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Abortion Bans Fuel a Rise in High-Risk Patients Heading to Illinois Hospitals

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Kristen Schorsch, WBEZ Chicago
Thu, 14 Sep 2023 09:00:00 +0000

When she was around 22 weeks pregnant, the patient found out that the son she was carrying didn't have kidneys and his lungs wouldn't develop. If he survived the birth, he would struggle to breathe and die within hours.

The patient had a crushing decision to make: continue the pregnancy — which could be a risk to her health and her ability to have children in the future — or have an abortion.

“I don't think I stopped crying for an entire two weeks,” she said. “The whole world felt heavy. … It's not something anybody should have to go through. It's not easy losing somebody you love.”

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KFF Health is not disclosing the woman's name or the name of the community where she lives, because she fears harm if her identity becomes known. She lives in Missouri, which has one of the strictest abortion bans in the nation. KFF Health News confirmed details of her experience.

After the fetal diagnosis, the patient's Missouri doctors told her that her life wasn't in immediate danger, but they also pointed out the risks of carrying the pregnancy to term. And in her family, there's a history of hemorrhaging while giving birth. If she started to bleed, her doctors said, she might lose her uterus, too. The patient said this possibility was devastating. She's a young mom who wants more children.

So she chose to get an abortion. Her Missouri doctors told her it was the safest option — but they wouldn't provide one.

The patient had to Missouri and cross the border to Illinois, which has become a legal haven for abortion rights. Because of her complicated pregnancy, she received the abortion in a hospital.

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Since the Dobbs decision overturned Roe v. Wade on June 24, 2022, determining who can get an abortion and where has been complicated by medically ambiguous language in new state laws that ban or restrict abortion. Doctors in those states fear they could lose their medical licenses or wind up in jail.

Amid these changes, physicians in abortion havens such as Illinois are stepping up to fill the void and provide care to as many patients as possible.

But getting each medically complex patient connected to a doctor and a hospital has been logistically complicated. In response to the growing demand, Illinois Gov. JB Pritzker, a Democrat, recently launched a state program with a goal to get patients who show up at clinics, yet need a higher level of abortion care, connected more quickly with Illinois hospitals. Providers will call a hotline to reach nurses who will handle the logistics.

There is little concrete data on how many more patients are traveling to other states for abortions at hospitals. The Centers for Disease Control and Prevention tracks some abortion data regarding out-of-state patients but doesn't collect it based on the type of facility they're performed in.

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Hospitals are a “black box” for abortion-related data, according to Rachel Jones, a longtime researcher at the nonprofit Guttmacher Institute.

Even before Roe fell, it was hard to wade through the hospital bureaucracy to understand more comprehensively how abortion care was provided, Jones said. Guttmacher has tracked hospital-based abortions in the past but doesn't have updated figures since Dobbs.

#WeCount, widely considered a reliable tracker of shifts in abortion care over the past year, doesn't break out hospital data separately. #WeCount co-chair Ushma Upadhyay said the data would have gaps anyway. She said it's been difficult to get providers in banned states to what's happening.

The Uncertainties Behind Life Exceptions

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All 15 states that ban abortions do allow exceptions to save the life of the pregnant person, according to tracking from the health policy nonprofit KFF. But exactly when the person's life is considered at risk is open to interpretation.

“It's very, very difficult to get an exception,” said Alina Salganicoff, director of women's health policy at KFF. “It's like, ‘How imminent is this threat?' And in many cases, patients can't wait until they're about to die before they get an abortion.”

The latest ban — in Indiana — took effect at the end of August.

In 2020, when Roe was still the law of the land, only 3% of abortions typically occurred in hospitals. Now, OB-GYNs in Chicago and other places across the U.S. that protect abortion rights say out-of-state patients are increasingly showing up to get abortion care at hospitals.

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Those more complex procedures and hospital stays often bring higher medical bills. More patients now need covering the expensive price tag of the procedures, according to medical providers and abortion funds that provide financial assistance.

The patient from Missouri made her way to Laura Laursen, an OB-GYN at Rush University Medical Center in Chicago, in May. The number of out-of-state abortions at Rush has quadrupled since Roe was overturned, Laursen said.

Laursen received the patient's consent to discuss her case with NPR and KFF Health News. She recalled the patient was frustrated about having to jump through so many hoops to get the abortion, and stressed about the cost of being in a hospital.

