators or have central venous catheter lines or feeding tubes…

Officials from both Memorial Medical Center and HSHS St. John’s Hospital said their institutions already are using the bleach-based cleaning solutions known to prevent the spread of C. auris and other infections.

The Illinois Department of Public Health’s website says more than one in every three people with “invasive C. auris infection” affecting the blood, heart or brain will die…

The state health department says 154 confirmed cases of C. auris and four probable cases have been identified, all in the Chicago area. Ninety-five cases were in Chicago, 56 were in Cook County outside of Chicago, and seven were spread among the counties of DuPage, Lake and Will.

Eighty-five of the 158 people making up the confirmed and probable cases have died, but only one death was “directly attributed” to the infection, Arnold said. It’s not known whether C. auris played a role in the deaths of the other 84 people, she said. (J)

“There is also the fact that some lab tests will not identify the superbug as the source of an illness, which means that some patients will receive the wrong treatment, increasing the duration of the infection and the chance to transmit the fungus to another person.” (K)

“Hospitals, state health departments and the Centers for Disease Control and Prevention are putting up a wall of silence to keep the public from knowing which hospitals harbor Candida auris.

New York health officials publish a yearly report on infection rates in each hospital. They disclose rates for infections like MRSA and C. Diff. But for several years, the same officials have been mum about the far deadlier Candida auris. That’s like posting “Wanted” pictures for pickpockets but not serial murderers.

Health officials say they’ll disclose the information in their next yearly report. That could be many months from now. Too late. Patients need information in real time about where the risks are…

Dr. Eleanor Adams, a state Health Department researcher, examined all the facilities in New York City affected by Candida auris over a four-year period. Adams found serious flaws, including “inadequate disinfection of shared equipment” to take vital signs, hasty cleaning and careless compliance with rules to keep infected patients isolated…” (L)

“Remedies for curtailing the advance of C. auris are familiar. Health care facilities must undergo stringent infection controls, test for new cases and quickly identify any sources passing it along. Visitors and medical workers must wash their hands after touching patients or surfaces. The yeast spreads widely throughout patients’ rooms. Some cleanups have reportedly required removing ceiling and floor tiles.

C. auris isn’t simply an opportunistic infection. Its rise is additional evidence that becoming too reliant on certain types of drugs may have unintended consequences. Exhibit A is the overuse of antibiotics in doctors’ offices and on farms that encourages the development of drug-resistant bacteria. Researchers suspect a similar situation involving C. auris and agricultural fungicides used on crops. So far the origins of C. auris are unclear, with different clusters arising in different areas of the world.

There’s no need to panic. But vigilance is required to track C. auris and raise awareness in order to combat it. Officials typically are eager to spread the word about potential health crises, from measles to MRSA. In this case, the CDC issued alerts about fungus to health care facilities, but the New York Times encountered an unusual wall of silence while investigating superbugs such as C. auris. Medical facilities didn’t want to scare off patients.

Any attempts to hide the spread of a communicable disease are irresponsible. Knowledge leads to faster prevention and treatment. Patients and their families have a right to know how hospitals and government agencies are responding to a new threat. Medical workers also deserve to be informed of the risks they encounter on the job.

Battling the superbugs requires aggressive responses and, ultimately, scientific advancements. Downplaying outbreaks won’t stop their rise.” (M)

“The rise of C. auris, which may have lurked unnoticed for millennia, owes entirely to human intervention – the massive use of fungicides in agriculture and on farm animals which winnowed away more vulnerable species, giving the last bug standing a free run. Sensitised to clinical fungicides, C. auris has proved to be difficult to extirpate, and culls infected humans who cannot fight diseases very effectively – infants, the old, diabetics, people with immune suppression, either because of diseases like HIV or the use of steroids. The new superfungus has the makings of a future plague, one of several which may cumulatively surpass cancer as a leading killer in a few decades.

The origin of C. auris is known because it broke out in the 21st century, but the plagues from antiquity lack origin stories. Even their spread was understood only retrospectively, in the light of modern science. The father of all plagues, the Black Death, originated in China in the early 14th century and ravaged most of the local population before it began its long journey westwards down the Silk Route, via Samarkand. At the time, the chain of hosts that carried it would have been incomprehensible – the afflicting organism Yersinia pestis, the fleas which it infested, the rats which the fleas in turn infested, which carried it into the homes of humans….” (N)

“WebMD: Most of us know candida from common yeast infections that you might get on your skin or mucous membranes. What makes this one different?

Chiller: It’s not acting like your typical candida. We’re used to seeing those.

Candida – the regular ones – are already a major cause of bloodstream infection in hospitalized patients. When we get invasive infections, for example, bloodstream infections, we think that you sort of auto-infect yourself. You come in with the candida already living in your gut. You’re in the ICU, you’re on a broad spectrum antibiotic. You’re killing off bad bacteria, you’re killing off good bacteria, so what are you left with? Yeast, and it takes over.

What’s new with Candida auris is that it doesn’t act like the typical candida that comes from our gut. This seems to be more of a skin organism. It’s very happy on the skin and on surfaces.

It can survive on surfaces for long periods of time, weeks to months. We know of patients that are colonized [meaning the Candida auris lives on their skin without making them sick] for over a year now.

It is spreading in health care settings, more like bacteria would, so it’s yeast that’s acting like bacteria” (O).

PART 2. In 30 years, I’ve never faced so tough a reporting challenge – and one so unexpected. Who wouldn’t want to talk about a fungus?…

“C. auris is a drug-resistant fungus that has emerged mysteriously around the world, and it is understood to be a clear and present danger. But Connecticut state officials wouldn’t tell us the name of the hospital where they had had a C. auris patient, let alone connect us with her family. Neither would officials in Texas, where the woman was transferred and died. A spokeswoman for the City of Chicago, where C. auris has become rampant in long-term health care facilities, promised to find a family and then stopped returning my calls without explanation.” (A)

“Candida auris, also referred to as C. auris, is a potentially deadly fungal infection that appears to be making its way through hospitals and long-term care facilities across the country. The New York City area and New Jersey have reported more than 400 cases over the last few years alone. Federal health authorities have declared this fungus a “serious global health threat.”” (B)

“The Council of State and Territorial Epidemiologists (CSTE) says Candida auris infections have been “associated with up to 40% in-hospital mortality.”

“Most strains of C. auris are resistant to at least one antifungal drug, one-third are resistant to two antifungal drug classes, and some strains are resistant to all three major classes of antifungal drugs. C. auris can spread readily between patients in healthcare facilities. It has caused numerous healthcare-associated outbreaks that have been difficult to control,” the CSTE said.

The CDC added, “Patients who have been hospitalized in a healthcare facility a long time, have a central venous catheter, or other lines or tubes entering their body, or have previously received antibiotics or antifungal medications, appear to be at highest risk of infection with this yeast.”

The CDC is alerting U.S. healthcare facilities to be on the lookout for C. auris in their patients.” (C)

“”It’s a very serious health threat,” said Dr. Irwin Redlener, Columbia University professor and an expert on public health policy. “It’s a superbug, meaning resistant to all-known antibiotics.”..

“These people would be in danger, so you don’t want somebody visiting the hospital not knowing that it’s around and somehow contracting the infection,” Dr. Redlener said. “That would be an utter disaster.”..

Dr. Redlener says the secrecy is a big mistake.

“If they’re rattled by Candida auris to the point where we have secrecy pacts among hospitals and public health agencies, then you’re just hiding something that obviously needs more attention and resources to deal with,” he said.

The state Department of Health says there is no risk to the general public and notes that the vast majority of patients have had serious underlying medical conditions.

Jill Montag, a spokesperson for the New York State Department of Health, issued a statement to Eyewitness News.

“We are working aggressively with impacted hospitals and nursing homes to implement infection control strategies for Candida auris,” it read.

Montag says they plan to include the name of the impacted facilities in their annual infection report, which will be released later this year.

Dr. Redlener says they have the information now and should release the names now…

“To keep that a secret is putting people in danger,” he said. “And I don’t think that’s reasonable or ethical.”” (D)

“We don’t know why it emerged,” said Dr. Maurizio Del Poeta, a professor of molecular genetics and microbiology at Stony Brook University’s Renaissance School of Medicine. At the very least, he is recommending hospitals develop stricter rules on foot traffic in and out of patients’ rooms because the microbe can be carried on the bottom of shoes.

The pathogen clings to surfaces in hospital rooms, flourishes on floors, and adheres to patients’ skin, phones and food trays. It is odorless, invisible – and unlikely to vanish from health care institutions anytime soon.

“It can survive on a hospital floor for up to four weeks,” Del Poeta said of C. auris. “It attaches to plastic objects and doorknobs.”..…

“If we don’t want it to become like Staphylococcus aureus, then we have to act now,” said Del Poeta, referring to the bacteria that became the poster child of drug resistance when it developed the ability to defeat the antibiotic methicillin, garnering the name methicillin-resistant Staphylococcus aureus, or MRSA…

“In order to get Candida auris out of a room, you have to take away everything – doorknobs, plastic items, everything. It is very difficult to eradicate it in a hospital,” Del Poeta said. He said his institution has never had a patient with C. auris…

Scientists such as Del Poeta contend it’s time for new methods of addressing resistant microbes of all kinds because infectious pathogens have developed the power to outwit, outpace and outmaneuver humankind’s most potent agents of chemical warfare, many of them developed in the 20th century.” (E)

“A case management program piloted by the New York City health department monitors patients colonized with Candida auris after they are discharged into the community and notifies health care facilities of their status, researchers reported at the CDC’s annual Epidemic Intelligence Service conference….

Patients can remain colonized with C. auris for months in a health care setting, but it is unclear if they remain colonized after discharge, noted Genevieve Bergeron, MD, MPH, an Epidemic Intelligence Service officer with the New York City Department of Health and Mental Hygiene (DOHMH), and colleagues.

According to Bergeron and colleagues, the state health department began referring patients colonized with C. auris to the DOHMH on Oct. 4, 2017. Approximately 12 case managers handled the referrals, conducting patient interviews and reviewing medical records to obtain relevant clinical information. They informed the patients’ providers and health care facilities about their C. auris status and infection control needs.

“We requested that facilities flag the patient in their electronic medical records to ensure that the patient has the proper precautions, if the patient were to seek care again at those facilities,” Bergeron said in a presentation. “Case mangers sent a medical alert card to the patients for them to use when encountering health care providers unaware of their infection control needs.”” (F)

“Regions are considering the use of electronic registries to track patients that carry antibiotic-resistant bacteria including carbapenem-resistant Enterobacteriaceae (CRE). Implementing such a registry can be challenging and requires time, effort, and resources; therefore, there is a need to better understand the potential impact…

When all Illinois facilities participated (n=402), the registry reduced the number of new carriers by 11.7% and CRE prevalence by 7.6% over a 3-year period. When 75% of the largest Illinois facilities participated (n=304), registry use resulted in a 11.6% relative reduction in new carriers (16.9% and 1.2% in participating and non-participating facilities, respectively) and 5.0% relative reduction in prevalence. When 50% participated (n=201), there were 10.7% and 5.6% relative reductions in incident carriers and prevalence, respectively. When 25% participated (n=101), there was a 9.1% relative reduction in incident carriers (20.4% and 1.6% in participating and non-participating facilities, respectively) and 2.8% relative reduction in prevalence.

Implementing an XDRO registry reduced CRE spread, even when only 25% of the largest Illinois facilities participated due to patient sharing. Non-participating facilities garnered benefits, with reductions in new carriers.” (G)

“Quebec public-health authorities are bracing for the inevitable arrival of a multi drug-resistant fungus that has been spreading around the globe and causing infections, some of them fatal…

“We will definitely have cases here and there at one point,” said Dr. Karl Weiss, chief of infectious diseases at the Jewish General Hospital. “It’s almost guaranteed. The only thing is when you know what you’re fighting against, it’s always easier and we will be able to contain it a lot faster.”

C. auris poses a quadruple threat: it’s tricky to identify; it can thrive in hospitals for weeks (preying on patients with weakened immune systems); it’s resistant to two classes of anti-fungal medications; and it can cause invasive disease, with lingering bloodstream infections that are hard to treat. The mortality rate can rise as high as 60 per cent.

The pathogen has emerged at a time when hospitals in Quebec – their budgets stretched more than ever – are already struggling with antibiotic-resistant superbugs like C. difficile, MRSA and VRE that have caused outbreaks. The Institut national de santé publique du Québec published a bulletin last year on steps that hospitals and long-term centres can take to prevent C. auris outbreaks.

“The problem is if you don’t identify the fungus properly, then it can slip in between your hands, and you can have an outbreak in your institution without even knowing it,” Weiss explained.

There was a lot of mis-indentification of this with other Candida (fungi); and even the automated systems in institutions that identify bacteria and yeast were mislabelling this Candida for something else. For a while, people were not aware of this auris. But now we know how to identify it.

“The first thing we did in Quebec – and this was for all the microbiology labs – is we taught all the microbiologists how to properly identify Candida auris,” Weiss continued. “All the major labs in Quebec put in place protocols.”

Weiss, who is president of the Quebec Association of Medical Microbiologists, noted that under a quality assurance program, samples have been sent to different labs to test whether the fungus is identified correctly. The results show that that labs are detecting C. auris to a high degree.

If a patient is discovered to be infected, hospital protocol dictates that the patient be isolated. During the patient’s hospitalization, the housekeeping staff must disinfect the room daily with hydrogen peroxide and other chemicals…” (H)

“Federal officials should declare an emergency over a deadly, incurable fungus infecting people in New York, New Jersey and across the country, Sen. Chuck Schumer said Sunday.

Schumer said he’s pushing the federal government to allocate millions of dollars to fighting Candida auris, which is drug-resistant and proving very difficult to eradicate…

“When it comes to the superbug, New York could use a little more help,” said Schumer. “The CDC has the power to declare this an emergency and automatically give us the resources we need.”..

Schumer said that an emergency declaration by the CDC would lead to more cases being identified with better testing, and to better tracking of the disease. It might also reduce the number of unnecessary antibiotic prescriptions, which Schumer says have helped the disease become drug-resistant…

Schumer cited other CDC emergency declarations that helped stop the spread of deadly diseases, including a $25 million award to fight the Zika virus in 2016 and $165 million given to contain Ebola in 2014.

“Every dollar we can use to better identify, tackle and treat this deadly fungus is a dollar well spent,” Schumer said.” (I)

“Other medical experts see the overuse of human antifungal medications in agriculture and floriculture as potential reasons for resistance in Candida auris, known as C. auris, and possibly other fungi.

Dr. Matt McCarthy, a specialist in infectious diseases at Weill Cornell Medicine in Manhattan, said tulips, signature flowers of the Netherlands, are dosed with the same antifungal medications developed to treat human infections.

“Antifungals are pumped into tulips in Amsterdam to achieve flawless plants,” he said. “As a fungal expert, I know that we have very few antifungal medications, and this is a misuse of the drugs.”

Studies conducted at Trinity College in Ireland support McCarthy’s argument and have demonstrated that tulip and narcissus bulbs from the Netherlands may be vehicles that spread drug-resistant fungi.

Trinity scientists, who examined resistance in another potentially deadly fungus, Aspergillus fumigatus, uncovered why the bugs repelled the drugs known as triazoles. The fungi became resistant because of the overuse of triazoles in floriculture. As with C. auris, drug-resistant A. fumigatus can be deadly in people with poor immunity.

