Seattlearea VA hospital criticized
Sat, 16 Jun 2007 04:44:40 GMT
By GENE JOHNSON, Associated Press Writer
SEATTLE - The
Department of Veterans Affairs knew for months that shower heads, handrails and other fixtures posed serious suicide risks to Seattle-area psychiatric patients, but refused to fix the problems, inspectors said in a report released Friday.
The VA said it scrambled to remedy problems in Seattle after a medical standards group threatened to pull its endorsement of two area hospitals last month. Health care for the nation's veterans has been rocked in recent months by accounts of shoddy treatment at the
Department of Defense's Walter Reed Army Medical Center.
Sen. Patty Murray, D-Wash., inspected the Seattle VA hospital's progress Friday and said the hospital is correcting problems identified by inspectors. She spent nearly two hours touring the hospital's two psychiatric wards and repeatedly asked VA officials to let her know if they need more money.
But Murray also criticized how the problems were handled.
"What happened in those four months?" Murray, D-Wash., asked her tour guides. "Can I be absolutely blunt? I heard it wasn't a resources issue. ... It was a lack of leadership issue."
The Chicago-based Joint Commission, a nonprofit hospital standards group, said psychiatric ward conditions posed an "immediate threat to life" after it inspected the VA Puget Sound Health Care System in May.
Commission inspectors found picture frames with sharp metal corners hung on the walls and fire extinguishers sitting behind breakable glass panes. The furniture in the common areas was neither terribly heavy nor bolted down.
VA officials initially refused to release details of the inspection, which was first reported by The News Tribune of Tacoma. Murray, a senior member of the Senate Veterans Affairs Committee, released it Friday after obtaining a copy.
The document said VA officials knew in February that suicidal patients could use several room fixtures to hang themselves, but "rejected that these were viable risks and elected not to correct." An internal report was issued that month after a patient at the Seattle VA hospital was found hanging from a support rail in November.
Dennis Lewis, director of the VA Northwest Health Network, and Stan Johnson, who moved to Seattle two weeks ago to become the hospital's director, acknowledged that administrators didn't properly respond to the staff's recommendations following the suicide. They said the VA is responding to all the commission's findings.
The VA has removed rails from the beds and ordered 70 new beds and extra-heavy furniture for the psych wards at the Puget Sound hospitals. It has also removed pictures from the walls except in public areas, and is taking other steps such as covering pipes under bathroom sinks to prevent patients from hanging themselves.
The improvements cost $450,000, and administrators said they expected other VA hospitals around the country to reevaluate their psychiatric facilities. Health care for veterans has been a top concern in recent months following accounts of shoddy treatment at the Defense Department's Walter Reed Army Medical Center.
The joint commission, which sends inspectors for unannounced visits every three years, had never complained about the support rails, picture frames or other items it cited in a preliminary report last month, administrators said.
On Thursday, officials told The Associated Press that the Army is planning to hire at least 25 percent more psychiatrists, psychologists and social workers to help a growing number of soldiers with post-traumatic stress disorder and other mental health needs.
Walter Reed's new commanding officer, Maj. Gen. Eric B. Schoomaker, said the Army medical system has lost the trust of soldiers, their relatives and the American people but is working hard to fix its problems and provide quality care to troops.
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Associated Press writer Ron Word, in Jacksonville, Fla., contributed to this report.
L.A. hospital outlines response to death
Sat, 16 Jun 2007 11:44:35 GMT
By DAISY NGUYEN, Associated Press Writer
LOS ANGELES - Workers at an inner-city hospital where a woman died last month on the floor of an emergency room have received training on their responsibilities, officials said.
Signs have also been posted at Martin Luther King Jr.-Harbor Hospital advising patients of their rights to get examined and treated for emergency medical conditions, according to a report released Friday by the county health department, which runs the hospital.
The report details the hospital's response to the death of Edith Isabel Rodriguez, which was captured on a security videotape. Rodriguez died of a perforated bowel at King-Harbor on May 9. Her death was ruled accidental by the county coroner's office.
The case stirred public outrage this week with the release of two 911 calls in which her boyfriend and a bystander unsuccessfully pleaded with emergency dispatchers for help.
In their report to the U.S. Centers for Medicare and Medicaid Services, county health officials said hospital workers in the emergency room at the time of Rodriguez's death received "verbal and/or written counseling" on their responsibilities.
Last week, the federal agency gave the hospital 23 days to correct problems or face a loss of federal funding that provides much of its budget, which could prompt it to close.
Dr. Bruce Chernof, director and chief medical officer of the county Department of Health Services, said officials have been doing what they can to fix the problems and keep the hospital open.
"We, at the department, believe strongly that the community needs this hospital," Chernof said in a telephone interview.
Also Friday, the chairman of the U.S.
Senate Finance Committee asked the federal agency how it plans to protect patients at the hospital, which has been cited more than a dozen times in 3 1/2 years for inadequate care that has led to patient deaths and injuries.
