This 32-Year-Old Florida Woman Is Dead Because Her State Refused To Expand Medicai

Charlene Dill died because Florida Republicans refused to expand Medicaid that would have paid for her heart health care CREDIT: GoFundMe

This 32-Year-Old Florida Woman Is Dead Because Her State Refused To Expand Medicaid
By Tara Culp-Ressler
Think Progress
April 9, 2014

Charlene Dill, a 32-year-old mother of three, collapsed and died on a stranger’s floor at the end of March. She was at an appointment to try to sell a vacuum cleaner, one of the three part-time jobs that she worked to try to make ends meet for her family. Her death was a result of a documented heart condition — and it could have been prevented.

Dill was uninsured, and she went years without the care she needed to address her chronic conditions because she couldn’t afford it.

Under the health reform law, which seeks to expand coverage to millions of low-income Americans, Dill wasn’t supposed to lack insurance. She was supposed to have access to a public health plan through the law’s expansion of the Medicaid program. But Dill, a Florida resident, is one of the millions of Americans living in a state that has refused to accept Obamacare’s Medicaid expansion after the Supreme Court ruled this provision to be optional. Those low-income people have been left in a coverage gap, making too much income to qualify for a public Medicaid plan but too little income to qualify for the federal subsidies to buy a plan on Obamacare’s private exchanges.

Florida has one of the highest uninsurance rates in the nation, and is home to a disproportionately large number of residents who struggle to afford health services. Nonetheless, lawmakers have continued to resist accepting generous federal funds to expand Medicaid to an estimated 750,000 low-income Floridians like Dill.

Although Florida Gov. Rick Scott (R) initially indicated that he was in favor of accepting the funds for expansion, he’s since walked back that position. Meanwhile, Republicans in the legislature don’t even plan to schedule a vote to address Medicaid expansion during their current session, suggesting that the federal government won’t actually come through with the funding to support the policy.

Dill made about $9,000 annually by babysitting, cleaning houses, and selling vacuum cleaners. As the Orlando Weekly reports, she was optimistic about her coverage options under President Obama’s administration. She tried to sign up for Obamacare using the online calculator on HealthCare.gov, but quickly found out she fell within the coverage gap.

In the absence of health coverage, Dill’s best friend, Kathleen Voss Woolrich, occasionally turned to crowdfunding sites on the internet to raise the money Dill needed to pay for her heart medication. Last month, Woolrich crowdfunded to pay for Dill’s funeral.

In an emotional blog post published on the site Women on the Move at the end of last month, Woolrich blamed Florida politicians for her friend’s early death.

“You see the main argument Republicans use is that it’s some lazy person who needs Medicaid expansion. That those of us living without healthcare or dental care are lazy. But my friend, a single beautiful mother, worked three jobs,” Woolrich wrote. “I am burying my best friend because of the policies of the Republican Party. I am burying my best friend because had Medicaid expanded, her needs would have been met.”

And Dill won’t be the only one. A recent study conducted by Harvard researchers estimated that as many as 17,000 people will die directly as a result of their states refusing to expand Medicaid. In Florida, that translates to about six deaths like Dill’s every single day. This issue is exacerbated by the fact that the low-income residents in states that have resisted Medicaid expansion tend to have more health problems than the residents in other states.

Democratic officials in Florida have responded strongly to Woolrich’s story. Rep. Alan Grayson (D) — who told the Orlando Weekly that his colleaugues’ resistance to Medicaid expansion “has put the GOP’s appalling disregard for human life on full display” — entered Woolrich’s blog post into the Congressional record.

“I memorialized Charlene’s life and death in the Congressional Record, because the Republicans want to pretend that none of this is happening. That Charlene didn’t die as a result of their callous neglect — that no Floridians will die as a result of their willful refusal to expand Medicaid at no cost,” Grayson explained. “But I’m not going to let them forget. I’m not going to let them pretend. This is not a game; this is very real. This is life and death.”

Dead' man's recovery shows why prolonged CPR works

When you run out of air to breathe, apparently the best thing to do is to dip your head in ice cubes and hope that someone comes along and revives you.

