The Ultimate Prescription for Dealing With Medical Debt

So you went to the ER or underwent an expensive medical procedure. Now the bill is here, and you’re worried that the shock is going to send you back to the hospital — and further into debt.

Your health is your most valuable asset. Yet there’s something so frustrating about going into debt over it. You didn’t decide to splurge on a hospital stay or a costly battery of tests just because.

Add in the maze of medical jargon and coding, health insurance and hospital billing departments, and medical debt can be downright maddening.

It’s probably of little comfort, but if you can’t afford to pay your medical bills, you have plenty of company.

About 3 in 10 people reported that they or someone in their household had trouble paying a medical bill in the past year, according to a 2017 Kaiser Family Foundation poll of 1,160 Americans over age 18. That same poll also found that 45% of people reported they would struggle to pay a surprise $ 500 medical bill.

Consider that the average patient with health insurance will pay more than $ 1,000 out of pocket for a hospital stay, and it’s easy to see how medical bills can quickly become a burden.

But there is hope. You have options for reducing or eliminating medical debt that don’t involve being hounded by debt collectors or filing for bankruptcy.

How Medical Debt Really Affects Your Finances

Before we talk about how to tackle your medical bills, let’s talk about how medical debt works.

Unlike your mortgage lender or credit card company, your doctor or hospital almost certainly doesn’t regularly report your medical payments to the three major credit bureaus. That means that unless your medical debt becomes delinquent, it will not affect your credit score.

Left unpaid, a medical bill will probably end up in collections, just as any other unpaid bill would. That’s when the credit bureaus will be notified.

Even then, medical debt collection works a little differently from other types of debt collection.

Regardless of when the debt was incurred, debt collectors must wait 180 days to report a delinquent medical bill to the credit bureaus, giving you extra time to work out an agreement with your provider or insurance company.

If the collections account is reported to the bureaus, expect your credit score to plummet. The exact impact depends on your credit situation, but even someone with a good credit score could see a drop of as much as 50 to 100 points, though the effect will lessen over time.

The good news is, FICO 9 scoring model weighs medical debt in collections less heavily than past models. The bad news: Most creditors are still using FICO 8.

Like other derogatory marks, an unpaid medical bill stays on your credit report for seven years, though if your insurance company pays the bill, the credit bureaus have to remove the debt from your file.

You could also be sued for what you owe. If a creditor gets a judgment against you, it could result in your wages being garnished or your assets being taken through a court-ordered bank levy.

The statute of limitations for unpaid medical bills varies by state. Typically, it’s between three and six years after the bill was reported as delinquent, though in some states, it’s as long as 15 years. If the statute of limitations has passed on a medical bill, a creditor can’t sue you over the debt, though they still might keep bugging you to pay up.

7 Ways to Deal With Medical Debt You Can’t Afford

Closeup of a senior man at an MRI scanning clinic waiting to be examined

When you can’t afford to pay a medical bill, the single worst thing you can do is ignore it. You have a lot of power to negotiate your bill, and medical providers are often willing to work with you.

Trust us: A hospital or doctor’s office will almost always be easier to work with than a debt collection agency. And when you’re dealing with medical debt — or any kind of debt you can’t afford — it’s in your best interest to take action right away.

If you need medical debt relief, try these seven steps. Note that these are all steps to take before your bill has been sent to collections. If your bill has already been sent to collections, don’t just silence your phone. Follow these tips for dealing with debt collectors.

1. Check Your Medical Bill for Errors

As many as 80% of hospital bills have errors, so the first thing you should do when you receive a bill is scrutinize it for mistakes.

Ask the hospital or medical provider for an itemized billing statement, which will include the charges for all medications, tests, procedures and other services.

If you have health insurance, ask your insurer for an explanation of benefits (EOB). This statement will tell you what services you were billed for, how much your insurance was billed, how much your insurance did or didn’t pay, and the amount you still owe.

Some inaccuracies will be tough to spot if you’re not a medical coding expert, but here are some common errors that could be easier for a layperson to catch:

  • Duplicate billing, i.e., when you’re billed more than once for the same service. This is one of the most common billing errors.
  • Incorrect patient information: If your name is misspelled, or your insurance information or Social Security number is incorrect, your insurance company could deny your claim.
  • Charges for canceled tests or procedures
  • Inaccurate medication quantities

If you don’t understand a charge or believe that your bill has incorrect information, call the hospital billing department or doctor’s office. Be sure to document every conversation.

2. Review Your Insurance Policy

If you have health insurance, read up on all that stuff that made your eyes glaze over during open enrollment — your copays, deductibles, out-of-pocket maximums and whether your providers are considered in-network vs. out-of-network.

Make sure your bill and explanation of benefits match up with what your policy says it covers.

If you think a service should have been covered under your health plan, call your insurance company. You may find that your claim was denied due to an error — say, a procedure that your doctor incorrectly coded — that can be easily corrected.

But sometimes, claims are denied for more complicated reasons. For example, your insurance company may say a treatment is experimental or not medically necessary. In these cases, you have the right to appeal your insurance company’s decision. You can ask for an internal review by your insurer, but the Affordable Care Act also allows you to request an external review by an independent third party. Just be sure to ask your insurance company about any deadlines.

Pro Tip

If you’re appealing your insurance company’s decision, be sure to let your health care provider know to avoid having your bill sent to collections.

3. Negotiate to Pay Less

If you can’t afford to pay your bill, the best thing you can do is be honest about it. Call the hospital billing department or your doctor’s office and tell them about your financial situation. Be ready to provide documentation verifying your status.

Your provider is more likely to negotiate in hopes of getting something, rather than nothing, if they know you don’t have the means to pay the bill in full.

If you can afford to pay at least part of the bill in cash, you’re in an especially good position to negotiate. Try starting small by offering to settle the bill for 25% or 30% of the total in cash.

Pro Tip

Even if you can afford to pay the whole bill, ask if there’s a prompt pay discount. Some providers will give you a discount of as much as 30% when you pay upfront.

If you don’t have health insurance or were billed for out-of-network services, research what an insurance company would have paid for the services you received. Use a website such as Healthcare Bluebook, which estimates what insurers pay for treatments, and offer to pay the discounted price an insurance company would pay.

Regardless of your tactic, don’t expect to negotiate a major discount with a single phone call. Expect to hear “no” a lot. Don’t accept it. Keep asking for the supervisor of the person you’re speaking to and explaining your situation. Document every conversation. If you do agree on a reduced amount, be sure to get it in writing.

4. Ask About Financial Assistance Programs

When you think your medical bill is accurate but you still can’t afford it, call the hospital billing department or provider’s office to let them know.

Hospitals often have financial assistance and charity programs available for people who can’t afford to pay. You’re likely to qualify if you’re on a low income or don’t have a job, are uninsured or still owe a significant amount beyond what your insurance covers.

Some hospitals will require you to first apply for Medicaid, which will cover up to three months of expenses retroactively if you qualify, and then allow you to apply for financial help if you’re rejected.

5. Ask for a Payment Plan

If you can’t negotiate your bill down to an affordable number and you don’t qualify for financial assistance, many hospitals and providers will still allow you to pay your bill in monthly installments. The good news is, this option is often interest-free.

Just be realistic about what you can afford each month, and as with any agreement, be sure to get it in writing.

6. Work With a Medical Bill Advocate

If you’re dealing with an especially large or complex bill, it may be worth consulting with a medical bill advocate who can negotiate for you and possibly find billing errors you wouldn’t be able to spot on your own.

Medical bill advocates typically charge either by the hour (expect to pay $ 100 per hour or more) or a percentage of the amount they’re able to get reduced from the bill (25% to 35% is the norm). If you’re experiencing hardship, you may be able to get free or low-cost services through a nonprofit advocacy organization.

The Alliance of Claims Assistance Professionals and Medical Billing Advocates of America are two good resources for finding an advocate.

7. Consider Bankruptcy, but Only if You’re out of Options

There’s no such thing as “medical bankruptcy,” but if you’re overwhelmed by medical bills, filing bankruptcy might be your only option.

Unlike your student loan or tax debt, medical debt can be discharged in bankruptcy. Individuals and couples have two options: Chapter 7 bankruptcy, aka “liquidation bankruptcy,” which is for those who don’t have the means to repay their debt; or Chapter 13 bankruptcy, aka “wage-earner bankruptcy,” for those whose income makes them ineligible for Chapter 7.

Bankruptcy will kill your credit score, so be sure you’ve considered all your options before filing. Chapter 7 bankruptcy stays on your credit report for 10 years, while Chapter 13 sticks around for seven years.

Pro Tip

Keep in mind that bankruptcy won’t protect you from future debts, so if you’re anticipating significant medical bills in the near future, you might want to hold off on filing.

Medical Debt Relief: 4 Mistakes to Avoid

Pharmacist taking a credit card payment from a female customer in a pharmacy

Being proactive is key to getting medical debt relief. That said, some solutions sound good but are either unreliable or could make your financial situation even shakier. Here are four things to avoid if possible.

1. Paying Your Bill With a Credit Card

Medical bills typically don’t accrue interest, while credit card interest rates are currently north of 17%. That means you’ll save money on interest by negotiating a payment plan directly with the hospital or doctor’s office.

Even if you have a credit card with a zero-interest introductory period, it’s way better to work out a payment plan. You won’t increase your credit-utilization ratio, which you want to keep low to have a healthy FICO score. Plus, your provider is way more likely to be flexible about adjusting your payment plans or late payments than your credit card company.

2. … Especially a Medical Credit Card

If you can’t afford a medical bill, your doctor’s office or hospital might suggest applying for a medical credit card that typically comes with what’s advertised as an interest-free period. Once that’s up, though, you’ll often pay more in interest than you would with a regular credit card.

But what makes medical credit cards really scary is that “interest-free period” is actually deferred interest. With a deferred-interest card, if you don’t pay your bill in full by the end of the introductory period, you’ll owe interest on the entire amount you charged. Seriously. So if you charge $ 3,000 and have a $ 500 balance at the end of the so-called interest-free period, you’ll owe interest on the entire $ 3,000.

3. Consolidating Your Medical Bills

If you have multiple medical bills, it can be tempting to consolidate them with a loan so you’re making a single payment. But remember: Medical debt usually isn’t accruing interest. So with medical debt consolidation, you’re likely to pay more in the long term.

4. Taking Money From Your Retirement Plan

You may be able to avoid the 10% penalty you’d normally pay on an early 401(k) or IRA withdrawal if you can prove medical hardship. But your 401(k) is protected from creditors in bankruptcy, as is up to $ 1,283,025 in your IRA, so avoid tapping into these funds if possible.

Plus, when you withdraw from retirement savings, you’re borrowing against your future. If you’re 35, withdrawing $ 20,000 from a Roth IRA to pay a hospital bill could amount to nearly $ 115,000 in lost savings by the time you’re 65, assuming average annual returns of 6%.

Pro Tip

Don’t count on crowdfunding to make your medical debt disappear. A 2017 review of 200 GoFundMe campaigns for health care expenses found that 90% of them did not reach their goal.

How to Avoid Medical Debt in the Future

This advice isn’t helpful when you’re already facing medical bills you can’t pay, but the best way to avoid medical debt is to plan ahead before you get treatment.

If you’re planning to get medical care, be sure to verify that your doctor is in your insurer’s network and that your insurer covers the procedure. Ask upfront about projected costs, and then comparison shop.

Also ask your doctor about cheaper generic alternatives to pricy name-brand drugs. If you have health coverage, your insurance company’s drug formulary is a great resource for figuring out what your plan covers.

When possible, avoid the ER and get treatment from your primary care doctor. If you can’t afford to go to the doctor, try these alternative ways to get treatment.

But when it comes to medical bills, the most important thing to remember is this: Don’t put off treatment because you’re worried about the bill. You’ll pay more money in the long term, and it could cost you your most valuable asset: your health.

Robin Hartill is a senior editor at The Penny Hoarder.

This was originally published on The Penny Hoarder, which helps millions of readers worldwide earn and save money by sharing unique job opportunities, personal stories, freebies and more. The Inc. 5000 ranked The Penny Hoarder as the fastest-growing private media company in the U.S. in 2017.

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Sam's Club Membership Offer

Child Medical Consent Basics

There may come a time when you’re called away from
home—perhaps for work or a family emergency—and you must entrust your child to
a guardian in your absence.

In an event like this, it’s likely you’ll tell the guardian about your child’s medical history and of any precautions they’ll have to take or procedures they’ll have to follow if the child gets sick or injured.

