“Bangladesh probes marriage of teen to elderly man - Miami Herald” plus 4 more

Bangladesh probes marriage of teen to elderly man - Miami Herald
Court Orders Patient to Leave Hospital - The Ledger
Man Accused Of Cutting Baby - WCPO
Father of stillborn baby seeks inquest - The Australian
Rationed care already exists - Detroit News

Bangladesh probes marriage of teen to elderly man - Miami Herald

Posted: 13 Sep 2009 08:29 AM PDT

DHAKA, Bangladesh -- Authorities in southern Bangladesh are investigating whether a 13-year-old girl was forced to marry a 75-year-old man as a way to pay off her father's debt, local media reported Sunday.

Lokman Shikder loaned the girl's father, Azhar Bepari, 4,000 takas ($59) several months ago, but Bepari had trouble repaying it, the United News of Bangladesh news agency reported. Shikder recently gave Bepari the choice of immediately paying back the money plus interest or allowing him to marry his daughter in exchange for waiving the loan, it said.

Shikder, who was already married, is the father of four grown children and has a host of grandchildren, the news agency said.

Badrul Huq, a government official in Barisal district, said authorities were investigating and legal action would be taken against the father and husband if the marriage indeed took place, the report said. People under the age of 18 are not legally allowed to marry in Bangladesh.

Shikder's first wife also wants her husband punished because he married the girl without her permission, the report said. Men can marry up to four women in Bangladesh, but their wives must agree in writing to any new marriages.

Human rights groups say child marriage is rampant in rural Bangladesh, an impoverished nation of 150 million people where almost half of the population lives on less than $1 a day. They say the punishment for violations of child marriage laws is too mild - one month in jail or a fine of 1,000 takas ($15), or both.

Rashida Akhter Shirin, a women's rights lawyer, said she would help the girl and her family if they want to file a court case against Shikder, the report said.

Officials could not be reached for comment Sunday.

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Court Orders Patient to Leave Hospital - The Ledger

Posted: 13 Sep 2009 11:57 AM PDT

He has racked up a hospital bill — in addition to his doctors' fees — of more than $1.7 million, his family says.

His mind is alert, but he can't walk or talk and must use a ventilator to breathe 24 hours a day, seven days a week.

But soon the 77-year-old retired printer and dump truck driver will be discharged under a court order, ending the hospital's unprecedented two-year effort to move him and taking his family into uncertain territory as they attempt to care for him at

home.

Lengthy stays and million-dollar hospital bills are not unheard of. But Brazil's case raises serious questions about health care access and costs.

How can one patient remain in the hospital for so long — likely at taxpayers' expense — at a time when millions of others struggle to get health care?

And why is it so difficult for families like the Brazils to find good options for long-term care outside the hospital?

Brazil's case "is an anomaly, but it's an expensive anomaly," said Jay Wolfson, an expert on health policy at the University of South Florida.

Brazil spent Christmas 2006 at the small home in North Tampa where he and and his wife, Doris, have lived for 50 years, raising four children. He even played and danced with his great-grandchildren.

But days later, he told Doris he was having trouble breathing.

She is legally blind and cannot drive, so she called an ambulance. He was admitted to UCH on Dec. 30, 2006, where he was treated for acute and chronic respiratory failure.

The family said he had fluid in his lungs and developed pneumonia; the hospital would not talk about his medical condition, citing privacy laws.

Brazil was placed on a ventilator at night; eventually, he needed it full-time.

By May of 2007, according to court documents, Brazil's physicians determined that his condition had stabilized, he would not improve, and so should leave the hospital.

Doctors said he should be cared for at home or in a skilled nursing facility.

With that determination made, the family was told Medicare would no longer pay for his hospital stay.

The hospital found beds in at least two facilities, one in Miami and another in Sarasota.

But the family said no.

"We felt he could not be discharged. We just felt it wasn't safe," Doris Brazil said.

The family wanted Brazil closer to home, where relatives — most of whom live in Hillsborough County — could see him every day and help care for him.

