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Doug Allan

Study raises red flag for universal flu vaccine | Toronto Star - 0 views

www.thestar.com/...for_universal_flu_vaccine.html

flu

shared by Doug Allan on 29 Aug 13 - No Cached
  • A new study sounds a cautionary note for work that is being done to try to develop vaccines to protect against all subtypes of influenza.
  • The research describes a phenomenon in which vaccination against one strain of flu actually seems to raise the risk of severe infection following exposure to a related but different strain, an effect called vaccine-associated enhanced respiratory disease.
  • The scientists say it’s not currently known why the effect happens. Nor is it clear that it would be seen in other species — this research was done in piglets — or with the kinds of flu vaccines used to protect people. But they suggest the findings should be considered during the development and assessment of experimental universal flu vaccines.
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  • in British Columbia who contracted H1N1 in the spring and summer of 2009. People who had received a seasonal flu shot the previous autumn were more likely to contract the new pandemic strain.
  • Still, the finding is reminiscent of something that was observed in people in Canada during the 2009 H1N1 pandemic.
  • The authors cautioned against drawing a line between what happened to the pigs in the study and what might happen with people.
  • Her findings, which were initially dismissed by many in the global influenza research community, were later replicated in studies done in other provinces as well, leading some to dub the phenomenon “the Canadian problem.”
  • “I think . . . what they’re showing is a biological mechanism that warrants further evaluation in terms of its relevance to the use of seasonal vaccines in humans and what that may mean for the next pandemic threat,” Skowronski said.
  • It’s a frustrating target for flu vaccine designers. There are 17 known hemagglutinins, which give flu viruses the H in their name. (Most don’t currently infect people.) The hemagglutinins on H1 viruses look different than those on H3 viruses, and antibodies to one don’t protect against another.
  • Even within a subtype — H1, for instance — there are different strains, and a vaccine against one might offer lots, some or no protection against another. And all these hemagglutinins are constantly changing, which is why flu vaccines have to be updated almost every year.
  • Instead of being protected, the H1N2-vaccinated pigs developed more severe disease than exposed pigs that hadn’t been pre-vaccinated. When the researchers tested the blood of the vaccinated pigs, they found high levels of antibodies that attached to the stalk of the H1N1 hemagglutinin, but not to the head of the protein.
  • Skowronski and others suggested the work demonstrates the complexity of influenza immunology — the science of how the viruses interact with immune systems. “The problem is everybody wants influenza to be simple and be like other vaccine-preventable diseases. And it’s not,” Skowronski said.
  • Infectious diseases expert Dr. Michael Osterholm said with influenza, there is always a complicated interplay between the virus and the person the virus infects, one that is influenced by what viruses and vaccines the person’s immune system has previously encountered.
  • “It really drives home the need to be very cautious about what are we actually accomplishing.”
  • Doug Allan on 29 Aug 13
     
    Mandatory flu shot anyone?
Doug Allan

Why this expert is against making flu shots mandatory for health-care workers - The Glo... - 0 views

www.theglobeandmail.com/...article21057766

flu

shared by Doug Allan on 27 Oct 14 - No Cached
  • “A few years ago, I was also for mandatory flu shots [for health-care workers],” Gardam says. “Then what happened is I started reading and I started going back to the original studies. I don’t feel that I can sugar-coat those any more.”
  • It turns out that the evidence in favour of mandatory vaccination policies is far from conclusive. For instance, a review of the medical literature published in the Cochrane Database of Systematic Reviews in July, 2013, found vaccinated health-care workers had no measurable benefit on flu rates or the number of related complications of long-term-care residents. Another review by researchers from the U.S. Centers for Disease Control and Prevention found the quality of evidence for reduced influenza death and total number of cases among patients to be moderate and low, respectively.
  • Gardam says he is still being criticized by other public-health professionals for an opinion piece published in the summer in which he argued that such campaigns are not based in evidence. Another physician, based in Western Canada, is so concerned about the consequences of expressing his opposition to mandatory flu-shot campaigns that he agreed to be interviewed on condition of anonymity.
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  • The truth is the flu shot is about 60-per-cent effective, on average, in healthy adults. Depending on the year, that number can vary. It’s certainly better than nothing, and until a better vaccine comes along, it is the best way to prevent the flu.
  • The physician argues that given the limited effectiveness of the annual flu shot and the lack of evidence showing that mandatory campaigns can reduce transmission rates, health-care workers should retain the ability to choose.
  • He also points out that a few of the loudest voices to have argued in favour of mandatory vaccination policies have received research and other funding from vaccine-makers.
  • It’s also true that there’s no reliable, high-quality evidence showing that vaccinating every health-care worker greatly reduces flu cases and deaths.
  • So why create a battle with health-care workers instead of using the facts to make a reasoned, compelling argument encouraging them to get the flu shot, wash their hands and stay home when sick?
  • Coercion and threats may work in the short term, but they surely aren’t a good basis for truly effective health policy.
Doug Allan

Scientists say UK wasted £560m on flu drugs that are not proven | World news ... - 0 views

www.theguardian.com/...ted-560m-stockpiling-flu-drugs

flu

shared by Doug Allan on 10 Apr 14 - No Cached
  • The government has wasted half a billion pounds stockpiling two anti-flu drugs that have not been proved to stop the spread of infection or to prevent people becoming seriously ill, according to a team of scientists who have analysed the full clinical trials data, obtained after a four-year fight.
  • But the Cochrane Collaboration, a group of independent scientists who investigate the effectiveness of medicines, says that the best Tamiflu can do is shorten a bout of flu by approximately half a day – from around seven to 6.3 days.
  • They also found worrying side-effects in people taking it to prevent flu, which had not been fully disclosed, including psychiatric and kidney problems. "There is no credible way these drugs could prevent a pandemic," said Carl Heneghan, professor of evidence-based medicine at Oxford University and one of the team. They are now calling for the WHO to review its advice to countries and for the UK government not to renew its stockpile when the drugs go out of date.
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  • "When one thinks of what half a billion pounds could have been spent on in the NHS, let alone around the world, one has to be pretty scathing about that decision."
  • The findings come at the end of a gruelling battle with the drug companies to see the actual data produced during all the trials, rather than the often ghostwritten and always company-funded scientific papers selectively published in medical journals. In a watershed development, they have put all the company data online, to allow anybody to interrogate the source material.
  • The Department of Health said it looked forward to receiving the report, but insisted that the stockpile was important.
  • Roche said it fundamentally disagreed with the review and maintained that the drugs were a vital treatment option for flu patients. Cochrane had got it wrong, the company said. "The report's methodology is often unclear and inappropriate, and their conclusions could potentially have serious public-health implications," said UK medical director Dr Daniel Thurley. "We'd absolutely defend [Tamiflu] for treatment and prevention." A recent study of 30,000 patients given Tamiflu in the swine-flu pandemic, published in the Lancet, found it saved lives.
Govind Rao

Lancaster House | Headlines | Arbitrator upholds mandatory flu shot policy for health... - 0 views