When patients need treatment with triazole-class medications, the drugs don’t work because the fungi have been overexposed in the environment, McCarthy said.

He added that the use of antifungal medications in floriculture is similar to the overuse of antibiotics in the poultry and beef industries, which have helped drive resistance to those drugs.

The floriculture example is just one way that drug-resistant fungi can spread around the world. Global trade networks, human travel and the movement of animals and crops are others.” (J)

“It will take further research to determine if the new strains of C. auris have their origins in agriculture, but Aspergillus has already illustrated the perils of modern farming. Antibiotics are applied on a massive scale in food production, pushing the rise of bacterial drug resistance. A British government study published in 2016 estimated that, within 30 years, drug-resistant infections will be a bigger killer than cancer, with some 10 million people dying from infections every year.

We don’t have to end up there. Pesticide use on most farms can be greatly reduced, or even eliminated, without reducing crop yields or profitability. Methods of organic farming, even as simple as crop rotation, tend to promote the growth of mutualistic fungi that crowd out pathogenic strains such as C. auris. Unfortunately, because conventional agriculture is heavily subsidized and market prices don’t reflect the costs to the environment or human health, organic food is more expensive and faces an uphill battle for greater consumption.

Of course, improved technology could help, with drugs of new kinds or in breeding and engineering resistant strains of plants. There’s also plenty of opportunity for lightweight agricultural robots, which can weed mechanically or spray pesticides more accurately, reducing the quantity of chemicals used. But tech shouldn’t be the sole focus just because it happens to be the most profitable route for big industries.” (K)

“The recent outbreak of the so-called superbug – and other drug-resistant germs – has thrown a spotlight on locally based Xenex Disinfection Systems. The company makes a robot that uses pulsing, ultraviolet rays to disinfect surgical suites and other environments that are supposed to be germ-free.

With the spread of C. auris, Xenex officials say they’ve seen an uptick in queries about their LightStrike Germ-Zapping Robots, which are in use at more than 400 health-care facilities around the world since manufacturing started in 2011.

These devices – often called R2Clean2, Mr. Clean and The Germinator – disinfect rooms in a matter of minutes. A dome on the top of the robot rises up, exposing a xenon bulb that emits UV light waves that kill germs on contaminated surfaces.

Bexar County-owned University Hospital has a fleet of six Xenex robots. One of the robots is assigned to the Cystic Fibrosis Center to help protect patients from infection by other patients.

“We are taking every measure possible to reduce the risk of infections, and this is an additional layer of security that bathes the room in UV-C light,” said Elizabeth Allen, public relations manager at University Health System…

Another study, recently published by a doctor at the Minnesota-based Mayo Clinic, showed that when the hospital used the robots in rooms that had already been cleaned, infection rates of another superbug – called Clostridium difficile, or C. diff – fell by 47 percent.” (L)

“It wasn’t publicized locally, but within the past few years teams of health officials at two Oklahoma health facilities took rapid actions to contain the spread of a fungal “superbug” that federal officials have declared a serious global health threat.

Only one patient at each facility was infected, and both patients recovered. But the incidents reflect the growing alarm among health officials over the deadly, multidrug-resistant Candida auris, or C. auris, which can kill 30 percent to 60 percent of those infected…

In April 2017, a team of experts from the federal Centers for Disease Control and Prevention converged on the University of Oklahoma Medical Center in Oklahoma City after a patient tested positive for the drug-resistant fungus.

About a year later, a patient at a southeast Oklahoma health facility tested positive for the germ during a routine test. In both cases, health officials isolated the patients, locked down their rooms and ordered dozens of lab tests to see if the multidrug-resistant fungus had spread…

Unlike with outbreaks in Illinois, New York and New Jersey, the potentially deadly infection was quickly contained.”..

Public knowledge about the OU Medical Center case makes it an exception. Typically, health care facilities across the nation don’t release to the public information when C. auris and other drug-resistant pathogens are found. No law or policy requires them to do so.

Patient-rights advocates maintain that the public has the right to know when and where outbreaks or even single cases occur. But health officials have routinely fought back, suggesting that it could violate patient rights and discourage patients from seeking hospital care.

But the CDC allows states to make that decision.

Burnsed said the Department of Health tries to walk a tight line between notifying the public and protecting the patient’s privacy.

He said he would be more likely to identify a facility if it’s anything more than an isolated case or if officials believed the exposure wasn’t contained.

“What we consider is if there was a risk to a broader group of individuals and if there was any evidence that there were a breach in lab controls,” Burnsed said. “We didn’t put out anything at the time (on Oklahoma’s two cases) because we didn’t think there was a greater risk to the public, but it’s a good question to consider.”” (M)

“How many people will needlessly die from a deadly bug sweeping through New York hospitals and nursing homes before local health officials acknowledge the danger publicly – and act accordingly?..

Yet public-health officials here have been slow to let patients know in which hospitals the bug is lurking. Folks are left to take their chances. That’s outrageous.

Why are officials mum? Partly because they fear that if they disclose the information, some people who need treatment won’t go for it.

That’s a weak excuse: As McCaughey notes, there are plenty of local hospitals that aren’t plagued by Candida auris, so patients could get care and avoid the risk, if they know where it’s safe to go.

More likely, no one wants to damage the reputations (or incomes) of the affected hospitals. Yet the best way to protect those reputations is to make sure the facilities are Candida auris-free…

Meanwhile, officials say they will reveal which hospitals have the germ – in their next yearly report. But that could be months away; patients need to know now.

If neither the hospitals nor their government regulators are willing to move sooner, perhaps state lawmaker should step in and require them to do so… (N)

Infectious disease experts tell Axios they agree with a dire scenario painted in the UN report posted earlier this week saying that, if nothing changes, antimicrobial resistance (AMR) could be “catastrophic” in its economic and death toll.

Threat level, per the report: By 2030, up to 24 million people could be forced into extreme poverty and annual economic damage could resemble that from the 2008–2009 global financial crisis, if pathogens continue becoming resistant to medications. By 2050, AMR could kill 10 million people per year, in its worst-case scenario.

“There is no time to wait. Unless the world acts urgently, antimicrobial resistance will have disastrous impact within a generation.”..

By the numbers: Currently, at least 700,000 people die each year due to drug-resistant diseases, including 230,000 people from multidrug-resistant tuberculosis, per the UN. Common diseases – like respiratory infections, STDs and urinary tract infections – are increasingly untreatable as the pathogens develop resistance to current medications.

The Centers for Disease Control and Prevention says AMR causes more than 23,000 deaths and 2 million illnesses in the U.S. annually…

What needs to be done: Jasarevic says the economic and health systems of all nations must be considered, and targets made to increase investment in new medicines, diagnostic tools, vaccines and other interventions.”

The bottom line: Action must be taken to avoid a catastrophic future.” (O)

“A recent study of patients at 10 academic hospitals in the United States found that just over half care about what their doctors wear, most of them preferring the traditional white coat.

Some doctors prefer the white coat, too, viewing it as a defining symbol of the profession.

What many might not realize, though, is that health care workers’ attire – including that seemingly “clean” white coat that many prefer – can harbor dangerous bacteria and pathogens.

A systematic review of studies found that white coats are frequently contaminated with strains of harmful and sometimes drug-resistant bacteria associated with hospital-acquired infections. As many as 16 percent of white coats tested positive for MRSA, and up to 42 percent for the bacterial class Gram-negative rods.”

It isn’t just white coats that can be problematic. The review also found that stethoscopes, phones and tablets can be contaminated with harmful bacteria. One study of orthopedic surgeons showed a 45 percent match between the species of bacteria found on their ties and in the wounds of patients they had treated. Nurses’ uniforms have also been found to be contaminated.

Among possible remedies, antimicrobial textiles can help reduce the presence of certain kinds of bacteria, according to a randomized study. Daily laundering of health care workers’ attire can help somewhat, though studies show that bacteria can contaminate them within hours…

It’s a powerful symbol. But maybe tradition doesn’t have to be abandoned, just modified. Combining bare-below-the-elbows white attire, more frequently washed, and with more conveniently placed hand sanitizers – including wearable sanitizer dispensers – could help reduce the spread of harmful bacteria.

Until these ideas or others are fully rolled out, one thing we can all do right now is ask our doctors about hand sanitizing before they make physical contact with us (including handshakes). A little reminder could go a long way.” (P)

PART 3. May 28, 2019. CADIDA AURIS. “Antibiotic-resistant superbugs are everywhere. If your hospital claims it doesn’t have them, it isn’t looking hard enough.”

“So far, 12 states from coast to coast have had confirmed cases of Candida auris, which has spread with particularly speed in New York, which has had more than half of the nation’s infections.

Some are even calling for the federal government to declare a national state of emergency and fund better containment of the fungus. 

Health officials there are scrambling to contain what the Centers for Disease Control and Prevention (CDC) have deemed an emerging health threat, but without stricter guidelines and screening, the fungus will only get more deadly…

Doctors sometimes struggle to diagnose fungal infections, in part because their symptoms are little different from those of bacterial infections…

‘Candida auris has the ability to develop resistance and has developed mechanisms to survive,’..

‘It’s at least starting to figure that out, and that’s obviously concerning.’

There are really only three antifungal medications in the US, so it doesn’t take long for a fungus to become wholly drug resistant.

Dr Chiller says that approximately 90 percent of strains the CDC has logged are resistant to the first-line drug, another third are resistant to a second, and between 20 and 30 percent of Candida auris infections have acquired multi-drug resistance.

‘Some are pan-resistant and those need to be isolated and stopped and we need to try to prevent them from developing,’ he says. 

Neither the CDC, other nation’s health officials or any of the 12 affected states have been able to work out where the fungus came from, or how exactly it has spread from state-to-state… 

If states don’t require their hospitals to report cases the fungal infection, the CDC may be severely underestimating the number of cases across the country.

‘It’s a bit of an uphill battle and it needs to be a really concerted effort on multiple tiers of the health care system,’ Dr Chiller says…

‘We need to stay on top of it and not let our guard down.’   (A)

“New York State health officials are considering rigorous new requirements for hospitals and nursing homes to prevent the spread of a deadly drug-resistant fungus called Candida auris.

The requirements could include mandatory pre-admission screening of patients believed to be at-risk and placing in isolation those patients who are infected, or even those just carrying the fungus on their skin.

Dr. Howard Zucker, the state health commissioner, and a fungal expert from the federal Centers for Disease Control and Prevention met last Friday in Manhattan with nearly 60 hospital officials from across the state to discuss the proposed guidelines. State health officials said they were seeking hospital input before issuing the guidelines, which they acknowledged would likely be a hardship for some institutions.

“One of our guiding objectives is to stop the geographic spread,” said Brad Hutton, the state’s deputy commissioner of public health. He said the state’s efforts to contain the spread have required significant resources — including sending individual infection specialists to investigate more than 150 cases — and that New York now needs help from individual institutions.

“We’re at a point where our response strategy needs to change,” he said. He added that he hoped the guidelines would be finalized by the end of the year, but said the state is still determining whether to apply them statewide or just to New York City and surrounding areas. It has yet to be decided whether the guidelines would be recommendations or regulatory requirements, he said…

For the moment…. hospitals are pre-screening many patients who appear to be at risk. But it can take a week to get skin-swab results back from the state laboratory, posing challenges for housing patients in isolation during the interim. Further, she said, regular testing is likely to turn up patients who are carriers but not infected, increasing the number of patients who require isolation, appropriately or not.”..

For now, much of the burden for surveillance has fallen to the state. The effort has involved the development of a fast-screening test that can analyze a skin swab in a matter of hours. But all hospitals, for the moment, have to send those tests to a state laboratory in Albany and wait several days before receiving the results, though hospitals say the backlog means tests can take a week.” (B)

“Unlike cholesterol drugs taken by millions of people for their entire lives, or $100,000 cancer drugs designed to prolong life, antibiotics are short-term drugs with limited shelf lives.

“Antibiotics are not valued by society as a high-value product, so they’re not priced very high,” said Gregory Frank, director of infectious disease policy at the Biotechnology Innovation Organization, in a phone interview.

A 2014 paper.. cited a London School of Economics study showing that while a new arthritis drug’s net present value – a measure of a drug’s net value over the ensuing decades – would be $1 billion, that of a new antibiotic would be negative $50 million…

People will buy innovative products in almost any other part of the economy, but doctors will still keep even the most innovative antibiotic behind the glass and use it only in the most dire circumstances.

“Antibiotic stewardship is a good thing, but devastating for the company developing it,” Outterson said…

Jersey City, New Jersey-based Scynexis is one company developing a treatment for drug-resistant fungal infections, ibrexafungerp, currently in several clinical trials, including one for C. auris. The company plans to file its first approval application with the FDA for ibrexafungerp next year. The drug is expected cost $450-600 per day, in line with the pricing of other antifungals, said company CEO Marco Taglietti, in a phone interview…

The race against drug-resistant infectious is ultimately a scientific one.  It’s not about finding better treatments, but newer ones in an endless war that requires always staying one step ahead of ever-evolving germs, Taglietti said. On the one hand, it’s important to practice good stewardship in order to delay resistance.

“But that creates a big challenge from an economic point of view – from the moment you launch your product after spending several hundreds of millions to develop it, it doesn’t sell,” he said.

The problem appears to be a vicious cycle of science and economics: Even existing push incentives, however generous, don’t make up for antibiotics’ lack of the large and chronic patient populations of cardiovascular disease drugs or the high prices of cancer drugs.” (C)

“Demanding that hospitals release lists of every superbug they find within their walls, however, as many transparency advocates want, is not the answer. The irony is that the hospitals that see the most superbugs are often the best ones we have, for the simple reason that they have the most sophisticated diagnostic platforms, the most powerful antibiotics and the experts to administer them.

Compelling a world-class hospital like Massachusetts General Hospital, where I saw my first superbug as a medical student, to reveal a microbe list would only freak patients out. It wouldn’t explain where the microbes came from, whether any patients were infected, and how they were cured.

In a worst-case scenario, more transparency could lead to patients avoiding medical care out of a misplaced fear of encountering drug-resistant bacteria. Hospitals might start refusing patients with certain infections, especially those coming from nursing facilities where these microbes are common, out of a concern that the patient’s bacteria could be added to the list. This would do everyone a disservice: Patients wouldn’t receive optimal care and superbugs would multiply.

But hospital administrators and government officials do need to be honest about the microbes in our medical centers and explain what is really going on. No comment will no longer suffice. People have questions and this story is not going away. To ensure that patients are well-informed, hospitals should train spokesmen to address these issues and states should revisit their reluctance to disclose information. Above all, health care workers and administrators should speak openly about the measures their hospitals are already employing to keep people safe.