The couple's daughter Diane Noriega, 50, said she has contacted many nearby nursing facilities, only to find that they either had no space, do not take patients on ventilators or only take patients who can be eventually weaned from the ventilator.

The family and hospital officials agree Brazil likely cannot be weaned.

The hospital acknowledges there aren't many places for ventilator patients to go.

Dr. Brad Bjornstad, chief medical officer, said such patients are either cared for at home or transferred to states with more available facilities, such as Illinois or Pennsylvania.

The family didn't consider bringing Brazil home, because Doris Brazil, 72, has heart problems and diabetes. Nor did they want him far from home.

"We were not refusing to move him," Noriega said. "There's just no place we can find to send him."

Over the course of his hospital stay, Brazil has lost the strength to walk and now has only limited use of his hands, his family said.

Though he suffers from some dementia, he is aware of what's going on around him. His eyes are expressive, showing excitement when someone enters the room. He answers questions with a nod or shake of his head.

Family and friends visit him twice a day, every day. Pictures line a wall of his room, including one showing Brazil during his glory days as a local car racing champion.

"How are you feeling?" Noriega asked her father on a recent visit. "Do you want to go home? Are you ready to go home?"

Brazil nods and mouths the word, "home."

GOING TO COURT

By 2009, the hospital decided it had to do something it never had done to get Larry Brazil out of UCH.

Bjornstad said the hospital sued Doris Brazil for three main reasons:

The family would not cooperate with the discharge.

Brazil's continued stay at the hospital could prevent other needy patients from getting care there.

The hospital was spending money it had no hope of recovering.

"Face the facts, we're probably not going to be paid for a very large chunk of the care," Bjornstad said. "That means that's dollars that are not available to potentially expand services, to buy equipment, which is what not-for-profit hospitals use their dollars for."

On May 29, the hospital asked the courts to force Doris Brazil to have her husband discharged, and if she refused, to allow UCH to transfer Brazil without her consent.

"We don't normally try to get confrontational with families and patients," Bjornstad said. "But we had no other choice."

On June 4, a Circuit Court judge ruled in the hospital's favor, and the family's lawyers appealed. But on Aug. 6, both sides agreed to discharge Brazil in September.

Noriega said her family couldn't afford a court fight.

"At that point, we just knew that we had to do what the court order said," she said.

The agreement also requires the family to complete a medical assistance/charity application financial statement, presumably so the hospital can write off the bill as charity care, which is ultimately paid for by taxpayers.

Noriega says the family didn't intend to be uncooperative. Still, she admits they didn't want to face the ordeal of moving her father from a situation they trusted into the unknown.

"When you don't accept things, you sometimes ignore them," Noriega said.

LONG STAYS RARE

Lengthy patient stays are rare, but not unheard of. Tampa General Hospital, for example, has patients who have been there for more than 100 days; one has been there for more than 1,000 days, hospital spokesman John Dunn said.

But such cases raise issues about the costs and availability of care, said Wolfson, of USF.

Besides the hefty bill Brazil will leave behind, there are other costs to the community, he said. A prolonged stay at a hospital for a patient who needs only advanced nursing care, for example, could deprive others of needed care there.

He said since hospitals can't discharge patients without consent, they are sometimes left to take patient's families to court as a last resort.

"And you don't want to get the courts involved in patient care," he said.

But Wolfson said the case also illustrates the dilemma of families like the Brazils having few good options for care outside the hospital.

Nursing homes in Florida are often full, and "they don't have capacity to care for respirator patients," he said.

And caring for someone at home has become tougher because home health providers have seen their Medicare reimbursement rates reduced in recent years, at the urging of hospitals and nursing homes, Wolfson said.

Ideally, Wolfson said, there should be more room at nursing facilities and better reimbursement for those who provide care at home.

As the baby boomers age and demand grows, he expects both situations to improve.

But not in time to help Larry Brazil.

HARD FUTURE

Caring for an elderly man who can do virtually nothing for himself and who must be tethered to a breathing machine at all times will not be easy.

The work is far too physical for Doris alone. So the family is cobbling together a care team that includes his four children, five grandchildren, two great-

grandchildren, plus friends.

