OSF is Afraid

OSF in Peoria is afraid.

They don't want the story out.

What story?

The story that describes how they are letting their Haitian patients die miserable deaths.

Like Heureuse.

The President of OSF Healthcare System, Sister Diane Marie, is one of the remaining Sisters at OSF. She has very little control over day to day management of the medical center.

Here is what Sister recently wrote in "Connections"--an OSF pamphlet:

"While the world outside of OSF gears up for a new focus on collabortion and team-building, we can take great pride and give thanks for our Foundational Value of teamwork and for our tradition of caring for the sick, the poor, and the dying. We are well-positioned to continue and enhance our service to patients and to extend our Mission of caring "with the greatest care and love"."

Why would Sister be writing this? This is nonsense. Just ask Heureuse.

Today, I e mailed thomas.hammerton@osfhealthcare.org, stacy.litersky@osfhealthcare.org,sarah.chaddock@osfhealthcare.org,mari.osborne@osfhealthcare.org,lauren.m.obalil@osfhealthcare.org, and jayne.gibson@osfhealthcare.org.

I tried to send this this post regarding Heureuse.

All of the e mails bounced back to me because OSF has blocked my e mails.

For good reason OSF obviously don't want these Children's Hospital of Illinois Foundation members receiving my e mail. OSF's policy denying care to Heureuse is against all that the Sisters preach (and write about) and the U.S. Bishops demand regarding Catholic health care.

This is Not What They Wanted

This is not what they wanted.

OSF, AMT, and the physicians that have not advocated and pushed for change, must be shaking their heads. They have written and had their own lapdogs write articles to the Journal Star stating that EMS in Peoria was fine.

Everyone in the central Illinois EMS circle know who these people are and why they needed to control the Peoria Fire Department.

Their machinations just didn't work. Shame on these institutions and individuals for protecting each other instead of the public.

It will take time, but the Fire Department will advance further and give people in Peoria the emergency care they deserve.

Hurricaine Ike

OSF-Saint Francis Medical Center and Catholic Diocese of Peoria, are you reading the news?

Photo from the Miami Herald.

Bishop Wenski

I first met Father Thomas Wenski in the late 90’s. My eighty year old mother and I stayed in his large rectory with an interesting mix of individuals. There were young law students representing Haitian refugees as well as Haitian-Americans working for Father Wenski.

I think Father charged my mom and me $6 dollars per day and this included three meals that we prepared ourselves in the simple rectory kitchen.

His rectory was located in Little Haiti in Miami and was guarded by two German shepherds. The neighborhood was dangerous. I found a bullet that had been shot on the sidewalk and two Haitian market owners were killed by burglars one Saturday on a bright sunny afternoon.

Fr. Wenski is an advocate for Haitian immigrants and for Haiti. His rectory was next door to a Catholic Church and a large school that seemed to have been vacated years before by middle class Miamians who wanted to flee this part of Miami. Father used this school for Haitians to teach them English and various other skills. He also ran a legal center across the street to give the Haitians as much free legal representation as possible.

Fr. Wenski was very matter of fact and practical. I wouldn’t describe him as warm and fuzzy, but he was very efficient in his work for Haitians. He said mass in the church nearby at 6 PM on weekdays in fluent Creole.

In the last 10 years Fr. Wenski has become a Bishop and is currently the Bishop of the Diocese of Orlando. He is also the chairman of the USCCB Committee on International Justice and Peace.

The following article is from the Catholic Post in Peoria:

U.S. church official says Haiti desperately needs political stability

PORT-AU-PRINCE, Haiti (CNS) -- Haiti desperately needs political stability so that jobs can be created to lift the poor out of a critical situation, said the chairman of the U.S. bishops' Committee on International Policy. "The situation is critical, although there is still a glimmer of hope," Bishop Thomas G. Wenski of Orlando, Fla., told Catholic News Service July 16. "Haiti now needs a solid success story so that hope does not disappear." Bishop Wenski, who visited Haiti in mid-July, said that in a private meeting earlier that day, Haitian President Rene Preval expressed his thanks for the work of the Catholic Church in advocating for the Haitian Hemispheric Opportunity Through Partnership Encouragement Act and for the job opportunities it could create. The U.S. HOPE Act II, as it is known, allows the United States to import Haitian textiles and could create 30,000 jobs in Haiti where, the bishop said, it is estimated that every job feeds an extended family of 10 people, so "30,000 jobs could feed 300,000 people."
----------------------------

I doubt Bishop Wenski would be thrilled with the Catholic Diocese of Peoria and the way the Diocese supported OSF when the 1.6 billion dollar OSF Medical Center in Peoria cut all funding for Haitian Hearts.

And in Peoria...

So while Heureuse hides from hurricaines and fights through her heart failure in Port-au-Prince, the Catholic Diocese in Peoria is building.

Bishop Jenky should have helped Heureuse.

Heureuse's Seaside Home

Here is Heureuse, the outside of her home, and her kitchen.

Her echocardiogram showed that the hole between the lower chambers of her heart has opened up again and her heart is shunting blood in the wrong direction.

She needs surgery soon.
And we just got done spending $104 million dollars for the four day Republican National Convention.

Photos by Frandy

Physician-Industry Relationships---Not Just About Free Pens

There is an article in this weeks Journal of the American Medical Association (JAMA) regarding unhealthy physician-industry relationships.

It is copied at the bottom of this post.

