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At long last, a favorable ruling  came in December 2016 for former patients at Yakima Regional Medical and Cardiac Center and Toppenish Community Hospital, both in Central Washington, when the hospitals agreed to pay $4.5 million into a settlement fund to compensate those who were wrongly denied financial  assistance from 2007-2014.  Last July, Yakima County Superior Court Judge Susan Hahn ruled that the hospitals had violated Washington’s Consumer Protection Act by failing to notify and screen low-income patients for free or reduced-cost care, as required under another state law, the Charity Care Act which was enacted in 1989. The Charity Care Act applies to all hospitals operating in Washington, and to all patients, insured or uninsured alike, who meet income eligibility requirements: those with incomes at 100% or less of the Federal Poverty Level  (FPL) are eligible for free care, and those whose incomes are at 101-200% of FPL are entitled to discounts.

The legal case on behalf of the patients took slightly over 3 years to be resolved. Due to record-keeping gaps at the hospitals, it is unknown how many former patients are potentially eligible for compensation under the settlement. Deliberate intent by the hospitals to withhold the required notice and eligibility screening was established during the proceedings.

Documents submitted in the lawsuit indicate hospital staff were given incentives and talking points to help them get as much money as possible from low-income patients, and that they were directed not to mention charity care as an option unless a patient knew to specifically ask for it.

In August 2016, the advocacy groups Northwest Health Law Advocates ( NoHLA) and OneAmerica published a report Yakima Regional and Toppenish Hospitals Fail to Provide Sufficient Charity Care   based on their research which revealed the financial hardships suffered by patients who could have been eligible for charity care. Likewise it was found that

Yakima Regional Medical & Cardiac Center

……although Yakima Regional is the most profitable hospital in Central Washington, it provides a significantly lower level of charity care than the regional average.

 

 

 

As a sidebar note since the settlement was announced, the two hospitals are due to soon change hands , for the third time in fourteen years. In 2003, the pair was sold to Health Management Associates and subsequently in 2014 to Tennessee-based Community Health Associates, both for-profit hospital chains. Unlike in other parts of the country, for-profit hospitals are uncommon in Washington. Commitment to upholding the Charity Care Act is one of the conditions for Department of Health approval of a hospital’s conversion from nonprofit-to-for profit.

Across the state, full compliance with the long-standing financial assistance rules can remain still elusive.  In June 2016 a class-action lawsuit against Northwest Hospital in Seattle for Charity Care violations was filed. State legislators seeking a remedy filed HB 1359  and companion SB 5231 early this year, to require that a written notice of the availability of Charity Care be included on all hospital bills. The House bill made it through the first cut-off date, and is moving forward in the legislative process. I will be posting on new developments, including provisions in the bill to ensure that notices are given in the language that patients understand.

 

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Back to blogging

2017 Greetings! It’s been much longer than I anticipated to be able to get back to writing this blog, so return now to fulfill one of my New Year’s resolutions.  Health justice work is more important than ever and I created this blog to share information and perspectives on topics that may not get much attention elsewhere.  My goal is to post once a month at minimum, and to keep a focus on my Washington as well as local developments and the bigger picture.  I will start with a story on a positive development for healthcare consumers in our state.

In the wake of the recent US measles outbreak, Public Health Seattle King County has published searchable data on student immunization levels covering all K-12 schools in the county.  Data fields include vaccination completion rates at each specific school ( color-coded to show rate levels); MMR immunization among kindergarteners; and immunization coverage rates in general among kindergarten and 6th grade students.  The sociodemographic correlations to vaccination  rates reflect the national trends that have made headlines, are not a surprise to locals. Kudos to the PHSKC  team for innovative use of technology in the public interest!

