TOPEKA – T-Mobile customers in Kansas who were charged for third-party services on their mobile phone bills without their consent are eligible to receive refunds as part of a multi-state settlement reached earlier this week, Kansas Attorney General Derek Schmidt said in a media release.

The national settlement announced today was reached between T-Mobile, the attorneys general of Kansas and 49 other states and the District of Columbia, the Federal Trade Commission and the Federal Communications Commission. It includes a total payment of $90 million to resolve allegations that T-Mobile placed charges on consumers’ mobile phone bills for third-party services that had not been authorized by the consumer, a practice known as “mobile cramming.” This settlement follows a similar one reached with AT&T Mobility in October.

Under the terms of the settlement, T-Mobile is required to provide at least $67.5 million in refunds to consumers who were victims of cramming.

“Consumers have a right to be clearly informed about the services they are purchasing – and the cost,” Schmidt said. “This settlement returns to consumers charges for programs they didn’t know they were signing up for and were often unable to cancel.”

For more information on how to obtain a refund, Kansas consumers should visit the attorney general’s consumer protection website at www.InYourCornerKansas.org or call (800) 432-2310.

EMPORIA, Kan. (AP) — Hunter Brenda Doudican had to do a double take this month when she saw a bull elk wandering through a Lyon County clearing with deer.

The Emporia Gazette reported that the spotting led Doudican to obtain a permit on Dec. 12 to hunt elk, which are unusual in the area. She didn’t catch a glimpse of the elk that night, but the next morning she got a clear shot. She then completed the paperwork needed to have the animal processed. Doudican says she’s “still kind of in awe.”

Doudican began hunting with muzzle loader season. She continued with bow season and then followed with rifle season. She says she spent a great deal of time waiting and now feels it was worth it.

ELLIOT SPAGAT, Associated Press

SAN DIEGO (AP) — The search for documents is on for immigrants who may qualify for a work permit and reprieve from deportation under measures President Barack Obama announced last month.

Applicants must prove they were in the country continuously since January 2010 — a tall order for many accustomed to avoiding trails. For critics, conditions are ripe for fraud.

The administration has not said which documents it will accept, but advocates are taking guidance from a 2012 reprieve for immigrants who came to the country as young children. The Deferred Action for Childhood Arrivals program allows vehicle registrations, baptism records, mortgages, postmarked letters — and those are just some suggestions from the agency.

Denver immigration attorney Laura Lichter suggests using movie rental receipts, veterinarian bills and customer loyalty programs that detail purchase histories.

KANSAS CITY – A Kansas woman was injured in an accident just after 6 p.m. on Friday in Wyandotte County.

The Kansas Highway Patrol reported a 2002 Jaguar X driven by Charles O. Bailey Jr., 46, Kansas City was southbound on Interstate 635 just north of Kansas Avenue.

Another, unknown vehicle made a lane change, struck the Jaguar causing it to spin out and strike the barrier wall. The other vehicle left the scene.

A passenger in the Jaguar Rhonda M. Cunningham-Green, 48, Kansas City was transported to Shawnee Mission Medical Center. Bailey Jr. was not injured.

The KHP reported both were properly restrained at the time of the accident.

The accident remains under investigation.

DES MOINES, Iowa (AP) — U.S. Sen. Chuck Grassley says U.S. Attorney General Eric Holder will personally review the case of an Iowa man who drowned while in a Missouri state trooper’s custody.

Grassley said Friday he recently spoke with Holder about 20-year-old Brandon Ellingson’s drowning in late May on the Lake of the Ozarks. He says the attorney general told him he would personally review information about the case before providing it to staff attorneys at the U.S. Justice Department.

Witnesses say Ellingson had been detained on suspicion of boating while intoxicated. He was handcuffed when he slipped through a life jacket and drowned.

A jury ruled the death an accident during a coroner’s inquest in September. Ellingson’s family says there are unanswered questions about the circumstances of the death.

LINCOLN, Neb. (AP) — Nebraska and Oklahoma are asking the U.S. Supreme Court to declare Colorado’s legalization of marijuana unconstitutional.

