Don’t be a hero

Over the years I have smashed a mallet on the idea that “First Responders” are heroes of any kind. I have tried to dispel the notion that Doctors and Nurses are these icons of good and of course I have said the same about those in my profession of Education. We are all humans and we are all flawed but some more than others and with that their position enables if not allows it to fester like a Boil and when popped the pus and infection spreads.

I found this article today in the LA Times and while I should be writing about the Writer’s Strike and what that means for the profession of writing, I found this article worth reading. It discusses the Fire Department of Los Angeles and its sordid history of abuse. They are not the first nor last I have written about the EMT and Fire Department members that stood by and watched and waited to treat a man who was seriously beaten to death in the streets of Memphis. They too were not the first nor the last who do nothing when it comes to saving lives and rescuing Cats from trees. That said, there are good and bad and ineffectual but when it comes to the idea that First Responders are idols and should be worshiped, I have to go, REALLY?

I know few care and even few do have any desire to know this but every time you call 911 you put your life and other in their hands. Sometimes it works and sometimes it doesn’t. I also have many issues with the 911 system and it too needs a good shake up but again they too are a part of the Justice System and a faction within municipalities that are only as good as the budgets they are provided and the training they are given. Neither of which is all that great. Here in Jersey City you are lucky they respond. In Texas the sight of the mass shooting, not the most recent that is Atlanta as of this hour in this day, the neighbor had called 5 times to 911 with no response. 5 of them are dead, two children. So again tell me about these heroes again?

At the LAFD, pay for sex on duty, batter a cop, lie on medical records — and keep your job

The Los Angeles Times May 4, 2023 By Paul Pringle, Staff Writer

One firefighter made off with a Los Angeles Fire Department cellphone last year and used it to solicit a prostitute while on duty. He then abandoned his dispatch post at the department’s downtown communications center, which handles 911 calls, drove to a hotel near Los Angeles International Airport and had sex with her before returning to work.

A second city of L.A. firefighter drove with a blood-alcohol level nearly 2½ times the legal limit, resisted arrest and committed a battery on a law enforcement officer, according to LAFD disciplinary records on the 2020 incident.

In a third case, three LAFD firefighters reported in 2020 that their captain kicked a homeless man in the head with his steel-toe boot while the man was lying motionless, the department records show. One witness said the blow was so hard that he heard the man’s teeth “clank together.”

How many of the firefighters lost their jobs?

None.

The LAFD almost never terminates firefighters, even those who have committed crimes or other types of egregious wrongdoing, a Times investigation has found. Their misconduct is detailed in the department’s own disciplinary files as well as court records and other public documents.

Not a single firefighter was fired in 2021, the last year for which comprehensive disciplinary information is publicly available, according to department records. Not for domestic violence. Not for falsifying medical records. Not for making racially offensive remarks or publicly promoting an alleged hate group.

Disciplinary procedures dragged on for so long that some firefighters were able to retire before any punishment was imposed. Others escaped with their jobs after a Board of Rights panel, made up of three fire officials, imposed lesser penalties, such as suspensions. And in many other cases, the department issued reprimands or no discipline at all.

“How in the world does nobody get fired for some of these things?” asked Jimmie Woods-Gray, president of the Fire Commission, the civilian panel that oversees the LAFD, in response to questions about the cases reviewed by The Times. “If you were in any other job, you would be fired. What is it that keeps firefighters from getting fired?”

California

What you need to know about the misconduct cases at the Los Angeles Fire Department

May 4, 2023

The 2021 cases were compiled in an internal review of disciplinary procedures by the LAFD’s Office of Independent Assessor, which reported its findings to the Fire Commission. The report shows that the LAFD meted out no punishment in more than 90% of the roughly 1,900 disciplinary cases that were closed in 2021 and from 2017 through 2019, combined. Figures for 2020 were not compiled by the assessor.

Of the 648 cases closed in 2021, the Fire Department sustained the allegations in just 112, or 17%, and disciplinary action was taken in even fewer — 47, or 7% of the total. The LAFD has withheld the names of all but a handful of the firefighters whose disciplinary cases are addressed in this story. Open-government experts say the department’s refusal to disclose the names violates the California Public Records Act.

The documents that The Times managed to obtain reflect what critics say is a long-entrenched pattern of the LAFD failing to hold firefighters fully accountable for serious misconduct.

A montage of screenshots of LAFD disciplinary cases from a 2022 report

For example, since January 2018, the 3,400-member department has discharged just three firefighters, according to an LAFD spokesperson. The department did not release their names nor the specific circumstances of the dismissals. Two firings were noted in the LAFD’s quarterly disciplinary reports from January 2019 through the end of last year. Both were for the vaguely stated reason of “failure to meet conditions of employment.” One other firefighter during that period resigned during a Board of Rights hearing and another resigned “in lieu of termination,” the reports state.

In the same time frame, at least 16 firefighters were accused of either domestic violence, drunk driving or other criminal conduct, according to the available records.

The Times sought to examine additional years of disciplinary cases, but the quarterly reports from July 2016 through December 2018 were missing from the LAFD’s online archives. The department provided no explanation for why the records could not be found.

The LAFD also did not respond to queries about discrepancies in some of the records, including inconsistencies between the independent assessor’s report and the department’s quarterly summaries of disciplinary actions.

In recent years, The Times has documented cases in which high-ranking fire officials escaped discipline entirely. Then-Chief Deputy Fred Mathis was able to retire last year with a $1.4-million payout after a colleague reported that he appeared to be intoxicated while overseeing the agency’s operations center during the 2021 Palisades fire.

And the department waited more than two years before scheduling a Board of Rights hearing for Ellsworth Fortman, then an assistant chief, after he was involved in a hit-and-run crash, LAFD and law enforcement records show. A department investigation concluded Fortman, who was criminally charged in the crash, had been drinking before he smashed his truck into a parked car, propelling it 160 feet and toppling a street lamp, and fled the scene. In the two years after the incident, Fortman made $354,000 in overtime in addition to his annual salary of $221,500. He retired before any discipline was imposed.

Fire Chief Kristin Crowley declined to be interviewed for this story, and she did not answer a number of written questions about the disciplinary cases. Crowley became chief in March 2022 but was a member of the LAFD’s executive team for a half-dozen years and once headed the department’s Professional Standards Division, which investigates misconduct and recommends discipline.

A spokesperson for Mayor Karen Bass said in an email to The Times that she “has no tolerance for misconduct at the Los Angeles Fire Department or anywhere else especially when racism, sexual harassment and violence are involved. She expects — and the people of Los Angeles deserve — reform.”

