indicted over brain-eating amoeba testing
Two Louisiana utility workers have been indicted for allegedly failing to
test the water supply for a brain-eating amoeba and then lying about it.
In late August, St. John the Baptist Parish officials told 13,000 people in
three Louisiana towns that the deadly amoeba, called Naegleria fowleri,
had been found in their water supply. The following month, state police
officers began to inspect inconsistencies in the water inspection data,
according to ABC New Orleans affiliate WGNO.
Utility workers Kevin Branch, 54, and Danielle Roussel, 43, were both
indicted Monday on one count of failing to perform a duty required of a
public employee and another count of creating and maintaining false public
records, according to the indictment obtained by ABC News.
Naegleria fowleri causes primary
amoebic meningoencephalitis, an extremely rare but almost invariably fatal
brain infection, according to the U.S. Centers for Disease Control and
Prevention. The amoeba thrives in warm freshwater and enters the brain
through the nose. This infection is not caused by drinking water
contaminated by the amoeba.
A 4-year-old boy from a nearby parish died last year after contracting the
amoeba while playing on a Slip 'N Slide. Afterward, New Orleans flushed its
water supply with chlorine. In July, 9-year-old Hally Yust died after being
infected with the amoeba in Kansas.
According to the grand jury indictment filed Monday, investigators compared
the water inspection logs with data from the GPS devices on Branch's and
Roussel's parish vehicles and concluded that Branch did not stop at 30 of
the 48 water inspections he claimed to have done between Aug. 1 and Aug. 27.
And Roussel did not stop for three of the six inspections she claimed to
have completed over the same period, the indictment states.
There have been 132 other reported cases of
Naegleria fowleri infections between 1962 and 2013, with only a handful
occurring each year, according to the CDC. By comparison, about ten people
die in unintentional drownings per day, the agency said. Four of those
Naegleria fowleri cases occurred in Louisiana.
Visit ABC News for the article.
for physicians â€“ Which price is right?
Does your physician know the cost of the test he just ordered for you, and
what are the ethical implications, either way? In response to research
indicating that healthcare costs go down when physicians are shown the cost
of tests at the time of ordering, a pair of medical ethicists at Johns
Hopkins has outlined the ethical issues that need consideration when
designing and displaying prices for physicians.
The Viewpoint article in The Journal of the American Medical Association (JAMA) highlights
a core problem with price displays: In modern medicine "price" can refer to
various types of charges, including cost of service provision, cost plus
profit, charges, or expected reimbursement, among others. Some of these
prices may vary by as much as 10-fold â€“ from $11 up to $142 for a complete
blood count, for example. Displaying the right price is important, as well
as where the price came from and what it means, may also be important to
"Price displays are growing in popularity, and yet these different possible
meanings of price have different ethical implications," says Matthew DeCamp,
co-author of the study. For example, DeCamp says, displaying the highest
possible price might more effectively lower costs, but could it cause
physicians not to order beneficial interventions? How do price displays
relate to patientsâ€™ concerns about out-of-pocket expenses?
"These and other ethical issues must be considered before the price displays
become widely implemented," says DeCamp. Both he and co-author Kevin
Riggs are practicing physicians in the Johns Hopkins Division of General
Internal Medicine and are affiliated with the universityâ€™s Berman Institute
The authors recommend these ethical considerations be taken into account
when deciding which price to display:
Transparency â€” "At the very least, reference to the source of the price
should be shown alongside the price display."
Informing Patients â€” "Protecting patient autonomy requires informing
patients that price displays are being used."
Protecting Well-Being â€” there must be protection against the "risk of
patients not receiving beneficial services."
Ensuring Fair Treatment â€” "Fairness mandates that price displays should not
systematically disadvantage certain patient groups," for example, uninsured
patients. "Displaying the same amount for all patients could help ensure
they are treated fairly."
"This is new territory, clinically and ethically, and we need more research
into how displays operate in practice," says Riggs. "Displaying prices to
physicians could help put resources to their best use, but to fully realize
that potential these ethical considerations must be kept in mind."
