Squirrels and Other Rodents

I have this Camellia I’ve pampered all year, it has dark green foliage and huge deep red flowers with yellow stamens. I have it in a pot in front of the living room window. I repotted it, fertilized it and loved it all year; it has huge buds, which promise to bloom in late winter early spring. The other day I looked out the living room window and the red of the petals had started to show. A squirrel ran down the Oak tree and up the camellia it pulled off a flower bud like it was picking an apple and sat on the edge of the terra cotta pot and took a huge bite. I started waving my hands and stomping my feet in the window. The squirrel turned his head slowly toward me and stuck up his middle finger.

So what about the medical center’s favorite fury friend, Dave Kears? Dave runs the Alameda County Healthcare Services Agency. So complex and confusing are the county’s budget battles and bureaucratic labyrinths that those charged with serving the county’s poor spend most of their time serving Dave Kears and fighting other organizations they should be working with, for cash and turf. Sure we have some great services but they all operate in a vacuum instead of cooperating to provide the best care. Closing the medical center and looting Measure “A” funds are top priorities for the secret squirrel: he needs more cash for brain-dead billboards, consultants and committees.

With winter here and the new executives distracted by operational issues and settling labor contracts, opportunity knocks. Kears can’t take money outright but he can attack the medical center’s credibility and bottom line. It’s a shell game; Alameda County Healthcare Services Agency makes consultants rich, gives fat contracts to political suck ups and leaves the poor, sick and confused. For years the agency has been trying and failing to get county residents enrolled in Healthy Families, a program which gives low-income families MediCal (state paid health insurance.) Tons of county residents qualify but don’t get the services because of the daunting and bureaucratic application process, and the complete and total ineptitude of Alameda County’s Health Care Service Agency.

So of course Healthy Families has flopped but Kears knows how to turn personal failure into opportunity! Kears has now mandated the cumbersome and overwhelming state application, the 1-E-Application for financial eligibility, be used at the medical center. This electronic application can then go directly to the state’s computer, decreasing the time needed to get MediCal. They haven’t worked out the technical details like software compatibility with the state, necessary middleware or how to convert all archived paper applications to the new electronic format, but in theory it’s a great idea. In practice in order for the medical center to get the MediCal a patient desperately needs and deserves, the medical center must get detailed information about the whole family. So Highland’s overworked, underpaid and under resourced eligibility clerks now have to get a translator to explain to the patient that they need their mother’s bank account records for the medical center to get them the coverage they need to get dialysis.

Imposing this application on the medical center increases the time and complexity of each financial screen and because of the huge amount of information required, it decreases the success rate for the same reason. Kears is no dummy he conceded this might be difficult so he threw the medical center some “chump change” for a couple extra, temporary, non-union clerks. See Dave’s not looking for success, he doesn’t care about the county’s poor or sick; he cares about his beloved bureaucracy. Kears plans to shift blame for Alameda County’s failure to get families the state health coverage they deserve, onto the medical center.

Celebrate

"My friend Daniel celebrates Hanukkah. I celebrate..... sea lions."

Emma Rose Nomura Fisher (4 years old)

Thanksgiving

‘Tis the season to withdraw from alcohol, overdose, breakdown, or my personal favorite overeat. Don’t laugh over eating, or dietary indiscretion as we call professionals call it, lands lots of people up in the hospital. It’s the fat and salt that tips you right over into heart failure.

Isn’t that a great emphismism, dietary indiscretion, it sounds like you slept with a Danish, when actually all you did is wake up late and finish off the left over turkey, dressing, and three pies. Americans have so much wealth and so little happiness. We have so much stuff and so little security; we all need a warm safe place to go where we can be cared for.

So the hospital has filled up with people, trying to get well, to get warm or to get the help they need to die with dignity and comfort. Fear of illness and the cost of illness has become a disease onto itself here in the U.S. So people come to the hospital so sick and so frightened, and so shocked and grateful for the care we give them. The holidays provides a huge opportunity to help to heal and to comfort, it also gives those of us lucky enough to work at the medical center an up close and personal view of how hard our country has become.

The medical center, in spite of staff shortages, broken equipment, consultants, turnarounds, somersaults and frontal attacks on revenue by the Sheriff and other sundry politicians, remains a warm place. We try to give patients what they need to get well and to care for each other and patients understand that we have very few resources with which to help them but that we will do all we can with what we have.

Lassiter Alert

That’s right, Wright’s out and about thanking staff for working so hard. He gets big points for noticing the hospital has filled up and backed up with really sick people. I appreciate the support, apparently he’s working days and nights while his dogs chew up his new California home. Wright Lassiter III comes from Texas where you can by a small town for what a two-bedroom house in Monclair costs you. Still, in the pit of my stomach I have a deep uneasy feeling about Mr. Lassiter. He’s nice, he’s smart he’s positive and hard working but he’s from Texas, which begs the inevitable and ominous question: is he a Dallas Cowboys fan? I can’t stand the Cowboys!

Poets, Philosophers and Politicians

So the medical center can’t decide what to pay healthcare providers because they have yet to develop a “compensation philosophy”.

I have a liberal arts education. I read Kant, Locke, Descartes but I never heard of a compensation philosopher. The management bargaining team assures us that the executive committee considers “compensation philosophy” a top priority. I imagine them all sitting around a steamy bathhouse in white towels contemplating different philosophical positions.

Maybe our compensation philosopher has a thick beard and an old pipe and is sitting out under tree somewhere vigorously contemplating. It is unclear to me which department ACMC’s philosopher would report to. I would suggest HR, that’s the department that seems most conducive to uninterrupted thought.

Still, one ponders, if we need a philosopher, shouldn’t we have a poet. You can get a good poet at a great price in the Bay Area but I think the poet should have union protections. Well, I find it comforting to know that our executive leaders have taken up the big philosophical questions and I’m eager to learn what all this deep thinking produces.

Ho Ho Ho

Here we go again. The medical center did get some good news, Kay Eisenhower the chair of Vote Health and Brad Cleveland (SEIU 616) both got appointed to the Measure “A” oversight committee. Supervisor Nate Miley in a fit of good judgment appointed Kay. This should slow any obvious looting and if there is any malfeasance, at least we’ll get to read about it in the Vote Health newsletter.

For anyone who doesn’t know about Vote Health they’re worth checking out, they’re a real grass roots community group. They give you big bangs for little bucks. We live in the era of polished plastic nonprofits, all fundraising all the time. Vote Health is an eclectic collection of healthcare policy super heroes. All advocacy all the time. Check them out http://www.votehealth.org/ or just send them a check.

So aside from that news about the committees, what’s happening back at the farm? Well, Wright Lassiter the 3rd, the new CEO, scored some big points with the little people for actually admitting that payroll is having some “difficulties” and saying he’d try to fix it.

Schmooze and Booze

We have a new dynamic duo, CEO and COO. Mostly it’s been palace politics and finger food: nervous executives, administrators, middle mismanagement all sucking up while sucking down refreshments. I can’t do small talk, so at the appropriate time the Dirt and the hired help plan to invite our new leadership team to the Bedpans and Barbeque welcome party, real food, real people and real information. Cambio executives managed to spend over a year at the medical center completely unbothered by facts or the operational realities of the ACMC. They had lots of meeting with middle management about what was really going on.

By all accounts Wright Lassiter, the new CEO is well, nice. Shocking absolutely shocking! Those with enough suction around the medical center to have actually met or talked to our new leader (doctors, executives and politicians) all agree he’s “nice.” Some see this as strength others as a weakness. Personally I see kindness as a plus not a minus. Besides only people who really love the work last around Highland Hospital, ACMC’s a love it or leave it kind of job.

So, nice is nice. So along with the open invitation to the Bedpans and Barbeque welcome, the Dirt would like to offer the honorable Mr. Lassiter some humble but practical advice. Payroll you see has begun to melt down: missed checks, errors, compounding errors, manual checks and ACMC’s very own direct withdrawal (the medical center actually sucks money in and out of employees accounts). Historically the medical center refuses to acknowledge or address such problems until a lawsuit is actually filed, so this problem probably won’t come up in any committees.

Mr. Lassiter as a new hire is at considerable risk of not getting paid, since we definitely want him to stay around we’d like to offer some survival tips for new hires who want to get paid. Do not use direct deposit (it’s too dangerous), know your payroll clerk’s name and telephone number, when you receive your check run to the bank and deposit it (you never know when the medical center is going to run out of money) and always check your leave balances and deductions.

Welcome to the medical center Mr. Lassiter we’re so happy to have you.

Vote Out Loud !

Call or come to the Oakland Alliance Headquarter
7992 Capwell Drive (to phone bank )
(510) 569-3655

Phone Bank Times
Friday Night, Saturday all day, Sunday all day after 11:00 and Monday all day

Precinct Walk
Oakland Teamsters
70 Hegenberger Rd Suite 150
All day everyday

If these times and places don’t work for you call 569-3655 and tell them what you can do and where and they’ll get you going

Vote!

Dear voting friends,

November 8th would be a good day to take off work and concentrate on getting out the vote--really! If the turnout for this all-referendum/no personalities election is as low as expected, every vote that does get cast counts double--does that make sense? It's what I've heard anyway: that a big turnout in San Francisco and Alameda counties could shut down the Schwarznegger machine. Other ways to get out the vote:

1) Email all your friends
2) Put a "Vote Nov 8" sign in your window (car or house--I used one of those glow-in-the-dark markers that they sell at Halloween supply stores for drawing spider webs)
3) Phone bank (call around for where to show up: I know the unions like SEIU and CLUW have organized different nights)
4) Pull a couple of neighbors with you when you go to vote
5) Vote absentee so you don't forget to vote yourself.

