Bedside Manner

Color me shocked!  No, the reality is that with the rising costs of medical care and the growth of these mall install Medicine to Go clinics I can tell this is going to end well. 

My first foray into the walk in clinic was years ago and the treatment to say lacked, I got sicker and ended up in the ER.  I still use them but in reality I have no medical insurance so it is cheaper for me to pay for these then wait three weeks and still pay for the call as it goes toward a deductible that is huge.  I have catastophic care insurance and with a 5K deductible I figure at that point it won’t matter, put it on a credit card, file bankruptcy or I am dead either/or. 

So this little rant is not shocking.   What is is that the criminal justice system gave a shit. It is increasingly hard to file malpractice across the country and in normal situations this would fall under the personal injury legal envelope but at least it got some attention which is better than nothing. And nothing is the reality for those in the American Medical Industrial Complex. 

A doctor shouted at a sick mother to ‘get the hell out.’ Now he’s under criminal investigation.
By Lindsey Bever October 12 The Washington Post

A doctor in northern Florida is under criminal investigation after he was seen on video shouting at a patient to “get the hell out” of an urgent-care clinic, then apparently grabbing her daughter’s cellphone, which was recording the incident.

Peter Gallogly, a physician at Gainesville After-Hours Clinic, was captured on video Monday arguing with a patient who was scolding him for a long wait time.

“Are you kidding me?” Gallogly shouted at the patient, Jessica Stipe, reminding her that he had already tested her urine. “Does that take three seconds, you think?”

“I don’t know how long it takes,” Stipe said.

“Do you want to be seen or not?” he replied.

Stipe told the doctor that she was “miserable” and just wanted to “go home and get in my bed.”

“Fine,” Gallogly responded, “then get the hell out. Get your money and get the hell out.”

When Stipe told him he was being rude, he shouted: “Get the f— out of my office. Now.”

Stipe’s daughter, who was recording the incident on a cellphone, then asked the doctor for his name. He appeared to snatch the cellphone out of her hand and walk away with it, saying, “You’re recording this?”

Gainesville police spokesman Ben Tobias told The Washington Post that officers responded to the incident and have opened a criminal investigation into the case.

Stipe posted the video Monday night on Facebook, writing that she had made an appointment for 6:30 p.m. Stipe, who said she was “in severe pain and throwing up in the trash can,” had still not been seen at 7:45 p.m.

She said she requested that her co-pay be returned to her so she could go home to bed and then seek treatment elsewhere the next day. She said the doctor was “mad” and “when he saw it was being recorded he snatched my baby’s phone and shoved her when she tried to get it back.”

A person who answered the phone at the Gainesville After-Hours Clinic on Thursday declined to comment, but a statement on the medical center’s Facebook page states that there was more to the exchange.

Gallogly, the physician, wrote that the video shows only the final moments of an hour-long argument, claiming that throughout her time in the clinic, Stipe had become “increasingly belligerent and abusive to the office staff, cursing them and threatening them with violence, because she was unwell and had been waiting to be seen by me for more than an hour.”

He said that even after Stipe’s co-payment had been returned to her, she would not leave.

When he walked into the waiting room to speak with her, he said, Stipe and her daughter “cursed and threatened me as they had done with the office staff previously.”

“At the very end of the events,” he said in the statement, “I most regrettably lost my temper, and spoke to the women in a most unprofessional manner. I make no excuses for my unacceptable behavior.”

The urgent care clinic also appeared to post an incident report and written testimonies from witnesses, but Gainesville police would not confirm whether those were legitimate police documents.

After the video spread throughout social media, Stipe said in a statement Tuesday that she was still sick and tired but wanted to set the record straight.

“Yes I’m employed, I don’t do drugs & yes I wanted meds . . . a antibiotic!” she wrote. “To those of you who support me you have my heartfelt thanks . . . to those who know me . . . you know this was uncalled for & for those of you who don’t and are being rude and hateful to me and my child . . . god bless your hearts. I pray you and your kids are never in this situation . . . you may sing a different tune if you are.”

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.”

Tort Anyone?

Lawyers who make laws. Hmm conflict of interest? Oxymoron? Or the ways laws should be written?

I am on the fence with how laws are written as clearly no one actually reads them. The reality is that we are a country of laws, written and administered and in turn implemented or rejected by those who write them.  And those are Lawyers or are they?  This is the breakdown of Congress in 2013 and not much has changed since that as we all know the dipshits are re-elected regardless.  I question our “Democrat” Jim Cooper here in Nashville as not really a Democrat as he does not describe himself as such and we could use some actual legislation that might actually represent the composition of Nashville. 

Now true we have a big animal Veternarian, Medical Doctors, a former Reality Star, (actually not just Trump check Wisconsin on that one), a Pizza parlor owner (not the one that was a pedophile sex trafficking ring that was another Lawyer who made that one up however!)  And in reality actually few in Congress are actually Lawyers!!  What?  Yes few are funny isn’t.   But also Members of Congress are sixty-eight times as likely as all American adults to have practiced law.

The Supreme Court is the only body of our Government that one actually must be a practicing Lawyer/Judge.  Or so you believe.  Nope

The United States Constitution contains no prerequisites for appointment to the Supreme Court. How many U.S. Supreme Court justices have not been lawyers and what were their names?

You are certainly correct about qualifications (or lack of same) to be considered for the Supreme Court. But every single justice on the court, dating back to John Jay, has been a lawyer; each one either attended law school, took law classes, was admitted to the bar, or practiced law.

Thought you needed a businessman in the White House well how about in a gig for life reviewing all the laws of the land. Trump hates Judges and on this one I have a slight agreement, they are not infallible nor are they under any supervision, guidance or any type of oversight.  This I believe contributes to many problems we are seeing across the country with regards to both civil and criminal law and the odd decisions and behaviors being exhibited by many Judges.  That and that are elected and not appointed by a bi-partisan committee to whom they report and are responsible to.  Truly why are we voting for Prosecutors and Judges, we know nothing about them other than bullshit promises and that means what exactly.  Note that this is often mentioned with regards to Justice reform and like everything else utterly ignored.  To quote a Nashvillian: “I don’t know anything about that!”

I have immense respect for Ralph Nader until he drank the kool aid that convinced him he needed to run for President.  And while I respect that and it drew attention to the two party system and its failures it may have led to a Presidency and in turn a series of events that we can now look back in anger/amazement/shock or hey not that bad considering what is in office right now.   But in turn much of what he said came to fruition.  The reality is that Democratic party sabotaged a valid candidate and what Russian could not do the Republicans managed to shoot themselves in the foot, arm and whatever body parts were left during that bizarre primary campaign. 

But now as we have the Dictator in Charge the reality is that the republic might actually become one – some cross between a Banana one and the Soviet model.  This comes in the form of disparaging the media and the source of information becomes part propaganda part bullshit and then slowly civil rights are eroded by access and in turn openness.

The first started decades ago when the banks and lenders put in an arbitration and mediation clause in all agreements to settle differences when a customer felt wronged.  The tech sector has been doing this for decades as well as a way of data mining and generating profit.  Who actually reads all the information in that agreement we check when we buy a new phone or laptop?  Then employers placed these in contracts to prevent those from often seeking jobs outside the company, under the idea of non compete and in turn prevent any whistleblowing by those who found company errors. And yes our beloved Obama Administration had no problem prosecuting whistleblowers who violated said agreements and laws in place to prevent or deter said blowers of the whistle.

Tort reform has long been a mainstay of the Republican mantra. And with Dr. Tom Price now in charge of DHS expect that will become a signature of import when it comes to Malpractice.  In many States now it is already a massive hurdle to overcome laws put in place to file a suit against a hospital or Doctor.  I live in Tennessee and they are not any different than Washington State that had both the mediation clause in the law and the mediators had to come from whom – medical providers – and in turn restored the contributory law and reduced secondary damage awards.

This I know from personal experience as I had to file my case pro se as no Attorney would touch my case as I was still alive and functioning.  Those are two factors that can severely affect one’s case.

A person who has been injured by medical malpractice in Washington State should consider:

• Any medical negligence-type claim from the state of Washington must be filed within three years of the malpractice, or within one year of discovering the injury
• Washington State has no cap on damages, but it does place limits on the amount that an attorney can bill and collect for legal services in medical malpractice actions, thus limiting the overall costs to both plaintiffs and defendants upon resolution of a case
• Parties to a medical malpractice case must participate in mandatory mediation, which has no effect on their right to a jury trial, but is a statutorily mandated pathway to filing medical malpractice lawsuits in Washington
• Washington is a “pure comparative negligence” jurisdiction that allows recovery of damages regardless of the relative liability of the injured party
• Expert testimony is not mandated by statute to validate the injured party’s claim, but most medical malpractice cases in Washington State require expert testimony to verify a deviation from medical standards

Important Deadlines Pertinent to Medical Malpractice Cases in Washington

The state of Washington gives an injured party a generous three years to file a claim after an occurrence of medical malpractice but provides a less generous one-year period if the injury is discovered later than the initial three years, expected immediate discovery period in cases of obvious medical malpractice. Further, the state has an absolute eight-year statute of repose that will prevent any claims from proceeding if they are filed more than eight years after the malpractice

Washington State also treats medical malpractice claims by minors differently than many other states, specifically, in Washington State, the time limit for starting a claim does not begin to run until a person’s eighteenth birthday. A minor’s parents can still initiate a medical malpractice claim before the child turns eighteen. If that case is not filed, then the child will typically be subject to the one-year filing period after his eighteenth birthday as his injuries will probably be known by then.

Washington State’s various statutes of limitations can run into each other and defeat a party’s claim if the injured party fails to follow the rules. For example, the Washington requires mandatory mediation, and a party’s good faith request for mediation, which must occur before filing a lawsuit, that will delay the deadline for filing the lawsuit by one year. Lawsuits filed before mediation requests if other deadlines are not met, are subject to dismissal. Having a practicing medical malpractice lawyer in Washington will be essential to gaining specific clarity on the dates and statutes of limitation applicable to your individual case.

Damages Statutes in Washington Medical Malpractice Laws Explained

Washington State does not cap damages that a party may receive in a medical malpractice action. It does apply a formulaic approach to calculating noneconomic damages as a function of an injured party’s income and lifestyle.  Washington State also exposes attorneys’ fee to a Court’s scrutiny to determine if those fees are reasonable.  Additionally, a party’s damages will be reduced in proportion to his relative liability for his injuries. Unlike several other states, Washington State will not refuse all damages if a party is more than fifty per cent liable.  If more than one doctor or facility caused the medical malpractice, Washington State treats them as “joint and several” tortfeasors and allows the injured party to collect the full amount of damages from any one of the ostensibly liable parties.

