Editorial Roundup: New England

Hartford Courant. September 21, 2022.

Editorial: A state trooper’s humanity toward a veteran is a lesson to all

You really have to see the bodycam video.

But if you don’t get that chance, take our word for it: the Connecticut State Police trooper did the right thing.

During what probably initially seemed like a routine check on a motorist who was pulled over on Interstate 84 with his hazard lights on, Trooper Kyle Kaelberer behaved in a way that was anything but routine.

After approaching the vehicle, Kaelberer addressed the male driver in a respectful manner — immediately asking him what was going on, but addressing the driver as “boss,” according to the video the state police released.

What Kaelberer heard next had to have been unexpected. The male driver told Kaelberer that he was on the phone with a VA hotline for suicide.

Kaelberer didn’t miss a beat.

“All right, hey, I got you man, all right,” the trooper said, an immediate offer of reassurance.

And while we have to believe all state troopers get training for such situations, what came next from Kaelberer seemed to come naturally and conversationally and as a way to connect with a stranger.

“What branch you in,” Kaelberer asked the man.

“Army,” the man says.

Kaelberer continued to reassure the veteran throughout, offering his first name, asking about any deployments, and telling the man he would be helped and “I’m here with you man.”

When Kaelberer told the veteran that he would call an ambulance and the man said he could not afford it, the trooper rightfully reassured him that the state would cover the cost.

Even more humanity was shown when the man got out of his vehicle and asked Kaelberer for a hug. Kaelberer gave him one.

We can’t be sure what happened to the veteran after that, though state police said he was able to receive medical assistance and we very sincerely hope he got all the help he needed.

But we do know this: veteran deaths by suicide are “increasing at a greater rate than that of the general U.S. population,” according to the federal Centers for Disease Control and Prevention.

The CDC reports that, from 2001 to 2019, “the rate of suicide among veterans increased nearly 36% relative to an increase of 30% in the general population.”

After 2019, however, there was a drop in veteran suicide deaths, with 6,146 in 2020, or 343 fewer than in 2019, according to the 2022 National Veteran Suicide Prevention Annual Report released this week. In Connecticut, 40 veterans lost their lives to suicide in 2020, according to the U.S. Department of Veterans Affairs.

None of those deaths can be thought of as statistics, but as fellow Americans. Each veteran served this country, each had loved ones and each faced demons that others may not have known about.

The Department of Veterans Affairs says that “veteran suicide prevention is VA’s highest clinical priority.”

Significantly, the agency also notes “we can’t do it alone. Suicide is preventable and everyone has a role to play in saving lives,” and notes there are ways to support veterans.

“You don’t need special training and you don’t have to be an expert to help the veterans you care about,” the agency says.

That’s what Kaelberer showed us. The trooper may have expertise in dealing with people in mental distress, but what he also demonstrated was as important in those moments: the ability to connect with another person without judgment, acknowledging the pain the person was in and to show caring even as he professionally took care of what he needed to do.

“We’ll help you out, all right, bud?” Kaelberer to the veteran, “I’m here with you. I’m here with you, all right?”

In reaching out to share what occurred, the state police did the same: issuing a reminder to call 988 for immediate help in case where a person or someone they know is contemplating suicide. The VA notes that veterans who call 988, can then press “1″ and they will reach the Veterans Crisis Line.

“We encourage (people contemplating suicide) to call 988, call 911 if it’s immediate, and we’ll respond,” Sgt. Christine Jeltema told The Courant. “988 will respond as well to them and get them the help that they need.”

And if you need help when on the road, Jeltema noted, put your hazard lights on, as troopers are trained to check on motorists with active hazards even when off-duty.

The Department of Veterans Affairs said they can’t do it alone. What Kaelberer showed us is that they are not alone.

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Bangor Daily News. September 22, 2022.

Editorial: Medicaid expansion helped Maine see large drop in people without insurance

Maine had the largest drop in the percentage of people without health insurance in the country over the past two years. Having more people insured and able to access health care is good for their health, and for the economy of the state.

The drop in uninsured Mainers is due in part to the expansion of Medicaid, the health insurance program for low-income Americans, which is called MaineCare here.

Voters strongly approved the expansion of Medicaid in 2017. That came after then-Gov. Paul LePage vetoed legislation to expand eligibility for Medicaid, which was approved by Democratic and Republican lawmakers, several times. Even after voters approved the referendum to extend the government insurance program to more Mainers, LePage still refused to implement it.

Gov. Janet Mills did so on her first day in office in January 2019. Nearly 100,000 people have gained access to health insurance since then. Most of those helped by Medicaid expansion were working but did not previously have access to an affordable insurance plan.

According to the U.S. Census Bureau, Maine’s uninsured rate dropped from 8 percent in 2019 to 5.7 percent in 2021. This was the largest percentage decline among all states in the nation.

Maine now ranks 14th among all 50 states for the percentage of uninsured residents, down from 26th two years earlier.

