America’s Top Model

Much is made of the varying models presented to the Federal Government and those used by the State Governments to determine the course of action when it comes to Covid and reducing the impact that the virus has on the overall health of the country be that in its residents or in its economy.  And what we have seen is a massive overall failure of both. This we can say was due to the CDC and WHO failing to secure clear messaging, information and processing testing to tracking and tracing the outbreak. China’s unwillingness or its own political decision making clearly contributed to that but by the time this virus spread to Europe it was again largely ignored with regards to the affects that it would have globally as it literally jumped aboard planes and flew across oceans, states and countries while the band played on the the waters also landing in shores with more than good vibes to further spread chaos and disease.

As this went the modeling factors came into high gear often contradicting each other in some cases making the worst case scenario of impending doom that did little to actually assist Governors and others to make wise decisions as they had little actual guidance from any who had experienced this type of scenario, had no federal guidance and in turn political gamesmanship and alliances also led to further divisions and confusion as the virus spread. Did such individuals exist? Did the Government at one point have such a playback and in turn the ability to function as a clear leader and informational processor in this case? Yes and no. Under the Trump Administration and the GOP Leadership the funding of public health, the proverbial bogeyman of the deep state and the endless turnover and chaos of the Trump Administration and their appointing ill qualified and trained individuals into positions over their heads and skill sets lent another level of incompetence to a very already incompetent leader.

Strong medical Epidemiologists and other medical professionals have decried much of the decision making that contributed to massive collapse of the global economy from the shutting of doors, to literally closing off cities and states from one another as if they are enemy’s at war.  That divisive nature set up what we see as States that re-opened versus those that are still in process and the fear factors used  to somehow defend, if not hope, that they spike with high levels of Covid to prove “they” were right all along seems to be into play at this point, and what good that is again seems to be political if not cultural in making.

The fight wars are also among the varying institutes who created the models, from the University of Washington and its model to the one the CDC uses, created by John Hopkins.  In turn the model of the Imperial College in Great Britain adds another layer of even further doom and gloom if its predictions were in fact correct but have since been exposed as well not. 

We are seeing medical journals retract studies and admit that they were wrong as they were publishing studies without sufficient peer review and the media was already off and running sure they had the next big story be it cure or curse on the Covid virus.

If in fact anyone noticed between protests and riots we already passed a landmark of June 1 where at one point there was the belief that we would hit 200K dead which in fact is now 111K but again these numbers are well just wrong.  Anything at this point with regards to Covid is truly debatable over positive cases, those dead and in fact those possessing antibodies as they are that unreliable.

What the models are to do is three fold. This from the NEJM:

• First, we remain uncertain about the extent of protective immunity.4 If SARS-CoV-2 infection produces strong, long-lasting immunity, then the risk of recurrent, annual outbreaks is lower. If there is waning, only partially protective, or no immunity, then epidemics may recur frequently or seasonally, as the Kissler model explores. Most models (such as the Ferguson, Aleta, and Hellewell models) assume that immunity completely protects against infection for at least a year or two — often the duration of the simulation. Until we have better data on antibody kinetics and protection against reinfection, models will be useful for exploring possibilities rather than making strong predictions about longer-term disease dynamics.
• Second, the extent of transmission and immunity among people with no or minimal symptoms (including children) plays an important role in predictions: if there is very little asymptomatic infection, we are probably still far from the epidemic peak. If there is a lot of asymptomatic transmission, there are many unobserved cases, but we may be further along the epidemic curve than we thought — assuming some protective immunity. Carefully designed serologic surveys will clarify this issue, but meanwhile models vary in their assumptions, primarily affecting estimates about the peak’s timing and the epidemic’s duration.
• Third, it remains extremely challenging to measure and model contact rates between susceptible and infectious people, not only under physical distancing policies but also in various reopening scenarios. Models must make assumptions about how people interact with others, and they often do so on the basis of diary studies conducted in different countries at different times.5 Contact rates will be hard to predict during such a rapidly changing crisis and are therefore a key source of model uncertainty.
• In all mechanistic models, epidemics can die away in two ways: either the disease runs out of fuel because there are no longer enough susceptible people to infect, or something changes to slow or halt transmission — for example, the number of contacts is reduced by dramatic physical distancing interventions. Since this latter mechanism slows the spread of disease without changing the number of people at risk, Covid-19 models agree that almost all populations are at risk of disease resurgence when societies reopen. Recent serosurveys indicate that even where this pandemic has been most severe, we remain far from starving it of susceptible hosts and must continue to control spread with contact-reduction measures.
• Unlike other scientific efforts, in which researchers continuously refine methods and collectively attempt to approach a truth about the world, epidemiologic models are often designed to help us systematically examine the implications of various assumptions about a highly nonlinear process that is hard to predict using only intuition. Models are constrained by what we know and what we assume, but used appropriately and with an understanding of these limitations, they can and should help guide us through this pandemic.

In other words this is a game of guessing and using whatever data they can find and that is based on the States getting that to the CDC to process, those two factors right there can make one go: REALLY?  Certainly they are already off to a rocky start and at this point it’s a little late to fix.

This from The Atlantic:

The Centers for Disease Control and Prevention is conflating the results of two different types of coronavirus tests, distorting several important metrics and providing the country with an inaccurate picture of the state of the pandemic. We’ve learned that the CDC is making, at best, a debilitating mistake: combining test results that diagnose current coronavirus infections with test results that measure whether someone has ever had the virus. The upshot is that the government’s disease-fighting agency is overstating the country’s ability to test people who are sick with COVID-19. The agency confirmed to The Atlantic on Wednesday that it is mixing the results of viral and antibody tests, even though the two tests reveal different information and are used for different reasons.
This is not merely a technical error. States have set quantitative guidelines for reopening their economies based on these flawed data points.

So again, as the Knucklehead Governor of New Jersey likes to say, “We are reopening the State based on Science, Data and Facts.”  Good plan if there was one and those three variables were accurate but nope.

