Oliver Sacks Dies at 82; Neurologist and Author Explored the Brain’s Quirks - The New York Times

Oliver Sacks as portrayed by Robin Williams in   "The Awakening"

Oliver Sacks Dies at 82; Neurologist and Author Explored the Brain’s Quirks - The New York Times

Mental Health Access in Critical Condition

Jamycheal Mitchell, 24, had been held in Virginia jail without bail for nearly four months, accused of stealing a Mountain Dew, Snickers bar and a Zebra Cake was found dead on the floor of his jail cell 

after spending almost four months behind bars without bail for stealing groceries worth $5.

Jamycheal Mitchell, who had mental health problems, was discovered lying on the floor of his cell by guards early last Wednesday, according to authorities. While his body is still awaiting an autopsy, senior prison officials said his death was not being treated as suspicious.

“As of right now it is deemed ‘natural causes’,” Natasha Perry, the master jail officer at the Hampton Roads regional jail in Portsmouth, said of his death in an interview. Perry said there were no obvious outward signs of injury to the 24-year-old’s body. Portsmouth police are looking into the death.

Mitchell’s family said they believed he starved to death after refusing meals and medication at the jail, where he was being held on misdemeanour charges of petty larceny and trespassing. A clerk at Portsmouth district court said Mitchell was accused of stealing a bottle of Mountain Dew, a Snickers bar and a Zebra Cake worth a total of $5 from a 7-Eleven.

“His body failed,” said Roxanne Adams, Mitchell’s aunt. “It is extraordinary. The person I saw deceased was not even the same person.” Adams, who is a registered nurse, said Mitchell had practically no muscle mass left by the time of his death.

Except for a brief item stating that an inmate had been found dead, the story of Mitchell’s death has not been covered by local media in Virginia, and is reported for the first time here.

Adams said in an interview that her nephew had bipolar disorder and schizophrenia for about five years. Nicknamed Weezy, he lived with his mother Sonia and had been unable to hold down work. “He just chain-smoked and made people laugh,” said Adams. “He never did anything serious, never harmed anybody.”

Officials said that after his arrest, Mitchell was taken to Portsmouth city jail, where he stayed for almost three weeks before being transferred across the city to the regional jail on 11 May.

Ten days after that, the court clerk said, Judge Morton Whitlow ruled Mitchell was not competent to stand trial and ordered that he be transferred to Eastern State hospital, a state-run mental health facility in Williamsburg, for treatment.

The clerk said that typically in such cases “we do an order to restore the defendant to competence, send it to the hospital, and when the hospital has a bed, we do a transportation order, and he’s taken to the hospital.” Whitlow reiterated the order on 31 July and was due to review the case again on 4 September, according to the clerk.

But the hospital said it had no vacancy and the 24-year-old was therefore detained in jail until his death on 19 August, according to Adams, Mitchell’s aunt, who said she had tried to assist the hospitalisation process herself but was left frustrated.

Except for a brief item stating that an inmate had been found dead, the story of Mitchell’s death has not been covered by local media in Virginia, and is reported for the first time here.

Adams said in an interview that her nephew had bipolar disorder and schizophrenia for about five years. Nicknamed Weezy, he lived with his mother Sonia and had been unable to hold down work. “He just chain-smoked and made people laugh,” said Adams. “He never did anything serious, never harmed anybody.”

Officials said that after his arrest, Mitchell was taken to Portsmouth city jail, where he stayed for almost three weeks before being transferred across the city to the regional jail on 11 May.

Ten days after that, the court clerk said, Judge Morton Whitlow ruled Mitchell was not competent to stand trial and ordered that he be transferred to Eastern State hospital, a state-run mental health facility in Williamsburg, for treatment.

The clerk said that typically in such cases “we do an order to restore the defendant to competence, send it to the hospital, and when the hospital has a bed, we do a transportation order, and he’s taken to the hospital.” Whitlow reiterated the order on 31 July and was due to review the case again on 4 September, according to the clerk.

