Beth's Everything Blog

Archive for the ‘Health Care’ Category

Hang on to your hats, folks. The legal fight of the century is about to begin.

As early as March of next year, the Supreme Court will hear arguments as to the legality of the part of the Affordable Care Act which requires all individuals to buy health insurance.  Congress voted for the law. Three state courts have already upheld it but on August 12, 2011, a three-judge panel of the 11th Circuit Court of Appeal in Atlanta struck down the individual insurance mandate which requires everyone to buy health insurance, as beyond Congress’ constitutional authority under the Commerce Clause of the U.S. Constitution.

This is what Article 1, Section 8, Clause 3 of the constitution says: The Congress shall have Power To regulate Commerce with foreign Nations, and among the several States, and with the Indian tribes.

Section 1501 of the Health Bill requires that “all U.S. citizens, with certain exceptions, maintain a minimum level of health insurance coverage for each month beginning in 2014. The failure to comply with Section 1501, results in a penalty reflected in the person’s annual federal tax return.”

While the 11th. Circuit Court voted against this one requirement, it upheld the rest of the health care law which includes one million more young Americans having health insurance, inability of insurance companies to turn away people with  pre-existing conditions or charging them more, and Medicaid expansion which will include health care for 16 million more people.

Here’s what the administration says: 1. The act not only requires everyone to buy health insurance but that insurance companies must make it affordable to everyone even if they have a pre-existing condition. 2.The law is clearly and absolutely constitutional.

The opposition argues: 1.That congress has usurped the power of the states. 2. That congress lacks the power to compel people to buy health insurance. 3. That the law is unconstitutional.

The Court has set aside an unprecedented 5 1/2 hours to hear arguments and here’s why. There are other issues they will be asked to decide: Whether the entire law must fail because its centerpiece — the individual mandate — is unconstitutional. Whether states can be forced by the federal government to expand their share of Medicaid costs and administration, with the risk of losing that funding if they refuse. Whether state employees can receive a federally mandated level of health insurance coverage.

The Health-Care Law is unquestionably President Obama’s signature legislative achievement.

On the other hand, the decision of the nine, appointed for life justices, could define Chief Justice John Robert’s court.

The overriding question is, who really runs the country, Congress or The Supreme Court?

My friend Valerie, a thirty five year old doctor, called with wonderful news. She was pregnant. She and her husband Joe, also a doctor, had been trying for a while with discouraging results. Then suddenly, a baby was on the way. Friends at the hospital rejoiced when they heard the news.

Some doctors volunteered to take Val’s ‘on call’ nights during those first few wobbly weeks when she didn’t feel so good. But then, as she neared the end of her third month, things got better. Her appetite returned and she happily pointed to her ‘baby bump.’

The hospital where we worked had a new ultrasound machine. Four months into her pregnancy, Valerie and Joe decided to check up on their little one. The results were devastating. The baby, a girl, was anencephalic meaning none of the baby’s brain had formed above the brainstem. If carried to term, the baby would die within minutes or at best days after its birth. She would never be able to see, hear, feel or think.

Joe wanted Valerie to honor the religious sanctity of life from conception to birth and carry the baby to term but Valerie, though grief-stricken, decided to terminate the pregnancy immediately. “My body, my decision,” she told him. And that’s the crux of the matter; religious dogma as opposed to a woman’s right to choose.

Avowed pro-life freshman Governor Sam Brownback urged new legislators to “create a culture of life” in the state of Kansas. Duly elected officials are doing just that by passing legislation that would ban abortion after the 21st week of life because of the scientifically unsubstantiated claim that a fetus can feel pain.

Though Planned Parenthood provides abortions, they account for only 3 percent of women’s services. On July 1st, Kansas will prohibit funding for Planned Parenthood, which, if found legal, will deny women all other Planned Parenthood services such as cancer screening, contraception, tests and treatment for sexually transmitted diseases, urinary track tests and counseling.

Another Kansas law beginning on July1st  “prohibits insurance companies from offering coverage of abortions as part of their general health plans, except when a woman’s life is at risk,” and  “individuals and employers who want abortion coverage would have to buy supplemental policies that cover only abortion.”

Though extremely controversial with constant barriers being thrown in the way, abortion is still legal in every state of the union and every woman’s right to choose is protected, at least through the first trimester.

Valerie and Joe still wanted a big family but because of Val’s age, decided not to try again. Instead, they adopted a family of five brothers and sisters, ages one to fifteen, a monumental task but one they are doing with great quantities of love and enthusiasm. All are doing well. Religion plays an important part in their lives and they are regular church goers.

