Emergency Departments and Hazardous Environments

The Annals of Emergency Medicine, June 2009, issue has an article that reports from an Emergency Department (ED) Safety Survey.

The Survey solicited perceptions of working conditions in the ED from more than 3,000 ED clinicians in 65 EDs.

"The results show that nearly two thirds of EDs do not consistently have sufficient space to deliver patient care , and one third consistently care for sick patients in hallways.

"In addition, more than a third of EDs do not have sufficient physician staffing to consistently handle patient loads during busy hours. Thus, not surprisingly, about one third of EDs consistently exceed their capacity to provide safe care for their patients.

"Important clinical information is consistently communicated from physician to physician and nurse to nurse at change of shift only about half the time. A quarter of our triage nurses are not well trained in emergency assessment. And, when patients are triaged back to the waiting room by these nurses, only a little more than a third are consistently monitored as often as necessary for their clinical condition.

"Almost a quarter of EDs do not consistently list patient safety as a top priority in providing clinical care, and a quarter of staff feel uncomfortable raising safety concerns with their supervisors. Finally, only about half report consistent support from hospital administration for safety improvements in the ED.

"These results suggest that our EDs are far from operating as high-reliability organizations; the number needed to harm for infrastructure failures here is around 10 compared with a number needed to harm for highly reliable organizations of around 1,000,000.

"However, high reliability organizations rely on the resilience of their staff for unexampled, extreme, or unforeseen events when established systems might be expected to falter; but EDs rely on the resilience of their staff for routine operations. Instead of the infrastructure supporting the clinicians, ED workers compensate for the infrastructure.

"We however pay a heavy price for depending on staff resilience to make up for system defects."

OSF and ED Overcrowding and "Where the Money Is"

Keith Steffen, OSF's CEO, photo at right.

When I wrote Keith Steffen and OSF's ED Attendings the letter in September, 2001 about OSF's Emergency Department overcrowding, I had no idea that for the majority of the coming decade, this would be the "hot topic" in Emergency Medicine literature.

I thought then that OSF's ED leadership and OSF's Administration were not giving the ER patients a fair chance for improved care. I thought that we were putting our patients at risk.

OSF, like many medical centers across the nation, are "bottlenecking" patients in the door for profit. Patient safety is on the back burner.

Here is a good article that was published this month in Emergency Medicine News that describes OSF's (and many other medical centers) problem very well.
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Emergency Medicine News Vol 31 (7) July, 2009

Emergency Department Crowding

(Beginning in the middle of the article):

Dr. Ackroyd-Stolarz found that older people who stayed longer in the emergency department were more likely to have adverse events.

In her retrospective cohort study, she included 982 patients 65 and older. The average age was 77.8 years, and 75 percent of them experienced a prolonged ED stay of six hours or more. Studying the records, she found that 140 had adverse events. Adjusting for total ED stay, she found that long stays in the emergency department were associated with a higher risk of adverse events.

Those who suffered an adverse event stayed in the hospital twice as long as those who did not (20.2 days versus 9.8 days). Because the patients stayed in the hospital longer, they occupied acute care beds, an increasingly scarce commodity that exacerbated ED crowding.

Even when there are readily available beds, elderly people tend to stay longer in the emergency department because they come in with more complex illnesses and require a longer workup.

But by far, the lack of inpatient beds is the most significant contributor as to why they are waiting, Dr. Ackroyd-Stolarz said. There is evidence that the elderly are more likely to be admitted to the hospital. They don't want to go to the emergency department unless they are really sick because they know they will wait, she said.
The higher risk for these patients often comes from a decreased physiologic reserve. They are often sicker with comorbid conditions, she said. In the future, we need to demonstrate that this association holds true in other hospitals.

Fixing the problem requires a system approach, said Dr. Ackroyd-Stolarz, not just focusing on the emergency department. People outside of emergency medicine will say, 'If we just fix how they do their business,' but it goes beyond the doors of the emergency department, she said, noting that hospitals need to investigate bed management and what occurs in the community, such as whether services are available to help avoid ED visits.

If we provide more primary care services to nursing home residents, we may prevent that transfer to an emergency department in the middle of the night because there is no physician in the nursing home, she said.

For those who must come to the ED, Dr. Ackroyd-Stolarz said it is important to recognize that the crowding and long waits can be distressing. Often, people end up being admitted for something that could be managed in the nursing home if the services were available.

We need a coordinated, systemic look at every part of the system to figure out where we can make changes to improve the flow, she said.

The extended length of stay for those with adverse events presents a special issue, she added. They take up extra acute care bed time, and the medical literature says hospitals do not have acute care beds because patients are waiting to be transferred to nursing homes.

By preventing the adverse event, EDs could reduce the length of stay. We do not know which came first, she said. Did they have an adverse event because they were in the hospital longer, or did the adverse event contribute to the length of stay?

In fact, profitability creates a mixed message. Studies published in the past five to 10 years show that crowding is associated with lower quality care, but a wave of studies in the past year or so has associated crowded EDs with higher profits for the hospital.

Arguing that crowding is profitable, that it hurts patients, and that it is associated with lower quality portends a tough solution where the federal government disallows crowding. They could implement a solution like that in the United Kingdom or Australia where they won't pay for emergency department patients who stayed there longer than a certain time, Dr. Pines said. It's certainly a possibility. How long should it take to evaluate a patient? Four hours is too short; eight hours might be more reasonable.

Dr. Pines said another solution would be not to pay for admissions until they get to the floor. Hospitals now bill from the time of the bed request, and this solution would not allow the hospital to bill a DRG for an ED patient. Even if they spend 24 hours in the emergency department hallway, Medicare gets a bill for a whole hospital day, he said.

Alternative solutions will likely prove more effective, he said, such as creating incentives for doctors to see patients in their offices during what are now off-hours. Could we pay primary care doctors to see patients after 5 p.m.? Dr. Pines asked. Could we pay surgeons more to operate toward the end of the week or even on weekends? That could smooth schedules and make primary care available when patients actually need it. Essentially, we need a system of acute care that reflects the physiology of how people get sick, which is at unexpected times.

The issue boils down to how patients get medical care in the United States, Dr. Pines said. The system is built around where the money is. The money, for whatever reason, is in specialty care and procedural services. We have a lot of specialists in this country for that reason.

Jenny

 

Dear OSF,

This is Jenny.

She is your patient and was operated at OSF in 1999 for rheumatic heart disease.

She has done well over the past 10 years but needs to return to OSF for repeat heart surgery.

A founder of Haitian Hearts donated $23,000 cash to Paul Kramer at OSF-Children's Hospital of Illinois in 1999 for her surgery. This was money well spent.

Haitian Hearts will donate $10,000 more and my wife Maria and I will provide an additional $10,000 dollars if you will reaccept Jenny for heart surgery now. Please don't turn down $20,000 for repeat heart surgery.

Please give Jenny more time. She is a valuable member of Haitian society. And she is a human being.

Please follow OSF's Mission Statements.

Sincerely,

John

Bishop Jenky Needs a Blog

I think Peoria's Bishop Daniel Jenky should start his own blog.

Cardinal Sean O’Malley of Boston has a blog that is called Cardinal Sean’s Blog.

Cardinal Sean posted on June 26, 2009 that Caritas Christi withdrew its membership in CeltiCare Health Plan.

“…our singular goal has been to provide for the needs of the poor and underserved in a manner that is fully and completely in accord with Catholic moral teaching.

Expansion of Caritas’ care for the poor and the uninsured was the original motivating force in entering the agreement with Celtic Group, Inc. (a subsidiary of Centene Corporation).

Catholic health care in the United States has two principal goals: providing health care for all, a basic requirement of social justice; and protecting the sacredness of human life from conception until natural death. The protection of human life and dignity demands that Catholic institutions never contribute to procedures which are inconsistent with Catholic moral teaching, such as abortion and sterilization. These procedures and others are prohibited by the Ethical and Religious Directives of the United States Conference of Catholic Bishops.

Having withdrawn from the original joint venture, the provider agreement will allow Caritas Christi to fulfill its mission of serving the poor without participation or cooperation in procedures forbidden by the moral teaching of the Catholic Church."

So what is all of this about?

Simply stated, Cardinal O’Malley did not want to be part and parcel of abortions in the Boston Diocese that would be covered by the HMO insurance package referenced above.

I would think that Bishop Jenky could explain on his blog why he is silent regarding Peoria’s OSF policy regarding oral contraceptives.

Bishop Jenky could also explain his silence regarding Humana/OSF HealthPlans offering sterilization and a long list of oral contraceptives in its formulary.

Cardinal O’Malley mentioned in his most recent post the US Bishop’s support for Bishop John D’Arcy and the way he handled the University of Notre Dame (UND) debacle with President Obama. Again, Bishop Jenky could use his blog to explain how he voted as a Trustee of UND regarding President Obama's invitation to Notre Dame. Bishop Jenky could also explain his silence regarding President Obama’s appearance at UND.

What this boils down to in Peoria is that Bishop Jenky should not accept a "little bit of evil" in exchange for the "financial greater good" of OSF in Peoria.

Clearly, Bishop Jenky has lost his courage regarding serious teachings of the Catholic Church, and Cardinal O'Malley has not.

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Below is an article from the Boston Globe from June 11, 2009.

Judie Brown of the American Life League is quoted. Ms. Brown is well aware of what is happening in the Catholic Diocese of Peoria and has written to Bishop Jenky.

Isn't amazing that lay people like Ms. Brown need to "encourage" Cardinals and Bishops to follow the teachings of the Catholic Church?


The Boston Globe
Caritas insurance deal faces changes
Provider's link to abortion criticized

By Michael Paulson and Kay Lazar, Globe Staff | June 11, 2009

Cardinal Sean P. O'Malley, concerned about the relationship between Caritas Christi Health Care and an insurance plan that covers abortions, is seeking modifications to the joint venture that the beleaguered Catholic hospital chain has entered into with a St. Louis-based healthcare company to provide insurance to low-income Massachusetts residents.

O'Malley, who has been criticized by several conservative Catholic and antiabortion activists for his handling of the Caritas venture, issued a statement yesterday declaring that "under no circumstances" will Caritas provide or refer patients for procedures prohibited by Catholic teaching, which include abortion, contraception, and sterilization.

And the Archdiocese of Boston said publicly for the first time yesterday that Caritas would not be permitted to profit from the provision of abortion services by others.

The archdiocese would not specify the changes it is seeking to the joint venture, called CeltiCare, which is 49 percent owned by Caritas Christi.

But the church sought to clarify its requirements for the deal after a number of conservative bloggers and interest groups had recently criticized the venture, accusing O'Malley, often in quite angry language, of abandoning the church's commitment to protecting the unborn.

This week, many of the activists have seized upon, as evidence of the problematic nature of the venture, the new website of CeltiCare. The website specifies the copayments for abortions (from 0 to $100, depending on the plan), and lists family planning and reproductive service providers, including Planned Parenthood facilities in Boston, Somerville, and Worcester.

The president of Caritas Christi, Dr. Ralph de la Torre, issued a statement yesterday saying that individuals covered under the new venture will be told to talk to their insurance company if they seek abortions or other services prohibited by Catholic teaching.

"When a patient seeks such a procedure, Caritas healthcare professionals will be clear that (a) the hospital does not perform them and (b) the patient must turn to his or her insurer for further guidance," de la Torre said. "This, in fact, is the practice currently in place in the Caritas system as we work with other insurance companies under state laws that mandate access to procedures not provided within the Caritas system."

The joint venture, with Centene Corp. of St. Louis, will provide health insurance to thousands of low-income residents of Massachusetts under the Commonwealth Care program, a state-subsidized health insurance program for the working poor. The companies have said that CeltiCare is 51 percent owned by a subsidiary of Centene and 49 percent owned by Caritas Christi, which is incorporated independently from the archdiocese but has a Catholic identity overseen by the archbishop of Boston.

The hospitals are facing time pressure to resolve the cardinal's concerns, because CeltiCare has already begun enrolling low-income people and is supposed to begin providing them with health insurance coverage July 1. Neither the state Connector Authority, which oversees Commonwealth Care, nor CeltiCare would say how many residents have signed up for coverage.

The archdiocese said it is optimistic that Caritas will be able to renegotiate its arrangement with Centene in a way that will be acceptable to the cardinal, who is obligated under church law to ensure that Catholic hospitals in the archdiocese comply with Catholic healthcare ethics.

The cardinal is eager to find a way to make the venture work, because it will serve the poor, which is a priority of the church, and because it will help the Caritas chain, which has had financial problems. But the archdiocese said that the cardinal cannot compromise on the church's ethical directives for Catholic hospitals and that if the final deal does not comply with his understanding of those directives, he will be obligated to block the venture.

The archdiocese would not say yesterday whether the ownership structure of CeltiCare would change, but a statement from the archdiocese and Caritas said, "Caritas is in active discussions with Celtic Group [a Centene subsidiary] and CeltiCare with a view to making acceptable modifications to their arrangement." Centene referred questions to CeltiCare, and its spokesman said he had no comment.

Some of the cardinal's critics are applying a tougher standard to the deal than are many moral theologians and Catholic healthcare officials, who have said that the issue here is whether Caritas is "cooperating with the evil of abortion."

Judie Brown, president of the American Life League, an antiabortion organization, said she does not believe there is any way to modify the arrangement that would make it acceptable.

"Caritas Christi has been put in a position of having to align itself with a provider that does provide abortions, contraception, and sterilization, and it would be crippling to the Catholic identity of Caritas Christi, and therefore the credibility of the archdiocese, if this agreement were to go forward in any way," Brown said.

Brown said she believes the Caritas arrangement is not unusual among Catholic hospitals, and said, "This is a scandal throughout the church."

Brian Delaney, a spokesman for CeltiCare, said an abortion rights group, NARAL Pro-Choice of Massachusetts, will serve on an advisory group for the health plan but he did not know whether any Catholic groups would be on the panel.

Andrea Miller, NARAL executive director, said of the possible modifications to the venture: "The real question is how this plays out in the real world. If it turns out this process of refusing to provide even referrals and sending patients back to health plans creates a barrier to low- or lower-income people obtaining care that they need and have a right to, we will have to . . . ask some hard questions."

Paulson can be reached at mpaulson@globe.com; Lazar at klazar@globe.com.
© Copyright 2009 The New York Times Company

Haitian Hearts has Another Patient Accepted Today

We are very fortunate to have had another heart patient accepted today.

He is an 18 year old young man who was operated several years ago at a large, well known medical center.

He needs to be reoperated and the medical center accepted him back for no charge.

Haitian Hearts has had numerous heart patients that needed repeat surgery. All were accepted back to the medical centers where they were originally operated....except OSF in Peoria.

OSF has abandonded their Haitian Hearts patients and is letting them die.

Peoria's Beleagured Bishop...a Moral Dilemma

I believe that Bishop Jenky was probably a much happier fellow at University of Notre Dame (UND). And I think he would go back to South Bend in a minute.

When I met with Bishop Jenky in his Chancery office in Peoria in February 2003, I felt like I was talking to a man who was very afraid.

I thought he was afraid of Peoria’s local politics.

I thought he was afraid of OSF and Caterpillar Inc., Peoria's largest employers.

I thought that he was afraid for the financial future of the Catholic Diocese of Peoria.

I thought he was afraid to support dying Haitian children.

And even though Bishop Jenky threatened me in the Chancery, I thought he was angry at himself and others, not at me.

I had picketed OSF in January, 2003 after OSF had notified the American Consulate in Haiti. This action stopped my Haitian patients from coming to OSF in Peoria for medical care and cost some of them their lives. The sign I carried in front of OSF questioned OSF's respect for life.

OSF needed to get Bishop Jenky involved because OSF was causing a public relations nightmare. They saw no way out without Bishop Jenky at their side.

At that time I did not know that OSF had a contraceptive accommodation or that Bishop Jenky was going along with OSF’s policy of allowing OSF physicians to write prescriptions for oral contraceptives. This policy had been approved under Bishop John Myers in the mid-90's. Bishop Jenky had inherited this local scandal, and behind the scenes, was allowing it to continue to flourish to help OSF's pocketbook. It was simply money over morality.

According to Catholic teaching, OSF’s contraceptive policy and Bishop Jenky’s acquiescence are not pro-life. My sign questioning OSF's respect for life for Haitians hit them harder than I expected.

So what has happened at OSF and with Bishop Jenky since I picketed the hospital in 2003?

Some of my Haitian kids have died. And OSF is still contacting the US Consulate in Haiti and Cleveland Clinic in Ohio regarding confidential information about my Haitian patients that they have no right or need to know. Bishop Jenky remains silent about this.

OSF’s contraceptive practice continues, and Bishop Jenky maintains his silence regarding this too.

Bishop Jenky is a Fellow and Trustee at the University of Notre Dame (UND). Any comments he had regarding the UND scandal allowing President Obama to give the commencement address was kept below the media radar.

And since 2003 I have learned much about how dysfunctional the Church hierarchy really is.

Is Bishop Jenky conservative or liberal? It totally depends upon where the money is.

Trying to stop President Obama from speaking at UND would not have been good for Bishop Jenky, so he took a silent, safer, and liberal approach.

And he took a conservative approach with his public silence regarding OSF’s abandonment of Haitian Hearts patients. What OSF is doing, allowing their Haitian kids to die, is against moral and ethical standards, and Bishop Jenky has said nothing in the media. (If he is talking to OSF privately, it isn't working.)

As mentioned above, Bishop Jenky has been silent about OSF’s contraceptive practice, which obviously would be a liberal approach. I wonder how much OSF contributes to the Diocese?

His "flip-flop" approaches are consistent only in that they do follow the money each time.

Cardinal Francis George, who is also president of the U.S. Conference of Catholic Bishops, was described by George Weigel as “one of the most articulate critics of Notre Dame’s decision to honor a president who manifestly does not share what Notre Dame claims is its institutional commitment to the Church’s defense of life.” Interestingly, Cardinal George requests Temporary Protected Status for Haitians.

Cardinal George's statements in Chicago seems world's away from what is happening just down the interstate from him in the Catholic Diocese of Peoria.

My Catholic pro life friends say how we need to pray for the culture of life in Peoria. This is true but we need to pray that Bishop Jenky finds the courage to demand that his Catholic hospital respect the culture of life, which they are not doing. And that includes Haitians.

In conclusion, quoting from a pro life friend of mine who quotes from this link:

http://www.zenit.org/article-26023?l=english

To hearten and encourage us all, when we find ourselves confronting bishops, archbishops, and even cardinals:

Laypeople are not merely the clergy's collaborators, but rather share in the responsibility of the Church's ministry, says Benedict XVI.

"There should be a renewed becoming aware of our being Church and of the pastoral co-responsibility that, in the name of Christ, all of us are called to carry out," the Holy Father said. This co-responsibility should advance "respect for vocations and for the functions of consecrated persons and laypeople," he added.

The Pontiff acknowledged that this requires a "change of mentality," especially regarding laypeople, shifting from "considering themselves collaborators of the clergy to recognizing themselves truly as 'co-responsible' for the being and action of the Church, favoring the consolidation of a mature and committed laity."

The Bishop of Rome suggested that "there is still a tendency to unilaterally identify the Church with the hierarchy, forgetting the common responsibility, the common mission" of all the baptized.

ER Crowding...A Moral Dilemma

Moral Consequences of ED Crowding

A family in the area recently called me and told me of their long 10 hour wait in the ER at OSF-SFMC in Peoria.

See my letter written to OSF's Keith Steffen regarding my concerns of dangerous overcrowding in the OSF Emergency Department.

In the May, 2009 issue of Annals of Emergency Medicine there is a two part article regarding crowding in the Emergency Departments in the United States.

Below are key points from these articles and my comments regarding OSF’s Emergency Room:


1. According to Hospital Based Emergency Care: At the Breaking Point, a 2006 report of the Insitute of Medicine (IOM), there is a national crisis of ED crowding.

2. ED overcrowding occurs primarily when sick patients, evaluated by the emergency physician and admitted to the hospital, have no place to go and remain in the ED. It is mainly a symptom of an overcrowded hospital, not the result of “inappropriate” ED use (like patients with sprained ankles, etc.)

This was the exact position I found myself and my patients in on September 26, 2001.

3. Current research on ED crowding strongly suggests that discouraging the use of the ED for non-emergency issues (sprained ankles) will not solve the problem. Rather, output issues, especially the inability to transfer emergency patients to inpatient beds and the resultant “boarding” of admitted patients in the ED for long periods, are most commonly associated with ED crowding.

4. There are moral consequences to ED crowding and serious ethical concerns.

5. ED crowding has a variety of undesirable consequences, including increased patient waiting times, decreased ability to protect patient privacy and confidentiality (if they are lying on a gurney in a busy hallway), impaired evaluation and treatment, and difficulties in delivering person-centered care. ED crowding frequently interferes with the ability of emergency physicians to honor these fundamental principles.

6. When a circumstance such as ED crowding makes it increasingly difficult or even impossible for health care professionals to respect basic moral norms, it is essential to address that circumstance to reduce the likelihood of conflict between these moral norms and to enable professionals to satisfy all of the reasonable moral expectations of their patients.

7. The Joint Commision reported that 55 events associated with delays in care, 29 occurred in EDs. Crowding was noted to contribute to 31% of sentinel events in the ED. Two recent studies found a significant association between ED crowding and increased inpatient mortality. Crowding increased the risk of harmful medical errors in a variety of ways. In a crowded ED, errors may occur as a result of hurried treatment decisions with limited information, of delayed or poorly organized transfer of information from one clinician to another, or of failure to reexamine a patient or to reevaluate a previous physician’s provisional diagnosis or treatment plan.

8. Multiple studies associate ED crowding with delays in access to definitive therapy for emergency conditions, thereby increasing the risk of poorer outcomes. Numerous emergency conditions, including myocardial infarction, stroke, trauma, meningitis, and pneumonia, have been shown to have time-sensitive outcomes.

9. By delaying patient access to assessment and treatment, crowding also forces patient to endure existing harms, including pain and anxiety, for prolonged periods. In all of these ways, crowding impedes clinicians efforts to carry out their duties of beneficence.

10. Patient choice of care is in fact limited by personal and system resources, but enabling patients to choose care that is effective and convenient remains a legitimate moral goal. ED crowding interferes with the satisfaction of that goal when it triggers ambulance diversion and long waiting times for ED care and for hospital admission. Ambulance diversion to other hospitals often thwarts patient strong preference to receive care in the hospital in which their physicians and medical records are located. Diversion also increases transportation time for each patient. Longer transportation times may increase ambulance response time to subsequent patients, there by delaying those patients’ access to out-of-hospital and ED care for their emergency medical conditions.


11. This is what I think is happening at OSF in Peoria:

There are financial barriers that diminish the response of hospital administrators to solve the problem of ED crowding. The IOM report offers the following reason: “No major changes in health care can take place without strong financial incentives, and today hospitals have almost no incentives to address the myriad problems associated with inefficient patient flow or ED crowding. Indeed….hospitals have a number of financial incentives to continue the practices that lead to these problems.”

What are these alleged financial incentives? The IOM report identifies the following 4:

1. Hospitals maximize income by operating at high capacity, making full use of their employees and facilities. The ED can enable its hospital to operate at or near full capacity by acting as an escape valve for excess demand, providing necessary care for seriously ill or injured patients until the hospital can accommodate them as inpatients.

2. Patients awaiting an inpatient bed in the ED compete for beds with patients admitted electively for surgery or other invasive procedures. Such elective admission patients are usually insured and the procedures they undergo are often well reimbursed, generating significant revenue for hospitals. Emergency admissions, in contrast, are more likely to be uninsured or underinsured, to have more severe illnesses, and to have lower rates of reimbursement. Hospitals thus have a financial incentive to prefer elective over emergency admissions. Failure to honor requests for elective admissions, or frequent cancellation of scheduled admissions, may in fact alienate surgeons and other procedural specialists whose patients generate substantial income for the hospital.

3. Hospitals with EDs are required by federal Emergency Medical Treatment and Active Labor Act (EMTALA) regulations to provide a screening examination and necessary emergency care for all patients, regardless of ability to pay. When the ED is crowded, however, access to emergency care is inevitable delayed, and some patients choose to leaves the ED without being seen. In the case of ED closure and ambulance diversion, access to care through the ED is temporarily denied. Thus, hospitals may have a financial incentive to permit ED crowding and subsequent closure because those conditions can limit the hospital’s legal duty to assume the care of uninsured and underinsured patients.

4. Giving elective admissions priority over emergency admissions may enable hospitals to maximize revenues in another easy. If they are denied admission, elective patients may choose not be hospitalized, or to go to a different hospital, and the hospital will lose their patronage. In contrast, patient boarded in the ED are “captive”; they are already in the hospital and cannot easily go elsewhere. So, despite lower priority and longer wait for an inpatient bed, the boarding patients will receive continuing care in the ED and will also eventually be admitted. In this way, the hospital will secure 2 admissions instead of just 1.

If the wait got too long for the patient and their family, on occasion, I directly transported the patient to the inpatient bed myself. I doubt this was looked upon favorably by Dr. Rick Miller, who was in charge of the ED at OSF at the time. Rick did not want waves made that in any way challenged the administrative powers that controlled Dr. Miller and his assistant director, George Hevesy, M.D. Unfortunately for ED patients and staff, there was a dangerous parasitic relationship between the ED directors and OSF Administration.

According to May, 2009 Annals of Emergency Medicine:

Hospitals can implement “full capacity protocols” in periods of severe hospital and ED crowding. Under these protocols, patient boarding in hallways or other unsafe areas in the ED are moved to hallways in various inpatient units. Such protocols alleviate the burden on the ED of boarded patients by distributing those patient throughout the hospital. This strategy may also increase hospital-wide awareness of crowded conditions and thereby motivate physicians and staff to make beds available.

Several years after I was fired from OSF-SFMC, OSF created an observation unit to attempt to relieve ED crowding. Clinical decision units or observation units, for example, can monitor patients with symptoms such as chest pain, abdominal pain, or shortness of breath who may or may not ultimately need hospitalization. Admission pending units can provide continuing evaluation and treatment for admitted patients outside the ED when other inpatient units are full. Discharge units, sometimes referred to as discharge lounges, can accommodate patients who have been discharged by their physician and are merely awaiting discharge instructions or a ride home for the the hospital.

In the early ‘90’s I gave an Emergency Department Grand Rounds regarding creating an Observation Unit at OSF in order to decompress the ER. I asked Jim Moore to attend and explain the financial reasons regarding an observation unit. He agreed to be there. Mr. Moore was Administrator of OSF at the time and is now CEO of OSF Coroprotate. I also asked a general surgeon, and adult cardiologist to attend. All attended the ED Grand Rounds except Mr. Moore.

And as mentioned above, 10 more years went by until OSF implemented an Observation Unit.

In Summary:

1. To maximize efficiency hospitals must decide how to distribute resource among their current patients to do the best job of caring for all.

2. Although emergency physicians and other emergency care professionals confront the moral challenges of ED crowding firsthand, effective response must come from the institutional and system-wide level. Although emergency physicians do not have the power to change the health care system, they certainly can and should participate in addressing the problem of ED crowding.

3. When I wrote Keith Steffen in 2001, I was hoping for his guidance. Instead, he referred to me as a cancer in the emergency room at OSF and I was placed on “probation” the next day.

4. In April 2005, emergency physicians at Vancouver General Hospital, frustrated by their ongoing failure to persuade hospital administration “to address the crisis of admitted patients in our ED,” began giving selected patients a statement expressing their “non-confidence in the ability of the Vancouver Gerneral Hospital ED to provide safe, timely, and appropriate emergency medical care.” This action stimulated heated public, political, and professional debate in British Columbia. After emergency physicians at other Vancouver area hospitals publicly expressed similar concerns about patient safety, the provincial Ministry of Health funded a $7 million campaign to address the problem. Despite this campaign, however, the ED at Vancouver General Hospital remained gridlocked with admitted patients in 2006.

5. The Vancouver no-confidence statement certainly called attention to the problem and it evoked an official governmental response. The Vancouver emergency physician’s proposed strategy for alleviating ED crowding, namely, the use of time limits on ED stays to trigger protocols that distribute admitted ED patients throughout hospital hallways, is also intended to raise the visibility of the crowding problem by spreading the burden to areas other than the ED. This strategy is obviously not an ideal solution, because patients are likely to feel almost as exposed and uncomfortable in a hallway of an inpatient unit as in a hallway of the ED.

6. If hospital EDs in the United States have a moral and legal mandate to provide quality emergency care to all who need it, it is important that emergency physicians and nurses make governmental and institutional leaders aware of the significant problem of ED crowding and that they participate in efforts to address this problem.

Diverting Diversion

On September 26, 2001, I worked a PM shift in the OSF-SFMC Emergency Room.

I thought that the ER was overcrowded and dangerous for my patients.

I wrote the letter documented in this post to OSF's Administrator, Keith Steffen.

The next day I was put on "probation" and then fired from OSF-SFMC in December, 2001.

The following article appeared in Emergency Medical News this month (May, 2009).

It stresses that hospital administrators have to be "on board" with overcrowding and long waits in their Emergency Rooms and seek to find solutions.

Simply, in my opinion, OSF-SFMC was and is mismanaged, caters to elective insured admissions, which puts patients coming to the ER at risk.



From Emergency Medicine News:

EMN Diversion
May, 2009

Diverting the Diversion Diversion

SoRelle, Ruth MPH

Paul Dreyer, PhD, the director of Health Care Safety and Quality at the Massachusetts Department of Public, was coming out of a task force meeting on rules for ambulance diversion more than 18 months ago when he had an epiphany. Diversion was not the problem.

In fact, it was diverting attention and resources away from the real problem plaguing the state's emergency departments. The real issue was crowding.
I discussed it with a number of the members of the committee who were chatting. Instead of talking about diversion rules, I suggested we eliminate diversion. I circulated the idea informally among the members, and at the next meeting, we discussed it formally, and came to a consensus decision that was essentially policy, he said.

On Jan. 1, 2009, Massachusetts eliminated ambulance diversion within its borders except when an internal emergency closes a hospital to all patients. It gets diversion off the table as a potential solution, and enables us to focus on the real issues, said Dr. Dreyer. And it focuses the attention of hospital CEOs and others on the issue of crowding itself. They can't say 'go on diversion' when the emergency department is crowded.

In fact, many emergency experts have long criticized diversion because it simply pushes the problem from one hospital to the next until too many hospitals are on diversion and the system has to open again. Historically, the situation has been that in areas that went on diversion, the situation that led one hospital to go on diversion would lead all hospitals to be on diversion, said Dr. Dreyer.

In two conference calls prior to the no-diversion policy taking effect, he was struck by the steps hospitals had taken to address patient flow issues in anticipation of the new rules. One prior worry had been that the policy would increase the turnaround time for ambulances taking patients to the hospitals.

We heard from the head of a large municipal ambulance service in Boston that contrary to his expectations, the turnaround time had gone down in every single Boston hospital, Dr. Dreyer said. It was a sort of clearing of the decks. Now the focus is on crowding, and the solution to crowding is upstream. Diversion was a diversion so we just got it off the table.

Alasdair Conn, MD, the chief of emergency services at Massachusetts General Hospital in Boston, said diversion created a number of problems for patients and physicians. Patients tend to come to the hospitals where their physicians are. If we were on divert, it created an enormous issue for the patients. They had to see a strange specialist, and the hospitals tried to transfer them later in the day. We all sort of bit the bullet on this, and decided to see how it goes. His hospital and Brigham and Women's Hospital accounted for the highest number of divert hours in the city. We said we had to step to the plate here. We did a pilot of 'no divert' for two weeks a year and a half ago. That went okay. There were no giant catastrophes. Now it looks a though some of our fears have not been realized.

In fact, the length of time ambulance crews had to wait in the emergency department decreased. One downside is that it has put a lot of pressure on the emergency departments, he said. Comparing January 2008 (when the hospitals could divert) with January 2009 (when they could not), he found that while ambulance arrivals went up 17 percent at his institution, the total volume was up only six percent. Thirty percent of patients come by ambulance, but the rest are walk-ins, he said, noting that ambulance arrivals do often generate hospital admissions and stress the hospital's inpatient units.

Because his hospital's leaders knew that the no-diversion policy was in the works, they have changed the way their emergency department works, Dr. Conn said.

Physician-led triage for eight hours a day has dropped the walkout rate from seven percent to two percent, he said, and decreased door-to-doctor time. We implemented this with our existing physical plant and the redesigned the triage area and four screen rooms last October, he said. It has certainly helped. We have sent patients from triage directly to observation or an inpatient bed.

While the emergency department's boarding time has decreased, it is still high, he said. Patients were waiting an average of ten and a half hours for a hospital bed. Now it's down to seven hours. We have also speeded throughput on the inpatient units and boarded more medical patients on the surgical units. All of these have been possible by a hospital administration that agreed that this was the hospital's issue and not just limited to the emergency department.

When Massachusetts General went on divert in previous years, the neighboring hospitals got the overflow and often within 30 minutes went on divert themselves, Dr. Conn said. Now everybody is open. If there is an equal distribution of patients throughout the system, then we all can bear the pain. If the distribution changes slightly, then one hospital suffers more than the others. His department's volume is up six percent month-to-month, but another facility's volume is down and others are only slightly increased.

If you built an emergency department for 70,000 visits annually, and you are now dealing with 80,000, then a change in referrals or ambulance destinations pushes your volume up to 85,000, it will cause a problem long-term, Dr. Conn said. And if one hospital closes its doors, increasing his emergency department volume by 18 or 20 percent, we can't take that, he said.

Opening more hospital beds seems the easy answer, but it will not happen overnight. His hospital is in the process of constructing a new building and opening 150 more beds, but making the inpatient side more efficient over the long term also reduces pressure. If the average length of stay is 5.8 days, reducing it to 5.6 days is the equivalent of opening 24 more beds, he said. A length of stay of 5.5 days is the equivalent of 36 beds.

Changing the timing of elective admissions might also help, Dr. Conn said. Sometimes, a hospital goes on divert because surgeons do most of their cases on Tuesdays and Wednesdays, taking up the inpatient beds and causing others to be boarded in the emergency department. If the admissions were spread out more equitably across the week, the pressure would be reduced and the need to divert goes away. Such plans not only reduce emergency department stress, they also reduce health care costs, he said.

We absolutely have no plan to go back, Dr. Dreyer said. One emergency department director in Boston said things had been busy and in previous times, he might have been tempted to press the divert button. They managed, and he thinks things are better because patient flow is smoother. Because no one goes on diversion, no one gets an excess load.

Dr. Dreyer's ED is also collecting data on patient boarding to track the progress in patient flow over time. In future meetings, they will broach improving patient flow in greater detail. We didn't expect the elimination of diversion to solve anything, but we took diversion as a bad solution off the table, he said. It seems to have had positive consequences because it forced hospitals to take serious measures to improve patient flow. We made it a hospital problem, not just one of the emergency department.

