Support California Senate Bill 43 ! – From the website of California State Senator JERRY HILL

Senate Bill 43—Superbug Tracking

This legislation will establish a first-in-the-nation system to monitor and track antibiotic-resistant infections and deaths related to these infections caused by “superbugs.”

The federal Centers for Disease Control and Prevention estimate that antibiotic resistance kills 23,000 Americans each year and sickens some 2 million people. In California, health authorities estimate that superbugs are to blame for 3,000 deaths and 260,000 illnesses annually.

Despite the catastrophic nature of the public health threat posed by superbugs, California – and the federal government – do not track antibiotic resistant infections or deaths associated with the infections.

“We cannot hope to effectively combat superbug infections without such critical information,” said Senator Hill. “What we don’t know can kill us.”

This bill will ensure that California has a system in place to closely monitor the development of superbug infections and track deaths related to those infections.

Senator Hill is a policy leader on efforts to curb the rise of superbugs, having authored the first legislation in the U.S. to control use of antibiotics in livestock, SB 27 (2015), and first-in-the-nation legislation to require hospitals, SB 1311 (2014), and nursing homes, SB 361 (2015), to have programs to promote better managed and more accurate prescribing of antibiotics.

From the Boston Globe on Aleppo. However, Main Stream Media Coverage misleads the American Public on many issues…

COVERAGE OF the Syrian war will be remembered as one of the most shameful episodes in the history of the American press. Reporting about carnage in the ancient city of Aleppo is the latest reason why.

For three years, violent militants have run Aleppo. Their rule began with a wave of repression. They posted notices warning residents: “Don’t send your children to school. If you do, we will get the backpack and you will get the coffin.” Then they destroyed factories, hoping that unemployed workers would have no recourse other than to become fighters. They trucked looted machinery to Turkey and sold it.

This month, people in Aleppo have finally seen glimmers of hope. The Syrian army and its allies have been pushing militants out of the city. Last week they reclaimed the main power plant. Regular electricity may soon be restored. The militants’ hold on the city could be ending.

Militants, true to form, are wreaking havoc as they are pushed out of the city by Russian and Syrian Army forces. “Turkish-Saudi backed ‘moderate rebels’ showered the residential neighborhoods of Aleppo with unguided rockets and gas jars,” one Aleppo resident wrote on social media. The Beirut-based analyst Marwa Osma asked, “The Syrian Arab Army, which is led by President Bashar Assad, is the only force on the ground, along with their allies, who are fighting ISIS — so you want to weaken the only system that is fighting ISIS?”

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This does not fit with Washington’s narrative. As a result, much of the American press is reporting the opposite of what is actually happening. Many news reports suggest that Aleppo has been a “liberated zone” for three years but is now being pulled back into misery.

Americans are being told that the virtuous course in Syria is to fight the Assad regime and its Russian and Iranian partners. We are supposed to hope that a righteous coalition of Americans, Turks, Saudis, Kurds, and the “moderate opposition” will win.

This is convoluted nonsense, but Americans cannot be blamed for believing it. We have almost no real information about the combatants, their goals, or their tactics. Much blame for this lies with our media.

Under intense financial pressure, most American newspapers, magazines, and broadcast networks have drastically reduced their corps of foreign correspondents. Much important news about the world now comes from reporters based in Washington. In that environment, access and credibility depend on acceptance of official paradigms. Reporters who cover Syria check with the Pentagon, the State Department, the White House, and think tank “experts.” After a spin on that soiled carousel, they feel they have covered all sides of the story. This form of stenography produces the pabulum that passes for news about Syria.

Astonishingly brave correspondents in the war zone, including Americans, seek to counteract Washington-based reporting. At great risk to their own safety, these reporters are pushing to find the truth about the Syrian war. Their reporting often illuminates the darkness of groupthink. Yet for many consumers of news, their voices are lost in the cacophony. Reporting from the ground is often overwhelmed by the Washington consensus.

