Thursday, August 28, 2008
This excerpt is from a letter by a physician printed in Emergency Medicine News, July 2008.
The letter makes a lot of sense.
There is a fair amount of paranoia at OSF amongst physicians and some feel if they speak out they will be punished. Many doctors know some policies at OSF are not ethical. And I think patient care in Peoria suffers due to physicians fearing for their jobs.
Debt Makes Doctors Miserable
I am a 30-something EP practicing for
five years in California. I also spent a
couple of years on the East Coast. It really
is a jungle out there in the ED “pits”
from coast to coast. The lack of control
most doctors experience is definitely
adding fuel to the general burnout.
make every attempt to limit and
eliminate debt when possible, which
gives me a degree of autonomy in my
practice. I do not need to work an
obscene number of shifts just to keep
up. There is also mental freedom knowing
I am not in jeopardy of losing my
income and home from an unpleasant
interaction, whether it is with a patient,
hospital administrator, ED staff member,
or fellow physician. If things ever get
rough, there is security in knowing I
have many options, including taking
some time off.
As a result, I find myself within a
minority of emergency physicians who
do not wish to bury their heads in the
sand and simply collect a paycheck. I
find myself one of the few voices present
and willing to speak up at monthly meetings,
even when there are grumblings in
the pit all month long. I believe in the
idea of right and wrong, and in not simply
looking the other way when one is in
the midst of wrongdoing, even when it is
too complicated to pinpoint precisely.
When physicians are scared to ask about
money billed in their names and not
allowed to collectively control practice
details, that just seems wrong to me. It
also seems wrong when we physicians
are more concerned about keeping up
with the Joneses than we are about the
details of our practice sites.
I strongly believe physicians have an
obligation to make choices carefully.
Even our personal life choices can have
an impact on the overall health care system.
For example, when we acquire massive
debt, we are no longer free to
express important opinions, which may
be distasteful to certain interested parties.
We are all well aware that certain
powerful individuals can immediately
reduce our workload without reason,
consequently controlling our income. As
inconvenient as our opinions may be,
they are important and should not be
silenced, which is something we do to
ourselves and our colleagues when we
have massive monthly overheads and/or
work for the highest bidder without
regard to company structure and process.
We all know the decades of sacrifice
and delayed gratification it takes to
become an EP. It’s only natural to enjoy
the income we experience after completing
residency. Many of us have families
to support, or simply wish to play
after many years of sacrifice. The more
money we make, the more fun we can
have playing, and we can buy better toys
as well. I only wish some of us didn’t go
so crazy with the extra zeroes we start
seeing on our paychecks after residency.
When I see a friend or colleague add
a high six- or seven-figure home to a six figure
education debt, I immediately
know that he will never be able to stand
up for himself or anybody else for that
Debt is the new shackle. There
are some great doctors out there supporting
groups that should not occupy
such an important place in our specialty
nor wield so much control over our lives
and livelihoods. I hope we will shift our
mind-set regarding contract holders.
They never call themselves employers
for legal and business/financial reasons,
and we should never consider them
Haitian Hearts is managing Heureuse’s congestive heart failure from 1,500 miles away.
Frandy, our contact in Port-au-Prince, took her to the General Hospital in the capital last week and the doctor suggested that Heureuse be admitted. However, Heureuse had no one to take care of her in the hospital, so she could not be admitted.
In Haiti, at large public hospitals such as the General Hospital, a patient needs a family member with them to assist them in the hospital. The family member would be responsible for obtaining food and water, bathing the patient, providing bed sheets and washing them, emptying the commode, and buying medications for the patient.
Heureuse’s family lives on Haiti’s southern coast in Benet and are not present in the capital. Heureuse's husband is dead and she has sent out her two small children to live in different parts of the country while she awaits death.
Incredibly, during the last few days, Heureuse has improved. She is breathing better and is able to do more. We have increased her furosemide and added a medication to control her blood pressure.
However, Hurricane Gustav hit Haiti pretty hard the other day and caused massive flooding and a quite a few deaths (according to Frandy) on the southern coast (near her family). And it has been much harder for Frandy to assist Heureuse because of the weather. Frandy has been providing Heureuse with food, water, and medications.
If she can survive this week, there is a possibility that Heureuse can get an echocardiogram next week. For her to have a chance of being accepted in the States, a cardiologist or surgeon needs to view her echocardiogram.
All of this seems so incredible. Heureuse is trying to survive congestive heart failure living in a shack alone with no money and not enough food and water. And Gustav hits Haiti with such force it stops 19 year old Frandy, another very poor Haitian who has a heart defect also, from helping her.
And OSF in Peoria precedes with its one half billion dollar medical campus expansion in a city that is 1/20th the size of Port-au-Prince.
“The world is a dangerous place to live; not because of the people who are evil, but because of the people who don’t do anything about it.” (Albert Einstein)
Wednesday, August 27, 2008
I sent the letter below to quite a few people including Sister Judith Ann, Bishop Jenky, and OSF-Corporate ethicist Joe Piccione. Joe also sits on the International Committee for OSF-SFMC. The International Committee reviews which international patients are operated at OSF.
Also, I sent a letter to Jim Stowell who is President of the Children's Hospital of Illinois Community Advisory Board.
No answer from any of these people regarding Heureuse.
Also, I sent a letter to Jim Stowell who is President of the Children's Hospital of Illinois Community Advisory Board.
No answer from any of these people regarding Heureuse.
Thursday, August 21, 2008
A few days ago I sent this letter out on behalf of Haitian Hearts patient Heureuse.
Heureuse is a 29 year old female who lives in Haiti. She was operated at OSF in 2002 for a serious heart valve problem. She needs more surgery now as the letter explains.
OSF has abandoned her but other Haitian Hearts patients in Haiti are helping her tremendously. However, unless she has surgery soon she will leave two little children in the slum without parents. And Haiti is suffering greatly now with the "food shortage".
Today I forwarded an e mail from Haiti describing Heureuse's condition to Keith Steffen, CEO of OSF-SFMC. The e mail bounced back consistent with OSF's policy blocking my e mail as it has done in the past. This certainly is not doing Heureuse a favor.
International Committee and Children’s Hospital Community Advisory Board
August 14, 2008
Haitian Hearts is currently working on bringing 14 more patients to the States this year for heart surgery. Two other children were successfully operated earlier this year.
However, in addition to the above, we have three previous patients that need to come back to OSF to be reoperated in Peoria.
Many of you will remember Jenny Guillaume, Heuruese Joseph, and Henri Andrique. All three were operated at OSF 5-10 years ago.
Haitian Hearts has followed up with these patients in Haiti after they left Peoria and we supply them with examinations, medications, repeat echocardiograms, etc. during our frequent stays in Haiti.
Jenny is 29 years old now and teaches hearing impaired students in the Haitian capital, Port-au-Prince. She has never been married and still lives with her mother. She communicates with us by e mail and is fluent in French and Creole. She also speaks English fairly well. She and her family have helped us considerably in Haiti over the years.
Heureuse is 29 years also. She lives in a seaside slum in Port-au-Prince. She is raising her two small children alone. Her father is dead and her family lives on the Haiti’s southern coast and is not able to be of much help to her. She has no job and Haiti’s food prices have climbed dramatically over the course of the last year. Heureuse and her kids go to bed hungry.
(I have learned in the last few days that Heureuse is very sick. She is in congestive heart failure and lying in her bed unable to walk. Below is an online conversation I had with Dejean Frandy today, a Haitian Hearts patient who is 19 years old. Two other Haitian Hearts patients, Jenny Guiallaume and Suze will attempt to help Heureuse also. We are doing whatever we can to keep her alive until I can bring her to the States.)
Henri is 34 years old now and just got out of the hospital in Port-au-Prince due to cardiac problems. He is unable to work and his weight is down to 130 lbs.
