Kindred Spirit

“Freedom had been hunted around the globe; reason was considered as rebellion; and the slavery of fear had made men afraid to think. But such is the irresistible nature of truth that all it asks, and all it wants, is the liberty of appearing...In such a situation, man becomes what he ought. He sees his species, not with the inhuman idea of a natural enemy, but as a kindred.”

Thomas Paine, 1791

"Time is of the Essence"

The Peoria Journal Star recently reported that a new Life Flight hangar was dedicated on August 28.

The new hangar, which cost 2.6 million dollars, is 12,000 square feet and will house the fleet of four Life Flight helicopters. The four helicopters are used by OSF in Peoria and Rockford.

A flight nurse that has worked with the OSF helicopter program for many years stated, “Time is of the essence...We just try to get the best patient outcome for them.”

I assume that Dr. George Hevesy and Dr. Rick Miller agree with their flight nurse’s assessment regarding speed and emergency medical services. Both Hevesy and Miller are employed by OSF and both have been project medical directors for the Peoria area. These two physicians have controlled ground and air transport in the Peoria area for many years.

If time is of the essence arriving at the scene and transporting the patient, why can’t the Peoria Fire Department (PFD) give ground based advanced life support and transport patients? The PFD frequently arrives at the scene quicker than Advanced Medical Transport.

Where have Drs. Hevesy and Miller been for the past 15 years? Why haven’t they enabled the PFD to treat and transport like AMT is allowed to do and the Life Flight helicopters do when “time is of the essence”?

Peoria's Catholic Post

The Catholic Post in Peoria can leave one confused.

The July 29, 2007 issue had an article about OSF’s groundbreaking ceremonies immediately followed by an article on the legacy of Dorothy Day.

What is the reader to believe? Mixed messages are being sent.

The article regarding OSF’s $234 million dollar Milestone project was replete with statements that the Sisters started from humble beginnings 130 years ago in Peoria. Sister JudithAnn, president of OSF Healthcare System stated, “We have placed these resources into the hands of the most caring physicians, nurses and technicians so that all who come to us in need of health care can be received with open hands and hearts. The true joy of this day is to realize that in serving those in need we serve Christ Himself.”

But OSF is not doing what Sister JudithAnn told the crowd at the ceremony. What about the Haitian Hearts patients that are being turned away at OSF and are dying? Would the pioneer Sisters that started with "humble beginnings" in Peoria 130 years ago be proud of OSF's immoral behavior now? I don’t think so especially with the amount of money available for medical care.

Multiple dignitaries spoke of the Sisters great work in Peoria over the last century, and I agree it has been great work. However, the dignitaries are hiding behind the Sisters now as OSF ignores the sick and dying Haitian kids.

Bishop Jenky "prayed that God would bless the builders, benefactors, physicians, nurses, employees, and all those cared for by OSF Saint Francis and Children’s Hospital, especially “the little ones”". I completely agree with this also. But it seems to me that Bishop Jenky forgot Haiti’s “little ones” when he abandoned the Haitian Hearts program in Peoria several years ago. His Chancellor, Monsignor Rohlfs, called a picture of a Haitian child with heart disease an “advertisement”, rather than a “little one” during a Haitian Hearts committee meeting.

What is one to believe from the Diocese and OSF?

Dr. Kay Saving, the medical director of Children’s Hospital, personally turned away a Haitian child from receiving care at Children’s Hospital several years ago. However, at the groundbreaking ceremony the Post reported that Dr. Saving stated that the guiding principal of the new facility is “the patient will be first”. Amazingly this statement meant that the new $234 million dollar Children’s Hospital will “feature private rooms that include comfortable beds for a parent that may wish to stay the night.”

What about the Haitian kids who live in small stifling rooms with 10 other family members who have no options for medical treatment? What would the OSF founding Sisters say about that? Contrary to Dr. Saving's declaration, the sick Haitian child is definitely not coming first.

And the article on the legacy of Dorothy Day described a lady who “handed herself over totally to the humble and courageous service of the poorest of the poor" by fighting for their causes in her newspaper, “The Catholic Worker”.

Bishop Jenky is the Publisher of The Catholic Post, the newspaper of the Diocese of Peoria. Too bad he and the Post send mixed messages to all of us regarding care of the Haitian poor. I bet Dorothy Day would have been honest regarding this issue and would not have hid behind the OSF Sisters as did the groundbreaking dignitaries.

(Pictured at the top of this post is my niece standing in front of a tiny hospital in a slum in Port-au-Prince, Haiti. The slum is home to 400,000 people and this is the only hospital that is functioning. Below is OSF, the largest medical center in downstate Illinois.)

Does Cite Soleil Deserve Simple Technology?

Since 1995, Haitian Hearts has helped bring approximately 150 infants, children, and young adults to the United States for medical treatment unavailable in Haiti. The vast majority of these kids have suffered congenital heart disease or rheumatic heart disease.

Congenital heart disease means the patient was born with an abnormally formed heart. Rheumatic heart disease is an acquired heart problem due to Group A beta hemolytic streptococcus infection. The streptococcus infection is usually a pharyngitis that goes untreated in resource poor settings.

The teenagers in Haiti with rheumatic heart disease break our hearts when we examine their broken hearts. These patients usually have valves that have been injured and do not work well. They are leaky or calcified and tight and won’t open like they should. Many times the valve is leaky and tight at the same time.

These teenagers are in a constant state of congestive heart failure. They have missed much school over the years and can’t contribute much to the family because they can’t physically exert themselves. Their hearts are just too weak from rheumatic heart disease.

Many of these kids die in Haiti before we can find an accepting hospital in the States to operate them. The children and teenagers that have made it to the States and have their valve repaired or replaced have a new lease on life. But surgery is very difficult, being placed on a blood thinner can be problematic, and sometimes more surgery is needed if the valve fails again or another episode of rheumatic fever occurs.

The New England Journal of Medicine has two excellent articles on rheumatic fever this week (August 2, 2007).

Important points made in the two articles:

1. Rheumatic fever is a disease of poverty. Overcrowding and poor hygiene allow the easy transmission of streptococcus. Malaria, tuberculosis, and AIDS are bad diseases and are very prevalent...but so is rheumatic heart disease.

2. In the mid-20th century, children with rheumatic fever occupied many of the beds in pediatric wards in industrialized countries---some hospitals were totally dedicated to the treatment and rehabilitation from rheumatic fever.

3. In the later half of the 20th century, rheumatic fever receded as an important health problem in almost all wealthy countries because the standard of living is so high and because penicillin is available.

4. For the resource poor world, rheumatic fever and rheumatic heart disease are huge problems right now.

5. It was recently estimated that worldwide 15.6 million people have rheumatic heart disease. These are conservative estimates. A walk through Port-au-Prince and Cite Soleil would prove that to you. And almost all of these cases and deaths that occur happen in the resource poor world like Haiti.

6. An unfortunate consequence of the decline in rheumatic fever in industrialized countries has been a parallel reduction in related research. In other words, if we in our well-to-do world don’t get this disease, why do much research?

7. Most resource poor countries do not have effective primary or secondary preventative measures and higher degrees of treatment such as medication for heart surgery, valve surgery, and anticoagulation are not found in places like Cite Soleil.

8. The authors of one of the articles studied kids in high risk settings in Cambodia and Mozambique, and found that echocardiographic screening found many subclinical cases of rheumatic heart disease that could be treated to prevent further valve destruction. Echocardiography picked up many more cases than did the stethoscope and clinical exam.

9. The authors concluded that it is not acceptable to leave these cases undiagnosed and these children at risk for recurrence of rheumatic fever simply because echocardiographic screening is seen as an inappropriate use of modern technology in developing countries. Instead, further research is needed to define models of echocardiographic screening that are practical, affordable, and widely applicable.

10. Portable on site echocardiograms are not difficult, the machines are small and give very good images, and should be done in research poor settings. That would include Cite Soleil.

Cost Effective to Treat the Poor?

A great article was written by Darshak Sanghavi this month--Wrong Number. It is a must read.