There is more as this from STAT explains:

A widely followed model for projecting Covid-19 deaths in the U.S. is producing results that have been bouncing up and down like an unpredictable fever, and now epidemiologists are criticizing it as flawed and misleading for both the public and policy makers. In particular, they warn against relying on it as the basis for government decision-making, including on “re-opening America.” 

“It’s not a model that most of us in the infectious disease epidemiology field think is well suited” to projecting Covid-19 deaths, epidemiologist Marc Lipsitch of the Harvard T.H. Chan School of Public Health told reporters this week, referring to projections by the Institute for Health Metrics and Evaluation at the University of Washington. 

Others experts, including some colleagues of the model-makers, are even harsher. “That the IHME model keeps changing is evidence of its lack of reliability as a predictive tool,” said epidemiologist Ruth Etzioni of the Fred Hutchinson Cancer Center, who has served on a search committee for IHME. “That it is being used for policy decisions and its results interpreted wrongly is a travesty unfolding before our eyes.” 

While other epidemiologists disagree on whether IHME’s deaths projections are too high or too low, there is consensus that their volatility has confused policy makers and the public.

They explain in detail the flaws with this and for the record the Covid task force has not met now for over two weeks I guess they re-branded and are the Floyd Force now dealing with Police Brutality.

In addition this also may have contributed to the misdiagnosis and ultimate mistreatment medically of many patients, including the histrionic overuse of intubation as a form of treatment, which ultimately became the death panel we once feared.  This from Medical Life Sciences. 

The researchers, whose paper has been published in The British Medical Journal (BMJ), found that the data and methods used in these studies were potentially at high risk of bias, while some of the studies included recommendations that were questionable if put into practice. 

The researchers warn that the potentially flawed models may result in doctors making inappropriate decisions about whether patients have the virus, need a ventilator or should remain in hospital. 

Since the outbreak in December, health care systems across the world have been under severe strain. 

More than one million people have been diagnosed with the virus worldwide and the death toll has surpassed 51,000. 

Doctors face significant pressure to detect and diagnose patients who are infected with the virus and to give a prognosis for each confirmed case. 

The researchers reviewed 27 studies – 25 used data from China, one used data from Italy, while another used international data. The data was collected between 8 December 2019 and 15 March 2020. 

They found that all the studies had a high risk of bias. Some of the studies had a non-representative selection of patients, while others excluded patients who were still ill at the end of the studies. Others had poor statistical analysis. 

The researchers acknowledge that clinical data from Covid-19 patients is scarce and that the studies were done under severe time constraints so that they could help medical decision-making as quickly as possible. 

However, given the identified flaws, the researchers said it was a concern that some of the proposed models were already being used to support medical decisions.

But let’s keep the fear going and right now we have civil unrest happening.  In a way Covid helped bring attention to an issue that has been going on for over a century, not decades, not years.. A CENTURY.  Good luck with that shit doesn’t change in America unless you are afraid and well we are it just went in different direction, shame the models couldn’t predict that.

Science
Why this Nobel laureate predicts a quicker coronavirus recovery: ‘We’re going to be fine’
Los Angeles Times
By Joe Mozingo Staff Writer
March 23, 2020

Michael Levitt, a Nobel laureate and Stanford biophysicist, began analyzing the number of COVID-19 cases worldwide in January and correctly calculated that China would get through the worst of its coronavirus outbreak long before many health experts had predicted.

Now he foresees a similar outcome in the United States and the rest of the world.

While many epidemiologists are warning of months, or even years, of massive social disruption and millions of deaths, Levitt says the data simply don’t support such a dire scenario — especially in areas where reasonable social distancing measures are in place.

“What we need is to control the panic,” he said. In the grand scheme, “we’re going to be fine.”

Here’s what Levitt noticed in China: On Jan. 31, the country had 46 new deaths due to the novel coronavirus, compared with 42 new deaths the day before.

Although the number of daily deaths had increased, the rate of that increase had begun to ease off. In his view, the fact that new cases were being identified at a slower rate was more telling than the number of new cases itself. It was an early sign that the trajectory of the outbreak had shifted.

Think of the outbreak as a car racing down an open highway, he said. Although the car is still gaining speed, it’s not accelerating as rapidly as before.

“This suggests that the rate of increase in the number of deaths will slow down even more over the next week,” Levitt wrote in a report he sent to friends Feb. 1 that was widely shared on Chinese social media. And soon, he predicted, the number of deaths would be decreasing every day.

Three weeks later, Levitt told the China Daily News that the virus’ rate of growth had peaked. He predicted that the total number of confirmed COVID-19 cases in China would end up around 80,000, with about 3,250 deaths.

This forecast turned out to be remarkably accurate: As of March 16, China had counted a total of 80,298 cases and 3,245 deaths — in a nation of nearly 1.4 billion people where roughly 10 million die every year. The number of newly diagnosed patients has dropped to around 25 a day, with no cases of community spread reported since Wednesday.

Now Levitt, who received the 2013 Nobel Prize in chemistry for developing complex models of chemical systems, is seeing similar turning points in other nations, even those that did not instill the draconian isolation measures that China did.

He analyzed data from 78 countries that reported more than 50 newcases of COVID-19 every day and sees “signs of recovery” in many of them. He’s not focusing on the total number ofcases in a country, but on the number of new cases identified every day — and, especially, on the change in that number from one day to the next.

“Numbers are still noisy, but there are clear signs of slowed growth.”

In South Korea, for example, newly confirmed cases are being added to the country’s total each day, but the daily tally has dropped in recent weeks, remaining below 200. That suggests the outbreak there may be winding down.

In Iran, the number of newly confirmed COVID-19 cases per day remained relatively flat last week, going from 1,053 last Monday to 1,028 on Sunday. Although that’s still a lot of new cases, Levitt said, the pattern suggests the outbreak there “is past the halfway mark.”

Italy, on the other hand, looks like it’s still on the upswing. In that country, the number of newly confirmed cases increased on most days this past week.

In places that have managed to recover from an initial outbreak, officials must still contend with the fact that the coronavirus may return. China is now fighting to stop new waves of infection coming in from places where the virus is spreading out of control. Other countries are bound to face the same problem.