Yet they believe, as do I and the majority of Americans, that the matter of abortion is a personal decision and should be kept out of the political arena.

The range of attachment reaches from the securely attached child to the child who does not connect with others at all.  The good news is that children are very resilient so they may display only the more subtle signs of strained attachment issues.  Here are the four most observed signs of troubled attachment.

1.  Excessive anxiety, does not self-calm well by themselves

2.  Sleep disturbances, night terrors, fear of sleeping alone

3.  Picking at scabs and sores, picking nose, plucking eyelashes

4.  Difficulty with transitions and changes

Some children who join a family through domestic, international or foster care adoption have difficulty attaching to their new family. Research shows that a majority of children experience some attachment strain.  The more times a child’s primary caregiver changes, the more difficult bonding and attachment can be. If your child has experienced this trauma, this article is for you.

(In this article we use ‘she’ when referring to the child but you know we mean either ‘he’ or ‘she’.)

A child that has been in foster care or is adopted after the first few weeks of life can go through many significant changes during their first  vital months of life (birth to eighteen months) when the ability to learn, speak, think and control their emotions are just beginning to develop.  The physical connection between a baby and another human being is truly life sustaining for the child.  Is it any wonder then that their cognitive, social and emotional development is affected?

Subtle signs are good reminders that children have some attachment issues that we must address in a loving and responsive manner.  Attachment is a function of reciprocal and responsive communication between the parents and the child.  It is vital that the parents recognize and work toward an attuned connection.

Super Nanny teaches “time out” or the naughty chair for misbehaving children. This practice is dangerous for children with poor attachment histories.  Scoop up your child and keep him with you. Draw, color, sing, talk, or just sit and watch television until the storm has passed.  Help her calm down.  Don’t expect her to know how and don’t leave her to “cry it out” alone.  Children with attachment issues have not learned how to calm down because no one was there to teach them in the early months of their lives.

Take every opportunity to baby your overly independent one.  When she has fallen and scraped an elbow or knee, shower her with care, hugs and kisses.  When she’s not feeling well, go overboard with care. Check her forehead. Feed her soup and crackers. Take this time to cuddle with her as much as possible.  Children respond better to love and nurturing at this vulnerable time and you’ll find that it carries over to healthier moments.

If it has been determined that your child has bonding or attachment issues, help is available.

Contact LYNN B. BARNETT
MidAmerica Family Treatment Center
913-626-1018
maftc.kc@gmail.com

I was there the day the neurologist accidentally killed his patient.  It was during my hospital training as an  x-ray technologist. The patient had been admitted complaining of migraine headaches.  As part of her workup, the doctor performed  a carotid arteriogram, an injection of contrast material followed by a rapid series of x-rays taken to visualize the brain.

In preparation for the exam, a tray had been set up with the equipment the doctor would need; sterile gloves, hemostats, gauze pads, a syringe, and containers holding the dye and some green tinged alcohol used to clean the sight of injection.  I had positioned two rapid fire film changers holding multiple x-ray films, one under and one to the side of the patient’s head. The patient lay flat on her back, her head held by a radiolucent sponge and thrust back so that the doctor had easy access to the arteries in her neck.  (Today, a catheter is threaded into position through an artery in the groin but in those days, the injection was made directly into an artery in the neck.)

The doctor wore a lead apron to protect himself from the scatter of the x-ray exposures and my teacher and I stood behind a lead glass window. I held the trigger in my hand, ready to press the button that would expose the films. The doctor, his back to us, spoke to the patient as he prepared her for the injections.  My eyes flicked to  the exposure settings of the x-ray machine to be sure they were correct. As he made the injection, the doctor yelled SHOOT and I pressed the button. Hearing  the reassuring clangs made by the multiple exposure machines, he quickly stepped back and laid the syringe on the tray.

Almost immediately, we knew something had gone terribly wrong. Instead of lying motionless on the table, the patient  began to seize. The doctor ran to her side and tried to hold her down. We rushed to help keep her from falling off the table. And then . . . her body went limp. Her breathing stopped. Her eyes rolled back in her head. She was gone.

Shocked and confused, the doctor stared from the motionless body on the table to us. “Jesus! he cried. “What happened?”