I’m not particularly interested in the microbes that dwell inside of a given hospital; what matters is whether its employees follow the strict protocols that prevent these organisms from going where they shouldn’t…

Silence and evasion gives the perception that this is a problem spiraling out of control when, in fact, it’s not. An intricate tracking system exists so that epidemiologists across the country can monitor any outbreaks to ensure that proper protocols and containment strategies are implemented. We need to hear more from these superbug hunters.” (D)

“A new study published in the Journal of Occupational and Environmental Health has established protocols for containing the drug resistant Candida auris (C. auris ) in an animal facility, and by doing so, has identified four simple rules that can potentially be adopted by healthcare facilities to limit exposure to staff and patients. The study found that their double personal protective equipment (PPE), work ‘buddy’ system, disinfection and biomonitoring protocols were effective at containing high levels of C. auris infection within their animal facility, even six months after their experiments…

Before entering the animal holding and procedure rooms, staff donned a second layer of booties, gloves and gowns, which were later removed and placed in biohazard bins before exiting the rooms. Handling of infected cages and equipment was restricted to biosafety cabinets where a buddy system was implemented so that one person handed clean cages and supplies to a second person working inside the contaminated biosafety cabinet. This system-controlled workflow from clearly defined ‘clean’ to ‘dirty’ areas and allowed workers to monitor each other to ensure proper procedures were followed. Surfaces and equipment that came in contact with infected mice or tissues were treated with a strict disinfection protocol of 10% bleach followed (after five minutes) by 70% ethanol. The effectiveness of the workflow and protocols were continually monitored using swab testing on surfaces suspected to be contaminated, and as a second measure, Sabbaroud dextrose plates were placed inside the biosafety cabinet and on the floor underneath to determine whether C. auris was aerosolised within the cabinet or whether any debris contaminated the floor.

The researchers found that possible contamination came from direct contact with the infected mice or tissues but not from aerosolisation.” (E)

“A pernicious disease is eating away at Roy Petteway’s orange trees. The bacterial infection, transmitted by a tiny winged insect from China, has evaded all efforts to contain it, decimating Florida’s citrus industry and forcing scores of growers out of business.

In a last-ditch attempt to slow the infection, Mr. Petteway revved up his industrial sprayer one recent afternoon and doused the trees with a novel pesticide: antibiotics used to treat syphilis, tuberculosis, urinary tract infections and a number of other illnesses in humans…

The use of antibiotics on citrus adds a wrinkle to an intensifying debate about whether the heavy use of antimicrobials in agriculture endangers human health by neutering the drugs’ germ-slaying abilities. Much of that debate has focused on livestock farmers, who use 80 percent of antibiotics sold in the United States.

Although the research on antibiotic use in crops is not as extensive, scientists say the same dynamic is already playing out with the fungicides that are liberally sprayed on vegetables and flowers across the world. Researchers believe the surge in a drug-resistant lung infection called aspergillosis is associated with agricultural fungicides, and many suspect the drugs are behind the rise of Candida auris, a deadly fungal infection.” (F)

OCTOBER 3, 2018

“A large Candida auris outbreak at a hospital in England appears to be linked to reusable patient-monitoring equipment, a team of researchers reports today in the New England Journal of Medicine.

The outbreak in the neurosciences intensive care unit (ICU) at Oxford University Hospitals involved 70 patients who were infected or colonized with C auris, a fungus that has become increasingly resistant to azoles, echinocandins, and polyenes—the three classes of antifungals used to treat infections caused by Candida and other fungal species.

An epidemiologic investigation and case-control study by investigators from the University of Oxford, Public Health England, and elsewhere found that the most compelling explanation for the prolonged outbreak was the persistence of the organism on reusable skin-surface axillary probes, a device placed in a patient’s armpit for continuous temperature monitoring.

“Our results indicate that reusable patient equipment may serve as a source of healthcare-associated outbreaks of infection with C. auris,” the authors of the study write.” (G)

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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

In the doctors’ meeting, the (UNC) 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.”

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.

New PART 2 after PART 1.

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

Assignment: How would this problem have been avoided if Johns Hopkins quality assurance and patient safety protocols been followed?

“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.

https://health.usnews.com/best-hospitals/area/nc/north-carolina-childrens-hospital-at-unc-PA6360260/pediatric-rankings/cardiology-and-heart-surgery

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

https://health.usnews.com/best-hospitals/area/nc/duke-university-medical-center-6360355/pediatric-rankings/cardiology-and-heart-surgery
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PART 2. May 28, 2019. “BATTLEFIELD” MEDICINE: THE CIVIL WAR. “Many of America’s modern medical accomplishments have their roots in the legacy of America’s defining war.”

ASSIGNMENT: Profile medical advances made during World War I, World WAR II, the Korean War, Vietnam, Afghanistan and Iraq.

Memorial Day 2019

From 1967 to 1970, during the Vietnam War, I served first as a 2nd Lieutenant and  Administrative Officer of the 4th Casualty Staging Flight attached to Wilford Hall USAF Medical Center, Lackland AFB in San Antonio, Texas. We received combat casualties still in battlefield bandages, often within 24 hours of injury, and either admitted them to Wilford Hall or further transported them to hospitals near home.

New PART 2 after PART 1

Part 1. July 3, 2018. “BATTLEFIELD MEDICINE: THE REVOLUTIONARY WAR

“When the Revolutionary War began its actual skirmishes in 1776, early attempts to prepare for the medical needs related to War were made in the City of New York. During the spring and summer of 1776, Samuel Loudon was publishing his newspaper the New York Packet, in which he included numerous articles and announcements regarding the Continental Army. On July 29, for example, came the following announcement written by Thomas Carnes, Stewart and Quartermaster to the General Hospital of King’s College, New York. Anticipating an increase demand for medically trained staff, he filed the following request for volunteers:

“GENERAL HOSPITAL New-York, July 29, 1776 Wanted immediately in the General Hospital, a number of women who can be recommended for their honesty, to act in the capacity of nurses: and a number of faithful men for the same purpose…King’s College, New York” (A)

“One of the most famous surgeons, and the first, was Cornelius Osborn. He was recruited in the Spring of 1776 and had little training even as a physician. The Continental Congress was even concerned about the well-being of the troops and the militia. They passed several ordinances and helped establish the order for the several field Hospitals during the War. The hospitals served about 20,000 men in the fight. Each hospital was required for each surgery to have at least one physician or surgeon, and one assistant, which was usually and apprentice of some sort. Each hospitals staff numbers varied on how many wounded it served and the severity of the wounds….

Most of the deaths in the Revolutionary War were from infection and illness rather than actual combat. The common practice if a limb was badly infected of fractured was amputate it. Where most amputees died of gangrene a result of not properly cleaning instruments after surgeries. Only 35% of amputees actually survived surgery. There was no pain killers quite developed back then. So at most the patient were given alcohol and a stick to bite down on while the surgeon worked. Two assistant would hold him down, a good surgeon could perform the entire process in a mere 45 seconds, after which the patient usually went into shock and fainted. This allowed the surgeon to stich up the wound, and prepare for the next amputation. Another way they decided to clean wounds, disease, or infection was by applying mercury directly to the cut of injured space, and letting it run through the blood stream which usually resulted in death.” (B)

“To seek treatment for any serious ailment, a soldier would have had to go to a hospital of sorts. Military regiments had a surgeon on staff to care for the men, so the soldier’s first stop would be with the surgeon. During battles, the surgeon could be found in a makeshift or “flying” hospital that consisted of a tent, an operating table, and some medical equipment. If the surgeon could not treat the soldier, he might be sent to a hospital. Many regimental hospitals were in nearby houses, while general hospitals for more in-depth treatment were sometimes set up in barns, churches, or other public buildings. The conditions were often cramped, which resulted in the rapid spread of contagious illnesses and infections….

Woe to the soldier who required surgery after being wounded on the battlefield! The conditions in “flying” hospitals were deplorable. Not only was the operating room simply a table in a tent, but there was little thought given to keeping the table and tools clean. In fact, wounds were sometimes cleaned using plain water from a bucket, and the used water would be saved to clean out the next soldier’s wounds as well. (C)

Hospitalization was a serious problem during the American Revolutionary War. Plans were made quite early to care for the wounded and sick, but at the best they were meager and inadequate. However on April 11, 1777 Dr. William Shippen Jr., of Philadelphia was chosen Director General of all the military hospitals for the army. Consequently the reorganization of hospital conditions took place.

Four hospital districts were created: Easter, Northern, Southern and Middle. The wage scale was as follows: Director General’s pay $6.00 a day and 9 rations; District Deputy Director $5.00 a day and 6 rations; Senior Surgeon $4.00 a day and 6 rations; Junior Surgeon $2.00 and 4 rations; Surgeon mate $1.00 and 2 rations.

After the battle of Brandywine, September 11, 1777, hospitals were established at Bethlehem, Allentown, Easton and Ephrata. After the battle of Germantown, October 4, 1777, emergency hospitals were organized at Evansburg, Trappe, Falkner Swamp and Skippack. Hospitals at Litiz and Reading were also continued. By December 1777, new hospitals were opened at Rheimstown, Warwick and Shaeferstown. Yellow Springs (now Chester Springs) an important hospital was organized under the direction of Dr. Samuel Kennedy. At Lionville, Uwchlan Quaker Meeting House was also made a hospital for a time. Apothecary General Craigie’s shop, Carlisle, was the source of hospital drugs….

It seems there was carelessness in making necessary health reports, consequently Washington ordered on January 2, 1778: “Every Monday morning regimental surgeons are to make returns to the Surgeon Gen’l. or in his absence to one of the senior surgeions, present in camp or otherwise under the immediate care of the regimental surgeons specifying the mens names Comps. Regts. and diseases.” [Weedon’s Valley Forge Orderly Book, p. 175]

January 13, 1778. “The Flying Hospitals are to be 15 feet wide and 25 feet long in the clear and the story at least 9 feet high to be covered with boards or shingles only without any dirt, windows made on each side and a chimney at one end. Two such hospitals are to be made for each brigade at or near the center and if the ground permits of it not more than 100 yards distance from the brigade.” [Weedon’s Valley Forge Orderly Book, p. 191] The Commander-in-Chief always solicitous about the comfort of his soldiers issued the following order January 15, 1778: “The Qr. Mr. Genl. is positively ordered to provide straw for the use of the troops and the surgeons to see that the sick when they are removed to huts assigned for the hospital are plentifully supplied with this article.” [Weedon’s Valley Forge Orderly Book, pp. 192-199-204-216] ” (D)

PART 2. May 28, 2019. “BATTLEFIELD” MEDICINE: THE CIVIL WAR. “Many of America’s modern medical accomplishments have their roots in the legacy of America’s defining war.”

 “During the 1860s, doctors had yet to develop bacteriology and were generally ignorant of the causes of disease. Generally, Civil War doctors underwent two years of medical school, though some pursued more education. Medicine in the United States was woefully behind Europe. Harvard Medical School did not even own a single stethoscope or microscope until after the war. Most Civil War surgeons had never treated a gunshot wound and many had never performed surgery. Medical boards admitted many “quacks,” with little to no qualification. Yet, for the most part, the Civil War doctor (as understaffed, underqualified, and under-supplied as he was) did the best he could, muddling through the so-called “medical middle ages.” Some 10,000 surgeons served in the Union army and about 4,000 served in the Confederate. Medicine made significant gains during the course of the war. However, it was the tragedy of the era that medical knowledge of the 1860s had not yet encompassed the use of sterile dressings, antiseptic surgery, and the recognition of the importance of sanitation and hygiene. As a result, thousands died from diseases such as typhoid or dysentery.

The deadliest thing that faced the Civil War soldier was disease. For every soldier who died in battle, two died of disease. In particular, intestinal complaints such as dysentery and diarrhea claimed many lives. In fact, diarrhea and dysentery alone claimed more men than did battle wounds. The Civil War soldier also faced outbreaks of measles, small pox, malaria, pneumonia, or camp itch. Soldiers were exposed to malaria when camping in damp areas which were conductive to breeding mosquitos, while camp itch was caused by insects or a skin disease. In brief, the high incidence of disease was caused by a) inadequate physical examination of recruits; b) ignorance; c) the rural origin of my soldiers; d) neglect of camp hygiene; e) insects and vermin; f) exposure; g) lack of clothing and shoes; h) poor food and water…

Battlefield surgery…was also at best archaic. Doctors often took over houses, churches, schools, even barns for hospitals. The field hospital was located near the front lines — sometimes only a mile behind the lines — and was marked with (in the Federal Army from 1862 on) with a yellow flag with a green “H”. Anesthesia’s first recorded use was in 1846 and was commonly in use during the Civil War. In fact, there are 800,000 recorded cases of its use. Chloroform was the most common anesthetic, used in 75% of operations. ..A capable surgeon could amputate a limb in 10 minutes. Surgeons worked all night, with piles of limbs reaching four or five feet. Lack of water and time meant they did not wash off hands or instruments

Bloody fingers often were used as probes. Bloody knives were used as scalpels. Doctors operated in pus stained coats. Everything about Civil War surgery was septic. The antiseptic era and Lister’s pioneering works in medicine were in the future. Blood poisoning, sepsis or Pyemia (Pyemia meaning literally pus in the blood) was common and often very deadly…”  (A)

“Early on, stretcher bearers were members of the regimental band, and many fled when the battle started. Soldiers acting as stretcher bearers rarely returned to the front lines. As the war evolved, stretcher bearers became part of the medical corps. At the battle of Antietam, there were 71 Union field hospitals. As the war went on, these were consolidated. There were ambulances here that were used to bring the wounded to temporary battlefield hospitals, which were larger, often under tents, and out of artillery range. Later in the war, patients were transported to large general hospitals by train or ship in urban centers. These did not exist when the war began. There was no military ambulance corps in the Union Army until August of 1862. Until that time, civilians drove the ambulances. Initially the ambulance corps was under the Quartermaster corps, which meant that ambulances were often commandeered to deliver supplies and ammunition to the front…

Large general hospitals were established by September of 1862 (11). These were in large cities, and soldiers were transported there by train or ship. At the end of the war, there were about 400 hospitals with about 400,000 beds. There were 2 million admissions to these hospitals with an overall mortality of 8%. In the South, the largest general hospital, Chimborazo, was in Richmond, Virginia. It was built out of tobacco crates on 40 acres. It contained five separate hospitals, each made up of 30 buildings. There were 150 wards with 40 to 60 patients per ward. The census was as high as 4000. They treated about 76,000 patients with a 9% mortality (12)…

Three of every four surgical procedures performed during the war were amputations. Each amputation took about 2 to 10 minutes to complete. There were 175,000 extremity wounds to Union soldiers, and about 30,000 of these underwent amputation with a 26.3% mortality… Only about 1 in 15 Union physicians was allowed to amputate. Only the most senior and experienced surgeons performed amputations. These changes were put into effect because of the public perception that too many amputations were being performed. Amputations were not carried out using sterile technique, given that Lister’s classic paper on antisepsis did not appear until after the war in 1867…

Physicians at the time had an extraordinary workload. The following was excerpted from a letter Dr. Daniel Holt wrote to his wife, Euphrasia:

You cannot imagine the amount of labor I have to perform. As an instance of what almost daily occurs, I will give you an account of day-before-yesterday’s duty. At early dawn, while you, I hope, were quietly sleeping, I was up at Surgeon’s call and before breakfast prescribed for 86 patients at the door of my tent. After meal I visited the hospitals and a barn where our sick are lying, and dealt medicines and write prescriptions for one hundred more; in all visited and prescribed for, one hundred and eighty-six men. I had no dinner. At 4 o’clock this labor was completed and a cold bite was eaten. After this, in the rain, I started for Sharpsburg, four miles distant, for medical supplies (17). (B)

Most of the major medical advances of the Civil War were in organization and technique, rather than medical breakthroughs.  In August of 1862, Jonathan Letterman, the Medical Director of the Army of the Potomac, created a highly-organized system of ambulances and trained stretcher bearers designed to evacuate the wounded as quickly as possible.  A similar plan was adopted by the Confederate Army.  This system was a great improvement on previous methods.  He established a trained ambulance corps, consolidated all of the ambulances of a Brigade, and created a system of layered levels of care for the wounded on the battlefield.  The levels of care were small field dressing stations (usually directly on the battlefield), field hospitals (located in a safer place just beyond the battlefield), and a system of general hospitals in most large cities.  Transporting the wounded men from one hospital to another was also coordinated.  The Letterman plan remains the basis for present military evacuation systems.

