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What are the lawmakers, and other state and federal officials, up to when it comes to health reform laws?

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Woman Says She Was Shackled Just Before Giving Birth To Son

Giving birth can be a trying experience all by itself. Imagine going through labor in hand-cuffs or leg restraints. The Patrick administration is taking steps to make sure that doesn’t happen in any jails or prisons in this state.

Massachusetts is moving closer to joining 18 states that prohibit putting restraints on prisoners while they’re in labor. That’s thanks to a regulation that Governor Deval Patrick announced yesterday.

“Regulation is good, but here, law is better. The legislature is considering a bill that would make this ban law. I want to be clear that I support this bill and I urge the legislature to send it to my desk for signature this session,” Patrick said.

State undersecretary of criminal justice Sandra McCroom says the practice was already prohibited at state-run prisons, but the new rule also applies to county houses of corrections operated by sheriffs.

“Sheriffs are all independent elected officials, and their policies aren’t regulated by us in any way. So now the Governor has insisted that the Department of Corrections create immediate regulations that resolve that issue,” she said.

The executive director of the Massachusetts Sheriffs’ Association says he knows of no sheriffs who permit women to be shackled during labor, but activists, including the group NARAL Pro-Choice, say they’ve heard otherwise. Megan Amundson, Executive Director of NARAL Pro-Choice, says, “We’re hearing from facilities across the state that the practice is still happening. We are hearing from doctors and from women that they are being shackled during labor.”

“They Would Not Remove The Cuffs”

“When I was in active labor the jail medical staff had denied that I was in the late stages of labor that I was,” said Kenzie, a woman who asked that WBUR only use her first name because she doesn’t want any more problems with the criminal justice system.

Kenzie says she was restrained by correctional officers from the Western Massachusetts Regional Women’s Correctional facility.

“This being my sixth child, I kept telling them that it was time. They just kept denying me, saying I wasn’t really that far into labor because I was not hysterically screaming. It wasn’t until I had said that I had the urge to push that they decided to take me seriously,” she said.

“On the car ride there, I asked if they could remove my cuffs because I needed to be able to hang on, and, not only, so I didn’t fly around the hard plastic seats but also just to brace myself and be able to not push, and they would not remove the cuffs.”

And she says the restraints stayed on once she got to the hospital, driven there by two correctional officers — one male and one female. The female correctional officer stayed with her during delivery.

“… Right immediately after delivery, they immediately shackled my leg to the bed,” she said. “You know, no woman should ever have to go through that. If you ever delivered and had a child you would understand.”
– Kenzie

“I was in the emergency room, and it took a lot of convincing but the CO finally had taken the cuffs off of me so I could take my pants off and be able to get checked and get onto the bed safely,” she said.

But Kenzie says she was back in cuffs pretty quickly.

“We left the jail at 9:50 a.m. and my son was born at 10:01 a.m. and right immediately after delivery, they immediately shackled my leg to the bed,” she said. “You know, no woman should ever have to go through that. If you ever delivered and had a child you would understand.

We asked a representative of Hampden County Sheriff Michael Ashe for comment. Patricia Murphy, Assistant Superintendent of the Western Regional Correctional Center, says the facility has had a policy for some twenty years not to shackle during labor. She admits the restraints are allowed during transport from the correctional facility to a hospital. She says that even under the Governor’s new policy, restraints during transport are allowed.

Kenzie is out of jail now after serving 15 months of an 18-month sentence.

Before her release, her son was diagnosed with leukemia. He’s in remission now, but she says she spends a lot of time traveling with him from Western Massachusetts to Boston for medical treatment.

Editor’s note: This post was expanded on 2/25 with additional material, including the response from Patricia Murphy of the Western Regional Correctional Center.

Gov. Patrick Issues Emergency Regulations Banning Restraints On Pregnant Inmates In Labor

At a forum on public safety today, Gov. Deval Patrick said the practice of shackling female inmates while they are in labor should end immediately. He said he’s issuing emergency regulations through the state Department of Corrections to ban the practice in all correctional facilities.

