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   TRENTON, N.J. (AP) - Men who are bashful about needing help in the bedroom no longer have to visit a drugstore to buy that little blue pill.

   In a first for the drug industry, Pfizer Inc. says starting today it will sell begin selling erectile dysfunction pill Viagra directly to patients on its website.

   Men still will need a prescription to buy the blue pill on viagra.com, but they won't have to face a pharmacist to get it filled.

   Other drugmakers likely will watch closely, and could begin selling other medicines online.'

 
Monday, 06 May 2013 04:13
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NEW YORK (AP) -- The suicide rate among middle-aged Americans climbed a startling 28 percent in a decade, a period that included the recession and the mortgage crisis, the government reported Thursday.

The trend was most pronounced among white men and women in that age group. Their suicide rate jumped 40 percent between 1999 and 2010.

But the rates in younger and older people held steady. And there was little change among middle-aged blacks, Hispanics and most other racial and ethnic groups, the report from the Centers for Disease Control and Prevention found.

Why did so many middle-aged whites - that is, those who are 35 to 64 years old - take their own lives?

One theory suggests the recession caused more emotional trauma in whites, who tend not to have the same kind of church support and extended families that blacks and Hispanics do.

The economy was in recession from the end of 2007 until mid-2009. Even well afterward, polls showed most Americans remained worried about weak hiring, a depressed housing market and other problems.

Pat Smith, violence-prevention program coordinator for the Michigan Department of Community Health, said the recession - which hit manufacturing-heavy states particularly hard - may have pushed already-troubled people over the brink. Being unable to find a job or settling for one with lower pay or prestige could add "that final weight to a whole chain of events," she said.

Another theory notes that white baby boomers have always had higher rates of depression and suicide, and that has held true as they've hit middle age. During the 11-year period studied, suicide went from the eighth leading cause of death among middle-aged Americans to the fourth, behind cancer, heart disease and accidents.

"Some of us think we're facing an upsurge as this generation moves into later life," said Dr. Eric Caine, a suicide researcher at the University of Rochester.

One more possible contributor is the growing sale and abuse of prescription painkillers over the past decade. Some people commit suicide by overdose. In other cases, abuse of the drugs helps put people in a frame of mind to attempt suicide by other means, said Thomas Simon, one of the authors of the CDC report, which was based on death certificates.

People ages 35 to 64 account for about 57 percent of suicides in the U.S.

The report contained surprising information about how middle-aged people kill themselves: During the period studied, hangings overtook drug overdoses in that age group, becoming the No. 2 manner of suicide. But guns remained far in the lead and were the instrument of death in nearly half of all suicides among the middle-aged in 2010.

The CDC does not collect gun ownership statistics and did not look at the relationship between suicide rates and the prevalence of firearms.

For the entire U.S. population, there were 38,350 suicides in 2010, making it the nation's 10th leading cause of death, the CDC said. The overall national suicide rate climbed from 12 suicides per 100,000 people in 1999 to 14 per 100,000 in 2010. That was a 15 percent increase.

For the middle-aged, the rate jumped from about 14 per 100,000 to nearly 18 - a 28 percent increase. Among whites in that age group, it spiked from about 16 to 22.

Suicide prevention efforts have tended to concentrate on teenagers and the elderly, but research over the past several years has begun to focus on the middle-aged. The new CDC report is being called the first to show how the trend is playing out nationally and to look in depth at the racial and geographic breakdown.

Thirty-nine out of 50 states registered a statistically significant increase in suicide rates among the middle-aged. The West and the South had the highest rates. It's not clear why, but one factor may be cultural differences in willingness to seek help during tough times, Simon said.

Also, it may be more difficult to find counseling and mental health services in certain places, he added.

Suicides among middle-aged Native Americans and Alaska Natives climbed 65 percent, to 18.5 per 100,000. However, the overall numbers remain very small - 171 such deaths in 2010. And changes in small numbers can look unusually dramatic.

The CDC did not break out suicides of current and former military service members, a tragedy that has been getting increased attention. But a recent Department of Veterans Affairs report concluded that suicides among veterans have been relatively stable in the past decade and that veterans have been a shrinking percentage of suicides nationally.

--- Associated Press writer Jeff Karoub in Detroit contributed to this report.

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Friday, 03 May 2013 09:14
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   Air quality forecasting officially begins Wednesday for the 2013 summer season, and St. Louis residents will want to pay attention in order to protect their health.  