A system of triage was established that is still used today.  The sheer number of wounded at some of the battles made triage necessary.  In general, the wounded soldiers were divided into three groups: the slightly wounded, those “beyond hope”, and surgical cases.  The surgical cases were dealt with first since they would be the most likely to benefit from immediate care.  These included many of the men wounded in the extremities and some with head wounds that were considered treatable.  The slightly wounded would be tended to next, their wounds were not considered life-threatening so they could wait until the first group was treated.  Those beyond hope included most wounds to the trunk of the body and serious head wounds.  The men would have been given morphine for pain and made as comfortable as possible… 

Hospitals became places of healing rather than places to go to die, as they were widely considered before the war.  The large-scale hospitals set up by the medical departments had an astounding average death rate of only 9%…  Women nurses were first truly accepted during the war, mainly out of necessity.  Although there was a great deal of prejudice against them, especially early on, surgeons came to see that their contributions went a long way in aiding the patients.  Once they had an established place in medical care they would not give it up.  Nursing as a profession was born.

Due to the sheer number of wounded patients the surgeons had to care for, surgical techniques and the management of traumatic wounds improved dramatically.  Specialization became more commonplace during the war, and great strides were made in orthopedic medicine, plastic surgery, neurosurgery and prosthetics.  Specialized hospitals were established, the most famous of which was set up in Atlanta, Georgia, by Dr. James Baxter Bean for treating maxillofacial injuries.  General anesthesia was widely used in the war, helping it become acceptable to the public.  Embalming the dead also became commonplace.

Medical technology and scientific knowledge have changed dramatically since the Civil War, but the basic principles of military health care remain the same.  Location of medical personnel near the action, rapid evacuation of the wounded, and providing adequate supplies of medicines and equipment continue to be crucial in the goal of saving soldiers’ lives.”  (C)

“Many misconceptions exist regarding medicine during the Civil War era, and this period is commonly referred to as the Middle Ages of American medicine. Medical care was heavily criticized in the press throughout the war. It was stated that surgery was often done without anesthesia, many unnecessary amputations were done, and that care was not state of the art for the times. None of these assertions is true. Actually, during the Civil War, there were many medical advances and discoveries..

Medical                Use of quinine for the prevention of malaria

Use of quarantine, which virtually eliminated yellow fever

Successful treatment of hospital gangrene with bromine and isolation

Development of an ambulance system for evacuation of the wounded

Use of trains and boats to transport patients

Establishment of large general hospitals

Creation of specialty hospitals

Surgical Safe use of anesthetics

Performance of rudimentary neurosurgery

Development of techniques for arterial ligation

Performance of the first plastic surgery..” (B)

“However, while “advanced” or “hygienic” may not be terms attributed to medicine in the nineteenth century, modern hospital practices and treatment methods owe much to the legacy of Civil War medicine. Of the approximately 620,000 soldiers who died in the war, two-thirds of these deaths were not the result of enemy fire, but of a force stronger than any army of men: disease. Combating disease as well treating the legions of wounded soldiers pushed Americans to rethink their theories on health and develop efficient practices to care for the sick and wounded.

At the beginning of the Civil War, medical equipment and knowledge was hardly up to the challenges posed by the wounds, infections and diseases which plagued millions on both sides. Illnesses like dysentery, typhoid fever, pneumonia, mumps, measles and tuberculosis spread among the poorly sanitized camps, felling men already weakened by fierce fighting and meager diet. Additionally, armies initially struggled to efficiently tend to and transport their wounded, inadvertently sacrificing more lives to mere disorganization…

The wounded and sick suffered from the haphazard hospitalization systems that existed at the start of the Civil War. As battles ended, the wounded were rushed down railroad lines to nearby cities and towns, where doctors and nurses coped with the onslaught of dying men in makeshift hospitals. These hospitals saw a great influx of wounded from both sides and the wounded and dying filled the available facilities to the brim. The Fairfax Seminary, for example, opened its doors twenty years prior to the war with only fourteen students, but it housed an overwhelming 1,700 sick and wounded soldiers during the course of the war…

However, the heavy and constant demands of the sick and wounded sped up the technological progression of medicine, wrenching American medical practices into the light of modernity.  Field and pavilion hospitals replaced makeshift ones and efficient hospitalization systems encouraged the accumulation of medical records and reports, which slowed bad practices as accessible knowledge spread the use of beneficial treatments…

The sheer quantity of those who suffered from disease and severe wounds during the Civil War forced the army and medical practitioners to develop new therapies, technologies and practices to combat death. Thanks to Hammond’s design of clean, well ventilated and large pavilion-style hospitals, suffering soldiers received care that was efficient and sanitary. In the later years of the war, these hospitals had a previously unheard of 8% mortality rate for their patients…

In field hospitals and pavilion-style hospitals, thousands of physicians received experience and training.  As doctors and nurses became widely familiar with prevention and treatment of infectious diseases, anesthetics, and best surgical practices, medicine was catapulted into the modern era of quality care. Organized relief agencies like the 1861 United States Sanitary Commission dovetailed doctors’ efforts to save wounded and ill soldiers and set the pattern for future organizations like the American Red Cross, founded in 1881.

Death from wounds and disease was an additional burden of the war that took a toll on the hearts, minds, and bodies of all Americans, but it also sped up the progression of medicine and influenced practices the army and medical practitioners still use today. While the Union certainly had the advantage of better medical supplies and manpower, both Rebels and Federals attempted to combat illness and improve medical care for their soldiers during the war. Many of America’s modern medical accomplishments have their roots in the legacy of America’s defining war.” (D)

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PART 2. May 20, 2019. OUT-OF-NETWORK BILLS. Private Equity is a Driving Force Behind Devious Surprise Billings

ASSIGNMENT: Draft the principles for federal “surprise bill” legislation

I thought I was a good OUT-OF-NETWORK detective and could avoid SURPRISE MEDICAL BILLS. Not so! Recently I switched physicians within a sub-specialty practice group. The first MD took my Medicare “GAP” insurance but the second did not. This lesson already cost me $1,000 versus an in network cost of probably $200. One can never be too vigilant!

New PART 2 after PART 1.

PART 1. July 29, 2018. SURPRISE MEDICAL BILLS.  Write in AS LONG AS THE PROVIDERS ARE IN MY NETWORK…before you sign any hospital admission documents accepting financial responsibility for your care.

“No Surprise Charges” is one of the key Lessons Learned in Elisabeth Rosenthal’s fabulous new book AN AMERICAN SICKNESS (Penguin Press, 2017). “Hospitals in your network should also be required to guarantee that all doctors who treat you are in your insurance network.”

We have all harshly experienced or heard about under-the counter out-of-network hospital charges:

“A Kaiser Family Foundation survey finds that among insured, non-elderly adults struggling with medical bill problems, charges from out-of-network providers were a contributing factor about one-third of the time. Further, nearly 7 in 10 of individuals with unaffordable out-of-network medical bills did not know the health care provider was not in their plan’s network at the time they received care.”(A)

A study that looked at more than 2 million emergency department visits found that more than 1 in 5 patients who went to ERs within their health-insurance networks ended up being treated by an “out-of-network” doctor – and thus exposed to additional charges not covered by their insurance plan.” (B)

Here is a brief case study:

“When Janet Wolfe was admitted to the hospital near Macon, Georgia, a few years ago, her lungs were functioning at just one-fifth their normal capacity. The problem: graft-versus-host disease, a complication from a stem cell transplant she received to treat lymphoma. Over the course of three days she saw three different doctors. Unbeknownst to Janet and her husband, Andrew, however, none of them was in her health plan’s network of providers. That led the insurer to pay a smaller fraction of those doctors’ bills, leaving the couple with some hefty charges.” (C)

So what can you do to avoid out-of-network charges?

– Speak with a practice representative before being seen to understand the costs of seeing your doctor on an out-of-network or a cash basis. (DOCTOR note: maybe you need to leave and go to an in-network physician instead)

– If you need additional services, such as surgery, imaging or physical therapy, ask your doctor to refer you to an in-network facility to keep your costs down. (D)

A New York law is a great start toward transparency to reduce out-of-network surprises.

Under a recent New York law, Hold Harmless Protections for Insured Patients, “… patients are generally protected from owing more than their in-network copayment, coinsurance or deductible on bills they receive for out-of-network emergency services or on surprise bills.

A bill is considered a surprise if consumers receive services without their knowledge from an out-of-network doctor at an in-network hospital or ambulatory surgical center, among other things. In addition, if consumers are referred to out-of-network providers but don’t sign a written consent form saying they understand the services will be out of network and may result in higher out-of-pocket costs, it’s considered a surprise bill.” (E)

“Advocates for patients, senior citizens, labor unions, and businesses hailed Gov. Phil Murphy’s signing of a complex and controversial measure designed to curb the impact of costly “surprise” medical bills in New Jersey. Supporters said the law, nearly 10 years in the making, is the strongest of its kind nationwide…

The Democratic governor, who pledged his support for the bill in March, said the law closed a loophole to protect patients and make healthcare more affordable; sponsors called it the right thing to do to protect vulnerable residents. “We have put patients first. We have made clear that New Jersey stands for transparency when it comes to health care,” …

The reform is designed to protect patients, businesses, and others who pay for medical care from the high-cost bills associated with emergency or unintentional care from doctors or other providers who are not part of their insurance network. The law requires greater disclosure from both insurance companies and providers – so patients are clear on what their plan covers – ensures patients aren’t responsible for excess costs, and establishes an arbitration process to resolve payment disputes between providers and insurers, a mechanism intended to better control costs…

“It’s a solution that is fair to healthcare providers and consumers alike because it strikes a balance between providing reasonable compensation to facility-based providers, while protecting consumers from unexpected, nonnegotiable bills that drive health insurance premiums higher,” said NJBIA president and CEO Michele Siekerka. “This was an extremely difficult and complicated issue, and NJBIA commends the governor and the bill sponsors who worked hard to address the concerns of all stakeholders.”” (F)

A price transparency RFI released by the agency this week asks for input on how CMS might develop consumer-friendly policy. In a request for information announced Thursday, the Centers for Medicare & Medicaid Services asked whether providers and suppliers should be required to tell patients, in advance, how much a given healthcare service will cost out-of-pocket. If the agency were to move forward with a price transparency requirement on physician practices, it could prove controversial. Many doctors say they themselves lack the training they would need to have effective conversations about how much the healthcare services they provide will ultimately cost patients.

But CMS has repeatedly indicated that it aims to get more pricing information to consumers one way or another. “We are concerned that challenges continue to exist for patients due to insufficient price transparency,” the agency wrote in its RFI, which is included in proposed revisions to the Physician Fee Schedule, Quality Payment Program, and other policies for 2019…

In order to determine what additional actions may be appropriate to connect consumers with accessible price information, the CMS price transparency RFI includes a variety of questions, including the following:How should the phrase “standard charges” be defined in various provider and supplier settings?

Which information types would be most useful to beneficiaries, and how can providers and suppliers empower consumers to engage in price-conscious decision-making?

Should providers and suppliers have to tell patients how high their out-of-pocket costs are expected to be before providing a service?” (G)

“Patients are at a higher risk of receiving surprise medical bills on Affordable Care Act exchanges, according to a new report.

In 2018, more than 73% of plans available in the exchange marketplace offered restrictive networks, compared with 48% in 2014, according to the report (PDF) commissioned by Physicians for Fair Coverage. PFC is a nonprofit alliance of physician groups which advocates for ending surprise insurance gaps and improving patient protections…

“This research confirms what patients and physicians across the country have known for some time,” said PFC President and CEO Michele Kimball in a statement. “Insurers have been systematically narrowing their networks and increasing premiums, creating surprise insurance gaps that patients don’t realize exist until it’s too late. While insurers are making record profits, patients are paying more for less.”

The coalition, which includes tens of thousands of emergency physicians, anesthesiologists and radiologists from across the country, is pressing for more states to adopt legislation to solve the problem of surprise medical bills. The problem often occurs when a patient seeks care at an in-network hospital but is then surprised the doctor treating them is out of their insurance company’s network-a fact they usually find out when they get the doctor’s bill.

“When it comes to health care, nobody likes a surprise. This study confirms what we’ve been hearing from patients for years: there is no real way for patients to avoid a ‘surprise’ medical bill, even when they’re insured and try to stay in-network. We need a transparent healthcare system designed for patients, not profits,” Rebecca Kirch, executive vice president of healthcare quality and value at the National Patient Advocate Foundation, said in a statement…

The best estimates indicate that 1 out of 7 times someone goes to the emergency department, they are going to be stuck with a surprise bill.” (H)

A patient came to see me with lower abdominal pain. Was she interested in my medical opinion? Not really. She was told to see me by her gynecologist who had advised that the patient undergo a hysterectomy. Was this physician seeking my medical advice? Not really. Was this patient coming to see me as her day was boring and she needed an activity? Not really. After the visit with me, was the patient planning to return for further discussion of her medical status? Not really.

So, what was going on here. What had occurred that day was the result of an insurance company practice that I had thought had been properly interred years ago.

The woman had pelvic pain and consulted with her gynecologist. An ultrasound found a lesion within her uterus. A hysterectomy was advised. The insurance company directed that a second opinion be solicited. A second gynecologist concurred with the first specialist. The patient advised me that the insurance company wanted an opinion from a gastroenterologist that there was no gastrointestinal explanation for her pain. In other words, they did not want to pay for a hysterectomy that they deemed to be unnecessary.

How should we respond? (I)

“In the absence of laws barring balance bills and surprise bills, there are steps hospitals and health plans can take to protect consumers from medical debt. The Healthcare Financial Management Association urges hospitals to inform patients that they may be eligible for financial assistance provided directly by the hospital and make clear to patients what services are and are not included in their price estimates. Hospitals also need to communicate better with uninsured patients about medical costs and options for sharing costs..

Health plan best practices include helping members estimate expected out-of-pocket costs and sharing price information for providers in a given region.

Beyond that, hospitals need to double down to ensure they have contracts with as many in-network providers as possible. “It requires the physicians, hospitals, health plans all working together to make sure that everybody’s in-network or, if they’re not, the patient knows that clearly up front,” says Rick Gundling, HFMA’s senior vice president for healthcare financial practices. “It’s kind of a three-legged stool.”

Consumers also need to become savvier when it comes to costs of medical care. Most people do see providers in their network, says Gupta. However, “because of their high-deductible health plan, they often don’t recognize until they get hit with a bill that the same MRI might be $3,000 after the deductible at a local hospital that is convenient for them versus $1,000 a mile down the street at an imaging center,” he adds.” (J)

“Cooper works as a physician assistant and hears about medical billing problems all the time.

