2012 is Almost History

Medic Command Calls Slowed a Dysfunctional OSF Emergency Department

While working in the ER at OSF in Peoria the medic command calls rolled in all day long. The calls were from medics in the field who knew what they were doing and their care was protocol driven.

I thought it was largely a waste of time for physicians to answer these calls. And sick patients in the ER and the ER waiting room waited longer because of these calls.

And there was pressure to answer these calls. The number of medic command calls answered by each physician was tallied and distributed at the end of each month.

Why?

EMS in the Peoria Area was based at OSF and still is. And the idea was for OSF to keep control of the Peoria Area EMS. It's all about money as we know. 

The letter to the editor below describes my feelings quite well. 

John 

Emergency Medicine News:

January 2013 - Volume 35 - Issue 1 - p 4

doi: 10.1097/01.EEM.0000425855.74142.40

Letter to the Editor

Letter to the Editor: EMS an EM Mess

Editor:

Maybe it's just me, but has anyone wondered about the efficacy and effectiveness of providing on-line medical command to prehospital care providers?

To me, the medic command calls are just one more senseless interruption, (along with signing crutch forms, signing the PA's charts, and looking at urine culture sensitivities for discharged patients). Having become increasingly aware of the potential for interruptions during a busy shift to wreak havoc with “door-to-doctor time” and “length-of-stay” statistics, I am seeking new ways to stay focused on minimizing “task stacking,” and actually to finishing something I start. Our CEO was witnessed recently sitting in the ED waiting area with a stopwatch. No joke!

So when the radio or phone goes off and the nurse or secretary calls out, “Medic command!” (my Pavlov's bell), I am rarely actually interrupting my current task for any logical reason. Most prehospital arrivals at my shop are, in effect, primarily horizontal rides to the hospital. The vanishing minority of calls that are true medical emergencies are almost all protocol-driven (e.g., hypoglycemia, chest pain, respiratory distress, seizure activity, hemorrhage, stroke), so why am I even being asked to give command?

And if the medics are only calling to notify our ED of an imminent arrival, why can't the secretary or nurse answer the call and make a bed available?

Drs. Michael Callaham and Brian Bledsoe have been strident and eloquent iconoclasts on the mythology of the EMS system and its protocols.

Lights and sirens, MAST trousers, helicopters, most cardiac medications, home AEDs, merit-badge courses, and even ambulance transport itself are of little or no benefit. What's up with medic command?

David M. Lemonick, MD

Pittsburgh, PA

Breaking News: AMT to Take Over Ambulance Service in Chillicothe...Are You Surprised?

Rescue 33 rejects consolidation offer shar.es/hsw3H via @sharethis
— John A. Carroll (@haitianhearts) December 18, 2012

Medical Repatriation

New York Lawyers for the Public Interest and the Center for Social Justice at Seton Hall University School of Law Release Report Documenting Hundreds of Cases of Coerced Medical Repatriation of Undocumented Immigrants by U.S. Hospitals

Medical repatriations of undocumented immigrants likely to rise as result of federal funding reductions to safety net hospitals under Affordable Care Act

_____________________________________________________________________________________

New York, NY, and Newark, New Jersey, December 17, 2012 − Today, the Center for Social Justice (CSJ) at Seton Hall University School of Law and New York Lawyers for the Public Interest (NYLPI) released a report documenting an alarming number of cases in which U.S. hospitals have forcibly repatriated vulnerable undocumented patients, who are ineligible for public insurance as a result of their immigration status, in an effort to cut costs. This practice is inherently risky and often results in significant deterioration of a patient’s health, or even death.  The report asserts that such actions are in violation of basic human rights, in particular the right to due process and the right to life.

According to the report, the U.S. is responsible for this situation by failing to appropriately reform immigration and health care laws and protect those within its borders from human rights abuses. The report argues that medical deportations will likely increase as safety net hospitals, which provide the majority of care to undocumented and un- or underinsured patients, encounter tremendous financial pressure resulting from dramatic funding cutbacks under the Affordable Care Act.

The report cites more than 800 cases of attempted or actual medical deportations across the country in recent years, including: a nineteen-year-old girl who died shortly after being wheeled out of a hospital back entrance typically used for garbage disposal and transferred to Mexico; a car accident victim who died shortly after being left on the tarmac at an airport in Guatemala; and a young man with catastrophic brain injury who remains bed-ridden and suffering from constant seizures after being forcibly deported to his elderly mother’s hilltop home in Guatemala.

According to Lori A. Nessel, a Professor at Seton Hall University School of Law and Director of the School’s Center for Social Justice, “When immigrants are in need of ongoing medical care, they find themselves at the crossroads of two systems that are in dire need of reform—health care and immigration law. Aside from emergency care, hospitals are not reimbursed by the government for providing ongoing treatment for uninsured immigrant patients.  Therefore, many hospitals are engaging in de facto deportations of immigrant patients without any governmental oversight or accountability.  This type of situation is ripe for abuse.”

         

“Any efforts at comprehensive immigration reform must take into account the reality that there are millions of immigrants with long-standing ties to this country who are not eligible for health insurance.  Because health reform has excluded these immigrants from its reach, they remain uninsured and at a heightened risk of medical deportation,” added Shena Elrington, Director of the Health Justice Program at NYLPI. “Absent legislative or regulatory change, the number of forced or coerced medical repatriations is likely to grow as hospitals face mounting financial pressures and reduced Charity Care and federal contributions.”

