Tuesday, January 25, 2005

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

Wednesday, January 19, 2005

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:


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

Tuesday, January 04, 2005

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: