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HHS: Expand antidiscrimination protections to transgender patients
Transgender patients who receive health care via government programs or funding must receive equal access to treatments and insurance coverage, according to a proposed rule issued Sept. 3 by the Health and Human Services department. The rule would extend antidiscrimination policies under the Affordable Care Act to include gender identity.
The rule would apply to health providers who accept patients covered by Medicare and Medicaid as well as insurance purchased via the health insurance marketplaces.
“The proposed rule clarifies and harmonizes existing well-established federal civil rights laws and clarifies the standards that HHS and in particular, the Office of Civil Rights, will apply in implementing [ACA] Section 1557,” Jocelyn Samuels, OCR director, said in a press conference. “Prior laws enforced by the Office of Civil Rights barred discrimination based only on race, color, national origin, age, or disability. All of the protections against sex discrimination that will be incorporated into the rule are new in this space.”
Section 1557 of the ACA extends civil rights protections to ban sex discrimination in federal health care programs and activities. The new proposed rule establishes that the prohibition on sex discrimination includes discrimination based on gender identity. The rule also includes requirements for effective communication for patients with disabilities and enhanced language assistance for patients with limited English proficiency.
Specifics of the proposed rule include:
• Patients must be treated equally and consistent with their gender identity by health providers. Insurers must provide fair access to coverage regardless of gender identity. For example, some insurers have historically excluded coverage of all care related to gender transition. Such categorical exclusions are prohibited under the proposed rule.
• Women must be treated equally with men in the health care they receive, not only in the health coverage they obtain but in the services they seek from providers.
• For patients with disabilities, the rule contains requirements for the provision of auxiliary aids and services, including alternative formats and sign language interpreters and the accessibility of programs offered through electronic and information technology.
• The rule bolsters language assistance for people with limited English proficiency so that patients are able to more effectively communicate with their providers to describe their symptoms and understand treatment.
During the press conference, Ms. Samuels clarified that the rule does not mean that health insurers must cover any specific treatments or procedures, rather they must apply nondiscriminatory criteria when assessing coverage requests.
The proposed extension of protections is, in part, driven by ongoing cases of sex and identity discrimination by some health providers. In one case, a hospital denied a transgender patient a room assignment consistent with her gender identity. In another, a male domestic violence victim was denied services at a hospital because he did not fit the traditional profile of a domestic violence victim, Ms. Samuels said. In another case, a health provider required that a husband be the guarantor for his wife’s medical bills but did not require the same for male patients and their spouses.
“There continue to be serious problems of discrimination in the health care arena,” she said. “This proposed rule provides very valuable tools for us to be able to appropriately address them.”
HHS is requesting comments on whether Section 1557 should include exemptions for religious organizations and, if so, to what extent. The administration notes that nothing in the proposed rule would affect the application of existing protections for religious beliefs and practices, such as provider conscience laws and regulations under the ACA involving preventive health services.
Comments on the rule will be accepted at www.regulations.gov until Nov. 6.
On Twitter @legal_med
Transgender patients who receive health care via government programs or funding must receive equal access to treatments and insurance coverage, according to a proposed rule issued Sept. 3 by the Health and Human Services department. The rule would extend antidiscrimination policies under the Affordable Care Act to include gender identity.
The rule would apply to health providers who accept patients covered by Medicare and Medicaid as well as insurance purchased via the health insurance marketplaces.
“The proposed rule clarifies and harmonizes existing well-established federal civil rights laws and clarifies the standards that HHS and in particular, the Office of Civil Rights, will apply in implementing [ACA] Section 1557,” Jocelyn Samuels, OCR director, said in a press conference. “Prior laws enforced by the Office of Civil Rights barred discrimination based only on race, color, national origin, age, or disability. All of the protections against sex discrimination that will be incorporated into the rule are new in this space.”
Section 1557 of the ACA extends civil rights protections to ban sex discrimination in federal health care programs and activities. The new proposed rule establishes that the prohibition on sex discrimination includes discrimination based on gender identity. The rule also includes requirements for effective communication for patients with disabilities and enhanced language assistance for patients with limited English proficiency.
Specifics of the proposed rule include:
• Patients must be treated equally and consistent with their gender identity by health providers. Insurers must provide fair access to coverage regardless of gender identity. For example, some insurers have historically excluded coverage of all care related to gender transition. Such categorical exclusions are prohibited under the proposed rule.
• Women must be treated equally with men in the health care they receive, not only in the health coverage they obtain but in the services they seek from providers.
• For patients with disabilities, the rule contains requirements for the provision of auxiliary aids and services, including alternative formats and sign language interpreters and the accessibility of programs offered through electronic and information technology.
• The rule bolsters language assistance for people with limited English proficiency so that patients are able to more effectively communicate with their providers to describe their symptoms and understand treatment.
During the press conference, Ms. Samuels clarified that the rule does not mean that health insurers must cover any specific treatments or procedures, rather they must apply nondiscriminatory criteria when assessing coverage requests.
The proposed extension of protections is, in part, driven by ongoing cases of sex and identity discrimination by some health providers. In one case, a hospital denied a transgender patient a room assignment consistent with her gender identity. In another, a male domestic violence victim was denied services at a hospital because he did not fit the traditional profile of a domestic violence victim, Ms. Samuels said. In another case, a health provider required that a husband be the guarantor for his wife’s medical bills but did not require the same for male patients and their spouses.
“There continue to be serious problems of discrimination in the health care arena,” she said. “This proposed rule provides very valuable tools for us to be able to appropriately address them.”
HHS is requesting comments on whether Section 1557 should include exemptions for religious organizations and, if so, to what extent. The administration notes that nothing in the proposed rule would affect the application of existing protections for religious beliefs and practices, such as provider conscience laws and regulations under the ACA involving preventive health services.
Comments on the rule will be accepted at www.regulations.gov until Nov. 6.
On Twitter @legal_med
Transgender patients who receive health care via government programs or funding must receive equal access to treatments and insurance coverage, according to a proposed rule issued Sept. 3 by the Health and Human Services department. The rule would extend antidiscrimination policies under the Affordable Care Act to include gender identity.
The rule would apply to health providers who accept patients covered by Medicare and Medicaid as well as insurance purchased via the health insurance marketplaces.
