Feds warned against risk seen in Buffalo VA

BUFFALO, N.Y. -- Federal authorities warned against the infection risks of using insulin pens on more than one patient, and officials on Monday asked why a Buffalo veterans hospital may have used the pens on many patients, causing an HIV scare.

More than 700 patients admitted to the Veterans Affairs Western New York Healthcare System over a two-year period may have been exposed to HIV, hepatitis B and hepatitis C, officials said following a review that found that multi-dose pens intended for use by a single patient may have been used on more than one person.

Although the needles were changed, the stored insulin could have been contaminated by a back flow of blood with each use, experts said.

On Monday, members of the region's congressional delegation sought an investigation.

"Is this situation isolated to the VA Medical Center in Buffalo or is it reflective of a systemic problem in patient labeling that has endangered veterans throughout the VA healthcare system?" Rep. Brian Higgins, D-N.Y., asked in a letter to Veterans Affairs Secretary Eric Shinseki.

The hospital, in a statement to The Associated Press, said only inpatients in Buffalo were affected.

Federal health agencies have been warning against sharing insulin pens for several years. The Food and Drug Administration issued an alert in March 2009 after learning that more than 2,000 patients may have been exposed at a Texas hospital between 2007 and 2009.

A clinical alert from the Centers for Disease Control last year came amid continued reports of the practice.

"This just shouldn't happen, but it does," Dr. Melissa Schaefer of the CDC said Monday, "and I think the incidents we hear about are likely underreported.

"Reuse of insulin pens for more than one patient essentially is akin to syringe reuse," she said. "You can get back flow of blood into that syringe or cartridge that contains the insulin and then you potentially expose others patients. And changing the needle wouldn't make it safe for multi-patient use."

Ignorance of the danger may be a factor, experts said, with hospital employees mistakenly viewing the pens like multi-dose drug vials that are meant to safely supply more than one patient if each dose is drawn with a new needle.

"As we get new technology, it's just re-educating personnel," Schaefer said.

The Buffalo hospital said it began using insulin pens in October 2010. An inspection in November 2012 led to the discovery of pens in medication carts without patient labels and the likelihood they may have been used on more than one patient.

"There is a very small chance that some patients could have been exposed to the hepatitis B virus, the hepatitis C virus or HIV, based on practices identified at the facility," a Friday memo from the VA to the region's congressional representatives said.

Rep. Chris Collins, R-N.Y., spoke with the undersecretary for health at the Department of Veterans Affairs, spokesman Grant Loomis said, and was told veterans would be contacted beginning Monday.

The VA said it was establishing a nurse-staffed call center to notify and respond to veterans' questions and arrange blood tests and any necessary follow-up care. Employees would also receive educational material on the appropriate use of insulin pens, the agency said.

"Once this was identified, immediate action was taken to ensure the insulin pens were labeled and only used according to pharmaceutical guidelines," the hospital's statement said.

The VA's National Center for Patient Safety, meanwhile, has been asked to prepare a safety alert for all VA facilities, spokesman Josh Taylor said. The notices are designed to reinforce best practices for patient care.

In 2009, Fort Polk's Bayne-Jones Army Community Hospital contacted and tested 15 patients who might have been injected with insulin from a pen first used on another patient. Hospital records don't indicate that any became ill because of those injections, spokeswoman Kathy Ports said Monday.

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Associated Press writers Janet McConnaughey in New Orleans and Kevin Freking in Washington contributed to this report.

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Econ 101: January 15, 2013

Welcome to ThinkProgress Economy’s morning link roundup. This is what we’re reading. Have you seen any interesting news? Let us know in the comments section. You can also follow ThinkProgress Economy on Twitter.

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Hagel Wins Over Key Democrats In Defense Secretary Bid

Sen. Chuck Schumer (D-NY) — rumored to be a potential roadblock in the confirmation of Chuck Hagel as Secretary of Defense, today announced his support of Hagel’s bid — following a lengthy meeting between the two.

Schumer was thought by many to be a bellwether on whether coordinated attacks on Hagel’s stance on Iran and Israel by neoconservatives were having the desired effect. In the aftermath of a ninety minute meeting between the two on Monday, Schumer made clear that the smear tactics of the Washington Post’s Jennifer Rubin and others had not swayed his decision, announcing his support in a prepared statement:

Based on several key assurances provided by Senator Hagel, I am currently prepared to vote for his confirmation. I encourage my Senate colleagues who have shared my previous concerns to also support him. [...]

I know some will question whether Senator Hagel’s assurances are merely attempts to quiet critics as he seeks confirmation to this critical post. But I don’t think so. Senator Hagel realizes the situation in the Middle East has changed, with Israel in a dramatically more endangered position than it was even five years ago. His views are genuine, and reflect this new reality.

In his statement, Schumer also noted that Hagel provided assurances on his commitment to female and LGBT service members, another concern of several members of the Senate.

By announcing his support, Schumer joins Sen. Barbara Boxer (D-CA) in firmly stating their backing of Hagel in the coming confirmation fight. “After speaking extensively with Sen. Hagel by phone last week and after receiving a detailed written response to my questions late today, I will support Sen. Hagel’s nomination as secretary of Defense,” Boxer said in a statement.

In an attempt to push Schumer, the Emergency Committee for Israel — one of the groups leading the charge against Hagel — took out a full page in today’s New York Times urging readers to call Schumer and Sen. Kristin Gillibrand (D-NY) to oppose Hagel. Schumer’s announcement seems to make that ad moot.

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Number Of ‘Working Poor’ Families Grows By 200,000

According to a new report, the number of families calssified as “working poor” — meaning they live in poverty despite the parents being employed — grew by 200,000 in 2011 (the latest data available from the Census Bureau). The Working Poor Families Project found that 10.4 million families live near poverty:

The result is 200,000 more such working families – the so-called “working poor” – emerged in 2011 than in 2010, according to the report, based on analysis of the most recent U.S. Census Bureau data.

