Interview: Dr. Michael Copass

Dr. Michael Copass, medical director of Medic One(InvestigateWest/Medic One Foundation)Dr. Michael Copass, whose famously crusty persona and exacting standards in the emergency room inspired equal parts dread and admiration among generations of medical students, residents, nurses and paramedics-in-training, sat down with InvestigateWest’s Carol Smith to talk about Medic One – the emergency response system he helped pioneer, and how it is responding to the epidemic of overdose deaths in King County.  Over the nearly four decades he was director of Emergency Services for Harborview Medical Center, the region’s Level 1 trauma service, Copass acquired a legendary status for his fierce devotion to patients and his high bar for those under his command. Paul Ramsey, dean of the University of Washington School of Medicine, once referred to him as a “cross between General Patton and Albert Schweitzer.” The Medic One model of emergency response, which began in the late 1960s, is now emulated around the world. Copass, who retired from Harborview in 2008, remains medical director of Medic One.Smith: I think the lay public confuses Medic One vehicles with ambulances, and we use the terms interchangeably. What kind of equipment is different on a Medic One versus a private ambulance?Copass: Private ambulances carry comfort equipment – oxygen, suction gear. A Medic One unit basically is an under-stocked ER. (It has) two defibrillators — one on active duty, one on reserve.  It has individuals trained at the 2,800-hour level of education versus individuals who are trained at 120 hours.

Riding with the Opiate Epidemic’s First Responders

I’ve been in the back of ambulances before, but never for work. So my recent ride-along in the front seat of one of Medic One’s fleet of response vehicles was a first for me. It was an unusual opportunity. Medics are understandably hesitant to import bystanders to a scene. The last time they did it, I was told, was when CBS News 60 Minutes correspondent Morley Safer reported on Medic One in 1974, noting for posterity that Seattle was the “best place in the country if you’re having a heart attack.”So I was grateful that the Seattle Fire Department granted my request to accompany their medics into the field to see the opioid drug epidemic from their perspective. I’d asked after learning, during the course of reporting about Washington’s prescription epidemic, that medics respond to up to 50 overdose calls a month in King County and about half of those calls involve prescription painkillers.My ride-along took months to arrange. The result is this piece for KUOW, about efforts underway to supply more bystanders with Narcan – an antidote that can wake someone up from an overdose and save his life. Medics carry Narcan, and citizens, by law, are allowed to. But the drug is not widely available. If more people did carry it, public health experts say there would likely be fewer calls to Medic One about overdoses.Lt. Craig Aman, a 22-year-veteran paramedic, met me at the Battalion 3 headquarters, a warren of small offices across the street from Harborview Medical Center’s emergency room. 

Legislature seeks Rx to discourage pharmacy robberies

Bill McNary smooths his white coat and steps out from behind the high counter where he presides over medications dispensed at the Maple Leaf Pharmacy in a quiet residential neighborhood of north Seattle. He scans the few customers who are browsing the aisles full of Ace bandages, aspirin and assorted other sundries for life’s aches and pains.These days, even the most benign-looking customer could be a deadly threat. Worried about the kinds of robberies McNary, co-workers, and customers have experienced, pharmacists across Washington are seeking changes in state law.In December, 2009, a young man who McNary said looked “normal enough” strolled into the pharmacy, glanced around, bought a Chapstick, which gave him a view over the counter, and left. When he came back a few hours later, the store was packed with customers waiting for flu shots. He was waving a gun.The man, Jacob Shook, burst behind the counter and overpowered one pharmacy technician, knocking her to ground.Technician Geraldine Crews whipped around, phone in hand, as her co-worker flew to the floor. She saw the glint of a gun barrel and hit the ground herself.“He jerked me up, and slapped me with the gun,” she said. “He got angry. He said, ‘Do you know what Oxy is?’ ” She knew that OxyContin, a powerful pain pill that acts like heroin, sells for upwards of $80 a pill on the street. She also knew that people addicted to it can be desperate.“Here – take it all and go,” she remembers telling him. She was terrified that if she didn’t, he’d turn the gun on customers.“This place was full of people — there was a five- or six-year-old little boy with his parents here,” she said. “I’m sure it gave that little boy nightmares.”