“The biggest thing was just making for her to express those emotions,” Laursen said. “Making sure that she felt comfortable with all the decisions she was making. And to make her feel as empowered as possible.”

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The patient's life wasn't immediately threatened, but it was safer for her to have an abortion than remain pregnant, Laursen said.

“I'm constantly hearing stories from my partners across the country of trying to figure out what counts as imminent danger,” Laursen said. “We're trying to prevent danger. We're not trying to get to the point where someone's an emergency.”

Sending Patients Over State Lines for Care

Jennifer McIntosh is an OB-GYN in Milwaukee who specializes in high-risk patients. Because of Wisconsin's abortion ban, she's referring more patients out of state.

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“It's really awful,” McIntosh said, recalling difficult conversations with patients who wanted to be pregnant, but whose babies faced dire outcomes.

She would tell them: “Yes, it's very reasonable to get an abortion. But oh, by the way, it's illegal in your own state. So now on top of this terrible news, I'm going to tell you that you have to figure out how to leave the state to get an abortion.”

In some cases, McIntosh can provide an abortion if the medical risk is significant enough to satisfy Wisconsin's life-of-the-mother exception. But it feels legally risky, she said.

“Am I worried that someone might think that it doesn't satisfy that?” McIntosh said. “Absolutely, that terrifies me.”

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Jonah Fleisher‘s phone is often ringing and buzzing with texts. An OB-GYN who specializes in abortion and contraception at the University of Illinois health system, near Rush hospital in Chicago, Fleisher is frequently asked to see how quickly he can squeeze in another patient from another state.

Since Roe fell, Fleisher estimated, the health system is treating at least three times as many patients who are traveling from other states for abortion care.

He worries about the “invisible” patients who live in states with abortion bans and never make it to his hospital. They may have medical problems that complicate their pregnancies yet don't know how to navigate the logistics required to make their way over state lines to his exam room, or don't have the financial resources.

“I know that some number of those women are not going to make it through birth and postpartum,” Fleisher said. “More than the stress of somebody who's actually making it to see me, that's the thing that causes me more stress.”

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Medical costs, in addition to travel, are a big obstacle for high-risk patients seeking abortion care at hospitals. The patient from Missouri owed around $6,000 for her hospital stay, Laursen said. Her bill was covered by local and national abortion funds. Some hospital bills can reach into the tens of thousands of dollars for more complicated procedures, according to the funds.

The Chicago Abortion Fund pledged to just over $440,000 in hospital bills for 224 patients in the year Dobbs, according to Meghan Daniel, CAF's director of services. Those bills were primarily for out-of-state patients. By comparison, in the year that preceded Dobbs, CAF helped cover just over $11,000 for 27 patients.

This increase in patients needing financial help for out-of-state abortion care is happening across the nation.

In many cases, patients have a hard time accessing abortion care, and the delays push them further into their pregnancies until they need to have the procedure in a hospital, said Melissa Fowler, chief program officer at the National Abortion Federation. And that costs much more.

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“We're seeing more cases right now [of] people who are later in gestation,” Fowler said. “More adolescents who are later in gestation, who are showing up at hospitals because this is really their last resort. They've been referred all over.”

All of this raises questions about how long these funds can afford to help.

“The current financial way in which people are paying for their abortions I fear is not sustainable,” Fleisher said.

Nonprofit hospitals could help. In return for getting tax breaks, they have financial assistance policies for people who are uninsured or can't afford their medical bills. But the policy at UI Health in Chicago, for example, covers only Illinois residents. UI Health spokesperson Jackie Carey said that for other patients, those who live in other states, the hospital offers discounts if they don't have insurance, or if their insurance won't pay.

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Laursen argues out-of-state Medicaid plans and insurance companies should be picking up the tab.

“Whose responsibility is this?” she asked.

Not Ready to Let Go

Back in Missouri, the patient has a special room dedicated to her son. She brought home a recording of his heartbeat and keeps his remains in a heart-shaped casket. She talks to her son, tells him how much she loves him.

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“I'm just not ready to let him go,” the patient said. “Even though they're not here on Earth anymore, you still see them in your dreams.”

She's working on healing emotionally and physically. And while she's thankful that she was able to travel to Illinois for care, the experience made her angry with her home state.

“There's a lot of good people out there who go through a lot of unfortunate situations like me who need abortion care,” the patient said. “To have that taken away by the government, it just doesn't feel right.”

