www.charlestondailymail.com Health http://www.charlestondailymail.com Daily Mail feed en-us Copyright 2014, Charleston Newspapers, Charleston, WV Newspapers West Virginia ranked most obese in nation http://www.charlestondailymail.com/article/20140904/DM01/140909593 DM01 http://www.charlestondailymail.com/article/20140904/DM01/140909593 Thu, 4 Sep 2014 21:23:08 -0400 Health official says state in a 'public health crisis'


Daily Mail Staff

West Virginia is tied with Mississippi for the highest obesity rate in the nation, a new report on obesity in America indicates.

According to "The State of Obesity" report from the Trust for America's Health and the Robert Wood Johnson Foundation, 35.1 percent of all adults in both states were obese in 2013.

West Virginia's obesity rate has steadily increased over the past few years. West Virginia's adult obesity rate was 32.4 percent, or the third-highest in the nation, in 2011. The adult obesity rate in West Virginia in 2004 was 27.6 percent, which was the third-highest mark in the country at that time. West Virginia's adult obesity rate has been among the four worst in the country since 1990, according to data shown in the report from the CDC's Behavioral Risk Factor Surveillance System dataset.

The Centers for Disease Control and Prevention pins the national adult obesity rate at 34.9 percent, or 78.6 million people. It estimates the annual cost of obesity in America is $147 billion.

Dr. Rahul Gupta, Kanawha-Charleston Health Department executive director, said the data are troubling, but nothing new. He said the rates of obesity among baby boomers (38.7 percent) and children (34 percent, according to the Kids Count data center) are especially alarming, though childhood obesity rates are stabilizing.

"We need to look at things in a more comprehensive manner in order to address this as a public health crisis, not only a crisis of huge proportions, but a crisis that needs immediate attention," Gupta said.

The report points out correlations between minorities and increased obesity rates, as well as a correlation between income and increased obesity. It finds more than 33 percent of adults who earn less than $15,000 per year are obese, compared to a 25.4 percent obesity rate for those who earn at least $50,000 per year. Nationwide, 11 states have obesity rates above 40 percent among their black populations, and 23 states have obesity rates above 35 percent for latino populations.

In West Virginia, the obesity rates for blacks and latinos are 36.5 percent and 32.1 percent, respectively, according to the report.

Gupta said obesity doesn't plague minorities in West Virginia as much as it does minorities in other states because the root of the issue in West Virginia is socioeconomics, not race.

"I think we need to understand that, and we need to understand that the other side of this is that obesity has reached a level of public health crisis in West Virginia," Gupta said. "Across all types of people from all origins, I think we're peaking. Every subgroup of the population across West Virginia is peaking with obesity rates."

Dr. Letitia Tierney, Commissioner of the West Virginia Bureau for Public Health and State Health Officer, said while West Virginia's obesity rates are high, the state has started many initiatives to combat obesity.

"We take obesity as a serious health issue and are working to improve the lifestyles of West Virginians," Tierney said. "Chronic diseases are the most common and the most costly of all health problems - and they are also the most preventable. Prevention and management of chronic disease requires that we all become advocates for health."

Tierney provided a list of 16 programs the Bureau of Public Health is involved in that are fighting obesity though education, outreach and partnerships. Through coordinated school health initiatives with the Department of Education, Tierney said less than 15% of West Virginia schools permit students to purchase soda on campus and less than 20% of West Virginia schools allow students to purchase sports drinks on campus.

Though Gupta said much progress has been made to push back against the obesity epidemic in West Virginia, much more needs to be done to ensure a more healthy future. Gupta proposed West Virginia could pass a "physical activity" law that would require students to have a certain amount of physical activity every week. He also proposed better nutritional education in schools.

Gupta said West Virginia doesn't need to "throw money at the problem", but instead needs to make "smart policies," and conduct thoughtful planning and study the problem further. The State Of Obesity report predicts if current trends continue, West Virginia's obesity rate will be above 60 percent by 2030.

"What we need to figure out is how to develop a comprehensive, best-practice approach to addressing obesity, otherwise we could be fighting this for 10, 20, 50 years and that's not what we want to do," Gupta said. "Not only is it important from the workforce standpoint and from the chronic disease standpoint, but ultimately it's draining resources, human capital, out of the system.

It's urgent, but whereas money and resources are an important part, it's not the only part."

The State of Obesity report is supported by a grant from the Robert Wood Johnson Foundation.

Contact writer Marcus Constantino at 304-348-1796 or marcus.c@dailymailwv.com. Follow him at www.twitter.com/amtino.

Vaccine effective on all types of dengue http://www.charlestondailymail.com/article/20140903/ARTICLE/140909763 ARTICLE http://www.charlestondailymail.com/article/20140903/ARTICLE/140909763 Wed, 3 Sep 2014 16:57:10 -0400


Bloomberg News

PARIS - Sanofi's experimental vaccine against dengue protected children with all four types of the mosquito-borne illness in a clinical test, a stronger result than shown in a smaller study this year.

In a trial of almost 21,000 children in Latin America and the Caribbean, the shot reduced the risk of infection by 60.8 percent, the Paris-based company said in a statement Wednesday. The vaccine also led to an 80.3 percent drop in the risk of hospitalizations.

The results are validation of Sanofi's two-decade effort to develop a vaccine for the debilitating infection, which is a growing problem in developing as well as developed countries. An outbreak in Tokyo has led to 34 cases, the Health Ministry said this week.

"For the first time ever, after 20 years of research and industrial commitment, dengue is set to become a vaccine-preventable disease," said Olivier Charmeil, president of the French drugmaker's Sanofi Pasteur vaccine unit.

About half the world's population lives in countries threatened by dengue, the World Health Organization estimates. Of 390 million infections a year, about 96 million people are sickened to some degree, according to research published last year.

In a trial involving more than 10,000 children in Southeast Asia, the vaccine reduced the risk of infection by 56.5 percent, according to results published in July, though the inoculation was less effective among the youngest children who are most at risk, and failed to protect against one of four viruses that cause it.

There's no approved treatment for dengue, which causes flu-like illness that can develop into potentially fatal complications including bleeding gums, vomiting, rapid breathing and severe abdominal pain.

Sanofi plans to publish full results from the Latin American trial in a scientific journal, and will present them at the American Society of Tropical Medicine and Hygiene conference in November. The Latin American and Southeast Asian studies are part of the third and final phase of clinical trials generally needed for regulatory approval.

Sanofi didn't say when it will submit the shot for approval. The trial results will be submitted to authorities in countries where dengue is a public-health priority, the company said.

The vaccine may have peak sales of $1.2 billion by 2025, Peter Verdult, an analyst at Citigroup, said in a report Wednesday.

Takeda Pharmaceutical of Osaka, Japan, is also developing a dengue vaccine, as are Merck & Co. and the U.S. National Institutes of Health.

Distance Run competitor balances jobs, baby and exercise ambition http://www.charlestondailymail.com/article/20140828/DM01/140829214 DM01 http://www.charlestondailymail.com/article/20140828/DM01/140829214 Thu, 28 Aug 2014 17:31:04 -0400



Strong legs and strong will carry runners to the finish each year at the Charleston Distance Run, and among this year's field, Jennifer Hillenbrand fits that mold as well as any.

Hillenbrand, a 40-year-old Scott Depot resident, builds her strength by training as she pushes her daughter in a jogging stroller and her resolve by making exercise a priority despite the rigors of being a mom, holding two jobs and maintaining a running regimen that coincides with her firefighter husband's unconventional work schedule.

She and thousands more will make time for the 42nd annual Charleston Distance Run, set to begin at 7:30 a.m. Saturday at the state Capitol.

"I think the main key is being flexible," Hillenbrand said of her quest to remain fit and run regularly.

The ability to adjust her training schedule is key for Hillenbrand, who works full-time as a clinical dietician at St. Francis Hospital in Charleston. She also counsels patients with PEIA Insurance at the Nautilus Fitness Center's Cross Lanes location about weight management one night each week.

"I've noticed now that I'm a mom, I run a lot more by myself, because I just go when the opportunity presents itself," she said. "Sometimes that's at nap time or if I get off work early. If a client of mine doesn't show up at the gym, I might just hop on the treadmill, whenever I can."

When Hillenbrand has company, it's typically her 19-month-old daughter Katie, riding along in a jogging stroller as Hillenbrand navigates. At other times, her husband Craig Matthews watches Katie in between his 24-hour shifts as a firefighter with the City of Charleston while she finds an opportunity to run.

Hillenbrand, who began running in 1999, said returning to the sport after Katie's arrival proved a tall task, one that tested her time constraints and emotions.

"The time management, at first, was kind of hard, because I felt bad about leaving her when she was small," she said. "Eventually, I started going to the gym and running on the treadmill for just like 30 minutes at a time. At about 4 months old, I started taking her for run/walks in the neighborhood. I started just walking at first, then I tried to run the flats of the neighborhood, then eventually I added on the hills."

Running can be tough on its own, but adding the bulky stroller to the mix increases the difficulty, Hillenbrand said.

"I started running with her and I was really slow at first, but then I started continuing to do it maybe three, four times a week," she said. "I was pushing her. My pace seemed awful slow and I thought 'Oh, my goodness. I'm just so slow,' but I actually went out and ran the Joker Run in (March) 2013 and I was really pleased with my time, because it was a lot easier. I didn't factor in how much easier it would be without the baby stroller."

Hillenbrand said she feels guilty at times for using moments of free time to run rather than to rush home from work, but hopes her daughter will eventually understand the benefits and demands of maintaining a healthy lifestyle.

"I try to remind myself in the long run, it's good for my health to try to stay healthy and try to maintain a healthy weight," Hillenbrand said. "I would really like my daughter to get into some type of sport. It doesn't have to be running but something to keep her active, to prevent obesity.

"That's part of my job, is preventing obesity, so I'm always thinking of that stuff. I just want her to be active and find something that she likes to do. I hope with her riding with me, with me pushing her during some of my races, that she gets the excitement of racing and maybe want to do it sometime when she's older."

Observing the excitement of the annual Charleston Distance Run as a youth helped propel Hillenbrand to a later interest in the event. This year's race marks her fourth participation.

"I think it's a local tradition," she said. "Growing up here in Charleston, Labor Day weekend, I always heard about the Distance Run. My grandparents actually live along the course, so they were always talking about it.

"It was something I always heard about and I thought, 'Wow, that sounds cool to do,' but I never thought I would be able to do it. The first time I ever did it, I was so proud of myself because it's very challenging, and it's part of the culture here in Charleston."

While Hillenbrand's journey might inspire others to make running a priority, she said she draws motivation from fellow harriers, like those with Charleston's Tallman Track Club.

"A lot of my inspiration comes from fellow runners," Hillenbrand said. "So many of them who I've know from the Tallman Track Club . . . others have had babies, they're juggling time management. Others have had injuries such as stress fractures and they've come back. Just watching them persevere through their injuries has really made an impression on me."

Of the thousands who test the hallowed race course in pursuit of the finish, many of the runners, like Hillenbrand, face their greatest challenge in making the time to train in order to reach the starting line.

"I try to be physically active and that way I can show my clients you can work it in here and there - that's what I've had to do," Hillenbrand said. "Sometimes I just don't have enough time and I just do three miles. That might have to be all I can get in, but I try to make those three miles the best I can, try to make it a really great run."

Distance runner overcomes hurdles http://www.charlestondailymail.com/article/20140828/DM01/140829215 DM01 http://www.charlestondailymail.com/article/20140828/DM01/140829215 Thu, 28 Aug 2014 17:30:12 -0400



Though the impetus to Brad Deel's running career occurred rather uneventfully in a department store, his story is one that continues to inspire as he encourages others to leave behind unhealthy habits for a life of fitness.

The 6-foot-tall Deel, who had smoked for 30 years and topped the scales at 230 pounds, found the starting line to a new path in life in a pair of pants. This weekend, a lighter, fitter Deel will join thousands of others as a participant in the Charleston Distance Run, which begins 7:30 a.m. Saturday.

"I always tell people I would love to say it was some kind of inspiring story, but the reality was, it was about spring of 2008, and I had to buy a pair of pants with a 42-inch waist," the 51-year-old Deel said. "It was sort of that shock of buying a pair of pants with a 42-inch waist that got me started."

Soon thereafter, Deel, of Scott Depot, began to run. He quickly discovered he possessed a natural talent for it, but something was still holding him back.

"I ran four about four months before I quit smoking," Deel said. "I started reaching a point where I was finishing runs and my legs felt great and wanted to go more and farther, but I couldn't catch my wind, and I thought well, if I'm going to keep running, I need to quit smoking, so I quit smoking the first week of July 2008."

His goals started small but grew as did his strength and ardor for running.

"My initial goal when I first started running, I wanted to lose weight, but I had some fitness goals, too," he said. "My fitness goal was I wanted to be able to run three miles nonstop. I thought, if I could run three miles nonstop, man I'm going to be in really good shape, and then I got to the point fairly quickly where I could run three miles nonstop.

"Then, I thought well then one of the things I couldn't even do when I was younger - I thought this will take me a while, but I would like to run five miles in under 40 minutes, and I ended up doing that. It only took me six or seven months to get to that point, and that was when I started realizing well, maybe I have a little bit of talent for running."

As his fitness increased, Deel pushed his limits further. For his 50th birthday, in October 2012, he ran 50 miles, starting at the Marshall University student center and finishing at the University of Charleston, where he works as an assistant professor of political science and the political science program director. Deel previously served in the United States Army National Guard and the United States Army Reserve from 1985 until 2013.  He retired in 2013 as a lieutenant colonel. 

This year's distance run will be Deel's seventh, and he's completed four marathons, including one Boston Marathon and one sub-three-hour marathon.

"It was more an evolution than a revolution," Deel said of his running journey. "I know I didn't really like it at first. For the first four or five months, I didn't like running, but it was kind of one of those things where I reached the point where I hated running, but I hated being fat more than I hated running, so I kept at it."

Now, a seasoned runner and more than 70 pounds lighter, Deel said he feels he can offer advice, as a coach, to others beginning their journey or looking to improve their running abilities.

"When I looked around it seemed every running coach I could find, they were a distance runner in college and they've been in shape their entire life, and they don't really get, on a visceral level, what it looks like to look at a track and think 'Man, that's a long way around. I don't know if I can run that far,'" he said.

"I think I have something to offer especially for folks who may be substantially out of shape and they look at a mile as a distance, which is way too far to run, because I've been there, done that. I know how that feels."

Deel knows the benefits of staying with a running program, too.

"I try to accentuate the positives of exercise, because there are just so many," he said. "There's a huge study out recently that showed that people who ran as little as 10 miles a week cut their risk of heart disease in half and cut their risk of mortality from all causes by a third."

Because running has provided Deel with so many benefits, he also gives back as the race director for the annual Scott Teays Elementary 5K. As part of the race, anyone who signs up may participate for no additional charge in the Couch to 5K program led by Deel at Hurricane's Valley Park.

"I start by telling people that the first thing we're going to do is get used to moving your body for 30 minutes without stopping, because most people aren't used to doing that," he said.

Not all runners must make a substantial time commitment as Deel, he said.

"Sixty to 90 minutes a week is really all you need to ultimately benefit," he said. "If they tell me they don't have 60 to 90 minutes a week, I'm going to ask them if they have a television, and is that television on 60 to 90 minutes a week? If the answer is yes, that television is on 60 to 90 minutes a week, then you have time. It's just a matter of deciding it's important to you."

CAMC leading way for new cardiac procedure http://www.charlestondailymail.com/article/20140827/DM01/140829272 DM01 http://www.charlestondailymail.com/article/20140827/DM01/140829272 Wed, 27 Aug 2014 22:58:24 -0400 By Charlotte Ferrell Smith More than 40 patients at Charleston Area Medical Center have undergone a procedure whereby the aortic valve is replaced without opening the chest, officials said.

Dr. Samuel Groves, cardiologist, went over the procedure on Wednesday morning during the regular meeting of the CAMC Board of Trustees.

Transcatheter aortic valve replacement is a non-invasive procedure for patients with severely restricted vessels in the aorta. A new valve is crimped on a balloon, passed through an artery, and positioned inside the narrowed valve. The balloon is inflated and a new valve is left to fully function.

"We can replace the aortic valve without cutting open a patient," Groves said.

Board members saw a video presentation explaining the basics of the complex medical procedure. Groves said CAMC is leading other facilities throughout the state in performing the state-of-the-art procedure for cardiac patients.

Meanwhile, University of Charleston President Ed Welch, who heads the quality committee, questioned the amount of time a patient spends in the emergency room before being evaluated for treatment. While the wait time is lower than a couple of years ago, it could be improved with the addition of more hospital beds because the emergency department is being "clogged" as patients wait to be admitted.

"We are trying to add beds at Memorial," he said.

The time frame between a patient's arrival and evaluation should fall within 90 minutes, he said. In one month's time, four patients waited longer than that, he said.

"They arrived by car," he said. "It's harder with no alert that they are coming."

In financial matters, Larry Hudson, chief financial officer, called July "a mixed bag." He reported the bottom line ahead of budget but the total down due to activity on Wall Street.

Bryan Cummings, of the CAMC Foundation, said the 2014 Golf Classic raised a record $216,000. Last year's tournament raised $170,000. Within the last 10 years, the event has raised $2.5 million and 3,000 golfers have participated, he said. Proceeds go to the children's endowment fund at Women and Children's Hospital.

In other business, it was announced that Tom Potter, who has served on the board for 19 years, will leave his position at the end of the year. The nominating committee is to meet over the next couple of months to seek a replacement.

It has been previously reported that Charleston Radiation Therapy Consultants will move into the new Cancer Center. CRTC is currently housed in the medical office building on the Memorial campus.

"Currently, radiation services are owned by a group of physicians," said David Ramsey, CAMC president and chief executive officer. "They own the doctor billing part and the equipment."

The physicians, working with an outside company, asked if CAMC would like to buy into ownership of the equipment, he said. An agreement was reached for CAMC to purchase 20 percent of the equipment at a cost of $6.5 million, Ramsey said.

At the beginning of each board meeting, a "Heart and Soul" award is given to an employee who goes beyond the call of duty to offer excellent care.

Ramsey presented the latest award to William Hovorka, a licensed practical nurse who has worked on 3 West at Memorial Hospital for 18 months. He was nominated by co-workers as well as patients for his self-motivation, positive attitude, and professionalism, Ramsey said. He is noted for his expertise in educating patients about medications and discharge instructions.

Hovorka said he wanted to dedicate the award to his co-workers as well as his parents who taught him the values of morals and hard work.

Contact writer Charlotte Ferrell Smith at charlotte@dailymailwv.com or 304-348-1246.

Women and Children's NICU renovations complete http://www.charlestondailymail.com/article/20140825/DM01/140829555 DM01 http://www.charlestondailymail.com/article/20140825/DM01/140829555 Mon, 25 Aug 2014 16:11:52 -0400 By Whitney Burdette The words "neonatal intensive care unit" may incite fear in many new parents, but the staff at Women and Children's Hospital is hoping to make the stay more bearable for families.

Women and Children's unveiled its new NICU Monday after completing months of renovations. The redesigned unit now focuses on family and creates an environment that allows premature babies to develop and grow in a more controlled space.

"I think the new design has more privacy," said Debby Minders, a registered nurse in the NICU. "We can better control the environment because all the lights are on dimmers and it helps decrease the noise for babies, which is better for babies who are premature and are growing. It also has more organized space. Before we didn't have any drawers or anything like that."

The unit had gone unchanged since the hospital opened in 1988. The old unit lacked privacy and storage space, but Women and Children's Vice President Andrew Weber said the hospital's NICU performs near the top worldwide.

"We have a great rate," he said. "We compare all of our care to a network of over 700 hospitals across the world, called the Vermont Oxford Network, and we compare our outcomes to hospitals all across the world. We are performing in the top tier in virtually all of our indicators. We have great outcomes with the babies here."

The NICU at Women and Children's maintains the same 30 bed spaces as before, but includes more modern touches, such as a better appointed care-by-parent room, which allows parents to gain some hands-on experience caring for their premature baby under a nurse's guidance. Breastfeeding moms also have access to a private lactation room. Minders said the NICU staff encourages family bonding, such as skin-to-skin contact between parents and babies, as well as breastfeeding.

"We made the unit more family friendly," Minders said. "They have an area to store their belongings at each bedside. We have a lactation room to help mom. We encourage all moms to provide breastmilk or to breastfeed their babies. We have a family area where they can go and wait with other family members."

The $1.6 million renovation began in March. While the NICU space was closed, patients were housed in the nursery in the mother-baby unit and in some patient rooms. However, nurses said the NICU was able to maintain the same number of bed spaces and the same level of care.

"We always give the best care to our babies," said Nancy Marcus, manager of the NICU. "What we really did was work to improve the environment and make it more private and efficient."

Minders said babies spend an average of two weeks in the unit. A neonatologist is always on duty, along with an average of 10 nurses per shift.

"The care is the same, it's the environment we improved," Marcus said.

Although women are more educated about potential risk factors that could lead to premature births, Minders said the NICU is seeing an increase in the number of such births. Substance abuse is a top cause.

"West Virginia has one of the highest preterm birth rates in the country," Minders said. "We have a high rate of smoking among moms and teen moms. Some drug abuse.

"We've seen an increase over the years."

Residents studying at the hospital perform about one-third, or 1,000 deliveries, each year. Weber said research conducted by the hospital has found a large percentage of babies are born addicted to drugs or alcohol.

"In the clinic area where we see and care for those patients prenatally, our latest study shows that 39 percent of (babies) test positive for one or more substances," he said. "Within that population that resident services care for, that's a pretty high percentage."

Weber said avoiding dangers, such as drugs and alcohol, and listening to the advice of obstetricians are just a few ways women can avoid having preterm births.

"The obvious are tobacco, alcohol, illicit drugs. Those things are seen frequently as causes for premature birth," Weber said. "Those are what you might call the low-hanging fruit, although I understand when folks have addictions they can be challenging, but we have programs and people to help when women are pregnant and have those addictions."

The birth of a healthy baby costs an average of $12,000. In contrast, the average cost for delivery and care for a preterm baby is about $39,000, though Weber pointed out that price tag depends wholly upon the care the baby needs. And the costs can add up even after the baby leaves the NICU.

"What we don't know and have trouble quantifying as a society is what are the longterm costs to the baby and the family and to society as a whole when these babies are born prematurely," he said. "They need care for potentially the rest of their lives. Some do (outgrow the need for care) but when we have babies born as early as 23 weeks and are viable, most of us can fit them in the palm of our hands. You can imagine how underdeveloped they are. When they're outside of their natural environment, outside the womb, things don't mature and develop the way they're supposed to - everything from the lungs to the brain - it can result in permanent issues."

Women and Children's is one of several NICUs in the state, but one of only three Level III facilities, meaning it is equipped to care for the smallest and sickest of newborns. Cabell-Huntington Hospital and West Virginia University also offer patients the highest level of care. Women and Children's staff care for premature and ill babies from central and southern West Virginia, as well as referred patients.

Contact writer Whitney Burdette at 304-348-7939 or whitney.burdette@dailymailwv.com. Follow her at www.Twitter.com/wburdette_DM.

Local woman relieved that cousin has survived deadly Ebola virus http://www.charlestondailymail.com/article/20140821/DM01/140829832 DM01 http://www.charlestondailymail.com/article/20140821/DM01/140829832 Thu, 21 Aug 2014 14:19:36 -0400 By Charlotte Ferrell Smith Dr. Kent Brantly released from hospital after Ebola treatment


Daily Mail Staff

Linda Workman, of South Charleston, wants to thank all of those who prayed and showed support for her cousin as he battled Ebola after caring for patients in Liberia.

Dr. Kent Brantly was released Thursday from Emory University Hospital in Atlanta where he had been treated for the deadly virus. At a news conference, the Samaritan's Purse doctor thanked God for sparing his life and hugged members of the medical team who cared for him during his recovery.

"I'm ecstatic about his release," Workman said. "That is all I can think about. There are no words. His family is so close and they are such good people. I have hated it for them the entire time. They have been an inspiration to me their whole lives."

She said Brantly has come from a long line of people who have given of themselves to serve others from doctors to missionaries.

"It was such a blow to find out he was sick," she said of her cousin.

During his illness, she asked that he be added to the prayer list at St. John's Episcopal Church where she is a member. She also posted requests for prayer on social media and was flooded with responses from those who agreed to pray.

News of his recovery and release from the hospital left her with tears of joy.

She had followed his progress through conversations with his sister in Indianapolis as well as the Samaritan's Purse website.

Brantly, 33, was initially treated at a hospital in Monrovia, Liberia. As the medical director for the North Carolina-based group Samaritan's Purse, he had been in Liberia since October. As a medical missionary, he spent months treating a stream of patients with Ebola in Liberia. While directing the clinic, he wore full-body protective gear but still contracted the deadly virus. When he recognized that he had symptoms, he immediately sought treatment.

"Because he was familiar with Ebola, he knew what was happening right away and took precautions," she said. "That is a big part of the solution. I think especially in Africa where people walk to medical centers, treatment is delayed."

Ebola begins with symptoms including fever and sore throat and escalates into vomiting, diarrhea and internal bleeding.

The Samaritan's Purse website reported that Brantly survived a virus with a mortality rate of 60 percent to 90 percent. It continues to say the current outbreak has claimed 1,350 lives in the west African countries of Guinea, Liberia, Nigeria and Sierra Leone.

Samaritan's Purse President Franklin Graham said Brantly's "faithfulness to God and compassion for the people of Africa have been an example to us all."

Earlier this month, Brantly was transported to Atlanta in a medical evacuation plane and taken to Emory University Hospital where he was treated in a special unit set up in collaboration with the Centers for Disease Control and Prevention.

The Samaritan's Purse website also reports these other details: Nancy Writebol, a missionary who also contracted Ebola in Liberia, was released from the hospital on Tuesday. Brantly and Writebol both received a dose of an experimental serum while in Liberia. Brantly also received a unit of blood from a 14-year-old boy who had survived Ebola under his care.

Brantly's wife and two children had been living with him in Liberia but flew home to the United States before he started showing any signs of being ill.

Some have been critical of bringing anyone ill with the virus into the country.

"There were people upset about bringing Ebola patients to the states for treatment," Workman said. "Having worked in health care for 20 years, it's not the people who you know who are sick that can hurt you. It's the ones you don't know about. They brought them here using so many precautions."

Workman, who now works for an oil and gas consulting firm, once worked in New York as a cytotechnologist screening cells to detect cancer.

"I had to prep a lot of specimens and use universal precautions to keep from becoming infected," she said.

Since news of Brantly's recovery, she has heard from numerous people through phone calls as well as social media.

"I really want everyone to know how much I appreciate their support and the fact that so many people were praying for him," she said. "The whole family is grateful for support and prayers."

She said the entire experience is a startling reminder. "Don't take life for granted."

She also encourages giving to Samaritan's Purse and its efforts for humanitarian aid. Go to www.samaritanspurse.org for more information.

Contact writer Charlotte Ferrell Smith at charlotte@dailymailwv.com or 304-348-1246.

Two American Ebola patients released from hospital http://www.charlestondailymail.com/article/20140821/ARTICLE/140829833 ARTICLE http://www.charlestondailymail.com/article/20140821/ARTICLE/140829833 Thu, 21 Aug 2014 14:11:18 -0400



ATLANTA - After nearly three weeks of treatment, the two American aid workers who were infected with the deadly Ebola virus in Africa have been discharged from an Atlanta hospital, officials said Thursday.

Their release poses no public health risk, Dr. Bruce Ribner of Emory University Hospital stressed. Dr. Kent Brantly, 33, and Nancy Writebol, 59, show no evidence of Ebola, and generally patients do not relapse and they are not contagious once they've recovered, said Ribner, director of the hospital's infectious disease unit.

At a news conference, Brantly, standing with his wife, said, "Today is a miraculous day."

"I am thrilled to be alive, to be well, and to be reunited with my family. As a medical missionary I never imagined myself in this position," said Brantly, who was released Thursday. Nancy Writebol, 59, was released Tuesday, and her husband said in statement emailed by aid group SIM that that she is free of the virus but in a weakened condition and was recuperating at an undisclosed location.

Brantly choked up several times while thanking his aid group, North Carolina-based Samaritan's Purse, and the Emory medical team. The couple hugged the medical staff and joked with them. Several blinked back tears, then cheered and applauded as Brantly and his wife made their way from the room. Brantly said he and his family would be going away as he continues to recover.

In his statement, David Writebol said his wife "was greatly encouraged knowing that there were so many people around the world lifting prayers to God for her return to health. Her departure from the hospital, free of the disease, is powerful testimony to God's sustaining grace in time of need."

Brantly was flown out of the west African nation of Liberia on Aug. 2, and Writebol followed Aug. 5. The two were infected while working at a missionary clinic outside Liberia's capital.

Brantly and Writebol received an experimental treatment called Zmapp, but it's not known whether the drug helped or whether they improved on their own, as has happened to others who have survived the disease. The treatment is so novel that it hasn't been tested in people.

The limited supply of Zmapp also was tried in a Spanish missionary priest, who died, and three Liberian health care workers, who are said to be improving.

The Ebola outbreak has killed more than 1,300 people across West Africa. There is no proven treatment or vaccine. Patients are given basic supportive care to keep them hydrated, maintain their blood pressure and treat any complicating infections. Ebola is spread only through direct contact with the bodily fluids of sick people experiencing symptoms.

On Thursday in the Liberian capital of Monrovia, calm set in one day after residents in a slum that was sealed off in an effort to contain the outbreak clashed with riot police and soldiers. World Health Organization officials were visiting two hospitals that are treating Ebola patients and struggling to keep up with the influx of patients.

The death toll is rising most quickly in Liberia, which now accounts for at least 576 of the fatalities, the WHO said. At least 2,473 people have been sickened across West Africa - more than the caseloads of all the previous two-dozen Ebola outbreaks combined.

New restrictions on hydrocodone to take effect http://www.charlestondailymail.com/article/20140821/DM01/140829838 DM01 http://www.charlestondailymail.com/article/20140821/DM01/140829838 Thu, 21 Aug 2014 12:54:39 -0400


The federal government is finalizing new restrictions on hundreds of medicines containing hydrocodone, a component in highly addictive and commonly abused painkillers in West Virginia.

The Drug Enforcement Agency is changing its classification of hydrocodone combination drugs from "schedule III" to "schedule II." Those drugs include medicines like Vicodin or Lortab, which combine hydrocodone with acetaminophen, the main ingredient in asprin.

"Schedule I" drugs, like cocaine, have the strictest regulations.

The changes, announced today, increase regulations on the drugs that contain hydrocone, allowing less to be prescribed at one time. It also means drugs like Vicodin, Lortab and other generic versions will be subject to the same prescribing rules as other powerful painkillers.

Patients will be limited to one 90-day supply of medication and will have to see a physician to receive a refill.

U.S. Sen. Joe Manchin, D-W.Va., pushed for the change in recent years. He heralded the move as a way combat rising abuse rates in West Virginia and across the country.

"For far too long, I have seen firsthand the devastating effects that these drugs have had on our communities. Job vacancies cannot be filled because of failed drug tests. Family lives are ripped apart because of addiction and overdose deaths," Manchin said in a press release.

"These circumstances are too common and simply unacceptable, which is why I am so grateful that the DEA has finalized the rescheduling process of hydrocodone. Although there is much more that must be done to curb prescription drug abuse, I am confident that rescheduling hydrocodone will undoubtedly begin saving hundreds of thousands of lives immediately."

People in West Virginia die from overdoses at a higher rate than people in any other state, according to a 2013 report from Trust for America's Health. West Virginia also sees the most prescriptions per person of any state in the country, according to the U.S. Centers for Disease Control and Prevention.

Veterans hospitals in West Virginia prescribed thousands of hydrocodone-based medications in the past decade, some of the many prescriptions that put the hospitals' prescription painkiller rate of use above most in the nation.

In 2002, the Beckley VA Medical Center issued 3,600 prescriptions of hydrocodone for 14,450 patients, according to information included in a report from the Center for Investigative Reporting. In 2012, there were 21,672 prescriptions for 13,805 patients.

The Beckley center acknowledged the high rate, but said they are working to find different ways of addressing pain.

In 2001, the Huntington VA Medical Center issued 7,166 prescriptions compared with 24,610 patients. With about 28,500 patients in 2012, there were 32,141 hydrocodone prescriptions.

The move, announced in a federal posting, comes more than a decade after the DEA first recommended reclassifying hydrocodone because of its risks for abuse and addiction. For years, physicians groups and the Food and Drug Administration opposed the move, saying it would create extra work and drive up health care costs.

