Health Care Problems in the USA

The following is from the New England Journal of Medicine, November 18, 2009.

Authors: Arthur L. Kellermann, M.D., Lawrence S. Lewin, M.B.A.


Adults who can’t get coverage through work, are too young for Medicare, and don’t qualify for Medicaid have only one option — individual health insurance. Consumer Reports describes the individual insurance market as a “nightmare” for consumers: “more costly than the equivalent job-based coverage, and for those in less-than-perfect health, unaffordable at best and unavailable at worst. Moreover, the lack of effective consumer protections in most states allows insurers to sell affordable plans whose skimpy coverage can leave people who get very sick with the added burden of ruinous medical debt.”5 In recent years, several states have attempted to reform the individual health insurance market, with little success.

Coverage matters. On average, uninsured Americans get about half the preventive services and medical care that insured Americans receive. Studies have shown that uninsured people with cancer, heart disease, stroke, lung diseases, and other conditions are more likely to have poor health and to die prematurely than similar people with coverage. Existing safety-net services are insufficient to overcome the gap between those who have health insurance and those who do not.

The economic consequences of a lack of insurance are equally grim. If even one family member lacks coverage, the entire family is exposed to the financial burden of severe illness or injury. In 2009, 20% of uninsured adults used up all or most of their savings paying medical bills.

When many people lack insurance, everyone’s access to care is compromised. University of Pennsylvania economist Mark Pauly and colleagues have found that in communities with high proportions of people who are uninsured, insured people are more likely than those elsewhere to have difficulty obtaining needed care and to be dissatisfied with the care they receive.1 In such communities, emergency services are strained, access to trauma care is diminished, and a growing number of specialists are unwilling to take emergency department call.

If states cut their Medicaid programs when ARRA funding runs out, uncompensated care will increase sharply. The burden that this increase will impose on health care providers will be more than some can bear. If many safety-net clinics and hospitals close their doors, the patients these institutions serve will have nowhere else to go. When they end up in private hospital emergency departments and inpatient beds, it could trigger additional facility closures. Access to care will be diminished for the insured and uninsured alike.

Voting for the status quo may be politically tempting, but it won’t stop the steady erosion of coverage in the United States. The authors of the 2009 IOM report were blunt: “There is no evidence,” they wrote, “to suggest that the trends driving loss of insurance coverage will reverse without concerted action.”1 Six years ago, the IOM Committee on the Consequences of Uninsurance was equally direct.2 It recommended “that the President and Congress develop a strategy to achieve universal insurance coverage and establish a firm and explicit schedule to reach this goal by 2010.” That deadline is less than 2 months away.

Upstander

"...few of us feel as though we’re going to be perpetrators; and most of us hope we’re never going to be victims... most of us live in the space not between perpetrators and victims but between bystander and, potentially, ‘upstander,’ to coin a term. The question of how we relate to this history that goes on around us, or to matters of injustice."

Samantha Power
http://www.portsmouthpeacetreaty.org/powerforum2.cfm

Still Homeless in Peoria

 

Father, Take This Cup From Me

 

Not All Bad Behavior is Actionable....

Peoria's OSF/SFMC behavior towards their Haitian Hearts patients was again abysmal in 2009.

OSF/SFMC is denying medical care to two patients, Jenny and Henri, both who had heart surgery at OSF/SFMC ten years ago. They both need repeat heart surgery. Both are in Haiti and both receive medications and exams from Haitian Hearts year after year.

They both have hope to stay alive. But where is the hospital in Peoria that "turns no patients away"?

----------

A couple of days ago I received a comment on this blog.

The commenter was a local Peoria blogger who actually signed his name.

The fact that the blogger/commenter signed his name was unusual...most comments are made anonymously because people fear OSF.

What even made this more unusual was that the blogger/commenter wrote that OSF/SFMC was indeed sliding downwards with regard to quality of care. The blogger/commenter had been a patient at OSF/SFMC recently and wrote that OSF/SFMC ignored and laughed at his requests for pain meds.

Who knows if that was true or not, but that was the comment.

I was really surprised that this person actually signed their name.

However, by the next morning, the blogger/commenter had removed the portion of their comment which regarded OSF's poor care.

Thus, another blogger/commenter thought twice about going after OSF with their name attached. Fear of OSF had won out again.

In this blog I have documented how Keith Steffen, OSF's Administrator, told me that fear is a good thing among OSF employees. I clearly documented how he intimidated two of his nurses in his office at OSF.

I have spoken with many people in the Peoria community during the last decade who genuinely fear OSF and Mr. Steffen. Even a huge benefactor to OSF won't come out against Mr. Steffen in attempts to have him replaced because she fears for her own medical care at OSF/SFMC.

Is this the way a Catholic hospital (or ANY hospital) should act?

Numerous members of the Peoria community fear losing their job and their health insurance if they go after OSF. Our business boards are related and when you go after one business you go after all of them.

And to make matters even worse for OSF/SFMC, this year their legal counsel Douglass Marshall contacted the US Consulate in Haiti regarding a Haitian Hearts patient receiving medical care in Peoria. Many people knew about Marshall's action, but they did nothing.

For good reason they fear OSF.

The seven remaining OSF Sisters that live in the massive convent near the hospital don't walk with a bounce in their step. They know all this is happening, but have lost their mission and their spirit and their will to stop the fear engendered by OSF's secular leaders.

How sad for OSF and for Peorians.

Web Album of One Day in Haiti in 2009

Please go to this album and view as a slideshow.

This was July 1, 2009 in Cite Soleil.

Advanced Cardiac Drugs Don't Work Anyway....Or Do They?

The study copied below concluded that advanced cardiac life support drugs like epinephrine and atropine don't help the patient much during certain types of cardiac arrest.

But maybe they DO help if a cardiac arrest is from an asthma or anaphylactic arrest or a pediatric drowning. Who knows?

Does this mean that Advanced Medical Transport in Peoria will stop giving drugs like epinephrine at the scene of a cardiac arrest? Will AMT explain to the family that they are going to WITHHOLD drugs and quote statistics regarding Uncle George's small chance of being discharged from the hospital with good neurologic function?

Do most families want Uncle George dying in the backyard next to the lawnmower or in an intensive care unit two days later?

And, I digress slightly, but who will tell the people in Peoria who have lost loved ones during heart attacks, asthma attacks, drownings, etc., during the last 15 years that the Peoria Fire Department, until this summer, had NO advanced life support drugs to give them in the first place? Even though giving advanced life support drugs was and is the standard of care for advanced life support, the doctors that run EMS tried to reassure Peoria's City Council and Peorians that all was fine and good...until this summer when they changed it all.

Please see article below:

From Heartwire CME
Hold the Epi: No Advantage Seen With IV Drugs at Out-of-Hospital Cardiac Arrest CME
News Author: Steve Stiles
CME Author: Penny Murata, MD

December 4, 2009 — Facing off with longstanding policy and tradition, a large randomized trial found that giving intravenous (IV) drugs like epinephrine and atropine in the setting of out-of-hospital cardiac arrest made it more likely that patients would be admitted to the hospital but little difference in whether they survived to discharge [1].