This article is from a partnership that includes WBEZ, NPR, and KFF Health News.

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——————————
By: Kristen Schorsch, WBEZ Chicago
Title: Abortion Bans Fuel a Rise in High-Risk Patients to Illinois Hospitals
Sourced From: kffhealthnews.org/news/article/hospital-abortions-npr-partnership/
Published Date: Thu, 14 Sep 2023 09:00:00 +0000

Did you miss our previous article…
https://www.biloxinewsevents.com/watch-in-emergencies-first-comes-the-ambulance-then-comes-the-bill/

Kaiser Health News

More Schools Stock Overdose Reversal Meds, but Others Worry About Stigma

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Rae Ellen Bichell and Virginia Garcia Pivik
Tue, 03 Oct 2023 09:00:00 +0000

Last year, a student fell unconscious after walking out of a bathroom at Central High School in Pueblo, Colorado. When Jessica Foster, the school district's lead nurse, heard the girl's distraught friends mention , she knew she had to act fast.

Emergency responders were just four minutes away. “But still four minutes — if they are completely not breathing, it's four minutes too long,” Foster said.

Foster said she got a dose of naloxone, a medication that can rapidly reverse an opioid overdose, and gave it to the student. The girl revived.

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Forty-five miles away in Colorado Springs, Mitchell High School didn't have naloxone on hand when a 15-year-old student overdosed in class in December 2021 after snorting a fentanyl-laced pill in a school bathroom. That student died.

Colorado Springs' school district has since joined Pueblo and dozens of other districts in the in supplying middle and high schools with the lifesaving medication, often known by one of its brand names, Narcan. Since passage of a 2019 state law, Colorado has had a program that allows schools to obtain the medicine, typically in nasal spray form, for free or at a reduced cost.

Not all schools are on board with the idea, though. Though more districts have signed on since last year, only about a third of Colorado districts had enrolled in the state's giveaway program at the start of this school year. And within the dozen counties with the highest drug overdose death rates in the state, many school districts had not signed up in the face of ongoing stigma around the need for the overdose reversal medication.

The federal Substance Abuse and Mental Services Administration recommends that schools, including elementary schools, keep naloxone on hand as fatal opioid overdoses rise, particularly from the potent drug fentanyl. And 33 states have laws that expressly allow schools or school employees to carry, store, or administer naloxone, according to Jon Woodruff, managing attorney at the Legislative Analysis and Public Policy Association, which tracks naloxone policies across the country.

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Among those, about nine states require at least some K-12 schools to store naloxone on-site, including Illinois, whose requirement goes into effect in January. Some states, such as Maine, also require that public schools offer training to students in how to administer naloxone in nasal spray form.

Rhode Island requires all K-12 schools, both public and private, to stock naloxone. Joseph Wendelken, a spokesperson for the Rhode Island Department of Health, said in the past four years naloxone was administered nine times to people ages 10 to 18 in educational settings.

In early September, the medication also became available over the counter nationally, though the $45 price tag per two-dose package has some addiction specialists worried it will be out of reach for those who need it most.

But the medicine still isn't as publicly widespread as automated external defibrillators or fire extinguishers. Kate King, president of the National Association of School Nurses, said reluctance to stock it in schools can stem from officials being afraid to provide a medical service or the ongoing cost of resupplying the naloxone and training people to use it. But the main hang-up she's heard is that schools are afraid they'll be stigmatized as a “bad school” that has a drug problem or as a school that condones bad choices.

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“School districts are very careful regarding their image,” said Yunuen Cisneros, community outreach and inclusion manager at the Public Education & Business Coalition, which serves most of the state's school districts. “Many of them don't want to accept this program, because to accept it is to accept a drug addiction problem.”

That's the wrong way to think about it, King said. “We really equate it to our stock albuterol for asthma attacks, our stock epinephrine for anaphylactic reactions,” she said.

Colorado health officials could not say how often naloxone had been used on school grounds in the state. So far this year, at least 15 ages 10 to 18 have died of fentanyl overdoses but not necessarily in schools. And in 2022, 34 children in that age group died, according to the state Department of Public Health and Environment. That included 13-year-old José Hernández, who died in August 2022 from a fentanyl overdose at home just days after starting eighth grade at Aurora Hills Middle School. His grandmother found his body over the bathroom sink in the early morning.

