The Petrie-Flom Center Staff - Bill of Health

Miami Downtown, FL, USA - MAY 31, 2020: Woman leading a group of demonstrators on road protesting for human rights and against racism.

Intentional Commitments to Diversity, Equity, Inclusion Needed in Health Care

April 1, 2021April 1, 2021 The Petrie-Flom Center Staff Leave a comment

By Eloho E. Akpovi

“They told me my baby was going to die.” Those words have sat with me since my acting internship in OB/GYN last summer. They were spoken by a young, Black, pregnant patient presenting to the emergency room to rule out preeclampsia.

As a Black woman and a medical student, those words were chilling. They reflect a health care system that is not built to provide the best care for Black patients and trains health care professionals in a way that is tone-deaf to racism and its manifestations in patient care.

A Medical Student Reflects on the Value of Time During the COVID-19 Pandemic

March 31, 2021March 30, 2021 The Petrie-Flom Center Staff Leave a comment

By Jess Ma

He passed away on the 107^th day. After I got home in the evening, I wrote down everything I could remember about him in my journal. For many days after his death, I often dreamed I was standing in that fluorescently bright ICU room. In the dreams, I would be watching him, and then he would wake up and start speaking to me, with those bright blue eyes glittering with animation and life. I always awoke feeling a little unsettled, not by his death, but rather by the fact that I knew so intimately the ways in which he was kept alive, and yet nothing about the life he lived until just hours before his final breath.

He was an existing patient on the unit when I joined the surgical ICU team, and for 10 days I followed him, tracking how every organ system was doing each day. Everyone on the team knew there was only one way this would end; his quality of life had deteriorated so rapidly since the early summer, after a bout of necrotizing pancreatitis and multiple tragic complications; he was barely able to interact with his own body, much less his environment, and his life was propped up precariously by every possible machine that could perform the function of a vital organ. For him, no medical intervention would add more significant chapters to his story. It was just a matter of when his daughter would be ready to close the book.

Because of the pandemic, visitors were only allowed after 12pm each day. When his adult daughter came to visit each afternoon, I was told to avoid intruding on their cherished private time together. I only ever really saw her shadow behind the drawn curtain as I walked past the room; and I knew that one of the surgeons on the service (a group of surgeons rotated between trauma, acute care, and surgical ICU) would routinely give her calls or meet up with her to discuss how her father was doing, even on days he had off. Surgeons are not generally thought off as doctors who can spend a lot of time just talking to patients – after all, in the time he spent on one of those daily conversations, he could complete an appendectomy. Though neither he, nor the rest of the team, could offer a magic solution, what he offered was crucial – his time.

Sisaket,Thailand,09 April 2019;Medical staff wearing face shield and medical mask for protect coronavirus covid-19 virus in CT scan room,Sisaket province,Thailand,ASIA.

The Future of Acute and Critical Care Nursing

March 30, 2021March 29, 2021 The Petrie-Flom Center Staff Leave a comment

By Sarah A. Delgado

We need to change the future for nurses. Even before the pandemic, nurses suffered high rates of burnout and a disproportionate risk of suicide. But the pandemic could be a tipping point that leads many nurses to change careers, leave their jobs, or retire early.

Moral distress, the consequence of feeling constrained from taking ethical action, was well-documented before the pandemic, particularly among critical care nurses providing end-of-life care. Additional research conducted before 2020 demonstrates that nurses were experiencing post-traumatic stress due to the suffering they witnessed and the demands of their work.

During the pandemic, surges in critically ill patients have led to untenable workloads. The distress of end-of-life care is heightened by restrictions on visitation and increased mortality rates. In addition, shortages of basic personal protective equipment contribute to fear and a sense of betrayal.

While the pre-pandemic state of the nursing profession was concerning, the pandemic creates imminent peril.

Bill of Health -man in glasses sitting in office holds yellow book labeled "PREP Act," PREP act pandemics, nursing home lawsuits

Elderly Plaintiffs Caught in the Fray of PREP Act Immunity

March 29, 2021July 15, 2022 The Petrie-Flom Center Staff Leave a comment

By Jordan Isern, J.D.

As of February 2, 2021, over one-third of U.S. COVID-19 deaths and five-percent of all U.S. COVID-19 cases are linked nursing homes. Unsurprisingly, over fifty-five negligence and wrongful death claims related to COVID-19 have been filed against assisted living facilities in state courts across the country in recent months. The claims are as repetitive as they are tragic. For example:

Sports Medicine in the Era of COVID-19

March 29, 2021March 29, 2021 The Petrie-Flom Center Staff Leave a comment

By Brian Feeley and William Levine

The world of sports and sports medicine offers a valuable window into understanding key developments in the COVID-19 pandemic and the broader health and equity issues at play.

Sports medicine, the practice of keeping athletes of all abilities in their peak through a combination of surgery, rehabilitation, and medications, has grown exponentially in the past few decades, with a concomitant rise in the popularity of professional and recreational sports.