That outcome was in spite of their undergoing resuscitation longer and receiving more defibrillations, and more often reattaining a spontaneous circulation, compared with another group that didn't receive IV drugs during arrest, observe the authors, led by Dr Theresa M Olasveengen (Oslo University Hospital, Norway), in this week's Journal of the American Medical Association.

The trial is only the latest of several in recent years to reappraise the efficacy of major elements of conventional cardiopulmonary resuscitation.

For now, the cornerstones of optimal cardiac resuscitation include high-quality cardiopulmonary resuscitation with minimal interruptions for anything, including any drug administration, and early defibrillation.

"These researchers present important and compelling data, which challenge the efficacy of one of the most common procedures in cardiac resuscitation: the administration of intravenous epinephrine," said Dr Bentley J Bobrow (Arizona Department of Health Services, Phoenix) in an email to heartwire . Bobrow, who wasn't involved in the study, is medical director of his state's Bureau of Emergency Medical Services & Trauma System.

"While epinephrine administration has been part of the guidelines for resuscitation for many years, there has been very little evidence supporting its benefit and some convincing evidence suggesting worse outcomes with higher doses of epinephrine," he remarked.

"The message for emergency providers is that, for now, the cornerstones of optimal cardiac resuscitation include high-quality cardiopulmonary resuscitation with minimal interruptions for anything, including any drug administration, and early defibrillation."

Olasveengen et al randomized 851 consecutive adults with nontraumatic out-of-hospital cardiac arrest to management according to advanced-cardiac-life-support guidelines with or without access to IV drug administration. In the no-IV-access group, those who achieved "return to spontaneous circulation" could receive IV drugs five minutes later, if indicated.

Those treated with access to IV drugs fared significantly better at first, but didn't outdo those managed without IV drug access for the primary end point of survival to hospital discharge.

Outcomes of Resuscitation in Out-of-Hospital Cardiac Arrest, With and Without IV Drug Access End point IV drugs (%), n=418 No IV drugs (%), n=433 OR (95% CI) p
Return of spontaneous circulation 40 25 1.99 (1.48-2.67) 0.001
Hospital admission 43 29 1.81 (1.36-2.40) 0.001
Survival to hospital discharge* 10.5 9.2 1.16 (0.74-1.82) 0.61


*Primary end point

Nor was there a significant difference for the primary end point in an analysis that controlled for response time, whether the arrest occurred in a public place or was witnessed, or whether ventricular fibrillation was the initial rhythm (odds ratio, 1.15; 95% CI, 0.69-1.91).

The quality of delivered cardiopulmonary resuscitation (including chest-compression rate, ventilation rate, and other factors), a prospectively defined secondary end point, was within guidelines and comparable in the two groups, Olasveengen et al report. So was the prevalence of therapeutic hypothermia as part of management, which exceeded 70%.

The trial has a number of limitations, the group notes, including the inability to blind emergency responders to the randomization and the involvement of a single emergency-response system. It also doesn't preclude the potential usefulness of other IV drug regimens. But, "at a minimum, our results indicate that clinical equipoise exists on the efficacy of intravenous drugs in the treatment of cardiac arrest and that more definitive trials could be ethically undertaken."

Olasveengen reports receiving fees for speaking from Medtronic and research support from Laerdal Medical. Of the coauthors, Dr Petter A Steen (Oslo University Hospital) reports being on the board of directors for Laerdal Medical and the Norwegian Air Ambulance Foundation (which provided partial funding for the study); and Dr Lars Wik (Oslo University Hospital) reports being on the medical advisory board of Physio-Control, consulting for Laerdal, Zoll, and Jolife, and being principle investigator of a Zoll-sponsored clinical trial.

Reference

1. Olasveengen TM, Sunde K, Brunborg C, et al. Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial. JAMA 2009; 302:2222-2229.

Clinical Context

Current cardiopulmonary resuscitation guidelines, as reported by the American Heart Association in the December 13, 2005, issue of Circulation, include IV drug administration. However, the benefits of epinephrine administration during advanced cardiac life support are not clear. In the July 2002 issue of Resuscitation, a retrospective study by Holmberg and colleagues found that the need for epinephrine after an out-of-hospital cardiac arrest was an independent predictor of poor outcome. Possible reasons include the effects of epinephrine or poor quality of cardiopulmonary resuscitation during the process of IV access and administration.

This prospective, randomized controlled trial assesses whether IV vs no IV drug administration during advanced cardiac life support after an out-of-hospital cardiac arrest in adults affects survival to hospital admission with return of spontaneous circulation (ROSC), survival to hospital discharge, 1 year survival, survival with favorable neurologic outcome, or quality of cardiopulmonary resuscitation.


Study Highlights

851 of 946 eligible adults older than 18 years with nontraumatic out-of-hospital cardiac arrest were randomly assigned to receive advanced cardiac life support with or without IV drug administration.

Exclusion criteria were cardiac arrest witnessed by ambulance team, resuscitation started or interrupted by physicians outside of ambulance team, or cardiac arrest resulting from asthma or anaphylactic shock.

Participants did not differ from nonparticipants in demographic data or outcomes.
418 patients were in the IV group.
433 patients were in the no-IV group, which received IV access and drugs (if indicated) 5 minutes after ROSC.
Mean age was 64 years.

IV vs no-IV group did not differ in sex, cardiac cause, location of cardiac arrest, bystander involvement, initial rhythm, presence of physician-staffed ambulance, response interval, or intubation.

Standard protocol included the 2000 International Guidelines (Circulation. 2000;102[8 Suppl]:I11-I11) modified by 3 minutes of cardiopulmonary resuscitation before first shock and between unsuccessful shocks for patients with ventricular fibrillation, defibrillators in manual mode, endotracheal intubation to secure airway, therapeutic hypothermia, and electrocardiogram transmission to cardiologist after ROSC.

Defibrillation attempts occurred more in the IV vs the no-IV group (47% vs 37%; odds ratio [OR], 1.16; 95% confidence interval [CI], 0.74 - 1.82).
Of patients who received defibrillation, more shocks were given to the IV vs the no-IV group (median, 3 vs 2; P = .008).

The primary outcome measure of survival to hospital discharge was similar for the IV vs the no-IV group (44 [10.5%] of 418 vs 40 [9.2%] of 433; OR, 1.16), even after adjusting for confounders (adjusted OR, 1.15).

Quality of cardiopulmonary resuscitation, assessed by hands-off ratio (hands-off time divided by total time without ROSC), compression rates, and ventilation rates, was adequate and similar for the IV vs the no-IV group.

Survival with favorable neurologic outcome (defined as good cerebral performance or moderate cerebral disability) was similar for the IV vs the no-IV group (9.8% vs 8.1%).

