Health & Fitness (138)
The men had health insurance from jobs at one of the nation's largest pork producers. But neither had legal permission to live in the U.S., nor was it clear whether their insurance would pay for the long-term rehabilitation they needed.
So Iowa Methodist Medical Center in Des Moines took matters into its own hands: After consulting with the patients' families, it quietly loaded the two comatose men onto a private jet that flew them back to Mexico, effectively deporting them without consulting any court or federal agency.
When the men awoke, they were more than 1,800 miles away in a hospital in Veracruz, on the Mexican Gulf Coast.
Hundreds of immigrants who are in the U.S. illegally have taken similar journeys through a little-known removal system run not by the federal government trying to enforce laws but by hospitals seeking to curb high costs. A recent report compiled by immigrant advocacy groups made a rare attempt to determine how many people are sent home, concluding that at least 600 immigrants were removed over a five-year period, though there were likely many more.
In interviews with immigrants, their families, attorneys and advocates, The Associated Press reviewed the obscure process known formally as "medical repatriation," which allows hospitals to put patients on chartered international flights, often while they are still unconscious. Hospitals typically pay for the flights.
"The problem is it's all taking place in this unregulated sort of a black hole ... and there is no tracking," said law professor Lori Nessel, director of the Center for Social Justice at Seton Hall Law School, which offers free legal representation to immigrants.
Now advocates for immigrants are concerned that hospitals could soon begin expanding the practice after full implementation of federal health care reform, which will make deep cuts to the payments hospitals receive for taking care of the uninsured.
Health care executives say they are caught between a requirement to accept all patients and a political battle over immigration.
"It really is a Catch-22 for us," said Dr. Mark Purtle, vice president of Medical Affairs for Iowa Health System, which includes Iowa Methodist Medical Center. "This is the area that the federal government, the state, everybody says we're not paying for the undocumented."
Hospitals are legally mandated to care for all patients who need emergency treatment, regardless of citizenship status or ability to pay. But once a patient is stabilized, that funding ceases, along with the requirement to provide care. Many immigrant workers without citizenship are ineligible for Medicaid, the government's insurance program for the poor and elderly.
That's why hospitals often try to send those patients to rehabilitation centers and nursing homes back in their home countries.
Civil rights groups say the practice violates U.S. and international laws and unfairly targets one of the nation's most defenseless populations.
"They don't have advocates, and they don't have people who will speak on their behalf," said Miami attorney John De Leon, who has been arguing such cases for a decade.
Estimating the number of cases is difficult since no government agency or organization keeps track.
The Center for Social Justice and New York Lawyers for the Public Interest have documented at least 600 immigrants who were involuntarily removed in the past five years for medical reasons. The figure is based on data from hospitals, humanitarian organizations, news reports and immigrant advocates who cited specific cases. But the actual number is believed to be significantly higher because many more cases almost certainly go unreported.
Some patients who were sent home subsequently died in hospitals that weren't equipped to meet their needs. Others suffered lingering medical problems because they never received adequate rehabilitation, the report said.
Gail Montenegro, a spokeswoman for U.S. Immigration and Customs Enforcement, said the agency "plays no role in a health care provider's private transfer of a patient to his or her country of origin."
Such transfers "are not the result of federal authority or action," she said in an email, nor are they considered "removals, deportations or voluntary departures" as defined by the Immigration and Nationality Act.
The two Mexican workers in Iowa came to the U.S. in search of better jobs and found work at Iowa Select Farms, which provided them with medical insurance even though they had no visas or other immigration documents.
Cruz had been here for about six months, Rodriguez-Saldana for a little over a year. The men were returning home from a fishing trip in May 2008 when their car was struck by a semitrailer truck. Both were thrown from the vehicle and suffered serious head injuries.
Insurance paid more than $100,000 for the two men's emergency treatment. But it was unclear whether the policies would pay for long-term rehabilitation. Two rehabilitation centers refused to take them.