“The proposed rule clarifies and harmonizes existing well-established federal civil rights laws and clarifies the standards that HHS and in particular, the Office of Civil Rights, will apply in implementing [ACA] Section 1557,” Jocelyn Samuels, OCR director, said in a press conference. “Prior laws enforced by the Office of Civil Rights barred discrimination based only on race, color, national origin, age, or disability. All of the protections against sex discrimination that will be incorporated into the rule are new in this space.”
Section 1557 of the ACA extends civil rights protections to ban sex discrimination in federal health care programs and activities. The new proposed rule establishes that the prohibition on sex discrimination includes discrimination based on gender identity. The rule also includes requirements for effective communication for patients with disabilities and enhanced language assistance for patients with limited English proficiency.
Specifics of the proposed rule include:
• Patients must be treated equally and consistent with their gender identity by health providers. Insurers must provide fair access to coverage regardless of gender identity. For example, some insurers have historically excluded coverage of all care related to gender transition. Such categorical exclusions are prohibited under the proposed rule.
• Women must be treated equally with men in the health care they receive, not only in the health coverage they obtain but in the services they seek from providers.
• For patients with disabilities, the rule contains requirements for the provision of auxiliary aids and services, including alternative formats and sign language interpreters and the accessibility of programs offered through electronic and information technology.
• The rule bolsters language assistance for people with limited English proficiency so that patients are able to more effectively communicate with their providers to describe their symptoms and understand treatment.
During the press conference, Ms. Samuels clarified that the rule does not mean that health insurers must cover any specific treatments or procedures, rather they must apply nondiscriminatory criteria when assessing coverage requests.
The proposed extension of protections is, in part, driven by ongoing cases of sex and identity discrimination by some health providers. In one case, a hospital denied a transgender patient a room assignment consistent with her gender identity. In another, a male domestic violence victim was denied services at a hospital because he did not fit the traditional profile of a domestic violence victim, Ms. Samuels said. In another case, a health provider required that a husband be the guarantor for his wife’s medical bills but did not require the same for male patients and their spouses.
“There continue to be serious problems of discrimination in the health care arena,” she said. “This proposed rule provides very valuable tools for us to be able to appropriately address them.”
HHS is requesting comments on whether Section 1557 should include exemptions for religious organizations and, if so, to what extent. The administration notes that nothing in the proposed rule would affect the application of existing protections for religious beliefs and practices, such as provider conscience laws and regulations under the ACA involving preventive health services.
Comments on the rule will be accepted at www.regulations.gov until Nov. 6.
On Twitter @legal_med
Community Health Centers Get More Expansion Funds
It started with a clinic in rural Mississippi and another in South Boston, and now community-based and patient-directed health centers provide primary care to 1 in 14 people living in the U.S., according to the Health Resources and Services Administration (HRSA). “Health centers have provided a source of high-quality primary care for people in rural and urban communities for 50 years,” said HHS Acting Deputy Secretary Mary Wakefield, PhD, RN.
Related:Treating Dual-Use Patients Across Two Health Care Systems: A Qualitative Study
During the National Health Center Week last month, HHS announced an additional $169 million in Affordable Care Act (ACA) funding for 266 new community health centers. The funding builds on the $101 million awarded to 164 new health centers in May.
Related: A Scenic Tour of the VA Patient Experience
More than 700 health centers have opened as a result of the ACA. The new sites are projected to increase access to health care services for more than 1.2 million patients. The HRSA Acting Administrator Jim Macrae said, “These awards mean that more communities than ever can count on a health center to help meet the increasing demand for primary care.”
It started with a clinic in rural Mississippi and another in South Boston, and now community-based and patient-directed health centers provide primary care to 1 in 14 people living in the U.S., according to the Health Resources and Services Administration (HRSA). “Health centers have provided a source of high-quality primary care for people in rural and urban communities for 50 years,” said HHS Acting Deputy Secretary Mary Wakefield, PhD, RN.
Related:Treating Dual-Use Patients Across Two Health Care Systems: A Qualitative Study
During the National Health Center Week last month, HHS announced an additional $169 million in Affordable Care Act (ACA) funding for 266 new community health centers. The funding builds on the $101 million awarded to 164 new health centers in May.
Related: A Scenic Tour of the VA Patient Experience
More than 700 health centers have opened as a result of the ACA. The new sites are projected to increase access to health care services for more than 1.2 million patients. The HRSA Acting Administrator Jim Macrae said, “These awards mean that more communities than ever can count on a health center to help meet the increasing demand for primary care.”
It started with a clinic in rural Mississippi and another in South Boston, and now community-based and patient-directed health centers provide primary care to 1 in 14 people living in the U.S., according to the Health Resources and Services Administration (HRSA). “Health centers have provided a source of high-quality primary care for people in rural and urban communities for 50 years,” said HHS Acting Deputy Secretary Mary Wakefield, PhD, RN.
Related:Treating Dual-Use Patients Across Two Health Care Systems: A Qualitative Study
During the National Health Center Week last month, HHS announced an additional $169 million in Affordable Care Act (ACA) funding for 266 new community health centers. The funding builds on the $101 million awarded to 164 new health centers in May.
Related: A Scenic Tour of the VA Patient Experience
More than 700 health centers have opened as a result of the ACA. The new sites are projected to increase access to health care services for more than 1.2 million patients. The HRSA Acting Administrator Jim Macrae said, “These awards mean that more communities than ever can count on a health center to help meet the increasing demand for primary care.”
HHS Hails Big Ideas
What do a project to streamline a loan-repayment program, an in-hospital program to improve care for surgical patients, and an initiative to reduce infant mortality have in common? They’re all winners of the HHS 2015 Innovation Awards, announced June 24.
Related: HHS Grants Fund Health IT in Communities
The program, now in its eighth year, challenges HHS employees to come up with innovative solutions to problems in health, health care, and government. Entries can address topics such as affordability, access, system enhancement, and return-on-investment for HHS resources. Innovations must have been implemented within the past 30 months and need to be potentially “scalable”—that is, relevant throughout HHS and beyond.
The 7 winners this year include a project to revamp the HHS Health Resources and Services Administration’s (HRSA’s) National Health Service Corps and NURSE Corps Loan Repayment Programs, which were “disconnected” and “inefficient.” The HRSA’s Bureau of Health Workforce consolidated all processes and technical systems into a single system, simplifying applicant submission and review, reducing redundancies, and supporting the push to go paperless. In doing so, the project saved the government $2.4 million and is expected to generate a 17% return on investment by 2020.
