Susan Abram, Author at �鶹Ů�� Health News

‘John Doe’ Patients Sometimes Force Hospital Staff To Play Detective

Susan Abram — Mon, 13 May 2019 09:00:07 +0000

The 50-something man with a shaved head and brown eyes was unresponsive when the paramedics wheeled him into the emergency room. His pockets were empty: no wallet, no cellphone, not a single scrap of paper that might reveal his identity to the nurses and doctors working to save his life. His body lacked any distinguishing scars or tattoos.

Almost two years after he was hit by a car on busy Santa Monica Boulevard in January 2017 and transported to Los Angeles County+USC Medical Center with a devastating brain injury, no one had come looking for him or reported him missing. The man died in the hospital, still a John Doe.

Hospital staffs sometimes must play detective when an unidentified patient arrives for care. Establishing identity helps avoid the treatment risks that come with not knowing a patient’s medical history. And they strive to find next of kin to help make medical decisions.

“We’re looking for a surrogate decision-maker, a person who can help us,” said Jan Crary, supervising clinical social worker at L.A. County+USC, whose team is frequently called on to identify unidentified patients.

The hospital also needs a name to collect payment from private insurance or government health programs such as Medicaid or Medicare.

But federal privacy laws can make uncovering a patient’s identity challenging for staff members at hospitals nationwide.

At L.A. County+USC, social workers pick through personal bags and clothing, scroll through cellphones that are not password-protected for names and numbers of family or friends, and scour receipts or crumpled pieces of paper for any trace of a patient’s identity. They quiz the paramedics who brought in the patient or the dispatchers who took the call.

They also make note of any tattoos and piercings, and even try to track down dental records. It’s more difficult to check fingerprints, because that’s done through law enforcement, which will get involved only if the case has a criminal aspect, Crary said.

Unidentified patients are often pedestrians or cyclists who left their IDs at home and were struck by vehicles, said Crary. They might also be people with severe cognitive impairment, such as Alzheimer’s, patients in a psychotic state or drug users who have overdosed. The hardest patients to identify are ones who are socially isolated, including homeless people — whose admissions to hospitals have sharply in recent years.

In the past three years, the number of patients who arrived unidentified at L.A. County+USC ticked up from 1,131 in 2016 to 1,176 in 2018, according to data provided by the hospital.

If a patient remains unidentified for too long, the staff at the hospital will make up an ID, usually beginning with the letter “M” or “F” for gender, followed by a number and a random name, Crary said.

Jan Crary, supervising clinical social worker at Los Angeles County+USC Medical Center, leads a team who increasingly must play detective when patients cannot be identified. ((Heidi de Marco/KHN))

Other hospitals resort to similar tactics to ease billing and treatment. In Nevada, hospitals have an electronic system that assigns unidentified patients a “trauma alias,” said Christopher Lake, executive director of community resilience at the Nevada Hospital Association.

The deadly mass shooting at a Las Vegas concert in October 2017 presented a challenge for local hospitals who sought to identify the victims. Most concertgoers were wearing wristbands with scannable chips that contained their names and credit card numbers so they could buy beer and souvenirs. On the night of the shooting, the final day of a three-day event, many patrons were so comfortable with the wristbands that they carried no wallets or purses.

More than 800 people were injured that night and rushed to numerous hospitals, none of which were equipped with the devices to scan the wristbands. Staff at the hospitals worked to identify patients by their tattoos, scars or other distinguishing features, as well as photographs on social media, said Lake. But it was a struggle, especially for smaller hospitals, he said.

The Health Insurance Portability and Accountability Act (HIPAA), a federal law intended to ensure the privacy of personal medical data, can sometimes make an identification more arduous because a hospital may not want to release information on unidentified patients to people inquiring about missing persons.

In 2016, a man with Alzheimer’s disease was admitted to a New York hospital through the emergency department as an unidentified patient and assigned the name “Trauma XXX.”

Police and family members inquired about him at the hospital several times but were told he was not there. After a week — during which hundreds of friends, family members and law enforcement officials searched for the man — a doctor who worked at the hospital saw a news story about him on television and realized he was the unidentified patient.

Hospital officials later told the man’s son that because he had not explicitly asked for “Trauma XXX,” they could not give him information that might have helped him identify his father.