But the hospital said it had no vacancy and the 24-year-old was therefore detained in jail until his death on 19 August, according to Adams, Mitchell’s aunt, who said she had tried to assist the hospitalisation process herself but was left frustrated.

Young black man jailed since April for alleged $5 theft found dead in cell | US news | The Guardian

What do President Obama, Grand Theft Auto-5 and Healthcare.gov have in common ? Warning ! Adult audiences only

An amazing synthesis of ideas and not to be taken seriously

Speech Analytics Tool Predicts Schizophrenia With 100% Accuracy - iHealthBeat

Speech Analytics Tool Predicts Schizophrenia With 100% Accuracy - iHealthBeat

Colo. Medical Board Adopts New Telehealth Guidelines for Providers - iHealthBeat

Patients and providers will be pleased that regulatory agencies and medical state boards are developing guidelines for the use of telehealth.









Colo. Medical Board Adopts New Telehealth Guidelines for Providers - iHealthBeat

New breed of paramedics treats patients before emergencies occur - LA Times

When  does a paramedic become a independent health care provider. The line between physicians, nurses, physicians assistance is  becoming blurred as the future of health care evolves.

Paramedic Jacob Modglin parks on a palm-lined street in Oxnard and jumps out of his ambulance. 

He is prepared for any kind of emergency.

But his patient is standing in the driveway of a one-story house, holding a thermos, and smiling. It's time for his 8 p.m. appointment.

Modglin is part of a new cadre of "community paramedics" working in a dozen pilot programs across California. Their jobs are to treat patients before they get sick enough to need emergency care.

Many insurance companies and healthcare providers are seeking to curb spending by focusing on the small number of patients who drive the majority of costs. These so-called super-utilizers often have chronic conditions or other social problems that keep sending them to hospital emergency rooms and racking up big bills.

See the most-read stories this hour >>

A patient who visits an emergency room unnecessarily or is repeatedly admitted to a hospital, for instance, could be suffering from a chronic medical condition, or may not be able to afford medicine, or may be too frail to go pick up fresh food — or all of the above.

That makes it difficult to know how to assist these patients. But California healthcare leaders hope these specially trained community paramedics can help.

"There's a missing link in the chain here and we don't know what that is, but we're trying to find out," said Dr. Steven Rottman, medical director of the UCLA Center for Prehospital Care, which trained the community paramedics.

Willl this become the next standard of care ?  

In Ventura County, Modglin administers tuberculosis medicine to infected patients. Health officials there are worried about the illness — especially some cases that appear drug-resistant — and believe paramedics are in the best position to help stop its spread by providing patients with pills each day at their homes.

This may be useful during times when paramedics are idle, however sudden emergency 911 calls may divert these first responders to a timely  call.  Using paramedic-firemen seems to be a shortcut that will fail.

In addition to that who reimburses for the preventive medicine care?  Is this a public service ordinarily paid for by the taxpayer. Does the insurance company save money by  cost shifting to the tax payers?

Chatting under a fruit tree in the house's frontyard, they also talk about the patient's diabetes and the medicine that controls his high blood pressure. Modglin takes a look at the man's knee, because he slipped and fell earlier in the day.

"Not only do I administer his TB medicine, but I'm here to make sure his overall health is good," Modglin said.

Ventura County runs the tuberculosis program and another that sends paramedics to the homes of hospice patients.

Comments

• It's probably a worthy idea to see if many of the 911 callers can be sent to urgent care centers instead of emergency rooms. It's a lot cheaper and may save the lives of people who actually need emergency care.
  RTAMTC
  AT 10:00 AM AUGUST 25, 2015 

1

Los Angeles County has two initiatives as well, gearing up next month. In one, community paramedics in Glendale will visit patients with congestive heart failure within three days of their discharge from the hospital. They will try to make sure those patients — who typically have high readmission rates — are following their doctors' recommendations and living in an environment that's conducive to recovery.