lancasterhouse.com/...92xc48jz

infectious disease lancaster house arbitrator flu shot

shared by Govind Rao on 07 Feb 14 - No Cached
  • February 7, 2014
  • Dismissing a union policy grievance, a British Columbia arbitrator held that a provincial government policy requiring health care workers to get a flu shot or wear a mask while caring for patients during flu season was a reasonable and valid exercise of the employer's management rights.
  • Arbitrator upholds mandatory flu shot policy for health care workers
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  • The Facts: In 2012, the Health Employers' Association of British Columbia introduced an Influenza Control Program Policy requiring health care workers to get a flu shot or wear a mask while caring for patients during flu season, which the union grieved. The employer, representing six Health Authorities in B.C., implemented the policy in response to low vaccine coverage rates of health care workers and an inability to achieve target rates of vaccination through campaigns promoting voluntary vaccination commencing in 2000. Acting on the advice of Dr. Perry Kendall, B.C.'s Provincial Health Officer, and relying on evidence suggesting that health care worker vaccination and masking reduce transmission of influenza to patients, the employer moved towards a mandatory policy. Asserting that members had the right to make personal health care decisions, the B.C. Health Sciences Association filed a policy grievance, contending that the policy violated the collective agreement, the Human Rights Code of British Columbia, privacy legislation, and the Canadian Charter of Rights and Freedoms. Extensive expert medical evidence during the hearing indicated that immunization was beneficial for the health care workers themselves, but was divided as to whether immunization of health care workers reduced transmission to patients. The evidence was similarly divided as to the utility of masking.
  • Comment:
  • Having determined that the policy was reasonable under the KVP test, Diebolt turned to the Irving test applicable to policies that affect privacy interests, which he characterized as requiring an arbitrator to balance the employer's interest in the policy as a patient safety measure against the harm to the privacy interest of the health care workers with respect to their vaccination status. Determining that the medical privacy right at stake in the annual disclosure of one's immunization status did not rise to the level of the right considered in Irving, which involved "highly intrusive" seizures of bodily samples, Diebolt further held that the employer's interest in patient safety related to a "real and serious patient safety issue" and that "the policy [was] a helpful program to reduce patient risk." Diebolt also considered that the employer had chosen the least intrusive means to advance its interest in light of the unsuccessful voluntary programs and in providing the alternative of masking. To quote the arbitrator: "[W]eighing the employer's interest in the policy as a patient safety measure against the harm to the privacy interest of the health care workers and applying a proportionality test respecting intrusion, based on the considerations set out above I am unable to conclude that the policy is unreasonable."
  • Diebolt also upheld the masking component of the policy as reasonable, finding on the evidence that masking had a "patient safety purpose and effect" by inhibiting the transmission of the influenza virus, and an "accommodative purpose" for health care workers who conscientiously objected to immunization. Observing that mandatory programs have been accepted in New Brunswick and the United States, Diebolt also considered that regard should be paid to the precautionary principle in health care settings that "it can be prudent to do a thing even though there may be scientific uncertainty." Moreover, he held that the absence of a reference to accommodation did not make the policy unreasonable, noting that this duty was a free-standing legal obligation that was not required explicitly to be incorporated into the policy and that any such issue should be addressed in an individual grievance if made necessary by the policy's application. He also rejected the union's submission that the policy could potentially harm health care workers' mental and physical health, considering the evidence to fall short of "establishing a significant risk of harm, such that the policy should be considered unreasonable."
  • Turning first to the KVP test, specifically whether the policy was consistent with the collective agreement and was a reasonable exercise of the employer's management rights, Diebolt noted that the only possible inconsistency with the collective agreement would be with the non-discrimination clause, given his ruling regarding the scope of Article 6.01, and that he would address this issue in his reasons with respect to the Human Rights Code. Diebolt then turned to the reasonableness of the policy and found, after an extensive review of the conflicting medical evidence that: (1) the influenza virus is a serious, even fatal disease; (2) immunization reduces the probability of contracting the disease; and (3) immunization of health care workers reduces the transmission of influenza to patients. Accordingly, Diebolt reasoned that the facts militated "strongly in favour of a conclusion that an immunization program that increases the rate of health care immunization is a reasonable policy."
  • Diebolt instead regarded the policy as a unilaterally imposed set of rules, making it necessary to establish that they were a legitimate exercise of the employer's residual management rights under the collective agreement and met the test of reasonableness set out in Lumber & Sawmill Workers' Union, Local 2537 v. KVP Co., [1965] O.L.A.A. No. 2 (QL) (Robinson). In addition, given that the policy contained elements that touched on privacy rights, Diebolt held that the policy must also meet the test articulated in CEP, Local 30 v. Irving Pulp & Paper, Ltd., 2013 SCC 34 (CanLII) (reviewed in Lancaster's Disability & Accommodation, August 9, 2013, eAlert No. 182), in which the Supreme Court of Canada held that an employer cannot unilaterally subject employees to a policy of random alcohol testing without evidence of a general problem with alcohol abuse in the workplace, based on an approach of balancing the employer's interest in the safety of its operations against employees' privacy.
  • In a 115-page decision, Arbitrator Robert Diebolt denied the grievance and upheld the policy as lawful and a reasonable exercise of the employer's management rights.
  • The Decision:
  • As noted by the arbitrator, no Canadian decision has addressed a seasonal immunization policy similar to the policy in this case. However, a number of decisions have addressed, and generally upheld, outbreak policies mandating vaccination or exclusion on unpaid leave. B.C. Health Sciences Association President Val Avery expressed his disappointment in the arbitrator's ruling, stating: "Our members believed they had a right to make personal health care decisions, but this policy says that's not the case." Avery said the Association is studying the ruling and could appeal. On the other hand, Dr. Perry Kendall, B.C.'s chief medical officer of health, applauded the decision, calling it a "win for patients and residents of long-term care facilities."
  • In 2012, Public Health Ontario changed its guidelines to call for mandatory flu shots because not enough health care workers were getting them voluntarily. Other municipal public health units – led by Toronto Public Health – also called for mandatory shots. Ontario's chief medical officer of health, Dr. Arlene King, stated in November 2013 that, while the government wants to see a dramatic increase in the number of health care workers who get a flu shot, it is stopping short of making vaccinations compulsory, but has instead implemented a three-year strategy to "strongly encourage health care workers to be immunized every year." She acknowledged, however, that the number of health care workers getting inoculated remains at 51 percent for those employed in hospitals and 75 percent for those in long-term care homes. For further discussion of the validity of employer rules, see section 14.1 in Mitchnick & Etherington's Leading Cases on Labour Arbitration Online.
Govind Rao