The general surgery department at the Phoenix Indian Medical Center, an IHS hospital, won with its Peri-Operative Surgical Home (POSH) project, which has “reorganized, reinvented, and repurposed disparate processes, equipment, staff, and time into a team-based, innovative program,” the designers say. The centerpiece of the program is the Assessment and Planning process, in which representatives from all POSH departments meet to plan care for complex surgical patients before, during, and after surgery. The multidisciplinary program has not only improved the patient experience, but also led to significant savings.
Related: Initiatives Aim at Improving HIV and Mental Health Services
A third project, the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality, created interstate “cyberteams” to exchange ideas and best practices and test new approaches. Using quality improvement principles from business and medicine, states with the highest rates of infant mortality were able to reduce infant mortality by 10% and more.
Fostering innovation, said HHS Secretary Sylvia M. Burwell, empowers teams with the resources they need to address the challenges of today’s health care.
What do a project to streamline a loan-repayment program, an in-hospital program to improve care for surgical patients, and an initiative to reduce infant mortality have in common? They’re all winners of the HHS 2015 Innovation Awards, announced June 24.
Related: HHS Grants Fund Health IT in Communities
The program, now in its eighth year, challenges HHS employees to come up with innovative solutions to problems in health, health care, and government. Entries can address topics such as affordability, access, system enhancement, and return-on-investment for HHS resources. Innovations must have been implemented within the past 30 months and need to be potentially “scalable”—that is, relevant throughout HHS and beyond.
The 7 winners this year include a project to revamp the HHS Health Resources and Services Administration’s (HRSA’s) National Health Service Corps and NURSE Corps Loan Repayment Programs, which were “disconnected” and “inefficient.” The HRSA’s Bureau of Health Workforce consolidated all processes and technical systems into a single system, simplifying applicant submission and review, reducing redundancies, and supporting the push to go paperless. In doing so, the project saved the government $2.4 million and is expected to generate a 17% return on investment by 2020.
The general surgery department at the Phoenix Indian Medical Center, an IHS hospital, won with its Peri-Operative Surgical Home (POSH) project, which has “reorganized, reinvented, and repurposed disparate processes, equipment, staff, and time into a team-based, innovative program,” the designers say. The centerpiece of the program is the Assessment and Planning process, in which representatives from all POSH departments meet to plan care for complex surgical patients before, during, and after surgery. The multidisciplinary program has not only improved the patient experience, but also led to significant savings.
Related: Initiatives Aim at Improving HIV and Mental Health Services
A third project, the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality, created interstate “cyberteams” to exchange ideas and best practices and test new approaches. Using quality improvement principles from business and medicine, states with the highest rates of infant mortality were able to reduce infant mortality by 10% and more.
Fostering innovation, said HHS Secretary Sylvia M. Burwell, empowers teams with the resources they need to address the challenges of today’s health care.
What do a project to streamline a loan-repayment program, an in-hospital program to improve care for surgical patients, and an initiative to reduce infant mortality have in common? They’re all winners of the HHS 2015 Innovation Awards, announced June 24.
Related: HHS Grants Fund Health IT in Communities
The program, now in its eighth year, challenges HHS employees to come up with innovative solutions to problems in health, health care, and government. Entries can address topics such as affordability, access, system enhancement, and return-on-investment for HHS resources. Innovations must have been implemented within the past 30 months and need to be potentially “scalable”—that is, relevant throughout HHS and beyond.
The 7 winners this year include a project to revamp the HHS Health Resources and Services Administration’s (HRSA’s) National Health Service Corps and NURSE Corps Loan Repayment Programs, which were “disconnected” and “inefficient.” The HRSA’s Bureau of Health Workforce consolidated all processes and technical systems into a single system, simplifying applicant submission and review, reducing redundancies, and supporting the push to go paperless. In doing so, the project saved the government $2.4 million and is expected to generate a 17% return on investment by 2020.
The general surgery department at the Phoenix Indian Medical Center, an IHS hospital, won with its Peri-Operative Surgical Home (POSH) project, which has “reorganized, reinvented, and repurposed disparate processes, equipment, staff, and time into a team-based, innovative program,” the designers say. The centerpiece of the program is the Assessment and Planning process, in which representatives from all POSH departments meet to plan care for complex surgical patients before, during, and after surgery. The multidisciplinary program has not only improved the patient experience, but also led to significant savings.
Related: Initiatives Aim at Improving HIV and Mental Health Services
A third project, the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality, created interstate “cyberteams” to exchange ideas and best practices and test new approaches. Using quality improvement principles from business and medicine, states with the highest rates of infant mortality were able to reduce infant mortality by 10% and more.
Fostering innovation, said HHS Secretary Sylvia M. Burwell, empowers teams with the resources they need to address the challenges of today’s health care.
FDA approves Synjardy for type 2 diabetes
The FDA has approved Synjardy (empagliflozin/metformin hydrochloride) to help control blood glucose in adults with type 2 diabetes, the drug’s manufacturers announced Aug. 27.
Synjardy, which contains the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin, is indicated as an adjunct to diet and exercise in patients unable to achieve sufficient glycemic control on empagliflozin or metformin, or in patients already being treated with both drugs.
When combined, empagliflozin and metformin offer “complementary mechanisms of action” to help control blood glucose, according to a statement by the manufacturers, Boehringer Ingelheim Pharmaceuticals and Eli Lilly and Co.
“Empagliflozin ... removes excess glucose through the urine by blocking glucose reabsorption in the kidney,” the statement said. Metformin, frequently prescribed as a first-line treatment, lowers glucose production by the liver and its absorption in the intestine.
Synjardy contains a boxed warning for lactic acidosis and should not be used by adults with severe kidney problems or allergies to empagliflozin, metformin, or any other ingredients in the medication. It also should not be used to treat type 1 diabetes or diabetic ketoacidosis.
Common side effects from Synjardy include runny nose, sore throat, urinary tract infections, female genital infections, diarrhea, headache, nausea, and vomiting.
Visit the Boehringer Ingelheim website for full prescribing information. Adverse effects may be reported to the FDA at http://www.fda.gov/medwatch.com.
The FDA has approved Synjardy (empagliflozin/metformin hydrochloride) to help control blood glucose in adults with type 2 diabetes, the drug’s manufacturers announced Aug. 27.