   Officials with the American Lung Association say that's because the air in St. Louis is getting worse.  Their latest State of the Air report shows the Gateway City is now ranked 25th worst in the nation for ozone pollution.  We were 34th last year.  

   And St. Louis is 12th when it comes to year round particulate pollution.  That's a slight improvement over our 10th place finish last year.  But officials say it still means St. Louis is among the most polluted metropolitan areas in the nation.  

   Residents who want to receive air quality updates by email, can sign up at the Clean Air St. Louis website

 

 
Wednesday, 01 May 2013 01:21
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   WASHINGTON (AP) - Looking for a new way to get that jolt of caffeine energy? Food companies are betting snacks like potato chips, jelly beans and gum with a caffeinated kick could be just the answer.

   The Food and Drug Administration is closely watching the marketing of these foods and wants to know more about their safety.

   The FDA said Monday it will look at the foods' effects on children in response to a caffeinated gum introduced this week by Wrigley. Alert Energy Gum promises "the right energy, right now."

   The agency is already investigating the safety of energy drinks and energy shots, prompted by consumer reports of illness and death.

 

A few products that have added caffeine:

— Wrigley Alert Energy Gum contains about 40 milligrams a piece, or the equivalent amount found in half a cup of coffee.

— Jelly Belly Extreme Sport Beans have 50 mg of caffeine in a 100-calorie pack.

— Arma Energy Snx markets chips, trail mix and other products that contain caffeine, including "chocolate caramel cookie caffeine mix."

— Wired Waffles sells caffeinated maple syrup and "energy waffles."

— Some varieties of Frito-Lay's Cracker Jack'd Power Bites are coated wafers that include two tablespoons of ground coffee.

— Kraft's Mio Energy "water enhancer" squirts caffeine and flavoring into water.

 
 
Tuesday, 30 April 2013 02:11
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NEW YORK (AP) -- They sweep. They swab. They sterilize. And still the germs persist.

In U.S. hospitals, an estimated 1 in 20 patients pick up infections they didn't have when they arrived, some caused by dangerous `superbugs' that are hard to treat.

The rise of these superbugs, along with increased pressure from the government and insurers, is driving hospitals to try all sorts of new approaches to stop their spread:

Machines that resemble "Star Wars" robots and emit ultraviolet light or hydrogen peroxide vapors. Germ-resistant copper bed rails, call buttons and IV poles. Antimicrobial linens, curtains and wall paint.

While these products can help get a room clean, their true impact is still debatable. There is no widely-accepted evidence that these inventions have prevented infections or deaths.

Meanwhile, insurers are pushing hospitals to do a better job and the government's Medicare program has moved to stop paying bills for certain infections caught in the hospital.

"We're seeing a culture change" in hospitals, said Jennie Mayfield, who tracks infections at Barnes-Jewish Hospital in St. Louis.

Those hospital infections are tied to an estimated 100,000 deaths each year and add as much as $30 billion a year in medical costs, according to the Centers for Disease Control and Prevention. The agency last month sounded an alarm about a "nightmare bacteria" resistant to one class of antibiotics. That kind is still rare but it showed up last year in at least 200 hospitals.

Hospitals started paying attention to infection control in the late 1880s, when mounting evidence showed unsanitary conditions were hurting patients. Hospital hygiene has been a concern in cycles ever since, with the latest spike triggered by the emergence a decade ago of a nasty strain of intestinal bug called Clostridium difficile, or C-diff.

The diarrhea-causing C-diff is now linked to 14,000 U.S. deaths annually. That's been the catalyst for the growing focus on infection control, said Mayfield, who is also president-elect of the Association for Professionals in Infection Control and Epidemiology.

C-diff is easier to treat than some other hospital superbugs, like methicillin-resistant staph, or MRSA, but it's particularly difficult to clean away. Alcohol-based hand sanitizers don't work and C-diff can persist on hospital room surfaces for days. The CDC recommends hospital staff clean their hands rigorously with soap and water - or better yet, wear gloves. And rooms should be cleaned intensively with bleach, the CDC says.

Michael Claes developed a bad case of C-diff while he was a kidney patient last fall at New York City's Lenox Hill Hospital. He and his doctor believe he caught it at the hospital. Claes praised his overall care, but felt the hospital's room cleaning and infection control was less than perfect.

"I would use the word `perfunctory,'" he said.

