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.”

Health and Care

Those are the two oxymorons dominating the landscape now.  For the first time Americans “got woke” to the reality of our super duper health care.  There never was and certainly is none now. Get it? Got it? Good.

I have railed on health care and medical insurance since 2012 when I was dragged in a coma to Harborview Medical Center in Seattle (I wrote of it of late in Harborzoo) and barely came out alive thanks to the medical malfeasance that is standard for that facility and many others like it in the United States.  I tried to sue them on my own to get well any truths but what I did walk away from is the 50K bill they tried to stiff me with for the pleasure of it.  Suing them stopped it and now the time frame for debt collection has passed so they can take that bill and promptly shove it up their sphincters.

The same with the former Group Health Cooperative (now Kaiser) known as Group Death for its years of mistreating and misdiagnosing people. My favorite was during the AIDS crisis a friend of mine tested POS for AIDS.  At that point he planned for his death and did his bucket list and then in France a friend said to come there it is free and get checked again as he had by then shown no signs and he thought he might be a good case study.  So while there he was tested and found to be NEGATIVE.  He returned to the United Staes and promptly sued them and settled and is very alive today in the nice house the settlement bought him.

These are just two of many many stories of innocent people being abused by the medical system, especially those without defenders (as I a single woman and my friend a Gay man) face any time we walk in. It happened to me again at Vanderbilt over fucking dental work.  An Intern was “concerned” that I came alone to appointments.  What the fuck business is that? A dental appointment and again there is no Anesthesia and nothing affecting my cognition being done so who//how I get there is NONE.OF.YOUR.BUSINESS.  I was going to get that tattooed on my ass at one point as the South seems to have issues with that.

Now with 20 million people lining up for unemployment and exposing the dated neglected systems of  our local//state and federal Government, another irony, that we are the tech center of the world shown that is another fallacy upon a lie wrapped in bullshit maybe now the American people will “get woke” that the whole no taxing bullshit has eroded any safety net, any true Government functioning and in turn we can all thank Voodoo President Reagan and his cohort of fuckwits starting with Grover Norquist for this in the 1980s.

Add to the equation of fuckwittery is that Health Care Insurers have dominated the marketplace and also consolidated and purchased drug distribution middleman, have refused to join the Government marketplace and left even certain states due to their lack of profit generated from enrollment. And they too contribute to the never ending bullshit cycle of adding to the costs of care.

As the health care crisis rages on and donations of food and funds to supply medical equipment and basic necessities to hospital workers continue I refuse to play a part. Why? None.of.my.business. Why? They have been doing this for years, buying medical practices, consolidating them, closing hospitals and not buying needed equipment, training staff or giving one flying fuck about patient care for years.  The AMA has fought single payer and many Doctors themselves have been committing Medicare/Medicaid fraud for decades to line their pockets. Applause you say for front line workers? Fuck you. This is your job you signed up for it and you have done nothing until now to bring this egregious system to the American Idiot’s attention.  Better late than never.  But then again tell that to the dead and dying.

Profit over people, cost over care: America’s broken healthcare exposed by virus
Healthcare at a hospital in Duluth, Minneapolis, take the temperature of every visitor.


There were 27.9 million people without health insurance in 2018, and record-high unemployment will increase that figure by millions

by Amanda Holpuch
Guardian
Thu 16 Apr 2020

With over 21,00 people dead and more than a 547,000 infected with the coronavirus in the US the last question on a person’s mind should be how they will pay for life-saving treatment.

But as the death toll mounted, a patient who was about to be put on a ventilator in one of New York City’s stretched to capacity intensive care units had a final question for his nurse: “Who’s going to pay for it?”

Those were the patient’s final words to his medical team, Derrick Smith, nurse anesthetist at a New York City hospital wrote on Facebook last week: “Next-level heartbreak – having to hear a dying patient use his last words to worry about healthcare finances.”

In the wealthiest country in the world, the Covid-19 pandemic has exposed the core of a healthcare system that is structurally incapable of dealing with the pandemic. Federal and local governments, health insurers and employers have pledged to help Americans pay their way through this crisis, but to do so requires a dramatic overhaul of a system which has for decades prioritized cost over care.

“As this epidemic makes clear, at any moment, any of us could become sick, could become hospitalized, could be on a mechanical ventilator,” said Adam Gaffney, an ICU doctor in Boston. “And that, in the United States, could mean potentially ruinous healthcare costs.”

Gaffney is president of Physicians for a Nationalized Health Plan, a group of more than 20,000 medical professionals who support universal healthcare in the US. PNHP members see first hand the consequences of people being forced to make medical decisions based on cost.

“I’ve heard from patients saying they’ve skipped their inhaler because they couldn’t afford the dose,” Gaffney said. “I’ve heard from patients who’ve gone for years without primary care because they were uninsured and wound up in the ICU.”

There were 27.9 million people without health insurance in 2018 and that figure is projected to increase by millions because of record-high unemployment. In the meantime the US has 600,000-plus confirmed coronavirus cases and more than 27,000 deaths, the true numbers will be far higher.
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The US government and major health insurers said they are covering the costs of Covid-19 testing and treatment, but fear of bankrupting costs and the byzantine complexities of the system leave unanswered questions about whether people will even seek care, let alone escape a potentially crippling medical bill weeks or months later.

How much testing and treatment costs individuals depends on if the patient was insured, how they were insured, and whether they survived. For example, a company that pays for its staff’s health insurance could decide not to cover an employee’s treatment, even if the health insurance company it’s using had said it would waive Covid-19 related payments.

And simply overcoming the American instinct to question how much medical treatment costs is a hurdle in the pandemic.

Since 2006, 30% of Americans each year on average have delayed any sort of medical treatment for cost, according to the polling firm Gallup. In that time, 19% of Americans each year on average have delayed treatment for a serious condition, according to Gallup’s December 2019 report.

More Americans are afraid of paying for healthcare if they became seriously ill (40%) than are afraid of getting seriously ill (33%), according to a 2018 poll by the University of Chicago and the West Health Institute.

“It’s hard to fight an epidemic if people are afraid to go to the doctor, to be seen in the emergency room,” Gaffney said. “It could mean some people not getting tested, it could mean some people delaying getting care and potentially harming their own health.”
Medical clinic closures and job losses in a pandemic

The pandemic crisis is being further exacerbated by the system’s devotion to profits over people. Medical workers are being furloughed and losing jobs because of the pandemic – including those on the frontlines – as their employers seek to cut costs.
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Alteon Health, a private-equity backed company which employs about 1,700 emergency medicine doctors and other physicians, said it would temporarily stop providing benefits including paid time off, according to the health website STAT.

While intensive care units and emergency rooms are billing sky-high figures, there has been a pause on non-essential care that has, in turn, cut medical system profits.

Without high-margin treatments such as physical therapy, cosmetic surgery and orthopedic procedures, medical systems are struggling to pay salaries and cover administrative costs.

The American Academy of Family Physicians projected 60,000 family practices will close or significantly scale back by June and 800,000 of their employees will be laid off, furloughed or have their hours reduced.

And in hospital corridors across the country, staff aren’t just extra mindful of a dry cough and high temperature, but also that their salaries and work equipment are dependent on the bottom line.

Joe Manginn, an ER nurse in Madison, Wisconsin, said: “The bottom line has always been very forefront and this now puts into an extra level of being conscious on our mind to not waste money.”

Manginn and his wife, who is also a healthcare worker, are on alert for their own healthcare costs.

“If we do get sick and need to be hospitalized, it hits us financially with the insurance and those kinds of payments, but it also hits us financially because we’re not able to work any longer,” Manginn said. “It’s a double whammy for the healthcare workers doing this right now.”

His health insurance, which also covers their three children, costs $5,000 a year plus the money they set aside for out-of-pocket costs in a tax-free account.

“We work for the hospital, it should be that we would have the most access to it [healthcare], but unfortunately yeah, that’s not how our country is set up.”

Congress has allocated $100bn to help hospitals. On Friday, the White House said hospitals that accept the funds will not be allowed to use two common billing practices: to bill uninsured patients or bill them for getting care from a doctor who is at the hospital, but not directly employed by it.

Like other parts of the planned government response, questions remain about just how effective that money will be in addressing the convoluted healthcare landscape and if it will arrive in time to save jobs and clinics.

Financial burden on the frontlines, not the insurers

This major disruption to the US healthcare system may leave nurses and doctors jobless, but there are early indications insurance companies could be insulated from the damage.

Not only did health insurance companies enter the crisis with capital, several analysts have anticipated these companies could have lower costs because fewer people are seeking routine medical care.

David Blumenthal, president of the global health thinktank the Commonwealth Fund, said people who have coverage year-round will still be paying premiums, while insurers have fewer procedures to cover.

“We will continue to pay our premiums, because we know that we could get coronavirus and end up in the intensive care unit and have to pay hundreds of thousands of dollars if we don’t have insurance,” Blumenthal said. “So we’re going to keep paying, but we’re not going to the doctor unless we absolutely need to. So that’s all good news for insurance companies.”

At the same time, the 16 million people who have lost their jobs in the past three weeks will put an increased burden on the healthcare system if they join the ranks of the uninsured or those who use Medicaid, government health insurance for low-income people.
A refrigerated truck is seen next to Wyckoff Heights Medical Center in New York City.
A refrigerated truck is seen next to Wyckoff Heights medical center in New York City. Photograph: Pablo Monsalve/Corbis via Getty Images

Blumenthal said there were also knock-on health effects to the economic crisis, such as depression from income loss and malnutrition, which would make people more susceptible to illness.

Benjamin Sommers, professor of health policy and economics at Harvard TH Chan school of public health said there are few signs the pandemic is driving the Trump administration to reflect on the healthcare system.

“We’ll have to see where the public ends up settling on in terms of what it demands from public officials in response to this epidemic,” said Sommers, a practicing primary care physician.

The ICU doctor, Gaffney, said he was certain the way healthcare is financed in the US is exacerbating the overall harm of the epidemic.

“At a time of soaring unemployment and at a time of deepening recession, people are going to be losing coverage and seeing more and more medical bills if they get sick,” Gaffney said. “That doesn’t make any sense.”

Harborzoo

I have nothing not one thing to say good about Harborview Medical Center in Seattle Washington. They are dangerous, deadly and utterly decrepit.  Yes I have personal experience in their malfeseance but long before my near death experience at their hands they had a long history/legacy of being a dump of a hospital; However from that I began to actually look into the medical system and Pro Publica has been long established in this so I am not alone in my disdain regarding medical care.  And hence that is why I am persistent in my complaints about the supposed great American medical system. It is if you are successfully treated  then you think in those terms but until you aren’t you dont and no I was not I survived in spite of Harborview not because of them.   It is during times like these I don’t believe many hospitals are very different and this pandemic has exposed them for what they are – insufficient, incompetent, hard-working, sometimes successful, many times not; Over priced, understaffed, under-trained and utterly unprepared for real disaster.  Call them heroes if you choose but I call them medical professionals just doing their job and for some that is less than enough and for others it is more.  I fear going in one of those facilities more than Corvid. 

Harborview Medical is at the center of coronavirus outbreak. Here’s what you need to know

By Ryan Sabalow

Tacoma News Tribune 

March 03, 2020

The death of the 54-year-old man at Harborview Medical Center, the ninth announced in Washington so far, has put the Seattle hospital in the spotlight. The hospital says that “potentially exposed staff” are being monitored and screened daily for the disease officially called COVID-19.

Harborview has faced critical inspections of its nursing staff and poor ratings for its emergency room. And this is not the first time the hospital has unwittingly exposed its staff to a disease. Last year, more than 150 workers in the Harborview operating room and the lab were tested and offered antibiotics after a lab worker dropped a test tube filled with potentially deadly bacteria in the hospital.

Days before Washington went onto high alarm because of the novel coronavirus, the 54-year-old man was being treated at Harborview. His caregivers at Harborview didn’t know it at the time, but he was positive for the virus. He died on Thursday

“We have determined that some staff may have been exposed while working in an intensive care unit where the patient had been treated,” UW Medicine said in a statement Tuesday. “We don’t believe that other patients were potentially exposed.”

The patient, who had underlying health problems, had recently been at Life Care Center, a nursing home in Kirkland, under quarantine after at least four patients died from the disease. About 50 people from the nursing home’s more than 100 residents and 180 staff are being monitored, public health officials said during the weekend, the Seattle Times reported.

Here’s what else we know about Harborview:

Major trauma center for the region

Harborview is a 433-bed public research hospital managed by the University of Washington School of Medicine. It’s the only Level I adult and pediatric trauma and verified burn center in the state of Washington, and it serves as a regional trauma and burn center for Alaska, Montana and Idaho.

It’s also the disaster preparedness and disaster control hospital for the city of Seattle and for King County. Last month, Harborview began sending out medical teams to make house calls to test people with symptoms of coronavirus. The five-person team — equipped protective gear, including respirators, full-body gowns and latex gloves — is designed to prevent infected people from coming to the emergency room and exposing others.

“Patients given priority for care include the non-English speaking poor; the uninsured or under-insured, victims of domestic violence or sexual assault; people incarcerated in King County’s jails; people with mental illness or substance abuse problems, particularly those treated involuntarily; people with sexually transmitted diseases; and those who require specialized emergency, trauma or burn care,” its website reads.

The Harborview Capital Planning Leadership Group recommended $1.74 billion in improvements to the facility, including a new tower, a behavioral health building and other renovations. The Seattle Times reports the county plans to seek financing through a bond measure as early as November.

How does it compare?

The U.S. Centers for Medicare & Medicaid Services’ Hospital Compare online ranking system, which tracks hospitals based on things like emergency room wait times, infection rates, costs and patient outcomes, gives the hospital an overall ranking of two out of five stars.

The hospital received poor marks for having a particularly overcrowded emergency department. The federal government noted the hospital struggles with emergency room wait times. It also has a high rate of patients leaving the department without being seen by a doctor and for having a “very high” emergency department volume.

