Monday, December 20, 2004

Angels in Oakland

Bureaucrats love numbers and the end of the year calls for the final count. So here’s some numbers for you 86, 109, 108, 84 and 80. Murders in Oakland for the last five years friends, children, husbands, wives and grandparents lost. Oakland actually has a neighborhood called “ghost town” of course city hall doesn’t recognize the name, it's bad PR. Oakland has become a city of ghosts, of angels and people whose lives have been forever changed by violence.

Our democratic machine has approached its people and their strife from a position of fear and ignorance. Liberal democrats wring their hands, “Why don’t the youth vote?” “Why are they so angry?” “What is wrong with them?” Then they vote for more prisons and close schools. I meet Oakland youth everyday who have personal experience with violence. They have ideas opinions and a very thoughtful perspective of the world and their place in it. They don’t vote or trust politicians because politicians have done nothing to win their respect or trust. They want to be heard, to be taught and to be loved and we do little or nothing to meet their simple needs.

Poor neighborhoods can’t get a beat cop in Oakland, but affluent enclaves like Montclair get two. Mayor Brown having done little or nothing for Oakland youth now plans to exploit their suffering to promote his own political career. Having played politics with our schools and our police services, leaving both much worse than he found them, Brown, a ruthless pollster, plans to run against crime and inner city youth for state attorney general. He will appeal to fear and a tired white liberal base, who remembers him as a governor, back when he cared and came to work.

Mayor what’s his name can’t help Oakland, leadership and hope in Oakland won’t come from has been politicians; it will come from our children. RIP, Rest in Peace, our children understand death and in a funny way life better than most forty year olds. These kids know the world in a hard dark way and face it with courage and hope. They love and remember lost friends, the people our politicians are so determined to forget. They know that to our leaders they are just troubling statistics, “ urban youth problems” not people. I had one young girl tell me, “ I feel like garbage, something that someone has thrown away and forgotten.”

Local democrats need to stop sucking up to developers, stop building ballparks and ice rinks, put down their spread sheets, walk out of their focus groups and go and meet our children. Every week these young people come through Highland Hospital their lives lost or forever changed by violence, not once in twelve years have I seen a politician come to talk to these kids or their families.

You can’t solve problems you don’t understand. Oakland’s political machine doesn’t care about our youth and our youth know it. We just voted money for violence prevention, let's see those politicians walk into the neighborhoods, the prisons and the hospitals, talk to our children then bring them back to city hall. Urban youth problems cannot be solved without buy in from urban youth. If you want to change the culture you have to understand it. RIP doesn’t just mean "Rest in Peace", it means Rich in Potential and if democrats continue to ignore these children, Rise in Protest.


Well, the Dirt’s a data driven blog so here are the numbers. I don’t want anyone saying I don’t know how to crunch a number or spread a sheet. Hits year to date 9,766. Average daily unique hits 24. Biggest day 129. Biggest fans consultants, they hit often and hard from Hiltons, hospitals and financial institutions all over the county. Dean Whitter, Deloitte and Touche read the Dirt; these hits definitely don’t come from my relatives, we don’t have any money to manage. Hospitals dig the Dirt: Kaiser, Children’s, UCSF, Highland, and more. Politicians read the Dirt: Alameda County, City and County of San Francisco, the City of Oakland and the California Assembly read the Dirt. Reporters read the blog and patients love the Dirt. Universities, unions and other hapless hospitals workers, under siege by consultants, all dig the Dirt.

The Dirt has more than 300 subscribers and has sent out close to 7,000 emails. An average of 47% of the emails sent are opened and an average of 32% of the readers click through to the blog. People even Google the Dirt “that dirty thang,” “the daily poop” or “low budget blog.” The Dirt gets lots of reads but no respect.

Wednesday, December 15, 2004


Well, it’s official according to the authority board the deconsultification process has begun. Deconsulting a public institution is sort of like desalinization, it’s a great idea that would save lives and feed the hungry but no one has quite worked out how to do it. The Dirt loves to be helpful, so how about a going away party? “Come on lets party, fiesta. All night long.” Send your “Adios Cambio Celebration” ideas to the Daily Dirt.

The Consultants Who Stole Christmas

“ While decorations are intended to create a festive atmosphere….Many decorative items can pose a potential fire hazard that could result in a disaster.” -excerpted official ACMC memo

If our leaders would come down on mismanagement half as hard as they came down on Christmas, the hospital would be in the black by now. Managers were also treated to sermon on politically correct and administratively approved language to describe the holidays. They’re taking the bull by the horns on this one. Caregivers speculate that the rash of holiday memos and directives is just Cambio’s not so subtle way of saying, “there will be no free Christmas dinner, we’re just too cheap.”

So aside from the recent morale boosters, what’s up? Well Highland nurses, many of whom already have other jobs, get more discouraged by the day. Senior management continues to heap more menial administrative tasks on the already overburdened clinicians. Nurses are now responsible for getting the History and Physical Exam form from the physician and faxing it to the pharmacy. Come on guys, everyone should be responsible for their own paperwork and getting it where it has to go. So starting last week nurses the hapless middle women of this misadventure began faxing all these forms to the pharmacy. The pharmacy ran out of fax paper and started calling back nursing stations to complain about the deluge of paper. This new plan would have been really bad for morale, but since on many nursing floors less than half the staff is permanent, the temps, travelers and registry could care less. They don’t worry about paperwork. Normal management wouldn’t try to run a McDonalds with less than half regular staff, but Cambio seems to think you can run an ICU this way. Oh, well.

Cambio’s keeping the budget lines down by not spending. You need 65 signatures to spend cash and at any given time 20 of those signatures are in Tennessee, Texas or just resting up at the Hilton. Parts don’t get bought, machines don’t get fixed and even the rare nurse who wants work at the medical center doesn’t get hired. Hey, I bet that budget’s looking better though.

Measure A -the rest of the cash

To read the Tribune's report on the rest of the
Measure A funds click here:

Article Link

Monday, December 06, 2004

Holiday Hospital

Well it’s that time of year again. Yeah, the shopping, the eating, the Christmas music and family fun that never ends. The overwhelming pressure to be full of joy and good cheer is enough to unmask even the most latent psychological problems. There’s no doubt about it the holidays can be hard on your health, but they’re good for our business.

Dietary indiscretion, isn’t that a great term? It sounds like you slept with a Ho Ho. Actually, dietary indiscretion fills lots of hospital beds, it’s the salt. Tips people right over the edge into heart failure. Trust me, I spent one holiday season in the Critical Care Unit fighting with my father-in-law over a bag of pork rinds.

Booze always fills a few beds. Alcohol, cars and testosterone: it’s that magic combination that keeps trauma centers full. Drinking is a time-honored strategy for coping with the family gathering.

Then there’s always the flu, the freeways and the family feuds. Doesn’t it feel good to be needed?

The Unholy Alliance

Did you know Alameda county runs an HMO? That’s right folks, we can’t afford a hospital or clinics for the uninsured but we have adequate funds to run an insurance company to administer public healthcare dollars- it’s called the Alameda Alliance for Health.

The Alliance was established in 1996 to “administer” healthcare dollars mostly Medi-Cal. The Alliance was Dave Kears’ brainchild why run a hospital when you could build a bureaucracy- all the money none of the hassles. When the Alliance was established most of the profitable Medi-Cal clients, young women with children were immediately sucked out of the county hospital. The Alliance referred them to private hospitals. Many of the medical center’s financial problems date back to the creation of the Alameda Alliance.

How could Mr. Kears sell such a bad idea to our well-meaning but inept county supervisors? The same way George Bush is trying to sell out Social Security. Dave Kears said the Alliance offered clients, “choice.” Whenever Dave or George say, “choice” one should understand that they plan to dismantle some public service.

Monday, November 22, 2004

Big Hug

The chest pounding and brow beating goes on. The medical center employees accepted a contract and important people are still talking about lay-offs. Physicians are pushing forward to try to fix clinic scheduling and develop programs to manage chronic illnesses, but no one is reaching out to staff to move on and move forward. Come on guys, if you don’t want to “charm and disarm”, just shut up.

The one truly multidisciplinary program in the hospital got offed, the part-time program specialist for the department of diversity affairs got canned (Cambio probably needed the cash for executive salaries). Diversity is dead, but we still have the “pink book” to train us on cultural sensitivity (it has a long section on the Amish, but doesn’t cover African Americans.) Many employees find it amusing, but no one has ever described it as useful.

As another morale raiser, the Sheriffs escorted a patient through the hospital at peak visiting hours with a loaded shotgun. They forgot to tell nursing they’d be heavily armed and when a social worker asked what was going on, he was told it was, “none of his business.” Discharging a shotgun on a crowded nursing floor could easily result in a buttock full of buckshot for social workers, nurses, other patients, and their guests. Many employees feel the our new VP of marketing will have a hard time marketing “Bright Birthing Beginnings” at Highland, if we have Sheriffs wandering around with loaded shotguns, but hey, what do they know, they’re just the hired help.

What, what, what is to be done? My thoughts exactly as I headed to Two Star Liquor for a six pack of Bud (to wash down my McNuggets.) As I headed back to my car, I passed Full Moon Seafood House. At night diners look like fish in an aquarium and someone caught my eye. At a table for six sat: Nate Miley (county sup), Floyd Huen (authority board trustee), Jean Quan (Floyd’s wife and Oakland city council woman) and a couple of other political hacks that I couldn’t readily identify. Undoubtedly they were discussing the same dilemma as I: what, what, what is to be done? They looked far more miserable than I felt, I briefly considered crashing their party, but my McNuggett’s were getting cold and my Bud was getting warm. Besides, I have two lovely kids at home, and an evening with dyspeptic politicians isn’t my idea of fun. So I went home to discuss the situation with my family. My advice is not original; in the words of Tinkie-Winkie, Dipsie, La La and Poe (the Teletubbies) it’s a good time for a “Big Hug.”