Credit monitoring available for security breach victims http://www.charlestondailymail.com/article/20140820/DM0104/140829944 DM0104 http://www.charlestondailymail.com/article/20140820/DM0104/140829944 Wed, 20 Aug 2014 16:56:21 -0400

Patients affected by a recent data security breach at hospitals and clinics in West Virginia will have access to free credit monitoring.

Attorney General Patrick Morrisey announced Wednesday his office has been in contact with Community Health Systems, parent company of four West Virginia hospitals and several clinics that discovered the security breach last week. The company said the information that was accessed was non-medical patient identification data related to the system's physician practice operations. No medical, health or financial information was stored on the data servers that were compromised.

Community Health Systems is working with Kroll, a risk management company, to set up a website and toll-free number for people affected by the breach or who have questions. The company will offer identity theft protection to patients identified as victims, and Kroll began sending letters to those patients Wednesday.

"Our office is committed to working with other states that were affected by this breach, and we will vigorously protect the consumers of West Virginia from any threat to their personal information," Morrisey said. "Any patient who received treatment at any of these offices in the last five years should contact the company and take advantage of any identity theft protection it offers. We will continue to update consumers on this important issue."

The breach affected Oak Hill Clinic Corp., Oak Hill Hospital Corp., Bluefield Clinic Company LLC., Greenbrier Valley Anesthesia LLC., Greenbrier Valley Emergency Physicians and Ronceverte Physician Group.

For information, patients can visit http://kroll.idmonitoringservice.com or call 1-855-205-6951.

Nurse sues South Charleston hospital over flu shot http://www.charlestondailymail.com/article/20140820/DM02/140829963 DM02 http://www.charlestondailymail.com/article/20140820/DM02/140829963 Wed, 20 Aug 2014 10:56:37 -0400 CHARLESTON, W.Va. (AP) - A South Charleston hospital is being sued by a nurse who says she was required to get a flu shot despite being allergic to the vaccine.

Susan Dean's lawsuit said a new policy at Thomas Memorial Hospital required her to prove her allergy, even though she had an immediate reaction to a flu shot administered by another Thomas nurse 15 years ago.

Dean filed the lawsuit last week in Kanawha County Circuit Court, the Charleston Gazette reported.

Dean has been employee of the hospital for more than 30 years. To keep her job, the lawsuit says Dean underwent allergy testing in October 2013 and had a reaction. Since then, she has been hospitalized several times and is unable to work, the lawsuit said.

Thomas Memorial's policy, which was implemented in September 2013, requires all health care workers, including volunteers and chaplains, to receive yearly flu shots. The hospital would grant exemptions if an employee had a statement from a doctor saying the employee was allergic to eggs, which would be verified through allergy testing at the employee's expense; a previous episode of Gullian-Barre, a rare disorder where the body's immune system attacks its nervous system, or upon recommendation from a doctor for a pregnant employee.

Hospital spokeswoman Paige Johnson told there also exemptions for religious reasons.

Employees who refuse to be immunized and who are found to not be exempt initially face a 30-day suspension without pay. They would be fired if they do not comply by the end of the suspension period.

Johnson said most medical facilities use the policy, which was set by The Joint Commission, an independent national organization that certifies thousands of health care organizations.

She declined to comment about Dean's lawsuit. But she said the hospital considers exemption cases carefully.

"We have an entire team of infection control nurses and they are very aware of individual situations and we make provisions for those," Johnson told the newspaper.

In addition to damages, the lawsuit seeks to require medical professionals to undergo training to deal with employees' allergy to the flu vaccine.

No WV health officials trained to respond to chemical leaks, CDC says http://www.charlestondailymail.com/article/20140819/DM01/140819165 DM01 http://www.charlestondailymail.com/article/20140819/DM01/140819165 Tue, 19 Aug 2014 13:26:37 -0400 By Dave Boucher None of West Virginia's state public health officials were trained to respond to a chemical disaster at the time of the recent massive chemical leak and water contamination, according to a new report from the U.S. Centers for Disease Control and Prevention.

There are not state epidemiologists assigned to respond to natural disasters either.

"Currently, there are no epidemiologists in positions that respond to acute chemical or radiological releases, or specifically tasked with natural disaster response," the report states.

"There also are no programs to enhance occupational safety and health of responders."

The report comes as an additional review of the state's response to the chemical leak earlier this year, where thousands of gallons of MCHM and other chemicals leaked into the Elk River and contaminated drinking water for roughly 300,000 people. Although the state discovered the leak Jan. 9, federal investigators believe it's likely as many as two tanks were leaking before that day.

The West Virginia Bureau for Public Health has some epidemiologists, public health officials who study patterns and causes of disease and injury to people, according to the U.S. Bureau for Labor statistics. The CDC determined none of those epidemiologists were specifically trained to deal with chemical or natural disasters.

Instead, epidemiologists who normally focus on infectious diseases led the epidemiological efforts for the state during the leak and contamination response, the report states.

Those epidemiologists didn't get training in "assessment to chemical exposure" until late March of this year, months after they started leading the health response to the chemical leak. The state has 34 epidemiological positions, but five aren't filled, the report states.

"DHHR may want to consider additional resources such as hiring an epidemiologist who would lead the response for environmental disasters and acute environmental incidents," the report states.

The CDC also recommended more DHHR planning for natural disasters like calamitous winter weather or a derecho and man-made disasters like chemical spills or bridge collapses. West Virginia should team with other states to get the proper training and access to information necessary to better respond to similar disasters in the future, the report suggests.

The DHHR's head of epidemiology said the state is considering the CDC's recommendation, but state health officials believe the CDC's report "confirms" the state is taking steps necessary to continue protecting citizens in the event of a disaster.

"Over the last six months, the Bureau for Public health has been exploring additional training opportunities that will further strengthen the response preparedness of our agency's epidemiologists during times of disaster," said Dr. Loretta Haddy, state epidemiologist.

Multiple state agencies and the water company were consistently criticized for their response to the leak. Gov. Earl Ray Tomblin said it was a personal decision whether families would believe their tap water was safe. Nearly a month after the leak, state public health officer Dr. Letitia Tierney compared a decision to drink tap water and jumping off a bridge with a parachute in arguing people have different definitions of "safe."

The CDC has also faced criticism. A week after the leak, the head of the CDC said it would be a good idea for pregnant women not to drink water that contained any amount of the chemical, but supplied few details as to why the announcement was delayed.

The federal agency was also slow in releasing information about how it determined the "screening level" for how much chemically tainted water could be safely consumed. It eventually announced the 1 part per million screening level was a "short term" guide, only to be used for consumption over a 14-day period. The screening level also only considered exposure through consumption of tainted water, not touching such water with the skin or inhaling contaminated vapor.

Hundreds of people reported rashes, burning skin and other negative health effects after state and federal officials announced water was safe to use once people flushed their plumbing systems. Eventually, the CDC and state health department acknowledged the symptoms could be a direct result of chemically tainted water in homes before and after residents flushed their plumbing.

Since then Tomblin has said he wouldn't change anything about the state's response to the leak. A state "after action review" looking into its response to the leak has not yet been released.

Contact writer Dave Boucher at 304-348-4843 or david.boucher@dailymailwv.com. Follow him at www.Twitter.com/Dave_Boucher1.

Ebola fears rise as clinic is looted http://www.charlestondailymail.com/article/20140817/ARTICLE/140819332 ARTICLE http://www.charlestondailymail.com/article/20140817/ARTICLE/140819332 Sun, 17 Aug 2014 13:56:53 -0400


The Associated Press

MONROVIA, Liberia - Liberian officials fear Ebola could soon spread through the capital's largest slum after residents raided a quarantine center for suspected patients and took items including bloody sheets and mattresses.

The violence in the West Point slum occurred late Saturday and was led by residents angry that patients were brought to the holding center from other parts of Monrovia, Tolbert Nyenswah, assistant health minister, said Sunday.

Up to 30 patients were staying at the center and many of them fled at the time of the raid, said Nyenswah. Once they are located they will be transferred to the Ebola center at Monrovia's largest hospital, he said.

West Point residents went on a "looting spree," stealing items from the clinic that were likely infected, said a senior police official, who insisted on anonymity because he was not authorized to brief the press. The residents took medical equipment and mattresses and sheets that had bloodstains, he said. Ebola is spread through bodily fluids including blood, vomit, feces and sweat.

"All between the houses you could see people fleeing with items looted from the patients," the official said, adding that he now feared "the whole of West Point will be infected."

Some of the looted items were visibly stained with blood, vomit and excrement, said Richard Kieh, who lives in the area.

The incident creates a new challenge for Liberian health officials who were already struggling to contain the outbreak.

Liberian police restored order to the West Point neighborhood Sunday. Sitting on land between the Montserrado River and the Atlantic Ocean, West Point is home to at least 50,000 people, according to a 2012 survey.

Distrust of government runs high in West Point, with rumors regularly circulating that the government plans to clear the slum out entirely.

Though there had been talk of putting West Point under quarantine should Ebola break out there, assistant health minister Nyenswah said Sunday no such step has been taken. "West Point is not yet quarantined as being reported," he said.

Ebola has killed 1,145 people in West Africa, including 413 in Liberia, according to the World Health Organization.

Other countries across Africa are grappling to prevent Ebola's spread with travel restrictions, suspensions of airline flights, public health messages and quarantines.

Nigeria appears to be making progress in containing the disease. The country has 12 confirmed cases of Ebola, all of which stem from direct contact with the Liberian-American man who flew to Nigeria late last month while ill. He infected several health workers before dying.

Since then three others have died in Nigeria from Ebola, according to figures released over the weekend.

One Nigerian doctor has survived the disease and was sent home Saturday night and five others confirmed with Ebola have almost fully recovered, said the Health Minister Onyebuchi Chukwu in a statement Saturday night.

The most important part of containing the disease is to track all those who had contact with Ebola patients and to closely monitor them in order to quarantine if they show any symptoms. Nigeria had 242 people under surveillance but now 61 have been cleared and released, after completing the 21-day period without showing any signs of Ebola, said the health ministry.

In East Africa, Kenya will bar passengers traveling from the three West African countries badly hit by the Ebola outbreak. The suspension is effective midnight Tuesday for all ports of entry for people traveling from or through Sierra Leone, Guinea and Liberia, said Kenya's Health Ministry. Nigeria was not included in the ban, which also allows entry to health professionals and Kenyans returning from those countries.

Following the government's announcement Saturday, Kenya Airways said it would suspend flights to Liberia and Sierra Leone. Kenya Airways, a major transport provider in Africa flies more than 70 flights a week to West Africa.

Several airlines have already suspended flights to Sierra Leone, Guinea and Liberia, including British Airways, Emirates Airlines, Arik Air and ASKY Airlines.

Officials in Cameroon, which borders Nigeria, announced Friday it would suspend all flights from all four Ebola-affected countries. Korean Air announced on Thursday it would temporarily halt its service to Kenya despite the fact there are no cases of Ebola in the country.