Its rate of healthcare workers receiving a influenza vaccine was 81 percent, around 10 points below the Washington and national averages.

The hospital did have infection rates similar to the national benchmarks, and its death rates for common conditions like heart attacks, pneumonia and strokes were no different than the national rates, the federal government reported.

Lab worker exposes staff to bacteria

Last summer, 158 employees of Harborview were monitored and tested for potential exposure to brucella, a bacteria that can cause the infectious disease, brucellosis

The exposure occurred in an operating room and a laboratory at Harborview, after a lab worker dropped a test tube with brucella bacteria in it, KIRO reported. A patient had been transferred from another hospital to Harborview for an urgent operation and later tests revealed that person had brucellosis.

People can get the disease when they’re in contact with infected animals or animal products contaminated with the bacteria. No employees appeared to have contracted the disease; the workers were offered antibiotics as a precaution.

Data breach

Last year, the hospital was among those linked to a University of Washington Medicine data breach that led to the release of the information of more than 1 million patients.

The files were exposed Dec. 4, 2018, because of “an internal human error,” The Seattle Times reported.

UW Medicine said files contained patients’ medical-record numbers, names, a description of the information shared and a description of who received the data. The reports do not include more detailed personal information such as Social Security numbers, the hospital chain said.

State inspection reports

State inspectors have issued critical reports of the hospital a handful of times, state records show. The reports from the Washington State Department of Health show the hospital, among 90 in the state, was noted for two violations on March 5, 2019, and another on Feb. 15, 2019.

The violations from March include failing to document when and how they moved patients in their beds and around the hospital.

This task by the “patient handling team” was supervised by the nursing department, and is considered important because failing to note how they handled patients “created risk for patient harm” and protected staff from injuries while moving patients.

The March inspection also noted that the hospital failed to ensure a patient who had fractured both legs had received daily skin assessments for signs of discoloration and bed sores. “The patient reported severe to moderate pain levels from fractures, especially movement in bed,” the report stated. “Pain levels interfered with routine daily patient care, including required assessment.”

Recent lawsuit

In 2018, The Seattle Times reported a King County jury issued a $25 million judgment for a woman who went to Harborview Medical Center’s Stroke Center for treatment but became paraylzed during her stay.

Doctors in Montana had sent Jerri Woodring-Thueson to Seattle in October 2013 to get care at the stroke center, which UW Medicine calls the region’s first comprehensive stroke center. Her attorneys alleged her symptoms got worse during the stay and she was largely treated by inexperienced interns and residents, the Times reported.

Read more here: https://www.thenewstribune.com/news/local/article240857081.html#storylink=cpy

Dr. Yelp

Here is where we need it the most, the ability to properly place accurate, truthful evaluations of all Service providers including Lawyers and Medical Professionals.  The confusion of YELP and its purpose is frankly a consumer site that is a mishmash of reviews from food, retail stores and other businesses that are rarely validated, often anonymous and can be fraudulent or at least dishonest.  

As Consumers our rights are going out the window as we speak and the endless consolidations of major industries that leave us with fewer choices has enabled large conglomerates to run most businesses and industry – Amazon anyone?  Then we have the confusion surrounding health care insurance, medical providers and other servers in the industry that give little information and assistance to consumers attempting to navigate these deep waters.  When you move to a new community how do you find a Dentist, a Doctor,  a Car Mechanic and so on? There are endless sites and sources and in turn all those do is further confuse and muddy those waters so you take a dive and hope for the best.   As for Facebook I think we know that it is about a trustworthy as  a Russian posing as a Lawyer to give advice or truthful suggestions.  But I did find this on my former Attorney’s Facebook page as I watched his meltdown the last two years it confirmed that he failed me in the same way Harborview Medical Center did.   The irony was that while he knew exactly what happened to me and that I provided him info on PTSD and brain damage from my accident and how Harborview mistreated me, he chose to have them do all the tests which he refers and irony that they found nothing.  Well they are good at that.  I can tell you otherwise the man is damaged beyond belief and that even a Harvard Degree failed to realize that he was fucked up way before Chron’s and that again he was awarded a law degree, practiced for years until his health collapsed.  Gosh stress much?

BRAIN DAMAGE, MENTAL HEALTH AND RETIREMENT FROM LAW
After extensive testing over the past couple of years, doctors have concluded that they can find no brain damage or abnormalities, and that if I did suffer any due to surgery, that I am too high functioning (IQ=165+) to be able to diagnose anyway. Psychiatrically, there is also a consensus that there is nothing wrong EXCEPT severe PTSD stemming from events as a child, exacerbated by the effects of having been homeless, Crohn’s disease and the two major surgeries I underwent for it.
I never realized that I had PTSD (or really even knew what it was) and so never did anything to address it … how would I know, after all, I have a great life. Unfortunately, a friendship caused me to revisit certain events, and face demons long blocked out, for the first time in decades …. that’s when I found out just how powerful and devastating PTSD can be as memories and emotions poured out of nowhere, drowning and crushing my psyche. Not only did it cost me that friend, second only to Kris in how special she is to me, but sent me spiraling in pain and confusion … greater than any I’ve ever faced before. I literally thought that I was going to die. I contemplated suicide, behaved erratically, alienated friends and family …. frantically tried to hang on any way I could … much of the time right here on Facebook … howling at the moon, desperate for anyone to understand … desperate, for the first time in my life, for someone to save ME … and some tried … but how could anyone … only I control my destiny and only I have what is necessary to save me … heart and enduring hope, even in the darkest of nights … and it was that glimmer of hope, even in the blackness, that kept me from ending things many nights …
I’m amazed and grateful that so many tried to help and that so many have remained my friends through all of this … it would have been easy to simply turn away. I’m still dealing with the pain and uncertainty that accompanies PTSD, but for the first time in almost two years, I’m growling back at the darkness … TODAY IS NOT THE DAY THAT I FALL.
I’m sorry to everyone that I let down, I never believed that I could be so fragile, that I could be broken by anything … I thought that I could be Captain America … when, in reality, I was simply a damaged human being … so I failed many of you … but not on purpose, I just got lost and frightened and didn’t know what to do. To my friend, I hope that one day you will understand, that you will forgive me and let me be part of your life again … nothing could ever give me more joy …
As for the law, I left every bit of passion, genius and myself I had to give it in the courtroom … I’ve got nothing left, so my journey continues elsewhere …. I hope that I made a positive impact and acquitted myself well …
And so, that said, another chapter begins … and the unwritten future awaits … NEVER QUIT!

He and the friend whom I believe he is referring (Kevin Trombold) I hired  and they lost both times, the other I sued on my own and lost that as well but at way less the cost.  The reality is that I went in with an acclaimed Lawyer whose mental health and physical health was corrupted and in turn he should have passed me onto to someone who could have helped me, funny Harborview could have done the same.  But you see the Medical and Legal professions are joined at the hip and this demonstrates how they rely on each other to keep each other always one step ahead and always put the patient or client at a loss. 

Doctors, hospitals sue patients who post negative comments, reviews on social media

Jayne O’Donnell and Ken Alltucker, USA TODAY |July 18, 2018 |

Surgeon says a former patient posted hundreds of negative reviews about him for a span of 10 years.

CLEVELAND – Retired Air Force colonel David Antoon agreed to pay $100 to settle what were once felony charges for emailing his former Cleveland Clinic surgeon articles the doctor found threatening and posting a list on Yelp of all the surgeries the urologist had scheduled at the same time as the one that left Antoon incontinent and impotent a decade ago.

He faced up to a year in prison.

Antoon’s 10-year crusade against the Cleveland Clinic and his urologist is unusual for its length and intensity, as is the extent to which Cleveland Clinic urologist Jihad Kaouk was able to convince police and prosecutors to advocate on his behalf.

Antoon’s plea deal last week comes as others in medical community aggressively combat negative social media posts, casting a pall over one of the few ways prospective patients can get unvarnished opinions of doctors.

Among recent cases:

• Cleveland physician Bahman Guyuron is suing a former patient for defamation for posting negative reviews on Yelp and other sites about her nose job. Guyuron’s attorney Steve Friedman notes that while the First Amendment protects patients’ rights to post their opinions, “our position is she did far beyond that (and) deliberately made false factual statements.” A settlement mediation is slated for early August and a trial is set for late August if no agreement is reached.

• Jazz singer Sherry Petta used her own website and doctor-rating sites to criticize a Scottsdale, Ariz., medical practice over her nasal tip surgery, laser treatment and other procedures. Her doctors, Albert Carlotti and Michelle Cabret-Carlotti, successfully sued for defamation. They won a $12 million jury award that was later vacated on appeal. Petta claimed the court judgment forced her to sell a house and file bankruptcy. The parties would not discuss the case and jointly asked for it to be dismissed in 2016, but declined to explain why.

• A Michigan hospital sued an elderly patient’s two daughters and a granddaughter recently over a Facebook post and for picketing in front of the hospital they said mistreated the late Eleanor Pound. The operator of Kalkaska Memorial Health Center sued Aliza Morse, Carol Pound and Diane Pound for defamation, tortious interference and invasion of privacy.

Petta’s attorney, Ryan Lorenz, says consumers need to know there can be consequences if they post factually incorrect information. Lorenz, who has represented both consumers and businesses on cases involving online comments, added that consumers are allowed to offer opinions that do not address factual points.

Cleveland Clinic doctor Jihad Kaouk takes the stand during a hearing in the Cuyahoga County Justice Center Friday, November 17th, 2017, in Cleveland, Ohio. (Photo: Tim Harrison, for USA TODAY)

“Make sure what you are saying is true – it has to be truthful,” he says.

“It would be great if the regulators of hospitals and doctors were more diligent about responding to harm to patients but they’re not, so people have turned to other people,” says Lisa McGiffert, former head of Consumer Reports’ Safe Patient Project. “This is what happens when your system of oversight is failing patients.”

As doctors and hospitals throw their considerable resources behind legal fights, some patients face huge legal bills for posting them and other consumers face their own challenges trying to get a straight story.

Experts say that doctors take on extra risk when they resort to suing a patient.

Doctors typically can’t successfully sue third-party websites such as Yelp that allow consumer comments, but they can sue patients over reviews.

Even so, “you can win (a case) and still not win,” said Eric Goldman, a professor at Santa Clara University’s law school.

Goldman, who has tracked about two dozen cases of doctors suing patients over online reviews, says physicians rarely win the cases, and in some cases, must pay the patients’ legal fees.

Physician-patient confidentiality rules complicate options for doctors, Goldman says, but they can respond to factually incorrect reviews if the patient agrees to waive confidentiality and publicly discuss the case.

The comments being challenged legally are typically those that were left online. Many medical review sites will remove posts they deem offensive or threatening to doctors, as many of Antoon or other Kaouk patients were. Yelp only removes reviews that violate the consumer website’s terms of service.

Patients should also first bring up complaints directly to the doctor or other medical provider, says Edward Hopkins, an attorney who represented Carlotti, Cabret-Carlotti and their medical practice for part of the case. Other options could include reporting a doctor to state oversight agencies, consulting with an attorney or filing complaints with a state attorneys’ general office.
Advocacy or obsession?

By the time he was arrested last December, Antoon had tried most every option with very little success.

Along the way, Antoon became a patient advocate – volunteering with Consumer Reports’ Safe Patient Project and HealthWatch USA – and advising others who say they were harmed by Kaouk and the Cleveland Clinic.

Kaouk and the Cleveland Clinic. known as one of the top-rated hospitals in the country and for having an aggressive legal department, prevailed in malpractice and fraud cases filed by Antoon and other patients who claimed they were harmed.

Matthew Donnelly, Cleveland Clinic’s deputy chief legal officer, attended Antoon’s November criminal hearing.

Linda Antoon, front left, and David Antoon talks with each other while waiting for Antoon’s hearing to start in a Cuyahoga County Justice Center courtroom Friday, November 17th, 2017, in Cleveland, Ohio. Seated behind them, from left are Dennis Wade, Ann and John Perrotti and Dan Gagliano. All three men were operated on by Dr. Kaouk. (Photo: Tim Harrison, for USA TODAY)

To Kaouk, a decade of negative reviews on social media led to what he considered an escalation when Antoon sent him several emails, including one with a link to an article about a Chinese crackdown on research fraud that could include the death penalty if people were injured or killed.

The day before Antoon posted on Yelp in November, Kaouk was granted a civil stalking protective order against Antoon, which barred him from contacting the doctor.

“What would be next – showing up at my door?” Kaouk said in court. “That’s what we feared.”

In his posts and emails, Antoon documented alleged issues including Kaouk and the urology department’s lack of credentialing and privileging to use the robotic device in his surgery. He also sent records to the Centers for Medicare and Medicaid Services (CMS) claiming they showed Kaouk was not present in the operating room during his surgery despite his insistence that only Kaouk could perform the surgery.

The Ohio Medical Board closed its investigation into Kaouk after five years without reprimanding him in any way. Antoon’s complaints to CMS temporarily put the hospital’s $1 billion annual Medicare reimbursement at risk.

Still, Antoon’s claims were rejected and Kaouk was held not liable for the surgical outcome left Antoon impotent and incontinent.

Along with more than $40,000 defending himself against the criminal charges, Antoon spent much of two days in jail. The second time was with young men accused of violent crimes whose bonds were far lower than the $50,000 bond he had to post in nearby Shaker Heights and again in Cleveland’s Cuyahoga County after the case was transferred there.

“It is rare, but what isn’t rare is for someone in a position of wealth, power and money go after someone like David to silence critics,” said Antoon’s attorney, Don Malarcik. “That happens often and it happened here.”

Hospitals including the Cleveland Clinic are combating negative comments with their own rating systems, which let them “control their message,” says McGiffert.

Some comments posted by Antoon and another patient who claimed he was injured patient, Dan Galliano, disappeared from the websites RateMDs and Vitals, as shown in screenshots Antoon took right after they were posted.