Medical Center Employees Accept a Contract

Service Employees International Union Local 616 has created a high quality blog! If you want to see the terms of the contract accepted by union represented employees of the medical center or just want to check it out.


SEIU local 616 represents some medical center employees, county employees, homecare workers and daycare providers. They have become an articulate voice and advocacy organization for care-providers. The Director Fran Jefferson has also recruited some exceptionally talented staff: Brad Cleveland, Wayne Templeton, Carol Ingoe and Angela McWhinnie to name a few. They’re the little union that could. Hey, the Dirt’s day’s maybe numbered, I’m getting out-blogged

Tuesday, November 16, 2004

Charge Back

The medical center must learn to compensate for its underprivileged status in the county bureaucracy. Dave Kears, much like George Bush, has pushed a privatization model on county health services. Non-profits, the medical center, and for profit healthcare providers all compete for limited county healthcare dollars; instead of cooperating to provide coordinated care. So if a mental health agency can drop off an alcoholic for a week or two at Highland and then let the medical center find them a place to live, it makes their bottom line look good.

Here’s a hypothetical you’re a private hospital administrator with a problem patient: she needs a nursing facility, she’s too young for Medicare, she has multiple sclerosis, she can’t walk, she’s incontinent, she has bedsores and psychiatric problems (which she refuses to treat.) She’s sitting in your thousand dollars a day hospital bed screaming and scaring your paying clients with non-stop profanities. In an effort to manage her screams and complaints her doctor has her on enough morphine to knock out a bull elephant and of late she’s taken to throwing food at the nursing staff and talking about suicide. Then she does you a big favor, she jumps out her first story window and sustains some scratches landing in the bushes below. In a stroke of administrative genius, it occurs to you, this is your opportunity. You dial 911 and when the ambulances arrive you tell them she is a trauma victim and have them take her to Highland. Patient dumping or appropriate triage, you be the judge?

Enough speculation, it suffices to say many clients with complex needs and problems miraculously end up in the medical center. This occurs in spite of private and public mental health services, adult protective services, the county conservator, Telecare, Regional Center and more. We have an enormous number of poorly coordinated county services and contractors. Somehow problem clients from all sorts of county funded services end up at the medical center in bad shape, at this point it falls on the medical center to fix not just their medical problems, but also their social and economic problems. The hospital has to get them well and get them a place to live. These patients sit in the hospital for weeks to months, until medical center’s social workers can find them a place to live with an appropriate level of care. These clients get put on administrative days (Medi-Cal won’t pay for their stays) so the medical center eats the costs.

So county agencies, private hospitals, non-profits and for profit providers all dump their “problems” at Highland. Once these clients end up in Highland the medical center must find them a place to live. At the end of the year county contractors receive “fiscal rewards” for providing cost effective services and the medical center gets to booby prize for spending too much on the sick. So what is to be done, well Cambio Healthcare Consulting could use a tool frequently employed by our corporate cousins, the “charge back.” This is a sound business move and since county healthcare services are based on competition instead of cooperation, it’s a smart defensive tactic. If the CEO of the moment kept records of all the costs incurred by medical center clients who are supposed to be managed by other agencies they could “charge back” these costs to the county at the year’s end and demand their “fiscal reward. “

Monday, November 08, 2004


“Mommy, you forgot to make the world a better place today”
James Gregor Nomura Fisher, 4 years old

Well, I guess its time to stop crying in my beer and get on with it. November second hit hard and hurt. At least Measure Z Oakland’s give potheads a break initiative passed. They had a big light it up party. Deep slow inhale… “Yeah... take this Ashcroft.” I don’t smoke pot, not because of moral objections; I just don’t care for it. In time times of hardship, loss, and crisis I hide in poetry, movies and books. Here's one of my favorites:

Children of Our Era

We are children of our era;
Our era is political.

All affairs, day and night,
Yours, ours, theirs,
are political affairs.

Like it or not,
your genes have a political past,
your skin has a political cast,
your eyes a political aspect.

What you say has a resonance;
What you are silent about is telling.
Either way, it’s political.

Even when you head for the hills
You’re taking political steps
on political ground.

Excerpted from “Children of Our Era”
miracle fair
Selected Poems
of Wislawa Szymbrorska

So the poet is right. The world is what we make it. How can the Democratic Party capture the hearts and minds of the county, if we the faithful barely believe in them? Our party has controlled California for a long while and liberal democrats own the Bay Area. So, why do we have crumpling schools and hospitals and why are we spending our limited monies building new prisons and hiring more police? County Supervisors whine and complain, “it’s prop 13, it’s term limits or it’s the State.” We need to stop waiting for vision and leadership; it is time for the good people of Oakland to put down the pot and to make our local officials build the city and county we deserve.

Without Compromise

Geeeez, well negotiations have broken down between the unions and management at the medical center. It’s heavy posturing, Cambio sent forth flunkies with a “last best and final offer.” The real decision makers never actually enter the room with the union team (it’s beneath them to meet directly with the hired help.) So executive temps and sub sub consultants with no real decision-making power run back and forth. Come on guys, hurt feelings are half the problem; a little courtesy goes a long way. The employee's negotiating team said, “ nope," to “last, best and final.” So, Cambio has effectively forced another strike vote. Then there are the ever-helpful trustees, rumored to be saying they will put the lay-offs back on the table. Come on guys, people are quitting in droves, lay-offs are entirely unnecessary.

The Tribune

The medical center made the front page. The inner workings and dirty details of inspections. The grapevine says those pesky inspectors tore apart a private hospital this week, let's hope the Tribune will show the same zeal in exposing their dirty laundry. I think not, Sutter unlike Highland has big suction with the press.

To read the Tribunes latest click here:,1413,82%257E1865%257E2520137,00.html?search=filter

Monday, November 01, 2004

Trick or Treat

Well, we’re close to a year and four CEOs into the Cambio Healthcare Consulting experience, at the medical center. Expect inspectors this week, these are the State guys, they give new meaning to the term nitpicking, they have been known to check between people’s toes. These guys are less fun than an elevator full of consultants.

Hopefully, this week we’ll get some good news. The Board of Trustees is having an emergency meeting to decide whether to give workers a tiny or small raise. Once a contract is signed a labor-management committee will be formed to review restructuring plans. This should allow employees to help fix processes and organizational problems. The CEO of the hour, Claude Watts, has also expressed a willingness to meet with workers directly, without management to get a more complete picture of how things work at the medical center. Is all of this good news a part of the new “stop-loss” program that Cambio is rolling out?

Barbara Selfridge’s Crib Sheet for November 2, 2004

State Propositions
1A Keep Local Tax Revenue Local. YES. In this summer’s budget compromise, Schwartznegger kept his No New Taxes pledge by stealing tax revenues from future generations (who will have to repay our bonds instead of funding their own needs) and local governments (property and sales taxes, etc). Prop 65 would stop the $1.3 billion dollar annual shift unless 50% of voters approve it; Prop 1A (put on the ballot to stop Prop 65) allows Sacramento to take the money for only two years and after that only if 2/3s of the state legislature okays it. The Greens like 65 better, but they say vote yes for both.
59 Limits on Government Secrecy. YES.
60 Open Elections. YES. Don’t let rich GOPers wipe everyone else off the ballot.
60A Earmarking Revenue. NO. This isn’t much money $30 million/yr but are we so anti-government that we won’t let Sacramento debate how to spend it?
61 Bond for Children’s Hospitals. NO. The Greens say we need big fixes, like single-payer health coverage not costly band-aids like this one.
62 Close Elections NO NO NO As in Louisiana, only the two highest vote-getters (read best-funded most-Republican) would make it onto our ballots.
63 Tax the Rich for Mental Health Services YES Good tax strategy.
64 Put Corporate Law Breakers Above the Law NO Don’t lose your right to sue.
65 Reverse the Theft of Local Tax Revenues YES Better than Prop 1A.
66 Three VIOLENT Strikes YES YES YES Amend an unjust costly law.
67 Phone Tax for Hospitals NO The Greens say only 1% goes to 911 services 90% to hospitals and MDs, and they don’t like Sacramento grabbing county funds.
68 Let the Mafia Run Casinos NO A set-up to take down their Indian biz rivals.
69 Forced DNA Sampling NO, NO, NO Even innocents would lose their rights.
70 Expand Indian Casinos YES? There are lots of reasons to vote no: gambling, non-union labor, non-environmental protections. But yes is pro-Indian.
71 Bonds to Fund the BioTechs NO Stem cell research is good, but the Greens say this would be a $3 billion giveaway to private industry (plus the $3B interest).
72 Healthcare Coverage Even Without a Union YES YES YES Wal-Mart, Target and other large employers would prefer their workers use ERs and Medi-Cal.

About the Propositions

My Sacto insider explains them thus: it’s the legislatures job to debate what needs California will fund and how we will raise those funds. But the Republican minority stops new taxes and the outsourced/ tanking/petroleum-dependent economy stops new surpluses, so it’s gridlock city in the state capitol. And so special interest groups good and bad go for propositions, most of which say protect my needs (or my tax bases) from the budget negotiations, please! So if representational democracy is not the way to get our societal needs met, we fall back on propositions? And they become law, even if hardly any voters can read them? What if they’re worded badly? What if they don’t go far enough? That’s how you end up with the good people who want stem cell research being opposed by the good people from Our Bodies Ourselves.

