Medical negligence cases in Washington and elsewhere have taken on a new shape during the pandemic, as hospital resources have been strained and the potential usefulness of certain treatments has ebbed and flowed.

Drugs like ivermectin, for instance, were touted online as a potential COVID-19 treatment but ultimately lacked scientific evidence to back up those claims.

Elizabeth Calora is a Tacoma lawyer who specializes in medical negligence cases. She said there are some legal requirements for determining if a health professional acted carelessly which have been affected by COVID.

"We need to figure out what a reasonably prudent provider should have been doing in that context," said Calora, "and it usually means talking to experts in the field and then determining if what the provider did in the moment or over the course of several visits violated that standard of care."

Calora said after that, the person has to prove that the breach is what caused the damages.

The Washington state Legislature modified evaluations of negligence cases in 2021 so that resources and staffing must be taken into account. For instance, hospitals have often lacked beds at the height of different COVID waves, a factor outside of doctors' or facilities' control.

Calora said the standard of care evolves over time. What was once an acceptable medical practice in the 1970s, for example, might not be anymore.

"But usually it happens in a much slower timeframe than what we experienced at the start of the pandemic," said Calora. "With COVID, you had physicians all over the world basically - it makes me think of throwing spaghetti on the wall to see what sticks. Everyone was trying everything they could."

Calora said the unforeseen nature of the pandemic has made it hard to bring medical negligence cases forward. However, she added that shouldn't discourage people from speaking with an attorney if they feel they or a loved one has been wronged.

"Even though things were bad," said Calora, "it doesn't give people license to practice beneath the standard of care."

Backers of a bill now in the U.S. Senate contended it will address rising health care costs and could provide Americans with some relief.

Part of the Inflation Reduction Act would allow Medicare to negotiate directly on prescription drug prices in 2023, and cap out-of-pocket drug costs for Medicare patients at $2,000 a year. It comes a month after Gov. Ned Lamont expanded the state's Covered Connecticut program to adults without children.

Jim Manley, board member of Consumers for Quality Care, noted rising out-of-pocket costs are a chief concern.

"The issue comes down to caps on copays, rising deductibles and prescription drug copays," Manley explained. "Caps on copays are largely absent from the current health care bill that the Senate is going to take up this week. And so, that's been driving out-of-pocket costs higher and higher for more and more Americans."

In the group's new survey, 45% of Americans said their out-of-pocket costs are far too high, and more than 70% feel health care costs are increasing "much more than other things they need." The Urban Institute said one in 10 people in Connecticut, and 13% of Americans overall, have past-due medical debt.

Manley feels while the issue is important, it will not be a dominant factor in the November midterm elections. However, he believes a change is needed. In the survey, 60% of people said they skipped or delayed medical treatment because it is so expensive.

"Health insurers have shifted costs onto patients through higher deductibles and out-of-pocket costs," Manley pointed out. "That's proven to be a real problem for the American consumer. It is leading them to either skip the care and/or go into medical debt. Medical debt is increasingly rampant throughout this country."

For now, the Affordable Care Act outlines out-of-pocket caps, but Manley believes they should be updated. His group also is backing a cap on the price of insulin, which according to a 2020 study is much higher in the U.S. than in most countries.

A new Economic Policy Institute report links staffing shortages in residential long-term care facilities in Nebraska and across the nation to low pay and poor working conditions.

The median pay for caregivers, at just over $15 an hour, is significantly below the national median of $20 an hour.

Todd Stubbendieck, state director of AARP Nebraska, said lack of sufficient staffing can lead to significant negative health impacts for residents.

"Decreased physical ability, more rates of infections, more falls, and then more hospitalizations," Stubbendieck outlined. "Tackling this staffing issue is fundamental to ensuring that we are providing good quality care to long-term care residents."

Long-term care workers also are less likely to be covered by employer-provided retirement and health insurance benefits. Even before COVID, staffing at nursing homes failed to meet demand, and the industry lost 235,000 workers since the onset of the pandemic. AARP analysts found one fifth of all nursing homes have reported a lack of sufficient staff every month since the summer of 2020.

Jeremy Nordquist, president of the Nebraska Hospital Association, said lack of staffing at nursing homes also is impacting Nebraska's hospitals. When long-term care facilities do not have adequate staffing, he said hospital patients cannot be discharged, and their bed is not available for the next patient who needs it.

"We've seen recently, just in the Omaha area, hospital emergency rooms start to back up because beds weren't available," Nordquist observed. "Because we didn't have enough skilled nursing facilities and nursing homes around the state to take those patients."

The report called for expanding public funding to ensure higher pay and better working conditions to attract and retain experienced and committed workers. States and localities also can establish industry-specific worker-standards boards to recommend changes on minimum wages and working conditions.

Stubbendieck added helping Nebraskans access home-based care would also ease demand.

"We know people want to stay in their homes as long as possible, or on the lowest level of care," Stubbendieck noted. "People are staying in their homes and getting care, and not having to go to long-term care facilities, which tend to be more expensive. And so bolstering that home and community-based care is one solution."

The federal health insurance program for children helps keep more than 620,000 Kentucky kids insured.

A new report finds that CHIP, which marks its 25th anniversary this week, is a lifeline for families who earn too much to qualify for Medicaid but don't have access to employer-sponsored coverage.

Emily Beauregard, executive director of Kentucky Voices for Health, said an emergency provision enacted during the pandemic has meant kids relying on CHIP had quality health care, no matter what their parents' changes in jobs or income.

"When your income changes from month to month, or if it's seasonal because you're perhaps a farmer," she said, "then you're more likely to have times when your income goes just above the limit - and then other times when you're below the limit."

Beauregard said the Public Health Emergency declaration is set to expire in October. The federal government has said it will give states at least 60 days notice of a final deadline, so agencies can began reaching out to families to ensure kids don't fall through the coverage gap.

Beauregard added that the state could make 12-month continuous eligibility permanent, which she believes would reduce costs down the road.

"It leads to healthier kids, but it's also less costly administratively," she said. "And over time, kids are healthier because they have coverage constantly."

Beauregard pointed out that CHIP and Medicaid covers more than half the nation's Black and Hispanic children, and said increasing awareness about upcoming changes and re-enrollment in these populations is critical, as well as ensuring lasting federal funding for the program.

"All of these are ways that we can make sure that kids are their healthiest," she said.

Research shows that kids who have CHIP coverage see their doctor and dentist regularly, and are less likely to visit an emergency room.