Jenny, Heureuse, and Henri all need valve surgery. All are in various degrees of heart failure due to their bad valves. I have not had any luck finding other medical centers to accept them. They will be difficult cases due to their previous surgery and their underlying pathology.
All three would like to live. What would you do if they were your relatives, children, or friends?
Please make sure that OSF and their legal counsel, Douglass Marshall, remove their embargo of Haitian kids at OSF. Their physicians would like to see them return to Peoria as would their host families.
I do not want these three to die painful deaths like Jackson Jean-Baptiste and Maxime Petion did after they were denied on going care at OSF.
I humbly ask you to be their advocates and will wait to hear from you regarding these three young adults.
John A. Carroll, M.D.
Online conversation today regarding Heureuse:
Dejean Frandy3:18 PM Dejean: HI i need to talk to you now me: frandy, can heureuse talk to...
3:37 PM (6 hours ago)
3:18 PM Dejean: HI
i need to talk to you now
can heureuse talk to you?
Dejean: yes i am there
i saw her this morning
3:19 PM she has prescription for Echocardiogram
she may need to see Dr Pilie for it
3:20 PM me: frandy,
Dejean: she has medicines
me: I want you to e mail a haitian friend of mine...her name is jenny guiallaume..
her e mail is...
3:21 PM firstname.lastname@example.org
3:22 PM she lives near delmas 33
she can help you and heureuse...
she is a heart patient....
heureuse needs to take a medicine called lasix (furosemeide)..
3:23 PM explain to me heureuse's condition
can she walk a little...
can she eat and drink?
Dejean: no she can not
me: are her legs swollen?
Dejean: she can but she does have money to feed herself
3:24 PM she does not have money
me: she does or she does not have money to feed her self?
is she short of breath?
Dejean: she does not have money
3:25 PM yes she is and her legs are not swollen
me: where are her kids??
3:26 PM Dejean: the boy is with her but the girl is somewhere else
she has the medicine you said above
will you contact jenny?
3:27 PM Dejean: let me tell exactly what she needs for now
me: can you and jenny take her to the General Hospital or the hospital in leoganne??
Dejean: yes i will
3:28 PM me: ok, tell me...type fast...i will wait...
Dejean: she already went to GCH
Dejean: she needs to do Echocardiogram
3:29 PM and Thyroidien, glycemie
me: frandy, she needs treatment with medication before echocardiogram...
3:30 PM do you have Jenny's number phone?
me: tell the doctor she has a problem with her valve aortic and valve mitral...she was operated in 2002...
no i do not have jennys number but she checks her email every day...please send her an email... and tell her to call you...
3:31 PM Dejean: ok i will do everything
me: maybe suze can help you with a ride for her to the general hospital....
Dejean: i am going to see Heures later
3:32 PM Dejean: i can do this
3:33 PM do you Andrique's Echocardiogram?
do you need Andrique's Echo...?
he said that he has it
3:34 PM i can scan it for you
me: tell heureuse not to take the thyroid medicine...she needs to take the furosemide...yes i need andriques echo results....maybe he can send me the results via e mail or you can scan it...
3:35 PM please get hold of jenny now...and suze...
Dejean: i will do that perhaps during the week end
me: yes, the echo on the weekend is good...
heureuse is problem number one right now....
3:36 PM tell heureuse that she should take furosemide 40 mg in the morning and 40 mg in the afternoon...
3:37 PM Dejean: ok byeee
talk to you later
Heureuse at the top. Keith Steffen at the bottom.
The Peoria Fire Department (PFD) was allowed to upgrade to Paramedic last month. Only two fire stations will provide this care, but it is a start. The PFD will remain non transport, i.e. will not be able to take 911 patients to local emergency departments. This arrangement will allow Advanced Medical Transport (AMT) to be the only provider of Paramedic and transport of emergency patients in Peoria.
