Archive for January, 2016

Celebrating 10 Years of Health Wonk Review: The party’s at Joe’s place

Friday, January 29th, 2016

champagne bottle eruption

Ten years of nerds and wonks opining on health policy, can you believe it? Founder and fearless leader Joe Paduda hosts the 10th Anniversary Edition of Health Wonk Review at Managed Care Matters, noting that this biweekly compendium has logged more than 200 editions. We couldn’t find a good metric for how 10 Internet years compare to real life years, but we think it has to be on par with dog years. Joe puts things in perspective:

“…Yup, since way back in the DSL days, before the birth of the iPhone, before the Great Recession, before health care reform, back when I had brown hair …”

He reflects back on a few highlights and brings a fresh crop of postings from many of the regulars. A good solid edition to mark the occasion – check it out.

Here’s a link if you want to wax nostalgic in the archives.

On a side, note, we were recently alerted to the fact that Workers Comp Insider was added to GWU.edu’s collection of 54 Healthcare Blogs to Read in 2016, We note that Health Wonk Review made the list, along with many past and present wonkers:

  • Joe Paduda
  • Health Affairs
  • Maggie Mahar
  • Brian Klepper
  • David Harlow
  • David Williams
  • The Health Care Blog
  • Healthcare Economist
  • The Health Care IT Guy
  • Health Care Renewal
  • Health News Watchdog Blog
  • InsureBlog
  • Workers Comp Insider

Chemical Safety Board Issues Report on West Fertilizer Company Explosion

Wednesday, January 27th, 2016

Two days after the 2013 Boston Marathon bombing, a giant explosion rocked the small town of West TX. Twelve emergency responders who rushed to the initial fire at the scene were killed in the subsequent blast, as were three civilians. More than 260 were injured and treated at hospitals; 150 buildings were damaged.

Initially, local authorities feared the blast was a terrorist event, but the cause of the blast was the storage of 270 tons of fertilizer grade ammonium nitrate (FGAN). To give some perspective to this, in the 1995 Oklahoma City bombing of the Alfred P. Murrah Building, Timothy McVeigh used 2 tons of ammonium nitrate.

Earlier this week, the U.S. Chemical Safety Board (CSB) issued a draft version of its 265-page Investigation Report into the April 2013 Fire and Explosion at West Fertilizer Company for public preview. The CSB’s January 28 public meeting to release its West Investigation Report will be available via live webcast at 6 pm CST

The report is dedicated to the 12 emergency responders and 3 members of the public who lost their lives. It represents one of the most destructive incidents ever investigated by the CSB.

“The CSB’s analysis includes findings on the technical causes of the fire and explosion; regulatory changes that could have resulted in safety enhancements to the facility; the failure of the insurer to conduct safety inspections or provide an adequate level of coverage; shortcomings in emergency response, including pre-incident planning or response training of the volunteer fire fighters; and deficiencies in land use planning that permitted the City of West to encroach upon the WFC over the years.”

The CSB directed recommendations to the Environmental Protection Agency (EPA), Occupational Safety and Health Administration (OSHA), U.S. Department of Labor, the Federal Emergency Management Agency (FEMA), U.S. Department of Homeland Security, the Texas Department of Insurance, the Texas Commission on Fire Protection, and other regional entities.

CSB estimated that total insurance-related losses were around $230 million, but the WFC was only insured for $1 million. One part of the report looks at related policies and regulations, including ” … the failure of the insurer to identify the risks posed by FGAN. A few years prior to the incident, WFC was dropped by one insurer for failing to address safety concerns identified in loss control surveys. The company that insured WFC at the time of the incident did not appear to have conducted its own safety inspections of the facility.”

The CSB’s analysis also pointed to:

  • A lack of training in hazardous materials response and pre-incident planning on the part of the West Volunteer Fire Department.
  • Shortcomings in federal and state regulations and standards that could reduce the risk of another incident of this type.
  • The location of the WFC relative to the surrounding community, which exacerbated offsite consequences.

In terms of the location, the risk to the public continues:

“CSB’s analysis shows that the risk to the public from a catastrophic incident exists at least within the state of Texas, if not more broadly. For example, 19 other Texas facilities storing more than 10,000 pounds of FGAN are located within 0.5 miles of a school, hospital, or nursing home, raising concerns that an incident with offsite consequences of this magnitude could happen again.”

Related coverage:

Dallas News: Federal investigators: Texans still face risk of West-like blast

The Waco Tribune: Report: Public still not safe from West-style industrial blasts

There are many ongoing related lawsuits. In October, The Waco Tribune reported: 1st West explosion trial gets settled

Earlier coverage

Interactive: West plant before and after – before & after aerial photos show scope of destruction

Ellis County remembers West fertilizer plant explosion – “The day a fertilizer plant exploded in West, Texas, Ellis County community members went to Facebook and Twitter to share their reactions. Here’s a look back at not only how the explosion that killed 15 people and destroyed most of the town unfolded, but reactions from the terrible tragedy.”

West blast survivors share their stories

Special Report: Poor planning left Texas firefighters unprepared

An excellent Reuters report by M.B. Pell, Ryan McNeill and Janet Roberts was issued in May of 2013.

