“Calling 911 (about Hurricane Harvey) didn’t work. Begging for help on Facebook and Instagram failed, too. “I was like, ‘Siri’s smart enough! Let me ask her!’ …

Stranded outside in the rising waters of Hurricane Harvey, feverish and in great pain, 14-year-old Tyler Frank tried desperately to think of ways to get herself and her family to safety.
And indeed, Siri was smart enough. With one inquiry to the Apple personal assistant — “Siri, call the Coast Guard” — Tyler got her whole family rescued after two days out in the storm. “(A)

“Hurricane Irma is a Category 5 storm expected to make landfall in Florida sometime this weekend, leaving local hospitals to prepare for a possible landfall and catastrophic damage.
Listed below are seven things every healthcare leader should know about the unfolding situation in Florida.
1. Florida Gov. Rick Scott (R) declared a state of emergency Monday for the entire state.
2. Three hospitals in the Florida Keys are beginning to evacuate patients: Key West, Fla.-based Lower Keys Medical Center, Tavernier, Fla.-based Mariners Hospital and Marathon, Fla.-based Fisherman’s Hospital. Monroe County, which encompasses the Keys, is also closing its health department… (B)

“Emergency disaster officials in cities like Baltimore, Boston and Seattle have spent the last week and a half monitoring how Texan government officials and storm-affected residents are responding to a crisis that destroyed homes and disrupted electricity, drinking water and communications.
The causes might be different, but the devastation and social disruption can be similar from disaster to disaster. As such, Houston is offering other cities a real-life run-through of their own emergency plans as well as a stark reminder of the inevitability of such events.” (C)

“Harvey is the first major storm since the federal government revised emergency preparedness standards for hospitals, in response to Katrina and 2012’s Superstorm Sandy. Now, health care institutions that receive Medicare or Medicaid dollars must have disaster preparedness plans, including relocation strategies for at-risk patients and mechanisms to maintain basic power.”
What kind of burden does a storm like Harvey place on local hospitals, and on the health care system?
What challenges should we expect in the storm’s wake? (D)

“Every flood disaster is also a public-health disaster, and even as Harvey dissipates over the Gulf Coast, the beginnings of that secondary calamity were on display in the Houston area…”
“A large-scale World Health Organization (WHO) study out of Europe investigated these health effects of flooding and found that the two-thirds of flood-related deaths are due to drowning, while the remainder are from trauma, electrocution, carbon monoxide poisoning, fire, or heart attacks. Weakened health care infrastructures during natural disasters make seeking care for these immediate injuries and infectious diseases even more difficult. In the case of Harvey, Houston’s biggest level one trauma center, Ben Taub Hospital, is itself being evacuated due to lack of food and flooding.
The need for immediate medical attention aside, basic necessities such as food and clean drinking water become critical for displaced flood survivors, says Koenig. Contamination of drinking water due to failures at water treatment plants and sewage system overloads can lead to outbreaks of diarrheal disease if clean water provisions are not prioritized. Even exposure to flood water itself for prolonged periods of time can lead to health risks ranging from animal bites and wound infections to electrical and chemical hazards. And according to Koenig, once the immediate crisis dissipates, the toll of the natural disaster can persist in the form of chronic disease, worsened poverty, and emotional and mental distress.” (E)

As Texas begins to rebuild its buildings and roadways in the wake of Hurricane Harvey, survivors of the catastrophic storm, along with the medical professionals who treat them, may face psychological trauma from displacement and the loss of homes, property and, especially, loved ones.
The link between a hurricane and mental health struggles has been documented through research on the survivors of Hurricane Katrina, which devastated Louisiana in 2005. A year after the storm, the Resilience in Survivors of Katrina (RISK) Project found that nearly half of the 392 low-income parents they studied reported symptoms consistent with post-traumatic stress disorder (PTSD). An associated study concluded that the rates of probable serious mental illness in low-income parents in New Orleans doubled in the aftermath of the hurricane, a rise that’s likely to be reflected in southeast Texas. (F)

The storm forced hospitals and medical centers in Houston to cancel surgeries, outpatient programs and even evacuate surgeries.
But that still wasn’t enough to help prevent shortages across the city.
Medical centers have had to reevaluate their treatment of patients as food and supply shortages left them overwhelmed.
This is only expected to get worse as more victims of Hurricane Harvey will continue to grow as the storm dies down.
The uninsured will be among them with an inability to pay for medical procedures that were caused from the damaging hurricane. (G)

“But it could have gone a lot worse. To put it into context, there are roughly 120 hospitals in the southeastern section of Texas, according to Darrell Pile, the leader of the Southeast Texas Regional Advisory Council (SETRAC), which operated the Catastrophic Medical Operations Center in charge of leading hospital responses to emergencies. Additionally, in the 25 hospitals that did evacuate, not all of the patients planned to move actually ended up moving. CNN reports that so far, roughly 1,000 patients have been transported to other hospitals. Doctors likely assessed that some patients could actually be safely treated where they are, and that supplies were more secure than they thought (no one ended up going without food at Ben Taub Hospital in Houston, Pile says). Those who were living in the flooded nursing home now are okay in the hospital in which they were placed.” (H)

“Inside the hospital, doctors, nurses, technicians and facilities and food service staff were keeping things running for more than 500 inpatients and their families…
You have a ride-out team, which refers to staff who have agreed to stay put and ride out the storm. How did that work?
We had about a thousand staff here. The unsung heroes in this disaster are our nurses, our lab techs, our pharmacy techs, our food services, our security who kept [everyone] safe.
We had 528 patients who were in the hospital on Sunday morning and probably another couple hundred family members. We were really able to care for these very sick individuals. There was no compromise in our ability to care for them….
Your staff at the hospital is obviously just as affected as everyone else. (I)

“Every flood disaster is also a public-health disaster, and even as Harvey dissipates over the Gulf Coast, the beginnings of that secondary calamity were on display in the Houston area. During the worst of the flooding, hospitals faced critical shortages of food and medicine, people with serious chronic diseases had to make difficult decisions between evacuation and sheltering in place, and hundreds of victims faced prescription shortages and mental-health issues. And based on the health problems people in New Orleans and elsewhere in the region faced after Hurricane Katrina, experts expect major public-health emergencies, environmental illnesses, and outbreaks will only intensify in the aftermath of Harvey.
“…one key public-health issue that attends the early stages of any disaster is the set of risks facing people who are disabled or elderly and face special health needs. “With our push towards home health-care and taking care of more Americans in the home,” Gentry said, “it quickly turns into ‘can we get their home health-care needs taken care of,’ with everything from oxygen to prescription meds to getting them clinical access, especially for dialysis. Those types of clinical worries compound as many days as the water stays up.” (J)

