Problems in South Dakota pharmacies?

STATES FAIL TO REPORT DISCIPLINED CAREGIVERS

By Tracy Weber & Charles Ornstein - ProPublica, 19 July 2010

Hundreds of state agencies nationwide have never told the federal government about health professionals they disciplined, undermining a central database meant to weed out dangerous caregivers.

The federal database is supposed to contain disciplinary actions taken against doctors, nurses, therapists and other health practitioners around the country so that hospitals and select others can run background checks before they hire new employees.

Federal officials discovered the missing reports after a ProPublica investigation in February found widespread gaps in the data, including hundreds of nurses and pharmacists who had been sanctioned for serious wrongdoing.

Since then, regulators nationwide -- prodded by federal health officials -- have submitted 72,000 new records to the database, nearly double the total submitted for all of 2009.

All states are required by law to report the licensed health workers they've sanctioned to databases run by the U.S. Health Resources and Services Administration (HRSA). But ProPublica found that many state agencies either didn't know about the requirement or simply weren't complying.

The failure to report means frontline health workers who have a record of on-the-job misconduct, incompetence or criminal acts aren't flagged to hospitals or other potential employers, who pay a fee to run checks on job applicants.

Wisconsin, for example, has not reported sanctions against emergency medical technicians. The state's Department of Health Services website, however, shows that more than two dozen EMTs have been disciplined, including several for criminal convictions and one for stealing drugs from an ambulance.

An agency spokeswoman said officials are working to submit the missing information.

HRSA's analysis of 13 nursing boards flagged by ProPublica as missing records shows the depth of the problem. Since being contacted by HRSA, those boards collectively have reported more than 2,000 missing cases, including 147 in California and 66 in Illinois. Florida alone had 972.

Despite the important public safety role of the database, federal officials have little power to enforce compliance. Earlier this month, they took what they said is the strongest action allowed against scofflaws: They put a checkmark next to state names indicating they were "noncompliant" and posted the information on the HRSA website.

"That's the tool we've been given by Congress," said Mary Wakefield, administrator of HRSA, noting that no prior administration had even used that before.

Twenty-one states and Puerto Rico were thus chastised for not reporting on at least one category of health professional or ignoring the government's requests for information. Kentucky was flagged for 10 professions; Louisiana, six; and Alabama and New Mexico, five each.

Many states were listed as "working toward compliance," meaning they were in the process of submitting missing information, or "under review" by the federal government.

Congress ordered the government to create a database of disciplinary actions against all health providers more than two decades ago; information about doctors and dentists was first made available in the National Practitioner Data Bank in 1990. But hospitals could begin searching other professions only in March of this year. The database is not open to the public.

The completeness of the database is important because health professionals often have licenses in multiple states. If a hospital checks just one state's oversight board, disciplinary actions elsewhere may not turn up.

California, for example, recently discovered that 3,500 registered nurses with clean records there had been disciplined in other states.

ProPublica's report in February found that no sanctioned pharmacists had been reported by South Dakota or New Hampshire and only one each in Alabama, Delaware, Ohio and Tennessee. But a search of those states' websites showed hundreds of sanctions, including a pharmacist in Ohio who ran an Internet pill mill that dispensed nearly 1.5 million drug doses without valid prescriptions.

Wakefield acknowledged that her agency is just beginning to assess the completeness of the information. After ProPublica detailed the gaps in the data, federal officials sent letters to the nation's governors requesting help and held numerous training sessions.

HRSA is still trying to sort out the compliance status of 450 licensing boards and agencies that appear to never have reported discipline for some of the professions they oversee. The agency plans to report additional information in October.

Officials are in the process of comparing disciplinary actions reported to the federal database to what states have listed on the states' own public websites. "This is a work in progress," Wakefield said.

The review did not examine state agencies overseeing doctors and dentists because they have been reporting actions for nearly a decade more than others.

Some state officials said they were surprised to be labeled noncompliant.

David Potters, executive director and general counsel of West Virginia's pharmacy board, acknowledged that his board had not submitted all of its disciplinary actions, but said he had turned in a plan to catch up.

Consumer advocate Dr. Sidney Wolfe, who has pushed for a more accurate databank, said the agency's work in recent months is a huge step forward.

"HRSA is at least making some moves in directions that it hasn't made for a while -- and hopefully there will be many more moves," said Wolfe, of Public Citizen, a Washington, D.C., nonprofit that advocates for patient safety.