----Barbara, your vote-out-loud friend

Six NOs and Two YESes (in that order) -- Barbara Selfridge's crib sheet for Tues Nov 8, 2005

73--Kill Pregnant Teens in Dysfunctional Families--NO. Did you know that Right-to-Lifers pack schools' HIV education committees and preach abstinence, born-again virginity, and that saving just one girl from premarital sex is a victory? No to the unwanted births and back alley abortions they would wish on the unsaved.
74--Blame Teachers for Under-Funded Schools--NO. To have good schools, you have to have taxes, but rather than repeal the stupid stupid cap on property taxes, Schwartznegger et al want to make the teaching vocation even less viable.
75--Silence the Labor Movement--NO. Schwartznegger wants to stop the nurses, teachers and firefighters, etc, from insisting he enforce the laws that he'd just as soon break.
76--Less Money for Schools, More Power for Republican Governors--NO. Schwartznegger hates having to negotiate a budget with the majority-Democratic legislature the damn public keeps electing. And he hates having to abide by the school spending demands of that same populace.
77--Republican Power-Grab Through Redistricting--NO. A vote for this is a vote for Tom Delay and the pro-Republican redistricting he financed in Texas.
78--Phony Prescription Drug Reform--NO. This is the pharmaceutical giants insisting that all discounts programs be voluntary, nothing that could be enforced in a court of law. Because they hate "trial lawyers”!! Yeah, right.
79--Actual Prescription Drug Reform--YES. This is the plan that would MANDATE life-saving drug discounts.
80--Use the Public Utilities Commission to Prevent Future Enrons--YES. This is supported by TURN, the great pro-consumer anti-corporate-energy organization, and would undo some of the disastrous deregulation that undid California's energy grid five years ago.

I’m Back

Now I tried very hard to retire. I have a full time job and more kids and pets than I can handle but those gosh darn healthcare consultants just couldn’t stop causing problems. Cambio healthcare consulting’s overpaid under-worked executives already have their plane tickets to return to the red states they came from, permanently. The medical center hired a new CEO, Wright Lassiter, things kept hobbling along, they way they do with vacant executives, but no… consultants can’t even leave gracefully. The aggressive infighting over turf, titles and the spoils of Measure “A” threatens to disrupt patient care and undermine the new CEO before he even arrives in California.

Since the medical center got occupied by consultants it has experienced out of control executive titles and salaries. We now have multiple vice presidents, none of whom were elected. Why the human resources department has four heads, a VP, a consultant/chief negotiator, and two private contractors to handle union negotiations and still they come to the negotiating table and can’t find their own memos. Other feverish executives desperate to say they have done something began implementing time clocks. This fiasco resulted in so many errors and so much confusion that SEIU had to take legal action just to get the executives to figure out what they had done.

The most alarming consultant driven mental breakdown is the secretive and paranoid behavior the Authority Board is starting to display around money and labor unions. The finance committee, misled by Supervisor Alice-Lai-Bitker’s appointee, has begun hiding numbers, refusing to share and acting fearful and mistrusting of medical center employees and concerned community members. They have become secretive, paranoid and hostile to anyone trying to get information, there is some speculation that the data just got lost.

The grapevine also says the Board also plans to undermine the new CEO by not allowing him to deal with labor unions or contract issues. This would justify keeping the four heads of human resources employed but would completely discredit the new CEO before he walked in the door. So I guess my early retirement is on hold for now.

Go Team!

Sorry, I have been off my game. The Trustee's are on it though, they shot back at the grand jury for that bogus report on the medical center. Read all about it. Dr. Ted Rose gets the Dirt's balls and brains salute for leadership. Go team!

http://www.insidebayarea.com/searchresults/ci_2895388

Oakland 911

“911”
“Yes, please help me, a pit bull is eating my poodle.”
“Sir, you don’t really think this is a ‘police emergency’ do you?”
“Oh my God! He’s finished my poodle and is attacking the neighbor’s Labrador.”
“Sir, maybe you should call animal control or your neighborhood watch captain.”
“Please, just do something. What’s the animal control number?”
“Sir, this is 911, not 411. Click.”

“Hello, you’ve reached the City of Oakland’s animal control. We are unable to take your call at this time; if you need immediate assistance call the Oakland Police Department’s non-emergency number or you may leave a message after the sound of the beep. Beep. The voice mailbox you are trying to access is currently full. Click.”

“You have reached the Oakland Police Department’s non-emergency number all our operators are currently busy with other calls please stay on the line and your call will be answered in the order received. The current wait time is approximately 3 hours and 20 minutes.”

“Hello, you have reached the Oakland City Council.”
“There’s a marauding pit bull headed to a pre-school.”
“You know, we get so many calls about dogs and let me assure you that the councilperson strongly supports dogs and their owners. Let me suggest that you go to our website where you can see pictures of the councilperson and dogs and you can read about all that this district has done for dogs.”

“No! I need help, someone might get hurt.”
“Oh, I’m sorry we get so many calls about crime, there’s nothing we can do at this time. We did successfully pass Measures B and S and the new funding should be available in 2020.”

“No, my neighborhood is being terrorized by a marauding pit bull.”
“Well, I can advise you to join your neighborhood watch and get organized. If you can bring lots of people to meetings where the councilperson can talk about all they have done for your community, we might be able to help you more.”
“Please I just need one police officer.”
“Sir, this is a nuisance crime, if you give me your name and address I will send you a helpful brochure about policing yourself, home safety tips and 25 reasons to elect Jerry Brown as California Attorney General.”

Memo To Cambio Healthcare Solutions

Happy Holidays Homeless Shelter

Joe, “Hey Bob, you got mail from Highland.”
Bob, “Really, I didn’t think they sent mail to homeless shelters must be a bill. Open it for me.”
Joe, “Dude, it’s a bill for $190,000 dollars.”
Bob, “Wow, I hit the jackpot nobody’s ever thought I was worth that much.”
Joe, “You’re going to have to collect a lot of cans to pay that.”

Most healthcare consultants have problems with the fundamental premise of county hospitals, see the medical center’s mission statement says it will provide healthcare to the indigent and the uninsured. So let me introduce an important concept here, listen carefully and take notes fellas. Many of the medical center’s client’s are poor, by that I mean they have no money. Got it? Poor, no money. At the point that you’re sending out itemized bills to prisons, homeless shelters and freeway underpasses you got a problem.

Now that we have introduced the concept of poor, sick and homeless people being unlikely to pay hundreds of thousands of dollars in hospital bills, lets apply these concepts to hospital management. See the medical center has services that assist clients in getting functional enough to work or in getting disability benefits, they’re called rehabilitation services. I know it’s tiresome listening to hospital employees who keep saying you need to help the patients more. Still, the medical center has to get patients well enough to work or get them the disability benefits, it’s the only way to get paid.

The medical center has a whole rehabilitation center so people can get intensive therapy to return to their lives and assistance in getting disability benefits if they are permanently disabled. This keeps people out of the emergency room, gets them back at work or at least gets them some income and medical coverage so the medical center can get paid for the services they provide.

So, when you consultant dudes wrote this year’s budget you looked at rehabilitation services and chop, chop, chop! You looked at the data and correctly concluded that the uninsured get therapy. Then you cut the funding for about a third of the therapists because they mostly serve the poor. The problem is if you want medical center clients to get unpoor enough to pay these huge consultant generated bills you have to get them well enough to work. Denying cheap appropriate care just frustrates patients and drives them back to the emergency room.

I know this is lots of new information and you consultant types probably never met any poor people, but most poor people want to get well. They work hard, expect little and want to be healthy. Cutting the services that patients need to return to work and manage their illnesses and injuries is unlikely to improve the medical center’s overall fiscal health, but I’m sure it looked good in your report!

Money Money Money…

It’s big money and bad idea time again. County and medical center budget time. The good news is the medical center is in decent financial shape; the bad news is Cambio Healthcare Solutions wrote the budget. They froze the hiring of caregivers again, so we’ll be using overtime and travelers in the many short-staffed departments. They need to keep cash available so they can hire more friends into fat executive positions and for legal fees.

Cambio got the medical center into what looks like a very long, very expensive legal battle with the psychiatrists and their union. The private contractor who wants the contract, the shrinks, and many of our temporary executives will all be deposing each other, meeting and conferring and generally building up more bad feelings and legal fees. Meanwhile, back at John George Psychiatric Pavilion, patients continue to back up in the psychiatric emergency area to dangerous levels and we don’t have enough permanent or temporary staff to care for them. Way to go Cambio!

So, this budget undoubtedly hides more than it reveals and the more eyes on it and our trusty trustees the better.

So the big budget meeting’s Tuesday, June 28th in Classroom A, Highland Hospital. They won’t tell us the time yet, but I’m sure the Sheriff knows. Just give the Sheriff a call or show up around 5:30 and wait with the rest of us.

The Jolly Jury and The Sweet Smell of Snark

Here we go again. The Grand Jury is putting out its final report on the medical center this week. Will they correct all the factual errors? Will they tone down the anti-union rhetoric? And will they give Sheriff Plummer the credit he deserves for doing most of the thinking for the jury?

No, I doubt it, you see most people don’t get to be grand jurors; these are rich people, political players. These are insiders in the Alameda County Democratic machine. They hire lots of non-union workers to take care of their kids, their kitchens and their cats, and then they complain about the poor quality of hired help. They support civil rights, workers rights and a service or two for the poor, but in tough economic times their inner Republican comes out. They want to close the hospitals, beef up the prisons and grease the right palms. So, expect more of the same, sloppy thinking, right wing ideological rant, and pointless prose.