Eleven days after the car crash, the two men were still comatose as they were carried aboard a jet bound for Veracruz, where a hospital had agreed to take them.
Rodriguez-Saldana, now 39, said the Des Moines hospital told his family that he was unlikely to survive and should be sent home.
The hospital "doesn't really want Mexicans," he said in a telephone interview with the AP. "They wanted to disconnect me so I could die. They said I couldn't survive, that I wouldn't live."
Hospital officials said they could not discuss the case because of litigation. The men and their families filed a lawsuit in 2010 claiming they received minimal rehabilitative care in Veracruz.
A judge dismissed the lawsuit last year ruling that Iowa Methodist was not to blame for the inadequate care in Veracruz. The courts also found that even though the families of the men may not have consented to their transport to Mexico, they also failed to object to it. An appeals court upheld the dismissal.
Patients are frequently told family members want them to come home. In cases where the patient is unconscious or can't communicate, relatives are told their loved one wants to return, De Leon said.
Sometimes they're told the situation is dire, and the patient may die, prompting many grief-stricken relatives to agree to a transfer, he said.
Some hospitals "emotionally extort family members in their home country," De Leon said. "They make family members back home feel guilty so they can simply put them on a plane and drop them off at the airport."
In court documents, Iowa hospital officials said they had received permission from Saldana's parents and Cruz's long-term partner for the flight to Mexico. Family members deny they gave consent.
There's no way to know for sure whether the two men would have recovered faster or better in the United States. But the accident left both of them with life-altering disabilities.
Nearly five years later, the 49-year-old Cruz is paralyzed on his left side, the result of damage to his hip and spine. He has difficulty speaking and can't work.
"I can't even walk," he said in a telephone interview, breaking into tears several times. His long-term partner, Belem, said he's more emotional since the accident.
"He feels bad because he went over there and came back like this," she said. "Now he can't work at all. ... He cries a lot."
She works selling food and cleaning houses. Their oldest son, 22, sometimes contributes to the family income.
Rodriguez-Saldana said he has to pay for intensive therapy for his swollen feet and bad circulation. He also said he walks poorly and has difficulty working. He sells home supplies such as kitchen and bath towels and dishes, a business that requires a lot of walking and visiting houses. He often forgets where he lives, but people recognize him on the street and take him home because he's confused.
The American Hospital Association said it does not have a specific policy governing immigrant removals, and it does not track how many hospitals encounter the issue.
Nessel expects medical removals to increase with implementation of health care reform, which makes many more patients eligible for Medicaid. As a result, the government plans to cut payments to hospitals that care for the uninsured.
Some hospitals call immigration authorities when they receive patients without immigration documentation, but the government rarely responds, Nessel said. Taking custody of the patient would also require the government to assume financial responsibility for care.
Jan Stipe runs the Iowa Methodist department that finds hospitals in patients' native countries that are willing to take them. The hospital's goal, she said, is to "get patients back to where their support systems are, their loved ones who will provide the care and the concern that each patient needs."
The American Medical Association's Council on Ethical and Judicial Affairs issued a strongly worded directive to doctors in 2009, urging them not to "allow hospital administrators to use their significant power and the current lack of regulations" to send patients to other countries.
Doctors cannot expect hospitals to provide costly uncompensated care to patients indefinitely, the statement said. "But neither should physicians allow hospitals to arbitrarily determine the fate of an uninsured noncitizen immigrant patient."
Arturo Morales, a Monterrey, Mexico, lawyer who helps Cruz and Rodriguez-Saldana with legal issues, is convinced the men would have been better off staying in Iowa.
"I have no doubt," he said. "You have a patient who doesn't have money to pay you. You can't let them die."
--- Associated Press Writer Barbara Rodriguez in Des Moines contributed to this report. ---
"I know this is how people live every day in other countries. But I'm not used to it here," said Greeley, 27, a technician at Tufts Medical Center who was on duty Monday when part of the hospital was briefly evacuated even as victims of the blast were being treated in the emergency room.