Wednesday, October 27, 2004

Another One Bites the Dust!

The medical center has no real communication system, sure we get the memos but people try not to read them. So when inquiring minds want to know, where do the go, the grapevine. The hospital has a pulse, it has moods and it has one of the most sophisticated systems of informal verbal communication on the planet. It’s sort of an oral history; it’s fast, funny and usually highly accurate.

So here’s what’s on the vine. The Permanent Interim CEO, Mike Burroughs, quit and that’s right, we get another Interim CEO. Let’s get real here, these aren’t “Interim CEOs” these are “Interval CEOs.” This makes four CEOs and counting since Cambio Healthcare Solutions took over in May. If it gets any worse, Cambio will be calling the executive registry and sending CEOs over to work shifts.

Rebecca's latest

Well, the medical center made the news again. The medical center has a huge budget for spin doctors, so why can't they buy us some good news? To read Rebecca Vesely's latest piece click here:,1413,82%257E1726%257E2494700,00.html

Monday, October 25, 2004

A Rally Really?

Yes, folks we have to do it again. Tuesday, October 26 at noon. Hospital employees will once again go out in front of the medical center facilities and rally. This time to remind our leaders that you have to give workers a contract and fair pay or there will be no one left to take care of patients.

See you there.

I Want A Refund

Well, the Cambio Healthcare Solutions consultants had an epiphany; they realized they have run off many of the caregivers they need to run the hospital. Half of the image technicians (people who work in x-ray, ultra sound and MRI) quit or threatened to quit in one week. Pharmacy, respiratory therapy and nursing have the same problem.

You can’t run a hospital with all of the critical service providers running out the door and what exactly have our leaders done to keep them here. Well, lets review, they told these highly trained employees they were overstaffed and threatened to lay them off. They also threatened to lay off all the support staff (nursing assistants, medical clerks, housekeepers, food services workers) all the people you need to make things run. What about wages, well these groups get paid 5% -20% less than people doing the same job in other hospitals.

Then there’s the public relations war, fought internally with piles of meaningless annoying memos and externally with “Bring it on Braley” saying the medical center just needs to cut the fat. They’ve got the medical center crawling with state inspectors and they started a war with the union represented workforce, apparently Cambio Healthcare Solutions had never heard of organized labor before they came to Alameda County.

So now that they realize they will have to pay workers or they will continue to quit, what now? Well guess what, now they say they don’t have any money. As Charlie Ridgell pointed out, “the medical center had money when they signed over millions to Cambio for consultants, they had money for PR and PG &E, they even had an extra million for more Sheriffs at John George, they had enough money for a walkout and a lockout (over a million dollars), but now that they have to pay the people who actually do the work they’re flat broke. This is entirely unacceptable.”

I’ve got a bright idea, consultant costs and expenses would pretty much cover the cost of a fair raise for hospital workers, how about if the board of supervisors just goes to Cambio and asks for a refund? I don’t know about Cambio, but most of us little people doing the work don’t think this relationship is working out, maybe its time to say, “Adios Cambio! “

Sunday, October 17, 2004

Charlie’s Place

Why does the Alameda county board of supervisors dislike the medical center so much? Excellent question. Well, county supervisors have a huge budget (1,944,765,581 dollars) a bigger bureaucracy (8,658 budgeted positions) and hopelessly frustrated personal political careers. The supervisors don’t run the county the bureaucrats do: Chief Administrator Susan Muranishi, Director of Health Care Services Dave Kears and Sheriff Charlie Plummer. Every year Dave, Susan and Charlie divide up the tax dollars and throw a few crumbs to politician’s pet projects. So Gail Steele, Alice Lai-Bitker, Keith Carson, Nate Miley, and Scott Haggerty get to cut a few ribbons, do a few opening ceremonies, and fund a few non-profits. The county government has a responsibility to take care of the underserved, this means healthcare (for the uninsured and underinsured), behavioral health (the mentally ill), public assistance (welfare), public protection (courts and prisons) and general government in the unincorporated areas (this means municipal programs: schools libraries, sheriff’s and such.) They also do transportation, buses ect.

Here’s the rub, the poor, the sick, the incarcerated and the needy don’t vote much and they are not big donors to political campaigns either. So county supervisors spend most of their time sucking up to corporations, developers and non-profits that provide the services. Telecare, the biggest for profit mental health contractor in the county is a generous donator. Non-profits, lawyers, and consultants, now all of these people understand how county government works. They know how to support a campaign. Special interest groups and voter rich unincorporated areas also have lots of suction with the sups.

Every year Sheriff Charlie and Dave Kears duke it out over money and every year Charlie wins. Susan Muranishi’s primary contribution to the county is to create a budget and budget process so boring, complicated and convoluted that it would take a team of forensic accountants ten years to find an extra fifty cents. Meanwhile Dave or Susan can always find a little cash in the other shoe, should the need arise. So when political insiders need to get something done, they don’t go to a county supervisor, they go to Dave, Susan or Charlie.

Ok, enough of the civics lesson why don’t Dave and the Sups like the medical center. Well, Dave feels the county should be “purchaser not a provider” of healthcare services. It’s the greed is good philosophy. Besides bureaucrats prefer tidy little contracts with non-union organizations, keep the healthcare providers without a voice and employment protection.

Still what’s wrong with taking care of sick people? Well, here’s the real problem, you know those tidy contacts and neat little focused lean county programs: they don’t work. When someone doesn’t get enough general assistance to buy their medications and has a stroke, where do they go? The medical center. When Adult Protective Services fails to get a senior out of an unsafe home and they get hurt, where do they go? The medical center. When the Sheriff decides to compassionately release a felon who has cancer and can no longer walk, talk or take care of themselves, where do they go? The medical center. When a mental health case managed client has a psychotic episode and then withdraws, where do they go? The medical center. As Dave and Susan improve efficiency (cut services and ration care) more and more people fall through the cracks, the medical center catches them. The county supervisors and bureaucrats hate the medical center because it reminds them how miserably they have failed the people they are supposed to serve. They also hate the medical center’s staff who refuse to dump these clients back out on the streets without first addressing their needs, this costs.

So when the supervisors close the medical center where will people go? Well, for years the county prison system has enjoyed fat funding, infra-structural upgrades and political support. If the sick and needy become a nuisance or a political liability the police can just pick them up and take them to Charlie’s place, Santa Rita Prison.

Monday, October 11, 2004

Imagine if there weren't a county Medical Center

Well, today's Oakland Tribune opinion piece said it all.

To read "Imagine if there weren't a county Medical Center":

Click here

Thursday, October 07, 2004

Managing Up

Well, Cambio Health Solutions changed their mind. They decided they had better not layoff 180 staff and maybe they should have a word with some of the employees or at least check in with the Service Employees International Union before completely reorganizing the medical center. Gee, it took them nine months and two work actions to arrive at the obvious. I hope these guys know how to do something besides layoffs.

Thank goodness for healthcare unions. Apparently they’re all that is left between patients and bad business decisions. Medical center employees have used their unions to manage up; they helped the Board of Supervisors to see the dangers of caregiver cuts. They have also pointed out that hospital workers feel demoralized and fatigued, and that getting a contract signed and removing the threat of layoffs is a necessary first step toward making the medical center work.

In spite of the rhetoric, the Cambio executives still have an aversion to speaking to working people. You need a suit or an MD to be heard at the hospital. Joyce Mc Glory, the Head of Human Resources, is the notable exception; she likes Highland and actually listens to employees. The Board of Trustees is still escorted by sheriffs, as are some Cambio executives. Come on guys, we’re overworked healthcare providers, no one’s going to hurt you. Shoot, if you got assaulted we’d just have to take you over to the emergency department and fix you up, and in case you haven’t noticed we have plenty of business already.

Look here’s the deal, this isn’t a good staff; this is a great staff. These are the people you want to take care of you, if something happens. We have an antique computer system, broken wheelchairs, no infrastructure and we make it work. The Cambio team spent a couple million on scab labor during work actions and probably fifty grand on a payroll goof, how about spending five hundred on donuts and coffee and trying to cheer up your worn out employees before more good people quit.

In and Out of My Mind

I’m born and raised in Berkeley so reality for me is negotiable, but I lost myself a little. I found myself crying in the behavioral health clinic. I couldn’t focus; I sat there just leafing through the magazines not even looking at the pictures. Did you know they have Guns and Ammo magazines in the psychiatry waiting room? I’m no shrink, but I think it might be a better idea to put the gun magazines in the dermatology or podiatry departments. I never heard of the acne or hammertoe defense.

I must have been pretty messed up because Kaiser told me take a week off, I thought you had to be bleeding from a major artery to get a week off from Kaiser. They gave me one of those little information sheets. It said I had post-traumatic stress disorder. I read the sheets, I think this stuff might be contagious and I definitely think it’s going around the medical center. It’s not like a different reality, just all the worst parts of your usual reality over and over again. You get stuck bouncing if the walls of your own mind. It comes from too many bad things happening in rapid succession. Since the upcoming presidential election could be ugly, we should all fortify ourselves with good news, multivitamins and extra sleep.

Tuesday, September 28, 2004

What’s Up?

What will happen? Did the board of supervisors know the medical center is in deep doo doo with the state and the feds or did they find out about it Sunday when they read the Oakland Tribune? They get those “secret briefings” with Cambio Health Solutions. Let’s hope somebody has a plan, November 10th isn’t that far away. Where’s Temporary CEO Mike and the spin doctors when you need them, a few lines would do, how about, “hope for the best, pray with us, or this might be a good time to tune up your resume.”