Of course, parents are hardwired with the desire to protect
their children and can sometimes feel uneasy when surrendering their care to
someone else. So, how can you confidently prepare a guardian to manage your
child’s health and well-being when you’re away?

In this post, learn about the importance of a Child Medical
Consent form and the possible outcomes of a situation without one.  

When Should You Use a Child Medical Consent Form?

You should use a Child Medical Consent form when you know you’ll be away from your child for an extended period of time. This could include time you spend away on a business trip, vacation, or caring for a sick family member or time your child spends traveling for a sports tournament, a school field trip, or away at summer camp.

If you’re going to be separated for a full day or more, it’s
recommended you send a Child Medical Consent form to your child care provider
so they are prepared for an emergency medical situation. With this form, your
child care provider will be updated on all of your child’s medical information,
including:

  • The child’s medical history (including health insurance information, medications, allergies, or illnesses)
  • The family doctor’s contact information
  • Any medical treatments that the child care provider is allowed to consent to (e.g. transportation by ambulance during a medical emergency)

A Child Medical Consent is especially important for children
who have pre-existing medical conditions. For example, there are some illnesses
(like anemia, kidney disease, or severe infections) that hinder a person’s
ability to create healthy blood. As a result, this person might require blood
transfusions at some point or on a regular basis.

If your child has a condition that may require special
medical treatment, it’s imperative you grant your child care provider the power
to authorize such treatment in your absence.

What Happens If You Don’t Have a Child Medical Consent?

In many situations, a health care provider cannot provide
medical treatment to a child without the informed consent of a parent or
guardian. The exception is with medical emergencies, in which an emergency
responder will decide if treatment is necessary to prevent death or serious
injury. In this situation, it’s assumed that any reasonable person would also
consent to the treatment.

However, when it comes to non-emergency situations, consent
is generally considered to be an ongoing process. So, a person needs to be
fully aware of the procedures and consequences of a treatment before they
consent to it and they can withdraw that consent at any time if they choose.
That being said, a Child Medical Consent form can be used to inform a health
practitioner whether consent is or is not
given.

For instance, there may be a child diagnosed with Attention
Deficit Hyperactive Disorder (ADHD) who regularly attends behavior therapy and
takes prescribed medication. The child’s parents are going away for a week and
want the child to continue with his ADHD treatment, but they do not want the
child to take any different or new medications while they’re away.

With a Child Medical Consent form, the parents may give a temporary
guardian instruction on how to administer the child’s medication and permission
to bring the child to and from therapy (some establishments do not allow anyone
but the child’s legal guardian to take the child home, so in this case written
permission is necessary). However, the parents can add a clause to the form
that states the guardian is not allowed to pick up new prescriptions or
administer any other medications for the child’s ADHD in their absence.

Without a Child Medical Consent, your child may temporarily be
denied much needed medical treatments or possibly given a treatment that you
don’t agree with.

Conversations to Have with Your Child Care Provider

There are a few questions you may want to ask a potential guardian to ensure they are capable of caring for your child in your absence.

First, you’ll want to know if the person is of legal age to
provide consent (in many places, they’ll have to be at least 18 years old). It
will also help to know whether or not the person shares your moral beliefs and
is genuinely invested in your child’s well-being; this way, you’ll know you can
trust this person to make medical decisions for your child that respect your
wishes.

Once you’ve chosen a temporary guardian, you should explain
the extent of powers granted in the Child Medical Consent. Tell the guardian
exactly what’s expected of them (any treatments that must be administered) and
for how long (the date on which their authority ends).

Going through this information with your child care provider
gives them the opportunity to ask questions they might not have thought to ask.
It can also prepare them to act swiftly and confidently should medical
attention be required.

A Child Medical Consent benefits both the absent parents and
the temporary caregiver: parents can relax knowing their child is being
properly cared for, and caregivers have the information they need to deal with
any medical issues that might arise.

Uphold Your Health Care Standards with a Child Medical Consent

A Child Medical Consent form is an excellent way to
guarantee your child’s health will be properly cared for in your absence. It can
advise a temporary guardian not only of any illnesses, allergies, or medical
conditions your child might have, but also of any medical treatments your child
may need to be healthy. Without a medical consent, your child might not have
access to the health care they need or they might be given a treatment that
goes against your wishes. 

Parents work hard to ensure their kids grow up safe and strong,
whether it be something as simple as making sure their hands are washed or
something more complicated like finding the right medication to treat an
illness. Having a Child Medical Consent can reassure parents who have to be
separated from their children that their hard work will be respected and
carried on by another responsible adult.

The post Child Medical Consent Basics appeared first on LawDepot Blog.

LawDepot Blog

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Maternal Health Week: I Gave Stillbirth At 20 Weeks After Complaining For Weeks, Did I Receive Substandard Medical Care?

Source: Priska Neely / Priska Neely

Black Maternal Health week (April 11-17), founded and led by the Black Mamas Matter Alliance.

My stomach had been hurting all day but I could not possibly be going into labor — I was only at 20 weeks. My water had broken. I had explained these stomach pains to my doctor earlier that month, earlier that week, and even earlier that day. Each time I drove to Beverly Hills for my appointment, I was told I was fine. The bleeding? Just spotting, you’re fine. The cramps? They’re normal, you’re fine. My request to have tests done? “No need, you’re fine.”

Early in my pregnancy, I had begun to wonder if I was receiving substandard medical care. Could my doctor be dismissing me because I was an unmarried, pregnant Black women on Medi-Cal? I was convinced by medical staff that most of my concerns were just typical first-time mother over-worrying. I saw all the upper class Persian women get more attention and face-time with the doctor, while I was getting an average of 10 minutes each visit but I made justifications because I trusted my doctor and his expertise. If this was where many rich women were going for care, I figured I must be in good hands.

My water had definitely broken. When my now husband and I got to the nearest hospital, which was not where I was supposed to deliver, our parents were all there. We were told the baby’s lungs had not fully developed and he would not live outside of my womb. Still, I would have to push. I had to go through the labor and the delivery.

It was not until I delivered the baby, a boy who was stillborn, that I cried. I couldn’t stop screaming the words “no” and “please”. “No” was my disbelief. “Please” was my last appeal to God to change what just happened.

My nurse, an older Black woman, held my hand and treated me with so much care and compassion. My grief would not allow me to hold the baby but she held him for me and pressed him against my chest. I just put my hand on his very small body and held it there, unable to take him into my arms. Today, I wish I would have.

The loss of our first baby was devastating. Seven months later, we found out I was pregnant once again. This time, we switched medical providers.

By month five of my second pregnancy, I was having complications. My new medical staff was checking in with me so frequently that I almost got annoyed. They immediately put me on bedrest. Everyone made me feel like my pregnancy was their priority. It was one of the most difficult periods of my life but the level of care I received gave me hope. It also confirmed for me that although I had previously gone to one of the most coveted medical providers in one of the richest neighborhoods in Los Angeles for my care, I had received racially biased and subpar care.

Despite the excellent prenatal care I was receiving this time around, I spent two months in the hospital before having my son at 27 weeks — an experience that brought me back to the discrimination of my first delivery. I was ignored. I was overlooked. My life and the life of my child were both in danger.

This time, I was told that I couldn’t possibly be having contractions because they weren’t showing up on a monitor. I was feeling such extreme pain that I thought I was dying. After my nurse ignored several of my concerns, I physically grabbed her arms and pulled her down to me and demanded that she check between my legs because the baby was coming.

Alarms went off, nurses were running and a doctor jumped onto my bed and told me she had to stick her hand inside of me to keep my son’s umbilical cord inside. A nurse told me I needed to go under so they could get my baby out immediately. I had little time to think about any of this. I had to give consent although I was unsure and under informed. In seconds, I was unconscious.

I woke up an hour later with a scream. I was in so much pain. I opened my eyes to my mother who informed me that my son was born. “Is he perfect?” I asked. “So perfect.” she responded. Only two pounds and 12 ounces, but perfect.

Today, my son is a beautiful 6 year old who is becoming bilingual, loves dancing, sports and Black people. He has dressed as both Bobby Seale and Malcolm X for Halloween, and throws up the power fist for photos without prompt.

Now, after all of this drama, would you believe I went on to have another baby? Chile…But this time, I knew what my care should look like and that I wanted a full term, safe and happy pregnancy.

My mother had a friend named Rae Jones who ran an organization called Great Beginnings for Black Babies and it was from them that I received so much support and access to resources. I joined the Black Infant Health Program, a California statewide pregnancy education program for Black women, and learned more about my pregnancy and how to advocate for myself. I learned that Black women in America are 2 to 6 times more likely to die from complications of pregnancy and more than twice as likely to lose their babies than white women. My story was just one of many.

Though I did require another surgery to maintain my latest pregnancy, my daughter was born full term with no issues. I then devoted my life to ensuring that other Black women would never have to have three tries in order to get it right. We have so much work ahead of us but there are organizations around the country, most represented in an alliance called Black Mamas Matter, who are fighting to ensure that other Black women don’t experience what I did.

Black mamas, a safe and sacred pregnancy is your birthright and your legacy. Black women were successfully delivering babies back when hospitals wouldn’t even let us in. Connect to doulas and midwives who will assist in making sure your expectations and goals are met. There is a nationwide support system ready to love on you and the life you plan to bring forth. Despite the statistics, we can have the birth experiences that we deserve.

HEAD BACK TO THE BLACKAMERICAWEB.COM HOMEPAGE

Life & Style – Black America Web

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Kelsey Grammer, Julia Stiles to Star in Medical Thriller ‘The God Committee’

Kelsey Grammer and Julia Stiles are starring in medical thriller “The God Committee.” Austin Stark is directing from his own script. Colman Domingo, Janeane Garofalo and Dan Hedaya are co-starring. “The God Committee” explores the U.S. organ transplant system. The movie follows a donor heart being flown to a New York hospital, where a transplant […]

Variety

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Kaiser Permanente Moanalua Medical Center Tops in Obstetrics

HONOLULU — Kaiser Permanente Moanalua Medical Center has been named one of America’s Best Hospitals for Obstetrics by the Women’s Choice Award®. Presented by WomenCertified Inc., this evidence-based designation scored Moanalua Medical Center in the top 17 percent of 2,778 U.S. hospitals offering obstetrics.

The America’s Best Hospitals for Obstetrics distinction is awarded based on the following criteria: low rates of early elective deliveries, high patient safety rankings for reducing infection and complication rates, and rankings above the national average for patient recommendation.

Moanalua Medical Center makes breastfeeding support and education a priority for new mothers. Additionally, the Family Birth Center at Moanalua Medical Center provides coordinated labor and delivery care in a safe and comfortable setting, facilitated by a team made up of the patient’s obstetrician-gynecologist, certified nurse-midwife, neonatologist and other care providers. New mothers and their families enjoy a personalized birth experience with private delivery suites, mother-baby rooms, room service, and labor aids such as a birthing ball and hydrotherapy tub.

“Prenatal and maternity care is essential to the health and well-being of mothers and their babies,” said Mabel Wong, MD, chief of obstetrics and gynecology at Kaiser Permanente Hawaii. “We’re grateful to be recognized by the Women’s Choice Award for promoting safe, patient-centered maternity care that revolves around mother and child.”

America’s Best Hospitals for Obstetrics combines national accreditations, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results and hospital outcome scores with primary research about women’s health care preferences. It is the only award recognizing excellence in obstetric services based on robust criteria that consider female patient satisfaction and clinical excellence.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12.2 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.

About the Women’s Choice Award®

The Women’s Choice Award sets the standard for helping women to make smarter choices for themselves and their families. The company and its awards identify the brands, products and services that are most recommended and trusted by women. The Women’s Choice Award is the only evidence-based quality designation that drives consumer and patient appreciation through education, empowerment and validation. Additionally, they recognize those that deliver a recommendation-worthy customer experience. Visit www.WomensChoiceAward.com to learn more.

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NEW PARENT ESSENTIAL UPDATE:

Hidden FDA Reports Detail Harm Caused By Scores Of Medical Devices

Dr. Douglas Kwazneski was helping a Pittsburgh surgeon remove an appendix when something jarring happened. The surgical stapler meant to cut and seal the tissue around the appendix locked up.

Kwazneski later turned to the Food and Drug Administration’s public database that tracks medical device failures and “there was nothing,” he said. Yet when he surveyed leading surgeons on the matter, he discovered that more than two-thirds had experienced a stapler malfunction, or knew a peer who did. Such failures can have deadly consequences.

Kwazneski had no idea the FDA had quietly granted the makers of surgical staplers a special “exemption” allowing them to file reports of malfunctions in a database hidden from doctors and from public view.

