“What does a Chief Happiness Officer actually do?” (A)
ASSIGNMENT: Find out which NFP mega-hospital system in your region has the most C-Suite titles and then develop a “reporting relationships” Table of Organization.
For example, here are some corporate leadership pages from New York/ New Jersey*:
PART 3. …the term “CEO” is not long for the world… we should do the business world a huge favor and decide, ahead of time, what term should replace “CEO”
“Everyone’s a Chief “Something” Officer. We used to run companies with a CEO, a president, a CFO, and a few VPs. Then we got COOs, CTOs, CMOs, CIOs, and CAOs. Now we have chief revenue officers, chief strategy officers, chief communications officers, chief performance officers, chief compliance officers, chief creative officers, chief diversity officers, chief visionary officers, it goes on and on. The C-suite can hardly hold all those chiefs and their giant egos. Better build a C-warehouse…
Corporate title inflation. Apple, the world’s most valuable company, has a CEO, a CFO, seven senior vice presidents, and about 70 vice presidents. That’s it. I know companies that are a tiny fraction of Apple’s size with more VPs. Some have several layers of VPs, presidents of divisions, more managers than workers, and every kind of Chief Whatever Officer you can think of. Ever heard “keep it simple, stupid?” It works for organizations, too. Organizational complexity kills companies.” (B)
“What’s driving the expansion of C-suite titles
Erica Seidel, founder of The Connective Good, a recruiting firm specializing in executive marketing, technology and analytic positions, says some of the new titles she has seen include Chief Customer Officer, Chief Growth Officer, Chief Data Officer and Chief AI Officer (AI for artificial intelligence).
Seidel believes the growing list of new C-level titles within B2B marketing reflects a growing professionalism and specialization among business leaders.
“The proliferation of these ‘Chief XXX’ titles is due to a combination of candidates having more clout than employers in a strong economy, titles being free, and talent managing their personal brand as they look ahead to the next step,” says Seidel, “In other words, candidates will often shape how their role is defined and in some cases ask for different titles, and get them as part of the negotiation process.”..
While there is no exact science to determine how the C-suite will continue to grow and expand, it appears businesses are more than happy to embrace new C-level titles. The most confusing aspect may be knowing exactly what the chief officer’s role is within the company as more chief-officer-acronyms are created.
To help, we’ve put together the following list of C-suite titles that fall outside the traditional leadership roles.
Another trend in title inflation is the actual growth of the title itself. Where three words used to be sufficient, we found hundreds of examples of Chief titles with four or more words.
Our longest title in the C-Suite was the Chief Human Resources and Civil Rights Officer role at Oregon Institute of Technology. (Suzette Yaezenko got the nod.)
Runners up for longest Chief titles were: Chief Corporate Communications and Development Officer; Chief Development, Marketing, & Communications Officer; Chief Facilities Design & Construction Officer; Chief Licensure And Field Experiences Officer; Chief Patient Safety and Experience Officer; Chief U.S. Pretrial Services and Probation Officer.
These more detailed titles indicate a level of specificity for the C-suite that is new in recent years. Whereas Chief Officer roles were historically broader with a purview across the entire firm, these very narrow duties combined with a lofty title indicate the importance of the role to the business or organization despite its smaller span of control.
So with that rather exhaustive review of the field, it’s worth asking: why? And why now?
It’s cheaper to give a title than give a raise. Perhaps the most cynical explanation for the ever-expanding grandeur in titles is the economic rationale. For a boss, giving a bigger title costs a lot less money than giving a raise, and may make the recipient just as happy.
We’re status-driven. It’s no secret that humans like to know where they are in the pecking order. A fancy-sound title feels like making it. The sense of having reached the upper echelons can be intrinsically rewarding. And beyond your corporate colleagues, it’s affirming to hear Mom, Dad — and maybe your siblings — be impressed with your new and lofty title… (D)
“Vint Cerf is called many things: a “computer scientist,” one of the “fathers of the Internet,” maybe even occasionally a “smarty pants.” So he wasn’t all that surprised when Google leaders Larry Page, Sergey Brin and Eric Schmidt came up with a new, never-been-used title for him: VP and Chief Internet Evangelist of Google.
“They first asked me what title I wanted, and I said ‘Arch Duke,’” Cerf told me, laughing. “They said, ‘Why don’t you be our Chief Internet Evangelist?’ Anytime you get a chief something it is a measure of respect.”
Cerf says the designation is fairly accurate, as he travels the world speaking with others about Internet connection, investment, policies and developments. He often hears: “That’s the most interesting title I’ve ever heard!” It has, however, backfired. On a trip to Russia, Cerf was asked four times in five days if he believed in God. He soon realized that they understood the term “evangelist” as a religious preacher. “I’m Geek Orthodox,” Cerf replied.” (E)
“… Some companies like to craft new positions with fancy titles just in order to appear like they’re paying attention to a particular business function. Others use C-level titles to combat the shortage of high-level talent in sought-after fields. CEOs and recruiters figure that if they give someone a “Chief Something” title, instead of a more-traditional VP or SVP role, an on-the-fence job candidate might be more likely to sign on the dotted line.
There are definite downsides to making everyone in your organization a chief. First, it can easily slow down decision making. Give someone a grandiose title, and you increase the risk that a needlessly large department or sub-organization will bloom underneath them to justify their high title. Bureaucracy sets in.,,
Naming too many C-level executives can also muddy a company’s focus. According to this write-up on online-education site Study.com, for example, the role of a corporate “chief listening officer” is “monitoring both external and internal communications about organizations,” including social-media channels. The role’s “primary focus is on gathering information from customers and employees in order to develop ways for an organization to enhance their relationships with both.”..
Finally, C-level fever can make corporate cultures sick, too. If CEOs hand out “chief” titles like candy in response to every new business trend, how will that make everybody else feel? Whenever I’ve done this myself as a CEO, hoping to cement a great performer in their role, it’s just led to more people coming to me with their hands out, looking for their own shiny titles. Plus, the trickle-down effect can make an otherwise logical org chart look more like a bank’s, where everyone’s a vice president and titles mean little… (F)
“When it comes to job titles, we live in an age of rampant inflation. Everybody you come across seems to be a chief or president of some variety. Title inflation is producing its own vocabulary: “uptitling” and “title-fluffing”. It is also producing technological aids. One website provides a simple formula: just take your job title, mix in a few grand words, such as “global”, “interface” and “customer”, and hey presto…
Does any of this matter? Title inflation clearly does violence to the language. But isn’t that par for the course in the corporate world? And isn’t it a small price to pay for corporate harmony? The snag is that the familiar problems of monetary inflation apply to job-title inflation as well. The benefits of giving people a fancy new title are usually short-lived. The harm is long-lasting. People become cynical about their monikers (particularly when they are given in lieu of pay rises). Organisations become more Ruritanian. The job market becomes more opaque. How do you work out the going rate for “vision controller of multiplatform and portfolio” (the BBC)? Or a “manager of futuring and innovation-based strategies” (the American Cancer Society)?
And, far from providing people with more security, fancy titles can often make them more expendable. Companies might hesitate before sacking an IT adviser. But what about a chief scrum master? The essence of inflation, after all, is that it devalues everything that it touches.” (G)
“Left to the chaos of a non-standardized organization (especially with a decentralized HR function), everyone does their own thing (which is to give out titles without much structure or consistency). Then someone in the org runs a report, and discovers the mailroom services guy is an AVP (Associate Vice President for all you non-title inflators out there).
You know the drill, especially if you have spent time in a larger company. What follows the AVP of Mailroom Services discovery is a title standardization campaign leaving many (and I mean many) employee relations issues (hard feelings) as titles are stripped away and replaced by more realistic tags describing what the employees actually do (or as close as they can get).
Been through some of that – it’s always much better to provide a little resistance up front and make sure all in the org are on board before handing out inflated titles. Best place to start? No manager titles if the person doesn’t manage direct reports, and no Director or VP titles if the person doesn’t manage managers who have direct reports (multiple layers in their organization).” (H)
“Especially in big companies, Campbell says, too many title promotions can lead to cynicism about what these new titles really mean. “A company does need to be frugal. Not everyone can be above average. Firms should be deliberate about how they give these title awards out to employees, because each additional person who gets a C-level title dilutes the currency” of the title structure…
Stevenson offers one final explanation for title inflation. She wonders whether the people pushing for higher titles are “the same ones who, as students, pushed for ‘A’s and caused grade inflation. Now they are making it into the corporate world and they want big titles.” She recalls a psychological study that looked at students from 1970 through today and concluded that the more recent entrants into the job market are significantly more spoiled and self-absorbed than their predecessors. The people who are getting inflated titles, she says, “could be part of what is an increasingly narcissistic generation.”(I)
“Today, there are signs that the “CEO” title is losing its luster. First, many CEOs are tacking “President” and “Chairman” onto their business card, as if they felt that “CEO” wasn’t special enough. Second, there’s been an explosion of bargain-basement “C-level” executives like “Chief Marketing Officer”, “Chief Sales Officer”, “Chief Ethics Officer”, “Chief Environmental Officer”, and so forth. That cheapens the “CEO” title, just like the “VP” explosion cheapened the “President” title.
We must therefore conclude that the term “CEO” is not long for the world. Since it’s absolutely critical to the success of a corporation that the top executive feel as if he were a god among mortals (hence the obscene pay packages), we should do the business world a huge favor and decide, ahead of time, what term should replace “CEO.”” (J)
_________________
Some examples of C-Suite title inflation in health care:
Becker’s Hospital Review is pleased to recognize 32 chief population health officers at hospitals and health systems across the country.
The individuals featured here lead initiatives for their organizations focused on improving the health and wellness in their communities. Many of their efforts have served as models for other organizations nationwide, effectively working with at-risk populations to reduce preventable disease, manage chronic illness and overcome negative social determinants of healthcare.
As the role of digital technology has grown in hospitals and health systems in recent years, so too has the need for a dedicated executive to oversee all things digital…
In a health system, the CDO is responsible for overall digital transformation. Whereas a CIO oversees the technical implementation and operation of information systems, clinical systems, revenue cycle, analytics and more, the CDO operates on more of a cultural level, developing a digital strategy for an organization, fostering innovation and bringing automatization and other digital initiatives to the health system.
Though the CIO and CDO may experience some overlap in their roles and should certainly work in close partnership to further a health system’s digitalization, many experts recommend that the roles remain separate, rather than being combined into one position.
Tamarah Duperval-Brownlee is Ascension’s first chief community impact officer, which means she is in charge of helping guide the hospital operator’s new strategic vision to reimagine the best way to care for those in communities across the country. Duperval-Brownlee, a family physician, is responsible for helping Ascension pivot away from its focus on hospital campuses to better care for patients outside hospital settings.
The University of Texas MD Anderson Cancer Center in Houston has selected David Jaffray, PhD, to serve as its inaugural chief technology and digital officer.
In his new role, Dr. Jaffray will be responsible for the strategic design, acquisition, management and implementation of a technology infrastructure enterprisewide as well as data governance and data management.
The American Medical Association has selected Aletha Maybank, MD, to serve as its inaugural chief health equity officer.
As chief health equity officer at the AMA, Dr. Maybank will establish the organization’s Center for Health Equity, which will focus on ingraining the notion of health equity within the AMA as part of its processes, innovation and organizational performance.
The county’s dominant health system is creating a new executive position in response to safety violations at its flagship hospital.
In one incident, a cognitively impaired patient wearing staff scrubs walked out of Lancaster General Hospital at night and was found across town at UPMC Pinnacle Lancaster.
The Pennsylvania Department of Health report said after the Feb. 15 citation — the hospital’s third in a year — Penn Medicine Lancaster General Health president and CEO Jan Bergen called an emergency meeting of system leaders…
The report also says Bergen decided to create a new position of Chief Operating and Integration Officer to oversee all clinical operations, and a national search is being conducted to fill it.
Wilmington, Del.-based Christiana Care Health System tapped Lisa Maxwell, MD, to serve as chief learning officer.
As chief learning officer, Dr. Maxwell will lead Christiana Care’s Institute for Learning Leadership and Development as well as oversee learning efforts across the system.
Susan Fuehrer, VA Northeast Ohio Healthcare System director and CEO, is retiring from that job to become the MetroHealth System’s president of social determinants of health and health equity.
Fuehrer, 56, will lead MetroHealth’s initiatives to address the root causes of health disparities and eliminate barriers that keep people from accessing high-quality health care. Her job will involve engaging MetroHealth’s community partners to connect Clevelanders to health care with the goal of ending health disparities.
As Chief Clinical Transformation Officer at Horizon Blue Cross Blue Shield of NJ, it’s my responsibility to work with New Jersey’s doctors and health systems to develop innovative strategies that improve health care quality, affordability and the experience for our members.
Kaylan A. Baban, MD MPH is Chief Wellness Officer and Assistant Professor of Medicine at the George Washington University School of Medicine and Health Sciences, and Director of the Lifestyle Medicine program at the GW Medical Faculty Associates. She is board-certified in Preventive Medicine and Lifestyle Medicine with a focus on holistic care and patient empowerment.
Dr. Baban’s research and curricular efforts address mindful provision of healthcare and digital health for prevention, patient empowerment, and optimized health outcomes. She currently leads a mixed methods evaluation of individualized lifestyle management for primary and secondary prevention of non-communicable conditions.
Cleveland Clinic has appointed Semih Sen chief business development officer, a newly created position.
In his new role, Mr. Sen will identify and drive new business opportunities, develop plans for new growth initiatives and build strategic partnerships and alliances. He will also head Cleveland Clinic Innovations, the commercialization arm of Cleveland Clinic.
ASSIGNMENT:
You are the head of the Department of Public Health Sciences, The University of
Texas at El Paso and have been “volunteered” to develop a Rapid Response
“shadow” licensing program for the new Carrizo Springs, Texas “emergency”
shelter which will house as many as 1,600 teens.
“What are the basic rules that determine how immigrant
children are treated in U.S. immigration detention?”..
In the 1980s, the Reagan administration aggressively used
detention of Central Americans as a device to deter migration from that region,
where violent civil wars had caused tens of thousands to flee…
One suit was filed by the American Civil Liberties Union in
1985 on behalf of Jenny Lisette Flores, a 15-year-old from El Salvador. She had
fled violence in her home country to live with an aunt who was in the U.S.
But Flores was detained by federal authorities at the U.S.
border for not having proper documentation permitting her to stay in the U.S…
But the primary legacy of the case was the subsequent
settlement, to which both the Clinton administration and the plaintiffs agreed
in 1997.
The Flores settlement established basic standards for the
treatment of unaccompanied minors who were in the custody of federal
authorities for violating immigration laws.
It requires the federal government to place children with a
close relative or family friend “without unnecessary delay,” rather than
detaining them; and to keep immigrant children who are in custody in the “least
restrictive conditions” possible. Generally speaking, this has meant migrant
children can be kept in federal immigrant detention for only 20 days…” (A)
“Bleak scenes of tearful, malnourished children reeking of
filth and jammed into frigid, overcrowded quarters have emerged in new accounts
from immigrant rights lawyers, who conducted dozens of interviews with children
inside Border Patrol stations across Texas…
Immigrant rights lawyers, just hours after the tour,
petitioned a federal judge to order additional oversight of Border Patrol
holding facilities across Texas, where migrant children are being held.
The filing asked the court to require immediate inspections
of the facilities by public health experts and accused the federal government
of violating standards for detained migrant care established in a court
settlement. The advocates also sought to have detained children released to
parents or other relatives living in the U.S…
On Friday, U.S. District Judge Dolly Gee ordered the court
monitor overseeing the settlement to bring the migrant lawyers and the federal
government together for mediation. She said the monitor may appoint “an
independent public health expert” to address conditions in facilities, if
she deems that is necessary. Both parties are to file status reports by July
12.” (B)
“Citing the Flores Settlement Agreement, which requires the
U.S. government to ensure “safe and sanitary” conditions for migrant
children in federal custody, attorneys…. “the children need immediate
access to emergency care and improved living conditions to prevent more illness
and even death.”..
In an interview with The Washington Post, Peter Schey, who
has been litigating the ongoing case since its initial filing in 1985, said
Wednesday’s filing represented the first time attorneys have felt the need to
seek emergency relief from a judge.” (C)
“Lawyers are particularly concerned about the spread of
illness inside Border Patrol facilities, which can sometimes turn fatal. Five
children have died in Border Patrol custody since December, some of whom were
initially diagnosed with a common cold or the flu. The processing center in
McAllen, known as Ursula, recently quarantined three dozen migrants who were
sick after a 16-year-old died of the flu at the same facility…
Dr. Julie Linton, the co-chair of the American Academy of
Pediatrics, previously told HuffPost that children can’t recover from illnesses
in Border Patrol facilities. These centers are described as “hieleras” ―
Spanish for iceboxes ― because of their freezing temperatures, and migrants
describe sleeping on floors under bright lights that shine 24/7, with nothing
but Mylar blankets to keep warm…” (D)
“More than 200 migrant children detained in a remote Border
Patrol station in southwest Texas without adequate food, water and sanitation
have been moved after news of the conditions became public last week…
A law professor who recently visited the facility, Warren
Binford of Willamette University, described the conditions for children in an
interview with NPR’s Lulu Garcia Navarro.
“Many of them are sleeping on concrete floors,
including infants, toddlers, preschoolers. They are being given nothing but
instant meals, Kool-Aid and cookies — many of them are sick. We are hearing
that many of them are not sleeping. Almost all of them are incredibly sad and
being traumatized. Many of them have not been given a shower for weeks. Many of
them are not being allowed to brush their teeth except for maybe once every 10
days. They have no access to soap. It’s incredibly unsanitary conditions, and
we’re very worried about the children’s health.”” (E)
“U.S. government officials say they’ve moved more than 100
kids back to a remote border facility where lawyers reported detained children
were caring for each other and had inadequate food, water, and sanitation.
An official from U.S. Customs and Border Protection said
Tuesday that the “majority” of the roughly 300 children detained at Clint,
Texas, last week have been placed in facilities operated by the Office of
Refugee Resettlement.
The official, who briefed reporters on the condition of
anonymity, wouldn’t say exactly how many children are currently detained there.
But the official says Clint is better equipped than some of the Border Patrol’s
tents to hold children…” (F)
“About half of the roughly 2,300 children confined in a
privately run Florida facility intended as a temporary shelter for migrant teenagers
have been there for more than 20 days and many of them for months, despite
legal standards that require children who cross the border to be speedily
released or sent to state-licensed shelters that are equipped to offer
longer-term care.
The Homestead center near Miami, the only one in the
government’s large network of shelters run by a private, for-profit
corporation, is intended to keep children for only a few days, but has been
holding them for much longer as a result of the unusually large number of
unaccompanied children arriving in recent months along the southwest border…
Children living at Homestead have complained that it is
extremely crowded and noisy, and that they enjoy no privacy, according to
reports filed with a federal court. They report feeling increasingly despondent
because they have no idea when they will be released, lawyers said. Rules
prohibit them from listening to music or writing in a journal. Some reported
having suicidal thoughts.
Amy Cohen, a psychiatrist who has visited the facility, said
the noise level was extremely high, especially in a tent with no soundproofing
where “children are crammed” and teachers must use microphones to be heard
above the noise…
Immigrant advocates have gone to court to argue that
Homestead should be required to meet the rigorous standards established for
detaining migrant children — though government officials argue that the
facility, operated as a temporary “influx” shelter, not a detention center, is
not legally required to do so.
Under those standards, established under a 1997 consent
decree, children must generally be released within about 20 days, or
transferred to a licensed shelter that has comfortable living accommodations
and a full education program.
Costing over $1 million a day to operate, Homestead opened
in February… “ (G)
“Maintenance reportedly eats up most of the $775 daily cost
per child for the tent camps, since it’s difficult to keep temporary structures
suitable for humans in a desert. In permanent facilities run by Health and Human
Services, the cost is $256 per person per night, and NBC News estimates that
even keeping children with their parents and guardians in Immigration and
Customs Enforcement facilities would only cost $298 per night…
“…Southwest Key Programs, a nonprofit that set up a boys’
shelter in the husk of an old Walmart, reportedly netted $955 million in
federal contracts between 2015 and 2018, according to The New York Times. A
network of nonprofit groups, BCFS, reportedly received $179 million in the same
time period. BCFS is the same contractor that held migrant kids in parked vans
for 39 hours earlier this year, as ICE slowly did the paperwork to reunite the
children with their families” (H)
“Hundreds of migrant children being transferred from
squalid, overcrowded Border Patrol detention centers are heading into the
custody of a federal refugee agency that’s already struggling to feed and care
for tens of thousands of minors…
The refugee office’s shelters have taken in more than 52,000
children since October — a 60 percent jump from the previous year, driven by a
record influx of migrants and complicated by the Trump administration’s
aggressive border policies. Its parent agency, the Department of Health and
Human Services, is pursuing strategies to cope with the surge, which include
freezing money for anti-trafficking efforts and services for survivors of
torture, and possibly furloughing employees.
The crunch is also slowing HHS’s oversight of shelters,
efforts to expand the number of beds and attempts to unite migrant children
with sponsors in the United States…
“This historical influx is challenging the capacity of the
federal government to shelter UAC [unaccompanied alien children] and presents
child welfare concerns beyond the treacherous journey that these minor children
take across the southern border,” said an HHS spokesperson in an emailed
statement…
“It’s a very difficult time,” an HHS official told
POLITICO. “The program grew faster than we were ready.” (I)
“A federal judge has ordered a mediator to move swiftly to
improve health and sanitation at Border Patrol facilities in Texas, where
observers reported migrant children were subject to filthy conditions that
imperiled their health.
Judge Dolly M. Gee of the Central District of California
asked late on Friday that an independent monitor, whom she appointed last year,
ensure that conditions in detention centers are promptly addressed. She set a
deadline of July 12 for the government to report on what it has accomplished
“post haste” to remedy them…
The new order stopped short of directly ordering the
government to take action but referred the issue to the monitor to take action
for the “prompt remediation” of conditions at the facilities, included the
retention of an independent public health expert…
In her order, Judge Gee said that the court had detailed
previous violations by the government of a 1997 consent decree, called the
Flores settlement agreement, which established standards for the care of
migrant children in its custody. A monitor had been appointed last year over
the government’s objections after plaintiffs in the Flores case successfully
argued that there had been egregious violations of the agreement…
The “emergent” nature of the recent reports “demands
immediate action,” the judge added…
The motion for a temporary restraining order asked the court
to mandate immediate inspection of facilities in McAllen, Clint and Weslaco,
all in Texas, by a public health expert. It also requested that medical
professionals obtain access to those facilities and that the government speed
up the release of children detained at the facility to sponsors — mainly
parents or relatives in the United States.” (J)
“A federal judge has ordered U.S. Customs and Border
Protection (CBP) to allow medical professionals into detention facilities
holding migrant children, CNN reported Sunday.
U.S. District Judge Dolly Gee ordered that health
professionals be allowed in the facilities to ensure the conditions are
“safe and sanitary” for children being detained there and to assess
the children’s medical needs.
The order pertains to all of CBP’s facilities in the El Paso
and Rio Grande Valley sectors in Texas, CNN reported. The centers are the
subject of a lawsuit regarding the 1997 Flores Settlement Agreement and reports
of unsafe and unsanitary conditions at detention centers.” (K)
“By the time Dr. Roberto “Bert” Johansson saw the
toddler in the emergency room, she was vomiting, feverish, dehydrated and
desperately ill with acute gastroenteritis.
The girl had been in Border Patrol custody for two days
before agents rushed her to El Paso Children’s Hospital. Johansson told CNN he
admitted her and put her on an IV line, fluids and other treatment.
“She lived, but her illness had been missed,” he
said of that day three months ago. “We need to get to these kids
earlier.”..
But Johansson, a pediatrician who specializes in emergency
medicine and intensive care, says there’s another pressing problem: The medical
screening the Border Patrol gives to undocumented children is “absolutely,
unequivocally inadequate.”” (L)
BREAKING NEWS.
“Health officials at the University of New Mexico are designing a program to
help treat sick migrants – many of them seeking asylum – being detained in
crowded government facilities near the border.
Dr. Sanjeev Arora, director of Project ECHO – Extension for
Community Healthcare Outcomes – at the University of New Mexico Health Sciences
Center, said that an ECHO program to help treat migrants in facilities near the
Mexican border is being developed and should be up and running in the coming
weeks.
“There are children and people (at the border) who are
housed in government facilities who need health care, and there isn’t enough
expertise there,” Arora said. “We are going to bring our existing resources to
bear and start an ECHO for them.”..
ECHO programs, which now total in the hundreds and reach
worldwide, are essentially video teleconferences where specialized experts of a
topic share knowledge with health care providers in areas where health
officials don’t have the same expertise, especially rural areas.
Instead of one doctor being able to treat one patient
through videoconference, the sharing of knowledge allows the number of patients
helped to grow exponentially, Arora said.” (M)
PART 16. June 21, 2019. “The federal government is
opening a new MASS FACILITY TO HOLD MIGRANT CHILDREN, a temporary emergency
shelter that will not be subject to state child welfare licensing
requirements.”
“Are you arguing seriously that you do not read the [Flores]
agreement as requiring you to do anything other than what I just described:
cold all night long, lights on all night long, sleeping on concrete and you’ve
got an aluminum foil blanket?”
HHS..”instructed officials to cut programs “not directly
necessary for the protection of life and safety,” a spokesperson for the HHS
said, according to the Washington Post. These services include English classes,
recreational programs like soccer, and legal aid,…”
Statement from the American Public Health Association and
Trust for America’s Health
“As public health professionals we know that children living
without their parents face immediate and long-term health consequences. Risks
include the acute mental trauma of separation, the loss of critical health
information that only parents would know about their children’s health status,
and in the case of breastfeeding children, the significant loss of maternal
child bonding essential for normal development. Parents’ health would also be
affected by this unjust separation.
“More alarming is the interruption of these children’s
chance at achieving a stable childhood. Decades of public health research have
shown that family structure, stability and environment are key social
determinants of a child’s and a community’s health.
