Alabama to expand trauma care communication system

Alabama is working to plug a deadly hole in the treatment of highway accident and other trauma victims - getting injured patients to the correct hospital.

Half of the state, including metro Birmingham-Hoover, Huntsville and Mobile, is already covered by a state trauma communications system that saves lives. Beginning early next month, 10 counties in east Alabama will join the system, including six with major highways used by Birmingham-area residents on trips to Atlanta, Auburn and Chattanooga.

Without such a system, an estimated 60 percent of injured patients end up in a hospital that can't properly treat them, and then are transferred to another hospital hours later, Alabama state health officials say. This can mean missing the "golden hour" after trauma, those fleeting minutes when prompt medical treatment gives the best chance of survival from serious injury.

An example would be a car wreck victim with a closed-head injury who was sent to a hospital that lacked a neurosurgeon. If there were bleeding inside the head, he could quickly deteriorate before reaching a surgeon who could help.

The same threat would exist for an accident victim who had two injuries to his long bones - either the upper arms or upper legs - if he were sent to a hospital that lacked an orthopedic surgeon.

Trauma death rates in metro Birmingham have dropped 12 percent since the Birmingham Regional Emergency Medical Service System started its pioneering trauma communication system 13 years ago, according to the Alabama Department of Public Health.

"This whole system is geared so that no one ever has to be transferred," said Dr. John Campbell, the department's EMS and trauma medical director. "They're always taken to the hospital that can give definitive care immediately, so hundreds of lives can be saved every year."

Eight volunteer hospitals in the east region have been screened and approved by the state health department, said Choona Lang, a registered nurse and the state trauma administrator.

"We are now installing computers and software to give real-time information on their ability to accept a trauma patient," she said.

With the system, medics at the accident scene evaluate the patient and contact Alabama Trauma Communications Center, based at the University of Alabama at Birmingham. A computer there lists all the trauma hospitals ready to accept patients, and it updates that information every 90 seconds.

"Paramedics (at UAB) will discuss the patient's injuries and will route the patient to an appropriate hospital," Lang said. Discussions may also include hospital emergency department staff, trauma surgeons and other caregivers.

After east Alabama joins the system, metro Montgomery and a large swath of west-central and southeast Alabama will be the last areas unprotected.

The state health department hopes to include those counties by the end of the year, making Alabama a model for the nation, Lang said. "No other state that we know of has the statewide, centralized communications center."

This will be particularly important for travelers on the road. According to the state health department, almost 80 percent of Alabama's trauma cases come from motor vehicle crashes, and trauma is the leading cause of death in the state for people younger than 45.

E-mail: jhansen@bhamnews.com Read More...

California hospitals fined for errors

Eleven California hospitals were fined $25,000 each in administrative penalties Thursday for violations that, in some cases, led to death or serious injury, according to Department of Public Health officials.

Most of the hospitals fined were in Southern California, and about half were cited because doctors or hospital staff had left foreign objects in patients after surgery. Coast Plaza Doctors Hospital in Norwalk and Los Angeles County-USC Medical Center were fined for failing to follow proper surgical procedures.

At County-USC, surgeons had to operate a second time to remove a surgical sponge left inside a gunshot victim in June 2008. The hospital has been fined two other times in the last two years, including a citation earlier this month for leaving surgical sponges and towels behind during surgery on another gunshot victim. County-USC doctors and staff perform about 1,000 surgeries a month, including a quarter of the county's trauma cases, said chief executive Pete Delgado.

Coast Plaza was fined after staff left two surgical clamps in a patient during surgery in December 2008 and had to operate again to remove them.

Of 115 penalties issued to 80 hospitals since the penalties became law two years ago, 21% were related to foreign objects left behind during surgery, the second-leading violation, according to Ralph Montano, a health department spokesman. About 36% of fines are due to medication or pharmacy errors, Montano said.

Other hospitals fined included Saint John’s Health Center in Santa Monica, where staff failed to follow surgical procedures in December 2008 and a fire erupted during eyelid surgery, burning a patient's face.

USC University Hospital was fined after mixing up two patients' test results, mistakenly telling a patient with a broken leg that he had cancer in August 2007 and unnecessarily amputating his leg. The hospital was also fined $30,300 for failing to report the incident, but hospital officials have appealed that fine, state records show.

Tenet Health Corp. sold the hospital to the university in April, and state officials emphasized that the fine was against Tenet, not the university. A Tenet spokesman said they may appeal the penalty.

Other local hospitals fined Thursday included Kindred Hospital in Ontario; Loma Linda University Medical Center; Sharp Chula Vista Medical Center and Tri-City Hospital District in Oceanside. Read More...

$350,000 grant going to water project in Southern Hills

State officials have approved a $350,000 grant that will help continue a water project aimed at eventually bringing drinking water to rural residents and cities throughout the Southern Black Hills.

