Exclusive: Federal agents found fetuses in body broker’s warehouse (Warning: Graphic images)

WASHINGTON (Reuters) – Federal agents discovered four preserved fetuses in the Detroit warehouse of a man who sold human body parts, confidential photographs reviewed by Reuters show.

The fetuses were found during a December 2013 raid of businessman Arthur Rathburn’s warehouse. The fetuses, which appear to have been in their second trimester, were submerged in a liquid that included human brain tissue.

Rathburn, a former body broker, is accused of defrauding customers by sending them diseased body parts. He has pleaded not guilty and his trial is set for January.

How Rathburn acquired the fetuses and what he intended to do with them is unclear. Rathburn’s lawyers did not respond to requests for comment, and neither the indictment nor other documents made public in his case mention the fetuses.

“This needs to be reviewed,” said U.S. Representative Marsha Blackburn, a Republican from Tennessee who recently chaired a special U.S. House committee on the use of fetal tissue.

Blackburn recoiled when a Reuters reporter showed her some of the photographs, taken by government officials involved in the raid.

In four of the photos, a crime scene investigator in a hazmat suit uses forceps to lift a different fetus from the brownish liquid. In three other photos, a marker that includes a government evidence identification number lies beside a fetus.

“The actions depicted in these photos are an insult to human dignity,” said U.S. Representative Bob Goodlatte, chairman of the House Judiciary Committee. A Republican from Virginia, Goodlatte said that if individuals “violate federal laws and traffic in body parts of unborn children for monetary gain,” they should be “held accountable.”

EDITOR’S NOTE: Reuters has pixelated this image; editors judged the original image to be disturbingly graphic.

In a photograph obtained by Reuters, a fetus lies alongside a government evidence marker. The fetus and three others were found during a 2013 search of a Detroit warehouse operated by Arthur Rathburn, a businessman who sold human body parts for medical research and education. Rathburn has pleaded not guilty to selling infected body parts of adults.
Government photo via REUTERS

Blackburn said the discoveries in Rathburn’s warehouse raise questions about the practices of body brokers across America. Such brokers take cadavers donated to science, dismember them and sell them for parts, typically for use in medical research and education. The multimillion-dollar industry has been built largely on the poor, who donate their bodies in return for a free cremation of leftover body parts.

The buying and selling of cadavers and other body parts — with the exception of organs used in transplants — is legal and virtually unregulated in America. But trading in fetal tissue violates U.S. law.

In most states, including Michigan, public health authorities are not required to regularly inspect body broker facilities. As a result, it’s impossible to know whether body brokers who deal in adult donors are acquiring and profiting from fetuses.

EDITOR’S NOTE: Reuters has pixelated this image; editors judged the original image to be disturbingly graphic.

In this photograph obtained by Reuters, a government worker in a hazmat suit uses forceps to lift a fetus found during a 2013 search of a Detroit warehouse operated by Arthur Rathburn, a businessman who sold human body parts for medical research and education. Rathburn has pleaded not guilty to selling infected body parts of adults.
Government photo via REUTERS

Blackburn’s call for action came in response to a Reuters series that exposed abuses in the human body trade and what Blackburn called “lax oversight” and “lax enforcement” of the industry.

Photos from inside Rathburn’s warehouse offered a stark example of government failures to police the industry. They include images of rotting human heads, some floating face up in a plastic cooler. The Federal Bureau of Investigation, which has been investigating Rathburn and other body brokers, declined to comment.

Blackburn said she found other Reuters stories about the body trade disturbing.

As part of the news agency’s examination of the industry, for example, a Reuters reporter was able to purchase two human heads and a cervical spine from Restore Life USA, a broker based in Blackburn’s home state of Tennessee. The deals were struck after just a few emails, at a cost of $900 plus shipping.

“It is sickening” how easily Restore Life sold the parts to Reuters, Blackburn said.

Told of Blackburn’s concerns, Restore Life owner James Byrd said his company has “invited her to tour our facility and to review the policy and procedures we have in place.”

Shiffman reported from Washington. Grow reported from Atlanta. Edited by Blake Morrison.

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Concussion protocol altered after recent missteps

(Reuters) – The NFL’s concussion protocol has been altered with late-season changes following recent incidents that have triggered investigations.

The changes were implemented last weekend, Dr. Allen Sills, the NFL’s chief medical officer, told ESPN.