With the arrival of this new school year, supplies of naloxone are on hand for kids in more Colorado schools. Last year, state lawmakers appropriated $19.7 million in federal aid to the Naloxone Bulk Purchase Fund, which is accessible to school districts, jails, first responders, and community service , among others.

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“It's the most we've ever had,” said Andrés Guerrero, manager of the state health department's overdose prevention program.

According to data provided by Colorado's health department, 65 school districts were enrolled in the state program to receive naloxone at low or no cost at the start of the school year. Another 16 had reached out to the state for information but hadn't finalized orders as of mid-August. The remaining 97 school districts either didn't stock naloxone at their schools or sourced it from elsewhere.

Guerrero said the districts decide whom to train to administer the medicine. “In some cases, it's just the school nurses. In some cases, it's school nurses and the teachers,” he said. “And in some cases, we have the students as well.”

In Durango, the 2021 death of a high schooler galvanized students to push for the right to carry naloxone with them to school with parental permission — and to administer it if need be — without fear of punishment.

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It took picketing outside a school board meeting to get permission, said Hays Stritikus, who graduated this spring from Durango High School. He's now involved in drafting legislation that would expressly allow students across the state to carry and distribute Narcan on school grounds.

“The ultimate goal is a world where Narcan is not necessary,” he said. “But that's just not where we .”

Some health experts disagree that all schools should stock naloxone. Lauren Cipriano, a health economist at Western University in Canada, has studied the cost-effectiveness of naloxone in secondary schools there. While opioid poisonings have occurred on school grounds, she said, high schools tend to be really low-risk settings.

More effective strategies for combating the opioid epidemic are needle exchange sites, supervised drug consumption sites, and medication-assisted treatment that reduces cravings or mutes highs, Cipriano said. But those approaches can be expensive with naloxone distribution.

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“When the state makes a big, free program like this, it looks like they're doing something about the opioid epidemic,” she said. “It's cheap and it looks like you're doing something, and that's, like, political gold.”

Denver Public Schools, the largest school district in Colorado, started stocking naloxone in 2022, said Jade Williamson, manager of the district's healthy schools program.

“We know some of the students are on the forefront of these things before older generations,” Williamson said. “To know where to find it, and to access it when needed through these adults who've trained, whether that's a school nurse or a school administrator, I think it brings them some sense of relief.”

The state's seven largest districts, with more than 25,000 students each, all participate in the state program. By contrast, a KFF Health News analysis found, only 21% of districts with up to 1,200 students have signed up for it — even though many of those small districts are in areas with drug overdose rates higher than the state average.

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Some school districts figured out a path to getting naloxone outside of the state program. That includes Pueblo School District 60, where lead nurse Foster gave naloxone to a student last year.

The Pueblo school district gets naloxone at no cost from a local nonprofit called the Southern Colorado Harm Reduction Association. Foster said she tried signing up for the state program but encountered difficulties. So she decided to stick with what was already working.

Moffat County School District RE-1 in Craig, Colorado, gets its naloxone from a local addiction treatment center, according to district nurse Myranda Lyons. She said she trains school staffers on how to administer it when she teaches them CPR.

Christopher deKay, superintendent of Ignacio School District 11Jt, said its school resource already carry naloxone but that the district enrolled in the state program, too, so that schools could stock the medication in the nursing office in case a resource officer isn't around.

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“It's like everything — like training for fire safety. You don't know what's going to happen in your school,” said deKay. “If the unthinkable happens, we want to be able to respond in the best way possible.”

This story was produced with reporting assistance from El Comercio de Colorado.

——————————
By: Rae Ellen Bichell and Virginia Garcia Pivik
Title: More Schools Stock Overdose Reversal Meds, but Others Worry About Stigma
Sourced From: kffhealthnews.org/news/article/schools-narcan-naloxone-overdose-reversal-colorado/
Published Date: Tue, 03 Oct 2023 09:00:00 +0000

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Police Blame Some Deaths on ‘Excited Delirium.’ ER Docs Consider Pulling the Plug on the Term.

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Markian Hawryluk and Renuka Rayasam
Mon, 02 Oct 2023 09:00:00 +0000

The way Sheldon Haleck's see it, the 38-year-old's only crime was jaywalking. But that March night in 2015, after Honolulu police found him behaving erratically, they pepper-sprayed him, shocked him with a Taser, and restrained him. Haleck became unresponsive and was taken to a hospital. Before his parents could get from their home in Utah to Hawaii, the former Hawaii Air National Guardsman was taken off life .