Elaine Hopkins reported on her web log that the Peoria Journal Star failed to report that the PFD became Paramedic. The Journal Star opposed this upgrade for at least a decade and did not want to report this historic news when the change was made last month.
Most people in Peoria do not even know that a change has been made. And thanks to the Journal, most people have not been aware that when Uncle Merle had his heart attack he did not receive advanced life support from the PFD when they arrived at Merle’s home. Maybe they would be upset if they realized what this meant for Merle.
On August 13 I submitted a second forum article. I contacted the Journal Star after a few days had passed and asked them if my article had been “killed” yet. The answer was, “No not yet.”
Here is the article just in case the Journal Star doesn’t publish it:
On July 8 the Peoria City Council voted unanimously to approve the Peoria Fire Department (PFD) contract. For the first time, two Peoria fire stations, 12 and 20, can independently function as paramedics and provide advanced life support for the citizens of Peoria.
Unfortunately, this historic news totally slipped under the radar of the Journal Star. The Journal printed not a word about the results of this vote and most Peorians remain unaware of what level of emergency care they are receiving.
Even though the PFD still cannot transport patients to hospitals, the fact that stations 12 and 20 will be paramedic is a step in the right direction. Now when private citizens and nursing homes in these two areas call 911 for medical reasons they will receive paramedic care by the PFD and they will not have to wait for Advanced Medical Transport (AMT) to arrive at the scene.
While this is good news for people covered by these two stations, the question has to be asked: Why isn't the rest of the city given the same paramedic care? In most parts of Peoria the firefighters are still only allowed to provide basic life support and basic medications.
I suggest that stations 12 and 20 document when they make important medical interventions for the emergency patients that call 911. The PFD needs to let their City Council members know when this happens. Also, people that call 911 from places in Peoria not covered by stations 12 and 20, should notify their Council member if the PFD responded first and the sick person had to wait for AMT to arrive to receive advanced life support.
Hopefully in the future, if more weak spots in the system have been identified, another City Council vote will occur and the PFD will be allowed to function as paramedics in these areas to save more lives.
The Journal Star probably has all sorts of problems of their own. I sure don’t know the specifics. But I think they are doing all they can not to rile up OSF and AMT and others during tough times like this. And so they suppress news and protect businesses that need to be exposed.
Too bad for Peoria.
On Sunday, August 24, the Journal Star published the above forum article. They did leave out the sentence I had written stating that the Journal Star failed to report that the Peoria Fire Department will now be paramedic and perform advanced life support.
Here is the article as it appeared in the Journal Star:
Forum: Let firefighters save lives
Posted Aug 24, 2008 @ 12:00 AM
On July 8 the Peoria City Council voted unanimously to approve the Peoria Fire Department contract. For the first time, firefighters at two stations - 12 and 20 - can function as paramedics and provide advanced life support for the citizens of Peoria.
Unfortunately, most Peorians remain unaware of what level of emergency care they are receiving.
Even though the PFD still cannot transport patients to hospitals, this move is a step in the right direction. Now when private citizens and nursing homes in these two areas call 911 for medical reasons they will receive paramedic care by the PFD and they will not have to wait for Advanced Medical Transport (AMT) to arrive at the scene.
While this is good news for people covered by these two stations, the question must be asked: Why isn't the rest of the city given the same paramedic care? In most parts of Peoria the firefighters are still only allowed to provide basic life support and medications.
I suggest that stations 12 and 20 document when they make important medical interventions for the emergency patients who call 911 and let City Council members know when this happens. Also, people who call 911 from places in Peoria not covered by stations 12 and 20 should notify their council member if the PFD responded first and the sick person had to wait for AMT to arrive to receive advanced life support.
Hopefully, if more weak spots in the system have been identified, another City Council vote will occur and the PFD will be allowed to function as paramedics in these areas to save more lives.
John A. Carroll, M.D.
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Original content available for non-commercial use under a Creative Commons license, except where noted.
Thursday, August 14, 2008
The fact that poor Haitians are eating mud patties to help stifle their hunger pangs has caught the attention of the international media.