Lenox Hill spokeswoman Ann Silverman disputed that characterization, noting hospital workers are making efforts that patients often can't see, like using hand cleansers dispensers in hallways. She ticked off a list of measure used to prevent the spread of germs, ranging from educating patients' family members to isolation and other protective steps with each C-diff patient.

The hospital's C-diff infection rate is lower than the state average, she said.

Westchester Medical Center, a 643-bed hospital in the suburbs of New York City has also been hit by cases of C-diff and the other superbugs.

Complicating matters is the fact that larger proportions of hospital patients today are sicker and more susceptible to the ravages of infections, said Dr. Marisa Montecalvo, a contagious diseases specialist at Westchester.

There's a growing recognition that it's not only surgical knives and operating rooms that need a thorough cleaning but also spots like bed rails and even television remote controls, she said. Now there's more attention to making sure "that all the nooks and crannies are clean, and that it's done in perfect a manner as can be done," Montecalvo said.

Enter companies like Xenex Healthcare Services, a Texas company that makes a portable, $125,000 machine that's rolled into rooms to zap C-diff and other bacteria and viruses dead with ultraviolet light. Xenex has sold or leased devices to more than 100 U.S. hospitals, including Westchester Medical Center.

The market niche is expected to grow from $30 million to $80 million in the next three years, according to Frost & Sullivan, a market research firm.

Mark Stibich, Xenex's chief scientific officer, said client hospitals sometimes call them robots and report improved satisfaction scores from patients who seem impressed that the medical center is trotting out that kind of technology.

At Westchester, they still clean rooms, but the staff appreciates the high-tech backup, said housekeeping manager Carolyn Bevans.

"We all like it," she said of the Xenex.

At Cooley Dickinson Hospital, a 140-bed facility in Northampton, Mass., the staff calls their machines Thing One, Thing Two, Thing Three and Thing Four, borrowing from the children's book "The Cat in the Hat."

But while the things in the Dr. Seuss tale were house-wrecking imps, Cooley Dickinson officials said the ultraviolet has done a terrific job at cleaning their hospital of the difficult C-diff.

"We did all the recommended things. We used bleach. We monitored the quality of cleaning," but C-diff rates wouldn't budge, said nurse Linda Riley, who's in charge of infection prevention at Cooley Dickinson.

A small observational study at the hospital showed C-diff infection rates fell by half and C-diff deaths fell from 14 to 2 during the last two years, compared to the two years before the machines.

Some experts say there's not enough evidence to show the machines are worth it. No national study has shown that these products have led to reduced deaths or infection rates, noted Dr. L. Clifford McDonald of the Centers for Disease Control and Prevention.

His point: It only takes a minute for a nurse or visitor with dirty hands to walk into a room, touch a vulnerable patient with germy hands, and undo the benefits of a recent space-age cleaning.

"Environments get dirty again," McDonald said, and thorough cleaning with conventional disinfectants ought to do the job.

Beyond products to disinfect a room, there are tools to make sure doctors, nurses and other hospital staff are properly cleaning their hands when they come into a patient's room. Among them are scanners that monitor how many times a health care worker uses a sink or hand sanitizer dispenser.

Still, "technology only takes us so far," said Christian Lillis, who runs a small foundation named after his mother who died from a C-diff infection.

Lillis said the hospitals he is most impressed with include Swedish Covenant Hospital in Chicago, where thorough cleanings are confirmed with spot checks. Fluorescent powder is dabbed around a room before it's cleaned and a special light shows if the powder was removed. That strategy was followed by a 28 percent decline in C-diff, he said.

He also cites Advocate Christ Medical Center in Oak Lawn, Ill., where the focus is on elbow grease and bleach wipes. What's different, he said, is the merger of the housekeeping and infection prevention staff. That emphasizes that cleaning is less about being a maid's service than about saving patients from superbugs.

"If your hospital's not clean, you're creating more problems than you're solving," Lillis said.

--- Online: CDC: HTTP://WWW.CDC.GOV/HAI/

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Monday, 29 April 2013 06:18
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WASHINGTON (AP) -- We're in denial: Americans underestimate their chances of needing long-term care as they get older - and are taking few steps to get ready.

A new poll examined how people 40 and over are preparing for this difficult and often pricey reality of aging, and found two-thirds say they've done little to no planning.

In fact, 3 in 10 would rather not think about getting older at all. Only a quarter predict it's very likely that they'll need help getting around or caring for themselves during their senior years, according to the poll by the AP-NORC Center for Public Affairs Research.