Levitt acknowledges that his figures are messy and that the official case counts in many areas are too low because testing is spotty. But even with incomplete data, “a consistent decline means there’s some factor at work that is not just noise in the numbers,” he said.

In other words, as long as the reasons for the inaccurate case counts remain the same, it’s still useful to compare them from one day to the next.

The trajectory of deaths backs up his findings, he said, since it follows the same basic trends as the new confirmed cases. So do data from outbreaks in confined environments, such as the one on the Diamond Princess cruise ship. Out of 3,711 people on board, 712 were infected, and eight died.

This unintended experiment in coronavirus spread will help researchers estimate the number of fatalities that would occur in a fully infected population, Levitt said. For instance, the Diamond Princess data allowed him to estimate that being exposed to the new coronavirus doubles a person’s risk of dying in the next two months. Most people have an extremely low risk of death in a two-month period, so that risk remains extremely low even when doubled.

Nicholas Reich, a biostatistician at the University of Massachusetts Amherst, said the analysis was thought-provoking, if nothing else.

“Time will tell if Levitt’s predictions are correct,” Reich said. “I do think that having a wide diversity of experts bringing their perspectives to the table will help decision-makers navigate the very tricky decisions they will be facing in the upcoming weeks and months.”

Levitt said he’s in sync with those calling for strong measures to fight the outbreak. The social-distancing mandates are critical — particularly the ban on large gatherings — because the virus is so new that the population has no immunity to it, and a vaccine is still many months away. “This is not the time to go out drinking with your buddies,” he said.

Getting vaccinated against the flu is important, too, because a coronavirus outbreak that strikes in the middle of a flu epidemic is much more likely to overwhelm hospitals and increases the odds that the coronavirus goes undetected. This was probably a factor in Italy, a country with a strong anti-vaccine movement, he said.

But he also blames the media for causing unnecessary panic by focusing on the relentless increase in the cumulative number of cases and spotlighting celebrities who contract the virus. By contrast, the flu has sickened 36 million Americans since September and killed an estimated 22,000, according to the CDC, but those deaths are largely unreported.

Levitt fears the public health measures that have shut down large swaths of the economy could cause their own health catastrophe, as lost jobs lead to poverty and hopelessness. Time and again, researchers have seen that suicide rates go up when the economy spirals down.

The virus can grow exponentially only when it is undetected and no one is acting to control it, Levitt said. That’s what happened in South Korea last month, when it ripped through a closed-off cult that refused to report the illness.

“People need to be considered heroes for announcing they have this virus,” he said.

The goal needs to be better early detection — not just through testing but perhaps with body-temperature surveillance, which China is implementing — and immediate social isolation.

While the COVID-19 fatality rate appears to be significantly higher than that of the flu, Levitt says it is, quite simply put, “not the end of the world.”

“The real situation is not as nearly as terrible as they make it out to be,” he said.

Dr. Loren Miller, a physician and infectious diseases researcher at the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, said it’s premature to draw any conclusions — either rosy or bleak — about the course the pandemic will take.

“There’s a lot of uncertainty right now,” he said. “In China they nipped it in the bud in the nick of time. In the U.S. we might have, or we might not have. We just don’t know.”

Harborzoo

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

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

By Ryan Sabalow

Tacoma News Tribune 

March 03, 2020

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

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

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

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

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

Here’s what else we know about Harborview:

Major trauma center for the region

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

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

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

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

How does it compare?

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

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

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

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

Lab worker exposes staff to bacteria

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

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

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

Data breach

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

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

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

State inspection reports

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

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

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

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

Recent lawsuit

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

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

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

The Intern

Much is being made of the idea of mobilizing Interns and Medical Students/Residents to step up to the front lines to take on some of the urgent care needs of those suffering from the Corvid Virus.  I would say great sort of if they are trained and have strong oversight.

I left Seattle 4 years ago because I had ZERO faith in its hospitals, at the time privately held Swedish was under scandal from a Neurologist overbooking, Virginia Mason, Group Health was once known as Group Death and is now a Kaiser facility and of course Harborview which is known as Harborzoo as it is run by the University of Washington as Public Facility for the county and is a dump teaching facility run as an offshoot of UW Medical School.  But the UW runs many hospitals in the Seattle area and they are almost all inadequate on some level or another but Harborview is lawsuit central regarding medical malpractice. 

Nothing surprises me as when I moved to Nashville Vanderbilt Hospitals were not much better but they were an unknown commodity but then again all are.  So while I have fuller knowledge and experience how bad the facility is frankly I felt my O-M surgeon was great but he should not be running the intern program as he cannot handle that cohort of students adequately enough which explained the Intern’s fuckup on my jaw.  But he fixed it and charged me nothing and that I cannot say enough good things about him and his work on me which is outstanding, much of which I was undercharged for as well.  My Dentist decided to try to rip me off but she is an idiot so much for that and I walked out with what I wanted and paid what I agreed to.

And that said the University of Washington Dental School was already in fiscal arrears by 2008 and fled for bankruptcy as for their medical school I think it says it all and again as it was ground zero for the initial outbreak it explains oh so much.

So as we man the front lines with those in training remember you get what you pay for and clearly we are not paying enough and yet who will foot the final bill for all of this. That remains unknown like all the rest of this nightmare. 

UW Medical Residents Hit With a Demoralizing Contract in the Midst of Coronavirus Outbreak
by Rich Smith • Mar 23, 2020
The Stranger

Last year, UW residents held a 15-min strike to protest their last bad offer. They say theyll continue to work during the outbreak without a contract for our patients, our community, and our country, but the recent offer was definitely not good for morale.

On March 1, four days after COVID-19 killed its first Washingtonian, Alexander Adami was called in to work the night shift on an intensive care unit at Harborview Medical Center. Adami, a second year resident in internal medicine at the University of Washington, was filling in for a physician who’d been sent home after being exposed to the first patient who’d died with the virus.

When he showed up for work, Adami discovered that one of the patients on the rotation was being tested for COVID-19, and that person was looking “very bad, as if they would need to be intubated,” he said.