Rachel Lopez, an Assistant Clinical Professor with CSJ stated, “The U.S. is bound to protect immigrants’ rights to due process under both international law and the U.S. Constitution.  Hospitals are becoming immigration agents and taking matters into their own hands.  It is incumbent on the government to stop the disturbing practice of medical deportation and to ensure that all persons within the country are treated with basic dignity.” 

More information about this issue can be found at medicalrepatriation.wordpress.com, a NYLPI- and CSJ-run website that monitors news and advocacy developments on the topic of medical deportation.

About New York Lawyers for the Public Interest

New York Lawyers for the Public Interest (NYLPI) advances equality and civil rights, with a focus on health justice, disability rights and environmental justice, through the power of community lawyering and partnerships with the private bar. Through community lawyering, NYLPI puts its legal, policy and community organizing expertise at the service of New York City communities and individuals.

About the Center for Social Justice at Seton Hall University School of Law

The Center for Social Justice (CSJ) is one of the nation’s strongest pro bono and clinical programs, empowering students to gain critical, hands-on experience by providing pro bono legal services for economically disadvantaged residents in the region. The cases on which students work span the range from the local to global. Providing educational equity for urban students, litigating on behalf of the victims of real estate fraud, protecting the human rights of immigrants, and obtaining asylum for those fleeing persecution are just some of the issues that CSJ faculty and students team up to address.

_______________________________________________

Andrew Rand's Letter to Chillicothe 33

Letter to Ambulance Rescue 33 From Advanced Medical Transport of Central Illinois

Haitian Hearts/Peoria

It's all the same.

Many good people on the ground that care.

Many good people who invoke Jesus's name all the time. Peoria version of "Si Bon Dieu vle".

Way more good here than bad.

It's all the same.

Young men smoking cigarettes talking through second floor open window of project housing to a woman that doesn't want to be bothered on sidewalk below.

United Against Violence on blue strap hanging from her neck.

John 3:16 carved in cement.

It's all the same.

Emergency Department Overcrowding Causes Patient Deaths

Please read this article from Annals of Emergency Medicine.

Physicians Fired for Questioning the Boss

---

November 30, 2012

A Hospital War Reflects a Bind for Doctors in the U.S.

By JULIE CRESWELL and REED ABELSON

For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments.

But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons.

Today, Boise is a medical battleground.

A little over half of the 1,400 doctors in southwestern Idaho are employed by St. Luke’s or its smaller competitor, St. Alphonsus Regional Medical Center.

Many of the independent doctors complain that both hospitals, but especially St. Luke’s, have too much power over every aspect of the medical pipeline, dictating which tests and procedures to perform, how much to charge and which patients to admit.

In interviews, they said their referrals from doctors now employed by St. Luke’s had dropped sharply, while patients, in many cases, were paying more there for the same level of treatment.

Boise’s experience reflects a growing national trend toward consolidation. Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe growing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay.

In Boise, just a few weeks ago, even the hospitals were at war. St. Alphonsus went to court seeking an injunction to stop St. Luke’s from buying another physician practice group, arguing that the hospital’s dominance in the market was enabling it to drive up prices and to demand exclusive or preferential agreements with insurers. The price of a colonoscopy has quadrupled in some instances, and in other cases St. Luke’s charges nearly three times as much for laboratory work as nearby facilities, according to the St. Alphonsus complaint.

Federal and state officials have also joined the fray. In one of a handful of similar cases, the Federal Trade Commission and the Idaho attorney general are investigating whether St. Luke’s has become too powerful in Boise, using its newfound leverage to stifle competition.

Dr. David C. Pate, chief executive of St. Luke’s, denied the assertions by St. Alphonsus that the hospital’s acquisitions had limited patient choice or always resulted in higher prices. In some cases, Dr. Pate said, services that had been underpriced were raised to reflect market value. St. Luke’s, he argued, is simply embracing the new model of health care, which he predicted would lead over the long term to lower overall costs as fewer unnecessary tests and procedures were performed.

Regulators expressed some skepticism about the results, for patients, of rapid consolidation, although the trend is still too new to know for sure. “We’re seeing a lot more consolidation than we did 10 years ago,” said Jeffrey Perry, an assistant director in the F.T.C.’s Bureau of Competition. “Historically, what we’ve seen with the consolidation in the health care industry is that prices go up, but quality does not improve.”

A Drive to Consolidate

An array of new economic realities, from reduced Medicare reimbursements to higher technology costs, is driving consolidation in health care and transforming the practice of medicine in Boise and other communities large and small. In one manifestation of the trend, hospitals,private equity firms and even health insurance companies are acquiring physician practices at a rapid rate.

Today, about 39 percent of doctors nationwide are independent, down from 57 percent in 2000, according to estimates by Accenture, a consulting firm.

Many policy experts praise the shift away from independent practices as a way of making health care less fragmented and expensive. Systems that employ doctors, modeled after well-known organizations like Kaiser Permanente, are better able to coordinate patient care and to find ways to deliver improved services at lower costs, these advocates say. Indeed, consolidation is encouraged by some aspects of the Obama administration’s health care law.

“If you’re going to be paid for value, for performance, you’ve got to perform together,” said Dr. Ricardo Martinez, chief medical officer for North Highland, an Atlanta-based consultant that works with hospitals.

The recent trend is reminiscent of the consolidation that swept the industry in the 1990s in response to the creation of health maintenance organizations, or H.M.O.’s — but there is one major difference. Then, hospitals had difficulty managing the practices, contending that doctors did not work as hard when they were employees as they had as private operators. Now, hospitals are writing contracts more in their own favor.

“Hospitals are constructing compensation in ways that are based on productivity and performance,” said Steve Messinger, president of ECG Management Consultants, which advises on physician acquisitions.

But the consolidation of health care may be coming at a hefty price. By one estimate, under its current reimbursement system, Medicare is paying in excess of a billion dollars a year more for the same services because hospitals, citing higher overall costs, can charge more when the doctors work for them. Laser eye surgery, for example, can cost $738 when performed by a hospital-employed doctor, compared with $389 when done by an unaffiliated doctor, according to national estimates by the independent Congressional panel that oversees Medicare. An echocardiogram can cost about twice as much in a hospital: $319, versus $143 in a doctor’s office.

Conflicts over the changes are numerous. One Florida primary care physician said he could earn a $5,000 bonus for keeping patients in the hospital for less than three days, according to a lawsuit he filed this year. Hospitals, which are typically reimbursed a fixed amount of money for treating a specific illness, can make more money if patients stay for shorter periods of time.

Last month, the Justice Department reached a $9.3 million settlement with Freeman Health System, a hospital group in Joplin, Mo., which was rewarding doctors it employed partly based on how many tests they ordered. Freeman says that it alerted regulators to the potential violations and that patient care was not affected.

Recently, the Office of Inspector General at the Health and Human Services Department sent a letter to emergency physicians across the country asking for information about inappropriate admissions. Federal regulators are also examining the higher numbers of physician contracts being created, searching for violations of laws that prevent hospitals from rewarding doctors for admitting patients or for ordering lucrative tests and procedures.

Health Management Associates, a for-profit hospital chain; EmCare, a Dallas-based emergency room staffing company for hospitals; and other hospitals have disclosed that they are the subjects of federal investigations. Regulators are looking into whether the hospitals improperly pressured physicians to admit patients.

Pumping Up Admissions

According to two emergency room doctors who worked at Carlisle Regional Medical Center in Pennsylvania, the message could not have been clearer: more patients needed to be admitted.

The doctors were employed by EmCare, whose parent company was later acquired by the private equity firm Clayton, Dubilier & Rice in 2011 as part of a $3.2 billion deal. EmCare, in turn, was under contract to provide emergency room doctors for the hospital, which is owned by Health Management Associates. In interviews, doctors said that hospital administrators created targets for how many patients they should admit. More admissions translated into more dollars for the hospital.

Dr. Jean-Paul Romes, one of the physicians, recalled getting phone calls in the middle of the night questioning why he had not admitted an older patient whose hospitalization he could easily have justified. “The pressure to admit was so high,” he said. Dr. Romes left the hospital last year.

After another physician, Dr. Cloyd B. Gatrell, raised concerns that the hospital had too few nurses to keep patients safe, an EmCare executive warned him to “back off,” according to a lawsuit Dr. Gatrell filed last year. EmCare later fired him at Carlisle’s request, according to the suit. Dr. Gatrell’s wife, Kathryn, a nurse at Carlisle, had been fired earlier and also filed a lawsuit. Both Gatrells maintained they were fired for bringing up patient safety concerns, according to Dr. Gatrell’s lawsuit.

Health Management, which operates 70 hospitals, said United States attorneys’ offices in seven states were investigating physician referrals, including financial arrangements and the “medical necessity of emergency room tests and patient admissions.”

EmCare said in an e-mailed statement that it could not comment on continuing legal matters involving it or its clients, but that its “first concern is the well-being of the patient.”

Health Management is also the target of a suit filed last year in Florida state court by a former executive who says there were improper admissions. The executive, Paul Meyer, an officer in the company’s compliance office, was a longtime employee of the Federal Bureau of Investigation. He said in his lawsuit that he was fired from H.M.A. in 2011 in retaliation for raising questions about what he felt were improper admissions at four of the chain’s hospitals. H.M.A. said its overall admission rate from the emergency department had remained constant in recent years and that its practices were in line with those of other hospitals. It also said there was no indication that Carlisle admitted any patients unnecessarily. Admissions are “based solely on what is best for patient care,” it said in an e-mailed statement.

The company said that it had addressed all of Mr. Meyer’s concerns, and that he was fired for what the company said was a failure to cooperate in an internal investigation. Health Management fired the Gatrells, it said, “for performance issues,” an accusation Dr. Gatrell strongly denied.

Doctors at other hospitals also say they have faced pressure to meet financial targets. Dr. Manuel Abreu said his contract with All Care Medical Consultants, a practice in Clearwater, Fla., allowed him to earn a bonus as high as $5,000 if he kept patients’ hospital stays to an average of no more than three days, according to a copy of the contract included with a lawsuit he filed in Florida state court this year. The parties reached a settlement and the case was voluntarily dismissed, court records show. Calls to Dr. Abreu’s lawyer and a lawyer for All Care were not returned.

Other physicians say they are pushed to ignore what is best for patients by referring them to doctors working for the same hospital. Dr. Victoria Rentel, a family practice doctor near Columbus, Ohio, recalled feeling pressured when she was employed by a local hospital to send her patients to doctors there for tests and procedures.

“I routinely got reports about the money I kept in the system,” Dr. Rentel said, detailing how much revenue she was generating for the hospital through in-house referrals. “I tended to refer to specialists I knew who would deliver better care.” The hospital eventually closed the clinic where she worked.

Some physicians also complain about quotas. Dr. Patricia F. White, an emergency room physician who worked at Baptist Health in Jacksonville, Fla., said that starting in 2010, her compensation was partly calculated based on the number of patients she saw an hour, according to a lawsuit she filed in August against the hospital and Emergency Resources Group, which provided emergency room staffing to Baptist.

The staffing group said it had no choice but to agree to the hospital’s demands. “If we don’t comply with their wishes as good partners, there is a termination notice in our contract,” wrote Paul Davidson, administrator for the group, in a series of e-mails that were included with Dr. White’s lawsuit.

In an e-mailed statement, Baptist Health said that patients expected timely access to quality care and that an emergency room physician’s “productivity and efficiency are vital components to delivering good patient care as well as ensuring patient safety and satisfaction.” A lawyer for Emergency Resources Group echoed those sentiments in an e-mailed statement, adding that efficiency was only one component of physician compensation.

Doctors at numerous hospitals said it was often difficult to criticize the policies instituted by hospitals or investor-owned physician groups because, as employees, they could easily be fired.

“We all have families, and we have mortgages,” said an emergency room physician. “If you get fired, it looks bad and it’s hard to get another job.”

Rising Medical Costs

It was about three years ago that Dr. Julie A. Foote, who has been an endocrinologist in Boise for 18 years, began noticing the ads in the local newspaper.

Each week, another advertisement appeared, heralding the hire of a physician or a practice group by either St. Luke’s or St. Alphonsus, which is part of Michigan’s Trinity Health, one of the nation’s largest hospital systems. “The playing field wound up being divvied up pretty aggressively,” Dr. Foote said.

In the last four years, St. Luke’s acquired 22 physician practices in the area.

Dr. Mark Johnson, a family practice physician who has worked in Boise for about 25 years, was part of a five-person practice that sold itself to St. Luke’s. Among the factors behind the decision were the high cost of adopting an electronic health records system, and a concern that the group members would not be able to find younger doctors willing to buy them out of the practice.

“But probably the driving reason was the changing landscape of health care delivery and the uncertainty around that,” Dr. Johnson said. “The thought was that we were going to be in a safer position if we were aligned and affiliated with a network.”

But as St. Luke’s moved forward with its plans to acquire most of the Saltzer Medical Group — a practice of about 50 doctors in Nampa, Idaho, about 20 miles west of Boise — St. Alphonsus filed an injunction to block the purchase.

St. Alphonsus argues that St. Luke’s dominance is hurting its business because it has experienced steep declines in hospital admissions and referrals from physicians acquired by St. Luke’s.

St. Luke’s says it is positioning itself to compete better by improving its ability to coordinate patient care. It recently filed an application with Medicare officials to become a so-called accountable care organization. Hospitals designated as A.C.O.’s can usually keep a portion of any savings they generate. They cut health care costs by avoiding unneeded procedures and tests or by keeping patients out of the hospital, while still meeting quality targets.

But St. Luke’s remains under investigation by state and federal authorities for possible antitrust violations. While most physician group purchases are too small to draw regulators’ attention, concerns have been raised about whether consolidation is resulting in higher prices and fewer choices for patients.

In 2009, the F.T.C. forced the sale of two outpatient clinics that had been acquired by Carilion Clinic, based in Roanoke, Va., saying Carilion’s fee structure would have increased patients’ out-of-pocket expenses for a brain imaging test, for example, to $350 from $40.

In another case, the F.T.C. and the Nevada attorney general ordered Renown Health in Reno to release 10 cardiologists from their noncompetition agreements after the hospital system bought the two largest cardiology groups in the area, giving it 88 percent of the market.

In Boise, doctors are pressured to refer only within their own system, according to St. Alphonsus in its complaint. It reported a 90 percent drop in admissions to its hospitals by physicians employed by St. Luke’s. In one community, independent doctors often send patients 40 miles away for CT scans because prices at St. Luke’s are 60 percent higher, the complaint said.

Mr. Pate, the St. Luke’s chief executive, disputed the notion that physicians employed by St. Luke’s were prohibited from referring patients to outside doctors.

“My own wife was referred by a St. Luke’s physician to a St. Al’s physician for her particular condition because he felt the St. Al’s physician was the best for this problem,” he said. “If the wife of the C.E.O. is being referred to a physician at another hospital, that should prove that our physicians send many referrals over there.”

Mr. Pate acknowledged that prices for some services had risen, but he said this was only because they had been severely underpriced. In the long run, he argued, overall costs will decline as St. Luke’s is better able to coordinate care, avoiding expensive emergency room visits and redundant tests.

But some people remain skeptical that patients will be better served.

“I’m not certain what all this means is that patients are getting cost-effective care, which is how the nation is painting this evolution,” Dr. Foote said. “If this is better quality for less price, I want to see the less price.”