Cleveland Clinic spokeswoman Eileen Sheil said it posts all the government-required satisfaction survey responses patients fill out about doctors on its ratings site, once at least 30 are received. Comments aren’t edited.

Sheil says Cleveland Clinic will request comments to be removed from other sites when they violate the sites’ terms of service.

RateMDs did not respond to requests for comment. Vitals spokeswoman Rosie Mattio says the site has a care team that will investigate reviews it is contacted about.

“While we will not pull down a necessarily negative review, we will remove the review if we find that it violates our terms and includes material that is threatening, racist or vulgar,” said Mattio.
Navigating Yelp

On Yelp, business owners can also flag a review to be removed for violation of the Yelp’s terms of services. Yelp reviews flagged comments and removes those that include hate speech, a conflict of interest or are not based on a commenter’s first-hand experience.

The website, however, doesn’t intervene over factual disputes, says Yelp spokeswoman Hannah Cheesman. Instead, it classifies consumer reviews as “recommended” or “not currently recommended” based on an automated software review.

If Yelp’s software detects multiple reviews from the same IP address or biased reviews from a competitor or disgruntled employee, it puts the comment in the not-recommended category. Consumers can still view such reviews by clicking on another page, but those comments are not factors in Yelp’s five-star rating system.

McGiffert has long advocated for a federal database where people could report medical errors and infections. Unless that happens, online review sites – including hospitals’ own and ones that will remove some reviews doctors object to – are among the only places patients can find physician reviews.

Still, doctors including Kaouk suggest they are the ones who are disadvantaged.

“It is something that if anybody would look just by Googling my name online you would see what he has written about me,” Kaouk said of Antoon.

Care Not Cash

Having been in the middle of massive dental reconstruction and dealing with the frustration about diet, eating and the side affects of depression and anxiety tied to the process and living in Nashville while all of this has been going on takes a toll on the mind and body.   I finally started to see the light at the end of the tunnel and as it is finishing up I am looking forward to eating what I want and planning to leave at the end of the year long observation period that I agreed to so my Dentist can see what having ostensibly a reconstructive dental process that she has never done before – Zygomatic implants, full dental arch on the uppers and dental bridge made of zirconium.   I certainly respect that and as a result of the time and costs involved, I  have decided to pass on doing the lower teeth until the time comes I have to.   Prematurely and “preventive” removing teeth (which again the Dentist in Seattle had recommended they have not said such in Nashville) to do the same on the lower is something I simply have decided to not do; Instead, I will keep up a rigorous maintenance plan, have my lower teeth cleaned every three months (the uppers need nothing, zirconium is impervious to bacteria) while I am here and if something changes that this plan needs to be amended then I will but otherwise I am out.

When the process began I recall having to justify and explain repeatedly that at age 16 after my braces came off my teeth were fully lose and I had juvenile peritonitis a disease common to older people who had little dental care, odd given I was under the care of an Orthodontist.  The reality is shit happens.  Was he a bad Ortho? I have no idea but I had serious dental issues that braces would not have fully resolved and in turn lousy with realizing what was happening during the process.  Would it have changed the outcome? This is impossible to know but the dental care that followed over the next 40 years was outstanding and all paid for out of pocket as Dental insurance in this country is another neglected and overlooked issue. 

Since that time I have been religious about dental maintenance and care until finally at age 50 the teeth finally gave out and I began the implant process.  The reality is that they failed and in turn I felt that I needed to stop it before it became overly expensive, time consuming and utterly which I now know a failure.  (Dental bone grafting and extensive implants 6 versus 4 would have failed and I have spoken to someone who did this process at the cost of 45K and it failed only to end up with the same process I have since undergone. Sorry but one car in my mouth is plenty and imagine going through all that twice.)

My run in with Vanderbilt aside I am happy that this has worked out and cannot wait to see the finished product.  But I can afford this and other than this I have been lucky to have had few other health problems.  But the most telling about the reality of what it is like to deal with the medical system was when I had my car accident in 2012 and that truly for me marked what it is like to be utterly dependent upon western medical treatment by what comprises the medical industrial complex in America.   The thought of willingly or even unwillingly being taken to a hospital today fills me with terror that cannot be explained.   The system is set up as a tool to judge, to segregate and in turn put you in debt for life for ostensibly getting sick.   And this by people doing what they signed up to do but during that process they overtly or indirectly decide that only some deserve care and some do not.   It is loaded with bias and unscrupulous individuals who, yes wear white coats, and who see you as the bottom line in which to experiment and mistreat for both professional and financial reasons.  America, your medical system sucks.

So every day we hear coffee is bad for you, good for you.  Wine is good for you bad for you. Fats are good for you bad for you and so on.  What.the.fuck. ever.  But you are treated by Physicians and others dependent upon what you tell them and what they decide and believe about you.  They are sure it is some intrinsic failure and your duplicity that contributed to this failure of your body.  Again I have the crazy medical records of Harborview that are full of misdiagnosis and my favorite comment by a physical therapist:  “Patient shows all signs of traumatic brain injury but given what she was admitted for that cannot be why she is showing said symptoms”  Let’s see I was brought in a coma with a 4 mm blood clot in my brain due to hitting my skull against the steering wheel that led to the  totality of a car with a blood alcohol count of .18 and testing positive for benzodiazephines in my system.  Two things that could have killed me on my own had I WILLINGLY taken them and jumped behind the wheel of a car. But that blood clot, coma = head injury. But for reasons unknown Harborview Medical Center diagnosed me as a crazy drunk who happened to have a head injury.  Okay then.   But well then again #METOO did not exist in 2012.

Harborview Medical Center also included in their diagnosis one for Lyme Disease for reasons unclear as there is no record of any tests done to confirm or rule out said diagnosis.  In 2000 I had Bells Palsy and again when I consulted a Neurologist after being affected by this (and supposedly Angelina Joile is one of its more famous victims) said that it was a bacterial infection.  And we suspected  that was due  to my dental issues, as  again just the year before  I had all my metal fillings removed; hence this  opened me up for infection and at the time I had Herpes Simplex two as evidence by a series of cold blisters on my face.  Again even that diagnosis is often confused with the vaginal kind and that too has been an issue of conflict.   But as the idea of Lyme Disease is absurd as the thought of me wandering the woods and having a tick bite is laughable as my idea of camping is a hotel without room service.

As a woman I am treated in one manner.  As one not wealthy that is another. Having no husband/partner/child  is another reason as I have no advocate.  If you are a person of color add another dimension to treatment and in turn how you offered care.  There are cases after cases of individuals having the Police called to hospitals to arrest patients and in turn take children when the staff are sure of some incident or another.  I still point to the case of Henrietta Lacks as the most egregious of care in the history of medicine.

Then we can also point out to the current President and the bizarre diagnosis of the soon to be Chief of Veteran’ Affairs who said this post physical of the fat fuck whose dietary habits and lifestyle alone would make anyone go WHAT THE FLYING FUCK?  BITCH PLEASE!!

Rear Adm. Ronny Jackson was so effusive in extolling the totally amazing, surpassingly marvelous, superbly stupendous and extremely awesome health of the president that the doctor sounded almost Trumpian. “The president’s overall health is excellent,” he said, repeating “excellent” eight times: “Hands down, there’s no question that he is in the excellent range. . . . I put out in the statement that the president’s health is excellent, because his overall health is excellent. . . . Overall, he has very, very good health. Excellent health.”

Basically it goes to know who you know and what they are willing to be paid. Period. 

This essay by perhaps the best chronicler of what is like to be the working  poor in America does a fantastic job of comparing how the rich are often treated and in turn equally dismissed as they are sure being rich will somehow compensate for their failures in health.  Good to know.

Why are the poor blamed and shamed for their deaths?

When someone dies, she often suffers a brutal moral autopsy, says Barbara Ehrenreich. Did she smoke? Drink excessively? Eat too much fat?

Barbara Ehrenreich
Guardian UK
Sat 31 Mar 2018

I watched in dismay as most of my educated, middle-class friends began, at the onset of middle age, to obsess about their health and likely longevity. Even those who were at one point determined to change the world refocused on changing their bodies. They undertook exercise or yoga regimens; they filled their calendars with medical tests and exams; they boasted about their “good” and “bad” cholesterol counts, their heart rates and blood pressure.

Mostly they understood the task of ageing to be self-denial, especially in the realm of diet, where one medical fad, one study or another, condemned fat and meat, carbs, gluten, dairy or all animal-derived products. In the health-conscious mindset that has prevailed among the world’s affluent people for about four decades now, health is indistinguishable from virtue, tasty foods are “sinfully delicious”, while healthful foods may taste good enough to be advertised as “guilt-free”. Those seeking to compensate for a lapse undertake punitive measures such as hours-long cardio sessions, fasts, purges or diets composed of different juices carefully sequenced throughout the day.

Of course I want to be healthy, too; I just don’t want to make the pursuit of health into a major life project. I eat well, meaning I choose foods that taste good and will stave off hunger for as long as possible, such as protein, fibre and fats. But I refuse to overthink the potential hazards of blue cheese on my salad or pepperoni on my pizza. I also exercise – not because it will make me live longer but because it feels good when I do. As for medical care, I will seek help for an urgent problem, but I am no longer interested in undergoing tests to uncover problems that remain undetectable to me. When friends berate me for my laxity, my heavy use of butter or habit of puffing (but not inhaling) on cigarettes, I gently remind them that I am, in most cases, older than they are.

So it was with a measure of schadenfreude that I began to record the cases of individuals whose healthy lifestyles failed to produce lasting health. It turns out that many of the people who got caught up in the health “craze” of the last few decades – people who exercised, watched what they ate, abstained from smoking and heavy drinking – have nevertheless died. Lucille Roberts, owner of a chain of women’s gyms, died incongruously from lung cancer at the age of 59, although she was a “self-described exercise nut” who, the New York Times reported, “wouldn’t touch a French fry, much less smoke a cigarette”. Jerry Rubin, who devoted his later years to trying every supposedly health-promoting diet fad, therapy and meditation system he could find, jaywalked into Wilshire Boulevard at the age of 56 and died of his injuries two weeks later.

Some of these deaths were genuinely shocking. Jim Fixx, author of the bestselling The Complete Book Of Running, believed he could outwit the cardiac problems that had carried his father off to an early death by running at least 10 miles a day and restricting himself to a diet of pasta, salads and fruit. But he was found dead on the side of a Vermont road in 1984, aged only 52.

Even more disturbing was the untimely demise of John H Knowles, director of the Rockefeller Foundation and promulgator of the “doctrine of personal responsibility” for one’s health. Most illnesses are self-inflicted, he argued – the result of “gluttony, alcoholic intemperance, reckless driving, sexual frenzy, smoking” and other bad choices. The “idea of a ‘right’ to health,” he wrote, “should be replaced by the idea of an individual moral obligation to preserve one’s own health.” But he died of pancreatic cancer at 52, prompting one physician commentator to observe, “Clearly we can’t all be held responsible for our health.”

Still, we persist in subjecting anyone who dies at a seemingly untimely age to a kind of bio-moral autopsy: did she smoke? Drink excessively? Eat too much fat and not enough fibre? Can she, in other words, be blamed for her own death? When David Bowie and Alan Rickman both died in early 2016 of what major US newspapers described only as “cancer”, some readers complained that it is the responsibility of obituaries to reveal what kind of cancer. Ostensibly, this information would help promote “awareness” of the particular cancers involved, as Betty Ford’s openness about her breast cancer diagnosis helped to destigmatise that disease. It would also, of course, prompt judgments about the victim’s “lifestyle”. Would Bowie have died – at the quite respectable age of 69 – if he hadn’t been a smoker?

With sufficient ingenuity – or malicious intent – almost any death can be blamed on some mistake of the deceased

Apple co-founder Steve Jobs’ 2011 death from pancreatic cancer continues to spark debate. He was a food faddist, eating only raw vegan foods, especially fruit, and refusing to deviate from that plan even when doctors recommended a high protein and fat diet to help compensate for his failing pancreas. His office refrigerator was filled with Odwalla juices; he antagonised non-vegan associates by attempting to proselytise among them, as biographer Walter Isaacson has reported: at a meal with Mitch Kapor, the chairman of Lotus software, Jobs was horrified to see Kapor slathering butter on his bread, and asked, “Have you ever heard of serum cholesterol?” Kapor responded, “I’ll make you a deal. You stay away from commenting on my dietary habits, and I will stay away from the subject of your personality.”

Defenders of veganism argue that his cancer could be attributed to his occasional forays into protein-eating (a meal of eel sushi has been reported) or to exposure to toxic metals as a young man tinkering with computers. But a case could be made that it was the fruitarian diet that killed him: metabolically, a diet of fruit is equivalent to a diet of candy, only with fructose instead of glucose, with the effect that the pancreas is strained to constantly produce more insulin. As for the personality issues – the almost manic-depressive mood swings – they could be traced to frequent bouts of hypoglycemia. Incidentally, 67-year-old Mitch Kapor is alive and well at the time of this writing.

Similarly, with sufficient ingenuity – or malicious intent – almost any death can be blamed on some mistake of the deceased. Surely Fixx had failed to “listen to his body” when he first felt chest pains and tightness while running, and maybe, if he had been less self-absorbed, Rubin would have looked both ways before crossing the street. Maybe it’s just the way the human mind works, but when bad things happen or someone dies, we seek an explanation, preferably one that features a conscious agent – a deity or spirit, an evil-doer or envious acquaintance, even the victim. We don’t read detective novels to find out that the universe is meaningless, but that, with sufficient information, it all makes sense. We can, or think we can, understand the causes of disease in cellular and chemical terms, so we should be able to avoid it by following the rules laid down by medical science: avoiding tobacco, exercising, undergoing routine medical screening and eating only foods currently considered healthy. Anyone who fails to do so is inviting an early death. Or, to put it another way, every death can now be understood as suicide.