Dr. George Hevesy received a salary from Advanced Medical Transport in Peoria while he was acting as Project Medical Director for the Peoria area. Dr. Hevesy is also Director of the Emergency Department at OSF. Amazingly, when I spoke with Sue Wozniak CFO at OSF-SFMC about Dr. Hevesy's relationship with AMT, she commented that it was a good idea when Dr. Hevesy resigned as Project Medical Director since he was receiving a salary from AMT. (Wozniak is on the Board of Directors at AMT which may be a negative conflict of interest too.)

Here is a summary of the article and some of my comments about Peoria's conflict of interest:

1. Research has shown that stipends from industry do influence a physicians behavior. AMT gave Dr. Hevesy a stipend for years. Dr. Hevesy controlled all the ambulances and their protocols in central Illinois. Interestingly, Dr. Hevesy also works for the Illinois Department of Public Health Region II Emergency Medical Services.

2. The media was relentless exposing physician-industry relationships around the United States. That does not include Peoria, where this relationship was hid.

3. Many medical centers in the United States have conflict of interest policies. Does this include the University of Illinois College of Medicine in Peoia (UICOMP)? And if there is a policy at UICOMP, would the dean actually look to see if Dr. Hevesy is still paid by Advanced Medical Transport in Peoria?

4. Change comes from the top. Deans of medical schools need to demand that patient need has to be more important than physicians being paid by industry. If AMT's stipend to Dr. Hevesy over many years helped keep other ambulance services functioning at lower levels of service, this would be negative conflict of interest.

5. The dean of the medical school has most influence over the academic medical center (like OSF-SFMC) faculty versus a community hospital. Thus, the UICOMP dean should strongly influence conflict of interest policy at OSF-SFMC. But Peoria is so tight, will the dean actually take on OSF-SFMC?

6. OSF-SFMC and UICOMP have residency programs where young doctors are trained. The young physicians need to know that relationships with industry are not always healthy and can be harmful to patients. Dr. Todd Nelson, a former resident physician in the Emergency Room at OSF, wrote an article in the Journal Star a few years ago lauding Peoria's EMS system. The EMS situation has recently changed for the better in Peoria. Too bad Dr. Nelson wasn't taught enough about EMS ethics while he was in training at OSF.




JAMA- 2008;300(9):1067-1069.

Over the past 2 years, policies governing the relationship between physicians and pharmaceutical and device companies have undergone remarkable changes. A 2004 task force appointed by the American Board of Internal Medicine Foundation (ABIM) and the Institute on Medicine as a Profession (IMAP) found existing guidelines to be lax.

At that time, the industry's Pharmaceutical Research and Manufacturers of America (PhRMA) Code ignored many salient issues, such as disclosure, speaker's bureaus, and ghostwriting and set only modest boundaries around dispensing food, gifts, and travel reimbursements.

The American Medical Association's ethical guidelines largely duplicated PhRMA’s; however, on such practices as gift taking, it was even more permissive.

The American College of Physicians acknowledged the influence of gifts on physician practices but did not prohibit them.

Government bodies, including the Office of the Inspector General of Health and Human Services, essentially endorsed the PhRMA Code.

Academic medical centers did not set a better example. Few of them had rigorous policies, and the exceptions received little notice.

At that same time, pressure to strengthen the governance of physician-industry relationships was mounting. First, a substantial body of research indicated that gifts, stipends, and honoraria from drug companies influenced physicians' treatment decisions.

Second, the media were relentless in exposing drug company–physician misconduct, which ranged from false statements and billing to off-label promotion of products to outright bribery.

Third, whistleblowers were alerting federal and state prosecutors to drug and device company illegalities, leading to successful prosecutions that resulted in millions of dollars in settlements and fines. From 2000 to 2004, 12 major health care fraud settlements led to pharmaceutical companies paying almost $4 billion in criminal and civil fines. The largest was the 2001 TAP/Lupron case, with an $875 million settlement.

Taken together, these developments were making the status quo unacceptable.

In January 2006, the ABIM-IMAP task force published its policy recommendations on conflict of interest.

The proposals captured significant media and academic attention and stimulated many academic medical centers (AMCs) to reconsider their guidelines. In April 2008, a task force appointed by the Association of American Medical Colleges (AAMC) issued recommendations on conflict of interest, and in June 2008, the association's executive council approved them.

With only a few exceptions, the positions in the 2 documents are similar, providing them with presumptive standing in the field.

Both proposals are much more exacting than earlier guidelines on physician-industry relationships. The proposed guidelines prohibit all gifts (zero-dollar limit), whether on- or off-site, and prohibit food provided by industry: "Industry-supplied food and meals are considered personal gifts and will not be permitted or accepted."

Both proposals recommend that product samples are centrally managed to "distance the company and its products from the physician."

The AAMC would also restrict industry representatives' access to physicians, requiring credentialing mechanisms and formal appointments and invitations. Both propose that industry funds for continuing medical education and travel to bona fide medical meetings should be distributed not by academic departments but from a central medical center office. Both prohibit ghostwriting and differ only on speaker's bureaus. The ABIM-IMAP task force prohibits these activities; the AAMC proposals "strongly discourage" them.


The AAMC report does not make reference to the many positive changes that some of its members have already made. At least 25 medical centers from both the public and the private sectors and from all regions of the country, including Boston University, University of Massachusetts–Worcester, and Yale University; University of Pennsylvania and Pittsburgh University; the universities of Michigan, Wisconsin, and Chicago; and the entire University of California system, now have in place strong conflict-of-interest policies.

These AMCs have been joined by such health care delivery organizations as the Henry Ford Health Systems (Detroit), Kaiser Permanente (northern California), and the US Veterans Administration network.

How did these changes come about?

Immediately after the publication of the ABIM-IMAP recommendations, the Pew Charitable Trusts contacted IMAP to explore strategies to promote their enactment. The discussions, joined by Community Catalyst, a national consumer advocacy organization, led to the establishment of the Pew-funded Prescription Project. Under its auspice, and with additional funding to IMAP from the Attorney General Consumer and Prescriber Grant Program, IMAP has been investigating the origins and consequences of the policy innovations and providing technical assistance to AMCs.

Presuming that the AAMC recommendations will further stimulate change, in this Commentary we report on findings to date to help facilitate the process.


Change has come from the top down. The dean's office has typically taken the lead in inspiring, formulating, and enacting new policies. Almost everywhere, the dean has had ready allies on the faculty. In particular, chairs of pharmacy and therapeutics committees, seasoned in industry strategies to influence purchasing and prescribing decisions, have often been supporters. Many deans have also been assisted by faculty, such as a professor of medicine who carried a supply of inexpensive pens in her white coat and, whenever she saw a colleague holding a pen with a drug company logo, took it away and substituted one of her own unmarked pens.

So too, deans have been prodded to tighten their conflict-of-interest policies by medical students and house staff. But in the end, medical centers are hierarchical places, and at universities like Yale, Stanford, Pennsylvania, and Pittsburgh, it was the deans who appointed and charged the task force to draft new policies, and together they presented and defended the documents before the governing committees (the faculty practice group, the department chairs, the faculty council). With approvals forthcoming, the new policies were announced. In no case that we know of was a dean's support for a rigorous policy derailed, voted down, or even substantially weakened.


What motivated the leadership? Deans and faculty leaders had read journal articles on the power of gifts to physicians. They had scanned the media stories and were eager to preempt the issue rather than be publicly embarrassed.

Beyond that, many of them expressed a vigorous and unqualified commitment to the principles of professionalism. They insisted that scientific knowledge and patient need, not marketing, had to drive medical decision making. Athletes might display company brands on their clothing, but physicians should follow a higher standard to protect their own and their profession's integrity.

What kept other deans from acting?

First, there was a fear that pharmaceutical companies would retaliate by withholding research funds, a fear exacerbated by a shrinking National Institutes of Health budget and an increasing dependence on industry support. Second was a fear that faculty members who were unhappy about the policy would leave for another institution that would not restrict their activities. Third, deans hesitated to tackle the issue in light of the complicated structures of their institutions. Could one policy cover not only the medical school faculty but also community physicians, nurses, dentists, physical therapists, and public health practitioners? Although no dean we spoke to minimized the importance of conflict of interest, some among them preferred to live with the problems they were familiar with rather than face those they could not predict.


It is too early in the process to evaluate fully the effects of the new policies.

Some first impressions, however, may be offered. Thus far, there has been no significant movement of faculty from AMCs with strong policies to those with weak policies. Undoubtedly a few "silent departures" have occurred, but they remain the exceptions. Also, no one has reported a decrease in pharmaceutical company research funding. This ought not to be surprising because pharmaceutical company innovation, and profits, require the knowledge that resides in academic basic science and clinical departments. Deans have also proven adept at initiating change that first affects faculty in the major allied hospitals, leaving for a later stage the community physicians in more distant facilities.

When new policies are introduced, discussions are often heated. Some deans have been accused by faculty members of depriving their children of a college education by taking away drug company payments. But once the policies are in place, passion dissipates. Advantages outweigh disadvantages. Faculty members welcome the time saved by not meeting with pharmaceutical representatives or having to fend them off. They discover that product samples are not as necessary as they had thought; in some places, physicians are able to dispense vouchers for samples or have the samples stored in and distributed from a central commissary.

No one seems to care much about pens, notepads, or even the disappearance of free lunches, certainly for themselves, with only occasional regrets for their staff. Some departments are subsidizing food at grand rounds or setting aside a reserved line in the cafeteria for residents so they will not be late for a meeting. There is also an increasing number of accounts of physicians taking personal pride in turning down speaker's bureau invitations. "My school does not allow it" is an efficient and sometimes welcome way out.

The AMCs are just beginning to devise monitoring and enforcement procedures, locating oversight (usually in the deans' offices), and setting up hotlines for questions or complaints or Web sites for disclosure reports. A number of universities (such as Pennsylvania, Pittsburgh, Wisconsin, and Michigan) have focused their enforcement efforts on the vendors. If a pharmaceutical company representative violates the rules on gifts, meals, registration, or formal appointments, they are first warned; if they persist in their violations, they are suspended and eventually banned. Under such circumstances, as would be expected, vendors are compliant.

Although some faculty members have asked whether they might be fired for accepting a drug company pen, they have learned that the goal is less on implementing a schedule of penalties or appointing a gift police than on changing the culture of the institution. The objective is to promote a shift away from a sense of entitlement among physicians and, even more important, among residents and medical students. Are there gaps in adherence? Of course there are, and they particularly occur off-site. But more noteworthy is the prevailing compliance and good will. The new policies lose their controversial character rather quickly. The faculty moves on—and this should encourage other AMCs to appoint their own task forces to design and implement change.

As change becomes embedded in medical centers, it will be vital to analyze outcomes both qualitatively and quantitatively. There are many important questions to be answered: Do attitudes and practices change over time? Do house staff and medical students experience the change in terms of an intensified commitment to professionalism? Do disclosure requirements affect appointments to formulary committees or teaching assignments? As visits from pharmaceutical representatives decline, do physicians' prescriptions for generics increase? What effect on research funding might occur? Does the pharmaceutical industry devise new strategies that undercut the policies, and if so, how do the AMCs respond?

Last, but certainly not least, will AMCs make sufficient progress to obviate the need for government intervention?




Corresponding Author: David J. Rothman, PhD, Center on Medicine as a Profession, Columbia College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032 (djr5@columbia.edu ).
Financial Disclosures: None reported.

More on Heureuse

Last week Heureuse survived Gustav and acute congestive heart failure at the same time. She lives in a slum near the ocean in Port-au-Prince.

Frandy, our 19 year old contact in Haiti, is doing all he can to help with Heureuse.
Frandy is very poor and doing what our very rich Catholic medical center in Peoria should be doing.

See below a chat I had with Frandy yesterday regarding Heureuse.


From: Dejean Frandy
Date: Sun, Aug 31, 2008 at 5:02 PM
Subject: Chat with Dejean Frandy
To: haitianhearts@gmail.com



4:50 PM me: frandy, did you see heureuse today?
4:51 PM Dejean: yes i did
she's doing better
me: what do you mean by better?
4:52 PM Dejean: when arrived at her house, so she was cooking
she's not too bad
now she's able to get 2 or 3 meals by day
me: is she breathing better?
4:53 PM Dejean: yes
me: is she happier?
is she sleeping better?
Dejean: yes
yes sir
me: is she walking outside or does she stay inside?
4:54 PM Dejean: and tomorrow, i'll take to Pilie's clinic
yes
me: good
Dejean: she even has opportunity to kook food
me: please have him send me the results of the echo via e mail...
Dejean: she cooks everyday now
ok i will
4:55 PM she said hello to you
me: i need the results right away...STAT...please tell heureuse hello for me...
4:56 PM henri adrique needs to see pilie also...please pay for his echo too if he has no money....
Dejean: ok
about Henrique's case, i am sorry i don't any money to do that
i don't have
4:57 PM me: frandy, heureuse cannot run out of medication....please go to Grace Children's and get more meds for her if she needs them...before she runs out...
Dejean: ok
she has some for now
4:58 PM me: check her medicines for her before you leave for pilie tomorrow and take all of her pills with her to dr pilie...see which ones she is short on...find out which ones she needs...
Dejean: ok
i will
4:59 PM me: i just got an echo result from dr pilie for suze....wait a minute please....
Dejean: ok
that's fine
me: ok...
5:00 PM frandy, thank you and I will wait to hear from dr pilie tomorrow about heureuse....i will e mail dr pilie now....
Dejean: ok
5:01 PM i hope you get all the information
me: please tell dr pilie that heureuse needs to be on potassium supplement.
thank you and bon nuit...
kembe fem
5:02 PM Dejean: thank you very much
may God bless you
5:03 PM byeeeeeeee
me: by
Dejean: tell your family hello for me
me: ok
thanks
Dejean: aaaaa you are very welcome

Peoria City Council

See "

Debt is a Shackle

This excerpt is from a letter by a physician printed in Emergency Medicine News, July 2008.

The letter makes a lot of sense.

There is a fair amount of paranoia at OSF amongst physicians and some feel if they speak out they will be punished. Many doctors know some policies at OSF are not ethical. And I think patient care in Peoria suffers due to physicians fearing for their jobs.
------------------------

Debt Makes Doctors Miserable

I am a 30-something EP practicing for
five years in California. I also spent a
couple of years on the East Coast. It really
is a jungle out there in the ED “pits”
from coast to coast. The lack of control
most doctors experience is definitely
adding fuel to the general burnout.

I personally
make every attempt to limit and
eliminate debt when possible, which
gives me a degree of autonomy in my
practice. I do not need to work an
obscene number of shifts just to keep
up. There is also mental freedom knowing
I am not in jeopardy of losing my
income and home from an unpleasant
interaction, whether it is with a patient,
hospital administrator, ED staff member,
or fellow physician. If things ever get
rough, there is security in knowing I
have many options, including taking
some time off.

As a result, I find myself within a
minority of emergency physicians who
do not wish to bury their heads in the
sand and simply collect a paycheck. I
find myself one of the few voices present
and willing to speak up at monthly meetings,
even when there are grumblings in
the pit all month long. I believe in the
idea of right and wrong, and in not simply
looking the other way when one is in
the midst of wrongdoing, even when it is
too complicated to pinpoint precisely.

When physicians are scared to ask about
money billed in their names and not
allowed to collectively control practice
details, that just seems wrong to me. It
also seems wrong when we physicians
are more concerned about keeping up
with the Joneses than we are about the
details of our practice sites.

I strongly believe physicians have an
obligation to make choices carefully.
Even our personal life choices can have
an impact on the overall health care system.

For example, when we acquire massive
debt, we are no longer free to
express important opinions, which may
be distasteful to certain interested parties.
We are all well aware that certain
powerful individuals can immediately
reduce our workload without reason,
consequently controlling our income. As
inconvenient as our opinions may be,
they are important and should not be
silenced, which is something we do to
ourselves and our colleagues when we
have massive monthly overheads and/or
work for the highest bidder without
regard to company structure and process.

We all know the decades of sacrifice
and delayed gratification it takes to
become an EP. It’s only natural to enjoy
the income we experience after completing
residency. Many of us have families
to support, or simply wish to play
after many years of sacrifice. The more
money we make, the more fun we can
have playing, and we can buy better toys
as well. I only wish some of us didn’t go
so crazy with the extra zeroes we start
seeing on our paychecks after residency.
When I see a friend or colleague add
a high six- or seven-figure home to a six figure
education debt, I immediately
know that he will never be able to stand
up for himself or anybody else for that
matter.

Debt is the new shackle. There
are some great doctors out there supporting
groups that should not occupy
such an important place in our specialty
nor wield so much control over our lives
and livelihoods. I hope we will shift our
mind-set regarding contract holders.
They never call themselves employers
for legal and business/financial reasons,
and we should never consider them
employers.

Heureuse and Hurricane Gustav

Haitian Hearts is managing Heureuse’s congestive heart failure from 1,500 miles away.

Frandy, our contact in Port-au-Prince, took her to the General Hospital in the capital last week and the doctor suggested that Heureuse be admitted. However, Heureuse had no one to take care of her in the hospital, so she could not be admitted.

In Haiti, at large public hospitals such as the General Hospital, a patient needs a family member with them to assist them in the hospital. The family member would be responsible for obtaining food and water, bathing the patient, providing bed sheets and washing them, emptying the commode, and buying medications for the patient.

Heureuse’s family lives on Haiti’s southern coast in Benet and are not present in the capital. Heureuse's husband is dead and she has sent out her two small children to live in different parts of the country while she awaits death.

Incredibly, during the last few days, Heureuse has improved. She is breathing better and is able to do more. We have increased her furosemide and added a medication to control her blood pressure.

However, Hurricane Gustav hit Haiti pretty hard the other day and caused massive flooding and a quite a few deaths (according to Frandy) on the southern coast (near her family). And it has been much harder for Frandy to assist Heureuse because of the weather. Frandy has been providing Heureuse with food, water, and medications.

If she can survive this week, there is a possibility that Heureuse can get an echocardiogram next week. For her to have a chance of being accepted in the States, a cardiologist or surgeon needs to view her echocardiogram.

All of this seems so incredible. Heureuse is trying to survive congestive heart failure living in a shack alone with no money and not enough food and water. And Gustav hits Haiti with such force it stops 19 year old Frandy, another very poor Haitian who has a heart defect also, from helping her.

And OSF in Peoria precedes with its one half billion dollar medical campus expansion in a city that is 1/20th the size of Port-au-Prince.

“The world is a dangerous place to live; not because of the people who are evil, but because of the people who don’t do anything about it.” (Albert Einstein)

No Answers

I sent the letter below to quite a few people including Sister Judith Ann, Bishop Jenky, and OSF-Corporate ethicist Joe Piccione. Joe also sits on the International Committee for OSF-SFMC. The International Committee reviews which international patients are operated at OSF.

Also, I sent a letter to Jim Stowell who is President of the Children's Hospital of Illinois Community Advisory Board.

No answer from any of these people regarding Heureuse.

Letter Asking for Help

A few days ago I sent this letter out on behalf of Haitian Hearts patient Heureuse.

Heureuse is a 29 year old female who lives in Haiti. She was operated at OSF in 2002 for a serious heart valve problem. She needs more surgery now as the letter explains.

OSF has abandoned her but other Haitian Hearts patients in Haiti are helping her tremendously. However, unless she has surgery soon she will leave two little children in the slum without parents. And Haiti is suffering greatly now with the "food shortage".

Today I forwarded an e mail from Haiti describing Heureuse's condition to Keith Steffen, CEO of OSF-SFMC. The e mail bounced back consistent with OSF's policy blocking my e mail as it has done in the past. This certainly is not doing Heureuse a favor.


International Committee and Children’s Hospital Community Advisory Board

August 14, 2008

Dear

Haitian Hearts is currently working on bringing 14 more patients to the States this year for heart surgery. Two other children were successfully operated earlier this year.

However, in addition to the above, we have three previous patients that need to come back to OSF to be reoperated in Peoria.

Many of you will remember Jenny Guillaume, Heuruese Joseph, and Henri Andrique. All three were operated at OSF 5-10 years ago.

Haitian Hearts has followed up with these patients in Haiti after they left Peoria and we supply them with examinations, medications, repeat echocardiograms, etc. during our frequent stays in Haiti.

Jenny is 29 years old now and teaches hearing impaired students in the Haitian capital, Port-au-Prince. She has never been married and still lives with her mother. She communicates with us by e mail and is fluent in French and Creole. She also speaks English fairly well. She and her family have helped us considerably in Haiti over the years.

Heureuse is 29 years also. She lives in a seaside slum in Port-au-Prince. She is raising her two small children alone. Her father is dead and her family lives on the Haiti’s southern coast and is not able to be of much help to her. She has no job and Haiti’s food prices have climbed dramatically over the course of the last year. Heureuse and her kids go to bed hungry.

(I have learned in the last few days that Heureuse is very sick. She is in congestive heart failure and lying in her bed unable to walk. Below is an online conversation I had with Dejean Frandy today, a Haitian Hearts patient who is 19 years old. Two other Haitian Hearts patients, Jenny Guiallaume and Suze will attempt to help Heureuse also. We are doing whatever we can to keep her alive until I can bring her to the States.)

Henri is 34 years old now and just got out of the hospital in Port-au-Prince due to cardiac problems. He is unable to work and his weight is down to 130 lbs.