News Roundup

From the hyper-local to the global, news of note:

American Red Cross Under Pressure to Stop Accepting Tobacco Money

Questions arise over hospital ‘reality’ TV shows

Unlike ZoomCare, Legacy will accept Medicare and Medicaid at new Portland clinics

Tax Preparers Get Ready To Be Bearers Of Bad News About Health Law

Sea Mar Health Centers to pay $3.35 million in Attorney General’s Office investigation of improper billing

The Nasty Patent Games Drug Companies Play To Stop You From Getting Cheaper Drugs

Exciting news came at the end of the year for Gary Schwitzer’s Health News Review project which had lost the funding that supported the team of reviewers that analyzed the accuracy of health stories in the news and published their findings. HNR was awarded a two-year, $1.3 million grant from the Laura and John Arnold Foundation to continue and expand its work, which will now be housed in the new Center for Media Communication and Health in the U of Minnesota School of Public Health.

I’ll be looking forward to more important stories coming our way soon to share here.  And all of us can hone our critical thinking skills on health news stories by applying the HNR  framework anytime:

What’s the total cost?
How often do benefits occur?HealthNewsReview
How often do harms occur?
How strong is the evidence?
Is this condition exaggerated?
Are there alternative options?
Is this really a new approach?
Is it available to me?
Who’s promoting this?
Do they have a conflict of interest?

News from China  gives us even more pause to reflect on the access to medicines scenario. The situation in the US where there are no good excuses for unaffordable medicines, pales in comparison to this chilling tale of a patient whose actions to secure the life-saving drug imatinib mesylate at an affordable price, has resulted in his criminal prosecution.

Veenat400mgTo prosecutors, a leukemia patient named Lu Yong is a criminal involved in credit card fraud and a counterfeit drug scam. But to 1,000 fellow leukemia patients in China, Lu is an unsung hero for helping them get access to cheap, life-saving generic medicines from India.

His crime?  Selling fake drugs and breaking a law about purchase of international credit cards.  What Lu did was considered criminal because any drug  produced in or imported into China without the government’s approval is classified as a “fake drug,”  and Lu purchased international credit cards online to facilitate the transactions. China.org.cn reported that:

The defendant, Lu Yong, was diagnosed with chronic myelocytic leukemia in 2002. He was prescribed Gleevec, a drug produced by Swiss drug-maker Novartis, which cost 23,500 yuan (US$ 3,775) per month, far too expensive for average Chinese families. Lu was even more depressed since the expenses of treating leukemia are not covered by China’s medical insurance system.

Lu later found out that India produced a generic drug which was comparable to Gleevec but which cost only 4,000 yuan, about 17 percent of the cost of Gleevec. He took the medicine himself and found it effective. Later, Lu began helping several thousand fellow patients buy the drug, since the purchasing process was difficult and some patients were not able to fill out the English purchase forms.

Meanwhile, Lu’s trial has been postponed due to his health problems, and some 300 fellow patients with CML have signed an online petition asking for his release.

Also of significance is the astronomical price of Gleevec in China,  said to be the highest in the world, which led  Lu to seek an alternative.  As a point of comparison, Costco’s US online pharmacy is now selling a 30-day supply of the standard 400mg dose of Gleevec for $9022.05.

Glivec400mg

 

A bevy of news stories local and national have highlighted the ever-worsening situation for consumers , especially  for folks who need so-called specialty drugs but also for the much larger segment of the population who use plain old generic medicines.  While raising awareness is essential, mostly what we are seeing, is increased an amount of talk about the problem, but less often are suggestions being offered in the way of sustainable solutions. Shock over the price for new Hepatitis C drug Sovaldi  was a wake-up call for policy makers and the public; it remains to be seen what will be prescribed as a remedy.  Here’s a sampling of  some more recent headlines:

Small group of specialty drugs could make up half of total pharmacy spending by 2018

Prices Soaring for Specialty Drugs, Researchers Find

Generic drug prices skyrocket in past year

Will Rising Prices for Some Generic Drugs Never End? Monthly Cost for One Heart Drug Can Approach $1,200

Pharmacists Report Soaring Generic Drug Purchasing Prices Impacting Patients, Pharmacies

New strategies needed to curb specialty drug costs

While some in Congress have been asking why in 2014, it remains to be seen if the political will can be mustered anytime soon to secure pricing changes from Big Biopharma.