Liberal commentators countered that this view represented a kind of “victim-blaming”. In her books Illness As Metaphor and Aids And Its Metaphors, Susan Sontag argued against the oppressive moralising of disease, which was increasingly portrayed as an individual problem. The lesson, she said, was, “Watch your appetites. Take care of yourself. Don’t let yourself go.” Even breast cancer, she noted, which has no clear lifestyle correlates, could be blamed on a “cancer personality”, sometimes defined in terms of repressed anger which, presumably, one could have sought therapy to cure. Little was said, even by the major breast cancer advocacy groups, about possible environmental carcinogens or carcinogenic medical regimes such as hormone replacement therapy.

While the affluent struggled dutifully to conform to the latest prescriptions for healthy living – adding whole grains and gym time to their daily plans – the less affluent remained mired in the old comfortable, unhealthy ways of the past – smoking cigarettes and eating foods they found tasty and affordable. There are some obvious reasons why the poor and the working class resisted the health craze: gym memberships can be expensive; “health foods” usually cost more than “junk food”. But as the classes diverged, the new stereotype of the lower classes as wilfully unhealthy quickly fused with their old stereotype as semi-literate louts. I confront this in my work as an advocate for a higher minimum wage. Affluent audiences may cluck sympathetically over the miserably low wages offered to blue-collar workers, but they often want to know “why these people don’t take better care of themselves”. Why do they smoke or eat fast food? Concern for the poor usually comes tinged with pity. And contempt.

In the 00s, British celebrity chef Jamie Oliver took it on himself to reform the eating habits of the masses, starting with school lunches. Pizza and burgers were replaced with menu items one might expect to find in a restaurant – fresh greens, for example, and roast chicken. But the experiment was a failure. In the US and UK, schoolchildren dumped out their healthy new lunches or stamped them underfoot. Mothers passed burgers to their children through school fences. Administrators complained that the new meals were vastly over-budget; nutritionists noted that they were cruelly deficient in calories. In Oliver’s defence, it should be observed that ordinary “junk food” is chemically engineered to provide an addictive combination of salt, sugar and fat. But it probably matters, too, that he didn’t study local eating habits in sufficient depth before challenging them, nor seems to have given enough thought to creatively modifying them. In West Virginia, he alienated parents by bringing a local mother to tears when he publicly announced the food she gave her four children was “killing” them.

There may well be unfortunate consequences from eating the wrong foods. But what are the “wrong” foods? In the 80s and 90s, the educated classes turned against fat in all forms, advocating the low-fat and protein diet that, journalist Gary Taubes argues, paved the way for an “epidemic of obesity” as health-seekers switched from cheese cubes to low-fat desserts. The evidence linking dietary fat to poor health had always been shaky, but class prejudice prevailed: fatty and greasy foods were for the poor and unenlightened; their betters stuck to bone-dry biscotti and fat-free milk. Other nutrients went in and out of style as medical opinion shifted: it turns out high dietary cholesterol, as in oysters, is not a problem after all, and doctors have stopped pushing calcium on women over 40. Increasingly, the main villains appear to be sugar and refined carbohydrates, as in hamburger buns. Eat a pile of fries washed down with a sugary drink and you will probably be hungry again in a couple of hours, when the sugar rush subsides. If the only cure for that is more of the same, your blood sugar levels may permanently rise – what we call diabetes.

Special opprobrium is attached to fast food, thought to be the food of the ignorant. Film-maker Morgan Spurlock spent a month eating nothing but McDonald’s to create his famous Super Size Me, documenting his 11kg (24lb) weight gain and soaring blood cholesterol. I have also spent many weeks eating fast food because it’s cheap and filling but, in my case, to no perceptible ill effects. It should be pointed out, though, that I ate selectively, skipping the fries and sugary drinks to double down on the protein. When, at a later point, a notable food writer called to interview me on the subject of fast food, I started by mentioning my favourites (Wendy’s and Popeyes), but it turned out they were all indistinguishable to him. He wanted a comment on the general category, which was like asking me what I thought about restaurants.

I grew up in the 1940s and 50s, when cigarettes served not only as a comfort for the lonely but a powerful social glue

If food choices defined the class gap, smoking provided a firewall between the classes. To be a smoker in almost any modern, industrialised country is to be a pariah and, most likely, a sneak. I grew up in another world, in the 1940s and 50s, when cigarettes served not only as a comfort for the lonely but a powerful social glue. People offered each other cigarettes, and lights, indoors and out, in bars, restaurants, workplaces and living rooms, to the point where tobacco smoke became, for better or worse, the scent of home. My parents smoked; one of my grandfathers could roll a cigarette with one hand; my aunt, who was eventually to die of lung cancer, taught me how to smoke when I was a teenager. And the government seemed to approve. It wasn’t till 1975 that the armed forces stopped including cigarettes along with food rations.

As more affluent people gave up the habit, the war on smoking – which was always presented as an entirely benevolent effort – began to look like a war against the working class. When the break rooms offered by employers banned smoking, workers were forced outdoors, leaning against walls to shelter their cigarettes from the wind. When working-class bars went non-smoking, their clienteles dispersed to drink and smoke in private, leaving few indoor sites for gatherings and conversations. Escalating cigarette taxes hurt the poor and the working class hardest. The way out is to buy single cigarettes on the streets, but strangely enough the sale of these “loosies” is largely illegal. In 2014 a Staten Island man, Eric Garner, was killed in a chokehold by city police for precisely this crime.

Why do people smoke? I once worked in a restaurant in the era when smoking was still permitted in break rooms, and many workers left their cigarettes burning in the common ashtray so they could catch a puff whenever they had a chance to, without bothering to relight. Everything else they did was done for the boss or the customers; smoking was the only thing they did for themselves. In one of the few studies of why people smoke, a British sociologist found smoking among working-class women was associated with greater responsibilities for the care of family members – again suggesting a kind of defiant self-nurturance.

When the notion of “stress” was crafted in the mid-20th century, the emphasis was on the health of executives, whose anxieties presumably outweighed those of the manual labourer who had no major decisions to make. It turns out, however, that stress – measured by blood levels of the stress hormone cortisol – increases as you move down the socioeconomic scale, with the most stress inflicted on those who have the least control over their work. In the restaurant industry, stress is concentrated among the people responding to the minute-by-minute demands of customers, not those who sit in offices discussing future menus. Add to these workplace stresses the challenges imposed by poverty and you get a combination that is highly resistant to, for example, anti-smoking propaganda – as Linda Tirado reported about her life as a low-wage worker with two jobs and two children: “I smoke. It’s expensive. It’s also the best option. You see, I am always, always exhausted. It’s a stimulant. When I am too tired to walk one more step, I can smoke and go for another hour. When I am enraged and beaten down and incapable of accomplishing one more thing, I can smoke and I feel a little better, just for a minute. It is the only relaxation I am allowed.”

Nothing has happened to ease the pressures on low-wage workers. On the contrary, if the old paradigm of a blue-collar job was 40 hours a week, an annual two-week vacation and benefits such as a pension and health insurance, the new expectation is that one will work on demand, as needed, without benefits or guarantees. Some surveys now find a majority of US retail staff working without regular schedules – on call for when an employer wants them to come and unable to predict how much they will earn. With the rise in “just in time” scheduling, it becomes impossible to plan ahead: will you have enough money to pay the rent? Who will take care of the children? The consequences of employee “flexibility” can be just as damaging as a programme of random electric shocks applied to caged laboratory animals.

Sometime in the early to mid-00s, demographers noticed an unexpected rise in the death rates of poor white Americans. This was not supposed to happen. For almost a century, the comforting American narrative was that better nutrition and medical care would guarantee longer lives for all. It was especially not supposed to happen to whites who, in relation to people of colour, have long had the advantage of higher earnings, better access to healthcare, safer neighbourhoods and freedom from the daily insults and harms inflicted on the darker skinned. But the gap between the life expectancies of blacks and whites has been narrowing. The first response of some researchers – themselves likely to be well above the poverty level – was to blame the victims: didn’t the poor have worse health habits? Didn’t they smoke?

The class gap in mortality will not be closed by tweaking individual tastes

In late 2015, the British economist Angus Deaton won the Nobel prize for work he had done with Anne Case, showing that the mortality gap between wealthy white men and poor ones was widening at a rate of one year a year, and slightly less for women. Smoking could account for only one fifth to one third of the excess working-class deaths. The rest were apparently attributable to alcoholism, opioid addiction and actual suicide – as opposed to metaphorically “killing” oneself through unwise lifestyle choices.

Why the excess mortality among poor white Americans? In the last few decades, things have not been going well for working-class people of any colour. I grew up in an America where a man with a strong back – and a strong union – could reasonably expect to support a family on his own without a college degree. By 2015, those jobs were long gone, leaving only the kind of work once relegated to women and people of colour available in areas such as retail, landscaping and delivery truck driving. This means those in the bottom 20% of the white income distribution face material circumstances like those long familiar to poor blacks, including erratic employment and crowded, hazardous living spaces. Poor whites always had the comfort of knowing that someone was worse off and more despised than they were; racial subjugation was the ground under their feet, the rock they stood upon, even when their own situation was deteriorating. That slender reassurance is shrinking.

There are some practical reasons why whites are likely to be more efficient than blacks at killing themselves. For one thing, they are more likely to be gun owners, and white men favour gunshot as a means of suicide. For another, doctors, undoubtedly acting on stereotypes of non-whites as drug addicts, are more likely to prescribe powerful opioid painkillers to whites. Pain is endemic among the blue-collar working class, from waitresses to construction workers, and few people make it past 50 without palpable damage to their knees, back or shoulders. As opioids became more expensive and closely regulated, users often made the switch to heroin which, being illegal, can vary widely in strength, leading to accidental overdoses.

Affluent reformers are perpetually frustrated by the unhealthy habits of the poor, but it is hard to see how problems arising from poverty – and damaging work conditions – could be cured by imposing the doctrine of “personal responsibility”. I have no objections to efforts encouraging people to stop smoking or add more vegetables to their diets. But the class gap in mortality will not be closed by tweaking individual tastes. This is an effort that requires concerted action on a vast scale: a welfare state to alleviate poverty; environmental clean-up of, for example, lead in drinking water; access to medical care including mental health services; occupational health reform to reduce disabilities inflicted by work.

The wealthier classes will also benefit from these measures, but what they need right now is a little humility. We will all die – whether we slake our thirst with kombucha or Coca-Cola, whether we run five miles a day or remain confined to our trailer homes, whether we dine on quinoa or KFC. This is the human condition. It’s time we began facing it together.

Waste Not, Want Not

A phrase used as a way to advise someone not to waste anything, because they might need it in the future and that applies in the case of medical care.

The exploitation and opportunity wasted regarding how deeply flawed our medical system is not wasted.   Over the last few days CBS investigated a group buying up failing rural hospitals and in turn billing tests to outside labs which they also owned or had investment interest in and were receiving reimbursements at over 100% payback on claims.  Gosh think you get refused or have a significant deductible before you can get covered, these guys had it down.

Then we have the Surgeons and others pushing on patients unnecessary tests and treatments under the idea that it was to prevent them from malpractice litigation.  Meanwhile filing and actually doing a medical malpractice suit across the country has become literally impossible so that is another one we can call BS on.  The reality is that in the pay for play deals that are often established and in turn hospital for profit management demands this as a means to generate funds.  As who wants to be a failing hospital?

This comes from ProPublica one of the few sites of investigative journalism left in the U.S. and they dedicate a reporter to the medical industrial complex to cover how we are paying more for medical care and getting less results than any other industrialized nation.  

This study comes from my former home state and I sued a Hospital and their Physicians on my own with regards to neglect of care and abuse.  The University of Washington and their role at Harborview Medical Center in Seattle is a dump, largely funded by being the number one Trauma Center for several states and in turn the city requiring everyone to go to one place in which to be exploited and dumped if poor.  They are a shithole with a history of shit.  

It is also the home of Swedish Medical Centers that had a neurosurgeon that was so dangerous the staff demanded action and asked the largely ineffectual Medical Board of the State to rescind his license to practice.  Seattle is great if you don’t get sick.

Unnecessary Medical Care Is More Common Than You Think

A study in Washington state found that in a single year more than 600,000 patients underwent treatment they didn’t need, at an estimated cost of $282 million. “Do no harm” should include the cost of care, too, the report author says.

by Marshall Allen Feb. 1,2018
ProPublica
Wasted Medicine
Squandered Health Care Dollars

This story was co-published with NPR’s Shots blog.

It’s one of the intractable financial boondoggles of the U.S. health care system: Lots and lots of patients get lots and lots of tests and procedures that they don’t need.

Women still get annual cervical cancer testing even when it’s recommended every three to five years for most women. Healthy patients are subjected to slates of unnecessary lab work before elective procedures. Doctors routinely order annual electrocardiograms and other heart tests for people who don’t need them.

That all adds up to a substantial expense that helps drive up the cost of care for all of us. Just how much, though, is seldom tallied. So, the Washington Health Alliance, a nonprofit dedicated to making care safer and more affordable, decided to find out.

The group scoured the insurance claims from 1.3 million patients in Washington state who received one of 47 tests or services that medical experts have flagged as overused or unnecessary. What they found should cause both doctors and their patients to rethink that next referral. In a single year:

More than 600,000 patients underwent a treatment they didn’t need, treatments that collectively cost an estimated $282 million.

More than a third of the money spent on the 47 tests or services went to unnecessary care.

Three of four annual cervical cancer screenings were performed on women who had adequate prior screenings — at a cost of $19 million.

About 85 percent of the lab tests to prep healthy patients for low-risk surgery were unnecessary — squandering about $86 million.

Needless annual heart tests on low-risk patients consumed $40 million.

Susie Dade, deputy director of the alliance and primary author of the report released Thursday, said almost half the care examined was wasteful. Much of it comprised the sort of low-cost, ubiquitous tests and treatments that don’t garner a second look. But “little things add up,” she said. “It’s easy for a single doctor and patient to say, ‘Why not do this test? What difference does it make?’”

An epidemic of unnecessary treatment is wasting billions of health care dollars a year. Patients and taxpayers are paying for it.

ProPublica has spent the past year examining how the American health care system squanders money — often in ways that are overlooked by providers and patients alike. The waste is widespread — estimated at $765 billion a year by the National Academy of Medicine, about a fourth of all the money spent each year on health care.

The waste contributes to health care costs that have outpaced inflation for decades, making patients and employers desperate for relief. This week Amazon, Berkshire Hathaway and JPMorgan rattled the industry by pledging to create their own venture to lower their health care costs.

Wasted spending isn’t hard to find once researchers — and reporters — look for it. An analysis in Virginia identified $586 million in wasted spending in a single year. Minnesota looked at fewer treatments and found about $55 million in unnecessary spending.

Dr. H. Gilbert Welch, a professor at The Dartmouth Institute who writes books about overuse, said the findings come back to “Economics 101.” The medical system is still dominated by a payment system that pays providers for doing tests and procedures. “Incentives matter,” Welch said. “As long as people are paid more to do more they will tend to do too much.”

Dade said the medical community’s pledge to “Do no harm” should also cover saddling patients with medical bills they can’t pay. “Doing things that are unnecessary and then sending patients big bills is financial harm,” she said.

Officials from Washington’s hospital and medical associations didn’t quibble with the alliance’s findings, calling them an important step in reducing the money wasted by the medical system. But they said patients bear some responsibility for wasteful treatment. Patients often insist that a medical provider “do something,” like write a prescription or perform a test. That mindset has contributed to problems like the overuse of antibiotics — one of the items examined in the study.

And, the report may help change assumptions made by providers and patients that lead to unnecessary care, said Jennifer Graves, vice president for patient safety at the Washington State Hospital Association. Often a prescription or technology isn’t going to provide a simple cure, Graves said. “Watching and waiting” might be a better approach, she said.

To identify waste, the alliance study ran commercial insurance claims through a software tool called the Milliman MedInsight Health Waste Calculator. The services were provided during a one-year period starting in mid-2015. The claims were for tests and treatments identified as frequently overused by the U.S. Preventive Services Task Force and the American Board of Internal Medicine Foundation’s Choosing Wisely campaign. The tool categorized the services one of three ways: necessary, likely wasteful or wasteful.

The report’s “call to action” said overuse must become a focus of “honest discussions” about the value of health care. It also said the system needs to transition from paying for the volume of services to paying for the value of what’s provided.

Denied!

When I heard of this lawsuit regarding Aetna I was not surprised in the least.  They have been sued repeatedly, the most recent was about their reasoning for leaving the health care marketplace.  Or their disclosures on HIV status.     And there are many others.  And Aetna is on the verge of a merger with CVS pharmacy’s which will again change the dynamic in health care.  But this story that CNN reported on took on new heights when their Director admitted to not reading any of the medical data or reports on the patients and their health needs when approving or denying care..  Ultimately care is decided by how much, if any, and ultimately not what the Physician requests but what the insurer permits.  Your health and needs are secondary if not ultimately ignored depending on the situation.

After my near fatal car accident a few years ago of which I have said repeatedly was not an accident but possible assault or intent to bring harm to me by my date, I crashed into a light post, had a seizure, fell into a coma the result of a blood on the brain due to a head injury and an alcohol blood count of over .18 which should have killed me in my own right.  I was taken to our Trauma one hospital in Seattle, and in turn awoke 24 hours later with full on Traumatic Brain Injury only to be released in 72 hours with full on post traumatic amnesia.

 I sued Harborview Medical Center myself or what is called pro se or propia persona, meaning without a Lawyer, as few personal injuries would touch the case as it had no big money attached to it.  It was a public hospital for the poor and  I was alive and was functioning.  These are not qualities personal injury lawyers need for clients.   Nearly being murdered by my date or by the hospital via releasing me without due process and diligence is not a big money maker. So, yes regular people can actually use Latin and in turn access legal documents, do research on cases that relates to your case and in turn use any legal decisions that were made of record  and apply them to your brief to substantiate your argument.  Basically I pulled dozens of malpractice cases and largely copied their format and tailored my case around the issues that were interconnected.  I did use a paralegal to review and assist in phrasing and format as that has strict guidelines you must follow and ultimately they cost about 3K and regardless of wining and losing, which I lost, but I had lost not one but two criminal case with Attorneys costing over 35k so why spend more money?   Kevin Trombold and Ted Vosk fucked me over like my date just sans drugs and alcohol poisoning. I had no car to drive off into so they were unable to put me into one to ultimately kill myself which I am sure they would have preferred.  Yes Vosk and Trombold I have little to say good about either so I will not say anything good about them ever.  But they I did not sue.

The issues around my case was that Harborview did not find any individuals who could “vouch” for me and in turn validate and verify insurance which they did after they released me.  Whoops! As I have written many indigent people are released from hospitals in all kinds of states as was I in full blown post traumatic brain injury amnesia, to a person unknown as no signed release documents were available and apparently I signed  Power of Attorney to the Hospital which was never registered with the County for reasons I am still unclear as without that it is not legal.   The diagnosis documents were switched and despite being brought in with a brain bleed of 2mm and in a coma that was at the end of a lengthy list of other diagnosis that included, depression, alcoholism, Lyme disease and other ailments that I neither had nor was actually brought in for.  In other words they lied.  They lied and I have the records to prove it.  I lost on technical issues only and nothing was brought up in the records about any of the quality of care that Harborview failed to provide.  The Attorney for Harborview knew the truth and he did not add any contradictions to my claims to prove otherwise.  He kept in on the technicalities and urged me to appeal.  I actually liked him and he has now crossed over to the dark side to defend people like me.

My insurer was Group Health, since purchased by Kaiser,  are too culpable for failing to communicate with Harborview and in turn transfer me to one of their hospitals until I recovered.  I did not sue them but then I never paid them anything so it all worked out.  But that was again after forcing them to place me on charity care and they did so as I am sure they knew it was the best way to avoid a lawsuit.  There records show I was dragged into their offices by the person who took me out of the hospital, a person unknown (but I suspect my dead dog’s former walker)  as no signed release forms exist with this person’s name or signature, no signed POA was ever provided to any provider who saw me in that individuals  care which once again falls under a liability issue.

And yes providers at Group Health asked said individual if I had sustained a head injury (again coma and 2 mm of blood on the brain is pretty much a yes) she responded to them “no”  as that is not what the release documents said.  So they too mistreated me and attempted to get me to commit myself for a mental health evaluation. Again I have no recollection of this due to Amnesia and irony began coming out of it during a session with a therapist who at that moment had no paperwork, no medical history and was trying to get me to admit to being insane and ultimately self commit.  I recall this very moment as I utterly panicked why I was there.  The irony is that this individual who was asked to leave Group Health a week later due to some of her own issues with care for others.  I tracked her down and spoke to her about my injuries and what transpired using the medical records I had in hand and she admitted knowing nothing about my case and that I was with a young woman when I came in but when I left (which I recall as when you emerge out of amnesia it is terrifying and I was gone for about a week in which you function but have no recall of anything, in other words it is like Alzheimer’s) that person was not in the waiting room.  So going home was terrifying and to this day I have no idea what exactly happened to me during that week I was released to ostensibly my own care.

I tell this story as I am a woman, over 50, white, who had means and insurance and yet I was treated as an indigent mentally ill person who was denied care, denied my civil rights and dismissed by those put into a position to help those like me – Attorneys, Police, Medical professionals.  So to understand my story  and to prove that this is not abnormal or unique is the point. My story is horrifying and the reality is I am ONE OF MANY.

Public Hospitals are dumps and the staff treats the patients there in the same fashion.  Anyone who thinks you are getting decent care at Harborview I want to point out to City Hospital here in Nashville, running at a deficit and unable to generate any income for treating the indigent,  is on the verge of being closed.  God knows what that place is like.  However,  Harborview circumvents this  same way Vanderbilt does by having a level one Trauma Center for the region and this enables them to staff and train the Medical Students as does Harborview via the University of Washington and their medical school.  And I have had elective surgery at Vanderbilt and they too have been under scrutiny for many of their practices, which again is not shocking in the least.   So what this means is that you are a second class citizen with third rate care the minute you walk or are brought in the door.  And only after checks are issued maybe just maybe you might get care.  I, however,  without a next of kin I was screwed as there was no advocate for me to get the care I needed.

This week I read another article about another Patient Advocacy group about their daughter Talia and her mistreatment at another Seattle hospital, Swedish.  Now unlike Harborview, Swedish is a private, for profit hospital.  And they too have had a myriad of problems of late and is not the be all end all of care that it once was.   And while Talia’s family are upset and rightfully so, they are now one of many who have founded groups and foundations to attempt to change the culture of hospitals and overall the concepts of patient civil rights.   ProPublica has long had a site devoted to similar stories, mine is one of them.  There is the National Patient Safety Foundation, The Institute for Healthcare Improvement and many more.    I believe little will change.  Good luck with that.

No one helped me and no one ever will. I learned that the hard way.  I went on a date, was drugged and boozed up out of my mind and allowed to get behind the wheel of a car where I could have killed others in addition to myself.  The man who found me called 911 not once but twice in a state of urgency, the Police did nothing but took my blood without my civil rights protected as I lay dying as that was all that mattered.  My two Attorneys did little to ensure that my rights were protected and threw together junk as a defense and let me lose not one but two cases.  And the City of Seattle did little to verify and check my story nor even try nor allow me to test evidence let alone have a defense.

I have been denied in more ways than one. Its the price of doing business.

This is America and you have nothing if you are not rich enough to pay for it.    But more importantly the ones who you think care,  the Hospital entrusted with my care, threw me into the streets like a dump bucket to wander them utterly delusional for a week. And my secondary provider, Group Health, did not bother to attain my medical records or ensure my safety and proper recovery.  American health care at its finest has a long way to go to change its culture.  Look at the state of our Government today. That swamp any cleaner?

Inhale This

Sickness and poverty are the two plus two that makes the Medical Industrial Complex healthy.  The idea is that seems counter intuitive to how the complex is compensated and in turn rewarded for their efforts.

I want to point out that the poor are desperate, usually of color and often so ill that they are unable to take the time to make needed decisions with regards to care.  Otherwise known as second opinions.

I refer to the story of Henrietta Lacks that demonstrates how little those faces matter when a medical breakthrough is possible or in fact quality of care as this person is poor, often ill educated and are willing to do anything to restore their health.   Ah the human guinea pig ready, willing and able.

Teaching hospitals are the most notorious and they are in turn staffed and managed by the local Medical School.  Here in Nashville, that is the Metro General Hospital,  the one stop public health facility in a City with less than 40% carrying health insurance (Tennessee opted out of the Medicaid expansion).   This place ran literally bled red until suddenly the Mayor decided to close the facility and change its focus and in turn turn it to Meharry Medical College to operate it as an out paitent facility.    The timing I am sure is coincidental with the Affordable Care Act being whittled away that the once booming business of care is now coming to end with the insurance policies that enabled it and this will be changing across the country.  Note the current CVS/Aetna merger.   So with fewer patients having public insurance and now the potential likelihood of Tennessee ever getting any type of public monies for health of the poor is going on the window.  See the new tax bill lately? It eviscerates social safety nets.

As I know from living in the ‘vile the public housing units are ripe with drug problems and gun violence two very expensive ailments to treat.  Vanderbilt has to be making millions off being the singular trauma center in the area as they treat everything from the daily gunshot wounds to the major traffic accidents that litter the highway.  They are what Harborview Medical Center was in Seattle, massive trauma and treatment center, run by the University of Washington as a science lab.    They are certainly not washing any feet at Vanderbilt but there are several other hospital chains that have doors open and waiting.  Medicaid is big business and money.

I personally experienced the shitty care at Harborview and that colors much of my perception of most medical treatment but I am constantly confirmed by the endless stories at endless hospitals that function as the major treatment center for the great unwashed. The trauma portion is the money maker and the public care is the teaching factor.  Third rate care for third tier population.

When I read this story below I once again thought of Henrietta Lacks as she was a victim as was her survivors of Baltimore’s legendary medical facilities.  Nothing changes when it comes to exploitation of the poor.

Hospitals find asthma hot spots more profitable to neglect than fix
By Jay Hancock, Rachel Bluth of Kaiser Health News and Daniel Trielli of Capital News Service
The Washington Post December 4 2017

BALTIMORE — Keyonta Parnell has had asthma most of his young life, but it wasn’t until his family moved to the 140-year-old house here on Lemmon Street two years ago that he became one of the health-care system’s frequent customers.

“I call 911 so much since I’ve been living here, they know my name,” said the 9-year-old’s mother, Darlene Summerville, who calls the emergency medical system her “best friend.”

Summerville and her family live in the worst asthma hot spot in Baltimore: Zip code 21223, where decrepit houses, rodents and bugs trigger the disease and where few community doctors work to prevent asthma emergencies.

Residents of this area visit hospitals for asthma flare-ups at more than four times the rate of people from the city’s wealthier neighborhoods, according to data analyzed by Kaiser Health News and the University of Maryland’s Capital News Service.

Baltimore paramedic crews make more asthma-related visits per capita in 21223 than anywhere else in the city, according to fire department records. It is the second-most-common Zip code among patients hospitalized for asthma, which, when addressed properly, should never require emergency visits or hospitalization.

The supreme irony of the localized epidemic is that Keyonta’s neighborhood in southwest Baltimore is in the shadow of prestigious medical centers — Johns Hopkins, whose researchers are international experts on asthma prevention, and the University of Maryland Medical Center (UMMC).

Both receive massive tax breaks in return for providing “community benefit,” a poorly defined federal requirement that they serve their neighborhoods. Under Maryland’s ambitious effort to control medical costs, both are supposed to try to improve residents’ health outside the hospital and prevent admissions.

But like hospitals across the country, the institutions have done little to address the root causes of asthma. The perverse incentives of the health-care payment system have long made it far more lucrative to treat severe, dangerous asthma attacks than to prevent them.

