All pharmacists provide some level of drug information, whether to other clinicians or to patients. In fact, a exact survey found that 96.4% of 491 hospitals have staff pharmacists who routinely answer drug information questions,^[1] and a separate survey of colleges of pharmacy showed that 89% of first professional pharmacy degree programs require at least one didactic course in drug information.^[2] While most pharmacists are equipped with knowledge regarding the practice of drug information, the ever-expanding list of pharmaceuticals, as well as the overwhelming amount of clinical data, makes it difficult for practitioners to stay current with exact developments. This also results in the need for more advanced problem-solving skills in order to answer the more complex questions that challenge practitioners today.

Training in Drug Information Practice

Drug information specialists are pharmacists whose primary responsibility is the provision of drug information. As with any specialty, formalized training beyond that received in pharmacy school is not required; however, this focused training does Strengthen the practitioner's clinical credibility and ability to compete with others for employment opportunities. These two intangible attributes may also be obtained with time and experience.

The American Society of Health-System Pharmacists (ASHP) provides residency accreditation in drug information. There are currently 31 ASHP-accredited drug information specialty residencies located throughout the United States. These residency programs are housed in community, academic, and industrial settings and offer a variety of learning opportunities. Although there are additional drug information residency programs that are not ASHP accredited, the standards and objectives for such accreditation may be used to describe the clinical skills set of the drug information specialist which go beyond the minimum standards required of all pharmacists.^[3]

Most drug information residency programs provide the resident with 12 months of directed, postgraduate practical experience in the provision of comprehensive drug information. During this 12-month period, the resident is exposed to various aspects of drug information practice that range in scope and complexity, with the ultimate goal of training the resident to become a competent drug information specialist. Many of the competencies required of a drug information resident are specific to executive issues, such as the development and management of a drug information center, but there are many more competencies that construct the foundation of a drug information specialist's clinical practice. Drug information specialists must be up-to-date with relevant drug-related literature in order to provide the most current information. They are often tasked as a pharmacy representative to pharmacy and therapeutics (P&T) committees. Responsibilities may include preparing medication-use policies and procedures, improving a health system's adverse-drug-reaction reporting and medication-use evaluation programs, and creating and distributing newsletters containing pertinent medication-use information. The drug information specialist must have advanced literature search and assessment skills to develop drug monographs. Additional responsibilities often include developing patient safety initiatives, ensuring compliance with Joint Commission on Accreditation of Healthcare Organizations's standards, and appropriately utilizing drug-contracting opportunities to decrease drug expenditures. Drug information specialists may also work in pharmacy informatics.

Career Opportunities in Drug Information

As previously mentioned, drug information specialists work in a variety of settings, each with its own unique scope of practice. Academic drug information centers staffed by drug information specialists offer pharmacy students practical experience in utilizing available medical media and developing literature-search strategies. Of 88 colleges of pharmacy surveyed, 20% require a drug information practice experience and 70% offer the experience as an elective.^[2] These centers are often located within colleges of pharmacy or university hospitals. Most offer their services to a limited range of health care professionals, such as those within certain facilities or within the region or state. Others offer their services to community pharmacists and patients. Many health maintenance organizations (HMOs) and group purchasing organizations (GPOs) have contractual relationships with academic drug information centers, which in turn offer their services to the respective members of the organizations. In addition, HMOs, GPOs, and pharmacy benefit management companies (PBMs) have internal drug information departments that assist their members on a grander scale by providing many of the items utilized by P&T committees in making medication-use decisions. Many PBMs also provide consumer-based drug information via the Internet that is prepared by drug information specialists.

Proprietary and generic drug manufacturers are staffed with pharmacists who provide drug information specifically for the drugs manufactured by the respective companies. Although there is some information they cannot legally share and all information received should be critically evaluated, they do maintain a database of clinical studies, both published and unpublished, that provides hard-to-find information. These drug information specialists are available to health care professionals and the public and should be contacted if a patient has an unexpected adverse drug reaction. In addition, drug information specialists have practical knowledge of clinical trial design and often provide valuable insight as medical writers and in governmental agencies analyzing drug efficacy and safety claims.

An Underutilized Resource

Drug information specialists are trained to provide clear, concise, and accurate drug information in a variety of settings. Not only do they provide quality service, but pharmacist-provided drug information, adverse-drug-reaction monitoring, and formulary management have been associated with significant reductions in the total cost of care in hospital settings, as well as reductions in patient deaths.^[4] The presence of a drug information center providing these services in 232 hospitals reduced total cost of care per hospital by $5,226,128.22 (p = 0.003), including a $391,604.94 reduction in drug costs per hospital, and was associated with a total of 10,463 fewer deaths.^[4] Disappointingly, an online survey of health care professionals showed that only 1% of respondents contact a drug information center when the need arises.^[5] Another exact survey found that only 5.9% of 491 hospitals have a staff position dedicated to the provision of drug information and 4.1% have a formal drug information center.^[1] Granted, contacting a drug information specialist may not be the fastest way to obtain drug information in an emergency situation; nonetheless, this underutilization raises several questions.

Today, the Internet provides a plethora of information for both health care professionals and their patients. Many practitioners probably use the Internet when seeking answers to questions. However, at least one study judged significantly more responses obtained from a drug information center as accurate when compared with those received from a Usenet newsgroup (p = 0.001).^[6] Also, there is no quality control for these types of newsgroup services and other similar medical information sources housed on the Internet, and practitioners may be jeopardizing their own credibility when using these resources. Another source of information is facility-housed references, including print and electronic products. Electronic drug information products are becoming increasingly popular. A exact survey showed that 60.4% of 491 hospitals subscribed to some sort of electronic product.^[1] Two interesting surveys on drug information references have been conducted.^[7,8] In one survey, 40.9% of 22 respondents said they were not satisfied with the drug information resources to which their pharmacy currently subscribed.^[7] In another survey, 38% of 71 respondents said they used a drug information reference at least 10 times a day, and another 35.2% used such a reference 3-5 times daily.^[8] This discrepancy shows that practitioners regularly use some sort of drug information reference, even though they are not always satisfied with the information obtained.

