Med Mal News

Many local public health agencies around the United States are unprepared to quickly learn about and respond to naturally occurring outbreaks of deadly infectious diseases and to acts of bioterrorism, a test conducted by the RAND Corporation found. A novel effort to test the preparedness of local public health agencies to accept reports of suspicious illnesses found that most fell short of federal guidelines intended to assure a prompt response to potential infectious disease outbreaks. A study reporting the test results was published online Aug. 30 by the journal Health Affairs.

“Despite efforts to strengthen local public health agencies, there is a lot of room for improvement in how these agencies receive and respond to reports that might indicate a disease outbreak,” said Dr. Nicole Lurie, the Paul O'Neill Alcoa Professor of Public Policy at RAND. “Local public health agencies are one of the nation's first lines of defense against disease outbreaks and they are falling short.”

To conduct the test, RAND Health researchers posed as local physicians who were reporting cases of concern — including fictitious cases of botulism, anthrax, smallpox and bubonic plague — to 19 public health agencies in 18 states that were selected as a sample of public health agencies across the nation.

Agency directors agreed in advance to participate in the tests, but did not inform their staffs. The survey included large and small public health agencies in rural and metropolitan areas. The study does not identify the local agencies participating in the tests because the agencies were promised confidentiality in return for their participation.

Only two of the 19 local public health agencies sampled consistently met federal goals to respond to all calls within 30 minutes, according to the study. Three local public health agencies did not respond to the first five calls they received. Researchers say the time it took for local public health agencies to return calls varied from one minute to nearly two days. Delays in returning calls were most likely to occur near the end of the workday, during the evening and on weekends.

Some workers who responded to disease reports appeared to have no training in infectious diseases and others provided poor advice to callers, according to the study. In one case, after listening to a description of the classic symptoms of bubonic plague, a public health worker advised the caller not to worry and to “go back to sleep” because no similar cases had been reported. In another instance, a caller who reported a case with symptoms of botulism was told: “You're right, it does sound like botulism. I wouldn't worry too much if I were you.”

“We found wide variation not only in response time, but also in the way workers handled information about the disease reports,” said David J. Dausey, a RAND researcher and lead author of the report. “There is a strong chance that the early stages of a serious infectious disease outbreak could be missed by local public health officials.”

“Many of the public health agencies had a low level of what we call the index of suspicion,” Dausey added. “They didn't take seriously reports that could signal a serious infectious disease outbreak, even in the face of heightened awareness about bioterrorism.”

The study is part of a larger effort by RAND Health supported by funding by the U.S. Department of Health and Human Services to develop methods to measure the performance of public health agencies.

Maryland Law Too Much, Too Late

Maryland, which recently passed a law granting subsidies to physicians to help pay their medical malpractice insurance premiums, has a conundrum to deal with: instead of being hit with rising premiums this year as they have been in past years, Maryland's physicians, most of whom are insured by one major insurer, are not going to see their premiums rise at all this year, throwing the legality of the subsidy program into question. The state's top insurer, The Medical Mutual Liability Insurance Society of Maryland, informed its policyholders in August that because of lower payouts last year, premium rates next year will remain flat. According to a report in The Washington Post, the Maryland Insurance Administration is seeking legal advice on whether the subsidy program can continue if premiums are no longer on the rise. (Wagner, Washington Post, 8/19).

New Group to Monitor Medical Errors Internationally

The World Health Organization (WHO) has designated the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and Joint Commission International (JCI) as the world's first WHO Collaborating Centre dedicated solely to patient safety. WHO's move is aimed at reducing the numbers of serious medical injuries around the world each day – reportedly one in every 10 patients. The organizations plan to work together to facilitate a system in which medical errors that occur in one country will be reported to others so that all can learn from the mistakes. This will be accomplished by collaborating internationally with ministries of health, patient safety experts, national agencies on patient safety, health care professional associations, and consumer organizations.

Study Finds Public Health Agencies Often Miss Signs of Bioterrorism Danger

Many local public health agencies around the United States are unprepared to quickly learn about and respond to naturally occurring outbreaks of deadly infectious diseases and to acts of bioterrorism, a test conducted by the RAND Corporation found. A novel effort to test the preparedness of local public health agencies to accept reports of suspicious illnesses found that most fell short of federal guidelines intended to assure a prompt response to potential infectious disease outbreaks. A study reporting the test results was published online Aug. 30 by the journal Health Affairs.

“Despite efforts to strengthen local public health agencies, there is a lot of room for improvement in how these agencies receive and respond to reports that might indicate a disease outbreak,” said Dr. Nicole Lurie, the Paul O'Neill Alcoa Professor of Public Policy at RAND. “Local public health agencies are one of the nation's first lines of defense against disease outbreaks and they are falling short.”

To conduct the test, RAND Health researchers posed as local physicians who were reporting cases of concern — including fictitious cases of botulism, anthrax, smallpox and bubonic plague — to 19 public health agencies in 18 states that were selected as a sample of public health agencies across the nation.

Agency directors agreed in advance to participate in the tests, but did not inform their staffs. The survey included large and small public health agencies in rural and metropolitan areas. The study does not identify the local agencies participating in the tests because the agencies were promised confidentiality in return for their participation.

Only two of the 19 local public health agencies sampled consistently met federal goals to respond to all calls within 30 minutes, according to the study. Three local public health agencies did not respond to the first five calls they received. Researchers say the time it took for local public health agencies to return calls varied from one minute to nearly two days. Delays in returning calls were most likely to occur near the end of the workday, during the evening and on weekends.

Some workers who responded to disease reports appeared to have no training in infectious diseases and others provided poor advice to callers, according to the study. In one case, after listening to a description of the classic symptoms of bubonic plague, a public health worker advised the caller not to worry and to “go back to sleep” because no similar cases had been reported. In another instance, a caller who reported a case with symptoms of botulism was told: “You're right, it does sound like botulism. I wouldn't worry too much if I were you.”

“We found wide variation not only in response time, but also in the way workers handled information about the disease reports,” said David J. Dausey, a RAND researcher and lead author of the report. “There is a strong chance that the early stages of a serious infectious disease outbreak could be missed by local public health officials.”

“Many of the public health agencies had a low level of what we call the index of suspicion,” Dausey added. “They didn't take seriously reports that could signal a serious infectious disease outbreak, even in the face of heightened awareness about bioterrorism.”

The study is part of a larger effort by RAND Health supported by funding by the U.S. Department of Health and Human Services to develop methods to measure the performance of public health agencies.

Maryland Law Too Much, Too Late

Maryland, which recently passed a law granting subsidies to physicians to help pay their medical malpractice insurance premiums, has a conundrum to deal with: instead of being hit with rising premiums this year as they have been in past years, Maryland's physicians, most of whom are insured by one major insurer, are not going to see their premiums rise at all this year, throwing the legality of the subsidy program into question. The state's top insurer, The Medical Mutual Liability Insurance Society of Maryland, informed its policyholders in August that because of lower payouts last year, premium rates next year will remain flat. According to a report in The Washington Post, the Maryland Insurance Administration is seeking legal advice on whether the subsidy program can continue if premiums are no longer on the rise. (Wagner, Washington Post, 8/19).