MEDICARE STAR RATINGS ALLOW NURSING HOMES TO GAME THE SYSTEM

Original Story, NYTimes.com

CARMICHAEL, Calif. — The lobby of Rosewood Post-Acute Rehab, a nursing home in this Sacramento suburb, bears all the touches of a luxury hotel, including high ceilings, leather club chairs and paintings of bucolic landscapes. A Milwaukee Nursing Home Lawyer is familiar with these types of facilities.

What really sets Rosewood apart, however, is its five-star rating from Medicare, which has been assigning hotel-style ratings to nearly every nursing home in the country for the last five years. Rosewood’s five-star status — the best possible — places it in rarefied company: Only one-fifth of more than 15,000 nursing homes nationwide hold such a distinction.

But an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes. A Nashville Nursing Home Litigation Attorney has experience representing clients in nursing home negligence cases.

The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify. Only one of the three criteria used to determine the star ratings — the results of annual health inspections — relies on assessments from independent reviewers. The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value.

The ratings also do not take into account entire sets of potentially negative information, including fines and other enforcement actions by state, rather than federal, authorities, as well as complaints filed by consumers with state agencies. Last year, the State of California, for example, fined Rosewood $100,000 — the highest penalty possible — for causing the 2006 death of a woman who was given an overdose of a powerful blood thinner.

From 2009 to 2013, California fielded 102 consumer complaints and reports of problems at Rosewood, according to a state website. California Advocates for Nursing Home Reform, which also tracks complaints, put the number even higher, at 164, which it says is twice the state average. Nursing home officials are appealing the state fine and point out that only a small fraction of the complaints at Rosewood, which has about 110 beds, have ever been substantiated. While that may be true, the sheer number could be a sign of trouble, industry experts say.

In interviews conducted during a recent visit, a half dozen current and former residents, including some who had lived in other homes, said they did not believe that the home merited a five-star rating. “If I fell down, they’d pick me up, but that’s about it,” said Michael McFadden, 76, who has lived at Rosewood for several years.

John L. Sorensen, the chief executive of North American Health Care, the chain that operates Rosewood, said the quality of the home was excellent. “I would put my parent there,” he said.

Rosewood struggles with many of the same challenges faced by other nursing homes around the country, offering a window into the rating system’s flaws, The Times found. Many residents live three to a room, and there is often a scarcity of basic supplies like washcloths, as well as a shortage of quality staff, according to interviews with current and former patients, their families and statements from former employees.

Lawsuits From Families

Rosewood has also been the subject of about a dozen lawsuits in recent years from patients and their families claiming substandard care.

“It looks nice when you walk in,” said Bonnie Nathan, who said she placed her mother in Rosewood in 2010 mainly because of its five-star rating. She is now suing the home because she claims that workers there failed to treat her mother, Janet Zagon, for a respiratory condition that led to her death. “But I really didn’t have a sense of where patients were going to be cared for,” Ms. Nathan said.

Mr. Sorensen said that his nursing home was not at fault and that even excellent homes occasionally make mistakes.

“While we have had a few problems, they’re pretty minor compared to the overall accomplishments and tremendous customer satisfaction that’s being provided,” he said. The many lawsuits against Rosewood could be attributed to a “very litigious marketplace” in the Sacramento area, he said, and not to poor quality at the nursing home.

Receiving a high star rating has never been more important to nursing homes. When nurses and doctors discharge patients from hospitals, they often use the ratings in referral decisions, and insurers consider them when setting up preferred networks. The ratings are also often a first stop for investors and lenders, who consult them to decide whether a nursing home company is a safe bet.

“This whole program has walked into parts of our industry that we never expected,” said Steven Littlehale, executive vice president and chief clinical officer at PointRight, one of a handful of consulting firms that advise nursing homes on how to improve their ratings.

Widespread acceptance of the ratings is leading to their use beyond the elder-care industry. Beginning this year, Medicare plans to introduce similar five-star ratings for hospitals, dialysis centers and home-health-care agencies.

Federal officials say that while the rating system can be improved — and that they are working to make it better — it gives nursing homes incentives to get better.

“We have seen improvements,” said Dr. Patrick Conway, the chief medical officer at the Centers for Medicare and Medicaid Services. As evidence, he pointed to a decrease in the use of physical restraints by nursing homes and in the number of homes reporting bedsores among patients at a high risk of developing them.

