Oregon Public Broadcasting

Zip Code May Be More Important To Health Than Genetic Code

A couple of hundred health experts gathered at the Nutrition of Girls and Women conference in Portland on Thursday to discuss the generational effects of poor nutrition on women of child-bearing age.

Most of us understand we inherit our genes from our parents. But what scientists now know is that those genes can be turned on and off by environmental factors, such as stress and what a person eats.

Dr. Kent Thornburg, director of the Moore Institute for Nutrition and Wellness, told conference attendees that environment is particularly important for women of child-bearing age — to the point where their zip code may be more important to their health than their genetic code.

"During development, before you're born, that's when you're more susceptible to environmental changes like nutrition and stress from your mother," he said.

"That changes your genes and that can last for the rest of your life," he added.

The head of the Oregon Health Authority, Lynne Saxton, told the conference she's worked with children who are a foot short for their age because of poor nutrition. And while the state has expanded tax credits and opened new food pantries, she said, more work is needed.

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Oregon Coordinated Care Organization Threatens To Sue The State

One of Oregon's coordinated care organizations, FamilyCare, has notified the state it intends to sue over the way health insurance rates are set.

Under Oregon's health care experiment, the federal government has given the state flexibility to sets rates.

For example, last year Portland-based FamilyCare had its rates reduced by about 9 percent. The head of the CCO, Jeff Heatherington, says that translated to a loss of more than $4 million a month - and the state won't tell him why it reduced the rates.

"If the Oregon Health Authority would actually just open up their books and say, 'Look, this is how we did it,'" he said, "we could all look at it and have a discussion.

"But the first thing they did is bury everything deep and won't answer questions."

A spokeswoman for the Oregon Health Authority said the agency can't comment on potential litigation.

The economics of Oregon's 16 CCOs might become clearer at the end of the month, when the state is expected to release financial details.

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Severely Mentally Ill Prisoners Routinely Pepper-Sprayed And Denied Health Care

A report by Disability Rights Oregon has found that prisoners in the Behavioral Health Unit at the State Penitentiary are routinely tasered, pepper-sprayed, isolated, and denied access to adequate mental health care.

Disability Rights Oregon is authorized by the federal government to protect the legal rights of people with disabilities here.

For it's report, it toured the Behavioral Health Unit, reviewed hours of video and interviewed 19 prisoners.

Disability Rights found one prisoner who was so troubled by spending 23 hours a day in his cell, he started harming himself.

He wasn't identified in the report. But Disability Rights says his hope was to be sent to the hospital or the prison's Mental Health Infirmary, because he thought staff there were more sympathetic and delivered better care.

He told correctional staff many times he was in crisis, but with little response and no result. Eventually he was told, "You have to get pepper sprayed to go [to the hospital or infirmary]."

So he hung a sheet across the front of his cell.

Prisoners aren't allowed to do that. And when he wouldn't remove it, officers in riot gear sprayed him, pulled him out and transferred him to the infirmary. He can be heard on video saying, “That’s all I wanted in the first place.”

Sarah Radcliffe, an attorney with Disability Rights Oregon, said such stories highlight the ugly effects solitary confinement can have on a mentally ill person. "So they're in small cells with no access to fresh air or natural light for 23 hours a day and sometimes more."

"We found that access to showers and exercise was very limited, even though they're supposed to be entitled to those two things at the very least," she added.

The Disability Rights report also found that security staff consistently ignore the advice of mental health staff and instead handle mental crises with tasers, restraint chairs and "psychological torment."

"Prisoners in this unit are subjected to frequent unnecessary use of force, by staff, often in response to behaviors that are related to their mental illnesses," said Radcliffe.Disability Rights has three main recommendations: That prisoners be allowed out of their cells for a minimum of five hours a day; that there be a 30-minute cooling-down period before a prisoner is forcibly removed from his cell; and that there be enough resources for mental health staff to regularly observe prisoners and meet with them in a confidential setting.

"I can't really speak to specific actions that we are going to take, but they are definitely things that we are considering," said Steve Robbins, who's responsible for overseeing mental health care at the Department of Corrections.

He said their resources are limited, but the department will consider the recommendations.

However, he was not convinced about problems between security and mental health staff. "Security plays as big a role as our mental health staff in actually helping to de-escalate."He gave this example: "We had a situation where one of these inmates actually successfully stabbed one of our security staff members. Once that person healed and was back at work, he actually sat down with this inmate and worked through the behaviors and talked through these things."