“Due to the failure of the city’s water pump, it is in the best interest of our current patients to transfer to other acute care facilities,” Baptist Hospitals of Southeast Texas said in a statement Thursday morning. “Due to the city-wide lack of services, we have no other alternative but to discontinue all services which will include emergency services. This is being done immediately.”
“The hospital needs about 50,000 gallons of water a day to run,” hospital medical director Ali Osman told weather.com. “The hospital administration tried to procure that water from water tankers, state and local resources. So far, we are unable to.”
“We started with maybe 260 patients, we are down to 193 patients,” he added. “We are evacuating the sickest of our patients first, intubated patients, patients who need dialysis. Things are serious … come Saturday or Sunday, we still don’t have any water, the bad situation will turn into a disaster.” (K)

““Just like their members, health plans are a part of their communities and deeply committed to the wellness and safety of those who live there,” America’s Health Insurance Plans said in a statement. “When a community is impacted by a tragic, disastrous event like we’re seeing unfold with this storm, plans connect immediately with state and local officials to offer support and ensure those impacted have swift access to the healthcare, resources and medical services they need.”
Here’s a look at what some major health plans are doing:
Cigna is lifting prescription refill restrictions; waiving prior authorization requirements for acute care; and forgiving late payment of premiums for customers in affected areas. It is also offering a free 24/7 telephone help line through which members can speak to a clinician about issues like coping with loss, anxiety, stress resulting from the hurricane. Finally, the insurer noted that MDLIVE, which provides telehealth services to Cigna customers, is offering one free medical consultation through Sept. 8. (L)

“Tom Bossert, the official leading the White House’s response to the disaster, estimated that 100,000 homes in Texas and Louisiana had been damaged or destroyed, and said that President Trump would soon seek billions in aid.
Mr. Bossert said that rescuers would provide aid to the estimated 500,000 undocumented immigrants in the Houston area, and that federal officials would not round up those whose only offense was entering the country illegally. But undocumented immigrants would likely not be eligible for long-term aid, he said, including subsidies to replace damaged housing.” (and what about health care?) (M)

(A) Siri saves sick girl from Harvey floodwaters, by Elizabeth Cohen and John Bonifield, http://www.cnn.com/2017/09/04/health/siri-harvey-rescue-sickle-cell/index.html
(B) Florida hospitals prepare for Hurricane Irma: 7 things to know Wednesday, by Leo Vartorella, http://www.beckershospitalreview.com/patient-flow/florida-hospitals-prepare-for-hurricane-irma-7-things-to-know-wednesday.html
(C) In Houston, a Terrifying Real-Life Lesson for Disaster-Prone Cities, by ADAM NAGOURNEY and JESS BIDGOOD, https://www.nytimes.com/2017/09/05/us/houston-harvey-disaster-lessons.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(D) A Doctor Who Weathered Katrina Now Tends Victims Of Harvey, by SHEFALI LUTHRA, http://www.npr.org/sections/health-shots/2017/09/05/548626760/a-doctor-who-survived-katrina-now-tends-victims-of-harvey
(E) Beyond infrastructure dangers, the survivors of Harvey will likely also face serious health hazards, Farah Naz Khan, https://www.self.com/story/health-crises-that-follow-horrific-floods
(F) From The Mental Health Wreckage Of Katrina, Lessons To Help Harvey’s Victims, by Kaeli Subberwal, http://www.huffingtonpost.com/entry/hurricane-harvey-mental-health_us_59a9f092e4b0354e440a7b3f
(G) Now the hospitals are going to have to figure out how to treat the many uninsured who need medical care because increased hospital admissions always happen after a natural disaster, by Danielle Zoellner, http://www.dailymail.co.uk/health/article-4840574/Hurricane-Harvey-crippled-health-system.html
(H) Houston hospitals kept patients safe during Harvey thanks to years of forced team bonding, Katherine Ellen Foley, https://qz.com/1066787/hurricane-harvey-how-houston-hospitals-handled-the-storm/
(I) An ‘Army Of People’ Helps Houston Cancer Patients Get Treatment, ANDREA HSU, http://www.npr.org/sections/health-shots/2017/08/31/547539504/an-army-of-people-helps-houston-cancer-patients-get-treatment
(J) Hurricane Harvey’s Public-Health Nightmare, https://www.theatlantic.com/politics/archive/2017/09/hurricane-harveys-public-health-nightmare/538767/
(K) Harvey Beyond Houston: Beaumont Residents Wait in Mile-Long Lines for Bottled Water, by Sean Breslin, https://weather.com/storms/hurricane/news/beaumont-texas-loses-water-supply-due-to-neches-river-flooding
(L) How health insurers are helping members, employees affected by Hurricane Harvey, by Leslie Small, http://www.fiercehealthcare.com/payer/how-insurers-are-helping-members-cope-hurricane-harvey
(M) New Hazard in Storm Zone: Chemical Blasts and ‘Noxious’ Smoke, by JULIE TURKEWITZ, HENRY FOUNTAIN and HIROKO TABUCHIA, https://www.nytimes.com/2017/08/31/us/texas-chemical-plant-explosion-arkema.html

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TrumpCare. “If you don’t know (`or care`) where you’re going, any road will get you there.” – Lewis Carroll

“… Trump’s views about health care have been anything but consistent. Rather, there have been three constants: agnosticism about what a plan should look like; a fanatical desire to notch a win regardless of the quality of that win; and a refusal to give up.
In the meantime, Trump has vacillated frequently, mostly pinging between three incompatible positions: first, that Obamacare should be repealed and replaced; second, that Republicans should repeal Obamacare and worry about a replacement later; and third, as here, that Republicans should simply let Obamacare die. Let’s consider a somewhat simplified timeline of Trump’s views. (A)

Here are three promises Trump made that will not come true under the current bills moving through Congress:
‘Everybody’s got to be covered.’
‘No cuts’ to Medicaid
‘Every bit as good on pre-existing conditions as Obamacare.’ (B)

Mr. Trump usually steers clear of policy details and has grown impatient with the painstaking behind-the-scenes bargaining that has marked the health care negotiations. But he said on Wednesday that he was hopeful that the Senate would deliver a bill that he could sign. (C)

“Republicans should just REPEAL failing Obamacare now & work on a new Healthcare Plan that will start from a clean slate,” the president tweeted, adding that “Dems will join in!” (D)

“Trump’s predictions of collapse and threats to withhold critical government payments to insurers — have obscured an encouraging fact: Many of the remaining companies have sharply narrowed their losses, analysts say, and some are even beginning to prosper…
The insurers that stayed in the individual market have come to realize that the individual market was more like Medicaid than the employer business. Some customers have chronic conditions that have been poorly treated in the past, and insurers need to manage their care more closely. People shopping for a plan are very concerned about price, making it essential for insurers to find hospitals and doctors that provide care at the lowest cost. (E)

Let’s stipulate up front that congressional leaders and President Trump are unlikely to lead that effort, given that they narrowly failed to take health insurance away from millions of people. This conversation would need to be led by senators who have committed to a bipartisan approach, and by state governments, some of which have already begun to take action.
Change might not come soon enough for the 29 million people without health insurance or the many millions who struggle to afford high premiums, deductibles and other health costs.” (F)