Anger, crying jags and nightmares are all normal reactions for both survivors of the Boston Marathon bombings and witnesses to the mayhem. While the injured and those closest to the blasts are most prone to psychological aftershocks, even people with no physical injuries and those like Greeley might feel the emotional impact for weeks afterward as they struggle to regain a sense of security. What's not clear is who will suffer lingering anxiety, depression or even post-traumatic stress disorder.
But specialists say that how resilient people are helps determine how quickly they bounce back. The resilient tend to be people who share their emotions before becoming overwhelmed, who know how to copewith stress, and who have the ability to look for a silver lining - such as focusing on bystanders who helped the wounded.
Focusing on the horror, "that's harder on our body and our mind," said Dr. Catherine Mogil, co-director of the family trauma service at the University of California, Los Angeles. "People who tend to be able to make positive meaning out of tough situations are going to fare better."
Among the typical reactions that psychologists say anyone who witnessed the bombings or their aftermath might experience include difficulty sleeping or eating; sweats or stomachaches; anxiety or fear - especially in crowded situations that remind people of the bombing. People may have a hard time focusing on work or other everyday activities. They may feel numb, anger easily, or cry often.
Priscilla Dass-Brailsford, a psychologist at Georgetown University Medical Center, said that if those symptoms don't fade in about a month, of if they are bad enough to impair function, people should seek help.
But for most, "time is a great healer," said Dass-Brailsford, who served on disaster mental health teams that counseled survivors of 9/11 in New York.
Specialists say only a small number of people are expected to be so severely affected that they develop PTSD, a disorder that can include flashbacks, debilitating anxiety, irritability and insomnia months after the trauma. Even among veterans of the Iraq and Afghanistan wars, the best estimate was that just under 20 percent returned with symptoms of PTSD or major depression.
More at risk for lingering psychological effects are people who've previously been exposed to trauma, whether from the battlefield, a car crash or a hurricane.
During two stints in Iraq as a Marine, Eusebio Collazo of Humble, Texas, was gravely wounded and today runs regularly to help deal with PTSD. Running with a veterans group called Team Red, White & Blue, he was at mile 25 of the marathon when the bombs detonated - and adrenaline fueled his frantic race to find his wife, Karla, at the finish line. She was unharmed.
"My wife keeps asking me, `I don't know how I should be feeling. I want to cry but I can't.' And then I want to cry, and I can't cry either. So, there's a lot of weird, different feelings going on," Collazo said Thursday. It's harder, he said, to handle explosions on the home front than in a war zone.
In Boston's hospitals, teams of counselors and social workers are telling patients and their families what to expect in the difficult days and weeks ahead.
"Most people are having a lot of flashbacks," and thoughts of the bombing interrupt their days and nights, said Lisa Allee, who directs the Community Violence Response Team at Boston Medical Center. "These are very typical, normal, expected emotions after any traumatic event or disaster."
Beyond hospitalized patients, part of coping is awareness about how to take care of the psyche - turning off scary TV coverage and reading a book, going out for a quiet dinner, anything to temporarily cut the stress, says Dass-Brailsford, the disaster specialist.
That's especially true for parents who are trying to calm their children, added UCLA's Mogil, because kids take their emotional cues from the adults around them. Younger children especially don't need to see repeated footage of the blasts, because they may think it's happening again.
For a lot of people, psychiatrists say, talking about their experience can be cathartic.
A cashier's routine "how are you?" was enough for Anndee Hochman to tear up in a Philadelphia hardware store Wednesday. Hochman and her 12-year-old daughter had traveled to Boston to watch her partner run the marathon - and all three were in different places when the bombs exploded, Hochman herself just a few blocks from the finish line.
Hochman spent 10 minutes telling the store clerk her family's story of reuniting - and said it helps every time she's told friends, family, even a near-stranger about the experience.
Unknowingly, Hochman echoed the advice to look for a silver lining as she counseled daughter Sasha, who was nervous about returning to school.
