November 29, 2015

Rules approved for EpiPen use in schools

Nicole Proesch (file photo).

Nicole Proesch (file photo).

The State Board of Education has approved the final draft of rules to allow schools to use a device that is expected to help save the lives of students or others who experience severe allergic reactions.

Governor Terry Branstad signed a bill into law in April allowing schools to use what are called epinephrine auto-injectors or EpiPens.

Board of Education lawyer Nicole Proesch says one of the adjustments made to the final rules narrowed the definition of a school building. Proesch says the Iowa Association of School Boards asked for a change so the definition wouldn’t be so broad that it would include a shed or storage facility or a building where there weren’t people.

Proesch says they decided to make the definition of a school building a place where there would be students, adults or other people are present. “We know even if you had an EpiPen in a bus barn, the problem would be the practicality of being able to use it if you had it in a bus barn or somewhere other than where you would have a school nurse present or somebody that would be adequately trained,” Proesch explains. “Because it is more likely than not that the individual who is going to be trained to use the EPiPen injector is going to be your school nurse or some other individual present in the attendance center.”

The EpiPen can only be used by a person who has the proper training. The other change requires the schools to have two separate doses on hand. “We are requiring both a pediatric dose and an adult dose in every attendance center. And we had some pushback on that until we explained that you have to have both doses available as an equity issue. And you may have students who might be a weight that is not consistent with a pediatric dose. You have adults in the building as well, so we are going to be a sticklers about requiring both doses — that way you have either doses available if you need it.”

Proesch says they are also requiring schools to make a report when they use the device. “We wanted to get information back on that so we understand and know if our training the we have for EpiPens is adequate training,” according to Proesch. “So having the reporting mechanism allows us to make sure that we have the appropriate training that we need to have as well down the road.”

The decision on whether to have the EpiPens on hand is still up to the districts. “They are not required to, this is a voluntary thing that school districts can do. But if they do volunteer to do it, then they have to follow the rules and do it the way that the rules have outlined,” Proesch says.

She says the rules will go before the Legislative Rules Review Committee one more time, and if there are not major concerns, they would go into effect in January.


Iowa Medicaid costs projected to skyrocket for Alzheimer’s patients

Alzheimer's diseaseA new report projects the expense to Medicaid for people afflicted with Alzheimer’s disease in Iowa and nationwide will increase dramatically over the next decade.

Melissa Kramer, spokeswoman for the Greater Iowa Chapter of the Alzheimer’s Association, says the costs will have a tremendous impact on the thousands of patients in Iowa who are living with the memory-robbing disease.

“The current budget for Medicaid here in Iowa, we spend about $576-million on Medicaid and 14% of that is actually spent on people with Alzheimer’s disease or other dementias.”

Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks. Alzheimer’s accounts for 60- to 80% of dementia cases. A majority of people with Alzheimer’s are 65 years old and older, but early onset can strike someone in their 40s or 50s.

“Alzheimer’s is a triple threat,” she says. “It’s soaring in prevalence, it’s lack of treatment and it has enormous costs associated that really no one can afford. This is an expensive disease and if we don’t do something now, down the road, it will bankrupt America.”

There is no cure for Alzheimer’s. Last year in Iowa, it was estimated there were 62,000 people statewide who’d been diagnosed with the disease.

By Pat Powers, KQWC, Webster City


Campaign works to reduce ‘elective’ labor before 39th week of pregnancy

Nearly one out of 10 babies born in Iowa are born prematurely and the March of Dimes is among the groups working to reduce the number of “elective” births that occur when a pregnancy reaches 37 or 38 weeks.

“It very much happens, more often I would like to say it happens for such things as convenience or the mother’s uncomfortable,” says Michelle Gogerty, state director for programs and advocacy for the March of Dimes.

Gogerty says for many years women were told it was fine to induce labor once their pregnancy reached 37 weeks.

“What we have learned is that would be a late pre-term and so those infants, they have additional growing that needs to occur, specifically with their brains and their lungs and their nervous systems,” Gogerty says, “so the longer the pregnancy is without risk and there’s no medical reason for an induction, we most definitely should not be getting induced.”

In 2013, national groups that represent obstetricians and gynecologists launched a “just say no” campaign to any delivery before 39 weeks, unless there is a valid medical reason for an early birth. The state director for the March of Dimes says Iowa hospitals and doctors “have been great” about this.

“But we do still see some that will deliver a woman early, for convenience sake,” Gogery says. “…But the hospitals, with the policies that are in place, are stopping that practice and so we’ve seen a drastic, drastic reduction in early elective deliveries in the state of Iowa.”

A full-term pregnancy lasts 40 weeks. The March of Dimes was formed in 1938 in response to the polio epidemic, but after the polio vaccine became available in the 1950s, the organization turned its focus on finding ways to prevent premature births and infant deaths.

Judge issues ruling on Medicaid management

Governor Terry Branstad.

Governor Terry Branstad.

A ruling from an administrative law judge issued late Wednesday afternoon recommends Iowa dismiss one of the four contracts awarded to companies that were chosen to manage Iowa’s Medicaid program.

The Branstad administration wants to implement the managed care plan on January 1. It would privatize the state’s $4.2 billion health care program for the poor and disabled. The unsuccessful bidders for the contracts filed the legal challenge.

The judge’s ruling questions the contract awarded to WellCare, a company that had three former executives sent to prison last year on fraud convictions. A statement released by Governor Branstad’s office expressed confidence that the plan to transfer management of the Medicaid program would “remain on schedule.”

Health care providers and patients have complained that the January 1 target date for privatization is unrealistic.

Gov. Branstad’s office issues statement on Administrative Law Judge (ALJ) decision on Medicaid Modernization

(DES MOINES)  – Gov. Terry Branstad’s Communications Director, Ben Hammes, issued a statement on the ALJ’s decision on Medicaid Modernization that was released late Wednesday afternoon.

