Care if you can find it

I have written a great deal over the years regarding medical fraud and failures associated with the Medical Industrial Complex. This includes Hospitals, Doctors, Nurses, Care Clinics, Hospices and of cour-se Medical Insurance which all fall under this umbrella. And with that we have numerous stories about Veterans and their own system of ineptitude that leave many who have served this country, under-served. Why? Money natch. And the reality is that while many claim to be non profit they are anything but when it comes to salaries and bonuses for Executives and of course all at the cost of patient care.

I could go into the stories about Physicians abusing, drugs abusing patients, Nurses mocking patients, via YouTube or TicToc, and the rest of the salacious stories about how people are consistently exposed to just overall shitty medical care, but the core of this fruit is the real story. And there are exceptions to the rule who are hamstrung by systems set up to literally fail. Even Britain is now facing a crisis over its beloved NHS which we have failed repeatedly to mimic and in turn attempt to provide a national health standard, has found itself under the gun for failing to fund that program adequately for the last decade, thanks to the same Conservative politics that do the same here in America, just not as directly.

I have written about this particular chain,Ascension, and as before and this is just another article about how bad it really is. If you ask yourself why all the Politicians and Dr. Fauci kept the warning bells on about Covid it was not about you, not at all, It was about Hospital providers, both public and private, and that they knew they were fucked and could not handle any influx of patients regardless of how sick due to lack of staffing, lack of equipment and supplies that had long been a part of a cost-reduction plan over the last few years. Many have died, many have been misdiagnosed and mistreated by these facilities, not just during Covid but before. It will continue and that is why they ring the alarm bell as once again they cannot handle the patients they have. The closing of rural hospitals are a part of the problem, the limiting of the type of care as in the case of Children is another. The medical industrial complex is a money making machine like the Defense Department down to drone like care. It is akin to a dark hole in space where money just gets sucked into it never to be seen again. Well unless in the pockets of those who lobby and contract, the boots on the ground not.so.much.

We are a Nation with the most expensive care in the world with the least results. A current study found that most ER’s misdiagnose patients and while the study was not done here, you can be sure we have long passed that mark of ineptitude. But let us not forget how they also do it particularly to Women and People of Color. This is a standard of non-care across the complex.

So with that I give you the below article to read and know that the last place you want to go is a Hospital.

How a Sprawling Hospital Chain Ignited Its Own Staffing Crisis

Ascension, one of the country’s largest health systems, spent years cutting jobs, leaving it flat-footed when the pandemic hit.

By Rebecca Robbins, Katie Thomas and Jessica Silver-Greenberg

This article, the third in a series on nonprofit hospitals, was reported from Joliet, Ill., Grand Blanc, Mich., and New York.

• Published Dec. 15, 2022 THE NEW YORK TIMES

At a hospital in a Chicago suburb last winter, there were so few nurses that psychiatric patients with Covid were left waiting a full day for beds, and a single aide was on hand to assist with 32 infected patients. Nurses were so distraught about the inadequate staffing that they banded together to file formal complaints every day for more than a month.

About 300 miles away, at a hospital outside Flint, Mich., similar scenes were unfolding. Chronic understaffing meant that patients languished in dried feces, while robots replaced nursing assistants who would normally sit with mentally impaired patients.

Both hospitals are owned by one of the country’s largest health systems, Ascension. It spent years reducing its staffing levels in an effort to improve profitability, even though the chain is a nonprofit organization with nearly $18 billion of cash reserves.

Since the start of the pandemic, nurses have been leaving hospitals in droves. The exodus stems from many factors, with the hospital industry blaming Covid, staff burnout and tight labor markets for acute shortages of staff.

But a New York Times investigation has found that hospitals helped lay the groundwork for the labor crisis long before the arrival of the coronavirus. Looking to bolster their bottom lines, hospitals sought to wring more work out of fewer employees. When the pandemic swamped hospitals with critically ill patients, their lean staffing went from a financial strength to a glaring weakness.

More than half of the roughly 5,000 hospitals in the United States are nonprofits. In exchange for avoiding taxes, the Internal Revenue Service requires them to offer services, such as free health care for low-income patients, that help their communities.

But The Times this year has documented how large chains of nonprofit hospitals have moved away from their charitable missions.

Some have skimped on free care for the poor, illegally saddling tens of thousands of patients with debts. Others have plowed resources into affluent suburbs while siphoning money from poorer areas.

And many have cut staff to skeletal levels, often at the expense of patient safety.

At a single hospital in Northern California, the sprawling nonprofit hospital chain Providence laid off dozens of medical staff in 2017 and 2018, resulting in long waits for crucial care. At a Washington State hospital that is part of CommonSpirit Health, another giant nonprofit chain, years of belt-tightening reached a breaking point in October when an overwhelmed nurse called 911 dispatchers, who sent the fire department to help care for patients.

Ascension, which runs 139 hospitals, among the most of any chain in the United States, is emblematic of the industrywide movement to keep labor costs low.

As recently as 2019, Ascension was trumpeting its success at reducing its number of employees per occupied bed, a common industry staffing metric. At one point, executives boasted to their peers about how they had slashed $500 million from the chain’s labor costs. In the years before the pandemic, they routinely refused requests to hire more medical workers or fill open jobs, according to current and former hospital administrators and employees.

The yearslong effort — a combination of widespread layoffs and attrition — rarely attracted public attention. But it left Ascension flat-footed for Covid.

During surges in the coronavirus, Ascension repeatedly reduced its capacity by more than 500 beds nationwide because it did not have enough workers. In Michigan alone late last year, the chain had 1,100 nursing vacancies. The head of an Ascension hospital in Baltimore last year blamed staffing shortages for the emergency room being dangerously overcrowded.

To understand how Ascension’s strategies affected patients, The Times focused on two hospitals, St. Joseph in Illinois and Genesys in Michigan, where nurses belonged to unions that tracked staffing cuts and kept detailed logs of what they said were unsafe conditions. The Times reviewed more than 3,000 pages of those logs and interviewed 70 current and former nurses, executives and other employees at Ascension hospitals.

Nurses said that Ascension’s downsizing had stark consequences.

Patients lingered for hours on gurneys with serious, time-sensitive problems. Surgeries were delayed. Other patients developed bed sores — gaping wounds that for frail patients can be deadly — because they were not repositioned often enough.

“You feel awful because you know you’re not turning these patients,” said Jillian Wahlfors, a nurse at Genesys. “You know they’re getting their meds late. You don’t have time to listen to them. They’re having accidents, because you can’t get in fast enough to take them to the bathroom.”

Nick Ragone, an Ascension spokesman, denied that cost-cutting contributed to staffing shortages during the pandemic. Such a claim, he said, “is fundamentally misguided, misleading and demonstrates a lack of understanding of the impact of Covid-19 on the health care work force.” He also said Ascension offers superior care that “has been improving over time” and that the hospital provides free treatment for many low-income patients.

Unlike some rivals, Ascension avoided layoffs early in the pandemic, and Mr. Ragone said the chain has more employees relative to patients than many of its peers. From December 2015 to June 2021, he said, Ascension’s ratio of bedside nursing capacity to its discharged patients has increased by 64 percent, with staff increasing and discharges holding roughly steady.

Academics who study hospital workforces cautioned that the metric makes Ascension’s staffing conditions seem better than they are. For example, the ratio’s increasing number of nurses over time at least partly reflects Ascension having added about 17 hospitals, while the data on discharges does not include outpatients, even though nurses are spending more and more time caring for them.

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Because it is difficult for outsiders to verify such industry-supplied data, hospitals can use it to serve their own purposes.

“The complexity and the lack of transparency, all of these things make it impossible to try and figure out exactly what’s going on,” said Linda Aiken, a professor at the University of Pennsylvania School of Nursing, who has conducted large surveys of hospital staff. “That’s why we ask nurses.”

A Ministry, Not a Business

Ascension was created in 1999 through the merger of two networks of hospitals, many founded in the 1800s by nuns who ministered to the poor.

The combined hospital system swiftly became a juggernaut, its profits soaring sixfold in its first decade. (As a nonprofit, Ascension describes this figure as “excess of revenues and gains over expenses and losses.”) By 2010, Ascension’s $15 billion in revenue rivaled that of companies like General Mills and Gap.

Today, Ascension operates in 19 states, mostly in the South and the Midwest. It serves about six million patients.

By many measures, Ascension is rich.

In addition to its billions in cash, it runs an investment company that manages more than $41 billion. Last year it paid its chief executive, Joseph Impicciche, $13 million.

Because of its nonprofit status, Ascension avoids more than $1 billion a year in federal, state and local taxes, according to the Lown Institute, a health care think tank. Until the pandemic, Ascension was consistently profitable, earning hundreds of millions a year. The past year was a rare exception: Because of the stock market downturn and soaring labor costs, Ascension lost $1.8 billion.

Ascension and its executives have powerful incentives to be as profitable as possible. The more money the chain makes, the more its executives get paid. (Mr. Ragone said that a larger proportion of executives’ pay is based on other factors, like delivering high-quality care.) And stronger financial metrics allow the chain to borrow money at lower interest rates, enabling it to buy new hospitals and add services.

Executives have described their profit-seeking strategies as key to the hospital system’s stability and its mission of serving the poor and vulnerable.

“We are a ministry,” Anthony Tersigni, Ascension’s previous chief executive, said in 2007. “We’re not a business.” (Mr. Tersigni now leads Ascension’s investment arm, a job that paid him $11 million his first year.)

Four former executives who joined Ascension from other nonprofit hospital systems said the profit-driven culture surprised them. There were few conversations, they recalled, about how profits could be used to advance Ascension’s charitable mission. The pressure to reach financial targets struck them as more befitting a for-profit company.

“Their whole approach to the finances was right out of the Wall Street playbook,” said William Weeks, who until his retirement in 2019 was the chief operating officer of a five-hospital chain that Ascension owns in Oklahoma.

For example, Ascension charged its hospitals management fees, which covered the cost of centralized services like human resources, that were so high that they sometimes drove hospitals into financial peril.

In Washington, Ascension charged tens of millions of dollars in fees to Providence Hospital, which largely served poor, Black patients. The district’s attorney general investigated whether Ascension’s fees were excessive. In response, the chain in 2018 agreed to forgive $130 million of debt owed by the struggling hospital, which by then was being downsized into an urgent care center.

But the heart of Ascension’s business strategy was cutting costs.

A Late-Night Phone Call

In 2010, Dr. Michael Schatzlein, who had spent years at a for-profit hospital chain, was hired to run a handful of Ascension hospitals in Tennessee and Alabama.

“The idea was to bring what I’d learned about containing costs through improving efficiencies to a mission-driven organization,” he said.

It was a tumultuous time in the health care industry. The federal government was reducing the amounts that Medicare paid hospitals to care for older patients. Plus, the coming rollout of the Affordable Care Act created deep uncertainty about hospitals’ financial prospects.

Around 2013, Ascension executives made a series of projections that showed that, over the next five years, their costs were expected to outpace their revenue by more than $5 billion.

To close that anticipated gap, Ascension turned to its biggest expense: labor. That year, the chain laid off thousands of workers, including medical staff.

Dr. Schatzlein, who by then had been promoted to run more than a dozen hospitals, was asleep at the JW Marriott in Indianapolis, where he was attending an industry conference with other Ascension executives. A phone call woke him. He was asked to come to a meeting downstairs, where executives decided they had to lay off thousands of workers across Ascension.

For Dr. Schatzlein, that meant axing about 3 percent of the staff, or about 1,000 nurses and other employees, in his hospitals. “I felt horrible about it,” he said. “My entire career was based on avoiding across-the-board layoffs.”

Across its network of hospitals, Ascension set individual financial targets, and executives whose hospitals did not achieve their goals would not get bonuses, according to three former executives. Keeping staffing low was one of the easiest ways to get paid, since labor costs make up about half of a hospital’s expenses.

Ascension also closely tracked the number of nurses on duty relative to how many patients were treated in each hospital unit. Managers felt pressure to require fewer nurses to handle more patients. Some had to show they were hitting productivity targets before they could hire more workers, according to current and former Ascension employees.

Ascension began showcasing its initiatives to cut labor costs. At a 2015 industry conference, two Ascension executives gave a presentation titled “Successful Labor Optimization Efforts” that detailed their tactics, which they said had saved nearly $500 million in just three years.

In Michigan and Illinois, Ascension lobbied against legislation that would have required minimum nurse-to-patient ratios. The measures never became law. In the following years, staffing levels at Ascension hospitals in those states were routinely below what the bills would have required, according to nurses at those hospitals.

Ascension’s fears about looming financial shortfalls never came to pass. Over the five years in which Ascension executives had projected the $5.2 billion loss, the system instead earned $2.7 billion in profits.

Even so, it continued to cut workers.

Running for Supplies

When the pandemic hit, nurses at St. Joseph, the only hospital in Joliet, Ill., were overwhelmed and feared for the safety of patients, according to state inspection records and thousands of pages of formal complaints that nurses filed with the hospital warning about unsafe conditions.

“Every day it’s unsafe staffing!!!” one nurse wrote in June 2020, underlining “every day” four times.

Nurses said they had been finding themselves in such situations more and more since 2018, when Ascension took over St. Joseph.

Shortly after the acquisition, St. Joseph employed 791 nurses. That number has since dropped by 23 percent, according to the Illinois Nurses Association, which represents the hospital’s nurses and has clashed with Ascension’s management over pay and other issues.

The staff reductions were largely the result of nurses leaving to pursue better pay and working conditions elsewhere. Ascension then left many vacant jobs open, though some slots were filled by nurses on short-term contracts, employees said. Nurses at St. Joseph generally make between $29 and $52 an hour and can earn multiples more working for medical staffing companies.

Mr. Ragone said that St. Joseph’s number of employees per occupied bed went up 6 percent between 2018 and 2021. But that figure partly reflects Ascension having reduced its capacity. The data also includes many employees who do not treat patients. Mr. Ragone would not provide data specific to nurses.

Some of the nurses’ grievances have been substantiated by state authorities.

In April 2021, Illinois health inspectors cited St. Joseph for failing to care for patients who needed to be regularly repositioned. The inspectors found that some patients developed bed sores after they were not moved for as much as 20 hours, despite doctors’ orders that they be shifted often.

Since then, the problems have intensified.

In January 2022, as the Omicron wave pummeled the Chicago area, groups of nurses signed the formal complaints on more than 130 occasions.

At the beginning of the month, an entire shift of eight nurses in one unit signed a complaint that there was only one nurses’ aide available for 32 patients with Covid, most of them on oxygen. The complaint said a supervisor told the nurses that the entire hospital was short-staffed.

At the end of the month, no one showed up to staff the surgical supply room. When two patients needed emergency surgery, nurses were left to gather instruments themselves. One surgery was delayed, and a nurse had to abandon a 100-year-old patient to run for supplies.