Aghast, we searched the room for a cause. Our eyes came to rest on the syringe lying on the tray, a drop of green tinged fluid seeping out of the tip of the needle. As realization dawned, the doctor made a choking noise and  staggered against the table. “Oh my God. ” Shoulders slumping, he took off his gloves and struggled out of his protective lead apron. “I must speak with her husband,” he murmured.

Dazed, I asked my instructor, “What do we do now?”

“Nothing. I’ll take care of this. You go to lunch, and . . . ” she added. . . “don’t say anything.”

As time went by, I heard or witnessed other incidents, some of which caused the death of the patient. Surgical instruments or sponges left inside patients happened so frequently that one surgeon demanded his patient be x-rayed before being taken to the recovery room.  Miscommunication between patient, physicians and hospital personnel  occurred all the time.

In 2000 the Committee on Quality of Health Care in America reported “that between 45,000 and 98,000 Americans die each year as the result of medical errors. If the lower figure is used as an estimate, deaths in hospitals resulting from medical errors are the eighth leading cause of mortality in the United States, surpassing deaths attributable to motor vehicle accidents (43,458), breast cancer (42,297), and AIDS (16,516). Moreover, these figures refer only to hospitalized patients. . . ” These figures were published by the Institute of Medicine.

After the report came out, hospitals took a much more serious approach to error prevention. For years, hospitals had been paying large fees to gain accreditation by The Joint Commission, one of several privately funded organizations whose goal is to monitor and continually improve the health care provided by hospitals and their personnel.  Those organizations have ramped up efforts to decrease medical mistakes.

Computers have helped prevent some communication problems but mistakes still occur and now we face a serious shortage of trained hospital personnel resulting in an often overworked staff with its incumbent fatigue-driven results. Yet, the simple practice of hand cleanliness has substantially reduced infection.

However, lest we get too complacent, like it or not there is still a ‘wall of silence” that surrounds hospitals. Fear of lawsuits prevents some doctors from admitting negligence. The neurologist of whom I spoke told the patient’s family the woman had suffered a stroke and died before anything could be done to save her. Medical staff members said nothing , perhaps out of loyalty, fear of job loss or reprisal. Blame played a part and reputations were at stake.

This too may be changing. Reporting has been made easier and in some cases, can be done anonymously. Cause of errors becomes a reason for protective procedural changes with better safety measures the goal.

I am still haunted by my decision to say nothing that day long ago. At times, my family and I need the services of a hospital and my hope is that change comes fast enough to protect us all.

Why do the numbers of abused and neglected children continue to grow?

What happens to our little unwanted?

According to the child abuse hotline (1-800-4-a-child), over 5 million reports of child abuse are received in the United States each year, or one report every 10 seconds of every day.

More than half (61 percent) of the children (771,700 children) were victims of neglect, meaning a parent or guardian failed to provide for the child’s basic needs. Forms of neglect include educational neglect (360,500 children), physical neglect (295,300 children), emotional neglect (193,400) and vastly under reported medical needs neglect.

Another 44 percent were victims of abuse (553,300 children), including physical abuse (325,000 children), sexual abuse (135,000 children), and emotional abuse (148,500 children).

More than 160 children under the age of 4 die each month as a result of child abuse.

It is estimated however, that between 60-85% of child fatalities that are due to maltreatment are not recorded as such on death certificates.

Poverty can be a driving force that requires more than 500,000 foster care placements a year. Bear in mind, the children, half of whom are female, have no doubt already suffered significant trauma because of physical abuse, neglect, sexual abuse, abandonment, medical neglect, caretaker incarceration or death.

Some of those in foster care are reunited with their parent, some adopted. Most receive more than one placement and some eventually age out of the system. In Texas, that’s called the cradle to prison pipeline.

CHILDHELP prevention and treatment of child abuse writes that about 30% of abused and neglected children will later abuse their own children, continuing the horrible cycle of abuse. According to the Guttmacher report, they are more likely than the population as a whole to have unintended pregnancies, continuing the epidemic of child abuse. Abused children are 25% more likely to experience teen pregnancy.

Add the stress of the times, loss of homes, jobs and income, is it any wonder that the annual cost of child abuse and neglect in the United States exceeds 1 billion dollars a year.

In a study done in 2004, The Minnesota Department of Health found that women whose pregnancies are unintended are more likely to have infants who are low birth weight and are less likely to breastfeed. Their infants are more likely to be abused and more likely to die in their first year. They are more likely to be raised by one parent, and these children are more likely to become teen parents themselves.

Further, about half of all unintended pregnancies end in abortion.

One has to wonder if that isn’t best for the unwanted and the unintended.