That's a surprise considering the poll found more than half of the 40-plus crowd already have been caregivers for an impaired relative or friend - seeing from the other side the kind of assistance they, too, may need later on.

"I didn't think I was old. I still don't think I'm old," explained retired schoolteacher Malinda Bowman, 60, of Laura, Ohio.

Bowman has been a caregiver twice, first for her grandmother. Then after her father died in 2006, Bowman moved in with her mother, caring for her until her death in January. Yet Bowman has made few plans for herself.

"I guess I was focused on caring for my grandmother and mom and dad, so I didn't really think about myself," she said. "Everything we had was devoted to taking care of them."

The poll found most people expect family to step up if they need long-term care - even though 6 in 10 haven't talked with loved ones about the possibility and how they'd like it to work.

Bowman said she's healthy now but expects to need help someday from her two grown sons. Last month, prompted by a brother's fall and blood clot, she began the conversation by telling her youngest son about her living will and life insurance policy.

"I need to plan eventually," she acknowledged.

Those family conversations are crucial: Even if they want to help, do your relatives have the time, money and knowhow? What starts as driving Dad to the doctor or picking up his groceries gradually can turn into feeding and bathing him, maybe even doing tasks once left to nurses such as giving injections or cleaning open wounds. If loved ones can't do all that, can they afford to hire help? What if you no longer can live alone?

"The expectation that your family is going to be there when you need them often doesn't mean they understand the full extent of what the job of caregiving will be," Susan Reinhard, a nurse who directs AARP's Public Policy Institute, said. "Your survey is pointing out a problem for not just people approaching the need for long-term care, but for family members who will be expected to take on the huge responsibility of providing care."

Those who have been through the experience of receiving care are less apt to say they can rely on their families in times of need, the poll found.

With a rapidly aging population, more families will be facing those responsibilities. Government figures show nearly 7 in 10 Americans will need long-term care at some point after they reach age 65, whether it's from a relative, a home health aide, assisted living or a nursing home. On average, they'll need that care for three years.

Despite the "it won't happen to me" reaction, the AP-NORC Center poll found half of those surveyed think just about everyone will need some assistance at some point. There are widespread misperceptions about how much care costs and who will pay for it. Nearly 60 percent of those surveyed underestimated the cost of a nursing home, which averages more than $6,700 a month.

Medicare doesn't pay for the most common types of long-term care. Yet 37 percent of those surveyed mistakenly think it will pay for a nursing home and even more expect it to cover a home health aide when that's only approved under certain conditions.

The harsh reality: Medicaid, the federal-state program for the poor, is the main payer of long-term care in the U.S., and to qualify seniors must have spent most of their savings and assets. But fewer than half of those polled think they'll ever need Medicaid - even though only a third are setting aside money for later care, and just 27 percent are confident they'll have the financial resources they'll need.

In Cottage Grove, Ore., Police Chief Mike Grover, 64, says his retirement plan means he could afford a nursing home. And like 47 percent of those polled, he's created an advance directive, a legal document outlining what medical care he'd want if he couldn't communicate.

Otherwise, Grover said he hasn't thought much about his future care needs. He knows caregiving is difficult, as he and his brother are caring for their 85-year-old mother.

Still, "until I cross that bridge, I don't know what I would do. I hope that my kids and wife will pick the right thing," he said. "It depends on my physical condition, because I do not want to be a burden to my children."

The AP-NORC Center poll found widespread support for tax breaks to encourage saving for long-term care, and about half favor the government establishing a voluntary long-term care insurance program. An Obama administration attempt to create such a program ended in 2011 because it was too costly.

The older they get, the more preparations people take. Just 8 percent of 40- to 54-year-olds have done much planning for long-term care, compared with 30 percent of those 65 or older, the poll found.

Mary Pastrano, 74, of Port Orchard, Wash., has planned extensively for her future health care. She has lupus, heart problems and other conditions, and now uses a wheelchair. She also remembers her family's financial struggles after her own father died when she was a child.

"I don't want people to stand around and wring their hands and wonder, `What would Mom think was the best?'" said Pastrano, who has discussed her insurance policies, living will and care preferences with her husband and children.

Still, Pastrano wishes she and her husband had started saving earlier, during their working years.

"You never know how soon you're going to be down," she said. "That's what older people have a problem understanding: You can be in your 60s and then next flat on your back. You think you're invincible, until you can't walk."

