Blame Anderson Cooper

I jokingly blame Anderson Cooper for my ultimate selection of Vanderbilt Medical and Dental Clinic to do my reconstruction work as it is connected to him via his Mother’s familial legacy. I doubt that Anderson has ever set foot on the campus or inside the medical facility that bears the name of his predecessors and as the University and Medical facility have long split and only share a name I see no reason why anyone would think this hospital is as elegant and as intellectually interesting as either he or his Mother were or are.

Vanderbilt is a medical behemoth in Nashville and largely responsible for some of the reimagining of everything from malls to neighborhoods thanks to their growth and ever expanding footprint in Nashville, a city dominated by many legacy medical landmarks, one tied to the Frist family, another said family with a storied legacy in America. Perhaps one recalls the former Senator from the state of Tennessee, William Harrison Frist; He is an American physician, businessman, and politician who began his career as a heart and lung transplant surgeon. He later served two terms as a Republican United States Senator representing Tennessee. He was the Senate Majority Leader from 2003 to 2007 and nowhere near as divisive as the current Southern leadership. The Frist family founded HCA and in turn is why the area is known for its role in remaking Nashville as more than music city. Bill worked at Vanderbilt and was a successful transplant surgeon and is still affiliated with them and I am sure like all the wealthy families in the area have no interest in day to day operations as their legacy and footprint in contemporary Nashville is secure and well defined. That is the South, where money talks and the people talk out of two sides of their mouth to tell you what they think you want to hear and what they think they need to hear to be believed. Everyone lies in the South like a dog on a carpet on a hot day so they assume you too lie and if not it does you no favors.

The main players in almost every city, especially the South, are defined by “old money” meaning that most of the family earnings are at least three generations old and come from a business or industry started by a senior Patriarch. Think the Rockefeller’s, the Kennedy’s, the Mellon’s and so forth. Then we have “new money” and that is the first generation who created wealth usually already from a well established family but they were not at that level until they hit the big well.  The Gates family define as such as the senior Bill was already a well established Attorney and the same for Warren Buffett whose father was well connected and in turn those connections enabled the son to better the father.  The Nouveau Riche are the current Tech heads like Zuckerberg who simply just got fuck all lucky.

Now the reality is that it takes three generations to piss off the cash and they usually do through a series of bad decisions and often you see that in many families, like the Hilton’s who have Paris that can explain that a name can buy you entry but you still need to work for a living its just the kind of work one does that defines the distinction.  Anderson Cooper has the cache of Vanderbilt but he made his own way through the access that the name provides its just that he chose to actually develop an intellect and manner that demonstrates class is in fact earned and learned.  Try that Countess!  (Watch the housewives of NYC for that reference)

But Vanderbilt is just a name of the past for those in the present and when one thinks of it you think of the school, the football team and the reputation as the “Ivy League” school of the Athens of the South.   A dated reference that has no relevance in the New South as few who live and come from the area go to Vanderbilt let alone any of the schools that encircle the area.  Keep em dumb and they stay stum.   Which is why they rarely vote, have few opinions as those requires thoughts and the ability to think critically, a skill set lacking in the South given its attitude and history regarding public education.   Smarts is for the rich and the rich keep it that way.

I go for my next surgery in a few days the one that was fucked up by the incompetence of the last Intern who was so busy worrying about my Vagina (meaning as a woman how can I function and cope on my own – just fine, thank you.) then the jaw and the bone structure where the implant was being placed. And naturally the implant failed.  A bone graft and implant replacement made simultaneously was done and I was sent on my way pushing back all of my work for another three months. Thanks asshole as he is like all of them in the revolving door of medical care, fuck up one and done.

Vanderbilt has a legacy of problems and a history that includes many issues like the one below.  It is probably why they are pushing back against those who do not want to be anesthetized. Trust me if I had an option on my first run around I would have, they did not even bother to give me a Valium to ease my nerves and were so utterly bizarre pre-surgery that my already high blood pressure was rising and in turn putting me further at risk after keeping me under two hours longer than necessary as they were overbooked. Another problem which they have repeatedly.   My former neighbor who was just out of Nursing school two years earlier was the senior Nurse in the NICU, that must be comforting to parents of at risk babies.   That is nothing compared to all the folks I have seen come and go in my three years there.  I finally quit trying to know names there was no purpose.  Vanderbilt is a dump. But then little in Nashville is anything but.

