Police pledge ‘thorough investigation’ of patient deaths
By ANDREW WELSH-HUGGINS
Thursday, February 28
COLUMBUS, Ohio (AP) — Law enforcement authorities on Thursday pledged a “thorough investigation” into allegations against an intensive-care doctor accused of ordering painkiller overdoses for dozens of Ohio hospital patients.
In addition, the state attorney general’s office confirmed it is conducting a Medicaid fraud investigation related to the doctor.
At issue are accusations against William Husel, a doctor fired by the Columbus-area Mount Carmel Health System in December. The hospital found he ordered potentially fatal doses for 29 patients and doses for six more patients that were excessive but not likely what caused their deaths.
Police and prosecutors said Thursday they are investigating the 29 deaths, with dozens of interviews to be conducted. Those include doctors, nurses, pharmacists, and patients’ families.
Investigators and then medical experts must also obtain and review thousands of pages of medical reports, said Franklin County Prosecutor Ron O’Brien and Tim Becker, the acting Columbus police chief.
Authorities “intend to conduct a thorough investigation of complex ethical, medical, and legal issues,” the two said in a joint statement.
Husel voluntarily surrendered his passport to authorities during the investigation, according to Thursday’s statement. “We’re continuing to cooperate with the prosecutor’s office,” said Richard Blake, an attorney representing Husel.
Mount Carmel has apologized , put 23 other employees on leave and said it changed its medication protocols to prevent similar situations.
Information will be shared with authorities and family members as the hospital learns more, Mount Carmel said Thursday.
“The deaths of patients under the care of Dr. William Husel are tragic,” the hospital said in a statement. “The facts of these cases are complex, and the ongoing nature of the investigations means that new information can continue to surface.”
Mount Carmel operates four hospitals around Columbus. It is part of parent organization Trinity Health, one of the country’s largest Roman Catholic health care systems.
The investigation is being conducted with the state medical, pharmacy and nursing boards. The Medicaid fraud investigation is being conducted by Attorney General David Yost, said Yost spokeswoman Bethany McCorkle, without providing details.
Husel is set for a July hearing at the State Medical Board before it decides whether to take further action against his suspended license.
National Consumer Protection Week March 3-9
State Department of Insurance Saved Ohioans $42 Million in 2018
Claim denial top consumer complaint
COLUMBUS — In advance of National Consumer Protection Week, March 3-9, Department of Insurance director Jillian Froment announced that the department helped Ohio insurance consumers save or recover nearly $42 million in 2018.
“One of the most important and fulfilling responsibilities we have is to help consumers understand their policies and to make sure their claims are paid in accordance with their policy,” Froment said. “We want to hear from consumers anytime they have questions or concerns about their insurance coverage.”
In 2018, the department handled nearly 6,000 insurance-related complaints from consumers, Froment said. Mostly mirroring national complaints trends, the top complaint reasons in Ohio were for claim denial and claim delay while the coverage types most complained about were health insurance and automobile insurance.
One of the largest consumer protection agencies in the state, the department provides free information and services related to all types of insurance, including Medicare, through its website, toll-free hotlines, community outreach, counseling, and more.
The department, along with investigating insurance complaints, also protects consumers by licensing insurance companies and agents, monitoring industry financial solvency and business conduct, reviewing insurance products and rates, and fighting insurance fraud.
Consumers can contact the Ohio Department of Insurance at 1-800-686-1526 or at 1-800-686-1578 for help navigating Medicare. Information and services are also available at www.insurance.ohio.gov.
Study: US pedestrian deaths hit highest number since 1990
By TOM KRISHER
AP Auto Writer
Thursday, February 28
DETROIT (AP) — The number of pedestrians killed on U.S. roads last year was the highest in 28 years, an increase due in part to driver and walker distraction, alcohol and drug impairment and more SUVs on the road, a safety organization report says.
Using data reported by states for the first half of 2018, the Governors Highway Safety Association estimates that 6,227 pedestrians were killed last year. That’s up 4 percent from 2017 and 35 percent — or more than 1,500 additional deaths — from 2008.
The association says more people are walking to work and they’re more distracted by smartphones. America’s massive switch from cars to SUVs and light trucks caused more deaths because the taller SUVs tend to hit pedestrians in the head and upper torso, causing more severe injuries, the report said.
“At the same impact speed, a pedestrian is much more likely to die in an SUV crash than in a car crash,” said Richard Retting, a consultant and former top traffic safety official with the city of New York who authored the report. “Even at 20 or 25 miles per hour, being hit by an SUV, the chance of fatal injuries increases significantly.”