MORE IN BUSINESS DAY (3 OF 26 ARTICLES)

Retail Frenzy: Prices on the Web Change Hourly

Read More »

Luckner Doing Well After Heart Surgery in Naperville

Luckner doing well after heart surgery. Please see this Chicago Tribune article.

More on Rescue 33

Chillicothe questioning OSF's Mission statements regarding Rescue 33.

See this article.

Rescue 33 Denied

An e mail was sent to Rescue 33 from the Project Medical Director at OSF stating that Rescue 33 in Chillicothe is finished.

The meeting was held at an undisclosed location and the press and public were not allowed by OSF to attend.

See this article in today's Peoria Journal Star.

There They Go Again....

Rescue 33 in Chillicothe has been permanently suspended by OSF's physician in charge of EMS.

OSF will not disclose where the meeting deciding Rescue 33's fate is going to be and the press and public have been banned from attending. The meeting is on Monday (10/1/2012).

See this article in today's Journal Star.

Comments that follow the article do not show much trust in OSF or AMT.

I think it is a done deal already. Rescue 33 is toast and the people of Chillicothe won't even know why. That is too bad.

I would love to have to eat my words. We will see.

A Broken Heart in a Cholera Treatment Center

Luckner

In June of 2011 I was notified by a physician friend of mine, Dr. Jen in Port-au-Prince, that she had a young patient named Luckner with a serious heart problem. She wanted to know if I would examine him and evaluate him as a candidate for heart surgery through Haitian Hearts.

I agreed to do this but I was located in central Haiti about three hours north of Port-au-Prince working in a Cholera Treatment Center at Albert Schweitzer Hospital. I asked Dr. Jen if Luckner could come up to Schweitzer and I would examine him. She said he would make the trip.

At the Cholera Treatment Center we had a tiny admit room. Hundreds of sick patients were coming every day with cholera. We put IV's in the sickest cholera patients in this room and sometimes we would have six or seven very ill patients in shock slumped in their chairs or lying unconscious on cots. Sometimes the patients were even slumped against each other in these close quarters.

One day a young man showed up. Even though I had never seen him I thought he had to be Luckner. He looked too strong and healthy to be a sick with cholera.

The young man was  Luckner and he looked scared. He was scared to be around so many deathly ill appearing cholera patients. I could tell he wanted to leave the Cholera Treatment Center as fast as possible.

I examined him quickly and could hear the loud murmur coming from his leaky aortic valve.

I assured Luckner that we would help him as much as we could and that he could head back to Port-au-Prince. He seemed to be a perfect candidate for repair or replacement of his aortic valve.

So I e mailed Dr. Jen and explained to her that Haitian Hearts would do what we could to get Luckner admitted into a US medical center for heart surgery.

I sent Luckner's history and physical and his echocardiogram to Dr. Bryan Foy a heart surgeon in Illinois who has operated many Haitian Hearts patients in the past. Dr. Foy reviewed the echo and agreed that Luckner needed surgery.

Dr. Foy operates out of a number of medical centers in northern Illinois. Edward Hospital in Naperville is one of them and they accepted Luckner for surgery.

During the past year Dr. Jen and her group of friends in Port-au-Prince were able to obtain a medical visa for Luckner. And they brought him to Naperville about one month ago. He is with a wonderful host family there.

And guess what? Dr. Foy operated on Luckner several hours ago and replaced his leaky aortic valve. (As I post this Luckner is in stable condition in ICU.)

This fortunate 25 year old man just received a new lease on life. My thanks to EVERYONE for all their help with Luckner during the last year.


John A. Carroll, MD
www.haitianhearts.org

Little Problems and Big Problems in Peoria's EMS

See this article in todays Peoria Journal Star.

Sometimes it is hard to see the forest through the trees.

Chillicothe Loses Ambulance Service and AMT Takes Over...

See this article and comments.

George and Keith at OSF

George Hevesy, MD

Keith Steffen

George is just about gone. He announced his resignation a few days ago.

What will this mean for Keith who has supported George for many years?

See this post.

This could get interesting.

Stay tuned.

Palliative Care Medicine

Palliative Care Medicine is "the active total care of patients whose disease is not responsive to curative treatment".

I think Palliative Care Medicine can be good in many ways. But it should not be forced on the patient or family.

The Archives of Internal Medicine in 2008 found that patients who received palliative care services cost the hospital $1696 to $4908 less per admission. And insurers notice these things. And so do hospital administrators who may not care for your loved one as much as you do.

So beware if the Palliative Care team of doctors and nurses seems extra-nice. Financial concerns for their hospital could be driving them as much as their desire to help the patient.

Mindless Menace of Violence

“Our lives on this planet are too short and the work to be done too great

to let this spirit flourish any longer in our land.

Of course, we cannot vanish it with a program nor with a resolution.

But we can perhaps remember, if only for a time,

that those who live with us are our brothers and sisters;

that they share with us the same short moment of life;

that they seek, as do we, nothing but the chance

to live out our lives in purpose and in happiness,

winning what satisfaction and fulfillment we can.

Surely this bond of a common fate, this bond of a common goal,

can begin to teach us something.

Surely we can learn, at least, to look at those around us as fellow man;

and surely we can begin to work a little harder

to bind up the wounds among us and

to become in our hearts brothers and sisters, compatriots once again.”