Bass’ office did not respond to questions asking for specifics on such reforms. The mayor nominates the fire chief, whose appointment must be approved by the City Council. The fire commissioners are also selected by the mayor and approved by the council, and help set policy for the department.

On an April day last year, an LAFD captain noticed that a department cellphone was missing at Metro Fire Communications, as the downtown dispatch center is known. The phone was one of the older flip models available as a backup to firefighters in emergencies — and someone had been taking them from time to time without logging them out. The next day, the captain saw that the missing phone had been returned and needed to be charged.

After charging it, he found a series of text messages in which Armando Gabaldon, a 15-year LAFD veteran, solicited sex from a prostitute at the Four Points by Sheraton near LAX, according to disciplinary records, which described the events as they unfolded.

A series of text messages on a flip-phone screen regarding a solicitation for sex.

“Gonna have to re schedule,” one text said, “went to the atm and f— ate my card only have 80 And like I shouldn’t f— for free already know how that went last time don’t wanna be on your bad side.”

The captain compared the times of the texts with images from a video camera filming the dispatch center parking lot. The camera captured Gabaldon driving out of the lot in his white pickup truck at 12:41 a.m., leaving his post without permission from his supervisor. He was seen in the video returning to the lot an hour to an hour and a half later. The captain informed his superiors and an internal investigation was launched.

Some days later, according to the LAFD records, Gabaldon approached another captain and said, “I want to come clean.” The captain told investigators that a crying Gabaldon had said, “I need help.”

In a subsequent interview with investigators, Gabaldon admitted that he used the phone to hire the prostitute and left his post without permission to meet her at the Sheraton. He said he had sex with her on four occasions but only once while he was on duty, and each time he paid her $100 to $150. Gabaldon said he was in treatment for sex addiction, a condition he attributed in part to post-traumatic stress disorder from an emergency call early in his career during which a year-old boy died.

Gabaldon was relieved of duty in October. In January, a Board of Rights made up of three LAFD battalion chiefs accepted his guilty plea to two administrative charges of using the department phone to solicit a prostitute and leaving his post. The board determined that his conduct violated three sections of the Fire Department’s rules and regulations.

“When you made a decision to engage in illicit sex while on duty,” the panel wrote in its findings, “you not only broke the law but you violated the trust of the department and most importantly the citizens of the city of Los Angeles.”

Although the panel could have fired Gabaldon, a majority of the board opted to suspend him without pay for six months. Among the reasons for the lesser punishment were his admission of guilt, his years of satisfactory performance, his psychologist’s comments about his condition and his “working countless days in a row” at the dispatch center. (Gabaldon was well-compensated for those days; his gross pay last year was $291,500, according to the LAFD.)

But one of the board members, Battalion Chief Timothy Lambert, disagreed that Gabaldon should not be fired. Lambert wrote in a statement of dissent that he questioned the sincerity of Gabaldon’s testimony and “was skeptical that he would have made any of the life changes he described had he not been caught. Mr. Gabaldon committed a crime, he did it while on duty, and he knowingly tried to hide his actions until they were discovered.”

In an interview with The Times, Gabaldon said, “I regret everything I did,” but added that he should not have been fired. He echoed his statements to investigators in saying his conduct grew out of PTSD. Gabaldon said he had been reluctant to seek help because of his position as a firefighter.

“The helper doesn’t want to ask for help,” he said.

The LAFD reported Gabaldon’s admission of soliciting a prostitute to the Los Angeles Police Department for a possible criminal investigation. Gabaldon said he was not charged. An LAPD spokesperson said it had no record of an arrest of Gabaldon, and the L.A. city attorney’s office confirmed that it had received no request from the LAPD to prosecute him.

The Times asked Crowley if she agreed with the decision not to fire Gabaldon. As she did in response to several other questions for this story, Crowley replied in writing through a spokesperson and did not provide a direct answer. “Chief Crowley agreed that the Board [of Rights] determines Firefighter Gabaldon’s duty status,” the spokesperson wrote.

Woods-Gray, the fire commissioner, said Gabaldon’s case underscored the need to replace the Board of Rights system with an independent disciplinary body, such as a panel of retired judges. She said Boards of Rights amount to self-policing by firefighters as if they were “one big family,” which inevitably breeds leniency against wrongdoers.

And she said that the commission has virtually no say in the LAFD’s disciplinary actions. The agency “kind of runs itself,” Woods-Gray said. “The department has no real discipline policy. It’s subjective.”

Of the 112 cases in 2021 in which the LAFD determined there was evidence supporting a complaint, the department decided punishment was not warranted in 65. Among them:

  • An internal complaint alleged that two firefighters, one of them a captain, made racist comments in a phone call, including, “Candidates should try a different department, and it’s too bad, we’re not hiring Mexicans right now. … Oh, I guess the candidates have to be black faces and paint their face black to pass the interview.” An inquiry sustained the allegation, but no punishment was imposed. The captain is Filipino and the firefighter is Latino, a department spokesperson said. In statements to The Times, the LAFD said it determined “the facts of the case did not support a punitive resolution” because “it was a first-time occurrence, made by an off-duty member during a private conversation.” The department said one of the firefighters “received counseling and training from his supervisor.”
  • In a social media post, a white firefighter wrote, “SAY HER NAME … DRUG DEALER,” in an apparent reference to Breonna Taylor, the 26-year-old Black medical worker who was shot to death by Louisville police officers in a botched 2020 drug raid on her apartment. Four current and former officers were charged last year with federal crimes, including civil rights violations in connection with the shooting, and one pleaded guilty. In an email to The Times, the LAFD stated, “The social media post was determined to be protected speech under the U.S. Constitution.”
  • Twelve men in swimsuits at a lake or river posed for an Instagram post with a Trump 2020 banner and a caption that read in part, “Proud Boy Fire Department #wattstowers #Firestation64 #lafd #Watts.” Civil rights organizations have labeled the Proud Boys a hate group whose members often espouse white nationalist views. A Washington D.C. jury Thursday convicted four Proud Boy members on seditious conspiracy charges for their role in the Jan. 6, 2021, assault on the U.S. Capitol. The LAFD told The Times that the post was also protected speech under the Constitution.

Woods-Gray, until recently the only one of the five members of the commission to respond to Times queries about LAFD misconduct, said that “something needs to be done” about firefighters who make racist remarks and that she was “livid” about the Proud Boys post.
“Firefighters represent the Fire Department wherever they are, whether they are on duty or off duty,” Woods-Gray said.

A new commissioner, Sharon Delugach, who joined the panel last month, said she planned to get up to speed on the complaints about the disciplinary process. “I’m interested in digging into this,” Delugach said.