Prompted by that mix-up, the New York State Missing Persons Clearinghouse drafted a set of who receive information requests about missing persons from police or family members. The guidelines include about two dozen steps for hospitals to follow, including notifying the front desk, entering detailed physical descriptions into a database, taking DNA samples and monitoring emails and faxes about missing persons.

stipulate that if a patient is unidentified and cognitively incapacitated, “the hospital may disclose only the minimum necessary information that is directly relevant to locating a patient’s next-of-kin, if doing so is in the best interest of the patient.”

Lenh Vuong, a clinical social worker at Los Angeles County+USC Medical Center, checks on a former John Doe patient who was recently identified. (Heidi de Marco/KHN)

Maria Torres visits Felipe Luna, her brother. Luna ended up at Los Angeles County+USC Medical Center after he was hit by a car and suffered head injuries. “The only thing he had on him was a bank card and a receipt,” Torres says. “I think that was a good thing he had that in his pocket, but that’s not an ID.” (Heidi de Marco/KHN)

At L.A. County+USC, most John Does are quickly identified: They either regain consciousness or, as in a majority of cases, friends or relatives call asking about them, Crary said.

Still, the hospital does not always succeed. From 2016 to 2018, 10 John and Jane Does remained unidentified during their stays at L.A. County+USC. Some died at the hospital; others went to nursing homes with made-up names.

But Crary said she and her team pursue every avenue in search of an identity.

Once, an unidentified and distinguished-looking older man with a neatly trimmed beard was rushed into the emergency room, delirious with what was later diagnosed as encephalitis and unable to speak.

Acting on a gut instinct that the well-groomed man must have a loved one who had reported him missing, Crary checked with police stations in the area. She learned instead that this John Doe was wanted in several states for sexual assault.

“He was done in by a mosquito,” Crary mused.

“It is a case that I will never forget,” she added. “The truth is that I am more elated when we are able to identify a patient and locate family for a beautiful reunification rather than finding a felon.”

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First Female Dean ‘A Sea Of Change’ At USC’s Scandal-Plagued Medical School

Susan Abram — Wed, 20 Jun 2018 09:00:43 +0000

The University of Southern California veered sharply and deliberately from tradition in naming the first woman — and the first geriatrician — to lead its 133-year-old medical school.

, who took over the position on May 1, said she’ll work hard to steer more young doctors toward elderly care to treat the country’s aging population. At the same time, she will face a stiff challenge trying to help rehabilitate the image of USC as it grapples with the growing fallout from recent drug and sexual misconduct scandals.

Mosqueda’s appointment is partly the result of USC’s #MeToo moment. It sends an unmistakable message that campus officials want to open a new chapter after the sobering revelations that toppled Mosqueda’s two immediate predecessors and the — all men.

“I think it signals a sea of change at USC,” Mosqueda, 58, said in an interview. “I think as a woman I’m probably more likely to bring a less competitive and more collaborative, more nurturing approach. I think we women are tough in different ways.”

She added that the decision to put her in charge of the university’s was “a really odd choice at this university. It’s an obvious action that says we’re doing things differently.”

Mosqueda’s ascent also signals that Keck is ready to embrace a new perspective reflecting the nation’s changing demographics. It shows that the field of geriatrics “is coming of age,” said Dr. Sharon Brangman, chief of geriatrics at the State University of New York’s Upstate Medical University.

Care for the elderly is a “crucial” part of training health care professionals, Brangman said. “Every doctor-to-be, nurse-, physical therapist- and pharmacist-to-be should have some training in caring for older adults, because that population is growing.”

living in the United States, or about 15 percent of the population, are 65 and older, according to the U.S. Census Bureau. That number is expected to rise to , or nearly 25 percent, by 2060. Of those, about 20 million will be over age 85.

Geriatrics is “not about curing,” Mosqueda said. “We’re about caring. It’s not a heroic specialty. It takes a bit more of an understanding to appreciate it as a specialty. Yet it’s tremendously rewarding. We need to get it into the curriculum.”

As dean, Mosqueda will oversee more than 4,150 full-time and voluntary faculty members who educate 800 medical students and 1,000 others pursuing graduate and postgraduate degrees. The school also trains more than 900 resident physicians in more than 50 specialties or sub-specialties.

Mosqueda comes to the job with Trojan pride deep in her blood. Both her parents graduated from the USC medical school when “there was a quota of six women per class,” Mosqueda said. Mosqueda herself is also a USC medical school graduate, and she later returned as a professor and chair of the family medicine department before being named interim dean last October.

Mosqueda’s mother, a radiologist specializing in mammography, and her father, a gastroenterologist, had successful careers at Kaiser Permanente in Los Angeles. But they never pressured their daughter to become a physician, Mosqueda recalled. (Kaiser Health News is not affiliated with Kaiser Permanente.)