Robert F. Kennedy      ( 1925 – 1968 )

Insignificant but Important

Whatever you do will be insignificant, but it is very important that you do it.
Let's work together for a better tomorrow...

M Gandhi

Is OSF's CEO Worth 2.2 Million Dollars?

Sister Judith Ann Duvall
Chairperson of OSF St. Francis Healthcare System
(Photo by Peoria Journal Star)

Kevin Schoeplein, CEO of OSF Healthcare System in Peoria, received a salary of 2.2 million dollars in 2009. See this article.

Yet, OSF lets their own Haitian Hearts patients die in Haiti with no medical care. And Sister Judith Ann, pictured above, told me multiple times that OSF would never turn down a Haitian child for medical care. But they have.

Sister refers to OSF as a "sacred ministry." Unfortunately, this sacred ministry is a 5 billion dollar not-for-profit enterprise that has lost its core values.



John A. Carroll, MD
www.haitianhearts.org

OSF Mission Continues...

Long Waits in ER Dangerous for Patients

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.

Emergency Medicine News
July, 2009

Corrupt Corporations...Large Medical Centers Not Excluded

Company executives are paid to maximize profits, not to behave ethically. Evidence suggests that they behave as corruptly as they can, within whatever constraints are imposed by law and reputation. 


New York Times
July 11, 2012

Death in Haiti Deserves Thought

Photo by John Carroll

"Death in Haiti can be cruel, raw, and often devastatingly premature. There is often no explanation, no sympathy, and no peace, especially for the poor. Death's ubiquity, however, does not mean that it deserves any less attention or thought."

New England Journal of Medicine
July 5, 2012
Antonia P. Eyssallenne, M.D., Ph.D.

Doing the Right Thing

“You don’t want to be the outsider who betrays the institution; whistleblowers are always the weirdos,” Lessig said. “There are so many ways to rationalize doing the easy thing. And it’s really easy for us to overlook how our inaction to step up and do even the simplest thing leads to profoundly destructive consequences in our society.”

I asked Cory Booker, the Newark mayor, why he ignored his security team and made a snap decision to run into a burning house to save his neighbor. He said his parents taught him to feel indebted to all the people who had sacrificed for his family. And he recoiled in law school at the idea that there was not always a legal obligation to help the vulnerable.

“We have to fight the dangerous streams in culture, the consumerism and narcissism and me-ism that erode the borders of our moral culture,” he said. “We can’t put shallow celebrity before core decency. We have to have a deeper faith in the human spirit. As they say, he who has the heart to help has the right to complain.”

Maureen Dowd

The New York Times

American Sisters Under Direction of Holy See

See this article.

Rezko: Blago Knew

Read this article.

ER Overcrowding in Canada

Please see this article.

The Greatness of a Man

Great men in Cite Soleil--May, 2012 (Photo by John Carroll)

"...the greatness of a man is measured not in his lack of faults, but in the abundance of his strength."

Emerson

Catholic Dioceses Sue Obama Administration....Peoria Diocese not one of Them...

See this article in todays Peoria Journal Star.

My comment:

Bishop Daniel Jenky of Peoria sits on the Board of Fellows at the University of Notre Dame. He did NOT publicly state that he was against President Obama's visit to South Bend in 2009. Bishop Jenky did NOT sign the Cardinal Newman petition which contained the names of dozens of US Catholic bishops who disagreed with President Obama's appearance at UND. 

And for some reason the Catholic Diocese of Peoria is not part of this lawsuit against the Obama administration. The Diocese says they may have their own lawsuit. (Why would they tell the media this? Is it true?) 

However, Bishop Jenky could be a real hero to conservative Catholics (and others) today if he seized the moment.

After Bishop Jenky's criticism of President Obama's health care mandate, and now with the UND lawsuit against the President, Bishop Jenky should end the OSF HealthCare contraceptive policy which was created with the help of the Catholic Diocese of Peoria. This policy allows OSF physicians to prescribe oral contraceptives for thousands OSF patients from OSF offices throughout the entire OSF HealthCare System. 

We can only hope and pray that Bishop Jenky has the courage to take on OSF right here in Peoria. It is his duty to lead with morally consistent words and actions. Confronting OSF with their power and money will be his toughest challenge.

Notre Dame Sues Obama Administration

See this breaking news.

Bishop Daniel Jenky of Peoria sits on the Board of Fellows at the University of Notre Dame. He did NOT publicly state that he was against President Obama coming to South Bend in 2009. And Bishop Jenky did NOT sign the Cardinal Newman petition which disagreed with the Presiden't appearance at UND.

However, Bishop Jenky could be a real hero to conservative Catholics (and others) now if he seized the moment.

After Bishop Jenky's criticism of President Obama's health care mandate, and now with the UND lawsuit against the President, Bishop Jenky should end the OSF HealthCare policy which allows OSF physicians to prescribe oral contraceptives for OSF patients from OSF offices.

We can only hope and pray that Bishop Jenky has the courage to take on OSF right here in Peoria. This will be his toughest challenge.