Imperial Cheese

This is the most embarrassing use of public funds that I’ll ever seen. Did they get Carmela Soprano to design this website? Be sure you have the sound on your computer turned on, you need the music to get the full effect.

Click here to see you tax dollars at work:
Imperial Cheese

The Dirt Stands Corrected

County Supervisor Nate Miley’s charming staff pointed out that their violence prevention program will not be overseen by the Sheriff and that it is a sincere attempt to consolidate and coordinate these services in order to make them more accessible to county residents. The Sheriff just gave his enthusiastic and heartfelt support, he won’t be gaining turf or influence through this proposal. In fairness, Supervisor Miley has strongly supported the medical center since he came into office. He championed Measure “A”, he appointed Dr. Floyd Huen to the Authority Board (Dr. Huen and Dr. Rose are often the lone voices of reason) and he visits the medical center and talks to patients and staff.

Historically Supervisor Carson has been the main supporter of coordinated and compassionate healthcare on the Alameda County Board of Supervisors. Carson’s leadership helped get the new clinic and critical care building funded and built. Supervisor Haggerty, the only Republican on the Board, has also supported sane and sensible healthcare policy in Alameda County. He remains one of the most reasonable, honest and balanced voices on the Board.

The super chicks, Alice Lai-Bitker and Gail Steele have been the worst. Gail Steele because of her tireless passion for punishment. Gail promotes herself as a child advocate, she just, sniff sniff, wants to do something for our kids. That’s why she’s fought tirelessly and ferociously for a bigger better juvenile prison. It’s her legacy, a huge kiddy-jail, way to go Gail! I know my children are excited about it. The Supes are so invested in prisons they even have a web cam so you can check the prison construction progress at any time day or night:
http://www.co.alameda.ca.us/gsa/juvenile/.

If we could only get the Supes as excited about libraries, schools or hospitals. As for Alice well, who knows, does she care about anything? Is she an empty power suit, nylons and pumps? And when Alice and Gail get together to discuss healthcare what do they talk about, pedicures?

Mr. Scambio: A Poem

Mister Cambio? He’s a Scambio!

He came here 18 months ago,
But little did we know,
That Mr. Cambio was a Scambio!

He came to help us ‘turn around’,
But put us deeper in the ground!
That Mister Cambio, what a Scambio!

They said he was a real smart dude,
But it just seems we’re getting screwed
By that Scambio, Mr. Cambio!

Like a used car salesman he smiles,
Racking up the frequent-flyer miles!
That traveling Scambio, Mr. Cambio!

He stole our money and he lied,
Now he’s going to run and hide!
What a Scambio, Mr. Cambio!

He’s runnin’ back to Tennessee,
Fooled nobody but the B-O-T!
That sneaky Scambio, Mr. Cambio!

If our Sheriff’s worth the tax we pay,
He’d arrest Mr. Cambio and lock him away!
No bail for Scambios, Mr. Cambio!

And after all is said and done,
We’ll be right back where we started from!
So where’s the ‘Cambio’, Mr. Scambio?

An SEIU UHW member.

Follow the Money

I’m talking here about the County money, not the Measure A money. It’s Alameda County budget time; get ready for some fancy footwork, excuses, hand wringing, charts, huge stacks of unreadable reports and self-important bureaucrats acting officious.

So get involved, its gonna be fun, you got to keep your eye on these guys or they’ll close all the schools, hospitals and libraries and build huge multi-use prisons. They don’t call it prisons, courts and cops; they call it “public safety” it’s great spin. Investing heavily in crime and punishment does not make us safer.

Shoot, Supervisor Miley’s pushing to put the Sheriff in charge of violence prevention. Yeah, why pay experts who work for lean focused non-profits, when you can pay prison guards. If current trends continue all county services will be offered out of Santa Rita Prison. Prisons have the infrastructure, the money and the political support.

Don’t give up, politicians are wimps, weenies and whiners, they’ll do the right thing if you make them.

So here’s the link to a site with a budget overview, and stay tuned, low-budget lobbying is my specialty.

http://eastbayliving.org/mediaroom/newsline.asp?ID=278

Everybody’s a Winner

Who is Alameda County’s number one public health enemy, do you think you know? Have a good idea? Now’s your chance, the Dirt is currently accepting nominations for the Alameda County Enemies of Public Health Competition. All companies, boards, juries, persons, and politicians working in Alameda County are eligible, locals only. State and federal officials are being omitted, the Dirt recognizes that the Governor’s a public health menace and that State Senator Perata is probably dirtier than Delay, but this contest will focus locally on Alameda County and highlight the good, the bad and the ugly. Get your nominations in now!

Help Wanted – (Part II of Our Continuing Report on the Grand Jury, the DA, the Sheriff and other Snark)

“The medical center is not an employment agency for SEIU (healthcare unions).”
-Sheriff Charles Chainsaw Plummer

The Sheriff did most of the thinking for the Grand Jury report that slams the medical center. Chainsaw Charlie and Deputy DA Stark, use union bashing as sort of a literary theme to hold the report together. The report concludes that the medical center should fire hundreds of lazy union workers, give millions back to the county and thus “save healthcare.”

Chainsaw Charlie and DA Tom Orloff want that Measure " A" money; they feel they’ve earned it. Chainsaw endorsed Measure “A” and Orloff was the Treasurer. That much cash doesn’t come to the county without Tom and Chuck taking a piece. They’ve already cut a deal with the Supes; any cash they squeeze out of other county agencies goes right to them, for “public safety.” This has made libraries; schools and hospitals feel decidedly “unsafe.”

Besides, union bashing, the Grand Jury’s report is remarkable for its uncritical praise for Cambio Healthcare Solutions; in fact the Grand Jury and the Sheriff are the only people in Alameda County who haven’t declared the Cambio consulting deal a complete and expensive failure.

Suppose the hospital implemented the huge service cuts recommended by the Grand Jury, who stands to benefit from the cuts and closures at the medical center: Cambio Healthcare Solutions, the Sheriff and the District Attorney. What’s the common denominator here, clout: they all have so much political clout; they don’t have to worry about facts or public opinion.

The Sheriff has 1,500 employees most of them armed; an ex-sheriff is the Chief of Police for Oakland and the Foreman of the Grand Jury. Retired Deputy Boyer, Grand Jury Foreman is a friend of Deputy DA Stark’s daddy congressman “Pete” Stark.

What about the consultants, well, Cambio’s the ERON of Tennessee. Cambio’s Susan Crutchfield CEO for a second of the medical center sure looks like she’s related to Tennessee’s Senator Crutchfield (he’s getting a lot of attention from the FBI lately).

District Attorney Orloff’s real job is preserving his job; he’s a professional career preservationist. The DA hired Congressman Stark’s son and daughter-in-law, Attorney General Lockyer’s daughter, Congressman Leon Panetta’s kin and many of the sons and daughters of judges in his courts. He’s got so much political capital he’ll be dead and buried and still holding that office.

This is politics after all, its not what you know; its who you know or more precisely, who you hire. The Sheriff is right if the medical center continues to hire people based on their qualifications rather than their “relations” they’re sunk. That’s why the medical center has to begin an aggressive recruitment effort to hire close friends and relatives of important politicians. They need a Senator’s kid or better. If the medical center can bag a Rockefeller or a Kennedy, money might actually flow out of the prisons and into healthcare.

A Friend Remembered- Memorial Day

Working at the county hospital you don’t expect to meet veterans. Born and raised in Berkeley, I’m against war and afraid of guns. My father served briefly between wars but mostly uniforms, tanks, guns and soldiers frighten me. This county put my father in a camp during the World War II and I still haven’t forgiven us.

I never knew soldiers and I certainly didn’t expect to meet so many. I met John teaching swimming to disabled students in Berkeley. John, a former Marine had a huge brain tumor, the bad kind. He worked in construction when he started to have headaches and mood swings. His first doc thought, young healthy former Marine must be post-traumatic stress, PTSD. He got some mood meds. His balance got really bad and he looked drunk when he walked, he lost his job. He started living in his car and trying to get more pain meds, the headaches got unbearable. The police arrested John; they thought he was drunk but when he didn’t dry up the sent him to psychiatric hospital. The psych hospital sent him to the county hospital.

I never met a Marine before. John knew he wasn’t going to live and probably wouldn’t walk again. That’s why he wanted to smoke, laugh and be outside. He didn’t have any family and not many regrets; he was one of the strongest and kindest people I’ve ever met.

People don’t think of Highland Hospital as serving veterans but it does. I have worked with veterans from, World War II, Korea, Vietnam, Gulf War I and I’m sure we’ll be seeing veterans from Iraq soon. They are some of the medical center’s most gracious and likable clients.

County Supes Union Busting for Fun and Profit

The county supes are starting to sound just like Arnold, they’re blaming all healthcare problems and shortages on the “special interests:” nurses, housekeepers, respiratory therapists, physical therapists, radiology technicians and their unions. They all parrot the sheriff’s mantra “ the problem with the medical center is that the unions have too much power.” What does that mean? If the unions and the employees had any clout or power they would fix the medical center’s billing department. Many supervisors refuse to meet with union representatives and hospital employees, the Grand Jury and consultants’ slander them, they have little or no access to the hospital authority board and the sheriffs outnumber and intimidate them at all public meetings.

