It's Time: Broad Progressive Coalition Launches New Push for Public Option
by Deirdre Fulton - Common Dreams
In what's being described as a "2016 debate changer," a broad coalition of progressive lawmakers and organizations is launching on Thursday a new push for a national public health insurance option.
With a congressional resolution backed by a grassroots campaign, "this is the most significant healthcare push by Democrats since the passage of Obamacare," saidStephanie Taylor, co-founder of the Progressive Change Campaign Committee (PCCC), which is leading a coalition of groups that will engage millions of Americans this week in support of the effort.
The resolution is being led in the Senate by Jeff Merkley (D-Ore.), Chuck Schumer (D-N.Y.), Patty Murray (D-Wash.), Dick Durbin (D-Ill.), and Bernie Sanders (I-Vt.), as well as 22 other original co-sponsors. It lays out a clear case for a public option—citing persistent health disparities and 31 million underinsured under the Affordable Care Act (ACA), as well as the proven cost-effectiveness of public programs like Medicare—and states:
Resolved, that the Senate supports efforts to build on the Affordable Care Act by ensuring that, in addition to the coverage options provided by private insurers, every American has access to a public health insurance option which, when established, will strengthen competition, improve affordability for families by reducing premiums and increasing choices, and save American taxpayers billions of dollars.
A 2015 poll (pdf) showed overwhelming support among 2016 likely voters for such a program, and both Democratic presidential nominee Hillary Clinton and President Barack Obama have recently come out in favor of a Medicare-like public plan. U.S. Health and Human Services Secretary Sylvia Burwell, too, recently advocated for Congress "introducing a public option in places with limited competition."
What's more, campaigners said Thursday, Aetna's recent decision to pull out of 11 state exchanges means that in 2017, one-third of ACA healthcare exchanges will be served by a single health insurer and more than half may end up having two or fewer to choose from. This erasure of competition "has created new urgency in this moment for making a public option available to every American," as Taylor put it.
"Insurance companies have shown they are more concerned with serving their shareholders than their customers," Sanders added in a statement. "Every American deserves the choice of a public option in health insurance."
And Charles Chamberlain, executive director of Democracy For America, declared: "If our leaders are serious about ensuring real competition in the health insurance market and driving down our out-of-control healthcare costs, giving every American the option to buy into a public, Medicare-like health insurance program is a no-brainer that every single Democrat should support."
Or, as the "We Want A Public Option!" petition states: "Aetna attacked the public. We're attacking back."
"All Americans should have the option of health insurance like Medicare that competes with private for-profit insurers," the petition reads. "Members of Congress and candidates should embrace it in 2016 so we have momentum and can pass it under the next president."
Senate Progressives, Activists Plan Big Public Option Push
They’re seeking to boost Hillary Clinton’s advocacy for a government-run health insurance plan in Obamacare
by Jeffrey Young - Huffington Post
WASHINGTON ― Progressive senators and liberal activist groups plan a renewed effort to achieve what they couldn’t when the Affordable Care Act became law in 2010: Create a “public option” health plan in Obamacare that consumers can choose instead of private insurance.
Sen. Jeff Merkley (D-Ore.) and Sen. Bernie Sanders (I-Vt.) are among the leaders of the effort, which also includes three members of the Senate Democratic leadership: Dick Durbin (Ill.), Chuck Schumer (N.Y.) and Patty Murray (Wash.).
The senators will introduce a resolution Thursday calling for the creation of a public option, and the Progressive Change Campaign Committee will spearhead a grassroots campaign to promote the cause to other senators ― and to Democratic presidential nominee Hillary Clinton.
The revival of the public option comes after Clinton and President Barack Obama both endorsed it as a progressive priority this summer, more than six years after liberal lawmakers left it out of the Affordable Care Act after a lengthy debate.
Moreover, bad news about Obamacare’s health insurance exchanges ― where premiums appear set to rise significantly for at least some customers and fewer insurers will be offering plans for next year ― has invigorated interest among Democrats and other supporters of the health care law in expanding health coverage and reducing costs.