“I don’t want to sound overdramatic here, but it seemed like a cover-up,” said Kwazneski, who practiced in Pasco County, Fla., from 2016 through earlier this year.

After Dr. Douglas Kwazneski witnessed a surgical stapler malfunction, he surveyed leading surgeons and discovered that more than two-thirds had experienced a stapler malfunction, or knew a peer who did.(Kendra Stanley-Mills for KHN)

The FDA has built and expanded a vast and hidden repository of reports on device-related injuries and malfunctions, a Kaiser Health News investigation shows. Since 2016, at least 1.1 million incidents have flowed into the internal “alternative summary reporting” repository, instead of being described individually in the widely scrutinized public database known as MAUDE, which medical experts trust to identify problems that could put patients in jeopardy.

Deaths must still be reported in MAUDE. But the hidden database has included serious injury and malfunction reports for about 100 medical devices, according to the FDA, many implanted in patients or used in countless surgeries. They have included surgical staplers, balloon pumps snaked into vessels to improve circulation and mechanical breathing machines.

An FDA official said that the program is for issues that are “well-known and well-documented with the FDA” and that it was reformed in 2017 as a new voluntary summary reporting program was put in place for up to 5,600 devices.

Yet the program, in all its iterations, has been so obscure that it is unknown to many of the doctors and engineers dedicated to improving device safety. Even a former FDA commissioner said he knew nothing of the program.

KHN pored over reams of public records for oblique references to reporting exemptions. After months of questions to the FDA, the agency confirmed the existence of reporting-exemption programs and thousands of never-before-acknowledged instances of malfunctions or harm.

Amid the blackout in information about device risks, patients have been injured, hundreds of times in some cases, lawsuits and FDA records show.

“The public has a right to know about this,” said Dr. S. Lori Brown, a former FDA official who accessed the data for her research. She said doctors relying just on the public reports — and unaware that many incidents may be omitted — can easily reach the wrong conclusion about the safety record of a particular device.

The FDA has also opened additional — and equally obscure — pathways for device makers to report thousands of injuries brought to light by lawsuits or even deaths that appear in private registries that medical societies use to track patients. Those exemptions apply to risky and controversial products, including pelvic mesh and devices implanted in the heart.

FDA spokeswoman Deborah Kotz confirmed that the “registry exemption” was created without any public notice or regulations. “Any device manufacturer can request an exemption from its reporting requirements,” she said in an email.

I don’t want to sound overdramatic here, but it seemed like a cover-up.

Dr. Douglas Kwazneski, surgeon

Agency records provided to KHN show that more than 480,000 injuries or malfunctions were reported through the alternative summary reporting program in 2017 alone.

Alison Hunt, another FDA spokeswoman, said the majority of device makers’ “exemptions” were revoked that year as a program took shape that requires a “placeholder” report to be filed publicly.

More than a million reports of malfunctions or harm spanning about 15 years remain in a database accessible only to the FDA. But with the agency’s new transparency push, the public may find a public report and submit a Freedom of Information Act request to get information about incidents. A response can take up to two years.

The long-standing exemption program “has allowed the FDA to more efficiently review adverse events … and take action when warranted without sacrificing the quality of our review or the information we receive,” Hunt said in an email.

Madris Tomes(Courtesy of Madris Tomes)

To those outside the agency, though, the exceptions to the reporting rules are troubling. They strike Madris Tomes, a former FDA manager, as the agency surrendering some of the strongest oversight and transparency powers it wields.

“The FDA is basically giving away its authority over device manufacturers,” said Tomes, who now runs Device Events, a website that makes FDA device data user-friendly. “If they’ve given that up, they’ve handed over their ability to oversee the safety and effectiveness of these devices.”

Doctors, like Kwazneski, who have turned to the public data to gauge the risks of surgical staplers have seen little. He wrote about the “unacknowledged” problem of stapler malfunctions in a 2013 article in the journal Surgical Endoscopy. In 2016, while reports of 84 stapler injuries or malfunctions were openly submitted, nearly 10,000 malfunction reports were included in the hidden database, according to the FDA.

Device maker Medtronic, which owns stapler maker Covidien, has been described as the market leader in surgical staplers. A company spokesman said that the firm has used reporting exemptions to file stapler-related reports through July 2017. Ethicon, the other major stapler maker, said it has not.

The public database shows that Medtronic has reported more than 250 deaths related to staplers or staples since 2001.

Mark Levering, 62, nearly lost his life after a stapler malfunction early last year, according to a lawsuit filed by his family. His surgeon has testified that a surgical stapler misfired during his liver surgery at ProMedica Toledo Hospital in Ohio.

Staff performed CPR for 22 minutes while surgeons rushed to suture the severed vein. He emerged from a coma unable to walk or consistently recognize his wife and son. The surgeon, hospital and device maker Covidien have denied allegations of wrongdoing in an ongoing legal case.

Told of the reporting “exemption” for surgical staplers, his wife, Doris Levering, was incredulous.

“Why would this information not be made available to doctors? The true information — I mean the actual numbers …” she said. “People’s lives are at stake. Mark’s life will never be the same.”

Doris Levering says her husband, Mark, underwent a procedure to remove an abscess from his liver and ended up in a coma for weeks.(Heidi de Marco/KHN)

Phil Levering (left) says his father, Mark Levering, used to have a calm demeanor but now exhibits signs of aggression due to a brain injury he suffered after a surgery gone wrong. (Heidi de Marco/KHN)

Doris Levering holds a photograph of her and her husband predating his surgery. Levering says it’s clear that the man who used to tend to stray cats and enjoy dinner out with his family is gone. “People’s lives are at stake. Mark’s life will never be the same,” she says.(Heidi de Marco/KHN)

The Stapler Problem

The sheer number of malfunctions made surgical staplers an easy pick for the new alternative summary reporting program at its inception nearly 20 years ago, according to Larry Kessler, a former FDA official and now a University of Washington health services professor.

Surgical staplers have a unique ability to help — or harm — patients. The device is designed to cut and seal tissues or vessels quickly, often during minimally invasive surgeries. When it fails to seal a major blood vessel, medical staff can quickly shift into “code blue” mode to rescue a patient from bleeding to death.

The severity of some of the injuries caught former FDA official Brown’s attention in the early years of its reporting exemption. Her 2004 article on stapler mishaps, published in the Journal of the American College of Surgeons, accounts for one of the few places in public records where an FDA authority mentions the “alternative summary” program. She found that in the first 28 months of filing to the hidden database, stapler makers filed more than 5,100 reports of malfunctions or injuries.

Mark Levering, now 62, was in a medically induced coma and had several surgeries after a surgical stapler malfunctioned during a Feb. 17, 2018, liver surgery. His wife, Doris Levering, said in a deposition that he did not open his eyes after the initial surgery until March 13.(Courtesy of Doris Levering)

She also noted that the publicly reported 112 stapler-related deaths in patients aged 22 to 91 from 1994 to 2001 were a “reason for concern.”

In the public data filed since, it would appear that the staplers rarely misfire. In 2011, only 18 injury or malfunction reports were filed publicly. Last year, the number was 79.

Lawsuits detail how quickly a stapler failure can turn a smooth surgery into a catastrophe.

In Michigan, Eugene Snook’s surgeon was in the process of removing part of his lung when he cut but couldn’t seal a major vessel due to a “stapler malfunction,” the surgeon said in sworn court testimony. Snook, then 59, had no detectable blood pressure for four minutes during the 2012 surgery.

The damage to Snook’s artery was so great, his surgeon decided to remove his lung completely, medical records filed in court say. Snook sued stapler maker Covidien, which in court records said there was no proof the stapler was unsafe when it left Covidien’s control and also that the surgeon used it improperly. The case reached a confidential settlement in 2017.

Another surgeon attempting to remove a benign liver growth from April Strange, 33, in 2013, testified that a stapler malfunction caused the woman to bleed to death. Strange, of central Illinois, left behind a husband and two daughters, then 6 and 8.

The stapler was thrown out after surgery, court records say. Covidien argued in court records that Ryan Strange couldn’t prove that the stapler had a specific defect.

Covidien reached an agreement to settle the family’s claims for $ 250,000, part of a larger settlement in the case.

Doctors initially thought Mark Levering had liver cancer. So when the diagnosis came back as an abscess that needed to be surgically removed last February, it came as a relief to his wife, Doris.

That relief turned to dread the day of surgery. The procedure was supposed to last two hours, she said. But the surgery hit a snag when the stapler “misfired,” according to the surgeon, causing so much bleeding that the minimally invasive procedure was converted to an open procedure so the doctor could suture the vein.

Levering underwent CPR for 22 minutes. A code blue was called, a nurse testified. Levering lost 3 quarts of blood — about half the blood in his body. He was put on life support and would remain in a coma for weeks.

After Levering reopened his eyes, it was clear that the man who used to tend to stray cats and enjoy dinner out with his family was gone. Levering could no longer walk, comb his hair or recognize the letters of the alphabet.

Doris and Mark Levering have sued the doctor, hospital and surgical stapler maker, alleging that the device caused Mark’s bleeding and brain injury. The surgeon has acknowledged in sworn testimony that the stapler malfunctioned, but denied other wrongdoing. The hospital said in a legal filing that its actions were “prudent, proper” and “lawful.”

Covidien denies any defect with the stapler or that it caused Levering’s injuries. A spokesman for parent company Medtronic declined to comment further on any lawsuit but said that “we always make patient safety our top priority” and that the company complies with FDA requirements.

The company’s reports of stapler problems in the public database remain relatively low. But in 2018, with the reporting exemption gone, a spike of reports emerged for Covidien’s staples — not to be confused with staplers. While Medtronic reported 1,000 staple malfunctions or injuries in 2015, the number soared to 11,000 for 2018.

Rolling Out The Program

The alternative summary reporting program started two decades ago with a simple goal: to cut down on redundant paperwork, according to officials who were at the FDA at the time.

Kessler, the former FDA official, said the program took shape after scandals over under-reporting of device problems spurred changes allowing criminal penalties against device companies.

Soon, thousands of injury and malfunction reports poured into the agency each month, with about 15 staff members dedicated to reviewing them, Kessler said. Many reports were so similar that reviewing them individually was “mind-numbing.” Kessler went to the FDA’s legal department and to device manufacturers to propose a solution.

Device makers would be able to seek a special “exemption” to avoid reporting certain complications to the public database. The manufacturers would instead send the FDA a spreadsheet of injury or malfunctions each quarter, half-year or year.

That way, Kessler said, reviewers could quickly look for new problems or spikes in known issues. When the program launched in 2000, the list of exempted devices was made public and only a few devices were involved, Kessler said.

“I don’t know why it’s not [made public] now,” he said. “I’m surprised about that.”

Starting in September, KHN filed Freedom of Information Act requests for “exemption” agreements and reports for several medical devices. Health and Human Services officials denied an appeal to provide some of the records quickly, concluding there was no “compelling need” for haste. For one request, the records were estimated to arrive in 22 months.

The FDA did provide some top-level data. It shows that from 2014 through 2017, the overall number of alternative summary reports filed by device makers rose from 431,000 to 481,000.

The FDA declined to provide a complete list of “about 100” devices that have been granted reporting exemptions over the years, but confirmed that exemptions have been used for mechanical breathing machines and balloon pumps, known as intra-aortic balloon pumps, inserted in the vessels of people with circulation problems.

An FDA spokeswoman said “alternative summary” exemptions remain in place for pacemaker electrodes and implantable defibrillators.

Matthew Baretich, a biomedical engineer in the Denver area, said he helps several area health systems analyze device-related patient injuries and make equipment-purchasing decisions.

He said he regularly scans the FDA’s public device-injury reports. Asked about “alternative summary” reports, he said, “I’ve got to tell you, that’s a new term to me.”

Bruce Barkalow, president of a Michigan-based biomedical engineering firm, said he’s the guy government officials, attorneys or device makers call if someone gets a pacemaker and dies in the shower three days later.

In an interview, he said he was not aware of the reports, either. He said they may appear to the FDA to be a “nothing burger,” but the data would be meaningful to his forensic investigations.

The ECRI Institute, a nonprofit leader in medical device safety, declined to provide an engineer for an interview. Educating hospital leaders and health providers, the institute issues an annual “Top 10” in medical technology hazards. Its tagline: “Separating fact from fiction in healthcare.”

Among the institute’s “top medical device subject matter experts,” spokeswoman Laurie Menyo said in an email, “none of them had any familiarity with FDA’s Alternative Summary Reporting Program.”

Even Dr. Robert Califf, former FDA deputy commissioner and commissioner from 2015 to 2017, said in an interview that he was unaware of the program. “Never heard anything about it,” he said. “It’s interesting.”