“Furthermore, this practice places children at heightened
risk of experiencing adverse childhood events and trauma, which research has
definitively linked to poorer long-term health. Negative outcomes associated
with adverse childhood events include some of society’s most intractable health
issues: alcoholism, substance misuse, depression, suicide, poor physical health
and obesity.” (T)
“Migrant children are
increasingly resorting to sleeping outside of border patrol stations because
the agency charged with sheltering them, the Department of Health and Human
Services, has been overwhelmed by the influx of asylum-seekers, NBC News
reported Tuesday.
HHS, which is reportedly operating at 97 percent capacity,
is responsible for caring for the record number of migrant children that are
arriving at the border each day until they can be placed with a sponsor. As
reports of a humanitarian crisis at the border continue to mount, HHS officials
have urged Congress to provide more resources for the provision of medical care
and shelter.
As of May 31, 1,448 unaccompanied migrant children have
remained in border patrol custody for at least 72 hours, the maximum time
allotted by law, while waiting to be transferred to HHS, according to NBC News.
In total, 1,402 unaccompanied migrant children have been
processed by border patrol and are now waiting to be transferred to a HHS
facility, where are they supposed to receive a bed and support from a social
worker.
The children often resort to sleeping on concrete slabs or
outside the border patrol stations while they await transfer to an HHS facility
that corresponds to their gender and age. The influx of women and children
arriving at the border in recent months has delayed this process as HHS lacks
adequate housing to accommodate a population that is no longer comprised mostly
of single adult males as it once was.” (A)
“The federal government is opening a new mass facility to
hold migrant children in Texas and considering detaining hundreds more youths
on three military bases around the country, adding up to 3,000 new beds to the
already overtaxed system.
The new emergency facility in Carrizo Springs, Texas, will
hold as many as 1,600 teens in a complex that once housed oil field workers on
government-leased land near the border, said Mark Weber, a spokesman for Office
of Refugee Resettlement.
The agency is also weighing using Army and Air Force bases
in Georgia, Montana and Oklahoma to house an additional 1,400 kids in the
coming weeks, amid the influx of children traveling to the U.S. alone. Most of
the children crossed the border without their parents, escaping violence and
corruption in Central America, and are held in government custody while
authorities determine if they can be released to relatives or family friends.
All the new facilities will be considered temporary
emergency shelters, so they won’t be subject to state child welfare licensing
requirements, Weber said. In January, the government shut down an unlicensed
detention camp in the Texas desert under political pressure, and another
unlicensed facility called Homestead remains in operation in the Miami
suburbs.” (B)
“The Trump administration is scaling back services for unaccompanied
minors who cross the US-Mexico border, citing budget constraints after a surge
in crossings not seen in over a decade.
The Trump administration is struggling to deal with the
number of migrants entering the US, and has placed much of the blame for
insufficient services and even several recent deaths of migrant children onto
migrants themselves.
According to new data released by Customs and Border
Protection, 109,144 people were taken into custody last month, nearly 9,000 of
them unaccompanied children.
The Trump administration is slashing support and services
for unaccompanied minors who cross the US-Mexico border, citing budget
constraints after a surge in crossings not seen in for more than a decade.
The Office of Refugee Resettlement (ORR), which is part of
the Department of Health and Human Services (HHS) and provides housing and
resources for migrant children, has instructed providers to suspend funding for
certain programs.
It instructed officials to cut programs “not directly
necessary for the protection of life and safety,” a spokesperson for the HHS
said, according to the Washington Post. These services include English classes,
recreational programs like soccer, and legal aid, the Post said.” (C)
“The government’s plans were swiftly rebuked by civil rights
lawyers representing unaccompanied children, who have been crossing the border
in ever-larger numbers this year to flee poverty and violence in their home
countries, mainly in Central America. And the chief of at least one large
shelter operator said he would continue to offer education and sports at his
network’s facilities.
Some 13,200 migrant children, including adolescents who
crossed the border alone and young children who were separated from their
parents, are currently housed in more than 100 shelters across the country.
They receive English instruction, as well as math, civics and other classes.
Most facilities have a sports field and allow children to go outside, often to
play soccer, at least once a day…
Civil rights and child welfare advocates said that any move
by the government to eliminate education and recreation would constitute a
violation of the Flores settlement, which in 1997 established the standards for
treating migrant children held in government facilities, and would prompt them
to sue for reinstatement of the activities.
“If this administration goes forward with denying education,
recreation and other unspecified so-called nonessential services, it would be
in flagrant violation of the Flores settlement and will face immediate legal
action,” said Neha Desai, co-counsel on the settlement decree, who visits
government shelters to ensure compliance. She is also the immigration director
at the National Center for Youth Law in Oakland, Calif.
“To those of us whose job it is to promote the health and
safety of children, this is a shocking directive,” said Amy Cohen, a
psychiatrist who consults for the Flores team and regularly interviews children
at shelters. “It violates every tenet of basic child welfare practice and will further
harm the medical and psychological health of children fleeing extraordinarily
dangerous circumstances in their home countries.”…
“We have not and we
are not going to curtail recreation and education. We just can’t do that,” said
Kevin Dinnin, president of BCFS, the second-largest shelter network, which
houses about 1,000 children in facilities in Texas. “We will have to use
reserve funds until the government figures out what they are going to do.” (D)
“For the past year and a half, Dr. Eric Russell has been
traveling from Houston to McAllen, Texas, every three months or so to volunteer
at the Catholic Charities Humanitarian Respite Center, a first stop for many
asylum-seeking migrants who’ve been released by U.S. Customs and Border
Protection in the Rio Grande Valley.
During his most recent visit to the clinic in April, when he
saw more than 150 migrants, he noted a troubling new trend: a number of people
reported that their medication had been taken from them by U.S. border
officials.
“I had a few adults that came who had high blood pressure,
who had their blood pressure medications taken from them and, not surprisingly,
their blood pressure was elevated,” Russell told Yahoo News. “There was a
couple of adults that had diabetes that had their diabetes medicines taken from
them, and wanted to come in because they were worried about their blood sugar.
And, not surprisingly, their blood sugar was elevated.”
For Russell, a pediatric emergency medicine physician, the
patient who stood out the most during that visit was a boy of 8 or 9 with a
history of seizures. According to his mother, the child had been on a long-term
seizure medicine in their home country, but the medication had been taken from
him upon entering the Border Patrol custody in McAllen and never returned…
“My concern is,
what’s going to happen if you put a 9-year-old child who has a history of
seizures, without any seizure medicine on a bus for 3 days … is that he’s going
to have a seizure,” Russell said.
Russell added that he can understand the need for a policy
regarding the use of outside medication by detainees. However, he said, “At the
end of the day, as a medical provider, as a physician, we take an oath to first
do no harm. And taking somebody’s medications seems like it’s causing harm.”…
In light of these deaths, the American Academy of
Pediatrics, along with other child health and welfare experts, have offered a
number of recommendations for how CBP can improve the care of migrant children
in its custody, which include ensuring access to screenings and treatment by
medical professionals who know how to recognize and respond to the subtle yet
often rapidly worsening signs of illness in children.
“The AAP has been in discussions for months with [CBP] about
increasing the number of pediatric-trained providers that are at these large
processing centers,” said Griffin. However, information provided by CBP
officials suggests the agency has yet to heed the AAP’s advice as it expands
contracted medical services across the southwest border.” (E)
“The government agency that takes custody over all
unaccompanied minors who arrive on the border has been unable to answer
questions about the number of children who have died in its custody in the
years since President Donald Trump took office.
When children who are traveling by themselves either ask for
asylum at ports of entry or are apprehended by Border Patrol, they are
eventually transferred into the custody of the Office of Refugee Resettlement.
ORR—an agency within the Department of Health and Human Services
(HHS)—maintains a series of shelters for the unaccompanied minors, many of
which are run by independent contractors…
On May 23rd, Pacific Standard sent an email to HHS asking
if, since 2016, any other children had died in ORR custody that the public had
not been made aware of. A media contact in the HHS’s Administration for
Children and Families office confirmed that the email had been received, and
said: “[The] inquiry is with the program office for response—we’ll get the
information back to you just as soon as we have it.”
HHS never got back to Pacific Standard’s inquiry, nor to two
subsequent inquiries sent the next day and again on June 5th…
Jennifer Podkul, the senior director of policy and advocacy
for Kids in Need of Defense—an advocacy organization for immigrant
children—says it’s plausible that there are more children who have died than
the public is aware of.
“It’s certainly possible,” Podkul says. “I don’t have any
specific information about specific cases [that have’t been reported], but
there are a few reasons why I say it’s plausible: One is that there’s no
mandatory reporting requirement for ORR, unlike ICE. And the other reason,
that’s really important, is that ORR doesn’t have any sort of public monitoring
system.”
According to Podkul, though ORR and HHS completes reviews of
the facilities they run for children—both those run by the government and those
run by contractors—those sorts of audits aren’t released to the public.” (F)
“A 16-year-old from Guatemala died of complications of the
flu while in U.S. Border Patrol custody, according to preliminary autopsy
findings, alarming doctors who questioned whether immigration authorities
missed warning signs or chances to save his life.
Carlos Hernandez Vasquez contracted bacterial infections in
addition to the flu, as well as sepsis, which can lead to tissue damage and
organ failure, according to a report released by Hidalgo County authorities
this week. He died May 20. A full autopsy is pending.
Carlos is the sixth child in the last year to die after U.S.
border agents detained him, and the second known to have died of the flu, after
8-year-old Felipe Gómez Alonzo died on Christmas Eve…
“By the time you’re
16 years old, you have great immunity, and you shouldn’t be dying so quickly,”
said Dr. Nizam Peerwani, the Tarrant County medical examiner in Fort Worth,
Texas, and an adviser for the advocacy group Physicians for Human Rights.
Peerwani said Carlos’ rapid deterioration raised questions
about whether he may have had potential symptoms including a fever, body aches,
or breathing trouble before the Border Patrol says he reported being sick.
He should have been taken to a medical facility or clinic
instead of remaining in detention, Peerwani said.
Dr. Julie Linton, co-chair of the American Academy of
Pediatrics’ immigrant health special interest group, also said the prescription
of Tamiflu may not have been enough treatment, especially since the medicine
works best in the first two to three days of illness. While Carlos’ illness was
discovered the day before his death, he may have sick well before then, she
said. “We cannot treat Tamiflu as a substitute for the other care that is
required,” Linton said.
Doctors who treat the flu rely on a patient telling them how
long they’ve had symptoms. Linton pointed out that the processing center where
Carlos was detained has the lights on 24 hours a day, which may have made it
difficult for him to know how long he had been sick.” (G)
“County health officials announced Thursday that the
influenza outbreak at a local migrant shelter continues to worsen with 22 new
cases of flu or flu-like symptoms.
The total number of confirmed flu and “influenza-like
illness” since May 19 among asylum-seeking migrants at a shelter in Bankers
Hill operated by Jewish Family Service of San Diego now stands at 81. Officials
with the county’s Health and Human Services Agency confirmed 12 new cases on
both Tuesday and Wednesday.
In addition, the county has quarantined 63 asylum seekers at
various local hotels to try to contain the outbreak. Two asylum seekers at the
shelter have been transported to the hospital due to their flu symptoms,
according to the county. Health officials have screened roughly 450
asylum-seeking migrants at the shelter for symptoms since May 19.
The county defines an outbreak as one person contracted an
illness and a second person contracting it and showing symptoms within 72
hours. The county first declared the outbreak May 23…
Cases of flu and chicken pox have afflicted immigrant
detention facilities for months, with some detained infants and children
showing fevers of up to 105 degrees. CBP agents temporarily closed processing
functions at the McAllen facility last week amid a flu outbreak, during which
it quarantined more than 30 detainees, according to the Washington Post.
The flu has also caused multiple deaths among detainees at
the border in the last six months. Immigration officials confirmed the
flu-related death of a 16-year-old Guatemalan boy at the McAllen facility last
week, the fifth Guatemalan child to die in federal custody since December and
at least the second to die from flu complications.
The county said it plans to continue monitoring the
situation and providing updates on new flu cases at the shelter. County health
officials are also treating outwardly healthy people at the shelter to prevent
the flu from spreading any further.” (H)
“The recent death of a Guatemalan child after a flu outbreak
at the Customs and Border Protection Centralized Processing Center in McAllen
is unsurprising, according to the American Academy of Pediatrics.
Dr. Julie Linton is the co-chair of the American Academy of
Pediatrics Immigrant Health Special Interest Group. She said processing
facilities and detention centers are no place for children.
Linton said the Ursula Central Processing Center, which is
the largest in the nation, is the type of facility that is a haven for
infectious diseases like flu or tuberculosis and infestations like scabies.
“When you enclose people in close quarters and large spaces,
it’s much more difficult to control the spread of illness,” Linton said. “I
think what we also know, however, is that we have children who are presenting
and asking for medical attention — we have families who are asking for medical
evaluations for their children — and they’re being evaluated, and then after
evaluation they’re being sent back to processing centers.”
Linton said a sick child is not going to do well in those
conditions.
“I’m a pediatrician, and I care for sick children all the
time, and I would never suggest, in healing, a child return to a cold concrete
floor, covered by a silver, mylar blanket which is really more of a sheet, to
heal from their illness, and certainly not in a setting where they’re exposed
to constant stress,” Linton said…
The AAP has created a toolkit to help those who come into
contact with immigrant children to help them get and stay healthy.
The McAllen processing center temporarily closed last week
after medical staff identified 32 other migrants who were experiencing symptoms
of the flu.” (I)
“The deaths of migrant children in U.S. custody raise grave
humanitarian concerns and set off alarms. Medical experts, human rights groups
and children’s advocates long have decried unsanitary and crowded conditions at
the facilities where children and families are detained for days before they
are transferred to shelters or released with notices to appear before a judge.
These experts have warned that the living conditions, coupled with the physical
and traumatic effects of migrants’ grueling journeys here, exact a punishing
toll that endangers the children’s lives.
Castro and other members of Congress have called for a
federal investigation. According to Castro, prior to the deaths over the past
eight months, U.S. Customs and Border Protection had gone more than a decade
without a child dying in its custody.
Federal scrutiny of the immigration detention facilities
holding children and families is urgently needed. Americans deserve a full
accounting of the deaths and a plan for averting more tragedies. The U.S. must
guard its borders, but it must do so responsibly, ensuring the welfare of the
children it holds in its custody. Detaining 10-year-olds in fenced-in pens who
are not a threat to this country and who, with their families, are merely
seeking protection is punitive and not what America stands for. If the
administration cannot adequately care for the children in its custody, it must
re-examine its detention policy.
No investigation can be complete without a thorough vetting
of the administration’s hard-line border enforcement policies, which once
separated thousands of children from their families, literally tearing some
from their parents’ arms, a policy since discarded amid an international
outcry. It may take up to two years for authorities to identify the children,
the federal government said in April. It is no wonder that such a dereliction
of duty leads some to question if children are merely considered collateral
damage in the administration’s crackdown on immigration…
The Border Patrol needs help, agreed Marsha Griffin, a
pediatrician on the South Texas border and a spokesperson for the American
Academy of Pediatrics. “We need to provide them with more and better medical
(staff), especially when it pertains to children,” Griffin told us.
Along with other facets of its border enforcement
crackdowns, the federal government is trying to send a message to deter
migrants from coming, Gilman said.” (J)
“As the Trump administration works to address what it
describes as a growing “crisis” at the U.S.-Mexico border, officials said in a
court filing that it may take two years for the government to identify
thousands of migrant children who were separated from their families.
The filing Friday outlined the government’s plan to use data
analysis and manual reviews to sift through the cases of about 47,000 children
who were apprehended by U.S. immigration officials from July 1, 2017, to June
25, 2018, to identify which children might have been taken from family members.
It estimated the process “would take at least 12 months, and possibly up to 24
months.”
Last month, U.S. District Judge Dana Sabraw expanded the
number of migrant families that the government may be forced to reunite under
his previous order after an inspector general report revealed that the
administration had an undisclosed family separation pilot program in place
starting in July of 2017. The ruling was made as part of a lawsuit led by the American
Civil Liberties Union.
“The administration refuses to treat the family separation
crisis it created with urgency, ” the ACLU said in a statement Saturday. “We
strongly oppose any plan that gives the government up to two years to find
kids. The government swiftly gathered resources to tear families apart. It must
do the same to fix the damage.” (K)
“Rom Rahimian, a medical student working at
Banner-University Medical Center Tucson, was trying to help a 20-year-old
Guatemalan woman who had been found late last year in the desert — dehydrated,
pregnant and already in labor months before her due date. But the Border Patrol
agents lingering in the room were making him uncomfortable.
The agents remained in the obstetrics ward night and day as
physicians worked to halt her labor. They were present during her medical
examinations, listened in on conversations with doctors and watched her
ultrasounds, Mr. Rahimian said. They kept the television on loud, interfering
with her sleep. When agents began pressing the medical staff to discharge the
woman to an immigration detention facility, the doctors took action.
“It was a race against the clock to see if we can get her
into any other situation,” Mr. Rahimian said. He called a lawyer and asked,
“What can we do? What are her rights?”
As apprehensions of migrants climb at the southwest border,
and dozens a day are taken to community hospitals, medical providers are
challenging practices — by both government agencies and their own hospitals —
that they say are endangering patients and undermining recent pledges to
improve health care for migrants.
The problems range from shackling patients to beds and not
permitting them to use restrooms to pressuring doctors to discharge patients
quickly and certify that they can be held in crowded detention facilities that
immigration officials themselves say are unsafe. Physicians say that needed
follow-up care for long-term detainees is often neglected, and that they have
been prevented from informing family members about the status of critically ill
patients. Agency vehicles parked conspicuously near hospital entrances, health
providers say, are also stoking fear and interfering with broader immigrant
care.
Doctors typically do not know what rights they might have to
challenge these practices. At Banner and several other hospital systems across
the country, they have called on administrators to oppose and change security
measures that they view as endangering health..
Health systems, too, maintain policies that doctors say are
problematic. Banner Health, like some others, has a policy that applies equally
to immigration detainees and prisoners. It disallows bathroom privileges,
requires at least two limbs to be secured to beds unless medically inadvisable,
gives agents discretion over whether mothers may visit newborns and obliges law
enforcement officers to remain with patients.” (L)
“A premature newborn baby girl and her 17-year-old migrant
mother were almost entirely ignored and neglected for an entire week while held
by Border Patrol near the Texas border.
Lawyers who visited the immigration processing station in
McAllen, TX, told HuffPost that the one-month-old infant was wrapped in a dirty
towel and wore soiled clothing. The mother was severely underslept,
wheelchair-bound, and unable to walk or lie down due to pain from an emergency
C-section.
The baby was born in Mexico after the mother left Guatemala
for the U.S. while eight months pregnant. Neither mother nor child has been
publicly identified.
According to immigration and human rights attorney Hope
Frye, the mother was taken to a hospital at least once for pain medication, but
the baby had not received any medical care since being placed in Border Patrol
custody.” (M)
“The Trump administration has made its position on
immigration clear as day. But the executive branch’s crackdown on immigration —
legal and otherwise — has come with a cost. A new NBC News analysis found that
24 immigrants died in ICE custody since President Trump took office, and that
figure notably doesn’t include migrants who died while they were detained by
other government agencies.
“What we’re seeing is a reckless and unprecedented expansion
of a system that is punitive, harmful and costly,” Katharina Obser, a senior
policy adviser at the Women’s Refugee Commission, told the news outlet. The
government has filed to provide immigrants in its custody with medical and
mental health care, she added.
The NBC News report comes as the number of migrant children
who die after crossing the U.S.-Mexico border continues to rise. The report
also indicates that the number of immigrants in U.S. custody has recently
reached an all-time high, with about 52,500 immigrants currently in ICE custody
per day.
In a statement provided to NBC News, ICE said that “it takes
very seriously the health, safety and welfare of those in our care,” and that
“any death that happens in ICE custody is a cause for concern.”
So far, at least five migrant children have died after being
apprehended at or near the U.S.-Mexico border since December. A 10-year-old
girl from El Salvador also died in September, although the public did not learn
about her death until May of this year,
per the BBC. The five children who have died since December were all from
Guatemala.” (N)
“The Texas Tribune reports more than 5,800 unaccompanied
migrant children are living in 35 shelters across the state as of last month.
The U.S. government has also reported more than 144,000
migrants were apprehended or denied entry last month, which is a 13-year high.
They say more than half of the families detained had
children. And 8 percent of these migrants are considered to be unaccompanied
minors…
Right now, Texas has 35 state-licensed shelters. The Texas
Health and Human Services Commission says combined, the 35 shelters can
accommodate up to 6,423 children, meaning the state shelters are at about 90
percent capacity.
These migrant children living in federal shelters no longer
have access to English classes, recreational programs, like soccer, and legal
aid, after the Trump Administration decided to cancel these activities due to
budget pressures earlier this month.
The Texas Tribune reported that the director of Hope Border
Institute, Dylan Corbett, told them this decision was.. “a demonstration of
their willingness to use children as pawns in a politically motivated plan to
inflict as much pain as possible.” (O)
“……the administration is taking new steps to deprive the
children it is holding in custody of basic necessities. Last week, the
administration cut funding for education, recreation and legal aid for migrant
children and youth in federal shelters. An estimated 13,200 minors are
currently being held in shelters contracted by the Office of Refugee
Resettlement (ORR). The Children’s Defense Fund recently joined more than 100
other organizations signing on to a letter to the Secretary of HHS and other
federal leaders condemning the decision.
As the letter explains, “It is widely recognized in
international, federal, and state law that children are unique from adults and
should be afforded special protections that support their developmental needs.”
That’s why the Flores settlement, the existing agreement that limits the length
of time and conditions under which federal officials can detain immigrant
children, requires the government to place children in the least restrictive
setting that is in the best interest of the child.
It’s also why the services the administration is taking away
from these children — including English, math, science and reading classes and
outdoor activities such as soccer and basketball — are essential to their
development…
Immigrant children are still children. They are our
children. It doesn’t matter how a child came to be in our country — once they
are here, in the wealthiest and most powerful nation on earth, it is our duty
and our obligation to care for them, support them and give them the opportunity
to grow up and thrive. Instead, we are cruelly stripping away their chance to
learn, to play and to connect. And in the worst and most unforgivable cases, we
are letting them die on our watch.
Even for an administration already known for its cruel
treatment of immigrant children this is another heartless and disgraceful step
too far. We are better than this.” (P)
“A 2-year-old boy locked in detention wants to be held all
the time. A few girls, ages 10 to 15, say they’ve been doing their best to feed
and soothe the clingy toddler who was handed to them by a guard days ago.
Lawyers warn that kids are taking care of kids, and there’s inadequate food,
water and sanitation for the 250 infants, children and teens at the Border
Patrol station.
The bleak portrait emerged Thursday after a legal team
interviewed 60 children at the facility near El Paso that has become the latest
place where attorneys say young migrants are describing neglect and
mistreatment at the hands of the U.S. government.
Data obtained by The Associated Press showed that on
Wednesday there were three infants in the station, all with their teen mothers,
along with a 1-year-old, two 2-year-olds and a 3-year-old. There are dozens
more under 12. Fifteen have the flu, and 10 more are quarantined.
Three girls told attorneys they were trying to take care of
the 2-year-old boy, who had wet his pants and had no diaper and was wearing a
mucus-smeared shirt when the legal team encountered him…
The lawyers inspected the facilities because they are
involved in the Flores settlement, a Clinton-era legal agreement that governs
detention conditions for migrant children and families. The lawyers negotiated
access to the facility with officials, and say Border Patrol knew the dates of
their visit three weeks in advance.
Many children interviewed had arrived alone at the
U.S.-Mexico border, but some had been separated from their parents or other
adult caregivers including aunts and uncles, the attorneys said.
Government rules call for the children to be held by the
Border Patrol for no longer than 72 hours before they are transferred to the
custody of Health and Human Services, which houses migrant youth in facilities
around the country.” (Q)
“Although the conditions in which migrant children are being
detained has prompted widespread outrage, the Trump administration defended its
detention centers in court on Thursday, Newsweek reports. At the 9th Circuit
Court in San Francisco, a Justice Department lawyer said that denying migrant
children soap and toothbrushes, and requiring them to sleep on concrete floors
in cold and crowded rooms, still qualifies as “safe and sanitary” treatment.
This prompted incredulity from several judges at the hearing, according to
Newsweek.
“Are you arguing seriously that you do not read the [Flores]
agreement as requiring you to do anything other than what I just described:
cold all night long, lights on all night long, sleeping on concrete and you’ve
got an aluminum foil blanket?” U.S. Circuit Judge William Fletcher asked. “I
find that inconceivable that the government would say that that is safe and
sanitary.”” (R)
“Fellow Judge A Wallace Tashima remarked: “It’s within
everybody’s common understanding that if you don’t have a toothbrush, you don’t
have soap, you don’t have a blanket, those are not safe and sanitary
conditions” (S)
PART 1. June 18, 2018 “The Trump administration’s
policy of separating parents and children at the U.S.-Mexico border will have a
dire impact on their health, both now and into the future.”
PART 4. June 21, 2018. “The business of housing,
transporting and watching over migrant children detained along the southwest border
is not a multimillion-dollar business. It’s a billion-dollar one…
PART 8. June 26, 2018. White House Press Secretary Sarah
Huckabee Sanders said the government was starting to “run out of
space” to house people apprehended crossing the border
PART 9. June 27, 2018. “…the only way parents can
quickly be reunited with their children is to drop their claims for asylum… and
agree to be deported.”
PART 13. July 5, 2018. “Most immigrants facing
deportation wouldn’t climb onto a table during their court hearings. But then
again, most 3-year-olds don’t go to court without parents or lawyers.
PART 15. December 4, 2018. PUBLIC HEALTH administrators can
transform monumental unique challenges to “rapid response”
opportunities. Think: Hurricanes Florence and Michael, the California
wildfires, the mysterious polio-like illness, the opioid epidemic, mass
shootings, and immigrant family separation.
ASSIGNMENT: You are the head of the Department of Public Health Sciences, The University of Texas at El Paso and have been “volunteered” to develop a Rapid Response “shadow” licensing program for the new Carrizo Springs, Texas “emergency” shelter which will house as many as 1,600 teens.