“Nobody's supposed to die from something like this,” said Haleck's father, William.

An initial autopsy ruled Haleck's a homicide and his family filed a civil in federal court against the three officers who tried to him from the street. The case should have been “one of the easiest wrongful death cases” to win, said Eric Seitz, an attorney who represented Haleck's family.

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But the officers' attorneys seized on a largely discredited, four-decade-old diagnostic theory called “ delirium,” which has been increasingly used over the past 15 years as a legal defense to explain how a person experiencing severe agitation can die suddenly through no fault of the police. “The entire use of that particular theory, I think, is what convinced the jury,” Seitz said.

Haleck's case is just one legal battle in which the theory of excited delirium exonerated law enforcement despite mounting opposition to the term among most prominent medical groups. The theory has been cited as a defense in the 2020 deaths of George Floyd in Minneapolis; Daniel Prude in Rochester, New York; and Angelo Quinto in Antioch, California. It figures in a criminal trial against two police officers involved in the 2019 death of Elijah McClain in Aurora, Colorado, now underway. It has defense attorneys to argue that individuals in police custody died not of restraint, not of a Taser shock, but of a medical condition that can lead to sudden death.

But now, the American College of Emergency Physicians will vote at an October meeting on whether to formally disavow its 2009 position paper supporting excited delirium as a diagnosis that helped undergird those court cases. The draft resolution also calls on ACEP to discourage physicians who serve as expert witnesses from promoting the theory in criminal and civil trials.

“It's junk science,” said Martin Chenevert, an emergency medicine physician at UCLA Santa Monica Medical Center, who often testifies as an expert witness. The theory has been used to provide a cover for police misconduct, he said. “It had an agenda.”

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Passing the resolution wouldn't bring Haleck back, but his parents hope it would prevent other families from experiencing their agony. “May that excited delirium die here,” said his mother, Verdell.

Democratic California Gov. Gavin Newsom is considering signing into law a bill passed Sept. 12 that would do much of the same in his state.

“If we don't fully denounce this now, it will be there for the grasping, again,” said Jennifer Brody, a physician with the Boston Health Care for the Homeless Program, who co-authored a 2021 editorial calling on organized medicine to denounce excited delirium. “Historically, we know what happens: The pendulum swings the other way.”

Most major medical societies, including the American Medical Association and the American Psychiatric Association, don't recognize excited delirium as a medical condition. This year, the National Association of Medical Examiners rejected excited delirium as a cause of death. No blood test or other diagnostic test can confirm the syndrome. It's not listed in the “Diagnostic and Statistical Manual of Mental Disorders,” a reference book of mental health conditions, nor does it have its own diagnostic code, a system used by health professionals to identify diseases and disorders.

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But the argument's pervasiveness in excessive-use-of-force cases has persisted in large part because of the American College of Emergency Physicians' 2009 white paper proposing that individuals in a mental health crisis, often under the influence of drugs or alcohol, can exhibit superhuman strength as police try to control them, and then die from the condition.

The ACEP white paper has been cited in cases across the U.S., and lawyers who file police misconduct cases said that courts and judges accept the science without sufficient scrutiny.

ACEP's position “has done a lot of harm” by justifying first responder tactics that contribute to a person's death, said Joanna Naples-Mitchell, an attorney who worked on a Physicians for Human Rights review of excited delirium. The term has also been used in cases in Australia, the United Kingdom, Canada, and other countries, according to the group.

“This is a really important opportunity for ACEP to make things right,” she said of the upcoming vote.

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ACEP declined KFF Health News requests for an interview.

Starting in the mid-1990s, the leading proponents of excited delirium produced research with funding from Taser International, a maker of stun guns used by police, which later changed its name to Axon. The research purported to show that the technique of prone restraint, in which suspects are lying face down on the ground with the police officer's weight on top of them, and Taser shocks couldn't kill someone. That research formed the basis of the white paper, providing an alternative cause of death that defense attorneys could argue in court. Many emergency physicians say the ACEP document never lived up to the group's standard for clinical guidelines.

Axon officials did not respond to a call or email seeking comment on the white paper or the upcoming ACEP vote. In 2017, Taser officials used the American College of Emergency Physicians' position on excited delirium as evidence that it is a “universally recognized condition,” according to Reuters.