Some solutions for ending the prescription drug epidemic

A mother who lost her son. A cop who lost his career. A family who lost their home. These are just a few of the devastating human costs we uncovered in the course of delving into the prescription painkiller epidemic that grips Washington state. Their stories are shocking, but not rare.While Washington has just passed the strictest state law in the country to try to curb the epidemic, and while we have launched a number of innovative pilot programs here, the experts we spoke with, including addicts themselves, said there is still much work to be done before we can remove ourselves from the list of worst states for prescription drug deaths.Some of the challenges that remain• Washington’s Prescription Monitoring Program, a step in the right direction, still lacks permanent funding, and clinicians are not required to consult it before prescribing narcotic pain medication. Nor is the data shared, yet, with licensing agencies, or with neighboring states along the corridors where prescription drugs are trafficked.• Washington’s emergency rooms, which have long been a place where people hooked on prescription painkillers have sought drugs to feed their habits, have no way to systematically share data across the state about multiple users of the ER.• Insurance companies don’t yet provide enough coverage for alternative forms of pain treatment, including physical therapy, counseling, acupuncture, massage, or other alternatives.

A Cop Battles Addiction

Editor’s Note: Sean Riley will be on KCTS 9 Connects with Enrique Cerna tonight to talk about prescription drug abuse. Watch the Preview.Sean Riley, a 20-year homicide cop, was working an elder abuse case in 1999 in Kirkland, when he discovered one of the “perks” of his investigation.“I’d been having a tough year,” he said. He’d gone through a divorce and had started drinking heavily. Then a gym injury led to a prescription for Vicodin. He started bumming prescriptions off doctors at the institutions where he was doing his investigations.One pill led to another, and before long he was popping 20 to 30 a day. “I learned to chew pills to get the drug into my system faster,” he said.By 2005, Riley was also taking increasing amounts of Percoset, morphine and Oxycontin. Eventually, a drug test busted him, and his own police chief turned him in to authorities.Riley still figured he could beat the charges. “I know how to build cases,” he said. He shrugs now at his own arrogance. “As a police officer, you have to have an ego, be confident,” he said. “It’s how you stay safe.”It also makes them their own worst enemies when it comes to admitting a take-down by addiction.But shame worked.“My dad – a guy who’d worked for 40 years, who had never had the opportunities I’d had, he looked at me and asked, ‘At what point in life do you take responsibility for your actions?’ ”Riley said. “That was it. I was done.”He went to treatment, pleaded guilty and received three years probation.But with a felony conviction on his record, his career as a police officer was done.  He turned instead to helping people like himself.

The Devil in the Medicine Cabinet

Rosemary Orr with her son, Robin, at his high school graduation in June, 2000.Photo courtesy of the Rice family.Dr. Rosemary Orr didn’t see it coming that day. It was the morning after Mother’s Day. She needed a ride to work, so her 24-year-old son Robin drove her. She was in a hurry to get to Children’s Hospital and Medical Center in Seattle, where she is a pediatric anesthesiologist. Otherwise, she says, she would have spent more time talking with him.She’d been worried about his sleeping habits, his weight loss lately. She knew her smart, handsome son had struggled with addiction to OxyContin in the past. But he’d kicked it. He’d assured her of that. He’d looked her in the eye and said, ‘You don’t have to worry about me, Mom.”No parent wants to believe her child is using. Not even one who is a doctor.“I was stupid and desperate enough to believe that explanation,” Orr says now, five years later, over coffee a few miles from her work, where she takes care of the pain of others. Her own pain, she takes with her.When she got home from work that day, Robin’s phone was ringing, but he wasn’t answering in his room downstairs. She knocked. And knocked again. She went around her house and peered in through his bedroom window.