Two problems immediately presented themselves. The first was that UW Medicine had not yet trained Adami nor the senior resident on the shift to care for COVID-19 patients. Such care required the use of special protective equipment and adherence to certain procedures, which the ICU supervising physician had to track down and teach “on the fly,” Adami said.

The other problem? When you need to “intubate” someone, i.e. shove a tube down their throat, you need to have an anesthesiologist. And, according to Adami, “there was not a single anesthesia attending who was trained to enter that room that night.”

The team ended up calling in an anesthesiologist who could handle the situation if need be, and the patients were cared for accordingly. But Adami believes poor management from UW administrators needlessly put everyone in the ICU that night at risk.

“It shows how little attention UW was paying to this,” Adami said.

Lack of Training

Despite the fact that an Everett hospital treated the first man in the U.S. with the virus back in January, Adami said UW hadn’t adequately prepared by early March: “They just said they were monitoring the situation and they’ll come up with a training plan at some point. Then they had to scramble.”

The Accreditation Council for Graduate Medical Education (ACGME) published expectations for resident training on COVID-19 patients on Feb. 19.

Aside from not training residents on how to treat COVID-19 patients more than a month after Patient Zero landed in Washington, other signs, for him, pointed to administrative disfunction. During that first week in March, Adami said UW was sending residents “five, six, seven emails a day with information that would change hour to hour.”

A representative from UW Medicine did not return a request for comment by my deadline. I’ll update when I hear back. In the meantime, a spokesperson for the program told the Seattle Times that every hospital in its system “had a surge-capacity plan being adapted for the outbreak,” and that “daily planning sessions monitor our available beds, supply usage, and human resources.”

Training for residents, who make up 20% of the doctors in King County, has since ramped up, and things are running “much smoother” now that “frontline people in infection control” are more or less running the show, Adami said.

“Definitely Not Good for Morale”

However, on March 11 UW added insult to injury by hitting residents with a “final offer” on a contract the college has been negotiating with University of Washington Housestaff Association for nearly a year now.

The new offer gives residents a 2% raise, increased travel and home call stipends by next year, an added week of vacation in two years (bringing the total up to four), and a fully subsidized UPASS.

Residents describe the raise as a pay cut, given its failure to match the local cost of living increase of 2.5%, and given the fact their last contract secured 3% raises. They also point out the paucity of the travel/home call stipend relative to similar institutions, and add that a vast majority of programs already offer four weeks vacation.

“It’s a blow, to be honest,” said Krishna Prabhu, an internal medicine resident. “They offered that to us in the middle of this epidemic, and we’re on the frontlines here. Definitely not good for morale.”

“There are people working 28-hour shifts in the ICU, and there is no other class of health care worker that’s doing that.” Prabhu continued. “It’s a hard thing to do without COVID-19, and now with it the workload has increased tremendously.”

“The normal stuff that continues to happen is hard. It’s not like traumas are going to stop happening. You’re still going to have folks who have heart attacks,” Adami added. “We just don’t have the staff or the equipment to do it if it really gets bad. And it really doesn’t help having the majority of our employers look at this stuff and offer a contract that says they really don’t value us enough. It doesn’t inspire many people wanting to stay here afterwards. And I think that’s a sentiment many in this residency will have after all this.”

Nevertheless, They’re Persisting

Right now, Prabhu said, different hospitals are handling COVID patients in different ways. At Harborview, non-resident physicians rule out patients presenting symptoms for the virus, and a dedicated team cares for confirmed cases. But the ICU is a different story. There, a team of four residents (who work 28-hour shifts every fourth day), along with supervising physicians, also care for COVID-19 patients.

At UW Medical Center and at the Veterans Administration hospital, COVID-19 patients are being distributed across resident and non-resident teams. “They’re turning Northwest Hospital into a COVID hospital. There are 24 people there who are positive,” Adami said last Wednesday. At the moment, internal medicine doctors primarily care for those patients, but “that could always change if that epidemic grows like we expect it to,” Prabhu said.

Though many were disheartened by the latest contract offer, several residents are volunteering to transfer out of their “easier” rotations to help overloaded hospitals screen and treat COVID patients or absorb non-COVID patients. Adami says there’s also talk of having residents from surgical and anesthesia specialties help take care of non-COVID patients on the medical side.

Prabhu remains “cautiously optimistic” about turning things around. “We’re adaptable, and we’ll continue to find solutions and the ingenuity within our spirit. Though all residents are still working on an expired contract, we’ll continue to show up because we’re doing it for our patients, our community, and our country,” he said.

Waste Not, Want Not

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

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

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

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

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

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

Unnecessary Medical Care Is More Common Than You Think

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Poor Care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

David Rosenbaum was one of them.

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

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

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

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

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

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

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

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

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

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

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

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

But this sweltering July 2012 evening was different.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hospital officials declined to comment on the case.

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

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

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

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

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

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

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

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

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

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

Hospital officials declined to comment on the case.

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

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

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

Worse than Ebola

I was going to comment but the article and the Buzz Feed story says it all.    Perhaps this is why tuition is so expensive? Talk about campus rape. 

Sex harassment, porn, personal use of state money among litany of complaints against UW prof

Originally published June 30, 2016 The Seattle Times 

Michael Katze, UW professor of microbiology, has been removed from his research lab and the lab was shut down after investigations found he routinely bullied and harassed employees. (Mark Harrison/The Seattle Times)

A University of Washington researcher has been removed from his lab and put on home assignment after the university found he sexually harassed women who worked in his lab and asked employees to solicit a prostitute for him.

A University of Washington researcher whose cutting-edge work has put the UW on the forefront of Ebola and flu research has been removed from his lab after two university investigations found he sexually harassed women who worked there and asked employees to solicit a prostitute for him.

The investigations, first reported Wednesday by BuzzFeed News, found that microbiology professor Michael Katze, associate director for research in the Regional Primate Research Center, routinely bullied and demeaned employees.

Katze is still drawing his $120,000-a-year base salary, UW officials said. A faculty adjudication panel is now weighing whether Katze, who is a tenured professor, should lose his job.