Synjardy, which contains the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin, is indicated as an adjunct to diet and exercise in patients unable to achieve sufficient glycemic control on empagliflozin or metformin, or in patients already being treated with both drugs.
When combined, empagliflozin and metformin offer “complementary mechanisms of action” to help control blood glucose, according to a statement by the manufacturers, Boehringer Ingelheim Pharmaceuticals and Eli Lilly and Co.
“Empagliflozin ... removes excess glucose through the urine by blocking glucose reabsorption in the kidney,” the statement said. Metformin, frequently prescribed as a first-line treatment, lowers glucose production by the liver and its absorption in the intestine.
Synjardy contains a boxed warning for lactic acidosis and should not be used by adults with severe kidney problems or allergies to empagliflozin, metformin, or any other ingredients in the medication. It also should not be used to treat type 1 diabetes or diabetic ketoacidosis.
Common side effects from Synjardy include runny nose, sore throat, urinary tract infections, female genital infections, diarrhea, headache, nausea, and vomiting.
Visit the Boehringer Ingelheim website for full prescribing information. Adverse effects may be reported to the FDA at http://www.fda.gov/medwatch.com.
The FDA has approved Synjardy (empagliflozin/metformin hydrochloride) to help control blood glucose in adults with type 2 diabetes, the drug’s manufacturers announced Aug. 27.
Synjardy, which contains the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin, is indicated as an adjunct to diet and exercise in patients unable to achieve sufficient glycemic control on empagliflozin or metformin, or in patients already being treated with both drugs.
When combined, empagliflozin and metformin offer “complementary mechanisms of action” to help control blood glucose, according to a statement by the manufacturers, Boehringer Ingelheim Pharmaceuticals and Eli Lilly and Co.
“Empagliflozin ... removes excess glucose through the urine by blocking glucose reabsorption in the kidney,” the statement said. Metformin, frequently prescribed as a first-line treatment, lowers glucose production by the liver and its absorption in the intestine.
Synjardy contains a boxed warning for lactic acidosis and should not be used by adults with severe kidney problems or allergies to empagliflozin, metformin, or any other ingredients in the medication. It also should not be used to treat type 1 diabetes or diabetic ketoacidosis.
Common side effects from Synjardy include runny nose, sore throat, urinary tract infections, female genital infections, diarrhea, headache, nausea, and vomiting.
Visit the Boehringer Ingelheim website for full prescribing information. Adverse effects may be reported to the FDA at http://www.fda.gov/medwatch.com.
Banking on Vets for Better PTSD Research
Veterans can now help advance PTSD research by enrolling in a “brain bank.” A consortium led by the VA National Center for Posttraumatic Stress Disorder has launched the first brain tissue repository to support research into causes, progression, and treatment of PTSD.
Related: PTSD Campaign: Caring and Sharing
The Leahy-Friedman National PTSD Brain Bank is the fruit of 12 years of labor by Senator Patrick Leahy (D-VT) and Dr. Matthew Friedman, senior advisor to the VA PTSD Center and its former executive director. Dr. Friedman is directing the consortium, which will have sites across the U.S.
Brain bank researchers will follow the health of enrolled participants during their lifetime; participants will donate brain and body tissue after death. Any veteran with PTSD living in the U.S. is eligible to enroll—as are veterans without PTSD, who are needed for purposes of comparison.
Related: Evidence-Based Psychotherapy Telemental Health Center and Regional Pilot
Participation involves filling out surveys by telephone, mail, or a secure Internet website. Surveys ask about exposure to chemicals at home, work, or during military service. Participants are also asked about mental health and given brief tests of memory and concentration. Information collected is labeled with a code that does not identify the veteran directly; all information is kept confidential. The veteran has the right to withdraw at any time, even after signing consent forms. VA benefits and VA health care will not be influenced in any way by agreeing or refusing to participate. Next of kin can give consent immediately following a veteran’s death.
Related: Attention-Deficit/Hyperactivity Disorder in a VA Polytrauma Clinic
The data will expand knowledge about a significant health concern for veterans: In 2013, 533,720 veterans with a primary or secondary diagnosis of PTSD were treated at VAMCs and clinics. “Although we have learned a great deal about abnormalities in brain structure and function from brain imaging research, there is no substitute for looking at the neurons themselves,” said Dr. Friedman. “Understanding the cellular and circuit contributions to abnormal brain activity in PTSD is critical in the search for potential biomarkers of susceptibility, illness, and treatment response and for developing new treatments targeting the conditions at the cellular level.”
Veterans interested in learning more about the brain bank and enrollment can call (800) 762-6609 or visit www.research.va.gov/programs/tissue_banking/PTSD/default.cfm.
Veterans can now help advance PTSD research by enrolling in a “brain bank.” A consortium led by the VA National Center for Posttraumatic Stress Disorder has launched the first brain tissue repository to support research into causes, progression, and treatment of PTSD.
Related: PTSD Campaign: Caring and Sharing
The Leahy-Friedman National PTSD Brain Bank is the fruit of 12 years of labor by Senator Patrick Leahy (D-VT) and Dr. Matthew Friedman, senior advisor to the VA PTSD Center and its former executive director. Dr. Friedman is directing the consortium, which will have sites across the U.S.
Brain bank researchers will follow the health of enrolled participants during their lifetime; participants will donate brain and body tissue after death. Any veteran with PTSD living in the U.S. is eligible to enroll—as are veterans without PTSD, who are needed for purposes of comparison.
Related: Evidence-Based Psychotherapy Telemental Health Center and Regional Pilot
Participation involves filling out surveys by telephone, mail, or a secure Internet website. Surveys ask about exposure to chemicals at home, work, or during military service. Participants are also asked about mental health and given brief tests of memory and concentration. Information collected is labeled with a code that does not identify the veteran directly; all information is kept confidential. The veteran has the right to withdraw at any time, even after signing consent forms. VA benefits and VA health care will not be influenced in any way by agreeing or refusing to participate. Next of kin can give consent immediately following a veteran’s death.