“Firefighters represent the Fire Department wherever they are, whether they are on duty or off duty,”

— Jimmie Woods-Gray, president of the Fire Commission

Woods-Gray and other critics of the disciplinary system largely blame the influence that the Fire Department’s two unions have over the city’s elected officials and the department’s leadership. The critics say the unions use the clout that comes from their election endorsements and campaign contributions to thwart reforms.

Andrew Glazier, who advocated for fair treatment of women and nonwhite firefighters during eight years on the Fire Commission, said the unions have local politicians “wrapped around their finger.”

“You’re fighting the unions,” Glazier said of prospective changes in the policies. “They’re not the only problem, but they’re part of the problem.” He said another roadblock to reform is bureaucratic bungling within the Professional Standards Division.

Glazier contended that then-Mayor Eric Garcetti did not reappoint him to the panel in 2021 because of complaints about him from the rank-and-file union, United Firefighters of Los Angeles City, which the labor organization’s president denied.

UFLAC and a union that represents Fire Department chief officers did not respond to Times requests for interviews or comment.

Erika Hall, an Emory University professor of organization and management who studies racial and gender biases on the job, said the actions of several firefighters in the LAFD cases would be “absolutely” fireable in a well-run organization.

“They sound pretty egregious,” she said.

Hall said that type of conduct has persisted in some fire and police agencies because of a “machismo” culture that breeds and tolerates racist and sexist behavior. “These workplace climates are extremely sticky because of the good ol’ boy network,” she added. “You have to take out the system. The entire system is built on keeping this culture alive.”

A racist and sexist culture within the LAFD has been a perennial source of complaints and calls for reform. Nearly 50 years ago, they led to a federal consent decree that forced the department to dramatically increase recruitment of people of color, who at the time accounted for just 5% of the firefighting force.

The court-enforced decree remained in place until 2002, when the number of nonwhite employees had reached 50%, but allegations of racial and sexual discrimination persisted. Five years after the decree was lifted, the city paid $1.5 million to settle a lawsuit by a Black firefighter who was fed dog food in a firehouse prank. And in 2021, six Black employees in the Fire Prevention Bureau, which is responsible for safety inspections and investigating the causes of fires, sued the city, alleging the LAFD favors white employees in granting promotions.

Despite repeated pledges by City Hall to boost recruitment of female firefighters, women still constitute only 3.4% of the force. The Times reported in 2021 that many female firefighters felt bullied and discriminated against. In August 2021, the U.S. Justice Department said it was “carefully reviewing” complaints by organizations representing female and nonwhite firefighters of discriminatory treatment in the LAFD, including in disciplinary cases. The federal agency has taken no public action since then.

The Times review of department records found there were seven cases in 2021 in which the department sustained domestic violence allegations against firefighters, up from one in the three previous years the independent assessor examined, combined. None of the firefighters has been fired, although as of last month two cases were awaiting a Board of Rights hearing, which could result in a firing or lesser punishment. Five of the firefighters received initial suspensions that ranged from eight to 26 days. Some suspensions were reduced to as few as two days because the firefighter took a counseling course, the records show.

In May 2020, the wife of LAFD firefighter Brian Corntassel asked the Huntington Beach police to meet her near the couple’s home. She told the two officers who handled the call that she was moving out and that her husband had struck her on several occasions in the past. Theofficers spotted Corntassel driving up to the house at a high rate of speed, according to LAFD disciplinary records that detailed the department’s investigation. Corntassel, the records say, then parked his Ford Excursion, got out and yelled at the officers. The officers eventually confronted him, and he shoved one of them and resisted arrest. They subdued him with a neck hold that caused him to lose consciousness.

After his arrest, a blood test showed his alcohol level at 0.18 and 0.19. One officer noted in an interview with an LAFD investigator that the test was performed several hours after Corntassel arrived in the Excursion, meaning the firefighter probably had been even more intoxicated than the result indicated.

The Orange County district attorney’s office charged Corntassel with five misdemeanors. He was arrested on suspicion of domestic violence, but the D.A. did not charge him with that. His wife later declined to speak to an LAFD investigator about the domestic violence allegations because the couple had “moved past those issues and they have sought counseling,” according to the LAFD disciplinary records.

Corntassel denied to LAFD investigators that he ever struck his wife or threatened to hit her. He further denied driving drunk; he said he started drinking after he parked the Excursion. In January, he pleaded guilty to battery on a police officer and alcohol-related reckless driving, court records show.

An LAFD investigation determined by a “preponderance” of the evidence that Corntassel, on separate occasions, slapped his wife on her feet and forearm, hit her with a pillow and threatened to punch her in the face, the disciplinary records show. Earlier in his career, Corntassel had been suspended three times for being absent without leave, hazing and failing to notify the LAFD that he had been arrested on suspicion of drunk driving, according to the records.

In the 2020 incident, the department suspended him for 26 days.

Crowley did not respond after The Times asked why Corntassel wasn’t fired.

Corntassel, 53, was found dead at his Huntington Beach home early last month. A determination of the cause of death is pending the results of toxicology tests, a spokesperson for the Orange County coroner’s office said.

Many of the 2021 cases involved allegations that firefighters violated medical protocols during emergency responses, including by failing to administer electrocardiograms to patients and falsifying records. In most of those cases, more than one firefighter was accused of the violation. Twelve of the cases resulted in reprimands and the others in suspensions that ranged from four to 16 days. Firefighters challenged many of the suspensions by requesting Board of Rights hearings that were pending at the time the assessor compiled the report last fall.

A veteran fire official with expertise in LAFD disciplinary procedures said medical protocol cases have often involved firefighters who refuse to treat homeless patients because the patients are unsanitary. In those cases, firefighters falsified medical records by stating the patient could not be found, said the official, who requested anonymity because he was not authorized to speak about the matter. He said these cases sometimes come to light because a patient later died or a lawsuit was filed against the city.

The Times asked the LAFD to identify any of the 2021 cases that grew out of allegations that firefighters violated protocols by declining to help homeless people. A department spokesperson replied: “The LAFD has no responsive documents pertaining to your additional inquiries.”

In another statement, the Fire Department sought to justify not releasing the names of all but a handful of the disciplined firefighters, saying that “a blanket release of the names … may violate a member’s privacy rights,” and that identities of firefighters in individual cases could be withheld after a “balancing of interests between an employee’s right to privacy and the public’s interest in disclosure.”

David Loy, legal director for the San Rafael-based First Amendment Coalition, said the LAFD’s refusal to release the names of all the firefighters accused in the 2021 cases is “absolutely an affront to transparency.”

“It’s an outrage,” he said. “These are public employees paid with public money to perform a public service.”