Verification of Claims via Expert Testimony in Washington Medical Malpractice Cases

Although not required by state statute, most or all medical malpractice claims in Washington State are supported by expert testimony to verify claims that standards of medical care were not met or followed. The depth and extent of expert testimony will vary with the facts of each case.

Filing a medical malpractice case in Washington State can be favorable to a plaintiff, but given legal fee review and limitations, they may not be favorable to all Washington attorneys. Persons who believe that they have been injured by a physician’s or treatment facility’s malpractice in Washington State should nonetheless consult with legal counsel at the earliest possible date to preserve and protect their potential claims via an experienced and practicing medical malpractice lawyer Washington state.

 I tried and lost despite the fact that my case was solid. I lost as I had not filed the forms with the State appropriately deemed by law informing them that I was suing them.  That I was suing a State run hospital that is one more hurdle that is added to further eliminate the rights of citizens to sue any agency of the State regardless of the type.

As for the lack of experts (which I had yet to hire as that too is another expensive hurdle)  was debatable and cited in the Summary Judgement but that was not the issue by the Appeals Court they focused on that filing form and that yes the law does not mandate experts but it should have been addressed by the plaintiff.  They never mentioned the mediation clause which is where the case should have been remanded according to the law but again how one files matters.

This is Tort Refom. And it is coming your way.  Mr. Nader wrote this for Harper’s Magazine. 

The story of how tort law originally evolved from its roots in medieval England is a story of millions of actors and judicial decisions that proceeded in small but steady advances. These advances embodied the democratic principles on which our country was founded and together make up a revolutionary process of personal-conflict resolution. Tort law allows an individual who believes that he or she has been wrongfully injured in person or property to retain an attorney on a contingency fee, paid only if the plaintiff prevails. After a lawsuit has been filed, and has survived a defendant’s motion to dismiss, the plaintiff’s attorney may compel the defendant, be it a person, a corporation, or a city’s police department, to disclose factual information regarding the claim. State and federal procedures urge the contending parties to exchange all relevant information beforehand in an attempt to encourage settlements and expedite any eventual trial. The court proceedings, should there be any, are open to the press and the public. Verbatim transcripts of the trial testimony are made. In pursuit of what is called “truthful evidence,” attorneys for both sides can vigorously cross-examine witnesses. Settlement can occur at any time, but if one does not occur, the trial jury is responsible for returning a verdict and assessing damages. The judge has the authority, though it is rarely invoked, to reduce or increase the damages if he or she thinks the jury is way off base. The losing party can then appeal, again in open court. The media can track the proceedings from start to finish. No decisions by the other two branches of government come close to being so clearly refereed, so open, and so subject to public review.

The reality is that many people are entitled under the law to the truth but as we now realize the truth are just alternative facts in which we can choose those that fit our beliefs.  I believe we are in deep trouble that our rights are in jeopardy and they are by those who have no knowledge or experience in the law. When I defend a Lawyer I know we are fucked, without dinner so there will be no torte for dessert. 

Doctors Death

Right now I am watching a histrionic Representative Jim Jordan from Ohio rambling on hysterically about repealing Obamacare and what the plan is to replace this massive health care bill that has its failings until you realize that it is better than nothing, and the mantra is “free market.”  Yes clearly that concept works well with regards to health care.

How many people actually sit down research Doctors, Hospitals, Drugs, Procedures and sort through all the warm ads that tell you if you come to Heavenly your cancer care will be top notch.  Of course full disclosure of costs, the coverage by your insurer to actually cover the costs in a timely manner without constant phone calling, appeals and begging to get the records one needs to ensure that this procedure/Doctor/drug is in fact insured at all. Good times.

I just got a notice from an insurer declining a claim from August of last year while covering 4.90 cents of the charges. Okay then.

I want to point out that Obamacare does not cover dental or vision so any repeal or replace won’t either and that too is another major issue that will once again be ignored along with any meaningful change to the current miasma that defines the medical industrial complex.

In my former home town the Seattle Times did an investigative piece about the once stalwart Swedish Hospital and what has happened as it too became a part of the free market and was absorbed into another health provider – Providence – and how that has affected profits at the expense of patient care.

The reality is that money is the driver of health care and unlike most other countries it dominates a significant portion of our GDP and that is also why the costs are so flux and inconsistent throughout the country.  And in turn the quality of care is also an issue due to the same concept of free market that draws Physicians and Surgeons to one area or region and in turn leaving another area without sufficient or adequate care and coverage.  Health care is not a car and one does not have the option of shopping around for the best deal when one is sick or in need.  But hey that free market worked out well clearly as the article about Swedish suggests and the Doctors Oskouian or Delashaw or those who were treated by Dr. Death.

Texas neurosurgeon nicknamed ‘Dr. Death’ found guilty of maiming woman during surgery

By Travis M. Andrews The Washington Post The Morning MixFebruary 16 2017

When Mary Efurd woke from her surgery, she couldn’t stand.

Crippling pain shot through the 74-year-old’s body.

It shouldn’t be like this. The surgery to fuse two of her vertebrae, performed in 2012 at the Dallas Medical Center, wasn’t a difficult one. Her surgeon, Dr. Christopher Duntsch, had seventeen years of training and experience under his belt.

Still, something was clearly wrong.

Days later, she underwent surgery again, this time under the scalpel of Dr. Robert Henderson. What he found shocked him.

Spinal fusion hardware was left in her soft tissue. One of her nerve roots — the segment where a nerve attaches to the central nervous system — had been severed. Another nerve root had a screw in it. He found multiple screw holes, meanwhile, on an area of Efurd’s spine where they had no business being.

How had Duntsch messed up this badly?

Efurd didn’t know the surgeon’s background.

Duntsch, as described to Dallas magazine by his colleagues, was a confident man, perhaps too confident. He’d make statements like “Everybody’s doing it wrong. I’m the only clean minimally invasive guy in the whole state,” according to fellow surgeon Mark Hoyle.

Hoyle quickly learned this wasn’t true during the first and only surgery he conducted with Duntsch that became so botched, the incision so pooled with blood, it looked like Duntsch was “fishing in a pond at night, saying he was working by feel, not sight.”

That was a Nov. 2011 surgery on Lee Passmore, which left him a partially broken man. As Goodman wrote:

Lee Passmore can’t feel his feet. His right leg is as stiff as his pressed blue jeans, and when he walks, he appears to use his hips to heave it forward. He also vibrates — his chest shakes, his right hand jitters.

Hoyle canceled the remaining operations the two had planned together and refused to work with Duntsch ever again.

Now, no one will.

On Tuesday, after just four hours of deliberation, a Dallas County jury convicted Duntsch of aggravated assault for deliberately maiming Efurd. According to the Dallas Morning News, he faces life in prison.

Efurd, for one, felt justified by the verdict.

“I think it’s going to be like a floodgate that’s going to really open, crying. I’ll do some crying. And I’ll reflect back on how difficult those first months were afterwards. I had so much anger, because my life changed so much. I was very independent and I had to become dependent on others for transportation, for my meals, for a lot of things,” she told reporters at the court.

But she’s far from the only one who considers Duntsch’s conviction a deserved retribution.

Police originally accused Duntsch of causing the death of two patients and crippling four others between July 2012 and June 2013. In July 2015, he was arrested on five aggravated assault charges, but prosecutors eventually chose to focus solely on Efurd.

But there may have been many more. As Matt Goodman wrote in the Dallas magazine article that gave Duntsch the chilling nickname Dr. Death:

There was Kellie Martin, who died from massive blood loss after a surgery at Baylor Plano. There was Floella Brown, whose sliced vertebral artery triggered the stroke that killed her at Dallas Medical Center. There was Duntsch’s childhood friend, Jerry Summers, who woke up from a procedure unable to move his arms and legs. There was a dissection of one patient’s esophagus, and screws that an indictment labeled “far too long” that caused significant blood loss in another patient. One surgeon described these as “never events.” They shouldn’t ever happen in someone’s entire career. And yet they occurred in Duntsch’s operating rooms over a period of just two years.

Somehow, though, many of these were passed off as accidents, random mistakes. His medical license wouldn’t be suspended until 2013. Lawsuits besieged him; almost everyone quickly settled after signing nondisclosure agreements. Bizarre as that might be, it’s only half as strange as the conviction that ended up sticking.

“I cannot recall a physician being indicted for aggravated assault for acts committed during surgery,” Toby Shook, a Dallas defense attorney who spent 23 years working as a Dallas County prosecutor, told Dallas. “And not just Dallas County — I don’t recall hearing about it anywhere.”

What Duntsch’s motive might have been is anyone’s guess. Girlfriends and friends (or, more accurately, ex-girlfriends and former friends) relayed to Goodman stories of abuse and a social life (which often allegedly blurred into his work life) loaded with bottles of vodka, mounds of cocaine and sheets of LSD.

He reportedly behaved erratically. In a particularly long, rambling email he sent to one of his employees, which was published by the Dallas Morning News, the doctor sounded delusional.

In one excerpt, he compared himself to both God and Satan:

Anyone close to me thinks that I likely am something between god, Einstein and the antichrist. Because how can I do anything I want and cross every discipline boundary like its a playground and never ever lose. But unfortunately, despite the fact I am winning it is not happening fast enough.

In another, he announced plans to become a murderer:

You, my child, are the only one between me and the other side. I am ready to leave the love and kindness and goodness and patience that I mix with everything else that I am and become a cold blooded killer.

Whatever his motive, his alleged victims may have finally found peace. In a taped interview with the Dallas Morning News, 45-year-old Philip Mayfield, who awoke from a surgery paralyzed, said “I am very well pleased that he will remain in jail and that justice will eventually be served for the crimes he committed

Tale of Two Lawyers

Ah if Charles Dickens was alive would his subjects be these men? Lawyers are the reason we have well what we have. Their obsession and adversarial nature has led to a corruption of procedure and process – from elections to worker’s safety.

Perhaps Dr Suess could come up with a new book – I Am a Crook, I know I am.

Enjoy the tales of these two lawyers, I only hope more will follow.

A Manhattan Lawyer’s Slip and Fall

By BENJAMIN WEISER
THE NEW YORK TIMES
MAY 21, 2016

Stuart A. Schlesinger spent half a century building a reputation and a practice as a personal injury lawyer in New York, representing clients in lawsuits and negotiating settlements on their behalf. But when he appeared recently before a federal judge in Manhattan, he found himself in an unfamiliar position for a lawyer: He was the defendant.

Mr. Schlesinger, 76, had been arrested on a fraud charge in one of the more brazen schemes in the annals of New York law: He settled lawsuits on behalf of clients, sometimes for $1 million or more, and then simply kept much of the money for himself.

When his clients complained that they had not received the proceeds of their settlements, Mr. Schlesinger responded with a litany of excuses. “We are short-staffed,” he said in an email to one client, Kenneth Lawler, a British man who was owed more than $900,000 from the settlement of a medical malpractice lawsuit stemming from the death of his son in a New Jersey hospital. “Our phones and computer systems were down,” Mr. Schlesinger wrote in another email to Mr. Lawler. “Sorry for the delay,” he said in a third email, adding strangely, “Waiting for our golf game.”

Mr. Lawler, 63, said that now, four years after the settlement was reached, he had not yet received a penny. “It’s a betrayal,” he said.

That day in Federal District Court in Manhattan two weeks ago, Mr. Schlesinger admitted to the judge, William H. Pauley III, that he had improperly withheld money from settlements since 2008 and had used it for his personal benefit.

When the judge asked how much money he had taken, he replied, “Approximately $5 million.”

Several former clients watched silently in the courtroom as Mr. Schlesinger pleaded guilty to the fraud charge, which carries a maximum prison sentence of 20 years.

Mr. Schlesinger has never explained what happened to his clients’ money, and his lawyer, Murray Richman, declined to let him be interviewed. Mr. Richman said Mr. Schlesinger had decided to plead guilty because he wanted to see his former clients repaid. “He’s making every effort toward restitution,” Mr. Richman said. “He’s selling everything he’s got.”

One asset he has agreed to forfeit is an eight-bedroom house on five and a half acres in Quogue, on Long Island, which is listed for sale at $11.5 million and is advertised as having a pool and a hot tub overlooking the ocean.

Mr. Schlesinger is also no longer practicing law. Last year, after a lawyer disciplinary committee moved for his immediate suspension, he agreed to surrender his law license and was disbarred. But his case has put a harsh spotlight on the process of discipline for lawyers in New York, which is conducted in total secrecy until a public sanction, like a suspension or disbarment, is imposed.

In Mr. Schlesinger’s case, that process took a full year, during which he continued to represent clients, even filing at least one medical malpractice suit.

It could not be learned when the disciplinary authorities began receiving complaints against Mr. Schlesinger. Several months before the committee opened its investigation in September 2014, for example, it received — but did not pursue — a complaint from a Queens resident. New York court officials, citing confidentiality laws governing investigations into misconduct by lawyers, declined to say when the committee had received its first complaint against Mr. Schlesinger, how many complaints were filed or what they alleged.

David Bookstaver, communications director for the state court system, said, “It would require legislative action to change the law as it pertains to secrecy or transparency in attorney disciplinary proceedings.”

Many questions remain about Mr. Schlesinger’s fall, but there is little doubt about the ripple effect beyond his clients. His longtime law firm, Julien & Schlesinger, closed, and a small collection of partners and associates, including at least one of his sons, had to find work elsewhere.

Mr. Schlesinger earned his law degree from Fordham University in 1964 and joined a small law firm, where he eventually became a partner with a prominent personal injury lawyer, Alfred Julien. Their firm continued to bear both of their names after Mr. Julien’s death in 1989. Lawyers who had worked at the firm either declined to be interviewed for this article or did not respond to messages seeking comment.

Joseph L. Forstadt, a retired partner at the law firm Stroock & Stroock & Lavan who is a longtime friend of Mr. Schlesinger’s, said that he had occasionally referred personal injury cases to him and that Mr. Schlesinger had “a great reputation” for being able to win favorable settlements for clients. “Stuart was known as the guy who could sit down with insurance companies and get the best deal possible,” Mr. Forstadt said.

Mr. Schlesinger also taught as an adjunct professor at New York Law School, and for a time he wrote a column for The New York Law Journal.

When Mr. Schlesinger was arrested in December, he was released on a $1 million bond, which was secured by the Quogue property. His wife, Linda Schlesinger, a real estate agent, and a first cousin, Stephen Lefkowitz, a Manhattan real estate lawyer, signed the bond as guarantors.

“I got a call from his wife saying he was in this difficult situation and would I help,” Mr. Lefkowitz recalled. “And of course I did.”

Mr. Lefkowitz, 78, said that although he had known Mr. Schlesinger since childhood and their families were close, he knew little about his cousin’s legal practice and had been surprised at the news of his arrest.

The lawyer disciplinary committee, one of a number of such panels run by the state court system, has said that Mr. Schlesinger’s misconduct “came to the committee’s attention” through complaints from two clients that arrived on Sept. 2, 2014, according to a confidential legal motion later filed by the committee seeking his immediate suspension. (The motion was released last year after he was disbarred.) The two clients complained that Mr. Schlesinger owed them a total of $66,000 in settlement money, and an investigation “ensued immediately,” the motion said.

But the committee had in fact received an earlier complaint, involving a larger unpaid settlement, which it decided not to pursue. In June 2014, Albin F. Luczak of Queens complained to the committee that Mr. Schlesinger had not paid him his share of a $1.5 million dental malpractice settlement.

Mr. Luczak said in an interview that he had been the victim of medical negligence during a root canal that had required him to undergo several surgical procedures, including the removal of muscle in his neck. Mr. Schlesinger sued on his behalf and settled the case in fall 2013.

Under a retainer agreement, Mr. Luczak was owed about $1.1 million after Mr. Schlesinger took his legal fee.

But despite repeated requests, Mr. Luczak said, Mr. Schlesinger did not send him his share. Mr. Luczak recalled that when he and his wife visited Mr. Schlesinger’s office, the lawyer said: “Please trust me, please trust me. I’m treating you like family members.”

In March 2014, Mr. Luczak retained a new lawyer, Dustin Bowman of Kew Gardens, Queens. After trying unsuccessfully to resolve the problem through phone calls and emails, Mr. Bowman sued Mr. Schlesinger on Mr. Luczak’s behalf and helped him file a formal complaint with the disciplinary committee.

“I am writing to complain about a very serious matter,” Mr. Luczak wrote to the committee on June 13, 2014. He attached copies of the retainer agreement and his lawsuit against Mr. Schlesinger.

Two months later, Mr. Luczak received a letter from Jorge Dopico, the committee’s chief counsel, informing him that because of Mr. Luczak’s pending lawsuit, the committee would “defer further investigation at this time.”

According to the committee’s website, it does not investigate lawyers in cases in which a lawsuit is pending on a similar issue.

Mr. Bowman said he was shocked that the committee did not pursue the matter, given the amount of money Mr. Luczak was owed and what Mr. Bowman saw as an easily provable allegation.

On Aug. 22, 2014, Mr. Bowman wrote directly to the committee, saying that Mr. Luczak was complaining of “very serious ethical violations” concerning the mishandling of client money and was “imploring you to keep the docket open and inquire into this matter.”

Mr. Bowman said he heard nothing from the committee for nine months. Then in May 2015, he received a call from a committee lawyer. Mr. Bowman said he expressed surprise to the lawyer that the committee had not followed up on Mr. Luczak’s complaint and that it had taken so long to respond to his own letter.

According to Mr. Bowman, the lawyer did not offer a satisfactory explanation, except to suggest that the committee was understaffed and had a large backlog.

Mr. Luczak said that he and his wife had concluded at the time that what Mr. Schlesinger had done to them, he had also quite likely done to others. In early 2015, Mr. Luczak said, he contacted the Federal Bureau of Investigation, and within a week, a special agent, James H. Hilliard Jr., came to his home to interview him and to collect copies of his papers. Within a day, Mr. Luczak said, the F.B.I. called him to say it would open an investigation — apparently the inquiry that led to Mr. Schlesinger’s arrest.

Mr. Luczak, 56, said recently that he had yet to receive any part of his settlement, more than two years after it was completed. “Nothing — zero,” he said.

In November 2014, two months after the disciplinary committee began its investigation, Hal R. Lieberman, a lawyer representing Mr. Schlesinger in the misconduct inquiry, wrote to the committee and asked that his client not be penalized.

Mr. Lieberman described Mr. Schlesinger as a “distinguished” lawyer who had practiced “without a blemish for 49 years,” adding that, but for his “extraordinary efforts, there would be no settlement funds to begin with.”

On March 10, 2015, Mr. Schlesinger gave a deposition to the committee in which he expressed remorse for his actions. “I 100 percent acknowledge what I did,” he said. “I did wrong.”

But less than two weeks after making that statement, Mr. Schlesinger filed a new lawsuit, a medical malpractice case, on behalf of Zdzislaw Oleszkiewicz of Queens, to whom he already owed $33,000 from the settlement of an earlier claim.

“I never imagined I could be so taken advantage of,” Mr. Oleszkiewicz said through an interpreter.

In May 2015, the committee filed its motion seeking Mr. Schlesinger’s immediate suspension, citing evidence and his admissions that he had misappropriated settlement money from at least 16 clients.

Victims of Mr. Schlesinger’s scheme said they were uncertain as to whether they would ever recover their lost money, through Mr. Schlesinger’s restitution or other means. Cheryl Parisi, a Staten Island resident who said she was still owed about $60,000 from a medical malpractice settlement, recalled that one of Mr. Schlesinger’s checks had bounced.

Mr. Lawler, who is still owed his share of the 2012 settlement from the lawsuit stemming from the death of his 32-year-old son, Scott, said Mr. Schlesinger’s actions had left him aghast.

Scott Lawler, who had worked as a software developer at Barclays Bank in Manhattan, died after abdominal surgery at a New Jersey hospital, the lawsuit said.

Mr. Schlesinger’s former clients may seek compensation from a special client protection fund that reimburses people whose lawyers have stolen their money, but the awards are capped at $400,000 per client, meaning that people like Mr. Luczak and Mr. Lawler would not fully cover their losses. Others have followed Mr. Luczak’s path and have sued Mr. Schlesinger. Dolores Nordone of South Salem, N.Y., is owed more than $300,000 from her share of an $850,000 car-crash settlement reached six years ago, according to her lawsuit.

Ms. Nordone, 73, a former accountant, said that the accident had resulted in incessant lower back pain, requiring three surgeries, and that she could no longer work. “Words can’t really explain how I feel,” she said. “You put your trust in someone who you believe is going to help you, and it’s unbelievable.”

Her lawyer, Arnold N. Kriss, who went to the courtroom to see Mr. Schlesinger plead guilty this month, said, “I felt embarrassed as a lawyer to sit there.”

When his $5 million Ponzi scheme collapsed, a N.Y. lawyer tried to kill himself. He survived — but so did his confession.

The Washington Post
Michael E. Miller
May 23, 2016

Charles Bennett leaves the federal courthouse in Manhattan on May 19, 2016 after being sentenced to five years in prison for running a more than $5 million Ponzi scheme. © REUTERS/Nate Raymond Charles Bennett leaves the federal courthouse in Manhattan on May 19, 2016 after being sentenced to five years in prison for running a more than $5 million Ponzi scheme.

Charles Bennett stood on a Manhattan pier and stared at the cold, dark water below.

Once a successful lawyer at a powerful firm, he was now a wreck. His once promising career had been consumed by addiction. Meetings with clients had given way to bottles of liquor and 8-balls of cocaine, his lawyer would later admit in a court document. When his attempt at starting his own practice failed, he burned through his savings, then began duping friends and family members into investing in a Ponzi scheme. He even stole from his own mother.