The number of pedestrian deaths involving SUVs rose 50 percent from 2013 to 2017, while passenger-car-related deaths increased by 30 percent, the study found. The number of walkers killed by passenger cars was still higher in 2017 at 2,279, but SUVs accounted for 1,097 deaths.
Pedestrian deaths had been declining for decades until 2009, when smartphone sales and data use began to spike, Retting said. While Retting said the correlation between the two needs to be studied more, phone use is one of the only variables that could cause the increase in deaths. “Cellphone use is one of the few metrics I can find that shows a consistent change, a large scale change, year after year,” Retting said.
In about half the fatal crashes, either the driver or the pedestrian was impaired by alcohol, with blood alcohol levels of 0.08 grams per deciliter, the study found.
The report also says most deaths happen on local roads at night and away from intersections, and it called for safer road crossings. Night pedestrian fatalities increased by 45 percent from 2008 to 2017, while daytime deaths rose a much smaller 11 percent.
Retting said municipal governments should evaluate pedestrian crossing patterns and consider installing crosswalks and lights even if there’s no intersection.
The increase in pedestrian deaths from 2008 to 2017 came as overall traffic deaths fell 6 percent, the report said.
It also called for law enforcement and safety education campaigns to make sure drivers and walkers can safely coexist, as well as for road safety audits.
It said that 23 states saw declines in pedestrian deaths during the first half of last year, with six states reporting double-digit drops.
Retting said he expects pedestrian deaths to fall as more SUVs and cars are equipped with automatic emergency braking and pedestrian detection systems. Most automakers in the U.S. have pledged to make automatic braking standard across their lineups by September of 2022.
Farm loan delinquencies highest in 9 years as prices slump
By ROXANA HEGEMAN
Thursday, February 28
WICHITA, Kan. (AP) — The nation’s farmers are struggling to pay back loans after years of low crop prices and a backlash from foreign buyers over President Donald Trump’s tariffs, with a key government program showing the highest default rate in at least nine years.
Many agricultural loans come due around Jan. 1, in part to give producers enough time to sell crops and livestock and to give them more flexibility in timing interest payments for tax filing purposes.
“It is beginning to become a serious situation nationwide at least in the grain crops — those that produce corn, soybeans, wheat,” said Allen Featherstone, head of the Department of Agricultural Economics at Kansas State University.
While the federal government shutdown delayed reporting, January figures show an overall rise in delinquencies for those producers with direct loans from the Agriculture Department’s Farm Service Agency.
Nationwide, 19.4 percent of FSA direct loans were delinquent in January, compared to 16.5 percent for the same month a year ago, said David Schemm, executive director of the Farm Service Agency in Kansas. During the past nine years, the agency’s January delinquency rate hit a high of 18.8 percent in 2011 and fell to a low of 16.1 percent when crop prices were significantly better in 2015.
While those FSA direct loan delinquencies are high, the agency is a lender of last resort for riskier agricultural borrowers who don’t qualify for commercial loans. Its delinquency rates typically drop in subsequent months as more farmers pay off overdue notes and refinance debt.
With today’s low crop prices, it takes high yields to mitigate some of the losses and even a normal harvest or a crop failure could devastate a farm’s bottom line. The high delinquency rates are caused by back-to-back years of low prices, with those producers who are in more financial trouble being ones who also had low yields, Featherstone said.
The situation now is not as bad as the farm credit crisis of the 1980s — a time of high interest rates and falling land prices that was marked by widespread farm foreclosures. At the height of that crisis in 1987, U.S. farmers filed 5,788 Chapter 12 bankruptcies. There were 498 in 2018.
Some fears are also surfacing in reports such as one this month from the Federal Reserve Bank of Minneapolis, which said the outlook is pessimistic for the start of this year with respondents predicting a further decline in farm income. About 36 percent of farm lenders who responded said they had a lower rate of loan repayment from a year earlier.
Tom Giessel said he borrowed some operating money from his local bank last year and paid it off. Giessel, who raises wheat and corn on some 2,500 acres in western Kansas, said the only thing that kept the farm economy afloat in his area was that people had pretty good fall crop yields. Giessel, 66, said he had once gotten to the point where he didn’t have to borrow his working capital and had a relatively new set of equipment, but he has had to borrow money for the last three years just to put in a crop.
“A lot of people are in denial about what is going on, but reality is going to set in or has set in already,” Giessel said.