She took an initial interest in veterinary medicine and marine biology — she’s still an avid scuba diver — but later found her path in primary care, family medicine and geriatrics, as well as the .

In a memo announcing Mosqueda’s appointment to the USC community, provost Michael Quick said support for her among faculty, staff and students had been overwhelming.

“It was clear to us, and to the vast majority of the Keck community, that we had identified the right dean,” Quick said.

The institution Mosqueda now heads was forced late last year to acknowledge alleged misconduct by two former deans, Dr. Carmen Puliafito and Dr. Rohit Varma.

Puliafito, a renowned eye surgeon, led the medical school from 2007 until March 2016, when he abruptly resigned as dean, saying he wanted to pursue other opportunities, though he remained on the faculty. The Los Angeles Times that three weeks before his resignation he had been in a Pasadena hotel room with a young woman who overdosed in his presence and was rushed to the hospital.

Puliafito was later after the Times reported he had associated with criminals and drug abusers. In September, the state to practice medicine. Varma, who succeeded Puliafito as dean, resigned last fall after reports surfaced he had once against a female fellow.

More recently, the university has been embroiled in a controversy over allegations of sexual abuse spanning decades by USC gynecologist George Tyndall. The allegations have landed the university in a heap of legal trouble, drawing and a .

Late last month, USC president Max Nikias agreed to under pressure from students and faculty. And earlier this month, students to protest how the university has handled the Tyndall case.

“Students are feeling largely unheard, neglected and misled,” said Nivedita Kar, a doctoral student in biostatistics at Keck. “At places like Keck, where men hold a tremendous amount of privilege and therefore institutional power, the new dean must completely change the medical school culture to hear the voices of the underrepresented, restore trust and actually protect its students.”

Mosqueda knows she’s got her work cut out for her.

“We’ve been through a bad series here and we have to accept responsibility for the part of this that is our own doing,” she said. “I don’t want to be distracted. I want to own up to what was wrong and make it right.”

Making it right includes addressing the ongoing concerns of students, she said, and changing the way women’s health is discussed.

Mosqueda recalled sexist comments by male physicians when she was a medical student at USC in the 1980s. “I would hear things like ‘You’re a good girl,’ in the operating room,” she said. “In my time, it wasn’t OK to make those comments, but [there was] just acceptance of the fact that it was going to happen.”

Mosqueda is respected by her peers nationwide as a researcher and an expert in geriatrics and family medicine. She directs the , a federally funded initiative, and she co-founded the nation’s first Elder Abuse Forensic Center.

“Physicians like Dr. Mosqueda, who was one of the first wave of doctors specializing in geriatrics, have had to innovate and revamp programs and teach medical schools about the value of geriatrics,” said Brangman, the Upstate Medical University geriatrics chief. “All of these things created the leadership skills that have come to fruition.”

One of the challenges in improving elder care will be to make geriatrics an attractive field for new doctors, Brangman and Mosqueda said. Older adults have complicated health care issues but the specialty doesn’t pay well.

In addition, the stigma attached to aging persists even now. “We live in an ageist society,” Mosqueda said.

Mosqueda said she is eager to tackle head-on the challenges facing USC. Honesty and humility are the two elements that make a good doctor, and that’s what is needed to heal the university and move beyond its current troubles, she said.

“I don’t view myself as a token,” Mosqueda said of being the medical school’s first female dean. “I want to do the right things for the right reasons.”

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Black Men’s Blood Pressure Is Cut Along With Their Hair

Susan Abram — Mon, 12 Mar 2018 22:20:15 +0000

Amid the buzz of hair clippers and the beat of hip-hop, barber Corey Thomas squeezes in a little advice to the clients who come into his Inglewood, Calif., shop for shaves and fade cuts. Watch what you eat, he tells them. Check your blood pressure. Don’t take life so hard.

“We’re a high statistic for … hypertension and everything, and it’s something we let go by,” Thomas said as he worked at the shop, A New You, on Friday. “Our customers, they’ll talk to us before they talk to anybody else.”

And that can be good for their health. Thomas, who himself has high blood pressure, helped lead a group of customers as part of published Monday in the New England Journal of Medicine showing that providing information and inviting a pharmacist onsite can go a long way toward helping black men reduce their blood pressure.

The group, which met for about a year in 2016, included a once-a-week visit from the pharmacist, who prescribed blood pressure medicine and followed up with the customers to make sure they were taking it. A blood pressure machine installed in the barbershop sent patients’ readings directly to their doctors and to the pharmacist.