With so many pharmacists retrieving information from drug information references, the underutilization of drug information specialists as a resource cannot be attributed to a lack in the number of questions that need to be answered. Perhaps practitioners do not know how to find drug information specialists. Industry-based specialists can be contacted via the manufacturer's Web site, and the Physicians' Desk Reference provides a listing of contact information for drug manufacturers.^[9] Drug Topics's Red Book contains a list of academic drug information centers, and many colleges of pharmacy provide these services to the pharmacies in their respective states.^[10] It is also worth contacting HMOs or GPOs, where applicable, to learn about the services they provide.

Drug information specialists are a valuable resource available to support appropriate drug use and Strengthen quality of patient care. New practitioners are urged to take advantage of the expertise of drug information specialists, either within or outside of their own institutions.

A body has been found in the search for the missing woman Nicola Bulley after a tipoff by members of the public, police have said.

Bulley, 45, a mortgage adviser from Inskip, Lancashire, vanished while walking her dog after dropping off her daughters, six and nine, at school more than three weeks ago, on 27 January.

Lancashire constabulary said on Sunday no formal identification had yet been carried out on the body, but that Bulley’s family had been informed.

On Sunday evening Bulley’s partner Paul Ansell spoke of his “agony” at the discovery. “No words right now, just agony,” he told Sky News’s Inzamam Rashid. “We’re all together, we have to be strong.”

The police force said it received a call at 11.36am on Sunday about a body in the River Wyre, close to Rawcliffe Road, within a mile of where Bulley was last seen.

“An underwater search team and specialist officers have subsequently attended the scene, entered the water, and have sadly recovered a body. No formal identification has yet been carried out, so we are unable to say whether this is Nicola Bulley at this time,” Lancashire constabulary said in a statement.

“Procedures to identify the body are ongoing. We are currently treating the death as unexplained. Nicola’s family have been informed of developments and our thoughts are with them at this most difficult of times. We ask that their privacy is respected.”

The discovery came three days after the Lancashire force was heavily criticised for releasing a statement referring to Bulley’s struggles with alcohol and the perimenopause.

It was these “vulnerabilities”, coupled with the numerous sightings before she went missing, which led detectives to believe that she was more likely to have fallen into the river than been harmed by a third party.

The body was found just after a sharp bend in the river, about half a mile downstream from the village of St Michael’s. Police divers were seen searching an area of undergrowth at the river’s edge on Sunday morning, several metres below the banking on Rawcliffe Road.

A dead tree appeared to have fallen into the river there some time ago, with decaying reeds obscuring the water’s edge.

Within a week of her going missing, police said they believed she had fallen into the river while walking her dog, Willow, along the Wyre.

Piecing together CCTV footage, mobile phone data and sightings from people who knew Bulley, detectives believed there was only a 10-minute window when she was out of sight. Her phone, which was still connected to a work call, was found on a bench by the river, alongside Willow’s harness.

Bulley’s disappearance sparked unusually strong public interest, with amateur detectives and YouTubers making ghoulish pilgrimages to the area as they shared their unsubstantiated theories on the case.

Some were served with dispersal notices, forcing them to leave the area, amid reports that properties near to the river had been broken into by would-be sleuths.

Rawcliffe Road was closed for several hours on Sunday so that the body could be recovered and removed. As soon as the road reopened, a steady stream of local people and crime scene tourists visited the spot, after seeing photographs of the search on social media.

For more than three weeks, the community in this small Lancashire village had been desperate for news of the missing mother. Every other lamp-post and telegraph pole bears laminated “missing” posters, appealing for information about Bulley’s disappearance.

Photographs of her smiling face were printed on banners placed at road junctions, in the hope of jogging the memories of motorists who may have seen her the morning she went missing.

A footbridge over the Wyre in St Michael’s has become a focal point in the hunt for Bulley, with well-wishers encouraged to leave messages on yellow ribbons tied to the ironwork. “We will never deliver up” reads one. “We all miss you so much. Please come home Nikki,” reads another.

A child’s drawing is attached to one ribbon, showing a big red love heart and a bright yellow sun. An eight-year-old has written: “I hope you get found today!”

But as the days went on and detectives stuck to their hypothesis that the river had claimed Bulley, the chances of her being found alive grew ever slimmer.

Though the identity of the body had not been confirmed on Sunday night, there was widespread acceptance that it was almost certainly Bulley.

The home secretary, Suella Braverman, tweeted: “These are heart-breaking and distressing developments. My thoughts remain with Nicola’s family at this extremely difficult time.”

On Friday Braverman demanded that Lancashire constabulary explain why it released personal information about Bulley.

Police took the unusual step of revealing last week that Bulley had previously had “significant issues with alcohol which were brought on by her ongoing struggles with the menopause and that these struggles had resurfaced over exact months”.

A response car staffed by both police and health professionals attended the family home on 10 January amid a “report of concern for welfare”, the force said.

The disclosure of such personal information prompted widespread consternation, with the prime minister, Rishi Sunak, saying he was “concerned” about the disclosures.