And the state group that previously dealt with diversion? They've renamed it, said Dr. Dreyer. It's now the Boarding and Crowding Task Force.

© 2009 Lippincott Williams & Wilkins, Inc.

A Mother's Love

This lady ran barefoot through the streets of Soleil carrying her seizing two year old daughter.

Her daughter, Abagaille, started having a fit out of the blue last Thursday morning. She hadn't had a fever and never had seizures prior to this one.

Mom and her 7 kids live in Beleco which is about one and one-half miles from the pediatric clinic.

As Abagaille seized, this lady suffered. She cried, shook her head, and extended her arms pleading to her God to stop this. But she held on to Abagaelle and kept running.

When I examined Abagaille, she seemed post ictal, and then would clench her teeth and seem to smile. But she blinked when I touched her eyelids and cried when she received an IM injection. Her vital signs were stable.

Abagaille's seizures stopped. Her blood glucose came back at 47. We gave her sips of powdered milk forumla. She looked around and appeared normal.

I should have done much more from a diagnostic workup, but I couldn't under the circumstances, that I should not explain.

Mom was relieved that her terrible seizures had stopped, and I told mom to come back the next morning.

Mom and Abagaielle returned the next morning and both looked fine.

The hundreds of thousands of people in Soleil like Abagaielle and her mom deserve so much more.

Peoria's Ambulance Monopoly is Falling Apart

Very slowly, Peoria's corrupt ambulance system is changing.

Last week this article reported that Peoria Fire Station 12 is paramedic.

This took almost two decades to happen.

OSF has supported AMT for the same period of time. OSF's ambulance director was on AMT's salary.

A short Forum article of mine was printed yesterday in the Journal Star.

It will be important for the PFD Station 12 to document the number of people that it helps. The entire city of Peoria needs to be served by the PFD paramedics with advanced life support drugs and technology that AMT has had for years.

----------------------


Forum: Keep improving Fire Department equipment

Posted May 08, 2009 @ 10:30 PM

Re. May 2 story, "Specialized fire engine looks to save lives":

The people covered by Peoria Fire Station 12 are now in good hands. But what about the rest of Peoria?

I wonder if it will take two more decades to permit Peoria Fire Department paramedics to obtain a second "advanced life support engine" to save even more Peorians.

John A. Carroll, M.D.

Peoria
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haitianhearts
1 day ago
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The 'advanced life support engines' that I refer to in the article are simply regular fire engines with advanced life support medication and equipment. The medication and equipment are very cheap but can be very effective in saving lives.... especially when used immediately upon arrival.

The Peoria Fire Department has had Paramedics and Intermediate EMT's for years. Unfortunately for Peoria, they were not allowed to use these individuals for their advanced medical expertise.

The real question is: How long will it take until OSF and the other 'powers that be' to permit other PFD engines to be supplied with advanced technology? Or will local power and greed continue to keep the Peoria ambulance monopoly in AMT's hands?

John A. Carroll, M.D.

JDUB
1 day ago
Report Abuse
Well put John. And also maybe the city should support this and not have to only rely on AMT to get it started. I wonder how much the city has budgeted for the ALS? ? I dont care how broke a city may be, common sense tells me that if this will help save lives then maybe we should budget some money toward this and make it happen. This is a great addition to the City of Peoria.

haitianhearts
23 hours ago
Report Abuse
JDUB (JW),

This article reported on a staged event.

OSF and its Emergency physician leaders were not quoted, if you noticed. They have been telling the public for years that everything was fine with Peoria's Emergency Medical Services, when it was not.

And both OSF and its Emergency physician leaders have been fighting against the PFD from advancing its medical care for years, while they supported Advanced Medical Transport (AMT).

In 2003, when AMT did not get the vote they needed for a multi year contract with the City, they pulled their offer to help the PFD advance its medical care education. So I doubt AMT is thrilled about even one PFD Station giving Paramedic care now. AMT was told what to say by OSF.

You are right. This is a great addition for the City of Peoria. Hopefully, the political support will be there for more PFD Paramedics and more engines carrying advanced life support medication very soon.

John


kate
5 hours ago
Report Abuse
The iretrucks almost always get to the scene before the ambulance. It only makes sense that the firetrucks should have the equipment that is most urgently needed in emergency situations.

JDUB
46 minutes ago
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And the main thing Kate is that people like you and me and anyone elso out there need to speek up to the city council, and maybe things will get done.

One of Haiti's Scourges...Rheumatic Fever

New Haitian Hearts Patients

This week, on the same day, I examined three new patients with congenital heart problems.

I will describe two of the cases. (My satellite signal for the internet is weak right now. I will load pictures of the kids as soon as the signal improves.)

The first patient is five month old Merlinda. She lives with her mom and dad just north of Port-au-Prince.

Merlinda had a fever of 101.5 F and a heart rate of 180/minute. However, she did not appear to be in any respiratory distress. She avidly took her mother's breast. I think her fever was from a recent vaccination.

Merlinda appeared quite healthy.

Her exam revealed a loud blowing murmur to the left of her sternum that radiated everywhere across her chest. The murmur was classic for a hole between the lower chambers of her heart (ventricular septal defect).

Sometimes these holes can "heal themselves", but the location of this hole is up high on the septum and not as amenable to seal over on its own.

So Haitian Hearts will begin its search for a medical center to evaluate and possibly operate Merlinda.

The second patient is Jimi.

Jimi is 5 years old and weighed 17 kilograms. He was brought to me by his father.

Last August, during the hurricaine season, heavy rains caused the river to rise near their home. Their home was flooded, a wall was destroyed, and they lost their garden. Both Jimi and his father are rail thin.

Jimi's heart exam was the same as Merlinda's above.

Jimi was so sweet and did not say a word.

We will do our best with Jimi too. His father has already started on Jimi's passport.

If any one out there in cyberspace has any connections with pediatric medical centers for these two kids, we really need your help.

Thanks.

Dr. John
haitianhearts@gmail.com

Ti Pierre Dies

Haitian Hearts could not find a medical center for Ti Pierre and he died.

The principal of his school in Port-au-Prince called me yesterday to tell me this terrible news. She was very frustrated with his death.

Ti Pierre needed a new mitral valve. That is all he needed.

She said he is in a better place now. I am sure he is.

New Haitian Hearts Patients

This week, on the same day, I examined three new patients with congenital heart problems.

I will describe two of the cases. (My satellite signal for the internet is weak right now. I will load pictures of the kids as soon as the signal improves.)

The first patient is five month old Merlinda. She lives with her mom and dad just north of Port-au-Prince.

Merlinda had a fever of 101.5 F and a heart rate of 180/minute. However, she did not appear to be in any respiratory distress. She avidly took her mother's breast. I think her fever was from a recent vaccination.

Merlinda appeared quite healthy.

Her exam revealed a loud blowing murmur to the left of her sternum that radiated everywhere across her chest. The murmur was classic for a hole between the lower chambers of her heart (ventricular septal defect).

Sometimes these holes can "heal themselves", but the location of this hole is up high on the septum and not as amenable to seal over on its own.

So Haitian Hearts will begin its search for a medical center to evaluate and possibly operate Merlinda.

The second patient is Jimi.

Jimi is 5 years old and weighed 17 kilograms. He was brought to me by his father.

Last August, during the hurricaine season, heavy rains caused the river to rise near their home. Their home was flooded, a wall was destroyed, and they lost their garden. Both Jimi and his father are rail thin.

Jimi's heart exam was the same as Merlinda's above.

Jimi was so sweet and did not say a word.

We will do our best with Jimi too. His father has already started on Jimi's passport.

If any one out there in cyberspace has any connections with pediatric medical centers for these two kids, we really need your help.

Thanks.

Dr. John
haitianhearts@gmail.com

Another Bad Day for the Catholic Diocese of Peoria

See Journal Star article below.

Elaine Hopkins also covered the news conference.

I think Bishop Jenky was much happier at Notre Dame than he is in Peoria. He is still on the Board of Directors at Notre Dame and is a big part of the controversy regarding Mr. Obama's upcoming commencement speech at Notre Dame. Bishop Jenky's silence has miffed many a pro life person around the country.



Diocese facing allegations of abuse
Mendota teacher/victim says Peoria Catholics reneging on settlement
By TERRY BIBO
Journal Star
Posted May 07, 2009 @ 09:14 PM
PEORIA —

Mitchell Landgraf thinks Bishop Daniel Jenky paid 10 times more than necessary to settle at least one case involving a survivor of sexual abuse in the church.

He should know. It was his case.

"I never used a lawyer," the one-time seminarian said at a news conference Thursday near the new Roman Catholic Diocese of Peoria chancery offices. "I never sued. I never got a penny in damages."

On Feb. 24, one day before the state statute of limitations on breaches of contract would have resulted in a lawsuit, the diocese settled with Landgraf for $10,000. Five years earlier, Landgraf had asked for $780 for his counseling costs. Diocesan officials had agreed to pay for his counselor, since Landgraf was sexually abused during a retreat in the diocese during the early 1980s. When the officials changed, the payments stopped.

"Not everybody makes it out of the pain of sexual abuse in the church. I almost didn't, either," said Landgraf, who said he once attempted suicide.

"This is not about what happened 30 years ago by one sick man. It's about everything that is happening right now."

Reneging on the agreement triggered the feelings of abuse all over again, which required more counseling, he said. The five-year battle to make the diocese keep its agreement was "disheartening," he said, despite support from family and the Survivors Network of those Abused by Priests.

Landgraf said he knows it doesn't have to be this way. The priest involved in his abuse was from the Catholic Diocese of Dallas.

According to Landgraf that diocese treated him with compassion. That is one reason he offered to use some of the settlement from Dallas to pay for additional support during retreats here.

He said he refused to blame Monsignor Steven Rohlfs, who agreed to pay for his counseling while he was still chancellor here, calling him "a holy and good man who treated me with honesty and compassion."

But he said the current chancellor, Patricia Gibson, "respects no one."

After he spent five years seeking every possible avenue to redress the problem, he decided to speak out because others need this counseling and their bills are not being paid.

"I'm out to protect current survivors who want and need this counseling," he said, calling for Jenky's removal if he did not change.

Gibson issued a statement to say the bishop was "disappointed" in some "groundless and outrageous statements" made during the news conference. He believes the diocese has treated Landgraf with the "utmost respect and sensitivity." Despite a settlement from the Diocese of Dallas, the Diocese of Peoria has paid significant counseling bills for Landgraf.

"Bishop Jenky believes that counseling - rather than the payment of large monetary settlements - is the only way that true healing can occur for credible victims of sexual abuse," the statement says. "Not every allegation of abuse has been found to be credible by the Diocesan Review Commission, and so the diocese has denied counseling in those claims that simply cannot be sustained by the facts."

Although the statement did not challenge Landgraf's own abuse story, it said that he simply won't accept that some other allegations are not credible. And, over the last six months, the diocese has paid bills for what it calls credible allegations.

Now married and a father of three children, Landgraf is a high school counselor in Mendota. With his wife at his side to describe the effects on their family, this is the first time he has spoken out about this situation in public.



Terry Bibo can be reached at 686-3189 or tbibo@pjstar.com.
Copyright © 2009 GateHouse Media, Inc. Some Rights Reserved.
Original content available for non-commercial use under a Creative Commons license, except where noted.

Ninety-One Minutes Away

JH, thank you for all of your support as we seek the truth.

Time for OSF and the Diocese to Explain

Here was the first patient in pediatric clinic this morning.

And things didn't improve.

About two hundred patients showed up even though four hours of heavy rain last night flooded Port-au-Prince. And since water runs down hill, the Soleil clinic courtyard was inundated with water.

The only hospital in Soleil, across the flooded field from the clinic, had water in the main hallway. And lying on a bench in the main hallway was the uncovered body of a young man who had come in yesterday with an abscess on his neck. His arms were tied together resting on his abdomen.

American Airlines flights come in and go out over Soleil. The noise of their engines is deafening inside the hospital. Miami is 91 minutes away.

Time for Dr. Hevesy to Explain

Now that Fire Station 12 in Peoria can give paramedic care, I think it would be a good idea if OSF and Dr. George Hevesy would make a statement regarding Dr. Hevesy receiving a salary from Advanced Medical Transport.

The time is now.

If people clearly understood what has happened, and understood the seriousness of the conflict of interest, they would push the policy makers harder for the Peoria Fire Department (PFD) to expand its paramedic service for all of Peoria.

Waiting on AMT to arrive on scene and give advanced life support to patients in extremis would be a thing of the past.

Many people in the Peoria area believe there has been a conflict of interest with Dr. Hevesy receiving a salary from AMT. He worked for many years as the local Project Medical Director (physician who controls all ambulances in the area) and is now the Director of Emergency Medicine at OSF.

Why did it take the PFD almost two decades to be able to administer advanced life support? AMT wanted to be the only ambulance providers of this service in Peoria and Dr. Hevesy supported AMT while he was paid by AMT.

Did Dr. Hevesy support the PFD and encourage them to advance their care as Station 12 just did? Did he ever discourage the PFD or influence the Peoria City Council in any way that would slow the PFD from advancing? Journal Star archived articles say yes.

OSF, AMT, University of Illinois College of Medicine in Peoria, and Dr. Hevesy all need to admit to the public in Peoria (an advertisement in the Journal Star?) that Dr. Hevesy is on AMT’s payroll.

Then, maybe it wouldn't take two more decades for the PFD to save some lives.

Peorians need to know. It is time for Dr. Hevesy to tell us.


Read the first few paragraphs of this weeks New England Journal of Medicine (April 29, 2009) regarding medical conflict of interest. In my opinion, it is very relevant in Peoria.

Controlling Conflict of Interest — Proposals from the Institute of Medicine
Robert Steinbrook, M.D.

As Congress considers mandating the disclosure of industry gifts and payments to physicians on a searchable federal government Web site, others have been developing proposals for reforming physician–industry relations, and key changes are being made to policies at various academic medical centers, professional societies, and companies.

In late April 2009, the Institute of Medicine (IOM) issued a report on conflicts of interest that is notable for its breadth — it covers many aspects of medical research, education, and practice as well as both individual and institutional financial relationships — and the variety of its proposals (see Overview of IOM Recommendations about Conflict of Interest in Medicine).

The IOM defined a conflict of interest as "a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest." The primary interests of concern include "promoting and protecting the integrity of research, the welfare of patients, and the quality of medical education." Secondary interests "may include not only financial gain but also the desire for professional advancement, recognition for personal achievement, and favors to friends and family or to students and colleagues."

Of course, public attention has focused primarily on financial conflicts of interest, and the IOM did so as well, viewing them as "not . . . necessarily more corrupting" than other secondary interests but "relatively more objective, fungible and quantifiable" and "more effectively and fairly regulated."

"Highly Unique Story"

For almost two decades Emergency Medicine physicians at OSF, who have been Directors of Peoria's Emergency Medical Services (EMS), have told the public that Peoria's EMS was just fine.

At least one of the physicians is on Advanced Medical Transport's (AMT) payroll, and according to the Peoria Fire Department (PFD), this physican threw up roadblocks during the past 15 years when the PFD tried to advance their level of care for Peorians.

Despite what the OSF physicians would have us believe, an article in the Journal Star today clearly indicates that not all has been fine in Peoria's emergency services.

The PFD finally has an engine and their paramedics are now allowed to give Peorians the emergency care they deserve when 911 is called.

And what the Journal does not report is the conflict of interest that has been hidden from the public.

I wonder how many lives have been needlessly lost in Peoria during the last two decades?


Here is the article:

Specialized Fire Engine Looks to Save Lives

Vehicle to treat more patients made possible by cooperative effort
By RYAN ORI of the Journal Star

Posted May 01, 2009 @ 08:05 PM
PEORIA —

Nearly two decades after first seeking an advanced life support engine, the Peoria Fire Department has one on the streets.

Friday morning at Station 12, 3006 NE Adams St., Peoria fire Chief Kent Tomblin, Mayor Jim Ardis, Advanced Medical Transport Executive Director Andrew Rand, Firefighters Local 50 union President Tony Ardis and other officials gathered to discuss details of the cooperative effort that brought the first ALS engine to Peoria.

"This cooperative effort involves a municipal government, a non-profit organization and a fire union," Rand said. "This is a highly unique story. I don't know of any other agreement like this."

Other than East Peoria, where the fire department also operates the city's ambulance service, Peoria is the only city in the area now offering an ALS engine.

The actual vehicle remains the same, but it is now stocked with higher-tech equipment and many more types of medications to treat patients with life-threatening conditions such as heart attacks. Another key difference is that to maintain ALS status, an engine must have at least one firefighter with paramedic-level training on board at all times.

In many cases, that means the first people responding to a scene will now have a higher level of medical training than in years past.

All Peoria firefighters are required to have a minimum of emergency medical technician training. There are nine current firefighters with paramedic training and 10 more in training for that level of certification.

"With an ALS engine, we can now intubate - put a tube down someone's throat to assist with their breathing - as well as administer an IV, shock or pace the heart, and use a lot more medications," said engineer Clint Kuhlman, who has paramedic training. "When we're there before an ambulance, we can start advanced life support more quickly. This will save lives that we previously may not have been able to save."

Kuhlman said Station 12 used its new ALS capabilities in the first week since initiating the engine April 24.

"When we get the kinks out of it, our goal is to add ALS service throughout the city," Tomblin said.

The Fire Department had discussed adding an ALS engine in the early 1990s, but there has been a long-running territorial battle between AMT - which provides ambulance service to Peoria - and the city of Peoria.

In November 2007, AMT and the City Council passed an ordinance providing AMT with franchise protection for 20 years.

Rand said with its place in Peoria secure, AMT was able to join the city in ironing out details of an ALS engine. As part of its requirements as a not-for-profit organization, AMT is providing the Fire Department with $10,000 worth of start-up equipment and medical supplies and will continue to provide those items as more patients are served.

As Peoria adds other ALS engines, Rand said AMT will provide more equipment, supplies and training of firefighters.

"It should always be about patients, but a lot of the time it's about political turf," Rand said. "Mayor Ardis has a greater skill set than more people I've met for getting people into a room to talk and do the right thing."

Tomblin said the timing also was improved by the increasing number of paramedic-certified firefighters in the department.

"We've always from the get-go wanted to do what's best for the patient," Tomblin said. "We have the right people in place to do this now. We have an amazing partnership with all the people involved.

"I've been here 30 years, and there were times our partnership wasn't that amazing."



Ryan Ori can be reached at 686-3264 or rori@pjstar.com.
Copyright © 2009 GateHouse Media, Inc. Some Rights Reserved.
Original content available for non-commercial use under a Creative Commons license, except where noted.

Hospital in Cite Soleil

I wonder how much of the 300 million dollars of the international money will go to this baby.

Hospital in Soleil

Hospital in Cite Soleil

This is NOT Children's Hospital of Illinois

Mr. Marshall's E-Mails to Consulate in Haiti

This post consists of a series of e mails sent back and forth from OSF’s attorney Douglass Marshall and the American Consulate in Port-au-Prince, Haiti.

My comments follow individual e mails.

Quick Summary:

Mr. Marshall contacted the American Consulate in Haiti regarding Heurese Joseph. Heurese is a patient of mine in the Haitian Hearts program. And Mr. Marshall e mailed me that he phoned Cleveland Clinic Foundation (CCF) about Heurese’s legal status in the States.

Heurese had heart surgery at OSF in Peoria in 2002, but she had been refused further care at OSF when she became ill in 2008. Cleveland Clinic accepted Heurese for life saving heart surgery. Heurese was operated in Cleveland in December, 2008.

As you can see below, Mr. Marshall presumably sent his first e mail to the Consulate on April 1, 2009.

At the same time Mr. Marshall was e mailing the Consulate, Gertrude the Haitian Hearts Coordinator in Haiti, was feverishly working on obtaining a medical visa (B2 visa) for another Haitian Hearts patient, Katina Antoine.

Katina is a 14 year old girl who had heart surgery at OSF in Peoria in 2002. I examined Katina in November, 2008 and she needed repeat heart surgery also. She was quite ill. Just like Heurese, Katina was denied further medical care by OSF and needed heart surgery quickly.

After four months of "begging and pleading" Haitian Hearts was able to get Katina accepted into Cleveland Clinic for heart surgery.

Gertrude told me that she had an unusually hard time getting the B2 visa for Katina. She went to the Consulate on three separate occasions and Katina’s visa application was denied twice. This was intensely difficult to accomplish and a huge physical strain on Katina who was very weak.

After many e mails and letter revisions by Cleveland Clinic, Katina’s visa was granted on April 14, 2009.

Did Mr. Marshall’s contact with the American Consulate have anything to do with slowing the visa approval for Katina? Will Mr. Marshall’s meddling negatively influence visa applications for future Haitian Hearts patients that are accepted at US medical centers and need the visa for travel for life saving heart surgery?

Here is the string of e mails. We have no documentation what was said during Mr. Marshall’s phone calls to Cleveland Clinic.




From: Douglass Marshall [mailto:dmarshall@hinshawlaw.com]
Sent: Wednesday, April 01, 2009 1:32 PM
To: Port-au-Prince, NIV
Subject: B2 visa


I would like to find out who is listed as the financial support person and at what hospital Heurese Joseph was supposed to receive medical services. She lives in Port-au-Prince. I represent OSF Saint Francis Medical Center in Peoria, Illinois, and Ms. Joseph has requested medical services at OSF. However, OSF did not sign a support affidavit for her. Her physician is Dr. John Carroll, and we believe that the Cleveland Clinic is listed as the supporting hospital.

Can you provide me with any information? Thank you.


My Comment:

Why is OSF interested in this information on a person who has applied for charity assistance? Do they make these kinds of inquiries on all patients who apply for charity assistance? When OSF treats people who aren’t U.S. citizens—much less reviews applications for charity assistance--do they typically contact the Consulate in the person’s home countries making inquires about their visa status?

What is most revealing about this e-mail is that OSF acknowledges that they know the answer to the question they are asking: Cleveland Clinic is the supporting hospital. This information was provided to OSF on the Ms. Joseph’s charity application form. So why would they write the Consulate to ask a question they already had the answer to?

In my opinion, they are trying to sabotage not only Ms. Joseph’s ability to get medical care but also that of future Haitian Hearts’ patients.




E Mail Response from the American Consulate in Port-au-Prince, April 8, 2009:

Mr. Marshall,

Could you please explain to me how you, as an attorney, are involved? I mean that as a very sincere question and for my own education. This the first time an attorney has been in touch with my office for this type of request.

Have you indeed contacted Dr. John Carroll and Cleveland Clinic? If not, I would suggest that you do so, since you seem already to have elicited that information from someone, I suppose Ms. Joseph.

Visa records are subject to confidentiality regulations. I will seek guidance and I would be very interested in any further information you can give me about how your hospital became involved.

Sincerely,
Nancy McCarthy
NIV Chief


My Comment:

Understandably, the Consulate official is confused and states that she has never received this type of a request before. She makes the sensible suggestion that OSF contact me and also points out that he already has the information he is requesting. She tells him nicely that visa records are confidential.



The following is an e mail from the Consulate to Cleveland Clinic and cc’d to me:

Dear (I left out the CC employee name),

I have received an inquiry about a patient to whom we issued a visa on your request, Heuruse Joseph, dob 08-08-1978.

The visa was issued on Nov 24, 2008 and she was to have arrived for urgent heart surgery on Dec. 27. Your information informed us that a stay of two months was required and the visa was so annotated. She actually entered the US on Nov 27, 2008. Did she in fact ever receive treatment through your program?

I have just received an inquiry from another hospital, in Peoria, stating that as of now she is applying to them for medical services.

Any light you can shed on the current situation would be appreciated.

Sincerely,
Nancy McCarthy
NIV Chief


My Comment:

As one can see, the Consulate is confused and is now e mailing CCF and even wonders if Heurese was operated at Cleveland.

CCF asked me to respond to the Consulate official. Here is my response:


Dear Ms. McCarthy,

Heurese Joseph had major heart surgery at Cleveland Clinic in December, 2008.

Heurese is being followed by me with blood tests and physical exams. The results of an upcoming echocardiogram will be reviewed by her heart surgeon at Cleveland Clinic to determine her immediate and long term care.

Heurese has applied to OSF's Charity Assistance Program in Peoria for an outpatient echocardiogram. She is waiting to hear from OSF.

Her I-94 document is valid until May 26, 2009.

Thank you very much.

Sincerely,

John A. Carroll, M.D


Here is the Consulate response to me on April 9, 2009:

Thanks for your reply. Could you please get in touch with the hospital in Peoria to clarify with them what is needed? They have written me directly for information.

Thanks,

Nancy McCarthy


However, OSF's Doug Marshall pressed forward with his inquiry about Heurese and her visa status:


From: Douglass Marshall [mailto:dmarshall@hinshawlaw.com]
Sent: Monday, April 20, 2009 7:29 PM
To: McCarthy, Nancy H
Subject: B2 Visa

Ms. McCarthy,

Thank you for replying. My firm is General Counsel to OSF Healthcare System, located in Peoria, Illinois. OSF owns and operates Saint Francis Medical Center. I am working with OSF to resolve the issue of Ms. Joseph's status in the United States, and Dr. Carroll's request for services to be rendered to Ms. Joseph by OSF.

For many years, Dr. John Carroll brought Haitian children to OSF through the Haitian Hearts Program in Central Illinois. OSF sponsored these children and cared for them. However, in approximately 2002, OSF stopped sponsoring Haitian children through this program. (OSF's employees still go to Haiti and provide free medical and healthcare services to children through another Central Illinois program called, Friends of the Children of Haiti. In addition, OSF treats children, not from just Haiti, but from all over the world).

In December, 2002, OSF contacted Consul General Roger Daley to make him aware that OSF was no longer sponsoring Dr. Carroll's patients. OSF received a reply on December 6, 2002 from Bisola Ojikutu, Vice-Consul, that the Consulate was surprised to learn that OSF was no longer sponsoring Dr. Carroll's patients. The Vice-Consul stated that medical visas would no longer be issued under OSF's name for Dr. Carroll's patients. Also involved in these discussion were Julia Stanley and William Rowland at the Embassy.

It is my understanding that in order to have a Non-Immigrant Medical B2 Visa approved, there has to be a letter from a sponsoring hospital, who will treat the patient. Even though OSF no longer sponsors his patients, Dr. Carroll continues to ask OSF to treat patients that are in the United States, presumably sponsored by some other hospital. Ms. Joseph is the most recent request by Dr. Carroll for services from OSF. OSF is pleased that Dr. Carroll is able to continue his treatment of Haitian children through sponsorship by other hospitals. However, such requests of OSF seem not to comply with the B2 Visa requirements. OSF would like your position on this matter.

Thank you for your attention to this matter.


My Comment:

Why is OSF interested in resolving “the issue of Ms. Joseph’s status in the United States”? Why do they have any interest in this? And, in fact, who is it an “issue” for? It certainly isn’t an issue for the Catholic Church. On March 19, 2009, Cardinal Francis George of Chicago, President of the U.S. Conference of Catholic Bishops sent a letter to President Obama asking him to grant Haitians currently in the United States Temporary Protected Status. TPS would allow Haitian citizens who are already here to continue their stay. TPS is granted for citizens from countries that have experienced recent extreme hardship. Haiti would seem to definitely qualify.

So while the U.S. Bishops are requesting that Haitians be permitted to stay in the country, OSF is questioning the consulate on the visa status of a Haitian. Again, why?

Heurese Joseph is here legally on a B-2 visa. She did indeed have very successful heart surgery at Cleveland Clinic. She is residing in central Illinois and needs a follow up echocardiogram. She could go back to Cleveland to receive this test, but since she is here and OSF has a charity assistance program, she applied for an echo. All OSF had to say was no. Ms. Joseph never received any kind of answer from OSF. The only action the application prompted was a flurry of e-mails and phone calls from OSF to the consulate and Cleveland Clinic. They haven’t once evidenced any care or concern about Ms. Joseph’s medical concerns, though they are very concerned about her visa status.

Since OSF discontinued their involvement with Haitian Hearts and stopped caring for Haitian Hearts patients, I have never requested a visa for a patient and listed OSF as the treating hospital. I do continue to ask OSF if they will accept patients, WHO ARE TRAPPED IN HAITI WITH NO REAL MEDICAL CARE, especially those like Ms. Joseph and Katina Antoine who have been their patients before and whom they might presumably feel some kind of moral obligation. Though they have continued to say no (or more typically they don’t answer at all), I will continue to ask in the hopes that they change their mind. And even though Mr. Marshall intends the reader to believe that I request OSF’s help with patients that are in the States, this is false. Medical centers in the States that have accepted Haitian Hearts patients follow up with my patients and obtain echocardiograms and other post op testing as a matter of principal. Heurese is the first Haitian Hearts patient of mine in the United States that has filled out the OSF Charity Assistance application. (By the way, she never did hear from OSF about the echocardiogram she requested.)

My requests of them to provide medical care to Haitian patients obviously upsets OSF and is one of the reasons for their e-mails to the consulate. Though OSF might like it to be the case, there is no violation of a B-2 visa by my asking OSF for charity assistance. In fact, to maintain their tax exempt status, they are legally required to provide a certain amount of charity care. They can decline the request, but in my opinion, there is no good reason for them to contact the consulate other than to attempt to sabotage the ability of Ms. Joseph and future Haitian Hearts patients to receive medical care in the United States.

Mr. Marshall also leaves out the important fact that Haitian Hearts donated over 1.1 million dollars to OSF-Children’s Hospital of Illinois for the care of Haitian Hearts patients. His word “sponsorship” makes it sound as if the work for my Haitian kids was done pro bono. It was not.

To obtain passports, medical letters, and visas for one child can take up to three years in Haiti. The roads are not great, there has been much violence in the last several years, and communication with the families in Haiti can be very difficult. If Mr. Marshall tried to find one medical center and one visa for one child for heart surgery in the United States, he would immediately see the complexity of the situation. And if the child does not leave Haiti for heart surgery, it usually means death for that child.

OSF and Mr. Marshall need to understand this and understand that creating confusion at the level of the Consulate in Haiti and at Cleveland Clinic may indeed be life threatening for Haitian children that need heart surgery in the future.

One last note at a very human, "non-legal" level, Bisolo the Consulate Official referred to by Mr. Marshall above, was shaking and had tears in her eyes when I spoke with her at the Consulate in Haiti in 2003. She told me that Paul Kramer, Executive Director of Children’s Hospital of Illinois, had called the Consulate and told her that OSF was withdrawing support for Haitian Hearts and so she could not grant any more B2 visas for Haitian Hearts patients. Bisolo is from Africa and she knew this would mean the deaths of more Haitian kids. And it has.


Next e mail is from the Consulate to OSF's Mr. Marshall:

"McCarthy, Nancy H"
04/23/2009 09:30 AM

Thanks for your reply. It is very informative. I did give Dr. Carroll your contact information and I hope that at this point the two of you have a had a chance to sort this specific case out. I certainly understand your position. I have made note that your hospital no longer has a collaborative relationship with Dr. Carroll and I let my officers know, as well.

Consular officers must look at the information presented and come to a conclusion that the applicant meets the requirements or not – that includes looking at the purpose of travel and how that purpose will be accomplished financially.

Visas of any category allow the holder to apply for entry at the port of entry, and at that time the DHS official gives them an approved length of stay. However, the length of stay and the category of admission are determined by DHS, not be the visa itself, so if this applicant was admitted as a B2 for a period of, say, six months, that decision was made by DHS and we don’t have any control over it.

Again, thanks for your response and rest assured that we will not expect to see OSF being presented as a sponsor for medical treatment.

Sincerely,
Nancy McCarthy
NIV Chief

My Comment:

Her last sentence says it all. Bishop Jenky and Sisters of OSF, where are you?

---------------------



Both the U.S. Consulate and Cleveland Clinic asked me to contact OSF to clear up their confusion. Here is an open e-mail to Mr. Marshall:


Dear Mr. Marshall,

You make it clear in your communications that no possibility existed for OSF to grant my request for charity consideration for an echocardiogram for Heurese Joseph. Given that, the only defensible response to my request would have been the simple, sufficient, "No".

As the Consular officer noted, you seem to have had all the information there was.

What pretense do you make for contacting the Consulate, or Cleveland Clinic? The inquiry was not part of a sincere consideration of my application for Heurese.

Given OSF’s, and your own, history with me, the singular treatment of Heurese can only be seen for what it is, i.e., harassment and intimidation. As OSF’s attorney, your responsibility is to guide OSF away from legally questionable actions, not participate in them.

Regarding other statements you make:

1. "We wanted to ensure that the Consulate personnel understood that OSF is no longer a sponsor of Haitian Hearts" What support can you offer for belief that the Consulate might have thought otherwise?

2. "However, such requests of OSF seem not to comply with the B2 Visa requirements." In what way? Does Heurese’s visa restrict her from obtaining services from other than Cleveland Clinic? Does Heurese’s visa restrict her to Cleveland?

3. You have not provided your communication with Cleveland Clinic. Which did you contact first, Cleveland Clinic, or the Consulate? Whichever was the first, you received the answer that Cleveland Clinic was the sponsor of Heurese’s visa. There is no innocent explanation for contacting the second institution.

4. If you intend for OSF to investigate all charity applicants immigration status, then Heurese Joseph’s passport would have provided sufficient proof of hers. Heurese was already in the U.S., we were not requesting OSF’s involvement in Heurese obtaining a visa.

5. "OSF's employees still go to Haiti and provide free medical and healthcare services to children …" What pertinence does this have to your communication with the Consulate as a representative of OSF? What do the private, volunteer efforts of OSF employees have to do with OSF? (And Haitian Hearts brought many kids from that organization for heart surgery...now no one comes for heart surgery from that organization.)

6. An echocardiogram can hardly be considered treatment. It is a test. Heurese had surgery at Cleveland Clinic, as her visa application stated. There is no open-ended treatment being requested of OSF.

7. "OSF … is pleased that you have found hospitals that will sponsor Haitian Hearts patients" Your actions contradict your statement. Malicious interference does not demonstrate pleasure.

8. Why did OSF stop sponsoring children through Haitian Hearts? Sr. Judith Ann repeatedly assured me that OSF would never abandon any child.

Sincerely,

John

Dear Haitian-American Community

Dear Haitian-American Community,


I am very worried about what is happening in Peoria.

OSF's lawyer, Douglass Marshall, has sent e mails to the United States Consulate in Port-au-Prince and to Cleveland Clinic Foundation (CCF).

The correspondence concerns the visa status of a patient of mine...Heurese Joseph.

Here is a sample of the confusion Mr. Marshall has created. This is a snippet of one interdepartmental e mail at CCF regarding Heurese from two days ago:

We talked last week about a patient named Heurese Joseph from Haiti. A hospital in IL is interested in knowing whether we approved or signed off on a B-2 visa form saying we would provide medical care to this patient. Is there a particular person in GPS that handles B-2 visas?

So what is being said here?