Most notably, a central unaffiliated neurotrauma consultant (UNC) was stationed at the command center that has been used primarily for game-replay review, Sills said.

“We are constantly looking at the protocol and how it’s applied and trying to get better,” Sills said. “The process happens through the season.”

An injury to Houston Texans quarterback Tom Savage on Dec. 10 as well as Seattle Seahawks quarterback Russell Wilson’s concussion protocol misstep in Week 10 that resulted in a $100,000 fine for the franchise were two incidents that fueled the investigation.

Other notable changes in the new protocol were:

–Any sign of impact seizure will be considered the same as loss of consciousness, with the player being ruled out of the game.

–A referee who removes a player from the game for suspected head trauma must notify the medical staff.

–A player who exhibits gross motor instability or significant loss of balance must be taken to the locker room for evaluation if it is not diagnosed as an orthopedic injury.

–A player who is evaluated for a concussion must be re-evaluated within 24 hours, even if the player has an off day.

–A third UNC will be on site for the playoffs and the Super Bowl, in addition to the two already assigned to each regular-season game.

Reporting by Rory Carroll

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Peers may influence how well type 1 diabetes is managed

(Reuters Health) – How young people with type 1 diabetes relate to their peers may have important effects on how well they manage the disease and how distressing it is for them, a small study suggests.

Peers can help teens and young adults accept their disease and follow their treatment plans, but youth who are too attuned to what their friends think of them may neglect disease management to fit in, the authors report in Diabetes Care.

“This was one of the first studies to ask adolescents and emerging adults with type 1 diabetes about their relations with peers at a certain point in time and one year later,” lead author Koen Raymaekers from the University of Leuven in Belgium told Reuters Health by email.

“We found that more general positive relations with peers at one point in time predicted less diabetes-specific distress one year later,” he said.

But, because young adults who were very oriented toward peers at the start had worse blood sugar control a year later, paying additional attention to peer relations during this time seems important, Raymaekers added.

The researchers recruited more than 400 Dutch-speaking young people in Belgium, aged 14 to 25, with type 1 diabetes. The participants answered questionnaires rating how they felt about the support they got from their peers as well as their perceptions of their parents’ responsiveness to their needs.

The study team also measured “peer orientation” – whether participants were more likely to listen to their parents or to their peers – with questions such as, “Would you ignore your diabetes management needs in order to make someone like you?”

The researchers had access to long-term blood sugar measurements and the young people answered questions about their treatment adherence as well as their diabetes-related distress levels.

The study team found that having supportive peers was associated with less diabetes-related distress over time. But, having extreme peer orientation was associated with greater treatment distress over time and poorer blood sugar control.

Conversely, good treatment adherence was tied to lower peer-orientation scores, less treatment distress and better blood sugar control.

Youth who reported having more responsive parents tended to have less food distress over time, the researchers also found.

“Our study indicates that as a parent/grandparent/caregiver it may be informative to ask about patients’ peer relations,” Raymaekers said.

If patients indicate that they experience difficulties with peer relations this may have an impact on their diabetes-related distress and perhaps even on treatment adherence and blood sugar control in the long term, he said.

“In addition, some patients may experience their diabetes as a burden when interacting with peers, and therefore neglect treatment in favor of fitting in with peers,” Raymaekers noted.

Therefore, he said, when there are indications of problematic relations with peers, as a parent/grandparent/caregiver one could think and talk with the patient on how to improve these relations without sacrificing treatment or feeling distressed by their diabetes.

Raymaekers added that he was not surprised to see that peers are important for patients with type 1 diabetes, but there were some specific “rather striking” findings, for example, that the 18-24 year olds who were very oriented toward peers at baseline had worse blood sugar control one year later.

There is a need for more research on this topic, which could uncover the cause and effect relationships between peer relationships and diabetes outcomes and the mechanisms at work, he said.

SOURCE: bit.ly/2A4oiU8 Diabetes Care, online November 14, 2017.

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Israel’s Super-Pharm in talks to buy Teva Pharm plant: source

TEL AVIV (Reuters) – Israel’s largest pharmacy chain Super-Pharm (Israel) Ltd is in talks to acquire Teva Pharmaceutical Industries’ plant in the coastal city of Ashdod, a source familiar with the matter said on Sunday, confirming media reports.