Lancashire constabulary admitted that it was “an unusual step for us to take to go into this level of detail about someone’s private life”, but said it did so to avoid speculation or misinterpretation.

Midway through the investigation, the force released a statement decrying “the huge amount of commentary from so-called experts, ill-informed speculation and conspiracy theories which is damaging to the investigation, the community of St Michael’s and, worst of all, to Nicola’s family”.

The case had resulted in the “groundless and hurtful abuse of innocent people, including witnesses and local businesses, which is totally unacceptable”, the constabulary said.

As night fell on Sunday, some locals asked why it had taken so long to find a body when police divers and drones, including a private contractor who conducted extensive searches of the riverbed using sonar technology, had failed to find any trace of the missing woman.

Earlier in the search, Ansell said he was “100%” sure she was not in the water. Her family also felt police were too quick to reach their conclusion that she had most likely fallen into the river.

Peter Faulding, chief executive of Specialist Group International, whose dive team joined the search for a number of days using sonar scanners, said last week that he did not think Bulley was in the river.

Had she fallen down the bank, she would have been easily able to stand up and wait for help rather than be swept away with the current, he told the Daily Mail.

But he changed his mind after hearing of Bulley’s issues with alcohol and her mental health.

“I can confirm that my usually trusted team and I were not passed this crucial information during our search, which would have changed search strategy,” he tweeted.

The hunt for Bulley was one of the most substantial missing person searches in England for years, involving underwater search teams, drones, mounted police and a police helicopter.

Medical Billing and Coding Specialist FAQ

What does a Medical Biller and Coder do?

Medical Billers and Coders are responsible for processing patient data including medical records and related insurance. In this position, you will code a patient's diagnosis and then request payment from the patient's insurance company. You will play an important role in ensuring that healthcare providers are quickly and accurately paid for the treatment they deliver patients.

Is there a difference between medical billing and medical coding?

Yes. Medical coders translate patient care into current procedural terminology (CPT) codes. Their primary responsibility is to ensure that the medical services provided are accurately coded. Medical billers are responsible for creating a claim based on the codes a medical coder provides. Many professionals in this area do both medical billing and medical coding.

What are the requirements for a medical billing and coding career?

Entry-level positions typically require completion of a certificate and passing one of the certification exams or an associate degree program in medical billing and coding. Additionally, medical billing and coding professionals must understand the Health Insurance Portability and Accountability Act (HIPAA).

How long does it take to become a Medical Biller and Coder?

In most cases, it takes between one and three years to become a medical biller and coder. Earning a medical billing and coding certification can take up to one year, while earning an associate degree can take up to three years.

What is the difference between certification exams (CPC, CCA, and CBCS)?

Obtaining a CPC, CCA, or CBCS certification implies that an individual has met competencies in the field of medical billing and coding. Certification is invaluable to the student's career goals. Students have an opportunity to make confident, informed decisions about the national certification they prefer.

The Certified Professional Coder (CPC) test is offered by the American Academy of Professional Coders (AAPC). It is the gold standard entry-level coding certification for physician, or professional fee, coders.

The Certified Coding Associate (CCA) is offered by the American Health Information Management Association (AHIMA). It is an entry-level medical coding certification across all settings--physician practices and inpatient hospital.

The Certified Billing and Coding Specialist (CBCS) is offered by the National Healthcareer Association (NHA) and is currently an entry-level medical billing certification for physician practices. In the summer of 2021, the test will transition to an entry-level billing and coding certification, with the inclusion of ICD-10-CM, CPT, and HCPCS Level II testing.

Is medical billing and coding a good career?

U.S. News & World Report ranked medical records technician (professionals that perform medical billing, medical coding or both) as #9 on its list of “25 Best Jobs that Don’t Require a College Degree," #12 in “Best Health Care Support Jobs” and on the “The 100 Best Jobs” list.

Course Objectives

• Be fully prepared to pass one of the following professional certifications that best aligns with your interest and career goals:
  • Certified Professional Coder (CPC) test offered by the American Academy of Professional Coders (AAPC)
  • Certified Coding Associate (CCA) test offered by the American Health Information Management Association (AHIMA)
  • Certified Billing and Coding Specialist (CBCS) test offered by the National Healthcareer Association (NHA)
• Learn how the CPT Category II codes and ICD-10 codes work and how to assign them in common medical billing and coding procedures
• Gain hands-on billing experience with medical billing and coding software
• Externship Starter Kit to help you gain valuable experience in the field
• Medical Biller standalone option for those who aren’t interested in Medical Coding

Course Curriculum

1. Medical Terminology
   1. Introduction to medical terminology
   2. The Musculoskeletal System
   3. The Cardiovascular System
   4. The Lymphatic and Immune Systems
   5. The Respiratory System
   6. The Digestive System
   7. The Urinary System
   8. The Nervous System
   9. The Special Senses: the Eyes and Ears
   10. The Integumentary System
   11. The Endocrine System
   12. The Reproductive System
   13. Diagnostic Procedures, Nuclear Medicine, Pharmacology

2. Medical billing and coding
   1. Introduction to Medical Billing and Coding
   2. Introduction to Health Insurance
   3. Managed Healthcare
   4. Revenue Cycle Management
   5. Legal Aspects of Health Insurance and Reimbursement
   6. ICD-10-CM Coding
   7. CPT Coding
   8. HCPCS Level II Coding
   9. ICD-10-PCS Coding
   10. Pharmacology for Coders
   11. Midterm
   12. Clinical Documentation Improvement (CDI)
   13. Insurance Claims
   14. Commercial Insurance
   15. Blue Cross/Blue Shield
   16. Medicare
   17. Medicaid, CHIP, TRICARE, Workers' Compensation
   18. Certification
   19. How to Find a Job in Medical Billing and Coding
   20. Final

Instructors

Nancy Smith has over 30 years of experience in the healthcare industry. Her clinical experience includes working as a medical assistant for a network of rural health clinics, and as a medical coder, insurance claims specialist, and medical records auditor. She worked as a medical office manager for ten years, where she recruited and trained all medical assistants. Nancy holds a bachelor's degree in vocational education and has developed and taught medical assistant programs.