One night in October, nurses in St. Joseph’s intensive care unit learned that they would have to care for four patients each — double the industry standard. The hospital had to divert ambulances from delivering patients until more nurses arrived.

Four nights later, nurses in the emergency room refused to clock in because they were being asked to care for 11 patients each, instead of the recommended four.

“It was inevitable,” said Jillian Moffett, who was among the nurses who protested the staffing levels. “One of these days someone was going to put their foot down and say, ‘I’m not taking this anymore.’”

The Rise of the Robots

In 2019, Ascension received an award from a company called AvaSure. The “AvaPrize” was bestowed upon the hospital chain because of its embrace of a new cost-cutting innovation: robots.

Traditionally, Ascension, like other hospitals, sent nurses’ aides into the rooms of patients who needed close supervision. Left untended, these patients, many with dementia or psychiatric illnesses, might get out of bed and hurt themselves.

But in the years before the pandemic, some Ascension hospitals switched course. Going forward, they would generally assign nurses’ aides only to patients who were deemed at high risk of dying by suicide.

For other patients, aides would be replaced by AvaSure’s “TeleSitters.” By 2019, Ascension had installed 450 of the robots in more than 50 of its hospitals. The devices — essentially a video camera mounted on a metal pole — send live footage to an off-site command center, where workers talk to patients through speakers in the machine.

In marketing materials, AvaSure boasts that the TeleSitter — which is used by about 1,000 hospitals nationwide — allows workers to monitor the movements of up to 16 patients at once.

Its website features the testimonial of a top nurse at a Texas hospital that started using AvaSure devices during the pandemic. He said they would enable someone like him to “do three shifts in the E.R. and then do a shift at home using this.”

AvaSure cites research showing its robots reduce dangerous falls. And some Ascension officials said the TeleSitters were invaluable during the pandemic. “Somebody had eyes on those patients,” Maureen Chadwick, an Ascension executive, said at an event this year.

But at Ascension’s Genesys hospital in Michigan, nurses said patients, many of them already disoriented, were confused by the disembodied voices coming from TeleSitters. There were sometimes not enough robots — which nurses derided as “sitters on a stick” — to go around.

And when workers at the command center 80 miles away called the hospital about wayward patients, there were often no secretaries at Genesys available to answer the phones.

Ascension had cut those jobs.

16-Hour Shifts

Patients enter Genesys through a four-story atrium decorated with greenery and rock pools. Inside, the 400-bed hospital is reeling from years of downsizing.

In 2018, Ascension had laid off workers, including at least 500 in Michigan — even as the chain that year reported profits of $2.2 billion. Genesys, one of a handful of unionized Ascension hospitals, avoided those layoffs. Instead, administrators froze hiring.

That freeze eventually thawed. Even then, vacant positions were rarely advertised online.

Since the hiring freeze was imposed, the number of permanent nurses working at Genesys has fallen by roughly 30 percent, according to the Teamsters union that represents the nurses.

Ascension partially filled that gap by hiring temporary nurses, and Mr. Ragone said Genesys’s employees per occupied bed increased 12 percent between 2018 and 2021. (Like St. Joseph, Genesys reduced its patient capacity, which contributed to the rise in the staffing ratio, and Mr. Ragone would not provide data about the hospital’s nursing staff.)

Yet nurses said that to keep things running, Genesys demanded they work 16-hour shifts, threatening to fire some who refused because of exhaustion or child-care commitments. Hospitals commonly require nurses to work past their scheduled shifts as an emergency stopgap, such as during a blizzard. But at Genesys, nurses said, the tactic is used to make up for chronic understaffing.

Stephanie Bates, a Genesys nurse who works a 12-hour shift ending at 11:30 p.m., said that multiple times a week, she is ordered to work until 3:30 a.m. She said that she refuses so that she can care for her young children early in the morning. Other nurses echoed her experience.

On at least four occasions this year, managers have written in nurses’ employment files that refusing to work 16-hour shifts “is not in line with our value of dedication,” according to internal disciplinary records reviewed by The Times.

Nurses in nearly every unit at the hospital said in interviews that they were regularly required to care for more patients than allowed under their contract — restrictions that are supposed to ensure the safety of patients. “You just try to do damage control your whole shift,” said Stephanie Atchley, a Genesys nurse. “It just all snowballs into very poor care.”

Dr. Dale Hanson, a physician who treats patients at Genesys, said that most days, there are not enough nurses, resulting in prolonged hospital stays for his patients. Some get marooned in the emergency room because of nursing shortages in other parts of the hospital.

Dr. Hanson blamed Ascension’s aggressive cost-cutting, which he said has resulted in “miserable” conditions for patients and staff.

‘Someone Is Going to Die’

As of this month, 24 of the 52 night-shift positions in Genesys’s medical and surgical intensive-care units were listed as unfilled, and 17 of the open jobs had yet to be advertised, according to the hospital’s internal tally, which The Times reviewed.

Even as the pandemic has waned, nurses at St. Joseph and Genesys said, there remained so many unfilled positions that they felt like they were working in a perpetual crisis.

Jill Bruff, a nurse who works in those I.C.U.s, said that about once a week, she arrives for her night shift to find patients who had been lying in their own feces for so long that the excrement had dried. On one recent occasion, Ms. Bruff said, the nurse working before her cried when she explained that she had not had time to clean up a soiled patient.

“That patient shouldn’t ever had to sit for that long, and that nurse shouldn’t have had to cry because she felt so awful,” Ms. Bruff said. Four other nurses said their patients have had similar experiences as a result of understaffing.

Mr. Ragone said that “the publication of an assertion from an unsubstantiated claim that our dedicated nursing staff would allow a patient in the I.C.U. to be left improperly unattended, without evidence, is irresponsible.”

Nurses at St. Joseph in Illinois also were at their breaking point.

“MAKE THIS BETTER ASCENSION. SHAME ON YOU!!!” one nurse wrote in a formal complaint in June. The nurse described a chaotic scene in the emergency room where there were not enough nurses or beds for seriously ill patients.

“Someone is going to die if this continues,” another nurse wrote in July, “and there is no indication that anyone is concerned.”

Covid Chronicles – The Vaccine Edition

Well as we round the corner on well the vaccine rollout, more anticipated than any IPhone in the history of IPhones, we are still a long, very long way from the great unwashed receiving their shots.

We have the new hybrid model arriving and no I don’t mean an electric car, I mean of hte Covid virus that we know shit all about. We think it means it packs a bigger viral load meaning it makes it more infectious, so instead of a 1:3 spread its 1:10, 100, or 1000. Pick a one. Or we think its Covid 2.1 a new variant that also spreads the time frame of infection to longer. First it was 14 days, then it was 7 and now its forever. The British science team that detected this are clear: They have no evidence to tell us shit for anything but they are working on it. Again the quest for Patient Zero and that story behind that infection is likely with the Koreans who found the restaurant patron who contracted Covid from being 27 feet away and in turn was in the room for less than five minutes. I got time, so get back to me.

As the shots are being filmed, noted and administered across America again that too is up for grabs and debate for who gets what, when and why. Shocking that this was not figured out the months beforehand or any logistical plan on how this was to be handled is not surprising as this is the same bullshit that plagued (pun intended) the testing regimen. So right now as hospitals are getting vaccines and just like Covid hypothesis, fake cures, the origins of the virus, this too has become a victims to social media lies and rumors, again not shocking. What is shocking is the source, the Doctors, Nurses and Staff of varying hospitals who are in mid rollout.

Here in New York the fuck up continues and has led to this, the turning on their own:

Hospital Workers Start to ‘Turn Against Each Other’ to Get Vaccine

“I am so disappointed and saddened that this happened,” a New York hospital executive wrote to his staff after workers who did not have priority cut the line for the vaccine.

By Joseph Goldstein The New York Times Published Dec. 24, 2020

At NewYork-Presbyterian Morgan Stanley Children’s Hospital, one of the most highly regarded hospitals in New York City, a rumor spread last week that the line for the coronavirus vaccine on the ninth floor was unguarded and anyone could stealthily join and receive the shot.

Under the rules, the most exposed health care employees were supposed to go first, but soon those from lower-risk departments, including a few who spent much of the pandemic working from home, were getting vaccinated.

The lapse, which occurred within 48 hours of the first doses arriving in the city, incited anger among staff members — and an apology from the hospital.

“I am so disappointed and saddened that this happened,” a top executive at NewYork-Presbyterian Morgan Stanley Children’s Hospital, Dr. Craig Albanese, wrote in an email to staff, which was obtained by The New York Times.

The arrival of thousands of vaccine doses in New York City hospitals last week was greeted with an outpouring of hope from doctors and nurses who had worked through the devastating first wave in March and April. But for now, the vaccine is in very short supply, and some hospitals seem to have stumbled through the rollout.

Most of the vaccinations in the New York region to date have involved hospitals giving shots to their own employees, a relatively easy process compared with what is to come as part of the largest vaccination initiative in the nation since the 1940s.

The dynamics playing out at hospitals in New York City may be emblematic of what may happen across the country in the near future, when all adults will be given a place in the vaccination line by either the government or their employers.

In interviews for this article, more than half a dozen doctors and nurses at New York area hospitals said they were upset at how the vaccine was being distributed at their institutions. They described what had happened to The New York Times but most asked that their names not be used because hospitals have shown a willingness to fire or punish employees for speaking to the news media during the pandemic.

At some major hospitals in Manhattan, doctors and nurses have recalled scrolling through social media and pausing to make a snap judgment each time they saw a selfie one of their colleagues had posted of getting vaccinated: Did that person deserve to be vaccinated before they were?

“We feel disrespected and underappreciated due to our second-tier priority for vaccination,” a group of anesthesiologists at Mount Sinai Hospital wrote to administrators over the weekend.

Health care workers said rumors were proliferating in WhatsApp groups and amid the banter of the operating room. Stories have begun to circulate of a plastic surgeon who managed to get vaccinated early, of doses being thrown out at one Manhattan hospital because of poor planning. On group chats, doctors debate how — and whether — to try to get vaccinated ahead of schedule.

At Mount Sinai Hospital, some doctors told others that you could talk your way into receiving a vaccine just by getting in line and repeating that you do “Covid-related procedures,” one Mount Sinai doctor, who requested anonymity for fear of retribution, recalled.

One doctor at the Morgan Stanley Children’s Hospital said, “Clearly, we’re ready to mow each other down for it.”Coronavirus Briefing: An informed guide to the global outbreak, with the latest developments and expert advice.

Many of the rumors have not been true. Still, they illustrate a growing distrust and “every man for himself” attitude, another Mount Sinai doctor said.

Dr. Ramon Tallaj, who serves on a state task force advising the governor on the vaccine’s roll out, said that ill-will and resentment would fade as the vaccine became more widely available.

“People are going to fight over who goes first, or who doesn’t go first, but the important thing is that it’s happening,” Dr. Tallaj, the chairman of SOMOS Community Care, a network of clinics across New York City that treat many patients from Hispanic and Asian immigrant communities, said of the vaccinations.The Coronavirus Outbreak ›

Health care workers and nursing home residents and staff members form what is called Phase 1 of New York State’s vaccine distribution plan. About two million people are in this group, and the state’s initial allocation of the vaccine most likely means that Phase 2, which includes essential workers, won’t begin until late January. (Widespread distribution isn’t likely to begin until the summer, officials have said.)

But the state has left it mostly to each health care institution to devise a vaccination plan during the first phase. In the first week of vaccinations, many hospitals chose a wide variety of health care workers — nurses, doctors, housekeepers — from emergency rooms and intensive care units to be the first at their institutions to receive the vaccine. But in the days after the celebrations accompanying the first shots, the moods at hospitals have shifted.

Asked about workers cutting the vaccine line at Morgan Stanley Children’s Hospital, NewYork-Presbyterian said in a statement, “We are proud to have vaccinated thousands of patient-facing employees in just over a week, and we will continue to do so until everyone receives a vaccine. We are following all New York State Department of Health guidelines on vaccine priority, with our initial focus on I.C.U. and E.D. staff and equitable access for all.”

Still, The Times interviewed four health care workers at Morgan Stanley Children’s Hospital, all of whom expressed resentment at colleagues and dismay that hospital administrators had allowed the vaccine distribution system to devolve.

One nurse at Morgan Stanley Children’s Hospital said she had gone as far as to confront a social worker who she believed had jumped the line about why the social worker thought she deserved the vaccine ahead of others.

“She said, ‘We have to go to E.R. sometime,’ but that’s not true,” the nurse said of the social worker.

At some places, doctors and nurses who work in dedicated Covid-19 units were not included in the priority group.

Ivy Vega — an occupational therapist who has been treating Covid-19 patients at another NewYork-Presbyterian hospital, the Columbia University Irving Medical Center — said she grew frustrated waiting to be vaccinated while others received the shot. She received her first dose on Wednesday.

“There has been a sense of camaraderie — that’s what’s helped us carry on during the pandemic,” she said. “And now this thing we should be celebrating — the arrival of this much anticipated vaccine — it’s turning into a rivalry. There is competitiveness and skepticism and mistrust.”

At Morgan Stanley Children’s Hospital, some of these nurses said they had yet to be vaccinated a week after vaccinations began.

“I think the sad thing is people are starting to turn against each other,” one doctor who works at the hospital said. “Can you honestly say this clerk deserves it before I do? No, but nobody deserves it before anyone else.”

Another doctor working in an intensive care unit at the children’s hospital recalled the scene last week: A group of staff members were striding energetically toward the elevator banks, where a vaccination station awaited. One of them even explained in passing that they were on their way to get the vaccine.

“It was a free-for-all,” said the doctor, who requested anonymity for fear of retribution from the hospital.

Dr. Albanese, the chief operating officer of the children’s hospital, addressed the free-for-all in the email, placing some blame on the vaccination team for not limiting vaccinations to people on their list.

“We need to prioritize the highest risk teams,” he wrote.

At Mount Sinai Hospital in Manhattan, the vaccine rollout has unfolded in plain view, in the hospital’s atrium, which staff members crisscross throughout the work day or visit to grab a snack or coffee. Many doctors and nurses said they would glance over to see who was standing in line — and whether that person fit the government’s recommendations for those who should be prioritized.

“Despite our strict and stringent vaccination policies and procedures, we are aware of a handful of accusations of improprieties,” Mount Sinai said in a statement. “Due to confidentiality, we cannot speak to any specific individual issue, however, any allegations of any missteps will be appropriately and thoroughly investigated.”

This weekend, anesthesiologists — who have played a crucial role in treating the sickest patients during the outbreak in New York — complained as they say they have watched others get vaccinated before them.

That led to the anonymous letter sent to hospital administrators.