Super-Pharm would pay 60-80 million shekels ($17-23 million) and is prepared to commit to continue employing the factory’s 70 workers, said the source, who asked not to be named.

Super-Pharm is interested in the pharmaceutical preparation activities that have an estimated 100 million shekels in annual sales, the Globes financial news site said.

Teva said this month it would cut its workforce by more than a quarter and give up many of its manufacturing plants including the one in Ashdod in a much-anticipated overhaul to help pay off its nearly $35 billion debt.

Most of the Ashdod plant’s operations involve preparing liquid medications for treatments in hospitals and homes, such as antibiotics and chemotherapy as well as food for premature babies.

Super-Pharm, which already operates laboratories providing custom-made treatments, did not confirm the talks but said it would be interested in a deal.

“Super-Pharm would be happy to acquire Teva Medical and integrate its workforce. The chain hopes to continue operations in this vital factory, which is responsible among other things for feeding premature babies in hospitals around the country,” Super-Pharm said.

A spokeswoman for Teva, the world’s biggest maker of generic drugs, declined to comment.

Teva workers have been protesting the planned layoffs at various Teva facilities across the country.

Reporting by Tova Cohen; Editing by Steven Scheer/Keith Weir

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Children’s Insurance, Other Health Programs Funded — For Now — In Bill

The bill passed by Congress late Thursday to keep most of the federal government funded for another month also provided a temporary reprieve to a number of health programs in danger of running out of money, most notably the Children’s Health Insurance Program, or CHIP.

Funding for CHIP technically expired Oct. 1. States have been operating their programs with leftover funds provided by the Department of Health and Human Services since then. But nearly half of the states were projected to run out of money entirely by the end of January, putting health coverage for nearly 2 million children at risk by that point.

The funding provided by Congress for CHIP — $2.85 billion — is for six months, but it is back-dated to Oct. 1, so it will run out at the end of March 2018. The program covers 9 million children across the country.

This week, Alabama announced it would curtail enrollment and renewals starting Jan. 1, and start disenrolling children currently in the program Feb. 1. On Friday, the state posted a notice on its website that those plans were now canceled. Several other states, including Colorado, Virginia and Utah, have begun the process of notifying families that their coverage could end unless Congress acts.

The funding bill also provided a temporary reprieve for a raft of other health programs that were running out of money, most notably the nation’s community health centers, which provide basic primary care to 27 million Americans. Many centers are already freezing hiring, laying off staff and closing sites due to the uncertain funding stream from Washington.

Other health programs that were set to expire but have been funded, for now, include the National Health Service Corps, which places health practitioners in medically underserved areas, and the teaching health centers program, which trains medical residents in community health centers.

Backers of CHIP complain that short-term funding fixes are disruptive to the program.

“By failing to extend long-term funding for the Children’s Health Insurance Program, Congress falls far short of the reassurance and relief families deserve,” said a statement from the American Academy of Pediatrics.

A coalition of children’s groups, including the Children’s Defense Fund and the March of Dimes, agreed, saying the short-term funding “only causes more chaos and confusion on the ground.”

Both Republicans and Democrats strongly support CHIP, which was created in a 1997 budget bill. What they disagree on is whether its funding — expected to be roughly $8 billion over the next 10 years — should be paid for by cutting other health programs. The House in November passed a five-year renewal that would finance CHIP primarily by reducing the Affordable Care Act’s Prevention and Public Health Fund and by raising some people’s Medicare premiums. Democrats question why CHIP needs to have its funding offset while Republicans are adding $1.4 trillion to the deficit through their tax cut bill.

KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation.

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FDA Chief Says He’s Open To Rethinking Incentives On Orphan Drugs

The commissioner of the Food and Drug Administration questions whether the right financial incentives are in place for drugmakers who develop orphan drugs for rare diseases.

In an interview this week, the FDA’s Scott Gottlieb said the Orphan Drug Act of 1983 has provided “an enormous amount of public health value” over the years, but the “market has changed.”

Gottlieb said it’s time to ask the question: “Do we have the right incentives in place?”

The nearly 35-year-old law created incentives for companies to develop “orphan drugs” considered not financially viable because they treat rare diseases affecting fewer than 200,000 people. Those incentives include a waive on millions of dollars in fees, seven years of market exclusivity and a tax break for research and development expenses.