Loy said that without the names of the firefighters, it is impossible for the public to know whether the department handled the cases appropriately. “Was there bias?” he said. “Were they given a sweetheart deal?”

A third firefighter identified by the department for this story is former Capt. Paul Steele. (Last week, the LAFD partially identified two more firefighters.)

In December 2020, Steele was accompanying a three-person engine crew on a 911 call about a homeless man who was lying on a sidewalk, possibly unconscious. Two of the firefighters spoke to the man while Steele and the third crew member stood by. The man told the firefighters he was sleeping and did not need medical help. The firefighters said he had to sleep somewhere else so they wouldn’t get another 911 call about him.

Suddenly, Steele, with an agitated look on his face, said, “This is f— bulls—,” according to LAFD records documenting the internal investigation. He walked over to the man and yelled at him, “Get the f— up! Get the f— out of here!”

Steele then “purposely, deliberately, and forcefully kicked the patient right on the top of his head,” one of the firefighters is said to have told investigators. Dazed, the man scurried into nearby bushes and was not seen again.

All three crew members formally complained about the incident the next day. One said Steele’s kick was so hard that the man’s teeth could be heard clanking together. The blow was also described as a “big thump” and a “soccer kick.” When a crew member confronted Steele back at the fire station, saying his actions could bring consequences, Steele allegedly cut him off and said, “I looked around. I made sure there were no cameras before I did that,” according to the LAFD records.

In an interview with an LAFD investigator, Steele denied the account given by the crew members and accused them of lying to force him out of their station. He acknowledged that he was wrong to make any contact with the patient’s head, but he said he merely “tapped” him with his toe a couple of times, and the man’s head was cushioned by a blanket.

After he made contact with the man’s head, Steele told the investigator, Steele stepped back toward the engine and said to the firefighters: “Oh, s—. That wasn’t good. I knew I did wrong right there.”

Steele had a history of discipline, the department records show. He was previously suspended for leaving his assignment without securing relief, and he was reprimanded three times for violating various rules and for disrespectful behavior toward a colleague.

The department assigned Steele to his home — with pay — while the disciplinary process dragged on. It also reported him to the LAPD, and he was subsequently charged with misdemeanor battery, according to the LAFD records.

A spokesperson for Los Angeles City Atty. Hydee Feldstein Soto said the court has sealed all records in the Steele case under a state law that allows a defendant to ask that such records be kept under wraps if the defendant completes a diversion program. The spokesperson declined to release any more information.

Internal critics of the LAFD say the city attorney’s office has long gone easy on firefighters accused of misconduct, including by stalling investigations of serious wrongdoing by farming them out to private law firms. Feldstein Soto, who was elected in November, had her swearing-in ceremony at the LAFD’s training center, with UFLAC President Freddy Escobar serving as emcee.

In a statement to The Times, Feldstein Soto said: “Before my election as city attorney, I publicly called for reform within the LAFD after a series of alleged incidents of misconduct targeting women and Black firefighters came to light. I urged the chief, the firefighters’ union and the rank and file employees to work together to change the culture. To this date, my message has not changed.”

It was not until nine months after the Steele incident that the LAFD proposed a Board of Rights hearing for him. He retired before the hearing was held, thus escaping punishment. The Times was unable to reach Steele for comment. Upon retiring, he received a payout of about $120,000 in what the department described as unused leave and banked overtime.

Glazier, the former Fire Commission member, said the LAFD is facing the same disciplinary problems as it did when he joined the panel nearly a decade ago. He said he was disappointed but not surprised at the lack of progress, because the department remains afflicted with a deep-seated “culture of ‘boys will be boys.’”

“All I can do is shake my head at this point,” Glazier added

The Fugitive

Well as the under-utilized naval ship sailed away from the harbor (whosever idea that was showed how tax payer dollars are abused that one was it) to the temporary closing (as in still set up but not being used) Javitz Center and the tents of the Salvation Army or whatever weird fucking religious crew run by homophobe Franklin Graham on public lands, which could have been used well for the public to go while being locked down, get folded up we are back to just the overworked and underprepared/supplied public hospitals, and those private ones stocked by Warren Buffet, to treat the  new/next/more Covid patients. The ones in the prisons or in Convents, nursing homes well you will be fine if no one notices you are dead.  And well even those on the Subway, again wondering how many hours those bodies were there shedding viruses or whatever caused them to die.  Remember if you are not tested POS for Covid and you die you die of that but still are likely counted as dead by Covid, maybe or maybe not. Who knows?  Does anyone care?  Well apparently law enforcement does.

I had read about arrests, chases and hunts of others in other less democratic countries who had escaped Covid treatment facilities; such as the woman in Chile, Russia, India , Africa and even Israel. 

When I read this article in the Tennessean about a homeless man who “escaped” the Covid facility from the fairgrounds (where I lived only about a mile away) and was set up exclusively for homeless it again made me wonder who was being treated at the varying satellite facilities in New York and New Jersey. Something tells me not the insured or the white but what do I know? Well nothing as they don’t tell you shit screaming HIPAA laws. Well wrong again.

Yes folks buried in the article was the policy regarding HIPAA and the ruling on public safety (of which there are many guidelines) .  Good times as this is what I had been looking for when I tried to explain to someone that HIPAA does not apply in the case of COVID as it is highly infectious and back in the day during the height of the AIDS crisis that debate raged as it was believed solely blood born and sexually transmitted.  Then came the Ryan White story and the affect on the blood supply and well game on and hence the law in New York that if you have had sex in the last 6 months you cannot donate blood despite that all blood regardless of donors sexual history is tested for any disease including AIDS.  That is called the work-around. And of course with Covid that is contagious via close contact,  the same way but without sex, meaning that coughing, sneezing, drooling, vomiting, diarrhea,  heavy sweat (as in a fever) makes this virus virulent and highly transmittable.  No it is not again in the air like measles, whooping cough or TB all by coming into contact via the air.  Covid is  flu like and that means close prolonged contact.  So keep moving and when out wash your hands immediately upon returning from those essential errands, then clean the surfaces that anything you brought in touched and dispose of those items, toss the gloves, the mask in the trash or in turn wash your mask after wearing and then finally clean your skin, such as a face or exposed areas again to eliminate any potential infection.  But no the virus is not floating in the air in the same way airborne diseases are unless again in a confined space.. you know the ones I keep mentioning.  But if you live in an apartment or home with others they have to follow the exact same protocol which means intense cleaning and agreement on that policy and good luck with that.  You might want to escape too.