Here’s what the governor said (according to a spokesperson, who emailed me his comments):

While on the subject on the use of restraints, let me be clear that we will also end — finally, completely and immediately — the use of restraints on pregnant inmates in labor. Our current regulations prohibit this in state prisons and today the Department of Corrections will issue emergency regulations extending that prohibition to all facilities, including Houses of Correction. Regulation is good but here law would be better. The Legislature is considering a bill that would make this ban the law. I support that bill and I urge the Legislature to send it to my desk for signature this session.

The bill that Patrick referred to has been on file for over a decade, according to Megan Amundson, executive director of NARAL Pro-Choice Massachusetts.

Regarding the governor’s order today, Amundson said: “We applaud the governor for taking this action.”

But, she added, the proposed legislation “is more comprehensive in terms of supporting and also protecting women’s health. The bill protects women’s health throughout pregnancy and labor and postpartum. The regulations ensure that women aren’t shackled during labor but the bill is stronger, and having something in statute is stronger than having something in regulation because it ensures the protection of women’s health going forward.”

In a press release issued after the governor’s announcement, NARAL Pro-Choice Massachusetts said:

…We look forward to seeing the emergency regulations when they are filed later today.

We join the Governor in calling upon the legislature to pass the Anti-Shackling bill (S.2012), currently in Senate Ways and Means, this session to put an end to this practice and ensure that the health of all pregnant women in the Commonwealth is protected. Massachusetts needs to join the 18 states – including Texas and Louisiana – that have already passed laws to ban shackling of pregnant women in jails and state prisons.

The Massachusetts proposal would prohibit the practice and create streamlined laws in both county jails and the state prison system “banning the shackling of pregnant women during childbirth and post-delivery recuperation — unless they present a specific safety or flight risk.”

Report Blames Mass. Health Website Troubles On Lack Of Skills, Leadership

In the months after President Obama signed the Affordable Care Act (ACA) in 2010, officials in Massachusetts started planning for a new Health Connector website that would be compatible with the new federal regulations. UMass Medical School, the Massachusetts Health Connector and MassHealth came together to work on the project. They hired a Canadian firm, CGI, to build the site which launched in October 2013, but “was not fully operational,” according to a report released Thursday by the technology firm MITRE. Residents who’ve tried to apply for insurance through the site use words like “disaster.”

The MITRE report, which was commissioned by the state, says CGI did not have the expertise to create or maintain the site. Functions were not tested. Data was lost. Tools to fix bugs were not in place. So who from the state should have spotted and corrected these problems? MITRE concludes that it was never clear which of the three state partners was in charge. Gov. Deval Patrick says the shared leadership structure would have been fine if CGI had done its job.

But, Patrick added, “It turns out that this vendor has required and will require a much, much shorter leash. And that’s hard to do by committee.”

The lack of clear authority created other problems, according to the report. The website never had a baseline set of requirements. There was no master schedule. Decisions were not explicit and were not communicated clearly. CGI received conflicting instructions and deadlines from the three parties in charge.

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More Answers Sought On Troubled Mass. Health Website

In Tuesday's State of the Commonwealth address, Gov. Deval Patrick made just one mention of the problems with the state's health care website. (Steven Senne/AP)

In Tuesday’s State of the Commonwealth address, Gov. Deval Patrick made just one mention of the problems with the state’s health care website. (Steven Senne/AP)

Before the annual State of the Commonwealth address this week, a lot of people had hoped Gov. Deval Patrick would talk about the ongoing problems with Massachusetts’ health care website, the Connector. But it rated just a mention.

“We have dealt with serious failings before,” Patrick said in his speech. “Now, we must strengthen the Department of Children and Families and fix the Connector’s website.”

That’s all he said, and now, there are rumblings of discontent.