His lab, which employed 25 to 35 employees, was shut down in April and the money disbursed to other labs. Meanwhile, Katze unsuccessfully sued the UW for removing him from his job and also unsuccessfully sued the UW and BuzzFeed reporter Azeen Ghorayshi, saying BuzzFeed’s records request would violate his right to privacy if disclosed. He could not be immediately reached for comment.

During the Ebola outbreak in 2014, Katze was widely interviewed in the media because of his expertise in viruses.

In a statement, UW spokesman Norm Arkans said Katze was removed from the lab and put on home assignment after the sexual-harassment complaints were made.

“His conduct was inappropriate and not in any way reflective of the university’s values,” Arkans said. “That is why the matter is now in the faculty disciplinary process, through which an appropriate outcome will be adjudicated.”

In January, UW investigator Ian Messerle found that Katze created a hostile work environment for a woman under his direct supervision because he “persistently, and for an extended period of time, made unwanted sexual comments and jokes,” attempted to kiss or touch her, sent her sexually themed emails and reminded her often that he could fire her.

Messerle’s 53-page report found that Katze had a quid pro quo sexual relationship with another woman under his direct supervision, that he was “grossly overpaying her for the small amount of University work that she performed,” and that he suggested to her that maintaining a sexual relationship with him was “an implicit condition of her employment.”

The woman, whose primary job was managing Katze’s calendar, made $75,732 a year.

Messerle also found that Katze persisted in viewing pornography on his computer even when he was warned not to, and that his behavior and language was described by employees as cruel and crude, as well as racist, sexist and homophobic.

The investigator wrote that the university had received complaints about Katze’s behavior on six separate occasions, as far back as 2006.

In November 2015, the UW’s School of Medicine created a special investigations committee to examine whether Katze violated university or state policies. The committee found that Katze asked UW employees to solicit a prostitute for him, and to procure medical marijuana and a prescription painkiller for him.

Employees also performed personal errands for him, including buying and overseeing the delivery of furniture, paying a parking ticket, and providing technological support for someone who did not appear to be a UW employee, the investigations committee found. Those actions violated administrative policies because he asked staff to perform work of a personal nature.

Katze was also found to have violated the UW Medicine policy on professional conduct, and state policy on use of state resources for personal use.

According to BuzzFeed, the university received about $30 million in federal grants to support Katze’s research into viruses and AIDS vaccines. In spring 2015, however, a scientist at the University of North Carolina at Chapel Hill who collaborated with Katze terminated a $1.2 million federal research contract with him. The contract was ended after an audit raised questions about how the money was spent.

BuzzFeed reported that Katze was also accused of financial improprieties in 2007 but was never investigated.

Katze sued the UW for removing him from the job, and for damaging his name, honor and integrity.
In his report, Messerle said that he interviewed 26 witnesses, and that his review included about 1.2 million email and text messages, although some were duplicates.

He called the investigation “unique, in my experience, for the great number of interviewees who expressed to me concerns about retaliation.”

Wrote Messerle: “The level of across-the-board concern I observed was unlike anything I had seen in any investigation I had previously conducted.”

Gentleman’s Guide

to Love and Murder is currently on Broadway. The lead character sings a song about how it is better to be rich and no one understand the poors. No one does that better than apparently the heads of the towers of ivory and education that were to lead to the halls of equality and meritocracy. And enter stage right.

It was found that while athletics do dominate budgets in most Universities it is in fact the head of the school whose outrageous CEO-like salary is a great determinant with regards to the overall cost of education. In other words to restate the equation – the higher the President’s salary the higher the student debt. Well that is cost for value right there. Does Ohio have a good football team too? I know the University of Washington is upgrading Husky Stadium to include private boxes. Top that bitches!

In addition the quality of education also sufferred and the long tenured class finds themselves insourced with adjuncts. Nothing says beleagured more than the upper crust driving between gigs and not having the time to do the endless research needed to attain and maintain tenure. Publish or perish as they say…guess the latter in this one.

It is not about tenure or even the idea that the kids are getting second tier education as a result, they are going into debt to pay for administrative costs. Wasn’t that a big issue in Obamacare too? This is everywhere and anywhere and we simply pass it on and down. The regressive system of taxing and penalizing is finally catching up. Here where we have the University of Washington in our back yard it is amusing to note they are also the greatest land owner and in turn run a huge hospital network. There is money coming in front and back with this University from a highly successful sports program and in turn the ever present largess with the technology set trying to turn the UW into the Stanford of the Northwest. Money is not a problem but student debt is.

Trickle down economics apparently the legendary philosophy from the University of Chicago means – piss on the poors they will pay for it. In Seattle we get that from one levy to another, to the immense sales tax and miscellaneous fees and costs paid to build school, affordable housing, provide parks and upgrade infrastructure. The things the poors need and use. I think they teach that at the UW too!

Student Debt Grows Faster at Universities With Highest-Paid Leaders, Study Finds
By TAMAR LEWIN
MAY 18, 2014

At the 25 public universities with the highest-paid presidents, both student debt and the use of part-time adjunct faculty grew far faster than at the average state university from 2005 to 2012, according to a new study by the Institute for Policy Studies, a left-leaning Washington research group.

The study, “The One Percent at State U: How University Presidents Profit from Rising Student Debt and Low-Wage Faculty Labor,” examined the relationship between executive pay, student debt and low-wage faculty labor at the 25 top-paying public universities.

The co-authors, Andrew Erwin and Marjorie Wood, found that administrative expenditures at the highest-paying universities outpaced spending on scholarships by more than two to one. And while adjunct faculty members became more numerous at the 25 universities, the share of permanent faculty declined drastically.

“The high executive pay obviously isn’t the direct cause of higher student debt, or cuts in labor spending,” Ms. Wood said. “But if you think about it in terms of the allocation of resources, it does seem to be the tip of a very large iceberg, with universities that have top-heavy executive spending also having more adjuncts, more tuition increases and more administrative spending.”

Since the 2008 financial crisis, the report found, the leaders of the highest-paying universities fared well, largely at the expense of students and faculty.