The law proved successful — in the decade before it passed, only 10 industry-supported rare-disease drugs had been brought to market, according to the FDA.

Today, orphan drugs often carry six-figure price tags and pharmaceutical companies readily develop them. In 2016, 41 percent of the new drugs approved by the FDA were orphans. And 2017 is on track to be a record year.

In the past year, rare-disease drugs commanded attention through numerous pricing controversies. Examples include Marathon Pharmaceuticals, which sold its $89,000 drug for Duchenne muscular dystrophy after public outcry, and Strongbridge Biopharma, which relaunched a glaucoma drug this year after winning orphan approval to treat a rare neuromuscular condition. The drug’s annual price tag is at least $109,500.

“Clearly, [the Orphan Drug Act] has delivered,” said Bernard Munos, a former corporate strategy adviser at drug giant Eli Lilly who is now a senior fellow at FasterCures. “In that same vein, I think a problem that we didn’t anticipate some 30 years ago is the pricing crisis.”

The top 100 orphan drugs in the U.S. cost an average of $140,442 per patient last year, according to EvaluatePharma.

Gottlieb’s comments come after a year of scrutiny around orphan drugs.

An investigation by Kaiser Health News that NPR published and aired in January found that many drugs with orphan status weren’t entirely new when approved. Of about 450 drugs that have won orphan approval since 1983, more than 70 were drugs first greenlighted by the FDA for mass-market uses. Those include the cholesterol blockbuster Crestor, Abilify for psychiatric disorders, and the rheumatoid arthritis drug Humira, the world’s best-selling drug.

More than 80 other orphan drugs won FDA approval for more than one rare disease, and in some cases, multiple rare diseases. For each approval, the drugmaker qualified for a fresh batch of incentives. Altogether, KHN’s investigation found that about a third of drugs given the FDA’s orphan status have either been repurposed mass-market drugs or drugs that received multiple orphan approvals.

Gottlieb and other industry experts have said that repurposing common drugs to treat rare diseases is scientifically sound and good for patients. But Gottlieb has also said high drug prices are a public health concern, and in the phone interview Wednesday he questioned whether the financial incentives should be different for drugs that receive “secondary approvals.”

“It could very well be that you need to think differently about how you would create a framework around the secondary indication and the primary indication,” Gottlieb said, adding that he doesn’t have an answer but the agency has been asking the question.

At the same time, Gottlieb pointed to rare diseases without treatments, even under the current incentive system: “You have to ask why various uses of drugs aren’t getting studied.”

Paul Melmeyer, director of federal policy at the National Organization for Rare Disorders, said there is a lot of unmet need since nearly 7,000 diseases lack treatments for an estimated 30 million Americans.

While Gottlieb can change agency guidelines, any change to the Orphan Drug Act’s incentives would require congressional action. And there may be an appetite for such a change.

Gottlieb became commissioner in May, a few months after three key Republican senators called for a federal investigation into potential abuses of the Orphan Drug Act. The Government Accountability Office began an investigation last month.

Congress included changes to orphan drug incentives in its sweeping tax legislation, reducing the orphan drug tax credit from 50 percent of research and development costs to 25 percent — a move that will save the government $32.5 billion from 2018 to 2027. Earlier versions of the bill included transparency requirements and an elimination of credits for repurposed drugs — both of which were struck from the final version.

Gottlieb, though, has not waited for the GAO or Congress before doing what he can to revamp the program. In late June, he announced a modernization plan that included closing a loophole that allows manufacturers to skip pediatric testing requirements when developing a mass-market drug for treating rare diseases in children.

When asked about the coming year, Gottlieb said: “We are going to look for other ways to make sure the program is achieving its public health goals.”

Sydney Lupkin contributed to this report.

KHN’s coverage of prescription drug development, costs and pricing is supported by the Laura and John Arnold Foundation.

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Boston-area paramedics on front lines of U.S. opioid crisis

(Reuters) – The paramedics find them everywhere – slumped over car steering wheels, barely breathing in doughnut shop bathrooms or dead in derelict apartments and expensive mansions.

For the Cataldo Ambulance Service crews outside Boston on the front lines of the U.S. opioid epidemic, the flood of overdose calls is a grim daily reality, despite expanded access to overdose reversal drugs.

