Category: Blog

NYC Ban on Soda Won’t Happen After All

Justice Milton Tingling struck down Mayor Bloomberg’s ban on large soda drinks, calling it “arbitrary and capricious”.

The ban was an attempt to improve the health of NYC citizens, after seeing obesity rates rise from 18% of adults in 2002 to 24%. The ban was championed by Bloomberg and approved by the Board of Health in September, 2012. Justice Tingling wrote that the power to create the ban belonged to the elected City Council, and not the Board of Health appointed by the mayor.

According to city Health Commissioner Dr. Thomas Farley, obesity-related illnesses cost the city about $2.8 billion a year.

Businesses faced costs associated with the change that they would not be compensated for – reprinting menus, changing bottles and labels, and movie theaters in particular were concerned about losing soda sales that account for 20% of their profits.

Breast Pumps For All, But Not Necessarily The Best

The ACA requires insurance companies to provide new mothers with breast pumps and other equipment that is necessary to help them breast feed.

Unfortunately, the law doesn’t specify the type or quality of the breast pumps to be provided, so the companies (with doctors’ recommendations) get to decide. This issue leads to whether a company will provide a manual or an electric pump.

The benefits of an electric pump over a manual pump are several: they’re high-powered and can simulate a nursing child, while manual pumps can be weak, clumsy, and cumbersome for a working mother to use. They take more time to pump than an electrical pump.

The costs are also considerably different, when a high-end electric pump coming in at around $300, and a manual pump costing as little as $35.

Surprise Benefit of Obamacare: Less Spending

On March 7th, Kathleen Sebelius of Health and Human Services announced that there has been a slowdown in medical spending since the implementation of the Affordable Care Act.

Obamacare, Sebelius said, is due the credit for increased efficiency and slowed medical spending growth.

“The health care law’s push for coordinated care and paying for quality rather than quantity is putting downward pressure on medical costs, the article reports,” Sebelius wrote in a blog post. “It’s improving the way health care providers do business, and that’s good news for patients.”

Sebelius cited a USA Today study that found the ACA’s cost-control measures are working.

Competing Nurse Ratio Laws Face Off in D.C.

[caption id="" align="alignleft" width="200"]nursing law Nursing Students Prepare for Care Services, Courtesy: Vlastimil[/caption]

Federal, state, and local governments regulate many aspects of health care. However, it is physicians, nurses, and other health professionals that provide care directly to patients.  The ever growing demands of an aging population have led to overfilled hospitals, struggling to avoid turning away patients, with some nurses caring for five or more patients at any given time.  As a result, there has been considerable debate over the past few years as to whether or not such a workload can be detrimental to patients.

This debate has recently been renewed by the Council of the District of Columbia.  The “Patient Protection Act of 2013” (Leg. No. B20-0101), presented by Council Chairman Phil Mendelson and cosponsored by eight other Council Members,[i] sets strict nurse-to-patient limits depending on the type of hospital setting in which a patient is treated.  For example, an operating nurse would only be permitted to care for one patient at any given time, while a non-trauma emergency department nurse or a medical/surgical nurse could only cover a maximum of four patients.

This proposed legislation is based on a similar framework created by the California state government in 1999 and put into force in 2005.  That system has been touted as a “landmark” law by National Nurses United (NNU), a nursing union.  While NNU points to California as glowing proof for the need for state-mandated limits on nurse staffing ratios, the evidence is not so clear.

A California HealthCare Federation study of various nurse-sensitive indicators in California hospitals suggests that despite significantly increased costs, there is little positive effect on patient care.  The study found that between 1999 (when the legislation was passed) and 2006, the rates of pneumonia death and failure to rescue steadily declined, yet the rates of post operative sepsis, deep vein thrombosis, and pressure ulcers increased.  The study concluded that most of the indicators they measured “do not appear to have been directly affected by the increase in RN staffing.[ii]  On the contrary, the authors found that some hospital staff members reported experiencing difficulties in meeting both staffing requirements and requirements that nurses take mandatory breaks during the day,  that emergency department wait times had increased, and that in some rare cases ambulances were being diverted to other hospitals in an effort not to break the ratio requirements.

The American Nursing Association (ANA) lists California as the only state to require minimum nursing ratios for all nursing units at all times.  Instead, most of the states listed have laws requiring individual hospitals to have committees, comprised of nurses and administrators, that set ratios based on the specific needs of the patients on that unit.  These laws let the health care professionals decide what is appropriate for the patients under their care.  Notably, the California law cited by the NNU only required that the California Department of Public Health establish and enforce ratios, but the law itself did not take on the task of mandating specific ratios, as the D.C. proposed legislation does.

The ANA supports a model where the nurses themselves are involved in creating unit-specific staffing plans.  This model is similar to competing D.C. legislation put forth by Council Member Mary M. Cheh, representing D.C.’s Ward 3.  The “Nurse Safe Staffing Act of 2013” (Leg. No. B20-011) calls for each hospital in Washington D.C. to create a committee comprised of at least 55% direct-care registered nurses, with at least one patient care nurse from each unit,[iii] which will be tasked with setting hospital-wide nurse-to-patient ratios.  The ratios set by the committee must “[b]e based upon input from the registered nurse staff of the hospital who provide direct patient care or their exclusive representatives,”[iv] standing in stark contrast to the Mendelson bill, which puts the job of determining what is best for patients solely in the hands of politicians.[v]

Given that the ANA and the D.C. Hospitals Association reject such strong requirements, the loudest voice in support of the proposed legislation is the NNU nursing union.   Their Uniform National Professional Standards largely match the proposed Mendelson bill.  However, certain provisions buried in the legislation may point to an additional goal.  Despite the stated goal of patient protection, section 6(h)(4) of the Mendelson bill states that a “hospital (or an individual representing [a hospital]) shall not in any way interfere with the rights of nurses to organize, bargain collectively, and engage in concerted activity under section 7 of the National Labor Relations Act.”[vi]  (Emphasis added).