So when she initially found out she was pregnant, this health care provider did everything she could to make sure anyone associated with her pregnancy would be considered what’s referred to as “in-network.”

She contacted her insurance company, Aetna, and she also contacted Banner Gateway Hospital, the hospital where she planned to give birth. The hospital then sent her written confirmation that she had nothing to worry about.

“She said, ‘Send me a picture of your insurance card front and back and I’ll double check that you’re covered.’ And, she sent me back an hour later saying, ‘Yes, you are in network,'” Cooper said.

Cooper eventually delivered her little girl at Banner Gateway Hospital. But, not long after, Cooper started getting a number of large “out-of-network” medical bills.

“Aetna then sent me back something that said, ‘No you are out-of-network’ and that’s how everything started to trickle through,” she said.

“Out-of-network.” How could that happen? Remember, she got written confirmation from Banner Gateway Hospital indicating she was “in-network.”…

When she added them all up, her medical bills came to around $18,000, money she shouldn’t have been responsible for. Still, she says she wasn’t getting any resolution…

We asked them to review Cooper’s case and after they did, they acknowledged there was a mistake.

As a result, Aetna reprocessed all of Heather’s bills as “in-network.”..

That means Cooper will now only have to pay just $750 out of pocket, the cost of her deductible rather than $18,000. Cooper said she couldn’t be happier and says it all happened with the help of 3 On Your Side.” (K)

“On the first morning of Jang Yeo-im’s vacation to San Francisco in 2016, her eight-month-old son Park Jeong-whan fell off the bed in the family’s hotel room and hit his head.

There was no blood, but the baby was inconsolable. Jang and her husband worried he might have an injury they couldn’t see, so they called 911, and an ambulance took the family – tourists from South Korea – to Zuckerberg San Francisco General Hospital.

The doctors at the hospital quickly determined that baby Jeong-whan was fine – just a little bruising on his nose and forehead. He took a short nap in his mother’s arms, drank some infant formula, and was discharged a few hours later with a clean bill of health. The family continued their vacation, and the incident was quickly forgotten.

Two years later, the bill finally arrived at their home: They owed the hospital $18,836 for the 3 hour and 22 minute visit, the bulk of which was for a mysterious fee for $15,666 labeled “trauma activation,” which sometimes is known as “a trauma response fee.”

Update: After this story was published on June 28, Zuckerberg San Francisco General Hospital agreed to waive the $15,666 trauma response fee charged for Park Jeong-whan’s visit to the hospital. In a letter, the hospital’s patient experience manager said the hospital did a clinical review and offered “a sincere apology for any distress the family experienced over this bill.” Further, the hospital manager wrote that the case “offered us an opportunity to review our system and consider changes.” (L)

“The health insurer Anthem is coming under intense criticism for denying claims for emergency room visits it has deemed unwarranted…

The insurer initially rolled out the policy in three states, sending letters to its members warning them that, if their emergency room visits were for minor ailments, they might not be covered. Last year, Anthem denied more than 12,000 claims on the grounds that the visits were “avoidable,” according to data the insurer provided to Senator Claire McCaskill, a Democrat from Missouri, one of the affected states.

But when patients challenged their denials, Anthem reversed itself most of the time, according to data the company gave Ms. McCaskill. The report concludes that the high rate of reversals suggests that Anthem did not do a good initial job of identifying improper claims, meaning some patients who did not challenge their denials may have been stuck paying big bills they should not have been responsible for.” (M)

PART 2. Private Equity is a Driving Force Behind Devious Surprise Billings,

 “The expectant mother was in labor at South Shore Hospital when she requested a common pain medicine, which was administered by an anesthesiologist. Home with a newborn days later, she was surprised when a bill arrived from the doctor’s group for $2,143.44.

Another patient who went to Emerson Hospital’s emergency department for what turned out to be a broken rib also received a surprise bill: $300.91, for the services of the doctor who read the X-ray…

Patients should not have to “contact their health plan and complain,’’ said David Seltz, executive director of the Massachusetts Health Policy Commission, which monitors health care spending in the state. “Through no fault of their own they are being put in this situation.’’

An analysis by the policy commission found that 10,000 Massachusetts patients in just one year may have received surprise bills for so-called out-of-network care, and policy experts believe that figure underestimates the extent of the problem…

More than 35 percent of complaints filed with Healey were over out-of-network charges, which can be up to 200 percent higher than what insurers pay in-network doctors. Among the physicians that were outside the patients’ insurance networks were anesthesiologists assisting in colonoscopies and emergency medicine doctors repairing broken bones and treating heart attacks, something that frustrated patients told Healey’s office they had no way of knowing in advance. Radiologists and pathologists also directly billed patients out-of-network charges.

It’s not unusual for a hospital to have practitioners working in their facilities who are not covered by all their agreements with insurers, a technicality that is often not apparent to patients.” (A)

“ (Trump)” In my State of the Union address, I asked Congress to pass legislation to protect American patients.  For too long, surprise billings — which has been a tremendous problem in this country — has left some patients with thousands of dollars of unexpected and unjustified charges for services they did not know anything about and, sometimes, services they did not have any information on.  They weren’t told by the doctor.  They weren’t told by the hospitals in the areas they were going to.  And they get, what we call, a “surprise bill.”  Not a pleasant surprise; a very unpleasant surprise.

So this must end.  We’re going to hold insurance companies and hospitals totally accountable.” (B)

“But physician advocacy groups, including the American Medical Association (AMA) while applauding the effort to eliminate surprise bills, expressed some concern that a simplified approach to a complex problem could have unintended consequences for healthcare delivery…

“We agree with the president that patients should not be responsible for coverage gaps and for any costs beyond their in-network cost sharing when they do not have an opportunity to choose an in-network physician,” said Barbara L. McAneny, MD, AMA’s president in a statement. “We also agree that physicians and hospitals should be transparent about their costs, and payers should offer transparency about their networks, scope of coverage, and out-of-pocket costs. In addition, insurers should be held accountable for their contributions to the problem and ensure network adequacy, adherence to the prudent layperson standard for emergency care in current law, and reasonable cost-sharing requirements.”” (C)

“Reps. Frank Pallone (D-NJ) and Greg Walden (R-OR), the top Democrat and Republican on the House Energy and Commerce Committee, have jointly released a draft bill that would prevent patients from facing unexpected charges after they go to the emergency room or receive other non-emergency medical care…

The Pallone and Walden bill takes a multi-pronged approach to ending surprise medical bills:

Health insurers would be required to treat out-of-network emergency care as in network for their enrollee’s cost-sharing and out-of-pocket obligations. So patients wouldn’t have to pay any more for receiving emergency treatment at an out-of-network hospital than they would at an in-network one.

Balance billing — when a health care provider sends a patient a bill charging them whatever the difference is between the price set for a service by the provider and the price the health insurer is willing to pay — would be prohibited.

Insurers would have to make a minimum payment to out-of-network providers for their enrollee’s care, based on the price the insurer pays to nearby in-network providers… (D)

“These protections would apply to all out-of-network emergency services and to all out-of-network nonemergency services received at an in-network facility from “facility-based providers,” which the bill defines to include anesthesiologists, radiologists, pathologists, neonatologists, assistant surgeons, hospitalists, intensivists, and any additional provider types specified by the Secretary of Health and Human Services (HHS). Other provider types would still be allowed to treat patients on an out-of-network basis in nonemergency situations if they met the strong notice and consent requirements detailed in the discussion draft. Limiting notice and consent exceptions to physician specialties that patients typically actively choose strikes a sensible balance. It preserves patients’ ability to seek out-of-network care in circumstances where it is appropriate, while mitigating the risk that the flood of paperwork involved in seeking medical care will result in some patients consenting to out-of-network billing without understanding what they are consenting to or whether they have a reasonable alternative.” (E)

“A new draft bill released this morning sets up a so-called “baseball-style” arbitration process for providers and plans as an option to settle payment disputes, POLITICO’s Rachel Roubein writes. Today’s draft comes after Sens. Bill Cassidy (R-La.), Michael Bennet (D-Colo.) and four others spent eight months refining legislation first introduced in September. More for Pros.

— Today’s legislation prohibits balance billing in three instances, Rachel writes. (1) For emergency care, (2) during elective care at an in-network facility but when a service is performed by an out-of-network provider and (3) when a patient needs additional medical care after an emergency at an out-of-network facility but can’t travel elsewhere.

— The most contentious part of addressing surprise medical bills: the payment. Under the new bill, providers would automatically be paid the median in-network rate. But they can dispute that, initiating a so-called “baseball-style” arbitration process, where mediators will base decisions on “commercially reasonable rates” (the in-network rates for that area and not actual charges).” (F)

“The House of Representatives and the Senate have unveiled dueling legislation aimed at surprise billing, and the two are split on one key element: arbitration.

The House bill (PDF), which was introduced earlier this week by Reps. Frank Pallone, D-New Jersey and Greg Walden, R-Oregon, would require insurers to cover out-of-network emergency care at in-network rates and would ban balance billing.

Balance billing most often occurs in emergency departments or during elective surgery, when a patient goes to an in-network facility but is treated by an out-of-network clinician, typically an anesthesiologist or radiologist.

The Senate’s bill, however—which is backed by Sens. Bill Cassidy, R-Louisiana, and Maggie Hassan, D-New Hampshire—would include a “baseball-style” arbitration program to mitigate disputes, alongside similar elements to the House iteration.” (G)

“The administration said its top priority is to make sure patients no longer receive separate bills from out-of-network doctors, an approach known as a “bundled payment.”..

Vidor Friedman, president of the American College of Emergency Physicians, said a bundled payment puts too much pressure on hospitals to contract with physicians, essentially making hospitals take on the role of insurer.

“It would create another layer between the patient and providers of care,” Friedman said, noting that doctors would need to negotiate directly with hospitals for payment, rather than with insurance companies…

Instead, doctors and hospitals want an independent arbitrator to examine the amount the doctor is charging and what the insurer is agreeing to pay — and then determine which one is fairer…

But insurers are opposed to arbitration, and they’re pushing for Congress to set reimbursement rates.

In a letter to House and Senate leaders in March, America’s Health Insurance Plans urged lawmakers to “avoid the use of complex, costly and opaque arbitration processes that can keep consumers in the middle and lead to higher premiums.”

The White House also threw cold water on arbitration. During a briefing with reporters on Thursday, administration officials called arbitration an “unnecessary distraction.”..

 “Providers point fingers at payers, payers point fingers at providers, and the American people are left really getting the shaft,” a senior administration official said.

The White House and lawmakers have been warning all the players to solve the problem on their own. But now with pressure from the White House, Congress is likely to act.

“There will come a point in time when they want to move a solution forward,” AHA’s Smith said. “It’s unlikely you’ll come to a solution where every one of the stakeholders is happy.”” (H)

“One of the major drivers of surprise bills is the deliberate decision by health insurance plans to narrow the networks of providers available to their insureds—core network adequacy requirements should be an essential component of any solution,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in the letters to committee leaders. “Shrinking networks increase the likelihood that patients may receive care from an out-of-network provider, particularly in emergency situations.”

..Patients are shouldering more of the costs through larger deductibles and higher copays. The median out-of-network deductible for individual marketplace is $12,000 and almost a third of individual market plans have deductibles of more than $20,000 according to research by the Robert Wood Johnson Foundation cited in the letter.

“Limited networks of providers and unaffordable deductibles for care outside those networks can expose patients to high out-of-pocket costs,” Dr. Madara wrote.

..Often insurance companies will use tactics such as prior authorization or “fail-first” step therapy protocols to make patients pay out of pocket for medically necessary treatment they refuse to cover.

.. Despite federal mental health-parity requirements, patients can feel squeezed by their health plans when it comes to mental health and substance-use disorder treatments—and that leads to a greater reliance on out-of-network care…

..Some insurance companies have enacted policies of not paying for emergency care after it was determined that patients did not require it—even though the severity of their symptoms at the time made it prudent to go to the nearest emergency department.

..Insurance companies often change their drug formularies after patients are locked into their plan. This can lead to restricting access to treatment that has proven to work for them and has stabilized their condition. Patients may seek to pay out of pocket to continue their treatment rather than jump through their insurance company’s prior-authorization hoops.” (I)

“Surprise medical bills exist for a number of reasons, each of which are specifically rooted in problems inherent to a privatized, profit-driven health-care system. For one thing, there wouldn’t be out-of-network bills without networks themselves—a health insurance innovation put forward in the 1980s. Unlike more regulated health-care systems in peer nations, the American health-care system lacks a robust mechanism to control prices. This leaves each insurance plan to negotiate with providers on its own, and gives the latter more power to set prices.

Once health-care prices began to skyrocket in the 1970s, insurance companies began to try several cost-cutting measures that are now all too familiar to modern policyholders…The theory behind networks was simple enough: By contracting only with certain providers, insurers could deliver a higher volume of patients to each one and thereby gain more leverage over pricing negotiations. They could then translate the savings into lower premiums, attract more customers, and increase market share…

..and it’s the same problem underlying the proliferation of varied “insurance products” that cater to different types of patients. The degree of “choice” a given person has is overwhelmingly determined by their income and health status, which is a shamefully unjust way to allocate the costs of running a health-care system. The healthiest people are able to take their chances on a narrow network, while those with greater health-care needs are financially penalized for needing a wider breadth of providers. Meanwhile, the less money someone has available, the more they’re coerced into “choosing” a plan based on price rather than benefits…

Discussing and tackling the inequities—and potential for financial ruin—in our health-care financing system demands an acknowledgment that the sheer diversity of insurance plans in this country, each with their own pricing and benefit structures, is an inherently bad thing. When it comes to insurance policies, a multitude of consumer choices translates into genuine differences in the ability to access care. “Surprise out-of-network bills” are one highly visible example of how that hurts people. Others are never hard to find.” (J)

“While President Donald Trump prods Congress to limit surprise billing, at least three states are debating legislation to ban the practice…

Current state laws vary in scale and effectiveness. Federal legislation would be more effective, as it would protect the millions who receive self-funded coverage through their employer. But the political climate in Washington, where even historically bipartisan efforts move slowly at best, has left states to step in and do what they can…

The Colorado General Assembly passed a bill earlier this month that prohibits surprise billing and sets a reimbursement rate based on either commercial claims data or the insurers’ median in-network rate for the service. Gov. Jared Polis, a Democratic, is expected to sign the bill Tuesday, a spokesman told Healthcare Dive.

A surprise billing law is also on the governor’s desk In Washington. It calls for a “commercial reasonable amount” to be paid to out-of-network providers and establishes arbitration if the parties cannot agree on a rate through negotiation.

In Texas, a bill has passed the Senate and is currently making its way through the House. It requires an arbitration process for payments that do not include patient involvement. Previous legislation in the state required people receiving surprise bills to request remediation…

The Employee Retirement Income Security Act of 1974 limits the effectiveness of state surprise billing legislation because state laws can’t apply to employer self-funded plans, which cover the majority of Americans. Still, the laws can serve a few key purposes.