A New You barbershop in Inglewood, Calif., was part of a Cedars-Sinai Medical Center medical study to reduce blood pressure in black barbershops. (Heidi de Marco/KHN)

A blood pressure monitor sits in the corner of A New You. Thomas says clients use it regularly to check their blood pressure. (Heidi de Marco/KHN)

Researchers found that after six months, the men who received both the education from their barbers and the drug therapy from the pharmacists were more likely to see their blood pressure drop to a healthier level and remain under control than the comparison group that received only information and encouragement to see their doctors.

Nearly two-thirds of the men who got the drug therapy achieved a healthy blood pressure of less than 130/80 mm Hg, while only about 12 percent of the second group did.

“We all expected the intervention to be effective, but I don’t think any of us could have predicted the magnitude of the effect we ultimately saw,” said pharmacist Ciantel Adair Blyler, one of the co-authors of the study, who visited 10 different barbershops in Inglewood, Compton, Bellflower and Long Beach. She went to each shop once a week for a year to see patients, she said.

A team of pharmacists, along with physicians from several medical centers in Southern California, conducted the study at 52 Los Angeles-area barbershops with an $8.5 million federal grant from the National Heart, Lung, and Blood Institute.

Each of the 319 barbershop clients in the study had hypertension, defined as an average systolic blood pressure of 140 mm Hg or higher (that’s the maximum pressure exerted on the arteries when the heart is pushing blood through the body). They were randomly assigned to an intervention group or a control group.

Uncontrolled hypertension is one of the biggest health problems facing the African-American community, health officials say. It affects blacks more often, and at an earlier age, than whites and Hispanics, according to the federal Centers for Disease Control and Prevention. About 43 percent of black men have high blood pressure, compared to 34 percent of white men and 28 percent of Mexican Americans, show.

Art hangs in the barbershop. (Heidi de Marco/KHN)

Thomas cuts a client’s hair on March 9, 2018. (Heidi de Marco/KHN)

Stress related to racial discrimination, mistrust of the medical system and less frequent use of health care services and medications, are some of the reasons why African Americans are more likely to have high blood pressure, according to the CDC. Undetected hypertension can lead to heart and kidney damage as well as strokes and heart attacks.

Blyler said she and the team understood the mistrust, which is why they chose barbershops, traditionally a common venue for community gatherings in black neighborhoods.

“When you meet people where they are, there is a different level of trust and respect that’s earned,” Blyler said. “I think that’s why this intervention was ultimately so successful.”

But there were still some challenges gaining the trust of the barbershop patrons, Blyler observed.

Thomas participated in a Cedars-Sinai Medical Center study to reduce blood pressure in black barbershops. (Heidi de Marco/KHN)

“The hurdle we had to get over was getting them to trust me, to trust that the medication I was prescribing was good for them, that it wasn’t an experiment and I wasn’t somehow financially benefiting from drug companies,” she said.

Once she earned their trust, the men were not shy about sharing their health history, Blyler said. “Many openly admitted to not going to see their doctors for long periods despite knowing they had high blood pressure and other untreated conditions.”

The Los Angeles study was led by Dr. Ronald Victor, a cardiovascular physician at Cedars-Sinai Medical Center, who secured the $8.5 million grant to study LA’s black-owned barbershops.

Thomas, the barber at A New You, agreed to participate in the study and help his clients check their blood pressure.

“One day one of the pharmacists asked me, ‘what about you?’” Thomas recounted. “I’m like, ‘Nah. I’m all right.’ … I’d been on high blood pressure medicine for like two years then. I said ‘I don’t like it. It’s messing my body up.’”

Thomas, 49, who had suffered a stroke six years before, said the pills he was taking made him feel sluggish. The pharmacist assigned to A New You was persistent. “They asked me about my lifestyle, how I ate and everything — as opposed to my doctor. He didn’t ask me nothing,” Thomas said.

The pharmacist changed his medicine, the blood pressure machine was moved in, and Thomas — as well as his patrons — started to listen.

With a little golf he plays now, and some changes in his diet, Thomas said his systolic blood pressure is down to 129. “I feel great,” he said, adding that “it’s also fulfilling” to help his customers control their blood pressure as well.

Even though the study is over, Thomas still talks to his customers about hypertension. And the blood pressure machine is still there for anyone to use.

Thomas said efforts like these can help change long-engrained habits among African-American men.

“A lot of us use the emergency room as doctors,” he said. “So I think [these] studies will help out a great deal.”

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