Wheelchair scams expose Medicare's weak defenses against fraud http://www.charlestondailymail.com/article/20140817/ARTICLE/140819334 ARTICLE http://www.charlestondailymail.com/article/20140817/ARTICLE/140819334 Sun, 17 Aug 2014 13:52:29 -0400

By David A. Fahrenthold


LOS ANGELES - In the little office where they ran the scam, a cellphone would ring on Sonia Bonilla's desk. That was the sound of good news: Somebody had found them a patient.

When Bonilla answered the phone, one of the scam's professional "patient recruiters" would read off the personal data of a senior citizen. Name. Date of birth. Medicare ID number. Bonilla would hang up and call Medicare, the enormous federal health-insurance program for those 65 and older.

She asked a single question: Had the government ever bought this patient a power wheelchair?

No? Then the scam was off and running.

"If they did not have one, they would be taken to the doctor, so the doctor could prescribe a chair for them," Bonilla recalled. On a log sheet, Bonilla would make a note that the recruiter was owed an $800 finder's fee. "They were paid for each chair."

This summer, in a Los Angeles courtroom, Bonilla described the workings of a peculiar fraud scheme that - starting in the mid-1990s - became one of the great success stories in American crime.

The sucker in this scheme was the U.S. government. That wasn't the peculiar part.

The tool of the crime was the motorized wheelchair.

The wheelchair scam was designed to exploit blind spots in Medicare, which often pays insurance claims without checking them first. Criminals disguised themselves as medical-supply companies. They ginned up bogus bills - saying they'd provided expensive wheelchairs to Medicare's patients, and now needed Medicare to pay them back.

A lot of the time, Medicare was fooled. The government paid.

Since 1999, Medicare has spent $8.2 billion to procure power wheelchairs and "scooters" for 2.7 million people. Today, the government cannot even guess at how much of that money was paid to scammers.

Now, the golden age of the wheelchair scam is probably over.

But, while it lasted, the scam illuminated a critical failure point in the federal bureaucracy: Medicare's weak defenses against fraud. The government knew how the wheelchair scheme worked in 1998. But it wasn't until 15 years later that officials finally did enough to significantly curb the practice.

"If you play it right, you can make a lot of money quickly, stealing from Medicare," said James Quiggle, of the nonprofit Coalition Against Insurance Fraud, recounting the lesson of the past decade and a half. "You can walk into the United States, with limited English skills, no knowledge of medicine, and - if you hook up with the right people, that know how to play the system like a Stradivarius - you can become an overnight millionaire."

- - -

In the courtroom in Los Angeles, 42-year-old Olufunke Fadojutimi was on trial. Prosecutors alleged that she'd run a wheelchair-scam operation out of an office park suite in suburban Carson, Calif.

As these scams go, this one was medium-size. It billed Medicare for about 1,000 power wheelchairs.

"I said I didn't need it," witness Heriberto Cortez, 73, testified. Cortez was recalling the day when a stranger - allegedly one of Fadojutimi's patient recruiters - came to his house and offered him a wheelchair. He said no. She didn't listen.

"She insisted," Cortez said. "She said that they were giving the chairs away."

Later in the trial, 71-year-old Rodolfo Fernandez testified that a woman showed up at his house in Los Angeles. The woman asked whether he was on Medicare. He was.

The next day, she came back with a van. Other seniors were already inside.

"They took us to a clinic. They did an exam on us," Fernandez recalled, speaking through a Spanish interpreter.

Authorities said the doctor at this clinic was in on the scam, too. He was paid to find the same problems, every time. The patient was too weak to use a cane. Or a walker. Or even a non-motorized wheelchair. Only a motorized wheelchair would do. Instead of making lame men walk, the doctor's job was to make walking men lame - at least on paper.

In his testimony, Fernandez noted that the clinic was in a second-floor walk-up.

"I had to climb the stairs," Fernandez said, in order for the doctor to proclaim him unfit to climb stairs.

After seeing the doctor, prosecutors said, both Cortez and Fernandez got power wheelchairs from Fadojutimi's company. The company then sent Medicare the bills. Medicare paid.

Today, Cortez's wheelchair sits in his garage, still wrapped in plastic from the factory. Fernandez's wheelchair is occupied by an enormous stuffed animal wearing a Los Angeles Lakers hat.

"I put my little teddy bear on top of it," Fernandez said, as jurors smiled at a photo of the bear in the chair.

- - -

Fraud in Medicare has been a top concern in Washington for decades, in part because the program's mistakes are so expensive. In fiscal 2013, for instance, Medicare paid out almost $50 billion in "improper payments." These were bills that, upon further reflection, contained mistakes and should not have been paid.

No one knows how much of that money was actually lost to fraud and how much of it was caused by innocent errors.

The power-wheelchair scam provided a painful and expensive example of why Medicare frauds work so often. The fault lay partly with Congress, which designed this system to be fast and generous. And it lay partly with Medicare bureaucrats, who were slow to recognize the threat and use the powers they had to stop it. As a result, scammers took advantage of a system that was overwhelmed by its own claims and lacked the manpower and money to check most of those claims before it paid.

The scheme first appeared in the mid-1990s in Miami - a city whose mix of elderly people and professional scammers have always made it an incubator of Medicare fraud.

"The patients would be walking," said one former Justice Department official, recalling investigations from that time. "And they'd have the wheelchair, a $2,500 wheelchair, sitting in the corner with stacks of 1/8stuff3/8 on it. And 1/8investigators3/8 would say, 'Why do you have this?' And they would say, 'They told me I could have this, so I took it.' "


Fraudsters, they were learning, had invented a twist on an old trick: the Medicare equipment scam.

The original equipment scam had sprung up in the 1970s, when Medicare was young and criminals were still learning how to steal its money. Doctors, for example, could bill Medicare for exams they didn't do. Hospitals could bill for tests that patients didn't need.

The equipment scam was the poor man's way in, an entry-level fraud that didn't require a medical degree or a hospital.

Instead, the crooks only had to set up a "medical equipment" company and get access to the Medicare system. Then, they needed to learn a simple scheme, in which the fraudster would run the normal order of medical decision-making in reverse.

A legitimate medical-supply company must wait for a patient to see a doctor, then come looking for somebody to fill a prescription. But a fraudster starts with a prescription he wants to fill.

Then he goes looking for a patient and a doctor to foist it on.

By the 1990s, fraudsters had perfected parts of this equipment scam. To find the patients, for instance, they had learned to use professional recruiters, called "marketers" or "cappers."

These recruiters induced seniors to hand over their Medicare ID numbers. Sometimes, they just paid the patients a bribe. Other times, they talked them into giving the number up free. The government is offering free wheelchairs, but only for a limited time. If you don't act now . . .

Most fraudsters had also learned to buy off a doctor or two, paying a set price for each bogus prescription. But some had also perfected a cheaper method.

They corrupted dead doctors instead.

"The Russian mob up in Brooklyn has been doing this for years. . . . They scour the obits. They find out when Doctor Morris has died. They immediately write to Medicare and they say, 'Hi, I'm Doctor Morris, and I'm changing my address,' " said Lewis Morris, a former top official at the Department of Health and Human Services' office of the inspector general.

If it works, the dead doctor's mail is delivered to the live crook. Including paperwork with the doctor's Medicare ID number. "So the new Doctor Morris, Sammy Scumbag, starts writing scrip in the name of Doctor Morris," Morris said. Recent reforms have lessened this problem.

The payoff of this whole scheme came when a scammer sent Medicare a bill. The bill would say that the bought-off doctor had prescribed some piece of equipment to the bought-off (or hoodwinked) patient.

The fraudster would say that he had supplied that thing. Now, he wanted Medicare to pay its share - usually, 80 percent of the price tag.

But what was the best kind of equipment to use?

This was the piece of the scam that wasn't perfect yet. Through the '80s and '90s, scammers had tried orthopedic braces. Oxygen tanks. Electric nerve-stimulation kits. Prosthetic limbs. Everything had a downside. The items that didn't arouse suspicions (like diabetes test strips) were often too cheap to make much money from. And the real big-ticket items (like limbs) attracted too much attention if you billed them by the hundreds.

Then they discovered the power wheelchair.

And it was perfect.

"Let me put it to you this way: An $840 power wheelchair, Medicare pays close to $5,000 for. So there's a huge profit margin there. Huge," said one California man who participated in a recent fraud scheme involving wheelchairs.

Medicare used to set its payments for most power wheelchairs based on manufacturers' suggested retail prices. It did not lower those prices significantly for years, even when it was obvious that wholesale prices were far, far lower. So for scammers, each wheelchair brought a hefty profit.

And the chairs were also good for evading authorities' attention. A wheelchair was supposed to treat a condition - trouble with mobility - that was a heck of a lot easier to fake than a missing arm.

"You don't have to do s---, and make a s---load of money," the California fraudster said, summing up the scam's appeal in a single profane sentence. He spoke on the condition of anonymity because his court case is pending. "I would say there's almost no hassle at all."

In the courtroom in Los Angeles, another member of Fadojutimi's operation - office manager Maritza Velasquez - was testifying. She said her husband drove the delivery truck, delivering real wheelchairs to the scam's bogus patients.

She said he would take pictures at each stop - the chair and the person together - to keep in their files as proof of receipt. Legally, this was not a great idea. Mainly because many of the photos showed recipients standing up. Right next to the chair that Medicare had bought them because they couldn't stand up.

"There was a guy who was actually in work clothes, like construction clothes, with cement kneepads," Velasquez said, recalling one photo. He been out doing hard manual labor.

"So that was . . ." - Velasquez paused on the stand, looking for the right word - "different."


In the early 2000s, the wheelchair scam spread from Miami to Houston. There, it exploded. In 2001, for example, Medicare had paid for only 3,000 power wheelchairs in the county that includes Houston.

In 2002, it paid for 31,000.

"I was told that I could make a quick 200 bucks. And basically I went up there and I made like $800" on the first day, said Lorine Hawthorne, of Houston. She had been recruited as a marketer for a Houston scam in those go-go days, finding elderly people and delivering them to a handpicked clinic.

"The most I ever made in one day, probably, was like $20,000," she said. "That's a lot of money for one day." Hawthorne pleaded guilty to one count of fraud in 2005.

From Houston, the scam spread: to Louisiana, to Arkansas, to California. Nationwide, Medicare saw a sharp spike in wheelchair claims. Before the fraud had taken off, the chairs were rare: One study estimated that in 1994, only 1 in 9,000 beneficiaries got a new wheelchair.

By 2000, it was 1 in 479.

By 2001, it was 1 in 362.

By 2002, it was 1 in 242.

And beyond the simple increase in wheelchair claims, there were other signs that these claims might be bogus. Before the scam took off, for example, power-wheelchair prescriptions were usually written for patients with serious and advanced illnesses such as multiple sclerosis or Parkinson's disease.

But as the scam grew, that changed.