“A boiling point was reached when we witnessed vaccines being administered, seemingly at random, to employees who were not a part of the originally-planned cohort,” read the letter, which was sent anonymously in the name of “Concerned Faculty Members” of the department of anesthesiology, perioperative and pain medicine. The letter was first reported by Politico.

In interviews, several anesthesiologists at Mount Sinai noted that their colleagues at some other hospitals had already been vaccinated.

The anesthesiologists said they expected to play a major role in the second wave if hospitalizations kept rising, and in recent days some in the department have gotten vaccinated.

But just last week, an email from the head of the anesthesiology department, Dr. Andrew Leibowitz, asked for volunteers willing to work full time in a unit for critically ill Covid-19 patients if the outbreak worsened. Some in the department felt they were being told there might be an upside to volunteering.

“I am looking into the possibility of having persons volunteering to perform this duty possibly vaccinated earlier than they might otherwise be,” Dr. Leibowitz wrote.

Dr. Leibowitz did not immediately respond to requests for comment.

One anesthesiologist said he recognized it was reasonable to vaccinate the volunteers first.

But also, he said, it “felt that they were using the vaccine as a bargaining chip.”

I am already sure that more will follow as the debate about “essential workers” will also become an issue as it has been reported about Uber’s CEO lobbying with Cuomo about his contracted staff getting vaccinated in line with I suspect other workers way more at risk, but hey they are not covered by wealthy lobbyists who have to do the bidding of the rich. And watching Doctors and Nurses turn on each other are clearly not familiar with the medical industrial complex and its own issues with inequality and access. I have no love lost for this group either having been at their receiving end for malfeseance and abuse, this is an industry ripe with bias and incompetence so again I do believe many Covid deaths could have been avoided had they had proper equipment, training and of course resources. This is a for-profit industry that has only the bottom line in mind, patient care is a low priority. As for many staff they too have an agenda and I have covered many stories about Doctors whose financial gains are tied to their ability to generate patients and like used cars they drive them on the lot and rollback the mileage to get a sale then let the buyer beware. And the AMA, the great lobbyist of all times, patronizes the States to reduce, if not eliminate, ways for patients voices to be heard via malpractice suits. Why do you think McConnell has been so stalwart about any stimulus bill? Because of the demand to get waivers in place backed by the feds to prevent any class action suits due to malfeseance. Business at its best

I will reiterate that while I have my own issues with medicine I am pro vaccine and pro health I am just virulently opposed to commercial medicine and private insurance. I have no less loathing than Bernie Sanders and I am afraid Joe Biden is not about to fix this in his administration. He is ironically 78 years old, covered on a Government plan and yet does not believe or think the rest of America should be. Okay then.

Off to the arenas to watch the Medical heroes we loved last month duke it to the death for a shot.

White Coats White Care

As we take to the streets or our screens we have to realize that systemic racism and sexism dominates most of the larger institutions established in our country. And none other is as large as the medical industrial complex, and the emphasis on complex has truly come to fruition with the Coronavirus and the exposures with regards to the failings of public health. We have for years found a lack of funding for public enterprises, from housing, to education and lastly to health care has lent itself to major disparities of equity when it comes to the working poor. And no group composes the working poor more than faces of color.

There is some roots in this vested in racsim but it is also with regards to gender and now sexuality identity. The AIDS crisis exposed again how the system failed when it came to helping those who identified as Gay and had contracted that disease. It was labeled the “Gay disease” and much like Covid today, contributed to a genocide of those who were not part of the acceptable mainstream aka White/Male/Christian. Women’s rights so fought for in the 70’s and ultimately leading to the failure of the ERA, also plays a factor as men in leadership roles found that by having women enter the workplace they may have expectations reagarding rights and privileges that were largely the domain of men. We finally saw that come to head with #MeToo and again with Covid the rights of Trans folks shows again another marginalized group shoved aside when it comes to crime, violence, and of course health care.

Below are two articles, one about the failings of the MIC to properly treat, diagnose and care for faces brown and black and that implied if not overt bias dominates the field when it comes to finding medical care. The next is on reproductive rights and how the BLM group do not see this as an issue. Well then remind me why again I am not to support you, a woman, a face of color and with the genitalia we share, with the same reproductive rights issues and needs regardless of the shade of our skin. Of all groups most affected again by denial of access to abortion it has also led to closures of clinics that do more than provide abortion and in turn provide pre and post natal care, two issues of import that again largely affect faces of color. When you take away one right you have a domino affect that leads to a reduction of rights across the spectrum. Again, we have the right to care and because of the complext needs of Trans folks the access to proper medical care is essential. Got tits? Well welcome to breast cancer and the ability to screed for that or any other cancer is again a reproductive sexual right. Safe sex is informed sex and these clinics again provide essential information and education to eliminate the transmission of sexually transmitted diseases and the necessary vaccine to prevent cervical cancer.

So agai you say you don’t have time for this? Okay then don’t ask me for any time to spend on your issue. As clearly you have one where your sexuality is not a part of your identity and your identity is more than skin color.

Racism in care leads to health disparities, doctors and other experts say as they push for change

 

The Washington Post

By Tonya Russell
July 11, 2020 at 10:00 a.m. EDT

The protests over the deaths of black men and women at the hands of police have turned attention to other American institutions, including health care, where some members of the profession are calling for transformation of a system they say results in poorer health for black Americans because of deep-rooted racism.

“Racism is a public health emergency of global concern,” a recent editorial in the Lancet said. “It is the root cause of continued disparities in death and disease between Black and white people in the USA.”

A New England Journal of Medicine editorial puts it this way: “Slavery has produced a legacy of racism, injustice, and brutality that runs from 1619 to the present, and that legacy infects medicine as it does all social institutions.”

The novel coronavirus has provided the most recent reminder of the disparities, with black Americans falling ill and dying from covid-19 at higher rates than whites. Even so, the NEJM editorial noted, “when physicians describing its manifestations have presented images of dermatologic effects, black skin has not been included. The ‘covid toes’ have all been pink and white.”

Black Americans die younger than white Americans and they have higher rates of death from a string of diseases including heart diseases, stroke, cancer, asthma and diabetes.

By one measure, they are worse off than in the time of slavery. The black infant mortality rate (babies who die before their first birthday) is more than two times higher than for whites — 11.4 deaths per 1,000 live births for blacks compared with 4.9 for whites. Historians estimate that in 1850 it was 1.6 times higher for blacks — 340 per 1,000 vs. 217 for whites.

Medical professionals describe the effects of racism across specialties and illnesses. Tina Douroudian, an optometrist in Sterling, Va., has observed differences in the severity of her patients with diabetes, as well as their management plans.

“Black folks have higher rates of diabetes and often worse outcomes. It’s universally understood that nutrition counseling is the key factor for proper control, and this goes beyond telling patients to lose weight and cut carbs,” Douroudian says.

“I ask all of my diabetic patients if they have ever seen a registered dietitian,” she says. “The answer is an overwhelming ‘yes’ from my white patients, and an overwhelming ‘no’ from my black patients. Is there any wonder why they struggle more with their blood sugar, or why some studies cite a fourfold greater risk of visual loss from diabetes complications in black people?”

Douroudian’s patients who have never met with a dietitian in most cases have also never even heard of a dietitian, she says, and she is unsure why they don’t have this information.

Her remedy is teaching her patients how to advocate for themselves:

“I tell my diabetic patients to demand a referral from their [primary care physician] or endocrinologist. If for some reason that doctor declines, I tell them to ask to see where they documented in their medical record that the patient is struggling to control their blood sugar and the doctor is declining to provide the referral. Hint: You’ll get your referral real fast.”

Black women are facing a childbirth mortality crisis. Doulas are trying to help.

Jameta Barlow, a community health psychologist at George Washington University, says that the infant mortality rate is a reflection of how black women and their pain are ignored. Brushing aside pain can mean ignoring important warning signs.

“Centering black women and their full humanity in their medical encounters should be a clinical imperative,” she says. “Instead, their humanity is often erased and replaced with stereotypes and institutionalized practices masked as medical procedure.”

Black women are more than three times as likely as white women to die of childbirth-related causes, according to the Centers for Disease Control and Prevention, (40.8 per 100,000 births vs. 12.7). Experts blame the high rate on untreated chronic conditions and lack of good health care. The CDC says that early and regular prenatal care can help prevent complications and death.

Barlow says that the high mortality rate, and many other poor health outcomes, are a result of a “failure to understand the institutionalization of racism in medicine with respect to how the medical field views patients, their needs, wants and pain thresholds. The foundation of medicine is severely cracked and it will never adequately serve black people, especially black women, until we begin to decolonize approaches and ways of doing medicine.”

Barlow’s research centers on black women’s health, and her own great-grandmother died while giving birth to her grandmother in 1924. “In the past, black women were being blamed for the maternal mortality rate, without considering the impact of living conditions due to poverty and slavery then,” she says. “The same can be said of black women today.”

Natalie DiCenzo, an OB/GYN who is set to begin her practice in New Jersey this fall, says she hopes to find ways to close the infant mortality gap. Awareness of racism is necessary for change, she says.

“I realize that fighting for health equity is often in opposition to what is valued in medicine,” she says. “As a white physician treating black patients within a racist health-care system, where only 5 percent of physicians identify as black, I recognize that I have benefited from white privilege, and I now benefit from the power inherent to the white coat. It is my responsibility to do the continuous work of dismantling both, and to check myself daily.

“That work begins with being an outspoken advocate for black patients and reproductive justice,” she says. “This means listening to black patients and centering their lived experiences — holding my patients’ expertise over their own bodies in equal or higher power to my expertise as a physician — and letting that guide my decisions and actions. This means recognizing and highlighting the strength and resilience of black birthing parents.”

DiCenzo blames the racist history of the United States for the disparities in health care. “I’m not surprised that the states with the strictest abortion laws also have the worst pregnancy-related mortality. For black LGBTQIA+ patients, all of these disparities are amplified by additional discrimination. Black, American Indian and Alaska Native women are at least two to four times more likely to die of pregnancy-related causes than white women, regardless of level of education and income,” she says.

As for covid-19, although black people are dying at a rate of 92.3 per 100,000, patients admitted to the hospital were most likely to be white, and they die at a rate of 45.2 per 100,000.

The CDC says that racial discrimination puts blacks at risk for a number of reasons, including historic practices such as redlining that segregate them in densely populated areas, where they often must travel to get food or visit a doctor.

“For many people in racial and ethnic minority groups, living conditions may contribute to underlying health conditions and make it difficult to follow steps to prevent getting sick with COVID-19 or to seek treatment if they do get sick,” the CDC says.

The CDC is urging health-care providers to follow a standard protocol with all patients, and to “[i]dentify and address implicit bias that could hinder patient-provider interactions and communication.”

In her 16 years in medicine, internist Jen Tang has provided care for mid- to upper-class Princeton residents as well as residents of inner city Trenton, N.J. She has seen privatization of medicine adversely affect people of color who may be insured by government-run programs that medical organizations refuse to accept. Some doctors complain that the fees they are paid are too low.

And that can make referrals to specialists difficult.

“Often my hands are tied,” says Tang, who now works part time at a federally qualified health center in California. “I try to give my patients the same level of care that I gave my patients in Princeton, but a lot of my patients have the free Los Angeles County insurance, so to get your patient to see a specialist is difficult. You have to work harder as a clinician, and it takes extremely long.”

Tang has also encountered what medical experts say is another effect of long-term racism: skepticism about the health-care system.

“Some patients don’t trust doctors because they haven’t had access to quality health care,” she says. “They are also extremely vulnerable.”

American history is rife with examples of how medicine has used people of color badly. In Puerto Rico, women were sterilized in the name of population control. From the 1930s to the 1970s, one-third of Puerto Rican mothers of childbearing age were sterilized.

As a result of the Family Planning Services and Population Research Act of 1970, close to 25 percent of Native American women were also sterilized. California, Virginia and North Carolina performed the most sterilizations.

The Tuskegee experiments from 1932 to 1972, which were government-sanctioned, also ruined the lives of many black families. Men recruited for the syphilis study were not given informed consent, and they were not given adequate treatment, despite the study leading to the discovery that penicillin was effective.

Though modern discrimination isn’t as apparent, it is still insidious, Barlow says, citing myths that lead to inadequate treatment, such as one that black people don’t feel pain.

“We must decolonize science,” Barlow says, by which she means examining practices that developed out of bias but are accepted because they have always been done that way. “For example, race is a social construct and not clinically useful in knowing a patient, understanding a patient’s disease, or creating a treatment plan,” she says, but it still informs patient treatment.

She calls upon fellow researchers to question research, data collection, methodologies and interpretations.

Like Douroudian, she recommends self-advocacy for patients. This can mean asking as many questions as needed to get clarification, and if feasible, getting a second opinion. Bring a friend along to the doctor, and record conversations with your doctor for later reflection.

“I tell every woman this when doctors recommend a drug or procedure that you have reservations about: ‘Is this drug or procedure medically necessary?’ If they answer yes, then have them put it in your medical chart,” Barlow says. “If they say it is not necessary to do that, then be sure to get another doctor’s opinion on the recommendation. Black women have always had to look out for themselves, even in the most vulnerable medical situations such as giving birth.”

Medicine’s relationship with black people has advanced beyond keeping slaves healthy enough to perform their tasks. Barlow says, however, that more work needs to be done to regain trust, and uproot the bias that runs over 400 years deep.

“This medical industrial complex will only improve,” she says, “when it is dismantled and reimagined.”

Can’t Focus on Abortion Access if My People Are Dying’

Some Gen Z and millennial women said they viewed abortion rights as important but less urgent than other social justice causes. Others said racial disparities in reproductive health must be a focus.

Emma Goldman|| The New York Times

Like many young Americans, Brea Baker experienced her first moment of political outrage after the killing of a Black man. She was 18 when Trayvon Martin was shot. When she saw his photo on the news, she thought of her younger brother, and the boundary between her politics and her sense of survival collapsed.

In college she volunteered for the N.A.A.C.P. and as a national organizer for the Women’s March. But when conversations among campus activists turned to abortion access, she didn’t feel the same sense of personal rage.

“A lot of the language I heard was about protecting Roe v. Wade,” Ms. Baker, 26, said. “It felt grounded in the ’70s feminist movement. And it felt like, I can’t focus on abortion access if my people are dying. The narrative around abortion access wasn’t made for people from the hood.”

Ms. Baker has attended protests against police brutality in Atlanta in recent weeks, but the looming Supreme Court decision on reproductive health, June Medical Services v. Russo, felt more distant. As she learned more about the case and other legal threats to abortion access, she wished that advocates would talk about the issue in a way that felt urgent to members of Generation Z and young millennials like her.

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“It’s not that young people don’t care about abortion, it’s that they don’t think it applies to them,” she said. Language about “protecting Roe” feels “antiquated,” she added. “If I’m a high school student who got activated by March for Our Lives, I’m not hip to Supreme Court cases that happened before my time.”