Union: Can't force mask use ; HEALTH: About 30 hospitals implemented policy which force... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|kldn|20150911|229048645

from heather Ontario infectious disease nursing nurses union

shared by Govind Rao on 11 Sep 15 - No Cached
  • The Kirkland Lake Northern News Fri Sep 11 2015
  • TORONTO -- The Ontario Nurses Association says hospitals will no longer be allowed to shame health-care workers into getting a flu shot following an arbitrator's ruling striking down a "vaccinate or mask" policy. About 30 Ontario hospitals implemented the policy, which forces nurses and other hospital workers to wear an unfitted surgical mask for the entire flu season if they do not get the influenza vaccine, ONA president Linda Haslam-Stroud said Thursday. The test case was against the Sault Area Hospital in Sault Ste. Marie, which tried to use the policy to boost their staff immunization rates, added Haslam-Stroud.
  • "The sad part about it is it was giving our patients a false sense of security, and we knew that," said Haslam-Stroud. The Ontario Hospital Association said it was disappointed in the arbitrator's ruling. "In light of the arbitrator's decision we are considering a number of options," said OHA president Anthony Dale. "In addition, we will continue to work with government and our partners on best practices for the upcoming flu season."
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  • Arbitrator Jim Hayes found the "vaccinate or mask" policy was unreasonable, and "a coercive tool" to force heath-care workers to get the flu shot. Experts testified that it was illogical to force healthy nurses to wear masks, and Hayes concluded the masks were not protecting patients or nurses from the flu.
  • "They were basically coercing and shaming nurses into getting the influenza vaccine if they individually chose not to take it," she said. "They made them all wear masks and they had little stickers on their name tag that everyone knew meant 'I don't have my vaccine.' " The policy made private medical information public because everyone could tell who had been vaccinated and who had not, said Dr. Michael Gardam, director of infection prevention and control at the University Health Network and Women's College Hospital in Toronto. "Essentially they are outing you, because your personal health information -- whether you get vaccinated or not -- is now public knowledge because you're forced to wear a mask," said Gardam. "People know who you are."
  • The influenza vaccine is only about 40 to 60 per cent effective even in good years, said Gardam, which means all hospital workers should wear masks all the time if they were actually effective at preventing the spread of the flu. "So the only way you can really explain that argument is to say 'well, it's not really that the masks are working,' " he said. "It's because the masks are a way of driving you towards vaccination."
  • The policy "was symbolic rather than a scientifically based tool in the fight against influenza," and amounted to a "draconian shaking of the finger at nurses," said Haslam-Stroud. The ONA said there are provisions in its agreements with hospitals that require a non-vaccinated nurse to move to another ward if the medical officer of health determines there is a flu outbreak in the area where he or she works. "I am not going to suggest that anyone should be forced to take the vaccine," said Haslam-Stroud. "I personally take it, but it is an individual right as a nurse." The "vaccinate or mask" policy started in B.C. hospitals before moving to some health-care facilities in New Brunswick and Ontario.
  • FRANK GUNN/CANADIAN PRESS FILES • The Ontario Nurses Association says hospitals will no longer be allowed to shame health-care workers into getting a flu shot following an arbitrator's ruling striking down a "vaccinate or mask" policy.
Govind Rao