‘We Need A Plan’

Anna Eves paid $1,065 in late December for private insurance through the Connector. In January, the bank confirmed that the Connector had cashed her check, but she had not received any information about an insurance plan, so she called the Connector.

“The girl there said, ‘Yep, we got your check, but you’re not covered,’ ” Eves said.

Eves, who owns a fine art printing company in Gloucester, was angry. In one phone call after another, she tried to find out what happened. At one point she was told her check for family coverage would be applied to February, then she was told the money had been applied to January, but only for herself. And now she doesn’t know what is going on.

“[I'm feeling] very, very frustrated,” she said. “Confused — just not happy at all with how incompetent they are over there.”

Now even longtime supporters of Massachusetts’ landmark effort to cover uninsured residents say the state’s performance is unacceptable.

“We are not getting any clear explanation from the state administration, when it’s going to be fixed, how it’s going to be fixed and why this has been so difficult.”
– John McDonough,
Harvard School of Public Health

“We are not getting any clear explanation from the state administration, when it’s going to be fixed, how it’s going to be fixed, and why this has been so difficult,” said John McDonough, of Harvard’s School of Public Health, who worked on the original coverage law. “We need transparency, we need information, we need a plan from the governor and the administration.”

Health insurers are worried about how long it will take to enroll the more than 200,000 people the Connector expected to sign up by the end of March. Only 5,400 people have been processed since Oct. 1, when new rules under the Affordable Care Act kicked in, requiring a new website in Massachusetts.
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From DIY Death To Live-Longer Workouts: Juiciest Health Stories Of 2013

happy new year

When people ask what we cover here at CommonHealth, we tell them our beat is broad, encompassing everything from personal health and medical research to health-related policy and politics.

But looking back at our 2013 oeuvre, we could also say that our beat ranges from cradle to grave, from below the belt to above the neck, from big-world news to inner-world angst.

2013 has been a banner year for CommonHealth: We crossed the 1-million-hits-a-month mark. (A million thanks to all who clicked or shared or tweeted.) We partnered with Slate to launch a regular podcast called The Checkup, which is expected to resume next year. And WBUR listeners heard us more on air than ever, as we crossed back and forth between media platforms.

More soon on our hopes and goals for 2014, but is there anything you’d like to see more or less or just different? Please let us know in the comments below. For now, here are our top  CommonHealth posts from 2013, based on traffic, reader response and a little personal bias. Here’s to a health-filled 2014.

1. DIY Death: Natural, At-Home Funerals And Their Boomer Appeal
Death remains a topic that many of us would rather avoid. And when it comes to the actual nuts and bolts of caring for the dead, most of us tend to think it’s best — and furthermore, required by law — to let professional funeral arrangers handle the arrangements. Well, it turns out that in most states it’s perfectly legal to care for your own dead. And, with new momentum to shatter longstanding taboos and stop tip-toeing around death — from “death with dignity” measures sweeping the country to projects promoting kitchen table “conversations”about our deepest end-of-life wishes — a re-energized DIY death movement is emerging.

2. Is It Time To Rethink Co-Sleeping?
bedsharePediatricians and public health officials have long warned that “co-sleeping,” or sharing a bed with an infant, is unsafe. But let’s face it: almost everybody does it. So perhaps the time has come for the public health message to focus less on advising against it and more on advising how to do it more safely.

3. Caring For Kevin: An Autistic Man, An Exceptional Doctor, A Life Renewed
Institutionalized since childhood, Kevin, now 56, has been losing his sight for the past two years to the point that doctors said he can see little more than shadows. He’s here at Boston Medical Center awaiting cataract surgery, a fairly simple procedure that generally takes about 30 minutes in the operating room. But for Kevin, who has long feared doctors and has a history of aggressive, unpredictable behavior — like hitting himself or inadvertently hurting others or running away when he’s in distress — the procedure isn’t simple at all.