How Supervised Injection Sites Can Help Address the Overdose Crisis

March 26, 2021March 26, 2021 The Petrie-Flom Center Staff Leave a comment

By Carly Roberts

Supervised injection sites, also known as safe injection sites, are among the most effective, evidence-based harm reduction tools available to counter the opioid overdose crisis.

Supervised injection sites are legally sanctioned locations that provide a hygienic space for people to inject pre-obtained drugs under the supervision of trained staff. Safe injection sites often provide additional services including needle exchanges, drug testing (especially important for detecting lethal fentanyl-laced drugs and preventing “mass overdose” events), and referral to treatment and social services.

The opioid overdose crisis in the U.S., which had a death toll of over 45,000 in 2018, and which is predicted to worsen amid the COVID-19 pandemic, warrants a bold, brave, and thorough response. Harm reduction programs, including supervised injection sites, should be integrated into opioid epidemic response strategies in order to save lives and improve individual and community outcomes.

Hundred dollar bills rolled up in a pill bottle

New Rule Might Increase Out-of-Pocket Drug Costs for Patients

March 26, 2021March 25, 2021 The Petrie-Flom Center Staff Leave a comment

This blog post is adapted from a commentary published in the American Journal of Managed Care.

By Bryan Walsh and Aaron S. Kesselheim

Patients may face increased out-of-pocket drug costs as a result of a new rule finalized by the Centers for Medicare & Medicaid Services (CMS) in July 2020 that would permit wide use of co-pay accumulator adjustment programs (CAAPs).

These increased costs may have effects on medication adherence, and in turn may affect health outcomes. In a recent commentary published in the American Journal of Managed Care, we explain the background to this rule and suggest ways CMS could narrow it to avoid these potential negative effects.

A patient is seen in the intensive care unit for the coronavirus disease (COVID-19) in Thoracic Diseases Hospital of Athens in Greece on November 8, 2020.

Learning During the COVID-19 Pandemic: The Importance of Humanism in Medicine

March 26, 2021March 25, 2021 The Petrie-Flom Center Staff Leave a comment

By John C. Messinger

On March 17, 2020, in the first days of the COVID-19 pandemic in the United States, the Association of American Medical Colleges (AAMC) released a statement strongly urging medical schools to pause all clinical rotations and patient-facing activities.

While there was a clear necessity to limit student participation as a means of reserving PPE and creating a safe environment for patients and health care providers, restricting medical students from clinical settings has drastically changed their education.

As a first-year medical student removed from training at the time of this announcement, my greatest fear has been that these changes will alter my approach to care for patients.

Bill of Health - teacher teaches math while wearing a mask, teacher in mask in front of blackboard, teachers' rights in the pandemic

The Rights of Public School Teachers in a Pandemic

March 25, 2021July 15, 2022 The Petrie-Flom Center Staff Leave a comment

By Kimberly Foreiter, J.D.

With the Biden administration pushing schools to reopen in-person, it is necessary to reflect on the hardships our educators have met and continue to encounter as the COVID-19 crisis lives on.[1] The gaps in teacher employment protections have and continue to cause excruciating consequences. This blog post serves as documentation of our teachers’ plights. The pandemic has pulled back the curtain on massive areas of the law that do little to nothing to protect our teachers. Accounts of the lived teacher experience, shared below, is proof of our system’s failure to protect them. In Fall 2020, under the supervision of former HLS Dean Martha Minow, I wrote a legal analysis on the rights of teachers in a pandemic. I am a product of Miami-Dade County Public Schools, a first-generation daughter of South American immigrants, and a licensed teacher in early childhood education currently studying law. I mention my identities first as my “why” for writing the paper, and this post based upon what I’ve learned.

Bill of health - $100 bill Ben Franklin wearing mask with economic line chart and bar graph going down, pandemic economic crisis, post pandemic economy

Preparing for the Post-Pandemic Economy

March 25, 2021July 15, 2022 The Petrie-Flom Center Staff Leave a comment

By Kareem Caryll, J.D.

The end of the COVID-19 pandemic may be in sight, but how do we prepare for a new economic environment once the health crisis is behind us? The negative economic impact of the health crisis cannot be overstated. In 2020, the domestic economy contracted by 3.5%, the largest decline since World War II. During the year, the unemployment rate reached nearly 15% at its peak as Americans lost 22 million jobs between February and April. Recent data shows that the economy, while slightly improved, remains in a perilous state. There are approximately 9.5 million fewer jobs than in February 2020. While the unemployment rate currently sits at 6.2%, experts suggest that the real rate is closer to 9.5% after accounting for, among other things, the more than 4 million workers who have dropped out the labor force. These facts do not exist in isolation. When individuals lose their jobs, the impact is felt in many facets of their lives. A January 28, 2021 report by the Center on Budget and Policy Priorities revealed that nearly 1 in 6 adults in households with children lacked sufficient food. 21% of adult renters report being behind on rent. 35% of adults report difficulty paying for usual household expenses such as car payments, medical expenses, and student loans.

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