"I reminded her, " `Sweetie' - and reminded myself, too - `there may have been a few people who planned those bombs and wanted to hurt people," Hochman said, "but there are so many more people there and in the world who want to help.'"
AP Medical Writer Lauran Neergaard reported from Washington. AP writer Kevin Freking contributed to this report.
LOS ANGELES (AP) — Dick Van Dyke is seeing doctors for an undiagnosed health problem, and he's seeking advice online as well.
"My head bangs every time I lay down," the 87-year-old actor posted on his Twitter account. "I've had every test come back that I'm perfectly healthy. Anybody got any ideas?"
Bob Palmer, a spokesman for Van Dyke, said Thursday that he's undergoing tests for "cranial throbbing" that's causing him to lose sleep. The sensation occurs when Van Dyke lies down, and scans and other tests have yet to yield a diagnosis, Palmer said.
Van Dyke drew a number of responses to his tweet for help Wednesday, including questions about what's been done so far for the problem he described as stubborn.
"It has been going on for 7 years. I've had every test you can think of," he replied, including an MRI and spinal tap.
Van Dyke has a strong constitution and is otherwise OK, but the "fatigue factor has become acute," Palmer said. Until he receives a diagnosis and treatment plan he's been advised not to fly, and is resting at his Malibu home.
He was to accept an award next week from New York's 92nd Street Y but canceled the trip.
Van Dyke's credits include "The Dick Van Dyke Show" and "Diagnosis Murder."
SPRINGFILED, IL (AP) - State health officials are urging parents to make sure their children have received all their recommended vaccinations.
The Illinois Department of Public Health says the state is reporting its highest number of pertussis cases since 1950.
In 2012 there were 2,026 cases of the illness, also known as whooping cough.
Dr. LaMar Hasbrouck is director of the state public health department. He says the record number of cases is "the perfect example of the importance of continued immunization."
Saturday marks the start of National Infant Immunization Week.
Hasbrouck says parents may visit the department's website to find a list of recommended vaccines and the age at which children should receive them. Illinois residents who cannot afford to pay for the immunizations may be eligible for assistance.
The tests also showed the veterinary anti-inflammatory drug phenylbutazone, or bute, was present about .50 percent of the horse meat. Bute is banned for human use because in rare cases it causes severe side effects, but veterinary experts say there is little risk from consuming small amounts of the drug in horse meat.
European Health Commissioner Tonio Borg said Tuesday that "today's findings have confirmed that this is a matter of food fraud and not of food safety."
Borg said in the upcoming months the European Commission, the EU's executive arm, would propose measures "to strengthen the controls along the food chain."
The Supreme Court grapples Monday with the question of whether human genes can be patented. Its ultimate answer could reshape U.S. medical research, the fight against diseases like breast and ovarian cancer and the multi-billion dollar medical and biotechnology business.
"The intellectual framework that comes out of the decision could have a significant impact on other patents - for antibiotics, vaccines, hormones, stem cells and diagnostics on infectious microbes that are found in nature," Robert Cook-Deegan, director for genome ethics, law & policy at Duke University, said in a statement.
"This could affect agricultural biotechnology, environmental biotechnology, green-tech, the use of organisms to produce alternative fuels and other applications," he said.
The nine justices' decision will also have a profound effect on American business, with billions of dollars of investment and years of research on the line. The U.S. Patent and Trademark Office has been awarding patents on human genes for almost 30 years.
And Myriad Genetics alone has $500 million invested in the patents being argued over in this case. Without the ability to recoup that investment, breakthrough scientific discoveries needed to combat all kind of medical maladies wouldn't happen, the company says.
"Countless companies and investors have risked billions of dollars to research and develop scientific advances under the promise of strong patent protection," said Peter D. Meldrum, the president and CEO of Myriad Genetics, in a statement.
But their opponents argue that allowing companies like Myriad to patent human genes or parts of human genes will slow down or cripple lifesaving medical research like in the battle against breast cancer.
"What that means is that no other researcher or doctor can develop an additional test, therapy or conduct research on these genes," said Karuna Jagger, executive director of Breast Cancer Action.
