DiversityNursing Blog

BY M. ALEX JOHNSON

www.nbcnews.com

Ronnie Dickinson of Frankfort, Kentucky, turned himself in to authorities with an incredible story, sheriff's officials said Tuesday: His name isn't Ronnie Dickinson, he's been a fugitive for nearly 39 years and he wants to go back to prison for the health care.

Clarence David Moore, 66, called the Franklin County Sheriff's Office on Monday and said he wanted to turn himself in, the sheriff's office said. When deputies arrived, they found Moore — who'd been living in Frankfort since 2009 and had ID'd himself as Ronnie Dickinson — partially paralyzed and unable to walk because of a recent stroke. He was arrested and taken by ambulance to a hospital for examination before he was taken to the Franklin County Regional Jail.

Sheriff Pat Melton told NBC station WLEX of Lexington on Tuesday that Moore said he'd escaped from the Henderson County, North Carolina, Prison Unit in the mid-1970s and has been on the lam for almost four decades.

But as he got sicker, he couldn't get medical coverage to pay for the complications of his stroke and other health problems, because he doesn't have a valid Social Security number under his alias.

"You can't make this up," Melton said.

North Carolina prison records show that Moore, in fact, escaped at least three times from state prisons — the first time in 1971, as he was serving an eight-year sentence for larceny. He was caught within hours, but he escaped again the next year and remained loose until 1975 before he was captured.

Finally, on Aug. 6, 1976, he vanished again — this time, seemingly, for good.

What Moore's been doing for the last almost 39 years remains unclear; Melton said he has difficulty talking because of his stroke. Since 2009, however, he's been the frail, bearded man who was always pleasant to folks in Frankfort, if somewhat reserved, said Edward Jordan, a neighbor.

"I'm shocked," Jordan told WLEX. "I can't believe it.

"He's a diabetic and I'm a diabetic, and we'd sit on the porch and talk about that," Jordan said.

Moore was arraigned Tuesday morning and waived extradition to North Carolina on a charge of being a fugitive from another state. He was being held without bond pending his being returned sometime this week.

Whatever happens, he won't go back to the same prison he escaped from in 1976. It closed in 2002.

James McIntosh

It is vital that treatment for stroke is given as quickly as possible in order to minimize the amount of long-term damage that occurs. Unfortunately, a new study has suggested that one third of Americans would be unable to access a primary stroke center within 1 hour should they need to.

The study, published online in Neurology, was a population-level virtual trial simulating how long it would take for patients to access stroke care following changes to systems of treatment.

"Research has shown that specialized stroke care has the potential to reduce death and disability," says study author Dr. Michael T. Mullen. "Stroke is a time-critical disease. Each second after a stroke begins, brain cells die, so it is critically important that specialized stroke care be rapidly accessible to the population."

According to the authors, stroke is one of the leading causes of death and disability in the US, occurring when the flow of blood to a portion of the brain is blocked or an artery in the brain ruptures or leaks.

In 2012, the beginnings of a three-tiered regionalized system of care were implemented. This involved the designation of certain hospitals as primary stroke centers (PSCs) and comprehensive stroke centers (CSCs), with CSCs providing the highest level of care.

Dr. Mullen and his colleagues decided to create virtual models in order to estimate what percentage of the population would have access to a comprehensive stroke center after selectively converting a number of primary stroke centers to facilities providing a higher level of care.

"In this report, we demonstrate how mathematical optimization modeling can inform the strategic development of the US network of stroke centers by simulating the conversion of PSCs into CSCs," the authors write. "This allows for virtual trials of competing system configurations in order to design a system that maximizes population access to care."

Reduced access to specialized stroke care could worsen pre-existing disparities in health

Data from 2010 was utilized, at which point there were 811 PSCs and no CSCs in the US. The researchers converted up to 20 PSCs in each state into CSCs and calculated how long it would take local populations to access these treatment facilities by ambulance or plane in optimum conditions.

After converting the PSCs to CSCs, the researchers found that only 63% would live within a 1-hour drive of a CSC, with an additional 23% within a 1-hour flight of one. 

"Even under optimal conditions, many people may not have rapid access to comprehensive stroke centers, and without oversight and population level planning, actual systems of care are likely to be substantially worse than these optimized models," says Dr. Mullen.

Levels of access to care also varied in different geographical areas. Worryingly, access to care was lowest in an area often referred to as the "Stroke Belt" - 11 states where stroke death rates are more than 10% higher than the national average, predominantly situated in the southeast of the US.

"Reduced access to specialized stroke care in these areas has the potential to worsen these disparities," says Dr. Mullen. "This emphasizes the need for oversight of developing systems of care."

The authors suggest the actual number of CSCs that will be established is likely to be much smaller than 20 per state, and that increasing the number of CSCs is not an ideal way to improve access for patients due to the high costs involved.

A number of limitations are acknowledged, such as using trauma data to calculate the amount of time taken to reach a hospital, and calculating population access to hospitals using where people live, rather than where strokes occur. However, the authors argue that the majority of strokes (over 70%) occur at home.

In a linked editorial, Dr. Adam G. Kelly and Dr. John Attia suggest that CSC status is likely to be determined more by financial motives, however, rather than a population health basis.

They write that timely accessibility of PSC services, either on-site or via telemedicine, should be the first priority in the organization of regional stroke care. Following this, "CSCs should be added in a coordinated, stepwise manner with regional needs - not hospital bottom lines - as the major determinant for new CSCs."

Source: www.medicalnewstoday.com