So, why do county supervisors keep blaming everything from world hunger to the rising cost of pharmaceuticals on the healthcare unions? Well, it’s a bad budget year and they’re looking for easy money. You break a few unions, contract out a few services, and dump people off those county pensions, you cash in. Then the supes reap the added benefit of giving fat contracts to big campaign donors. Union busting for fun and profit, it’s not very original.

So the hospital authority is leading the charge, impervious to reason, due process and bad press. They forged ahead and contracted out the entire psychiatry staff. They were so eager to attack a union that they didn’t bother with the necessary negotiating steps or even the price tag. The authority board’s contract actually increases the cost of services, but the private contractor has lots of political suction, she makes regular thousand-dollar donations to county supervisors and initiative campaigns. The private contractor gets a huge return on investment, the supervisors get to bust a union and the medical center gets a bigger bill for the same services, and a costly lawsuit. It’s just the kind of lose lose deal the hospital authority board has become famous for.

Jim Price Talking Sense

Comments from the Hospital Authority Board Meeting Monday, May 23rd

Ladies and gentlemen my name is Jim Price and I represent members of
EastBayLiving. We're a local advocacy group whose members all have one thing in common. We want to see the communities in our county thrive. My father worked at the medical center for over 30 years, which really meant that this hospital was part of my family for over 30 years. I grew up concerned about our patients, their care and our hospital.

I'm here tonight to suggest that with the addition of our new board members, that this is as good a time as any to begin to create a new environment of trust and open honest communication between the board, the administration, the employees and unions leaders. I've been talking and mostly listening to all of you for a while now and the one thing that concerns me the most is the lack of trust that exists. The internal bickering, lack of focus and a unified vision results in bad press and misrepresentation of the exceptional work that is done here every day.

Lack of trust and communication prevents caregivers, administrators, trustees and unions from focusing on the real work of building operational infrastructure. This Board should ask the consultants, the managers, the doctors, all the employees and their unions representatives to work with them to make this hospital better.

If the trustees lead the hospital on a comprehensive campaign to fix the billing department and took the time to educate and involve everyone, they could improve revenue and morale. Hospital workers and their unions want to help, doctors want to help, community members want to help. The trustees as leaders must provide the leadership and vision we all need to work together.

Knowing the medical center is under such tremendous financial pressure. We must all focus on improving revenue, which will create job security, good press and good relationships with the Board of Supervisors and other county agencies. We want to work on positive change, like making county debt repayment based on a percentage of net revenue. This will create an incentive for success. The county will profit from our success, instead of from service cuts.

This Board must work to create a culture of trust and cooperation. It must develop policies, which encourage cooperation and mutual respect between the County Hospital and other county agencies. In this way the medical center can lead the county, toward more cost effective and caring service for all residents who need county care.

Doctors, nurses, caregivers, staff, their union leaders, administrators, patients, community members and the voters of Alameda County all want the medical center to thrive. We want to help you to make this hospital better, please give us the opportunity.

Banana Board

The Dirt’s report on the “new and improved” Alameda County
Medical Center Board of Trustees.

The small narrow room filled quickly, the air thick with tension; staff set up fans and the door and the windows were opened, but it kept getting hotter and hotter. The air just stopped moving. Hoards of sober dark suits milled around trying to stay cool. Most of the guests had more enemies than friends in the room and armed sheriff’s stood guard and flanked El Generalissimo. As usual the meeting was delayed. No one wanted to come to this meeting. Union busting, lawsuits, lay-offs, all bad news that would result in more bad feelings and bad press.

Afghanistan? Columbia? Guatemala during the seventies? Nope, the left coast, the liberal heartland, the democratic machine, the Alameda County public hospital. The County Supervisor’s own little banana republic complete with El Generalissimo Plummer and puppet appointees who take orders from the county supervisors who feign ignorance and indifference.

El Generalissimo and his command captains take copious notes on luxurious sheriff’s letterhead and send copies to all the politicians, grand juries and commanders so they know what to think. The supes insist Generalissimo Plummer is really “a great guy” and “he’s just trying to be helpful.” El Generalissimo Plummer wants attendees to kiss his ring.

Wake Up and Smell The Snark (Part I)

Yes, I’m slipping into bloglish. So you say what’s snark? Well, it’s that smell emanating from the President’s kill Social Security campaign, or Swartzenegger’s border bashing plan or the Grand Jury’s interim report on the medical center. In fact the smell of that report was so bad the Dirt convened a task force. If the odor doesn’t let up we’ll have to create committees and focus groups. There are so many factual errors, offensive statements, and poorly reasoned conclusions; we’ve had to divide up the work. We’ll be doing a series on the Grand Jury’s interim snark report.

So, who wrote the snark report? The Grand Jury is overseen by political wannabe, Jeff Stark, congressman “Pete” Stark’s son. I thought these guys we’re democrats, but what do I know. Jeff’s helper was the Foreman of the Grand Jury, Keith Boyer. Mr. Boyer was a Captain in the Sheriff’s department for 27 years and he’s a perennial appointee to county commissions. He’s friends with Gail Steele, “Chainsaw” Charlie Plummer and “Pete.” It really helps to have friends on the Grand Jury. The 2003-2004 Grand Jury Report on the Sheriff’s Department reads like a budget request.

“ The Grand Jury urges future grand juries to closely monitor the sheriff’s on-going planning process, paying close attention to the ability to provide a funding source for this sorely needed project [replacement of Eden Township Substation]. “

The conclusion was: “All three facilities, Eden Township Substation, the coroner’s bureau, and the communications center-are all in need of replacement as soon as possible.“

The Grand Jury walked through Highland and didn’t even offer to get us more toilet paper. No, they focused on attacking the unions, the trustees and glorifying consultants. Measure “A” monies must have looked like that “funding source” the Sheriff sorely needed.

Stay tuned for Part II: The Jolly Jury and the Sweet Smell of Snark

Community Support Growing- Thanks Jim!

The medical center has always enjoyed a huge amount of community support and trust. Jim Price a member of East Bay Living and a community leader has taken a welcome and personal interest in the medical center.

Many people have misconceptions and prejudices about public hospitals; Jim Price is part of the medical center’s family, his father worked at Highland for more than 30 years; he grew up worrying about our patients, their care and our hospital.

Check out East Bay Living’s report on the medical center:
http://eastbayliving.blogspot.com/

Hasta La Vista Chainsaw

The good people of Alameda County sent Chainsaw Charlie Plummer packing. They told the Board of Supervisors in no uncertain terms that they do not want the Sheriff in charge of the hospitals. After hundreds of instructive phone calls, letters, and faxes the Board of Supervisors realized his appointment to the Hospital Authority Board was unwise, unethical and probably illegal. In fact all of the Supervisors deny nominating him for the Board, they don’t know how it happened.

Ever concerned about the proper functioning of the County government, they went right to work concocting a plan that would allow Sheriff Plummer to “save face.” They replaced him with another nominee and attempted move the meeting along as quickly as possible. Old Chainsaw Charlie, never one to pass up an audience, even gave a concession speech.

Stop Chainsaw Charlie

It’s time for everyone to have a heart-to-heart discussion with the Alameda County Supervisors. Putting the Sheriff on the Hospital Authority Board to cut services, to close hospitals and to break unions is a mean and ugly idea. He has a huge conflict of interest and hundreds of community members, patients, physicians, nurses and caregivers have already called, faxed and written to express their shock and outrage at the proposal.

The Medical Center and local elected officials should be building bridges; not blowing them up. The hospital has nearly balanced the budget, there is no financial crisis; there is a crisis of leadership. We need hospital trustees who want to work with the community, the unions, the physicians, and the patients to make the hospital better.

Please call right now:
President of the Board Supervisor
Keith Carson (510) 272-6695
Tell him:
I oppose the appointment of Sheriff Plummer to the Hospital Authority Board because of his conflict of interest.”

Please Come to the
Board of Supervisors Meeting:
Tuesday May 17th 10:00 am
1221 Oak Street, 5th Floor
Oakland, CA

Chainsaw Charlie Plummer

The Tribune’s been covering Sheriff Charlie Plummer’s coup of the Medical Center with uncritical awe and adoration. Awhile ago it looked like they were interested in doing some real reporting, now it looks like they’re back to doing PR work for the prison industrial complex. I think they’re letting the Sheriff write the articles himself to save on labor costs.

According to the Tribune the unions “said” there is a conflict of interest in putting the Sheriff on the Alameda County Hospital Authority Board. I guess nobody had time to read the bylaws of the Hospital Authority Board, which specifically prohibit contractors from sitting on the Hospital Authority Board. You see the Medical Center contracts with the Sheriff for security and the Sheriff contracts with the Medical Center for healthcare for prisoners. The Sheriff and the Medical Center also compete for county funding from the County General Fund. You’d be hard pressed to find anyone in Alameda County with more conflict of interest than the Sheriff.

The Medical Center has nearly balanced the budget; if the Sheriff stopped billing so much overtime for security and started paying the bills for health services provided to prisoners, the Medical Center might be at break even. That’s not really the point though is it, Supervisor Carson wants lay-offs, the Sheriff wants money and all the Supes want land. They brought in Chainsaw Charlie to close Fairmont Hospital and disperse the patients and caregivers in an orderly fashion. Throwing out all those patients will save millions, that money will go back to the County and the Sheriff will get it, the land will go to the Supes.

Fairmont’s a choice piece of real estate, why the Supes will make a mint with lots of developer friends chopping up that land. It’s a politician’s wet dream, make rich friends and do them big favors. What do you think they’ll put at Fairmont, Keith Carson’s Casino and Western Grill?