Visit JAMA for the study.
demonstrates hospitals value Group Purchasing Organizations
The vast majority of hospitals utilize Group Purchasing Organizations (GPOs)
to bend the healthcare cost curve and meet patient supply needs. This is
just one finding from a new survey conducted by Wharton School and sponsored
by the American Hospital Association (AHA) and the Association for
Healthcare Resource & Materials Management (AHRMM). The survey also finds
that while hospital's purchasing decisions are driven by clinical rather
than financial considerations, GPOs succeed in obtaining price discounts and
lower product prices for hospitals.
"This important report shows GPOs provide a valuable service for the
hospital field," said Rick Pollack, AHA Executive Vice President. "By
helping them manage supply costs, hospitals utilize GPOs as a very important
tool in their supply chain toolbox."
Highlights from the survey, conducted for AHA and AHRMM by The Wharton
School at the University of Pennsylvania, include:
Ninety percent of hospitals utilize national GPOs, with an average tenure of
11 years as members.
Hospitals route the majority of their product purchases (56%) through their
Eighty-eight percent of hospitals agree or strongly agree that their GPO
generates savings from lower prices.
"Our study shows that not only do GPOs provide cost savings, but they help
hospitals meet their need for physician preference items," said Lawton
Robert Burns, Ph.D., MBA, professor, The Wharton School and lead author. "In
addition, GPOs help hospitals purchase everything from commodity items to
pharmaceuticals to dietary items."
Visit AHRMM for a copy of the survey report.
occur every 8 minutes in U.S. children
A child receives the wrong medication or the wrong dosage every eight
minutes in the United States, according to a recent study released online on
Oct. 20 in the journal Pediatrics.
Nearly 700,000 children under 6 years old experienced an out-of-hospital
medication error between 2002 and 2012. Out of those episodes, one out of
four children was under a year old. As the age of children decreased, the
likelihood of an error increased, the study found.
Though 94 percent of the mistakes didn't require medical treatment, the
errors led to 25 deaths and about 1,900 critical care admissions, according
to the study.
"Even the most conscientious parents make errors," said lead author Dr.
Huiyun Xiang, director of the Center for Pediatric Trauma Research at
Nationwide Children's Hospital in Columbus, OH. That conscientiousness may
even lead to one of the most common errors: Just over a quarter of these
mistakes involved a child receiving the prescribed dosage twice.
"One caregiver may give a child a dose, and then a second caregiver, who
does not know that and wants to make sure the child gets the proper amount
of medicine, may give the child a dose, too," Xiang said. Other reasons for
errors included incorrectly measuring the dosage or overprescription of some
medications, he said.
Xiang and his colleagues analyzed all the medication errors reported to the
National Poison Data System for all children under 6 years old during the
Another common feature was that eight of every 10 errors involved liquid
"Young children are more likely to be given liquid medicine than medicine in
other forms, like tablets or capsules," he said, especially since many
prescription and over-the-counter children's medications are in liquid form.
"A second reason is that liquids can be difficult to measure correctly,"
Xiang said. "Some liquid medications are measured in milliliters, other in
teaspoons, some with measuring cups, some with syringes. That can be
confusing to parents and caregivers."
A different study -- from the August issue of Pediatrics -- found
that using teaspoons or tablespoons to administer children's medications was
behind many drug dosing errors. Instructions requiring teaspoons or
tablespoons made it twice as likely that parents or another caregiver would
incorrectly follow the doctor's prescription than if the instructions were
in milliliters, that study found. An error was even more likely if parents
used a kitchen spoon to measure out the dose, according to the earlier
In the current study, Xiang's team also found that errors involving cough
and cold medicines suddenly dropped by two-thirds from 2005 to 2012, a dive
likely linked to two events, Xiang said. In 2007, the U.S. Food and Drug
Administration announced that it was reviewing the safety of
over-the-counter cough and cold medicines for children and soon after,
manufacturers voluntarily withdrew those drugs from shelves for children
under 2 years old.
Shortly thereafter, the American Academy of Pediatrics said that cough and
cold medicines weren't effective in children under 6, and that those
medications might pose a health risk to young children.
While errors related to those medicines dropped, however, mistakes involving
other medications increased by 37 percent, though the study did not look at
"It may be associated with the increased use of analgesics and
antihistamines among young children," said Xiang.
Pain relievers and cough and cold medicines
each comprised about a quarter of all the errors identified, and
antihistamines made up 15 percent of the errors. Antibiotics made up about
12 percent. The medications causing the highest rate of hospitalization or
death included muscle relaxants, cardiovascular drugs and mental health
drugs, such as sedatives and antipsychotics. (HealthDay)
Visit NIH for the report.