By Nov. 3, 2014, Bennett’s fraud was quickly unraveling. That morning, an investor again demanded his $100,000 back.

“Sorry but let’s talk after I have confirmed the wire … which shall be done this afternoon as promised,” Bennett replied in an email.

But Bennett was bluffing. There would be no wire transfer. He had already spent the money on drugs, fine dining, vacations and his girlfriend, authorities would later determine. And instead of going to the bank, Bennett took some sleeping pills, washed them down with vodka and went to the pier.

Then he jumped.

As he sank into the Hudson River, Bennett left behind more than 30 victims and a web of deceit worth more than $5 million.

He also left behind a suicide note saying he could no longer bear “the pure emotional weight of the guilt I feel.”

His heart stopped. He was dead: another financial fraudster fleeing justice in this world for forgiveness in the next.

But then he came back.

New York Police divers pulled Bennett from the river and performed CPR, restarting his heart, pumping air into his water-logged lungs and rushing him to the hospital.

When investigators searched his West Side hotel room, however, they found his 16-page suicide note, titled “A Sad Ending to My Life.”

Instead of a sad ending to life, the note would mark the painful beginning of a new one for Bennett. Armed with his confession to running “a huge Ponzi scheme envelopping [sic] my family and closest friends,” prosecutors charged him with fraud. In Oct. 2015 he pleaded guilty.

“I am deeply, deeply ashamed by my conduct,” he said at the time, according to Reuters.

On Thursday, Bennett’s life and near death came full circle. He appeared in court looking more like his old self, dressed in a dark suit and sporting a tie. Over the past 18 months, he had moved into his mother’s basement in the St. Paul, Minn., gotten sober and tried to atone for his crimes by teaching English to immigrants. Family members he had bilked said they forgave him.

“The moment I first saw him in the hospital … when he became conscious I saw the agony of his suffering visible on his face and when I looked into his eyes, I saw his deep remorse, shame and sorrow, a remorse so deep, he took his life believing that even his own mother wouldn’t love him,” his mother wrote in a letter to the judge.

But other victims had not forgiven Bennett. They called him a “narcissist” and a “manipulator” whose plunge into the Hudson wasn’t a suicide attempt but a ploy for sympathy.

Which way would the judge see it? Would Bennett be forgiven, or sent to prison?

Several fifths of liquor and an 8-ball of coke

To his friends and family back in Minnesota, Charlie Bennett was the Midwestern boy who made it good in Manhattan. That’s why many of them didn’t think twice about handing him their money.

Bennett’s childhood in St. Paul wasn’t bucolic, however. His father was an alcoholic and his mother suffered from bipolar disorder, according to a letter his lawyer sent to the judge ahead of sentencing. His parents got divorced when he was young, leaving a teenage Bennett to bounce between homes and schools.

But Bennett was smart. He earned a BA and MA from the University of Florida, then a law degree from Boston University, working part-time to pay for all three, according to the letter. After law school, he snagged a job in New York City as an associate at Skadden, Arps, Slate, Meagher & Flom, one of the biggest law firms in the world. He rubbed shoulders with other up-and-coming attorneys, including Silda Wall — at the time, the wife of Attorney General and future governor Eliot Spitzer.

When he tired of New York, he moved to Paris to work for another top firm, then it was back to Manhattan to join Proskauer Rose, another huge law practice.

“His family and friends back home watched with awe and pride at Charlie’s life trajectory — from a small town Midwestern boy to a successful New York City lawyer,” his public defender, Julia L. Gatto, wrote. “So much of his personal worth and value was derived from his family and friends’ image of him as a success.”

“Charlie was driven, rising above the fray, always pushing himself, making it on his own, successful but never taking an easy path because he wanted to learn more, experience more,” his younger sister, Kelly B. Joyce, wrote in her own letter to the judge.

In 2000, Bennett quit Proskauer Rose to start his own practice. It was supposed to the peak of an already soaring career.

Instead, it was the beginning of his downfall.

For years, Bennett had propped himself up with alcohol and cocaine, according to his lawyer.

“Things were not exactly as they appeared,” Gatto wrote. “In New York, Charlie was lonely and depressed. His family had a history of mental health issues and it appears that Charlie carried this legacy. He was also addicted to cocaine — a sometimes daily habit for him — and he was an alcoholic who regularly engaged in binge drinking.

“During binge episodes, Charlie typically consumed several fifths of liquor and, at least, an ‘8-ball’,” or 3.5 grams of cocaine, Gatto said. “As he watched people around him couple off and start families, Charlie was emotionally unable to form that kind of connection. Charlie was suffering from severe and undiagnosed clinical depression. Nevertheless, he always presented as together and happy.”

With his drug use accelerating and his law firm imploding, Bennett burned through his savings. But he was too proud to ask for a loan.

“In a cloud of cocaine-use, alcohol dependency, and significant mental health issues, Charlie proposed an ‘investment opportunity’ to a handful of friends and family,” Gatto wrote.

According to prosecutors, Bennett pretended to have personal connections to important people involved in European real-estate mortgage-backed securities deals with extraordinarily high yields. Eliot Spitzer was one of his investors, he claimed.

To his friends and family members back in the Midwest, it looked like the golden boy had found the goose that laid the golden egg. Many signed up, including his mother, brother, two sisters, and an aunt. He emailed them frequently with updates on their fake earnings.

“Blimey you are getting close to $1mil!” he wrote to one close friend who eventually lost $600,000 in the scheme, according to the complaint.

He also coaxed his investors to give ever increasing amounts.

“Yo, huge game changer 10 day deal,” he wrote to another investor, identified in the complaint as Victim 3. “It’s going to be a gangbuster I am sure (25%+ return is our model…).”

According to investigators, Bennett spent that ill-gotten money on vacations and expensive hotels.

According to his lawyer, however, “at no point did Charlie grow rich off the scheme.” Instead, she says, he spent the money on his spiraling drug addiction.

Whether or not he ever intended on paying back his creditors is up for debate.

“In his diminished mental state, Charlie genuinely believed he would figure out a way to pay back the money with interest,” Gatto wrote in her letter to the judge. “Since boyhood, Charlie had used his brains and skill with positive results. He went to good schools, earned top grades, and excelled at prestigious jobs. With blind and irrational ego, he assumed he would figure it out here too.”

The end of the pier

Bennett never did figure out how to make his investors whole again. And on the morning of Nov. 3, 2014, his house of cards came tumbling down around him. Victim 3 was demanding his money back. Other investors were also antsy. From his hotel room on the West Side, Bennett stalled for time, emailing Victim 3 that he would wire the money that afternoon.

Instead, he penned his suicide note.

“A Sad Ending to My Life,” began the 16-page handwritten note.

“I have systematically over the course of five years or so perpetrated a huge Ponzi scheme envelopping [sic] my family and closest friends,” he wrote. “I managed to completely squander the hard earned money that my family and dear friends managed to set aside over the course of their working lives.”

Saying that he was weighed down by guilt, Bennett came clean before jumping into the Hudson. “To be clear about this: the whole… investment scheme that so many thought was real was in fact a complete… fiction of my crazed imagination… It was all an illusion… The bulk of the funds were used in classic Ponzi scheme fashion to pay off other supposed ‘investors’ and my absurd lifestyle. All the while pretending I was making everyone wealthy with absurd returns on their money…

“It was a Ponzi scheme pure and simple.”

After “drugging” himself with vodka and sleeping pills, Bennett then walked to the pier and jumped in.

His family members and attorney claim Bennett’s suicide attempt was about accepting responsibility for his scheme.

“Suicide was not an escape from his crime, it was to protect us and because he was convinced that we would really want him gone,” his sister, Kelly Joyce, wrote later.

To his critics, however, Bennett’s plunge was every bit as calculated as the Ponzi scheme he had pulled off for half a decade.

Bennett happened to dive in the river right near the NYPD’s SCUBA team, the New York Post pointed out.

“He’s such a manipulator,” John Hanson, one of Bennett’s victims, told the newspaper. “His goal was to get attention and hope everyone feels sorry for him.”

“I think he’s a narcissist who’s trying to beat the system,” said Brendt Mullan, another victim.

“There was no cloud of cocaine,” a third victim, Mark Loader, told the Post, of the Ponzi scheme. “It was calculated. It was premeditated. He was sober.”

If Bennett’s plunge into the Hudson was a fake suicide, then it came dangerously close to working. According to his attorney, his heart stopped working while in the water. Once at the hospital, his lung collapsed and he went into “respiratory arrest.” For several weeks he was in and out of intensive care with pneumonia and fluid in his lungs. Psychiatrists diagnosed him with severe depression.

As he was recovering, federal prosecutors charged him with operating a $5 million fraud and froze what little assets he had left.

When Bennett bonded out of jail, he was allowed to move to his mother’s house back in St. Paul. The prodigal son had returned, and now he was broke, living in the basement and taking care of his aunt’s dog. He volunteered at a community center, teaching English as a second language. He attended court-mandated drug counseling, where he admitted to being an alcoholic. He even decided to reach out to a woman with whom he believed he had fathered a child years before. Above all, he apologized to the family and friends he had betrayed.

“As I have told him myself, I forgive him,” wrote Toni Lasorella Murphy, one of his sisters and also a victim. “I sense that he feels little reason to believe that I truly forgive him — his remorse is heavy on his heart and I think it prevents him from accepting my forgiveness.”

“Taking his life was not about escaping his responsibility,” his mother wrote, “for all I have seen him do since that moment of consciousness [in the hospital] is take responsibility.”

With his suicide note functioning as a full confession, Bennett had little option but to plead guilty in October.

That left only sentencing. Bennett faced a broad range of possible sentences, from the maximum of 20 years in prison to the prosecutors’ recommendation of five years to the one year asked for by his attorney.

His fate was in the hands of the Honorable Laura Taylor Swain, federal judge for the Southern District of New York.

A judge’s decision

On Thursday, Bennett appeared in court appearing every bit the lawyer he once was. He wept as family members asked Swain not to send Bennett to prison, arguing that he was sorry and could better pay back his victims if free and working.

But other victims told Swain that prison time was only right for swindling them out of their savings.

“The scar is too deep, but prison time will help with the healing,” Hope Mullan told the court, according to Reuters. Brendt Mullan, her relative, said he was evicted after losing his money to Bennett’s Ponzi scheme.

“Fifteen to 20 years in jail would be optimal for my sense of justice,” he said, according to the Post.

Bennett did not argue with his detractors.

“Why did I do this? I don’t know. I’m a criminal. I’m a thief, I’m a liar,” he told the courtroom, according to the Post.

Perhaps, it was part of his ploy to gain sympathy. Or perhaps it was genuine self-loathing over what he had done to his friends, his family, even his own mother.

“I didn’t run anywhere except off a pier,” Bennett added, according to the Associated Press. “I just thought that’s what you do when you steal from your own mother.”

“I just can’t say enough how sorry I am,” he concluded. “I deserve to be punished.”

Swain agreed. On May 19, she sentenced Bennett to five years in prison.

Ollie the Ostrich

Once again another failing of our medical industrial complex. First the story of the woman with locked in syndrome who could hear every negative thing her Physician team sad about her case. And subsequent denials that this too place by the Physician with a finger pointing to some “others” who may have been negligent in their professionalism. I am sure denial is a common daily mantra in most hospitals.

Then I read this article about how post discharge is the most dangerous time for a patient (why yes on this I can speak from personal experience) and until we get nationalized health care a patient bill of rights I suspect this will continue.

Hospital discharge: It’s one of the most dangerous periods for patients
By Jordan Rau
The Washington Post
April 29 20126

Joyce Oyler died because of medication mistakes by a Missouri pharmacy and home health agency. Her daughter, holding the photo of her mother and aunt, says the error “should have been caught about five different ways.”

Within two weeks of Joyce Oyler’s discharge from the hospital, sores developed in her mouth and throat, and blood began seeping from her nose and bowels.

Her daughter traced the source of these problems to the medicine bottles in Oyler’s home in St. Joseph, Mo. One drug that keeps heart patients such as Oyler from retaining fluids was missing. In its place was a toxic drug with a similar name but a different purpose, primarily to treat cancer and severe arthritis. The label said to take it daily.

“I gathered all her medicine, and as soon as I saw that bottle, I knew she couldn’t come back from this,” said Kristin Sigg, the younger of her two children. “There were many layers and mistakes made after she left the hospital. It should have been caught about five different ways.”

Oyler’s death occurred at one of the most dangerous junctures in medical care: when patients leave the hospital. Bad coordination often plagues patients’ transition to the care of home health agencies as well as to nursing homes and other professionals charged with helping them recuperate, studies show.

“Poor transitional care is a huge, huge issue for everybody, but especially for older people with complex needs,” said Alicia Arbaje, an assistant professor at the Johns Hopkins School of Medicine in Baltimore. “The most risky transition is from hospital to home with the additional need for home care services, and that’s the one we know the least about.”

Medication mistakes like the one in Oyler’s case — which slipped past both her pharmacist and home health nurses, according to court records — are, in fact, one of the most common complications for discharged patients. The federal government views them as “a major patient safety and public health issue,” and a Kaiser Health News analysis of government records shows such errors are frequently missed by home health agencies.

Between January 2010 and July 2015, the analysis found, inspectors identified 3,016 home health agencies — nearly a quarter of all those examined by Medicare — that had inadequately reviewed or tracked medications for new patients. In some cases, nurses failed to realize that patients were taking potentially dangerous combinations of drugs, risking abnormal heart rhythms, bleeding, kidney damage and seizures.

The variety of providers that patients may use after a hospitalization creates fertile ground for error, said Don Goldmann, chief medical and science officer at the nonprofit Institute for Healthcare Improvement. “This episodic care at different places at different times is not designed to keep the overall safety of the patient in mind,” Goldmann said.

One factor is the lack of organization and communication among these other parts of the medical system. Of the $30 billion that Congress appropriated to help shift the system to electronic medical records — to ensure better coordination of care and reduce errors across the board — none went to nursing homes, rehabilitation facilities or providers working with individuals in their homes.

“The systems are not adequately connected,” said Robert Wachter, a professor at the University of California at San Francisco who studies patient safety.

At any point, problems can occur.

At hospitals, federal data show that fewer than half of patients say they’re confident that they understand the instructions of how to care for themselves after discharge.

In nursing homes, case management frequently comes up short. A 2013 government report found more than a third of facilities did not properly assess patients’ needs, devise a plan for their care and then follow through on that.

And at home health agencies, failures to create and execute a care plan are the most common issues government inspectors identify, followed by deficient medication review, according to KHN’s analysis. Over the first half of this decade, 1,591 agencies — 1 in 8 — had a defect inspectors considered so substantial that it warranted the agencies’ removal from the Medicare program unless the lapses were remedied.

‘Devastating’ cancer drug

Oyler’s death in October 2013 shows how a fatal mistake can slip past multiple checkpoints. The 66-year-old retired safety manager left Heartland Regional Medical Center in St. Joseph after being treated for congestive heart failure, in which the heart fails to pump effectively, causing fluid buildup in the lungs, shortness of breath and swelling in the feet. She returned home as a hospital nurse telephoned the local Hy-Vee Pharmacy with eight new prescriptions. One was for the diuretic metolazone.

But the medications a pharmacy technician wrote down did not include metolazone. Instead, it listed methotrexate, which can damage blood cell counts, organs and the lining of the mouth, stomach and intestines. The drug is so potent that the Institute for Safe Medication Practices includes it among eight “high-alert” medications with consequences so “devastating” that they warrant special safeguards against incorrect dispensing.

Oyler’s prescription included daily-dosage instructions for the diuretic. Methotrexate is never supposed to be taken more than once or twice a week for patients not being treated for cancer, and almost always at a much lower dose.

Kristin Sigg discovered her mother had been given a highly toxic cancer drug, not a heart medicine, after her hospitalization. Joyce Oyler died less than three weeks later. (Travis Young/Austin Walsh Studio for KHN)

In a court deposition taken as part of the lawsuit the family brought, Hy-Vee’s pharmacist blamed himself for not catching the error. “For whatever reason, on that certain day, that didn’t trigger with me,” he testified. Hy-Vee argued that its safeguards were as strong as those at other pharmacies, although the pharmacy manager admitted in a deposition that “quite honestly, there was a breakdown in the system.”

The family’s attorney, Leland Dempsey, said court evidence suggested the drug mix-up was made by the pharmacy technician who took the prescription orders. “The pharmacy tech made numerous spelling errors on the drugs,” he said. “She had a dosage off on another drug.”

In February, a jury awarded Oyler’s family $2 million in damages from the pharmacy. The judge lowered the award to $125,000 because of Missouri’s cap for noneconomic damages in medical malpractice cases. Hy-Vee declined to comment.

Nurses overlook prescription mistake

Yet the error could have been snagged right as Oyler began getting care from Heartland’s home health care agency. Medicare requires home health agencies to examine details of a patient’s medications to ensure all the drugs match the prescriptions ordered, are being taken in the right dose and frequency, and don’t have negative interactions.

Still, neither of two Heartland nurses who visited Oyler at home stopped her from taking the wrong drug. Less than a year before, Missouri state inspectors had cited the agency for inadequately reviewing medications for three patients. State records show it had pledged to make improvements.

“Why they didn’t catch it was beyond me,” Oyler’s husband, Carl, said recently. “They had a printout from the hospital” with every medication correctly listed. “It was all there,” he said.

After 18 days, her family took her to North Kansas City Hospital, where doctors determined that the methotrexate had irreparably damaged her bone marrow’s ability to create blood cells. She died three days later of multiple organ failure.

“By the time we got her into the emergency room, essentially she had no blood cell count,” her husband recounted. “It was irreversible. It was a gruesome, slow, painful way to die.”

Heartland Regional Medical Center paid Oyler’s family $225,000 in a settlement last year, court records show. Mosaic Life Care, the name by which Heartland now operates, said in a statement that it is “consistently improving processes and adopting new technologies to further reduce risks of errors and to improve communication.”

“Most people don’t know this is a problem,” Sigg said. “They assume doctors are talking to each other, until they experience it, and it’s not the case.”

— Kaiser Health News

And it was on this note that I was sharing a horror story about a VA Hospital (in another city) and how they had released a patient after months of being in hospital, sent home via a taxi to an empty house with no caregiver, no food, with nothing that would assist in his needs for either long term care or recovery. It led the man to contact 911 and the operator so horrified about his request for someone to bring him food, she arranged with the police to deliver said food and also came along to prepare some as well. This story shows that at times good people are there despite the horror stories we hear of 911 Operators and Police, there are good ones to share as well.

The young lady I was telling this tale along with others about hideous Veteran hospital abuses, promptly informed me, “That is not what you call 911 for.”

What I wanted to say and what I said are not the same. I said yes I was but I thought it was great story about someone who tried to do more than what she needed to and that was a gesture of true kindness which you don’t hear enough of, while of course utterly demonizing the VA Hospital. What I wanted to say, “was yes I know but what was the man to do? Do you have any empathy or compassion at all?”

She then informed me that her mother was a 911 operator for 20 years and when people called with non essentials they were given a secondary number to call and that she would not be allowed to leave the call center and go to person’s home as it is liability and regulation issues. I decided to move on and say well this was small town and they may have different rules so I cannot comment.

So to prove that point that 911 is used inappropriately and again the VA seems to have no problem with that,  I shared story about our own local Veteran Hospital and former vet managed to drive himself there but could not walk nor get out of the car without assistance and when he called the hospital to tell him he was just outside the hospital, they told him to call 911 for assistance. So I asked her is that what you call 911 for?

She said yes as that the employees should not due to liability issues and workman comp issue, such as getting injured themselves while helping the man get out of his car, so of course they won’t. I asked why are they working there if they are not able to actually well help people? And her response they will just not without being sure that they are not injured and if they are they are covered by workman’s comp insurance.  Well that is good to know isn’t it?

I asked if that if it was an Emergency and an ambulance brought him then they are covered but not in an non emergent situation, despite the fact that there was no actual policy stated by the VA that justified that and that calling 911 seems to then make it an emergency when not so how is that policy?

She went on about workman’s comp and liability and that again her mother was a Government employee and there are many rules about protocol and procedure that dictate what workers can and cannot do. And my response is now you see why people are angry and believe that crushing the Government will actually be better for people and that private industry is the panacea we need for this despite again no proof that they are actually better either and in fact there is more than ample evidence to the contrary.

And oddly she agrees despite that her mother is in fact a long term Government employee and then she launched into  a criticism of why do they have VA Hospitals at all if the Government is not capable to providing a service then they should no longer do it. This is again another argument that requires reading understanding and seeking inquiry to the reasoning behind the VA failures. And like most other Governmental agencies it is about funding. That while the Government has no problem funding wars the true need of funding comes after the fact and that is akin to “entitlements” of which many in the chief seats feel should not be adequately done and so they don’t.

Our Congress ensures that Government doesn’t function.  It  doesn’t fund the IRS despite the fact that due to this million in taxes that we do need go uncollected; we fail to fund prisons so we outsource and force men and women to remain in incarcerated needlessly; we don’t fund education which is a prime factor in elevating one’s life and socioeconomic status and yet also claim that college is a necessity, leaving billions in student debt.  We don’t fund anything that the private sector has not mandated as necessary  And this same young lady claimed that the private sector was the reason space is being explored… well they are now as we no longer fund that program either and if anyone thinks the private sector is doing so for any reasons other than ulterior, think again.   Again a millennal that is sure the answer is not the goverment yet a family dependent upon for it income.. how well Rand Paulish.