Related: Attention-Deficit/Hyperactivity Disorder in a VA Polytrauma Clinic
The data will expand knowledge about a significant health concern for veterans: In 2013, 533,720 veterans with a primary or secondary diagnosis of PTSD were treated at VAMCs and clinics. “Although we have learned a great deal about abnormalities in brain structure and function from brain imaging research, there is no substitute for looking at the neurons themselves,” said Dr. Friedman. “Understanding the cellular and circuit contributions to abnormal brain activity in PTSD is critical in the search for potential biomarkers of susceptibility, illness, and treatment response and for developing new treatments targeting the conditions at the cellular level.”
Veterans interested in learning more about the brain bank and enrollment can call (800) 762-6609 or visit www.research.va.gov/programs/tissue_banking/PTSD/default.cfm.
Veterans can now help advance PTSD research by enrolling in a “brain bank.” A consortium led by the VA National Center for Posttraumatic Stress Disorder has launched the first brain tissue repository to support research into causes, progression, and treatment of PTSD.
Related: PTSD Campaign: Caring and Sharing
The Leahy-Friedman National PTSD Brain Bank is the fruit of 12 years of labor by Senator Patrick Leahy (D-VT) and Dr. Matthew Friedman, senior advisor to the VA PTSD Center and its former executive director. Dr. Friedman is directing the consortium, which will have sites across the U.S.
Brain bank researchers will follow the health of enrolled participants during their lifetime; participants will donate brain and body tissue after death. Any veteran with PTSD living in the U.S. is eligible to enroll—as are veterans without PTSD, who are needed for purposes of comparison.
Related: Evidence-Based Psychotherapy Telemental Health Center and Regional Pilot
Participation involves filling out surveys by telephone, mail, or a secure Internet website. Surveys ask about exposure to chemicals at home, work, or during military service. Participants are also asked about mental health and given brief tests of memory and concentration. Information collected is labeled with a code that does not identify the veteran directly; all information is kept confidential. The veteran has the right to withdraw at any time, even after signing consent forms. VA benefits and VA health care will not be influenced in any way by agreeing or refusing to participate. Next of kin can give consent immediately following a veteran’s death.
Related: Attention-Deficit/Hyperactivity Disorder in a VA Polytrauma Clinic
The data will expand knowledge about a significant health concern for veterans: In 2013, 533,720 veterans with a primary or secondary diagnosis of PTSD were treated at VAMCs and clinics. “Although we have learned a great deal about abnormalities in brain structure and function from brain imaging research, there is no substitute for looking at the neurons themselves,” said Dr. Friedman. “Understanding the cellular and circuit contributions to abnormal brain activity in PTSD is critical in the search for potential biomarkers of susceptibility, illness, and treatment response and for developing new treatments targeting the conditions at the cellular level.”
Veterans interested in learning more about the brain bank and enrollment can call (800) 762-6609 or visit www.research.va.gov/programs/tissue_banking/PTSD/default.cfm.
TBI Biomarker Development on the Horizon
A number of advanced efforts in traumatic brain injury (TBI) research are on the verge of reporting new data, according to a roundtable discussion that took place during the Military Health System Research Symposium on August 19. Among the most notable is in the area of biomarker development.
A 2,000-patient pivotal trial recently closed, and analysis should be completed by the end of the year. By March 2016, the research team expects to submit for FDA clearance a first-ever blood test for TBI. In addition, TBI research is currently being conducted in the areas of eye movement and balance.
Related: Brain Training for TBI Patients
A problem with assessing and treating the complexities of TBI up to this point is that although there are hundreds of measures of brain function, the evidence isn’t strong enough to provide a gold standard. “The whole area of drugs in neuroscience has been very difficult,” said Col. Dallas Hack, MD, senior medical advisor to the principal assistant for research and technology. “We have a couple of major efforts that are aimed at solving the problems of achieving results that can be measured according to the standards required to have them approved.”
Related: Stopping TBI-Related Brain Degeneration
To address the lack of a gold standard, the TBI Endpoints Development multiyear effort is making progress to give validity to the many existing measures of brain injury. Another effort is the VA/DoD Chronic Effects of Neurotrauma Consortium (CENC), a federally funded program that identifies gaps in research and provides support services for scientific, clinical, and translational research projects focused on the long-term effects of mild TBI in veterans and active-duty service members.
For information about the CENC, click here.
A number of advanced efforts in traumatic brain injury (TBI) research are on the verge of reporting new data, according to a roundtable discussion that took place during the Military Health System Research Symposium on August 19. Among the most notable is in the area of biomarker development.
A 2,000-patient pivotal trial recently closed, and analysis should be completed by the end of the year. By March 2016, the research team expects to submit for FDA clearance a first-ever blood test for TBI. In addition, TBI research is currently being conducted in the areas of eye movement and balance.
Related: Brain Training for TBI Patients
A problem with assessing and treating the complexities of TBI up to this point is that although there are hundreds of measures of brain function, the evidence isn’t strong enough to provide a gold standard. “The whole area of drugs in neuroscience has been very difficult,” said Col. Dallas Hack, MD, senior medical advisor to the principal assistant for research and technology. “We have a couple of major efforts that are aimed at solving the problems of achieving results that can be measured according to the standards required to have them approved.”
Related: Stopping TBI-Related Brain Degeneration
To address the lack of a gold standard, the TBI Endpoints Development multiyear effort is making progress to give validity to the many existing measures of brain injury. Another effort is the VA/DoD Chronic Effects of Neurotrauma Consortium (CENC), a federally funded program that identifies gaps in research and provides support services for scientific, clinical, and translational research projects focused on the long-term effects of mild TBI in veterans and active-duty service members.
For information about the CENC, click here.
A number of advanced efforts in traumatic brain injury (TBI) research are on the verge of reporting new data, according to a roundtable discussion that took place during the Military Health System Research Symposium on August 19. Among the most notable is in the area of biomarker development.
A 2,000-patient pivotal trial recently closed, and analysis should be completed by the end of the year. By March 2016, the research team expects to submit for FDA clearance a first-ever blood test for TBI. In addition, TBI research is currently being conducted in the areas of eye movement and balance.
Related: Brain Training for TBI Patients
A problem with assessing and treating the complexities of TBI up to this point is that although there are hundreds of measures of brain function, the evidence isn’t strong enough to provide a gold standard. “The whole area of drugs in neuroscience has been very difficult,” said Col. Dallas Hack, MD, senior medical advisor to the principal assistant for research and technology. “We have a couple of major efforts that are aimed at solving the problems of achieving results that can be measured according to the standards required to have them approved.”