Nebraska Attorney General Jon Bruning announced Thursday that the states are seeking a court order to prevent Colorado from enforcing a measure that was approved by voters in 2012. Bruning says Oklahoma Attorney General Scott Pruitt is also a party to the lawsuit.

The complaint alleges that Colorado’s Amendment 64 runs afoul of federal law.

Washington state also has legalized marijuana, but Bruning says Nebraska isn’t suing over that law because it doesn’t share a border with Washington.

Colorado Attorney General John Suthers says in a statement that the lawsuit is without merit. He says his office will vigorously defend the marijuana law in the U.S. Supreme Court.

By Jordan Rau
Kaiser Health News

WASHINGTON, D.C. — In its toughest crackdown yet on medical errors, the federal government is cutting payments to 721 hospitals for having high rates of infections and other patient injuries, records released Thursday show.

Medicare assessed these new penalties against some of the most renowned hospitals in the nation, including the Cleveland Clinic, Brigham and Women’s Hospital in Boston, the Hospital of the University of Pennsylvania in Philadelphia and Geisinger Medical Center in Danville, Pa. Eleven Kansas hospitals are among those being penalized.
One out of every seven hospitals in the nation will have their Medicare payments lowered by 1 percent over the fiscal year that began Oct. 1 and continues through September 2015. The health law mandates the reductions for the quarter of hospitals that Medicare assessed as having the highest rates of “hospital-acquired conditions,” or HACs. These conditions include infections from catheters, blood clots, bed sores and other complications that are considered avoidable.

The penalties are falling particularly hard on academic medical centers: Roughly half of them will be punished, according to a Kaiser Health News analysis.

Dr. Eric Schneider, a Boston health researcher who has interviewed patient safety experts for his studies, said research has demonstrated that medical errors can be reduced through a number of techniques. But “there’s a pretty strong sense among the experts we talked to that they are not widely implemented,” he said. Those methods include entering physician orders into computers rather than scrawling them on paper, better hand hygiene and checklists on procedures to follow during surgeries. “Too many clinicians fail to use those techniques consistently,” he said.

The penalties come as the hospital industry is showing some success in reducing avoidable errors. A recent federal report found the frequency of mistakes dropped by 17 percent between 2010 and 2013, an improvement U.S. Health and Human Services Secretary Sylvia Burwell called “a big deal, but it’s only a start.” Even with the reduction, one in eight hospital admissions in 2013 included a patient injury, according to the report from the federal Agency for Healthcare Research and Quality, or AHRQ.
he new penalties are harsher than any prior government effort to reduce patient harm. Since 2008, Medicare has refused to pay hospitals for the cost of treating patients who suffer avoidable complications. Legally, Medicare can expel a hospital with high rates of errors from its program, but that punishment is almost never done, as it is a financial death sentence for most hospitals. Some states issue their own penalties — California, for instance, levies fines as high as $100,000 per incident on hospitals that are repeat offenders.

The government has also been giving money to some hospitals and quality groups to help improve patient safety efforts.

The HAC program has “put attention to the issue of complications and that attention wasn’t everywhere,” said Dr. John Bulger, Geisinger’s chief quality officer. However, he said hospitals such as his now must spend more time reviewing their Medicare billing records as the government uses those to evaluate patient safety. The penalty program, he said, “has the potential to take the time that could be spent on improvement and making sure the coding is accurate.”

Hospitals complain that the new penalties are arbitrary, since there may be almost no difference between hospitals that are penalized and those that narrowly escape falling into the worst quarter.

“Hospitals may be penalized on things they are getting safer on, and that sends a fairly mixed message,” said Nancy Foster, a quality expert at the American Hospital Association.

Hospital officials also point out those that do the best job identifying infections in patients may end up looking worse than others. “How hard you look for something influences your results,” said Dr. Darrell Campbell Jr., chief medical officer at the University of Michigan Health System. “We have a huge infection control group, one of the largest in the country. I tell them to go out and find it.” Campbell’s hospital had a high rate of urinary tract infections but was not penalized because it had fewer serious complications than most hospitals, records show.

