Veterans' Health

Yale Study: Clinicians Often Overlook Veterans’ Mental Health Disorders

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Nationally, at least one in five military veterans who experience trauma are at a heightened risk for depression, suicide or substance abuse but are often overlooked in clinical settings because they don’t fit the criteria for post-traumatic stress disorder (PTSD), according to a Yale University-led study. The research, published June 1 in the World Psychiatry journal, examined sub-threshold PTSD, which occurs when someone experiences trauma-related symptoms that aren’t severe or long-lasting enough to warrant a PTSD diagnosis. The study, which included 1,484 veterans nationwide, found 8 percent were diagnosed with PTSD but more than 22 percent met criteria for sub-threshold PTSD. Also, in addition to 4.5 percent of veterans diagnosed with PTSD within the last month, 13 percent had sub-threshold symptoms, the study reported. Veterans with sub-threshold PTSD had a 20 percent chance of suffering from major depression in their lifetimes, compared with about 4 percent of veterans without sub-threshold symptoms, the study found.

Disparities

Low-Income Diabetics Paying High Price For Insulin

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The high cost of insulin, which has risen by triple-digit percentages in the last five years, is endangering the lives of many diabetics who can’t afford the price tag, say Connecticut physicians who treat diabetics. The doctors say that the out-of-pocket costs for insulin, ranging from $25 to upwards of $600 a month, depending on insurance coverage, are forcing many of their low-income patients to choose between treatment and paying their bills. “Some of my patients have to make the choice between rent or insulin,” said Dr. Bismruta Misra, an endocrinologist with the Stamford Health Medical Group. “So they spread out taking insulin [injecting it less frequently than a doctor has prescribed] or don’t take it.”

Experts and recent studies point to drug companies’ long-standing patents and the lack of generic or “biosimilar” insulin as key reasons why the drug is so expensive. A study by Philip Clarke, a professor of health economics at the University of Melbourne in Australia, reported that the price of insulin has tripled from 2002-2013.

Fines & Sanctions

Fewer Errors Reported By Hospitals, But Concerns Remain

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Connecticut hospitals reported fewer numbers of patients killed or seriously injured by falls or perforations during surgery or suffering from severe pressure ulcers in 2014 than in 2013, but the incidence of such “adverse events” still remains higher than in 2012, a new state report shows. The report by the Department of Public Health (DPH) shows that the total number of hospital adverse events, or errors, dropped by 12 percent — from 534 in 2013, to 471 last year. Deaths or serious injuries from falls declined from 90 to 78; perforations during surgical procedures fell from 79 to 70; and life-threatening medication errors fell from six to one. The number of patients with serious pressure ulcers dropped from 277 to 245. Rates of all four of those incidents had climbed in 2013, in part because of an expansion of required reporting on pressure sores to include “unstageable” ulcers.

Women's Health

Children’s Sexting, Internet Safety, Among Rising Worries Of Parents

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Parents are increasingly worried about the negative effects of technology – sexting, in particular – and its effects on their children’s health, according to a national poll. “Parents are seeing [sexting] happen more with their kids or kids’ friends,” said Dr. Brian Keyes, a child, adolescent and adult psychiatrist who sees patients through various non-profits including the Children’s Center in Hamden and NAFI Connecticut in Hartford. “Parents get concerned, and rightly so, as kids start to get involved in any sexually related material.”

Sexting – sending sexually explicit text, photo or video messages via mobile phone or other electronic devices – also is gaining more attention in the media, bringing it to the forefront of parents’ minds, said Keyes, who also is on the clinical faculty at the University of Connecticut School of Medicine and the Yale Child Study Center. In the C.S. Mott Children’s Hospital National Poll on Children’s Health, adults ranked sexting as the sixth health concern facing children. Forty-five percent of adults listed sexting as a top concern, the poll released in August reported.

I-Team In-Depth

Mental Health Is Main Cause Of Hospitalizations in CT, New Data Show

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Mental disorders surpassed respiratory problems and all other ailments as the leading cause of hospitalization in Connecticut in 2012 for children ages 5 to 14, teenagers and younger adults, according to a new state health department report. The report shows that the number of days that patients with behavioral health problems were hospitalized surged 5.3 percent between 2011 and 2013, to nearly 260,000 patient days. Other categories of hospitalizations, including cardiac and cancer care, declined during that time. The data show five hospitals had increases of more than 12 percent in the number of days that patients with behavioral health problems were hospitalized. The biggest increases were at Yale-New Haven Hospital, which saw the number of patients rise 61 percent, and inpatient days jump 51 percent; and Waterbury Hospital, with 26 percent more patients and a 37 percent increase in inpatient days.

Disparities

Undocumented Immigrants To Strain Safety-Net Hospitals

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Undocumented immigrants are expected to make up a larger share of Connecticut’s uninsured population next year, putting new financial pressures on safety-net hospitals that provide emergency care to everyone, state and national health experts predict. The Affordable Care Act (ACA) provides coverage options for legal immigrants, but those in the U.S. illegally cannot apply for Medicaid, even if they are poor, or buy coverage at Access Health CT (the new insurance marketplace), even if they have cash. That means illegal residents without coverage will continue turning to local emergency departments for care at a time when Connecticut hospitals face the loss of millions of dollars in federal and state subsidies to help defray the cost of uncompensated care. “This is a global problem that isn’t going away. This population (of undocumented residents) is not being addressed by any state or federal initiatives.

Fines & Sanctions

Three Doctors Fined By Medical Board, One Operated On Wrong Disc

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The state Medical Examining Board imposed fines ranging from $2,000 to $7,000 on three doctors Tuesday, including $5,000 against a Greenwich neurosurgeon who operated on the wrong disc on a patient’s spine in 2011. Dr. Mark Camel, who is affiliated with Greenwich Hospital, discovered his error during spinal surgery on Oct. 27, 2011 and then operated on the correct disc.  State investigators found that Camel admitted that he had written down the wrong spinal location during a pre-operative visit and neither he nor the patient noticed the error when signing consent forms, records indicated. When Camel was reviewing an MRI and preparing to close the patient, he noticed his mistake.  Camel immediately reported his error and has put in place protocols to be sure such an error never happens again, records show. It was the second time in two months that the board had taken up “wrong site” incidents at Greenwich Hospital.

Fines & Sanctions

Med Board Opts Not To Discipline Greenwich Anesthesiologist

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The state Medical Examining Board on Tuesday imposed no disciplinary action against a Greenwich Hospital anesthesiologist who in 2010 administered a nerve block on the wrong arm of a patient who was about to undergo a wrist arthroscopy. Though a board hearing panel had concluded that the state had proven misconduct on the part of Dr. Paul Sygall, the board voted to change the word “misconduct” to “error” and imposed no disciplinary action. State records show the hearing panel considered Sygall’s “stellar professional record” in which he had performed 10,000 procedures and his credible testimony at a hearing and concluded that he posed to “no threat to public health and safety.”

DPH records showed the error occurred because a nurse had changed equipment to the opposite side of the patient while Sygall was out of the room. Sygall administered the nerve block on the wrong side, noticed the error right away, stopped the procedure and kept the patient overnight for observation, DPH records show. In recent years, the board has fined or reprimanded other physicians for similar errors.  For example, in June 2011, the board approved a consent order fining Dr. David Heimbinder of Glastonbury $5,000 for administering a nerve block in the wrong shoulder of a patient in 2009.

Disparities

How Much Is A New Hip? Now You Can Compare Prices

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Hospitals in Connecticut charge vastly different amounts of money for the same procedure – sometimes triple the price — according to data released Wednesday by federal Medicare officials. The cost discrepancies are detailed in a report by the federal Centers for Medicare & Medicaid Services, which for the first time is making data available to the public on prices for the 100 most common medical procedures. The report shows what hospitals charge to Medicare, as well as the lower amounts that they collect from the government. In Connecticut, prices for most procedures varied widely among hospitals.  For a cardiac pacemaker implant, for example, Yale-New Haven Hospital’s average bill was $85,902, while Manchester Memorial Hospital billed a low of $22,096. Stamford Hospital billed $25, 493 to treat simple pneumonia, while Charlotte Hungerford Hospital’s average bill was $8,177.

I-Team In-Depth

Surgical Errors Climb, Bed Sores Decline In State’s Hospitals

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Reports of wrong-site surgeries increased 62 percent in the past year in Connecticut hospitals, while the number of patient deaths or disabilities resulting from surgery or falls also rose, a new state report shows. At the same time, reports of patients suffering from serious pressure ulcers declined, as a number of hospitals made progress in preventing the painful bed sores. The new Adverse Event Report, compiled by the state Department of Public Health and covering 2011, marks the second year that acute-care hospitals and other medical facilities have been publicly identified by name, as they report errors that caused harm to patients. The five hospitals with the highest rate of adverse events in 2011, calculated per 100,000 inpatient days, were: Charlotte Hungerford Hospital, in Torrington (49.2); Sharon Hospital (35.4); New Milford Hospital (32.9); Stamford Hospital (19.7); and the Hospital of Central Connecticut, in Southington and New Britain (19.3). In terms of the sheer volume of events, Yale-New Haven and its affiliated Hospital of St.