Companies that get the exemptions tend to be very “tight-lipped” about them, said Christine Posin, a former device firm manager and consultant to device companies.

The relative secrecy around the program can give them an advantage, she said. For instance, sales representatives can print out only the public reports of device problems, ignoring what’s buried elsewhere.

That creates a business opportunity to persuade a doctor to try a different device. “‘We have a good product that does the same thing,’” Posin said a sales representative might tell a physician.

Exemptions Multiply

The FDA has spent millions, convened experts and pledged to improve its work in device safety in recent years. All the while, it has quietly opened new avenues for the makers of controversial and risky devices to file injury and even death reports with little public review.

Pelvic mesh is one example. The fabric-like device has long been used to hold up pelvic organs in women experiencing organ prolapse. In 2011, the FDA issued a “safety communication” saying “serious complications” like pain or infection were “not rare.”

The agency soon reclassified the device, ordered safety studies and saw most mesh makers remove the device from the market.

Behind closed doors, though, the agency has since granted pelvic mesh makers a special exemption from reporting injuries to the public, according to the FDA and mesh makers who were asked about the practices.

Under what the FDA calls the “litigation complaint summary reporting” exemption, device makers can file a single placeholder “injury” report. Attached to the summary report, device makers have sent the FDA a spreadsheet with as many as 1,175 reports of patient injuries, based on allegations in lawsuits. 

To someone tallying the overall number of injuries related to pelvic mesh, the report would appear as a single injury. It would take a sharp eye to find the summary report and a special request — taking up to two years to be filled — to get the details on the 1,175 cases submitted directly to the FDA.

According to the FDA, in 2017 alone, eight mesh makers used their exemptions to send nearly 12,000 injury reports to the FDA.

The FDA is basically giving away its authority over device manufacturers. If they’ve given that up, they’ve handed over their ability to oversee the safety and effectiveness of these devices.

Madris Tomes, former FDA manager

Dr. M. Tom Margolis, a urogynecologist in the San Francisco Bay Area and an expert medical witness for those who are suing mesh makers, said a program that might hinder doctors relying on open FDA data to assess the risks of mesh is “horrible” and “unethical.”

“We need to know the good and the bad,” said Margolis, who treats patients in his urogynecology practice. “If you’re trying to hide complications from me, well that’s … wrong, my God, it’s heinous.”

The FDA issued the same kind of exemption to the makers of da Vinci surgical robots months after Johns Hopkins University School of Medicine researchers pointed out that the company was filing a notably small number of injury reports in the public database. Johns Hopkins professor Dr. Marty Makary noted in 2013 that the handful of reports sent to the FDA at the time were signs of a “haphazard” system that is “not independent and not transparent.”

Within months, the FDA allowed the makers of the robots to file a single report, noting that a spreadsheet sent straight to the FDA summarizes about 1,400 injuries alleged in lawsuits, with some injuries dating to 2004. Since then, the device maker has reported smaller batches of 99 and 130 injuries at a time.

Homa Alemzadeh(Courtesy of Homa Alemzadeh)

“This is very frustrating,” said Homa Alemzadeh, an assistant professor of computer engineering at the University of Virginia who is working with MAUDE data to create software to identify errors in real time or before they happen in surgeries performed by robots. She said she was not aware of the reporting exemption.

Under another reporting exemption, the FDA is allowing device makers to report hundreds of death cases in spreadsheets sent directly to the agency.

Under the “registry exemption,” device makers can summarize what they learn from registries that tend to be held by specialty medical societies, and track the use of a certain kind of device, according to FDA spokeswoman Kotz. 

Kotz said the data in registries often falls short of the level of detail that the FDA seeks for the more thorough death reports that device makers are required to file.

Device makers filing such reports include Edwards Lifesciences, which makes the Sapien 3 valve that’s snaked through a vessel and implanted in the heart. Some hail the device as a breakthrough for saving patients from the trauma of open-heart surgery to replace a valve. Others raise concerns over limited data showing how long the valve will last in the body.

The summary reports offer potential patients few answers. Such reports document as many as 297 deaths or 1,800 injuries in a single filing, with virtually no detail readily available to the public. In all, Edwards has filed more than 1,800 Sapien 3 valve patient deaths as summaries since 2016.

Edwards spokeswoman Sarah Huoh said in an email that the FDA mandated the tracking of every patient who has the valve in the registry to provide “comprehensive evidence for device safety.”

“The approval of alternative reporting protects against duplicate reports coming from multiple sources,” Huoh said.

Another device, the MitraClip, is used to attach two flaps in the heart that are allowing blood to flow backward. The device has been controversial, with some scientists saying it is crucial for a certain subset of patients, and others pointing to the harm it can cause to the heart.

The FDA has allowed Abbott Vascular, which makes the MitraClip, to report as many as 347 deaths or 1,000 injuries in a single filing, also shipping the details straight to the agency, FDA records show.

An Abbott spokesman said in an email that the company has done clinical trials with thousands of patients to establish the MitraClip’s safety. He said the exemption was granted because data in the registry was stripped of patient identifiers, making it hard to know whether the company would be filing redundant reports to the FDA.

We need to know the good and the bad. If you’re trying to hide complications from me, well that’s … wrong, my God, it’s heinous.

Dr. M. Tom Margolis, urogynecologist and expert medical witness

Last year, the FDA finalized regulations for yet another summary reporting program. Under the newest system, device makers do not have to seek an exemption or notify the FDA that they’ll be filing a public summary report in MAUDE.

The FDA has deemed the makers of more than 5,600 types of devices eligible to file “voluntary malfunction summary reports.” Among them are some of the riskiest devices the agency oversees, including cardiac stents, leadless pacemakers and mechanical heart valves.

The growing cadre of exceptions to the injury- and death-reporting rules strikes Dr. Michael Carome, director of the Public Citizen Health Research Group, as a retreat by the FDA from making crucial information available for researchers and patients.

“It’s just another example of a flawed oversight system,” he said, “bent toward making it easier for industry rather than making protection of public health the primary goal.”

California Healthline reporter and producer Heidi de Marco contributed to this report.

Kaiser Health News

BEST DEAL UPDATE:

Texas Lawmakers Take Aim At Surprise Medical Bills

A bipartisan group of lawmakers announced plans to address surprise medical bills in a way that would take the “burden” off Texans.

During a press conference Thursday, state Sen. Kelly Hancock, a Republican from suburban Fort Worth, announced he had filed a bill aimed at preventing medical providers from balance-billing patients, among other things. State Rep. Trey Martinez Fischer, a Democrat from San Antonio, is filing a similar bill in the House.

If passed, the legislation would force medical providers and health insurers to mediate payment disputes before they send bills to patients. Hancock said the point of SB 1264 is to take “the burden off of patients.”

“[It] takes it off of their plates completely,” Hancock said.

He highlighted the case of Drew Calver, a public school teacher in Austin whose six-figure hospital bill after a heart attack was featured in a “Bill of the Month” investigation by KHN, NPR member station KUT and CBS. Hancock noted Calver’s bill was reduced after the media attention, but it shouldn’t take such attention for a patient to get a reasonable bill.

Under this legislation, both sides of the payment dispute would settle their issues through an existing balance-bill mediation program. The Texas Department of Insurance program has been successful in lowering medical bills across the state.

The legislation would beef up the program, which addresses surprise balance bills greater than $ 500 from all emergency providers, including free-standing emergency departments and all out-of-network providers working at a network facility.

“This is designed to apply in situations where patients don’t have any choice which facility they go to or which physician is involved in their care,” Hancock said.

The insurance department’s mediation program, historically, had many loopholes and few consumers qualified for help. It was expanded in 2017, though, and more patients have been filing complaints.

For example, in 2014, the department was asked to mediate 686 medical bills. During the 2018 fiscal year, it received 4,445 bills.

Hancock said the program, so far, has saved Texas patients $ 30 million.

Consumer advocates argued the system works only when patients know mediation is an option, however.

Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities, said patients don’t always know help is available or they find the process intimidating.

“The instructions for how to do it are on your medical bill and your explanation of benefits — the most indecipherable documents you are going to get,” she told KUT earlier this year.

She and others have argued Texas should adopt a program similar to those in states like New York, California and Florida, whose systems are more consumer-friendly.

Martinez Fischer said it’s time Texas officials step in to help patients who are caught in the middle of disputes between medical providers and health insurers.

“It has been an industry issue for a few years — I grant you that,” he said, “the health plans and the providers fighting over their business interests, and I respect that. But 10 years later, it is a consumer issue.”

Among other things, Hancock’s bill would allow people with federally regulated self-funded health plans to opt into the state’s mediation program. According to Hancock, those plans make up about 40 percent of Texas’ insurance market, but those consumers are currently not able to take part in the program. Hancock said this should provide relief to consumers while federal lawmakers weigh their own efforts to address surprise medical bills.

“Texas will send a loud and clear signal to D.C. that similar consumer protections need to be passed at the federal level,” Hancock said. “Until then, Texas … [is] committed to doing something about it.”

U.S. Rep. Lloyd Doggett said he’s encouraged by Texas’ efforts, but called federal protections “essential.”

“Only approval in Congress of legislation like my End Surprise Billing Act can both protect those who work for large employers with self-funded, federally regulated ERISA plans and assure that patients across America are not forced to pay the price for conflicts between insurers and health care providers,” he said in a statement.

This story is part of a partnership that includes KUT, NPR and Kaiser Health News.

Kaiser Health News

BEST DEAL UPDATE:

Teens living in US states allowing medical marijuana smoke less cannabis

According to a large-scale study of American high school students, legalizing medicinal marijuana has actually led to a drop in cannabis use among teenagers. The study used the results of an anonymous survey given to more than 800,000 high school students across 45 states to calculate the number of teens who smoke cannabis.
Teen Health News — ScienceDaily

SPECIAL CHILDREN UPDATE:

Texans Can Appeal Surprise Medical Bills, But The Process Can Be Draining

In Texas, a growing number of patients are turning to a little-known state mediation program to deal with unexpected hospital bills.

The bills in question often arrive in patients’ mailboxes with shocking balances that run into the tens or even hundreds of thousands of dollars.

When patients, through no fault of their own, are treated outside their insurers’ network of hospitals, the result can be a surprise bill. Other times, insurers won’t agree to pay what the hospital charges, and the patient is on the hook for the balance.

The Texas Department of Insurance’s mediation program can intervene when Texans complain about an unexpected bill — often after an emergency in which a patient is rushed for treatment at an out-of-network hospital.

Historically, the state program had many restrictions that left few consumers eligible for help. But the Texas Legislature expanded it in 2017.

Since then, more patients have been filing complaints. In 2014, the department was asked to mediate 686 medical bills. During the 2018 fiscal year, however, it received 4,445 bills, more than double the 2,063 bills received in 2017.

Even after the changes, the mediation program could be a lot more robust and is likely addressing only a fraction of these problematic bills, consumer advocates say.

The Road To A Surprise Medical Bill

Brad Buckingham had to deal with a surprise medical bill after a bicycle accident in 2016.

Buckingham sent his bill to Kaiser Health News and NPR’s “Bill of the Month” portal last year.

The Austin, Texas, dentist said he was on a ride with friends in December 2016 when he crossed train tracks at an angle to avoid a pileup. His wheel slipped out from under him, and he landed hard on his left hip.

“All I could do was scream,” he said. “I couldn’t even make words.”

His friends called an ambulance, and Buckingham was taken to the nearest hospital: St. David’s South Austin Medical Center.

“I specifically remember I gave them my health insurance information in the ambulance,” he said. “And they put me in the ER, and from the ER they took my insurance information again.”

Buckingham had insurance through Baylor Scott & White Health, which he bought through the Affordable Care Act marketplace. St. David’s was out of his plan’s network, but no one told him that — at first.

Buckingham had broken his hip, and doctors took him into surgery the same day.

“They held me in the hospital for three days just for recovery and never told me I was out of network until the time of my discharge,” he said.

A few weeks later, Buckingham got a bill that said he owed $ 71,543.

The total bill eventually came to $ 75,346. Baylor Scott & White, which left the ACA marketplace the following year, paid only $ 3,812.

Buckingham thought it was a mistake, he said. He called the hospital and the insurer to sort it out. But after weeks of inquiring about it, there was no resolution.

Both the hospital and insurer insisted payment was his responsibility.

“I’m sitting there thinking to myself that there is no way — there is no way — this is right,” he said.

Baylor Scott & White said it couldn’t discuss Buckingham’s bill “due to confidentiality requirements.”