"Many more of the diagnoses were things where you sort of go, 'What?' " said James Goodwin, a University of Texas medical school professor. Looking in Medicare's own data, he saw a rise in power wheelchairs prescribed for more common conditions such as arthritis and back pain. "It becomes a very, very strong picture, strongly suggesting there's a lot of abuse going on there."

As early as 1998, Medicare had recognized the existence of the wheelchair scam with a national "fraud alert." But, to front-line fraud investigators, it was obvious that the crooks were still getting their claims paid.


"An agent in Little Rock witnessed a scooter race in one of the neighborhoods. Old people. One of them had attached an ice chest to it," said Mike Fields, a fraud investigator at the Department of Health and Human Services (A "scooter" is a less expensive kind of powered chair, also heavily used in frauds.) "It just gets your blood up, you know. Knowing how much we'd paid for them."

But for Medicare officials at headquarters, seeing the problem and stopping it were two different things.

That's because Medicare is an enormous system, doing one of the most difficult jobs in the federal government. It receives about 4.9 million claims per day, each of them reflecting the nuances of a particular patient's condition and particular doctor's treatment decisions.

By law, Medicare must pay most of those claims within 30 days. In that short window, it is supposed to filter out the frauds, finding bills where the diagnosis or the prescription seems bogus.

The way the system copes is with a procedure called "pay and chase." Only a small fraction of claims - 3 percent or less - are reviewed by a live person before they are paid. The rest are reviewed only after the money is spent. If at all.

The whole thing is set up as a kind of honor system, built at the heart of a system so rich that it made it easy for people to be dishonorable.

"The thing had been set up to pay the claims of Dr. Marcus Welby, M.D., and it was very good at doing that," said Ted Doolittle, a former top Medicare fraud-control expert. Marcus Welby, a kindly and honest doctor, was the protagonist of a 1970s TV show.

The wheelchair scam, Doolittle said, hit the system in "a big, undefended underbelly."

Starting in 2003, Medicare officials started trying to stop the wheelchair scams by changing their rules. That was the beginning of a long - and one-sided - game of cat and mouse.

The officials always thought they'd done enough. The scammers were always a step ahead.

In 2004, for instance, Medicare started to require that any doctor who prescribed a power wheelchair actually had to see the patient, in person. For the scammers, that was a new obstacle. But not a big one. They just had their corrupt doctors see patients in person.

Then, in 2007, the government began a legal crackdown. It began a "strike force" of prosecutors, who targeted equipment frauds in problem cities.

They nailed some of the most egregious wheelchair scammers. But the courts could only handle a relatively small number of scammers, so prosecutors tended to choose the most obvious fraud operations. The smarter, steadier operations didn't stand out, and survived.

"Not only greedy, but stupid. Those are the ones we catch," said Malcolm Sparrow, a professor at Harvard's John F. Kennedy School of Government who has studied Medicare fraud. "We're mostly getting people who didn't finish high school, who've stolen more than $10 million in three months. Those are the ones we get. And you know the clever people are just invisible."

So despite these efforts, the scam churned on. In 2012, about 219,000 people got a wheelchair from Medicare. That was 1 in 235 beneficiaries: After a decade in which Medicare tried to make these chairs harder to get, people were getting them at about the same rate as in 2002.


So why didn't Medicare do even more to stop the wheelchair scam?

The answer seems to be that - in the huge universe of Medicare's money - this big scam was still not that big. Last year, for instance, power wheelchairs accounted for just 2 percent of Medicare's equipment spending. Which accounted for just 3 percent of Medicare's $248 billion outpatient spending (called "part B").

"Even though power wheelchairs was sort of the big gorilla in the room of 1/8equipment fraud3/8, it was still a tiny little gorilla, in comparison to the rest of Medicare," said John Warren, who worked in Medicare's anti-fraud office between 2005 and 2007.

Also, he said, Medicare was always reluctant to clamp down too much on wheelchairs, for fear that it would backlog the system and keep legitimate wheelchair patients from getting their chairs. "Looking back, I think we did pretty good," Warren said.

In the Los Angeles trial, prosecutors said that Fadojutimi's operation ran for six years. It adapted to the requirement that doctors see patients in person. It stayed below the radar well enough to avoid the strike-force crackdown.

In fact, it shut down on its own after Medicare started giving its claims special scrutiny. By the time the scam wrapped up in 2010, prosecutors said, it had taken in about $4.3 million from Medicare.

Later, however, fraud investigators stumbled upon the operation. And when they started looking, the scam unraveled quickly.

For one thing, Velasquez had saved pages from the "marketer log," which the scam used to track which recruiters had brought in which patients. That was, in effect, a running diary of a criminal conspiracy. Government's Exhibit 25.

"When the government is presenting its case, you might be inclined to say, 'Wow! She's guilty,' " Fadojutimi's defense attorney, Femi Banjo, told the jury during his opening statement. His only play was to make the best of a bad situation, urging them to keep an open mind.

Banjo also told the jury that he objected to something a prosecutor had said: that Fadojutimi's wheelchair operation had "stolen" money from the government.

"This is not about stealing," Banjo said, trying to draw a moral distinction. "This is fraud."

After a five-day trial, jurors found Fadojutimi guilty on all seven counts of health-care fraud, plus one count of conspiracy and one count of money laundering. She is awaiting her sentence.

- - -

In the past few years, at last, the government says it has outsmarted the wheelchair scammers.

For one thing, Medicare began using competitive-bidding processes to lower what it paid for wheelchairs. The total spending on wheelchairs and scooters - which had reached $964 million in 2003 - fell to $190 million last year.

It also required wheelchairs to be given out on a rent-to-own basis, instead of paid for upfront. That gave more time to check whether the claim was bogus. And in 2012, Medicare also made a crucial change in the way it handled wheelchair claims. Now, in 19 states, the government reviews all wheelchair bills before it pays them.

Finally, last year the feds went after the Scooter Store.

That company had become famous for its commercials telling seniors, "Your power chair will be paid in full." In 2007, the store had already been fined for fraudulent practices, which included billing Medicare for power wheelchairs that patients did not want or need.

Last year, as part of a new investigation, federal agents with a search warrant raided the Scooter Store headquarters in New Braunfels, Texas. No new criminal charges have been brought. But Medicare was still concerned enough to cut off funding to the Scooter Store.

It was a death sentence. The business, heavily dependent on federal payments, shut down last fall.

Last year, about 124,000 people got power wheelchairs from Medicare. That was the lowest total since 2001, equivalent to one for every 400 beneficiaries.


That's the good news. The bad news: When officials go back to try to figure out what the scammers stole, they get mired in an unholy bureaucratic mess.

When officials review old wheelchair bills, they discover that at least 80 percent of them were "improper": They contain major errors and shouldn't have been paid as is. Perhaps the patient's diagnosis didn't actually qualify for a power wheelchair. Perhaps the paperwork was incomplete.

How many of those bills were sent in by fraudsters trying to squeeze through the system's blind spots?

Medicare can't say.

"You'd have to talk to the patient. You'd have to talk to the providers" and ask whether the wheelchair was really needed, said Shantanu Agarwal, a doctor who is Medicare's top fraud fighter. "And then, at the end of it, you could make a reasonable, fact-based, experienced-based determination about whether this is probably fraud." Agarwal said. Medicare doesn't have the time or money to do that for power wheelchairs now.


Today, even while the wheelchair scam is in decline, that same "pay and chase" system is allowing other variants of the Medicare equipment scam to thrive.

They aren't perfect. But they work. In Brooklyn, for instance, the next big thing is shoe inserts. Scammers bill Medicare for a $500 custom-made orthotic, according to investigators. They give the patient a $30 Dr. Scholl's.

In Puerto Rico, the next big thing seems to be arms and legs.

In one case there, two dozen companies billed Medicare for $5.3 million in prosthetic legs inside of a year. In many cases, their "patients" had no record of amputations in their medical history. Many of them didn't even live in Puerto Rico. But Medicare paid for the legs.

Williams among famous comedians who suffered mental illness http://www.charlestondailymail.com/article/20140814/ARTICLE/140819631 ARTICLE http://www.charlestondailymail.com/article/20140814/ARTICLE/140819631 Thu, 14 Aug 2014 00:01:00 -0400



Bloomberg News

NEW YORK - When you think of Ellen DeGeneres, Conan O'Brien, David Letterman and Robin Williams, the first word that comes to mind isn't depression.

But the four comedians have all struggled with the disease suffered by an estimated 350 million people worldwide, according to their own comments or those close to them. Williams, a comedian known for his manic energy, committed suicide Aug. 11 at age 63. He had suffered a period of severe depression, his publicist Mara Buxbaum said in a statement.

"Not everybody who has a depression disorder gets recognized," Paul Summergrad, the president of the American Psychiatric Association, said in a telephone interview. "It affects rich people, it affects poor people, it affects people across the spectrum."

Symptoms vary and can include feelings of hopelessness, extreme anxiety, appetite changes, insomnia or excessive sleeping and suicide risk, according to the National Institute of Mental Health in Washington. Depression often occurs in concert with substance abuse, according to the institute.

Treatment can include a combination of prescription drugs and talk therapy, said Jeff Borenstein, president of the Brain and Behavior Research Foundation. For a number of people, multiple drugs must be tried, or a combination of drugs, before finding a treatment that works, he said.

"It is a physical condition that affects the brain," Borenstein said. "The symptoms include feeling depressed, obviously. But it also can include difficulty functioning at work, home or at school, inability to enjoy oneself, and low level of energy, difficulty concentrating and, most importantly, thoughts of wanting to kill oneself."

Drugs used to treat the disease include Eli Lilly's Prozac, Pfizer's Zoloft and GlaxoSmithKline's Paxil. Side effects can include nausea, dizziness, insomnia and weight gain or loss. They belong to a class of drugs called selective serotonin reuptake inhibitors, which build up levels of a chemical in the brain, serotonin, the lack of which has been associated with depression.

It's a class of drugs that's been controversial in the past because of a link to suicidal thoughts. They now carry warning labels that advise close monitoring when patients first start on the medication.

Recently, investigators at Johns Hopkins University in Baltimore published research on a gene tied to negative thoughts and impulses. It may lead to a blood test predicting suicide risk, they said. The research, published in the Journal of Psychiatry in July, adds to recent genetic discoveries in psychiatry that promise to advance treatment and diagnostics in the field.

Suicide is the 10th-leading cause of death in the United States, according to the Centers for Disease Control and Prevention. While there are known risk factors, such as mental illness, drug abuse or distressful life events, there is no consistent way to predict suicide, researchers said.

The greatest risk comes when people who are severely depressed don't get treated, or when treatment is inadequate or sporadic, according to Summergrad. Those also dealing with substance abuse or other illnesses need to have that care coordinate with their depression treatment, he said.

"When a treatment is started, people need to be monitored very, very carefully," he said.

Just half of Americans diagnosed with major depression are treated and only 20 percent are cared for according to practice guidelines, according to the National Institutes of Health.

David Letterman is expected to address Robin Williams' passing in his late night show on Aug. 18, according to a spokesman. In interview with "CBS This Morning" in 2012, Letterman said he avoided treatment initially because he feared the drugs could make some symptoms worse.

