Kennedy vax suit revised & sharpened | Hospital discharges examined | Nursing units awarded | And more high-level briefs

The American Academy of Pediatrics and co-plaintiffs are tightening the screws in their lawsuit against HHS Secretary Robert F. Kennedy Jr. and other healthcare leaders in the Trump administration.   

This week the groups filed a fourth set of amendments to the complaint. The original action dates to last July, when the AAP’s main beef involved the removal of CDC recommendations for healthy children and pregnant women to get the COVID vaccine. 

• The suers’ objective now includes getting HHS—along with the FDA, NIH, CDC and their respective heads—to roll back changes to the federal recommendations for childhood immunizations that went live Jan. 5. The present version of the suit, filed Jan. 19, stresses the charge that Kennedy and colleagues have failed to “examine the relevant data and articulate a satisfactory explanation” for four actions:
   
  • The appointment of vaccine skeptics to Advisory Committee on Immunization Practices (ACIP) after all previous members were fired;
     
  • Votes taken by ACIP changing recommendations on the hepatitis B and COVID-19 vaccines and urging manufacturers to stop using thimerosal as a preservative in influenza vaccines;
     
  • The alteration of the immunization schedule, which no longer recommends shots for hepatitis A and B, rotavirus, respiratory syncytial virus, flu and meningococcal disease for all infants; and
     
  • Kennedy’s removal of the CDC’s routine recommendation for healthy children and pregnant women to receive the COVID-19 vaccine.
     
• In addition, the AAP and some powerful fellow plaintiffs say they plan to file a motion for preliminary injunction next week. Among the co-plaintiffs are the American College of Physicians, the American Public Health Association, the Infectious Diseases Society of America and the Society for Maternal-Fetal Medicine. With the motion for prelim injunction they’ll ask the court not only to halt implementation of the new CDC immunization schedule but also to block an upcoming meeting of that agency’s Advisory Committee on Immunization Practices (ACIP). The meeting is slated for Feb. 25 to 26. A hearing on the injunction is expected to take place Feb. 13. 
   
  • In announcing the above updates Jan. 20, the AAP says it will continue to make its own evidence-based immunization recommendations—“as it has since the 1930s.”
     
• In a fact sheet defending the new recommendations, the CDC says it recommends all vaccines for which there is consensus among peer nations. “The updated CDC childhood immunization schedule allows for more flexibility and choice, with less coercion, by reassigning non-consensus vaccines to certain high-risk groups or populations and shared clinical decision-making,” the fact sheet adds. “[It also] ensures that all the diseases covered by the previous immunization schedule will still be available to anyone who wants them.” Read the rest.
   
• Unrelatedly but interestingly, Kennedy recently suggested his rare neurological voice disorder, spasmodic dysphonia, might have been brought on by an annual flu shot some years back. The vaccinating jab in question is “a potential culprit that I cannot rule out,” he tells USA Today. “I can’t prove it.”
   
• And now for something completely coincidental. Last night, just as this edition of HealthExec was getting tucked in, a news item from an unfamiliar outlet blew in. Headline: “BREAKING: Children’s Health Defense hits AAP with RICO suit over fraudulent vaccine safety claims.” Unless it’s an early April Fool’s joke, we’ll have more on this development later. 

Hospitals often discharge inpatients to post-acute care settings chosen for iffy aims like insurer preferences and geographic ease. 

What should be guiding these next-step decisions? Clinical needs, caregiver support and the values and preferences of patients and caregivers, according to researchers who reviewed the relevant literature and drew on their own professional expertise. JAMA Internal Medicine published the team’s findings Jan. 20. “To deliver high-quality, person-centered care,” James Deardorff, MD, of UC-San Francisco and co-authors write, “hospital-based clinicians should understand the distinctions among post-acute care (PAC) settings, take an active role in the selection of PAC, and engage in serious illness discussions with patients at high risk to facilitate better transitions for patients and caregivers.” More: 

• The PAC discharge process is often rushed. Drivers of the haste include external pressures to expedite discharges, professionals who lack knowledge of optimal options, and a dearth of clear frameworks for discharge decision-making, Deardorff and colleagues report. In such situations, patients and families leave the hospital unprepared for the hospital-to-PAC transition, the authors note. “Traditionally, clinicians assume a passive role in this process, in part due to lack of a knowledge base regarding post-acute care,” they point out. “However, clinicians can improve PAC decision planning by synthesizing their knowledge of a patient’s medical needs and prognosis with the assessments of a patient’s rehabilitative and social needs from therapists, case managers, social workers and nurses.”
   
• Given the overlap in services provided, a patient may be eligible for multiple PAC settings. Existing evidence comparing outcomes among PAC settings is heterogeneous and limited to observational studies, Deardorff et al. explain. “However, clinicians may advocate for specific PAC settings for targeted conditions,” they write. “Given that the best PAC setting is highly individualized, clinicians should avoid interjecting their own values (eg, patient safety) ahead of patient values (eg, independence).” Instead, the authors maintain, hospital-based clinicians should “elicit the goals and priorities of patients and caregivers, discuss tradeoffs and provide education around the capabilities and constraints of PAC.”
   
• Prognosis discussions prior to a PAC admission can help set expectations for recovery, guide referrals to palliative care and unmask indications for hospice. Patients and caregivers often receive overly optimistic prognostic estimates, the authors point out. “Clinicians should set realistic expectations for recovery and avoid blanket statements (eg, ‘You will get rehab for a couple of weeks to get stronger before you return home’). A variety of serious illness communication guides are available to assist with these discussions.” 
   
  • The study is available in full for free. 

Some 580 nursing units at more than 300 hospitals have been recognized for outstanding performance in the field. 

The awarder is the American Association of Critical-Care Nurses (AACN). The program is the Beacon Award for Excellence. The group seeks and accepts applications, then looks for units that demonstrate the use of evidence-based practices to improve outcomes and the work environment. The annual exercise presents gold, silver and bronze awards à la the Olympics. For 2025, only 16% of hopefuls took home the gold. Three-quarters won a silver, 10% a bronze.  

• Hospital units in 43 states and the District of Columbia were recognized with Beacon Awards. With 80 awards, New York can lay claim to honors for highest “medal” count. 
   
  • More details here, searchable directory of awardees here.

Also of interest: 

• AHA responds to House RFI on modernizing MACRA … The AHA appreciates the Doctors’ Caucus recognizing the need for large scale reform to further the transition to value-based care. (American Hospital Association) 
   
• When profit kills: How private equity is eroding healthcare … Research published in the last nine months links private equity takeovers to more deaths and medical complications. (U.S. Right to Know)  
   
• ‘Set up to fail’ nurses ditch draining hospital jobs for careers at plush medical spas ... ‘They were understaffing us to save money’ (New York Post)

From HealthExec’s sibling news outlets:

• Radiologists, rad oncologists and thoracic surgeons rail against lung cancer screening misinformation (Radiology Business) 
   
• Confirmed: Mediterranean diet helps heart patients live longer, healthier lives (Cardiovascular Business)