After Buckingham gave St. David’s permission to discuss his case with the media, the hospital released a statement saying his bill was actually the amount he owed from his deductible and coinsurance — not a balance bill.

The hospital also said the bill was so large because of his “high deductible plan.”

Those plans “may be attractive to some people because they cost less, though they place more financial responsibility on the patient,” the statement from St. David’s said.

Buckingham said his policy had a deductible of $ 5,000 for in-network care and $ 10,000 for out-of-network care. He still doesn’t know how his bill got to be so high, he said.

Buckingham didn’t know about the state’s mediation program. But even if he had known, he wasn’t eligible for the program at the time. His bike accident and the billing dispute with the hospital happened months before the Texas Legislature decided to expand the pool of eligible patients. So he hired his own lawyer to help him negotiate with the hospital.

Buckingham now owes a couple of thousand dollars to St. David’s, he said, but he remains frustrated by the experience.

“You know, whenever I tell my story to anybody, they kind of agree — like, ‘Oh my gosh, this is ridiculous,’” he said. “But then when you talk to the people that have any control over it, it’s the exact opposite. It’s: ‘You owe it; we don’t.’”

‘A Total Roll Of The Dice’

A surprise bill can happen to anyone who makes an urgent trip to the nearest emergency room.

“It’s a total roll of the dice,” said Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities in Austin. She has been looking into balance billing for years. “The medical emergency that’s going to send you to the hospital where you could get a surprise bill — is that emergency room going to be in or out of network?”

Pogue said the Texas Department of Insurance’s mediation process forces an insurance company and the hospital or medical provider to negotiate a fair price for services. Ninety percent of the time those negotiations happen over the phone, she said.

There are two big reasons the number of bills sent for mediation more than doubled from 2017 to 2018, Pogue said.

“One is just increased awareness,” she said. “There is constant media attention now to surprise medical bills because the stories are so shocking, right? We see them covered more, so people are more aware that when they get one, they could do something about it.”

The second reason is that, in 2017, the Texas Legislature opened the mediation program up to more people, including teachers.

Stacey Shapiro got a $ 6,720 bill after being treated in the hospital for a hypoglycemic attack.(Gabriel C. Pérez/KUT)

Can’t Wish It Away

Stacey Shapiro, a first-grade teacher in Austin, also received a surprise bill from St. David’s South Austin Medical Center after she landed in the emergency room last March.

The marathon runner said she woke up one Saturday for an early run and wasn’t feeling well.

“All of a sudden the whole room started spinning. … I started sweating, sweating like buckets,” she said. “It was terrible, and then all I remember is that my ears started popping, my vision got blurred and then the next thing I knew, I had passed out.”

Shapiro’s boyfriend heard her hit the bathroom floor. He found her passed out, with her eyes open and hardly breathing. He took her to St. David’s because it was the closest hospital.

Shapiro was taken care of in a few hours, she said. Hospital staff gave her fluids and anti-nausea medication. Doctors found she had a dramatic change in her blood pressure that was likely due to a spell of hypoglycemia, or low blood sugar.

Two months later, a bill for $ 6,720 came in the mail.

Like many teachers in Austin, Shapiro gets her health insurance from Aetna.

In a statement, the insurer said Austin school district employees are supposed to use the Seton Accountable Care Organization network, comprising several Catholic hospitals in the area. The parent company for St. David’s, the for-profit hospital chain HCA, doesn’t participate in that network.

“Unfortunately, HCA is not currently accepting payments through Aetna’s [contracted payment] program, which provides set payment fees for non-participating providers. This has resulted in Ms. Shapiro being balance billed for her emergency room visit,” Aetna wrote in a statement.

Shapiro said she had heard of other Austin Independent School District employees dealing with high hospital bills. In fact, Shapiro reached out to radio station KUT after hearing the story of Drew Calver, an Austin high school teacher who was balance-billed for nearly $ 109,000 by St. David’s after a heart attack. Calver’s story was part of Kaiser Health News and NPR’s “Bill of the Month” series last year.

In her case, Shapiro said, Aetna told her not to pay what the hospital was charging her. She was told to pay only her deductible ($ 1,275), which she did right away, she said. But St. David’s kept sending her bills for the remaining balance, which was more than $ 5,000.

“I guess I just thought that it was going to go away,” Shapiro said.

But it didn’t. For a public school teacher, $ 5,000 would have been a huge blow to her budget, she said.

Shapiro applied for financial assistance, but St. David’s told her she didn’t qualify. She felt out of options, she said — until a friend told her about the state’s mediation program.

After she contacted the program, a state mediator set up a scheduled call with Aetna and St. David’s. But before it took place, a KUT reporter asked St. David’s for a comment on the situation. Shortly afterward, Shapiro said, St. David’s told her she no longer owed anything.

St. David’s later told KUT that Shapiro had “already satisfied her financial obligation.” It also denied that she was balance-billed to begin with.

Shapiro called the whole experience exhausting. “It’s just very frustrating because this has been very time-consuming,” she said.

More Work To Do

Pogue, of the Center for Public Policy Priorities, has been arguing that the state needs to find more ways to get involved. The current mediation process is pretty good, she said, but not enough people know it’s an option.

“Because first, the instructions for how to do it are on your medical bill and your explanation of benefits — the most indecipherable documents you are going to get,” she said.

And even if people understand they have a right to mediation, they might get scared off by the concept and think they need a lawyer, Pogue added.

When people do use the program, though, it tends to work by saving patients money.

In fiscal year 2018, the initial complaints amounted to $ 9.7 million worth of medical bills, according to the state insurance agency. After mediation, the final charges had been negotiated down to $ 1.3 million.

Mediation is helpful, Pogue said, but it still puts a big burden on the patient, who may be confused. “Why didn’t this happen in the first place?” she said. “How come I had to, while recovering from an emergency, decipher medical bills, fill out paperwork with the state department of insurance, jump through all these hoops, when all that needed to happen was a phone call?”

The ideal solution to surprise medical bills would remove consumers from this confusing web altogether, she said.

States like New York, California and Florida have systems that make things easier for consumers, Pogue said, and Texas should, too.

In 2015, New York became the first state to pass a law aimed at protecting patients from surprise medical bills from out-of-network hospitals. Its Emergency Medical Services and Surprise Bills Law holds consumers harmless if they are treated by an out-of-network doctor at a participating hospital, among other things.

In 2016, Florida lawmakers passed legislation protecting consumers from receiving surprise medical bills “from doctors and hospitals that don’t have a contract with the patient’s insurance plan,” the Miami Herald reported.

And in 2017, California passed a law shielding patients from balance billing. The law kicks in if someone visits an in-network provider, including a hospital, imaging center or lab. Under the law, patients would be responsible only for their in-network share of the cost, even if they’re seen by an out-of-network provider.

In the meantime, Pogue said, more Texans should take advantage of what’s already in place in the state.

The number of people who seek mediation is “tiny compared to the number of people who get surprise bills,” she said, “so there is a ton of work to be done.”

This story is part of a partnership that includes KUT, NPR and Kaiser Health News.

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Kaiser Permanente Moanalua Medical Center Receives Women’s Choice Award for Excellence in Bariatric Surgery

HONOLULU — For the fourth straight year, Kaiser Permanente Moanalua Medical Center has been recognized as one of America’s Best Hospitals for Bariatric Surgery by the Women’s Choice Award®. Presented by WomenCertified Inc., this evidence-based designation scored Moanalua Medical Center in the top 8 percent of 4,797 U.S. hospitals reviewed.

The America’s Best Hospitals for Bariatric Surgery award is given to hospitals recognized by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery. To be eligible for consideration, hospitals must be accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which indicates the highest standards for patient safety and quality care in the treatment of severe obesity. The award also takes into account patient safety data from the Centers for Medicare and Medicaid Services, and patient recommendation ratings from the Hospital Consumer Assessment of Healthcare Providers and Systems survey.

“Nearly 24 percent of Hawaii’s adult population is obese, living with an increased risk of developing diabetes, hypertension, heart disease, arthritis and obesity-related cancer,” said Peggy Latare, MD, co-chief of the bariatric surgery department at Kaiser Permanente Hawaii. “Our bariatric team focuses on offering high-quality, integrated care and support that includes surgery, medication and meal replacements to treat obesity and its many associated risks, as well as education and resources that help patients improve their overall health and quality of life.” Kaiser Permanente Hawaii members who are interested in these services can call 808-432-7830.

America’s Best Hospitals for Bariatric Surgery combines national accreditations, HCAHPS survey results and hospital outcome scores with primary research about women’s health care preferences. It is the only award recognizing excellence in bariatric surgery based on robust criteria that consider female patient satisfaction and clinical excellence.


About the Women’s Choice Award®
The Women’s Choice Award sets the standard for helping women to make smarter choices for themselves and their families. The company and its awards identify the brands, products and services that are most recommended and trusted by women. The Women’s Choice Award is the only evidence-based quality designation that drives consumer and patient appreciation through education, empowerment and validation. Additionally, they recognize those that deliver a recommendation-worthy customer experience. Visit www.WomensChoiceAward.com to learn more.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12.2 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to kp.org/share.

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The U.S. Has Never Needed Paid Family and Medical Leave More

The Family and Medical Leave Act (FMLA) turned 26 this week, just as President Trump was preparing to talk paid leave during his State of the Union address.

The Family Medical Leave Act was an important first step. Now it’s time to pass the FAMILY Act. (MomsRising)

As the most female Congress in history gets to work, lawmakers have an urgent imperative to adopt comprehensive paid family and medical leave that allows all workers to care for their families without risking their jobs or financial security. No issue is more important to moms across the country.

Moms need paid leave to care for new babies, for sure, but also to care for a spouse or sibling who is battling heart disease or a parent struggling with dementia, or to recover from illness or injury.

Not just any paid leave program will do: The U.S. needs a comprehensive, meaningful paid leave program that covers all workers, addresses the range of caregiving needs families face, expands the definition of family, provides wage replacement sufficient to allow workers with low wages to take leave and ensures that the same or comparable jobs will be there when workers return from their leave.

We expect that, as with last year’s State of the Union, Trump’s lip service to paid leave will be followed with sparse details. In the past, his paid leave proposals have fallen far short of what working families need—providing only parental leave, doing nothing for workers who need leave to care for a sick family member or to recover from illness—and the benefits they would offer would not be meaningful, and would be especially inadequate for workers with lower incomes and wages. Their eligibility rules may even exclude the new parents who need leave the most.

That is not what the country needs.

Similarly, some Republican lawmakers have offered proposals that are deeply, even fatally, flawed—because they would reinforce stereotypes about women, require workers to trade future Social Security benefits for paid leave and/or provide inadequate job protections.

That would not be what our country needs.

Twenty-six years ago, the FMLA required certain employers to provide workers with 12 weeks of unpaid job-protected leave to welcome a new child, care for an ill family member or recover from a serious illness. It was a vitally important starting point, but it does not meet the needs of working families or our economy today.

We need the Family and Medical Insurance Leave (FAMILY) Act to boost moms and families, strengthen our economy, improve our health and make our workplaces more equitable.

The FAMILY Act, which we expect will be introduced in both the House and Senate very soon, would create a social insurance fund with small contributions from employees and employers; provide all workers with a meaningful amount of leave to meet the full range of caregiving needs; and be affordable, cost-effective and sustainable for workers, employers and taxpayers.

We want to be clear: A paid leave program that provides only parental leave is a non-starter for the millions of MomsRising members across the country who see paid family and medical leave as top priority issue.

Congress must pass the FAMILY Act, and President Trump must sign it into law. It’s time for the U.S. to finally give moms, and all workers, access to paid family and medical leave.

Kristin Rowe-Finkbeiner is the author of Keep Marching and Executive Director and CEO of MomsRising—an on-the-ground and online grassroots organization of more than a million people who are working to increase family economic security, decrease discrimination against women and moms and build a nation where businesses and families can thrive. 

Ruth Martin is the Vice President of Workplace Justice Campaigns at MomsRising.

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http://www.acrx.org -As millions of Americans strive to deal with the economic downturn,loss of jobs,foreclosures,high cost of gas,and the rising cost of prescription drug cost. Charles Myrick ,the President of American Consultants Rx, announced the re-release of the American Consultants Rx community service project which consist of millions of free discount prescription cards being donated to thousands of not for profits,hospitals,schools,churches,etc. in an effort to assist the uninsured,under insured,and seniors deal with the high cost of prescription drugs.-American Consultants Rx -Pharmacy Discount Network News

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CBS Blocked a Medical Marijuana Commercial From Playing During the Super Bowl

(Bloomberg) — The Super Bowl isn’t ready for medical marijuana.

Acreage Holdings, the multi-state cannabis company backed by John Boehner, says CBS rejected a television advertisement that calls for the legalization of medical marijuana. The network, which is airing the game on Feb. 3, nixed the proposed spot after seeing a rough outline, according to the company.

While medical marijuana is now legal in more than 30 states, the federal prohibition on cannabis has restricted research and made it difficult for some potential patients to get their hands on a drug that proponents say helps treat seizures, pain and other ailments.

The advertisement aimed to “create an advocacy campaign for constituents who are being lost in the dialogue,” Acreage President George Allen said. Super Bowl airtime would have been the best way to achieve this, he added.

“It’s hard to compete with the amount of attention something gets when it airs during the Super Bowl,” Allen said in a telephone interview.

CBS didn’t immediately reply to a request for comment on Monday, which was a federal holiday.

The Super Bowl is typically the most-watched television program of the year, and it’s an opportunity for brands to get in front of millions of Americans. Companies typically debut new publicity campaigns and air their most creative commercials during the event. Some viewers eagerly anticipate the advertisements that run during stoppages in play.

In past years, some advertisers have also grabbed the spotlight for offering up commercials that weren’t likely to be approved.

Injuries, Seizures

Acreage, one of the most valuable U.S. weed companies with a market value of more than $ 2.4 billion, had hoped to raise its profile and push for increased access to medical marijuana. The proposed ad features two subjects who have benefited from medicinal cannabis: a veteran with combat injuries and a child with seizures.

Super Bowl ads are expensive, reportedly costing more than $ 5 million for an average 30-second spot last year. Acreage, which went public in Canada last year, was prepared to pony up, and created the ad thinking it had a legitimate chance of getting onto the air. The company said it was careful to position the spot as a “call to political action” rather than a pitch for its brand, which now has cannabis operations in roughly 15 states.

“We certainly thought there was a chance,” Allen said. “You strike when the chance of your strike has the probability of success — this isn’t a doomed mission.”

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CBS sacks Super Bowl ad for medical marijuana

CBS has sacked a Super Bowl ad by a cannabis company that calls for the legalization of medical marijuana. Acreage Holdings, the US-based company backed by former House Speaker John Boehner, said the network nixed the proposed 30-second spot after seeing a rough outline, according to Bloomberg News. The ad aimed to “create an advocacy…
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http://www.acrx.org -As millions of Americans strive to deal with the economic downturn,loss of jobs,foreclosures,high cost of gas,and the rising cost of prescription drug cost. Charles Myrick ,the President of American Consultants Rx, announced the re-release of the American Consultants Rx community service project which consist of millions of free discount prescription cards being donated to thousands of not for profits,hospitals,schools,churches,etc. in an effort to assist the uninsured,under insured,and seniors deal with the high cost of prescription drugs.-American Consultants Rx -Pharmacy Discount Network News

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Kaiser Permanente Moanalua Medical Center Receives Women’s Choice Award for Cancer Care

HONOLULU — For the second consecutive year, Kaiser Permanente Moanalua Medical Center has been named one of America’s Best Hospitals for Cancer Care by the Women’s Choice Award®. This evidence-based designation places Moanalua Medical Center in the top 9 percent of 4,797 U.S. hospitals offering cancer care services.

The America’s Best Hospitals for Cancer Care award is based on criteria such as the comprehensiveness of diagnostic and treatment services offered, low rates of infection compared to the national average, national accreditations, and female patient satisfaction and preference ratings on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

Kaiser Permanente’s multidisciplinary, team-based approach focuses on all stages of cancer care, from prevention through treatment. The organization holds an annual Cancer Screening and Prevention Fair where medical specialists and counselors provide screening and lifestyle education to hundreds of attendees. Kaiser Permanente also recognizes that women have specialized health care needs. Moanalua Medical Center’s cancer care services include a breast care clinic, which provides cancer patients with a coordinated team made up of oncologists, geneticists, radiologists, surgeons and support staff who provide comprehensive care under one roof.

“Every year, thousands of people in Hawaii receive a cancer diagnosis,” said Jennifer Carney, MD, chief of oncology and hematology at Kaiser Permanente Hawaii. “Getting that news is never easy. We strive to provide coordinated care that takes into account our patients’ total picture of health so we can deliver safer, more effective care that is also more convenient for our members. We’re grateful to be able to make a difference in the lives of our many members, who survive cancer every year.”

In 2016, Kaiser Permanente Hawaii was ranked first in the state on breast and colorectal cancer screenings by the National Committee for Quality Assurance, a national quality assurance organization. In 2017, Moanalua Medical Center received a 3-year accreditation, the longest available, from the American College of Surgeons Commission on Cancer (ACS CoC) based on quality measures including early diagnosis, cancer staging, optimal treatment, rehabilitation and end-of-life care.


About the Women’s Choice Award®
The Women’s Choice Award sets the standard for helping women to make smarter choices for themselves and their families. The company and its awards identify the brands, products and services that are most recommended and trusted by women. The Women’s Choice Award is the only evidence-based quality designation that drives consumer and patient appreciation through education, empowerment and validation. Additionally, they recognize those that deliver a recommendation-worthy customer experience. Visit www.WomensChoiceAward.com to learn more.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12.2 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to kp.org/share.

 

###

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LIVE from CES: Clark discusses keyless door locks, smartphone developments, eliminating porch pirates, medical devices and more!

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Insured But Still In Debt: 5 Jobs Pulling In $100K A Year No Match For Medical Bills

Robert and Tiffany Cano of San Tan Valley, Ariz., have a new marriage, a new house and a 10-month-old son, Brody, who is delighted by his ability to blow raspberries.

They also have a stack of medical bills that threatens to undermine it all.

In the months since their sturdy, brown-eyed boy was born, the Canos have acquired more than $ 12,000 in medical debt — so much that they need a spreadsheet to track what they owe to hospitals and doctors.

“I’m on these payment arrangements that are killing us,” said Tiffany Cano, 37, who has spent her lunch hours on the phone negotiating payoff plans that now total $ 700 a month. “My husband is working four jobs. I work full time. We’re a hardworking family doing our best and not getting anywhere.”

The pair, who earn nearly $ 100,000 a year, are insured and have had no major illnesses or injuries. Still, the Canos are among the 1 in 4 Americans who report in multiple polls that the high cost of health care is the biggest concern facing their families. And they’re at risk of joining the 62 percent of people who file for bankruptcy tied to medical bills.

“Oh, yes, that worry is always in the back of my mind,” Tiffany said.

The family is part of a struggling group: middle-class folks who have followed the rules and paid for employer-based medical insurance, only to find that soaring health care costs — combined with high deductibles, high copayments and surprise medical bills — leave them vulnerable.

“I thought we’d be covered, and it’s just not enough coverage at all,” she said.

Robert Cano, also 37, had family health insurance for 2018 through his job as a manager at a large-chain retail store, for which he pays nearly $ 500 per month. The plan’s $ 3,000 annual deductible and 40 percent coinsurance fees have added up faster than the Canos anticipated.

First came the nearly $ 4,000 bill from the in-network hospital where Brody was born Jan. 2, followed by separate fees from the anesthesiologist and the doctor who performed the routine delivery. Then, at 2 months, Brody was hospitalized with breathing problems doctors said could be related to allergies or asthma. In May, Tiffany came down with a stomach virus that sent her to the emergency room for drugs to treat nausea and dehydration. In October, the baby developed a bad case of bacterial conjunctivitis, or pinkeye.

“It’s been, like, $ 300 here, $ 700 there,” said Tiffany. “We had a hospital bill for him being sick of, like, $ 1,800.” Unable initially to find a pediatrician she liked, Tiffany has agonized over whether to use the ER when Brody gets sick. When he had pinkeye, she debated whether to take him in, hoping it would get better on its own.

Then he got worse, she said, pulling up a photo on her phone of her son with half-moons of red, puffy flesh under his dark eyes.

“I let him suffer for a day like that,” she said.

The Canos lost their first child, a girl, midway through her pregnancy in 2016. Tiffany acknowledges that experience has left her more anxious than the average first-time mom.

“It gave me so much fear that something would happen to him,” she said.

As for their own health care needs, the couple put themselves lower on the priority list. Tiffany has used a prosthetic limb since childhood, when her lower left leg was amputated because of a birth defect.

She needs a new prosthesis because her body changed during pregnancy, but she can’t see how to afford it.

Tiffany Cano with her son, Brody. Cano was born with birth defects that left her with only three fingers on her right hand and a left leg that had to be amputated below the knee during childhood. Because of physical changes during pregnancy, her five-year-old prosthetic leg no longer fits, but she can’t afford her share of the cost of the new limb.

A model suitable for the busy life of a working mom would easily cost $ 10,000 to $ 15,000, according to Tom Fise, executive director of the American Orthotic & Prosthetic Association.

“I try to push through,” Tiffany said. “I put on that brave face of just walking, but it’s so painful to walk. I have bruises all over my leg. I get blisters all the time.” Lately, she’s been wearing an old prosthesis, one she used in high school, because it’s more comfortable.

The Canos don’t know how exactly they fell into such debt, since they tried hard to make responsible decisions. After meeting three years ago, they knew quickly that they wanted to marry and have a family.

“I waited until I found the right guy,” said Tiffany, who was thrilled when, in 2016, they were able to afford a 2,500-square-foot, two-story home in one of the stucco-and-tile neighborhoods an hour outside Phoenix.

But, taken together, the medical payment plans and premiums are almost as much as their $ 1,300 monthly mortgage. All told, the Canos spend about 15 percent of their annual income on health care, almost three times the average for non-Medicare households in the U.S.

That leaves too little for day care, car payments, gas, food and dozens of other domestic expenses, Tiffany said.

For 17 years, Robert Cano had comprehensive health insurance through his job as a soldier in the Army Reserve and paid little or nothing for medical care. He left the Army in 2017, however, after he learned he would be deployed for an extended time away from his wife and new son.

“I told them, ‘I have to be at home,’” he recalled. The Army insurance ended on Dec. 31, 2017, two days before Brody was born.

That meant moving to his employer’s insurance plan. Like more than 40 percent of 152 million Americans who get health insurance through work, the Canos are enrolled in a plan that demands thousands of dollars before any coverage kicks in.

The couple discovered that they earn too much to qualify for financial assistance from medical providers, or for subsidies if they shifted their insurance to a plan under the federal health insurance exchange. She is a full-time bank compliance officer. He is a full-time store manager.

Tiffany wrote to KHN after seeing stories about sky-high medical bills on TV. Dr. Merrit Quarum, the chief executive of WellRithms, a health care consulting firm, reviewed the family’s medical bills and the responses from their health care providers.

Though Quarum had questions about some of the fees in the itemized bills — $ 4 for a 600-milligram ibuprofen tablet? $ 3,125 to place an epidural? — he found the charges were legitimate under the terms of the contract between the hospital and the Canos’ insurer. Tiffany’s only recourse was to set up the five payment plans she navigates each month.

“I wish I could say it wasn’t so, but it is,” Quarum said.

Robert Cano plays with his 10-month-old son, Brody, before leaving for work on a recent Saturday morning.(Heidi de Marco/KHN)

Robert Cano of San Tan Valley, Ariz., gets ready for work on Oct. 20, 2018. He estimates he works up to 120 hours a week, mostly to cover the extra costs of his family’s health care. In addition to his retail job, he is a substitute teacher and a nighttime security guard, and delivers sandwiches for a fast-food chain.(Heidi de Marco/KHN)

Tiffany Cano feeds 10-month-old Brody on Oct. 20, 2018. She works 40 hours a week at a local bank as a compliance officer, commuting more than 90 minutes each way, while Brody attends a local day care center. Because her husband works so much, she says, she often feels as if she’s raising their son alone.(Heidi de Marco/KHN)

Mostly to pay off that health care debt, Robert has taken several part-time gigs this year — he works as a substitute teacher and a nighttime security guard and delivers sandwiches for a fast-food chain in Scottsdale, 40 miles away, where tips are better. He said he sometimes works up to 120 hours in a week.

“I’m not ashamed or embarrassed, even as old as I am, to deliver sandwiches,” he said, pulling on his retail chain polo shirt before rushing to a Saturday morning shift.

He continued: “I know people, they’d rather get food stamps and feel sorry for themselves. But I’m a fighter. I will not give up. … If I can bring in an extra $ 400 a week or $ 800 a month, she can get what she needs for the baby.”

Often getting home after midnight, he keeps shampoo and shaving cream in his car and naps in parking lots between jobs, relying on Red Bull and aspirin to stay alert.