Hopkins, UMMC and other hospitals collected $84 million over the three years ending in 2015 to treat acutely ill Baltimore asthma patients as inpatients or in emergency rooms, according to the news organizations’ analysis of statewide hospital data. Hopkins and a sister hospital received $31 million of that.

Executives at Hopkins and UMMC acknowledge that they should do more about asthma in the community but note that there are many competing problems: diabetes, drug overdoses, infant mortality and mental illness among the homeless.

Science has shown it’s relatively easy and inexpensive to reduce asthma attacks: Remove rodents, carpets, bugs, cigarette smoke and other triggers. Deploy community doctors to prescribe preventive medicine and health workers to teach patients to use it.

Ben Carson, secretary of the Department of Housing and Urban Development, who saw hundreds of asthmatic children from low-income Baltimore during his decades as a Hopkins neurosurgeon, said that the research on asthma triggers is unequivocal. “It’s the environment — the moist environments that encourage the mold, the ticks, the fleas, the mice, the roaches,” he said in an interview.

As the leader of HUD, he says he favors reducing asthma risks in public housing as a way of cutting expensive hospital visits. The agency is discussing ways to finance pest removal, moisture control and other remediation in places asthma patients live, a spokesman for HUD said.

“The cost of not taking care of people is probably greater than the cost of taking care of them” by removing triggers, Carson said, adding, “It depends on whether you take the short-term view or the long-term view.”

The long view

Asthma is the most common childhood medical condition, with rates 50 percent higher in families below the poverty line, who often live in run-down homes, than among kids in wealthier households. The disease causes nearly half a million hospital admissions in the United States a year, about 2 million visits to the emergency room and thousands of deaths annually.

That drives the total annual cost of asthma care, including medicine and office visits, well over $50 billion.

Keyonta lives in a two-bedroom rowhouse on the 1900 block of Lemmon Street, which some residents call the “Forgetabout Neighborhood,” about a mile from UMMC and three miles from Hopkins.

Reporters spent months interviewing patients and parents and visiting homes in 21223, a multi­racial community where the average household income of $38,911 is lower than in all but two other Zip codes in Maryland.

To uncover the impact of asthma, the news organizations analyzed every Maryland inpatient and emergency room case over more than three years through a special agreement with the state commission that sets hospital rates and collects such data. The records did not include identifying personal information.

For each emergency room visit to treat Baltimore residents for asthma, according to the data, hospitals were paid $871, on average. For each inpatient case, the average revenue was $8,698. In one recent three-year period, hospitals collected $6.1 million for treating just 50 inpatients, the ones most frequently ill with asthma, each of whom visited the hospital at least 10 times.

Hopkins’s own research shows that shifting dollars from hospitals to Lemmon Street and other asthma hot spots could more than pay for itself. Half the cost of one admission — a few thousand dollars — could buy air purifiers, pest control, visits by community health workers and other measures proven to slash asthma attacks and hospital visits by frequent users.

“We love” these ideas, and “we think it’s the right thing to do,” said Patricia Brown, a senior vice president at Hopkins in charge of managed care and population health. “We know who these people are. . . . This is doable, and somebody should do it.”

But converting ideas to action hasn’t happened at Hopkins or much of anywhere else.

One of the few hospitals making a substantial effort, Children’s National Health System in Washington, has found that its good work comes at a price to its bottom line.

Children’s sends asthma patients treated in the emergency room to follow-up care at a clinic that teaches them and their families how to take medication properly and remove home triggers. The program, begun in the early 2000s, cut emergency-room use and other unscheduled visits by those patients by 40 percent, a study showed.

While recognizing that it decreases potential revenue, hospital managers fully support the program, said Stephen Teach, the pediatrics chief who runs it.

“ ‘Asthma visits and admissions are down again, and it’s all your fault!’ ” Children’s chief executive likes to tease him, Teach said. “And half his brain is actually serious, but the other half of his brain is celebrating the fact that the health of the children of the District of Columbia is better.”

The close-up view

Half the 32 rowhouses on Summerville’s block of Lemmon Street are boarded up, occupied only by the occasional heroin user. Late last year at least 10 people on the block had asthma, according to interviews with residents.

All three of Summerville’s kids have asthma. Before moving to Lemmon Street two years ago, she remembers, Keyonta’s asthma attacks rarely required medical attention.

But their house contained a clinical catalogue of asthma triggers.

The moldy basement has a dirt floor. Piles of garbage in nearby vacant lots draw vermin: mice, which are one of the worst asthma triggers, along with rats. Summerville kept a census of invading insects: gnats, flies, spiders, ants, grasshoppers, “little teeny black bugs,” she laughs.

Often she smokes inside the house.

The state hospital data show that about 25 Marylanders die annually from acute asthma, their airways so constricted and blocked by mucus that they suffocate.

Keyonta missed dozens of school days last year because of his illness, staying home so often that Summerville had to quit her cooking job to care for him. Without that income, the family nearly got evicted last fall and again in January. The rent is $750.

About a third of Baltimore high school students report they have had asthma, causing frequent absences and missed learning, said Leana Wen, Baltimore’s health commissioner.

With numbers like that, West Baltimore’s primary-care clinics, which treat a wide range of illnesses, are insufficient, as is the city health department’s asthma program, whose three employees visit homes of asthmatic children to demonstrate how to take medication and reduce triggers.

The program, which an analysis by Wen’s office showed cut asthma symptoms by 89 percent, “is chronically underfunded,” she said. “We’re serving 200 children [a year,] and there are thousands that we could expand the program to.”

‘We’re a business’

The federal government paid for $1.3 billion in asthma-related research over the past decade, of which $205 million went to Hopkins, records show. The money supports basic science as well as many studies showing that modest investments in community care and home remediation can improve lives and save money.

“Getting health-care providers to pay for home-based interventions is going to be necessary if we want to make a dent in the asthma problem,” said Patrick Breysse, a former Hopkins official, who as director of the National Center for Environmental Health at the Centers for Disease Control and Prevention is one of the country’s top public health officials.

Other factors can trigger asthma: outdoor air pollution and pollen, in particular. But eliminating home-based triggers could reduce asthma flare-ups by 44 percent, one study showed.

Perhaps no better place exists to try community asthma prevention than Maryland. By guaranteeing hospitals’ revenue each year, the state’s unique rate-setting system encourages them to cut admissions with preventive care, policy authorities say.

But Hopkins, UMMC and their corporate parents, whose four main Baltimore hospitals together collect some $5 billion in revenue a year, have so far limited their community asthma prevention to small, often temporary efforts, often financed by somebody else’s money.

UMMC’s Breathmobile program, which visits Baltimore schools dispensing asthma treatment and education, depends on outside grants and could easily be expanded with the proper resources, said its medical director, Mary Bollinger. “The need is there, absolutely,” she said.

Hopkins runs Camp Superkids, a week-long, sleep-away summer session for children with asthma that costs participants $400, although it awards scholarships to low-income families. It’s also conducting yet another study — testing referral to follow-up care for emergency-room asthma patients, which Children’s National long ago showed was effective.

But no hospital has invested substantially in home remediation to eliminate triggers, a proven strategy supported by the HUD secretary and promoted by Green and Healthy Homes Initiative, a Baltimore nonprofit that works to reduce asthma and lead poisoning.

“We either go forward to do what has been empirically shown to work or we continue to bury our heads in the sand and kids will continue to go to the hospital instead of the classroom,” said Ruth Ann Norton, the nonprofit’s chief executive.

Hopkins and UMMC say they do plenty to earn their community benefit tax breaks.

“It’s always a challenge to say, ‘Where do we start first?’ ” said Dana Farrakhan, a senior vice president at UMMC whose duties include community health improvement.

Among other initiatives, UMMC takes credit for working with city officials to sharply reduce infant mortality by working with expectant mothers. The organization’s planned outpatient center will include health workers to help people reduce home asthma triggers, Farrakhan said.

“Living with people that got asthma — it’s really scary,” said Darlene Summerville, here with son Keyonta Parnell and daughter Ka-niya. (Doug Kapustin for Kaiser Health News)

Hopkins officials point to their health fairs and charity care as well as work in school and neighborhood clinics to help ­low-income families prevent asthma attacks.

“What we do is perhaps not sufficiently focused,” Brown of Hopkins said. At the same time, “we have to have revenue,” she said. “We’re a business.”

After months of waiting, Summerville considered herself lucky to get an appointment with the city health department’s asthma program.

One of its workers came to the house late last year, bearing mousetraps and mattress and pillow covers to control mites and other triggers. She helped force Summerville’s landlord to fix holes in the ceiling and floor.

She urged Summerville to stop smoking inside and gave medication lessons, which uncovered that Summerville had mixed up a preventive inhaler with the medicine used for Keyonta’s flaring symptoms.

“The asthma lady taught me what I needed to know to keep them healthy,” Summerville said of her family. That was late in 2016. Since then, Summerville said last month, she hadn’t needed an ambulance.

— Kaiser Health News

Methodology: Kaiser Health News and Capital News Service obtained data held by the Maryland Health Services Cost Review Commission on every hospital inpatient and emergency room case in the state from mid-2012 to mid-2016 — some 10 million cases. The anonymized data did not include identifying personal information.

The news organizations measured asthma costs by calculating total charges for cases in which asthma was the principal diagnosis. Maryland’s hospital rate-setting system ensures that such listed charges are very close to equaling the payments collected.

To determine asthma prevalence, reporters calculated the per capita rate of hospital visits with asthma as a principal diagnosis — a method frequently used by health departments and researchers. This may exaggerate asthma prevalence in low-income Zip codes because of those communities’ tendency to use hospital services at greater rates.

However, other data also point to high asthma rates in 21223 and other low-income Baltimore communities — for example, asthma prevalence among hospital patients in a given Zip code.

Poor Care

When you are poor medical care is biased and based on the ability to pay. Even today with the Affordable Care Act there are serious gaps that have put people in serious financial jeopardy despite possessing insurance. That said the GOP alternative to not have hospital stays covered is laughable as most of the new plan was.

The ACA needs repair and we need to examine across the board how hospitals and medical centers and physicians are covered and in turn compensated. Which means a thorough investigation into billing practices and standards of care as defined by a national board that is supposed to do that but it seems to have little to no relevance when accrediting hospitals and those Physicians that are affiliated with it.  This is is just one of many stories about Harborview as is this about Patient Grievances regarding sexual assault while in their care. and even a very middling Consumer Report safety rating.    
Most people are ill informed and take little notice of their local facility unless they are placed within it.  In the period of 2012 to 2015,  I found numerous incidents and all of public record (which makes one wonder about the rest) about the bizarre ethics by Harborview Medical Center staff.

When I was mistreated by Harborview Medical Center in Seattle it fell under the management of the University of Washington. It served the original mandate by King County to treat all indigent patients regardless of the ability to pay but also as a teaching hospital.  In addition, they are supposedly the number one trauma center for 5 states and take that extremely possessively, demeaning other hospitals for daring to step in and do their job.  In addition they are to treat all the criminal population in both the County and City jail. In a city with a massive homeless population it is bursting at the seams and for decades has been nicknamed Harborzoo for the sheer volume of patients who are neglected and set into halls, strapped to beds and drugged as an alternative to jail.

Many of those on Medicaid and Medicare love the dump but the reality is that it makes the Veteran’s Hospital seem first class. Little is done and thanks to issues that I wrote about in the last blog, malpractice cases rarely make it past go to highlight how bad it truly is. But the poor don’t complain but they should and this story about Howard University Hospital was not something that shocked me in the least. Read the book, The Immortal Life of Henrietta Lacks, to understand how vulnerable a group that those of color are when it comes to medical care.

I am a white woman but I had no family, no advocates and was thought uninsured so it made it easy for Harborview to throw me into the street as a deranged brain damaged woman. I often wonder why I survived but I think it was to tell others that while color is the easy marker, gender and age are also reasons/excuses or justifications by those in authority positions to dismiss and disregard US.

Howard University Hospital shows symptoms of a severe crisis
By Cheryl W. Thompson March 25 2017

Where medical mishaps become serious: The woes of Howard University Hospital

When Howard University Hospital opened its doors as Freedmen’s in Northwest D.C. in 1862, it stood out for the medical care it offered freed slaves and became an incubator for some of the country’s brightest African American physicians.

But over the past decade, the once-grand hospital that was the go-to place for the city’s middle-class black patients has been beset by financial troubles, empty beds and an exodus of respected physicians and administrators, many of whom said they are fed up with the way it is run. The facility has faced layoffs, accreditation issues, and sexual harassment and discrimination lawsuits, and it has paid out at least $27 million in malpractice or wrongful-death settlements since 2007, a Washington Post examination has found.

The Post reviewed more than 675 medical malpractice and wrongful-death lawsuits filed since 2006 involving six D.C. hospitals: Howard University, George Washington University, MedStar Georgetown University, Providence and Sibley Memorial hospitals and MedStar Washington Hospital Center. Of that group, Howard had the highest rate of death lawsuits per bed.

The $27 million paid out by Howard represents just 22 of the 82 cases filed against the hospital and tracked by The Post; the terms of most of the settlements were not made public.

The Post also found that Howard University Hospital has frequently been cited by the District for violating the hospital’s own policies, as well as local and federal laws. City health regulators have documented dozens of problems, including little oversight of medical residents, inoperable emergency room equipment, sloppy record-keeping and a lax nursing staff.

“Howard has had a lot of instability in leadership, particularly at the hospital, which has made it difficult to have a sustainable strategy,” said Chiledum Ahaghotu, the hospital’s former chief of urology and a Howard alumnus who resigned in 2015. He now is vice president of medical affairs at MedStar Southern Maryland Hospital Center. “Accountability is an issue.”

It is very difficult to compare one hospital to another or even rate individual facilities because there are few requirements for hospitals to report their data to government agencies. But the lawsuits, other publicly available documents and more than three dozen interviews with patients, doctors, nurses, administrators and others show a hospital that is struggling.