Haiti is Not Immortal

The situation is serious. The Nation is not immortal, it is dying. The country is short of breath, [...] he world attended, without illusions, to the sad spectacle of Haitian political impasses that succeed by partisan rivalries and sterile, of inquisition on issues foolish such as dual citizenship, while Haiti needs the cooperation of all his daughters and all his son, to see them answer to the appeal of the ancestors, so often sublimated, become a dead letter: 'Unity is strength!' Of the union we have nothing to do, we prefer the division and endless confrontations. [...] we have only for force that of sinking further our land and a population in the poverty, the abject poverty, the misery, the confusion.

It happens to me, I confess, to be ashamed of this pathetic betrayal of our achievements and our conquests of yesteryear. Betrayal of our noblest aspirations to freedom, equality and fraternity. Betrayal of our highest dreams to break all the chains.

I hurt in my heart of Haitian to be challenged by them, smile, pulling the line and only see in Haiti a country ruined, deliquescent, without compass, without State, without a future, a rotten trunk, a world of corruption and some don't hesitate to describes it, of incapable.


Michaelle Jean

Eric Whitaker, MD

Read this article.

A Clever Move by Bishop Jenky

See this forum article in the Peoria Journal Star.

OSF Buys Ottawa Regional Hospital

OSF buys Ottawa Regional Hospital.

See this article.

The article states that medical personnel will retain their cinical privileges.

I wonder what this means regarding Catholic ethical and religious values inside OSF's latest purchase?

Peoria's Catholic Lie Exposed

See this editorial from this morning by the Peoria Journal Star.

We can't blame President Obama for our contraceptive compromise here at OSF and The Catholic Diocese of Peoria.

Bishop Jenky in Peoria

See this Peoria Journal Star article.

Here is the podcast.

Sister Judith Ann

There was an article in the PJS a few weeks ago about OSF's Sister Judith Ann.

It has to be a parody of OSF.

To be honest, it was kind of sad.

Emphasis on Profit

This Journal Star Forum article describes OSF in Peoria quite well.

The New York Times and OSF's Oral Contraceptive Policy

The New York Times published an article today (February 21, 2012) explaining the ramifications of health care mergers.  They wrote about what happens when large Catholic health care systems buy smaller secular hospitals. Situations exist where patients still want to have contraceptives and sterilizations, but the Catholic health care system wants to restrict them.

Here is the link: http://www.nytimes.com/2012/02/21/health/policy/growth-of-catholic-hospitals-may-limit-access-to-reproductive-care.html

It is a very interesting article and mentions OSF in Rockford. OSF Health Care System based out of Peoria is trying to buy a secular hospital in Rockford.  OSF already owns OSF-St. Anthony's in Rockford. 

People in Rockford are concerned that they might not have access to sterilizations at their secular hospital if OSF acquires it. 

But I don't think the people of Rockford have anything to worry about regarding getting contraceptives from OSF physicians with the anticipated new hospital merger. And here is why.

For 15 years now The Catholic Diocese of Peoria and The Catholic Diocese of Rockford have worked with OSF to allow contraceptives to be prescribed by OSF physicians in Rockford and Peoria through the "limited private practice" provision designed in the mid-90's right here in Peoria. It is a loophole that was created to allow OSF to remain competitive in the medical market place. And I doubt most people would even know that this dismal policy even exists if the Peoria Journal Star did not publish the story in 1995.

The New York Times reports today:

"OSF says Rockford needs fewer hospitals and wants to expand its network to better serve the area. “It’s all about how to deliver care, coordinated and efficient care,” said Robert C. Sehring, an executive at OSF.

OSF has already developed an arrangement in which affiliated doctors can prescribe birth control pills through a separate practice."

The "affiliated doctors" mentioned by the Times are OSF physicians. Similar words, "affiliated physicians", were used in a Peoria Journal Star editorial last week that was describing the outcry created by the new Obama mandate and the Catholic bishops reaction. (See this post.)

So what is my point?

If OSF buys the secular hospital in Rockford, it should apply Catholic morals to this hospital. OSF should not give in and have an elevator to a "secular floor" (or any other provisions) where sterilizations can be performed. 

And there should not be ANY policy to allow ANY Catholic teachings to be butchered inside an OSF facility. The limited private practice policy/loophole mentioned above DOES allow the Catholic bishops in Peoria and Rockford to cooperate with evil regarding contraceptives and should be stopped. 

Peoria Bishops John J. Myers and Daniel Jenky, as well as the Sisters of the Third Order in Peoria and OSF Corporate Ethicist Joseph Piccione, should be hanging their heads right now. Their devious policy created 15 years ago is being scrutinized and should be abolished if the Catholic bishops of the United States really mean what they say about their disagreement with President Obama and religious conscience.

Peoria Journal Star Editorial--February 14, 2012

Peoria Journal Star Editorial--February 14, 2012

From a public health and personal freedom perspective, those who wish to engage in family planning should be able to do so, with the intricacies that go into that decision a fundamentally private matter. From a religious liberty view, churches and their affiliates should not be required by government to do things that violate their consciences.

Between those walls one hoped the president could find room for an accommodation regarding his wishes for free access to insurance coverage for contraception that would, if not make everybody happy, at least compel them to return the swords to their scabbards. Religious leaders, most vocally America's Catholic bishops, had objected to the initial mandate, arguing that it was contrary to their moral convictions and a First Amendment that begins, "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof ..."

President Obama thought a workable compromise had been found last week, announcing he would pursue a policy that, like Hawaii's, targets insurance companies rather than employers so that "religious organizations won't have to pay for these services, and no religious institution will have to provide these services directly." Some of those straddling this divide had wondered aloud why the White House hadn't gone that route in the first place.