She was having none of my belief that we are capable of having a functioning government  and I cannot tell if all of this is due to the Millennial constant need to be argumentative and be quasi libertarian socialists (meaning legal pot, love gays and have medicare for all but that is about it) or she is just one angry angry unhappy girl. I went with the later.

The contradictory and constant need to say one thing do another is also very much a character trait.  Espousing hate for unions while receiving the benefit of said unions, that 40 hr, 7 day workweek is one.  Not realizing that Education is in fact Socialist as are Public Libraries and Parks.

And millennial have never experience positive Government or workers Unions. They and their parents who are of the X generation are angry people who have only ever seen and experienced the exact opposite.  So to come of age in the era of neo liberalism, anger is badge worn with pride.  So for every argument there is another argument, for every solution there is a criticism.  If you wonder how we got where we got today, look to the left and the right to see the person next to you, they are an angry lot.

So what is the problem?  It seems to is be us but we are also the solution and it is a relatively simple one –  it’s called voting. From that we can and must demand change, not with money but with votes.  From offering those versus checks we can  demand overturning Citizens United, ending Lobbying and push the concept of public funding for elections.  All of these are possible but not without an army – of active voters.  

It is medal of honor for people in Seattle to be proverbial scolds under the guise of being liberal. Now with the advent of population growth related to the tech sector, a field dominated with the need to be adversarial and accusatory, it furthers the dynamic  to constantly reprimand and dismiss anyone who disagrees with them or they don’t understand. I work in the schools and see endless issue of this when it comes to truly helping kids learn, instead it is endless meetings, summits, groups and pledges that go nowhere. It is akin to a circle jerk where no one cums.

I feel badly in all my exchanges with people here as the negativity is palpable. I am honest and I am not one to pull punches but I like to focus on the good side, it may not seem that way in the blog but in reality there are solutions to problems but you have to be willing to do the heavy lifting – most people are not.

I think it is easier to be an Ostrich and live life with your head in the sand only today that sand is filled with social media, blogs and other Ostrich’s who reaffirm your beliefs, misconceptions and more importantly refuel your anger. Anger needs oil to feed the flames and there is a lot of gas in Ostrich air.

Press Record

This is what it has become in modern medicine, Doctors as adversaries. Regardless of a patient’s challenges, attitudes the reality is that Medical professionals are to treat each person equally and without bias as to not jeopardize their care. We know that is a lie.

We know that acronyms are used on charts to label a patient which affects care. We have read that is “okay” for Nurses and Doctors to laugh at you as it relieves stress, the endless danger of care through improper cleaning and maintenance of the building, equipment and the staff. We have heard of Doctors photographing patients during procedures and sexting people during others.  Yes this recording seems an unorthodox way to enter an operating room but the response by the hospital is quite orthodox.

 Patient secretly recorded doctors as they operated on her. Should she be so distressed by what she heard? 
 By Yanan Wang Morning Mix
The Washington Post April 7 2016

 Last summer, Ethel Easter wanted nothing more than to see a doctor. A hiatal hernia had caused her to suffer more than a hundred abdominal attacks within 24 hours, her stomach was bruised, and she found blood in her urine. The pain was excruciating, so Easter prayed that a surgery could be scheduled as soon as possible.

 The doctor who would be operating on her at Lyndon B. Johnson Hospital in Houston did not share her urgency. He told the 44-year-old Easter that she would have to wait two months, and Easter burst into tears. “I can’t do this for two months,” she cried. “I can’t do this anymore.” “Well, who do you think you are?” Easter recalled the doctor abruptly yelling back at her. “You’re gonna wait like everybody else.”

Shaken, Easter later went to see her family doctor, who told her that the surgeon had taken notes on their meeting and raised “red flags” about her attitude — “as if I was the problem,” Easter said in a phone interview with The Washington Post on Wednesday. The Harris Health System, to which Easter’s hospital belongs, said in an email statement that confidentiality laws prevented it from commenting on specific cases without the patient’s “written authorization.”

From the start, Easter was troubled that she didn’t trust her own surgeon, but she was in too much pain to cancel the operation. Then she had an idea: She would go through with the surgery — it was ultimately scheduled about a month later, for August — but she would sneak a recorder into the operating room so that her family could know what happened to her in case things went wrong. She had a “bad feeling,” after all. The audio recorder was the size of a USB drive.

At the time, Easter had braided extensions in her hair. When she was changing into her hospital gown, she put her hair up in a ponytail and stuck the recorder inside. “I was fearful,” Easter said. “I didn’t know if I was going to come out of the surgery, so I just wanted my family to know if something went on.”

 The surreptitious recording, parts of which she shared with The Post, became the most traumatic part of the experience. It began with the surgeon asking Easter about what happens to her when she takes penicillin. “When I was a baby, they said I swelled up,” Easter can be heard responding in the recording.

An anesthesiologist then arrived, and Easter grew silent as she was instructed to just “keep breathing. You’re doing perfect.” After Easter was sedated, the surgeon recounted their dispute to the other doctors.

 “She’s a handful,” he said in the recording. “She had some choice words for us in the clinic when we didn’t book her case in two weeks.” “She said, ‘I’m going to call a lawyer and file a complaint,’” he recalled with a laugh. (Easter said she never mentioned a lawyer.) “That doesn’t seem like the thing to say to the person who’s going to do your surgery,” another male voice retorted.

 The comments afterward became personal. The surgeon and the anesthesiologist repeatedly referred to her belly button in jest. “Did you see her belly button?” one doctor said, followed by peals of laughter. At another point in the procedure, the anesthesiologist appeared to refer to Easter as “always the queen,” to which the surgeon responded, “I feel sorry for her husband.” The surgeon also used the name “Precious” several times in a manner that Easter interpreted as racial.

 “Precious, yes, this is Precious over here, saying hi to Precious over there,” he can be heard saying in the recording, though it is unclear whom he is addressing. Moments later, he asked: “What do her eyes look like? You know the eyes are the windows to the soul.” After the doctors concurred that there had been many “teaching moments” that day, the anesthesiologist asked, “Do you want me to touch her?”

 “I can touch her,” the surgeon is heard saying. “That’s a Bill Cosby suggestion,” someone interjected. “Everybody’s got things on phones these days. Everybody’s got a camera.” “Do you have photos?” the surgeon asked a couple times. “[indiscernible] thought about it, but I didn’t do it.”

 While much of the exact dialogue is difficult to discern from the recording, Easter was distressed by what she believed to be its subject matter. She thought “Precious” might be an allusion to the 2009 movie of the same name, chronicling the life of an illiterate African American teenager who suffers childhood abuse.

 “He called me Precious, an African American obese woman who was raped by her father,” Easter told The Post. She also thought the comments about “touching” and Bill Cosby were suggestive, and according to her, the surgeon said: “I thought about touching her. I could take pictures.”

“To think that I’m lying there,” Easter said, “and they’re talking about touching me inappropriately. Sexually.”

 What bothered Easter the most were moments in the recording when, in her view, the doctors acted flippant about her health and well-being. She was disturbed that the surgeon talked on his cellphone at one point during the surgery, and even more so that he seemed unbothered by her penicillin allergy. He said in the recording that swelling and rashes were not severe enough reactions to preclude Easter from receiving Ancef, an antibiotic injection that causes side effects in a small percentage of penicillin-allergic patients.

 The surgeon suggested first giving Easter a small dose as a trial. This would prove an unfortunate decision. At the end of the recording, a groggy Easter can be heard telling a doctor that she was “itchy.” Shortly after the surgery, Easter said, her arms swelled up and started getting rashes, though her hernia was successfully repaired. Her husband brought her back to the hospital — this time to the emergency room, where she was treated for an allergic reaction. For several days, Easter said, she had trouble breathing.

These symptoms prompted Easter to listen to the recording. She was angered by what she found. “He jeopardized my life,” Easter said. “It’s just by the grace of God that I’m even alive right now. It was an unnecessary risk that he took with me.”

 Last fall, Easter sent the hospital a letter with her complaints with the recording attached. Stacey Mitchell, the administrative director of risk management and patient safety for the Harris Health System, responded by thanking her for providing them a copy of the recording “to better analyze your concerns.”

 “With regards to the recording, as I explained in my prior correspondence, we reminded the OR staff and physicians to be mindful of their comments at all times,” Mitchell said in a letter dated December. “After carefully listening to the recording that you provided, Harris Health does not believe further action is warranted at this time.”

 Mitchell also noted that the doctors in the recording are employees of the University of Texas Health Science Center at Houston, not of the Harris Health System. The UT Health system likewise told ABC News that it could not comment on the case because of patient confidentiality laws.

 Easter has not decided whether to initiate legal action against the doctors and hospital. She said currently she just wants to “let everybody know what was going on — make people aware of what was happening.” Morning Mix newsletter Stories that will be the talk of the morning.

 The experienced has changed Easter emotionally and psychologically, she said, and she now struggles with “trust issues.” “Even my husband has said that I’m not the same person he married,” Easter said. What did she hope would come out of making the recording public?

 “If I had it my way,” Easter said, “I’d like them to come forward and apologize. Come forward and say, ‘We took an oath, and we violated it.’ This is for all the workers and the doctors: Don’t do this. Just treat people the way they would like their mother, their sister, their wives to be treated.”

Spinning the Tales

Do you know who you’re going to, what they are going to do to you? Do you know? Well given the haphazard irregular ways records of Doctor’s disciplinary history or if they have ever been mentioned in a Malpractice suit is once again a function of state’s. And we know how great that differentiation is between states.  The reality is that even State run boards such as Washington States MQUAC, (perfect name) are highly protective about conventional Doctors and investigating claims.

The reality is that you have no idea who or what you are walking into. It is the same reasoning behind public schools, whatever does or more importantly does not affect you is irrelevant. Well surprise the membership in the greater community does and when this type of inadequate care, education, etc occurs the community suffers. The added costs, the burden it places on already overwhelmed systems pushes people further into the fringe and the medical debt in this case is passed on via bankruptcy. Gee you think you don’t pay for that? Wrong. Banks pass on those losses via higher interest rates, reduction in lending and closing of branches.

Doctors Behaving Badly.. makes a great band name.

For doctors behaving badly, which state’s the best? Team finds wide variation

March 23, 2016

These maps show states’ physician discipline rates by decile, with the states with the lowest rates of discipline in the darkest colors. Credit: University of Michigan

What happens when doctors misbehave? The answer depends a lot on which state they practice in, a new study shows. 

In fact, the percentage of doctors who get disciplined or pay a malpractice claim is four times less in some states than the percentage in other states, the research by a pair of University of Michigan Medical School researchers shows.