Short-term survival was greater in the IV vs the no-IV group:
ROSC (40% vs 25%; OR, 1.99; 95% CI, 1.48 - 2.67; P < .001)
Admission to hospital (43% vs 29%; OR, 1.81; 95% CI, 1.36 - 2.40; P < .001)
Admission to intensive care unit (30% vs 20%; OR, 1.67; 95% CI, 1.22 - 2.29; P = .002)

In patients with initial ventricular fibrillation or pulseless ventricular tachycardia, there were no outcome differences between groups.

In patients with initial nonshockable rhythms, the rates for ROSC, hospital admission, and intensive care unit admission were higher in the IV vs the no-IV group.

Multivariate analysis, adjusted for public location of cardiac arrest, response interval, and initial ventricular fibrillation, showed greater long-term survival if cardiac arrest showed initial ventricular fibrillation or pulseless ventricular tachycardia, was witnessed by bystander, or occurred in a public place.

Long-term survival odds decreased by 17% per minute of prolonged response interval (adjusted OR, 0.83).

Adjusted survival to intensive care unit was greater for the IV vs the no-IV group (adjusted OR, 1.78).

Cumulative survival rates for the IV vs the no-IV group include 7-day survival (14.6% vs 12.8%), 1-month survival (11.3% vs 8.8%), and 1-year survival (9.8% vs 8.4%).
Study limitations included inability to blind ambulance team to treatment group, cardiopulmonary resuscitation quality assessment in only 75% of cases, lack of reliable time line for drug administration, and lack of data on time of cardiac arrest.

Clinical Implications

In adults with an out-of-hospital cardiac arrest, IV vs no IV drug administration as part of advanced cardiac life support guidelines results in higher rates of short-term survival but does not affect survival to hospital discharge.

In adults with an out-of-hospital cardiac arrest, IV vs no IV drug administration as part of advanced cardiac life support guidelines does not affect 1-year survival duration, survival with favorable neurologic outcome, or quality of cardiopulmonary resuscitation.

The World's One Hope

 
"When a child steps out in front of a moving car, someone will snatch the child back to the sidewalk. It's not only a kind person who'd do that, not only the kind of person they honor with statues, and memorial plaques. Anyone would pull a child out of the path of the car. But here, many people have been run down, and many pass by, doing nothing. Is that because there are so many suffering people? Shouldn't there be more help when there's more suffering? There's less help. Even kind people walk past, doing nothing, and they're just as kind as they were before."

--from The World's One Hope, a poem fby Bertolt Brecht translated by Tony Kushner

The Catholic Diocese of Peoria Needs New Management

Fifteen years ago OSF in Peoria and The Catholic Diocese of Peoria figured out a way to allow OSF physicians to write oral contraceptives while on OSF property.

This policy flies in the face of the official pro life philosophy of the Catholic Church.

However, with OSF's policy it makes the Freedom of Choice Act a mute point in Peoria.

OSF and The Catholic Diocese of Peoria gave in and let the market place control their consciences.

The following is from the book "Diagnosis Critical--The Urgent Threats Confronting Catholic Health Care", by Leonard J. Nelson III.

"John Paul II noted that the alliance between ethical relativism and liberal democracy has the potential 'to remove any sure moral reference point from political and social life, and on a deeper level make the acknowledgement of truth impossible'. This is particularly the case when in comparison or opposition to claims of sexual or reproductive autonomy, perhaps the most cherished of contemporary rights in our highly individualistic culture. And, as Fr. Robert Araujo has prophesized, it may be that the liberal democracies of the twenty-first century will mandate compliance with their beliefs on abortion, euthanasia, and emergency contraception."

"John Paul II called upon Christians to not participate in such acts. He characterized the right to refuse to participate in such procedures a 'basic human right' and called for governments to provide 'those who have recourse to conscientious objection...(with protection) not only from legal penalties but also from any negative effects on the legal, disciplinary, financial and professional plane'. But he also recognized these procedures 'may require the sacrifice of prestigious professional positions or the relinquishing of reasonable hopes of career advancement'."

Found this Poster Yesterday

Yesterday, while cleaning, I found this poster.

Haitian Hearts and Peoria Area Peace Network carried this poster in 2005 in front of OSF-SFMC as we protested OSF's discriminatory and dangerous policy against Haitian Hearts patients.

OSF refuses to operate on any Haitian Hearts patients even if OSF operated on them initially. In other words, OSF is refusing to give medical care to their own patients even after Haitian Hearts has offered full or partial charges for their medical care.

My wife and I took care of both of these young people in our room in Haiti. Jackson was with us for one month in cardiogenic shock and heart failure. Faustina had severe heart failure.

OSF did not answer repeated requests to save their lives.

Haitian Hearts was able eventually to get both Jackson and Faustina accepted into other medical centers in the United States.

However, it was too late for Jackson. Jackson Jean-Baptiste died a slow and very painful death in January, 2006. He is buried in Goodfield, Illinois.

However, Faustina was operated and did very well. She is a happy thriving teenager today.

Other OSF patients are sick in Haiti. I examine them and we provide them with their heart medication. They need surgery and will die without it.

OSF does not answer when contacted about their current sick Haitian patients. The Ethics Department does nothing. And The Catholic Diocese of Peoria remains silent.

As OSF continues to expand with their one-half million dollar Milestone Project, OSF continues their deadly policy against innocent Haitian Hearts patients as 2009 comes to a close.

Peoria Heights Firefighters Gain Advanced Status

There is an incredible article in the Peoria Journal Star this morning.

The article states that the Peoria Heights Fire Department received its official Advanced Life Support certification last night. This makes it the first city or village run ambulance service to offer paramedic care 24 hours per day, seven days a week in Peoria County history.

Please see this article and this article which gives some history regarding the above.

I don't think that the Peoria Heights firefighters ever trusted Advanced Medical Transport (AMT) to do a good job for the people of Peoria Heights. I don't think they trusted former OSF Project Medical Directors to do the right thing for the people of Peoria Heights.

The Peoria Heights firefighters have watched for 15 years as the Peoria Fire Department was kept out of the "paramedic business" in Peoria. They are aware of the conflict of interest that kept Peoria mired in Basic Life Support.

But during the last couple of years the Peoria Fire Department has been upgraded to paramedic and Peoria citizens serviced by Station #12 are receiving advanced life support for the first time in Peoria history. (I have been told that Station #12 in Peoria is responding to 911 medical calls with advanced life support 2-3 times each day.)

Conflict of interest is still present in Peoria's medical community but Dr. Cheryl Colbenson, the Project Medical Director for the Peoria region, gave the "official certification" to the Peoria Heights firefighters last night. She is an OSF employee and was only able to certify the Heights firefighters with OSF's and Dr. George Hevesy's approval. Dr. Hevesy has been on OSF's and AMTs's salary for many years.

EMS is slowly upgrading in the Peoria area. It has been a long struggle, but it is changing.

Here is today's Journal article regarding Peoria Heights Fire Department:

Heights firefighters gain advanced status
Department 1st in county to offer around-the-clock advanced coverage.