Washington-based reporters tell us that one potent force in Syria, al-Nusra, is made up of “rebels” or “moderates,” not that it is the local al-Qaeda franchise. Saudi Arabia is portrayed as aiding freedom fighters when in fact it is a prime sponsor of ISIS. Turkey has for years been running a “rat line” for foreign fighters wanting to join terror groups in Syria, but because the United States wants to stay on Turkey’s good side, we hear little about it. Nor are we often reminded that although we want to support the secular and battle-hardened Kurds, Turkey wants to kill them. Everything Russia and Iran do in Syria is described as negative and destabilizing, simply because it is they who are doing it — and because that is the official line in Washington.

Inevitably, this kind of disinformation has bled into the American presidential campaign. At the recent debate in Milwaukee, Hillary Clinton claimed that United Nations peace efforts in Syria were based on “an agreement I negotiated in June of 2012 in Geneva.” The precise opposite is true. In 2012 Secretary of State Clinton joined Turkey, Saudi Arabia, and Israel in a successful effort to kill Kofi Annan’s UN peace plan because it would have accommodated Iran and kept Assad in power, at least temporarily. No one on the Milwaukee stage knew enough to challenge her.

Politicians may be forgiven for distorting their past actions. Governments may also be excused for promoting whatever narrative they believe best suits them. Journalism, however, is supposed to remain apart from the power elite and its inbred mendacity. In this crisis it has failed miserably.

Americans are said to be ignorant of the world. We are, but so are people in other countries. If people in Bhutan or Bolivia misunderstand Syria, however, that has no real effect. Our ignorance is more dangerous, because we act on it. The United States has the power to decree the death of nations. It can do so with popular support because many Americans — and many journalists — are content with the official story. In Syria, it is: “Fight Assad, Russia, and Iran! Join with our Turkish, Saudi, and Kurdish friends to support peace!” This is appallingly distant from reality. It is also likely to prolong the war and condemn more Syrians to suffering and death.

Stephen Kinzer is a senior fellow at the Watson Institute for International Studies at Brown University. Follow him on Twitter @stephenkinzer.

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Trump’s looming showdown with the ‘secret government’ will effect the entire Federal bureaucracy…

 

IDEAS | MICHAEL J. GLENNON
Trump’s looming showdown with the ‘secret government’

By Michael J. Glennon DECEMBER 01, 2016

Many incoming presidents learn quickly that the managers of the military, intelligence, and law enforcement departments of our government are largely self-governing, virtually immune from democratic accountability and the checks and balances described in civics books.

They make up a second government: The one we elect provides public frontage, but the concealed, unelected one actually defines and manages the nation’s security.

Two years ago that’s what I told the Globe when I was asked why programs such as mass surveillance, drone strikes, whistle-blower prosecutions, and unchecked war-making remained virtually unchanged from the Bush administration to the Obama administration.

The questions we face now are: Will double government have the same ability to check the power of the Trump administration? And can Americans expect President Trump to maintain the national security policies of his predecessors?

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I expect not — on both counts.

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Vote all you want. The secret government won’t change.
The people we elect aren’t the ones calling the shots, says Tufts University’s Michael Glennon.

The one essential condition for double government to function effectively is that the elected and concealed institutions present a united front. Harmony between the two institutions, at least in the eyes of the public, is vital. Trump, unlike his predecessors, has openly broken with the security directorate. Moreover, most of the program he’s espoused entails ramping up rather than scaling back security, which the bureaucracy has historically embraced.

All modern presidents have had an abiding incentive to remain in sync with the security managers, as have Congress and the courts, for a simple reason. No president, senator, or judge has wanted to confront the “if only” argument: “If only you had heeded the advice of the security experts, this devastating attack would not have occurred.” Better safe than sorry; safe means deferring to the security experts.

