Pre-pregnancy diabetes tied to more birth defects

Date: 7/30/2008 12:01 AM

BC-MED--

By MIKE STOBBE
AP Medical Writer

ATLANTA (AP) _ Diabetic women who get pregnant are three to four times more likely to have a child with birth defects than other women, according to new government research.

The study is the largest of its kind, and provides the most detailed information to date on types of birth defects that befall the infants of diabetic mothers, including heart defects, missing kidneys and spine deformities.

The study lists nearly 40 types of birth defects found to be significantly more common in the infants of diabetic mothers than in those who weren't diabetic or who were diagnosed with diabetes after they became pregnant.

The study's list of diabetes-associated birth defects is surprising — it's much longer than was previously understood, said Janis Biermann, senior vice president for education and health promotion at the March of Dimes.

"It adds more information about the specific types of birth defects associated with pregestational diabetes and gestational diabetes," said Biermann, who was not involved in the research.

Researchers from the Centers for Disease Control and Prevention led the study, which is being published in the American Journal of Obstetrics and Gynecology. CDC officials released the study Wednesday.

Birth defects affect one in 33 babies born in the United States, and cause about one in five infant deaths. The cause of most birth defects isn't known but some risk factors include obesity, alcohol, smoking and infections.

Doctors have known for decades about the threat diabetes poses to pregnancies. Past research has focused on dangers to the infant by the extra amounts of glucose — sugar — circulating in the womb of a diabetic mother. Studies with rats and mice clearly show excess sugar harms fetal tissue development, said Dr. E. Albert Reece, a study co-author, who directs birth defects research at the University of Maryland School of Medicine.

The new study draws from the birth records between 1997 and 2003 at hospitals in 10 states — Arkansas, California, Georgia, Iowa, Massachusetts, New Jersey, New York, North Carolina, Texas and Utah.

The study focused on the 13,000 births involving a major birth defect, and compared them to nearly 5,000 randomly selected healthy births from the same locations.

Mothers were asked if they had been diagnosed with diabetes before or during their pregnancy. The researchers said those who were diagnosed while pregnant either had a temporary, pregnancy-induced condition called gestational diabetes or had diabetes that had gone undiagnosed until they were pregnant.

The study found that there was no diabetes involved in 93 percent of the birth defects.

About 2 percent of the children with single birth defects were born to mothers who had diabetes before they became pregnant. About 5 percent of the infants with multiple defects were born to mothers with that condition. In healthy births, the percentage of mothers who were diabetic before pregnancy was much lower.

The study also showed a wide range of birth defects that included malformation of the heart, spine, limbs and gastrointestinal tract.

"Diabetes is not discriminating" in which birth defects it's linked to, said Dr. Adolfo Correa, a CDC epidemiologist who was the study's lead author.

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On the Net:

CDC: http://www.cdc.gov/ncbddd/bd/facts.htm

Copyright 2008 The Associated Press.

Rapid rise seen in fatal medication errors at home

Date: 07/28/2008 04:04 PM

By CARLA K. JOHNSON
Associated Press Writer

CHICAGO (AP) _ Deaths from medication mistakes at home, like actor Heath Ledger's accidental overdose, rose dramatically during the past two decades, an analysis of U.S. death certificates finds.

The authors blame soaring home use of prescription painkillers and other potent drugs, which 25 years ago were given mainly inside hospitals.

"The amount of medical supervision is going down and the amount of responsibility put on the patient's shoulders is going up," said lead author David P. Phillips of the University of California, San Diego.

The findings, based on nearly 50 million U.S. death certificates, are published in Monday's Archives of Internal Medicine. Of those, more than 224,000 involved fatal medication errors, including overdoses and mixing prescription drugs with alcohol or street drugs.

Deaths from medication mistakes at home increased from 1,132 deaths in 1983 to 12,426 in 2004. Adjusted for population growth, that amounts to an increase of more than 700 percent during that time.

In contrast, there was only a 5 percent increase in fatal medication errors away from home, including hospitals, and not involving alcohol or street drugs.

Abuse of prescription drugs plays a role, but it's unclear how much. Valid prescriptions taken in error, especially narcotics such as methadone and oxycodone, account for a growing number of deaths, said experts who reviewed the study.

The increases coincided with changing attitudes about painkillers among doctors who now regard pain management as a key to healing. Multiple prescription drugs taken at once — like the sleeping pills, painkillers and anxiety drugs that killed "Dark Knight" star Ledger — also play a part, experts said.

"When we see overdoses, we're seeing many more mixed drug overdoses," said Dr. Jeffrey Jentzen, president of the National Association of Medical Examiners and director of autopsies at the University of Michigan in Ann Arbor. Jentzen said autopsies are much more likely to include toxicology tests today than 25 years ago, which would contribute to finding more fatal medication errors as cause of death.

But Phillips said there were no significant increases in other poisonings like suicidal overdoses or homicides, so more testing doesn't explain the huge increase. The analysis excluded suicides, homicides and deaths related to side effects.