The state Board of Water and Natural Resources this week approved a $350,000 State Water Resources Management System grant for Southern Black Hills Water System Inc. Other funds have been made available through the U.S. Department of Agriculture’s Rural Development program.

The money will be used to build pipeline from a project well along the 7-11 road west of Buffalo Gap west to about halfway to S.D. Highway 89 south of Pringle, according to Bob Peplinski, a member of the water system board.

Phase One of the project will bring Madison Aquifer water to about 130 families in the area, Peplinski said.

He said the board hoped to put the initial project out for bid within the next 30 to 40 days.

Phase Two of the project will bring water farther west to include several rural subdivisions west of Highway 89.

The project has a permit to drill a second well, Peplinski said.

The water system board hopes to build a system that eventually would pump water along more than 100 miles of trunk line connecting Hermosa, Hot Springs, Edgemont, Pringle, Custer, Hill City and, eventually, Keystone. The line could provide drinking water to as many as 6,000 rural residents of the Southern Hills, where finding drinkable well water is an iffy proposition.

Peplinski said costs for the entire project could reach well over $100 million.

Gov. Mike Rounds recommended the $350,000 funding to the 2009 Legislature, and lawmakers appropriated funds from the state Water and Environment Fund through the Governor’s 2009 Omnibus Water Funding Bill.

“Because of the lack of water supplies in the southern Black Hills, this area needs a regional water system to supply a reliable source of high-quality, safe drinking water to enhance continued economic growth,” Rounds said. “These funds will help keep this much-needed project moving forward.” Read More...

6.3% of children uninsured statewide

An estimated 11.8 percent of St. Cloud residents ages 18-64 did not have health insurance last year, according to the Census Bureau’s 2008 American Community Survey. An estimated 3.2 percent of St. Cloud’s children under 18 are uninsured.

The American Community Survey is the federal government’s annual survey of about 3 million households. It provides a wealth of social, economic and demographic information between the 10-year census.

Last year was the first time the American Community Survey included a question about health insurance coverage.

The results show that uninsured rates vary greatly across the nation. According to the new snapshot, one in four people in Texas lacked health insurance in 2008, the highest rate in the nation. At the other end of the spectrum, fewer than one in 20 Massachusetts residents lacked coverage.

The uninsured rate for children ranged from 2.1 percent in Massachusetts to 20.2 percent in Nevada.

Among the 50 states, Minnesota’s uninsured rates — 11 percent for working-age adults and 6.3 percent for children — were near the bottom.

That’s partly because Minnesota has a state-sponsored health insurance program for low-income residents called MinnesotaCare. Enrollees pay a monthly premium based on their family’s income, size and number of family members covered.

“Minnesota tends to have a lower uninsured rate than many other states,” said Kathy Parsons, director of managed care for St. Cloud Hospital. There are additional programs that cover children, she said.

But Parsons said the survey results indicate a higher percentage of uninsured than she would have expected, and could be due to people losing insurance coverage because of job layoffs.

In Stearns County, the number of uninsured — 9.2 percent for adults and 4.5 percent for children — is slightly below the state rate.

Sherburne County’s numbers are similar to Minnesota’s, with an estimated 12.5 percent of adults age 18-64 and 4.8 percent of children without insurance. No data is available for Benton County because it is too small to be included in the ACS.

The uninsured rate for adults 65 and older tends to be very low because they qualify for Medicare, the federal government’s health insurance program for seniors.

No job, no insurance

It’s not clear from the data how the recession is affecting uninsured rates, but experts say they suspect it’s having an impact.

Andy Vinson, executive director of HealthPartners Central Minnesota Clinics, said his clinics have seen only a slight increase in the number of uninsured patients in recent months.

However, they have seen a shift from most people having employer-backed insurance plans to more having government-sponsored insurance, something Vinson attributes to job loss.

An employee can get continuing insurance coverage after losing a job, but it may be more expensive, said Li Zhang, assistant professor of finance, insurance and real estate at St. Cloud State University.

And if there’s a lapse in coverage of more than a couple months, the employee’s pre-existing conditions won’t be covered for a certain period of time once he or she does get insurance, she said.

Zhang said she expects the uninsured rate to increase if job losses in the area continue. Even for those with health insurance, the costs are going up as many employers shift more of the cost to employees, she said.

Reasons, impact

There are other reasons a percentage of the population doesn’t have coverage despite the availability of government-sponsored insurance, experts say.

They might earn too much or have too many assets to qualify for MinnesotaCare or other programs, or they might not think they can afford the premiums, Parsons said. Or they might not even be aware of the programs.

“Sometimes you don’t think about it until you need it,” Parsons said.

Sometimes recent college graduates who haven’t found a job remain uninsured, Parsons said, or younger, healthy adults decide not get coverage.

“They’re kind of in that middle place where they’re going to take that chance,” she said.