“When I started, this was a rare thing. You did one or two here and there. Now, we do quite a few,” said Dave Franklin, 44, a supervisor at the private service that contracts with cities who has worked in the field for more than 20 years.

In Massachusetts, EMS opioid overdose calls hit 20,978 in 2016, up from 8,389 in 2013, according to a state report.

Amid wider use by bystanders and police of naloxone, a drug that reverses overdose symptoms, state figures showed a small drop in opioid deaths in the first nine months of 2017 compared with 2016. But Franklin does not yet see a turning point.

“It’s not going away anytime soon. People are still dying regularly,” he said.

In the United States, deaths from drug overdoses have surpassed deaths by firearms and motor vehicle crashes, according to a 2017 Drug Enforcement Administration report.

President Donald Trump has declared a public health emergency over opioid abuse, promising to increase treatment but initially dedicating no money for it.

Opioids, primarily prescription painkillers, heroin and synthetic drugs like fentanyl, a pain medicine 50 to 100 times more powerful than morphine, are fueling the crisis. Opioid-related overdoses kill 91 people in the United States each day, the Drug Enforcement Administration said.

On Thursday, the Centers for Disease Control reported, based on the latest available figures, that the U.S. rate of drug overdose deaths in 2016 grew 21 percent from the prior year.

“It’s hard to watch, and it’s devastating,” said Domenic Corey, 27, who has seen the evidence up close working as a Cataldo paramedic.

Mornings before starting his shift, another Cataldo paramedic, Andrew Simpson, grabs his stethoscope, intravenous supplies, scissors and pen light.

Cataldo Ambulance medics John Gardner (L) and David Farmer care for a man in his 40’s who was found unresponsive after overdosing on an opioid in the Boston suburb of Salem, Massachusetts, U.S., August 9, 2017. REUTERS/Brian Snyder

At the ambulance, he checks to make sure there is enough naloxone. They carry more than double the amount they once did because stronger opioids mean that multiple doses of naloxone are often required for someone who is barely breathing.

Simpson, 34, works at least two 24-hour shifts a week in a high-turnover job that can be stressful and where pay starts at $14 an hour. Just touching Fentanyl can send an EMS worker into overdose.

Simpson’s radio crackles with calls. Difficulty breathing. Person down. Unresponsive. Overdose. They turn on the lights and roll. From experience, they know it might be a man who overdosed into unconsciousness while driving, a teen or elderly user passed out in a park or an already stiffened corpse in a hotel room strewn with needles and powder.

On arrival, they spray naloxone up the nose or inject it into the user, pump oxygen into lungs and wait. Some respond gulping for air or vomiting and confused.

Slideshow (9 Images)

“Why are you in my house? What’s going on?” Simpson recalled as a common question from recipients of his aid. Some people are grateful and repentant, crying, shaking hands and promising to get treatment. Others deny they took drugs at all.

The calls often come in waves when fentanyl too potent for users hits the streets. Time of day matters, too.

“If it’s in the afternoon, there’s a much better chance they are still alive,” he said. “If we get the call at 7 a.m., they probably shot up the night before.”

The paramedics say they often see families torn apart in front of their eyes or bereaved parents.

“You see the parents, they’re crushed; just the look of defeat, you know? They lost the most important person in the world to them. I can’t even imagine. But you see it over and over again,” Corey said.

The cost of naloxone has risen with demand, eating into the service’s budgets, Franklin said. But they are also using their steady overdose runs to help some cities map drug hotspots and for police to visit users to urge them into treatment.

“In the back of the ambulance, you talk to them and hope they get treatment,” Simpson said, explaining that most agree they need to get help. “But then at times I’ll see the same person three months down the line and they have overdosed.”

Related photo essay at reut.rs/2BiUBvD

Reporting by Chris Kenning; Editing by Toni Reinhold

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FDA rejects Agile’s contraceptive patch, shares plunge

(Reuters) – Agile Therapeutics Inc said on Friday the U.S. Food and Drug Administration declined to approve its contraceptive patch for the second time, sending the drug developer’s shares down about 50 percent.

The health regulator cited deficiencies related to its quality adhesion test methods and asked the company to resolve the observations found during an inspection of its third-party manufacturing facility, Corium International Inc.

Agile’s lead product, Twirla, is a once-weekly, low-dose contraceptive patch made from a combination of ethinyl estradiol and levonorgestrel.