By SCOTT HILYARD
OF THE JOURNAL STAR
Posted Oct 06, 2009 @ 10:03 PM



PEORIA HEIGHTS — The Peoria Heights Fire Department received its official Advanced Life Support certification at the Village Board meeting Tuesday night, making it the first city- or village-run ambulance service to offer advanced coverage 24 hours a day, seven days a week in Peoria County.

Officially certified by the state Department of Public Health, the new, more advanced, less restrictive procedures and equipment were available to paramedics and ambulance staff on the first ambulance run after 7 p.m. Tuesday.

"We've gone through our records and we do believe that the Peoria Heights Fire Department Ambulance Services is the first 24/7, advanced life support, transporting agency in Peoria County history," said Kenny Martin, ambulance administrator. "We're all pretty well pumped up about it."

As recently as 2007, the village's ambulance service had 12 part-time employees and was able only to provide basic life support and coverage from 5 a.m. to 5 p.m. There are now 37 people on staff, including three full-time shift leaders, and 13 licensed paramedics. Of the 24 employees who are certified emergency medical technicians, 13 are currently in training to become paramedics.

The new designation changes the way paramedics can treat patients on their way to emergency services at an area hospital. The service is able to carry and use a wider range of medications, including narcotics. Paramedics now are able to use a heart monitor and advanced airway equipment on patients.

"Basically what it does is allow us to do more advanced procedures in the field," Martin said. "It's unusual for a department our size to be able to do what we have done by getting this certification."

The service passed the inspection of four public health inspectors Tuesday morning and was given the official certification at the board meeting Tuesday evening by Cheryl Colbenson, the medical director of Region 2 Emergency Medical Services, which includes Peoria County.



Scott Hilyard can be reached at 686-3244 or at shilyard@pjstar.com.
..
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Copyright © 2009 GateHouse Media, Inc. Some Rights Reserved.
Original content available for non-commercial use under a Creative Commons license, except where noted..

OSF and Ethicist Joe Piccione

OSF purchased Carle Clinic in Bloomington, Illinois. Since September 13 the facility is now part of OSF and the forty new OSF physician employees in Bloomington can now prescribe oral contraceptives.

When OSF Corporate Ethicist Joe Piccione was hired by OSF in 1993 he told me this summer that he did NOT know that he was to help craft a policy with The Catholic Diocese of Peoria that would allow OSF physicians to write for oral contraceptives.

Here is the article from the Journal Star archives written in 1995 which describes Mr. Piccione's new job at OSF.

Make up your own mind on what Mr. Piccione knew and what he didn't....



Journal Star (Peoria, IL)

May 7, 1995


DEAN OLSEN

GRAY AREAS ARE CORPORATE ETHICIST'S SPECIALTY--ONE OF HIS JOBS: TO RECONCILE CATHOLICISM AND FAMILY PLANNING

Editor's note: "In the Heartland" is a weekly feature profiling folks who do their living, working and dreaming in central Illinois without a lot of fanfare. These are neighbors and co-workers all with a unique story to tell.



PEORIA -- From his first day of work here on June 1, 1993, Joseph J. Piccione felt the urgency and knew the dilemma.



His task: search for an ethical way, under Catholic doctrine, that the growing number of doctors employed by Saint Francis Medical Center and its six sister hospitals could prescribe birth-control pills.



Many of the doctors provided that family planning service before they sold their private practices to the hospitals, and they wanted to continue even though the Roman Catholic system opposes artificial contraception.



Piccione, a New Jersey native who holds the unique job of corporate ethicist for St. Francis' parent company, OSF Healthcare System, knew that unhappy physicians could spell disaster for OSF's developing integrated health-care delivery network. Doctors could leave it or refuse to join.



Piccione worked with others at OSF to develop a policy that satisfied doctors and one that the system's owners, an order of nuns, could live with -- reluctantly.



The plan broke ground nationally in the Catholic health- care community and reflected Piccione's positive and comprehensive outlook on ethics and life in general.



"People have a sense that ethics is something that happens when you're in trouble -- that it's a negative, line-drawing activity," said Piccione, a soft-spoken but confident and articulate man who will celebrate his 43rd birthday on Monday.



"Ethics is planning to do the good in a good way," he said. "Ethics is something that pervades our activities."


The work of sorting out all the ethical issues involved in birth-control required him to draw on the many aspects of his Christian faith and training as a lawyer, philosopher, national policy analyst and student of Catholic principles.



Through an intricate set of bureaucratic rules, St. Francis' primary-care doctors can issue birth-control pill prescriptions after explaining to patients that they are doing so under their "limited private practice" -- separate from OSF Healthcare.



OSF, based at 800 NE Glen Oak Ave., next to St. Francis, doesn't directly benefit financially from the prescriptions. Patients can read more details of the birth-control policy on a statement that must be posted in doctors' offices. And doctors must individually buy malpractice insurance for birth-control prescriptions through a process Piccione and OSF helped design and isn't subsidized by the system.



Piccione said he and the Sisters of the Third Order of Saint Francis believe the plan the sisters approved in November 1993 preserves the 118-year-old system's stand on artificial contraception while allowing OSF to "do the good you can in an imperfect world. We recognize that our hands are getting dirty on this, but in a limited way."



Piccione also helped the system's for-profit, managed-care arm, OSF HealthPlans Inc., develop a plan that lets employers contract with OSF for health-care services while obtaining "rider" coverage for contraceptive and sterilization services -- but not abortion -- provided outside the OSF network.



Both arrangements -- the coverage for family planning services and birth-control prescriptions -- received approval from Peoria Bishop John J. Myers. OSF could have offered a package of services and left health-care purchasers on their own to arrange for non- Catholic family planning services. But many potential clients would have shunned OSF altogether, Piccione said.



Accommodations are necessary so OSF can survive financially in an era when managed- care and comprehensive services are required by the private sector, he said.



The position of corporate ethicist is relatively new for OSF and reflects the Sisters' realization that changes in health care nationwide can create ethical questions that need answers, especially for a Catholic system intent on surviving long-term, Piccione said.



Most of his job doesn't involve high-profile issues, though. In lectures and one- on-one conversations, he educates doctors, nurses and other caregivers about how they can work through ethical questions.



A product of public grammar schools and a Catholic high school, Piccione once studied to become a priest. He now is married to Nancy Myers, 31, former communications director for National Right to Life, and they both live in Metamora.




Piccione's training has included a law degree from Catholic University in Washington, D.C., and 14 years of work there as a "policy wonk. " For several years, he analyzed tax- fairness and family-related welfare issues -- for the conservative National Forum Foundation and Free Congress Research and Education Foundation.



He worked four years for the U.S. Department of Health and Human Services, and was a staff member of the National Commission on America's Urban Families and the National Commission on Children.



He wrote op-ed pieces in 1994 for USA Today criticizing human embryo research and condom-distribution programs. In the 1980s, while still in Washington, he discussed death-and-dying issues on "The Oprah Winfrey Show" and "20/20." He was comfortable in his government civil service job when OSF learned about him from a priest he knew in Champaign. He said he accepted the system's offer because of the challenge and because it was a chance to directly carry out his Catholic faith.