I just don’t get it, the medical center is about to be closed down over staffing and safety issues and the board of supervisors is still fighting for layoffs. I’m confused and well frankly annoyed; I should be spending my precious free time trying to get a Democrat into the White House. Instead, I’m stuck here struggling to explain the obvious to a bunch of Democratic supervisors that I voted into office. Sometimes it’s hard and well quite honestly embarrassing being a Democrat in Alameda County.

Rumor is that Cambio and the board of trustees may have finally come to their senses and that some kind of proposal to postpone layoffs and focus on the more immediate problems maybe forthcoming. This thanks to the tireless work of medical center employees and SEIU locals 250, 616 and 535. So anyway, things will happen this week.

The board of trustees is meeting:

Wednesday September 29
Highland Hospital
Classroom A
Public Comment at 6:00 pm

Sunday, September 26, 2004

Medical Center Closing?

Well those fun loving Cambio Health Consultants and their spin doctor have done it again. There's so much dirt even the Tribune's digging into them.

To read Rebecca Vesely's piece, "Feds May Close Medical Center," in the Oakland Tribune click here:,1413,82~1865~2428356,00.html#

Tuesday, September 21, 2004

Good News At Last- Walkouts

I got a medical opinion at Highland about my consultant-induced situational depression. A physician I admire and respect told me quite candidly that it would take a lot of prescription medications and possibly recreational drugs to take the edge off the current situation.

The most popular conspiracy theory this week is that Cambio Health Solutions was brought in to close the medical center down, employees can’t believe they could make this many mistakes unintentionally. Personally, I’m a big believer in stupidity and incompetence. Besides if CEO Burroughs had a timeline to close the hospital he’d come to work more. According to his assistant Mr. Burroughs will be at an offsite conference this week. These Cambio Health Solutions guys are on the George Bush attendance plan. If you can mismanage a country working a couple of days a week, there’s no reason you can’t mismanage a hospital on the same schedule.

But I digress there is great news; we’re planning wildcat walkouts. That’s right union employees have begun planning multiple surprise work actions. Workers have basically given up on influencing hospital leaders. We’re going to picket the politicians. That’s right, picture a thousand healthcare workers picketing down at the county board of supervisor’s offices- dawn to dusk. They can’t just send their staff out to say they’re at important meetings- they’ll have to come out to eat or pee. It’s pressure and accountability my favorite approach to incompetent elected officials. Supervisor Alice Lai-Bitker and Gail Steele here we come.

I’m personally quite excited since lately when you come to work at the medical center you may or may not get paid and since our leaders have yet to acknowledge their “security problem” you may or may not get hurt. So cheer up folks, fun is on the way, and remember you don’t have to work at the medical center to come down and picket!

Sunday, September 19, 2004

Let Your Fingers Do the Walking

I took my own advice had a cold one and cooled off. So let’s look at the situation objectively, what’s going on? Well, Cambio Health Solutions on the eve of what the press is calling a gang war, is still proposing to layoff a big piece of the emergency department staff. Nurses continue to quit citing safety, incompetent senior management, heavier patient care loads, and less support staff than other hospitals. The layoffs have been put off so long that many employees have begun to focus on the more immediate problems, like getting paid and avoiding friendly fire.

Our leaders continue unpaying workers, yep, you heard right, medical center employees with direct deposit get their paychecks sucked back and forth in and out of their accounts. Our leaders are pioneering a cutting edge direct withdrawal system. This results in headaches, bounced checks, delayed vacations and piles of overdraft fees. The problem is of such severity and magnitude that even management noticed it. They actually wrote about it, Cambio is busy fixing the “payroll goof.” Golly fellas, in California when you screw up a multimillion dollar payroll, we don’t call it a boo boo, we call it a mistake and since people’s money is being taken without their permission an apology might help.

Personal safety issues eclipsed the medical center’s ongoing problems with layoffs, short staffing, missing payroll and lack of leadership this week. Staff who witnessed the bullet riddled Lincoln crash into the hospital grounds and the dead, dying and shot up young people crawling out of the car, just keep talking about it. They tell you what they saw over and over again. When social work and the chaplain put together a debriefing, for traumatized workers they were scolded for holding an “unauthorized meeting.”

The numerous staff that called Claude Watts and Mike Burroughs about the lack of a preparedness and a security plan, have not gotten responses. Apparently Chief Operating Officer Watts and Chief Executive Officer Burroughs’s gang security plan was to leave early Friday and be out of town for the weekend. Until management puts forward a credible written security plan and shares it with those of us who might get hurt, the Dirt recommends that Highland patients and staff let their fingers do the walking and dial 911 at the first sign of trouble.

Meet the President of the Hospital Authority Board

Vote Health, the coalition of community groups and labor unions who have fought tirelessly and successfully to keep the medical center open is having its monthly meeting. The hospital authority board’s newly elected Commander and Chief Dr. Ted Rose will be the guest speaker. If you’re concerned about the way things are going, come down and give Dr. Ted a piece of your mind. He’s the man.

Monday September 20
7-9 pm
California Nurses Association Offices
2000 Franklin Street, Oakland

If you really must learn more about the medical center and the people and organizations fighting to save it, here are some fun links:

Vote Health :
Service Employees International Union (SEIU) local 250:
Service Employees International (SEIU) local 616:

RIP Chivo

Rest in peace Chivo, gee thanks Cambio Healthcare Solutions, now we have gang tags (graffiti) on Highland’s sidewalks. Is this a part of that marketing magic we’re paying so much for or is this another “goof.” Did you know “memorials” are being removed all over Oakland because they become crime scenes?

Tuesday, September 14, 2004

I don't know what to say, I'm so upset.

I came into work today to find that three of my friends had nearly been killed when a car full of shot up young people crashed at Highland Hospital, according to the Tribune, probable victims of gang violence. I then was threatened by a group of six young men going up in the elevator to visit a “friend.” When I left the hospital at lunch there were four sheriff’s cars in front of the hospital, they had been called in to break up fights in the lobby.

All day the nursing floors of the hospitals were overrun with “friends” of the victims. I called Mr. Watts, the COO, he was in a meeting and his assistant didn’t know who was in charge. It wasn’t until the security, the sheriffs, and the Board of Supervisors had received dozen of complaints that we began to see security on the nursing floors and an attempt to limit visitors.

After five pm when I was leaving the hospital I saw a fight erupting in the lobby and had to go get security. More “friends” of the victims were parked in cars in the entrance to the hospital and still more were driving around the hospital.

I have worked at Highland for almost twelve years, I have seen a great deal of this kind of violence, but I have never witnessed such a complete failure of leadership and security. No administrator even came around to assess the situation much less manage it.

There are simple measures that can be taken to insure the safety of our patients and staff, since the Oakland Police Department feels this could be gang violence, maybe some executive could be torn away from an important meeting to work with staff on a plan to make sure that Highland does not become a crime scene.

Thank You

It is very saddening to have violence taking center stage again in Oakland, but I am so proud of the exceptional response of Highland's staff to yesterday's tragic shootings. Staff who were nearly killed by the vehicle as it crashed, ran to get gurneys to help out the injured passengers. Nurses and doctors from all over the hospital responded. I am very proud of my friends and co-workers.

Monday, September 06, 2004

“Why Can’t We Be Friends?”

Well, Cambio Health Solutions took another decisive step toward that cliff they keep flirting with. They had close to a thousand employees walk off the job. Those that didn’t walk out the consultants locked out. Negotiations, lay-offs, board meetings, everything except Cambio’s weekly paychecks has ground to a halt. Sure the Board of Trustees and the Alameda County Board of Supervisors are having closed, hot, sweaty, and unproductive meetings, but nothing is happening.

The medical center pays millions for leadership, PR and experts so what do you get when they put their heads together? That’s right, another memo, last week the medical center employees were treated to the, “why can’t we be friends memo.” Arg! Stop, already with the patronizing dribble, it just irritates people. Save a tree! Remember what your mother used to say, “if you don’t have anything good to say, don’t say anything at all!”

The problem with healthcare consultants is that they’re “experts.” Since they’re supposed to know more than the poor slobs they’re sent in to help, they don’t listen. The medical center’s employees have been valiantly trying to explain things to the consultants but they just can’t seem to shut up long enough to hear anything. They have a set game plan, never mind that they’re playing football on a basketball court with a bunch of gymnasts.

The thing about healthcare is that it’s both complex and regional. You cannot ignore the caregivers, the community, the politics, and the services around a hospital and understand your patient’s needs. After nine months the “experts” still don’t understand the medical center’s problems, so they can’t possibly implement a solution.

Simple Solutions for Supervisor Keith Carson

Caregivers have given up on trying to reason with Cambio Health Solutions. They have taken it to the politicians, hundreds of the medical center’s employees and patients have called, visited, or written the Alameda County Board of Supervisors. Supervisors Keith Carson and Alice Lai-Bitker hide in their offices and send out hapless staff members. The coalition of community groups, labor groups, patients and staff who passed Measure “A” are being ignored by the Cambio Health Solutions and the Board of Supervisors.

But don’t despair, the Dirt is listening, it feels your pain and frustration. More importantly it hears the leadership plan emerging from the many voices who fought for Measure “A” and want to see the medical center thrive. So Keith, Buddy, these are four simple steps that will stop walkouts, lockouts, bad press, bad medicine, and those pesky visits from hundreds of union employees.

Get a real CEO for the medical center someone with experience managing a public hospital by December 2004.