4. Long After Recession’s End, Deep Layoff Scars May Remain
Everybody knows it hurts to lose your job. But what has caught me by surprise is that even though my family didn’t suffer much financially from my layoff, and even though I tend to be pretty upbeat and resilient, and even though I’ve landed well, it still hurts. More than four years later, I’m still not fully over it. At work, I feel hypervigilant – as if nothing I do is ever enough, or good enough, to feel safe. At home, making life plans fills me with anxiety. Which makes me wonder: Are these feelings normal?

(Newbirth35/flickr)

(Newbirth35/flickr)

5. I’m Finally Thin — But Is Living In A Crazymaking Food Prison Really Worth It?
It shocks me to even write this, but after a zaftig childhood and a curvy-bordering-on-chunky early adulthood, I find myself, in middle age, after two kids, to have reached my “ideal” weight. But lately I wonder if it’s really worth it.

 6. Every Minute Of Exercise Could Lengthen Your Life Seven Minutes
If you play with the data of a recent major paper on exercise and longevity, you can calculate that not only do you get the time back; it comes back to you multiplied — possibly by as much as seven or eight or nine.

7. The Scariest Reason To Get The Shingles Vaccine
The reason my heart dropped when I saw my rash — and the reason I am now going to pay out of pocket for the vaccine because my health insurance covers it only for those over 60 — is an affliction even less familiar to most people than shingles. It is called postherpetic neuralgia. Think of it as “Extended Release” shingles. Or as the closest thing to the trials of Job for an unlucky few.

8. ‘Thigh Gap’: Reflections On Teenage Girls’ Latest Obsession
That extra layer of influence is coming from the Internet and social media, and the way I see it, it’s like peer pressure on steroids — a vehicle for immediate feedback about you, the way you look, or what you think of others. And those opinions are so widely broadcast. Depending on a teen’s social media prowess, that can mean hundreds, even thousands of extra eyes.

(Photo: Robin Lubbock/WBUR)

(Photo: Robin Lubbock/WBUR)

9. Why A Sex Therapist Worries About Internet Porn
You may have seen the recent film Don Jon, featuring Joseph Gordon-Levitt as Jon, an Internet porn addict whose habit hurts his love life. I see too many Jons in my office…I see a sexual and relational train wreck happening, and I need to speak out.

10. A Doctor’s Decision To Quit 
When I introduce myself as a physician who left clinical practice, non-physicians ask me why I left. They’re generally intrigued that someone who sacrificed many years and many dollars for medical training would then change her mind. But physicians, almost universally, never ask me why I left. Instead, they ask me how.  It may be dramatic and self-serving to frame my career change as a way to avoid suicide, but I can attest that medicine was not conducive to my health.

Special thanks to WBUR’s Martha Bebinger, CommonHealth’s founder, whose deep grasp of health care’s Byzantine ways is unmatched by any reporter we know. Her knowledge and humanity continue to enrich the site immeasurably. A few of her notable 2013 reports:

Web Glitches Snarl Health Insurance Enrollment In Mass.
Mass. Employers May Sue Feds Over Obamacare Small-Business Premiums
Marathon Bombing Victim Makes Strides Toward Her New Normal
Medicare, You Can Do Better (Or Why You Need A Translator For This Post)
Searching For The Best Colonoscopy In Town

And just some personal faves:
My Son, The Dragon Slayer: Risks And Rewards Of Growing Up Gaming
Proof In The Pants: A Pivotal Moment In Pre-Viagra History
How Gardening Is Better Than Parenting: Let’s Count The Ways
When A Patient Asks: Why Won’t Anybody Just Talk To Me?
High Anxiety: How I (Sort of) Overcame My Fear Of Flying

What were yours?

Surgeon General Nominee: Not Likely To Suffer From Invisibility

Dr. Vivek Hallegere Murthy (AP, provided by Brigham and Women's Hospital)

Dr. Vivek  Murthy (AP, provided by Brigham and Women’s Hospital)

The last surgeon general of the United States, Dr. Regina Benjamin, took flak for not doing more — or at least, given the limited powers of the office, for not speaking out more.  Forbes called her not just ineffective but “invisible.” New York Times food columnist Mark Bittman wrote a piece headlined “Our M.I.A. Surgeon General,” and accused her of failing to counteract lies by “Big Food” with the truth: that the American diet is making millions of us sick.