And this may be why…..

After a patient was killed by the wrong drug, Vanderbilt didn’t record fatal error in four ways
Brett Kelman, Nashville
The Tennessean Published  Dec. 15, 2019 |

Vanderbilt University Medical Center’s actions effectively hid the cause of death of Charlene Murphey for 10 months until an anonymous complaint prompted investigations by federal health officials and state law enforcement.

Charlene Murphey, 75, died at Vanderbilt after being injected with the wrong drug.
The hospital didn’t report the error to government regulators or its accrediting agency.
Vanderbilt doctors falsely told the medical examiner the death was “natural.”

After a Nashville-area woman died two years ago from a grievous medication mistake at Vanderbilt University Medical Center, the hospital’s response obscured the error from the government and the public. Vanderbilt violated state law, reported the patient’s death as “natural” and swore her family to silence, according to a Tennessean review of hundreds of pages of county, state and federal records.

The hospital’s actions effectively hid the cause of death of Charlene Murphey, 75, for 10 months until an anonymous complaint in October 2018 prompted investigations by federal health officials and state law enforcement.

Those investigations detailed how Murphey was accidentally given a fatal dose a vecuronium, a paralyzing medication that sent her into cardiac arrest while she waited for a medical scan in Vanderbilt’s radiology department.

The nurse who injected Murphey with the drug, RaDonda Vaught, was criminally charged with reckless homicide and impaired adult abuse in February, and her case has become a rallying cry for medical professionals who fear honest mistakes will be criminalized. Meanwhile, Vanderbilt, the biggest and most renowned hospital in Nashville, largely avoided repercussions. For the first time, this story explores how the actions — and inaction — of Vanderbilt delayed and hampered scrutiny of Murphey’s death.

In the months after Murphey died in December 2017, Vanderbilt officials did not document or report the deadly medication error in four ways.

Two Vanderbilt neurologists provided false information about Murphey’s death, saying she died naturally from a brain injury, according to the Davidson County Medical Examiner.
Vanderbilt did not report the fatal error to The Joint Commission, an independent organization that accredits the hospital, said a commission spokeswoman. Joint Commission policy strongly encourages but does not require hospitals to report fatal medical errors.

Vanderbilt officials “failed to report this incident” to the Tennessee Department of Health even though state law requires the hospital to do so, according to a federal investigation report.
The report also found that Vanderbilt staff did not document the medication mix-up in Murphey’s medical records, then subsequently provided different explanations for the omission.

More: 4 revelations from our story about Vanderbilt and the RaDonda Vaught case

Vanderbilt officials declined to comment for this story. Spokesman John Howser said the hospital would not speak further about Murphey’s death “to avoid impacting either our former employee’s right to a fair trial or the district attorney’s ability to pursue the case as he deems necessary and appropriate.”

In prior statements about Murphey’s death, Vanderbilt officials stressed the medication error was immediately disclosed to her family. The hospital negotiated an out-of-court settlement that bars those family members from discussing her death or revealing the settlement agreement to anyone.

Vanderbilt officials confirmed the settlement during a public hearing earlier this year.

Charlene Murphey’s grandson, Allen Murphey, 35, who is not part of the settlement, said he thinks the hospital tried to hide its mistake and protect its reputation.

“A cover-up — that’s what it screams,” he said. “They didn’t want this to be known, so they didn’t let it be known.”

Court records show syringes and a vial of vecuronium that have become potential evidence in the trial of RaDonda Vaught, a former Vanderbilt nurse accused of killing patient Charlene Murphey with a medication error.

Vanderbilt leaders have acknowledged their response to Murphey’s death was flawed. During a February meeting with the Tennessee Board for Licensing Health Care Facilities, Vanderbilt Health System CEO C. Wright Pinson confirmed Murphey’s death wasn’t reported to state regulators and said the hospital’s response was “too limited.”

At the same meeting, Mitch Edgeworth, who was then CEO of the hospital, said an internal review of Murphey’s death led to “opportunities to improve the knowledge of our clinicians regarding reporting” to the medical examiner.

The health care facilities board, which oversees hospitals throughout the state, took no disciplinary action against Vanderbilt.