About 10.4 million such families – or 47.5 million Americans – now live near poverty, defined as earning less than 200 percent of the official poverty rate, which is $22,811 for a family of four.

Overall, nearly one-third of working families now struggle, up from 31 percent in 2010 and 28 percent in 2007, when the recession began, according to the analysis.

“As the economy has improved one would expect that the benefits of that improvement would to some extent tie to these low-income families, and we’d see a decrease or at least a stabilization in the numbers,” said the report’s co-author, Brandon Roberts. “But the reality, the data show that the benefits of — even though it’s modest economic growth — it’s not going to these low-income families.” Overall, the poverty rate stabilized in 2011, despite analysts’ predictions that it would rise.

The number of Americans living in extreme poverty is up by 50 percent since 2000. Just three other countries in the developed world (Mexico, Chile, and Turkey) have a higher rate of child poverty than the U.S.

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The Surprising Root Of The United States’ Wasteful Health Care Spending

Over the last several decades, U.S. national health expenditures have skyrocketed, increasing everything from the cost of treatment to the cost of coverage and the federal government’s entitlement obligations.

Experts have long held that anywhere from 30 to 50 percent of America’s $2.7 trillion annual health care spending is wasteful, either due to ineffective treatments, excess medical tests, hospital re-admissions, and medical billing fraud.

But there has been some debate over exactly how much each of these factors contributes to wasteful health expenditures. On Thursday, the nonprofit group New England Health Institute (NEHI) held a round table in which they explored exactly that, and their findings are striking: of the seven biggest factors contributing to waste, the largest by far is patients not adhering to their medication regimens. NEHI estimates that a staggering 50 percent of the 187 million Americans taking prescription drugs every year do not take them properly:

When Americans neglect to stick to their prescribed treatment regimens, they risk increasing the frequency of hospitalizations and preventable diseases and deaths. Other major factors in medical waste include the overuse of antibiotics leading to super resistant pathogen forms, as well as Americans’ woefully low rates of vaccinations.

Most of the policy solutions that NEHI explored to these problems are fairly standard for health reform advocates, including measures such as greater care coordination and case management, an emphasis on primary and preventative care, patient education, pay-for-performance for hospitals and doctors, and prospective rather than retrospective payments for patients’ care. Several of these measures — including extending access to preventative and primary care and pay-for-performance — are already slated to be implemented under Obamacare.

But another event speaker, Institute of Medicine scholar Dr. Michael McGinnis, emphasized that cost controls and expansions of access to care alone would not solve the underlying problem of wasteful spending — as evidenced by the study’s findings. Doctors and patients alike have to find incentives for effectively tracking and treating diseases, and get a handle on illnesses before they become more complex and expensive to treat. “We need to have a multi-faceted approach,” Dr. McGinnis said. “We need a change in prices, a change in culture, a change in health care delivery.”

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How Walgreens Plans To Lower America’s Health Care Costs

ThinkProgress has previously reported that a massive contributor to America’s annual $2.7 trillion health care expenditures is the staggering 50 percent of Americans who simply do not take their prescribed medications properly.

Now, Wonk Blog’s Sarah Kliff is reporting that corporate pharmacy giant Walgreens wants to start bucking that trend by forming “accountable care organizations” (ACOs) in conjunction with local physicians and hospitals. ACOs are coordinated care systems that are paid on the basis of their performance. If an ACO successfully provides Medicare beneficiaries with quality care while keeping costs under a year-to-year target, it is rewarded with higher Medicare reimbursements from the government by netting the savings — but if it goes over the annual target, it has to swallow the losses.

Although most ACO applications so far have been partnerships between more specialized health care providers, more convenient access to local pharmacies might make them effective venues for managing and tracking Americans’ treatments after their hospital visits:

While a pharmacy-run ACO is not the traditional model, [Walgreens' Senior Vice President Jeffrey Kang] argues it actually makes a lot of sense. Pharmacy stores are open every day of the year, making them a more accessible point of contact than most doctor offices. They have begun to handle basic health care, like vaccination and preventive check-ups, right in the store, which could prevent more costly diseases down the line.

Health care research shows that unnecessary hospital readmissions are often caused by a patient not following the prescribed medical regiment after discharge, creating another place where pharmacists could easily intervene. [...]

“The way I like to describe it is as a physician-led plan where we’re an active partner,” Kang says. “They’re the quarterback who creates the treatment plan. We can be care extenders who help implement and execute the plan.”

In order to make that active partnership work, Walgreens is working to become better integrated with its partner health care systems. While both the pharmacies and doctors, for example, already have electronic medical records, they now need to ensure that each system can interface, allowing all health care providers to track a given patients’ care.

Walgreens’ decision to venture into the coordinated care market underscores the broad innovative potential of Obamacare provisions such as ACOs. Centering medical treatment followups in pharmacies could go a long way towards making sure that Americans stay on their treatment regimens, thus reducing sickness, deaths, and costly hospital re-admissions.

However, lawmakers should make sure that pharmacies that provide more extensive services have the proper oversight, so as not to fall into the same pitfalls as laxly regulated compounding pharmacies in the wake of last year’s deadly meningitis outbreak.

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Head Injuries in the NFL

 Highlight transcript below to create clipTranscript:  Print  |  Email Go  Click text to jump within videoThu 10 Jan 13 | 07:16 PM ET A study shows Junior Seau had a brain disease called CTE when he committed suicide last year. Ben Reiter, Sports Illustrated writer, discusses just how much damage this news could be for the NFL.

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