“Are you arguing seriously that you do not read the [Flores] agreement as requiring you to do anything other than what I just described: cold all night long, lights on all night long, sleeping on concrete and you’ve got an aluminum foil blanket?”
HHS..”instructed officials to cut programs “not
directly necessary for the protection of life and safety,” a spokesperson
for the HHS said, according to the Washington Post. These services include
English classes, recreational programs like soccer, and legal aid,…”
Statement from the American Public Health Association and Trust for America’s Health
“As public health professionals we know that children living without their parents face immediate and long-term health consequences. Risks include the acute mental trauma of separation, the loss of critical health information that only parents would know about their children’s health status, and in the case of breastfeeding children, the significant loss of maternal child bonding essential for normal development. Parents’ health would also be affected by this unjust separation.
“More alarming is the interruption of these children’s
chance at achieving a stable childhood. Decades of public health research have
shown that family structure, stability and environment are key social
determinants of a child’s and a community’s health.
“Furthermore, this practice places children at heightened
risk of experiencing adverse childhood events and trauma, which research has
definitively linked to poorer long-term health. Negative outcomes associated
with adverse childhood events include some of society’s most intractable health
issues: alcoholism, substance misuse, depression, suicide, poor physical health
and obesity.”
PART 16. June 21,
2019. The Trump administration is slashing support and services for unaccompanied
minors who cross the US-Mexico border.
“Migrant children are increasingly resorting to sleeping
outside of border patrol stations because the agency charged with sheltering
them, the Department of Health and Human Services, has been overwhelmed by the
influx of asylum-seekers, NBC News reported Tuesday.
HHS, which is reportedly operating at 97 percent capacity,
is responsible for caring for the record number of migrant children that are
arriving at the border each day until they can be placed with a sponsor. As
reports of a humanitarian crisis at the border continue to mount, HHS officials
have urged Congress to provide more resources for the provision of medical care
and shelter.
As of May 31, 1,448 unaccompanied migrant children have
remained in border patrol custody for at least 72 hours, the maximum time
allotted by law, while waiting to be transferred to HHS, according to NBC News.
In total, 1,402 unaccompanied migrant children have been
processed by border patrol and are now waiting to be transferred to a HHS
facility, where are they supposed to receive a bed and support from a social
worker.
The children often resort to sleeping on concrete slabs or
outside the border patrol stations while they await transfer to an HHS facility
that corresponds to their gender and age. The influx of women and children
arriving at the border in recent months has delayed this process as HHS lacks
adequate housing to accommodate a population that is no longer comprised mostly
of single adult males as it once was.” (A)
“The federal government is opening a new mass facility to
hold migrant children in Texas and considering detaining hundreds more youths
on three military bases around the country, adding up to 3,000 new beds to the
already overtaxed system.
The new emergency facility in Carrizo Springs, Texas, will
hold as many as 1,600 teens in a complex that once housed oil field workers on
government-leased land near the border, said Mark Weber, a spokesman for Office
of Refugee Resettlement.
The agency is also weighing using Army and Air Force bases
in Georgia, Montana and Oklahoma to house an additional 1,400 kids in the
coming weeks, amid the influx of children traveling to the U.S. alone. Most of
the children crossed the border without their parents, escaping violence and
corruption in Central America, and are held in government custody while
authorities determine if they can be released to relatives or family friends.
All the new facilities will be considered temporary
emergency shelters, so they won’t be subject to state child welfare licensing
requirements, Weber said. In January, the government shut down an unlicensed
detention camp in the Texas desert under political pressure, and another
unlicensed facility called Homestead remains in operation in the Miami suburbs.”
(B)
“The Trump administration is scaling back services for
unaccompanied minors who cross the US-Mexico border, citing budget constraints
after a surge in crossings not seen in over a decade.
The Trump administration is struggling to deal with the number
of migrants entering the US, and has placed much of the blame for insufficient
services and even several recent deaths of migrant children onto migrants
themselves.
According to new data released by Customs and Border
Protection, 109,144 people were taken into custody last month, nearly 9,000 of
them unaccompanied children.
The Trump administration is slashing support and services
for unaccompanied minors who cross the US-Mexico border, citing budget
constraints after a surge in crossings not seen in for more than a decade.
The Office of Refugee Resettlement (ORR), which is part of
the Department of Health and Human Services (HHS) and provides housing and
resources for migrant children, has instructed providers to suspend funding for
certain programs.
It instructed officials to cut programs “not directly
necessary for the protection of life and safety,” a spokesperson for the
HHS said, according to the Washington Post. These services include English
classes, recreational programs like soccer, and legal aid, the Post said.” (C)
“The government’s plans were swiftly rebuked by civil rights
lawyers representing unaccompanied children, who have been crossing the border
in ever-larger numbers this year to flee poverty and violence in their home
countries, mainly in Central America. And the chief of at least one large
shelter operator said he would continue to offer education and sports at his
network’s facilities.
Some 13,200 migrant children, including adolescents who
crossed the border alone and young children who were separated from their
parents, are currently housed in more than 100 shelters across the country.
They receive English instruction, as well as math, civics and other classes.
Most facilities have a sports field and allow children to go outside, often to
play soccer, at least once a day…
Civil rights and child welfare advocates said that any move
by the government to eliminate education and recreation would constitute a
violation of the Flores settlement, which in 1997 established the standards for
treating migrant children held in government facilities, and would prompt them
to sue for reinstatement of the activities.
“If this administration goes forward with denying education,
recreation and other unspecified so-called nonessential services, it would be
in flagrant violation of the Flores settlement and will face immediate legal
action,” said Neha Desai, co-counsel on the settlement decree, who visits
government shelters to ensure compliance. She is also the immigration director
at the National Center for Youth Law in Oakland, Calif.
“To those of us whose job it is to promote the health and
safety of children, this is a shocking directive,” said Amy Cohen, a
psychiatrist who consults for the Flores team and regularly interviews children
at shelters. “It violates every tenet of basic child welfare practice and will
further harm the medical and psychological health of children fleeing
extraordinarily dangerous circumstances in their home countries.”…
“We have not and we
are not going to curtail recreation and education. We just can’t do that,” said
Kevin Dinnin, president of BCFS, the second-largest shelter network, which
houses about 1,000 children in facilities in Texas. “We will have to use
reserve funds until the government figures out what they are going to do.” (D)
“For the past year and a half, Dr. Eric Russell has been
traveling from Houston to McAllen, Texas, every three months or so to volunteer
at the Catholic Charities Humanitarian Respite Center, a first stop for many
asylum-seeking migrants who’ve been released by U.S. Customs and Border
Protection in the Rio Grande Valley.
During his most recent visit to the clinic in April, when he
saw more than 150 migrants, he noted a troubling new trend: a number of people
reported that their medication had been taken from them by U.S. border
officials.
“I had a few adults that came who had high blood pressure,
who had their blood pressure medications taken from them and, not surprisingly,
their blood pressure was elevated,” Russell told Yahoo News. “There was a
couple of adults that had diabetes that had their diabetes medicines taken from
them, and wanted to come in because they were worried about their blood sugar.
And, not surprisingly, their blood sugar was elevated.”
For Russell, a pediatric emergency medicine physician, the
patient who stood out the most during that visit was a boy of 8 or 9 with a
history of seizures. According to his mother, the child had been on a long-term
seizure medicine in their home country, but the medication had been taken from
him upon entering the Border Patrol custody in McAllen and never returned…
“My concern is,
what’s going to happen if you put a 9-year-old child who has a history of
seizures, without any seizure medicine on a bus for 3 days … is that he’s going
to have a seizure,” Russell said.
Russell added that he can understand the need for a policy
regarding the use of outside medication by detainees. However, he said, “At the
end of the day, as a medical provider, as a physician, we take an oath to first
do no harm. And taking somebody’s medications seems like it’s causing harm.”…
In light of these deaths, the American Academy of
Pediatrics, along with other child health and welfare experts, have offered a
number of recommendations for how CBP can improve the care of migrant children
in its custody, which include ensuring access to screenings and treatment by
medical professionals who know how to recognize and respond to the subtle yet
often rapidly worsening signs of illness in children.
“The AAP has been in discussions for months with [CBP] about
increasing the number of pediatric-trained providers that are at these large
processing centers,” said Griffin. However, information provided by CBP
officials suggests the agency has yet to heed the AAP’s advice as it expands
contracted medical services across the southwest border.” (E)
“The government agency that takes custody over all
unaccompanied minors who arrive on the border has been unable to answer
questions about the number of children who have died in its custody in the
years since President Donald Trump took office.
When children who are traveling by themselves either ask for
asylum at ports of entry or are apprehended by Border Patrol, they are
eventually transferred into the custody of the Office of Refugee Resettlement.
ORR—an agency within the Department of Health and Human Services
(HHS)—maintains a series of shelters for the unaccompanied minors, many of
which are run by independent contractors…
On May 23rd, Pacific Standard sent an email to HHS asking
if, since 2016, any other children had died in ORR custody that the public had
not been made aware of. A media contact in the HHS’s Administration for
Children and Families office confirmed that the email had been received, and
said: “[The] inquiry is with the program office for response—we’ll get the
information back to you just as soon as we have it.”
HHS never got back to Pacific Standard’s inquiry, nor to two
subsequent inquiries sent the next day and again on June 5th…
Jennifer Podkul, the senior director of policy and advocacy
for Kids in Need of Defense—an advocacy organization for immigrant
children—says it’s plausible that there are more children who have died than
the public is aware of.
“It’s certainly possible,” Podkul says. “I
don’t have any specific information about specific cases [that have’t been
reported], but there are a few reasons why I say it’s plausible: One is that
there’s no mandatory reporting requirement for ORR, unlike ICE. And the other
reason, that’s really important, is that ORR doesn’t have any sort of public
monitoring system.”
According to Podkul, though ORR and HHS completes reviews of
the facilities they run for children—both those run by the government and those
run by contractors—those sorts of audits aren’t released to the public.” (F)
“A 16-year-old from Guatemala died of complications of the
flu while in U.S. Border Patrol custody, according to preliminary autopsy
findings, alarming doctors who questioned whether immigration authorities
missed warning signs or chances to save his life.
Carlos Hernandez Vasquez contracted bacterial infections in
addition to the flu, as well as sepsis, which can lead to tissue damage and
organ failure, according to a report released by Hidalgo County authorities
this week. He died May 20. A full autopsy is pending.
Carlos is the sixth child in the last year to die after U.S.
border agents detained him, and the second known to have died of the flu, after
8-year-old Felipe Gómez Alonzo died on Christmas Eve…
“By the time you’re
16 years old, you have great immunity, and you shouldn’t be dying so quickly,”
said Dr. Nizam Peerwani, the Tarrant County medical examiner in Fort Worth,
Texas, and an adviser for the advocacy group Physicians for Human Rights.
Peerwani said Carlos’ rapid deterioration raised questions
about whether he may have had potential symptoms including a fever, body aches,
or breathing trouble before the Border Patrol says he reported being sick.
He should have been taken to a medical facility or clinic
instead of remaining in detention, Peerwani said.
Dr. Julie Linton, co-chair of the American Academy of
Pediatrics’ immigrant health special interest group, also said the prescription
of Tamiflu may not have been enough treatment, especially since the medicine
works best in the first two to three days of illness. While Carlos’ illness was
discovered the day before his death, he may have sick well before then, she
said. “We cannot treat Tamiflu as a substitute for the other care that is
required,” Linton said.
Doctors who treat the flu rely on a patient telling them how
long they’ve had symptoms. Linton pointed out that the processing center where
Carlos was detained has the lights on 24 hours a day, which may have made it
difficult for him to know how long he had been sick.” (G)
“County health officials announced Thursday that the
influenza outbreak at a local migrant shelter continues to worsen with 22 new
cases of flu or flu-like symptoms.
The total number of confirmed flu and “influenza-like
illness” since May 19 among asylum-seeking migrants at a shelter in Bankers
Hill operated by Jewish Family Service of San Diego now stands at 81. Officials
with the county’s Health and Human Services Agency confirmed 12 new cases on
both Tuesday and Wednesday.
In addition, the county has quarantined 63 asylum seekers at
various local hotels to try to contain the outbreak. Two asylum seekers at the
shelter have been transported to the hospital due to their flu symptoms,
according to the county. Health officials have screened roughly 450
asylum-seeking migrants at the shelter for symptoms since May 19.
The county defines an outbreak as one person contracted an
illness and a second person contracting it and showing symptoms within 72
hours. The county first declared the outbreak May 23…
Cases of flu and chicken pox have afflicted immigrant
detention facilities for months, with some detained infants and children
showing fevers of up to 105 degrees. CBP agents temporarily closed processing
functions at the McAllen facility last week amid a flu outbreak, during which
it quarantined more than 30 detainees, according to the Washington Post.
The flu has also caused multiple deaths among detainees at
the border in the last six months. Immigration officials confirmed the
flu-related death of a 16-year-old Guatemalan boy at the McAllen facility last
week, the fifth Guatemalan child to die in federal custody since December and
at least the second to die from flu complications.
The county said it plans to continue monitoring the
situation and providing updates on new flu cases at the shelter. County health
officials are also treating outwardly healthy people at the shelter to prevent
the flu from spreading any further.” (H)
“The recent death of a Guatemalan child after a flu outbreak
at the Customs and Border Protection Centralized Processing Center in McAllen
is unsurprising, according to the American Academy of Pediatrics.
Dr. Julie Linton is the co-chair of the American Academy of
Pediatrics Immigrant Health Special Interest Group. She said processing
facilities and detention centers are no place for children.
Linton said the Ursula Central Processing Center, which is
the largest in the nation, is the type of facility that is a haven for
infectious diseases like flu or tuberculosis and infestations like scabies.
“When you enclose people in close quarters and large
spaces, it’s much more difficult to control the spread of illness,” Linton
said. “I think what we also know, however, is that we have children who are
presenting and asking for medical attention — we have families who are asking
for medical evaluations for their children — and they’re being evaluated, and
then after evaluation they’re being sent back to processing centers.”
Linton said a sick child is not going to do well in those
conditions.
“I’m a pediatrician, and I care for sick children all
the time, and I would never suggest, in healing, a child return to a cold
concrete floor, covered by a silver, mylar blanket which is really more of a
sheet, to heal from their illness, and certainly not in a setting where they’re
exposed to constant stress,” Linton said…
The AAP has created a toolkit to help those who come into
contact with immigrant children to help them get and stay healthy.
The McAllen processing center temporarily closed last week
after medical staff identified 32 other migrants who were experiencing symptoms
of the flu.” (I)
“The deaths of migrant children in U.S. custody raise grave
humanitarian concerns and set off alarms. Medical experts, human rights groups
and children’s advocates long have decried unsanitary and crowded conditions at
the facilities where children and families are detained for days before they
are transferred to shelters or released with notices to appear before a judge.
These experts have warned that the living conditions, coupled with the physical
and traumatic effects of migrants’ grueling journeys here, exact a punishing
toll that endangers the children’s lives.
Castro and other members of Congress have called for a
federal investigation. According to Castro, prior to the deaths over the past
eight months, U.S. Customs and Border Protection had gone more than a decade
without a child dying in its custody.
Federal scrutiny of the immigration detention facilities
holding children and families is urgently needed. Americans deserve a full
accounting of the deaths and a plan for averting more tragedies. The U.S. must
guard its borders, but it must do so responsibly, ensuring the welfare of the
children it holds in its custody. Detaining 10-year-olds in fenced-in pens who
are not a threat to this country and who, with their families, are merely
seeking protection is punitive and not what America stands for. If the
administration cannot adequately care for the children in its custody, it must
re-examine its detention policy.
No investigation can be complete without a thorough vetting
of the administration’s hard-line border enforcement policies, which once
separated thousands of children from their families, literally tearing some
from their parents’ arms, a policy since discarded amid an international
outcry. It may take up to two years for authorities to identify the children,
the federal government said in April. It is no wonder that such a dereliction
of duty leads some to question if children are merely considered collateral
damage in the administration’s crackdown on immigration…
The Border Patrol needs help, agreed Marsha Griffin, a
pediatrician on the South Texas border and a spokesperson for the American
Academy of Pediatrics. “We need to provide them with more and better medical
(staff), especially when it pertains to children,” Griffin told us.
Along with other facets of its border enforcement
crackdowns, the federal government is trying to send a message to deter
migrants from coming, Gilman said.” (J)
“As the Trump administration works to address what it
describes as a growing “crisis” at the U.S.-Mexico border, officials
said in a court filing that it may take two years for the government to
identify thousands of migrant children who were separated from their families.
The filing Friday outlined the government’s plan to use data
analysis and manual reviews to sift through the cases of about 47,000 children
who were apprehended by U.S. immigration officials from July 1, 2017, to June
25, 2018, to identify which children might have been taken from family members.
It estimated the process “would take at least 12 months, and possibly up
to 24 months.”
Last month, U.S. District Judge Dana Sabraw expanded the
number of migrant families that the government may be forced to reunite under
his previous order after an inspector general report revealed that the
administration had an undisclosed family separation pilot program in place
starting in July of 2017. The ruling was made as part of a lawsuit led by the
American Civil Liberties Union.
“The administration refuses to treat the family
separation crisis it created with urgency, ” the ACLU said in a statement
Saturday. “We strongly oppose any plan that gives the government up to two
years to find kids. The government swiftly gathered resources to tear families
apart. It must do the same to fix the damage.” (K)
“Rom Rahimian, a medical student working at
Banner-University Medical Center Tucson, was trying to help a 20-year-old
Guatemalan woman who had been found late last year in the desert — dehydrated,
pregnant and already in labor months before her due date. But the Border Patrol
agents lingering in the room were making him uncomfortable.
The agents remained in the obstetrics ward night and day as
physicians worked to halt her labor. They were present during her medical
examinations, listened in on conversations with doctors and watched her
ultrasounds, Mr. Rahimian said. They kept the television on loud, interfering
with her sleep. When agents began pressing the medical staff to discharge the
woman to an immigration detention facility, the doctors took action.
“It was a race against the clock to see if we can get her
into any other situation,” Mr. Rahimian said. He called a lawyer and asked,
“What can we do? What are her rights?”
As apprehensions of migrants climb at the southwest border,
and dozens a day are taken to community hospitals, medical providers are
challenging practices — by both government agencies and their own hospitals —
that they say are endangering patients and undermining recent pledges to
improve health care for migrants.
The problems range from shackling patients to beds and not
permitting them to use restrooms to pressuring doctors to discharge patients
quickly and certify that they can be held in crowded detention facilities that
immigration officials themselves say are unsafe. Physicians say that needed
follow-up care for long-term detainees is often neglected, and that they have
been prevented from informing family members about the status of critically ill
patients. Agency vehicles parked conspicuously near hospital entrances, health
providers say, are also stoking fear and interfering with broader immigrant
care.
Doctors typically do not know what rights they might have to
challenge these practices. At Banner and several other hospital systems across
the country, they have called on administrators to oppose and change security
measures that they view as endangering health..
Health systems, too, maintain policies that doctors say are
problematic. Banner Health, like some others, has a policy that applies equally
to immigration detainees and prisoners. It disallows bathroom privileges,
requires at least two limbs to be secured to beds unless medically inadvisable,
gives agents discretion over whether mothers may visit newborns and obliges law
enforcement officers to remain with patients.” (L)
“A premature newborn baby girl and her 17-year-old migrant
mother were almost entirely ignored and neglected for an entire week while held
by Border Patrol near the Texas border.
Lawyers who visited the immigration processing station in
McAllen, TX, told HuffPost that the one-month-old infant was wrapped in a dirty
towel and wore soiled clothing. The mother was severely underslept,
wheelchair-bound, and unable to walk or lie down due to pain from an emergency
C-section.
The baby was born in Mexico after the mother left Guatemala
for the U.S. while eight months pregnant. Neither mother nor child has been
publicly identified.
According to immigration and human rights attorney Hope
Frye, the mother was taken to a hospital at least once for pain medication, but
the baby had not received any medical care since being placed in Border Patrol
custody.” (M)
“The Trump administration has made its position on
immigration clear as day. But the executive branch’s crackdown on immigration —
legal and otherwise — has come with a cost. A new NBC News analysis found that
24 immigrants died in ICE custody since President Trump took office, and that
figure notably doesn’t include migrants who died while they were detained by
other government agencies.
“What we’re seeing is a reckless and unprecedented
expansion of a system that is punitive, harmful and costly,” Katharina
Obser, a senior policy adviser at the Women’s Refugee Commission, told the news
outlet. The government has filed to provide immigrants in its custody with
medical and mental health care, she added.
The NBC News report comes as the number of migrant children
who die after crossing the U.S.-Mexico border continues to rise. The report
also indicates that the number of immigrants in U.S. custody has recently
reached an all-time high, with about 52,500 immigrants currently in ICE custody
per day.
In a statement provided to NBC News, ICE said that “it
takes very seriously the health, safety and welfare of those in our care,”
and that “any death that happens in ICE custody is a cause for
concern.”
So far, at least five migrant children have died after being
apprehended at or near the U.S.-Mexico border since December. A 10-year-old
girl from El Salvador also died in September, although the public did not learn
about her death until May of this year,
per the BBC. The five children who have died since December were all from
Guatemala.” (N)
“The Texas Tribune reports more than 5,800 unaccompanied
migrant children are living in 35 shelters across the state as of last month.
The U.S. government has also reported more than 144,000
migrants were apprehended or denied entry last month, which is a 13-year high.
They say more than half of the families detained had
children. And 8 percent of these migrants are considered to be unaccompanied
minors…
Right now, Texas has 35 state-licensed shelters. The Texas
Health and Human Services Commission says combined, the 35 shelters can
accommodate up to 6,423 children, meaning the state shelters are at about 90
percent capacity.
These migrant children living in federal shelters no longer
have access to English classes, recreational programs, like soccer, and legal
aid, after the Trump Administration decided to cancel these activities due to
budget pressures earlier this month.
The Texas Tribune reported that the director of Hope Border
Institute, Dylan Corbett, told them this decision was.. “a demonstration of
their willingness to use children as pawns in a politically motivated plan to
inflict as much pain as possible.” (O)
“……the administration is taking new steps to deprive the
children it is holding in custody of basic necessities. Last week, the
administration cut funding for education, recreation and legal aid for migrant
children and youth in federal shelters. An estimated 13,200 minors are
currently being held in shelters contracted by the Office of Refugee
Resettlement (ORR). The Children’s Defense Fund recently joined more than 100
other organizations signing on to a letter to the Secretary of HHS and other
federal leaders condemning the decision.
As the letter explains, “It is widely recognized in
international, federal, and state law that children are unique from adults and
should be afforded special protections that support their developmental needs.”
That’s why the Flores settlement, the existing agreement that limits the length
of time and conditions under which federal officials can detain immigrant
children, requires the government to place children in the least restrictive
setting that is in the best interest of the child.
It’s also why the services the administration is taking away
from these children — including English, math, science and reading classes and
outdoor activities such as soccer and basketball — are essential to their
development…
Immigrant children are still children. They are our
children. It doesn’t matter how a child came to be in our country — once they
are here, in the wealthiest and most powerful nation on earth, it is our duty
and our obligation to care for them, support them and give them the opportunity
to grow up and thrive. Instead, we are cruelly stripping away their chance to
learn, to play and to connect. And in the worst and most unforgivable cases, we
are letting them die on our watch.
Even for an administration already known for its cruel
treatment of immigrant children this is another heartless and disgraceful step
too far. We are better than this.” (P)
“A 2-year-old boy locked in detention wants to be held all
the time. A few girls, ages 10 to 15, say they’ve been doing their best to feed
and soothe the clingy toddler who was handed to them by a guard days ago.
Lawyers warn that kids are taking care of kids, and there’s inadequate food,
water and sanitation for the 250 infants, children and teens at the Border
Patrol station.
The bleak portrait emerged Thursday after a legal team
interviewed 60 children at the facility near El Paso that has become the latest
place where attorneys say young migrants are describing neglect and mistreatment
at the hands of the U.S. government.
Data obtained by The Associated Press showed that on
Wednesday there were three infants in the station, all with their teen mothers,
along with a 1-year-old, two 2-year-olds and a 3-year-old. There are dozens
more under 12. Fifteen have the flu, and 10 more are quarantined.
Three girls told attorneys they were trying to take care of
the 2-year-old boy, who had wet his pants and had no diaper and was wearing a
mucus-smeared shirt when the legal team encountered him…
The lawyers inspected the facilities because they are
involved in the Flores settlement, a Clinton-era legal agreement that governs
detention conditions for migrant children and families. The lawyers negotiated
access to the facility with officials, and say Border Patrol knew the dates of
their visit three weeks in advance.
Many children interviewed had arrived alone at the
U.S.-Mexico border, but some had been separated from their parents or other
adult caregivers including aunts and uncles, the attorneys said.
Government rules call for the children to be held by the
Border Patrol for no longer than 72 hours before they are transferred to the
custody of Health and Human Services, which houses migrant youth in facilities
around the country.” (Q)
“Although the conditions in which migrant children are being
detained has prompted widespread outrage, the Trump administration defended its
detention centers in court on Thursday, Newsweek reports. At the 9th Circuit
Court in San Francisco, a Justice Department lawyer said that denying migrant
children soap and toothbrushes, and requiring them to sleep on concrete floors
in cold and crowded rooms, still qualifies as “safe and sanitary”
treatment. This prompted incredulity from several judges at the hearing,
according to Newsweek.