And since there probably isn’t a fourfold difference in the actual behavior of doctors, the reason for this difference lies in the wide variation between states in their regulations, procedures and resources for punishing doctors who do wrong.

Consumer advocates have noted variation between states’ physician discipline rates and standards in the past. But this study, published in BMJ Quality and Safety, is the first nationwide academic evaluation of the topic, and uses statistical techniques to more reliably calculate the actual situation in each state.

Delaware, Kentucky and Ohio came in with the highest adjusted rates for all disciplinary actions. But it’s the states with the lowest rates – such as Massachusetts, New York, Connecticut and Pennsylvania – that should probably look the hardest at their current standards, say the researchers.

“We don’t know what the ‘right’ rate of physician disciplinary action is, but no state should want to be in the extremes,” says John A. Harris, M.D., senior author of the new paper. “Patients assume oversight of doctors is well-regulated in all states, that all doctors are held to the same ethical standards and disciplined appropriately when needed. But there’s no central governing body, and there’s significant variation.”

Harris and his co-author Elena Byhoff, M.D., are both Robert Wood Johnson Foundation Clinical Scholars at the U-M Medical School and the U-M Institute for Healthcare Policy and Innovation.
This is the latest study of physician misbehavior by Harris, an obstetrician-gynecologist. He has also studied how the rise in female practitioners in his specialty has affected the rate of allegations of sexual misconduct against Ob/Gyn doctors.

National data reveals state variation

The data for the study came from the U.S. Department of Health & Human Services’ National Practitioner Data Bank, which covers all 50 states and the District of Columbia. The researchers focused on the most recent data available, for 2010 through 2014.
 

Since 1986, the NPDB has collected data from each state on actions that state medical boards take against doctors who have been shown to have done something wrong, from substance abuse and sexual misconduct to improper prescribing, fraud and negligence

The NPDB includes information about punishments ranging from minor fines or required monitoring, to major actions such as revoking or suspending a doctor’s medical license. It also includes information on payments made by doctors in response to malpractice claims, which the researchers used to create a measure of the malpractice climate in each state. It doesn’t include actions taken by individual hospitals that don’t get reported to the state medical board.

Hospitals, clinics, state medical boards and insurers routinely access the NPDB when making decisions about which physicians to hire, credential, license or include in their networks. Patients can’t access it, and public access to state-level information about individual physicians varies greatly by state, Harris says.

Harris and Byhoff combined all this with information on the number of physicians practicing in the state, to calculate a reliability-adjusted yearly state rate of all medical board disciplinary actions per 1,000 physicians.

For the U.S. as a whole, they show that there are 3.75 disciplinary actions each year for every 1,000 physicians practicing – including 1.15 serious disciplinary actions. But the yearly range among states was huge, from 7.93 disciplinary actions of any type per 1,000 physicians in Delaware down to 2.13 per 1,000 in Massachusetts, and from 2.71 major actions per 1,000 physicians in Delaware down to 0.64 in New York.

Medical boards make the difference

The researchers note that in each state, the medical board acts as a self-governing body, with wide discretion on what kind of punishment to dole out for violations of different sorts.

“In one state the punishment for a particular violation could be a fine, while in another state you could lose your license for doing the same thing,” says Byhoff. “It has implications for the ability of physicians to move from state to state,” if their punishment in one state is not enough to keep a hospital or practice in another state from hiring them.

The researchers hope their findings will be heeded by state regulators and medical boards. Factors such as how easy it is to make a complaint to a state board, how many resources a board has to investigate complaints, the actual makeup of the board including how many non-physicians are on it, and the standards for making a judgment and choosing a disciplinary action all play into the variation, they believe.

The U.S. is actually one of few countries that lack a national system for overseeing and punishing physician misbehavior. Australia recently changed over to one, after decades with each state or territory having its own medical board. Studying other countries’ systems compared with the state-level systems in the U.S. could yield further information about how to address variation and protect the public, Harris notes.

He asks, “Ultimately, don’t we want all doctors operating in the same ethical way, and being disciplined appropriately if they fail to do so?”

Whoops, My Bad

I read the most fascinating article where Doctors decided to actually unionize and federate with of all groups the American Federation of Teachers. All of this now coming at a time when the Supreme Court is examining the requirement to unionize in select professions and that profession – Teacher.

 I have long said that Doctors are unofficially unionized and their patronage group the AMA are one of the most powerful lobbyists and agents who have large voices and pocketbooks to mobilize their troops and get the legislators to do their bidding. They have been instrumental in some of the elements in the ACA (but frankly don’t like it either) they have added medical malpractice requirements embedded into large national bills,  as the continue to do locally to prevent individuals from filing malpractices cases.  Here in Washington all Malpractice must all go through mediation/arbitration and of course that panel is comprised of whom – medical doctors – and few if any do, they are dispensed prior in either Summary Judgement or settlement.

There are two areas that the AMA is obsessed with – Doctor’s insurance and Medicare payout rates –  the rest is about them and always about them. The sheer long white clad coats have committed more medical fraud on this country collectively and yet a group of Doctors actually stomped their feet to just say no, we actually want to care for our patients! How absurd, how dare they!

And then we have the rest…….

Doctors dismissed his pain as migraines. Then they said he had 24 hours to live.
 By Sandra G. Boodman Reporter
 The Washington Post January 11 2016

 A huge sense of relief washed over Brad Chesivoir when a Maryland emergency room doctor told him the good news: He had not suffered a heart attack or a stroke, as he had feared. Instead he was being discharged with a diagnosis of headache, although doctors weren’t sure of its cause.

Several hours earlier, on the day after Thanksgiving 2013, Chesivoir’s family had summoned an ambulance to their Montgomery County home after he became suddenly weak and unable to walk. But by the time he got to a hospital, the 60-year-old commercial property manager was feeling much better, walking and talking without difficulty.

 After undergoing CT and MRI brain scans as well as numerous blood tests, doctors sent Chesivoir home and advised him to follow up with his internist. View Archive Less than five weeks later, Chesivoir was back in a hospital, his life measured in hours. “He was teetering on the edge,” recalled Edward Aulisi, the chairman of neurosurgery at MedStar Washington Hospital Center, who treated him there.

The emergency room doctors had been partly right — but Chesivoir’s problem turned out to be every bit as life-threatening as a stroke or a heart attack. And in the intervening weeks two specialists who saw him had missed it.

 “You know, you’re lucky,” Aulisi recalled telling Chesivoir shortly after they met. Without emergency surgery, the neurosurgeon said, patients with his condition “are the people who go to sleep one night and don’t wake up.”

 Splitting headaches A few weeks before the Thanksgiving episode, Chesivoir had suddenly begun experiencing lightheadedness and tingling on his left side. “I felt as if I might not be able to walk or might collapse,” he recalled. When an episode occurred in a grocery store parking lot, Chesivoir’s first thought was that he was having a stroke.

 He got back in his car and examined his face in the mirror, unable to detect a facial droop that is a characteristic sign of stroke. The odd feeling passed quickly and Chesivoir, who had no underlying health problems that could predispose him to a stroke, felt reassured. He’d had similar episodes a few years earlier, but doctors had found nothing. This time his shakiness seemed more pronounced when he stood up after sitting. Chesivoir also began suffering from headaches. The doctors who reviewed his tests at the emergency room said the only thing of significance was evidence of a possible old brain bleed. Had he fallen or hit his head?

Chesivoir told them that he had banged his head on the mantel putting wood in his fireplace and while roughhousing with his teenage sons — but never hard enough to see stars or lose consciousness. “They didn’t seem too concerned about it,” Chesivoir recalled. Doctors told him they suspected his head pain was caused by either migraines or cluster headaches. After conferring with his internist, Chesivoir consulted a neurologist.

Looking at the images Chesivoir had brought with him from his ER visit, he recalled that she seemed concerned that something on his spine might be causing the tingling. She ordered more tests and scheduled a follow-up appointment for Jan. 21. But over the next few weeks, Chesivoir’s headaches worsened.

“I’d go to bed and wake up in the middle of the night feeling like flaming railroad spikes were thrusting into my skull,” he said. “But at that point I wasn’t too concerned, because so many tests had been done and there was nothing awful found. I figured it was some kind of headache” that could be treated with medication.

 On New Year’s Eve, while watching a movie at home, Chesivoir stood up, complained that his head hurt and pitched face forward onto a coffee table, briefly losing consciousness. His wife, Carole Klein, called an ambulance; by the time it arrived Chesivoir seemed to be functioning normally. He walked out of the house, met the crew in the driveway and sent them away saying he was okay.

 Klein, an intellectual-property lawyer, had grown increasingly worried about her husband. “The scariest thing was that it seemed like his personality was changing,” she recalls. “He just wasn’t right. Brad is very gregarious and outgoing. He became cautious and would look like he was on edge and afraid.”

 By Jan. 2, 2014, the headaches were worse. Chesivoir called the neurologist’s office and saw a second specialist — the first was out of town — who told him that his problem was most likely an atypical migraine, which is not preceded by the aura many migraine patients describe. “I thought, ‘Finally I have a diagnosis,’ ” Chesivoir recalled.

The neurologist prescribed amitriptyline, an antidepressant frequently used to prevent migraines. Chesivoir began taking the drug. A few days later, he telephoned the new neurologist after developing double vision in his right eye. “We see this with this medication,” Chesivoir remembers the doctor saying. “Cut the dose in half.”

On Friday, Jan. 11, Chesivoir called the doctor again, minutes after his office opened. His double vision was worse and accompanied by zigzag lines; he was terrified that he was going blind. “I stressed to the doctor’s assistant who took the call that this was very serious,” said Chesivoir, adding that he was assured that the doctor would call him back. Chesivoir said he never heard from the neurologist. ‘Don’t stop anywhere’

 On Monday morning Chesivoir called his wife’s ophthalmologist, who agreed to see him; she had an opening in her schedule that morning. Klein drove her husband to the office. Minutes after the doctor peered into Chesivoir’s dilated eyes, she issued terse instructions to Klein: Drive straight to the emergency room at Washington Hospital Center, where she was on staff. Don’t go home first or stop anywhere en route. Chesivoir had papilledema, a badly swollen optic nerve caused by excess pressure on his brain, and needed immediate attention. When they arrived, Chesivoir said, the ER was a zoo. (The ophthalmologist later told Chesivoir she regretted not calling an ambulance, which would have expedited his admission.) He and Klein were sent to a bay to wait for a doctor.

On the other side of the curtain was a family whose members began loudly playing cellphone ring tones. “I lost it and started screaming at them that my head was about to explode and to please keep it down.” Chesivoir was admitted several hours later, after undergoing MRI and CT scans.