See Kate Kennedy's recent article in Macleans.
It is imperative that all of this press turn into something good for Haitians. Haitian farmers need to be supported so the food that Haiti needs is grown and sold in Haiti.
Wednesday, August 6, 2008
Here is my letter to Keith Steffen in 2001. I was put on probation from the OSF-Emergency Room the next day.
The OSF-ER was seeing far too many patients for its size in 2001. I did not think it was safe for patients to wait so long to be admitted to the hospital. Neither does the American College of Emergency Physicians.
Below is a Policy Statement by the American College of Emergency Physicians in 2008.
Boarding of Admitted and Intensive Care Patients in the Emergency Department
Annals of Emergency Medicine - Volume 52, Issue 2 (August 2008)
Optimal utilization of the emergency department (ED) includes the timely evaluation, management, and stabilization of all patients. The ED should not be utilized as an extension of the intensive care and other inpatient units for admitted patients, because this practice adversely affects quality of care and access to care. ED leadership, hospital administrators, EMS directors, community leaders, state and federal officials, hospital regulators and accrediting bodies should work together to resolve this problem. In order for the ED to continue to provide quality patient care and access to that care, the American College of Emergency Physicians (ACEP) believes that:
• Hospitals have the responsibility to provide quality patient care and optimize patient safety by ensuring the prompt transfer of patients admitted to inpatient units as soon as the treating emergency physician makes such a decision. If such a transfer cannot be promptly effected for whatever reason, the hospital must provide the supplemental nursing manpower necessary to care for these inpatients boarded in the ED.
• In the event that the number of patients needing evaluation or treatment in an ED is equal to or exceeds the ED's treatment space capacity, admitted patients should be promptly distributed to inpatient units regardless of inpatient bed availability.
• Hospitals should have staffing plans in place that can mobilize sufficient health care and support personnel to meet increased patient needs.
• Hospitals should develop appropriate mechanisms to facilitate availability of inpatient beds.
• Emergency physicians should work with their hospital and medical staff to monitor and improve the use of inpatient resources.
• Staffing patterns applicable to other specialized areas/units of the hospital should apply equally to the ED to assure that patients receive a consistent standard of care, appropriate for the acuity of their condition, within the organization.
• Mutual aid agreements should be in place to assist any hospital that is unable to meet the emergency and intensive care needs of its community.
• Hospital diversion should be instituted only when internal resources have been exhausted and other community facilities have resources available to meet the needs of patients presenting to their facilities. EMS systems should develop mechanisms to address patient diversion by health care facilities utilizing the ACEP policy on ambulance diversion.
• Hospital regulatory and accrediting bodies should mandate standards for prompt transfer of admitted patients from the ED to inpatient units and proactive planning for hospital bed availability.
Revised and approved by the ACEP Board of Directors April 2008
Revised and approved by ACEP Board of Directors January 2007
Originally approved by the ACEP Board of Directors October 2000
Tuesday, August 5, 2008
If you didn't see the New York Times article regarding U.S. hospitals flying immigrants back to their homes, here it is. It is a must read.
Sister Margaret McBride, vice president for mission services for Saint Joseph's in Phoenix, was truthful when she said that the patient/immigrant's families were not happy about repatriation but they (Saint Joseph's) don't require consent from the family to repatriate. She should know since her hospital returns quite a few unlucky souls each year.
This reminds me of OSF in Peoria.
When Haitian Hearts was negotiating with OSF and the Catholic Diocese of Peoria regarding the fates of numerous Haitian children suffering from heart disease, neither OSF nor the Diocese would tell me the details that I had to accept to receive any support from OSF. However, they did allude to the fact that the Director of Children's Hospital of Illinois (CHOI) would be holding the passports and visas of my Haitian Hearts children. I knew the Director's behavior in the past, and so I was afraid that he and Children's may attempt to send Haitian kids back to Haiti before they were safely cleared for me to fly them back to Haiti.