Piccione said he doesn't regret moving to the nation's heartland to work with health-care providers.



"It's been a great delight and a thrill," he said. "Washington is a very heady and exciting place to be. But Peoria has a lot of concerned people, a strong tradition and pride in their Midwestern values. " @ART CAPTION: Joseph J. Piccione, corporate ethicist for OSF, based at 800 NE Glen Oak Ave., which serves Saint Francis Medical Center, must balance the needs and convictions of the Catholic church and the public demand for services.

Bill Moyers

See this video.

The Silence of The Catholic Diocese of Peoria

Bishop Jenky of the Catholic Diocese of Peoria has been silent regarding the fact that OSF's new acquisition, OSF Medical Group--College Avenue in Bloomington, Illinois, will employee new OSF physicians who will prescribe oral contraceptives.

Bishop Jenky was also quite destructive to Haitian Hearts as OSF in Peoria did all they could to stop Haitian children from coming to Peoria for further heart surgery.

And now Bishop D'Arcy in Indiana is accusing the University of Notre Dame Trustees of being silent regarding their discussions of President Obama's visit to UND in May. Bishop Jenky serves as a Trustee at UND.

See this article in America, August 31, 2009.

The Silent Board

In the midst of the crisis at Notre Dame, the board of trustees came to campus in April for their long-scheduled spring meeting. They said nothing. When the meeting was completed, they made no statement and gave no advice. In an age when transparency is urged as a way of life on and off campus, they chose not to enter the conversation going on all around them and shaking the university to its roots. We learned nothing about their discussions.

I firmly believe that the board of trustees must take up its responsibility afresh, with appropriate study and prayer. They also must understand the seriousness of the present moment. This requires spiritual and intellectual formation on the part of the men and women of industry, business and technology who make up the majority of the board. Financial generosity is no longer sufficient for membership on the boards of great universities, if indeed it ever was. The responsibility of university boards is great, and decisions must not be made by a few. Like bishops, they are asked to leave politics and ambition at the door, and make serious decisions before God. In the case of Notre Dame, they owe it to the Congregation of Holy Cross, which has turned this magnificent place over to a predominately lay board; they owe it to the students who have not yet come; they owe it to the intrepid missionary priest, Edward Sorin, C.S.C., and the Holy Cross religious who built this magnificent place out of the wilderness. They owe it to Mary, the Mother of God, who has always been honored here. Let us pray that they will take this responsibility with greater seriousness and in a truly Catholic spirit.

Perhaps the most important questions asked by Bishop D'Arcy revolve around the necessity for communication and dialogue to occur between the administration of Catholic Universities and the Ordinary Magistarium of the Church. The facts that he was informed of decisions after they were made suggest lack of communication and perhaps trust. His points suggesting that financial largesse trumps Catholic Cultural Values in the decisions to appoint board members is one that seems most likely. This parallels what might also be seen in the Catholic Health Care Arena which like Catholic Education has seen great erosion in Gospel driven mission objectives. Market driven financial incentives often militate against Gospel mission objectives. This article is fair, and asks some very important questions that I would hope the Board of Directors at Notre Dame and other Catholic Universities will consider, and then be forthcoming as they communicate their mission focused discussions.

By Rev. Daniel Callahan, SAf on August 29, 2009 at 12:17 AM

I pray that the suffering this debacle has caused faithful Catholics turns into a renewal of commitment to Christ, His Church, His real presence in the Eucharist and His little ones. Finally, in response to the Saturday disgraces, I do not hesitate to quote Pope Benedict XVI (then Cardinal Joseph Ratzinger), who, in his 1997 book, Salt of the Earth: Christianity and the Catholic Church at the End of the Millennium, wrote of the state of the Church, including the “lowering of moral standards even among men of the Church”:

The words of the Bible and of the Church fathers rang in my ears, those sharp condemnations of shepherds who are like mute dogs; in order to avoid conflicts, that let the poison spread. Peace is not the first civic duty, and a bishop whose only concern is not to have any problems and to gloss over as many conflicts as possible is an image I find repulsive.

Crowded ER's Put Patients at Risk

A recent article in the Peoria Journal Star reported that the new ER at OSF would grow from 19 rooms to 55 rooms.

This seems like a good move but studies have shown that the main problem with ER overcrowding is lack of beds in the hospital to move ER patients that are waiting to be admitted.

This was the problem that I faced eight years ago when I worked a busy shift in the ER at OSF. A couple of elderly patients of mine "signed out" and went home because I could not get them admitted to OSF in a timely fashion.

Studies during this decade have shown that patients that are "boarded" in the ER have worse outcomes. In other words they get sicker, have more complications, and die more often than patients efficiently admitted.

I wrote a letter to Keith Steffen on September 27, 2001 explaining my fear of this problem in the ER at OSF. I was placed on probabtion the next day and fired in December, 2001.

A wise administrative decision by Mr. Steffen was what was needed at the time. The ER chaos at OSF was unsafe for patients. Elective surgical and cardiac admissions needed to be controlled at OSF to allow room for ER patients.

And ER patient and employee disatisfaction was the highest in the medical center.

Here is a recent article describing ER overcrowding in the US in 2009. Not much different than 2001 in Peoria....



Emergency Medicine News:Volume 31(8)August 2009

Crowding Irrefutably Puts Patients and EPs at Risk

Glauser, Jonathan MD, MBA

Dr. Glauser is an assistant professor of medicine at Case Western Reserve University and attending faculty in emergency medicine at the Cleveland Clinic Foundation in Cleveland.

So much has been written about emergency department crowding in recent years that I would be remiss not to mention this as a legal risk to emergency physicians and a medical risk to patients. ED crowding as a major health problem and public issue has been in our literature for years (Ann Emerg Med 2002; 39[4]:430), and can safely be claimed to be irrefutable.

A striking fact worth noting is that the patients who wait more than 30 minutes to see a physician are five times more likely to sue than those who are seen within 30 minutes. (Emergency Department Crowding: High-Impact Solutions. ACEP Task Force on Boarding. April 2008; www.acep.org/workarea/downloadasset.aspx?id=37960. ) This is especially disturbing because, failing a completely dysfunctional triage system, those patients not seen in 30 minutes should theoretically be less sick than the ones seen immediately. The implication that an irate patient with an ankle sprain is more likely a litigant than a patient with a STEMI seen promptly should grab our attention.

We should be alarmed at a recent survey finding that 44 percent of emergency physicians polled said their EDs are understaffed, and 40 percent said understaffing negatively affected patient safety. (EPM 2009;16[5]:1.) Of course, our productivity is measured in patients seen per hour, RVUs generated per hour, or overall census. If ED crowding is all about held admissions, then the reported workload and nursing and physician staffing patterns of the ED should reflect the number of patients being cared for at any given time.

Problem Isn't Going Away

It may be that there is no or insufficient surge capacity in this country. It simply does not pay for hospitals to keep empty beds staffed waiting for emergencies and disasters. In our current reimbursement system, elective surgery and cardiac workups pay well. Even if they did not, emergency admissions are disruptive to planned processes, especially scheduled operating room procedures. The market is not going to create more inpatient availability for ED admissions; it is debatable whether government regulation to mandate a number of beds for unscheduled admissions is feasible, but short of outside intervention, this isn't going to happen.

