Author Archives: Karen Weintraub

AG Hasn’t Ruled Out Legal Action To Prevent Closure Of Quincy Medical Center

Attorney General Martha Coakley’s office hasn’t ruled out court action to prevent Quincy Medical Center from shutting down.

Steward Health Care, the hospital’s parent company, announced this month that it would close the 124-year-old facility at the end of the year. The hospital has since moved the closing back to Feb. 4.

Bob Ross, head of the attorney general’s business and labor bureau, said Tuesday in a letter to a Steward lawyer that the closing could violate an agreement the company signed when it purchased the hospital in 2011 to keep it open for at least 10 years.

Ross said officials were willing to discuss Steward’s claim that the agreement should be altered.

Steward has said the hospital, with nearly 700 employees, is losing $20 million a year in the face of increased regional competition.

‘Silent Trauma': Hearing Loss, Ear Damage Linger Long After Marathon Bombing

Emergency responders comfort a woman on a stretcher who was injured in the Boston Marathon bombing on April 15, 2013. (Jeremy Pavia/AP)

Emergency responders comfort a woman on a stretcher who was injured in the Boston Marathon bombing on April 15, 2013. (Jeremy Pavia/AP)

After two bombs exploded at the Boston Marathon in April of last year, the initial focus was on the lives and the multiple limbs lost in the attack. But ear damage was the most common physical injury. A new report finds that many victims are still suffering from hearing loss and ear damage related to the blasts.

A team of Boston researchers report on the lingering impact of those ear and hearing problems in a new study published in the journal Otology and Neurotology.

The report’s conclusion

Blast-related otologic injuries constitute a major source of morbidity after the Boston Marathon bombings. Orthopedic and soft tissue trauma was sustained by many, but far more incurred ear-related damage. This represents much of the silent trauma that requires continued evaluation and treatment…

More specifically:

Among the 94 study participants, researchers found that 90 percent of the hospitalized patients sustained “tympanic membrane perforation,” basically a ruptured ear drum, following the bombings. From the study:

Proximity to blast and significant nonotologic injury were positive predictors of perforation. Spontaneous healing occurred in 38% of patients, and tympanoplasty success was 86%…Hearing loss, tinnitus, hyperacusis, and difficulty hearing in noise remain persistent and, in some cases, progressive complaints for patients. Otologic-specific quality of life was impaired in this population.

Notably, it took many blast victims some time to realize the extent of their hearing problems, researchers report. Alicia M. Quesnel, an otologic surgeon at Massachusetts Eye and Ear and Harvard Medical School, a senior author of the study told The Washington Post:

“I saw patients who were traumatized by what had just happened, and there was a lot going on emotionally,” Quesnel said. “We were seeing people coming into the clinic in the days and weeks after the bombing. They realized that they can’t hear very well.”

“A bomb going off — that loudness results in some temporary deafening. It may have taken people a few days or weeks to realize ‘I can’t hear from one ear or both ears.'”

Continue reading

Memo To Gov.-Elect: Include Pain Sufferers As You Seek Opiate Solution

(tudedude via Compfight)

(tudedude via Compfight)

By Cindy Steinberg
Guest contrbutor

Cindy Steinberg is the policy chair for the Massachusetts Pain Initiative and the national director of policy and advocacy for the U.S. Pain Foundation.

Charlie Baker vows to tackle state opiate problem,” was the Boston Globe headline two days after Election Day.

It’s good to hear from our newly elected governor that he plans to take steps to curb the ongoing problem with illegal use of prescription medication in our state. There’s little doubt that too many lives are being harmed by drug abuse and addiction.

But in a quest to fix one problem, policymakers need to consider the potential unintended negative consequences for the patients for whom these medications are a lifeline.

Cindy Steinberg (courtesy)

Cindy Steinberg (courtesy)

Gov.-elect Baker said in that Globe interview that he plans to convene a coalition of lawmakers, health care providers and labor leaders to confront the opioid crisis in our state. Representatives of the pain community — an estimated 1.2 million Massachusetts residents live with chronic pain — must be included in these discussions as well.

For many with chronic pain, the right medications mean the difference between a life worth living or not.

But despite these legitimate needs, more and more I’m hearing from residents of our state who are unable to access treatment that their doctors say they need and that they depend on. These are not addicts; these are people who are trying to manage their lives with debilitating conditions such as cancer, diabetic neuropathy, sickle cell, daily migraine, fibromyalgia, severe back pain and many others.

These are not addicts; these are people who are trying to manage their lives with debilitating conditions such as cancer, diabetic neuropathy, sickle cell, daily migraine, fibromyalgia.

