health care quality
Even doctors are consumers of health care, points out Dr. Stephanie Wolf-Rosenblum.

“We all get health care in our institutions, and so do our families and neighbors,” she says. In other words, we all have a vested interest in our hospitals using the best practices available.

But, until five years ago, hospitals and ambulatory surgical centers (ASCs) weren’t sharing their best practices with each other. If a patient were injured from a procedure, shares Rep. Jim Craig (D-Manchester), a facility would want to keep it as quiet as possible for fear of liability or hurting its reputation.

Now, hospitals and ASCs can share best practices confidentially in a forum provided by the N.H. Health Care Quality Assurance Commission. The Legislature created the commission in 2005, and it’s scheduled to “sunset” this year.

“We really didn’t know how it would work,” says Craig, who helped put the commission together five years ago. He’s pleased with the commission’s performance and has now sponsored House Bill 1169 to let it continue.

Dr. Wolf-Rosenblum, past chair of the commission, is proud of the group’s work. “It’s serving as a model for other states in terms of how to approach quality in an integrated fashion,” she says.

She points to adoption of the “surgical safety checklist,” an initiative of the World Health Organization, as one example of success. WHO’s studies indicate surgery-related complications and deaths can be reduced by up to one-third by adopting this two-minute checklist. The commission’s 2009 annual report states that New Hampshire is the only state with 100 percent commitment to the checklist from every hospital and ASC in the state.

“We are functioning as if (HB 1169) will absolutely go through,” Wolf-Rosenblum says. “We have not broken stride.”

Craig, an attorney, explains that while confidentiality is key to the commission’s success, it was also a sticking point for trial lawyers. “They were concerned about the hospitals being able to use this to hide evidence of malpractice,” he says. “So we drafted language that would minimize that risk, and the trial lawyers signed off on it because they realized it was a good idea to protect patients.”

There will be a public hearing on extending the N.H. Health Care Quality Assurance Commission on Feb. 9 in the House Health, Human Services & Elderly Affairs Committee.

suicide prevention
For every homicide committed nationally, fewer than two people commit suicide. But that figure jumps to almost eight suicides for every homicide in the Granite State.

“And if you look not just at those who actually (commit suicide), but at the number of people who have thought about it,” says Rep. Roger Wells (R-Hampstead), “it’s just staggering.”

Wells works on public policy for the New Hampshire Council on Suicide Prevention. This year, he’s introduced House Bill 1384 to create a committee that would review suicide fatalities in the Granite State. Specifically, it would study the incidence and causes of all suicide deaths in an effort to better understand how to prevent suicide in the future.

Between 2001 and 2005, an average of 158 people per year died from suicide in New Hampshire, according to the committee’s 2009 report. Nearly 700 were hospitalized and close to 1,200 were treated in emergency departments for self-inflicted injuries. These attempts and suicides represented an estimated $6.2 million in acute health care costs in 2001, alone.

Wells says suicide is typically the result of many stresses piled on top of one another. “It’s not always the biggest stress factor that causes it,” he says. “It’s the final stress.”

Studying data from suicide incidence can lead to new, and sometimes surprising, discoveries. Wells points to a common assumption that the horrors and trauma of war cause the high suicide rate among military veterans. “But suicide rates are just as high in vets who are not deployed,” he says.

Wells attributes this to a repeated loss of support structure from repeated relocations and being alternately separated from family and colleagues. Subsequent feelings of aloneness can add to other stresses, leaving the soldier more susceptible to suicide.

Financial stress is a common factor, but Wells thinks it’s oversimplifying to blame the economy for higher suicide rates during a recession. Wells gives an example: himself.

Suvivors—those left behind after a loved one commits suicide—are themselves at higher risk for suicide. Wells is a double survivor. His first wife died in 1969 and his 19-year-old died in 1985, both from suicide.

Wells is a white male over age 65—another high-risk group. And as a veterinarian, he is statistically twice as likely to commit suicide than any other health professional (and four times more likely than the general population).

He was retired, but returned to work last year when his retirement plan was “devastated” in the financial collapse. “Now, suppose my house went into foreclosure and I committed suicide,” he says. “What was the cause?” He points not to one, but to all.

Wells distinguishes the entire issue from that of assisted suicide, or “death with dignity,” as he prefers to call it, for terminally ill patients, which is the focus of another bill this session. On Jan. 13, the N.H. House voted down House Bill 304, which sought to legalize that practice.

To Wells, “suicide” refers to the “untimely death” of potentially healthy people. He sees the choice of a terminally ill patient, within days or weeks of dying, as a different matter entirely. The subcommitte that generated HB 1384 (the bill Wells is sponsoring) could not reach consensus on the assisted suicide initiative, Wells says, so they agreed not to take a position on that matter.

They are focused on the potential of the proposed suicide fatality review committee to help inform the efforts of the Suicide Prevention Council, including public education, data analysis, promoting effective professional practices, and developing lasting public policies to address suicide prevention.

HB 1384 is scheduled to receive a public hearing in the House Health, Human Services and Elderly Affairs Committee on Feb. 4. More information on suicide prevention and the N.H. chapter of the National Alliance on Mental Illness at www.naminh.org/SuicidePreventionCouncil.php.

Front Door Politics is a jargon-free weekly legislative update for all citizens affected by New Hampshire laws. Find more at www.frontdoorpolitics.com.