LaTisha Cottingham has over 20 years of experience in the healthcare industry. She has six years of teaching experience in the field of medical billing and coding and Medical Assisting. Currently she is employed as an HIM Analyst for a long-term care establishment that is based out of Alabama.

Registration and Enrollment

This course is 100% online. Start anytime.

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An independent dive specialist who was involved in the search for Nicola Bulley, said his team would have had a completley different strategy if police had told them about the missing mum's health issues.

With the new information known, he predicts she is more likely to have been swept out to sea or simply wandered off.

The 45-year-old disappeared while on a dog walk along the River Wyre on January 27 - with Specialist Group International drafted in 10 days later to search for her.

Read more: New 'Sienna' route and tourism park proposed for Third Menai Crossing before scheme was axed

They spent 72 hours scouring an area of water near where the missing mum's phone was found on a bench, with police investigators allegedly working on the hypothesis she had accidentally fallen into the water but was of sound mind.

However, SGI chief Peter Faulding has told the Mirror last night he was just as surprised as anyone when Lancashire Police revealed Nicola had problems.

He has also criticised the decision to release the sensitive information publicly at all.

The force said Nicola had previously had "significant" issues with alcohol and they were brought on by struggles with the menopause and had recently resurfaced.

Just 17 days before she vanished, police had been to her address in Inskip following reports of concerns for her welfare.

Mr Faulding said he was told none of this when he arrived at the scene despite being briefed each day. "I would normally be given that information to make my job easier and deploy the appropriate resources to do that search," he explained.

SGI had been working along the theory she had slipped into the water and due to the weak current and many shallows, Mr Faulding said if she'd drowned her body would have been within 500 metres of the entry point.

But a high risk missing person who is potentially suicidal and has possible intoxication completely changes that, he said.

As a result of the misinformation, Mr Faulding said he was "adamant" she couldn't have slipped in the river and his three-day search proved that.

But adding in the other factors, he said the phone being left on the bench is a possible red herring, as if Nicola was disoriented she may have wandered further upstream and gone in there.

And if she'd jumped in she'd have likely swept out to sea.

"We would have extended our search even further upstream. Just because you’ve got a phone there, that doesn’t mean you’ve got an entry point," he continued.

If he was knowingly looking for a potential alcoholic Mr Faulding and his team would be "looking for other evidence" as well, he said.

"I’d be looking for things like whisky bottles, because a lot of suicides - if it’s a suicide - we find bottles of pills, we find whisky bottle, half a bottle of whisky," he continued.

"I did three female suicide victims last year and they all had tablets and bottles of brandy or whisky before they went in.

"If that’s the case, they might try jump in and swim and go 'oh no, I don’t want to do this'. So they start paddling and go downstream.

"If they drown, just fall in and drown, they tend to go straight down, they don’t drift. Unless it’s flood water and it wasn’t flood water on the day."

Mr Faulding said if Nicola had wandered back through the gate where her dog Willow was found and to the bridge - a CCTV blindspot - "she could’ve literally wandered off and no one would have seen her".

The underwater forensics expert went on to question if there is other information being withheld by the police.

"Do they know something else again that they are not telling us?" he said: "Is there another snippet of information here that actually we don’t know?"

Since leaving the search last Wednesday, Mr Faulding has offered to return and use his expertise for a land search, but said he hasn't heard from the police.

He said: "My offer is open to Lancashire Police but I’ve had no communication with Lancs Police since we left. Our phone has been quiet. I’m not ringing them because I don’t want to interfere but we have had no contact at all. We left the scene, that was job done. We did what we’d been tasked with," he added.

He went on to criticise the police for giving out the information publicly at all.

"From my point of view…this information should never have been made public this afternoon at all. It’s not fair," Mr Faulding said.

"If we were given that information on the search, she is a vulnerable 'misper', which is normal for me to get that information, and she’s had alcohol issues etcetera, I’m not going to tell you.

"If I’m told to keep quiet I keep it between us. Our whole approach to the media may have different from day one."

"My thoughts are with the family and I feel bad that information has come out to the public," he added.

The Samaritans is available 24/7 if you need to talk. You can contact them for free by calling 116 123, email jo@samaritans.org or head to the website to find your nearest branch. You matter.

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Jai Prakash Narain

Former Director, Communicable Diseases, WHO Regional Office for South-East Asia

SHARING the international border with Tibet in the Himalayas, the district of Lahaul & Spiti in Himachal Pradesh is characterised by geographic remoteness and harsh climatic conditions. While people living in this tribal district suffer from the double burden of disease — coexistence of communicable and non-communicable or chronic diseases — the health infrastructure is abysmally poor and people lack access to essential health services.

For example, of the seven specialist posts sanctioned at the Keylong district hospital, all but one are currently lying vacant. There is not even a single paediatrician, gynaecologist, surgeon, internal medicine specialist or an emergency care expert in the entire district. Nor is there an epidemiologist to prepare for or respond to emerging infection outbreaks, epidemics or a pandemic. It has been so for the past many years.