The increase was steepest in death rates from mixing medicine with alcohol or street drugs at home; that death rate climbed from 0.04 per 100,000 people in 1983 to 1.29 per 100,000 people in 2004.

Many patients ignore the risk of mixing alcohol with prescriptions, said Cynthia Kuhn of Duke University Medical Center, who was not involved in the study.

"They think, 'Oh, one drink won't hurt.' Then they have three or four," Kuhn said.

The increase in deaths was highest among baby boomers, people in their 40s and 50s.

"We're sort of drug happy," said boomer Dr. J. Lyle Bootman, the University of Arizona's pharmacy dean, who was not involved in the research. "We have this general attitude that drugs can fix everything."

People share prescriptions at an alarming rate, Bootman said. One recent study found 23 percent of people say they have loaned their prescription medicine to someone else and 27 percent say they have borrowed someone else's prescription drugs.

Kenneth Kolosh, a statistics expert at the National Safety Council, praised the study but said improved attention to coding location on death certificates may account, in part, for the huge increases the researchers found.

Phillips countered that home deaths from any cause increased relatively little during the time period, so better coding doesn't explain the change.

Michael R. Cohen, president of the Institute for Safe Medication Practices, said more states should require pharmacists to teach patients about dangerous drugs and insurers should pay pharmacists to do so.

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On the Net:

Archives of Internal Medicine: http://www.archinternmed.com

Copyright 2008 The Associated Press.

La. doctor cleared in patient deaths recalls storm

Date: 07/20/2008 01:54 PM

By MARY FOSTER
Associated Press Writer

NEW ORLEANS (AP) _ Trapped in a hospital with 2,000 people in the aftermath of Hurricane Katrina, Dr. Anna Pou recalls her throat burning from the rancid smell.

Toilets had backed up and temperatures in the eight-story building reached almost 110 degrees because the windows didn't open. Power had failed, levees broke and 80 percent of New Orleans was flooded, including the hospital basement where the generators were.

It was completely dark at night. Stories of murders, gangs raping women and children circulated through Memorial Medical Center, where the people, including more than 200 patients, feared for their lives.

Pou, the doctor accused — and later cleared — of giving lethal doses of drugs to four patients during the chaos recalled the four days of misery in a recent interview with The Associated Press. It was her most detailed account of the scene where 34 patients died since the storm three years ago.

"You can't really understand what it was like if you weren't there," Pou said. "Nothing can describe it."

It began as a typical weekend for Pou, who wasn't worried when she made her way to Memorial in August 2005.

Hurricane Katrina appeared headed to Florida. Even when warnings were issued for New Orleans, the respected cancer surgeon never thought of leaving. She stayed with her patients in what would become a personal and professional hell.

After the storm passed Monday, Aug. 29, it seemed the decision not to evacuate patients and staff was a good one. They didn't know levees were collapsing.

"We made it through the storm pretty good," Pou remembered. "On Monday, it was just a little hot, but we had some generators working and food and water twice a day."

By Tuesday, water was rising in the streets, eventually reaching 10 feet. The hospital basement flooded and the generators failed.

When nightfall came, the hospital and the city were in darkness. Water pressure dropped, toilets backed up and the temperatures began to swelter.

"The smell got to be rancid in no time," Pou said. "It burned the back of your throat."

The deteriorating situation had dire consequences. Those trapped in the hospital could hear voices in the dark. People had broken into a credit union office across the street and holed up there.

"We started hearing stories about murders, about gangs raping women and children," Pou said. "The women that had their children there were really scared."

They had a few flashlights but no spare batteries.

"One of the nurses showed me how to bump my foot against the next step to find it," Pou said. "We counted the steps from one floor to another so we wouldn't miss one and fall."

Pou said staff struggled to climb stairwells, carry supplies, and spent two-hour shifts squeezing ventilators to keep patients alive.

"The heat was so terrible, it wore you down," Pou said. "We were trying to keep the patients comfortable. The 9-year-old daughter of one of the nurses even took shifts fanning them."

Airboats evacuated some patients and babies from the nursery, but most remained. All Pou said she could do was try to keep critically ill patients comfortable.

"Tuesday night was when we realized we were going to be there for a while," Pou said.

They gathered supplies, rationed food and water with non-patients, and prayed.

About seven medical staffers, including Pou, stayed with patients. Others went to the roof and the ground floor to coordinate the intermittent rescue efforts with the few boats and helicopters that showed up.

"When a helicopter left, we never knew if they would be back," Pou recalled. "They might be sent to another rescue. And after dark it was too dangerous for them to fly at all."

Under the military's orders, the staff did reverse triage. The healthiest patients were taken out first in an effort to save the greatest number of people.

Many had to be carried to the roof. It was slow, backbreaking work, with as many as 10 people struggling up the dark stairs with a stretcher. At least 34 people died waiting for rescuers.

Pou was one of the last to leave Memorial. She returned to New Orleans — her house had not been flooded — from Baton Rouge a few months later at Thanksgiving. In January 2006, she started working at a Baton Rouge hospital, trying to put Katrina behind her.

Then, in July 2007, she was greeted by four police officers on her arrival home from a 13-hour day of surgery. They handcuffed her, still in her scrubs, and drove her to jail. She was booked on four counts of second-degree murder.

