… 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
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)
“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
“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/
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
The OPIOD CRISIS developed under-the-radar into a large scale national epidemic. This calamity was created, not by a virus, but by the over-production of very profitable prescription pain medication, and over-prescribing due in part to “pain management” goals and patient demand.
And in the recent past ZIKA spread on an unpredictable trajectory followed by a confirmed link between ZIKA and microcephaly.
The OPIOD CRISIS, like ZIKA, is a complex problem where participants have to reach agreement on goals while simultaneously evaluating options, in the context of “unknown unknowns.” Previous experience, even with Ebola, were not necessarily templates for ZIKA and the many existing and emerging mosquito-borne viruses. There is no real existing template for the OPIOD CRISIS.
The OPIOD CRISIS and the ZIKA EPIDEMIC led me to reflect on my professional hospital administrator experience with “disasters”.
My first experience was in 1975; I was 30 years old, the Mount Sinai Administrator at Elmhurst Hospital. “A powerful bomb ripped through a baggage area crowded with holiday travelers at LaGuardia Airport….. killing 12 persons and injuring at least 75 others.” (2) The most seriously injured were transported to nearby EH, a trauma center. I manned a security post keeping family members and press out of the E.R., observed much but learned little.
The first World Trade Center bombing was in 1993, four years into my tenure as President and CEO of Jersey City Medical Center. (3) As the nearby EMS service we sent all our ambulances through the Holland Tunnel into Manhattan. They got caught in the gridlock, were useless, and we didn’t get them back for three days and had to rely on Mutual Assist to cover our home turf.
In the mid 1990’s we had a 4-alarm arson fire in the hospital. The extraordinary efforts of the JCFD saved the day and 400 patients as we were evacuating the smoke-filled hospital, hampered by archaic elevators and narrow, dark stairways.
My focus on LESSONS LEARNED started on September 11th, 2001 when as President and CEO of Jersey City Medical Center we were a lead responder to the World Trade Center attacks. A confidential LESSONS LEARNED memorandum to the New Jersey Commissioner of Health became public when the Mayor of Jersey, who was out of the country on Sept 11th and was planning a run for governor, leaked the report “Schundler Assails New Jersey’s Response to Terrorist Attack.” (4) The Governor’s Office was not happy.
In 2004 I was visited by a Secret Service agent who told me that JCMC had been one of two hospitals designated as the primary back-up facilities for the Republican National Convention in Madison Square Garden and that we had to be fully staffed during the week before Labor Day, one of the slowest weeks of the year – and I couldn’t tell anyone why.
In 2009 I suggested to the new Acting Mayor of Hoboken that the Swine Flu maps showed it pointing to the NYC/ Hoboken metropolitan area. This led to ““Hoboken Creates Swine Flu Task Force.” (5) Interestingly Swine Flu did not reach epidemic proportions most probably due to “herd” immunity (6) from the prior year’s sub-clinical outbreak.
I monitored the Ebola outbreak starting in 2014 and advocated for the designation of regional centers as even as community hospitals “marketed” their preparedness. (7)
While I was not involved in Super Storm Sandy in 2015, the new Jersey City Medical Center opened in 2004 was hard hit even though it had been built to withstand the “100 year flood plain.” The hospitals in Hoboken and nearby North Bergen were totally evacuated.
While it may be true that “no battle plan ever survives the first encounter with the enemy” (8), plans for “New” types of emergencies are always needed as a starting point.
I taught an MBA/ MPA/ MPHA course “Project Management. The hardest part about getting started……is getting started.” The public needs confidence that OPIOD CRISIS planning is underway.
POSTSCRIPT
Bronx-Lebanon Hospital Siege Offers Counterterrorism Lessons (9)
1. Donald Rumsfeld. “There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know.”
2. http://www.nydailynews.com/new-york/queens/laguardia-airport-bombing-kills-10-1975-article-1.2454144
3. http://news.bbc.co.uk/onthisday/hi/dates/stories/february/26/newsid_2516000/2516469.stm
4. http://www.nytimes.com/2001/09/22/nyregion/schundler-assails-new-jersey-s-response-to-terrorist-attack.html
5. http://www.nj.com/hobokennow/index.ssf/2009/08/hoboken_creates_swine_flu_task.html
6. http://www.vaccinestoday.eu/vaccines/what-is-herd-immunity/
7. http://hudsonreporter.com/view/full_story/25983889/article-Ebola–Local-medical-professional-releases-paper-on-what-to-do
8. http://www.lexician.com/lexblog/2010/11/no-battle-plan-survives-contact-with-the-enemy/
9. https://www.nytimes.com/2017/08/24/nyregion/bronx-lebanon-hospital-siege-counterterrorism-nypd.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
She was triaged and escorted to a treatment room. Then sat there for 45 minutes because the desk never told the doctor she was waiting, even though the ER had a computerized patient tracking system. A COMMUNICATIONS FAILURE.
While standing at the treatment room door, trying to remind the staff she was there, she overheard doctors talking about other patients’ clinical information. A HIPPA (CONFIDENTIALITY) VIOLATION.
A tetanus shot was ordered by the doctor, but it took another 45 minutes for the nurse to show up. A SYSTEMS PROBLEM.
When asked if she had washed her hand, the nurse said she always washed her hands after each patient, and then proceeded to wash her hands. Really? A PATIENT SAFETY ISSUE.
I sent an email to the CEO and got a “form letter” response addressed to the wrong last name. A PUBLIC RELATIONS PROBLEM.
Two weeks later when she touched the punctured area a splinter popped out. When this information was emailed to the ER the email response was “A splinter?! After reading the note and talking to the physician, I was under the impression that the wound was from a “barbeque skewer”. I guess it was not really clarified in the note whether it was metal or wood. I suppose I was just thinking that it was metal.” A CHARTING OMMISSION & A MEDICAL ERROR. AND A DUMB STATEMENT TO PUT IN WRITING!
If this happened to you, what would you have done? Most people just ignore these situations. That is how systems breakdowns become permanent operating procedures.