In addition to providing political cover, the appearance of public rapport invests double government with stability. Open feuding would unveil the power of the back-stage directorate, discrediting both institutions and causing the whole structure to “fall to earth.” That was the prediction of Walter Bagehot, the 19th-century English constitutional theorist who originated the concept of double government.

Trump, however, is unenthralled by experts — he wouldn’t be moving into the White House otherwise — so he has been indifferent to the effects of an open rupture with the security directorate. Either he doesn’t appreciate the need for legitimizing public harmony, or he’s decided to take on the whole bifurcated system and replace it with the single, unitary executive that the Constitution originally envisioned.

Trump’s response to former NSA and CIA director Michael Hayden may have been predictive. Hayden said that, if given an order to kill families of suspected terrorists, “the American armed forces would refuse to act.” “They won’t refuse,” Trump replied. “They’re not going to refuse me. Believe me — if I say do it, they’re gonna do it.”

Hayden later dug in his heels. If Trump wants to resume waterboarding, Trump can “get his own damn bucket,” Hayden said. He called Trump a “useful fool” of the Russian government, “manipulated by Moscow, secretly held in contempt.” But the breach between Trump and Hayden is the least of it. A gaping public rift has now developed between Trump and the national security establishment. An open letter from 122 Republican national security experts called Trump “fundamentally dishonest” and “utterly unfitted to the office.” Numerous current and former security officials have vowed they will never work for Trump or will openly defy presidential orders.

Trump, true to form, has counterattacked, disparaging the experts’ expertise. When the intelligence community concluded that Russia had hacked the Democratic National Committee and then disseminated purloined e-mails, Trump dismissed their assessment as unreliable. “Our country has no idea,” he said. “I don’t think anybody knows it was Russia that broke into the DNC.” The military is unable to defeat ISIS, Trump proclaimed, because the “generals have been reduced to rubble.” “They have been reduced to a point where it’s embarrassing to our country,” he said, indicating he might fire a few. Retired Marine general John Allen summed things up: If Trump were elected, Allen said, “I think we would be facing a civil military crisis, the like of which we’ve not seen in this country before.”

Contrast this unprecedented discord with the image of harmony projected by earlier presidents. Barack Obama resisted the managers’ push for a large-scale troop buildup in Afghanistan — but facing continuing pressure, he then introduced the negotiated compromise as his own. Seeming to be taken by surprise at the Edward Snowden revelations, Obama later embraced NSA mass surveillance as his own program. The 2014 Senate torture report said that President George W. Bush was not briefed on waterboarding when it began — which was confirmed by the CIA’s General Counsel — but Bush said that, no, he had personally approved it. President Bill Clinton proposed ending the ban on gays in the military — and then presented “Don’t Ask, Don’t Tell” as his own policy. After the Bay of Pigs disaster, President John F. Kennedy privately cursed the CIA for enticing him into it and said he wanted to “splinter the CIA into a thousand pieces and scatter it into the winds” — only to allow, in a public press conference, that he was the responsible decision-maker.

Why the incentive to maintain public harmony? In short, to sustain legitimacy. Presidents must appear to be the decider to maintain public deference. If the curtain were pulled back and the security managers were revealed to exercise extravagant power, presidential credibility would collapse.

And so would that of the managers: With no electoral connection, their legitimacy derives from that of the president. Were a president to appear as presider rather than decider, compliance with presidential directives would be undermined. Legitimacy, in a system of double government, depends upon mutual cooperation to mask the two layers.

But wittingly or unwittingly, Trump has not bought into the duality. And given his popular base of support, he’ll have little incentive to do so.

Unlike Obama and earlier presidents, Trump has made a public show of disdaining experts. Trump presents himself as his own expert (“I know more about ISIS than the generals do, believe me”) with no need to pour over background briefings or policy papers written by bean-counters from the swamp he’s been elected to drain. Trump not only has little to lose by crossing swords with Washington’s security glitterati — he fortifies support from those who put him into office by publicly taking on the Beltway power elite.