Her question, as she kept her eyes on the court, was: “How can we reframe it so it feels like a young woman’s fight?”

On Monday the Supreme Court ruled on the case, striking down a Louisiana law that required abortion clinics to have admitting privileges at local hospitals, four years after deciding that an effectively identical Texas requirement was unconstitutional because it placed an “undue burden” on safe abortion access. The Guttmacher Institute had estimated that 15 states could potentially put similarly restrictive laws on the books if the Supreme Court upheld the Louisiana law.

The leaders of reproductive rights organizations celebrated their victory with caution. At least 16 cases that would restrict access to legal abortion remain in lower courts, and 25 abortion bans have been enacted in more than a dozen states in the last year.

“The fight is far from over,” said Alexis McGill Johnson, the president of Planned Parenthood. “Our vigilance continues, knowing the makeup of the court as well as the federal judiciary is not in our favor.

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Interviews with more than a dozen young women who have taken to the streets for racial justice in recent weeks, though, reflected some ambivalence about their role in the movement for reproductive rights.

These young women recognized that while some American women can now gain easy access to abortion, millions more cannot; at least five states have only one abortion clinic.

But some, raised in a post-Roe world, do not feel the same urgency toward abortion as they do for other social justice causes; others want to ensure that the fight is broadly defined, with an emphasis on racial disparities in reproductive health.

Members of Gen Z and millennials are more progressive than older generations; they’ve also been politically active, whether organizing a global climate strike or mass marches against gun violence in schools.

While Gen Z women ranked abortion as very important to them in a 2019 survey from Ignite, a nonpartisan group focused on young women’s political education, mass shootings, climate change, education and racial inequality all edged it out. On the right, meanwhile, researchers say that opposition to abortion has become more central to young people’s political beliefs.

Melissa Deckman, a professor of political science at Washington College who studies young women’s political beliefs, said that Gen Z women predominantly believe in reproductive freedom but that some believe it is less pressing because they see it as a “given,” having grown up in a world of legalized abortion.

“Myself and other activists in my community are focused on issues that feel like immediate life or death, like the environment,” said Kaitlin Ahern, 19, who was raised in Scranton, Pa., in a community where air quality was low because of proximity to a landfill. “It’s easier to disassociate from abortion rights.”

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Fatimata Cham, 19, an ambassador for the anti-gun violence advocacy group Youth Over Guns, agreed that the fight for reproductive rights felt less personal. “For many activists, we have a calling, a realm of work we want to pursue because of our own personal experiences,” Ms. Cham said. “Growing up, abortion never came to mind as an issue I needed to work on.”

Some young women said that they considered reproductive rights an important factor in determining how they vote, but they struggled to see how their activism on the issue could have an effect.

When Ms. Baker helped coordinate local walkouts against gun violence, she sensed that young people no longer needed to wait for “permission” to demand change. With abortion advocacy, she said, organizers seem focused on waiting for decisions from the highest courts.

And even as those decisions move through the courts, the possibility of a future without legal abortion can feel implausible. “I know we have a lot to lose, but it’s hard to imagine us going backward,” said Alliyah Logan, 18, a recent high school graduate from the Bronx. “Is it possible to go that far back?”

Then she added: “Of course in this administration, anything is possible.”

For many women in the 1970s and ’80s, fighting for legal abortion was an essential aspect of being a feminist activist. A 1989 march for reproductive rights drew crowds larger than most protests since the Vietnam War, with more than half a million women rallying in Washington, D.C.

Today, young women who define themselves as progressive and politically active do not always consider the issue central to their identities, said Johanna Schoen, a professor of history at Rutgers and the author of “Abortion After Roe.”

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“Women in the ’70s understood very clearly that having control over reproduction is central to women’s ability to determine their own futures, to get the education they want, to have careers,” Dr. Schoen said. “As people got used to having access to abortion — and there’s a false sense that we’ve achieved a measure of equality — that radicalism women had in the early years got lost.”

Some millennial women who can easily and safely get abortions do not connect the experience to their political activism. Cynthia Gutierrez, 30, a community organizer in California, got a medication abortion in 2013. Because she did not struggle with medical access or insurance, the experience did not immediately propel her toward advocacy.

“I had no idea about the political landscape around it,” she said. “I had no idea that other people had challenges with access or finding a clinic or being able to afford an abortion.”

Around that time, Ms. Gutierrez began working at a criminal justice reform organization. “I wasn’t thinking, let me go to the next pro-choice rally,” she said. “The racial justice and criminal justice work I did felt more relevant because I had people in my life who had gone through the prison industrial complex, and I experienced discrimination.”

Other young women said they felt less drawn to reproductive rights messaging that is focused strictly on legal abortion access, and more drawn to messaging about racial and socioeconomic disparities in access to abortion, widely referred to as reproductive justice.

Deja Foxx, 20, a college student from Tucson, Ariz., became involved in reproductive justice advocacy when she confronted former Senator Jeff Flake, Republican of Arizona, at a town hall event over his push to defund Planned Parenthood.

But abortion access is not what initially drew her to the movement. She wanted to fight for coverage of contraceptives, as someone who was then homeless and uninsured, and for comprehensive sex education, since her high school’s curriculum did not mention the word consent.

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“There’s a need to protect the wins of the generation before us,” Ms. Foxx said. But she believes the conversations that engage members of her generation look different. “My story is about birth control access as a young person who didn’t have access to insurance,” she said.

The generational shift is evident at national gatherings for abortion providers. Ms. Schoen has attended the National Abortion Federation’s annual conference each year from 2003 to 2019. In recent years, she said, its attendees have grown more racially diverse and the agenda has shifted, from calls to keep abortion “safe, legal and rare” to an emphasis on racial equity in abortion access.

“The political questions and demands that the younger generation raises are very different,” she said. “There’s more of a focus on health inequalities and lack of access that Black and brown women have to abortion.”

Amid the coronavirus outbreak, even the most fundamental legal access to abortion seemed in question in some states. At least nine states took steps to temporarily ban abortions, deeming them elective or not medically necessary, although all the bans were challenged in court.

Research from the Kaiser Family Foundation found that the pandemic led to various new legal and logistical hurdles. In South Dakota, abortion providers have been unable to travel to their clinics from out of state. In Arkansas, women could receive abortions only with a negative Covid-19 swab within 72 hours of the procedure, and some have struggled to get tested.

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Alliyah Logan, a recent high school graduate, near her home in the Bronx. “I know we have a lot to lose, but it’s hard to imagine us going backward,” she said.Credit…Hiroko Masuike/The New York Times

But in spite of the threats, for some young women the calls to action feel sharpest when they go beyond defending rights they were raised with.

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“Right now, in a lot of social justice movements we’re seeing language about the future,” said Molly Brodsky, 25. “I hear ‘protect Roe v. Wade,’ and it feels like there needs to be another clause about the future we’re going to build. What other changes do we need? We can’t be complacent with past wins.”

The Vaccine Quest

For the uninitiated we had this before it was called SARS and that was the first shot over the bow that we needed to be prepared for variations of the same and sure enough over the last decade there has been and nothing, like now, was done. Why? Money, its always money. And due to that we will have again a hoard mentality with the rich being at the top of the line to get vaccinated. And it will not be enough initially to meet demand regardless.

 Its going to be fun the next year or so.  Get used to it as I never will and hope you don’t either as complacency means that we will be compliant and we cannot be if we are to move forward.  Look what it got us now.

Scientists were close to a coronavirus vaccine years ago. Then the money dried up.

“We just could not generate much interest,” a researcher said of the difficulty in getting funding to test the vaccine in humans.
                                        –    Dr. Peter Hotez
March 5, 2020 NBC
By Mike Hixenbaugh

HOUSTON — Dr. Peter Hotez says he made the pitch to anyone who would listen. After years of research, his team of scientists in Texas had helped develop a vaccine to protect against a deadly strain of coronavirus. Now they needed money to begin testing it in humans.

But this was 2016. More than a decade had passed since the viral disease known as severe acute respiratory syndrome, or SARS, had spread through China, killing more than 770 people. That disease, an earlier coronavirus similar to the one now sweeping the globe, was a distant memory by the time Hotez and his team sought funding to test whether their vaccine would work in humans.

“We tried like heck to see if we could get investors or grants to move this into the clinic,” said Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital and dean of the National School of Tropical Medicine at the Baylor College of Medicine in Houston. “But we just could not generate much interest.”

That was a big missed opportunity, according to Hotez and other vaccine scientists, who argue that SARS, and the Middle East respiratory syndrome, or MERS, of 2012, should have triggered major federal and global investments to develop vaccines in anticipation of future epidemics.

Instead, the SARS vaccine that Hotez’s team created in collaboration with scientists at the University of Texas Medical Branch at Galveston is sitting in a freezer, no closer to commercial production than it was four years ago.

“We could have had this ready to go and been testing the vaccine’s efficacy at the start of this new outbreak in China,” said Hotez, who believes the vaccine could provide cross-protection against the new coronavirus, which causes a respiratory disease known as COVID-19. “There is a problem with the ecosystem in vaccine development, and we’ve got to fix this.”

Hotez took that message to Congress on Thursday while testifying before the House Committee on Science, Space and Technology. He argued that the new coronavirus should trigger changes in the way the government funds vaccine development.

“It’s tragic that we won’t have a vaccine ready for this epidemic,” Hotez wrote in prepared remarks. “Practically speaking, we’ll be fighting these outbreaks with one hand tied behind our backs.”

As of Sunday, there had been well over 100,000 confirmed coronavirus cases globally and at least 3,700 deaths. Public health officials are concerned that the virus, which can lead to respiratory failure brought on by pneumonia, will spread widely in the U.S. and last beyond this year — much like the seasonal flu, but more severe and potentially deadlier.

In response, pharmaceutical companies, university researchers and the federal government have been rushing to develop a vaccine. In addition to the official government effort led by the National Institutes of Health, several drugmakers are also scrambling to develop a vaccine that can be tested in humans in the coming months. But even under the rosiest of projections, one won’t be ready for more than a year, government officials say.

“I’m cautiously optimistic that we will get a vaccine,” Dr. Anthony Fauci, the National Institutes of Health’s director for infectious diseases, said in an interview this week. “The thing that’s sobering is that it’s not a vaccine we’re going to have next month, so we’re going to have to tough it out through this evolution.”

Early efforts to develop a SARS vaccine in animal trials were plagued by a phenomenon known as “vaccine-induced enhancement,” in which recipients exhibit worse symptoms after being injected — something Fauci said researchers must be mindful of as they work to quickly develop a vaccine to protect against COVID-19.

That kind of research — figuring out which vaccine strategies work and which don’t — potentially could have been completed before the new outbreak, said Jason Schwartz, a professor at the Yale School of Public Health who studies vaccine development. He said the global response to the coronavirus exposes broader flaws in the way medical research is funded, which he says tends to be market-driven and reactive, rather than proactive.

“We have a pattern in our medical research landscape in which outbreaks lead to a surge in research investment, and if and when those outbreaks wane, as they invariably do, other priorities take their place,” Schwartz said. “As a result, you lose those opportunities to capitalize on that initial investment, and the cycle starts over again.”

The responsibility to fund this type of research must rest with governments and nonprofits, Schwartz said, because for-profit pharmaceutical companies can’t be counted on to fund projects that, in most cases, will never make money.

Some progress was made in the wake of the West Africa Ebola outbreak that ended in 2016. It spurred global leaders to create the Coalition for Epidemic Preparedness Innovations, or CEPI, a private-public partnership that’s based in Norway and funded in part by the Bill and Melinda Gates Foundation. The nonprofit group has poured millions of dollars into vaccine development, but Schwartz and other experts say more is needed.

“We need to make sure that there are incentives outside of our traditional business model that can lead to greater investments in that foundational research,” Schwartz said.

Dr. James LeDuc, director of the Galveston National Laboratory, said work has resumed on the SARS vaccine that his researchers helped develop with Hotez’s team. The laboratory, a high-security biocontainment facility on Texas’ Gulf Coast, received a live sample of the new coronavirus last month and will use it to test the vaccine in mice.

But first the lab must breed a colony of mice genetically engineered to replicate the human disease, a process that LeDuc said will take months.

“I think we as a nation and as a society need to be more agile in recognizing that new diseases do occur, and once they’ve cropped up, they very well may come again, maybe not the same but very similar,” said LeDuc, who formerly directed influenza response efforts at the Centers for Disease Control and Prevention. “So it was a shame that we had to stop that work and now are having to try and restart it.”

For weeks, Hotez has been reaching out to pharmaceutical companies and federal scientific agencies — and even the Medical Research Council in the United Kingdom — asking them to provide the roughly $3 million needed to begin testing the vaccine’s safety in humans, but so far none have done so.

“We’ve had some conversations with big pharma companies in recent weeks about our vaccine, and literally one said, ‘Well, we’re holding back to see if this thing comes back year after year,'” Hotez said.

He said he hopes the seriousness of the outbreak leads to reforms in how the federal government funds vaccine development, although he notes that he called for similar changes after the SARS and Ebola outbreaks. He said he’s particularly worried about the toll the coronavirus will take on elderly nursing home residents and health care workers. But in his testimony to Congress on Thursday, Hotez also made an economic argument.

“Because nobody would invest a few million dollars into these SARS vaccines, we’re looking at, I don’t know what the number is, $10 billion, $100 billion in economic losses,” Hotez said ahead of his appearance in Washington. “The stakes are so high, and the amount of money you’re talking about to fund this researc

Got Drugs?

Back in the day we used that expression for whatever drug was on offer.  Today that is the siren call for the Pharmaceutical companies to create a version of another drug, raise prices on ones that exist to pay for said new version and then make sure we are all in need of it some way or another.

And that argument is vested in Capitalism and of course the idea that winner take all. So public health  is the Knight int the Chess game and we are playing for our lives. The idea that profit over safety is not a debate and not mutually exclusive. But then again it has been as we have the most horrific health care system in the world, not the best, or would we see on the nightly news medical professional after medical professional begging for equipment, some of it just made of paper?

Now why we have so many different groups and agencies on the trail of Corvid is because they all want to patent the miracle cure or test that will generate millions. But the reality is that what should be a collaborative cooperative process is now a divisive and protective one largely not due to just economics but to trade wars, borders and other prohibitive restrictions that make this type of process nearly impossible.

And why the hysteria over unproven drugs for other treatments such as Malaria and Arthritis are being tested in desperation and out of need as something is better than nothing.  And we got nothing.

The New York Times did an amazing essay story on Why We Can’t Have Nice Drugs which explains in detail the drama behind why this is happening.  It begins on this note:

The United States, an unrivaled scientific power, is led by a president who openly scoffs at international cooperation while pursuing a global trade war. India, which produces staggering amounts of drugs, is ruled by a Hindu nationalist who has ratcheted up confrontation with neighbors. China, a dominant source of protective gear and medicines, is bent on a mission to restore its former imperial glory. 