RADONDA VAUGHT: Vanderbilt largely to blame for deadly medication error, attorney says
‘She held us all together’

Charlene Murphey, who lived most of her life in the Gallatin area, was married for nearly six decades to her teenage sweetheart, Sam, and they had two sons, Gary and Michael.

She was the quintessential Southern matriarch who was always quick with a warm smile, a quip or a plate of food, said grandson Allen Murphey.

“She really was the glue of the family. She held us all together,” he said.

Charlene Murphey fell ill on Christmas Eve 2017. She was diagnosed with a subdural hematoma at Sumner Regional Medical Center, then transferred by ambulance to Vanderbilt, where her condition began to improve.

By Christmas Day, she appeared to be on the verge of leaving the hospital, her grandson said. Family members were so confident she was recovering they decided to delay celebrating the holiday until she was back home in a day or two.

“Everyone was saying at that point the best Christmas present ever would be to not have Christmas at the hospital,” Allen Murphey said. “But it didn’t work out that way.”

On Dec. 26, in preparation for her release, Charlene Murphey was scheduled for a PET scan in the hospital’s radiology department. This scan, similar to an MRI, requires a patient to lie still in a tubular machine for about 30 minutes. Murphey was claustrophobic, so a doctor prescribed her a sedative, Versed, to keep her calm.

In court records, prosecutors said Vaught, the Vanderbilt nurse, attempted to retrieve the Versed from an electronic medication dispensing cabinet but could not find it. She then disengaged one of the cabinet’s safeguards, unlocking more powerful medications, documents show, and typed “VE” into the cabinet’s search tool.

She picked the first drug that was offered, documents show. It was not Versed. It was vecuronium.

In court records, prosecutors say Vaught ignored multiple warning signs that she had the wrong drug. While drawing the vecuronium into a syringe, Vaught must have looked directly at a medication bottle cap that said “WARNING: PARALYZING AGENT.”

Prosecutors say Vaught then injected Murphey with the syringe and left her for the PET scan as the vecuronium paralyzed her body. By the time the error was discovered, she had suffered cardiac arrest and partial brain death.

About nine hours later, Muprhey’s family, who were once so confident she was coming home, gathered at the hospital to say goodbye.

“But it wasn’t really a goodbye,” Allen Murphey said with tears in his eyes. “I was talking to her, but she wasn’t there. She was long gone.”

Charlene Murphey officially died at 1:07 a.m. on Dec. 27, 2017, when she was disconnected from a breathing machine.

RADONDA VAUGHT: Health officials reverse decision not to punish ex-Vanderbilt nurse for fatal error

Vanderbilt didn’t report error to state, feds or medical examiner

Vanderbilt staff told Murphey’s family what happened but never documented the vecuronium injection in her medical records, according to a federal investigation report of the death.

One unnamed Vanderbilt official told federal investigators Vaught didn’t document the injection because “everyone was focused on resuscitation” and there was “no opportunity” to update the records, the federal report states. Although Vaught is not named in the federal report, the document states the nurse who gave the vecuronium injection said she did not document it in medical records because she was told by a nursing manager it was unnecessary and would be recorded automatically.

The deadly injection wasn’t reported to the Davidson County Medical Examiner’s Office, which is responsible for investigating non-natural deaths in Nashville. Medical examiner records state Vanderbilt neurologist Dr. Adam Hartman reported the death as having “no foul play suspected” while another neurologist, Dr. Eli Zimmerman, attested Murphey died from “natural causes of complications of the intra-cerebral hemorrhage.”

If a vecuronium injection had been mentioned, it would have immediately triggered an investigation, said Dr. Feng Li, the medical examiner.

“Especially with that kind of medication given, we would have investigated the case,” Li said. “We would have taken jurisdiction.”

Li said he changed Murphey’s manner of death — from natural to accidental — in August 2019 to correct the official record.

Vanderbilt did not report the fatal error to The Joint Commission, said commission spokeswoman Maureen Lyons. The commission did not learn about Murphey’s death until after media reports began the following year. It then evaluated the incident and took “appropriate actions,” which are confidential, Lyons said.

The hospital didn’t report the fatal medication error to the Tennessee Department of Health, which would have then alerted the state Board for Licensing Health Care Facilities and the federal Centers of Medicare and Medicaid Services (CMS). State law requires Vanderbilt to report all incidents of abuse or neglect with within seven days.