It’s possible, of course, that Trump could back off, become “presidential,” and join the long list of predecessors who made public peace with the security directorate. If Trump chooses that course, the substance of his security policies will differ little from Obama’s.

But it’s also possible that, loyal to his base and true to his seeming instincts, President Trump will remain as confrontational toward the security managers as he was as a candidate. What would a prolonged assault on the authority of expert insiders mean for Trump’s security policies?

It depends on whether security managers see the particular measure as raising or lowering the level of protection.

Trump would get considerable support for measures they see as beefing up security. The security managers are in the business of selling protection. They operate in an incentive structure where threat inflation and overprotection are rewarded, not penalized. When a president wants more rather than less protection, they are delighted to provide it.

With toothless congressional overseers and spineless judges manning the watchtowers, the likely upshot is therefore bureaucratic deference to more drone strikes and cyberattacks, tighter mass surveillance, weakened cellphone encryption, stepped up FBI investigations, and, yes, a resumption of torture. Following release of the Senate torture report, CIA Director John Brennan was asked whether the CIA could ever resume those practices. In a rare moment of candor, he replied: “I defer to the policy makers in future times.” Numerous officials who ran the CIA’s torture program still work for the agency. Not one has been prosecuted.

Any efforts by Trump to scale back protection would encounter opposition. Into this category fall the nuclear nonproliferation regime, sanctions against Russia, and the NATO, Japan, and South Korea security alliances. Security programs are “sticky down” — much harder to cut back than to maintain or expand. Efforts by Trump to ratchet down measures that the security managers have long nurtured would thus meet not only the usual bureaucratic slows but also resignations and occasional outright defiance.

Would such tactics bring Trump to heel?

Not likely. Resignation in protest is a time-honored way of registering dissent within the bounds of the system. Elliot Richardson and William Ruckelshaus resigned rather than follow President Nixon’s order to fire the Watergate special prosecutor, Archibald Cox. However, very few resignations have occurred in response to perceived governmental wrongdoing, particularly within the military. The cost in professional ostracism, economic hardship, and upended family life is too high for most to endure. And the payoff is typically slim. Willing replacements normally are plentiful, eager to get promoted, pick up and carry out orders where the dissenter left off. Richardson, Ruckelshaus, and Cox were distinguished, courageous public servants. Cox still got fired.

Similarly, direct disobedience could be dramatic — but it’s hard to see how it could work. Their functional autonomy notwithstanding, top military, intelligence, and law enforcement officials do serve at the pleasure of the president. An official who disobeyed a direct order from the president would be fired and replaced with someone who would obey.

Most importantly, in confronting bureaucratic insubordination, Trump would have a strong hand to play. Whether he realizes it or not, he would be launching a de facto assault on double government — with undertones of constitutional revivalism. Unlike Congress, the courts, and the presidency, the national security bureaucracy is not, after all, part of the constitutional system of checks and balances. Federal departments and agencies were never intended to check the elected officials who created them. Quite the opposite: Power was always believed to be delegated to the bureaucracy, not by it.

Trump’s public face-off with the security directorate is, in sum, a game-changer. Bagehot did not explain what happens when open discord causes double government to fall to earth. We may be about to find out.

Michael J. Glennon is a law professor at the Fletcher School of Law and Diplomacy, Tufts University. This