Related: Stopping TBI-Related Brain Degeneration
To address the lack of a gold standard, the TBI Endpoints Development multiyear effort is making progress to give validity to the many existing measures of brain injury. Another effort is the VA/DoD Chronic Effects of Neurotrauma Consortium (CENC), a federally funded program that identifies gaps in research and provides support services for scientific, clinical, and translational research projects focused on the long-term effects of mild TBI in veterans and active-duty service members.
For information about the CENC, click here.
Power to the Patients
An interactive online tool that monitors power outages during major storms could make a life-or-death difference for the more than 1.6 million Medicare beneficiaries who use electricity-dependent medical and assistive equipment, such as ventilators and wheelchairs.
The HHS emPOWER Map, launched by the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR), shows the monthly total number of Medicare beneficiaries’ claims for electricity-dependent equipment at the national, state, territory, county, and zip code levels. The tool combines those data with real-time severe weather tracking services from the National Oceanic and Atmospheric Administration in a geographic information system (GIS).
Related: Pre-Storm Dialysis Saves Lives
The HHS says the GIS-based tool could help hospitals, health care coalitions, and emergency medical services plan better for surges in medical services. It could, for instance, guide electric utility companies in restoring power based on the location of the largest concentrations of electricity-dependent patients. Emergency planners could also use it to determine whether emergency shelters might experience greater electricity demand.
The ASPR is also pursuing other emergency-preparedness solutions, such as equipment signaling technology that will allow family members, caregivers, and responders to remotely monitor a critical device’s back-up battery power.
Related: Perceived Attitudes and Staff Roles of Emergency Management at CBOCs
“With the rise in home-based care, real-time awareness of population-level needs, and the ability to respond to them, is critical,” said RADM Nicole Lurie, MD, MSPH, HHS assistant secretary for preparedness and response. “Better planning helps communities respond better and recover faster.”
An interactive online tool that monitors power outages during major storms could make a life-or-death difference for the more than 1.6 million Medicare beneficiaries who use electricity-dependent medical and assistive equipment, such as ventilators and wheelchairs.
The HHS emPOWER Map, launched by the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR), shows the monthly total number of Medicare beneficiaries’ claims for electricity-dependent equipment at the national, state, territory, county, and zip code levels. The tool combines those data with real-time severe weather tracking services from the National Oceanic and Atmospheric Administration in a geographic information system (GIS).
Related: Pre-Storm Dialysis Saves Lives
The HHS says the GIS-based tool could help hospitals, health care coalitions, and emergency medical services plan better for surges in medical services. It could, for instance, guide electric utility companies in restoring power based on the location of the largest concentrations of electricity-dependent patients. Emergency planners could also use it to determine whether emergency shelters might experience greater electricity demand.
The ASPR is also pursuing other emergency-preparedness solutions, such as equipment signaling technology that will allow family members, caregivers, and responders to remotely monitor a critical device’s back-up battery power.
Related: Perceived Attitudes and Staff Roles of Emergency Management at CBOCs
“With the rise in home-based care, real-time awareness of population-level needs, and the ability to respond to them, is critical,” said RADM Nicole Lurie, MD, MSPH, HHS assistant secretary for preparedness and response. “Better planning helps communities respond better and recover faster.”
An interactive online tool that monitors power outages during major storms could make a life-or-death difference for the more than 1.6 million Medicare beneficiaries who use electricity-dependent medical and assistive equipment, such as ventilators and wheelchairs.
The HHS emPOWER Map, launched by the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR), shows the monthly total number of Medicare beneficiaries’ claims for electricity-dependent equipment at the national, state, territory, county, and zip code levels. The tool combines those data with real-time severe weather tracking services from the National Oceanic and Atmospheric Administration in a geographic information system (GIS).
Related: Pre-Storm Dialysis Saves Lives
The HHS says the GIS-based tool could help hospitals, health care coalitions, and emergency medical services plan better for surges in medical services. It could, for instance, guide electric utility companies in restoring power based on the location of the largest concentrations of electricity-dependent patients. Emergency planners could also use it to determine whether emergency shelters might experience greater electricity demand.
The ASPR is also pursuing other emergency-preparedness solutions, such as equipment signaling technology that will allow family members, caregivers, and responders to remotely monitor a critical device’s back-up battery power.
Related: Perceived Attitudes and Staff Roles of Emergency Management at CBOCs
“With the rise in home-based care, real-time awareness of population-level needs, and the ability to respond to them, is critical,” said RADM Nicole Lurie, MD, MSPH, HHS assistant secretary for preparedness and response. “Better planning helps communities respond better and recover faster.”
Student Nurses on the Floor: Boons, Not Burdens
Most nurse preceptors in a VA Nursing Academy (VANA) clinical training program find the experience has more pros than cons, according to researchers who surveyed staff nurses at all 15 active VANA sites about the “spillover effect” of the academic-practice partnerships on hospital nursing staff. The nurses reported “moderately high levels of satisfaction” with VANA program components. The staff nurses who were more involved with VANA were more satisfied. They rated as “very satisfied or satisfied” on such factors as the aptitude of students, clinical expertise of instructors, and personal reward from working with students.
Related: The VALOR Program: Preparing Nursing Students to Care for Our Veterans
Most of the staff nurses working on VANA units interacted with VANA students a “sizable proportion” of the time that they were caring for patients on the units. But the staff nurses did not feel burdened by the students, nor did they see the students as making their work more difficult. In fact, they reported direct benefits: For example, the students’ presence spurred some of the staff nurses to pursue further education.
Most nurse preceptors in a VA Nursing Academy (VANA) clinical training program find the experience has more pros than cons, according to researchers who surveyed staff nurses at all 15 active VANA sites about the “spillover effect” of the academic-practice partnerships on hospital nursing staff. The nurses reported “moderately high levels of satisfaction” with VANA program components. The staff nurses who were more involved with VANA were more satisfied. They rated as “very satisfied or satisfied” on such factors as the aptitude of students, clinical expertise of instructors, and personal reward from working with students.
Related: The VALOR Program: Preparing Nursing Students to Care for Our Veterans
Most of the staff nurses working on VANA units interacted with VANA students a “sizable proportion” of the time that they were caring for patients on the units. But the staff nurses did not feel burdened by the students, nor did they see the students as making their work more difficult. In fact, they reported direct benefits: For example, the students’ presence spurred some of the staff nurses to pursue further education.