On the wrong side of history

Our neighbor Lorraine Collins always has an interesting perspective on a wide range of topics. Here's another that should catch your interest -- and perhaps spur a comment or two. Her commentaries appear regularly in the Black Hills Pioneer, and she graciously allows us to share them with on-line readers here.

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The first column I wrote for the Black Hills Pioneer in August, 2006, concerned the slow and reluctant implementation of Title IX, which mandated equal treatment for women and girls in schools and colleges. I reported that it was only then, after 30 years, that Black Hills State University was finally making some real progress in offering women's sports programs.~

One thing I noted in that article was that the State of South Dakota had filed a "friend of the court" brief in a case before the Supreme Court of the United States, supporting the city of Birmingham, Alabama fighting against Title IX. I wondered why South Dakota would defend the right of the Birmingham school district to say that it was okay for the school to fire a girls basketball coach when he complained that the girls team had to pay their own way to games and were allowed less practice time than boys and so forth. Why on earth would citizens of South Dakota defend such a thing?

I contacted the Attorney General's office to inquire. I was told that they had undertaken this at the request of the Associated School Boards of South Dakota and that the state did not have to spend any money to do this. The specific argument was that the coach was not covered by Title IX since he was not a girl, just a coach of girls. Luckily, Birmingham and South Dakota lost the argument, but I was pretty embarrassed to live in a state that would join such a lawsuit. It certainly demonstrated that when it came to equality for women, we were on the wrong side of history.

Now, all these years later, I'm embarrassed again. My state is party to a lawsuit to deny implementation of the health care reform act. Apparently this time the lawsuit will cost taxpayers some money, though Gov. Rounds said on PBS that he hoped it wouldn't be more than $30,000. I hope not, since I am told by most sources the lawsuit is frivolous and doomed. Those who think it's a great idea to sue the government cite Medicaid costs or they object to the federal government mandating that citizens buy health insurance. These are legitimate concerns, but since these folks also object to the so-called public option or anything as radical as single-payer health insurance, the only idea they seem to have is to leave everything as it is now.

But so far I have never heard any pundit or political leader claim that what we have now is doing the job of providing health care for millions of people, or reducing costs, or limiting fraud and abuse. Now finally, after decades of inaction, a year of argument, millions of dollars spent on lobbying and advertisements opposing health care reform, we have the beginning of some attempt to do something. At least we are finally on the road to trying to reform a health care system that burdens businesses and families, denies coverage to millions and costs us millions of dollars more than any other country in the world even though the World Health Organization ranks the US only 37th among nations in health care.

There will no doubt be detours and, I hope, improvements. But we have to start somewhere. Because of what seem to be the political realities in this country, and how the system works, we're starting here. Better than not starting at all. It's going to happen, more slowly than we may imagine, less perfectly than we'd like. But we are finally going to achieve something that many other nations have achieved generations ago.

So I'm sorry that the only thing we South Dakotans seem to think of doing is to join a law suit to try to stop it. This does not put us on the right side of history.


Lorraine Collins is a writer who lives in Spearfish. she can be contacted at collins1@rushmore.com.

Winning a food fight

Our neighbor Lorraine Collins always has an interesting perspective on a wide range of topics. Here's another that should catch your interest -- and perhaps spur a comment or two. Her commentaries appear regularly in the Black Hills Pioneer, and this gives new meaning to the old term "food fight." Lorraine graciously allows us to share it with on-line readers here.

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A few weeks ago when I was in a supermarket browsing through the frozen food section, I saw a box labeled "chicken fried rice" so I thought I'd try that. Usually I make fried rice myself, but I thought this would save me some trouble. I checked the sodium content and it didn't seem too bad, so I happily purchased it. After I got home I took time to read the whole label, and was chagrined to discover the small print that said, "contains shell fish." I am extremely allergic to shell fish and didn't dare eat what I'd bought, so I gave it to a neighbor.

Why would something labeled chicken fried rice contain shell fish? Maybe it was just some fragments left over from some other kind of fried rice, but no matter how miniscule the bits may be, they're poisonous to me.

I was trained some years ago to check food labels for trans fats, sodium and the like, after my husband had a heart attack and the cardiologist sent me to a nutrition class. I have been so dedicated to serving low sodium dishes for a decade that last summer the cardiologist finally got alarmed about the guy having too low a sodium count and told him to go eat a piece of watermelon and put salt on it.

