Local, state and national news of interest to the physician community

January 3, 2024

Mental health emergency room concerns are front and center following a pre-Christmas shooting at a Richmond hospital that left two people injured.

Investigations continue into the December 22 shooting at the Chippenham Hospital ER. At 4 a.m. that morning, 27-year-old Glen Allen man Rasheed Pope, Jr. admitted himself for a mental health evaluation. He suddenly drew a weapon and began firing; a patient was hit, suffering life-threatening injuries, and a Chesterfield police officer was grazed.

Pope was taken into custody without incident. He's been charged with attempted murder and use of a firearm in the commission of a felony. Calls for metal detectors at HCA facilities grew following the incident, and the hospital announced new security measures in response.

Chippenham isn't the only local hospital to face a sudden security crisis. Last May, a stairwell quarrel erupted in gunfire at VCU Medical Center, leaving a hospital employee dead and spurring sweeping safety changes at the facility. The shooter, a fellow co-worker, was convicted of second-degree murder and sentenced to 20 years in prison last month.

A VDH report released December 20 assigns fault to Parham Doctors Hospital in its care of Irvo Otieno (pictured at right), a 28-year-old man treated there for a mental health crisis who later died at Central State Hospital in the custody of sheriff's deputies. "Parham staff were found to be 'not in compliance' with health guidelines for hospitals that treat mental health crisis patients. The report also states that Otieno was never examined by a psychiatrist during his six-hour stay in the emergency department," the Richmond Times-Dispatch says.

ALSO:

• Sweeping changes to state's psychiatric hospital system recommended by state report. (Henrico Citizen).
• State psychiatric hospitals have no say in admissions; discharges difficult. (Richmond Times-Dispatch).
• Congress may allow Medicaid to treat substance abuse in mental hospitals for first time in nearly 60 years. (Politico)

Flovent is the go-to preventative inhaler for thousands of asthma patients. Yet, beginning this past Monday (January 1), its manufacturer, GSK, has discontinued it. In its place will be "authorized generics" that are identical in function but not in marketed form, CBS News reports.

Physicians and concerned patients now worry they will encounter difficulties with refills, as insurer red tape may cause coverage delays in switching to the new forced alternatives, which also appear to be less widely covered, WSJ notes. Patients, physicians and pharmacists are urged to touch base with insurers as soon as possible to avoid any hiccups. One physician has described the situation as a "huge shock to the system," poorly timed in the midst of respiratory virus season.

The manufacturer claims it is providing "potentially lower cost alternatives," but CNN notes that it "is making the switch at precisely the time a change in Medicaid rebates could cause the company to have to pay large [inflation] penalties because of price increases on Flovent."



IN RELATED NEWS... Find out why 2024 will be a crucial year for the government's Medicare drug price negotiation program here... $35 insulin price caps for many patients went into effect January 1 (CNN)... In the face of Biden administration moves, drugmakers plan to raise U.S. prices for over 500 medications this month (Reuters)... Can drug prices be too low? For generic injectables, the answer is yes (NPR).

A recent study found that a whopping 32% of academic physicians are burned out and fed up with a lack of professional fulfillment, giving more than just some thought to leaving their facility within the next two years.

Who's most at risk for dropping out? "Physicians practicing anesthesiology reported the highest rate of intention to leave at 46.8%. Physicians practicing gastroenterology (41.3%), thoracic surgery (40.2%), neurological surgery (40.0%), critical care (39.8%), and radiology (39.8%) also had high rates of intention to leave," RevCycleIntelligence reports.

A "comprehensive approach to reduce physician turnover" is recommended by the study, including "prioritizing initiatives that address burnout, professional fulfillment, and other well-being factors."