 He was told he would be meeting with Aulisi, the neurosurgeon on call. Aulisi minced no words. Chesivoir had suffered a brain bleed, an acute subdural hematoma, which had grown so large it was now the size of an adult’s palm. Without brain surgery, which Aulisi planned to perform first thing the next morning, Chesivoir would probably die. Scans, including those performed on Thanksgiving weekend six weeks earlier, showed evidence of multiple bleeds, some old and some recent. Blood was pressing on brain tissue, causing his visual disturbances, weakness and searing headaches.

 A subdural hematoma occurs when blood pools in the space between the dura, which covers the brain, and the surface of the brain. It frequently results from a head injury that can occur during a fall; in some cases the bump is so minor patients don’t remember it. In other cases there is no bump at all. Aulisi remembers one patient who developed a serious brain bleed after a violent sneeze.

 “It’s a closed space, like a pressure cooker,” Aulisi said. A buildup of pressure in a confined space can cause the brain to herniate, or shift from its proper position, which is often fatal. “They basically missed it,” said Aulisi of the brain bleeds, adding that diagnosis is easier in retrospect.

 One reason for the error, he speculated, is that a neurosurgeon did not read the original scans. A radiologist who read Chesivoir’s CT scan raised the possibility of old bleeds, but other doctors did not pursue that. By the time Aulisi saw Chesivoir, there was no choice other than surgery. Klein said he told the couple that Chesivoir probably had less than 24 hours to live when he reached the ER.

“I just sort of felt like I was waiting for the inevitable,” Chesivoir recalls of the night before his operation. Klein remembers feeling terrified and trying to calm their children, who were then 16 and 20. The surgery went well. In the recovery room, Chesivoir said, he “felt so much better that I hadn’t realized how bad I had felt.” Recovery was arduous and involved lying flat on his back for two days.

 At one point Chesivoir suddenly became confused, triggering fears that he might have suffered cognitive damage, a known complication of the surgery, or another bleed. But the confusion resolved within hours and was chalked up to postoperative swelling. Click here for more information! “That was the scariest part of the whole episode,” Chesivoir said. “I wasn’t that afraid of dying, but I didn’t want to be a burden on my family.”

Several weeks after he was sent home, Chesivoir, whose hobbies include photography, was taking pictures again, his vision dramatically improved. After three months he had fully recovered. The ordeal was life-changing, he said. “

When things bother me now I just have to remind myself that in the continuum of problems, this is very small.” Klein said that her husband’s experience has shaken her faith in doctors. In retrospect, she said, she’s not sure what else they could have done.

 “There was nothing different to do,” she said. “We had gone to an ER and seen two neurologists. I felt like we covered the bases. There were so many misses.”

Happy New Year?

When one is pronounced dead you want to be assure its been confirmed, sort of like Santa’s list where at least it’s confirmed twice. Apparently no.

This is not just about aging and terminal illness with regards to end of life care; that should be part of wellness care and in some actual cases and hospitals has a set of protocols and demands that should take many factors into account with regards to the patients best interest.  Those should include  that confirmation part by the patient, if conscious/rational and able to consent,  the family, as well as an unbiased individual advocate deigned to provide balance, legal obligations, etc.  Yes a “para lawyer” a cross between a moron, whoops I mean, Social Worker and an Asshole, whoops I mean Lawyer.

But what if you are dead but not.  Well that one is a little tougher.  I think it does depend on the hospital but also frankly once again the money train.  For that is what really defines care or death upon arrival at a hospital.  And of course malpractice insurance.  Speaking to a former air transporter for medical evacuations done, he was told to make sure that NONE died enroute.  The reality was even when dead they weren’t declared as such until admission.  Harborview Medical Center that contracted with the group, and also run by its Chief Trauma Manager, wanted to ensure that options could be made and payment guaranteed.   No conflict of interest what.so.ever and not for any other purpose as such as teaching as Harborview is not just a public and trauma designated hospital, it is a teaching one. It is a three way in everything but the good sense and explains the discrepancy and irregularity of care.

So yes it definitely depends on the hospital and of course the dead or not dead.  That is the question.

When are you dead? It may depend on which hospital makes the call.

By Sarah Kaplan 

The Morning Mix

The Washington Post

December 29 2015

The narrow, inscrutable zone between undeniably still here and unequivocally gone includes a range of states that look like life but may not be: a beating heart, a functioning digestive system, even moving fingers and toes. Death is less a moment than a process, a gradual drift out of existence as essential functions switch off, be it rapidly or one by one.

It was exactly midnight when Colleen Burns was wheeled into the operating room at St. Joseph’s Hospital Health Center in Syracuse, N.Y. She had been deep in a coma for several days after overdosing on a toxic cocktail of drugs. Scans of electrical activity in her brain were poor, and oxygen didn’t seem to be flowing. Burns was brain dead, her family was told; if they wanted to donate her organs, now was the time to do it.

But there, under the bright lights of the prep room in the OR, Burns opened her eyes. The 41-year-old wasn’t brain dead. She wasn’t even unconscious anymore. And doctors had been minutes away from cutting into her to remove her organs.

This is the nightmare scenario, the one that sends doctors and neurologists into cold sweats. It’s the reason that, in 2010, the American Academy of Neurology issued new guidelines for hospitals for determining brain death — the condition that legally demarcates life from whatever lies beyond. Those standards, according to Yale University,  neurologist David Greer, who worked on them, are meant to ensure that no patient is declared dead unless they really are beyond all hope of recovery.
“This is truly one of those matters of life and death, and we want to make sure this is done right every single time,” he told NPR.

But five years later, according to a study led by Greer that was published in the journal JAMA Neurology Monday, not all hospitals have adopted the guidelines.

Of the nearly 500 hospitals Greer and his colleagues surveyed over a three-year period, most facilities did not require that someone with expertise in neurology or neurosurgery be present to determine brain death. At more than half of hospitals, the person who makes the call doesn’t even have to be the patient’s attending physician. A majority also didn’t require doctors to test for hypotension (abnormally low blood pressure) or hypothermia, both of which can suppress brain function which could mimic the appearance of brain death.

There were large improvements in standardization of brain death assessments across hospitals since the 2010 criteria were published. The survey also looked at standards, not practices.
But the lingering lapses are still worrying, Greer told NPR.

“There are very few things in medicine that should be black and white, but this is certainly one of them,” he said. “There really are no excuses at this point for hospitals not to be able to do this 100 percent of the time.”

Burns’s near-disastrous declaration of death happened in 2009, before the new guidelines were released, though a U.S. Department of Health and Human Services report on the incident found that St. Joseph’s had failed to meet previous standards for assessing death. Hospital staff missed several signs that Burns’s brain was still functioning the night she was due for organ donation surgery: her nostrils flared, her lips and tongue moved, she was breathing “above the ventilator” (meaning, taking breaths of her own accord). And when a nurse performed a reflex test, scraping a finger along the bottom of Burns’s foot, the woman’s toes curled inward, according to the Syracuse Post-Standard.

Doctors failed to order repeat CT scans and inexplicably and inaccurately said that she suffered from cardiac arrest when she hadn’t. Crucially, they also failed to measure whether the drugs she had taken still lingered in her system, preventing her from exhibiting even the most primitive reflexes expected of someone with brain activity.

This is a widespread problem, Greer’s report indicates: only about 32 percent of hospitals surveyed required drug tests to rule out toxic levels that can mimic the loss of primitive reflexes associated with brain death.

As soon as Burns opened her eyes, she was rushed back into the ICU and her doctors resumed treatment. She ultimately recovered from her overdose and was discharged two weeks later. But 16 months after the near-miss in the OR Burns committed suicide, her mother told the Post-Standard.
Burns’ mother, Lucille Kuss, said that depression, not what happened at the hospital, is what drove Burns to her death.

“She was so depressed that it really didn’t make any difference to her,” Kuss said of the incident.
Cases like Burns’s are increasingly rare, but they are emblematic of an anxiety at the root of all discussions about brain death. If death is a process, at what point in the process is the person no longer alive?

For most of history, this question was mostly moot. In the Victorian era, for example, doctors couldn’t keep blood pumping through a permanently unresponsive person’s body, even if they wanted to, and a person who lost brain function would surely quit breathing shortly after. Determining the exact point of death was less a medical necessity than a philosophical diversion: In the early 1900s, Boston doctor Duncan MacDougall recruited a number of terminally ill patients to lie down on a massive scale during their final moments. By measuring fluctuations in their weight at the moment they died, MacDougall claimed, he could determine the mass of the soul.

The advent of organ donation procedures in the 1960s changed that. That period of collapse as functions failed became not only a tragic inevitability, but a vital window when organs could be taken from a dead body and used to keep another alive. Yet defining that window is medically and ethically complicated. Open it too early, as Burns’s doctors almost did, and you risk sacrificing a patient who might have survived. Too late, and the organs will deteriorate along with the life they once sustained.

This is how we arrived at a definition of death as brain death, the complete and irreversible loss of brain function, including in the brain stem (which controls the heart and lungs). It comes largely from a 1968 definition written for the The Journal of the American Medical Association by an ad hoc Harvard Medical School committee, and then affirmed by a blue ribbon medical commission just over a decade later. A person can also be declared dead if they suffer an irreversible cessation of respiratory and circulatory functions — in other words, their heart and lungs permanently stop.

Some critics of brain death as a barometer for organ donation worry that it might encourage doctors to give up on their patients too soon.

Of course, the extraction of organs from a failing body is not the only reason to come up with a legal definition of death. It also helps hospitals to determine when and how to end life-saving interventions and remove a patient from life support.

The logic behind marking brain death as the end of life is that existence without a brain isn’t living.
“The brain is the person, the evolved person, not the machine person,” Cornell University neurologist Fred Plum said at a symposium on comas and death in 2000, according to the New Yorker. “… We are not one living cell. We are the evolution of a very large group of systems into the awareness of self and the environment.”

But not everyone agrees. Cultural and legal definitions of life and death vary —  in an interview with NPR, Georgetown University medical ethics professor Robert Veatch called defining death “the abortion question at the other end of life.”

Right now, the family of Jahi McMath, a California teenager who was declared brain dead two years ago but has been kept on life support, is suing to have her death certificate invalidated according to the Associated Press. The McMaths are devout Christians, their lawyer wrote in a brief, who believe that “as long as the heart is beating, Jahi is alive.”

McMath is currently on a ventilator in New Jersey, where state law allows hospitals to take a family’s religion into consideration when making decisions about end-of-life procedures.

Yet despite the legal, medical and moral complexities in determining brain death, there is no federally mandated procedure for doing so, according to the New York Times. There are only the guidelines issued by neurologists, and how hospitals choose to apply them.

That they do so inconsistently only exacerbates the anxieties people have about death and organ donation, Leslie Whetstine, a bioethicist at Walsh University in Ohio, told NPR.

“If one hospital is using a testing method that’s different from another hospital,” she said, “people might wonder: ‘Are they really dead?’