Their home will be equipped with "two of everything," said Pat Rager of All American Medical Equipment Inc., who was at the hospital recently with one of two ventilators that will be brought to the family's 1,000-square-foot home. A hospital bed will be brought in, and the family also will purchase a generator in case of power failures.

A home health nurse will visit every day for the first week to make sure the family is properly trained, Noriega said. After that, they expect periodic visits from the nurse and Brazil's doctor.

Noriega isn't sure what Medicare or her father's Blue Cross/Blue Shield supplemental insurance will cover. The family is also applying for Medicaid, and will see how far Brazil's Social Security, retirement and small VA pension will go.

"It's a task we may not be able to do," said Noriega, who has moved back to her parents' home with her son to help out.

"But we owe it to him to try."

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Man Accused Of Cutting Baby - WCPO

Posted: 06 Sep 2009 07:29 PM PDT

A man from northwest Fairmount is headed to court to face child endangering charges.

Police say 21-year-old Jeremy Reidell caused severe injuries to a 13-month-old baby girl and allegedly failed to call for medical care in a timely manner.

The baby suffered several contusions and lacerations and is now in intensive care.

Reidell remains in jail.

He's scheduled to appear in court at 9 a.m. Monday morning.

Father of stillborn baby seeks inquest - The Australian

Posted: 06 Sep 2009 09:49 AM PDT

THE husband of a woman who gave birth unnoticed to a stillborn baby in intensive care at one of Western Australia's biggest hospitals wants police to investigate possible criminal charges for medical negligence.

Danny May said yesterday he believed his wife, Sharon, had been negligently treated because she was not admitted to hospital with pneumonia and swine flu days before she miscarried and lost the 23-week-old fetus.

According to Mr May, his 32-year-old wife was referred to Armadale Kelmscott Memorial Hospital by a GP, who recommended she be admitted.

At the hospital on August 18, Mrs May was seen in the emergency department, advised she was severely dehydrated and an IV piece was inserted. However, it took hours for a doctor to hook up the fluids and Mrs May was later told she had swine flu and there was no need to admit her as a patient, Mr May said.

With her condition worsening, she returned two days later and, after being diagnosed with pneumonia, was admitted and transferred to Sir Charles Gairdner Hospital, one of Perth's major teaching hospitals, and placed in an induced coma in intensive care.

Mr May said he was told by hospital staff on August 22, Mrs May's second day at the hospital, that his wife had given birth to a stillborn baby and the baby was found lying under the sheet on Mrs May's bed.

Yesterday Mr May, a storeman for Holden, said he would never know whether the child, Angus, could have survived if his wife had been admitted when she first presented at Armadale hospital. He was outraged that his wife gave birth without help from medical staff and said the health of the baby was not considered.

Mr May said his wife should have been referred to Perth's maternity hospital, King Edward Memorial Hospital, instead of Gairdner Hospital.

"I see fault at Charlies, King Edward and Armadale," he said.

Mr May's lawyer, John Hammond, compared Mrs May's treatment with what could be expected in a Third World country. "Armadale Hospital, in particular, would be better off being located in Bangladesh because of the way they treated Sharon May," he said.

Mr May said he wanted the case investigated by the coroner and the police so he could get answers and avoid other people going through such tragedy.

He said his wife was out of an induced coma but he had had to tell her four times that their son had died because she could not comprehend what had happened and was still heavily medicated.

Mr May had also had to tell their four-year-old daughter, Emily, she would not be getting a little brother. The couple also have a 14-month-old daughter, Taylor. Yesterday, the chief executive of the North Metropolitan Area Health Service, Shirley Bowen, said the suggestion of criminal negligence was offensive and the nurses and doctors at the hospital provided excellent care to Mrs May.

She said a nurse attended Mrs May as soon as Angus was born and blood was observed. She said because Mrs May was extremely unwell, there were no clear signs she was going into labour.

Dr Bowen said the hospital was the best one to treat Mrs May. "We believe she had excellent and appropriate care," she said.

Two internal health department investigations of the incident are under way and Dr Bowen said she would be happy to make them public once completed because the hospital had "nothing to hide".