A doctor recently drew harsh criticisms but also received plenty of support for explaining why he did not step in to help with a medical emergency while traveling onboard a commercial flight. When the call seeking a doctor was issued over the telecom, the 30-year-old internist remained silent despite prodding from an increasingly frustrated fellow passenger. "Normally, I would present myself to the cabin crew and help out, but after several hours of boozing, I was pretty drunk. I was not able to think clearly and probably would have done more harm than good." As his supporters note, the doctor was on his own time and perfectly within his right to enjoy free drinks, and his decision not to intervene may have averted poor judgments that could have further harmed the patient. (Newsweek)

Scientists have nervously kept watch over chronic wasting disease, an infectious, always fatal neurological disease with no cure currently exclusive to deer. The National Wildlife Health Center issued an update in December which noted the disease's expansion into 32 states (including northern and southwestern Virginia) and four Canadian provinces despite efforts to contain it.

"The illness has earned the nickname 'zombie deer disease' because it eats away at the brain and causes stumbling, excessive drooling and head lowering, blank stares, listlessness, and lack of fear of people," Everyday Health reports.

The CDC warns that there is a very real possibility this disease could make the jump from cervids (deer, moose, and elk) to humans, especially through meat consumption. Should it ever do so, the prion-based disease would be particularly difficult to contend with.

IN RELATED NEWS... Another zoonotic infection: A western equine encephalitis case is the first in Argentina in over twenty years. (WHO)

A specific California government code allows medical groups to establish 70 as a mandatory retirement age for physicians. However, a recent decision by the U.S. Equal Employment Opportunity Commission (EEOC) has deemed that code (and all medical group policies based upon it) in violation of federal discrimination laws.

As a result, San Diego-based Scripps Clinic Medical Group has agreed to pay affected doctors a total of $6.875 million. The medical group claims its 2014 policy, "which required doctors age 75 and older to retire," was established using the California state code and "was put in place to enhance patient safety," MedPageToday reports.

In the settlement, the medical group did not admit liability, claiming the clinic "[did] not believe our policy was unlawful, but did not wish to be involved in litigation with the EEOC." The age cutoff was rescinded in 2018 after EOCC caught wind of the policy.

The negative consequences of private equity buyouts in health care are widely known: Increased medical costs for the patient, corners cut for the bottom line, and lower quality and axed medical services have all been observed. But just how bad can care get?

"A new study shows an increase in the rate of inpatient complications, including infections and falls, though patients were no more likely to die," The New York Times reports. Within three years of a buyout, adverse events increased 25% among Medicare patients. Central line bloodstream infections (CLABSI) increased an unnerving 38%. These events persisted "despite a likely lower-risk pool of admitted Medicare beneficiaries, suggesting poorer quality of inpatient care."

Researchers note the most likely explanation for the findings was fewer hospital employees, an issue encountered across the medical field but also likely exacerbated in private equity's case by cost-cutting policies.

RAM Events & News

And Don't Forget Your White Coat!!

The upcoming General Assembly session will be another important one with issues likely including COPN and scope of practice. These issues may carry significant consequences for you, your practice, and your patients. We'll also have a number of new legislators in the General Assembly who will need to be educated on our issues.

WE NEED YOU to be a leader on the legislative front! Please continue to help us contribute to the conversation by making plans to join us for one or both of our upcoming Lobby Days (Tuesday, January 23 and Monday, February 19).

Block your calendar from 7:15 – 11:30 a.m. on these lobby days to meet with local legislators. As always, you'll be briefed by MSV lobbyists about what's happening that day at the General Assembly and we'll meet in small groups with legislators. RAM staff will arrange these meetings and provide you with an easy-to-follow personal schedule.

Medi¢: The Business of Medicine

Telemedicine has become a means for patients to overcome numerous barriers to healthcare access. But challenges still exist, including technology, insurance coverage, comfort level, and regulatory compliance. Check out this video interview with Brandon Welch, MS, PhD, founder and CEO of doxy.me, who offers advice for providers who may be considering incorporating telemedicine into their practice.