Most nurse preceptors in a VA Nursing Academy (VANA) clinical training program find the experience has more pros than cons, according to researchers who surveyed staff nurses at all 15 active VANA sites about the “spillover effect” of the academic-practice partnerships on hospital nursing staff. The nurses reported “moderately high levels of satisfaction” with VANA program components. The staff nurses who were more involved with VANA were more satisfied. They rated as “very satisfied or satisfied” on such factors as the aptitude of students, clinical expertise of instructors, and personal reward from working with students.
Related: The VALOR Program: Preparing Nursing Students to Care for Our Veterans
Most of the staff nurses working on VANA units interacted with VANA students a “sizable proportion” of the time that they were caring for patients on the units. But the staff nurses did not feel burdened by the students, nor did they see the students as making their work more difficult. In fact, they reported direct benefits: For example, the students’ presence spurred some of the staff nurses to pursue further education.
What to Do When Chronic Conditions Add Up
One in 4 Americans has multiple chronic conditions (MCC)—such as heart disease and depression—and their care costs nearly two-thirds of health care spending in the U.S., according to HHS. But health-professional education tends to focus on caring for patients with a single disease. Thus, HHS is aiming to bolster interprofessional education and training materials with the first-of-its-kind training materials on MCC, designed specifically for health professions students, faculty, practitioners, direct care workers, and patients and their families.
Related: Attention-Deficit/Hyperactivity Disorder in a VA Polytrauma Clinic
The resources, which are available online, include:
- The “Multiple Chronic Conditions Education and Training Repository” searchable database of existing educational resources on care of people with MCC
- “Multiple Chronic Conditions: A Framework for Education and Training” conceptual model that outlines the core domains and competencies for the interprofessional health care team
- Clinical guidelines
- Current research
- Videos and podcasts
- Periodic e-mail updates on MCC
- A web-based 6-module course, “Education and Training Curriculum on Multiple Chronic Conditions”
Related: Workshops on Heart Disease and Comorbid Conditions
The site also links users to other pertinent resources, such as maps and charts on the prevalence of chronic conditions across the nation, and Medicare Chronic Conditions Dashboard(s), with statistical views of the prevalence, utilization, and spending for patients with MCC.
For more information, visit www.hhs.gov/ash/initiatives/mcc.
One in 4 Americans has multiple chronic conditions (MCC)—such as heart disease and depression—and their care costs nearly two-thirds of health care spending in the U.S., according to HHS. But health-professional education tends to focus on caring for patients with a single disease. Thus, HHS is aiming to bolster interprofessional education and training materials with the first-of-its-kind training materials on MCC, designed specifically for health professions students, faculty, practitioners, direct care workers, and patients and their families.
Related: Attention-Deficit/Hyperactivity Disorder in a VA Polytrauma Clinic
The resources, which are available online, include:
- The “Multiple Chronic Conditions Education and Training Repository” searchable database of existing educational resources on care of people with MCC
- “Multiple Chronic Conditions: A Framework for Education and Training” conceptual model that outlines the core domains and competencies for the interprofessional health care team
- Clinical guidelines
- Current research
- Videos and podcasts
- Periodic e-mail updates on MCC
- A web-based 6-module course, “Education and Training Curriculum on Multiple Chronic Conditions”
Related: Workshops on Heart Disease and Comorbid Conditions
The site also links users to other pertinent resources, such as maps and charts on the prevalence of chronic conditions across the nation, and Medicare Chronic Conditions Dashboard(s), with statistical views of the prevalence, utilization, and spending for patients with MCC.
For more information, visit www.hhs.gov/ash/initiatives/mcc.
One in 4 Americans has multiple chronic conditions (MCC)—such as heart disease and depression—and their care costs nearly two-thirds of health care spending in the U.S., according to HHS. But health-professional education tends to focus on caring for patients with a single disease. Thus, HHS is aiming to bolster interprofessional education and training materials with the first-of-its-kind training materials on MCC, designed specifically for health professions students, faculty, practitioners, direct care workers, and patients and their families.
Related: Attention-Deficit/Hyperactivity Disorder in a VA Polytrauma Clinic
The resources, which are available online, include:
- The “Multiple Chronic Conditions Education and Training Repository” searchable database of existing educational resources on care of people with MCC
- “Multiple Chronic Conditions: A Framework for Education and Training” conceptual model that outlines the core domains and competencies for the interprofessional health care team
- Clinical guidelines
- Current research
- Videos and podcasts
- Periodic e-mail updates on MCC
- A web-based 6-module course, “Education and Training Curriculum on Multiple Chronic Conditions”
Related: Workshops on Heart Disease and Comorbid Conditions
The site also links users to other pertinent resources, such as maps and charts on the prevalence of chronic conditions across the nation, and Medicare Chronic Conditions Dashboard(s), with statistical views of the prevalence, utilization, and spending for patients with MCC.
For more information, visit www.hhs.gov/ash/initiatives/mcc.
VA Hospital Deficiencies Contributed to Marine’s Death
On August 30, 2014, a 35-year-old marine died during inpatient treatment for mental health at the Tomah VAMC in Wisconsin. A year later, the VA Office of Inspector General (OIG) Office of Healthcare Inspections determined a number of deficiencies in hospital operations as a result of the investigation of this patient’s death.
Among these deficiencies were a lack of documenting patient consent for treatment and insufficient response to the patient’s cardiopulmonary emergency.
“We are deeply saddened by the tragic, avoidable death of this veteran and are committed to learning from this event and making improvements in the care we provide to our veterans,” the Tomah VAMC said in a statement.
Related: Negligence Settlement Reached After Army Hospital Death
Neither of the 2 psychiatrists treating the patient, Jason Simcakoski, obtained informed consent, verbal or written, for the buprenorphine/naloxone, according to both the patient’s electronic health record and the treating psychiatrists’ accounts. The prescription was administered to the patient with an off-label indication beginning the day prior to his death.
In addition, when the patient was found unresponsive in his room, “unit staff did not immediately assess the patient and determine the need for cardiopulmonary resuscitation,” nor did they use the in-room emergency call system or determine cardiac activity with the automatic external defibrillator, as noted in the OIG report.