As Ebola patients
vanish in Liberiaâ€™s health system, survivors go on a desperate search
MONROVIA, Liberia â€” Ebola ravaged this capital so quickly that some patients
passed through an already broken medical system with hardly any paper trail.
Others were admitted to one clinic and transferred to another without
notice. Hundreds were cremated long before their families were notified that
they had died.
The world has heard about the deaths. Ebola has claimed 2,500 lives in this
country, most of them in Monrovia. But the epidemic has also left in its
trail another form of grief and anguish for those whose friends and
relatives are missing. About 30 percent of Ebola victims survive. Thatâ€™s the
number many here obsess over â€” it is just high enough to offer hope and to
Their vigil is a reflection of a medical system so overwhelmed by the virus
that it has lost track of both the living and the dead. The United States
and other foreign donors are working with the Liberian government to improve
its system of medical records. Some clinics and hospitals have started
posting more accurate lists of the deceased on their front walls, where
families now gather, collapsing into tears as soon as the names appear. But
many are left without even a hint of their loved onesâ€™ whereabouts.
Relatives and friends spend hours each day outside the cityâ€™s four Ebola
clinics. Some come to pray. Many are not sure if theyâ€™re in the right place.
They wait for visiting hours, held in special partitioned spaces, even
though the loved ones they are looking for never show up. They check patient
lists, even though theyâ€™re almost always incomplete. They ask nurses for
help, even though the requests usually donâ€™t yield information.
Speaking with the families of the missing has become a second job for
hospital employees at Island Clinic â€” a product of their rare access to the
The streets are still crowded in Monrovia. The markets are still full of men
hawking bootleg DVDs, and women selling fruit and bags of rice. Almost
everywhere, music blasts from car radios. After sunset, joggers run along a
street near the beach.
The cityâ€™s four Ebola treatment centers are a world away. Each is fenced off
and tightly secured. When relatives arrive, theyâ€™re asked to wait outside
with other families. They watch men and women in full-coverage "moon suits"
through the fencing, sometimes shouting questions to them.
When survivors are released, looking disoriented and lethargic, the crowd
outside scans for the familiar face of a loved one. When families hear that
their relatives have died, the wailing is immediate and seems to come from
Visit the Washington Post for the story.
PDI Prevantics Device
Swab 3.15% Chlorhexidine Gluconate/70% alcohol solution receives FDA market
Clinical investigators recently released results from the first and only
randomized, cross-over, prospective, comparative effectiveness clinical
study evaluating the benefits of a 3.15% Chlorhexidine Gluconate (CHG) and
70% Isopropyl Alcohol over 70% Isopropyl Alcohol alone in disinfecting
needleless connectors. The study was funded by the US Centers for Disease
Control and Prevention (CDC) Epicenters Program and executed by Rush
University in Chicago, IL.
The findings align with CDC Guidelines which state: "Some studies have shown
that disinfection of the devices with chlorhexidine/alcohol solutions
appears to be most effective in reducing colonization."
The investigators determined that the CHG and alcohol scrub resulted in less
needleless connector contamination than an alcohol scrub at a five second
scrub time. Prevantics Device Swab from PDI, leading provider of infection
prevention solutions, is the only 3.15% Chlorhexidine Gluconate and 70%
Isopropyl Alcohol solution that has received market authorization from the
U.S. Food and Drug Administration (FDA) for disinfecting needleless access
sites prior to use.
"This study answers a previously unknown clinical question about the most
efficacious antiseptic for disinfection of needleless access sites and also
ideal prep times," said Hudson Garrett, PhD, Vice-President, Clinical
Affairs for PDI. "This study demonstrates the importance of targeted efforts
to reduce contamination on needleless access sites and ensure evidence-based
practices for disinfection of needleless access sites."
Visit PDI for the study.
hardball with rival drug chains
CVS Health Corp. is offering a prescription-drug plan that charges patients
more if they buy their medications at pharmacies that sell tobacco products,
a plan that could benefit the companyâ€™s own network of drugstores.
The plan, offered by CVSâ€™s pharmacy benefits unit Caremark, features
copayments that are up to $15 higher on prescriptions filled where tobacco
is sold. That could give people covered by such plans an incentive to buy
their medications at CVS, which stopped selling tobacco products last month.