Ontario Council of Hospital Unions - defending healthcare in every community - 0 views

www.ochu.on.ca

from heather cupe Ontario private clinics privatization

shared by Govind Rao on 17 Sep 13 - No Cached
  • Request for an inquest was denied; Family sues hospital for son's death, Sept. 12 Toronto Star - Mon Sep 16 2013 Family sues hospital for son's death, Sept. 12
  • the Ontario Council of Hospital Unions (OCHU), which represents front-line staff at St. Joseph's in Hamilton where the death occurred, publicly called for an inquest.
  • Mandatory flu shot for health staff misdirected November 2, 2012To save lives, prevent thousands of needless deaths stop provincial policies that cause medical errors, bed sores and superbug ... [Read More]infections
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  • To target health care workers and take away their right to choose by making the flu shot mandatory, is misdirected in the face of recent evidence that 41 per cent of people who get a flu vaccine receive no protection against the flu,” says Michael Hurley the president of the Ontario Council of Hospital Unions (OCHU).
  • Mandatory Flu Vaccinations for Health Care Workers CUPE encourages health care workers to get an influenza vaccination if they can safely do so. But making flu shots mandatory for health care workers is a serious intrusion on the freedom and personal autonomy of health care workers that may sometimes have detrimental effects on their own health.Forcing people to take flu shots against their will may well undermine public confidence in vaccination programs, even vaccination programs with an excellent results and high safety standards.
  • Govind Rao on 16 Oct 13
     
    Union calls for halt to move procedures from hospitals to private clinics Submission by the Ontario Council of Hospital Unions / CUPE on the Proposed amendment to O. Reg. 264/07 made under the Local Health System Integration Act, 2006 and A Regulation under the Independent Health Facilities Act - Prescribed Persons .  The Ontario Council of Hospital Unions / CUPE represents 30,000 workers in hospitals across the province, including Registered Practical Nurses, service workers, and administrative workers. We are opposed to the government’s plan to move surgical, diagnostic, and other work from public hospitals to private clinics. Our objections can be summarized as falling within seven distinct areas: 1] Quality • Even minor operations can go wrong. We believe that, in contrast with hospitals, it is unlikely private clinics will be able to handle emergencies and that they will likely simply call EMS. Will ambulances be able to move patients to hospitals when things go wrong? (We say “when” advisably, as sooner or later there will be problems.) Indeed, private surgical clinics first came to public attention when a patient died and the paramedics arrived to find a patient with no vital signs. Is it appropriate to establish a system that inherently requires extra time to effectively treat patients who fall into emergency situations? This is particularly troubling as underfunding and restructuring have challenged EMS response times. The government and government officials must be prepared to accept responsibility for such deaths if this plan is approved. 
Govind Rao

No flu shot means health-care workers must wear masks - 0 views

www.timescolonist.com/...kers-must-wear-masks-1.2122902

from heather bc infectious disease

shared by Govind Rao on 01 Dec 15 - No Cached
  • December 1, 2015
  • People who have not been vaccinated and are visiting or working at a B.C. health- care facility are once again being asked to don masks. The mask policy goes into effect today, the official start of flu season, and continues until March 31. Flu is usually most prevalent between late December and early January. The B.C. Health Ministry said each year there are about 3,500 deaths from the flu and its complications in Canada. Provincial health officer Perry Kendall said the flu causes by far the most deaths among vaccine-preventable diseases, outpacing all others combined.
Govind Rao