Mr. Marshall is asking CCF if they approved a B-2 visa for Heurese to travel to the United States for heart surgery at CCF. Why does Mr. Marshall and the hospital that he represents, OSF in Peoria, care whether CCF signed off on her visa? Her surgery was done in Cleveland, not Peoria.

The confusion created by Mr. Marshall runs through many departments at CCF as evidenced by the e mail stream.

The American Consulate was alarmed last week when Mr. Marshall contacted them about Heurese. The American Consulate contacted me. I responded and the Consulate thanked me and asked me if I would explain to Mr. Marshall.

Why did Mr. Marshall contact the American Consulate in Haiti about Heurese?

My great fear is that OSF and Mr. Marshall are "poisoning the well" at CCF and the American Consulate in Haiti. This could make it difficult for me to get Haitian Hearts patients out of Haiti and accepted by CCF in the future.

And my fear is supported by OSF's recent history. Several years ago OSF and Mr. Marshall blocked my Haitian patients from returning to OSF in Peoria even with full and partial charges offered for their medical care at OSF. Many Haitian kids have suffered and some have died.

I doubt Mr. Marshall will answer my e mail in the preceeding post.

I also doubt that our local Catholic Diocese, lead by Bishop Daniel Jenky, will do anything to stop OSF from creating further confusion. Bishop Jenky has been impotent regarding important moral and ethical issues, including Haitian Hearts patients, at OSF in the past. (I e mailed the Chancellor of the Peoria Diocese last night and asked her to forward my e mail to Bishop Jenky since I do not have Bishop Jenky's e mail address.)

Thus, sick Haitian children and young adults with serious heart problems, need your help. There are no meaningful checks and balances in Peoria regarding the above issues. Hardly anyone really cares about these Haitian children to step out of their comfort zone and challenge OSF and Mr. Marshall.

I depend on you to intervene to try and convince OSF to live the Catholic faith and abide by their mission philosophy and give the Haitian children a meaningful chance at life.

Sincerely,

John A. Carroll, M.D.
Peoria, Illinois

E Mail to OSF's Attorney

Dear Mr. Marshall,

The United States Consulate in Haiti and Cleveland Clinic Foundation (CCF) have contacted me and asked me to answer your questions regarding Heurese Joseph and her visa status. They have labelled their e mails as "Urgent" and "Important".

Please send me all of your e mails to the Consulate and to CCF and I will try to clear up your confusion.

Many people around the country and in Haiti are interested in your inquiry regarding Heurese. So I will post this e mail on my web logs and will post your e mails as well. I will answer your inquiries to the best of my ability.

Sincerely,

John

OSF's Doug Marshall Continues to Confuse

Doug Marshall, OSF's lawyer, continues to confuse the American Consulate in Haiti and Cleveland Clinic Foundation.

The collateral damage will be Haitian children that need heart surgery. I fear they will be denied surgery in places other than Peoria.

What a shame.

Bishop Jenky, where are you?

Katina has Surgery

Dear Everybody,

Thank you all for pulling and praying for Katina.

Katina is 14 years old and had surgery at OSF in Peoria in 2002. As the years passed, her mitral valve repair failed, and Katina slipped back into heart failure. She couldn't walk the hills of Port-au-Prince near as well because she was weak and short of breath.

Katina needed a new mitral valve.

With the support and love of Senator Mike DeWine and his family, Cleveland Clinic accepted Katina for heart surgery. Gertrude in Haiti fought through the visa application process, and Mary cared for Katina as she flew with her from Haiti to the States.

Cleveland Clinic did a wonderful pre-op workup to assure that Katina would have the best results possible.

The day before surgery Katina had a large double lumen catheter placed in a large vein and underwent an exchange transfusion so her blood would be healthier and able to withstand the rigors of bypass.

Katina talked with her courageous parents in Haiti the night before surgery and was very animated on the phone.

Yesterday morning Katina received a new mitral valve. And by late afternoon Katina was very alert, pointing to her breathing tube, while clearly indicating that she wanted it removed.

Many thanks to Katina's host families in Cleveland for having the heart, soul, and faith to bring her to this point.

Katina is not home yet, but will get there. We can't forget that even though she only weighs 66 pounds, she is Haitian.

Dr. John

Peoria has a Serious Problem

Five weeks ago Haitian Hearts patient Heurese Joseph wrote a letter to OSF.

The letter is here and Heurese was requesting an outpatient echocardiogram to be done at HeartCare Midwest. OSF bought HeartCare Midwest last year.

Heurese still does not have an answer from OSF regarding whether they will do the echocardiorgram. Heurese does not have the funds to pay the $1609.00 fee that OSF charges for the echocardiogram.

Several weeks ago I received a call from a lady at OSF. She works for the Charity Assistance Program.

The lady asked me only two questions: Was Heurese here on a “medical visa” and what institution accepted her for heart surgery. I anwered her questions right away but thought that her questions were unusual... especially the question regarding whether Heurese was here on a “medical visa”. I wondered what that had to do with Heurese’s request for assistance to obtain an echocardiogram.

I asked the lady from OSF if a decision had been made whether the Sisters would allow an echocardiogram to be done for Heurese through the Charity Assistance Program. She said that the decision had not been made and implied that Heurese’s straight forward request was still being reviewed. She was nervous and she seemed to want to get off the phone as quickly as possible. (I asked for her name before she hung up and she gave it to me.)

Last year Heurese was dying in Haiti. She gave away her children to family members as she prepared to die. I documented her status on this post and I wrote this letter and sent it to important people at OSF and the Catholic Diocese of Peoria.

I did not hear back from OSF regarding Heurese.

However, Haitian Hearts was able to provide Heurese with months of medication and were able to examine her in Port-au-Prince and obtain an echocardiogram ($75 US). She had a leaky aortic valve that had been repaired at OSF in 2002, but now the aortic valve needed to be replaced. She also had a hole in the ventricular septum, just below her aortic valve, that needed to be shored up because there was a leak across it.

Heurese was in congestive heart failure. Haiti had deadly food riots and four tropical storms in 2008 and Heurese was not eating much. She was quite thin, but had not given up hope.

Haitian Hearts moved Heurese to a guest house in the capital where she could eat every day and take her medication and just try and hold on.

Heurese did hold on and Cleveland Clinic Foundation accepted Heurese for heart surgery. We were able to renew Heurese’s Haitian passport, obtain a non immigrant visa, and purchase a airlines ticket for her to travel to the United States for heart surgery.

Heurese flew to Cleveland in December, 2008 and underwent heart surgery. She is doing great thanks to Cleveland Clinic and her host family in Cleveland.

However, the other day, as documented on Elaine Hopkins Peoria Story, I received this urgent e mail from the American Consulate in Port-au-Prince:


URGENT - From Non-Immigrant visa section, Port-au-Prince


McCarthy, Nancy H
Apr 8


Dear

I have received an inquiry about a patient to whom we issued a visa on your request, Heuruse Joseph, dob 08-08-1978.

The visa was issued on Nov 24, 2008 and she was to have arrived for urgent heart surgery on Dec. 27. Your information informed us that a stay of two months was required and the visa was so annotated. She actually entered the US on Nov 27, 2008.

Did she in fact ever receive treatment through your program?

I have just received an inquiry from another hospital, in Peoria, stating that as of now she is applying to them for medical services.

Any light you can shed on the current situation would be appreciated.

Sincerely,

Nancy McCarthy
NIV Chief


I couldn’t believe what I was reading.

OSF had contacted the US Consulate again regarding Haitian Hearts patients. This time Heurese had been mentioned.

I answered the e mail from the Consulate official immediately and told her that Heurese had been operated in Cleveland and that her visa was up to date.

Heurese had documented in her letter to OSF’s Charity Assistance Program that she had been operated and all she needed was an outpatient echocardiogram in Peoria.

So why was the American Consulate confused after OSF contacted them about Heurese?

I asked the Consulate Chief who from OSF inquired about Heurese. The Consulate official responded that it was Douglass Marshall, OSF’s lawyer.

History was repeating itself here in Peoria to the detriment of Haitians suffering heart problems.

Several years ago Paul Kramer, Executive Director of Children’s Hospital of Illinois, notified the Consulate and asked them not to grant any more non immigrant visas for my Haitian Hearts patients to travel to OSF for care. And Mr. Marshall followed that with a certified letter to me that OSF would not care for any patient referred by me to OSF. And this included Haitian Hearts patients.

Since that time, due to OSF’s refusal to care for their Haitian Hearts patients, even with partial charges and full charges offered for their care, some young Haitian patients of mine have died, and others like Heurese have been suffering greatly.

But for Mr. Marshall to notify the Consulate regarding Heurese seemed quite cruel and unusual. Heurese's children are waiting for her in Haiti.

Heurese had survived poverty, heart disease, Haitian gangs, the UN forces, and four tropical storms. But it hasn't been easy for her.

Why would OSF’s Mr.Marshall call the Consulate regarding Heurese when Heurese made it very clear in her letter that she was operated and all she needed was a 15 minute outpatient echocardiogram? And OSF says that they refuse no one, so it should have been a no-brainer. Right?

Something in Mr. Marshalls e mail concerning Heurese obviously bothered the Consulate official. What could he have written? Why would the Consulate official have sent me an “URGENT” e mail?

Was Mr. Marshall worried that Heurese would not get her echocardiogram at OSF?
And does Mr. Marshall e mail other Consulates from around Central America when other patients with odd names apply to the OSF Sisters Charity Assistance Program? Has OSF become a branch of Homeland Security?

Are the Sisters aware of Mr. Marshall's actions? Is the OSF Board of Directors aware of Mr. Marshall's actions?

Peoria has a serious problem. Too many people are silent and afraid. They are afraid for their jobs and their health insurance and their status in the community.

The Journal Star in Peoria is aware of Heurese and her problems here, but as usual, the Journal is protecting Peoria’s largest medical center. OSF is the Journal Star’s largest advertiser too.

The OSF Sisters need to be ashamed of their medical center's actions against Haitian Hearts’ patients. OSF’s ethicists and chaplains and doctors and nurses are cringing behind the scenes. Yet they say nothing in a public forum. If they all stood together, they could send a message safely and effectively.

And where is Bishop Jenky and the Catholic Diocese of Peoria? They are hiding as usual. Bishop Jenky fears OSF. So the hundreds of people that Bishop Jenky controls around the Diocese have to be silent also.

Several weeks ago while Cardinal George was appealing to President Obama to grant Temporary Protected Status (TPS) for illegal Haitians in this country, OSF's Mr. Marshall was notifying the US Consulate in Haiti that a poor Haitian lady was requesting a tiny amount of medical help here in Peoria.

OSF's actions and the silence that surrounds them is very dangerous--not only for Haitians but for all of us.

Quentin Young Won't Let OSF Use Him

When OSF in Peoria wants to build another half-billion dollar expansion or a new Center for Health, they won't have convicted felon Stuart Levine to lobby.

Just a few years ago Levine and ex-governor Blagojevich's pal Tony Rezko were controlling votes on the Illinois Health Facilities Board. This Board determined which Illinois hospitals could expand, build, and buy new equipment.

OSF made out well with Levine and Rezko. They will have a tough time with Dr.Young.

Dr. Young was the Director of the Internal Medicine Department at Cook County Hospital when I did my Internal Medicine rotation there as a student at Chicago Medical School.

Here is the announcement today in the Chicago Sun-Times that Governor Patrick Quinn appointed Quentin Young to head the Board.



Quinn appoints Young to health planning board

April 16, 2009

BY JORDAN WILSON Sun-Times Springfield Bureau | jwilson@suntimes.com

SPRINGFIELD — Gov. Quinn appointed a longtime friend to head the scandal-plagued state health planning board that prosecutors said was once controlled by convicted felon Tony Rezko.

Quentin Young, one of Chicago's top experts on public health and an outspoken advocate for healthcare reform, will be announced Friday as the chairman of the Illinois Health Facilities Planning Board.

Young, who walked across the state with Quinn and was his personal doctor for five years, admitted the challenges of pumping integrity into the once-disgraced board. Yet, he remains optimistic he could help re-establish the planning board that had an "evil recent past."

"It's crucial because the public is entitled to an honest and well-run board," Young said. "I'll do everything I can to make that happen."

Prosecutors in the Rezko trial said Rezko worked in conjunction with former chairman Thomas Beck and board member Stuart Levine to control the board, which weighs bids for new hospitals, among other things. Rezko was set to cash in on a $1.5 million bribe, prosecutors said, by persuading board members to approve a controversial $81 million hospital in Crystal Lake.

Quinn’s hand-picked appointee isn’t expected to bring with him any political baggage that once haunted the planning board.

“The appointment of Dr. Quentin Young is yet another effort by Governor Quinn to restore integrity back to state government,” Quinn spokeswoman Marlena Jentz said in a statement.

The permanent chairmanship has been vacant since the scandal unfolded. Young will not be paid to head the board, but a bill that passed the Senate and is expected to pass the House could change that and provide board members up to a $10,000 per-year reimbursement.

Secretary Hillary Rodham Clinton on Haiti

Remarks at the Haiti Donors Conference
Hillary Rodham Clinton
Secretary of State
Inter-American Development Bank
Washington, DC
April 14, 2009


Well, thank you very much, and I congratulate the IDB, President Moreno and the staff for hosting this important donors conference. I thank Secretary General Ban Ki-moon not only for the United Nations commitment, but your personal commitment with the recent trip that you took with my husband to Haiti. And I congratulate the prime minister for an excellent plan that was laid out and clearly explained, and now presented to all of us. And to Minister Oda, thank you and your government for linking the aid that we hope comes from this donors conference with the effectiveness that needs to be present.

Now, for some of us, Haiti is a neighbor, and for others of us, it is a place of historic and cultural ties. But for all of us, it is now a test of resolve and commitment. Now, some may ask, and I am sure there are some in my country and my Congress who may ask, why a small nation in the middle of the Caribbean should command so much attention. Why should countries in the Western Hemisphere, Europe, the Middle East and Asia offer assistance to Haiti in the midst of a global economic downturn (inaudible)? And I think the answer is very clear. Because what happens in Haiti affects far beyond the Caribbean and even the region. This small nation of 9 million people is on a brink. It is on a brink of either moving forward with the help of the collective community or falling further back. And it, as well as this region, will be shaped to a large extent by the decisions that we make.

On a personal note, my husband and I went to Haiti for the first time shortly after we were married, so we have a deep commitment to Haiti and the people of Haiti. Our homes are filled with art from Haiti. We have friends who hail from Haiti. But it is not only my personal concern that brings me here today. On behalf of the United States, we are here because Haiti is a neighbor and a friend. Our ties reach back to the early years of both of our nations. They have endured for generations, through our struggles for independence, through the defeat of slavery in Haiti which inspired slaves and abolitionists in my country, to the hundreds of thousands of Haitians who have emigrated to the United States and have strengthened us through their contributions in politics and business and health and education, in science, sports, and culture – the benefits of which I experienced firsthand as a senator representing New York, which has a vibrant Haitian American community.

We are also committed to creating a hemisphere in which every nation, no matter their present level of wealth or their current political circumstances, is moving in the same direction, toward greater peace, prosperity, freedom, and opportunity. With Haiti, we have the chance through global cooperation and collaboration to stand in solidarity with a government and a people who are seeking that way forward, a nation where small investments and assistance from other countries are beginning to reap dividends in economic growth, wider access to education and healthcare, stronger governmental institutions, greater safety and security, and a higher quality of life that results when material conditions improve.

Now, today Haiti is the poorest nation in our hemisphere, with one of our region’s biggest gaps between the haves and the have-nots. But just two years ago, in 2007, Haiti achieved the highest rate of real economic growth since the 1990s. It is on track to reach the completion point for the IMF’s Heavily Indebted Poor Countries Initiative in the next few months. Now, that will mean that significant debt relief is on the way, freeing up approximately $4 million a month, money that Haiti can invest directly in improving the lives of its people and building futures of self-sufficiency and confidence.

Haiti does have the region’s highest rate of HIV/AIDS, the highest rate of maternal mortality and child mortality. But the numbers of maternal deaths have stabilized and the numbers of HIV infections and child deaths are coming down.

Not long ago, from the 1950s until the 1980s, Haiti endured a brutal military dictatorship. The U.S. removed a military dictatorship in 1995, clearing the way for democracy. And after several years of political disputes, common in any country making a transition, Haiti began to see progress. And the national and presidential elections in 2006 really moved Haiti’s democracy forward. What the president and the prime minister are seeking is to maintain a strong commitment to democratic governance which will take another step forward with elections for the senate on Sunday.

Now, like many nations, Haiti struggles against crime, particularly the global scourge of drug trafficking. But reforms to improve policing, strengthening the justice system and fighting corruption are now underway. And a peacekeeping force, led so ably by Brazil, has helped to bring stability to many communities.

Haiti made these strides through the efforts of its government and its citizens and many of the nations and institutions represented here. This represents the full range of resources and relationships, from businesses and universities to NGOs and religious and cultural groups, as well as committed individuals, which is at the heart of smart power.

The trajectory of progress for Haiti, however, has been undermined by the combined winds of hurricanes and the global economic recession. So Haiti is in danger of stalling. This conference gives us all an opportunity to reignite its path to progress by working as a team with Haiti at the helm to advance a comprehensive, long-term strategy for Haiti’s growth, by coordinating hemispheric and international efforts, by targeting clear goals, by setting benchmarks to gauge our progress, and deploying our diverse skills and resources efficiently and effectively.

The president and the prime minister have identified what Haiti needs to stay on track. And with these priorities as our guide, we can make progress. Now is the time to step up our investment in Haiti, not just because the situation is dire and because the consequences of inaction could lead to significantly greater human suffering, but because Haiti has a real opportunity to make substantial progress. It has a plan to do so, and it has demonstrated the determination to carry it out.

Just think, for $150 we can pay to send one Haitian child to school for a year, or we can immunize 15 children. That is a tiny fraction of the costs of solving these problems if they escalate over time. The United States will target our support toward four areas that President Preval and Prime Minister Pierre-Louis have requested, all of which are essential for national and regional progress. First, the Haitian people need and deserve to be secure. They must be able to travel safely to work and school, and participate in civic lives without fear of violence. Second, the country needs stronger infrastructure, particularly roads, which are the circulatory system of any robust economy. And going along with the infrastructure needs is the need for jobs. So we can accomplish two things at once: putting people to work, building roads and other infrastructure throughout the country.

Third, last year’s hurricanes blew a hole in the government’s budget. Now Haiti is facing a huge deficit which will make it harder for them to meet their own goals and the needs of their people. Their debt obligations further constrain their ability to lay the groundwork for the future. And fourth, agriculture – you heard the prime minister refer to it – once again, providing a strong agricultural base for the people of Haiti to become more self-sufficient, as well as to move toward reforestation as part of that agricultural initiative, will give Haiti tools for growth it desperately needs. Now on each of these issues, we will lend our assistance and we seek partners with other nations to maximize our collective impact.

First, security. As you heard, the Secretary General referred to Cité Soleil. It was a no-man’s land. Now there is a new sense of security and freedom in its streets. The Haitian National Police have been supported in their work by the UN peacekeeping operations. Those peacekeeping forces are more than half from Latin American and Caribbean countries. And with Brazil’s lead of determination and skill, there has been an upgrade in both police functions and basic security.

But criminal networks operating in Haiti have not been eliminated. They continue to fight drug traffickers who have made the country a transit point for illegal drugs heading to the United States, Canada and Europe. We will give $2 million to fight drug trafficking through the Merida Initiative, a plan conceived by Mexico, Central America and the United States. This money will fund a secure communications network for the Haitian police, provide a maritime base, vehicles, and operational support for police drug units, provide training to promote cross-border cooperation between Haiti and the Dominican Republic, and sharpen the investigation and prosecution of drug crimes.

Once security is established, opportunity can take root, and nations from Canada to Spain to Japan offered generous assistance to help repair the damage from last year’s storms. But now is the time to take the step beyond – beyond peacekeeping and disaster relief to long-term reconstruction and development. Haiti has the highest unemployment rate in our hemisphere. Seventy percent of its people do not have jobs. It also has one of the region’s highest growth rates. Together, these trends have created what Paul Collier has called a youth tsunami. Nearly one million young people are expected to come into the job market in the next five years.

To spur the creation of jobs, the United States passed the HOPE Act of 2006 to give garments made in Haiti tariff-free access to U.S. markets. Last October, we did extend this trade preference for another decade. Apparel is one of the largest sectors in Haiti’s economy, and we see great possibility for job creation in this field, and we are especially gratified by Brazil’s interest in supporting the Haitian apparel industry.

But to build a diversified economy, Haiti needs more than trade deals. It needs an infrastructure to support the flow of goods and services. The roads in Haiti, for anyone who has ever visited, are beyond inadequate. Many communities are isolated, in the year 2009, by the lack of passable roads. That prevents people from holding jobs, children from going to schools, farmers from bringing crops to market. Better roads are essential.

Haiti also needs better roads and tourist areas to promote that sector of the economy. In addition, urgent infrastructure needs include digging water catchments to prevent floods, completing a garment workers training center, and creating canals to help irrigation. As part of the $287 million in nonemergency assistance we will provide Haiti this year, we have authorized $20 million in aid to generate jobs in building roads and infrastructure. And we know that there are other ways we can use this money, but we will be more effective if we coordinate together so that we are all working off the same page, the page of the recovery plan that the prime minister described.

Now even the most responsible government in the world cannot prevent a natural disaster. The hurricanes didn’t just wash away crops and houses. They washed away months of government planning. Haiti is facing an approximately $50 million budget deficit which could undermine its plans. We will provide $20 million to help pay Haiti’s upcoming debt service obligations and to free up other resources, and we invite other donors to join us in taking care of this budget deficit.

Now fourthly, there is an urgent need for sustainable agriculture and food security. The combined effects of rising food prices globally and the destruction of crops of hurricanes have exposed millions of Haitians to malnutrition and destructive effects on health and productivity. We all know the effect of malnourished people. They’re too weak to work. Children are too hungry to learn in school. So food security is not only a source of suffering; it is a direct threat to economic growth and global stability.

Here, we need to be creative. Now, the United States will provide a $15 million in-kind contribution of food to help Haiti as it rebuilds, but that is not an answer. We need to revitalize Haitian agriculture. We need to reforest the upper watersheds. We need to borrow from the intelligence of other nations to learn how, as we help rebuild Haiti, it can become more energy independent.

Brazil has shown the extraordinary energy efficiency of using sugar cane. What other crops could be used in Haiti? We know Haiti, like the Dominican Republic, have some of the windiest areas in our hemisphere. What more could be done to promote wind energy and solar energy? We are ready to partner with any of you who have such good ideas working with the Haitian Government. But think of the people we could put to work doing the work that Haiti needs.

Now, this work is not only a matter for governments, but it is a mission for the people of our country. I’ve heard from many individuals and groups who care deeply about Haiti, but they don’t know how to invest their time and money in a way to make a real impact. We will, through our government, help to create a 501(c)(3) charitable organization that the Haitian Diaspora and the United States can contribute to. And we will help coordinate other NGOs, particularly those that have been started by Haitian Americans who want to give back and are looking for the best way forward.

When I think about all of that eroded bare land that I see when I fly over Haiti – and I can always tell where the Dominican Republic starts, because that’s where the green starts – I think about what other countries have done to reforest. When our daughter was born, a dozen people paid to plant trees in Israel in her honor. Think of what we could do for individuals to pay to plant trees in Haiti, and then to pay Haitians to learn foresting techniques to nurture and grow those trees, and to come with alternatives to burning wood so people can be warm and cook their food. All of this is connected, and we’ve got to start making those connections working together.

Now, we know from empirical data that small investments go a long way, and I’ve seen this for myself in Haiti. In addition to traveling there as a newlywed, I traveled as First Lady. I traveled out into the country to meet a doctor who had emigrated to the United States, joined the United States Air Force, had become a colonel, but then wanted to give back to the country of his birth – return to Haiti to his hometown in Pignon, to run a center for health, women’s literacy and microcredit. They had few resources, but they offered a comprehensive range of services to thousands of clients.

I have visited a family planning clinic, one of the great urgent needs in Haiti, where young people were trained to educate their peers about how to protect their health and prevent teen pregnancy. And I have met with women from a group called Women in Democracy who had attended a global conference on women’s leadership that I helped to sponsor ten years ago in Montevideo. When they returned home, thanks to the Vital Voices network that they joined, they began to help support Haitian women running for office, who wanted to see a better life for their own families. Eleven years later, their organization is growing strong. They hold trade fairs for women entrepreneurs, run civic education programs to teach women their rights, support women journalists and build even more connections to the broader region. These Haitian women remind us of the resilience of the people of Haiti, but also that we will never achieve real progress unless we reach deep into Haitian society.

When I think of the successful Haitian Americans who serve in state legislatures and on city councils, who populate our hospitals as doctors and nurses from New York to Florida, who run businesses, who are creative entrepreneurs, there is no reason that could not have happened in Haiti. Talent is universal; opportunity is not. And it is our task through this donors conference to open the door of opportunity for Haitians and to send a message of what does occur through the power of collaboration.

Every poor nation that has worked hard to gain a foothold in the global economy that has been knocked off their footing is looking to see what we can do together. I’m confident that we will make not only significant pledges here, but we will match those pledges by our follow-up efforts and our coordination, and that we will demonstrate to ourselves as well as to the people of Haiti and far beyond that we can, working together, make a significant difference. Thank you all very much.

OSF Sinks to New Low

See Peoria Story.

Looking Back....Haitian Hearts and OSF Patients Die Needlessly

As the years passed, OSF continued their abandonment of Haitian Hearts patients that were treated at OSF and needed to return to OSF for further surgery.

And as we had warned early in the decade, the kids began to die. Their heart repairs performed at OSF would not last forever; everyone involved with their care knew they would need further surgery at some point.

Their doctors wanted them back. Their nurses wanted them back. The ICU cleaning ladies wanted them back. Their host families wanted them back.

But then when they needed surgery, OSF would not allow them to return to OSF for definitive repairs.

Jackson Jean-Baptiste died in January, 2006 and Maxime Petion died in January, 2007. They both went through agony before dying horrible deaths.

This is so hard to think about, write about, and see Jackson's and Maxime's eyes in pictures from several years ago. They trusted us so much.

Their deaths were needless.

How could this have happened?

(Jackson Jean-Baptiste above. December, 2005.)

Looking Back....PFD Becomes Paramedic in 2008

In 2008, as documented in this blog, the PFD became paramedic.

As the years pass in Peoria, EMS leadership will change. We can hope that new leadership will be transparent and strive for excellence in pre hospital care for Peoria.

Looking Back....Rescue Services Get Some Criticism (Revised)

My comments are at the bottom.

Even though this article downplayed the situation, EMS was going to change for the better in Peoria. The Journal Star wasn't going to make it look like it had been too bad either.

And anyone that had read my Forum articles and posts carefully knew that I wanted the Peoria Fire Department to be able to help the citizens of Peoria and not be held back. I knew many of the AMT paramedics and relied on them greatly when they brought a patient to me in the Emergency Department. The paramedics were not at fault. Peoria's EMS leadership was the problem.


Peoria Journal Star
July 7, 2005

JENNIFER DAVIS
DAYNA R. BROWN

Rescue services get some criticism - EMTs, firefighters work well together, officials say

PEORIA - Criticism of the city's private ambulance service by a former emergency room physician is being downplayed but could still lead to discussion on how to improve the system.

Dr. John Carroll, who worked for 21 years at OSF Saint Francis Medical Center before he was fired in 2001, told the City Council on Tuesday of a recent incident in which a man at a Peoria restaurant went into full cardiac arrest and later died while a Peoria firefighter/paramedic on the scene wasn't allowed to try to help save him.

"Just think if that was your family member," Carroll told the council. "Valuable minutes really shouldn't be wasted at the scene" waiting for the city's ambulance service to arrive.

Carroll has been critical of Advanced Medical Transport, the city's only ambulance provider, since at least 2002, but some question whether his accusations are personally motivated by his firing.

"Dr. Carroll has been critical of our operations for some time now. I don't recall ever having the chance to speak with him personally," said Andrew Rand, AMT's executive director. "It's regrettable that these sort of anecdotal references are made that are unsubstantiated."

Rand noted that the AMT was recently given its second perfect score from the Commission on Accreditation of Ambulance Services, making it the only private provider in Illinois thus recognized.

"We have an excellent system," said Dr. Rick Miller, Emergency Medical Services Medical director. An employee of St. Francis, Miller has the responsibility of certifying people as paramedics and EMTs and overseeing their education. If there are any problems and someone has to be reprimanded, he is also involved.

"To say (firefighters) are standing around is inflammatory and an insult to the fire department," Miller added.

Firefighters can perform CPR, control a patient's airway, ventilate a patient, give oxygen and administer several medications. They can also use a defibrillator, which could be the most important tool for a cardiac patient, Miller said.

Those firefighters who are also system-certified paramedics can also use their skills to assist AMT paramedics if they request help - a relatively new change allowed by Miller.

It's also an example of what appears to be a sea change in the relationship between the fire department and AMT. Just a couple years ago, the fire department wanted to get into the ambulance transport business over AMT's objections. But now both sides say they are working together like never before.

"The last thing we want to do is go backwards in terms of the relationship between the fire department and AMT," said Tony Ardis, president of the firefighters' union.
Rand agreed.

"One of the important results of the city's emergency services study was to show the community and the policymakers the benefits of an organized emergency response system. (The study) was the catalyst for us to begin talking about things we never talked about before," Rand said. "We are talking constantly. The dialogue is weekly at various levels."

Indeed, Rand said it's likely both sides will talk about allowing firefighters who are already paramedics to do more, "but it's not because someone is beating me over the head."

Mayor Jim Ardis said he would like all sides to discuss ways to improve the system "as long as we differentiate the conversation and make sure it's clear we're not talking about transport.

"I think it would be a productive discussion to have, and I don't think it's getting into AMT's business," the mayor said. "I'm going to see if there's a feeling on the council as well as long as everyone understands that I don't see this as an effort to start up that whole transport war again."
--------------

My comments today--March 30, 2009. Here is what was really going on in the summer of 2005:

1. Dr Rick Miller was in charge of 80 EMS agencies (ambulance and rescues services) in the area. OSF appointed him to the job when Dr. Jim Hubler resigned from this position.

2. I was told in June, 2005 that Dr. Miller had reprimanded a Peoria Fire Department (PFD) firefighter and the firefighter was suspended from answering medical calls. The PFD firefighter had tried to secure an airway in an emergency by intubating the patient and that was apparently against the rules.

Apparently there were other airway issues with other patients in the weeks before I spoke to the Council. However, Dr. Miller was told that if the media found out about the suspension of the Peoria firefighter, after the firefighter had been trying to help the patient, that it would not be good for Dr. Miller and Peoria’s EMS.

3. As the Journal Star article above stated, I spoke to the City Council in early July and described the medical emergency that had happened in a Peoria restaruant.

4. I had spoken with the PFD paramedic who had taken care of this gentleman. The paramedic had told me that a man collapsed at a restaurant and 911 was called. The PFD arrived before AMT arrived and found the patient in full cardiac arrest. The PFD defibrillated the patient’s heart with successful return of a pulse. AMT arrived at the scene and attempted to intubate (place a breathing tube in the trachea) in the patient. When AMT was unsuccessful, they asked the PFD paramedic firefighter to intubate. Since he was not allowed to and his fire station captain was there to make sure that he did not intubate the patient, the PFD paramedic declined. Apparently, the AMT paramedics were able to intubate the patient successfully, but the patient died.

5. The Journal Star reported, “Those firefighters who are also system-certified paramedics can also use their skills to assist AMT paramedics if they request help - a relatively new change allowed by Miller.”

At some point after this terrible situation in the restaurant, Dr. Miller changed the rules. Dr. Miller was on the defense. Even though he was stating what an “excellent system” was in place, he was changing rules behind the scenes. The new rules stated that the PFD paramedics could intubate and give advanced life support drugs only if Advanced Medical Transport was on the scene AND asked for help from the PFD paramedics.

As a Basic unit, the PFD did not carry advanced medication, laryngoscopes, or tubes. So the new rules still had the patient waiting until AMT arrived to receive paramedic care.

6. In reality things had not been working great between the PFD, the Project Medical Director (Dr. Miller), and AMT as the Journal Star tried to convince the reader. There were a lot of politics involved behind the scenes. And there was a lot of money at stake if AMT lost their ability to be the sole transporter of pre hospital patients in Peoria.

7. After I spoke to the Council a committee was set up behind the scenes with the usual players involved in Peoria’s EMS placed on the committee. The Journal Star did not report this either.

8. Andrew Rand, Executive Director of Advanced Medical Transport, of course never denied that what I said occurred. And as I mentioned above, I always had respect for the AMT paramedics. It is the leadership in the Peoria Area EMS that is the problem.

9. The Journal Star reported, “Firefighters can perform CPR, control a patient's airway, ventilate a patient, give oxygen and administer several medications. They can also use a defibrillator, which could be the most important tool for a cardiac patient, Miller said.”

This is Basic-D care. Not advanced care. Controlling a patients airway and ventilating the patient is bagging them with a bag-valve-mask. The medications were medications that the patient could have had in their pockets. Dr. Miller made it sound like a lot, but it was not Intermediate or Paramedic care. The PFD paramedics were not allowed to function as independent paramedics for three more years in Dr. Miller’s “excellent system”.

Looking Back....OSF's Dr. Rick Miller (Revised)

Well, it was time for OSF's Rick Miller to jump in and defend OSF and Peoria's EMS. That is what he was paid to do.

See my comments below.

Peoria Journal Star
March 10, 2005


End false allegations about Peoria's ambulance service

Re. Feb. 23 Forum letter by Dr. John Carroll, "Let Peoria Fire Department operate its ambulance:"

Dr. Carroll's letter is filled with misleading statements.

First, the ambulance owned by the Peoria Fire Department never had a license or a staffing pattern to be placed into use. All pre-hospital services that provide ambulance transport are strictly governed by the Illinois Department of Public Health. The fire department does an excellent job as a basic life support, non-transporting agency.

Second, Emergency Medical Services (EMS) for Peoria have markedly advanced in the past 20 years through a commitment by the Peoria area hospitals to support a single quality agency. This agency pioneered throughout central Illinois the first critical care curriculum for paramedics and transport and has been accredited, receiving an outstanding score. Dr. Carroll's attempt to paint a picture of negligence and poor care is absolutely erroneous and inflammatory.

Third, emergency rooms at St. Francis, Methodist and Proctor receive traffic from up to 80 different ambulance agencies. The quality of care of each patient transported is of great importance.

Protocols have been developed for quality patient care to be delivered. In the last five years, the system has continued improvement by the addition of medications for all in the system. Physicians who monitor patient care and work to improve EMS protocols are provided a stipend for their services.

Dr. Carroll continues to create, by innuendo, a sense that the system he knows little about is not meeting the needs of Peoria. It is a shame that this continued dialogue may confuse some people regarding emergency care for the city.

Dr. Rick Miller
Medical Director
Peoria Area Emergency Medical System

Comments by me March 26, 2009:

1. If you scan down to the post below, where are the misleading statements that Dr. Miller attributes to me in the article from February 23, 2005? I was pleading for transparency in Peoria's EMS and was willing to buy the PFD ambulance that they were selling on e bay?

My point is that OSF and AMT, using Dr. Miller, did not want this to happen. AMT's money is made in patient transportation and they did not want to lose any of this to the PFD.

2. Actually Dr. Miller's Forum article is full of misleading statements.

3. The PFD ambulance could have been used by them if Dr. Miller and Dr. Hevesy at OSF had agreed. The Matrix consulting firm had noted in 2004 that the PFD had applied to Dr. Miller to outfit their engine with basic and advanced life support medication and equipment and their request was denied. And Dr. Hevesy worked for IDPH. So Dr. Miller did not need to cast all the responsibility on IDPH. This was diversionary and misleading on his part. The decision to let the PFD use their ambulance was a local decision that should have been made by Dr. Miller and supported by Dr. Hevesy. IDPH would have backed the local project medical director's decision.

4. Notice that Dr. Miller did not mention Advanced Medical Transport (AMT) by name any where in his Forum article. He referred to AMT as an "agency". He did not want the public to read a letter from him, respresenting OSF and Peoria Area EMS, with any connection to AMT at all. In reality, OSF and AMT are joined at the hip.

And his statement about 80 different ambulance agencies in the area was just meant to be confusing. Dr. Miller just wanted AMT to imperceptibly blend in with all of the rest. But AMT had been paying Dr. Hevesy for years to get what they wanted.

5. Dr. Miller wrote that my "attempt to paint a picture of negligence and poor care is absolutely erroneous and inflammatory." Please scroll down to my February 23 article and tell me where I wrote of "negligence and poor care". I didn't write of negligence and poor care. Dr. Miller was misleading the reader again.

6. Dr. Miller wrote that "physicians who monitor patient care and work to improve EMS protocols are provided a stipend for their services". What he didn't tell the public was who was providing the "stipend". What he didn't want people to know was that AMT had paying Dr. Hevesy for years. Was AMT paying Dr. Miller also?

7. As indicated on a previous post, I heard from an excellent source that a very high ranking EMS physician asked to be the Medical Director of the PFD for a salary. And if this occured the PFD was assured they would advance from Basic to a higher level of medical care--Intermediate or Paramedic. Peoples' lives in Peoria should not depend on whether the PFD paid off a physician.

8. Unfortunately for Dr. Miller, his Forum article was badly timed. He stated that the Peoria EMS, which he was Director, was meeting the needs of Peorians. The PFD warned Dr. Miller several months later that the needs of Peorians were not being met and that things needed to change before the media found out. Pre-hosptial patient management in Peoria was not optimum to say the least. The "negligence and poor care" that Dr. Miller was writing about was occurring under his watch.

Several months later, behind the scenes, Dr. Miller would give in and allow PFD paramedics to use their skills for the first time in Peoria EMS history.

More to come.

Looking Back....Let Peoria Fire Department Operate its Own Ambulance

Peoria Journal Star
February 23, 2005


Let Peoria Fire Department operate its own ambulance

On Feb. 1 the Peoria City Council voted to sell the only Peoria Fire Department ambulance, which has been sitting idle in a garage. It was never allowed to respond to 911 calls. Numerous firefighters who are certified paramedics are not allowed to use their skills. They have been wasted.

To help rectify this situation, I will purchase the PFD's ambulance at its present market value and donate it back to the PFD if these conditions are met:

1. This ambulance will be used for sick or injured Peorians and staffed by PFD firefighters/paramedics allowed to use their advanced life support skills in Peoria.

2. Doctors George Hevesey and Rick Miller have been directors of the Emergency Department at OSF for the past 15 years. They have controlled all ambulances in the area. Both physicians need to publicly declare any fees, stipends, salaries or other benefits they've received from their relationship with Advanced Medical Transport, the only company allowed to operate in Peoria.

3. OSF's Emergency Medical Services Department needs to provide health-care data for the past decade to the city manager and City Council revealing how Peoria's pre-hospital patients did when cared for and transported by AMT. This data was conspicuously absent in the 149-page consultant's report that evaluated fire and emergency medical services in Peoria last year.

The medical ambulance debacle in Peoria, plagued by conflicts of interest, confusion and corporate greed for many years, needs to end.

Dr. John Carroll
Peoria
---------

My comments today March 29, 2009:

1. I wasn't taken up on any of my offers. I thought it would be win-win for the city of Peoria. But other people influencing and making local EMS policy obviously did not agree.

2. I heard from an excellent source that a high ranking physician in the EMS circle approached the Peoria Fire Department (PFD) and tried to cut a deal with them. The PFD was allegedly told that if they paid this physician, the PFD would be able to advance their level of care for the people of Peoria. The PFD did not think this was the manner in which policy should be changed, and declined the offer.

3. Once again, the PFD remained at Basic level and non transport. As mentioned in the previous post, the PFD ambulance was sold.

Looking Back...Should the Peoria Fire Department Sell its Only Ambulance?

Peoria Journal Star
December 12, 2004


Should Peoria Fire Department sell its only ambulance?

What will the city do with the one Peoria Fire Department ambulance that sits alone and unused? Will it be sold for something more important than saving people's lives?

In September, the Matrix Consulting Group evaluated Peoria's emergency medical services. Matrix reported that the fire department's average response time to life-threatening emergencies was almost two minutes faster than Advanced Medical Transport's. Since the fire department can only provide basic life support, patients frequently wait until AMT arrives for paramedic intervention.

One plan formulated by the consulting firm to improve service was to target certain areas with four non-transport fire department engines. These vehicles would be staffed by firefighter/paramedics who would provide advanced life support. The fire department has paramedics who could provide their expertise for these engines.

The problem is the two physicians who have controlled ambulances in Peoria for the last two decades don't support the fire department's advancing from basic life support service to advanced life support. Unfortunately, Peoria firefighter/paramedics are not allowed to use their paramedic skills at emergencies.

Matrix noted the fire department has applied to the physician in charge of ambulances to outfit its only engine with various basic and advanced life support medications and equipment. That request was denied.

The boards of directors of our local "health-care industry," and the doctors who have been responsible for ambulances in Peoria, need to disclose their private interests and explain why selling the one and only fire department ambulance is beneficial to sick and injured pre-hospital patients in Peoria.

Dr. John Carroll
Peoria

-----------------

My Comments today March 25, 2009:

1. Peoria Area EMS did not take the suggestions of Matrix. Peoria Fire Department firefighters/paramedics were not allowed to use their advanced skills saving lives.

2. The Peoria Fire Department sold their one and only ambulance.

3. It took until the middle of 2005 for change to occur.

Looking Back....OSF and Willie Fortune

What was happening in 2004 at OSF was unimaginable.

OSF was going to let Willie die in Haiti from a worn out pacemaker. And Willie had been on the cover of the Children's Hospital of Illinois (CHOI) magazine a few years before. Now he seemed to mean nothing to CHOI.

At the same time, Jackson Jean-Baptiste was becoming more ill in Haiti and OSF would not allow him to return to OSF either. Jackson would be dead in early 2006.

Read how OSF's administrator seemed to find some humor in Willie's picketing the hosptial. Doesn't seem possible, but it happened.



Peoria Journal Star
June 16, 2004

ELAINE HOPKINS

Haitian Hearts doctor pickets Saint Francis

PEORIA - Dr. John Carroll and Willy Fortune, a 16-year-old heart patient, picketed OSF Saint Francis Medical Center on Tuesday because the hospital has refused to provide heart care to Fortune.

"I'm asking for a good pediatric cardiology exam," he said. Haitian Hearts is willing to fully pay for the care, Carroll added, but St. Francis has refused.

Fortune received a pacemaker at St. Francis in 2000. When St. Francis would not replace it this year, Carroll arranged for Fortune to have the surgery done May 21 at Vanderbilt Children's Hospital in Nashville, Tenn. More care is needed, he said.

"You just don't replace a pacemaker and forget about things," Carroll said.
Carroll said he should not have to take Fortune back to Nashville. "He's here. This hospital has a value system. He's a St. Francis patient."

On Tuesday, Carroll carried a sign with a photograph of Fortune on a poster the hospital used in 2000. It stated "Willy, a mended Haitian Heart at Children's Hospital."

Fortune said he was feeling "good, but was hungry after a long day of picketing."

St. Francis spokesman Chris Lofgren said the hospital would not comment on Carroll, an emergency room physician for 21 years who was fired in December 2001.

Last year, Haitian Hearts became an independent foundation that can accept tax-deductible gifts, and continues to raise money to bring Haitian patients to the U.S. for heart and other care. In 2003, it brought in 16 patients. So far this year, the organization has brought in three patients, Carroll said, and others are planned.

Haitian Hearts was once a part of Children's Hospital at St. Francis, but the hospital severed ties with the group in July after the two entities could not agree on several issues. Since then, the hospital has refused to participate in Haitian Hearts' program.

Carroll also said the Illinois Attorney General's office has been investigating whether St. Francis misused funds donated to its Children's Hospital that were earmarked for Haitian Hearts. People have told him about donations which never were credited to Haitian Hearts, Carroll said. He complained to the Attorney General's Charitable Trust division, he said, and provided the office with records.

"We responded in detail" to the attorney general, Lofgren said. "As far as I know, it's over."

A spokesman for the attorney general, Scott Mulford, said Tuesday that the office is still "looking into the situation."

Carroll said people should be alarmed about St. Francis' refusal to provide care for Fortune.

For the hospital to refuse care to a former patient "is unprecedented," he said. "Where are the Catholic ethicists at St. Francis?" he asked.
---------------------

My Comments from today March 25, 2009:

1. My wife Maria and I were working in Haiti in early 2004.

2. Willie’s mom brought him to me because he was short of breath. He could walk up a small incline, but walked slowly and was quite short of breath. My exam in Haiti revealed that his pacemaker was malfunctioning. Willie’s pacemaker was on a back up mode which was keeping him alive. He needed a new pacemaker.

3. Willie had been operated at OSF in Peoria in 2000. He had an extended stay in the hospital. Willie had a permanent pacemaker put in at that time. Many excellent people took care of Willie at OSF.

4. However, OSF would not accept Willie back in 2004 even with Haitian Hearts offering complete charges for the new pacemaker. The pacemaker would have been donated by the company for an international patient, and so would not have cost OSF anything. And pacemakers are frequently placed as outpatients.

5. His host family in the Peoria area was shocked and worried. We all thought this may be the end for Willie. We wondered how OSF could turn their back on this young man after he had survived two heart surgeries at OSF a few years before. This did not seem possible.

6. So for the next few months we looked for another medical center in the United States to accept Willie Fortune.

7. In a convoluted fashion Willie was accepted at Vanderbilt Children’s. Haitian Hearts donated $5,000 dollars to Vanderbilt Children’s for the procedure.

8. When Willie showed up at Vanderbilt Children’s, they kept him in the hospital and performed the procedure in a semi urgent fashion. The Vanderbilt Children’s Administrator questioned OSF’s medical ethics when OSF refused Willie.

9. Willie did great after receiving the new pacemaker and came to Peoria to live with Maria and me while he recovered. We walked along the Rock Island Trail and he was able to walk well.

10. For the first time in all of Haitian Hearts history, a physician at OSF who had taken care of Willie in 2000 refused to give Willie a complete cardiac exam in his office. The physician was very frightened to check Willie.

11. So, as the article states, Willie and I picketed OSF. While we were picketing OSF’s administrator Keith Steffen showed up at Sister Canisia’s big plate glass window that looked out over Glen Oak Ave. Mr. Steffen stood slightly behind Sister Canisia and threw back his head and acted like he was laughing at Willie and me on the sidewalk. Sister Canisia could not see Mr. Steffen’s antics. Willie witnessed all of this too but did not understand the inappropriate behavior of Mr. Steffen.

12. The article states that hospital spokesperson Chris Lofgren had no comment. What was Mr. Lofgren to say? Should he have said that everyone at OSF felt great rejecting Willie and that OSF would have left Willie in Haiti to die from a worn out pacemaker after OSF had been offered full charges by Haitian Hearts?

13. And I asked in 2004 where OSF's ethicists were. I am still asking the same question in 2009.

14. Pictured above is Willie's mom in Haiti a few months ago. What right does any medical center have to turn down her son? What right does any medical center have to turn down her son after full charges have been offered for his medical care?

Evidence Against "Stay and Play" Pre-Hospital Care

Emergency Physicians Monthly published an article in February, 2009.

The article concerned pre hospital patients suffering trauma (car accidents, etc.) The Ontario Pre-hospital Advanced Life Support Study (OPALS) was used as evidence. OPALS is the largest study examining the impact that Advanced Life Support (ALS) has on patient care.

In a before/after analysis OPALS analyzed the effect ALS (paramedic care) had on almost 3000 major trauma patients. The idea was to see how much ALS improved outcomes at the scene of a trauma.

Here is what they concluded:

"When on scene and transport times are considered, Basic Life Support is better than Advanced Life Support. The longer they stay, the worse the patients do.

"So is it time to get rid of Advanced Life Support? Probably not.

"We know that most, if not all, of the skills and procedures that EMT-I and EMT-P providers can perform are beneficial in the hospital setting or we wouldn't have extended such procedures and capabilities to them (pre hospital providers).

"The question is, "At what point in time in the field to we reach the point of diminishing returns on any additional time spent."

"This data tells a compelling story that time is, perhaps, the most critical factor in prehospital care delivery."

So what about Peoria?

In 2004 when my brother and I wrote these Forum articles, Advanced Life Support and rapid transport were considered the gold standard. However, the Peoria Fire Department was not allowed to perform Advanced Life Support or transport patients. The injured patient needed to wait for Advanced Medical Transport to arrive to give Advanced Life Support and transport the patient.

Would it not have made sense to allow the Peoria Fire Department to transport patients and give Advanced Life Support at the same time? The Peoria Fire Department had and has firefighters that are paramedics and work for AMT also. But these same firefighters were not allowed to give their paramedic Advanced Life Support while working for the Peoria Fire Department for trauma patients or any type of patient.

And the Peoria Fire Department still cannot transport trauma patients or ANY type of patient even today. This goes against the OPALS conclusions.

Looking Back...Peoria's Medical Mafia

Peoria Journal Star
July 27, 2004


Peoria's medical mafia limiting emergency care

Re. July 16 editorial, "Send corrupt health facilities planning board to morgue":
The Journal Star states that in Illinois, "Any board with this much authority over this much money becomes a trough of corruption." Truer words could not have been written.

For 30 years lobbyists, attorneys and politically connected people have influenced the decisions made by this nine-member board regarding construction of new hospitals and expansion of existing ones in Illinois.

Unfortunately, similar conflicts of interest and cronyism are currently occurring in Peoria. The stakes are very high here with lives and money on the line.

In Peoria we have one paramedic transport company, Advanced Medical Transport (AMT). Its medical director is Dr. George Hevesy, who happens to be the medical director of OSF-St. Francis' emergency department. Dr. Hevesy is salaried by both OSF-St. Francis and AMT. OSF is the main supporter of AMT and is also the base station for all emergency medical services in central Illinois.

The AMT board of directors, composed of prominent Peorians, has the support of the OSF-St. Francis board of directors. Dr. Hevesy's relationship with the Illinois Department of Public Health in Springfield, which regulates paramedics and ambulances in the state, is well known in emergency medicine circles throughout Illinois.

And finally, the Peoria City Council, which will decide if AMT remains in total control of paramedic care and transport in Peoria for the next decade, will consider the findings and recommendations of a California-based consulting firm.

Some members of the council suspect a pre-existing relationship between AMT and this California firm. One needs a scorecard to keep track of this local health care travesty.

In the meantime, the Peoria Fire Department continues to respond to medical emergencies, can only provide basic life support (not paramedic care) and cannot transport patients, even with its one ambulance.

The PFD obviously does not enjoy the support of the above-named individuals, boards and state agencies.

The real loss, of course, is for Peorians who suffer an out-of-hospital medical emergency. State-of-the-art, pre-hospital emergency care is not offered in Peoria, not because we can't, but because our medical mafia will not allow it.

Dr. John Carroll
Peoria

Looking Back....Let Fire Department Transport

See my comments that follow this Forum article.

Peoria Journal Star
February 28, 2004


Let fire department transport critically ill patients

The Peoria Fire Department purchased one or two ambulances recently. A Feb. 3 Journal Star editorial asked, ". . . what good is a fire department ambulance if it can't transport patients to the hospital?" Good question.

Perhaps a better question is, "Why can't the fire department transport patients in the first place?"

Fire department personnel, many of whom are trained paramedics, are the first responders to emergency medical calls every day. However, the fire department is not allowed to transport patients to a hospital and cannot provide advanced medical care at the scene.

Trauma patients must wait for paramedics from Advanced Medical Transport, a private ambulance company, to arrive. Since patient survival improves with faster response, the firefighters should be allowed to use their skills.

Control of ambulances and emergency medical services lies in the hands of the project medical director. The OSF-employed physician who held this post for nine of the last 12 years, Dr. George Hevesy, was paid a salary by AMT.

Freedom of Information documents from the state of Illinois reveal that OSF administrators knew and approved of this arrangement. There is an immense conflict of interest when a project medical director accepts money from a private ambulance company. Small wonder the fire department is not competing with AMT in the paramedic and transport business.

OSF should not allow an employee to accept money from an ambulance company he or she regulates. OSF also needs to explain why corporate profits have been given greater importance than fast emergency response times. City Manager Randy Oliver's commission on emergency services must address this conflict of interest.

The present project medical director, Dr. Rick Miller, needs to assure Peoria that the Peoria Fire Department will be adequately trained and allowed to transport patients in their new ambulances and that financial gain will not be allowed to override the public's right to the fastest and most efficient medical care possible.

Tom Carroll
Peoria

My comments today March 23, 2009:

1. My brother Tom wrote this article.

2. The PFD owned one ambulance at the time. However, they were never allowed to use it to transport patients in Peoria. They eventually sold the ambulance. The PFD still has no amublance today and cannot transport patients.

Last summer (2008) there was a bus accident in Peoria. Due to the number of patients involved, AMT was overwhelmed, and did not have the vehicles to transport all of the victims. The PFD could not transport these patients. So CityLink, the Peoria public transportation company, did transport these patients to local emergency departments. Doesn't something seem wrong here?

3. Tom thought that rapid transport for trauma patients may save their lives. The next post will provide information from a Canadian study that suggests rapid transport of trauma patients is the most important intervention.

4. The conflict of interest that my brother documented still continues today in Peoria. And there is no end in sight.

Looking Back...City Needs Independent Study of Amblulance Service

Please see my comments that follow the article.



Peoria Journal Star

January 10, 2004

EDITORIAL


City needs independent study of ambulance service

Peoria's new city manager, Randy Oliver, is organizing a commission to study emergency medical services (EMS) in Peoria. The editorial board of the Journal Star pleads for a fiscally responsible decision regarding these services. Local physicians need to insist that both fiscally and medically responsible choices are made for pre-hospital patients.

The EMS services in Peoria are provided by two agencies. Advanced Medical Transport (AMT) provides the only advanced life support service and transport of patients. This company is supported by Peoria's three hospitals and governing boards. AMT grosses over $7 million per year and desires a 10-year contract to remain the only paramedic and transport agency in Peoria.

The second agency is the Peoria Fire Department. Firefighters arrive quickly at the scene, but can provide only basic life support and are not permitted to transport patients.

The Peoria Medical Society needs to consider the following questions: Who will compile and interpret the statistics regarding local EMS care? What EMS issues will be analyzed? What is the response time for the Peoria Fire Department versus AMT to an emergency? How much time elapses from the 911 dispatch call until the electrical shock is administered to a patient in full cardiac arrest?

When AMT arrives at the scene and begins its advanced life support, have the patients waited longer than necessary? What percentage of Peorians survive and walk out of the hospital after suffering a cardiac arrest? Are Peoria's trauma patients transported quickly and efficiently with the "scoop and treat" philosophy? How does Peoria compare to other cities in the U.S. and Canada that have state-of-the-art EMS? Might it not be responsible and medically important to allow Peoria firefighters to advance their skills (such as improved airway control and IV medication administration) to improve patient outcome?

The most important question is: Can Peoria's EMS system be studied in an independent and unbiased fashion? The same doctors, administrators and boards of directors that made questionable decisions 10 years ago are still in absolute control today.

Thus, the Peoria Medical Society needs to do exactly what the first sentence of its mission statement professes: To promote the health and general welfare of the Peoria public.

Peoria's pre-hospital patients have never been in a more perilous situation.

Encourage Oliver's study to ask the correct questions and answer them using scientific rigor. Then and only then will fiscal and medically appropriate decisions be made regarding EMS in Peoria.

Dr. John Carroll
Peoria
-------------------

My comments today, March 22, 2009:

1. This Forum article was written 5 years ago. Since I submitted this article, the Peoria Fire Department paramedics have been allowed by OSF to give advanced life support drugs and can intubate the patient at the scene of an emergency. And two fire stations in Peoria have become paramedic. OSF EMS leaders were critical of my attempts to inform the public, but then the same doctors made the needed changes. More about this later.

2. The Matrix Consulting firm came to Peoria in September, 2004, six months after this Forum article, and documented that the Peoria Fire Department responded to life threatening emergencies almost two minutes faster than Advanced Medical Transport. (When I called the Peoria Area EMS office, I was told by the director that no statistics existed regarding how Peoria pre hospital patients were doing in Peoria's EMS.)

3. I did write the President of the Peoria Medical Society, Richard Anderson, M.D., during these years and he assured me that all was fine with Peoria's EMS. He also told me not to publish the contents of his letter.

4. In March, 2005, EMS Director Rick Miller, would write the Journal Star criticizing me. However, a couple of months later in 2005, a man would die in a Peoria restaurant, and Dr. Miller would change the policy. His policy change would allow the PFD paramedics to intubate the patient at the scene.

5. Even now in 2009, the Peoria Fire Department cannot transport patients. AMT still has this monopolized. I will report the summary of a study that states that quick transport in trauma patients can be life saving. Peoria is not there yet....

Good News for Katina

Please check this out.

The accepting medical center confirmed this today with her official medical record number.

This news was a great way to end the week.

Cardinal George's Letter to President Obama

Office of the President
3211 FOURTH STREET NE
WASHINGTON DC 20017-1194
202-541-3100 FAX 202-541-3166
Cardinal Francis George, OMI
Archbishop of Chicago



March 19, 2009


Honorable Barack Obama
President
United States of America
The White House
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500

Dear Mr. President:

On behalf of the Catholic Bishops of the United States, I write to ask you to designate the country of Haiti for Temporary Protected Status (TPS) for a period of eighteen months. The United States Catholic Bishops Conference (USCCB) has a long history of serving the Haitian community, both in the United States and in Haiti, and has first-hand knowledge of the great humanitarian challenges facing the Haitian people.

As you know, a designation of TPS permits nationals of a designated nation living in the United States to reside here legally and qualify for work authorization. A designation of TPS is based upon a determination that armed conflict, political unrest, environmental disaster, or other extraordinary and temporary conditions exist in a nation and that the return of that country’s nationals would further destabilize the nation and potentially bring harm to those returned.

Haiti meets the standard for TPS because it has experienced political tumult, four natural disasters, and severe food shortages in the last year, not to mention the devastation of Hurricane Jeanne in 2004. In April 2008, starving citizens took to the streets to protest rising food prices, causing political instability.

In August and September 2008, Hurricanes Gustav and Ike and Tropical Storms Fay and Hanna passed through Haiti, causing severe damage and the death of close to 700 persons. Massive flooding from the storms has destroyed homes, crops, roads, and bridges, and largely rendered areas like Gonaives inaccessible to relief workers. Over 90 percent of Haiti has been impacted. Tens of thousands have been displaced, and the fate of thousands more is unknown. More than 300,000 children have been affected.

In addition, the conditions in Haiti are at least as bad, if not worse, than those in nations which recently received an extension of TPS. The Department of Homeland Security (DHS) announced late last year that it was extending TPS for El Salvador, Nicaragua, and Honduras because of “lingering effects” from the earthquakes in 2001 and from Hurricane Mitch in 2004. These effects included destroyed roads and bridges, high unemployment, and incomplete international development efforts.

We agree wholeheartedly with DHS’ decision to extend TPS to these countries. However, if “lingering effects” in these countries merit a grant of TPS, then so do the conditions in Haiti, where multiple disasters this year have left immediate and devastating effects.

Some observers argue that granting TPS to Haiti would cause a massive “boatlift” that would bring thousands of Haitians to the United States. In our view, this argument holds little merit, since TPS is only available to Haitian nationals already in the United States at the time of the designation. No such boatlift occurred in 1997, when President Clinton granted Deferred Enforced Departure (DED) to Haiti, or in subsequent years when Haiti experienced increased political violence and civil unrest. Additionally, few Haitian water craft currently exist, having been destroyed by the recent storms.

Another consideration is that designating TPS to Haiti would allow Haitian nationals already in the United States to work and send much-needed remittances back to their poverty-stricken homeland. The Inter-American Development Bank reports that Haitians abroad sent close to $1.83 billion home in 2007, which equals about 35% of the country’s gross domestic product. It is critical that this life-blood of the fragile Haitian economy be sustained.

Mr. President, by any measure, the conditions in Haiti meet the statutory requirements for TPS. There has been “substantial disruption” in living conditions and Haiti is “unable to handle adequately” the return of its citizens abroad. Extending this mantle of protection to struggling Haiti is a just, compassionate, and concrete step the United States can take toward alleviating the human suffering of the Haitian people.

Thank you for your consideration.

Sincerely yours,

Francis Cardinal George, OMI
Archbishop of Chicago

Interview with Heurese

March 15, 2009

The following is an interview I did with Heurese.

The interview was conducted in Creole and translated into English. The words in English are not direct translations of her words in Creole, but are very close. Her narrative’s meaning is the same in both languages.

I left out my interview questions and wrote this in the first person. It is in chronological order as Heurese's life has played out.
-----------------------


I was born in Bainet, Haiti in 1978. Like the rest of my brothers and sisters, I was born at home. I have four brothers and four sisters. My mom is living in Bainet now. My parents were never married.

Bainet is on Haiti’s southern peninsula and is a seacoast village. I don't know how many people live in Bainet. We lived up on a mountain side and we could see all that was happening in Bainet. We could also see the ocean to the south.

My father is dead. His name was Vicaisse. He died in February, 1991 at age 41 years. I was about 13 years old when he died.

My father was a fisherman and he use to drop lines into the ocean from a cliff perched above the water. He and a friend left home about 6 PM and sometimes they did not get back until morning.

One night my father and his friend made a fire and sat down on the cliff. His friend was sitting about twenty feet away from my father. At some point his friend hollered out to my father but my father did not answer. His friend walked over to the place where my father was fishing and my father had disappeared.

My father’s friend looked down and saw my father in the ocean below. My father yelled back up that he did not know how he ended up in the ocean. My father said that he did not jump.

My father’s friend threw some rope over the edge of the cliff, but my father could not get to it. So my father’s friend descended the cliff and by the time he got to the water, my father was gone.

My father’s friend came back up the road to our house sobbing.

They searched for my father’s body for two days without success.

My mother went “fou” (crazy) after my father’s death. She talked and screamed a lot. She had to be tied to a chair.

Before my father died, my life was pretty good. I went with him in the morning when he worked in the field. When I stayed at home with my mom she spanked me a lot. But my father disagreed with this and he did not spank me. My father knew that there was something wrong with me. Even when I was four years old my legs were swelling.

Since my father died, my life hasn’t been good. Mwen pa viv bien.

After my father died, my mom made us get up very early and herd the goats and pigs into the woods. My mother still works very hard. Her name is Dieuta. She is about 62 years old now. She doesn’t sit down much.

I love my mother because she carried me in her abdomen for 9 months. She spent a lot of money on me over the years when I was sick. But she didn’t speak nicely to us when we were growing up and spanked me a lot.

(I have spoken to her since surgery in December, 2008 and she is happy that I survived. It was a nice conversation. But she doesn’t really understand.)

My mother goes to a market on a donkey. The market is a long ways away. It is near Mirogoane. She buys beans, bananas, yam, peanuts, and several types of fruit. She sells them from our house which sits right along the road above Bainet.

My mother does not go to church.

My mother does vote. But she does not say who she is voting for. In Haiti that can be dangerous. My brothers go to a church that forbids them talking about politics.

I went to grade school in Bainet. But I was sick a lot. I went to the local Baptist church. I was in the choir and I went on “missions”. I was baptized when I was 12 years old. Now I don’t go to church but I still believe in God.

As the years went by, I moved into Port-au-Prince and went to school in Petionville. When I did not have my lessons done correctly, my teacher would beat the palms of my hands in class with a whip. I would cry and become quite short of breath. Finally, I got so sick that I needed to go back to Bainet.

The years passed in Bainet, and by the time I was 18 years old, I was very sick.

My mother and I went to the houngan's home in Bainet and we both lived with him for two months. My mother paid him a lot of money to care for me.

The houngan believed I had five zombies inside of me. He would beat me to try and drive the zombies out. Also, he made a potion of leaves mixed with water and spread it all over my body including my face. It smelled terrible. Also, this concoction got into my eyes and I could not see.

An elder in the village convinced my mother to take me to our local hospital in Bainet. The houngan asked my mom for $5000 Haitian in order for me to come back to him. After I left the hospital, I could see better and my mom never took me back to the houngan and did not pay him any more money.

I went back home all swollen and was at home in Bainet for about 6 months with no medication. I laid in bed in my mother’s house. I had no medication. Fluid was leaking out of my legs. Many people from Bainet came and visited me and I could hear many of them say that I was going to die.

My mother said I was going to die too. She went out and bought me a mahogany casket for $1,000 Haitian dollars. She put it up off the floor hanging from the boards above. I stared at the casket but I did not think that I would end up in it. My mother thought that someone in Port had sent a zombie to me. I tried to assure her that no one was upset with me in Port and I didn’t believe in zombies. I didn’t think I was going to die.

The doctors in Bainet eventually told my mom that I had tuberculosis and started treating me with injections for tuberculosis.

My mother took me to the General Hospital in Port but most of the hospital was on strike. I went to another hospital in the capital and they told me that I did not have tuberculosis. They told me that I had heart disease. The doctors also told me that I was going to die. However, the doctors at this hospital wrote a note to the doctors not on strike at the General Hospital.

I went back to the General Hospital Emergency Department and they admitted me to a part of the hospital that was still working. They started treating my heart disease and I felt better. I could breathe better. I was in the General Hospital for 15 days. My mothers and sister Vita took care of me there.

The doctors at the General Hospital told my mother that I needed to go to Milot for heart surgery. Milot is a northern city near Cap Haitian. A group of foreign doctors come in once a year and do heart surgery for a couple of weeks.

I was released from the General Hospital and lived in Port with a relative. I returned to the General Hospital every month where I received a shot of penicillin and got more heart medications.

During this period of time I started to feel better. My mother and Vita were working in Bainet and Port, saving their money, and making plans to send me to Milot for heart surgery.

During the days before I was to leave for Milot, I was staying in my aunt’s home in Port. The night before I was to leave Port for Milot, I had a dream. In the dream someone came to me and told me not to go to Milot. After the dream, I woke up early, got up, and snuck to a friend’s house. The driver that had come to take me to Milot could not find me.

I remained in my friend's house for three days.

When I returned to my aunt’s house, my mother and Vita were really mad. They said they were finished with me and refused to pay for any more medication for me or to take me back to the General Hospital.

So I went back to Bainet and stayed a few months in my mother’s home. I felt better but needed more medication. Eventually my mother gave in and paid for more medication. I had been without medication for three months.

In 2002 I decided to go back into the Port to make peace with my sister Vita. Vita was working at a home for disabled children. The home is called Notre Maison.

When I arrived Vita told me that her boss, the director of Notre Maison, had met Dr. John and told him about my medical problems.

I immediately went to see Dr. John. He examined me and told me that he would bring me to the U.S. for heart surgery. I went back to Bainet and told my mother this. She said that Dr. John would never take me.

Dr. John took me to the U.S. for heart surgery in 2002. I did very well and felt good after surgery.

I have no jealousy towards the people of the United States with all that they have. I believe the people in the U.S. deserve what they have because they work hard.

When I came back from Haiti after my surgery in October 2002, I traveled alone on a bus from Port to Bainet. I was dropped off in Bainet with my one suitcase and met my sister Jenny at her school in Bainet. Jenny was happy to see me.

Jenny and I walked up the mountain for 45 minutes and arrived at my mom’s house. Jenny helped me carry the suitcase.

When I got to my house in Bainet, the doors and windows were closed. I knocked on the door and no one answered. Eventually Jenny put her finger on her lips like to say “shhh”.

My mom finally came to the door and asked me why I came back from the States. She asked my why I didn’t stay there and work. She was very mad at me for returning to Haiti. A passerby on the street heard my mother shouting at me and intervened and tried to be a peacemaker. After some talking, my mother calmed down and let me in the house and things were better.

In July 2003, I moved back to Petionville and took a part time job with a missionary from Canada. I worked in her school in Delmas.

I also met a young man who I liked very much. He was from Bainet.

I became pregnant with his child. However, his family were devout Baptists that thought a man and a woman should be married when having children. However, they were very much against their son marrying me because they described me “pa youn moun anke”. What this means is that I was not a whole person, I was just a "piece of a person" because I had heart surgery in the United States.

One day in 2003 I was eating with my boyfriend at his place in Bainet and was given a plate of rice and beans. He was given the same meal on a different plate.

After the meal, my boyfriend went to Jacmel to collect his check from Teleco. He supplied me with money.

But in Jacmel he became quite ill. The next day he found someone with a motor scooter to give him a ride back to Bainet. My boyfriend was so weak that he had to be tied with a rope to the driver so he would not fall off the motor scooter.

When my boyfriend arrived in Bainet he was very sick and was vomiting blood. His last words to me were that his family had tried to poison me, but they got the plates of food mixed up, and in fact had accidentally poisoned him.

He died 10 days later after that meal of rice and beans. I did not go to his funeral. His family was mad at me and said that my mother was the person that poisoned their son.

Two months later I delivered our baby girl.

I went back to Carefour. Carefour is a zone in Port.

The years went by and I met another young man and had a baby boy with him in 2004. He stayed with me for two years but then left us for another woman.

In March, 2008 I became quite ill again. I was too sick to go to Mirogoane to the market to buy used clothes to sell in the market in Carefour. I sold fruit in the market in Carefour when I felt good enough. However, I had no constant source of food to give to my children and my health was deteriorating. None of us were eating regularly. I thought I was going to die.