The AP-NORC Center for Public Affairs Research survey was conducted Feb. 21 through March 27, with funding from the SCAN Foundation. The SCAN Foundation is an independent, nonprofit organization that supports research and other initiatives on aging and health care. The nationally representative poll involved landline and cellphone interviews with 1,019 Americans age 40 or older. It has a margin of sampling error of plus or minus 4.1 percentage points.

---

Associated Press writer Stacy A. Anderson and News Survey Specialist Dennis Junius contributed to this report.

---

Online:

Government long-term care primer: HTTP://LONGTERMCARE.GOV

AP-NORC Center for Public Affairs Research: HTTP://WWW.APNORC.ORG

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Wednesday, 24 April 2013 08:08
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DES MOINES, Iowa (AP) -- Days after they were badly hurt in a car accident, Jacinto Cruz and Jose Rodriguez-Saldana lay unconscious in an Iowa hospital while the American health care system weighed what to do with the two immigrants from Mexico.

The men had health insurance from jobs at one of the nation's largest pork producers. But neither had legal permission to live in the U.S., nor was it clear whether their insurance would pay for the long-term rehabilitation they needed.

So Iowa Methodist Medical Center in Des Moines took matters into its own hands: After consulting with the patients' families, it quietly loaded the two comatose men onto a private jet that flew them back to Mexico, effectively deporting them without consulting any court or federal agency.

When the men awoke, they were more than 1,800 miles away in a hospital in Veracruz, on the Mexican Gulf Coast.

Hundreds of immigrants who are in the U.S. illegally have taken similar journeys through a little-known removal system run not by the federal government trying to enforce laws but by hospitals seeking to curb high costs. A recent report compiled by immigrant advocacy groups made a rare attempt to determine how many people are sent home, concluding that at least 600 immigrants were removed over a five-year period, though there were likely many more.

In interviews with immigrants, their families, attorneys and advocates, The Associated Press reviewed the obscure process known formally as "medical repatriation," which allows hospitals to put patients on chartered international flights, often while they are still unconscious. Hospitals typically pay for the flights.

"The problem is it's all taking place in this unregulated sort of a black hole ... and there is no tracking," said law professor Lori Nessel, director of the Center for Social Justice at Seton Hall Law School, which offers free legal representation to immigrants.

Now advocates for immigrants are concerned that hospitals could soon begin expanding the practice after full implementation of federal health care reform, which will make deep cuts to the payments hospitals receive for taking care of the uninsured.

Health care executives say they are caught between a requirement to accept all patients and a political battle over immigration.

"It really is a Catch-22 for us," said Dr. Mark Purtle, vice president of Medical Affairs for Iowa Health System, which includes Iowa Methodist Medical Center. "This is the area that the federal government, the state, everybody says we're not paying for the undocumented."

Hospitals are legally mandated to care for all patients who need emergency treatment, regardless of citizenship status or ability to pay. But once a patient is stabilized, that funding ceases, along with the requirement to provide care. Many immigrant workers without citizenship are ineligible for Medicaid, the government's insurance program for the poor and elderly.

That's why hospitals often try to send those patients to rehabilitation centers and nursing homes back in their home countries.

Civil rights groups say the practice violates U.S. and international laws and unfairly targets one of the nation's most defenseless populations.

"They don't have advocates, and they don't have people who will speak on their behalf," said Miami attorney John De Leon, who has been arguing such cases for a decade.

Estimating the number of cases is difficult since no government agency or organization keeps track.

The Center for Social Justice and New York Lawyers for the Public Interest have documented at least 600 immigrants who were involuntarily removed in the past five years for medical reasons. The figure is based on data from hospitals, humanitarian organizations, news reports and immigrant advocates who cited specific cases. But the actual number is believed to be significantly higher because many more cases almost certainly go unreported.

Some patients who were sent home subsequently died in hospitals that weren't equipped to meet their needs. Others suffered lingering medical problems because they never received adequate rehabilitation, the report said.

Gail Montenegro, a spokeswoman for U.S. Immigration and Customs Enforcement, said the agency "plays no role in a health care provider's private transfer of a patient to his or her country of origin."

Such transfers "are not the result of federal authority or action," she said in an email, nor are they considered "removals, deportations or voluntary departures" as defined by the Immigration and Nationality Act.