Attorney General Charles Foti accused Pou and two nurses of using a "lethal cocktail" of medication to kill four elderly patients. Pou has always maintained she killed no one during those desperate days, though she acknowledges patients were sedated.

She was forced to give up private practice and started teaching at the LSU medical school in Baton Rouge.

Months of pain and frustration set in.

A year after their arrest, the New Orleans district attorney dropped charges against the nurses, and a grand jury refused to indict Pou. Two civil lawsuits in the deaths are pending.

"I felt very alone," Pou said of her year of fighting the criminal accusations. "Even if people were around me I felt an intense loneliness. It was as if no one knew what I was going through."

Pou's supporters believed she and the nurses acted heroically. A group of doctors and nurses held a rally on the anniversary of her arrest, and hundreds turned in support.

Her experience helped her get landmark state legislation approved to protect the actions of doctors and nurses during disasters.

"It was that support and prayer that got me through it," said Pou, who is back in private practice.

As Katrina's third anniversary nears, Pou said the experience was life-altering.

"I've learned a lot from this," she said. "I thought I had suffered at times in my life, but I had no ideal the depths of pain one person could feel. I think that has made me a better person and certainly a more compassionate doctor."

Copyright 2008 The Associated Press.

Oregon doctor ordered to Australia to face trial on manslaughter charges in patient deaths

Date: 07/15/2008 10:40 PM

By WILLIAM McCALL
Associated Press Writer

PORTLAND, Oregon (AP) _ An Oregon doctor charged with manslaughter in the deaths of three patients at an Australian hospital has been ordered to return to Australia to stand trial.

U.S. Magistrate Judge Dennis Hubel said Tuesday he had ordered the U.S. Marshals Service to return Dr. Jayant Patel to Australian authorities by July 21.

The Marshals Service said the agency had begun extradition but declined to give any details.

Dale Ortmann, a marshals spokesman, also declined to release any details at an evening news conference Tuesday on the steps of the federal courthouse in Portland.

But Ortmann said that, in general, marshals can accompany a prisoner to a foreign country or authorities from the nation requesting extradition can handle the transfer themselves.

Patel worked at the Bundaberg Base Hospital in the Australian state of Queensland after leaving Kaiser Permanente hospital in Portland in 2001 following a series of lawsuits and an investigation that led the Oregon Board of Medical Examiners to restrict his practice statewide.

The national news agency, the Australian Associated Press, reported that U.S. marshals were expected to hand Patel over to two senior Queensland police officers for the flight back to Australia.

Patel was arrested March 11 by FBI agents acting on an extradition request from Queensland authorities following a public outcry in Australia that began in 2005 over his role in the deaths of patients at Bundaberg.

The complaints included failure to stop internal bleeding in one patient who later died, tearing another patient's esophagus and removing healthy tissue while leaving cancerous tissue behind.

In addition to manslaughter, Patel is charged with fraud and causing grievous bodily harm in Australia. He could face a possible life sentence if convicted.

Patel, 58, is a U.S. citizen who was born in India and trained in New York, where he was disciplined by the state early in his career for failing to examine patients before operating on them.

He moved to Portland to join Kaiser Permanente in 1989 and was sued several times — including at least one lawsuit that is still pending. The hospital reviewed 79 separate complaints against him before the state restricted his practice.

The AAP said the extradition had been awaiting the approval of U.S. Secretary of State Condoleezza Rice.

Copyright 2008 The Associated Press.

Child welfare worker charged in baby's death

7/2008 03:18 PM

By SUSAN HAIGH
Associated Press Writer

HARTFORD, Conn. (AP) _ An employee of the state Department of Children and Families has been charged in the death of a 7-month-old foster child in her care, prompting the agency to seek her dismissal.

State police charged Suzanne Listro, 40, of Mansfield, with manslaughter Wednesday in the May 19 death of Michael Brown Jr., who suffered a blunt trauma head injury at her home. At a court appearance Thursday, a judge set bond at $1 million.

"We don't expect her to be posting bond today," her attorney, Matthew Potter, said Thursday. He declined to comment further.

Listro, a children's services consultant for the department, received a foster care provider's license earlier this year, despite having been investigated twice within the past two years on allegations she abused another child she adopted, said the agency's commissioner, Susan Hamilton. The allegations were not substantiated.

Listro has been placed on unpaid leave, and Hamilton is seeking to have her fired.

The agency will start requiring an outside firm to review agency employees who want to be foster parents.

Hamilton said she also plans to dismiss a department investigator who handled the two previous abuse probes in 2006 and 2007 involving Listro and her adopted child. She called those investigations "substandard and unacceptable."

A manager who approved both investigations will be suspended for 20 days, Hamilton said.

Because the alleged abuse was unsubstantiated, Listro's name was not listed in the automated child abuse and neglect registry when she was being investigated for a foster care license, Hamilton said.

"Although it's impossible to determine whether this information would have changed the licensing decision, it's clear that it should have been easily accessible to the licensing staff," Hamilton said