Now, a repeal plan proposed by GOP Sens. Bill Cassidy of Louisiana, Lindsey Graham of South Carolina and Dean Heller of Nevada is, as Cassidy put it recently, “about the only game left in town” when it comes to the GOP’s hackneyed promise to repeal and replace Obamacare, as the law is also known…
There’s no compelling rationale for the changes Republicans continue to propose to the nation’s health care policies. It’s clearly not to extend health coverage to more people or to maintain it for those who currently have it. It’s clearly not to make matters easier for the states. And it’s clearly not to tackle the genuine health care problems Americans face, such as staggeringly high costs and inferior outcomes.
With clearly no helpful intentions in mind, Cassidy, Graham and Heller ought to let this Obamacare repeal plan fail like its predecessors. (G)

Next month the Senate will try a novel approach to break away from seven years of polarization on health care: actual committee hearings, with expert witnesses and input from lawmakers in both parties.
And if those go well, Congress could see an even unlikelier development—the advance of viable, bipartisan legislation to fix parts of the Affordable Care Act.
The hearings are the brainchild of Senator Lamar Alexander of Tennessee, the Republican chairman of the Health, Education, Labor, and Pensions Committee, who has been talking for months about the need to stabilize Obamacare’s individual insurance market. What makes this effort different is that following the GOP’s failure to repeal and replace the law, Alexander now has the blessing of his party’s leadership and buy-in from the committee’s top Democrat, Senator Patty Murray of Washington State…
“I’m looking for the simplest bill possible that Republicans and Democrats can agree on that will stabilize the individual insurance market,” Alexander told reporters earlier this month. (H)

“A Trump administration official said Wednesday that the administration wanted to stabilize health insurance markets, but refused to say if the government would promote enrollment this fall under the Affordable Care Act or pay for the activities of counselors who help people sign up for coverage.
The official also declined to say whether the administration would continue paying subsidies to insurance companies to compensate them for reducing deductibles and other out-of-pocket costs for low-income people. Without the subsidies, insurers say, they would sharply increase premiums.
The administration, the official suggested, will do the minimum necessary to comply with the law, which Mr. Trump has called “an absolute disaster” and threatened to let collapse.
“I don’t think we can force people to sign up for the program,” the official said. “ (I)

“But what about ideas that go beyond the oft-repeated ones? Here are five proposals that are more controversial but generating buzz.
1. Allow people into Medicare starting at age 55.
2. Allow people to ‘buy in’ to Medicaid.
3. Get younger adults off their parents’ insurance and back into the individual market.
4. Require insurers who participate in other government programs to offer marketplace coverage.
5. Let people use HSA contributions to pay health insurance premiums. (J)

“Colorado Gov. John Hickenlooper and his Republican counterpart from Ohio, John Kasich, on Thursday morning released their bipartisan plan to stabilize the individual health insurance market.
Among their recommendations:
The Trump administration should commit to making cost-sharing reduction payments to keep premiums from going up 20-25 percent and increasing the federal deficit.
Congress should create a temporary stability fund for states to create reinsurance programs that reduce premiums.
Congress should encourage health insurance companies to enter underserved counties by exempting insurers that do so from the federal health insurance tax on their exchange plans in those counties.
Keep the individual mandate (for now) to prevent the rapid exit of carriers from the market.
Maximize market participation by encouraging young people to get insurance.
Modify and strengthen federal risk-sharing mechanisms, including risk adjustments and reinsurance to stabilize risk pools. (K)

“Last fall, as consumers in Minnesota were facing health insurance rate increases of 50 percent or more, Gov. Mark Dayton, a Democrat, said the Affordable Care Act was “no longer affordable to increasing numbers of people.” The state’s top insurance regulator said the Minnesota market was “on the verge of collapse.”
The outlook now is much better. Rate increases requested for 2018 are relatively modest, thanks in part to a new program under which the state will help pay the largest claims. The program, known as reinsurance, and the efforts that led to its creation hold lessons for other states where rates are rising rapidly, and for Congress, where lawmakers are considering the introduction of a similar program…
But the program will be invisible to consumers. They will not have to file additional paperwork or do anything different from what they would ordinarily do..
Minnesota’s experience with such an effort is instructive. The bill creating its reinsurance program, the Minnesota Premium Security Plan, became law within three months of being introduced — lightning speed when compared with the pace in Congress.” (L)

“Despite the setbacks of the past eight months, including the inability of Republicans to agree on a single alternative to the ACA, it is still not too late for this Congress to pass health care reform legislation…
What united the fractured Democratic members (on ObamaCare) was that they were unified in their desire to pass something that would move the country in the direction of more government control over health care, with fewer individual choices. They differed greatly on the details, and on how far they wanted to push the agenda in that first step. But their agreed on the need to pass something.
Republicans have spent every election cycle since 2010 promising voters that they will push health care in the other direction – favoring more choice and less regulatory control, and as a result, lower costs. With that campaign agenda, they captured the House, then the Senate, and finally the Presidency. Now, with numerous proposals about how to proceed, can they at least agree on the need to pass something?
It doesn’t have to be perfect. It just has to be better than what we have now. With so many American paying so much money for so little in return, that’s really not such a high bar. “(M)

“The Trump administration is slashing spending on advertising and promotion for enrollment under the Affordable Care Act, a move some critics charged was a blatant attempt to sabotage the law.
Officials with the Department of Health and Human Services, who insisted on not being identified during a conference call with reporters, said on Thursday that the advertising budget for the open enrollment period that starts in November would be cut to $10 million, compared with $100 million spent by the Obama administration last year, a drop of 90 percent. Additionally, grants to about 100 nonprofit groups, known as navigators, that help people enroll in health plans offered by the insurance marketplaces will be cut to a total of $36 million, from about $63 million.
The officials said the administration believed that the cuts were necessary because of “diminishing returns” from advertising…” (N)

Senate Republicans will soon run out of time to rely on their slim majority to dismantle the Obama health law.
The Senate parliamentarian has determined that rules governing the effort will expire when the fiscal year ends Sept. 30, according to independent Sen. Bernie Sanders of Vermont, the ranking member of the Senate Budget Committee. The rules allow Republicans to dismantle President Barack Obama’s health care law with just 51 votes, avoiding a filibuster.
Republicans control the Senate 52-48 and were using the special filibuster-proof process in the face of unified Democratic opposition. Now, if Republicans can’t revive the repeal measure in the next four weeks, they will be forced to work with Democrats to change it.” (O)