In the absence of specialist doctors, many patients from Lahaul & Spiti have to be taken to the neighbouring district of Kullu or other places, causing them considerable discomfort, delay in receiving appropriate medical care and economic hardships. Since there are no private hospitals or doctors, people are dependant entirely on the government system for healthcare and support.

The lack of specialists is of course not unique to Lahaul & Spiti. Many other geographical regions in India are struggling with this challenge. According to the Rural Health Statistics, 2021-22, released recently, there is an 80 per cent shortfall of specialists at community health centres. Against the requirement for the existing infrastructure, there is a shortfall of 83.2 per cent surgeons, 74.2 per cent obstetricians and gynaecologists, 79.1 per cent physicians and 81.6 per cent paediatricians. While Himachal Pradesh has one of the highest shortfalls, Kerala has the lowest.

There is a stark urban-rural divide, with specialised healthcare missing in rural areas, where the majority of the population lives. The scarce human resource for health in rural areas is the most common reason that the poor and those living in remote areas remain not only vulnerable to infectious disease outbreaks, but are also unable to access basic healthcare which people elsewhere take for granted.

This is ironical as India is committed to the United Nations’ sustainable development goals with the underlying theme of ‘no one should be left behind’. Enshrined within it is the concept of universal health coverage, which means that ‘everyone, everywhere should have equitable access to quality healthcare irrespective of their geographic location or ability to pay’.

As the G20 president, India is envisaging the creation of a fairer global health architecture with the premise that both rich and poor countries deserve good health. Under this architecture, priority is to be given to building a robust and resilient national health system with adequate health manpower — to prevent, prepare for and respond to major outbreaks, including the pandemics. The huge sacrifices made by health workers during the Covid-19 pandemic cannot be easily forgotten.

Faced with critical shortage of healthcare manpower, various states have adopted innovative approaches, including offering a variety of incentives in addition to salaries as a ‘pull’ factor to entice medical specialists to serve in their under-served areas.

The predominantly tribal district of Bijapur in Chhattisgarh, a forested and Naxal-affected area, is an excellent model where with support from the National Health Mission (NHM), the district hospital has since 2016 got transformed into a state-of-the-art facility. Increased salaries and other incentives such as free housing have attracted many specialists to work in this district hospital.

To meet the urgent requirement of specialist doctors to save lives, the Uttarakhand NHM recently launched a scheme “You quote, we pay” with offers of basic pay of Rs 2,25,000 per month, besides usual allowances.

In a specialist recruitment drive, Andhra Pradesh has fixed a salary of Rs 2,50,000 per month for specialists working in tribal areas. Interestingly, the state advertisement explicitly says, “Apart from this, the government is ready to provide remuneration as much as you want, depending on your qualification, experience and place of work.”

A few years ago, former Union Health Minister Harsh Vardhan urged the states — health is a state subject — to recruit health manpower, including medical specialists, while promising that the Central Government would pay their salaries.

Addressing effectively the scarcity of medical specialists, which is assuming alarming proportions, must be the country’s top priority. We must invest in health workforce and its development and distribution now and in future, catering to the need of new medical colleges and ensure that medical specialists are available to serve patients at the district level too.

Immediate steps must be taken to fill all vacant posts of medical specialist in the district hospitals and community health centres and those posted must report to their duty station without any political interference. Any politician found interfering in the posting of specialist doctors, thereby depriving the people in under-served areas of their genuine right to equitable healthcare, must be held accountable for unethical practices.

The incumbent doctor, on completion of his/her tenure in a difficult area, such as a tribal area, should be transferred out to a location of his/her choice. And he should not be required to arrange for his replacement, which can otherwise constitute a major disincentive for joining in the first place.

The specialists opting to serve at the district level should be offered incentives such as additional increments based on their qualifications. The Uttarakhand Government offers five increments to those with a postgraduate degree and seven increments to super-specialists. Simultaneously, the district administration must create an enabling environment and provide a decent accommodation or residential facility for the doctors and their families.

While there are not enough medical specialists in the government sector, the state governments must allow the districts to actively recruit them from the open market by offering attractive salaries under the NHM, as is being done in other states such as Chhattisgarh, Andhra Pradesh and Uttarakhand.

Finally, whether the states learn from the experience of each other remains to be seen. Clearly, the provision of essential healthcare in geographically remote and under-served areas is not only a systemic necessity, but also an ethical and moral imperative.

#Lahaul and Spiti

GMB: Police reveal Nicola Bulley had 'significant issues with alcohol'

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An underwater forensic specialist says the hunt for missing Nicola Bulley would have changed if he was aware of the mum's health issues. Peter Faulding, head of Specialist Group International (SGI), says he was not informed by police about the 45-year-old's 'significant issues with alcohol', adding that he would have changed his search strategy if he had known.

Mr Faulding also hit out at the police for making the mum-of-two's health struggles public. Now aware, he says he believes it is more likely that the mortgage advisor either just wandered off or has been swept out to sea. It comes after Wednesday's (Feb 15) press conference, which focussed on combating disinformation about Ms Bulley's disappearance.

Led by Assistant Chief Constable Peter Lawson and Senior Investigating Officer Detective Superintendent Rebecca Smith, the officers said Ms Bulley experienced "significant" issues with alcohol in the past, which have resurfaced due to menopause. It was also revealed that Ms Bulley had been classed as "vulnerable" and a "high-risk" missing person by police.

READ MORE: Nicola Bulley press conference: What police said about red van, fishermen, phone, CCTV and glove

After an alert was raised by Ms Bulley's partner, Paul Ansell, following her disappearance, specialist officers launched an investigation, deeming her to be "high-risk" due to information Mr Ansell had provided them with. The College of Policing regards a high-risk missing person as someone at risk of serious harm to themselves or the public and requiring the immediate deployment of police resources.