Review Cambio Health Solutions performance and make the gruesome details available to the public who voted for Measure “A”.

Delay the layoffs until a real CEO takes over and has time to develop a strategic plan.

Continue to support the medical center financially. You asked the public to support this institution with a sales tax, so lead by example and make good on Measure “A” campaign promises.

I could say more but I don’t want to overwhelm our local leaders.

Monday, August 30, 2004

Consultants Pay Workers to Picket

Nurses called a work action in response to Cambio Healthcare Solution’s ignoring their input on patient care and safe staffing, they called for a one day walk out. The walk out was scheduled for Highland Hospital, Fairmont Hospital and John George Psychiatric Hospital. When workers at the county clinics showed up to their work on Friday, they were given a memo saying that the clinics would be closed on the day of the walk out and that clinic workers would be expected to report to the hospitals. When clinic workers showed up to work on Monday, August 30, they were locked out. So hundreds of additional paid picketers came to the hospitals and joined the protest.

Cambio Healthcare Solutions mismanages three hospitals and a string of community clinics. Most of their employees were standing outside today in front of the hospitals with signs that said “Safe Staffing Now”, “Don’t Close the County Hospital” and “Cambio Has Got to Go” and Cambio decided to play it coy. A Cambio representative at the rally actually told a reporter he didn’t know what this walk out was all about. Scary but probably true, Cambio and the executive temps don’t even show up to union negotiations anymore, they send a sub sub consultant and they do seem utterly befuddled by hospital management. They have however correctly identified that they have, well, a “situation.” So they’re doing what any patient centered quality minded management team would do, they’re getting more public relations. Cambio muzzled their millions of dollars worth of temporary executives, all of whom are vying for permanent positions at the medical center. Now Mike Brown, from Raleigh and Brown Public Relations Consulting, takes all the questions. Raleigh is apparently in Afghanistan trying to put a happy face on the Bush administration’s little problem over there.

A Reader's Response to "What Are They Hiding?"

Want to know what Cambio Healthcare Solutions is hiding? I can tell you. I am just an RN but I can tell you what I would hide from the politicos. I can't get food for my patients, everyday. I can't get my meds on time to my patients, everyday. I can't get basic supplies to take care of my patients, everyday. I can't get clean linens for my patients, everyday. I can't get charts from medical records for my patients, everyday. I can't provide safe and competent care to my patients, everyday. I can't get blood products for my patients, everyday. I can't get critical labs for my patients, everyday. I can't get x-rays or CT scans for my patients, everyday. I am forced to work with registry and travelers who could care less about our policies and procedures, everyday. I cannot and will not blame these problems on their various departments, as it is not the frontline providers who are to blame. Well, whom do you blame? That, I can tell you. Cambio and the executive team are aware of these problems, as I have spoken to several of them personally. The Board of Trustees is aware of these problems, as I have spoken to several of them personally. Supervisor Gail Steele is aware of these problems, as I have spoken to her personally. Our Chief Nurse Executive is aware of these problems as I have, along with others on many, many occasions brought these problems to her attention. We as frontline caregivers must focus our anger and frustration on those who perpetuate the persistent and very dangerous environment we are forced to work in. At least those of us who are left. I applaud my co-workers for the commitment they have to our patients. We are not the problem, we are the solution. WE ALL MUST BAND TOGETHER AND SUPPORT THE SAFE AND DIGNIFIED CARE OUR PATIENTS DESERVE EACH AND EVERYDAY!!!!!!!!!

Lynne Behr RN

Thursday, August 26, 2004

Walking Out

Walk out! Actually, medical center staff just won’t walk into work on Monday August 30, 2004. Caregivers have tired of reasoning with absent executives and Cambio consulting.

The Highland emergency department (this includes the trauma center) is budgeted to have 126 full time staff. There are 29 vacant positions. When Cambio presented their lay-off proposal to employees they re-labeled the 29 vacant positions overage, cut them, and then decided they could lay-off an additional 12 people. It’s the, Eron school of accounting. Their proposal leaves 85 people to do 24 hours, 7 days week coverage of the emergency department. This kind of staffing won’t get us through a mild flu season, much less an earthquake or State hospital inspection.

Caregivers have decided to take their case to the public, the politicians and the private hospitals. After all Alta Bates and Summit Hospitals will have to take all the patients who will be turned away from the medical center because of staffing shortages.

What Are They Hiding?

Well just when you think things can’t get any stranger, they do. Today representatives from State Senator Figueroa’s office, and staff from Assembly Member's Ellen Corbet, Wilma Chan and John Dutra’s office along with County Supervisor Steele and staff from Supervisor Carson and Lai-Bitker’s office all came with union representatives to tour Highland Hospital and speak with hospital employees.

They were met in the lobby by the Cambio Health Solutions team, the temporary executive staff and Cambio’s attorney. The politicians were told they could not tour the facility without a Cambio escort. This resulted in a heated exchange between County Supervisor Steele and a herd of tall suited men. The consultants maintained that patient privacy would be compromised if politicians walked through patient care floors. Staff found this a little odd since they sent a documentary film crew through a couple months ago with just a PR guy. In the spirit of compromise and in an effort to get out of the lobby, the state and local politicos agreed to only visit outpatient areas and to do so under the supervision of a sheriff’s deputy.

Patients and staff were really disappointed when the standoff in the lobby broke up, and no one is quite sure what the consultants were trying to hide.

Tuesday, August 24, 2004

Rock Bottom

Well, the medical center has been around awhile, it’s seen some spectacular scandals, some flamboyant flops, but lately it feels like things might have sunk to a new low. Staff and supply shortages have ground many areas to a crawl if not a halt. Sure the consultants continue to forge ahead insisting that cutting 43% of the staff on a nursing floor that treats the critically ill won’t affect service or quality, but no one really listens to them anymore. They keep coming up with new bad ideas, but the consultant/executive team has become so dysfunctional at this point they couldn’t fix a sandwich, without 20 subcontractors.

The county supervisors hired them to “downsize.” The supervisors wanted a fast neat surgical strike, hundreds of annoying union employees gone in a single blow, leaving a budget surplus. The extra cash could be quietly moved back into the county supervisor’s pockets and used for Alameda County’s high priority projects like paying off Al Davis, building more jails, or granting fat contracts to big political donors. Well, things didn’t go as expected, that’s the problem with these “get rich quick plans.” The consultants couldn’t deliver the cash, but that’s the good news, the bad news is they don’t know how to run a hospital; things aren’t just staying the same they are deteriorating rapidly. It‘s time that we officially declare this situation a quagmire.

What has frightened staff and patients more then ridiculous lay-off proposals is the consulting team’s complete inability to manage the day-to-day operations. As my mother used to say when I would leave her home alone with my father and my brother, “I’m in a sinking ship with blind sailors!”

Cambio Health Solutions Attempts to Kill Free Money

In the last few years the medical center created the, better late than never, department of diversity affairs. Though good intensions count, funding has been lean, so the physician director of the department applied for $500,000 worth of grant funding to run programs for patients with low English proficiency. There’s nothing better than free money and most hospital administrators encourage their people to seek this kind of funding. Not so with Cambio Health Solutions. Temporary COO Watts contacted the grant agency and withdrew the proposal. This created a huge dust up, politicians, doctors and community groups all called foul, so Cambio backed down and allowed the grant to be submitted. No one can figure out if it’s the free money or the minorities that they don’t like.

Anonymous said... (from comments to "Rally Fever")

Anonymous said...
Well,well,well. Did Cambio get caught by suprise when the state inspectors showed up? Do you suppose that they actually thought their fine work would go un-noticed? Hey, speaking of work, what have they actually done since February 6th? That fabulous productivity report is garbage and unusable. You can't compare apples to hot dogs and get away with it. Perhaps they could generate some revenue if at the next rally they give us cups and signs to beg for donations. Hey, better yet they could charge us admission to rallies or board meetings. If we didn't do our jobs for 6 months (with pay) we would either be fired or offered a job in administration. The clock is ticking Cambio. How about earning some of those millions your sucking from our poor patients. Remember, we know where to post our part of your resume!!!!!!!!!

Sunday, August 15, 2004

Thank You Jesse Jackson

On August 12, 2004 the Reverend Jesse Jackson came to Highland Hospital and spoke to the promises of Measure "A" and the need for healthcare in our community.

Thank you Reverend Jackson for keeping hope alive at the medical center.

Friday, August 13, 2004

Rally Fever

Our new leaders, Cambio consulting and the imported executives they flew in to put a kinder gentler face on downsizing have spent most of the week hiding from the hospital inspectors who have been ripping the hospital apart for the last four days. According to staff, the inspectors noticed the staffing shortages, the housekeeping rationing and the sloppy charting that results from lack of management and over reliance on outsourced providers. Ken Cohen, the CEO who the Board of Supervisors ran off a year ago helped the medical center sail through the last inspection with high marks. There was a coordinated effort to prepare the staff and the facility for inspection. Many of the employees Cambio ran off were hired to bring the hospital into compliance with state and federal regulations.

So did Cambio scrub the facility and fatten the staffing in preparation for the scrutiny? Well, no. In fact there had been no consultant or executive sitings for days. For 5 million dollars you don’t just get an empty suit, you get an empty desk, an empty limo and an empty suite at the Hilton. The only sign that most employees get that there is any management is the increased police presence and the weekly memos from Temporary CEO Mike, which contain mostly anti-union rhetoric and pious dribble about fiscal responsibility (as if overworked employees were flushing cash down the toilets on their breaks). It turns out that even Mike’s memos are outsourced to the $100,000 dollar a year public relations firm. So that’s two hundred words a week for a $100,000 dollars a year, that’s $2,000 dollars per memo plus the cost of Mike’s signature. And they’re talking to us about fiscal responsibility! Well, in the interest of teamwork and financial responsibility, the Dirt is officially offering to write the weekly memos for half the cost of our PR firm.