But some nursing homes are not truly improving. Instead, they have learned how to game the rating system, according to interviews with current and former nursing home employees, lawyers and patient advocacy groups.

Nationally, the proportion of homes with above-average ratings has risen steadily. In 2009, when the program began, 37 percent of them received four- or five-star ratings. By 2013, nearly half did.

The Times analysis shows that even nursing homes with a history of poor care rate highly in the areas that rely on self-reported data. Of more than 50 nursing homes on a federal watch list for quality, nearly two-thirds hold four- or five-star ratings for their staff levels and quality statistics. The same homes do not fare as well on the sole criterion that is based on an independent review. More than 95 percent of the homes on the watch list received one or two stars for the health inspection, which is conducted by state workers.

“These are among the very worst facilities, and yet they are self-reporting data that gives them very high staffing and very high quality measures,” said Toby S. Edelman, a senior policy lawyer with the Center for Medicare Advocacy, a nonprofit organization that helps patients. “It seems implausible.”

‘False Sense of Security’

The seed of Medicare’s five-star rating system was planted in 2007, when during a congressional hearing, Senator Ron Wyden, Democrat of Oregon, asked why it was easier to shop for washing machines than it was to select a nursing home. Medicare officials set up the rating system in 2009, a move that was applauded by consumer groups, who hoped that more transparency would lead to greater accountability.

The nursing home industry, which lobbied against the ratings, later largely embraced them. An industry trade group, the American Health Care Association, offers members a free service that helps companies track their star rating; it says the rising scores are evidence that quality is improving.

Some advocates say the rating system is the best resource available. “I think it’s imperfect, but it’s by far the most valuable tool for people,” said Richard J. Mollot, executive director of the Long Term Care Community Coalition.

Other patients’ groups consider the ratings so inflated that they no longer support their use and have found them helpful only in weeding out the worst-performing homes.

“They’ve given a false sense of security to the public,” Carole Herman, president of the Foundation Aiding the Elderly, a Sacramento patients’ rights group, said.

One of the simplest ways to inflate a score, according to interviews with academics and groups that monitor the process, is through the staffing measure. Nursing homes get an extra star on their overall rating if they score a four- or five-star rating on staff levels.

In 2009, only 39 percent of nursing homes had a four- or five-star rating for staff levels. By 2013, 52 percent did.

The staff rating is based on a form that a home completes once a year, at the time of the annual inspection. Homes often know when an inspection will occur, and many of them have learned to add workers in the period leading up to it.

The inspection period is so crucial that in 2010, an administrator at a home on Long Island described it as “our Super Bowl” and explained that staff levels would drop once the inspection was completed. “The staffing hours will be a little high for this week but will drop the following week,” David Fielding, the administrator of the home, the Medford Multicare Center for Living, wrote in an email, which was excerpted in a lawsuit filed this year against the home by the New York State attorney general.

Since 2008, more than a dozen employees at the Medford home have been convicted on charges of patient neglect and falsification of records. In June, nine more were indicted on a range of charges related to the death of a 72-year-old woman, Aurelia Rios. Medford nonetheless holds a three-star, or average, rating from Medicare and a four-star rating for its health inspection, and state health workers reported no deficiencies during the home’s most recent health inspection last August.

A provision of the Affordable Care Act of 2010 requires Medicare to use payroll data to verify the accuracy of staff levels, but the agency has not begun to follow the requirement. The agency said it was still working on the verification system and hoped to have it running soon.

The other major part of the ratings that is not checked by Medicare, the so-called quality measures, is also susceptible to manipulation. The score in this area is based on data collected by the home about every patient, such as whether bedridden or wheelchair patients are developing bedsores and how many residents experience serious falls.

Nursing homes receive an extra star on their overall rating if they get five stars in this area. The number of nursing homes with five stars in quality measures has increased significantly since the beginning of the program, to 29 percent in 2013 from 11 percent in 2009.

“They need to spot-audit those, but they haven’t done it,” said Charlene Harrington, a professor emeritus at the University of California, San Francisco, School of Nursing, who is an expert on nursing home staffing.

Federal officials acknowledged that the quality measures rating needed improvement and said they were testing an auditing program that they hoped to expand nationally. The agency also plans to consider additional metrics, such as the number of residents being given antipsychotic drugs.

Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, the nursing home trade group, says the ratings have had a positive effect on the industry. “I think it’s helped move us all along in the right direction,” he said, adding that any suggestion that facilities were manipulating their ratings was far-fetched. “I have not seen any evidence of that or heard any evidence of it,” he said.

A Five-Star Pursuit

Few have pursued top ratings with more zeal than North American Health Care, which operates Rosewood and 34 other nursing homes scattered across California and three other Western states. Each of the chain’s nursing homes has a five-star rating, and the company maintains a team of more than 30 nurses who conduct mock inspections to ensure the homes perform well. In recent years, the chain has awarded $50,000 bonuses to nursing home administrators who achieve or maintain a five-star rating.

“It’s everything to us,” Mr. Sorensen, the chief executive of North American, said. “If you create a product that people can trust and admire, the profits that you hope for — they follow as a result of excellence.”

Despite the chain’s exemplary performance in the Medicare ratings, Rosewood is not the only one of its homes to have had problems that are not reflected in the score. State inspectors concluded that staff at another home, Chatsworth Park Health Care Center in Los Angeles, neglected in 2010 and 2011 to properly care for a man with Parkinson’s disease who developed malnutrition and extensive bedsores, which typically occur because of substandard care, and later died.

At another of the chain’s nursing homes, the Grand Terrace Care Center near San Bernardino, Calif., the staff failed in 2010 to properly care for a woman with diabetes and other conditions. The coroner ruled that her death was due in part to a urinary tract infection and bedsores that had become so bad, they had developed gangrene and were infested with maggots, according to a state report about the case.

In 2010, when both episodes took place, Chatsworth carried an overall rating of three stars, and Grand Terrace was rated four stars. Both now hold five-star ratings.

Mr. Sorensen said his staff disputed the facts in these cases, and he maintained that the residents received good care.

Neither case shows up on the Medicare website. Until recently, California often refused to cite nursing homes for federal-level violations, the only type that counts toward a star rating. State workers are responsible for enforcing both state and federal laws governing nursing homes. A spokesman for the California Department of Public Health said the state was now doing so.

Dr. Conway, of the Centers for Medicare and Medicaid Services, said his agency worked hard to make sure states were enforcing federal law but acknowledged that there had been problems. “We are aware of some issues with states,” he said, adding that the federal website warned consumers that state actions were not listed there. Still, he said, “the goal would be not to have that gap.”

North American is also under investigation by the office of the inspector general for the federal Health and Human Services Department. Mr. Sorensen declined to say what the investigation entailed, and a spokesman for the inspector general’s office would not comment. It is not publicly known whether the investigation relates to care.

Ed Dudensing, a Sacramento lawyer who has represented several clients against the chain’s homes, including Rosewood, said he had deposed more than 30 current and former employees of North American Health Care in recent years. Based on those interviews, he said, “I strongly disagree with the suggestion that its nursing homes are five-star quality.”

Mr. Sorensen said the lawsuits against Rosewood were without merit. “We’re in this business because we want to do the right thing for our patients,” he said. “That is our agenda.”

In 2012, nearly all of North American Health Care’s nursing homes held four- or five-star ratings for staff levels, an outcome that Mr. Sorensen attributed to the company’s investment in quality workers.

Nevertheless, an analysis by The Times of 2012 staffing data reported by North American’s nursing homes in California shows that the company consistently reported higher levels of staffing to Medicare than it reported to Medi-Cal, California’s health care program for the poor, which audits the data.

The chain’s 29 homes in California reported staff levels to the federal government that were on average 23 percent higher than what they reported to the state in 2012, the most recent year for which state data were available. Statewide, California nursing homes reported levels to Medicare that were 15 percent higher than what they reported to Medi-Cal.

Mr. Sorensen said the state and federal staff data could not be compared because some employees, like the director of nursing and other supervisory positions, were not counted by the state but were counted at the federal level. He said the disparity could also be a result of different reporting periods and month-to-month variations in staff and patient levels.

A spokesman for the California Office of Statewide Health Planning and Development said that supervisory positions like the director of nursing were included in state staff data and that the main reason for the disparity was probably that the federal data accounted only for the two weeks preceding the annual survey, while the state data reflected the whole year.

