Sudden Infant Death Syndrome remains a mystery
TAHLEQUAH, Okla. – Cherokee Nation citizen Angela Garrett remembers the cold day in January 1993 as one that began like a normal day.
She had just per her 2-month-old son, Blaine, down for a nap in his crib. She checked on him frequently, but despite that, one hour later Blaine died in his sleep. The cause was Sudden Infant Death Syndrome.
October is Sudden Infant Death Syndrome, or SIDS, Awareness Month. SIDS occurs at a rate of about 0.5 per 1,000 births. However, in American Indian and African American populations, the rate is around one per 1,000 births.
SIDS is considered the death of a child less than 1 year old that remains “unexplained” after a thorough investigation including an autopsy, review of clinical history and investigation of the scene of death, said Dr. Tom Kincade, chief of Pediatrics at the Cherokee Nation Three Rivers Health Center in Muskogee.
“I think it is important for our communities to know abut SIDS due to the increased rates in Native Americans and also to be aware of the factors that can help prevent SIDS,” Kincade said.
SIDS remains a leading cause of death in healthy infants less than 1 year old, and approximately 2,100 infants in the United States die of SIDS per year, he said.
Parents can reduce the risk of SIDS by placing babies on their backs to sleep.
“Studies show that over 90 percent of infants that died from SIDS were not sleeping on their backs,” he said. “Most were sleeping on their stomachs.”
Garrett said she put Blaine on his back for his nap, but when she found him, he was on his stomach and his face was in the crib mattress.
“Somehow, at 2 months old he rolled over,” she said. “He was already gone when I found him. I didn’t even call 911(immediately.) I called my mom because he was already gone.”
She said afterward she was in a state of shock, and since then she’s blocked out most of the memory of losing Blaine to SIDS.
“I don’t even remember them taking him out,” she said. “I thought he was still in the room after the ambulance got there and everything. It was a couple of hours later and I thought he was still there.”
Even now, 14 years later, Garrett said she’s stilly trying to understand SIDS.
“From the moment I found him, I don’t remember too much of anything else,” she said. “He wasn’t sick. He didn’t have a cold. There wasn’t anything wrong with him.”
Studies have also shown that letting babies use pacifiers while sleeping can reduce the SIDS risk, Kincade said. He added that infants should sleep on a firm sleeping surface, should not be overdressed while they sleep and stuffed animals, excess bedding and blankets should be avoided.
“When babies leave the hospital nursery they should be able to maintain a normal body temperature which means if parents feel comfortable in shorts and a tee shirt, their babies will too,” he said.
Educational materials about SIDS have been placed in the clinic and exam rooms at the Three Rivers Health Center, and other tribal clinics have been encouraged to do the same, Kincade said.
TAHLEQUAH, Okla. – The Cherokee Nation’s Elder Care Program is working with its auditing agency to correct deficiencies found by a routine audit in March and a follow-up audit in September.
The Centers for Medicare & Medicaid Service, which is part of the Department of Health and Human Services, found nine deficiencies during its September audit of ECP’s Program of All-Inclusive Care for the Elderly or PACE, which operates a 15,600-square-foot facility in Tahlequah. The facility serves older adults who are eligible for nursing-home-level care to remain healthy, safe and independent at home.
ECP Director Sharon Washington said of the nine deficiencies only three remain open and CMS would monitor and work on those with the ECP. The rest have been closed.
One of the three remaining deficiencies is the development of a formal process to resolve grievances by participants and their families. The CMS audit states the plan should include written policies, procedures and internal controls to ensure a thorough and completed disposition of grievances by participants or their family members.
The second deficiency involves social work and dietary assessments. The CMS audit states ECP should develop policies and procedures to identify methods to track and ensure proper documentation of all participants’ assessments. The audit showed annual and semi-annual social work assessments were missing as well as initial and annual dietary assessments necessary for a participants’ plan of care.