In 2013, the FDA rejected Twirla, citing efficacy issues and sought additional clinical data. After that, Agile completed a late-stage trial in 2,032 women and once again applied for approval in June.

Expressing surprise over the decision, Agile said on Friday the drug regulator has not identified any safety issue related to the product and it intends to seek a meeting with the regulator soon.

The company also pointed out that an amendment addressing the regulator’s concerns about the manufacturing facility and issues related to quality adhesion test methods was not reviewed before the FDA decided to reject the drug.

The amendment was submitted on Dec 1, Chief Executive Al Altomari said on a conference call, adding that he is surprised the FDA didn’t review it.

If approved, Agile’s Twirla would have competed with Mylan NV’s Xulane, a generic version of a Johnson & Johnson’s Ortho Evra product that was withdrawn in 2015.

Xulane generated sales of $211 million last year, a fraction of the $5.5 billion U.S. contraceptive market.

Shares of the Princeton, New Jersey-based Agile were trading at $2.43, while that of Corium dropped 4.6 percent to $10.74.

Reporting by Divya Grover in Bengaluru and Toni Clarke in Washington; Editing by Anil D’Silva and Arun Koyyur

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Podcast: ‘What The Health?’ 2017: The Year In Health Policy

This has been quite a year in health policy. In 2017, the Affordable Care Act survived numerous GOP efforts to repeal and replace it, although the year-end tax bill will eliminate fines for failing to obtain health insurance in 2019. And, ironically, the more Republicans talked the health law down, the more popular it got.

Meanwhile, Congress may have passed the tax bill, but lawmakers are still scrambling to finish legislation needed to keep the government open after Dec. 22. On the line in that bill is the Children’s Health Insurance Program that provides coverage to 9 million kids around the country. Its formal funding ran out in September.

This week’s “What the Health?” guests are:

Julie Rovner of Kaiser Health News
Joanne Kenen of Politico
Alice Ollstein of Talking Points Memo
Margot Sanger-Katz of The New York Times

They discuss these topics as well as health issues in 2017 that were less covered and remain unresolved.

Among the takeaways from this week’s podcast:

  • The Republican repeal of the individual mandate penalties will lead to higher premiums and higher numbers of uninsured, but the magnitude of that change is still unknown.
  • The promise Sen. Susan Collins (R-Maine) secured for bills to help stabilize the individual insurance market has faltered, and those bills will not be part of any end-of-the-year legislation. This time, she didn’t have other moderate GOP allies to help strengthen her negotiating position.
  • Two surprising year-end observations: Despite Republicans’ efforts to get rid of the Affordable Care Act, the health law seems to be resilient and the public appears to be more committed than ever to sustaining Medicaid, the health program for low-income residents.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Julie Rovner: Politico’s “The stealth repeal of Obamacare,” by Joanne Kenen

Joanne Kenen: HuffPost’s “Health Insurers See Higher Prices And A Big Mess Ahead Without The Obamacare Mandate,” by Jeffrey Young

Alice Ollstein: Politico’s “HHS defends withholding comments critical of abortion, transgender policy,” by Dan Diamond

Margot Sanger-Katz: Bloomberg’s “A Hospital Giant Discovers That Collecting Debt Pays Better Than Curing Ills,” by John Tozzi and Vox.com’s “How well does bariatric surgery work? We asked 11 people who got it,” by Julia Belluz

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunes, Stitcher or Google Play.

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Near Incineration Of Psychiatric Hospital Highlights Gaping Need For More Beds

As fire raged in Ventura, Calif., earlier this month, Gracie Hartman made her way to the county fairgrounds to look for her friend, Fernando.

She found him there at the evacuation center, among 69 patients from the Vista del Mar acute psychiatric hospital, one of two such facilities in the county. They had been removed with little time to spare as the hospital was overtaken by flames.

Over the next couple of days, Fernando was transferred to one general hospital as a stopgap, then to another, because, unlike the first, it would accept his insurance.

“He was so upset, that he was throwing up,” said Hartman, who spoke on condition that Fernando be identified only by his first name to protect his privacy. “It was a nightmare.”

Overnight, the private hospital’s shutdown wiped out about two-thirds of the psychiatric hospital capacity in Ventura County, population 850,000. That a fire could so quickly devastate a county’s inpatient psychiatric services only underscores how few beds there are — a phenomenon that holds true across California and nationwide.