Other Medical Business News:

• "A Seat at the Table": Physician unionization saw a dramatic uptake in 2024. (MedPageToday)
• Hospitals and insurers hope AI can help make billing and processing more efficient. (Politico)
• Consulting firm McKinsey & Co. to pay $78 million in opioid epidemic settlement. (Reuters)

• Cognitive impairment following severe COVID lasts at least 18 months. (MedPageToday)
• Brain injury markers remain in the blood months after COVID infection. (CIDRAP)

National News

• Governor Mike Wine (R) of Ohio vetoes bill that would have outlawed transition care for minors. (NYT)
• Amazon warned by FDA for distributing men's energy supplements containing unauthorized erectile dysfunction drugs. (MedPageToday)

Virginia Focus

• "Control Your Care" public awareness campaign aims to educate Virginians about their medical rights and recent health care reforms. (Henrico Citizen)
• Tuckahoe Rescue Squad celebrates 70th anniversary facing a serious volunteer dearth. (Richmond Times-Dispatch)

Drug, Tech & Vax News

• More American adults trust flu vaccines than COVID and RSV shots. (CIDRAP)
• Nirsevimab's effectiveness at reducing infant RSV hospitalizations confirmed. (MedPageToday)
• New FDA label for Carvykti (CAR T-cell treatment) warns of secondary cancers following drug's use. (Fierce Pharma)
• Benzodiazepine's use during pregnancy raises miscarriage risks. (MedPageToday)
• New method for fine-tuning gene therapies could work around body's neutralizing immune responses. (Reuters)
• Calcium channel blocking drugs may be a treatment for muscular dystrophy. (Reuters)

FDA Approvals

• Udenyca Onbody, on-body injector for pegfilgrastim biosimilar (Udenyca) to reduce risk of infection following chemotherapy. (Coherus)

Medical Miscellany

• A year after first successful procedure, innovative partial heart transplants for infants could double lives saved by donor hearts. (Reuters)
• Vibrating molecules stimulated by light rupture melanoma cell membranes, Rice University researchers have discovered.
• Hospitalized high-risk pulmonary embolism patients face a 20% mortality rate. (MedPageToday)
• "Older adults with cataracts, age-related macular degeneration (AMD), and glaucoma are all more likely to have falls or fractures." (MedPageToday)
• "Folic acid supplementation throughout pregnancy was correlated with a lower risk of early-onset Kawasaki disease in offspring." (MedPageToday)
• Decreased brain volume and increased Alzheimer's risk were associated with smoking. (Fox News)
• Severe infections associated with unregulated med spa IV drips and injections are on the rise. (NBC News)

Pathogen Report

• Respiratory virus activity is high and rising following the 2023 holiday season (CNN). Post-holiday spikes expected (CBS News) as RHHD reports rising COVID cases (NBC 12).
• First pediatric flu death of 2023-24 season reported. (VDH)
• Whooping cough cases surface in New York area. (CBS News)
• Legionnaire's disease at New Hampshire luxury resort. (USA Today)
• Possible Cronobacter sakazakii contamination initiates Nutramigen hypoallergenic infant formula powder recall. (FDA)
• Potential E. coli contamination prompts recall of 7,000 pounds of ground beef. (USA Today)

FUN FACT OF THE WEEK

How can a hibernating squirrel maintain its health and remain illness-free whilst going months without eating, drinking or moving? A biotechnology startup and drugmaker Eli Lilly are working together to learn the answer to that question, and others posed by animals that survive in extreme conditions, with the hopes that the genetic information gleaned may result in beneficial applications for humans. From possible new obesity drugs to viral resistances to preventing cancer, a whole plethora of possibilities lies waiting to be discovered. Click here for more.

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I appreciate all of your feedback! Thanks to several readers for their recent kind comments. Per their suggestion, The Leg.Up is striving for a punchier, more streamlined form. Please let me know your thoughts!

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Scott C. Matthew

RAM Director of Communications

Richmond Academy of Medicine

www.ramdocs.org

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