So no one expected the consultants or temporary executives to come out of hiding until the inspectors left, and they certainly did not expect them to attend the Stop the Service Cuts Rally called by the unions, the workers and the community. The fight to see that the spirit and the letter of the Measure “A” initiative is implemented has now attracted national attention. The Reverend Jesse Jackson came to Highland to speak out against the staff and service cuts and to the importance of the medical center, to our community. On August 12 at noon hundreds of healthcare workers, union members, patients, and community members rallied in front of Highland Hospital and chanted:

Hey Hey Ho Ho
Healthcare cuts have got to go!

Standing with the crowd was TCEO Burroughs, Cambio’s Chief Implementation Officer, Susan Crutchfield and Temporary Chief Operating Officer, Claude Watts Jr. Why, the union representatives even gave them sign-in cards and workers say when Jesse led the chant calling for more staff their lips were moving! At the next rally healthcare providers plan to invite them to hold hands.

Wednesday, August 04, 2004

Performance Review

Six months into rightsizing and re-organizing what do you get? The county of Alameda is millions of dollars deep into Cambio consulting. Cambio has consultants and interim executives flying into Oakland, riding to their executive suites, and living on unlimited expense accounts.

So what does the public get, besides a good show? Well we got a lay-off list filled with retirees and other ex-employees, we get lots of memos from Mike the temporary CEO, on the nice thick paper, we have four hour waits in the pharmacy, and patients stuck for days in the emergency department, and if things continue on the current path we will likely have a strike. Actually, Cambio has run-off, run over and retired close to a hundred employees, not necessarily employees the medical center could afford to lose but they are gone.

Cambio did produce a budget and the board of trustees did approve it. It contains the incredible shrinking lay-off list, which is down to 185 people; while there are 350 vacant positions, so it isn’t even clear that lay-offs are needed. Unfortunately the consultants can’t get their spread sheets lined up straight enough to determine if the employees slated for lay-off can all be moved into vacant positions. They have succeeded in revitalizing the health care labor movement in the East Bay. Hundreds perhaps thousands of healthcare workers outraged by the misuse of
Measure A funds and the wasteful consultant contracts have begun organizing. There is huge energy and momentum.

On Tuesday, August 03, 2004, workers at all of the county health care clinics walked out and went to 1221 Oak Street to meet with their County Supervisors. The County Supervisors sensing rightly that this was an unusually large crowd and that things have gotten well “out of hand,” took decisive action. They invited the labor unions and the board of trustees to a tea party. The labor unions, and the care providers are doubtful that their differences can be worked out over brunch, so it looks like a strike. The good news is service in many areas has deteriorated so badly that patients might not notice if workers left for a day.

Tuesday, July 27, 2004

Public Information

Well all of a sudden the bean counters and temps running the medical center want to share information. The many million dollar “plan” is now public, available on CD. Digital documents, impressive! Well if you can’t save lives you can at least save a tree. Maybe Cambio Health Solutions consultants are closeted tree huggers.

“The plan” is not completely without merit but it is humorless. It consists of mostly numbers on paper. These guys can make some real contributions to getting bills posted and paid. It’s when they start to dismember patient services where they get kind of scary. But what about the “secret data?” Well, a nurse with a nose for numbers read through the whole report. According to Lynn, “consultants are like slugs, they leave a trail”, buried in the pages of electronic prose she found a reference to a book. The reference got her online where voila! She found that “proprietary healthcare data” could be purchased for $500 dollars. Five hundred dollars to 3.2 millions dollars (consulting fees paid by the medical center), in sales that’s called an excellent mark up.

What about the rest of the medical center’s brain trust, the authority board? Well they’re meeting away. The authority board is the county supervisor’s answer to Jerry Springer. In an effort to discourage public participation meetings are announced at the last moment and get crammed into small hot meeting rooms, Sheriff Plummer and his merry men flank the members. The last public meeting had 4 commanders, four uniformed sheriffs and Mr. P himself. County bureaucrats, the consultants and the executive temps try to fill the room so that community members and staff won’t fit. Board member Irene Weinreb does an excellent judge Judy impression, she wrestles the gavel from other trustees and threatens to clear the room and the president of the Alameda county board of supervisors, Gaile Steele power knits throughout the proceedings.

Though highly entertaining the authority board has no real power, the county supervisors get to make all the real decisions (most of them bad.) So what are these four fearless democrats doing about this mess? If you were a liberal democrat like Nate Miley, Keith Carson, Alice Lai-Bitker or Gail Steele what would you do? Clearly the public wants and needs a public hospital; in fact they’re willing to pay for it. Clearly there’s a vacuum of leadership the size of Texas and the supervisors and their staff are being flooded with concerned calls and letters about the dangers of implementing “ the plan.” Fortunately the real financial crisis ended with Measure, “A” which put the hospital quite close to break even, so the radical service cuts could easily be avoided. The supervisors could easily appoint some new board members, stop the service cuts, and move toward bringing in some permanent management, executives that understand hospital operations, as well as staff cuts and collections. So what have these dazzling democrats actually done? Well mostly they’ve been dodging phone calls and avoiding pulic meetings. The only decisive move taken recently has been to raise the medical center’s rent by close to two million dollars!

Monday, July 26, 2004

Petition Progress Report

Wow! Thank you. Thank you. Thank you, 171 signatures to state attorney general Lockyer and they aren’t all my relatives, in fact I don’t know most of them, but I sure like them. Here’s what some of them had to say.

I've needed and used services-don't cut! - Marie Kochaver

Thirty years ago, County Medical Centers from two thirds of California's 58 counties were privatized in a highly political battle for all of that public money. Alameda County survived those attacks from private corporate raiders. The Alameda County Medical Center is among the best in the world, providing the most efficiency, best outcomes, training for new medical & nursing professionals (who provide their exquisite technical skills to the voters working double their contracted hours essentially below minimum wage). What do you think will happen if we have a serious earthquake or terrorist disaster & no longer have a county medical center? Where are women going to go for prenatal care & birth of their babies? Do you really want the cost of the rise in births & birth defects you can expect from cutbacks to land squarely on this County's educational, welfare, &, potentially, criminal budgets? Ask yourself, as every voter & news agency soon will be asking you: Who stands to PROFIT from this attack? Someone does.
-Elyse Eisenberg MD

I voted to keep Highland open. What's going on? - Chris Knepper

If you haven't signed yet or want to read all the comments click on the link:

Tuesday, July 20, 2004

Sign This!

Dear Friends,

The Alameda County Board of Supervisors are either unwilling or unable to ensure the competent administration of Measure “A” funds. In fact the Board of Supervisors are almost entirely occupied thinking up new ways to take funds away from the Medical Center and put them back in the county’s pocket ( a 1.7 million dollar rent increase being the most recent example.) So the Dirt is going to California’s top cop, Attorney General Bill Lockyer. Bill is rumored to have his eye on the Governor’s seat, so it is important that we see what he’s made of. Does he care about health care? Does he listen to the little guy or just his political cronies?

The Dirt needs you. Please sign the petition and send it to a friend, click here:

Thanks and yes my mom signed.

Ann Nomura

Wednesday, July 14, 2004

Jury Duty

Well the Grand Jury put out its final report on the Medical Center and its current management team Cambio Consulting, the Tribune called it “scathing.” The Dirt found it well reasoned and insightful in fact they made some very helpful suggestions:

Recommendation 04-02:
The Board of Trustees must carefully scrutinize Cambio Health Solutions recommendations, implementing those, which improve financial efficiency without sacrificing medical care. For those of us who don’t speak bureaucrat this says, “we know you really want to save money, but try not to kill anyone!”

Recommendation 04-03:
The Board of Trustees must carefully review any proposed increase in fees and payments to Cambio health Solutions. Translation, holly moley! Who negotiated these contracts? And what were they smoking? This is the biggest rip off since the Raiders. Don’t let this Board sign over another penny to these guys.

But hey, that’s just the highlights you can read the whole report online at:

The Dirt put a few questions to our legal advisor, Elvis the cat. What, for example do you need to do to get indicted by the grand jury? Does the Board of Trustees have to read this report or follow the recommendations? Will we get to see a politician or bureaucrat do the perp walk? Elvis, the cat refused to get out from under the bed.

The Dirt isn’t a low budget blog; it’s a no budget blog, so if you have free legal advice or opinions please post.

Meeting Matters

So many different groups of people are upset about the current management of the Medical Center and the mismanagement of the public’s trust and public funds, that they have banded together and formed a group, CURE Alameda County Medical Center (Citizens United for a Responsible ACMC.) They have decided to take a very pragmatic approach to our local elected officials, public pressure and political embarrassment. Sure it’s cheaper and faster just to buy a politician but this is so much more fun and so much more democratic. There’s nothing more frightening to a politician than a room full of focused angry voters, so in an effort to persuade the County Supervisors to do the right thing they are having a town hall meeting. Plan to attend, but if you can’t just visit your Supervisor in person.