The two Mexican workers in Iowa came to the U.S. in search of better jobs and found work at Iowa Select Farms, which provided them with medical insurance even though they had no visas or other immigration documents.

Cruz had been here for about six months, Rodriguez-Saldana for a little over a year. The men were returning home from a fishing trip in May 2008 when their car was struck by a semitrailer truck. Both were thrown from the vehicle and suffered serious head injuries.

Insurance paid more than $100,000 for the two men's emergency treatment. But it was unclear whether the policies would pay for long-term rehabilitation. Two rehabilitation centers refused to take them.

Eleven days after the car crash, the two men were still comatose as they were carried aboard a jet bound for Veracruz, where a hospital had agreed to take them.

Rodriguez-Saldana, now 39, said the Des Moines hospital told his family that he was unlikely to survive and should be sent home.

The hospital "doesn't really want Mexicans," he said in a telephone interview with the AP. "They wanted to disconnect me so I could die. They said I couldn't survive, that I wouldn't live."

Hospital officials said they could not discuss the case because of litigation. The men and their families filed a lawsuit in 2010 claiming they received minimal rehabilitative care in Veracruz.

A judge dismissed the lawsuit last year ruling that Iowa Methodist was not to blame for the inadequate care in Veracruz. The courts also found that even though the families of the men may not have consented to their transport to Mexico, they also failed to object to it. An appeals court upheld the dismissal.

Patients are frequently told family members want them to come home. In cases where the patient is unconscious or can't communicate, relatives are told their loved one wants to return, De Leon said.

Sometimes they're told the situation is dire, and the patient may die, prompting many grief-stricken relatives to agree to a transfer, he said.

Some hospitals "emotionally extort family members in their home country," De Leon said. "They make family members back home feel guilty so they can simply put them on a plane and drop them off at the airport."

In court documents, Iowa hospital officials said they had received permission from Saldana's parents and Cruz's long-term partner for the flight to Mexico. Family members deny they gave consent.

There's no way to know for sure whether the two men would have recovered faster or better in the United States. But the accident left both of them with life-altering disabilities.

Nearly five years later, the 49-year-old Cruz is paralyzed on his left side, the result of damage to his hip and spine. He has difficulty speaking and can't work.

"I can't even walk," he said in a telephone interview, breaking into tears several times. His long-term partner, Belem, said he's more emotional since the accident.

"He feels bad because he went over there and came back like this," she said. "Now he can't work at all. ... He cries a lot."

She works selling food and cleaning houses. Their oldest son, 22, sometimes contributes to the family income.

Rodriguez-Saldana said he has to pay for intensive therapy for his swollen feet and bad circulation. He also said he walks poorly and has difficulty working. He sells home supplies such as kitchen and bath towels and dishes, a business that requires a lot of walking and visiting houses. He often forgets where he lives, but people recognize him on the street and take him home because he's confused.

The American Hospital Association said it does not have a specific policy governing immigrant removals, and it does not track how many hospitals encounter the issue.

Nessel expects medical removals to increase with implementation of health care reform, which makes many more patients eligible for Medicaid. As a result, the government plans to cut payments to hospitals that care for the uninsured.

Some hospitals call immigration authorities when they receive patients without immigration documentation, but the government rarely responds, Nessel said. Taking custody of the patient would also require the government to assume financial responsibility for care.

Jan Stipe runs the Iowa Methodist department that finds hospitals in patients' native countries that are willing to take them. The hospital's goal, she said, is to "get patients back to where their support systems are, their loved ones who will provide the care and the concern that each patient needs."

The American Medical Association's Council on Ethical and Judicial Affairs issued a strongly worded directive to doctors in 2009, urging them not to "allow hospital administrators to use their significant power and the current lack of regulations" to send patients to other countries.

Doctors cannot expect hospitals to provide costly uncompensated care to patients indefinitely, the statement said. "But neither should physicians allow hospitals to arbitrarily determine the fate of an uninsured noncitizen immigrant patient."

Arturo Morales, a Monterrey, Mexico, lawyer who helps Cruz and Rodriguez-Saldana with legal issues, is convinced the men would have been better off staying in Iowa.

"I have no doubt," he said. "You have a patient who doesn't have money to pay you. You can't let them die."

--- Associated Press Writer Barbara Rodriguez in Des Moines contributed to this report. ---

Follow David Pitt on Twitter at: HTTP://TWITTER.COM/DAVEPITT . © 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Tuesday, 23 April 2013 06:25
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