From THE ORKIN MAN – the worst American cities for MOSQUITOES

  1. Atlanta
  2. Chicago
  3. Washington, D.C.
  4. Detroit
  5. New York
  6. Dallas-Ft. Worth
  7. Nashville, Tenn.
  8. Charlotte, N.C.
  9. Raleigh-Durham, N.C.
  10. Boston
  11. Memphis, Tenn.
  12. Houston
  13. Miami-Ft. Lauderdale, Fla.
  14. Norfolk-Portsmouth-Newport News, Va.
  15. Grand Rapids-Kalamazoo-Battle Creek, Mich.
  16. Greenville-Spartanburg, S.C., Asheville, N.C.
  17. Albany-Schenectady-Troy, N.Y.
  18. Cleveland-Akron-Canton
  19. Minneapolis-St. Paul, Minn.
  20. Phoenix
  21. Richmond-Petersburg, Va.
  22. Tampa-St. Petersburg, Fla.
  23. Hartford-New Haven, Conn.
  24. Orlando-Daytona Beach-Melbourn, Fla.
  25. Charleston, S.C.
  26. Mobile-Pensacola, Fla.
  27. Indianapolis
  28. Flint-Saginaw-Bay City, Mich.
  29. Bangor, Maine
  30. Philadelphia
  31. West Palm Beach-Ft. Pierce, Fla.
  32. Columbus, Ohio
  33. Lansing, Mich.
  34. Knoxville, Tenn.
  35. Wayne, Ind.
  36. Tulsa, Okla.
  37. Baltimore, Md.
  38. Greensboro-High Pt.-Winston-Salem, N.C.
  39. Burlington, Vt.-Plattsburgh, N.Y.
  40. Portland-Auburn, Ore.
  41. Buffalo, N.Y.
  42. Shreveport, La.
  43. New Orleans
  44. LaFayette, La.
  45. Cincinnati, Ohio
  46. Myrtle Beach-Florence, S.C.
  47. Birmingham, Ala.
  48. Austin, Texas
  49. Kansas City, Mo.
  50. Macon, Ga.

Greater Cleveland – Cuyahoga County is serious about killing mosquitoes…

Mosquito Control

2

For an Appointment or Information Call

Joe Lynch, RS, MPH
Program Manager
(216) 201-2000 ext. 1241
jlynch@ccbh.net

In 1975, the Cuyahoga County Board of Health instituted its Mosquito Control Program in response to a local outbreak of mosquito-borne encephalitis. Encephalitis is a potentially fatal inflammation of the brain and spinal cord. In Ohio, there are three prevalent mosquito-borne viruses that cause encephalitis. LaCrosse Encephalitis (LAC) virus is transmitted between small woodland animals and mosquitoes. St. Louis Encephalitis (SLE) and West Nile Virus (WNV) are transmitted between several species of mosquitoes and wild birds. Humans are at risk of acquiring encephalitis if bitten by a female mosquito that is infected with either virus. LAC is usually an infection in young children between the ages of one and fourteen. SLE and the WNV are a more serious concern for the elderly.

Currently, outbreaks of Zika virus are occurring in many countries. No locally transmitted Zika cases have been reported in the continental United States, but cases have been reported in returning travelers. The Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito. These are the same mosquitoes that spread Dengue and Chikungunya viruses.

Early symptoms of mosquito-borne disease may include nausea, fever, vomiting, and/or headache. These symptoms usually develop in approximately two weeks. More serious cases include drowsiness, stiff neck, stupor, disorientation, tremors, and convulsions (especially in infants). Diagnosis of encephalitis can only be made through laboratory testing. Consult your physician if any or all of these symptoms occur, especially during the peak months of virus transmission, which are June through October.

Things We Do

  • Sanitarians and trained Mosquito Control Technicians survey areas to identify the level of mosquito breeding and adult mosquito populations.
  • They treat areas of standing water that may act as potential mosquito breeding sites.  These include catch basins, roadside ditches, and woodland pools.  Treating standing water will prevent the immature mosquitoes (larvae) from becoming adults.
  • Our staff responds to individual complaints regarding standing water and heavy adult mosquito populations.  Educational materials and recommendations are provided to homeowners to help lessen the potential for exposure to mosquitoes that may carry disease.
  • Adult mosquito surveillance (trapping) is also conducted throughout the county to monitor adult mosquito populations and potential disease activity.
  • Adult mosquitoes are submitted to the Ohio Department of Health for West Nile Virus testing. This information is utilized to help the Board of Health and local community officials determine necessary steps to protect the public from disease.