“Like executives in the corporate and banking sectors, public university presidents weathered the immediate aftermath of the fall 2008 financial crisis with minimal or no reductions in total compensation,” the report said.

While the average executive compensation at public research universities increased 14 percent from 2009 to 2012, to an average of $544,554, compensation for the presidents of the highest-paying universities increased by a third, to $974,006, during that period.

The Chronicle of Higher Education’s annual survey of public university presidents’ compensation, also released Sunday, found that nine chief executives earned more than $1 million in total compensation in 2012-13, up from four the previous year, and three in 2010-11.

The median total compensation of the 256 presidents in the survey was $478,896, a 5 percent increase over the previous year.

But, The Chronicle found, chief executives were hardly alone among the highest-paid public university officials. Athletic coaches made up 70 percent of the public university employees earning more than $1 million last year, and medical doctors another 20 percent.

As in several past years, the highest-compensated president, at $6,057,615 in this period, was E. Gordon Gee, who resigned from Ohio State last summer amid trustee complaints about frequent gaffes. He has since become the president of West Virginia University.

In the study by the Institute for Policy Studies, Ohio State was No. 1 on the list of what it called the most unequal public universities. The report found that from fiscal 2010 to fiscal 2012, Ohio State paid Mr. Gee a total of $5.9 million. During the same period, it said, the university hired 670 new administrators, 498 contingent and part-time faculty — and 45 permanent faculty members. Student debt at Ohio State grew 23 percent faster than the national average during that time, the report found.

Others on the “most unequal” list were Pennsylvania State University, the University of Minnesota, the University of Michigan and the University of Washington.

Fool me once

This article is from a year ago but I thought it was relevant.  Why?  Because in our condemnation culture I find it interesting that when you commit a misdemeanor crime in Washington State you are promptly treated as a felon.  Yet when you assault, rape and ultimately kidnap a woman – which you do when you take someone from one location to another without their knowledge and consent, hold them there – that would be a felony.

If Prosecutors are willing to up the ante and add charges such as murder for DUI, attempted murder for Domestic Violence and kick down doors to get Pot, well this would be a slam dunk, apparently not.

I am not sure what to say about this case and this individual who not only did it once, but twice.  How does that expression go – first time, shame on you, twice shame on me – well there is much to be ashamed about.  And you wonder how many times before he actually got caught?

And he was a University of Washington Fraternity President.  Irony on top of irony as the maniac who assaulted me was a UW Graduate student majoring in Chemistry. They must really have a great program there teaching men how to be druggists and rapists. 

When I was “allegedly”  drugged and “allegedly” raped, as again I can never actually prove that as thanks to the hideous morons at Harborview Hospital, that right was taken away from me, and instead enabled me to be Prosecuted for my actions that resulted from being drugged and raped. I don’t allege anything frankly I know differently. But it was my own Attorney who said that I should go into deferred prosecution or counseling to help me understand that my “lifestyle choices” contributed to the act of violence perpetuated against me.  Clearly,  as I had never had it happen to me before or since, I am pretty good without it, but the maniac who did it to me I have always believed will do it again and this article I think shows that yep that is likely but he is only a part of the problem.

The Attorney representing Harborview, the dump I am suing for malpractice,  without a Lawyer as clearly I have issues with them as well,  asked me why I had not gone to the Police when I realized I had been assaulted by not just my date but the person(s) they sent me home with. Well the drugs, the accident, the injuries, the whole malpractice thing kind of prevented that.

Add to that when in  Court when my same Attorney tried to actually do the right thing and get the perpetrator by giving the Prosecutor the name of the individual, it was mid trial before she even passed it on to the Police, WHO DID NOTHING about it but later accused me of making him up.  Yes with the hospital intake records noting texts, and his phone number,  even calling him with no response by him, but hey they made him up too, right?

 The excuses about this one still make me laugh.  I think the most recent was his name.  I called him by his nickname and I was unsure of his last name so I did a trace on the phone, which led me to his mother’s name and address.  I assume this as I have never spoken to the woman but hey “friends and family” from Verizon and all.  And this was seemingly beyond law enforcement to do this simple act.  So why would I do this and have this name and address?  Again accuse some random made up person in order to come up with a legal address for which the phone is registered?

Again you can’t make this shit up, but I was accused of doing this, and yes my one Attorney seemed to at one point believe this.  I have no idea we have the communication of a wall and that also contributed I believe to many of the problems that later resulted.  And yes he is still my Attorney, why?  Because I think he has no idea what to do to assuage my pain but when it actually comes to law and shit he does know his shit.  Beside manner on this case not so much.  As Harvard, Attorney number 4.5 (counting the half lawyer who quit after me ripping his ass off) says, “he has never had anything bad ever happen to him so he doesn’t know how to handle people who have.” Okay Harvard.   Well he has now had me as a client so it’s a double down on that.

 *I really hope fired Lawyer number 2 reads this as I love rubbing that douche’s face in the whole Harvard thing.  Harvard asked me when he heard of this ass actually accosting his colleague in open court, “who is this guy?” And once again he was defended by the same Attorney as a good Attorney.  This is how nice this man is.  So hey fuckwit if you are still reading this blog know that and know that he would not allow me to file a Bar Association complaint about you, asshole.  Again, I can’t make this shit up

This is our system of justice – non existent – in the supposed great liberal and utterly livable city.  I can’t wait to get the fuck out of here.  So when anyone says if you have good Lawyers and can buy your way out of shit.. well not this case.  Nothing would have done it. And when you look at the Bar Association survey about the Municipal Judges here in the City there are about two who actually have “decent” ratings and that pretty much cements the fact that you are fucked without either dinner or date rape drugs if you go to Court here.   And again the numbers speak volumes about how many actual trials do take place and the end result.  Stacked.

I have become the Mia Farrow of this but if they can do this over something 20 years ago and victim rights advocates seem to think that overkill is essential in getting respect and recognition for their violations, I am going to give this a shot too.   Oh wait no one gives a shit but I tried. 