Dead' man's recovery shows why prolonged CPR works
Barbara Mantel
NBC News
August 22, 2013

An Ohio man’s recovery several minutes after doctors declared him dead shows how murky the decision can be about when to stop resuscitation efforts.

While Anthony Yahle, 37, may not have been dead for 45 minutes, as was widely reported, his remarkable bounce back without suffering brain damage or other ill effects stunned doctors at Kettering Medical Center in Kettering, Ohio.

Yahle, a diesel mechanic from West Carrollton, Ohio, “coded” -- a term meaning emergency -- on the afternoon of Aug. 5, after arriving in the hospital that morning in cardiac arrest. A team of doctors rushed to his hospital bedside and used chest compressions, a bag connected to a breathing tube and medications to force blood and oxygen through his body. After 45 minutes, they gave up and declared him dead.

“He was truly flatlined at the end of that code. He had no electrical motion, no respiration, and no heart beat, and no blood pressure,” says Jayne Testa, director of cardiovascular services at Kettering.

But five to seven minutes later, the team noticed a trace of electrical activity on his heart monitor and resumed their efforts to resuscitate him. Yahle is now home recovering, according to Testa.

While Yahle "was not dead for 45 minutes," the Kettering doctors “have never seen somebody come back after the code was ended and especially after so many minutes,” says Testa.

Michael Sayre, a professor of emergency medicine at the University of Washington in Seattle and a spokesperson for the American Heart Association, says he has seen and heard of similar cases. It’s unusual but not unique, he says. Sayre doesn’t know what happened in Yahle's case, but sometimes during resuscitation air gets trapped and pressure builds in the lungs, preventing blood from flowing into the heart.

“So, I have seen once or twice where we would disconnect the bag from the breathing tube and push on the chest to let the air out, and then the patient would get a pulse and have a blood pressure because they were able to get blood back to the heart,” says Sayre.

In any case, Sayre says more hospitals may want to follow Kettering’s lead and sustain resuscitation efforts for longer than the typical 20 to 25 minutes. A 2012 nationwide study of hospitals showed that “in the hospitals where they worked for longer, they got more people back, who ended up surviving and going home,” says Sayre.

Technology can help a team decide when to stop. Most hospitals now have the ability to measure the amount of carbon dioxide in the air coming out of the patient. Carbon dioxide is a byproduct of living cells. No carbon dioxide would add to the evidence that the patient is dead. Kettering Medical Center does not continuously measure carbon dioxide levels during resuscitation.

“However, you can be faked out,” says Sayre. And sometimes even with fairly normal carbon dioxide levels, a team will stop resuscitation because “we still cannot get the heart to beat on its own,” says Sayre.

But in Yahle’s case, doctors were finally able to get his heart to beat spontaneously.

“This team did a really good job. They were able to keep his brain alive, and that’s why he survived,” says Sayre.

The Kettering doctors cooled Yahle’s body, and that may have preserved his brain function. “People can definitely go seven minutes without blood flow if the brain is cooled. That is something that is well known,” says Sayre. For example, during brain surgery, doctors cool the body and stop blood flow for even longer periods of time.

There are theories about why that works. “But no one really knows the answer to that,” says Sayre.

Do doctors have too much political clout? Kamala Harris protects bad doctors from public scrutiny

Doctors seem to have too much clout in government, protecting them from scrutiny. We need more oversight of doctors and less secrecy in the medical profession.

Kamala Harris has a powerful tool for identifying reckless doctors, but she doesn't use it.
By Lisa Girion and Scott Glover
LA Times
December 30, 2012

As California's attorney general, Harris controls a database that tracks prescriptions for painkillers and other commonly abused drugs from doctors' offices to pharmacy counters and into patients' hands.

The system, known as CURES, was created so physicians and pharmacists could check to see whether patients were obtaining drugs from multiple providers.

Law enforcement officials and medical regulators could mine the data for a different purpose: To draw a bead on rogue doctors.

But they don't, and that has allowed corrupt or negligent physicians to prescribe narcotics recklessly for years before authorities learned about their conduct through other means, a Times investigation found.