“Are you arguing seriously that you do not read the
[Flores] agreement as requiring you to do anything other than what I just
described: cold all night long, lights on all night long, sleeping on concrete
and you’ve got an aluminum foil blanket?” U.S. Circuit Judge William Fletcher
asked. “I find that inconceivable that the government would say that that
is safe and sanitary.”” (R)
“Fellow Judge A Wallace Tashima remarked: “It’s within everybody’s common understanding that if you don’t have a toothbrush, you don’t have soap, you don’t have a blanket, those are not safe and sanitary.” (S)
PART 1. June 18, 2018 “The Trump administration’s policy of
separating parents and children at the U.S.-Mexico border will have a dire
impact on their health, both now and into the future.” (C)
PART 4. June 21, 2018. “The business of housing,
transporting and watching over migrant children detained along the southwest
border is not a multimillion-dollar business. It’s a billion-dollar one…
PART 8. June 26, 2018. White House Press Secretary Sarah
Huckabee Sanders said the government was starting to “run out of space” to
house people apprehended crossing the border
PART 9. June 27, 2018. “…the only way parents can quickly be
reunited with their children is to drop their claims for asylum… and agree to
be deported.”
PART 13. July 5, 2018. “Most immigrants facing deportation
wouldn’t climb onto a table during their court hearings. But then again, most
3-year-olds don’t go to court without parents or lawyers.
PART 15. December 4, 2018. PUBLIC HEALTH administrators can
transform monumental unique challenges to “rapid response” opportunities.
Think: Hurricanes Florence and Michael, the California wildfires, the
mysterious polio-like illness, the opioid epidemic, mass shootings, and
immigrant family separation.
In a “worst-case scenario,” the current Ebola
outbreak in the Democratic Republic of Congo may take up to two years to end….
San Antonio found itself ill-prepared to handle a sudden influx of refugees from the Democratic Republic of Congo.
ASSIGNMENT: What immediate actions should be taken in the United States?
PARTS 1-11,
May 15, 2017 to August 30, 2018, after new PART 12.
PART 12. June17,
2019. “Three cases of Ebola have emerged in Uganda, a neighboring
country to the Democratic Republic of the Congo.”
“Dr. Jeremy Farrar, director of Wellcome Trust, a UK medical
research charity, said that while Uganda was well-prepared to cope with the
disease, global health authorities should be ready for more cases in the
Democratic Republic of Congo and other neighboring countries.
“This epidemic is in a truly frightening phase and
shows no sign of stopping anytime soon,” he said in a statement.
“There are now more deaths than any other Ebola
outbreak in history, bar the West Africa Epidemic of 2013-16, and there can be
no doubt that the situation could escalate towards those terrible levels.”..
WHO is likely to come under pressure to declare the outbreak
an international health emergency. In April, the health body said it did not
constitute a “public health emergency of international concern.”
WHO defines a public health emergency of international
concern as “an extraordinary event” that constitutes a “public
health risk to other States through the international spread of disease”
and “to potentially require a coordinated international response.”’’
“A step up in the national response with full
international support is critical if we’re to contain the epidemic and ensure
the very best protection for the communities at risk and for the health workers
working to protect lives,” Farrar said. “This needs to be championed
at the highest political levels, including at the UN and the upcoming
G20.” (A)
“Three cases of Ebola have emerged in Uganda, a neighboring
country to the Democratic Republic of the Congo (DRC), officials said.
On Tuesday, the World Health Organization (WHO) announced
that a 5-year-old boy had been diagnosed in Uganda, apparently after crossing
over from the DRC. WHO officials said it was the first Ebola case in Uganda
during the ongoing outbreak in the DRC.
Then, early Wednesday, Uganda’s health ministry said two
additional cases had been diagnosed — the boy’s grandmother and a 3-year-old
sibling, now in an isolation unit. The ministry also said the 5-year-old had
died.
In an all-too-familiar scenario when it comes to infectious
diseases, the cases appear to be travel-related. When the 5-year-old became
ill, the family sought care at a hospital in Bwera, Uganda, which is less than
a mile from the DRC’s eastern border. Ebola was identified as a potential cause
of illness, the WHO said.
“This is a sobering development that everyone has been
working to avoid, and highlights the complexity of the Ebola outbreak in the
Democratic Republic of the Congo,” said CDC director Robert Redfield, MD,
in a statement about the first case.
Uganda was not entirely unprepared for imported Ebola, as
about 4,700 health workers in the country have already been vaccinated in 165
health facilities. The WHO and the country’s Ministry of Health have dispatched
a rapid response team to identify, monitor and care for those who might be at
risk. In addition, those who have come into contact with the patient, as well
as at-risk previously unvaccinated health workers, will be vaccinated, they
said…” (B)
“Twenty-seven people are said to have been in contact with
the three confirmed cases in Uganda. They have been restricted to their homes
and will be vaccinated against Ebola.
The people who fled from a hospital isolation unit had been
found to have high temperatures when they crossed the border from DR Congo to
the Ugandan district of Kanungu, which is about 150km (93 miles) south of
Kasese. Medical workers did not get a chance to take samples of their blood to
send for testing before their escape.” (C)
“Over the weekend and through today the Democratic Republic
of the Congo (DRC) reported 23 new Ebola cases, 2 of them in healthcare workers
and one involving a reintroduction of the virus into an earlier affected area…
The cases involving healthcare workers are in Mabalako. One
worker is a vaccinated nurse who agreed to be taken to an Ebola treatment
center after she tested positive for Ebola, marking the second case at the same
clinic following the admission of several Ebola patients. The other is also a
vaccinated health worker, raising the cumulative number of cases in healthcare
workers to 113.” (D)
“The World Health Organization warned Friday that it may not
be possible to contain Ebola to the two affected provinces in eastern Congo if
violent attacks on health teams continue.
The ominous statement comes amid escalating violence nine
months after the outbreak began, crippling efforts to identify suspected cases
in the community and vaccinate those most at risk. Earlier this week, Mai-Mai
militia fighters attacked the town of Butembo at the epicenter of the crisis.
The update also noted that a burial team had been “violently
attacked” after they interred an Ebola victim in the town of Katwa. The corpses
of victims are highly contagious, requiring special precautions to ensure the
disease is not transmitted at funerals…
David Miliband, president of International Rescue Committee,
has met with health workers in the regional capital of Goma this week. Some
fear it could take another year to get the disease under control, he said.
“There is a real concern to make sure it doesn’t spread to
Goma,” he said. “And so this is, I think, a more dangerous situation than is
widely recognized outside the country.”..
In addition to the risks posed by militias there also has
been widespread community mistrust in eastern Congo, a byproduct of years of
conflict and grievances with the government. WHO said it was aiming to have the
of majority vaccine teams comprised of local health workers by the end of the
month in an effort to reduce tensions.” (E)
“In a “worst-case scenario,” the current Ebola
outbreak in the Democratic Republic of Congo may take up to two years to end, a
World Health Organization official said Thursday.
The outbreak, which began Aug. 1, is “not under
control,” Mike Ryan, executive director of WHO Health Emergencies
Programme, said during a press briefing. “We may end up dealing with this
outbreak for a long time.”..
Dr. Ryan said that numbers have stabilized and even fallen
in the last two weeks, yet he also said there’s still “substantial
transmission” in some health zones. While there is a smaller geographic
footprint, the spread of disease is rampant within affected zones, he added.”
(F)
“The World Health Organization is considering whether to
declare the current Ebola outbreak in central Africa a global health crisis
after new cases spread to Uganda from neighboring Democratic Republic of the
Congo, where the disease has already killed nearly 1,400 people…
A WHO expert committee on the outbreak was scheduled to meet
for a third time, this time on Friday in Geneva, where it will discuss whether
to declare a global health emergency.
The latest Ebola outbreak, centered in northeastern Congo,
was declared in August. It is “by far the largest” of 10 such
outbreaks in the country in the past 40 years, according to Doctors Without
Borders.
Meanwhile Rwanda, which neighbors both the DRC and Uganda,
says it is tightening its borders with both countries and the government is
urging people not to travel to affected areas, according to the state-backed
newspaper The New Times.
Earlier this year, Rwanda said it would begin issuing
front-line health workers an experimental Ebola vaccine in an effort to keep
the disease from crossing into its territory. And Uganda’s health ministry has
been encouraging its public to get the vaccine, assuring them of the vaccines
safety and effectiveness, Aceng said in a statement.”..(G)
.
“We are entering a very new phase of high impact
epidemics and this isn’t just Ebola,” Dr Michael Ryan, the executive
director of the WHO’s health emergencies programme told me.
He said the world is “seeing a very worrying
convergence of risks” that are increasing the dangers of diseases
including Ebola, cholera and yellow fever.
He said climate change, emerging diseases, exploitation of
the rainforest, large and highly mobile populations, weak governments and
conflict were making outbreaks more likely to occur and more likely to swell in
size once they did.
Dr Ryan said the World Health Organization was tracking 160
disease events around the world and nine were grade three emergencies (the
WHO’s highest emergency level).
“I don’t think we’ve ever had a situation where we’re
responding to so many emergencies at one time. This is a new normal, I don’t
expect the frequency of these events to reduce.”
As a result, he argued that countries and other bodies
needed to “get to grips with readiness [and] be ready for these
epidemics”.
It took 224 days for the number of cases to reach 1,000, but
just a further 71 days to reach 2,000.” (H)
High impact disease outbreaks such as Ebola could become the
“new normal”, the World Health Organization has said…
“We are entering a
new phase in terms of high impact epidemics and this isn’t just Ebola. You look
at cholera, yellow fever, many other diseases – we’re seeing both re-emergence
and resurgence,” Dr Ryan said.
He added that 80 per cent of such epidemics were occurring
in fragile, conflict-affected states such as DRC.
“So we’re seeing a very worrying convergence of risks. Areas
of high biodiversity, high population density, high population mobility, weak
governance, conflict and many other things layered on top of each other,” he
said.
WHO is currently monitoring 160 different disease events
around the world, including 33 emergencies, nine of which are grade three,
requiring the highest level of operational response.” (I)
“When West Africa was declared Ebola-free in January 2016,
the international community — having realized how the world’s weakest health
systems threaten global health security — vowed that never again would we let
such a health crisis fester until it became a calamity. A period of unprecedented
attention to global health security began.
We had learned the importance of a rapid mobilization after
the World Health Organization’s (WHO) egregious failure to sound the alarm
until months into outbreak. We saw the necessity to declare the highest level
of global emergency to secure political commitments and mobilize scarce
resources.
We discovered that distrust of government often obstructed
the response, and that every means must be sought to vest the affected
populations, enlisting traditional leaders, priests, imams, midwives, youth
leaders, civil society, local journalists, anyone with a trusted voice.
And it was the United States that led the global scale-up,
including the deployment to Liberia of the 101st Airborne.
Three years later in the Democratic Republic of the Congo
(DRC), it feels like many of the lessons learned were learned in vain — and
with the White House decision to bar U.S. officials, including the Centers for
Disease Control (CDC), from entering the worst-affected zones as well as a
strict interpretation of the Trafficking Victims Protection Act resulting in
the withholding of non-humanitarian assistance, we have an unprecedented
sidelining of U.S. expertise that — until now —has been on the frontlines for
every Ebola outbreak…
Ebola was defeated in West Africa when a global declaration
of emergency created the conditions for charities and frontline healthcare
workers to get ahead of the Ebola transmission curve. The disease was brought
under control only after it was acknowledged that you don’t isolate the
communities, you work with them, to isolate the virus. And it was defeated with
U.S. leadership.” (J)
“This outbreak has featured organized attacks on the
response efforts, specifically targeting medical facilities and healthcare personnel
in violation of humanitarian laws, reported Annie Sparrow, MBBS, MD, of the
Icahn School of Medicine at Mount Sinai in New York City, and colleagues…
“These attacks arouse concern that armed groups are
exploiting the epidemic for broader military or political ambitions, and they
have resulted in recurrent temporary suspension of response activities in
affected areas,” the authors wrote…
Sparrow and colleagues agreed, writing, “Even in the
middle of intractable conflicts, success in controlling Ebola must be achieved.
We have the tools of global disease surveillance, rapid-response systems, and
biomedical solutions — if there is the political will to protect health
workers in conflict zones.”
Moeti described that the Ebola outbreak in the DRC as
“one of the most complex health emergencies the world has faced,”
adding that juggling the dual responsibilities of protecting staff and
colleagues while responding to the outbreak is no small feat.” (K)
“Though community attitudes and the decisions of individuals
contribute to how outbreaks spread, a broken health system seems to be the
single largest contributor to how susceptible a country might be to an
outbreak, and how quickly it can be stamped out.
During the West Africa outbreak, which was considerably
larger and more deadly than the outbreak in Congo, most people who fell ill
never had Ebola. Early on, sick patients waited days, sometimes weeks, for
laboratory tests. When someone showed symptoms of Ebola, they were sent into a
“holding unit,” hastily constructed tarpaulin-walled units, where it was hot
and often crowded with make-shift cots.
Unfortunately, the symptoms of Ebola resemble many other
diseases prevalent in the region and all sick people with Ebola-like symptoms
were held in the same room, increasing the likelihood of transmission within
the facilities themselves…
One of the key reasons Ebola spread so rapidly in Sierra
Leone, Liberia and Guinea was that those countries’ health systems were
woefully under-resourced to respond to basic health needs, let alone an
outbreak of a deadly infectious disease. In Congo, the number of people who
have access to comprehensive care is not just low — it’s basically zero…
America has a role to play. One of the greatest global
health funding mechanisms was implemented by President George W. Bush, who
created the President’s Emergency Plan for AIDS Relief (PEPFAR), which helped
millions of people dying from HIV/AIDS access treatment. We need similarly bold
and comprehensive aid packages for strengthening public health systems in poor
countries — ones that fund training for the next generation of doctors and
nurses, improve supply chains for essential medicines and build public teaching
hospitals and clinics and other essential health infrastructure. Such a program
would be a long-term commitment, untethered from a specific emergency.
Some Americans may argue that we don’t have a responsibility
to fix health care in far-off places. President Donald J. Trump might be among
them. The afternoon after Congo declared its latest Ebola outbreak, he cut $252
million for global disease prevention funding because it was “no longer
needed.”
But even people who do not see this as a moral imperative
should see it as a national security issue. Epidemics should worry us more than
terrorists: tuberculosis, unlike Ebola, is airborne, and Congo has among the
highest TB rates in the world. That impacts us all.” (L)
“There are 88 nations where the per capita GDP is lower than
that of Guatemala, which stands at $4,471 as of 2017. That is likely well over
one billion people living in similar or worse conditions than those coming to
our border today, primarily from Central America. As such, it’s no surprise
that once our government telegraphed the message to the world that our
sovereignty no longer matters when someone invades with a child, people are now
coming in large numbers from all over the world, including from the most
disease-prone countries in Africa.
While Africans have been trickling over our border in recent
months, on Friday, Customs and Border Protection (CBP) announced that “the
first large group of people from Africa” were apprehended in the Del Rio sector
of Texas. In total, 116 individuals were apprehended in this African caravan on
Thursday morning, including 35 from Angola, one from Cameroon, and 80 from
Congo.
This demonstrates that the global migration, at this pace,
will be a bottomless pit, because even if we eventually empty out the northern
triangle of Central America, there are unlimited regions in the world where
poverty is pervasive and from which people will travel to seek the de facto
amnesty being offered…
With family units being released within days, often within
hours, how can our government be certain that Americans, not to mention Border
Patrol and local health officials, are not being put in danger? This is why the
law (8 U.S.C. § 1222(a)) requires the government to detain all migrants “for a
sufficient time to enable the immigration officers and medical officers to
subject such aliens to observation and an examination sufficient to determine
whether or not they belong to inadmissible classes.” This was for all migrants.
It was always presumed that we would never take in people from specific
countries that were experiencing deadly epidemics.” (M)
“For the third time, the World Health Organization declined
on Friday to declare the Ebola outbreak in the Democratic Republic of Congo a
public health emergency, though the outbreak spread this week into neighboring
Uganda and ranks as the second deadliest in history.
An expert panel advising the W.H.O. advised against it
because the risk of the disease spreading beyond the region remained low and
declaring an emergency could have backfired. Other countries might have reacted
by stopping flights to the region, closing borders or restricting travel, steps
that could have damaged Congo’s economy.
Dr. Preben Aavitsland, a Norwegian public health expert who
served as the acting chairman of the emergency committee advising the W.H.O.,
said there was “not much to be gained but potentially a lot to lose.” ..
Experts do not expect the Ugandan outbreak to spiral out of
control.
Uganda has a strong central government and a cash-starved
but organized health care system. It has endured and beaten three previous
Ebola outbreaks, in 2000, 2007 and 2012.” (N)
“Neighboring countries have been preparing for the
possibility that the virus might jump borders in a region where the population
is highly mobile and where more than a million people are displaced from their
homes because of decades of ethnic conflict.
Thousands of medical personnel in Uganda, Rwanda and South
Sudan have already received a vaccine to protect themselves, and border guards
have screened more than 65 million people crossing through 80 ports of entry
and operational health checkpoints.” (O)
“In Uganda, the battle against Ebola will be determined by
the government’s ability to win the confidence of the people. The country is
not strife-torn like its volatile neighbour, and has a more robust health
system. For the time being, at least, there is hope the disease will be
contained in Uganda.” (P)
“The isolation ward for Ebola patients is a tent erected in
the garden of the local hospital. Gloves are given out sparingly to health
workers. And when the second person in this Uganda border town died after the
virus outbreak spread from neighboring Congo, the hospital for several hours
couldn’t find a vehicle to take away the body.
“We don’t really have an isolation ward,” the Bwera
Hospital’s administrator, Pedson Buthalha, told The Associated Press. “It’s
just a tent. To be honest, we can’t accommodate more than five people.”
Medical workers leading Uganda’s effort against Ebola lament
what they call limited support in the days since infected members of a
Congolese-Ugandan family showed up, one vomiting blood. Three have since died.
While Ugandan authorities praise the health workers as
“heroes” and say they are prepared to contain the virus, some workers disagree,
wondering where the millions of dollars spent on preparing for Ebola have gone
if a hospital on the front line lacks basic supplies.” (Q)
“The Tanzanian Minister of Health issued an “alert” on
Sunday following the outbreak of Ebola cases this week in Uganda, a country
with which Tanzania shares a long border.“I would like to alert the public to
the existence of a threat of an Ebola epidemic in our country following the
outbreak of this disease in Uganda,” said Health Minister Ummy Mwalimu. She
justified this warning by “the important interactions between the populations
of the two countries via official borders or other unofficial channels”.” (R)
“Alexandra Phelan, a global health expert at Georgetown
University, said the legal criteria for declaring Ebola a global emergency have
long been met, even before the virus reached Uganda.
“I think the declaration should be made tonight,”
she said. “Given that we are still seeing daily numbers of cases in the
double digits and we do not have adequate surveillance, this indicates the
outbreak is a persistent regional risk.”
Phelan said she was concerned WHO might be swayed by
political considerations.
As the far deadlier 2014-16 Ebola outbreak raged in West
Africa, WHO was heavily criticized for not declaring a global emergency until
nearly 1,000 people had died and the virus had spread to at least three
countries. Internal WHO documents later showed the agency feared the
declaration would have economic and social implications for Liberia, Guinea and
Sierra Leone.”
“It’s legitimate for countries to raise these concerns,
but the basis on which WHO and its emergency committee should be looking at is
the risk to public health and the risk of international spread,” Phelan
said.”” (S)
“Today the U.S. Centers for Disease Control and Prevention
(CDC) is announcing activation of its Emergency Operations Center (EOC) on
Thursday, June 13, 2019, to support the inter-agency response to the current
Ebola outbreak in eastern Democratic Republic of the Congo (DRC). The DRC
outbreak is the second largest outbreak of Ebola ever recorded and the largest
outbreak in DRC’s history. The confirmation this week of three
travel-associated cases in Uganda further emphasizes the ongoing threat of this
outbreak. As part of the Administration’s whole-of-government effort, CDC
subject matter experts are working with the USAID Disaster Assistance Response
Team (DART) on the ground in the DRC and the American Embassy in Kinshasa to
support the Congolese and international response. The CDC’s EOC staff will
further enhance this effort.
CDC’s activation of the EOC at Level 3, the lowest level of
activation, allows the agency to provide increased operational support for the
response to meet the outbreak’s evolving challenges. CDC subject matter experts
will continue to lead the CDC response with enhanced support from other CDC and
EOC staff.
“We are activating the Emergency Operations Center at CDC
headquarters to provide enhanced operational support to our expanded Ebola
response team deployed in DRC,” said CDC Director Robert R. Redfield, M.D.
“Through CDC’s command center we are consolidating our public health expertise
and logistics planning for a longer term, sustained effort to bring this
complex epidemic to an end.”” (T)
“San Antonio found itself ill-prepared to handle a sudden
influx of refugees from the Democratic Republic of Congo.
The Texas city was reportedly not informed by U.S. Border
Patrol that the migrants, who began arriving on Tuesday, were coming, according
to Interim Assistant City Manager Dr. Colleen Bridger.
“We didn’t get a heads up,” Bridger told KENS 5 on Thursday.
“When we called Border Patrol to confirm, they said, ‘yeah,
another 200 to 300 from the Congo and Angola will be coming to San Antonio,’”
she added.
The refugees, fleeing the Congo where an Ebola epidemic that
began last year has now surpassed 2,000 cases, arrived in the Alamo city after
reportedly traveling to the southern U.S. border with a group of about 350
migrants through Ecuador.
The city says Border Patrol told them earlier this week
(when the city reached out) to expect 200-300 more migrants from the Congo and
Angola to arrive in the coming days.
Besides the burden of processing and sheltering the
migrants, the city has found an added challenge of communication, as KENS 5
reported that San Antonio is now “in desperate need of French-speaking
volunteers.”
About 375 people, from a total of 450 just on Wednesday at
the Migrant Resource Center, were housed at Travis Park Church that night.
Another center was opened to shelter hundreds more expected to arrive, but
plans to send the migrants to other cities have not yet panned out.
“The plan was 350 of them would travel from San Antonio to
Portland. When we reached out to Portland Maine they said, ‘Please don’t send
us any more. We’re already stretched way beyond our capacity,” Bridger said.
“So we’re working with them [the migrants] now to identify other cities
throughout the United States where they can go and begin their asylum seeking
process.”” (U)
“In Portland — the largest city in Maine, with a population
of 66,417 — about 200 African migrants were sleeping on cots on Friday night in
a temporary emergency shelter set up in the Portland Expo Center. The city has
a large Congolese community, and has built a reputation as a place friendly to
asylum seekers. It created the government-financed Portland Community Support
Fund to provide rental payments to landlords and other forms of assistance for
asylum seekers, the only fund of its kind in the country, Portland officials
said.
Many of the recent African migrants do not have relatives in
the country, so they are being released with no travel arrangements, a problem
that local officials and nonprofit groups are forced to sort out.
The mayor of Portland, Ethan K. Strimling, said they
welcomed African migrants, and a donation campaign for them had raised more
than $20,000 in its first 36 hours.
“I don’t consider it a crisis, in the sense that it is going
to be detrimental to our city,” Mr. Strimling said. “We’re not building walls.
We’re not trying to stop people. In Maine, and Portland in particular, we’ve
been built on the backs of immigrants for 200 years, and this is just the
current wave that’s arriving.”” (V)
PART 4. June 11, 2018 . “With an outbreak like this, it’s a
race against time, as one Ebola patient with symptoms can infect several people
every day.”
PART 5. June 16, 2018.
EBOLA, ZIKA. EMERGING VIRUSES. “ All too often with infectious diseases,
it is only when people start to die that necessary action is taken.”
PART 8. June 24, 2018.
“Slightly over a month into the response, further spread of [Ebola Virus
Disease] has largely been contained,” WHO announced on June 20.
PART 10. August 20, 2018. At least 10 health-care workers
have been infected with the deadly Ebola virus as they battle an outbreak in an
eastern province of Congo
ASSIGNMENT: How should a hospital respond to the New York State initiative to prevent the spread of Candida auris, when there are no evidenced based best practices?
New PART 3 after PARTS 1 & 2
ART 1. April16, 2019. Is it ethical for the public not to be notified about new “super bugs” in hospitals so they can decide whether or not to go to affected hospitals?
PART 2. May 13, 2019. CANDIDA AURIS. “In 30 years, I’ve
never faced so tough a reporting challenge – and one so unexpected. Who
wouldn’t want to talk about a fungus?…
PART 1. April16,
2019. Is it ethical for the public not
be notified about new “super bugs” in hospitals so they can decide
whether or not to go to affected hospitals?
“Last May, an elderly man was admitted to the Brooklyn
branch of Mount Sinai Hospital for abdominal surgery. A blood test revealed
that he was infected with a newly discovered germ as deadly as it was
mysterious. Doctors swiftly isolated him in the intensive care unit.
The germ, a fungus called Candida auris, preys on people
with weakened immune systems, and it is quietly spreading across the globe. Over
the last five years, it has hit a neonatal unit in Venezuela, swept through a
hospital in Spain, forced a prestigious British medical center to shut down its
intensive care unit, and taken root in India, Pakistan and South Africa.
Recently C. auris reached New York, New Jersey and Illinois,
leading the federal Centers for Disease Control and Prevention to add it to a
list of germs deemed “urgent threats.”
The man at Mount Sinai died after 90 days in the hospital,
but C. auris did not. Tests showed it was everywhere in his room, so invasive
that the hospital needed special cleaning equipment and had to rip out some of
the ceiling and floor tiles to eradicate it.
“Everything was positive – the walls, the bed, the
doors, the curtains, the phones, the sink, the whiteboard, the poles, the
pump,” said Dr. Scott Lorin, the hospital’s president. “The mattress,
the bed rails, the canister holes, the window shades, the ceiling, everything
in the room was positive.”” (A)
“Back in 2009, a 70-year-old Japanese woman’s ear
infection puzzled doctors. It turned out to be the first in a series of
hard-to-contain infections around the globe, and the beginning of an ongoing
scientific and medical mystery.
The fungus that infected the Japanese woman, Candida auris,
kills more than 1 in 3 people who get an infection that spreads to their blood
or organs. It hits people who have weakened immune systems, and is most often
found in places like care homes and hospitals. Once it shows up, it’s hard to
get rid of: unlike most species of fungi, Candida auris spreads from person to
person and can live outside the body for long periods of time.