Other factors are not going away either. Data only a decade or two ago indicated that EPs might see 1.8 to 5.0 patients per hour in an undifferentiated emergency department. That figure was scaled down to 2.4 patients per hour in one widely cited publication more than 20 years ago. (Emergency Medicine Risk Management. Irving, TX: American College of Emergency Physicians; 1997; Physician Staffing in Management of Emergency Services. Rockville, MD: Aspen Publishers; 1987.) The population is aging, and has more complex disorders on presentation. If the ED of the future is one that sees a progressively older and sicker population, we will have to rethink how we approach care of the elderly. Many experts challenge anyone to undress an octogenarian referred from a long-term facility, obtain a reliable list of his medications, and secure a urine specimen in under 20 minutes.

Who is Responsible?

There are hardly any publications regarding ED crowding that do not cite boarded patients as the primary cause. Because a fair amount of literature has documented bad outcomes and prolonged hospital stays among boarded patients (Acad Emerg Med 2005;12[5 Suppl 1]:49; Med J Aust 2006;184[5]: 213), it's fair to ask which providers are responsible for admitted ED patients waiting for a bed. Emergency medicine's answer is unequivocal: Boarded patients are the responsibility of the admitting service. That, by the way, has to be the stance of any emergency physician, or the number of new patients we are expected to see per hour becomes a moot point.

Experts advise EPs not to skip meals during a long shift and to limit the number of patients being actively managed to six. (Six!) At that number, sensory overload presumably kicks in, and we should be making some dispositions. With sick inpatients to manage, it becomes impossible to adhere to any given number of active new patients per hour.

Is crowding a defense for bad outcomes? This is not a winnable argument, in court or with one's hospital administration or medical staff. Eight people may be sympathetic to a doctor who has to manage many patients in hallways while a hospital is booking lucrative elective surgeries, but it is perilous and unwise to be at odds with one's hospital, financially or in court.

We should make it clear that the official care of admitted patients changes hands at the time of admission, but we also know that we have to take responsibility for adverse outcomes in the ED, for preventing those results, and for the comfort of any patient in our department.

The Bottom Line

Moving patients from ED hallways to inpatient hallways may work in some settings but not most. This is the most frequently cited solution to ED crowding, but patients are dissatisfied sitting in any hallway. Still, the most unsafe place for a patient is in the waiting room, unseen. Do whatever it takes to avoid this within the culture of your institution. I always work under the assumption that patient safety will ultimately reward us in the tort system.

It is besides the point whether all those EPs who feel they are working in understaffed EDs really are in an unsafe environment. The perception should be enough to change the way we practice. I personally take people at their word when they feel overwhelmed. Some people are whiners, some are lazier than others, but a perception of understaffing is enough to worry me. We need to look hard at the processes and resources brought to this problem.

I have never really had much use for tracking patient census as an excuse for an untoward event. I know attorneys will always look at staffing patterns and patient census when an EP discharged a patient with crescendo angina. Yet the activity of an ED cannot be tracked accurately by number of arrivals, especially if held admissions are not counted in the workload for physicians and nurses. No tracking system I have found will accurately reflect how time-consuming each patient was at the time. Numbers may not lie, but they can mislead.

© 2009 Lippincott Williams & Wilkins, Inc.

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Don't Wait for Clerical Leadership...Sounds Like Peoria's Problem

From Judie Brown's American Life League

August 17, 2009

There are valuable lessons to be learned from the Catholic trenches in Boston in terms of what lies ahead nationally. In late February of this year, the Caritas Christi health care delivery network sought and was awarded a contract that includes providing abortions, family planning services and other moral evils to the uncatechized, the unsuspecting poor and women emotionally distraught due to an unplanned pregnancy.

It should be noted that Cardinal O’Malley tried to generate support for the arrangement by purporting that Catholic theology permitted entering into a contract that binds a Catholic in the performance of moral evils; in effect, he claimed that even though we realize the sinful nature of performing those moral evils, so long as we recruit others to perform the evils, it does not violate Catholic ethics. Theologically, spiritually and ethically, nothing could be more unsound. Knowing something is wrong and sinful, and then baiting somebody else into doing it who doesn’t know, compounds the sin. The Caritas arrangement is as ethical as hiring Kevorkian to kill your elderly parents when they become a personal and financial burden.

The Catechism of the Catholic Church is clear about those who give scandal by becoming their “neighbor’s tempter” (Sections 2284–2287). Leading others to do evil “takes on a particular gravity” for those in authority who cause it:

Anyone who uses the power at his disposal in such a way that it leads others to do wrong becomes guilty of scandal and responsible for the evil that he has directly or indirectly encouraged. “Temptations to sin are sure to come; but woe to him by whom they come!” (Section 2287)

The fight for life, liberty and the pursuit of happiness for the next generation of Catholics is in the hands of lay leaders. Every one of us must raise our voices in the public square.



Judie Brown

Another Baffling Phone Conversation with OSF's Ethicist Joe Piccione

I had another phone conversation with OSF's Corporate Ethicist Joe Piccione on August 6, 2009.

Joe called me as a follow up to our conversation in mid-July.

In July, Joe told me that he did not know if the physicians at OSF Medical Group--College Avenue in Bloomington would be OSF employees. And when I asked him other questions regarding OSF's new purchase of this Carle Clinic practice, he said he did not know most of the answers. Amazingly, when I spoke with this OSF office in Bloomington, they seemed to know all of the answers to my questions. Why Joe Piccione at OSF Corporate was allegedly kept in the dark remains a mystery to me.

However, during the August 6 phone call Joe seemed to know all of the answers. He had done his homework. But he spoke in fragmented sentences and seemed quite hesitant and sad.

Joe started out the conversation about "limited private practice" at OSF Medical Group in Bloomington.

He said that when he was hired by OSF in the mid 90's he did not know that he would be a major player in creating this policy which he referred to as "regretable" and even said "we mourn this practice" (limited private practice). This policy allows OSF physicians to prescribe oral contraceptives.

Joe said there are a declining number of OSF physicians using the limited private practice option which implied that fewer OSF physicians in the OSF HealthCare System are prescribing birth contol pills. However he did not provide me with any numbers to prove this.

He then quickly moved on to the OB-GYN department in the OSF Medical Group in Bloomington and said that the OB-GYN doctors would be "partial employees" of OSF. I don't understand what "partial employees" means but I do understand why he described them that way. He called OB-GYN doctors "moving targets" and implied that OSF may not be able to control what these physicans do for about 6 months.

Joe stated that he had not met with the OB-GYN docs at this new facility but he sure seemed focused on them. I think he is quite afraid of what they may intend to do in OSF's facility.

My take is that Joe and OSF are cobbling together a new set of ethical loopholes. OSF Medical Group OB-GYN doctors who will be labeled "partial employees" of OSF is just another "ethical firewall" created by Joe to separate the OSF Sisters from "cooperation" with "evil acts" most likely to occur by these physicians at OSF Medical Group in Bloomington.