Take home messages from this article:

1. Don't pit the poor against the poor.

2. QALY's dont count if YOU are sick. (Read the article to find out what QALY's really are.)

3. Farmer proved that treating poor Haitians with AIDS is reasonable, rational, and the right thing to do.

4. One's economic paradigm powerfully influences what can be done locally.

5. Haitian Hearts met with Dr. Aldo Castaneda several years ago in Guatamala. He was considered the best pediatric heart surgeon in the world. Dr. Castaneda accepted a Haitian child for cardiac surgery in Guatamala and will accept more. Dr. Castaneda and the Haitian child's mom don't care about QALY's either.

Mauricio Accepted!

Good news!!

Mauricio, the seven month old baby boy in Port-au-Prince with congenital heart disease, was accepted yesterday into a major children's medical center for heart surgery.

Also, two other Haitian children were accepted yesterday by another children's medical center, for surgical repair of their heart defects.

And a fourth baby, who is six months old, is very close to acceptance in the U.S. by yet another medical center. E mails have been flying back and forth between Haiti and the United States.

The childrens' families are very happy.

I would like to divulge the names of these generous medical centers, but won't at this time, to prevent anyone from attempting to stop these miracles from happening.

Luke and OSF

As documented in previous posts, our four year old son Luke has been intermittently urinating blood. With a sonogram, we found that he has a large kidney stone in his right kidney. The stone needs to be removed to protect his right kidney function and to protect him from infection that could occur with an obstructed kidney.

Today (7/20/2007) I called the pediatric urology office at OSF-Children’s Hospital of Illinois (CHOI) and told the office nurse that after much thought we have decided not to have Luke treated at OSF-CHOI. We arrived at this decision based on the following:

Luke has been on antibiotics daily for about two months. It has been approximately seven weeks since Luke was first evaluated by a pediatric urologist and it has been five weeks since he underwent a general anesthetic in the operating room at OSF to look at his kidney anatomy.

Since Luke’s general anesthetic and procedure five weeks ago, no meetings have been arranged to discuss options to remove his kidney stone. My wife and I have been to the pediatric urology office or contacted the office six times.

Why has there been such a delay? Why have their been no formal discussions regarding treatment options with the physicians that need to be involved in removing the kidney stone?

When I talked to an employee of CHOI and described the above time scenario to this person, the employee replied that he would be “concerned” if Luke were his child.

I am “concerned” also and do not feel our son has been treated appropriately by CHOI. Several years ago my Haitian Hearts patient’s cardiac surgeries were delayed, so this is nothing new to me.

If OSF were asked about the delay, I would think OSF and their attorney would have well thought out reasons why Luke has not been treated.

What happened to Luke is disappointing but not surprising. The Community Advisory Board at OSF is unaware of Luke's situation, but what would they do if they knew? What did this Advisory Board do to prevent the deaths of Haitian children denied care at OSF?

What about the Pediatric Resource Center at OSF? Would they intervene to help kids marginalized by OSF? My e mails to OSF are blocked.

Also, based on my past experiences, there is not an impartial ethics committee at OSF or in the Catholic Diocese of Peoria to present this problem. All of my ethics consults at OSF over the past six years have been ignored. When I told Monsignor Rohlfs about a Haitian Hearts baby that suffered an outpatient arrest before his cardiac surgery, Rohlf's reply was, "Let me know if it happens again." Our family has no one to go to.

There is no real self accountability at OSF or at the Diocesan level.

When I spoke with the nurse in the office today, I reiterated to her that it was not her fault that Luke did not receive appropriate care. I told her that I thought OSF-SFMC, the largest hospital in downstate Illinois, had 5,000 good employees, and that the real problem with OSF is their leadership.

Until these leaders are replaced with Catholic hospital leaders that are encouraged by an unafraid Bishop Jenky to respect and follow the Ethical and Religious Directives for Health Care at OSF, nothing will change.

Common Good

The common good may be defined as the sum total of those conditions of social living whereby citizens are enabled more fully and more readily to achieve their own perfection. Most social evils and injustices are the result of the exclusion of some persons from the common good in which they have a right to share.

Jesus, moreover, taught an ethics that clearly went beyond even this demand for distributive justice based on merit (i.e., each receives in proportion as he or she contributes). Jesus proclaimed the coming of the Kingdom of God (Mk 1:15), which was not merely a heavenly kingdom but was also the fulfillment of the Old Testament prophecies of the Reign of God on the earth.

The Beatitudes (Lk 6:20-22;Mt 5:3-11) are the joyful announcement to the poor (i.e., those excluded from the common good) that at last they are to be included in this common good, not only economically, but also spiritually (“the poor have the good news preached to them”; Lk 7-22). Consequently, the principle of the early church was “from according to his (or her) ability, to each according to his (or her) needs,” a principle Karl Marx borrowed from the Acts of the Apostles (32-35). Thus the common good requires love and mercy and the distribution of possessions according to need. The mark of all Jesus’s work was his concern for the neglected, the outcast, the leper, the prostitute, the Samaritan heretic, and the pagan unbeliever.

A Christian ethics of health care allocation must be based not on merit, and certainly not on the ability to pay, but on need, because the needy are the most neglected. In this sense, health care is a right. Moreover, social oppression is the chief cause of illness. Hence those who are helpless by reason of poverty, disease, defect, or age (the unborn or the senile) should be the first to be considered under any health plan.

Yet all persons should contribute to the plan according to their ability. Thus the social responsibility for health care falls first on those who have the ability to heal, the health care professionals, and second on those who have the ability to pay, that is, those who have profited the most financially from society. For such affluent individuals to claim that they have made their wealth simply by their own efforts is an absurdity. They may have worked hard, but their wealth would not have been possible without the existence of the society of which they are a part. Consequently, their debt to the common good is in proportion to the wealth they have received from it.

Ethics of Health Care, Third Edition
Benedict M. Ashley, O.P.
Kevin D. O'Rourke, O.P.

Physician as Witness

At the end of Camus' The Plague, the main character--a physician named Rieux--reflects on his role throughout the plague epidemic. He realizes that, along with providing care that had to be given "by all who...strive...to be healers," he bore witness to patients' suffering. Physicians surely have the duty to fight disease in most circumstances, but physicians always have the still greater duty to see patients and survivors through their suffering and thereby to bear witness to it. Perhaps that greater duty lifts medicine from a mere occupation to a true profession.

Annals of Internal Medicine Volume 147, Number 1

Charity Assistance at OSF

The OSF Healthcare system has a site on www.osfhealthcare.org. It is signed by "The Sisters of the Third Order of St. Francis".

The site states the following--

"Dear Patient:

The Philosophy of OSF HealthCare is that all people have a right to receive needed health care. Our doors are open to persons of every faith and ethnic background regardless of their ability to pay."

Why would the Sisters sign this when OSF-SFMC attorney Doug Marshall has made it very clear that OSF will not take care of my dying Haitian Hearts patients?

Also, the Ethical and Religious Directives for Catholic Health Care Services, which OSF Corporate Ethicist Joe Piccione recently quoted in the Catholic Post, lists the following directive:

Directive #3-- "In accord with its mission, Catholic health care should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination: the poor; the uninsured and the underinsured; children and the unborn; single parnts; the elderly; those with incurable diseases and chemical dependencies; racial minorities; immigrants and refugees. In particular, the person with mental or physical disabilities, regardless of the cause or severity, must be treated as unique person of incomparable worth, with the same right to life and to adequate health care as all other persons."

The Haitian children and their families are living in extreme distress. Why are the Sisters, Bishop Jenky, and the OSF Board of Directors and Ethics committees ignoring Directive #3 regarding Haitian children that need their advocacy?

Catholics, Capitalism, and the Gold Shovel

Several days ago in Peoria, OSF broke ground for its new $234 million dollar hospital expansion. (The article and comments that appeared in the Journal Star are located at the bottom of this post).

It is interesting to contrast the three paragraphs below from “Ethics of Health Care” by Ashley and O’Rourke with the Journal Star article and the reality of the “ethics of health care at OSF”.

While OSF “looks to the future” to treat “those who need it most”, they are allowing Haitian Hearts patients to suffer and die. OSF’s philosophy of respect for life does not seem to include Haitian lives.

Three quick, important, and potentially threatening ethics paragraphs from Ashley and O'Rourke:

“Many Catholics are under the impression that the Catholic Church, because it opposes communism, favors capitalism. They are unacquainted with the fully developed social teaching of recent popes, which must be considered in any Catholic approach to today’s ethical problems, including those in the medical field. The popes urge us to work for a world community based on spiritual goods or values and economic cooperation. They link human health and world poverty as the most fundamental ethical problems of our time, problems that in the United States are often ignored by ethicists and health care professionals…

“Thus the Kingdom of God begins here on earth with social justice, as modern popes have constantly preached, and no one will gain heaven who has neglected to work for social justice on earth. Jesus said, “I was hungry and you never gave me food…insofar as you neglected to do this to one of the least of these, you neglected to do it to me” (Mt 25:31-46). In the parable of Lazarus and the rich man (Lk 16:19-31), he taught the same lesson.

“Consequently, genuine Christian ethics cannot be conceived from the viewpoint of the status quo, which in a sinful world tends to reflect the materialistic spirit of domination and possessiveness. It must also view the world from the side of the oppressed, whose needs have been ignored and neglected. Thus, Jesus pointed to his preaching of the Gospel to the poor as the best sign of the authenticity of his own mission (Mt 11:5). A Christian politics of health care must then be based on an option for the poor.”


Hospital Looks to Future
OSF Saint Francis Medical Center embarks on largest private building project in Peoria's history with $235 million facility

Friday, July 13, 2007

BY JOHN SHARP
OF THE JOURNAL STAR

PEORIA - What started with "humble" origins inside a small house on Southwest Adams Street 130 years ago will blossom in 2010 into what OSF Saint Francis Medical Center officials claim will be one of the premiere facilities for pediatric care in the Midwest.

The $234 million Milestone Project will add an eight-story, 440,000-square-foot building to a hospital complex that is much more than 1 million square feet, further enhancing the mission of the Sisters of the Third Order of Saint Francis to serve people with "the greatest love and care."

"This is simply the largest undertaking we've ever done at OSF," Sister Judith Ann Duvall, chairwoman of OSF Healthcare System, said Thursday during a ceremony to officially begin construction on the largest private building project in Peoria's history. "It's been made for the right reasons . . . so we can be here to help the people who need it most."

Thirty-three dignitaries, including the sisters, local politicians, hospital physicians, patients and administrators, picked up gold shovels outside the future home of the Milestone Project and ceremoniously tossed dirt to officially start what will be a three-year project.

"We really believe this will take health care in Peoria to a whole new level," hospital CEO Keith Steffen said, who, along with other dignitaries, praised the sisters for the hospital's founding and dedication to helping it evolve.
The project, which will be paid for primarily through hospital debt, is a modernization and expansion of the medical center and the Children's Hospital of Illinois.

Three floors of the new building will be solely dedicated to the Children's Hospital, with one floor serving adult cardiac patients. The other four floors will contain services for both adults and children.

Derrick Brown, 13, of Peoria, a longtime Children's Hospital patient, said he looks forward to coming to a much larger facility.
"It's going to be great," said Brown, who has been treated for sickle cell anemia for years and who will be a freshman at Richwoods High School this year.

The St. Jude Midwest Affiliate will also move to the new building. The affiliate's wing will be named in honor of former Peoria Mayor Jim Maloof. Maloof, who still is recovering from the effects of an automobile crash last year, attended the ceremony and praised it as something other communities simply cannot offer.

Though planning for the Milestone Project began about two years ago, Maloof said having a strong St. Jude affiliate was something considered during a June 1966 visit by Danny Thomas, founder of St. Jude Children's Research Hospital.

"He said, 'someday we should have an affiliate,'" Maloof said. "Little did we dream it would be this facility."

Minneapolis-based M.A. Mortenson Co., a specialist in health-care construction, is the project manager for the Milestone Project. Steffen said the project will attract 600 to 650 construction-related jobs to Peoria for the next three years.

In addition, once the facility is completed, between 250 to 300 new positions will be added at St. Francis, Steffen said. St. Francis already is the largest hospital in downstate Illinois, with approximately 5,200 employees, and is the only Level 1 trauma center in the area.

A private fundraising campaign is expected to begin soon, but there is no timetable or goal set for raising money to help offset hospital debt. Already, the hospital has announced a $5 million donation from Jerry and Helen Stephens and a $500,000 gift from Lynn and Susan McPheeters.

Activities on the hospital campus over the past year have prepared the area for the new building. Those included construction of a new parking deck, a new helipad for LifeFlight and the demolition of a 900-vehicle parking deck.

John Sharp can be reached at 686-3234 or jsharp@pjstar.com.

Comments:

Pat
July 14, 2007 - 07:00
Subject:

Dear TT
OSF has a for profit and a non-profit interest. The hospital and all these interests are owned by a huge corporation. Do you think their huge insurance industry doesn't have stock holders? The main hospital, which is non-profit, operates at state minimum standards. They are under staffed and their help is over worked. Patients are told they can't find enough employees so how are they going to staff this huge expansion? Go read Dr. John Carroll's web site. He was one of OSF's best emergency room physicians. Disagree all you want but keep a wary eye if you are ever a patient at OSF. I personally know a case of hospital error that killed a young patient. These things never make the paper, settlements are based on the grounds nothing is ever made public. People here telling you the facts are in the profession or have first hand inside knowledge of the situation. OSF depends on the gullible to shovel dollars into their pockets by playing on an image of honesty and charity that no longer contols the organization. The Sisters don't run the place, but their image brings in big bucks. Yes they do good, yes they have saved lives. What good they do is in direct line with the patient's ability to pay or ability to qualify for tax payer funded programs. Too much of their money is funneled back into the for profit portion and into the pockets of people who have had nothing to do with patient care.



Nancy Bovee
July 14, 2007 - 06:35
Subject:
How lucky Peoria is to have 3 wonderful hospitals! I am sure we Peorians are the envy of many other cities - many residennts of whom come here to use the fine services provided by fine physicians. We should all thank hospitals when they expand and offer us more. Who knows when we might be the ones using ths state-of-the- art facilities?



johnson drake – Peoria
July 14, 2007 - 05:56
Subject:
I like to know if a venture like this will decrease any future healthcare expenses I have. Will it? Or will it increase them? I'm sure the increased revs will get at least one or two doctors membership into the Country Club of.



monkfellow
July 13, 2007 - 16:54
Subject:
Subject:
Monkfellow is living in a dream world. St. Francis and its chain of hospitals is one of the most crooked organizations I have ever been privy regarding. I saw the inside at very high levels. If you look real deep into the background ( go back to Bloomington) of their current leadership you will find deception and crookedness to the extreme. People who give to that organization to perpetuate its modus apparenda have more money than brains.--
--
care to put any validity to this pack of lies??????????
You have privvy to NOTHING...and you're fortunate you can besmirch this wonderful organization.



KAG
July 13, 2007 - 15:51
Subject:
Congratulations to OSF St. Francis and to Children's Hospital of Central Illinois. My son was very ill when he was born and the wonderful, caring staff at St. Francis and Children's Hospital saved my life and my son's life. I'm thrilled that the Children's Hospital is expanding and their NICU will be able to save even more children -- this is such wonderful news!



Mr. Johnson
July 13, 2007 - 15:30
Subject:
Why don't we take care of the sick Americans first? I would prefer that we take care of "our" business first before we give foreign people free medical care.





John A. Carroll, MD
July 13, 2007 - 13:19
Subject: Gold Shovels

As OSF looks to the future with their 234 million dollar campus renovation, the largest medical center in downstate Illinois is turning its back on suffering and dying Haitian Hearts patients. Even Haitian patients that have been treated in the past at OSF, and need surgery to stay alive, are being refused further care at OSF with full and partial charges offered for their care.

Why doesn’t OSF’s “respect for life” philosophy include Haitian lives?

Sister Judith Ann said the new project “could help people that need it most”. The hypocrisy in the air as the dignitaries’ gold shovels broke ground must have been stifling.