Town Hall Meeting
Thursday July 22
6:00 pm
First Unitarian Church
785 14th Street

For more information click on:

Tuesday, June 29, 2004

Petition Update

Thank you readers for signing up to sign the petition. We got a wonderful response. The current secret budget process and consulting spending spree is not yet spending Measure money. Measure “A” funds will start being collected in July and should hit the Medical Center sometime after October. Unfortunately with budget being developed now and the Authority Board signing over millions of dollars in the consultant contracts it will be spent long before it arrives. The public got a reprieve this week, two Authority Board members have resigned and the rest of the Board declined to pass the proposed budget. Rumor is a flurry of grand jury subpoenas have made the Authority Board much more “thoughtful” about their decisions. The proposed huge staffing cuts have created fear and concern about patient safety. Many of these cuts are in critical patient care areas, like the emergency department, the critical care units, and the cancer and AIDS clinics. We will be moving forward with the Attorney General, Bill Lockyer petition and will need you and your mother’s help. Thanks for your support and stay-tuned.

Correction: the two trustees did not resign they just resigned from their offices, but it is a step in the right direction, toward the door.

Recommended Reading

Grand jury reports come out yearly in July, the Dirt suggests that you put it on your summer reading list. The civil grand jury acts as a “watch-dog” by investigating the efficiencies of the county and local governments. The Dirt loves watch-dogs and did you know that anyone can make a grand jury complaint?

You got to love our justice system, here’s the link:

There’s Good Money in Bad Medicine

The thing about medicine is, it’s hands on, actually good medicine is many hands on. It’s about giving care, touching, and listening. It’s not a vending machine kind of product. The same is true of hospitals. Good hospital management looks at patients first, operations second and financials last. You come into a hospital to be nursed; you might need IVs, dialysis, breathing treatments. If you’re really sick you could need many doctors, a dedicated nurse, a respiratory therapist to run your ventilator, a dietitian to make sure the tube food they give you does not provoke non-stop diarrhea, and when you’re well enough, a physical therapist to teach you to walk with your accident changed body. Hospital operations are no joke, making things run well takes talent, commitment, and real hands on experience. So explaining how a 10% staffing reduction (300 people, 600 hundred hands), will have a negligible effect on patients and operations, while simultaneously fixing the “financial picture” is no simple feat.

In defense of the consultants currently running the Alameda County Medical Center, they have been dealt a tough hand. They have been directed to make massive staffing cuts without disclosing that they are crippling or closing services. Honest outright closing of services would necessitate embarrassing public meetings, which the Alameda County Board of Supervisors are determined to avoid. This has forced the consultants to come up with very imaginative, if unrealistic proposals. The lay-off list presented to the unions included staff that had retired or left the Medical Center years before. Doorknobs were scavenged from bathrooms in old clinic areas, unfortunately they forgot to tell the staff who still work in those areas and employees have gotten locked in the bathrooms. Instead of ordering more linen for the new Clinic and Critical Care Building, they just took half the linen from the hospital floors. Supply shortages create work and inconvenience, staffing shortages can lead to accidents and deaths. Fear of the bad patient outcomes has become a real concern for Medical Center employees. Some employees have pledged to bring toilet paper from home, if it would help soften the proposed caregiver cuts.

If the county of Alameda has funds to pay for two Sheriff’s deputies on jet skis’, and every County Supervisor has a staff of 6, why can’t we afford to pay nurses to give the 300 to 400 hundred doses of chemotherapy that cancer patient need each month? If the consultant’s calculations are right and you don’t actually need these nurses to give chemotherapy, perhaps Supervisor Gaile Steele and her hoards of hired help will come down, and hang IV bags for patients.

Numerous patient care and safety concerns have been raised to the Cambio consulting crew and they have finally begun to respond. They have begun an extreme public-relations makeover. They no longer call themselves consultants; they have renamed themselves and the Board of Trustees as, “our leaders.” It’s a curious choice since they have done nothing but follow the Board of Supervisors directives and they couldn’t get staff to follow them to happy hour. Hopefully, they will continue the makeover, soften the look, ditch the power suits, the cologne and the tight shoes. At the point that Temporary Chief Executive Officer, (TCEO), Mike Burroughs, puts on some scrubs and works three twelve hour shifts in a four bed room with three confused patients and one combative patient, no nursing assistant, no sheets and no toilet paper, well then he’s earned the right to be called a co-worker. When TCEO Burroughs gets real and tells the Board of Supervisors, he can’t safely run the Medical Center and give them 10 million dollars a year, the staff will gladly call him a leader. Until then the consultants proposed cuts have created fear and apprehension about the “human costs” these savings will exact.

Tuesday, June 22, 2004

Answer This!

The Dirt is thinking about petitioning California
Attorney General, Bill Lockyer, to investigate the
"irregularities" associated with the way
Measure A money is being spent (i.e. on slash &
burn consultants and not on patient care).

This action is deemed necessary because the Alameda
County Board of Supervisors appear to be either
unwilling or unable to do the job.

If The Dirt were to create and circulate such a
petition, would you sign it? Could you get your
mother, your neighbors, and your co-workers to
sign? The Dirt needs you!

My mother said she'd sign. Please email me your
thoughts, opinions or pledges of support.

Tuesday, June 15, 2004

Inside and Outside the Rightsize

So what’s it like getting right-sized? Is it like loosing 30 pounds in one week without dieting for only $19.99? Not exactly, the Cambio Health Solutions consultants are in the process of fixing the Medical Center’s “financial picture.” They want to produce some attractive little charts and graphs to show how much money they are saving, some dramatic power pointable figures. Consultants produce piles of pie charts and fancy reports. In fact their contract says they will produce a MAP “Management Action Plan.” The Medical Center paid extra for the clever language. None of the little people who provide the care have seen the MAP and budget meetings are top-secret: open only to consultants, bureaucrats and politicians. The Medical Center’s staff sincerely hopes that somebody has a plan, or a map, or at least a clue.

On the ground level, the consultants have been cutting and chopping. By most reasonable estimates staffing the new Critical Care and Clinic Building would require 140 additional employees. The consultants ran their secret formulas and determined the new building could run just fine with no extra employees. It will look great in the report, more for less, better, cheaper, faster.

So, back on the farm, what actually happens? Well, waits in the new building’s sparkling new pharmacy are up to four hours long just to drop off your prescription, that’s before you start waiting to have it filled. The housekeeping staff is stretched so thin that they don’t have time to mop and clean in the old building, and in the new facility the dust bunnies are winning the war. The radiology department also finds itself barely limping along.

Cost containment isn’t good enough for the Board of Supervisors; they brought in the consultants to cut costs! And that’s exactly what they plan to do. Through more expert analysis they determined that, all three of these departments have an excess of staff. They have proposed cutting 5 positions from pharmacy, 12 from radiology, and 14 from housekeeping. These consultants really know how to pinch a penny.

Understaffing and lay-off offs are the sunny side of the right-sizing and fiscal responsibility program. The really mean-spirited stuff is aimed at the patients. The Medical Center has a new “Charity Care Plan.” Around the hospital it’s called the “You Better Get Blood From a Turnip or Else Plan”. Patients must now pay a $100 deposit per Highland clinic visit. This plan ought to keep people from coming to the hospital. They haven’t figured out how we will control or monitor diseases like TB or SARS with the new financial barriers to care, but the saving should be stupendous. It’s the no money no honey medical services model.

But enough about the insides of the rightsize, what about the outside. What about the nice numbers, the pie charts, the return on investments and the politicians who will cash in on these cuts. Well, if things keep on their current path, the Board of Supervisors should be whistling all the way to the bank.

Transitional Care Patients at Highland Hospital are in Danger!

By C. Gathright, Registered Nurse TCU

The consultant team, Cambio has proposed that the nurse/patient ratio be changed from 1:3 to 1:4 in the Transitional Care Unit (TCU). There was no tour of the unit or assessment of the patients done by the consultants. No input was solicited from the staff who work in this unit. There were no statistics presented to justify this staff reduction. Cambio bases its service cuts on “proprietary statistics” which they refuse to share, even with the Board of Trustees.

Many people are upset with Cambio for these proposed cuts, but the real responsibility lies with the Alameda County Board of Trustees. It is their ethical and moral responsibility to ensure the safety of the Medical Center’s patients. Have they forgotten that they are making life and death decisions when they cut medical services? Many of the patients in TCU are very sick and should actually be in Intensive Care Unit. The 1:3 ratio ensures that these patients are properly and safely cared for.

The Board of Trustees has already shown the employees of the Medical Center how little they value their work by approving huge staff cuts and by neglecting the day-to-day management of the Medical Center. We wish that ensuring the safety of patients in TCU were as worthy an expense to the Board of Trustees as the consultants they continue to spend millions of dollars on.

Tuesday, June 08, 2004

Where’s The Beef?

Your Tax Dollars At Work and Play

So what do you get for $200,000+ dollars a month from consultants and outsourced executives? The Dirt asked hospital employees what they think of our new management. The most common answer was, “What management?” Most Highland employees have never seen the “turnaround team.” One housekeeper said he thought he saw one but it turned out to be a patient’s lawyer. It is rumored that our leaders are busy consulting among themselves, power pointing, writing expense reports, and spending, $56 thousand dollars in April alone.

The consultants have engaged in a very effective cost cutting strategy, they aren’t paying the bills. If they continue this strategy another year the deficit may disappear, the hospital spends thousands maybe millions on things like blood, medications and surgical supplies. Although no one can stop the Board of Trustees from spending millions and millions on consultants, the hospital staff must now get multiple signatures for any spending of greater then $2,500 dollars. These signatures come from our out-of-state executives. Since executive signatures can be hard to get, staff that have to buy expensive items like AIDs drugs and chemotherapy spend their time writing lots of little purchase orders.