A recent review published in the journal Forensic Science, Medicine, and Pathology concluded no scientific evidence exists for the diagnosis, and that the authors of the 2009 white paper engaged in circular reasoning and faulty logic.

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“Excited delirium is a proxy for prone-related restraint when there is a death,” said Michael Freeman, an associate professor of forensic medicine at Maastricht University in the Netherlands, who co-authored the review. “You don't find that people get ‘excited delirium' if they haven't also been restrained.”

Between 2009 and 2019, Florida medical examiners attributed 85 deaths to excited delirium, and at least 62% involved the use of force by law enforcement, according to a January 2020 report in Florida Today. Black and Hispanic people accounted for 56% of 166 deaths in police custody attributed to excited delirium from 2010 to 2020, according to a December 2021 Virginia Law Review article.

This year, ACEP issued a formal statement saying the group no longer recognizes the term “excited delirium” and new guidance to on how to treat individuals presenting with delirium and agitation in what it now calls “hyperactive delirium syndrome.” But the group stopped short of retracting the 2009 white paper. For the past 14 years, ACEP took no steps to withdraw the document or to discourage defense attorneys from using it in court.

Even now, lawyers say, they must continually debunk the theory.

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“Excited delirium has continued to come up in every single restraint asphyxia case that my partner and I have handled,” said Julia Sherwin, a California civil rights attorney. “Instead of acknowledging that the person died from the police tactics, they want to point to this alternate theory of deaths.”

Now, plaintiffs' attorneys say, if ACEP passes the resolution it would be the most meaningful step yet toward keeping the theory out of the courtroom. The resolution calls on ACEP to “clarify its position in writing that the 2009 white paper is inaccurate and outdated,” and to withdraw approval for it.

Despite the theory's lack of scientific underpinning, backers of the ACEP resolution expect heated debate before the vote scheduled for the weekend of Oct. 7-8. Emergency physicians often encounter patients with agitation and delirium, they say, and are sympathetic to other first responders who share the challenge of managing such patients. While they have tools like sedation to them in the emergency room, law enforcement officials must often subdue potentially dangerous individuals without such help.

Most people won't die as a result of police tactics such as prone restraint or Taser use, but a small fraction do.

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“It's a crappy, crappy situation, when you have someone who's out of control, who can't make decisions for himself, and is potentially a threat somewhere,” said Jared Strote, an emergency medicine professor at the University of Washington. “It's not like they have a sticker on their head that says, ‘Hey, I'm at high risk. If you hold me down, then I could go into sudden cardiac arrest.'”

Nonetheless, sentiment is growing among emergency physicians that the 2009 ACEP white paper has resulted in real harm and injustices, and it's time to set it aside.

“We'll be able to close the chapter on it and move forward to recognize explicitly that this was in error,” said Brooks Walsh, an emergency physician from Bridgeport, Connecticut, and a key player in bringing the resolution up for a vote. “We definitely have an ethical responsibility to address mistakes or evolutions in medical thinking.”

Chris Vanderveen, KUSA-TV's director of special projects, contributed to this report.

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——————————
By: Markian Hawryluk and Renuka Rayasam
Title: Police Blame Some Deaths on ‘Excited Delirium.' ER Docs Consider Pulling the Plug on the Term.
Sourced From: kffhealthnews.org/news/article/police-blame-some-deaths-on-excited-delirium-er-docs-consider-pulling-the-plug-on-the-term/
Published Date: Mon, 02 Oct 2023 09:00:00 +0000

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Facing Criticism, Feds Award First Maternal Health Grant to a Predominantly Black Rural Area

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Sarah Jane Tribble, KFF News
Mon, 02 Oct 2023 09:00:00 +0000

A federal program to combat the alarming rates of rural women dying from pregnancy complications has marked a first: It's supporting an organization that serves predominantly Black counties in the Deep South.

The news came Sept. 27, three months after KFF Health News' raised questions about why a federal Health Resources and Services Administration program targeting rural maternal mortality hadn't sent a grant to serve mothers in majority-Black rural communities.

Non-Hispanic Black women — regardless of income or education level — die of pregnancy-related causes at nearly three times the rate of non-Hispanic white women.

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The Institute for the Advancement of Minority Health in Madison, Mississippi, was one of two winners in the latest round of an initiative administered by HRSA. Mary Hitchcock Memorial Hospital in Lebanon, New Hampshire, was the other winner, according to an agency announcement.

