Clip file / Local news from the states

Each month, this column features selected short items about state health care policy digested from publications from around the country.

Improving Medicaid services for the disabled to be focus of HCFA technical advisory group

BETHESDA, MD—Fixing shortfalls in caring for the disabled under the Medicaid program is the focus of a two-year technical advisory group being organized by the Health Care Financing Administration (HCFA).

"It’s not going to be an easy task, but it’s a task we need to be about," Sally K. Richardson, director of HCFA’s Center for Medicaid and State Operations, recently told Medicaid directors at an October meeting in Bethesda, MD.

Medicaid policy has not kept pace with the increasingly complicated technology of caring for the disabled, nor with the move of the disabled into the workplace, she says.

"As they move into employment, they endanger their eligibility," Ms. Richardson says.

The workgroup will be asked to address problems surrounding the Americans with Disabilities Act and other issues. Membership will include state and federal officials as well as advocates for the disabled, says Ann Wedgeworth, an assistant to Ms. Richardson.

—Staff reports

Chicago files suit against gun industry, seeks millions from "public nuisance"

CHICAGO—Reasoning that the gun shops are like factories that pollute or bar owners who serve minors, city officials in mid-November filed suit to collect $433 million in damages from what Mayor Richard Daley called a "public nuisance."

The suit against gun shops, manufacturers and distributors is of dubious legal merit, says University of Chicago Law School fellow John Lott Jr. It could have the desired effect nevertheless, he says, because the gun industry may not have the resources to support a drawn-out legal defense.

Mr. Daley planned a trip to Washington, DC, after the announcement to continue his campaign against guns.

"If money is the only language they understand, then money is the language we will use to make them understand that they have no business in Chicago," Mr. Daley declared. "We’re going to hit them where it hurts — in their bank accounts — and we won’t stop hitting them until they stop flooding our streets with guns."

The suit was widely denounced by the those in the gun and recreational sports industries, but drew the support of University of Arkansas at Little Rock professor Andrew McClurg, who noted that taxpayers assume about 80% of the $20 billion expended annually in caring for gunshot victims.

The suit filed in Cook County Circuit Court charges that the 22 manufacturers and four distributors listed as defendants in the suit "saturate the market . . . knowing that persons will illegally bring [weapons] into" Chicago.

This way, they "maximize their profits while disclaiming any knowledge of or responsibility for where their products end up or how they are used," the suit charges.

Mr. Daley announced plans for new state laws to crack down on gun ownership, including annual limits on the purchase of guns.

Chicago Tribune, Nov. 13

Women’s health information available through federal Internet clearinghouse

WASHINGTON, DC—The National Women’s Health Information Center (NWHIC), a combination Internet site and toll-free hotline for women’s health information, is available through the U.S. Public Health Service.

The address for the Web site is www.4woman.gov; the toll-free number is (800) 994-WOMAN.

The Web site links to all federal agencies and publications on women’s health, and to hundreds of government-screened private sector organizations. NWHIC also provides answers to frequently asked questions on top health issues of concern to American women.

The toll-free number connects the caller to a health information specialist who will refer the caller to the right source of information. Women and their health care providers also can order fact sheets, brochures, and other printed materials by phone.

NWHIC hyperlinks to more than 1,000 Web sites, including more than 300 federal sites, and to more than 2,700 federal documents on women’s health, 1,800 of which are already on-line. It organizes resources in a subject index to facilitate searches, links to databases and Web search engines by topic and agency, and offers graphical and text versions to accommodate all users. Information specialists are available on its toll-free telephone service from 9 a.m. to 6 p.m. Eastern time.

—U.S. Public Health Service release, Nov. 16

For more Americans, regular’ care is found at hospital outpatient departments or not at all

WASHINGTON, DC—A growing number of people do not have a regular source of medical care, and those who do have a "medical home" are more likely to rely on a hospital outpatient department than a physician’s office, according to a study published in the Journal of Health Care for the Poor and Underserved.

From 1987 to 1992, the number of Americans who did not have a regular source of care rose from 30 million to 39 million, or from 17% to 21% of the population, according to an analysis of data from the National Health Interview Survey.

Every population group experienced declines in access to regular care, with the most pronounced reductions found among Hispanics, people with less education or lower income, those in worse health, and residents of the South or rural areas.

People with a regular source of medical care are more likely to have better access to care and more likely to receive needed services, particularly preventive health services.

—Agency for Health Care Policy and Research release, Nov. 11

Study says nursing homes dispense unnecessary, harmful drugs; side effects mistaken for symptoms

ST. LOUIS—Nearly one-third of nursing home residents receive at least one drug that is at best unnecessary for their condition or at worst can be potentially harmful to them, according to a study presented by the American College of Clinical Pharmacy in St. Louis.

Researchers investigated charts on 500,000 residents in five states over a five-year period living in Medicare- or Medicaid-certified homes in Kansas, Maine, Mississippi, New York, and South Dakota.

The most common drug being improperly dosed was Darvon (propoxyphene), which the study notes was given without a rational medical reason or could be deemed harmful in approximately one of eight residents studied. Along with other drugs given improperly, the study found that nearly one in three residents receive a drug that doesn’t help their condition, while one in 10 are dosed with drugs "likely" to cause undesirable side effects.

"It’s not unusual for a new problem to be treated by an additional drug, and not be recognized as a side effect of a drug the patient is taking already," says Kate Lapane, PhD, an epidemiologist at Brown University. "Misuse of drugs in the elderly population is of concern because the elderly can react differently to a drug due to the effects of aging, and can experience more side effects," she says.

Drug Utilization Review, January 1999