Joe continued and said that tubal ligation would not be part of limited private practice in Bloomington. He said that sterilization could not be scheduled at this new facility and a separate phone number would need to be used. I didn't understand Joe's "separate phone number" statement at all...

I was really getting confused at this point with my talk with Joe. So a few days later I called the clinic in Bloomington to see what they had to say about tubal ligations.

I talked to Jan in the OB/GYN department and she told me very clearly and directly that a decision had not been made regarding tubal ligations (sterilization for females) and that this topic was still being discussed. This of course is not good because it should have been settled by now and Jan seemed to know much more about all of this than OSF's Corporate Ethicist.

My take on all of this as I attempt to sort out Joe's speech is that tubal ligations will be scheduled at OSF Medical Group in Bloomington....at least for the first six months. If someone knows different please let Joe and me know.

When I asked Joe if the remaining 40 doctors at the new OSF facility would be OSF employees, he knew the answer now. Yes, they would be OSF employees and all 40 physicians would be able to write for oral contraceptives using OSF's "regretable" limited private practice policy.

Interestingly, Joe said that OSF would rent the building in Bloomington, they would not own it. I think he said this to act as another "ethical firewall"...in other words, anything that goes on inside OSF-Medical Group College Avenue is not really happening in an OSF building because OSF is just renting the building. Maybe the phones are being rented too.

Joe ended his disjointed dialogue by saying something like he wanted us all to "be proud of our Catholicism"...

Peoria Pastor Doesn't Open Mail

During the last two weeks, my brother and I have sent out over 200 letters. The letter went to all of the pastors of all of the Catholic parishes in The Diocese of Peoria. Bishop Jenky, OSF "leaders", and The Catholic Post of Peoria were also recipients. (The letter is published at the end of this post.)

The letter is very self explanatory and explains the OSF contraceptive policy created in the mid-90's in Peoria. OSF's new purchase, OSF Medical Group--College Avenue in Bloomington, Illinois, will use this unfortunate policy to allow their 40 new OSF physicians to prescribe oral contraceptives. This is, of course, against the teachings of the Catholic Church.

In response to the letter we have received remarks from different pastors wondering how are they going to explain this scandal to their parishoners. And they have called OSF's oral contraceptive policy "disturbing". Even OSF Corporate Ethicist Joe Piccione explained to me that this policy that he helped create is "regretable" and also stated, "We are mourning this policy."

Joe and OSF may be mourning the policy but 40 new OSF physicians are getting ready to use it.

When we sent the letters out we were worried that some priests may not even open their letter out of fear.

Today I received an unopened letter from Father David Heinz, Pastor of Saint Anthony's in Bartonville, Illinois. The photo of the letter is above.

Father Heinz appeared to have written in red ink that he will receive no correspondence from my address. Our names were not on the return address.

HOW did he know not to open this letter? Why would he NOT want to open this letter?

I have never met Father Heinz and I think he probably has many good qualities. I just think it is very painful for him and for many other priests in the Catholic Diocese of Peoria to witness their Bishop give into the secular/economic forces at OSF.

Father Heinz and the other pastors have watched as Haitian Hearts patients have been denied care at OSF and have died. As OSF continues with their hypocrisy Father Heinz probably does not want to know about it, and may well have been instructed not to read the letter. The Catholic Church is not a democracy and the priests must be obedient to their bishop. We just wish Bishop Jenky was leading his priests and flock the right way.

I fully believe that OSF controls much of what The Catholic Diocese does. When I spoke with Bishop Jenky in person, I could see how much he feared OSF's power and money.

And we can't forget that Father Heinz gets his paycheck and health insurance from the Diocese.

We feel sorry for Fr. Heinz and will continue to pray for him.

Here is the letter Fr. Heinz returned to us.



23 July, 2009


Dear Father,


Are you aware that another OSF medical facility will soon be prescribing oral contraceptives? This letter concerns OSF HealthCare’s recent acquisition of Carle Clinic in Bloomington, Illinois. Please refer to the article in the July 12, 2009 issue of The Catholic Post for details of the acquisition.

At Mass on Sunday July 19, our pastor announced the month of July was designated Natural Family Planning Month by the US Conference of Catholic Bishops. The bulletin stated, "NFP is a completely Church-approved alternative to contraception and sterilization." The bulletin also stated: “The Church condemns artificial contraception not just because of its bad consequences. She condemns artificial contraception because it is intrinsically evil (and because it is evil it has bad consequences.)"

For many years, OSF has had a policy called "limited private practice.” This policy allows OSF physicians to write prescriptions for oral contraceptives. For the few seconds it takes to write the prescription, OSF physicians are not considered to be OSF employees. This contrived change in employment status is how OSF justifies allowing their physicians to prescribe oral contraceptives despite the fact that the physicians are in an OSF office building and are still being paid as full-time employees.

Last week OSF Corporate Ethicist Joe Piccione, when contacted by phone, said that he did not know if the physicians presently employed at Carle Clinic in Bloomington will become employees of OSF. However, a representative of Carle Clinic, contacted by phone, said the approximately 40 physicians at Carle would be OSF employees and that they would be able to prescribe oral contraceptives.

It does not take a theological degree to see the grave moral contradiction in permitting employees to prescribe oral contraceptives while saying, “They are not our employees when writing those prescriptions.” OSF should change their policy to prohibit their employees prescribing oral contraceptives rather than allowing it. The limited private practice policy should not be allowed to be placed into effect in the newly acquired OSF clinic anymore than it should be allowed to continue anywhere in the OSF HealthCare System.

The transition from “Carle Clinic” to “OSF Medical Group – College Avenue” will occur on September 13. The OSF policy is obviously not supportive of Humane Vitae and respect for life. Please, after prayerfully considering this matter, advise Bishop Jenky that you disagree with OSF’s policy and advise your parishioners to do the same. Ask Bishop Jenky to reverse OSF’s contraceptive policy. It is important that you act soon since the policy will be harder to reverse once it is put into effect.

Sincerely,


John Carroll, M.D.

Tom Carroll

Heurese Survives Port-au-Prince and Peoria

Heurese went back to Haiti yesterday.

She is back in her one room shack with her two kids and her brother in a massive slum named Carefour.

You may remember Heurese.

During the last 12 months Heurese survived:

Four tropical storms that devastated Haiti last year;

Congestive heart failure;

Extreme poverty with very little food and water for herself and her kids;

UN soldiers who prey on Haitian women;

Haitian gangs who prey on Haitian women;

Peoria's OSF refusal to accept her back for heart surgery;

The silence of The Catholic Diocese of Peoria, the OSF Sisters and OSF Administration, and the Children's Hospital of Illinois Advisory Board who were notified last year that Heurese would die without surgery;

The Haitian government that provides next to nothing for sick people like Heurese;

Giving her children away while she waited to die in the Haitian slum;

Major heart surgery at the top rated heart surgery medical center in the United States;

OSF's Charity Assistance program who refused to do a post operative outpatient echocardiogram for her, but instead had OSF's attorney Douglass Marshall contact the Amercian Embassy in Haiti and request classified information on her visa status;

The pleas of her family in Haiti who told her NOT to return to Haiti now because life is almost impossible.