Mr. Simcakoski served with the U.S. Marine Corp from 1998 until his honorable discharge in 2002. Mr. Simcakoski established VA medical care in 2003, according to the OIG report. Two years later, he sought help for his addiction to oxycodone, a medication he said he obtained from a friend; no VA provider ever prescribed Mr. Simcakoski oxycodone or other Schedule II opioid analgesic. The patient was treated for addiction at a non-VA clinic through 2007 and again in 2010.
Related: VISN 22 Evidence-Based Psychotherapy Telemental Health Center and Regional Pilot
The patient’s psychiatric diagnoses included posttraumatic stress disorder, bipolar I disorder, generalized anxiety disorder, attention deficit/hyperactivity disorder, panic disorder, opioid dependence, and alcohol and benzodiazepine abuse.
As a result of OIG recommendations, one of the psychiatrists involved in this case was terminated and the second awaits administrative proceedings. Under the direction of the Tomah VAMC acting chief of staff, all appropriate providers will be required to take relevant VHA training on informed consent, and all patients currently on buprenorphine will be reviewed to ensure consent has been obtained, both of which have an October 2015 target date of completion.
“I feel some comfort knowing they have admitted they failed Jason,” Heather Fluty Simcakoski, the victim’s widow, told Gannett Wisconsin Media. “It doesn't bring him back, but I know it's a step closer to getting justice for him.”
On August 30, 2014, a 35-year-old marine died during inpatient treatment for mental health at the Tomah VAMC in Wisconsin. A year later, the VA Office of Inspector General (OIG) Office of Healthcare Inspections determined a number of deficiencies in hospital operations as a result of the investigation of this patient’s death.
Among these deficiencies were a lack of documenting patient consent for treatment and insufficient response to the patient’s cardiopulmonary emergency.
“We are deeply saddened by the tragic, avoidable death of this veteran and are committed to learning from this event and making improvements in the care we provide to our veterans,” the Tomah VAMC said in a statement.
Related: Negligence Settlement Reached After Army Hospital Death
Neither of the 2 psychiatrists treating the patient, Jason Simcakoski, obtained informed consent, verbal or written, for the buprenorphine/naloxone, according to both the patient’s electronic health record and the treating psychiatrists’ accounts. The prescription was administered to the patient with an off-label indication beginning the day prior to his death.
In addition, when the patient was found unresponsive in his room, “unit staff did not immediately assess the patient and determine the need for cardiopulmonary resuscitation,” nor did they use the in-room emergency call system or determine cardiac activity with the automatic external defibrillator, as noted in the OIG report.
Mr. Simcakoski served with the U.S. Marine Corp from 1998 until his honorable discharge in 2002. Mr. Simcakoski established VA medical care in 2003, according to the OIG report. Two years later, he sought help for his addiction to oxycodone, a medication he said he obtained from a friend; no VA provider ever prescribed Mr. Simcakoski oxycodone or other Schedule II opioid analgesic. The patient was treated for addiction at a non-VA clinic through 2007 and again in 2010.
Related: VISN 22 Evidence-Based Psychotherapy Telemental Health Center and Regional Pilot
The patient’s psychiatric diagnoses included posttraumatic stress disorder, bipolar I disorder, generalized anxiety disorder, attention deficit/hyperactivity disorder, panic disorder, opioid dependence, and alcohol and benzodiazepine abuse.
As a result of OIG recommendations, one of the psychiatrists involved in this case was terminated and the second awaits administrative proceedings. Under the direction of the Tomah VAMC acting chief of staff, all appropriate providers will be required to take relevant VHA training on informed consent, and all patients currently on buprenorphine will be reviewed to ensure consent has been obtained, both of which have an October 2015 target date of completion.
“I feel some comfort knowing they have admitted they failed Jason,” Heather Fluty Simcakoski, the victim’s widow, told Gannett Wisconsin Media. “It doesn't bring him back, but I know it's a step closer to getting justice for him.”
On August 30, 2014, a 35-year-old marine died during inpatient treatment for mental health at the Tomah VAMC in Wisconsin. A year later, the VA Office of Inspector General (OIG) Office of Healthcare Inspections determined a number of deficiencies in hospital operations as a result of the investigation of this patient’s death.
Among these deficiencies were a lack of documenting patient consent for treatment and insufficient response to the patient’s cardiopulmonary emergency.
“We are deeply saddened by the tragic, avoidable death of this veteran and are committed to learning from this event and making improvements in the care we provide to our veterans,” the Tomah VAMC said in a statement.
Related: Negligence Settlement Reached After Army Hospital Death
Neither of the 2 psychiatrists treating the patient, Jason Simcakoski, obtained informed consent, verbal or written, for the buprenorphine/naloxone, according to both the patient’s electronic health record and the treating psychiatrists’ accounts. The prescription was administered to the patient with an off-label indication beginning the day prior to his death.
In addition, when the patient was found unresponsive in his room, “unit staff did not immediately assess the patient and determine the need for cardiopulmonary resuscitation,” nor did they use the in-room emergency call system or determine cardiac activity with the automatic external defibrillator, as noted in the OIG report.
Mr. Simcakoski served with the U.S. Marine Corp from 1998 until his honorable discharge in 2002. Mr. Simcakoski established VA medical care in 2003, according to the OIG report. Two years later, he sought help for his addiction to oxycodone, a medication he said he obtained from a friend; no VA provider ever prescribed Mr. Simcakoski oxycodone or other Schedule II opioid analgesic. The patient was treated for addiction at a non-VA clinic through 2007 and again in 2010.
Related: VISN 22 Evidence-Based Psychotherapy Telemental Health Center and Regional Pilot
The patient’s psychiatric diagnoses included posttraumatic stress disorder, bipolar I disorder, generalized anxiety disorder, attention deficit/hyperactivity disorder, panic disorder, opioid dependence, and alcohol and benzodiazepine abuse.
As a result of OIG recommendations, one of the psychiatrists involved in this case was terminated and the second awaits administrative proceedings. Under the direction of the Tomah VAMC acting chief of staff, all appropriate providers will be required to take relevant VHA training on informed consent, and all patients currently on buprenorphine will be reviewed to ensure consent has been obtained, both of which have an October 2015 target date of completion.
“I feel some comfort knowing they have admitted they failed Jason,” Heather Fluty Simcakoski, the victim’s widow, told Gannett Wisconsin Media. “It doesn't bring him back, but I know it's a step closer to getting justice for him.”