Instead, regulators learned about the death from an anonymous complaint in October 2018. CMS responded with a surprise inspection at Vanderbilt, then threatened to suspend Medicare payments if the hospital did not take steps to prevent a similar death. Within days, Vanderbilt created a written “plan of correction” for CMS.

The Tennessean obtained a copy of Vanderbilt’s correction plan in November through a Freedom of Information Act request.

The corrective plan says Vanderbilt changed its medication dispensing cabinets so vecuronium can no longer be accessed by overriding a safeguard.

The hospital also made the process of obtaining other paralyzing medications more deliberate. These medications can only be accessed by searching a cabinet specifically for “PARA” and require two nurses for an “independent double check.” Cabinets display new messages warning these drugs cause “respiratory arrest.”

Vanderbilt also revised policies on documenting medical errors and reporting errors to the medical examiner and the Tennessee Department of Health. Hospital policy now specifically requires a medication error to be documented in medical records and reported to the medical examiner if it contributes to a death. Vanderbilt’s Office of Risk and Insurance Management is now responsible for reporting errors to the health department.

The hospital added instructions to its medication policies, telling medical staff how to monitor patients after giving them drugs. Previously, Vanderbilt’s policies included no such instructions, according to the federal investigation report.

Numerous officials would not comment or answer questions for this story. The Tennessee Department of Health said it would not comment because of pending litigation. CMS declined an interview request and to answer emailed questions. Tennessee Board for Licensing Health Care Facilities officials did not respond to requests for comment. Vaught and her attorney did not agree to an interview. The two Vanderbilt neurologists who misreported Murphey’s death did not respond to multiple email requests for comment. Edgeworth, who left Vanderbilt last year for an executive job at TriStar Health, declined to comment through a spokesperson.

Inhale This

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The long view

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

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

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

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

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

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

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

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

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

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

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

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

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

The close-up view

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

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

But their house contained a clinical catalogue of asthma triggers.

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

Often she smokes inside the house.

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

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

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

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

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

‘We’re a business’

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

— Kaiser Health News

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

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

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

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

Bite Me 2.0

After 72 Hours post dental surgery I want to say that I actually feel better physically but emotionally I am broken.

The reality is that I don’t “get” the South. The level of illiteracy, the fake manners, the low education and in turn compensation explains much of what I am experiencing and while I can place those extrinsic issues onto others I cannot explain how much it affects one intrinsically.  After awhile you can only be as verbally abused and as dismissed without it affecting you on a deep inner level.

Yesterday I was broken, truly broken and tried to come up with ways to avoid the rage and the depression that accompanies this much anger.  I thought the best way was to avoid speaking and I truly think that by communicating in writing will be more effective and enable me to have a moment to clear my head and compose my thoughts and words in a way that will allow me to be understood here.  I am at the point the less said the less mended and this way I can be sure less will be said.

Today I got up and actually walked and had a lukewarm coffee sitting on my porch reading the paper.  I felt civilized and in some way “normal” but when one feels as if you have been stung by 100 bees (but seriously I kinda of want to keep the lips) and a face that looks like Mitch McConnell’s you ask yourself: “Could I have done this differently? Better?” And that I cannot answer.

What I am concerned about is that not that I will be fine but what I will go through in order to be fine and that is what frightens me most.  When you have zero support network and no one to trust to provide feedback or just a shoulder it becomes overwhelming.  There is only so much one can do alone before the branches on the tree breaks and in turn leaves the tree exposed to the elements. I feel very exposed here.

I was planning to write my first book about Teaching but right now I have elected to write a series of essays about living here and what it is like to truly be a fish out of water and be in water that is as deep as red as one could get in the deep red sea.  So many of these blog entries will evolve into essays about the people and the place that I call anything but home.

And why I can never call it home it is because I could never live anywhere where the state of society is so abhorrent so vicious and cruel that is based in such self loathing as that is what it is all about, the feeling that you are so worthless in the bigger picture you kick anyone in the smaller picture just to feel better about yourself.  And that explains the Vanderbilt problem as they are staffed with so many low level lowly educated and marginalized people they direct that to the only people they can – patients and they do it with impunity as they know in a State with largely lowly educated individuals the have neither the skills nor the resources on how to demand respect.  Nor do they as they fear the power structure and in a State that has little medical care for those in need they hold the cards and they hold them tight.  It is abusive and it is fueled in class and race.   And the anger and fear trickle down like ice cream on a cone on a hot day but nowhere as sweet.

