The White death spiral, the fallen figure skater and what hospitals can do

Two news items I came across last week were upsetting for their facts and interconnections.

The first involves Debi Thomas, former figure skater and the first African-American to win a medal at the Winter Olympics. She graduated from Stanford University and studied medicine at Northwestern University after her skating career, eventually becoming an orthopedic surgeon.

Thomas is currently living penniless in a rundown trailer in rural Virginia. She said two divorces and an unsuccessful shift from hospital employment to private practice led to her current straits. 

Thomas and her fiance, Jamie Looney, who struggles with alcohol use, created a crowdfunding page that includes a pledge to restore prosperity to the Appalachian mining community, and some videos they hope to eventually turn into a reality show. The show's working title: "Can We Go Nowhere Any Faster?"

That situation seems to illuminate the second story: A large swath of Americans whose life expectancies are dropping like stones. They're not the elite athletes and specialty physicians of the world, but people with Looney's background--caucasians without a college degree. They are killing themselves intentionally or unintentionally with drugs and alcohol or the collateral damage, such as liver disease. Their death rate rose 22 percent between 1999 and last year, or by an additional 134 deaths per 100,000 population--an astonishing statistic.

Hospitals have been swamped by this reality; ER visits for drug overdoses and alcohol poisoning nearly doubled between 2004 and 2009. Drug overdoses are now the leading killer of adults in the U.S., taking more lives than automobile accidents.

A lot of these adults don't have insurance- the particular subset of Americans who are dying in larger numbers have seen their incomes decrease 19 percent between 1999 and last year. Hospitals have had to carry much of their cost, particularly in states such as Virginia that have not expanded Medicaid under the Affordable Care Act.

I recently spoke with two volunteers at a Seattle healthcare system who help coordinate care for chronically ill patients. They tell me that depression and despair are as big an impediment to patients obtaining services than any of their medical conditions. In other words, the sense of hopelessness pervading many Americans is no doubt exacerbating this death spiral.

Curiously, these rising mortality rates are not occurring in the Latino population, an ethnic group with among the highest rates of uninsured. Mortality rates for that group are going down. Theories about this have been batted about, including the fact that Latinos have a more cohesive support system--think close-knit extended families-- han do whites.

Hospitals could play a role in attempting to reverse this spiral. Not just from a clinical standpoint, but by creating new community programs and helping existing ones that foster social bonds. Ever wonder why the Lions, Rotarians, Optimists and other community clubs of the world have all but vanished? Hospitals have hundreds of millions of dollars at their disposal--and mandates to provide community benefits--to help rebuild these collegial, nurturing organizations.

For now, Debi Thomas appears to be trapped in that same massive downward trajectory. I wish her the strength to confront her demons and a return to healing others. Once back on her feet, she has the potential to communicate the scourge plaguing Looney and tens of millions of other Americans--and prod hospitals and other providers to provide them with more support. - Ron (@FierceHealth)

Related Articles:
Boomers don't take full blame for lax self-care 
Opioid addiction strains hospital bottom lines

Suggested Articles

A commonly used format for formulary submissions has been updated to enable drug companies to share information with payers on unapproved products.

NextGen Healthcare's Rusty Frantz sounded off about hospitals opposing proposed federal data-sharing rules while also sharing data with tech giants.

Welcome to this week's Chutes & Ladders, our roundup of hirings, firings and retirings throughout the industry.