Now, just as the world requires collaboration to defeat the coronavirus — scientists joining forces across borders to create vaccines, and manufacturers coordinating to deliver critical supplies — national interests are winning out. This time, the contest is over far more than which countries will make iPads or even advanced jets. This is a battle for supremacy over products that may determine who lives and who dies.

This is World War Z. Talk about the War on Drugs!

Now the reality is that we also have testing issues such as well getting tested without meeting the strict criteria in which to do so.  So you lie and in turn are tested and are you certain you are either POS or NEG? Well the margin of error is not given in the daily updates when the varying Governors announce the current POS and in turn Hospitalized and those are now broken down into those admitted into ICU and those on Ventilators which again says nothing about the remaining core group.  Are they sick, sickish or what, just walking super spreaders?

Which brings me to the core of the story about how irony or is it an oxymoron that a drug company became the super spreader not just in America but globally. I love this story and wonder if it will affect their stock prices as that is all that matters. And how about the Lifetime movie on this one!  Also that it started in Boston home of the Massholes.   Then it went to Nashville. Shit that poor city can’t get a break!   And did they release Pharma Bro yet from prison as he thinks he can find a cure? But really shouldn’t Tiger King get a pardon too?

How a Premier U.S. Drug Company Became a Virus ‘Super Spreader’
Biogen employees unwittingly spread the coronavirus from Massachusetts to Indiana, Tennessee and North Carolina.

By Farah Stockman and Kim Barker
The New York Times
April 12, 2020

BOSTON — On the first Monday in March, Michel Vounatsos, chief executive of the drug company Biogen, appeared in good spirits. The company’s new Alzheimer’s drug was showing promise after years of setbacks. Revenues had never been higher.

Onstage at an elite health care conference in Boston, Mr. Vounatsos touted the drug’s “remarkable journey.” Asked if the coronavirus that was ravaging China would disrupt supply chains and upend the company’s big plans, Mr. Vounatsos said no.

“So far, so good,” he said.

But even as he spoke, the virus was already silently spreading among Biogen’s senior executives, who did not know they had been infected days earlier at the company’s annual leadership meeting.

Biogen employees, most feeling healthy, boarded planes full of passengers. They drove home to their families. And they carried the virus to at least six states, the District of Columbia and three countries, outstripping the ability of local public health officials to trace the spread.

The Biogen meeting was one of the earliest examples in the United States of what epidemiologists call “superspreading events” of Covid-19, where a small gathering of people leads to a huge number of infections. Unlike the most infamous clusters of cases stemming from a nursing home outside Seattle or a 40th birthday party in Connecticut, the Biogen cluster happened at a meeting of top health care professionals whose job it was to fight disease, not spread it.

“The smartest people in health care and drug development — and they were completely oblivious to the biggest thing that was about to shatter their world,” said John Carroll, editor of Endpoints News, which covers the biotech industry.

The official count of those sickened — 99, including employees and their contacts, according to the Massachusetts Department of Public Health — includes only those who live in that state. The true number across the United States is certainly higher. The first two cases in Indiana were Biogen executives. So was the first known case in Tennessee, and six of the earliest cases in North Carolina.

All the people outside Massachusetts whom The New York Times has connected to the cluster have recovered. But it’s impossible to say for certain whether anyone became gravely ill or died from the spread out of the conference.

In hindsight, many people have criticized Biogen’s decision to continue with its leadership meeting in late February, which was attended by vice presidents from European countries already hit by the virus. Others in the industry fault Biogen for being too tight-lipped about the outbreak.

At least two of the company’s senior executives have tested positive. Citing privacy concerns, the company has declined to name them, even as other chief executives in biotech have disclosed their positive tests.

Responding to questions from The Times, Mr. Vounatsos refused to say even whether he had been tested for Covid-19.

“He is completely focused on employee safety, supplying medicines to patients, and leading the company,” said a Biogen spokesman, David Caouette. “This takes precedence over his personal health status.”

The company has defended its handling of the leadership meeting and its aftermath, saying it made the best decisions it could with the information available at the time.

“For a company whose mission is to save lives, it was very difficult to see our colleagues and community directly affected by this disease,” Mr. Vounatsos said in his first public comments about what happened at Biogen. “We would never have knowingly put anyone at risk.”

Founded in 1978 and based near Boston, Biogen helped pioneer the biotechnology industry, specializing in multiple sclerosis drugs. The company is best known now for its work on a promising treatment for Alzheimer’s.

Its experimental drug was seen as a potential holy grail — until the company announced about a year ago that the drug appeared to be a failure in large-scale trials. Patients were devastated. The company’s stock nose-dived.

But last fall, in a stunning reversal, Biogen announced that further analysis of the data suggested the drug actually worked at higher doses. Mr. Vounatsos said the company planned to seek approval from the Food and Drug Administration “as soon as possible.” The stock soared; the company pulled in record annual revenues of about $14.4 billion.

By the time of Biogen’s annual leadership meeting on Feb. 26 and 27, spirits were high. So was the pressure to deliver.

Although some other companies canceled international meetings around that time, Biogen never discussed doing so. The outbreak was raging in China but had not yet been declared a worldwide pandemic. As of Feb. 21, the Friday before the meeting, the United States had only 30 confirmed cases, according to data compiled by The Times. Biogen executives in Germany, Switzerland and Italy — where there were just 20 known cases — packed their bags.

On the first night, about 175 executives gathered for a buffet dinner and cocktails at the Marriott Long Wharf overlooking Boston Harbor. Colleagues who hadn’t seen each other in a year shook hands and vied for face time with bosses. Europeans gave customary kisses on both cheeks.
ImageOn the first night of Biogen’s annual leadership meeting, 175 executives gathered for a buffet dinner and cocktails at the Marriott Long Wharf in Boston, touching off a Covid-19 cluster in Massachusetts and several other states.
On the first night of Biogen’s annual leadership meeting, 175 executives gathered for a buffet dinner and cocktails at the Marriott Long Wharf in Boston, touching off a Covid-19 cluster in Massachusetts and several other states. Credit…Cody O’Loughlin for The New York Times

“It’s unfortunately the perfect breeding ground for a virus,” said one former vice president, who spoke on condition of anonymity because of his ties to Biogen.

Two days later, the senior executives returned to their offices. One drove to a manufacturing center in North Carolina. Others flew back to Europe.

Peter Bergethon, the head of digital and quantitative medicine at Biogen, went home to his wife, an infectious-disease doctor.

A Biogen vice president in the Alzheimer’s franchise and her husband attended a party the following Saturday night at a friend’s home in Princeton, N.J., with about 45 other people.

They celebrated a holiday in the Greek Orthodox calendar, the end of the Carnival season, with special sweets and traditional dances that involved holding hands in a circle. Although celebrations in Greece had been canceled, the party in New Jersey went forward, since White House officials had just pronounced the virus in the United States to be under control.

That night, Allana Taranto, a photographer who covered the leadership meeting for Biogen, celebrated her 42nd birthday with her boyfriend and another couple.

Over that weekend, though, some people in the company had already started feeling sick.

Jie Li, a 37-year-old biostatistician who worked on the Alzheimer’s drug team, had chills, a cough and aches. She was too junior to attend the company’s leadership conference, but her boss went, and showed up at the office afterward.

On March 2, the following Monday, the company’s chief medical officer sent an email informing everyone who attended the leadership meeting that some people had fallen ill and telling them to contact a health care provider if they felt sick.

“We moved quickly,” Mr. Caouette said.

Still, that same day, the company’s four top executives attended a huge health care conference hosted by the investment firm Cowen. At another Marriott in Boston, they held meetings in hotel rooms with potential investors. Another attendee who met some of the same investors said he heard that members of the Biogen team looked sick.

At the conference, concern about the coronavirus mounted as word spread that some companies, including Vertex and Seattle Genetics, had canceled their appearances. By Tuesday, the second day of the conference, many attendees had stopped shaking hands.

Later, investors were informed that two of the four Biogen executives at the conference tested positive for the virus.

In defense of his company’s decision to attend the event, Mr. Vounatsos said, “When we learned a number of our colleagues were ill, we did not know the cause was Covid-19.”

That Tuesday, Biogen contacted the Massachusetts Department of Public Health and reported that about 50 employees in the Boston area and overseas had flulike symptoms. Biogen employees began showing up at the emergency room of Massachusetts General Hospital, demanding tests. They were told their cases didn’t satisfy the testing criteria at the time, since none had traveled to a hot spot or had known exposure to someone who had tested positive for Covid-19.

The next day, confirmation of the worst arrived. Two Biogen executives who had returned home to Germany and Switzerland, where tests were more widely available, had tested positive.

On Thursday, the company held a call with its staff and shared the news. All office-based employees were directed to work from home.

Yet on that same day, a Biogen executive visited the Washington office of Pharmaceutical Research and Manufacturers of America, or PhRMA, the industry’s top lobbying group. Soon after, that executive tested positive, prompting the group to close its headquarters for deep cleaning.

The next few weeks turned into a blur of Biogen employees leaving casseroles on one another’s doorsteps and trading news about who had fallen ill.

Dr. Bergethon infected his wife, the infectious-disease specialist. While their symptoms were manageable, the scariest part was the uncertainty, Dr. Bergethon recalled recently at a virtual event hosted by the University of Rochester.

“We didn’t know we were going to recover,” he said. “We didn’t know what was coming next.”

Ms. Taranto, the photographer who had been at Biogen’s leadership conference, unknowingly gave the illness to a friend at her birthday dinner. She had felt healthy at the time.

Of the four dozen people who attended the party in New Jersey, at least 15 later tested positive, according to public health authorities.

A Biogen executive, Chris Baumgartner, became the first Covid case in Tennessee. “I was patient zero,” he wrote on Facebook. He added: “Imagine having to confront a virus so feared, it now has the entire world on the brink of mass hysteria.”

The earliest cases in Indiana and North Carolina were tied to the company. One Biogen employee even carried the virus back to China.

After falling ill with flu-like symptoms, Ms. Li called an ambulance and was given a coronavirus test, according to a public health official in Belmont, the upscale Boston suburb where she lived. But before she received the results, she booked a flight to Beijing, boarding a plane with her husband and son, leaving behind their house, a white BMW and other trappings of the life they had built in the United States over 15 years.

“They must have been desperate,” said Dr. William Q. Meeker, a statistics professor at Iowa State University who had worked closely with Ms. Li’s husband, Yili Hong, also a statistician. The couple worried most about their 2-year-old, who would be far from relatives if they both fell ill, according to a former graduate school classmate.

Ms. Li took medicine to conceal her symptoms, and revealed her health condition to flight attendants on board the flight, Air China and Beijing disease control officials said last month.

After she landed in China, authorities placed her under investigation for “obstructing the prevention of infectious diseases,” a crime that reportedly carries a sentence of up to seven years in prison.

In Beijing, the couple suffered from high fevers and lung infections and were hospitalized, Dr. Meeker said. He recently received an email from Mr. Hong that said they were recuperating, but that their lives “will be different in the future.”

It appears that all of Biogen’s employees who fell ill have recovered. Aside from Ms. Li, who was fired, all have returned to work, Mr. Caouette said.

Biogen has since joined the fight against the virus. The company donated $10 million to expand access to testing and to provide emergency food and protective gear for hospital workers.

Company officials said its struggle against the pandemic is just beginning: Biogen, for instance, has also entered into talks with Vir Technology about manufacturing a potential treatment for Covid-19, another pharmaceutical holy grail that could make untold amounts of money.

Corporate Medicine

As you stand up and applaud the efforts of the medical profession doing their “best” to combat the Covid virus you need to understand that most medicine is for profit and many are in the present state of laying off non essential workers and in turn closing more facilities in rural areas that would all be able to treat an overflow of patients or be facilities for those not infected but needing care or again those seeking non-essential medical treatment.  Well no as that is why Governors are getting Naval ships and turning convention centers and other public facilities as overflow hospitals, of course they are not actually serving in that capacity and shocking, no not really, as like the test itself there is a protocol that must be followed in which to transfer and receive said patients. And largely because well they are not HOSPITALS

The tale of these two temporary hospitals is one of disconnect between public expectations and political declarations, and what’s possible to achieve — logistically and medically — under the circumstances. Covid-19 patients can deteriorate rapidly and suddenly, even when they seem to be on the mend, and often require oxygen for days or weeks. With an increase in the severity of cases treated comes the need for more equipment and staffing. And at the moment, it remains to be seen whether either the Javits Center or the Comfort can adequately care for very many of the most seriously ill covid-19 patients, as state and federal officials have indicated is their new mission.

Between the two, there are 1,200 beds available, military officials said — far fewer than the 3,000 described in public statements by Gov. Andrew M. Cuomo (D) or the 5,000 touted in initial media announcements. As of Friday, about 250 beds were occupied, officials said. 

Military officials said they are continually revising their admissions criteria as they’ve had to transform the facilities into ICU-capable covid-19 field hospitals, instead of medical wards to treat noncritical, non-covid patients as New York state initially requested. The slow start, one defense official said, is owed in part to the military being unfamiliar with the local hospitals and the hospitals’ unfamiliarity with the military medical system. 

Initially, both the Javits Center and the Comfort were envisioned as overflow facilities capable of relieving the city’s hospitals of the added burden of providing more-routine care, so they could focus exclusively on the surge of coronavirus cases. But victims of trauma and other ailments vanished from emergency departments as automobile traffic and crime rates — except for domestic violence — plunged. 

“Lo and behold,” said physician Arthur Fougner, president of the Medical Society of the State of New York, “there aren’t that many non-covid patients.”
Everything was upended last week, after an uproar from hospital executives who questioned why these federal facilities were sitting nearly empty when the city’s doctors and nurses were overwhelmed. At first, Javits began accepting covid-19 patients transferred from hospitals, but only those convalescing, which “means they are in the recovery period and less likely to deteriorate and require major medical care,” a military official, speaking on the condition of anonymity because of sensitivities over the matter, said via email. “We had no safety outlet if the patient deteriorated (i.e. no ventilators, no ICU beds, etc.).” 

Yet until the admission criteria were updated this week, the threshold for sending patients to either the Javits Center or the Comfort were so restrictive that few people qualified, said one frustrated New York doctor, who spoke on the condition anonymity to be candid. “The hospitals are housing ICU-level patients in the patients in the lobbies and the cafeterias,” the doctor said, while the Javits beds added “nothing.”lobbies and the cafeterias,” the doctor said, while the Javits beds added “nothing.”

The military has attempted to streamline the transfer process. Because they’re both taking covid patients now, the Javits Center and the Comfort are working as one unit. Military doctors have been dispatched to hospitals around New York City where they help identify potential patients who can be transferred to the temporary sites. A command center within Javits decides whether ambulances ferry them to the convention hall or the ship. 