Jenny, Heureuse, and Henri all need valve surgery. All are in various degrees of heart failure due to their bad valves. I have not had any luck finding other medical centers to accept them. They will be difficult cases due to their previous surgery and their underlying pathology.

All three would like to live. What would you do if they were your relatives, children, or friends?

Please make sure that OSF and their legal counsel, Douglass Marshall, remove their embargo of Haitian kids at OSF. Their physicians would like to see them return to Peoria as would their host families.

I do not want these three to die painful deaths like Jackson Jean-Baptiste and Maxime Petion did after they were denied on going care at OSF.

I humbly ask you to be their advocates and will wait to hear from you regarding these three young adults.

John A. Carroll, M.D.
309-648-1087

haitianhearts@gmail.com

www.peoriasmedicalmafia.com
www.pmmdaily.blogspot.com
www.dyinginhaiti.blogspot.com


Online conversation today regarding Heureuse:

Dejean Frandy3:18 PM Dejean: HI i need to talk to you now me: frandy, can heureuse talk to...
3:37 PM (6 hours ago)
3:18 PM Dejean: HI
i need to talk to you now
me: frandy,
can heureuse talk to you?
Dejean: yes i am there
i saw her this morning
3:19 PM she has prescription for Echocardiogram
she may need to see Dr Pilie for it
3:20 PM me: frandy,
Dejean: she has medicines
me: I want you to e mail a haitian friend of mine...her name is jenny guiallaume..
her e mail is...
3:21 PM gjenny12@yahoo.fr
3:22 PM she lives near delmas 33
she can help you and heureuse...
she is a heart patient....
heureuse needs to take a medicine called lasix (furosemeide)..
3:23 PM explain to me heureuse's condition
can she walk a little...
can she eat and drink?
Dejean: no she can not
me: are her legs swollen?
Dejean: she can but she does have money to feed herself
3:24 PM she does not have money
me: she does or she does not have money to feed her self?
is she short of breath?
Dejean: she does not have money
3:25 PM yes she is and her legs are not swollen
me: where are her kids??
3:26 PM Dejean: the boy is with her but the girl is somewhere else
maybe delmas
she has the medicine you said above
me: ok...
will you contact jenny?
3:27 PM Dejean: let me tell exactly what she needs for now
me: can you and jenny take her to the General Hospital or the hospital in leoganne??
Dejean: yes i will
3:28 PM me: ok, tell me...type fast...i will wait...
Dejean: she already went to GCH
me: ok
Dejean: she needs to do Echocardiogram
3:29 PM and Thyroidien, glycemie
me: frandy, she needs treatment with medication before echocardiogram...
Dejean: ok
3:30 PM do you have Jenny's number phone?
me: tell the doctor she has a problem with her valve aortic and valve mitral...she was operated in 2002...
no i do not have jennys number but she checks her email every day...please send her an email... and tell her to call you...
3:31 PM Dejean: ok i will do everything
me: maybe suze can help you with a ride for her to the general hospital....
Dejean: i am going to see Heures later
me: ok.
3:32 PM Dejean: i can do this
3:33 PM do you Andrique's Echocardiogram?
do you need Andrique's Echo...?
he said that he has it
3:34 PM i can scan it for you
me: tell heureuse not to take the thyroid medicine...she needs to take the furosemide...yes i need andriques echo results....maybe he can send me the results via e mail or you can scan it...
3:35 PM please get hold of jenny now...and suze...
Dejean: i will do that perhaps during the week end
ok
byeee
me: yes, the echo on the weekend is good...
heureuse is problem number one right now....
3:36 PM tell heureuse that she should take furosemide 40 mg in the morning and 40 mg in the afternoon...
3:37 PM Dejean: ok byeee
talk to you later
--------------------------

Heureuse at the top. Keith Steffen at the bottom.

Protection

The Catholic Diocese and the Peoria media are protecting OSF. It won't last forever. As I told Mr. Steffen in the past, the truth will eventually come out.

Peoria Journal Star Hides Again (REVISED)

The Peoria Fire Department (PFD) was allowed to upgrade to Paramedic last month. Only two fire stations will provide this care, but it is a start. The PFD will remain non transport, i.e. will not be able to take 911 patients to local emergency departments. This arrangement will allow Advanced Medical Transport (AMT) to be the only provider of Paramedic and transport of emergency patients in Peoria.

Elaine Hopkins reported on her web log that the Peoria Journal Star failed to report that the PFD became Paramedic. The Journal Star opposed this upgrade for at least a decade and did not want to report this historic news when the change was made last month.

Most people in Peoria do not even know that a change has been made. And thanks to the Journal, most people have not been aware that when Uncle Merle had his heart attack he did not receive advanced life support from the PFD when they arrived at Merle’s home. Maybe they would be upset if they realized what this meant for Merle.

On August 13 I submitted a second forum article. I contacted the Journal Star after a few days had passed and asked them if my article had been “killed” yet. The answer was, “No not yet.”

Here is the article just in case the Journal Star doesn’t publish it:

On July 8 the Peoria City Council voted unanimously to approve the Peoria Fire Department (PFD) contract. For the first time, two Peoria fire stations, 12 and 20, can independently function as paramedics and provide advanced life support for the citizens of Peoria.

Unfortunately, this historic news totally slipped under the radar of the Journal Star. The Journal printed not a word about the results of this vote and most Peorians remain unaware of what level of emergency care they are receiving.