Mount Sinai wasn’t the first hospital to face this task: a
London hospital found itself with an outbreak in 2016, and the only way to stop
it was to rip out fixtures…
Scientists still aren’t sure exactly where this happened or
when. That’s one of the things they’re working on now, says Cuomo, because
figuring out how the fungus evolved could help researchers develop treatments
for it…
Although the “superbug” moniker might sound
alarmist, Candida auris qualifies for two reasons, says Cuomo. First, all
strains of the yeast are resistant to antifungals. There are three major kinds
of antifungals used to treat humans, and some strains of Candida auris are
resistant to all of them, while other strains are resistant to one or two. That
limits the treatment options for someone who has been infected-someone who is
probably already in poor health. The other reason is “this really scary
property of not being able to get rid of it,” Cuomo says.” (B)
“Superbugs are a terrifying prospect because of their
resistance to treatment, and one superbug that is sweeping all over the world
is the Candida auris.
C. auris is a fungus that causes serious infections in
various parts of the body, including the bloodstream and the ear.
While its discovery has been relatively recent in 2009, this
fungus has already wreaked havoc in hospitals in more than 20 different
countries, including the United States, United Kingdom, and Spain, among
others.
In the United States, CDC reports a total of 587 clinical
cases of C. auris infections as of February. Most of it occurred in the areas
of New York City, New Jersey, and Chicago.” (C)
“The CDC issued a public alert in January about a drug-resistant
bacteria that a dozen Americans contracted after undergoing elective surgeries
at Grand View Hospital in Tijuana, Mexico. Yet when similar outbreaks occur at
U.S. hospitals, the agency does not issue a public warning. This is due to an
agreement with states that prohibits the CDC from publicly disclosing hospitals
undergoing outbreaks of drug-resistant infections, according to NYT.
Patient advocates are pushing for more transparency into
hospital-based infection outbreaks, saying the lack of warning could put
patients at risk of harm.
“They might not get up and go to another hospital, but
patients and their families have the right to know when they are at a hospital
where an outbreak is occurring,” Lisa McGiffert, an advocate with the
Patient Safety Action Network, told NYT. “That said, if you’re going to
have hip replacement surgery, you may choose to go elsewhere.”..
The CDC declined NYT’s request for comment. Agency officials
have previously told the publication the confidentiality surrounding outbreaks
is necessary to encourage hospitals to report the drug-resistant
infections.” (D)
“New Jersey is among the states worst affected by an
increasing incidence of the potentially deadly fungus Candida auris, whose
resistance to drugs is causing headaches for hospitals, state and federal
health officials said on Monday.
There were 104 confirmed and 22 probable cases of people
infected by the fungus in New Jersey by the end of February, according to the
federal Centers for Disease Control and Prevention, up sharply from a handful
when the fungus was first identified in the state about two years ago.
The state’s number of cases – now the third-highest after
New York and Illinois – has risen in tandem with an increase, first overseas,
and now in the United States, in a trend that some doctors attribute to the
overuse of drugs to treat infections, prompting the mutation of infection
sources, in this case, a fungus.
The fungus mostly affects people who have existing
illnesses, and may already be hospitalized with compromised immune systems,
health officials said.
Nicole Kirgan, a spokeswoman for the New Jersey Department
of Health, said she didn’t know whether any of the state’s cases have been
fatal, and couldn’t say which hospitals are treating people with the fungus
because they have not, so far, been required to report their cases to state
officials…
But Dr. Ted Louie, an infectious disease specialist at
Robert Wood Johnson University Hospital in New Brunswick, said many hospitals
don’t know how to eradicate the fungus once it has occurred.
Some disinfectants commonly used in hospitals have proved
ineffective in removing the fungus, Dr. Louie said, so hospitals have been
urged to use other disinfecting agents, although it’s not yet clear which of
them work, if any.
“This is a fairly new occurrence and we are still
learning how to deal with it,” he said. “We have to figure out which
disinfectant procedures may be best to try to eradicate the infection, so at
this point, I don’t think we have good enough information to advise.” (E)
“Adding to the difficulty of treating candida auris is
finding it in the first place. The infection is often asymptomatic, showing few
to no immediate symptoms, said Chauhan. The symptoms that do appear, such as
fever, are often confused for bacterial infections, he said.
“Most routine diagnostic tests don’t work very well for
candida auris,” he said. “They’re often misidenfitied as other
species.”
The best way to identify candida auris is by looking under a
microscope, which often takes time because it requires doctors to grow the
fungus, Chauhan said.
As with most infectious diseases, the best course of action
is good hygiene and sterilization protocol. Washing your hands and using hand
sanitizer after helps to prevent transmission and infection, Chauhan said.
Doctors and healthcare workers should use protective gear,
and people visiting loved ones in hospitals and long-term care centers should
take proper precautions, he said.
The Center for Disease Control recommends using a special
disinfectant that is used to treat clostridium difficile spores. The
disinfectant has been effective in wiping out clostridium difficile, known as
c. diff, and disinfects surfaces contaminated with candida auris, as
well.” (F)
“Hospitals and nursing homes in California and Illinois
are testing a surprisingly simple strategy against the dangerous,
antibiotic-resistant superbugs that kill thousands of people each year: washing
patients with a special soap.
The efforts – funded with roughly $8 million from the
federal government’s Centers for Disease Control and Prevention – are taking
place at 50 facilities in those two states.
This novel approach recognizes that superbugs don’t remain
isolated in one hospital or nursing home but move quickly through a community,
said Dr. John Jernigan, who directs the CDC’s office on health care-acquired
infection research.
“No health care facility is an island,” Jernigan
said. “We all are in this complicated network.”
At least 2 million people in the U.S. become infected with
an antibiotic-resistant bacterium each year, and about 23,000 die from those
infections, according to the CDC…
Containing the dangerous bacteria has been a challenge for
hospitals and nursing homes. As part of the CDC effort, doctors and health care
workers in Chicago and Southern California are using the antimicrobial soap
chlorhexidine, which has been shown to reduce infections when patients bathe
with it. Though chlorhexidine is frequently used for bathing in hospital
intensive care units and as a mouthwash for dental infections, it is used less
commonly for bathing in nursing homes…
The infection-control work was new to many nursing homes,
which don’t have the same resources as hospitals, Lin said.
In fact, three-quarters of nursing homes in the U.S.
received citations for infection-control problems over a four-year period,
according to a Kaiser Health News analysis, and the facilities with repeat
citations almost never were fined. Nursing home residents often are sent back
to hospitals because of infections.” (G)
“The C.D.C. declined to comment, but in the past
officials have said their approach to confidentiality is necessary to encourage
the cooperation of hospitals and nursing homes, which might otherwise seek to
conceal infectious outbreaks.
Those pushing for increased transparency say they are up
against powerful medical institutions eager to protect their reputations, as
well as state health officials who also shield hospitals from public scrutiny…
Hospital administrators and public health officials say the
emphasis on greater transparency is misguided. Dr. Tina Tan, the top
epidemiologist at the New Jersey Department of Health, said that alerting the
public about hospitals where cases of Candida auris have been reported would
not be useful because most people were at low risk for exposure and public
disclosure could scare people away from seeking medical care.
“That could pose greater health risks than that of the
organism itself,” she said.
Nancy Foster, the vice president for quality and patient
safety at the American Hospital Association, agreed, saying that publicly
identifying health care facilities as the source of an infectious outbreak was
an imperfect science.
“That’s a lot of information to throw at people,”
she said, “and many hospitals are big places so if an outbreak occurs in a
small unit, a patient coming to an ambulatory surgical center might not be at
risk.”
Still, hospitals and local health officials sometimes hide
outbreaks even when disclosure could save lives. Between 2012 and 2014, more
than three dozen people at a Seattle hospital were infected with a
drug-resistant organism they got from a contaminated medical scope. Eighteen of
them died, but the hospital, Virginia Mason Medical Center, did not disclose
the outbreak, saying at the time that it did not see the need to do so.”
(H)
“Many have heard of the rise of drug-resistant
infections. But few know about an issue that’s making this threat even scarier
in the United States: the shortage of specialists capable of diagnosing and
treating those infections. Infectious diseases is one of just two medicine
subspecialties that routinely do not fill all of their training spots every
year in the National Resident Matching Program (the other is nephrology).
Between 2009 and 2017, the number of programs filling all of their
adult-infectious-disease training positions dropped by more than 40 percent…
Everyone who works in health care agrees that we need more
infectious-disease doctors, yet very few actually want the job. What’s going on?
The problem is that infectious-disease specialists care for
some of the most complicated patients in the health care system, yet they are
among the lowest paid. It is one of the only specialties in medicine that
sometimes pays worse than being a general practitioner. At many medical
centers, a board-certified internist accepts a pay cut of 30 percent to 40
percent to become an infectious-disease specialist.
This has to do with the way our insurance system reimburses
doctors. Medicare assigns relative value units to the thousands of services
that doctors provide, and these units largely determine how much physicians are
paid. The formula prioritizes invasive procedures over intellectual expertise.
The problem is that infectious-disease doctors don’t really
do procedures. It is a cognitive specialty, providing expert consultation, and
insurance doesn’t pay much for that…
Infectious-disease specialists are often the only health
care providers in a hospital – or an entire town – who know when to use all of
the new antibiotics (and when to withhold them). These experts serve as an
indispensable cog in the health care machine, but if trends continue, we won’t
have enough of them to go around. The terrifying part is that most patients
won’t even know about the deficit. Your doctor won’t ask a specialist for help
because in some parts of the country, the service simply won’t be available.
She’ll just have to wing it…
We must hurry. Superbugs are coming for us. We need experts
who know how to treat them.” (I)
People visiting patients at the hospital, and most
hospitalized patients, have little to fear from a novel fungal disease that has
struck more than 150 people in Illinois – all in the Chicago area – a Memorial
Medical Center official said Friday.
“For normal, healthy people, this is not a
concern,” Gina Carnduff, Memorial Health System director of infection
prevention, said in reference to Candida auris infections.
Carnduff, who is based at Memorial Medical Center, said only
the “sickest of the sick” patients are at risk of catching or
spreading the C. auris infection or dying from it.
Those patients, she said, include people who have stayed for
long periods at health care facilities – such as skilled-care nursing homes or
long-term acute-care hospitals – and who are on ventilators or have central
venous catheter lines or feeding tubes…
Officials from both Memorial Medical Center and HSHS St.
John’s Hospital said their institutions already are using the bleach-based
cleaning solutions known to prevent the spread of C. auris and other
infections.
The Illinois Department of Public Health’s website says more
than one in every three people with “invasive C. auris infection”
affecting the blood, heart or brain will die…
The state health department says 154 confirmed cases of C.
auris and four probable cases have been identified, all in the Chicago area.
Ninety-five cases were in Chicago, 56 were in Cook County outside of Chicago,
and seven were spread among the counties of DuPage, Lake and Will.
Eighty-five of the 158 people making up the confirmed and
probable cases have died, but only one death was “directly
attributed” to the infection, Arnold said. It’s not known whether C. auris
played a role in the deaths of the other 84 people, she said. (J)
“There is also the fact that some lab tests will not
identify the superbug as the source of an illness, which means that some
patients will receive the wrong treatment, increasing the duration of the
infection and the chance to transmit the fungus to another person.” (K)
“Hospitals, state health departments and the Centers
for Disease Control and Prevention are putting up a wall of silence to keep the
public from knowing which hospitals harbor Candida auris.
New York health officials publish a yearly report on
infection rates in each hospital. They disclose rates for infections like MRSA
and C. Diff. But for several years, the same officials have been mum about the
far deadlier Candida auris. That’s like posting “Wanted” pictures for
pickpockets but not serial murderers.
Health officials say they’ll disclose the information in
their next yearly report. That could be many months from now. Too late.
Patients need information in real time about where the risks are…
Dr. Eleanor Adams, a state Health Department researcher,
examined all the facilities in New York City affected by Candida auris over a
four-year period. Adams found serious flaws, including “inadequate
disinfection of shared equipment” to take vital signs, hasty cleaning and
careless compliance with rules to keep infected patients isolated…” (L)
“Remedies for curtailing the advance of C. auris are
familiar. Health care facilities must undergo stringent infection controls,
test for new cases and quickly identify any sources passing it along. Visitors
and medical workers must wash their hands after touching patients or surfaces.
The yeast spreads widely throughout patients’ rooms. Some cleanups have
reportedly required removing ceiling and floor tiles.
C. auris isn’t simply an opportunistic infection. Its rise
is additional evidence that becoming too reliant on certain types of drugs may
have unintended consequences. Exhibit A is the overuse of antibiotics in
doctors’ offices and on farms that encourages the development of drug-resistant
bacteria. Researchers suspect a similar situation involving C. auris and
agricultural fungicides used on crops. So far the origins of C. auris are
unclear, with different clusters arising in different areas of the world.
There’s no need to panic. But vigilance is required to track
C. auris and raise awareness in order to combat it. Officials typically are
eager to spread the word about potential health crises, from measles to MRSA.
In this case, the CDC issued alerts about fungus to health care facilities, but
the New York Times encountered an unusual wall of silence while investigating
superbugs such as C. auris. Medical facilities didn’t want to scare off
patients.
Any attempts to hide the spread of a communicable disease
are irresponsible. Knowledge leads to faster prevention and treatment. Patients
and their families have a right to know how hospitals and government agencies
are responding to a new threat. Medical workers also deserve to be informed of
the risks they encounter on the job.
Battling the superbugs requires aggressive responses and,
ultimately, scientific advancements. Downplaying outbreaks won’t stop their
rise.” (M)
“The rise of C. auris, which may have lurked unnoticed
for millennia, owes entirely to human intervention – the massive use of
fungicides in agriculture and on farm animals which winnowed away more
vulnerable species, giving the last bug standing a free run. Sensitised to
clinical fungicides, C. auris has proved to be difficult to extirpate, and
culls infected humans who cannot fight diseases very effectively – infants, the
old, diabetics, people with immune suppression, either because of diseases like
HIV or the use of steroids. The new superfungus has the makings of a future
plague, one of several which may cumulatively surpass cancer as a leading
killer in a few decades.
The origin of C. auris is known because it broke out in the
21st century, but the plagues from antiquity lack origin stories. Even their
spread was understood only retrospectively, in the light of modern science. The
father of all plagues, the Black Death, originated in China in the early 14th
century and ravaged most of the local population before it began its long
journey westwards down the Silk Route, via Samarkand. At the time, the chain of
hosts that carried it would have been incomprehensible – the afflicting
organism Yersinia pestis, the fleas which it infested, the rats which the fleas
in turn infested, which carried it into the homes of humans….” (N)
“WebMD: Most of us know candida from common yeast
infections that you might get on your skin or mucous membranes. What makes this
one different?
Chiller: It’s not acting like your typical candida. We’re
used to seeing those.
Candida – the regular ones – are already a major cause of
bloodstream infection in hospitalized patients. When we get invasive
infections, for example, bloodstream infections, we think that you sort of
auto-infect yourself. You come in with the candida already living in your gut.
You’re in the ICU, you’re on a broad spectrum antibiotic. You’re killing off
bad bacteria, you’re killing off good bacteria, so what are you left with?
Yeast, and it takes over.
What’s new with Candida auris is that it doesn’t act like
the typical candida that comes from our gut. This seems to be more of a skin
organism. It’s very happy on the skin and on surfaces.
It can survive on surfaces for long periods of time, weeks
to months. We know of patients that are colonized [meaning the Candida auris
lives on their skin without making them sick] for over a year now.
It is spreading in health care settings, more like bacteria
would, so it’s yeast that’s acting like bacteria” (O).
PART 2. In 30
years, I’ve never faced so tough a reporting challenge – and one so unexpected.
Who wouldn’t want to talk about a fungus?…
“C. auris is a drug-resistant fungus that has emerged
mysteriously around the world, and it is understood to be a clear and present
danger. But Connecticut state officials wouldn’t tell us the name of the
hospital where they had had a C. auris patient, let alone connect us with her
family. Neither would officials in Texas, where the woman was transferred and
died. A spokeswoman for the City of Chicago, where C. auris has become rampant
in long-term health care facilities, promised to find a family and then stopped
returning my calls without explanation.” (A)
“Candida auris, also referred to as C. auris, is a
potentially deadly fungal infection that appears to be making its way through
hospitals and long-term care facilities across the country. The New York City
area and New Jersey have reported more than 400 cases over the last few years
alone. Federal health authorities have declared this fungus a “serious
global health threat.”” (B)
“The Council of State and Territorial Epidemiologists
(CSTE) says Candida auris infections have been “associated with up to 40%
in-hospital mortality.”
“Most strains of C. auris are resistant to at least one
antifungal drug, one-third are resistant to two antifungal drug classes, and
some strains are resistant to all three major classes of antifungal drugs. C.
auris can spread readily between patients in healthcare facilities. It has
caused numerous healthcare-associated outbreaks that have been difficult to
control,” the CSTE said.
The CDC added, “Patients who have been hospitalized in
a healthcare facility a long time, have a central venous catheter, or other
lines or tubes entering their body, or have previously received antibiotics or
antifungal medications, appear to be at highest risk of infection with this
yeast.”
The CDC is alerting U.S. healthcare facilities to be on the
lookout for C. auris in their patients.” (C)
“”It’s a very serious health threat,” said
Dr. Irwin Redlener, Columbia University professor and an expert on public
health policy. “It’s a superbug, meaning resistant to all-known
antibiotics.”..
“These people would be in danger, so you don’t want
somebody visiting the hospital not knowing that it’s around and somehow
contracting the infection,” Dr. Redlener said. “That would be an
utter disaster.”..
Dr. Redlener says the secrecy is a big mistake.
“If they’re rattled by Candida auris to the point where
we have secrecy pacts among hospitals and public health agencies, then you’re
just hiding something that obviously needs more attention and resources to deal
with,” he said.
The state Department of Health says there is no risk to the
general public and notes that the vast majority of patients have had serious
underlying medical conditions.
Jill Montag, a spokesperson for the New York State
Department of Health, issued a statement to Eyewitness News.
“We are working aggressively with impacted hospitals
and nursing homes to implement infection control strategies for Candida
auris,” it read.
Montag says they plan to include the name of the impacted
facilities in their annual infection report, which will be released later this
year.
Dr. Redlener says they have the information now and should
release the names now…
“To keep that a secret is putting people in
danger,” he said. “And I don’t think that’s reasonable or
ethical.”” (D)
“We don’t know why it emerged,” said Dr. Maurizio
Del Poeta, a professor of molecular genetics and microbiology at Stony Brook
University’s Renaissance School of Medicine. At the very least, he is
recommending hospitals develop stricter rules on foot traffic in and out of
patients’ rooms because the microbe can be carried on the bottom of shoes.
The pathogen clings to surfaces in hospital rooms,
flourishes on floors, and adheres to patients’ skin, phones and food trays. It
is odorless, invisible – and unlikely to vanish from health care institutions
anytime soon.
“It can survive on a hospital floor for up to four
weeks,” Del Poeta said of C. auris. “It attaches to plastic objects
and doorknobs.”..…
“If we don’t want it to become like Staphylococcus
aureus, then we have to act now,” said Del Poeta, referring to the
bacteria that became the poster child of drug resistance when it developed the
ability to defeat the antibiotic methicillin, garnering the name
methicillin-resistant Staphylococcus aureus, or MRSA…
“In order to get Candida auris out of a room, you have
to take away everything – doorknobs, plastic items, everything. It is very
difficult to eradicate it in a hospital,” Del Poeta said. He said his
institution has never had a patient with C. auris…
Scientists such as Del Poeta contend it’s time for new
methods of addressing resistant microbes of all kinds because infectious
pathogens have developed the power to outwit, outpace and outmaneuver
humankind’s most potent agents of chemical warfare, many of them developed in
the 20th century.” (E)
“A case management program piloted by the New York City
health department monitors patients colonized with Candida auris after they are
discharged into the community and notifies health care facilities of their
status, researchers reported at the CDC’s annual Epidemic Intelligence Service
conference….
Patients can remain colonized with C. auris for months in a
health care setting, but it is unclear if they remain colonized after
discharge, noted Genevieve Bergeron, MD, MPH, an Epidemic Intelligence Service
officer with the New York City Department of Health and Mental Hygiene (DOHMH),
and colleagues.
According to Bergeron and colleagues, the state health
department began referring patients colonized with C. auris to the DOHMH on
Oct. 4, 2017. Approximately 12 case managers handled the referrals, conducting
patient interviews and reviewing medical records to obtain relevant clinical
information. They informed the patients’ providers and health care facilities
about their C. auris status and infection control needs.
“We requested that facilities flag the patient in their
electronic medical records to ensure that the patient has the proper
precautions, if the patient were to seek care again at those facilities,”
Bergeron said in a presentation. “Case mangers sent a medical alert card
to the patients for them to use when encountering health care providers unaware
of their infection control needs.”” (F)
“Regions are considering the use of electronic
registries to track patients that carry antibiotic-resistant bacteria including
carbapenem-resistant Enterobacteriaceae (CRE). Implementing such a registry can
be challenging and requires time, effort, and resources; therefore, there is a
need to better understand the potential impact…
When all Illinois facilities participated (n=402), the
registry reduced the number of new carriers by 11.7% and CRE prevalence by 7.6%
over a 3-year period. When 75% of the largest Illinois facilities participated
(n=304), registry use resulted in a 11.6% relative reduction in new carriers
(16.9% and 1.2% in participating and non-participating facilities,
respectively) and 5.0% relative reduction in prevalence. When 50% participated
(n=201), there were 10.7% and 5.6% relative reductions in incident carriers and
prevalence, respectively. When 25% participated (n=101), there was a 9.1%
relative reduction in incident carriers (20.4% and 1.6% in participating and
non-participating facilities, respectively) and 2.8% relative reduction in
prevalence.
Implementing an XDRO registry reduced CRE spread, even when
only 25% of the largest Illinois facilities participated due to patient
sharing. Non-participating facilities garnered benefits, with reductions in new
carriers.” (G)
“Quebec public-health authorities are bracing for the
inevitable arrival of a multi drug-resistant fungus that has been spreading
around the globe and causing infections, some of them fatal…
“We will definitely have cases here and there at one
point,” said Dr. Karl Weiss, chief of infectious diseases at the Jewish
General Hospital. “It’s almost guaranteed. The only thing is when you know
what you’re fighting against, it’s always easier and we will be able to contain
it a lot faster.”
C. auris poses a quadruple threat: it’s tricky to identify;
it can thrive in hospitals for weeks (preying on patients with weakened immune
systems); it’s resistant to two classes of anti-fungal medications; and it can
cause invasive disease, with lingering bloodstream infections that are hard to
treat. The mortality rate can rise as high as 60 per cent.
The pathogen has emerged at a time when hospitals in Quebec
– their budgets stretched more than ever – are already struggling with
antibiotic-resistant superbugs like C. difficile, MRSA and VRE that have caused
outbreaks. The Institut national de santé publique du Québec published a
bulletin last year on steps that hospitals and long-term centres can take to
prevent C. auris outbreaks.
“The problem is if you don’t identify the fungus
properly, then it can slip in between your hands, and you can have an outbreak
in your institution without even knowing it,” Weiss explained.
There was a lot of mis-indentification of this with other
Candida (fungi); and even the automated systems in institutions that identify
bacteria and yeast were mislabelling this Candida for something else. For a
while, people were not aware of this auris. But now we know how to identify it.
“The first thing we did in Quebec – and this was for
all the microbiology labs – is we taught all the microbiologists how to
properly identify Candida auris,” Weiss continued. “All the major
labs in Quebec put in place protocols.”
Weiss, who is president of the Quebec Association of Medical
Microbiologists, noted that under a quality assurance program, samples have
been sent to different labs to test whether the fungus is identified correctly.
The results show that that labs are detecting C. auris to a high degree.
If a patient is discovered to be infected, hospital protocol
dictates that the patient be isolated. During the patient’s hospitalization,
the housekeeping staff must disinfect the room daily with hydrogen peroxide and
other chemicals…” (H)
“Federal officials should declare an emergency over a
deadly, incurable fungus infecting people in New York, New Jersey and across
the country, Sen. Chuck Schumer said Sunday.
Schumer said he’s pushing the federal government to allocate
millions of dollars to fighting Candida auris, which is drug-resistant and
proving very difficult to eradicate…
“When it comes to the superbug, New York could use a little
more help,” said Schumer. “The CDC has the power to declare this an
emergency and automatically give us the resources we need.”..
Schumer said that an emergency declaration by the CDC would
lead to more cases being identified with better testing, and to better tracking
of the disease. It might also reduce the number of unnecessary antibiotic
prescriptions, which Schumer says have helped the disease become
drug-resistant…
Schumer cited other CDC emergency declarations that helped
stop the spread of deadly diseases, including a $25 million award to fight the
Zika virus in 2016 and $165 million given to contain Ebola in 2014.
“Every dollar we can use to better identify, tackle and
treat this deadly fungus is a dollar well spent,” Schumer said.” (I)
“Other medical experts see the overuse of human
antifungal medications in agriculture and floriculture as potential reasons for
resistance in Candida auris, known as C. auris, and possibly other fungi.
Dr. Matt McCarthy, a specialist in infectious diseases at Weill
Cornell Medicine in Manhattan, said tulips, signature flowers of the
Netherlands, are dosed with the same antifungal medications developed to treat
human infections.
“Antifungals are pumped into tulips in Amsterdam to
achieve flawless plants,” he said. “As a fungal expert, I know that
we have very few antifungal medications, and this is a misuse of the
drugs.”
Studies conducted at Trinity College in Ireland support
McCarthy’s argument and have demonstrated that tulip and narcissus bulbs from
the Netherlands may be vehicles that spread drug-resistant fungi.
Trinity scientists, who examined resistance in another
potentially deadly fungus, Aspergillus fumigatus, uncovered why the bugs
repelled the drugs known as triazoles. The fungi became resistant because of
the overuse of triazoles in floriculture. As with C. auris, drug-resistant A.
fumigatus can be deadly in people with poor immunity.
When patients need treatment with triazole-class
medications, the drugs don’t work because the fungi have been overexposed in
the environment, McCarthy said.
He added that the use of antifungal medications in
floriculture is similar to the overuse of antibiotics in the poultry and beef
industries, which have helped drive resistance to those drugs.