Ms. Harrington, who sits on the technical advisory board for Medicare’s rating system and has served as an expert witness on behalf of plaintiffs suing nursing homes, said the disparity showed that the chain’s homes were probably adding people before the annual inspection. “They’re inflating their staffing,” she said.

Even as North American’s nursing homes were reporting high levels of staffing to Medicare, executives were focusing on keeping labor costs low, according to interviews with former employees and records made available in connection with lawsuits.

In 2011, for example, the nursing home administrator at Rosewood eliminated six full-time jobs and cut back on staff hours just days after the annual inspection was completed, according to emails the chain provided to plaintiff lawyers in a pending lawsuit against Rosewood. Ms. Harrington described such cuts as “substantial.” The home received a four-star rating in staffing that year.

Kyle Dahl, Rosewood’s administrator at the time, said in an interview that the staff reductions had been made to prepare for expected cuts to Medicare and Medi-Cal. But he acknowledged that consultant nurses were often brought in before the annual inspection to prepare the home. Their presence also had the effect of keeping staff levels higher than usual. Mr. Dahl likened the annual inspection to a visit from one’s mother-in-law. “You might throw an extra vacuum over the carpet to make sure everything looks good,” he said. “People could potentially staff up during that time period.”

For some families, however, all that effort did not translate to high-quality care, and they said they wished they had better options. Elizabeth Chandler and her husband, Ken, placed his mother in Rosewood in 2011 to recover from a broken femur. Ms. Chandler said she had been impressed that Rosewood had a top rating, “like a hotel.”

Mr. Chandler’s mother died after experiencing serious falls at the home, and the family is suing Rosewood. Ms. Chandler said she felt misled by the rating system.

“You don’t know where to look to get accurate information,” she said. “I can go and find a preschool for my child better than I can find a skilled nursing facility for my loved one.”

Requirements of Health Care Reform Affirmed

story first appeared in Los Angeles Times

The Obama administration reaffirmed key requirements of the new healthcare law Tuesday, setting out how insurance companies will cover nearly all Americans, even if they are already ill, and provide plans with minimum benefits.

Consumer advocates, insurers and business groups were looking for signs the administration might try to modify some of the law's requirements as the federal government races to implement the legislation by the end of next year.

But the proposed rules issued Tuesday hew closely to the Affordable Care Act that President Obama signed in 2010. At the same time, administration officials restated their commitment to move rapidly ahead, despite continued resistance from some Republican governors.

Health and Human Services Secretary Kathleen Sebelius said  this means that beginning in October next year, families and small-business owners everywhere will be able to shop for affordable, quality health coverage and entrepreneurs won't have to give up their chance at affordable health coverage to start a new business.

Under the law, Americans who are not covered through work will be able to comparison shop for health insurance in online markets, also known as exchanges, designed to mimic the shopping experience of popular travel sites.

These exchanges will be run by state governments, except in states that elect to leave the job to the federal government or to partner with Washington.

More than 15 states, mostly with GOP governors, have said they will not operate an exchange. Some governors have complained the federal government has put too many requirements on the exchanges.

In state and federally run exchanges, insurance companies will be prohibited from denying coverage to sick Americans. Insurers will no longer be able to charge more from women or customers with medical conditions.

And for the first time, insurers will have to cover 10 basic benefits, including hospitalizations, emergency care, newborn and maternity care, and prescription drugs.

The Obama administration has allowed each state to detail this set of benefits, allowing for some variations of drugs that might be covered, for example.

That worries many consumer advocates who would like to see a national standard for health insurance. Carl Schmid, deputy executive director of the AIDS Institute fears that leaving the decision up to the states of which drugs insurance plans must cover, many patients, particularly those with complex medical conditions, may not have the coverage they need.

But several leading consumer groups, including AARP, which represents older residents, and the American Cancer Society's Cancer Action Network, applauded the administration for retaining key protections in the law, including a requirement that insurers charge elderly consumers no more than three times as much as they charge young customers.

Insurers had pushed for more leeway to vary rates based on age, arguing that this was necessary to keep premiums affordable for younger, healthier customers.

Gary Cohen, who oversees insurance regulations at the Department of Health and Human Services, said the administration did not believe this was necessary to attract younger consumers, who will have access to a lower-priced health plan to cover catastrophic illness and also may qualify for new subsidies to offset their premiums.