Howard officials hired California-based Paladin Healthcare in October 2014 to oversee its day-to-day management and try to turn things around. The hospital posted a $58 million loss in fiscal 2014; the loss was $19 million in 2015, according to figures provided by the university.

Michael Rembis, the chief executive officer of Paladin Healthcare Management, did not return three calls seeking comment.

“It’s going through a challenging time right now, and I think they’re trying to figure out the next step,” said Oritsetsemaye Otubu, a family medicine physician who left the hospital in June after five years “to pursue other interests.” She said her patients often complained about not being able to make appointments because no one answered the hospital phones.
Howard University President Wayne A. I. Frederick, center, discusses a plan to improve Howard University Hospital at a news conference in September. (Marvin Joseph/The Washington Post)

Howard University President Wayne A.I. Frederick, a physician who also oversees the hospital, said at a news briefing in the fall that the medical facility has made “significant strides in achieving our financial and operational stability.” Officials announced that the hospital had a $4.3 million surplus at the end of June, the first time since 2012.

“We recognize we have a lot more to do,” Frederick said.

The surplus came a month after officials announced they were reducing the hospital’s workforce by 110 employees. Hospital officials now say the surplus is $21 million, even though operating revenue has remained about the same.

Frederick has raised the idea of selling the hospital, which has been a financial drain on the university, and said at the briefing that Paladin Healthcare could be “a potential owner.”

Frederick declined six interview requests from The Post, which then emailed him a series of specific questions about its findings. He declined to answer those questions and instead released financial data and a statement on the hospital’s background, noting its “commitment to high standards and quality patient care.”

Former Howard University president H. Patrick Swygert said the hospital continues to be an important partner for the medical school and D.C. residents.

“It’s been a major resource for the community for a very long time,” said Swygert, who headed the institution from 1995 to 2008. He declined to discuss the current status of the hospital, saying he’s “been away too long.”

Robert L. DeWitty Jr. always thought he would retire from Howard University Hospital. The cancer surgeon’s relationship with the hospital began in 1968 when he arrived as a medical student. He remained there through his surgical residency and was on staff for more than 30 years until August 2015, when he severed his ties, citing “an unhealthy environment.”

DeWitty said the problems start “at the highest level of management.” “I decided instead of spending the rest of my days being in an environment that was unhealthy, I would leave and go to another hospital.”

DeWitty, who now practices at Providence Hospital in Northeast Washington, said Howard has been on a rapid decline for years, prompted in part by the 2001 shuttering of the city’s only public hospital, D.C. General.

“When it closed, we became the city hospital — unofficially,” he said. “Patients have to go somewhere, and they may be discouraged from showing up at certain places.”

DeWitty described Howard University Hospital as the “second D.C. General” because it became the place where many of the city’s poorest residents would go for health care, which contributed to the hospital’s financial troubles.

“I think it probably did play a role,” DeWitty said. “It was a combination of things that made us more financially strapped than I think we should have been.”

The hospital also is poorly run, with staff often taking a year or more to bill patients, he said. Frederick acknowledged at the fall news conference that billing has been an issue, and hospital officials attributed the hospital’s financial difficulties in part to a decline in inpatient admissions.

The teaching hospital has struggled repeatedly to maintain several of its residency programs. The Chicago-based Accreditation Council for Graduate Medical Education has withdrawn the accreditation of residency programs at Howard more often than at any other D.C. hospital in the last 15 years, records show.

Howard has lost accreditation for five training programs since 2002, the council’s database shows. George Washington Hospital, MedStar Georgetown and MedStar Washington Hospital Center have lost accreditation for one program in the same time period.

The Howard programs that have lost accreditation are emergency medicine, pediatrics, urology, radiation oncology and diagnostic radiology. None of the five programs have been reaccredited, according to records. The ACGME withdrawals typically occur after repeated warnings, according to Emily Vasiliou, a spokeswoman for the accreditation council.

“We’ve lost a lot of programs,” DeWitty said. “And a lot of scholarships, too, because of that.”

Vasiliou said hospitals cannot use public money to employ residents from programs that aren’t accredited.

Jullette M. Saussy, the former medical director of D.C.’s Fire and Emergency Medical Services Department, said the hospital’s problems are widespread, from empty beds to a troubled emergency room.

“I know they’re having a hell of a time in the ER and having a hell of a time staffing it,” said Saussy, who resigned from her D.C. position in February 2016. “It’s a broken system at Howard.”

Wayne Moore, another former medical director of D.C. Fire and EMS, said he considered the hospital a “dumping ground” during his tenure.

“Certainly for the drunks and homeless and the undesirables,” said Moore, who also worked in Howard University Hospital’s emergency room before leaving in 1999.

Moore said the facility has a history of “bad care and long waits in the emergency room,” and it wasn’t unusual for patients to be left in the hallways or on gurneys.

David Rosenbaum was one of them.

Rosenbaum arrived as a John Doe at Howard’s emergency room in January 2006 after being found on the street without identification. A paramedic told a nurse he was drunk. Hospital workers failed to perform basic assessments that could have indicated the seriousness of his injuries, according to a D.C. inspector general’s report. He lay on a gurney for several hours before anyone took him to the operating room, records show. He died less than 48 hours after arriving at the emergency room.

Rosenbaum was a longtime New York Times reporter who had been mugged while taking an after-dinner stroll in his Friendship Heights neighborhood. His death sparked national outrage and sullied the hospital’s reputation. His family sued the city and the hospital, demanding that officials take steps to ensure nothing like that happened again.

The incident was supposed to be a turning point for the city’s emergency medical services and for Howard University Hospital. But at least for the hospital, it wasn’t.

Solomon J. Okoroh was known at Classic Cab Company in D.C. for picking up every fare. He needed the money to help provide for his wife and their five children, one of whom was a student at Howard University and played on its basketball team.

Shortly before 3 a.m. on June 4, 2013, Okoroh picked up two young men in Adams Morgan in Northwest Washington. Minutes after climbing into Okoroh’s taxi, one of them shot him in a botched robbery. Three undercover D.C. police officers heard a gunshot and a revving car engine. Then, Okoroh’s Ford Explorer taxi whizzed by and shots were fired inside the SUV again before it crashed.

Both suspects fled; paramedics found Okoroh bleeding heavily from his shoulder, court records show. They took him to Howard University Hospital for treatment.

Okoroh lay unattended on a gurney for 70 minutes because there was no bed available, and nurses were unable to take his blood pressure because of a “machine malfunction,” his family alleged in a lawsuit filed in 2015. When Okoroh was moved to a bed, his neck was “extremely swollen” and he was “twisting and turning,” according to the lawsuit. It was only after Okoroh was unable to breathe that the medical team realized he had been shot twice. Okoroh, 59, died within minutes.

His wife, Patience, described what happened to her husband as “horrible.” The lawsuit was dismissed in December after she decided that the matter was “going on too long,” according to her attorney, C. Jude Iweanoge.

“It was putting too much pressure on her and her family,” Iweanoge said. “She didn’t want her children to relive this.”

Okoroh said dropping the lawsuit gave her “a little peace.”

Frederick declined to comment, but the hospital released a statement saying that “Howard University does not discuss specific issues regarding individuals who receive health care services at Howard University Hospital.”

D.C. taxi driver Mohammed Nur was used to making runs to pick up fares from Howard University Hospital.

But this sweltering July 2012 evening was different.

When Nur pulled up in front of the hospital at 7:45, Patricia Moore was waiting in a wheelchair, accompanied by a hospital staffer. The 61-year-old Moore, who suffered from asthma and other ailments, had come to the emergency room four days before complaining of shortness of breath. Doctors diagnosed her with fluid around the heart, records show.

“I said, ‘What’s going on?’ ” Nur recalled in an interview. “She was alert but very, very weak. I don’t know why they released her.”

Moore, unable to walk unassisted, was helped into the cab for the 10-minute ride home to Wah Luck House, an assisted-living housing complex in nearby Chinatown. Lasan Baldwin, a home health aide who worked for other tenants in the building, said a hospital social worker called her, saying they needed someone to be there when Moore came home.

“I don’t know why they called me,” Baldwin said in an interview. “She has family.”

Baldwin said she was stunned when she saw Moore, the mother of one grown son.

“She didn’t have no shoes on and she was in a hospital gown — her whole butt was out,” Baldwin recalled in an interview. “I told the cabdriver, ‘They sent her home like this?’ ”

Nur said he had never seen anything like it in his 20 years of driving a cab.

“It was sad,” he said. “I told the aide to take care of her.”

Baldwin said she sat Moore in a chair in the lobby and went to her ninth-floor apartment to retrieve her inhaler and walker. She returned minutes later to find Moore slumped in the chair.

Baldwin called 911, and paramedics took Moore back to Howard, where she died the next day.

“Every time I think about what happened to Miss Patricia, I want to cry,” Baldwin said, adding that she used to bring McDonald’s hamburgers to Moore and a friend, a Catholic nun, who often visited her.

Moore’s son sued Howard University Hospital, which settled the case in 2015 for an undisclosed amount. Hospital officials declined to discuss the matter.

Moore’s younger sister, Kathleen, said she was appalled to learn that the hospital sent her home alone, unable to walk, still ailing and scantily clad.

“For the sake of human decency, why anybody allowed that to happen is mind-boggling,” Kathleen Moore said. “It was just awful.”

Moore said she regrets allowing her sister to go to Howard.

“When I heard she was taken there, I thought it had high standards,” Moore said. “I was so, so surprised. You always feel like people are in good hands at a hospital.”
Assessments are tricky

Measuring a hospital is complex because there are few public metrics, according to health policy and patient safety experts.

“It’s very difficult to come up with comprehensive measures of quality,” said Martin Makary, a surgeon who teaches health policy at the Johns Hopkins Bloomberg School of Public Health. “That’s what everyone wants, but we have to do it carefully. We don’t want to punish doctors who take on high-risk quality.”

Some patients consider being satisfied with their doctor a good metric, Makary said. But it’s not, because “it doesn’t tell you if the doctor prescribes too much medicine or whether they have a lot of experience,” he said.

Hospital infection and readmission rates also may be good measures of quality, but they are not comprehensive, Makary said.

Tejal Gandhi, a physician and chief executive officer of the National Patient Safety Foundation, agreed that it is difficult — but not impossible — for the public to find data to measure a hospital’s quality.

“It’s not that we don’t want to have good metrics,” said Gandhi, an associate professor at Harvard Medical School. “It is challenging and labor-intensive to have good, robust metrics.”

The federal government rates a variety of aspects in health care, including readmission and death rates, and timeliness and effectiveness of care. Data from the Centers for Medicare and Medicaid Services, which compares hospitals across the country, found that Howard University Hospital performed worse than other hospitals in some key categories.

For instance, the average wait time for a patient visiting Howard’s emergency department before being seen by a health-care professional was 113 minutes, compared with 27 minutes nationally and 79 minutes at other high-volume D.C. hospitals that serve roughly 40,000 to 60,000 patients per year, according to data released in December, the most recent available.

While Howard University Hospital was worse than the national average for the amount of time patients stayed in the emergency room before being admitted — 415 minutes, compared with 295 minutes nationally — it fared better than other high-volume District hospitals, which averaged 464 minutes, the data showed.

The average time that patients who came to Howard University Hospital’s emergency department with broken bones waited before being administered pain medication was 101 minutes, nearly 40 minutes longer than other D.C. hospitals. Nationally, patients waited 52 minutes.

The federal government in 2015 began awarding star ratings based on patient appraisals. The ratings are based on patient experiences with medical professionals, including communication and whether they would recommend a hospital. According to the most recent ratings on Medicare’s website, Howard University, George Washington University, Providence and MedStar Georgetown University hospitals got one star out of five. MedStar Washington Hospital Center got two stars, while Sibley Memorial was rated a three-star hospital.

The D.C. Health Regulation and Licensing Administration inspector entered the Neonatal Intensive Care Unit at Howard University Hospital at 2:55 p.m. on July 22, 2015, and counted six fragile newborns. She looked around for a nurse but saw none, even though three are assigned to the unit.

After walking the length of the nursery, she found an employee “around a corner where s/he could not observe the patients and was out of direct vision of anyone entering the nursery,” according to a health department inspection report obtained under the District’s Freedom of Information Act. The nurse was on her cellphone, and the inspector cited the hospital for “failing to provide a safe environment” for infants in the NICU, a violation of the D.C. Nurse Practice Act.

It is one of dozens of deficiencies found at the hospital over the past decade by city health regulators who are supposed to review D.C. hospitals annually for compliance with everything from laws to delivery of patient care. The inspections show lax oversight at Howard.

“If we find anything egregious, we make sure it’s taken care of before we leave the hospital,” said Sharon Lewis, senior deputy director with the D.C. Department of Health’s Health Regulation and Licensing Administration.

The agency typically doesn’t do periodic reviews to determine whether a hospital has corrected the deficiency, Lewis said. Instead, it checks back the next year during the annual review.

A complaint filed in July 2015 alleged that Howard University Hospital allowed a resident fellow to practice medicine without a license for a year, a violation of D.C. law. A health department review substantiated the allegation. That review also found that 10 of the hospital’s 26 medical fellows “lacked documented evidence” that they took the required CPR classes.

An inspection of Howard University Hospital last March found various problems: an inoperable defibrillator in the emergency room and a lack of documentation showing that medical staff had the required biennial tuberculosis screening and/or physical health exam “in accordance with established District of Columbia Municipal Regulations for Hospitals.”

In 10 of 26 cases — nearly 40 percent — Howard University Hospital staff failed to document whether pain-relieving drugs and other controlled substances were given to patients as ordered or given in a timely manner. In some instances, the drugs — Percocet, OxyContin, morphine and others — were removed from the automatic dispensing machine with no record that they were administered, according to the inspection report. Similar deficiencies were found in 2015 and 2014, records show. In one case, 11 of 13 doses of pain medication were given to a patient more than an hour late.

In another instance, a physician wrote an order for an addict to restart methadone without specific directions. There was no indication that the doctor was registered with the Drug Enforcement Administration or that the patient was in a treatment center as required by federal law.