Prescription drug overdoses have increased sharply over the last decade, fueling a doubling of drug fatalities in the U.S. To help stem the loss of life, the federal Centers for Disease Control and Prevention recommends that states use prescription data to spot signs of irresponsible prescribing, and at least six states do.

California is not one of them.

By monitoring the flow of prescriptions, authorities can get an early jump on illegal or dangerous conduct by a doctor. Among the telltale signs: writing an inordinate number of prescriptions for addictive medications or for combinations of drugs popular among addicts.

Harris' office keeps CURES off-limits to the public and the news media. But information from a commercial database containing the same kind of data illustrates how valuable CURES could be as an investigative tool.

Private firms purchase prescription data from pharmacies and sell it to drug companies for use in marketing their products. The Times obtained a list from such a database ranking the most prolific prescribers of narcotic painkillers in the Los Angeles area for June 2008.

Of the top 10 doctors on the list, six were eventually convicted of drug dealing or similar crimes or were sanctioned by medical regulators. One of them was a cocaine addict. Some had been prescribing narcotics in high volume for years before authorities caught up with them.

At least 20 of their patients died of overdoses or related causes after taking drugs they prescribed, according to coroners' records.

Had officials been tracking the doctors' prescriptions in CURES, some of those deaths might have been prevented.

Harris, a career prosecutor who was elected attorney general in 2010, declined repeated requests to be interviewed for this article.

Nathan Barankin, her chief of staff, said Harris wants to improve CURES so more doctors can use it to identify drug-seeking patients, and to help prosecutors pursue dealers and other drug offenders.

She has not proposed using CURES to detect signs of excessive prescribing.

Barankin said financial constraints limit the attorney general's options. CURES is "on life support" because of state budget cuts and is barely able to fulfill its primary mission of helping doctors and pharmacists track patients' use of medications, he said.

Even so, the database, as is, could be used to look for signs of improper prescribing. "It certainly has that capacity, as I understand it," Barankin said.

He added, however, that if Harris did begin using CURES to monitor doctors, the state Department of Justice lacks the resources to follow up on leads.

"We don't have the horses or the ability to do that kind of work," he said.

The Medical Board of California, which licenses and oversees physicians, has appealed to the public to report instances of excessive prescribing, a step it took in response to recent Times articles on overdose deaths.

But the board does not use CURES to identify doctors whose prescribing poses a danger to patients.

"We don't have the resources," said executive director Linda K. Whitney.

Dr. Tyron Reece was one physician who would have tripped an alarm early on, if officials had been watching his prescriptions in CURES.

The Inglewood family practitioner ranked fourth among prescribers of oxycodone and hydrocodone in the Los Angeles area in June 2008, according to the commercial database. Reece's customers paid for nearly all those prescriptions in cash, the data show.

The pharmacies that filled Reece's prescriptions were required by law to report them to CURES.

But Reece was not stopped until 2011, and then only because federal authorities investigating a drug smuggling ring stumbled upon evidence that implicated him. Dozens of prescription vials bearing the doctor's name had been found in the trash at a suspect's home.

Confronted by investigators, Reece admitted that he regularly sold prescriptions for cash to patients he had never examined. He pleaded guilty to drug dealing and is awaiting sentencing.

Nathan Kuemmerle, a West Hollywood psychiatrist, was busted in 2010 after narcotics detectives arrested a suspect for selling prescription pills on Craigslist. The suspect identified Kuemmerle as the source of the drugs, court records show.

During their investigation, detectives requested a CURES report on Kuemmerle in 2009 and found that he was the No. 2 prescriber of narcotic painkillers in California and the No. 1 prescriber of the highest-dose form of the stimulant Adderall, according to court records.

Kuemmerle prescribed nearly four times as many of the Adderall pills as the next doctor on the list, the CURES report showed. A medical expert said Kuemmerle wrote an average of 15 prescriptions per day for controlled substances over a four-year period, a "remarkably high" figure, court records show.

Kuemmerle pleaded guilty in 2011 to drug dealing and was sentenced to three years' probation.

Investigators expressed amazement that Kuemmerle was able to get away with such high-volume prescribing while his prescriptions were being reported to CURES. The failure to use the database to look for signs of improper prescribing closes off a valuable source of leads, they say.