“It’s a huge loss,” said Dr. Bryan Wong, chief medical officer of the county-run Ventura County Medical Center, which has a 43-bed psychiatric unit. “It leaves us vulnerable. It was a crisis even before the fires. We were at full capacity consistently. Now, it’s turned into a level beyond that.”

There are about 8,805 acute psychiatric beds in California, according to the Office of Statewide Health Planning and Development — not enough, advocates say, to meet the need. California has about 15 psychiatric beds per 100,000 residents compared with a recommended standard of 50 beds for 100,000 people, according to the Arlington, Va.-based Treatment Advocacy Center, which promotes greater access to mental health treatment.

The country has struggled with a national shortage of psychiatric hospital beds for many years. Last year, the United States had 37,679 state psychiatric beds, down 13 percent from 2010, according to the center.

The closure of public psychiatric hospitals has left many people with nowhere to go for treatment during an acute mental health crisis, according to the Virginia-based center. Without a reliable source of inpatient care, patients languish in overcrowded emergency rooms or, even worse, deteriorate until they’re arrested and jailed, often for minor infractions. Some become homeless.

In addition, many people experience severe psychiatric problems while trying to cope with disasters — and those very disasters can limit their options for care.

In recent years, catastrophes have damaged or threatened psychiatric facilities elsewhere around the country, sending doctors and families scrambling to transfer patients to other facilities, sometimes far away from their community, friends and family.

In 2011, Tropical Storm Irene severely damaged Vermont’s state-run psychiatric hospital, forcing the evacuation of 51 residents. The hospital never reopened, and the state replaced it with a smaller facility several years later. Before Hurricane Katrina struck in 2005, 73 adult, adolescent and child patients at an acute psychiatric facility were evacuated by bus from New Orleans to Memphis, Tenn., on a weekend night — a trip of about 400 miles.

Vista del Mar, an 87-bed acute care facility and the only one that treats children and teens, as well as adults, in Ventura County, didn’t completely burn down, but it lost key buildings. Although its owner, Corona, Calif.-based Signature Healthcare Services, has said it will rebuild, it is unlikely to reopen soon.

Vista del Mar’s closure further burdens the region’s emergency rooms, which often board psychiatric patients for days on end while they wait for a mental health bed to open up, Wong said. These patients are seriously ill, posing a danger to themselves or others, he said.

A nearby addiction treatment center, Evolve Camarillo, has offered “emergency mental health triage” for teens, but the center is not a licensed psychiatric hospital.

A state bill that would have established an online registry to help medical providers find psychiatric beds was supported by the California Psychiatric Association but opposed by the California Hospital Association as unlikely to meet the complex challenge of finding appropriate treatment for patients, and the bill died in committee in late 2016.

In Ventura, Wong said the county-run acute psychiatric facility accepted 20 patients from Vista del Mar the night they were evacuated, hastily revamping a triage area to house them. Other patients, including children and teens, were sent to hospitals as far away as Bakersfield and Los Angeles.

The patients likely would stay for several days, then be referred to outpatient treatment if they were well enough, Wong said.

Fernando, who suffers from a rare bone disease, was being treated for anxiety and depression at Vista del Mar. He eventually was transferred to a Kaiser Permanente psychiatric facility in Los Angeles, Hartman said. (Kaiser Health News is not affiliated with Kaiser Permanente.)

Blair Stam, executive vice president for Vista del Mar’s owner, said his company plans not just to rebuild but to expand the hospital “because the need is so great.”

The hospital has been between 85 and 90 percent full at any given time, he said. He hopes state health officials will fast-track construction plans, he said. But that could take years, given complex hospital building regulations and what’s likely to be intense competition for construction resources in the region.

The vast and deadly Thomas Fire, which has burned an estimated 272,000 acres and destroyed hundreds of buildings, was only about 55 percent contained as of Wednesday, according to firefighters.

In the meantime, “families are scrambling” as their loved ones are on the verge of being discharged from the far-flung hospitals they were sent to after the fires, said David Deutsch, executive director of the National Alliance on Mental Illness-Ventura chapter, an advocacy group. “We’re in pretty dire straits here” Deutsch said. “It’s quite chaotic.”

Kaiser Health News senior correspondent Liz Szabo contributed to this report.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

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