Cudos to Pat
July 13, 2007 - 08:03
Subject:
Monkfellow is living in a dream world. St. Francis and its chain of hospitals is one of the most crooked organizations I have ever been privy regarding. I saw the inside at very high levels. If you look real deep into the background ( go back to Bloomington) of their current leadership you will find deception and crookedness to the extreme. People who give to that organization to perpetuate its modus apparenda have more money than brains.



monkfellow
July 13, 2007 - 06:57
Subject:
Congratulations, again, to the Sisters of the Third Order of St. Francis, and the members of the health care community at OSF St. Francis for all their hard work and care throughout this area.
I hope the Catholic-haters note patient payment for services WILL NOT be used to build this complex(and the weak complaints about "high-paid" staff or health care executives shows the hidden contempt for the good in this institution-since they have so little to offer themselves they revert to anti-Catholic rhetoric which, in another arena, could be considered hate speech).
We are fortunate to have all our health care institutions. Kudos, too,to Methodist for its expansion plans.



Reply to monkfellow
Pat
July 13, 2007 - 07:13
Subject:
The Sisters have very little to do with OSF, it is ran by a corporation. I've never heard anything about high paid staff, the bulk of their employees are eligible for public assistance programs. The real winners in this expansion will be the stock holders, it should bring in a lot more revenue. I can't help but wonder exactly how they plan to hire so many new people when, by their own admission, they can't find enough applicants to staff the exsisting hospital. The era of "Catholic haters" is past. The ones who criticize OSF actually are those who work in the profession, or have inside knowledge of it's management. This expansion should go a long way to keeping the fund raising portion of their operation non-profit. We do have a lot of good dedicated doctors in the area. As long as they are willing to make money for the corporation they will practice at OSF. There isn't much room at OSF for those who put patient well being over bottom line.

Urgent Situations

Emergency rooms are getting more crowded as many patients look for immediate care.

Tuesday, July 10, 2007

By DAYNA BROWN

of the Journal Star

Dr. Rick Harris spent the morning treating a heart attack patient, helping someone with pneumonia and showing a man how to give himself a shot of blood thinner medicine.

It was a typical Monday in the OSF Saint Francis Emergency Department in Peoria.

"It's hectic. Right now we are at a Crisis 2, because triage keeps filling up and all the beds are full," Harris said. "I expected it when I got up. Mondays are probably one of our busiest days."

But more and more, every day seems like a Monday, doctors said, as visits to emergency departments have grown to an all-time high.

Nationwide, 115 million patients visited the emergency room in 2005, up five million from 2004.

Locally, the numbers are also growing, with the three Peoria hospitals seeing more emergency patients than ever before, doctors said.

"The emergency department is the safety net," said Dr. George Hevesy, director of emergency medical services at St. Francis. "We will see anybody."

There are a wide variety of reasons for emergency room visits, the top cause being chest pain and abdominal pain. Injuries also are a big cause.

"Several years ago, if you called your doctor and said you were having chest pains, they may have wanted to see you in the office. Now they say, go to the emergency department," Hevesy said.

The aging population contributes to the growing numbers, as do the large numbers of uninsured, who often don't have primary physicians to treat their ailments.

"We are seeing people who are waiting longer and coming in sicker. . . . I think part of it is an inability to access their primary care physicians," Hevesy said.

Some of the increase is because of a lack of patience among the patients, said Dr. Greg Sowards, emergency department medical director at Methodist Medical Center.

"Our society is a now society ... it doesn't matter what our thing is, we want it now. And medicine is no different," Sowards said. "People want to be seen, they want to be seen quickly. A lot of this stuff is not life threatening, They are just not willing to wait."

Both Methodist and St. Francis are working to accommodate the increased need.

Later this week St. Francis will break ground on a $234 million construction project that will include a "much needed" emergency department expansion. The emergency room was constructed to serve 32,000 patients annually, but this year it will surpass 70,000.

Methodist also has plans to build a new emergency department, and uses a physician triage department to help the flow of patients. From 9 a.m. to 1 a.m., Methodist has a physician in the emergency department area to triage patients.

"It shaves hours and hours off their stay in the emergency department," Sowards said.

Each of the hospitals has urgent care offices, where people can walk in without an appointment and be treated.

Almost 40,000 patients were seen at Methodist MedPointe centers last year, and a similar number were seen at OSF Prompt Care locations.

Doctors believe many of those patients would end up in the emergency department without these facilities.

"It definitely helps," Sowards said. "The urgent care around town, they see a good portion of the less urgent patients."

Pekin Hospital has seen a slight dip in ER visits, in part because it relocated an urgent care facility within the hospital. "One of the reasons we brought UrgentCare on campus was to pull some of those less acute visits off of the ER," said Cindy Justus, unit director of emergency and urgent care at Pekin. "If we hadn't done that, we would be seeing those numbers completely in the ER."

When UrgentCare was located off site, it averaged about 4,000 visits annually. Last year, 13,834 went to Pekin's urgent care facility.


Dayna R. Brown can be reached at 686-3255 or dbrown@pjstar.com.

Comments:

PJS reader
July 10, 2007 - 20:28
Subject: Dr. Carroll
WOW & WOW! Dr. Carroll thank you for your open honest words. I'm told this type of behaviour is not only at the administrative level, but also among "buddying" directors and management on the units, limiting the input of dedicated staff as to how units should be run and who should run them. It often seems that patients appear to get shuffled through without getting the most appropriate care, and caring staff on the units are deemed unproductive for not moving patients fast enough, yet are afraid to speak up for fear of getting fired......this is all highly interesting.

Reply to PJS reader
John A. Carroll, MD
July 11, 2007 - 11:15
Subject: Fear
PJS reader,

Unfortunately, what you say about management on units and intimidation of dedicated staff at OSF is true.

Mr. Steffen told me a number of times in his office that "fear is a good thing" among employees. When that is OSF's Administrator's philosophy, how can we expect management on units to be any different?

With dysfunction at the top, the patient is the one that suffers at the bottom.

Jade
July 10, 2007 - 14:44
Subject:
I was in the OSF emergency room last night until around midnight. It was very busy and it did take 4 hours but the nurses, lab tech, and doctors that we saw were all very nice and thorough with the tests and instructions given. I had the same postive ER experience a few months ago which happened to also be on a Monday.It's the nurses in the rest of the hospital who need some training in compassion and courtesy.

John A. Carroll, MD
July 10, 2007 - 11:07
Subject: ER OVERCROWDING MEANS HOSPITAL OVERCROWDING
On September 27, 2001, as an attending physician working in the OSF-Emergency Department, I wrote Keith Steffen a letter. (peoriasmedicalmafia.blogspot.com).

Mr. Steffen is the OSF-SFMC Administrator and overcrowding is a hospital problem—not just an ER problem. As my letter states, I was very concerned boarding my elderly patients in the ER for prolonged dangerous periods of time. I was asking Mr. Steffen for his guidance as Administrator.

The next day, I was placed on probabation by Dr. George Hevesy, the Director of the OSF-ED. Dr. Hevesy also serves as Medical Director of Advanced Medical Transport. Several days later when I met with Mr. Steffen in his office, he referred to me as an uncontrolled hemorrhage and cancer that needed to be “cut out” before spreading.

However, even with the punitive actions and inappropriate comments by Mr. Steffen, there seemed to be a serious disagreement and disconnect between OSF leaders. OSF administrator Tim Miller, MD, whose office was just a few feet from Mr. Steffen's office, told me the downtown OSF campus had been "ignored". Instead millions of dollars were spent by OSF building the Center for Health in north Peoria that would help guarantee paying insured patients. Center for Health patients seem to be treated more efficiently that OSF-ER patients. Interestingly, Mr. Steffen referred to the Center for Health as "the Mecca".

The OSF-ER was dysfunctional for many reasons. But one of the main reasons was that the inpatient hospital beds were lacking which limited my ability to get my sick ER patients admitted. Was OSF was stacking the inpatient beds with elective surgical admissions that would guarantee payment? Had the OSF’s founding sisters priorities shifted from patient care to profit?

A recent article from Critical Care Medicine 2007 June; 35:1477-83 analyzed prolonged waiting times in Emergency Rooms. A conclusion from this article written by a reviewer stated:

“The reason for increased mortality in critically ill patients boarding in the ED for 6 hours is ill-defined but is most likely related to resource limitations in a highly vulnerable patient population. Although an ED might provide optimal resuscitative care, it might not be the most advantageous location for ongoing intensive care.

"The time has come for overcrowding to be acknowledged and managed as a hospital-wide problem with real consequences in terms of bad outcomes for patients. As an editorialist notes, as minutes within the "golden hour" are squandered in inefficiency, the cost is human lives.”

Reply to John A. Carroll, MD
Pat
July 10, 2007 - 15:02
Subject:
You are one of a few doctors who actually practices medicine for the right reasons. This is something OSF doesn't want. Profit is their main motivation and when a patient passes the time frame of prime profit potential they prefer them to move on, one way or the other. Of course they favor the new enterprises in North Peoria these are the profit making ventures. Keeping the main hospital in the appearance of non-profit enables them to launch massive campaigns for charitable funds. Medical costs are high because about half of every dollar paid in goes for corporate profit and into the pockets of people who do nothing to care for patients. This is the nation wide trend in Medicine. OSF has a very profitable insurance program for seniors, Medicare pays in the range of $10,000 a year for each member plus OSF collects a premium and co-pays from the insured. The medical community has a very effective lobby to prevent universal pay medical insurance, they would lose their cash cow. No dollar is spared scaring the public with lies about "socialism" thus influencing the ill informed masses against their own best interests. People die in this country daily for lack of medical care, we rate with third world countries in infant mortality. There is no medical waiting line longer in the world than ours, which is never for thousands of tax paying Americans.

The Leavings of the Powerful

My reading of “basic health care” ethics continues:

“In our contemporary world, there are two predominant views about the relation of a person to community, and they are in constant competition. One is collectivism, which is characteristic of communist governments…Generally, collectivism favors an economic system in which the state closely regulates the production and distribution of wealth. Collectivism teaches that the welfare of individual persons must be strictly subordinated to the welfare of the total community, and thus the rights of persons can be sacrificed to the interests of the nation.

“The other theory, individualism, begets a system that is characteristic of democracies in the Western world. We often hear individualism called the “democratic way of life”.

"Many argue that the goal of government is to protect maximum individual freedoms from the influence of collectivism, so that any restrictions on freedom, including any regulation of the economy, are believed to be an attack on the survival of the nation.

“The Christian point of view, which also has support in many other religions and philosophies of life, rejects both collectivism and individualism. Christianity repudiates collectivism, because the community should exit to serve persons and not persons to serve the community as if the community were a superperson. Christianity also renounces individualism, because Christianity teaches that the highest and most important goods of the person are not private property but spiritual goods, which can be achieved and fully enjoyed only by sharing with others. Because modern states, both collectivistic and individualistic, are oriented to maximizing material goods and economic power rather than maximizing spiritual goods, the struggle between person and community has become chronic.

“The Christian point of view is neither idealistic nor altruistic. The words of Jesus are “Treat others in the way you would have them treat you; this sums up the law and the prophets” (Mt 7:12) and “You shall love your neighbor as yourself” (Mt 22:39). According to this teaching, we are not asked to love our neighbor and not love ourself, but to love our neighbor as ourself. In other words, if we really love ourself—not selfishly, but intelligently—we will realize that we cannot be happy in isolation, because we were created as social beings. We can be truly happy only by sharing in a community of happy people, and that means that we each must not only respect the rights of others in a negative sense, but must be actively concerned to promote each other’s welfare.

“The social teaching of the Catholic Church, which is derived from the teaching of Jesus, insists therefore that the human community, including its governments, must be actively concerned to promote the health and welfare of every one of its members, so that each member can contribute to the common good. This concern cannot be a matter of a mere trickle down by which the weak live on the leavings of the powerful, but must be aimed directly at enabling the weak to share in the goods of life.”

Ethics of Health Care, Third Edition
Benedict M. Ashley, O.P.
Kevin D. O’Rourke, O.P.

Human Dignity

“The root cause of all unjust discrimination is the failure to understand that human dignity is not based on physical or mental health, any more than it is upon money or education, but upon the single fact that a human person is made in the image of God. Once this principle is firmly held, there is no shame or personal inferiority in being blind, crippled, homosexually oriented, poor, or illiterate. All are equally persons, have the same human rights, and have the same claim to justice and dignity. Thus, it is contrary to the Gospel to refuse to respect the rights of others because of their nationality, race, sex, age, or physical or mental impairment. The health care professions, in their best tradition, have always sought to help people on the basis of need, not because of social status.

“Jesus said, “Treat others they way you would have them treat you: this sums up the law and the prophets” (Mt 7:12). Thus, we formulate the principle of human dignity as follows: All ethical decisions in health care must aim at human dignity, that is, the maximal integrated satisfaction of the innate and cultural needs—biological, psychological, ethical, and spiritual—of all human persons, as individuals and as members of both their national communities and the world community.”


(From Ethics of Health Care, Third Edition
Benedict M. Ashley, O.P., Kevin D. O’Rourke, O.P.)

Ethics 101

Yesterday morning I spent some time in the OSF-SFMC medical library catching up on some journals. The library is a quiet peaceful place on Sunday mornings.

One of the new books on display in the library is “Ethics of Health Care” by Benedict M. Ashley, O.P. and Kevin D. O’Rourke, O.P. It is an introductory textbook regarding Catholic ethics in the health care field.

On the first page of the Introduction, the authors state that the Catholic tradition in ethics or morality has something important to contribute to the dialogue regarding “health care ethics”. Interestingly, the authors also state that the Ethical and Religious Directives for Catholic Health Care Facilities (National Conference of Catholic Bishops 2001) is the main compendium of Catholic teaching for Catholic health care institutions and professionals in the United States.

I do not believe that OSF-SFMC has followed the Ethical and Religious Directives(ERD) established by the U.S. Catholic Bishops. Yet, this book on Catholic health care ethics is based on the ERD and is prominently displayed in the OSF-SFMC library. There seems to be a gap between theory on quiet Sunday mornings and reality during the week at the very busy Catholic medical center in Peoria.

Haitian children are being ignored by OSF-SFMC and they are dying slow painful deaths from reversible cardiac problems.

Regarding Principles of Christian Love, “Ethics of Health Care” state:

“The principles of love related to health care are threefold: (1) Every person must be valued as a unique, irreplaceable member of the human community (the principle of human dignity). (2) Every person must be encouraged to play a part in the human community and fully share in its benefits (the principle of common good, sometimes called the principle of participation in community). (3) All persons must be helped to realize their full potential (the principle of the totality and integrity of the human person).

Dishonesty in the Diocese

The July 1, 2007 issue of The Catholic Post in Peoria has an article: “Bishop Reestablishes Diocesan Health Care Committee”.

The article begins:

“As the culture moves further from Catholic moral teachings in the field of health care, strengthening the Catholic identity of our health care institutions is more important than ever.

“That is the primary mission of the Diocesan Health Care Committee, co-chaired by Father Mark Merdian, pastor of St. Matthew’s Parish in Champaign, and Lynn Grandon, director of the diocesan Office of Respect Life and Human Dignity.”

Father Merdian asked Bishop Daniel R. Jenky to revive what was formerly called the Diocesan Ethics Committee.

“The ethics committee had gone dormant when the chairman, Msgr. Steven Rohlfs, became rector of Mount St. Mary’s Seminary in Emmitsburg, Md, more than two years ago.

“Father Merdian, along with OSF HealthCare corporate ethicist Joseph Piccione, had served on that committee.

“The reconstituted and renamed committee, which meets quarterly, currently has 26 active members. Father Merdian, Grandon, Piccione and Sister Judith Ann Duvall, OSF, chairperson of OSF Healthcare System, serve together on the Diocesan Health Care Committee’s planning committee.

“The other members include hospital administrators, doctors, priests and deacons who serve as heads of pastoral care committees at hospitals, and ethics committee members from different hospitals.