Several of the bills proposed in Congress defer to state laws on issues like rate setting or arbitration. So even if Washington passes a ban on surprise billing, states that want to set their own plans can count on using their own laws going forward…

“States have a lot of authority over providers … just making sure the providers have posted information and are being as informative as possible when consumers are coming into their facilities,” she said.” (K)

Arizona’s new law on surprise medical bills went into effect January 1. It sets up a procedure where patients can request dispute resolution through the state’s Department of Insurance. Unresolved disputes will enter arbitration. If an enrollee participates in an informal settlement teleconference (IST) beforehand, the law spells out what an enrollee’s liability: “By virtue of having participated in the IST, the enrollee can only be held responsible for paying the amount of the enrollee’s cost-sharing requirements (copay, coinsurance and deductible) plus any amount the health insurer paid the enrollee for the services provided by the out-of-network health care provider.” (L)

“Consumer complaints about surprise medical bills have fallen substantially in New York in the wake of a 2014 law that established a “baseball-style” arbitration protocol to address these situations, according to a new report.

Researchers at the Georgetown University Center on Health Insurance Reforms (CHIR) conducted a case study (PDF) on the state’s Emergency Services and Balance Billing Law and found that state officials report a “dramatic” decline in consumer reports about balance bills since the law took effect in 2015.

Based on an analysis of calls to the Consumer Service Society’s helpline for surprise billing, 57% of complaints were handled using the systems established under the law.

 “It’s downgraded the issue from one of the biggest [consumer complaints our call center receives] to barely an issue,” a state regulator told the CHIR researchers.

In addition to surveying state officials, the Georgetown researchers also interviewed physicians, insurers and patients, and they found that overall the participants view the arbitration process as fair. However, providers were more enthusiastic than insurers, according to the study.

As of October, the number of resolutions in favor of insurers and in favor of physicians is about even, according to the study—618 were decided in favor of payers and 561 in favor of providers. 

Insurers were more likely to win disputes over out-of-network emergency care billing, while providers were more likely to win in situations where a patient is treated by an out-of-network physician without his or her knowledge during an elective procedure.” (M)

“The American Hospital Association was among six national hospital groups that sent a letter to Congress on Wednesday to suggest parameters and ideas that legislators should keep in mind as they pursue a solution to surprise medical bills…

The letter to Congress, a copy of which was obtained by ROI-NJ, asks federal representatives to consider:

Defining what is considered a surprise bill;

Ensuring patients are protected and not balance billed;

Ensuring patients are not denied emergency coverage if a visit is considered non-emergent in retrospect;

Avoiding setting a fixed payment rate;

Ensuring patients are educated about their rights and coverage;

Supporting state laws (like those in New Jersey) that are protecting consumers.”  (N)

“Assemblyman Nick Chiaravalloti is planning to introduce legislation in May that would plug a loophole in the (New Jersey) out-of-network law that has been affecting patients transferred out of state…

Health care professionals would be required to document in the patient records and notify patients of

The patient’s right to receive care at a facility of choice;

Clinical rationale for the out-of-state transfer;

Location of the out-of-state facility;

Availability of clinically appropriate services at nearby New Jersey facilities;

The nature of the relationship if the patient is being transferred or referred to an affiliated facility; and

In instances of trauma, stroke or cardiovascular diagnoses, an explanation as to why the patient is not being transferred to a facility in New Jersey.

The bill also requires patients be provided information from their insurance providers as to their potential out-of-pocket costs for an out-of-state facility, and requires health facilities to disclose to patients their relationships with out-of-state providers the patients are being referred to.

This is particularly important with the recent merger activity in South Jersey with some hospitals tied to health systems in Pennsylvania…

 “To ensure that health care consumers are able to make well-informed health care decisions, patients should be informed of their right to select the facility in which they receive their care before being transferred to another state,” he said. “Patients should have all the information about why they are being transferred, and their financial responsibilities associated with the transfer — only then can a patient make an informed choice.” (O)

“One of the many wonderful advantages we have as residents of New Jersey is access to high quality, advanced health care. In fact, more than half of New Jersey’s 67 acute-care hospitals received an “A” rating in the Leapfrog Hospital Safety Report, the highest percentage of “A” ratings in any state across the nation. New Jersey is also home to tremendously skilled physicians and nurses, as well as 13 academic health systems training the next generation of health care professionals and researchers. Clearly, New Jersey residents have access to some of the nation’s greatest health care resources.

Despite these facts, a significant number of patients are referred or transferred to health care providers and hospitals located out of state. Some estimates indicate that New Jersey residents spend more than $2 billion annually on health care services out of state. Often these patients are paying considerably more for their out-of-state health care and receiving care that is equal to or less effective than they could have received at hospitals in New Jersey. With health care consumers paying a larger percentage of their health care costs through higher deductibles, copayments, and coinsurance, paying more for the same quality of care further from home makes little sense.

New Jersey residents should have the right to obtain health care wherever they believe it is best, but often patients do not have critical information necessary to make an informed decision. Moreover, many New Jersey residents do not understand the strong consumer protections they are forfeiting by seeking care outside of the state.” (P)

“Bob Ensor didn’t see the boom swinging violently toward him as he cleaned a sailboat in dry dock on a spring day two years ago. But he heard the crack as it hit him in the face.

He was transported by ambulance to an in-network hospital near his home in Middletown, N.J., where initial X-rays showed his nose was broken as were several bones of his left eye socket. The emergency physician summoned the on-call plastic surgeon, who admitted him to the hospital and scheduled him for surgery the next day.

Shortly before surgery, the doctor introduced Ensor to a second plastic surgeon who would assist in the 90-minute procedure. Entering through Ensor’s nose, the physicians realigned his facial bones, temporarily sewing Ensor’s left eye shut so that the lids would stay in place as the bones knitted back together.

Six weeks later, as Ensor, then 65, continued to make an uneventful recovery, a collection agency called to inquire how he and his wife planned to pay the $71,729 bill for the assistant surgeon. Ensor’s company health plan had denied payment because the surgeon wasn’t part of its contracted physician network.

There was more bad news. Ensor received notice that the health plan wouldn’t cover the $95,885 charged by the first plastic surgeon either because he also was out-of-network.

“The hospital knew these doctors were out-of-network and didn’t bother to tell us,” said his wife, Linda Ensor, noting they faced more than $167,000 in charges. “We were panicked.”

Riverview Medical Center in Red Bank, N.J., where Ensor was treated, said that it “empathizes with patients who are trying to navigate the complexity of the health care billing system” and that transparency in billing has not always been optimal for emergency department patients…

Many plastic surgeons don’t participate in health plans because they have flexibility other physicians may not have — their practices often focus on elective cosmetic procedures like nose reshaping and breast augmentation that patients pay for on their own…

Luckily for the Ensors, the sailing club stepped in to take up his case with the out-of-network plastic surgeons. Since sailing club members were required to volunteer on work projects to keep membership costs in check, the club’s insurer agreed to cover the accident as a workers’ compensation case. It paid 100% of the outstanding bill.” (Q)

“In an email to a complaining patient, the CEO of Spectrum Health acknowledged there needs to be more transparency regarding how patients are billed for doctor visits.

“We agree with you that a more transparent process is necessary,” Spectrum Health CEO Tina Freese Decker wrote (PDF) in response to a complaint. “I have shared your suggestion (for additional transparency) with our Spectrum Health Medical Group leadership so that we can apply this suggestion into our workflow.”..

The patient who sent the email to the CEO — and shared the response with Target 8 — had been charged $142 for a second appointment because she briefly discussed two minor issues with her doctor during her annual exam…

A month later, the patient received her bill. The annual wellness visit was covered by insurance, but there was a second charge for the same day that was not covered…

Additionally, a single mother from a small town in Kent County, who Target 8 is identifying only as Lindsey, previously reached out to Target 8 regarding a bill she got after a wellness visit with a physician at Spectrum medical building in Grand Rapids. While she waited for the appointment, Lindsey filled out the standard questionnaire, checking a box to indicate she had periodic leg cramps.

“(The doctor) looked at the form and she said, ‘Oh, I see you checked yes to leg cramps. Tell me more about it,’” Lindsey recalled.

Lindsey said the doctor showed her some stretches, told her to drink more water and checked her magnesium and iron levels in addition to the routine blood tests that were already scheduled for her annual physical.

“I get the bill… and I was charged for two office visits,” Lindsey said in an interview with Target 8 Thursday. “I called the doctor’s office right away and I said, ‘This can’t be right. Is this a mistake?’”

But it wasn’t a mistake…

If you’re going in for preventive services, know that there is a scope of services that’s considered preventive with zero cost, but if you go in and have a complaint or a scenario diagnosed, then it changes… to another category of care,” ”.. (R)

“Yale researchers Zack Cooper and Fiona Scott Morton looked at emergency department visits that occurred at hospitals that were in insurers’ networks, in a paper for the New England Journal of Medicine. “On average,” they found, “in-network emergency-physician claims were paid at 297% of Medicare rates,” while “out-of-network emergency physicians [within in-network hospitals] charged an average of 798% of Medicare rates.”

A study from UnitedHealthGroup, looking at its own claims nationwide, recently estimated that out-of-network emergency physicians increased health care charges by $6 billion per year.” (S)

What’s behind this explosion of outrageous charges and surprise medical bills? Physicians’ groups, it turns out, can opt out of a contract with insurers even if the hospital has such a contract. The doctors are then free to charge patients, who desperately need care, however much they want.

This has made physicians’ practices in specialties such as emergency care, neonatal intensive care and anesthesiology attractive takeover targets for private equity firms…

A 2018 study by Yale health economists looked at what happened when the two largest emergency room outsourcing companies — EmCare and TeamHealth — took over hospital ERs. They found:

“…that after EmCare took over the management of emergency services at hospitals with previously low out-of-network rates, they raised out-of-network rates by over 81 percentage points. In addition, the firm raised its charges by 96 percent relative to the charges billed by the physician groups they succeeded.”

TeamHealth used the threat of sending high out-of-network bills to the insurance company’s covered patients to gain high fees as in-network doctors. The researchers found:

“…in most instances, several months after going out-of-network, TeamHealth physicians rejoined the network and received in-network payment rates that were 68 percent higher than previous in-network rates.”

What the Yale study failed to note, however, is that EmCare has been in and out of PE hands since 2005 and is currently owned by KKR. Blackstone is the once and current owner of TeamHealth, having held it from 2005 to 2009 before buying it again in 2016.

Private equity has shaped how these companies do business. In the health-care settings where they operate, market forces do not constrain the raw pursuit of profit. People desperate for care are in no position to reject over-priced medical services or shop for in-network doctors.

Private equity firms are attracted by this opportunity to reap above-market returns for themselves and their investors.

Patients hate surprise medical bills, but they are very profitable for the private equity owners of companies like EmCare (now called Envision) and TeamHealth. Fixing this problem may be more difficult than the White House imagines. (T)

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PART 2. May 13, 2019. CANDIDA AURIS. “In 30 years, I’ve never faced so tough a reporting challenge — and one so unexpected. Who wouldn’t want to talk about a fungus?…

New PART 2 after PART 1.

PART 1. April16, 2019. Assignment: it ethical for the public not be notified about new “super bugs” in hospitals so they can decide whether or not to go to affected hospitals?

“Last May, an elderly man was admitted to the Brooklyn branch of Mount Sinai Hospital for abdominal surgery. A blood test revealed that he was infected with a newly discovered germ as deadly as it was mysterious. Doctors swiftly isolated him in the intensive care unit.

The germ, a fungus called Candida auris, preys on people with weakened immune systems, and it is quietly spreading across the globe. Over the last five years, it has hit a neonatal unit in Venezuela, swept through a hospital in Spain, forced a prestigious British medical center to shut down its intensive care unit, and taken root in India, Pakistan and South Africa.

Recently C. auris reached New York, New Jersey and Illinois, leading the federal Centers for Disease Control and Prevention to add it to a list of germs deemed “urgent threats.”

The man at Mount Sinai died after 90 days in the hospital, but C. auris did not. Tests showed it was everywhere in his room, so invasive that the hospital needed special cleaning equipment and had to rip out some of the ceiling and floor tiles to eradicate it.

“Everything was positive – the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump,” said Dr. Scott Lorin, the hospital’s president. “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.”” (A)

“Back in 2009, a 70-year-old Japanese woman’s ear infection puzzled doctors. It turned out to be the first in a series of hard-to-contain infections around the globe, and the beginning of an ongoing scientific and medical mystery.

The fungus that infected the Japanese woman, Candida auris, kills more than 1 in 3 people who get an infection that spreads to their blood or organs. It hits people who have weakened immune systems, and is most often found in places like care homes and hospitals. Once it shows up, it’s hard to get rid of: unlike most species of fungi, Candida auris spreads from person to person and can live outside the body for long periods of time.

Mount Sinai wasn’t the first hospital to face this task: a London hospital found itself with an outbreak in 2016, and the only way to stop it was to rip out fixtures…

Scientists still aren’t sure exactly where this happened or when. That’s one of the things they’re working on now, says Cuomo, because figuring out how the fungus evolved could help researchers develop treatments for it…

Although the “superbug” moniker might sound alarmist, Candida auris qualifies for two reasons, says Cuomo. First, all strains of the yeast are resistant to antifungals. There are three major kinds of antifungals used to treat humans, and some strains of Candida auris are resistant to all of them, while other strains are resistant to one or two. That limits the treatment options for someone who has been infected-someone who is probably already in poor health. The other reason is “this really scary property of not being able to get rid of it,” Cuomo says.” (B)

“Superbugs are a terrifying prospect because of their resistance to treatment, and one superbug that is sweeping all over the world is the Candida auris.

C. auris is a fungus that causes serious infections in various parts of the body, including the bloodstream and the ear.

While its discovery has been relatively recent in 2009, this fungus has already wreaked havoc in hospitals in more than 20 different countries, including the United States, United Kingdom, and Spain, among others.

In the United States, CDC reports a total of 587 clinical cases of C. auris infections as of February. Most of it occurred in the areas of New York City, New Jersey, and Chicago.” (C)

“The CDC issued a public alert in January about a drug-resistant bacteria that a dozen Americans contracted after undergoing elective surgeries at Grand View Hospital in Tijuana, Mexico. Yet when similar outbreaks occur at U.S. hospitals, the agency does not issue a public warning. This is due to an agreement with states that prohibits the CDC from publicly disclosing hospitals undergoing outbreaks of drug-resistant infections, according to NYT.

Patient advocates are pushing for more transparency into hospital-based infection outbreaks, saying the lack of warning could put patients at risk of harm.

“They might not get up and go to another hospital, but patients and their families have the right to know when they are at a hospital where an outbreak is occurring,” Lisa McGiffert, an advocate with the Patient Safety Action Network, told NYT. “That said, if you’re going to have hip replacement surgery, you may choose to go elsewhere.”..

The CDC declined NYT’s request for comment. Agency officials have previously told the publication the confidentiality surrounding outbreaks is necessary to encourage hospitals to report the drug-resistant infections.” (D)

“New Jersey is among the states worst affected by an increasing incidence of the potentially deadly fungus Candida auris, whose resistance to drugs is causing headaches for hospitals, state and federal health officials said on Monday.

There were 104 confirmed and 22 probable cases of people infected by the fungus in New Jersey by the end of February, according to the federal Centers for Disease Control and Prevention, up sharply from a handful when the fungus was first identified in the state about two years ago.

The state’s number of cases – now the third-highest after New York and Illinois – has risen in tandem with an increase, first overseas, and now in the United States, in a trend that some doctors attribute to the overuse of drugs to treat infections, prompting the mutation of infection sources, in this case, a fungus.