Help Mosquito Control by

  • Disposing of containers that collect water (buckets, tires, cans, etc.)
  • Eliminating areas of standing water
  • Repairing leaky outdoor faucets that may leave puddles
  • Emptying bird baths at least once a week
  • Keeping pools and spas in good operating condition or covered
  • Draining and unclogging gutters
  • Filling tree holes with tar or cement

You Can Minimize Contact with Mosquitoes by

  • Tightly screening all openings of your home
  • Keeping children indoors during times of high mosquito activity (1 hour before and 1 hour after sunset)
  • Routinely reapplying an insect repellent containing 30% DEET (diethyl-m-toluamide) for adults. Children and pregnant women should utilize a product with a lower concentration (10%) of DEET.
  • Wearing long-sleeved shirts and long pants whenever possible to cover exposed skin.

Follow manufacturer directions for the application of insect repellents. All of the EPA-registered active ingredients have demonstrated repellency, however some provide more longer lasting protection than others. Additional research reviewed by CDC suggests that repellents containing DEET or picaridin typically provide longer-lasting protection than the other products.  Oil of lemon eucalyptus provides longer lasting protection than other plant-based repellents. Permethrin is another long-lasting repellent that is intended for application to clothing and gear, but not directly to skin. In general, the more active ingredient (higher concentration) a repellent contains, the longer time it protects against mosquito bites.

Remember…

Prompt diagnosis and treatment of mosquito-borne encephalitis is important to a patient’s recovery. If you feel that you may have been exposed to the encephalitis virus, consult a physician immediately.

Greater Cleveland #20 worst city for mosquitoes…

Cleveland area breaks into top 20 worst cities for mosquitoes; Zika virus not yet a concern here

mosquito.jpeg
The Cleveland region ranks 18th among the nation’s worst cities for mosquitoes. But to date, the dreaded Zika-carrying mosquito — the Aedes species pictured here — cannot survive in Northeast Ohio. (Photo courtesy of the Centers for Disease Control and Prevention)

James F. McCarty, The Plain DealerBy James F. McCarty, The Plain Dealer
Email the author | Follow on Twitter
on June 10, 2016 at 3:00 PM, updated June 13, 2016 at 7:03 AM

CLEVELAND, Ohio – The latest rankings of the 50 worst cities for mosquitoes in the United States has been released, and the Cleveland area is listed at number 18 — worse than a dozen cities in Florida, North and South Carolina, Louisiana, Alabama and Georgia.

Those findings by the Orkin pest control company may come as a surprise to many of us, but not to Joe Lynch, mosquito program manager for the Cuyahoga County Board of Health.

Since mid-March, Lynch and his crews of county workers and college interns have been busy on mosquito suppression programs, applying larvacides to standing water in puddles and curbside catch basins where female mosquitoes lay up to 200 eggs at a time.

When mosquitoes are plentiful and pesky, the complaints typically find their way to Lynch.

“With only a 12-week summer, Clevelanders want to get outside and have fun with parties and backyard barbecues,” Lynch said. “If the mosquitoes are biting, people call us, and it’s our job to lessen the impact.”

Since the arrival of Moses Cleaveland in the late 18th century, Cleveland has been known as a buggy region. The first settlers encountered a swamp at the mouth of the Cuyahoga River, and many were sickened or killed by diseases carried by mosquitoes.

Massive draining and dredging projects helped to alleviate the mosquito problem over the decades, but they couldn’t eliminate it altogether, Lynch said. Such Midwest topographical features as clay soil and flat land naturally generate  standing water. Add swimming pools, bird baths and uncovered rain barrels to the mix, and mosquitoes are bound to proliferate, Lynch said.