How Low Can the County Go?

Well, it’s a race for the bottom. County government hits a new low. The Grand Jury wrote a scathing, completely biased and often inaccurate report on the Medical Center. The authors clearly hate unions, love consultants and didn’t bother to talk to the workers they were so willing to slander. At first I thought it read like something Arnold Schwarzenegger would write, pissed off at nurses and not thinking clearly.

Then it hit me, many of the statements sounded like quotes of things Sheriff Plummer has said at Authority Board meetings. According to some sources Sheriff Plummer and the Civil Grand Jury are pen pals; he writes them little notes. The Sheriff sure must be mad that the Grand Jury report uses lots of his exotic ideas and even some of his language and doesn’t give him credit anywhere, they didn’t even say they spoke to him.

Then the same day the Grand Jury Report comes out slamming the Medical Center, we learn that the Board of Supes plans to appoint Sheriff Plummer to the Hospital Authority Board; corruption or coincidence, you be the judge.

Vote Health Alert

Supporters of access to quality health care for the most vulnerable of Alameda County's residents need to protest the plan of the County Board of Supervisors to appoint Sheriff Charles Plummer to the Alameda County Medical Center (ACMC) Board of Trustees. Why is this a problem?

ACMC trustees have a legal fiduciary responsibility to act in the best interest of the Medical Center. Plummer cannot fulfill this responsibility because as elected sheriff he has advocated against the Medical Center getting adequate funding from the County's General Fund, which is also the source of Sheriff's Dept. funding. In other words, he would have a conflict of interest if he served on the ACMC Board, which he insists competes for public funding that he wants for his own department. His public solution to budget problems at ACMC is to cut services to the poor.

There is no financial crisis at the Medical Center. There is a crisis of leadership. ACMC needs an experienced CEO with the vision to move the Medical Center forward. Plummer's appointment is the "nuclear option" which sabotages the current effort to hire a new CEO - his many attacks on the Medical Center have included criticism of their efforts to build a working relationship with labor and community groups like Vote Health.

Please call your Supervisor to vote against the appointment of Sheriff Plummer to the ACMC Board of Trustees:

Trustees have a legal fiduciary responsibility to act in the best interest of the Medical Center, and Plummer cannot fulfill this charge due to his conflict of interest as Sheriff.
ACMC faces a leadership crisis, not a financial crisis. Plummer's appointment will sabotage current efforts to hire a new CEO.
Here are phone numbers, faxes and email address for the four supervisors who support the appointment of Plummer to the Board of Trustees:

President Keith Carson
dist5@acgov.org
510/272-6695
510/271-5151

Vice President Scott Haggerty
district1@acgov.org
510/272-6691
510/208-3910

Supervisor Gail Steele
dist2@acgov.org
510/272-6692
510/271-5115

Supervisor Alice Lai-Bitker
BOSDist3@acgov.org510/272-6693
510/268-8004

Please note that the appointment has been buried in the consent calendar (item #39) for Tuesday at 10am,
May 17th's meeting of the Board of Supervisors
at 1221 Oak St., Oakland
Fifth floor.

Circle Time

Some time ago my friend Allan‘s truck got stolen. Allan worked as an electrician but he was really a musician. He wanted to play music all the time and resented everything that kept him from it, like work. He needed the old pick-up truck for work and play, to carry his bass and his tools. The police called when they found the truck, the thieves left some women’s lingerie, an empty Whisky Bottle and two packages of condoms in the cab. Allan said the most troubling part about the crime was that the thieves had had more fun in his truck in two weeks than he had in two years. Allan had a sense of cosmic harmony, karma and all that.

Allan and I grew up in Berkeley so we had lots of exposure to all manner of enlightenment and spirituality. I guess I’m less fertile soil, than my friend. When I started looking for schools for my little McNuggets (Blot and Og are 3 and 4 years old). I discovered hippie practices have been integrated into the Montessori curriculum, circle time. The whole school does sort of a feel good group hug and sing along. Cum ba ya, it its like the seventies without the pot.

Highland needs a big circle time. Trust has decayed, and blame and paranoia have taken root. Consultants have perfected the fine art of hiding; the only indication we now have that they exist is the unwanted appearance of time clocks replacing pay phones on nursing floors. They bear an unfortunate likeness to ATMs and patients have already been sighted trying to pry cash out of them.

I hate to get “Berkeley” on you, but it’s a crisis of confidence. It’s an opportunity to lead, somebody please take the county healthcare challenge and put forth a plan and a vision, not just another bogus budget.

Vote Health

Vote Health is a cool organization, they do real grassroots healthcare advocacy, policy watch and single payer work. They are the medical center’s fairy godparents. Check them out at: www.votehealth.net

The Con is On

Here we go Sheriff Plummer is getting ready for the big shake down. He’s balking at taking budget cuts. Orloff our incompetent DA is balking with him and they’re balking right to the press. Yeah, the Sheriff is hurting so bad they have four officers guarding one patient with twenty-five tubes and enough meds on board to take out a bull elephant. If current trends continue we’ll have more sheriff’s than nurses on the hospital floors.

Besides, the supes fell all over themselves at the budget meetings to give the Sheriff more money, and have already promised any “additional funds” which magically appear in the budget would go the Sheriff.

So if the Sheriff and DA can balk for bucks, how come no one’s out balking for healthcare, where’s the Authority Board, where’s Dave Kears, where’s the leadership?

No Free Lunch!

Thursday is a good day to go outside for lunch. Cambio Healthcare consultants have held up the intern's and resident's contract, messed with union physicians and generally blamed caregivers, unions, and patients for their own shocking lack of vision and leadership. Yes, we have officially reached the blame and recrimination portion of the consulting contract.

Those darn interns and residents, “it’s the free Highland meals and their pricey health insurance that’s eating up profits.” Give me a break, they’re young, healthy and they don’t use sick time. Besides, anyone forced to eat only Highland food for days on end needs decent health coverage.

The challenge will be to not bicker and blame each other, see we’re left with the mess and well, the consultants, rumor is they already left. We’re a team, so rally to support Highland interns, residents, nurses, caregivers and all the people who do real work everyday without expense accounts.

Thursday April 28
12:00 noon
In Front of the Emergency Room
Highland Hospital
See You There!

Measure A- Fun with Funds

The Tribune's on the job. The sups are giving out the non-medical center monies. The best part of the article are the pictures of Dave Kears and Alice Lai-Bitker with the captions: "Kears says recommendations are fair" and "(Kears) is trying to do his best." Way to stand by your man Alice! You're gonna have to do some super sucking up to the Sheriff to top that, how about: "I just love a man in a uniform."

To read all the gory details click here:
http://www.insidebayarea.com/searchresults/ci_2687758

Discharge This

“Get over to Vista Isles. Their nursing home division wants to get rid of Medicare patients and replace them with private payers. They’re loosing fifteen grand per bed per year. Guess who got the removal contract?”

“How are you getting rid of them? You’re not killing them, are you?” asked Flag.

“Of course I’m not killing them!” said Zaragosa. “I’m, uh, liberating them.”…

What Zaragosa was doing was driving them out of state. Most were senile or had Alzheimer’s disease. He’d strip them of ID and pack them in vans. Then he’d drive north and scatter them around bus stations from Macon to Shreveport.

Tim Dorsey
Hammerhead Ranch Motel

So is Mr. Dorsey a healthcare consultant? Will he be handling the medical center’s re-organization of the discharge planning process? Nope, we have social workers trying to get people out of the hospital and since Cambio came along we have fewer and fewer of them (down five and one with a foot out the door). So how has our leadership responded to this crisis? Well, the department head apparently requested nine computers and a corner office, instead of additional social workers.

Brad Cleveland Talks Turkey

The medical center has employees from 3 different unions, Brad Cleveland works for SEIU 616. He does exceptional research and analysis, he goes to countless meetings and stays cheerful. Good thing we have him. Check out his latest piece:

http://www.seiu616.org/blog/index.cfm?display=entry&bge_id=177

Cambio Pink Slips the Shrinks

That’s right the Tennessee Titans are at it again. They sent notice to the psychiatrists at John George Psychiatric Pavilion that their jobs would be contracted out to a subcontractor effective June 1, 2005. That’s right, the Psychic Hotline will be providing the service at a fraction of the cost. Actually Cambio has some friends, cronies or relatives they plan to give work to. Cambio once again forgot about union protection, the Memorandum of Understanding and the physician’s liaison committee, so this will likely turn into a long, protracted and expensive legal dispute, which will cost time, energy and money.

Staff can barely contain their excitement at the consultant withdrawal. Occupation of the medical center by health care consultants has created huge problems, stress and political instability. As a step toward autonomous self-governance and healing, staff have proposed that all Cambio hires and promotions be re-interviewed for their positions after the official pull-out in August.

The medical center is a mere $3 million over budget and still Supervisor Haggerty wants to see lay-offs. Meanwhile the County’s own department of Risk Management overspent by $ 7.6 million and the supervisors are not whining about fiscal mismanagement. The hospital deserves a break.

Arnold Folded Like A Cheap Suit

That’s right folks the governor is no match for the nurses. Arnold got tired of sneaking into hotels and hiding from angry teachers, nurses and firefighter who followed him like a bad smell. Why the superhero developed the political equivalent of a social disease, that’s right Mr. Muscle now has “an image problem.” So Arnie gave in and took his “pension reform initiative” off the table. We did it!