The fungus mostly affects people who have existing illnesses, and may already be hospitalized with compromised immune systems, health officials said.

Nicole Kirgan, a spokeswoman for the New Jersey Department of Health, said she didn’t know whether any of the state’s cases have been fatal, and couldn’t say which hospitals are treating people with the fungus because they have not, so far, been required to report their cases to state officials…

But Dr. Ted Louie, an infectious disease specialist at Robert Wood Johnson University Hospital in New Brunswick, said many hospitals don’t know how to eradicate the fungus once it has occurred.

Some disinfectants commonly used in hospitals have proved ineffective in removing the fungus, Dr. Louie said, so hospitals have been urged to use other disinfecting agents, although it’s not yet clear which of them work, if any.

“This is a fairly new occurrence and we are still learning how to deal with it,” he said. “We have to figure out which disinfectant procedures may be best to try to eradicate the infection, so at this point, I don’t think we have good enough information to advise.” (E)

“Adding to the difficulty of treating candida auris is finding it in the first place. The infection is often asymptomatic, showing few to no immediate symptoms, said Chauhan. The symptoms that do appear, such as fever, are often confused for bacterial infections, he said.

“Most routine diagnostic tests don’t work very well for candida auris,” he said. “They’re often misidenfitied as other species.”

The best way to identify candida auris is by looking under a microscope, which often takes time because it requires doctors to grow the fungus, Chauhan said.

As with most infectious diseases, the best course of action is good hygiene and sterilization protocol. Washing your hands and using hand sanitizer after helps to prevent transmission and infection, Chauhan said.

Doctors and healthcare workers should use protective gear, and people visiting loved ones in hospitals and long-term care centers should take proper precautions, he said.

The Center for Disease Control recommends using a special disinfectant that is used to treat clostridium difficile spores. The disinfectant has been effective in wiping out clostridium difficile, known as c. diff, and disinfects surfaces contaminated with candida auris, as well.” (F)

“Hospitals and nursing homes in California and Illinois are testing a surprisingly simple strategy against the dangerous, antibiotic-resistant superbugs that kill thousands of people each year: washing patients with a special soap.

The efforts – funded with roughly $8 million from the federal government’s Centers for Disease Control and Prevention – are taking place at 50 facilities in those two states.

This novel approach recognizes that superbugs don’t remain isolated in one hospital or nursing home but move quickly through a community, said Dr. John Jernigan, who directs the CDC’s office on health care-acquired infection research.

“No health care facility is an island,” Jernigan said. “We all are in this complicated network.”

At least 2 million people in the U.S. become infected with an antibiotic-resistant bacterium each year, and about 23,000 die from those infections, according to the CDC…

Containing the dangerous bacteria has been a challenge for hospitals and nursing homes. As part of the CDC effort, doctors and health care workers in Chicago and Southern California are using the antimicrobial soap chlorhexidine, which has been shown to reduce infections when patients bathe with it. Though chlorhexidine is frequently used for bathing in hospital intensive care units and as a mouthwash for dental infections, it is used less commonly for bathing in nursing homes…

The infection-control work was new to many nursing homes, which don’t have the same resources as hospitals, Lin said.

In fact, three-quarters of nursing homes in the U.S. received citations for infection-control problems over a four-year period, according to a Kaiser Health News analysis, and the facilities with repeat citations almost never were fined. Nursing home residents often are sent back to hospitals because of infections.”  (G)

“The C.D.C. declined to comment, but in the past officials have said their approach to confidentiality is necessary to encourage the cooperation of hospitals and nursing homes, which might otherwise seek to conceal infectious outbreaks.

Those pushing for increased transparency say they are up against powerful medical institutions eager to protect their reputations, as well as state health officials who also shield hospitals from public scrutiny…

Hospital administrators and public health officials say the emphasis on greater transparency is misguided. Dr. Tina Tan, the top epidemiologist at the New Jersey Department of Health, said that alerting the public about hospitals where cases of Candida auris have been reported would not be useful because most people were at low risk for exposure and public disclosure could scare people away from seeking medical care.

“That could pose greater health risks than that of the organism itself,” she said.

Nancy Foster, the vice president for quality and patient safety at the American Hospital Association, agreed, saying that publicly identifying health care facilities as the source of an infectious outbreak was an imperfect science.

“That’s a lot of information to throw at people,” she said, “and many hospitals are big places so if an outbreak occurs in a small unit, a patient coming to an ambulatory surgical center might not be at risk.”

Still, hospitals and local health officials sometimes hide outbreaks even when disclosure could save lives. Between 2012 and 2014, more than three dozen people at a Seattle hospital were infected with a drug-resistant organism they got from a contaminated medical scope. Eighteen of them died, but the hospital, Virginia Mason Medical Center, did not disclose the outbreak, saying at the time that it did not see the need to do so.”  (H)

“Many have heard of the rise of drug-resistant infections. But few know about an issue that’s making this threat even scarier in the United States: the shortage of specialists capable of diagnosing and treating those infections. Infectious diseases is one of just two medicine subspecialties that routinely do not fill all of their training spots every year in the National Resident Matching Program (the other is nephrology). Between 2009 and 2017, the number of programs filling all of their adult-infectious-disease training positions dropped by more than 40 percent…

Everyone who works in health care agrees that we need more infectious-disease doctors, yet very few actually want the job. What’s going on?

The problem is that infectious-disease specialists care for some of the most complicated patients in the health care system, yet they are among the lowest paid. It is one of the only specialties in medicine that sometimes pays worse than being a general practitioner. At many medical centers, a board-certified internist accepts a pay cut of 30 percent to 40 percent to become an infectious-disease specialist.

This has to do with the way our insurance system reimburses doctors. Medicare assigns relative value units to the thousands of services that doctors provide, and these units largely determine how much physicians are paid. The formula prioritizes invasive procedures over intellectual expertise.

The problem is that infectious-disease doctors don’t really do procedures. It is a cognitive specialty, providing expert consultation, and insurance doesn’t pay much for that…

Infectious-disease specialists are often the only health care providers in a hospital – or an entire town – who know when to use all of the new antibiotics (and when to withhold them). These experts serve as an indispensable cog in the health care machine, but if trends continue, we won’t have enough of them to go around. The terrifying part is that most patients won’t even know about the deficit. Your doctor won’t ask a specialist for help because in some parts of the country, the service simply won’t be available. She’ll just have to wing it…

We must hurry. Superbugs are coming for us. We need experts who know how to treat them.” (I)

People visiting patients at the hospital, and most hospitalized patients, have little to fear from a novel fungal disease that has struck more than 150 people in Illinois – all in the Chicago area – a Memorial Medical Center official said Friday.

“For normal, healthy people, this is not a concern,” Gina Carnduff, Memorial Health System director of infection prevention, said in reference to Candida auris infections.

Carnduff, who is based at Memorial Medical Center, said only the “sickest of the sick” patients are at risk of catching or spreading the C. auris infection or dying from it.

Those patients, she said, include people who have stayed for long periods at health care facilities – such as skilled-care nursing homes or long-term acute-care hospitals – and who are on ventilators or have central venous catheter lines or feeding tubes…

Officials from both Memorial Medical Center and HSHS St. John’s Hospital said their institutions already are using the bleach-based cleaning solutions known to prevent the spread of C. auris and other infections.

The Illinois Department of Public Health’s website says more than one in every three people with “invasive C. auris infection” affecting the blood, heart or brain will die…

The state health department says 154 confirmed cases of C. auris and four probable cases have been identified, all in the Chicago area. Ninety-five cases were in Chicago, 56 were in Cook County outside of Chicago, and seven were spread among the counties of DuPage, Lake and Will.

Eighty-five of the 158 people making up the confirmed and probable cases have died, but only one death was “directly attributed” to the infection, Arnold said. It’s not known whether C. auris played a role in the deaths of the other 84 people, she said. (J)

“There is also the fact that some lab tests will not identify the superbug as the source of an illness, which means that some patients will receive the wrong treatment, increasing the duration of the infection and the chance to transmit the fungus to another person.” (K)

“Hospitals, state health departments and the Centers for Disease Control and Prevention are putting up a wall of silence to keep the public from knowing which hospitals harbor Candida auris.

New York health officials publish a yearly report on infection rates in each hospital. They disclose rates for infections like MRSA and C. Diff. But for several years, the same officials have been mum about the far deadlier Candida auris. That’s like posting “Wanted” pictures for pickpockets but not serial murderers.

Health officials say they’ll disclose the information in their next yearly report. That could be many months from now. Too late. Patients need information in real time about where the risks are…

Dr. Eleanor Adams, a state Health Department researcher, examined all the facilities in New York City affected by Candida auris over a four-year period. Adams found serious flaws, including “inadequate disinfection of shared equipment” to take vital signs, hasty cleaning and careless compliance with rules to keep infected patients isolated…” (L)

“Remedies for curtailing the advance of C. auris are familiar. Health care facilities must undergo stringent infection controls, test for new cases and quickly identify any sources passing it along. Visitors and medical workers must wash their hands after touching patients or surfaces. The yeast spreads widely throughout patients’ rooms. Some cleanups have reportedly required removing ceiling and floor tiles.

C. auris isn’t simply an opportunistic infection. Its rise is additional evidence that becoming too reliant on certain types of drugs may have unintended consequences. Exhibit A is the overuse of antibiotics in doctors’ offices and on farms that encourages the development of drug-resistant bacteria. Researchers suspect a similar situation involving C. auris and agricultural fungicides used on crops. So far the origins of C. auris are unclear, with different clusters arising in different areas of the world.

There’s no need to panic. But vigilance is required to track C. auris and raise awareness in order to combat it. Officials typically are eager to spread the word about potential health crises, from measles to MRSA. In this case, the CDC issued alerts about fungus to health care facilities, but the New York Times encountered an unusual wall of silence while investigating superbugs such as C. auris. Medical facilities didn’t want to scare off patients.

Any attempts to hide the spread of a communicable disease are irresponsible. Knowledge leads to faster prevention and treatment. Patients and their families have a right to know how hospitals and government agencies are responding to a new threat. Medical workers also deserve to be informed of the risks they encounter on the job.

Battling the superbugs requires aggressive responses and, ultimately, scientific advancements. Downplaying outbreaks won’t stop their rise.” (M)

“The rise of C. auris, which may have lurked unnoticed for millennia, owes entirely to human intervention – the massive use of fungicides in agriculture and on farm animals which winnowed away more vulnerable species, giving the last bug standing a free run. Sensitised to clinical fungicides, C. auris has proved to be difficult to extirpate, and culls infected humans who cannot fight diseases very effectively – infants, the old, diabetics, people with immune suppression, either because of diseases like HIV or the use of steroids. The new superfungus has the makings of a future plague, one of several which may cumulatively surpass cancer as a leading killer in a few decades.

The origin of C. auris is known because it broke out in the 21st century, but the plagues from antiquity lack origin stories. Even their spread was understood only retrospectively, in the light of modern science. The father of all plagues, the Black Death, originated in China in the early 14th century and ravaged most of the local population before it began its long journey westwards down the Silk Route, via Samarkand. At the time, the chain of hosts that carried it would have been incomprehensible – the afflicting organism Yersinia pestis, the fleas which it infested, the rats which the fleas in turn infested, which carried it into the homes of humans….” (N)

“WebMD: Most of us know candida from common yeast infections that you might get on your skin or mucous membranes. What makes this one different?

Chiller: It’s not acting like your typical candida. We’re used to seeing those.

Candida – the regular ones – are already a major cause of bloodstream infection in hospitalized patients. When we get invasive infections, for example, bloodstream infections, we think that you sort of auto-infect yourself. You come in with the candida already living in your gut. You’re in the ICU, you’re on a broad spectrum antibiotic. You’re killing off bad bacteria, you’re killing off good bacteria, so what are you left with? Yeast, and it takes over.

What’s new with Candida auris is that it doesn’t act like the typical candida that comes from our gut. This seems to be more of a skin organism. It’s very happy on the skin and on surfaces.

It can survive on surfaces for long periods of time, weeks to months. We know of patients that are colonized [meaning the Candida auris lives on their skin without making them sick] for over a year now.

It is spreading in health care settings, more like bacteria would, so it’s yeast that’s acting like bacteria” (O).

PART 2. In 30 years, I’ve never faced so tough a reporting challenge — and one so unexpected. Who wouldn’t want to talk about a fungus?…

“C. auris is a drug-resistant fungus that has emerged mysteriously around the world, and it is understood to be a clear and present danger. But Connecticut state officials wouldn’t tell us the name of the hospital where they had had a C. auris patient, let alone connect us with her family. Neither would officials in Texas, where the woman was transferred and died. A spokeswoman for the City of Chicago, where C. auris has become rampant in long-term health care facilities, promised to find a family and then stopped returning my calls without explanation.” (A)

“Candida auris, also referred to as C. auris, is a potentially deadly fungal infection that appears to be making its way through hospitals and long-term care facilities across the country. The New York City area and New Jersey have reported more than 400 cases over the last few years alone. Federal health authorities have declared this fungus a “serious global health threat.”” (B)

“The Council of State and Territorial Epidemiologists (CSTE) says Candida auris infections have been “associated with up to 40% in-hospital mortality.”

“Most strains of C. auris are resistant to at least one antifungal drug, one-third are resistant to two antifungal drug classes, and some strains are resistant to all three major classes of antifungal drugs. C. auris can spread readily between patients in healthcare facilities. It has caused numerous healthcare-associated outbreaks that have been difficult to control,” the CSTE said.

The CDC added, “Patients who have been hospitalized in a healthcare facility a long time, have a central venous catheter, or other lines or tubes entering their body, or have previously received antibiotics or antifungal medications, appear to be at highest risk of infection with this yeast.”

The CDC is alerting U.S. healthcare facilities to be on the lookout for C. auris in their patients.” (C)

“”It’s a very serious health threat,” said Dr. Irwin Redlener, Columbia University professor and an expert on public health policy. “It’s a superbug, meaning resistant to all-known antibiotics.”..

“These people would be in danger, so you don’t want somebody visiting the hospital not knowing that it’s around and somehow contracting the infection,” Dr. Redlener said. “That would be an utter disaster.”..

Dr. Redlener says the secrecy is a big mistake.

“If they’re rattled by Candida auris to the point where we have secrecy pacts among hospitals and public health agencies, then you’re just hiding something that obviously needs more attention and resources to deal with,” he said.

The state Department of Health says there is no risk to the general public and notes that the vast majority of patients have had serious underlying medical conditions.

Jill Montag, a spokesperson for the New York State Department of Health, issued a statement to Eyewitness News.

“We are working aggressively with impacted hospitals and nursing homes to implement infection control strategies for Candida auris,” it read.

Montag says they plan to include the name of the impacted facilities in their annual infection report, which will be released later this year.

Dr. Redlener says they have the information now and should release the names now…

“To keep that a secret is putting people in danger,” he said. “And I don’t think that’s reasonable or ethical.”” (D)

 “We don’t know why it emerged,” said Dr. Maurizio Del Poeta, a professor of molecular genetics and microbiology at Stony Brook University’s Renaissance School of Medicine. At the very least, he is recommending hospitals develop stricter rules on foot traffic in and out of patients’ rooms because the microbe can be carried on the bottom of shoes.