In Arizona I knew a woman who was so allergic to monosodium glutamate that she became deathly ill after eating green bean casserole because it was made with soup containing MSG. I had not realized that MSG is used so ubiquitously in canned soups and other products, until I began seeing signs on some packaged and canned foods bragging that they don't have any of it in them.

Labeling the contents of frozen, packaged, canned food is very important to our health and safety, but at the same time consumers have to take the time to read labels and know whether high fructose corn syrup is really something their kids should be ingesting. When food is prepared at home, we know what's in it, but when it has been prepared in a factory, it often contains substances from fat to salt to food coloring to flavor enhancers in order to make it look good and taste appetizing, regardless of what this process does to nutritional value.

And the fact seems to be that the more our food is processed for us, the fatter and less healthy we become. In 1960, when the "TV dinner" had been marketed for just half a dozen years and fast food restaurants were not on every corner, according to a Center of Disease Control study, the average American man weighed just over 166 pounds. By 2004, he weighed 191. Women in 1960 averaged 140 pounds but by 2004 this had increased to over 164.

First Lady Michelle Obama recently announced she will be devoting time and energy trying to combat childhood obesity and this is a very timely cause to espouse. CDC statistics indicate that childhood obesity in America has tripled in the last 30 years. Just 6.5% of children were regarded as obese 30 years ago and now that number is 19%. Adolescent obesity has grown from 5% to 18%. No doubt many lifestyle changes contribute to these statistics including children being less physically active, but certainly the American diet of processed and "fast" foods must be part of the problem.

Now some frozen food purveyors are providing more healthful entrees and some alternatives are provided for children's meals picked up at the drive through window including fruit and milk instead of fries and soda. But it's hard to say how much of this is window dressing to counter negative publicity and how much is an earnest effort to improve nutrition.

There is a lot of resistance to change in this country, whether in energy policy, health care, financial reform and other issues. I can only assume that there will be forces aligned against food reform, too. But winning the food fight is important for our kids.


Lorraine Collins is a writer who lives in Spearfish. She can be reached at collins1@rushmore.com.

Looking for transparency

It’s hard to cut through the crap.

Over the past many months, we’ve been bombarded with claims and counter-claims regarding health care reform. It’s likely to continue for the next several weeks with no real resolution in sight for the American people.

From assertions that we have the “best health care system in the world” to protestations that it’s “a broken health care system,” politicians and analysts of all stripes have hashed and re-hashed the topic with much hoopla but little clarity. Most of the dialogue has been in a less than thoughtful context, usually displayed in “point-counterpoint” sound bites with little substance.

We remain skeptical of the hyperbole offered from both sides of this squabble, but each has offered at least some evidence to justify their position – so it’s easy to be confused by the babble surrounding this important issue.

Passage of the Senate health care bill in the wee hours of December 21st was tainted with “compromise.” $100 million for the University Hospital in Senator Chris Dodd’s home state of Connecticut; exemptions from insurance fees for Michigan Blue Cross/Blue Shield; giving Florida a $ 3 billion to $5 billion sweetheart exemption from losing Medicare Advantage benefits; and numerous other deals.

None was more egregious than the $100 million federal payment for new Medicaid coverage in Nebraska – as well as an exemption from an insurance fee for Nebraska Blue Cross/Blue Shield and Mutual of Omaha.

Only days earlier, while visiting the Cornhusker state, we heard local radio stations playing sound bites in which Nebraska’s U.S. Senator Ben Nelson denied allegations that he and Nebraska had been threatened with federal cuts, if he didn’t support the administration’s health bill.

Rather than asking Nelson if he’d been threatened, reporters should have been asking him if he had been approached with bribes….er, “compromises.” Despite proclaiming that his vote “wasn’t for sale,” it was only a matter of hours before Nelson signed on to the health care package, greasing the skids to Nebraska for lots of federal money – at the expense of all other states.

But even these distasteful events weren’t what left us most disheartened.

Rather, it was the assurances offered earlier by President Obama that health care reform discussions would be out in the open and involve a wide range of players. They would even be aired on C-SPAN, he said. This turned out to be not true. There’ve been allegations that few senators even read the 2,100 page bill.

And when it comes time for a conference between the House and Senate versions of health care reform, it seems the president has chosen the West Wing of the White House as the location.

We believe our health care system is in serious need of reform, and we’re unconvinced that Congress is moving in the right direction. The fact that it has been back-room politics as usual, rather than the promised open deliberations, leaves us wondering if the only thing needing more attention than health care might be the Obama administration claim to "openness."