Rival drugstore chains like Walgreen Co. and Rite-Aid Corp. have resisted
calls to stop selling tobacco themselves, saying it wouldnâ€™t have a
significant impact on smoking rates.
CVS spokeswoman Carolyn Castel said the company created the plan after being
approached by Caremark clients interested in creating a tobacco-free
pharmacy network. People covered by the new plan would be able to buy
medications at the lower copays at Target Corp., which doesnâ€™t sell tobacco,
as well as tobacco-free local or regional drugstores.
Still, the company is opening itself up to criticism that it is designing
coverage plans that give an advantage to its own pharmacies. David Balto, a
former policy director at the U.S. Federal Trade Commission who is now an
antitrust attorney, said the tobacco-free network could be problematic if it
effectively steers patients to CVS.
"Thereâ€™s no cost savings that comes about from limiting the network," Balto
said. "Itâ€™s really another effort to limit the ability of their rivals to
CVSâ€™s tobacco-free network is only in the early stages. The first employer
to sign on is the city of Philadelphia, where around 5,400 nonunion
employees will have to make an additional $15 copayment if they fill their
prescriptions at pharmacies that arenâ€™t part of what is called a preferred
"I look at it as a win-win," says James Startare, the cityâ€™s deputy
human-resources director, who says his department approached Caremark about
the idea. "I think it has long-term positive health impacts, because we want
to promote a tobacco-free workforce."
About 100 independent pharmacies and between 150 and 200 CVS stores will
participate in the Philadelphia network, Startare said.
Some independent pharmacies are crying foul.
"Itâ€™s an unfair competitive practice," said John Giampolo, who heads the
Independent Pharmacy Alliance, a trade group and buying cooperative that
represents 3,000 pharmacies in New York and three other states. "Consider a
local pharmacy that hasnâ€™t carried tobacco for years, but the consumer may
not know whether the pharmacy participates or not. So a consumer may go to a
CVS pharmacy to save the $15. An independent pharmacy may have to scramble
to do their own marketing."
The company says it will provide lists of qualifying pharmacies.
CVS has come under fire in the past for
practices that steered its pharmacy-benefits clients to its pharmacies.
CVSâ€™s $27 billion acquisition of Caremark in 2007 faced scrutiny from the
Federal Trade Commission over just such an issue, and a subsequent
investigation was launched in 2009 as well. The FTC concluded its review in
2012 without taking any action on whether CVS was being anti-competitive.
Visit the Wall Street Journal for the story.
Reminder: HPN to
salute Supply Chain Operations Worth Watching
For the 4th consecutive year, Healthcare Purchasing News is
recognizing and saluting healthcare Supply Chain Operations Worth Watching.
These involve teams of professionals who seem to go beyond the call of duty
to make a difference and succeed as tangible examples for others to follow.
What makes a supply chain op worth watching? What theyâ€™re doing and why they
matter in the areas of cost-cutting, efficiency-driven, clinically motivated
and patient-centric concepts, ideas, activities and outcomes. While these
categories may seem rather cut-and-dry statistically, we use anecdotal,
unscientific and completely subjective methods to choose organizations,
motivated by self-reported innovative thinking and work.
Hereâ€™s where we need your help. Within your organization, just tell us whoâ€™s
doing top-notch, innovative work. Weâ€™d like your help in suggesting,
justifying and validating these organizations. Mini-profiles of these
leading organizations will appear in HPNâ€™s December 2014 edition.
HPN has profiled 30 to date, so who in your organization should join
this august and elite group? You wonâ€™t know unless you nominate a facility
by answering the following two questions.
1. What/who are the top 3-5 hospital and/or IDN supply chain organizations
youâ€™d recommend for consideration? Please list the organization name,
location, contact person and contact information.
2. For each of the recommendations above, please highlight in a few bullet
points and/or sentences why you believe this organizationâ€™s supply chain
operation is one to watch and perhaps emulate?
Weâ€™re going to collect the recommendations and evaluate them based on their
"nominations." Please note that you or your organization will not be
identified as nominating the organization, but if a number of your
organizations make the list youâ€™ll certainly earn some bragging rights.
E-mail us your nominations by Friday, October