I am all for my civil rights being ignored in a public health crisis and in a state of emergency, again 9/11 anyone. And that little office that housed ex-patriot Edward Snowden, is an example of what they did in the surveillance state. We have the capability and technology, Stingray’s anyone?  All available to monitor and track and trace people. So to have corporations such as Google and Apple come up with an App for that, I say no thanks.  Sorry but no. They are already underfire for either not providing or providing such information to law enforcement to use at their discretion and those cases of SWAT arriving at doors and taking down bad guys has worked out so well or not. What.ever. you decide.  And that is the problem, the lack of consistency, oversight, regulations and other issues that well ended up with stop and frisk, the drug wars and the new Jim Crow and the incarcerations of black men. It ends up with immigrants being detained for no actual crime and of course just innocent people getting caught in the crossfire.  So no thanks on that one.

I don’t take my phone anywhere.  I have a daily journal that I mark where I go and what I did that day and in turn most likely would provide that info if asked but most likely I would also tell the usual suspects whom I do contact regularly what my status is.  I also would do the testing at a private physician to speed up the results and also keep them private as unless I go to a hospital as it is a need to know basis and who needs to know?  I also know that as I am single, a woman and without an advocate I would be shoved onto a ventilator or put in some satellite facility as I don’t have health insurance.  So yes death panels do exist.   It is also why the journal along with all my directives, will and the like sits on my desk.  I have no ICE and there is no need as I am quite clear and there can be no confusion with it clearly marked and dated.  It is also notarized and updated annually.  So I have learned first hand how neglectful and abusive hospitals are.  Ask me about my experience at Harborview Medical Center in Seattle in 2012. They treated me like animal and I will never cheer medical personnel for as long as I live as a result.

Why this is so bad is  because right now no one is tracking, testing or tracing.  A woman here in Jersey City died from a heart attack brought on by an asthma attack; she originally was turned away from a hospital as she did not exhibit ALL of the symptoms(as if anyone does), got worse and by the time she returned to the same facility she was too ill and died.  Her death is listed as the result of a heart attack. Okay then, as she was never tested even in post mortem and yet since that time 9 others in her same building have all tested positive, a sort of mini hot zone if you will.  None of them knew about the other and there you go and the building was not cleaned or even touched to reduce the spread from day one.. at least in my building where we “know” of three units none of the staff knew until after and they are pissed, one quit.  So there you go. So much for public safety. Again the virus from symptoms to actual affects on the body varies and so if you are in at “at risk” group you should be tested immediately if one symptom is present, not because of a checklist, and in turn if you have other health issues immediately put on a 24-48 hour watch (many times it is week two when all hell breaks lose)  and that can be at a satellite facility with close contact upon release to ensure you are receiving appropriate, contactless care and in turn tested upon having no symptoms. That has not happened and again if it has what are the numbers for those cases and the results?

So why would you not escape as you aint’ getting shit. And neither are we.  And I would be happy to allow these facilities or organizations and hotels that are open of these kind of business to be available to treat all kinds of COVID patients and the like if they are just that, equipped, trained and able to do so.  Not so sure about that either as if you are short of PPE, etc then what do they have and are they able to do anything but handle the most minor of cases and if they do code then what?  So if this is about public safety and tax dollars we have the right to know and HIPAA has allowed us that much so cough it up… pun intended.

Tennessee, Nashville health officials provide names of those testing positive for coronavirus to police

Natalie Allison and Yihyun Jeong, Nashville
 Tennessean May 8, 2020

Gov. Bill Lee says the state’s release to police departments and sheriff’s offices the names and addresses of Tennesseans who have tested positive for the coronavirus is necessary to protect officers’ lives — information that is also being independently shared between city health officials and police in Nashville.

Lee told reporters at Second Harvest Food Bank in Nashville on Friday the details are only for those working “from a law enforcement standpoint” to know who has tested positive.

“We believe that that’s appropriate to protect the lives of law enforcement,” Lee said when asked why police need the information

The Tennessee Lookout, a new nonprofit news organization, first reported the agreement between local law enforcement agencies and the state Department of Health, which is releasing the information.

The agencies receiving lists from the state of individuals who have contracted the coronavirus include the Knoxville Police Department, the Nashville Airport Authority, the Montgomery County Sheriff’s Office and dozens more.
Nashville health officials share coronavirus patient data with police, fire officials

Separately, in Nashville, the Metro Health Department confirmed to The Tennessean Friday that officials have been providing to the Metro Nashville Police Department the addresses of people who have tested positive or are quarantined for COVID-19.

The data is inputted into the police department’s computer system so that any officer who has contact with an individual who has tested positive for the virus can take additional precautions, Metro Health spokesperson Brian Todd said.

Metro police spokesman Don Aaron said in a similar statement the department uses the information so officers can “take additional precautions.”

The information is also put into the Department of Emergency Communications dispatch system so that fire and EMS workers responding to an address can take steps to use increased personal protective equipment and distancing protocols.

“At no time is this data shared with the U.S. Immigration and Customs Enforcement (ICE) or the Davidson County Sheriff’s Office,” Todd said in a statement.

In a statement, Cooper spokesperson Chris Song reiterated Todd’s comments, and said the information is “safely kept” among Metro agencies.

“We are taking necessary precautions to protect both our first responders and our residents, including those who are part of Nashville’s diverse immigrant communities,” Song said, adding officials are communicating with community partners that the information will not be shared with federal immigration authorities.

“As Mayor Cooper has stated repeatedly, everyone deserves to feel safe in our community, including our front line personnel and the valued members of our immigrant communities,” he said in a statement.

Though the data isn’t not shared with the sheriff’s office, the health department said if a police officer arrests a person who has tested positive for COVID-19, they will inform sheriff’s personnel when releasing them into their custody.

All public safety personnel have been noticed that the information cannot be publicly released and is for “official use only,” Todd and Aaron said. Unauthorized use is a violation of Metro police policy.

The information is updated regularly, and once a person has recovered from COVID-19, they are removed from the list.

According to the Tennessee Department of Health, as of Friday 68 police chiefs and sheriffs have signed on to a memorandum of understanding that they will receive a running list of names and addresses of individuals in Tennessee “documented as having tested positive, or received treatment for COVID-19.”

The list is updated for law enforcement each day, the MOU states, and individuals’ names are removed from the list after 30 days.

Metro police and the Davidson County Sheriff’s Office have no plans to move into an agreement with the state, according to both Aaron and Todd.

Hedy Weinberg, executive director of the American Civil Liberties Union of Tennessee, criticized the policy’s impact on privacy and said it’s more important for law enforcement “Protecting the health of first responders is certainly an important priority. However, as public health experts have noted, disclosing names and addresses of positive cases does not protect first responders, as many people have not been tested and many people who do carry the virus are asymptomatic,” Weinberg said in a statement.