The floriculture example is just one way that drug-resistant
fungi can spread around the world. Global trade networks, human travel and the
movement of animals and crops are others.” (J)
“It will take further research to determine if the new
strains of C. auris have their origins in agriculture, but Aspergillus has
already illustrated the perils of modern farming. Antibiotics are applied on a
massive scale in food production, pushing the rise of bacterial drug
resistance. A British government study published in 2016 estimated that, within
30 years, drug-resistant infections will be a bigger killer than cancer, with
some 10 million people dying from infections every year.
We don’t have to end up there. Pesticide use on most farms
can be greatly reduced, or even eliminated, without reducing crop yields or
profitability. Methods of organic farming, even as simple as crop rotation,
tend to promote the growth of mutualistic fungi that crowd out pathogenic
strains such as C. auris. Unfortunately, because conventional agriculture is
heavily subsidized and market prices don’t reflect the costs to the environment
or human health, organic food is more expensive and faces an uphill battle for
greater consumption.
Of course, improved technology could help, with drugs of new
kinds or in breeding and engineering resistant strains of plants. There’s also
plenty of opportunity for lightweight agricultural robots, which can weed
mechanically or spray pesticides more accurately, reducing the quantity of
chemicals used. But tech shouldn’t be the sole focus just because it happens to
be the most profitable route for big industries.” (K)
“The recent outbreak of the so-called superbug – and
other drug-resistant germs – has thrown a spotlight on locally based Xenex
Disinfection Systems. The company makes a robot that uses pulsing, ultraviolet
rays to disinfect surgical suites and other environments that are supposed to
be germ-free.
With the spread of C. auris, Xenex officials say they’ve
seen an uptick in queries about their LightStrike Germ-Zapping Robots, which
are in use at more than 400 health-care facilities around the world since
manufacturing started in 2011.
These devices – often called R2Clean2, Mr. Clean and The
Germinator – disinfect rooms in a matter of minutes. A dome on the top of the
robot rises up, exposing a xenon bulb that emits UV light waves that kill germs
on contaminated surfaces.
Bexar County-owned University Hospital has a fleet of six
Xenex robots. One of the robots is assigned to the Cystic Fibrosis Center to
help protect patients from infection by other patients.
“We are taking every measure possible to reduce the
risk of infections, and this is an additional layer of security that bathes the
room in UV-C light,” said Elizabeth Allen, public relations manager at
University Health System…
Another study, recently published by a doctor at the
Minnesota-based Mayo Clinic, showed that when the hospital used the robots in
rooms that had already been cleaned, infection rates of another superbug –
called Clostridium difficile, or C. diff – fell by 47 percent.” (L)
“It wasn’t publicized locally, but within the past few
years teams of health officials at two Oklahoma health facilities took rapid
actions to contain the spread of a fungal “superbug” that federal
officials have declared a serious global health threat.
Only one patient at each facility was infected, and both
patients recovered. But the incidents reflect the growing alarm among health
officials over the deadly, multidrug-resistant Candida auris, or C. auris,
which can kill 30 percent to 60 percent of those infected…
In April 2017, a team of experts from the federal Centers
for Disease Control and Prevention converged on the University of Oklahoma
Medical Center in Oklahoma City after a patient tested positive for the
drug-resistant fungus.
About a year later, a patient at a southeast Oklahoma health
facility tested positive for the germ during a routine test. In both cases,
health officials isolated the patients, locked down their rooms and ordered
dozens of lab tests to see if the multidrug-resistant fungus had spread…
Unlike with outbreaks in Illinois, New York and New Jersey,
the potentially deadly infection was quickly contained.”..
Public knowledge about the OU Medical Center case makes it
an exception. Typically, health care facilities across the nation don’t release
to the public information when C. auris and other drug-resistant pathogens are
found. No law or policy requires them to do so.
Patient-rights advocates maintain that the public has the
right to know when and where outbreaks or even single cases occur. But health
officials have routinely fought back, suggesting that it could violate patient
rights and discourage patients from seeking hospital care.
But the CDC allows states to make that decision.
Burnsed said the Department of Health tries to walk a tight
line between notifying the public and protecting the patient’s privacy.
He said he would be more likely to identify a facility if
it’s anything more than an isolated case or if officials believed the exposure
wasn’t contained.
“What we consider is if there was a risk to a broader
group of individuals and if there was any evidence that there were a breach in
lab controls,” Burnsed said. “We didn’t put out anything at the time
(on Oklahoma’s two cases) because we didn’t think there was a greater risk to
the public, but it’s a good question to consider.”” (M)
“How many people will needlessly die from a deadly bug
sweeping through New York hospitals and nursing homes before local health
officials acknowledge the danger publicly – and act accordingly?..
Yet public-health officials here have been slow to let
patients know in which hospitals the bug is lurking. Folks are left to take
their chances. That’s outrageous.
Why are officials mum? Partly because they fear that if they
disclose the information, some people who need treatment won’t go for it.
That’s a weak excuse: As McCaughey notes, there are plenty
of local hospitals that aren’t plagued by Candida auris, so patients could get
care and avoid the risk, if they know where it’s safe to go.
More likely, no one wants to damage the reputations (or
incomes) of the affected hospitals. Yet the best way to protect those
reputations is to make sure the facilities are Candida auris-free…
Meanwhile, officials say they will reveal which hospitals
have the germ – in their next yearly report. But that could be months away;
patients need to know now.
If neither the hospitals nor their government regulators are
willing to move sooner, perhaps state lawmaker should step in and require them
to do so… (N)
Infectious disease experts tell Axios they agree with a dire
scenario painted in the UN report posted earlier this week saying that, if
nothing changes, antimicrobial resistance (AMR) could be
“catastrophic” in its economic and death toll.
Threat level, per the report: By 2030, up to 24 million
people could be forced into extreme poverty and annual economic damage could
resemble that from the 2008–2009 global financial crisis, if pathogens continue
becoming resistant to medications. By 2050, AMR could kill 10 million people
per year, in its worst-case scenario.
“There is no time to wait. Unless the world acts
urgently, antimicrobial resistance will have disastrous impact within a
generation.”..
By the numbers: Currently, at least 700,000 people die each
year due to drug-resistant diseases, including 230,000 people from
multidrug-resistant tuberculosis, per the UN. Common diseases – like
respiratory infections, STDs and urinary tract infections – are increasingly
untreatable as the pathogens develop resistance to current medications.
The Centers for Disease Control and Prevention says AMR
causes more than 23,000 deaths and 2 million illnesses in the U.S. annually…
What needs to be done: Jasarevic says the economic and
health systems of all nations must be considered, and targets made to increase
investment in new medicines, diagnostic tools, vaccines and other
interventions.”
The bottom line: Action must be taken to avoid a
catastrophic future.” (O)
“A recent study of patients at 10 academic hospitals in
the United States found that just over half care about what their doctors wear,
most of them preferring the traditional white coat.
Some doctors prefer the white coat, too, viewing it as a
defining symbol of the profession.
What many might not realize, though, is that health care
workers’ attire – including that seemingly “clean” white coat that
many prefer – can harbor dangerous bacteria and pathogens.
A systematic review of studies found that white coats are
frequently contaminated with strains of harmful and sometimes drug-resistant
bacteria associated with hospital-acquired infections. As many as 16 percent of
white coats tested positive for MRSA, and up to 42 percent for the bacterial
class Gram-negative rods.”
It isn’t just white coats that can be problematic. The
review also found that stethoscopes, phones and tablets can be contaminated
with harmful bacteria. One study of orthopedic surgeons showed a 45 percent
match between the species of bacteria found on their ties and in the wounds of patients
they had treated. Nurses’ uniforms have also been found to be contaminated.
Among possible remedies, antimicrobial textiles can help
reduce the presence of certain kinds of bacteria, according to a randomized
study. Daily laundering of health care workers’ attire can help somewhat,
though studies show that bacteria can contaminate them within hours…
It’s a powerful symbol. But maybe tradition doesn’t have to
be abandoned, just modified. Combining bare-below-the-elbows white attire, more
frequently washed, and with more conveniently placed hand sanitizers –
including wearable sanitizer dispensers – could help reduce the spread of
harmful bacteria.
Until these ideas or others are fully rolled out, one thing
we can all do right now is ask our doctors about hand sanitizing before they
make physical contact with us (including handshakes). A little reminder could
go a long way.” (P)
PART 3. May 28,
2019. CADIDA AURIS. “Antibiotic-resistant superbugs are everywhere. If your
hospital claims it doesn’t have them, it isn’t looking hard enough.”
“So far, 12 states from coast to coast have had confirmed
cases of Candida auris, which has spread with particularly speed in New York,
which has had more than half of the nation’s infections.
Some are even calling for the federal government to declare
a national state of emergency and fund better containment of the fungus.
Health officials there are scrambling to contain what the
Centers for Disease Control and Prevention (CDC) have deemed an emerging health
threat, but without stricter guidelines and screening, the fungus will only get
more deadly…
Doctors sometimes struggle to diagnose fungal infections, in
part because their symptoms are little different from those of bacterial
infections…
‘Candida auris has the ability to develop resistance and has
developed mechanisms to survive,’..
‘It’s at least starting to figure that out, and that’s
obviously concerning.’
There are really only three antifungal medications in the
US, so it doesn’t take long for a fungus to become wholly drug resistant.
Dr Chiller says that approximately 90 percent of strains the
CDC has logged are resistant to the first-line drug, another third are
resistant to a second, and between 20 and 30 percent of Candida auris
infections have acquired multi-drug resistance.
‘Some are pan-resistant and those need to be isolated and
stopped and we need to try to prevent them from developing,’ he says.
Neither the CDC, other nation’s health officials or any of
the 12 affected states have been able to work out where the fungus came from,
or how exactly it has spread from state-to-state…
If states don’t require their hospitals to report cases the
fungal infection, the CDC may be severely underestimating the number of cases
across the country.
‘It’s a bit of an uphill battle and it needs to be a really
concerted effort on multiple tiers of the health care system,’ Dr Chiller says…
‘We need to stay on top of it and not let our guard
down.’ (A)
“New York State health officials are considering rigorous
new requirements for hospitals and nursing homes to prevent the spread of a
deadly drug-resistant fungus called Candida auris.
The requirements could include mandatory pre-admission
screening of patients believed to be at-risk and placing in isolation those
patients who are infected, or even those just carrying the fungus on their
skin.
Dr. Howard Zucker, the state health commissioner, and a
fungal expert from the federal Centers for Disease Control and Prevention met
last Friday in Manhattan with nearly 60 hospital officials from across the
state to discuss the proposed guidelines. State health officials said they were
seeking hospital input before issuing the guidelines, which they acknowledged
would likely be a hardship for some institutions.
“One of our guiding objectives is to stop the geographic
spread,” said Brad Hutton, the state’s deputy commissioner of public health. He
said the state’s efforts to contain the spread have required significant
resources — including sending individual infection specialists to investigate
more than 150 cases — and that New York now needs help from individual
institutions.
“We’re at a point where our response strategy needs to
change,” he said. He added that he hoped the guidelines would be finalized by
the end of the year, but said the state is still determining whether to apply
them statewide or just to New York City and surrounding areas. It has yet to be
decided whether the guidelines would be recommendations or regulatory
requirements, he said…
For the moment…. hospitals are pre-screening many patients
who appear to be at risk. But it can take a week to get skin-swab results back
from the state laboratory, posing challenges for housing patients in isolation
during the interim. Further, she said, regular testing is likely to turn up
patients who are carriers but not infected, increasing the number of patients
who require isolation, appropriately or not.”..
For now, much of the burden for surveillance has fallen to
the state. The effort has involved the development of a fast-screening test
that can analyze a skin swab in a matter of hours. But all hospitals, for the
moment, have to send those tests to a state laboratory in Albany and wait
several days before receiving the results, though hospitals say the backlog
means tests can take a week.” (B)
“Unlike cholesterol drugs taken by millions of people for
their entire lives, or $100,000 cancer drugs designed to prolong life,
antibiotics are short-term drugs with limited shelf lives.
“Antibiotics are not valued by society as a high-value
product, so they’re not priced very high,” said Gregory Frank, director of
infectious disease policy at the Biotechnology Innovation Organization, in a
phone interview.
A 2014 paper.. cited a London School of Economics study
showing that while a new arthritis drug’s net present value – a measure of a
drug’s net value over the ensuing decades – would be $1 billion, that of a new
antibiotic would be negative $50 million…
People will buy innovative products in almost any other part
of the economy, but doctors will still keep even the most innovative antibiotic
behind the glass and use it only in the most dire circumstances.
“Antibiotic stewardship is a good thing, but devastating for
the company developing it,” Outterson said…
Jersey City, New Jersey-based Scynexis is one company
developing a treatment for drug-resistant fungal infections, ibrexafungerp, currently
in several clinical trials, including one for C. auris. The company plans to
file its first approval application with the FDA for ibrexafungerp next year.
The drug is expected cost $450-600 per day, in line with the pricing of other
antifungals, said company CEO Marco Taglietti, in a phone interview…
The race against drug-resistant infectious is ultimately a
scientific one. It’s not about finding
better treatments, but newer ones in an endless war that requires always
staying one step ahead of ever-evolving germs, Taglietti said. On the one hand,
it’s important to practice good stewardship in order to delay resistance.
“But that creates a big challenge from an economic point of
view – from the moment you launch your product after spending several hundreds
of millions to develop it, it doesn’t sell,” he said.
The problem appears to be a vicious cycle of science and
economics: Even existing push incentives, however generous, don’t make up for
antibiotics’ lack of the large and chronic patient populations of
cardiovascular disease drugs or the high prices of cancer drugs.” (C)
“Demanding that hospitals release lists of every superbug
they find within their walls, however, as many transparency advocates want, is
not the answer. The irony is that the hospitals that see the most superbugs are
often the best ones we have, for the simple reason that they have the most
sophisticated diagnostic platforms, the most powerful antibiotics and the
experts to administer them.
Compelling a world-class hospital like Massachusetts General
Hospital, where I saw my first superbug as a medical student, to reveal a
microbe list would only freak patients out. It wouldn’t explain where the
microbes came from, whether any patients were infected, and how they were
cured.
In a worst-case scenario, more transparency could lead to
patients avoiding medical care out of a misplaced fear of encountering
drug-resistant bacteria. Hospitals might start refusing patients with certain
infections, especially those coming from nursing facilities where these
microbes are common, out of a concern that the patient’s bacteria could be
added to the list. This would do everyone a disservice: Patients wouldn’t
receive optimal care and superbugs would multiply.
But hospital administrators and government officials do need
to be honest about the microbes in our medical centers and explain what is
really going on. No comment will no longer suffice. People have questions and
this story is not going away. To ensure that patients are well-informed, hospitals
should train spokesmen to address these issues and states should revisit their
reluctance to disclose information. Above all, health care workers and
administrators should speak openly about the measures their hospitals are
already employing to keep people safe.
I’m not particularly interested in the microbes that dwell
inside of a given hospital; what matters is whether its employees follow the
strict protocols that prevent these organisms from going where they shouldn’t…
Silence and evasion gives the perception that this is a
problem spiraling out of control when, in fact, it’s not. An intricate tracking
system exists so that epidemiologists across the country can monitor any
outbreaks to ensure that proper protocols and containment strategies are implemented.
We need to hear more from these superbug hunters.” (D)
“A new study published in the Journal of Occupational and
Environmental Health has established protocols for containing the drug
resistant Candida auris (C. auris ) in an animal facility, and by doing so, has
identified four simple rules that can potentially be adopted by healthcare
facilities to limit exposure to staff and patients. The study found that their
double personal protective equipment (PPE), work ‘buddy’ system, disinfection
and biomonitoring protocols were effective at containing high levels of C.
auris infection within their animal facility, even six months after their
experiments…
Before entering the animal holding and procedure rooms,
staff donned a second layer of booties, gloves and gowns, which were later
removed and placed in biohazard bins before exiting the rooms. Handling of
infected cages and equipment was restricted to biosafety cabinets where a buddy
system was implemented so that one person handed clean cages and supplies to a
second person working inside the contaminated biosafety cabinet. This
system-controlled workflow from clearly defined ‘clean’ to ‘dirty’ areas and
allowed workers to monitor each other to ensure proper procedures were
followed. Surfaces and equipment that came in contact with infected mice or
tissues were treated with a strict disinfection protocol of 10% bleach followed
(after five minutes) by 70% ethanol. The effectiveness of the workflow and
protocols were continually monitored using swab testing on surfaces suspected
to be contaminated, and as a second measure, Sabbaroud dextrose plates were
placed inside the biosafety cabinet and on the floor underneath to determine
whether C. auris was aerosolised within the cabinet or whether any debris contaminated
the floor.
The researchers found that possible contamination came from
direct contact with the infected mice or tissues but not from aerosolisation.”
(E)
“A pernicious disease is eating away at Roy Petteway’s
orange trees. The bacterial infection, transmitted by a tiny winged insect from
China, has evaded all efforts to contain it, decimating Florida’s citrus
industry and forcing scores of growers out of business.
In a last-ditch attempt to slow the infection, Mr. Petteway
revved up his industrial sprayer one recent afternoon and doused the trees with
a novel pesticide: antibiotics used to treat syphilis, tuberculosis, urinary
tract infections and a number of other illnesses in humans…
The use of antibiotics on citrus adds a wrinkle to an
intensifying debate about whether the heavy use of antimicrobials in
agriculture endangers human health by neutering the drugs’ germ-slaying
abilities. Much of that debate has focused on livestock farmers, who use 80
percent of antibiotics sold in the United States.
Although the research on antibiotic use in crops is not as
extensive, scientists say the same dynamic is already playing out with the
fungicides that are liberally sprayed on vegetables and flowers across the
world. Researchers believe the surge in a drug-resistant lung infection called
aspergillosis is associated with agricultural fungicides, and many suspect the
drugs are behind the rise of Candida auris, a deadly fungal infection.” (F)
OCTOBER 3, 2018
“A large Candida auris outbreak at a hospital in England
appears to be linked to reusable patient-monitoring equipment, a team of
researchers reports today in the New England Journal of Medicine.
The outbreak in the neurosciences intensive care unit (ICU)
at Oxford University Hospitals involved 70 patients who were infected or
colonized with C auris, a fungus that has become increasingly resistant to
azoles, echinocandins, and polyenes—the three classes of antifungals used to
treat infections caused by Candida and other fungal species.
An epidemiologic investigation and case-control study by
investigators from the University of Oxford, Public Health England, and
elsewhere found that the most compelling explanation for the prolonged outbreak
was the persistence of the organism on reusable skin-surface axillary probes, a
device placed in a patient’s armpit for continuous temperature monitoring.
“Our results indicate that reusable patient equipment
may serve as a source of healthcare-associated outbreaks of infection with C.
auris,” the authors of the study write.” (G)
G. Study links hospital Candida auris outbreak to reusable thermometers, by Chris Dall, http://www.cidrap.umn.edu/news-perspective/2018/10/study-links-hospital-candida-auris-outbreak-reusable-thermometers
In the
doctors’ meeting, the (UNC) chief of pediatric cardiology, Dr. Timothy Hoffman,
was blunt. “It’s a nightmare right now,” he said. “We are in crisis, and
everyone is aware of that.”
North Carolina’s
secretary of health on Friday called for an investigation into a hospital where
doctors had suspected children with complex heart conditions had been dying at
higher than expected rates after undergoing heart surgery.
New PART 2 after PART 1.
PART 1. February 26, 2019. Johns Hopkins All
Children’s Hospital (St Petersburg, Florida) – problems in the hospital’s heart
surgery unit
Assignment:
How would this problem have been avoided if Johns Hopkins quality assurance and
patient safety protocols been followed?
“The Patient
Safety and Healthcare Quality Masters program is a fully online,
interdisciplinary degree offered by Johns Hopkins University. It is a
first-of-its-kind collaboration between the Johns Hopkins Bloomberg School of
Public Health, Johns Hopkins School of Medicine, Johns Hopkins School of
Nursing and the Armstrong Institute for Patient Safety and Quality. It combines
coursework from JHU’s top ranked schools and the Armstrong Institute’s
pioneering advances in patient safety-educating students in the transformative
mechanisms and evidence-based protocols that reduce preventable patient harm
and improve clinical outcomes.
Renowned,
industry-shaping experts lead this exciting new program designed for working
adults. The program focuses on: Measurement of safety and quality; Designing
safer systems; Organizational and cultural change. ” (A)
“Patient
Safety and Quality at Johns Hopkins Medicine.
Each day in
a hospital, staff members undertake complicated tasks caring for patients.
Johns Hopkins Medicine’s patient safety efforts aim to ensure that all of these
steps work together to deliver high-quality, compassionate care to all patients
across our health system.
Johns
Hopkins Health System hospitals and services consistently receive awards and
honors for patient safety and quality, including Top Performer on Key Quality
Measures by the Joint Commission, Magnet designation for nursing, HomeCare
Elite and Delmarva Foundation Excellence Awards. The Johns Hopkins Hospital has
been ranked No. 1 in the nation by U.S. News & World Report for 22 years of
the survey’s 25-year history, most recently in 2013.
Patient
Safety and Quality Measures
This website
shares data for the Johns Hopkins Health System. Here, you will find
information about key safety issues and the patient’s experience of care,
including:
Patient
Experience – Based on survey results from previous patients, you can see how
others rated their experience of care from a Johns Hopkins Medicine hospital or
home health care provider.
Infection
Prevention – These measures include the rate of CLABSIs, a bloodstream
infection caused by a central line (large IV) that are considered preventable
and hand hygiene, the percentage of medical staff members observed washing
their hands or using hand sanitizer before and after caring for a patient.
Core
Measures – These measures are national standards of care and treatment
processes for common conditions. Core measure compliance shows how often a
hospital follows each of these steps.
Surgical
Volumes – Studies have shown a strong relationship exists between the number of
times a hospital performs a specific surgical procedure and the outcomes for
those patients. In 2016, we started sharing our hospitals’ surgical volumes for
many common and high-risk procedures.
Quality of
Care Ratings – The quality of patient care star rating is a summary of how well
the Johns Hopkins Home Care Group and Potomac Home Health Care perform on nine
quality measures such as ambulation.
Pediatrics –
These measures include national standards of treatment for common conditions,
infection prevention, pain management and emergency department wait times for
Johns Hopkins’ pediatric divisions.
Hospital
Readmissions – Patients are most vulnerable for readmission to a hospital
immediately following discharge. This measure tracks how many Medicare patients
with specific conditions were readmitted to the hospital within 30 days for any
reason.
Our
Commitment to Transparency
Patients and
their loved ones deserve to be informed about the quality of their heath care.
At Johns Hopkins Medicine, we are dedicated to sharing our performance and how
we work to provide the best care with past, present and future patients. The
Johns Hopkins Armstrong Institute for Patient Safety and Quality coordinates
safety and quality improvement efforts and training across our health system.
We hope you
will find this website a valuable resource and encourage you to ask your health
care team if you have any questions or concerns. (B)
“Patient
Trust, Confidence Built on Interprofessional Innovation
Medical
errors and preventable patient infections and injuries together make up the
third-leading cause of death in the United States, a startling statistic.
The Johns
Hopkins School of Nursing understands that an increasing focus on patient
safety and quality of care depends upon a healthcare workforce that knows the
risks and the proper responses from patients’ arrival to their safe discharge.
The Helene Fuld
Leadership Program for the Advancement of Patient Safety and Quality (The Fuld
Fellows Program) emphasizes interprofessional education and training,
simulation, and service-learning experiences involving nurses, medical
students, pharmacists, and other health professionals whose collaboration is
critical for reducing preventable harm to patients.
Nurses, as
the primary contact with patients, play a key role in their safety. Hopkins
Nursing, as part of an interprofessional team that includes the Armstrong
Institute for Patient Safety & Quality and the Johns Hopkins Health
Systems, works to prepare nurses ready to communicate, cooperate, innovate, and
lead on issues of patient safety and quality of care.” (C)
“Johns
Hopkins Medicine Armstrong Institute for Patient Safety and Quality
A roadmap
for patient safety and quality improvement
This month
the Agency for Healthcare Research and Quality (AHRQ) published a new report
that identifies the most promising practices for improving patient safety in
U.S. hospitals.
An update to
the 2001 publication Making Health Care Safer: A Critical Analysis of Patient
Safety Practices, the new report reflects just how much the science of safety
has advanced.
A decade ago
the science was immature; researchers posited quick fixes without fully
appreciating the difficulty of challenging and changing accepted behaviors and
beliefs.
Today, based
on years of work by patient safety researchers-including many at Johns
Hopkins-hospitals are able to implement evidence-based solutions to address the
most pernicious causes of preventable patient harm. According to the report,
here is a list of the top 10 patient safety interventions that hospitals should
adopt now.
Top 10
Recommended Patient Safety Strategies
1.
Preoperative checklists and anesthesia checklists to prevent operative and
postoperative events.
2. Bundles
that include checklists to prevent central line-associated bloodstream
infections
3.
Interventions to reduce urinary catheter use, including catheter reminders,
stop orders, or nurse-initiated removal protocols
4. Bundles
that include head-of-bed elevation, sedation vacations, oral care with
chlorhexidine, and subglottic-suctioning endotracheal tubes to prevent
ventilator-associated pneumonia
5. Hand
hygiene
6. The
do-not-use list for hazardous abbreviations
7.
Multicomponent interventions to reduce pressure ulcers
8. Barrier
precautions to prevent healthcare-associated infections
9. Use of
real-time ultrasonography for central line placement
10.
Interventions to improve prophylaxis for venous thromboembolisms…
Even with a
list of sound strategies, creating a plan to implement all or even half of them
may sound like a daunting task. The Armstrong Institute for Patient Safety and
Quality has created a checklist to help you get started.
1. Identify
priorities and assess readiness for change.
2. Establish
engagement and accountability at all levels of the organization.
3.
Communicate constantly (the good and the bad).
4. Measure,
measure, measure… and then measure some more. (D)
“Johns
Hopkins All Children’s Hospital provides expert pediatric care for infants,
children and teens with some of the most challenging medical problems in our
community and around the world.