For three days the River Wyre, which Ms Bulley was believe to have last been at while walking her dog before vanishing, was searched by Mr Faulding and his team. They were working on the theory that she had fell into the water and was of sound mind - discounting any foul play or third-party involvement.

However, speaking to The Mirror, he says he was just as surprised as anyone when Lancashire Police revealed Ms Bulley had issues. Seventeen days before her disappearance, police had been to her address following reports of concerns for her welfare.

Mr Faulding said he was told none of this when he arrived at the scene, despite being briefed each day. "From my point of view… this information should never have been made public this afternoon at all. It’s not fair," he said.

"If we were given that information on the search, she is a vulnerable 'misper', which is normal for me to get that information, and she’s had alcohol issues etcetera, I’m not going to tell you. I would normally be given that information to make my job easier and deploy the appropriate resources to do that search," he added.

© PA Peter Faulding talking to reporters

Mr Faulding also said that if he knew he was hunting for someone with 'significant alcohol issues', then him and his team would be "looking for other evidence", such as "looking for things like whisky bottles". He says the phone left on a bench near to the riverbank and where Ms Bulley's dog was running back and fourth from - which was still connected to a work call - could be a 'red herring'.

Mr Faulding said that if Ms Bulley was disoriented she could have wandered further upstream and entered the water there. Or if she had jumped in the river, rather tumbled in, she would have been more likely to have been swept out to sea.

Commenting on ways he would have altered his search strategy, Mr Faulding said: "We would have extended our search even further upstream. Just because you’ve got a phone there, that doesn’t mean you’ve got an entry point.

"They might jump in and swim and go 'oh no, I don’t want to do this'. So they start paddling and go downstream. If they drown, just fall in and drown, they tend to go straight down, they don’t drift. Unless it’s flood water and it wasn’t flood water on the day."

In reference to the "crucial" information withheld from him, he mused: "Do they know something else again that they are not telling us?" Is there another snippet of information here that actually we don’t know?"

Following yesterday's press conference, Mr Faulding has says he has suggested to use his expertise for a land search. He said: "My offer is open to Lancashire Police but I’ve had no communication with Lancs Police since we left. Our phone has been quiet. I’m not ringing them because I don’t want to interfere but we have had no contact at all. We left the scene, that was job done. We did what we’d been tasked with."

In a exact statement on the Lancashire Police website, the force said: “We have described how Nicola had some vulnerabilities at the time she went missing and we just wanted to expand on that a little. Sadly, it is clear from speaking to Paul and the family that Nicola had in the past suffered with some significant issues with alcohol which were brought on by her ongoing struggles with the menopause and that these struggles had resurfaced over exact months.

© Getty Assistant Chief Constable Peter Lawson and Senior Investigating Officer Detective Superintendent Rebecca Smith of Lancashire Police hold a press conference

“This caused some real challenges for Paul and the family. As a result of those issues, a response car staffed by both police and health professionals attended a report of concern for welfare at Nicola’s home address on January 10th.

"No one has been arrested in relation to this incident, but it is being investigated. It is an unusual step for us to take to go into this level of detail about someone’s private life, but we felt it was important to clarify what we meant when we talked about vulnerabilities to avoid any further speculation or misinterpretation.”

Ms Bulley disappeared on January 27. She dropped her two girls, aged six and nine, off at school around 8.40am before heading towards the River Wyre to walk her springer spaniel, Willow, around 9.10am in a route she took daily. Her phone was found just over 20 minutes later on a bench overlooking the riverbank, with her dog running loose.

Since she vanished, huge public and media interest has resulted in what police described as “false information, accusations and rumours” and an “unprecedented” search of both the River Wyre, downstream to Morecambe Bay and miles of neighbouring farmland.

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Indian Air Force's Globemaster C-17 with 100 Indian Army officials along with medical equipment took off for Turkey from Hindon Airbase, Ghaziabad on Monday. India is extending its support to Turkey through the ongoing crisis after the earthquake that jolted the country on Monday. Speaking to ANI, Commanding Officer said, "We are taking a level II medical facility to Turkey to treat earthquake victims. A total of 100 Army officials are leaving from here. Medical specialists including surgeons, orthopaedic surgeons, critical care specialists, preventive medical specialist, dental officers along with the paramedical staff are present with us."

Earlier on Monday, the Additional Directorate General of Public Information, IHQ of MoD (Army), in a tweet stated, "The members of #IndianArmy Humanitarian Assistance Team are committed & determined to execute their task and assist the affected people of earthquake hit #Turkiye. The team is well equipped and geared up to provide the relief and medical assistance." Earlier on Monday, the Ministry of External Affairs spokesperson Arindam Bagchi in a tweet stated, "India dispatches an @adgpi field hospital to Turkiye to establish a 30 bedded medical facility. Its first component has left on @IAF_MCC C17 with a 45-member medical team, including critical care specialists & surgeons. Also has an X-ray machine, ventilators, OT and other equipment."

Earlier on Monday, India's Air Force plane carrying the first batch of disaster relief material and rescue team to support search and rescue efforts in Turkey reached Adana in the earthquake-hit country. Several other countries have also come forward to assist Turkey after earthquakes shattered lives in the country. Turkish Embassy in New Delhi tweeted "First batch of earthquake relief material along with NDRF's special search & rescue teams and trained dog squads just arrived in Turkiye. Thank you, India for your support and solidarity."