“Disclosing the personal information of individuals who will never have contact with law enforcement raises fundamental concerns about privacy without yielding a significant public health benefit. It is incumbent that any government policy implemented during the pandemic be grounded in science and public health and be no more intrusive on civil liberties than absolutely necessary.”

The Tennessee Immigration and Refugee Rights Coalition has worked during the pandemic to reduce barriers preventing immigrants statewide from getting care and have formally partnered with Metro Nashville and other organizations to increase more community outreach.

In a statement posted on Twitter Friday, TIRRC said the state’s policy to share information with law enforcement should be “rescinded immediately.”

“This completely undermines all of the work organizations like ours are doing to encourage people to go get tested. This will exacerbate the public health crisis,” TIRRC said.

The group did not immediately respond to a request for comment about Nashville’s policy.

Lee said Friday the state was providing this information to law enforcement agencies in compliance with guidelines put forth by the federal Department of Health and Human Services.

A document published by DHHS’ Office for Civil Rights states the HIPAA Privacy Rule permits an entity like a health department to release protected health information to first responders “to prevent or lessen a serious and imminent threat to the health and safety of a person or the public.”

Shelley Walker, spokesperson fro the Tennessee Department of Health, said in a statement the department “believes these disclosures are necessary to avert a serious threat to health or safety.”

More than 14,000 people in Tennessee have tested positive for the virus.

Lee defended the information only being made available to law enforcement and not other front-line workers, such as grocery store employees who also must interact with possible coronavirus patients, by saying that officers are “required to come into contact with these people.

“We know that first responders are required to and law enforcement are required to come into contact with these people as part of their job,” Lee said. “That’s why Health and Human Services gave that guidance to states and that’s why we’re implementing that.” to focus on offering officers proper protective gear as a way to keep them safe.

“Protecting the health of first responders is certainly an important priority. However, as public health experts have noted, disclosing names and addresses of positive cases does not protect first responders, as many people have not been tested and many people who do carry the virus are asymptomatic,” Weinberg said in a statement.

“Disclosing the personal information of individuals who will never have contact with law enforcement raises fundamental concerns about privacy without yielding a significant public health benefit. It is incumbent that any government policy implemented during the pandemic be grounded in science and public health and be no more intrusive on civil liberties than absolutely necessary.”

Calling 911

If it is not shootings by cops, death at the hands of cops or under their watch, we have the EMT’s who are the ones we assume who put politics and personal feelings aside. Well we know that in the case of Eric Garner in Staten Island, EMT workers stood idly by as he slowly died on the street, and we have EMT’s that didn’t want to interrupt their break to help a pregnant woman in urgent need and then we have the story below.

Detroit EMT fired after refusing to help baby
8-month-old girl died next morning at hospital
Author: Shawn Ley, Local 4 Reporter,
Published On: Jun 23 2015 1

Detroit EMT fired for refusing to respond to call of baby in distress
Show Transcript 

DETROIT – The Detroit fire commissioner has fired an EMT who refused to help a baby when she was just minutes away from the home. 

Commissioner Edsel Jenkins said Ann Marie Thomas’s employment with the Detroit Fire Department has been terminated.  

“Today, we conducted an appeals hearing, which Ms. Thomas requested. After reviewing all of the facts of this incident, I have determined that the appropriate course of action is to terminate Ms. Thomas’ employment with the Detroit Fire Department effective immediately,” said Jenkins in a statement released Wednesday. 

What happened:

A frantic supervisor ordered the veteran medic to get to the house where a baby was not breathing and her mother was calling for help. Thomas was just around the corner on her previous run a few streets east. She refused to respond to the scene.  

The 8-month-old baby was exactly 9 tenths of a mile away — a two minute drive at normal speeds — but Thomas took six minutes and then shocked dispatchers by telling them “33 is in position on Pembroke around the corner from the scene.” 

“33, I’m going to need you to make that scene,” said the Detroit Fire EMS supervisor. “You’re going to have to make patient contact.” 

Thomas parked her unit on a corner a street away from the baby. She and her partner were in a SUV outfitted to be just like an ambulance to help medics get to people faster. But in this case, Thomas refused to go to the house. 

Click here to view the internal report of this incident

911: “Uh, Romeo 33? Updated information that the child is not breathing. The baby was hooked up to an oxygen machine because it was premature. Romeo 33?” 

Even with that information, Thomas and her partner didn’t move. 

911: “Romeo 33, Medic 51, be advised CPR is being performed on your scene. Romeo 33, Medic 51. CPR is being performed by the baby’s mother.” 

‘I’m not about to be on no scene 10 minutes doing CPR” 

Two internal investigations were done. The report reads that Thomas told her boss, “I’m not about to be on no scene 10 minutes doing CPR, you know how these families get.” 

An ambulance eventually got the baby to a hospital. She was revived but died the next morning. 

“EMT Thomas was immediately removed from duty following this incident,” said Commissioner Jenkins. “She has since filed an appeal. As executive fire commissioner, I have the ability to make the ultimate determination.” 

Jenkins announced the firing on Wednesday. 

I want to point out the obvious. The EMT is a woman of color, the family are also of people of color. And this is Detroit a city where services of this kind are already at risk.  I note the comment made “you know how these families get” and I wondered what the hell that meant and all the connotations of that remark.

We are so racially polarized that we are dividing and arguing over whose deaths matter more when they are killed or let to die or in the custody of those we assume will do the right thing regardless of color, of who they are and why they are in their hands. It should not matter if you are male, female, LGBT, tall, short, ugly, old, young, black, brown, a criminal, a suspected criminal, a passer by, the color is only part of the equation.   There are so many stories of individuals who have died or using the more appropriate word, murdered,  by Police that we are now over 600 by the Guardian counter. 

Equality means regardless of all of those above and any other distinction other than being a human.. or even a family pet who is murdered by cops. The idea that we have to distinguish and segregate the lives that matter is part of the problem, not the solution.

And as I write this another lunatic walked into a theatre and killed 2 people, not including himself. He managed to do that before the gun toting police made it. Now we will await the profiling, the histrionics and the speculations as to why. I am going with once again an extrinsic reason and that he hated Amy Schumer and that she is somehow to blame as it was her movie where the assault took place.

 The only thing I could say is that he at least was an angry Boomer this time (the alleged shooter was 58) as opposed to the standard profile of angry youth of late. We are up to one a week now yes? And the problem is not guns no not at all. I guess with open carry laws of Louisiana no patrons of the theatre were packing heat and could have done what, save more lives?   Sure guns are not the problem.