Another factor at play, according to scientists from the Natural Resources Defense Council, is the impact of milder winters in the Midwest brought on by climate change. In a report released last year, the agency warned of an increase of standing water for breeding, and shifting populations, raising the likelihood of growing hordes of disease-carrying mosquitoes.

In Northeast Ohio, the most common diseases are the West Nile virus, which more often infects birds such as crows and blue jays, but occasionally spills over into humans; and La Crosse encephalitis, which usually affects children under 15, and is only encountered every few years, Lynch said.

The greatest concern in recent months has focused on the Zika virus, which has infected thousands of victims in South and Central America and in the Caribbean, with some cases in the southern U.S. Although rarely fatal, Zika can cause serious birth defects and severe brain defects.

Residents of Northeast Ohio have little chance of catching Zika unless they travel to countries where it has become a problem, Lynch said.

“Ninety-nine percent of the mosquitoes found here cannot carry or transmit Zika,” Lynch said. “But anyone traveling to Puerto Rico or the Caribbean should be aware of the risks.”

The best way to reduce risk of infection is to prevent mosquito bites. The Centers for Disease Control and Prevention recommends using insect repellent, wearing long-sleeved shirts, long pants and socks, and staying indoors during times when mosquitoes are most active.

Here is Orkin’s list of the 50 Worst Cities for Mosquitoes in the U.S., based on the number of customers the company served in 2015:

  1. Atlanta
  2. Chicago
  3. Washington, D.C.
  4. Detroit
  5. New York
  6. Dallas-Ft. Worth
  7. Nashville, Tenn.
  8. Charlotte, N.C.
  9. Raleigh-Durham, N.C.
  10. Boston
  11. Memphis, Tenn.
  12. Houston
  13. Miami-Ft. Lauderdale, Fla.
  14. Norfolk-Portsmouth-Newport News, Va.
  15. Grand Rapids-Kalamazoo-Battle Creek, Mich.
  16. Greenville-Spartanburg, S.C., Asheville, N.C.
  17. Albany-Schenectady-Troy, N.Y.
  18. Cleveland-Akron-Canton
  19. Minneapolis-St. Paul, Minn.
  20. Phoenix
  21. Richmond-Petersburg, Va.
  22. Tampa-St. Petersburg, Fla.
  23. Hartford-New Haven, Conn.
  24. Orlando-Daytona Beach-Melbourn, Fla.
  25. Charleston, S.C.
  26. Mobile-Pensacola, Fla.
  27. Indianapolis
  28. Flint-Saginaw-Bay City, Mich.
  29. Bangor, Maine
  30. Philadelphia
  31. West Palm Beach-Ft. Pierce, Fla.
  32. Columbus, Ohio
  33. Lansing, Mich.
  34. Knoxville, Tenn.
  35. Wayne, Ind.
  36. Tulsa, Okla.
  37. Baltimore, Md.
  38. Greensboro-High Pt.-Winston-Salem, N.C.
  39. Burlington, Vt.-Plattsburgh, N.Y.
  40. Portland-Auburn, Ore.
  41. Buffalo, N.Y.
  42. Shreveport, La.
  43. New Orleans
  44. LaFayette, La.
  45. Cincinnati, Ohio
  46. Myrtle Beach-Florence, S.C.
  47. Birmingham, Ala.
  48. Austin, Texas
  49. Kansas City, Mo.
  50. Macon, Ga.

California takes the lead in fighting Hospital Acquired Infetions…

http://www.reuters.com/article/us-usa-uncounted-california-idUSKBN13U2U6

California bill would require reporting of ‘superbug’ infections, deaths

By Yasmeen Abutaleb | SAN FRANCISCO

A California state senator introduced a bill on Monday that would mandate reporting of antibiotic-resistant infections and deaths and require doctors to record the infections on death certificates when they are a cause of death.

The legislation also aims to establish the nation’s most comprehensive statewide surveillance system to track infections and deaths from drug-resistant pathogens. Data from death certificates would be used to help compile an annual state report on superbug infections and related deaths.