"There have been many prior deaths and long-standing problems, and local and state attempts to improve the hospital have failed," Sen. Max Baucus, D-Mont., wrote in a letter.
According to the county report, a security camera showed Rodriguez being brought to the emergency room lobby by police officers around 1 a.m. When the officers told a nurse that Rodriguez was complaining of stomach pains, according to the report, the nurse told the patient: "You have already been seen and there is nothing we can do."
A few minutes later, Rodriguez slipped off her wheelchair and on to the lobby floor, screaming in pain as she lay in a fetal position. The nurse told her: "Get off the floor and on to a chair," the report said.
The security camera also showed that for about 30 minutes, hospital staff walked past Rodriguez or cleaned the floor next to her "without interacting with her," the report said.
When Rodriguez began kicking her feet, two staff members looked at her and then walked back through the door to an area within the emergency room. Police officers then wheeled her into the emergency room as she was dying.
Federal inspectors noted that during the time Rodriguez spent in the lobby, she did not receive a screening exam to determine if she required emergency medical attention and her presence was not noted in the emergency room log.
30 percent of Cubans are overweight
Sat, 16 Jun 2007 02:34:28 GMT
By ANITA SNOW, Associated Press Writer
HAVANA - Cubans are no strangers to the battle of the bulge. Waistlines have expanded since the economic crisis of the early 1990s eased on the communist-run island — so much so that 30 percent of adults are now overweight, a newly released government study reveals.
Some people outside Cuba hold on to a stereotype of malnourished Cubans waiting in lines for a few potatoes, but there's ample evidence to the contrary in Havana, where bulging waistlines are stuffed into snug skirts or peek through too-tight guayabera shirts.
"People eat lots of things like pizza and bread that fill you up, but put on a lot of weight," said Lucia, a plump housewife who didn't want her last name used, saying she was embarrassed about her weight and uncomfortable talking publicly about something as political as food.
"If you want to go on a diet it's hard because vegetables and fruits cost a lot," she said.
In Cuba, as elsewhere, "obesity and excess weight represent a serious public health problem," causing conditions such as diabetes, hypertension and heart troubles, said the study by Cuba's Nutrition and Food Safety Institute.
Released by state media this month, the 2004 study focused on urban areas, where three-quarters of Cubans live. The study said 30 percent of Cuba's men and 31 percent of its women are overweight, and that about a fourth of the island's 11.2 million people have a tendency toward obesity. Those most likely to be overweight are in their 50s, it added.
An estimated two-thirds of American adults are overweight or obese, according to U.S. federal statistics. Using a ratio taking into account height and weight, the U.S. Centers for Disease Control and Prevention says that generally anyone with a body mass index greater than 25 is overweight. Greater than 30 is obese.
It was unclear if the same index was used for the Cuban study. However, Cuban nutrition researchers told the communist youth newspaper Juventud Rebelde that BMI is the most effective way to determine if someone is overweight or obese.
Cuba has a food ration system that supplements diets with a subsidized basket of rice, beans, potatoes, bread, eggs, a little meat, fish and chicken and other goods. The government estimates it provides a third of the 3,300 calories each Cuban consumes daily.
Cubans also get subsidized meals at work and school, and buy food at farmers markets and overpriced supermarkets or through black market purchases and trades.
Residents say getting food remains challenging, but it's easier now than in the early 1990s when the Soviet Union collapsed and generous subsidies ended. Officially, Cuba's gross domestic product fell by about 35 percent between 1989 and 1990, sparking widespread food shortages.
In 1994, the government opened markets where private farmers could sell crops at unrestricted prices — previously a crime. The state also runs farmers markets with less variety, but lower prices. Together, the markets are the only source of fresh fruits and vegetables for most urban Cubans.
Prices are low by U.S. standards: five pounds of tomatoes and a big pineapple each cost less than an American nickel.
But even with free housing and health services and subsidized services, Cubans complain that salaries averaging about 350 pesos a month don't buy more than a few items, such as onions and garlic and maybe a few tropical fruits.
"It is true that maintaining a balanced diet in today's Cuba, with the economic conditions the country faces, is difficult," endocrinologist Malicela Barcelo told Juventud Rebelde. "We have vegetables and fruits all year, but they are very expensive."
Even if Cubans had the money, there is no guarantee they would spend more on produce. Government-run vegetarian restaurants are often nearly empty. At home, salads are usually just some chopped cabbage, a few tomato slices and a wedge of avocado dressed with oil and vinegar.
The Cuban diet is heavy in starch, especially rice and potatoes. Fried foods are popular, and pork is generally preferred over fish.
And like Americans, many Cubans are sedentary, although they tend to walk more because most don't have cars.
Barcelo and other experts said changing eating habits would help.
"It is common for Cubans to skip breakfast and eat the majority of their food when they get home from work," said Armando Rodriguez Suarez, a researcher for the nutrition institute. "Then all that turns into fat because they sit in front of the television to watch the baseball game or the telenovela."