“Bishop Jenky agreed with Father Merdian’s request to reestablish the committee, according to Grandon, because he saw the need to keep up communications between the bishop and the diocese's health care institution, and to help them make sure they adhere to Catholic moral teaching.

“It’s such an exciting group to be a part of. I’m so glad the bishop is letting us do this,” Grandon said.

“Bishop Jenky understands, Grandon explained, that advancing respect for life isn’t just about fighting abortion. That is just one important thread in the fabric of Catholic moral teaching and medical ethics, she said.

Piccione agreed. “We have a biblical mandate to care for the poor,” he said. “The first right, which is the right to life, includes adequate health care. It says that in the Ethical and Religious Directives for Catholic Health Care Services, from the Catholic bishops of the U.S., so it really has the level of a church teaching.”

The church’s concern for the sick, Piccione said, is “rooted in the lived example of our Lord, but also the experience of the apostles in the early church.”

Health care ministry “is ancient in the church’s experience, and it’s to be applied to our experience in the 21st century,” he said.

“Among the responsibilities of the Diocesan Health Care Committee are assisting and advising diocesan health care institutions with matters of medical ethics. The committee also offers guidance regarding competition with other health care institutions and financial and marketing issues, said Father Merdian.

“According to Grandon, the committee is also planning to create a questionnaire and an audit system to ensure diocesan health care institutions are adhering to and are effectively teaching the church’s religious and ethical directives.”

My comments regarding The Catholic Post article:

The article is shameless. If I would have read this article a few years ago, I would have thought how worthwhile this idea was. Now I have a hard time believing that our Catholic leaders will actually do the right thing. I've seen too much damage and watched local Catholic leaders threaten, ignore, and hide.

I have extensively documented my thoughts regarding the Catholic Diocese of Peoria and OSF in Peoria on Peoria’s Medical Mafia, PMM Daily, Dying in Haiti, and John Carroll’s Posts. Both institutions have shown little respect for young Haitians that need to return to Peoria for heart surgery.

I would like to believe that the new Health Care Committee will make a difference. I think that Fr. Merdian’s hopes and goals are sincere. However, he has many obstacles in his way.

Joe Piccione was hired by OSF in the mid 1990’s to find a way, with the collaboration of the Catholic Diocese of Peoria, to allow OSF to better compete in the local medical market regarding prescribing oral contraceptives and constructing a “firewall” for sterilization procedeures. Joe, the Diocese, and OSF were successful.

Joe, who is extensively quoted in the article above, is currently on the International Committee at OSF-Children's Hospital of Illinois, to select or deny kids needing surgery at OSF-Children's Hospital of Illinois. Haitian Hearts patients, that were operated at OSF several years ago, are now dying in Haiti. OSF refuses to accept them back even with full and partial charges offered by Haitian Hearts for their care.

Other medical centers don’t want to accept these OSF patients for a multiplicity of reasons. Other medical center physicians and administrators believe that OSF is acting negligently.

Where have Joe’s public statements been supporting these kids returning to OSF for their care? Joe states that it is a “biblical mandate” to care for the poor. He even states that the Ethical and Religious Directives of the Catholic Bishops regarding health care are at the level of church teaching. Does Joe Piccione really believe that OSF needs to follow these Directives? Remember, OSF signs his paycheck.

I believe that if the Diocese and OSF, with the help of their Catholic ethicists, Monsignor Rohlfs, Piccione, and a few others, could so adeptly deal with the local oral contraceptive issue at OSF, then they can easily dismiss Haitian kids to early deaths.

Will the new Committee have any ability to have creative discussions or dissent? Will the Committee use the Ethical and Religious Directives as "church teaching" and evidence to convince OSF and Bishop Jenky that the Directives need to be followed and that respect for life includes Haitians? Will the Committee mainly be “yes” people from the Diocese and the OSF System that will maintain the status quo regarding respect for life issues at OSF?

A July 5, 2007 article in the New England Journal of Medicine mentioned ethics committees:

“Whereas the judicial system assures Americans of having a “jury of peers", hospital ethics committees are not held to this standard. Although it is true that most committees include one or two members of the community (often grateful patients of the hospital), most members are physicians, nurses, and other clinicians from the hospital staff. Without in any way calling into question their motivations or intentions, we must recognize that they are unavoidably “insiders,” completely acculturated to the clinical world and its attendant values.

“Of course we could do better. Some have suggested setting up ad hoc ethics committees with a membership that truly represents the diversity of the local population, without any financial or social ties to the hospitals they serve, specifically to offer a more legitimate sounding board for difficult cases in which the hospital ethics committee could be seen as having a conflict of interest or a biased perspective.”

I worry that the new Diocesan Committee may have a "biased perspective".

Until Bishop Jenky takes control, dismisses his fear of OSF, and insists that the Ethical and Religious Directives be followed at OSF, Haitian children will continue to die.

Father Merdian has his work cut out for him.

Luke--Part III

Luke’s OSF Bill

I received Luke’s itemized bill from OSF a couple of days ago.

The bill was for his outpatient tests done on June 15, 2007 in the operating room with a general anesthesia. No surgery was performed.

Below is the itemized bill. (I tried to scan his original bill, but I couldn’t get it to scan and paste on this post.)

June 15, 2007—

1. Pulse Oximeter--$81.00
The pulse oximeter is a non invasive technique to measure oxygen level in the blood. A piece of disposable tape with a sensor is wrapped around a digit and attached to the pulse oximeter.

2.Retrograde Urogram--$481.00
The urologist injected dye up Luke’s ureters to better deliniate his anatomy.

3. Acetaminophen 650 mg.--$3.25
Acetaminophen is generic Tylenol. I called a local pharmacy. If #12 650 mg acetaminophen suppositories are purchased, each suppository is 21 cents.

4. Dexamethasone 10 mg.—$19.40

5. Ondansetron--$22.45

6. Fentanyl--$17.50

7. Cefazolin--$64.80

8. Gentamicin 40mg/ml--$63.40
Gentamicin is an antibiotic that is commonly used for kidney infections. It is given IV or IM. If I were to buy the same amount of Gentamicin from a local pharmacy in Peoria, it would have cost me 40 cents, not $63.40.

9. Sodium Chloride 0.9% IVSL--$82.10
This is sterile salt water in an IV bag.

10. SFMC-OR-Conray 60% 30 ml vial--$33.00

11. SFMC-OR-Basin-Sterile-All sizes--$19.00

12. Drape:Proc Pack/Kit/Tray:Urology--$45.00

13. Surgery, 1st 30 minutes Level II--$1,771.00
This charge is for the first 30 minutes in the operating room.

14. Surgery, Each Additional 30 minutes Level II--$856.00

15. Anesthesia Services, 0-30 minutes--$1,873.00
This was the first 30 minutes after Luke was given the general anesthetic.

16. Anesthesia Services, Each Additional 30 minutes--$575.00

17. PACU Phase 10-30 minutes--$842.00
This was for Recovery immediately after coming out of the OR.

18. PACU Phase 2 0-30 minutes--$156.00

19. PACU Phase 2 Each Additional 15 minutes--$182.00

Total owed to OSF: $7,204.35. (I did not add this up.)

Luke entered the OR at 9 AM and was discharged to home at 11:10 AM.

The doctors’ bills are not included.


Luke’s medical care was excellent. However, the charges at OSF are obviously exorbitant.

The nurses and transports are the people carrying out the OSF mission philosophy while OSF Administration and OSF Corporate leaders make the big salaries and plan 500 million dollar OSF campus expansions.

ER Overcrowding at OSF

In September 2001 I wrote a letter to Keith Steffen regarding the ER at OSF. As documented in Keith’s Letter, the ER was not working well.

I was put on probation the next day by George Hevesy, the Director of the ED at OSF. Three months later I was fired from OSF by Mr. Steffen.

I believed then and believe now that not enough effort was directed to the main ER at OSF to help patients move efficiently through the system.