The penalties come on top of other financial incentives Medicare has been placing on hospitals. This year, Medicare has already fined 2,610 hospitals for having too many patients return within a month of discharge. This is the third year those readmission penalties have been assessed. This is also the third year Medicare gave bonuses and penalties based on a variety of quality measures, including death rates and patient appraisals of their care. With the HAC penalties now in place, the worst-performing hospitals this year risk losing more than 5 percent of their regular Medicare reimbursements.

In determining the HAC penalties, Medicare judged hospitals on three measures: the frequency of central-line bloodstream infections caused by tubes used to pump fluids or medicine into veins, infections from tubes placed in bladders to remove urine, and rates of eight kinds of serious complications that occurred in hospitals, including collapsed lungs, surgical cuts, tears and reopened wounds and broken hips. Medicare tallied that and gave each hospital a score on a 10-point scale. Those in the top quarter — with a total score above 7 — were penalized.

About 1,400 hospitals are exempt from penalties because they provide specialized treatments such as psychiatry and rehabilitation or because they cater to a particular type of patient such as children and veterans. Small “critical access hospitals” that are mostly located in rural areas are also exempt, as are hospitals in Maryland, which have a special payment arrangement with the federal government.

The AHRQ study found that the biggest decreases in errors among those it studied occurred in the two categories of infections Medicare used in setting the penalties. Central-line associated bloodstream infections decreased by 49 percent and catheter-associated urinary tract infections dropped by 28 percent between 2010 and 2013. By contrast, pneumonia cases picked up by patients on ventilators that help them breathe – a condition not covered by the new penalties — decreased by only 3 percent during the same period.

Some of the errors on which the Medicare HAC penalties are based are rare compared to other mistakes the government tracks. For instance, AHRQ estimated that in 2013 there were 760,000 bad drug reactions to medicine that controls blood sugar in diabetics, but only 9,200 central-line infections. Infections from tubes inserted into urinary tracts are more common — AHRQ estimated there were 290,000 in 2013 — but those infections tend to be easier to treat and less likely to be lethal.

On the other measures, the study estimated there were 240,000 falls and more than 1 million bedsores.

In evaluating hospitals for the HAC penalties, the government adjusted infection rates by the type of hospital. When judging complications, it took into account the differing levels of sickness of each hospital’s patients, their ages and other factors that might make the patients more fragile. Still, academic medical centers have been complaining those adjustments are insufficient given the especially complicated cases they handle, such as organ transplants.

Medicare penalized 143 of 292 major teaching hospitals, the KHN analysis found. Penalized teaching hospitals included Ronald Reagan UCLA Medical Center and Keck Medicine of USC in Los Angeles; Grady Memorial Hospital in Atlanta; Northwestern Memorial Hospital and University of Illinois Hospital in Chicago; George Washington University Hospital and Washington Hospital Center in Washington, D.C.

“We know some of the procedures we do — heart transplants or resecting cancerous portions of the esophagus — are going to be just more prone to having some of these adverse events,” said Dr. Atul Grover, the chief public policy officer of the Association of American Medical Colleges. “To lump in all of those things that are very complex procedures with simple things like pneumonia or hip replacements may not be giving an accurate result.”

Medicare levied penalties against a third or more of the hospitals it assessed in Colorado, Connecticut, Delaware, Nevada, New Jersey, New Mexico, Rhode Island, Utah, Washington and the District of Columbia, the KHN analysis found.

The penalties are reassessed each year and Medicare plans to add in more kinds of injuries. Starting next October, Medicare will assess rates of surgical site infections to its analysis. The following year, Medicare will examine the frequency of two antibiotic-resistant germs: Clostridium difficile, known as C. diff, and methicillin-resistant Staphylococcus aureus, known as MRSA.

Jordan Rau is a reporter for Heartland Health Monitor, a news collaboration focusing on health issues and their impact in Missouri and Kansas.