Dirt Alert- See Arnold Run

As most Dirt readers already know nurses are chasing the governor around the county. He’s has attacked the nurses, the teachers, the police, the firemen, the disabled, the children and the poor: special interest groups. As one teacher said, “only girlie men break promises to children.”

He plans to fundraise for the initiatives
Tuesday, April 5, 2005
at 6:00pm
in San Francisco at the Ritz Carlton (Stockton and California)

It’s a rally, it’s time to stand by teachers and nurses and insist that we fix education and healthcare and stop blaming service providers. Consultants and managers are welcome to attend. See you there. Need to know more check out www.calnurses.org.

All Offense

That’s right it's county budget time again. The battle of the bureaucrats: the Sheriff and Dave Kears have started staking out positions, the lobbying and bullying has begun. Local politicians have already started poor mouthing and blaming the medical center, the governor, the religious right, the mediocre middle and the apathetic left for the current state of financial affairs.

The sups plan to cut cut cut healthcare, but ask them about the prison budget, they’ll tell you, “You know the Sheriff is very popular.” Poppycock they’re scared of the dude.

This is not just another year, this year the public plans to weigh in on the budget. That’s right we’re fed up with county budgets that don’t reflect our values and priorities. This budget will not be balanced on the backs of the elderly and sick. This time we all get a say, stay tuned, it's pressure and accountability time, this is gonna be fun!


Postscript: In spite of ongoing problems and leadership deficits the medical center has a nearly balanced budget.

Just Unplug Me

In writing on the record, “I do not want to outlive my brain. I do not want to persist in a vegetative state.”

Brain injury or cognitive problems don’t get discussed. We talk in terms of lists of deficits, level of consciousness, attention problems, and memory and language deficits, movement disorders. We have a whole lexicon of terms to describe “cognitive deficits” we try to take it apart and track and describe the differences. We like to fix and improve things, better diet, better joints better boobs, medicine fixes and improves.

With brain injuries we watch and see, we teach compensations and we coach the family to accept the changes caused whatever happened inside their loved one’s head. When you work with the families of brain-injured clients they often say to you, “they are not the same person.” That’s when you know they have started not just to understand but also to accept what has happened. Sometimes families never accept the changes in their brain injured relatives and loved ones and they keep waiting for the person they remember to come back.

That’s why we don’t like to talk about brain damage, it begs big questions, where is our soul? Which parts can you take away, replace or enhance and still have the same person? Americans can spend hours discussing makeovers and surgical improvement, they can tell you which movie stars have had work done, but could they tell you the man talking too loud in the restaurant with the scar above his eye had a brain injury? No, they would tell you he’s just a jerk.

There is something terrifying about the thought of loosing part of one’s self and still having one’s body inhabiting your life. Can the soul be changed and rearranged and at what point are we gone but still here. We would rather not think about it.

So instead of a national dialog about brain injury we have the Schiavo case: court room drama, political posturing, fear, ignorance, denial, and righteousness. Never has so much been said and so little learned.

Cambio Healthcare Solution’s Twelve-Steps to Quality Care

When policy makers use the term “quality healthcare” what they are really talking about is the absence of bad outcomes, deaths, dismemberments, lawsuits or citation provoking mistakes. So has Cambio’s management caused a crisis of quality at the medical center? Yes. So how did they make the medical center dangerous? Well, actually they used a twelve-step approach.

The first step was to cut staff, and to replace highly skilled clinicians with temps in critical care areas. You want the nurse in the intensive care area to know where the “crash cart” is. If half of the ICU staff flew in from the red states the night before, not only do they not know where things are, they don’t have anyone to ask. The medical center doesn’t have enough oncology nurses, chemotherapy treatments are being delayed, this is a big no no, and will definitely get the hospital cited.

The second step: ignore maintenance in important areas, while spending extravagantly in others. Like why spend money on things like computers for doctors orders, telephones for nursing stations and patient’s rooms and elevators when you could blow millions on time clocks and PR. So under Cambio’s tenure, elevators have actually crashed down the shafts, when telephones break they don’t get replaced and computers, which generate physician’s orders for whole departments, are broken for weeks at a time. What is the point of clocking employees in if they don’t have any work because the computer broke?

The third step, keep executives away from all patient care areas, don’t articulate any long term vision for the hospital and blame employees and indigent patients for the hospital's financial problems. “Cambio doesn’t want these people in the hospital.”

So, while Cambio Healthcare Solutions failed to articulate a vision for the medical center, they have hurt patient care through cuts, bad staffing strategies, failure to maintain essential equipment and a negative attitude toward our clients. Once a consulting company causes this kind of damage what do they do? They claim victory having reined in cost and moved the facility toward “fiscal responsibility.” At the end of a consultant contract not much gets done. The Tennessee temps are busy keeping their chairs warm and trying to hire their buddy’s into high paid management spots before they fly home.

In the interest of getting a decent night’s sleep, I will skip the last nine steps of Cambio’s twelve-steps to getting blood from a stone or a public hospital. Still these consultants will be leaving on a high note; doctors, unions, managers, politicians and board members all express giddy optimism about the consultant’s departure. Everyone wants a real CEO. Awareness about healthcare has changed as well; people expect a functional public hospital. Medical center employees enjoy a new level of support and respect in the community and employees, patients and Alameda county residents expect the board of supervisors to make good on the promises of Measure A.

Belt Tightening and IOU’s

Cambio Healthcare Solutions wants to look good to the politicians, lower costs at any price. They have given up on revenue enhancement and fixing the broken billing department. They are focusing instead on more cost cutting: squeezing budgets, running off more staff, and not paying bills. Who knew you could run a hospital on IOU’s?

Cambio’s brain trust is going department-by-department chopping fat and waste. Physical therapy lost its wheel chair budget, respiratory therapy its equipment budget (those ventilators are a real excess). We fully expect that they’ll just fire all the discharge planners and replace them with new technology: the hospital ejecto-bed (which will propel patients off the roof and back into the streets of Oakland).

Actually, the consultant’s high-risk management schemes have begun melting down. Cambio Healthcare Solutions thinks unions are icky, so they have replaced many permanent staff with travelers and temps. They outsourced about half the nurses in the emergency department and the critical care areas.

Whenever a highly qualified specialist nurse tries to get hired on at the medical center, their resume gets lost. “You can teach the traveler from Virginia how to give chemotherapy. She has ten years of experience in labor and delivery it can’t be that different.”

So aside from frightening patient care scenarios this passion for outsourcing has now created a financial crisis. You see temp agencies are ruthless negotiators and when they supply a huge percentage of your staff, they can pretty much name their price. That’s just what the agency that supplies one third of the medical center’s respiratory therapists did. The raised the hourly rate from $ 38 to $54 dollars an hour. Oops, there goes your cost savings.

Cambio showed them, they cancelled the contract. Starting Saturday they’re gone, no more travelers. So now they will be paying the regular staff tons of overtime. Actually the department maybe able to run with less respiratory therapists if the ventilators get repossessed, that will really cut the work down.

Any day now, the nursing outsourcers (who provide half of the critical care nurses) will decide to gouge the medical center and raise their rates; this will catapult the medical center back into big debt. Cambio’s betting they can ride on temps, IOUs and service cuts until their contract is up. They run a lean mean healthcare machine and they’re running the medical center right into the ground.

Measure A Giveaway

The Oakland Tribune is keeping an eye on the cash. The Sups are going to give millions to Saint Rose Hospital to cover the cost of treating the uninsured. Oh, poor private hospital.

Look, I'm all for supporting hospitals who reach out to the poor and the uninsured, but Saint Rose is not known for its soft touch with needy. Hospitals who get these funds should have to demonstrate that they don't discriminate or dump patients.

If an accident victim gets discharged from Saint Rose with an unfixed broken hip, and they still need an orthopedic surgery at Highland, why should our tax dollars go to the hospital that gave the poor patient expensive advice and Vicodin.

I'm guessing there's no strings attached to this public funds giveaway and Saint Rose doesn't plan to use the funds to develop substance abuse program for all the meth addicts who live within commuting distance of their hospital.

Oh, well at least the Tribune's on the job, to read Karen Holzmeister's piece click here:

http://www.insidebayarea.com/searchresults/ci_2592564

Highland’s Good at Bad

We did it. We passed the inspection with only minimal findings. No one could find the elusive consulting team, Cambio Healthcare Solutions, the only proof we have of their continued existence is the massive revenue drain from their billing and the occasional memo. Still the inspectors actually noticed that private hospitals “dump” into the county system. Shocking, absolutely shocking. Who knew that they even cared, next time they come we’ll give them a list of dumped patients.

See dumping, or as one CEO I knew called it, “referral of underinsured patients to the appropriate public provider” is what keeps profits up and statistics pretty at private hospitals. People think you have to be poor, or a drug user, or perhaps illegal to get dumped, sure basic prejudice and discrimination counts, but the bottom line is really how costly is the disease. Cancer, now that’s an expensive disease and lupus there’s a disease that just keeps on costing. So county hospitals don’t just get the very poor, they get the very sick. When you’re real sick it’s easy to forget those extra forms and payments, and poof, insurance is gone. Bye bye, so long, you get referred to “the appropriate public healthcare provider.”

So who needs a public hospital, the really sick. The cancer business is booming at the medical center, as are all the medical clinics for people with diabetes, high blood pressure, heart disease and kidney disease. Medical center doctors can’t get rid of hard problems; they have no choice but to try to help patients to manage even the most difficult diseases. That’s why many of the best doctors in the Bay Area work at the medical center. They are really good at managing really bad health problems.