"I thought it would make me loopy or make me hallucinate or make me drowsy," Letterman said in 2012. "It's different than, 'Oh I don't feel good today.' It's different than feeling sad, it's different than feeling blue."

O'Brien's depression deepened after losing his job as the host of NBC Universal's "The Tonight Show" in 2010, he told Rolling Stone magazine. "I felt like I'd just been in a car accident," he was quoted as saying.

DeGeneres said her depression settled in during a lull in her career in 1997 after she first came out as a lesbian, facing a slowdown in advertisers on her show and tabloid attention, according to a report in the Guardian.

Williams had film roles touching on mental illness. As the title character in Patch Adams, he portrayed a man who committed himself to a mental institution and became a doctor. He also played a therapist in Good Will Hunting.

Being highly successful is no protection against depression, said Scott Krakower, a psychiatrist at Zucker Hillside Hospital in Glen Oaks, New York, in a telephone interview. In fact, it may be a contributor, he said.

"They do have a really nice life," Krakower said. "But there's always a lot of pressure on them being in the spotlight constantly, and sometimes you need almost an escape from that."

Actors, in particular, may feel the extreme level of anxiety that is symptomatic of the disease, according to Krakower. "When they go on the stage they want to be perfect," he said. "There's a lot of pressure on them and they put a lot of pressure on themselves."

Williams was released from a rehab center last month, according to published reports. He has commented in the past on his struggles with both alcoholism and drug addiction, a troubling situation that can lead to difficulties in treating depression, according to Summergrad.

Substance abuse "can change the way depression appears," making it "harder to treat," Summergrad said. "In some cases you need to treat the mental health illness, the addictions and general health issues all at the same time."

Charleston neurologist accused of unethical behavior http://www.charlestondailymail.com/article/20140813/DM01/140819696 DM01 http://www.charlestondailymail.com/article/20140813/DM01/140819696 Wed, 13 Aug 2014 09:12:27 -0400 By Dave Boucher A Charleston neurologist with a history of problems faces new allegations of unethical behavior from the West Virginia Board of Medicine.

Dr. Iraj Derakhshan is accused of yelling at a patient and acquiring her records after he was no longer her doctor, according to a complaint and notice of hearing issued in July by the board.

The board believes the actions make Derakhshan unqualified to continue practicing in the state, according to the complaint.

Tuesday afternoon from his office in Charleston, Derakhshan denied any wrongdoing but said he was sorry for what happened. Although he said he was familiar with the accusations, he said he hadn't read the complaint.

"There was a clerical error, that's what it was," Derakhshan said.

He said he thinks he had an office manager at the time who "exceeded authority" or didn't pay enough attention.

The complaint says in March 2012 Derakhshan yelled at a female patient, named in the complaint only as "Patient A." Derakhshan also threatened to no longer keep her as a patient "if she cried or continued to cry during her appointment."

Derakhshan released the person as a patient sometime around Jan. 18, 2012. The complaint alleges the doctor obtained her medical records without her permission and altered the patient's release papers to remove the date of execution "and other pertinent limitations on its use."

Derakhshan allegedly altered the release to obtain her medical records from other medical providers after she left his care.

The complaint states Derakhshan knowingly broke the law by obtaining the records of a former patient and engaging in dishonorable or unethical behavior.

Derakhshan was adamant he did nothing wrong.

"I'm never combative with a patient, it's not in me," Derakhshan said.

He referred further comment to his attorney, Nick Casey. Casey, a Charleston attorney and the Democratic nominee for the 2nd Congressional District, did not respond to requests for comment.

Derakhshan did want to talk about narcotic medicines. Although he was not asked about the topic, Derakshan said he thought laws regulating plants like poppy - a plant used to make the drugs opium and heroin - are "dumb."

"I believe humanity would not have survived without opium," Derakhshan said.

Derakhshan prescribed more hydrocodone-acetaminophen, a powerful and potentially addictive pain medication, for Medicare Part D patients than any other doctor in West Virginia in 2010, according to an analysis from investigative journalism outlet ProPublica.

He wrote 4,032 prescriptions for the drug that year, prescribing the medicine for 94 percent of his 609 Medicare patients.

"Pain is the No. 1 complaint that takes a patient to a doctor, so it makes sense to write anti-pain medication. I'm a neurologist. I see a lot of headache patients," Derakhshan told the Daily Mail at the time.

West Virginia has some of the most painkiller prescriptions and fatal overdoses per person in the nation, according to the U.S. Centers for Disease Control and Prevention and the organization Trust for America's Health.

Derakhshan has offices in Beckley and Charleston and is licensed to practice medicine in West Virginia, Ohio, Washington, D.C. and California. He has reprimands or complaints on his record in each state, some of which stem from the same incident.

In 2002 at least two patients accused Derakhshan of advising them to take medication "in an unsafe manner." Derakhshan told the Daily Mail in 2013 he advised the patients to cut in half pills of the powerful pain medication Oxycontin.

A 2005 consent order states Derakhshan agreed to stop advising patients to cut their pills, agreed to no longer see more than 25 patients in a 24-hour time span and took a course in "controlled substances management" and record keeping.

Derakhshan was reprimanded by and reached similar consent agreements with the boards of medicine in Ohio, Washington, D.C. and California relating to the West Virginia allegations, according to websites for each state's board.

West Virginia again reprimanded Derakhshan in 2010 when he didn't note the Ohio or California reprimands on his application to renew his license. The doctor also agreed to pay a $2,000 fine.

Derakhshan is set to appear Oct. 9 before one of the board's hearing examiners. If the examiner determines the complaint is valid, the examiner refers the case to the board.

Contact writer Dave Boucher at 304-348-4843 or david.boucher@dailymailwv.com. Follow him at www.Twitter.com/Dave_Boucher1.

Report: Doctor wrote bad prescriptions, forced co-worker to 'motor boat' breasts http://www.charlestondailymail.com/article/20140812/DM01/140819739 DM01 http://www.charlestondailymail.com/article/20140812/DM01/140819739 Tue, 12 Aug 2014 20:43:38 -0400 By Dave Boucher

A Martinsburg doctor unethically doled out powerful prescription drugs and repeatedly exposed herself at the office - including forcing a female co-worker to "motor boat" her surgically enlarged breasts - according to allegations in a report from the state Board of Medicine.

A 31-page complaint issued by the board in July accuses Dr. Tressie Montene Duffy of breaking a litany of medical and ethics laws and standards. The board argues Duffy is unqualified to continue practicing medicine.

Duffy, 44, is the CEO and co-owner of West Virginia Weight and Wellness Inc. in Martinsburg. The clinic's website says its doctors focus on weight management, but they also offer primary and urgent care needs and a "Chronic Pain and Opioid Dependency Treatment Program."

Duffy did not return a phone message left Tuesday at the clinic.

Lisa Lilly, Duffy's attorney, said Duffy was familiar with the complaint and "denies any and all wrongdoing." Lilly stressed this is "not the first time" the board has tried to revoke Duffy's license, but declined to elaborate further.

Complaints from at least three different people provide extensive details about Duffy's alleged misconduct dating back to 2010. Former employees identified as "Complainant M" and "Complainant R" and other anonymous sources cited in the report say Duffy's sordid behavior led to many problems.

More than a dozen patients received powerful pain and anxiety medications like Oxycodone, Opana, Valium and Xanax with prescriptions from Duffy filled while she was out of the state on vacation or at a conference, according to the complaint.

Duffy would sign pads of blank prescriptions and tell her office staff - some of whom aren't doctors - to fill them out for patients in her absence, the complaint said.

Duffy - who only accepted direct payments as opposed to billing insurance - said patients had to pay for a doctor visit even when she wasn't in the office if they wanted their medication, the complaint said.

She also allegedly distributed many doses of Suboxone and other controlled substances during years when she was not allowed to do so from her office.

Similar to methadone, Suboxone is a drug that can be used to help wean addicts off of medications but is also easily abused.

Duffy purchased more than 1,000 doses of Suboxone in 2010 and distributed it through 2013, even though she wasn't registered to give out such medications from her office until December of 2013, according to the complaint.

Duffy also reportedly self-prescribed Suboxone and testosterone, although she's never given the board medical records of self-treatment or self-prescribing. In 2013 a board investigator found medications, some surrendered by patients, in a safe at the clinic and labeled for "office use," according to the complaint.

Complainant R also says Duffy, "engaged in a scheme with a drug salesperson to inflate the salesperson's sales in exchange for consideration from the salesperson, including paid parties and office staff."

Her medical license also lapsed from July 1 to Sept. 18, 2012.

Other anonymous complaints accused Duffy of similar charges, in addition to sexual behavior after she underwent breast augmentation surgery. Duffy repeatedly exposed her "post-augmentation breasts" to staff and patients at the clinic, according to the complaint. She also reportedly rubbed them against staff and allowed or permitted drug salespeople to feel her breasts while staff or patients were present.

In early 2012 Duffy allegedly placed her hands on the head of Complainant R.

"Dr. Duffy pulled Complainant R's head between Dr. Duffy's breasts and asked Complainant R to 'motor boat' her," the complaint states.

"Motor boating" is slang for a person moving his or her face back and forth between another person's breasts and making a sound like a boat engine.

"Later that same day, Dr. Duffy grabbed Complainant R by the back of her head and kissed her on the lips," the complaint continues.

Complainant R told Duffy the actions were unwelcome and asked her to stop. Duffy said Complainant R was being a "titty baby," the complaint states.

Complainant R cited the alleged sexual abuse - and Duffy throwing a chair at her - as reasons she quit her job.

Duffy kicked a chair at an employee, verbally abused people and was prone to "temper tantrums," according to the complaint.

The board investigation stems back to at least 2012 and includes the complaints, an audit, an inspection, at least one hearing and subpoenaed documents. In April the board hired a medical doctor licensed in West Virginia to review information obtained during the investigation.

The doctor found Duffy didn't discuss pain medication options with patients, instead telling them to choose their own pain medications, and that many patients received a "prescription concoction" of pain and anxiety medications "without clear documentation of a specific medical justification." The doctor also found patient records were "scant and contradictory."

"The continued licensing of Dr. Duffy to practice medicine and surgery in the State of West Virginia presents a danger to the public due to her violations of the West Virginia Medical Practice Act," the complaint concludes.

The board has taken action against Duffy in the past related to illegal prescriptions.

In 2009 she was charged with felony prescription fraud and conspiracy to commit prescription fraud, according to a Berkeley County court document posted online by the Martinsburg Journal newspaper.

Duffy worked with a local pharmacist to obtain a prescription under another person's name, the report states. After pleading no contest to a misdemeanor charge of insurance fraud Duffy agreed to pay a $500 court fine and other court costs, according to the Herald-Mail newspaper in Hagerstown, Maryland.

The Board of Medicine determined in February 2010 the crime was "the result of a series of extraordinarily poor decisions on the part of Dr. Duffy in her personal life" but not related to patient treatment.