(A) on Health Care, by David A. Graham, https://www.theatlantic.com/politics/archive/2017/07/as-i-have-always-said-trumps-ever-changing-position-on-health-care/535293/
(B) 3 promises Trump made about health care that repeal plans haven’t kept, by Eliza Collins, https://www.usatoday.com/story/news/politics/2017/06/24/promises-trump-made-health-care-repeal-plans/426089001/
(C) Trump Demands That Senators Find a Way to Replace Obamacare, By JULIE HIRSCHFELD DAVIS, THOMAS KAPLAN and MAGGIE HABERMAN, https://www.nytimes.com/2017/07/19/us/politics/donald-trump-obamacare-health-care-republicans-senators.html?mcubz=0
(D) As Health Care Bill Stalls, Trump Calls For Outright Repeal Of Obamacare, Nick Visser, http://www.huffingtonpost.com/entry/trump-health-care-bill-response_us_596d719ee4b010d7767345ff
(E) Trump’s Threats on Health Law Hide an Upside: Gains Made by Some Insurers, by REED ABELSON, https://www.nytimes.com/2017/08/26/health/obamacare-market-insurance.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(F) Looking Beyond the Obamacare Debate to Improve Health Care, https://www.nytimes.com/2017/08/26/opinion/sunday/obamacare-universal-health-coverage.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(G) Senate GOP trio offer another Obamacare repeal plan that deserves to fail, https://bangordailynews.com/2017/08/28/opinion/editorials/senate-gop-trio-offer-another-obamacare-repeal-plan-that-deserves-to-fail/?ref=OpinionBox
(H) The Senate Tests a New Approach on Obamacare: Bipartisanship, by RUSSELL BERMAN, https://www.theatlantic.com/politics/archive/2017/08/the-senate-tries-a-new-approach-on-obamacare-bipartisanship/538083/
(I) Trump Administration Wants to Stabilize Health Markets but Won’t Say How, by By ROBERT PEARAUG, https://www.nytimes.com/2017/08/30/us/politics/trump-obamacare-enrollment-markets-subsidies.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(J) 5 Outside-The-Box Ideas For Fixing The Individual Insurance Market, by Julie Rovner, http://khn.org/news/5-outside-the-box-ideas-for-fixing-the-individual-insurance-market/
(K) John Hickenlooper, Ohio Gov. John Kasich release their bipartisan plan to address health care, by JESSE PAUL, http://www.denverpost.com/2017/08/31/john-hickenlooper-ohio-gov-john-kasich-release-their-awaitied-bipartisan-plan-to-address-health-care/
(L) Minnesota Finds a Way to Slow Soaring Health Premiums, by ROBERT PEAR, https://www.nytimes.com/2017/09/02/us/politics/minnesota-health-care-reinsurance.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(M) It’s Not Too Late To Reform Health Care – The ACA Took Longer, by Robert Book, https://www.forbes.com/sites/theapothecary/2017/08/31/its-not-too-late-to-reform-health-care-the-aca-took-longer/2/#5aadf4ba1c7b
(N) Trump Administration Sharply Cuts Spending on Health Law Enrollment, by ABBY GOODNOUGH and ROBERT PEAR, https://www.nytimes.com/2017/08/31/health/affordable-care-act-trump-spending.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(O) GOP ability to dismantle health law expires at month’s end, http://abcnews.go.com/Politics/wireStory/gop-ability-dismantle-health-law-expires-months-end-49571509

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Opioid Crisis. ““We got here in part because there was a paper done in the 1980s by a well-meaning physician that said opioids are not addictive….

… and they should not be withheld from anybody with acute or chronic pain,”
“Then we came out with the fifth vital sign, that every physician was held to the standard that we would do pain scores on everyone. Based on those studies, we couldn’t restrict opioids at all. In fact, physicians from a New England state went to jail because they did not prescribe opioids for somebody with severe pain.
“This hit the medical community like a bombshell, and therefore it was easy to give opioids.”
As it turns out, it was just one of the contributing factors.
Another was the way the treatment of pain was recorded, through Press Ganey customer satisfaction scores.
“In this state and other states, the fifth vital sign became the standard of care,” Rosenberg said. “If you have pain, we have to treat it. And the goal was to get you to zero on the pain scale.
“So, if you came into my emergency department or you went to the dentist, our options for treatment were either to give you Motrin or Tylenol, something benign or easy, or I just go all out and give you opioids.”” (A)

“In December 1995, Purdue received FDA approval for Oxycontin, an opioid which was itself supposed to deter abuse, through its allegedly rush-curbing, time-release formulation. Purdue lacked anything in the way of persuasive evidence for this claim at the time, and later studies would debunk it entirely, but, as detailed in Barry Meier’s Pain Killer, that didn’t stop the FDA from allowing them to include it in the drug’s labeling—an unprecedented decision which, in Meier’s words, “threw open the door to the drug’s widespread marketing,” and in turn generated precisely the catastrophic conditions which brought us there, to that Sheraton, in the first place.” (B)

“For the last 20 years, the pharmaceutical industry has been whitewashing the lasting impact of highly addictive narcotics through its use of marketing, effectively encouraging doctors and other providers to prescribe these powerful drugs in increasing, extremely dangerous levels.
In other words, Big Pharma found a way to turn a profit at the expense of American lives. By misleading doctors to overprescribe a drug powerful enough to treat the level of pain endured by patients recovering from major surgery for more routine issues, Big Pharma made possible the addiction of thousands in Philadelphia alone. But it doesn’t stop at prescription pills manufactured and distributed by these companies.
When that prescription runs out — and it will — users who are dependent are often drawn to a substance far less expensive and, unfortunately, extremely accessible on the black market: heroin…” (C)

NO FORMAL DECLARATION OF NATIONAL OPIOID EMERGENCY YET!
Two weeks ago, President Trump declared the opioid crisis a national emergency and called it “a serious problem the likes of which we have never had.”
“We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis,” the president insisted.
But so far, Trump hasn’t formally signed such a declaration and sent it to Congress.
And that means the millions the executive branch could direct towards expanding treatment facilities — or supplying police officers with the anti-overdose remedy naloxone — aren’t going anywhere because Trump has not yet followed through.
A White House spokesperson would not say when Trump would get around to it.
“The president recently instructed his administration to take all appropriate measures to confront the opioid crisis,” the spokesperson said. “Right now these actions are undergoing an expedited legal review.”” (D)

“The president’s budget ignores the findings of addiction treatment research. Recently Price suggested that Medication Assisted Treatment (MAT) was not the best way to treat opioid use disorder by saying, “if we just simply substitute buprenorphine or methadone or some other opioid-type medication for the opioid addiction, then we haven’t moved the dial much…”” (E)

MORE CONSEQUENCES
““Too many people with migraines are prescribed potentially addictive opiate painkillers, while too few may be getting recommended medications, a new study suggests.
Researchers found that of nearly 2,900 Americans who visited the doctor for migraine relief, 15 percent were prescribed opioids such as oxycodone (OxyContin or Percocet) or hydrocodone (Norco, Vicoprofen).
That’s despite the fact that the drugs should really be used only as a “last resort,” said study lead researcher Dr. Larry Charleston IV.” (F)

The number of kids placed in foster care continues to increase as the opioid crisis worsens in Ohio, but there aren’t enough foster care families to meet the need.
It’s a heartbreaking problem, many people probably don’t realize is happening all around them. There are more than 15,000 kids in Ohio’s foster care system, but only 7,200 families to take them in. (G)

The nation’s opioid crisis has hit hard in Maine, where at least one person died every day last year of drug overdoses.
It’s also penetrated the state’s lobster industry. Some fishermen are suffering in silence in a community that rarely asks for help.
Josh Kane has spent more than 15 years fishing off the coast of Maine. For 10 of those years, he struggled with an opioid addiction as his fellow lobstermen looked the other way.
“It’s one of those things that’s kind of like, ‘Don’t ask, don’t tell,'” Kane said. “As long as you show up every day and do your job, nobody is really going to say anything.”
They’re a tough, proud and private bunch with grueling hours and serious, physical demands. But the payoff can easily be in the six-figure range for the short summer season. (H)

In an unrelenting opioid epidemic, hepatitis C is infecting tens of thousands of mostly young, white injection drug users, with the highest prevalence in the same Appalachian, Midwestern and New England states that are seeing the steepest overdose death rates.
Like the opioid epidemic that is driving it, the rate of new hepatitis C cases has spiked in the last five years. After declining for two decades, new hepatitis C cases shot to an estimated 34,000 in 2015, nearly triple the number in 2010, according to a recent report from the U.S. Centers for Disease Control and Prevention (CDC).
With better screening for the bloodborne disease and more treatment using costly but highly effective new drugs, hepatitis C could be eradicated, according to a new study from the National Academies of Sciences, Engineering, and Medicine…
“We have two public health problems that are related — it’s called a syndemic — and we can’t address one without addressing the other,” said James Galbraith, an emergency room physician at the University of Alabama at Birmingham Hospital. (I)

SOLUTIONS
“Virginia Governor Terry McAuliffe announced his state’s drive to stem the state’s opioid addiction problem by crunching healthcare data. The move is the latest in a series of efforts by governments and large healthcare organizations to get a handle on the problem.
The governor’s announcement comes amid widespread concern over a deepening addiction crisis, with the state’s commissioner of health declaring opioid and heroin overdoses a public health emergency last year.
Using data currently being collected by interns from George Washington University and George Mason University, 15 teams will collaborate with a variety of subject matter experts to develop solutions to the myriad challenges facing communities and the commonwealth.
“We know that if collected and used correctly, data can help us fight this opioid epidemic by identifying the communities and populations that are most vulnerable,” said Virginia Secretary of Health and Human Resources Dr. Bill Hazel.”” (J)

“The good news is that many technology-based alternatives to opioids are already available. Spinal cord stimulation is an underutilized pain management alternative for patients struggling with chronic pain. This implanted pacemaker-like device is shown to effectively manage pain while significantly reducing opioid use. Regional pain pumps are a promising alternative for acute pain. They deliver local, non-opioid anesthetics directly to nerves feeding the surgical site, and can provide significant pain relief for several days after a procedure. These types of technologies enable what is known as multi-modal pain control, promoting a combination of devices and analgesics that have a low risk of addiction, such as ibuprofen, to manage pain – thus reserving opioids as a last resort.
But, weighing the value of these alternatives requires a shift in thinking that prioritizes investment in opioid avoidance. Today, these alternatives are often viewed as financially unviable or cumbersome to implement. And newer technologies that show promising initial results face even greater barriers. When not given a choice, clinicians have no other option but opioids. We must now create the pathways that facilitate alternative treatments.” (K)

(A) The opioid discussion: In the beginning — How did we get here? How did we become the nation with the biggest (perhaps the only) problem with opioid abuse?, http://www.njbiz.com/apps/pbcs.dll/article?AID=/20170814/NJBIZ01/170819953/the-opioid-discussion-in-the-beginning–how-did-we-get-here-how-did-we-become-the-nation-with-the-biggest-perhaps-the-only-problem-with-opioid-abuse&template=mobileart
(B) Why the FDA Can’t Fix the Opioid Crisis, by Daniel Kolitz, http://gizmodo.com/why-the-fda-cant-fix-the-opioid-crisis-1797950053
(C) Big Pharma must be held accountable for its role in opioid crisis, by Joe Torsella, http://www.philly.com/philly/opinion/commentary/big-pharma-must-be-held-accountable-for-its-role-in-opioid-crisis-20170828.html
(D) Trump Calls Opioid Crisis a National Emergency But Still Hasn’t Made It Official, by ALI VITALI and CORKY SIEMASZKO, https://www.nbcnews.com/storyline/americas-heroin-epidemic/trump-calls-opioid-crisis-national-emergency-still-hasn-t-made-n795351
(E) Trump and Tom Price are making it harder to combat opioid epidemic, BY RICHARD G. FRANK AND KEITH HUMPHREYS, http://thehill.com/blogs/pundits-blog/healthcare/348315-trump-and-tom-price-are-making-it-harder-to-combat-opioids
(F) Many Migraine Patients Given Unnecessary Opioids, Addictive painkillers should be treatment of last resort, headache expert says, by Amy Norton, http://www.webmd.com/migraines-headaches/news/20170825/many-migraine-patients-given-unnecessary-opioids#1
(G) Opioid crisis leaves thousands of kids trapped in foster care, by Shelby Miller, http://m.cleveland19.com/19actionnews/db_348172/contentdetail.htm?contentguid=sIfgvu2E
(H) Opioid crisis takes toll in Maine lobster industry, by Kenneth Craig, https://www.cbsnews.com/news/opioid-crisis-maine-lobster-industry/
(I) With Opioid Crisis, A Surge In Hepatitis C, By Christine Vestal, http://www.huffingtonpost.com/entry/with-opioid-crisis-a-surge-in-hepatitis-c_us_59a41ed5e4b0a62d0987b0c4
(J) Virginia turns to data analytics to fight opioid crisis; Intermountain Healthcare EHR effort cuts prescriptions, by Matt Kuhrt, http://www.fiercehealthcare.com/technology/virginia-turns-to-data-to-solve-opioid-crisis
(K) Are We Doing All We Can to Stop the Opioid Crisis?, by Cummings, http://health.usnews.com/health-care/for-better/articles/2017-08-31/are-we-doing-all-we-can-to-stop-the-opioid-crisis

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Hurricane Harvey. “There’s no need to test it (flood water),”…“It’s contaminated. There’s millions of contaminants.”…

Officials in Houston are just beginning to grapple with the health and environmental risks that lurk in the waters dumped by Hurricane Harvey, a stew of toxic chemicals, sewage, debris and waste that still floods much of the city.
Flooded sewers are stoking fears of cholera, typhoid and other infectious diseases. Runoff from the city’s sprawling petroleum and chemicals complex contains any number of hazardous compounds. Lead, arsenic and other toxic and carcinogenic elements may be leaching from some two dozen Superfund sites in the Houston area…
“Harris County, home to Houston, hosts more than two dozen current and former toxic waste sites designated under the federal Superfund program. The sites contain what the Environmental Protection Agency calls legacy contamination: lead, arsenic, polychlorinated biphenyls, benzene and other toxic and carcinogenic compounds from industrial activities many years ago… (A)