So today when I called for my post surgical follow up I was told that it needed to be on the 14th, week to the day it was done.  I had been very clear when I originally anticipated this and scheduled this that it would not coincide with vacations or dates that would lead to delays or problems should I have issues/questions or needs.  And if so who would be my contact person to ensure they would be able to help me if a problem occurred.   And sure enough my Surgeon is on holiday next week.  Interesting for those undergoing surgery this week but hey not my problem.  And so I was told that my next appointment was the 25th, 18 days following surgery.  Really?

When I said the info given said the 14th I was told that was the earliest I could come in and that he was on holiday and that the 25th was not two weeks post surgery so apparently I was wrong.  I simply commented that since I had no choice is there another person I could see just to make sure I am on course and was told no as that my Surgeon had done the work no one else could look at it.  Once again a Really?  Then I said this is my only choice with regards to my health and a procedure that I paid over 9K for so I guess that is it yes?  And then the placed on hold to be told that Thursday at 3:30 he could see me.  Interesting and once again the manner in which I was spoken to only further contributes to the increasing frustration and rage I feel every time I contact Vanderbilt.  I don’t look forward to my appointment where I will communicate only in writing  as it seems to be the only way I can without losing it. And we know if I lose it at Vanderbilt the Cops will come to the door and this is not the time nor place for this and I disagree with my Neighbor that I am over thinking this.  I never thought this way in my life and since coming here I have been open to a way of thought that terrifies me and saddens me. 

I am not sure how I will come out of this but at this point I just want out.

 

Bite Me

Today I had round one of my dental reconstruction.  I had no real idea or any information about Vanderbilt when I came here and like Nashville I chose to ignore the flags of caution and allow myself my own experiences to make my own decisions about both.  And I have mixed feelings about both and as Vanderbilt is the largest employer in the area and in turn my encounters with many in the area have been mixed as well I had doubts.  But I knew that I wanted a woman Dentist and someone not “from” here.  And while she Asian she is from Missouri but there is nothing Southern about her which I appreciate and in turn my Oral Surgeon is from the Princess Bride I can say nothing but I did not kill his father.

As for the rest of them only one other I met whom I have seen only one time since is the perfect stereotype of adorable Southern Boy you would take home to Mother and she would be relieved.  Sadly I wished I had seen him today but alas I met two nice Interns and that was the end of it.  I have no idea who operated on me, who was in the room and know nothing.  And on some level that is a good thing given how the day started out.  And the number of flags thrown down that day would have brought a stop to any game on any field but I progressed.

My first encounter was at the check in desk.  No one was there but I asked in another section if they knew if I was in the right place and she said to ask at the desk out front.  By the time I and my Nurse Practioner (whom I hired from a private agency) arrived the woman was there but not taking inquiries.  And finally she acknowledged us and to say in an abrupt manner would be insufficient as she then informed us we were in the wrong place, lectured me about a phone call and message she had left with said instructions. then demanded payment (which I had given credit info the day before) and then promptly gave us wrong directions which the NP knew as she facility and had been with many clients previously.  So a quick pit stop to the wrong location and we arrived.

And then another Nurse was there asked who I was and told us my procedure was scheduled for 3 hours and I should be done by 11 or 12 at the latest.  I told my NP that she was to “move the car” but in reality the nonsense that someone sits there the entire procedure is absurd so I informed her be back by 11:30.  She was but I wasn’t.  But I shall explain later.

I was taken to pre op and asked all the questions that I had submitted on a form the day before.  So let’s back track here.  I was scheduled for this surgery for at least a month.  Then the day before I get two emails from Patient Coordinators, one with the form and the instructions to fill it out and email it back or just provide basic answers to the questions.  And I found out why as the document is not one you can edit or revise or electrically sign so you just sort of answer them in a generic response.  Mine did have the big caveat:  I AM AFRAID OF GENERAL ANESTHESIA.    

The other was an urgent response to another provider whose main goal was to get paid.  She ran it through immediately and of course abruptly, the constant manner of Vanderbilt staff, discontinued the conversation.