She was publicly reprimanded and agreed to undergo counseling for 18 months.

Duffy hadn't started receiving treatment by late August 2010, resulting in another complaint by the board. In March 2011 she was fined $1,000, again publicly reprimanded and ordered to complete the 18 months of counseling.

Lilly said there are no criminal charges pending against Duffy "that we're aware of."

Duffy first received a license to practice medicine in 1999 after graduating from the West Virginia University School of Medicine. In May WVU noted on its website Duffy was recently honored by two medical organizations.

"Over her 13 years in practice, Dr. Duffy has continued to demonstrate the passion, dedication, and enthusiasm for patient care necessary to be considered a Top Physician in her field," WVU's website states.

Duffy is required to attend a hearing in November if she wants to keep her license. The hearing, scheduled to start Nov. 17, is before a doctor hired by the board as a hearing examiner.

The full board has the right to accept, reject or modify the hearing examiner's findings.

Contact writer Dave Boucher at 304-348-4843 or david.boucher@dailymailwv.com. Follow him at wwww.Twitter.com/Dave_Boucher1.

Colgate's unseen FDA pages flag consumer concerns http://www.charlestondailymail.com/article/20140812/ARTICLE/140819856 ARTICLE http://www.charlestondailymail.com/article/20140812/ARTICLE/140819856 Tue, 12 Aug 2014 00:01:00 -0400


Bloomberg News

NEW YORK - The chemical triclosan has been linked to cancer-cell growth and disrupted development in animals. Regulators are reviewing whether it's safe to put in soap, cutting boards and toys. Consumer companies are phasing it out. Minnesota voted in May to ban it in many products.

At the same time, millions of Americans are putting it in their mouths every day, by way of a top-selling toothpaste that uses the antibacterial chemical to head off gum disease - Colgate-Palmolive Co.'s Total.

Total is safe, Colgate says, citing the rigorous Food and Drug Administration process that led to the toothpaste's 1997 approval as an over-the-counter drug. A closer look at that application process, however, reveals that the some of the scientific findings that Colgate put forward to establish triclosan's safety in toothpaste weren't black and white - and weren't, until this year, available to the public.

Colgate's Total application included 35 pages summarizing toxicology studies on triclosan, which the FDA withheld from view. The agency released the pages earlier this year in response to a lawsuit over a Freedom of Information Act request. Later, following inquiries from Bloomberg News, the FDA put the pages on its website.

The pages show how even with one of the U.S.'s most stringent regulatory processes - FDA approval of a new drug - the government relies on company-backed science to show products are safe and effective. The recently released pages, taken alongside new research on triclosan, raise questions about whether the agency did appropriate due diligence in approving Total 17 years ago, and whether its approval should stand in light of new research, said three scientists who reviewed the pages at Bloomberg News's request.

Among the pages were studies showing fetal bone malformations in mice and rats. Colgate said the findings weren't relevant. Viewed through the prism of today's science, such malformations look more like a signal that triclosan is disrupting the endocrine system and throwing off hormonal functioning, according to the three scientists.

Colgate's application materials also show that the FDA asked questions about the thoroughness of cancer studies, which are partly addressed in recently released documents.

Some questions about triclosan's potential impact on people are, by nature, unanswerable. Humans are exposed to dozens of chemicals that may interact in the body, making it almost impossible to link one substance to one disease, said Thomas Zoeller, a biology professor at the University of Massachusetts Amherst, who specializes in how chemicals affect the endocrine system.

"We have created a system where we are testing these chemicals out on the human population. I love the idea they are all safe," Zoeller said. "But when we have studies on animals that suggest otherwise, I think we're taking a huge risk."

New York-based Colgate isn't accused of wrongdoing, and the 35 pages don't prove triclosan is harmful. It was the FDA's decision to keep the documents off of its website, Colgate said.

The FDA followed standard procedure by redacting information that had come from a third party, said spokeswoman Andrea Fischer. Some studies were done in the labs of Ciba- Geigy, the first triclosan maker and a predecessor to its current primary maker, BASF SE, according to the documents. The pages didn't denote which studies were done by an outside party, or who the party was. Fischer declined to identify them.

Colgate said Total's effectiveness and safety are supported by more than 80 clinical studies involving 19,000 people, and that it gave the FDA 98 volumes, numbering hundreds of pages each, in support of Total. Colgate submits annual reports to the FDA reviewing new science and safety findings, said Colgate spokesman Thomas DiPiazza.

"In the nearly 18 years that Colgate Total has been on the market in the U.S., there has been no signal of a safety issue from adverse-event reports," DiPiazza said. Colgate also pointed to an independent 2013 review by the Cochrane Oral Health Group, a network of doctors, researchers and health advocates, which found no evidence of harmful effects associated with using Colgate Total.

Total has an important health benefit because it fights plaque and gingivitis, DiPiazza said. Gingivitis can progress to periodontal disease, which affects almost half of Americans 30 and over, according to a 2012 study by the Centers for Disease Control and Prevention.

The FDA reviews all new safety information on ingredients to determine whether a reassessment is necessary, said Jeff Ventura, a spokesman. The agency is revisiting triclosan in hand soaps though not in Total, said Sandra Kweder, deputy director of the agency's Office of New Drugs. That's because while triclosan hasn't been proven superior to soap and water at washing hands, she said, its benefit as an active ingredient in toothpaste was made clear through its FDA approval process.

Colgate removed triclosan from its Softsoap liquid handsoaps and Palmolive antibacterial dish liquid in 2011, citing changing consumer preferences and superior formulations. It said it has no plans to reformulate Total, which is the only triclosan toothpaste approved for U.S. sale.

This article is based on interviews with Colgate, former and current FDA staff and oral biology experts, transcripts of FDA meetings, as well as on the 35 pages, which the FDA shared in January with the Natural Resources Defense Council, a public-health advocate that sued for them. The scientists who examined the pages included Zoeller, a second university- affiliated endocrine specialist, and an environmental toxicologist affiliated with the Environmental Working Group, a public health advocacy.

Of the more than 84,000 chemicals sold in the U.S., few are attracting more scrutiny than triclosan. Used for decades in handsoaps, it is now part of almost 200 products including rugs and pet-food dispensers. Companies including Johnson & Johnson and Procter & Gamble Co. have vowed to remove it from their lineups. In May, Avon Products Inc. announced its plans to go triclosan-free.

Bioengineers create most realistic fake brain tissue to date http://www.charlestondailymail.com/article/20140811/ARTICLE/140819859 ARTICLE http://www.charlestondailymail.com/article/20140811/ARTICLE/140819859 Mon, 11 Aug 2014 18:59:22 -0400


The Washington Post

Bioengineers have created the most realistic fake brain tissue ever - and it's built like a jelly doughnut. The 3D tissue, described in a paper published Monday in PNAS, is so structurally similar to a real rat brain (a common substitute for human brains in the lab) that it could help scientists answer longstanding questions about brain injuries and disease.

Currently, the best way to study brain tissue is to grow neurons in a petri dish. But while these neurons can only be grown flat, a real brain contains a complicated structure of 3D tissue. Simply giving the neurons room to grow in three dimensions didn't prove successful: While neurons will grow into more complicated structures in the right kind of gel, they don't survive very long or mimic the structure of a real brain.

Led by David Kaplan, the director of the Tissue Engineering Resource Center at Tufts University, researchers developed a new combination of materials to mimic the gray and white matter of the brain. The new model relies on a doughnut-shaped, spongy scaffold made of silk proteins with a collagen-based gel at the center.

The outer scaffold layer, which is filled with rat neurons, acts as the gray matter of the brain. As the neurons grew networks throughout the scaffold, they sent branches out across the gel-filled center to connect with neurons on the other side. And that configuration is about as brain-like as lab-grown tissue can get. The basic structure can be reconfigured, too.

By creating a model with six concentric rings, each populated with different types of neurons, the researchers were able to mimic the six layers of a human brain cortex. "It's a form-fitting, Lego-like system, so we don't have to worry about using glues, and how they might complicate the interfaces between these different compartments," Kaplan said.

In the PNAS paper, Kaplan and his colleagues report that the tissue can already survive for months at a time in the lab. They've used it to study the effect of traumatic brain injury on neuron activity (by dropping weights onto the tissue) immediately, instead of having to dissect a brain.

"This is a very tunable way to construct a brain-like tissue with both the structure and function of a brain," Kaplan said. And the Lego-block nature of the design means that researchers can manipulate it into the kinds of brain structures they want to study. "It could help us answer questions about neurological diseases like Alzheimer's," Kaplan said. And the model could be used to study the effects of the drugs used to treat brain-related ailments, like depression and epilepsy. Often, Kaplan said, the actual mechanisms of these vital drugs are a mystery.

But a good model of the brain could probe into deeper questions, too. "There are questions we have that are more difficult to define, like how we store memories or how the brain feels pain," Kaplan said. "It's a long list of questions to answer, which is why we're so excited."

New app helps people navigate health care system http://www.charlestondailymail.com/article/20140811/DM05/140819920 DM05 http://www.charlestondailymail.com/article/20140811/DM05/140819920 Mon, 11 Aug 2014 00:01:00 -0400 By Josephine Mendez A new app created by UnitedHealthcare will help the public understand how to better navigate the health care system.

The app, Health4Me, was launched in 2012 for UnitedHealthcare members only, but a new guest version recently was released to all iPhone and Android users.

With the guest version, users can find the closest urgent care facility or ER, as well as search for doctors by specialty and location.

Will Shanley, a spokesman for UnitedHealthcare, said the app is convenient and very easy to use.

"The app is great when you are traveling and need to find the closest hospital or urgent care," Shanley said. "It's also helpful if you are new to a city and you need to find a pediatrician or any type of health care provider."

A price transparency feature within the guest version of the app allows people to review the market average prices for more than 520 common medical services.

The app also shows the user a breakdown of what patients can expect throughout the course of a specific treatment.

"It shows you step-by-step and makes it so people can really understand and anticipate what their medical services will entail," Shanley said.

The app is customized to individuals' health plans and takes into account their current deductibles and co-pays. Members also can view the contracted rates for various providers and facilities.

"Say you need a knee MRI," Shanley said. "You can go in and find out how much it would cost one facility versus another facility. It is so very useful because there is a tremendous price variation for medical services - jaw droppingly so. In some cases, it can be many times more expensive in the same market."

With the app, consumers can have more control of their health benefits.

"No one would go and buy a TV without doing a little bit of comparison shopping, but health care has historically been different," Shanley said. "Hopefully with the app we can change that."

Additional features for the members' version include a digital health care ID card, access to a registered nurse 24/7 and access to personal health records.

The app has been downloaded by 900,000 UnitedHealthcare members. According to a survey, 84 percent of the users said they would use it again and 67 percent said the tool gave them confidence to make better health care choices.

"People are very mobile; people are traveling and need this information when and where they are at," Shanley said.

Health4Me can be downloaded as a free app from the Apple iTunes App Store for the iPhone, iPod Touch and iPad. It can also be downloaded for Android phones in the Android marketplace.