Houston was already affected by inequality and healthcare disparities. The Manchester neighborhood in Houston is what Samson described as a “classic environmental justice” area – a Latino neighborhood on the Houston shipping channel where petrochemical plants surround houses and most people speak Spanish.
“Barium is ubiquitous in the area because of refineries, as well as arsenic and mercury,” said Sansom. “All of that is going to be in potential of coming into contact with humans. There’s sort of the complex chemical mixture.”
Wildlife can also become a sudden danger. Standing water left after the flood recedes will leave an ideal breeding ground for mosquitoes – which were already a pest in Houston..
Zika captures the most headlines of any mosquito-spread diseases, but it’s far from the only one. The same Houston-endemic mosquitoes transmit dengue and chikungunya, infections characterized by fever. Other mosquito species spread West Nile virus, which can be dangerous for the elderly and health compromised.
Flood waters have also delivered fire ants to front doors, and Sansom warned flooded houses can become a home for venomous snakes such as water moccasins.
Water-borne and person-to-person infections can also easily spread after a disaster. Overwhelmed sewer systems bring people into contact with disease-spreading bacteria. Stomach illnesses are common following floods, public health officials said… (B)

“Authorities warned of the danger posed by the plant in Crosby, about 30 miles northeast of Houston. The French company operating the plant said explosions were possible, and William “Brock” Long, administrator of the Federal Emergency Management Agency, called the potential for a chemical plume “incredibly dangerous.”
Still, officials offered differing accounts regarding what occurred at the Crosby plant, which makes organic peroxides for use in items such as counter tops and pipes. The plant’s operators, which had earlier Thursday reported explosions, later said they believe at least one valve “popped” there, though they noted it was impossible to know for sure since all employees had left the site. (C)

“In the aftermath (of Katrina), a coalition of hospitals, emergency medical services, fire departments and community leaders undertook intensive efforts to fortify the city’s medical system. This led to such physical changes in the sprawling medical center as submarine doors that can be closed to wall off parts of a tunnel system that runs beneath the blocks-long area. Outside berms were built for protection should a gully off Brays Bayou overflow its banks, and strategically located flood gates that can rise three feet were installed. Hospitals that had emergency electricity generators in the basement moved them higher.
Such fortifications were tested as never before in recent days.
Based on protocols written over the intervening years, hospitals stationed extra staff members in their facilities so stranded workers could rotate in shifts. Other systems lessened the risk of running out of crucial supplies.
And unlike after Hurricane Katrina, in which no one knew where some New Orleans patients had been moved and some arrived at distant hospitals without medical records, a regional Catastrophic Medical Operations Center coordinated transfers and kept track of which hospitals had beds available for specific types of care…” (D)

A. A Sea of Health and Environmental Hazards in Houston’s Floodwaters, By HIROKO TABUCHI and SHEILA KAPLAN, https://www.nytimes.com/2017/08/31/us/houston-contaminated-floodwaters.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
B. Sewage, debris, mosquitoes: flood waters increase health risk for Harvey victims, https://www.theguardian.com/us-news/2017/aug/30/health-implications-texas-floods-hurrican-harvey
C. Chemicals ignite at flooded plant in Texas as Harvey’s devastation lingers, by Alex Horton and Mark Berman, https://www.washingtonpost.com/news/post-nation/wp/2017/08/31/harveys-wrath-moves-across-the-louisiana-texas-border-as-water-recedes-in-houston/?utm_term=.8973b6e86b6b
D. Some hospitals evacuated, but Houston’s medical world mostly withstands Harvey, https://www.washingtonpost.com/national/health-science/some-hospitals-evacuated-but-houstons-vaunted-medical-world-mostly-withstands-harvey/2017/08/30/2e9e5a2c-8d90-11e7-84c0-02cc069f2c37_story.html?utm_term=.70679d68f226
E. Here’s how to deal with those clumps of floating fire ants in Houston, by Megan Farokhmanesh, https://www.theverge.com/2017/8/29/16221842/hurricane-harvey-houston-fire-ants

“In addition to the catastrophic flooding from Hurricane Harvey, Houston residents have one more thing to worry about: floating colonies of fire ants.
Fire ants have waxy bodies that allow them to repel water. Should a colony find itself waterlogged, ants will protect their queen by forming a mass around her, as well as eggs, larvae, and pupae (ants that are in between larvae and adults). As the ants float, they rotate, so that the underwater ants will get to the top and vice versa..…
The ants, in fact, aren’t harmless, she says. People who come in contact with the colonies will get at least a few itchy, probably painful pustules. But how your skin reacts can differ from swelling to life-threatening allergic reactions. “Once they hit you, you’re a solid surface so they’re gonna crawl on you,” …. “When the first one stings, they emit a pheromone that causes a chain reaction that tells everybody else to sting, so you’re going to experience quite a few stings.”… (E)

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After Hurricane Harvey – Robust Public Health Response

“In the immediate emergency there’s concern around drowning, and especially for folks who are in motor vehicles where there is severe flooding, blunt trauma, fire-related injuries,” said Marisa Raphael, deputy commissioner of the Office of Emergency Preparedness and Response at the New York City Health Department.
Vulnerable populations, like the homeless, the elderly and the chronically ill, are especially at risk during and in the aftermath of a disaster…
Here’s a rundown of some of the public health concerns Texas faces in the days, weeks and months to come.
1. Inadequate access to medical care and prescriptions
2. Tight quarters promote the spread of infectious disease
3. Contaminated water can cause disease and infection
4. Rescue workers face risks associated with mold
5. Standing water may cause mosquito-borne infectious disease
6. Uncertainty takes a psychological toll
In the face of physical threats, it’s easy to underestimate the mental health toll that a disaster can take on a community. “Medical systems can deal with physical stuff quite well,” Jackson said, while noting the relative complexity of treating psychological maladies compared with an acute physical problem, like a broken leg.” (A)

“The muddy floodwaters now soaking through drywall, carpeting, mattresses and furniture in Houston will pose a massive cleanup challenge with potential public health consequences.
It’s not known yet what kinds or how much sewage, chemicals and waterborne germs are mixed in the water. For now, health officials are more concerned about drownings, carbon monoxide poisoning from generators and hygiene at shelters. In the months and years to come, their worries will turn to the effects of trauma from Hurricane Harvey on mental health.
At a shelter set up inside Houston’s George R. Brown Convention Center, Dr. David Persse is building a clinic of doctors and nurses and trying to prevent the spread of viruses or having to send people to hospitals already stretched thin. (B)