The impact of the uninsured on the health care system can be costly. People without insurance often skip regular physicals and preventive or prenatal care and can end up in the emergency room with a more complex health problem, Parsons said.

“The ER is the most expensive place to try to get your basic care,” she said.

It can also be costly for individuals, particularly if they have a catastrophic health problem or accident.

“It is a leading cause of personal bankruptcy,” Zhang said. Read More...

Senate OK’s Kennedy successor bill

The state Senate approved a bill yesterday that would let Governor Deval Patrick appoint an interim successor to Edward M. Kennedy, paving the way for the appointment of a new US senator as early as tomorrow and providing Democrats in Washington the potential 60th vote they have been seeking to pass a health care overhaul.

The state Senate approved the measure by a 24-to-16 vote, just five days after the House had voted 95 to 58 to change Massachusetts election law and allow the appointment of an interim US senator. Both chambers are planning to give a final procedural endorsement to the measure and to send it to the governor’s desk today; the only potential hurdle is that Republicans are contemplating a last-ditch legal challenge in an effort to derail the legislation.

News of the vote reverberated yesterday from Beacon Hill to Washington, where US Senate majority leader Harry Reid, informed of the news when a note was passed to him, pumped his fist into the air and cracked a small smile, according to an aide.

All attention now turns to Patrick, who has been weighing the appointment options with a close circle of advisers in recent days, asking them to cast a wide net, according to a person with knowledge of the process who requested anonymity because of the sensitivity of the discussions. It has been an “extensive vetting process,’’ but the governor is still mulling over candidates, the person said.

The governor is hoping to be able to appoint someone tomorrow or Friday, the person said.

Mindful of recent controversies over interim US Senate appointments in New York and Illinois, Patrick administration officials have declined to release the names of those under consideration.

“The governor appreciates the support voiced in the Senate today and the action taken by the House last week to ensure Massachusetts has full representation in the Congress,’’ Patrick’s spokesman, Kyle Sullivan, said in a statement.

The interim senator appointed by Patrick would serve until voters elect a new senator in a Jan. 19 special election. That senator would serve the remaining three years of Kennedy’s term.

Kennedy’s two sons, US Representative Patrick J. Kennedy of Rhode Island and businessman Edward M. Kennedy Jr., have told Governor Patrick that their first choice for an interim senator is former Democratic National Committee chairman Paul G. Kirk Jr., according to a Kennedy family associate.

Kirk, an attorney who lives on Cape Cod, worked as a special assistant to Senator Kennedy from 1969 to 1977, is currently the chairman of the John F. Kennedy Library Foundation, and last month served as master of ceremonies at a widely watched memorial service the night before Senator Kennedy’s funeral. Read More...

More than 10,000 children in isles remain uninsured

Hawaii appears to be increasing health insurance coverage among residents.
Click Here For More Info!

But despite the state's health insurance programs for the poor and elderly, it still has tens of thousands of uninsured, including more than 10,000 children.

The percentage of those without health insurance in Hawaii was 6.7 percent in 2008, compared with 8.2 for years 2006-2007, according to the U.S. Census Bureau.

In 2008 an estimated 83,111 people were without health insurance in Hawaii, more than 10,330 under age 18, the Census Bureau said.

State Sen. David Ige, chairman of the Senate Health Committee, said lawmakers are aware there is a gap group of working poor who do not qualify for state services.

Ige (D, Aiea-Pearl City) said the Legislature authorized $350,000 to cover an estimated 4,500 children without health insurance statewide in 2007 and 2008, but Gov. Linda Lingle's administration has ceased the program and declined to release the funds.

State Department of Human Services spokeswoman Toni Schwartz said the administration has raised the level of income eligibility and increased the number of families qualifying for health insurance benefits.

Schwartz said the department halted the release of funds for the gap group because people who could afford insurance were entering the health insurance program.

The Census Bureau ranked Hawaii first for the percentage of workers who carpool to work and was seventh in the U.S. for workers 16 and over who travel to work by public transportation.

Hawaii also led states in the largest percentage of households with at least three generations living together.

They totaled 7 percent of Hawaii's households, followed by California, Mississippi, Texas and Louisiana. Read More...

Specialist insurers do not always offer the lowest quote

Specialist insurers, which are marketed towards a specific type of driver are not always the cheapest, according to a comparison website .

Steve Sweeney, head of motor insurance at moneysupermarket.com, noted that there are many people who use specialist insurers because they believe they will always be offered a lower quote . He indicated that this is true for some drivers, but not everybody, so people should shop around for the best deal. He added: "I would advise anyone unsure about whether to go down the specialist insurer route or stick to more traditional providers to weigh up all their options."

Mr Sweeney also said that often specialist insurers will provide worthwhile extra benefits such as handbag cover on women-only policies, however in general it will not pay to stay with your existing insurer.

Recently, moneysupermarket.com stated that it will be showing the total excess payable on policies when people compare quotes on its website. Read More...