Mandatory flu vaccinations for health care workers |Defending Public Healthcare - 0 views

ochuleftwords.blogspot.ca/...u-vaccinations-for-health.html

from heather Ontario cupe hospital infectious disease

shared by Govind Rao on 19 Dec 13 - No Cached
  • December 18, 2013
  • Mandatory flu vaccinations for health care workers
  • But making flu shots mandatory for health care workers is a serious intrusion on the freedom and personal autonomy of health care workers that may sometimes have detrimental effects on their own health.    Forcing people to take flu shots against their will may well undermine public confidence in vaccination programs, even vaccination programs with an excellent results and high safety standards. 
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  • Employers do not provide any sick leave to half of CUPE hospital workers. 
Govind Rao

New York City Mandates Flu Shots for Toddlers Even After Centers for Disease Control (C... - 0 views

www.globalresearch.ca/...5423201

from heather infectious disease US

shared by Govind Rao on 06 Jan 15 - No Cached
  • By Ethan A. Huff Global Research, January 06, 2015
  • Unless their parents opt for a medical or religious exemption, young school children in New York City will soon be required to get a flu shot in order to attend preschool or gain access to a child care facility.
  • What makes these new requirements even more outrageous is the fact that the U.S. Centers for Disease Control and Prevention (CDC) recently admitted that this year’s flu shot doesn’t work because it doesn’t target the appropriate strains. This, on top of the fact that flu shots are already a dismal failure when it comes to safety and effectiveness. “… roughly half of the H3N2 viruses analyzed are drift variants: viruses with antigenic or genetic changes that make them different from that season’s vaccine virus,” reads a recent press release issued by the CDC. “This means the vaccine’s ability to protect against those viruses may be reduced.”
Govind Rao

H1N1 virus returns, triggering flu vaccine warning - British Columbia - CBC News - 0 views

www.cbc.ca/...-flu-vaccine-warning-1.2469285

from heather infectious disease

shared by Govind Rao on 19 Dec 13 - No Cached
  • oung children, people with chronic health conditions advised to get vaccinated
  • Dec 18, 2013
  • Health officials in B.C. are advising young people to get a flu vaccine after determining that the H1N1 influenza strain, which circulated during the global pandemic in 2009, has returned to become the predominant strain this flu season.
Govind Rao

Fraser Health's automated calls on flu vaccine "inappropriate," says HEU | Hospital Emp... - 0 views

www.heu.org/...nappropriate%E2%80%9D-says-heu

from heather bc cupe hai infectious disease

shared by Govind Rao on 28 Nov 13 - No Cached
  • Newsletter November 27, 2013
  • The Hospital Employees’ Union says that a robocall campaign launched by Fraser Health on Monday night is highly inappropriate. The automated calls appear to be directed to the home numbers of HEU members who have not yet “self-reported” to their employer on whether or not they have received the flu vaccine for the current flu season.
Govind Rao

Should we have Mandatory Flu Shots for Health Care Workers? | The Current with Anna Mar... - 0 views

www.cbc.ca/...-shots-for-health-care-workers

from heather bc infectious disease

shared by Govind Rao on 01 Nov 13 - No Cached
  • Monday, October 21, 2013
  • For the past year, B.C.'s attempts to force all of its health care workers to vaccinate against flu have been in dispute. While other provinces and Canadian health jurisdictions have tried to encourage health care workers in this vein, no other Canadian jurisdiction has tried to go as far. As we head into flu season, we examine which is more dangerous ... the directive or the disease?
Govind Rao

B.C. policy requiring health-care workers to get flu shot or wear masks upheld - Brando... - 0 views

www.brandonsun.com/...flu-shot-policy-229103411.html

from heather bc infectious disease

shared by Govind Rao on 01 Nov 13 - No Cached
  • By: Helen Branswell, The Canadian Press Thursday, Oct. 24, 2013
  • A British Columbia health-care workers union has lost its grievance against a provincial policy requiring members to get a flu shot or wear a mask during flu season — a development that may embolden other provinces to follow suit.
  • An arbitrator appointed by the provincial Labour Relations Board ruled the policy is reasonable, and a valid exercise of the employer's management rights.
Govind Rao