The administration adjusted several rules to accommodate industry concerns, including allowing insurance companies to institute higher deductibles in plans they sell to small businesses and setting enrollment periods to prevent consumers from signing up for insurance only when they get sick.

The proposed new rules drew cautious praise from several leading industry representatives. Karen Ignagni, head of America's Health Insurance Plans, reiterated concerns that requirements still may force consumers to purchase coverage that is more costly than they have today.

Quality of Heath Care Varies by Region According to Study

story first appeared on usatoday.com

Where you live – and where your doctors did their training – has a lot to do with whether you'll be operated on, get an infection or have other potentially risky medical tests, a report out Tuesday said.

And we're not talking about small-town vs. big-city medicine. The report by Dartmouth Medical School's Atlas Project looked closely at 23 medical centers, including many of the top-rated hospitals for clinical excellence by U.S. News and World Report and other leading hospitals affiliated with universities. New Atlas data that include nearly all the teaching hospitals in the U.S. were also released.

The study was done to help medical students decide where to do their residencies, but it also helps consumers better understand how their local hospitals differ from the norm.

Among the findings: If you're in Salt Lake City, you're twice as likely to get knee-replacement surgery than if you're in New York City. Lubbock, Texas, had the highest rate of knee replacements -- 13.2 per 1,000 Medicare beneficiaries.

Arthritis in the knee is "not a dependably progressive disorder" that nearly always requires surgery, says David Goodman, a doctor who is co-principal investigator for the Atlas Project.

The report uses new 2010 Medicare data to update previous reports on regional variations in the treatment of patients at the end of life, trends in surgical procedures and trends in quality of care as it relates to patient experience and safety.

There is an emphasis on more aggressive treatment over preventive care at some hospitals, Goodman says. The report includes a "hospital care intensity index" when it comes to treatment of people at the "end of life."

Goodman says some hospitals may have a lot of capacity in their intensive care units and not enough in primary care.

Patients at NYU Langone Medical Center were 47 times less likely to get an infection from a urinary catheter than patients at the University of Michigan Health System, for example. Mount Sinai Medical Center had the second lowest. Goodman says such infections are "largely preventable."

David Muller, dean for medical education at the Mount Sinai School of Medicine, says the population of patients a hospital treats -- that is, whether they are low income and already in poor health -- can have a lot to do with whether a patient contracts an infection and can recover fully from it. The report's rates were adjusted for age, race and gender using the U.S. Medicare population as the standard.

Muller says the Dartmouth report can be valuable for both medical students and patients, but he notes that the Atlas Project's research is sometimes practically considered a bible, but he says any measures of quality of care in hospitals, varies widely and the subject is controversial.

This list ranks 23 teaching hospitals by the Hospital Care Intensity (HCI) index, which is a measure that combines the number of days patients spent in the hospital and the average number of inpatient physician visits during the last two years of life.

Hospital (ranked by Hospital Care Intensity (HCI) index):

• Cedars-Sinai Medical Center 2.06
• NYU Langone Medical Center 1.73
• Mount Sinai Medical Center 1.50
• Ronald Reagan UCLA Medical Center 1.48
• New York-Presbyterian Hospital 1.37
• University of Pittsburgh Medical Center 1.28
• Northwestern Memorial Hospital 1.28
• Massachusetts General Hospital 1.19
• Cleveland Clinic 1.12
• Hospital of the Univ. of Pennsylvania 1.08
• University of Michigan Health System 1.07
• Brigham and Women's Hospital 1.06
• Johns Hopkins Hospital 1.01
• United States average 1.00
• Indiana Univ. Health (Clarian Health) 0.96
• Barnes-Jewish Hospital/Washington Univ. 0.95
• UCSF Medical Center 0.92
• Duke University Medical Center 0.87
• Vanderbilt Univ. Medical Center 0.80
• University of Washington Medical Center 0.78
• Stanford Hospital and Clinics 0.78
• St. Mary's Hospital, Mayo Clinic 0.70
• Scott & White Memorial Hospital 0.62
• University of Utah Health Care 0.62

Unused Medical Supplies Donated Overseas

Story first appeared in the San Francisco Chronicle.