It’s highly unlikely we’ll ever see cameras in the West Wing, but President Obama could go a long way toward regaining citizen support by re-visiting his promise of government transparency and pushing for 11th hour C-SPAN coverage of this enormously important subject. But don't hold your breath.

History Calls

Certain words or phrases have a way of collecting baggage that causes us to embrace or reject the concepts they represent. Such seems to be the case in the current din about health care reform. Good neighbor Lorraine Collins offers her views on this timely topic.

Quite a few years ago a friend told me that the last ten days of her mother’s life cost a quarter of a million dollars. She was in anguish as she told me this, not only because of the financial burden, but because the last ten days of her mother’s life were not improved by this huge expenditure. She was either unconscious or suffering during the entire time. It was cruel for everybody, and there should have been some way to prevent this from happening.

These days we know about living wills and powers of attorney for health care, and when we go to a doctor’s office or the hospital we may see pamphlets dealing with end of life issues. In fact, if we sign up with a new clinic or are admitted to the hospital we may be asked whether we have drawn up some kind of end of life document giving our preferences about how to treat us in the final extremity. This is not exactly a radical idea.

This is why I was so outraged by people who appear to object to any health care reform talking about “death panels”, trying to scare us oldsters about how the government wants to more or less send us out on ice floes into the Arctic Sea to get rid of us because we cost a lot of money.

Elderly people generally do cost a lot of money. One reason Medicare is predicted to be in financial straits is that the dread Baby Boomer generation is about to become old enough to qualify for it. So, what do you think we should do about this situation, other than having the government convene death panels deciding who gets that extra week of life and who doesn’t?

Well, health care reform might be a good idea. It may even take care of other problems, such as the millions of people with no health insurance, the millions who show up at emergency rooms to be treated by hospitals whether they ever get reimbursed or not, the millions who go bankrupt because of medical expenses. By now, if we don’t know the statistics, we must have been living in a cave next to Osama Bin Laden, who, so far as we know, has no health care insurance plan other than an AK47. The statistics tell us we have the most expensive health care in the world, but leave the largest number of citizens without health care. We are a society that relies on rummage sales and chili feeds organized by neighbors to help people pay for the cancer treatment or the operation or the rehab after a tragic accident. We are a society that says if you have a job that provides affordable health insurance, you’re lucky, and if you lose your job, well, good luck.

There are a whole lot of problems with the current way we deal, or fail to deal with health care problems in the United States, and you must have heard of some of them by now. For instance: the lack of preventative care so small problems don’t become big ones; a lack of primary care physicians who aren’t reimbursed as handsomely as specialists; paying doctors on the basis of how many procedures are done, which encourages more procedures; defensive medicine that requires more tests than necessary to protect from malpractice suits.

Health care reform in the United States is a very complicated, long overdue and extremely necessary process for us to undergo. Our nation will go broke, to heck in a hand basket without it. We don’t need scare tactics, or lies, or TV ads by those who make money in health care. We need a patriotic, compassionate and rational discussion. As Republican Senator Olympia Snow said last week, “When history calls, history calls.”

For heaven’s sake, lets answer the phone.

~

Our thanks to Spearfish writer Lorraine Collins.

Federal website surprisingly good

There are few things in this world more anguish-ridden than having to move a loved one into a nursing home. The emotion of the task is further complicated by the challenge of trying to choose the right place.

Almost unbelievably, the federal government has offered up a website that promises to help inject some valuable information into the process. They have boldly rated nursing homes using a Five Star scale, evaluating factors like health conditions, overall quality, and staffing.

I am most familiar with three Nebraska nursing homes, located in Chadron, Crawford, and Hay Springs. I’ve heard much about facilities in Belle Fourche and Spearfish, South Dakota, and my own anecdotal experience with these nursing homes is consistent with the government ratings found at www.medicare.gov I was not surprised that nursing homes in Belle Fourche and Crawford fared well.

Of course, there’s no substitute for scrutinizing nursing homes through a personal visit, and this website can help provide a head start in preparing for such visits. Critics may say the ratings are flawed, but we believe they are a valuable resource for persons wanting to learn more about how nursing homes stack up, and what kinds of things to look for when examining nursing home options.

All is well with the world

Since retiring to the beautiful northern Black Hills region of South Dakota, we’ve become acquainted with many other retirees. Among these new-found friends are Roger and Fran Whorton, who grew up near Waterloo, Iowa, and were wed in 1966.