“Very happy to see Mississippi,” said Peiyin Hung, deputy director of the University of South Carolina's Rural and Minority Health Research Center. Mississippi has the highest rate of maternal deaths and injuries among Black people in the U.S., she said.

Hung, who is a member of the health equity advisory group for the maternal grant program, said the Mississippi nonprofit is an unusual awardee because it is not part of a larger health system.

In June, KFF Health News found that HRSA's Rural Maternity and Obstetrics Management Strategies Program, or RMOMS, had failed to fund any sites in the Southeast, where the U.S. Census Bureau shows the largest concentration of predominantly Black rural communities. The program began four years ago and had budgeted nearly $32 million to access and care for thousands of mothers and babies nationwide — Hispanic women along the Rio Grande and Indigenous mothers in Minnesota.

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The rural Southeast was omitted despite a White House declaration to make Black maternal health a priority, and despite statistics showing America's maternal mortality rate rising sharply in recent years.

Rep. Robin Kelly (D-Ill.) introduced the “CARE for Moms Act” in mid-September and — in response to KFF Health News' reporting ― called for accountability and reporting requirements for maternal health under the Department of Health and Human Services.

“Where is the money going?” she said during a September press conference. “Is it going where it's needed or is it going to bigger who have the people who can write the grants?” She added that “maybe smaller areas or more rural areas” need it more.

HRSA spokesperson Martin Kramer declined to provide more information about the rural maternity grant and did not respond when asked about Kelly's bill. The legislation also would establish regional “centers of excellence,” Kelly said, to address implicit bias and cultural competency in health care providers. She said the bill would also “build up the doula workforce” and establish a state-based perinatal quality collaborative to improve care nationwide.

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In an interview with KFF Health News, Kelly, co-chair of the House Maternity Care Caucus and a congressional leader in expanding for postpartum care, suggested the lack of grants to the predominantly Black rural South could be because of “implicit bias,” and she said her bill would “get to the heart of the matter and get [the money] to the people that really need it.”

The roughly $2 million in new rural grants are part of nearly $90 million in maternal health funding announced in late September by HRSA, an agency within HHS.

The Mississippi-based Institute for the Advancement of Minority Health was created in 2019 to reduce health disparities through partnerships, according to federal filings. Chief executive Sandra Melvin confirmed in an email that this is the first time the institute has applied for the grant, but also noted that it has been working to reduce maternal and infant health disparities since 2019.

Work performed with the grant “will be successful,” she said, because the organization plans to take a community-based approach that includes partnering with health centers, hospitals, and a university.

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In past years, the grant application process skewed toward large health systems because they “have much higher capacity to form a statewide network,” Hung said. That's, in part, because grant winners were required to create a network of specific health care clinics, hospitals, and the state Medicaid office. In recent years, the agency has “become much more flexible,” Hung said.

The success of the Mississippi application is a “promising signal” for states that don't have large rural health systems focusing on maternal care, said Hung, who hopes a South Carolina applicant receives a grant in the future.

In New Hampshire — where awardee Mary Hitchcock Memorial Hospital is part of the larger Dartmouth Health system in New England ― three rural hospital labor and delivery units have closed in recent years. The closures forced pregnant women to up to an hour and a half to appointments or delivery services, said Greg Norman, senior director of community health at Dartmouth Hitchcock Medical Center.

Its HRSA application included the North Country Maternity Network, a collaboration of hospitals and clinics created in late 2021, Norman said. The New Hampshire group did not win the federal maternity grant the first time it applied. But this time the network was more established , he said.

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The money from the New Hampshire grant — up to $1 million a year for four years — will help create standardized medical and social screening for pregnant people. It will also pay for a shared high-risk coordinator and increased use of doulas and community health workers who could do home visits, he said.

The whole project, Norman said, is “a step in the direction of more equitable care.”

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By: Sarah Jane Tribble, KFF Health News
Title: Facing Criticism, Feds Award First Maternal Health Grant to a Predominantly Black Rural Area
Sourced From: kffhealthnews.org/news/article/facing-criticism-feds-award-first-maternal-health-grant-to-a-predominantly-black-rural-area/
Published Date: Mon, 02 Oct 2023 09:00:00 +0000

Did you miss our previous article…
https://www.biloxinewsevents.com/these-appalachia-hospitals-made-big-promises-to-gain-a-monopoly-theyre-failing-to-deliver/

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