Even though the PFD still cannot transport patients to hospitals, the fact that stations 12 and 20 will be paramedic is a step in the right direction. Now when private citizens and nursing homes in these two areas call 911 for medical reasons they will receive paramedic care by the PFD and they will not have to wait for Advanced Medical Transport (AMT) to arrive at the scene.

While this is good news for people covered by these two stations, the question has to be asked: Why isn't the rest of the city given the same paramedic care? In most parts of Peoria the firefighters are still only allowed to provide basic life support and basic medications.

I suggest that stations 12 and 20 document when they make important medical interventions for the emergency patients that call 911. The PFD needs to let their City Council members know when this happens. Also, people that call 911 from places in Peoria not covered by stations 12 and 20, should notify their Council member if the PFD responded first and the sick person had to wait for AMT to arrive to receive advanced life support.

Hopefully in the future, if more weak spots in the system have been identified, another City Council vote will occur and the PFD will be allowed to function as paramedics in these areas to save more lives.

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

The Journal Star probably has all sorts of problems of their own. I sure don’t know the specifics. But I think they are doing all they can not to rile up OSF and AMT and others during tough times like this. And so they suppress news and protect businesses that need to be exposed.

Too bad for Peoria.
-------------------------
August 26,2008:

On Sunday, August 24, the Journal Star published the above forum article. They did leave out the sentence I had written stating that the Journal Star failed to report that the Peoria Fire Department will now be paramedic and perform advanced life support.

Here is the article as it appeared in the Journal Star:

Forum: Let firefighters save lives

Journal Star
Posted Aug 24, 2008 @ 12:00 AM

PEORIA —
On July 8 the Peoria City Council voted unanimously to approve the Peoria Fire Department contract. For the first time, firefighters at two stations - 12 and 20 - can function as paramedics and provide advanced life support for the citizens of Peoria.

Unfortunately, most Peorians remain unaware of what level of emergency care they are receiving.

Even though the PFD still cannot transport patients to hospitals, this move is a step in the right direction. Now when private citizens and nursing homes in these two areas call 911 for medical reasons they will receive paramedic care by the PFD and they will not have to wait for Advanced Medical Transport (AMT) to arrive at the scene.

While this is good news for people covered by these two stations, the question must be asked: Why isn't the rest of the city given the same paramedic care? In most parts of Peoria the firefighters are still only allowed to provide basic life support and medications.

I suggest that stations 12 and 20 document when they make important medical interventions for the emergency patients who call 911 and let City Council members know when this happens. Also, people who call 911 from places in Peoria not covered by stations 12 and 20 should notify their council member if the PFD responded first and the sick person had to wait for AMT to arrive to receive advanced life support.

Hopefully, if more weak spots in the system have been identified, another City Council vote will occur and the PFD will be allowed to function as paramedics in these areas to save more lives.

John A. Carroll, M.D.
Peoria

Copyright © 2008 GateHouse Media, Inc. Some Rights Reserved.
Original content available for non-commercial use under a Creative Commons license, except where noted.

The Story That Won't Go Away...

The fact that poor Haitians are eating mud patties to help stifle their hunger pangs has caught the attention of the international media.

See Kate Kennedy's recent article in Macleans.

It is imperative that all of this press turn into something good for Haitians. Haitian farmers need to be supported so the food that Haiti needs is grown and sold in Haiti.

Boarding of Admitted and Intensive Care Patients in the Emergency Department

Here is my letter to Keith Steffen in 2001. I was put on probation from the OSF-Emergency Room the next day.

The OSF-ER was seeing far too many patients for its size in 2001. I did not think it was safe for patients to wait so long to be admitted to the hospital. Neither does the American College of Emergency Physicians.

Below is a Policy Statement by the American College of Emergency Physicians in 2008.

Boarding of Admitted and Intensive Care Patients in the Emergency Department

Annals of Emergency Medicine - Volume 52, Issue 2 (August 2008)


Optimal utilization of the emergency department (ED) includes the timely evaluation, management, and stabilization of all patients. The ED should not be utilized as an extension of the intensive care and other inpatient units for admitted patients, because this practice adversely affects quality of care and access to care. ED leadership, hospital administrators, EMS directors, community leaders, state and federal officials, hospital regulators and accrediting bodies should work together to resolve this problem. In order for the ED to continue to provide quality patient care and access to that care, the American College of Emergency Physicians (ACEP) believes that:

• Hospitals have the responsibility to provide quality patient care and optimize patient safety by ensuring the prompt transfer of patients admitted to inpatient units as soon as the treating emergency physician makes such a decision. If such a transfer cannot be promptly effected for whatever reason, the hospital must provide the supplemental nursing manpower necessary to care for these inpatients boarded in the ED.

• In the event that the number of patients needing evaluation or treatment in an ED is equal to or exceeds the ED's treatment space capacity, admitted patients should be promptly distributed to inpatient units regardless of inpatient bed availability.

• Hospitals should have staffing plans in place that can mobilize sufficient health care and support personnel to meet increased patient needs.

• Hospitals should develop appropriate mechanisms to facilitate availability of inpatient beds.

• Emergency physicians should work with their hospital and medical staff to monitor and improve the use of inpatient resources.

• Staffing patterns applicable to other specialized areas/units of the hospital should apply equally to the ED to assure that patients receive a consistent standard of care, appropriate for the acuity of their condition, within the organization.

• Mutual aid agreements should be in place to assist any hospital that is unable to meet the emergency and intensive care needs of its community.