The third deficiency deals with establishing plans of care that are measurable with attempts to reach specific goals. The audit showed the plans of care for 10 of 10 records reviewed had set goals that were more related to medical goals than care goals. The care plan goals “were not measured and/or obtainable;” and the care plans were not reviewed, evaluated and updated as needed.
CMS recommends the ECP conduct training of appropriate staff to ensure they are cognizant of developing a proper plan of care and submit documentation to CMS that details the nature of this training.
CMS performed a routine audit of ECP from Feb. 24-28 of this year and followed up that audit with an on-site visit on Sept. 15-16 “to supplement the information provided by the review of the monthly reports and results of internal monitoring” ECP submitted for deficiencies found in March.
“Based on this information we conclude you are not making adequate progress toward correcting the deficiencies within the time frame specified in the Corrective Action Plan. This represents a failure of the original CAP,” states a CMS letter dated Sept. 22.
CMS gave the program 30 days from the date of the letter to submit a revised plan “for taking appropriate and effective steps to restore compliance with the requirements for these elements,” the letter states.
“The new CAP must provide a detailed account of the steps you will be taking to correct the deficiencies as soon as possible and an ongoing monitoring plan to ensure the deficiencies do not reoccur,” the letter further states.
CMS also outlined penalties the ECP would face for non-compliance, including a warning letter, sanctions, civil money penalties and the loss of new or expanded Medicare contracts for the ECP.
Washington said of the nine deficiencies found in March, one was immediately closed and five more were closed in September. Also, CAPs have been submitted for the three deficiencies that remain open.
“So, if I find the Correction Action Plan acceptable, what I will do is I’ll send them a letter saying this is acceptable and then we give them a 60-day time period to come into compliance,” CMS Nurse Consultant Kirby McGahagin Jr. said.
He said if he does not accept the CAPs, ECP would have to submit more information to him.
“Usually what we have them do is send us monthly materials for quality improvements to let us know they are putting in internal controls in place to come into compliance,” he said.
McGahagin said it should be determined by the end of January whether the ECP has come into compliance with CMS regulations.
Other deficiencies listed by the CMS in September included:
• Failing to maintain a sanitary kitchen environment,
• Failing to ensure a safe environment for the physical safety of participants,
• Failing to ensure a safe and sanitary environment that prevents and controls the transmission of disease and infection,
• Failing to complete training for a registered nurse,
• Failing to ensure certified nurses completed a skill competency check off list before providing care,
• Failing to ensure that a restraining device used by participant had a current physician’s order and the device was continually assessed, monitored and reevaluated, and
• Failing to follow its own policy of complaint investigation of alleged abuse of participant.
The ECP has addresses these deficiencies and have been closed by CMS.
Washington said, while she takes them seriously, the ECP’s number of deficiencies was low compared to the 15 to 20 deficiencies other agencies under CMS receive. She said she attends regional meetings with CMS, and their auditors have been working with the ECP to correct its deficiencies.
Cherokee Elder Care is a nonprofit agency of the CN with a five-member board appointed by the Tribal Council and principal chief. It has 132 participants who are serviced by 60 full-time staff.
Covering 25 zip codes in the area surrounding Tahlequah, PACE buses in elders from Cherokee and Adair counties as well as parts of Delaware, Mayes and Muskogee counties to the PACE center in Tahlequah.
TAHLEQUAH, Okla. –The Oklahoma Blood Institute will visit the Cherokee Nation on Dec. 16 for Donor Appreciation Day. The day will include door prizes, lunch and blood donation.
The blood drive will be from 9 a.m. to 4 p.m. in the CN’s Ballroom behind the Restaurant of the Cherokees.
There will also be a “treasure chest” from which for donors to choose an appreciation item. Donors will also be able to receive free health screenings and donor reward points, which can be redeemed at the OBI’s online store.
“We’re blessed to be surrounded by giving people who respond when they know of a need,” President and CEO of Oklahoma Blood Institute John Armitage said. “The gift of blood is a priceless one. It’s difficult to think of anything more important that we personally can do.”