We must continue to make needed health care reforms so that the American people can have health care as a right, not a privilege. Sen. Bernie Sanders (I-Vt.)
“The Affordable Care Act has already expanded health coverage to millions who were previously uninsured and given countless Americans greater peace of mind,” Merkley said in a written statement provided by the Progressive Change Campaign Committee. “We should build on this success by driving competition and holding insurance companies accountable with a public, Medicare-like option available to every American.”
As he did during his unsuccessful White House bid, Sanders acknowledged the Affordable Care Act’s accomplishments ― namely the historic reduction in the number of uninsured Americans ― and described the public option as the next step toward universal coverage.
“The Affordable Care Act has made great progress in helping millions of people get access to health insurance. But at a time when 29 million people are still uninsured, and 31 million are underinsured, we must continue to make needed health care reforms so that the American people can have health care as a right, not a privilege,” Sanders said in a written statement provided by the Progressive Change Campaign Committee.
The Progressive Change Campaign Committee also shared a portion of the resolution, which Merkley will introduce Thursday, with The Huffington Post in advance of the announcement.
Resolved, that the Senate supports efforts to build on the Affordable Care Act by ensuring that, in addition to the coverage options provided by private insurers, every American has access to a public health insurance option which, when established, will strengthen competition, improve affordability for families by reducing premiums and increasing choices, and save American taxpayers billions of dollars.
Other sponsors of the resolution include Democratic Sens. Debbie Stabenow (Mich.), Barbara Boxer (Calif.), Dianne Feinstein (Calif.), Sheldon Whitehouse (R.I.) and Al Franken (Minn.).
The Progressive Change Campaign Committee also has partnered with other groups to generate support for enacting a public option next year, including MoveOn.organd Democracy for America. These organizations will create a petition for supporters to express their views at a new website, WeWantAPublicOption.com.
“We see this as the most significant health care push by Democrats since the passage of Obamacare,” Progressive Change Campaign Committee co-founder Stephanie Taylor said in a written statement.
No matter how much muscle Senate Democrats may put behind enacting a public option, the policy faces significant and possibly insurmountable obstacles in the near term.
Congressional Republicans continue to focus on repealing all of the Affordable Care Act and replacing it with some other scheme that would provide coverage and financial assistance to far fewer people. Republican presidential nominee Donald Trump also backs Obamacare repeal and has outlined a vague alternative that would substantially increase the number of uninsured people.
And even if Clinton prevails over Trump in November and Democrats win the Senate, the party faces slim odds of gaining a majority in the House next year.
The Shady History of Big Sugar
by David Singerman - NYT
Charlottesville, Va. — On Monday, an article in JAMA Internal Medicine reported that in the 1960s, the sugar industry paid Harvard scientists to publish a study blaming fat and cholesterol for coronary heart disease while largely exculpating sugar. This study, published in the prestigious New England Journal of Medicine in 1967, helped set the agenda for decades of public health policy designed to steer Americans into low-fat foods, which increased carbohydrate consumption and exacerbated our obesity epidemic.
This revelation rightly reminds us to view industry-funded nutrition science with skepticism and to continue to demand transparency in scientific research. But ending Big Sugar’s hold on the American diet will require a broader understanding of the various ways in which the industry, for 150 years, has shaped government policy in order to fuel our sugar addiction.
Today’s sugar industry is a product of the 19th century, when the key federal sugar policy was not a dietary guideline but a tariff on sugar imports. In the decades after the Civil War, Americans’ per capita consumption of sugar more than doubled, from 32 pounds in 1870 to 80 pounds in 1910. As a result, the government got hooked on sugar, too: By 1880, sugar accounted for a sixth of the federal budget.
To protect domestic refiners, then the largest manufacturing employer in Northern cities, the tariff distinguished between two kinds of sugar: “refined” and “raw.” Refined sugar that was meant for direct consumption paid a much higher rate than did raw sugar crystals intended for further refining and whitening. But by the late 1870s, new industrial sugar factories in the Caribbean began to jeopardize this protectionist structure. Technologically sophisticated, these factories could produce sugar that, while raw by the government’s standard, was consistently much closer to refined sugar than ever before (akin to sweeteners such as Sugar in the Raw today). The American industry now faced potential competition from abroad.