Named a top
50 children’s hospital by U.S. News & World Report, we provide access to
innovative treatments and therapies. Taking part in pediatric medical education
and clinical research helps us to provide care in more than 50 specialties.
With more
than half of our 259 beds devoted to intensive care level services, we are the
regional pediatric referral center for Florida’s West Coast. Physicians and
community hospitals count on us to care for critically ill patients and perform
complex surgical procedures.
Parents
count on us, too. Our philosophy of family-centered care means family members
are an important part of our health care team. We include parents in making
decisions and plans for their child’s care. We also include patients who are
old enough to take part in these discussions.
To help us
design our hospital that we opened in January 2010, we asked patients, parents
and our staff to share ideas. The result was a spacious and bright hospital
with individual rooms where parents can comfortably spend the night. With the
latest technology and our commitment to family-centered care, our hospital
provides an ideal environment for healing.” (E)
“Quality,
Outcomes and Patient Safety at Johns Hopkins All Children’s
We are
committed to treating you and your child with compassion and respect. We
believe that you deserve honesty in our communication about the plan for your
child’s care and we will demonstrate uncompromising integrity to earn your
trust. We will be responsible for including each family as a part of our care
team that is committed to safe and innovative care practices. Our goal is to
inspire hope for you and your child through our focus on inquiry,
collaboration, and team work.
Johns
Hopkins All Children’s Hospital believes in Creating healthy tomorrows… for one
child, for All Children. Our focus on Quality assures that we are continually
improving our processes in an effort to achieve this vision. Using a team
approach we tap into the know-how of our expert medical staff and employees to
improve the quality and safety of the care we provide.
Our Quality
Model provides the basis for understanding patient needs, measuring and using
data, and achieving real improvement. Improving continuously is our goal. To do
this we encourage each member of our team to find ways to do their work better
and to make patient safety a priority. Together we are focused on pursuing
perfection for All Children.
Quality
Measures
There are
many ways to look at and measure quality. Our data uses information from key
areas to help families, healthcare providers, and others learn about our
progress in pursuing perfection for All Children.” (F)
“Sandra
Vázquez paced the heart unit at Johns Hopkins All Children’s Hospital.
Her
5-month-old son, Sebastián Vixtha, lay unconscious in his hospital crib,
breathing faintly through a tube. Two surgeries to fix his heart had failed,
even the one that was supposed to be straightforward.
Vázquez saw
another mom in the room next door crying. Her baby was also in bad shape.
Down the
hall, 4-month-old Leslie Lugo had developed a serious infection in the surgical
incision that snaked down her chest. Her parents argued with the doctors. They
didn’t believe the hospital room had been kept sterile.
By the end
of the week, all three babies would die…
The
internationally renowned Johns Hopkins had taken over the St. Petersburg
hospital six years earlier and vowed to transform its heart surgery unit into
one of the nation’s best.
Instead, the
program got worse and worse until children were dying at a stunning rate, a
Tampa Bay Times investigation has found.
Nearly one
in 10 patients died last year. The mortality rate, suddenly the highest in
Florida, had tripled since 2015…
Times
reporters spent a year examining the All Children’s Heart Institute – a small,
but important division of the larger hospital devoted to caring for children
born with heart defects…
They
discovered a program beset with problems that were whispered about in heart
surgery circles but hidden from the public.
Among the
findings:
All
Children’s surgeons made serious mistakes, and their procedures went wrong in
unusual ways. They lost needles in at least two infants’ chests. Sutures burst.
Infections mounted. Patches designed to cover holes in tiny hearts failed.
Johns
Hopkins’ handpicked administrators disregarded safety concerns the program’s staff
had raised as early as 2015. It wasn’t until early 2017 that All Children’s
stopped performing the most complex procedures. And it wasn’t until late that
year that it pulled one of its main surgeons from the operating room.
Even after
the hospital stopped the most complex procedures, children continued to suffer.
A doctor told Cash Beni-King’s parents his operation would be easy. His mother
and father imagined him growing up, playing football. Instead multiple
surgeries failed, and he died.
In just a year
and a half, at least 11 patients died after operations by the hospital’s two
principal heart surgeons. The 2017 death rate was the highest any Florida
pediatric heart program had seen in the last decade.
Parents were
kept in the dark about the institute’s troubles, including some that affected
their children’s care. Leslie Lugo’s family didn’t know she caught pneumonia in
the hospital until they read her autopsy report. The parents of another child
didn’t learn a surgical needle was left inside their baby until after she was
sent home.
The Times
presented its findings to hospital leaders in a series of memos early this
month. They declined interview requests and did not make the institute’s
doctors available to comment.
In a
statement, All Children’s did not dispute the Times’ reporting. The hospital
said it halted all pediatric heart surgeries in October and is conducting a
review of the program.
“Johns
Hopkins All Children’s Hospital is defined by our commitment to patient safety
and providing the highest quality care possible to the children and families we
serve,” the hospital wrote. “An important part of that commitment is a
willingness to learn.” (G)
The top
three leaders of Johns Hopkins All Children’s Hospital in Florida resigned
Tuesday following a Tampa Bay Times investigation that revealed increasing
mortality rates among heart surgery patients.
The
resignations from the 259-bed teaching hospital in St. Petersburg included CEO
Jonathan Ellen, M.D., and Vice President Jackie Crain, as well as Jeffrey
Jacobs, M.D., who is the heart institute’s deputy director, the Tampa Bay Times
reported. Paul Colombani, M.D., stepped down as chairman of the department of
surgery but will continue working in a clinical capacity, a statement from the
health system said.
“Losing a
child is something no family should have to endure, and we are committed to
learning everything we can about what happened at the Heart Institute,
including a top-to-bottom evaluation of its leadership and key processes,” a
statement from Johns Hopkins read. “The events described in recent news reports
are unacceptable.”
Johns
Hopkins, which owns and operates the hospital, said it would install Kevin
Sowers, who is president of the Johns Hopkins Health System and executive vice
president of Johns Hopkins Medicine, to lead the hospital in a temporary
capacity while a plan for interim leadership is put into place.
George
Jallo, M.D., who is medical director of the Institute for Brain Protection
Sciences and chief of pediatric neurosurgery, will serve as interim vice dean
and physician-in-chief, and Paul Danielson, M.D., who is chief of the Division
of Pediatric Surgery at Johns Hopkins All Children’s Hospital, will serve as
interim chair of the surgery department.
Johns
Hopkins’ board also said it commissioned an external review to examine the
heart surgery program and said it would share its lessons from the review to
help hospitals around the country avoid the same mistakes.
The moves
come following the Tampa Bay Times investigation that highlighted a growing
number of heart surgery deaths at the hospital amid warnings about safety from
staffers that went unheeded. (H)
“Three
additional senior administrators have left Johns Hopkins All Children’s
Hospital in the wake of a Tampa Bay Times investigation into high mortality
rates at the hospital’s Heart Institute, the hospital announced Wednesday.
A total of
six senior officials have left since the Times report, including the hospital’s
CEO, three vice presidents and two surgeons who held leadership roles at the
Heart Institute. A seventh official stepped down as chairman of the surgery
department but remained employed at the hospital as a doctor.
The
resignations announced Wednesday included vice presidents Dr. Brigitta Mueller,
the hospital’s chief patient safety officer, and Sylvia Ameen, who oversaw
culture and employee engagement and served as the hospital’s chief spokeswoman.
The hospital
also said Dr. Gerhard Ziemer, who started as the Heart Institute’s new director
and chief of cardiovascular surgery in October, would leave the hospital. The
hospital never publicly announced Ziemer had been hired, and he had not yet
obtained his Florida medical license when the Times investigation was published
at the end of November. At that point, the hospital said the Heart Institute
had already stopped performing surgeries.
“While Dr.
Ziemer is not responsible for the current state of the program, we agreed that
a fresh start was needed to ensure success for the program,” Johns Hopkins
Health System President Kevin Sowers said in a letter to the hospital’s staff.”
..
In his
letter to the staff, Sowers said that several hospital executives had been
tasked with leading “critically important work around advancing our culture of
safety.”
“As we work
to rebuild the trust of our community, we must also work to fully embrace and
support a culture where we are each empowered and encouraged to speak up and
speak out if we see or hear something that concerns us,” he wrote. “This
commitment applies to clinical concerns as well as inappropriate workplace
behavior.”
Sowers also
announced that Johns Hopkins had hired external experts to develop a plan to
restart heart surgeries at All Children’s.
That is a
separate effort from an external review of the problems in the Heart Institute,
which Johns Hopkins announced its board had commissioned last month,
spokeswoman Kim Hoppe said…
Johns
Hopkins is one of the most prestigious brands in medicine and is
internationally renowned for developing innovative patient safety protocols
that are used at hospitals across the world. But last weekend, the Times
published a story detailing a series of safety problems at hospitals across its
network. In response, the health system pledged to “do better.” (I)
“The Johns
Hopkins Medicine Board of Trustees has appointed a former federal prosecutor to
lead its investigation into the Johns Hopkins All Children’s Hospital’s heart
surgery unit, the health system announced late Tuesday.
F. Joseph
Warin, of the global law firm Gibson Dunn, and his team will review the high
mortality rates and other problems at the hospital’s Heart Institute and report
back to a special committee of the board of trustees by May, the health system
said.
Once the
review is complete, the health system said it would also name an independent
monitor at All Children’s to “make sure that the hospital is being held
accountable for taking corrective action where necessary.”
The
announcement was accompanied by a video of Johns Hopkins Health System
president Kevin Sowers, who acknowledged for the first time that the hospital
had been warned about problems by frontline workers.
“I know
personally that many of you courageously spoke out when you had concerns but
were ignored or turned away,” he said. “That behavior is unacceptable and will
not be tolerated going forward.”
Sowers, who
is also interim president at All Children’s, said he hoped to meet with the
families of patients affected by problems in the Heart Institute in the coming
days to share his “profound sadness for the failures of care they experienced.”
(J)
“The
external review was prompted by multiple reports by the Tampa Bay Times about
problems at the center which could have contributed to its mortality rate
tripling between 2015 and 2017…
Health News
Florida’s Stephanie Colombini talked about what could come next with Kathleen
McGrory, one of the lead reporters.
One of the
big problems you uncovered in your reporting was the lack of available data
about mortality rates at a lot of these heart surgery programs…
Officials
have either refused to release it or they only release four-year averages,
which could mislead families about the current state of the program they’re
choosing.
How is the
state looking at making these programs more transparent?
There were
some problems at another pediatric heart surgery program in 2015 in Palm Beach
County (St. Mary’s Medical Center), and after those problems surfaced, the
legislature put together a panel (Pediatric Cardiology Technical Advisory
Panel) tasked with looking at transparency and ways we could, as a state, make
these programs better and more accountable.
That panel
is in the middle of doing its work right now and in fact has come close to
finalizing some recommendations.
The panel
would like all of these heart surgery programs to be reporting their one-year
data (on mortality rates) rather than their four-year data because that
four-year data can sometimes hide serious problems…
So the state
is looking into making heart surgery programs more accountable, but is anyone
calling for change when it comes to the government’s role in this?
You reported
that multiple times state and federal regulators were alerted to problems at
All Children’s and yet little, to no action was taken.
We saw U.S.
Reps. Kathy Castor and Charlie Crist put some really tough questions to federal
regulators asking what they had investigated and when. We haven’t heard back
yet on that front but we know it’s something they’ll be looking into.
The state
told us that they did the best they could do with the information that they
had, same thing with the federal government.
But ACHA has
a new chief (Mary Mayhew). We haven’t gotten a chance to connect with her yet
and see what her thoughts are on this, but we certainly will do that in the new
year. (K)
“State and federal
inspectors descended on Johns Hopkins All Children’s Hospital this week,
following sharp calls for an investigation into problems in the hospital’s
heart surgery unit, the Tampa Bay Times has learned.
The scope of
the inspection is unclear. But hospital regulators had been criticized in
recent weeks for their lax response to early signs of an increase in mortality
at the hospital’s Heart Institute.
A Florida
Agency for Health Care Administration spokeswoman said her agency had been at
the facility.
A
spokeswoman for the hospital confirmed federal inspectors had been there, too.
“We
appreciate the oversight role that our regulators play and we will, as always,
be fully cooperative and collaborative as they conduct any reviews necessary,”
a statement from the hospital said.
A
spokeswoman for the federal Centers for Medicare and Medicaid Services declined
to comment beyond saying the matter remained “an ongoing review.”
In November,
the Times reported that the mortality rate for heart surgery patients at All
Children’s tripled from 2015 to 2017 to become the highest rate in Florida. The
increase occurred after staff members warned the hospital’s leaders about
problems with two heart surgeons, the Times found.
State and
federal regulators knew the institute was having problems months earlier. In
April, the hospital’s CEO told the Times that the institute had “challenges”
that led to an uptick in mortality, and acknowledged the hospital had left
surgical needles inside two children.
In May,
state regulators cited the hospital for not properly reporting two medical
mistakes, which is required by state law. Days later, a spokeswoman for the
federal agency told the Times that it would perform its own investigation.
But state
regulators didn’t fine the hospital, and overlooked several subsequent warnings
that its surgical results had been poor.
And federal
inspectors later changed course and decided not to undertake a comprehensive
review of the heart surgery program, the Times reported last month. One reason
was that state inspectors hadn’t found any violations of federal rules, a
spokeswoman said. Another was that a nonprofit hospital accreditor was due to
perform a scheduled review.” (L)
Two Omaha
surgeons filed a lawsuit Friday against Children’s Hospital & Medical
Center, alleging that they were wrongfully suspended and forced to resign
privileges there after they raised patient safety concerns.
In the suit,
Dr. Jason Miller and Dr. Mark Puccioni say that the hospital suspended their
privileges to practice at the Omaha facility after they raised concerns about
the death of a 7-month-old during an operation. That operation was performed
this fall by another surgeon, Dr. Adam Conley, the suit says.
In their
communications, according to the suit filed in Douglas County District Court,
the two also questioned Conley’s “skill and ability.”
In addition
to the hospital, the lawsuit names as defendants Conley, as well as Dr. Richard
Azizkhan, who took over as Children’s president and CEO in October 2015.
Children’s
officials said in a statement that the hospital does not comment on pending
litigation “other than to say we strongly disagree with these allegations…
Children’s
has faced other issues in recent months.
In late
November, a former pharmacy director at the hospital was accused of funneling
more than $4.4 million from the organization into her personal account over six
years. She was terminated in June and faces a hearing regarding possible
disciplinary action later this month.
About three
weeks ago, the Nebraska Medical Association sent a letter to the board of
Children’s Hospital expressing concerns about “patient care, safety and
quality” at the Omaha hospital, in addition to the loss of longtime physicians.
In the Dec.
11 letter, the president of the group, Dr. Britt Thedinger, wrote, “We as
physicians are concerned about the summary suspensions, terminations and
resignations of long-time outstanding physician colleagues.” The letter also
expressed concern that children were being transferred to outside institutions
because of “complications” and inadequate staffing at the Omaha hospital.
Thedinger
said the organization did not intend for the letter to become public. The
intent, he said, was to bring issues that had been raised by members to the
hospital board and administration.” (M)
“The New
Jersey Department of Health is investigating four Acinetobacter baumannii cases
in the neonatal intensive care unit (NICU) of University Hospital in Newark,
authorities announced Thursday evening.
DOH
officials stated:
“The
department first became aware of this bacterial infection on Oct. 1 and two
department teams have been closely monitoring the situation. Those department
teams, which have been at the facility last week and this week, have been
ensuring that infection control protocols are followed and are tracking cases
of the infection. The department’s inspection revealed major infection control
deficiencies.”
According to
the DOH, a premature baby with the bacteria who had been cared for at
University Hospital was transferred to another facility and passed away toward
the end of September, prior to the department’s notification of problems in the
NICU.
“Due to the
other compounding medical conditions, the exact cause of death is still being
investigated,” DOH officials said.
The
department has ordered a Directed Plan of Correction that requires University
Hospital to employ a full-time Certified Infection Control Practitioner
consultant, who will report to the DOH on immediate actions taken in the coming
days.
DOH officials
said they are also exploring further actions the agency may need to take in the
coming days to “ensure patient safety.” (N)
“Four New
Jersey pediatric care facilities and one hospital are now under the state’s
microscope after nine children died and 26 people were sickened by a deadly
virus over the past month.
A Department
of Health team of infection control experts and epidemiologists will visit
University Hospital in Newark and four pediatric long-term care facilities in
November to conduct training and assessments of infection control procedures,
Commissioner Dr. Shereef Elnahal has announced.
The team of
experts will visit University Hospital, the Wanaque Center for Nursing &
Rehabilitation in Haskell, Voorhees Pediatric Facility in Voorhees and Children’s
Specialized Hospital in Toms River and Mountainside. The department reached out
to the facilities last week to schedule visits in November.
The decision
comes after nine children at a Wanaque facility have died since an outbreak of
the adenovirus was declared there. Victims became sick between Sept. 26 and
Oct. 22. Authorities confirmed that the virus killed eight of the nine kids.
Twenty-six
kids and a staff member, who has since recovered, have become ill as part of
the outbreak, state health officials said. Laboratory tests confirmed the 26th
case. (O)
“Two decades
ago, the Institute of Medicine shook the medical profession with its “To Err is
Human” report which said nearly 100,000 people a year lost their lives to
preventable medical errors…
During the
7th Annual World Patient Safety, Science & Technology Summit over the
weekend, the Patient Safety Movement Foundation released a new tool on its
website to help with the training.
The patient
safety curriculum is one of 17 Actionable Patient Safety Solutions (APSS) made
available to organizations for free to help train health professionals in
systems science so they can help find ways to reduce preventable patient
deaths, officials said.
“The goal is
to get every health professional to think in a system way,” said Steven
Scheinman, M.D., the president and dean of Geisinger Commonwealth School of
Medicine. He led a Patient Safety Movement working group which included experts
from Geisinger, San Diego State, University of Pittsburgh Medical Center, Johns
Hopkins Health, and MedStar Georgetown to develop the curriculum over an
18-month period.
The Patient
Safety Movement was founded in 2013 to help reduce preventable deaths in
healthcare and in 2015 set a goal of zero preventable deaths by 2020. More than
90,000 patients who might have died as a result of medical errors were saved in
2018 due to efforts made by more than 4,700 hospitals that committed to patient
safety efforts, according to figures released by the foundation. In all, a
total of 273,077 lives have been saved since the first summit, officials said.
The newly
released safety curriculum can be adapted to any healthcare profession
including medicine, nursing, pharmacy, and behavioral health and can be used
for student training, as well as training for experienced professionals.
“We want to
train every health professional to take ownership of the patient’s safety and
experience so they understand safe communication and know when they are telling
another person about the patient or handing them over or referring them over,
how to make sure they get all the critical information there,” Scheinman said…
“The airline
industry solved safety by creating the right systems,” Scheinman said. “Medical
errors are very widespread. But they usually aren’t a doctor making a mistake.
They can be. But they’re more often the system failed to pick something up or
allowed something bad to happen.”
And with
this training, he said, those medical professionals might be that much more
likely to help figure out a new solution to make sure something bad doesn’t
happen again.” (P)
“..
experience showcases the promise of a much-touted but little understood
collaboration in health care: alliances between community hospitals and some of
the nation’s biggest and most respected institutions.
For
prospective patients, it can be hard to assess what these relationships
actually mean – and whether they matter.
Leah Binder,
president and chief executive of the Leapfrog Group, a Washington-based patient
safety organization that grades hospitals based on data involving medical
errors and best practices, cautions that affiliation with a famous name is not
a guarantee of quality.
“Brand names
don’t always signify the highest quality of care,” she said. “And hospitals are
really complicated places.”..
To expand
their reach, flagship hospitals including Mayo, the Cleveland Clinic and
Houston’s MD Anderson Cancer Center have signed affiliation agreements with
smaller hospitals around the country. These agreements, which can involve
different levels of clinical integration, typically grant community hospitals
access to experts and specialized services at the larger hospitals while
allowing them to remain independently owned and operated. For community
hospitals, a primary goal of the brand-name affiliation is stemming the loss of
patients to local competitors…
In some
cases, large hospital systems opt for a different approach, largely involving
acquisition. Johns Hopkins acquired Sibley Memorial and Suburban hospitals in
the Washington, D.C., area, along with All Children’s Hospital in St.
Petersburg, Fla. The latter was re-christened Johns Hopkins All Children’s
Hospital in 2016…
Although
affiliation agreements differ, many involve payment of an annual fee by smaller
hospitals. Officials at Mayo and MD Anderson declined to reveal the amount, as
did executives at several affiliates. Contracts with Mayo must be renewed
annually, while some with MD Anderson exceed five years…
“It is not
the Mayo Clinic,” said Dr. David Hayes, medical director of the Mayo Clinic
Care Network, which was launched in 2011. “It is a Mayo clinic affiliate.”
Of the 250
U.S. hospitals or health systems that have expressed serious interest in
joining Mayo’s network, 34 have become members.
For patients
considering a hospital that has such an affiliation, Binder advises checking
ratings from a variety of sources, among them Leapfrog, Medicare and Consumer
Reports, and not just relying on reputation.
“In theory,
it can be very helpful,” Binder said of such alliances. “The problem is that
theory and reality don’t always come together in health care.”
Case in
point: Hopkins’ All Children’s has been besieged by recent reports of
catastrophic surgical injuries and errors and a spike in deaths among pediatric
heart patients since Hopkins took over. Hopkins’ chief executive has
apologized, more than a half-dozen top executives resigned and Hopkins recently
hired a former federal prosecutor to conduct a review of what went wrong.
“For me and
my family, I always look at the data,” Binder said. “Nothing else matters if
you’re not taken care of in a hospital, or you have the best surgeon in the
world and die from an infection.” ” (Q)
PART 2. June 1, 2019. “The situation that the New York Times described in North Carolina parallels that at Johns Hopkins All Children’s Hospital in St. Petersburg, which stopped performing heart surgeries after the Tampa Bay Times reported on problems in the unit
“Johns Hopkins All Children’s Hospital in St.
Petersburg, Fla., has been given another extension from federal regulators to
correct its problems. The pediatric hospital came under fire in late 2018 after
the Tampa Bay Times uncovered widespread problems at the facility, including a
rising death rate in the pediatric heart unit.
The
reporting from the Times led to the resignation of several high-profile
executives at the hospital and a federal investigation from CMS that led to a
series of corrective actions with the government.
Now, the
hospital still needs more time to meet the demands of inspectors, the Tampa Bay
Times reported. Inspectors found problems with All Children’s infection control
unit, which the hospital must fix by “early May.” The agreement with CMS to
meet corrective actions underscores how the hospital has been at risk of losing
public funding, which covered more than 60% of its patients in 2017, according
to the Times.” (A)
“Care in a
special heart surgery unit at Johns Hopkins All Children’s Hospital in St.
Petersburg, Fla., became so troubled that last year one in 10 patients died and
others suffered devastating complications before procedures were halted, a
year-long investigation by the Tampa Bay Times found.
The
investigation found that staff raised safety concerns as early as 2015 but the
hospital, led by administrators sent by Hopkins, disregarded warnings and
didn’t stop performing the most complex procedures until early last year. All
surgeries were curtailed eventually and a review launched. The status of two
surgeons connected to most of the complications is unclear…
In a
statement to the Tampa Bay Times, All Children’s said it “is defined by our
commitment to patient safety and providing the highest quality care possible to
the children and families we serve. An important part of that commitment is a
willingness to learn. When we became aware of challenges with our heart
institute we took action to address them.”
The hospital
said it initially stopped performing complex cases and brought in a surgeon
from Baltimore. Then it halted all surgeries after that surgeon left. The
hospital said it is currently reviewing the program and recruiting new surgeons
with aid from Hopkins and plans to resume surgeries “when all involved are
confident that the care being delivered meets the high standards set by this
organization.”
A statement
from Johns Hopkins Medicine to The Baltimore Sun said, “We are devastated when
children suffer, and losing a child is something that no parent should have to
endure. We are continuing to take a very close look at the program, and will
not resume open heart surgeries until we are confident this program at Johns
Hopkins All Children’s Hospital delivers care that meets the highest
standards.”” (B)
“Johns
Hopkins All Children’s Hospital posted an operating loss in the three months
ended March 31, as the St. Petersburg pediatric hospital dealt with the fallout
of federal and state probes into its practices.
The hospital
had an $11.5 million quarterly operating loss, according to a May 13 financial
report from The Johns Hopkins Health System Corp. and affiliates. Operating
revenue dropped 7.1 percent to $119.9 million, while operating expenses climbed
10.5 percent to $131.4 million.
The
operating loss was attributed to closing the hospital’s Heart Institute. The
facility closed after an investigation by the Tampa Bay Times found seven
children had died or were permanently injured due to substandard care in the
cardiovascular surgery program…
“The
decrease in income from operations and operating margin percentage was mainly
driven by lower net patient service revenue at [Johns Hopkins All Children’s
Hospital] as a result of the closing of the Heart Institute,” the May 13 report
said.” (C)
“Tasha and
Thomas Jones sat beside their 2-year-old daughter as she lay in intensive care
at North Carolina Children’s Hospital. Skylar had just come out of heart
surgery and should recover well, her parents were told. But that night, she
flatlined. Doctors and nurses swarmed around her, performing chest compressions
for nearly an hour before putting the little girl on life support.
Five days
later, in June 2016, the hospital’s pediatric cardiologists gathered one floor
below for what became a wrenching discussion. Patients with complex conditions
had been dying at higher-than-expected rates in past years, some of the doctors
suspected. Now, even children like Skylar, undergoing less risky surgeries,
seemed to fare poorly.
The
cardiologists pressed their division chief about what was happening at the
hospital, part of the respected University of North Carolina medical center in
Chapel Hill, while struggling to decide if they should continue to send
patients to UNC for heart surgery…
That March,
a newborn had died after muscles supporting a valve in his heart appeared to
have been damaged during surgery. At least two patients undergoing low-risk
surgeries had recently experienced complications. In May, a baby girl with a
complex heart condition died two weeks after her operation. Two days later,
Skylar went in for surgery.