About 6,500 boxes of Doctor Medical Supplies - sterile surgical sutures, syringes, gloves, slightly used walkers and wheelchairs, exam tables, gauze bandages - are piled up in a San Leandro warehouse, waiting to be shipped off to developing countries and health clinics that need them.

The warehouse, which started accepting medical and Nursing Supplies in August and is just beginning to ship the goods overseas, is the first expansion in the 10-year history of MedShare International, a nonprofit based in Decatur, Ga., that sends surplus medical materials overseas to hospital and medical clinics.

The organization uses a Web inventory management system that allows health care providers throughout the world to order exactly what they need.

The Bay Area's three largest hospital chains - Kaiser Permanente, Catholic Healthcare West and Sutter Health - have signed on as donor partners with MedShare, which uses a network of volunteers to collect supplies from the medical centers.

Hospitals are among the highest waste-generating industries in the United States, discarding more than 7,000 tons of trash and surplus material daily.

While statistics are unavailable on the percentage of that refuse that is reusable, as much as 80 to 85 percent of a health care facility's waste is nonhazardous solid waste - such as paper, cardboard, food waste, metal, glass and plastics, according to Practice Greenhealth, a nonprofit organization that promotes sustainable hospitals and health care services.

Sterile items included

Medical Supplies that could be salvaged include sterile items that are part of surgical kits or equipment, furniture and supplies that have been replaced with updated versions. While those materials could be used, they are generally discarded because it takes too much time, effort and expense on the part of the medical staff to collect and find some way to redistribute them.

The excess waste in the health care troubled the founders of Operation Access, a 15-year-old Bay Area organization that provides outpatient surgeries to the uninsured through a network of volunteer doctors and nurses.

More than two years ago, one of Operation Access' founders, began researching methods to ship those excess supplies overseas. He discovered a number of smaller groups and individual efforts by dedicated providers but was quickly intrigued by MedShare.

Well-meaning groups sometimes ship materials overseas that the staff may not need, doesn't know how to use or is otherwise inappropriate, such as equipment with the wrong voltage. MedShare's online ordering system, which is managed out of the Decatur headquarters and can be accessed from an Internet cafe in remote regions of developing countries, helps solve that problem.

One of the most unique characteristics of MedShare is the recipient organization has the ability to be very precise. MedShare places bins outside operation rooms and other areas of the hospital that are picked up on a weekly basis. Volunteers at the distribution center sort and pack the supplies.

MedShare's chief executive officer and founder, said Operation Access approached the organization just as MedShare was considering expanding. Operation Access was looking for a concentration of hospital beds in a transportation corridor that made sense from a logistics point of view. MedShare can collect materials primarily from Northern California hospitals and ship 40-foot containers, which hold about 1,100 boxes of supplies, out of the Port of Oakland.

Kaiser Permanente has donated a number of supplies, including 32 pallets of IV central line materials, 21 pallets of miscellaneous supplies and a forklift for the distribution center. Kaiser Permanente's relationship with MedShare is mutually beneficial. As the facility introduces newer and more accurate and efficient equipment into the facilities, they are able to avoid sending the replaced items to landfills.

In addition to the environmental benefits, the equipment provided to MedShare has an extended useful life supporting populations in areas of the world that would not otherwise be able to afford access to such devices.

Ironically, getting hospitals and manufacturers to donate excess medical supplies is the easy part. The tough part is having enough volunteers to keep pace with the collection and sorting of those supplies.

In San Leandro, more than 80 people have volunteered, requiring training sessions to be increased from every two weeks to four times a week. The group can use more participants but stressed that contributions to cover the cost of shipping the supplies overseas, about $20,000 per container, is the most pressing need.

The new distribution center already has exceeded its expectations for donations of medical supplies. Donations include 80 hospital beds from Dominican Hospital in Santa Cruz and 60 examination tables from Woodland Healthcare, both affiliates of Catholic Healthcare West.

MedShare's first shipment, a half-container sponsored by a Gilroy church, was sent last month to Owerri, Nigeria. The organization is planning to ship its first full container of supplies this month to a hospital in Ecuador.

Gloves and sutures are the most requested items. None of the material has been contaminated, it has never come in contact with a patient. This stuff is just taken and thrown away. Doctor Bags are also highly requested now, with access to more useful equipment overseas doctors are in need of a mode of transportation for it.


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