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Roger served a stint in the Marine Corps and ended up as a career officer in the U.S. Coast Guard as a pilot. He served in a variety of interesting assignments, including one as Commanding Officer of the Coast Guard Air Station at Barber's Point in Hawaii. They have three grown children. Roger retired as a Captain in 2002, and he and Fran moved to Spearfish.

In the few years that we’ve known them, the Whortons have had their world altered considerably, due to a life-changing health condition. Roger has reflected upon their experience, and he's been kind enough share it with the Black Hills Journal. That's Fran and Roger in the photo, enjoying their grandchildren before learning about Roger's condition.

In the first of three installments over the next few days, Roger Whorton writes...

A HEART'S STORY

(Part 1)

by Roger Whorton

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Mid-April of this year, 2008, I appeared to be a picture of health at 61 years old. Trim and active, I had never smoked, carefully watched my diet, and had exercised all my life. A month later, I had open-heart surgery and a quadruple Coronary Artery Bypass Graft (CABG).

How did things change so rapidly? (Read more...)

Chantix may not be for...(anyone?)

Amid reports last week in the Wall Street Journal that Pfizer’s smoking-cessation drug Chantix might be tied to serious psychiatric symptoms came even more disturbing information about certain drugs.

The New York Times on Friday (February 1) reported that, according to the Food & Drug Administration, some drugs used to treat epilepsy, bipolar illness and mood problems double the risks of suicidal thoughts and behavior, and patients taking them should be watched for sudden behavioral changes. Read the story.

As health care in the United States becomes an increasingly prominent and volatile issue, certain things seem clear:

1) while our knowledge of medicine and capabilities to provide health care are enormous, our ability to actually deliver services is broken; and

2) drug companies spend enormous amounts on “research and development,” but talk little about how much they spend on advertising – luring Americans to believe a pill will cure whatever ails us;

I applaud those national media which aggressively report what’s going on at major pharmaceutical companies, but more needs to be explored.

What about the unparalleled extent to which drug companies go to indoctrinate the doctors of tomorrow – while they’re still in medical school – to a mindset that drugs are a cure-all?

What about pervasive advertising that serves only to lure more people into drugstores and pay higher prices for all drugs, many of marginal value, but including those that are life-saving?

A recent random sampling of ABC World News Tonight and NBC Nightly News found that some two-thirds of all advertising on the half-hour television programs was for pharmaceutical companies. Personally, I miss the dog food, automobile, and floor wax commercials of yesteryear! But they apparently can't pony up the kind of big bucks available to the drug companies.

It makes the drug culture of the ‘60s look lame by comparison.

Tune In...Take Drugs...

I take an aspirin a day, so I'm reluctant to be a radical on the the subject of "big drug companies" ruining our lives. But I do believe they've had a profound negative effect on our quality of life. How is that possible you may ask, given the development of life-saving drugs that have also provided healthier lives for millions of Americans?

Let's clearly distinguish between the drugs themselves and their marketers.

A generation or more ago, the corner drugstore was a community gathering place, where you could visit with friends, pick up a prescription, and perhaps enjoy a milk shake at the soda fountain. Clearly, there were pharmaceutical companies -- even large ones, but they were not driven by the fierce market forces of the 21st century.

Some of you will remember the days of Huntley-Brinkley and Walter Cronkite, when the evening network news was replete with commercials for soap, breakfast food, automobiles, beer, and -- yes -- pharmaceuticals. Fast forward 50 years and discover that the Hamm's bears have gone into permanent hibernation from the airwaves, and that drug companies have come to dominate commercial time not just during the evening news -- but throughout the evening television schedule.

The enormity of the economic force wielded by big drug companies is reflected in a bit of research done by the Center for Public Integrity, a non-profit and non-partisan public policy organization in Washington, D.C. They report that big drug company lobbyists in Washington easily outnumber members of Congress, and that those lobbyists spent some $155 million between January 2005 and June 2006. It's little wonder that they were successful in beating back efforts by Congress to revisit a provision in the Medicare Prescription Drug, Improvement and Modernization Act of 2003 that barred the federal government from negotiating on Medicare drug prices. The Center for Public Integrity further reports that drug lobbyists also worked hard for the protection of lucrative drug patents and the prevention of the importation of lower-priced Canadian drugs.

Three cheers to the Center for Public Integrity for its investigative efforts focusing on this timely issue. A situation that threatens to push costs for health care even farther out of sight......alongside drug company profits. You can read more about it at: http://secure.publicintegrity.org/ It's enough to give a fella a headache. Would you please pass the aspirin?