Maine saw gains in both public and private health insurance, with a 1.1 point rise in the percentage of Mainers with private insurance.

There are many benefits to having more people covered by health insurance. For one, those who are newly covered can now better afford to go to a medical provider. That means they can get preventative care and care for chronic conditions before they worsen. This includes mental health care and care for substance use disorder. This improves their lives and lowers costs for others.

Beyond the individual benefits, having more people covered by insurance helps hospitals reduce uncompensated care and maintain their workforce. Maine hospitals saw their uncompensated care decrease by $84 million between 2018 and 2020, according to the governor’s office.

“This is a big win for Maine people, hospitals and other providers of care, and the Maine economy,” Steve Michaud, president of the Maine Hospital Association, said of the Census Bureau data and Medicaid expansion, which is primarily funded by the federal government.

Medicaid expansion has also reduced costs for those who were already insured and led to economic and job growth.

“Over the last two years, despite the challenges of the pandemic, Maine outperformed every other state in improving health coverage,” Gov. Janet Mills said in a press release earlier this week. “Now more Maine people can see a doctor, afford medications, and receive preventive care, keeping families and our economy both healthy.”

The governor also pointed to other steps the state has taken to increase the accessibility of health insurance and health care, including codifying protections for people with pre-existing medical conditions into state law and reducing health insurance costs for small businesses.

There is still work to be done. Maine lags other New England states for the rate of insured people; more than 77,000 people in Maine still lack health insurance.

Still, the Census Bureau data show that Medicaid expansion, which was supported by the majority of Maine people and Maine lawmakers, has made a significant difference in the state.

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Boston Globe. September 18, 2022.

Editorial: Patients’ rights in the Live Free or Die state

Spotlight’s exposure of Dr. Yvon Baribeau’s record shows need for transparency in malpractice cases.

The tale of Dr. Yvon Baribeau is more than the sum of a record-shattering number of medical malpractice settlements, more than the personal pain and tragedy of the families who brought them and more than the crises of conscience felt by some of his colleagues.

No, at its heart it’s about a hospital and its governing board that did too little to stop the damage as the surgery gravy train kept rolling and a state medical board so derelict in its duty to protect patients that even today it remains complicit in shielding Baribeau’s sorry record.

Baribeau, a cardiac surgeon at Catholic Medical Center in Manchester, N.H., for nearly three decades amassed one of the worst surgical malpractice settlement records in the nation, according to a recent two-part series reported by the Globe’s Spotlight Team.

The first of those malpractice cases was filed in connection with a 1994 lung surgery performed not even two years after Baribeau joined the hospital. It was settled in 1998 for about $1 million.

Many of the settlements that followed would contain confidentiality agreements forbidding the families from discussing their cases. That was the case for the family of Frank Pelligrino.

Pelligrino came into the CMC emergency room in September of 2014 with a behind the knee blood clot. Pelligrino’s leg was later amputated after Baribeau opted to do an elective surgery on another patient before tending to Pelligrino.

“The system is severely broken,” his daughters said in a statement. “People’s lives have been absolutely devastated by the lack of intervention in allowing these atrocities to occur and continue unchecked.”

The pattern of requiring such confidentiality agreements is a familiar one for those who remember the Spotlight series of two decades ago about the Catholic Church’s cover-up of the sexual abuse by priests of minors in their charge.

“Since 1997, the archdiocese has settled about 50 lawsuits against (the Rev. John J.) Geoghan, for more than $10 million — but with no confidential documents ever made public,” the Spotlight report noted about just one of the accused priests.

The practice was wrong then, and it’s wrong now.

Hospital executives in an e-mail to CMC staff Wednesday promised to bring in an outside firm to do an independent review of hospital procedures in the wake of the Globe series. But in an online “town meeting” with employees CEO Alex Walker denied that the hospital withheld information about Baribeau’s work from the public — a fact that flies in the face of its use of nondisclosure agreements.

Greater transparency around those past settlements — and a pledge not to use them in the future — would certainly be evidence of Walker’s sincerity.

Even more critical would be transparency on the part of the New Hampshire Board of Medicine, which still lists the now retired Baribeau as having a flawless record. That’s contrary to the Massachusetts Board of Registration in Medicine, which lists medical malpractice claims filed against Baribeau dating back to 1999.

In fact, a 2019 study by Public Citizen, a consumer advocacy group, put New Hampshire’s medical board dead last among states for the rate at which it disciplines physicians and among the least transparent in the data it makes available to the public. (Massachusetts ranks around the middle of the pack on disciplinary issues.)

The study also compared public data collected by the National Practitioner Data Bank (NPDB) and found that by the end of 2019, some 8,633 physicians had five or more malpractice payment reports since the NPDB starting collecting such information in 1990. “Yet, dangerously and unacceptably,” 76 percent of those physicians had “never had a medical board licensure action of any kind, serious or non-serious.”