The pathogen clings to surfaces in hospital rooms, flourishes on floors, and adheres to patients’ skin, phones and food trays. It is odorless, invisible — and unlikely to vanish from health care institutions anytime soon.

“It can survive on a hospital floor for up to four weeks,” Del Poeta said of C. auris. “It attaches to plastic objects and doorknobs.”..…

 “If we don’t want it to become like Staphylococcus aureus, then we have to act now,” said Del Poeta, referring to the bacteria that became the poster child of drug resistance when it developed the ability to defeat the antibiotic methicillin, garnering the name methicillin-resistant Staphylococcus aureus, or MRSA…

 “In order to get Candida auris out of a room, you have to take away everything — doorknobs, plastic items, everything. It is very difficult to eradicate it in a hospital,” Del Poeta said. He said his institution has never had a patient with C. auris…

Scientists such as Del Poeta contend it’s time for new methods of addressing resistant microbes of all kinds because infectious pathogens have developed the power to outwit, outpace and outmaneuver humankind’s most potent agents of chemical warfare, many of them developed in the 20th century.” (E)

“A case management program piloted by the New York City health department monitors patients colonized with Candida auris after they are discharged into the community and notifies health care facilities of their status, researchers reported at the CDC’s annual Epidemic Intelligence Service conference….

Patients can remain colonized with C. auris for months in a health care setting, but it is unclear if they remain colonized after discharge, noted Genevieve Bergeron, MD, MPH, an Epidemic Intelligence Service officer with the New York City Department of Health and Mental Hygiene (DOHMH), and colleagues.

According to Bergeron and colleagues, the state health department began referring patients colonized with C. auris to the DOHMH on Oct. 4, 2017. Approximately 12 case managers handled the referrals, conducting patient interviews and reviewing medical records to obtain relevant clinical information. They informed the patients’ providers and health care facilities about their C. auris status and infection control needs.

“We requested that facilities flag the patient in their electronic medical records to ensure that the patient has the proper precautions, if the patient were to seek care again at those facilities,” Bergeron said in a presentation. “Case mangers sent a medical alert card to the patients for them to use when encountering health care providers unaware of their infection control needs.”” (F)

“Regions are considering the use of electronic registries to track patients that carry antibiotic-resistant bacteria including carbapenem-resistant Enterobacteriaceae (CRE). Implementing such a registry can be challenging and requires time, effort, and resources; therefore, there is a need to better understand the potential impact…

When all Illinois facilities participated (n=402), the registry reduced the number of new carriers by 11.7% and CRE prevalence by 7.6% over a 3-year period. When 75% of the largest Illinois facilities participated (n=304), registry use resulted in a 11.6% relative reduction in new carriers (16.9% and 1.2% in participating and non-participating facilities, respectively) and 5.0% relative reduction in prevalence. When 50% participated (n=201), there were 10.7% and 5.6% relative reductions in incident carriers and prevalence, respectively. When 25% participated (n=101), there was a 9.1% relative reduction in incident carriers (20.4% and 1.6% in participating and non-participating facilities, respectively) and 2.8% relative reduction in prevalence.

Implementing an XDRO registry reduced CRE spread, even when only 25% of the largest Illinois facilities participated due to patient sharing. Non-participating facilities garnered benefits, with reductions in new carriers.” (G)

“Quebec public-health authorities are bracing for the inevitable arrival of a multi drug-resistant fungus that has been spreading around the globe and causing infections, some of them fatal…

 “We will definitely have cases here and there at one point,” said Dr. Karl Weiss, chief of infectious diseases at the Jewish General Hospital. “It’s almost guaranteed. The only thing is when you know what you’re fighting against, it’s always easier and we will be able to contain it a lot faster.”

C. auris poses a quadruple threat: it’s tricky to identify; it can thrive in hospitals for weeks (preying on patients with weakened immune systems); it’s resistant to two classes of anti-fungal medications; and it can cause invasive disease, with lingering bloodstream infections that are hard to treat. The mortality rate can rise as high as 60 per cent.

The pathogen has emerged at a time when hospitals in Quebec — their budgets stretched more than ever — are already struggling with antibiotic-resistant superbugs like C. difficile, MRSA and VRE that have caused outbreaks. The Institut national de santé publique du Québec published a bulletin last year on steps that hospitals and long-term centres can take to prevent C. auris outbreaks.

“The problem is if you don’t identify the fungus properly, then it can slip in between your hands, and you can have an outbreak in your institution without even knowing it,” Weiss explained.

There was a lot of mis-indentification of this with other Candida (fungi); and even the automated systems in institutions that identify bacteria and yeast were mislabelling this Candida for something else. For a while, people were not aware of this auris. But now we know how to identify it.

“The first thing we did in Quebec — and this was for all the microbiology labs — is we taught all the microbiologists how to properly identify Candida auris,” Weiss continued.  “All the major labs in Quebec put in place protocols.”

Weiss, who is president of the Quebec Association of Medical Microbiologists, noted that under a quality assurance program, samples have been sent to different labs to test whether the fungus is identified correctly. The results show that that labs are detecting C. auris to a high degree.

If a patient is discovered to be infected, hospital protocol dictates that the patient be isolated. During the patient’s hospitalization, the housekeeping staff must disinfect the room daily with hydrogen peroxide and other chemicals…”  (H)

“Federal officials should declare an emergency over a deadly, incurable fungus infecting people in New York, New Jersey and across the country, Sen. Chuck Schumer said Sunday.

Schumer said he’s pushing the federal government to allocate millions of dollars to fighting Candida auris, which is drug-resistant and proving very difficult to eradicate…

“When it comes to the superbug, New York could use a little more help,” said Schumer. “The CDC has the power to declare this an emergency and automatically give us the resources we need.”..

Schumer said that an emergency declaration by the CDC would lead to more cases being identified with better testing, and to better tracking of the disease. It might also reduce the number of unnecessary antibiotic prescriptions, which Schumer says have helped the disease become drug-resistant…

Schumer cited other CDC emergency declarations that helped stop the spread of deadly diseases, including a $25 million award to fight the Zika virus in 2016 and $165 million given to contain Ebola in 2014.

“Every dollar we can use to better identify, tackle and treat this deadly fungus is a dollar well spent,” Schumer said.” (I)

“Other medical experts see the overuse of human antifungal medications in agriculture and floriculture as potential reasons for resistance in Candida auris, known as C. auris, and possibly other fungi.

Dr. Matt McCarthy, a specialist in infectious diseases at Weill Cornell Medicine in Manhattan, said tulips, signature flowers of the Netherlands, are dosed with the same antifungal medications developed to treat human infections.

“Antifungals are pumped into tulips in Amsterdam to achieve flawless plants,” he said. “As a fungal expert, I know that we have very few antifungal medications, and this is a misuse of the drugs.”

Studies conducted at Trinity College in Ireland support McCarthy’s argument and have demonstrated that tulip and narcissus bulbs from the Netherlands may be vehicles that spread drug-resistant fungi.

Trinity scientists, who examined resistance in another potentially deadly fungus, Aspergillus fumigatus, uncovered why the bugs repelled the drugs known as triazoles. The fungi became resistant because of the overuse of triazoles in floriculture. As with C. auris, drug-resistant A. fumigatus can be deadly in people with poor immunity.

When patients need treatment with triazole-class medications, the drugs don’t work because the fungi have been overexposed in the environment, McCarthy said.

He added that the use of antifungal medications in floriculture is similar to the overuse of antibiotics in the poultry and beef industries, which have helped drive resistance to those drugs.

The floriculture example is just one way that drug-resistant fungi can spread around the world. Global trade networks, human travel and the movement of animals and crops are others.”  (J)

“It will take further research to determine if the new strains of C. auris have their origins in agriculture, but Aspergillus has already illustrated the perils of modern farming. Antibiotics are applied on a massive scale in food production, pushing the rise of bacterial drug resistance. A British government study published in 2016 estimated that, within 30 years, drug-resistant infections will be a bigger killer than cancer, with some 10 million people dying from infections every year.

We don’t have to end up there. Pesticide use on most farms can be greatly reduced, or even eliminated, without reducing crop yields or profitability. Methods of organic farming, even as simple as crop rotation, tend to promote the growth of mutualistic fungi that crowd out pathogenic strains such as C. auris. Unfortunately, because conventional agriculture is heavily subsidized and market prices don’t reflect the costs to the environment or human health, organic food is more expensive and faces an uphill battle for greater consumption.

Of course, improved technology could help, with drugs of new kinds or in breeding and engineering resistant strains of plants. There’s also plenty of opportunity for lightweight agricultural robots, which can weed mechanically or spray pesticides more accurately, reducing the quantity of chemicals used. But tech shouldn’t be the sole focus just because it happens to be the most profitable route for big industries.” (K)

“The recent outbreak of the so-called superbug — and other drug-resistant germs — has thrown a spotlight on locally based Xenex Disinfection Systems. The company makes a robot that uses pulsing, ultraviolet rays to disinfect surgical suites and other environments that are supposed to be germ-free.

With the spread of C. auris, Xenex officials say they’ve seen an uptick in queries about their LightStrike Germ-Zapping Robots, which are in use at more than 400 health-care facilities around the world since manufacturing started in 2011.

These devices — often called R2Clean2, Mr. Clean and The Germinator — disinfect rooms in a matter of minutes. A dome on the top of the robot rises up, exposing a xenon bulb that emits UV light waves that kill germs on contaminated surfaces.

Bexar County-owned University Hospital has a fleet of six Xenex robots. One of the robots is assigned to the Cystic Fibrosis Center to help protect patients from infection by other patients.

“We are taking every measure possible to reduce the risk of infections, and this is an additional layer of security that bathes the room in UV-C light,” said Elizabeth Allen, public relations manager at University Health System…

Another study, recently published by a doctor at the Minnesota-based Mayo Clinic, showed that when the hospital used the robots in rooms that had already been cleaned, infection rates of another superbug — called Clostridium difficile, or C. diff — fell by 47 percent.” (L)

“It wasn’t publicized locally, but within the past few years teams of health officials at two Oklahoma health facilities took rapid actions to contain the spread of a fungal “superbug” that federal officials have declared a serious global health threat.

Only one patient at each facility was infected, and both patients recovered. But the incidents reflect the growing alarm among health officials over the deadly, multidrug-resistant Candida auris, or C. auris, which can kill 30 percent to 60 percent of those infected…

In April 2017, a team of experts from the federal Centers for Disease Control and Prevention converged on the University of Oklahoma Medical Center in Oklahoma City after a patient tested positive for the drug-resistant fungus.

About a year later, a patient at a southeast Oklahoma health facility tested positive for the germ during a routine test. In both cases, health officials isolated the patients, locked down their rooms and ordered dozens of lab tests to see if the multidrug-resistant fungus had spread…

Unlike with outbreaks in Illinois, New York and New Jersey, the potentially deadly infection was quickly contained.”..

Public knowledge about the OU Medical Center case makes it an exception. Typically, health care facilities across the nation don’t release to the public information when C. auris and other drug-resistant pathogens are found. No law or policy requires them to do so.

Patient-rights advocates maintain that the public has the right to know when and where outbreaks or even single cases occur. But health officials have routinely fought back, suggesting that it could violate patient rights and discourage patients from seeking hospital care.

But the CDC allows states to make that decision.

Burnsed said the Department of Health tries to walk a tight line between notifying the public and protecting the patient’s privacy.

He said he would be more likely to identify a facility if it’s anything more than an isolated case or if officials believed the exposure wasn’t contained.

“What we consider is if there was a risk to a broader group of individuals and if there was any evidence that there were a breach in lab controls,” Burnsed said. “We didn’t put out anything at the time (on Oklahoma’s two cases) because we didn’t think there was a greater risk to the public, but it’s a good question to consider.”” (M)

“How many people will needlessly die from a deadly bug sweeping through New York hospitals and nursing homes before local health officials acknowledge the danger publicly — and act accordingly?..

Yet public-health officials here have been slow to let patients know in which hospitals the bug is lurking. Folks are left to take their chances. That’s outrageous.

Why are officials mum? Partly because they fear that if they disclose the information, some people who need treatment won’t go for it.

That’s a weak excuse: As McCaughey notes, there are plenty of local hospitals that aren’t plagued by Candida auris, so patients could get care and avoid the risk, if they know where it’s safe to go.

More likely, no one wants to damage the reputations (or incomes) of the affected hospitals. Yet the best way to protect those reputations is to make sure the facilities are Candida auris-free…

Meanwhile, officials say they will reveal which hospitals have the germ — in their next yearly report. But that could be months away; patients need to know now.

If neither the hospitals nor their government regulators are willing to move sooner, perhaps state lawmaker should step in and require them to do so… (N)

Infectious disease experts tell Axios they agree with a dire scenario painted in the UN report posted earlier this week saying that, if nothing changes, antimicrobial resistance (AMR) could be “catastrophic” in its economic and death toll.

Threat level, per the report: By 2030, up to 24 million people could be forced into extreme poverty and annual economic damage could resemble that from the 2008–2009 global financial crisis, if pathogens continue becoming resistant to medications. By 2050, AMR could kill 10 million people per year, in its worst-case scenario.

“There is no time to wait. Unless the world acts urgently, antimicrobial resistance will have disastrous impact within a generation.”..

By the numbers: Currently, at least 700,000 people die each year due to drug-resistant diseases, including 230,000 people from multidrug-resistant tuberculosis, per the UN. Common diseases — like respiratory infections, STDs and urinary tract infections — are increasingly untreatable as the pathogens develop resistance to current medications.

The Centers for Disease Control and Prevention says AMR causes more than 23,000 deaths and 2 million illnesses in the U.S. annually…

What needs to be done: Jasarevic says the economic and health systems of all nations must be considered, and targets made to increase investment in new medicines, diagnostic tools, vaccines and other interventions.”

The bottom line: Action must be taken to avoid a catastrophic future.” (O)

“A recent study of patients at 10 academic hospitals in the United States found that just over half care about what their doctors wear, most of them preferring the traditional white coat.

Some doctors prefer the white coat, too, viewing it as a defining symbol of the profession.

What many might not realize, though, is that health care workers’ attire — including that seemingly “clean” white coat that many prefer — can harbor dangerous bacteria and pathogens.

A systematic review of studies found that white coats are frequently contaminated with strains of harmful and sometimes drug-resistant bacteria associated with hospital-acquired infections. As many as 16 percent of white coats tested positive for MRSA, and up to 42 percent for the bacterial class Gram-negative rods.”

It isn’t just white coats that can be problematic. The review also found that stethoscopes, phones and tablets can be contaminated with harmful bacteria. One study of orthopedic surgeons showed a 45 percent match between the species of bacteria found on their ties and in the wounds of patients they had treated. Nurses’ uniforms have also been found to be contaminated.

Among possible remedies, antimicrobial textiles can help reduce the presence of certain kinds of bacteria, according to a randomized study. Daily laundering of health care workers’ attire can help somewhat, though studies show that bacteria can contaminate them within hours…

It’s a powerful symbol. But maybe tradition doesn’t have to be abandoned, just modified. Combining bare-below-the-elbows white attire, more frequently washed, and with more conveniently placed hand sanitizers — including wearable sanitizer dispensers — could help reduce the spread of harmful bacteria.

Until these ideas or others are fully rolled out, one thing we can all do right now is ask our doctors about hand sanitizing before they make physical contact with us (including handshakes). A little reminder could go a long way.” (P)

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