Not including members of the pain community in discussions about how these medications are prescribed, regulated and controlled marginalizes the lives of thousands of Massachusetts citizens who live with pain caused by a myriad of conditions and serious injuries.

There is not a silver bullet solution to solving the abuse of prescription drugs. We need to take a thoughtful, multifaceted approach to ensure that those who need pain medication have access to it, and that those who choose to abuse these medications are stopped. There is no group more invested in making sure that medications are responsibly controlled than members of the pain community. Continue reading

New Mass. Health Connector Website Works, But Some Enrollees Have Problems

Updated November 16, 2014, 9:26 a.m.

State officials and the folks at the Massachusetts Health Connector call the first day of the new health insurance website a success.

“The website was stable and available throughout the entire day,” said Maydad Cohen, a special adviser to Gov. Deval Patrick on the website project. “Response times were averaging under half a second. Throughout the day, no complaints about an inability to get on, no slowness, no issues at all with our performance and usage of the site, which was fantastic.”

  • 5,967 residents were able to put in their income information and figure out what kind of coverage assistance, if any, they could receive.
  • 2,660 of those people qualified for free coverage through the state’s Medicaid program, MassHealth.
  • 1,704 people chose a plan but have not yet paid.
  • 60 people paid and are awaiting confirmation from their insurer.

Roughly 1,600 people did not complete their application. They may still be weighing their plan options, they may have run out of time, or they may have had trouble using the site. And 1,713 people dialed the Connector’s call center number seeking help with their application.

The Connector does not know how many people received error messages, got stuck, had to start over or were told they must fill out a paper application.

But unlike last year, the website is working.

The Connector highlights a Facebook comment from Dianne Anagnos, who says, “My enrollment went smoothly. I am a happy customer and the website was very user friendly.”

Some people were able to enroll with few, if any problems.

But there were also more than a dozen complaints posted to Facebook, Twitter and other social networking programs. These people reported problems verifying their identity, their immigration status or their income. They had trouble enrolling family members. When they dialed the Connector’s call center for help, some people reported wait times of 50 minutes or more. Some were told they would have to fill out a paper application.

Linda Mederios says she was told she would have to fill out a paper application because the site could not verify her identity.

“Not working any better than the old website did,” Medeiros wrote on Facebook, “trying to register & it says ‘cannot verify’ @ this time … been ON HOLD w/phone center for the past 40 mins. UGH !!!!!!!!!”

Medeiros says she started her application at 8 a.m. Saturday. Sometime during the day, she says, a team of Connector staffers called and helped her through the website. By 4:45, she and her husband were enrolled in subsidized coverage.

The Connector will be issuing daily reports in an effort to be transparent about the website. It’s not clear how those reports will measure trouble people have using the site.

The Connector does not know how many people received error messages and had to start over. But here’s a sample of complaints posted to the Connector’s Facebook page:

Continue reading

New Health Connector Website Launches

The command center monitors the traffic on the relaunched Health Connector website. (Rachel Paiste/WBUR)

The command center monitors the traffic on the relaunched Health Connector website. (Rachel Paiste/WBUR)

Updated at 1:30 p.m.

The new Health Connector website for Massachusetts launched successfully Saturday morning and was working as designed upon launch.

“All right, everyone ready to see this thing go up live? Let’s do it,” Maydad Cohen, who oversaw the effort, said to applause just before 8 a.m. Saturday.

The new website allows Massachusetts residents to browse health plans, find out what program they qualify for and complete an application during the open enrollment period between Nov. 15, 2014 and Feb. 15, 2015.

The Health Connector team prepares for the relaunch Saturday morning. (Rachel Paiste/WBUR)

The Health Connector team prepares for the relaunch Saturday morning. (Rachel Paiste/WBUR)

They will also be able to compare plans, including premiums, co-pays and benefits. People who meet income eligibility requirements can get help paying for their coverage through the Health Connector or free coverage through MassHealth.

Nearly a year ago, the former site crashed repeatedly and the state spent millions of dollars to launch the redesigned site.

Deputy Medicaid Director Robin Callahan said the governor’s involvement in the redesign meant a lot to the team building the site.

“I think that’s one of the things we didn’t have the first time around — a real organizing, strong presence,” Callahan said.

Jean Yang, executive director of the Health Connector, said she’s excited about the new site, compared to last year’s.

“A difference of night and day, for the very first time we’re going to be seeing people getting determined for qualified health plan, real time,” she said.

The state expects more than 400,000 people will get their health insurance through this website.