Saskatchewan pauses mandatory flu shot policy for health-care workers | Globalnews.ca - 0 views

globalnews.ca/...policy-for-health-care-workers

from heather Saskatchewan infectious disease

shared by Govind Rao on 21 Oct 15 - No Cached
  • October 20, 2015
  • By Jennifer Graham
  • REGINA – Health officials in Saskatchewan say health-care workers won’t be forced to get a flu shot or wear a surgical mask while caring for patients. The Medical Health Officers’ Council of Saskatchewan says getting the shot or wearing a mask will be voluntary this flu season while health authorities review a ruling from Ontario.
Govind Rao

Flu shots won't be mandatory for health-care workers in Alberta - Calgary - CBC News - 0 views

www.cbc.ca/...-care-workers-policy-1.3274107

from heather Alberta infectious disease

shared by Govind Rao on 16 Oct 15 - No Cached
  • Hospital units have immunization 'champions' appointed to spread the word
  • Oct 16, 2015
  • Health officials say there are no plans to impose mandatory flu vaccinations on health-care workers in Alberta this year.
Irene Jansen

HCA, Giant Hospital Chain, Creates a Windfall for Private Equity - NYTimes.com - 0 views

www.nytimes.com/...ndfall-for-private-equity.html

us hospital hca fraud staffing quality corporation

shared by Irene Jansen on 22 Aug 12 - No Cached
  • profits at the health care industry giant HCA, which controls 163 hospitals from New Hampshire to California, have soared
  • The big winners have been three private equity firms — including Bain Capital, co-founded by Mitt Romney, the Republican presidential candidate — that bought HCA in late 2006.
  • only a decade ago the company was badly shaken by a wide-ranging Medicare fraud investigation that it eventually settled for more than $1.7 billion
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  • 35 buyouts of hospitals or chains of facilities in the last two and a half years by private equity firms
  • Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the cost of its medical staff
  • HCA decided not to treat patients who came in with nonurgent conditions, like a cold or the flu or even a sprained wrist, unless those patients paid in advance.
  • In one measure of adequate staffing — the prevalence of bedsores in patients bedridden for long periods of time — HCA clearly struggled. Some of its hospitals fended off lawsuits over the problem in recent years, and were admonished by regulators over staffing issues more than once.
  • inadequate staffing in important areas like critical care
  • Many doctors interviewed at various HCA facilities said they had felt increased pressure to focus on profits under the private equity ownership. “Their profits are going through the roof, but, unfortunately, it’s occurring at the expense of patients,” said Dr. Abraham Awwad, a kidney specialist in St. Petersburg, Fla., whose complaints over the safety of the dialysis programs at two HCA-owned hospitals prompted state investigations.
  • One facility was fined $8,000 in 2008 and $14,000 last year for delaying the start of dialysis in patients, not administering physician-prescribed drugs and not documenting whether ordered tests had been performed.
  • Claiming he provided poor care, the other hospital did not renew Dr. Awwad’s privileges. Dr. Awwad is suing to have them reinstated.
  • “If you were a for-profit hospital with investors and shareholders,” said Paul Levy, a former nonprofit hospital executive in Boston unaffiliated with HCA, “there would be a natural tendency to be more aggressive and to seek more revenues.” Executives at profit-making hospitals are “judged in greater measure by profitability” than the administrators of nonprofit hospitals, he said.
  • some of HCA’s tactics are now under scrutiny by the Justice Department. Last week, HCA disclosed that the United States attorney’s office in Miami has requested information about cardiac procedures at 10 of its hospitals in Florida and elsewhere.
  • HCA’s cardiac business is extremely lucrative, and the Justice Department has requested reviews that HCA conducted that indicate some of the heart procedures at some of its hospitals might not have been necessary and resulted in unjustified reimbursements from Medicare and other insurers.
  • Small and nonprofit hospitals are closing or being gobbled up by medical conglomerates, many of which operate for a profit and therefore try to increase revenue and reduce costs even as they improve patient care. The trend toward consolidation is likely to accelerate under the Obama administration’s health care law as hospitals grapple with what are expected to be lower reimbursements from the federal and state governments and private insurers.
  • Columbia/HCA became the target of a widespread fraud investigation in the late 1990s, which led to one of the largest Medicare settlements ever.
  • HCA wanted to attract more patients to its emergency rooms, and it did. Annual visits climbed 20 percent from 2007 to 2011. But while emergency departments are often a critical source of patient admissions, they are frequently money-losers because many patients do not have insurance. HCA found a solution: it figured out how to be paid more for the patients it was seeing.
  • Nearly overnight, HCA’s patients appeared to be much, much sicker.
  • No one has accused HCA of up-coding, or billing for more expensive services that were not needed — one of the complaints made against it a decade ago.
  • The acting head of Medicare is Marilyn B. Tavenner, a former HCA executive who left there in 2005 to become the secretary of Health and Human Resources in Virginia.
  • Several former emergency department doctors at Lawnwood Regional Medical Center in Fort Pierce, Fla., said they frequently had felt compelled to override the screening system in order to treat patients.
  • When the doctors failed to meet the hospital’s goals for how many patients should be considered emergencies, “they really started putting pressure on.”
  • Regulators in several states have taken HCA hospitals to task over screening out patients too aggressively, including situations where the screening missed serious conditions.
  • “Staffing is critical,” said Courtney H. Lyder, the dean at the UCLA School of Nursing and an expert on wound care. “When you see high levels of wounds, you usually see a high level of dysfunctional staff,” he said.
  • HCA owned eight of the 15 worst hospitals for bedsores among 545 profit-making hospitals nationwide, each with more than 1,000 patient discharges, tracked by the Sunlight Foundation using Medicare data from October 2008 to June 2010.
  • an examination of lawsuits shows bedsore problems have been persistent at several HCA facilities
  • The hospital was cited twice by Florida regulators, in 2008 and 2010, for having inadequate numbers of nurses on its staff to oversee wound care for patients.
Govind Rao