Before the Board of Trustees tilted the hospital budget with their consultant-spending spree, the Medical Center’s finances had begun to improve, according the pre-consultant CFO, Robert Strawn. So with the new state of the art Critical Care and Clinic Building, the budget improving and Measure A money about to come in, why did the Board of Supervisors search out a “slash and burn” consulting firm? With the future looking so bright why didn’t they bring in permanent administrators with the skills to improve operations and a desire to advocate for the Medical Center?

Could it be just old-fashioned greed and self-interest? If the Medical Center gets cut to the bone or goes bankrupt, where does the Measure A money go? The top county bureaucrat, Dave Kears, insisted on getting his piece of Measure A up front, 25% of the yearly revenue (25%of $90 million.) Here’s where the “bait and switch” comes in. Voters never would have supported $90 million dollars a year to be spent at the discretion of politicians and bureaucrats. They know better, they supported the Medical Center and the services it provides. That’s why the politicians need consultants. No real hospital administrator would let the county take money away from the Medical Center; the consultants on the other hand might.

Rumor is that Alameda County’s Health Care Czar, Dave Kears, already has his hand out and wants an additional $10 million dollars a year from the Medical Center to go back to the county. They can’t take the Measure A money directly, that would be too obvious, the money has to be laundered. Where can the Medical Center get $10 million dollars a year? Well, those consultants got right on it, they determined that by laying off 350 hospital service providers you could save $14 million dollars a year. After giving $10 million to the county there would still be a $4 million dollar cushion for any additional consultant spending or expenses. After cutbacks, kickbacks and consultants, the Medical Center’s patients will be lucky to get new band-aids out of this deal.

Monday, May 31, 2004

“Hey, No One’s Watching the Dogs!”

After the Alameda County Hospital Authority Board signed away the first $3,000,000 dollars to consultants, the public got a little concerned. When they then agreed to pay another $700,000 dollars for telecommuting consultant/executives to manage the Medical Center, shock set in. The Hospital Authority Board has been on a non-stop consultant-spending spree for months now.

The Authority Board contends that the only way to stop the financial crisis is to spend even more on consultants. “You have to spend money to make money.” It’s the consultant mantra. “Healthcare for all” the slogan used to get Measure A passed is just more California claptrap to our imported experts. They will focus on cost reduction first, and then they will explore “revenue opportunities.” Two thirds of the voters in Alameda County figured out that a critical lack of “revenue opportunities” necessitates subsidies for the public hospital. If insurance companies could suck a profit out of the very sick, the very poor and the uninsured, we wouldn’t need the Medical Center!

In addition to lavish spending on consultants the Board now needs five or more Sheriffs at public meetings. Are they afraid the Grey Panthers will storm the stage? Do they think the Medical Staff will attack them in a fevered frenzy? Who’s paying for all this firepower and do they have live ammunition or rubber bullets? Is this just another situation where we have to spend money to make money?

Well, the Dirt went back to Measure A and looked at the language. Nowhere within the text does it say, “You have to spend money to make money.” It does say something about a Citizen’s Oversight Committee. They’re supposed to look at the spending once a year and report back to the Board of Supervisors. The voters are paying for this mess, not the politicians. Besides, the consultants will likely have flown back to Tennessee, first class, long before this report gets written.

Sunday, May 23, 2004

Consult This!

For years the county hospital has been a treated like a stepchild by Alameda County’s top bureaucrats, Sheriff Plummer and the Health Czar, Dave Kears. They’ve complained, huffed, diverted funds and mostly just plain neglected the Medical Center. Highland Hospital, Fairmont, and the County clinics have stayed alive mostly because of the work and dedication of care providers, patients, real leaders like Supervisor Carson and community groups. Measure A put it to the voters. The people of Alameda County were asked if they would pay a little more to keep the public hospital open and they answered,” yes” by more than a two thirds majority.

And that’s where the trouble began, 70 million dollars worth of trouble. Supervisor Steele appointed her best “buddy” to the Authority Board and even tried to put the Sheriff on it. All of a sudden everyone wanted to help the Medical Center, consultants came crawling out of the woodwork. An Authority Board runs the Medical Center. This is a device designed to keep a comfortable distance between the politicians and public.

All of a sudden the Authority Board had money in its pocket. County Supervisors calling them daily and top bureaucrats lobbying them. They became important people. Money and power, they had to do something. Actually they had to do exactly what the County Supervisors who appointed them wanted. That’s why they needed every politician’s best friend, consultants. They’re solicitous, they’re loyal; they’re not burdened by strong connections to the community or institutions they serve; and if it doesn’t work out the consultants can be blamed. The Board got really extravagant when they hired Cambio, who brought in their turnaround team, a bunch of guys from Tennessee in dark suites and tight shoes. The turnaround team turned around and hired more consultants, they then fired the entire executive staff of the Medical Center and replaced them with, that’s right, you got it, more consultants. The Board also hired $100,000 dollars worth of public relations consultants to explain the activities of the other consultants to the confused taxpayers, who just wanted a public hospital.

Why consultants? Have they been successful in the past? No. Do they understand the Byzantine complexities of the County of Alameda’s Health Care Services Agency? No. Do they have strong ties to the community, or the trust of the labor and community groups who advocate for the hospital? Of course not.

So why does the Board of Supervisors have such a never-ending romance with consultants? Politicians bring in consultants to solve their political problems. They don’t strengthen public institutions; they cut costs and take the heat, so politicians don’t have to get involved. Fixing the Medical Center would require political involvement, investment in infrastructure, committed permanent administrators, and real leadership from the Board of Supervisors. This clearly isn’t happening, so what do we get, consultants, cuts in services, and public relations, to tell us it’s a good thing. McMedicine, brought to you for the bargain price of 3.2 million dollars per year, and if you don’t like it, don’t call your County Supervisor; it’s not their problem, it’s yours.

The Dirt gets around: circulation 118 and growing!

News Call: the Daily Needs the Dirt

Well, the dirt’s piling up at the public hospital, Memo Mike, the Permanent Interim CEO has begun carrying the “communication ball,” he’s glad-handing and we’ll soon be having “chats.” Our newly acquired $100,000 dollar PR firm pumps out updates faster then employees can say, “recycle”, and the Hospital Authority may be planning another round of musical board members. Who’ll be the next president? The Dirt heard that the turnaround team is back peddling on the lay-offs. What have you heard? The dirt wants to know.

Send any tips, tid-bits or advice to the comments or to

Saturday, May 15, 2004

Highland’s CEO Shuffle

Gee, when those Cambio Consultants say, “turnaround team” they really mean it. It’s costing taxpayers three million two hundred thousand dollars to get this consultant team into the Medical Center to turn things around. Once in the door they turned around and hired more consultants, consultants to consultants, to fix John George, the psychiatric hospital. Next, they turned around and fired the entire executive staff. They then noted that there was a vacuum of leadership at the Medical Center. In an attempt to be helpful, they offered to hire their own staff as executives for a meager $720,000 a year. So Cambio’s Susan Crutchfield replaced Efton Hall as Interim Chief Executive Officer. Ms. Crutchfield’s only visible act as Interim Chief Executive Officer was to put out a memo. The memo confirmed that consultants had run over a Highland employee in the parking lot and pointed out that police had not cited anyone. For the record the consultants were backing up; not turning around when the accident occurred. Then exactly one week after CEO Hall’s surprise dismissal, Cambio announced the new Permanent Interim Chief Executive Officer, Michael Burroughs. Three CEOs in one week, I don’t know about everyone else, but I don’t feel like I’m getting my 3 or 4 millions dollars worth.

Alameda County Healthcare History

1992: The State (of California) provides approximately 40 million in Disproportionate Share Hospital (DSH) funding earmarked for Highland and Fairmont. Instead of using this money to improve the hospital, Supervisors Steele and King choose to divert half of it to the County Sheriff. Kears “borrows” the other half for projects which, it is said, will save the County money in future years. It is unknown if these “savings” were ever returned to assist ACMC.

Excerpted from the “Alameda County Health Care Timeline” Produced by Vote Health, PUSH, and the Bella Vista Neighbors, 1998.

Thursday, May 13, 2004

Highland Consultants Cut Waste and Fat

Cambio did it; they found the fat and waste. They announced their long awaited lay-off list. Cambio’s cut list spared the bloated middle management structure. They concentrated their efforts mostly on laying-off clerks, housekeepers, and patient care providers.

The emergency room will lose all its nursing assistants. I guess we’d rather pay an RN or MD to push a gurney to a broken elevator and wait there to take the patient to their room. It can take up to an hour to get a patient from the emergency department to a room and we’ve just doubled or tripled the salary of the staff that will perform this task. Then I suppose the doctor will come back and clean the equipment for the next patient. But hey, there is an upside with Highland’s highly unreliable elevators it’s probably is safer to have a registered nurse or doctor riding them at all times.

They also hit housekeeping hard-that makes sense, patients often complain that Highland’s just too clean. Maybe it’s that excessive cleanliness that results in so many patients with multi-drug resistant infections. I’m sure the cost of excessive cleaning has driven many businesses into financial ruin. Isn’t that what happened with Enron?

Medical clerks, there’s another huge waste. Why do you need someone on a nursing floor who can decipher physician’s orders or coordinate admissions and discharges. It just takes all the fun out of medicine. Nurses should just guess what the doctor wrote, and since they can’t read the signatures either, just guess who wrote it. As for discharges, well if they go slow enough patients will learn to get themselves home. Admissions, well that should be less of a problem because now that doctors will be doing transport and equipment cleaning we’ll be expecting far fewer admissions.

You just have to give it to those consultants and many of the staff would like to, but you just can’t find them. One was spotted last week scurrying up the backstairs.