But even that is a complicated process. The Comfort was built to rescue trauma patients from battlefields and natural disasters. Getting a covid patient who’s attached to a ventilator through the ship’s passageways, which are narrower than a hospital’s, can be time-intensive, according to military officials.

Late in the week, the military patient assessment team sent out an email relaxing the restrictions for sicker covid patients to enter the Javits Center, yet again. What the medical teams were learning was that trying to screen for the most stable patients with this disease was pretty much like playing roulette. “It’s Las Vegas. You just hope you get it right,” said Gonzalez. 

Even under the earlier guidelines, Gonzalez said, several covid patients at the Javits Center had crashed and were being treated in the convention hall’s makeshift ICU. The restrictions on patient numbers, he added, are intended to protect them. “I could fill this place over the weekend,” he said, “but if you ramp up to 1,000 and you don’t do it right, you’re going to have a lot of casualties. . . . There is no blueprint for this.” 

In other words its complicated. And of course in the hysteria to prove which city has the biggest baddest dick in town, more cases began to emerge across the country and the national stockpile of good and equipment that Jared Kushner so grandly explained was “ours” as in apparently the Trump’s are not to be used by the states.. So again more confusion and contradictions.

And while many private hospitals go on with business as usual it shows that before all and end all profit matters most. 

Anguished nurses say Pennsylvania hospital risked infecting cancer patients, babies and staff with covid-19

Heroic effort to treat patients despite rationing of protective gowns, masks and tests

 The Washington Post
By Desmond Butler
April 11 2020

The nurse was pregnant — and worried. But in mid-March, early in the covid-19 crisis, a manager at Moses Taylor Hospital in Scranton, Pa., assured her she would not be sent to the floor for patients infected with the deadly virus. The risks for expectant mothers were too uncertain.

Two days later, she says, the administration changed course, saying the hospital needed “all hands on deck.” The pregnant nurse said she was sent back and forth between the “covid floor” and the neonatal intensive care unit, known as the NICU, where she normally treated vulnerable newborns and recovering mothers.

It wasn’t just her baby she was worried about, she said, but the immunocompromised newborns and mothers who she was treating without informing them that she was also working on the covid floor. Even as she cared for patients symptomatic of covid-19, administrators provided her with crucial protective gear only after tests came back positive, usually several days after she first attended to the infected patients.

The nurse was one of 11 medical staff and union representatives who described from the inside how a hospital in a small Pennsylvania city struggled to protect medical staff and patients during the chaotic early days of the crisis. Seven of the nurses, who work at two sister hospitals in Scranton, spoke on the condition of anonymity for fear of reprisals by the Tennessee-based company that owns their hospitals, Community Health Systems.

Like many hospitals across the country, Moses Taylor wasn’t prepared for the influx of highly contagious patients in the absence of vast quantities of protective gear. But measures taken by CHS to cope with the crisis stand out. The shortage led administrators to initially order staff to work with suspected covid-19 patients without adequate protection and to shuttle back and forth between floors where they feared they would infect cancer patients and babies, nurses say.

Staff interviewed by The Washington Post said that they were speaking up out of concern for what they see as a perilous situation and out of anger over the disorganization, carelessness and greed that they say flows from a distant corporate owner.

The nurses and representatives of their union said that many of their safety concerns were dismissed as recently as last Friday, April 3, during a meeting with the hospital administration. But on Tuesday, after CHS was contacted by The Post, the hospital announced several changes in policy to prevent the spread of infection.

The hospital’s chief executive, Michael Brown, said in a statement that covid-19 has been an unprecedented challenge that required frequent changes and that the hospital is following guidelines from the Centers for Disease Control and Prevention.

“None of us has experienced a health crisis of this magnitude before,” he said. “We are adjusting and improving our response every day, and I am incredibly proud of all of the ways our physicians, nurses and team members are working together to care for our patients and each other.”

Matthew Yarnell, the president of Service Employees International Union Healthcare PA, the state’s largest union of nurses and health workers, welcomed the changes announced this week, which include designating an employee entrance to the building and screening staff members for fevers before entering and leaving the 214-bed hospital.

But he added in a statement: “It shouldn’t take attention from a national media outlet to move CHS to put the safety of patients and frontline caregivers first.”

The hospital said in a statement that it had implemented temperature checks on April 4, but a memo to staff this week obtained by The Post says they went into effect April 8.

With 99 hospitals in 17 states, CHS is one of the largest for-profit health companies in the U.S. But through spinoffs, sales and closures, the number of hospitals in the chain has fallen from over 200 in 2014. CHS has been facing sizable debt, and its share price has more than halved since the pandemic began to take hold in February.

“Over the past few years, we have made significant progress in our operational and financial performance, putting the company back on a positive trajectory with future growth potential,” Tomi Galin, the head of corporate communications for CHS, said in an email. “Since 2016, we have been divesting hospitals to pay down debt and also to create a stronger core portfolio for the future.”

The years have been good for CHS chief executive Wayne Smith, whose total compensation has ballooned in recent years to $8 million, including stock awards and incentives, according to the Securities and Exchange Commission.

After being contacted by The Post for comment on this story, the company filed a document to the SEC stating that Smith was voluntarily taking a 25 percent cut to his base salary, which was $1.6 million last year, and that other executives were taking a 10 percent cut. The company said in a statement that the pay cuts would help pay for a $3 million fund for employees “suffering hardships.”

CHS owns six hospitals in Pennsylvania. In interviews, workers in other CHS hospitals also reported problems over the lack of protective gear and inconsistent policies since covid-19 patients began to be admitted.

Union officials representing the nurses say that they had repeatedly tried to raise their concerns about the dangers to their members and patients but had been mostly rebuffed until this week.

“Anything you say, anything about the coronavirus or that we don’t have enough equipment at the hospital, they’re pulling you into the office,” says Dan Coviello, who works as a surgical tech at a sister CHS hospital in Scranton and is the president of the SEIU PA chapter that represents nurses at that hospital.

Brown, the chief executive, says the company urges employees to speak up about safety concerns and says that they can make anonymous complaints about retaliation to a hotline.

“Our organization does not support or condone retaliation and will address it immediately if such behavior is found to have occurred,” he said.

But Coviello says that employees at the two CHS hospitals in Scranton who have raised concerns about unprotected contact with specific covid-19 patients have been threatened with termination for violating health privacy laws. When he has gone to management with safety complaints from members at his hospital, he says the first question is “What’s the person’s name?” which he says reflects their primary interest in rooting out complainers.

Timothy Landers, a professor of nursing at Ohio State University, says that this kind of pressure on nurses, especially during a health-care crisis, can harm patients.

“If you have nurses who are kind of overworked, overstressed, feeling underappreciated, put upon, not respected or protected by management, then you see all kinds of bad things happen with patient care,” he said.

Galin, the CHS spokeswoman, said in a statement that the company is working around-the-clock to resupply its hospitals with protective equipment.

“First and foremost, we recognize that protecting our caregivers is critically important, and we are doing everything possible to create the safest work environments possible,” she said in an email.

Nevertheless, the union and nurses say those who speak out about problems have been hauled in for disciplinary meetings, had their shift hours cut, or had their schedules changed.

“In the last week, we have members being pulled in to managers’ offices and they’re giving them coaching because they’re speaking out and they want them to be quiet,” Coviello said of his hospital, Regional Hospital of Scranton. “And some got written discipline. And in those disciplines, which I’ve been in, they said that if they continue to speak out, there will be further discipline up to being fired from the hospital.”

A second nurse who works in the neonatal intensive care unit said that fear of retaliation is the reason she could not speak publicly. “That’s why I’ve been so adamant about being anonymous,” she said, “because it’s ugly.”

She and others said say they are losing the very thing that made them want to be nurses — the chance to help the sick and infirm. They say that tensions with management and hospital policies have put them in the impossible situation of endangering the lives of their patients.

“It feels like these guys are loading a gun,” the nurse said. “But we’re the ones who have to pull the trigger.”

When it came to questions about whether pregnant nurses could be removed from duties on the covid floor, one nurse says the hospital’s chief medical officer told her, “Absolutely not.”

“Then it would be only males and postmenopausal women taking care of these patients,” she recalled him saying.

The hospital said in a statement that the allegation took the officer’s comments out of context.

“What he was saying is that the CDC can give no direction at this time regarding pregnant healthcare workers and ‘without CDC guidance, I can’t ask only male and post-menopausal women to care for COVID-19 patients,’” the emailed statement said.

Landers said that there have not been definitive studies on the health risks for pregnant nurses, but he added that hospitals should defer to nurses’ concerns and redeploy them if they are worried about their safety.

Moses Taylor is an acute care hospital with 400 doctors that is best known for its pediatric and neonatal care. With more than 2,500 births last year — an average of 48 a week — nurses were worried about how to deliver babies without infecting their mothers.

As they watched the coronavirus march across the globe months ago, the nurses said they got no guidance and saw no planning from administrators on how it would cope when coronavirus arrived at the hospital’s threshold. Their anxiety was compounded by past experience: Even before this crisis, they said, Moses Taylor was constantly scrimping on supplies and shifts to cover busy wards.

The only sign they saw that the hospital was preparing was when managers began locking away in administrative offices the critical N95 masks and gear that can prevent infection. When one nurse asked a manager what they planned to do if any medical staff were infected, she said she was told: “Well we’ll figure that out when that time comes.”

Brown, the chief executive, disputes that charge, saying that the hospital is being transparent with staff about the covid-19 cases, the supply of protective gear, staffing and “other things that matter to them, because we believe that they need to know what’s happening across the hospital.” Moses Taylor said as of April 8 it was caring for seven patients confirmed to have covid-19 and five patients whose test results were still pending.

Two of the nurses have not spoken publicly about their working conditions in fear of retaliation from their supervisors and hospital management. (Elizabeth Herman/For The Washington Post)

In early March, as the first patients began to arrive, staff say they got different directives every day from their managers on how to protect themselves and patients. Then late last month, a nurse working on a floor that housed the oncology and orthopedic departments ran into the hospital’s chief medical officer, who had news.

“We’d lost the coin toss between us and another floor,” the nurse said. “We were now going to be the covid floor.”

They immediately began staffing the floor with some full-time nurses, while alternating others between departments. Some nurses were going directly from treating covid patients to administering chemotherapy to cancer patients, who would be especially endangered by a covid-19 infection.

The nurse on the orthopedic and oncology floor complained to a supervisor about the risks at the beginning of her shift. The manager told her she would look into the issue and provide guidance at the end of the day — after the nurse would have already treated several cancer patients. She never heard back from the supervisor. “It goes in one ear and out the other,” she said.

Even when the nurses have secured access to protective gear, they said, it has been extremely limited. They were expected to wear one-use masks for five shifts. Some were told to disinfect the masks in between uses with rubbing alcohol that gave them headaches when they put them back on. Others were told to use one mask each time they treated a specific patient and to put it in a paper bag until the next time — a practice that could allow virus particles to migrate, potentially infecting them. They witnessed staff coming out from treating virus patients in protective gowns and then sitting on chairs in the hallway without taking them off.

The hospital says it is following CDC guidance on the use and reuse of protective masks and sent a link to the recommendations, which specifically refer to using paper bags for N95 storage. However, the same recommendations rule out the reuse of masks in such circumstances without sterilization.

“Discard N95 respirators following close contact with any patient co-infected with an infectious disease requiring contact precautions,” the recommendations say. Covid-19 is such an infectious disease, Landers, the Ohio State professor, said.

“That would not be an example of good practice,” he said of Moses Taylor

According to the nurses, the protective masks were only being given out for treating confirmed covid-19 patients. But nurses are often expected to walk into rooms without knowing a patient’s condition.

“They just tell us, you know, go check on and see so-and-so,” one nurse explained. “You have absolutely no idea what you are walking into. No idea why this person is in the hospital. No idea what they have. Nothing.”

The hospital says that since mid-March medical staff has been told to report symptoms, but nurses say managers ignored symptoms they reported on more than one occasion.

In one instance, a nurse with a newborn and a young daughter at home who had been out sick for two days with a fever and a cough reported for duty and asked whether she should get to work, according to two nurses she spoke with. The nurse’s supervisor sent her to human resources. Human resources sent her back to her supervisor, who then took her temperature.

Despite having taken an ibuprofen, she still had a low-grade fever. The supervisor said, “‘Well I’m not worried about it. Just clock it,’” one nurse recounted.

The problems were extensive. One of the NICU nurses said staff had been asking for weeks what they would do if an expectant mother came in with signs of infection. They were given no answer. And then late last month it happened.

“It was literally chaos. Nobody knew what was going on. We had to fight to get N95 masks to take care of this mother,” she recalled.

Then they couldn’t figure out where to take the baby for quarantine. The administration wanted to send the newborn to the pediatric unit, where there was a risk of older children passing on the flu or other illnesses.

Only days after this incident did the hospital offer a written plan for such circumstances, she said.

The hospital says that no newborn or new mother has tested positive following hospital care.

The nurses’ allegations come as hospitals across the country are facing test and mask shortages and a torrent of infections that is stretching their capacity. Concerns similar to those raised by the Moses Taylor medical staff were recently highlighted by the U.S. Department of Health and Human Services’s internal watchdog in a survey of hundreds of hospitals.

The HHS’s inspector general found that medical staff is facing high levels of anxiety. It pointed to one hospital where a staff member who tested positive for covid-19 exposed other employees. It said the hospital did not have enough test kits to screen them. It also found that many hospitals were setting aside best practices for personal protection equipment because of shortages.

“This place actually makes you second-guess your career choice,” one nurse lamented. “As much as I love my job, it’s like, is it even worth it being a nurse and putting these patients at risk? I mean, that’s the biggest concern, you know, at the end of the day, did I give my best care possible? And this place prevents you from doing that.”

Union officials and hospital staff finally met with hospital administrators last Friday, after weeks of complaints about safety. But staff say they got little information. When they asked how many masks the hospital had and how it was distributing them, they were told that the hospital had adequate supplies and would follow guidelines from the CDC.

When they asked for clarity on what employees should do if they came down with covid-19 symptoms, they were told that they were relying on staff to consult their own physicians and to “self-screen.” The hospital would not test staff.

“Self-screening for covid?” one union official asked, incredulous. “Are you kidding me?”

On Wednesday, the hospital began screening the staff.

The Big Box

We love our big box stores, the Walmarts, the Costco’s, the Best Buy and the other giant versions of Bodegas but with white people. Well as customers as behind the scenes those essential workers are largely faces of color, people whose incomes fall just above the poverty line or at which enables them to attain some social services safety nets while of course being labeled “welfare queens” or the like and are now defined as “essential workers.”  While still making shit for wages, living in substandard housing and with extended family members who may already have been exposed to the virus through their commute, the families or people they work with and/or for and of course their already physical health issues that make them a magnet for said virus.  Then they told 25 friends and so on.  Just a thought people as you await your Whole Foods delivery.