Howard University Hospital came under scrutiny in 2007, after inspectors found the remains of 25 newborns and fetuses in its morgue, some of which had been there for several years.
Amputations

The city’s health department also has cited Howard University Hospital several times for failing to provide proper care and treatment for patients with diabetes, records show.

When Frances Barnes, a retired postal worker, was admitted on Aug. 22, 2008, for a possible stroke, her family felt confident that Howard’s medical team would make her better. The hospital designated the 80-year-old Barnes, a diabetic, a high-risk patient and laid out a plan: She would be seen by a nutritionist, have a soft care bed, be turned every two hours and have a weekly skin assessment. They ordered anti-embolism stockings to help her circulation, with orders from the doctor to remove them “at least once per shift” for at least 30 minutes, according to records.

But health department documents show that the nurses failed to remove the stockings for three days at a time on three separate occasions, and they didn’t document problems with Barnes’s feet during the weekly skin assessment. It was only after Barnes’s family entered her hospital room and noticed “an extremely foul smell” that they learned of the sores, recalled Sandra Ford, one of Barnes’s eight children.

“I took her sock off and there the sores were on her foot,” Ford said. “They were big and black. I was shocked.”

The sores spread so fast that doctors had to amputate Barnes’s leg below the knee, Ford said.

Barnes’s granddaughter, Shelly Ford-Jackson, filed a complaint against the hospital, questioning the quality of Barnes’s care. Ford-Jackson is a supervisory health licensing specialist for the D.C. Department of Health.

Shelly Ford-Jackson stands on the porch of her home in Landover, Md. She filed a complaint against the hospital, questioning the quality of the care her grandmother received. (Marvin Joseph/The Washington Post)

“I kept a journal and noted everything that was going on,” she said. “I saw so many things that were done inappropriately.”

The health department found that the hospital’s nursing staff “failed to follow the standard of care” in treating Barnes, city records show.

“Final analysis determined that a violation of law was found and a deficiency was cited,” according to a health department letter to the family.

The hospital agreed to devise a plan of correction that included developing written guidelines on managing patients with anti-
embolism stockings and random monitoring of those patients three times a week for 90 days.

Barnes died on Feb. 2, 2009. Her family sued Howard University Hospital the following year and settled the case in 2011 for an undisclosed amount, court records show.

Hospital officials declined to comment on the case.

“There was blood on his blanket,” Julio Palma Jr. recalled. “But he not feel when he hurt his foot.”

The younger Palma said he called the nurse twice, who promised to take care of it.

“Nobody show up,” he said. “I was there for maybe an hour and a half. I call him [the elder Palma] in the morning and ask him if someone show up and he said ‘no.’ ”

Nurses wrapped the injured foot in gauze and discharged Palma. When his wife and a daughter cleaned him, they noticed that his big toe was black.

“They sent him home like that,” his daughter Gisa said through an interpreter.

Palma returned to the hospital to see a specialist, and “that’s when we got the bad news that they were going to cut off his big toe,” his son said.

Despite the amputation, the wound didn’t heal, so they cut off a second toe three weeks later, according to court records. Seeing no improvement, Palma went to another hospital.

“The specialist there said he had to cut higher because there was an infection,” his son said. “We never went back to Howard.”

Palma’s family said the amputations changed his life. He could no longer drive. Or work. Or dance with his wife of more than 40 years. He sank into depression.

“It was all because of Howard,” Gisa said. “They could have prevented that.”

Hospital officials declined to comment on the case.

Palma and his wife, Bertalisa Sagastume, sued the hospital in federal court in 2008 and settled for $90,000, according to their children.

D.C. Fire and EMS Chief Gregory M. Dean said that he sympathizes with families who have “compelling stories” about their experiences at Howard University Hospital, but he said that the facility is sorely needed in the nation’s capital.

“Howard is a teaching hospital,” Dean said. “It’s an institution and an incredible part of the District.”

Check Your HIPAA

Well most Americans have no idea so why should anyone in the Medical Profession?

HIPAA confuses everyone who works in the medical fields, it confuses Educators as it has relevance there with regards to students with special needs to health issues (such as allergies to diabetes) and of course the average person to which it applies.

I thought this was a great simple 5 point essay on what HIPAA is and more importantly is not.

HIPAA is violated all the time and sometimes with your consent.  How?  Waivers are often blindly signed by individuals when they sign up for auto Insurance to a job application.  Yes, much like the casual clause in all legal docs we “agree” to that waives our right to sue and forces us into arbitration, we allow many business access to our health records and information.

When I sued Harborview Medical Center accessing my records was essential but you must do so to know that they have caveats in place to deny you records that include Doctor and Nurse notes and other “relevant” data that they claim is violation of HIPAA.  No they are not and that includes texts, emails and even messages. So you need to request those as well. As for mental health notes that is a separate request and include dates even following your dismissal as the records can go beyond treatment dates.   And of course they charge you for that as another way to discourage patient review.

And I did this with Group Health Cooperative my primary patient provider and what was interesting is comparing the notes between the two how different their recollection and documentation was.

What was consistent was that neither Group Health nor Harborview had any record and identification nor legal documentation supporting my release to “friend” and a note on one form they forced me to sign as Brandy Solberg and  phone number.

Harborview forced me an injured individual with Traumatic Brain Injury and the amnesia that accompanies it to sign a Power of Attorney.  What they used that for was to release me to this “friend” with no identification by her, never actually filing the POA and making it legal under the law (so it was null and in turn void also by not having me checked by a third party that I actually knew and understood what I was signing) neither did Group Health actually ask for the same substantiation and documentation when she brought me to their facilities not once, not twice but three times in an attempt to get me medical care. But also she was given misinformation about my medical condition that delayed and in turn affected my care and recovery.

And yes I tried to sue but I want to point out Washington State law makes it impossible to sue any medical provider without first going into Arbitration and Mediation.  And who oversees that – The University of Washington (that manages Harborview) and Group Health Cooperative.  So I would never have “won” anything with or without a Lawyer.  The game is rigged.

But reading one’s medical records is a right and absolutely necessary in order to understand how you are seen as a patient and in turn what and how that can affect your care, and more importantly your perception in your working life.  Those records can be released to employers, future insurers and others who will in turn make assessments and evaluations based on that (mis)information.

So when a medical professional claims that they can’t even give you a copy of your medical records let alone a family member claim them wrong.

Five myths about patient privacy

By Charles G. Kels July 28 The Washington Post
Charles G. Kels is a senior attorney at the American Medical Association and a judge advocate in the Air Force Reserve.

Shortly after the recent massacre at an Orlando nightclub, the city’s mayor declared that the White House had agreed to waive federal privacy rules to allow doctors to update victims’ families. News of the waiver was widely reported, but as the Obama administration later clarified, both the mayor and the media were “simply mistaken.” No waiver was granted because none was needed. The confusion amid the tragedy in Orlando underscores widespread misconceptions about the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Here we shed light on a handful of myths that bedevil doctors and patients alike.

Myth No. 1

HIPAA prohibits communicating with patients’ loved ones.

HIPAA sets national standards to safeguard the privacy of individuals’ health information. As in Orlando, it is often perceived as a barrier to effective communication between doctors and patients’ loved ones. Virginia state Sen. Creigh Deeds — whose mentally ill son attacked him before committing suicide in 2013 — recently testified before Congress that “HIPAA prevented me from accessing the information I needed to keep him safe and help him towards recovery.”

Such stories are heart-wrenching but misattributed to HIPAA. In most cases, the privacy regulation permits doctors and nurses to communicate with a patient’s family, friends or caretakers. The rules were crafted to account for the realities of health care, including the integral role often played by those closest to the patient.

As the former head of HIPAA enforcement told Congress, “HIPAA is meant to be a valve, not a blockage.” When the patient is present and clearheaded, the law allows hospitals to share relevant information with loved ones so long as the patient does not protest. This can be accomplished through the patient’s agreement or acquiescence, or based on a doctor’s professional judgment that the patient does not object. If a person accompanies the patient to an appointment, for example, doctors can reasonably infer that discussing the patient’s treatment in front of that individual is appropriate.

When the patient is unavailable or incapacitated, doctors can also exercise professional judgment to determine whether disclosure is in the patient’s best interests. A clear example is when the patient is unconscious, but this provision can also apply if the patient is suffering from temporary psychosis and lacks the ability to make health-care decisions.

Still, studies have shown that confusion and fear over privacy laws often lead hospitals to unnecessarily withhold information and reflexively cite HIPAA as justification — an approach that can make families feel locked out of care.

But overall, HIPAA affords doctors significant flexibility to communicate with patients’ loved ones, whether about routine or time-sensitive matters. The only time the law truly forecloses the sharing of such information is when the patient is present, lucid and tells doctors not to — and even then, patients’ wishes can be overridden in the event that they pose a serious and imminent threat to health or safety.

Myth No. 2

Same-sex marriage rights are critical to equality under HIPAA.

Before the rumors of a HIPAA waiver in Orlando were quelled, various news outlets reported that it marked a “victory for gay rights.” Waiving medical privacy laws was portrayed as a prerequisite for sharing information with same-sex partners.

In reality, HIPAA enables discussions with relatives, friends or anyone else identified by the patient, meaning that the impact of the Supreme Court’s marriage-equality rulings on permissible communication was marginal at best. HIPAA does not require doctors to obtain proof of identity when inquirers say they are a patient’s friends or relatives. Providing information to family and friends under HIPAA is linked to their involvement in the patient’s medical affairs, not the legal status of their relationship. Patients’ sexual preferences were irrelevant long before same-sex marriage became the law of the land.

Early in his administration, President Obama emphasized the importance of hospital visitation rights for same-sex partners and sought to enforce this policy through Medicare rules. However, spouses — unlike parents vis-a-vis their minor children — are not automatically presumed to have access to patient records. It is up to the patient to designate them or doctors to involve them as clinically appropriate.

Myth No. 3

HIPAA provides extra protections for mental health information.

Rep. Tim Murphy, also a psychologist from Pennsylvania, believes that amending HIPAA is crucial to mental health reform. Rep. Eddie Bernice Johnson, a registered nurse from Texas, says that “individuals with mental illness and substance use disorders often face obstacles to treatment because of the Privacy Rule within HIPAA.” New York’s chief psychiatrist has described HIPAA as “the tragedy of mental health law.”

Yet HIPAA does not distinguish between physical and mental health information, nor does it provide extra protections for the latter. Indeed, HIPAA is generally agnostic as to the type of health information being protected. The drafters of the privacy regulation acknowledged that many states had laws specifically guarding records related to mental illness and “other stigmatized conditions” but declined to follow their lead. While the HIPAA rules in no way erode these additional state protections, they do not confer any special status on mental health information.

The rare instance in which HIPAA affords greater protection to sensitive information involves “psychotherapy notes.” However, this exception is much narrower than is commonly understood. Psychotherapy notes are therapists’ private, desk-drawer notes reflecting on conversations during counseling sessions. They exist for therapists’ personal use as memory joggers and must be kept separate and apart from patient charts in order to retain their designation. Any information of wider utility — such as treatment or diagnosis — is excluded from the definition and associated protections. In fact, a main reason psychotherapy notes are shielded from disclosure is because they would have so little relevance or use to anyone other than the doctor who created them.

Myth No. 4

HIPAA stops doctorsfrom reporting threats.

Mass shootings involving mentally ill suspects often prompt discussion about what warning signs doctors should have reported. These questions persist even in cases when doctors had alerted authorities, as happened before the 2012 movie theater tragedy in Aurora, Colo.

After the Sandy Hook Elementary School shooting, one of Obama’s 23 executive actions was to clarify that “no federal law” prohibits health-care professionals from reporting threats of violence to the police. This mandate was accomplished via an open letter to the health-care community explaining that HIPAA allows doctors to issue appropriate warnings when they believe that patients present a serious and imminent threat to themselves or someone else. In such cases, doctors can disclose necessary information to law enforcement, school officials, family members, the target of a credible threat or anyone else in a position to avert the danger. Under the HIPAA rules, doctors who take these steps are generally presumed to have acted in good faith.

When patients make threats or pose a high suicide risk, doctors often have a “duty to warn” emanating from state laws, court decisions or professional ethics rules. HIPAA does not in itself impose such a duty, but it explicitly permits health-care professionals to take action “consistent with” these standards.

Myth No. 5

HIPAA is the reasonfor medical privacy.

HIPAA is often singled out as the basis of patient confidentiality. Yet privacy was a core value in health care long before the HIPAA rules were promulgated in the early 2000s. The Hippocratic Oath admonishes doctors to keep secret what they “see or hear” from patients. The American Medical Association’s first code of ethics, adopted in 1847, emphasized the “obligation of secrecy” at the heart of the doctor-patient relationship.

In practice, HIPAA provides a federal floor of privacy protections, not a ceiling. It defers to state laws that are “more stringent” or protective of patient rights. State laws that create additional safeguards for conditions deemed especially sensitive — whether HIV/AIDS, communicable diseases, cancer or mental illness — remain in full force. Neither does HIPAA override other federal laws. Thus, for example, substance-abuse programs subject to 1970s-era federal confidentiality requirements continue to follow those stricter standards in the vast majority of cases.

Even where HIPAA allows health information to be shared, it almost never requires it. Doctors and hospitals must still be cognizant of other applicable laws or professional ethics guidelines that impose stricter limitations. HIPAA is designed to align with these obligations as often as possible, but those instances where gaps arise tend to be the most complex and emotionally fraught.

HIPAA established a procedural framework for doctors, hospitals and other health-care players to exchange information without compromising patient privacy. Even if the law disappeared tomorrow, the legal precepts and ethical norms that long preceded it would remain in place — as would many of the frustrations cited by HIPAA’s most ardent detractors. This month, the House of Representatives proclaimed that “there exists confusion in the health care community around what is currently permissible under HIPAA rules.” Alas, that just may be the most accurate statement about HIPAA ever uttered.