"If a doctor is prescribing in a way that could be considered unreasonable, there is nothing from CURES to say, 'This might be a problem,'" said Redondo Beach Police Det. Robert Carlborg, who worked on the case. "If there had been, Kuemmerle would have been caught way sooner."...

Debra, 54, and Jesse Barajas, 20

Amos Barajas holds his wife's driver's license and a photograph of his son Jesse as a young boy. As Jesse got older, he began abusing drugs and alcohol and stole his mother's medications, Amos said. Jesse was 20 when he died of an overdose on fentanyl, which was believed to have been his mother's. Debra died of an overdose about 16 months later at the age of 54. Amos Barajas' son, Jesse, and his wife, Debra, overdosed in their home in Goleta, where Amos still lives with the family dog. Amos Barajas lost his 20-year-old son, Jesse, then his wife, Debra, to prescription medication overdoses.

Joey Rovero, 21

Joey Rovero drove more than 350 miles from Arizona State University in Tempe to get his prescriptions from a doctor in Rowland Heights and then 33 more miles to Pacifica Pharmacy in Huntington Beach. “I thought to myself, ‘Why in the world would these kids go that much farther out of their way?’ ” said Joey’s mother, April Rovero, above, with husband Joe. The fading sun reflects off the windows of the apartment complex in Tempe, Ariz., where Joey Rovero overdosed. (Aaron Lavinsky / For the Los Angeles Times) April and Joe Rovero hold a picture of their son Joey with his birthday cupcakes. He had flown home from Arizona State University to celebrate his 20th birthday with his family and girlfriend. He was 21 when he died from a drug overdose.

Byron McKinney, 33

Byron McKinney in a family photo with his brother Clint, left. Clint McKinney's brother Byron died of prescription drug-related causes in 2008. Byron McKinney was found dead of a prescription medication overdose in this Van Nuys house.

Andrew Corless, 46

Leslie Greenberg found her boyfriend, Andrew Corless, dead in front of their Northridge home. “He was a kind and gentle soul and did not deserve this,” Leslie Greenberg said of her late boyfriend Andrew Corless. He called Dr. Carlos Estiandan’s office on Aug. 11, 2006, saying he was about to undergo drug detoxification and asking the doctor to “please not see him anymore.” Corless recanted, and Estiandan continued prescribing drugs for him. He died of an overdose months later. Greenberg said the phone call was a “cry for help.” Leslie Greenberg keeps a photo and mementos from her late boyfriend, Andrew Corless, who died at the age of 46 of acute combined medicinal drug and alcohol intoxication in December 2006.

Naythan Kenney was living in an apartment in this building in Huntington Beach when he fatally overdosed in 2008, at the age of 34. Photographs of Verlene Crawford's late son, Naythan Kenney, fill much of the space on her refrigerator. “It's sad, but I need to see his face,” Crawford said. “I don't want to forget him … or put him in a storage closet. It hurts to look at him, but I can't imagine putting everything away and not looking at him.” “A lot of people say it stems from home, drugs. No, not all of it stems from home. It takes just a prescription. Just a prescription can tear a whole family apart. And that's the God's truth,” Darlene Cronin, right, with daughter Verlene Crawford, says of her grandson Naythan Kenney.

Naythan Kenney, 34 speaking, grandmother Darlene Cronin

Kelle Stavron found her son Matthew on her bathroom floor, dead at the age of 24. OxyContin, Soma and Xanax were strewn around. Matthew Stavron was 13 when he shattered his leg in a motorcycle accident in the 1990s. He had numerous surgeries — with complications — and began abusing prescription drugs. “I mean, oh my God, how could this be? How could this be? On the street, when the kids are using...they're using, they're using. But this is a doctor. My son saw a doctor,” Kelle Stavron, with her husband, Bruce, said of their son Matthew's death.

Matthew Stavron, 24 speaking, mother Kelle Stavron

Chaz La Bry, a 26-year-old aspiring rapper from San Clemente, died of an overdose of prescription medication and methamphetamine at his parents' apartment in San Clemente. Chaz La Bry, 26, was last seen alive by his father, Randy La Bry, sleeping on the living room couch. He had recently been released from jail and had been living with his parents. Darenee La Bry comforts her mother, Robin, center, as Robin recounts the day her son died of an overdose.