Parenting For Politicians

Our meditating, miso-drinking, dog-loving mayor wants to beef up his image. Jerry Brown wants to go back to Sacramento as Attorney General, California’s top cop. Unfortunately the “strong mayor” doesn’t look strong; he looks tired and bored, so he has to take tough stands. Political consultants and the Oakland Tribune have re-invented Jerry as the “Crime Stopper.” As part of the PR push to pump up the Mayor’s image, he rolled out the “curfew” plan for parolees.

Mayor Brown noticed that people come out of our prisons and they aren’t “rehabilitated,” in fact they are very likely to get involved in more trouble. So Jerry decided that the same unsuccessful approach that is being applied within prisons would work in Oakland, take away their freedom. The curfew keeps parolees locked in their homes from 10:00 pm to 6:00 am, it’s sort of a “time out “ “you’re grounded” approach to urban youth and crime.

Oakland has something of a crisis of critical thinking when it comes to politicians. They all want to look tough, so most went along with this bad plan. “ They just have to take some responsibility” that’s the rationale one council staffer gave me. Here’s the problem, most kids in “the system” have little or no family support, they get punished, thrown out, and beaten based on the same rationale, “you have to take some responsibility.” Any thoughtful parent will tell you “ time out” or “ curfew” is for the parents so they can calm down and figure out how to help and guide their child. Punishment in the absence of parenting does not make responsible adults.

Two adolescent boys lived in the neighborhood around my work. They lived in a run down house with their adoptive mother. Their mom died of cancer with little support and the boys struggling to care for her. The home health nurse tried to get some help for the boys but there was none. At about 14 and 15 years old they were left in the house (they didn’t own it because they weren’t officially adopted). They got lost and sad and the house became more and more run down. The kids got sick and hurt and into more and more trouble. They got evicted, the house was boarded up, and the kids had nowhere to go. They wandered the neighborhood, it was the only home they ever had. They were in and out of jail and I suppose they are in prison now. They are nice kids. We completely failed them.

Oakland youth know we’re afraid of them and that we don’t like them. They expect to be locked up, harassed, and treated like criminals, even those who aren’t. We get kids at Highland Hospital all the time who are working hard and “taking responsibility,” they get shot paralyzed, hurt or killed. The Oakland police department doesn’t investigate their cases; they barely take reports. Our kids get crippled and government moves forward as if nothing happened. It breaks their hearts and their spirits to loose so much and be treated so badly.

Stay at home, “you have to take some responsibility”. See if you don’t have adults to teach you what that means its just more punishment, it will fail for the same reasons that the prisons fail. Oakland parents talk about keeping their children alive and out of jail into adulthood. They worry about the crime, and the police. Oakland’s politicians feel safer with our youth locked up or locked in. Careful parents don’t just protect their children; they prepare them to live in the world and to make it a better place. I explain to my children that Mayor Brown and many of the City Council Representatives are racist, stupid and mean, but that most of the people who live in Oakland are not.

Preparing for Failure, Fighting for Survival

The nurse crouches over to examine the bleeding patient in the crowded emergency room. The loudspeaker cracks, and an authoritative and threatening voice comes on, “all nurses who have not completed their charting will be hunted down.” A bead of sweat forms on the nurse’s head and the patient says, “Gee that’s sounds draconian.”

For those new to the Dirt, in good financial times county supervisors leave the public hospital alone, neglect has been the prevalent approach of the county supervisors to the medical center. In tougher financial times the supervisors consistently “bad mouth” the institution, berating it for providing expensive medical services to the indigent and failing to reap a profit (this is the mission of the hospital and the legal responsibility of the county).

So when the most recent financial crunch hit, the sups supported a tax to provide financial support for the hospital (Measure A) and when the tax passed they developed a pay back plan, so the hospital, could actually give money back to the county. Now no competent hospital management team would sign off on this plan so the politicians hired, consultants, Cambio Healthcare Solutions. They have managed to run off and retired many skilled employees, they upgraded executive titles and salaries and they have gotten the hospital in deep doo doo with ”regulatory bodies.”

Anyone who works in healthcare knows the fear and dread that inspections from regulatory bodies inspire. So how does a high-end top draw consulting giant like Cambio Healthcare Solutions approach the impending invasion of inspectors? Well consultants don’t make their money in smooth running well-oiled healthcare delivery machines, chaos and crisis is what drives their business. A well-planned failure, now that would necessitate more consultants, there would be cost cuts, blame to assign, reports to write and layoffs to implement. It’s a consultant’s wet dream.

A strategic belly flop, well Cambio laid the groundwork over the last year by running off nursing staff and replacing them with temps and travelers. Many of the nurses who will be attempting to comply with Medicare and Medi-Cal regulations are visiting from Canada. They don’t even have Medicare in Cananda, in Canada nurses treat patients not the medical chart.

Managers keep introducing more and more new forms to nurses who have more and more patients. Nurses can’t fill out the tons new forms, which have been introduced in the last two weeks if they don’t have nursing assistants to help them with patient care. While nurses get crushed under unbearable patients loads, hoards of managers run around auditing charts and threatening nurses.

The terms “patients” or “quality care” have not come up in the numerous mandatory meetings, which mangers attend in preparation for the coming inspection. Why last week a hoard of mangers was seen slaving feverously over the chart of a patient who had died weeks before. It is the strong sentiment of many Highland clinicians that quality documentation is most effectively achieved through quality patient care and that sane staffing would allow them to better achieve both.

One caregiver said trying to provide quality care and appropriate documentation in the current atmosphere of hysteria and blame was like trying to fry an egg in the back of Winnebago heading down Highway One with a drunk at the wheel. While Cambio Healthcare Solutions does all they can to fail the upcoming inspection, medical center employees have risen to the challenge, they plan to beat the odds and pass.

Oaklandrising.com

Oakland lacks a newspaper interested in real investigative journalism, this crisis of critical thinking has resulted in little or no public discussion of issues. The absence of any scrutiny has resulted in a bumper crop of incompetent, unethical, inept and absent politicians. Flagrant mismanagement of public institutions and resources has become the norm; the Alameda County Medical Center is well managed compared to the Peralta College System or the Oakland Schools.

The decay of integrity and the basic competence of elected officials in Oakland has started to attract some very talented reporters to Oakland. They see career making scandals. My current favorites are: Douglas Allan Taylor, the Berkeley Daily Planet, Chris Thompson, Will Harper and Kara Platoni all of whom write for the East Bay Express.

Douglas Allan Taylor is an Oaklander, a parent and the most thoughtful and intelligent voice we have right now. His most recent piece is posted in http:www.Oaklandrising.com

Slumber Party At Mayor Brown’s Pad

Well, mayor Brown plans to pair up with Tom Orloff (the DA who couldn’t convict the crooked cops) to attack parolee’s civil liberties. The dynamic duo, the absent and the incompetent will work together to implement the ill advised (a mandatory bedtime for parolees: a 10:00 pm curfew). You see Jerry really wants to look tough on crime, he’s running for Attorney General, so he’s trying to beef up his image. He’ll be long gone when the American Civil Liberties Union starts suing the Oakland into oblivion over this curfew business.

Besides, Jerry’s a big idea man; he can’t be bothered with testy details. So what if parolees become homeless, it happens all the time, do they just have to report to a designated freeway overpass or parking lot; or are they in violation of their parole? Is homelessness now an automatic parole violation? Is this “curfew” just a tool to send hundreds of homeless parolees to prison?

What about those parolees that don’t come from stable loving homes, a cold hard truth? Say junior comes home and mom’s locked him out, do junior and mom go to jail? Let’s say little miss gets put on curfew, and someone in the stable home attacks her at 11:15 pm. Can she sue the city and county for forcing her to stay in an unsafe environment? Here’s one Jerry should know something about, say a dude with a history of disputes with his female partners, gets into an altercation one late night with his wife in their home. The attacker then uses the “curfew defense” insisting that had he not been on curfew, he would have done what they taught him in anger management and left the environment.

So do I oppose the “curfew” approach to curbing crime? No, the idea is not without merit it just needs some modification to reflect the realities of life in Oakland. You see the curfew only works if we can guarantee a safe and stable home environment for parolees. I think this is just the job for Jerry; he can bring all the parolees over to his loft for slumber parties, anger management groups and seminars on animal rights and leash laws. Jerry can start “We the Parolees” and take, real hands-on approach to fighting crime.

Vote Health Letter to Hospital Authority

The Medical Center needs a permanent, experienced public hospital management team to establish a strategic vision for ACMC and to lead its restructuring effort. Cambio's part-time management team has not and cannot fulfill this role because they have no long term commitment to the success of the institution or to county residents who depend on ACMC for its life-saving services.

We are concerned that the Board of Trustees did not begin its search for a permanent CEO last year. Now that you contracted with Russell Reynolds Associates, we ask your board to:

· Expedite its efforts to hire a permanent CEO, and
· Allow the new CEO to hire the executive team of COO, CFO and HR Director.

We also ask that the Board of Trustees conduct a performance evaluation of Cambio and its management team, and make this review public. One year into Cambio's tenure at the Medical Center, the Trustees have yet to hold Cambio accountable for delivering on its promises. Some of these failures are reflected in the most recent financial report:

1. Registry use "hit new highs" of $1.7 million in December, and runs $2 million
over budget in just six months, a 30% variance;

2. Discharged Not Final Billed has risen for the past three months;

3. Medi-Cal is under-budget by over $12.5 million, while CMSP is over-budget by
$3 million;

4. Despite an investment of $300,000 into a "marketing campaign,"
obstetrical deliveries continue to decline.

We believe the quality of care at ACMC has suffered under Cambio’s leadership. The most egregious example of Cambio’s failures involves ACMC’s growing reliance on temporary nurses. The situation is particularly dangerous at John George, and in Highland's ER, ICU and TCU. Cambio's team of consultants and managers has only exacerbated a difficult situation. According to the HR Department, there were 117 RN vacancies in November, but ACMC conducted only five interviews that month. The Medical Center hired five RNs, but eight quit. In a letter to the Trustee's HR Committee, SEIU Local 616 wrote that Cambio has failed to act on its own recommendations regarding nurse recruitment and retention, contained in its May, 2004 Nursing Assessment.