State licensing boards, hospitals, and other health care entities are all required to report disciplinary actions and certain adverse events to the NPDB. Malpractice insurers and other payers are also required to report payments made on behalf of individual practitioners. That physician-specific data, however, is not available to the public but only to licensing authorities and hospitals.

The obvious answer to leveling the health care information playing field would be for Congress to amend the Health Care Quality Improvement Act that created the NPDB to allow anyone to check up on a physician’s record. That would, of course, raise the hackles of the American Medical Association, which as a matter of policy “opposes all efforts to open the National Practitioner Data Bank to public access” and “strongly opposes” public access to malpractice case payments.

Improving the operations of the New Hampshire medical board would be simpler and has the potential to bring more immediate relief. And there is one hopeful sign in that regard with the appointment earlier this year by Governor Chris Sununu of Dr. David Goldberg, a former Catholic Medical Center cardiologist, who filed a successful whistleblower suit against the hospital and Baribeau.

“My priority as a doctor has always been to advocate for top medical care and patient safety,” Goldberg told the Spotlight team.

Sununu has at least two current vacancies to fill on the board, including one of its public members. That too can make a difference — assuming the governor has an abiding interest in putting patient safety first. The board should follow up on that independent investigation promised by the hospital — to assure that it is indeed independent, that its findings are shared with the public, and that any flaws are corrected.

The case of Yvon Baribeau may be an outlier, but it certainly won’t be the last of its kind. Health care consumers in New Hampshire at least deserve the right to make better informed decisions before literally putting their lives in a physician’s hands.

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Rutland Herald. September 20, 2022.

Editorial: Under pressure

In the last few weeks, the Vermont State Police, as well as local law enforcement, have reported on some dangerous domestic violence and road rage incidents.

The level of microaggressions seems to be dialing up to good, old-fashioned aggression — often in the form of intimidation and harassment. Somewhere along the way, we decided it was OK for bullies and trolls to have their own station in society.

That behavior is not right. It is not healthy. And, we believe, it is leading to more instances of violence. It certainly is creating more fear and anxiety.

Don’t believe us? Ask someone who works a help line these days. Ask leaders of our social services? Talk to our church leaders? Try to get an appointment to talk to a counselor or therapist.

It has become so acute, in fact, that new health guidelines suggest U.S. doctors should regularly screen all adults under 65 for anxiety.

Anxiety disorders are among the most common mental health complaints, affecting about 40% of U.S. women at some point in their lives and more than 1 in 4 men. Given those double-digit percentages, we would agree with the U.S. Preventive Services Task Force that such screening is necessary.

This is the first time the group has recommended anxiety screening in primary care for adults without symptoms.

According to the Associated Press, the recommendations are based on a review that began before the COVID-19 pandemic, evaluating studies showing potential benefits and risks from screening. Given reports of a surge in mental health problems linked with pandemic isolation and stress, the guidance is “very timely,” Lori Pbert, a task force member and co-author, told the AP.

The task force said evidence for benefits, including effective treatments, outweighs any risks, which include inaccurate screening results that could lead to unnecessary follow-up care.

People living in poverty, people of color, people who have lost partners and those who have other mental health issues are among adults who face higher risks for developing anxiety, which can manifest as panic attacks, phobias or feeling always on edge. Also, about 1 in 10 pregnant and postpartum women experience anxiety, the AP article noted.

Common screening tools include brief questionnaires about symptoms, such as fears and worries that interfere with usual activities. These can easily be given in a primary care setting, the task force said, although it didn’t specify how often patients should be screened.

But the screening is only the first step. Given the statistics, chances are good that something in your life — whether it’s threats of aggression or violence or financial concerns or worries about health — will give you anxiety.

“The most important thing to recognize is that a screening test alone is not sufficient to diagnose anxiety,” Pbert told the AP. The next step is a more thorough evaluation by a mental health professional, though Pbert acknowledged that finding mental health care can be difficult given shortages of specialists.

The task force said there isn’t enough solid research in older adults to recommend for or against anxiety screening in those aged 65 and up, according to AP. The group continues to recommend depression screening for adults and children, but said there isn’t enough evidence to evaluate potential benefits and harms of suicide screening in adults who show no worrisome symptoms.

In April, the group issued similar draft guidance for children and teens, recommending anxiety screening but stating that more research is needed on potential benefits and harms of suicide screening kids with no obvious signs.

Guidelines from the task force often determine insurance coverage, but anxiety is already on the radar of many primary care doctors. In 2020, a group affiliated with the American College of Obstetricians and Gynecologists recommended routine primary care anxiety screening for women and girls starting at age 13.

The U.S. Preventive Services Task Force proposal is open for public comment until Oct. 17, but the group usually affirms its draft guidance.

We hope they do. Stress affects health — physical and mental — at every level.

With more screening, the emphasis on providing mental health help will get the front and center attention it needs. Our quality of life actually depends on it.

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