Unfortunately, with the recent New York Times article addressing the unethical business of sending immigrant/patients home, it reminded me how these hospitals have nothing on OSF in Peoria.
Elaine Hopkins recent article contained information that the Peoria Journal Star did not want Peoria to know. The article has scared off alot of other people as well.
The Peoria City Council recently voted unanimously to approve the PFD contract. Part of the new contract allowed the PFD to provide Paramedic care for the first time ever.
This was historic news for Peoria regarding a topic that has been called "closed" by Peoria's leaders.
Consider this paragraph in Elaine's article:"Carroll’s complaints to hospital ethicists, the Peoria Medical Society, the Christian Medical Society, the Peoria Catholic Diocese and other organizations have all been ignored or brushed off, Carroll said".
What does this paragraph mean and why is it so intimidating?
On three separate occasions, I let Joe Piccione, OSF Corporate Ethicist, know of my concerns regarding the Emergency Medical Services (EMS) monopoly. He told me that I was mandated to report this. However when I did, Piccione, Sister Judith Ann, Jim Moore, and Dr. Gerry McShane did not respond. In my opinion, OSF ethicists did not want to debate the ethics of an issue like this that was being sustained by OSF (and others) for economic reasons.
I contacted the President of the Peoria Medical Society (Dr. Rich Anderson) and let him know of my concerns. Dr. Anderson e mailed me and told me that the EMS situation in Peoria was fine...and also told me not to reproduce any of his e mail. Why would he not want his e mail reproduced? And as it turned out, it does not appear that everything regarding EMS was "fine" in Peoria, as evidenced by the policy change.
The Catholic Diocese of Peoria didn't want to deal with Peoria's ambulance monopoly either and threatened me if I got involved. Monsignor Steven Rohlfs, who was Vicar General of the Diocese, and Patricia Gibson the Canon Law Lawyer for the Diocese, told me in Monsignor Rohlf's office that if I petitioned for a Canon Law Tribunal regarding OSF and ANY ISSUE, the Diocese would come out in the media against me and Haitian Hearts. And when I did file the petition with the Diocese regarding the EMS monopoly sustained by OSF, Monsignor Rohlfs wrote me back to take the ambulance monopoly issue to Rome. He said that Bishop Jenky had no jurisdiction regarding this issue generated from the largest Catholic hospital south of Chicago located about six blocks from the Diocesan Chancery.
These are three big reasons that the Journal Star and others did not want to print the news. Who would want to alienate these three powerful institutions?
Monday, August 4, 2008
The Peoria magazine, InterBusiness Issues, has an article in the August, 2008 edition.
The article was written by Keith Steffen, Administrator of OSF-SFMC in Peoria.
Mr. Steffen starts out his brief article with this sentence:
“Being able to serve all the patients who come to us is our primary priority.”
I wonder if Mr. Steffen really believes this. He cut all funding for Haitian Hearts patients in July, 2002 and OSF-SFMC is denying care to past OSF Haitian patients who need repeat heart surgery.
Two young patients, Jackson Jean-Baptiste and Maxime Petion have died in the last couple of years after they were refused surgery at OSF-SFMC. Four other Haitian Hearts patients need repeat surgery soon or they will all die.
Mr. Steffen also writes about OSF’s Milestone Project which is costing about 400 million dollars.
“The Milestone Project will use 47,000 square feet of glass, 22,000 cubic yards of concrete, 143,000 pounds of rebar (used for reinforcing concrete) and nearly 10 million pounds of steel.”
He then ends his article with the following paragraph:
“This new facility will help us to better “serve persons with the greatest care and love in a community that celebrates the gift of life”. And that is the OSF HealthCare mission.”
Notice that he put the mission statement in quotes…possibly distancing himself from this philosophy.
Many Haitian patients and their families wouldn’t believe this if they read his article. And I am sure the hypocrisy of Mr. Steffen’s words are not lost on many people in central Illinois.