The country’s largest refiners mobilized on several fronts. They lobbied the United States Congress to adopt chemical instruments that could measure the percentage of sucrose in a sugar cargo, and to deem sugar refined when its sucrose content was sufficiently high. Previously, customs officers had judged the purpose of a sugar cargo by its color, smell, taste and texture, as people throughout the sugar trade had done for centuries. Now refiners argued that such sensory methods were ripe for abuse because they depended on a subjective appraisal. They demanded a scientific standard instead — one that would reveal some “raw” sugar to be nearly pure and thus subject to higher tariffs — and they prevailed.
Their plea for scientific objectivity may have sounded sensible, but it masked nefarious aims. Like the tobacco industry in the 1960s, these refiners knew that scientific questions were hard for outsiders to adjudicate, and thus easier to manipulate to an industry’s advantage. If refiners were to bribe a customs chemist to shade his results in their favor — as they were routinely accused of doing for decades, beginning in the 1870s — such corruption would be much harder for the government to detect than it had been when everyone could see and smell the same sugar.
In addition to their lobbying, refiners waged a public campaign to dissuade Americans from eating raw sugar. One of their common advertisements featured a disgusting insect that supposedly inhabited raw sugar and caused an ailment called “grocer’s itch” in those who handled it. Other pamphlets suggested that Cuban factories operated by slaves or Chinese indentured workers would “give the people sugar teeming with animals and Cuban dirt.”
The refiners’ real agenda, of course, was not Americans’ health; it was to maximize their profits from selling sugar. Thanks in part to their influence over both tariff policy and the new methods of customs collection, the big refiners were soon able to form the Sugar Trust, one of the most notorious and successful monopolies of the Gilded Age. By the early 20th century, belief in the health benefits of refined sugar was so widespread that increasing Americans’ consumption of it actually became a goal of federal policy.
Looking back at the industry’s transformation of sugar (an edible substance derived from a plant) into sucrose (a molecule), we also see the roots of “nutritionism” in United States policy. That’s the idea that what matters to human health is not food per se but rather a handful of isolable biochemical factors. As food critics like Michael Pollan and Marion Nestle have argued, nutritionism is better at helping processed-food companies market their products as healthy (“with Omega-3 added!”) than it is at promoting our well-being.
Today, the sugar industry remains politically powerful, with consequences for both public health and the environment. The Miami Herald reported this summer, for example, that the industry contributed $57 million to Florida elections in the last 22 years; meanwhile, state officials have resisted efforts to make sugar companies pay for their damage to the Everglades.
If we want to check the power of Big Sugar, we’d be well served to acknowledge the long record — past as well as present — of the industry’s machinations.
EpiPen Maker Lobbies to Shift High Costs to Others
by Eric Lipton and Rachel Abrams - NYT
WASHINGTON — Against a growing outcry over the surging price of EpiPens, a chorus of prominent voices has emerged with a smart-sounding solution: Add the EpiPen, the lifesaving allergy treatment, to a federal list of preventive medical services, a move that would eliminate the out-of-pocket costs of the product for millions of families — and mute the protests.
Dr. Leonard Fromer, an assistant clinical professor of family medicine at the University of California, Los Angeles, just promoted the idea in the prestigious American Journal of Medicine. A handful of groups are preparing a formal request to the government. And Tonya Winders, who runs a patient advocacy nonprofit organization, reached out late last month to crucial lawmakers on Capitol Hill.
“We can save lives by ensuring access to these medications,” said Ms. Winders, chief executive of the Allergy and Asthma Network.
A point not mentioned by these advocates is that a big potential beneficiary of the campaign is Mylan, the pharmaceutical giant behind EpiPens. The company would be able to continue charging high prices for the product without patients complaining about the cost.
An examination of the campaign by The New York Times, including a review of documents and interviews with more than a dozen people, shows that Mylan is well aware of that benefit and, in fact, has been helping orchestrate and pay for the effort.