A recent study published in March 2007 in Annals of Emergency Medicine described the relative impact of input, throughput, and output factors on the average daily ED length of stay. Output factors examined included the number of elective surgical admissions, the number of ED admissions to the hospital, the number of critical care admissions, and hospital census. The only factors that were independently associated with increased ED length of stay were output factors. These included hospital occupancy, the number of ED admissions to the hospital, and the number of elective surgical admissions.

An editorial in Annals regarding this study indicated that “smooth functioning of the ED is highly dependent on the ability of a hospital to accept admitted patients. (This is considered “output”). Any disruption in the outflow of patients from the ED to the hospital drains resources and impairs the ED’s ability to car for new seriously ill or injured patients. Hospitals that have had the most success alleviating ED crowding are those that have recognized the hospital-wide nature of patient flow problems and designed initiatives to move admitted patient out of the ED more efficiently.”

My letter to Mr. Steffen six years ago was pleading for help for patients in the OSF ER that were not being admitted in a timely fashion. Were the number of “elective surgical admissions” at OSF, guaranteed to make money for OSF, keeping my ER patients boarded in the ER for long periods of time?

The Annals editorial continued:

“It is no longer just the key stake holders in the emergency care system who are calling for the end of inpatient boarding in the ED. The Institute of Medicine (IOM) has also recognized that boarding inpatients is the most important driver of ED crowding and has called on hospitals and the regulatory bodies that govern them to end the practice of boarding. The IOM committee didn’t leave shades of gray when it published the following recommendation:

“Hospitals should end the practices of boarding patients in the ED and ambulance diversion, except in the most extreme cases, such as a community mass casualty event. The Centers for Medicare and Medicaid Services should convene a working group that includes experts in emergency care, inpatient critical care, hospital operations management, nursing, and other relevant disciplines to develop boarding and diversion standard, as well as guidelines, measures, and incentives for implementation, monitoring, and enforcement of these standards.”
----------------

In January, 2007 Emergency Medicine News contains an article written by Dr. Peter Viccellio. Dr. Viccellio is a professor of emergency medicine and the vice chairman and clinical director of the department of emergency medicine at the State University of New York at Stony Brook.

His article was titled, “I’m as Mad as Hell, and I’m Not Going to Take This Anymore”.

Here are some interesting facts and thoughts from his article regarding the crisis of emergency departments across the United States:

1. There were 120 million people that visited emergency departments last year in the United States.

2. The patients’ needs and how long their needs take to be cared for should be enumerated in the ER. Their needs have been viewed as impossible or as a burden to be suffered alone. We (ER doctors and nurses) have been in the underbelly of the beast too long. Our view of our own world (emergency rooms) is too dysfunctional.

3. Dr. Viccellio states, “I am convinced at this point that the real under-pinning is not that we have too many patients. The real thing that drives this issue is that our hospitals as a culture are organized around the needs of the staff and not the patient. That is why we let them sit in the waiting room.”

4. The ED should be designed to save lives. It should be the front door of the medical center determined to do the same. The ED should provide a service to the individual and the community. This is an ED (and hospital) where everyone is a Very Important Person who deserves, if we can give them the chance, to continue their Very Important Life, and not to toss it away in the waiting room or ED hallway because we can only hope for an ED built on compromise and capitulation. Why demand any less?

Peoria's Airway

Annals of Emergency Medicine reported last year:

“Many researchers, emergency medical service (EMS) providers, and emergency physicians are increasingly viewing ground transport, out-of-hospital endotracheal intubation with skepticism.”

There are people on both sides of the argument. Some think that endotracheal intubation should continue for the outpatient while others think that there is not credible evidence that out-of-hospital endotracheal intubation contributes meaningfully toward the reduction of morbidity or mortality in ground transported EMS patients.

Annals continues:

“In the spirit of seeking system-level improvements, one cannot ignore the question, Should we intubate at all? For apneic or near-apneic patients, alternate airways such as the Combitube (esophageal-tracheal twin-lumen airway device; Kendall, Inc., Mansfield, MA) and laryngeal mask airway (LMA North America, San Diego, CA) have appealing characteristics and are supported by some data. These devices are conceptually simpler than endotracheal intubation, easier to insert than endotracheal tubes, require less training, and are less subject to skill delay. These devices have been extensively used as primary and secondary airway management devices. There is wide experience with the use of these devices by nonphysicians and even basic-level rescuers. Combitubes and laryngeal mask airways offer ventilation and oxygenation comparable with endotracheal intubation in controlled and field settings. Current advanced cardiac life support guidelines recommend the use of these devices when rescuers have only limited endotracheal intubation experience.”

In Peoria, the Peoria Fire Department (PFD) can oxygenate and ventilate the patient with the bag-valve-mask (BVM). The PFD cannot endotracheally intubate the patient regardless of the literature in support of this technique. Also, the PFD does not use the alternate airway techniques described above. With the blessing of the local Project Medical Director, employed by OSF-SFMC, Advanced Medical Transport (AMT) can use the BVM or select to endotracheally intubate the patient at the determination of the AMT paramedic on scene.

It has been a serious mistake not to educate the PFD in airway control that could supercede the BVM that they use now. The Combitube and the laryngeal mask airway (LMA) are two alternate airways that could and should have been used by the PFD for many patients in respiratory distress.

The local Peoria Project Medical Director, the three Peoria hospitals that influence decision making in the city, Advanced Medical Transport, PAEMS, and the City Council all need to support and encourage the PFD to develop these skills.

Resuscitation in Peoria

In Emergency Medicine News, September 2006, the following was written:

"Three years ago, the physician director of the Houston EMS system with investigators at Baylor College of Medicine, the Houston Medical School at the University of Texas, and Ohio State University looked at cardiac arrest survival as a function of ambulance deployment strategy. Though limited to a single geographic area, this study showed definiteively that outcomes for cadiac arrest patents improve when they are cared for by paramedics than by basic EMT's. (Resuscitation 2003;59:97.)

"What was the difference? The busy urban area used paramedics, and a suburb used EMT's (Basic).

"The authors said the study demonstrated better response times and better skills proficency by the "targeted response" team in the urban core, or as they call it, the TR paramedics."

In Peoria, the Peoria Fire Department (PFD) is Basic. The PFD has paramedics that cannot use their skills to resuscitate patients. This unfortunate decision has been made by multiple individuals. The majority of the Peoria public is not aware that the PFD cannot resuscitate them with advanced life support when the public calls 911.

The medical literature also states that having too many paramedics trained in an area may not be ideal for patient care because an individual paramedic may not be able to keep up his/her skills with competition for procedeures by other paramedics.

Thus, the literature is begging these questions:

1. Should the PFD petition the State of Illinois and the Peoria Area EMS (PAEMS) to allow their paramedics to give advanced life support at the scene of a medical emergency? When the PFD arrives before Advanced Medical Transport (AMT) and the paramedic firemen cannot do anything but provide Basic service, that seems suboptimal if one reads and believes the medical literature regarding patients who suffer from cardiac arrest.

2. Should AMT cut their staff of paramedics so as not to dilute the skills of their own paramedics? And if the PFD paramedics were allowed to function as paramedics, less AMT paramedics may be desirable.

Peoria's City Council and PAEMS have to decide what is more important--the business and money generated by AMT or quality of pre hospital patient care in central Illinois.

A Byte Out Of Poverty

Peoria Journal Star
Tuesday, June 19, 2007

"Humanity's greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity. Whether through democracy, strong public education, quality health care, or broad economic opportunity, reducing inequity is the highest human achievement."

That's a pretty powerful quote. And this altruistic appeal originates not from a preacher or presidential candidate but from a software engineer named William Henry Gates III - better known as "Bill."

The Microsoft mogul recently addressed the graduating class of Harvard, the Ivy League school he famously quit to pursue his passion for computers. After accepting an honorary degree, Gates joked he was glad to finally get his diploma. But jokes aside, this commencement address transcended the usual fodder college grads hear. It was revelatory, honest, a humanitarian call to arms.

The 52-year-old Gates admitted he left campus in the mid-1970s "with no real awareness of the awful inequities in the world - the appalling disparities of health, and wealth, and opportunity that condemn millions of people to lives of despair." It took him "decades to find out" that others, especially in developing nations, were getting substandard schooling, enduring hunger or dying of treatable illnesses like malaria and measles - not of their own fault, but because both private and public sectors had failed them.