The next is the way the virus emerged en mass.  The New York area tracked it to a woman on a flight from Iran where NONE of the passengers were tested and in turn the protocol screening test “Were you in contact with anyone who had it or have they or you been to a high risk area – at that time just China but soon Italy?”  And if the answer was no you were dismissed and not tested.  So in New York an Attorney from New Rochelle who commuted into Manhattan every day was ground zero as it was tracked to his Synagogue and in turn that area went into mass lockdown or from now on I will call full on Wuhan. But of course he had already shared it with 2.5 of his commuter friends and they shared it and so on.   And remember this virus has a three to 14 day window in which it sits and relaxes before it takes hold and for many particularly young folks it appears as a flu or small treatable virus and then they move on and in that time frame they are the most social of transporters as they found  while researching the stories of those who had contracted the illness and perhaps spread it as well  and shocking how the found repeatedly ignorance and arrogance by those who for some nutfuck reason were symptomatic but not fitting the profile.  .  And they were aggressive from the get go in Seattle as it was a like a board game tracing the origins. And the irony was this was early days and the most essential info was the symptoms, NO ONE had them all. Again shocking, I know!!! Not really.

But what we have learned is that people who think they are not at risk are and the reality is that its a virus and the more social you are the more at risk you are so unless you are living in social isolation and physically distancing 24/7, which pretty much describes me; however I was on planes flying in and out of Newark at the same time as the outbreak I have no idea who was sitting next to me and in turn touched my bags, chairs, the airplane itself and we know that airlines are not actually doing much to flatten the curve so there you go.

 So while the poor and elderly fit the profile of the most serious victims of Covid it is about the overall health and predisposition and that brings me to the box warehouses we house our most beloved.  Really, you do?  You do. As we learned in Seattle/Kirkland where the Old People Warehouse where the epidemic took hold and became ground zero for the U.S. outbreak.  

And the reality we see this homeless shelters and prisons as when you confine folks into a tightly closed in space you will have more outbreaks and the reality of every single worker in turn is a carrier and so it goes when you limit testing and defining the pattern of physical ailments that define the disease.   It is a a virus not a clone.   Ever see Orphan Black even clones exhibit varying behaviors!

And even a Doctor who contracted Covid found himself realizing how this disease progresses and the need for tracking and tracing all contacts as his son also a Doctor became sick and who treated himself with the controversial malaria drug and recovered. But note he comments that there is a desperate need for a vaccine as there is no way of ever containing it.  So we do what for the next 18 months?  Sit in isolation? Can I get my Whole Foods person to pick my veggies better?

Testing and tracking and maybe start at the biggest warehouses we have, no well yes Cruise Ships, actually all and everyone in a hospital, prisons, churches, shelters and your old folks home. But let me assure you me and the SATC crowd, remember those girls are not much better as we are fucked without dinner or safe sex and we will likely be the most neglected when it comes to care. So no wonder we far being shoved into one of these homes.  I have always said the minute we started killing off the old women no one would care and guess what I was right. We like old people out of site and out of mind, like prisoners, sick people, not white people, not any people just like us all white, healthy and rich and stuff until we need them.

At Va. facility where virus killed 40, doctor blames society’s willingness to ‘warehouse’ elders

The Washington Post
By Laura Vozzella
April 11, 2020

RICHMOND — The doctor in charge of a Richmond-area nursing home with one of the nation’s worst coronavirus death tolls says society is partly to blame because of its willingness to “warehouse” the elderly in underfunded public facilities.

James Wright, medical director at Canterbury Rehabilitation & Healthcare Center, was asked at a news briefing Friday what he might have done to better stem the spread of the novel coronavirus, which has infected 148 residents and staff, killing 40.

“If I were to do something different, I would have a nursing home that had enough staff around-the-clock, around all the time,” he said. “I would have a nursing home where everyone had private rooms. I would have a nursing home where there was greater access to the outdoors. In other words, I would have a nursing home funded by a society that puts more emphasis on treating our elders the way they should be treated.”

Wright acknowledged the need to look back and consider how he and the Henrico County facility responded to the outbreak that began about a month ago. But he said the examination can’t stop there.

“It’s also important to see what we, as society, could do differently, because this will not be the last untreatable virus to decimate our elders,” he said. “When we, as a society, see that it’s appropriate to warehouse our elders, and to put them in small spaces, to underpay their staff so that there are chronic staffing shortages . . . we are going to see this over and over again. We all opted for this type of environment for our elders. And as a result, this virus spread through a publicly funded nursing home . . . like wildfire.”

Wright called it “ridiculous” and “stupid” that the Washington state nursing home with the nation’s first major outbreak of the novel coronavirus faces a potential $611,000 fine for deficiencies that contributed to the spread. Forty-three deaths have been associated with that Seattle-area home, Life Care Center of Kirkland.

Sign up for our Coronavirus Updates newsletter to track the outbreak. All stories linked in the newsletter are free to access.

Washington state nursing home faces $611,000 fine over lapses during fatal coronavirus outbreak

Wright said federal health officials should “mentor” facilities with problems and supply additional staff, not fine them.

“We need to do something different than just punish,” he said.

Canterbury temporarily lost much of its staff — to illness, fear and economic necessity — at the start of the outbreak. Many low-paid health care workers hold down jobs at multiple nursing homes. Some had to quit Canterbury because their other employers stopped accepting anyone who was pulling shifts at Canterbury.

Wright declined to specify just much his staff shrank but said he wound up on the front lines. “I was changing patients, cleaning beds,” he said. His wife, a palliative care doctor at a local hospital, took a week and a half of leave to volunteer at Canterbury.

“My wife was in there, much to her delight at times and much to her chagrin,” he said. “Glad I married her.”

Wright indicated that Canterbury may be turning a corner in the crisis, despite stubborn shortages in protective gear. He said about 85 infected patients were recovering well enough that they could resume some group activities, such as eating meals together. They will remain separated from the rest of Canterbury’s population. Thirty-five residents have tested negative.

At care facility linked to three coronavirus deaths, official says staff need more protective equipment to halt spread

Some of the 25 staff members who tested positive for the virus are back on the job. Some were ill but have recovered. Others tested positive but never showed signs of illness; those employees are working exclusively with residents with covid-19, so there is no chance of infecting those who are negative.

Canterbury is exploring whether it can use those workers, who are “theoretically immune” because of their prior exposure to the virus, to specialize in caring for covid-19 patients, Wright said. The facility is working with a lab to see if testing can be developed to demonstrate immunity.

“We feel like we’re the experts in treating covid-positive patients now,” he said. “It’s not a great niche to be in, but it’s the niche we’re in.”

False Gods and Idols

Right now we are suddenly worshipping Medical Professionals and other first responders along with Grocery clerk, errand runners and other lowly paid individuals who are now defined as “essential workers” who are the lowest rung on the economic ladder other than Physicians who at least have some higher education other than that no.  Remember when they told you that having a degree would enable you to earn more well it depends on the degree and when the shiny keys are thrown in your direction. Well right now they are being literally thrown to the Valet and he/she is in charge of your survival. Remember to tip well.

Remember STEM? Remember Student Tests and the importance of evaluating Teachers based on the students performance of said tests? How is that working for you now home schoolers?  And it appears that online learning has been a big bust. From special needs to English language learners to available broadband this was another farce exposed in the “wealthiest” country in the world.  Shocking, no not really.  Remember the fad that was going to be free online college learning? I do and what happened there? Oh nothing.  And all of that may be for naught. Big duh.

I was and to some extent still want to teach just a sub as I loathe the politics and bullshit of what has become Education. It always was a pink collar profession and in turn women ran the school house and we know what bitches unhappy women are so go figure.  Then Daddy or literally the token female Administrator who was also a bitch had to run the school like a business with no training or education in business so it was clearly why education was a hot mess as you cannot be both a Teacher or Businessperson.  Kind of like Trump as Business person/President.

I got nothing good to say about my experience in Education other than many of the students who never ceased to amaze me in ways that I still relish and cherish.  How is that home school going with no play time, no music, no breaks what.so.ever. Welcome to the school room. Teachers are heroes!

Now the new focus is on STEM and right now that is a fucked up industry on its own other than the big three and even Apple I wonder how they will pull out of this when the tariffs and hating China kick in when this ends.   That timeline is coming and being done quietly behind closed doors.  Meanwhile in the Valley of Doom they are coming to terms with their bullshit of handing money over to a bunch of idiots who are rebranding how to bag groceries, wash your hair and walk across the street.  To that I say good luck and good bye.

But they will always be ahead of the game as they play it better than anyone and this column in the New York Times highlights a great deal of news coming out of this pandemic and what the Valley is doing to aid this crisis. Its not but it is staffing underpaid and unemployed folks to run and get coffee for someone to afraid to do it themselves.

And of course posted yesterday, Laughter is the Best Medicine, about how Nurses laugh at you.   And there are many many earlier posts in the blog that shares one story after another about medical malpractice and negligence;  For the record there are many happening right now as they are in chaos and they were placed there by the for profit organizations who ran them like some sort of experiment in science that FAILED. And many are laying off personnel while shutting doors to others as a way of balancing the budget. EPIC FAIL.

The stories that will come out of this with many being sent home not tested to end up sick and making others sicker to those intubating patients and doing so poorly, untrained and well then neglected or even unnecessarily as it was easier than putting them on an Oxygen regimen and treating with meds and quality care.. again it should be thought of as a last resort will also be debated.  Of course the infamous death panels are now really happening so that worked out in Trump’s favor to decimate the ACA!

Now with that do I want us to go vigilante on medical professionals? No just quit the idolizing and in turn respect them, listen to them and in fact try to figure out how we can fix this broken mess in a way that it will never happen again.  But it will ask anyone who has ever been in hospital and experienced first had the neglect, the abuse, the plain shitty care.  We are legion so when a Covid victim who was a Physical Therapist here in NYC refused to go to hospital, Mt. Sinai, came up with a system of checks and video conferences on those released patients and out of 35 only one was readmitted so there is one good story out of this. But again when an employee refuses to be admitted what does he know that we don’t.  They are dumps.

As coronavirus fears grow, doctors and nurses face abuse, attacks

By Mary Beth Sheridan, Niha Masih and Regine Cabato
The Washington Post April 8, 2020

It’s hard enough being a doctor in the midst of the coronavirus pandemic. But Sanjibani Panigrahi, a psychiatrist at a government hospital in western India, now finds her own neighbors turning against her.

“We are sure you have corona,” one woman recently shrieked at her, she says, — part of a torrent of abuse from residents at her apartment complex. “We will not allow you in the building.”

In some cities, health-care workers are earning standing ovations for the long, life-risking hours they’re putting in to battle the coronavirus. But in others, they’re facing discrimination and even attacks.

In Mexico, Colombia, India, the Philippines, Australia and other countries, people terrified by the highly infectious virus are lashing out at medical professionals — kicking them off buses, evicting them from apartments, even dousing them with water mixed with chlorine.

The culprits are a minority of the population. But Mexican state authorities are so worried that they’ve arranged special buses for nurses. In parts of Australia, hospitals are urging nurses not to wear their uniforms in public, to avoid attacks.

Last week, Philippine President Rodrigo Duterte ordered police to protect health workers after reports of assaults — including one in which someone splashed bleach in a hospital employee’s face.

The hostility has been a shock to medical professionals already under immense strain. Scores of doctors and nurses around the world have died after being infected with the coronavirus. In many countries, health workers are struggling with a lack of basic protective equipment, such as masks.

“I understand people are afraid, but abusing doctors is not okay,” Panigrahi said by phone from the industrial town of Surat. “We are at risk more than them.”

In her case, the harassment ended after local police and politicians intervened, Panigrahi said. Her neighbors apologized, saying they had been frightened by news about the virus.

Coronavirus lockdowns across Latin America send Venezuelan migrants back to their broken homeland

But other health professionals continue to be stigmatized.

A doctors’ association in Delhi wrote to the central government that health workers were being evicted by landlords over their work. “Many doctors are now stranded on the roads with all their luggage, nowhere to go, across the country,” the association said.

“DEEPLY ANGUISHED,” the country’s health minister, Harsh Vardhan, tweeted in response to such reports. “All precautions are being taken by doctors & staff on #COVID2019 duty to ensure they’re not carriers of infection in any way.”

Authorities say the attacks reflect misunderstanding of the virus and the strict hygiene maintained by hospitals to limit its spread.

In one jarring incident, a man allegedly shot an ambulance driver last week in Quezon province in the Philippines. The assailant was worried the vehicle was going to enter a subdivision and spread the virus, the hospital said.

The Peter Paul Medical Center of Candelaria said its ambulance driver was transporting hospital personnel, not coronavirus patients. “Moreover, proper cleaning and disinfection of the vehicle is done on a regular basis,” the hospital said.

The driver survived, with a finger wound.

Scattered attacks have occurred in many parts of the world, including the United States. A nurse in Chicago told the local ABC7 TV channel last week that she had been punched in the eye on a public bus by a man who accused her of spreading the virus.

“Going to and from work in my scrubs, I often watch people take two steps back away from me” — and not just because of social distancing, she told the station, speaking on the condition that she not be identified. “I think the concern is that any health care provider is contagious themselves.”

Authorities worry such fears could erupt in violence, not just against health professionals but medical facilities.

Protesters in Abidjan, the commercial capital of Ivory Coast, tried to destroy a coronavirus testing center under construction on Monday. Videos on social media showed people ripping planks of wood off the structure as police fired tear gas canisters.

Some told reporters they did not want a treatment facility so close to their homes. “They want to kill us,” one told Reuters.

Health Ministry officials said the center was not even designed to treat patients with covid-19, the disease the virus causes, but rather to test for the virus.

Mexican factories boost production of medical supplies for U.S. hospitals while country struggles with its own coronavirus outbreak

Medical professionals worry the attacks and insults could demoralize health workers just when they’re most needed.

“If we continue to harass them, more of them will quit their jobs, and our health-care system would be in danger,” said Reigner Antiquera, president of the Alliance of Young Nurse Leaders and Advocates in the Philippines.

In Mexico, suspicion of nurses is so widespread that many have stopped going to work in their uniforms.

Maria Luisa Castillo, a 30-year nursing veteran, has worn her white uniform proudly. But on a recent afternoon, after working the daytime shift at Guadalajara’s Civil Hospital, it proved a liability. She was standing alone at a bus stop. A bus approached, she tried to wave it down, and it zoomed on by — to the next block, where it stopped and deposited passengers.

“It was clear they didn’t want to pick me up,” the 51-year-old nurse said.

She was among at least a half-dozen nurses in western Jalisco state who have filed complaints of discrimination or other harassment in recent weeks. In response, the state government is providing free transportation for nurses, along with face masks.