That means on many nights, when Tiffany picks up Brody from day care after her 90-minute commute, she handles most of the chores at home.

“Sometimes I feel like a single mom because my husband is never around,” she said.

She carefully tracks the family’s medical expenses, trying to juggle them with ordinary outlays that can’t wait — like $ 500 for the brakes that went out on her car this month.

At the rate they’re going, the bills won’t be paid until Brody is 3, Tiffany said. The Canos are getting older and they’d like to have another baby before it’s too late, but, for now, that seems impossible.

For 2019, the couple have decided to switch to a different plan offered through the regional bank where Tiffany works. The premium is higher — $ 650 a month — but the deductible is $ 1,500 with just 10 percent coinsurance.

“It is going to be a lot more per paycheck, which is going to hurt us,” Tiffany said. “But after what just happened, I want to make sure we are prepared in case anything does occur.”

How to fix a health care system that burdens middle-class families so heavily is beyond her, she said.

“The only thing we can do is just keep working,” Tiffany said. “I always wonder: How does everybody else do it?”


KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation.

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Charity buys and erases past-due medical debt

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http://www.acrx.org -As millions of Americans strive to deal with the economic downturn,loss of jobs,foreclosures,high cost of gas,and the rising cost of prescription drug cost. Charles Myrick ,the President of American Consultants Rx, announced the re-release of the American Consultants Rx community service project which consist of millions of free discount prescription cards being donated to thousands of not for profits,hospitals,schools,churches,etc. in an effort to assist the uninsured,under insured,and seniors deal with the high cost of prescription drugs.-American Consultants Rx -Pharmacy Discount Network News

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Massachusetts Stroke Patient Receives ‘Outrageous’ $474,725 Medical Flight Bill

Kristina Cunningham was in stable condition on an evening in June, when EMTs lifted her gurney into a medical flight, bound for Boston.

The 34-year-old couldn’t use her right arm or speak clearly after a stroke six days earlier, and still had two blood clots at the base of her brain. Cunningham’s dad, Jim Royer, remembers doctors at the small hospital in Wichita, Kan., where Cunningham had attended a family wedding, saying she needed to see a neurosurgeon.

“There was discussion of flying her to St. Louis, there was discussion of flying her to Chicago, there was discussion of flying her to Dallas,” Royer recalled, but “we don’t have family in any of those locations.”

So the doctors arranged to transfer Cunningham, via an Angel MedFlight Learjet, to Massachusetts General Hospital, where she would be diagnosed with a rare blood vessel disease of the brain. MGH is about an hour from Cunningham’s home in Berlin, Mass. — and her 7-year-old son. Cunningham’s doctors and her insurer, CareFirst BlueCross BlueShield, based in Maryland, agreed the transfer was medically necessary.

“We assumed it would be [covered],” Royer said, “because it was supposedly preapproved by the insurer before any flight took place.”

Royer said he and Cunningham didn’t think about the Angel MedFlight piece of her health scare again until a letter arrived in August. It was a one-page “explanation of benefits” with a jaw-dropping total in a column labeled “other amounts not covered.”
“When I got the bill for $ 474,725, I’m thinking six or seven flights, and you can buy a whole new jet,” Royer said with a wry laugh.

That nearly half-million dollars is the total of four items, the largest of which is a per-mile charge. That figure, $ 389,125, breaks down to $ 275 a mile.

“It’s larger than any surprise medical bill I’ve personally seen,” said Chuck Bell, program director for the advocacy division at Consumer Reports. “It’s really outrageous.”

In a study last year, Consumer Reports detailed some of the reasons excessively high air ambulance bills have become more common. Use of air ambulances is rising as more rural hospitals close, baby boomers age and the use of telemedicine increases.

“The industry has really grown by leaps and bounds over the last 15 years and prices have doubled or tripled,” Bell said. “Most of the operators of air ambulances now are for-profit, Wall Street-type corporations reporting very large profits to investors.”

The Association of Air Medical Services (AAMS), a trade group, counters that it is not unique, that many hospitals and health insurers across the country are also for-profit and that some are owned by private equity firms.

AAMS said a key reason bills for patients with private insurance plans are often high is this: Companies have to make up for the money they lose transporting other patients.

“Medicare pays about 60 percent of the cost of the flight. Medicaid pays 35 percent or less. Self-paid patients pay a few cents on the dollar. And that has led to a crisis of being able to sustain the service,” Christopher Eastlee, AAMS vice president for government relations, said in a statement, stressing that he has cost data only for emergency helicopter transports, not jets like the one in which Cunningham traveled.

In 2018, Medicare paid $ 8.65 per mile for a fixed-wing aircraft like the Learjet that transported Cunningham. That’s a stark contrast to Angel MedFlight’s $ 275 charge per mile. There are no guidelines for determining reasonable charges in this case.

Cunningham’s insurer, CareFirst, initially paid $ 14,304.55, leaving about $ 460,420 unpaid. In Massachusetts, a ground-based ambulance could not demand that Cunningham pay the balance, as state law doesn’t allow so-called balance billing. But air ambulances are governed by federal aviation laws. There are numerous cases of companies demanding payments from patients. A few states have tried to intervene but been unsuccessful, with courts saying that federal law prevails.

Cunningham has been focused on recovering her speech and preparing for surgery. In January, she will meet with her doctors to decide which type of surgery they recommend for removing or bypassing the blood clots at the base of her brain.

But Cunningham and her father have another worry: what the mail may bring.
“I don’t know, we’ll see,” Cunningham said, with a shrug.

“It’s a big bill to be sitting out there wondering what’s going on,” said Royer, who contacted KHN-NPR’s Bill of the Month on his daughter’s behalf. “It would force her into bankruptcy.”

Angel MedFlight COO Andrew Bess told WBUR the company is negotiating with CareFirst and will not demand payment from Cunningham.

“We’re quite confident we’ll come to a clear resolution despite the insurer placing the patient in the middle of the dispute,” said Bess.

Royer said it was a letter from Angel MedFlight that sounded threatening. As he read it, the company told Cunningham she must sign over the rights for Angel MedFlight to negotiate with CareFirst or risk being held liable if the insurer did not pay. Cunningham signed the request.

Bell, with Consumer Reports, said agreeing to such terms can be risky. Some air ambulance companies ask for detailed information about the patient’s personal finances, information they then use to determine how much the patient can pay if the insurance reimbursement is deemed inadequate.

During inquiries for this story, CareFirst told WBUR it would increase the proposed payment to Angel MedFlight. The insurer said it had discovered an error in its initial reimbursement to Angel MedFlight. CareFirst is now proposing to pay $ 70,864.90, or about one-seventh of the original charge.

“Unfortunately, exorbitant charges like these by air ambulance providers are not uncommon,” said Scott Graham, a spokesman for CareFirst, in an email. “This is an issue because companies like Angel MedFlight typically do not contract with health insurers on negotiated rates.”

WBUR forwarded this update to Bess, who called it a “meaningful offer” in his emailed response.

“We provide a valuable service, and for that providers should be fairly compensated and reimbursed,” Bess said. “We strive to work with our patients and advocate on behalf of them to get coverage rightfully owed to them under their insurance plans.”

Royer, a retired Air Force air traffic control systems manager, knows something about the cost of operating jets. To him, it looks like Angel MedFlight inflated the bill, hoping the insurer would agree to a generous settlement.

“I guess that the way things work nowadays. You ask for the moon and if you only get a large island, that’s what you get,” Royer said.

Bess responded to Royer’s claim in a statement.

“Staffing what is essentially an Intensive Care Unit at 30,000 feet presents unique medical and aviation challenges that may not be apparent to those outside of the medical aviation industry,” Bess wrote. “The amount we receive per flight is a fraction of the billed charge.”

Patients caught up in an air ambulance billing dispute can file a complaint with the U.S. Department of Transportation.

A recent push for stricter federal billing regulations was stripped out of the Federal Aviation Reauthorization Act, passed in October. The legislation did establish a council of industry representatives, including air ambulance providers and insurance company representatives, among others, to write and re-evaluate consumer protections, including balance-billing practices. It did not add a requirement for more price and other data transparency called for in a Government Accountability Office report on the air ambulance industry.

The National Association of Insurance Commissioners says federal legislation is needed so that states can intervene to oppose unreasonable air ambulance charges. Lawmakers from rural states, including Sen. Jon Tester, a Montana Democrat, said they’ll reintroduce such legislation.

The air ambulance trade group says any such change would create “borders in the sky” that would interfere with lifesaving air rescues across state borders.

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

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‘Widespread and dangerous’: Facing medical uncertainty, doctors tell patients it’s all in their heads

When 7-year-old Bailey Sheehan arrived at a hospital in Oregon partially paralyzed, a doctor said the girl was faking her symptoms to get her parents’ attention because she was jealous of her new baby sister.


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Gently stroking babies before medical procedures may reduce pain processing

Researchers found that gently stroking a baby seems to reduce activity in the infant brain associated with painful experiences. Their results suggest that lightly brushing an infant at a certain speed — of approximately 3 centimeters per second — could provide effective pain relief before clinically necessary medical procedures.
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Birth Justice: Where #MeToo and Medical Sexism Intersect

Never before have conversations about sexual harassment and violence been so commonplace. Around the world, feminists are declaring that they #BelieveWomen and women are telling their #MeToo stories. Despite a wave of fierce backlash to the feminist movement, we have broken the silence around the interpersonal and systemic violence that so frequently faces women, female-bodied, queer and trans people.

But I can’t help but notice a huge blind spot around birth.

Thousands of birthing women experience violence every day. (George Ruiz / Creative Commons)

UNICEF estimates that about 353,000 babies are born each day around the world—and in the process, thousands of birthing women experience violence. Birthing people are often coerced, threatened and violated during and after labor; they are separated from their babies, ignored by their doctors and forced into numerous other inhumane acts perpetrated by the patriarchal hospital system.

Doulas often say there is a “hidden epidemic” of doctors abusing women in labor—and in the last five years alone, women have begun to speak up about obstetrical violence. Caroline Malatesta won a lawsuit against the hospital where she gave birth after she suffered from PTSD and permanent nerve damage in response to the nurse forcefully holding her baby in her vagina while she waited for the doctor to come into the room. A woman known by the pseudonym “Kelly” sued her obstetrician for assault and battery after he conducted a multiple-cut episiotomy after she explicitly refused the procedure. 

But there are still millions of cases globally where the rights of birthing people are ignored—where their genitals are touched or cut without their consent, or their bodies are used in ways they explicitly refused. It is not uncommon to see doctors forcefully conduct vaginal exams on women during labor, even while they explicitly tell them to stop, for no medical reason whatsoever—a course of action that is, by definition, rape.

The #MeToo movement has openly grappled with the issues of privilege that shape its explosion. It takes privilege to stand up and say that one has suffered sexual harassment, abuse and rape. It is, in some ways, still a privilege just to be believed once you have spoken up. For every story told with the hashtag, thousands of stories go untold by women around the world because they fear greater violence or disenfranchisement. 

While every woman is vulnerable to obstetric violence, we are not all affected equally. Immigrants, people of color and poor folks are the least likely to be heard, and in many cases the most likely to be impacted, by birthing violence. In the U.S., black birthing people are dying in childbirth three to four times as often as white women. Latinx birthing people are dying twice as often as white women. 

My partner’s mother was raped when she went to her doctor for a routine prenatal checkup; she stopped going to that doctor, but didn’t report him to the hospital because race and class dynamics made her feel that nobody would listen. My grandmother is more willing to talk about the horrible atrocities she suffered during the Holocaust as a teenager than her first birth experience in a Brooklyn hospital in 1962—in which she was strapped to a bed, verbally abused and locked in a room alone during labor, and then separated from her baby for a week and discouraged from breastfeeding.

Unfortunately, although the vast majority of doctors have good intentions and want to take care of their patients as best they can, they work in a system that does not prioritize consent, that positions their patients as less knowledgeable about their own bodies than they are and that sets up a power dynamic where doctors can exploit their knowledge to get inappropriate access to their patient’s bodies. 

This violence is rooted in the history of the field: James Marion Sims, known as “the father of modern gynecology,” conducted experiments against female slaves without their consent and without anesthesia; today, medical students are still sometimes taught to perform pelvic exams on anesthetized women without their knowledge or consent—a practice that is only illegal in four states.

The midwifery model of care offers a much-needed alternative to western obstetrics. Midwifery, a century-old craft which means “with woman,” utilizes a model that prioritizes holistic female well-being. It is not only about keeping the birth safe—it is about keeping the birthing person feeling safe, and thus protecting the physiological process of birth.