The Medical Center's staff and patients, and county residents who fund this institution deserve better. Vote Health has confidence that you will act expeditiously to hire a permanent CEO and to hold Cambio accountable for its performance.

Sincerely yours,
Kay Eisenhower
Kay Eisenhower, Chair
Vote Health http://www.votehealth.net

Harm Reduction or in Plain English Damage Control

Bare with me folks I’m running on empty. My daughter, Emma (imagine a three-year-old 40 pound Afropolurican with very good lungs) has made a serious attempt on her parent’s lives. She’s waking up three to four times a night screaming, usually with a fashion request like “I need my party shoes.”

So damage control or Harm Reduction is first and foremost in my cloudy mind. The thing about public hospitals is that they’re public. Only sound county policies can fix the medical center, fix Oakland and fix people. That’s the job, the endgame, and the bottom line. That’s where the solutions start, with sick people. Our experts look at budgets, at billing, at politicians, at contracts and studies. No one has spoken to the patients and they especially haven’t talked to the “problem patients” or “frequent flyers.”

You ask any ten homeless people in Oakland what they need, they’ll usually tell you two things: first they will tell you how sick they feel and second they will tell you they are trying to get Disability. By this they mean Social Security Income and Medi-Cal the health benefit that comes with it. You see in Alameda County we have bureaucracies on top of bureaucracies all not managing the poor and sick’s basic problems: healthcare coverage and disability benefits.

Alameda County non-profits, public services, community clinics and private healthcare providers all compete for funding. It’s every agency for itself; they don’t cooperate to get poor disabled people benefits. The very sick and poor (hence very expensive clients) just get bounced around between agencies. County agencies don’t coordinate care and advocate for patients, they compete for Dave Kears’ favor by cutting costs and position themselves for funding. In fact the prison system spends its time knocking people off benefits and then dropping them back into Oakland without a job, an income or a healthcare benefit.

It’s hard to get over that terminal cancer when you have to stand on the corner and sell the Street Sheet Newspaper to get money for yourself and your two young children. Sure you’re dying and certainly you deserve the social security income you paid into for twenty years but in Alameda County we preach the "personal responsibility approach" to getting disability benefits. Yeah, drag your sick self down to the Social Security office and fill out the forms, than fight with all the public agencies that have your medical records to try to make them give them to Social Security. In the mean time live on the street and “hey, if it doesn’t work, it’s not our fault, you have to take some responsibility.“

The good people at The Positive Resource Center, in San Francisco, keep the data on these things and it turns out 90% of claims submitted without an advocate get denied and 30% submitted with an advocate get denied. So clearly the personal responsibility policy is based more on prejudice than on data. See, many people who use county services use drugs, or did use drugs, or have been to prison or have mental illness and the county doesn’t really want to help them. Sure we have a few non-profits, who help the super-sick or special groups, but we have no coordinated plan and worse, we lack a philosophy of compassion and service, and the political leadership to address the problems of our most needy.

So in my little neighborhood in Oakland, the Dimond, we have five to ten people with all sorts of mental and physical illnesses living in parking lots and on the street. We have a clearly schizophrenic woman in urine-soaked clothes, who is sometimes too frightened to stand in line for food. We have a serial defecator who deposits little surprises in shopkeepers doorways, we have a woman with an amputation, and an assortment of men with physical, mental health and substance abuse problems. A local business owner called the county, concerned about the health and welfare of these obvious mentally or physically ill people and was told call the Oakland Police Department.

So, Harm Reduction, it’s a global philosophical approach to dealing with public health problems. It’s a pragmatic approach to substance abuse and high-risk behaviors. The idea is limit the damage. If the public health problem is AIDS, focus on stopping the spread of AIDS; not stopping sex (sex is fun and cheap and therefore very hard to stop). Try to prevent violence, instead of only investing in punishment. It’s a more pragmatic and less Puritanical approach to public health. Besides sticking drug offenders in jail has done little or nothing to slow public health problems.

So as a practical matter what does this mean. Well, in San Francisco, that great city by the Bay. It means all county agencies or agencies funded by the county must work together to get the social security benefits for eligible clients. They can’t dump them on other agencies or send clients chasing down bureaucratic black holes. That’s right, San Francisco plans to put in place performance measures and standards, they’re not just addressing the problem they’re managing the solution. This means merchants, neighbors and police don’t have to watch sick people suffering on their streets, and it means state and federal funds are used to pay for health and income benefits, this saves the county money and keeps public services like hospitals financially viable.

Postscript: Any advice on how to keep Emma "Slave-to-Fashion" Fisher off the catwalk in the wee hours of the night would be deeply appreciated.

My Favorite Non-Profit

The Positive Resource Center in San Francisco is a model of how powerful a non-profit can be. They do benefits and employment advocacy: they are thinkers, teachers, advocates and wonderful people. They fight to get benefits for the most underserved and deserving clients, and they share their expertise through classes and trainings. I learned most of what I know about benefits through their trainings.Their exceptional work makes the world a better place.

Check them out or just send them a check:

http://www.positiveresource.org/

Go San Francisco!

San Francisco Department of Public Health Philosophy
Social Security Income benefits help disabled clients achieve their therapeutic goals by improving access to healthcare and by giving them the financial means to stabilize their living situation and better meet their nutritional needs

Department of Public Health Goal
Department of Public Health clients should be screened for Social Security Income eligibility. All clients deemed eligible for Social Security Income benefits will be assisted through the application process.


Excerpted from Positive Resource Training Materials 2004

So, You Wanna to Be Highland’s CEO

The new smash hit reality TV series brought to you by the same fun loving politicos who brought you the Raiders and the Alameda county football tax.

It’s sort of a cross between ER and In Living Color. The medical center has had over 10 CEO’s in the last 12 years and while most have done little or nothing to improve or maintain healthcare services in Alameda County this crew of villains, rogues, ne’er do wells and actually a few good people are an untapped geyser of entertainment value.

So the search is on, all applicants for the newly posted position of CEO of the medical center position will be asked to participate. Ken Cohen the best CEO the medical center has had will host the show (the county supervisors got rid of Ken because of his excess of competence and real aptitude for the job.)

All contestants will begin their journey to greatness on BART or AC transit, while you can get to a football game in reasonable time using public transit from most places in Oakland, it can take hours to get to the county hospital. Contestants are advised to start early and get a transfer.

Once at Highland, contestants (dressed in clothes donated by patients) will approach the ER triage desk with complaints of nausea, pain, long-term substance abuse, and paranoid ideation. Successful candidates will be admitted to the hospital and bonus points will be given to any candidates who get transferred to the locked psychiatric facility at John George.

Once admitted to the hospital all contestants will be required to eat only the diet prescribed by their doctor and provided by nutritional services. After completing the mandatory two-day stay at Hotel Highland, successful applicants will receive coaching and legal advice from previous CEO’s.

Mike Wall will be the show’s official golf coach. Ophelia Long will speak on the Grand Jury and how an indictment does not have to end your career in Alameda County. Mike Smart will speak on the art and science of mumbling and on the importance of a close friendship with Dave Kears. Dave Kears will discuss how to write legislation to specifically exclude oneself from conflict of interest accountability. Ken Cohen, Paul Hayes, and Dr. Mittelberger, the medical center’s most competent past leaders will discuss current problems, past failures, political pitfalls and bear traps. Efton Hall will give a very short speech on how to outsource your own job. Mike Burroughs and Susan Crutchfield will discuss the joys of consulting, traveling first class and how to choose a Hilton.

Survivors will come to the Highland Auditorium for a Jeopardy style QA (on issues of medical management and local politics) Ken Cohen will host.
Sample Questions
1. The neck bone is connected to the?
2. OK, here’s a tough one, which county supervisor owned blighted property within blocks of Highland Hospital?
3. What was the name of the county supervisor who would snore audibly or read the newspaper, while matters concerning the medical center were discussed?

The winner will be selected based on his overall score, the swimsuit and talent competition and audience applause.

All proceeds from, “So, you wanna be Highland’s CEO” will be donated to the Highland Foundation earmarked for actual healthcare (durable equipment, caregiver salaries and medications); none of the proceeds will be re-invested in PR, BS or consultants.

Answers to sample question: 1. Head bone 2. Supervisor Gail Steele 3. Supervisor Mary King

The Medi-Cal Massacre

Well, the Governator is going to kick some disabled behinds; he’s going to blow the sick and infirm right off their benefits. Political insiders say Arnold’s super budget is super mean. It attacks Health and Human Services and Medi-Cal with a fevered frenzy.

Arnold, Arnold, Arnold, you’re off script, out of character, your characters were always violent, but ultimately kind hearted and humanistic. Conan didn’t run around taking blood pressure medications away from old ladies. The terminator would never rob from the sick and give to the prisons. What has happened? You’re supposed to be the good guy.

To get all the gory details from the good people who follow these things, at Health Access, click here:

http://www.health-access.org/blogger.html