The ALJ’s decision allows Medicaid Modernization to move forward.  The decision emphasizes that the process was both “thorough and methodical.”  We continue to evaluate the next steps in the administrative review of the procurement process and remain on schedule to implement our plan on January 1, 2016.

Clinton touts $6,000 federal tax credit for family caregivers

Hillary Clinton (file photo)

Hillary Clinton (file photo)

Democratic presidential candidate Hillary Clinton says it’s time to pay more attention to the “caring economy.”

She is proposing a new federal tax credit that would offset some of what people spend to care for an elderly or disabled relative.

“The bottom line for me is caregiving takes a lot of love,” Clinton says, “and a lot of challenging experiences that often test one’s emotional and physical well-being.”

Clinton also is proposing a recalculation of Social Security benefits for caregivers.

“All the time that people take out of paid work to care for a family member can end up putting a big dent in their retirement benefits,” Clinton says.

Clinton says it is predominantly women who leave the workforce to care for a spouse or a parent.

“I want to expand Social Security by taking into account the often overlooked and undervalued work of family caregivers,” Clinton says.

Clinton made her comments during a town hall meeting in Clinton, Iowa, today. About 400 people attended and Clinton told them her husband is a “fanatic” football fan who’s been following the Iowa Hawkeye’s winning season.

“Three weeks ago he goes: ‘You know, I think Iowa is really for real.’ And I said: ‘Yeah, it looks like it.’…And he goes: I’m wondering whether I can get there before the season’s over,'” Clinton said, laughing along with the crowd “And I said: ‘Well, let’s try to figure that out.'”

Iowa played its final home game this past Saturday. The undefeated Hawkeyes play their final regular season game at Nebraska on Friday.

(Reporting by Dave Vickers, KROS, Clinton; additional reporting by Radio Iowa’s O. Kay Henderson)



Review shows annual cost of care at four state Mental Health Institutes

Auditor-logoA review from the state auditor’s office shows just how much the state has been spending to care for mentally ill patients who’ve been residents of the state-run hospitals in Clarinda, Cherokee, Independence and Mount Pleasant.

Only two of those Mental Health Institutes are open today. Governor Branstad closed the MHIs in Clarinda and Mount Pleasant this summer.

According to the auditor’s calculations for fiscal year 2014, it cost more than $160,000 a year to care for a resident in Mount Pleasant’s MHI. It cost about twice that much to care for a patient in the MHI in Clarinda. The state spent $440,000 per resident at the MHI in Independence.

Cherokee’s costs were highest, at more than half a million dollars per patient. However, the auditor’s report says that figure includes some of the out-patient services provided by Cherokee’s MHI, but the data wasn’t available to auditors to separate how much was spent on in-patient care and on out-patient care at Cherokee.

Spot checks by the state auditor’s office have led to changes in how staff at the Mental Health Institute in Cherokee handle prescription medications. The auditor’s review raised concerns about the inventory of prescription drugs kept at the Mental Health Institute in Cherokee. It cited a “lack of segregation.” Officials say the pharmacist and pharmacy technicians at the MHI were not routinely following established procedures, but now, one technician receives the prescription drugs and someone else logs it into the pharmacy’s inventory.

The auditor’s review also raised concerns about bookkeeping at the now-closed Mental Health Institute in Clarinda. Cash deposits were being made, but they were not within the 10-day window required by law. Staff in Clarinda started to make deposits once a week after the auditor flagged the problem.

Binge drinking rate high in Iowa; obesity rate stable from 2013 to 2014

Health-Department-LogoA new report indicates the percentage of Iowans who were overweight or obese was almost identical in 2013 and 2014, however two-thirds of Iowans still fit into that category. Don Shepherd of the Iowa Department of Public Health says it’s too early to tell if this is the beginning of a decline in obesity rates in Iowa.

“We’re on the high side, even though we’ve paused this year and not gone up any,” Shepherd says.

The data on obesity rates comes from the 2014 “Behavioral Risk Factor Surveillance System” report. The just-released report found the vast majority of Iowans consider themselves in good health. However, health care professionals are looking for improvement in the number of Iowans taking important cancer screening tests. The percentage of Iowa women who’ve had the “pap” test to screen for cervical cancer has declined by about three percent over the past three years.

“I was surprised by that one myself because I hadn’t heard any reports of it doing down,” Shepherd says, “but it is showing a decline.”

More than 71 percent of Iowans above the age of 50 have had a colonoscopy — the screening test for colon cancer — and Shepherd says that’s a welcome increase.

“There’s a campaign out to try to get 80 percent screening (for colon cancer) and we’ve still got a ways to go for that, but we’re better than we have been in the past,” Shepherd says.

Nearly 67 percent of elderly Iowans got a flu shot last year.

“We were the top state in the country a couple, three years ago in terms of having people over the age of 65 get flu vaccinations and we’ve dropped somewhat,” Shepherd says, “but we’re still in the top 10.”

Nearly five percent of Iowans surveyed last year admitted to driving while they were intoxicated. Only one other state had a higher rate of admitted drunk driving and Shepherd says there are likely more who’ve driven while intoxicated, but wouldn’t admit it. About one in five Iowans surveyed in 2014 admitted to binge drinking. That puts Iowa among the top five states for binge drinking — and it’s not just a problem in college towns. Shepherd says it’s a “widespread” problem.

“It seems to have something to do with the geography of the country because the upper Midwest is a high binge drinking area in general,” Shepherd says. “Quite often four of the top five states in binge drinking are up here in the upper Midwest.”

Health professionals define binge drinkers as a man who drinks more than five alcoholic beverages or a woman who has more than four drinks on one occasion.