Clarification: This post’s headline was updated to reflect the fact that the website appeared successful upon launch, but more information is forthcoming about its performance.

Earlier:

Yes, Medicare Will Cover Lung Cancer Scans For Longtime Smokers, But…

(Source: Wikimedia Commons)

(Source: Wikimedia Commons)

…to finish the sentence in the headline: But it was not the simple no-brainer that you might think.

Lung cancer is the biggest cancer killer of all, causing 160,000 American deaths a year. But should we use lung scans to screen longtime smokers en masse for it? That question has been vigorously debated of late in medical circles, as Medicare has weighed whether to pay for the scans.

This week, Medicare announced that it did indeed propose to cover annual low-dose CT scans for smokers and former smokers, ages 55 to 74, with a smoking history equivalent to a 30-year pack-a-day habit. (More details here.)

People say ‘You deserve this because you brought it on yourself, and thus, suffer the consequences.’
– Laurie Fenton Ambrose

The draft decision now gathers public comment for a month and will still need to be finalized, but cancer activists and some doctors are already hailing it as a victory. Laurie Fenton Ambrose, president of the Lung Cancer Alliance, which had helped lead the push for the coverage, predicted that the scans would save tens of thousands of lives.

So why has screening for lung cancer sparked such hot debate? Why did it even recently trigger a rare point-counterpoint duel in the pages of a major medical journal, JAMA Internal Medicine?

Well, first, the pendulum has been swinging lately towards greater skepticism about routine cancer screening, from mammograms to prostate tests.

(Source: FDA)

(Source: FDA)

At issue is the pivotal question of whether some forms of cancer screening do more harm than good, given that some of the tumors they pick up would never have caused any trouble. Routine blood tests for prostate cancer have fallen out of favor, for example, and the New England Journal of Medicine just published a cautionary tale from Korea about how mass ultrasound scans for thyroid cancer saved no lives.

So that’s the broader medical context. Then there’s the money. I recently heard a Medicare official say with pained realism at a public forum, “We can’t cover everything good.” Close to 5 million people on Medicare would be eligible for the screening, NPR reports, and the scans cost an estimated $241 each.

So at a time of greater emphasis on health costs and greater doubts about cancer screening, “We just found ourselves caught in that crossfire,” said Fenton Ambrose of the Lung Cancer Alliance.

With lung cancer, there’s also the question of special stigma. People say “You deserve this because you brought it on yourself, and thus, suffer the consequences,” Fenton Ambrose said. “It has always had that type of stigma, that even carried through in some of the public comments that came forth during the Medicare consideration.”

Dr. Chrisopher Lathan, a medical oncologist at the Dana-Farber Cancer Institute, similarly cited stigma as a source of “hesitation” on the coverage. “This is a cancer that’s heavily linked to a behavior,” he said. “The amount of data needed to convince everyone that this was a good screening tool — that hurdle was much higher. And also, we are in a more skeptical time, academically, when we look at screening. We know that screening is good, but it’s good in certain circumstances.”

Which circumstances, when it comes to lung scans? This is the moment for the Public Service Announcement that says, “Talk with your doctor.”

“At the end of the day, this is about the relationship between doctors and patients,” Fenton Ambrose said. And in particular, there are some gray areas that require discussion, she noted. What if, for example, you’re a bit younger, or smoked a bit less than the cut-off? Research is now under way on that “second tier” of potential scan subjects, she said. Continue reading

Bullying Is Ageless: Conflict And Violence Widespread In Nursing Homes, Study Finds

Ulrich Joho/flickr

Ulrich Joho/flickr

By Nell Lake
Guest Contributor

For Eileen, who is disabled and reliant on a wheelchair to get around, life in a nursing home isn’t easy. Particularly when it comes to the other residents: “There’s this guy,” she says. “He made advances to me all the time. I did not want his advances. Many times I had to take my grabber and actually strike him to get him to leave me alone.” Another resident, Eileen says, is a “real bully. She has terrorized quite a few people. She tries to boss people around. She says harassing things.”

In coping with this type of hostile behavior, Eileen (who asked not to be identified) has plenty of company. New research released last week shows that aggression among residents in nursing homes is widespread and “extremely high rates of conflict and violence” are common, according to study author Karl Pillemer, professor of gerontology in medicine at Weill Cornell College of Medicine in New York. His stark findings, presented at the annual meeting of the Gerontological Society of America: One in five people living in the nursing facilities studied was involved in at least one “negative and aggressive encounter” with another resident during a four-week period.

“In most environments — say my work environment at a university — someone yelling at me angrily is so unusual that it would keep me up all night worrying about it,” Pillemer says. Yet such conflict in nursing homes appears to be routine.

Abuse and Mistreatment

As part of the study, researchers examined patient records at ten nursing homes in New York state, interviewed staff and residents, and recorded incidents through direct observation. In a sample of more than 2,000 residents, 16 percent were involved in incidents of cursing, screaming, or yelling; about 6 percent in physical violence such as hitting, kicking, or biting; one percent in “sexual incidents, such as exposing one’s genitals, touching other residents, or attempting to gain sexual favors”; and 10.5 percent in events researchers labeled “other” — residents entering rooms uninvited, for example, or rummaging through others’ belongings. Continue reading

What You Need To Know For Saturday’s New Health Connector Launch

Call it the countdown to Saturday.

In total, the state Health Connector expects roughly 414,000 Massachusetts residents to use its new website to sign up for health insurance between this Saturday, Nov. 15, and Feb. 15, 2015.

Beginning at 8 a.m. Saturday — the first day of open enrollment — we’ll know if you can get back on track with a permanent plan, ending a year of frustrating dead-ends online, confusing calls and letters, and uncertainty about your care.

Here are some basic details: Continue reading

The Politics Of Gluten

LaShawn Wiltz/flickr

LaShawn Wiltz/flickr

A close kid relative of mine can die if he eats gluten. Actually, this child is so allergic to gluten that you can’t even cook pasta if he’s in the room or he’ll break out in a rash, or worse. He’s been to emergency rooms, both in the U.S. and abroad, due to his allergies, and it usually happens when someone hands him a so-called “gluten-free” cookie or snack that actually wasn’t.

So gluten is a hot topic in our family. Recently, though, skepticism has been rising about the very notion of gluten allergies, or sensitivities. Exhibit A in this arena is Michael Specter’s latest New Yorker story on the current gluten-free craze, which has enraged more than a few parents whose kids have real and scary reactions to gluten. Specter writes:

While there are no scientific data to demonstrate that millions of people have become allergic or intolerant to gluten (or to other wheat proteins), there is convincing and repeated evidence that dietary self-diagnoses are almost always wrong, particularly when the diagnosis extends to most of society. We still feel more comfortable relying on anecdotes and intuition than on statistics or data.

Speaking on Here & Now yesterday, Specter reiterated the article’s takeaway that the national gluten-free obsession is mostly just the latest fad diet.

Maybe. But here’s some reaction from a parent who thinks Specter should have taken a broader view:

“My son has gone into anaphylaxis from accidentally ingesting gluten four different times over the course of his life.  Each time we had to administer an emergency Epipen injection and rush him to the ER.  I don’t think he was reacting to a fad…

It is fine to debate the merits of going gluten free as a diet or lifestyle choice for some. But for others it is a clear medical issue, with the most serious consequences. The number of Americans suffering from celiac or severe gluten allergy seems to be growing fast, and that merits substantial funding and research to figure out why and find cures. It would be a mistake if that fact were to be lost amid the current efforts at “de-bunking” the risks of eating gluten for some.”

Westminster Officials Shut Down Rowdy Hearing On Tobacco Ban After 20 Minutes

Brian Vincent poses in front of a large display of tobacco products at Vincent's Country Store in Westminster on Nov. 6. Local officials are contemplating what could be a first: a blanket ban on all forms of tobacco and e-cigarettes, leaving some shop owners fuming. (Elise Amendola/AP)

Brian Vincent poses in front of a large display of tobacco products at Vincent’s Country Store in Westminster on Nov. 6. Local officials are contemplating what could be a first: a blanket ban on all forms of tobacco and e-cigarettes, leaving some shop owners fuming. (Elise Amendola/AP)

Health officials in the central Massachusetts town of Westminster say they will not hold another public hearing on their proposed first-in-the-nation town-wide ban on tobacco sales, after a rowdy crowd of hundreds forced Wednesday night’s meeting to end in just 20 minutes.

Board members began the hearing with warnings that if the crowd couldn’t remain calm and respectful, they would end the meeting.

The hearing was dominated by opponents of the ban, such as Westminster resident Kevin West.

“I find smoking to be one of the most disgusting habits anybody could possibly do. On top of that, I find this proposal to be even more of a disgusting thing that anybody could ever give any town in the United States of America,” he said.

When repeated efforts to calm the crowd, which erupted into applause a number of times, failed, the meeting was ended and health board members were escorted out by police.

Instead of another meeting, the board will accept written comments through the end of the month.