In September, a Reuters investigation revealed that tens of thousands of superbug deaths nationwide go uncounted every year. The infections are often omitted from death certificates, and even when they are recorded, they aren’t counted because of the lack of a unified national surveillance system.

“The (Reuters) story highlighted some of the problems that have come from the lack of information, the lack of reporting, especially deaths,” said state Senator Jerry Hill, who introduced the bill. “I wasn’t aware that on death certificates, antibiotic-resistant infections have never been called out.”

Because there is no federal surveillance system, monitoring of superbug infections and deaths falls to the states. A Reuters survey of all 50 state health departments and the District of Columbia found that reporting requirements vary widely.

California is among the states that do not require reporting of superbug-related deaths. A Reuters analysis of death certificates from 2003 to 2014 identified more than 20,000 deaths linked to the infections in California, the most of any state – and probably an undercount, given the unreliability of death certificate data.

Hill’s bill would require hospitals and clinical labs to submit an annual summary of antibiotic-resistant infections to the California Department of Health beginning July 1, 2018; amend a law governing death certificates by requiring that doctors specify on death certificates when a superbug was the leading or a contributing cause of death; and require the state Health Department to publish an annual report on resistant infections and deaths, including data culled from death certificates.

Hill introduced legislation in 2014 that would require reporting of superbug infections – not deaths. It was ultimately stripped down to mandate that all hospitals in California implement “stewardship” programs to prevent the overprescription of antibiotics that promotes drug resistance. Hill said the state medical association and other physician groups opposed the initial proposal.

The 2014 legislation followed a 2013 threat report from the Centers for Disease Control and Prevention, which estimated that at least 23,000 people in the U.S. die every year from antibiotic-resistant infections. A Reuters analysis of the agency’s math found that the numbers are based on such small sample sizes that they are mostly guesswork.

Hill has written several superbug-related bills that have been signed into law in recent years. Those include laws that regulate antibiotic use in livestock and others that mandate antibiotic stewardship programs in nursing homes and other healthcare facilities.

“We don’t know how (superbugs) affect California,” Hill said. “We could be overreacting in certain areas or underreacting in areas that could create real problems for people.”

(Edited by John Blanton)

The quest for profits …

Retired cardiologist says hospitals’ quest for profits fuels higher healthcare costs

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Four of the 10 hospitals that earned the largest profits from patient care services in 2013 were nonprofit, and the value of the nonprofit hospital tax exemption has grown significantly in recent years. Without action by Congress, nonprofit hospitals’ earnings will continue to grow, according to a recent commentary in The American Journal of Medicine by Robert M. Doroghazi, MD.

Dr. Doroghazi, a retired cardiologist and publisher of The Physician Investor, says nonprofit hospitals’ earnings began to soar in 1969 when the IRS eliminated charity care as the requirement for tax-exempt status and replaced it with community benefit.

“The less well defined requirements allowed hospitals to substitute programs in community health improvement and determinants of health for direct charity care,” wrote Dr. Doroghazi.

Under the new requirements for tax-exempt status, the value of the nonprofit hospital tax exemption increased. A study published in Health Affairs in 2015 estimates tax-exempt hospitals across the nation received a collective $24.6 billion tax break in 2011, up from the congressional Joint Committee on Taxations’ $12.6 billion estimate in 2002.

Dr. Doroghazi argues both nonprofit and for-profit hospitals are pushing for higher earnings, which is causing healthcare costs to rise in the U.S.

“I believe the quest for profits between all hospitals, nonprofit and for-profit, has been one of the main drivers causing our healthcare costs to be the highest in the world, far outstripping inflation,” he wrote.

To help solve the problem, Dr. Doroghazi says Congress needs to provide a new definition of nonprofit. He recommends a nonprofit hospital be defined as one that has zero profit, “aside from that required to maintain quality operations, prudent reserves and fund future capital needs.”

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