All lives matter.

###ALLLIVESMATTER

Do I Have To?

The
Affordable Care Act (ACA) also has a mandate to encourage Doctors and Hospitals to switch to electronic medical records to supposedly expedite care and in turn reduce costs.  And I have a nice bridge to sell you.

Once again the blame game is on full volume with the Medical profession whining that they are not ready to do so because the big bad Government wolf is not providing the safeguards needed to make this transition a secure one.  In other words the fraud and abuse are all the Government’s fault and not the Medical professionals who are actually doing it.

And on this note the price of brand-name prescription medicines is rising far faster than the inflation rate, while the price of generic drugs has plummeted, creating the largest gap so far between the two, according to a report published Wednesday by the pharmacy benefits manager Express Scripts.    And given that generics are exempt from malpractice and regulation in the same ways brand name drugs are I can see that once again Doctors 2, Patients Zero.  It just never ends.

If I meet a Doctor who is a competent, honest, ethical professional that may actually kill me.  I just met another “highly qualified”  Ph.D who managed to not again read one word of my electronic medical records and instead simply had a single page, extrapolated what information he thought essential, and said, “this doesn’t say traumatic brain injury so unless it says that I can’t say that.”  And as I pointed out the phase “IVH means TBI just in fancy terms” And his response: ” that is not the same” Yes, blood in the brain or inter venal hemorrhage in the brain is not the same at all if you don’t understand neurology. I guess he doesn’t. So what does he understand.. stuff on the page that he can read duh!

I cannot believe the utter incompetent professionals that are earning a living in the medical fields but alas they are and they are earning said living off of your living or dying, either is fine.

Billions of our dollars are going to this concept of putting our medical records online. How about putting it into affordable decent care, I will be happy to put my medical records in my smartphone to use that to coordinate and communicate care myself and will call it even! Then as they wheel me into the ER (hopefully never again actually) they can extrapolate that data and actually use that to help me versus surfing my phone to find the the moron they called whom they ended up releasing me to before I was acceptably recovered.  That is one thing that electronic medical records do provide – excellent bedside reading as you recover. I find mine hilarious.


Medicare Is Faulted on Shift to Electronic Records

By Reed Abelson
Published: November 29, 2012

The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical repor to be issued Thursday by federal investigators.
The use of electronic medical records has been central to the aim of overhauling health care in America. Advocates contend that electronic records systems will improve patient care and lower costs through better coordination of medical services, and the Obama administration is spending billions of dollars to encourage doctors and hospitals to switch to electronic records to track patient care.
But the report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.
Medicare “faces obstacles” in overseeing the electronic records incentive program “that leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements,” the investigators concluded. The report was prepared by the Office of Inspector General for the Department of Health and Human Services, which oversees Medicare.

The investigators contrasted the looser management of the incentive program with the agency’s pledge to more closely monitor Medicare payments of medical claims. Medicare officials have indicated that the agency intends to move away from a “pay and chase” model, in which it tried to get back any money it has paid in error, to one in which it focuses on trying to avoid making unjustified payments in the first place.
Late Wednesday, a Medicare spokesman said in a statement: “Protecting taxpayer dollars is our top priority and we have implemented aggressive procedures to hold providers accountable. Making a false claim is a serious offense with serious consequences and we believe the overwhelming majority of doctors and hospitals take seriously their responsibility to honestly report their performance.”

The government’s investment in electronic records was authorized under the broader stimulus package passed in 2009. Medicare expects to spend nearly $7 billion over five years as a way of inducing doctors and hospitals to adopt and use electronic records. So far, the report said, the agency has paid 74, 317 health professionals and 1,333 hospitals. By attesting that they meet the criteria established under the program, a doctor can receive as much as $44,000 for adopting electronic records, while a hospital could be paid as much as $2 million in the first year of its adoption. The inspector general’s report follows earlier concerns among regulators and others over whether doctors and hospitals are using electronic records inappropriately to charge more for services, as reported by The New York Times last September, and is likely to fuel the debate over the government’s efforts to promote electronic records. Critics say the push for electronic records may be resulting in higher Medicare spending with little in the way of improvement in patients’ health. Thursday’s report did not address patient care. 
Even those within the industry say the speed with which systems are being developed and adopted by hospitals and doctors has led to a lack of clarity over how the records should be used and concerns about their overall accuracy. 
“We’ve gone from the horse and buggy to the Model T, and we don’t know the rules of the road. Now we’ve had a big car pileup,” said Lynne Thomas Gordon, the chief executive of the American Health Information Management Association, a trade group in Chicago. The association, which contends more study is needed to determine whether hospitals and doctors actually are abusing electronic records to increase their payments, says it supports more clarity. 
Although there is little disagreement over the potential benefits of electronic records in reducing duplicative tests and avoiding medical errors, critics increasingly argue that the federal government has not devoted enough time or resources to making certain the money it is investing is being well spent.
 
House Republicans echoed these concerns in early October in a letter to Kathleen Sebelius, secretary of health and human services. Citing the Times article, they called for suspending the incentive program until concerns about standardization had been resolved. “The top House policy makers on health care are concerned that H.H.S. is squandering taxpayer dollars by asking little of providers in return for incentive payments,” said a statement issued at the same time by the Republicans, who are likely to seize on the latest inspector general report as further evidence of lax oversight. Republicans have said they will continue to monitor the program.
In her letter in response, which has not been made public, Ms. Sebelius dismissed the idea of suspending the incentive program, arguing that it “would be profoundly unfair to the hospitals and eligible professionals that have invested billions of dollars and devoted countless hours of work to purchase and install systems and educate staff.” She said Medicare was trying to determine whether electronic records had been used in any fraudulent billing but she insisted that the current efforts to certify the systems and address the concerns raised by the Republicans and others were adequate.
The report also takes to task another federal agency that certifies the software systems used to qualify for the Medicare incentive payments, saying it should do more to ensure the systems’ reports are accurate and meet the “meaningful use” criteria. 
Medicare has not audited any of the $3.6 billion payments it has made to date, according to the report, which faults the agency for its lack of prepayment review and reliance on self-reporting after money has been spent. 
In their written response to the report, federal officials said they agreed with some of the inspector general’s recommendations that they clarify what hospitals and doctors need to do to qualify for the payments. But Marilyn Tavenner, the acting administrator for Medicare, strongly disagreed with the idea that the agency should do more to ensure payments are appropriate before writing a check.
Requiring an audit before paying hospitals and doctors “could significantly delay payments to providers,” she said, and these reviews “would also impose an increased upfront burden on providers.” Ms. Tavenner said Medicare took some steps to make sure providers were eligible for the payments but “does not believe prepayment audit is necessary at this juncture.” Medicare maintains that it has systems in place to verify the information being submitted.
Medicare has developed plans to audit payments it has made since the program started in 2011 and says it expects to issue additional guidance for hospitals and doctors.
The other federal agency, the Office of the National Coordinator for Health Information Technology, agreed with the inspector general’s recommendations and said officials were already working to improve the process of certifying systems.
The inspector general said Medicare should be able to review at least some payments before they were made to determine whether the hospitals and doctors actually qualified. The investigators suggest identifying a small number of providers where the information provided was inconsistent and conducting a review or audit.