I gave my children to my family members in Bainet and went back to Carefour to live in our one room shack with my 19 year old brother, Saint Louis.

In addition to all of this, Haiti’s food prices are very high and we had food riots last year. Four hurricanes hit Haiti last year and many people starved to death all over Haiti.

And the kidnappings continued in 2008.

However, one day my brother Saint Louis, was in a cyber cafe in Carefour. A young man entered the cyber cafe and asked my brother if he could type a quick e mail on my brother's computer because he had no money. My brother agreed.

My brother noted that this young man, who he did not know, was sending an e mail to Dr. John. Saint-Louis asked the young man how he knew Dr. John. The young man, whose name is Frandy, replied that he had a heart problem too and was taken to the United States also by Haitian Hearts. Saint Louis then told Frandy that I was very sick, and that I had heart surgery in the United States in 2002, and needed to see Dr. John as soon as possible.

A few weeks after that Frandy came to visit me and asked me questions about Dr. John and his family to see if I really knew him or not. I answered the questions correctly and Frandy believed me.

Frandy contacted Dr. John and told him that I was very sick and needed help. Frandy helped me a lot.

When I found out that OSF in Peoria would not accept me back for repeat heart surgery, I thought it was because I had done something to hurt my heart after they fixed it and that the hospital was mad at me. Dr. John assured me that that was not the case.

In December, 2008 I returned to the U.S. for heart surgery at a different hospital. I am gaining weight again and feel good. When I go back to Haiti, I hope to move to a cleaner and safer area of Port. I live near the gang members in Carefour. I hear in the mornings how they asked people for their money or cell phone as the people are heading to Carefour market. If people do not give them something, they will be killed by the gang. But the gang in Carefour is not as bad as the gangs in Soleil.

I think the UN provides good security for Haiti. However, Haitian girls sell themselves to UN soldiers all of the time for money. This is how Haitian girls can feed their families. This is Haiti’s biggest problem.

----------------------------

Heurese Asks OSF for Help

March 16, 2009


Dear OSF Charity Assistance Program and Sister Judith Ann,


My name is Heurese Joseph and I am from Haiti. I am 30 years old. Dr. John Carroll is helping me write this letter to you since I don’t speak English.

I am humbly requesting an echocardiogram to be done pro bono by OSF through the Charity Assistance Program. I would have it done as an outpatient at HeartCare Midwest. The cardiologist that would read the echocardiogram told Dr. John that he would read it for no charge.

In 2002, Dr. John brought me to OSF for heart valve surgery and closure of a ventricular septal defect. I was very thankful for all the physicians and nurses who took care of me at OSF.

I returned to Haiti in 2002 and Dr. John and his wife Maria returned to Haiti many times during the next six years. Dr. Carroll examined me each year and Haitian Hearts brought me medicine and provided me with echocardiograms in Port-au-Prince.

However in 2008 I became quite ill again and had to give my two young children to my family to care for. I was in congestive heart failure and could not feed my children or myself. I felt like I was dying.

Dr. John examined me again and another echocardiogram showed that I needed repeat heart surgery.

During November, 2008 Haitian Hearts moved me to a guest house in Port-au-Prince for the entire month. I was able to eat three meals a day and did not worry about being kidnapped from my home in the slum.

Since OSF-SFMC would not accept me back last year, Dr. John fortunately found another medical center to do my surgery. In December, 2008 I was successfully operated and have a new aortic valve.

I am living with Dr. John and his family during the last month of my stay in the United States. I feel great for the first time in a long time.

I have no income in Haiti. My mother, who is also very poor, pays equivalent to 90 dollars U.S. every six months for my one room home in Port-au-Prince. The room is about 15 feet by 15 feet. I share it with my 19 year old brother.

I have no running water and cook on a charcoal grill outside my front door. I have electricity occasionally. My hope is to move to a safer and cleaner area of Port-au-Prince with my children when I return to Haiti.

Dr. John stopped my Coumadin today and started me on another type of blood thinner. My surgeon wants me to have an echocardiogram in one week. We have to be sure that my new aortic valve is working properly.

Please allow me to have my echocardiogram done free of charge. I have no funds to pay you.

Thank you for all you did for me in 2002.

Sincerely,


Heurese Joseph



P.S. Please forward a copy of this to Sister Judith Ann Duval at OSF Corporate. I know that she would not refuse me.

University of Chicago ED Halts New Policies

Chicago Hospital to Halt New Emergency Department Policies After Criticism

Kathleen Louden

Medscape Medical News 2009. © 2009 Medscape

March 16, 2009 (Chicago, Illinois) — After 2 national emergency physician groups took the unusual action of separately voicing concerns last month about emergency department (ED) policies at a large Chicago hospital — policies they believe could reduce patient access and quality of care — the hospital has said it will reconsider its policies.

At the center of the controversy is the University of Chicago Medical Center, which recently announced reorganization plans, including reducing the number of inpatient beds available to emergency patients by more than 30 and expanding efforts to redirect to other hospitals and clinics those ED patients who do not need emergency care. The tertiary care hospital, which has a high percentage of Medicaid patients, reported that about one third of the patients who come to its ED have nonurgent conditions. In a news release last month, the medical center said the changes, along with other cost-cutting measures, were needed to "meet today's financial challenges."

The University of Chicago Medical Center has decided to halt plans to redirect patients deemed nonurgent from its ED to other facilities, the Chicago Tribune reported on Saturday. The move came after external and internal protests of the plans.

Reorganization Opposed

Both the American College of Emergency Physicians (ACEP) and the American Academy of Emergency Medicine (AAEM) made public statements opposing the proposed reorganization. ACEP also questioned whether the south side medical center's treatment of a young dog-bite victim nearly violated the requirements of the Emergency Medical Treatment and Labor Act (EMTALA).

ACEP, the country's largest professional association of emergency physicians, commented on the individual case because its leadership believes the case represents a growing national problem, said the college's president-elect, Angela Gardner, MD. She spoke to Medscape Emergency Medicine in a phone interview.

"The concern of the American College of Emergency Physicians is that [more and more] hospitals across the country are taking measures that fulfill the letter of the law for EMTALA but decrease care for patients," said Dr. Gardner, an emergency physician at the University of Texas Medical Branch at Galveston.

The case involves 12-year-old Dontae Adams, who last August was attacked by a pit bull that allegedly tore off part of his upper lip. According to the February 13 Chicago Tribune, the boy's mother alleged that the University of Chicago ED physicians did not adequately treat her son because they did not want to accept his Medicaid insurance. The mother claimed that the ED staff gave the boy only painkillers, a tetanus shot, and an antibiotic prescription; refused to perform reconstructive surgery; and instructed them to follow up in a week with the county public hospital, John H. Stroger Jr. Hospital of Cook County, regarding possible reconstruction.

Instead, the mother immediately took her son by bus to Stroger Hospital on the city's west side, where Dontae underwent successful reconstructive surgery on his lip the same day.

The Tribune also cited the University of Chicago's plans to expand a "controversial program aimed at clearing its ER" of patients with nonurgent injuries and illnesses by redirecting them to community hospitals and clinics.

Emergency Physicians Speak Out

In a written public statement February 19, ACEP said "the University of Chicago Medical Center is failing in its obligation to treat emergency patients" and its policy toward emergency patients is "dangerously close to 'patient dumping.' "

Nick Jouriles, MD, president of the Dallas, Texas–headquartered ACEP and an Akron, Ohio, emergency physician, said in the statement, "This is a dangerous precedent that could have catastrophic effects in poor neighborhoods across the country."

University of Chicago officials said Dr. Jouriles did not attempt to verify the facts of Dontae's case. On its Web site, the medical center disputed ACEP's claims and reported that its pediatric ED physicians determined it was not medically appropriate to close the boy's wound at the time.

"He got the full treatment he needed here," said Robert Mulliken, MD, medical director of the adult ED and interim co-section chief of emergency medicine at the University of Chicago Medical Center, in a telephone interview with Medscape Emergency Medicine.

A hospital spokesperson said the boy's treatment included intravenous antibiotics, pain medicine, and cleaning and dressing the wound.

However, ACEP's Dr. Gardner said emergency physicians must consider not only legal obligations but also moral and ethical responsibilities to the patient.

"Every action we take as emergency physicians should pass the 'Aunt Betsy' test: 'Is it good enough for your Aunt Betsy?' " she said. "If not, I don't think it's something emergency physicians should be doing."

Days after ACEP's statement last month, the Milwaukee, Wisconsin–headquartered AAEM told the Chicago Tribune that the University of Chicago Medical Center should "re-evaluate its triage and screening examination policies."

AAEM President Larry Weiss, MD, JD, told Medscape Emergency Medicine in an email that the academy received information from University of Chicago physicians that the hospital had "drastically changed" the manner in which nurses and physicians perform triage and screening examinations in their ED. The doctors told them, "A physician is now directed by policy to discharge a patient at the time the physician determines that the patient is stable, rather than completing a diagnostic evaluation and providing admission or appropriate outpatient treatment," wrote Dr. Weiss, professor of emergency medicine at the University of Maryland School of Medicine, Baltimore.

"AAEM has a policy stating that an emergency department may triage a patient to another facility for treatment and follow-up care," he added. "However, this must be done in a safe manner. Hospitals should not merely tell patients to go to another hospital without proper referral."

"Triage Out": Pros and Cons

To do so is a form of "triage out" — sending low-acuity patients, after a medical screening examination, out of the ED to receive care at an urgent care center, clinic, or physician's office. One expert who spoke with Medscape Emergency Medicine called it the "push" system of triage out.

Arthur Kellermann, MD, MPH, chairman of the Institute of Medicine's planning committee for the National Emergency Care Enterprise workshops, described the "push" system: "We've looked you over. You're not that sick. Now go away."

The danger is that patients without private insurance often do not have access to care elsewhere.

"If we don't see them in the emergency room, they will not get the care they need, and some of them will come back much sicker," said Dr. Kellermann, professor and associate dean for health policy at Emory University School of Medicine in Atlanta, Georgia. "Most of my colleagues are unwilling to not treat [low-acuity] ED patients if they do not have reasonable assurance that the patients have someplace appropriate to go."

Still, advocates of triage out say it is more efficient and decreases misuse of the ED. The University of Colorado Health Sciences Center in Denver and its affiliate, Denver Health Medical Center, use a triage-out plan in their EDs. Christopher Colwell, MD, associate director of emergency medicine at Denver Health, told Medscape Emergency Medicine that the screening process works well there. Their program gives patients deemed as having nonemergent problems the option of going elsewhere and getting help making the appointment, or of receiving treatment in the ED but paying an insurance copayment or full payment up front.

The approach does, however, have limitations, he said. Any triage-out program must be blind to patients' insurance status before the medical screening examination, Dr. Colwell stressed. As a result, the ED will lose the revenue of any insured patients it screens out. Neither does the approach solve the problem of ED "boarding" due to lack of inpatient beds. Also, the triage staff could miss a true medical emergency.

Most emergency physicians who have not used triage out are uncomfortable with the concept, Dr. Colwell said, which he can understand. He said he sometimes thinks, "Selecting out patients we're not going to see goes against what our specialty is about."

A good way of screening out ED patients whose conditions are not emergent is a "pull" system, Dr. Kellermann said. Before discharge the hospital arranges accessible options for the patient, such as a medical home for primary care.

University of Chicago Tells Its Side

That is what the University of Chicago Medical Center is trying to do with its Urban Health Initiative and South Side Health Collaborative program, hospital officials said. The South Side Health Collaborative sends patient advocates into the ED — after treatment, if needed — to help patients with nonemergent conditions establish an ongoing relationship with a community health center or physician if they do not have a medical home.

By doing so, the medical center hoped to eventually reduce the long waiting times in its ED and to more quickly treat the severe injuries and illnesses that, as a level I trauma center, it is best equipped to handle, said Carolyn Wilson, RN, MBA, chief operating officer, University of Chicago Medical Center. At the same time, it would send business to partner hospitals and clinics that want to provide less complex urgent care and can do so at much lower cost than the academic hospital can.

"Our emergency department demand outstrips our capacity," she told Medscape Emergency Medicine in a phone interview. "Part of the controversy is that we're not trying to grow, like most hospitals. We're trying to be good stewards of limited resources across the south side [of Chicago]."

Most of the changes proposed for the ED have not yet occurred and are still being refined, Ms. Wilson said. The hospital did eliminate its urgent care center on February 8 and plans to add a resident physician to help the triage nurse. But the policy change announcement likely means that those plans are on hold.

The University of Chicago Medical Center, she said, is trying to create a national model for urban hospitals and to be a leader in finding solutions to the problems facing emergency care in the United States.

John Fildes, MD, chair of the American College of Surgeons Committee on Trauma and a University of Nevada trauma surgeon, agreed that the US emergency care system is broken. But he said, "The underpinning principle is that patients have to have access to care that is reliable, accountable, and affordable."

Some of the University of Chicago Medical Center's own physicians apparently consider patient safety threatened by the hospital's plans to decrease the number of inpatient beds available to emergency patients requiring admission. More than 190 fellows and residents from multiple specialties — including emergency medicine — protested the plan in a letter addressed to hospital trustees, The Wall Street Journal reported last week.

They wrote that "these changes directly violate our oath as physicians to do no harm."

None of the sources in this article reported any financial conflict of interest.
Discuss This Article in Physician Connect »

Haiti's Kidnapping Nightmare

Haiti has had many kidnappings during the last three years. More kidnappings have occurred in Haiti the last few years than in any other country in the Western Hemisphere. There were hundreds of people kidnapped in 2006, 2007, and 2008. Everyone is fair game to be taken. Both children and adults are kidnapped.

Twenty-five U.S. citizens were kidnapped in 2008. We have known a fair number of people who were kidnapped or had family members kidnapped and Haitian Hearts has been involved in negotiations for their release.

This video tells the story of a man named Phil. After he was kidnapped in Port-au-Prince several years ago, we were with his family. There was much anxiety as deliberations went on between the kidnappers and the FBI. Phil's family was not allowed to talk to him on the phone or to deliberate with the kidnappers.

The night he was released, he appeared amazingly good for all that he had endured. While he was held in the slum, he told us that he couldn't understand why family members would not answer when the kidnappers called them on his cell phone. Phil understood after he was released that the FBI did not want family members offering outrageous ransoms and getting in the way of deliberations. It was a very tricky business.

We examined him the night he was released and started him on antibiotics for the shotgun wound to his left shoulder.

Phil left Haiti 5 days later with a child that needed eye surgery in the States. Phil and his family continue to work in Haiti today.

All kidnappings in Haiti must stop. Prostitution and kidnappings are not the answer for poor people that need money. Real long term, fair paying jobs for Haiti is the answer.

Looking Back

The last post takes us to the end of 2003.

The next series of Looking Back posts will be about the ambulance monopoly in Peoria and how it changed in the last few years. Some of the posts will be about OSF's denial of care to Haitian kids that continues today.

Looking Back...Haitian Hearts Expands to National Program

Peoria Journal Star
September 21, 2003

ELAINE HOPKINS

Haitian Hearts expands to national program -- Group continuing mission as independent foundation

PEORIA - Cut off from OSF Saint Francis Medical Center, where it operated for years, Haitian Hearts is expanding into a national organization.

It now has 16 patients who have undergone heart surgery this year or who have been accepted for surgery at hospitals in New York, Virginia, Florida, Ohio and elsewhere in Illinois, founder Dr. John Carroll said.

"We're really happy," he said.

The group has become an independent foundation and can accept tax-deductible gifts. It will continue to raise money and bring Haitians to the United States for treatment, Carroll said.

Several of the surgical procedures this year are being funded by the Rotary Club's Gift of Life program, through contacts he made in New York, Carroll said. This program pays hospitals $5,000 per case.

Haitian Hearts arranges for the surgery, negotiates discounts with hospitals when payment is necessary, Carroll said, and pays for travel, visa and other expenses.
Physicians donate their services, and hospital social workers find temporary placements for the patients, mostly children, as they recover, he said.

The downside, he said, is that the patients no longer will be staying with families in the Peoria area. Many people have benefited from the experience of hosting these children and developing contacts with their families in Haiti, he said.
Carroll said the Haitian Hearts program arranged for 17 patients to have surgery last year, with 15 of those at St. Francis.

Since the program began, it has brought almost 100 Haitians to the United States for life-saving treatment. Most are children and most had heart surgery unavailable in Haiti.

"We gave Children's Hospital (at St. Francis) $1.1 million over six years. In cash," Carroll said.

But in July, OSF Healthcare System and the Catholic Diocese of Peoria announced they would no longer participate in the program after financial negotiations failed.

Carroll said St. Francis then was offered $25,000 cash to perform a surgical procedure, but the hospital refused to accept the patient, who was successfully treated elsewhere for $5,400.

St. Francis spokesman Chris Lofgren said the hospital would not comment.
Last December, St. Francis refused to approve any more visas for medical care for the Haitian patients.

St. Francis fired Carroll in December 2001 from his job of 21 years as an emergency room physician after a dispute with hospital managers.
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1. As the article mentioned, we were very happy to have patients operated on elsewhere. These kids stood no chance in Haiti without surgery.

2. Late in 2003, Haitian Hearts noticed that we had received no funds from OSF. Generous people in the community were still donating to Haitian Hearts but their donations were going to Children's Hospital of Illinois. And we became a 501 C 3 not for profit in 2002. We questioned OSF Foundation repeatedly and they said they would provide us with a donor list, but they never did. If we didn't get the funds we at least wanted to know who to thank. Finally, late in 2003, OSF turned over a check to Haitian Hearts signed by Keith Steffen and Sister Canisia for money that was donated to Haitian Hearts, not Children's Hosptial of Illinois. (I am quite sure that Sister Canisia had no idea that she was giving us our own money back.) Children's had taken the money, was going to keep it, except we kept after them for it, so they finally gave it up. And they never told us who donated the funds, so we had no one to thank as 2003 ended.

OSF was blocking the door to Haitian kids every way they could manage.

Looking Back...Haitian Hearts Will Continue Program

Peoria Journal Star
August 14, 2003

ELAINE HOPKINS

Haitian Hearts will continue its program -- Patients will be treated in the U.S. and elsewhere

PEORIA - Haitian Hearts will continue to bring heart patients from Haiti for treatment at hospitals in the U.S. and perhaps elsewhere, its founder, Dr. John Carroll said Wednesday.

Carroll returned last week from Haiti where he arranged for two adult patients to be treated in the U.S. One is scheduled to receive a pacemaker at St. John's Hospital in Springfield, he said, and the other is to have heart valve surgery at a Jacksonville, Fla., hospital.

In July, OSF Healthcare System and the Catholic Diocese of Peoria announced they would no longer participate in the Haitian Hearts program.

Haitian Hearts has brought nearly 100 Haitians, mainly children, from Haiti to Peoria for medical treatment, mostly heart surgery at OSF Saint Francis Medical Center.

On Tuesday, the last Haitian child in Peoria, a 10-year-old girl who has been in the U.S. since last year, received heart surgery at St. Francis, a follow-up to earlier surgery.

Carroll said the surgery went well.

Doctors, nurses and others who have cared for this child and other Haitians have expressed regret that the program is ending in Peoria, Carroll said. Some have donated their time and materials, and even offered to care for Haitian children in their homes while they recovered, he said.

Carroll said he now is working with others interested in Haiti, including the Mercy and Sharing Foundation, founded by philanthropist Susan Scott Krabacher. The organization operates an orphanage and medical center in Haiti. Its Web site is www.haitichildren.com.

Carroll said he hopes that up to 20 children soon will be placed in hospitals in the U.S., Canada and Europe for surgery. He has identified 38 who need surgery. A 19-year-old died while on the waiting list, he said.

Since December, St. Francis has refused to approve any visas for medical care for Haitian Hearts patients.

St. Francis fired Carroll in December 2001 from his job of 21 years as an emergency room physician after a dispute with hospital managers.

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My comments today, March 12, 2009:

1. Haitian Hearts has had Haitian kids operated in New York, Florida, Georgia, Tennessee, Indiana, Illinois, Iowa, Missouri, New Jersey, and Ohio. My wife Maria and I travelled to Guatamala and met Dr. Aldo Castaneda in Guatamala City. He was considered the best pediatric heart surgeon in the world during his years in Boston. Dr. Castaneda and his team accepted a Haitian toddler with a ventricular septal defect to be operated in Guatamala.

2. And as mentioned in a previous post, we have brought or played a role in bringing about 150 kids to the States for surgery, usually cardiac.

3. Douglass Marshall, OSF's attorney, sent me a letter several years ago stating that OSF would not accept any patients from me. So far they are sticking to this unfair and deadly embargo of their own Haitian patients that need to return to OSF for follow up surgery. The Children's Hospital Advisory Board and the Children's Hospital International Committee must be in agreement with this policy because I have written them pleading for their help with no answer. Finding other medical centers to take care of OSF's Haitian kids that have been abandonded by OSF is not easy. Other medical centers that have accepted OSF's Haitian Hearts patients are not happy with OSF.

Looking Back...Failed Mediation

Peoria Journal Star
July 19, 2003

ELAINE HOPKINS

Failed mediation may break Haitian Hearts -- Talks between OSF, diocese, doctor dissolve

PEORIA - After a failed bargaining session, the OSF Healthcare System and the Catholic Diocese of Peoria announced Friday that Haitian Hearts has stopped beating, at least in Peoria.

''OSF Healthcare System will no longer participate in the Haitian Hearts program,'' said a written statement from corporate director of marketing and communications James Farrell. ''They (Haitian Hearts supporters) did not accept the offer,'' Farrell said of the bargaining.

''The cardiologists, pediatric intensivists and cardiovascular surgeons'' at OSF Saint Francis Medical Center support this decision, according to the statement.

The diocese also issued a statement Friday saying it ''was unable to successfully facilitate an agreement'' between the hospital and the Haitian Hearts program.'' Spokeswoman Kate Kenny said no diocese officials would comment further.

Haitian Hearts is a program that brings children from Haiti to Peoria for medical treatment, mainly heart surgery, at St. Francis. Nearly 100 children have received surgery at the hospital through the program, but disputes between the two sides over debt and organization spurred the diocese to step in and help negotiate.

Haitian Hearts founder Dr. John Carroll, contacted Friday on his way to Haiti, said he attended Thursday's meeting, the second held since the diocese agreed to get involved six months ago.

After an hour, Monsignor Steven Rohlfs adjourned the meeting and left, Carroll said. The bishop did not attend.

Carroll said hospital officials told Haitian Hearts it must accept the $200,000-a-year grant St. Francis offered, plus a 55 percent discount on costs above that grant, then details of the program would be negotiated further.

''We can't bargain that way. The details could stop the program,'' he said. ''You wouldn't buy a house like this.''

There were many details that needed negotiating, Carroll said, including the hospital's insistence on a ''no cap'' clause, so that if one patient ran up a $1 million hospital bill, the group would be liable for it.

The hospital also wanted its committee to review visa extensions, he said. Visas are granted for only six months, but if a child needs follow-up care, they must be extended.

''I've been pushed to take kids back before they were ready,'' Carroll said.

Dr. William Albers, who served on the committee but left it recently, blamed Carroll for the failure. ''He was unwilling to negotiate. It's too bad. I think people tried, but it didn't work.''

Farrell said the hospital will continue to provide medical care to Haitian patients who came to Peoria in 2002.

Carroll said recently he has a waiting list of 31 patients, mostly children, who need lifesaving surgery. He would like to bring back the five worst cases, but since December, St. Francis has refused to approve any visas for medical care for Haitian Hearts patients.

''Children's lives depend on decisions to be made here,'' in Peoria, he said.

In January, Bishop Daniel Jenky announced the diocese would help Haitian Hearts, and hospital officials said they wanted the program to continue, but they needed to limit charity care to Haitians and wanted better planning for the patients brought in for care.

St. Francis fired Carroll in December 2001 from his job of 21 years as an emergency room physician after a dispute with hospital managers.

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My comments today, March 12, 2009:

1. Reading this article again is very painful. After two and one half years of fighting local Haitian Heart battles with OSF and the Catholic Diocese of Peoria, we had now reached the lowest of the low. Bishop Jenky had walked away from the Haitian kids too. (He wasn't at the meeting...Monsignor Rohlfs did all the dirty work.)

2. As this article explained, Haitian Hearts kids were going to die now.

3. A very reasonable thing for Bishop Jenky to have done if he had been serious about Haitian Hearts from the beginning, would have been this:

Bishop Jenky should have thanked OSF for all they had done for Haitian kids over the years. He then should have made an announcement that I would be leaving for Haiti to pick up three sick kids accepted by other medical centers that he had contacted. Bishop Jenky definitely had the say-so and knowledge of how medical centers work to get the kids accepted. Three medical centers could have accepted one child apiece. This would have been collaborating for health care which is a Directive of the U.S. Catholic Bishops for Catholic Health Care. The Diocese would not have had to go to Haiti or even spend any money. Haitian Hearts would have done all of the "grunt work" for the Diocese. However, as mentioned before, The Catholic Diocese of Peoria did not want OSF to look bad in any way. So after the Diocese threatened to go to the media AGAINST Haitian Hearts several months before, now they were walking away in a very public way. Instead of becoming more docile, the Diocese should have become proactive for the Haitian kids. The Diocese saw first hand what I was dealing with at OSF. In the Catholic Post, after the Diocese left, the Diocese said there had been good faith by both parties, i.e. OSF and Haitian Hearts. This was untrue. There was not good faith exhibited by OSF or the Diocese of Peoria.

4. One of the Haitian Hearts supporters was so depressed that night after Monsignor Rohlfs closed the meeting, she got into a minor car accident on the way home. At the meeting Monsignor referred to one of may Haitian kids pictures at the meeting as "an advertisement."

5. The Diocese and OSF had been setting a trap for months and now wanted us to accept details without knowing what they were.

6. Joe Piccione, OSF Corporate Ethicist was at the meeting, and was openly aggresive against Haitian Hearts. Jerry McShane, Director of Ethics at OSF, was at the meeting too. He had his golf shoes on and was ready to be done with all of this.

7. Interestingly, OSF Sister Diane was there, and appeared quite upset. She said that Haitian Hearts would be responsible for any bills that went over $200,000 per year. She and Dr. McShane had an open disagreement at the meeting, so it told us that OSF did not have their act together. And the Diocese already said that they would contribute no financial assistance to Haitian Hearts. And if Paul Kramer, et al were keeping the books, and the Haitian kids visas, the kids were doomed.

8. Jim Farrell, OSF's Corporate Director of Marketing and Communications, quote in the paper was a very low blow. He said that the CHOI doctors were in agreement. This statement hurt so much because the CHOI doctors had been and still were so supportive of my Haitian kids. I called Dr. Dale Geiss, the pediatric heart surgeon, the day this article was published, and he denied that he was aware of what was going on...so how could he be supportive of the tragic decision against Haitian kids? I called another doctor who was highly involved in the kids care, and he knew nothing either. I didn't believe Jim Farrell's comments at the time and don't believe them today. It was a public relations move on Jim's part to try and convince the community that even CHOI doctors were in agreement with OSF Administration that it was time for Haitian Hearts to go.

9. Dr. William Albers was NEVER on a Haitian Hearts committee of any type. But OSF attempted to show that Dr. Albers was in agreement with the decision. Dr. Albers said that I failed to negotiate. Nobody negotiated more than I did for the lives of these kids in Haiti and Peoria. I have negotiated for the lives of 150 kids that have made it to the U.S., and I negotiated for months and months before this meeting. Again, this was an attack by OSF using Dr. Albers this time. I was use to it at this point, but it was still hard to accept. Dr. Albers had been my mentor for two decades and he was doing incredible damage. My brother called Dr. Albers after this article appeared and Dr. Albers hung up and would not answer my brother's questions.

10. The day after this terrible meeting I flew from Peoria to Miami and was on my way to Haiti to start another clinic. The Diocese spokesperson Kate Kenny called me in Miami just as I was boarding the plane. She told me it was over...i.e., support for Haitian Hearts from the Diocese of Peoria. This was a terrible feeling and then getting on the plane to fly to Haiti was pretty miserable.

11. At the meeting the night before, my brother asked Monsignor Rohlfs for another meeting. My brother knew that OSF (Sister Diane and Jerry McShane) did not have their facts right, and more time was needed for discussion. Haitian kids lives were at stake. Monsignor Rohlfs said the meeting was going to last only 60 minutes. My brother asked "why only 60 minutes", and Monsignor Rohlfs responded "because I said so." So who was not negotiating---Haitian Hearts or the Catholic Diocese of Peoria?

12. So Haitian Hearts had fought the "good fight". We did negotiate for the lives of kids. And we still are. This was an incredible learning experience for all of us at Haitian Hearts. We saw the ugly side of our Catholic hospital and our Catholic Diocese. The warnings of my friends about the "help" of the Diocese still haunts me today.

Looking Back...Haitian Hearts Still in Limbo

See my comments written today, March 9, 2009, at end of this Peoria Journal Star editorial.
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Peoria Journal Star
January 12, 2003

Haitians highlight limits on care for Peorians


On Wednesday a man called the Heartland Community Clinic for help. An out-ofwork diabetic, he was about to become an out-of-insulin diabetic. His supply was dwindling, and he had no money to replace it.

The clinic, godsend to many of this area's uninsured, told the man to phone back Monday morning, the only time in the week it takes calls from people hoping to become patients. This is because its small volunteer staff is overwhelmed.
But it accepts only one new diabetic patient every month. This is because diabetics require intensive, costly care the clinic cannot afford.

And, generally speaking, it confines its practice to the working-poor uninsured. This is because that is its unique mission, and it's a fine one.

Last year the Heartland had to turn away two out of three people who got their phone calls in on Monday mornings. Those who succeeded had to wait for screening. Those who were sick had to wait again as long as 15 working days to be seen. ''We're doing the best we can,'' says Joan Krupa, the executive director. ''But that's pretty awful when you're sick and trying to get well.''

So the odds of getting seen at Heartland are against this man, who said he'd sought help from government sources and been denied. He was encouraged to try other charitable clinics, but they also are overwhelmed by too many patients, too few doctors and too little money.

Adults who seek appointments at the clinics Methodist Medical Center runs at Carver Center and Friendship House typically have to wait four weeks, unless it's an emergency, in which case they'll be referred to a hospital walk-in clinic. Mother Frances Krasse Center has temporarily suspended taking new patients until it can hire another doctor. OSF Community Health Care Center is closed to new adult patients, except for those who meet stringent poverty guidelines, so it can catch up with the backlog.

Even godsends have their limits, as Sister Judith Ann Duvall, president of OSF Health Care System, was acknowledging just about the same time the unemployed diabetic was calling the Heartland.

She was acknowledging it in the course of a conversation about efforts to keep alive a popular program that provides free care and surgery for Haitian children with life-threatening heart problems. The program counts on volunteer doctors, some of whom say they also are overwhelmed; deep hospital discounts; and community fund-raising.

The founder, Dr. John Carroll, picketed OSF St. Francis last week when the hospital suspended the program, which it says owes $400,000 to its Children's Hospital affiliate.

Children's Hospital subsequently agreed to forgive the debt and to work with Bishop Daniel Jenky, who wants to make Haitian Hearts a Diocesan mission. It seems a good compromise, intended to keep the number of Haitian children coming here to a level local doctors and volunteers can support while recognizing Peorians' passion for the effort and the doctor who began it.

Children's Hospital officials say the number of Haitian Hearts patients quadrupled over the last four years, and they can't afford for that to continue. The hospital bill alone can run from several thousand to several hundred thousand dollars. Rooms and specialized nursing staff are limited, too. The more resources devoted to Haitian children, the less there may be for Peoria-area kids.

''We've never had to turn a central Illinois patient away'' because a Haitian child is filling a bed,'' says Paul Kramer, executive director of Children's Hospital. ''But it's been close,'' adds Dr. Richard Pearl, director of pediatric trauma.

OSF expects to spend an impressive $40 million this year on charitable care but still does not claim to fill all local needs. Last year it quit supporting in-school health clinics and church-based nurses. More sobering decisions likely lie ahead in a state approaching a $5 billion budget gap. Half of the Children's Hospital patients are enrolled in Medicaid, the government-funded health-care program for the poor. State Medicaid spending is second only to state school spending, and substantial cuts are feared.

When Haitian Hearts were threatened, anguished central Illinoisans mourned on TV and complained to the newspaper that OSF had abandoned its mission. Forty million dollars say it has not.

But when a Peoria diabetic can't get his insulin, when a Pekinite with a Medicaid card can't find a doctor to see her, when somebody who is sick has to wait a month for an appointment, when dental care for poor adults nearly vanishes from the community, as it has here, nobody calls, nobody writes, nobody pickets.

If the problems Peoria-area people have in getting health care evoked as much sympathy as do the needs of strangers, then the solutions would come quickly. The community needs them.
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My comments today, March 9, 2009:

1. The Journal Star and OSF are pitting the poor against the poor in this editorial. That is not ethical and they should not do that.

2. Paul Kramer, Executive Director of Children's Hospital of Illinois, and Rick Pearl, M.D., Medical Director of Childen's Hospital of Illinois, were trying to scare readers in central Illinois in to thinking that Haitian kids could possibly be taking intensive care beds from our kids. I made rounds on my Haitian patients in intensive care for years and years and never saw a dilemma like this occur. Mr. Kramer and Dr. Pearl were simply playing the "fear card", and don't forget that Dr. Pearl had asked me repeatedly over the years to bring him Haitian kids to operate at OSF-Children's Hospital of Illinois.

Looking Back...Haitians Highlight Limits

See my comments written today, March 9, 2009, at end of this Peoria Journal Star editorial.
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Peoria Journal Star
January 12, 2003

Haitians highlight limits on care for Peorians


On Wednesday a man called the Heartland Community Clinic for help. An out-ofwork diabetic, he was about to become an out-of-insulin diabetic. His supply was dwindling, and he had no money to replace it.

The clinic, godsend to many of this area's uninsured, told the man to phone back Monday morning, the only time in the week it takes calls from people hoping to become patients. This is because its small volunteer staff is overwhelmed.
But it accepts only one new diabetic patient every month. This is because diabetics require intensive, costly care the clinic cannot afford.

And, generally speaking, it confines its practice to the working-poor uninsured. This is because that is its unique mission, and it's a fine one.

Last year the Heartland had to turn away two out of three people who got their phone calls in on Monday mornings. Those who succeeded had to wait for screening. Those who were sick had to wait again as long as 15 working days to be seen. ''We're doing the best we can,'' says Joan Krupa, the executive director. ''But that's pretty awful when you're sick and trying to get well.''

So the odds of getting seen at Heartland are against this man, who said he'd sought help from government sources and been denied. He was encouraged to try other charitable clinics, but they also are overwhelmed by too many patients, too few doctors and too little money.