But anyway, the point is women are blamed, our complaints are ignored the second a glass of wine is involved.  We have somehow contributed to the depravity of an individual who drugs and rapes women and has a pattern of it. But in his case law enforcement assisted in this by plea bargaining, down the charges.  Worked out didn’t it.

Our priorities are clearly confused in this country when it comes to acts of true crime.  I can see why women don’t file rape charges very often, this is just another example why.

Ex-UW frat president charged with rape, again

By LEVI PULKKINEN,  
SEATTLEPI.COM STAFF
Wednesday, January 30, 2013

 A Federal Way man accused of drugging and sexually assaulting a young woman during a date has been charged with rape.

The charge marks the second time in three years Edwin “Kevin” De Boer has been charged with sexually assaulting a young woman following a night of drinking.

The earlier allegations against De Boer saw him plead guilty to harassment in a plea agreement that did not require he register as a sex offender or admit to raping the young woman at a University of Washington fraternity, where he was serving as president.

This time, though, prosecutors claim to have evidence De Boer drugged a young woman before raping her. He is also alleged to have made a partial admission of wrongdoing in a text message to the purported victim.

King County prosecutors contend De Boer, 26, spiked the woman’s drink with a sedative during a date, then raped her at his apartment. He has pleaded not guilty to the rape charge.

According to charging documents, the woman agreed to go out for dinner and drinks with De Boer in November. The pair went to several Tacoma bars; the last thing the woman remembered was a table of beer and appetizers.

She awoke naked and in pain in the bedroom of De Boer’s Federal Way apartment, she later told police. Confused, the woman spoke with De Boer briefly before leaving his apartment.

Shortly thereafter, the woman contacted her sister, who rushed home and ultimately took her to a nearby hospital for a sexual assault examination, a Federal Way detective told the court. The results of that exam were subsequently forwarded to police.

According to charging documents, lab tests showed the woman had ingested a potent sedative that also causes amnesia. Police contend photos taken during the examination support the woman’s claims. 

Concerned De Boer had drugged her, the woman sent him a text message asserting the same. Police contend De Boer denied drugging her but admitted to sexually assaulting her while they were together.

Speaking with police, the woman said she’d never blacked out before and had not planned on having sex with De Boer during their date. She was also able to describe his home to police.

The woman also recalled De Boer had complained that another woman he was seeing while he was president of the fraternity three years before had “gone crazy” on him, the detective told the court. He also mentioned he was enrolled in a graduate program at University of Washington’s Tacoma campus; court records show De Boer’s car carries a personalized license plate with the word “DAWGS” on it.

De Boer was enrolled at UW in Seattle as an undergrad in July 2009, when he was alleged to have raped a 21-year-old student during a fraternity party.

The night of the assault, De Boer prodded the woman to have several shots of liquor and then attempted to make out with her on the steps of Phi Kappa Theta fraternity. She rebuffed his advances while remaining at the house.

Charging De Boer with third-degree rape, prosecutors contended De Boer later pulled the woman into a room and demanded oral sex. She told De Boer she did not have sex with drunk men.

At the time, prosecutors claimed De Boer then pinned the young woman on a bed and raped her. She later underwent a sexual assault examination and testified in an “administrative hearing” conducted by fraternity members and alumni.

During that “hearing,” De Boer claimed the young woman changed her mind after they were already having sex, a Seattle detective told the court. The fraternity subsequently voted to expel De Boer.

De Boer would later deny any wrongdoing through a statement to police, according to the detective’s statement. He claimed she only protested because he did not take precautions to avoid impregnating her.

“The defense counsel and I together interviewed 11 witnesses,” the Seattle detective told the court. “None of the witnesses saw (the young woman) kiss, touch or show any interest in Mr. De Boer, so it appears that Mr. De Boer is not being truthful.”

De Boer ultimately entered a modified guilty plea to a harassment charge. Doing so, he refused to admit he had harassed the woman while agreeing that a jury would likely convict him.

Prosecutors withdrew the rape charge as part of the plea agreement. De Boer received a suspended sentence and probation, and was ordered to perform 15 days of community service.

Now facing a second-degree rape charge, De Boer is currently jailed on $300,000 bail.

Get the Paddles, STAT!

I love Eduardo Porter’s columns in the New York Times he has stepped up to assume a big mantle of my other former favorite Econ columnist who was promoted last year, Dave Leonhardt, and rarely I disagree but I have one bone to pick.

Eduardo notes that care in non-profit facilities are superior in care and costs overall than there for profit equals.  On that we agree, kinda, sorta.  Medicine should not be for profit at all but we have a large variance on what defines “non-profit.”  Many local hospitals and medical facilities are in fact non-profits.  They are charted and in turn registered that way under the IRS code.  Many insurance companies are also registered as non profit.  Two of which I can point out here in Seattle are Group Health Cooperative as a non profit HMO organization and Lifewise Insurance as coverage agent, also not for profit.

Then we have of course all the State and/or University Hospitals.  Harborview Medical Center is run by the University of Washington which also owns Northwest Hospitals. Both not for profit.

Having been the victim of the first two and what defines “standard of care” I would rather go to a Veterinary Hospital than set foot in Harborview or have any UW “Doctor” aka “Student” lay their filthy hands on me.  I equate my nightmare akin to the Steubenville Rape Gang only with higher degrees and vocabulary (okay maybe not the vocabulary part).  And Group Health here is not much better frankly. Its nickname “Group Death” and I cannot disagree.

Not for profit means nothing in this country. NOTHING. We have many many not for profits that seem to have a statement of intent that has NOTHING to do with its operations.  Many of these not for profit hospitals and HMO’s have millions of dollars in resources of available and in turn millions of dollars in compensation for Executives and Administrative staff.  The rank file however, you know the ones cleaning your ass, make well shit.  Perfect metaphor frankly.  And as a result your care is shit as well.  Clean up in Room 10.

However if we do examine what appropriate care is and define it and remove the profit, put appropriate regulation and legislation in place, monitor, audit and in turn manage it appropriately with clear expectations, we might have the ability to have not for profit care for all.  But again as in all things in this country we have chickens in the hen house and the Rooster too.  Busy he is making sure his needs come first.  We have no one available, willing or able to actually do anything in this country.