I had asked repeatedly to have a face to face meeting, to review pre op, to get a detailed itemized billing and in turn any restrictions or requirements I should follow prior to surgery.  This includes the outdated NPO bullshit that says no fluids after 12.   I get the no food especially if being intubated by mouth but in dental surgery is nostril intubation general anesthesia was administered.  So basically I followed the National Association of Anesthesiologists and had a black coffee and water at 5 am.   I then made sure that I took a long walk and eliminated any excess waste and the humidity and sweat took care of the rest.

So when I arrived the Nurse that had demanded payment stopped the pre op went to look at my file as that was more important that giving a shit about the water drinking and my own fear and found I had paid.  It proceeded with another rant on my part  that I was appalled at the lack of communication and response as well as overall treatment  that I am a deadbeat/liar/incompetent and such when I walk in takes a toll; which should explain why I have White Coat Syndrome with an immensely high blood pressure that rarely levels unless I have time to calm down.  Remember this is the same crew who called the Cops on me when I blew up over the incorrect treatment plan the first time and said “what do I need to do get a gun a blow my head off to get help here?”  That is because Vanderbilt is the largest trauma center (much like Harborview in Seattle and my experience there is well documented) and as a result their energy is spent in ER, which is not surprising given the guns here. So hence the cops four days later when I could have harmed myself and others in the interim not an issue but 7 am arriving at my home uncalled not stressful in the least.

She apologized and in turn finished the procedure.  She was a typical Nurse and again I have no comment to lend to that but 26 year olds are not my favorite.  And she won no fans when I told her about my BP she said I need to get a Physician to help me monitor it.  I go, “Yeah that should do it!” Thanks I will keep to staying out of hospitals unless absolutely necessary, go work out and now that I am going to have teeth eat healthy and be happy having functioning teeth and get out of Nashville. My favorite question was “does someone hurt or threaten you at home?’  Well that was what led to the blow up with the first coordinator about being married or having a partner and me hiring a Nurse so who is doing that?  I responded, “No school is out so I don’t expect that until about September when I return to work as in my 20 years Teaching I have never encountered Students with such violent outbursts.”  She did not respond to that.

Then came the Nurse Anesthesiologist who was administering my GA.  This guy was everything I hate in Nashville, the old white Southern guy whose condescending patronizing manner was in high gear.  I did not admit to drinking the coffee as I knew the reaction about the water was a tipping point and he heard little about my research regarding the the Anesthesiologist society and that they said clear fluid was fine within 2 hours despite that that it was actually 3 hours earlier followed by  a 30 minute walk after. And again in this heat I  had urinated and  was feeling  pretty dehydrated at the moment.   But the manner of speech, his manner towards me told me he dismissed anything I had to say.  And to be this dehydrated prior to GA  means you are in a state that requires more fluid during surgery and is in fact more dangerous but whatever.  He was clearly not believing any of my responses about anything.

When I informed him that I had Bell’s Palsy 15 years ago and residual paralysis next to my right nostril, my upper lip and right forehead was all that remains but quite obvious to those in in the “know.”  And Medical people or former Bell’s see it right away.   But instead he kept asking if I had a droopy eye. I said no, he repeated the question so as soon as I get that angry I respond a question with one so I go, “No, but is it drooping now? Is there something I am not seeing?”  Then he was obsessed with my cane that I brought in case I was dizzy post surgery and needed to walk with rather than rely on the Nurse and sure enough given the bum’s rush I did use it and later at home getting off the couch, so it was needed.   And I said no it is not something I use on a regular basis. Did you not hear me I went for a 30 min walk and wouldn’t that be noted in my med records about my cane/walk?

But he was an asshole and then his boss came in a, real Doctor, however he was equally patronizing and dismissing  with regards to my analogy that I think Bus Drivers are the real heroes compared to Pilots (the one he used to brag about their role in surgery and he really needed to be brought down a peg)   as they have to deal with just as many crazy people and get us all there safely every hour on the hour.  And in Seattle I lived with many Drivers being assaulted, stabbed and one killed. The old duffer then hauled me out like the fuckwit he was cutting me off telling me it was time to get the implants in.  But it wasn’t.