Somehow, I think that if President Obama’s new nominee for surgeon general, Dr. Vivek Murthy, is confirmed in the post, he will not have an invisibility problem.

First clue: The striking Reuters photo at the top of the Boston Globe profile of Dr. Murthy, who’s now 36 and affiliated with Brigham and Women’s Hospital and Harvard Medical School. He’s standing in his white coat outside the Supreme Court during the legal arguments over Obamacare in 2012, his arms crossed and his expression — well, judge for yourself. To me, he looks appalled, in a long-suffering way. (Dr. Murthy is not available for comment, but my personal interpretation is that anyone confronted often by the flaws and gaps of the American health care system tends to start looking appalled in a long-suffering way…)

Second clue, from Dr. Neel Shah, founder of the non-profit Costs of Care and a friend of the nominee:

One of the things I admire and love about Vivek is that he beats to the tune of his own drum and in many ways worked outside of the medical establishment in order to advance the interests of the American people….Doctors for America was largely an answer to the less progressive AMA.

Dr. Murthy is co-founder and president of Doctors for America, which describes itself as “a national movement of physicians and medical students working together to improve the health of the nation and to ensure that everyone has access to affordable, high quality health care.” The Globe notes that it began as Doctors For Obama in 2008, and that Dr. Murthy believes doctors should take more of the lead in efforts to improve the country’s health care system.

Other bona-fides, the Globe reports: Continue reading

Coakley: Mental Health Care Is Next Great Mass. Challenge

Attorney General Martha Coakley

Attorney General Martha Coakley

As WBUR’s Martha Bebinger reported, Massachusetts attorney general (and gubernatorial candidate) Martha Coakley is calling for the state to build “a behavioral health system for the 21st century.” Coakley spoke this morning to the Massachusetts Association of Health Plans. She recalled her brother, Edward, who began to struggle with depression at 17 and committed suicide at 33. We asked her office for the prepared text of her speech; it is excerpted below.

“…Which brings us to the third great challenge that I would like to pose to everyone today – improving access to quality behavior health care for everyone who needs it.

This is no small challenge.

There are millions of families dealing with the effects of mental illness across our country.

According to the National Institute on Mental Health, one in four adults suffers from a mental disorder in any given year. It’s probably higher.

And in a time when soldiers have returned from two separate wars, studies have shown that 20% of returning Iraq and Afghanistan veterans report symptoms of PTSD or major depression. It’s also most likely higher.

On Veterans Day, I learned that there are 22 suicides a day by veterans.

Some of you may know that my family dealt with the impact of mental illness.

My younger brother Edward was a brilliant person – he was smart, funny, a great pianist. He also suffered from depression, onset around 17 or so.

He struggled with it for much of his adult life, and my family struggled with how to help him.

When he was 33 years old, he committed suicide.

My parents had died just 1 and 3 years earlier. It was difficult for me and my sisters.

It is why I know first-hand – as many of you do – that behavior health care is as vital to the treatment of many patients as physical health care. Continue reading

In Defense Of Health Care Law, Obama Cites Mass. Success

President Obama spoke at Faneuil Hall about the federal health care law. (Charles Dharapak/AP)

President Obama spoke at Faneuil Hall Wednesday about the federal health care law. (Charles Dharapak/AP)

President Obama’s visit to Boston Wednesday was a carefully orchestrated effort to revive momentum for the Affordable Care Act. The president took the stage at Faneuil Hall, the same place where former Gov. Mitt Romney signed the Massachusetts health coverage law in 2006.

Romney was not invited. Instead, Faneuil Hall was packed with hand-picked supporters of Obamacare. The president congratulated those who supported the 2006 law for making Massachusetts the state with the lowest rate of uninsured people in the country.