According to the OBI, the OBI is the ninth largest blood center in American and is the exclusive blood provider to patients at the W.W. Hastings Indian Hospital and Northeastern Health System. Approximately 140 medical facilities also receive blood from the OBI.
ANCHORAGE, Alaska (AP) – American Indian and Alaska Native children are exposed to violence at rates higher than any other social group in the nation, according to a new report that urges creation of a new Native American affairs office, additional federal funding and other measures to combat the problem.
The report released Tuesday by a U.S. Department of Justice advisory committee reflects information gathered at public hearings across the country in 2013 and 2014.
“We discovered something we’d known when we started – that this is an urgent problem that needs to be addressed,” committee co-chair and former U.S. Sen. Byron Dorgan of North Dakota said during a teleconference.
Based on the public input and research, the committee assessed the effects of violence on tribal youth and came up with an action plan.
The report’s goal is to be a catalyst for action by Congress and the Obama administration, said Dorgan, who served as chairman of the Senate Indian Affairs Committee until his retirement in 2010.
“State and federal governments must recognize and respect the primacy of tribal governments,” the report said.
According to the report, exposure to violence results in American Indian and Alaska Native children experiencing post-traumatic stress at three times the rate of the non-Native population. The task force compared the level of stress to that of veterans returning from Afghanistan and Iraq.
The study says 75 percent of deaths among indigenous children between the ages of 12 and 20 are caused by violence, including homicides and suicides.
Alaska Native children were singled out as having the worst conditions systemically for various reasons including Alaska’s vastness, remoteness and steep transportation costs, along with a lack of respect for tribal sovereignty.
Among recommendations specific to the state, the report urges that more sovereignty be granted to Alaska Native tribes. Currently the only reservation in the state is the community of Metlakatla, in southeast Alaska.
A key recommendation in the report is to establish a White House Native American affairs office to coordinate services affecting children, among other things.
The committee also said increased mandatory funding and coordination between tribal, federal and state governments are crucial to reversing the trend. The funding process also should be streamlined and less administratively burdensome, task force members said.
“We all have to come together to make this work,” said committee member Valerie Davidson, with the Alaska Native Tribal Health Consortium.
Dorgan said it’s difficult to predict how such recommendations as creating a new office to deal with the problem will be received in the new Republican-led Congress.
“I think the series of recommendations in this report about children exposed to violence and about the help that we need to provide for these children will fall on the ears of Republicans and Democrats,” he said. “They must care about children.”
The recommendations are a step forward in helping Native American children receive opportunities to succeed, said U.S. Sen. Heidi Heitkamp, a North Dakota Democrat and member of the Senate Indian Affairs Committee.
“Native children dealing with the dire effects of exposure to violence has truly reached pandemic levels – and it requires our immediate attention,” Heitkamp said in a statement.
ROCKVILLE, Md. – Officials with the Indian Health Service Bemidji Area recently determined that a physician employed by a staffing IHS contracted company had improperly accessed protected health information from three IHS facilities.
The IHS, an agency in the U.S. Department of Health and Human Services, provides a comprehensive health service delivery system for approximately 2.1 million American Indians and Alaska Natives.
The three facilities include the Fort Yates Service Unit in the IHS Great Plains Area, the Cass Lake Service Unit in the IHS Bemidji Area and the Crow Service Unit in the IHS Billings Area.
The data breach included patient names, Social Security numbers and health information such as diagnoses, prescribed medications and laboratory results. However, there is no current indication that the information has been used by or disclosed to any unauthorized individuals.
“IHS is very disappointed that this breach occurred given that the staffing company contract included the requirement that contract providers must protect patient privacy and meet HIPAA regulations. We are committed to ensuring the security and integrity of all our patients’ personal information and are putting additional protections in place” said Dr. Yvette Roubideaux, acting IHS director. “Keeping patient information secure is of the utmost importance to us and we very much regret that this situation occurred.”