And to make things even worse for the hypocrisy in Peoria, the July 7 issue of The Catholic Post in Peoria had articles on Pope Benedict's encyclical "Caritas in Veritate" (Charity in Truth).

The pope's main concern in his encyclical is the dignity of the human person.

My family and I have never seen anyone with more dignity than Heurese....a dignity that was totally ignored by Peoria's spiritual and secular leaders.

Joe Piccione, OSF's Corporate Ethicist, who turned his back on Haitian Hearts patients too, called the encyclical "beautiful".

From The Catholic Post in Peoria:

"The new encyclical states that ethical values are needed to overcome the current global economic crisis as well as to eradicate hunger and promote the real development of all the world's peoples.

"The truth that God is the creator of human life, that every life is sacred, that the earth was given to humanity to use and protect and that God has a plan for each person must be respected in development programs and in economic recovery efforts if they are to have real and lasting benefits, the pope said.

"Charity or love is not an option for Christians, he said, and "practicing charity in truth helps people understand that adhering to0 the values of Christianity is not merely useful, but essential for building a good society and for true integral development.

"In addressing the global economic crisis and the ending poverty of the world's poorest countries, he said, "the primary capital to be safeguarded and valued is man, the human person in his or her integrity".

"The global dimension of the financial crisis is an expression of the moral failure of greedy financiers and investors, of the lack of oversight by national governments and of a lack of understanding that the global economy required internationally recognized global control, Pope Benedict said.

"The pope also said that "more economically developed nations should do all they can to allocate larger portions of their gross domestic product to development aid," respecting the obligations they made to the U.N. Millennium Development Goals aimed at significantly reducing poverty by 2015.

"Pope Benedict said food and water are the "universal rights of all human beings without distinction or discrimination" and are part of the basic right to life.

"He also said that being pro-life means being pro-development, especially given the connection between poverty and infant mortality, and that the only way to promote the true development of people is to promote a culture in which every human life is welcomed and valued."


It seems to me that the OSF and The Catholic Diocese of Peoria is not promoting a culture where every human life is welcomed and valued.

As mentioned above, OSF's Coroporate Ethicist Joe Piccione commented on the "beauty" of this encyclical in another article in the same issue of The Catholic Post.

"He (Pope Benedict) is speaking to the conscience of the world. What is possible when human persons interact for the common good."

I spoke to Joe on the phone recently about OSF's abandonment of their Haitian Hearts patients. I asked Joe what Pope Benedict would say about this abandonment.

Joe's response was that he thought that Benedict would say that barriers need to be broken down to allow these Haitian kids to return to OSF.

I reminded Joe that OSF and their attorney Douglass Marshall had banned all Haitian Hearts patients from returning to OSF. (Joe told me that he was unaware of this.) I also reminded Joe again that my Haitian patients were suffering and dying with this policy of patient abandonment.

Therefore, it seems like the first barrier to be broken down at OSF would OSF's embargo against my Haitian kids.

Another barrier that could be broken down would be the "fear barrier". Mr. Steffen, OSF's Administrator, told me that fear at OSF is a "good thing" among OSF employees. If this barrier were broken down, the OSF International Committee could speak up for the Haitian Hearts patients like Heurese that need to come back to OSF and OSF's ethicists could act in the Haitian patients' best interests. (The OSF-SFMC ethicist has not responded to three different requests for help with Haitian Hearts patients.) This barrier of fear working against Haitian kids is significant.

So I do agree with OSF Corporate Ethicist Joe Piccione that Pope Benedict's encyclical is beautiful and that barriers do need to be lifted at OSF in Peoria to prevent Haitian kids from dying.

Elizabeth

This is Elizabeth.

Elizabeth is a young Haitian woman who is a university student and was the second Haitian Hearts patient who had heart surgery at OSF in Peoria.

She was operated in 1996.

Why did OSF Administration stop Haitian Hearts patients from coming to OSF?

Look at the results with Elizabeth. Isn't she the real mission of OSF?

OSF's Keith Steffen and the "Corridors of Shame"

During my blogging the last couple of years, I have documented a number of serious reasons I thought Keith Steffen should be fired from OSF.

His actions regarding Haitian Hearts is deadly, OSF's EMS monopoly is deadly, and the overcrowding in the OSF-Emergency Department is deadly.

I don't think OSF will fire Keith because they would have to admit that they supported him for so long and paid him quite well as OSF's administrator. And it would expose many others at OSF that are telling Keith what to do and how to make more money for this very large and powerful Catholic medical center.

The reason I wrote Keith in 2001 regarded my concerns of the overcrowding and dangerous work conditions in the OSF-Emergency Department.

While I was speaking with Keith in his office for the first time after I wrote him, he likened me to a malignancy that needed to be "cut out". I was surprised to say the least.

David Newman, M.D. is an ED physician and writer. He recently wrote about the huge number of people that were flooding the ER's in New York City this year due to Swine Flu fear.

Dr. Newman writes:

"The impact is clear: lives were lost. High quality studies have shown repeatedly that when ED's experience crowding patients in need of rapid, high intensity care are identified later, treated nore slowly, and devoted fewer resources.

Mortality goes up during crowding in virtually every condition that has been studied, including MI, sepsis, and others. The irony is stark: Once a critical mass is reached, the more that come to be saved, the fewer we can save."

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A brief Emergency medical abstract that I recently read stated the following:

"ED overcrowding is a steadily increasing patient safety hazard. Practical solutions to ED overcrowding are rare, but the United Kingdom has mandated a 4-hour ED stay rule since 2005 whereby 98% of patients must be in and out of the department within this brief time period. Strict adherence to this rule requires buy-in from hospital board members, senior administrators and departmental leaders.

"...themes to implement and sustain successful change included diagnostic testing ordered upon patient arrival, senior decision makers involved early in the care cycle, clincial decision units, and hospital leadership responsive to ensuring timely inpatient bed availability.

"TURNING POINTS TO SUCCESS WERE ONE OF TWO EVENTS: CHANGE IN HOSPITAL LEADERSHIP OR EFFECTIVE CHIEF EXECUTIVE RESPONSE TO A CRISIS."

OSF doesn't have the courage to admit their mistakes. They won't get rid of Keith Steffen.

Too bad for Peoria.

Emergency Departments and Hazardous Environments

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

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

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

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

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

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

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

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

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

OSF and ED Overcrowding and "Where the Money Is"

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

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

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

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

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

Emergency Department Crowding

(Beginning in the middle of the article):

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Jenny

 

Dear OSF,

This is Jenny.

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

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

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

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

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

Please follow OSF's Mission Statements.

Sincerely,

John

Bishop Jenky Needs a Blog

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

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

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

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

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

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

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

So what is all of this about?

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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