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!
Wednesday, April 27, 2005
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
To read all the gory details click here:
http://www.insidebayarea.com/searchresults/ci_2687758
Tuesday, April 19, 2005
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.
“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.
Wednesday, April 13, 2005
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
http://www.seiu616.org/blog/index.cfm?display=entry&bge_id=177
Friday, April 08, 2005
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.
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.
Thursday, April 07, 2005
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!
Sunday, April 03, 2005
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.
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.
Sunday, March 27, 2005
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.
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.
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.
Thursday, March 17, 2005
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.
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.
Friday, March 04, 2005
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.
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.
Thursday, March 03, 2005
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
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
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.
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.
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.
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
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
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.
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
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.
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/
Check them out or just send them a check:
http://www.positiveresource.org/
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