PMMDaily

Tuesday, March 17, 2009

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 »

Monday, March 16, 2009

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.

Saturday, March 14, 2009

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.

Saturday, March 7, 2009

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

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.
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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.

Thursday, March 5, 2009

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.

Sunday, March 1, 2009

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.

Thursday, February 26, 2009

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.