The journal article says it was “drafted and revised” by a medical writing consulting firm paid by Mylan, in consultation with Dr. Fromer. And Dr. Fromer himself has served in the last year as a paid Mylan consultant — which he discloses as part of the journal article. The company has also contributed money to many other groups behind the effort, and it has met with them — and Ms. Winders’s organization in particular — to coordinate its strategy, the participants said.
The effort has accelerated in recent weeks, just as Mylan has faced a flood of criticism about its pricing of EpiPens. The retail price for the standard two-pack has jumped nearly fivefold since 2010, hitting $608 this year. Multiple lawmakers and regulators have opened investigations into the pricing of the product, which has virtually no market competition.
The idea being advanced is simple: If the EpiPen makes the federal preventive list, most Americans would have no insurance co-pay when getting the product. That means they could obtain the medication with no direct cost, regardless of its retail price. Mylan could keep the EpiPen at the current price, or perhaps raise it more, while keeping patient anger at a minimum.
Instead, the federal government, health insurers and employers would pay the bill. Those costs, in turn, could be passed on to consumers in other ways, as in higher premiums or higher co-pays on other drugs.
“In a way, it is brilliant,” said Rachel E. Sachs, a law professor who specializes in public health policy at Washington University in St. Louis. “We are all seeing them for what they are — the poster child for high drug prices right now, but they don’t want to be. And this tactic is nothing but a self-serving move, not a public-regarding one.”
Mylan, in a statement, acknowledged financing “research, resource development and travel” by the nonprofit coalition Ms. Winders formed in collaboration with the company to help push for the change. But, the company said, “we were clear in our corporate sponsorship agreements that the coalition would maintain control.”
The company also pointed to steps it had taken to lower the price of the EpiPen. Mylan has announced more rebates for some patients and it is preparing to release a less expensive generic version.
EpiPen: A Big, and Growing, Moneymaker
Mylan’s revenue from sales of its EpiPen topped $1 billion last year.
It's Time: Broad Progressive Coalition Launches New Push for Public Option
MYLAN’S ESTIMATED ANNUAL
REVENUE FROM EPIPEN
WHOLESALE PRICE FOR
A TWO-PEN SET
2007: Mylan
purchases
the drug
from Merck.
The decision about whether to label EpiPens a preventive drug will fall to the United States Preventive Services Task Force, a federally appointed group of physicians and public health experts. The group reviews disease screenings, counseling and other treatments to determine if they are sufficiently effective to make the list. Under the Affordable Care Act, certain recommendations from the task force must be adoptedby almost all insurers.
The EpiPen is an epinephrine auto-injector, meaning it contains a portable supply of epinephrine that can be quickly administered to a person suffering from an allergic reaction. Proponents of adding EpiPen to the federal list argue that it can prevent a fatal allergic reaction, by stopping anaphylactic shock from progressing, if taken immediately.
Getting the designation could be difficult, since there are no prescription medications for diagnosed illnesses on the preventive list. The task force has recommended at least one over-the-counter medication: aspirin. But generally it lists treatments for a patient only if there are “no signs or symptoms of the specific disease or condition,” the agency said — like a cancer screening. The task force chairwoman, in a statement, appeared to all but rule out adding EpiPens to its list of recommendations.
But a review of Mylan’s lobbying history makes clear that the company has an exceptional track record at influencing government policies, both in Washington and in state capitals. Heather Bresch, Mylan’s chief executive, called the effort “our unconventional approach to growing this franchise” in remarks to Wall Street analysts last year.
Mylan was actively involved in pushing a 2013 federal law encouraging schools nationwide to stock EpiPens. And the company takes credit for legislation in at least 10 states that require the product in hotels, restaurants and other places, and additional school-related legislation in nearly every state. It is also helping push legislation pending in Congress that would require epinephrine auto-injectors on all commercial airline flights.
The company and its employees are major contributors to lawmakers, both Democrats and Republicans, on Capitol Hill. Ms. Bresch is the daughter of Senator Joe Manchin, Democrat of West Virginia.