Of course, it hit a brick wall with opponents, who found the wording a bit too careful. The bishops have no intention of participating, directly or indirectly, in any practice they consider an evil. Providing access to abortifacients falls into that category for them. "There are two other branches of government that may treat our concerns more seriously," said a spokesman.

In short, this fight is a long way from over. Sigh.

The battle lines are drawn, and this page has heard ... and heard ... and heard from both camps. Some observations:

"It's not about contraception," said GOP presidential candidate Rick Santorum. "It's about economic liberty." It's disingenuous to say it's not about contraception. How many times have the bishops said recently that "pregnancy is not a disease"? One doubts this uproar would have accompanied a government command to provide flu vaccines.

The White House has been quick to note that 28 states already have similar measures, and eight don't even exempt churches. So why hasn't this fuss been raised before? Church leaders will forgive those who ask, as the director of the admittedly progressive Catholics United group did, whether the opposition "serve(s) the interests of a political agenda, not the needs of the American people."Even for those who believe in a strict, constitutionally guaranteed separation of church and state - though all too conveniently most tend not to explore both sides of that coin - no religious organization has carte blanche. Unfortunately, in recent memory great damage was done to the church, diminishing its moral authority, when some in its hierarchy failed to recognize their obligations to notify and cooperate with civil authorities as crimes against children were committed within their ranks. No right is absolute.

• On the flip side, Obama seemed flabbergasted and frustrated by the original firestorm. One is surprised he was surprised in this hyper-charged, hyper-partisan environment. He and others want to argue that hospitals, schools and social service agencies don't necessarily further a religious mission. That's debatable, especially in parochial schools that educate children not only in the three Rs but in the faith. The president also seems to subscribe to the myth that he can declare something "free" and magically, it becomes so. If someone is getting contraceptives for nothing, someone else - the employer, other health care consumers - is subsidizing them.

  Yes, some religious institutions already provide this coverage to employees. Doctors affiliated with Peoria's Catholic hospital can prescribe oral contraceptives for patients, though it must be made clear they're "acting separately from OSF." If some institutions are in noncompliance with the bishops' current stance, that's also an argument for letting the marketplace work. The fair counter is that but for government intervention historically, many reproductive and other health care procedures for women might never have been covered.

  One also is told that polling shows most Americans on the White House's side, that these institutions employ people of many faiths who are not obligated to subscribe to the beliefs of their employer, that 98 percent of U.S. adult women have used contraception. To which one might respond that constitutional rights are not subordinate to public opinion; that no one has a constitutional right to a job; and if that's so, what's the access problem in need of being resolved? Finally, disagreement exists on whether some of these contraceptives are abortifacients. That depends on how you define a pregnancy; there's not enough space left to get into that.

  All in all, this page continues to believe the White House overstepped at first. Beyond that, one agrees with the bishops' first-blush reaction to the compromise - later retracted - that this was a "step in the right direction." Regardless, between the "war on religion" and the "war on women" camps, there may be no bridging this divide.

  We settle political disputes in America legislatively, to be sure, but ultimately through the courts and elections. Fortunately, both those opportunities present themselves this year. We'll just have to see those processes through.
  
  My comment:
  
  
  I appreciate the Journal Star devoting so much time to the issue of President Obama vs. the Catholic Church and religious liberties. Legal scholars are necessary who can debate all sides of this important issue. And legislation needs to occur to settle the issue.
  
  Many politicians are considered sincere and many are not. Same with Catholic Bishops.
  
  It has seemed strange to me that the Catholic Diocese of Peoria seems to be talking out of both sides of their mouth. The Journal Star editorial this morning states that Bishops have no intention of participating directly or indirectly in any practice they consider evil.
  
  Does Bishop Jenky view oral contraceptive use as evil?
  
  Two weeks ago Bishop Jenky wrote that Catholic institutions should not have to cover oral contraceptives in their insurance plans. But at the same time, the Diocese and OSF still concur on a policy that they designed over 15 years ago which allows OSF physicians to prescribe oral contraceptives from OSF offices for OSF patients throughout the entire OSF Health Care System. And they did this to keep OSF competitive in the medical marketplace.
  
  The Journal Star editorial this morning states:
  
  Yes, some religious institutions already provide this coverage to employees. Doctors affiliated with Peoria's Catholic hospital can prescribe oral contraceptives for patients, though it must be made clear they're 'acting separately from OSF.'
  
  I really doubt that OSFs patients who go to their OSF doctor at an OSF office and come out with their oral contraceptives understand that OSF is not responsible for this.
  
  It seems to me that there is cooperation in a direct or indirect way here from the Diocese who could stop this coverage if they really wanted to. Bishop Jenky cannot tell the Sisters at OSF what color to paint Saint Francis Medical Center, but he can intervene at OSF on matters of morals and faith.
  
  If it means that OSF-SFMC needs to lose its tax exempt status and not accept federal funds to be a Catholic hospital more than in name only, maybe that is what should happen. It sure would take some of the pressure off of Bishop Jenky and he would not have to cooperate with evil. The Diocese may lose the financial support of OSF, but legally and morally the Diocese would be doing the right thing.
  
  John A. Carroll, MD
  West Peoria