Coronavirus on the border: Why Mexico has so few cases compared with the U.S.

Further north, in Durango state, officials summoned bus companies to explain that there was no health risk in transporting health workers.

“We see how in Italy a nurse leaves her home to go to work and people applaud,” said Fernando Ríos Quiñones, a spokesman for the state health department. “But here we see these sad situations.”

He said special buses were now dropping employees off at hospitals, and taxi drivers were offering 30 percent discounts to doctors and nurses.

Sandra Alemán has heard the advice: Don’t wear your uniform in public. But last Friday, while driving to a public hospital in the city of San Luis Potosi for the night shift, the 32-year-old nurse stopped at a convenience store for a cup of coffee. As she was leaving, she said, some children hurled juice and soda at her, yelling, “Covid! Covid!”
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When Aleman scolded the children, she said, their mother slapped her in the face. As she attempted to run away, she said, she fell and fractured a finger.

She’s now feeling something she never experienced in her nine years on the job: fear of going out in public in her uniform. Nonetheless, she said, she plans to return to her job.

“When I recover, I’m going back,” she said.

In Poker its called the Bluff

In the card game of poker, a bluff is a bet or raise made with a hand which is not thought to be the best hand. To bluff is to make such a bet. The objective of a bluff is to induce a fold by at least one opponent who holds a better hand. The size and frequency of a bluff determines its profitability to the bluffer

The winners in this hand will be the Tech sector as they were the targets until the virus hit and now these data miners that have deep recesses of info, have stepped up to provide “essential” services will now be the winners who take all in the next wave of whatever comes up on shore the next time.

America showed its soft underbelly of bleeding mass, it gave the world a glimpse into our weaknesses and paranoia, and in turn confirmed to Russia that we are just really bad at bluffing and game is over so turn your cards.   Thanks to Crazy Grandpa in Chief he has just turned his rallies into nightly propaganda speeches that have odd other professionals face palming, eye rolling and zieg heiling behind him to spare his wrath. What that fuck is that all about in a supposed Democracy that allows dissension.  Well no it doesn’t as we have curfews, house arrests and other tenets of martial law in place to ensure conformity and cooperation.   Ah yes wartime powers.

The reality is that we have no fucking clue what is happening and they are turning stadiums, conference centers and floating death ships into whatever they are turning into.  For a little info the country of Iceland tested a large percent of the population and found everyone is about 50% POS. Well they bathe naked together there, I should know and the food sucks, so this is not that exciting. What it means is that of that only a few were symptomatic and actually exhibited the full capabilities of the virus. WHAT you say!

Again we have no way of knowing how fast and furious this virus will travel, whom it will just crash for awhile and some who it will crash literally into.  We assume it was the old fucks and then again we are still alive so that moral panic button was pushed and now we are apparently the collateral damage in which to restart the economy.  Those death panels the Republicans feared are now the ones leading us into the showers.  Thanks I prefer a bath!

Again we are fucking leaderless, clueless and utterly abjectly alone here and well this whole personal responsibility thing takes on a whole new meaning as well Tennessee just coming out of the Tornado zone is now buying more guns which when the legislature returns can finish up that open carry law they were working on.  God I may be at ground zero but I am safer here.  There is no cure for crazy.

So I am again exhausted as I also wonder what will happen when the economy has to come back to those non-essential businesses, you know the Yoga Studios, Hair/Nail Salons, Dentists and of course the decimated restaurant industry.  Well this one should be fascinating as that will need a reset in ways that the SBA and the Chamber of Commerce’s will have to face and those faces will be a lot of colors and sexualities that normally don’t come to the meetings.

But America’s hand in the game has been played, no irony that Kenny Rogers folded his cards and left the table as you can only bluff so long. The Emperor wears no clothes.

The Coronavirus Called America’s Bluff

Like Japan in the mid-1800s, the United States now faces a crisis that disproves everything the country believes about itself.

March 15, 2020
Anne Applebaum
Staff writer at The Atlantic

On July 8, 1853, Commodore Matthew Perry of the U.S. Navy sailed into Tokyo Bay with two steamships and two sailing vessels under his command. He landed a squadron of heavily armed sailors and marines; he moved one of the ships ostentatiously up the harbor, so that more people could see it. He delivered a letter from President Millard Fillmore demanding that the Japanese open up their ports to American trade. As they left, Perry’s fleets fired their guns into the ether. In the port, people were terrified: “It sounded like distant thunder,” a contemporary diarist wrote at the time, “and the mountains echoed back the noise of the shots. This was so formidable that the people in Edo [modern Tokyo] were fearful.”

But the noise was not the only thing that frightened the Japanese. The Perry expedition famously convinced them that their political system was incapable of coping with new kinds of threats. Secure in their island homeland, the rulers of Japan had been convinced for decades of their cultural superiority. Japan was unique, special, the homeland of the gods. “Japan’s position, at the vertex of the earth, makes it the standard for the nations of the world,” the nationalist thinker Aizawa Seishisai wrote nearly three decades before Perry’s arrival. But the steamships and the guns changed all that. Suddenly, the Japanese realized that their culture, their political system, and their technology were out of date. Their samurai-warrior leaders and honor culture were not able to compete in a world dominated by science.

The coronavirus pandemic is in its early days. But the scale and force of the economic and medical crisis that is about to hit the United States may turn out to be as formidable as Perry’s famous voyage was. Two weeks ago—it already seems like an infinity—I was in Italy, writing about the first signs of the virus. Epidemics, I wrote, “have a way of revealing underlying truths about the societies they impact.” This one has already done so, and with terrifying speed. What it reveals about the United States—not just this administration, but also our health-care system, our bureaucracy, our political system itself—should make Americans as fearful as the Japanese who heard the “distant thunder” of Perry’s guns.

Not everybody has yet realized this, and indeed, it will take some time, just as it has taken time for the nature of the virus to sink in. At the moment, many Americans are still convinced that, even in this crisis, our society is more capable than others. Quite a lot was written about the terrifying and reckless behavior of the authorities in Wuhan, China, who initially threatened doctors who began posting information about the new virus, forcing them into silence.

On the very day that one of those doctors, Li Wenliang, contracted the virus, the Wuhan Municipal Health Commission issued a statement declaring,“So far no infection [has been] found among medical staff, no proof of human-to-human transmission.” Only three weeks after the initial reports were posted did authorities begin to take the spread of the disease seriously, confirming that human-to-human transmission had in fact occurred. And only three days later did the lockdown of the city, and eventually the entire province, actually begin.

This story has been told repeatedly—and correctly—as an illustration of what’s wrong with the Chinese system: The secrecy and mania for control inside the Communist Party lost the government many days during which it could have put a better plan into place. But many of those recounting China’s missteps have become just a little bit too smug.

The United States also had an early warning of the new virus—but it, too, suppressed that information. In late January, just as instances of COVID-19, the disease caused by the coronavirus, began to appear in the United States, an infectious-disease specialist in Seattle, Helen Y. Chu, realized that she had a way to monitor its presence. She had been collecting nasal swabs from people in and around Seattle as part of a flu study, and proposed checking them for the new virus. State and federal officials rejected that idea, citing privacy concerns and throwing up bureaucratic obstacles related to lab licenses.

Finally, at the end of February, Chu could stand the intransigence no longer. Her lab performed some tests and found the coronavirus in a local teenager who had not traveled overseas. That meant the disease was already spreading in the Seattle region among people who had never been abroad. If Chu had found this information a month earlier, lives might have been saved and the spread of the disease might have slowed—but even after the urgency of her work became evident, her lab was told to stop testing.

Chu was not threatened by the government, like Li had been in Wuhan. But she was just as effectively silenced by a rule-bound bureaucracy that was insufficiently worried about the pandemic—and by officials at the Food and Drug Administration and the Centers for Disease Control and Prevention who may even have felt political pressure not to take this disease as seriously as they should.

For Chu was not alone. We all now know that COVID-19 diagnostic tests are in scarce supply. South Korea, which has had exactly the same amount of time as the U.S. to prepare, is capable of administering 10,000 tests every day. The United States, with a population more than six times larger, had only tested about 10,000 people in total as of Friday. Vietnam, a poor country, has tested more people than the United States. During congressional testimony on Thursday, Anthony Fauci, the most distinguished infectious-disease doctor in the nation, described the American testing system as “failing.” “The idea of anybody getting [tested] easily the way people in other countries are doing it? We’re not set up for that,” he said. “Do I think we should be? Yes, but we’re not.”

And why not? Once again, no officials from the Chinese Communist Party instructed anyone in the United States not to carry out testing. Nobody prevented American public officials from ordering the immediate production of a massive number of tests. Nevertheless, they did not. We don’t know all the details yet, but one element of the situation cannot be denied: The president himself did not want the disease talked of too widely, did not want knowledge of it to spread, and, above all, did not want the numbers of those infected to appear too high. He said so himself, while explaining why he didn’t want a cruise ship full of infected Americans to dock in California. “I like the numbers being where they are,” he said. “I don’t need to have the numbers double because of one ship that wasn’t our fault.”

Donald Trump, just like the officials in Wuhan, was concerned about the numbers—the optics of how a pandemic looks. And everybody around him knew it. There are some indications that Alex Azar, the former pharmaceutical-industry executive and lobbyist who heads the Department of Health and Human Services, was not keen on telling the president things he did not want to hear. Here is how Dan Diamond, a Politico reporter who writes about health policy, delicately described the problem in a radio interview: “My understanding is [that Azar] did not push to do aggressive additional testing in recent weeks, and that’s partly because more testing might have led to more cases being discovered of coronavirus outbreak, and the president had made clear—the lower the numbers on coronavirus, the better for the president, the better for his potential reelection this fall.”

Without the threats and violence of the Chinese system, in other words, we have the same results: scientists not allowed to do their job; public-health officials not pushing for aggressive testing; preparedness delayed, all because too many people feared that it might damage the political prospects of the leader. I am not writing this in order to praise Chinese communism—far from it. I am writing this so that Americans understand that our government is producing some of the same outcomes as Chinese communism. This means that our political system is in far, far worse shape than we have hitherto understood.

What if it turns out, as it almost certainly will, that other nations are far better than we are at coping with this kind of catastrophe? Look at Singapore, which immediately created an app that could physically track everyone who was quarantined, and that energetically tracked down all the contacts of everyone identified to have the disease. Look at South Korea, with its proven testing ability. Look at Germany, where Chancellor Angela Merkel managed to speak honestly and openly about the disease—she predicted that 70 percent of Germans would get it—and yet did not crash the markets.

The United States, long accustomed to thinking of itself as the best, most efficient, and most technologically advanced society in the world, is about to be proved an unclothed emperor. When human life is in peril, we are not as good as Singapore, as South Korea, as Germany. And the problem is not that we are behind technologically, as the Japanese were in 1853. The problem is that American bureaucracies, and the antiquated, hidebound, unloved federal government of which they are part, are no longer up to the job of coping with the kinds of challenges that face us in the 21st century. Global pandemics, cyberwarfare, information warfare—these are threats that require highly motivated, highly educated bureaucrats; a national health-care system that covers the entire population; public schools that train students to think both deeply and flexibly; and much more.

The failures of the moment can be partly ascribed to the loyalty culture that Trump himself has spent three years building in Washington. Only two weeks ago, he named his 29-year-old former bodyguard, a man who was previously fired from the White House for financial shenanigans, to head up a new personnel-vetting team. Its role is to ensure that only people certifiably loyal are allowed to work for the president. Trump also fired, ostentatiously, the officials who testified honestly during the impeachment hearings, an action that sends a signal to others about the danger of truth-telling.

These are only the most recent manifestations of an autocratic style that has been described, over and over again, by many people. And now we see why, exactly, that style is so dangerous, and why previous American presidents, of both political parties, have operated much differently. Within a loyalty cult, no one will tell the president that starting widespread emergency testing would be prudent, because anyone who does is at risk of losing the president’s favor, even of being fired. Not that it matters, because Trump has very few truth-tellers around him anymore. The kinds of people who would dare make the president angry have left the upper ranks of the Cabinet and the bureaucracy already.

But some of what we are seeing is unrelated to Trump. American dysfunction is also the result of our bifurcated health-care system, which is both the best in the world and the worst in the world, and is simply not geared up for any kind of collective national response. The present crisis is the result of decades of underinvestment in civil service, of undervaluing bureaucracy in public health and other areas, and, above all, of underrating the value of long-term planning.

Back from 2001 to 2003, I wrote multiple editorials for The Washington Post about biological warfare and pandemic preparedness—issues that were at the top of everyone’s agenda in the wake of 9/11 and the brief anthrax scare. At the time, some very big investments were made into precisely those issues, especially into scientific research. We will now benefit from them. But in recent years, the subjects fell out of the news. Senators, among them the vaunted Republican moderate Susan Collins of Maine, knocked “pandemic preparedness” out of spending bills. New flu epidemics didn’t scare people enough. More recently, Trump eliminated the officials responsible for international health from the National Security Council because this kind of subject didn’t interest him—or very many other people in Washington, really.

As a nation, we are not good at long-term planning, and no wonder: Our political system insists that every president be allowed to appoint thousands of new officials, including the kinds of officials who think about pandemics. Why is that necessary? Why can’t expertise be allowed to accumulate at the highest levels of agencies such as the CDC? I’ve written before about the problem of discontinuity in foreign policy: New presidents arrive and think they can have a “reset” with other nations, as if other nations are going to forget everything that happened before their arrival—as if we can cheerfully start all relationships from scratch. But the same is true on health, the environment, and other policy issues. Of course there should be new Cabinet members every four or eight years. But should all their deputies change? And their deputies’ deputies? And their deputies’ deputies’ deputies? Because that’s often how it works right now.

All of this happens on top of all the other familiar pathologies: the profound polarization; the merger of politics and entertainment; the loss of faith in democratic institutions; the blind eyes turned to corruption, white-collar crime, and money laundering; the growth of inequality; the conversion of social media and a part of the news media into for-profit vectors of disinformation. These are all part of the deep background to this crisis too.

The question, of course, is whether this crisis will shock us enough to change our ways. The Japanese did eventually react to Commodore Perry’s squadron of ships with something more than fear. They stopped talking about themselves as the vertex of the Earth. They overhauled their education system. They adopted Western scientific methods, reorganized their state, and created a modern bureaucracy. This massive change, known as the Meiji Restoration, is what brought Japan, for better or for worse, into the modern world. Naturally, the old samurai-warrior class fought back against it, bitterly and angrily.

But by then the new threat was so obvious that enough people got it, enough people understood that a national mobilization was necessary, enough people understood that things could not go on that way indefinitely. Could it happen here, too?

Dr. Yelp

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

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

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

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

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

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

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

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

He faced up to a year in prison.

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

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

Among recent cases:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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