The evidence and politics of mandatory health care worker vaccination - Healthy Debate - 0 views

healthydebate.ca/...health-care-worker-vaccination

from heather infectious disease

shared by Govind Rao on 06 Feb 14 - No Cached
  • by Sophia Ikura, Christopher Doig & Andreas Laupacis (Show all posts by Sophia Ikura, Christopher Doig & Andreas Laupacis) February 6, 2014
  • Unions oppose mandatory vaccination policies
  • ONA representative Vicki McKenna
  • ...2 more annotations...
  • However, the BC government and New York State have instituted policies that require workers to either be vaccinated or wear a mask.
  • Michael Gardam, Medical Director of Infection Prevention and Control at University Health Network says that the debate has galvanized a growing group of experts, including the authors of the Cochrane review, who believe the limited efficacy of the flu shot generally does not warrant a policy of mandatory vaccination for workers.
Govind Rao

Ontario Nurses' Association | Flu Prevention is More than a Shot in the Arm: Ontario Nu... - 0 views

www.newswire.ca/...sociation-launches-ad-campaign

from heather nursing Ontario union infectious disease

shared by Govind Rao on 11 Dec 13 - No Cached
  • LONDON, ON, Dec. 10, 2013 /CNW/ - The Ontario Nurses' Association (ONA) has launched a new ad campaign in London and St. Thomas that calls for an end to the stigmatization of nurses who choose not to have a flu vaccine. ONA is also calling for the provincial government to work collaboratively to develop a province-wide, comprehensive and truly effective policy to fight the spread of influenza.
Govind Rao

Hospitals may ask staff to get flu shots - Infomart - 0 views

www.fpinfomart.ca/...181975535

from heather infectious disease

shared by Govind Rao on 07 Nov 13 - No Cached
  • The Brantford Expositor Thu Nov 7 2013
  • LONDON --Tired of waiting for Ontario to protect the vulnerable from deadly flu, hospitals are talking about requiring health care workers to get vaccinated. It's a measure that would save lives, but anger health care unions that have fought against mandatory flu shots. "Some groups of hospitals are talking," said Dr. Allison McGeer, a microbiologist and director of infectious disease at Mount Sinai Hospital in Toronto.
Irene Jansen

Should health care workers be required to get the flu vaccine? Healthy Debate Nov 10, 2011 - 0 views

www.healthydebate.ca/...fluvaccine

health and safety hhr ontario

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Is it time for Ontario to make the flu vaccine mandatory for health care workers?
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