• Hospital diversion should be instituted only when internal resources have been exhausted and other community facilities have resources available to meet the needs of patients presenting to their facilities. EMS systems should develop mechanisms to address patient diversion by health care facilities utilizing the ACEP policy on ambulance diversion.

• Hospital regulatory and accrediting bodies should mandate standards for prompt transfer of admitted patients from the ED to inpatient units and proactive planning for hospital bed availability.


Revised and approved by the ACEP Board of Directors April 2008

Revised and approved by ACEP Board of Directors January 2007

Originally approved by the ACEP Board of Directors October 2000

Hospitals Sending Immigrants Home

If you didn't see the New York Times article regarding U.S. hospitals flying immigrants back to their homes, here it is. It is a must read.

Sister Margaret McBride, vice president for mission services for Saint Joseph's in Phoenix, was truthful when she said that the patient/immigrant's families were not happy about repatriation but they (Saint Joseph's) don't require consent from the family to repatriate. She should know since her hospital returns quite a few unlucky souls each year.

This reminds me of OSF in Peoria.

When Haitian Hearts was negotiating with OSF and the Catholic Diocese of Peoria regarding the fates of numerous Haitian children suffering from heart disease, neither OSF nor the Diocese would tell me the details that I had to accept to receive any support from OSF. However, they did allude to the fact that the Director of Children's Hospital of Illinois (CHOI) would be holding the passports and visas of my Haitian Hearts children. I knew the Director's behavior in the past, and so I was afraid that he and Children's may attempt to send Haitian kids back to Haiti before they were safely cleared for me to fly them back to Haiti.

Unfortunately, with the recent New York Times article addressing the unethical business of sending immigrant/patients home, it reminded me how these hospitals have nothing on OSF in Peoria.

Alienating the Powerful

Elaine Hopkins recent article contained information that the Peoria Journal Star did not want Peoria to know. The article has scared off alot of other people as well.

The Peoria City Council recently voted unanimously to approve the PFD contract. Part of the new contract allowed the PFD to provide Paramedic care for the first time ever.

This was historic news for Peoria regarding a topic that has been called "closed" by Peoria's leaders.

Consider this paragraph in Elaine's article:"Carroll’s complaints to hospital ethicists, the Peoria Medical Society, the Christian Medical Society, the Peoria Catholic Diocese and other organizations have all been ignored or brushed off, Carroll said".

What does this paragraph mean and why is it so intimidating?

On three separate occasions, I let Joe Piccione, OSF Corporate Ethicist, know of my concerns regarding the Emergency Medical Services (EMS) monopoly. He told me that I was mandated to report this. However when I did, Piccione, Sister Judith Ann, Jim Moore, and Dr. Gerry McShane did not respond. In my opinion, OSF ethicists did not want to debate the ethics of an issue like this that was being sustained by OSF (and others) for economic reasons.

I contacted the President of the Peoria Medical Society (Dr. Rich Anderson) and let him know of my concerns. Dr. Anderson e mailed me and told me that the EMS situation in Peoria was fine...and also told me not to reproduce any of his e mail. Why would he not want his e mail reproduced? And as it turned out, it does not appear that everything regarding EMS was "fine" in Peoria, as evidenced by the policy change.

The Catholic Diocese of Peoria didn't want to deal with Peoria's ambulance monopoly either and threatened me if I got involved. Monsignor Steven Rohlfs, who was Vicar General of the Diocese, and Patricia Gibson the Canon Law Lawyer for the Diocese, told me in Monsignor Rohlf's office that if I petitioned for a Canon Law Tribunal regarding OSF and ANY ISSUE, the Diocese would come out in the media against me and Haitian Hearts. And when I did file the petition with the Diocese regarding the EMS monopoly sustained by OSF, Monsignor Rohlfs wrote me back to take the ambulance monopoly issue to Rome. He said that Bishop Jenky had no jurisdiction regarding this issue generated from the largest Catholic hospital south of Chicago located about six blocks from the Diocesan Chancery.

These are three big reasons that the Journal Star and others did not want to print the news. Who would want to alienate these three powerful institutions?

OSF's Hypocrisy Continues...

The Peoria magazine, InterBusiness Issues, has an article in the August, 2008 edition.

The article was written by Keith Steffen, Administrator of OSF-SFMC in Peoria.

Mr. Steffen starts out his brief article with this sentence:

“Being able to serve all the patients who come to us is our primary priority.”

I wonder if Mr. Steffen really believes this. He cut all funding for Haitian Hearts patients in July, 2002 and OSF-SFMC is denying care to past OSF Haitian patients who need repeat heart surgery.

Two young patients, Jackson Jean-Baptiste and Maxime Petion have died in the last couple of years after they were refused surgery at OSF-SFMC. Four other Haitian Hearts patients need repeat surgery soon or they will all die.

Mr. Steffen also writes about OSF’s Milestone Project which is costing about 400 million dollars.

“The Milestone Project will use 47,000 square feet of glass, 22,000 cubic yards of concrete, 143,000 pounds of rebar (used for reinforcing concrete) and nearly 10 million pounds of steel.”

He then ends his article with the following paragraph:

“This new facility will help us to better “serve persons with the greatest care and love in a community that celebrates the gift of life”. And that is the OSF HealthCare mission.”

Notice that he put the mission statement in quotes…possibly distancing himself from this philosophy.

Many Haitian patients and their families wouldn’t believe this if they read his article. And I am sure the hypocrisy of Mr. Steffen’s words are not lost on many people in central Illinois.