The February survey of rural bankers in parts of 10 Plains and Western states showed that nearly two-thirds of banks in the region raised loan collateral requirements on fears of a weakening farm income. The Rural Mainstreet survey showed nearly one-third of banks reported they rejected more farm loan applications for that reason.
Grain prices are down because farmers around the world have had above-average production for several years. But some nations’ economies are not doing as well, decreasing demand for those crops, Featherstone said. Grain prices peaked in 2012 and prices have roughly fallen 36 percent since then for soybeans, 50 percent for corn and 48 percent for wheat.
When Trump imposed tariffs, China retaliated by stopping soybean purchases, closing the biggest U.S. market. While trade negotiations with China continue, many farmers fear it will take years for markets to recover — as it did when President Jimmy Carter imposed a grain embargo on the then-Soviet Union in 1980.
“The tariffs Trump is messing around with are not helpful at all — I don’t think anybody knows the true effect,” said Steve Morris, who farms near Hugoton in southwest Kansas.
Morris, who has been cutting back acreage in an effort to avoid borrowing money, said drought conditions last year in his area devastated his wheat yields. Trump has offered farmers subsidies to compensate for the tariffs but they are based on harvested bushels. Morris, 73, received a subsidy payment last year for his wheat crop of only $268.
Many farmers are now scrambling to borrow money as spring planting nears.
Matt Ubel, a 36-year-old Kansas farmer who bought out his parents’ farm in December 2016, said they have not been delinquent on their FSA loans, but acknowledged the payment was “a challenge to make last year.”
“We have had trouble for several years getting operating loans,” he said. “This year doesn’t look any better.”
A key factor in whether farmers receive loans is the value of their land.
Farmland values in parts of the Midwest and Plains regions largely held steady at the end of last year, according to the Federal Reserve Bank of Kansas City. But slightly higher interest rates and an uptick in the pace of farmland sales in states with higher concentrations of crop production could drive those land values down, it said.
“The big key in terms of whether or not we enter a financial crisis would be what would happen to land values,” Featherstone said. “So far land values have gradually declined, so that has kind of prevented us from maybe entering a situation like we did in the 1980s.”
Your lungs are really amazing. An anatomy professor explains why
March 1, 2019
Author: Arthur Dalley, Professor of Anatomy, Vanderbilt University
Disclosure statement: Arthur Dalley authors and edits anatomical textbooks and atlases for, and consults with, Wolters Kluwer Health, LLC, a publisher for health care students and professionals.
Partners: Vanderbilt University provides funding as a founding partner of The Conversation US.
Lungs are remarkable organs that continuously achieve amazing feats, which they do so well that we take them for granted, except when their function is diminished. It all happens in a space inside your chest, divided in two and reduced by the presence of the heart, the great vessels and the esophagus.
With Supreme Court Justice Ruth Bader Ginsburg having recently returned to the court after surgery for lung cancer, I have been asked a lot of questions about the lungs, as I am a professor of anatomy.
Many lung cancers are not operable, but to treat some types of lung disease, such as early stages of lung cancer, a surgical treatment called a lobectomy may be performed. In this operation, a lobe of a lung (your right lung has three lobes, your left lung has two) is removed. Afterward, the other lobes expand to adapt and compensate for the missing tissue, allowing the lungs to work as well or better than they did before.
In addition to being highly efficient organs, the lungs are beautifully complex in their structure. I can’t help but wonder: If we appreciated them more, would we be more proactive in taking care of them?
Breath of life
The primary function of the respiratory system is to bring oxygen into our lungs. There it is exchanged for a waste product, carbon dioxide, which is then removed from the body.
Several weeks following conception, the work of the lungs is performed by the placenta, a structure outside our fetal bodies where our blood exchanges carbon dioxide and oxygen with the maternal blood of the uterus.
Before birth, we just practice respiratory movements, moving amniotic fluid instead of air in and out of the lungs.
A newborn and mother. After birth, a baby gasps because of a buildup of CO2 and takes its first breath to take in oxygen.
Within seconds after the umbilical cord is cut, a buildup of carbon dioxide causes newborns to gasp for breath to exchange it for oxygen, an activity that will continue until our death. The average person breathes some 13 million cubic feet of air during their lifetime.
During quiet activity, such as bed rest or sitting, we take eight to 16 breaths per minute, each breath inhaling about a pint of air containing 21 percent oxygen and a small amount of carbon dioxide for about two seconds. Then for three seconds, we exhale the same amount of air, but it now contains 16 percent oxygen and a 100-fold increase in carbon dioxide. In other words, you spend about 40 percent of your life drawing air in, and 60 percent of your life expelling it.