One of the Department of Corrections' major complaints about the report is that no security staff were interviewed. Disability Rights says it will try to interview security staff -- and issue a supplementary report if warranted.

Currently there are about 37 inmates in the Behavioral Health Unit.  Their crimes range from robbery to the unauthorized use of a motor vehicle.

Twenty-two of the inmates have some type of assault conviction as part of their current custody cycle. "These are folks that have a history of when they are in public places with other people, people get hurt," said Robbins.

OPB asked to visit the unit after the Disability Rights report was released, but the request was denied.

The Department of Corrections cited a rule that "generally" does not permit media access to special housing units.

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Oregon's Medical Facilities Report 624 Mistakes Last Year

Oregon's hospitals, nursing facilities, pharmacies and surgery centers reported 624 medical mistakes last year. But it's hard to know whether that's better or worse than previous years.

Oregon's eight-year old Patient Safety Reporting Program is voluntary. Medical facilities don't have to let the program know about surgical mistakes, falls or delayed care.

Bethany Walmsley, the director of the Oregon Patient Safety Commission, said the voluntary nature of the program is an issue. But each year more facilities are participating and the quality of reports are improving, she said.

"The real goal for this is shared learning across the state of Oregon," Walmsley said. "What can we share that will help rise all boats and help people overcome and prevent those events from happening in their own facilities?"

About half of all mistakes reported resulted in serious harm or death for a patient.

And while many families may be told what happened, only 29 percent got written notification.

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Cost Of Medication To Cope With Multiple Sclerosis Continues To Climb

Usually, the more competitive a market, the lower the price. But that hasn’t happened over the last couple of decades for multiple sclerosis drugs.

Back in the 1990s, when the first drugs to slow multiple sclerosis came to market, they cost about $10,000 a year. Doctor Dennis Bourdette, the chair of neurology at Oregon Health & Science University, says he expected that price to drop over time, but now it’s about $60,000 a year.

“The pattern is a new drug comes on the market at a higher price than the existing drugs, and the response of the existing drugs is to raise their prices to close to the new drugs,” said Bourdette.

A new study, published in this month’s issue of Neurology, found prices of old multiple sclerosis drugs have shown ‘an alarming rise.’

Researchers say the absence of a national system to negotiate prices has contributed. One manufacturer, Teva, said its drug is competitive with other therapies and the price reflects the cost of research and development.

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Cases Of Whooping Cough Spike Around Washington State

So far this year, health officials in Washington state have recorded more than 341 cases of whooping cough. According to the Washington Department of Health, last year at this time, there were 57 cases.

“At this point we’re about 500 percent increase in the number of pertussis cases this year over last year," said Dr. Scott Lindquist, Washington's epidemiologist for communicable diseases.

The greatest risk is to children younger than a year.

"You can actually die from pertussis when you’re an infant," Lindquist said.

He said his agency strongly recommends pregnant women get a booster of the pertussis vaccine.

While the outbreak is concerning, other years have been worse.

“This is certainly small in comparison to the large outbreak we had in the state in 2012," he said. "We had about 5,000 in 2012.”

The whooping cough outbreak started about a month ago in Walla Walla and Kitsap counties, according to health officials. Since then, the number of cases has grown. Washington’s Clark County is among the most affected.

State health officials said they’ve documented 46 cases there so far this year, though Clark County health officials said that number is even higher. At this time last year there were just 16 cases in the county.

This year, most are in adolescent children. That’s also true in the rest of the state.

Monica Czapla, the communicable disease program manager with the Clark County Health Department, said the increase in whooping cough cases is part of a natural cycle. But she said there are other factors at work.

“A lot of it has to do with declining vaccination rates," she said.

Over time, Czapla said, the vaccine becomes less effective. Most children start receiving a series of vaccines to immunize against whooping cough a few months after they're born.

“But what we’re seeing happening is that the immunity that’s provided by this vaccination series starts to wane over time so that you’re less protected as you get older, which might be why were seeing pertussis disease in sort of the high-school age, adult population," she said.

What Czapla means is that the immunization essentially wears off. By the time kids reach their late teens, she said, it’s time for another vaccine. But it’s not clear how many are getting it, in part because there isn’t a lot of data, she said.

So far this year in Oregon, the number of whooping cough cases is more in line with years past.

Dr. Paul Cieslak, the medical director for the Oregon Immunization Program, said the state’s documented more than 150 cases of whooping cough this year.