New Prescription Drug Law Holds Promise, but Concerns Linger

In Spokane, Dr. Darin Nevin (left) and Lee Taylor want to expand data sharing to emergency rooms across the state.Credit: Dan Pelle/The Spokesman-ReviewWashington State has made an aggressive attempt to crack down on the prescription drug epidemic by passing strict new rules governing pain management. But even those may not be enough to stanch the flood of deaths from prescription opiates in this state.The passage of a new law, regarded as one of the toughest in the nation, makes Washington the first state to require dosing limits for doctors and others who prescribe these medicines. The law, RCW 2876, went into effect January 2, but those who have watched the epidemic spiral out of control still see significant challenges ahead.Among the first is the dearth of pain specialists in the state. Under the new law, doctors and other prescribers with patients who need more than 120 mg a day must seek a second opinion from a pain specialist. But there are few of those professionals to go around.Medicaid is already struggling to comply with the new law. Despite having thousands of patients currently over the threshold limit, the agency can only get one or two evaluated by a pain specialist a month, said Dr. Jeff Thompson, medical director of the state’s Medicaid program.“Access is an issue,” said Dr. Gary Franklin, medical director of the state’s Department of Labor & Industries, adding that telemedicine consultation programs and other efforts to increase capacity are helping, but still don’t fill the need.  The new law makes Dr. Merle Janes of Valley Rehab & Emergency in Spokane angry. He said legitimate pain patients and doctors who prescribe for them are paying the price for the policy changes designed to nab addicts. People in real pain can’t get adequate relief, he says.“It’s been a disaster for all these people,” Janes said.Dr. David Tauben, a clinical associate professor and director of medical education in pain management at the University of Washington, agreed that not enough doctors are treating pain well.“But this problem was happening well before the new law,” Tauben said. He’s optimistic that the new law will actually encourage more doctors to take on pain patients because they will have guidelines to follow to help keep them from running afoul of disciplinary agencies. The guidelines should remove ambiguity and help doctors communicate better with patients about the goals and limitations of pain treatment, he said.

Duwamish neighborhoods are a ‘food desert’ in foodie Seattle

Seattle has gained a national reputation as a haven for “foodies” – but there’s a “food desert” in its own back yard, ironically in an area that once helped feed a growing city.The area near the banks of the Duwamish River south of Seattle is where the founder of the Pike Place Market had his original farm. Today, some yards in that area are so contaminated with dioxins in the dirt, the health department advises residents not to grow their own gardens. It’s a place where waves of tribes and immigrants continue to fish the river as they have for decades, but where PCB’s in the river bed have made resident fish no longer safe to eat.After a century of industrial use, the lower Duwamish River now runs through one of the largest urban Superfund sites in the country. A recent examination of public health data by InvestigateWest revealed that residents who live in the vicinity face more chronic health problems than people who live in other parts of the county. Data show residents in the Duwamish communities are typically more overweight, and have higher incidence of diabetes and more deaths from heart disease. Life expectancy in the area is five years lower than for other, more affluent parts of King County, likely because of some combination of poverty, pollution, and lifestyle.And food lies at the intersection of all those problems. Affordable nutrition– or lack of it – is at the heart of many of the health problems facing residents in the region along the Duwamish.

Homeless student populations on rise around state

Editor’s note:      The following is an updated version of a story about homeless students in school districts throughout the state, including the most recent data collected by the Office of the Superintendent of Public Instruction. ..;.. For updated information on each district, see interactive map.For updated information on each district, see interactive map.By Carol SmithInvestigateWest School districts around the state are grappling with how to help growing populations of homeless students, even as budget cuts further slash their ability to meet their federal obligation to do so.Under the federal McKinney-Vento Act, school districts are required to identify and report homeless students and to guarantee those students transportation so they can stay at their original schools even if they have been forced to find emergency shelter outside the district. The districts are required to track how many students are living in motels, doubled up with relatives, in cars or in shelters.Being homeless can affect how children learn, can lead to depression, and can be misdiagnosed as learning disabilities, labels that stick with a child for years.

Learning from the Duwamish River Communities

Seattle is a city built on water – its identity, its celebrated beauty, and much of its economic lifeblood comes from its relationship to Puget Sound and the rivers that flow into it.But the Duwamish River, which runs through the center of Seattle’s urban industrial core, is not the one you see on post cards. Now named one of the largest Superfund sites in the country, it is also the river in the backyard of more than 38,000 of Seattle’s poorest and most diverse residents.The goal of my 2010 National Health Fellowship project was to identify the community health issues that face the people living in two neighborhoods – Georgetown and South Park — which face each other across the toxic river in the middle of the Superfund site. The thinking was that by identifying these problems, we could call out the issue of accountability, and more importantly point the way toward creative solutions for a portion of the population the greater Seattle community has historically ignored. The backdrop for the story was a looming multi-million dollar Superfund decision about how best to clean up the river, and to what extent.The precipitating event for the story, though, was the closure of the bridge that links the two communities, effectively cutting off easy access to downtown Seattle a few miles away. To me it seemed the perfect metaphor for the attitude of the larger population toward those struggling to carve a life on the banks of the river that built the prosperous city down the road.