“And it’s because you guys had a proven model that we built the Affordable Care Act on this template of proven bipartisan success,” Obama said. “Your law was the model for the nation’s law.”

But rolling out the model nationwide has been rocky. Some governors are refusing to participate. The U.S. House of Representatives has voted to repeal the national law again and again. And the federal website, where Americans are supposed to be able to shop for insurance, is a mess.

“There’s no denying it,” the president said, “right now the website is too slow. Too many people have gotten stuck and I am not happy about it. And neither are a lot of Americans who need health care. And they’re trying to figure out how they can sign up as quickly as possible. So there’s no excuse for it. And I take full responsibility for making sure it gets fixed ASAP.”

Obama looked to Massachusetts for relief. Continue reading

Single-Payer Rumblings In Mass. Legislature

The Massachusetts State House (Wikimedia Commons)

The Massachusetts State House

The dominant story about Obamacare right now is the technical debacle of the Healthcare.gov Website, but you’ll also find an occasional bit of this sub-theme among the punditry: The flaws of Obamacare will push the country further toward a single-payer system like Canada’s. (Exhibit #1 from The Los Angeles Times: Health Law’s Ailments Can Be Cured By Single-Payer System.)

So it’s a particularly interesting moment to see a report by Matt Murphy of the State House News Service that begins like this:

SINGLE-PAYER DEBATED AS POSSIBLE NEXT STEP IN HEALTH REFORM

STATE HOUSE, BOSTON, OCT. 22, 2013…. Massachusetts might not be ready to adopt a single-payer health care system but advocates on Tuesday, including a number of progressive lawmakers, suggested it might only be a matter of time.

Sen. Jamie Eldridge, an Acton Democrat, testified before the Joint Committee on Health Care Financing in favor of two bills he has filed this session to implement a universal Medicare plan in Massachusetts (S 515), or to take the more incremental step of creating a public health insurance option (S 514) to give consumers a taste.

“As much as we’ve made great advances here in Massachusetts and covered nearly all people, there are still some deep flaws in our health care system,” Eldridge said. “A single-payer model is a more efficient system, better health care options and something employers prefer because they no longer have to provide health care.”

Asked if he thought either proposal had a chance of winning approval, Eldridge said, “No. I don’t. I think what’s happening now is single-payer advocates are engaging the business community.”

Also: Continue reading

Dr. Tim Johnson’s Obamacare Podcast: The ‘Unbelievable Bumble’

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

As president, you know things are really getting bad when every humor outlet from The New Yorker’s Andy Borowitz (“Snowden Offers To Fix Healthcare.gov“) to The Onion (“New Improved Obamacare Program Released On 35 Floppy Disks“) is mocking your program’s failures.

President Obama himself expressed his frustration today over the widespread technical glitches besetting people trying to sign up for health insurance under Obamacare, saying that “nobody is madder than me,” NPR reports.

Here, in his latest podcast on health reform, Dr. Timothy Johnson, retired medical editor for ABC News, takes on what he calls “the very rocky start to the centerpiece of the Affordable Care Act: the insurance exchanges.” He and his guests discuss the technical SNAFUs that are marking the launch of the exchanges and dissect their causes. He begins with a New York Times article today that says federal health authorities simply did not have the expertise to do the job of setting up the technological infrastructure needed for Obamacare. He asks, “Question #1, are they right, these reporters? And question #2, can it be fixed?”

Listen to the podcast above to hear some answers (and to hear guest Dr. Gail Wilensky, a high health official under the first President Bush, refer to Obamacare’s technical failings as “an unbelievable bumble” — what a fun phrase, rolling so nicely off the tongue!) And here’s one useful tip: For those who have trouble on healthcare.gov, the Kaiser Family Foundation is offering a simple calculator of health insurance subsidies on its website, www.kff.org.

Readers, reactions? Please share below. And catch Dr. Johnson’s inaugural podcast here.