Adults who seek appointments at the clinics Methodist Medical Center runs at Carver Center and Friendship House typically have to wait four weeks, unless it's an emergency, in which case they'll be referred to a hospital walk-in clinic. Mother Frances Krasse Center has temporarily suspended taking new patients until it can hire another doctor. OSF Community Health Care Center is closed to new adult patients, except for those who meet stringent poverty guidelines, so it can catch up with the backlog.

Even godsends have their limits, as Sister Judith Ann Duvall, president of OSF Health Care System, was acknowledging just about the same time the unemployed diabetic was calling the Heartland.

She was acknowledging it in the course of a conversation about efforts to keep alive a popular program that provides free care and surgery for Haitian children with life-threatening heart problems. The program counts on volunteer doctors, some of whom say they also are overwhelmed; deep hospital discounts; and community fund-raising.

The founder, Dr. John Carroll, picketed OSF St. Francis last week when the hospital suspended the program, which it says owes $400,000 to its Children's Hospital affiliate.

Children's Hospital subsequently agreed to forgive the debt and to work with Bishop Daniel Jenky, who wants to make Haitian Hearts a Diocesan mission. It seems a good compromise, intended to keep the number of Haitian children coming here to a level local doctors and volunteers can support while recognizing Peorians' passion for the effort and the doctor who began it.

Children's Hospital officials say the number of Haitian Hearts patients quadrupled over the last four years, and they can't afford for that to continue. The hospital bill alone can run from several thousand to several hundred thousand dollars. Rooms and specialized nursing staff are limited, too. The more resources devoted to Haitian children, the less there may be for Peoria-area kids.

''We've never had to turn a central Illinois patient away'' because a Haitian child is filling a bed,'' says Paul Kramer, executive director of Children's Hospital. ''But it's been close,'' adds Dr. Richard Pearl, director of pediatric trauma.

OSF expects to spend an impressive $40 million this year on charitable care but still does not claim to fill all local needs. Last year it quit supporting in-school health clinics and church-based nurses. More sobering decisions likely lie ahead in a state approaching a $5 billion budget gap. Half of the Children's Hospital patients are enrolled in Medicaid, the government-funded health-care program for the poor. State Medicaid spending is second only to state school spending, and substantial cuts are feared.

When Haitian Hearts were threatened, anguished central Illinoisans mourned on TV and complained to the newspaper that OSF had abandoned its mission. Forty million dollars say it has not.

But when a Peoria diabetic can't get his insulin, when a Pekinite with a Medicaid card can't find a doctor to see her, when somebody who is sick has to wait a month for an appointment, when dental care for poor adults nearly vanishes from the community, as it has here, nobody calls, nobody writes, nobody pickets.

If the problems Peoria-area people have in getting health care evoked as much sympathy as do the needs of strangers, then the solutions would come quickly. The community needs them.
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My comments today, March 9, 2009:

1. The Journal Star and OSF are pitting the poor against the poor in this editorial. That is not ethical and they should not do that.

2. Paul Kramer, Executive Director of Children's Hospital of Illinois, and Rick Pearl, M.D., Medical Director of Childen's Hospital of Illinois, were trying to scare readers in central Illinois in to thinking that Haitian kids could possibly be taking intensive care beds from our kids. I made rounds on my Haitian patients in intensive care for years and years and never saw a dilemma like this occur. Mr. Kramer and Dr. Pearl were simply playing the "fear card", and don't forget that Dr. Pearl had asked me repeatedly over the years to bring him Haitian kids to operate at OSF-Children's Hospital of Illinois.

Looking Back...Hearts Program Still Beating

January 10, 2003

ELAINE HOPKINS

'Hearts' program still beating -- Peoria hospital forgives debt

PEORIA - The Haitian Hearts program could become a not-for-profit charity under the Catholic Diocese of Peoria, with OSF Saint Francis Medical Center forgiving its debts so the organization can get a fresh start.

Bishop Daniel Jenky announced Thursday that he will initiate talks between hospital officials and others to create a new oversight structure for the Haitian Hearts organization, overseen by the diocese.

The Children's Hospital of Illinois at St. Francis announced it will forgive the Haitian Hearts debt, now at nearly $400,000, when an oversight structure is set up, and will continue to offer a 55 percent discount to the program's patients.

''The balance is now zero,'' said Dr. Rick Pearl, director of pediatric surgery.

The intent of this week's events is for the diocese, OSF and Haitian Hearts officials to select a board of directors and management structure for Haitian Hearts.

Dr. John Carroll, the founder of Haitian Hearts, will play a crucial role in the new organization, said Patricia Gibson, vice chancellor of the Peoria Diocese, though that role is not clear.

Carroll ''is aware that Bishop Jenky (and others) will work toward this goal and is most grateful and willing to work with this group,'' Gibson said. ''He was aware of what was going on and it has become finalized. We could not tell him that on Monday.''

Carroll is now in Haiti and could not be reached for comment. On Sunday and Monday, he picketed St. Francis to protest a hospital decision to stop cooperating with the Haitian Hearts program.

The hospital had said it would not accept any more Haitian patients until the organization paid its debt.

Hospital and diocese officials spoke with the Journal Star editorial board later Thursday to discuss the changes. Sister Judith Ann Duvall, president of OSF Healthcare System, said the charitable mission of the hospital's founders has not changed.

''We want this program to continue for the good of the children,'' she said.
Paul Kramer, executive director of Children's Hospital, said the Haitian Hearts program has been expanding, and last year treated 17 children. But the hospital system's charity burden also has been growing, he said, and is expected to be $40 million this year, including up to $6 million at Children's Hospital.

''We need limits'' on the number of Haitian children treated here, Kramer said.
Before more children come, better planning is needed, he said, including ''adequate medical input into the decisions'' about which children should come to Peoria. ''Dr. Carroll has agreed (with) this approach.''

Kramer said Carroll likely will not bring back any children from Haiti on this trip, though some still here need more care and will be treated.

Carroll's supporters on Thursday expressed optimism about the future of Haitian Hearts after learning about Jenky's initiative.

''I am grateful to the diocese for stepping in and taking an interest in this program for its continued benefit to the Haitian kids,'' Ann Wagenbach, coordinator of Haitian Hearts, said. ''There are a lot of details we'll have to work out (but) it sounds very positive.''

''If the bishop is supportive, I'm thrilled,'' said supporter Laurie Howard.

The bad feelings and misunderstandings between Carroll and hospital managers can be overcome with a fresh start, diocese and hospital officials said. ''Once partners work together, trust occurs,'' Pearl said.

St. Francis fired Carroll in December of 2001 from his job of 21 years as an emergency room physician after a dispute with hospital managers over standards of care, which Carroll wanted to improve. He still retains his hospital privileges.

CAPTION: A NEW PLAN: Bishop Daniel Jenky (left) hopes to create a new oversight structure for Haitian Hearts. Dr. John Carroll (right), founder of group, will play a role in the new organization.
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My comments today, March 9, 2009:

1. OSF asked for a meeting with the Journal Star and the Catholic Diocese of Peoria. They had the meeting at the Journal Star. Haitian Hearts was not invited and I was in Haiti working.

2. OSF changed the figure yet again of the amount Haitian Hearts owed them. In this article OSF said less than $400,000 dollars. This was significantly less than what they told the Journal a few days before when OSF reported that we owed them over $500,000 dollars. The bottom line is OSF didn't know. So they forgave the debt and hoped no one would want to look at their books.

3. Haitian Hearts had no say at all in the creation of a "board of directors" with the Diocese of Peoria. Contrary to Patricia Gibson's statements, I did not know what was going to happen in Peoria. OSF just needed the Bishop to take over to try and legitimize OSF's horrible actions against the Haitian kids. It seems odd that Bishop Jenky would want to be involved since he and Monsignor Rohlfs and Patricia Gibson always claimed that OSF was a "pontificate of Rome" and OSF could do what they wanted without Diocesan approval. Why would the Diocese want to get involved with a bunch of sick, poor, black kids from Haiti? It was damage control.

During the next 6 months we met with Bishop Jenky just once, in February 2003, for a total of 45 minutes. I would have thought that Haitian lives were more important than the 45 minutes dedicated to them. The meeting was run by Bishop Jenky and Monsignor Rohlfs and was comprised of hand picked people by the Diocese. My brother Tom asked Bishop Jenky at that meeting if I could go to Haiti and pick out some sick kids and bring them back to Peoria. The Bishop said no. We were given "jobs" and told we would meet again in a couple of weeks. I called Patricia Gibson repeatedly during the next month, however no further meeting occurred until the middle of July, 2003 when a tiny group of us met with Monsignor Rohlfs and some people from OSF. This final meeting lasted 60 minutes and Haitian Hearts was ditched by the Diocese and OSF. Bishop Jenky was not at that final meeting.

4. Right after the meeting between the Diocese, the Journal Star, and OSF reported in the article above, my brother Tom called me in Haiti and basically told me that Bishop Jenky and the Diocese were taking over. Tom asked me if that was ok. Neither of us thought Haitian Hearts had a choice at that point. They had the Haitian kids between a rock and a hard spot. Friends of ours counselled us that the Diocese may not act in the best interest of the Haitian Hearts' patients. That proved to be the case. During the next six months Bishop Jenky was afraid to stand up to OSF for money reasons. He wanted his Diocesan Capital Campaign to run smoothly in 2003. And so in July, 2003 Haitian Hearts became history in Peoria.

Looking Back....Haitians Face Hurdles

Peoria Journal Star
January 8, 2003

Editorial

Pam Adams


Haitians face hurdles in Miami, Peoria


In Miami, Haitians arrive by the hundreds.

In Peoria, they come a few at a time.

In Miami, Haitians arrive in rickety wooden boats.

In Peoria, they come by plane.

In Miami, Haitians, adults and children, dive off the rickety, wooden boats.

In Peoria, Haitian babies and children get off the plane.

In Miami, Haitians must sneak off the boats.

In Peoria, there's always someone waiting for them at the airport.

In Miami, Haitians are arrested if they're caught sneaking off the boat.

In Peoria, they go to a warm home with a soft bed and running water after they get off the plane.

In Miami, Haitians willfully risk their lives to reach U.S. shores.

In Peoria, sick Haitian children come because Dr. John Carroll, a local doctor, risks his time, money and, lately, his career to save their lives.

In Miami, Haitians arrive because they're fleeing Haiti.

In Peoria, they arrive knowing they will go to OSF St. Francis Medical Center for surgery.

In Miami, Haitians face months in prison, then deportation, after they're arrested.

In Peoria, Haitian babies face a new life with a healthy heart after the surgery.

The Haitians flooding into Miami are refugees.

The Haitians trickling in and out of Peoria are among the healthiest of Haiti's sickest children.

The United States is tired of Haitian refugees flooding into Miami seeking political asylum.

OSF St. Francis is tired of Haitian babies trickling into Peoria for heart surgery.

Early last year, the government's Immigration and Naturalization Service began carrying out a new secret policy, meant only for Haitian boat people.

Early last year, OSF St. Francis began cutting back on the millions in charity aid the hospital once gave Haitian Hearts, the volunteers who bring Haitian children to Peoria, care for them in their homes before and after surgery, and raise money to help pay for the surgeries.

The INS said the new, secret policy reflects government fears of a mass exodus from the poverty-stricken, politically-lawless country.

OSF St. Francis' chief of surgery said, ''We can't do everything for everybody all the time.''

The government's policy toward Haitian refugees brought out longstanding contradictions in the government's policy toward Haiti.

OSF St. Francis' much earlier decision to fire Dr. John Carroll, for matters unrelated to Haitian's hearts, brought out growing queasiness about the hospital's commitment to the poorest of the poor.

While the INS cracked tough on Haitian refugees, the Bush administration blocked federal aid to Haiti, including aid for medical care.

When OSF St. Francis fired Dr. Carroll, he predicted the hospital would eventually kill the Haitian Hearts program.

As the year ended, national newscasts flashed the spectacle of frantic Haitian refugees, plowing ashore, dodging traffic across one of Miami's busiest highways, begging strangers for a lift to freedom.

Right after the year began, local television outlets carried the lonely scene of Dr. Carroll picketing St. Francis, carrying a sign saying ''OSF Administrators: Respect for Life Includes Haitians.''

The U.S. government declared all Haitian detainees would be treated fairly, appropriately and humanely.

OSF St. Francis suspended the Haitian Hearts program, saying the group owed the hospital at least $500,000, and Dr. Carroll wasn't following previous agreements.

In Miami, supporters of the Haitian refugees called the government's actions racist. Cuban boat people, they noted, are treated differently.

In Peoria, Dr. Carroll's supporters called OSF St. Francis' actions heartless. The hospital's mission, they noted, is not based on anyone's ability to pay.

In Miami, even the most stringent, most racist government policies won't stop hundreds of Haitian refugees from risking their lives.

In Peoria, the stand-off between one doctor and one hospital risks the lives of dozens of Haitian children.

Pam Adams is a columnist with the Journal Star.
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My comments from today, March 8, 2009:

1. Pam was wrong. Haitian Hearts WAS one of the reasons I was fired from OSF.

2. The OSF ER was sick and I told OSF Administration that the ER problems were part of a systemic hospital wide problem that needed a hospital wide solution. And the ambulance monopoly in Peoria was controlled by OSF and the conflict of interest ran deep and they knew I knew this also.

3. OSF fired me, their Adminstrator spoke to many people outside the community about me and my termination, cut all funding for Haitian kids heart surgery, dangerously delayed Haitian surgeries of patients in Peoria, attempted to obtain money that was Haitian Hearts, offered Haitian Hearts no itemized bills, promised to follow the founding Sisters Mission philosophy but didn't, called the American Consulate in Haiti, condemned Haitian kids to misery and death, yet OSF said I was not following procedeures.
----------------

Peoria Journal Star

April 27, 2005

EDITORIAL

PAM ADAMS

Shame, compassion powerful tools

First came word of the city's new policy of shaming negligent landlords into fixing up neglected property.

With fanfare generated by press conference - meaning city officials want the media to know what they're doing this time - workers staked up a big, embarrassing sign in front of a dilapidated house along Illinois Avenue, naming the landlord and urging neighbors to urge him to do the right thing and repair the house.

City Manager Randy Oliver clearly hopes public humiliation can make a dent where laws, code violation notices and court-imposed fines have failed. The city plans to post shaming signs on five more properties this week. Maybe shaming will make a difference; maybe it won't.

But by Monday, workers were already repositioning the sign in front of the house along Illinois. Apparently someone tore it down over the weekend.

Then came Saturday's meeting of middle-school students in Tri-County Urban League's Tomorrow's Scientists, Technicians and Managers (TSTM). Carl Cannon, assistant manager of the RiverPlex, was the speaker.

Cannon, a former prison guard, became famous in these parts for his efforts to scare young people into doing the right thing with a youth empowerment program called CHOICES. He still brings the former inmates and parolees with him, and they still use shock tactics to grab and hold students' attention as they detail the harsh consequences of felonious choices. But Cannon admits he has evolved from his initial macho "scared-straight" mentality.

"Working in the (prison) industry," he says, "that was all I knew." Once he started talking and listening to the students he was trying to reach or save or change, his thinking moved beyond the prison walls. He added a pledge about hope and began telling young people he loved them. He began changing; his message began changing.

Shock and shame and fear and embarrassment have always been potent weapons in the cultural arsenal of regulating public behavior. Sometimes it's the little guy, with little power, who tries embarrassing a powerful entity into changing its ways. We saw that last year with Dr. John Carroll's failed and lonely effort to picket OSF St. Francis Medical Center, as he tried to shame his former employer into treating more heart patients from Haiti.

Remember when the state began releasing mug shots of deadbeat dads, along with the amounts of child support they owed? Remember Penny Wood, the Pekin woman who became the poster child for "just say no" when a Tazewell County judge got her to agree to the release of her photo pre- and post-methamphetamine use?

In a society that has turned government-administered punishment into an industry, it is getting easier and easier to find small but telltale admissions of the fact that legally justified forms of punishment leave a lot to be desired in terms of deterrence or encouraging people to change - as long as they're more about winning or revenge than healing.

I give you the city's shaming signs press conference last Thursday as exhibit A. Carl Cannon's evolution from scaring kids straight to scaring them with compassion would be my exhibit B.

But the most powerful evidence presented locally in the last few days came when former Gov. George Ryan spoke here about abolishing the death penalty.

Ryan was a powerful man, arguably the most powerful elected official in the state, when he called a moratorium on state-sponsored executions five years ago. He was also plagued with his own shame and scandal and is awaiting trial now on multiple corruption charges.

But there is no denying that the shame and shock of learning that 13 people were wrongfully sentenced to execution changed his conscience and his behavior.

Pam Adams is a columnist with the Journal Star. Her e-mail address is padams@pjstar.com.
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My comments today, March 8, 2009:

Did my attempts fail?

OSF now has an International Committee that does screen international kids for surgery. And they have accepted some Haitian kids in the last few years for surgery at OSF.

But they won't take Haitian Hearts patients that have been operated at OSF in the past or any new patients from me.

I think OSF has failed their Haitian patients but not as badly as they might have if nothing was done to make the public aware.

OSF's Administration and attorney respond to bad publicity and lawsuits. Sorry, the Sister's Mission Statements don't mean much to these guys.

Looking Back....OSF Suspends Haitian Hearts Program

Peoria Journal Star

January 7, 2003

ELAINE HOPKINS

OSF suspends Haitian Hearts program -- Hospital says group must pay $500,000 debt

PEORIA - OSF Saint Francis Medical Center is suspending its participation in the Haitian Hearts program until the organization pays $500,000 to The Children's Hospital of Illinois at St. Francis.

''The program is suspended at this point,'' St. Francis spokesman Chris Lofgren said Monday. ''The debt has to be taken care of, and Dr. John Carroll needs to follow procedures and work with physicians who are going to treat them before he leaves'' for Haiti to bring back more children.

Carroll plans to leave for Haiti today and said he does not know whether the American consulate will issue visas for the children.

Carroll and his supporters said the hospital's action is not in keeping with its mission and that of the Sisters of the Third Order of St. Francis. Those values do not limit care only to those who live in central Illinois, Carroll said.

''My hope would be that the sisters and their mission would override'' the decision, he said.

Carroll said Sunday he has up to 20 children in Haiti waiting for treatment. Once he locates children needing the delicate heart surgery not available in their country, he confers with physicians in Peoria before bringing children back, he said.

Carroll picketed the hospital Sunday and Monday to call attention to its actions.
He received a certified letter Friday stating the hospital contacted the American consulate in Haiti to say no visas should be issued ''without prior written approval from The Children's Hospital.'' That contact could disrupt the delicate procedures for obtaining visas for the sick children, Carroll said.

The letter to Carroll, from the Peoria law firm of Hinshaw & Culbertson, signed by its attorney Douglass Marshall, states, ''The consulate was surprised to learn that The Children's Hospital had not granted prior approval to you and had not agreed to provide care free of charge.''

But Carroll on Monday produced a form letter from The Children's Hospital signed by its executive director, Paul Kramer, stating the hospital ''will cover all costs for surgery and hospitalization.'' The letter allowed the date and name of the patient to be filled in, so that a visa could be obtained.

The form letter was last used in October, Carroll said, but apparently the hospital has revoked it.

Carroll and others also said they were not sure of the $500,000 figure St. Francis says Haitian Hearts owes. A committee of the organization has been auditing the bills and already has found three mistakes, he said.

''We don't get itemized bills,'' Carroll said. ''I've asked for itemized bills.''

Lofgren said itemized bills for each patient will be sent if the organization requests them. He also said the amount owed is actually higher than $500,000, though he conceded any items in a bill could be disputed.

Laurie Howard of Peoria, the adoptive mother of the first Haitian Hearts baby, is wary of St. Francis' figures.

''Haitian Hearts is raising money and has paid'' for the care, Howard said. ''They (St. Francis) definitely dealt a low, low blow'' to the Haitian Hearts program.
Lofgren disagrees.

''The program has not ended'' but is only suspended, he said. ''When these two things are taken care of - the debt and he meets with us prior to going - we're back in business.''

Carroll is a former St. Francis emergency room physician who worked at the hospital for 21 years. He was fired in December 2001.

Carroll said St. Francis actually makes a profit on Haitian Hearts patients, despite a 55 percent discount, because there is a difference between the hospital's actual costs and what it charges for services. Its costs are 30 percent of the listed price, he said, and Haitian Hearts pays 45 percent.

''It's higher than that,'' Lofgren countered, adding it's under 45 percent. ''You have to have extra money'' to pay for expenses and future expansion, he said.
The 55 percent discount for Haitian Hearts patients, Lofgren added, is the greatest given to any organization or group.

Lofgren stated Sunday that St. Francis and The Children's Hospital provided $34 million in uncompensated care for local and international children last year.

Haitian Hearts recently has applied for a $1 million health care award from a foundation, Carroll said, but added that the hospital's action could jeopardize that award.

Anne Wagenbach, coordinator of Haitian Hearts, questioned the hospital's motives.
''They're saying it's all financial. Is that really true? I don't know,'' she said.

CAPTION: Dr. John Carroll walks the sidewalk outside OSF Saint Francis Medical Center on Monday bearing a sign with a message for hospital administrators who contacted the American consulate in Haiti to voice concern over issuing visas for Haitian children seeking medical treatment at St. Francis. Carroll is a former emergency room physician at the hospital and a founder of Haitian Hearts, an organization which brings children from Haiti to Peoria for medical treatment.
Dr. John Carroll walks the sidewalk outside OSF Saint Francis Medical Center on Monday bearing a sign with a message for hospital administrators who contacted the American consulate in Haiti to voice concern over issuing visas for Haitian children seeking medical treatment at St. Francis. Carroll is a former emergency room physician at the hospital and a founder of Haitian Hearts, an organization which brings children from Haiti to Peoria for medical treatment.

My comments today, March 8, 2009:

1. I did leave for Haiti the day this article was published. And the American Consulate would not grant any visas for Haitian Hearts kids to travel to Peoria.

OSF had no choice but to "suspend" Haitian Hearts. This was a public relations nightmare for them.

The only thing left for OSF to do to try and get rid of us was to involve Bishop Daniel Jenky. And that would be OSF's next move.

2. While I was in Haiti evaluating many children with congenital and rheumatic heart disease, I did call multiple physicians at Children's Hospital of Illinois (CHOI) on a satellite phone that I carried with me. The physicians were very helpful and encouraged me to bring kids back to Children's Hospital of Illinois. On one occasion I was planning to take a baby with congential heart disease to another medical center in the United States, and the CHOI physician strongly recommended that I bring the baby to CHOI. I took his advice regarding this very sick baby and the baby did great with surgery at CHOI. On another occasion, I had an accepting hospital in another state for three Haitian Hearts children. A different CHOI physician told me to bring them to CHOI--not the other medical center.

The bottom line is I had a great working relationship and communication with the CHOI physicians regarding Haitian Hearts patients. I consulted them from Haiti via the satellite phone, attended the cardiac cath conferences at CHOI when the pediatric cardiologists and surgeons reviewed Haitian echocardiograms, scrubbed in or observed during their surgeries in the operating room, examined the child in the physician offices pre and post op, and I followed the children in the hospital by examining them everyday in intensive care at CHOI.

Chris Lofgren did not mention any of this. And after I was fired from OSF, Paul Kramer met with another OSF administrator to try and keep me out of surgery with the children. Paul Kramer and OSF were unsuccessful. I think they felt that the backlash from the host families would be too severe if OSF tried to keep me out of the operating room along with everything else OSF was doing to stop Haitian Hearts.

3. I was hoping Sister Judith Ann would come through...but she didn't. She had told me that OSF would never refuse a child for medical care. But now they were.

4. Douglass Marshall, OSF's attorney, would write me a letter in the coming year which would refuse all Haitian Hearts patients. And kids started dying.

5. As mentioned in a previous post, OSF cut all funding for Haitian Hearts in July, 2002. And we were responsible for 55 per cent of total charges, not 45 per cent of total charges as reported in the Journal. And if Haitian Hearts owed OSF money for Haitian surgeries, now we didn't have the $257,000 dollars that OSF had slashed to help pay. The reality is that OSF had no idea about the figure and had to say something in the Journal when I picketed the hospital. And they changed the figure every article until they "forgave" the debt because OSF didn't want anyone looking at their books.

6. The first day I protested in front of OSF, Patricia Gibson, the attorney for the Catholic Diocese of Peoria came to my mother's home and met with my family (while I was picketing). She said that my protest was the right thing to do. Little did I know what was going to happen with the Diocese.

7. And contrary to what Chris Lofgren said in the article, Haitian Hearts had asked OSF for itemized bills in the fall of 2002. We never received an itemized bill from OSF after this request.

8. A glaring error made by OSF---Chris Lofgren should have never said that OSF needed to make some money for future expansion. They should not have tried to make money off of operating on some of the poorest kids in the world and charging us the way they did. Lofgren made a big mistake.

9. Anne Wagenbach was coordinator of Haitian Hearts and an OSF employee. Her quote at the bottom questioned OSF's motives. When Haitian Hearts did offer OSF full charges for Haitian Hearts patients in the years to come, the kids were still denied care at OSF. So I guess it wasn't all financial. (Incidentally, Keith Steffen threatened to sue Anne in his office at OSF.)

10. And Laurie Howard was quoted also. Laurie was an OSF employee too. Both Laurie and Anne were putting their jobs on the line to speak with the Journal Star. But Haitian kids lives were more important to them than were their jobs at OSF. Subsequently, Laurie was told by an assistant administrator that Paul Kramer wanted to talk with her in his office. Laurie smartly declined Mr. Kramer's invitation. (Neither Laurie nor Anne work for OSF in 2009.)

11. Well, OSF had to decide what to do now. It was time to call in The Catholic Diocese of Peoria for help.
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The photo above is a Haitian child's heart at surgery. It is distended and blue in color at the start of surgery. At the end of surgery, it is much smaller, pinker, and much healthier. The child is doing very well now, thanks to modern technology, and the hand of the surgeon, and skilled post op care. This child was accepted by a medical center that has operated on OSF patients that OSF did not want any more.

Looking Back....Paul Kramer Calls the American Consulate in Haiti

Peoria Journal Star
January 6, 2003

ELIZABETH KINDER

St. Francis frustrates doctor -- Haitian Hearts founder fears hospital letter to U.S. consulate will impede children's visas

PEORIA - OSF Saint Francis Medical Center is owed more than $500,000 for the treatment of Haitian children, a hospital official said.

The American consulate in Haiti has been contacted by representatives of the hospital about the distribution of visas to children seeking heart surgery at St. Francis, prompting Dr. John Carroll to demonstrate Sunday.

Carroll, a former emergency room physician at the hospital and a founder of Haitian Hearts, said he ''could not comment on the $500,000'' but said ''figures can be hard to come by from the Children's Hospital of Illinois Foundation, and it's hard for us to know where we stand.''

Carroll worked at St. Francis for 21 years before being fired in December 2001.

Haitian Hearts brings children from Haiti to Peoria for medical treatment, mainly heart surgery, at St. Francis. The program has made it possible for 94 children to receive necessary surgery at the hospital.

''We have uncompensated expenses in excess of $500,000 for Haitian kids brought through,'' said hospital spokesman Chris Lofgren. ''There needs to be controls placed. Any organization has limitations on what they can afford.''

Last week, Carroll received a certified letter from St. Francis' lawyers, Hinshaw & Culbertson, telling him that the American consulate in Port-au-Prince, Haiti, has been contacted about visa distribution for Haitian children seeking heart surgery at St. Francis.

He fears this contact may make it ''next to impossible for me to obtain visas'' for the sick children.

''My long-standing relationship with the consulate has probably been destroyed,'' Carroll said.

In protest, Carroll, 49, paced and carried a sign Sunday afternoon outside St. Francis, which read: ''OSF Administration: Respect for Life Includes Haitians.''

''Dr. Carroll needs to engage in conversation with the people trying to contact him,'' Lofgren said.

Carroll said he has ''been contemplating'' talking with administrators.

Since 1995, Carroll has traveled to Haiti about four times a year to bring children who need medical treatment to Peoria - treatment that Carroll says the island country cannot provide but is available at St. Francis.

''The technology is not there in Haiti . . . even the electricity can't be depended on,'' he said.

Carroll will fly to Haiti on Tuesday, where he plans to see if the consulate will continue to grant him visas. He has not yet called the consulate or set up any meetings, he said.

''I have to see how much damage has been done by the OSF administration or their legal counsel,'' Carroll said. ''(The program) has been working well over the years - we hate to see it destroyed because Haitian children will be destroyed.''

The Peoria native said he has up to 20 children waiting for treatment.
Lofgren said the hospital has ''not refused service'' to children brought in by Carroll, even with the debt in place.

''Last year, OSF St. Francis Medical Center and the Children's Hospital of Illinois provided a total of $34 million in uncompensated care to local and international children,'' Lofgren said.

In July, the hospital decided to stop providing $257,000 annually to Haitian Hearts, opting instead to offer 55 percent off regular charges.

To fill the hole, Carroll and other Haitian Hearts supporters held fund-raisers and sought donations. Carroll said $435,000 was raised in 2002 for his program.
He could not set a price for the average amount of treatment each child receives, saying it depends on the type of surgery.

All the money raised goes toward medical care, Carroll continued, with no overhead cost and no money given to the Peoria families who take in the Haitian children after surgery.

Lofgren said there's ''not really a set amount'' for the service the hospital is willing to provide, but the ''Sisters have been very generous in 125 years.''

Carroll thinks the original mission of the Sisters of St. Francis is being defiled.
''The Sisters' mission needs to be preserved, and that's what we're trying to do,'' Carroll said. ''There's a huge gap between the Sisters' mission in theory and the way the administration is approaching it.''

Mary Kay Hersemann has taken in five Haitian children into her Washington home since 1995.

Hersemann, 48, said when she and others from the Haitian Hearts program attempted to talk with members of the hospital's administration in the past, ''They don't clearly answer questions. They use intimidation and fear - fear sometimes works.''

CAPTION: Dr. John Carroll

My comments today, March 5, 2009:

1. OSF had no idea regarding charges. They had to say something on the weekend when I protested in front of the hospital. Chris Lofgren described my protest as a public relations nightmare for OSF. OSF changed the charges day to day in the newspaper (as can be seen in the following posts) and then had Dr. Rick Pearl "forgive our debt". (No one knew that Dr. Pearl was asking me to bring him Haitian patients to operate over the previous years.) And OSF didn't want anyone looking at their books so they decided to "forgive". And note that OSF cut out ALL financial support (257 thousand dollars/year) for Haitian Hearts six months earlier in July, 2002. And contrary to what was reported in the article, OSF was charging Haitian Hearts 55 per cent of total charges, not 45 percent.

2. Picketing OSF that morning was a very painful experience. But I thought Paul Kramer's call to the American Consulate in Haiti was inexcusable. His action was against the 125 year old mission philosophy of OSF. The Consulate official in Haiti was hyperventilating when she told me that Paul Kramer had called. She knew that would mean Haitian kids would die.

3. This day was the beginning of a very dark history for OSF. A few years later Jackson Jean-Baptiste and Maxime Petion would die after they were refused care at OSF.

Looking Back....Paul Kramer at Children's Hospital of Illinois

Paul Kramer, Executive Director of Children's Hosptial of Illinois (CHOI), obstructed care of my Haitian Hearts patients.


Haitian Hearts started as a small group of friends of mine that sat around my kitchen table and planned ways to raise money for CHOI to help pay for the Haitian kids we brought to Peoria for heart surgery. We had no overhead and all funds we raised went directly to CHOI. We paid for the Haitian kids passports, visas, airline tickets, food, medications, and on occasion, we even paid for surgery from our back pocket.

As the years went by we raised over $1.1 million that went to OSF-CHOI. The doctors at OSF never charged Haitian Hearts for their services.

During a meeting I had with Paul in his office in 2000, Paul told me that “Haitian Hearts is becoming too competitive for CHOI.” He meant that we were raising so much money in the Peoria community that was earmarked Haitian kids surgery at CHOI, he was worried that CHOI was being left out for purposes other than Haitian Hearts. Paul and other OSF administrators wanted money donated to CHOI to go for bricks and cement for the new Children's Hospital that they were planning at OSF. (That $250 million project is now underway.) I think he was nervous that people were contributing to CHOI-Haitian Hearts and other administrators were breathing down his neck. I think that OSF thought they needed to get control of Haitian Hearts.

Caterpillar Foundation was donating $10,000 per year to CHOI for Haitian Hearts. We noticed that on April 1, 2001, Caterpillar only donated $500 to Haitian Hearts. Where had the other $9,500 gone?

When CHOI hired Linda Arnold as director of CHOI Foundation in the late 90's she brought me a letter to sign that said that Haitian Hearts had donated $300,000 to CHOI. (I knew we had donated at least $600,000 to CHOI over the years. ) I told Linda that her amount was wrong, so she changed it to $400,000. I refused to sign that letter as well, telling her the amount was at least $600,000. She left the room and changed the letter yet again to $600,000. I signed this letter. My faith in the good faith of CHOI Foundation was falling quickly. The best I could say, was that their “book keeping” was bad.

Haitian Hearts never received itemized bills for our Haitian kids. CHOI just told us what they “cost”. So to check this out, an OSF nurse reviewed 6 charts of Haitian kids bills, and found that we had been charged $40,000 too much. (Example: Heart valves that were donated by the companies that make them for the Haitian surgeries, were charged to the kids.) When we showed Paul Kramer the errors, he did give Haitian Hearts credit for these OSF mistakes. I wondered how many more mistakes there were that we would never know about. This was so important to know, because it could mean that we were leaving kids in Haiti because of poor bookkeeping at OSF.

I did ask for itemized bills with a written request in 2002, but never received the bills. Hospital spokesman Chris Lofgren played this down in the Journal Star.

OSF also purchased a $21,000 sonogram probe with Haitian Heats money by mistake, and apparently returned the money to the Haitian Hearts account within CHOI.

A physician donated overtime hours he had worked to CHOI-Haitian Hearts. His donations over the years did not show up on the computer sheet at OSF Foundation as going towards surgery for Haitian kids. I tried to track down his money for 2 years at OSF, and was unable to. He was afraid to look for it himself for fear of repurcussions against him by OSF. He also would not speak to a Journal Star reporter over where he thought his donations ended up.

After I was fired on December 18, 2001 Paul Kramer constructed a letter to the financial supporters of CHOI. However, Paul would not sign the letter. Also, there was not a date on the letter. It was signed by the wife of one of the cardiologists who took care of Haitian kids over the years. The letter stated, that despite my “leaving” OSF, "the future of the Haitian Hearts program was bright and that the commitment of the Sisters and much of the central Illinois community is strong. This program will continue.”

The idea, of course, was that just because I was gone, don’t stop donating to CHOI. I was pretty sure that OSF was going to stop their support of Haitian kids coming to OSF, I just didn’t know when. Paul Kramer was too smart to sign the letter, probably because he knew what the fate of Haitian Hearts at CHOI was going to be also. (Sources close to Steffen within the medical center had told me, prior to my firing, that Steffen was going to cut OSF’s support of Haitian Hearts.)