The Supreme Court has already said that abstract ideas, natural phenomena and laws of nature cannot be given a patent, which gives an inventor the right to prevent others from making, using or selling a novel device, process or application.
Myriad's case involves patents on two genes linked to increased risk of breast and ovarian cancer. Myriad's BRACAnalysis test looks for mutations on the breast cancer predisposition gene, or BRCA. Those mutations are associated with much greater risks of breast and ovarian cancer.
Women with a faulty gene have a three to seven times greater risk of developing breast cancer and a higher risk of ovarian cancer. Men can also carry a BRCA mutation, raising their risk of prostate, pancreatic and other types of cancer. The mutations are most common in people of eastern European Jewish descent.
Myriad sells the only BRCA gene test.
The American Civil Liberties Union challenged Myriad's patents, arguing that genes couldn't be patented, and in March 2010 a New York district court agreed. But the U.S. Court of Appeals for the Federal Circuit has now twice ruled that genes can be patented. In Myriad's case, it's because the isolated DNA has a "markedly different chemical structure" from DNA within the body.
Mark C. Capone, president of Myriad Genetics Laboratories, Inc., a subsidiary of Myriad, said some of the concerns over what they have patented are overblown and some simply incorrect.
"Myriad cannot, should not and has not patented genes as they exist in the human body on DNA," Capone said in an interview. "This case is truly about isolated DNA molecules which are synthetic chemicals created by the human ingenuity of man that have very important clinical utilities, which is why this was eligible for a patent."
But the ACLU is arguing that isolating the DNA molecules doesn't stop them from being DNA molecules, which they say aren't patentable.
"Under this theory, Hans Dehmelt, who won the Nobel Prize for being the first to isolate a single electron from an atom, could have patented the electron itself," said Christopher A. Hansen, the ACLU's lawyer in court papers. "A kidney removed from the body (or gold extracted from a stream) would be patentable subject matter."
The Obama administration seems to agree. Artificially created DNA can be patented, but "isolated but otherwise unmodified genomic DNA is not patent-eligible," Solicitor General Donald Verrilli said in court papers.
That was the ruling of the original judge who looked at Myriad's patents after they were challenged by the ACLU in 2009. U.S. District Judge Robert Sweet said he invalidated the patents because DNA's existence in an isolated form does not alter the fundamental quality of DNA as it exists in the body or the information it encodes. But the federal appeals court reversed him in 2011, saying Myriad's genes can be patented because the isolated DNA has a "markedly different chemical structure" from DNA within the body.
The Supreme Court threw out that decision and sent the case back to the lower courts for rehearing. This came after the high court unanimously threw out patents on a Prometheus Laboratories, Inc., test that could help doctors set drug doses for autoimmune diseases like Crohn's disease, saying the laws of nature are unpatentable.
But the federal circuit upheld Myriad's patents again in August, leading to the current review. The court will rule before the end of the summer.
"The key issue now for the court will therefore be whether the scientist working in the lab to isolate a particular gene innovated in a way that allows for that isolated gene to be patented," said Bruce Wexler, a lawyer with the law firm Paul Hastings, who advises pharmaceutical and biotech companies on patent issues.
The case is 12-398, Association for Molecular Pathology v. Myriad Genetics, Inc.
WASHINGTON (AP) - A congressional investigation finds that specialty pharmacies like the one that triggered a deadly meningitis outbreak last year have little state oversight.
The report being released Monday by House Democrats shows that most states do not track or routinely inspect compounding pharmacies and that pharmacy boards in nearly all 50 states lack the information and expertise they need.
Missouri and Mississippi were the only two states that require permits or licenses and also the only ones with complete data on how many facilities they had.
None of the states indicated that they track whether pharmacies sell compounded drugs across state lines or in large quantities. Twenty-two states said they do not keep histories of problems.
Compounding pharmacies mix customized medications based on doctors' prescriptions. There have been calls for more federal oversight.