Effectively pushing such arguments through various public awareness campaigns has helped expand the epinephrine auto-injector market. The product now accounts for 99 percent of the market’s $1 billion in sales in the first six months of this year, the research firm IMS Health estimates.
EpiPen’s market dominance is partly the result of the recall last year of a main competitor, Auvi-Q, after its manufacturer discovered problems with the dosage.
The drive to get EpiPens added to the preventive services list appears to have started in earnest late last year, just as the public and politicians started to focus on drug pricing.
Mylan began to hear complaints, including some from the patient advocacy groups that it funds with millions of dollars in grants. Ms. Winders of the Allergy and Asthma Network said it was at a meeting with Mylan in November that the company proposed getting the epinephrine auto-injectors designated a preventive drug, and she agreed to help.
Mylan gives money to Ms. Winders’s organization to help expand treatment for severe allergies. She would not say how much the company has given, or the exact terms, citing a confidentiality agreement. But part of that money is related to this push, Ms. Winders acknowledged.
“I am being compensated to ensure access to epinephrine,” Ms. Winders said in an interview last week.
Nina Devlin, a Mylan executive, rejected a request by The Times to release these nonprofit groups from their confidentiality agreements. But she did say that the company donated a total of $1.8 million this year to nine nonprofits “in support of anaphylaxis awareness and education initiatives,” of which about $227,500 was to push for the federal listing.
Financial relationships between pharmaceutical companies and patient advocacy groups are extremely common — and often benefit the drug company’s lobbying agendas.
With company support, Ms. Winders’s organization hosts conferences every year that bring together allergists, pediatricians, school nurses and elected officials. At the conferences, held in St. Louis, Orlando and Las Vegas this year, the attendees detail plans to help win passage of legislation intended to increase the distribution of epinephrine.
For the preventive drug push, Ms. Winders has been joined by representatives from other allergy organizations, all with somewhat similar financial ties to Mylan. They include the American Latex Allergy Association, the Food Allergy & Anaphylaxis Connection Team and the Asthma and Allergy Foundation of America.
Eleanor Garrow-Holding, the president of the Ohio-based Food Allergy & Anaphylaxis Connection Team, said the effort was “initiated by Mylan” and acknowledged that her group also receives annual grants from the company.
After The Times raised questions about the arrangement, she added in an email this week that Mylan was “not part of this task force moving forward. Only the patient advocacy groups are actively participating.”
In addition, Ms. Winders and Ms. Garrow-Holding both took offense to the idea that Mylan’s money had affected their organizations’ work.
“Mylan nor any other industry partner dictates our position,” Ms. Winders said. “They have no direct influence over our messaging.”
But at least two groups declined to participate in the effort, citing the appearance of a conflict of interest, their representatives said in interviews.
Dr. Bobby Quentin Lanier, executive medical director of the American College of Allergy, Asthma and Immunology, a nonprofit group of allergy doctors, said his group had spurned Mylan’s offer of payments for a series of papers focused on “the possibility of adding the epinephrine auto-injector to the national preventive drug list.”
“As we looked at it, we thought, ‘No way that we could do that,’” Dr. Lanier said.
Dr. James R. Baker Jr., chief executive and medical director of the Food Allergy Research and Education group, which has historically taken money from Mylan, said he had been offered money to lead the effort, a role Ms. Winders is now playing.
“We just didn’t feel, given the structuring, that it fully aligned with our role as a patient advocate,” Dr. Baker said. (He would not name the organization that he said had offered him the money, citing a confidentiality agreement.)
As of last week, he decided to no longer accept donations from pharmaceutical companies that make products that serve his members.
With the nonprofit groups that still take donations from Mylan, the effort to get epinephrine auto-injectors on the preventive list is moving ahead.
Ms. Winders said her group planned to send a formal submission to the United States Preventive Services Task Force in November. The patient advocates are separately planning to set up meetings with the nation’s eight largest insurers to ask them to add epinephrine auto-injectors to their own lists, even if the federal government does not make the move.