In revisiting his naivete, Gates urged not only graduates but also Harvard as an institution to "make market forces work better for the poor" and use "creative capitalism . . . so that more people can make a profit, or at least make a living." In addition, citizens should "press governments around the world to spend taxpayer money in ways that better reflect the values of the people who pay the taxes."

Gates should know something about values. The man who tops Forbes' billionaires list has, along with wife Melinda, thrown himself into philanthropy. His foundation, with an endowment of $33 billion, has given millions in grants to fund the kind of "teach a man to fish" initiatives he referenced in his speech: college scholarships, public school curriculum support, access to vaccines and, of course, money to bridge the digital divide. Like Warren Buffett, another billionaire benefactor, Gates seems to have realized money is only as good as the man who makes it, and that wealth and position can motivate others - politicians, businesses, the media - to pay attention to those less fortunate.

In his late middle age, the world's richest man has dedicated his time to the world's poorest people. Ironic, yes, but nicely so. Would that those of us mere mortals with more modest means but equally generous spirit follow suit.



--------------------------------------------------------------------------------
My comment:

The PJS editorial states, “…Gates seems to have realized that money is only as good as the man who makes it, and that wealth and position can motivate others—politicians, businesses, the media—to pay attention to those less fortunate.”

Why isn’t the Journal Star “paying attention” to those less fortunate that have lived right here in Peoria? I wonder what the Journal Star thinks of OSF’s refusal to take care of Haitian Hearts patients that have been treated at OSF in the past and now need further heart surgery to stay alive.

Haitians kids are dying because of OSF’s refusal to care for their patients. Gates’ cry for reducing inequity as the “highest human achievement” generates no action in Peoria for Haitians, only written words.

The Cuban Experience

“It is increasingly rare for many of us to believe that people can be poor, but honest; poor, but deserving of respect. Poverty is no longer blamed on anyone but the poor themselves. Contempt for the poor has become virtue.”

John Cardinal O’Connor
Archbishop of New York

After working a fair number of years in Haiti, I think that Haiti’s medical problems are solvable. All problems in Haiti are solvable, but this post regards how adopting certain aspects of Cuba's health system could help Haiti and, quite possibly, improve the lives of certain poor populations in the United States.

The International Journal of Epidemiology published an article in August, 2006: “Health in Cuba”. It is written by Richard Cooper, Joan Kennelly, and Pedro Ordunez-Garcia.

The authors write that no matter what one believes about the politics of Cuba, there is a lesson to be learned regarding Cuba’s health care system. And with just a little water separating Cuba from Haiti, my very small mind asks, why can’t Haiti adopt some of Cuba’s life saving public health measures?

The article reports that the word needs to disseminate that Cuba has done something very worthwhile regarding health care.

The abstract of the paper states:

“The poorer countries of the world continue to struggle with an enormous health burden from diseases that we have long had the capacity to eliminate. Similarly, the health systems of some countries, rich and poor alike, are fragmented and inefficient, leaving many population groups underserved and often without health care access entirely.

"Cuba represents an important alternative example where modest infrastructure investments combined with a well developed public health strategy have generated health status measures comparable with those of industrialized countries. Areas of success include control of infectious diseases, reduction in infant mortality, establishment of a research and biotechnology industry, and progress in control of chronic diseases, among others.

"If the Cuban experience were generalized to other poor and middle income countries, human health would be transformed. Given current political alignments, however, the major public health advances in Cuba, and the underlying strategy that has guided its health gains, have been systematically ignored.”

The authors are saying that the biomedical literature in English has been almost entirely silent on the Cuban health experience and Cuban health revolution since 1959. They think that an open discussion should take place on the potential lessons to be learned from the Cuban medical experience because the “raison d’etre of the health sciences is the discovery of new knowledge and the use of that knowledge to improve health”.

In 1991 the Soviet Union withdrew economic support for Cuba. The authors refer to this as an “abrupt economic disruption”. However, they noted, “The impact on health indices was relatively modest and short-lived, however, further demonstrating that economic measures alone are poor predictors of physical well-being within a society. One potential explanation of this anomalous pattern may be the relative absence of extreme poverty, which is the most powerful economic correlate of ill health and can confound the effect of average Gross National Product (GNP). Cuba has a high degree of income equality and lacks the marginalized slum populations of most of Latin America, although the growing dependence of the tourist economy and, to a lesser extent, foreign remittances has widened the income distribution”.

Regarding the infant mortality rate, the article reports, “Since 2002 Cuba has had the second lowest infant mortality in the Americas, 20% below the US rate for all ethnic groups and just below the rate for US whites... Thirty-five per cent of the Cuban population is black or mulatto, yet the infant mortality rate are less than half of what is observed in the US black.”

“In terms of child survival, a ‘continuum of care’ that provides for the pre-conceptional health of women, prenatal care, skilled birth attendants, and a comprehensive well-baby program can quickly reduce infant mortality to levels approaching the biological minimum. Many observers will regard these propositions as reasonable, yet hopelessly too ambitious for the poorer nations of the world, It must be recognized, however, that these principles have been successfully implemented in Cuba at a cost well within the reach of most middle-income countries.”

I have had a number of young mothers in Haiti bring in their newborns that they delivered alone at home lying on their dirt floor. One mother told me that when her newborn cried immediately after delivery, the neighbor man next door heard the baby’s cry, and rushed over and cut the baby’s cord. This neighbor man could be considered a concerned person, but hardly a “skilled birth attendant”, which almost all Cuban mothers have during labor. This scenario in Haiti is absurd and wrong and could and should be fixed.

I think the real problem is fear. How much will the gran mange in Haiti have to give up for the vast poor underclass in Haiti can live like humans? How much will the well-to-do in the United States have to give up for our poor health care statistics to improve? Probably very little. And all social classes in Haiti and the United States would live stronger and more productive lives if the slightest amount of compassion, energy, and action were directed for the benefit of the poor.

The Cuban story regarding improving the health of its population needs to get out and be implemented in resource rich and resource poor countries whose people suffer from health care inequalities.

Luke--Part 2

Luke underwent his tests yesterday at OSF in Peoria.

The tests reveal that he has a large kidney stone in his right kidney that will need to be removed so that it does not obstruct and further injure his kidney.

The stone probably formed due his severe malnutrition several years ago in Haiti with infection possibly playing a role.

The medical care that he received yesterday from the nurses and physicians was excellent.

Luke spent approximately 30-40 minutes in the operating room where the procedure and xrays were obtained. No surgery was performed. He entered the operating room at about 9 AM and was discharged to home at 11:10 AM.

OSF's charges for the above are $9,500. The physicians charges are not included.

I asked OSF for an itemized bill so we can see how this breaks down. Will post the bill when I receive it.

Haitian Has Heart Surgery At Provena St. Joseph

Marie Amazan, a 24 year old Haitian Hearts patient, received two new heart valves at Provena St. Joseph Medical Center in Joliet, Illinois. See Press Release. Provena St. Joseph provided their medical center pro bono as they did for four previous Haitian Hearts patients.

Dr. Bryan Foy performed the delicate heart surgery and Dr. Kinder placed a permanent pacemaker. All physicians involved in Marie's care provided their services at no charge.

Marie is from Carefour Feuilles in Port-au-Prince. She lives in a crowded two room house on the side of a steep hill. Many family members live with her. She has six older sisters and no brothers. Her father is dead.

Her family does not eat everyday due to the poverty of Haiti and her neighborhood can be dangerous with the gang and political violence that plagues much of Port-au-Prince.

Marie has been unable to do much for many years due to congestive heart failure. She could mop the floor and make her bed, but that was about it.

This week, Marie was discharged from the hospital and is improving everyday. A Cardiovascular Intensive Care nurse, Anita, has been supervising Marie's outpatient medical care and transportation since discharge from the hospital.

Marie was given a chance by Provena St. Joseph and its physicians and nursing staff. Haitian Hearts cannot thank all of you enough.
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See more about Marie's recovery as reported in Chicago at ABC News.