“There are some hot spots," he said. "We’ve had little mini-outbreaks in Deschutes County and in Benton County. But overall state wide we’re about average.”

Cieslak said he’s not sure why Clark County’s outbreak isn’t affecting Portland more.

“We have had some high years recently in the Portland area and maybe there’s a little bit more immunity right now, but it's hard to predict who’s going to see rises in cases and when," he said.

Like Washington, Oregon’s highest case count in recent history was in 2012, when state health officials documented more than 900 cases.

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Effort To Make Ore. Hospitals Post Prices Misses Legislative Deadline

An effort to make Oregon hospitals give consumers up-front prices, had a setback in Salem Tuesday.

Senate Bill 891 didn't meet Tuesday's deadline for all ongoing bills to clear committee.

Jesse O'Brien with the Oregon Public Interest Research Group said lobbying killed it.

"The health care industry's strong opposition to increased price transparency has dealt Oregon consumers a real set back," he said. "However, we are not giving up."The Oregon Association of Hospitals and Health Systems was one of the groups opposed to the bill. Spokesman Philip Schmidt said the group supports another bill, which would require the state to set up a website showing the median price of hospital procedures. "Consumers would get a good ballpark estimate of what was being charged and paid at each hospital around the state, and be able to do comparison shopping frankly," said  Schmidt.

There's some concern about that bill because of its cost to the state budget. It's been referred to the Ways and Means Committee.

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Bill Would Make It Easier To Compare Health Plans

A bill that would make it easier to compare health insurance plans has made it out of an Oregon Senate committee.

Oregon's current health care experiment measures performance in many ways — like what percentage of health records are computerized or how many patients get a follow up visit after a hospital stay.

Such metrics it makes it easier to compare the quality of health plans, but they're only used by Oregon's Medicaid system.

Sen. Elizabeth Steiner Hayward, D-Portland, says Senate Bill 440 would require everyone to use the same metrics.

"Different insurance companies have held providers accountable to different metrics," she said. "And for primary care providers, it's really tough when you have patients who are covered by multiple different types of insurance, to make sure that you're meeting the metrics from different insurance carriers and Medicaid at the same time."

Passage of the bill is far from assured. Proposed changes are expensive for insurance companies, hospitals and clinics.

A spokeswoman from Gov. Kate Brown's office says she will review it once it reaches her desk.

The bill now moves to the House.

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Lawmakers Vote On Bill To Make Birth Control Pills Available Without Doctor's Prescription

The Oregon House Health Care Committee will vote on a bill Friday that would change the types of services pharmacists are allowed to provide.

Among the changes, is an amendment proposed by Rep. Knute Buehler, R-Bend, that would allow pharmacists to dispense birth control pills to adults over the age of 18 without a doctor’s prescription. If adopted, the bill would broaden pharmacists' clinical practice to promote disease prevention and patient wellness.

The bill would require women to take a self-screening test to check for their risk of side effects. It would also permit health insurers to cover the cost of oral contraceptives prescribed by a pharmacist.

Buehler told Think Out Loud that the bill is important for bringing women’s health into the 21st century.

"It’s clear from best practices and evidence out there that having improved access to oral birth control really improves women’s health and decreases unintended pregnancies by up to 25 percent," said Buehler.

The bill would uphold the state Pharmacy Board guidance paper that allows pharmacists to opt-out from dispensing birth control for ethical, moral or religious reasons.

California is the only other state in the country to have adopted a similar bill.

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VA Wait Times Slowly Improving In Northwest Clinics

Most of the wait times for patients at VA clinics around the Pacific Northwest fall below the national average, according to an analysis of data by the Associated Press.

Twelve of the 29 clinics analyzed in Oregon and Washington had appointments that didn’t meet the agency’s goal of seeing a patient within 30 days, according to the analysis of data by the AP.

From September 2014 to February 2015, the AP found that 2.78 percent of wait times at VA clinics around the country were delayed at least 31 days.

Regionally, the Salem VA  -- at 5.49 percent -- had the highest percentage of appointments that were delayed at least 31 days. The lowest was the La Grande VA Clinic with .05 percent of appointments over the VA’s goal, according to the AP.

A report last April from the Department of Veterans Affairs Office of Inspector General found Portland VA clinics had some of the longest wait times in the country, something that’s since been improved, Portland VA official and veteran group both said.

According to the AP, 3.58 percent of the appointments at the Portland VA from September 2014 to February 2015 exceeded the agency’s 30 day goal.

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