Mr Hammond said he would write to the coroner today, asking for an inquest into the death.

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Rationed care already exists - Detroit News

Posted: 13 Sep 2009 07:03 AM PDT

Clarence Page

"Rationing" is one of the scariest words in the current health care debate.

It conjures up apocalyptic nightmare images from "Soylent Green," the sci-fi thriller about a future in which the old and weak are quietly lured into early extinction for the sake of future generations.

What the scaremongers don't like to talk about is how much our private insurers ration now -- mostly for the sake of their own profits.

They're clever enough to avoid using the R-word. They use other words, like "Read the fine print on your policy."

My friend Sarah Wildman learned the hard way. She's the new mom with what she calls a "$20,000 baby."

That's how much she and her husband had to pay out of their own pockets after her insurer decided her baby was a "pre-existing condition."

Self-employed, Sarah and her husband fall into the individual insurance market, which the American Medical Association estimates to be as high as 27 million people.

Falling between the fully covered and the uncovered, their numbers have grown faster as thousands of Americans lose their job-based insurance every day.

Some of them are women who discover the hard way, as Sarah did, that if you bought maternity coverage after the pregnancy began, the fetus is viewed as an uncovered "pre-existing condition."

The Pregnancy Discrimination Act of 1978 requires employers with more than 15 workers to include maternity benefits in their insurance packages. But only 14 states require maternity coverage in policies sold on the individual market, according to the Kaiser Family Foundation.

And a report last fall by the National Women's Law Center found only 12 percent of 3,500 individual insurance policies included comprehensive maternity coverage. Another 20 percent offered it with a rider that cost as much as $1,100 a month. Others required a two-year waiting period.

Fortunately Sarah's story had a happy ending. She's a freelance writer for magazines like The New Republic, The New York Times, The American Prospect and the online publication Slate.

When she told the company's press rep she was going to write about their "crappy" maternity policy, "I got kicked up the food chain."

In the end, she reports, she was able to get 90 percent of her hospital costs paid by the company, which also promised to adjust claims paid to some similarly situated women.

After she wrote about her horror story in Double XX, a woman-oriented Slate spinoff, she heard from numerous fellow sufferers, some with hospital bills bigger than hers. Last Thursday she testified before the House Joint Economic Committee, which released a report that found women more economically vulnerable than men to high medical costs and related bankruptcy.

She also has received the inevitable scolding in today's heated blogosphere from opponents of national health insurance reform. It's her own fault, some said; she should have read the fine print. Right. As if everybody reads the fine print on their insurance policies -- and understands it.

And she hears the fears of those who suspect national reform will lead to government rationing of health care. I'm old enough to remember how similar fears were vented when Medicare was born in the 1960s. It is now so popular that President Obama and others have heard satisfied, if a little confused, constituents say, "Keep your government hands off my Medicare," even though Medicare is a federal program.

Left unsaid by those who raise fears of rationing by any "government-run" or government-related health care is how much rationing the insurance industry does now.

For decades, experts writing in the New England Journal of Medicine and elsewhere have concluded that we do "ration" health care. We just do it through gross disparities in race, sex, age, regions, income and education.

And, although Sarah's insurer may deny it, we also ration it to those who are lucky enough to have access to the big soapbox that she happened to have.

If anything, social conservatives should be on her side. By penalizing mothers in this way, the private insurance industry throws more barriers in the way of parents and prospective parents than the government does.

Under pressure, the private insurance industry has come to the table. A spokesman for the insurance industry recently responded to congressional criticism by listing concessions that the industry has offered as alternatives to a publicly funded option.

The industry has proposed "guaranteed coverage for pre-existing conditions, discontinuing rating based on a person's health status or gender, and a personal coverage requirement to get everyone into the system," said Robert Zirkelbach, spokesman for America's Health Insurance Plans.

Sounds great. But why wait? Insurers don't need the government's permission to reform themselves. Just do it.

Clarence Page writes for the Chicago Tribune. His column is distributed by Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, NY 14207. You can reach him at cpage@tribune.com.