The task force could list the EpiPen in a couple of different ways: either mandating that insurers cover the auto injectors with no co-pay or putting them on a lower-priority list that many insurers still adopt, eliminating the co-pay even though the insurer is not required to do so. But Mylan, in a statement, said it was seeking the most exclusive status, on the A list. Under the Affordable Care Act, most private health insurance plans must cover certain recommended preventive service, including those on the A list, without any charge to the patient.
The article Dr. Fromer published in The American Journal of Medicine will almost certainly help the cause. It makes the exact argument that Mylan wants to push: “The recognition and classification of epinephrine as a preventive medicine by both the U.S. Preventive Services Task Force and insurers could increase patient access, improve outcomes and save lives.”
The article, published online in late August, says in an acknowledgments section that Mylan paid for medical writing consultants who “drafted and revised” the paper based on input from Dr. Fromer. But in interviews, Dr. Fromer and a Mylan spokesman said the article had not been ghostwritten and that Dr. Fromer was heavily involved in the paper. He said he intended to ask the journal to revise the language in the article to make clear that he helped write it.
“My sole purpose in writing this article was to improve access to a lifesaving medication for millions of patients,” he said. He added that while he has served as a consultant to Mylan — with payments as recently as December — he was not paid by the company to write the article.
Senator Richard Blumenthal, Democrat of Connecticut, whose office was among those contacted recently by the nonprofit groups working with Mylan, said he was disappointed with the company’s tactics: turning to patient groups and a doctor it has retained as a consultant to try to get its drug on the preventive list.
“This is the dark side of pharmaceutical practices in enlisting and paying professioals to pitch their profit-making drug,” he said.
Losing antibiotics is a global threat
Editorial Board - Washington Post
THE UNITED Nations General Assembly will hold its first high-level meeting Wednesday on the growing problem of antimicrobial resistance — the tendency of bacteria to fight back against antibiotics. This is a rare example of the world body devoting time to a public-health issue, and though concrete results may be a long way off, the event itself suggests a stirring awareness that it is a global threat.
Antibiotics were truly “wonder drugs” when created in the middle of the 20th century, and they became a pillar of modern medicine. But it has been known for decades that bacteria evolve to fight the drugs, and that overuse and abuse of antibiotics in human health and agriculture have stimulated resistance. Now the point has been reached where some antibiotics have lost their efficacy. Warnings of a looming post-antibiotic era, when a sore throat or a playground scratch could again lead to life-threatening infections, must be taken seriously. To make matters worse, the pipeline of new antibiotics has been running dry.
The United States and Britain have focused high-level attention on the growing threat in the past few years, but the rise of antimicrobial resistance transcends any one country. Superbugs — resistant to more than one antibiotic — are leapfrogging around the world. Last year, Chinese researchers reported finding a “major increase” in resistance to the antibiotic colistin. The resistance mechanism is mobile and can be transferred from one bacterium to another. Soon it started showing up in other countries, too.
The point is that what happens in China does not stay in China. While colistin has been used on farm animals in China, it has been a last-resort antibiotic for people in the United States and elsewhere. Losing it would leave another hole in the antibiotic armamentarium. China, the world’s largest consumer of antibiotics, has recently launched an action plan on resistance, and none too soon.
Antimicrobial resistance is about more than human health. It also involves difficult questions that affect agriculture and the environment. The U.N. General Assembly, with heads of state present, seems like the right place to debate a more concerted and broad response. The session ought to impress world leaders on the need for better stewardship of antibiotics in human health and for farm animals; improved diagnostics to help determine when people really need them and when they don’t; better surveillance of infectious diseases; and methods to stimulate the discovery and development of new antibiotics for all.
Later, it will be important to set targets for action and provide funding to track them. As in climate change, this is a real problem that affects everyone in the long run but is too easy to ignore today. If the United Nations meeting raises awareness about the risks of not taking action, it will be a worthwhile start.
Eastern Maine Medical Center Looks to Airline Industry to Prevent Errors
by Patty Wight - MPBN
A recent study shows that medical errors are likely the third leading cause of death in the U.S. The findings by researchers at Johns Hopkins were controversial, but one of the takeaways has been that the health care system should take lessons from aviation.