“The majority of people who die during floods drown: About 75 percent of the fatalities are drownings, per the World Health Organization. Two feet of rapid floodwater will sweep away an SUV. Just six inches of water, if it moves quickly enough, can knock over an adult, according to the National Weather Service….
Short term: Infectious disease
A flood contains more than rain. Sewage systems spill their guts. And the water can dredge up things more disturbing, if less infectious, than human waste. In New Orleans in 2005, the flooding from Hurricane Katrina exhumed corpses, sending coffins afloat through neighborhoods….
Short term: Power outages
Short term: Drug access
Short and long term: Mosquitoes
Long term: Mental health
Long term: Mold..
“All of those forces,” he explained Monday, “combine to make the Gulf Coast especially susceptible to infectious and tropical disease.” (C)

“With mosquito-borne illnesses specifically, it appears that there may be a delayed effect. In the short term, after a hurricane, there should actually be a lower risk of contracting these viruses, because the water likely washed away the existing breeding sites.
“But then over time, as the floodwaters recede, you’re left with pockets of water which are good for breeding both Culex mosquitoes and Aedes mosquitoes,” says Peter Hotez, the dean of the National School of Tropical Medicine at Baylor College of Medicine in Texas. Culex mosquitoes carry West Nile, as well as St. Louis encephalitis and Japanese encephalitis. Aedes aegypti are the primary carriers for Zika, as well as dengue, chikungunya, and yellow fever.y means introducing a new ecosystem of fungal growth that will change the health of the population in ways we are only beginning to understand. The same infrastructure and geography that have kept this water from dissipating created a uniquely prolonged period for fungal overgrowth to take hold, which can mean health effects that will bear out over years and lifetimes. (D)

The documented dangers of excessive mold exposure are many. Guidelines issued by the World Health Organization note that living or working amid mold is associated with respiratory symptoms, allergies, asthma, and immunological reactions. The document cites a wide array of “inflammatory and toxic responses after exposure to microorganisms isolated from damp buildings, including their spores, metabolites, and components,” as well as evidence that mold exposure can increase risks of rare conditions like hypersensitivity pneumonitis, allergic alveolitis, and chronic sinusitis.” (E)

“The area’s historic flooding has many of the region’s hospitals facing a monumental crisis, as more than 1,500 patients had been evacuated by Tuesday afternoon.
Twenty-three licensed hospitals across the Houston region have taken the extraordinary step of evacuating their sickest patients because of rising water or compromised services as Tropical Storm Harvey continues to lash the area…
Even worse, as many as 25 additional hospitals in the Houston area now carry “internal disaster status,” which means they are considered vulnerable to shutting down or shuttling their sickest patients to new locations, said Darrell Pile, chief executive of the Southeast Texas Regional Advisory Council, whose catastrophic medical operations center is coordinating the response to the troubled hospitals.” (F)

(A) Hurricane Harvey’s Public Health Impact Extends Beyond Flooding, “Disasters magnify fragilities that are already present in society.”, by Erin Schumaker, http://www.huffingtonpost.com/entry/harvey-public-health-impact_us_59a42136e4b06d67e33913a6
(B) Public health dangers loom in Harvey-hit areas, by By nomaan merchant and carla k. johnson, http://abcnews.go.com/Technology/wireStory/public-health-dangers-loom-harvey-hit-areas-49476410
(C) The health dangers from Hurricane Harvey’s floods, by Ben Guarino, https://www.washingtonpost.com/news/to-your-health/wp/2017/08/29/the-health-consequences-to-expect-from-hurricane-harveys-floods/?utm_term=.df3c601e3be3
(D) Will Flooding in Texas Lead to More Mosquito-Borne Illness?, by Julie Beck, https://www.theatlantic.com/health/archive/2017/08/will-flooding-in-texas-lead-to-more-mosquito-borne-illness/538242/
(E) The Looming Consequences of Breathing Mold, James Hamblin, https://www.theatlantic.com/health/archive/2017/08/mold-city/538224/
(F) Hospital crisis deepens as water rises; 1,500 patients evacuated so far, by Jenny Deam, http://www.chron.com/business/article/Hospital-crisis-deepens-as-water-rises-1-500-12159473.php

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“Houston’s world-renowned health care infrastructure found itself battered by Hurricane Harvey, struggling to treat storm victims while becoming a victim itself.”

“Water poured into hospitals. Ambulances were caught up in roiling floodwaters. Medical transport helicopters were grounded by high winds. Houston’s world-renowned health care infrastructure found itself battered by Hurricane Harvey, struggling to treat storm victims while becoming a victim itself….
The response to Harvey, now a tropical storm but still wreaking havoc over the state, promises answers to whether health officials learned lessons from the catastrophe of Katrina when it comes to the medically vulnerable — in particular whether they did enough to prepare for the disaster and to move patients out of its path.
“We’ve made significant investments,” Dr. Umair Shah, executive director of Harris County’s public health department, said in a telephone interview on Sunday. “The challenge is until it unfolds there’s so many moving pieces and it’s never the same as the situations you’ve previously encountered.”
Responders point to dozens of improvements, from better engineered structures to well-practiced cooperation, that are helping protect lives. Still, sometimes even the soundest plans have been foiled.” (A)

“Houston’s unprecedented rainfall on Sunday pushed area medical facilities to take precautions — including, in some cases, evacuations — in a bid to protect patients.
Texas Medical Center early Sunday began closing its massive “submarine” doors, designed to seal off lower floors — Texas Children’s Hospital, as well as Memorial Hermann-Texas Medical Center and TIRR Memorial Hermann Hospital, deployed the doors, a spokeswoman told the Houston Chronicle.
The system is part of a safety upgrade installed after Tropical Storm Allison devastated the medical campus in 2001, the Chronicle reported. That storm drowned tens of thousands of laboratory animals and forced patient evacuations. Decades of medical research were lost as well…. (B)

“But for the patients and staff inside, it was pretty much business as usual. Most of the TMC hospitals adopted a shelter-in-place strategy, which meant they called in staff prior to the storm and divided them into shifts of working and rest, on the premises, so they wouldn’t have to leave the hospital. Previous experience from storms suggested this was the best strategy; evacuating patients is a tricky process, since sometimes the evacuation procedure can be more medically dangerous if traffic jams out of a vulnerable area mean people will be stuck in ambulances or makeshift mobile care units for hours on end.” (C)

“Water flooded the basement of the Ben Taub General Hospital, disrupting food, pharmacy and central supply services. Ben Taub, one of only two comprehensive, level 1 trauma centers in Houston, says their concern now is finding ways to get critical care patients to safety.
“Our first concern is patients on ventilator support,” hospital spokesman Bryan McLeod said.
For now, 17 to 18 patients require ventilator support to breathe, McLeod told ABC News. After they have been evacuated, McLeod said, the hospital plans to move the rest of the approximate 350 patients.” (D)