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On the Net:
http://www.cdc.gov/nccdphp/dnpa/bmi
Group sues NYC over new calorie rules
Sat, 16 Jun 2007 03:36:33 GMT
By LARRY NEUMEISTER, Associated Press Writer
NEW YORK - A restaurant trade group asked a court Friday to outlaw a new city regulation that would require some eateries to list calorie counts on their menu boards right next to the price.
The New York State Restaurant Association filed the lawsuit in U.S. District Court in Manhattan, asking that the rule be declared unconstitutional and that it be awarded unspecified damages.
The association said the rule would apply only to a small group of restaurants — effectively punishing those that have made efforts to tell the public the nutritional facts about food on their menus.
The city law due to take effect July 1 targets big, national fast-food chains. It applies only to restaurants that were already making calorie information available voluntarily as of March 1.
The association argued the regulation infringes on the First Amendment rights of the affected restaurants and has chilled their desire to provide the facts to customers at all.
According to the regulation, calorie counts would have to be displayed on eatery menus in the same type-size as the name of the dish and the price.
The city has estimated that only 10 percent of New York City restaurants will be subject to the regulation, the lawsuit said. Of the association's more than 7,000 members, nearly 1,000 are located in New York City.
In a statement, the city Health Department said the rule merely requires restaurant to provide the information in a manner so that customers will actually see it.
"It is unfortunate that some restaurants are so ashamed of what they are serving the public that they would rather go to court than share this information with their customers," it said.
Anxiety affects obesity surgery success
Fri, 15 Jun 2007 22:34:51 GMT
By ALICIA CHANG, AP Science Writer
LOS ANGELES - Extremely obese people suffering from depression or anxiety tend to lose less weight after obesity surgery than mentally healthy people, researchers reported Thursday in a study that suggests such patients could benefit from treatment beforehand.
People diagnosed with mood or anxiety disorders on average lost 81 pounds six months after gastric bypass surgery compared to their counterparts who shed 86 pounds. Although both groups lost significant weight after surgery, people without mental health problems did slightly better.
"Patients with a lifetime history of mental health problems might benefit from closer surveillance," said lead author Melissa Kalarchian of the University of Pittsburgh Medical Center.
The federally funded research was presented at a meeting of bariatric surgeons in San Diego Thursday. Researchers plan to follow patients for up to two years to determine if there's a weight difference over time.
Many hospitals and insurers require surgery candidates to go through a psychological evaluation before obesity surgery to make sure they are mentally fit for the operation and the lifestyle change afterward. Depressed people aren't automatically disqualified for surgery, but those who are suicidal or abusing drugs and alcohol are usually ruled out.
How depression and other mental health disorders are handled before obesity surgery vary widely by medical center.
For example, surgery candidates at the University of California, San Diego, go through a rigorous mental health evaluation first.
Those with serious problems are usually treated before surgery. That could include antidepressants, psychotherapy or more family involvement, said the center's director William Perry.
"The success of surgery is only as good as the willingness of a patient to make a life change," Perry said.
In the new study, Pittsburgh researchers interviewed 207 surgery candidates and found two-thirds had a history of depression, bipolar disorder, post-traumatic stress syndrome or panic attacks. The vast majority were women with an average body-mass index of 51. A person with a BMI of over 40 is considered morbidly obese.
After adjusting for age, gender and race, researchers compared weight loss six months after surgery. Patients with a history of depression on average weighed 322 pounds before surgery and 241 afterward. Those with no mental health problems weighed 303 pounds before the operation and 217 pounds afterward.
Having a history of mental health problems should not prevent people from getting obesity surgery, even though they may not lose quite as much weight as mentally healthy people, said Dr. Philip Schauer, president of the American Society for Bariatric Surgery.
Gastric bypass, or stomach-stapling surgery, is the most common obesity operation performed in the United States with about 177,600 people undergoing the procedure last year. Federal guidelines say a person should be at least 100 pounds overweight and should have tried traditional weight-loss means before choosing surgery.
Gastric bypass involves reducing the size of the stomach and bypassing part of the small intestine, where digestion occurs. People eat less and absorb fewer calories as a result.
Meg Phelps, a 48-year-old social worker from Pennsylvania, struggled with major depression and low self-esteem for a decade. Often, she wouldn't go out or even make eye contact with people.
Four years ago, Phelps had obesity surgery at the Geisinger Medical Center in Danville, Pa. Beforehand, she had a medical evaluation and attended several months of counseling for depression.
Phelps, who weighed 335 pounds, shed 120 pounds after the surgery and no longer has to see a therapist. She even went back to college and got a degree in social work last year.
"It helped me to take charge of my life," Phelps said of the operation.
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On the Net:
American Society for Bariatric Surgery: http://www.asbs.org
University of Pittsburgh Medical Center: http://www.upmc.com