Your lungs, by the numbers
Each day, 5,000 gallons of air are transported through airways leading into and extending throughout the lungs. The airways branch and diminish in size 22 times. Almost of all this occurs within our lungs, with these airways reaching a combined length of 14,900 miles.
About 2,600 gallons of the transported air are delivered into and removed from 300 million tiny, thin-walled, hollow sacs, or alveoli, that provide an enormous surface for the exchange of oxygen, required by all our cells, for carbon dioxide, a waste product from them. This is an area varying in size between half and most of a regulation tennis court.
This immense area is contained within two lungs, each only somewhat smaller than three, 1-liter bottles. The left lung is 10 percent smaller than the right, due to the left-sided position of the heart.
The alveoli are tightly surrounded by blood vessels, or capillaries, so small that red blood cells continuously pass through them squeezed into a single row as they exchange carbon dioxide for oxygen.
The capillaries of the lung receive an immense blood supply, equal to that distributed to all other parts of the entire body. The alveoli expand and contract 15,000 times a day. During activity, the rate of respiration doubles – and in extreme activities triples – and the amount of air reaching the alveoli increases three to five times. Breathing deeper and faster uses lung capacity that’s held in reserve while at rest. Stress can also result in deeper and faster respiration.
Your lungs at work
The air we breathe is far from clean, however, and one of the primary jobs of the respiratory system is to “condition” the air before it reaches the air sacs deep inside your lungs.
Indoor air pollutants can have two to five times more pollutants than outdoor air. (Have you observed and changed filters on your heating/AC system recently?)
The respiratory system “conditions” the air in several ways. First, it raises the temperature of cool air to body temperature, or it cools hot air to body temperature. Second, it moisturizes the air to 100 percent humidity to prevent dehydration of alveolar membranes. Last, it cleans the air.
Foreign and possibly harmful substances are filtered from in-flowing air and removed by several means, including nasal hairs and sticky mucus lining the airways that is produced at a rate of about a quart a day. It contains antimicrobial agents that help to neutralize harmful germs and many viruses.
Importantly, hair-like projections on cells lining the airways, called cilia, move the soiled mucus out of the lungs and air passages to the throat to be swallowed and destroyed by stomach acid.
Pollutants reaching the alveolar gas-exchanging membranes are removed by specialized cells called phagocytes and macrophages that ingest particles to move most to be carried away via lymph vessels and nodes. However, much of the black carbon is merely moved to non-exchanging portions of the lung.
In addition to conditioning air for the alveoli, ventilation of the lungs helps to cool the body down when it is overheated. About 7 percent of body heat is removed via evaporation from airways inside and outside the lungs. Eleven ounces of water per day are lost as water vapor. Three percent of body heat is lost by heating air below body temperature as the lungs are ventilated.
Other amazing functions of the lungs include controlling the acid-base balance (pH) of the body as a whole by selectively retaining or eliminating carbon dioxide. In order to be ventilated for gas exchange, the lungs act as bellows. The propulsion of air from the lungs enables the larynx to serve as a “voice box,” vibrating the vocal cords to produce the tone that is modified by the tongue, teeth and lips to produce our voice for interpersonal communication and for singing. This air output also allows us to blow up balloons or play wind instruments.
Air drawn in by expansion of the lungs passes over the olfactory areas of the nose, enabling our sense of smell. The lungs also act as “packing foam” inside the rib cage, supporting and protecting the vital heart that delivers half of its output to the lungs, and the other half to the rest of the body.
The dark side of the lungs, and of their care
While the lungs were a pristine pink at birth, our lungs gradually darken to a gray and mottled appearance due to these carbon particles, much of which remains in place, usually with no detrimental effect. Larger, irritating particles are commonly “blasted” away by reflexive coughing and sneezing. This air conditioning system is compromised in smokers, whose airways lose cilia and their directional coordination, and so must revert to coughing as a major means of pollutant removal.
Smokers’ lungs darken faster, becoming more mottled, and take on an orange tone due to nicotine and brown tars. Prolonged exposure to these carcinogens causes chronic bronchitis, emphysema and cancer in many parts of the body, but especially around airways just inside the entrance to the lungs. In emphysema, the alveolar structure of the lungs collapses, especially in the upper lung, making it difficult to fully exhale.
Take a deep breath and consider all the miraculous activities your incredible lungs are performing.