With the advent of telemedicine it may allow physician supervision of first responders, much like first responders who communicate with an emergency  room in  transit as they treat a critically ill patient, such as in shock or in cardiac arrest.

As this concept spread there should be a careful evaluation. In 2017, researchers from UC San Francisco will evaluate the programs' success.

California's modern version of these emergency responders originated with a pilot program in Los Angeles County in the late 1960s as people started to take note of a high number of cardiac arrest deaths occurring outside hospitals. In 1970, California became the first state in the nation to allow paramedics to perform advanced medical life support.

But these days, Glendale paramedic Todd Tucker estimates that 10% to 20% of his calls aren't medical emergencies.

"We get called for you-name-it," said the Glendale fire captain, who's part of both Los Angeles County pilot programs. 

New breed of paramedics treats patients before emergencies occur - LA Times

Doctors' Virtual Consults With Patients To Double By 2020 - Forbes

Thanks to expanding health insurance coverage, the number of virtual video consultations between primary health care providers and their patients will double in five years in the U.S., fueling the nation’s telehealth boom, according to a new analysis.

A new report from information and analytics firm IHS says video consultations will jump overall to nearly 27 million in the U.S. market, driven by the primary care market where insurance coverage is rapidly widening. IHS  projects there will be cumulative annual growth of nearly 25% a year over the next five years to 5.4 million video consultations between primary care providers and their patients by 2020 from this year’s 2 million video consultations, IHS says.  “We’ve seen growth in reimbursement,” Roeen Roashan, medical technology analyst with IHS said in an interview.  “There’s no doubt payers are focused on virtual consultations. They are really pushing it.”

There are  however certain caveats, which include whether your insurer covers this type of virtual visit. In reality they are so inexpensive that many people would not even think about using their  health insurance, especially if it does not count as a 'deductible expense'..The swinging door is still open for change.  

State medical boards are 'waffleing' on the new virtual visit.   Previously a clinician had to examine a person before making a diagnosis or treatment. This was assumed to a real visit. Now that we have virtual visits the standard of care must be re-visited. Certainly not all conditions will require a real visit, however for good care, some conditions patients must still be seen. A virtual visit could serve as the first step to make an appointment.

Health plans see a way for patients to get high quality care from a physician and the potential to avoid a more expensive trip to a hospital emergency room. It also may be a way to get a quick answer from a doctor about an existing treatment regimen.

“We’ve seen growth in reimbursement,” Roeen Roashan, medical technology analyst with IHS said in an interview.  “There’s no doubt payers are focused on virtual consultations. They are really pushing it.”

 To be sure, major health plans like Aetna (AET), Anthem (ANTM), Cigna (CI) and UnitedHealth (UNH) are expanding coverage and offering more options to employer clients.

Total numbers of virtual consults is growing 10% a year with 16.6 million this year with growth projected to hit 26.9 million including consultations with specialists in many fields including mental health and dermatology. Specialty consultations are projected to jump from 14.5 million to 21.5 million, IHS figures show.

Much, however, needs to be done to meld virtual consultations into the health care system, analysts say, as the Affordable Care Act and insurers move providers to a more coordinated approach that is value-based and moves away from traditional fee-for-service medicine.

“Even though more and more people use online urgent care for $49, there won’t necessarily be an improvement of healthcare until providers integrate virtual consultations as part of their care delivery,” Roashan says. “This will allow a much more intimate experience and most likely at a lower cost than $49. We’ve seen large providers providing complimentary virtual consults for their patient population, and . . . that’s the model we need to see more of.”

What is interesting is that payors are at the forefront of the medical economy promoting virtual medicine because overall it will save money. The data will be analyzed and hopefully the savings will be apparent. 

Doctors' Virtual Consults With Patients To Double By 2020 - Forbes