On January 3,2002 OSF spokesperson Chris Lofgren confidently stated in the Peoria Journal Star, “John’s leaving (St. Francis) really doesn’t change Haitian Hearts at all. I was quoted as saying, “Haitian Hearts was held over my head by Keith Steffen. The implication was, Haitian Hearts would survive if I survived (at St. Francis). ”

During the Spring, 2002, Haitian Hearts under the guidance of Jim Holmes, a Haitian Hearts supporter, approached CHOI and Paul Kramer and told them we wanted to build a house in East Peoria, sell the house, and give what we made on the house (Haitian House) to CHOI for Haitian children’s surgeries. Paul did all he could to talk Jim Holmes out of this. Jim did it anyway and with the help of the central Illinois community, was able to sell the house for $177,000 at the end of 2002.

After the house sold, Mr. Kramer talked to Jim and begged him for this money. Mr. Kramer was quite insistent on getting this money from the project he discouraged from the beginning. Jim told him that the check would be sent when I gave the ok. Mr. Kramer told Jim, “Haitian Hearts does not exist and it wasn’t important for me to give the “OK”. (Haitian Hearts authorized that this money go to CHOI in early December, 2002.)

Haitian Hearts worst fears were realized when OSF pulled all financial support for the Haitian kids. This occurred on July 12, 2002. Chris Lofrgen’s statements to the media had been misleading in January and the letter written by Paul Kramer had misled the public. (Lofgren told me that he was intimately involved in the discussions with administration regarding my termination, so I don’t think the July news was a surprise to Lofgren either.)

Then things got serious.

Mr. Kramer spoke with the pediatric cardiology office and asked them not to schedule a cardiac catheterization on one of my Haitian girls in Peoria. The nurses in the office told me this. Thus, this delayed her diagnostic work up and surgery. I could tell the nurses felt bad about this.

I took a nun with me to Mr. Kramer's office and confronted him about his behavior. He didn't deny that he did this but I could tell he was not happy about being caught.

I called the Pediatric Resource Center at OSF and made a formal report regarding negligent behavior of the Executive Director of Children's Hospital of Illinois, Mr. Kramer, towards Children's Hospital patient needing heart surgery. Immediately, Mr. Kramer's ruling was overturned, and the Haitian girl was put on the schedule that afternoon.

In early August, 2002, another Haitian Hearts patient of mine, 7 month old Samuel suffered an arrest in his host family's home in Roanoke, Illinois. The host family and I thought that Samuel's surgery has been delayed inappropriately. We spoke with Mr. Kramer about this also. He denied, as usual, and Samuel's American mother told Mr. Kramer that she did not believe him.

In the fall, 2002, a Rotary Club North (RCN) official, Lyn Banta, called me one afternoon. He told me that Linda Arnold at OSF Foundation had just called him and demanded RCN turn over any funds they had collected for Haitian Hearts for transportation, food, medication, for the Haitian kids. This amounted to $12,500. This fund was designed for people like the small group of us who sat around my kitchen table and paid for these expenses out of our pockets. Now, OSF-CHOI Foundation was attempting to get these funds. Paul Kramer told a Haitian Hearts supporter that he had asked Arnold to make this call to Mr. Banta. Paul was part of the original conversations with Lyn Banta when this independent fund was started by RCN, and Paul knew that money was not to go inside of CHOI for CHOI’s expenses. Mr. Banta refused to turn over the funds to Arnold, even though she was “adamant” that he give them up. Mr. Banta told me that day, “John, you would never have seen these funds, if I had given them to CHOI- Foundation. ”

So, at the end of 2002, Haitian Hearts had raised and donated $445,000 to CHOI for their work with the Haitian kids. This totalled at least $1.1 million raised by Haitian hearts in 7 years, all of it going to CHOI. Multiple attempts were made to discourage us from raising funds for these kids by Mr. Kramer, and Arnold had tried to tap into Haitian Hearts funds that were not to go to CHOI. And true to what I was told, OSF-Administration cut any funding for Haitian Hearts in July, 2002 which was opposite to what OSF was telling the media in January. (No one in Haitian Hearts really believed what OSF said to the media.)

Then, to top off the year, Paul Kramer called the American Consulate in Port-au-Prince, Haiti after he received the Haitian House check in December, and asked the Consulate not to grant any more visas for my kids who needed to travel to OSF-CHOI for surgery. When the Consulate officials were telling me this in Haiti, a young lady, Bisolo, who was a Consulate official, began to hyperventilate and had to sit down. She knew what OSF-CHOI’s demand would mean for the Haitian kids in Haiti that would now not be able to leave Haiti…..

In 2003, as the end of summer came, Haitian Hearts had received no money from Children's Hospital of Illinois. We had become a non-profit in October, 2002. CHOI was keeping donations that was meant for Haitian Hearts. We took this to Illinois Attorney General Lisa Madigan's office. Their point man told me that OSF had "clearly done Haitian Hearts wrong" (not exact quote, but very close.)

And in the last few years Mr. Kramer has sat on OSF's International Committee that has rejected Jackson Jean-Baptiste and Maxime Petion. Both have died after they have not been allowed to return to OSF for repeat heart surgery.

During the last 15 years, OSF-CHOI has lost a fair number of pediatric specialists. They have left town. It is very sad because they were excellent clinicians. Most people in central Illinois don't even know what we have lost for our children.

One of the physicians that left Peoria told me that Paul Kramer disappointed the most. I would agree.

Haitian Deportations Continue

Haitians Look for Shift in Immigration Policy


By GINGER THOMPSON
New York Times
February 27, 2009

MIAMI — Vialine Jean Paul has noticed a change when she drops her 7-year-old daughter off at school each morning in recent weeks. Her daughter, Angela, is not sure that her mother will be back to pick her up.

“She tells me, ‘Mommy, good luck,’ ” Mrs. Jean Paul said. “She asks me, ‘Mommy, if you go to Haiti what will happen to me?’ ”

Though Angela does not know it, the hopes of tens of thousands of Haitian immigrants and their relatives have become fixed on her mother’s fate. Mrs. Jean Paul is one of more than 30,000 Haitian citizens who have been ordered deported from the United States. Her case could be an early test of whether the Obama administration will break with the strict immigration enforcement policies of the Bush administration.
After an estimated 1,000 people were killed in mudslides in Haiti last year, the government asked the United States to grant temporary protected status to Haitian immigrants — relief that was extended when Honduras and El Salvador were hit by similar disasters. The designation is intended for countries in such dire trouble that receiving deportees would undermine their stability.

Deportations of Haitians were temporarily suspended last September, while the Bush administration considered the request. In December, the request was denied and the deportations resumed.

Lawyers say hundreds of people were detained, pushing detention centers across Florida beyond capacity. Hundreds of other immigrants were forced to wear electronic monitoring devices.

Advocates for immigrants said the arrests and deportations have taken a toll on Haitian communities, tearing immigrants — whose crime was entering the United States illegally — from their American spouses and children.

“They told us they were going after criminal aliens,” said her lawyer, Cheryl Little, referring to the immigration policies of the Bush administration. “Would we be any safer if Vialine were deported? I think not. We are devoting a lot of resources going after the wrong people.”

Mrs. Jean Paul, 35, had not set foot in Haiti since she fled 17 years ago, in the turmoil after a military coup. During her time in this country, she had married an American citizen and devoted herself to taking care of Angela, who suffers from an undiagnosed illness that causes severe headaches and vomiting.

On Feb. 10, the date she was ordered to report for deportation after exhausting efforts to remain in the United States, she was on her way to an immigration office to turn herself in. Then her cellphone rang, and an immigration officer told her that her deportation had been delayed.

Aides to Homeland Security Secretary Janet Napolitano said she was reviewing the matter of Haitian deportations.

Meanwhile, the Haitian government has refused to issue travel documents to deportees, and the United States authorities said they were worried that confusion in Haiti over American policy was causing a surge in the numbers of Haitians trying to flee their country.

The Coast Guard intercepted 624 Haitians at sea in January, compared with none in November. Another 214 were intercepted on an overloaded freighter last weekend.
A decision on Ms. Jean Paul’s case is expected March 9.

Saintenese Mentor said her husband, Brice, might not have that long. A former aide at an adult education center and the father of two children born in the United States, he was detained six months ago, Mrs. Mentor said.

Mr. Mentor’s lawyers said the authorities had told them his deportation was imminent.
A State Department official, who asked not to be named because temporary protected status is a Homeland Security matter, said the United States was aware of the hardship caused in Haiti by last year’s storms. He noted that the United States responded with humanitarian assistance, including medical services provided aboard the amphibious assault ship Kearsarge.

But, he said, the United States determined that a strong international presence in Haiti, led by some 10,000 United Nation peacekeepers, gave that country sufficient support to accommodate deportees.

“This is a controversial position,” the official said, acknowledging a flood of letters from Haitian advocates and members of Congress, along with newspaper editorials calling onPresident Obama to stop the deportations. “But we believed Haiti had the structures on the ground that it needed to solve its problems.”

Haiti’s ambassador to the United States, Ray Joseph, disagreed with that assessment. Haiti’s existence has largely been defined by chaos. But the storms, he said, deepened the crisis, fueling runaway inflation and food shortages. He said tens of thousands of storm victims have been left without proper shelter, and the country is plagued by violent crime.

“Haiti had a very, very bad year in 2008,” Mr. Joseph said. “Why send these people back, when we have no place to put them?”

Louiness Petit-Frere exists on the charity of friends, according to his wife and relatives. He was detained six months ago when he and his wife, an American citizen went to request legal status for him. He was deported in January.

“He has no family there,” said his wife, Sherly Desir Petit-Frere, who recently returned from visiting him. “He has no water, no electricity, no work. It’s hell for him.”

Mr. Petit-Frere’s brother, Sgt. Nikenson Pierre Louis, just returned from two combat tours in Iraq.

“All the hard work and fighting I did to defend this country, I feel like none of that mattered,” said Sergeant Pierre Louis.

OSF's Ethics Director Does not Answer Consult

On February 12 I posted a letter I had written to the new Ethics Director at OSF-SFMC.

I did not receive an answer.

Is it ethical not to answer an inquiry regarding an ethics question?

My guess is that Ms. Skujdak Mackiewicz was told not to answer by the "higher ups" at OSF.

Welcome to OSF and Peoria.

Looking Back....The Peoria Ambulance Monopoly

On November 17, 2002, the Journal Star published an article I had written as an Op-Ed.

The article expressed my concerns over the ambulance/paramedic monopoly in Peoria.

(I have been unable to find this Op-Ed in the Journal Star Archives and so I was not able to post it here.)

Over the next few months after the Op-Ed was published readers wrote to the Journal Forum. Some were in agreement and others wrote that Peoria's EMS situation was just fine.

However, in 2008, the Peoria Fire Deparment became Paramedic for the first time. So things probably weren't fine in Peoria during the previous 15 years.

The following article was exceptionally good and appeared in the Journal Star.

My comments follow.


December 8, 2002
Sunday

CATHARINE SCHAIDLE

City explores giving fire department more power -- However, proposal taken off Peoria City Council's agenda

PEORIA - The city of Peoria wants to upgrade its fire department from offering basic life support services as it does now to becoming an intermediate service that can also administer medication in emergency situations.

''The fire department has been given the power by the city to explore the possibility of going into ILS (intermediate life support),'' said Fire Chief Roy Modglin. ''Intermediate life support is one step higher than what we are allowed to do at this time.''

At the intermediate level, firefighters would be able to administer drugs and other medication in addition to instituting a defibrillation program that will increase the chance of survival for those who suffer a heart attack. A proposal to make this happen was on the Peoria City Council's agenda for this week, but it recently was retracted.

For 15 months, representatives of Advanced Medical Transport, the fire department and the city have been meeting to discuss the issue and possibly develop a collaboration program with AMT. The latter group would provide the necessary training.

One caveat of the proposal was that it didn't let the fire department enter the ambulance business for a certain number of years, said at-large Councilman Jim Ardis, who is involved in the negotiations. Most ambulance services are certified to provide advanced life support services - which is yet another step higher.

For years, AMT has balked at the fire department entering this arena. AMT is an independent not-for-profit organization initiated by the three Peoria hospitals. It has been providing ambulance and wheelchair van transportation services to 22 communities in the Peoria area for more than 10 years.

The majority of municipal fire departments provide ambulance services says Pete Stehman, information service manager of Associated Firefighters of Illinois in Springfield. According to the association's figures, in Illinois there are 16 union fire departments with 100 or more firefighters. Of this number, at least 13 of them or 81 percent transport patients. There are eight fire departments that serve populations of 90,000. Of this, six departments or 75 percent handle transportation.

AMT is willing to help the fire department advance to the intermediate level, but it does not want the department to transport patients, said Andrew Rand, AMT executive director.

''They can provide more comprehensive care than they do now,'' Rand said. ''It's a powerful system, and in fact we agreed to provide that training free.''

Rand said Ardis had also proposed a franchise agreement where both parties would collaborate on improving services.

''We were going to receive hazmat training and decontamination procedures from them because we are on the frontlines of bioterrorism and decontamination,'' Rand said.

The point of contention however, Ardis said, is AMT's insistence that the city keep out of the ambulance business for an extended period of time.

''That's one of the issues that has fluctuated a lot,'' Ardis said. ''It has been anywhere from four years to 10 years. My impression is that we aren't going to commit to anything longer than four to five years.''

Proponents of letting the fire department transport patients argue that the fire department should be in the ambulance business because it is usually first on the scene of an emergency situation and provides basic life support. They argue that two or three minutes can make a difference in saving a life. In addition to transporting patients, proponents want the firefighters to be able to administer the necessary drugs and bill the patient for the service.

The proponents have written several letters to the editor recently publicizing their stance.

Rand disputes that the fire department is usually the first responder.

''That is absolutely false,'' Rand said. ''They keep propagating it but their response time doesn't jive with their records.''

Rand said he's obtained fire department records through the Freedom of Information Act which shows otherwise.

In addition, Rand said that while the fire department responds to all calls with lights and sirens, the AMT uses lights and sirens only half the time. ''We prefer not to risk life and limb of citizens when there is no immediate emergency,'' he said, adding that if a person had a minor injury, an additional two or three minutes would not make a difference in that situation.

Rand also said the fire department has stated it is not interested in providing ambulance service.

''All of the discussions have been that the fire department wants to do intermediate life support, and it does not want to transport patients. That has always been the position. That was what the agreement was written to address; to balance the collaboration of both parties,'' Rand said.

But, city officials have not ruled it out.

''If we want to have a highly trained fire and medical department in the city, there is nothing that AMT can do to prevent us from doing so,'' Ardis said. ''That is a policy decision. I don't think that anybody can make the argument that anybody would not want the best trained people to be there for them all the time in case of an emergency. Why would you not want that?''

Rand said he requested that the proposal not be presented to the Council at this time because City Manager Michael McKnight had advised the council not to adopt it. McKnight did not return Journal Star phone calls.

''I don't think it is appropriate for that agreement to come up, and what we have asked the city to do is sit down and see what it takes to solve 15 months of negotiation,'' Rand said.

While Rand is confident that all the differences will be resolved, Mayor Dave Ransburg said he did not know when the subject is likely to come before the council.

''Will it come back on? I don't know,'' Ransburg said. ''It may never come up again.''

Another part of the proposal is for AMT to pay the city a fee of $60,000 a year for using the city's dispatch system. Currently, they pay nothing.

''All that the city provides to AMT is an address to an emergency situation,'' Rand said. He said the service is not comparable to what other departments, such as the Peoria Sheriff's Department, receive.

''The city's dispatch center actually follows a deputy to that whole call,'' he said. ''With AMT it is not even dispatching; it's simply messaging from their computer to ours.''
-------------------

My comments from today, February 25, 2009:

1. Not much had changed since 1992. AMT wanted to keep the transport monopoly of sick EMS patients in Peoria. And Andrew Rand was proven wrong when Matrix came to Peoria and studied response times in and reported to the City Council that the PFD responded about 1.5 minutes quicker than AMT to life threatening events. Peoria Fire Fighter Terry Carter had hit it all on the head 10 years earlier.

2. Where were Drs. George Hevesy and Rick Miller? Why weren't they supporting that the PFD upgrading to Intermediate level? Did OSF have anything to do with their silence?

Dr. Hevesy was being paid by AMT.

3. The next month, January 2003, AMT lost a City Council vote for the contract to be the only paramedic/transport agency in Peoria for the next ten years. And Andrew Rand and AMT did not teach the PFD to become Intermediate providers.

4. I will provide Forum letters that appeared over the next several years in coming posts. Dr. Rick Miller at OSF continued to defend Peoria EMS and the PFD stayed at Basic-D with Basic drugs. When a man died in the restaurant a few years later, and I spoke to the City Council about this, things started to change.

Looking Back....Samuel Valbrun

Peoria Journal Star, The (IL)
August 27, 2002

ELAINE HOPKINS

A chance to survive -- Haitian Hearts program provides child's surgery

PEORIA - With his aunt and cousin at his bedside, a 7-month-old Haitian baby struggled for breath Monday as he recovered from heart surgery at The Children's Hospital at OSF Saint Francis Medical Center.

''He's a survivor,'' said Janet Knepp, a Haitian Hearts supporter who has cared for the baby, Dan-Samuel Valbrun.

Samuel's cousin, 32-year-old nursing student Myrtho Dupresil of Jersey City, N.J., said hospitals in New Jersey turned her down when she asked them to provide the lifesaving surgery that the baby needed.

A friend of a friend in Haiti knew of Dr. John Carroll, the Peoria physician who founded the Haitian Hearts program, she said.

''He saw the baby and said surgery was needed or he would die. They brought him here,'' Dupresil said.

Samuel is one of 90 Haitian children whom Carroll has brought to the U.S. for surgery and post-operative care unavailable in Haiti. The charity program has been supported by donations and fund-raisers.

Doctors donate their surgical skills, and the hospital, usually St. Francis in Peoria, has supported the effort in various ways, lately by offering discounts to Haitian Hearts patients.

Asked about the ethics of spending scarce medical resources on a few very sick children, Carroll questioned whether medical spending should be a matter of selecting priorities.

''The money is there in our society,'' he said. ''The technology is there. The will is there, among the nurses, the physicians, the providers, and we should be doing this. There's no reason every hospital in the U.S. could not help out'' by providing this type of care.

Dr. Gary Raff performed heart surgery on Samuel that repaired a congenital defect complicated by the reversal of his abdominal organs. He had suffered oxygen deprivation since birth, Carroll said, and his body still is adjusting to the repairs.

His prognosis is guarded, Carroll said. ''He doesn't have a normal heart and may need further corrective surgery but the (procedure) helped him and raised (his) oxygen levels. Every day is a big day for Samuel. He fights a bunch of little battles every day.''

Dupresil and the baby's aunt, Anchise Valbrun of Haiti, arrived last week. They're leaving today but Dupresil is adopting Samuel to keep him in the U.S. for additional medical care.

Samuel arrived in Peoria on June 29, and was cared for by a registered nurse in the Haitian Hearts program until a family emergency sent him to live with the Knepps.

The surgery and its difficult recovery were only the latest travail for Samuel.

Tears filled Knepp's eyes as she described how Samuel awoke early Aug. 3, was fed, then suddenly stopped breathing. Knepp said she called for her husband, dialed 9-1-1 then watched in amazement as the couple's 17-year-old daughter, Sarah Knepp, who had been asleep, awoke and administered CPR, saving Samuel's life.

Sarah had been a lifeguard, Knepp said, but had never saved a life at the pool.

Knepp had gone to Haiti with Carroll, had taken Samuel from his mother, Rosemond Valbrun, and held him on the flight back to Peoria. ''I was the one who carried him home. I took him from his mother. Nothing could happen to him,'' she said.

Samuel is the Knepp family's fifth Haitian child in the program. ''You can tell your (own) kids about helping others but until they experience it,'' she said, they won't understand.

Samuel's birth in Haiti was also difficult. He is the only child of Rosemond Valbrun, a 40-year-old single mother, Dupresil said. Just before her due date, the mother collapsed and had to be resuscitated, Dupresil said.

Samuel immediately had breathing problems because of his heart difficulties, and spent most of the spring in Haitian hospitals on oxygen.

Despite his medical problems, Samuel is bright and friendly, Knepp said. He says ''da-da'' and smiles, and plays with toys. He weights only 11 pounds, but has gained weight since arriving in central Illinois.

''They're big challenges,'' Carroll said of the Haitian children. ''It takes courage to take care of them.''

CAPTION: Dan-Samuel Valbrun

CAPTION: Myrtho Dupresil, left, of New Jersey and Anchise Valbrun, of Haiti smile at 7-month-old Dan-Samuel Valbrun as he lies beneath an oxygen hood at OSF Saint Francis Medical Center's pediatric's intensive care unit Monday morning. Dupresil found the Haitian Hearts Program while desperately trying to find a way to get her tiny second-cousin life-saving medical treatment unavailable in Haiti. Samuel was born with a defective heart and other serious health problems. Dupresil and Valbrun, Samuel's aunt, came to Peoria last Friday before his heart operation.


My comments:


1. At the clinic in Haiti in June, Samuel was brought to me. He had congenital heart disease. I examined him and reviewed his echocardiogram. I called Dr. Dale Geiss, our excellent pediatric heart surgeon in Peoria. He told me that if I did not bring Samuel, the baby would die.

2. We returned to Peoria with Samuel and with other kids that needed heart surgery on June 29, 2002.

3. Samuel had his appointment with the pediatric cardiologist soon after we arrived in Peoria. His cardiologist recommended surgery within the week.

4. Samuel’s host mom was pediatric cardiac intensive care nurse at OSF. She was pleading that Samuel be operated quickly.

5. However, weeks went by, and Samuel was not operated.

6. At about 6 AM on August 3, 2002, I received a phone call. On the other end of the line was Janet Knepp who was hysterical and screaming that Samuel had just quit breathing and her daughter was doing CPR. They lived 25 miles from Peoria and called the local volunteer ambulance service. I told Janet to continue all support and that I would meet them in the OSF-ER.

7. As I quickly drove down Main Street in Peoria, I was planning Samuel’s funeral. How terrible and sad, I thought. I felt physically ill.

8. Waiting in the OSF ER for the arrival of the ambulance was torture for many reasons. Finally, the squad arrived and we descended on the big white stretcher with Samuel’s little brown body in the middle. However, as I looked at him, I heard him make a whimper.

9. Samuel was alive and trying to breathe. His eyes opened and, even though his gaze was divergent, he was looking around.

10. In the ER we supported him with oxygen and an IV and admitted him to pediatric cardiac intensive care.

11. As the days went by, Janet Knepp and I told Paul Kramer, Executive Director of Children’s Hospital, how upset we were with the delay in Samuel’s surgery and his subsequent arrest.

12. Samuel was stabilized and operated at OSF Children’s Hospital of Illinois.

13. I met with Monsignor Steven Rohlfs of the Catholic Diocese of Peoria to report Samuel’s neglectful care at OSF. Monsignor Rohlfs responded, “If it ever happens again, let me know.” That was it.

Looking Back...OSF Cuts all Financial Support for Haitian Hearts

Peoria Journal Star
July 14, 2002

ELAINE HOPKINS

Haitian Hearts loses funding -- St. Francis slashes support

PEORIA - OSF Saint Francis Medical Center has cut most of its financial support for the Haitian Hearts program.

The hospital has been providing $257,000 yearly in nursing and other support for the sick children from Haiti, Dr. John Carroll, who founded the program seven years ago, said Saturday.

But at a meeting Friday night, the Haitian Hearts committee learned that support will be cut and the hospital now will offer only a 55 percent discount off its regular charges to care for the children, Carroll said.
''This will mean the deaths of Haitian children,'' Carroll said. ''I walked out the door'' at the meeting, where some others in attendance were in tears, he said.

St. Francis spokesman Chris Lofgren said Saturday the discount offered to the Haitian Hearts program softens the blow. ''It probably is a deeper discount than other contracts'' at the hospital, he said.

''We're contacted by a wide variety of groups for international kids. We have to get a handle on services provided to all international patients, including Haitian Hearts patients,'' Lofgren said.

With fund-raising from the Haitian Hearts group, about 15 patients will be served annually, Lofgren said. ''We are not turning our back on the Haitian Hearts program.''

Carroll said the hospital's support of $257,000 was in addition to a 45 percent discount for the children's care, a discount that he believes was above the hospital's actual costs.

Carroll worked at St. Francis for 21 years but was fired in December after a dispute with hospital officials over care standards in the emergency department. He still retains hospital privileges, however.

At the time, hospital officials said support for Haitian Hearts would continue, though Carroll expressed concern that it would diminish or end.

If the hospital cannot afford the program, top executives should take pay cuts and channel that money into the program, Carroll said Saturday.

Surgeons have donated their services to the Haitian children, he said. Carroll also has financially supported the program himself.

Support for the program is ''the right thing to do,'' follows the mission of the Sisters of St. Francis and also provides valuable learning experiences for the hospital's residents and medical students, he said. ''These kids are from the developing world.''

Since the year began, the Haitian Hearts committee has raised more than $400,000, which Carroll said has been paid to Children's Hospital at St. Francis. It's raised more than $1 million in the past 41/2 years. That level of fund-raising will be difficult to sustain, he said.

Carroll said he was not sure when the hospital's support was ending, but he felt the fund-raising had been sufficient to treat the seven Haitians he brought here at the end of June.

Lofgren said he also was unsure when the cutback goes into effect, but the hospital's fiscal year begins Oct. 1.

My comments:

1. As Haitian Hearts predicted, OSF cut all financial support for Haitian Hearts. Behind the scenes Keith Steffen had indicated all along that he was going to cut support. (Behind the scenes Mr. Steffen also said that Haitian kids make him want to vomit...) And Chris Lofgren told the public that OSF was not turning their back on the Haitian Hearts program....as they were cutting all financial support for the program.

2. Now OSF was going to charge Haitian Hearts 55% of total charges per case. This was a lot of money. We raised money with spaghetti dinners and selling cookies. And this would mean the death of Haitian children.

3. No OSF Sisters were present at the meeting. Sister Judith Ann had told me multiple times that they would never turn down a child. But at the same time the Sisters were allowing their administrators to cut all funding for these kids. The Sisters had lost control of the hospital. And it was going to get worse in the coming years.

Looking Back at the Haitian House after Paul Kramer told us not to build it...

This will be an interesting post...

What will this be about?

It will be about Children's Hospital of Illinois discouraging us from building the house. And then when we built it, Paul Kramer pleaded for the money.

Mr. Kramer told Jim Holmes there was no such thing as Haitian Hearts and asked Community Foundation Director James Sullivan to release the money. Neither individual would release the money to Mr. Kramer.

After Haitian Hearts donated the money (approximately $187,000) to Children's Hospital at the end of 2002, Mr. Kramer "thanked us" by calling the American Consulate in Haiti to stop me from bringing any more Haitian children for heart surgery to OSF.



Peoria Journal Star
March 20, 2002

MICHAEL SMOTHERS

Haitian Hearts breaking new ground -- Proceeds from sale of $200,000 home will go to Carroll program

EAST PEORIA - Katina Antoine clutched her arms around her jacket and looked out of her element. Temperatures never dip near freezing in Haiti.

But the muddy ground on the wooded lot along Illini Drive has thawed by now and Katina, 7, took the gold-painted shovel handed to her and joined local dignitaries and friends, including Dr. John Carroll, in turning a ceremonial first spade of earth.

Soon, the holes they started will reach deep enough to hold the full basement of a house that Carroll and other members of the grass-roots Haitian Hearts Program hope will sell for $200,000 or more.

None of that money will pay the home's builders, Jim Holmes & Sons of Groveland, or even the building materials' costs, said Holmes and Jeff Kolbus, who represented the Homebuilders Association of Greater Peoria at the groundbreaking ceremony.

Every dollar from the home's purchase, they said, will go directly to the charity, which Carroll helped found to bring young people from the poverty-stricken Caribbean country to Peoria for live-saving heart surgeries.

''When I see this project (begin), I'm seeing five Haitian kids waiting to come for heart surgery,'' Carroll told the group, which included Mayor Charles Dobbelaire and city commissioners Harold Fogelmark and Betty Dodson.

Carroll and Kolbus credited Holmes, who with his wife is adopting a Haitian child too ill to return home with much hope for survival, for organizing the plan to build the home entirely with donated materials and labor for the charity's benefit.

Carroll and other charity officials personalized the point of their program by bringing Katina and five other Haitians, whom Carroll has most recently selected for surgery, to the one-third-acre site in the 700 block of Illini. All but Yvel Gresseau, 28, are children, ages 2 to 16.

''They all need surgery,'' said Carroll, who in December was released from OSF Saint Francis Medical Center after 21 years as an emergency room physician but still maintains ties between the hospital and the charity he co-founded.

Holmes said he expects to begin construction of the home by next week and complete it in time for sale offering in late June.

Looking Back....the Journal had to Silence Pam Adams in 1992

Why did Pam Adams publish nothing during the next 16 years about Dr. Hevesy being on Advanced Medical Transport's (AMT) salary? Or about AMT's Medicare fraud conviction?

Why did Pam Adams publish nothing on Haitian Hearts kids being allowed to die due to OSF's negligence?

I don't think her Journal Editors would allow her to write about these stories.

Her articles would be too bad for Peoria and for the Journal.

Here is an article that Pam wrote in 1992 regarding the newly formed Advanced Medical Transport.

Below the article are my comments.
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Journal Star (Peoria, IL)
November 8, 1992

PAM ADAMS


AMBULANCE COSTS SOAR WITH SERVICE....BILLS FOR BETTER CARE CAN MAKE TEMPERS FLARE

Rona Ramage thought she was taken for more than an ambulance ride when the $440 bill arrived.

"I thought it was a mistake," she says. "They didn't do anything but get me out of bed and take me across town."

The $400 was the base rate, the $40 was a $5-a-mile-charge.

Ramage's injuries were no more than a muscle spasm, but her husband didn't know that when he dialed 911 for an ambulance last June. She had gone to bed with a stiff neck, only to awaken unable to move without excruciating pain.

Though the pain was gone in a few days, it came back a few weeks later when her insurer asked for an itemized bill because the ambulance charge was so high.
Angry at the cost, Ramage started asking questions. And she got a stiff-necked lesson in what it means for a city to have almost state-of-the-art ambulance service -- Advanced Medical Transport of Central Illinois.

AMT, the only ambulance service in the city of Peoria and parts of the rest of the county, is a not-for-profit corporation owned by Saint Francis and Methodist medical centers and Proctor Hospital. (Although officials say their eventual goal is to convert it to a for-profit private company.)

The good news is, until AMT was started in 1991, Peoria had never had such a high level of ambulance service. "The city has not been this well covered, ever. It's one of those things nobody knows," says Dr. Jim Thomas, emergency services director at Methodist and associate medical director for the Peoria Area Emergency Medical Service System.

AMT has 14 paramedic ambulances to cover Peoria, Bartonville, Dunlap and Limestone Township. Each ambulance is staffed with a paramedic and an emergency medical technician.

In years past, there were only two paramedic ambulances to cover the area.

The bad news is, citizens pay high-level prices for care that involves highly trained paramedics operating out of ambulances that are basically mobile emergency rooms, or Advanced Life Support systems.

The base rate increased from $300 to $400, which does not include mileage or charges for any medical services provided by paramedics. The other bad news is that AMT's aggressive tactics created tensions with some other Emergency Medical Service providers -- fire department rescue squads, volunteer fire departments, ambulance companies -- most of whom operate with Basic Life Support systems, staffed with emergency medical technicians. Those emergency technicians only provide the basics until a paramedic arrives or the patients gets to the hospital.

"There's the general feeling that when something is more expensive, it's a bad thing. The other issue gets to be, in some ways the ambulances appear to encroach on what may have been viewed as the work of government units, like a fire department," says Peoria County State's Attorney Kevin Lyons, himself a member of the volunteer fire department in Hanna City.

"I hate to say it's competing for victims, but it is."

Dr. George Hevesy of St. Francis is project medical director of the Peoria Area Emergency Medical Services System, a state-mandated entity made up of public and private agencies responsible for pre-hospital care in a 16- county region.

Because St. Francis is the resource hospital for the system, Hevesy acts as sort of an emergency czar, with ultimate responsibility and supervision of the medical aspects of ambulance companies, fire departments, rescue squads and their paramedics or emergency medical technicians.

"I do not -- nor will I -- allow competition for victims," Hevesy says. "The patient loses because the focus is not patient care, but politics."

Hevesy, along with associate medical directors of the area's emergency services system who are based at Methodist and Proctor, were strong proponents of an Advanced Life Support system with fast response and flexible deployment. Good or cheap Ramage questioned the care she got, but what she really wanted to know was how AMT could get away with charging so much.

Hevesy's answer is that area residents either can have a good, fast system or a cheap system.

Basically, Ramage paid Advanced Life Support prices when all she needed was basic care. But people don't always know that when they dial 911 -- which automatically means that they will receive advanced care.

Ramage got a clue to the complexities when she called the American Ambulance Association and the Illinois Department of Health, which regulates emergency medical service systems.

She also called other area ambulance companies to compare prices. That's when she learned, "There's a great deal of animosity out there about AMT." Using the information she gathered, Ramage railed at AMT until it reduced her bill to $175, Blue Cross/Blue Shield's usual and customary fee.

Andrew Rand, director of AMT, says the care Ramage received did not deviate from accepted standards and that the reduced bill was a last resort to resolve a problem with a persistent, irate customer.

"The American public will always expect ambulance service at taxicab rates. Those aren't taxicabs," he says, gesturing toward the fleet of ambulances beyond his office walls.

Quick response sought Rand, 31, is a paramedic with a degree in finance. The three hospitals hired him to shepherd a fragmented, slow- responding, money-losing system into an efficient, life-saving, financially black fleet with at least one paramedic on each ambulance. They also wanted a system capable of responding to 90 percent of the life-threatening emergency calls within 10 minutes -- 12 in outlying areas.

AMT was created in September 1991 by merging each hospital's paramedics unit with their Mobile Medics Ambulance, itself the result of the hospitals' earlier attempts to improve ambulance services.

Along with adding paramedic rigs, the way of keeping them at hospitals changed. System Status Management strategically placed ambulances throughout the coverage area to match supply with demand. Locations are determined by use.

In reorganizing, Rand also increased the ratio of scheduled calls, for instance non- emergency transportation between hospitals and nursing homes, to 40 percent. It had previously been about 15 percent, he says.

The base rate for scheduled, non-emergency transportation, is $200. Though most scheduled transportation is paid by Medicare or Public Aid, emergency transportation for Public Aid recipients drains AMT's revenues, Rand says.

Another reason costs were lower in the past is that the hospitals were absorbing the ambulance company's losses, Dr. Thomas says.

Reimbursements from Medicare and Public Aid are $84 and $70, respectively. About 50 percent of AMT's payment sources are from Medicare and Medicaid; 32 percent from individuals; and 16 percent from private insurers.