We are all born, and medical research has concluded that birth affects us in deep, lasting and powerful ways. If mothers feel unsafe, violated or abused during births, their newborn babies will store those experiences in their nervous systems. Whether we are born through a cesarean section, vaginally in a hospital with an epidural or at home, our birth experiences affect us for the rest of our lives. 

Birth justice is finally becoming a part of the conversation, with states like New York and California creating initiatives to attempt to address the birth disparities facing communities of color—but we have so much more to do. We need to start calling obstetric violence what it is, and we need to start connecting the dots between #MeToo and medical sexism.

Men who are true allies to women need to be actively engaging with other men to end rape culture, and obstetricians must band together to stop obstetric violence. Men need to stop thinking that they deserve control over female bodie, and doctors need to stop thinking that they can do anything they want to our bodies under the guise of practicing medicine.

Marea Goodman is a home-birth midwife practicing in Oakland, California. 

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Kaiser Permanente Opens New Beaverton Medical and Dental Office

PORTLAND, Ore. — Today, Kaiser Permanente opens its new Beaverton Medical and Dental Office. The new facility is our vision for the future of health care: person-centered care for body, mind and spirit, powered by innovation.

The three-floor, 90,000-square-foot facility replaces the current Beaverton facility that opened nearly 50 years ago, and is the first Kaiser Permanente facility outside of California that was built from the ground up to harness design, technology and workflow to create an intuitive and convenient experience for members and care teams.

This state-of-the-art care facility features a public square at its heart to educate, engage and inspire wellness, and appointment notification text alerts allowing patients to relax, enjoy something from the café, or take in the Northwest-created art displayed throughout the building. Larger exam rooms are designed to be less clinical and more conversational, and digital screens let providers share notes and display other medical information.

Medical and dental — together

One of the innovative ways that Kaiser Permanente is a national leader in care delivery is with medical and dental integration, which leads to improved health outcomes. For example, clinicians can look ahead at the dental patients on their schedule to see whether they’re due for any medical procedures, such as flu shots, immunizations or blood pressure checks, which can be taken care of during their visit. Because of Kaiser Permanente’s integrated medical record, a dental team provider can then, for example, send a message directly to the patient’s primary care doctor.

“Kaiser Permanente is unique in our movement toward integrated medical and dental care, and our new Beaverton office was built from the ground up to offer a convenient and highly personal total health experience,” said Curt Lemrick, DMD, the lead dentist at the new office. “Dental health can often give clues about a person’s overall health, and we strongly believe that the future state of medicine will be one where the two are integrated. We’re excited our Beaverton neighbors can now receive all of their medical and dental care in this state-of-the-art facility.”

Key Services

  • Primary care for adults and children
  • Dental care and dental hygiene services for adults and children
  • Imaging
  • Laboratory
  • Occupational Health
  • Nurse Treatment Center
  • Pharmacy
  • Urgent Care
  • Vision Essentials/Optometry

The new medical and dental office is adjacent to the old building at the corner of Western Avenue and Beaverton Hillsdale Highway. (The old building will be razed in 2019.)


About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12.2 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to kp.org/share.

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This patient’s medical record said she’d given birth twice — in fact, she’d never been pregnant

Medical record errors are extremely common and can be life-threatening. For 20-year-old patient Morgan Gleason, it took many hours to fix a glaring mistake. 
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Kaiser Permanente Moanalua Medical Center Maintains “A” Grade for Patient Safety

HONOLULU — The Leapfrog Group, a nonprofit advocate for health care transparency, has awarded Kaiser Permanente Moanalua Medical Center its seventh straight “A” grade in the Fall 2018 Leapfrog Hospital Safety Grade. The Hospital Safety Grade, administered in the spring and fall every year, measures the overall performance of more than 2,500 hospitals nationwide in keeping patients safe from preventable medical errors. Moanalua Medical Center is 1 of 4 hospitals in Hawaii honored with the Straight A distinction of receiving five or more consecutive A grades.

The Hospital Safety Score uses hospital performance data collected by national health care organizations, including the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services. Scores are calculated based on 27 types of publicly available hospital data related to patient care, medication errors and infection prevention. It’s published as a free resource to help patients and their families make informed health care decisions. Only 32 percent of hospitals in the U.S. have received an A grade in the Fall 2018 report.

“Patient safety is a top priority at Kaiser Permanente, and we’re proud of our doctors, providers and staff who work together to create a healthy healing environment for patients,” said Linda Puu, RN, vice president of quality, safety and care experience at Kaiser Permanente in Hawaii. “Our integrated electronic health record system and coordinated care approach helps reduce errors and safety risks, which improves patient outcomes and ensures a higher quality of care.”


About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 11.8 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to kp.org/share.

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Flipped classroom enhances learning outcomes in medical certificate education

The quality of medical certificates written by students of medicine was better when they were taught by using the flipped classroom approach instead of traditional lecturing. A randomly selected student from the flipped classroom group had an 85 percent probability to receive a better total score than a student from the traditional teaching group, according to a new study.
Literacy News — ScienceDaily

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Thai lawmakers back medical marijuana amendment

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Keiki Patients Enjoy Halloween Fun at Kaiser Permanente Moanalua Medical Center Trick-Or-Treat Event

HONOLULU — Kaiser Permanente Moanalua Medical Center held its annual trick-or-treat event for the hospital’s youngest patients today, celebrating Halloween with festive costumes, decorations and healthy treats. Eight pediatric patients ranging in age from toddlers to teens traveled through nearly every floor of the facility, showing off their costumes in exchange for stickers, coloring books and healthy snacks from physicians and staff.

Baby shark and friends enjoyed the healthy treats from staff.

Baby shark and friends enjoyed the healthy treats from staff.

Dressed as superheroes and movie characters, keiki visited General Surgery, Cardiology, Food & Nutrition and other departments to take in the hospital’s Halloween decorations and meet physicians and staff in costume. Five young patients who were unable to leave the pediatrics floor received a special delivery of Halloween treats delivered to their rooms by staff members.

“Our annual Halloween trick-or-treat event is a favorite for physicians, staff and parents, because it allows our young patients to celebrate the holidays without leaving the hospital,” said Kathryn Martin, RN, manager of pediatrics at Moanalua Medical Center. “We look forward to brightening the spirits of all our keiki with healthy treats and festive Halloween fun.”


About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12.2 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.

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California’s Medi-Cal program paid $4B to recipients who may have been ineligible, audit shows

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‘Weed the People’ Explores Medical Marijuana for Kids With Cancer

Marijuana, both medicinal and recreational, is growing more mainstream. Medical marijuana is now legalized in a majority of states, and 62% of Americans support legalizing it outright — but in the political realm, the plant has long been controversial.

Now, a new documentary called Weed the People, which opens in some theaters in October, explores the potential of medical marijuana for childhood cancers and the regulatory hurdles facing people who want to use cannabis. The film, which was executive produced by former talk-show host Ricki Lake, follows five families using cannabis oils to treat pediatric cancers. Some of the children used cannabis alongside treatments like chemotherapy, while others turned to the drug after conventional treatments had failed.

Lake became interested in medical marijuana when her late ex-husband, Christian Evans, began researching cannabidiol (CBD) — a compound in marijuana that does not cause a high —for his own health issues, including chronic pain and ADHD. (Evans died by suicide last year.) The two met a young girl with a tumor disorder whose family was desperate to get her off chemotherapy, and they helped connect her with a doctor who specializes in medical marijuana. Lake and her production partner, director Abby Epstein, were inspired to find other families in similar situations and tell their stories on screen. They made Weed the People to explore the potential of medical marijuana, and the regulatory challenges families and researchers must overcome to use it.

“I want to get people seeing it as a medicine, seeing what it was able to do for these children, and fight for this medicine to be available to everyone who needs it,” Lake says. “It’s a human rights issue.”

The film paints a rosy, anecdotal picture of the effectiveness of cannabis oils; some of the children featured had their tumors shrink substantially or disappear entirely, even if they were using cannabis oils in place of chemotherapy and other conventional treatments. “You can’t say the ‘cure’ word,” Lake says, “but how else do you explain it?”

But the concept is far from proven and could even be dangerous. While there is some evidence that marijuana can ease chronic pain and chemotherapy side effects, the American Cancer Society (ACS) warns that “relying on marijuana alone as treatment while avoiding or delaying conventional medical care for cancer may have serious health consequences.” And while some studies have shown that compounds in marijuana can slow growth of or kill tumor cells in animals or lab dishes, evidence in humans — particularly around marijuana oils — is lacking, the ACS says. While conventional treatments like chemotherapy are still the standard, pediatric cancer providers are increasingly voicing their support for the use of medical marijuana, particularly in palliative or end-of-life care when other treatments may not be necessary.

More research is needed to learn about the potential effects and limitations of cannabis-derived medicines for both adult and pediatric cancers. As the families and experts in Weed the People see it, this lack of evidence is precisely the problem — and it’s exacerbated by current regulations around medical marijuana.

Marijuana, like heroin and LSD, is classified by the Drug Enforcement Administration (DEA) as a Schedule I drug, meaning it has “no currently accepted medical use and a high potential for abuse.” But in June, the FDA approved the first drug derived from marijuana, a purified version of CBD called Epidiolex, for kids and adults suffering from two rare forms of epilepsy; the DEA then rescheduled Epidiolex (but not CBD as a whole) to schedule V, the lowest restriction classification for controlled substances. Researchers who wish to study cannabis need a Schedule I drug license and must submit to background checks and site visits from the DEA.

The DEA also only permits one institution, the University of Mississippi, to grow marijuana for study, though DEA spokesperson Melvin Patterson says it is planning to grant additional licenses to other growers, which would “increase access to marijuana for researchers, potentially increase the number of available strains for research, and may foster additional research on marijuana.”

This means scientists are limited to studying only the products and formulations available from the University of Mississippi, which doesn’t include popular consumer products like vapes and edibles, says Dr. Jeff Chen, director of the University of California Los Angeles Cannabis Research Initiative. “At my office at UCLA, I look out my window and I can count two dispensaries that I can see,” Chen says. “We can’t touch that cannabis—not even to understand what’s in it.”

As a result of these challenges, many families who wish to use cannabis, including those in the documentary, are forced to buy it from sources outside the conventional medical system, and must trust that what they’re using is safe. “I just find it absolutely staggering to accept that in this day and age, with the billions of dollars that are spent on cancer research, the medicine we were relying on was made in somebody’s kitchen,” says Angela Smith in the film, whose son, Chico, uses cannabis oils to treat his soft tissue cancer.

Chen, who was not in the film but shares its frustration with current marijuana regulations, became swayed by the medical potential of cannabis compounds early in his career, when he encountered a young patient with epilepsy whose parents were treating her with CBD. Unfamiliar with CBD, Chen and his colleagues almost called Child Protective Services to intervene—until Chen looked into the compound further and saw how much he didn’t know.

“That’s when I realized that science had completely left cannabis in the dark,” Chen says. “It was time for science to step up and really to push on this issue. I felt a duty.” Today, Chen works to understand the health benefits and risks of marijuana and its many compounds, including CBD.

The film also touches on funding challenges associated with marijuana research, an impediment Chen has encountered with his own research. While the government does fund some marijuana research, Chen says the “vast majority” of federal dollars go toward understanding the harms of cannabis, not the potential benefits. Researchers who wish to study how marijuana may improve treatment for conditions ranging from cancer to chronic pain are largely left to find the money themselves, Chen says.

These roadblocks have led many researchers, including those quoted in the film, to call for looser marijuana scheduling, but the DEA denied two such petitions in 2016. Dr. Igor Grant, director of the Center for Medical Cannabis Research at the University of California San Diego, who was not in the film, agrees that current regulations have made research more difficult, and says marijuana probably doesn’t belong in schedule I. But he says he doesn’t believe that the government is actively trying to stifle cannabis research, as many people—including some in Weed the People—have alleged.

Grant says there’s some evidence that the barriers are becoming fewer. His lab recently made history by importing research-approved marijuana from Canada, a move that suggests U.S. researchers may soon have greater access to the plant. That access, combined with lighter regulations from the government, could open new doors, Grant says.

“You would have to both reschedule it and increase the availability of manufacturers,” he says. “This could be a joint effort between states, manufacturers, academia and federal [regulators].”

This type of collaboration is crucial, Lake says, and she hopes her documentary will garner public support for it. “I’m really hoping to reach the people who really have this idea that this drug is bad,” Lake says. “It’s a matter of just changing mindsets and having them fight to have access to this plant. I do believe change is coming.”


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