“The lack of preparedness endangers not only firefighters and emergency medical technicians, but also people nationwide living near chemical stockpiles similar to those that exploded in West.

At least 800,000 people in the United States live within a mile of 440 sites that store potentially explosive ammonium nitrate, which investigators say was the source of the explosion in West, according to a Reuters analysis of hazardous-chemical storage data maintained by 29 states.”

Another section of this report indicates how adequate preparation and training might have saved lives:

“Firefighters who have battled ammonium nitrate fires elsewhere – without death or injury to first responders – say having the Tier II information was critical to their success. They knew what they were facing going in, and responded accordingly.
Called to a fire at a similar fertilizer facility in 2009 in Bryan, Texas, firefighters opted not to fight the blaze. Although the circumstances were somewhat different – firefighters knew going in that ammonium nitrate already had ignited – the first responders decided to keep a safe distance and evacuate nearby residents. No one was injured, and the fire burned itself out.

Key to the response, said Chief Joe Ondrasek of the Brazos County Fire Department Precinct 4, was having the fertilizer company’s Tier II report in hand. Firefighters were unable to contact the plant manager immediately, he said, and therefore relied on the report to inform their response.

A federally funded program intended to grant fire departments online access to the Tier II reports was not being used in West. Although some firefighters in Texas said they know about and use the system, known as E-Plan, others said they didn’t know of its existence or how to access it.

Federal funding for the E-Plan system was eliminated last October, which could hurt efforts to keep it up and running.”

A new season of Health Wonk Review kicks off at InsureBlog

Friday, January 15th, 2016

A New Year, new season of Health Wonk Review! Hank Stern kicks off the first edition of the new season over at InsureBlog with Health Wonk Review: Happy New Year! Edition. There’s quite a cornucopia of topics: Trends in healthcare for the coming year, CDC guidelines on pain, taking the temperature of the ACA, evaluation of ACA replacement proposals from Republican candidates, and more.

Stop by and wish Hank a happy blogiversary – he marks 11 years of blogging this year – that’s an eon in Internet time!

 

 

Studies: Opioid epidemic grows; Is obesity a smoking gun in rise of prescription drugs?

Wednesday, January 13th, 2016

You may have taken hope from studies that pointed to a decrease or leveling of the rate of deaths related to opioid and prescription drug use in 2012-2013. If so, the Centers for Disease Control wasted no time this year in throwing some cold water on those hopes.

On January 1, via the Morbidity and Mortality Weekly Report (MMWR), the CDC issued new data on Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014.

                      Age-adjusted rate of drug overdose deaths and drug overdose deaths involving opioids: US 2000–2014

mmwr opioid trends

Here are some of the key findings:

  • During 2014, a total of 47,055 drug overdose deaths occurred in the United States, representing a 1-year increase of 6.5%, from 13.8 per 100,000 persons in 2013 to 14.7 per 100,000 persons in 2014.
  • Rates of opioid overdose deaths also increased significantly, from 7.9 per 100,000 in 2013 to 9.0 per 100,000 in 2014, a 14% increase.
  • In 2014, there were approximately one and a half times more drug overdose deaths in the United States than deaths from motor vehicle crashes
  • The 2014 data demonstrate that the United States’ opioid overdose epidemic includes two distinct but interrelated trends: a 15-year increase in overdose deaths involving prescription opioid pain relievers and a recent surge in illicit opioid overdose deaths, driven largely by heroin.
  • From 2000 to 2014 nearly half a million persons in the United States have died from drug overdoses.
  • The rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids (opioid pain relievers and heroin).

The 2013-2014 increase was geographically pervasive. In 2014, the five states with the highest rates of drug overdose deaths were:

  • West Virginia (35.5 deaths per 100,000)
  • New Mexico (27.3)
  • New Hampshire (26.2)
  • Kentucky (24.7)
  • Ohio (24.6).

States with statistically significant increases in the rate of drug overdose deaths from 2013 to 2014 included Alabama, Georgia, Illinois, Indiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Mexico, North Dakota, Ohio, Pennsylvania, and Virginia.

For more analysis of the data, see Kim Krisberg’s story at The Pump Handle.

Obesity: A Smoking Gun?

Is obesity a contributing factor to the opioid epidemic? That’s certainly an avenue worth further investigation. Recent research shows more evidence of the increase in prescription drug use and study authors suggest an obesity connection.

In November, researchers at Harvard’s T.H. Chan School of Public Health issued a report which was published in in JAMA, the journal of the American Medical Association: Trends in Prescription Drug Use Among Adults in the United States From 1999-2012

NPR’s Alison Kodjak reports on the study in Americans Are Using More Prescription Drugs; Is Obesity To Blame?

Two of the key findings:

  • 59% of adults used a prescription drug in a 30-day period, up from 50% a decade earlier.
  • The share of people taking more than five prescription drugs in a month doubled to 15%.

Lead author Elizabeth Kantor said that:

” … the rise in prescription drug use may have to do with the rise in obesity, since many of the most widely prescribed drugs treat obesity-related conditions such as diabetes, high blood pressure, and high cholesterol. The study found, for example, that the share of people using cholesterol-lowering agents, mostly statins, jumped from 7% to 17%.”

 

Related opioid reading matter: