More than one-quarter of serious cases of nursing home abuse are not reported to the police, according to an alert released Monday morning by the Office of Inspector General in the Department of Health and Human Services.

The cases went unreported despite the fact that state and federal law require that serious cases of abuse in nursing homes be turned over to the police.

Government investigators are conducting an ongoing review into nursing home abuse and neglect but say they are releasing the alert now because they want immediate fixes.

These are cases of abuse severe enough to send someone to the emergency room. One example cited in the alert is a woman who was left deeply bruised after being sexually assaulted at her nursing home. Federal law says that incident should have been reported to the police within two hours. But the nursing home didn’t do that, says Curtis Roy, an assistant regional inspector general in the Department of Health and Human Services.

“They cleaned off the victim,” he says. “In doing so, they destroyed all of the evidence that law enforcement could have used as part of an investigation into this crime.”

The nursing home told the victim’s family about the assault the next day. It was the family that informed the police. But Roy says that even then, the nursing home tried to cover up the crime.

“They went so far as to contact the local police department to tell them that they did not need to come out to facility to conduct an investigation,” says Roy.

Looking at records from 2015 and 2016, Curtis Roy and his team of investigators found 134 cases of abuse of nursing home residents severe enough to require emergency treatment. The vast majority of the cases involved sexual assault.

“There’s never an excuse to allow somebody to suffer this kind of torment, really, ever,” says Roy.

The incidents of abuse were spread across 33 states. Illinois had the most at 17. Seventy-two percent of all the cases appear to have been reported to local law enforcement within two hours. But twenty-eight percent were not. Investigators from the Office of the Inspector General decided to report all 134 cases to the police. “We’re so concerned,” says Roy, “we’d rather over-report something than not have it reported at all.”

The alert from the Inspector General’s office says that the Centers for Medicare and Medicaid Services (CMS), which regulate nursing homes, need to do more to track these cases of abuse. The alert suggests that the agency should do what Curtis Roy’s investigators did: cross-reference Medicare claims from nursing home residents with their claims from the emergency room. Investigators were able to see if an individual on Medicare filed claims for both nursing home care and emergency room services. Investigators could then see if the emergency room diagnosis indicated the patient was a victim of a crime, such as physical or sexual assault.

The alert notes that federal law on this issue was strengthened in 2011. It requires someone who suspects abuse of a nursing home resident causing serious bodily injury, to report their suspicion to local law enforcement in two hours or less. If their suspicion of abuse does not involve serious bodily injury of the nursing home resident, they have 24 hours to report it. Failure to do so can result in fines of up to $300,000.

But CMS never got explicit authority from the Secretary of Health and Human Services to enforce the penalties. According to the Inspector General’s alert, CMS only began seeking that authority this year. CMS did not make anyone available for an interview.

Clearly, the 134 cases of severe abuse uncovered by the Inspector General’s office represent a tiny fraction of the nation’s 1.4 million nursing home residents. But Curtis Roy says the cases they found are likely just a small fraction of the ones that exist, since they were only able to identify victims of abuse who were taken to an emergency room. “It’s the worst of the worst,” he says. “I don’t believe that anyone thinks this is acceptable.

“We’ve got to do a better job,” says Roy, of “getting [abuse] out of our health care system.”

One thing investigators don’t yet know is whether the nursing homes where abuses took place were ever fined or punished in any way. That will be part of the Inspector General’s full report which is expected in about a year.

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Five dogs turned blue in Mumbai.

That was a story that journalist Deepak Gharat broke this past week. He was following up on a story in the industrial zone of Taloja, home to about 1,000 pharmaceutical and chemical factories. Every week, there’s something going wrong over there, he says. Industrial waste catches fire. Dead fish float up to the surface of the local river en masse.

Last week, he noticed a canine of unusual hue snoozing under a truck. Unable to believe his eyes, he took pictures and mailed them to his newsroom.

Puddles for the pooches

Some people, like local animal rights activist Arati Chauhan, suggested the dogs turned blue because of waste in the local Kasardi River, where the dogs were thought to have gone wading.

That theory appeared in many media outlets but does not appear to be true. The dogs hang out at a pigment and detergent factory about 2 miles away from the river, and they’re too territorial to venture that far, says Gharat.

“The dogs go looking for food in the dye factory compound,” Gharat found.

Locals have seen the dogs crawling on their bellies under the factory’s gate to loll in the ubiquitous puddles of cool, blue water in the grounds.

So they’re definitely not swimming in the river and instead are picking it up from the dye in the stagnant water on the factory grounds, Gharat observed.

Gharat confirmed with a local vet that the dye on their fur had dried to leave behind a powdery, blue residue.

While the dye isn’t permanent, it’s toxic to the dogs, who lick their fur to groom themselves and end up ingesting the chemical.

The dogs are lucky it’s monsoon season, because the dye washes off after several rainy rinses. After activist Chauhan and her organization, the Navi Mumbai Animal Protection Cell, filed a complaint, the local chapter of the Society for the Prevention of Cruelty to Animals checked the dogs, including one with an eye infection. All the animals have been given a clean bill of health, and the dye has been scrubbed off. The factory has put up a temporary net under the gate to prevent dogs from getting back in.

Not fine for fish

So the problem with the dogs was apparently cosmetic. But the media attention pushed the state pollution control board to shut down the chemical factory, identified as Ducol Organics & Colours Pvt Ltd. The factory was releasing untreated chemicals into the river and toxic residual dye powder into the atmosphere, violating India’s Water Act from 1974 and the Air Act from 1981.

That’s not a problem for dogs, because they don’t appear to drink from the river. But it is a problem for fish.

Last year, local fishermen complained that their catch volumes had dropped by 90 percent. They had the water tested at the municipal environment laboratory. Measured against guidelines from the Central Pollution Control Board, a national regulatory body, the pollution in the Kasardi River was 13 times over the safe limit for fish to survive, and 40 times over the limit for human consumption.

At the source of the Kasardi River, 24 miles away, the water is used for agriculture, drinking and washing clothes, says Gharat. “But where the industrial zone starts in Mumbai, the water is totally chemical.”

Factories were set up in this area in the 1960s, he says, and more than 300 of them make chemicals.

‘Successfully polluted’

V.M. Balsaraf, a professor of applied chemistry at the Datta Meghe College of Engineering and a researcher of groundwater pollution in Mumbai, is surprised at the sudden brouhaha over the river pollution. “We have found heavy metals and chemicals in the area water. Most of the industries don’t have treatment for sewage,” he says. “All our water sources are successfully polluted, they’ve become gutters. Even birds and animals have nowhere to drink water.”

Chauhan, the activist, has asked the pollution board to plant more trees, clean up the river and stop the dumping of untreated waste in the area.

Shutting down the factory, though, is shortsighted, she says. It would be better to hold all the factories accountable rather than depriving some workers a livelihood, she suggests.

“People are saying just implement the law, get the pollution under control,” echoes Gharat, who says that fixing the treatment plant, monitoring waste discharge and punishing offenders would be a good place to start.

But he and the activists are afraid that official action will taper off once the memory of the blue dogs fades away.

Chhavi Sachdev is a journalist based in Mumbai. Contact her @chhavi

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Congress and the Trump administration could boost insurance coverage by a couple of million people and lower premiums by taking a few actions to stabilize the Affordable Care Act insurance markets, according to a new analysis by the consulting firm Oliver Wyman.

The paper, which lays out a simple blueprint for making insurance more affordable for more people while working within the current health law’s structure, comes just days before the Senate Health, Education, Labor and Pensions Committee begins hearings on ways to stabilize markets in the short term.

“Together, these approaches could increase enrollment by roughly two million individuals, reduce average premiums by more than 20 percent and be roughly revenue neutral,” the analysis by Kurt Giesa and Peter Kaczmarek says.

The analysis concludes that under current law, about 17 million people will buy insurance in the individual market next year, many of them outside the ACA marketplaces. If the four actions outlined in the paper are implemented, about 19 million people would buy individual insurance, the study finds.

At the same time, the average monthly premium would fall from $486 to $384.

Some of the actions, including extending the Affordable Care Act’s cost-sharing subsidies, are already on the table for next month’s committee hearings.

These are the four steps that Oliver Wyman recommends to stabilize Obamacare.

1. Fund the cost-sharing reduction payments for the long term

These are payments the government makes to insurance companies as reimbursement for discounts on copayments and deductibles the companies are required by law to give to low-income customers. President Trump has said he wants to end the payments — which a court has ruled are unlawful since Congress never authorized them. But now lawmakers, including Republican Sen. Lamar Alexander of Tennessee, chairman of the health committee, say they want Congress to fund the payments through next year.

“State insurance commissioners have warned that abrupt cancellation of cost-sharing subsidies would cause premiums, copays and deductibles to increase and more insurance companies to leave the markets in 2018,” Alexander said in a statement on Aug. 16. “Congress now should pass balanced, bipartisan, limited legislation in September that will fund cost-sharing payments for 2018.”

2. Create a reinsurance program

The ACA included a temporary reinsurance program that protected insurance companies from huge losses while they transitioned to the new market under the new law.

Senate Republicans included a reinsurance program in the Better Care Reconciliation Act, the health care overhaul that failed earlier this summer.

Govs. John Hickenlooper of Colorado and John Kasich of Ohio are publicly advocating such a program.

“Top of our list would be this notion of having some sort of reinsurance to make sure the high-cost pool is not causing higher rates for all,” Hickenlooper said in an interview with Colorado Public Radio.

3. Strongly enforce the individual mandate

President Trump has suggested he doesn’t want the Internal Revenue Service to enforce Obamacare’s requirement that every person have insurance. Today, individuals who can’t prove they have coverage must pay a fine of $695 or more. Oliver Wyman’s analysis shows that if the mandate isn’t enforced, many young healthy people would drop their coverage.

“As younger and healthier people opt out of the market, the cost of coverage would increase, and market-average premiums would increase in parallel,” the study said.

4. Get rid of the health insurance tax

Obamacare includes a tax on health insurance companies to help offset the costs of federal subsidies that help people buy policies on the ACA markets. It was in place from 2014 through 2016, but then Congress passed a moratorium on the levy for this year. Insurance companies are lobbying hard to ensure it doesn’t return next year. Oliver Wyman’s analysis shows that continuing that moratorium would cut premiums by about 3 percent next year.

Insurance companies have until Sept. 27 to commit to selling policies on the ACA marketplaces in 2018. Alexander says he wants some legislation to pass before then to help stabilize the markets and cut premiums.

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