The airline industry has seen a dramatic increase in safety, including fewer crashes, since adopting a set of standardized safety practices. Eastern Maine Medical Center in Bangor has spent four years integrating aviation-inspired protocols in an effort to improve safety and reduce medical errors.
One of the first places where EMMC applied those aviation protocols is where the stakes are often the highest: the operating room.
“Our first patient is a gentleman who had a fractured dislocation to his elbow about nine months ago,” says orthopedic surgeon Dr. David Carmack, who is going to remove and tighten some of the hardware embedded in the patient’s arm from a previous reconstruction.
It’s a pretty straightforward surgery. Still, there’s room for error.
“Room for error, in orthopedics especially, is laterality. The correct side, left and right,” he says.
Operating on the wrong part of the body, the wrong patient, even doing the wrong procedure is rare in hospitals, but it does happen. To prevent mistakes, EMMC started working with a company four years ago called LifeWings, which takes best practices from the aviation industry and adapts them to health care.
One is a team huddle right before launching into surgery. It’s called a time out.
“Are we all ready for a time out?” a charge nurse calls, and everyone in the OR stops, faces each other, and reviews what they’re about to do.
“So what we’re going to do is a revision of his internal fixation and take some hardware out. I don’t anticipate any critical events or critical blood loss,” Carmack says, taking the lead.
Time outs themselves aren’t new. They became a quality standard in 2004. But subsequent studies have found that time outs really haven’t done much to prevent surgeons from operating on the wrong arm or leg.
Part of the problem, observers say, is that time outs are not standardized. That’s why EMMC sought help from LifeWings.
A checklist posted on the OR wall lists the information that teams review before every surgery — about the procedure and the patient’s allergies and medications — and it ends with a crucial statement by the lead doctor.
“So that completes the time out, and the expectation is that everyone will speak up with safety concerns or suggestions throughout the case,” Carmack says.
That statement is important because it emphasizes the principle that everyone on the team is responsible for the patient’s safety. It may sound like a no-brainer, but EMMC Chief Medical Officer Dr. James Raczek says sometimes top-down health care culture can make it hard for people to speak up.
“It’s not unusual for someone who might be a technician not to feel it’s appropriate or the right environment to ask a question of a nurse or physician because of that difference in status, that difference in hierarchy,” he says.
“Before, the doctors had more — maybe not control is the right word, but influence,” says Steve L’Italien, a surgical technician. “And now we feel we have more of an influence now that they want to have our input, so it’s not so scary to say something.”
After working to empower employees and improve communication in the OR, EMMC started adapting LifeWings protocols in other areas.
In a typical shift, Frank Connolly, a transporter at EMMC, will move between 25 and 35 patients to different areas of the hospital, for X-rays, testing and other procedures.
“Hand offs are one of the biggest times for safety issues to occur because of communication,” he says.
“It can be anything from not knowing the patient can’t stand up, risking a potential fall,” says Andrea Huntley, program manager for LifeWings at EMMC.
So, when Connolly picks up a patient for an echocardiogram, he asks the staff nurse seven questions, which are also printed on a business-size card he keeps in his pocket for quick reference.
Connolly says those standard questions ensure nothing slips through the cracks.
“We’re not giving excellent care to one patient, and then mediocre care to the next,” he says.
Though it’s working well now, Connolly says, LifeWings initially had a turbulent start. It took a few attempts to create an effective communication protocol. And some staffers were slow to get on board.
“I guess I would consider myself somewhat of a resister in the beginning,” Carmack says.
Back in the OR, Carmack says he bought in after he had a near miss that was caught by a new, young surgical tech.
“Learning about near misses and actual problems and complications that really are preventable, I kind of made the decision that there’s no good reason for me not to be 100 percent behind this,” he says.
After EMMC implemented LifeWings safety protocols in the OR in 2013, it recorded 10 surgical errors. The next year it had edged downward to nine, and last year, it had dropped to one.
Carmack says these tools aren’t revolutionary — they’re common sense. What makes them work is they’re part of a set process that everyone follows.
The protocols are always being updated. The next change, he says, will be ensuring that EMMC’s post-operation debrief is incorporated at the end of every surgery.
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