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
……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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Posted in Access to Medicines, Advocacy, Assistance, Cancer, Economics of Health Care, Generics, Glivec, Global Health, Health Care Marketing, Health Insurance, Leukemia, Patient groups, Prescription drugs on 29 December 2014|
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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.
To 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.
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Posted in Advocacy, Discrimination, Ethics, Health Disparities, Healthcare Inequalities, Hispanic/Latino, Immigrants, Language Access, Language Services, Limited English Proficiency, Paitent safety, Patient Safety, Translation on 30 November 2014|
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In recent weeks I’ve received email alerts announcing “Hospitals Making Progress on Health Care Disparities“, a new study from the American Hospital Association’s Hospitals in Pursuit of Excellence program and associated organizations. I took a look first at the infographic accompanying the notices, and then at the published study itself, the 2013 Diversity and Disparities: A Benchmark Study of U.S. Hospitals. It was no surprise to read that the demographic profile of hospital executives and boards is still so far from representative of the general population, since the last HPoE study in 2011. However, the 2013 study reports data on language services in hospitals that raised my eyebrows ( 2011 comparison data points shown in parentheses):
- 95% (90%) are collecting data on primary language of patients
- 87% (80%) are translating forms and documents for patients
- 66% (61%) collected information on patient language needs
Leaving aside the matter of ascertaining the difference between collecting “primary language of patient” and “patient language needs,” these highly encouraging results led me to seek details in the source report. Having recently done extensive research for my own presentation on the status of language services in healthcare for the 2014 WASCLA Summit, the HPoE findings seemed even more amazing. What I found in the report itself , which did conclude that more needs to be done to achieve equity of care in the broader sense, was that some basic background and research points seemed not to have been included or were too limited in scope to be meaningful. For example, the report did not include the list of hospitals which had participated in the survey, nor how the recent cohort compares to the 2011 and 2009 participant groups. There was no discussion of the statistical validity of the response rate of 1109 hospitals (~19% of all 5922 AHA member hospitals invited to participate), nor how representative the response sample is for hospitals nationwide. For example, while the study noted that all data was self-reported, there was no mention of the possibility that only hospitals which have disparities reduction initiatives chose to participate. I am pursuing the actual data used for the study, and hope to have information to share soon.
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Posted in Advocacy, Assistance, Discrimination, Ethics, Global Health, Health Care Marketing, Health Care Reform, Health Disparities, Health Insurance, Health Literacy, Healthcare Inequalities, Hispanic/Latino, Immigrants, Language Access, Language Services, Limited English Proficiency, Medicaid, Promotions, State of Washington, Translation on 20 December 2013|
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Consumer info fact sheets translated into WA’s threshold written languages
(Chinese, Lao, Khmer ( Cambodian), Korean, Russian, Somali, Spanish, and Vietnamese) were posted on Dec. 16, just one week before the deadline to start an application for coverage to be effective Jan. 1, 2014. In an unrelated development, HBE decided on this brief extension
for completing applications due to various problems people have had in being able to use the online forms and or access phone customer services. Regarding the translated fact sheets, it’s taken almost 6 months for their publication to replace the original problematic versions
that were taken down from the site.
However, the new fact sheets are not easy to find as they are not posted on the consumer website, but located exclusively on the HBE corporate website
. The corporate site features a line at top right-hand side of homepage entitled “Information in Other Languages” which links to the fact sheets page, plus also links out to the consumer website. In contrast, the consumer Healthplanfinder site
(which is in both English and Spanish) does not offer any such subject line, nor does it display a link to corporate site. The Healthplanfinder site likewise does not contain any readily visible clear statement of consumer language access or disability access rights, except for a message in tiny font on bottom of the homepage that says [sic] : If you need additional language or disability accomodations, you may call 1-855-WAFINDER (1-855-923-4633).
On the Spanish version of the website, this statement illustrates yet another example of faulty translation, as the term “disability accomodation
” is twice translated, and very ungrammatically, as “discapacidad alojamiento
” which means disability lodging. Sure enough, a quick check on Google Translate English > Spanish reveals “lodging” as the first translation for “accommodation.” Since 2012 advocates had been recommending the inclusion of multilingual tag lines and/or translated summaries sections for the website.
Information on some metrics for the Healthplanfinder call center became available last week with the release of the November Healthplanfinder Data Repor
t. On the language access side of things (p.10 of the report) the numbers are not encouraging: the call center received almost 12,000 calls in Spanish, but handled only some 1600 of them. The call center in Spokane has bilingual Spanish-English staff (reported as 6 out of 80 employees
at start-up) on site and routes calls in other languages to a telephonic interpreter service. For calls in all languages besides Spanish combined, 1045 were actually handled (answered)out of 3621 calls attempted. The report does not state if the multilingual calls are included in the totals for approximately 35,000 calls handled in November or the almost 158,000 calls throttled (deflected from the system, i.e. not put into the queue to await a response). While the HBE is said to be increasing staffing for the call center
, any increases planned for its language capacity are as yet unknown. Given the demand, it would seem that Spanish-speaking callers too could benefit from immediate access to interpreter services.
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