“Nurses and doctors at Cook Children’s are preparing for at least 10 babies’ arrival as Hurricane Harvey edges closer to making landfall.
Children’s Medical Center in Dallas is also flying out to bring back several babies to care for away from the storm. Physicians are worried high winds and flooding could create major power outages and a shortage of clean water and food.” (E)

“At Texas Children’s Hospital, staff took turns on 12 hour shifts beginning Friday night to care for the 600 patients across three facilities. Doctors also called in women with high risk pregnancies who were due to give birth imminently as a precaution, and housed them in the Marriott next door to the main campus so they could be at the hospital quickly when their labor began. That meant their babies would also have access to the neonatal ICU if they needed it, rather than risking a dangerous ride through the storm to get to the hospital. “We assessed every patient, every pregnant mom, knowing that if they delivered and were unable to get to us, it would be devastating,” said Cris Daskevich, senior vice president at Texas Children’s.”(C)

“Preparation is key, according to Dr. Andrew Rhim, a physician and assistant professor at the University of Texas MD Anderson Cancer Center, one of the leading oncology institutes in the world. “MD Anderson was hit really hard in 2001 during Hurricane Allison,” he told Fortune in a phone interview. Rhim wasn’t at the center back then–but he says that administrators took that event as a wakeup call and worked to shore up disaster management in the years since. “The response to Harvey has been a product of those preparations.”
MD Anderson is currently experiencing some flooding, forcing appointment cancellations and closures for outpatient procedures. But there hasn’t been an evacuation, and the facility remains staffed for inpatients who cannot be discharged, according to Rhim. That’s thanks to preventive measures like flood gates which minimize damage and so-called “Ride Out” teams that prepare to, well, ride out the storm. These include nursing and technical support staff, custodial and food management, and extra food, water, and changes of clothes (in addition to a barrage of emails and other communications between administrators and staff).” (F)

(A) Houston’s Hospitals Treat Storm Victims and Become Victims Themselves, by SHERI FINK and ALAN BLINDER, https://www.nytimes.com/2017/08/28/us/hurricane-harvey-houston-hospitals-rescue.html?_r=0
(B) Harvey: Houston flooding pushes hospitals to act, Greg Toppo, https://www.usatoday.com/story/news/2017/08/27/houston-flooding-pushes-hospitals-act/606802001/
(C) What Happens When a Hurricane Hits a Hospital, by Alice Park, http://time.com/4919261/hurricane-harvey-houston-texas-medical-center/
(D) Hurricane Harvey: Houston-area hospitals preparing to evacuate patients, by MERIDITH MCGRAW DAN CHILDS, http://abcnews.go.com/US/hurricane-harvey-houston-area-hospitals-preparing-evacuate-patients/story?id=49457425
(E) Hospitals Join State Agencies Helping People In Hurricane Harvey’s Path, by Jeff Paul, http://dfw.cbslocal.com/2017/08/24/hospitals-join-state-agencies-helping-people-in-hurricane-harveys-path/
(F) How Hospitals Prepare for a Hurricane Like Harvey, by Sy Mukherjee, http://fortune.com/2017/08/28/hurricane-harvey-md-anderson-hospitals/

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Stress Tests for super-size NFP hospital systems already too big to fail!


When I was growing up in Queens in the late mid-1950s the two “go-to” hospitals were Long Island Jewish and Booth Memorial.

In the early 1970’s the hospital system in the NYC metropolitan area was anchored and dominated by internationally renowned academic medical centers (then defined as a medical school and its primary teaching hospital on the same campus) – e.g., Columbia Presbyterian, Mount Sinai, NYU and Cornell. Academic affiliations were in place with area hospitals for teaching medical students and training residents.

Probably triggered by the North Shore/ LIJ merger in 1997 (North Shore was already a regional system with 10 hospitals) we have seen a rapidly accelerating merger trajectory from regional hospital systems focusing on becoming integrated health care delivery systems, to mega systems focusing on geographic reach, to super-size systems which have started or taken over medical schools, functioning almost like insurance companies and investment banks.

Some examples of the scale of super size systems:
North Shore, recently rebranded itself as Northwell Health, has annual revenue of $7.0 billion.  The LIJ name is history. http://medicine.hofstra.edu/about/history/history_nslij.html
The Mount Sinai Health System * has 3,535 beds on 7 hospital campuses.http://www.mountsinaihealth.org/about-the-health-system/facts-and-figures
New York Presbyterian includes two medical schools. Booth Memorial is now NYP Queens. http://www.nyp.org/about-us
RWJBarnabas Health, created by the merger of two mega systems, serves a geographic area that covers 5 million people, or more than half of New Jersey’s population. http://www.mycentraljersey.com/story/money/business/consumer/2016/03/31/robert-wood-johnson-barnabas-health/82489800/
Followed by the merger of Hackensack and Meridian https://www.meridianhealth.com/media/press-releases/2016/hackensack-university-health-network-and-meridian-health-announce-board-members.aspx
Geisinger, the powerhouse in central, south-central and northeast Pennsylvania now includes AtlantiCare in New Jersey http://www.geisinger.org/pages/about-geisinger/index.html  A number of New Jersey hospitals have academic and programmatic affiliations with NYC and Philadelphia medical schools.

All of the super-size systems are not-for-profits.

The NFP corporate veil has been weakened by the Atlantic Health System, owners of the Morristown Medical Center, agreeing to pay the town $15.5 million over the next 10 years in a property tax settlement based on its for-profit subsidiary profits. http://www.nj.com/morris/index.ssf/2015/11/atlantic_health_to_pay_morristown_155m_to_settle_t.html This is a template for all NFP hospitals in New Jersey and nationwide.

In New Jersey for-profit systems have been created or bought previously NFP hospitals. While “prohibited” in New York, recently there was talk of allowing for-profits demonstration projects particularly focused on rebuilding the hospital system with “other people’s money.”

In April, 2016 “The Federal Reserve and the Federal Deposit Insurance Corporation said that five of the nation’s eight largest banks — including JPMorgan Chase and Bank of America — did not have “credible” plans for how they would wind themselves down in a crisis without sowing panic.” http://www.nytimes.com/2016/04/14/business/dealbook/living-wills-of-5-banks-fail-to-pass-muster.html

Are NFP super size hospital systems structured to handle a “bubble”? Are we ready for some to become “for-profits” to have access to capital?

The FTC opposed the 1997 North Shore/ LIJ merger, which was “approved” through litigation. Now in New Jersey and New York Certificates of Need for super-size mergers are awarded in a few months time.

Maybe it’s time for STRESS TESTS!

UPDATE
Northwell* Health said in a statement that it will wind down its four-year-old CareConnect Insurance Co. business over the next year, after it suffered financial losses linked to a program designed to steady the exchanges where consumers can buy coverage.
https://www.bloomberg.com/news/articles/2017-08-24/new-york-hospital-system-shuts-obamacare-unit-after-losses

* North Shore is now Northwell

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