Chaz La Bry, 26 speaking, mother Robin La Bry

William “Skip” Halpin was found dead in a planter outside a private business complex in the 6011 block of Ball Road in Cypress from a prescription drug overdose. “There's just something different about it. It's not heroin. It's not marijuana. It's not cocaine. It's not alcohol. They're just little pills,” Jerry Halpin, principal of Brea Olinda High School in Brea, said about his brother's abuse of prescription drugs. Jerry Halpin's older brother, William “Skip” Halpin, second from left, died of a prescription drug overdose in 2008. He was a heroin abuser who had been sober for nine days before his death and was using methadone for detoxification, according to coroner's records.

William "Skip" Halpin, 51 speaking, brother Jerry Halpin

Margaret Polizo, an occupational therapist, saw her husband Doneno “Rick” Polizo on the couch before he died in 2009. He appeared to be “sleeping and snoring.” He died of multiple drug overdose. Margaret Polizo's husband, Doneno “Rick” Polizo died of an overdose in 2009. Not only did he miss watching his son and daughter grow up, she said, but his children missed out on having him in their adult lives. Margaret Polizo holds a photograph of her and her husband, Doneno “Rick” Polizo, who had a long-term problem with heroin and other illicit drugs.

Doneno "Rick" Polizo, 58 speaking, wife Margaret Polizo

“When I look at the Medicare statements that I was given for the last three months of his life, and I look at the incredible, unbelievable number of prescriptions that were prescribed to him by five different doctors — it makes me wonder what is going on out there,” Sally Finnila-Sloane says of her brother Karl Finnila, who died of an overdose in 2007. Karl Finnila sat down on the curb and died of a prescription medication overdose on the cul-de-sac at the end of this street near a sober-living home he checked into that day. Sally Finnila-Sloane's brother Karl Finnila in a photograph taken at the sober-living home shortly before he died of an overdose.

Karl Finnila, 43 speaking, sister Sally Finnila-Sloane

Danielle Thurber keeps a photograph of her late sister, Jennifer Beth Thurber, in a wallet that once belonged to her sister, who died of a prescription medication overdose in 2007 at the age of 22. Jennifer Thurber overdosed at home in May 2007. Her father, Charles, found her in her bed, pale and motionless. Charles Thurber, an Orange County sheriff's deputy, sits with his daughter, Danielle, at a park near their home in Fountain Valley.

Jennifer Thurber, 22 speaking, father Charles Thurber

As a teenager, Alex Clyburn was an athlete and Eagle Scout. In 2006, after he suffered painful injuries in an auto accident, he became addicted to OxyContin. Alex Clyburn, 23, died of a drug overdose after being admitted to a rehab facility in 2008. "If it can happen to us, it can happen to anybody," Arline Clyburn said of her son Alex's addiction to prescription drugs.

Alex Clyburn, 23 speaking, father Ron Clyburn

Larry Carmichael filled a doctor's prescription for half a dozen pain and anxiety medications days before he fatally overdosed on March 12, 2007. He was 51. Dan Carmichael found his father, Larry, dead from an accidental overdose of morphine in this apartment complex. Larry had moved in days before his death and Dan told a coroner's investigator that he thought his father’s back might have been bothering him during the move. Larry Carmichael didn’t live to see the children of his son Dan, and daughter-in-law, Rachel.

Larry Carmichael, 51 speaking, son Dan Carmichael

“Was he a junkie? No. Was he in pain? Yes. Could he get it fixed with prescriptions? Evidently not; you have to take too many,” Ron Oshier said about his brother, Clifford Dwight Oshier, who died of a prescription medication overdose in July 2009. Clifford Dwight Oshier, who had worked as a financial planner, had lost his business and home in the months before he died, said his brother, Ron Oshier. Clifford had been involved in multiple motorcycle accidents and had developed chronic pain. Clifford Oshier died in his San Diego apartment located in this residential community atop a secluded hill overlooking Mission Valley.

Clifford Dwight Oshier, 60 speaking, brother Ron Oshier