The death toll from the earthquakes that hit Turkey and Syria on Monday is now at least 7,266. Turkish Health Minister Fahrettin Koca said that the death toll in Turkey is now at 5,434, CNN reported. At least 31,777 people have been injured in Turkey. On Monday, an earthquake of magnitude 7.7 centered in the Pazarcik district jolted Kahramanmaras and hit several provinces, including Gaziantep, Sanliurfa, Diyarbakir, Adana, Adiyaman, Malatya, Osmaniye, Hatay, and Kilis, Anadolu Agency reported.

Later in the day, an earthquake of 7.6 magnitude centered in Kahramanmaras's Elbistan district jolted the region. The third earthquake of magnitude 6.0 hit Goksun, Turkey on Monday, the United States Geological Survey (USGS) said. (ANI)

(This story has not been edited by Devdiscourse staff and is auto-generated from a syndicated feed.)

Nicola Bulley: Police provide update on search

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A specialist diver brought in to help with the search for Nicola Bulley has said his search methods would have been different if he had known of the mum's health issues. He says he and his team at Specialist Group International (SGI) would have used another strategy if police had given them that information.

With the new facts revealed by police yesterday, he predicts Nicola is more likely to have been swept out to sea or simply wandered off. The 45-year-old mum disappeared while on a dog walk along the River Wyre on January 27 – with SGI drafted in 10 days later.

SGI chief Peter Faulding told the Mirror he was just as surprised as anyone when Lancashire Police revealed Nicola had problems with alcohol. He has also criticised the decision to release the sensitive information publicly at all.

Read more: Police called to Nicola Bulley's home 17 days before she vanished

Mr Faulding's team spent 72 hours scouring an area of water near where the missing mum's phone was found on a bench, with police investigators allegedly working on the hypothesis she had accidentally fallen into the water but was of sound mind. Yesterday, the force said Nicola had previously had "significant" issues with alcohol and they were brought on by struggles with the menopause and had recently resurfaced.

Just 17 days before she vanished, police had been to her address in Inskip following reports of concerns for her welfare. Mr Faulding said he was told none of this when he arrived at the scene despite being briefed each day.

"I would normally be given that information to make my job easier and deploy the appropriate resources to do that search," he explained. SGI had been working along the theory she had slipped into the water and due to the weak current and many shallows, Mr Faulding said if she'd drowned her body would have been within 500 metres of the entry point.

But a high risk missing person who is potentially suicidal and has possible intoxication completely changes that, he said. As a result of the misinformation, Mr Faulding said he was "adamant" she couldn't have slipped in the river and his three-day search proved that.

© PA The bench where Nicola Bulley's phone was found, on the banks of the River Wyre in St Michael's on Wyre, Lancashire, as police continue their search for Nicola Bulley, 45, who vanished on January 27 while walking her springer spaniel Willow shortly after dropping her daughters, aged six and nine, at school. Picture date: Wednesday February 15, 2023.

But adding in the other factors, he said the phone being left on the bench is a possible red herring, as if Nicola was disoriented she may have wandered further upstream and gone in there. And if she'd jumped in she'd have likely swept out to sea.

"We would have extended our search even further upstream. Just because you’ve got a phone there, that doesn’t mean you’ve got an entry point," he continued.

If he was knowingly looking for a potential alcoholic Mr Faulding and his team would be "looking for other evidence" as well, he said. "I’d be looking for things like whisky bottles, because a lot of suicides – if it’s a suicide – we find bottles of pills, we find whisky bottle, half a bottle of whisky," he continued.

"I [worked on] three female suicide victims last year and they all had tablets and bottles of brandy or whisky before they went in. If that’s the case, they might try jump in and swim and go 'oh no, I don’t want to do this'. So they start paddling and go downstream.

"If they drown, just fall in and drown, they tend to go straight down, they don’t drift. Unless it’s flood water and it wasn’t flood water on the day."

© PA Detective Superintendent Rebecca Smith of Lancashire Police updates the media in St Michael's on Wyre, Lancashire, as police continue their search for Nicola Bulley, 45, who vanished on January 27 while walking her springer spaniel Willow shortly after dropping her daughters, aged six and nine, at school. Picture date: Wednesday February 15, 2023.

Mr Faulding also explained that if Nicola had wandered back through the gate where her dog Willow was found and to the bridge – a CCTV blindspot – "she could’ve literally wandered off and no one would have seen her". The underwater forensics expert went on to question if there is other information being withheld by the police.

"Do they know something else again that they are not telling us?" he said. "Is there another snippet of information here that actually we don’t know?"

Since leaving the search last Wednesday, Mr Faulding has offered to return and use his expertise for a land search, but said he hasn't heard from the police. He said: "My offer is open to Lancashire Police but I’ve had no communication with Lancs Police since we left.

"Our phone has been quiet. I’m not ringing them because I don’t want to interfere but we have had no contact at all."

He went on to criticise the police for giving out the information publicly at all. "From my point of view…this information should never have been made public this afternoon at all. It’s not fair," Mr Faulding said.

"My thoughts are with the family and I feel bad that information has come out to the public," he added.

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Marina Lousararian worked in her home country of Argentina as a cardiologist.

Now in B.C. since mid-2021, she cleans schools to make money and is studying hospitality management.

Foreign-trained medical specialists are expressing frustration over how difficult it is to practice in B.C. if they are certified in other countries.

“I graduated as a medical doctor in 2010 from the University of Córdoba,” Lousararian told Global News. “It’s a worldwide recognized university. After that, I started training in cardiology. I became an adult cardiologist in 2016, recognized by the Medical Council of my city, which is Córdoba, and my training was in a military hospital that belongs to the Argentinian Air Force.”