  

Doctor Doctor Give Me the News

This morning was an editorial from a Doctor and Professor at Yale regarding the rise and use of Electronic Medical Records as a part of the Affordable Care Act aka “Obamacare.”  Part of the funding included the requirement that Hospitals and Physicians use EMT to facilitate transfer of records and in turn reduce costs associated with duplication, misinformation and miscommunication as a presumptive reason for why costs are rising.  Well that may be one thing but as we recently found out that in fact that has enabled by far more duplicity and corruption than led to believe. And of course the Medical profession denies culpability blaming the Government for instituting the change without guidance.  They did that with regards to HIPAA too.  Considering how little regulation and intervention the Medical Industrial Complex has nationally let alone locally, its amusing that the most minimal of change that benefits of all things patients is seen as challenging.  And you thought Cancer was a bitch!

I think that EMT records are the new Titanic frankly. I have the evidence in my own 200 pages of farce that document my recent stay at Horrorview, clearly showing how little communication,  coordination and actual medicine takes place.  What does take place is extrapolation of data and phrases that others use to diagnose or dismiss their actual need to diagnose or do something.  To prove this I gave these records to two different Attorneys who did exactly the same thing. Well to be honest they make Doctors seem benevolent.   And recently I went to a Speech Therapist who chose to read and interpret my records in a non-sensical fashion – neither sequential nor chronological which in my case are the same, but instead she chose to isolate and in turn mis-sequence the order of issues I have faced as the result of my injuries.  Point-proven.

So when others say this matters because it happened to you, my response is yes but if it happened to me its happening to others. I am not that big of a narcissist to think I am that special and exclusive. I am afraid this incompetence and inaccuracy is more the rule than the exception.

Without appropriate guidelines, rules and in turn firewalls to protect one’s personal medical history and records expect further issues and problems to arise.  HIPAA frankly needs strengthening and tightening as it has more holes than the safety nets,  and the Medical matrix needs to be more accountable for their greed, laziness and ineptitude.  And not via the courts and malpractice but by regulation and supervision.  Consistency and mandatory expectations works so why not just do it. And no that doesn’t mean more paperwork or documentation what it means is simply better streamlined care and in turn substantiation of it.  Doctors are quick to criticize and condemn but be different, be brave and instead of acting like a member of dysfunction junction be different and do something. Work with Legislators, the DSHS, Attorney Generals and other groups to find ways to make the process easier for both patients and Doctors.  If you are so smart then prove it.

A Shortcut to Wasted Time

A FEW years ago, we doctors kept handwritten charts about patients. Back then, it sometimes seemed like we spent half our time walking around looking for misplaced charts, and the other half trying to decipher the handwriting when we found them. The upside was that if I did have the chart in front of me, and I saw that someone had taken the trouble to write something down, I believed it. 
Unfortunately, this is no longer the case. The advent of electronic medical records has been a boon to patient safety and physician efficiency in many ways. But it has also brought with it a slew of “timesaving” tricks that have had some unintended consequences. These tricks make it so easy for doctors to document the results of standard exams and conversations with patients that it appears more and more of them are being documented without ever having happened in the first place. 
For instance, doctors used to have to fill out a checklist for every step in a physical exam. Now, they can click one button that automatically places a comprehensive normal physical exam in the record. Another click brings up a normal review of systems — the series of screening questions we ask patients about anything from nasal congestion to constipation. 
Of course, you shouldn’t click those buttons unless you have done the work. And I have many compulsively honest colleagues who wouldn’t dream of doing so. But physicians are not saints.
Hospitals received $1 billion more from Medicare in 2010 than they did in 2005. They say this is largely because electronic medical records have made it easier for doctors to document and be reimbursed for the real work that they do. That’s probably true to an extent. But I bet a lot of doctors have succumbed to the temptation of the click. Medicare thinks so too. This fall, the attorney general and secretary of health and human services warned the five major hospital associations that this kind of abuse would not be tolerated. 
And then there are the evil twins, copy and paste. I’ve seen “patient is on day two of antibiotics” appear for five days in a row on one chart. Worse, I’ve seen my own assessments of a patient’s health appear in another doctor’s notes. A 2009 study found that 90 percent of physicians reported copying and pasting when writing daily notes. 
In short, reading the electronic chart has become a game of looking for a small needle of new information in a haystack of falsely comprehensive documentation and outdated, copied text. Why do we doctors do this to ourselves? Largely, it turns out, for the same reason most people do most things: money. 
Doctors are paid not by how much time they spend with patients, how well they listen or how hard they think about what could be wrong, but by how much they write down. And the rules for what we have to write are Byzantine: Medicare’s explanation takes 87 pages. To receive the highest level of payment for an office visit, I have to document several aspects of the main problem, screening questions about at least 10 organ systems, something about the patient’s family and/or social history, and/or a lengthy physical exam. In addition, I have to demonstrate that my medical decision making was very complicated, considering the number of possible diagnoses and treatments, the complexity of the data and/or the patient’s risk of serious complications. That type of visit is supposed to take about 40 minutes. 
Last week, I spent 40 minutes with a patient who had just placed her mother into hospice care. My patient was distraught, not sleeping, not eating. I gave her some advice, but mostly I just listened. By the end of our visit, she was feeling much better. But I wouldn’t be able to bill much for that visit based on my documentation: I didn’t review her medical or family history, conduct a review of organ systems or perform a physical exam. 
What the payment system tells me to do is to cut her off after 10 minutes, listen to her heart and lungs and give her a sleeping pill. Which doctor visit would you prefer? 
Of course, I would never go back to the bad old days of lost charts, illegible writing, manual prescription refills and forgotten information. Electronic medical records help us avoid dangerous drug interactions and medical ordering errors, remind us to provide preventive care and allow us to view data as trends over time. Even copy and paste have legitimate uses. 
But physicians need to be better stewards of our records so they remain useful, regardless of skewed incentives and new technology. And as a nation, we should question whether paying physicians by documentation — instead of by time spent on quality patient care — is such a great idea after all. 
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