I found out when I came out of anesthesia that they went out to my NP and informed her that I would be another hour that they were backlogged and she heard them tell a patient that was scheduled that he would have to come back in an hour and half.  How was that no fluids thing working for him I wonder? Another they told to reschedule for another day.  Gee got that scheduling thing down well don’t they. So people take time from work arrange for someone to care from them which means more days off and they yet questioned why I hired someone and wanted a pre-surgery consult.  One worked the other didn’t.  The one in my control and yet Vanderbilt had real problems with my need for control.  I see why.

When I came out they had to hustle me out as clearly they needed the room and apparently shut down at 3.  Which may explain why I was dazed and confused and needed time to recover but no instead I was given the bum’s rush.  In the process I was left exposed without covering by a doorway, a bizarre ice pack that did not even remotely cover what I needed as it was utterly useless (even my NP thought it was odd)  and given a small list for post op and instructions to call on Monday for my follow up.  I see I am doing all the work here and had I not hired a professional I would have been utterly without any true support as how is a layman to know what to do? Sure tell a friend to take a day off of work and then say its only a half a day.. but not.  What I loved was that I was told to have someone 24 hours to help me.  Really? Then should I not be admitted if that was the case?  I said we will take care of when we get home and exchanged a glance.

So when I reviewed the inadequate post op compared to the ones I collected online from other O/M’s I followed the ones that had detail and information that I found useful.  I guess Vanderbilt is aware that 40% of the population is illiterate so they keep it simple.  I mean only 33% of the population is educated and in turn probably all work in the Surgery and the School in leadership gigs and the rest are well the “others’ whom I encountered in my “odd”essey.

The NP dropped me as she had scheduled another patient at 3 but I was fine with that as I needed to get my bearings and get that GA out of my system.  I tried some fluids then a broth then the projectile vomiting happened and that ended that.  Cleaning vomit, doing laundry after surgery is not a job for a Nurse but a Maid at that point.  I emptied garbage and in turn did dishes.  I was Martha Stewart on Hydrocodone.   This Juice Cleanse was now in hindsight was a good idea.  I have yet to start it so that might be wishful drinking.

So I also reviewed the take home pack which included Ginger Ale and Sprite. Why I paid for that is beyond me as I don’t drink Sprite and I had ample Ginger Ale in my home in anticipation.  I bet the mark up was a good one on that.  Then some gauze and a spoon for reasons I am unclear.  But my favorite thing in the pack was a HAZMAT envelope with a set of teeth.  Were these my temps that I was to wear post surgery? Really?  I had mine with me and had properly wrapped them and put them away in a proper container but these were just sitting there without fluid or any proper care what.so.ever and this is what I am to use? Really?

I immediately emailed my Dentist to ask about this and her assistant read it got back to me immediately by phone (funny how many are able to contact me by my land line which I prefer so who is the one with literacy issues) that this was bizarre and she had forwarded my email onto the O/M office but they were already gone for the day (it was 3:17 pm) so not to expect anything until Monday.  I asked about care or what should I do with it and she said to bring it to my follow up appointment that I will be making myself as I know they won’t.   We did laugh as I said if these are for me I am going to pass on them thanks as they are a bio hazard!

The reality is that I got more online about my procedure pre and post than I did from Vanderbilt.  And while I am pleased with my Dentist and my Surgeon the communication at that place was appalling. And the complaints about this issue is well noted on almost every site and review.  This is where the ACA was supposed to kick into gear with electronic messaging and records but that would require Vanderbilt to give a shit.  They care about research.  The reality is that since Tennessee elected to not extend Medicaid they treat only the few insured in the area and in turn the few Insurers that exist in the area.   So while mine is Dental and I pay out of pocket for this procedure my exposure to the Hospital side is very typical of a facility that has now largely a Teaching facility and trauma one.  But the issues here in the medical tourism capital as we house two other national Hospital and Insurers is ironic if you actually live here.  I call myself an interim resident and I don’t think in all frankness it is different anywhere else.  I left Seattle as I could not get the care I wanted and needed at an affordable price and this is half of what I would pay so I guess you get what you pay for.  But by all when it is said and done this will hit 20K but thanks to Trump it is all tax deductible.

But I have round two next year and this worries me, it worries me a lot. But at least I know now what to expect and none of it good but the final result I suspect will make me realize that no pain no gain. But with Vanderbilt they are no different or better than the rest and that is the state of care in America.