Lousararian passed all her exams to become a doctor and worked for seven years in Argentina.

She said in the last few years there she had three jobs. “I worked for the Argentinian Air Force, and then I worked for another hospital, which is called Privado, and I had my private practice where I performed complementary diagnostic methods for cardiovascular disease like treadmill tests and ambulatory monitoring of blood pressure – studies like that.”

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5:09 Report: Administrative red tape burden on doctors a barrier to patient care

Lousararian said she knew the process of becoming certified in Canada as a cardiologist would be a difficult one as she had heard many stories about other doctors’ experiences.

“I also knew that my medical degree could be recognized here, but not my specialty. So even though I tried to start the process, I found some barriers.”

She said she registered at the Medical Council of Canada while studying hospitality management and she had to pay a fee to do that.

She was then required to upload all of her certifications, which required a fee of $800 – that was only the beginning of a process that is too expensive.

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“After that is when the process starts because to get my certification, or at least to see if I am eligible, I need to take between three or four exams,” she said. “Of course, I need to prove my knowledge and my language proficiency. I know I have to do that, but the process could cost me over $10,000. And of course, I cannot afford that right now.”

2:11 B.C. aims to triple licensing rate of foreign-trained doctors by 2024

Lousararian said that while her medical degree can be approved in Canada, her specialty cannot because the Medical Council of Canada does not consider Argentina a valid training centre.

She said other countries, including Australia, New Zealand and the United Kingdom are approved but many are not.

“I wasn’t going to be able to practice as a cardiologist here because my postgraduate training was not valid,” Lousararian added.

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“So I asked if they could at least consider me as a doctor. It’s not a problem about trying to prove my knowledge because I know I have to prove my knowledge and I know I have to study a lot because this is medicine. We are not talking about things. We are talking about people. And we are willing to prove that we have the knowledge, we have the experience, and we can study as much as we have to study to prove that. But we need the training.”

Last November, the B.C. government announced it is expanding a program that helps internationally educated doctors get licences in B.C.

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This was a move to try and address the dire lack of family doctors within the province.

“The pandemic has exposed underlying challenges and added new strains to our public health-care system, and too many British Columbians are struggling to find a family doctor,” said B.C. Premier David Eby at the time.

“Meanwhile, family doctors trained outside of Canada aren’t able to practise family medicine because they lack a pathway to be licensed here.”

2:13 Doctor says process to get certified in B.C. has taken nearly a decade

Lousararian said she is willing to take the appropriate training but the program announced last year is geared towards family doctors, which she is not.

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“We know that people need specialists here also because they can be waiting for months to get an appointment with a specialist. And some health issues can wait,” she said. “Others cannot wait, especially in my specialty. So it’s really hard and really difficult to see that we are not considered in those programs and patients end up going into an emergency room or maybe they go again to their family doctors, which are already exhausted or retiring because they cannot reach an appointment with a specialist.”

She wants to practice medicine and if that meant changing her specialty, she would do that. But the cost right now is too high.

She would have to take four exams, which she was told would cost $7,500. Then she would have to go through the eligibility process which would cost $4,500 according to the Medical Council of Canada.

“I couldn’t even upload my certification because I am a newcomer, I have to pay my college fees, the rent, and especially when you have kids, you have more expenses. It’s impossible for me to pay $800 just to upload my certifications. I mean, it’s impossible for me today.”

Lousararian said the whole process has left her with mixed feelings.

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“It’s really sad and it’s really frustrating because we know that we can provide a lot of help through our knowledge, through our experience. We can help satisfy the genuine health-care needs, but we are still not being considered for that.”

2:11 B.C. aims to triple licensing rate of foreign-trained doctors by 2024

Loicel Aguero is in a similar situation.

He is a trained physician with a specialty in internal medicine.

But he was educated in Venezuela and did his residency in Caracas. He then worked as an internal medicine physician from 2011 until he left to come to Canada four years ago.

Internal medicine physicians treat and diagnose people with internal, complex conditions or problems and then they can also refer patients to a specialist, such as a cardiologist or a gastroenterologist

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“I can treat cirrhosis, cirrhosis hepatic,” Aguero said. “Any kind of pneumonia. I can treat hypertension.”

He said he and his wife left Venezuela due to political upheaval and economic uncertainty.

Since coming to Canada he has been a cleaner, construction worker and unit clerk and is currently a perioperative unit assistant at Richmond Hospital, only starting in January.

He sets up the operating rooms before surgeries.

Aguero wants to become a certified doctor in Canada, but he too is facing financial barriers.

“I think I would need around $10,000 to cover all the things. For example, the MCCQE1 test, I can take it here in British Columbia, and it’s about $1,500 for taking the test.”

Another test he would need costs around $3,500, he said, and it is not even available in B.C. He would have to travel to another province.

“The other thing is you need to have time to prepare yourself for those ones because if you fail the first one, you can repeat that test, but you have to pay it again. But if you pass the test with a lower score, you’re not able to continue your way. You don’t have another opportunity to take again that test.”

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Aguero said he gets frustrated not being able to have an opportunity to practice medicine in Canada.

2:09 Canada’s ER crisis: Doctors urge governments to find solutions for ‘dangerous’ wait times

He would like to see the government deliver people from other countries the chance and financial help to become certified in Canada.

“So I think that the government should open courses or programs for international medical graduates to help us. To teach us how the Canadian health-care system works.”

For now, Aguero said he will continue to try to seek accreditation as a doctor in Canada.

“If the door is open, I will enter. I will do it.”

 – with files from Global News’ Paul Johnson

© 2023 Global News, a division of Corus Entertainment Inc.