In the
doctors’ meeting, the chief of pediatric cardiology, Dr. Timothy Hoffman, was
blunt. “It’s a nightmare right now,” he said. “We are in crisis, and everyone
is aware of that.”
That comment
and others — captured in secret audio recordings provided to The New York Times
— offer a rare, unfiltered look inside a medical institution as physicians
weighed their ethical obligations to patients while their bosses also worried
about harming the surgical program.
In meetings
in 2016 and 2017, all nine cardiologists expressed concerns about the program’s
performance. The head of the hospital and other leaders there were alarmed as
well, according to the recordings. The cardiologists — who diagnose and treat
heart conditions but don’t perform surgeries — could not pinpoint what might be
going wrong in an intertwined system involving surgeons, anesthesiologists,
intensive care doctors and support staff. But they discussed everything from
inadequate resources to misgivings about the chief pediatric cardiac surgeon to
whether the hospital was taking on patients it wasn’t equipped to handle.
Several doctors began referring more children elsewhere for surgery.
The heart
specialists had been asking to review the institution’s mortality statistics
for cardiac surgery — information that most other hospitals make public — but
said they had not been able to get it for several years. Last month, after
repeated requests from The Times, UNC released limited data showing that for
four years through June 2017, it had a higher death rate than nearly all of the
82 institutions nationwide that do publicly report…
The best
option, Dr. Kelly said, was to combine UNC’s surgery program with Duke’s. For
years, physicians at both children’s hospitals talked informally about joining
forces, but nothing came of it. They were “basically destroying each other’s
capacity to be great,” Dr. Kelly said, by running competing programs less than
15 miles apart. But even combining the programs wasn’t an instant fix: It would
take at least a year and a half, he said…
At a
conference last fall, Dr. Backer, the Chicago heart surgeon, urged fellow
surgeons to consider “rational regionalization,” or joining forces in an effort
to reduce mortalities nationwide for congenital heart defects, potentially
saving hundreds of lives.
Reaching
adequate case volumes to keep up skills is a challenge because so many
hospitals are competing for patients — surgical programs are an important
driver of revenue. The Orlando, Fla., and San Antonio metropolitan areas, for
example, each have three hospitals doing pediatric heart surgeries. Cleveland
has two about a mile apart. A study last year by Dr. Backer and other
physicians found that 66 percent of hospitals doing the surgeries were within
25 miles of another one.” (D)
“The
situation that the New York Times described in North Carolina parallels that at
Johns Hopkins All Children’s Hospital in St. Petersburg, which stopped
performing heart surgeries after the Tampa Bay Times reported on problems in
the unit.
A Tampa Bay
Times analysis found that the death rate among pediatric heart surgery patients
at All Children’s had tripled from 2015 to 2017…
UNC Health
Care only made some of its death rate data public to the New York Times after
numerous requests from the newsroom. The statistics showed that UNC’s
children’s heart surgery program had one of the highest four-year death rates
in the country.
The
newspaper said it is suing the health system for more data.
UNC Health
Care told the New York Times that the physicians’ concerns had been handled
appropriately.
After the
New York Times started reporting, the hospital ramped up efforts to find a
temporary pediatric heart surgeon and reached out to families whose children had
died or had unusual complications to discuss their cases…
The turmoil
at UNC underscores concerns about the quality and consistency of care provided
by dozens of pediatric heart surgery programs across the country. Each year in
the United States about 40,000 babies are born with heart defects; about 10,000
are likely to need surgery or other procedures before their first birthday.
The best
outcomes for patients with complex heart problems correlate with hospitals that
perform a high volume of surgeries — several hundred a year — studies show. But
a proliferation of the surgery programs has made it difficult for many
institutions, including UNC, to reach those numbers: The North Carolina
hospital does about 100 to 150 a year. Lower numbers can leave surgeons and
staff at some hospitals with insufficient experience and resources to achieve
better results, researchers have found.
“We can do
better. And it’s not that hard to do better,” said Dr. Carl Backer, former
president of the Congenital Heart Surgeons’ Society, who practices at Lurie
Children’s Hospital of Chicago. “We don’t have to build new hospitals. We don’t
have to build new ICUs. We just need to move patients to more appropriate
centers.”
North
Carolina Children’s Hospital, part of the University of North Carolina medical
center, performs about 100 to 150 pediatric heart surgeries a year.
Studies show
that the best outcomes for patients with complex heart problems correlate with
hospitals that do a higher volume of surgeries — several hundred a year.
At least
five pediatric heart surgery programs across the country were suspended or shut
down in the last decade after questions were raised about their performance; a
Florida institution run by the prestigious Johns Hopkins medical system stopped
operations after reporting by The Tampa Bay Times in 2018. At least a
half-dozen hospitals have merged their programs with larger ones to achieve
more consistent results. And more institutions are considering such
partnerships.” (E)
“UNC Health
declined a CBS 17 request for an interview. Phil Bridges, UNC Health’s
Integrated Communications Executive Director issued a written statement:
We are proud
of our pediatric congenital heart surgery program, and our current team is
receiving top results that would place us among the best in the nation. We have
been engaged in continuous quality improvement efforts for decades and have
made significant improvements in the past 10+ years.
As the
state’s leading public hospital, the UNC Pediatric Congenital Heart Surgery
program often receives the most complex and serious cases. For many of these
very sick children, we are often parents’ last hope.
As we shared
with the New York Times, there were team culture issues back in 2016. They were
handled appropriately. That, combined with decades of continuous quality
improvement (CQI) efforts, have led us to today in which we have a very strong
program. For our team, and each family, even a single death is too many, and we
will continue our CQI work.
To
characterize today’s program as anything but strong, would not only be
misleading, but not factual. To say we ignored issues would also be false.” (F)
“First and
foremost, we are physicians who have dedicated our lives to caring for and
caring about patients. We celebrate with families the joys of curing illness;
and we are deeply impacted by any death, particularly that of a young child. We
lead our respective areas of surgery and pediatrics with the mindset of always
doing what is right for children and families. Caring for these children is a
privilege. Children and families are always our top priority. Our mission is to
provide the best care for all children across North Carolina. We and our
colleagues live this mission every day.
Regarding
this week’s story from The New York Times (“Doctors Were Alarmed: Would I have
my children have surgery here”): We are proud of the medical care provided to
all patients at UNC Children’s. They become part of our family, and as
providers we wouldn’t hesitate to bring our own loved ones here for treatment.
Any negative outcome or death is taken incredibly seriously and we strive to
constantly look for ways to improve the care provided.” (G)
“North
Carolina’s secretary of health on Friday called for an investigation into a
hospital where doctors had suspected children with complex heart conditions had
been dying at higher than expected rates after undergoing heart surgery.
Dr. Mandy
Cohen, the secretary, said in a statement that a team from the state’s division
of health service regulation would work with federal regulators to conduct a
“thorough investigation” into events that occurred in 2016 and 2017 at North
Carolina Children’s Hospital, part of the University of North Carolina medical
center in Chapel Hill.
“As a mother
and a doctor my heart goes out to any family that loses a child,” Dr. Cohen
said in the statement. “Patient safety, particularly for the most vulnerable
children, is paramount.”
The
investigation is in response to an article published by The New York Times on
Thursday, which gave a detailed look inside the medical institution as
cardiologists grappled with whether to keep sending their young patients there
for surgery.
The article
included discussions among doctors that were captured on secret audio
recordings provided to The Times, in which the physicians talked openly about
their concerns, including that some might not feel comfortable allowing their
own children to have surgery at the hospital. The physicians also discussed
unexpected complications with lower-risk patients.
While the
doctors could not pinpoint what might be going wrong, they considered
everything from inadequate resources to misgivings about the chief pediatric
cardiac surgeon to whether the hospital was taking on patients it was not
equipped to handle.” (H)
The 2018-19
Best Children’s Hospitals Honor Roll (I)
1. Boston
Children’s Hospital
2.
Cincinnati Children’s Hospital Medical Center
3.
Children’s Hospital of Philadelphia
4. Texas
Children’s Hospital
5.
Children’s National Medical Center
6.
Children’s Hospital Los Angeles
7.
Nationwide Children’s Hospital
8. Johns Hopkins Children’s Center
(BALTIMORE)
9.
Children’s Hospital Colorado
10. Ann and
Robert H. Lurie Children’s Hospital of Chicago
North
Carolina Children’s Hospital at UNC. Pediatric Cardiology & Heart Surgery Scorecard.
ASSIGNMENT: Profile medical advances made during World War I, World WAR II, the Korean War, Vietnam, Afghanistan and Iraq.
Memorial Day 2019
From 1967 to 1970, during the Vietnam War, I served first as
a 2nd Lieutenant and Administrative
Officer of the 4th Casualty Staging Flight attached to Wilford Hall USAF
Medical Center, Lackland AFB in San Antonio, Texas. We received combat
casualties still in battlefield bandages, often within 24 hours of injury, and
either admitted them to Wilford Hall or further transported them to hospitals
near home.
New PART 2 after
PART 1
Part 1. July 3,
2018. “BATTLEFIELD MEDICINE: THE REVOLUTIONARY WAR
“When the Revolutionary War began its actual skirmishes
in 1776, early attempts to prepare for the medical needs related to War were
made in the City of New York. During the spring and summer of 1776, Samuel
Loudon was publishing his newspaper the New York Packet, in which he included
numerous articles and announcements regarding the Continental Army. On July 29,
for example, came the following announcement written by Thomas Carnes, Stewart
and Quartermaster to the General Hospital of King’s College, New York.
Anticipating an increase demand for medically trained staff, he filed the
following request for volunteers:
“GENERAL HOSPITAL New-York, July 29, 1776 Wanted
immediately in the General Hospital, a number of women who can be recommended
for their honesty, to act in the capacity of nurses: and a number of faithful
men for the same purpose…King’s College, New York” (A)
“One of the most famous surgeons, and the first, was
Cornelius Osborn. He was recruited in the Spring of 1776 and had little
training even as a physician. The Continental Congress was even concerned about
the well-being of the troops and the militia. They passed several ordinances
and helped establish the order for the several field Hospitals during the War.
The hospitals served about 20,000 men in the fight. Each hospital was required
for each surgery to have at least one physician or surgeon, and one assistant,
which was usually and apprentice of some sort. Each hospitals staff numbers
varied on how many wounded it served and the severity of the wounds….
Most of the deaths in the Revolutionary War were from
infection and illness rather than actual combat. The common practice if a limb
was badly infected of fractured was amputate it. Where most amputees died of
gangrene a result of not properly cleaning instruments after surgeries. Only
35% of amputees actually survived surgery. There was no pain killers quite
developed back then. So at most the patient were given alcohol and a stick to
bite down on while the surgeon worked. Two assistant would hold him down, a
good surgeon could perform the entire process in a mere 45 seconds, after which
the patient usually went into shock and fainted. This allowed the surgeon to
stich up the wound, and prepare for the next amputation. Another way they
decided to clean wounds, disease, or infection was by applying mercury directly
to the cut of injured space, and letting it run through the blood stream which
usually resulted in death.” (B)
“To seek treatment for any serious ailment, a soldier
would have had to go to a hospital of sorts. Military regiments had a surgeon
on staff to care for the men, so the soldier’s first stop would be with the
surgeon. During battles, the surgeon could be found in a makeshift or
“flying” hospital that consisted of a tent, an operating table, and
some medical equipment. If the surgeon could not treat the soldier, he might be
sent to a hospital. Many regimental hospitals were in nearby houses, while
general hospitals for more in-depth treatment were sometimes set up in barns,
churches, or other public buildings. The conditions were often cramped, which
resulted in the rapid spread of contagious illnesses and infections….
Woe to the soldier who required surgery after being wounded
on the battlefield! The conditions in “flying” hospitals were
deplorable. Not only was the operating room simply a table in a tent, but there
was little thought given to keeping the table and tools clean. In fact, wounds
were sometimes cleaned using plain water from a bucket, and the used water
would be saved to clean out the next soldier’s wounds as well. (C)
Hospitalization was a serious problem during the American
Revolutionary War. Plans were made quite early to care for the wounded and
sick, but at the best they were meager and inadequate. However on April 11,
1777 Dr. William Shippen Jr., of Philadelphia was chosen Director General of
all the military hospitals for the army. Consequently the reorganization of
hospital conditions took place.
Four hospital districts were created: Easter, Northern,
Southern and Middle. The wage scale was as follows: Director General’s pay
$6.00 a day and 9 rations; District Deputy Director $5.00 a day and 6 rations;
Senior Surgeon $4.00 a day and 6 rations; Junior Surgeon $2.00 and 4 rations;
Surgeon mate $1.00 and 2 rations.
After the battle of Brandywine, September 11, 1777, hospitals
were established at Bethlehem, Allentown, Easton and Ephrata. After the battle
of Germantown, October 4, 1777, emergency hospitals were organized at
Evansburg, Trappe, Falkner Swamp and Skippack. Hospitals at Litiz and Reading
were also continued. By December 1777, new hospitals were opened at Rheimstown,
Warwick and Shaeferstown. Yellow Springs (now Chester Springs) an important
hospital was organized under the direction of Dr. Samuel Kennedy. At Lionville,
Uwchlan Quaker Meeting House was also made a hospital for a time. Apothecary
General Craigie’s shop, Carlisle, was the source of hospital drugs….
It seems there was carelessness in making necessary health
reports, consequently Washington ordered on January 2, 1778: “Every Monday
morning regimental surgeons are to make returns to the Surgeon Gen’l. or in his
absence to one of the senior surgeions, present in camp or otherwise under the
immediate care of the regimental surgeons specifying the mens names Comps.
Regts. and diseases.” [Weedon’s Valley Forge Orderly Book, p. 175]
January 13, 1778. “The Flying Hospitals are to be 15
feet wide and 25 feet long in the clear and the story at least 9 feet high to
be covered with boards or shingles only without any dirt, windows made on each
side and a chimney at one end. Two such hospitals are to be made for each
brigade at or near the center and if the ground permits of it not more than 100
yards distance from the brigade.” [Weedon’s Valley Forge Orderly Book, p.
191] The Commander-in-Chief always solicitous about the comfort of his soldiers
issued the following order January 15, 1778: “The Qr. Mr. Genl. is
positively ordered to provide straw for the use of the troops and the surgeons
to see that the sick when they are removed to huts assigned for the hospital are
plentifully supplied with this article.” [Weedon’s Valley Forge Orderly
Book, pp. 192-199-204-216] ” (D)
PART 2. May 28,
2019. “BATTLEFIELD” MEDICINE: THE CIVIL WAR. “Many of America’s modern medical
accomplishments have their roots in the legacy of America’s defining war.”
“During the 1860s,
doctors had yet to develop bacteriology and were generally ignorant of the
causes of disease. Generally, Civil War doctors underwent two years of medical
school, though some pursued more education. Medicine in the United States was
woefully behind Europe. Harvard Medical School did not even own a single
stethoscope or microscope until after the war. Most Civil War surgeons had
never treated a gunshot wound and many had never performed surgery. Medical
boards admitted many “quacks,” with little to no qualification. Yet,
for the most part, the Civil War doctor (as understaffed, underqualified, and
under-supplied as he was) did the best he could, muddling through the so-called
“medical middle ages.” Some 10,000 surgeons served in the Union army
and about 4,000 served in the Confederate. Medicine made significant gains
during the course of the war. However, it was the tragedy of the era that
medical knowledge of the 1860s had not yet encompassed the use of sterile
dressings, antiseptic surgery, and the recognition of the importance of
sanitation and hygiene. As a result, thousands died from diseases such as
typhoid or dysentery.
The deadliest thing that faced the Civil War soldier was
disease. For every soldier who died in battle, two died of disease. In
particular, intestinal complaints such as dysentery and diarrhea claimed many
lives. In fact, diarrhea and dysentery alone claimed more men than did battle
wounds. The Civil War soldier also faced outbreaks of measles, small pox,
malaria, pneumonia, or camp itch. Soldiers were exposed to malaria when camping
in damp areas which were conductive to breeding mosquitos, while camp itch was
caused by insects or a skin disease. In brief, the high incidence of disease
was caused by a) inadequate physical examination of recruits; b) ignorance; c)
the rural origin of my soldiers; d) neglect of camp hygiene; e) insects and
vermin; f) exposure; g) lack of clothing and shoes; h) poor food and water…
Battlefield surgery…was also at best archaic. Doctors often
took over houses, churches, schools, even barns for hospitals. The field
hospital was located near the front lines — sometimes only a mile behind the
lines — and was marked with (in the Federal Army from 1862 on) with a yellow
flag with a green “H”. Anesthesia’s first recorded use was in 1846
and was commonly in use during the Civil War. In fact, there are 800,000
recorded cases of its use. Chloroform was the most common anesthetic, used in
75% of operations. ..A capable surgeon could amputate a limb in 10 minutes.
Surgeons worked all night, with piles of limbs reaching four or five feet. Lack
of water and time meant they did not wash off hands or instruments
Bloody fingers often were used as probes. Bloody knives were
used as scalpels. Doctors operated in pus stained coats. Everything about Civil
War surgery was septic. The antiseptic era and Lister’s pioneering works in
medicine were in the future. Blood poisoning, sepsis or Pyemia (Pyemia meaning
literally pus in the blood) was common and often very deadly…” (A)
“Early on, stretcher bearers were members of the regimental
band, and many fled when the battle started. Soldiers acting as stretcher
bearers rarely returned to the front lines. As the war evolved, stretcher
bearers became part of the medical corps. At the battle of Antietam, there were
71 Union field hospitals. As the war went on, these were consolidated. There
were ambulances here that were used to bring the wounded to temporary
battlefield hospitals, which were larger, often under tents, and out of
artillery range. Later in the war, patients were transported to large general
hospitals by train or ship in urban centers. These did not exist when the war
began. There was no military ambulance corps in the Union Army until August of
1862. Until that time, civilians drove the ambulances. Initially the ambulance
corps was under the Quartermaster corps, which meant that ambulances were often
commandeered to deliver supplies and ammunition to the front…
Large general hospitals were established by September of
1862 (11). These were in large cities, and soldiers were transported there by
train or ship. At the end of the war, there were about 400 hospitals with about
400,000 beds. There were 2 million admissions to these hospitals with an
overall mortality of 8%. In the South, the largest general hospital,
Chimborazo, was in Richmond, Virginia. It was built out of tobacco crates on 40
acres. It contained five separate hospitals, each made up of 30 buildings.
There were 150 wards with 40 to 60 patients per ward. The census was as high as
4000. They treated about 76,000 patients with a 9% mortality (12)…
Three of every four surgical procedures performed during the
war were amputations. Each amputation took about 2 to 10 minutes to complete.
There were 175,000 extremity wounds to Union soldiers, and about 30,000 of
these underwent amputation with a 26.3% mortality… Only about 1 in 15 Union
physicians was allowed to amputate. Only the most senior and experienced
surgeons performed amputations. These changes were put into effect because of
the public perception that too many amputations were being performed.
Amputations were not carried out using sterile technique, given that Lister’s
classic paper on antisepsis did not appear until after the war in 1867…
Physicians at the time had an extraordinary workload. The
following was excerpted from a letter Dr. Daniel Holt wrote to his wife,
Euphrasia:
You cannot imagine the amount of labor I have to perform. As
an instance of what almost daily occurs, I will give you an account of
day-before-yesterday’s duty. At early dawn, while you, I hope, were quietly
sleeping, I was up at Surgeon’s call and before breakfast prescribed for 86
patients at the door of my tent. After meal I visited the hospitals and a barn
where our sick are lying, and dealt medicines and write prescriptions for one
hundred more; in all visited and prescribed for, one hundred and eighty-six
men. I had no dinner. At 4 o’clock this labor was completed and a cold bite was
eaten. After this, in the rain, I started for Sharpsburg, four miles distant,
for medical supplies (17). (B)
Most of the major medical advances of the Civil War were in
organization and technique, rather than medical breakthroughs. In August of 1862, Jonathan Letterman, the
Medical Director of the Army of the Potomac, created a highly-organized system
of ambulances and trained stretcher bearers designed to evacuate the wounded as
quickly as possible. A similar plan was
adopted by the Confederate Army. This
system was a great improvement on previous methods. He established a trained ambulance corps,
consolidated all of the ambulances of a Brigade, and created a system of
layered levels of care for the wounded on the battlefield. The levels of care were small field dressing
stations (usually directly on the battlefield), field hospitals (located in a
safer place just beyond the battlefield), and a system of general hospitals in
most large cities. Transporting the
wounded men from one hospital to another was also coordinated. The Letterman plan remains the basis for present
military evacuation systems.
A system of triage was established that is still used
today. The sheer number of wounded at
some of the battles made triage necessary.
In general, the wounded soldiers were divided into three groups: the
slightly wounded, those “beyond hope”, and surgical cases. The surgical cases were dealt with first
since they would be the most likely to benefit from immediate care. These included many of the men wounded in the
extremities and some with head wounds that were considered treatable. The slightly wounded would be tended to next,
their wounds were not considered life-threatening so they could wait until the
first group was treated. Those beyond
hope included most wounds to the trunk of the body and serious head wounds. The men would have been given morphine for
pain and made as comfortable as possible…
Hospitals became places of healing rather than places to go
to die, as they were widely considered before the war. The large-scale hospitals set up by the
medical departments had an astounding average death rate of only 9%… Women nurses were first truly accepted during
the war, mainly out of necessity.
Although there was a great deal of prejudice against them, especially
early on, surgeons came to see that their contributions went a long way in
aiding the patients. Once they had an
established place in medical care they would not give it up. Nursing as a profession was born.
Due to the sheer number of wounded patients the surgeons had
to care for, surgical techniques and the management of traumatic wounds
improved dramatically. Specialization
became more commonplace during the war, and great strides were made in
orthopedic medicine, plastic surgery, neurosurgery and prosthetics. Specialized hospitals were established, the
most famous of which was set up in Atlanta, Georgia, by Dr. James Baxter Bean
for treating maxillofacial injuries.
General anesthesia was widely used in the war, helping it become
acceptable to the public. Embalming the
dead also became commonplace.
Medical technology and scientific knowledge have changed
dramatically since the Civil War, but the basic principles of military health
care remain the same. Location of
medical personnel near the action, rapid evacuation of the wounded, and providing
adequate supplies of medicines and equipment continue to be crucial in the goal
of saving soldiers’ lives.” (C)
“Many misconceptions exist regarding medicine during the
Civil War era, and this period is commonly referred to as the Middle Ages of
American medicine. Medical care was heavily criticized in the press throughout
the war. It was stated that surgery was often done without anesthesia, many
unnecessary amputations were done, and that care was not state of the art for
the times. None of these assertions is true. Actually, during the Civil War,
there were many medical advances and discoveries..
Medical Use
of quinine for the prevention of malaria
Use of quarantine, which virtually eliminated yellow fever
Successful treatment of hospital gangrene with bromine and
isolation
Development of an ambulance system for evacuation of the
wounded
Use of trains and boats to transport patients
Establishment of large general hospitals
Creation of specialty hospitals
Surgical Safe use of
anesthetics
Performance of rudimentary neurosurgery
Development of techniques for arterial ligation
Performance of the first plastic surgery..” (B)
“However, while “advanced” or “hygienic” may not be terms
attributed to medicine in the nineteenth century, modern hospital practices and
treatment methods owe much to the legacy of Civil War medicine. Of the
approximately 620,000 soldiers who died in the war, two-thirds of these deaths
were not the result of enemy fire, but of a force stronger than any army of
men: disease. Combating disease as well treating the legions of wounded
soldiers pushed Americans to rethink their theories on health and develop
efficient practices to care for the sick and wounded.
At the beginning of the Civil War, medical equipment and
knowledge was hardly up to the challenges posed by the wounds, infections and
diseases which plagued millions on both sides. Illnesses like dysentery,
typhoid fever, pneumonia, mumps, measles and tuberculosis spread among the
poorly sanitized camps, felling men already weakened by fierce fighting and
meager diet. Additionally, armies initially struggled to efficiently tend to
and transport their wounded, inadvertently sacrificing more lives to mere
disorganization…
The wounded and sick suffered from the haphazard
hospitalization systems that existed at the start of the Civil War. As battles
ended, the wounded were rushed down railroad lines to nearby cities and towns,
where doctors and nurses coped with the onslaught of dying men in makeshift
hospitals. These hospitals saw a great influx of wounded from both sides and
the wounded and dying filled the available facilities to the brim. The Fairfax
Seminary, for example, opened its doors twenty years prior to the war with only
fourteen students, but it housed an overwhelming 1,700 sick and wounded
soldiers during the course of the war…
However, the heavy and constant demands of the sick and
wounded sped up the technological progression of medicine, wrenching American
medical practices into the light of modernity.
Field and pavilion hospitals replaced makeshift ones and efficient
hospitalization systems encouraged the accumulation of medical records and
reports, which slowed bad practices as accessible knowledge spread the use of
beneficial treatments…
The sheer quantity of those who suffered from disease and
severe wounds during the Civil War forced the army and medical practitioners to
develop new therapies, technologies and practices to combat death. Thanks to
Hammond’s design of clean, well ventilated and large pavilion-style hospitals,
suffering soldiers received care that was efficient and sanitary. In the later
years of the war, these hospitals had a previously unheard of 8% mortality rate
for their patients…
In field hospitals and pavilion-style hospitals, thousands
of physicians received experience and training.
As doctors and nurses became widely familiar with prevention and
treatment of infectious diseases, anesthetics, and best surgical practices,
medicine was catapulted into the modern era of quality care. Organized relief
agencies like the 1861 United States Sanitary Commission dovetailed doctors’
efforts to save wounded and ill soldiers and set the pattern for future
organizations like the American Red Cross, founded in 1881.
Death from wounds and disease was an additional burden of
the war that took a toll on the hearts, minds, and bodies of all Americans, but
it also sped up the progression of medicine and influenced practices the army
and medical practitioners still use today. While the Union certainly had the
advantage of better medical supplies and manpower, both Rebels and Federals
attempted to combat illness and improve medical care for their soldiers during
the war. Many of America’s modern medical accomplishments have their roots in
the legacy of America’s defining war.” (D)