The IHS contract at issue contained the requirement that contractors must protect patient privacy and comply with the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations. Even though these protections were required as a part of the staffing company’s contract with IHS, the contract provider improperly accessed these records.
In accordance with regulations implementing HIPAA, on Oct. 17 the IHS has notified all persons whose information was improperly accessed.
The Area HIPAA Coordinators have completed an investigation and the matter has been referred for appropriate action in accordance with HIPAA and its implementing regulations.
Patients who received the letter and have any questions can contact the following Area HIPAA coordinators:
• Cass Lake Service Unit in the IHS Bemidji Area – Phillip Talamasy at 218-444-0538 or email <a href="mailto: firstname.lastname@example.org">email@example.com</a>
• Fort Yates Service Unit in the IHS Great Plains Area – Heather H. McClane at 605-226-7730 or email <a href="mailto: firstname.lastname@example.org">email@example.com</a>
• Crow Service Unit in the IHS Billings Area- Felicia Blackhoop at 406-247-7184 or email <a href="mailto: firstname.lastname@example.org">email@example.com</a>
TAHLEQUAH, Okla. –The Centers for Medicare and Medicaid Services recently awarded $3.9 million for outreach and enrollment efforts targeted at American Indian and Alaska Native children who are eligible for the Children’s Health Insurance Program and Medicaid.
The awarded money from the grant will go towards funding activities that are designed to engage schools and tribes in Medicaid and CHIP outreach and enrollment efforts.
CMS awarded grant funds to health programs that are operated by tribes, tribal organizations, Indian Health Services and urban Indian organizations located in Oklahoma, California, Arizona, Alaska and New Mexico.
“We are very pleased to support efforts that help eligible American Indian and Alaska Native children gain access to affordable health coverage,” said Centers for Medicare and Medicaid Services and CHIP Services Director Cindy Mann. “More people with health coverage also benefits local health care facilities, allowing them to offer more services and improve health care for the whole community.”
Grantees will organize activities that are focused on helping eligible teens enroll for coverage and ultimately ensure that eligible children maintain coverage for as long as they qualify.
These awards ensure that Native American and Alaska Native children will be given the opportunities to receive quality health care services.
For more information, visit <a href="http://www.insurekidsnow.gov" target="_blank">www.insurekidsnow.gov</a>.
JAY, Okla. – Cherokee Nation and Cherokee Nation Businesses officials on Nov. 19 celebrated the topping out of the tribe’s new health center in Delaware County, which is still under construction.
“Access to quality health care is the most important issue facing our people. We made a strategic investment to ensure Cherokee citizens would have every opportunity to receive the kind of world-class health care they deserve,” Principal Chief Bill John Baker said. “The expanded space, coupled with new state-of-the-art equipment, allows us to deliver better and faster care to more people.”
The health center will be 42,00 square feet and is expected to cost approximately $13.5 million. It will have services such as behavioral health, contract health, dental, diabetes care, laboratory, nutrition, optometry, pharmacy with mail order, physical therapy services, primary care, public health nursing, radiology and Women, Infants and Children.
According to a CNB press release, the original Sam Hider Health Center was opened in 1989, which makes it one of the oldest health centers in the tribe’s health care system. Approximately 100 people are employed in the existing 26,000-square-foot facility. In 2013, that facility served more than 80,000 patient visits.
“It was time for a new health center,” Tribal Councilor Harley Buzzard said. “Health care is important to the Cherokee people, and I am grateful we are able to make this investment for the citizens.”
The new Sam Hider Health Center is one of four health centers under construction with the help of CNB, which provided funds of more than $100 million.
“This new health center is something that Cherokees will take pride in for years,” Tribal Councilor Curtis Snell said. “This has been a dream for a long time, and I couldn’t be more pleased that local citizens will have access to improved health facilities.”