The D.C. Council should strongly consider the difference between the Mendelson and Cheh bills.  The Mendelson bill calls for local politicians to determine how many patients a nurse can care for, based only on the general nature of a hospital unit.  The Cheh bill puts that decision in the hands of the very healthcare professionals who provide direct hands-on patient care.  The nurses working in a hospital unit, caring for patients 24 hours a day, 7 days a week, 365 days a year, are in a far better position to decide on staffing levels than politicians.  In an era of personalized medicine, local politicians should not use the broad brush of legislation to make generalized decisions in place of nurses and healthcare administrators.

[i] This bill was introduced by Council Members Mendelson, Barry (Ward 8), Evans (Ward 2), Grosso (At-Large), Orange (At-Large), Alexander (Ward 7), Bonds (At-Large), Graham (Ward 1), and McDuffie (Ward 5), and it was co-sponsored by Council Member Wells (Ward 6).

[ii] Joanne Spetz, et al., Assessing the Impact of California’s Nurse Staffing Ratios on Hospitals and Patient Care, California HealthCare Foundation at *7 (Feb. 2009).

[iii] Nurse Safe Staffing Act of 2013 § 3(c)(1)(a-d).

[iv] Nurse Safe Staffing Act of 2013 § 3(d)(1).

[v] The Mendelson bill does require each hospital unit to create a committee to review staffing measures. However, the committee is only permitted to impose restrictions which are more stringent than those laid out by law.  Patient Protection Act of 2013 § 4(b)(1).  For example a medical/surgical unit committee could decide that the mandated 4 patients to 1 nurse is not sufficient, and the committee could then set the ratio to 3 patients to 1 nurse, but it could not change it to 5 patients to 1 nurse.

[vi] Patient Protection Act of 2013 § 6(h)(4).

Colorado Suffers From Huge Health Gap

In Colorado, a Latino baby is 63% more likely to die in the first year of life than a white baby.

The mortality rate for black babies is more than 3 times the rate of white babies. The mortality rate for white babies in Colorado is lower than the national average, and yet the mortality rates for Latino and black babies is higher than the national average.

Not only that, but while the mortality rates for white babies improves, the rates for minority babies worsens.

Black adults are more likely to suffer from asthma, diabetes, high blood pressure, prostate cancer and obesity in Colorado. Latino adults are more likely to die from the flu or pneumonia.

Infant mortality – the tragic occurrence when a baby dies within its first year of life – is often use an indicator of a nation’s overall health. It’s also used to distinguish between developed and developing countries.

Not only does access to healthcare affect these differences, but many social determinants are in play. Poverty, education, the food one eats, whether one wears a seatbelt, exercise. The list covers many and most aspects of life. The biggest in play seems to be poverty, especially when combined with race or ethnicity. A study conducted by Boston Children’s Hospital found that black and Latino children reported significantly lower levels of physical activity, and were much less likely than white children to wear seat belts or bike helmets.

One way to improve life expectancy is to educate those who have a harder time gaining access to information, traditionally the poor. The Center for African American Health in Denver offers courses in diabetes management and screenings for various types of cancer. However, health is also determined by individual choices and there are those who refuse information when offered. Debates exist on the level of compulsion governments can induce with regards to personal health decisions. In general, the ideal is to strike a balance between being overly coercive and letting people die. So instead of outlawing cigarettes, for example, smoking in restaurants is outlawed.

The people of Colorado are currently trying to address these issues, many through non-profit and non-governmental organizations. Organizations like the Center for African American Health have been cropping up, to mild success.

Connecticut To Improve Mental Health Support in Public Schools

Since the Newtown shooting, the national discourse on mental health and treatment has been at the forefront of political interest. Connecticut is currently reviewing a chance to improve mental health policies in public schools.

While President Obama is developing a plan to provide $15 million for training school teachers and officials to recognize and deal with students with mental health issues, Connecticut is looking towards supplementing that plan with more social workers in schools.

Senator Beth Bye points out, “We need people in the schools to be more aware of kids who are dealing with social and emotional issues. Early intervention does make a difference.”

Connecticut does not currently allow involuntary outpatient treatment, but change is in the air. It is only one of six states that prohibits this type of treatment.

Some advocates are concerned that improvement to the mental health industry is coming on the heels of a violent tragedy. Those with mental illness are more likely to be victims of violent crimes, they warn, more than they are likely to be the perpetrators. Conflating mental health with violence does more harm than good, to the detriment of all.

As Victoria Veltri, the state’s healthcare advocate, says, “The system needs a lot of work but it’s not because of what happened on Dec. 14… People may be unintentionally equating gun violence with having a mental health diagnosis. Gun violence is its own public health crisis.”