"As we expand, we can cut costs," he says. "That's just based on economy of scale. " Broad changes AMT bought out B&B Ambulance, a privately owned company in Limestone Township, in September. In a little more than a year, AMT has been the catalyst for broad changes in emergency services. Even its critics agree that ambulance service is better.

But change is difficult, Rand says.

AMT's employees, including paramedics and EMTs, had to accept a new role "as care givers, not just lights-and- sirens response," he says. "That was very, very difficult."

Other emergency service providers, seeing AMT's growth and prestige, may have felt like they were targets, he says. "That was not our aim."

And AMT needs to improve its marketing, when it comes to explaining fees to the public, he says.

Eventually, says Thomas of Methodist, the goal is for AMT to phase out its dependence on the hospitals until it is a private company.
--------------

My comments today, February 19, 2009:

1. Wow.

2. I don't know where to begin.

3. Pam Adams described Dr. Hevesy in his role as Project Medical Director for the Peoria area as an "emergency czar". I think many EMS agencies in the area would agree with that description.

Dr. Hevesy's comments above were very definitive regarding the fact that under his watch he was not going to allow competition between EMS agencies for "victims". (The fact that he was paid by AMT may have helped him implement his policy regarding no competition.) The Peoria Fire Department (PFD) has said multiple times that Dr. Hevesy created obstructions when the PFD wanted to upgrade their services for the people of Peoria.

4. OSF and the Peoria Area EMS (PAEMSS) should have never allowed Dr. Hevesy to receive a salary from AMT. As Director of all ambulance agencies in the area, none of which paid him except AMT, he should have never accepted a salary because of the appearance of negative conflict of interest.

5. One of AMT's employees would turn in AMT to the Feds several years after this article was written. AMT was upcoding and charging the patient and taxpayer too much.

6. Why did the three hospitals in Peoria allow Andrew Rand to resume his job at AMT after AMT was found guilty of Medicare fraud?

7. Dr. Hevesy stated above that Peoria can have a "good, fast system or a cheap system" was not true. The Matrix study performed 10 years later in Peoria revealed that the PFD was responding faster to life threatening 911 calls than was AMT.

8. Too bad Pam Adams was silenced regarding EMS after this article in 1992.

Looking Back...Life Support Call Unacceptable

I found two mind blowing articles today in the Journal Star Archives which I have printed below and in the next post.

In 2001, while OSF, Dr. Hevesy, and Keith Steffen were preparing to fire me, I learned from multiple different people at OSF and EMS agencies in the Peoria area that Dr. Hevesy, OSF-Emergency Department Director, was also on the payroll at Advanced Medical Transport. Everyone, including an OSF-ER physician were screaming "conflict of interest" regarding Dr. Hevesy.

EMS providers everywhere seemed to be upset but did not know what to do since Dr. Hevesy held their EMT licenses in his hand. Dr. Hevesy also works for the IDPH and has some power and friends at the State level (which might not be a position of prestige right now...)

One day, after being warned by others, I waited for Andrew Rand, Executive Director of AMT, to leave Dr. Hevesy's office at OSF. I was having yet another meeting with Dr. Hevesy regarding my limited future at OSF. And remember, AMT was paying Dr. Hevesy, the Peoria Fire Department was not.

I was being educated by many people in the area regarding how EMS in Peoria worked.

A good friend of mine told me in detail how she lost her husband to a heart attack at OSF while waiting for Advanced Medical Transport to arrive at her home and transport her husband. Dr. Hevesy spent a fair amount of time in her home with her to try and stop a lawsuit against OSF and AMT. And over the next few years, I became aware of other people in the area that waited excessive times for AMT's arrival with subsequent bad consequences for their loved ones.

In 2002, I wrote an OP-ED which the Journal Star printed in November, 2002. The article was about my concerns that OSF and AMT were dangerously monopolizing ambulance paramedic and transport care in Peoria. (I had to submit it twice over two months since the Journal told me they never received it.) Today, I looked for my article on the Journal Star Archives and cannot find it. Maybe it is there, but I sure can't find it.

Anyway, today after my search in the Journal Archives the article below showed me that I was NOT the first to complain or document Peoria's dangerous EMS. In fact, I was ten years late.

What is not mentioned in these articles is the fact that Dr. Hevesy was being paid by AMT and, because it hadn't happened yet, AMT with Mr. Rand at the helm, was found guilty of Medicare fraud and fined over $2,000,000 dollars by the Federal government. (Peoria's three hospitals paid the fine.)

Here is the article and Pam Adams article is in the next post.

And if I can find my missing OP-ED, I will post it. Many forum articles followed it in the years to come...some supportive of AMT and some not supportive of the AMT ambulance paramedic monopoly.

Interestingly, OSF leaders defended their EMS policy to the max.... until they changed the policy in 2008. The new policy allowed the Peoria Fire Department to advance to paramedic providers for the first time in their history. More on that later.

And kudos to Peoria firefighter Terry Carter for being the first to document Peoria's dangerous EMS. I wonder how many lives in Peoria have been lost in the intervening 16 years?



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Life Support Call—Response Time Unacceptable
April 1, 1992

Journal Star (Peoria, IL)
April 1, 1992

EDITORIAL

The citizens of Peoria need to be informed of the fact that Firefighters Local 544's warning to the City Council has come true.

A basic life support call was received by Engine 12 at the Lutheran Home on Galena Road (across from the now vacant Fire Station 17) between the hours of 9 a.m. and 10 a.m. on March 19. Engine 12 just happened to be at the Fire Academy on Galena attending a CPR refresher course and responded to the nursing home, providing initial care in less than three minutes.

It took the ambulance, the one specially assigned at the foot of War Drive to cover the area lost by the 17's, 10 minutes and six seconds to arrive on the scene. This proves that response times to this area are unacceptable even under ideal conditions. Had it not been for fire units training across Galena Road, the ambulance would have been first on the scene.

A heart attack or stroke victim doesn't have 10 minutes and six seconds to spare. The public needs that initial Emergency Medical Services crew on Engine 17 that has been snatched away from them by their elected officials.

In addition, City Manager Peter Korn stated on local television that the ambulance used at War Memorial Drive and Galena Road to cover the loss of Engine 17 is a rescue team. It is not. They carry no extrication tools of any type. This crew can't even aid the fire department in extrication of accident victims for they carry no personal protective equipment such as leather gloves, helmets or eye protection.

Finally, I would like to bring attention to two people for their work.

First is Andrew Rand, manager of Advanced Medical Transportation, for aiding our city officials in not only reducing EMS personnel, but also lengthening response times through ambulance relocation. He exaggerated AMT's ability to quickly respond to Engine 17's area, rather than aiding in the fight to keep Engine 17 in service.

Second is Mayor James Maloof, who begged and pleaded to join the United Auto Workers at their recent rally in order to appear to be on the union's side. Does the mayor need to be reminded that the United Auto Workers and the International Association of Firefighters are both AFL-CIO unions?

Terry S. Carter
Peoria Firefighters
Local 544 Peoria

Looking Back...Maxime is Dead and Katina Still Fighting for her Life in 2009

My comments from today follow the article.
--------------

Haitian Hearts Still Beats Strong

February 6, 2002

ELAINE HOPKINS


Haitian Hearts still beats strong -- Despite losing his job, Dr. Carroll still helps sick children get treatment

PEORIA - After four weeks in Haiti, Dr. John Carroll arrived back in Peoria on Tuesday night accompanied by six children and an adult, all needing medical care.

''All will be big-time challenges to Peoria's medical community,'' Carroll said. ''They are all surgical cases. These kids will get the care they need; I know they will.''

About 50 friends and supporters met Carroll and the Haitians at Greater Peoria Regional Airport. The Haitians will stay with host families while undergoing medical treatment.

Carroll, 48, of Peoria, is a founder of Haitian Hearts, a charity that brings children with life-threatening illnesses to Peoria and elsewhere in the United States for treatment they otherwise could not receive. He has won awards and visibility for his work with the Haitians.

A week before Christmas, however, Carroll was fired from his job of 21 years as a physician in the emergency department of OSF Saint Francis Medical Center. He said the dispute began over his push for more beds in the department.

St. Francis officials will not comment on the firing but have said the hospital's support for the Haitian Hearts program will continue.

Despite his firing, Carroll retains medical privileges at St. Francis, and he said Tuesday he will focus, for now, on overseeing care for the Haitians.

''My goal is to keep the kids healthy, improve them, get them back to Haiti,'' he said.

Carroll's mother, Mary, was among the group at the airport. She said several potential employers have attempted to contact her son recently.

Carroll said Tuesday he is still working on treatment plans for the Haitians. ''I would like to give Children's Hospital (of Illinois at St. Francis) the privilege of taking care of Haitian children.''

All the Haitians he brought back have either rheumatic heart disease or congenital heart problems.

He first met the 28-year-old, Yvel, three years ago. Yvel had rheumatic fever as a child and likely will need two heart valves replaced, Carroll said. ''He was hard to turn down after three years.''

Dr. Stephen Bash and his wife, Patty, were among the group meeting Carroll. Bash, a pediatric cardiologist, said he is scheduled to see three of the patients immediately.

''I'll find out tomorrow (what is wrong with them) and see if we can fix them,'' he said.

The newly arrived Haitians spoke no English and were weary and hungry after 12 hours of travel. Carroll said a nurse he knew from St. Francis happened to be on the same flight from Miami, and she helped with the children. They are Katina, 7, Cathia, 11, Stanley, 5, Jean, 5, Maxime, 16, and Jocelyn, 11.

Debbie Fischer of Benson brought the four children in her household, ages 4 to 16, to meet the Haitian child she will host. She has hosted others in the past and as a nurse can handle children with special needs.

Helen Martin of Eureka and her daughter, Sally Achterberg, a board member of Children's Hospital, brought homemade comforters and bags filled with small items for the newly arriving Haitians.

Martin said her church, Roanoke Apostolic Christian Church, funded the bags and made the comforters through its World Relief program.

Achterberg said she is serving on the Haitian Hearts Auction committee, an event scheduled for April 12. She hopes the auction this year will raise $100,000 for the program. It raised $60,000 last year.

''People are very generous,'' she said.

CAPTION: Clinging to Dr. John Carroll, Katina, a 7-year-old Haitian girl, appears timid after arriving Tuesday night at Greater Peoria Regional Airport. Katina is among seven Haitians--six childre--who were flown to the United States through the Haitian Hearts program to undergo heart surgery.

---------------

My comments from today, February 19, 2009:

1. Maxime Petion, who was part of this group I brought to Peoria, was operated in Peoria in 2002. I took Maxime back to Haiti after he recovered from his surgery.

In 2006 while I was in Haiti, Maxime became sick again. He needed heart surgery. OSF refused him care along with all Haitian Hearts patients. He died at another medical center in the States in 2007 and is buried overlooking the Illinois River.

2. Katina, who is also referred to in this article, was operated at OSF also in Peoria. As documented on this blog in multiple posts, Katina is fighting for her life in Haiti now. She needs heart surgery again and, so far, I can't find a medical center for her. OSF is refusing her care too.


(Photograph of Maxime at the American Consulate in Port-au-Prince, Haiti. This picture was taken one month before he died in 2007.)

Looking Back...You can Disagree to a Point...but then be Careful

My comments today follow the article.

Journal Star
January 9, 2002

ELAINE HOPKINS

Fired doctor: Dispute began over suggested ER upgrades -- OSF official declines comment on issue

PEORIA - Dr. John Carroll was fired from OSF Saint Francis Medical Center in a dispute that began over more patient beds for the emergency department where he worked, he said Tuesday.

Carroll, an award-winning physician and founder of the Haitian Hearts program that brings sick children from Haiti to St. Francis for treatment, said he has no regrets about pushing for improved service for emergency patients.

''Would I do it again? Yes,'' he said.

Carroll said his job problems began with a letter he wrote about bed capacity in the emergency room, a letter which caused the hospital to discipline him in a ''punitive'' manner.

''The letter precipitated the incident and the discipline I disagreed with,'' he said.

The discipline involved placing him on ''probation'' for six months, Carroll said. The letter of dismissal that St. Francis sent to him mentioned ''disobedience,'' he said.

The 48-year-old Peoria native worked at the hospital for 21 years. St. Francis has been his only employer.

Hospital spokesman Chris Lofgren would not discuss the matter. ''It's an employee issue. We won't talk about it,'' he said.

Lofgren then added that Carroll ''was not fired because of ER issues. That's the only thing I will say at this point.''

Carroll said he was not offered another position at the hospital as the situation between him and his employer deteriorated. Both sides ''dug in their heels,'' he said.

Carroll acknowledged that the letter he sent to his colleagues and hospital officials circumvented the usual chain of command at the hospital. He knew he was taking a risk when he sent that letter, he said, adding, ''I wrote the letter with some trepidation.''

Carroll's firing, a week before Christmas, stunned his friends and supporters.
''He was by far the most compassionate doctor we had there,'' said a co-worker who didn't want to be identified. ''John has high standards of care and expects that care to be delivered to patients.''

The person said ''we are afraid to talk,'' for fear of being fired. ''We are in complete, absolute fear.''

''All he wanted to do is improve the ER procedures,'' a colleague said. ''He was frustrated. Others are also.''

People who have worked with Carroll confirmed Carroll's concerns about the emergency department. It was built to serve 35,000 patients a year but now is serving more than 60,000 annually. Some wait for hours, co-workers said.

Lofgren confirmed the usage figures, and said the hospital is planning to spend more than $2 million to alleviate the crowded conditions. The plans have been in the works ''for some time,'' he said.

Carroll has talked about his personal situation reluctantly, but said the truth should be told. He still believes in the hospital's mission, he said, and also does not want to jeopardize the hospital's support for the Haitian Hearts program.

He is leaving for Haiti soon and plans to stay there for a month. He said he has no idea what he will do about his career when he returns. He still retains physician privileges at the hospital, and his medical work was not an issue in his dismissal, he said.

Carroll has consulted an attorney about his dismissal, he said, but is reluctant to sue the hospital, because he doesn't want to enrich himself at the hospital's expense.

''It's not about money,'' he said of his dispute with St. Francis.
---------------

My comments on this article today, February 18, 2009:

1. While I was writing the letter to Mr. Steffen and my colleagues in September, 2001, another OSF employee in the Emergency Department strongly warned me that I may be fired if I sent the letter.

I viewed the ER overcrowding as a "hospital problem" that needed to be solved with everyone involved. Plus, I did not believe that Drs. Hevesy and Miller were strong enough or politically inclined to try and solve the overcrowding issue on their own.

2. During my first meeting with Mr. Steffen in early October, 2001 he told me in his office that "whenever there is bleeding the bleeding must be stopped before it turns into a hemorrhage" and that a "cancer needs to be cut out before it metastasizes". (Not exact quotes but very close.) He was referring to me.

3. During that same meeting with him, I told Mr. Steffen that I was worried about "institutional neglect" regarding the overcrowded Emergency Room. He asked me what "institutional neglect" was.

4. Mr. Lofgren may not have wanted to comment in the Journal about my termination, but he was sure talking inappropriately with other OSF employees. And I WAS fired regarding ER issues. Mr. Lofgren was not being truthful to reporter Elaine Hopkins.

5. The patient and employee satisfaction in the OSF ER was the lowest in the medical center. Dr. Hevesy looked at me once and said look what I have inherited. He meant that the ER was very dysfunctional under Rick Miller's direction.

6. And as Elaine Hopkins documented, we were seeing tens of thousands of patients more each year than the ER was designed to see. Elective (insured) patients were filling inpatient beds, so ER patients like mine had to wait a long time to be admitted. And studies performed since 2001 have documented increased morbidity and mortality for ER patients that are boarded in the ER.

7. I invited Mr. Steffen to come to the ER and work with us. I really thought it would be a win-win situation if he would come and join us for an evening. I thought that ER personnel attitudes would improve if they saw him working on the overcrowding issue, and I also thought that patients and their families would take solace in talking with the OSF administrator regarding their long wait in the ER.

Mr. Steffen declined my offer.

Looking Back

Peoria Journal Star
January 5, 2002

Editorial

John Carroll is the kind of a doctor all patients need

Knowing the dedication that Dr. John Carroll has shown the patients of St. Francis and the children of Haiti, his quiet dismissal was as loud as a bomb to many of his friends, volunteers and admirers.

Statements by hospital spokesman Chris Lofgren in the Journal Star were very confusing and left me wondering if this dismissal had really been done thoughtfully. How can Dr. Carroll ''still have hospital privileges to practice medicine at St. Francis'' and at the same time be told to ''leave the premises''?

I find it hard to believe that Haitian Hearts would be ''unaffected by John's departure.'' Dr. Carroll, the hospital administration and employees did not reveal the reason for dismissal. However, from statements in the Journal Star and knowing Dr. Carroll's dedication to his patients, I have to believe that the problem was due to differences with the administration over patient care and policy.

When a doctor employed by a hospital for 21 years hopes he doesn't get ''in trouble'' for carrying an infant to intensive care, there's something wrong. Also, Dr. Carroll being described as ''a perfectionist and a fighter for his patients'' may sound good to the public, but this attitude must have caused problems for the administration of St. Francis and proved to be detrimental to his career.

Dr. Carroll's friends, peers and co-workers have witnessed the dedication, self-sacrifice and care he has given his patients. The administration of St. Francis should have thought a lot longer before ever considering dismissal. He is a superb physician who will disagree vehemently with anyone or any organization that he believes does not give proper treatment to a patient. He is a doctor that all patients need in their corner when they enter an emergency room.

Terminating his employment at St. Francis will definitely not improve emergency room care and may make citizens of Peoria wonder why such an excellent doctor found it so difficult to fit into the mold dictated by his employer.

Dottie Canellas
Former St. Francis employee
Tucson, Ariz.

Looking Back...Haitian Hearts Skips a Beat

Peoria Journal Star
January 3, 2002

Phil Luciano

Haitian Hearts skips beat

Haitian Hearts still beats, but time will tell how long or how strong.

Its founder, Dr. John Carroll, was fired by OSF Saint Francis Medical Center last month. Since then, this newspaper has been deluged by calls and letters, most of them confused about the future of Haitian Hearts.

The official line from St. Francis: The hospital will keep donating its services.

But Dr. Carroll says he has been told St. Francis will stop assisting Haitian Hearts as early as this year - a move that would greatly reduce the number of children the group saves.

''The last thing we'd like to see is the demise of Haitian Hearts,'' says Carroll, 48.

Before we get to the nittygritty, let me make a disclosure: I've known Carroll for years and have worked with him at medical missions in Haiti. I'd consider him a friend, though I see him at most maybe three times a year.

I don't aim to vindicate John Carroll. I honestly have no idea why he was canned from St. Francis after 21 years in the emergency room. Maybe he doesn't brush his teeth enough, or he wears bunny slippers. But he did nothing nefarious: His termination had something to do with professional differences between Carroll and hospital poo-bahs.

The hospital refuses to discuss personnel matters, and Carroll won't talk about his firing. He doesn't want to burn any bridges that remain between St. Francis and Haitian Hearts, which he started in 1995.

Years before, Carroll had begun making medical missions to Haiti, the poorest county in the Western Hemisphere, where medical care is almost nonexistent for 95 percent of the population. During his visits, Carroll would examine children with severe ailments, many of them heart-related, that are treatable in the United States but fatal in Haiti.

Carroll began to bring back one or two kids a year, beg his cardiac colleagues for help and lean on St. Francis for assistance. Carroll began spending six months a year at Haitian medical clinics, and he'd find more and more kids with bum tickers.

St. Francis donates bed space, nurses and other services; it won't reveal the worth of its donations, but Carroll estimates the figure at about $257,000 a year. Cardiac surgeons and other specialists donate their time. Carroll himself covers many extraneous costs, such as air fare.

But those donations don't cover everything. Haitian Hearts treats about 10 children a year, at an average of $25,000 per hospital stay. However, complications can prompt overruns; one lad needed some $750,00 worth of care before returning to Haiti.

So Carroll created Haitian Hearts to help raise money. It's part of St. Francis's Children's Hospital of Illinois. Over the past three years, Haitian Hearts has raised nearly $600,000, with about $275,000 pledged for this year.

So what's the problem?

Lately, this newspaper's letters-to-the-editor have railed against Carroll's dismissal. Some question whether Haitian Hearts can survive.

Chris Lofgren, spokesman for St. Francis, wants people to understand that the hospital hired Carroll as an ER doctor, not as administrator of Haitian Hearts. The group is independent of the hospital, he says.

Carroll's termination had nothing to do with Haitian Hearts, Lofgren says. Further, he says, the hospital will continue to support the program as it has in the past, regardless of Carroll's firing.

''John's leaving (St. Francis) really doesn't change Haitian Hearts at all,'' Lofgren.

Not so, says Carroll. Though he won't talk about the explicit reason behind his termination, he says St. Francis CEO Keith Steffen wanted him to somehow change his ways.

''Haitian Hearts was held over my head by Keith Steffen,'' Carroll says. ''The implication was, Haitian Hearts would survive if I survived (at St. Franics).''

Hospital spokesman Lofgren says Steffen never tied Carroll's job to the future of Haitian Hearts. Yet Carroll says that after he was fired, St. Francis sources told him Haitian Hearts funding would be discontinued - part of a hospitalwide cost-cutting measure to offset expected decreases in Medicaid and Medicare reimbursements.

If that were to happen, Haitian Hearts could continue, but at half-power or less. But that only takes into account dollars and cents.

Without his half-time job at St. Francis, Carroll cannot afford to spend half a year in Haiti. That means not only will he encounter fewer children, but he will have less time to wade through the quagmire of Haitian bureaucracy. Visas can take upwards of a year to procure, and that's only with a Haiti-savvy guy like Carroll greasing the wheels.

Plus, without a job, Carroll could have a harder time prompting donations. Potential contributors might be skittish about writing a check to Haitian Hearts when its lead physician isn't employed.

Carroll, along with the Haitian Hearts board of directors, plan to push forward - business as usual. Upwards of 10 Haitian kids are scheduled to come to St. Francis in the next couple of months, and Carroll says everything is in place for their treatment.

After that, who knows? But Carroll (who leaves this week for another monthlong clinic in Haiti) remains optimistic.

''If we can do only one children a year instead of 10, one is better than none,'' he says.

* Write Phil Luciano at 1 News Plaza, Peoria, IL 61643, or call 686-3155 or (800) 225-5757, Ext. 3155. E-mail him at pluciano@pjstar.com.
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My comments today, February 18, 2009:

1. As Phil accurately wrote, the future of Haitian Hearts was up in the air in early January, 2002. I don't think he believed Chris Lofgren or Keith Steffen either. And Mr. Steffen did indicate to me that Haitian Hearts at OSF depended on me being employed at OSF. And even if Mr. Steffen didn't fire me in December, 2001, he was telling others that Haitian Hearts days were numbered.

2. I sure did not want to be fired from OSF. I loved the place. Taking care of patients and teaching UICOMP medical students and resident physicians was fun. Also, some residents from UICOMP and other students and medical students from other medical centers in the U.S. travelled with me to Haiti and worked in the Haitian clinics and hospitals. It was a great experience for them and for me.

Also, working with Haitian Hearts host families in the Peoria area was a superb experience. We went through many tough times together when Haitian children had setbacks with surgery...but we went through it together, and usually everything worked out fine. At times, the local host family would travel back to Haiti with the child after recovery from surgery and present them to their Haitian mother. There are no words to express this situation.

However, the more I talked with Mr. Steffen and Dr. Hevesy, I could see that OSF was headed down the wrong path regarding the Emergency Department, intimidation of OSF employees, conflict of interest, general "administrative malaise" (described by a Monsignor in the Diocese), and lack of respect for the Ethical and Religious Directives that guide Catholic health care. Dr. David Gorenz, who is President of District 150 School Board, and Sue Wozniak, CFO at OSF-SFMC, even entered a meeting I was having with Sister Canisia through a side door from Mr. Steffen's office. I had not invited them. Their main goal was to sabotage my only meeting with 87 year old Sister Cansisia.

All in all, I thought it was time to let OSF fire me if that is what they wanted. Phil Luciano of course did not know what was happening in Mr. Steffen's office. He had no idea of what Mr. Steffen was saying to me or how bizarre he was acting.

A Look Back....Letters of Support

These letters of support were printed in the Forum section of the Peoria Journal Star.

My comments follow.
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Peoria Journal Star
December 29, 2001

Editorial

Carroll's firing raises questions for St. Francis

It is very puzzling that the administrators at OSF St. Francis Medical Center would quietly fire the finest and most caring doctor in the emergency department. Was this done to intimidate other employees of the department so they would kowtow to administrators?

To me, the fact that Dr. John Carroll's dismissal was done quietly indicates guilt. I am not surprised that the administration did not want publicity for their action, given Dr. Carroll's sterling reputation in our community.

Dr. John Carroll wanted improvements made in the ER, but his suggestions were apparently rebuffed - probably because his ideas were superior to those of the administration. Dr. Carroll's dissatisfaction with the ER is certainly understandable given its recent rating of 25 out of a possible 100. Is this the kind of health care you want for you and your family?

The last time I was in the ER at St. Francis, I had to wait more than an hour before seeing medical personnel. During that time, I was left in a hall, and I felt like a spectacle for all to see. The two doctors I finally saw were not able to give a diagnosis. However, several days later, Dr. Carroll diagnosed my problem and proper medication was given.

By the way, who owns St. Francis? Why do the sisters allow situations such as this to occur? Do they ever observe procedures in the ER? Do the sisters attend meetings when important decisions are made? Do they know how the unfortunate situation created by uncaring administrators is affecting the reputation of their hospital? Why are they allowing the administrators to make important decisions that should not be made without the approval of the sisters? Did they approve the firing of Dr. Carroll?

Geraldine DuMars
Peoria



Peoria Journal Star
January 1, 2002

Editorial

St. Francis must keep supporting Haitian Hearts

OSF Saint Francis Medical Center has been very generous to Haitian Hearts. The sisters' mission needs to be preserved; Haitian Hearts is an excellent example of their love, compassion and devotion. They have supported Dr. John Carroll in his work for over six years. We want to thank the Sisters of St. Francis for their incredible generosity.

Dr. Carroll will not comment on his firing and he will not brag about his accomplishments. His patients from the emergency room and the host families of the Haitian patients are quick to tell everyone they know how he has selflessly devoted himself to their care. He has often met extended family members and others in emergency situations and made sure that we were taken care of. We are all stunned that he has been fired, because we have received such good personal care from Dr. Carroll and the other doctors in the emergency room.

The week before he was fired, he went to New Orleans and spoke to help raise money for Haitian Hearts and Children's Hospital. He knew he was going to be fired, but he went anyway. Nothing will stop him from helping those who need him. Those of us involved in Haitian Hearts hope and pray that his firing will not affect the future care of these very needy children.

There will be some financial difficulties, but we know that the sisters have been good to us in the past, and they will continue to be charitable and live up to their mission statement.

Dr. Carroll and his Haitian Hearts supporters have raised hundreds of thousands of dollars in the last three years for Children's Hospital, and we will continue to raise funds for this cause that we so deeply believe in.

Mary Kay Hersemann
Washington


Peoria Journal Star
January 3, 2002

Editorial


Haitians Hearts can't continue without Carroll

The high integrity and the moral character of Dr. John Carroll has been an inspiration to all of us who have been associated with him in his work with Haitian Hearts and the emergency room at OSF hospital.

For over 20 years, he has always lived up to his oath as a humanitarian. The dismissal of Dr. Carroll from OSF, in such a degrading manner, is not due to any professional incompetence, but rather with the administration.

As lifelong supporters of OSF, we are bitterly disappointed in the reaction of the sisters by allowing the administration to dismiss Dr. Carroll. Just last month, Dr. Carroll was the recipient of the Catholic Diocese's Bishop's Award for Service. He also received the Governor's Award last year for his Haitian Hearts program. Through all his honors and work, Dr. Carroll has always put OSF and the Children's Hospital in the forefront.

Be not deceived; there is not a Haitian Hearts program without Dr. John Carroll. He is the founder, torchbearer and the keeper of this wonderful and compassionate program.

Rebecca, Fred and Jo Ann Schotthofer
Chillicothe

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My thoughts today, February 17, 2009:

I was very grateful for the written support of these people.

However, Haitian Hearts had a bad feeling that OSF was going to withdraw their support of the program now that they had me out of the way. OSF was trying to reassure the public in the Journal and they even wrote a letter to Children's Hospital supporters saying that Haitian Hearts would continue at OSF.

Sister Judith Ann, President of OSF, had told me numerous times that the Sisters would "never turn down a child".

However, Keith Steffen, Paul Kramer, and OSF ended all financial support for Haitian Hearts in July, 2002.

Our worst fears were realized.

A Look Back and Lessons Learned

The "take home" lessons are listed below the article.
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Peoria Journal Star
December 21, 2001

ELAINE HOPKINS

St. Francis quietly fires doctor -- Renowned Haitian Hearts founder will keep healing children

PEORIA - A prominent OSF Saint Francis Medical Center physician who founded the Haitian Hearts program has lost his job at the hospital.

Dr. John Carroll, whose program brings sick children from Haiti to Peoria for treatment, said he was fired from St. Francis on Tuesday. ''I was told to leave the premises,'' he said Thursday, adding the ''situation had evolved over a number of weeks.''

St. Francis spokesman Chris Lofgren said the hospital cannot comment on why Carroll lost his job as an emergency room physician.

''This was not done lightly,'' Lofgren said. ''it was done thoughtfully over a long period of time.''

Carroll said he was not sure of his long-term plans, but he is planning to leave for Haiti on Jan. 9 for a monthlong stay. He wants to bring back more children, he said. Without advanced medical care, these children will die, he said.

''The main thing to me is the future of Haitian Hearts,'' Carroll said. He would not discuss the reasons for his job loss, but said he regretted leaving.

Carroll, 48, worked in the hospital's emergency department and has been at the hospital for 21 years. A Peoria native, he did his residency there and never has worked anywhere else.

Carroll has won numerous awards and brought national publicity to St. Francis and its Children's Hospital for the Haitian Hearts program, and also raised money for the program.

He said he has raised $819,000 in donations and pledges for the Children's Hospital of Illinois at OSF St. Francis Medical Center in the past three years.
''We're the single-highest private donor to OSF Children's Hospital,'' he said.
Carroll still has hospital privileges to practice medicine at St. Francis, Lofgren said.

Asked about the Haitian Hearts program, Lofgren responded, ''as it stands right now, it's unaffected by John's departure.''

Carroll will have to discuss future treatment of the Haitian children with the staff and physicians who treat them, Lofgren added.

Heart surgeon Dr. Dale Geiss, who has worked with Carroll and donated his services for the Haitian children, termed Carroll ''an outstanding individual and superb physician.'' He said he was not familiar with the issues leading to Carroll's job loss.

Saying he hopes Carroll stays in Peoria, Geiss added, ''I've been assured that Haitian Hearts will continue to be supported by St. Francis if that is what Dr. Carroll wants.''

Other physicians also support the program, he said.

Dr. Greg Tudor, who worked with Carroll, said hospital employees were told not to comment on Carroll's departure. Carroll is ''a community icon and nothing short of that. I can't believe it,'' he said.

Karol Holmes of Tremont is caring for a 1-year-old Haitian baby who has been treated at St. Francis since May.

''Everybody in Haitian Hearts is devastated,'' she said. ''I can't begin to understand it.''

Carroll has given ''his whole life for this. The emergency room and Haitian Hearts is his whole life. His compassion is incredible. I've never known a man like him,'' she said.

She told of Carroll fighting to save the baby's life, and at one point, personally carrying the infant to the pediatric intensive care unit without prior approval, saying ''I hope I don't get in trouble for this.''

She and others described Carroll as a perfectionist and a fighter for his patients.
''He's pretty strong willed. That's not a bad thing. If I'm sick and dying, I want him on my side,'' Holmes said.

Holmes is planning to accompany Carroll to Haiti in January, where they will seek the mother's approval for the Holmes family to adopt the baby, who will need medical care for years.

In the months before that adoption can take place, she said, the family will be dependent on Haitian Hearts and St. Francis for medical care for the boy. Carroll's situation has her worried, she said. ''What am I going to do without Carroll?''

Geiss said that Carroll's use of expensive medical resources for the Haitian children is not an issue for St. Francis, whose officials have often expressed support for Haitian Hearts.

About 75 children from Haiti have been treated since 1995, Carroll said.

''A lot of families are involved,'' he said. ''I don't think it's done anywhere else in the U.S., and I don't think the generosity of hospitals anywhere in the U.S.'' can match the generosity at St. Francis.
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My comments today, February 16, 2009:


1. This article was written a few days after I was fired from OSF in 2001. As documented in Peoria’s Medical Mafia, I was placed on probation at OSF on September 28, 2001. The day before I had written OSF administrator Keith Steffen warning him of the overcrowded and dangerous Emergency Department at OSF.

I was also aware of OSF Emergency Department Director Dr. George Hevesy’s financial conflict of interest with Advanced Medical Transport. I did not feel that Dr. Hevesy or Dr. Rick Miller, previous OSF-ER Director, would be able to do much of anything about overcrowding in the ER due to the fact that they both had excellent jobs in the ER and Mr. Steffen had too much on them for either of them to contest him on anything.

2. I was attempting to save Haitian Hearts at this point. I had been told by an insider that Mr. Steffen was going to withdraw all financial support from Haitian Hearts…I just didn’t know when he was going to do this. (OSF withdrew all financial support for Haitian Hearts in July, 2002...six months after I was fired.) Dr. Geiss was given the wrong information when he was quoted above saying that OSF would continue their support of Haitian Hearts. Paul Kramer, Executive Director of Children's Hospital of Illinois (CHOI), told me in his office before I was fired, that Haitian Hearts was becoming "too much competition" for Children's (due to our very successful volunteer fundraising). Caterpillar Inc. was donating significant money to Haitian Hearts that went directly to CHOI. I think this really unnerved OSF because they wanted donated money to go to the Milestone Project, not to children from Haiti who needed heart surgery. (Also, $9,500 dollars from Caterpillar to Haitian Hearts in 2001, months before I was fired, turned up missing at Children's Hospital of Illinois...I wonder where it went...)

Even though I was fired, we were able to keep Haitian Hearts alive at many other medical centers in the United States.

3. In the months before he fired me, in his office, Mr. Steffen would smile and tell me, “When this comes out about you, John, it won’t be good.” When I asked him what he was talking about, he would just shake his head and smile. He spoke to other employees about me and to people outside of the hospital. They told me what he said.

Mr. Lofgren, hospital spokesman, also spoke inappropriately about my termination... he admitted to me that he did. (Much of what Mr. Steffen and Mr. Lofgren were saying came back to me and my family.)

How was I supposed to explain this bizarre behavior by OSF to Elaine Hopkins, the Journal Star reporter a