We need an new Amendment to that wonderfully outdated document that the White Establishment adores so much.  One that states: “We the People means now we the Rich People and the Corporations and under that we are permitting who is equal and what it means to be entitled. The rest can go fuck yourself”

This is our Country. If we are ever to restore it, we need to rebuild it.

Health Care and Profits, a Poor Mix

By EDUARDO PORTER
Published: January 8, 2013

Patients entering church-affiliated nonprofit homes were prescribed drugs roughly as often as those entering profit-making “proprietary” institutions. But patients in proprietary homes received, on average, more than four times the dose of patients at nonprofits.

Writing about his colleagues’ research in his 1988 book “The Nonprofit Economy,” the economist Burton Weisbrod provided a straightforward explanation: “differences in the pursuit of profit.” Sedatives are cheap, Mr. Weisbrod noted. “Less expensive than, say, giving special attention to more active patients who need to be kept busy.”

This behavior was hardly surprising. Hospitals run for profit are also less likely than nonprofit and government-run institutionsto offer services like home health care and psychiatric emergency care, which are not as profitable as open-heart surgery.

A shareholder might even applaud the creativity with which profit-seeking institutions go about seeking profit. But the consequences of this pursuit might not be so great for other stakeholders in the system — patients, for instance. One study found that patients’ mortality rates spiked when nonprofit hospitals switched to become profit-making, and their staff levels declined.

These profit-maximizing tactics point to a troubling conflict of interest that goes beyond the private delivery of health care. They raise a broader, more important question: How much should we rely on the private sector to satisfy broad social needs?

From health to pensions to education, the United States relies on private enterprise more than pretty much every other advanced, industrial nation to provide essential social services. The government pays Medicare Advantage plans to deliver health care to aging Americans. It provides a tax break to encourage employers to cover workers under 65.

Businesses devote almost 6 percent of the nation’s economic output to pay for health insurance for their employees. This amounts to nine times similar private spending on health benefits across the Organization for Economic Cooperation and Development, on average. Private plans cover more than a third of pension benefits. The average for 30 countries in the O.E.C.D. is just over one-fifth.

We let the private sector handle tasks other countries would never dream of moving outside the government’s purview. Consider bail bondsmen and their rugged sidekicks, the bounty hunters.

American TV audiences may reminisce fondly about Lee Majors in “The Fall Guy” chasing bad guys in a souped-up GMC truck — a cheap way to get felons to court. People in most other nations see them as an undue commercial intrusion into the criminal justice system that discriminates against the poor. < Our reliance on private enterprise to provide the most essential services stems, in part, from a more narrow understanding of our collective responsibility to provide social goods.

Private American health care has stood out for decades among industrial nations, where public universal coverage has long been considered a right of citizenship. But our faith in private solutions also draws on an ingrained belief that big government serves too many disparate objectives and must cater to too many conflicting interests to deliver services fairly and effectively. Our trust appears undeserved, however. Our track record suggests that handing over responsibility for social goals to private enterprise is providing us with social goods of lower quality, distributed more inequitably and at a higher cost than if government delivered or paid for them directly.

 The government’s most expensive housing support program — it will cost about $140 billion this year — is a tax break for individuals to buy homes on the private market. According to the Tax Policy Center, this break will benefit only 20 percent of mostly well-to-do taxpayers, and most economists agree that it does nothing to further its purported goal of increasing homeownership. Tax breaks for private pensions also mostly benefit the wealthy. And 401(k) plans are riskier and costlier to administer than Social Security.

From the high administrative costs incurred by health insurers to screen out sick patients to the array of expensive treatments prescribed by doctors who earn more money for every treatment they provide, our private health care industry provides perhaps the clearest illustration of how the profit motive can send incentives astray.

By many objective measures, the mostly private American system delivers worse value for money than every other in the developed world. We spend nearly 18 percent of the nation’s economic output on health care and still manage to leave tens of millions of Americans without adequate access to care.

Britain gets universal coverage for 10 percent of gross domestic product. Germany and France for 12 percent. What’s more, our free market for health services produces no better health than the public health care systems in other advanced nations. On some measures — infant mortality, for instance — it does much worse.

In a way, private delivery of health care misleads Americans about the financial burdens they must bear to lead an adequate existence. If they were to consider the additional private spending on health care as a form of tax — an indispensable cost to live a healthy life — the nation’s tax bill would rise to about 31 percent from 25 percent of the nation’s G.D.P. — much closer to the 34 percent average across the O.E.C.D.

A quarter of a century ago, a belief swept across America that we could reduce the ballooning costs of the government’s health care entitlements just by handing over their management to the private sector. Private companies would have a strong incentive to identify and wipe out wasteful treatment. They could encourage healthy lifestyles among beneficiaries, lowering use of costly care. Competition for government contracts would keep the overall price down.

We now know this didn’t work as advertised. Competition wasn’t as robust as hoped. Health maintenance organizations didn’t keep costs in check, and they spent heavily on administration and screening to enroll only the healthiest, most profitable beneficiaries.

One study of Medicare spending found that the program saved no money by relying on H.M.O.’s. Another found that moving Medicaid recipients into H.M.O.’s increased the average cost per beneficiary by 12 percent with no improvement in the quality of care for the poor. Two years ago, President Obama’s health care law cut almost $150 billion from Medicare simply by reducing payments to private plans that provide similar care to plain vanilla Medicare at a higher cost.

Today, again, entitlements are at the center of the national debate. Our elected officials are consumed by slashing a budget deficit that is expected to balloon over coming decades. With both Democrats and Republicans unwilling to raise taxes on the middle class, the discussion is quickly boiling down to how deeply entitlements must be cut.

We may want to broaden the debate. The relevant question is how best we can serve our social needs at the lowest possible cost. One answer is that we have a lot of room to do better. Improving the delivery of social services like health care and pensions may be possible without increasing the burden on American families, simply by removing the profit motive from the equation.