Thursday, February 17, 2005

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.

Monday, February 07, 2005

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.

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